Working with Electronic Health Records

Most ABA agencies have moved from paper data sheets and notes to Electronic Health Record (EHR) systems — CentralReach, Catalyst, Rethink, AccuPoint, and others. These systems streamline data entry, billing, and supervision, but they also introduce new risks the paper era didn't have.

The Audit Trail

Every action you take in an EHR is logged — when you opened a chart, what you viewed, what you edited, what you deleted (and when). Auditors, supervisors, and (in litigation) attorneys can pull this log. Two implications: (1) never share your login credentials, (2) never browse a client chart you don't have a clinical reason to view.

Common EHR Mistakes

  • Charting in the wrong chart — easy to do with two clients open in tabs. Cross-charting is a HIPAA violation.
  • Leaving the chart open on an unattended device
  • Sharing screenshots via personal text/messaging
  • Using the "remember me" login on a shared device
  • Forgetting to lock the device when stepping away
  • Working on personal email/social in a tab next to client data

Real-Time vs. End-of-Session Charting

EHRs allow real-time data entry on a tablet during session. This is generally more accurate than end-of-session recall — but it can also be distracting if the RBT is fumbling with the device instead of attending to the client. Find the balance that works for your specific case.

Corrections in an EHR

Unlike paper (where you draw a line through, initial, and date), EHR corrections create a new entry that supersedes the old one. The original is NEVER deleted from the audit trail. This is by design — it prevents tampering. If you correct an entry, the original remains visible in the audit log to anyone with permission.

Offline Sync Risks

Some EHR mobile apps allow offline data entry that syncs when network is restored. If you lose the device before sync, the data may be unrecoverable. If you reset the device, the data may be lost. Always sync before ending session or leaving the location.

Login Security

Use strong, unique passwords. Enable multi-factor authentication if the EHR offers it. Log out (don't just close the window) at the end of every shift. Report any suspected credential compromise immediately — including if you suspect a colleague has used your login.

If the EHR Goes Down

Have a paper backup plan. If the EHR is unavailable during a session, fall back to paper data collection. Photograph or transcribe into the EHR as soon as service is restored. Document the outage period for billing purposes.