TheraScribe 4.0

For nearly all mental health-care practitioners, the most satisfying aspect of our practice is our clinical interaction with patients. However, any practicing psychotherapist can attest to the frustrations in dealing with the mountains of paperwork that are required by various managed care payers and other regulatory entities. But theses demands are not necessarily all bad. Clear and well written treatment plans, progress notes, and homework planners can assist patients' progress in treatment. It also gives clinicians a clearer sense of their patients' progress and facilitates accountability.

An ideal solution to this problem would be a system that automates much of the repetitive and laborious processes required in our daily clinical practice. Therefore, an ideal computer software system would be one that is simple to use, does not require a steep learning curve, is flexible enough to accommodate our individual clinical styles, intuitive to use, and, most importantly, can easily and effortlessly be incorporated into our practice.

There are several computer programs that purport to help clinicians in organizing the labyrinth of paperwork that is required. TheraScribe 4.0 is the latest offering from PEC Technologies. It comes in three versions: 1) Solo / Small Group Edition - to install on one computer, 2) Solo / Small Group Edition - for installation on a Network of up to 10 Users, and 3) Enterprise SQL Edition Server Installation with Enterprise SQL Edition-Client. According to the company's literature, TheraScribe "is simply the most robust, yet easiest-to-use, behavioral health clinical management system available."

Strictly speaking, TheraScribe 4.0 is more than a simple tool that organizes paperwork. What separates this program from others is the "ability of the software to put the contents of Wiley's best-selling Practice Planner books (Treatment Planners, Homework Planners, and Progress Notes Planners) at user's fingertips…with thousands of prewritten clinical management components and tools…with…clinically sound language, and on-screen help to expertly guide you through each stage of the treatment process: intake/assessment, treatment planning, progress monitoring, and outcomes analysis."

The various features available in this program are too numerous to mention in this review. However, as expected, essential features like psychosocial assessment, billing authorization date (with numbers of remaining visits available), DSM IV codes, ability to input demographic information, mental status exam, and progress notes are all included in this program and they function as advertised.

A significant aspect of this program is its flexibility and the expandability via the use of various treatment and treatment-setting modules. For example, TheraScribe 4.0 integrates Wiley's Practice Planner books into the program, thus allowing clinicians easy assess to their bundled treatment planners and homework planners. Other treatment planner modules that can be purchased separately from the vendor include addictions, adult psychotherapy, child psychotherapy, family, group, and personality disorders. These treatment modules can also be custom-tailored to various treatment centers (e.g., adult criminal justice planner, behavioral medicine planner, pastoral counseling treatment planner, and the psychiatric evaluation and pharmacology planner). The same applies to the different progress note planners; the add-on module for adult progress notes planner, the adolescent progress notes planner, the addiction progress notes planner, and the child progress notes planner also can be purchased separately.

Another important feature of this software is the ability to customize it. Adding fields and creating custom reports can be relatively easily done, especially after getting familiar with the program. Yet to this reviewer, that is the most important question regarding migration to a computerized system in assisting with our clinical practice: usability.

No matter how powerful the features are, it means very little if the program is too difficult to understand and cumbersome to use. There is an inherent flexibility in using pen and paper in keeping records and creating a treatment plan. It allows for the freedom to be flexible and creative, and paper allows the leeway to use our clinical judgment without having to follow a rigid, prescribed course of treatment.

Of course some of this flexibility can be introduced into TheraScribe 4.0 but not without having sufficient familiarity with the details of the program. There is a substantial learning curve associated with this program though TheraScribe 4.0 comes with a CD-ROM based tutorial designed to help. The makers also offer telephone and onsite training for additional fees.

TheraScribe 4.0 essentially delivers what it promises in the promotional literature. The program interface is well designed, and with some practice, is relatively intuitive to navigate throughout the program (those who do not have much experience with using computers may have more difficulty.)

In this reviewer's opinion, TheraScribe's biggest strength is also its weakness. The programs' flexibility, power, and multitude of features require a great deal of time, energy, and effort to learn and understand. It requires a near-complete commitment to the program on the clinicians' part. Therefore, the essential question clinicians must ask when assessing the possibility of migrating their clinical information/practice to a computerized system such as TheraScribe is the degree of commitment to change their present way of doing things. Halfhearted commitment may be counterproductive as this may mean maintaining both handwritten notes and the computerized system at the same time, thus doubling the workload.

The TheraScribe 4.0 under review was a Demo disk with several key features disabled, including printing. Given these limitations, it was difficult to make a full commitment to switch more records to this program. It was difficult, therefore, to adequately assess the day-to-day practicality of using this system in clinical practice.

TheraScribe 4.0 is more than a simple record management program. It is a set of various tools. As with any tool, in order to use it effectively, it is important to understand how it is used and the strengths and weakness of that tool. In this case, TheraScribe 4.0 delivers what it purports. The ultimate question is whether that is sufficient to change the tried and true pen and paper method. This can only be answered by individual needs of clinicians and organizations.

TheraScribe can be a tremendously powerful practice aid but its real start-up costs must include a realistic calculation of the time and effort and motivation required to truly commit to optimal utilization.

© 2001 Chae Kwak