A ‘learn­ing sys­tem’ in be­hav­ioral health can help in shar­ing best prac­tices, in­no­va­tions

Modern Healthcare - - COMMENT - By Bradley D. Stein

While the U.S. health­care sys­tem’s em­brace of dif­fer­ent health in­for­ma­tion tech­nolo­gies is still a work in progress, new mod­els of cap­tur­ing and shar­ing health data have al­ready be­gun to trans­form the way health­care providers prac­tice medicine in this coun­try.

One such ini­tia­tive is the so-called “learn­ing” health­care sys­tem, a sym­bi­otic re­la­tion­ship, in which prac­tice in­forms re­search and re­search in­forms prac­tice.

His­tor­i­cally, the con­ver­sa­tion about learn­ing health­care sys­tems has mainly been fo­cused on the realm of phys­i­cal health­care. But the same bud­ding prom­ise of a learn­ing health­care sys­tem ex­ists in be­hav­ioral health, and the tools nec­es­sary to make it hap­pen are in­creas­ingly avail­able.

Bet­ter cap­tur­ing and shar­ing of the vast amounts of health data gen­er­ated each year through be­hav­ioral health re­search and clin­i­cal prac­tice can lead to the cre­ation of a be­hav­ioral health­care sys­tem that con­tin­u­ously im­proves—or, in other words, that “learns” from both its suc­cesses and fail­ures—and that is able to har­ness tech­nolo­gies to im­prove care in ways never be­fore pos­si­ble.

When providers use new elec­tronic tech­nolo­gies to log ob­ser­va­tions, treat­ment de­ci­sions or lessons learned from rou­tine clin­i­cal care, at the same time they can be adding to and im­prov­ing the knowl­edge base. Like­wise, providers can now have im­me­di­ate ac­cess to the knowl­edge base—made more ro­bust by their own clin­i­cal con­tri­bu­tions in real time—while they are car­ing for pa­tients.

The thinking be­hind this con­cept (first called for in a 2012 In­sti­tute of Medicine re­port) was that lever­ag­ing tech­no­log­i­cal ad­vances to make bet­ter use of the best avail­able data would help rein in costs and im­prove both qual­ity and safety. This makes sense whether the health­care be­ing de­liv­ered is phys­i­cal or be­hav­ioral.

Imag­ine a be­hav­ioral health­care sys­tem in which ev­ery pa­tient’s ex­pe­ri­ence can con­trib­ute to the over­all knowl­edge of how best to treat be­hav­ioral health disor­ders; in which lo­cal in­no­va­tions are doc­u­mented and shared; and in which ev­i­dence gath­ered from both prac­tice and re­search will con­tin­u­ally im­prove the un­der­stand­ing of the pros and cons of dif­fer­ent ap­proaches to di­ag­nos­ing, treat­ing and pre­vent­ing be­hav­ioral health prob­lems.

Imag­ine a be­hav­ioral health­care sys­tem in which providers can at once con­trib­ute to the ev­i­dence base and ben­e­fit from it at the point of care. This is the po­ten­tial of a learn­ing be­hav­ioral health­care sys­tem.

A trans­for­ma­tion to such a sys­tem is within reach. A road map ex­ists for how to pro­ceed, and the tech­nolo- gies needed to im­prove care are in­creas­ingly ac­ces­si­ble. Fed­eral health re­forms, such as the Af­ford­able Care Act and the Men­tal Health Par­ity and Ad­dic­tion Eq­uity Act, have paved the way for the de­liv­ery of be­hav­ioral health ser­vices on par with gen­eral med­i­cal ser­vices. And the 21st Cen­tury Cures Act, en­acted late last year, also in­cludes sev­eral pro­vi­sions that hold prom­ise to ad­vance learn­ing in be­hav­ioral health.

Build­ing a learn­ing be­hav­ioral health sys­tem will re­quire the buyin of re­searchers, providers and health sys­tems. A suc­cess­ful trans­for­ma­tion will de­pend on a num­ber of crit­i­cal next steps: build­ing con­sen­sus around com­mon met­rics for high-qual­ity care, rel­e­vant out­comes and con­tex­tual fac­tors; fos­ter­ing part­ner­ships be­tween re­searchers, providers and clin­i­cal and com­mu­nity set­tings; cre­at­ing a “data com­mons” to pool in­for­ma­tion; and de­sign­ing and eval­u­at­ing de­ci­sion-sup­port tools that al­low for real-time feed­back.

Ex­pand­ing the dis­cus­sion to fo­cus on be­hav­ioral, as well as phys­i­cal, health­care is a wor­thy goal—one that has the po­ten­tial to en­hance the de­liv­ery of be­hav­ioral health, and ul­ti­mately im­prove out­comes for mil­lions of Americans.

Bradley D. Stein is a se­nior nat­u­ral sci­en­tist at the not-for-profit, non­par­ti­san RAND Corp. and an ad­junct as­so­ci­ate pro­fes­sor of psy­chi­a­try at the Univer­sity of Pitts­burgh.

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