Is an electronic medical record useful in the PES setting?

Emergency psychiatrist, New York City

Electronic medical records (EMRs) are becoming increasingly common in health care. Many hospitals use computer systems for some aspects of patient care, including gathering demographic and insurance information, posting laboratory results or radiology reports, providing access to transcribed dictations, and listing currently prescribed medications.

Within a psychiatric emergency service (PES), documentation of assessments and care given is still done primarily with handwritten notes. However, a PES is a good setting for an EMR system, because all patients receive a similar type of assessment and communicating the results of the assessment with other health care providers and services is crucial. Unstructured, handwritten notes are often difficult to read, especially when faxed, and may omit some important information. An EMR has the potential to improve the clinical care given by ensuring that notes are complete and that written communication with other health care providers is clear.

A PES considering the development of an EMR system needs to be aware that it is a large and costly project; there are currently no commercially available products specifically for a PES. The PES staff must determine what information is needed and how it will be documented (eg, free text vs forced-choice responses). Since most hospitals have some sort of EMR system, hospital staff may be available to help design an EMR system and submit a proposal to a software company to create the required product.

There are many advantages to having an EMR system in the PES setting. The benefits of an easy-to-read, typed, structured note cannot be overstated. Health care professionals in services providing further care to PES patients will love your EMR. A well-structured note guarantees that all necessary information is collected on every patient and can be found in the same place in every note. This makes it easier for learners (especially medical students) to write complete notes. The EMR system can be especially efficient if it interfaces with the hospital's system for demographic data; bringing information from old notes, lab work, or other dictations into the EMR system can also be helpful.

Having an EMR system can ensure that all notes are medicolegally sound by requiring the documentation of necessary topics such as suicide and violence risk, and informed consent for treatment. Depending on the system, health care professionals in other services may be able to easily acquire notes electronically, simplifying their access to previous PES assessments. In addition, an EMR system avoids double entry of data for research purposes or administrative service review. Statistics about the PES patient population can easily be generated, depending on how the EMR system is designed, and can be used for many purposes, including quality assurance.

There are also disadvantages to an EMR system in the PES setting. Foremost, developing a useful EMR system is time-consuming and very costly. Implementation can be disruptive and must be managed carefully to ensure support for the system by all users. A significant drawback to comprehensive notes is that they are time-consuming to complete, which can slow down the clinical service significantly. An EMR system that is difficult to modify can become obsolete as clinical needs change. If it does not meet the needs of the service for any reason, an EMR system can quickly become frustrating for all staff. Also, concerns about confidentiality need to be considered if the EMR system is to interface with other hospital data systems. Lastly, staff members who never learned to type may face considerable difficulties in adapting to an EMR system.

The director of a PES needs to carefully weigh the benefits and disadvantages in deciding to implement an EMR system.

Jennifer Brasch, MD

Medical Director

Psychiatric Emergency Service

St. Joseph's Healthcare Hamilton

Associate Professor

Department of Psychiatry and Behavioural Neurosciences

McMaster University

Hamilton, Ontario