Think having a client portal and an EHR aren’t important? Think again. Not long ago, most therapists wrote progress notes by hand. We all had the image of Freud with his infamous note pad ingrained in us. Although my style has always been to write notes at the end of the day, I’ve actually had a handful of clients ask me to take notes during the session. I guess it made them and/or me seem more legitimate.

Earlier in this century, when physical health care practitioners were required to begin using EHRs, many mental health practitioners were secretly glad our profession was not part of the mandate. Some criticized the whole concept of digital records, feeling that EHRs and portals dehumanize the relationship between us and our clients. Others worried that EHRs might not be safe.

However, despite our personal feelings, the healthcare digital age seems to be here to stay. Furthermore, consumers are not only accustomed to digitized healthcare, they’re accepting, and in some cases, embracing it.

My first hint of this was a remark made by an acquaintance. In a conversation about professional note-taking policies, she was shocked to learn that many mental health therapists prefer keeping hand-written notes. She said that since most of her other healthcare professionals used computers, if a behavioral health counselor used paper/pencil methods, she would view them as old-fashioned. She continued by saying that it might make her also wonder about the effectiveness of that therapist’s treatments. Since she saw their note-taking as antiquated, she reasoned that perhaps their treatment techniques were also behind the times. She ended by saying, “I’m not sure I’d feel comfortable seeing someone like that.”

The second event was a real wake-up call. During an introductory appointment, a new client told me she had first chosen another therapist. However, when she discovered that the therapist didn’t use a portal, she decided to keep looking. She explained that since her other healthcare professionals had portals – and that she enjoyed using them – she wanted her mental health counselor to also use one. This really shocked me. I had never heard of a consumer deciding against a therapist on the sole basis that that therapist did not use a portal. Surprisingly enough, this woman was in her late 50s as opposed to someone who was born after digital records became the norm.

Although mental health professionals were not required to use EHRs, most other health care professionals were. At first, complaints about EHRs were ubiquitous, so many of us felt a little smug about continuing to use our paper/pencil methods.  However, as EHRs have improved and become more affordable and widely used, it may be that we are now entering a time when we find ourselves in the uncomfortable position of realizing that the rest of the world has moved on without us. Regardless of our personal feelings about EHRs, our clients are accepting digitized practices as the standard. Those mental health professionals who continue to use paper/pencil techniques may be inadvertently fazing themselves out of at least a portion of the current market.

Susan C. Litton, Ph.D.

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