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Study: Mental health info often left out of EHR data


The lack of patients’ mental health data is a microcosm of a larger provider-sharing problem, say authors.

Electronic health records are missing significant details about patients’ mental health care, according to a study published in April in the Journal of the American Medical Informatics Association.

The study highlights the continuing problems with EHRs and the lack of data-sharing between patients’ primary care physicians, specialists and acute care hospitals, said study co-author Stephen B. Soumerai, ScD, a professor in the department of population medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute.

“We have a system where outpatient practices, hospitals and all kinds of health delivery systems are disconnected, and [that affects] the completeness of the data in the EHR,” he told Medical Economics.

Soumerai said the medical community has long recognized that EHRs contain an incomplete picture of patient healthcare, but there wasn’t a lot of research quantifying the problem prior to this study.

To begin to measure the scope of this, researchers compared the information recorded in a typical EHR at a large premier interdisciplinary practice (Massachusetts-based Harvard Vanguard Medical Associates) with data from insurance claims, focusing on diagnoses, outpatient and emergency department visits, and hospitalizations for depression and bipolar disorder.


They found that:

·      Patients with depression and bipolar disorder, respectively, averaged 8.4 and 14.0 days of outpatient behavioral care per year, but 60% and 54% of these care events, respectively, were missing from the EHR;

·      Total outpatient care days were 20.5 for those with depression and 25for those with bipolar disorder, but 45% and 46% were missing, respectively, from the EHR;

·      Some 89% of acute psychiatric services also were missing from the EHR; and

·      Study diagnoses were missing from the EHR’s structured event data for 27.3% and 27.7% of patients.

Although researchers focused on a Massachusetts-based practice, Soumerai said the findings reflect what’s happening nationwide.

Soumerai said several factors contribute to the lack of mental health data in EHRs, most notably the interoperability of the numerous software systems in use by various healthcare providers as well as the lag in EHR use among mental health providers (who if working in small or solo practices may not even have electronic record systems in place).

The study concluded that “EHRs alone inadequately capture mental health diagnoses, visits, specialty care, hospitalizations and medications.”

Moreover, the study noted that this is a particular worrisome issue for patients with mental health conditions, with the researchers writing: “Primary care physicians then not only run the risk of medication errors, but also miss opportunities to encourage adherence to mental health visits and medications. Treatment adherence is particularly poor among mentally ill outpatients and can lead to adverse outcomes, including hospitalization.”

Soumerai said the research is indicative of a problem that’s larger than only missing mental health data.

“Our study suggested that specialist care was often obtained outside the system that the primary care doctor worked in,” he added, “and a large portion of the care outside the system that the primary care physician is in will then not [become part of] the primary care physician’s EHR.”


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