Professionals who need an Electronic Health Record (EHR) for a private practice have a number of options, and the trick to finding software that works for the individual practice is settling on one of them.
My advice is to get a list of as many products as possible with a little information on each of them off the web and read it. Then, narrow the field to a half-dozen or so based on initial research and check their web sites out. This can be a complicated matter, what with the myriad of opinions on software out there and the temptation to just buy what your pal Joe uses in his practice. Don’t do that. Do the research, or hire a professional (like yours truly) to do the research and the satisfaction level will certainly be higher once the money’s spent.
.jpg)
A newsletter I subscribe to from an industry publication had a link to a practice management software package, and I’ve been threatening myself with tackling reviews of software for solo and small practice software for well over a year, so I took a look.
The product is called TheraQuick, and there’s a video on the website that gives a pretty concise overview. As with all overviews, this stimulates questions for me.
StarQuick Solutions is the small California company that manufactures TheraQuick. I was immediately encouraged to see the staff is comprised of varied disciplines, including a rocket scientist, a psychologist, and an expert in software interfacing. Depending on the charisma and personalities involved, there is at a fair chance that the software will be a balance between the needs of the users and a vendor’s business realities. I look for a practical development approach that keeps an eye on affordability for elegant features and functionality. That pragmatic statement is all about survival of the current software and the vendor’s business.
My overview of the product is positive; however I have almost no substantive knowledge of the company. If I were buying for a solo practice, I’d want to see more of the product and have some in-depth conversations with a couple people at StarQuick. I would like to know how long they’ve been in business, how many customers they have and to talk to some of those customers. It’s not out of line to ask those customers about their relationship with the company, hoping they aren’t the programmer’s aunt.
Here are the pros and cons I saw in a brief overview:
A lot of good: The software covers a lot of bases, and the more your primary software system does, the less a professional needs to get from some other source. • Billing, due to insurance requirements, is inherently difficult; a module is included, as well as basic accounting for services rendered and credit card charging. • The software seems pretty simple to operate. • I didn’t get an in-depth look at the customizing features, but the product enables the user to modify a “Dashboard” to suit their needs; Dashboards are a one-screen view and access point to whatever the user would use most – consumer record access, treatment history, billing, etc. • Professionals can minimally modify the session note to suit their particular style and needs; I’m not sure how far this goes, but regardless, it’s a positive feature. • Scheduling looks good, and there are a number of similarities to MS Outlook; I like to see all my tasks and appointments for the day, week, and month at a glance, and the product allows me to do this. • The system can be set up for different office locations for the professional who travels around (there are many folks meeting this description); this is a plus and in some states a requirement.
I’d Like More: Like all software packages, there’s always more work that can be done. • I’m a stickler for workflow. If the documentation doesn’t fit in with the daily work, it creates work because you have to come back and do it later. If, instead of collaborative documentation and treatment planning with the consumer, the professional writes nothing down and makes no follow up steps with the consumer to advance treatment, the documentation becomes an added step in accounting for what happens. I didn’t see much attention paid to concepts like these. • I’d like to see a treatment plan. Now, I’ve worked with treatment organizations for a long time, but haven’t really spent much time in solo practices…perhaps treatment is not planned with the consumer in this environment, but it seems reasonable to me that a treatment plan should be part of working with the consumer to resolve the problem by meeting short-term objectives and establishing roles and “rules of the road” for the treatment relationship. • I’d like to see a stronger Report Writer…I demand robust report writing capabilities, and as a Crystal Reports writer, perhaps I expect too much. An overwhelming majority of the folks I’ve talked to over the years about the Electronic Health Record (EHR) really want reports to look a certain, special, individual way. Sometimes that’s due to local or state regulations, sometimes a Joint Commission (JCHAO) or other accrediting, licensing or auditing agency; sometimes just because they’re happy with a format they’ve used for a long time. The point is without a very robust report writer, you just can’t make the reports look the way important people want them to look.
I think that anybody in the software manufacturing business who can sell their product to 100 people, continue to provide effective support and still grow probably has a product that will work for a bunch more people. Where a number of professionals drop the ball is in investigating the company they will be working with for a number of years. A little research pays off for the life of a practice, which is why busy professionals contact me.
Read more →My mom was big into psychics…not that she believed them, she was merely intrigued. Right?
Predictions regarding the Electronic Health Record (EHR) for the year are out, and not that I believe them, but I’m intrigued.
.jpg)
Let’s start with Marla Durben Hirsch, a contributing editor for FierceEMR. She has five predictions, and the one I’m most interested in is software vendors using cloud technology. Cloud technology is a marketing term that encompasses a bunch of services offered by an EHR vendor. Sometimes referred to as an ASP (Application Service Program), it includes using the server, gobs of disk space, and great services like automatic updates to the latest, greatest software enhancements. From a vendor standpoint it’s easier to maintain and support because the vendor has control of the technology. Sometimes professionals and the organizations they work for tend to cut corners on technology to save a few bucks. From a professional’s viewpoint, cloud technology may be good because they’d rather not become a technology expert or have to hire a local consultant to handle all the jobs involved in maintaining a system. The core of this provision of the EHR is that it’s deployed on the web.
The first worry that usually surfaces is the security of consumer data and confidentiality of a consumer’s health information.
I’ve talked before about security, and SSL, or Secure Socket Layer is the most common method of securing a connection between a professional and their data when the EHR is housed and maintained elsewhere. Another security method is Citrix, which is supposed to be even better security than SSL. There are more methods of securing the confidentiality of consumer records, and anybody who sells an EHR system must offer good data access security these days, or else the HIPAA police will get very upset and there will be consequences to pay. So, since this was all worked out years ago, data security is generally not an issue when a professional uses a web-based EHR; people buying software still ask about it, so I address it.
Cloud technology is especially valuable to solo professionals (products like practice fusion) or small organizations with under 100 employees (products like Foothold Technology’s AWARDS System. Professionals really need to be treating consumers, not troubleshooting server problems or wondering if a backup is available after a system crash.
InformationWeek has its predictions published already. I like number seven. I think what they’re talking about is providers of one product (like lab or pharmacy services) delivering web-based EHR modular software solutions to woo more customers into using their primary product or service.
One significant drawback to a solution of this sort is that it’s a module. Both professional and consumer are better off with a total solution where session notes (including breakthroughs and next steps) and mutually developed treatment plans can be attached to everything else in the consumer’s record. Still, the prediction is for this sort of modular approach to software in mental health and addiction treatment is on the upswing for 2012.
Healthcare IT News has a different take, and I find it quite interesting. For example, since the growth of Healthcare IT has been a major focus of the American Recovery and Reinvestment Act (ARRA), and the gains have only been modest, I agree that will played up quite heavily in the presidential election. This sort of thing can be spun to either create controversy, or used as evidence of doing a great job, depending on which side of the fence you’re standing on.
Politics. Sheesh.
Whether you accept the predictions that are coming at us like popcorn as valid or not, it is at least fun and educational to check in with what people in the world out there think.
Enjoy your day, and don’t sweat the predictions…unless you believe in psychics.
Read more →“It slows me down!”
A lot of professionals complain about entering their notes and other consumer care documents into the Electronic Health Record (EHR), saying it slows them down, or they don’t have time, or something of that ilk. My experience with this issue is that once the EHR is properly in place, it saves time and the professionals actually start to like it. I even hear comments from consumers that they like the idea of collaborating on their treatment plan and knowing what the next steps are going to be when they show up for their next session (a handy use for the EHR).
.jpg)
It’s true, however, that the EHR can slow professionals down for at least a few reasons:
The good news is that all these shortcomings can be avoided.
Process Analysis is simply following a consumer through treatment and seeing how the professionals’ documentation is captured before the EHR comes into play. Process Design for efficiency uses the analysis and needs a couple very important tools to enable the EHR to work to the advantage of the professional: The screen designer and the report writer (other tools like treatment team and consumer communications software are great, but these two tools are the foundation of designing a working system). Process Implementation actually pulls together an EHR design that makes documenting services less time and effort consuming.
So, if the EHR really can save professional time, provide treatment team communication and help deliver better treatment to the consumer, how come so many professionals resist using it? I’m sure there are hundreds of excuses and a number of valid reasons not to use the EHR, many related to specific technology problems that could be remedied for a price. Other than that, professionals would rather treat consumers than learn to use an EHR…or improve their keyboarding skills.
There are a bundle of solutions out there to address professional resistance to using the EHR, and one is a marriage of low-and-high tech: The Remote Scribe.
Imagine, if you will, you’re in a session with your psychologist, and there’s a large screen on the wall that displays your EHR. You answer questions in an assessment, or talk about the plan to treat your difficulty, and the screen starts displaying the assessment selections or typing magically appears during the session. Interesting.
The high-tech portion of this solution is the simple presence of the EHR in the first place. The low tech portion of the solution is that the notes are relayed via a headset and microphone to a “Remote Scribe” (a human being). So, another data entry person is on the payroll. Not a new twist, this is getting the same old documentation solution back into the healthcare arena. The scribe has been called a transcriptionist for many decades, and some professionals would rather retire than move away from this sort of medical treatment documentation service. I suppose it’s a valid way to keep technology resistant professionals working, but it strikes me as paying double for documenting services, which is the data entry bummer. Even if the Remote Scribe delivers a return on investment, it’s still adding a task into the mix that doesn’t need to be there if the EHR is designed and implemented with efficient and effective professional workflow and with the consumer’s best treatment in mind.
The simple solution, and a much more valid one for my money, is to follow the direction of the EHR that’s moving us toward National Health Record and better care for consumers with the help of technologies enabling electronic sharing of consumer records in order for professionals to treat the person as a team.
Read more →2011 has been a memorable year for MindHealthBiz. I hope I’ve helped steer some people in a positive direction with this bolg.
MindHealthBiz continues to evolve, focusing more on the core expertise, which incase you don’t know is Hands-on Electronic Health Record selection, implementation and vitalization. I’ve met some new friends this year, which inspires gratitude.
.jpg)
I’ve also had some people from my past help me out in ways I could never foresee. A ton of “coincidences” have come my way, all positive.
I’ve had some personal trials this year, who hasn’t? I am convinced that every challenge has led me to a better spot. Perhaps it’s just the old addage “That which doesn not kill us makes us stronger”…I prefer to look at each one of these events and situatios in my life as gifts from the Universe.
Remember in 2012, Peace and Love is where it’s at! -T.
Read more →It’s amazing how humans invent pet names for concepts…even money: Samoleons, bucks, sheckles, MU.
That last one, MU, is Meaningful Use incentives a subject near and dear to healthcare’s heart, since it helps pay for all that expensive Electronic Health Record (EHR) software and the effort to make it work efficiently and effectively. The EHR is intended to keep better records, thereby helping treatment professionals work as a team with consumers, whether they work for the same facility or not. The EHR is evolving into a tool delivering better access all treatment records, as long as the consumer signs a release of information form.
.jpg)
The MU delivers cash incentives to assure the professionals are using the EHR in a meaningful way, to guide treatment into productive, healing directions. There are rules, and the first set of rules, the 15 core objectives of Stage 1, are supposed to be on line now, following a strict timeline to speed up the process of getting the EHR working and accepted nationwide. The core measures are technological assurances that Meaningful Use incentives (our tax dollars) are invested wisely.
Progress has been a little slow.
Professionals feel the timeline has been too aggressive, or don’t want to spend the money, or don’t think it applies to their treatment discipline…pick one or more. The fact is, professionals who saw the opportunity are collecting checks. It’s all in how you work with the system.
In response to the slow EHR acceptance and in order to encourage more organizations to ramp up their EHR, The US Department of Health & Human Services (HHS) has announced a year’s delay to meeting Stage 2 of Meaningful Use so more people can implement their EHR to meet the Stage 1 requirements. Got that? Good, because it can be confusing. There are three Stages, and not room here to discuss it all in this discussion, so let’s stick to some early benefits and the aforementioned reason why Stage 2 has been delayed.
In line with our president’s primary EHR reasoning, MU has created 50,000 jobs so far in Healthcare IT. That can’t be bad.
OK, so what’s the big deal? Well, the Stage I core measures are the easy ones. Most software vendors of any significance can meet these requirements to collect the incentives already. You’ve probably seen some of the elements in your friendly neighborhood mental health center or your primary physical health physician’s office. These core measures include activities like electronic prescribing, which cuts the time to order medications and virtually eliminates medication errors that can be harmful or even fatal. One Stage I “Menu Set” measure assures that your information can be shared electronically among your professionals offering care, so the primary physician and the psychiatrist will offer supportive therapies instead of contrary ones.
Stage II objectives include some elements that may not be very tough for the software manufacturer to include, but to implement the software into the workplace is a chore. The hope is that the benefit exceeds the pain to get the functionality up and running. Another day, we’ll examine Stage II objectives.
The jobs created in healthcare and information technology make the expense worth the effort of meeting both the Stage I and Stage II requirements. The MU incentives can pay for an entire EHR and its implementation over the course of the five year period professionals collect the payments. And ultimately there’s one outcome that can’t be seriously denied.
When a professional has access to more health information about a consumer, she’s better able to treat the consumer. When professionals have outcome measurement tools that can be measured nationwide with de-identified data, treatment can improve. When professionals work together, the consumer gets more comprehensive and effective treatment by treating the whole person.
All this and samolians? What a deal!
Read more →The Electronic Health Record (EHR) is a traffic cop.
When I consider how many different sorts of traffic there are in a mental health or addictions treatment facility, I quickly become amazed with successful organizations of professionals. Sometimes it seems like it should be a magnified Three Stooges bit, there’s so much traffic. Just off the top of my head, there are 5 types of traffic that can be managed by an EHR.
Without managing the traffic, the facility just doesn’t run smoothly. Manyt facilities have a person who guides people to where they should be, is really good at what they do, and that person becomes known as the “go-to” person by professionals and consumers alike. That’s fine except when they’re out sick, or quit, or have a fit, or whatever. Reality gets in the way of the human traffic cop, and in this field, the EHR is a great tool to manage the traffic patterns I mentioned.
Consumers are likely not be aware of it, but in a mental health facility, their movements are planned; guided and recorded in the EHR. First, there’s the scheduled or unscheduled event…either way, the EHR can match up the right professional with a consumer to fill the need for that visit, whether it’s a regular counseling session, an HIV education session, or a visit with a nurse. Once an event is scheduled in the EHR, the front desk person can guide the consumer to the right place for the meeting; an effective scheduling module keeps people from bumping into each other in rooms that should have been reserved; reservations are in the EHR, and everybody involved in an encounter knows where to go, when, who will be in the room, and when they need to exit. Furthermore, when a room is freed up, the EHR has live information for a good place to have an impromptu meeting.
Having visited a lot of clinics and multi-professional offices, I’ve seen a ton of mis-scheduled rooms, complete with usurpers who try (sometimes effectively) to abscond with these valuable resources because the room was double booked. Or not booked according to Hoyle. Sometimes even professionals will try to beat the system. The problem is that valuable professional time that could be spent treating the consumer is too often diverted to searching for a place to get together or spent trying to get somebody else out of the spot they reserve.
Professionals in treatment generally want nothing more than to help the consumer, whether it’s a group therapy, a nurse’s session, physical therapy or any of a myriad of treatment options available in our sector these days, they just want to do their job. All too often, a problem erupts when consumer and professional are mis-scheduled…the wrong counselor can get matched with the consumer, or the room to meet in isn’t available or can’t be found, or the professional is double booked and both consumers show up in the same room. There are more examples, all of which can be avoided if time, place, professional and consumer are matched up in a good EHR scheduling module.
A good scheduling module will also know when a consumer is a no-show, and the professional’s available or a drop-in visit from a different person, perhaps in the room that freed up in the earlier example above.
Notes, treatment plan updates and other treatment documents that need to be updated resultant to a consumer’s visit can all be tied to a good scheduling module. Managing the traffic of documentation is the key job of an EHR.
That good scheduling module also has the ability to assure correct charges for services can be made once an event happens…so traffic through the billing office is also managed by the EHR. It’s easier to deal with insurance companies in billing disputes if all the documents are tied together from the admission, through treatment, to discharge.
All this connectivity makes for good statistics that most administrators love. The figures on how well professionals’ time is managed, how quickly a consumer gets served, and other benchmarks all tie together into a neat little bow that help manage organizations of professionals, keeping the lights on and paychecks flowing when the baby needs shoes. In fact, when a facility needs more room, the executive director can prove it to the board of directors and expand the facility.
Not bad work for a traffic cop.
Read more →I know, I’ve belabored the “release of information” subject.
It’s good to know somebody else is thinking about this, and in a far-reaching way. SATVA, our industry’s software vendors’ association recently posted an interesting article on Behavioral Healthcare’s magazine that lays out the importance of a “consent to disclose” form (I’ve called it a Release Of Information form or ROI) in the Electronic Health Record (EHR). Without a single, signed form in common, disclosure of the consumer’s health information can’t be shared without breaking at least one of 32 federal and state laws that protect consumers’ confidentiality. The goal would be to make a common electronic form available in all EHRs and RHIOs in order to assure a consumer gets the best treatment from any healthcare facility he walks into and maintains health information confidentiality.
Naturally, consumer records electronically shared among their professionals providing care can reduce duplicate tests, duplicate data input and other wasteful activities, and even prevent medication errors that could cause big trouble for consumers, simply because the professionals are acting as a team, not lone guns. None of these benefits can be realized without a solid, mutually accepted ROI or consumer consent agreement (same thing, I’ll stick with ROI for now)
SATVA even delivered a specification for the consent form, (amazing these guys agree on something given the competitive spirit in the software industry), stating a number of ways RHIOs are affected by the protective laws I mentioned above.
The ROI would deliver instant approval to share information, which means more timely treatment for the consumer and less pain, whether physical or emotional. Wouldn’t it be great if you moved from Oregon to New York and your new professional had access to your chart across the country when you came in for your appointment? That’s electronically possible now, except for the lack of an ROI.
So, why is this little stumbling block to all these benefits a problem, you ask? There must be a way to overcome the problems.
Right now, all it takes is a signed form to share the data between providers and that can be faxed. A major drawback of this system is that most providers have completely different forms to fill out, and filling out multiple forms them takes expensive professional time. Then there’s the clerical time and energy spent faxing different professionals for their specific ROI forms, getting them signed, and then faxing them back before the patient record is transferred. Then, depending on the professional’s legal limitations and technological status, the information sought (could be many pages) would need to be faxed, mailed or shipped. Now multiply all that effort and trouble by the number of physical and mental health professionals involved in the consumer’s care.
Oh, and next, multiply that by the number of consumers seeking care that day among all the professionals involved. The energy and expense both mount up.
I’ve commented quite a bit on Health Information Exchanges (HIEs) or Regional Health Information Organizations (RHIOs), and they’re key to this subject. RHIOs need to become intimately acquainted with those laws and rules I mentioned earlier…they have the same responsibilities to consumers as software vendors and professionals. This means the electronic ROI would need to be a common design among all the software vendors, professionals and their RHIOs, and also maintain the consumer’s stamp of approval and specific mention of the professionals involved, whether it’s an individual or an organization. That’s quite a job, too, but it can be done more simply and elegantly with electronic transfer of the health information data. The ROI also needs to cover why the consumer’s information is being shared; is the reason clinical, financial or something else? Since a RHIO can’t pass along information to anybody who’s a member without authorization, some sort of accountability needs to be built into the string of data sharing and availability to assure consumer confidentially.
Like I said, it’s a big job. The good news is that SATVA says they’ve already built it and have tentative approval of SAMHSA, and all the professionals and RHIOs need to do is buy it…but then again, maybe it’s free.
How likely is that?
Read more →Executive Summary
New York State Medicaid Health Homes have been defined, including the offer of payment for providing the coordination of care among a network of providers required to be a Health Home. Providers are diligently completing applications (due November 1, 2011). Electronic communication to facilitate this coordination of care for Severely and Persistently Mentally Ill (SPMI) consumers is critical to deliver care in a reasonable amount of time. A prime goal for the Health Home is to reduce emergency room and hospital stays for these folks.
This system of care is most efficiently managed with the help of interoperable software. An exploration of current thinking follows, discussing questions that have been raised in conjunction with efficient and effective planning to share data among Health Home network providers and the involvement of the Electronic Health Record (EHR) in this effort at the care provider level, and the involvement of the RHIO in securely sharing that patient data at the network level.
Although the EHR is not required to be in place at the outset of the Health Home adventure, some system of communication throughout the Health Home network is required. Without an electronic solution with a modicum of automation, documentation and communication requirements for coordinating treatment for some consumers will be onerous. The requirement of a plan to have an EHR in place within 18 months for all care provider organizations involved with Health Homes seems like a lot of time to some. It’s not; there are too many project details involved to delay. A few software companies brag that they can have an EHR up and running in 90 days. That is likely true, MindHealthBiz actually uses similar rapid change cycle software implementation methods. Care providers on the other hand may falter in meeting aggressive targets simply because they don’t have professionals with requisite skills and bandwidth available to do the job in a short time frame. Implementing an enterprise EHR is a huge task in itself, and tackling electronic communications among care providers for a SPMI patient complicates the job…this is a completely new application for software that has only the foundation elements defined and not yet assembled.
Paying for EHR Software As usual, the first question that arises is “who’s going to pay for all this?”
HEAL grants have been suggested as a way to pay for EHRs at the provider organization level, as significant work will need to be performed to get software ready to securely and electronically share patient data among members of a Health Home network. A number of HEAL awards have been granted over the past few years with regard to sharing consumer information among care providers, as well as establishing regional centers for Health Information Technology (HIT) assistance. The results of these grants are available to providers if they choose to use them.
Currently, Meaningful Use incentives are the best bet in gaining revenue to offset the expense of software. A few software companies capable of deploying to a large HHS organization have gained certifications required to qualify to receive Meaningful Use incentive funds. Other software companies are in the process of earning the certification, or plan to apply soon. If a care provider agency plans to fund their EHR purchase with Meaningful Use incentives, there are a few things to pay attention to from the outset. • Currently an organization must apply for incentives through their eligible professionals (prescribers, usually doctors) (http://blog.samhsa.gov/2011/09/09/behavioral-health-organizations-begin-receiving-incentive-payments-for-health-it/) o For Behavioral Health, The Behavioral Health Information Technology Act of 2011 (S. 539) is active in the US Senate to establish more appropriate criteria (http://www.informationweek.com/news/healthcare/EMR/229301263) for our field, and expand the list of eligible professionals to include other licensed professionals o The current reimbursement is $63,750 per eligible professional…if you have ten doctors working, that’s a significant amount to be paid over five years. If you don’t you’ll need the aforementioned bill to pass in order to collect significant incentives for Psychologists and Licensed Mental Health Counselors • Thirty percent of the eligible professionals’ consumers served must be Medicaid funded • Core Measures (http://www.cms.gov/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf) are generally attested to by the EHR vendor, however the agency is responsible to use the tool and meet the requirements.
There are more details (like connectivity to SHIN-NY (Statewide Health Information Network for New York) to address and more measures to meet as the EHR is used. If we address the foundation elements above first, future requirements are designed to fall into place as long as the provider uses the EHR as intended according to the certification and follows the rules. Of course a gap analysis performed by a neutral party is appropriate due diligence for any organization planning to be included in a Health Home network.
Recently I performed a survey of major New York City providers, like New York City’s HHC, and discovered that the majority of hospitals and large human services provider organizations have no enterprise Behavioral Health EHR on line, and are either just now implementing, or more likely, engaged in a purchasing process for the software.
This last point is a stickler, and where providers of care can stumble a bit in doing what they need to do to continue collecting Meaningful Use incentives. Some agencies have created a full time position for this job, others contract with companies like MindHealthBiz to assure they collect the incentives without incurring penalties along the way. Participants in the Meaningful Use incentive program are required to provide on-going proof of performance like self-attestation that will need to be proven in order to avoid having to return incentives already paid.
Connectivity Who is your Regional Health Information Organization (RHIO)? Are they working with your software vendor? Answer these questions and you’ve started a project, so be prepared to have adequate human resources available with time, persistence and expertise to dig into the details. It is best for care providers to have a voice in development of any system regarding what data flows to what electronic destination, and exactly how it gets there. Software vendors have varying levels of knowledge and expertise in confidentiality requirements and exact workflow within care providing organizations. Your organization could be a model for development of the Health Home network plan for your vendor, with great say in product development. Act quickly.
The point of electronic connectivity is communication throughout a disparate, multi-provider treatment team, through the Health Home’s care coordinator / case manager. Technology exists for the software vendor and RHIO can enable this, and it’s necessary for them to cooperate with one another on exactly how the electronic communications will flow among treatment team members. Questions arise at the care-giving level: How do I know my consumer has seen another provider? Who owns the treatment plan, and how is it shared? What notes can/must I share? The list of elements that affect care at the provider level continues.
As shared earlier, it’s important to be involved from the outset with your EHR vendor and have some say in the development of how new functionality will work. Would you rather your professional staff guide the details of gathering and sharing consumer data, or a software company’s project manager and programming staff? This has been a pet peeve of mine in software manufacture; programmers seldom analyze several common workflows for the same task in different care provider settings. One very handy remedy to this problem has turned out to be the dual edged sword of designer tools that come included with software packages.
These tools can potentially help save a ton of development costs. On the other hand, if a care providing agency doesn’t know the vendor’s communications plan for the Health Home network or doesn’t want to wait for a solution they may develop their own technology with design tools. This can hurt the provider as the vendor follows its development roadmap at their intended, albeit usually slow, pace. Be aware of details like this and avoid mistakes that waste resources and money.
Oh, one more connectivity item in this short story….Managed Care for all NYS Medicaid is the next step for our world, so remember to garner some sort of electronic link to your EHR with your Managed Care Organization (MCO) or BHO. This avenue may provide valuable encounter data and speed authorization processes. The BHOs to move forward with have been (or are being) defined in your region, and that may or may not mean the provider agency is destined for big change for managed care.
A comprehensive Release of Information must be negotiated to meet requirements of the Health Home, 42 CFR, the other provider agencies in the network and other interested parties. My suggestion has been an electronic form provided through the RHIO that includes all network member agencies. I would like the ability to disclose the sorts of information that will be shared among agencies and give the option to the consumer to select which agencies he approves with checkboxes, or “all Health Home network agencies. Some plans laid for this adventure include only the latter, not the option for a consumer to pick and choose. That said, the consumer’s choice may boil down to costs being covered by Medicaid…or not. More will be revealed as the details are ironed out and the technology is fine tuned.
Of course, if you’d rather not rush into an enterprise EHR purchase, your RHIO may have a software solution they would be happy to provide for a monthly fee; you’ll still need to implement it, and that effort is still expensive in money and the provider agency’s human resources. This software would be an “Application Service Provider” (ASP) arrangement, and may be adequate for the interim period while agencies select their EHR. Just make sure the ASP software is certified for all ARRA purposes and you can live with the functionality limitations.
Functionality The right way to go about understanding shortcomings of software technology is to balance requirements with the reality of who enters what data where. A functionality grid fills in the blanks that are opened by a gap analysis and returns a “score” for each vendor involved. These grids are used commonly in Requests for Proposal, and can be limited to functionality needed to accomplish the goals of a Health Home. Some of the Health-Home-specific elements that should be considered include: • A robust referral module o Drop-down dictionary selections for all Health Home Network members for multiple screens involved in a consumer’s treatment o Other network care provider treatment and discharge information should be tracked as it may affect your care’s outcomes for the consumer (psychotropic medications, physical trauma, etc) • A Health Home Requirements Checklist to assure the Health Home Case Manager/ care coordinator has information required to make reasonable consumer care decisions; all providers involved need to share their findings and cooperate with one another, so the best solution would be interactive among care providers • The care coordinator will need live access to key data for utilization and quality reports from all Home Health Network providers • Treatment data transfer mechanisms compatible with a number of EHRs o Note: A number of formats are already in place for HIPAA electronic formats as well as tools like the Health Level-7 (HL7) to securely share demographic, clinical and transaction data…your vendor may or may not elect to use these standard formats, replacing them instead with their own proprietary mechanism; certification issues may ensue if that’s the case • A pool of funds is promised to Home Health networks for proving effective treatment: o What is the mechanism to measure improvement? o What is the base line for the measurement? o How is the data aggregated? o Are these Quality Control measures reflected in tools in each care provider agency’s EHR? • Account for the 3M Clinical Risk Groups within the EHR and entry of that data into the consumer record during intake and sharing the score with the multiple treatment team members • Immediate access to Diagnosis & Treatment data from other agencies & possible storage of some of that data in the patient’s local record. • Active tracking of available Health Home slots with Health Home Network interaction • Some required functionality may not be available from some vendors, however, if they intend to stay in business, there is a roadmap to comply with the requirements; Be aware, there may be additional costs to care providers • It is wise to track whatever a consumer does, counseling sessions, physical health treatment, even if they simply show up for activities, track their presence and reason for being in the facility • Document Imaging attaches electronic files like scanned treatment documents and fax files from other agencies to your EHR’s consumer record…All agencies in the Health Home network are required to have an EHR 18 months after the start date – until then, some will have little or no technology and rely on telephone calls and faxes until that time, so other members will need to account for recording conversations and attaching such electronic documents to the consumer record in their software; not all EHRs come with document imaging, sometimes they can be quite expensive to add into the mix
In Closing The Health Home goal of coordinating care for SPMI consumers is lofty, and has been proven effective in New York. For care provider agencies participating in the Health Home program, the EHR is a requirement, and a lot of work and inter-provider cooperation is involved in bringing it up to speed. There’s time to do this, however, with a task like this, a dedicated human resource needs to be involved in order to meet the 18 month requirement for completion and the likely wish to take advantage of Meaningful Use incentives to help pay for the EHR.
One critical aspect in creating a functional electronic network for the Health Home environment to communicate and coordinate consumer care is the willingness for the RHIO to work with a number of software vendors. Vendors tend to work with differing platforms. Even though they all may be ODBC compliant, they way they actually work can present challenges to communication. The jealously-guarded code and database behind the graphics we see can be as different as night and day among software programs. The RHIO’s willingness to work with all comers in this is only half the equation. Vendors will need to be willing to cooperate with the RHIO, other software vendors, and multiple care providers to define and possibly accept foreign methods of accomplishing the Health Home electronic communication goals. Be as certain of upcoming costs as possible, and understand an exact dollar amount is not likely to be available until the project is complete.
All focused functionality needs to be in place as soon as possible. Since this involves development on multiple platforms, a comprehensive plan is needed. It’s certain that at least some RHIOs and software companies are working on this, to their individual or partnership advantage. Are your RHIO and EHR vendor working together, or at least have an agreement to work together on the same plan?
Contact MindHealthBiz at 631-419-6879 or info@ehrsio.com to discuss details of your situation and how your agency can influence the process to implement an effective, efficient EHR solution. Leverage the earned wisdom of an IT professional required to advance your project to participate an electronically integrated Health Home network.
Read more →Treating drug addiction with drugs is nothing new.
Disulfiram, more commonly known as Antabuse has been around to help folks stop drinking since the 1920s…it makes the abuser sick if they drink. Methadone has been used for opioid treatment since the mid-1960s. These days, medications like Naltrexone are used to treat both opioid and alcohol dependence. The word is these drugs take the edge off the craving, which can be a key motivator to relapse.
A difficulty in the past has been in actually tracking the prescriptions and medical treatment associated with treatment. In the 1990’s I worked with Gus Johnson, who invented a low-cost, comprehensive software system that tracked methadone and other medication prescriptions and administration with a link to specific consumer records; everything from writing the doctor’s order to dispensing was handled by the software, automatically saving all treatment records. Since then, a few companies like Metha-Soft and SMART have been moderately successful, resulting in a number of specialty software programs that work just fine for these purposes. These software programs are very focused to the clinic environment, and may not seek certification required to participate in ARRA funding to pay for software upgrades.
Where are the affordable comprehensive Electronic Health Records (EHRs) for small agencies? It’s getting tough for a clinic to focus only on opioid treatment or just alcoholism, since clinics are becoming increasingly involved in associated behavioral health and physical health issues. Larger software companies with an enterprise approach to electronic documentation and workflow management are certainly available, some with associated addiction treatment functionality, while others may not see an advantage to developing all the special features required in addiction treatment. Playing in that ballpark usually involves developing a bundle of said development by the software company, plus screen design and reporting tools that come with the system. If that advantage isn’t available, professional organizations generally get stuck with a never-ending series of development fees. In either event, some skilled human being needs to get paid for the development (good news for MindHealthBiz, since that work is part of the business).
Enter the almighty dollar.
Today, addiction treatment for a high number of consumers is funded by Medicaid, and not as many, but some, by Medicare. As incentive to use the EHR, beginning in 2015, Medicare payments will start to decrease for treatment agencies not using a certified EHR in a meaningful way. Medicaid doesn’t seem to have the same across the board penalty, but Medicaid programs are in financial jeopardy. Medicaid payments may also be affected for consumers who also have Medicare coverage. The skeptic in me suspects the decreases pioneered by Medicare may follow in future Medicaid adjustments.
Decreasing funding makes it tougher still to pay for the software update required to deliver an effective EHR and billing engine to professionals with all the right functionality for outcomes tracking, billing, etc. All this functionality is great stuff that benefits the consumer, however it all costs money in one way or another.
The upshot of this discussion is that smaller agencies need certified Electronic Health Records in order to improve their technology and track prescribing of these new medications. Enterprise (software that handles all an agency’s data and reporting needs) EHR software vendors are in a rush to get certified, so they can quite simply stay in business. In order to do that, the software is required to have an electronic prescribing capability, along with the ability to share patient data with Regional Health Information Organizations, (RHIOs), Health Home networks (http://www.health.state.ny.us/health_care/medicaid/program/medicaid_health_homes/)and organizations providing or tracking care to consumers from multiple care providers. The kinks are currently being worked out regarding consumer confidentiality, and that will be successful, I have no doubt. Smaller, specialty software vendors like the companies mentioned above have quite a challenge ahead of them.
Read more →I don’t believe it.
I’ve reviewed telemedicine a few times and new information about the subject grabs me. I recently heard a professional question the effectiveness of telemedicine, and since I hadn’t looked into studies about this, it seemed prudent to discover whether new effectiveness studies had overruled my previous positive opinion.
I’ve been a supporter of telemedicine for mental health and substance abuse recovery and treatment, and if anything, the presence of electronic solutions are being used more and more. Electronic resources have been around a while, including apps for iPhones and BlackBerry smartphones with links to addiction recovery materials whenever the consumer feels like they need a quick recovery tune-up. The ability to perform and possibly record sessions for consumers in remote areas using computers’ cameras and microphones to bring people into a virtual session sounded nothing but good and research backed that opinion up, so it hasn’t occurred to me to question its effectiveness till now.
A ton of supportive resources are on the internet and it turns out that electronic solutions are varied and well suited for a number of purposes.
I’ve covered therapy sessions via secure internet connections, and discovered that the availability of video in the session delivers the great benefit for the professional to better gauge the consumer’s body language…it can be difficult to pick up guarding postures and crossed legs and arms on the telephone. If you’re interested in telemedicine for mental health, you can see Demos and connect with one of the experts Secure Health. There are a number of companies providing secure telemedicine services, which is important, giving the nature of our industry, just search the internet to see other companies. There are just too many to mention here.
Last year CNN published a story on this subject citing an increase of success in depression treatment from 24 percent to 38 percent when on-line sessions were added to the treatment mix.
Telemedicine for mental health includes more than on-line sessions. In addition to the apps mentioned above, how about an Email or text on the smart phone to professionals for spot checks when a consumer feels off base. A few seconds spent with this technology could help bring a person into focus on recovery instead of relapse (there are security and confidentiality issues with this, so connect with a professional prior to moving ahead with this). Like a number of people, I think and process better either writing or by using pictures in a computer slide show. For folks like us, the solution of electronic communication with professionals can help us consider our thoughts and actions, and reflect on advice shared with us in past and in current communications.
The published account questioning effectiveness of telemedicine for mental health turned out to be rumor, anecdotal, without much support. I certainly support questioning effectiveness of any treatment in our industry, including the use of technological tools. This question, however, like Mark Twain’s famous quote, is the rumor of a death that’s greatly exaggerated.
Sheesh. I can get a kick out of sensationalism and exaggeration (I do that for fun sometimes), like most Americans (just watch the news to verify this), and the levels of that sort of thing has given me a healthy skepticism. I don’t believe everything I read. I’m glad to see there’s a growing interest in and value to telemedicine for behavioral health
Read more →