Types of EHRs: The Shared Chart Model


There are several factors to consider when choosing an EHR. Previously, we discussed some of the disadvantages of behavioral health therapists using EHRs that are specifically designed for the medical profession. Eliminating the large group of medical EHRs helps narrow the field quite a bit. However, even within the category of behavioral health EHRs, there are other factors to consider. For example, one thing you may not be aware of is a concept I refer to as the “shared chart model”. In a nutshell, agencies tend to need and use shared chart models, while those of us in private practice typically don’t.

The best way to describe the shared chart concept is to think through the workflow in a typical behavioral health agency compared to that of private practice. In an agency, a patient’s chart typically belongs to the agency. Clinicians come and go; cases get transferred from one professional to the next; the same consumer is often seen by several different people within the agency (e.g., front office personnel, an intake worker, a psychiatrist, the individual therapist, possibly a group and/or family therapist, etc.) In such settings, it makes sense for each consumer to have ONE chart – either paper or digital – that anyone within the agency can access, i.e., a shared chart model.

In contrast, when you’re in private practice – even if you practice with a large number of other clinicians in the same building – your clients’ charts – paper or digital – typically belong to YOU. They are not shared with others in the practice unless you specifically make arrangements for that. If a client named John Doe sees me for individual therapy, Dr. Smith for medications, and Joe Green for group, each of us would maintain separate charts for John. We might (or might not) choose to share our charts with one another – or even to allow one another to make notations on John in our chart. But bottom line is that I “own” my chart for John, Dr. Smith owns her chart, and Joe Green owns his.

Now the question becomes, “Why do I care whether my EHR uses a shared chart model or not? I’m going to be the only one using it so it should be a moot point.” In some ways, you’re absolutely right. If you are currently using an EHR that has a shared chart model and you love it, GREAT! No need to change. However, if you don’t currently have an EHR and are considering getting one, the thing to consider about shared chart model EHRs is that they’re typically more complex and more difficult to learn. Because they’re specifically created for agencies, even though they may be just for the behavioral health profession, they actually more closely resemble large scale medical EHRs in complexity, price, and learning curve. If you’re just starting out, you’re probably going to be happiest with an EHR made just for private practice, rather than one that caters more to agencies.

You can learn more about some of the problems with medical/agency EHRs in the post below: