Change is good. All the folks I work with will experience big changes in 2011. ARRA, the American Recovery and Reinvestment Act that has been a cornerstone of the Obama administration in pumping dollars into the economy will affect mental health and substance abuse treatment for both consumers and professionals in the upcoming year. $19 Billion has been set aside for Healthcare Technology and a good portion of that will be fed into organizations in the form of Medicare and Medicaid incentives for using the Electronic Health Record (EHR). Large agencies have been banking on this and buying EHR software in 2010, hoping that legislation that has been moving through the political system will pay either $44,000 or $63,750 for each doctor / prescriber using the EHR. A number of healthcare providers are now in a race to implement the EHR and qualify for the big bucks. They will need to meet 15 core measures of performance with their EHR, so folks just now implementing software will need to hustle through the implementation and prove they meet specific functionality, or the money doesn’t come. They have until September to have all the 15 elements in place if they want to collect incentives in 2011.
ARRA is forcing significant change in the way professionals work and consumers receive treatment. Some professionals are struggling with central scheduling, having to turn over control of their schedules to somebody else in order to serve more consumers. Consumers who have been accustomed to being able to drop-in for treatment are being encouraged to make appointments, and sometimes need to wait longer to see a professional if they do drop-in to their friendly neighborhood community mental health center to discuss an emerging problem.
In 2011, more consumers will see treatment documentation first hand, some for the first time, becoming involved in developing their own treatment plan. The professionals and consumers are working together more and more often to organize their discussions into focused efforts to (1) address items in the treatment plan or include new problems in that plan to address (2) write the progress note to summarize the discussion from the perspective of both the professional and the consumer, and (3) plan next steps for treatment. The elements of this interaction are not new, however some professionals have kept them behind the scenes, and the transparency of the EHR is forcing them out into the open. Funding that includes documentation in the price of a session is forcing use of the EHR; documenting on paper is just too cumbersome and inhibits the effectiveness and speed of audits from Medicaid, accrediting bodies and internal quality control people.
But wait, there’s more change in 2011!
January 3rd, New York OASAS licensed substance abuse treatment organizations follow a number of other states in moving from “threshold billing” (one charge per day pays for all that day’s treatment), to “APG” billing (a fee charged for each service provided, under extremely complicated rules). This is a huge change for professionals and consumers. I work with an organization that plans to continue using a paper record and another that is committed to electronic treatment documentation. The major difference between the two methods is tracking the services for billing purposes. Connecting a billing record to the treatment documentation is easier to follow with the EHR. Both clinics have fine professionals treating the patients, and the consumers get what they need. The paper record is simply more of a hassle.
So, you see, the conspiracy to move to the EHR is in full swing. In 2011, some of the changes forced by the EHR may leave a bad taste in some mouths. On the other hand, it helps pay the bills.Read more →
A few years ago, I worked with a behavioral health hospital in Rhode Island to improve their Electronic Health Record (EHR), and the thing that impressed me the most was staff acceptance of carrying wireless laptops around the ward as they were treating consumers. They were constantly connected to the EHR, and this design not only encouraged, but enforced collaborative documentation of services with the consumers.
According to Ken Congdon, editor in chief of Healthcare Technology Online, there has been a resurgence of interest in this sort of technology, adapted to the iPad. Congdon speaks from a physical health perspective, and perhaps I can add to his research angled toward mental health and addiction treatment.
I approve of the iPad. PC guys like me and the Apple brigade have kidded each other about which is better, and a lot of us PC guys are starting to see real value in Apple’s products.
I’ve gone on the record many times as a supporter of collaborative documentation, and this technology makes that sort of treatment planning and documentation easer. The keyboard is as good as non-existent, so drop down dictionaries, checkboxes and radio (yes/no) buttons are pretty much a requirement for documentation. That speeds up the process while keeping the consumer involved…plus, who doesn’t like a gadget? Most consumers would at least be curious about the using the iPad. Imagine how easy it would be to assure a note addressed a treatment plan item by handing the iPad to the consumer and covering that first thing in a session. Then you’d have the bulk of your session (when the real work happens) without touching the little computer. After the discussion, the professional and consumer would summarize and record the next steps on the iPad, especially if the software has been creatively modified to suit this process. I think a number of consumers’ curiosity would help move this technology into the mainstream and improve the documentation, involvement and possibly treatment.
The Information Technology (IT) department or project manager for the agency’s EHR would need to turn attention to the way documentation is used, modifying some screens and better fitting them to work with the iPad. Since the trend is toward developing software to work in an Internet browser, tools that bridge the gap between the Microsoft and Apple technologies are already available.The project is certainly worth looking into.
Mental health professionals have been slow to adopt the EHR, and by tackling software design and implementation projects like this, the EHR’s acceptance by those same professionals might come along more quickly.
The technology does raise some concerns. Security needs to be a priority. Any time wireless technology is used, the passwords and firewalls need to be in tip-top shape. That’s not a problem, IT departments specialize in this, and if they need help, there are plenty of security experts and lots of security training in the world today as a result of hackers and virus attacks.
When a professional uses primarily data dictionaries, check boxes and radio buttons to complete an assessment, treatment plan or progress note, there is a very real danger of cookie-cutter documentation. For auditors, this approach to documentation is a hot-button and alerts them to review it very carefully with this regard. Again, this has been resolved by many software companies serving mental health and addictions (let me know if you want some suggestions for companies who have creative solutions). The note could be set up with a required “append” function that would alert professionals to add some narrative once they get back to their desk. Not a big deal, just an opportunity to be creative.
Once again, technology makes the world a more interesting, if not brighter, place.Read more →
It’s an old saying, “You don’t go to the hardware store for a loaf of bread!” When it comes to mental health and substance abuse treatment, it seems that’s what people are doing…and that complicates the business behind treatment.
I reviewed a presentation by Laurie Alexander, a peer in the behavioral health consulting world, and Karl Wilson of Crider Health Center, and was surprised to discover that when people seek mental health or substance abuse services, the first place they go is to their primary care provider. Upon consideration, I guess it makes sense, simply because we’re all connected, body, mind and spirit. Difficulty could enter the equation when the consumer may get a prescription without qualified, licensed counseling, and in this age of mergers and acquisitions and forging of business partnerships, that problem is being resolved.
Relating this to technology is not a reach. Mental and physical health software systems may have the same goal (to document health problems and solutions), however the way they work are tremendously different. At least one software program rooted in hospital-based, physical healthcare has tried to include feature-functionality for our sector. According to the customers I have met in my work, they had a tough time developing the software and never really got that part of the product off the ground, simply because they lack experience in the different way of documenting mental health and substance abuse services. The workflows are quite different for mental and physical health treatment.
Physical health software concentrates on a limited number of types solutions for health problems. Documentation tends to include electronic results from X-Ray, lab, MRI and other machines that are created automatically from the machine’s results. Other elements are fairly predictable, using a lot of check-boxes and very little narrative. Documentation of physical healthcare has grown into a pretty simple documentation solution for that Electronic Health Record (EHR).
Mental health /substance abuse software tends to focus on assessments that are developed in an agency and may or may not be suited to a bundle of check-boxes and drop-down elements for the sake of measuring outcomes. Treatment plans that consist of a series of problems, goals and objectives, and progress notes with a lot of narrative leave mental health and substance abuse treatment professionals forever writing. For decades software developers have tried to come up with a simple (EHR) that serves these needs, and have found that an important key to successfully implementing software is to suit the customer’s workflow patterns. This has been a trial. We are finding that staff transience among agencies and other factors are leading to a more homogeneous solution, seeing the same software features in many of the mental health/ substance abuse treatment EHRs on the market
Once I went to the CEO of a software company I worked for with an idea to include physical health documentation in the mental health software. He’d spent over 25 years building software specific to our sector. He chuckled at the idea saying, “We can’t even spell what they want to track!” In other words, it wasn’t the software’s core competency and including physical health features, while possible, was not advisable simply because the company didn’t have the rich experience in physical healthcare—it was a different world to us.
It’s true that physical health and mental health oriented software can both generally handle each other’s business, and the difficulty in crossing those lines is that the manufacturers just don’t have the widespread experience in all areas of their business to readily handle both worlds…yet. That experience is being gained now.
Because ½ of all mental health and substance abuse services are performed by physical health clinics, and because the trend in mental health is to have physical health professionals on staff, software is evolving, and companies in both business sectors are coming to know the other side of the coin. Electronic Health Records (EHRs) are getting better, including more functionality that’s sensitive to workflows both in physical health and mental health/substance abuse treatment.Read more →
When you visit your friendly neighborhood Community Mental Health Center, the gap between adaptation of the Electronic Health Record (EHR) in general healthcare and the behavioral / addiction treatment world becomes evident pretty quickly, especially if a consumer is filling out paper forms in the lobby with a worn-down pencil with no practically no eraser left.
It’s getting better.
Recently, in helping a large New York City agency select an EHR, I was surprised to hear they had no common Master Patient Index (MPI). That’s a program that can relate the EHR to other software, like the Human Resources system. The goal of that sort of internal interoperability is keeping the same demographic data common among all the software systems in an agency.
Small and mid-sized agencies end up having to pay software vendors extra to connect their programs, foregoing an MPI mostly because of the added expense. Few saw that this could blossom into a continuous pain, so internal interoperability, sharing of data among an agency’s software programs, takes a back seat to paying the electric bill or giving holiday bonuses (hallowed ground, the holiday bonus).
Most physical health hospitals spent a lot of time and money over the past few decades concentrating on the MPI because they don’t want their doctors and nurses to spend their high-priced time re-writing a consumer’s name, address and other demographic information. Mental health and addictions treatment is just catching up, but we still find licensed professionals and front line staff re-writing this information…oh, and don’t forget about that consumer in the lobby with the worn down pencil. That little metal thing that holds the eraser onto the pencil has just torn through the form for the eighth time…he could get frustrated any moment, and he just wants help with his mental health problem. Perhaps an MPI would help expedite his treatment
Most of the larger agencies bought software for programs piecemeal. First, the accounting department got their software, then the automated time-clock appeared, which by rights should share professionals’ information with the human resources software…you get the picture. The result was a plethora of disconnected software, and it’s not difficult to see how we got to the point of needing the MPI, but not knowing much about it.
If you have three software programs feeding into a central MPI, the MPI must be king of the data, so it can send updates to the consumer’s record out to all those other programs. Sounds simple, but it’s not. Vendors of MPIs charge a pretty penny for their software and support with good reason…brokering changes to a consumer’s health information is serious business, and you gotta get it right, every time.
The agency I mentioned earlier (with no MPI) grew into the need over time, adding different sorts of programs to help them serve people with developmental disabilities and mental health disorders. Not-for-profit agencies’ business priorities seem to have a history of underestimating the value of all those minutes that can be saved when staff, professionals and consumers don’t have to fill out their name and address with that worn down pencil over and over again…not to mention the great benefit of cutting down on graphite and rubber (eraser) pollution.
Like I said, it’s getting better. At least we know what an MPI is, and are learning the value of it in this age of mergers and acquisitions.Read more →