4 Communicating with Clients About EHR and HIE

Section4.18 Implement

Section 4 Implement—Communicating with Clients about EHR and HIE - 1

Communicating with Clients about EHR and HIE

Behavioral health facilities should communicate updates at key points: during electronic health record (EHR) and health information exchange (HIE) implementation, at go-live, during the learning curve in using the new system, and as new clients enter a mature HIT environment.

Time needed: 2 – 4 hours
Suggested other tools: Section 2.1 Communication Plan

How to Use

Understand how clients look at HIT—what they like and what they have concerns about. Plan how you will communicate with your clients about EHR and HIE adoption in your facility. Outline your messages and ways to communicate them.

Client Perspective

Behavioral health facilities can benefit from consumer engagement and consumer support for EHR and HIE. Increasing evidence shows that engaged, informed clients achieve the best outcomes. They are more confident and better prepared to manage their illnesses. They are often more inspired to work with providers toward achieving shared health goals. Educating and engaging consumers’ builds trust, which is critical to advancing HIT.

A recent survey found that 57 percent of consumers polled report self-tracking elements of their personal health information, while 41 percent expressed interest in switching physicians for in order to have EHR access. Despite the HIPAA requirement to give individuals access to their health information (except for psychotherapy notes), 36 percent of physicians disagreed with giving individuals such access. Slightly more than 36 percent of consumers said they had full access to their health information and 37 percent reported no access. (See:

Planning for EHR Tools

You will want your clients to see or potentially interact with some components of your EHR. Think through these interactions from a client’s perspective. Determine what input device you will use, and whether you intend to have clients interact with it directly or view with you. Think about whether it will be user or viewer-friendly. For example, does the computer screen swivel? Can you share your tablet with the client? Some technologies may pose challenges.

Think through the physical infrastructure needed to support use (see Section 2.13 Space Planning). Where will you put the input and how will you manage client access:

During use
During non-use
When away from your office:
Desktop must be logged off
Portable can be taken outside the office
How will you share data with the client?
How will you demonstrate the security measures you are taking?

Preparing for Implementation

Understand that your new EHR and its implementation will affect clients, who may be aware of a difference during implementation. They might notice new computers or sense an undercurrent of stress among staff members learning a new system. Plan to communicate positively about your new EHR. Provide enough information to acknowledge your EHR project and potential fears, but don’t share more than your clients need to know.

A brochure to inform clients
AQ&A script for staff members
AWeb site to introduce clients to the EHR and explain how they can use computers to improve or maintain their health

Standard language that you might use in client communication resources might include:

We have a new computer system to help us keep track of our clients’ health information.

It helps us track medications you’re taking.
It helps ensure that we have your lab results and other information we need to treat you.
It helps remind us about ways we can help you.
It protects the security of your health information.

Client Portal

If you have or are planning a client portal, you might use these additional messages:

A special part of our Web site is available for you to:

–Request (or make) appointments

–Exchange email securely with your provider for non-emergency questions/e-visits

–Get more information about your illness or injury

–Enter your health history

To use this site, please requesta user ID and password
If you don’t have a computer at home, you may use a computer at a kiosk in our waiting room. Don’t hesitate to ask for assistance.
For life-threatening emergencies, call 911.

EHR Go-Live

Post “under construction” signs that ask clients to be understanding during EHR adoption. Some EHR vendors supply them. Include a message on the facility’s voice mail noting that clients may experience delays while you are implementing a new EHR system; apologize and ask for their understanding, and note that the new system is intended to improve their care.

Remind staff to be positive and honest when interacting with clients during go-live. If a staff member says, “I hate this new system,” clients may adopt the same attitude. Coach staff members so they feel comfortable saying, “We’re just learning how to use our new EHR system, so please bear with me,” or, “I’m new at this. It may take me a little longer to access your information.”

During the Learning Curve

After greeting your client, explain that you are implementing a new computer system. Use the script developed for staff to respond to questions. Let the client know that you may be a bit slow while you are learning, or may need to get help. Joking about “new fangled systems” can break the ice for you and your client. Remain positive and answer questions honestly.

New Clients with Mature EHR

Don’t assume that a new client will take to your EHR as well as you have. After greeting your client for the first time, inform the client that your facility uses an EHR. If clients do not seem at ease about this, ask them if they have any questions and explain how helpful this has been for your facility. Offer that you had doubts initially, too, but have come to believe the system improves your ability to care for your clients. Follow the script you developed for staff to respond to questions when the system was new to you.

Strategies for Using EHR at Point of Care

Overcome the barrier myth. You may feel like the computer is physically coming between you and your client. Consider your body’s position when you are writing notes in a paper chart. Often, a computer allows you to have better eye contact with clients than do paper charts.

Use EHR to advantage. The EHR allows you to share more information with your client—in more compelling ways. For example, in the past, you may not have been able to show a client how assessment scores have changed over time. Now you do. Through an EHR, you can provide tailored instructions or a summary of the visit.

Explain value to the client. Tell the client what the EHR is telling you.

It looks like I haven’t seen you in several months; how can I help you keep your appointments?
The system is telling me that your latest lab results indicate that the drug we’ve had you on for a while may too strong for you. There are some options that your insurer will pay for. Let’s take a look at some of these (calling up a comparison).
Ask your clients to look at their medication lists to see if they are current. Involving them in this process gives them a sense of ownership.

Assure clients of security. After you greet your clients and get ready to use the EHR, let them know that you are logging on to access their information. When you conclude a session with a client, say you are logging off so that his or her record will be filed securely.

Engage the client. Many clients have been curious about what you are writing in their records and have been too afraid to ask. HIPAA provides clients the right to access their records, but this can feel like an adversarial act to the client, even when that is not the intent. A growing body of evidence suggests that engaging the client aids in compliance with the care plan (e.g., instructions, medications, lifestyle changes). Even having clients enter their own health histories engages them; it also helps you document the information.

Stop using the EHR at any point where you might do the same if you were taking notes on paper. Depending on the situation, ask the client about his or her concerns. You might do this as soon as you notice concern, or later at the conclusion of the visit. Ask whether the client uses a computer at home, school, work, or elsewhere. Ask the client about cell phone use, texting, use of social media. (This can be important for other reasons, as well, because too much of such use is known to contribute to depression, isolation, etc.) It may be helpful to remind clients that the tools they are using all the time are simply being used for their visit activity as well. Still, if there is strong resistance to your note taking—in any form—stop and record your notes later.

Section 4 Implement—Communicating with Clients about EHR and HIE - 1