When the business of treatment gets better with the use of the Electronic Health Record (EHR), consumers get better.
These days, ePrescribing sends a prescription directly from the prescriber to our pharmacies. Mistakes made in simple medication prescriptions have been more commonplace in the past than we would like to admit, and ePrescribing is sending legible prescriptions to pharmacists which can only help reduce mistakes. Another benefit of ePrescribing is the incredible storehouse of data that is building nationwide and can be used in studies to improve professionals’ treatment of consumers.
Due to recent studies of suicide and suicide prevention, we know more about it than we ever have. A recent post from Thomas Insel, Director of the National Institute of Mental Health, quotes statistics gathered from a study of data (mostly gathered and analyzed by computers). Out of 100,000 deaths, 11 are suicide related. Out of 100 people you see walking down the street, one of them has been serious enough about suicide to have a plan. Knowing the depth of the problem is the first step in digging our way out of it.
Medications like Cozapine and Lithium have been proven effective in suicide prevention for specific target groups. Statistics that lead to conclusions of their effectiveness are naturally gathered in the EHR and analyzed on computers. As ePrescribing becomes more widespread, studies like this will become easier to perform, and results will be delivered to the medical community faster.
My peers on Mental Help Net talk about therapies like dialectical behavior therapy and cognitive behavior therapy. Studies show these therapies are effective in significantly reducing repeat attempts at suicide. Because of the data gathered from the studies, psychotherapy like this is increasing in usage.
If you are a consumer and worried about your name being associated as a subject in a study, please, don’t worry. For many years, “de-identified data” has been the source of studies like this…Once again, a little magic provided by the computers of those providing the data from their EHR. Consumers’ personal information never makes it out of the original databases used for the studies.
As new medications are developed and delivered through ePrescribing, more data will become available on the suicide prevention and the effectiveness of these drugs…faster. If mental health professionals know about a consumer’s suicidal thoughts and ideation, medications can be further prescribed, and evidence of their effectiveness (or ineffectiveness) will climb.
New assessments, usually delivered on the computer, deliver scores indicating the likelihood somebody will entertain suicide. These assessments lead to use of new psychotherapy methods in treatment to prevent suicide.
Once again, the EHR does its part.
Read more →Everybody likes to see results.
How many consumers really have a handle on their progress in treatment? A couple innovations involving the Electronic Health Record (EHR) have received a lot of attention lately, because they work…and that’s backed up by data from the EHR. 
Concurrent or collaborative documentation with the consumer and effective scheduling are perhaps the two most important tools that professionals and consumers can add to their tool box to deliver a clear vision of treatment effectiveness.
If a counselor cancels an appointment with a consumer, what message does that send? As a consumer, I might get the impression that it’s OK to miss appointments, with or without notice. Either way, missing appointments leads to less concentration on treatment goals and hampered recovery. Gathering data from the electronic central-scheduling module can help analyze who’s canceling appointments, and who’s simply not showing up for appointments. Once we know where the disconnect is, we can discover the reasons and overcome them.
I recently attended a web presentation by Bill Schmeltzer of MTM consulting discussing collaborative documentation (The slides are to be posted at http://www.omh.state.ny.us/omhweb/clinic_restructuring/resources.html), and I liked the approach because it had a focus of improving treatment results. The idea is to jointly recap the session (something most people receiving mental health services are used to) at the end of session, recording what the professional and consumer did together in the session, and how that discussion focused on one of the goals in the treatment plan, as well as any plans for the patient to employ tools like active listening or breathing techniques to improve daily life. Once again, this information will be available in the EHR. When the patient returns, the notes are handy reminders of where the professional and consumer left off; this might be a good place to resume discussions.
In many treatment centers, scheduling has been a topic of heated discussions over professionals’ control of their time. Recently The National Council (the mental health community’s most popular support organization) published a study that compiled data from ten Community Behavioral Health Organizations (CBHOs) that sheds some light on how important scheduling is.
One organization had a counselor with 30 “no-shows” by consumers. That seems like a lot. It certainly affects the bottom line, so agencies want to know more about this, because this consumers weren’t the only ones perpetrating the trend. As it turned out, the counselor didn’t show up for 24 of his appointments…legitimizing the idea of missing appointments. That’s a solid example of a work culture that needs to be changed.
The answer to decreasing no-shows and increasing effectiveness appears to be involving the consumer more in the nuts and bolts of treatment. Collaborative documentation keeps consumers and professionals focused on the goals of treatment, what the consumer actually wants to improve, as opposed to the mini-crisis of the moment. I like that, I learned that most of my crisis’ are bogus anyhow…a result of behaviors I have long-since changed.
One agency I heard about on Long Island hired a scheduling person with a master’s level education. This person was savvy enough to read a chart and consider treatment goals and objectives, as well as no-shows by both the counselor and consumer when scheduling appointments and determining what sorts of effort needed to go into getting the parties together to collaborate on effective treatment. Although the scheduling person was very expensive, filling the position with this type person paid off in the bottom line in reducing no-shows, and therefore paid sessions.
Yes, she used the scheduling module in the EHR to access the information needed to make these decisions, and she couldn’t be effective in the job without the treatment plan, progress notes and scheduling history information in the computer.
So, the foundation of success for both consumers and counselors, and even the treatment facility winds up being all wrapped up in the EHR. I love that.
Read more →Years ago, it was much more common to “fly by the seat of our pants”, making business decisions that “feel” right. A few billionaires can do that effectively.
Organizations that insist on making decisions by committee, with no real leader in decision making, can simply do nothing, which really makes for an organization that goes nowhere, does little new and exciting because so many plans just die in committee.
The rest of us need to base our decisions on something tangible. Other organizations’ successes can teach us, as can data. The Electronic Health Record (EHR) is where the data comes from, and since every interaction with a consumer requires some sort of data scribbled on a piece of paper (little value) or entered into the computer (high value), an organization measures its own success and future planning on that data. Although other factors enter the mix, this one’s value is provable and covered nicely by The National Council’s recent study on Enhanced Access and Engagement Quality Improvement Initiative Strategies to Increase Therapy Adherence (quite a title, eh?)
When a consumer doesn’t show for an appointment, a practitioner is oftentimes stuck sitting around with nothing to do…that’s a waste of the person’s time, and a drain on facility revenue. People need to work to have insurance and Medicaid pay the bill. This is a major problem nationwide, so the question of the moment is “How do we entice consumers to put their appointments on the top of their priority list?” Thinking now is that care provider and consumers are both tied into the equation.
A mental health or substance abuse treatment facility that is making ineffective decisions, flying by the seat of somebody’s pants, or one that makes little progress because the committee can’t make up their mind to do something, ends up with morale problems. If a care provider has low morale, then how do the consumers feel after walking out of a session with that person? Attitudes are contagious.
If, on the other hand, an agency is making strides to improve, collecting more money for what they do, you see the evidence in a new coat of paint, a gleam of excitement in a practitioner’s eye when they say ”Hello!” to the consumer, as well as general attitude and physical improvements throughout the agency. A dingy facility with bummed-out practitioners isn’t a place consumers want to go, so more appointments are broken in those environments.
So, what’s required in order to improve is change. Change that’s driven by data works better than the other two methods I’ve been talking about. What with today’s Rapid Change Cycle to make those changes, the implementation excitement’s over pretty quick, so the new coat of paint and improving attitudes are just around the corner, which help consumers justify putting treatment at a higher priority level.
Once the EHR is properly implemented, suiting workflows that make it the least disruptive to the staff and consumers, a facility gets the data required for good business decisions rather quickly. It’s simple to get quality data when central scheduling is in place and care is consumer-centered, involving the consumer and the practitioner in assessing the problems, developing the plan to recover, and recording the progress in notes. The data gathered in the process leads to improvement for the facility, practitioner and consumer.
Once again, the EHR saves the world. OK, maybe not the world, but isn’t it nice to see facilities improve?
Read more →Telemedicine is being called a boom, and when a nurse shares that she can “see” 20 patients in a day, as opposed to 6 or 7 patients for the same treatment, the positive business results are obvious. 
Devices are being used to monitor conditions in the home, electronically reporting the results to the healthcare provider, resulting in longer-term, more accurate information as well as better care. Psychotherapists are providing telephone sessions. Webcams and other devices bring us together with care providers without either party having to go anywhere.
When travel is removed from an equation, the overhead drops and profits increase. Additionally, office space costs money. Companies with “troops in the field” commonly maintain less office space to account for them. If 10 employees are in the field, they may be able to share 5 desks at headquarters, resulting in less rented space, less heat, less water in the water cooler…and more productive time because those troops aren’t clustered around that water cooler and can focus exclusively on the tasks they’re being paid for.
Meridian Health in New Jersey (http://www.meridianhealth.com/) was featured in a CNN story about telemedicine, and the positive results look to be good for business, good for the healthcare professional, and good for the patient. Now if we can only get somebody to pay for it.
Actually, insurance companies see promise in telemedicine, and the Center for Medicare and Medicaid Service (CMS) sees the value, determining that states can choose to include telemedicine as viable treatment alternatives that can be paid by Medicaid. Whether any states are actually paying for mental health or substance abuse treatment services will have to wait for another entry on this subject. The general outlook I see toward telemedicine is bright and positive, so if it’s not in your life today you may be on the phone, using devices or communicating via the internet through secure connections soon.
If the Electronic Health Records (EHR) would require modifications to account for telemedicine in mental health and substance abuse treatment, they would be minor, like changing the location code for a service, and perhaps adding a telemedicine provisional statement in documentation of those services. These sorts of things and the training and quality control measures of the EHR shouldn’t pose any problems for facilities considering adding telemedicine to their treatment arsenal.
With all the positive information I’ve run across, and the apparent willingness to pay for at least some telemedicine procedures, I felt compelled to dig up something negative to balance the scales.
The New York Times covered the negative side of the story. A recent article discusses how the technology might affect the doctor/patient relationship, decreasing the trust factor.
I’m a big fan of face-to-face connections. When I was in the sales profession, seeing somebody’s eyes was the most effective contact in gaining a person as a customer, so I tend to agree with Dr Pauline W Chen’s coverage in the Times story, trust is built stronger with personal contact. Today I find balance is necessary. In order to cultivate strong relationships and trust, I use all the communication avenues I can, and face-to-face contact is a key factor in those relationships.
A friend of mine uses the phone to connect with her therapist and gladly pays for the sessions out of her pocket, since they aren’t covered by her insurance. She lives in Manhattan, and her therapist is on Long Island. Needless to say, the relationship started years ago, and after many sessions, the travel got to bee too much. She wasn’t about to shop for another therapist, after spending years to find a professional she could relate with, open up to, and reap positive results.
Telemedicine certainly has a place in our world, and I’m sure I’ll be discussing more on the subject as the “boom” continues.
Read more →When it comes to teenage depression, better treatment results make for a more cheerful home life and deliver a better day for everybody involved in the treatment.
Over half the teenagers diagnosed as depressed who are resistant to treatment have a chance of dramatic improvement, quickly, according to a recent National Institute of Mental Health (NIMH) study.
Helping somebody get better by switching medications and possibly adding Cognitive Brain Therapy (CBT) are good business moves. When a teenager improves, the entire family notices it and spreads the word to the community. There’s a chance they’ll give credit where it’s due, to the professionals and center who administered the CBT or issued the prescription to change medications. Success stories are good marketing, and testimonials are even better.
The other side of the equation indicates almost half of the teenagers diagnosed as depressed and resistant to treatment didn’t get better. I postulate the study results above are an example of considerably effective research, simply based on the fact that if a medication switch was not tried, or CBT wasn’t brought into the picture, nothing was done to help the kids who did get better. People may have kept doing the same old thing that wasn’t working (and getting paid for it); the same old depression would be affecting the person and their family and result in some bad business. If I go to a treatment center, and the treatment doesn’t work after a reasonable time, I hope I’d consider doing something else, which would be bad for business at that center.
Another element of this story says that CBT accounted only for 14% of the success stories. The question is not whether CBT should be tried; if a professional determines it might be effective, why not? Either nothing will change, or a recovery will be forthcoming due to a change in behaviors added to the switch in medication. I’m a proponent of changing behaviors that can adversely affect recovery, and CBT appears to be a valid treatment.
The difficulty with CBT is whether it’s worthwhile to the offering center and will pay for the training, materials and general expenses it takes to institute and continue a CBT program. I suspect if the center is too small, CBT contributing to only 14% of the improvement in the study cited above would be too expensive to offer as an alternative. Larger facilities would have more patients to offer the treatment and get paid enough to support it.
Medications are effective in treating mental disorders, so centers get paid to prescribe and monitor that effectiveness. Psychiatrists are expected to evaluate the treatment and modify it as necessary. The way I understand it, the therapist treats issues at the root of the problem that the medication may be masking. Insurance companies like prescribing medications because they are the quickest cure, and a prescription and medication can cost less than therapy.
It strikes me that despite all this good news about good results from medication, the long term solution is still uncovering and accepting issues and learning to move on. I worry that by accepting the quick fix, some folks may cover up their issue by medicating the symptom, so a full, happy life may elude them.
Read more →After snoozing the alarm only once I woke up to a commercial for a doctor’s office on the radio.
Where have I been? When did this happen? Do mental health professionals advertise like this, too?
Long ago, when I had hair, I sold radio advertising. It was an enjoyable seven year career for me, and I learned a lot. One of the tenants was about doctors: Don’t bother. They’re above advertising (we ignored the yellow pages, which was then what the Internet is now).
I predict the ad for the family practice I heard on the radio will be tremendously successful. One reason is that it’s hard to find a doctor accepting patients on Long Island. Another is that it was clear, and devoid of false airs that tend to accompany image advertising. The image approach apparently works for Prada, but family practices and mental health professionals need a different approach if they want advertising to be effective.
Websites are great, however they aren’t intrusive. In addition to the fact that I’d never heard a doctor’s office advertised on the radio, the intrusiveness of the medium got to me. It came into my home when I was fresh and couldn’t help but pay attention.
I left advertising during the “blitz ’em with a deal!” era…Buy NOW, because if you don’t the sale will be over and you’ll miss these once in a lifetime savings of FIFTY PERCENT! I don’t see healthcare professionals doing that. The ad I heard this morning didn’t.
In addition to the ad I heard locked into a news block this morning, there are other ways professionals advertise, and I question their effectiveness.
Charity events are far too popular in mental health and substance abuse treatment. While working for a software company on Long Island, I bought tickets to a customer’s golfing event simply because it was a chance to play a course I’d normally not be allowed to set foot upon. It was great fun, and a successful fund raiser for the substance abuse treatment agency that threw the party. The advertising included telephone, direct mail, and a lot of talk. I had three people connect with me prior to the outing prior to the event. It wouldn’t leave me alone, and I was sold on the idea enough to sell my bosses into buying expensive tickets for some programmers and myself. I wound up being quite popular among those programmers for a while.
The reason the event was successful was the work that went into marketing that relied heavily on personal contact. As I said, I was sold.
I just received an expensive, glossy, professional newsletter from Stony Brook University Medical Center. I get a number of these from local hospitals. It didn’t work for me, and none of them have. The lead story was for the new Stony Brook Children’s Hospital. My kids are in their 30’s, and don’t live anywhere near here, and there are no grandkids yet anyway. How many other folks did SBUMC waste the $3.00 flyer on? This is definitely a long term sell that won’t work with me any time soon. I have a very effective hospital and primary care system I work with, and the hassles of securing care for physical and mental health are over for me until something changes. Then again, perhaps I’ll cultivate a nice resentment against a psychiatrist.
I’d like to hear testimonials for my neighborhood counseling center on the radio. If the staff of these organizations get out into the community and meet me, casting an attractive message my way, they might sell me into making a change.
I liked the radio ad.
Read more →I’m a dyed in the wool proponent of the Electronic Health Record (EHR). I’ve earned my daily bread because of it for decades. Along with that dedication to the field comes some conviction that the EHR is good. Good for treatment, good for business, just plain good for everybody involved.
A friend forwarded me an on-line discussion about the EHR, and it amazes me that people still fight the future that started developing so long ago. It’s here; the EHR is a part of treatment, so get used to it.
Here are the basics of why the EHR is good:
I could continue the list, at risk of becoming quite bored…so I won’t.
I share quite a bit about legislation that affects how insurance and Medicaid is changing. In some ways, consumers are getting a square deal, gaining back some of the ground lost over decades of effective lobbying on insurance companies parts. It’s good to see that consumers will be supported in getting healthcare paid for when it should be. On the other end of that equation, the back office of your local neighborhood Community Mental Health Center (CMHC) goes through fits over changes in billing practices.
Mental Health and Addictions professionals have come to rely on electronic treatment authorizations, billing, and even audits.
Computerized authorizations and billing is old hat, and changes are minor, usually easily adjusted to, and problems have commonly been resolved somewhere else, so solutions can be borrowed from other facilities. Audits are another story. The accreditation folks, the accountants, and a bundle of state and local agencies get into the picture. Audits go a lot easier with the EHR. Run some reports, provide some records, and poof! Another audit passed…provided comprehensive information was entered into the computer in the first place.
Yup. The EHR is good.
Read more →I was robbed a number of years ago, and it didn’t feel good.
It was like that old game show where contestants got a free shopping spree, leaving my possessions of less worth strewn about the house, and the ones worth anything were gone within the five minute shopping spree. I felt violated…and poorer. The new healthcare world could lead to lower crime, and I’m all for that. I’d rather you didn’t have to experience that sort of violation.
Most cops who pay attention to this sort of agree that methadone clinics in the neighborhood lower crime. If people with mental illness issues are treated, there is less panhandling, self-medicating with drugs and alcohol (which leads to crime), and homelessness. If a cocaine addict in addiction treatment pays the rent instead of heading to the dealer on payday, crime has instantly dropped.
Recent healthcare legislation has made treatment is more easily available to those who need it. In a recent Forbes article, Rachel E. Barkow and David B. Edwards say that of the 20 million American substance abusers, a little over 10% are getting treatment. By improving access to treatment, assuring treatment providers are paid on par with physical health counterparts, and policing treatment quality, the country is on track to improve that ratio.
A number of years ago, I read somewhere that 85% of prisoners in the California prison system were residents either because their crime was alcohol/drug related or they were high while doing the crime. Other than offering proof that sober criminals are better criminals, this anecdotal information asserts that crime and alcohol/drug abuse are related. Making it easier to get treatment can lower crime. Currently, over 25% of the 6.5 million people on prole, probation or supervised release are using illicit drugs according to Forbes. That in itself is a crime, and sets up the neighborhood for burglaries and such.
This makes me a bit nervous. I also think that number may be a bit low, but that’s another story.
We’ve known alcohol/drug abuse and crime are related for centuries, and we’ve started doing something about it. It’s not just a few cops on the street who notice the drop in crime when treatment is available. It’s people like you and me. Reports nationwide show drops in crime with increased access to treatment. The National Treatment Improvement Evaluation Study (a big one) showed a 64% drop in arrests and a 78% drop in drug sales. Holy cow! That’s cleaning up the neighborhood!
Since the proof is so overwhelming, you’d think opposition to supporting treatment in the neighborhood would disappear. Not so. I recently wrote about the insurance empire fighting Mental Health Parity, wherein these treatment centers (which are helping to lower crime) would be paid on-par with physical health providers. It seems that no matter how good an outocme may be, there will be those whose income is affected negatively, and they will fight for the money.
The fact is, I haven’t been robbed lately. There are a number of addictions and mental health treatment centers in the neighborhood. They are in jeopardy, however they’re solving their problems, in part due to improvements to the healthcare system. A drop in crime is a good thing.
Read more →While doctor and politician Howard Dean believes it’s better to have passed the recent healthcare bill than not, he says it’s not healthcare reform…It is coverage expansion.
It’s a simple concept, really. Everybody needs to put food on the table…and preferably have a table to put it on and a place to put the table. That assumes jobs and paychecks come into the mix. By guaranteeing medical coverage, payment for healthcare becomes guaranteed, healthcare providers earn a living, and people’s health problems get attention.
With healthcare payment guarantees, mental health issues become the next topic of discussion. There is resistance to comply with recent legislation assuring health and addiction treatment services getting paid on par with physical health issues. I recently discussed the battle the insurance industry is waging to escape restructuring their business to comply with Mental Health Parity. Additionally, millions of senior citizens need treatment services not likely to be paid for by Medicare, according to Dr Dean’s interview in The National Council’s Healthcare Reform Magazine It seems that Medicare has been exempted from the reforms of the healthcare bill. It appears that insurance companies and Medicare are in the same ethical boat when it comes to mental health and addictions treatment. Everybody says they want people to be well and have better lives and nobody wants to pay for it.
The place I see ethical responsibility in action is with treatment providers.
I was talking with a friend who runs a small addiction treatment facility recently, and I was stricken with his sincerity. He wants to help addicts stay off drugs and have a good life. In my experience, that’s true throughout the business. Whether you talk with helping professionals in your local community mental health center, addiction treatment facilities or social services organizations, they want to help others.
My peers write on a personal level about coping with issues, relieving symptoms of disorders and generally improving our mental health. I believe they, and most professionals in this business are sincere. They want alleviate suffering. The ability to help is slowly being improved.
The payment system for these professionals has appeared to be one to avoid paying for their services. Authorizations to provide services are dictated in many cases by insurance companies. For years I’ve heard many mental health and addictions providers say it’s murder trying to get insurance to pay for services that need to be delivered now. They took the attitude that when a person needs help, help them…not after treatment is approved by a bureaucrat for payment. These folks wound up providing free services in many cases…which doesn’t put food on the table. This leads to the most important point Dean made in the interview cited above.
Treatment decisions need to be in the hands of treatment professionals, not insurance bureaucrats, so this rebuilding of the system is necessary. It takes involvement and working within the system to rebuild the system. That’s happening now. The legislation I cite is the first step, a decision to assure payment for help that improves people’s lives with quality mental health and addictions treatment. My hope is that the professionals gain more control in healthcare decisions and are treated with the respect due a trained, experienced professional. As that happens, smart, caring, people with a sense of moral responsibility to help others will enter the helping professions, joining many others who are active in changing the system to enable treatment professionals to control treatment.
Active integration of moral responsibility into the business side of this business, my friends, will be true healthcare reform.
Read more →It’s no secret that Information Technology (IT) is changing the way professionals work in mental health and addictions treatment…and what’s that mean to you?
For treatment professionals, information is king, the key to delivering solid help to people who need it. That information is available in existing banks of information, contributing to an effective decision support system. The systems help assure the information is used properly to diagnose and treat problems, and without the information, both from professional resources and the consumer’s personal health disclosures, systems can still lead down the road to a bad statistics and ineffective treatment.
As workflows change in provider agencies like your local CMHC or addiction treatment facility, you’ll see a lot more of your records on screen…the record is not a secret, consumers have a right to know what’s in their record. By now, consumers should be walking through assessments for a quick evaluation of problems and measuring improvement during a visit. Counselors are involving consumers in building a treatment plan on the computer screen. Progress Notes are being included as a part of a session to make sure the next steps for the consumer and professional are mutually understood.
It’s all good. It wasn’t that long ago that most consumers wouldn’t have thought to ask for access to any of this paperwork. The fact is, in that paperwork are the keys to a better life.
Throughout all this paperwork, decision support is becoming interwoven, and valuable treatment information is being presented when it’s needed most.
The Internet and a number of paid research sources available on the computer can help the professional provide a diagnosis and treatment to a problem that may otherwise be mis-diagnosed and mistreated…as many as 70 percent of mental health problems are in this category. Dennis Morrison’s article in The National Council’s magazine on Healthcare Reform brings up an interesting case of mistaken diagnosis and treatment with potentially catastrophic outcomes. His case has a happy ending, because the right information was available on the computer. This example of effective decision support shows how IT can lead to lowering the ratio of mis-diagnosed and mistreated mental health problems.
Occasionally, I still hear mental health and addictions professionals complain that they are not “computer people”. Who is? We’re all on this planet with each other.
The computer is just a machine to record and spew out data…a decision support system will hopefully assure the data that presents itself leads to happier lives for real people who are being treated, not a happier computer. Decision support systems deliver information at the right time during treatment to offer alternatives that make sense, and some that don’t. If a professional is not presented alternatives to the same old way of treating consumers, nothing changes. If nothing about treatment changes consumers don’t improve, and that abysmal figure mentioned earlier, up to 70% mistreated mental health problems, doesn’t improve.
The American Recovery & Reinvestment Act has spawned a number of ways for provider organizations to improve their IT systems. Most computer systems out there these days have some decision support alternatives available. For the ones that don’t, perhaps market pressure to provide that sort of functionality needs to be applied. The money’s available in a number of healthcare grant programs, and political pressure is coming to bear to provide more help for mental health and addictions specifically.
Some providers, like Dennis Morrison are getting the picture and moving full speed ahead. Decision support will help improve care, and Information Technology drives these improvements.
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