Digital Tablet with stethoscope and brain scan

commentary

(Inside Sources)

December 20, 2016

Toward a Learning Behavioral Health Care System

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by Bradley D. Stein

While the U.S. health care system's embrace of different health information technologies is still a work in progress, new modes of capturing and sharing health data have already begun to transform the way health care providers practice medicine in this country. One such initiative is the “learning” health care system, a symbiotic relationship in which practice informs research and research informs practice.

To date, the conversation about learning health care systems has mostly been restricted to the realm of physical health care. But the same budding promise of a learning health care system exists in the realm of behavioral health care and the tools are in place to make it happen.

Better capturing and sharing the vast amounts of health data generated each year through behavioral health research and clinical practice can lead to the creation of a behavioral health care 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, they can now at the same time 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 health care being delivered is physical or behavioral.

Imagine a behavioral health care 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 health care 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 health care system.

A transformation to such a system is within reach. Not only is there a roadmap for how to proceed, but the technologies needed to improve care are increasingly accessible. Passage of the Affordable Care Act and the expansion of the federal Mental Health Parity and Addiction Equity Act have paved the way for the delivery of behavioral health services on par with general medical services.

Building a learning behavioral health system will require the buy-in of both researchers and providers. 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, health care is a worthy goal, one that has the potential to enhance the delivery of behavioral health care, and ultimately improve outcomes, for millions of Americans.


Bradley Stein is a senior natural scientist at the nonprofit, nonpartisan RAND Corp. and an adjunct associate professor of psychiatry at the University of Pittsburgh.

This commentary originally appeared on Inside Sources on December 19, 2016. Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.