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Study: EHRs Are a Barrier to Integrating Behavioral Health and Primary Care

October 13, 2015
by Heather Landi
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Eleven healthcare practices involved in an initiative to provide integrated care to patients with emotional and behavioral problems found a number of electronic health record (EHR) system challenges to integrating behavioral health and primary care, according to a study in the Journal of the American Board of Family Medicine.

The study authors concluded that EHR vendors and clinicians need to work together to design EHR products that supported integrated care delivery functions.

The topic of integrating behavioral health has gained more attention as a means of improving patient care and health outcomes.

The study outlined the EHR-related experiences of eight primary care clinics and three community mental health centers focused on bringing together behavioral health and primary care in a clinical research setting from 2012 to 2014, as part of the Advancing Care Together (ACT) initiative funded by The Colorado Health Foundation. And the initiative was partially supported by an award from the Agency for Healthcare Research and Quality (AHRQ).

The eight primary care practices used a single EHR and the three mental health centers used two different EHRs, one to document behavioral health and one to document primary care information.

According to the study, practices experienced common challenges with their EHRs’ capabilities to document and track relevant behavioral health and physical health information and to support communication and coordination of care among integrated teams. The practices also experienced challenges with EHRs exchanging information with tablet devices and other EHRs.

The practices developed workarounds to deal with challenges such as double documentation and duplicate data entry, scanning and transporting documents as well as reliance on patient or clinician recall for inaccessible EHR information and use of freestanding tracking systems, according to the study.

“As practices gained experience with integration, they began to move beyond workarounds to more permanent HIT solutions, ranging in complexity from customized HER templates, EHR upgrades and unified EHRs,” the authors stated.

To address the EHR-related challenges of integrated care delivery, EHR vendors, in coordination with clinicians, need to design EHR products to support integrated care delivery functions such as data documentation and reporting to support tracking patients with emotional and behavioral problems over time and settings as well as integrated teams working from shared care plans, template-driven documentation for common behavioral health conditions such as depression, and improved registry functionality and interoperability, the study authors stated.

“This work will require financial support and cooperative efforts among clinicians, EHR vendors, practice assistance organizations, regulators, standards setters and workforce educators,” the authors said.



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