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theses

The use of electronic health records (EHRs) is becoming normative in behavioral health treatment. Despite this, little is known about how to use these systems in a way that supports best practices, including the provision of person-centered care (PCC). PCC refers to a clinical approach that emphasizes individualized, collaborative care and a strong working alliance (WA) between clients and providers. Collaborative documentation (CD), the process of completing progress notes jointly with clients, has been promoted as a model of in-session computer use that can support this practice, but has been controversial among behavioral health providers. Advancement of CD has been hindered by the lack of empirical studies examining its effectiveness. This quantitative study examines how behavioral health providers use EHRs within a therapeutic context, and tests the impact CD has on PCC.
This exploratory study drew from a sample of 53 therapy sessions where EHRs were used. Data sources included a video recording of each session, and post-visit surveys completed by both clients and providers. Video data was coded for computing frequency, and the use of CD with clients. Surveys measured client and provider ratings of person-centered care and collaborative documentation. Univariate statistics describe the extent of computer use during sessions. Paired sample t-tests explored differences in client and provider perceptions of PCC and CD. Finally, the association between the amount of computer use, CD and PCC was tested using OLS regression, adjusting for nesting with a random effect at the provider level. The first model examined the direct effects of CD on PCC, and a second model explored the moderating effects of CD on the relationship between total computing and PCC.
Results indicate that behavioral health providers spend about 33% of visit time using the computer, but clients and providers view the impact of these behaviors on PCC differently. Among providers, total computing had a direct, negative association with working alliance (WA), an essential component of PCC. Conversely, clients generally had more favorable attitudes towards the quality of their WA with their providers and the ways in which they used computers in sessions. Furthermore, among clients, CD predicted higher ratings of PCC and WA, regardless of how often computers were used.
These findings suggest that, while providers felt pessimistically about the impact of EHRs on PCC, clients did not share this experience, particularly when CD was deployed. To this end, results indicate that requisite skills surrounding collaborative use of technology are critical to harnessing the benefits of this technology. This underscores the need to continue developing and disseminating effective strategies for EHR use.

ETD_9111

Ph.D.

Includes bibliographical references

by Elizabeth B. Matthews

doi:10.7282/t3-4zv3-sj22

ETD doctoral

The author owns the copyright to this work.