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President's New Freedom
Commission on Mental Health

Achieving the Promise: Transforming Mental Health Care in America

Goal 6: Technology Is Used to Access Mental Health Care and Information


    6.1 Use health technology and telehealth to improve access and coordination of mental health care, especially for Americans in remote areas or in underserved populations.

    6.2 Develop and implement integrated electronic health record and personal health information systems.

Understanding the Goal

Mental Health Care Lags in Using Technology

The time has come to establish a national health information infrastructure that will encourage the public and private sectors to invest in information technology while adequately safeguarding consumers.

To address this technological need in the mental health care system, this goal envisions two critical technological components:

Access to Care Is a Concern in Rural and Other Underserved Areas

Information Technology Can Now Enhance Medical Records Systems

Consumers May Not Have Access to Reliable Health Information

Achieving the Goal


6.1 Use health technology and telehealth to improve access and coordination of mental health care, especially for Americans in remote areas or in underserved populations.

Underserved Populations Can Benefit from Health Technology


6.2 Develop and implement integrated electronic health record and personal health information systems.

Electronic Medical Records Will Improve Coordination and Quality

Figure 6-1. Model Program: Veterans Administration Health Information and Communication Technology System


U.S. Department of Veterans Affairs (VA), Veterans Health Administration (VHA): Use of Health Information and Communication Technology.


Improve the quality, access, equity and efficiency of care by using a fully integrated electronic health record system, personal health information systems, and telemedicine.


VHA is the largest integrated health care system in the U.S. with approximately 1,300 sites providing a full continuum of health care services. VA provided mental health services to more than 750,000 veterans in 2002. All VHA medical facilities (clinics, hospitals, and nursing homes) use a fully integrated electronic medical record that is capable of supporting a paperless health record system. The VA system incorporates clinical problem lists, clinic notes, hospital summaries, laboratory, images and reports from diagnostic tests and radiological procedures, pharmacy, computerized order entry, a bar-code medication administration system, clinical practice guidelines, reminders and alerts, and a specialized package of mental health tools. In addition, VA uses innovative information technology and communication systems to give beneficiaries information on benefits and services, allow web-based enrollment, support a national electronic provider credentialing system, provide veterans and their families access to health information and support health care provider education.
Telemedicine is used to increase access to primary and specialty care for rural and underserved populations. VA provided approximately 350,000 telemedicine visits and consultations last year. Telemedicine mental health consultations and follow-up visits provide access to these services at locations where they would otherwise be unavailable.


In 2002, the Institute of Medicine reported, "VA's integrated health care information system, including its framework of performance measures, is considered to be one of the best in the nation."182 Utilizing an electronic health record with a clinical reminder system, VA screens 89% of primary care patients for depression and 81% for substance abuse. In VA, 80% of patients hospitalized for mental illnesses receive follow-up outpatient appointments within 30 days; the next best reported performance by NCQA is 73% and the Medicaid average is only 55%.

Biggest challenge

The public's lack of confidence in the privacy and security of the electronic health record and the lack of national standards for data and communications represent the biggest challenges to implementing such a system.

How other organizations can adopt

High-performance, reliable electronic health record and information systems are currently available for use by any provider, clinic, hospital, or health system. Incentives for adopting electronic health records would speed wider use.


All VHA clinics, hospitals, and nursing home facilities nationwide

Electronic mental health records may enhance quality by promoting adoption and adherence to evidence-based practices by including:

Another promising practice - using individualized, computer-generated reminders - will also become possible with electronic medical records.

Other innovations in mental health care are even more viable with the technology for electronic medical records. For example, using hospital bar-codes to administer medication reduces medication errors and, thus, improves patient safety.183 Electronic medical records also provide a platform for consumers to receive computerized, clinical instructions and automated alerts for drug interactions, contraindications, and allergies.

The Commission recommends that HHS and VA lead a voluntary public-private initiative to design and adopt a secure, privacy-protected, electronic health record and a system of health information exchange for providers to share information with the approval of consumers. Privacy and security of this system must remain primary concerns. The Commission proposes this national health information infrastructure not as a centralized government database, but rather as a means to connect and exchange health information in the framework of a secure, decentralized network.

Personal Health Information Systems Can Help Consumers Manage Their Own Care

Systems are already available to support access to Internet assessment services and health information sources in order to build a personalized health information library. Consumers can use these systems as research tools to:

The Network of Care for Mental Health, an individualized mental health resource Web site, provides a model for how consumers can use Internet technology to find pertinent mental health information; identify available services, supports, and community resources; and keep personal records on secure computer servers. (See Figure 6-2.)

Figure 6-2. Model Program: Individualized Mental Health Resource Web Site


Network of Care for Mental Health


To help ensure "No Wrong Door" exists for those who need mental health services.


The user-friendly Web site enables consumers and families to find pertinent mental health information; identify available services, supports, and community resources; and keep personal records on secure servers. Consumers and families can search the site's comprehensive Service Directory - by age group, diagnosis, program or agency name, key word, or by using the 20-category menu-for mental health treatment and supportive services provided by the county and other organizations. The site also offers up-to-date information about diagnoses, insurance, and advocacy, as well as daily news from around the world concerning mental health.

Biggest challenge

Gathering and organizing an enormous amount of information while making it easily accessible to Network of Care for Mental Health Web site users represents the major challenge.

How other organizations can adopt

The Network of Care Web site can be easily and cost-effectively replicated in any location because the entire infrastructure - and many of the data components; e.g., the library and national links - are identical from one region to another. Only certain county-specific data (e.g., available mental health treatment and support services) must be developed for each new site.


The San Diego Network of Care for Mental Health Web site was launched April 30, 2003; another is now being developed for Los Angeles County, California.

Web site

If health care systems do not make substantial, front-end, ongoing investments to protect privacy, electronic health information systems are doomed to fail.

The Commission recommends that HHS and VA lead a public-private effort to create and promote use of software for Internet access to privacy-protected, personal health information that consumers maintain and control. Consumers and families must be involved in designing, evaluating, and implementing the system that would enable them to personalize their records. The software and training should enable consumers to personalize their health information record through links to key portions of their health records, local consumer support groups, self-care trackers, advance directives, and directories of local service providers located in or near their own ZIP Codes. This personal health information system should include the following elements:


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