Feature

Psychologist Diana L. Prescott, PhD, already uses electronic health records in the integrated health-care work she does at Eastern Maine Medical Center. She even created the behavioral health component of the system for the center's pediatric obesity program. Now she wants to make the shift to electronic health records at the private practice she and her husband David L. Prescott, PhD, run in rural Maine.

"In a small practice, there's not a lot of space to store paper records," says Prescott, a member of APA's Committee for the Advancement of Professional Practice. "And it takes time to file those records." Plus, she says, patients expect electronic records, just like they see in medical offices.

But, she says, figuring out how to make the transition has been a time-consuming struggle. Should the practice buy a server—with all the expense and upkeep that entails—or go for a cloud-based product? The cloud offers protection from fires or burglary, but is it secure enough, especially since a breach of confidentiality could be particularly devastating to the reputation of a rural practice? How long would it take the Prescotts and practice manager Ruth Siebert to learn a new system? Answering these and other questions has proven so difficult that Prescott now hopes to make a decision some time during the new year.

Electronic health records are worth the hassle, says Lynn Bufka, PhD, associate executive director of research and policy in APA's Practice Directorate. In addition to offering "less paper, less filing, less cabinet space," she says, electronic records make it possible to access files remotely. It's easier to share records with patients or other providers when you can just click a button to print a copy or save to a flash drive instead of copying page after page of paper records. And thanks to the security measures you can put in place, such as automatic monitoring of who accesses what information and for how long, electronic records may actually be better at safeguarding confidentiality than paper ones, says Stacey Larson, JD, PsyD, a consultant who works with APA on legal and regulatory issues. "You can see if Joe Schmo accessed the record," she says. "You might not know if someone got into the file cabinet."

The federal government is also pushing the use of electronic health records, with the hope that "interoperable" records that can communicate not just within but across practices and health-care systems will reduce redundancies and improve care by ensuring that all providers involved in a patient's care have access to test results and treatment plans. Down the road, says Bufka, referrals from other health-care providers or even payers may even come via electronic records.

Given those advantages, how can you make the process of selecting a system easier? Bufka and others suggest the following steps:

Conduct a needs assessment. Think about the capabilities your practice needs in addition to such basic functions as billing and scheduling, says Bufka. If your office offers testing services, for example, determine whether the record can store the resulting data. If you'll be storing psychotherapy notes on the system, you'll need "data segmentation," which allows those notes to stay hidden when a record is shared. Also consider who will be using the system. If your practice includes a psychiatrist or another professional who can prescribe, you'll want a system that includes electronic prescribing. You might find other features—an internal email system or a web portal for patients, perhaps—attractive.

Set a budget. Many solo or small practices worry that electronic health record systems will be prohibitively expensive, says Larson. The high prices many people have heard about came from early adopters, she says. "There weren't as many options back then, so they adopted big, big systems," she says. Others may have invested in new servers to run their systems or opted for systems with all the bells and whistles small practices may not need, such as prescribing portals in practices where no one can prescribe, she says. Systems—especially cloud-based ones—are now much more affordable, she says, adding that she has seen ones that cost as little as $50 a month to use.

When you're looking at prices, make sure you're looking at all the costs involved, not just the initial start-up costs. Other costs may include training and monthly subscription fees either for the practice as a whole or per provider.

Ensure patient privacy. "Be knowledgeable about how data are stored," says Bufka. "There's not necessarily a right or wrong answer when it comes to cloud versus localized storage, but you'll want to know the pros and cons."

Privacy is the main issue Prescott is struggling with as she searches for the right system for her practice. Cloud-based products seem very secure, she says, and the vendors would assume much of the responsibility for complying with the Health Insurance Portability and Accountability Act (HIPAA). (With a server-based system, she explains, responsibility for HIPAA compliance rests on the practice.) "Even though there are a lot of arguments that records are more secure on the cloud, many people are uncomfortable with private information being placed in the cloud," she says. "You read in the paper all the time about things being hacked." While keeping records on a server within the building would probably be best for her, she adds, it's a much more expensive option.

Review your options. If you're already using practice management software, ask the vendor about electronic health record software that's compatible so you can stick with what you're already comfortable with, suggests Larson.

If that's not possible, ask colleagues whose practices have needs that are comparable to yours what system they like, says Prescott. A colleague who touted one brand turned out to like it because of its billing feature—a nonissue for Prescott's practice, which requires patients to pay up front.

You can also view options online through an aggregator site, such as www.capterra.com, which brings together information on hundreds of electronic health record systems, including about 150 systems specifically designed for mental health professionals. "You can type in what you want, and it spits back options," Larson says.

Test the system and the vendor's technical support. Be sure to try out an electronic health record system before you commit, Larson emphasizes. Once you've got your choices narrowed down to two or three, contact each vendor and ask them to walk you through their systems. Many will even let you test demos online. "If your practice isn't tech-savvy, choose a system that's more intuitive and has good customer support," says Bufka. Also ask what kind of support you'll have as you learn the system. And remember that you can always call APA and the APA Practice Organization staff for advice. "It has been super-helpful to talk with different staff members about the research they've done," says Prescott.

Additional resources

www.apapracticecentral.org
Visit APA's Practice Central and search for "electronic health records" to watch a video on using electronic health records.

www.HealthIT.gov
Learn more about contracts for electronic health records at the federal government website.