EHR Adoption Barriers, Facilitators in Behavioral Health Facilities

Behavioral health EHR developers and hospitals should recognize end users’ perspectives on specific barriers and facilitators before EHR implementation, according to a study featuring survey responses published in JMIR Publications.

For instance, enhanced EHR training and education are essential starting points. Survey respondents also wanted improved standard practices, such as behavioral health-specific EHR documentation and a seamless mental health workflow into the EHR system.

Mental and behavioral health are growing and essential fields of medicine. Roughly 25 percent of US adults report a mental health diagnosis, such as anxiety or depression, or experience emotional distress. Furthermore, the US has the highest suicide rate and second-highest drug-related death rate compared to other high-income countries, according to a recent Commonwealth Fund brief.

Nevertheless, although EHR adoption continues to climb across healthcare, behavioral health EHR adoption lags behind its counterparts. According to the ONC Health IT Dashboard, only 49 percent of psychiatric hospitals have certified EHRs compared to 89 percent of rehabilitation centers, 87 percent of children’s hospitals, and 59 percent of long-term care hospitals.

The researchers interviewed 43 behavioral health clinicians and health IT administrators at four separate hospitals to analyze EHR adoption barriers and facilitators.

Respondents revealed seven EHR implementation barriers. Of the seven barriers, three are connected to EHR usability: computer literacy, EHR system complexity, and steep learning curve. Respondents also highlighted EHR alert fatigue, poor organizational support, and general EHR anxiety.

“The first day I came, I thought maybe I'm going to put out my resignation letter,” said an anonymous nurse respondent. “I didn't know where this was leading me to.”

Respondents revealed four facilitators. Two of the four are directly related to the EHR system: a well-designed EHR system and one that focuses specifically on mental health.

“This mental health care EHR is more comprehensive and more relevant to psychiatry,” explained an anonymous physician respondent. “With other EHRs, relevance to psychiatry is not high. They have a little bit of a section of psychiatry. This is more relevant, and I find it comprehensive, easy to use, and navigate it very well."

Respondents also said marketing an EHR system that improves communication, productivity, and patient care could garner user buy-in. Organizational support during EHR implementation was also critical.

The study authors noted barriers and facilitators that overlapped characteristics.

“For example, some participants were worried about organizational support,” the study authors wrote. “However, some of them were satisfied with the support, such as good training and well-executed implementation planning. This means that a well-organized implementation plan and an educational support of an institution is one of the crucial elements for successful adoption of mental health care EHRs.”

A significant facilitator was implementing essential mental healthcare features that accommodate the unique psychiatry workflow. Because psychiatric clinicians frequently utilize questionnaires and question-based tests, the EHR is more likely to be a barrier in mental health and for other departments.

Furthermore, privacy is more complex in psychiatry compared to other specialties, respondents emphasized it.

“Exchange and integration of medical information among psychiatric hospitals is more likely to occur when integrating federal regulations into a workflow through mental health care EHRs,” wrote the study authors.  

“In fact, participants were satisfied that mental health care EHRs supported regulatory compliance. At the same time, when participants were asked to comment on how the system could be improved, they suggested to improve their function.”

Additionally, the respondents suggested ideas to enhance EHR usability and behavioral health EHR development.

Although a well-designed EHR system was vital to most clinicians, respondents said they would like tablet PCs to carry around the EHR and instantly access its data. Furthermore, most respondents revealed the need for CDS alerts to address the legal status of holding laws and an auto-recommendation of laboratory exams for antipsychotics.

“EHRs represent a key element of health care redesign,” concluded the study authors. “The introduction of EHRs is also important in psychiatric hospitals because it reduces drug-related errors and medical errors by sharing medical information among medical staff and makes it easier to apply regulatory rules to the workflow.”