Problems with the Electronic Medical Record in Clinical Psychiatry: A Hidden Cost

200 May 2005 Bioinformatics (BI) have led to improved genomic research, education, clinical care, data collection, billing/collection, and cost analyses. The most elemental form of bioinformatics is medical informatics, the electronic medical record (EMR). The hybrid combination of bioinformatics in its purest biological form and medical informatics is now termed biomedical informatics (BMI).1,2 Healthcare is currently undergoing a revolutionary change from paper records to the EMR.3 The degree that the EMR is used varies from one country to another.4,5 For example, the EMR is extensively available for use by more than 80% of Danish general practitioners. Benefits are alleged savings, maximization of information with rapidity of access by all clinicians, multidisciplinary coordination of medical care, increased quality of care, evidenced based medical care, education, and research.6–11 Disadvantages include the significant cost to install and then maintain Information Technology Infrastructures (ITI).7,12 Cost-benefit analyses of EMR have shown both net costs and net profits.3,13,14 Other potential disadvantages involve security, confidentiality, provider liability, and data entry errors.2,3,15–17 In large multi-specialty groups, such as academic university medical groups, the EMR can be a strong tool in clinical care, education, and research. Nonetheless, each speciality’s needs are different. In the case of psychiatry, clinicians need to capture narrative reports as well as data. When narrative reports are critical, the issue of lost information as a result of using the EMR has been raised.18 Therefore, for a psychiatrist to use EMR, he or she must be a proficient typist and there needs to be an excellent ITI and minimal dysfunction in the system. When a psychiatrist uses an EMR, he or she already pays a heavy price in decreased eye contact and ability to judge body movements and a clear change in the psychiatrist-patient relationship, while typing and monitoring the computer, without also losing narrative data to a dysfunctional EMR. This report looks at the hidden costs associated with a dysfunctional EMR when used in a university psychiatric faculty practice clinic.