Efficacy of automated electronic medical records (EMR) notification to promote provider intervention for severe depression: a retrospective record review

Abstract

Background:Depressive symptoms as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression (D; PROMIS-D) score is a patient-specific independent predictor of decreased improvement after orthopaedic surgery. Despite evidence that depression predicts worse surgical outcomes, data show orthopaedic surgeons rarely address mental health with their patients. Methods:The authors conducted a retrospective chart review of all patient visit data from October 1, 2018 through December 31, 2020, at Cedars-Sinai Orthopaedic Center outpatient clinics to determine if a best practices alert built into the electronic medical record (EMR) notifying surgeons of their patients who had PROMIS-D scores of 70+ (severe depression) would be impetus enough for providers to intervene. Records with PROMIS-D scores of 70+ (N = 361) were selected and reviewed; the authors examined how often the surgeons documented an action in the record in response to the depression notification. Results:Surgeons were found to take action in only 28.5% (N = 103) of the visits with qualifying scores. Conclusions:Notification of patient depression status alone was insufficient to persuade most surgeons to discuss mental health with their severely depressed patients. To empower surgeons to have these important conversations, extant barriers need to be identified and addressed. The association with rates of intervention and individual-level factors of both patients and providers could be explored.

Integration of collaborative care model ameliorates population level COVID-19 Pandemic-related depressive symptoms among orthopaedic clinic patient population in US major metropolitan area

“…Initially, follow-up with patients who screened positive for depression consisted of launching a provider alert that suggested talking points, encouraged primary care physician notification and referral to mental-health, and required documenting actions taken in patients’ Electronic Medical Record (EMR). An early review of alert-efficacy found low adherence with only 29% (N=103) of visits with qualifying PROMIS-D scores reflecting any actions by the treating surgeon 24. In response, department leadership hired a licensed clinical social worker (LCSW) to facilitate follow-up.…”

“…An early review of alertefficacy found low adherence with only 29% (N = 103) of visits with qualifying PROMIS-D scores reflecting any actions by the treating surgeon. 24 In response, department leadership hired a licensed clinical social worker (LCSW) to facilitate follow-up. The LCSW works to ensure that patients with a positive screen for depressive symptoms are followedup with, assessed, and linked to appropriate mental health or other care.…”