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Support for Mental Health Found Lacking in Patient Portals

“One key conclusion is the need to develop a mental health eVisit and, more broadly, Web-based tools to address mental health symptoms."

By Sara Heath

Although electronic health visits, or eVisits, for various health conditions are increasing, recent research shows healthcare providers still need to create considerable headway in providing mental and behavioral healthcare via eVisit.

In a study published in the American Journal of Managed Care, researchers looked at mental health eVisits that did not explicitly provide options for care. To do this, the researchers examined eVisits during which patients selected an “other” option for their symptoms and wrote in their specific answers.

By looking at final care outcomes, limited patient demographic information, date of eVisit, and potential diagnosis, the researchers concluded that some eVisit software on patient portals need to create mental healthcare options for a greater variety of patients.

Specifically, of the 685 patients who used the write in “other” option, nearly 13.4 percent were diagnosed with anxiety and depression disorders. This shows that a specific patient population is not being reached by the general parameters of the patient portal eVisit.

“One key conclusion is the need to develop a mental health eVisit and, more broadly, Web-based tools to address mental health symptoms. Research suggests that Internet-based tools are effective for screening and delivery of mental health services,” the report states. “As the evidence base for eVisits grows, it will be important to ensure full consideration of eVisits for mental health care.”

In addition to suggesting that patients are interested in utilizing eVisit tools on patient portals, this research shows the effectiveness of those eVisits. A notable population, despite not having clear symptoms, were still able to receive an effective diagnosis and receive quality care from an eVisit platform, showing that these systems have the power to create more widespread, quality mental and behavioral healthcare.

“Beyond diagnostic tools, Internet-based delivery of psychotherapy appears to be as effective as traditional in-person therapy and may be a reasonable firstline treatment for many patients making eVisits. Internet-based therapy for mental health conditions can be effective even without in-person personal contact,” the researchers explain.

Specifically, the researchers identified various changes to the eVisit software that can cater to the demographic who received their diagnoses through the “other” write in option. The researchers identified the following suggestions:


  • Users were younger and more likely to be female than patients not receiving mental health diagnoses in the eVisit.

  • It took physicians longer to respond to mental health eVisits.

  • Protocols that allow prompt attention to common mental health concerns in eVisits are needed.

Although the study suggests that eVisits for mental health diagnoses can be effective, and therefore healthcare professionals should continue to innovate eVisits, the researchers suggest various precautions.

One set of criteria proposed for effective Internet-based medical care includes the following: 1) the medical problem should have a clear “diagnostic data set” accessible to a patient and easily articulated in an online encounter; 2) patients should understand that the online interaction is problem-specific and may carry risks; and 3) treatment decisions should be algorithmic and not require a personal relationship with a physician because of emotional valence or medical history.

The third suggestion may be harder to implement due to the nature of mental and behavioral healthcare, the researchers conclude. Research indicates that personal relationships between patients and clinicians are critical in the delivery of quality mental and behavioral healthcare.

However, doing preliminary research such as this opens the door for more eVisit innovation because it shows that there is a need for such innovation. Continued research and assessment is also needed in order for healthcare professionals to determine what kinds of changes they must make in order to optimize eVisits.

“Assessment of the efficacy of mental health eVisits for diagnosis and entry to care remains an important area for future research,” the researchers conclude. “The current research helps set the stage for these investigations by showing that patients seek online care for mental health conditions in the setting of an eHealth portal even when such care is not explicitly available.”




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