Federal regulations currently allow electronic prescribing of controlled substances. However, the technological requirements of these prescriptions specify the use of “two-factor authentication” that requires biometric identification or a physical cryptographic key in addition to usual password protection. This, along with more restrictive regulations in some states, has thwarted the complete development of this function.
Reporting tools. Many HIT products can help facilitate the generation of a variety of reports about your practice. Clinical, business, and utilization reports are just a few of the many types of reports this technology can generate to help summarize the data that are collected by your EMR system.
Technical considerations. Some of the most important characteristics of this technology have to do with the user interface and usability in your practice environment. Various products offer features such as pen and tablet interfaces, mobile access, and a variety of other technical features that may or may not be of use to you. Other important technical characteristics include how the technology is implemented—some systems involve local (on-site) data processing and storage, while others are “cloud-based” systems in which data storage and processing occur on a remote server.
Cloud-based systems are generally associated with much lower initial cost and technical support expense; however, there is often less flexibility and absolute control over the data, and the system depends on a robust and reliable Internet connection. Local systems may be cost-effective for large practices that may be in a position to invest capital resources and can spread the overhead expense across a large group of providers.
Assessing the needs of your practice
The implementation of HIT resources may be a substantial, if not the largest, overhead expense for a psychiatric practice. The many decisions involved in configuring a system should therefore be guided by a clear strategic plan for the practice.
Knowing what you need and want is quite helpful. If resources are limited, you may need to prioritize your list of desired features and identify those that are absolutely necessary. In keeping with long-term goals, you may choose a system that allows for features to be added over time and that has the capability to export data if you need to switch vendors in the future.
If your expectations and needs for information technology are modest, you may be able to manage your medical records, accounts, and schedule with a standard office productivity software suite, perhaps supplemented with small-business accounting software. For electronic prescribing, you will need to choose a vendor to securely transmit prescription orders to pharmacies. You will also need to have a security plan in place to protect patient information from unauthorized access, and all information will need to be backed up daily. In addition, if you are in private practice, keeping all the old paper records in a file cabinet may be a satisfactory alternative to scanning all of the paper into the EMR system.
The transition to an EMR system is a process that unfolds over time. During the early stages of implementation, everything will take a bit longer than it did on the paper system and you may even regret embarking on this change. But, with appropriate commitment, training, and customization, the efficiencies and benefits will gradually become apparent.
In addition to simply learning how to operate and customize the new technology for your practice, it will also be important to evaluate, and if needed, redesign the workflows of your practice to optimally integrate HIT. New tools often warrant changes in processes that involve not only physicians but support staff as well.
It is important to plan the extent to which EMRs will be used during the face-to-face portion of the visit and to carefully consider its impact on your personal interaction and rapport with the patient. For example, it may be helpful to have the patient present when you are updating the medication list and reviewing and discussing laboratory results and other medical data. If so, will the monitor and keyboard be configured so that the patient can jointly view the information? Do procedures for patients to communicate with you and/or your office staff need to be redesigned to optimally use your new communication tools? The impact of HIT on the patient experience, and especially on the relationship between doctor and patient, is an emerging area of interest in informatics research and a compelling issue for clinical study.6
In addition, a plan for maintaining previous paper records needs to be in place. Several options are available: maintaining the availability of paper charts for every patient visit for a specific length of time; archiving the paper records for access on an as-needed basis; and scanning some or all paper records for viewing within the electronic system. Many practices choose a combination of these methods.
Opinions about the implementation of this type of technology vary as widely as the number of HIT products available on the market. Preparation and research can enhance the likelihood that practitioners will realize the potential benefits of a more efficient, cost-effective, and clinically sound practice through technology.