3. Electronic Tools to Support Communication & Collaboration
In this section, learn about best practices for using electronic tools to help coordinate care across providers, including warm handoffs, e-consults, and available platforms. Providers can learn about the different electronic tools and systems their colleagues in other fields may be using, while parents and caregivers can become familiar with the tools their child’s providers may use to communicate with families and each other.
Making the Most of Electronic Communication and Collaboration Tools
Electronic communication and collaboration tools increase opportunities for coordinating care across providers and families, but do not make for effective care on their own. Rather, to be used to their greatest advantage, these tools must be employed in the context of family-centered interprofessional collaborative practice.
Key to achieving positive outcomes is the establishment and maintenance of relationships between families and professionals from different disciplines who share in the care of children and youth facing behavioral health challenges. Face-to-face and virtual meetings are particularly helpful in building trusting relationships between providers working in different settings.
In addition to developing cross-sector relationships, successful at-a-distance collaboration employing electronic tools requires new workflows to be developed in each setting along with staff trainings that increase skills and comfort with the features and functionality of the electronic platforms.
When implemented in the context of care that is provided by a collaborative team comprised of family members and professionals, technology solutions can serve important roles in closing referral loops, broadening the scope of treatment plans, and enabling joint care management.
Advantages and Cautions
Recent advances and innovations in electronic health records (EHRs) and information sharing technologies have potential to support effective coordinated care, addressing many of the barriers historically identified as impeding routine cross-sector communication and collaboration.
The goal is for teams to choose tools to support systematic, collaborative communication about shared children/patients/students and engage in such communication at the optimal level of frequency for each child.
Readily accessible, easy-to-use electronic tools can make routine collaboration and shared decision-making between child-serving sectors and families the standard of care for referral, intervention planning, and treatment. Establishing a family-centered, routinized collaborative communication approach not only relieves parents of the burden of bridging the gap between service systems but also ensures that family voices are recognized as vital contributors to effective care and positive outcomes.
While recognizing the value of technology in enhancing communication between providers and families, it remains crucial to prioritize patient privacy and confidentiality. Professionals are required to utilize secure and HIPAA-compliant technology, obtaining proper parental/guardian/youth consent prior to sharing information. Learn more about privacy and confidentiality considerations for collaborative work in Section 4 of this toolkit.
Electronic Tools to Support Collaborative Care
Connecticut’s Health Information Exchange (Connie)
What is a Health Information Exchange?
Statewide Health Information Exchanges (HIEs) allow for the secure sharing of patient information between healthcare providers, even if the providers use different Electronic Health Record systems in their practices. A statewide HIE can prove especially beneficial for pediatric and behavioral health providers who operate independently and utilize different technologies. By facilitating the sharing of health information among providers in diverse settings, exchanges can significantly enhance the potential for comprehensive, coordinated, and person-centered care.
What is Connie?
Connie is Connecticut’s designated HIE. Similar to the HIEs being implemented nationwide, Connie provides a secure platform for healthcare practitioners to electronically share confidential health information when treating the same patient across different healthcare systems. Connie’s technology has achieved HITRUST certification, assuring that it conforms with the industry’s best practices in security. All users are required to comply with federal (e.g., HIPAA) and state requirements for privacy and security.
To facilitate coordinated interprofessional care, Connie also offers a secure email tool that allows clinicians to directly communicate with each other regarding shared patients.
According to Connecticut state statute, licensed healthcare providers (including behavioral health clinicians) are required to participate in Connie by contributing basic information related to patient care.
Family Participation in Connie
All Connecticut residents who receive healthcare are automatically enrolled in Connie. This enables providers to stay up to date about the physical and behavioral health of their shared patients and ensures that important information, such as medication changes and new diagnoses, are not missed. Moreover, Connie participation simplifies communication, reducing the need for parents/guardians to serve as intermediaries between multiple providers.
According to state law, any patient that can legally consent to health services can choose to opt out of Connie. Opting out of Connie should be done with careful consideration of the pros and cons of participation. Children under the age of 13 must have a parent or guardian opt out on their behalf, while adolescents (ages 13 to 17) who are permitted under the law to consent to some health services can, if desired, either opt out themselves or their parent/guardian can opt out for them.
Electronic Health Records Systems
An Electronic Health Record (EHR) system is a digital version of a patient’s medical record. It is a comprehensive, real-time collection of a patient’s health information, accessible to authorized healthcare providers. In addition to allowing for the storage and retrieval of patient health information, EHRs facilitate secure and efficient communication between providers, including pediatric and behavioral health clinicians, as long as the providers employ the same system or there is interoperability between their systems.
EHRs typically include basic demographic, medical history, and medication information as well as clinical entries and documents. Some EHR systems offer clinical decision support tools that provide alerts, reminders, and recommendations for best practices in patient care. Many platforms also offer features for scheduling and billing, customizable report templates, and e-prescriptions as well as allow for patient viewing of health information and the opportunity to send messages to other providers. Privacy concerns are addressed by security measures that protect patient data and comply with healthcare privacy regulations.
EHR implementation results in improvements in patient care, including, reduced medical errors, efficiencies in service delivery, increased coordination among healthcare providers, and enhanced patient engagement.
Links to specific services are provided for convenience only. The developers of this toolkit do not endorse any particular tool, software, or system.
Telehealth and Video Conferencing Platforms
Telehealth platforms are digital systems or software solutions that enable the remote provision of healthcare services by connecting providers with patients/family members and each other over the internet. Many people became familiar with telehealth platforms during the COVID-19 pandemic.
Video conferencing is one of the core features of telehealth platforms, offering patients/family members and healthcare providers the opportunity to interact in real-time, despite being physically located in separate settings. Video conferencing features are included in most Electronic Health Record (EHR) systems.
Several standalone video conferencing services are also available for hosting virtual healthcare consultations and meetings. Commonly used standalone video conferencing tools include Zoom, Doxy.me, Google Workspace, Microsoft Teams, and Cisco WebEx. (Links provided for reference only; the developers of this toolkit do not endorse any particular service).
Before using any video conferencing or telehealth service to communicate health information, providers must ensure that the platform complies with all applicable privacy and security laws and regulations, such as HIPAA. This will protect patients’ and family members’ sensitive information and can be accomplished through a Business Associates Agreement/Addendum along with having HIPAA-compliant policies and procedures in place.
Encrypted email is a method of securing the content of an email message so that it can only be accessed and read by authorized recipients. The process involves encoding the email’s content in a manner that renders it unreadable to anyone without the corresponding decryption key. This added layer of security ensures that even if the email is intercepted or accessed by unauthorized individuals, its contents remain confidential and protected.
The type of email encryption that is HIPAA compliant is called “end-to-end” encryption. This method of encryption ensures that data is unreadable to any unauthorized persons throughout its entire journey from the sender to the recipient. Providers wanting to use encryption should look for an email provider that offers such end-to-end encryption and offers a business associate agreement. Encrypted email capabilities help healthcare providers (both pediatric and behavioral health practitioners) stay in contact with families, school personnel, and one another.
Connecticut’s Health Information Exchange, Connie, has an encrypted email function, as do many Electronic Health Record systems.
Additional HIPAA-level encrypted email providers include:
Some of these platforms are free, while others are paid. The developers of this toolkit do not endorse any email provider in particular.
Encrypted Text Messaging
Secure, end-to-end encrypted text messaging apps can provide a quick and easy way for pediatric providers, behavioral health clinicians, school personnel, and parents/caregivers to communicate.
In addition to protecting health information and preventing unauthorized disclosure, secure messaging apps provide the speed and convenience of those that are not secure. They also address common challenges in family-to-provider and provider-to-provider communication, such as phone tag and delays in follow-up. Group text messaging capabilities allow for time-sensitive, collaborative decision-making and updates.
Commonly used encrypted text messaging services include:
Some of these platforms are free, while others are paid.
Links provided for convenience purposes only; the developers of this toolkit do not endorse any particular text messaging service.
Strategies for Using Electronic Tools to Coordinate Care
Virtual Team Meetings
Video conferencing increases the likelihood that a team meeting will be held, as in-person meetings can be challenging to convene due to logistical hurdles such as time constraints and transportation-related obstacles. Virtual team meetings reduce these barriers and are more family-friendly, since parents/caregivers/youth are able to take less time off from work/school and other responsibilities.
Virtual team meetings also foster improvements in care, as they enable collaborative treatment planning and management that is enriched by joint cross-sector decision-making, routinized updates on child/patient/student progress, timely adjustments to treatment goals and strategies, and active patient/family engagement.
Warm handoffs are a best practice in healthcare, especially when it comes to transitioning patients from one care provider to another, and particularly from medical to behavioral health providers. In this context, a warm handoff refers to a smooth and coordinated transfer of a segment of a patient’s care from a pediatric practitioner to a community or school-based behavioral health clinician.
Warm handoffs involve the direct introduction of the patient/family by the referring provider to the receiving provider. When providers do not work in the same setting, the introduction can be made through secure video conferencing.
Any secure telehealth platform can be used by a pediatric provider to introduce a patient/family to a behavioral health clinician practicing in a school or community setting. The introduction can occur during a pediatric visit if the behavioral health provider is available (or if a plan has been previously made to ensure availability). Alternatively, the handoff can be discussed during the pediatric visit and then scheduled for a time that is convenient for all.
Research has demonstrated the effectiveness of warm handoffs in enhancing patient and family engagement in behavioral health treatment. This success can be attributed, at least in part, to the familiarity and comfort that families experience when meeting the clinician in the presence of their trusted pediatric provider.
Strategies for Effective Warm Handoffs:
- Implement a standardized process
- Secure parent/guardian/adolescent agreement for participation
- Prepare before the handoff to facilitate a well-structured and concise exchange
- Allow sufficient time: most well executed warm handoffs require no more than 5 minutes, but when more time is needed, a follow-up meeting can be scheduled
- Brief summary of the most critical information
- Clear assignment of roles and responsibilities for each provider, e.g., the pediatric provider may prescribe medication while the behavioral health provider engages the adolescent in treatment and offers the parent/caregiver behavior management strategies
- The behavioral health provider establishes rapport with the child and family and plans for a follow-up visit (in-person or remote)
According to the Centers for Medicare & Medicaid Services (CMS), an eConsult is a telephone or internet-based consultation between two providers that is conducted for the direct benefit of a patient. The eConsult is typically initiated by the patient’s treating provider (primary care or specialist) requesting the opinion and/or treatment advice of a remote consulting specialist who has no direct contact with the patient.
The consulting provider assists the treating provider in caring for the patient – for example, by aiding in accurate diagnosis or comprehensive treatment planning – without face-to-face, in-person contact with either the patient or the treating provider. For example, a pediatric provider may seek suggestions from a psychiatrist or other behavioral health provider, without having to make an actual referral.
EConsults have been found successful in achieving their goal of facilitating effective and efficient care management by primary care providers.
Some eConsult services are free, while others require a subscription or payment for use. Aside from the eConsult platforms included with many EHRs, other commonly used platforms include ConferMED and RubiconMD.
Pediatric providers in Connecticut can also seek remote consultations and medical education on behavioral health topics through Project ECHO® (Extension for Community Healthcare Outcomes), an evidence-based interactive distance-learning community linking expert specialists with primary care practitioners. This telementoring program offers participants the opportunity to benefit from expert consultations and peer learning while gaining access to a wealth of evidence-based educational resources.
The National Child Traumatic Stress Network (NCTSN), a division of the Substance Abuse and Mental Health Services Administration (SAMHSA), provides free consultation services to healthcare practitioners working with children and adolescents who have experienced trauma. This service facilitates consultation with leading experts in the child trauma field, offering guidance on assessment, treatment, and referral.