The Technology of Mental Healthcare

Let's first examine the current state of technology among mental healthcare practitioners. Our work with therapists indicates three levels of technological sophistication in their practices.

Stone Age Office: This office may have one or more therapists working in a group practice or simply sharing overhead. The Stone Age Office may have a part-time secretary, but everything is done by hand. All insurance or patient billing is done manually or contracted out to a billing service. Accounts receivable are kept on ledger cards or a pegboard system. Letters are typed on an IBM Selectric typewriter. If a fax machine is used at all, materials are brought to a local print shop and handed to a technician to be faxed (at $2 for the first page and $1 for each additional page). When the secretary is out of the office, messages are left either with an answering service or on an answering machine.

Computer Age Office: This office may be a sole practitioner, therapists sharing overhead, or a small group. The Computer Age Office may have a part-time or full-time secretary who is moderately computer literate. The office more than likely has a computer system with automated office management programs for patient billing, accounts receivable, monthly statements, insurance billing, etc. Correspondence is typed on a word processing program and printed on a near-laser-quality or dot matrix printer. After-hours calls to the office are routed to a voice mail system that can even activate a pocket pager in emergencies. A fax machine rests near the computer and more than likely shares an office telephone line.

Information Age Office: This office may be a sole practitioner, a small group or a large provider organization. The Information Age Office has all the technology found in the Computer Age Office and more. All business operations are performed on computer by a highly computer-literate staff. Information is routinely communicated to and from other computers through electronic transmission. All insurance billing is transmitted via fax or modem by direct linkages with major insurance carriers. The fax machine is on a dedicated phone line. The office also has a sophisticated voice mail system that has distribution groups and preprogrammed "messaging" for emergency paging.

Where are most mental health professionals? Our work shows that approximately three-quarters of them are practicing in a Stone Age Office. Only about 25 percent have a Computer Age Office and less than one percent have an Information Age Office.

According to everything that we have read and heard, these therapists are going to need to move rapidly to a Computer Age Office (at a minimum). In the special issue of Behavioral Healthcare Tomorrow, Ronald Geraty, M.D. suggests that this transition will be complete by 2001.(1) Tamara Cagney and Dianne Rush Woods tell us, "Many managed care companies are planning to implement both electronic claims and clinical data systems by 1995."(2). More conservatively, Malcolm Harriman submits his guess that this system will be in widespread use within the next 10 to 15 years.(3) This timeline suggests that mental healthcare workers will need to be practicing in an Information Age Office in the not-too-distant future.

The "Psychology" of Technology

Are mental healthcare workers ready to embrace this change? We doubt it. Will this transition be difficult? Yes! There are several clear reasons why they will find it difficult to move up to the mandatory technology required to communicate with managed care and insurance carriers.

Too Many Choices/Lack of Information: First, you need to consider your software needs. In the latest issue of the APA (American Psychological Association) Monitor no fewer than 12 office management computer packages are advertised. How will you decide? Second, what hardware (computer) will run your office management program? Walk into any office warehouse store and you will see an array of perhaps 20 computers. Which one is right for you? Do you need a 50 MHz machine? Do you require a 486 machine? Can you use an Apple Computer, an IBM or maybe the new PowerPC? What about clones? Now, let's talk about the operating system. And the choices go on and on. Once you choose a computer you need a printer. There are many choices there, too. Next, you need to consider the rest of your office automation, including fax machines, photocopiers, voice mail, etc. Without clear information about your office technology needs, the choices are overwhelming.

Too Much Jargon: Who will help you make these choices? Certainly not the office warehouse salesman. Even the friendliest computer salesperson speaks a language unknown to most therapists. If you read an advertisement and call their toll-free information number, the salesperson will probably mutter a stream of jargon (RAM, Hard Drive, MS-DOS, megabytes, etc.) that makes little or no sense. You need a "technologist", someone who knows both technology and psychology. Consult your local mental healthcare organization and find someone who is versed in both technology and psychology and who can speak computerese with a psychological accent.(4,5)

Technophobia: One of our colleagues has stated: "I want my epitaph to read: 'I did it without a computer!'" Why do therapists find these choices so intimidating? Our work shows that over half of all mental healthcare workers are technophobic, although this doesn't necessarily mean that they break out in a cold sweat when they consider computerizing their practice. Based on over a decade of our own research and over two decades of work by other researchers, technophobia can mean any negative psychological reaction to technology, either severe or mild. However, the major definable symptoms are clear:

1. Avoid technology if possible;

2. Limit the use of technology to the basic functions when it is impossible to avoid, and;

3. Experience reduced effectiveness and increased psychological discomfort when you must use technology.

Technophobes are not comfortable with many forms of technology including VCRs (which they own and use only to play movies - as the VCR's clocks continues to blink: 12:00...12:00...12:00), fax machines, computers, voice mail systems, etc. Mental healthcare providers are not alone. A recent study by Dell Computer found that fifty-five percent of all Americans are technophobic.

Is technophobia "treatable?" In a three-year study, funded by the U.S. Department of Education, we developed and tested a model program that had a 92 percent success rate.(6) In only 5 hours, technophobes learned skills to alleviate their discomfort. In follow-up studies six months later, these former technophobes were busily (and eagerly) buying and using computer technology. (7)

Bad Early Experiences: How does technophobia arise in the first place? Our study on the etiology of technophobia (8) showed that a key factor in the development of technological discomfort was the style of its introduction. Many technophobes were introduced to technology by parents, teachers or colleagues who themselves were uncomfortable with technology. Through these uncomfortable early experiences, discomfort with technology gets passed on to the learner and the technophobia begins.

In other cases, technology is introduced in a haphazard, confusing or off-hand way. We have seen many examples of a teacher being asked by a student, "How do I make my computer do (fill in the blank)?" The teacher leans over the keyboard, rapidly pushes a few keys and says "There you go!" The student feels confused and has learned nothing creating a negative attitude toward technology and reducing his/her self-confidence. Additionally, technology is often introduced in a "pressure-cooker" fashion with high expectation of competence within a brief amount of time. Without time to play in a nonevaluative environment, students of any age cannot comfortably assimilate the new technology.

What do we recommend? Again, as we stated before, we strongly suggest that you find a "technologist" who is versed in both psychology and technology to introduce you to office automation. Through our work with therapists, students, business managers and secretaries, we have found that with careful and informed introduction technology can become not only comfortable but enjoyable

References

1. Cagney, T., & Woods, D.R. (1994). Clinician Update: Clinical MIS. Behavioral Healthcare Tomorrow, 3(1), 43-45.

2. Geraty, R. (1994). Vision 2001 - Behavioral Informatics. Behavioral Healthcare Tomorrow, 3(1), 64.

3. Harriman, M. (1994). Open networked, integrated, multimedia, client/server behavioral healthcare. Behavioral Healthcare Tomorrow, 3(1), 17-21.

4. Rosen, L.D., Sears, D.C., & Weil, M.M. (1993). Treating technophobia: A longitudinal evaluation of the Computerphobia Reduction Program. Computers in Human Behavior, 9, 27-50.

5. Rosen, L.D. & Weil, M.M. (1994, February). Planning for mental health care on the information superhighway. Orange County Psychologist, pp. 13-14.

6. Weil, M.M., & Rosen, L.D. (1994, January). Terms for the technologically timid. Orange County Psychologist, pp. 10-11.

7. Weil, M.M., Rosen, L.D., & Sears, D.C. (1987). The Computerphobia Reduction Program: Year 1. Program development and preliminary results. Behavior Research Methods, Instruments, & Computers, 19(2), 180-184.

8. Weil, M.M., Rosen, L.D., & Wugalter, S. (1990). The etiology of computerphobia. Computers in Human Behavior, 6, 361-379.