How to Chart Progress Notes Faster, Smarter, Better

Electronic health records (EHRs) have become much more common over the past decade, with federal incentives—and funding—for health systems and Medicare providers to implement computer systems, collect data, and report on outcomes. Overall, $35 billion has been allocated by the federal government to drive adoption of electronic charts.

But what about EHRs for behavioral health?

Generally, computer systems in the specialty of psychiatry have had limited adoption. In fact, adoption of EHRs is generally lower among specialists compared with primary care physicians. A 2013 study found that psychiatry was actually the medical specialty with the lowest EHR adoption rate.

Why the limited adoption of EHRs in psychiatry? Lack of comfort and familiarity with EHRs is one key factor. In a survey of psychiatrists conducted in 2012, more than 25 percent of psychiatrists said they weren’t comfortable using computers for clinical purposes, despite strong familiarity with consumer technologies for personal use. Another barrier is that using an EHR may be particularly distracting and even harmful to the therapeutic alliance for psychiatry visits, according to early research.

Another important barrier: finances and lack of resources. Because of the additional privacy and sensitivity surrounding behavioral health records as well as the added complexity, the government did not incentivize the use of electronic charts for nonphysician behavioral health providers, long-term care facilities, and addiction treatment centers.

But given the increasing adoption of EHRs—along with announcements in 2016 by the Centers for Medicare and Medicaid Services to provide financial incentives to long-term care, behavioral health, and substance use care providers—it’s only a matter of time before EHRs are the norm, not the exception.

Knowing how to effectively use EHRs in clinical settings can mean improved care, efficiency, and patient-doctor relationships—even improved communication. But this requires learning how to be attentive and computer proficient while using an EHR. It also requires that psychiatrists have an active voice and proactive stance to ensure EHRs are developed and responsive to the field’s needs.

In an early study of patient satisfaction for psychiatrists adopting EHRs, the authors found that “consistent with several decades of research in the nonpsychiatric realm, we found no change in satisfaction survey scores among adult psychiatric patients” in outpatient settings where EHRs were used versus paper charting, as measured by a modified form of the Rand Corporation’s previously validated Patient Satisfaction Questionnaire-18 (PSQ-18). The survey asked about items such as “Communication,” “Time Spent with Doctor,” and “Interpersonal Manner” and removed the original questions on “Financial Aspects” and “Accessibility & Convenience” subscales as research suggested that EHRs did not impact these factors.

Still, taking on an EHR can be arduous and difficult. Below are ways you can chart faster and smarter, so you can complete the work day in a timely manner.

In the next issue of Psychiatric News, the authors review six steps to keeping the patient-doctor relationship alive in the age of the EHR.