EHR's and APA

@dr_bob (http://www.dr-bob.org/) suggested psychiatrists might embrace an EHR (EMR) provided or sponsored by the Amereican Psychiatric Association. I said that might scare some of us away. He countered with the question of whether low cost might be an incentive.

I see 2 issues here. First the EHR: I learned a little Fortran in '69 at a summer job at NASA when the equivalent of pressing enter was to put a rubber band around a stack of punch cards, drive them across the base to the data reduction center, and drop them off at the IBM 360. With luck you got a printout the next day. I started patching together my own ersatz EHR around '84 after I bought my first PC. Now I use, on a Tablet PC I can hold in my lap and write upon while sitting with a patient, a combination of MS Word, GoldMine (contact management), iscribe (soon to be allscripts, online prescribing), efax, and Dragon. For evaluations and forensic reports I use Audiacity to create an mp3 which I encrypt before I ftp the file to New Delhi for transcription. I have templates for reports. I use Excel for keeping track of time and Access for record reviews on forensic cases. My billing software is still on an old DOS PC. I frequently synchronize my computer with my office manager's desktop, and her desktop with my (now obsolete) Palm Treo. I still do not trust the digital version of my records; I print a new page every time I add a progress note or paste in lab results and put it in a manila folder. I use Skype for some patient contacts. I do not "bill electronically" so I am not a covered entity under HIPAA.

I tried to "upgrade" to an EHR around 1988. I spent hours researching the product to make sure it would do everything I wanted it to. It took only about 2 days of use for me to discover that it was a total flop and revert to my existing system.

I could write pages about features, capabilities, bells and whistles, but the critical element for me that I doubt I will find in an EHR is this: My contact management software holds not only all my patient contact information, but also all my business, forensic, and personal contact information. I have everything in one place, two if you count the smart phone, practically all the time and everywhere I go. But after I mistakenly sent an email intended for a friend to the executive director of my state psychiatric association I decided I would not even keep a record of any patient's email address, much less communicate with patients via email.

So let me know when they write an EHR that allows me to keep all my non-patient contact info in the same place as my patient contacts. I also want it to be "in the cloud" and to be fully integrated with a smart phone like the iphone or Nexus One.

Now for APA: I'm disenchanted with the organization. I told Dr. Bob I probably would quit were it not for the cheap professional liability insurance, and for the opportunity to torment the risk managers there. I believe APA is stuck in the 1950's, still thinking of psychiatrists as "therapists" and of psychoanalytic theory as a core competency in psychiatry. And when I made inquiries about the professional liability insurance underwriting debacle several years ago someone in the APA administration had the audacity to refuse my questions based on a policy of not releasing that information "to the public."

So I don't want to get any more "hooked on" APA than I already am. On the other hand the idea that large numbers of practicing psychiatrists might have the same EHR appeals to me. And of course the cheaper the better.