I’m no professional, but I’d say prioritizing can make or break us in mental health and addictions treatment.
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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 →We just don’t communicate any more!
Mental Health and Addiction Treatment continue to lag behind physical health providers in the race to implement the Electronic Health Record (EHR), and after all these years of helping folks select, implement and optimize the EHR, I see some of the same problems come up as in the early days. Because mental health and addictions treatment are such different lines of business than software manufacture, professionals in these industries still have trouble communicating with one another. To be successful with the EHR these folks need to agree on every form, every data element, and every process as these elements relate to the software. It’s a big job, and frankly the reason IT consultants like me get calls to help agencies with their EHR woes.
I’m helping an agency in New York City that serves victims of crime with implementation of their EHR. They do a great job in this hyper-vertical line of treatment. They are smart people who keep up with treatment methods that are proven effective. The EHR will help them in three very important ways: • Intake: First contact with a consumer is critical; victims of various forms of abuse including verbal, physical and rape need the professional to listen, and professionals at this organization are very good at listening and still gathering all the information to validate the consumer has come to the right place for help, to record all clinical information needed to advance the consumer through the intake process and to confirm that the agency will be paid for the services rendered…The challenge comes in maintaining the very human, responsive relationship with the consumer while hunting around in the EHR to record information in the right place. The solution is assuring solid design of the data entry process that encourages a communication between the professional and the software while the professional’s mind is engaged and focused on the consumer’s needs. A key to success in designing this process is communications – “No” seems to be a watchword among software vendor implementers; the project manager (whether an employee or consultant like myself) turns the “No” into a “Yes” by virtue of knowing the specific business processes and personalities in the agency and how to manipulate software to meet agency, local, state and federal requirements. • Scheduling: Once the Intake professional and the consumer have made it through the initial phone call, the second stage is to see the consumer within a few days…as pain fades, the importance of the problem can seem to fade, too, so the rule of thumb is to make an appointment within 72 hours of first contact to increase the likelihood of the consumer getting treatment. The challenge met by the EHR appointment scheduling modules is to bring treatment to consumers when the abuse is fresh in the mind and willingness to recover is at its peak. It’s almost a software miracle to keep up with multiple professionals’ schedules as appointments are constantly made and cancelled; since information flows at the speed of light within the EHR, everybody knows what everybody else is doing and a central scheduler can make sure staff is kept busy, consumers are not kept waiting, and assure documentation is up to date…and as long as the software is decent, reminder messages can be sent to professionals to make sure their session documentation is up to date. • Treatment Documentation: When an agency is audited, staff can make friends with auditors by having an EHR. When Intake is directly connected to scheduling, Assessments, Treatment Plans, Progress Notes and billing, it’s an example of open communication at work; all professionals at an agency who serve a single consumer have the right information at their fingertips to help. Completing assessments on the computer with the consumer is an easy form of communication; most people have filled out a form on the computer with somebody sometime. Treatment Plans can be more of a challenge. The professional is coming to an agreement with the consumer about a mutually acceptable course of treatment, so it’s akin to the contracting process. Professional clarity and consumer transparency can be keys to writing a treatment plan that is destined to succeed, providing outcomes that both professional and consumer desire – what better way to assure this positive outcome than to write the plan together? Progress Notes are tougher to write with a consumer during treatment because most professionals think that to write the note they would need to have their heads buried in the computer screen as opposed to making eye-to-eye contact with the consumer. That would be pretty lousy communication, so a good project manager will recommend an alternative method of collaborative documentation. When the consumer comes into the room, have the subject for today’s session already written down in a note…that way the draft document is already started and if another topic erupts, so be it, you can record that early in the session. Address a few radio-button style questions like satisfying risk management requirements and current mental status then take hands off the keyboard and pay attention to the consumer with some eye-to-eye contact. Close the session with typing a recap into the note. The professional may need to clean up the note later, but so what?
If they need anything, EHR manufacturers and agencies need help communicating, and a good project manager, whether a dedicated internal employee or a consultant, gets the right information from the professionals to the EHR manufacturer in order to make a successful team effort of configuring and designing different agencies’ forms. They use the software and have valuable keys to configure it to meet the actual flow of a session serving the consumer.
Hoo-Rah.
Read more →I hadn’t heard Patrick Kennedy was running for office, but I may be living under a rock.
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Patrick is the son of the late Senator Ted Kennedy, and lately has been a featured speaker at several conferences. I hear tell he was featured on national television talking about his passion for recovery and his personal experiences that include both success and relapse.
I was happy to hear him speak to a packed house in New York at the Coalition for Behavioral Health Providers annual conference and he was dynamic, engaging, and open about his troubles with addictions and what he’s doing to recover. I liked that a lot.
He spoke well of the value of technology in Mental Health and addictions treatment, too, and I really liked that. Kennedy was responsible for introducing the Health Information Technology Extension for Behavioral Health Services Act of 2010. Although Kennedy is no longer a member of congress, the efforts continue in both houses of congress to garner government IT funding incentives for mental health and addiction treatment providers.
I have friends in New York treatment organizations who are applying for grants to help with selecting and and implementing Electronic Health Records (EHRs). It’s slim pickins’ these days for government grants to help fund these efforts. Googling grants in this area, I found mostly some private foundations, and they can’t help everybody. This highlights the importance of including mental health and addictions treatment providers in programs like the HIT extension.
That said, EHRs continue to improve. The more expensive ones tend to be more configurable and cost more to implement than the less expensive ones. Generally speaking it’s like buying anything: software might work better if you pay a little more money and invest more effort into setting it up. Becoming a professional in this industry costs a lot in education, so they can be expensive to employ, even if the salary is a bargain in the eyes of a typical businessman. So, professionals and the organizations need the help bankrolling technology.
I look forward to hearing Patrick Kennedy speak again at the National Council Conference in Washington DC in early May. It should be a great conference, so if you’re a professional and plan to go, look for my name tag among the thousands, match it to my photo on this site, and say “Howdy”. My three-fold mission is to talk with a lot of vendors and discover all the new and wonderful technology that’s available, talk with some old friends whom I’ve helped with technology in the past, and make some new friends.
Read more →It’s unusual to be in the behavioral health business without some sort of problem with an Electronic Health Record (EHR).
In 2013 associates and I helped two large nationwide chains, and two small, New York City non-profit clinics select EHRs. Yes, there are still agencies out there that don’t have computers on the professionals’ desks. Practically all behavioral health agencies have billing systems (if they didn’t they’d have big trouble getting paid by insurance, Medicaid and Medicare), but the clinical side of the business is still lagging behind. That’s problem number 1. 
Also in 20113 we helped a state mental health system design an EHR, a large Wisconsin county develop an entire reporting system and a number of smaller community substance abuse and mental health clinics implement new software systems because they needed professional help. A number of helping professionals have access to EHRs but aren’t using them because of failed or incomplete implementations. That’s problem number 2.
A number of behavioral health agencies we help have EHRs that just don’t act as advertised. We were not surprised to learn this. There are a number of contributing factors; software salespeople may not understand programmers’ descriptions of new features or functionality; software support departments constantly lose people because eventually anybody can get tired of listening to complaints all day; and finally, agency brass just can’t forecast the revenue to invest in fixing software problems. Optimizing software is problem number 3.
The crowd I work with is top-notch and resolve all three of these problems.
Recently our group was approached by a software company who needed our help with a product they recently purchased. We felt flattered.
I was happy to hear an EHR vendor indicate that he liked my style; I’m working with that company now on an EHR implementation. That’s a big complement…satisfying customers can be easy compared to getting a kind word from a software vendor.
When a software vendor sells out to a corporate conglomerate and most of the employees either abandon-ship or are “downsized” (AKA “chosen a different career path” because they don’t fit in with the new management style), MindHealthBiz and associates work well with vendors and have resources to complete a failed implementation or deliver software support and programming services that seem to no longer be available from the software company (even web services, which seems to be troublesome in this industry).
We’re here to help. Take a look around the site. If you want to know more about MindHealthBiz and the software selection, implementation and optimization services offered, connect with me at info@ehrsio.com.
-T.
Read more →Not really.
Professionals reach out to me occasionally looking for an Electronic Medical Record (EMR) that works for a solo practitioner or somebody working in a small practice. More often than not, they are frustrated because they can’t locate exactly what they want or are not necessarily tech savvy 
enough to configure and learn the software without aid of professional help. Moreover, they can’t justify the expense involved in paying tech people to help them with this tech problem. For these folks, I want to say it’s not a hopeless situation. There are some nice products out there that can help bring professionals into the 1990s, uh, I mean 2013, like TheraScribe.
Just for the record, I define the EMR as a record that’s limited to the practice and an Electronic Health Record (EHR) as a record capable of electronically sharing confidential consumer treatment information in a secure manner.
Most of the Electronic Health Record software (EHR) in the market caters to larger customers, organizations that employ a number of professionals sized from a Community Mental Health to a state psychiatric hospital system. A far cry from a solo practitioner, and not the market ThereScribe targets. The foundation of TheraScribe is treatment plan and assessment content. TheraScribe uses treatment plan content from Wiley Publishing, content also offered by a number of the manufacturers of larger systems. Checking into their website revealed a great education source in itself. If a professional wants to learn how the EMR ties to education, best practices, HIPAA and HITECH compliance, he could do worse than spending a couple hours with the TheraScribe website.
They even have audio-visual aids on the website. I reviewed their “get started” video recorded by TheraScribe creator Arthur Jongsma, PhD. The video gives a brief introduction to the electronic version of Treatment/Care Plans, Progress Notes, consumer homework and a bunch more. Jongsma says the software is quick & easy to learn, which you’d expect in a sales video, and on the surface it seems simple to me, however if you’re making a decision on an EMR, I’d suggest you look deeply into the product and try to connect with another professional or three who are actually using it successfully. References for products sometimes turn into mentors and we all need mentors.
The brief presentation started with the input of consumer standard demographics like name and address, and included gathering insurance information including authorizations (a novel approach to start at the beginning). If a professional has avoided working with insurance companies because the work involved can be more trouble than it’s worth, software like this combined with third party billers can increase revenue…and who doesn’t like the idea of a few more sheckles arriving in the mail?
I like that this product is enabled to attach electronic documents to the patient record, like scans, photos and PDFs. Sometimes outside information needs to come in because it’s valuable in treatment, and sometimes it’s valuable in billing, and this is a great organizational tool. The next trick is to make the document easily accessible, and you may want to ask a salesperson to show you how that happens in the software; sometimes it hard to locate the documents you attach to a record.
A huge advantage TheraScribe has is a design tool; it doesn’t appear too robust and may be limited in what it can do to modify the system to suit special needs, however you can create some custom fields in your EMR, and not all products will let you do that. Sometimes state and local licensing requirements insist certain information be tracked, and being able to add in a data field could be just the ticket to stay on the right side of the rules and regulations.
Sharing of Patient Health Information (PHI) is tracked in the software’s HIPAA module and enables recording of signed release forms and other documents required to keep consumer information confidential and prove that you’re following the rules. EHR software serving organizations need to be Meaningful Use certified, and this sort of thing is a pre-requisite, however for a solo professional this consideration seldom comes into play so TheraScribe isn’t certified. Still, even without certification, the rules need to be followed and sharing of consumer data needs special attention, and the software attempts to address the issue.
The assessment collects narrative about family, development, substance abuse, socio-economic factors and medical history. The thing that jumped out at me was the lack of check boxes to provide measurable metrics about the makeup of your practice over its lifetime. Other standard information like strengths and weaknesses have multiple select checkboxes, which the user can add to. A professional may want to check into this sort of functionality further if scientific method to improve a practice seems important.
If a professional uses a licensed assessment instrument, use of the tool and the scores can be noted in the consumer’s record, however you don’t see instruments in the system, simply because that would be infringement of another company’s intellectual property.
The mental status exam follows the same pattern as recording strengths and weaknesses with lots of check boxes, indicating risk assessment, thought form and content, as well as a narrative for the professional’s summary.
The Recovery section of the software is based on ASAM criteria, delivering a score to justify a level of care selected for a consumer; once again, narrative enables descriptions of outcome. If you like this sort of thing, it could come in handy.
One great fact about TheraScribe is that a solo professional can get some of the EMR functionality that they thought was reserved for peers working in large organizations. Once a professional gets used to using an EMR, they seldom want to do without it. The fact is, good documentation can help professionals deliver a high quality of care, and certainly extend billing into new payers (insurance).
If you’re a professional in the market for an EMR that would work in a solo setting, TheraScribe is certainly worth a look.
Read more →When they say “Don’t be so sensitive”, I have a stock answer: Bull.
When somebody tells you that emotional consideration has no place in business, well, that’s just not realistic. I tend to ask what they’re afraid of, which usually strikes a chord because we’re emotional beings. Many of us tend to avoid an emotional approach to business, some are successful. The fact is that our work can be a third of our life (sleep takes up a quarter or so), which is a big chunk; how can we avoid getting wrapped up in it emotionally?
Why, you may ask, is this tech guy talking about emotion in business? You could carry that one more step and ask why I feel people should go ahead and be sensitive sometimes.
Let’s take a look at the project manager, for example. In the worst case example, a “Project Manager” can be a misnomer, a title that has grown into a college discipline, with all sorts of groovy software tools to track productivity, count beans and generally justify existence. A true Electronic Health Record (EHR) implementation project manager becomes much more than that. One minute she’s a hard-nosed business person keeping a project on track and preventing “scope creep”, and the next she’s counseling a professional who is having emotional trouble making the leap from a paper system to using the software. She’s a superwoman who really needs to be sensitive to every aspect of the implementation, the professionals she works with and even the consumers walking through the door for service.
Jobs depend on cooperation and communication. In the business of law enforcement, a police officer depends on cooperation of citizens and expects to be listened to; the task of the day could save lives and cooperation and communication become a life and death necessity. Information technology doesn’t usually involve life or death situations although it can, if for example the Electronic Health Record (EHR) is expected to send a message to a professional who must complete a suicide risk assessment because a consumer says they are having ideas of how to take their own life. More often, the emotion that we see in implementing the EHR is frustration. That experience revolves around fear. Perhaps a professional has trust issues that the software will alert somebody about the need for a suicide assessment, or is simply afraid they won’t “get it” and be able to use the software successfully. Many times professionals so firmly believe that computers are de-humanizing that they don’t want anything to do with the EHR.
Unless the professional gets mad enough or sensitive enough over a situation like this to say something to the project manager, all that emotion gets bottled up and can affect the professional’s effectiveness in other areas of their work…and we don’t want that happening when they’re trying to help a consumer.
A consumer can recognize that a certain way of talking, specific communication techniques, can elicit a positive response from a professional. Treatment can be contagious. Those of us who have implemented a number of EHRs over the years spend a lot of time around professionals, training them, listening to problems they uncover and counseling them.
Anyone can have difficulty with a software program, especially professionals in mental health and addictions treatment who have been working in the field for a considerable amount of time. The answer is to screw on an attitude that is open to moving forward. Get mad enough to take action and be successful with the thing that gives you nothing but fear and frustration today.
Sometimes it works.
These days most professionals expect an EHR to be part of their work, however some work better than others, and some are just not configured to be convenient and intuitive for the user. That’s where that project manager / counselor comes in.
So, like I said, be sensitive. Let it out. If you’re a professional who’s frustrated with his EHR, go ahead and get emotional about it. It just might get you the attention you need.
Read more →“How much is this going to cost me?”
Fair enough. Fiscal reality is, after all…fiscal reality, and this question is forced to the front of a number of business conversations I have. Often I just have to look the person in the eye and tell the truth: “I don’t know”. That’s because getting an Electronic Health Record (EHR) to work isn’t just a matter of buying software and relying on a vendor to get it up and running. If that were so, the job would be pretty simple. Unfortunately, a number of professionals and professional organizations do just that, and become quite disillusioned when they discover how much work it is to get the EHR running effectively.
Hence, our headline. Buying and implementing an EHR is a lot of work for the buyer, and the habit has been to self-implement. Sounds a bit like self-treatment, eh? Implementation is not explosive, it can be frustrating. It’s not nuclear winter, it can be hot tempered moments. It’s not business as usual, it is certainly The End Of The World As We Know It. Professionals need help buying and implementing their EHR as much as a consumer with depression or anxiety needs professional help.
We don’t want to change much, just everything.
If the EHR starts with a software product that meets the needs of the professionals, software that’s capable of delivering a way to increase the quality of interactions with consumers and let professionals help more people by decreasing paperwork, then it’s a product that works and is usually sorely needed. Still, it’s a vision. The productive EHR doesn’t become a reality until it’s implemented and the professional comes to rely on it for documentation, billing and even communications with other professionals serving the same consumer.
If the implementation of an EHR focuses on the specific workflows for administrative, clinical, medical and other professionals involved in helping consumers, then their work lives will be drastically changed for the better. Each of these workflows involves filling out different documents on the computer and producing the results of that input that’s different depending on who needs the consumer information. The Electronic Health Record has changed the world for everybody who uses it productively and consumers can notice the change. Hopefully the change is positive and all that information at a professional’s fingertips will help with the person’s recovery.
The administrative person’s world is changed by keeping track of consumers who have been served before, and are being treated now, or who have inquired about getting help since the EHR came on-line. Being able to instantly access even sketchy consumer information and avoid re-entry of data by having consumers verify information like their address and such saves time, enabling the administrative person to help more folks…typically making it through the day in a better mood because stress is diminished. Ask anybody working in this capacity of helping treatment professionals and you’ll discover it’s a mixed bag whether their work life is improved by the EHR. Their answer may change by the minute if the EHR has been only partially configured to their workflow. The short story here is that if their needs were considered in purchasing the software and if implementation paid attention to their needs (somebody has to ask them), their work lives are improved. They get more done with fewer errors, and less falls through the cracks.
Clinical and medical professionals experience the same phenomenon in different ways. When a nurse treats a consumer for an injury or illness, certain things are important: Lab results, recording vital signs, and medical treatment requirements. If the EHR is selected and implemented with them in mind, the software they see could be much different from the software the clinical professional uses even it’s the same system. Clinical notes are concerned with addressing treatment goals and objectives, while medical notes are concerned with addressing health issues typically discovered by exams. The process of discovering a malady, diagnosing it, treating it and following through to assure healing happens is the same idea, but the actual tasks and subsequent measurement of success are quite different. That said, not only does the software need to do different things for these professionals, but the implementation needs to account for each of their workflows differently so the software tool will serve the consumer’s needs well.
Changing the world with the EHR involves one great, very human component: fear. A software vendor is not likely to be around enough to help the staff overcome the fear. That’s why it’s a good idea to have a cracker-jack project manager on the inside when you’re implementing the software that will change your world.
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.
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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.
Read more →“We’re a little short on resources and have to delay your EHR implementation a couple months.”
One issue a professional comes in contact with while implementing the Electronic Health Record (EHR) is lack of “resources”. When a software vendor says this, the conversation isn’t usually about memory in a PC, or a train that goes directly to the gym. They mean people. Not just any people; technical people. People who keep an implementation on track, who can write programs and train professionals to use the EHR and manage to count beans so another dreaded occurrence doesn’t occur – “overbudget!”
Sometimes the technical people who were counted on to do a job are busy with another job by the time it’s time to bring the EHR on-line. As a result, the professionals who have been preparing for the change to the EHR and could feel a little stressed over delays. Consumers can’t help but notice and possibly react to increased stress in a mental health organization.
There is a solution.
The salesperson probably indicated you’d be up and running lickety-split. During that conversation, they probably mumbled something about starting out with the “core system” or “out-of-the-box”. The difficulty with this sort of understanding is that even starting up with that software configuration, problems can be twofold; people (mental health professionals and other organization staff) need to become acclimated to the biggest change they can be put through. An EHR implementation doesn’t change much…just everything; and that “out-of-the-box” system probably doesn’t exist to fit every organization. People can get a little nervous, and that affects their job. Software configuration and programming changes are a fact of life when software is implemented.
There is a solution…really.
The people guiding this process (usually software vendors) repeatedly run low on staff. Just like any other business software vendors can be slaves to the next sale and cash flow problems, so they lay people off to run lean operations and POOF! They’re “a little short on resources”.
You’ve waited for it, here’s a solution.
For many years hospital systems have relied on consultants to configure and design systems to fit their staff workflows, as well as train the end users and offer support (technical support often requires emotional support). Likewise, mental health and addictions treatment professionals are increasingly relying on consultants. The key is to hire a “hands-on” consultant who can guide the project conceptually, knows how EHR software works, and understands that an organization is made up of people, not just “resources”, who need personal attention to understand and move forward with the technology they’ve spent a ton of money on. The consultant is generally less expensive than hiring technical staff because they’re only around and aside from retainer agreements, getting paid when they are needed.
If the product purchased has a database or programming environment other than SQL (like Cache’), it’s might be tough to have somebody available who’s familiar with the software and the software/development environment. It’s good to have somebody in your organization’s court who has worked with that environment or better yet, the software you’re purchasing. It’s good to have an implementation consultant who participated in the purchasing organization’s EHR selection process and knows the workflows of the professionals who’ll be using the software…it helps in setting up the software with efficiency in mind.
There’s good news.
The solution I promised? There are a number of people in the consulting business now who have the skills in question. Remember at the top of the page where I wrote that software companies like to lay people off when sales are slow or cash flow is tight? The folks who are out of work still have technical skills and fit very special needs required for implementing and supporting software. Whereas they may not have fit a software organization well, a project is much different than a job. It’s gratifying to some folks when their efforts have a beginning, middle and an end, so they tend to be pretty good associates.
Read more →“What happened?” asked the person on the left.
The person on the right replied, “I forgot my appointment!”
Whether you’re a consumer or a professional, you’ve likely been on one side or the other of this short conversation. Clearly, the reminder (if one’s being used) didn’t work. That signals a breakdown of marketing that can likely be improved by the Electronic Health Record (EHR).
The two most common methods of decreasing the occurrence of this conversation are (1) the telephone reminder and (2) a reminder note strategically mailed to the consumer to arrive a day or two before the appointment. The reminder needs to come close enough to the appointment that the significance doesn’t fade from memory…I read years ago that point is around 72 hours…people forget, even though they’ve been reminded. When this sort of marketing is successful, two things improve: (1) No-Shows are decreased, and (2) if a person needs to cancel or reschedule their appointment, time is available to fill the appointment with a consumer calling in at the last minute for an appointment.
So, these reminders are marketing tools because they show the professional cares enough to reach out to the consumer to assure they get the care they’ve asked for. You may ask how the EHR fits into this equation…I’m sure you have at least an inkling of how this works, and it doesn’t hurt to keep this sort of thing in mind as business processes evolve.
Appointment scheduling in the EHR is a collaborative effort among professionals (or their front desk person) and consumers, and that’s easy with the computer sharing what dates and times are available for the professional. Once an appointment is agreed upon, most EHRs are set up with the capability to both schedule an alert for a telephone call to be made and to print various reports, including a print run for appointment reminder letters to be sent to consumers that day.
If your EHR isn’t doing these things, consider the business angle: For the cost of a recouping a few no-shows, connecting with a professional (like yours truly) to set up this sort of marketing capability has a significant long-term payoff. Efficiencies gained for larger organizations should be significant.
Now, let’s talk about electronic communication between a referrer and referee. Referrals from primary physicians to Mental Health professionals assure the consumer gets integrated care. Integrated care is a buzz-phrase right now, and it makes sense, as we are all connected, body, mind and spirit.
The EHR can have a referrer portal as well as a consumer portal. The referrer portal is important because it helps the referrer track treatment in the external organization. After all, referrals are made with a specific purpose in mind, and if a consumer is being treated for anxiety or depression the referrer will need to know what’s happened since the last time the consumer was seen.
Consumer portals are a really handy method for a consumer to track their medications, appointments, bill, and other interactions with the professional. This is an attractive feature for the consumer and in some cases that can be good marketing (or perhaps some folks will agree that I’m reaching into the ozone with this concept).
These aspects of marketing are important ways the EHR can help the professional and the consumer. They’re not the only options available with this powerful tool. Newsletters can be generated and managed for a professional’s consumer base, reminders and holiday greetings can be managed by the software, and a ton of other possibilities can come into play offering better service to consumers, which equates to good marketing.
A always, more to come…
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