Category: SOS Blog

Spring Fever Has Always Been Real for Me

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Spring has finally arrived in central Florida. It has become warm enough not to need to wear cool weather clothing but cool enough to keep windows and doors open for most of the day. This is the time of year when I want to be outdoors even though the air is full of pollens. I experience a strong need to get my hands in the soil and new plants into the ground or into my hydroponic gardening units…or out riding a bicycle.

The biggest difficulty Spring provides for me is that it is hard for me to stay task-focused. This has been the case since I was a child. I just don’t much feel like being indoors, so working on indoor responsibilities comes much harder. As an adult, work is no exception. It is hard for me to focus on tasks that need to be accomplished. I would much rather be playing….or at least doing different work.

As a result of this year’s Spring fever, it was not difficult to decide that the celebration of Synergistic Office Solutions‘ 25th anniversary should happen at home rather than in a restaurant. It may cost me a bit more work, but it is not my usual work. I get to have a party instead of focusing on the changes I need to make to our web site or some other such task.

Yes, our software company has now been around for 25 years. Seth started doing consulting to other psychologists in 1985. Our billing software for mental health and medical practitioners followed in the next year. Florida psychologists were our first customers, but we started selling nationally in 1988 or 1989. Our electronic clinical record product was released in 1990. We made the transition from full-time practice of psychology to full-time software business in 1992-1993. Sometimes I am sure we jumped from the frying pan into the fire!

The primary benefit of the change from providing services to mental health clients to providing products and services to mental health providers has been that we have met so many wonderful folks who embody in their work their mission to care for others. Behavioral health providers and service organizations are the BEST! We are grateful for the opportunity we have had over the past 25 years to work with so many talented and caring people. Thanks to each and every one of you!

As you can see, my Spring Fever is so bad this year that I could not even write a blog article that would have the usual links to information you could use. It contains nothing about behavioral health electronic medical records or HIPAA or HITECH. Oh well, maybe next week will allow a return to those serious issues.

How do you respond to the appearance of Spring? Are you one of those wonderfully responsible people who can just put your head down and keep on taking care of business? Will you share with me how you do that? Or maybe you are just like me and want to have a party!

Please enter your comment in the box at the bottom of this article. If you don’t see one, double click on the title of the article, then scroll down to the box to make your comment.

New Phone Systems: Frustrations of an impatient newbie

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The last two weeks have been extremely challenging for me. As many of you know, I am not a techie; I am an end user. Without excellent in-house and outside product and computer support, I would not be a happy computer user most of the time.

We have been using a hosted PBX-style telephone system (Onebox) for the last couple of years. This service gives us the general functionality of a PBX system without the cost. We have extension numbers for each phone. We have automated attendants with different messages at different times of the day and night, as well as for Technical Support vs. Sales and Customer Service. We have multiple voicemail boxes at which customers can leave messages. We told the company what we wanted. They set it up for us. We use it.

Our one frustration has been the length of time needed to transfer a call from one person to another within our organization. It takes so long customers sometimes hang up. And sometimes transferring just does not work at all.

In 2009 and 2010 we have been cost saving fanatics. Since long distance telephone calls and numerous telephone lines are among our biggest expenses, we began to research options other than land lines and long distance contracts. About a year ago, we started using Voice over Internet Protocol (VOIP) telephone service through T-Mobile for our outgoing technical support calls. It has mostly done the job at a fraction of the cost of long distance service, so this month Seth started to research moving our entire telephone system to a hosted VOIP solution. After a couple of days of intense research, he decided that we should try Vocalocity, a company that focuses on small businesses.

Then Manon, our lead technical support staff person, left for vacation and my headache began. You see, Seth assists with doing tech support when one of our primary staffers is out. That meant the VOIP project was handed over to me…and oh what a mistake that was….because, remember, I am technologically impaired. Much of my other work has been on hold while I tried to make this work.

Seth had begun to set up our Auto Attendants, but they were not working properly. He emailed our phone system flow chart to a support representative at Vocalocity so they would know what we wanted to accomplish. Then, I needed to work with the support representative to make it happen. Over the course of three days, an excellent representative named Nathaniel worked with me to make changes in the setup of our account. It was much more complicated than either Seth or I realized. There were some things that had to be initiated on their end to accomplish our goals; they were not end user configurable. Finally, on Monday we tested all the work Nathaniel had done and the system appears to do what we want it to in the way we want. It even lets us transfer calls from one extension to another without a long wait time.

Today I called our telephone service provider and had our main line forwarded to the number assigned to us by Vocalocity. Tomorrow I expect to start receiving calls on the new system. We will let you know the outcome.

The moral of this story is this: using new technology may be just the way to save your organization lots of money; however, have your most tech-savvy person work to accomplish the goal. Giving the task to a less-than-patient person who just wants the darned thing to work is not the most effective way to adopt the new technology….no matter how cool the technology is.

What technology implementation stories do you have to share? Has your experience taught you some things about how to most effectively adopt new technology in your organization?

Just enter your comment in the box at the bottom of the page. If you don’t see a box, double click on the title of the article then scroll back down to the box to enter your comment. Please share your experience. I must get better at this!

Health Care Reform and Behavioral Health

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On March 21, 2010, the U.S. House of Representatives passed the Patient Protection and Affordable Care Act. Subsequently, they passed the Reconciliation Act  (H.R. 4872) making changes in the original bill. After some maneuvering, all the necessary legislation was passed by both houses of congress and on Tuesday, March 30, 2010, President Obama signed the Healthcare and Education Affordability Reconciliation Act of 2010 into law.

In the past week or two I have seen many questions about what the effects of this legislation will be. Behavioral health provider organizations are especially concerned about what the effects will be on mental health and addiction service funding.

One of the most useful resources I have come across was forwarded to the Florida Psychological Association member listserv by Dr. Bob Porter. The Bazelon Center for Mental Health Law has done an excellent job of summarizing the law and its impact on coverage for mental health services. While it will take years for all of the provisions of the new law to be implemented, a Congressional document summarizes some of the immediate effects.

In the private insurance sector, generic requirements of the law have particular impact for those with mental illnesses. In the past, such diagnoses have routinely triggered pre-existing condition clauses in policies. Within the first 6 months, the new law prohibits this discrimination.

  1. No discrimination against children with pre-existing conditions.
  2. No rescissions based on developing an illness.
  3. No lifetime limits on coverage.
  4. Tightly regulated annual limits on coverage.

In addition, for those who are currently uninsured, the law mandates:

  1. Immediate help for those with pre-existing conditions (an interim high-risk pool).
  2. Extending coverage for young people up to their 26th birthday through parents’ insurance.

Since so many who have been diagnosed with mental illnesses or with substance abuse issues have been denied coverage or have had coverage revoked or have reached the limits of their benefits, we should see immediate increased access to behavioral health and addiction services. The ability for parents to keep young adults on their insurance plans until they are 26 years old will assist some of the young people who experience late adolescent onset of serious mental illness or substance abuse conditions. This will allow a period during which their parents will be more able to facilitate transition to some other form of insurance coverage.

The National Council for Community Behavioral Healthcare, the trade association of behavioral health community service providers, hosted a webinar on healthcare reform and its impacts, Healthcare Reform: What Happens Next? Additionally, their Public Policy Update for April 1 gives links to resources as well as information about moving forward from here.

I attended the Council’s webinar this week and was struck by a couple of things. Because the Council primarily represents organizations that provide services in the public sector, their information is generally focused in this direction. For me, there were three take-aways from this session, and they were not all for public sector providers:

  1. The Council believes Fee for Service will probably go away in the long run, to be replaced by Case Rates with a Bonus for improvement of the consumer.
  2. Behavioral health providers need to position themselves for the long term. Integrated care is likely to be the way of the future and it is best to start to get positioned for that now.
  3. Private practices can be competitors in the new system; however, those with deep pockets who can manage the whole range of healthcare services will be better positioned to compete.

Community Behavioral Health Organizations (CHBOs) have been working on these steps for the past couple of years and there will be pilot programs using CBHOs together with Federally Qualified Health Programs to start to provide integrated care. Unless private behavioral health practitioners also start to position themselves to play in the Integrated Care setting, they are likely to get left behind.

Even the American Psychological Association’s advocacy efforts focus on the assurance that mental health services will be part of integrated care. This sounds very much like an integration of mental health services into such settings to me.

What do you think about how the new health care reform law will affect behavioral health services? Do you foresee changes in how care is provided? What changes are you willing to make in your organization in order to assure participation in a reformed health care system? Please enter your comment below. If you don’t see the comment box, just click on the title of the article and then enter you comment at the bottom.

The Day the Earth Stood Still: Humans & our planet

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Note: This article is my once-in-a-while exploration of human behavior and climate change. While it is in no way related to health care, it may be directly related to health.

Last weekend, we watched the critically unacclaimed remake of The Day the Earth Stood Still starring Keanu Reeves. While the movie left a great deal to be desired, it reminded me of the ongoing issue of human behavior and how we affect our world. This particular movie ends on a hopeful yet doubtful note that we will be able to change our behavior in time to keep climate change from destroying our species.

The American Psychological Association’s Climate Change Task Force Report has now been published in a nice booklet format. I am hopeful that the shorter, more attractive read will make the report accessible to more readers.

Section 2 of the report discusses the human behavioral contributions to climate change along with psychological and contextual components of the contributions. As is frequent in reports and studies by psychologists, ethical concerns are high on the list of issues to be considered. Since population growth and consumption of raw materials to manufacture those things which increase our perception of quality of life are two factors documented to contribute to the manner by which humans impact climate change, how we address population growth and consumption is crucial. Expecting developing nations to forego growth and consumption while the developed countries (like us) continue to consume is blatantly unjust. Many argue that expecting the developing world to forego growth is unjust even if we were to completely alter our own patterns of consumption.

Demographers have developed formulae to demonstrate the effect humans have on the environment. The basic

and widely known formula from the 1970s is I = PxAxT where I = Impact, P = Population, A = Affluence per capita and T = Technology. (APA Climate Change booklet, p 30, from Ehrlich & Holdren, 1971; Commoner, 1972; Holdren & Ehrlich, 1974)

Newer models take into account that countries with the highest per capita Gross Domestic Product plus intense consumption of goods and services requiring greenhouse gas production (environmental consumption) produce the most emissions and therefore the greatest environmental impact. These models are lovely ways to show in graphical form the impact of our reproductive and consumption choices. They do not, however, in any way address the variety of factors that contribute to growth in population (for example , individual and cultural religious beliefs; gender role beliefs; beliefs about individual vs. government control of reproduction; norms about when to start having children and how many to have; infant mortality; availability of food resources; and longevity. Population growth is a very complex phenomenon).

Consumption is an even more complex set of events and requires equally complex analysis. Each consumption behavior is multifactorially determined and requires analysis at different levels including institutional, sociocultural and physical environment context, individual factors such as demographics and psychological drivers, consumption of economic resources, consumption of environmental resources, greenhouse gases produced and emitted, and specific climate change.

The APA report discusses the need to separate consumption behaviors so we can determine which have the greatest impact on climate change. To spend significant resources researching behaviors with minimal impact will not be cost effective. To spend our time and energy learning about and affecting behaviors which have the most direct and largest impact on climate will be the best expenditure of psychological expertise.

While this report assesses what psychologists and the behavioral science community can do to impact climate change, the booklet is an articulate and readable explication of human behavior and climate change.

The question I have asked you before and will ask you again is the following: should we just sit helplessly by while the world (and our climate) changes around us, or should we learn what each of us can do in our individual and organizational lives to affect that change? What do you think?

How to Choose an EMR…and other pressing questions

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For those of you who attend to news about Health Information Technology (HIT) last week was a busy one.

  • The 10th annual meeting of the Health Information Management Systems Society (HIMSS) in Atlanta took top billing. One of my favorite bloggers [EMR (EHR) and HIPAA] attended and posted frequently during the conference. John has been writing about EMRs since December 2005 and his knowledge is considerable. In fact, he just published his own e-book on how to choose an EMR. He is sincerely interested in the best ways for a facility or practice to choose the best EMR for their organization. John’s Sunday post referenced an article by Didier Thizy from macadamian titled “Electronic Medical Records – 3 Key Differentiators“.The three most interesting and possibly most important differentiators Mr. Thizy heard being promoted by EMR vendors at HIMSS about their systems were:

The EMR has excellent UI (user interface) and usability.
The EMR is designed for a specific speciality.
The EMR’s technology makes the user’s life easier.

Obviously, when it comes to electronic medical records, one size does not fit all. Making sure that you take usability, specialty specificity, and life simplification into consideration is likely to make your selection a better fit for your organization.

  1. The Veterans Administration and the Department of Defense have been working diligently through a contractor to connect their respective EMRs so they can communicate with one another. After incorrect communication of patient information (providing information about the wrong patient in response to a user query), the VA decided to shut down access to the DoD system. Hopefully, this is a very temporary glitch and does not mean a complete return to the drawing board.
  2. The Medical Group Management Association (MGMA) expressed concern about results of a survey they completed recently. They found that practice executives are not as optimistic about productivity gains as software and information management executives. Over two-thirds of those surveyed believe that physician productivity will decrease because of the proposed meaningful use criteria. The other third of practice executives felt productivity would increase. This split resulted in MGMA’s chief Dr. William F. Jessee’s statement: “For the incentive program to succeed, the meaningful use criteria must be practical and achievable. If the final rule mirrors those outlined in the current proposal, there is significant risk that the program will fail to meet the intent of the legislation, and that a historic opportunity to transform the nation’s health care system will be missed.”The survey results indicated which criteria will be most difficult to meet:
  • The proposed requirement that 80 percent of all patient requests for an electronic copy of their health information be fulfilled within 48 hours (45.9 percent) and
  • The proposed requirement that 10 percent of all patients be given electronic access to their health information within 96 hours of the information being available (53.5 percent).

    • Those of you who like to closely follow news in the health care IT space might consider following these two excellent sources yourselves:

    EMR (EHR) and HIPAA and FierceHealthIT