16 May Mental illness and behavorial health pose challenges for electronic medical records
Editor’s Note: Dr. Ken Gersing spoke at WTN Media’s Digital Healthcare Conference on the topic of “The Behavioral Health EMR”. Click here to view his presentation.
MADISON – Using electronic medical records (or EMR) with patients having mental illness or behavior health issues pose unique challenges for psychiatrists, according to a national expert. Speaking at the recent Digital Healthcare Conference in Madison, Dr. Ken Gersing explained how an EMR system developed by a team he led is improving patient care at the 25 institutions across the country where it is used.
Gersing, director of clinical information services for the Departmet of Psychiatry at Duke University Medical System, said that the difficulty in managing mental illness begins with the challenge caregivers have in identifying the problem’s scope.
“It is really hard to get good numbers about the prevalence of mental illness,” Gersing said.
According to Gersing, a 1993 study estimated that roughly 28 percent of Americans have a mental or addictive disorder. He believes the percentage of Americans afflicted with mental illness lies closer to 20 percent. One-third of primary care visits concern mental health, and the majority of mental health patients, 54 percent, receive their care through primary care providers.
“The real problems are those patients who have no mental illness, and are still getting care through their primary care physician,” said Gersing.
The EMRs of these patients—the “worried well,” according to Gersing—present one of a number of difficulties in the use of EMRs in psychiatry. These EMRs are not “clean,” because they include, for example, a diagnosis of major depression by the primary care physician only for purposes of payment, Gersing said. Because these records contain false information about the patient, it’s very difficult to learn more about the illness through data mining.
There are other problems that make the use of EMRs in psychiatry difficult. Difficulties include different ways in which psychiatrists document the care and status of their patients. Treatment of patients through group therapy also makes post-visit documentation unusually burdensome. An anti-technology bias of psychiatrists also contributes to the problems, with less than 5 percent of psychiatrists using EMRs according to Gersing.
Gersing said that confidentiality associated with mental illness poses a stumbling block to patient care. The portion of the patent’s record dealing with this type of illness must be kept private, even from a patient’s other doctors. While a mental illness diagnosis and other related information is not available to primary care and other physicians, these caregivers can see prescription information.
“If a patient is taking an anti-psychotic drug, it means he or she is most likely psychotic,” Gersing said. “So what are we really hiding? We are half in and half out in terms of privacy.”
MindLinc, a comprehensive EMR management system for mental health providers, was developed by Gersing and other experts at Duke University Medical Center to help overcome these and other problems he described during his presentation. MindLinc seamlessly integrates clinical psychiatric care at all levels. It enables a psychiatric practice to treat patients at the most cost-effective care level, assure patient safety and confidentiality, and improve patient case management and outcomes.
According to Gersing, the system feeds the largest psychiatric registry in the world. It contains data from more than 180,000 patients gathered during 1.7 million visits to a mix of academic, community and private sites. The registry is a comprehensive psychiatric database for the outcomes, diagnosis, medications and adverse reactions data of the 25 organizations it serves. It also can be used pharmaceutical researchers as they explore drug-label extensions and new indications, and analyze adverse events.
MindLinc was most recently installed at the Boulder County, Colo., Public Health Addiction Recovery Centers and Grant-Blackford Mental Health Inc., in Marion, Ind.
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