BOX 2. How EHR Is Shaping Care: A Case Study
( The following is an excerpt of a behavioral health team’s implementation of EHR.)
We are several weeks into an EHR implementation. Cell phones are constantly ringing and vibrating on
the table, clinicians dart in and out. The department director, Dan, states flatly that,“the system is designed
by primary care folks, not us. We don’t work the way they do. They diagnose and then treat, and we treat
and over some period of time begin to diagnose what may be very complex patients.” Software design
abbreviates the sometimes long process of behavioral diagnosis with drop down menus and cumber-
some reports. Dan’s team is clearly uneasy with the implementation process, but can’t put their fingers on
exactly why. It is quietly stated by other medical staff that “it’s typical” of Dan’s team to “slow the process
Dan and each member of his group is asked to grab a tablet and role play an encounter. Dan plays a
male patient about his age who struggles with a history of drug abuse, referred by a probation officer for
evaluation. He is a violent offender, a diabetic, and HIV positive. Dan walks out of the room to prepare.
When he returns, he lumbers past Anna who takes on the role of interviewing clinician. Dan stuffs himself
into a tiny chair.
Logging in, Anna enters a few items into the computer. She begins dragging out of him a history of
drug abuse and asks if he had been using that day. She receives a nod and says:
“Do you see any problems with that?”
“Sometimes,” he says.“Like when someone like you tells me it’s bad.”
“I don’t think anyone here is telling you you’re bad. We’re just getting information,” Anna says.
“But that’s it - ‘cuz you’re gettin’info-mation, I know I’m bad. That’s how it goes: the more ‘formation-
gettin’ you do, the badder I get.”
Anna looks to her colleagues for support. Moving along, Anna asks:
“Are you married?”
“Yeah,” he says.