The Impact of Electronic Health Records on the Implementation of Person-Centered Care

Background and Purpose: Research has indicated that adopting an electronic health record (EHRs) can promote adherence to clinical guidelines and best practices by standardizing clinical workflows. Conversely, many providers, including mental health professionals, have indicated that such uniformity makes these systems inflexible to the unique needs of EHR users. Much of the research has focused on integrating new EHR systems but less is known about the role EHRs play when new practices are integrated into existing systems. Specifically, for practices that use a person-centered approach, the ability of EHRs to reflect individualization and adaptability is an important consideration for implementation. This study examined the impact of EHR use on provider fidelity to the implementation of person-centered care planning (PCCP), a recovery-oriented practice focused on service planning, within community mental health clinics (CMHCs). 

Method: This study was embedded within a large multi-site NIMH funded RTC examining the implementation of PCCP in CMHCs. This sample consisted of 7 CMHCs whose providers had been trained in PCCP, a practice that orients the service plan to the individual's personal life goals. Fidelity to PCCP was measured with an objective quantitative fidelity measure, assessing the person-centeredness of service plans using 13 items. Service plans were assessed from each site at baseline (N=126), 12 months (N=126), and 18 months (N=126). Of this sample, 4 sites (N=240 service plans) had an EHR system, and 3 sites (N=138 service plans) did not. Differences in PCCP fidelity among service plans from sites with and without EHR systems were examined at each timepoint using OLS regression with a random intercept at the site level to account for the nested data. The fully adjusted model controlled for leadership quality, organizational climate, and client level demographic variables. 

Results: Having an EHR system was not significantly associated with PCCP fidelity among providers trained in PCCP at baseline. However, having an EHR system did predict higher fidelity to PCCP at both 12 (b=3.45, p<.001) and 18-months (b=3.93, p<.001). Leadership quality predicted higher PCCP fidelity at baseline only (b=3.5, p<.05). Organizational climate was negatively associated with fidelity at baseline (b=-.4, p<.05), 12 (b=-.87, p<.001) and 18 months (b=-1.03, p<.001). At 12 months, PCCP fidelity was higher for service plans of younger consumers (b=1.06, p<.05), and lower among service plans of African American clients (b=-1.2 p<.01) 

Conclusions and Implications: These findings suggest that EHR systems can be used to support the delivery of PCCP in CMHCs. Service user and organizational factors also predict person-centered care. The lack of baseline differences in PCCP fidelity suggest that EHRs may not promote greater person-centeredness by themselves, but in tandem with a practice change effort designed to promote person-centered care, they can lead to greater fidelity. Overall, more research is needed to understand the role of EHRs in the implementation of new practice initiatives, particularly those that are person-centered.