Because I am expected by my current healthcare provider, I spend less time in the waiting room and no time filling out forms. That’s a far cry from my experience with other healthcare professionals. In times past, an appointment didn’t matter; I was destined to wait, and was always filling out forms with the same information.
My current healthcare provider delivers physical and mental health treatment, everything except dentistry, and for every appointment, I receive a couple reminders, and that’s an effective perk for a forgetful guy like me. First, there’s a printed reminder in the mail. It’s a very clear letter that simply states the date, time and place for the appointment, and who I’m meeting. It’s a wonderful thing to have all this attention paid to me and my poor memory. Incidentally, I record the appointment both in Outlook on my desktop and synchronize that to my BlackBerry. A day or two prior to my appointment, I get a telephone reminder. I’m fond of reminders, and apparently a lot of folks appreciate them; a few years ago, a study at the University of Rochester in New York showed over 75% of those polled thought they were a good idea.
I go with the flow, and make my appointments. It’s easy for me to assume these sorts of systems work. The letter can be generated by many scheduling systems that are built into the EHR, and a number of automated telephone-reminder systems are available to integrate into the scheduling system. I searched the internet and immediately came up with an option that looks like it would work from Stauffer Technologies in Cleveland. If I was in the market, I’d check it out further.
The letter is generated by the computer as part of EHR, most EHR reporting systems will tap the database to send out form letters. The telephone calls are generated by the computer interfacing the EHR to an automatic system with a computer generated message. I am simply not a “No-Show” because of this attention, and since these reminders are automated, nobody needs to write or print a letter, and nobody has to call me. These technical solutions contribute to the bottom line and can help assure that struggling mental health clinics will be around to help consumers as the business continues to change.
In Community Mental Health Centers, No-Shows account for tremendous revenue losses simply because they leave professionals sitting around doing nothing, or perpetuating the myth that they need that time to catch up on their paperwork. In August, I quoted a study commissioned by the National Council (the mental health community’s most popular support organization). One of the agencies in the study showed a professional had a couple No-Shows a month and canceled another couple to “catch up on paperwork” (see my past posts discussing collaborative documentation for another solution).
I can’t help but think that the possibility of No Shows is decreased for more folks than me by the use of letters and telephone calls generated by the EHR…they certainly get me into the office.
Read more →I have a beef with every doctor’s office I’ve ever been to except one. It’s those forms I have to fill out and papers I have to bring when I come in for an appointment. They have all the information in (or available to) their computers, yet they insist on wasting ink…and I wonder how they can read my handwriting these days anyway.
There is no point to it or reason for it. My health information could be printed out for a quick review easily enough, or just left on the screen. If the professional treating me wants to know the results of an excursion to another sort of healthcare provider, that information’s available electronically, too.
Health Information Exchange (HIE) has been around a long time, and these organizations specialize in security of our health information while sharing it among professionals treating us. Information on my address, health conditions, or prescription for a psychotropic drug is nobody’s business except professionals who treat me, and I really want that information shared securely to those folks. Since treatment is so disparate, it’s good to know that the physical health doctors, hospitals and mental health and addiction treatment facilities we use can access a medication list, or a discharge summary from other providers.
I believe our body, mind and spirit are all connected, and if I’m unconscious or incapacitated when brought in for treatment, people treating my body may need to know what’s been going on with treatment for my mind…I’d rather not be subjected to a bad drug-to-drug interaction or mis-diagnosis of a symptom. HIEs go a long way toward eliminating possible problems like these, simply by sharing personal health information among professionals.
It’s a bonus that the HIE can share my address and phone number so I don’t have to write it down on that silly form. Still, I see that only at the VA because it’s a monstrous healthcare system that has concentrated on the Electronic Health Record (EHR) for decades, and my data is available coast to coast, only to professionals who I want to see it.
A lot of care providers simply don’t belong to the exchanges and aren’t about to turn lose of the monthly fee to pay for that sort of security and efficiency…they’d rather send a fax when sharing health information. Investing a few moments investigating could put dollars back into the professional’s pocket. InformationWeek shared that Dr Mark Sandcock’s primary care practice in South Bend, Indiana saved $1 Million in the first year of working with an HIE. So, his patients benefited, and presumably, so did his family with holiday gift giving.
Lab results can drag out treatment simply because the information takes a while to travel between healthcare organizations and get processed…outpatient addiction treatment facilities have learned that getting urine toxicology results quickly when testing for abused substances helps confront the consumer quickly, which aids treatment. The paperwork and people involved in getting the information between the healthcare facility and the lab and re-recording results in patient charts, also adds to the cost of healthcare, and that affects the price tag when we go for help. Experiences like Dr Sandcock’s give me hope that the healthcare system may actually be coming around to better serve consumers and prices may actually stabilize.
HIEs are growing, and the string of positive outcomes is impressive, from prompting better healthcare decisions because folks who treat us being able to see our medication history to quick receipt of lab data. One factor really stands out for me: soon, I won’t have to fill out those silly forms when I go to an appointment, even if I’ve never seen the professional before.
Read more →America recently swapped out a number of Democrats for Republicans with the promise to voters of decreased government spending. As a result, a number of mental health and addiction treatment facilities could face increased hardship. Their primary source of paying the rent is drying up…Medicaid funding looks to be continuing a downhill slide.
Once again, mental health and addictions facilities are faced with improving the way we do business and securing alternate revenue sources. Every time this challenge has arisen over the past couple decades we’ve overcome it by improving the way we do business. I’m particularly grateful about this because it’s allowed me to make a living helping these folks become more efficient and effective by using the Electronic Health Record (EHR)
I tend to agree with Chuck Ingoglia, Vice President of Public Policy for the National Council for Behavioral Healthcare (NCCBH), when he forecasts that Medicaid funding in our business is likely to decrease over the next few years.
So, as Medicaid dollars shrink, the agencies need to make up for that somewhere, and as the old story goes, it’s better to teach somebody how to fish than simply give them their next meal.
One way to make up for losses in funding is to sharpen up with better use of the EHR. A number of mental health and addictions treatment providers are trying to make better use of their software by encouraging use of central management of practitioner scheduling in order to make sure their workload increases. As that workload increases, collaborative documentation, writing the notes and developing treatment plans as part of a therapy session becomes more a part of daily business. Just using the EHR this way leads to shorter wait times for a consumer to see a professional for the treatment they need, and helps focus on the problems in the treatment plan rather than digressing into the crisis of the moment with no direction toward recovery.
Facilities taking care of business with creative measures like this will survive, and some of them will flourish.
Recent gains made in healthcare reform will face some losses, and popular mandates like mental health parity that assures insurance companies must pay mental health and addictions claims on par with physical health claims will likely stick around. Consumers who benefit from reform measures are more easily motivated to write their legislators and encourage them to support reform gains.
For the past couple years, a number of mental health and addiction treatment facilities have been successfully weathering business changes required by decreases in their funding. A small rehab in Wisconsin survived long enough with a grant in order to implement enough of the EHR to assure they collected payments (or at least partial payments) from self pay consumers…sometimes that’s as simple as asking for a payment at the time of service. Before the EHR, they simply had no working system to do that. A mental health provider in the Midwest lost their grant funding and started reaching out to gain new self-pay and insurance consumers. They instituted sliding fees where they were warranted, and tracked accounts for this new way of doing business with their EHR. They aren’t flourishing, but they’re still helping people as a result of these marketing and business changes.
These are examples of a fighting spirit. These are people willing to make significant changes and a few sacrifices in order to continue helping others recover from mental health and addictions problems. Lately I’ve been helping a couple agencies switch from one method of funding to another, and in the process, helping them make better use of the EHR. Ten years ago, staff would have groused and fought the change. Now, I’m met with growing enthusiasm. You know you’re making headway in the battle to succeed when the troops lead the way into change.
Read more →I have a dim memory that in ancient cyber-times, a number of chat rooms for Alcoholics Anonymous on-line meetings were started on America Online. It was the start of something big.
I recently read an article in Healthcare Technology about social networking in healthcare, which prompted thoughts about how our field benefits from the phenomenon.
Nowdays we have Facebook, Twitter, and who knows how many general social networks; Linkedin and other services like it cover professional networking, and specialized social networks for other purposes abound. Social media in treatment is intermixed in all this. You can Google “online self help groups” to see the extent of social network availability for people who want to mix electronic communications into their treatment plan.
Friends sharing mental health or addictions problems have ongoing peer conversations; phones light up and Facebook messages help some people get through the day. In New York, The Office of Mental Health and Office of Alcoholism and Substance Abuse Services both have presence on Facebook to keep folks abreast of news and events (search Facebook “Groups” for more information). Professionals like this because it alerts them of free trainings, many available via the Web. Evidently there is value enough in these services to keep people involved…the law of supply and demand being what it is.
How does this enter into the Electronic Health Record (EHR)? You might see references to specific social networking pop up in progress notes, and in some cases as a part of the treatment plan. Because many social networking sites are so wide-open, on-line conversation about mental health and addiction issues potentially blow the cover of folks who would rather remain anonymous. At least one area the EHR shows promise that secure therapeutic social networking of a different sort is on the way.
In order to qualify for Medicare and Medicaid funding that helps pay for technology by demonstrating its effective use, EHRs are compelled to include Patient Portals, which is not far removed from social networking that’s secure. By taking the responsibility vendors can offer technology that enables a patient community password protected technology to help people with like problems network, and that can be a significant part of healing.
Patient portals generally offer a patient access to medication lists with prescription information like expiration dates, or to their scheduled appointments. They often include a communication method to get secure messages to a provider, and other nifty features. A number of hospitals have this technology available for both patients and providers, complete with confidentiality-inspiring security. Everything’s password protected. Very few patient portals are functional in our sector, but at least one manufacturer, Netsmart Technologies, has the technology in place for mental health and addictions.
Once again, the future has arrived.
With all these outlets, the question comes to mind, how many consumers are benefiting from social networking, and what’s the real value in treatment? Another question to address another day.
Read more →If people don’t feel included, for the most part, they just don’t bother to be involved at all, and may be quick to notice negatives and pass them around.
That’s why internal Implementation Blogs are becoming keys to increasing “buy in” into IT projects and avoiding disruption to the recovery process. A consumer is generally quite aware of the fact that new software’s being implemented where they receive mental health or addictions care. The activity is obvious, and usually affects every staff member. The consumer sees a different invoice, a different way of scheduling his appointments, and the professionals they work with will begin including them in writing up the summary of a session and the next steps in treatment in progress notes on the computer.
Sometimes the consumer hears about lingering problems with the system that aren’t being addressed. It’s good to avoid airing the dirty laundry like this. Much better to resolve problems that will affect the consumers early and communicating about those problems internally is better than sharing them with the consumers. The consumer comes to treatment to recover, not to hear about software implementation problems.
A few years ago a friend and customer who was implementing an enterprise software system in a Florida Community Mental Health Center (CMHC) shared that she started a blog page to increase staff involvement in the implementation. This accomplished a couple things:
1. Staff reported successes with the software increasing their efficiency and effectiveness in doing their job. 2. Staff complained.
The successes were little testimonials of great impact, and went on the page immediately. This helped people feel involved, like their efforts made a difference, and boosted morale.
If a complaint made it to the page, something needed to be done. It was OK to complain, and staff was coached in how to complain on the blog in such a way that the complaint wouldn’t bring people down and create negative attitudes about the project. Problems are meant to be solved, and any complaints included hope that the problem was temporary and a resolution was on the way. News of effective resolutions made it to the Implementation Blog really quick.
Negative comments were OK, and resulted in attention to the person making that comment. They seldom made it to the blog before the reporting staff edited the comment to show there was some hope, something was being done, or an alternate procedure worked around their problem…in effect, the blog was turning these negative comments into positive action.
I liked this idea and have suggested it in my work many times to folks about to implement software in their mental health or addictions facility. Usually, it’s viewed as one more thing to add to the ever-growing pile of things to do in an environment that’s already short handed. Of those who have instituted the Implementation Blog, Nobody’s wanted to back out. The staff buy-in to the project is much better, simply because staff feels more involved and like what they say counts.
Plus, the consumers heard very few negative comments about the software project, making it that much easier to focus on their own recovery.
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