EHRs Inadequate in Mental Health Care

Study results indicate that electronic health records (EHRs) appear to inadequately capture mental health diagnoses, office visits, hospitalizations, specialty care, and medications, with this missing clinical information raising concerns about medical errors and research integrity.

Predicated on the understanding that complementary sources of data can be used to provide greater detail on a patient’s health trajectory than a single source, as well as the assumption of improved patient safety, research capacity, and cost savings, significant investments were made in EHRs in recent years. However, most United States health systems and health records are fragmented and do not actually share patient information. Despite this fragmentation being a recognized problem, little data exist that estimate the extent of this problem.

In order to gain a better understanding of the problem, Jeanne M. Madden, PhD, an Associate Professor in the Department of Pharmacy and Health Systems Sciences of the Bouve College of Health Sciences at Northeastern University and an Instructor in the Department of Population Medicine at Harvard Medical School, and colleagues compared information available in a typical HER with more complete data from insurance claims, focusing on diagnoses, visits, and hospital care for depression and bipolar disorder.

For the study, published online on April 14, 2016 in the Journal of the American Medical Informatics Association, patients aged 12 and over who were assigned throughout 2009 to a large multispecialty medical practice in Massachusetts with a diagnosis of depression or bipolar disorder were included. The researchers extracted insurance claims and EHR data from the primary care site and compared diagnoses of interest, outpatient visits, and acute hospital events (overall and behavioral) between the two sources.

Madden and colleagues found that:

• EHRs alone inadequately capture mental health diagnoses, visits, specialty care, hospitalizations, and medications. This missing data could potentially result in medication errors and other patient harms from behavioral care services.
• Patients with depression and bipolar disorder, respectively, averaged 8.4 and 14.0 days of outpatient behavioral care per year, 60% and 54% of which, respectively, were missing from the EHR because they occurred offsite.
• Total outpatient care days were 20.5 for those with depression and 25.0 for those with bipolar disorder, with 45% and 46% missing, respectively, from the EHR.
• The EHR also missed 89% of acute psychiatric services.
• Study diagnoses were missing from the EHR’s structured event data for 27.3% and 27.7% of patients.

The findings suggest that external sources of information be used to complement EHR-derived data. “Given the fragmentation of health care and poor EHR interoperability, information exchange, and usability, priorities for further investment in health IT will need thoughtful reconsideration,” conclude the authors.