In a lot of ways, the future has arrived with answers….now if we can figure out what to do with the answers; we may end up in better mental health.
I Googled “gene scans” and the first thing that came up is a company that sells such things, deCODEme. I can give them 2,000 of my hard earned dollars and they promise information to guide my life in areas from heart health to male pattern baldness (too late, check my picture).
A saliva test can tell us a lot about our susceptibility to certain diseases. I had a minor heart attack a few years ago, which may have been averted had I known earlier in life about my genetic leaning toward that problem. Evidently my father’s side of the family is where I inherited the heart disease problem from, and those relatives have remained mysterious and unknown to me. Although we know that sort of thing can “run in the family” I had no clue of a possible heart problem, so a gene scan may have helped me.
A friend didn’t realize diabetes ran in her extended family; perhaps she could have avoided or at least delayed the need for daily injections with a lifestyle change…if she knew of her genetic inclination toward the disease. Nutrition and exercise go a long way in preventing all sorts of physical health problems, and avoiding some foods can improve our immediate mental health. I quit caffeinated coffee and I immediately felt better, less anxious. Perhaps a diet change would have helped my friend.
A genetic test can nudge us toward lifestyle changes that can help us stay physically healthier, but can the test unveil mental health needs? If it can, what changes could I make in my life to avoid mental health problems?
I find the possibility of how this information can fit into our overall health maintenance is terribly interesting, and could augment how mental health professionals treat consumers. It’s a snap to connect a scan of the gene or printed readout of results into the Electronic Health Record (EHR). In the future, this could be a reliable map to help us avoid mental health problems or lessen severity of those problems. Having the genetic clues on the professional’s computer could guide therapy and medication, helping the professional zero in on problems and treatment solutions much more quickly. That sounds like something of value in this fast-paced instant-gratification world.
I can see a future that imports the gene scan results into the EHR, which automatically reads them and posts alerts in a consumer’s record that they may be susceptible to certain conditions like schizophrenia or depression. Other treatment resources within the EHR already suggest medications for certain conditions, and educational resources are all over the Web. Gene scan technology can be brought into treatment technology with a goal of improving diagnosis methods and providing treatment guidance. It’s nice for a professional to have just the information she needs at her fingertips.
Once again, my vision jumps the gun. The National Institute of Mental Health (NIMH) says that we simply don’t yet know how to read the genetic codes and glean information about our mental health. The body of evidence is too small to provide accurate forecasting. Scientists will need to methodically compare a bundle of gene scans for multiple gene patterns in a bundle of people in order to suggest how gene scans can be valuable in forecasting likelihood of mental illness.
Considerable research is under way, so one thing is certain: The future is near.
Read more →Some days I forget that life is about reveling in the challenge and working to overcome my problems, and just sulk. I imagine many folks are like this, looking for a quick fix, not wanting to work through daily issues or even long term mental health problems.
Is the promise of brain scans such a quick fix in treating mental health problems? Rapid recovery sounds like a pretty good goal.
Thomas Insel, Director of the National Institute of Mental Health (NIMH) thinks brain scans are akin to rocket science of the 1950’s…not ready for prime time. That said, he does acquiesce that brain scans, have some very promising results. He cites the use of MEG, (magnetoencephalography) as being proven over 90% effective in diagnosing Post Traumatic Stress Disorder (PTSD)…sounds pretty effective to me.
One of the problem professionals and consumers have in mental health treatment is getting the right medications for that person. It would be simpler if everybody responded the same way to a single medication, but that’s not how it is. When NIMH researchers studied a specific MEG signal they were successful in predicting which patients would be served well by a new anti-depressent, ketamine. Since it takes a while for many of these sorts of medications to take efffect, this technology seems to be working now to shorten the time of misery.
Using brain scans to work with mental illness is, at the very least, a great example of how technology is expanding into the field. The scan can be read electronically, so the scan or results of the scan can be ported directly into the secure Electronic Health Record (EHR) of the consumer. This is a good thing in viewing the technology as an outcomes tool.
In mental health and addiction treatment, measuring tools like assessments can show improvement or decline of conditions over a period of time, and with the record at a professional’s fingertips on the computer, the consumer gets better treatment. Changes in a consumer’s condition as treatment progresses helps professionals adjust the course of treatment as it’s needed. Historically, these assessments have been a series of questions with answers and impressions scribbled on a piece of paper. The EHR has helped with legibility and being able to graph assessment results, which provides an easy-to-read format to view progress over time.
Is the brain scan such a tool? Oh, I dunno…as far as I know the scan could be a once-in-a-lifetime event, but I doubt it, simply because everything else changes and technology is still exploding in all areas of healthcare.
It is certain that emerging technologies are aimed at higher quality in diagnosing and treating mental health problems. The assessment tools in the EHR have helped professionals and consumers focus on improving specific conditions. Brain scans appear to be another tool that will be added to the mental health professionals’ toolbox that will help shorten the time to recovery. Insel appears unconvinced of widespread applicability of the tool, so more research is required…but it’s coming. I can foresee widespread use of the technology simply because the consumer wants to get better, faster.
Read more →Average wait time from calling a mental health treatment organization for help and actually engaging in treatment with a professional can take a month. A lot of consumers cancel their appointment or just don’t show up.
From what I’ve seen, physical health has that beat.
David Lloyd of MTM Consulting shared this statistic recently in a talk on the web focused on improving quality; I found that an amazing amount of time to wait for help…Who would wait that long? According to Lloyd’s research, not many folks, and I agree, it’s a long time to wait for health, and I know a lot goes on in my mind in a month.
Regardless of whether the consumers who end up not consuming mental health services are classified as No-Shows or cancellations, or somehow justified as exempt from statistics, the fact is that a bundle of folks aren’t getting help. A key to getting the folks who are now not showing up for appointments is simple business logic. If we serve them quicker, with high quality service, for a reasonable price, they’re more likely to make their appointments. Plus, under these conditions, people improve and tell their friends how great the results of treatment at this particular facility were.
Maintaining quality treatment and delivering it quickly boils down once again to streamlining systems, and the best way I’ve found to assure streamlining happens is to tailor the Electronic Health Record (EHR) to guide clinicians through the treatment and documentation processes. If a professional has clear signposts along the way, the policies and procedures placed to improve quality and timeliness of treatment are more likely to be adhered to. Here are a few things that can be done with the EHR to increase the value of treatment in the long haul that are statistically proven to reduce no-shows and help consumers get better.
• Cut time spent on paperwork and redundant entry of consumer data…who likes to answer the same question six times? An effective EHR can save all data that’s entered one time, like the patient’s name, address, reason for coming, medications, etc, and automatically add it to any form that’s shown in a professional’s workflow where it’s needed; tune up the EHR to do this • Decrease the time a consumer spends waiting for help… Lloyd’s statistics show a lot of professionals are very busy with a lot of peripheral activities like catching up on treatment documentation when there are No-Shows; take scheduling out of the professional’s control, schedule people to come in NOW…or at least within ten days and No-Shows dwindle. • Help the professional! Start Collaborative Documentation now: Involve the consumer in writing assessments, treatment plans and progress notes during the session, with the consumer…it improves focus on treatment goals and objectives and gets the paperwork done on time, reducing a facility’s risk of falling out of compliance with state, and federal governments, helps adhere to accreditation rules, and avoids billing audit problems
I know. That’s all well and good, but who has time to do this?
There will never be enough time to do these three simple things. Facilities will need to hire EHR professionals, spending money they don’t have. The money will come as No-Shows dwindle. There are tons of statistics out there that show how great a tool the EHR can be, and the solutions above are proven to work nationwide, in a ton of studies over many years (I cite them a lot).
Now is a good time to start improving treatment using the EHR to help.
Read more →A bundle of concerns erupt when an agency providing mental health or addiction services implements an Electronic Health Record (EHR). Since the only reason these agencies are in business is to improve the consumer’s well being, a question arises: How can the EHR help improve the quality of consumer care?
When I work in mental health and addictions treatment facilities, I see just how tough it is for professionals to envision the EHR as a tool to improve consumer focus on recovery. Expanding the vision of professionals, consumers and even the software implementers to view the EHR as a tool to improve treatment is a team effort, and getting the team cranked up can be a trial.
If the up-front analysis of how people get their work done and such is solid, a professional implementer should get at least some of the software up and running effectively and quickly, and the benefits to improving consumer care should be evident within weeks of use. Professionals and consumers begin focusing more directly on treatment goals and objectives, which are the reasons folks enter treatment anyway.
All too often staff is overwhelmed by the ever-increasing documentation that’s required in treatment, so they view the software implementation as a burden, an expansion of bureaucracy. The complaint is that with all the required documentation, there’s no time to treat the patient. The EHR solution is to document with the patient during the session. Assessments with a lot of check boxes and radio buttons are easy…just walk through the questions one at a time and review the resulting score with the consumer. Treatment Plans can be more daunting because the fast way to write a goal or objective of treatment is to pick it from a drop down box on the screen, and that can lead to cookie-cutter documentation. Progress Notes generate the same concern.
Collaborative documentation with the patient is the answer, not just because you get paid for the time spent documenting the service. The consumer truly participates in her own treatment when discussing what happened in a session; how it relates to one of her reasons for being in treatment, and what she should be concentrating on in recovery before the next session. Mutual creation of the documents is what draws the patient’s attention to reaching their own treatment goals.
Using the EHR to improve treatment is not a new story. I stumbled onto an article comparing the effectiveness of a simple checklist used in treatment on the computer with a checklist on paper. It’s a short story, and to make it even shorter, a “to-do” list on the computer works darn well. The study says that both mood disorder screenings and treatment documentation improved using the computer maintained task list. The article from Dale Cannon and S Allen of the University of Utah, was ancient, from the year 2000.
A successful EHR depends on a successful implementation and “after-care”, to include continuously gaining buy-in from professionals using the system and making it grow to suit needs better. As these folks embrace central scheduling and treatment documentation with the EHR, the implementation, the effectiveness of the software, and possible improvements in treating patients are likely to increase.
Read more →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.
Read more →Years ago, it was much more common to “fly by the seat of our pants”, making business decisions that “feel” right. A few billionaires can do that effectively.
Organizations that insist on making decisions by committee, with no real leader in decision making, can simply do nothing, which really makes for an organization that goes nowhere, does little new and exciting because so many plans just die in committee.
The rest of us need to base our decisions on something tangible. Other organizations’ successes can teach us, as can data. The Electronic Health Record (EHR) is where the data comes from, and since every interaction with a consumer requires some sort of data scribbled on a piece of paper (little value) or entered into the computer (high value), an organization measures its own success and future planning on that data. Although other factors enter the mix, this one’s value is provable and covered nicely by The National Council’s recent study on Enhanced Access and Engagement Quality Improvement Initiative Strategies to Increase Therapy Adherence (quite a title, eh?)
When a consumer doesn’t show for an appointment, a practitioner is oftentimes stuck sitting around with nothing to do…that’s a waste of the person’s time, and a drain on facility revenue. People need to work to have insurance and Medicaid pay the bill. This is a major problem nationwide, so the question of the moment is “How do we entice consumers to put their appointments on the top of their priority list?” Thinking now is that care provider and consumers are both tied into the equation.
A mental health or substance abuse treatment facility that is making ineffective decisions, flying by the seat of somebody’s pants, or one that makes little progress because the committee can’t make up their mind to do something, ends up with morale problems. If a care provider has low morale, then how do the consumers feel after walking out of a session with that person? Attitudes are contagious.
If, on the other hand, an agency is making strides to improve, collecting more money for what they do, you see the evidence in a new coat of paint, a gleam of excitement in a practitioner’s eye when they say ”Hello!” to the consumer, as well as general attitude and physical improvements throughout the agency. A dingy facility with bummed-out practitioners isn’t a place consumers want to go, so more appointments are broken in those environments.
So, what’s required in order to improve is change. Change that’s driven by data works better than the other two methods I’ve been talking about. What with today’s Rapid Change Cycle to make those changes, the implementation excitement’s over pretty quick, so the new coat of paint and improving attitudes are just around the corner, which help consumers justify putting treatment at a higher priority level.
Once the EHR is properly implemented, suiting workflows that make it the least disruptive to the staff and consumers, a facility gets the data required for good business decisions rather quickly. It’s simple to get quality data when central scheduling is in place and care is consumer-centered, involving the consumer and the practitioner in assessing the problems, developing the plan to recover, and recording the progress in notes. The data gathered in the process leads to improvement for the facility, practitioner and consumer.
Once again, the EHR saves the world. OK, maybe not the world, but isn’t it nice to see facilities improve?
Read more →