Technology, Psychology, and the Speed of Change
Why psychologists should embrace the Electronic Health Record (EHR)
Many psychologists consider themselves fairly low tech. The heart of our profession has often been the one on one connection, face to face, arm chair to arm chair. We fear losing the personal connection, become concerned about privacy, and worry patients will lose trust. And yet as technology continues to drive our society forward at exponential speeds, it is important for psychologists to embrace some of the advantages of technology in working with our clients.
A key area of technology that affects psychologists is electronic health records. I have been using electronic health records at the Cleveland Clinic since 2003, and even earlier during my VA practicum and internship training. While psychologists often worry about the security of EHR, the reality is that these systems can make your practice more efficient, communicate better with the healthcare team, and likely improve your best practices. My notes in EHR are generally available in the chart like any other note, allowing team members to access and integrate the information from my visit; this is crucial to providing good care to patients. For example, if my notes about a patient with an eating disorder were not accessible to the dietician who is treating the patient, she might miss important issues that would affect the patient’s care. In addition, I can directly bring one of my notes to the attention of other healthcare providers. If a patient notes to me they stopped their antidepressant that their PCP prescribed because of side effects, I can directly communicate with the PCP through the chart (even if they practice many miles away). In addition, when a patient and I feel that additional protections are needed for their notes, there are mechanisms that I can use to add layers of privacy (such as putting the note in a Psychiatry/Psychology Department file which makes it only accessible to mental health providers or those I designate).
There are changes to practice that are challenging with EHR. Psychologists may need to make changes to how they document their sessions. A good strategy is to keep your notes as behavioral/factual as possible, and write them as if you think your patient will be reading them in the future. Most psychologists will need to practice the ability to type on the computer and yet maintain eye contact and rapport with their patients; this is a skill that takes some time but you don’t have to lose connection just because you document on the computer.
Advantages to the EHR include the ability to template your notes. This means much of the repetitive language you use in evaluations, groups, or individual follow ups can be pulled up for you routinely which can save you time and energy. In addition, you can build in reminders about best practices such as start/stop times, PQRS documentation, risk management, diagnostic criteria, etc. Computers are much more reliable than our human memories! Templated notes can become bland and uninformative; psychologists need to be careful to include enough free text to make the notes meaningful and unique, while maintaining uniform best practices.
What I like best about EHR is my ability to have searchable information about the patient at my fingertips. Reviewing the chart is no longer a tedious puzzle, looking at indecipherable handwriting, and wading through reams of paper. Problem lists, medications, lab results are all tabbed and easily accessible. I can see if a patient was recently admitted to the ER for a panic attack, or search the records for multiple different mental health providers over time. I am much better prepared when I see a patient, having reviewed records from other health providers.
Beyond EHR, I believe there are a number of other advances in technology that will be positive for professional practice, including using health tracking apps, social media, and telehealth that will make psychological information and treatment more accessible to a wider population. I believe the APAPO will need to embrace this positive view of technology and advocate for practicing psychologist incentives to use health technology and be competitive in the quickly changing healthcare environment.
