Health Information Technologies for Practicing Psychiatrists

In today’s practice of medicine, it is highly unlikely that any physician entering into or already in practice will remain in the analog age without some type of health information technology. Computers today are just as important to the psychiatric office as was the proverbial couch, and they play a central role in data collection, storage, and retrieval in various domains such as scheduling, billing, and record keeping. For the novice or even for the experienced purveyor of electronic goods, to evaluate the numerous technologies available for their relevance to digital practice can be rather daunting. This article serves as a guide to the practicing psychiatrist to determine what technologies will be most useful—if not mission-critical.

Electronic health records

One of the first challenges is to determine what electronic health record (EHR) product to purchase as a foundation for a psychiatric practice. At the 2009 American Psychiatric Association (APA) annual meeting, more than a dozen vendors contended that their product is the best and most adaptable to the needs of every psychiatrist. There are some guiding principles to consider when choosing from this smorgasbord of vendors.

To begin with, it is important that any EHR product examined for consideration be approved by the Certification Commission for Health Information Technology (CCHIT).¹ While this certification is not a guarantee that the product will serve every need, it does indicate that the EHR system will enable providers to meet all meaningful use objectives. Products must significantly exceed minimum federal standards requirements—such as those specified in the Health Insurance Portability and Accountability Act—and must have proved usability at multiple sites.

Another key issue to consider is whether the EHR vendor has been in business for an extended period. Many EHR products have been created by physicians who were frustrated with existing products; the longevity and success of these products can be measured in terms of years in business as well as number of current and satisfied customers.

All too many new EHR vendors come out every year and just as many vendors cease operations. One key feature of CCHIT certification is an interoperability standard, which means that practice data can be migrated from one vendor to another as needed.

Once you have determined that the EHR system you are considering has CCHIT certification, it is time to consider how your practice will run. This will dictate the priorities of certain features. For example, if the practice is located at multiple sites, then a Web-based EHR system makes the most sense—especially if the practice has multiple users that include physicians and staff. A few Web-based EHR systems, such as LifeRecord² and eClinicalWorks,³ also provide remote access via smartphones, such as the iPhone and BlackBerry. This remote access is vital if the practitioner is often out of the office and needs to be able to remotely access patient records, check laboratory results, review messages, check schedules, enter charge capture, and refill prescriptions.

Although selecting an EHR system seems daunting, once you have screened a few of the systems using the parameters described above, the choice becomes a function of the results of a “test drive.” It is helpful to read reviews of EHRs found on the APA’s Web site “Members Corner,”⁴ but more important will be the intuitive nature of how the system is set up during the test drive. In general, if the system doesn’t work well “out of the box” and requires extensive training, it is not a system to consider.

CHECKPOINTS

■ It is important that any electronic health record product examined for consideration be approved by the Certification Commission for Health Information Technology.

■ The smartphone is one of the more critical tools in psychiatric practice. Among the popular applications is access to drug reference guides that provide dosing information, a drug-drug interaction checker, formulary information, a list of common adverse effects, black box warnings, contraindications, pill pictures, and safety and monitoring information.

■ The National ePrescribing Patient Safety Initiative provides a free Web-based system for every physician in the United States.

■ Information backup is crucial and the backup frequency is based on the number of days the practice can afford downtime to restore the system. In addition to on-site backup, off-site backup is highly recommended.

Smartphones

Over the years, the personal digital assistant (PDA) has given way to the smartphone, which is essentially a PDA with data access to the Internet. This piece of hardware is one of the more critical tools in the psychiatric practice. It provides remote access to an EHR system, but it also does much more. This field was defined and dominated by the Palm operating system, which was surpassed by Windows Mobile and subsequently by the iPhone and BlackBerry. Although the Google Android is new to the scene, it is quickly becoming a device to consider because many developers are creating applications for it.

One of the most popular applications on the smartphone for physicians is for accessing drug reference guides, such as Epocrates.⁵ These guides provide dosing information, a drug-drug interaction checker, formulary information, common adverse effects, black box warnings, contraindications, pill pictures, safety and monitoring advice, and much more information at the point of care.