Think you're not doing telehealth? Think again. Although there's no one-size-fits-all definition that cuts across state and/or discipline lines, most agree that telehealth basically involves any electronic method you use to communicate with or about your clients. This can include common things like phones, email and electronic file storage, in addition to video sessions, which is what we typically think of with the term telehealth.
I sometimes hear therapists mention specific software programs they’re using in their practices for tasks like notes, calendar/schedulers, online file storage, billing, video sessions or email and then add something like, “They’re HIPAA compliant. They just don’t – you know – have Business Associate Agreements.”
Let’s face it. There are LOTS of EHRs on the market and most of us simply don’t have the time, energy, or frankly – interest – to put a lot of effort into researching them. Some therapists have told me that although they’d sort of like to explore EHRs, they begin looking at all the options, get overwhelmed, and decide to put the whole thing off. Although it doesn’t have to be overwhelming, it IS an important decision. An EHR that’s designed well, with attention paid to usability issues so it’s easy to use, can simplify your life enormously and save you a lot of time and money. On the other hand, an EHR that’s poorly designed will have you pulling your hair out and cursing EHRs in general – possibly not realizing that not all EHRs are the same and that there might be better options.
The acronym EHR stands for Electronic Health Record. Originally the term EHR was supposed to mean a very specific thing. It was to be a type of digital (i.e., computerized) practice management system for health care professionals that could “talk to” (i.e., share data with) EHRs of other health care providers and organizations, such as laboratories, specialists, school and workplace clinics, medical imaging facilities, pharmacies, emergency facilities – essentially anyone that might be involved in a patient’s care. Similar products that did NOT automatically have the “talk to everyone” feature were to be referred to by other names, such as EMR (Electronic Medical Record) or simply, practice management system.
To begin this series of posts, let’s look at a concept I’m calling “scope”. In reference to EHRs, scope doesn’t refer to the number of users a particular EHR has, but rather, to the number of different roles for which it’s designed. For example, a large scale medical EHR needs different roles or tracks for each of the various personnel that might need to add something to a patient’s chart. That could mean, for example, different tracks for scheduling, billing, intake, nurses and other mid-levels, doctors, lab technicians, social workers, etc. Additionally, such EHRs are designed primarily for hospital settings. Doctors who are affiliated with the hospital can typically access the EHR from their office, but the EHR itself was developed with hospitals in mind.
At it’s simplest, digital record-keeping could simply mean a Word doc, Excel sheet or PDF that you’ve saved on your computer, tablet, phone, thumb drive or other type of digital storage device. There are advantages to digital record-keeping even at this elementary level. For example, with digital records, you no longer have to contend with bulging filing cabinets, finding adequate long-term storage, or shredding – all of which are factors with paper health records. Additionally, it’s relatively easy to make backup copies of digital files to guard against some type of disaster, whereas making copies of paper records is costly, both in terms of time and money and also, effectively doubles the number of filing cabinets or other physical storage space you need.
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.
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.
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.