June 15, 2022
Carlene MacMillan, MD
Mental healthcare can be a tangled web, where no one clinician can tackle every aspect of a patient's treatment. "It takes a village", and care teams can improve patient outcomes AND reduce clinical burnout by sharing the workload across a team.
Let's dive into:
Team-based care is defined by the National Academy of Medicine as “…the provision of health services to individuals, families, and/or their communities by at least two health providers who work collaboratively with patients and their caregivers—to the extent preferred by each patient—to accomplish shared goals within and across settings to achieve coordinated, high quality care.”
When it comes to mental health care, especially the care of more chronic or complex conditions, many patients work with a multidisciplinary team of helpers. A care team could consist of a psychiatrist or psychiatric nurse practitioner, a social worker therapist, a peer specialist, a nurse, a medical assistant and many other combinations of helping professionals.
When it comes to psychedelic medicine, we know that protocols for MDMA involve two practitioners in the room for the sessions. The clinician prescribing the medication may be a different person than the therapist in the room during the treatments, as is often the case for ketamine-assisted therapy as well.
We anticipate that team-based care will increasingly become the norm in mental health care and we need our EHRs to support these teams. Research suggests that team-based documentation also may reduce clinician burnout as it cuts down on the time a clinician spends charting. When an EHR makes it very clear who is on a patient’s care team, there are many benefits to the team and to the patient.
For Osmind clinicians, having the primary clinician role also means that if a patient endorses suicidal ideation on a rating scale sent out between session, the primary clinician will be notified rather than the main user on the account who does not have context on that given individual.
We also intentionally did not make any rules around who could be the primary clinician. Unlike many mental health EHRs which assume it would be the physician, it could be whoever really is the “key worker” for an individual case. I think of this person as the captain of the ship for that patient’s care journey and when it comes to multidisciplinary mental health care, that really depends on the care model and type of treatment being provided.
As the founder of a multidisciplinary group mental health practice, it always baffled me that the multiple EHRs we used over the years didn't make it easy to see which teammates in our group were working with an individual patient.
Most psychiatry EHRs have the concept of a primary or attending physician but that's it. If a therapist wanted to see a list of her patients, she couldn’t because they were all under the primary physician regardless of who that patient saw the most.
There are papers published about how difficult EHRs make it to determine who's actually on a patient’s team. The papers also suggest approaches to look manually at who signed notes or had visits on the calendar.
The manual approach seems like an inelegant solution to something that should be front and center upon opening a patient’s chart. Stage 2 of Medicare’s Meaningful Use Criteria, acknowledging the abysmal state of affairs, set a pathetically low bar for showing a care team in the EHR for at least 10% of patients at a clinic or hospital. I know we can do better than 10% of the charts!
They say that medicine is a team sport and I'm so excited that Osmind’s latest release provides a way to easily convey who is on a patient’s care team.
Dr. Carlene MacMillan is Vice President of Clinical Innovation at Osmind. She is the founder of Brooklyn Minds Psychiatry, a multidisciplinary team-based, multi-site practice in New York City. Her practice was one of the first to offer deep TMS for OCD and esketamine for severe depression and suicidal thinking.
Dr. MacMillan is an expert in mental health communities, with a large following on platforms including Clubhouse (@psychiatrist), where she champions awareness of evidence-based and innovative approaches in psychiatry. She is a member of the Ketamine Taskforce for Access to Safe Care and Insurance Coverage, and the Clinical TMS Society Insurance Committee. She is the Co-Chair of the American Academy of Child and Adolescent Psychiatry Consumer Issues Committee.
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