Electronic Health Records and Integrative Care

In recent weeks my psychology colleagues and I have been engaging in a spirited debate – online and at our annual state association conference – about the relative merits and perils of Electronic Health Records (EHR’s). The debate about (EHR’s) is heating up here in Minnesota because of a state mandate that all health care providers adopt an interoperable EHR. There are many technical issues – the definition of interoperable, health information exchanges, and more – related to EHR’s. There are also philosophical and ethical issues – definitions of client confidentiality, what constitutes the medical record, and therapy notes versus medical records. While each of these is an important aspect of the debate, my interest here is the relationship between EHR’s and integrative care. One of the driving goals of the federal and state push toward EHR’s is the belief that electronic health records afford the opportunity for better and more integrated care. A recent news report on Minnesota Public Radio is one of several news sources suggesting that this goal is being met. These news reports often cite anecdotal occurrences where an EHR foresees a potentially dangerous drug interaction or identifies a test that has been overlooked as evidence that health care is becoming more integrative. These are important advances in the safety and efficiency of health care and is this what we mean by integrative care? I hope not. Integrative care is much deeper than identifying drug interactions or catching overlooked tests and procedures. Integrative care is an opportunity to shift our core, fundamental beliefs regarding health care. Some aspects of the current debate regarding EHR’s, especially within the behavioral health community, suggests that we are a long way from truly integrative care. In particular I wonder if, at times, our passion about client confidentiality intersects with cultural and professional notions about separation of care in ways that seriously impede integrative care.

Many health care providers – physicians, psychologists, ministers – have grown up in a professional environment that encourages us to “stay within our area of expertise”. As such, physicians often steer clear of discussions about how chronic health care issues impact mental or spiritual health. Likewise, behavioral health providers seldom feel spiritual issues are within their purview. We often operate in specialized and disconnected arenas, leaving integration to our clients.

Fully integrative care requires that each and every health care provider – physician, psychologist, minister, massage therapist, physical therapist – sees the client’s presenting concern as part of a broader web within the client’s life and impacting multiple dimensions of experience – physical, emotional, energetic, and spiritual. EHR’s cannot usher in a new era of integrative care. Rather we must be willing to break down the barriers between diverse disciplines focusing on our common goal of client health instead of our unique position in the health care arena. My hope is that the debate about EHR’s might challenge all of us to recognize the unique contribution of diverse providers and embrace that all health care issues impact multiple dimensions of experience – now this would be integrative care!