The word is getting through to people who need it.
In his February 5, 2013 blog entry, Thomas Insel, Director of the National Institute of Mental Health reflected on how creating a network of integrated care for consumers resembles the IBM approach that transformed them from a hardware and software selling company into one that recognizes problems outside that box and creates solutions that may be innovative and different, or simply a network of people served by a digital network. Not necessarily a new thought, but one that has merit. In my early days of working with the Electronic Health Record (EHR), I worked with a large New York City network of over 20 methadone clinics. That organization had a special “Intake Clinic” at the time, charged with diagnosing the consumer with opioid addiction and any other psychological disorders or physical conditions, assuring the treatment was appropriate, and referring to a clinic that would best serve the consumer’s need. Our job at the time was to enable the EHR with a sort of funneling of consumer health information to the clinics so a record would be substantially completed by the time they arrived for treatment. Treatment, incidentally, needed to be provided within 72 hours due to the nature of opioid withdrawal. That 72 hour window for treatment certainly beats the tales of consumers waiting a month for treatment we hear of all too often.
It was not a bad system. The professionals in the clinics that would be treating the patient already knew the details they needed to know to treat the consumer when they arrived. If the consumer had co-occurring disorders like schizophrenia, they knew about it and could treat it because they go the word from the professionals who made the diagnosis in the Intake Clinic.
Essentially, it was a miniature health network of integrated healthcare that included a physician, nurses, medication, counseling for mental health and addictions issues, and even primary care in some cases.
All of that was driven by the EHR.
Insel talks about a recent study that encourages quick treatment at the onset of an initial episode of schizophrenia. As it turns out, early treatment helps consumers recover, decreasing the intensity of the disorder. Professionals throughout the healthcare world can’t help if they don’t know about the episode. A lot of treatments are available, and professionals in the consumer’s treatment network need to know about the episode and successful treatment, so they can be on the lookout for the recurrence of schizophrenia and do something about it quickly. That’s where the EHR and the Regional Health Information Organization (RHIO) come in. The RHIO shares information among professionals while maintaining confidentiality.
When a consumer is treated in an emergency room, a clinic, or by a solo professional for schizophrenia, the RHIO delivers a way to create an instant network of professionals; doctors, nurses, social workers, licensed clinical therapists and others aware of the problem and its treatment because they can access health information from other professionals participating in the RHIO. One key of success is the Release of Information.
Without it, the EHR and RHIO are rendered impotent for a patient. It’s a problem simply addressed by having the consumer sign a Release of Information that allows the health information to be shared with other professionals the consumer will see.
Another place these two tools for improving treatment are hampered is simply by not being used or consulted. When professionals fail to document treatment and decide not to participate in RHIOs, it’s usually driven by the cabbage, the dough, the shillings, the bucks. After all, an EHR is an expensive undertaking, and a RHIO provides a valuable service in sharing patient information securely and it adds an ongoing bill to the ever-growing pile in the office. Grants are available to resolve this issue.
The fact is, grants are being granted, and professionals and clinical organizations are increasingly using technology. The EHR and RHIO are gaining in success because they are being used, so the problem is disappearing.
The world is changing, and I choose to believe that the direction that change is taking in adopting these digital tools will ultimately help consumers recover and help professionals prosper.Read more →
“What happened?” asked the person on the left.
The person on the right replied, “I forgot my appointment!”
Whether you’re a consumer or a professional, you’ve likely been on one side or the other of this short conversation. Clearly, the reminder (if one’s being used) didn’t work. That signals a breakdown of marketing that can likely be improved by the Electronic Health Record (EHR).
The two most common methods of decreasing the occurrence of this conversation are (1) the telephone reminder and (2) a reminder note strategically mailed to the consumer to arrive a day or two before the appointment. The reminder needs to come close enough to the appointment that the significance doesn’t fade from memory…I read years ago that point is around 72 hours…people forget, even though they’ve been reminded. When this sort of marketing is successful, two things improve: (1) No-Shows are decreased, and (2) if a person needs to cancel or reschedule their appointment, time is available to fill the appointment with a consumer calling in at the last minute for an appointment.
So, these reminders are marketing tools because they show the professional cares enough to reach out to the consumer to assure they get the care they’ve asked for. You may ask how the EHR fits into this equation…I’m sure you have at least an inkling of how this works, and it doesn’t hurt to keep this sort of thing in mind as business processes evolve.
Appointment scheduling in the EHR is a collaborative effort among professionals (or their front desk person) and consumers, and that’s easy with the computer sharing what dates and times are available for the professional. Once an appointment is agreed upon, most EHRs are set up with the capability to both schedule an alert for a telephone call to be made and to print various reports, including a print run for appointment reminder letters to be sent to consumers that day.
If your EHR isn’t doing these things, consider the business angle: For the cost of a recouping a few no-shows, connecting with a professional (like yours truly) to set up this sort of marketing capability has a significant long-term payoff. Efficiencies gained for larger organizations should be significant.
Now, let’s talk about electronic communication between a referrer and referee. Referrals from primary physicians to Mental Health professionals assure the consumer gets integrated care. Integrated care is a buzz-phrase right now, and it makes sense, as we are all connected, body, mind and spirit.
The EHR can have a referrer portal as well as a consumer portal. The referrer portal is important because it helps the referrer track treatment in the external organization. After all, referrals are made with a specific purpose in mind, and if a consumer is being treated for anxiety or depression the referrer will need to know what’s happened since the last time the consumer was seen.
Consumer portals are a really handy method for a consumer to track their medications, appointments, bill, and other interactions with the professional. This is an attractive feature for the consumer and in some cases that can be good marketing (or perhaps some folks will agree that I’m reaching into the ozone with this concept).
These aspects of marketing are important ways the EHR can help the professional and the consumer. They’re not the only options available with this powerful tool. Newsletters can be generated and managed for a professional’s consumer base, reminders and holiday greetings can be managed by the software, and a ton of other possibilities can come into play offering better service to consumers, which equates to good marketing.
A always, more to come…Read more →
It’s continuously newer, better, and always adding more bling! It’s the Electronic Health Record!
One of the great things about the Electronic Health Record (EHR) is its constant advancement. Lately that’s been guided by Meaningful Use incentives, money from the American Recovery and Reinvestment Act (ARRA); The original idea for these legislations was at least twofold: (1) extend the EHR’s use, and (2) get some money pumping through the economy. It’s worked out pretty good for everybody involved, generally speaking. And now it feels like everything is constantly changing. The consumer wins with the EHR. I figure I’m like many Americans, and I have a tendency not to keep prescription details in my mind, reading assignments fall through the cracks unless I have them set as alerts in my SmartPhone, and Appointments? Fugghedaboudit, I must have both telephone reminders from the professional I’m working with and a calendar item set in my SmartPhone in order to focus on my healthcare issues before winding up in a place I don’t want to be, like an emergency room.
The EHR helps the consumer by recording the next appointment scheduled and creating a tickler list for calling the consumer with a reminder to make the appointment. The EHR also records what happened in the previous appointment and what direction treatment is supposed to take in the next appointment. That sort of information can be securely accessed in a “Consumer Portal”. The concept of a consumer accessing by actually using their consumer portal is a key to true participation in treatment, and just coming into use in many EHRs.
If the professional isn’t using their EHR to help the consumer focus on joint development of the treatment plan, one appointment at a time, then the software may not be living up to its potential. The professional’s records can actually help increase treatment effectiveness by keeping the treatment plan current with emergent issues and such, and assure it’s being constantly referenced. There are tons of regulations in play to enforce this practice, so it’s a good idea to optimize the treatment plan and let it do its job in this respect.
The organizations the professionals work for, behavioral health clinics, hospitals, emergency rooms and the like benefit from the improvement of treatment records on many levels. Primarily, there’s billing. What a nightmare insurance billing can be. The codes required and the rules of using them baffle PhDs across the country, and without the EHR to track what services are provided, when, and document that they meet insurance billing rules, payment may not be forthcoming. That said, the real culprit is not linking the billing portion of the software to the consumer’s medical record. When something’s done, it needs to be billed. Professionals in treatment may not be acquainted with billable services, and the software can be smart enough to automatically bill for services once a progress note is written or when a consumer successfully completes an appointment with the professional.
The software manufacturers sell software, and by reviewing the last year or so of my blog entries at www.mindhealthbiz.com, you’ll see most of the top-tier EHR programs in this industry have incredible features to help in that selling focus. They meet Meaningful Use incentive requirements, and they can do about anything a professional may need to improve both the clinical and business end of their work. Where all these benefits hang up is implementation. A professional can spend a tremendous amount of time and energy selecting just the right software, working with the perfect vendor, and in the end, if it doesn’t get used, it won’t work.
Implementation is a large project, lots of moving parts that touch every area of an organization trying to get the most out of the EHR. A lot of research goes into process workflows, insurance billing requirements, state licensing agency requirements and auditing requirements, and the result of this research needs to be part of the implementation. Too often, the implementation drags on and momentum is lost and the EHR ends up not performing as advertised because it’s not fully implemented.
And that’s not all.
Once the EHR is up and running, it’s constantly improved by the manufacturer, requiring work on the professional’s end of the equation. Constant optimization of the software adds to the complexity of the EHR implementation…it seems never ending. It’s a constantly changing world, and to respond to changing needs, software needs to be reconfigured from time to time to keep the EHR relevant and helping the consumer, the professional and mental health treatment organizations.
And that’s a never-ending story in itself.Read more →
It’s all in one place. Not.
Not long ago I received an Email from professional who read my post on the demise of GoogleHealth, and he brought up the topic of a “universal health record”. The current and past couple presidents have helped this country move toward electronic sharing of patients’ Protected Health Information (PHI), simply because it’s good for us. These days consumers have options. Primary Care Providers send them to specialists in every discipline from cardiology to mental health. When a consumer arrives to a new facility, the amount of paperwork can be daunting. Filling out name, address, and other duplicate information has become an unnecessary nuisance thanks to the Electronic Health Record (EHR).
My friend was a little critical of vendors of (EHR)s that computerize patient health records for professionals and the organizations they work for, believing that none have really made the jump into a practical method of sharing data that makes up the Universal Health Record that’s practical on a nationwide data-sharing basis. Whereas it’s taking far too long to have a terrific system to accomplish this in our country, I believe we’re taking baby steps in the right direction. He also suggested using a personal database to store personal health information that could be shared among the consumer and the professionals that serve him. In my mind, that might be a piece of the puzzle, but not a key to sharing PHI.
The solution to the sharing of PHI lies in organizations like a Regional Health Information Organization (RHIO). Without boring too many folks with the details, RHIOs and organizations like them act as data middlemen, assuring a consumer’s confidential information remains confidential (and “Protected”). They route data that’s been approved by the consumer to move among the specialists I mentioned above, hospitals and other healthcare organizations who might be helping the same consumer. Right now, the work is actually a long way down the line in creating electronic “Continuing Care Documents” (CCD)s that carry PHI like prescriptions and who’s treating whom for what. It’s far from finished, and not perfect…baby steps.
Vendors of EHRs have a particular interest in this because their products hold all the data at each of the healthcare specialists and organizations I’ve been talking about.
You can read my reviews and see some good things about the mental health and addictions treatment records on the market today. There are around 84 vendors out there serving this business sector, and the products vary in how they approach the EHR. My friend is more critical than I am, although I agree with some of the things he had to say.
The vendors who are selling software products in this sector have chosen an interesting way to make a living. You can’t please everyone…in fact, it’s difficult to please anyone. Technology being what it its (imperfect), and vendor organizations being made up of people (imperfect) who work with models for their software that really describe the need of a minority of organizations (imperfect, imperfect, imperfect). In my business I have been to many treatment facilities, and while there are many similarities, each one is original and different from its peers.
To resolve this difficulty and serve more organizations, vendors have included “simple” software screen design tools and report writers that will help manage a consumer’s record and run the business. The idea is for the customer to modify the system to suit their needs. It’s turned out to be a complicated addition to the EHR that can be a godsend or big trouble, depending on how it’s used and how fate decides to move in changing the ever-changing environment of mental health and addictions treatment. The EHR can lose consistency, and data commonly needed for treatment among many professionals for a consumer can get lost in all that “special” screen design, never being shared with other professionals who might need it to better treat a consumer.
The RHIOs and the CCD have added a level of consistency to the EHR that helps us move toward the Universal Health Record. Vendors are cooperating with one another in the effort by joining the Software Association (SATVA). The government has helped in the effort as a result of the American Recovery and Reinvestment Act (ARRA) and HITECH funneling funds to the states for the sake of supporting and improving the huge healthcare industry and healthcare IT that serves that industry.
We ain’t there yet, but we’re taking baby steps and will get to the Universal Health Record.Read more →
My mom was big into psychics…not that she believed them, she was merely intrigued. Right?
Predictions regarding the Electronic Health Record (EHR) for the year are out, and not that I believe them, but I’m intrigued. Let’s start with Marla Durben Hirsch, a contributing editor for FierceEMR. She has five predictions, and the one I’m most interested in is software vendors using cloud technology. Cloud technology is a marketing term that encompasses a bunch of services offered by an EHR vendor. Sometimes referred to as an ASP (Application Service Program), it includes using the server, gobs of disk space, and great services like automatic updates to the latest, greatest software enhancements. From a vendor standpoint it’s easier to maintain and support because the vendor has control of the technology. Sometimes professionals and the organizations they work for tend to cut corners on technology to save a few bucks. From a professional’s viewpoint, cloud technology may be good because they’d rather not become a technology expert or have to hire a local consultant to handle all the jobs involved in maintaining a system. The core of this provision of the EHR is that it’s deployed on the web.
The first worry that usually surfaces is the security of consumer data and confidentiality of a consumer’s health information.
I’ve talked before about security, and SSL, or Secure Socket Layer is the most common method of securing a connection between a professional and their data when the EHR is housed and maintained elsewhere. Another security method is Citrix, which is supposed to be even better security than SSL. There are more methods of securing the confidentiality of consumer records, and anybody who sells an EHR system must offer good data access security these days, or else the HIPAA police will get very upset and there will be consequences to pay. So, since this was all worked out years ago, data security is generally not an issue when a professional uses a web-based EHR; people buying software still ask about it, so I address it.
Cloud technology is especially valuable to solo professionals (products like practice fusion) or small organizations with under 100 employees (products like Foothold Technology’s AWARDS System. Professionals really need to be treating consumers, not troubleshooting server problems or wondering if a backup is available after a system crash.
InformationWeek has its predictions published already. I like number seven. I think what they’re talking about is providers of one product (like lab or pharmacy services) delivering web-based EHR modular software solutions to woo more customers into using their primary product or service.
One significant drawback to a solution of this sort is that it’s a module. Both professional and consumer are better off with a total solution where session notes (including breakthroughs and next steps) and mutually developed treatment plans can be attached to everything else in the consumer’s record. Still, the prediction is for this sort of modular approach to software in mental health and addiction treatment is on the upswing for 2012.
Healthcare IT News has a different take, and I find it quite interesting. For example, since the growth of Healthcare IT has been a major focus of the American Recovery and Reinvestment Act (ARRA), and the gains have only been modest, I agree that will played up quite heavily in the presidential election. This sort of thing can be spun to either create controversy, or used as evidence of doing a great job, depending on which side of the fence you’re standing on.
Whether you accept the predictions that are coming at us like popcorn as valid or not, it is at least fun and educational to check in with what people in the world out there think.
Enjoy your day, and don’t sweat the predictions…unless you believe in psychics.Read more →
“It slows me down!”
A lot of professionals complain about entering their notes and other consumer care documents into the Electronic Health Record (EHR), saying it slows them down, or they don’t have time, or something of that ilk. My experience with this issue is that once the EHR is properly in place, it saves time and the professionals actually start to like it. I even hear comments from consumers that they like the idea of collaborating on their treatment plan and knowing what the next steps are going to be when they show up for their next session (a handy use for the EHR). It’s true, however, that the EHR can slow professionals down for at least a few reasons:
The good news is that all these shortcomings can be avoided.
Process Analysis is simply following a consumer through treatment and seeing how the professionals’ documentation is captured before the EHR comes into play. Process Design for efficiency uses the analysis and needs a couple very important tools to enable the EHR to work to the advantage of the professional: The screen designer and the report writer (other tools like treatment team and consumer communications software are great, but these two tools are the foundation of designing a working system). Process Implementation actually pulls together an EHR design that makes documenting services less time and effort consuming.
So, if the EHR really can save professional time, provide treatment team communication and help deliver better treatment to the consumer, how come so many professionals resist using it? I’m sure there are hundreds of excuses and a number of valid reasons not to use the EHR, many related to specific technology problems that could be remedied for a price. Other than that, professionals would rather treat consumers than learn to use an EHR…or improve their keyboarding skills.
There are a bundle of solutions out there to address professional resistance to using the EHR, and one is a marriage of low-and-high tech: The Remote Scribe.
Imagine, if you will, you’re in a session with your psychologist, and there’s a large screen on the wall that displays your EHR. You answer questions in an assessment, or talk about the plan to treat your difficulty, and the screen starts displaying the assessment selections or typing magically appears during the session. Interesting.
The high-tech portion of this solution is the simple presence of the EHR in the first place. The low tech portion of the solution is that the notes are relayed via a headset and microphone to a “Remote Scribe” (a human being). So, another data entry person is on the payroll. Not a new twist, this is getting the same old documentation solution back into the healthcare arena. The scribe has been called a transcriptionist for many decades, and some professionals would rather retire than move away from this sort of medical treatment documentation service. I suppose it’s a valid way to keep technology resistant professionals working, but it strikes me as paying double for documenting services, which is the data entry bummer. Even if the Remote Scribe delivers a return on investment, it’s still adding a task into the mix that doesn’t need to be there if the EHR is designed and implemented with efficient and effective professional workflow and with the consumer’s best treatment in mind.
The simple solution, and a much more valid one for my money, is to follow the direction of the EHR that’s moving us toward National Health Record and better care for consumers with the help of technologies enabling electronic sharing of consumer records in order for professionals to treat the person as a team.Read more →
2011 has been a memorable year for MindHealthBiz. I hope I’ve helped steer some people in a positive direction with this bolg.
MindHealthBiz continues to evolve, focusing more on the core expertise, which incase you don’t know is Hands-on Electronic Health Record selection, implementation and vitalization. I’ve met some new friends this year, which inspires gratitude. I’ve also had some people from my past help me out in ways I could never foresee. A ton of “coincidences” have come my way, all positive.
I’ve had some personal trials this year, who hasn’t? I am convinced that every challenge has led me to a better spot. Perhaps it’s just the old addage “That which doesn not kill us makes us stronger”…I prefer to look at each one of these events and situatios in my life as gifts from the Universe.
Remember in 2012, Peace and Love is where it’s at! -T.Read more →
It’s amazing how humans invent pet names for concepts…even money: Samoleons, bucks, sheckles, MU.
That last one, MU, is Meaningful Use incentives a subject near and dear to healthcare’s heart, since it helps pay for all that expensive Electronic Health Record (EHR) software and the effort to make it work efficiently and effectively. The EHR is intended to keep better records, thereby helping treatment professionals work as a team with consumers, whether they work for the same facility or not. The EHR is evolving into a tool delivering better access all treatment records, as long as the consumer signs a release of information form.
The MU delivers cash incentives to assure the professionals are using the EHR in a meaningful way, to guide treatment into productive, healing directions. There are rules, and the first set of rules, the 15 core objectives of Stage 1, are supposed to be on line now, following a strict timeline to speed up the process of getting the EHR working and accepted nationwide. The core measures are technological assurances that Meaningful Use incentives (our tax dollars) are invested wisely.
Progress has been a little slow.
Professionals feel the timeline has been too aggressive, or don’t want to spend the money, or don’t think it applies to their treatment discipline…pick one or more. The fact is, professionals who saw the opportunity are collecting checks. It’s all in how you work with the system.
In response to the slow EHR acceptance and in order to encourage more organizations to ramp up their EHR, The US Department of Health & Human Services (HHS) has announced a year’s delay to meeting Stage 2 of Meaningful Use so more people can implement their EHR to meet the Stage 1 requirements. Got that? Good, because it can be confusing. There are three Stages, and not room here to discuss it all in this discussion, so let’s stick to some early benefits and the aforementioned reason why Stage 2 has been delayed.
In line with our president’s primary EHR reasoning, MU has created 50,000 jobs so far in Healthcare IT. That can’t be bad.
OK, so what’s the big deal? Well, the Stage I core measures are the easy ones. Most software vendors of any significance can meet these requirements to collect the incentives already. You’ve probably seen some of the elements in your friendly neighborhood mental health center or your primary physical health physician’s office. These core measures include activities like electronic prescribing, which cuts the time to order medications and virtually eliminates medication errors that can be harmful or even fatal. One Stage I “Menu Set” measure assures that your information can be shared electronically among your professionals offering care, so the primary physician and the psychiatrist will offer supportive therapies instead of contrary ones.
Stage II objectives include some elements that may not be very tough for the software manufacturer to include, but to implement the software into the workplace is a chore. The hope is that the benefit exceeds the pain to get the functionality up and running. Another day, we’ll examine Stage II objectives.
The jobs created in healthcare and information technology make the expense worth the effort of meeting both the Stage I and Stage II requirements. The MU incentives can pay for an entire EHR and its implementation over the course of the five year period professionals collect the payments. And ultimately there’s one outcome that can’t be seriously denied.
When a professional has access to more health information about a consumer, she’s better able to treat the consumer. When professionals have outcome measurement tools that can be measured nationwide with de-identified data, treatment can improve. When professionals work together, the consumer gets more comprehensive and effective treatment by treating the whole person.
All this and samolians? What a deal!Read more →
Toxicology, or urine testing consumers seeking treatment for drug problems, is a top notch tool in substance abuse.
These days, alternatives like saliva testing are available, and to hear the manufacturer talk about it, the oral testing alternative is better. It’s certainly less degrading to have a professional monitor an oral swab in the waiting room as opposed to monitoring the drop of a urine sample. As long as the results are accurate enough to be used in measuring outcomes of treatment, who cares which is used? But what’s that have to do with the Electronic Health Record (EHR), you may ask. The volume of toxicology testing results that are passed along to addictions treatment facilities in the course of a normal week can be tremendous. A few hundred consumers, all providing proof of using (or not using) substances on a regular basis multiplies the results data to an unmanageable amount of paperwork pretty quickly. Paying somebody to do that data entry is a really boring job and an unnecessary expense and it might be better to find something of more value for the person to do in the facility. The risk of inaccurate results being recorded manually in the EHR is a lot higher with manual entry than a direct feed of results from the testing machine to an electronic file. And that file can be directly passed to the consumer’s electronic record.
Whether a test is oral or urine, it has to be sent to the lab for testing…it’s not like the oral swab has a litmus paper test & turns different colors for different drugs. Actual test results that are passed from the testing machine can indicate not only the presence of a substance, but can actually tell how much is in the system, a level of intoxication, if you will.
Difficulty can arise when the data file of results has to be electronically transferred from the lab to the EHR. The standard tool to do this is the Health Level 7 (HL-7) a sort of traffic cop-software that sits between the lab and the EHR, telling the data where to go and what shape it needs to be in to arrive safely and securely. The HL7 can send data in either direction, so if the lab’s software needs the patient ID number or any demographic or specific test information it can travel from the EHR to the lab, and results can flow back. The HL7 is a nifty tool, because this can be either a live connection or a “batch file” that’s downloaded from a secure site with a secure connection…that security stuff assures no superstar in addiction treatment will see her toxicology results posted on Facebook.
OK, now that you know how wonderful the tool is, what’s the downside: When I was in the business of providing HL7 software for folks, it was easy to see a project costing $30,000. That means that sometime in about year three of using the tool in a typically sized addictions treatment facility you’d expect to outweigh the cost with the benefit of freeing up that data entry person I talked about earlier…unless he’s doing something that’s more valuable instead and generating revenue.
Labs concentrating on toxicology faced this dilemma years ago, and made the decision to make the results available electronically. This was before the HL-7 was a complete standard, and still carried quite a price tag. Consequently, labs had to pay programmers to develop a proprietary program and provide a secure way for the customer to retrieve the results file. A number of treatment professionals use these labs, and the downloaded files have turned out to be a dual edged sword.
Two costs suddenly erupt on the EHR end of the equation: A program to integrate the results into the EHR and ongoing support.
A number of EHR vendors have elected to work with a lab or two to assure their proprietary data can be imported into the EHR and make it back to the correct patient record and test record. Some require payment for this work. In my experience the range of cost is $0 to $15,000 to get started, and from $0 to $2,250 a year to support the program and assure quick response if something doesn’t go right with the data transfer.
It’s important to a professional to confront a consumer quickly if substance use is suspected; the value of confronting a consumer about their use of substances diminishes as time passes. Without good support from both the lab and vendor, the advantage of an early confrontation can be lost.
In short, the lab and the professional both want accurate results quickly. This is where professionals like yours truly come into the picture. Selecting and implementing a system to deliver results quickly is half the job, the other half is monitoring the system to assure the promise is delivered and the best tracking of outcomes becomes available for analysis in the EHR.
If you’re a professional working with an addictions treatment agency considering the purchase of an EHR, be sure to ask both the lab and the software vendor about the transfer of results data into the software. Success and tragic endings can depend upon the initial software purchase & support agreement.Read more →
I know, I’ve belabored the “release of information” subject.
It’s good to know somebody else is thinking about this, and in a far-reaching way. SATVA, our industry’s software vendors’ association recently posted an interesting article on Behavioral Healthcare’s magazine that lays out the importance of a “consent to disclose” form (I’ve called it a Release Of Information form or ROI) in the Electronic Health Record (EHR). Without a single, signed form in common, disclosure of the consumer’s health information can’t be shared without breaking at least one of 32 federal and state laws that protect consumers’ confidentiality. The goal would be to make a common electronic form available in all EHRs and RHIOs in order to assure a consumer gets the best treatment from any healthcare facility he walks into and maintains health information confidentiality. Naturally, consumer records electronically shared among their professionals providing care can reduce duplicate tests, duplicate data input and other wasteful activities, and even prevent medication errors that could cause big trouble for consumers, simply because the professionals are acting as a team, not lone guns. None of these benefits can be realized without a solid, mutually accepted ROI or consumer consent agreement (same thing, I’ll stick with ROI for now)
SATVA even delivered a specification for the consent form, (amazing these guys agree on something given the competitive spirit in the software industry), stating a number of ways RHIOs are affected by the protective laws I mentioned above.
The ROI would deliver instant approval to share information, which means more timely treatment for the consumer and less pain, whether physical or emotional. Wouldn’t it be great if you moved from Oregon to New York and your new professional had access to your chart across the country when you came in for your appointment? That’s electronically possible now, except for the lack of an ROI.
So, why is this little stumbling block to all these benefits a problem, you ask? There must be a way to overcome the problems.
Right now, all it takes is a signed form to share the data between providers and that can be faxed. A major drawback of this system is that most providers have completely different forms to fill out, and filling out multiple forms them takes expensive professional time. Then there’s the clerical time and energy spent faxing different professionals for their specific ROI forms, getting them signed, and then faxing them back before the patient record is transferred. Then, depending on the professional’s legal limitations and technological status, the information sought (could be many pages) would need to be faxed, mailed or shipped. Now multiply all that effort and trouble by the number of physical and mental health professionals involved in the consumer’s care.
Oh, and next, multiply that by the number of consumers seeking care that day among all the professionals involved. The energy and expense both mount up.
I’ve commented quite a bit on Health Information Exchanges (HIEs) or Regional Health Information Organizations (RHIOs), and they’re key to this subject. RHIOs need to become intimately acquainted with those laws and rules I mentioned earlier…they have the same responsibilities to consumers as software vendors and professionals. This means the electronic ROI would need to be a common design among all the software vendors, professionals and their RHIOs, and also maintain the consumer’s stamp of approval and specific mention of the professionals involved, whether it’s an individual or an organization. That’s quite a job, too, but it can be done more simply and elegantly with electronic transfer of the health information data. The ROI also needs to cover why the consumer’s information is being shared; is the reason clinical, financial or something else? Since a RHIO can’t pass along information to anybody who’s a member without authorization, some sort of accountability needs to be built into the string of data sharing and availability to assure consumer confidentially.
Like I said, it’s a big job. The good news is that SATVA says they’ve already built it and have tentative approval of SAMHSA, and all the professionals and RHIOs need to do is buy it…but then again, maybe it’s free.
How likely is that?Read more →