Are electronic health records keeping you from recognizing patient depression?

Electronic health records (EHRs) have forced primary care physicians (PCPs) to focus on the computer screen, and a new study from the University of Florida indicates that this trend may be keeping PCPs from recognizing and properly treating some cases of depression.

Practices still using paper records appear to be diagnosing and treating more cases of depression than PCP practices using EHRs, according to results of a study led by Jeffrey S. Harman, PhD, of the University of Florida and published recently in the Journal of General Internal Medicine.

The study authors hypothesized at the start of their study that because EHRs are designed to improve specialized care delivery, odds of depression treatment at practices with EHRs would be greater than at non-EHR practices. Using data from the 2006-08 National Ambulatory Medical Care Surveys, however, they found that depression treatment and mental health counseling were significantly less likely to be offered during visits to practices using EHRs.

Use of the technology also was significantly associated with reduced odds of treatment of depression during visits made by patients with three or more chronic conditions, the study notes. EHRs were associated with half the odds of depression treatment, including antidepressant medication, whereas EHRs were not associated with the receipt of depression treatment in visits by patients with two or fewer chronic conditions, the study notes.

“[EHRs] encourage biomedical exchange between the physician and patient including discussion of medication. In contrast, [EHRs] have been observed to have a negative impact on psychosocial exchange, with screen gaze being inversely related to physician engagement,” the study reports. “It is possible that the clinic workflows embedded in [EHRs] inadvertently encourage physicians to focus on these multiple physical problems and push depression treatment ‘off the radar screen,’ even after physicians diagnosed the condition.”

The authors conclude that the study should raise questions about the possible downside of EHR use, and that further investigation of the clinical workflows involving EHRs is warranted.

“While [EHRs] certainly have advantages within primary care settings, they may result in encouraging physicians to focus on issues identified by the [EHR] rather than those raised by the patient,” the study concludes.

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