EHR for psychiatric patients
Referring to a recent article on specific aspects of EHR for psychiatric patients, we would like to start a discussion on how the EHR can help the psychiatric community as well as how to deal with these specific issues. We would like to invite clinicians as well as patients to participate.
“Psychiatric treatment records are unique because of their narrative content and their need for greater privacy protection.”
When Psychiatric Records Go Digital
Lois J. Moore, H&HN’s Most Wired, October 2006
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Just as a follow-up to this article – Physicians have the option of using either
Structured Notes with drop downs, question/answer sets, check lists etc – or using free text style progress notes.
Initially, physicians preferred the structured notes due to the decrease in typing. However, since learning about the
system’s ability to provide “acronym expansion” (where the user assigns abbreviations to stand for text), physicians have
been able to create their own templates, apply acronym expansion in a free text note, and then edit to fill in pertinent
data.
In relation to record access and pychiatric records, I know there has been
some discussion on this blog. I am trying to get in touch with MIND (a charity in the UK representing patients with mental
illness) to include them in the discussion.
There are a few key issues I think:
1. patients with mental illness
are seen by professionals as peculiarly vulnerable (are they?)
2. the content of the record can sometimes go to the
heart of a person’s feelings about themselves (does that mean they should not see them?)
3. in psychotherapy and
counselling, records may contain the therapist’s analysis of the patient’s fantasies which the therapist may not intend
to discuss with the client at any time. (how should this be handled?)
4. the psychotherapy notes may also describe a
patienrt’s disturbing fantasies (murderous, for instance). If this went any further, the patient might be seen as at risk,
even though these were fantasies that have no intention of being carried out.
I’d welcome comments and solutions.
Also, I’d be interested to develop research in this field – to develop strategies for handling this in conjunction with
counsellors and psychiatrists.
Brian Fisher
GP with 20y experience of record sharing
I believe that a summary of patient records is acceptable for other clinicians to see, but the full records access is an individual matter due to the varying aspects of each case.