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(This is a long read. It might be easier if you save this file to your computer to read at your leisure. You may want to think about the issues I raise here).

Putting important clinical records on a computer can be a daunting challenge if you have never done that before. You know your records are important and their integrity must be secured. What might motivate you to do this when you already have some kind of a method you use that has served you?

An important motivation is the knowledge that record keeping is getting harder, and more demanding. Efficiency is getting to be more important . Whether you have a part time practice, or a full time one doesn't matter. It just becomes more visible faster with a full time practice. You have demands on you for disability reports, managed care outpatient treatment requests, letters, notes, and reports of many types. You also have complete clinical records to think about. Lawyers haven't stopped suing us. Licensing boards still peer over our shoulders. Insurance companies have demands on us. Medicare too. Various other boards come into play. Finally there are the standards of care for similar practitioners we need to keep up with. It finally dawns on us that we are running a business and we need to be efficient if we are to succeed. We must be efficient in our record keeping practices or it will be difficult to succeed.

For many of us, the clinical part of our work is what got us into this field. We wanted to use what we knew and who we were to help other people. There was the issue of autonomy, and making a living, but for many of us it wasn't as much about being business-like, as it was about clinical things. The business parts of our practices came later. Just like taxes. The issue as I see it is that we want to focus on the clinical work with our clients. That is where our priorities lie but the specter of our records keeps interfering with that. We have to alternate between working with clients (patients if you are a psychologist or psychiatrist) and the records. The work on the records takes us away from our real interest. This causes emotional stress and this tires us out. Sometimes it can be done effortlessly, but other times it can't. I submit that the reason a good method is so important for us is that it reduces that stress, makes it easier to do both things that are important in different ways, and go home at the end of the day with more energy and better records. My hypothesis has been borne out in talks with colleagues who report similar feelings. We have an incredible number of things asked of us administratively. It requires a lot of writing. We need a method to be just as efficient as is humanly possible in order to help us with these tasks.

So, many things impel us towards efficiency. It dawns on us one day that the number of filing cabinets we have in operation is growing. Piles of charts hit us. Filing gets to be a big chore. Pulling charts and putting them back suddenly seems like a burden. Paper usage goes way up. Then it hits us. We aren't very efficient. We submerge that thought for another 6 months and then bingo! It is back only this time with more force. Finally we begin to think of what we could do to fix it. It seems too horrible a prospect so we forget about it again until finally we wake up to what is happening and start looking for a solution.

One of the best ways to increase efficiency is to type. Typing for letters is a big improvement over handwriting. Don't get me wrong. I love a nice fountain pen and a sheet or two of good quality paper. It is just that efficiency is becoming more important. Most of us type letters, use letterhead templates, save various files on a computer, and integrate it into what we do as clinicians. Modern keyboards (especially laptops) are such a treat to use that it makes writing a pleasure. Typing programs like Stamina (http://www.typingsoft.com) and others go a long way toward helping us learn this important skill. Practice and regular use also play a major role in helping us become proficient.

If you can type, and use a mouse, my programs require almost nothing beyond point and click. Sounds incredible? I know, but they are arranged to do that. The database/word processor that I use as the engine for the two versions of the original CRK was designed by geniuses. They had wide experience in creating software programs that competed in the open marketplace with huge software companies and for years they were one of the most favored word processing software programs. The originator of the software that runs CRK Plus and Pro has had 40 years of experience writing software programs. Yes, the programs can be used even faster with certain key commands, but you can learn those when and if you are ready. Leave that for those who already know and use them, or when you are more familiar with the program. In the meantime point and click will get you through the vast majority of the work. If it is as I say, what in heaven's name is all the fuss about with other programs that seem so complex? The awful truth is that they were designed by technically oriented people who, naturally, thought differently than the rest of us. The expensive complicated programs that seem so difficult to use are difficult because they weren't designed by us. The technicians simply organized things along the lines they felt most familiar with. If you bought their programs you had to conform or go without.

In order to make it worth their while, they also included total office capabilities. Many clinicians would rather have a simpler system, that isn't overkill. I don't believe any of this was intentional but I read horror stories about this on the internet. Software nightmares I call them. I know of three multi-million dollar programs in Maine that are all but unusable by the clinicians. They are an impediment to their work! Someone didn't do their homework!!

Clinical Record Keeper and Clinical Record Keeper Plus and Pro™ are different. From the screen shots you can see that they were designed with a different goal in mind. I wanted a simple record keeper, no more, no less. What I got were programs that could do that work well. They were designed to be user-friendly. They are user-friendly. They are visually understandable. This means you can see the organization of the program, and by familiarizing yourself with things get the benefits of a computer program that is not overly complicated. If it is not overly technical, and complicated, then it means you can use a computer to increase your efficiency . That is, after all, what these tools are supposed to do, isn't it? They are supposed to help us, not fight us. They are supposed to cooperate ! They are supposed to make our jobs easier.

I have thought very carefully about all aspects of clinical records on computers for quite a while. I have solved the problems in my own practice using my own software. From the installation directions to the creation of their first chart novices tell me that everything goes off without a hitch. They also say that they really don't have difficulties running this program. (A recent review about to be published mentions my complete and helpful manual for users).

So consider a new alternative and think about actually using a tried and true method of keeping your records on computers. It involves some rearranging of the molecules in your brain but I hear that psychotherapy can actually promote new brain cell growth. Fancy that! I had to do the same thing in the early 90"s after 20 years of practice! E-mail me with your questions and concerns and I will do my best to help answer them. We are really all in this together. Wouldn't it be great for every practicing clinician to be efficient in their record keeping? Perhaps my software can help that cause. It has done that for me. Efficiency is a great bargain and it frees us up from tasks that have to be done but which aren't as much fun as talking with people.

I believe that the Clinical Record Keeper series of software programs will make it possible for you to have organized, tidy, easily accessible records that document what you need to more easily than any other method I know. It will mean that you can sail through record keeping with speed and grace. If you have a laptop you can work on letters, reports, and other things at a time and place of your choosing. Your efficiency will go up, and your stress level will go down . You will get home with energy to spare and in a good mood. Pretty good bargain, I'd say!

Charles M. Stewart, M.D.

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