Can the Electronic Medical Record Provide Reliable Indicators of Primary Care Behavioral Health Fidelity? Comparison of Accessibility and Productivity Indicators Assessed Through Observational Coding

Introduction: The primary care behavioral health (PCBH) model is one of the most widely implemented integrated care approaches. However, research on the model has been limited by inconsistent measurement and reporting of model fidelity. One way of making measurement of PCBH model fidelity more routine is to incorporate fidelity indicators into the electronic medical record (EMR), though research regarding the accuracy of EMR data is mixed. In this study, we aimed to assess the reliability of EMR data as a PCBH fidelity measurement tool by comparing key EMR indicators of PCBH fidelity to those recorded by an observational coder. Method: Over an 8-month period (October 2021-May 2022), 12 behavioral health consultants (BHCs; 92% White, 75% female) across five primary care clinics recorded indicators of PCBH fidelity in the EMR as part of their routine charting of behavioral health visits. During that same period, one observational coder completed seven 4-hr visits per clinic to obtain multiple samples of data from each over time and recorded the same variables (i.e., percentage of visits prompted by warm handoffs, number of warm handoffs, and number of patient visits). We used bivariate correlations to test the associations between the EMR variables and the observer-coded variables. Results: Correlations between EMR and observer-coded variables were moderate to strong, ranging from r = .46 to r = .97. Discussion: Leveraging EMR data appears to be a fairly reliable approach to capturing indicators of PCBH model fidelity in the key domains of accessibility and high productivity.

Automated summary

This study aimed to assess the reliability of EMR data as a measurement tool for PCBH fidelity. The results showed that leveraging EMR data appears to be a reliable approach for capturing indicators of PCBH model fidelity in the key domains of accessibility and high productivity.