Electronic Medical Records and Depression Screening in Primary Care

Sir: The article by Gill and Dansky¹ in a recent issue of the Companion is an excellent empirical demonstration of the efficiencies that can be gained by employing the electronic medical record as a communication tool in screening for depression. The authors candidly discuss the reasons why similar screening programs in primary care have not always been successful as well as the limitations of screening instruments, such as the Center for Epidemiological Studies Depression Scale,² which they employed in their study. However, their results suggest that such screening can be accomplished with minimal disruption and that the patients' physicians frequently use these results to conduct further evaluation and, where appropriate, initiate or alter treatment. The authors rightly point out the lack of a comparison “ordinary care group” from which to draw firm conclusions about how much the screening actually improved recognition and treatment. However, it seems likely that an underrecognized, significant disorder was identified and treated more promptly and effectively. Considering that patients with depression often overutilize health care, such a program could be expected to reduce health expenditures as well. As the electronic medical record improves, it may be possible for a patient to complete such a screening questionnaire electronically and for the results to be integrated into the record and posted automatically at the time of the physician interview, thus saving additional staff time. What is clear is that we must invent more effective and efficient ways of delivering health care, and the electronic record holds great promise in accomplishing this.