How the U.S. Army Personalized Its Mental Health Care

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By Jayakanth SrinivasanMillard D. BrownChristopher G. Ivany, and Jonathan Woodson

DECEMBER 07, 2016

This article has been re-shared from it’s original source, HBR.org

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The U.S. Army’s efforts to come to grips with a dramatic upsurge in war-related behavioral conditions over the past 13 years holds valuable lessons for bringing precision mental health care to the civilian world.

Virtually everyone realizes that precision medicine, which aims to tailor care to the individual patient’s needs, is essential. Yet in attempts to bring patient-centered, outcomes-based approaches to health care in recent years, mental health has taken a back seat to other areas of medical care. Almost alone among industrialized nations, the United States does not systematically collect data on mental health care outcomes and lacks any nationwide means for harnessing it. Further, the broad range of difficult conditions, competing therapies, and different professions within mental health care have made it seem a poor candidate for the precise assessment, ongoing monitoring, and individualized feedback that are necessary components for making precision medicine a reality.

All three of those essential components of precision medicine are now being addressed in the Army, using a system called the Behavioral Health Data Portal (BHDP). It makes possible the routine collection of patient-reported data using standardized screening instruments, incorporates redesigned patient and care team workflows to allow consistent monitoring, and embeds clinical-decision-support systems for providing individualized feedback and action at the point of care. And it tackles two of the most difficult challenges of ongoing precision care: following patients over time and as they move from place to place and from care provider to care provider.

Between 2003, when the Iraq war began and the conflict in Afghanistan was two years old, the Army’s volume of mental health care visits tripled, from 1.1 million to 3.3 million. Between 2007 and 2011, more than $2.5 billion was spent addressing the problem, yet there was no way to determine whether troubled soldiers were getting better or to more precisely tailor their treatment.

Against that backdrop, the Army began with hospital-level experiments focused on early and robust screening for behavioral health conditions. The Army’s centralized management team responsible for its behavioral health service line built consensus among Army psychiatrists, psychologists, and licensed clinical social workers on the standard instruments that would be used for screening and follow-up for specific conditions such as PTSD, depression, alcohol use, and for the general assessment of functioning.

Previous efforts at consistent patient screening employed a manual process. Soldiers completed paper forms, which were then scored by support personnel or the care provider. Depending on the responses to the initial screening, soldiers then filled out more forms before or during their session. Such a manual process is labor-intensive and potentially error prone. It also reduces time in session with a provider.

Today when soldiers check in for appointments, they are provided with a laptop or tablet with individualized log-in information. Depending on the nature of the appointment, they complete either a standardized intake screen for their initial appointment or a disease-specific set of screening instruments. This patient-reported data is captured in a HIPAA-compliant manner within BHDP, and the back-end server computes the score and charts progress. Providers log into the BHDP website, where they can immediately see the patient reported data and use the built-in- charting function to visualize progress over time. These data are persistent across geographical locations and can be transferred to other health systems if required when a soldier leaves the Army.

 

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