title: Using clinical decision support as a means of implementing a universal postpartum depression screening program.
abstract: A major barrier to the diagnosis of postpartum depression (PPD) includes symptom detection. The lack of awareness and understanding of PPD among new mothers, the variability in clinical presentation, and the various diagnostic strategies can increase this further. The purpose of this study was to test the feasibility of adding clinical decision support (CDS) to the electronic health record (EHR) as a means of implementing a universal standardized PPD screening program within a large, at high risk, population. All women returning to the Mount Sinai Hospital OB/GYN Ambulatory Practice for postpartum care between 2010 and 2013 were presented with the Edinburgh Postnatal Depression Scale (EPDS) in response to a CDS "hard stop" built into the EHR. Of the 2102 women who presented for postpartum care, 2092 women (99.5 %) were screened for PPD in response to a CDS hard stop module. Screens were missing on ten records (0.5 %) secondary to refusal, language barrier, or lack of clarity in the EHR. Technology is becoming increasingly important in addressing the challenges faced by health care providers. While the identification of PPD has become the recent focus of public health concerns secondary to the significant social burden, numerous barriers to screening still exist within the clinical setting. The utility of adding CDS in the form of a hard stop, requiring clinicians to enter a standardized PPD mood assessment score to the patient EHR, offers a sufficient way to address a primary barrier to PPD symptom identification at the practitioner level.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Science, Icahn Medical School at Mount Sinai Hospital, New York, NY, USA.
authors.forename: Holly
authors.initials: H
authors.lastname: Loudon
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Science, Icahn Medical School at Mount Sinai Hospital, New York, NY, USA.
authors.forename: Farida
authors.initials: F
authors.lastname: Nentin
authors.affiliation: Department of Psychiatry, Icahn Medical School at Mount Sinai Hospital, New York, NY, USA. michael.silverman@mssm.edu.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Silverman
mesh_terms: D000293:Adolescent; D000328:Adult; D020000:Decision Support Systems, Clinical; D019052:Depression, Postpartum / Q000175:diagnosis*; D057286:Electronic Health Records; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006284:Health Plan Implementation; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000458:organization & administration; D009035:Mothers; D009518:New York; D010043:Outcome and Process Assessment, Health Care; D011247:Pregnancy; D011569:Psychiatric Status Rating Scales; D055815:Young Adult
keywords: Clinical decision support (CDS); Electronic medical records (EMRs); Postpartum depression (PPD); Universal screening