JMIR Publications

ABSTRACT

Background:

Mental health contexts have been slow to adopt electronic health records (EHRs) and electronic medical records (EMRs) partly due to concerns regarding the collection of sensitive information, standardising mental health data and impacts on the therapeutic relationship. However, EHRs and EMRs are increasingly viewed as critical to improving the management and sharing of information – and more broadly, the quality of care provided.

Objective:

A scoping study was undertaken to explore the impact EHRs have on information management in mental health contexts. Further, issues relating to sensitive data, data standardisation and the therapeutic relationship aimed to be explored.

Methods:

A comprehensive literature search of electronic databases looked for articles from any date that described the implementation or adoption of an EHR, EMR, or associated systems, in mental health contexts. One author reviewed all full-texts, with two other authors screening half of the full-text articles. A fourth author mediated disagreements. A thematic synthesis approach was taken to analysing the result sections of the included studies and developing themes.

Results:

The final review included 41 papers. Several themes and sub-themes were developed that explore the impact of EHRs on information management in mental health contexts. EHRs were found to improve the amount of information documented compared to paper records, as well as addressing issues of readability. However, mental health information was regularly missing from EHRs – especially sensitive or stigmatising information. EHRs may improve some aspects of integrated care, but there are still issues regarding the interoperability of EHRs and what services are included. EHRs were found to disrupt workflows in mental health contexts, especially when they did not include appropriate templates or care plans. Usability of EHRs was an issue, especially regarding the computer literacy of the health workforce, and the provision of appropriate training. Issues were raised with how to manage the documentation of sensitive information in EHRs. In some cases, clinicians ‘watered down’ sensitive information, or chose to keep a separate record. However, in many cases, psychiatric records were sectioned off from the primary medical record. The included studies rarely involved service users, which is concerning due to the impacts EHRs may have on service users' experience of care and the types of care they receive. Further, many studies poorly identified the type of EHR being studies, its functions and design. This poses a challenge for the applicability of research findings to other contexts.

Conclusions:

This scoping study has raised several areas where work is needed to ensure EHRs benefit clinicians and service users in mental health contexts. The findings of this review are relevant for service users, health care professionals, designer of EHRs, policymakers and health service managers. As EHRs are increasingly considered critical for a modern health system, healthcare decision-makers should consider how EHRs reflect the complexity and sensitivity of information and workflows in mental health contexts.