Guest Blogger Dr. Jeff Soulen on the Pros of E-Prescribing

Over on our Clinical Psychiatry News website I'm writing about my struggles with electronic prescribing.  The post, "To E-Prescribe or Not? That is the Question" will be posted on December 7, 2011.  In order to write it, I bothered just about every shrink I know, or it least it felt that way.  One of the psychiatrists who was kind enough to respond with a great deal of useful information was Dr. Jeff Soulen, a psychiatrist in private practice, who has had a positive experience.  This is Dr. Soulen's first experience as a blogger. 
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I've been using Allscripts for about 3 years now, and I must say I like it a lot. It's free (no need to sign up for the paid Deluxe version) with a browser-based interface, so I can access it anywhere -- helpful when I'm away from my charts.  I pretty much do 100% of my scripts electronically except controlled substances, for which it's still illegal to e-prescribe. What I like about it:

• I see a list of every script my patient has filled, including those from other docs, though this information is sometimes spotty. It's led to some important discussions about controlled substances I didn't know the patient was taking, drugs that have interactions with the ones I'm prescribing, etc. Kind of wondrous to enter a patient's name, zip and birth date and 5 minutes later the whole list is on your computer screen.

• Patients love it.  Once they are in the system-- which takes a couple minutes the first time-- it takes me no more time to send a script electronically than to hand-write it, and by the time they get to their pharmacy later that day, the script is ready for them - no need to bring a paper script and wait.

• For repeat scripts, it's faster than hand-writing - select from the list of scripts you've sent previously for that patient and send.

• No more transcription errors from a paper or phoned script.

• It's been a huge time-saver in that I no longer get calls requesting refills of scripts where I wrote refills, but the pharmacy in their rush put 'no refills' in their computer. This used to happen a lot.

• All the mail-order pharmacies seem to be tied-in at this point, so sending mail-order scripts electronically is as easy as sending to a local pharmacy. Way faster than filling out fax forms by hand, then faxing them. And patients seem to receive mail-order meds about 4 daysafter I send an electronic script - significantly faster than faxed or phoned scripts.

It is true that an occasional script fails to make it through the system to the destination pharmacy. So far that's been well less than 1% of the scripts I have sent, and re-sending a script a few times a
year takes much less time than calling patients/pharmacies several times a month to tell them that yes, the original script did have refills on it.
 

If you want to prescribe from a smartphone, you have to purchase the Deluxe version.  I don't know how much that costs.

Bottom line, for my solo private practice it's been terrific -- faster and more accurate for me, gives me information on drugs my patients are taking and have failed to mention, and patients love it. I e-prescribe for all those reasons, not because of Medicare penalties.

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If you surfed over to the CPN article, you'll know that my experience with e-prescribing has not been as happy as Dr. Soulen's.  Of course you're invited to tell us about your experiences...

25 Steps to get rid of a Mental Blocks

Review Details Adolescent ADHD

Identify Symptoms of ADHD Children

Hurricane Katrina Survivors Lack Access to Mental Health Services

Not in My Record!

For a while now we've been talking about issues related to psychiatry and electronic medical records.  Roy is very interested in the evolution of EHR's.  


I don't like them.  I think they have too many problems still, both in terms of issues of efficiency and time, and how they divert the physician's attention away from the patient, and they focus medical appointments on the collection of data-- data that is used in a checkbox form: patient is not suicidal and I asked, whether it was clinically relevant or not-- and will therefore serve as protection in a lawsuit, or demographic information used by insurers, the government, who knows.

From a privacy standpoint, I think they are appalling.   If you are a patient in the hospital where I work, you get no say, your info goes in to the electronic record and everyone who treats you can access it.  And anyone else who uses the medical record in the hospital can access it as well; the "check" on the system, since much of our city is treated at this hospital, is the after-the-fact threat/fear of being fired or disciplined for looking at someone's record you shouldn't.  I believe the check should be before the fact-- that a patient should have a code, or PIN number they punch into the system that unlocks the system for that particular healthcare provider.  Or something akin to that.  


But what about the fears that people express on our comments that they will be judged and dismissed if their doctors know they've seen a psychiatrist or taken a psychotropic or been hospitalized?  On one hand, there is the idea that this information is more sensitive and should be protected, so that psychiatry records have traditionally been kept out of EHRs.  On the other hand, there is the belief that calling them "sensitive" further stigmatizes psychiatric disorders and it's time to treat them like every other medical problem.  


I will tell you that last year when we did a survey of Attitudes Towards Psychiatry, 41% of respondents thought psychiatry records should not be segregated.

Electronic Health Records (EHRs or EMRs) . . .

should not contain any records of psychiatric illnesses and treatments (including medications) even though that means my primary care doc or ER doc wouldn't know about my meds or condition unless I tell them 89 13% should have separate and higher protections for mental illness than for other health problems 218 32% should exist for psychiatry exactly as all other medical records do, with the same protections as for other health condition, because adding special protections increases stigma against mental illness 275 41% should allow patients to control which information they wish to be shared and with whom for all medical specialties 290 43% facilitate better communication and improve psychiatric care 261 39% negatively affect communication and detract from psychiatric care 49 7% I have no significant opinion about electronic health records in psychiatry 74 11% Other 94 14% People may select more than one checkbox, so percentages may add up to more than 100%. Your thoughts?  25 Steps to get rid of a Mental Blocks Review Details Adolescent ADHD Identify Symptoms of ADHD Children Hurricane Katrina Survivors Lack Access to Mental Health Services

Holiday Greetings, Approved by Our Lawyers and Institutional Review Boards

Best wishes for an environmentally conscious, socially responsible, low stress, nonaddictive, gender neutral, winter solstice holiday, practiced within the most joyous traditions of the religious persuasion of your choice, and with respect for the religious persuasions of others or their choice not to practice a religion at all; a fiscally successful, personally fulfilling, and medically uncomplicated recognition of the generally accepted calendar year 2011, but not without due respect for the calendars of choice of other cultures whose contributions to our society have helped make our country great.  This greeting is being sent to all without regard to political party, race, creed, color, religion, nationality, immigration status, sexual preferences, gender identity roles, physical or mental capacity, literacy, or marital & civil union status.

This greeting is subject to clarification or withdrawal. It implies no promise by the wisher to actually implement any of the wishes for her/himself or for others.  The implementation of those wishes, however, should be done in a manner that is compatible with the policies set forth by the Americans with Disabilities Act.  It is in no way to be construed as effecting a contractual obligation of any sort on the part of either the wisher or wishee.

This winter greeting is HIPAA compliant.  Your acceptance of our greeting will not be released to parties other than insurers, pharmaceutical companies, and market research institutions. If you wish to accept our holiday greeting, please read the six page document that accompanies this greeting and check the box that says "I have read and accept the terms of this winter greeting."  Please note that these terms are not negotiable, but they can be exchanged for another holiday greeting for a 10% restocking fee.   

25 Steps to get rid of a Mental Blocks

Review Details Adolescent ADHD

Identify Symptoms of ADHD Children

Hurricane Katrina Survivors Lack Access to Mental Health Services

Can Facebook Prevent Suicides?

Facebook is launching a new suicide prevention chat hotline for those who post worrisome comments on their walls.   From an article in Newsday:

Here's how it works:

A user spots a suicidal comment on a friend's page. He then clicks on a "report" button next to the posting that leads to a series of questions about the nature of the post, including whether it is violent, harassing, hate speech or harmful behavior.
If harmful behavior is clicked, then self-harm, Facebook's user safety team reviews it and sends it to Lifeline. Once the comment is determined to be legitimate, Facebook sends an email to the user who originally posted the thoughts perceived as suicidal. The email includes Lifeline's phone number and a link to start a confidential chat session.

The recipient decides whether to respond.
Facebook also sends an email to the person who reported the content to let the person know that the site responded. If a suicide or other threats appear imminent, Facebook encourages friends to call law enforcement.

Playing with Pigs

Playing with Pigs: Pig Chase from Utrecht School of the Arts on Vimeo.


I want this game. A company in the Netherlands is working on an iPad app that will let people interact remotely with pigs on a farm. Apparently pigs like to interact with bright balls of light. This app creates bright spheres of colored light on a panel in a pig sty. The pig touches the light with his snout, which scores a point. The number of touches racks up a score, and at the end of the game the high scores get displayed on the iPad. I'm not sure if the human is training the pig to touch the screen, or if the pig is training the human to play longer with an iPad. Either way, it looks like a lot more fun than Angry Birds.

Here's the web site for the video:

Playing With Pigs

And the other amazing thing is that we already have a "pig" label on the blog. Have we really talked about pigs here before?

And for Jesse, a hamster:




And here's one from Roy with ants...

Missed Opportunities?

Before I begin,  I wanted to let you know that ClinkShrink wrote a post called Can You Tame Wild Women? over on our Shrink Rap News blog this week. 
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When we talk about psychotherapy, one aspect of what we look at is the process of what occurs in the therapeutic relationship.  This is an important part of psychodynamic-based psychotherapy, meaning psychotherapy that is derived from the theories put forth by Freud.  Psychoanalysis (the purest form of psychodynamic psychotherapy) includes an emphasis on events that occurred during childhood, and a focus on understanding what goes on in the relationship between the therapist and the patient, including the transference and counter-transference. 


In some of our posts, our friend Jesse has commented about how it's important to understand what transpires in the mind of the patient when certain things are said and done.  Let me tell you that Jesse is a wonderful psychiatrist, he is warm and caring and attentive and gentle, and he's had extensive training in the analytic method, he's on my list of who I go to when I need help, so while I want to discuss this concept, I don't want anyone, especially Jesse, to think I don't respect him.  With that disclaimer.....


On my tongue-in-cheek post on What to Get Your Psychiatrist for the Holidays, Jesse wrote: 

 When I say the Shrink should look at the context, even in small matters a gift might come with a subtext: "I just told you some terrible things about me and I want to be sure you still like me." It can be a bribe. It can be a seduction. It can simply be a gift given out of gratitude. The important concept is that we think about everything. Unlike a physical examination done by an internist, everything that occurs might be some window into how we can help the patient, and we do not want to lose that opportunity.

So wait, the patient comes to me because he symptoms of a mental disorder, often depression or anxiety, or problems controlling his behavior, or he's overwhelmed with stress and isn't coping well. Why is it so important that we understand every aspect of the sub-texted interactions?  How does this cure mental illness?  Why is it bad to accept (or not) a gift and move on?  Why do we have to think about everything?  And if it's really important, won't it come up again?  Is it really crucial that we not lose that opportunity?  Maybe I just want to take the cookies and say 'thank you' because

•   A) I don't want to hurt my patient's feelings,
•   B) it can be difficult to look at the meaning without upsetting the patient or putting the patient on the defensive and so the patient has to be fully on-board for this type of therapy and those patients generally don't bring gifts (ah, maybe we should be asking all analytic patients why they didn't bring gifts, now that might yield interesting information), and 
•   C) I like cookies.

So the truth is that on these posts, the comments are always the most interesting part, so do write in and let me know what you think, not specifically about the cookie/holiday gift example, but about how important it is to understand the interactions that occur within the context of the psychotherapeutic relationship.  


Just so everyone knows that I am still Jesse's friend, I am posting the video he sent me of his late grand-chinchilla, Chinstrap.  And yes, Jesse had a grand-chinchilla.  He does assure me that Chinstrap was having a good time in this video, because I wondered. 




And I'd like to thank Steve over at Thought Broadcast for providing the graphic for today's post.  

25 Steps to get rid of a Mental Blocks

Review Details Adolescent ADHD

Identify Symptoms of ADHD Children

Hurricane Katrina Survivors Lack Access to Mental Health Services

Does Mental Illness Make People Better Leaders?

We've talked before about whether people with mental illnesses can be politicians (or pilots, or doctors).  Today, on Midday with Dan Rodricks on WYPR, psychiatrist Nassir Ghaemi, author of A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness makes the case that in good times, we need sane and stable leaders, but that in difficult times, "insanity produces good results" and that in hard times those with mental illness are better leaders.  He talks about how mood disorders lead people to be more realistic, empathetic, resilient, and creative.  Want to hear more?  Click HERE to listen.


Kind of nice to hear a positive take on psychiatric disorders for a change.  Tell me what you think.