We have an EMR – Why are We still Dealing with Paper?!?!

With the advent of electronic medical records came a whole slew of promises, hopes and dreams…

“Purchase an EMR and go paperless!”

“Less HIM staff time scanning and fixing paper records!”

But the reality is that healthcare will never go totally paperless. Yes, I said it, and I’ll say it again – the healthcare industry will never go paperless! There are a number of reasons why.

Information systems are built by humans. Humans introduce flaws. As a result, there will inevitably be times when an EMR must be taken offline, whether it is for an emergency fix or a planned upgrade. During these downtimes, a hospital must resort to using paper documentation in order to minimize any impact on operations and patient safety. This might include ordering medications or obtaining signatures on regulatory documents.

Speaking of which, unless your organization has implemented the capture of signatures electronically, chances are your patients still sign hard copies of documents like consents and privacy agreements. These paper documents are still considered part of the legal medical record, even if the rest of the record is electronic.

One of the problems with EMRs is that not every healthcare organization is using them. Many smaller, standalone practices simply cannot afford the large implementation and maintenance costs of an EMR. As such, these practices still document and communicate using paper.

And then there are those departments within healthcare organizations whose practices are simply not supported by the enterprise EMR. Behavioral health is one department that comes to mind. While the rest of the organization may utilize an EMR, some behavioral health departments are still documenting and communicating on paper.

But just because an organization will still rely on paper after the implementation of an EMR doesn’t mean that EMRs are not beneficial. I’ve seen numerous efficiencies that were gained as a result of implementing an EMR. These gains translated directly into cost savings. And of course, there is the patient safety aspect of EMRs – they are a wonderful tool for double checking one’s “work.”

One important thing to do when planning an EMR roll out is to remain realistic and future minded. This means planning for the continued use of paper in some areas. The success of an EMR roll out is directly correlated to the amount of planning conducted. Planning for the continued use of paper should involve the following:

• Identification of workflows that still use paper – Identify those areas that will continue to document and /or communicate on paper in the future. Document these processes and communicate them to the end users.

• Training – In addition to training end users on use of the EMR, it’s important to train users on what to do with paper documentation that comes into the organization.

• Policies and Procedures for paper document handling – In addition to training end users on the paper process flows, it’s more important than ever to identify polices and procedures regarding paper. Clinical documentation that comes in is part of the LMR and must be handled with the same amount of security as the electronic documentation. Additionally, there must be formal procedures in place that ensure the paper documentation is available when needed.

• Integration of paper documentation into the EMR – Many healthcare organizations purchase an electronic content/document management system along with their EMR. These systems offer many benefits, including easy retrieval and high availability of scanned paper documentation. For even more seamless workflows, most of these systems can be integrated into the EMR via HL7 messaging.

So I’ll say it a third time – paper is here to stay in our healthcare environment! However, with the proper planning, you can ensure that you’ll have less paper along with seamless workflows to handle the paper that does come in. You’ll also have a scalable solution that will allow you to optimize, with a clear path to further reduce your dependence on paper in the future.

The Legal and Ethical Implications of Telehealth

The United States Health Resources and Services Administration defines telehealth as “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration” (Human Resources and Services Administration, 2012, para. 1). Telehealth can involve the exchange of information between different providers as well as between patients and providers. Additionally, both patient and provider can use telehealth technologies to derive information from the Internet or other electronic data stores. The main goal of telehealth is to improve patient health outcomes by increasing the accessibility and quality of medical care while decreasing the cost (World Health Organization, 2010). 

Telehealth is not new to the medical industry. It has been used as early as the 1960’s to facilitate the exchange of information between psychiatrists and primary care physicians (World Health Organization, 2010). Currently, data exchange using telehealth services can take place over several different mediums including telephone consultations, text messages, and email. Multiple specialty fields provide services via telehealth, including radiology, pathology, and psychology (World Health Organization, 2010). Telemonitoring is the use of information technology and computerized devices to monitor patients remotely (World Health Organization, 2010).

In certain countries, telehealth has been widely used and extensively studied. The United Kingdom has utilized telehealth and studied its effects and has found significant benefits in its use. For example, a recent study in the United Kingdom found that telehealth services decreased patient deaths by 45 percent (Montgomery, 2011). Additionally, the same study found that telehealth cut emergency room visits by 15 percent (Montgomery, 2011).

Telehealth can also reduce the cost of care for both patients and providers. In a recent study in the United States, researchers found that the cost of hospital readmissions is approximately $16 billion per year (Deschenes, July 2012). Telehealth has been shown to reduce hospital readmissions and emergency visits by twenty percent by providing remote analysis and monitoring services, as well as at-home triaging services (Montgomery, 2011).

In addition to saving medical institutions and providers money, telehealth can be a source of new revenue. For example, healthcare providers can seek to contract with employers in order to provide services such as mental health counseling and nutrition counseling via video conferencing sessions (Deschenes, August 2012).

Lastly, telehealth can increase the quality of care by engaging or reengaging patients more effectively (Deschenes, August 2012). According to the magazine Healthcare Finance News, the introduction of performance-based payment incentives highlights the importance of coordinating care across the entire care continuum (Deschenes, August 2012). Telehealth services can provide an efficient way to link the different aspects of a patient’s care while keeping the patient engaged (Deschenes, August 2012)

Patients living in rural areas in the United States would benefit the most from access to telehealth services. This is because there are not many physicians available in rural areas that provide treatment in specialties like mental health, cardiology, and endocrinology. The disorders that these specialists treat are often prevalent in these poorer rural areas. Without access to telehealth services, patients living in these areas will have drive great distances to see these types of specialists or risk going without treatment.

Despite its proven ability to reduce costs in the United Kingdom and the potential benefits that could be realized from its use in underserved areas of the United States, physicians in the United States have remained reluctant to widely adopt this form of service. This is because telehealth remains a largely unregulated form of service delivery in the United States. Laws surrounding the provision of telehealth remain vague. Furthermore, insurance payers have yet to establish payment policies for telehealth services (Roberts J. Waters Center for Telehealth and e-Health Law, 2012). Lastly, as providers use telehealth to practice medicine across state lines, licensure issues have become a cause for concern. (Roberts J. Waters Center for Telehealth and e-Health Law, 2012).

Legal Implications of Telehealth

Because the laws surrounding telehealth are not yet well established, malpractice lawsuits involving treatment via telehealth technologies have been rare. There are only a handful of federal court cases involving the use of telehealth (Natoli, 2009). These cases primarily involve claims of negligence by “physicians prescribing medications to patients across state lines without previously examining the patient.” (Natoli, 2009, para. 12). However, there have been several criminal cases involving telehealth services tried in court.

In the notable case, Hageseth v. Superior Court, the issue of prescribing medication for patients using telehealth to deliver services was examined. On June 11, 2005, a California resident named John McKay purchased fluoxetine from an online pharmacy. The prescription, along with the answers to a short online questionnaire Mr. McKay completed, were sent to Dr. Hageseth for review. Dr. Hageseth was a physician with a license to practice medicine in the state of Colorado. He did not have a license to practice medicine in the state of California. Upon review of the questionnaire, Dr. Hageseth issued the prescription online to a pharmacy in Mississippi, who then mailed the medication to Mr. McKay in California (Hageseth v. Superior Court, 2012).             Mr. McKay subsequently committed suicide. The autopsy revealed fluoxetine and alcohol in his system at the time of his death (Hageseth v. Superior Court, 2012). This case will be tried under criminal law, as Dr. Hageseth is accused of breaking California state law by practicing law in the state without a license.

This case brings to light two issues with regard to telehealth. The first issue is that of state licensure. New York State has a very robust system of regulation for approximately 30,000 different professions (New York State Education Department, 2012). In New York State, a mental health counselor must have at least a master’s degree in mental health counseling. Furthermore, the counselor must pass an exam administered by New York State’s State Education Department for mental health counseling. At this point, the counselor can apply for a mental health counselor license. The license allows providers to practice their specialty only in New York State. This is true of most state issued professional licenses. If a New York State licensed professional wishes to practice his or her profession in another state, he or she must pass a corresponding exam administered by the state in which the professional would like to practice. This poses a problem for those professionals who wish to use video conferencing or other forms of telehealth to provide services for patients in different states.

The second issue in this case revolves around the standard of care in prescribing medications to patients. The Center for Medicare and Medicaid Services has identified that the standard of medical care is the same regardless if the care was provided in person or via a telehealth technology (Natoli, 2009). The standard of care in the United States for issuing prescriptions is to first thoroughly examine the patient for whom the prescription will be written. However, a physical examination cannot be performed on a patient that is receiving services via a telehealth technology, such as video conferencing.

We have seen prescriptions written for patients by their physicians without a prior physical examination. For example, it has been common practice for physicians to phone-in an antibiotic via telephone for patients that have been prone to certain infections. However, due to the unethical and in some cases, illegal nature of this practice, it is no longer common. As such, physicians will require patients to revisit the office for a physical examination if a sickness lingers or pain does not improve.

Another legal issue surrounding telehealth is that of payment for telehealth services. The Center for Telehealth and e-Health Law cited the absence of “consistent, comprehensive reimbursement policies” as a roadblock to the widespread use of telehealth (Roberts J. Waters Center for Telehealth and e-Health Law, 2012). The Center for Medicare and Medicaid Services combated this by enacting the Balanced Budget Act of 1997 (Roberts J. Waters Center for Telehealth and e-Health Law, 2012). The Act mandates that the Medicare program pay for telehealth services (Roberts J. Waters Center for Telehealth and e-Health Law, 2012). However, most private insurers have yet to follow suit and do not currently offer consistent payment programs for telehealth services.

Lastly, the legal issue surrounding the electronic storage of telehealth services has not been explored in great length. Questions regarding patient de-identification and privacy, as well as data storage have yet to be answered. For example, should physicians store copies of video consultations or sessions with patients? If so, how long should this data be stored? The archiving of treatment provided through telehealth services would certainly prove useful in negligence cases in which a physician is accused of conduct in which he or she did not engage. However, to which risks are providers leaving themselves open when storing these data? In today’s highly technological world, it is imperative that these issues are discussed and regulations determined.

Ethical Implications of Telehealth

            In addition to the legal questions surrounding telehealth that have yet to be answered, there are numerous ethical implications that must be addressed if telehealth is to become a routine form of service delivery.

In order to understand the first ethical concern surrounding telehealth, the meaning of an encounter, as it relates to the medical field, must be defined. Encounters are units of service for which Medicaid provides payment. New York State Medicaid states that encounters must meet certain criteria in order for payment to occur. The first criterion is that services must be medically necessary. For mental health patients, psychiatrists define the medical necessity of specific treatments in the patient treatment plan. The second criterion is that all encounters must be documented according to standards set forth by state and federal governments. In New York State, the Office of Mental Health defines the documentation standard for mental health services. The third criterion is that services must be administered in person.  However, in the case of telehealth, the CMS has drafted specific regulations to allow for payment for services that have been provided via a telehealth technology (Roberts J. Waters Center for Telehealth and e-Health Law, 2012).

Despite government support of telehealth as a valid form of service delivery, Dr. Marjorie Landes, a psychiatrist with more than 30 years experience, does not believe video conferencing sessions are an appropriate form of treatment for mental health patients (personal communication, July 20, 2012). Dr. Landes’ main concern is that telehealth does not allow for the physician and patient to form a proper relationship. The physician - patient relationship is vital in the mental health specialty. A proper physician - patient relationship tends to keep patients engaged in their care, while failure to forge a relationship can lead to patient disengagement.

There are two reasons why Dr. Landes does not perceive that a proper physician – patient relationship can be forged when engaging in treatment via video conferencing. The first is that telehealth does not allow for the proper viewing of body language for both patient and doctor. Dr. Landes explained that body language, such as the patient’s hand fidgeting or foot movements can “complete the patient’s story” for the physician. She argues that a complete patient story is necessary in order to properly treat the patient. Furthermore, Dr. Landes argues that slight inflections in voice that can also supply vital information to the doctor can be lost during video conferencing sessions. These losses can be due to any number of reasons, including sound distortion that may occur while sound data is going over networking lines, background noise in the patients home, or poor audio – video equipment in use by the provider or patient.

Another ethical implication that has been addressed by New York State, but not by other states is the responsibility of providers to ensure their credentials are in an area that is easily seen by patients engaging in services via telehealth technologies. New York State has required providers to display their credentials during video sessions. It is also important to educate patients to request to view providers’ credentials if they cannot be seen.

Finally, there are ethical, and in some cases, legal considerations when delivering services via remote monitoring or telemonitoring of chronic conditions such as diabetes and high blood pressure. As described above, telemonitoring involves the use of monitoring equipment to measure a patient’s symptoms or vital signs. However, telemonitoring does not replace human interaction and decision-making. When using telemonitoring technologies, it is imperative that medical teams are in place and have the ability to provide 24-hour support to answer patient questions or respond to a crisis.

Future Implications for Telehealth

With the passage of the Affordable Care Act in 2012 and the apparent cost savings associated with telehealth, the trend towards increasing the availability of telehealth services is gaining momentum. The Center for Medicare and Medicaid Services (CMS), being an early adopter of telehealth technologies, has developed several innovative telehealth programs for the massive number of troops returning from the wars in Afghanistan and Iraq. These troops are coming back home with a host of needs, ranging from rehabilitative services to mental health services (Miliard, 2012).  Furthermore, 45% of troops today are from rural locations (Miliard, 2012). CMS understood early on the need for telehealth services and in July of 2012 rolled out the Specialty Care Access Network-Extension for Community Healthcare Outcomes or SCAN-ECHO (Miliard, 2012). SCAN-ECHO seeks to “deploy video conferencing equipment to rural and underserved locations” (Miliard, 2012, para. 12).

Furthermore, the U.S. House of Representatives introduced the Veterans E-Health and Telehealth Act of 2012. The Act would supercede state laws that surround state licensing requirements for providing services via telehealth technologies (Miliard, 2012).

Lastly, in order to increase access to telehealth services for those in rural and underserved locations, the Department of Veterans Affairs removed the co-pay for telehealth consultations in the patient’s home or at a Veterans Affairs medical facility (Terry, 2012).

In the community at large, providers are beginning to see the value in integrating primary care and mental heath care. Satellite mental health offices are springing up in community primary care centers and primary care clinics have been making their way into community outpatient mental health clinics around Rochester, New York and in other cities across the U.S. These providers have begun or will begin using telehealth video conferencing services to consult with each other regarding patient care.

Even with the advances in telehealth technology for mental health, several problems persist that make access difficult. The first is that people living in remote areas often times do not know that telehealth services for mental health are available (Miliard, 2012). Education regarding available telehealth services must remain a focal point for providers.  One such initiative is the website MilitaryBenefitsReport.com. The website was started by Wolfgang Ward, who served in the U.S. Military for four years (Military Benefits Report, 2012). The website offers a personalized report that “pinpoints the exact benefits, services, and programs for which each member of the Military community is eligible” (Military Benefits Report, 2012, para. 12).

The second roadblock to access is workforce training. Telehealth services have yet to become mainstream in the United States. Providers will have to be trained and must learn to adapt to this new way of providing services (Miliard, 2012). As of yet, a standard training protocol for e-Health and Telehealth services has not been developed.

Finally, even with the proper access to care and robust training for providers, the stigma surrounding mental health continues to persist. Until we debunk the myths surrounding mental illness, patients may remain reluctant to access care.

Despite these roadblocks, CMS and other payers and providers continue to research and document the benefits of telehealth services. The Information Technology industry continues to develop and evolve telehealth technologies and the patient population continues to embrace the concept of telehealth. As such, one can easily assume that telehealth in the United States is here to stay.

References

Deschenes, S.  “5 ways telemedicine is reducing the cost of healthcare.” Healthcare Finance News, July 12, 2012. http://www.healthcarefinancenews.com/news/5-ways-telemedicine-reducing-cost-healthcare

Deschenes, S.  “5 ways telehealth improves market position.” Healthcare Finance News, August 1, 2012. http://www.healthcarefinancenews.com/news/5-ways-telehealth-improves-market-position

Find Law. “Hageseth v. superior court.” Accessed August 4, 2012. http://caselaw.findlaw.com/ca-court-of-appeal/1132989.html

Human Resources and Services Administration. U.S Department of Health and Human Services. Accessed August 4, 2012. http://www.hrsa.gov/ruralhealth/about/telehealth/

Miliard, M. “Health IT helps fight the war at home.” Healthcare IT News, August 2012, 4-8.

Military Benefits Reports. “About us.” Accessed August 12, 2012. http://MilitaryBenefitsReport.com/site/about#.UCm-o47bC20

Montgomery, J. “Landmark UK study shows telehealth cuts patient deaths by 45 percent.” mHealth Watch. December 9, 2011. http://mhealthwatch.com/landmark-uk-study-shows-telehealth-cuts-patient-deaths-by-45-percent-18371/

Natoli, C. M. “Summary of findings: malpractice and telemedicine.” Roberts J. Waters Center for Telehealth and e-Health Law. December, 2009. https://www.ctel.com/

New York State Education Department. Office of the Professions. Accessed August 12, 2012. http://www.op.nysed.gov/prof/mhp/mhcbroch.htm

Roberts J. Waters Center for Telehealth and e-Health Law. “Medicare reimbursement.” Accessed August 4, 2012. http://ctel.org/expertise/reimbursement/medicare-reimbursement/

Terry, K. “VA: Remove copayments for video telehealth consultations.” Information Week, April 13, 2012. http://www.informationweek.com/healthcare/mobile-wireless/va-remove-copayments-for-video-telehealt/232900280

World Health Organization. Telemedicine: opportunities and developments in member states. Geneva, Switzerland: WHO Press, 2010.

Do People who Look Up Health Information on the Internet Visit Medical Professionals Less or More? (Part 2)

Read Part 1 here.

In part 2 of our series, I examine the validity of the Internet as a tool in the provision of healthcare. Particularly, I’m looking to assess respondents’ understanding of the information they found online as well as their perception of the quality of the information they found online.

Let’s begin by taking a look at the following figures.

FIG 1

In FIG 1 above, 92 percent of respondents stated they had at least a good understanding of the information they found online.

Although not surprising, this figure struck me – in my interviews with patients, many stated that at one point or another, they left their doctors office or were discharged from a hospital confused and unsure as to the steps they should take next. However, in this study, most were sure of their understanding of the health information they found online.

 FIG 2

In FIG 2, 62 percent of respondents found online health information very or extremely accurate.

This figure was surprising – most people were able to weed through irrelevant or inaccurate information and get to factual data. This figure tells me that healthcare consumers today are smart and savvy. They know which information to ignore and which information to bring to their doctors attention.

FIG 3

In FIG 3, 96.4 percent of respondents stated that they would go online again to research health information. WOW! If I was a healthcare provider, and I wanted to get the word, any word, out in public quickly and cheaply, the cloud is the place to do this.

I conducted additional qualitative interviews with several people. The interviewees ranged from mothers and fathers of small children, to mid-level providers and MDs to single, young people. All answers led to the same conclusion; everyone wanted to actively participate in their own healthcare or the healthcare of their loved ones.

Based on these results, can we say that the Internet is a valid tool in the provision of healthcare? The answer is a resounding yes. In Part 1, we saw that respondents have already decided whether or not they are going to make an appointment with their doctor prior to going online. Knowing this, we determined that people go online to gather information in preparation for their upcoming appointments. This helps to make patients active participants in their own health care. Further adding to the legitimacy of the Internet as a tool in the provision of healthcare is the cost-effective reach of the Internet and its ease of use.

The Internet is the world’s biggest meeting space. It serves as a virtual bazaar for the exchange of goods and information, as well as the largest store of information and knowledge. Its highly unregulated nature makes it susceptible to the dissemination of misleading or incorrect information.  However, when leveraged properly, the Internet is a powerful tool that can provide good information to a lot of people, for very little cost.

As a matter of fact, many healthcare networks have already begun disseminating information and storing data in the cloud (see the CDC’s Weekly Influenza Summary Update here). Smart healthcare providers have begun tailoring it for patients use (I just downloaded the iPhone App “MyChart,” which allows me to view my son’s medical records at Rochester General Health System).

We began this series discussing the usefulness of surveys in the initial stages of project conception. Whether launching a new beauty product or designing a patient health care information portal, a survey is a great place to start.

Do People who Look Up Health Information on the Internet Visit Medical Professionals Less or More? (Part 1)

My sister is currently working on a new beauty product launch and has asked me to help her out. One of the tasks in her launch project is distributing a market survey to identify her target population and what this population would be willing to pay for a new product. Her survey inspired this month’s post.

Surveys, when designed appropriately, are a fantastic tool for getting feedback. In application development projects, this feedback can be used to drive anything from interface design to application training preferences. Surveys can also be used to determine the next logical project or initiative on which to embark.

I recently conducted a survey to gauge whether people who go on the Internet to research health information visit their doctors less or more. I also wanted to assess respondents' perceptions of the validity of the Internet as a tool in the provision of health care. This included respondents' perception of the accuracy of the information they found as well as their level of understanding of the information they found.

My #HITsm colleagues have been asking me for weeks to post the results. Well here they are – and they’re pretty interesting.

I started with an initial screening question asking respondents if they have visited the Internet within the past 12 months to look up health information for themselves or someone else. If the respondent answered “No” to this question, he or she was disqualified from completing the remainder of the survey.

For those respondents that answered “Yes,” they went on to complete a series of nine multiple choice questions. (For a list of the questions, please send me an email.)

The target population consisted of people who were accustomed to using the Internet for browsing or searching for content. The sample consisted of 89 respondents. The respondents were highly educated, with 88 percent holding an associates degree or higher. 76 percent of respondents fell into the 20-year to 40-year age range. Finally, 74 percent of the respondents were female and 26 percent were male.

66.7 percent of respondents, when asked what type of information they were looking for on the Internet, said that they were looking up symptoms (FIG 1).

FIG 1 

When asked if they made an appointment with a medical professional as a result of the information they found online, 63.1 percent of respondents replied “No” (FIG 2).

FIG 2

Based on these results, can we assume that people are using the Internet to self-diagnose? Are they subsequently deciding to not visit a medical professional after they conduct their online research? I conducted qualitative interviews with a number of people in this target population in order to attempt to answer these questions. One of my respondents, a mother of a 16 month old, said that she knew her child had a sinus infection based on the information she found online. When asked if she decided to make an appointment for her child to see a pediatrician as a result of this information, she responded that she already made the appointment prior to conducting her research online.

Based on these results and my qualitative interviews, we can reason that when people research health information online, they have already decided whether or not they are going to make an appointment with their doctor.

So why are people going online if they have already made this decision? The answer is clear; People go online to gather information in preparation for their upcoming appointment. These days, health care consumers are more involved in their health care. This population is proactive and efficient. They know that they have very little time with doctors during a visit. In order to make the most of this time, they go in prepared with information and questions and they expect to leave with answers.

Research like this is being used to drive public policy surrounding health care. This is nowhere more evident than in the criteria outlined in the Meaningful Use Program currently underway in our country.

The Regional Primary Care Coalition (RPCC) defines the Meaningful Use Program as “reimbursement incentives for medical professionals and hospitals that become compliant in the use of certified electronic health record (EHR) technology” (RegionalPrimaryCare.org, 2012). In stage one of the Program, one of the 10 measures listed in the Meaningful Use Menu states that providers must use EHR technology to provide patients with education resources that is specific to their diagnosis or state. Stage two of the Program takes this measure one step further by stating that providers must ensure that five percent of their patients access health information online. The criterion further states that the patients must take appropriate action based on this information.

We know that patients are going online to research health information. Now, doctors are required to make sure that their patients are accessing this information. How can we ensure that the Internet is providing accurate information in a way that patients can understand? In the next post in this 2 part series, I will review the survey respondents’ understanding of the health information they found online as well as their perception of the accuracy of this information in an attempt to answer this question.

The 5 Things Parenthood Taught me about I.T. Project Management

I recently read a fantastic article by my friend and fellow journalist, Daria Burke, about women having it all. In the article, Daria proclaims, “We must shift the perception that having a family is a hindrance to a successful career.” (Read Daria’s article here.) In other words, working mothers (and fathers) have a lot to offer on the job and need the support of their companies if they are to effectively lead. I couldn’t agree more.

The job of parenthood is the ultimate prep course for I.T. project management. Parenthood allows us to practice the skills necessary for successful project management everyday. How, you ask? Below, I’ve listed five ways in which parenthood prepared me to be an effective I.T. project manager.

1.) Negotiation. Its been said that negotiation is an art. It’s an art that I’ve perfected as a mother. Oh sure, I can muscle my way through any argument with my child, but what am I teaching him? And what am I learning? Negotiation requires us to build positive relationships. Positive relationships are integral to successful project management, and to parenthood.

2.) Delegation. Growing up, whenever my mother made me clean, I would mumble under my breath “When I have kids, I’m never going to make them do all this work.” Well, that was then. The fact is I need help, so I delegate tasks. Everyone in my family is responsible for their role in keeping the household running smoothly. Heck, I even have my extended family and friends pitch in when they’re available. Project management is no different. Project managers are not responsible for doing it all, we are responsible for ensuring that everyone knows what to do.

3.) Manage the triangle. Parenthood, like project management, has its own triangle. With enough time, money, and patience, my kid could be the smartest, most athletic, and most well behaved child in our neighborhood. Unfortunately, I only have two of those resources at any given time. The same holds true in project management. There are finite resources and infinite needs. Pick the most important needs on which to focus, remain flexible and adaptable, and breathe.

4.) Reuse, reuse, reuse. Code reuse in application development is one of the simplest concepts, yet offers the best returns. Reuse can and should be applied to every aspect of our lives, especially parenthood. Leftovers, household goods, clothing – reuse it all! Anything that prevents us from doing redundant work will not only save time, money, and energy, but our sanity as well.

5.) Every project has an end. Raising children is a project. And like every project, it has planning, initiation, implementation, monitoring, and closing stages. There are several projects I’ve worked on that I was glad to be done with, but raising my child will not one of them. Whether you’re glad to see a project come to an end or not, the most important thing is that you’ve learned from it. And if you’ve left the world a bit better after the close of your project, consider it a bonus.

Top 5 Reasons Why Established EMRs won't Cut it in Behavioral Healthcare

The federal government is considering extending the Meaningful Use Incentive program to eligible behavioral healthcare providers. The bill, called the “Behavioral Health Information Technology Act of 2012,” would redefine the term “eligible hospitals” to include residential or outpatient mental health or substance abuse treatment facilities. (Read the full text of the bill here.)

The bill is another step in the direction of the integration between primary healthcare and behavioral healthcare.

As with the originally defined eligible facilities, behavioral healthcare facilities would have to attest to the meaningful use of a certified EMR. This may prove to be harder than expected, as many established EMRs tend to focus predominantly on primary care.

With the introduction of this bill, the time has come to begin examining the gap between what established EMRs provide and what the behavioral healthcare industry needs in an EMR. Below are the top five areas where established EMRs may not currently meet the needs of behavioral healthcare providers.

1.)  Treatment plans. The concept of the treatment plan is relatively new in the primary care arena, however it is a practice that has been used for some time in the behavioral healthcare setting. Treatment plans are complex documents that reflect the prescribed treatment for the management of the patient’s disease. They are referred to as “living” documents because of the need to frequently update the document and because they are a reflection of the complexity of each individual patient and their diagnosis. Not only will a successful EMR application capture this complexity in electronic format, but also, the EMR will be able to preserve and present historical treatment plan data.
 

2.)  Social and behavioral data collection. Most state mental health and substance abuse agencies require large amounts of social and behavioral data to be collected during a behavioral health assessment. This data is used to determine if the services provided are appropriate for the patient. This data may include the patient’s current living situation, current and past family situation, social supports, sexual history, and past medical and behavioral health treatment history. Established EMRs may not allow for the complete capture of this information, nor provide for the analysis of this data. Successful EMRs will allow behavioral healthcare providers to collect the appropriate data. Furthermore, successful EMRs will be robust enough to facilitate analytics on this data, which tends to be highly varied and individualized.

3.)  Security and privacy. Although the protection of all health information is covered under several federal and state regulations, behavioral health data is “given heightened protection under the law” (HealthIT.gov, 2012). Successful EMRs will be agile enough to provide restricted access to behavioral health PHI based on federal and state laws as well as on the needs of the facility or provider.
 

4.)  Data exchange. A lawyer friend of mine recently told me that the future of healthcare is not in our hospitals – it’s in our communities. From long-term care facilities to stand alone behavioral health clinics, the importance of providing care along the entire continuum has never been more evident. For many behavioral health care patients, community clinics are the primary point of contact for treatment. An EMR that facilitates the exchange of data between larger health systems and community providers will be the EMR of choice as our healthcare systems move toward integration.
 

5.)  Documenting and measuring outcomes. Outcomes are king in the behavioral healthcare industry. It is by measuring the outcomes of prescribed treatments during and after episodes of care that the industry can make the case for increased funding. Successful EMRs will not only facilitate the capture and reporting of outcomes, but will also provide the ability to analyze outcome data.

RecoveryNet: Merging Behavioral Healthcare with the Patient-Centered Health Home

Ask Bob Lebman, President of RecoveryNet, where the large hospital behavioral health providers are failing patients and he’ll say “Access to treatment.”

“Right away, when a patient walks into a large hospital seeking alcohol or substance abuse treatment, you’ve lost them,” states Mr. Lebman. “They get the sense that it’s no loner personal, it’s no longer about them.”

In other words, patients become disengaged.

That’s why Mr. Lebman and several other substance abuse treatment facility leaders in the Rochester area started RecoveryNet 13 years ago. RecoveryNet began as a project to save Rochester’s community based substance abuse treatment centers. Since then, it has evolved into an innovative collaborative of 10 behavioral health providers, leveraging the power inherent in numbers to make a difference.

RecoveryNet’s main goal is to advocate for and protect community based substance abuse treatment as a care option for patients. The collaborative accomplishes this through several objectives. The first objective is to ensure uniformity among clinical documentation in use by all RecoveryNet partners. This allows the collaborative to track and measure outcomes among each individual partner agency as well as across the collaborative as a whole.

With the help of a grant from SAMHSA, RecoveryNet was able to mobilize all partner agencies to decide on and implement a common format for all clinical documentation. Additionally, the grant provided funds toward the implementation of an electronic medical record.

Three years after RecoveryNet began, the collaborative implemented Netsmart’s Tier, an EMR geared toward behavioral health care. Immediately after the implementation of Tier, one of the first health information exchange endeavors RecoveryNet embarked upon was an exchange between the Tier application and Monroe County’s Addiction Recovery Employment System. The Addiction Recovery Employment System, or ARES, is a web-based application that links to the County Department of Social Services. The exchange automated the electronic reporting of RecoveryNet’s ARES client outcomes directly into ARES.

Soon after, the collaborative was awarded a grant from New York State’s HEAL 5 initiative. The grant provided the resources to set up and administer cloud computing capabilities to the smaller RecoveryNet partner agencies that did not have the infrastructure in place to host the EMR locally. Additionally, the grant provided funding for the implementation of a RecoveryNet IT helpdesk.

The collaborative recruited a helpdesk technician, a database developer / administrator, and a network administrator to provide daily EMR support to partner agencies. Additionally, the RecoveryNet IT team is tasked with keeping tabs on any changes required in the EMR due to changes that occur at the state or federal level.

“This allowed the collaborative to bring EMR expertise in house, allowing us to improve the quality and timeliness of service to the partner agencies,” states Mr. Lebman.

Besides the economies of scale leveraged by having all partner agencies on the same EMR, the collaborative provides cost savings and efficiencies in other areas. For example, smaller partner agencies that do not have the resources to manage their revenue cycles can contract their billing functions to the larger partner agencies. Additionally, all partner agencies can take advantage of trainings, consultations, and knowledge transfer from other partners.

“The cost of these types of activities is included in the monthly fee all partners pay into the collaborative,” states Mr. Lebman.

Currently, RecoveryNet is implementing a primary care clinic on-site at one of the larger partner agencies. The clinic is slated to open this fall. The clinic will provide primary and OB/GYN care on site. Other RecoveryNet partner agencies can refer their clients to the primary care clinic while still continuing to provide substance abuse treatment services for the patient.

“We’re essentially building a patient-centered health home for our patients,” says Mr. Lebman, “That way, there’s no wrong door when patients come to us seeking treatment.”

This “no wrong door” approach works well for the other services the partner agencies provide. 

“If a woman with children and unstable housing walks into one of our outpatient substance abuse treatment clinics for treatment, we might refer her to the residential substance abuse treatment program at another partner agency instead,” says Mr. Lebman.

Perhaps the most useful thing to come out of RecoveryNet is the ability to track, measure, and report outcomes because in today’s behavioral healthcare environment, it’s all about outcomes.

“We know our programs work,” says Mr. Lebman, “But by working together, we can measure and report on the tremendous impact we have on the over 7,000 patients we see each year.”

For more information, please visit: http://www.asapnys.org/PDF/HealthcareReform/RECOVERYNETSMART.pdf