Implementation of an EHR-integrated web-based depression assessment in primary care: PORTAL-Depression.

IF 2.5 Q2 HEALTH CARE SCIENCES & SERVICES JAMIA Open Pub Date : 2024-09-24 eCollection Date: 2024-10-01 DOI:10.1093/jamiaopen/ooae094
Melissa I Franco, Erin M Staab, Mengqi Zhu, William Deehan, John Moses, Robert Gibbons, Lisa Vinci, Sachin Shah, Daniel Yohanna, Nancy Beckman, Neda Laiteerapong
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Abstract

Objectives: To integrate a computerized adaptive test for depression into the electronic health record (EHR) and establish systems for administering assessments in-clinic and via a patient portal to improve depression care.

Materials and methods: This article reports the adoption, implementation, and maintenance of a health information technology (IT) quality improvement (QI) project, Patient Outcomes Reporting for Timely Assessment of Life with Depression (PORTAL-Depression). The project was conducted in a hospital-based primary care clinic that serves a medically underserved metropolitan community. A 30-month (July 2017-March 2021) QI project was designed to create an EHR-embedded system to administer adaptive depression assessments in-clinic and via a patient portal. A multi-disciplinary team integrated 5 major health IT innovations into the EHR: (1) use of a computerized adaptive test for depression assessment, (2) 2-way secure communication between cloud-based software and the EHR, (3) improved accessibility of depression assessment results, (4) enhanced awareness and documentation of positive depression results, and (5) sending assessments via the portal. Throughout the 30-month observational period, we collected administrative, survey, and outcome data.

Results: Attending and resident physicians who participated in the project were trained in depression assessment workflows through presentations at clinic meetings, self-guided online materials, and individual support. Developing stakeholder relationships, using an evaluative and iterative process, and ongoing training were key implementation strategies.

Conclusions: The PORTAL-Depression project was a complex and labor-intensive intervention. Despite quick adoption by the clinic, only certain aspects of the intervention were sustained in the long term due to financial and personnel constraints.

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在初级保健中实施基于电子病历的网络抑郁评估:PORTAL-Depression.
目标:将抑郁症计算机化自适应测试整合到电子健康记录(EHR)中,并建立在诊所和通过患者门户网站进行评估的系统:将计算机化的抑郁症自适应测试整合到电子健康记录(EHR)中,并建立在诊所和通过患者门户网站进行评估的系统,以改善抑郁症护理:本文报告了医疗信息技术(IT)质量改进(QI)项目 "抑郁症患者及时评估生活结果报告"(PORTAL-Depression)的采用、实施和维护情况。该项目在一家以医院为基础的初级保健诊所开展,该诊所服务于医疗服务不足的大都市社区。设计了一个为期 30 个月(2017 年 7 月至 2021 年 3 月)的 QI 项目,旨在创建一个嵌入式电子病历系统,以便在诊所内并通过患者门户网站进行适应性抑郁评估。一个多学科团队在电子病历中整合了 5 项主要的医疗信息技术创新:(1)使用计算机化自适应测试进行抑郁评估;(2)基于云的软件与电子病历之间的双向安全通信;(3)提高抑郁评估结果的可及性;(4)加强对抑郁阳性结果的认识和记录;以及(5)通过门户网站发送评估结果。在为期 30 个月的观察期间,我们收集了管理、调查和结果数据:结果:参与该项目的主治医师和住院医师通过诊所会议上的演讲、自我指导的在线材料和个人支持,接受了抑郁评估工作流程方面的培训。发展利益相关者关系、使用评估和迭代流程以及持续培训是关键的实施策略:PORTAL-抑郁项目是一项复杂且劳动密集型的干预措施。尽管很快就被诊所采纳,但由于资金和人员方面的限制,只有干预措施的某些方面得以长期坚持。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
JAMIA Open
JAMIA Open Medicine-Health Informatics
CiteScore
4.10
自引率
4.80%
发文量
102
审稿时长
16 weeks
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