Hospitals are a center point for the Electronic Health Record (EHR) and a key to the National Health Record’s sharing of health data among treatment teams. Less than 12% of them have effectively implemented software.
I was mortified to discover this. So shocked and disbelieving, in fact, that I needed corroboration of the original story run in Health Affairs, and found the Robert Wood Johnson Foundation reference that’s linked above.
A hospital has huge Information Technology (IT) resources, and can share data among ancillary specialty clinics, like your psychiatrist, your cardiologist, or your pulmonary specialist. The doctors are associated with the hospitals, and when a patient is released to a doctor’s care, the idea is that the doctor has availability to the electronic records in the hospital, as long as the patient signs a release of information and knows about it. This saves a ton of aggravation in filling out the same information many times, and delivers more accurate treatment data to these members of a consumer’s treatment team.
The combined information is suddenly available in a secure environment, so when the patient moves, or needs to share that health data with somebody not in that hospital’s network, it’s available with a release of information via another component of the National Health Record, the Regional Health Information Organization (RHIO), or other similar health data organization. The RHIOs are all connected into the National Health Record, or will be soon, so our health information is secure behind firewalls and other technological wizardry. The idea is that nobody gets that information without a patient’s say-so, and that when the patient says it’s OK, the data is instantly in the doctor’s hands.
Here’s a scenario. • Joe has a heart problem and a pulmonary problem • Joe also has terrible anxiety that gives him breathing difficulty • Joe goes to the emergency room, and the docs determine the current problem is a panic attack, and Joe’s medicated and released, with instructions to follow up with the psychiatrist’s Mental Health Clinic; the clinic is part of the hospital’s network because the psychiatrist is affiliated with the hospital • Joe goes to the Mental Health Clinic, and the notes, the medication order and the discharge summary from the hospital are available on line, so the psychiatrist knows the details • Later, Joe goes to his cardiologist, who is also affiliated with the hospital and can consult the record of the emergency room visit in the EHR • Ditto with the pulmonologist
Access to that record and the ability to treat the patient as a team, making sure all bases are covered so Joe not only doesn’t die, and also has the highest quality life possible, isn’t possible in 88% of the hospital service areas across the nation.
With only 12% of the hospitals effectively implemented, the National Health Record, which was mandated to be operational in a few years by then-president Bush, is essentially nowhere.
I’ve reported on the value of Rapid Cycle Implementation in getting an EHR up and running as quickly as possible. This method of solving the highest-priority problems that the software can address with target groups of professionals, then rolling out those features to all users, is nothing new…and it’s effective. Soon enough, the organization has a functional EHR and is fine-tuning it, making those features that are already rolled out better. I wonder how many of the 88% of the hospitals without effective EHRs are incorporating Rapid Cycle Implementation into their software rollout.
There are many reasons software implementations fail. It could be that the CEO isn’t promoting it with the staff effectively. It could be that the team doing the implementation is more interested in keeping good statistics on how much money’s been spent on manpower than actually getting a feature rolled out. Resources (usually people) could be in such short supply that the project is sabotaged.
In these failings are the keys to successful implementations. Setbacks are unavoidable, but I’d call this failure.
12%. Sheesh.
Read more →A friend insisted that I come to Baltimore to visit during an upcoming American Telemedicine Association conference. The conference is for pediatricians. I’m all about mental health and substance abuse technology. So why am I going?
According to the US Human Resources Service Administration (HRSA), New York has enacted legislation for Medicaid to pay for telemedicine solutions in Mental Health. It only makes sense for me to learn a little more about the solution.
At least one program, Project Teach, currently includes telephone interviews for psychopharmacologic concerns. The program is an example of how the state’s Office of Mental Health is making good on the promise in the 2010 statewide plan to extend technology in mental health. Presumably, if New York is using telemedicine as a technological strategy to decrease the “burden of illness”, other states must be on the same beam, and evidence I’ve seen shows New York is not in the lead in paying for expanding the technology.
An earlier research foray into telemedicine in mental health yielded a little knowledge on its use, and the first thing that usually comes up is that it’s a solution for “rural and underserved communities”. This friend I mentioned earlier said “what about the woman who lives in Queens, has a job there, and has to take a bus and two subway trains to get to her therapist in Manhattan?” Telemedicine seems a great way for her to work with her current therapist without having to take a lot of time off work.
The elements of telemedicine for mental health are pretty simple, really: Mental health services using live, interactive videoconferencing doesn’t require tremendously expensive equipment. Some finesse is involved, like good lighting and camera angles to help with the feel of a professional environment, however, the technical requirements are available to most people. At the beginning of the year I bought a Netbook computer for $400, and there’s a camera for videoconferencing. This seems like a pretty low-cost solution for rural use and for the woman who lives in Queens.
As long as there is a two-way video and voice communication between professional and consumer, a number of sessions, like visits to review medication effectiveness can easily be remote events and are worth paying for…and that’s good for business in your local Community Mental Health Center.
So, there is value to telemedicine in mental health. I can’t help but feel there’s more we can do with the technology, medication review can’t be the only service worth paying for. What about an individual therapy session? What about the use of social networks like Facebook for a sort of group therapy? Or actual group therapy with people connected via a teleconferencing service. If the value exists, then it’s worth paying for. It’s easy for a business man to see the value of how this technology can lower costs and increase productivity. Are insurance companies and Medicaid coming to realize the value of telemedicine in general practice of improving our mental health?
That’s why I’m going to the conference, and I’ll keep you posted.
Read more →When the business of treatment gets better with the use of the Electronic Health Record (EHR), consumers get better.
These days, ePrescribing sends a prescription directly from the prescriber to our pharmacies. Mistakes made in simple medication prescriptions have been more commonplace in the past than we would like to admit, and ePrescribing is sending legible prescriptions to pharmacists which can only help reduce mistakes. Another benefit of ePrescribing is the incredible storehouse of data that is building nationwide and can be used in studies to improve professionals’ treatment of consumers.
Due to recent studies of suicide and suicide prevention, we know more about it than we ever have. A recent post from Thomas Insel, Director of the National Institute of Mental Health, quotes statistics gathered from a study of data (mostly gathered and analyzed by computers). Out of 100,000 deaths, 11 are suicide related. Out of 100 people you see walking down the street, one of them has been serious enough about suicide to have a plan. Knowing the depth of the problem is the first step in digging our way out of it.
Medications like Cozapine and Lithium have been proven effective in suicide prevention for specific target groups. Statistics that lead to conclusions of their effectiveness are naturally gathered in the EHR and analyzed on computers. As ePrescribing becomes more widespread, studies like this will become easier to perform, and results will be delivered to the medical community faster.
My peers on Mental Help Net talk about therapies like dialectical behavior therapy and cognitive behavior therapy. Studies show these therapies are effective in significantly reducing repeat attempts at suicide. Because of the data gathered from the studies, psychotherapy like this is increasing in usage.
If you are a consumer and worried about your name being associated as a subject in a study, please, don’t worry. For many years, “de-identified data” has been the source of studies like this…Once again, a little magic provided by the computers of those providing the data from their EHR. Consumers’ personal information never makes it out of the original databases used for the studies.
As new medications are developed and delivered through ePrescribing, more data will become available on the suicide prevention and the effectiveness of these drugs…faster. If mental health professionals know about a consumer’s suicidal thoughts and ideation, medications can be further prescribed, and evidence of their effectiveness (or ineffectiveness) will climb.
New assessments, usually delivered on the computer, deliver scores indicating the likelihood somebody will entertain suicide. These assessments lead to use of new psychotherapy methods in treatment to prevent suicide.
Once again, the EHR does its part.
Read more →Is it right to jerk somebody’s professional license to practice their profession if they are busted for selling illicit drugs? Sure, and the devil is in the details of when and how that’s done. Hitting somebody in the wallet for behavior that damages society has been a favorite of the courts (and professional self-regulating bodies) for a long time. People need to feel consequences to their actions. Addiction masks those feelings when the consequences befall others, and amplifies the consequences when they happen to they hit home.
A second story about a Florida attorney disbarred for drug trafficking came my way recently, and I’m not convinced it was the right move, simply because of the attorney, Noah Daniel Liberman’s continuous sobriety for six years. This guy probably has some marbles back and has demonstrated willingness to turn his life around. If the court’s disbarment decision had taken place five or six years ago, the punishment might be appropriate. Show the guy some consequences to his actions and give him a bottom, quick…but six years? Come on.
I know another fellow who is a nurse who was caught stealing narcotics. In short order, he was forbidden to practice his profession, losing his license. A few years later, he’s clean and sober and happy in his plumbing job, and considering not even bothering to get his nursing license back.
These two cases are similar, because they are both willing to recover. They differ in recognizing recovery. The nurse’s punishment was appropriate, and in an appropriate amount of time, the perpetrator feels contrite and has demonstrated a willingness to get clean and stay clean. The attorney has demonstrated the same thing, and in the inappropriate amount of time was disbarred.
What’s wrong with the Florida courts system? Florida is home to more rehabs that storks, and the courts don’t seem to have in inkling of an understanding about addiction and recovery. In fairness, two Florida justices, Barbara Pariente and Peggy Quince dissented, recognizing Liberman’s exemplary lifestyle over the past six years of staying clean. Still…he hasn’t worked as a lawyer all this time and was disbarred. That’s inappropriate punishment, Florida.
The good news is that enough time has passed for Liberman and my friend to apply to their respective professional accrediting and licensing bodies to be reinstated to their professional status. Disbarment, however, is quite a stain on one’s record. I wouldn’t blame Liberman if he decided to take up plumbing.
Read more →Everybody likes to see results.
How many consumers really have a handle on their progress in treatment? A couple innovations involving the Electronic Health Record (EHR) have received a lot of attention lately, because they work…and that’s backed up by data from the EHR. 
Concurrent or collaborative documentation with the consumer and effective scheduling are perhaps the two most important tools that professionals and consumers can add to their tool box to deliver a clear vision of treatment effectiveness.
If a counselor cancels an appointment with a consumer, what message does that send? As a consumer, I might get the impression that it’s OK to miss appointments, with or without notice. Either way, missing appointments leads to less concentration on treatment goals and hampered recovery. Gathering data from the electronic central-scheduling module can help analyze who’s canceling appointments, and who’s simply not showing up for appointments. Once we know where the disconnect is, we can discover the reasons and overcome them.
I recently attended a web presentation by Bill Schmeltzer of MTM consulting discussing collaborative documentation (The slides are to be posted at http://www.omh.state.ny.us/omhweb/clinic_restructuring/resources.html), and I liked the approach because it had a focus of improving treatment results. The idea is to jointly recap the session (something most people receiving mental health services are used to) at the end of session, recording what the professional and consumer did together in the session, and how that discussion focused on one of the goals in the treatment plan, as well as any plans for the patient to employ tools like active listening or breathing techniques to improve daily life. Once again, this information will be available in the EHR. When the patient returns, the notes are handy reminders of where the professional and consumer left off; this might be a good place to resume discussions.
In many treatment centers, scheduling has been a topic of heated discussions over professionals’ control of their time. Recently The National Council (the mental health community’s most popular support organization) published a study that compiled data from ten Community Behavioral Health Organizations (CBHOs) that sheds some light on how important scheduling is.
One organization had a counselor with 30 “no-shows” by consumers. That seems like a lot. It certainly affects the bottom line, so agencies want to know more about this, because this consumers weren’t the only ones perpetrating the trend. As it turned out, the counselor didn’t show up for 24 of his appointments…legitimizing the idea of missing appointments. That’s a solid example of a work culture that needs to be changed.
The answer to decreasing no-shows and increasing effectiveness appears to be involving the consumer more in the nuts and bolts of treatment. Collaborative documentation keeps consumers and professionals focused on the goals of treatment, what the consumer actually wants to improve, as opposed to the mini-crisis of the moment. I like that, I learned that most of my crisis’ are bogus anyhow…a result of behaviors I have long-since changed.
One agency I heard about on Long Island hired a scheduling person with a master’s level education. This person was savvy enough to read a chart and consider treatment goals and objectives, as well as no-shows by both the counselor and consumer when scheduling appointments and determining what sorts of effort needed to go into getting the parties together to collaborate on effective treatment. Although the scheduling person was very expensive, filling the position with this type person paid off in the bottom line in reducing no-shows, and therefore paid sessions.
Yes, she used the scheduling module in the EHR to access the information needed to make these decisions, and she couldn’t be effective in the job without the treatment plan, progress notes and scheduling history information in the computer.
So, the foundation of success for both consumers and counselors, and even the treatment facility winds up being all wrapped up in the EHR. I love that.
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