Researchers urge wider access to psych records

A research team from Johns Hopkins waded into the thorny debate over electronic access to patients' mental health information with a small study finding that readmission rates are lower for psychiatric patients whose records are available electronically and accessible to nonpsychiatric physicians.

The researchers' article appears online in the International Journal of Medical Informatics.

"Let's not keep mental health records out in the cold," said lead author Dr. Adam Kaplin, assistant professor of psychiatry and neurology at Johns Hopkins University School of Medicine, in a news release. Kaplin and the article's other authors noted that much apprehension about the use of electronic health records, in particular with regard to psychiatric records, "originates—correctly—from concern for confidentiality of records." Patients who have received psychiatric care may not want details of that care shared when they visit their primary-care physician for an unrelated matter, for example.

But does keeping part of a patient's medical history hidden prevent providers from delivering the best care? "The need to balance patient confidentiality with the provision of optimal quality of care requires careful consideration of the competing concerns of a variety of stakeholders," the article's authors concluded.

For their study, the researchers selected 18 hospitals from the 2007 U.S. News & World Report Best Hospital lists and sent questionnaires to psychiatrists or psychiatric department heads inquiring whether their hospitals' inpatient psychiatric records in four categories—admission summaries, discharge summaries, psychiatric emergency department evaluations and psychiatric consultations—were kept on paper or electronically, and whether they were able to be viewed by nonpsychiatric physicians "while working on a medicine floor."

The researchers then reviewed patient outcomes data for 2007 from 13 of the 18 hospitals to identify the percentages of psychiatric and nonpsychiatric patients readmitted within seven, 14 and 30 days of discharge as well as the average length of stay of psychiatric patients.

Hospitals that stored records electronically in all four categories had statistically lower seven-day readmission rates for psychiatric patients. In addition, hospitals that gave nonpsychiatric physicians full access to their patients' psychiatric records had statistically lower 14- and 30-day readmission rates.

The four hospitals studied that both kept all psych records in an EHR and gave psych-records access to nonpsychiatrist doctors had lower readmission rates for psychiatric patients at seven, 14 and 30 days. Average length of stay was not affected.

Although EHR use in and of itself is "a good step" toward optimizing care, Kaplin said in the release, "what you really need to do is share the records with nonpsychiatrists. It will really make a difference in terms of quality of care and readmission rates."

Eventually, the authors wrote, "we can envision a time where psychiatric records will be treated with the same confidentiality as other health records."