• Happy Holidays!

    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. HolidayCard 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.

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  • Got MU?

    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!

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  • Toxicology and IT

    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? ToxTesting 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.

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  • Consent…Again

    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. CautionSign 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?

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