Will Your Organization Weather a Storm…or Other Catastrophe?

Superstorm Sandy has had major impact on the lives of large numbers of our fellow Americans and colleagues who live in the Northeast U.S. The loss of life, property, and access to conveniences like electricity, warm showers, and transportation has made clear how vulnerable we are to the impacts of catastrophic events.

Sandy has also given us the unfortunate opportunity to evaluate the policies and procedures we have in place for dealing with physical catastrophes.

The Health Insurance Portability and Accountability Act (HIPAA) requires that organizations have in place a Contingency Plan (STANDARD § 164.308(a)(7) Contingency Plan, see page 19):

The Contingency Plan standard requires that covered entities:

“Establish (and implement as needed) policies and procedures for
responding to an emergency or other occurrence (for example, fire,
vandalism, system failure, and natural disaster) that damages systems that
contain electronic protected health information.”

This requirement is not aimed at giving you one more thing to do. The purpose is to protect the health information of your patients and to make sure that they have access to continuing care. Hurricane Andrew in 1992 and Hurricane Katrina in 2005 demonstrated how poorly prepared we have been to maintain continuity of care for our patients. The requirements of HIPAA are designed to prevent such huge failures as happened previously.

FiercePracticeManagement newsletter suggests three key steps.

  1. Know how your remote data is stored and can be accessed. This assumes that you have your data stored offsite, as it should be. Knowing just where it is and how to access it so you can get your system back up and running without delay is crucial. 
  2. Duplicate needed paper and have it with you. Make sure you have a copy of your schedule with you. Assure that you have with you ways to contact your patients so you can let them know your alternative arrangements for meeting with them.
  3. Plan where you will relocate physical data. Know where that alternative location will be so you can get access to your data again quickly.


In HealthCare IT News, Benjamin Harris covers some of the same ground. He also suggests three basic processes, but starts at a more basic level.

  1. On-site safety. How is your hardware and software and record systems protected at your site? Is your server located in the building basement along with the generator? As demonstrated by Sandy, the basement is not the best location for such equipment or records in the case of flooding . . . something that had previously been an issue in hurricanes Andrew and Katrina.
  2. Off-site data. If you are relying on a remote (cloud) storage facility or you need to access your data by means of the Internet, what do you do if your ISP (internet service provider) is down? And if your EHR is an online product, what do you do if those remote computers are underwater and without electricity? Having your schedules for the next week and treatment summaries for each of those patients printed out gives you a week of buffer time to give your vendors a chance to get back up and running.
  3. Accessibility. If you are using such remote storage or providers and they are not in the affected area or can implement access to backups quickly, having the capability of connecting to them becomes your responsibility. You can tether your laptop to your cell phone to reach your service or data in an emergency, as long as you have prepared in advance.


Madeline Hyden of the Medical Group Management Association (MGMA) suggests a slightly different but very practical list of steps.

  1. Secure your electronic information.
  2. Get the support of your professional colleagues.
  3. Immediately start securing new office space.
  4. Establish authority: Make sure someone in your organization is responsible to and has the authority to activate your contingency plan.
  5. Communicate with your vendors (hardware, software, backup services, electrical company, landlord, billing service, answering service).
  6. Develop a notification protocol: decide who to contact and how and who does the contacting. Determine just what they will be told.
  7. Communicate honestly with your patients.
  8. Protect your records so you are sure you can have access even if your main system is not accessible.
  9. Practice your emergency plan. If you have not done so, it is possible you will be too traumatized to carry it out.

If you are not sure how to go about establishing a contingency plan, AHIMA has some suggestions for you. This does not need to be a complicated process, but it is a process you need to address if you have not already done so. After all, the U.S. northeast coast did not think they were susceptible to a hurricane-like storm that could cause such disruption.

Whether it is hurricanes, snowstorms, tornadoes, earthquakes, or fires, our electrical systems and business facilities are not impervious to disasters. We must be prepared so our patients can rely upon continued care.  Behavioral health clients are especially susceptible to negative consequences from disruptive events. After all, they are likely to have just experienced the same trauma you did.

We hope all our SOS customers and their patients are safe and recovering in the aftermath of Sandy. We hope any of you, our readers will share your experiences and how you have assured the security of your data.


Psychiatric CPT Codes Changing in 2013

Every year, changes are made to the Current Procedural Terminology® codes to reflect changes in actual practice of medicine and related fields. Use of these CPT® codes, as they are called, is required for reimbursement by insurance carriers. The American Medical Association establishes procedures including workgroups in various disciplines to assure that the codes keep up with the times. Since payment is based on the codes used, it is essential that providers keep informed about changes.

In 2013, significant changes to psychiatry and psychotherapy codes will occur. While those changes are not yet finalized, providers should understand what they are and be on the alert for the publication of the final codes.

The American Psychological Association participated with the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, the American Nurses Association and the National Association of Social Workers to examine the definitions of the CPT psychotherapy codes. Most of the codes that have previously been used will be removed and new ones adopted.

Since these codes are the basis for payment for most behavioral health services, the billing of most behavioral health organizations will be affected. The National Council and other professional groups will be reporting on these changes. Stay tuned…


Current Procedural Terminology (CPT®) copyright 2012 American Medical Association. All rights reserved.

Favorite Technology Tools

I know that most of you work in behavioral health organizations. You probably use the technology that is provided to you even if you know of better tools that would make your work life smoother and easier. After all, the goal is to serve consumers of substance abuse and mental health services, not to the be the coolest technology shop around.

But maybe that is not totally the case. . . . Do you have a favorite technology tool that you love to use in your practice or workplace or at home? Is there something that has become so indispensable that you cannot imagine getting along without it?

I am not a big searcher for new software programs or apps for my Android cell phone or Amazon Fire. I tend to try things that are offered by family or friends, choose the ones that work for me, and then leave well enough alone. If I have chosen well, the updates offered by the company from whom I have purchased the product almost always keep up with and even anticipate my needs. But that is not always the case.

A few years ago, I was considering creating a training video for our electronic claims module. I saw some information about a program named Camtasia Studio, by TechSmith. I liked the description so much that I tried the free demo.

I was in love! This program does everything I need a video-creation tool to do, and it does it simply. I started with Camtasia 4 and am now at version 7.1. Like I said, when I find a tool that works for me, I tend to stick with it.

This is the sort of video you can create with Camtasia.

When I first started doing these movies, I let our web server handle them and just gave the direct link to the file to the customers we wanted to see them. This got the training module into the right hands, but did not make the video available at large.

Now I want to go farther. I want to be able to create videos and to embed them here on my blog or on our web site. Even though I am not an expert video maker, I want to create more of them and get them out there. The more I do, the better I will get at them.

What cool tools do you have that you rely on every day? Is there some program or app that you cannot do without?

Please tell me what you think. Your feedback and comments are always appreciated.

Collaborative Documentation: New National Council Webinar

If you have read this blog for a while, you are no doubt aware that I am a webinar junkie. There are loads of free webinars available and they provide lots of very useful information. I am especially fond of the webinars presented by The National Council and have written several articles based on their webinars on topics such as Health Information Exchange and behavioral health, integrating behavioral healthcare into the healthcare home, compliance requirements, and the impacts of healthcare reform on behavioral health providers.

These presentations have usually been packed with information, quick-moving, presented by very well informed individuals or panels, and a pleasure to attend. The webinar I attended today was no exception.

Collaborative Documentation Promotes Efficient Services for Children & Youth was presented by Katherine Hirsch, MSW, LCSW, Consultant, MTM Services, LLC. Ms. Hirsch did an excellent job of explaining just what collaborative documentation is, how to do it, how to engage the client in the process, and what the benefits are. She covered an impressive quantity of high quality information in 90 minutes.

If you are looking for ways to more effectively use psychotherapeutic time, improve the accountability of your staff, and assure that records are completed in a timely fashion, you need to see this webinar. In about 48 hours, the recording of the webinar will be available for viewing at the National Council website.

Behavioral healthcare faces many challenges in these rapidly changing times. Finding the time to provide services well and effectively while accurately and carefully documenting those services is a real challenge. Learning how to utilize collaborative documentation can increase your chances of success.

Are you already using this methodology? How is it working for you? for your staff? Please share your experiences in the comments below.


Self-Awareness and Personal Responsibility

The holiday last Monday made it difficult to get to my blog. As each new item that I needed to handle came up, I found myself thinking about what I had hoped to write. Thinking about it was all I managed. No matter how much I thought, I did not discipline myself to leave all the other items aside and write.

Self-discipline is not one of the things I have been short on in my life. I was raised and educated in a setting that strongly taught the need for and benefits of taking responsibility for my own thoughts and actions and shaping them to the way I wanted and needed them to be. The last ten years have included many times when it was harder than ever before to focus myself and move forward, but because I have long known the methods that are most effective for me to achieve self-discipline, I have been able to do so. Taking personal responsibility is second nature for me (except, of course, in the areas where I have complete blind spots!).

For me, this self-discipline has resulted in a strong tendency to take action. . . in pretty much any situation in which I deem action to be necessary. If I have allowed a few extra pounds to creep on, I act to reduce my caloric intake and increase my activity. If I am driving or walking somewhere and have become lost (and don’t happen to have a GPS with me), I ask for directions. If a cause in which I believe is being threatened, I make contributions and write emails. I have always seen it as my responsibility to take action when I could and when it was necessary.

I am currently reading Jon Kabat-Zinn’s book Wherever You Go There You Are. . . one small section at a time. This week, the following paragraph struck me:

What is required to participate more fully in our own health and well-being is simply to listen more carefully and to trust what we hear, to trust the messages from our own life, from our own body and mind and feelings. This sense of participation and trust is all too frequently a missing ingredient in medicine. We call it “mobilizing the inner resources of the patient” for healing, or for just coping better, for seeing a little more clearly, for being a little more assertive, for asking more questions, for getting by more skillfully. It’s not a replacement for expert medical care, but it is a necessary complement to it if you hope to live a truly healthy life—especially in the face of disease, disability, health challenges, and a frequently alienating, intimidating, insensitive, and sometimes iatrogenic healthcare system.

Developing such an attitude means authoring one’s own life and, therefore, assuming some measure of authority oneself. It requires believing in oneself. (My italics)

Most individuals who work in behavioral healthcare are expert at helping others to mobilize their inner resources. This is a large part of what psychotherapy is about. For the seriously mentally ill, helping them see that they have inner resources is significant. . . and a major contributor to the process of recovery.

I have a great deal of difficulty with the large number of people who see the things in their lives going wrong and who feel they can do nothing or who choose to take a passive rather than an active posture. . . but gladly complain about all that is wrong. Listen to talk radio, stand around the metaphorical office ‘water cooler’, shake their heads saying ‘what is this world coming to?’. . . and then go on with their own little lives as if nothing else matters.

I am currently watching this budget debacle unfold in state legislatures (I live in Florida) and Congress. As we all know, the recession and unemployment have resulted in significantly lower tax revenues at every level of government. We have allowed those who represent us to pass laws virtually exempting the wealthy and large corporations from taxation while they rake in the profits. The rest of us continue to pay our sales and property and income taxes, but the working and middle classes just do not earn enough or pay enough in taxes to support the level of government spending that we have all demanded.

The decisions that are being made will most likely result in the deconstruction of the ‘safety net’ that has for the past twenty years provided some minimal care for the chronically mentally ill. As usual, those least able to speak up for themselves will pay the price. . . for the mortgage crisis, unfunded wars, and irresponsible tax cuts.

What is the responsibility of each one of us for the upcoming deconstruction of Medicaid, and possibly Social Security and Medicare? How do you feel about sitting around and complaining vs taking action? Who’s job is it, anyway? Please share your comments below.