The Potential of EHRs to Empower Individuals with Depression from Underserved Communities: A Mixed Methods Examination of the Client Perspective

Background and Purpose: Electronic health records (EHR) are an integral component of the behavioral health system, and are a primary tool used to achieve the goals of behavioral health care reform. Yet, the potential of these systems has not yet been realized; behavioral health providers’ dissatisfaction with EHRs is well documented, and includes concerns that EHRs are cumbersome to navigate, have limited functional capacity to carry out essential clinical tasks, like service planning, and are not patient-centered. This mounting evidence has prompted widespread efforts to redesign systems to better meet the needs of health and behavioral health providers, but there is less focus on understanding how these systems can enhance clients’ experience in care, a key component of the triple aim guiding health reform. Indeed, much less is known about clients’ experiences with EHRs within the context of behavioral health care, including how clients perceive EHRs to impact service quality. Particularly little research has explored experiences with EHRs among underserved communities, where access to quality services has historically been limited. As research seeks to improve the functionality of EHRs, failing to identify and respond to the priorities and preferences of clients- particularly those most vulnerable to disparate health outcomes- is a missed opportunity to developed technology that is person-centered. This mixed methods study examined for the first time, the attitudes towards EHRs and satisfaction with EHR systems among clients with depression within a large, safety net primary care clinic.

Methods: Twenty-seven individuals with depression participated in the study. Participants completed a brief, quantitative survey examining their attitudes towards technology, followed by a semi-structured qualitative interview exploring their experience with EHR systems, their attitudes towards EHRs, and their perceptions of how technology has impacted the quality of services. Univariate statistics describe the sample’s attitudes towards technology. Inductive, thematic analysis was used to identify and describe emergent themes from qualitative interviews.

Findings: Average scores on the technology attitudes scale were 4.0 (SD=.50) on a scale of 1-5, reflecting positive attitudes towards technology. In qualitative interviews, respondents described that EHRs had both positive and negative impacts on their experience in care. EHRs improved service quality by allowing respondents to communicate with providers and access their health information. EHRs were also perceived to enhance care coordination, which improved trust in service quality, but participants wanted greater control over what information was included in their chart. Respondents appreciated when providers shared the computer screen during visits, but they also expressed concerns about disruptions to rapport caused by excessive EHR use.

Conclusions: Findings reflect that underserved individuals with depression have a strong desire for greater access to and control of the information included in their chart. EHRs can serve as a promising tool to promote patient empowerment and activation, an essential feature of quality depression care. Policies and practices that use EHRs to enhance the transparency of health inform may be particularly aligned with the priorities and preferences of clients receiving behavioral health treatment. Additional practice and policy implications will be discussed.