The effect that information source has on different surveillance methods depends on the type of AE. Integrating information from physician narratives with CSS using natural language processing would improve the detection of ADEs more than HAIs.

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OBJECTIVE The aim of this analysis was to determine changing patterns of depression screening and diagnosis over three years in primary and specialty mental health care in a large health maintenance organization (HMO) as part of a quality measure development project. METHODS Two series of aggregate data spanning three years (2010–12) were gathered from the electronic health record of the HMO summarizing unique adolescents age 12–21 (N=44,342) who had visits in primary and mental health care. Chi-square tests assessed the significance of changing frequency and departmental location of PHQ-9 administration, incident depression symptoms, and depression diagnoses. RESULTS There was a significant increase in PHQ-9 use from 2010 to 2012, predominantly in primary care, consistent with internally generated organizational recommendations to increase screening with the PHQ-9. The increase in PHQ-9 use led to an increase in depression diagnoses in primary care and shift in the location of some diagnoses from specialty mental health care to primary care. The increase in PHQ-9 use was also linked to an increase in the proportion of positive PHQ-9 results not leading to formal depression diagnoses. CONCLUSIONS The rate of depression screening in primary care increased over the study period. This increase corresponded to an increase in the number of depression diagnoses made in primary care and a shift in the location of depression diagnoses made from the mental health department to primary care. The frequency of positive PHQ-9 administrations not associated with depression diagnoses also increased.

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PURPOSE Health information technology (IT) offers promising tools for improving care coordination. We assessed the feasibility and acceptability of 6 proposed care coordination objectives for stage 3 of the Centers for Medicare and Medicaid Services electronic health record incentive program (Meaningful Use) related to referrals, notification of care from other facilities, patient clinical summaries, and patient dashboards. METHODSWe surveyed physician-owned and hospital/health system-affiliated primary care practices that achieved patient-centered medical home recognition and participated in the Meaningful Use program, and community health clinics with patient-centered medical home recognition (most with certified electronic health record systems). The response rate was 35.1%. We ascertained whether practices had implemented proposed objectives and perceptions of their importance. We analyzed the association of organizational and contextual factors with self-reported use of health IT to support care coordination activities.RESULTS Although 78% of the 350 respondents viewed timely notification of hospital discharges as very important, only 48.7% used health IT systems to accomplish this task. The activity most frequently supported by health IT was providing clinical summaries to patients, in 76.6% of practices; however, merely 47.7% considered this activity very important. Greater use of health IT to support care coordination activities was positively associated with the presence of a nonclinician responsible for care coordination and the practice's capacity for systematic change.CONCLUSIONS Even among practices having a strong commitment to the medical home model, the use of health IT to support care coordination objectives is not consistent. Health IT capabilities are not currently aligned with clinicians' priorities. Many practices will need financial and technical assistance for health IT to enhance care coordination. Ann Fam Med 2015;13:250-256. doi: 10.1370/afm.1797. INTRODUCTIONC oordinating patient care is important for several reasons including the delivery of consistent guidance and recommendations, avoidance of unnecessary and/or duplicative testing, and ensuring timely access to services. A recent national survey showed that onethird of patients reported experiencing a gap in exchange of information between health care professionals involved in their care or between themselves and their health care professionals. Electronic health records (EHRs) and other health information technology (IT) offer the promise of making information sharing easier. 2Existing research shows infrequent use of health IT for care coordination, however. 3,4 Even in settings where use of health IT is widespread, connectivity with other practices or facilities can be difficult.3 Beyond the technical challenges to information sharing, other factors such as internal workflows and lack of reimbursement for care coordination can limit successful use of health IT for care coordination. 2,5,6 Suzanne Morton, MPH METHODS Over...