Psychiatrists (especially this one) have a conflicted relationship with technology and particularly internet-based programs. On our main Shrink Rap blog, we have posted quite a bit about issues the psychiatrist grapples with as we figure out how new technologies can be helpful. I will post some links at the end of this article, and pleae do check out my post on Clinical Psychiatry News on Siri and the Psychiatrist.
Why are psychiatrists conflicted? Well, like everyone else, we're struggling with ways to harness technology to make for better medicine: to improve communications in a way that promotes safer care when it comes to issues like drug interactions and med/psych historical information that help with accurate diagnoses. We're also looking for ways to lighten our work load and make ourselves more efficient. Oh, and a lot of the toys and apps and social networking stuff is very fun!
So what's the conflict? Well, so far, there are many concerns about confidentiality and discretion in all realms of techno-life and psychiatrists and their patients may be very sensitive about these issues. Electronic Medical Records have traditionally excluded psychiatric notes, though that is changing, and concerns about sensitive information are increasing. What about a single psychiatrist's computer notes-- who can access them if he backs them up on a cloud, much less what happens if they are submitted to a centralized medical record that can be accessed by other health care workers?
Technology is not inexpensive and it requires time learn it and time to use it. Medicare has mandated that psychiatrists prescribe medications electronically (eprescribe) or a face a 1% fee cut. With few exceptions, the psychiatrists I know have calculated that the cost of implementing e-prescribing is far more than the lost fees will be. At a clinic where I work, I e-prescribe and 8 months into it, it still takes much much longer than writing a prescription. We know that using electronic medical records takes longer than writing notes, is subject to errors, slows efficiency, and is tremendously expensive.
And what about the doctor's privacy, or even issues of discretion and dignity? Should psychiatrists be on Facebook? Should they be tweeting and blogging? How does social media change the doctor-patient relationship?
I have been experimenting with ways to make technology helpful to me and Siri, the new iPhone 4s "personal assistant" is the latest addition to my practice. . A mix of some practical tips and a bit of humor...
If you'd like to read more about psychiatrists and technology over on other blogs, let me suggest:
Electronic Hair Records (warning, satire alert)
Does Anyone Know... (on psychiatric society listservs)