Sharing Psychiatry EHR Data Cuts Readmission Rates

As the federal government pushes the "segmentation" of sensitive parts of electronic health records (EHRs) -- think mental health or sexually transmitted diseases -- for the sake of privacy, a new study from Johns Hopkins researchers suggests that approach may harm patients.

Top teaching hospitals that provided non-psychiatrists with electronic access to inpatient psychiatric records had up to 39% lower rates of readmissions within 7, 14, and 30 days of initial discharge than comparable institutions that did not include inpatient psychiatric notes in their EHRs. Full access also cut 7-day readmission rates by as much as to 27% when compared to hospitals that did not let primary care and emergency physicians see psychiatric records in the EHR, according to the study, which appeared in the online version of the International Journal of Medical Informatics.

The study suggested the problem may be even more acute in smaller community hospitals than at leading the academic medical centers surveyed.

"There are unintended consequences of not including psychiatric information," said study leader Dr. Adam I. Kaplin, assistant professor of psychiatry and behavioral sciences and neurology at the Johns Hopkins University School of Medicine in Baltimore. "Psychiatric illnesses need to be treated like any other illnesses," he told InformationWeek Healthcare.

[ For more on the role of EHRs in clinical research, see Health IT's next challenge: Comparative Effectiveness Research. ]

Kaplin and colleagues surveyed psychiatrists at all 18 hospitals on the 2007 U.S. News and World Report list of the "best hospitals in the United States." Of that group, eight (44%) kept most or all of their inpatient psychiatric records electronically, and five (28%) let non-psychiatrist physicians see mental health records, including psychiatric admission notes, discharge summaries, notes from the emergency department, and consultation notes. Just four hospitals (22%) did both, but among this small group, readmission rates for psychiatric patients were substantially lower than at the others on the U.S. News list.

There was not much difference in length of stay based on whether a hospital shared psychiatric records with primary care and ED physicians.

"[I]t has become common practice to exclude details from psychiatric evaluations from a patient's medical charts," the study said. "This endeavor, however, counters any efforts to bridge the gap between medicine and psychiatry. Instead, the separation of psychiatric records from other medical records reinforces that medical professionals see a distinct difference between psychiatry and other healthcare specialties. Furthermore, it fails to address the importance of an interaction between the two fields." As Kaplin put it in an interview, "Not sharing this information has consequences."

He said that suicide rates today are the same as they were 50 years ago and have increased in the past 10 years. There are twice as many suicides than homicides in the U.S., and more people die at their own hands than in traffic accidents. "Why are we doing so badly? We're doing so badly because we are treating [mental illnesses] differently from other illnesses," Kaplin said.

"This study suggests that to ensure a higher quality of care for psychiatric patients, we must be willing to consider not only parity of coverage but also of record modernization and accessibility," Kaplin and colleagues explained in the online publication. "Eventually, we can envision a time where psychiatric records will be treated with the same confidentiality as other health records; this may then help to dispel the stigma surrounding the often misunderstood nature of mental illness for clinicians as well as the general public."

The issue of mental health of course has been thrust back into the national spotlight in the wake of last month's massacre at Sandy Hook Elementary School in Newtown, Conn. The 20-year-old alleged gunman reportedly took his own life after killing 26 others. "[It was suicide] in the worst possible way," said Kaplin.

"We're failing to improve the mental health of our children. There is an epidemic going on," Kaplin said. "Getting people before they kill themselves should be the norm."

Clinical, patient engagement, and consumer apps promise to re-energize healthcare. Also in the new, all-digital Mobile Power issue of InformationWeek Healthcare: Comparative effectiveness research taps the IT toolbox to compare treatments to determine which ones are most effective. (Free registration required.)