Shane Sparks, MD 1 ; J. Benjamin Guise, MD 1 ; Carol R. Thrush, EdD 2

1. Survey of Psychiatrists Views about the Utility, Accuracy, and Medical-Legal Aspects of Embedded Text in Electronic Medical Records  Shane Sparks, MD1; J. Benjamin Guise, MD1; Carol R. Thrush, EdD2 1UAMS Department of Psychiatry, 2UAMS Office of Educational Development Conclusions Automated disclaimer text embedded in EMRs is not used by the majority of psychiatrists surveyed at this time. Of those who do use it, they believe that it covers some legal documentation, and is somewhat helpful, with limited effect on “face time” with patients. The potential negative effects of automated disclaimer text are that it may make it more difficult to find information in the patient’s chart, it may be a misrepresentation of what actually happened during the patient encounter, and for a small percentage of psychiatrists it may be contradictory to the rest of their clinical notation. Though this study is limited by a small number of participants (to date), the results highlight limitations of automated embedded text in templates that merit further study. • Results • Demographics • 73% of respondents used EMRs to document patient encounters, 62% used templates in their electronic notes, and 41% used automatic disclaimer text in their templates. • Among respondents that used Automatic Text, the part of the notes in use were: HPI - 27%, Assessment - 33%, Past History - 47% MSE - 47%, Plan - 87% • Methods • Participants • Psychiatrists were recruited from among participants attending the 2009 American Psychiatric Association Annual Meeting in San Francisco, and from Psychiatry Departments of four universities: • Harvard • Tulane • University of Florida Gainesville • University of Michigan • Approximately 300 surveys were distributed in person at the APA, and emails were sent to recruit volunteers from each University. • To date, 37 participants have completed surveys. Survey • A 9-item survey was designed by the authors to assess psychiatrists’ views about: • Frequency of use of EMRs in patient care • Frequency of use of templates in the EMRs • Use of automatic disclaimer text in EMRs • The helpfulness of EMR automatic text • Effect of EMR automatic text on patient contact time • Effect of EMR automatic text on legal protection • Effect of EMR automatic text on efficiency in retrieving data from charts • Accuracy of data pertaining to the automatic text • Percentage of time the physician discusses the information contained in the text with patients • Example of Automatic Text: • “Patient educated on risks/benefits and alternatives to • medication. Patient voices his/her understanding.” Analysis • Responses to each question were summed and reported as the percent of total respondents who answered each question. • For questions with multiple potential answers (work environment and parts of notes in which automatic text occur), the percentage reported is from the total number of valid responses for that question. • Background • Although the U.S. lags well behind many other countries in adopting health information technology (Davis et al), there has been a significant push over the past several years to make electronic medical records (EMRs) the primary source of medical documentation. • Most published research has shown that hospitals with EMR systems have improved efficiency, communication, continuity of care, and decreased medical errors. • EMR systems and processes are not without risks, however. • Hammond et al, found a high risk of copying errors in 1 of every 10 medical charts. • Kaufman found lost productivity equal to one 50% FTE psychiatrist in a psychopharm clinic, due to system malfunctions. • Watson et al, found an unexpected increase in mortality coincident with Computerized Physician Order Entry implementation. • Mixed research findings exist as well; Linder et al, found EMRs were used in 18% of the estimated 1.8 billion ambulatory visits in the U.S., but were not associated with better quality ambulatory care. • With the implementation of EMRs, clinical documentation templates are common to ensure a thorough history and proper documentation for billing purposes. • As clinical templates for EMRs become more common, some institutions have begun to embed text into templates aimed at minimizing risk by automatically including pertinent negatives. No studies to date have examined the frequency or physician’s views of this occurrence. • Purpose • The purpose of this study was to explore the frequency of automatic embedded text usage by psychiatrists in electronic medical record templates, as well as their attitudes and opinions about the helpfulness of embedded text, medical/legal aspects, effect on time, ability to find information in a patient’s chart, and accuracy of information contained in chart. Shane Sparks, MD, Department of Psychiatry For additional information, please contact: University of Arkansas for Medical Sciences Sparksshanee@uams.edu