APA Office Is Your Partner In Delivering Quality Care

Electronic health records, buprenorphine treatment for opiate addiction, and patient-safety programs are three priority issues for psychiatrists that are being addressed by APA's Department of Quality Improvement and Psychiatric Services (QIPS). Under the direction of Claudia Hart, this department helps psychiatrists acquire the tools and information necessary to provide quality care.

In my column in the January 2, 2004, issue, I highlighted important programs the office supports, such as APA's practice guidelines, standards and accreditation, performance measurement, substance abuse, and children's issues. This column spotlights three additional key issues for QIPS: electronic health records, buprenorphine treatment for opiate addiction, and patient-safety programs.

Much of the current interest in electronic health records was triggered by an Institute of Medicine (IOM) report describing positive experiences other industries have had after adopting electronic technology. The IOM recommended that technology for electronic health records should incorporate the following elements: health information and data, result management, order management, decision support for clinicians, electronic communication and connectivity, patient support, and administrative processes such as billing and reporting.

The use of electronic health records is growing, and the Bush administration has called for electronic health records for most Americans within a decade. Dr. David Brailer, appointed by President Bush last year as the national health information technology coordinator, said the overall approach must include a method to certify that the records can be opened and read by doctors and other specialists, as authorized by the patient, even when clinics, hospitals, and physician offices have different computer systems. Developing trustworthy, functioning networks and programs that people with common computer capability can operate will require unprecedented coordination among and collaboration from government, health-technology companies, physicians, patients, and other members of the medical community.

To help ensure that psychiatrists in smaller practices keep abreast of this nascent trend in health care, APA became a founding member of the Physicians Electronic Health Record Coalition (PEHRC), whose mission is “to assist physicians, particularly those in small- and medium-sized ambulatory practices, to acquire and use affordable, standards-based electronic health records and other health information technology for the purposes of improving quality, enhancing patient safety, and increasing efficiency.”

APA has established a Corresponding Committee on Electronic Health Records, and QIPS staff are interacting with other APA components, representatives, and staff on issues key to their development. Working with the committee, QIPS staff will pull together tools to help psychiatrists select technology appropriate for their location and practice. And APA will continue to make known the perspective of psychiatrists throughout the long, complex, and, we expect, thorny development period.

In 2002 the Food and Drug Administration approved buprenorphine for office-based treatment of opiate addiction. The Drug Addiction Treatment Act of 2000 allows physicians to provide such treatment in an office-based setting if they complete eight hours of specialized training and then obtain a waiver to their licenses from the Drug Enforcement Administration (DEA).

APA is one of only five organizations legislatively authorized to provide this training. APA provides training at APA's annual meetings and offers a full, eight-hour course online. A four-hour online refresher course is available at<www.psych.org/cme/apacme/>. QIPS is also collaborating with several district branches and state associations to offer 15 regional training programs. Documented completion of a course, whether live or online, enables physicians to apply for the DEA waiver. For more information on the regional programs, send an e-mail to [email protected].

Finally, if you practice primarily in a hospital, you have seen the growing emphasis on patient-safety programs over the past five years. The National Patient Safety Foundation, Agency for Healthcare Research and Quality, Joint Commission on Accreditation of Healthcare Organizations, and others have organized patient-safety campaigns. While everyone believes that good patient care includes vigilance for patient safety, statistics demonstrate that reduction of adverse medical events in hospitals can be achieved through simple, deliberate, practical steps. Surgeons, for example, now mark the site of surgery and confirm that site with the patient and staff prior to beginning procedures. Not high tech, but it has significantly reduced wrong-site and wrong-person surgery.

APA's Committee on Patient Safety offers an analogous step for psychiatrists. Before your patient leaves your office, ask him or her to read back to you any new prescription you have just written. If the patient can't read the prescription, it is best to rewrite it. This exchange ensures the prescription is readable and allows for a check on the patient's understanding of the medication(s), dosage, and instructions. When picking up the medication from a pharmacy, the patient can check whether the medicine and instructions match what was earlier discussed in your office. QIPS has organized a page on the APA Web site at<www.psych.org/psych_pract/patient_safety/index.cfm> that has many patient-safety resources.

In closing, let me refer you to two important online resources that QIPS has recently helped develop: Guideline Watches, which are brief updates related to APA practice guidelines, posted at<www.psych.org/psych_pract/treatg/pg/prac_guide.cfm>; and two fact sheets, written for patients/families and physicians, respectively, on the use of antidepressants in children and adolescents, posted at<www.parentsmedguide.org>. The fact sheets were developed by a joint APA/AACAP work group.

QIPS is a vitally important component of APA, both for maintaining and strengthening our profession's capacities and for meeting our patients' needs. If you have questions or comments about this or other APA programs, please contact me by e-mail at [email protected].▪