title: Impact of electronic health record transition on behavioral health screening in a large pediatric practice.
abstract: OBJECTIVE
  The objective was to determine whether transitioning from paper to electronic health records affected behavioral health screening rates in a large Northeastern pediatric practice.
  
  
  METHODS
  The study setting was a pediatric practice with seven pediatricians, serving about 6,000 patients. The patient population was diverse (54% nonwhite, 40% publicly insured or self-paying, and 31% non-English speakers). An interrupted times series design was used to evaluate the impact of electronic record implementation on behavioral health screening rates. The main outcome measure was the rate of such screening 18 months before and 36 months after implementation.
  
  
  RESULTS
  The rate of behavioral health screening increased from 70% to 91% during the baseline period. The training period-six months before electronic record implementation-was associated with a 28% decline in adjusted screening rates (from 83.3% to 55.5%). Only 50% of eligible youths were screened in the first month after implementation. The screening rate took more than three years to recover to baseline levels, climbing to 82% by April 2008.
  
  
  CONCLUSIONS
  Practice changes resulting from electronic record adoption were highly disruptive of care, and disruptions took several years to resolve completely. When medical assistants rather than physicians were tasked with transferring data from paper screening forms to the electronic record, reporting compliance improved. Compliance with Healthcare Effectiveness Data and Information Set standards and Medicaid performance measures will likely be similarly affected as electronic records are implemented nationwide. Although implementing a fully automated medical record has some benefits, the unintended effects on care after implementation must be acknowledged.
authors.affiliation: Institute for Community Health, Cambridge Health Alliance, 163 Gore St., Cambridge, MA 02141, USA. khacker@challiance.org
authors.forename: Karen
authors.initials: K
authors.lastname: Hacker
authors.forename: Robert
authors.initials: R
authors.lastname: Penfold
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Soumerai
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D002648:Child; D002653:Child Behavior Disorders / Q000453:epidemiology*; D002675:Child, Preschool; D004059:Diffusion of Innovation; D017598:Efficiency, Organizational; D057286:Electronic Health Records; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000458:organization & administration*; D013997:Time Factors; D014481:United States