From One Who's Taken Leap: Advice for Going Paperless

It was only 7 a.m., and swaying palm trees and pristine beaches beckoned. Nonetheless, some 40 psychiatrists turned out for a workshop at APA's 2011 annual meeting in Honolulu in May titled "The Anatomy of the Paperless Practice." The workshop was led by Amy Berlin, M.D., who has a solo practice in San Francisco specializing in psychodynamic psychotherapy.

"I run my entire practice on my laptop," Berlin announced, qualifying that statement somewhat by adding, "I do use a little paper." She then asked audience members why they had come to the workshop.

Most, it turned out, were also in solo practices, but some were members of multispecialty practices or worked in hospitals. Nearly all said that they were already using computers for some aspect of their practices, such as billing, e-mailing patients, or e-prescribing, and wanted to harness their computers to conduct even more chores.

The first thing to do, Berlin advised audience members, is work up a wish list for what they would like their computer to do for them. "My wish list," she explained, "was to reduce redundancies; allow for streamlining of repetitive tasks, like progress notes, billing, and scheduling; have round-the-clock access to my patients' charts; have adequate security and data back-up; save space; be able to prescribe electronically; and be able to bill electronically."

The next step, she continued, is to search for products that can help clinicians fulfill their wish list. Compared with other medical specialists, "we don't have a great selection of products to consider," she acknowledged. For instance, a clinician can purchase a software product for electronic health records and a software product for practice management, such as billing and scheduling, or one product that bundles both functions. She decided to buy separate products for electronic health records and for practice management, but from the same company so that the two systems easily interfaced.

She recommended to her colleagues that a member of APA's Electronic Health Records Committee could be a good source of advice when choosing among competing products.

After deciding which product or products might be right for a particular practice, she urged psychiatrists to ask the companies that make them whether they can have a free trial with the product. Most companies do offer free trials, she noted. She also advised asking the companies for the names of psychiatrists who have already bought their products and might serve as references, she added.

Then, after choosing the product or products that seem the most appropriate, one more point should be considered, she said: Does the company or companies that make them offer technical support when things go wrong? "Unfortunately, as far as time differences are concerned, my vendor is on the East Coast, and I'm on the West Coast," she said. "So consider doing a test drive of the products to see how [the companies] provide technical support and whether it is satisfactory to you."

Before purchasing new software and hardware, she advised audience members to run the new practice scenario by their malpractice insurance carrier for risk-management input. "For instance, since I run my entire practice on my laptop, I secure it to my desk and lock my door when I leave for lunch. I discussed this procedure with my malpractice provider before I started doing it. Storing patients' medical records electronically is an evolving legal area."

She advised psychiatrists to consider purchasing insurance in case the computer system malfunctions, and she stressed the importance of backing up information regularly.

Finally, are all the time and money spent making the switch to a computer-based practice worth it? She thinks so. For example, she said, "I use my practice-management program for scheduling appointments with patients. I usually spend about 20 minutes entering the initial note for a psychotherapy patient and then about one minute entering each follow-up session. I spend only one minute at the end of each visit processing invoices for payment. And yes, I can scan written information into my patients' electronic health records."