Elsevier

General Hospital Psychiatry

Volume 35, Issue 4, July–August 2013, Pages 345-348
General Hospital Psychiatry

Special Section: Health Information Technology and Mental Health Services Research: A Path Forward
Advancing the adoption, integration and testing of technological advancements within existing care systems

https://doi.org/10.1016/j.genhosppsych.2013.03.012Get rights and content

Abstract

Objective

This manuscript reviews the work on uptake and dissemination of health information technologies in mental health populations and settings, with the goal of informing the future research agenda.

Methods

We reviewed both the formal and “grey” literature describing the rates and correlates of uptake for electronic health records (EHRs) and personal health records (PHRs) for general and specialty mental health settings.

Results

Rates of uptake and use of EHRs and PHRs are low in general medical settings, and the limited evidence suggests even lower rates for specialty mental health settings. Many of the patient, provider and system-level characteristics associated with lower rates of use in general populations would be expected to be exacerbated in mental health settings.

Conclusions

The findings suggest a need to better understand both the causes and strategies for overcoming barriers to uptake of health information technology (HIT) in mental health settings. Observational studies could help to better elucidate the barriers to adoption of HIT that are unique or disproportionate in mental health populations. Implementation science studies are needed to better identify strategies for addressing these barriers and optimizing uptake of mental health HIT interventions.

Introduction

Health information technology (IT) and interoperable health information exchange (HIE) are central to efforts to improve healthcare quality and control the cost of health care in the United States [1], [2], [3]. Health IT is critical for engaging consumers in illness self-management, supporting providers in the delivery of evidence-based clinical care coordinating care across settings and over time and facilitating performance and outcome measurement [4], [5]. The mental health system faces disproportionate challenges in each of these domains and, thus, could derive particular benefit from expanded use of Health IT [6]. Furthermore, because persons with mental illnesses, particularly those with comorbid medical conditions, are typically treated across multiple systems of care [7], research is needed about the best approaches for exchanging information between the mental health and medical systems as a tool for improving quality and outcomes of care.

A number of promising health IT interventions already exist that could be used to enhance care for persons with mental illnesses, most notably electronic health records (EHRs) and personal health records (PHRs). However, uptake of these interventions has been slower within the mental health system than for general healthcare. A research agenda in this area will need to systematically identify and develop strategies to overcome the barriers to adoption and use of these new health IT technologies for mental health consumers, providers and systems of care.

Section snippets

Methods

An a priori search strategy was developed to identify all studies examining uptake and use of technologies in mental health populations or settings. A comprehensive search without language restriction from inception through August 2011 was conducted within MEDLINE, EMBASE, CINAHL, PsycINFO, Social Sciences Abstracts and the Cochrane Library.

The search followed Cochrane guidelines from the Cochrane Effective Practice and Organization of Care Group [8]. Searches included the following terms:

EHRs in general health settings

A large body of work has demonstrated problematically low rates of use of health ITs in general health settings. The uptake of EHRs in ambulatory practices in the United States was initially low; a 2008 national survey of physicians found that only 13% of physicians had adopted EHRs [9]. However, rates have been rapidly rising; in 2011, 57% of office-based physicians used electronic medical record (EMR)/EHR systems, with about one third of physicians (34%) reporting having a “basic” system

Discussion: directions for future research

The results of this review suggest that uptake of EHRs and PHRs are low in general health settings. The limited data on use in mental health settings suggest even lower rates of uptake.

These findings suggest two complementary areas of research addressing the issue of barriers to adoption of health IT PHRs among mental health patients and EHRs among mental health providers. First, descriptive research is needed to identify barriers that may uniquely or disproportionately affect EHR adoption in

Conclusions

A confluence of factors, including the development of new technologies, growing interest in integration between mental health and general health and health reform legislation make developing a research program to understand and improve dissemination of health IT in mental health settings a high priority. Partnerships between IT experts, who understand these new technologies in general medical settings, and health services researchers, who understand research approaches for studying them, will

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