The Electronic Medical Record: Objective Records of Patient Interactions
Can you imagine remembering all the details of fifty cases?
In depth conversations, screening scores and results of a plethora of assessments bring an incredible amount of information into the mix for a single consumer, and in some treatment environments, mental health and addictions professionals can be responsible for the health of fifty consumers. Keeping the details straight seems like an impossible task, which is one reason charts were invented in the first place, and these days, one of the greatest reasons why the Electronic Health Record (EHR) is invaluable in the treatment world.
Thomas Insel, director of the National Institute of Mental Health tackled Memory in a recent blog, and the first thing that came to my mind was how computers store data and assist in decision-making. This study of human memory indicated there is a period of time where memories are fragile and begin to break down…computer data doesn't do that. Once you have it stored, you can retrieve it in that condition any old time you want it. Still, I wouldn't say the computer's memory is better than a professional's (some days, perhaps it's more accurate).
A computer saves a series of on-off switches onto its hard drive without intuition attached, without feelings associated. I begin to question the type of record that is saved. A simple suicide assessment can be a record of seven to a dozen questions or so, with answers that can be scored...something like "yes" = "1", "maybe" = "2" and "no" = "3". Write down the answers and add up the scores, and poof! You have a scorable assessment, and if you string a few iterations of this type of instrument completed over a period of time, you have an "outcomes study". The next question becomes "How reliable is this?"
If a patient knows he will be admitted to a facility, and is tired of living in a ward, he may elect to be less than truthful when answering the questions, indicating everything is fine, just fine…when it really isn't. If the consumer is accustomed to this sort of assessment, he could be sent home because the answers to the assessment indicate he doesn't need help. The judgment of the seasoned professional increases in value, and relying on a short assessment like this becomes questionable. Naturally, this doesn't mean the technology is meaningless or valueless, just that it's a tool, and the trained professional makes the decisions for treatment.
Based on a discussion with a patient while filling out an assessment, professionals may want to look into matters a little more deeply…other tools are at their disposal, including audio and video recording of filling out the assessment, which should be a collaboration between the consumer and the professional.
Most EHRs have the ability to attach electronic files to a patient's record, like an MP3 video recording of a session. This sort of technology can be revealing as a study of non-verbal communication, and the drawback is that it's cumbersome…once you record a session, the exact spot to be studied needs to be accessed, and locating it could take a while. The up-side to this idea is that it may be more reliable than human memory. According to Insel's research, when memories are retrieved, they can be changed, decreasing their reliability. An assessment's answers or a recording won't change. They are what they are.
Not long ago, this sort of technology required a substantial investment and a lot of equipment. My Notebook cost $400 and came with a camera that records audio/video in formats that are readable on most PCs.
The idea of recording sessions is an old one. Perhaps it's time to re-visit some ideas about the EHR like attaching electronically recorded treatment sessions to the consumer's record. Reviewing records like this could prove to be a lifesaver.