Collaboration in the presence of an electronic health record.

Abstract

Recent laws in the United States incent healthcare practices to adopt electronic health records (EHRs). While there is extensive research related to EHRs generally, there is a dearth of EHR research specific to collaborative care settings. This study reports responses from 101 collaborative care offices who completed a 13-question online survey. The mixed-methods analysis provides insights as to the satisfaction, obstacles, and solutions to interdisciplinary collaboration in the presence of an EHR. Respondents reported highest satisfaction with medical billing, interdisciplinary communication, and scheduling. Satisfaction was lower as it relates to time consumption, difficult learning curve, creation of appointment notes, and health registries. This research reveals varied and conflicting approaches to addressing confidentiality and HIPAA within the EHR. Recommendations for improving EHR to better support collaborative care include the addition of modules common in mental health-specific EHR, enhanced tracking of mental health outcomes, templates for joint appointments, and improvements in population-based registry functions.

Use of technology for care coordination initiatives for patients with mental health issues: a systematic literature review

“… 9 , 18 , 20 , 24 , 25 EHRs were the most common health information technology used. 12 , 18 , 19 , 21 – 23 , 26 , 29 , 30 A single study used the Aging Brain Care Medical Home model to facilitate care coordination. 18 …”

“…EHRs were the most commonly assessed technology for care coordination (n=9).12,18,19,21–23,26,29,30 In a survey of 101 collaborative care offices, 95% of primary care physicians and 87% of mental health clinicians used EHRs. 23 Across three studies, the identified advantages of using EHRs included increased shared access of patient information between providers; 22 high satisfaction with billing, scheduling, and screening for mental health; 23 and utility in promoting human rights for patients with mental illness in the correctional system. 29 A single study showed the utility of touch screen technology with wireless tablet computers for mental health screening.…”

“…The implementation of coordinated care for mental health continues to face challenges, especially related to cost, usability, and integration of EHRs. Eight studies identified barriers to implementing care coordination ( Table 1 ); 18 – 25 these barriers were related to provider setting (n=7) 18 – 23 , 25 and patient engagement (n=3). 18 , 24 , 25 …”

“… 19 Two studies mentioned the poor interdisciplinary integration of EHRs and their steep learning curves. 19 , 23 In an observational, cross-case comparative study of 11 health care centers, Cifuentes et al found many challenges to integrating EHRs, including lack of templates supporting shared care plans between primary and behavioral health providers, limited interoperability between EHRs and tablet devices, and double documentation with duplicate data entry for practices using two different EHRs. 19 Zeman et al described similar experiences when implementing computerized behavioral health assessment in four primary clinics.…”

Telemental health in Brazil: past, present and integration into primary care

“…A huge challenge must be overcome considering the regional differences and the telehealth implementation already experienced in Brazil's public health. Mainly, regarding resistance of technology implementation in the work environment, higher number of cases and with greater complexity to be followed, as well as confidentiality and health record usability by multidisciplinary teams 15,[29][30][31] . Historically, now there is an opportunity to articulate a TMH national program and coordinated research to detect high-risk status, early stage disorder, combine pharmacological and psychosocial interventions in a stepped-care fashion with long-term follow-up based on scientific evidences looking forward to improve mental health care service delivery and access to proper mental health care in primary care.…”