Feature

In an age when we're all more technologically connected than ever, there's promising news: Early indications suggest computers are enhancing communications among health professionals.

That's what Duke University Medical Center neuropsychologist Tyler Story, PhD, has found when he has shared patients' electronic health records with other professionals. Not only does it keep others informed about a patient's treatment, the records document the type of services he provides and how those services improve patient care.

Duke orthopedic surgeons, for example, may send older patients who need hip replacements to him to conduct dementia evaluations—the results of which can determine whether they can consent to the surgery and shed light on any post-surgery cognitive decline, Story said. At an APA 2009 Annual Convention session, Story and other psychologists discussed how the move from paper to digital charts brings this and other benefits—as well as challenges—to psychology.

As spelled out in the Health Information Technology for Economic and Clinical Health (HITECH) Act that became law in February, the government is encouraging health-care professionals to digitize health records by 2014 in an effort to improve patient care and reduce health-care costs. While many psychologists believe the move has the potential to do both, the transition also raises concerns about data privacy and security, questions about the type of data that should be included in electronic health records and trepidation over how HITECH could change independent psychology practice.

"Electronic health records are an opportunity to look at some of our beliefs about documentation and information and the role of collaboration in the care we provide," said Nancy Ruddy, PhD, a practitioner in Mountain Lakes, N.J.

A careful approach

Beyond promoting psychology's value to other health professionals, electronic health records can enhance psychologists' work with clients, said Ruddy, who discussed how electronic health records are being used in public health settings.

"We have a lot to gain from that information exchange," said Ruddy. "If I am seeing someone with diabetes, I want to see what their last hemoglobin A1C was, because how they are doing with their diabetes is a pretty good indicator of how they are doing in general."

Ruddy predicted that the use of electronic records will help psychology fit in with the future health-care system, in which psychologists will increasingly work alongside physicians.

"The way we provide care now is fragmented and a source of enormous frustration to people in the medical system," said Ruddy. "I hope that as we share information a bit more, it will help us collaborate more." At the same time, using electronic records in integrated-care settings could create problems, Story said. Information such as IQ scores and patient responses to test questions could potentially be misinterpreted by some medical providers, he pointed out. To prevent this at Duke, a patient's medical chart includes a note that a neuropsychological assessment was conducted, with a prompt that more data are available as needed. If a provider is qualified to see the report, he or she can access a summary that excludes raw data and standardized scores. The full file is stored in a clinical database that a provider can send to a health professional who is qualified to interpret it correctly, he said.

"We need to strike a balance between having useful content and making sure the data is secure, making sure access is tiered and that privileges are carefully monitored," said Story.

The trend toward electronic records also compels independent practitioners to reconsider the ways they communicate with other professionals and keep notes, said Elena J. Eisman, EdD, of the Massachusetts Psychological Association.

"Our records aren't useful in an integrated health-care setting the way we've learned to do it," Eisman said. "We need to learn to communicate in a quick, clear way that will help the patient."

In fact, the benefits of using electronic records could seem unclear for many psychologists who practice outside integrated care, said Cynthia Sturm, PhD, an independent practitioner in Portland, Ore. Costs, time, technology challenges and worries that patient data could be mishandled are among independent practitioners' concerns, she said.

"In my setting, people other than the client want records for a lot of reasons that often have nothing to do with the best interest of the client," such as for military recruitment decisions, and custody and divorce cases, she said. "There's a potential for a much more adversarial use for our records."

Such concerns should be part of state-level debates about health information technology, said Sturm, who encouraged psychologists to join these discussions.

APA's Practice Directorate is carefully monitoring state and federal developments on electronic health records and HITECH, said Alan Nessman, JD, a senior special counsel in the directorate's Office of Legal and Regulatory Affairs. The government will roll out a series of proposed HITECH regulations over the next year or so that will much more clearly define how health information technology will affect electronic recordkeeping, he said. These proposed regulations will give APA the opportunity to continue to push for extra privacy protections for psychotherapy notes, test data and other sensitive mental health information.

"We have the best expertise on what should be more protected," he said.


Updates on HITECH will be featured in the Practice Directorate e-newsletter and online.