I will confess that I wish I could snap my fingers and could start using electronic medical records (EMR) for my private practice. I would be so nice to have all the records at my fingertips. I could make a quicker review of their chart, chart progress in visual way to show the client, keep track of billing and insurance referrals.
But what are your experiences in being the patient of a doc with EMR?
My family doc uses EMR. He does a fine job of entering data and putting aside the laptop to chat with me. He uses good eye contact.
But yesterday I had to take a child to another provider at another site. The doc spent most of the time looking at his screen and trying to get his voice recognition software to work right. He had to fix a couple of mistakes, he made comments into the machine.
On the plus side, I know exactly what my child’s record says because I heard the notes: “___ weighs ___ and blood pressure is _____. Patient is tolerating the medicine well and shows improvements in_____”
Then he would fix errors in the dictation.
I calculated that the 17 minutes of “face time” with the doctor included 5 minutes of exam, 3 minutes of discussion about treatment and the rest fiddling with the EMR.
Didn’t feel like the most productive use of time.
Your experiences? Anyone have that experience in the mental health world (vs. general medicine)?
Musings on Faith and Psychology 
My therapist recently switched over to a computer system for making appointments — not sure about the records themselves. I wouldn’t be surprised if they were electronic.
As a client, I’m not sure how this affects me at all, honestly. My therapist doesn’t take notes while I talk (beyond the first few sessions). I think it would be really distracting if he started typing on a computer or scribbling notes.
I’m sure he keeps notes, since he remembers so many details and has a full load of clients, but I’m grateful to not have to be a part of it! (Do some therapists actually sit and type things up while clients are still there????)
Back during my predoc days I was required to do a fair amount of paperwork with my clients. Treatment plans, quarterly reviews, annual reviews, etc. The idea was that the more the client was invested in the treatment outcomes (we were working with a population of severely mentally ill persons) the better they would do.
I think that is right but doing notes during a session…not so good.
********* Philip G. Monroe, PsyD Professor of Counseling & Psychology Director, MA Counseling Program Biblical Seminary 200 N. Main Street Hatfield, PA 19440 http://www.biblical.edu http://www.wisecounsel.wordpress.com Following Jesus into the world
The best advice i have ever received for visiting doctors who get preoccupied with notes, either electronic or otherwise, is to stop talking when the doctor is writing and only resume talking when you have eye contact. The other piece of advice is to go to the doctor with all of your questions written down. I go to an extremely friendly doctor who loves to talk about all sorts of things…he is a lot of fun to visit. However, he gets off track sometimes and also tends to forget why i am visiting. My list of questions and determination not to leave without asking them…keeps us both on track.
I use Emar at my job as well, all meds, all charting is done via computer (COW: computer on wheels), we literally roll our carts from room, we treat find information and document on our Cow’s. Even if this isnt the mental health world, it really is in a sense. We deal with people at their most vulnerable time, so really…I think general medicine includes mental health, just different, and many times not recognized. I can tell you, I prefer simplicity. Emar just adds another thing that comes in between person to person contact. You have all the information you need, so you think, at your fingertips right there in the computer….but really, there is nothing like talking to the person, asking some questions, breaking down some barriers and walls that technology can serve to build even higher. If you walk on to any floor in a hosptial, for the most part, you will see personnel at a computer and not a pt bedside; well maybe exaggerating, but it is how it feels.
But using it for your own use, not an ‘instead of’…can be helpful i think as long as you dont lose in the process. I am not a fan of someone writing during sessions…it is distracting and impersonal. If someone were typing during a session….I’d leave.
Techonolgy has its good points, but especially in mental health establishing realationships is so important, I cannot imagine that this would work well at all within the realm of session.
Documentation and hardrives, even that has its drawbacks…if I go into techy talk here…I go way outof my comfort zone….
I work in community mental health and we have made the transition to a paperless system. I have to say, it has made community mental health and the amazing amount of paperwork actually bearable! Of particular usefulness is the fact that I can pull up a client’s most recent visit with the psychiatrist and see exactly what they are being prescribed (no more guessing what the doctor’s handwriting means). It also is very helpful because all of the client’s records are available with the a mouse click so that I can review past session notes right before they come in without having to find it in a pile of charts.
I don’t see many downsides to it, except maybe internet security and the client’s privacy is more at risk as the system is online, meaning we access a behavorial health website…
The Director of residential treatment agency I’ve spent the most time with engaged a 14 year old “nerd” about 15 years ago to begin crafting an in-house electronic record keeping system for the agency, and the agency went entirely paperless within a few years. This kid blossomed into a highly skilled programmer, and went on the road to market his complex but relatively elegant system, called Freemed-YiRC. All reports are filled in on-screen, and the system has a variety of reporting mechanisms to provide outcomes data. Our agency formed a partnership with several other agencies of our kind, and Ohio State University, in an agreement to upload outcomes data to the University so that outcomes and treatment modalities might be correlated and conclusions extrapolated.
I think electronic data capturing systems will make research a little more profitable, since the data can be mined at the point of delivery; some records templates guard against omissions of legally required elements of clinical notes, incident reports, etc. The cost of storage and backup is slight compared to the potential costs of paper and bulk storage. I became rather spoiled by using this system; coming to Philadelphia for grad school and going to work for agencies which were still stuck in the Stone Age (i.e., still doing notes and reports by hand) was a real culture shock! It made my job a lot easier.