Safety. Functions such as electronic prescribing can dramatically reduce adverse drug reactions through alerts regarding drug-drug interactions and can eliminate the problem of typographical errors on written prescriptions.3 EMRs can more effectively bring important safety-related clinical information, such as allergy and adverse drug reaction history, to the attention of the provider in the context of care delivery through rules-based decision support functions. Templates for progress notes in EMR systems offer a framework for the creation of legible, complete, and clinically useful information in the medical record.
Performance improvement. Many practices have documented that appropriate use of technology has led to more efficient workflow.4 HIT resources such as patient portals (which allow patients to transmit clinical history forms and rating scales to, and enable secure messaging with, the provider or office) can improve the patient experience and facilitate the incorporation of routine structured assessments of symptom severity into clinical practice. EMR systems may allow providers to develop patient registries to track outcomes and processes of patient care for groups of patients with similar diagnoses to improve the quality of care.
Although concerns about the confidentiality and security of psychiatric information in EMR systems are quite warranted, it can be argued that electronic systems have more robust capacity to protect sensitive clinical information than do paper records.5 If rigorously deployed, technological features such as data encryption, electronic audit trails, automated off-site backup functions, and user access controls not only can prevent unauthorized access to information but also can ensure that critical data are not accidentally lost or destroyed. (Editor’s note: please see the Special Report article “New Risks to Confidentiality in the Modern Era” by Dunne and colleagues for more on this topic.)
Choosing the right technology for your practice
With hundreds of HIT products on the market today, identifying the right products for a practice’s needs can be a daunting task. It is good to remember that the “perfect” HIT product simply does not exist, and every product will have its own strengths and weaknesses in the context of the individual practice’s needs. Before getting started with the process of “shopping around” for technology, it is a good idea to understand some of the basic functions of these products.
Products range from all-inclusive “package systems” to “modular pieces” with a single function. While you may be tempted to find a product that meets every one of your needs, many have found that using multiple components to meet fewer needs is also effective. When using modular products, keep in mind that the ability of these products to interface with one another is crucial to a well-run system.
Practice management. Functions such as scheduling, registration, billing, and patient accounts can be found in many stand-alone as well as package products. Some products add the ability to use a computer in the waiting room to gather information from the patient for use during the clinical session. Other functions can include tracking utilization review/insurance information and managing informed consent documents.
Communication with patients. Patient portals offer secure methods to allow patients to exchange information with their provider. This is akin to online banking or airline reservations. This evolving field of HIT can enable patients to read or download selected elements of their medical record, such as test reports and evaluation summaries; to request and/or schedule appointments; to personally submit information to the medical record, such as history; to complete assessment measures; and to exchange messages with their provider.
Clinical documentation. This is the “meat and potatoes” of most EMR products. These functions facilitate documentation of the clinical aspects of a practice. Most products offer some form of customizability in the templates used for documentation. Providers should find a level and mechanism of customization that fits their needs.
Some psychiatric products offer the functionality to handle security and access psychotherapy notes uniquely. Integration of rating scales and screens into clinical documentation is another potential feature. Many products offer the generation and maintenance of a Problem/Diagnosis list as a function of clinical documentation. Scanning of paper documents can also offer a bridge between traditional “paper-based” practices and the “paperless” office.
Medication management. Various EMR solutions integrate tools to manage medications. Potential features include support for formularies, drug interaction/allergy checking, FDA indication monitoring, and black box alerts. The term “electronic prescribing” refers to the electronic transmission of a prescription order to a pharmacy. This is distinguished from the use of a computer to print a prescription document or to fax an electronic version of that document to a pharmacy.