A Computer Assisted Medical and
Psychological Screening, Mentor Research Institute Conner@OregonCounseling.Org Table Of Contents The prevalence of co-morbid mental health disorders range from 30 to 70 percent in primary medical care settings. Failure to recognize and treat these disorders leads to significant and unnecessary utilization of medical resources. Valid identification and treatment of medical and mental health problems found in a primary medical care setting was improved by the collaborative installation of a Computer Assisted Medical and Psychological Screening (CAMPS) system that considered the routines, populations and resources of a primary medical care practice. CAMPS is based on an innovative fusion of computer and assessment technology that was developed with the intent of assisting medical caregivers in the identification and treatment of medical and mental health problems in a multicultural population. A two page medical and psychological checklist was designed to be completed by patients in waiting areas or in examination rooms in less than 10 minutes. Biological, psychological, social and cultural data is collected. An interactive computer program was developed to process the checklist and generate a one page physician report that includes severity of symptoms, risk of specific psychological disorders, a request for additional information where indicated, as well as medication, treatment and referral recommendations. Data can be input and processed in less than two minutes. The acceptability and uniqueness of the prototype was attributed to a collaborative design process between medical caregivers and a psychologist practicing in that primary care setting. The final prototype was compatible with primary care operations, saved time overall, provided data that was considered useful in practice decisions and facilitated appropriate consultation between mental health and medical services. Physicians, nurses and medical assistants were more supportive of a mental health role and treatment focus within primary care when they were provided with an efficient means of assessment, timely consultation and referral information when indicated. Megatrends in Mental Health Care The industry of health care is involved in providing service to populations, advancing the science of health care, as well as care giving to the individual. These three arenas present enormous challenges to individual understanding, management and clinical practice. The information available and necessary to support the practice of medicine exceeds the practitioners ability to implement.
Psychological disorders profoundly affect health care.
Mental health care is not peripheral or separate from medical care.
Mental health care can be effective and provide substantial medical offset.
Research, professional journals, professional groups and consultants recommend that we:
Computer Applications Hold Promise Since the advent of the computer, researchers have embraced visions of computer applications designed to replace or assist humans in every domain of information processing and intellectual functioning. Despite 25 years of research including the finest minds in computer science working at institutions such as MIT, Stanford and Rutgers, the field of artificial intelligence (AI) and decision support technology have failed to significantly impact the practice of medicine (Coiera, 1996). Today’s research efforts fall somewhere between the goals of pure research that would push forward the boundaries of knowledge and applications focused research that would profoundly improve clinical practice. This unfocused use of resources has produced an application technology not significantly advanced beyond data processing. Development of decision support systems in health care has proceeded on the assumptions that health care professionals are prone to errors, that efficiency can be improved, and that computers can be used to emulate part of the clinical process. The observed failure of these systems to impact health care have been explained historically by a lack of research, a lack of the necessary informational structure to support these system, and resistance to the use of this technology by health care professions. The value of decision support systems has been incorrectly assessed. There has been a mismatch between the genuine needs of health care professionals and the perception of those needs by computer science professionals. There is a variance between the owners of a problem and the needs of clinicians who can make use of decision support systems. Owners of problems include department heads, managers, administrators and executive in health care organizations. Users include physicians, nurse practitioners, physician assistants, nurses, medical assistants, technicians and other direct service personnel. The task of any decision support effort is to thoroughly and effectively apply established knowledge to the problem presented. An integrated system, can transform the unique patterns found during a patient encounter from loose unconnected data to clinically useful patterns. Primary care practice is a biopsychosocialcultural setting. Within that setting there are four essential functions that lend themselves to computer support: These are (1) to rapidly screen and assess patients, (2) to access practice guidelines based on that assessment, (3) to incorporate these guidelines into clinical practice, and (4) to submit clinical experience back to the computer system to help improve it. The amount of time that can be spent with a patient is largely a function of the number of appointments that are scheduled per hour which can range from 4 to 12. Physicians don’t have enough time to properly screen, evaluate, consult, treat and refer patients with a suspected mental disorder. Physicians have about 10 to 20 minutes to spend with a patient. That doesn’t leave much time to conduct a mental health screening or evaluation. A mental health screening can be given before, during or after the examination. The time available for consultation is about 5 minutes. Obtaining consultation from a psychiatrsit or psychologist has a narrow window of opportunity between patients and while seeing a patient. Physicians need a decision support procedure for mental health issues that can be completed and made available to them within 10 minutes. Physicians want a document that is one page long or rarely two. They want answers to the essential questions in clinical practice. They want information that leads to a solution, not just the burden of additional problems. They also want to see how it works. As their experience with decision support grows, they will want to see it modified to support specific areas of practice and to reflect their practice values and beliefs. Collaborative Research Opportunity (Computer Assisted Medical & Psychological Screen - CAMPS)Proposal
Substantiation of Need
Method/Activities
Potential Outcomes
Length of Demonstration Project/Study: 2 years
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