As the chair of the APA Committee on Electronic Health Records (EHRs), the most common question I get from other psychiatrists is “What EHR should I buy?” This is akin to my asking other people what car I should buy. They don’t know the amount of importance I place on fuel economy, acceleration, style, or creature comforts. My ideal car’s characteristics would be just as distinctive as those of an EHR system. So there is no universal answer to this question.
Most people do not think of usability as a feature requiring consideration in a car, as they are all designed to be usable. Steering wheel here, pedals there, and windshield, mirrors, dashboard, and seat controls pretty much in the same place across all vehicles. You don’t need months of planning and training to use a new one. Cars have perfected their user interface.
EHRs, in contrast, have not. Every one is different, displaying similar data in many different ways. They require much more preparation and training before one can start using them. We had 15 months of weekly meetings with dozens of people to prepare to use my hospital’s current EHR. That was nearly a year ago, yet users still do not feel confidant. Granted, EHRs are more complex than cars, but they can both affect people’s lives if the user interface is not perfect.
It doesn’t have to be this way. Paper EHRs did not have such an obtuse user interface. Paper charts did not require months of preparation to use. Electronic records do provide many more potentially useful features, but at a price.
The second most common question I get from other psychiatrists is “What EHR can I use on an iPad?” But why an iPad? The answers all have to do with usability—iPads are portable and simple to use, and have long battery life. You can turn it on and get access to information quickly and easily. The other reason is that psychiatrists want an EHR that allows them to do their job without first obtaining an engineering degree. Many have found that the iPad has freed them from the complexity of managing a computer, so an iPad EHR should have a better user experience than a desktop-computer-based EHR.
Indeed, many health care organizations are going tablet. A 2013 Harris survey of 204 health IT decision makers found that over 50 percent include tablets as a standard offering at their workplace. Participants in the Dell-commissioned study were mostly hospital-based and used tablets mostly for EHR access and input and for medical reference.
While generally, EHRs are not developed with psychiatrists’ needs in mind, there are some niche products that focus on psychiatrists’ needs, such as Valant, ICANotes, and Netsmart. The EHR-certifying body, Certification Commission for Healthcare Information Technology (CCHIT), has developed a specific certification for behavioral health EHRs. Only two products have earned this specialty certification: Askesis and NextGen. NextGen has a behavioral health module add-on to its ambulatory medicine EHR, while Askesis has a stand-alone behavioral health EHR. (Disclaimer: I cochaired the CCHIT work group that developed the behavioral health EHR certification standards. Also, the mention here of specific EHR products does not imply endorsement by me or APA.)
All of the above listed products are designed for computers, not tablets. But some of them have mobile versions that can connect to the desktop mothership, while those that are cloud-based can be used from any browser, including from a tablet or smartphone.
One of the best places to look for other physicians’ experiences with EHRs is AmericanEHR’s Web site at http://www.americanehr.com/Home.aspx. Physicians can complete a survey on what they like and don’t like about the EHR they use now. APA recently partnered with AmericanEHR to add psychiatry-specific questions to the survey. By choosing “Advanced Search,” you can tailor your view to see ratings by psychiatrists filtered by practice size and care setting. For example, choosing a practice size of one to three physicians and the setting of outpatient office, 17 products are listed, though only nine have the minimum volume of ratings to enable a comparison. Interestingly, none of the above-mentioned products is listed for solo practitioners. Unfortunately, the comparisons do not indicate which ones run as an iPad app, though one can filter to see only cloud-based products. The products with the most ratings were eClinicalWorks (156), AmazingCharts (78), and e-MDs (49). AmazingCharts had the highest rating for usability (4.45) and for interfaces (3.84).
Another place where psychiatrists can look for data on EHRs is the Web site of the Center for Medicare and Medicaid Services (CMS) at http://bit.ly/psychITmu13. CMS regularly lists the thousands of physicians who have attested to being “meaningful users” of certified EHR products, including their specialty. As of December 2012, over 900 psychiatrists have received their incentive payments for attesting to meaningful use. The data list satisfaction ratings and names of EHR products. With regard to the products attested to, the majority of psychiatrists who attested are hospital-based physicians: Epic accounts for more than half of the attestations (satisfaction=3.46). Others listed include Practice Fusion (3.69), Allscripts Enterprise (3.06), and NextGen (3.07).
So, where are the tablet EHRs? While other tablets are available, the majority of tablets in use are of the Apple flavor. So the iTunes App Store would be a good place to start looking for a mobile EHR, especially one that has a high usability level. We’ll look at these in a future column, including any input you send me about your own experiences with tablet EHRs. ■