Psych EMR effort poses special challenges

When the University of Texas-Harris County Psychiatric Center decided to digitize patient records, execs faced all of the usual barriers to EMR adoption, as well as a few challenges unique to their discipline. In addition to tackling standard automation challenges, administrators had to deal with narrative-heavy records and particularly stringent privacy requirements. During the three-year project, the organization struggled to find a combination of technology and workflow strategies that served their purposes.

Getting the interface right took a lot of time. For example, to avoid transcribing delays, UT-HCPC developed a dropdown menu template allowing doctors to enter progress notes easily. While the system worked, it took a lot of back-and-forth with providers to find the right dropdown choices. Also, administrators found that while the templates helped,doctors still needed individualize the notes with free text entries to capture the detail needed. Also, in response to doctor feedback, execs limited the number of EMR screens physicians had to access to get their work done.

Center execs also found that it was critical to back up automated records with verbal communication. For example, while nurses were used to having physicians physically flag paper records if patient precautions were needed, the nurses weren't in the habit of checking the EMR. The hospital found that it had to institute rules requiring physicians to check in verbally with nurses.

For more background on the EMR effort:
- read the Healthcare's Most Wired write-up

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