When you visit your friendly neighborhood Community Mental Health Center, the gap between adaptation of the Electronic Health Record (EHR) in general healthcare and the behavioral / addiction treatment world becomes evident pretty quickly, especially if a consumer is filling out paper forms in the lobby with a worn-down pencil with no practically no eraser left.
It’s getting better.
Recently, in helping a large New York City agency select an EHR, I was surprised to hear they had no common Master Patient Index (MPI). That’s a program that can relate the EHR to other software, like the Human Resources system. The goal of that sort of internal interoperability is keeping the same demographic data common among all the software systems in an agency.
Small and mid-sized agencies end up having to pay software vendors extra to connect their programs, foregoing an MPI mostly because of the added expense. Few saw that this could blossom into a continuous pain, so internal interoperability, sharing of data among an agency’s software programs, takes a back seat to paying the electric bill or giving holiday bonuses (hallowed ground, the holiday bonus).
Most physical health hospitals spent a lot of time and money over the past few decades concentrating on the MPI because they don’t want their doctors and nurses to spend their high-priced time re-writing a consumer’s name, address and other demographic information. Mental health and addictions treatment is just catching up, but we still find licensed professionals and front line staff re-writing this information…oh, and don’t forget about that consumer in the lobby with the worn down pencil. That little metal thing that holds the eraser onto the pencil has just torn through the form for the eighth time…he could get frustrated any moment, and he just wants help with his mental health problem. Perhaps an MPI would help expedite his treatment
Most of the larger agencies bought software for programs piecemeal. First, the accounting department got their software, then the automated time-clock appeared, which by rights should share professionals’ information with the human resources software…you get the picture. The result was a plethora of disconnected software, and it’s not difficult to see how we got to the point of needing the MPI, but not knowing much about it.
If you have three software programs feeding into a central MPI, the MPI must be king of the data, so it can send updates to the consumer’s record out to all those other programs. Sounds simple, but it’s not. Vendors of MPIs charge a pretty penny for their software and support with good reason…brokering changes to a consumer’s health information is serious business, and you gotta get it right, every time.
The agency I mentioned earlier (with no MPI) grew into the need over time, adding different sorts of programs to help them serve people with developmental disabilities and mental health disorders. Not-for-profit agencies’ business priorities seem to have a history of underestimating the value of all those minutes that can be saved when staff, professionals and consumers don’t have to fill out their name and address with that worn down pencil over and over again…not to mention the great benefit of cutting down on graphite and rubber (eraser) pollution.
Like I said, it’s getting better. At least we know what an MPI is, and are learning the value of it in this age of mergers and acquisitions.
Read more →When the business of treatment gets better with the use of the Electronic Health Record (EHR), consumers get better.
These days, ePrescribing sends a prescription directly from the prescriber to our pharmacies. Mistakes made in simple medication prescriptions have been more commonplace in the past than we would like to admit, and ePrescribing is sending legible prescriptions to pharmacists which can only help reduce mistakes. Another benefit of ePrescribing is the incredible storehouse of data that is building nationwide and can be used in studies to improve professionals’ treatment of consumers.
Due to recent studies of suicide and suicide prevention, we know more about it than we ever have. A recent post from Thomas Insel, Director of the National Institute of Mental Health, quotes statistics gathered from a study of data (mostly gathered and analyzed by computers). Out of 100,000 deaths, 11 are suicide related. Out of 100 people you see walking down the street, one of them has been serious enough about suicide to have a plan. Knowing the depth of the problem is the first step in digging our way out of it.
Medications like Cozapine and Lithium have been proven effective in suicide prevention for specific target groups. Statistics that lead to conclusions of their effectiveness are naturally gathered in the EHR and analyzed on computers. As ePrescribing becomes more widespread, studies like this will become easier to perform, and results will be delivered to the medical community faster.
My peers on Mental Help Net talk about therapies like dialectical behavior therapy and cognitive behavior therapy. Studies show these therapies are effective in significantly reducing repeat attempts at suicide. Because of the data gathered from the studies, psychotherapy like this is increasing in usage.
If you are a consumer and worried about your name being associated as a subject in a study, please, don’t worry. For many years, “de-identified data” has been the source of studies like this…Once again, a little magic provided by the computers of those providing the data from their EHR. Consumers’ personal information never makes it out of the original databases used for the studies.
As new medications are developed and delivered through ePrescribing, more data will become available on the suicide prevention and the effectiveness of these drugs…faster. If mental health professionals know about a consumer’s suicidal thoughts and ideation, medications can be further prescribed, and evidence of their effectiveness (or ineffectiveness) will climb.
New assessments, usually delivered on the computer, deliver scores indicating the likelihood somebody will entertain suicide. These assessments lead to use of new psychotherapy methods in treatment to prevent suicide.
Once again, the EHR does its part.
Read more →The Internet’s down!
What will we do? A question for which one of those wise old people I grew up with who always had an answer (usually right) comes to mind: “What did people do before we had the Internet?”
Hmmmm. I have to think about that. I think we waited. So, that’s what I did this morning. At other times in my life, I might have felt anxiety over that, but not this morning. I appreciate the old adage, “when the going gets tough – the tough go to lunch”.
In this particular vocation, I read a modicum of rather dull government documents. I get those documents off the web, so my planning consists of walking into my office in the morning, hitting a few sites on the web, and finding something I think is necessary or interesting in our business, and opening a blank document. I get a number of my quotes and topic information off the web, but not this morning…the Internet’s down!
I cannot imagine sending off to a government agency for a mailing, or going to some office to retrieve a document I may or may not be able to make sense out of and turn into something interesting or relevant.
I’d planned to write a piece about SAD, Seasonal Affective Disorder: Is it Real? Since it didn’t, I’m laying feelings and opinions out there. We all have those, and as we all do, I find mine most interesting and valid. Perhaps they are not so interesting or relevant to your life, tough cookies, the Internet was down!
Read more →On March 11, 2010, BlueCross BlueShield of Western New York (BCBSWNY), BlueShield of Northeastern New York (BSNENY) and American Well™ Inc agreed to provide on line care in upstate NY. This is good news for rural folks reported by Medical News.
I immediately suspect less than altruistic motives and question whether this will degrade outcomes since it’s headed up by insurance companies, leaders in the evil empire with a primary concern of quarterly numbers. I’ll wonder for a while, unless on line treatment is instituted immediately in enough places with rapid-cycle testing that can produce measurable data in three to six weeks. I’ve been a proponent of this sort of program implementation for treatment and software since the early 90’s. I’ve tried it, it works. It turns a situation whereby people must live with the final product into one that encourages fine tuning of the tools to produce the best outcome. Will rapid-cycle testing be used? It’s hard to say with huge companies, and could depend on who’s in charge of the project and current policy. Perhaps this is a newsworthy item for all you cub reporters out there…
Improving outcomes depends on a relentless search for the best way to treat people with problems. If on line treatment helps people get better, it will grow. Issues of saving both agencies and insurance companies money while producing acceptable outcomes in projects like this will determine on line treatment’s role in the future.
With over 1,000 clients, eGetgoing has been using on line treatment successfully a number of years, and it’s covered by insurance. Since it’s backed by CRC Healthcare, which is a pretty large company in the addiction treatment world, and headed up by their CTO, Jay Raimondi, I’d assume they have outcomes data to not only support continuing the business, but also proving outcomes to the insurance companies they do business with. But this is another story for another day.
It looks like on line treatment, telemedicine, gadgets and gizmos are in the treatment world to stay.
Read more →Gaining user trust is a special skill, and sometimes the project managers from software companies just don’t have it.
Software companies love bean counters as project managers because they keep track of billable hours. It’s always good to get paid. It’s better to gain the users’ trust, have a successful rollout with some aftercare, and get paid more. Some software companies’ solution to this is to insist on a person from the provider’s staff as an internal person to do the touchy-feely work with the users.
Sometimes the separation of implementation resources in to “us” (provider) and “them” (software vendor) causes problems.
Recently, a CFO friend’s boss has been getting testy about the EMR not being on line a few years after buying an expensive enterprise software system that’s expensive to maintain. Not his fault. Not even the vendor’s fault or the software’s fault. Some people simply have trouble relating to humans on a human level when it comes to business, and I think that’s what’s happened in their implementation.
The thing that strikes me as the most important thing to do is gain the trust of the users and get it up and running before they have a chance to think about it. There are always Negative Nelly’s around, and if given a chance, they will unwittingly sabotage the effort with negative rumors. Once you quietly design the software, move fast to implement. Having elements of the EMR, like progress notes, successfully operational creates a fabulously positive buzz in the organization, so be ready to roll something else out, quick!
There are a ton of experts out there who tout Rapid Cycle Implementation and other systems for making your software work. Mostly, they’re good and embody the ideas we pioneers had about getting software up and running years ago. They also add a bundle of good ideas every project manager should steal.
That said, gaining trust of the users is the one foundation that deserves more attention than it gets. Is that because there’s no line item in the budget for that?
I’m available at info@ehrsio.com
Read more →I attended a NIATx webcast supporting their Rapid Change initiative recently, and once again was impacted by the desire of agencies to provide more services with fewer resources…and not wait around a year and a half to discover whether an initiative is working…and if it doesn’t work, get rid of it. The webcast told agency success stories resulting in increased delivery of services.
Rapid Change played a part in this. The concept of Rapid Change has been around a while, and elements of getting staff buy-in, setting goals and proving you can meet the goal in a “pilot” effort to improve practices has been proven to work. Throw in a little Lean Thinking and a few business process analysis and management concepts, and you have a recipe for success. I was glad to see somebody implementing these concepts successfully; it proves the effectiveness of sensible business measures.
What seemed lacking in the efforts was effective use of the EMR to make the process more efficient, record the data, and minimize the effort of data entry and measurement of success.
Forms development & flexible reporting are great EMR tools that enable digital recording of the work performed and reporting outcomes of new processes that are instituted for the sake of process improvement and doing more with less.
Why don’t agencies who institute new processes in the interest of improving business practices use these tools to gather data quickly? It seems reasonable that a project could be abandoned in six weeks if the measures aren’t working as long as the data is available for analysis. If it is abandoned and a new form is involved, most software user tools make it easy to dump new forms or remove data elements that have been added.
The answer may lie in manpower. Resistance to change results in staff “noise” and over coming that is a skill in itself. Having instituted many systems that deliver results of increasing services without increasing staff to provide them, I’m sure I can help your agency develop and implement “practices” that become “best”. Connect with me at info@ehrsio.com.
Read more →I was invited as a guest to a group meeting of CFOs who meet on Long Island, and shared my insights about the conversation.
One topic I mentioned prompted note-taking: Marketing.
Once all the efficiencies of the EMR are introduced and measures are taken to shorten the time between the inquiry and delivery of service, staff will have time to provide more services. The methods of gaining referrals for Health & Human Services agencies that rolled off my tongue in closing were to establish relationships at the local Hospital Emergency Room and Police Precinct (not with CEOs and Captains, but the people who actually tell prospective patients where to go for help).
Coincidentally, this morning I was pointed to three reasons why patients may not refer others to an agency’s vital services. This observation from a chiropractor can be applied in many healthcare environments; see the article “The 3 Reasons Patients Don’t Refer “.
1. Patients will refer you to others if you ask them to. It’s a simple matter to have the front desk person smile at the person as they exit and exclaim “Be sure to tell folks we’re here to help!…or something of that ilk. Remind the person at the front desk in your EMR, or even with a billing system pop-up if the patient owes a co-pay.
2. Patients don’t feel comfortable referring you to others. Is this a treatment issue for the patient? A quality assurance issue for the agency? A suggestion aimed at building business could start with the person at your agency who knows the patient best, hopefully their counselor. This sort of discussion extends to the entire staff, and can be repeated with every patient visit. It should be simple enough to set up a reminder for the counselor in your EMR, perhaps to appear during concurrent documentation of the session.
3. Patients are reluctant to share with friends & acquaintances that you’re helping them. This could be an issue ranging from confidentiality to not liking somebody who needs help. We want to “do good” in this business, and the appropriate staff could help the patient overcome this reluctance with patient coaching. Staff would help their charge do some good, and it shouldn’t hurt the patient to help others. Another simple reminder to the appropriate staff in the EMR or billing software would help.
Staff may be unwilling to help…They can be sold on it. Company policy must be upheld for an agency to survive, and staff should want the agency to survive and thrive, not shrink. An employee joins the team when they’re hired, so engage them.
Staff may just plain forget to mention it at the end of a session. Remind them with your EMR and build in redundant impressions for the patient, like posters. Message repitition is a big key to advertising.
Staff may be opposed to helping build business: it’s not their job, man!. Everybody on the team needs to pull for the team.
Optimization of the EMR can help with these details, and we always need to provide more services with fewer resources.
Contact me if you need help.
Read more →By now, your Electronic Medical Record (EMR) should be changing out of necessity, and fast, to keep up with requirements.
In Health & Human Services, we can agree that software vendors are responsible to offer functionality and services that meet demands of major payors like Medicaid and Medicare, which change continuously. What about meeting “meaningful use” of the expensive software you own or are about to purchase? It seems commonly accepted that providers need to take responsibility to assure successful software implementation and its evolution for their agency.
For decades vendors have heard from users that the software they purchased doesn’t do what the users want. In many cases the software contains functionality to meet the need as expressed in an RFP, but fails in the trenches due to a configuration that doesn’t meet workflow requirements of the customer. Arguments over who’s responsible to fix problems can drag on for years.
There are likely as many ways to resolve EMR optimization problems as there are agency and software product combinations. The solution takes time, expertise, and some money.
The best place to start is when you purchase your system, and consultant Rich Temple has some good advice in his recent article “Vendor Viability Assessment – Financial/Strategic“. If you have a system that provides the essence of your enterprise system needs, and you wish to extend its value to your organization, it takes specialized work dealing with your vendor, your executives, supervisors and users to glue the project together. Mr Temple talks about the “seismic changes” in our industry, and what that points out to me is a lot of work most agencies are not staffed to carry out.
EMR optimization takes not only a specialized tool set, but also time that your staff probably can’t spare and complete their day job…the one you hired them to do. This is a new “hole” in the market where people like Terry McLeod come in.
That would be a shameless pitch for your host and his peers…I’m here to help.
Read more →