Docs lack access to psychiatric records

Researchers point to unintended consequences, readmissions

Medical centers that elect to keep psychiatric files private and separate from the rest of a person's medical record may be doing their patients a disservice, a Johns Hopkins study concludes.

In a survey of psychiatry departments at 18 of the top American hospitals as ranked by U.S. News & World Report's Best Hospitals in 2007, a Johns Hopkins team learned that fewer than half of the hospitals had all inpatient psychiatric records in their electronic medical record (EMR) systems and that fewer than 25 percent gave non-psychiatrists full access to those records.

Researchers say, psychiatric patients were 40 percent less likely to be readmitted to the hospital within the first month after discharge in institutions that provided full access to those medical records.

[See also: Johns Hopkins reduces psychiatric drug errors by almost 25 percent.]

"The big elephant in the room is the stigma," says Adam I. Kaplin, MD, an assistant professor of psychiatry and behavioral sciences and neurology at the Johns Hopkins University School of Medicine and leader of the study published online in the International Journal of Medical Informatics. "But there are unintended consequences of trying to protect the medical records of psychiatric patients. When you protect psychiatric patients in this way," Kaplin adds, "You're protecting them from getting better care. We're not helping anyone by not treating these diseases as we would other types of maladies. In fact, we're hurting our patients by not giving their medical doctors the full picture of their health."

Kaplin says that as more and more hospitals embrace EMRs, many choose to exclude psychiatric illnesses, even if that means keeping vital information about diagnoses and medications from primary care doctors who need it.

After the surveys were completed, the researchers tapped the University Health System Consortium Clinical Database, which includes information on readmission rates on 13 of the hospitals in the study. At institutions where psychiatric records were included in the EMR, psychiatric patients were 27 percent less likely to be readmitted to the hospital within a week of discharge, with little statistical difference after two weeks and a month. But in those hospitals where records were included in the EMR and non-psychiatrists were given access to them, patients were 40 percent less likely to be readmitted at seven days, 14 days and a month.

[See also: Johns Hopkins opens new health IT center.]

"If you have electronic medical records, that's a good step in the right direction," Kaplin says. "But what you really need to do is share the records with non-psychiatrists. It will really make a difference in terms of quality of care and readmission rates. Let's not keep mental health records out in the cold."

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