Author: SOS Blog

Alphabet Soup: HITSP, CCHIT, ONCHIT, SNOMED CT

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I try to keep informed about Electronic Medical records (EMRs), certification of those products, and funding for them provided through the economic stimulus bill (ARRA). After all, as a developer and vendor of a behavioral health EMR, I really should know some of this stuff. This week, I was struck by the number of acronyms that have come into common parlance in the past six months. I find the amount of information being generated about healthcare information technology (HIT) overwhelming. I am sure it feels even worse to someone who has not been trying to keep up with this information. After all, who can possibly know what all of these shorthands stand for and mean? 

So what would any good technology hound do? Well, of course, I googled ‘Health Information Technology acronyms‘ to see who out there has started to organize this information for the public. To my pleasant surprise, several documents attempt to do just that.

To start with, our federal department of Health and Human Services has a whole web site dedicated to HIT. On the left side of the page, there is a list of tabs. Under Resources there is a page called Acronyms. And that is just what it is. A list of the letters used as the shorthand referents for 112 terms ranging alphabetically from AHIC (American Health Information Community) to WW (Wounded Warrior). You can then cut and paste a name into the Search box on the top right of the page to find documents on the site that reference this “term”. When I do this for American Health Information Community, I get a list of 601 documents linked to this site that refer to AHIC in some fashion. If I do this same search on Google, I get about 129,000,000 hits. Be careful what you search for!

The Rural Health Resource Center, a not-for-profit located in Duluth, Minnesota has a document containing a list of 53 acronyms including brief definitions or descriptions of the terms or organizations listed as well as links to the sites of some of the organizations described.

Likewise, the Department of Health Services of the state of Wisconsin has published a list of acronyms and what they stand for. This list relates to eHealth rather than just health information technology, so it is bound to have some different entries.

A web site created by Pivotal Solution Group called HITECH Answers has their own list of acronyms and definitions. Pivotal Solution Group is a coaching and consultancy organization…a private group as opposed to the government sources listed above.

And finally, the Software and Technology Vendor Association (SATVA), a trade association of behavioral health software vendors to which we belong, has developed a section on their web site to monitor information regarding behavioral health EMR certification. Behavioral Health Certification Watch will be updated as new information is received. 

While some of you have probably clicked on the links above, I think it highly unlikely that you will spend much time reviewing this information. After all, who has the time to go looking into the masses of information that are being created about HIT, certification of products and paying for those products. Most behavioral health organizations are likely to just continue doing what they do until someone finally tells them they must move to an electronic medical record (EMR) by a certain date or they will not get paid for the services they provide. Oh wait, that is what has happened…at least, for Medicare and Medicaid payments.

Is that enough to start movement toward an EMR in your organization? Is your practice beginning to consider the possibilities? What do you believe it will take to move mental health providers into EMRs?

Meaningful Use & Behavioral Health Providers

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I have been avoiding writing about the second draft of the Meaningful Use of Electronic Medical Records (EMRs) definition released by the federal Health IT Policy Committee on July 16. I had been hoping I would hear something that would make me believe the definition would in some significant way benefit our customers. I am disappointed to report that it still appears that the ARRA stimulus funds for adoption of EMRs will be largely unavailable to behavioral health providers, except psychiatrists, unless some change is made through regulation.

Just to clarify my statements above: ARRA provided $19 billion in funding for EMRs. $2 billion will be provided to the states to distribute for grants. Community Behavioral Health Organizations (CBHOs) are included in the eligible organizations for these funds. Unfortunately, it appears that this funding is going to be used by the states where they see fit. I have heard from a representative of at least one children’s psychiatric hospital who was told that funding would be used by the state to build Health IT (HIT) infrastructure and data exchange capability. They were informed that providers could get their funds from the incentives. I will be very curious to see how much (if any) of that $2 billion winds up in the hands of providers of any sort.

The larger part of the funding, $17 billion for Medicare and Medicaid incentives, is designed to encourage providers to purchase EMRs and use them to improve the care of their patients. Of the providers eligible to receive these reimbursements, the only behavioral health providers who are eligible are psychiatrists and certain nurse practitioners. They would purchase a system and then receive reimbursements for some or all of what they have spent depending on a variety of complex formulas. If you are a psychiatrist and you do not see Medicaid or Medicare patients, you are not eligible for funding. If you do treat these populations, you will only be able to get funding from one source, Medicare or Medicaid. The amount of reimbursement you can receive depends upon what proportion of your patients are Medicaid or Medicare recipients, along with other complex criteria.

Senator Jay Rockefeller of West Virginia introduced the Health Information Technology Public Utility Act of 2009 in late April. This bill was intended to assure that certain “safety net” providers like rural clinics and mental health providers could also access funds. That bill has not moved. Unless something happens in regulation, it is not likely that psychologists, social workers, mental health counselors, addiction treatment programs, psychiatric hospitals, or community behavioral health service providers are going to benefit from the stimulus funds to help purchase EMRs.

That said, the Health IT Policy Committee did seem to take into account the input they received from the public about the initial attempt at defining “meaningful use of EMRs”. They have drafted a plan that widens definitions, expands time frames, and provides more opportunities for providers to demonstrate that they are using EMRs meaningfully. Their PowerPoint presentation does a good job of summarizing their points. Details can be found in their updated grid and matrix.

1. The primary goal of the definition is to improve the outcomes of healthcare interventions through data capture and sharing and use of advanced clinical processes. They want providers to focus on health outcomes, not on software. HIT is to be a primary aid to healthcare reform, not use of software for the sake of earning incentive money.

2. It is the intention of the committee that there be a phasing in of meaningful use criteria. The public was concerned that if providers could not meet the 2011 criteria in 2011, they would always be behind the train. The committee now recommends that a provider who does not adopt an EMR until 2012 (or 2015) will start at the 2011 criteria and progress from there.

3. Changing work flows to assure the proper use of IT tools is an essential part of the solution. Trying to use CPOE (computerized physician order entry) can actually cause problems if there are not work flow modifications to make sure the process flows smoothly. An unintended consequence of CPOE in at least one study was diminishing of appropriate care because it was inconvenient to enter the order for the care.

4. Since data-based decision support is the real payoff of using an EMR, the committee wants to see this happen sooner, even it if means implementing only one rule in the decision making process.

5. Since engaging patients in their care is crucial to reduction in costs, providing access to an electronic version of their health record needs to be higher priority and come earlier in the process than previously envisioned.

6. Certification of software should be done by more than one body; CCHIT should not be the sole arbiter of which products should be certified.

While the Health IT Policy Committee has now presented their second draft of the “meaningful use” policy, it has until the end of 2009 to finalize the rules. It appears, however, that the direction is set. If you want to get some of the incentive money to help you buy an EMR, you will need to demonstrate that you can use that EMR and can report a variety of metrics to show how your practice is handling a number of issues. So far, none of those metrics are vaguely related to mental health.

Do you expect your organization/practice to be seeking incentive funding to purchase an EMR? How are you proceeding to assure that outcome? Do you think it is important for behavioral health to be included in the adoption of EMRs?

Just click on the title of this article and enter your comments in the box a the bottom of the page. Thanks for sharing your thoughts.

Prevention & Self-Care: Essential to good health

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A couple of weeks ago I wrote about my experience of incapacitating back pain while on vacation. Today, I woke up feeling great. My visit to my chiropractor and massage therapist was unusually positive; my muscles were not in spasm and my spinal alignment was pretty good. It is clear that the things I have been doing are finally working.

What I did not write about two weeks ago were the efforts I had been making to manage my back and neck pain prior to its explosion while I was trying to have a good time. Two and a half years ago I fell from my bike and separated my shoulder. Six months after that, the neck pain caused by the fall spurred me to visit the chiropractor. For the last 18 months I have had massage and chiropractic adjustment every two weeks, on average. Our goal is a monthly maintenance schedule to prevent my poor spine from causing the kind of discomfort I experienced last month. Because I was not making the progress I had hoped for and was starting to get depressed about it, two months ago I started yoga classes and two weeks ago I added a Pilates class.

I have made efforts toward fitness for my entire adult life. I have eaten a mostly vegetarian diet since 2005. I have maintained my weight at a healthy level and my BMI (body mass index) is 21.3 (18.5 – 24.9 is considered normal). I have a couple of familial predispositions to heart disease, so I try to keep all the other risk factors down. For the last ten years, I have bicycled pretty regularly, and for most of my life I have been involved in physically active endeavors ranging from dance and aerobics classes to vigorous gardening. Familial tendencies toward depression and other mental health issues, along with my training as a psychologist, have also pressed me toward regular maintenance. My copy of David D. Burns, M.D.’s  Feeling Good, the New Mood Therapy and The Feeling Good Handbook are never far away.

The more I think about the health of my nearly 59 year old body, the clearer it is to me that my focus as an individual and our focus as a culture needs to be on good self-care and prevention of illness. For those who work in preventive medicine, my realization would be followed by a big “DUH…of course.” For most of the rest of us ordinary humans, it is easy to give lip service to this notion, but really acting upon it is another matter.

Newspaper reports about the effects of recession on preventive health care abound. Some insurance plans do not cover preventive care, and when money is tight people do not spend on a mammogram or colonoscopy. Those who have lost a job and their health insurance along with it may seek care for acute illnesses, but prevention and care of chronic illnesses often go by the wayside, sometimes resulting in expensive emergency room visits and hospital admissions.

The Agency for Healthcare Research and Quality (AHRQ) of the U.S. Department of Health and Human Services provides a Guide to Clinical Preventive Services. Screening and Counseling are the two forms that most preventive efforts take. Frequently, education about the disease and self-care for prevention are part of the Counseling. Unfortunately, for many of the illnesses listed there is insufficient evidence to determine the effectiveness of Screening or Counseling in preventing the disorder. The dates on most of these conclusions make it clear to me that it is time for a significant research push in this area; but, Evidence Based Practice will be the topic for another day.

One arena in which prevention has solid research basis and support of the medical community is cardiovascular health. “The American Heart Association believes that basic preventive health care services should be an integral part of an equitable, comprehensive health care plan, accessible to all.” Learning the risk factors of cardiovascular disease and intervening to diminish those factors is a sure way to decrease the likelihood of heart attack in your future. As the AHA indicates, “These are the risk factors we can modify, treat or control:

  • tobacco smoke
  • high blood cholesterol
  • high blood pressure
  • physical inactivity
  • obesity and overweight
  • diabetes mellitus.”

I am not a person who is happy to take a passive role in my life. Sometimes I wind up in that position because of a variety of factors, but the result is never a happy Kathy. I have always been proactive and forward-looking, trying to be prepared for eventualities before they occur. Sometimes I have missed the mark by looking too far ahead, but in the case of health it is never too soon to start taking steps to prolong good health.

Dr. Andrew Weil has long been a favorite of my family. His blending of Eastern and Western ideas in integrative medicine has an intuitive appeal for me. The notion, put forward in his book Healthy Aging, of avoiding many debilitating illnesses by proper diet and exercise and living a long healthy life with a rapid decline at the end seems a no-brainer to me. My health insurance won’t reimburse me for it. Traditional U.S. medicine won’t advocate it until there is significant research supporting it; but I find this active, involved focus on my health much more appealing than passively taking the medicine the doctor orders.

What is your role in your health? Do you see a place for behavioral health providers in prevention and general health care? How should we proceed to make ours a healthier country and each of us healthier individuals?

Please chime in! Let me know what you think.

Cheap Productivity Booster: Add a monitor

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Sometimes I am doing so many things at one time that I lose track of where I am and need to stop and scan my environment for clues to what I was last doing. Because each of us at SOS wears so many hats, most of us multitask every day. We have found a simple and inexpensive way to increase productivity.

First I must tell you that I resisted doing this for about a year. Seth and Manon had both expanded their world view as had two of our programmers before I decided it was something that might be useful. This simple solution is adding a second monitor to your desktop.

Okay, okay…I know. What could you possibly need with a second monitor? After all, your desktop is already hopelessly cluttered with stacks of paper (at least, if it is like mine it is) and there is no available real estate for adding something as silly as a monitor. That is what I thought. Then I added one.

Now I am able to spread the six or eight applications that I keep open all the time across two screens so I can see and use multiple programs at one time. This is especially useful if I am working in bookkeeping and spreadsheets simultaneously. I can go back and forth from one program to the other by turning my head and clicking. In the past, I could only view a small window into each application if I wanted both on my screen at one time.

One Monitor
One Monitor

You can see how scrunched things are above.  Below is the image of two monitors, side by side. My two open programs shown overlapping on the screen above have now gone to five open programs plus Google Sidebar. I still have several other items in my program tray that are not currently maximized, but with the two monitor arrangement, I can easily see my multiple tasks at one time.

Two Monitors
Two Monitors

 

This is especially useful for those of you who keep a product (like SOS Software or some other mental health billing software) active on your computer all the time. You need it there ready in case you have a phone call from a client, so you can check someone in when they arrive to see their psychotherapist, so you can enter their payment when they leave. But today you are also actively writing letters in your word processor, you are working on spreadsheets you have created by exporting some of your reports from Office Manager, and you are occasionally checking your email. With two monitors, all those tasks can be visible at one time!

To add the second monitor, you need to be sure you have adequate inputs on the computer box. Then use the Windows Control Panel > Display Properties > Settings to select which monitor is primary and to verify the appropriate settings. Just Google ‘dual monitors xp’ or ‘dual monitors vista’ without the quotation marks to get guidance from Microsoft about just what to do in your operating system.

We all have too much to do, so finding the most efficient and cost effective ways to get that work done is very high priority. Let us know what kind of steps you have taken to increase your efficiency. Have you considered multiple monitors?

To enter you comments, just click on the title of this article and enter your thoughts in the box at the bottom of the page.

U.S. Healthcare…Privilege, Poverty and Pain

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This is my second day back in the office after vacation. Yesterday and this morning were filled with catching up. That will take most of the rest of the week to complete. I decided to share an experience and some reflections before I get too removed from them.

While on vacation, my back went out. I have had chronic back issues since I was a young woman…maybe even since I was a child. In January 2007, I fell from my bicycle and separated my shoulder. Since October 2007, I have regularly visited a chiropractor to manage the neck pain that has become a focus since that fall. My neck and back have become chronic problems with intensity of pain varying depending upon multiple factors.

Vacation was a bicycling getaway in the Florida panhandle. The cottage we stayed at in Apalachicola had a bed that did not agree with my back. After two nights of wrong mattress and two days of riding, my lower back went into major spasm. I spent the third day of vacation searching for a massage therapist and traveling 100 miles to purchase a mattress topper to ease the pain. Everyone with whom we dealt was extremely kind and concerned, even when they were not able to help.

I did manage to relieve the discomfort somewhat and rode for three more days after we moved on to Monticello. Some correction to my bike position and change in pedaling technique also helped. You will notice that I did not try to see a physician and I did not go to an emergency room. Dealing with out-of-network services for a chronic rather than emergent condition felt too costly to justify. Fortunately, I found a massage therapist and could afford to pay her.

On our final day, we visited Thomasville, GA. As we drove into town, we passed a demonstration opposing health care reform. Signs indicated that “they” are going to increase our taxes to pay for someone else’s healthcare, and  “we” cannot afford to pay for the poor to have insurance. The participants were overwhelmingly white skinned, well-dressed individuals.

Today I managed to get to my own chiropractor and massage therapist. My insurance only pays the chiropractor $15 per visit; they do not cover massage therapy at all. Because these services keep me functioning, I choose to pay for them and am fortunate to be able to do so. But during this summer when Congress is working hard to come up with a plan to reform our healthcare system so more people can afford to receive care, I find myself wondering how we will succeed.

1. From amidst my pain, my thinking about how to resolve my discomfort was minimal and ineffectual. Soaking in the tub did not take care of the problem. Over the counter medications did not relieve the pain. Without my husband to find resources for me, I might still be in that tub. I think about the emotionally ill individual who has no one to advocate for them…mired in their pain and confusion without treatment.

2. Even with good, costly health insurance, the community in which I was located did not have resources for which my insurance would pay. If I were not privileged and educated and benefiting from adequate income, I would have been unable to pay for the resources we did locate. There are no local mental health services at all. I think of those who live in small town America and cannot travel to the resources of larger communities, as well as those who live in cities who cannot afford to access those resources.

3. I know very few health care providers or training programs or modern treatment procedures that were not assisted by government funds. Health research and hospitals and medical school and even graduate school in psychology cost too much for most of us to pay without government grants or loans. Even those of us who can afford to pay are dramatically benefited by government funding.

4. We are a kind and concerned people.

5. We are selfish and protective of our money, our privilege and our position.

6. There are no easy solutions to healthcare reform. It is going to cost all of us. The only question is how much it will cost and how we will pay for it, and whether the mechanisms are different from how we pay now. It is unconscionable that access to basic healthcare is not guaranteed to everyone who lives in the U.S.

This is all my opinion…for what it is worth. And what do you think? Please make your comments by clicking on the title of this article and entering your thoughts in the box at the bottom of the page.