Psychiatric Records and Ineffective Health Care

Should Psychiatric Records Always Be Restricted?


Keeping psychiatric records restricted may not ultimately benefit many patients, according to a new study.

Researchers from Johns Hopkins surveyed 18 of the country’s top hospitals and found that fewer than half of the hospitals had all inpatient psychiatric records in their electronic medical records system and that fewer than 25 percent of those hospitals gave non-psychiatrists full access to the records.

But, the researchers found, psychiatric patients whose physicians did have access to all their records were 40 percent less likely to be readmitted to a hospital within the first month after discharge. The researchers concluded that lack of access to psychiatric records, rather than the severity of illness, was a determining factor in the readmission rates. (Readmission rates are a crucial issue today, since the federal government has begun penalizing hospitals with excessive readmission rates. Many health-care experts see the readmission rate as an indicator of substandard care.)

Study leader Adam I. Kaplin, M.D., Ph.D., an assistant professor of psychiatry and behavioral sciences and neurology at the Johns Hopkins University School of Medicine, said in a statement that feelings of shame or embarrassment played a part in restricting access to psychiatric records. “The big elephant in the room is the stigma," Kaplin said.

He said that a lack of knowledge about a patient’s psychiatric illness could be crucial: for example, depression is the number-one determinant of whether a patient survives one year after a heart attack. Tthere are unintended consequences of trying to protect the medical records of psychiatric patients,” Kaplin said. “When you protect psychiatric patients in this way, you’re protecting them from getting better care.” The findings were published in the International Journal of Medical Informatics.  
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