The Electronic Health Record: A Recovery Aid?
A bundle of concerns erupt when an agency providing mental health or addiction services implements an Electronic Health Record (EHR). Since the only reason these agencies are in business is to improve the consumer's well being, a question arises: How can the EHR help improve the quality of consumer care?
When I work in mental health and addictions treatment facilities, I see just how tough it is for professionals to envision the EHR as a tool to improve consumer focus on recovery. Expanding the vision of professionals, consumers and even the software implementers to view the EHR as a tool to improve treatment is a team effort, and getting the team cranked up can be a trial.
If the up-front analysis of how people get their work done and such is solid, a professional implementer should get at least some of the software up and running effectively and quickly, and the benefits to improving consumer care should be evident within weeks of use. Professionals and consumers begin focusing more directly on treatment goals and objectives, which are the reasons folks enter treatment anyway.
All too often staff is overwhelmed by the ever-increasing documentation that's required in treatment, so they view the software implementation as a burden, an expansion of bureaucracy. The complaint is that with all the required documentation, there's no time to treat the patient. The EHR solution is to document with the patient during the session. Assessments with a lot of check boxes and radio buttons are easy…just walk through the questions one at a time and review the resulting score with the consumer. Treatment Plans can be more daunting because the fast way to write a goal or objective of treatment is to pick it from a drop down box on the screen, and that can lead to cookie-cutter documentation. Progress Notes generate the same concern.
Collaborative documentation with the patient is the answer, not just because you get paid for the time spent documenting the service. The consumer truly participates in her own treatment when discussing what happened in a session; how it relates to one of her reasons for being in treatment, and what she should be concentrating on in recovery before the next session. Mutual creation of the documents is what draws the patient's attention to reaching their own treatment goals.
Using the EHR to improve treatment is not a new story. I stumbled onto an article comparing the effectiveness of a simple checklist used in treatment on the computer with a checklist on paper. It's a short story, and to make it even shorter, a "to-do" list on the computer works darn well. The study says that both mood disorder screenings and treatment documentation improved using the computer maintained task list. The article from Dale Cannon and S Allen of the University of Utah, was ancient, from the year 2000.
A successful EHR depends on a successful implementation and "after-care", to include continuously gaining buy-in from professionals using the system and making it grow to suit needs better. As these folks embrace central scheduling and treatment documentation with the EHR, the implementation, the effectiveness of the software, and possible improvements in treating patients are likely to increase.