Category: SOS Blog

Activism: 101

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Note: This is one of an occasional series of postings on how we can work to affect climate change.
 

A couple of weeks ago we went to the home of friends in our book club planning to watch a movie together. When we arrived, we did not know what movie we would be watching, but I was delighted with the choice. We saw a movie called Pete Seeger: The Power of Song. 

In spite of being a bit younger than those most likely to know and appreciate the work and music of Pete Seeger, I have very fond memories of hearing and learning songs like Where Have All the Flowers Gone and This Land Is Your Land. I was surprised to learn that Pete Seeger had introduced the folk song We Shall Overcome to Dr. Martin Luther King and the Civil Rights movement, and I was inspired to learn that for the last 25 years he has lead and worked on efforts to clean up the Hudson River in New York. For most of his 90 years, Pete Seeger has used music to influence and inspire one aspirational movement after the next from the labor movement of the 1930s to the peace movement to the environmental revolution. He could teach well beyond Activism: 101.

One statement in the movie reminded me of a task I had set for myself. Pete talked about never hesitating to wade into some overwhelmingly large task. He said that he reminds himself to ‘think globally but to act locally’ because you can only be where you are and work to change that one place. While local action usually has the most impact on our daily lives, in this highly connected time in history, the ‘place’ we are is dramatically expanded by electronic media, so I’ll take the opportunity to work in this ‘place’.

Last Monday, I read a NY Times opinion piece by Thomas Homer-Dixon. The author was writing from his perch aboard the Louis S. St-Laurent, the floating laboratory for Arctic science that is part of the Canadian Coast Guard. Professor Homer-Dixon reported that the ice in the arctic looks completely different than when he was in the same location at the same time of year 20 years ago. The rapid changes in Arctic ice are not visible to most of us, but Professor Homer-Dixon reports that the severe melting and expected thinning of Arctic winter ice are indicative of rapid changes occurring in many aspects of our climate.

The year 2010 is turning out to be the warmest year since temperatures have been recorded globally. Mudslides in China, fires in Russia, flooding in Pakistan….all are considered by climate experts to be manifestations of the changes in climate that can readily be measured.

One of my colleagues returned from a summer visit to Mexico. While he was there, President Felipe Calderon of Mexico made a speech about climate change. Sr. Calderon wondered why it is only in the United States that there is still debate about whether climate change is occurring, when everywhere else in the world, the issue is what to do about it.

Professor Homer-Dixon is also concerned about the ‘what to do’ part of this issue. He suggests that our governments need to be developing interventions in case a large, catastrophic event occurs. He thinks this ‘Plan Z’ should be our outline for how to proceed if and when a large climate catastrophe occurs. Having evacuated from my Mother’s New Orleans home two days before Katrina hit five years ago, and then dealt with the results of 8 feet of water in her home, I am well aware of the effects of no plan, and a big fan of developing real plans to deal with possible climatic catastrophe.

My only question about a plan is whether it needs to be large-scale (national or world-wide) or small-scale (local communities and individuals). Lester Brown of the Earth Policy Institute believes that our plan (he calls it Plan B) must be comprehensive and must focus on what actions we can take prior to the catastrophe. Since I am a planner and a taker of action, I like Mr. Brown’s approach. His books are extremely intelligent and detailed assessments of what each of us as individuals as well as what governments and multi-national organizations and corporations can do to prepare for and to mitigate the effects of climate change.

The report of the American Psychological Association’s Task Force on the Interface between Psychology and Global Climate Change explores in depth aspects of human behavior, thinking and emotion that must be studied and addressed in order to impact climate change. The report discusses denial as one reaction to being faced with the possibility of catastrophic results of climate change. As our friends in 12-Step programs would tell us, denial is not a river in Egypt…it is what we do unconsciously when we cannot face the data presented to us. But face that data we must.

This week marks the 5 year anniversary of Hurricane Katrina’s landfall. Most of us know of the physical devastation caused by that storm. Some of the data released last week indicate that the effects on the mental health of those who were directly and indirectly affected by Katrina were equally devastating. But what are we doing to plan for the effects of climate change? How will we prepare ourselves personally and our organizations professionally to intervene to protect and recover the mental health of our communities when we are faced with catastrophes caused by climate change? What do we do now rather than after the fact?

This is my sixth post on climate change since last September. There are a total of four comments on those posts . . . two made by readers and two made by me in response. Are we in denial? Please share your comments below.

It’ll Never Happen To Me…

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This week one of our customers experienced a “happy ending” to a very unhappy story. We thought we would share it with you.

They were sure they had a good backup. When their server hard drive crashed, they were distressed but not terrified. Instead of dealing with the loss of all their data, it merely meant that they would need to get a new server and have someone spend time rebuilding the hard drive from installation CDs and all of the backed up data.

That’s when reality set in. Their consultant technician installed our software onto their new server from a CD and went to restore the data. The data folder was empty. He was unable to recreate his client’s practice management data from a usable backup. That is also when the customer’s panic started.

I don’t know if you have ever considered this scenario for your organization. After all, your IT specialist set up a tape or external drive backup for you and the system automatically backs up every day. Sometimes there is a strange error message on the monitor when you remove the tape or you get an email that says an error has occurred, but you don’t really have time to pursue it.

Have you ever tried restoring from one of your recent backups? Do you know that the data are usable? If someone in your organization has never restored one of your current backups to your system and made sure the restored data worked, then your backup process is incomplete and you are at risk for the same kind of upset our customer experienced this week.

Happy ending to this story. . . a hard drive retrieval company was able to pull data off the crashed drive. . . at a cost of $7500! Since that certainly played havoc with the budget, this happy ending is really a mixed one.

If you want reminders about backup procedures and our best thinking about what to consider take a look here and here and here and here. We have not written about this as recently as I thought, but data backup is a subject that we try to remind ourselves and our customers about regularly. Please think about and take action about yours.

Also from the ‘It’ll Never Happen To Me’ department. . . I attended a webinar on the HIPAA and HITECH breach notification requirements a couple of weeks ago. This was done by a company named IDExperts that specializes in guiding companies through the risk assessment process after a breach has occurred. They also have a software product that will walk you through the post-breach risk assessment and track the histories of all breaches. Their take on data security and the risks involved are like this: if you were interested enough to attend the webinar, the question is not if you will experience a data breach, but when. Statements like that always jar me. Since we are not a Covered Entity and have no PHI of our own, I am not too concerned about us experiencing a breach; our procedures are solid and any electronic PHI temporarily in our possession only resides on encrypted computers. Obviously the worry is not small for health care providers, especially large ones.

The concern about security and privacy of PHI has recently been complicated by the fact that HHS has decided to reconsider the final rule on breach notification. After privacy and security groups were distressed and complained to HHS about the methods for deciding whether the release of data presents a risk to involved patients, HHS decided to reconsider the final rule. There is speculation that the rule will be made tougher than it was. Up to this time, the organization that experienced the breach has been responsible for determining the severity of the risk to patients caused by the data loss and whether HHS needed to be notified off the breach. HHS did not indicate when a new rule could be expected.

Who in your organization is responsible for verifying that your backups are usable? When was the last time a test restore of crucial data was done? Would you have any idea how to do this; if not, who does? What is your plan of action if protected health information is accidentally released when it should not have been? Are you convinced it’ll never happen to you?

Please share your comments and your experience so all our readers can benefit from best practices on data backup and protection.

OpenNotes Project: Where does mental health fit in?

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On Monday of this week, Seth asked me if I had a topic for my current blog. As I had none at hand, he pointed me to last week’s episode of the podcast/NPR show, Science Friday. Seth is a regular subscriber to this series and I listen when I find the time. That effort is always rewarded by fascinating discussions of current science issues. For the science professional, wanna-be-scientist or interested layperson, this show is a ready source of truly valuable information.

On Friday, July 30, 2010 the discussion topic was a medical records project called OpenNotes. With the advent of electronic medical records (EMRs) and patient portals into the medical records system, it is only reasonable to begin to consider the nature of the records that physicians keep on their patients. The OpenNotes project is an attempt to allow some 25,000 patients direct access to what 100 participating primary care physicians write in their notes after seeing them.

The project will study the experiences of both the physicians and patients, the impact on work flow of such note taking/sharing, the possible increase in communications between patient and physician, and the reactions of both sets of participants to their experiences. The details of the study are published in an Annals of Internal Medicine article, Open Notes: Doctors and Patients Signing On.

The Science Friday discussion included concerns about sharing sensitive information with the patient and the ability of the patient to understand and process the information included in the note. It has especially been argued that the mental health patient might be too fragile to be exposed to the psychotherapist’s or the psychiatrist’s true evaluation of their status as stated in the progress note.

On the other hand, Concurrent (Collaborative) Documentation has been touted by some community behavioral health specialists as an essential tool for increasing both quality and efficiency of client interactions while simultaneously increasing client buy-in to the treatment plan. The New York State Office of Mental Health writes:

It has been suggested that Concurrent Collaborative Progress Notes were the ‘way to go’. What about uninterrupted direct face to face contact as the best way to achieve high rates of engagement and retention in our clinics?

Concurrent documentation does not require the clinician to take notes during a session or to detach themselves from the recipient. Rather it is advised that at the end of the session, a brief review of the session takes place and the recipient and clinician collaboratively record the progress note. This process supports the delivery of person centered services and often provides the clinician with important feedback about the recipient’s perspective and information obtained from the session.

The process of creating this record concurrent with the meeting and collaboratively with the client is the epitome of an open record. While the OpenNotes project does not go quite this far, it certainly opens the door in this direction. Since the patient owns the record, it seems only fair that they should have easy access to that record and even participate in its creation.

My background as a Feminist Therapist has long given me a strong leaning in this direction. In the view of Feminist Therapy, the treating professional is a consultant having special expertise who is hired by the client to assist them in solving their “problem”. This is certainly also the case in the medical office. The physician has expertise the patient is seeking in their efforts to treat illness and to live healthier lives. This collaborative relationship is more a meeting of equals working together for the patient’s benefit than a dictation of treatment by an authority-figure intent on successful treatment and risk management.

What do you think about opening progress notes to your patients and consumers of service? How would that change the work done by the provider of services? How do you imagine it would change the experience of the consumer?

Please share your comments below.

Information Overload: TMI

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Almost two months passed between my post last week and the last one before that. The combination of family illnesses followed by vacation and recovery from travel put me in a position of being so far behind in the reading I usually do that I could not possibly catch up. My personal inclination was to duck my head and try to ignore the overwhelming sea of information.

I found myself strongly empathizing with practitioners, administrators, and behavioral health care personnel of all stripes who spend their days trying to provide quality mental health services to their patients…and then spend their nights worrying about what has occurred that day that might get in the way of or assist them in doing their job, but not having the time or the energy to pursue that information. Certainly, the information is readily available on the Internet, but who has time.

There have been numerous discussions of the effects of too much information (TMI) on our functioning. In July, 2008 Nicholas Carr wrote an article in The Atlantic called Is Google Making Us Stupid? This year he has written a book length exposition of that subject called The Shallows: What the Internet is Doing to Our Brain. His thesis is that our brains are literally being changed by the way the Internet is organized. He posits that jumping from one place to another by way of hyperlinks results in shallow pursuit of topics rather than the in-depth exploration of a subject allowed by books. In my brief exploration about his book, I found an extremely articulate review and commentary by Venkatesh Rao who mentioned and hyperlinked to the blog of Jason Kottke, a writer whose name I had heard but had never read. I have demonstrated for you an example of Carr’s thesis. I got distracted from obtaining support for my original thought by the way the Internet presents information and by the ease of pursuing that linked information.

Back to my original thought…here I am adding one more place where there is a bit more information for you to take a look at…or not. You might find this a convenient place to check for information about behavioral health care and its place in the world-at-large, or you might drop in occasionally just to see if there is anything that interests you.

For those of you checking in for something interesting, here are a couple of tidbits.

  1. ONC (Office of the National Coordinator for Health Information Technology) has published a final rule in which it establishes a temporary certification program for electronic health records as required under HITECH. As reported by Healthcare & Technology blog, this rule should allow progress toward approval of certifying organizations for EMR products.
  2. iHealthBeat reports on release of final rules for “Meaningful Use”. Many observers believe that the easing of requirements for the meaningful use of an electronic health record required to receive stimulus funds made available under HITECH will make it easier for eligible providers to receive funds. Other observers believe that even the easing of the standards will not make it simple for stimulus funds to be acquired, even for those who have already purchased and implemented EMRs.

It appears that life gets more complicated all the time, even if we have information. Since I do believe that knowledge is power, I will keep trying to pass some of what I come across on to you. Thanks for reading. Please let us know what you are thinking about. Just enter your comments below.

The Healthcare Experience….Firsthand

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Six weeks ago, I started writing this post. I think it is time to put finished to it.

The second half of May and first half of June were a challenging time for us. Two elderly parents had acute medical needs at the same time in different cities. Both were hospitalized, one in a critical care unit.

During this time I found myself thinking about different aspects of the experience. For those of you who have not yet had the responsibility to care for an elderly parent, these issues might be interesting to look forward to. For those of you who are our age-mates, you will probably have additional issues to offer.

  1. Medicare mostly works. (Medicare with a secondary insurance works even better.)
  2. Health care workers, for the most part, really seem to care.
  3. The quality of care you receive depends upon your ability to advocate for yourself…or to have surrogate advocates.
  4. In the heat of the emotional moment, having siblings helps, even if they are in a different state.
  5. A Health care Surrogate, an Advance Directive, or a Living Will are not optional.
  6. The toll on family caregivers is huge.

1. Medicare mostly works. Medicare with a secondary insurance works better. I know doctors complain about Medicare and the amount they are reimbursed and about dealing with Medicare claims. I also know that health care services are provided without question when Medicare is the payer. In an emergency situation, not having to be concerned about the method of payment allows everyone to focus on the care of the patient. I think there is a great deal to be valued in that.

2. Health care workers, for the most part, really seem to care. Health care workers are overworked and hospitals are understaffed. Nurses and nurse technicians are responsible for so much documentation that they often feel that direct patient care gets shortchanged. In two separate hospitals in two parts of Florida, my experience was that hospital staff did an excellent job in spite of the demands on them…and that they really cared about their patients and about the job they were doing for them.

3. The quality of care you receive depends upon your ability to advocate for yourself…or to have surrogate advocates. Without a spouse and/or children or some other sort of advocate, people do not get as good care as when an advocate is present. The reasons are simple. A sick person is not in any position to ask for assistance, to question the treatment being provided, to assure the medication they have been handed is the correct one, or to guarantee that they understand the instructions they have been given.  If no one is present to say that they are hard of hearing, verbal instructions and questions may be forever lost. Even if a staff person eventually realizes they are not being heard, all of the previous interaction including important questions about history, may have been in vain. Without another person who understands how to go between the patient and the staff, a person may well get sicker because they could not ask for help or did not want to be a bother, could not question the protocols being followed and give benefit of their personal experience with previous treatment, did not recognize the medication they were given or understand the name and function of the medicine when the nurse administered it, or did not understand the follow-up instructions and the rationale for giving them.

4. In the heat of the emotional moment, having siblings helps, even if they are in a different state. Siblings are an asset when dealing with ill parents. Having others with whom to discuss the events and issues is crucial. They help generate additional questions that should be asked. They remind one another of family health history and events that can easily be forgotten. They can share the responsibility for sitting with and encouraging Mom or Dad. Having others to participate in important decisions if a parent is not capable of making those decisions for themselves is invaluable.

5. A Health care Surrogate, an Advance Directive, or a Living Will are not optional. Rightfully, hospitals and health care workers do not want to make decisions for a patient. They especially do not want to make decisions that are inconsistent with the wishes of the patient. They will strongly and clearly recommend what they see to be the best course of care and, with the patient’s permission, they will implement those recommendations up to the limits that the patient sets. If the patient has no person or document setting the limits, all care will be provided as the staff recommends and all of the care they recommend will be provided. Being clear about the limits is only fair to one’s children and essential to one’s care providers.

6. The toll on family caregivers is huge. No matter the outcome of the health care incident, the emotional and physical cost to family caregivers cannot be underestimated, especially if the other elderly parent is one of those caregivers. We most often think about the sick person and how they handled the health care event. It is important that we also think about the family members who participated in the caregiving for Mom or Dad while they were in the hospital and during the caretaking that follows.

My quick Google search for “caregiving” yielded 2,270,000 results. “Family care giving for older adults” yielded 924,000 results. Obviously, this is an area in which interest has exploded. While many of the search results are for some sort of paid service, adding the word “free” at the end still resulted in 514,000 hits. Many communities offer respite care and support groups through their local hospice agencies. Online information and organizations abound. As we baby-boomers age, I fully expect that this will become an industry in itself, with paid and volunteer and not-for-profit organizations.

In the meantime, we are very glad that our elderly parents made it through this round with the health care system. I wonder what your experiences with elder care and our health system have been. Where do you see us heading and what role do you see for behavioral health care in this elder care world?

Please share you comments below.