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STRANGER IN A STRANGE LAND

April 1, 2007
by DENNIS P. MORRISON, PHD
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Experience at the recent HIMSS conference shows how far the field has to go to be accepted by the medical community

At this year's Healthcare Information and Management Systems Society (HIMSS) conference in New Orleans in February, two behavioral health organizations were honored with the prestigious Nicholas E. Davies Award of Excellence for the implementation and use of health information technology. The Center for Behavioral Health (CBH) in Bloomington, Indiana, won in the organizational category, which includes hospitals and healthcare institutions. The Texas Department of State Health Services won in the public health category for its Behavioral Health Integrated Provider System (BHIPS).

Since the awards were created in 1994, only one other behavioral healthcare organization has been recognized—Heritage Behavioral Health in Decatur, Illinois. So having two behavioral healthcare winners this year was particularly noteworthy. One award ceremony attendee even went as so far as to tell me, “You've done behavioral healthcare proud.” I appreciate the compliment, but I don't think we deserve it quite yet.

The HIMSS conference is like nothing in the behavioral healthcare industry (the closest comparison probably being the annual meetings of the large professional associations, such as the American Psychiatric Association). There were 25,000 attendees and 900 vendors. The exhibit hall was 1.1 million square feet! The New Orleans Convention Center, where the conference took place, was the largest building I've ever seen. Some of the larger vendor displays had (and I'm not exaggerating) a larger footprint than my first home. The booths (if you can call a three-story, 2,000-square-foot space a booth) of the med-surg EHR vendors were larger than the booths of big players like Microsoft, HP, Dell, and GE. Only one behavioral healthcare IT vendor was present (with a booth of the size I'm accustomed to seeing).

In fact, everything was bigger at the HIMSS conference. We've all seen vendor promotions that offer a chance at a free gift if you leave your business card for a drawing at the end of the conference. In our industry it's usually an iPod or something of that scale. At the HIMSS conference one vendor gave away a jet ski. Another vendor gave away a Mini Cooper and yet another handed out a Mercedes (that prize, sponsored by vendors, was raffled off by Behavioral Healthcare's sister publication, Healthcare Informatics).

Along with big prizes, the HIMSS conference attracted big names. Although we certainly have very good speakers at our conferences, among the speakers at the HIMSS conference were the president of Microsoft, the governor of Tennessee, and Colin Powell. While all of this was stimulating (to the point of needing a dose of Adderall), it was also discouraging.

Behavioral healthcare was not on the radar screen for many people attending this conference. One way of gauging how attune someone is to behavioral healthcare issues is to use what I call the mental health joke index. You know how it works: If you tell someone you work in behavioral healthcare and his response is something like, “Oh, we really need your help in our company” or “Are you here to analyze us?” you know that he doesn't understand our field. We've all experienced this but I thought, somewhat naively as it turns out, that our med-surg brethren would be a little more enlightened. At the conference I often had to explain what behavioral healthcare was, and one hospital CFO told me that he believed behavioral healthcare providers do the same thing as “barbers, bartenders, and prostitutes” with the same outcomes.

There were glimpses of hope. Bruce Eckert did a great job chairing a behavioral healthcare special interest group. Yet only about 15 people attended, 5 of whom work at my organization. Behavioral healthcare could claim two Davies Award winners this year, but overall behavioral healthcare was clearly out of the loop at the conference and probably in the med-surg arena in general.

It appears that we have not done a good job of demonstrating the value of behavioral healthcare in general medicine. Despite years of research about the high incidence of behavioral health issues in primary care and the value of behavioral interventions in treating “medical” problems, the medical community still doesn't get it. I guess it's no wonder then that the Bush administration is encouraging behavioral healthcare services traditionally delivered by community mental health centers to be delivered by community health centers.

I don't have the answers for increasing our presence in the medical world, but we do need to get out of our silos and recognize that we are part of general healthcare. We need to stop preaching to the choir and start presenting on what we can do for general medicine at their conferences, not ours. We need to speak with one voice rather than register a cacophony of opinions. Evidence-based treatments are big in med-surg, and that could be the “Rosetta stone” of a common language between our disciplines. We have to start recognizing the real differences between behavioral healthcare and general medicine and stop posturing ourselves as unique and special in ways that don't matter.

However, we need not come hat in hand to the party. We lead the med-surg community in at least three areas: confidentiality of records, consumer empowerment, and team-based care. HIPAA confidentiality regulations came as a shock to med-surg but because of our history of dealing with confidential information, it was a nonissue for most of us. The recovery movement has rightly taught us that the patient, not the provider, is the center of care; med-surg is just learning that lesson. In many primary care settings the old “doctor-directed” care model is being replaced by a multidisciplinary team-based model similar to the one used by many community-based behavioral health providers.

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