I’m no professional, but I’d say prioritizing can make or break us in mental health and addictions treatment.
OK, so my work as an Electronic Health Record (EHR) Consultant has a very professional aspect, but I’m not a mental health and addictions treatment professional. We all have priorities, but it seems to me that the mental health and addictions treatment professionals’ priorities are likely to be based on criticality and probably carry more weight in the grand scheme of things than an EHR Consultant’s.
Let’s look at a day in the life of a sample mental health clinic. Our sample professional can be faced with priority list of tough choices about a whole caseload of consumers, and in the moment talking with a consumer who is experiencing suicidal ideation; this case creates its own ever-changing list of priorities. Simultaneously, the Chief Financial Officer (CFO) of the organization has a stake in our sample professional’s priorities for the day. The CFO’s priority is in making sure the professional’s work gets paid for with the highest rate of return. Yet another item in this day would be passing muster with audits in order to keep the money once treatment has been delivered and the bill paid to that professional, a situation that deserves its own spot high on the priority list. Our sample professional is still concerned with her consumer, whose welfare remains the top priority, however, after that she will likely cooperate to assure the other two priorities are met. The CFO and auditor both maintain their number one priorities, too, which can seem like a conflict.
So, all the priorities are on each other’s lists, it’s a matter of perspective as to which item floats to the top. In the end, the entire team involved in this day-in-the-life description needs to agree on one set of priorities…what comes first and how much energy should be devoted to getting each item on each list of priorities done.
When it comes to the EHR implementation, these daily scenarios need to be weighed for organization-wide importance and ordered realistically on the organization-wide list. Without team cooperation, what’s best for the entire organization may fall to the wayside and priorities may change enough to run out of budget before the EHR is fully implemented. A team needs to be forged; flexible and intent on doing the most for the organization with the available budget. Some items will be left off the list because money tends to run short before work.
The mission of the EHR is to document consumer treatment, bill for it and account for where the money goes; the mission of an EHR implementation project manager is to configure, train, comment, cajole and lead all these people to a happy consolidation of priorities that will satisfy them all in the end – at least mostly. It’s a tough job, satisfying many masters in an ever-changing environment, and if we don’t get agreement on consolidation of priorities at the outset, our project may be doomed. Sometimes priorities are mismanaged and the job is left unfinished with users struggling with a partially implemented EHR.
How can that happen?
When software configuration is out of kilter or the software’s procedures don’t dovetail with the organization’s, there are a number of factors that can be affected. Discoveries of inappropriate design and configuration come up during implementation and if the project manager and team aren’t responsive and willing to negotiate priorities, it leads to unexpected development costs. Sometimes the perfect solution is sacrificed for the good-enough solution.
Because difficulties like these are ignored, too many EHR implementation projects have been left incomplete, and that hurts the EHR manufacturers’ reputations, as well as hurting the professionals and support people who rely on the software to inject some efficiency into the flow of their work. A solid consolidation-of and agreement-upon priorities is the first step, and to avoid leaving a project unfinished, a balancing act comes into play. The team needs to stick to their guns and implement according to the original consolidation of priorities as closely as possible. When that goes off-track, the project usually requires more time, work and resources to live up to changing priorities OR some items on that priority list are dropped off with a plan to address them later (complete with a scheduled date)
I recently encountered the effects of an extensive issue where consolidation of priorities was not well done and consequently ineffective. In the Mental health and addictions treatment world, the number one reason not to use the EHR is a lack of “user friendliness”, which can mean about anything you want it to mean. Some of the project was completed, but not all. Managing schedules for consumers and professionals was left incomplete. Billing and posting payments was left about half done.
Consolidation of priorities to even make the implementation work for a team like the one described above was ineffective…gotta keep on top of that.
We want our highly skilled professional team described above to stick around, so configuring and implementing the software with “user friendliness” in mind becomes imperative. Since our EHR wasn’t implemented and managed to meet a set of negotiable, consolidated priorities, the list may have been unrealistic for the budget. The team may not have had a realistic appraisal of the number of man hours required for the job, or explosive growth may have gobbled up a bundle of the team’s time that was supposed to be devoted to the implementation. Priorities were not met, plans to meet them didn’t get made immediately upon realization that was happening.
Consolidating priorities has to be a joint agreement among all the players and needs to be revisited and re-negotiated on the inside of the organization. There has to be some give and take and a clear view of what’s best for the entire organization. If reality changes the priorities, a new plan with an adjusted budget needs to be agreed upon and approved.
…Easy-peasy, right?Read more →
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 →
These guys are gizmo hip.
That’s what struck me as a real high point for Credible Wireless when I recently saw their product. That and cloud-based technology. The product looks good. Whereas almost all of the other products I’ve seen this year have user interfaces that lean a bit toward the “1990’s look”, Credible looks current. It’s not surprising. Since they’re an internet based company, their focus for the past decade or so has been to look and act like they’re on the cutting edge of technology. A number of years ago, I was into computer games. Graphics development had just made some leaps and bounds, so the games were beginning to have a more real sense about the people and houses and roads and weather and other elements of life. Hardware technology had just made a couple huge leaps forward, and it seemed computers were improving overnight. From that foundation, I came to expect a lot out of software and hardware. These days, all that technology is deployed on the web for a bundle of industries, and products like Wii are setting the stage for the new world of the EHR. All the companies I’ve reviewed this year seem to be moving in the right direction, and I think Credible is somewhere near the head of the pack.
They’re proud of their ability to work on the SmartPhone, the iPad, and probably any other gizmo out there that’s internet-happy, and a lot of professionals like that. Consumers will appreciate another interesting factor that emerges from this sort of software manufacturing foundation. Electronic Health Records (EHRs) I’ve seen deployed on these sorts of technology just haven’t delivered enough real estate to do the job…the screens are too small. A well thought out screen goes a long way toward making them usable, and for consumers that means their professional can take notes or fill out assessments very quickly and efficiently. Nobody likes to wait on somebody who’s texting their girlfriend, and I think it’s the same thing when a professional’s filling out a form on the SmartPhone.
On the surface, the billing system looks good. Since I’ve been around billing systems for a long time, I walked away with questions that a facility might not ask. I plan to see the system in person soon and get some hands-on time with the software; I’ll have a better handle on whether the billing system has a reasonably sensible setup time and process and whether some key problems that occasionally come up with software have been addressed. I can’t imagine my concerns will cause them problems, but I gotta ask the questions. What I do know is that they can bill insurance electronically and have a “scrubber” that helps get a clean claim to the insurance company. This avoids denials to pay a consumer’s insurance claim…insurance companies are picky and it’s better to be ahead of the game in this regard.
I’m a big fan of screen design tools…I want to be able to make a form like an assessment or special type of progress note do exactly what I want it to do without paying a software company to write code. Credible EHR comes with just such a tool, and that will be another thing I will be looking into soon. I assume it works like a number of similar tools on the market, so it should be pretty straightforward. I have a couple of concerns I need cleared up about the technical capabilities, so it should be a fun time. I’m optimistic.
Reporting is always a concern for professionals…How many consumers are we helping? Are we helping folks with the right services? Are we getting paid for what we do? Are we able to pay our bills? These and hundreds of other questions can be answered by reports in an EHR. From what I saw, the reporting system in Credible’s EHR is good. It’s based on some standard technology and for a techie with medium skills writing reports with some value should not be a problem.
Credible’s a small company (around 140 customers and “choosing to grow slow” is what they say), so I wonder why more people aren’t buying the system. If you’re a professional working at a facility that’s purchasing an EHR, that’s a concern to address with Credible early in your selection process.
Still, after all is said and done, Credible’s probably worth a look in most parts of the country.Read more →
If the Electronic Health Record (EHR) selection process was a beauty contest, Netsmart’s myAvatar product would likely take the prize. The look and feel of the software as it was set up for a recent presentation I attended was excellent. One of the problems that can arise with EHR software is a lack of attention to making the software work within the special workflows in a mental health clinic. myAvatar’s workflows were well designed, suiting process flows for different user roles like billing, executive and clinical users. The idea is still along the lines of displaying sub-windows and rows of documents, activities and appointments; It’s easy on the eyes. As I’ve shared before, when an EHR takes this sort of detail into account, it makes for a more complete record of treatment, and the professional is better able to address the specific needs of each individual consumer. When information is at a professional’s fingertips, it’s more likely to be used; if not, and the records of previous sessions aren’t reviewed, is the consumer getting the best care?
Additionally, the inclusion of pulling data from Outlook is a plus for the Case Managers in the field. There is likely a way to launch Outlook from a hyperlink embedded in the program. I say this because it’s simple technology and a feature that was included in a previous version of the product. Data can also be pulled and pushed internally. The example was pushing problem data from an assessment to the treatment plan, and pulling goal and objective data from the treatment plan into a progress note. Professionals are human, and can be under pressure to see a high number of consumers in a given week. Those two factors conspire to make time-saving features like these vital to make the most of a professional’s time while giving her the information she needs to treat the consumer’s problems.
The reporting engine for Avatar is Crystal Reports, and although many vendors are moving toward internal reporting engines, Avatar provides a great map to the fields where certain data resides called “option documentation”; it’s quite simple to use, organizing the electronic record so it’s simple to pull data out of the system. As long as you have a person around to write the Crystal Reports, you’re set. From my experience, folks like yours truly can write Crystal Reports much less expensively than Netsmart (NTST) staff, so your organization may wish to consider outside consultants.
The EHR‘s RADplus toolkit is essentially a design tool that enables the customer to build their own system. In fact, this is what a number of customers have done. Because the RADplus is so robust, it also requires a level of skill somewhere between the design tools I’ve seen in other products and those of a programmer. If I had to guess, I’d say a slightly better-than-average Crystal Reports writer would have no problem using the tool. I’ve designed a number of screens and associated reports to them, and the outcomes have been good for the professionals using the system.
It’s tempting to use the RADplus tools and Crystal Reports to design a system from the bottom up because it would seem perfect. It would not be. The tried and true method to use for implementation is the same as for any major product on the market. Start with the existing forms and reports, modifying slightly during the implementation and approach improvements to make the system truly “my Avatar” only after the initial implementation has progressed to a level of Meaningful Use, billing and regulatory compliance.
The use of RADplus to design dashboards was flashy and impressive. Widgets can be included on dashboard screens to track whatever metrics exist in the system, from census to treatment plans due to authorizations due.
Predictive Modeling is a recent addition to NTST initiatives, encouraging research by sharing de-identified patient treatment information among the user group, a program reminiscent of the MindLinc business model. I’m not sure how far along in the process of bringing this offering to life, but if research is your bag, this is the sort of work that broadens data samples required to measure new methods of treatment and can help consumers recover on a grand scale.
Like most of the systems we’ve seen, Utilization Review and Quality Assurance problems are avoided by the customer adding compliance rules to specific activities like treatment plan reviews coming due and insurance prior authorization renewals. This removes most of the labor intensive data management from these two functions, and transfers tasks to a sort of “informed policing” of data and activities.
Netsmart has acquired a number of EHRs over the years, as well as ePrescribing, on-line education and other options. This has made them the largest EHR provider in mental health and addictions treatment and worth a look if you’re a professional whose organization is in the market for an EHR.Read more →
It’s more than “Just the facts, Ma’am” .
Qualifacts Electronic Health Record (EHR) slices, dices, and combines consumer health information in an impressive manner. This EHR is geared toward mental health clinics, and is another product that appears to have all the pieces. I was privy to a recent presentation of the software, and for the professional using assessments and other professional instruments to measure how a consumer is doing with ongoing treatment, the tools in the EHR look pretty good. The ability to include a few questions in a progress note with answers that can be plotted on a graph can help the professional and consumer zero in on what’s working in treatment; and that seems like signposts on the path to recovery.
Another tool that helps save some time for professionals is the ability to push data gathered in assessments directly to the treatment plan. If you’ve read my other reviews, you know this is nothing original, and that I feel it’s functionality necessary for success in today’s software world.
Billing seems to have all the pieces, and should a mental health or addictions treatment company move forward in the process, the billing functionality should be thoroughly researched. Due to the time allotted the presentation, I was unable to review this, and like any professionals, I’d want to be very careful with billing, since it holds the key to success with an enterprise-wide EHR.
In this age of data leaks, losses and thefts, a software company needs to do what they can to plug up the possibilities of data escaping. One of the things suggested by HIPAA is data encryption, and Qualifacts is in a minority of companies readily identifying their product and delivered environment as encrypted.
The report writer is an interesting approach. On the surface, it looks quite good, however it’s an integrated third party report writer, Panteho. Unlike Crystal Reports, which requires reports be written independent of some EHRs, this report writer is embedded into the program. The functionality seems fine, and the data dictionary looks superb at first glance. On the other hand, if I were checking out Qualifacts, I’d talk with Panteho, too. The idea is to feel good about Qualifacts receiving the maintenance and product improvements that are needed to keep up with technology as we move forward through the years. It’s likely not an issue, but it never hurts to ask questions like this.
The user interface (UI) could take some getting used to. I saw traditional design elements of systems like a persistent modular approach and needing to use several clicks to access a document from the user’s home page. From the home page, I really want one click access to tasks that need to be performed regularly like treatment plan updates and progress notes needing completion. In all fairness, I just because I didn’t see this as a consistent design element in Qualifacts doesn’t mean it doesn’t exist. Any system needs to be configured to meet workflow expectations of specific locations; it seemed like some items could be easily accessed, however, when a new item needed to be added, like an assessment, you had to go hunting through a lot of menus for it. This UI re-defines how a browser is used. The common look and feel of the menu bar that runs across the top is different than what internet-surfers are used to, even though it looks like the product is launched in the MS Internet Explorer. This is a pretty minor criticism considering every system takes some training and getting used to.
The look of the home page presents lists of tasks, scheduled appointments, documentation, and such. It makes it simple to pull up a consumer’s treatment documentation, and when documentation is easy to access, it’s more likely to actually be read.
Another design difference from some of the other EHRs lies in the way assessments are built. The facility builds assessments by selecting from components. Look at it like a suicide assessment is one component, and a mental status exam could be another component, and other sections are components of a bio-psych-social assessment that’s normally given at intake. They all add up to a lot of questions for the consumer, and that’s what an intake is like. Qualifacts uses the components to build the assessment, and then enables editing from there. The idea appears to be an attempt to cut down on the amount of work it takes to configure a system, and hopefully decrease the amount of time it takes to implement the software.
The treatment plan is a standard Wiley documentation approach. Problems-goals-objectives-interventions. As you proceed through each of these, context sensitive choices are presented. For example, a problem’s objectives list will present suggestions related to the selected problem. One thing to bear in mind is that the Wiley Libraries are available at a cost, and many mental health facilities forego the recurring fee and develop their own drop-down dictionaries, which can be a considerable task.
All-in-all, Qualifacts seems chock full of all the right stuff, and if you’re a professional whose employer is considering implementing an EHR, the software is worth a look, and if you like the User Interface and can get a half dozen or so positive references from appropriate customers, it’s worth more than a look.Read more →
To some professionals, that prestigious institution means a lot to the mental health field, simply because they have a program for professionals to earn a degree that’s stamped “Duke”“. That, in itself can mean a lot when the professional seeks a job, and to the consumer who really wants to find a well-educated professional to help manage and resolve difficult mental health problems. To me, “Duke’ means “MindLinc” an Electronic Medical Record (EMR). Note the difference from my usual software designation of Electronic Health Record (EHR). MindLinc is a quite complete EMR, however I see no billing component. That may be a drawback or not, depending on an organization’s needs or not. If a mental health or addictions treatment facility has a billing system they absolutely love (strange thing to love, that), or wants to use AccuMedic’s billing software (see my previous post), MindLinc is an expert in interfacing. Interfacing is the skill, talent and result of a lot of hard work that makes two different software products talk to one another, and from what I saw, MindLinc’s folks have mastered that.
Although not all companies can boast such expertise, that’s not the impressive thing discovered during the initial overview I received recently. MindLinc customers have universally opted into a de-identified sharing of data from the MindLinc data warehouse. The value is evidenced in thousands of cases treating mental illness diagnoses’ common to mental health clinics and hospitals across the nation, and the results that have been entered into that database. This tool offers tremendous treatment guidance based on real treatment results. The implications of this to consumers is obvious…if the professional a consumer is seeing is using MindLinc, they both benefit from a tremendous number success stories; if that data is being leveraged in daily treatment, people might have an improved chance to feel better.
Families frequently participate in their loved ones’ treatment. In fact, family can deliver the greatest support because they are in closest contact with the consumer. A number of software programs have been challenged by connecting family records to a consumer’s records, however MindLinc appears to have an effective method of including those records as a vital, easily accessible aspect of treatment documentation.
From what I saw, MindLinc uses measurement scales in every form to measure progress and outcomes. The idea is to monitor treatment and how the consumer is doing, and if this monitoring shows a statistical trend of a declining payoff in successful treatment, the measurements may guide the professional to a more successful path. The scales tend to be a few simple questions asked that can be quite revealing and are asked regularly. The answers can be graphed to show increasing or declining results of treatment.
The User Interface is what I would call “old school”, and any facility looking for an EMR should take a close look at MindLinc to assure the fit will be easily grasped by the professionals who will be using the software…If users find software easy to use, they are more likely to add it into their daily routine as opposed to becoming reluctant users.
MindLinc has a singular approach to some documentation, like the treatment plan. “Problems”, which are a key part of treatment that needs to be focused on in most sessions, are stored in a different place than the treatment plan. Some professionals will love this, some will want to gravitate toward the traditional “tree” approach to documentation. It’s a matter of choice, so be sure to have both schools weigh in if your organization is looking for an EMR.
The software includes 350 forms and reports, so you theoretically don’t spend all your time developing forms. This is a plus on one hand, and says a little about the software company. Since they are part of Duke University, I’m certain a lot of thought has gone into the approach of the software and the forms that are included.
MindLinc has a different approach to the EMR than some of the other vendors out there. Especially if you’re not seeing what you like for your professionals, check them out.Read more →
I had to chuckle when I read “user-friendly” in a recent list of demands from software.
We’ve been trying to capture that goal for the Electronic Health Record (EHR) on the personal computer since the pioneering days of the 1980s, and we keep working. The result has been software that’s pretty user friendly these days, and that’s part of the message Amazing Charts is trying to get across about its EHR. I like the part on the web site that says Amazing Charts is low-cost, and so do professionals in this business. Now, “low-cost” is a relative term, and before I spill the beans on the dollars, it’s important to know what the heck is available in this package. User Friendly When using an EHR It seems it can take “dozens of clicks” to get things done in many aging software packages, and although a general exaggeration, more than three clicks to get to a progress note is too many, neighbor…professionals find software navigation is often tedious and wish for a simple approach, which is what Amazing Charts claims in describing their process flow. To this end, the Amazing Charts website indicates the system is sensitive to your workflow. This is a big deal to me and if you’re looking for software the secret to this sort of success is to make sure it’s configurable to your needs with design tools to make the treatment notes, assessments, reports and treatment plans your own. Working with a software company’s rigid idea of a document can be a pain. Many software vendors need to pay one of their programmers to do work like this, and pass the charge along to the customer; it’s another thing to inquire about. If the tools are available, make sure you have somebody with time and the aptitude to use them and make the software work for you.
Meaningful Use This is a good one. The Office of the National Coordinator requires certification in order to collect the incentives of over $60,000 for every prescribing professional using the software. I’ve written many posts tracking this, and am a proponent of taking advantage of these incentives; they can more than pay for the system. Amazing Charts has a testimonial from a customer that’s received a check from Medicare. Medicaid is part of the program in most states.
Hardware Unless I missed something, this may be a drawback to some folks. Amazing Charts appears to be deployed on a local server (which the professional treatment organization must buy and support, which carries an annual cost), and is not delivered via the web. Many professionals want the server hosted by a technical organization and deployed via the web, others don’t; there are pros and cons both ways, so consult with somebody like yours truly before you buy.
Interfaces One of the major concerns in purchasing an EHR is interfaces to other software either on a Behavioral Health organization’s practice management software or sources of data that can be securely accessed over the web like laboratory and pharmacy programs. It’s much better to receive outside data on a patient electronically for two reasons: you don’t have to pay somebody to enter the results into the computer and because humans aren’t involved, the data that does go into the system tends to be more accurate. At first blush, Amazing Charts gets an “A+” in this area.
Other Stuff Amazing charts includes a scheduling module, electronic prescribing that’s Sure-Scripts certified and an internal messaging system for multiple provider organizations. Nice. A superbill can be generated, and insurance billing appears to be via a billing service, which can be worth the price if a professional is busy enough to need help with this. You can even review a chart on your smart phone for an after-hours call with the app. This is another “A+”
Price $1,995 per user is a reasonable price. A three month trial period is a good idea for any software company simply because after the ordeal of implementing software and getting used to having it around, a professional isn’t likely to dump it. Ongoing software support is $995, which seems a bit steep until I look at it as less than $83 a month…look at software support as insurance; it’s just something you gotta have. They’re maintaining a healthy GPA regarding price.
If I were buying, I’d want to know more about Amazing Charts specific Behavioral Health penetration. I am old-school in serving mental health and addictions and it remains clear to me that these disciplines of treatment are special. There’s a lot of talk about physicians on their website, and this is fine if you’re a mental health professional working a Federally Qualified Health Center (FQHC) or are partnered with an MD. With the integration of care and the relationships that seem to be building among professionals providing treatment for ills of the body, mind and spirit in the same facility, there’s value to the ability to track all this.
After all is said and done a behavioral health professional considering Amazing Charts should talk to a few people in a 200 mile radius that are using the software, and if it still seems like a good idea, make sure it meets your professional needs and workflow processes.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 →