Behavioral Health Data in the Electronic Health Record

Impact of Electronic Health Records on Information Practices in Mental Health Contexts: Scoping Review

Background

The adoption of electronic health records (EHRs) and electronic medical records (EMRs) has been slow in the mental health context, partly because of concerns regarding the collection of sensitive information, the standardization of mental health data, and the risk of negatively affecting therapeutic relationships. However, EHRs and EMRs are increasingly viewed as critical to improving information practices such as the documentation, use, and sharing of information and, more broadly, the quality of care provided.

Objective

This paper aims to undertake a scoping review to explore the impact of EHRs on information practices in mental health contexts and also explore how sensitive information, data standardization, and therapeutic relationships are managed when using EHRs in mental health contexts.

Methods

We considered a scoping review to be the most appropriate method for this review because of the relatively recent uptake of EHRs in mental health contexts. A comprehensive search of electronic databases was conducted with no date restrictions for articles that described the use of EHRs, EMRs, or associated systems in the mental health context. One of the authors reviewed all full texts, with 2 other authors each screening half of the full-text articles. The fourth author mediated the disagreements. Data regarding study characteristics were charted. A narrative and thematic synthesis approach was taken to analyze the included studies’ results and address the research questions.

Results

The final review included 40 articles. The included studies were highly heterogeneous with a variety of study designs, objectives, and settings. Several themes and subthemes were identified that explored the impact of EHRs on information practices in the mental health context. EHRs improved the amount of information documented compared with paper. However, mental health–related information was regularly missing from EHRs, especially sensitive information. EHRs introduced more standardized and formalized documentation practices that raised issues because of the focus on narrative information in the mental health context. EHRs were found to disrupt information workflows in the mental health context, especially when they did not include appropriate templates or care plans. Usability issues also contributed to workflow concerns. Managing the documentation of sensitive information in EHRs was problematic; clinicians sometimes watered down sensitive information or chose to keep it in separate records. Concerningly, the included studies rarely involved service user perspectives. Furthermore, many studies provided limited information on the functionality or technical specifications of the EHR being used.

Conclusions

We identified several areas in which work is needed to ensure that EHRs benefit clinicians and service users in the mental health context. As EHRs are increasingly considered critical for modern health systems, health care decision-makers should consider how EHRs can better reflect the complexity and sensitivity of information practices and workflows in the mental health context.

Perspectives on illness-related stigma and electronically sharing psychiatric health information by people with multiple sclerosis

BACKGROUND

Electronic medical records (EMRs) facilitate more integrated and comprehensive care. Despite this, EMRs are used less frequently in psychiatry compared to other medical disciplines, in part due to concerns regarding stigma surrounding mental health. This paper explores the willingness to share medical information among patients with multiple sclerosis (MS), who experience higher rates of psychiatric comorbidities compared to the general population, and the role that stigma plays in patient preferences.

METHODS

MS patients were surveyed about their co-occurring psychiatric and non-psychiatric diagnoses, willingness to share their health information electronically among their treating doctors, and levels of self and societal stigma associated with their diagnoses.

RESULTS

Participants were slightly more willing to share their non-psychiatric medical information vs. psychiatric information. Despite the presence of stigma decreasing patient willingness to share medical records, those with psychiatric co-occurring disorders, compared to those without, endorsed significantly greater willingness to electronically share their health records. The majority of diagnoses for which participants experienced the greatest difference in self vs. societal stigmas were psychiatric ones, including substance use, eating and mood disorders. Societal stigma strongly correlated with decreased non-psychiatric medication sharing, while self stigma was strongly correlated with decreased psychiatric medications sharing.

LIMITATIONS

Standardized scales were not used to assess patient stigma and there is a potential lack of generalizability of results beyond patients with MS.

CONCLUSIONS

These insights into patient preferences toward sharing their medical information should inform decisions to implement EMRs, particularly for patient populations experiencing higher than average levels of psychiatric comorbidities.

Patient Privacy Perspectives on Health Information Exchange in a Mental Health Context: Qualitative Study

BACKGROUND

The privacy of patients with mental health conditions is prominent in health information exchange (HIE) discussions, given that their potentially sensitive personal health information (PHI) may be electronically shared for various health care purposes. Currently, the patient privacy perspective in the mental health context is not well understood because of the paucity of in-depth patient privacy research; however, the evidence suggests that patient privacy perspectives are more nuanced than what has been assumed in the academic and health care community.

OBJECTIVE

This study aimed to generate an understanding on how patients with mental health conditions feel about privacy in the context of HIE in Canada. This study also sought to identify the factors underpinning their privacy perspectives and explored how their perspectives influenced their attitudes toward HIE.

METHODS

Semistructured interviews were conducted with patients at a Canadian academic hospital for addictions and mental health. Guided by the Antecedent-Privacy Concern-Outcome macro-model, interview transcripts underwent deductive and inductive thematic analyses.

RESULTS

We interviewed 14 participants. Their privacy concerns varied, depending on the participant's privacy experiences and health care perceptions. Media reports of privacy breaches and hackers had little impact on participants' privacy concerns because of a fatalistic belief that privacy breaches are a reality in the digital age. Rather, direct observations and experiences with the mistreatment of PHI in health care settings caused concern. Decisions to trust others with PHI depended on past experiences with the individual (or institution) and health care needs. Participants had little knowledge of patient privacy rights and legislation but were willing to participate in HIE because of perceived individual and societal benefits.

CONCLUSIONS

This study introduces evidence that patients with mental health conditions would support HIE. Participants were pragmatic, supporting HIE because they wanted the best care possible. They also understood that their PHI was critical in supporting the single-payer Canadian health care system. Participant health care experiences informed their privacy perspectives, trust, and PHI sharing attitudes-all accentuating the importance of the patient experience in building trust in HIE. Their lack of knowledge about patient rights and PHI uses highlights the degree of trust they have in the health care system to protect their privacy. These findings suggest that the patient privacy discourse should extend beyond the oft-cited barrier of patient privacy concerns to include discussions about building trust, communicating the benefits of HIE, and improving patient experiences. Although our findings are in the Canadian context, this study highlights the importance of engaging patients in privacy policy discussions, regardless of jurisdiction, to ensure their nuanced perspectives are reflected in policy decisions on their PHI.

Respecting the privacy of hospitalized patients: An integrative review

BACKGROUND

Privacy is a complicated and obscure concept, which has special meanings in the healthcare environment; therefore, it is essential for healthcare providers to fully understand this concept. However, there is no universally accepted definition for this concept in the texts, and it has been interpreted differently, based on its application.

AIM

To analyze and provide a clear and scientific definition for respect of privacy of hospitalized patients and identify the common aspects of this concept.

RESEARCH DESIGN

This study was conducted using the Whittemore and Knafl's modified framework as a conceptual analysis method. Ethical consideration: This study was approved by the Research Council of the University of Social Welfare and Rehabilitation Sciences. We have respected the ethical requirements required regarding the sources and authorship. Research context and data sources: Using integrative review, a search was performed using national and international databases, including CINAHL, Scopus, Medline, Web of Science, and ISI (with no date restriction). The keywords employed during the search process were "privacy of patients," "confidentiality," "and patients' rights." In total, 1345 articles were retrieved from the databases. After the elimination of repetitive studies and with regard to the study objectives, 124 articles, 3 books, and 4 theses were entered into the study. The data were analyzed using the conventional content analysis approach.

FINDINGS

The results were extracted in the form of four, seven, and two themes related to attributes such as physical, informational, social, and psychological and the antecedents and consequences of respecting patient privacy, respectively.

CONCLUSION

Respect for hospitalized patient privacy contains multiple dimensions. Factors affecting the achievement of this concept include individual backgrounds, nature of the disease, and rule of paternalism. The fulfillment of patient privacy leads to such consequences as protection and improvement of human dignity as well as improved communication between the patient and the health team.

Integrating Neuroscience Knowledge and Neuropsychiatric Skills Into Psychiatry: The Way Forward

Increasing the integration of neuroscience knowledge and neuropsychiatric skills into general psychiatric practice would facilitate expanded approaches to diagnosis, formulation, and treatment while positioning practitioners to utilize findings from emerging brain research. There is growing consensus that the field of psychiatry would benefit from more familiarity with neuroscience and neuropsychiatry. Yet there remain numerous factors impeding the integration of these domains of knowledge into general psychiatry.The authors make recommendations to move the field forward, focusing on the need for advocacy by psychiatry and medical organizations and changes in psychiatry education at all levels. For individual psychiatrists, the recommendations target obstacles to attaining expanded neuroscience and neuropsychiatry education and barriers stemming from widely held, often unspoken beliefs. For the system of psychiatric care, recommendations address the conceptual and physical separation of psychiatry from medicine, overemphasis on the Diagnostic and Statistical Manual of Mental Disorders and on psychopharmacology, and different systems in medicine and psychiatry for handling reimbursement and patient records. For psychiatry residency training, recommendations focus on expanding neuroscience/neuropsychiatry faculty and integrating neuroscience education throughout the curriculum.Psychiatry traditionally concerns itself with helping individuals construct meaningful life narratives. Brain function is one of the fundamental determinants of individuality. It is now possible for psychiatrists to integrate knowledge of neuroscience into understanding the whole person by asking, What person has this brain? How does this brain make this person unique? How does this brain make this disorder unique? What treatment will help this disorder in this person with this brain?