Gaps and Direction for Digital Records Impacting the Mental Health Patient-Provider Dyad: A Systematic Review

Behavioral health and the practices of psychiatry and mental health counseling have specific challenges around privacy, ethics, and data sharing that have prevented more widespread digital technology diffusion, especially with electronic health records (EHR). Little evidence exists to assess the impact of the relationship between the two, so we sought to identify gaps in the existing literature on the effects of the EHR in the dyad relationship between patient and provider in the mental health setting. We conducted a systematic review using PRISMA guidelines to examine the specific impact of EHR technology on the nature of the patient-provider relationship. We found evidence of eight articles that met our criteria. Studies covered urban and rural areas of the United States. One study specifically examined the inpatient setting, six examined the outpatient setting, and one was non-specific. Different patient demographics were well represented throughout all studies. Providers included psychiatrists, psychologists, doctoral-level trainees, and licensed mental health counselors. Studies utilized patient and provider-reported outcomes, and one study utilized observer data. Collectively, the patient-reported perspective did not indicate harm; however, a study from a provider perspective observed lower scores on the Working Alliance Inventory Observer Form in sessions where the therapist used a computer compared to sessions during which a computer was not used. As computer use in sessions becomes more common, there is a need to assess further its impact on the patient-provider relationship and patient outcomes in a behavioral health setting.