TCPR: Dr. Daviss, you are the chair of the Committee on Electronic Health Records for the APA. What does that entail?
Dr. Daviss: The charge of this committee is to follow developments in electronic health record issues—more related to policy than to technology—and to serve as a resource for members and for other councils and committees of the APA.
TCPR: And the biggest policy issue related to EHRs is probably the financial incentives offered by the government, right? [Editor’s note: For a quick rundown of these programs, see the article, “Financial Incentives to Adopt an EHR.”]
Dr. Daviss: Right. Unfortunately, given the various eligibility requirements, it is doubtful that many psychiatrists will be able to participate. For example, to be eligible for the Medicaid incentive program, at least 30% of your practice must be Medicaid patients, and I think very few psychiatrists have that kind of practice.
TCPR: So why should psychiatrists adopt an EHR?
Dr. Daviss: This is what I tell most people: If you want to get an EHR because you want to tap into all this money that is coming from the U.S. government—don’t. I don’t think as psychiatrists we are going to get much out of that and the costs of implementing a system are probably going to be more than any refund. However, if you want an EHR for the benefits that are inherent in this type of data collection and organization, then go for it. The higher the costs and learning curve, the harder it is to switch to a new system if you don’t like your current one. So, one must keep in mind the capabilities for data migration. They often make it easier to get data in than to export data out.
TCPR: Okay. If we decide to go for it, what are some basic factors we need to consider in choosing an EHR?
Dr. Daviss: There are two basic types of systems. First, there is the type that comes as a piece of software that you install directly on your computer. This requires you to update your software on a regular basis—you either have to download it or have it shipped to you and then install it. The second type is a web-based system, where you just need an Internet connection and a web browser and you can connect to the EHR software that resides on a server somewhere else. The advantage is that it is always up to date. You don’t have the hassle of installation and updating. There are pros and cons to each type.
TCPR: Such as?
Dr. Daviss: For the software type of EHR, the potential advantage is that these may be more secure than a web based system, though maintenance is more hands-on, making these more prone to being out-of-date and expensive to maintain. Web based systems have the advantages of being less expensive in general, and of allowing you to communicate directly with a lab or other practitioners, but they are more vulnerable to data breaches. Anytime you put something on the computer and upload it to the Internet it opens up a certain amount of risk that the wrong people could gain access to that data. There are those same risks with paper documents too, of course—if you have paper documents in your office and the cleaning person comes in the evening and empties your trash can, they could look through records and make copies. There certainly have been reports of people breaking into psychiatrists’ offices and copying records. But with computers the concern is that it opens it up to more people. We have seen these kinds of breaches with credit card companies, and certainly there is that risk with electronic health records.
TCPR: So there are some who would do well with a local software EHR.
Dr. Daviss: Yes, especially if you are a solo practitioner without the need for a lot of electronic interaction beyond getting occasional lab results, you can probably even get by with a very pared down version of an EHR.
TCPR: What are some other potential advantages of an EHR system in general?
Dr. Daviss: Using it for data analysis. For example, recently the FDA announced that prescribing doses of Celexa higher than 40 mg could cause cardiac problems. If you had a very basic EHR, you could easily ask the system to generate a list of all your patients on high dose Celexa. You could then pull up that list and call them or send them a note, which is a lot harder to do if you are using paper records.
TCPR: Do you have a sense of how well people are taking to using EHRs, how easy it is for psychiatrists to use them and to apply them to their practices?
Dr. Daviss: I think that depends a lot on what you think you are getting out of it, what you are willing to invest in it, and your overall comfort with technology. It definitely takes more of an effort, certainly initially, than keeping a paper record. And I suspect that even after you have gotten the hang of it, it probably still takes more time than it would take you to do a paper record. These electronic health record systems, by and large, are not very user-friendly; they are complicated programs and it takes a lot of training and learning to use them.
TCPR: Do you think we will all eventually need to have some type of EHR? Will it become such a standard of care that not having one might put you at risk for malpractice?
Dr. Daviss: That is an interesting question and I don’t think we are there yet. But given the fact that almost all of the EHRs on the market have the capability to do some kind of analysis of medications and look at the potential for drug interactions between them, we might end up there.
TCPR: Does the APA have any resources for helping members to decide on which EHR to get?
Dr. Daviss: We have information and links on the incentive programs, privacy and security issues, and many helpful links. There are a few EHR reviews on the APA website, but they are rather dated. We think the best way to help is for members to share their own experiences with various EHRs, and to post online their impressions of the pros and cons: what they like, don’t like, and how it fits in with what specific type of practice they have so that we can start helping each other. We expect this to be available for members by mid-spring 2012. [You can visit the APA’s EHR page at http://bit.ly/t5Xu8E]
TCPR: Thank you, Dr. Daviss.
Dr. Daviss is co-author of Shrink Rap: Three Psychiatrists Explain Their Work