Missing clinical and behavioral health data in a large electronic health record (EHR) system
Missing clinical and behavioral health data in a large electronic health record (EHR) system
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DOI：
10.1093/jamia/ocw021
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发表时间：
2016-11-01
影响因子：
6.4
通讯作者：
Soumerai, Stephen B.
中科院分区：
文献类型：
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作者：
Madden, Jeanne M.;Lakoma, Matthew D.;Soumerai, Stephen B.
目标 最近对电子健康记录 (EHR) 的大规模投资是基于提高患者安全、研究能力和节省成本的假设。然而，大多数美国卫生系统和健康记录都是分散的，并且不共享患者信息。我们的研究将典型 EHR 中提供的信息与保险索赔中更完整的数据进行了比较，重点关注抑郁症和双相情感障碍的诊断、就诊和医院护理。方法我们纳入了 12 岁及以上的保险计划成员，他们在 2009 年被分配到马萨诸塞州的一家大型多专科医疗诊所，诊断为抑郁症 (N = 5140) 或双相情感障碍 (N = 462)。我们从初级保健站点提取了保险索赔和 EHR 数据，并比较了两个来源之间的感兴趣的诊断、门诊就诊和急性医院事件（总体和行为）。 结果 抑郁症和双相情感障碍患者每年平均接受门诊行为护理天数分别为 8.4 天和 14.0 天；其中 60% 和 54% 的数据分别在 EHR 中缺失，因为它们发生在异地。抑郁症患者的总门诊护理天数为 20.5 天，双相情感障碍患者的总门诊护理天数为 25.0 天，EHR 分别缺失 45% 和 46%。 EHR 错过了 89% 的急性精神科服务。 EHR 的结构化事件数据中缺少 27.3% 和 27.7% 患者的研究诊断。结论 EHR 未能充分记录心理健康诊断、就诊、专科护理、住院和药物治疗。缺失的临床信息引起了人们对医疗错误和研究诚信的担忧。鉴于医疗保健的分散性以及 EHR 互操作性、信息交换和可用性较差，需要深思熟虑地重新考虑卫生 IT 进一步投资的优先事项。
Objective Recent massive investment in electronic health records (EHRs) was predicated on the assumption of improved patient safety, research capacity, and cost savings. However, most US health systems and health records are fragmented and do not share patient information. Our study compared information available in a typical EHR with more complete data from insurance claims, focusing on diagnoses, visits, and hospital care for depression and bipolar disorder.Methods We included insurance plan members aged 12 and over, assigned throughout 2009 to a large multispecialty medical practice in Massachusetts, with diagnoses of depression (N = 5140) or bipolar disorder (N = 462). We extracted insurance claims and EHR data from the primary care site and compared diagnoses of interest, outpatient visits, and acute hospital events (overall and behavioral) between the 2 sources.Results Patients with depression and bipolar disorder, respectively, averaged 8.4 and 14.0 days of outpatient behavioral care per year; 60% and 54% of these, respectively, were missing from the EHR because they occurred offsite. Total outpatient care days were 20.5 for those with depression and 25.0 for those with bipolar disorder, with 45% and 46% missing, respectively, from the EHR. The EHR missed 89% of acute psychiatric services. Study diagnoses were missing from the EHR's structured event data for 27.3% and 27.7% of patients.Conclusion EHRs inadequately capture mental health diagnoses, visits, specialty care, hospitalizations, and medications. Missing clinical information raises concerns about medical errors and research integrity. Given the fragmentation of health care and poor EHR interoperability, information exchange, and usability, priorities for further investment in health IT will need thoughtful reconsideration.