Depression may go overlooked when physicians use electronic medical records

By Jill Pease
Dr. Jeffrey Harman led a study that found patients with multiple chronic medical conditions are half as likely to receive depression treatment in primary care practices that use electronic medical records.

Dr. Jeffrey Harman led a study that found patients with multiple chronic medical conditions are half as likely to receive depression treatment in primary care practices that use electronic medical records.

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 UF study 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 appeared in the August 2012 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, Ph.D., 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.

The UF study team 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, Ph.D., a professor of health care organization and policy at the University of Alabama at Birmingham, 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.”

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Spring 2013

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