JMIR Publications

ABSTRACT

The authors of “Impact of Electronic Health Records on Information Practices in Mental Health Contexts: A Scoping Review” have effectively brought to our attention the failure of the EHR to represent the human context. Because mental health or behavioral disorders (and functional status in general) emerge from an interaction between the individual’s characteristics and the social context, it is really a failure of representing the human in context. The assessment and treatment of these disorders must reflect how the person lives, their degree of social connnectedness, their personal motivation, and their cultural background. This type of information is best both communicated through narrative and in collaboration with other providers and the patient – largely because human social memory is organized around situation models and natural episodes. Neither functionality is currently available in most EHRs. Narrative is effective for several reasons: 1) it supports communication of goals – between providers; 2) it allows for expression of the author’s belief other’s perspectives (theory of mind) – e.g. who will be reading these notes; and 3) supports incorporation of patient’s personal perspective. The failure of the EHR to support Mental Health information data and information practices, is therefore, really a failure to support basic communication functions necessary for narrative. The authors have rightly noted the problems of the EHR in this domain, but perhaps did not totally link the problems to the lack of functionality to support narrative communication. Suggestions for adding design elements are discussed.