I like new gizmos. I think most of us do, evidenced by the rocketing success of the Apples’ iPod, iPhone, and iPad.
These American products are taking over the world. Unfortunately, in medical technology, the trend is putting us behind the worldwide curve for the availability of innovative and exciting medical gizmos and medical technology in general. Price Waterhouse Cooper says this is a product of good, old-fashioned capitalism. American companies are seeking worldwide for medical solutions that can be marketed quickly and effectively. The fear of releasing products that are not approved by a government agency makes it hard for companies to market medical technologies.
Naturally, we’ll get the goodies eventually, and American professionals can be the last ones to get new technology, so American consumers could be the last to benefit from innovative gizmos and technology. It seems the increasing wealth in emerging nations and Europe is enabling these markets to pay the freight for the cool stuff.
Why is this so?
It’s simple, really. There’s a long history of medical technology being released in this country with negative effects, Medications like Ephedra (a base chemical for crystal methamphetamine, or speed) and Avandia for treating diabetes have their troubles, and Americans are frightened. Medication side effects, X-Ray or other electronic emission exposure, and gizmos manufactured and marketed with flaws have led to government intervention and a hyper-vigilant attitude toward medical innovation. This leads to more testing and a slower release curve, which looses time that can instead be spent marketing the product in other countries. Evidently, the rest of the world is not as careful (fearful?) of things going wrong as Americans are.
Combine this with the idea that the rest of the world is getting rich enough to afford new medical technology, and it’s easy to understand why the rest of the world is getting access to gizmos and medications before us.
In mental health and addictions, gizmos may be less of a factor than with other health concerns, like deteriorated knees that can now be replaced with artificials, however consumers can still benefit from technology, mostly in the area of diagnosis, like with brain scans.
It’s hard to tell what other technology can benefit mental health and addictions treatment when we aren’t clairvoyant, and still, it’s on the way. I guess the point of this meandering discussion is that as Americans, if we’re seeking a new solution to our mental health or addiction problems, technology may be on the way, however, in order to use it, we may need to take a European vacation. Provided we could overcome the fear of side effects and make the bold move to seek offshore solutions, the manufacturer of the gizmo would be happy, and we might end up with improved mental health.
This brings another factor to light…will insurance cover solutions a consumer seeks outside the United States, like use of a gizmo to bombard some brain malfunction that leads to depression or anxiety with newly discovered, healing electronic emissions? I bet they’d want to wait till the item was approved by the government for use in the United States (by the way, I made up this example).
If you’re intrigued about the prospect of an offshore solution to a mental health problem, keep your eyes open and keep surfing the web for new, innovative technology that’s becoming available elsewhere in the world. It’s a good idea to know what we’re getting into when we make bold moves, so check with your insurance company to understand who’s paying the bill, and understand possible side effects of any new treatment.Read more →
I hope I have been proven wrong…
Recently I looked into SmartPhones in medical use, and commented that I felt the applications were not ready for prime time, and that I hoped that somebody could prove me wrong as to the reason why: security. If it was me, I’d want effective security that my communications over the SmartPhone were going to the person I directed them to, and would not be intercepted by somebody else.
Well, the proof hasn’t come to me yet, and I must share that it may be on the way in the form of ACHESS a SmartPhone app for alcoholism and addiction treatment. A study is under way for ACHESS that will test its features from “panic buttons” to GPS locators helping consumers get peer and professional support when they are experiencing cravings or have wandered into the wrong place to stay clean and sober.
ACHESS, or Addiction CHESS, is being tested in the field right now, and we’ll know the outcome in a few months.
I like the ideas that form the foundation of the app and how it’s used.
Still, I wonder about security. I reviewed the ACHESS web site, discovering that current iterations of the product are primarily for the home computer, for which SSL and a few quite good security solutions like Citrix are about as effective as you’re going to get. The problem with the SmartPhone is that it’s wireless, and if your messages go out into the ether without some sort of scrambling called encryption, there is a high likelihood they could be intercepted. Addiction treatment has long been concerned with protecting the identity and treatment records of consumers in treatment, and that’s not about to change.
I looked, I called, and I Emailed, and still have no answer to this concern…then again, the test is just beginning, and the answer to that question is forthcoming.
…more to come.Read more →
Can you imagine remembering all the details of fifty cases?
In depth conversations, screening scores and results of a plethora of assessments bring an incredible amount of information into the mix for a single consumer, and in some treatment environments, mental health and addictions professionals can be responsible for the health of fifty consumers. Keeping the details straight seems like an impossible task, which is one reason charts were invented in the first place, and these days, one of the greatest reasons why the Electronic Health Record (EHR) is invaluable in the treatment world.
Thomas Insel, director of the National Institute of Mental Health tackled Memory in a recent blog, and the first thing that came to my mind was how computers store data and assist in decision-making. This study of human memory indicated there is a period of time where memories are fragile and begin to break down…computer data doesn’t do that. Once you have it stored, you can retrieve it in that condition any old time you want it. Still, I wouldn’t say the computer’s memory is better than a professional’s (some days, perhaps it’s more accurate).
A computer saves a series of on-off switches onto its hard drive without intuition attached, without feelings associated. I begin to question the type of record that is saved. A simple suicide assessment can be a record of seven to a dozen questions or so, with answers that can be scored…something like “yes” = “1”, “maybe” = “2” and “no” = “3”. Write down the answers and add up the scores, and poof! You have a scorable assessment, and if you string a few iterations of this type of instrument completed over a period of time, you have an “outcomes study”. The next question becomes “How reliable is this?”
If a patient knows he will be admitted to a facility, and is tired of living in a ward, he may elect to be less than truthful when answering the questions, indicating everything is fine, just fine…when it really isn’t. If the consumer is accustomed to this sort of assessment, he could be sent home because the answers to the assessment indicate he doesn’t need help. The judgment of the seasoned professional increases in value, and relying on a short assessment like this becomes questionable. Naturally, this doesn’t mean the technology is meaningless or valueless, just that it’s a tool, and the trained professional makes the decisions for treatment.
Based on a discussion with a patient while filling out an assessment, professionals may want to look into matters a little more deeply…other tools are at their disposal, including audio and video recording of filling out the assessment, which should be a collaboration between the consumer and the professional.
Most EHRs have the ability to attach electronic files to a patient’s record, like an MP3 video recording of a session. This sort of technology can be revealing as a study of non-verbal communication, and the drawback is that it’s cumbersome…once you record a session, the exact spot to be studied needs to be accessed, and locating it could take a while. The up-side to this idea is that it may be more reliable than human memory. According to Insel’s research, when memories are retrieved, they can be changed, decreasing their reliability. An assessment’s answers or a recording won’t change. They are what they are.
Not long ago, this sort of technology required a substantial investment and a lot of equipment. My Notebook cost $400 and came with a camera that records audio/video in formats that are readable on most PCs.
The idea of recording sessions is an old one. Perhaps it’s time to re-visit some ideas about the EHR like attaching electronically recorded treatment sessions to the consumer’s record. Reviewing records like this could prove to be a lifesaver.Read more →
Is this anonymous?
I ran across a headline sharing the wonderful news for OneRecovery who recently closed a deal with Aetna Insurance. Good for them, the salesperson in me cheers and applauds. For the consumer who is a member of the Aetna EAP involved in this sort of service, it means being attached to a traceable series of numbers to track usage. Before participating in programs like these, look into the security measures offered. Some are good, others may not be so great.
An EAP, or Employee Assistance Program, offers a number of services, some of which revolve around mental health and addiction services. Some EAPs offer telephone counseling with a professional, as well as other life-skills services.
Once again, our health information could be further shared due to insurance companies’ “need to know”…which, incidentally, is legitimate to a certain extent. After all, when an insurance company is paying claims, it’s only good business to know where the money’s going. That said, if I were a consumer just trying to overcome addiction or alcoholism, I may want to guard that information from my employer; if not the fact I was frequenting a site specializing in bearing one’s soul with relationship to the disease of addiction, then certainly to the details about my symptoms, relapses, etc. Recovery is a personal affair that improves lives, creates good workers and helps people become participating members of society who pay their bills. One question becomes “How do we keep recovery on that deeply personal level and still enable insurance/EAP billing without disclosing sensitive treatment details that are nobody’s business but the recovering person?”
Living up to this sort of ideal can be tough, but not impossible.
On the back end of social networking for recovery support, if somebody provides a service, whether it’s telephone counseling, monitoring a chat room, writing a social-networking software program or keeping the server up and running, they need to feed the baby and buy shoes. So, statistics, lots of statistics, need to change hands to assure the work’s getting done and the service is proving valuable. Proving that legitimate services were provided becomes an interesting challenge, not because the statistics aren’t available, but because of the details involved that really shouldn’t be shared.
Many years ago, a company in New York worked with the state to assure anonymity of substance abuse treatment consumers statewide. The state needed to provide and track Medicaid services to consumers in treatment in order to assure professionals got paid and consumers received the treatment they needed without names attached. Maintaining anonymity was a problem. The solution was to hire a third party who was the keeper of the numbers and the names. The state didn’t get the names of consumers, just the numbers. The idea worked fine to guard anonymity of involved consumers. The company that was hired had physical security that made it tough to get into the place. Years ago, the manager of this private, third-party facility protected the identity of a patient, not releasing records to the court and risked jail time. Security was about as good as a consumer could hope for. Every scrap of paper that might remotely be attached to a consumer was shredded, and even computer backup tapes were tightly guarded in a secure environment.
Private insurance companies aren’t necessarily as concerned with confidentiality. Although they may not release records without a consumer’s permission, how much information needs to pass from party to party? I’d say, just enough to validate that a service was provided by a qualified professional, who follows the rules established to protect consumers and assure treatment helps them recover.
I think the on line support groups are a good, and there are a number of them available: Here are a few:
If you’re shopping, I’d suggest you ask about security, and think about how your information, intimate details about a problem that you might discuss in a chat room or on-line with a professional, might be shared with folks like insurance companies, or as de-identified data for research. What safeguards are in place to protect your anonymity?
Caution on the front end could avoid some trouble down the line.Read more →