McLean Leaders Call for Expansion of Electronic Health Records in Psychiatric Care

In an essay to be published in the May 3 issue of the New England Journal of Medicine (NEJM), leaders from McLean Hospital make the case for expanding the use of electronic health records (EHRs) in psychiatric care. The authors report that psychiatric care providers have lagged behind the rest of the health care industry in adopting EHRs. This, they explain, has caused psychiatrists, psychologists, social workers, and counselors to often work without vital medical and psychiatric information about their patients and has denied psychiatric patients access to EHR data that could identify warning signs of psychiatric illnesses and lead to improved outcomes.

The essay will appear in the “Perspective” section of the NEJM. The authors are Alisa B. Busch, MD, MS, chief medical information officer and director of Clinical Performance Measurement & Health Services Research at McLean Hospital; Scott L. Rauch, MD, president and psychiatrist in chief at McLean Hospital; and David W. Bates, MD, MSc, medical director of Clinical and Quality Analysis at Partners HealthCare and chief of the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital.

According to Busch, the essay is aimed at policymakers who have the power to incentivize vendors to develop EHR products better suited to psychiatric care. “From a policy perspective, we wanted to lay out why expanding EHRs in psychiatric care is important,” she explained. “We wanted to describe the challenges facing mental health professionals and discuss what incentives can be used by the federal government to expand EHRs in psychiatric care.”

The authors say the major barriers to the adoption of EHRs in psychiatric care include a misalignment between clinical workflows in psychiatry and EHR design, complex privacy-related laws and regulations, and inadequate financial incentives and assistance for psychiatric providers.

The nature of psychiatric health care itself has also caused complications, explained Busch. “The psychiatric workforce is unique in that it contains many non-physician providers,” she said. “Also, there are different federal and state privacy standards for psychiatric care. Unfortunately, some of the tools that EHR vendors created for the medical industry were not developed with the unique needs of psychiatric care in mind.”

To address these issues, the authors call on the federal government to sponsor efforts aimed at improving EHR capabilities while meeting federal and state privacy requirements and to create a timeline for vendors to develop and implement EHR tools that enable patients to control how their health information is shared. They also recommend that Congress create an incentive program to facilitate EHR adoption in psychiatry, as it did elsewhere in medicine. Such a program, they say, would encourage competition among vendors to better serve the patient care needs of psychiatric providers.

“Right now,” Busch said, “psychiatric care is still in the adoption stage regarding EHRs, and a whole group of patients and providers have been left out.” With this essay, Busch and her colleagues hope to educate and influence policymakers, vendors, and providers with the goal of “creating a better coordinated, better integrated system that will lead to better quality of care for people with psychiatric illnesses.”