Articles on Topics You Need
Why Do People Hate Electronic Health Records (EHRs)?
Actually, most patients don't. A recent study conducted by Catalyst Healthcare Research found that 93% of adults would prefer to go to a doctor that offers email communication, even if there was a $25 fee (Pai, 2014). Encrypted email is incorporated into most, if not all present-day EHRs that also have patient portals. By being integrated with the entire medical record, it's relatively easy for doctors to correspond with patients right from their electronic chart. Leaders in prominent health care groups in Houston, encouraged patient enrollment in their EHR system and have found similar results. Dr. Robert Dickinson, Kelsey-Seybold's medical director for executive health and wellness says, "They think it's the coolest thing they've ever seen. It's like online banking. People love this kind of access. Before, it was kind of mysterious" (Hines, 2014).
However, when you ask doctors if they like EHRs, you often get an entirely different story. You mostly hear dislike, frustration and irritability. There are actually excellent reasons for this.
More Than a Three-Room House
Imagine a two-room house whose occupants have outgrown it. They decide to solve the dilemma by tacking another room on the back. Great! The siding doesn't quite match - nor does the roof. Some of the existing old-growth trees had to be felled to make the new room fit, and when you're inside, you have to remember to step down and duck a bit as you enter the new room. But hey! The owners still have that extra room! If they decide to put their home on the market, they can advertise it as having three rooms.
Unfortunately, some EHRs are built like this.
Why Get an Integrated Product?
As a therapist, you can amass your digital tools one at a time or you can invest in a well-integrated bundled product. For example, let's say right now you're mostly looking for a video platform so you can do telehealth. There are companies that ONLY offer subscriptions to video platforms. But is that the best choice?
Depends.
For example, what happens if, after you sign up for your standalone video product, you realize that you also need a way to collect your fees from your telehealth clients. And maybe you need encrypted email so you can contact people in a way that's secure. Or maybe now you need HIPAA-compliant file storage, as your clients begin to send you documents via their new encrypted email. Or perhaps a way to schedule clients online. Or maybe a way to efile and also to send statements and receipts digitally. That's a LOT of tools and we're just getting started!
Do I Have to use HIPAA-Compliant Video?
Right now is a stressful time as COVID-19, more commonly known as coronavirus, continues to spread. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have both emphasized how now it’s more important than ever for us to maintain “social distancing.” How do we do that and maintain our ethical and legal obligations to our clients – not to mention keeping our income relatively intact?
Are Web-Based EHRs Safe?
The most common reason people give for being reluctant to switch to a web-based EHR is safety. When we’re charged with protecting something – in this case, our clients’ records – most of us intuitively feel safer with something we can see and touch; something physical within our own office where we can maintain control of security ourselves. However, despite this subjective sense of safety, Hurricane Katrina taught us all a valuable lesson about the danger of keeping client records on paper. Floods, tornadoes, fires and other types of disasters can destroy paper records in a heartbeat. If you do maintain paper records, at the very least, you should have backup copies of everything – and those copies should be stored at a completely different location – preferably far away from where your paper records are stored.
Your Personal File Storage
In addition to being able to store files for each client, you can also upload and store your own digital records in an area set aside just for you. It’s important to note that files are maintained separately. Client files are stored in their charts – separate from all other clients and also separate from your personal files. This is one of the ways PSYBooks adheres to HIPAA/HITECH guidelines.
File Storage for Each Client
Each of your charts in PSYBooks has a Files tab where you can upload files specifically to that client’s chart. For example, initially you might want to upload scanned copies of their intake forms, insurance cards and/or driver’s license. Later on, you may want to upload copies of releases and consents, EOBs, reports or testing results. If you want, you can also keep copies of routine things you generate such as statements, insurance claims or receipts. Should your client request a PHI report, you can also upload that to their chart so you’ll have a record of what you gave them. There are several advantage to storing these kinds of documents in PSYBooks:
Managing Your PSYBooks Subscription
PSYBooks has a tab in the Libraries called Therapists that is devoted to administrative types of tasks for your practice. One of the tools on this page is the Manage Subscription tool. It looks like this:
New Features
We love coming up with new features for PSYBooks. It’s probably the most fun thing we do. When we release a new feature, your account will automatically get the update. If it’s a substantial release, we’ll email you and/or notify you next time you sign in to give you a brief description of the new feature and what it does.
Automatic Updates
PSYBooks is updated frequently. Most updates are small such as a minor bug or misspelled word which we fix and then refresh all instances of the application to reflect the change. Those kinds of updates are considered routine maintenance and most likely, unless you happened to notice the problem to begin with, you won’t even realize anything changed. This is one of the beauties of the Web. Unlike print material or software that you download, we can make updates and improvements as often as needed and deliver them to you right away.
Activity Log
The Activity Log is designed to meet HIPAA/HITECH specifications for tracking PHI. PSYBooks logs almost everything that takes place within the app and displays it for you in the Activity Log. The filter section of the Activity Log report looks like this:
When You Have to Produce a Medical Record
Before I started using practice management systems, being required to produce a client’s medical record was a bit scary for two reasons:
- First, I typically only received those requests when something important was going on, i.e., a legal proceeding of some sort, a disability or worker’s comp situation, or maybe something having to do with insurance. They were the kinds of things where I felt that a lot might be at stake for my client (and/or for me) so I wanted to make sure I “did it right”.
- Second, although I had my own system for organizing client files, the reality is that my records were scattered everywhere. I kept files on current clients in one filing cabinet – unless a certain file got too big, in which case I moved older portions of it to another filing cabinet, unless there was also large artwork in the file, in which case it had to go in the lateral filing cabinet. When a client terminated, files got moved to a storage area in my basement at home. If the client later returned and their file had been especially large, part of it would be brought back to my office, but older parts remained in my basement at home. Then, of course, some documents were on my computer – a smattering of various Word docs and Excel sheets I had pieced together for special notes I had written on clients, letters I had written on their behalf, and various attempts at coming up with THE perfect method for determining how much a client owed me when insurance was involved. I had also tried efiling for awhile at various insurance company’s websites, so some of my records were on various sites on the Internet, too. Somehow, when I was asked to produce a medical record, even though I knew I had everything I needed, finding it all and pulling it all together into some type of meaningful report was a daunting task.
Types of EHRs: Desktop vs Web
Previous posts have discussed advantages of EHRs made specifically for behavioral health vs generic EHRs made for the entire medical profession and also, the differences between EHRs with a shared chart model vs those without. This post addresses another important issue to consider when choosing an EHR: whether to choose a desktop app or a web app.
Are Web-Based EHRs Safe?
The most common reason people give for being reluctant to switch to a web-based EHR is safety. When we’re charged with protecting something – in this case, our clients’ records – most of us intuitively feel safer with something we can see and touch; something physical within our own office where we can maintain control of security ourselves. However, despite this subjective sense of safety, Hurricane Katrina taught us all a valuable lesson about the danger of keeping client records on paper. Floods, tornadoes, fires and other types of disasters can destroy paper records in a heartbeat. If you do maintain paper records, at the very least, you should have backup copies of everything – and those copies should be stored at a completely different location – preferably far away from where your paper records are stored.
Why Not Use a Free EHR?
There are a handful of free EHRs and who doesn’t like free? However, before you jump in with both feet, you may want to know some facts. First I don’t personally know of any behavioral health EHRs for private practice that are free. So if you want to use a free EHR, you’re probably going to have to be OK with a medical product that’s been designed for agency use. The cost factor of these types of EHRs has been eliminated, but there are still some reasons you may not want to use them.