Monday, October 1, 2012

Psychotherapy and Electronic Health Records (EHR) Q & A

EHR Q&A: Answers to Mental Health Practitioner’s Most Frequently Asked Questions
By Jill Squyres, PhD

Lately, there’s been a lot of buzz about electronic health records.  Here are answers to some of the most frequently asked questions about EHRs as they relate to mental health practice.

What’s the difference between an EHR and an EMR? What does this have to do with PII and PHI?
The digital age in health care requires us to keep track of a veritable alphabet soup of acronyms!  While the terms EHR and EMR are often used interchangeably, by the most stringent definition, EHR (Electronic Health Record) refers to all of a person’s health information maintained in an electronic format.  EMR (Electronic Medical Record) generally refers to a patient’s chart maintained by a health care practitioner or organization.  An electronic document that includes data entered by a health care provider as well as information added by the patient would be an EHR by this definition.  Many people are starting to use the term EMR to refer to both as a convenience because when typing in Microsoft Word, the spell check function automatically changes EHR to HER!  PII stands for personally identifiable information and PHI is protected health information, both of which are included in the EMR.  HIPAA guidelines require us to take careful security measures to protect PII and PHI.

Do mental health care practitioners have to use an EMR?
Currently, counselors and psychotherapists are not required to use EMRs.  However there are many benefits to an EMR that may outweigh any drawbacks.  Physicians currently have guidelines requiring them to adopt EMRs.    

I’ve heard the government will pay you a lot of money if you start using an EMR.  Is this true? 
Medicare and Medicaid have initiated an EHR (this is the term these programs use) adoption program that offers substantial cash incentives for meaningful use of electronic health records.  Detailed meaningful use criteria have been developed by Medicare and Medicaid.  At the present time, none of these criteria pertain to mental health practitioners so we are not eligible for these incentive payments.  However, mental health professional organizations, such as the American Psychological Association, are lobbying government agencies to have mental health care criteria included in the next stage of meaningful use incentives.

What are the benefits of using an EMR?
EMRs can make managing client documentation much easier and more convenient.  Most EMRs also include an entire suite of practice management tools including a scheduling calendar, billing module, and online insurance claim filing in addition to the standard chart.  Progress note templates and intake, assessment, and treatment planning forms are often included as well.  Of course, all documentation kept online saves paper, filing space and shredding costs.  Records requests can often be accommodated by faxing the documents directly from your practice computer, saving on mailing costs, paper and postage.  EMR developers are now adding integrated video conferencing modules to their software to make initiating online sessions a point and click option.  Online EMR’s offer the added convenience of being able to access your client’s chart and contact data from any device anywhere with internet access. 

If I use an EMR does it have to be online?
There are several different types of EMR software.  One type is stand-alone software that you load on to one personal computer.  This software does not require an internet connection and all of your data is stored on the single computer it’s loaded on.  Of course, frequent back-ups to a hard drive, data CD and / or a thumb drive will be necessary if you are using this type of system to protect against loss of all of your patient data.  From a HIPAA compliance standpoint, this type of system is the most secure, although a stand-alone computer can still be stolen or accessed by unauthorized personnel resulting in a data breach.  The risk of losing all of your data in a disaster or computer crash is an important consideration from a risk management stand-point as well.  While there are security issues to consider with web-based systems or online back-up, it is not acceptable professionally to lose all of your clients’ mental health care information because your computer died or you experienced a natural disaster or fire.

How do online EMRs work?
Online EMRs are generally accessed over the internet through a secure browser window.  Most will work with any browser software although some programs will only work on PCs, not Macs.  Traditionally, EMR software has not worked on tablets, PDAs or smartphones, however, many vendors are adding apps, which can be purchased for an additional charge, for convenient access on mobile devices. Large medical practices and hospitals often purchase software that is loaded onto a dedicated server which may be physically located on their premises but this is not an affordable option for private practitioners or small group practices.  This set-up allows for an online record that is only accessible to devices on the facility’s private network.

Can I be sure my online EMR is HIPAA compliant?
The developer of your software should provide documentation of their security measures and compliance with HIPAA standards.  Any browser window accessing an online EMR should have an address beginning with https: instead of the usual http.  Your EMR software vendor should also require you to sign a business contract attesting to their security measures for HIPAA compliance.

What about all of my paper notes?
Of course, you can keep all of your paper notes filed the same way you have traditionally kept them and start keeping records electronically from the date you implement your EMR.  Many clinicians purchase a scanner and scan in old records so the paper copies can be disposed of.  Most EMR software allows for easy uploading of paper documents.  Some clinicians even continue to write their notes on paper and then scan them into the client’s EMR when they close out the appointment.

I’m already spending a lot on running my practice.  Is it expensive to adopt and EMR?
There’s a lot of competition in the mental health electronic record market, which helps keep costs down.  For the most part, you will pay more for extra features like patient portals, billing features like automatic credit card payments and insurance filing, templates and state of the art interfaces.  The cost for most software is charged as a monthly fee although some companies charge an additional fee to get your account and data set up.  This set up fee can also include transferring data from old software to your new EMR, which may look expensive but can cost much less than paying someone hourly for data entry to get you up to speed.  The typical monthly cost ranges from $60 - $150 per month depending on what features and technical and administrative support you want from your software provider.  There are also free options, which are not specifically designed for mental health providers but can be easily adapted to our needs.

Twitter: @drjsquyres    Facebook: JillSquyresPhD

Not to be copied without written permission.
Text copyright 2012 by Jill Squyres, PhD.  All Rights Reserved


  1. Hi all,
    Thanx for all your comments. Very wellknown made. Is it really read like your comments.
    I hope you will continue to............

    Electronic Medical Records

    1. “EMRs can make managing client documentation much easier and more convenient.” – Definitely! With the use of electronic medical bills, patients can have a detailed and immediate access to or report about their personal medical records without delay. The process is incredibly quick, allowing the retrieval of their documents as soon as possible.

      James Guertin

  2. Using EHR has lots of advantages, both for the patient and healthcare providers. Aside from efficiency and convenience, it improves the coordination of care. With EHR, you can be assured not just of accurate and detailed records, but as well as the record’s security and privacy because the transfer is done electronically from provider to provider, hospital to hospital.

    -Almeta Tai

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  4. Thanks for sharing your info. I really appreciate your efforts and I will be waiting for your further write ups. Thanks again.

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  5. mycarevault Electronic Medical Records (EMR) offers care providers an ambulatory EMR that integrates well with revenue cycle management, patient management, and practice management solutions.

  6. The great thing about Electronic Health Records is that medical personnel can provide accurate, up-to-date, and complete information of their patients. That being said, health practitioners can diagnose their patients more effectively, preventing medical errors, thus providing them better health care. Likewise, patients are given the chance to have a better understanding of their medical condition as well.

    Carie Jewell @ Avanti Management Group, Inc

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  13. You may not be able to maintain, update or share your diagnostic reports and health records with your doctor from your home or anywhere, i have used one of the great online health record service, please check it It gives your doctor the facility of remote monitoring for your extra care and also allows your loved one to check and maintain your records. Say bye bye to those bunch of files of reports and records.

  14. Nice blog! EHR vs EMR has been a confusing topic for me before but I think you really need to know what's their difference so you could avoid misunderstandings during the process of using these softwares. Thank you very much for posting such useful blog.

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