Efficacy of automated electronic medical records (EMR) notification to promote provider intervention for severe depression: a retrospective record review

Background: Depressive symptoms as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression (D; PROMIS-D) score is a patient-specific independent predictor of decreased improvement after orthopaedic surgery. Despite evidence that depression predicts worse surgical outcomes, data show orthopaedic surgeons rarely address mental health with their patients. Methods: The authors conducted a retrospective chart review of all patient visit data from October 1, 2018 through December 31, 2020, at Cedars-Sinai Orthopaedic Center outpatient clinics to determine if a best practices alert built into the electronic medical record (EMR) notifying surgeons of their patients who had PROMIS-D scores of 70+ (severe depression) would be impetus enough for providers to intervene. Records with PROMIS-D scores of 70+ (N=361) were selected and reviewed; the authors examined how often the surgeons documented an action in the record in response to the depression notification. Results: Surgeons were found to take action in only 28.5% (N=103) of the visits with qualifying scores. Conclusions: Notification of patient depression status alone was insufficient to persuade most surgeons to discuss mental health with their severely depressed patients. To empower surgeons to have these important conversations, extant barriers need to be identified and addressed. The association with rates of intervention and individual-level factors of both patients and providers could be explored. Level of Evidence: Level IV.