Communication in the era of Electronic Medical Records
Who are we as a profession? Training models have sometimes emphasized neuropsychologist as report writer. Is our product patient care or is our product a report? Depending on the context of care, the answer may be different. Neuropsychology's tradition of long, detailed reports may continue to serve an important function in forensic and some educational settings. Long reports may no longer serve the profession in general healthcare settings. Beyond uncompensated time in the context of global payments, do our healthcare colleagues find shorter, targeted reports better tools to care for their patients? What will our reports look like in the context of electronic Medical Records? This section shares preliminary results of the national surveys of neuropsychologists and physicians about our reports, information about Electronic Medical Records, and templates for writing brief reports.
Stakeholder's project in neuropsychological report writing
The Massachusetts Neuropsychological Society, as part of their year long series of education forums on healthcare reform, held a stakeholder's conference on neuropsychological and psychological report writing. The conference brought together colleagues from many medical specialties including primary care, developmental pediatrics, physiatry, psychiatry, and neurology. The consensus of the panelists was that shorter, targeted reports were highly valued in patient care.
The event was the impetus to launch the Stakeholder's Project in Neuropsychological Report Writing, with national surveys for neuropsychologists, physician colleagues, and patients. Currently, 660 neuropsychologists, 350 physicians, and 175 patients have filled out the surveys. Data collection remains open. Click here to take the survey or to share links with colleagues.
Preliminary data from the Stakeholder's project
With an "n" in the mid 600s, the neuropsychologist survey data reveal a stunning disconnect between the time neuropsychologists are putting into writing lengthy reports, and their belief that referral sources do not typically read the whole report. The typical pediatric neuropsychologist is spending 5-10 hours writing an 11 page report that they feel their referral sources are not reading. The typical adult neuropsychologist is spending 2-3 hours writing a 6 page report that they likewise feel their referral sources are not reading.
Templates for shorter neuropsychological reports
Training programs have frequently utilized long neuropsychological report formats as a tool to ensure that assessments are well reasoned. Without additional advanced training in writing efficient, shorter reports, many clinicians do not feel comfortable writing shorter, more targeted reports designed to meet the needs of referral sources. In this section, we will be posting short templates for pediatric, adult, and geriatric reports. The purpose is not to prescribe how reports should be written, but rather to share some competent templates for how reports might be shortened while maintaining rigor and content. Some of these reports are dramatic departures from the modal long, cumbersome report. Others are crisp, briefer versions of the more traditional report. Please consider sharing your own brief template.
Ted Peck, Ph.D., ABPP-CN is a past board member of the American Academy Of Clinical Neuropsychology. He is a clinical faculty member in the Departments of Psychiatry at the Medical College Of Virginia and Clinical Psychology at Virginia Commonwealth University. He is a current Gubernatorial Appointee to the Virginia Board Of Psychology. His group practice (Neuropsychological Services Of Virginia) is in Richmond, Virginia. Dr. Peck has kindly shared a brief, neuropsychological report template.
Mark Barisa, Ph.D., ABPP-CN is the director of the Neuropsychology Service at Baylor Institute for Rehabilitation, and the Author of an AACN Workshop Series Book, The Business of Neuropsychology. Dr. Barisa has kindly shared his brief, targeted neuropsychological report templates.
Karen WIlls, Ph.D., ABPP-CN practices as a pediatric neuropsychologist at Children's Hospitals and Clinics of Minnesota. She is a board member of the American Academy of Clinical Neuropsychology and is active in research and teaching in neuropsychology. She has shared a brief pediatric report template she gives to her trainees.
Ingrid Leckliter, Ph.D., Associate Clinical Professor of Pediatrics at the UC Davis Health System M.I.N.D. Institute supplied a report template that exemplifies the "inverted pyramid style" of providing the most critical information, e.g. the conclusions, up front. Dr. Leckliter and her group have also provided a working draft "in progress" drop down EMR template
Caleb Pearson, Psy.D. is assistant professor of clinical neuropsychology at the Barrow Neurological Institute. He primarily works with epilepsy patients on the epilepsy monitoring unit where he also conducts clinical research. He provided a brief inpatient report template.
Mark Mahone, Ph.D., ABPP-CN is a child neuropsychologist, research scientist, and the director of the Department of Neuropsychology at the Kennedy Krieger Institute. He is the President elect of the American Academy of Clinical Neuropsychology.
Scroll down for EHR drop down templates
Visit our page devoted to tips for wiring shorter neuropsychological reports. We got help from a journalist and writing coach who works with NASA scientist and engineers to make their risk communication more clear.
Should I be concerned about Electronic Medical Records?
Many neuropsychologists in academic medical centers or large healthcare systems are already using electronic medical records (EMR). Private practitioners are typically not. For those in private practice, a big issue is whether to invest in an EMR system. While the switch to EMR can be daunting, large referrers may preference practitioners who can send reports electronically.
In political speeches, EMR allows medical professionals to communicate freely amongst each other, and between hospital systems. In reality, EMR software developers have been allowed to create proprietary systems that do no speak with one another. Many systems are very expensive, and therefor practitioners should exercise caution prior to investing in a system that may not allow them to communicate with more than one referral base. Some large hospital systems allow external practitioners to log into their EMR systems- not to read files- but to contribute their reports to patient files.
The APA Practice Organization held a workshop at the 2012 State Leadership Conference addressing psychologists' use of EMR. Click here for a link to the slide show. This is a VERY informative read for anyone considering investing in an EMR system.
Templates for Electronic Health Records/ drop down menu reports
As healthcare moves towards electronic health records (EHR) psychologists and neuropsychologists are negotiating how our reports will be integrated into EHR systems. Many neuropsychologists currently dictate reports or type them, and then upload copies into the EHR system. Other clinicians are beginning to experiment with drop down report templates, similar to what primary care and other specialists are using. Two groups of neuropsychologists have generously shared their EHR drop down report templates. These are here to stimulate discussion, and serve as jumping off points for other groups who want to develop similar templates, rather than "end point" examples of what EHR drop down templates should look like. If your group has a template that you would like to share, please contact us.