If you have three or more chronic medical conditions, you are only half as likely to receive treatment for depression if your doctor uses electronic medical records as opposed to one who uses paper-based records, according to a new University of Florida study.
Electronic medical records (EMRs) were designed to improve health care by offering better coordination of data and accuracy in diagnosis and treatment.
But the new study raises questions about how computer records systems may be affecting mental health care.
“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.
In 2011, 57 percent of office-based physicians were using EMRs, according to the National Center for Health Statistics.
The researchers analyzed 2006-2008 data from the National Ambulatory Medical Care Survey, a nationally representative sample of physician-office visits.
They looked into all visits in which patients 18 and older were given a depression diagnosis (a total of 3,467 visits) and noted whether the doctor prescribed or continued antidepressant medication, mental health counseling or both.
Depression treatments in patients with one or two chronic conditions were similar in EMR and non-EMR practices.
However, if patients had three or more conditions, they were half as likely to receive depression care at an EMR practice.
In earlier studies of EMRs in inpatient settings, doctors reported that entering data is more time-consuming, as it requires clicking through many screens and system options. Perhaps this could cause a decrease in 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 EMRs are more focused on biomedical issues than mental health. Still, more research is needed on this subject.
“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.”
The study is published in the Journal of General Internal Medicine.
Source: University of Florida