Patients who have three or more chronic medical conditions are half as
likely to receive depression treatment in primary care practices that use
electronic medical records as they are in practices that use paper-based
records, a new University of Florida study has found.
Electronic medical records, or
EMRs, are generally thought to improve health care by allowing better
coordination of care and increased accuracy in diagnosis and treatment. But the
UF study raises questions about how computerized records systems could affect
mental health care.
The findings appear in the August
issue of the Journal of General Internal Medicine.
“While we don’t know why EMRs are
associated with lower odds of depression treatment in patients with multiple
conditions, we think that either they reduce the amount of interaction between
patients and physicians or they focus a physician’s attention on physical
health issues, pushing mental health issues off the radar screen,” said lead
investigator Jeffrey Harman, an associate professor and the Louis C. and Jane
Gapenski Term Professor of Health Services Administration at the UF College of
Public Health and Health Professions.
Under the 2009 Health Information
Technology for Economic and Clinical Health Act, the federal government offers
incentive payments for Medicare and Medicaid providers who adopt electronic
health record systems. Practitioners and hospitals must demonstrate “meaningful
use” of the electronic health systems, that is, improvements in quality, safety
and effectiveness of care. In 2011, 57 percent of office-based physicians were
using EMRs, according to the National Center for Health Statistics.
The UF study team, which included
Dr. Robert Cook, a UF associate professor of epidemiology and medicine,
Christopher Harle, a UF assistant professor of health services research,
management and policy, and Kathryn Rost, a University of South Florida research
professor of mental health law and policy, analyzed 2006-2008 data from the
National Ambulatory Medical Care Survey, a nationally representative sample of
physician-office visits. They looked at all visits in which patients 18 and
older received a depression diagnosis, a total of 3,467 visits, and noted
whether the physician prescribed or continued antidepressant medication, mental
health counseling or a combination.
Depression treatment in patients
with one or two chronic conditions did not differ between EMR and non-EMR
practices. But if patients had three or more conditions, they were half as
likely to receive depression care at an EMR practice.
In previous studies of EMRs in
inpatient settings, physicians reported that entering data is more
time-consuming, as it requires clicking through many screens and system
options. The result could be decreased psychosocial interactions between
doctors and patients, Harman said.
“There is some evidence that
typing these notes into the computer is actually reducing the amount of time
that physicians and patients talk to each other during visits,” Harman said.
“If the physician only has time to address two out of three conditions, depression
may be the one that they’re not talking about.”
The researchers also theorize
that the prompts and guidelines in EMRs are focused more on biomedical issues
than mental health. Still, more research is needed to prove whether EMR use is
responsible for the levels of depression care noted.
“Although the UF study is unable
to determine a causal relationship between EMR adoption and decreased quality
of depression care, identifying such an association is an important first step
in better understanding the impact of EMRs on our health care system,” said Nir
Menachemi, a professor of health care organization and policy at the University
of Alabama at Birmingham School of Public Health, who was not involved in the
UF research. “The next step will be to rule out that physicians who adopt EMRs
are not somehow different from those who do not, which may explain the
differences observed. Either way, I commend the team at UF for contributing
valuable information to the ongoing debate on this critical topic.”
Provided
by University of
Florida
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