Psychiatric Informatics: Exploring Myths and Barriers

Over the last several months we've had the pleasure of sharing our thoughts about information technology and informatics through presentations at meetings, articles and conversation with colleagues. The response has been astonishing. We've been accepted, rejected, encouraged and discouraged in our pursuit to educate others and share our vision about the inevitability of information technology as a necessity for the survival of our field.

Often those who are most critical voice their opinions without any other direct experience than dealing with the local automated teller machine or seeing their son or daughter at work on their own home computer. Nevertheless, such critics have extremely strong views about why information technology is bad and should be avoided. It is our view that such opinions are based on ill-formed fears.

In this article we hope to deal with these fears. They are usually based on myths that often contain a grain of truth. These myths are the real barriers information technology faces, and they have contributed to the problems that have been encountered in its acceptance and development.

Myth No. 1.

I don't need computers in my work. There is some truth to this. Paperwork done in association with clinical care has been and can always be just that-paperwork. Computerization is not required. The falsehoods of this belief are the assumptions that information technology impacts only documentation and that our clinical work will continue to consist primarily of direct delivery of care. Patient contact is changing! Managed care and other market forces will continue to result in our doing less direct care and in making us more peripheral.

We will be asked to manage a growing number of cases that require our knowing patients yet seeing them less. We will need improved communication tools to keep us in contact with colleagues providing care, and data bases to track and manage our caseloads. We will need to constantly deliver information to utilization reviewers and managed care supervisors. It may be that some individuals can escape the onslaught of managed care and the information era by restricting or moving their practice. The majority, however, will need computers and computer training not just to prosper, but to survive.

Myth No. 2.

If I wait, things will stabilize and the prices will come down. Watching the prices of desktop computers plummet and seeing newer "user-friendly" interfaces under development, it is tempting to think that one should just wait for the field to stabilize and for easy-to-use systems to emerge. Historically, Moore's Law has held for decades: computer chip speed and power doubles every 18 to 24 months and the price falls by approximately 50% during the same time period. Why not just wait?

Although it is true computers will get more powerful and easier to use, there is never a right or a wrong time to start learning or to make your purchase. There will be no single point where the computer industry will stabilize and innovation will slow down, making it easier to get on board. It is a relentless field with millions of people constantly at work. There is no end in sight.

Like the previous myth, this idea is rooted in the desire to avoid change and to continue doing clinical work as it was done before. The rapid advance of technology is intimidating in the amount of time required to attain and to maintain proficiency. The true barrier is not that we are waiting for the equipment market to stabilize, it is the large investment in learning and impact the change will have on one's work and business practice. Such a major alteration results in changing more than just one's routines. It also extends to one's sense of self and accomplishments as a psychiatrist and practitioner.

In the end, you start when you want, with what you can afford. There are many courses offered through local colleges and community groups that teach the basics a person needs to know before they purchase their first system. Although the system you buy today may have to be replaced in two to three years, start now! Our recommendation is to get the most you can afford from what is a relatively stable company with a well-respected product. This will require some homework on your part, but it will pay off. Even if you must purchase a low-end machine because of financial constraints, it is important to begin somewhere and continue building.

Myth No. 3.

I'm too old to begin thinking about computers. This is ageism at its worst. Too often, I've heard my colleagues talk about themselves as if being 55 or older condemns then to never trying any new technology. This is just not the case! In fact we have had the pleasure of having Rosalie Ging, M.D., (University of Michigan, Medical School 1945), professor emeritus, department of psychiatry, University of Michigan, in our multimedia laboratory not as just a consumer but as an active participant. She has helped with the development of the department Web site and is proficient in programming html (hypertext markup language), the special coding language of the Web. She talks about her interest and thoughts about working on the Web (see related article). The barrier is not age, but the individual's trepidation upon entering a new and unfamiliar world.

Myth No. 4.

It's easier for men to understand computers than women. This is sexism at its worst. Worse yet, it's a statement that I've heard more from women than men. There is no evidence to support this notion. Certainly there has been and is a bias toward men being more involved with computers and technology, as clearly demonstrated by the organization and the content of the Web. Nevertheless, as anyone who has visited an elementary or middle school will attest, when computers are available in the classroom, they are fought over by both the girls and the boys. Times are changing. Technology knows no gender bias.

Sheila Marcus, M.D., assistant clinical professor, director of ambulatory division, department of psychiatry, University of Michigan, came to our group a couple of years ago and expressed an interest in computers. Yet despite an obvious aptitude, she talked about her son and her husband being the people in her life that she would turn to. In the accompanying article she talks about her fears and doubts. She is working on an application development team as well as providing leadership on the development of a computer-based on-screen multimedia presentation about postpartum depression. Not bad for a person who felt that she could never learn about computers. Attitude is everything!

These are just a few of the myths we've heard. In future articles we will deal with related issues such as confidentiality and security, and the dehumanization of technology. There will always be reasons why someone will resist becoming involved with computers. Yet, we need to separate the myths that we use as excuses to hide from our own fears, and the true barriers that we must overcome to do this work. It is an inevitable part of our future. Through constant analysis and discussion we will move forward. Getting involved with the information era does not happen by chance-you have to be purposeful and sometimes downright diligent, but anyone can and should become involved if they hope to practice in the 21st century.