EHRs on the Therapy Couch

EHRs, often designed as a one-size-fits-all factotum, present a special implementation challenge when it comes to niche specialities. One such area is behavioral therapy. Therapy's unique needs challenge some of the common practices in ambulatory care and introduce specific requirements. The following points attempt to capture a few of these unique needs:

1. Patient? Many behavioral therapy organizations do not refer to their consumers as "patients" but as "clients". While this may sound like a minor point of terminology, it makes a lot of sense: seeking counsel and therapy, most individuals do not consider themselves to be sick. However, the term "patient" is deeply ingrained and widely used in most EHRs, even in areas visible to the client: The patient portal, patient statements, the patient kiosk, and more. Therapy organizations would do well to seek a solution with maximum flexibility on this front.

2. Data Sharing for Thee But Not for Me! With MIPS, MACRA, PCMH and countless other incentives, EHRs are now built (or attempted to be built) to share information more easily. This does not only mean compatibility with HIEs or external interfaces, but also a built-in user interface that allows for the viewing of charts, orders, client names and provider schedules by administrators and clinicians across the organization. Naturally, this is not a good fit for therapy practices, where many clients wish for their charts and names to never be seen by anyone but their own therapist (in fact, this drives therapy consumers to independent practitioners in some cases).

3. Panic! At the Front Desk. The therapy front desk experience is much different from common ambulatory practice. In regular ambulatory clinics, experts and consultants have drilled-in the necessary "streamlining" of the check-in experience through a process of identity verification, insurance verification, co-payment charging and more (you know the drill!). This does not work in therapy. The average therapy client wishes to be left alone, especially if the waiting area is busy, and in some cases may respond negatively to prying questions regarding one's identity and finances. Therefore, it makes sense to promote self-check-in as much as possible through an EHR that supports kiosk, online payment and online registration functionality.

4. Coupling and De-Coupling. Like molecules subjected to Van Der Waals's equations, therapy clients may appear individually, then in a family group, then in a couple, then in a family again. Notes, records and accounts have to be flexible enough to avoid littering the system with duplicates (an account for the family, an account for the individual, etc.) yet also to preserve the different appointment and case types. Note that such flexibility extends to billing as well: An individual may be the one responsible for individual therapy, but not for a couple's therapy.

5. What Diagnosis? Many therapy clients prefer to not be associated with a diagnosis or an illness. While insurance billing typically requires the statement of a diagnosis, this is not necessarily the case when it comes to self-pay, a category that is very common in the therapy market. Meaning (and this may vary by state), self-pay statements and charges should ideally allow the flexibility to not include a diagnosis, even a generic one.

Based on my experience the search for the perfect therapy EHR is bound to end in disappointment. At this point, the market offers either general EHRs with reasonable therapy capabilities or highly specialized solutions that are difficult to scale. However, a satisfactory optimum can be found through defining priorities and must-have functionality. The above list hopefully illuminates some of the key areas that should be marked as high-priority.

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