Impact of a Web-Based Electronic Health Record on Behavioral Health Service Delivery for Children and Adolescents: Randomized Controlled Trial

Abstract

BackgroundElectronic health records (EHRs) have been widely proposed as a mechanism for improving health care quality. However, rigorous research on the impact of EHR systems on behavioral health service delivery is scant, especially for children and adolescents.ObjectiveThe current study evaluated the usability of an EHR developed to support the implementation of the Wraparound care coordination model for children and youth with complex behavioral health needs, and impact of the EHR on service processes, fidelity, and proximal outcomes.MethodsThirty-four Wraparound facilitators working in two programs in two states were randomized to either use the new EHR (19/34, 56%) or to continue to implement Wraparound services as usual (SAU) using paper-based documentation (15/34, 44%). Key functions of the EHR included standard fields such as youth and family information, diagnoses, assessment data, and progress notes. In addition, there was the maintenance of a coordinated plan of care, progress measurement on strategies and services, communication among team members, and reporting on services, expenditures, and outcomes. All children and youth referred to services for eight months (N=211) were eligible for the study. After excluding those who were ineligible (69/211, 33%) and who declined to participate (59/211, 28%), a total of 83/211 (39%) children and youth were enrolled in the study with 49/211 (23%) in the EHR condition and 34/211 (16%) in the SAU condition. Facilitators serving these youth and families and their supervisors completed measures of EHR usability and appropriateness, supervision processes and activities, work satisfaction, and use of and attitudes toward standardized assessments. Data from facilitators were collected by web survey and, where necessary, by phone interviews. Parents and caregivers completed measures via phone interviews. Related to fidelity and quality of behavioral health care, including Wraparound team climate, working alliance with providers, fidelity to the Wraparound model, and satisfaction with services.ResultsEHR-assigned facilitators from both sites demonstrated the robust use of the system. Facilitators in the EHR group reported spending significantly more time reviewing client progress (P=.03) in supervision, and less time overall sending reminders to youth/families (P=.04). A trend toward less time on administrative tasks (P=.098) in supervision was also found. Facilitators in both groups reported significantly increased use of measurement-based care strategies overall, which may reflect cross-group contamination (given that randomization of staff to the EHR occurred within agencies and supervisors supervised both types of staff). Although not significant at P<.05, there was a trend (P=.10) toward caregivers in the EHR group reporting poorer shared agreement on tasks on the measure of working alliance with providers. No other significant between-group differences were found.ConclusionsResults support the proposal that use of EHR systems can promote the use of client progress ...

Exploring association between certified EHRs adoption and patient experience in U.S. psychiatric hospitals

“…There is widespread agreement that the certified EHR is a lever to the care quality among hospitals which theoretically is helpful to improve service process and result in better patient experience. [9,41] Empirical evidence is needed to testify about the implications of certified EHR use on the patient experience in psychiatric hospitals. This study sought to explore association between certified EHR adoption and patient experience in U.S. psychiatric hospitals by assessing the disparities in patient perception between psychiatric hospitals with and without certified EHR.…”

“…Our study results showed that certified EHR adoption is positively related to the patient perception of the responsiveness of hospital staff. On the one hand, staff may be free from the manual task with digital technology and have more time for the attention to patient progress and subsequent problem solving; [45] on the other hand, certified EHR may assist mental health practitioners timely tracking the patient situation and behavior changes, manage risk with incident notification, and automatically remind staff of the upcoming events in the care plan [9]. All the efficient interaction between patients and mental health practitioners could potentially reduce their waiting time for services and thus improve their patient experience with responsiveness.…”

“…[7] There might be multiple barriers impeding adoption of certified EHR, including initial financial pressure of providers, narrative and non-structure feature of patient records, confidentiality of psychiatric care and stigma of mental illness. [8,9] Lag in certified EHR adoption among psychiatric hospitals might not only limit quality improvement of psychiatric care but also stymie efforts to achieve the targeted benefits, such as interoperability, across the health care continuum. [6,10] Therefore, it is necessary to identify the evidence to prove if certified EHR adoption has positive impacts to quality improvement and patient experience in psychiatric hospitals, and also if health policymakers should expand the incentive programs to psychiatric hospitals.…”

“…[31,32] Additionally, most literature on the relationship between patient experience and EHR adoption were conducted in non-psychiatric settings. [9,[22][23][24][25][26][27][28]30] Due to the confidentiality and sensitive nature in psychiatric records, and the special reliance on information for psychiatric diagnosis and treatment, the findings of previous works in non-psychiatric hospitals may not apply equally to psychiatric hospitals. [17] The aim of this cross-sectional study is to examine the relationship between certified EHR adoption and patient experience at hospital level in psychiatric care setting in the U.S. We hypothesized that certified EHR use would positively influence the patient experience across psychiatric hospitals.…”

Clinicians’ Concerns About Mobile Ecological Momentary Assessment Tools Designed for Emerging Psychiatric Problems: Prospective Acceptability Assessment of the MEmind App

“…Over the last decade, the field of medicine has evolved toward greater digitization of data in order to improve coordination and continuity of care [1,2]. Information and communication technologies have brought computer science into medical units; medical data collection software is now abundant, and its use is expanding into a variety of settings [2,3]. However, many clinicians view this new reliance on technology as an added burden to their existing workload [2,4-6].…”