EHRs may be inadequate in capturing mental health diagnosis, study finds
The diagnoses of 27.3 percent of patients with depression and 27.7 percent of patients with bipolar disorder were missing from their primary care electronic health records, a study published in the Journal of the American Medical Informatics Association has found.
These behavioral health patients had an average of three to eight visits during the year both at the EHR site and outside the site. But despite these high numbers, the data from the encounters were underreported.
In the study, researchers from the Department of Population Medicine at Harvard Medical School studied Harvard Pilgrim Health Care patients at Harvard Vanguard Medical Associates who in 2009, who had a depression or bipolar diagnosis. Researchers studied outpatient care visits and calculated the proportion of these visits not found in the EHR.
"In this research, we found the lack of integration, interoperability and exchange in US healthcare resulted in a major EHR missing roughly half of the clinical information," the authors wrote. "While behavioral healthcare is unique, it's important to emphasize our findings demonstrate the problem of incomplete clinical data in the EHR is not limited to behavioral care."
About half of the outpatient care days from insurance claims could not be matched to clinical contacts recorded in the EHR, the report shows. While this data is true for all areas of care, the extent of missing information was greater for behavioral services than for general outpatient.
Furthermore, 89 percent of acute psychiatric services in hospital-based events were missing from the EHR, and 43 percent of all hospital-based events were missing. In contrast, clinical events found in the EHR could be matched to claims 93 to 98 percent of the time.
The study also found there were also high rates of missing EHR data in general for healthcare, both for inpatient and outpatient care. Areas of specialist care were also grossly underrepresented in primary care EHRs.
"Published reports touting the anticipated benefits of the recent rapid adoption of EHRs should be tempered by frank examinations of EHRs as they currently exist," the authors said. "Individual providers and health system leaders need to be fully cognizant of the information gaps and disconnects that lie behind the screen.
"Features intended to improve care and protect patients from harm may be inadequate in typical fragmented health systems, offering false comfort," they added.