The Technology of Psychology and The Psychology of Technology

The Orange County Psychologist

May 1994

Michelle M. Weil, Ph.D.

Larry D. Rosen, Ph.D.

First, some old business. For those of you who read our last column ("Planning for Mental Health Care on the Information Superhighway") and are just dying to know, here are the answers to the "smiley" quiz (remember, you need to turn them sideways):

SMILEY	INTERPRETATION
: - (	a frown
; - )	a wink
: - o	surprise
8 - )	the smiler wears glasses
: - p	sticking out your tongue

Now, on to the serious business!

The entire January/February 1994 issue of Behavioral Healthcare Tomorrow covered the topic of "Computerization in Behavioral Healthcare Services." In this comprehensive yet somewhat frightening overview of the coming technology in our field, we found the experts very clear: national healthcare reform will mandate the use of technology. In the lead article of that issue, Ronald Manderscheid and Marilyn Henderson of the U.S. Department of Health and Human Services stated that: "Preparation to meet the information demands of the evolving healthcare system will require adaptation of existing computerized information systems and utilization of new technology." (p. 11). In a recent APA Monitor column, Russ Newman, Executive Director for the Practice Directorate agrees with this assessment: "Practitioners must also move to the next level of technology to keep pace with a changing market." (p. 9).

How soon can we expect these changes? According to the CPA Briefings from the Division of Professional Practice many of these changes are just around the corner. In an article in the Behavioral Healthcare Tomorrow special issue, Tamara Cagney and Dianne Rush Woods declare that: "Many managed care companies are planning to implement both electronic claims and clinical data systems by 1995." (p. 43).

THE TECHNOLOGY OF PSYCHOLOGY

Are we ready for these changes? Our research suggests that we are not! In our work with Psychologists we find three levels of technological sophistication in their practices.

Industrial Age Office or "Stone Age" Office

This office may have one or more therapists in a group or simply sharing overhead. The Stone Age Office may have a parttime 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 every additional page!). When the secretary is out of the office (if there is one) messages are left either with an answering service or on an answer 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 parttime or fulltime secretary who is moderately computer literate. The office more than likely has a computer system with an automated office management system 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 Psychologists? Our work shows that approximately 75% of them are practicing in a Stone Age Office. Only about 25% have a Computer Age Office and less than 1% have an Information Age Office.

According to everything that we have read and heard, therapists are going to need to move rapidly to a Computer Age Office. Leaders in the mental healthcare field tell us that these changes are planned for implementation beginning in 1995 (Cagney & Woods, 1994). Some experts suggest that this transition will be complete by 2001 (Geraty, 1994) while still others believe that healthcare will be computerized within the next 10 to 15 years (Harriman, 1994). It is clear from all of the expert opinions that Psychologists need to move into Computer Age Offices now. Once there the transition to an Information Age Office will be relatively straightforward (though not currently necessary).

THE "PSYCHOLOGY" OF TECHNOLOGY

Are Psychologists ready to embrace this change? Twenty-five percent already have. Will this transition be difficult for the other 75%? For many, the answer is yes! There are several clear reasons why these Psychologists 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 Monitor there were no fewer than 12 office management computer packages 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 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 on and 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, photocopy machines, 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 800 number for information the salesperson will probably mutter a stream of jargon (RAM, Hard Drive, MS-DOS, megabytes.....) that makes little or no sense. You need a "technologist", someone who knows both technology and psychology. Consult your local psychological organization and find someone who is versed in both technology and psychology and who can speak computerese with a psychological accent (Weil & Rosen, 1994, Rosen & Weil, 1994).

Technophobia. As one of our colleagues stated: "I want my epitaph to read: 'I did it without a computer!'" Why do therapists find technology so intimidating? Our work shows that over half of all Psychologists are "technophobic." This does not 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 be any negative psychological reaction to technology. This reaction can range from severe to 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 it, and (3) experience reduced effectiveness and increased psychological discomfort when you must use technology (Weil, Rosen & Sears, 1987).

Technophobes are not comfortable with many forms of technology including VCRs (which they own and use only to play movies - their clocks often blink 12:00...12:00...12:00), fax machines, computers, voice mail systems, etc. Psychologists are not alone (Rosen & Weil, 1994). A recent study by Dell Computer found that 55% 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% success rate (Weil, et al., 1987). In only 5 hours, technophobes learned skills to alleviate their discomfort. In follow-up studies six months later, these same "former" technophobes were busily (and eagerly) buying and using computer technology.

Bad Early Experiences and/or Poor Introduction to Technology. How does technophobia arise in the first place? Our study on the etiology of technophobia (Weil, Rosen & Wugalter, 1990) showed that a key factor in the development of technological discomfort was the style of its introduction. Many technophobes were introduced to technology by people (parents, teachers, colleagues) who were not themselves comfortable 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 offhanded way. We have seen many examples of a teacher being asked by a student, "How do I make my computer do ___________ (fill in whatever you wish 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 which creates a negative attitude toward technology and reduces his self-confidence. Additionally, technology is often introduced in a "pressure-cooker" fashion with high expectation of competence in a brief amount of time. Without the time to play in a nonevaluative environment, students (of all ages) 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 the "psychology of technology" and the "technology of psychology" to introduce you to the full range of 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!

Beginning in June we will be offering seminars throughout the state designed specifically to help Psychologists comfortably, successfully and comprehensively transition into a Computer Age Office. Watch for a brochure describing our program "Merging Psychology and Technology" or contact us at 790 Town & Country Road, Orange, CA 92668 for further information.

P.S. For those of you who love "puzzles" and challenges, try to guess which famous person each of these smileys represents.

(a) =| :-)~ (b) C| :-=) (c) : -.) (d) : - [ (e) (8) - )

Answers are found at the end of the Reference List. Good Luck!

References

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

CPA Briefings (1994, January). Look for more electronic claims and case management next year. California Psychologist, pp. 25.

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

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

Manderscheid, R.W., & Henderson, M.J. (1994). The new informatics of national healthcare reform. Behavioral Healthcare Tomorrow, 3(1), 11-15.

Newman, R. (1994, January). Times demand putting business into practice. American Psychological Association Monitor, p. 9.

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.

Rosen, L.D., & Weil, M.M. (1994). Adult and teenage consumers of technology: What determines who uses new devices and who does not? Article submitted for publication.

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

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

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.

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

ANSWERS TO SMILEY QUIZ:

(a) Uncle Sam (b) Charlie Chaplin (c) Cindy Crawford or Madonna

(d) Dracula (e) Jacques Cousteau