New technology, like health information technology (HIT), provides new opportunities to help clinics implement this evidence-based approach. However, it can be hard to add new computer tools to the system clinics already use. Zoobook Systems seeks to examine the latest research to develop features for our EHR solutions. One example is the PORTAL project. The PORTAL-Depression project tried to solve this problem. The team added a special online depression test to the clinic’s electronic health record (EHR). This made it easier for both patients and doctors to check for depression, whether patients were in the clinic or at home.

What problem does this study address?

Depression is a very common mental health problem in the United States, and the number of people experiencing symptoms has been rising in recent years. Many people who visit their regular doctor’s office actually have depression, but about half of them are never identified as having it. Even when depression is found, many patients do not get the right treatment or enough follow-up care. This means that a lot of people continue to struggle with depression without the help they need.

One important way to improve depression care is called “measurement-based care.” This means that doctors and nurses check patients’ depression symptoms regularly and adjust treatment as needed. Research has shown that this approach helps people get better faster and reduces delays in care. However, most primary care clinics are very busy and do not have enough staff or time to screen every patient for depression or to keep checking on their symptoms over time. Often, clinics use paper forms for depression screening, but these forms can be forgotten, misplaced, or not acted on quickly.

Technology has the potential to help with these problems. For example, using computerized tests and electronic health records (EHRs) can make it easier to find and track depression in patients. These tools can also allow patients to complete assessments at home, not just in the clinic, making it easier to keep up with their care.

The PORTAL-Depression project was created to address these challenges. The project aimed to make it easier for clinics to find, track, and treat depression by adding a special computerized depression test directly into the clinic’s EHR system. This system allowed patients to take the test either during a clinic visit or at home through the patient portal. Doctors could then see the results right away and get alerts if a patient’s depression was serious. By making depression screening and follow-up easier and more automatic, the project hoped to help more people get the care they need, even in busy clinics with limited resources.

How was the study conducted?

The main goal was to make it easier to check patients for depression and follow their symptoms over time. To do this, the team added a special online depression test (called CAT-MH) to the clinic’s electronic health record (EHR) system. This allowed both in-clinic and at-home depression assessments.

The PORTAL-Depression project was carried out in a large, urban primary care clinic at the University of Chicago. The clinic serves about 28,000 patients and has a diverse staff, including doctors, nurses, medical assistants, and a social worker. The project lasted for 30 months, from July 2017 to March 2021.

A multidisciplinary team was formed to plan and run the project. This team included primary care doctors, psychiatrists, psychologists, IT specialists, statisticians, and project managers. They met regularly to discuss progress, solve problems, and adjust the project as needed.

Key Steps and Features

1. Computerized Adaptive Test (CAT-MH):

   This is an online depression test that asks questions based on a patient’s previous answers. It can be done in English or Spanish and can read questions aloud for patients who have trouble reading. The test is designed to be quick and accurate.

2. EHR Integration:

   The test was connected to the clinic’s electronic health record system using special software. This allowed test results to be automatically and securely saved in the patient’s record.

3. Easy Access to Results:

   Once a patient completed the test, the results were stored in the EHR. Doctors could see the results right away, along with other lab results, and could also track changes over time.

4. Alerts for Doctors:

   If a patient’s test showed moderate or severe depression, the system would alert the doctor. The doctor could then take action, like adding depression to the patient’s problem list or starting treatment.

5. Remote Assessments:

   Patients could take the depression test at home using a secure link sent through the patient portal. Results from at-home tests were also automatically saved in the EHR.

6. Staff Training and Feedback:

   Doctors, nurses, and medical assistants were trained on how to use the new system through meetings, online guides, and one-on-one help. The team collected feedback from staff and adjusted the process as needed.

7. Evaluation:

   The project used surveys, EHR data, and project logs to track how well the new system was being used and what impact it was having.

Main Features of the PORTAL-Depression Project

The study was carefully planned and involved many different experts working together. It used new technology to help both patients and doctors check for depression more easily, whether in the clinic or at home. The team made sure to train staff, collect feedback, and adjust the process to make it work as smoothly as possible.

Feature/Step	Description
Setting	Urban primary care clinic, 28,000 patients
Duration	30 months (July 2017 – March 2021)
Team	Doctors, psychiatrists, psychologists, IT, statisticians, project managers
Computerized Test (CAT-MH)	Adaptive online depression test, English/Spanish, reads aloud if needed
EHR Integration	Secure, automatic transfer of results to patient records
Result Accessibility	Results visible to doctors alongside other lab results
Alerts for Doctors	Automatic alerts for moderate/severe depression scores
Remote Assessment	Patients can take test at home via patient portal
Staff Training	Presentations, online materials, one-on-one support
Evaluation Methods	Surveys, EHR data, project logs, regular team meetings

What did the study find?

The PORTAL-Depression project showed that adding a computerized depression test to the clinic’s electronic health record (EHR) system helped make depression screening and follow-up easier and more organized. The project was well received by staff, but some parts were hard to keep going due to limited resources.

Main Findings

• Quick and Widespread Adoption

  Doctors, nurses, and medical assistants learned how to use the new depression screening system quickly. Training was offered in different ways, including meetings, online materials, and one-on-one help. Staff felt more confident using the new system, and it became a regular part of clinic visits.

• Better Access to Depression Screening

  With the computerized test, depression screenings could be done either in the clinic or at home through the patient portal. Results were automatically saved in the EHR, so doctors could see them instantly, just like lab results.

• Improved Follow-Up and Documentation

  If a patient’s depression score was moderate or high, the system sent an alert to the doctor. This made it less likely for important results to be missed and helped doctors act quickly—such as starting treatment or making referrals.

• Reduced Staff Workload

  Because the test was automated and results were instantly available in the EHR, staff spent less time on paperwork and manual data entry. This made their jobs easier, especially during busy clinic days.

• Challenges with Long-Term Use

  Although the system was adopted quickly, keeping all parts of the project running over time was difficult. The main reasons were not enough staff and money to support it. Only some parts of the system continued after the initial project ended.

Feature	Before PORTAL-Depression	After PORTAL-Depression
How was depression checked	Paper forms, sometimes missed	Computerized, automatic in EHR
Where patients took the test	Only in clinic	In clinic or at home (portal)
How doctors got results	Sometimes delayed or missed	Instant, with alerts
Staff workload	Higher (manual work)	Lower (automated process)
Long-term use	Not always kept up	Some parts continued

The study found that using a computerized depression test linked to the EHR made it easier for doctors and staff to check on patients’ mental health, both in the clinic and at home. It helped doctors act quickly when patients needed help and made staff jobs easier. However, keeping the system running long-term was tough without enough resources.

Limitations of the study

Limitation	What it means
Resource Intensity	Needed a lot of time, money, and staff; hard to keep all parts running long-term.
Generalizability	Done in one big city clinic; results may not apply to all clinics or settings.
Observational Design	Focused on how the system was used, not on direct patient health outcomes.
Partial Sustainment	Not all parts of the system were kept after the first phase.
Survey Limitations	Staff surveys may not show everyone’s true opinions or capture all viewpoints.

Bottom Line

The PORTAL-Depression project showed that it is possible to use technology to make depression screening and follow-up easier and more effective in a busy primary care clinic. By adding a computerized depression test directly into the electronic health record (EHR), the clinic could check patients for depression both during visits and at home, and doctors could see results right away. This helped doctors and staff act quickly when patients needed help, and made it easier to keep track of patients’ mental health over time.

However, the project was complex and required a lot of teamwork, time, and money. Because of these challenges, not all parts of the system could be kept running long-term. The study also took place in a single large clinic, so results may not be the same in other clinics or settings.

Using a computerized depression test linked to EHR systems like Zoobook Systems EHR can help clinics diagnose and manage depression better, especially when staff are well-trained and involved. But for this kind of system to last, clinics need enough resources and support. At Zoobook Systems, we are dedicated to making these tools easier to use and more affordable, so more clinics and patients can benefit. We rely on studies like these to develop new features that will help clinics better treat depression; thereby, increasing access to the millions of Americans struggling with depression.