As if the controversy over electronic health records is complicated enough, a new University of Florida study found that physicians using EHR were about half as likely as physicians using paper-based records to provide appropriate depression treatment to patients with three or more chronic conditions.
The study analyzed 3,467 visits adult patients with a diagnosis of depression and noted whether the patient was prescribed an antidepressant, received mental health counseling or a got a combination of the two. For patients with one or two chronic conditions, the recommended treatment for depression was not different for patients of EHR users and paper-based physicians. But for patients with three or more chronic conditions, patients of EHR users were about half as likely to receive appropriate depression care as those whose physicians use paper charts.
This is disturbing, not just because my primary care physician has switched to EHR but because many health care providers, such as the Veterans Administration, have gone to EHR. Thankfully, my therapist doesn’t even own a computer and my psychiatric nurse practitioner is still uses the old-fashioned manilla folder that contains all kinds of handwritten notes and even Christmas cards I sent her.
I have mixed feelings about EHR. As someone in a profession that is also going digital – newspapers – I have accepted the reality that despite my nostalgic love of for books, newspapers and even paper medical records, they are quickly becoming obsolete. Many of my colleagues see the demise of the “dead-tree edition” as the end of journalism as we know it. I don’t. It’s a change – a big, nasty change that I do not like, but it is going to happen regardless of my feelings. Fighting it is a waste of time. The best use of my skill and time is to work within this new paradigm. Accept it. Work with it. Most of all, keep a close eye on the ethics of this new mode of delivering information.
Same with EHRs. It doesn’t matter whether you like ERHs, they are going to replace old-fashioned paper charts. As for why physicians using EHR are less likely to provide appropriate depression treatment for patients with three or more chronic conditions, the authors of the study suggested that ERH may be designed to focus more on physical health than mental health (Why the two are separate I will never understand.) Or, it could be that physicians who use EHR spend more time tapping on their tablets than observing their patients’ body language and demeanor – potentially valuable clues when doing that whole differential diagnosis thing.
You’re probably saying, “Hey, what’s the big deal? You’re talking about people with three or more chronic conditions. How many of those can there be?”
Well, as many as half the alcoholics and addicts out there – like me – have at least one other mental illness – bipolar, depression. Throw another chronic illness on the heap – such as diabetes – and we’re talking about a lot of people out there with three or more chronic illnesses. Yikes.
The moral of the study may be that, once again, those of us with mental illnesses need to be particularly pro-active in our treatment. If you don’t think your physician or psychiatric nurse practitioner is paying enough attention to you – if there is more tapping and writing going on than discussion and genuine human interaction – then do something. It’s okay to tell the doctor you are not okay with how she is interacting with you. If you are worried about hurting the doctor’s feelings, ask yourself this question: Whose feelings are more important? Mine or the doctor’s?
We need to trust and have faith in those who care for us. Yes, doctors are busy and have bad days like the rest of us. But we’re talking about your health here. Find out what all the tapping and typing on that tablet is about. If it makes you uncomfortable, say so. If you are curious, ask to see the darn thing. Remember, EHR are coming whether you like it or not but that does not mean you have to accept a lower standard of care.
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Last reviewed: 7 Sep 2012