Depression Screening Interfaced With an Electronic Health Record: A Feasibility Study in a Primary Care Clinic Using Optical Mark Reader Technology

Objective: Strategies to effectively and efficiently screen for depression remain elusive in the primary care setting. The purpose of this study was to assess the feasibility of a depression screening program in which patients completed a validated questionnaire in the waiting room. Using Optical Mark Reader technology (PatientLink), patient responses were interfaced into the electronic health record (EHR), where the responses and score were available to practitioners at the time of the visit.

Method: This was a prospective, observational study that enrolled all consenting patients, aged 18 years and older, who spoke English and arrived for any type of visit during a 1-week period at a family practice clinic (the first week of August 2004). Patient feedback was sought using a standardized survey. Feedback from practitioners and staff was sought using focus group methodology. The primary outcome measure was the proportion of patients successfully screened for depression by the front desk personnel using PatientLink.

Results: A total of 189 patients met eligibility criteria. Of those, 169 (89.4%) were successfully screened for depression. Of the patients who completed PHQ-9 questionnaires, 30 (17.8%) met DSM-IV criteria for moderate to severe depression. Four (2.4%) of these subjects with major depressive disorder were found not to have preexisting documentation of a depressive disorder in the medical record. In no case was the lack of successful screening due to technology error. Patients, staff, and practitioners supported this new screening strategy. No additional staff were needed to conduct the screening program.

Conclusion: This study demonstrates that depression screening using a Scantron-based PHQ-9 questionnaire completed by patients in the waiting room and uploaded into an EHR is technically feasible and resource efficient