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Health information technology is increasingly permeating psychiatry and behavioral health interactions.
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Limited data suggest that health information technology does not have to negatively impact the patient–provider relationship.
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Thoughtful interaction strategies and appropriate boundary setting strategies are needed to mitigate any potential impacts.
Child and Adolescent Psychiatric Clinics of North America
Volume 26, Issue 1, January 2017, Pages 67-75
The Impact of Health Information Technology on the Doctor-Patient Relationship in Child and Adolescent Psychiatry
Section snippets
Key points
How health information technology impacts psychiatric care
The impact of health information technology on the therapeutic relationship between patient and psychiatrist can be felt in several domains. The most obvious is the impact on the clinical visit itself. The arguably less-intrusive method of pen and paper note taking is increasingly being replaced by a computer monitor and keyboard that demand active attention over the course of the visit and become a third party in the room. Furthermore, the spread of EHRs and the ongoing drive to move
Electronic Medical Records and the Patient Encounter
There is, unfortunately, little to no hard data on the impact of HIT on the nature of the child and adolescent psychiatry encounter itself. Rather, we must extend from the small knowledge base found in general psychiatry and the larger knowledge base found in general medicine. We must also recognize the high variability in the child and adolescent psychiatry encounter itself. One can reasonably assume that the effects of HIT on interactions with a 17 year-old patient would be different from
Electronic Health Records and the Psychiatric Encounter
Although the available literature suggests a minimal impact of EHRs on the physician–patient relationship in general medicine5, 6, 7, 8, 9 and in general psychiatry,2 it also suggests changes to the quality of assessment, rapport building, and monitoring of effect.11, 12, 13 This literature, although not directly speaking to child psychiatry, offers strategies for mitigating the most harmful potential effects of EHRs on the therapeutic encounter. The following should be considered when using an
Online patient–provider communication
Ultimately, as a communication medium, patient portals, emails, and other technology-driven systems are conceptually similar to telephones, voice mails, letters, and other forms of outside-of-visit patient–provider communication that mental health professionals have dealt with for decades. As such, in the context of augmenting office-based visits with online communication, it can be argued that the existing collective knowledge in managing patient communication, boundary setting, and
Online care delivery
Providers of telehealth and other online care modalities have a different set of challenges with respect to the therapeutic relationship. Although available data suggest that a comparable relationship to face-to-face communication can be achieved,17, 18 in practice this is probably most true of interactions with parents as opposed to pediatric patients. Creating engagement with a disruptive child or a depressed and inherently disengaged teenager over a video display presents unique challenges
Summary
Health information technology has the potential to revolutionize care delivery in many ways. The particular value of the therapeutic relationship in psychiatry makes the potential of HIT to affect this relationship alarming. Although limited, the available literature fortunately suggests that HIT has many positive effects and may have only specific negative effects on the therapeutic relationship that can be mitigated with simple practices and thoughtful clinical skill and judgment. For the
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The author has no conflicts of interest.
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