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.
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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.
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