Psychiatry Case Study

"In my specialty the biggest thing is having good eye contact and really being attentive to the patient when the person is talking to you. In some medical settings physicians have their backs to the patient and are on the computer. I never do that - with Praxis that is the biggest improvement."

Tell us about your practice and your initial decision to use Praxis.

I am a psychiatrist and I also have an additional certification as a child and adolescent psychiatrist. I've had my practice for almost five years now. When I started my own practice I got Praxis. I think it works really well over time, and especially with my specialty I find it very helpful compared to what I was using at hospitals.

Can you walk through a typical case with Praxis?

For me it's very different - in most medical office settings, the nurses do the vitals and put all the information in, and then the doctor comes in. For me, I go and greet my patients myself. My setup is that the patient comes in, and on Praxis I check in patients so I know they are here. I go and get the patient and bring them back here, and over time I have established my own template that I have for a new patient, for the follow-up patient, and then for some of the different diagnoses that I have worked with.

I have diagnoses from simple mood disorder to depression to PTSD, ADHD, severe autism, Asperger's - so there are different sets of templates I have created. Once I do that initial medical information survey, where I put in allergies and medication, I then go into the history.

What has really been helpful, as compared to the paper chart, is that once the templates were put in order that I had created and modified over time, I had more time to talk to my patient and have more patient contact as compared to just writing my notes.

Obviously Praxis is smart; I can put in the information I already have from the previous visits and then add on to it and modify it, and that works really well. Now, with e-prescribing, I can send the scripts and then print the control one at the same time. And then the billing fees print out at the front desk or we can print them out at the end of the day. The whole set up works well.

What do you like most about Praxis?

I used a lot of EMRs during my residency and fellowship, so I had some sense of EMRs even before I used it. I can tell you that the biggest difference is that I'm not restrained with the template. With other EMRs, the biggest issue was that you had to use the drop down boxes to lead a simple physical exam, and obviously I don't do physical exams. So with Praxis I have a free text in the note, and if I want I can add on right in that moment. I don't have to look back in the drop down and find a match. Medications are easy: you just type in "Lexapro" and it comes up.

The main thing for me is I can really use it the way I want - I'm not constrained by the system. That's the biggest thing - flexibility. I think over time I've modified my template so much that I know once I start using it, "Okay, I'm seeing a kid, so I need the family history first, as compared to going into the other history." To me, flexibility is the biggest difference compared to other EMRs. That's the biggest change.

How does Praxis save you time? How much time does it save you?

Yes it does! Especially now that we have the e-prescription available; before that, I had to write out the whole prescription and then sign it. Now I can go to the prescription, print it, and sign off on it to finalize it and it already has everything - patient's name, date of birth, address - everything is already in the system. I just click and it comes out, instead of writing the whole order for all of my patients.

In my specialty the biggest thing is having good eye contact and really being attentive to the patient when the person is talking to you. I know in some medical settings physicians have their backs to the patient and are on the computer or something like that. I can never do that - I just have some paper in my lap while I'm talking to the patient, doing my notes. With Praxis that is the biggest improvement.

What would you tell other psychiatrists about Praxis?

In my specialty, we all do things differently because, based on the symptoms of a patient, a different physician might be thinking that the best medication is a different one because he is more comfortable with that one than the one I would use. I think that's the best thing about the system, because you can make it work for you. Praxis can do a lot more. I'd say that's what makes it the best for my specialty.

How have your experiences been with customer support?

It's been good. Now with the new feature, online chat, I can just tell them my clinic's name and number so that they can go right on the server and do whatever they need to do. They can do fixes right there.

What else do you want people to know about Praxis?

I think our specialty is very late to get anything they'd have in a hospital setting because psychiatry is much less charting, but I would say that for anyone who is in their own individual practice like I am, this is a good way to go. Now that we're getting mandated by most insurances, people are really seeing that electronic charting needs to be done, no matter how you work.