Mental health issues need to be an essential component of all the ongoing conversations around medical homes, EMRs, wellness plans, etc. Given the comorbity of mental health issues with both physical disease and substance abuse; not addressing these issues as an essential component of any change model dooms that model to failure.

Policy issues aside, from a health IT perspective, I agree that EMR/EHRs alone are grossly insufficient if quality improvement and cost control are our country’s goals. I disagree, however, that the necessary “technologies exist today as the platform for CCHT.” That’s because that has not been enough attention given to patient-centered cognitive support (PCCS), which I contend is essential.

According to a recent report by the National Research Council of the National Academies, PCCS is a computerized process that improves decision making by fostering profound understanding through use of a “virtual patient” model. The PCCS process employs a computerized model of a “virtual patient” that reflects an actual patient. An HIT tool would use this virtual patient to guide the selection and analysis of data.

As I discuss at http://curinghealthcare.blogspot.com/2009/06/meaningful-use-clinical-decision.html, the current crop of health IT tools lack a critical element, i.e., they don’t implement the PCCS process.

Since they do not use the PCCS process, mainstream health IT tools do not (a) help clinicians gain substantially greater understanding of their patients’ situations (i.e., their strengths, weaknesses, risks, needs, and options); nor do they (b) enable patients to understand their own situations better. Decision-making suffers as a consequence.

Eliminating the health IT-PCCS gap would enhance understanding and promote better shared decision-making about treatment, prevention, health promotion, and self-maintenance. Because both clinicians and patients would be better informed through the PCCS process, the decisions they make would be more likely result in better outcomes (higher quality and safety) at lower cost. This would translate into increased care value (effectiveness and efficiency). In other words, using health IT tools that implement the PCCS process would help realize important benefits to individuals and society.

As such, PCCS is a necessary ingredient for realizing the benefits of CCHT.

So, we ought not to be satisfied with EHRs alone since they simply cannot take us where we have to go. They ought to be augmented with PCCS if they are to be truly useful.