John Luo, MD
Assistant Professor of Psychiatry UCLA School of Medicine
Past President, American Association for Technology in Psychiatry (www.techpsych.org)
Dr. Luo has disclosed that he has no significant relationships with or financial interests in any commercial companies pertaining to this educational activity.
TCPR: Dr. Luo, you are one of the nation’s experts in how psychiatrists can use computer technology in their practice. When did you first get involved with using computers in psychiatry?
Dr. Luo: During my psychiatric residency at UCLA I designed a web page for the APA, and after residency I did a fellowship in medical informatics at U.C. Davis. I participated in a project introducing PDA’s to the medical consult service, so that we could do electronic sign-outs rather than depending on random sheets of paper on clipboards. Somehow, I became identified as an expert on PDAs, and the APA asked me to do a talk on the use of PDAs in psychiatry. I got this terrible time slot, Thursday afternoon, the last day of the conference, and I assumed nobody would show up. But instead there was a packed room of people wanting to learn about technology and psychiatry, so I knew that this was topic whose time had come.
TCPR: How do you use computers during the clinical encounter? Do you input data while you are talking with patients?
Dr. Luo: No, which is kind of ironic. I would rather jot a few notes on a piece of paper, allowing me to maintain good eye contact with the patient. After the session I then type the notes into the computer.
TCPR: Do you recommend that psychiatrists institute some type of electronic medical record (EMR) system in their offices?
Dr. Luo: EMR makes great sense for obvious reasons such as legibility and consistency of data collection; however at this time it is highly dependent on what type of practice you are in. For example, at UCLA I use a system that was developed by the university’s programmers. For small groups, it may make sense to invest in an off-the-shelf EMR system that can really do it all, including keeping clinical records, scheduling patients and billing.
TCPR: What about solo practitioners, like me?
Dr. Luo: Solo doctors might find the cost of EMR systems to be rather steep, and canoften just get by with a word processor and spreadsheet program. I have a colleaguewho has been using ICANotes, an electronic system that he uses with a tablet computer[a laptop that lets you fold the screen over and write on it]. He has an electronic tabletin front of him while he is speaking with a patient and he will tap a few things here andthere on the monitor to create a note.
TCPR: ICANotes is one of the software programs with a series of drop-downmenus with preprinted options for affect terms, mood terms, descriptions ofsleep, appetite, and so on. You tap on them and the program creates a narrativenote based on what you’ve entered.
Dr. Luo: Right, but I haven’t really found it to be that useful.
TCPR: Why not?
Dr. Luo: For two reasons: 1) I haven’t found using tablets to be all that easy and2) I use voice dictation software (Dragon Naturally Speaking) in writing notes.
TCPR: What is the status these days of voice recognition software. Is it user-friendly?
Dr. Luo: It is pretty user-friendly now, but for it to be really effective, you have to use it consistently; you have to train it. It will learn, but it sometimes needs to hear you say “schizophrenia” ten times before it finally figures it out. There are two packages for Dragon, the standard and the preferred version. The difference is that the preferred version gives you software so that you can use your Palm to record the dictation and then transfer it to the computer for a transcription.
TCPR: How much does Dragon software cost?
Dr. Luo: The medical version is over a thousand dollars. The company will tell you that the software allows dictation at 99% accu- racy, but that is only once you have done a fair amount of training with it. Out of the box you probably get about 85% accuracy.
TCPR: What are your thoughts about computer-based therapy?
Dr. Luo: I believe that, given the increasing use of the Internet for information gathering and communication, computer-based therapy will be a natural step. For example, ‘Good Days Ahead’ is a multimedia computer program created by Jesse Wright, M.D., that provides a version of cognitive therapy for depression. In one study, depressed patients were randomly assigned to standard cognitive therapy (50-minute sessions), computer-assisted therapy (25-minute sessions plus time using the software), and waitlist. Both treatment arms demonstrated reductions in the HAM-D scale better than wait list, but the computer-assisted group was superior to therapy for patients with dysfunctional attitudes (Wright et al, Am J Psychiatry 2005;162:1158-1164). ‘Student Bodies,’ an Internet based educational program geared to addressing eating disorders in college students, was able to reduce body dissatisfaction and change eating disordered attitudes (Taylor et al., Arch Gen Psychiatry 2006;8:881-888). The Internet is increasingly becoming a resource for health information and now health-care delivery.
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