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.
Because they’re designed for hospitals, medical EHRs have a tremendous amount of complexity. Since each hospital has its own unique needs, these EHRs typically have to be installed on your system by a representative of the company. The advantage to this is that representatives are trained to listen carefully to the specific needs of your institution and will then customize the product to fit your exact needs. The disadvantages are that all of this is extremely costly, takes a long time to implement, and makes the EHR difficult to learn – typically requiring quite a bit of staff training.
In contrast, some EHRs are designed for a specific healthcare profession – in our case, behavioral health. This sounds like it might be a step in the right direction, but even here, some of the behavioral health EHRs are designed for community mental health settings and other types of agencies, which means that the model they use is actually very similar to the model used by large scale medical EHRs and thus, they have the same set of advantages and disadvantages. Before we look further at behavioral health EHRs, we need to understand a concept I call the “shared chart model”. That concept is discussed in the next post.