I know all of you have huge amounts of time on your hands, right? Of course, that is not true. We are all terribly pressed for time. One way that many busy professionals have learned to increase their exposure to recent information in their fields of expertise is through listening to podcasts on an iPod or other mp3 or mp4 player.
Wikipedia defines podcast as “a type of digital media consisting of an episodic series of files (either audio or video) subscribed to and downloaded through web syndication.”
Those of you are under 30 are asking why I am defining the word podcast. Certainly, everyone knows what a podcast is. I am doing so because there are many of us in the 40+ age group who have never listened to or viewed a podcast, even if we know what it is. We are still getting up to speed!
I wanted to let you know that American Psychological Association (APA) mentioned the growing availability of psychology podcasts in the January edition of the Monitor on Psychology. There are shows that focus on the brain and behavior, others on the mind, others are interviews with psychologists and neuroscience researchers. It is an extensive list!
Obviously, there are lots of ways to find podcasts that might interest you. A quick Google search for ‘Podcast Directories’ turned up 63,600,000 results. You are bound to find some interesting ones in these listings.
I have not yet downloaded podcasts. I do, however, have benefit of listening to some of those Seth has downloaded. One of my favorites is Science Friday, an NPR radio program that also uses the podcast format. They frequently have psychology and mental health-related shows.
I hope you will try out some of these resources to determine if they are a good way for you to access information in your field of expertise. If you are already hooked on podcasts, please share the names of some of those you like, whether related to behavioral health or to other areas.
The Office of the National Coordinator for Health IT (ONC) recently launched a Privacy & Security Mobile Device project. Today I received an email about it.
Privacy and Security Mobile Device Good Practices Project Launched
ONC’s Office of the Chief Privacy Officer (OCPO), in working with the HHS Office for Civil Rights (OCR), recently launched a Privacy & Security Mobile Device project.
The project goal is to develop an effective and practical way to bring awareness and understanding to those in the clinical sector to help them better secure and protect health information while using mobile devices (e.g., laptops, tablets, and smartphones). Building on the existing HHS HIPAA Security Rule – Remote Use Guidance, the project is designed to identify privacy and security good practices for mobile devices. Identified good practices and use cases will be communicated in plain, practical, and easy to understand language for health care providers, professionals, and other entities.
HHS will be looking for your input. Stay tuned for a public roundtable this Spring.
The proliferation of laptops, smartphones, and tablets and their use to access Protected Health Information (PHI) of patients has lots of people worried. Some of the largest breaches of data reported have been through the loss of laptop computers. In November 2010, ONC developed a document on Cybersecurity: 10 Best Practices for the Small Healthcare Environment relating to offices and networks. The problem is that during the last 18 months, smartphones and tablet computers like iPads and Kindles that can access the Internet have become ubiquitous.
The biggest problem with using these devices to remotely access PHI is that there are not yet security protocols and procedures in most organizations aimed at guaranteeing the privacy of the PHI accessed remotely.
Imagine for a moment: your physician is sitting in a coffee bar with a public wi-fi when s/he gets a call that you need an emergency refill of your blood pressure medication. The doctor uses a smartphone to login to the ePrescribing software used by the practice and sends the prescription to your pharmacy. Doctor finishes the cup of coffee, slips the phone into a jacket pocket and gets up to leave the shop. Unfortunately, the phone does not make it into the pocket and winds up on the chair as the doctor leaves.
You know the rest of the story. Someone finds the phone and messes around with it while deciding whether to try to find the owner. Since Finder can start everything on the phone (you see, there is no password), they can go right back to the last app used to see what the owner was doing. Since Doctor had the browser set to save passwords, Finder can log right into the ePrescribing software. . . .
Unfortunately, additional scenarios are also possible. That public wi-fi is known to everyone in the neighborhood and there are a couple of folks who sit around drinking their coffee capturing usernames and passwords from insecure sites. Who knows what they are capturing and accessing . . . maybe your username and password for your organization’s network!
The biggest concern with mobile devices is that they have proliferated so rapidly that organizations have not had the opportunity to develop protocols and adequately train staff members to have some semblance of a guarantee that PHI is secure. So ONC is doing what it can to shed some light on the subject and increase awareness.
In the meantime, this article has 5 security tips for your smartphone or tablet.
What is your organization’s policy about accessing protected health information remotely? Do you have policies?
Please share your comments below.
We live in the world of mental health billing. When you live in that world, it is very easy to forget that not everyone else lives where you do. Some folks have never heard of what we do. Others just visit our world when they must.
As you know, there are massive changes happening in the healthcare world. Many of those changes pertain to electronic medical records (EMRs), but there are also important occurrences related to the billing/practice management side of the behavioral health organization.
So here are those three things you need to know:
- The 5010 changes only relate to electronic claims. If you are still filing claims on paper, changes from the 4010 to the 5010 versions of the 837 claim filing format do not affect you.
- January 1, 2012 is still the deadline for beginning to send 5010 formatted claims. CMS and the Office of Civil Rights (OCR) have indicated that they will not begin to fine organizations that are not yet sending 5010 claims or payers who are not yet receiving them, but the deadline date still stands. After March 31, 2012, OCR will begin the enforcement process
- Our clearinghouse partner, Emdeon, made this transition easier than anyone could have imagined.
We use only one clearinghouse, but we have customers who send claims directly to several Medicare and Medicaid payers. Those custom, direct-sends have been a royal pain. Some of the payers were not ready for us to test until the last possible moment. Some of them were ready for testing but required that our customer start sending the 5010 even before the deadline. Some changed the testing process along the way; others had a procedure but did not inform us of all the steps when we first contacted them months ago. Many have been virtually impossible to reach by telephone in order to get assistance for our customers.Emdeon has done just what a clearinghouse is supposed to do. They began a timeline for testing and implementation almost two years ago. They had a testing system in place so our development staff could get help if needed but could also do iterative testing without someone there needing to intervene at each step. And finally, they assured us that there would be the capability of sending a 5010 early or continuing to send a 4010 with them translating to 5010 if a customer needed that to occur.
Once our customers started sending, Emdeon was ready! Our customers are able to check the status of their claims using Emdeon’s Vision. If there were problems, we have an account representative we can speak to who intervenes immediately. In the couple of cases were there was an issue with a payer, Emdeon dealt with the payer, not us.
By our standards, all of those things make our Channel Partner relationship an extremely valuable asset for our customers.
The next big, systemic change will be the move to the ICD-10, with a current deadline date of October 1, 2013. This one will affect everyone, those who file claims electronically and those who file on paper. The American Medical Association (AMA) has decided to fight that deadline on behalf of American physicians. They believe the cost to providers is too large, especially following so quickly upon the move to EMRs. Whatever the deadline, this will be a massive change requiring everyone to use different diagnosis codes and requiring hospitals to use different procedure codes. We can only hope the chaos will not be as great as could be possible.
Please share your experiences and thoughts about these changes. Just comment below.
Before I get too far into this post, let me be clear about a couple of assumptions.
1. I am an advocate of Healthcare Reform. I was disappointed in the bill that finally passed because I believe it was not a strong enough protection for consumers. Given that, I am glad we have a healthcare reform law on the books.
2. I believe that most consumers would benefit in the greatest possible way from a single payer system. This could be modeled on Medicare or utilize some other possibilities, but I think a single payer system is the only way we will ever get a healthcare system that truly meets the needs of most consumers and costs the least.
Given those assumptions, you will understand my reaction when I read a new article in FierceHealthPayer, a weekly newsletter for healthcare plan executives. If you are involved in the purchase of health insurance for your organization, the title of the article, Insurers Profit from Health Reform, will come as no surprise to you. Of course insurers are the primary ones who will profit from health reform in its current incarnation.
After dropping almost $90 million to oppose the health reform law, repeatedly claiming its provisions would raise costs and disrupt coverage, health insurers actually have benefited the most from the law, according to a Bloomberg Government report released Thursday.
The article goes on to explain that most of the increases in revenue are the result of these companies expanding into government programs. You see, even though Medicaid and Medicare are government programs, they are often administered by private insurance companies. With the expected expansion of the Medicaid program mandated by the Affordable Care Act, there should be even more income growth for insurance companies.
So who’s going to lose money on healthcare reform? Guess what….it’s us again. Those of us who purchase insurance in the private marketplace were subjected to 9% increases on average in 2011…increases aimed at covering the costs of the mandates of the healthcare reform law long before required by the law. That way, we absorb the costs and the insurance companies get to go on paying their executives outrageous salaries and making their profits.
I wonder what it will take for people to finally realize that healthcare and health insurance need not cost so much. I don’t expect it to happen as long as corporations control our government and our lawmakers. I know many folks believe the problem is just the opposite. Government should get out of the middle of the relationship between the healthcare provider and the consumer. Competition and market forces would take care of costs.
What do you think? Who will pay for care for the chronically ill . . . and the chronically mentally ill if we don’t all chip in to do it? Is there enough compassion in the marketplace to assure that children, the poor, and those unable to pay for health insurance because of mental illness will also receive good quality healthcare? Please share your thoughts. I would love some help in understanding how we can assure that we will all get the healthcare we need without spending half our income on health costs.
Are you a resolution-maker? Are you gearing up to lose those extra pounds you put on last year? Have you set new goals for your productivity, your work ethic, your family time or your compassion? Some statistics show that 40 – 45% of adult Americans make New Year’s resolutions; if you do so, you have lots of company.
When I was a younger person, I made resolutions every year and worked hard to keep them. In the past several years, my energy has been scattered in too many directions to even make resolutions, much less to keep them.
This year feels somewhat different. I achieved several goals I set for myself personally in the last half of 2011 and doing that has made me more open to a resolution or two in 2012. Both of those I am setting pertain to my work and are shared with me by other members of the SOS team…particularly those of us in customer service.
- We have resolved to provide customer service that is strikingly above expectations to our clients. Those who trust us to provide software and support to accomplish their business needs deserve nothing less.
- We have resolved to help all of our customers to send their claims electronically . . . especially those who have already purchased our claims module, but who have never begun filing.
Neither of these resolutions is earth-shattering. We hope that makes them reasonable to accomplish. We trust that you will let us know how we are doing.
Please share your resolutions, or let us know why you have decided not to make any.
We hope for a healthy, happy and extraordinarily successful 2012 for all of you!
Last month I told you about a novel I had read that fascinated me. Now I am here to tell you that both the first book, Daemon, and its sequel, FreedomTM , are must-read books for individuals who are concerned about the way the U.S. is moving . . . . or not moving.
When I say the U.S., I do not just mean the U.S. Government. I also mean U.S. and multinational corporations that are loyal only to their bottom line, private U.S. military contractors (otherwise known as mercenaries), the U.S. economy, U.S. buying/consuming habits, and the knowledge, involvement, and activism of the U.S. citizenry.
Daniel Suarez, the author of these books, is a systems consultant and programmer. He knows about the software and devices that run our lives. He has consulted extensively on data security to Fortune 1000 companies. The technology described in his books is all current and real . . . and very frightening. His stories successfully make the point that our identities are so tied into the computer systems that run modern life, that our civilization could not survive without them. As we move toward digitizing our medical and mental health records, we simultaneoulsy decrease errors and increase our vulnerability. Long-term loss of electrical systems in a dozen major cities globally could destroy our entire way of life, including our food distribution system. Even a short-term loss of electricity can throw us into major disarray. But not necessarily . . .
A key element of FreedomTM, is that sustainable communities that are not totally reliant on centralization of resources can survive even major disruption. Sustainability is defined on Wikipedia as “the capacity to endure.” It is the ability to survive based on a balanced and reasonable use of resources that does not deplete those resources.
Currently, the concept of sustainability is enjoying popularity in some government circles. The EPA, HUD, and DOT have developed a program for developing sustainable communities. These programs focus on housing and business development in urban and rural areas and how to do it in a way that contributes to the well-being of everyone involved, including wildlife and the earth.
Not-for-profit organizations and think tanks focused on a sustainable future have been appearing over the last decade. Philosophical and spiritually grounded individuals have long taught of the need for changes in how we think and live that will result in our well-being. Even some businesses profess sustainability as part of their business mission.
But without action from concerned, educated, and involved individuals, none of these movements will gain the traction they need to affect how we live.
I have long believed that an informed community is also an activist community. When I take the time to educate myself about the events and issues of the day, I am also motivated to examine those events in light of my own beliefs and values. When the values I hold dear are threatened, I take action. At least, that is what I used to believe. I know a few people who do that, but not very many. I do not share the political values of the Tea Party. I do share their belief that it is the responsibility of citizens to express their opinions and to become involved in the political process . . . after educating themselves about the issues.
I know, I know…you don’t have time to breathe. You already work in healthcare, most of you in the mental health community. You take care of other people as part of how you make your living, you certainly cannot consider taking the time to learn more about what is happening in our country and worldwide so you can become even busier. Getting involved in your community or becoming activist about issues that concern you is just out of the question.
And yet . . . unless more of us take the time to become such activists, we may not have day-to-day activities to be concerned about.
I hope you will read these books when you can. They are very good reads . . . extremely entertaining and very informative. Just view them as a treat to yourself.
Then decide what you need to do.
In 1992, when Bill Clinton was elected President of the United States for the first time, I was a member of the Committee for the Advancement of Professional Practice (CAPP) of the American Psychological Association. CAPP is charged with general governance oversight of the Practice Directorate, the part of APA responsible for promoting “the practice of psychology and the availability and accessibility of psychological services, providing resources and services to practicing psychologists in all settings and to the public.”
Our first meeting immediately after the election was highly charged. Staff had been studying President Clinton’s healthcare proposals, and the notion of controlling cost through “managed care.”
President Clinton’s healthcare proposals did not fly, but the industry picked up the notion of controlling costs by managing the care provided to consumers, and psychological practice has never been the same. For private practitioners, “managed care” continues to be a primary obstacle to the practice of psychology. Costs might have been suppressed by managing care, but some would argue that the primary effect of the managed care revolution was the creation of a new industry that made money as the middle-men at the cost of providers. Indeed, after a few years of leveling of the costs of care, the rise has been renewed and expanded.
In mid-November, the Supreme Court of the U.S. agreed to hear an appeal of the Affordable Care Act, our nation’s most recent effort to reform our healthcare system.
The Supreme Court agreed to hear appeals from the United States Court of Appeals for the 11th Circuit in Atlanta, which is the only court to have struck down the individual mandate because it overstepped Congressional authority and wasn’t justified by the constitutional power “to regulate commerce” or “to lay and collect taxes.” FierceHealthPayer, November 18, 2011
According to editor Dina Overland of FierceHealthPayer newsletter, even a complete overturn of the law would have little significant impact. She believes that consumers like the changes the law is mandating and there is no stopping this train.
Mercom Capital Group, in their HIT Report of November 21, 2011, says the same thing about the massive changes in the healthcare arena at large. Basing their conclusions on a report by PwC (PricewaterhouseCoopers, LLC), Mercom reports that health organizations will continue to move forward with changes to their health technology and other innovations because the multiple drivers in the marketplace have finally come to a head. No matter the political or the financial uncertainties, PwC believes this movement will continue. These are changes consumers like, and the movement will continue no matter which market forces might change.
In their HIT Report of November 28, 2011, Mercom reports that Harvard and Aetna will ally to work to improve healthcare costs and quality. The two have formed a research collaborative focused on improving the quality and cost of healthcare. They will use bioinformatics, the interface of computer science and information technology with the fields of biology and medicine, to analyze healthcare data in innovative ways. They will focus on outcomes of various treatments considering quality and cost, factors that predict adherence to medical and drug treatments for chronic diseases, examining how claims and clinical data can be best used to predict disease and follow outcomes, as well as other treatments of data that will emerge over time.
Where is your organization in the midst of this dramatic change in how we manage healthcare? How do you see yourself participating in the sea change that is under way? Where does behavioral healthcare fit into this picture?
Just type in your thoughts below. Thanks for commenting.
I am feeling particularly grateful right now.
We spent the past weekend working hard for our bicycling club’s annual fundraiser, the Horrible Hundred. I have written about our work on this ride in the past, but this year I have been feeling especially grateful for our wonderful team. Without them . . . their willingness to work very hard for a long day for no apparent reason other than a job well done, and their ability to overlook and laugh at the foibles of their co-leaders . . . we would never have been able to organize a successful ride rest stop for eight years.
I am also grateful that this is our last year organizing that project.
Focusing on gratitude got me started in a direction I should go more often. With the annual Thanksgiving holiday just ahead, I was encouraged to look further. I took a quit trip to the web site for The Happiness Project, Gretchen Rubin’s bestseller, and sure enough . . . she is exploring the notion of gratitude this week . . . with a focus on thankfulness for things that do not happen. A quick search of her site revealed about 40 entries in which gratitude is explored in some fashion. After all, having an attitude of gratitude is considered by many to be a key ingredient of happiness.
In fact, a quick Google search of the word gratitude comes up with over 56,600,000 results. That number amazed me! It is not quite so many hits as a Google search for the word ‘greed’ produces (it comes in at 58,200,000 quick results), but it is still a well-mentioned concept in our culture.
The number of hits on ‘greed’ suggests that we might need to improve our focus on gratitude to become better human beings. I get irritated with those greedy folks and their sense of entitlement. I am very grateful for those in my life who have an ongoing sense of awe at the beauty of the world and the goodness of others. They remind me that not everyone . . . maybe not even most people . . . believe that the world owes them anything.
- I am thankful for my family and friends who are always there when I need them….and even when I don’t.
- I am grateful for my co-workers who have been with us for so long and keep on producing so our customers have outstanding software and great support.
- I really appreciate those of you who are our customers, who use our products and recommend us to your friends and colleagues.
- I am thankful that there are a few people in addition to our customers who like to read what I have to say.
- I am profoundly grateful that we live in a beautiful place where we feel connected to nature daily.
- I am thankful that I have found yoga practice, and that I have so far to go to get anywhere near maximum benefit from it. There is only upside!
- I so much appreciate that I will see well-loved family members in just a couple of days.
What role does gratitude play in your life? Is it important in your day-to-day view of the world? For what are you most grateful? What do you do to practice gratitude?
Please share your thoughts and experiences with the rest of us. We will be most grateful. And do have a wonderful Thanksgiving holiday.
Do you play multi-player interactive games on the internet? How involved are you in the world of those games? Have you ever wondered how those games relate to the real world…or if they do?
I recently finished reading Daemon by Daniel Suarez. I was so fascinated by the ideas in the book that I just downloaded the free chapters of the sequel, FreedomTM and have requested the book from my local library. While I am waiting, I have been thinking and doing some research.
The premise of the book is that a dying computer game writer creates a program (called a daemon) that initiates upon news of his death. The extent of the infiltration of that program into the worlds of the rest of us is amazing. The book explores the worlds of computer and credit card hackers, drug cartels and crime syndicates, and all the government and quasi-government but private organizations potentially involved in these events.
This book is written by a computer systems person who consults to Fortune 1000 companies. His presentation of the events and concepts makes for a very exciting though violent story. It is called a techno-thriller. I call it science fiction….but all the technologies are current, so the events could occur.
I work in a high tech industry. We write software, so I thought I was at least somewhat informed about the technological world. This book revealed to me that I am totally ignorant of this whole realm. That is part of what is interesting to me about it. How can I live and work in the sphere I do and still have no idea about this arena?
Techies find this book and its sequel pretty fascinating. An article written by Josh McHugh in 2008 in Wired magazine talks about how the author got serious credibility in the geek world after self-publishing the book.
An organization called The Long Now Foundation . . . that is focused on encouraging and supporting long-term thinking about and responsible action in our world . . . had Suarez present a seminar about bot-mediated reality to members. As with most things I find interesting, the links I find in the cyber-world about my starting point are equally fascinating!
I have tried not to be a spoiler about Suarez’ books. That may have made this article a bit too vague. I hope you are interested enough to take a look at the links. Maybe it is time for us to balance our focus on the present and too many things to do with thought about the future and where we are taking ourselves.
Please share your comments below. Since I have no history with computer games, please share your experience and insights in that world.
Several years ago, I signed up with the federal Office of Civil Rights online Privacy listserv so I would get notifications about HIPAA. I have been delighted with that subscription over the years. If you are an organization that provides healthcare services, you too should subscribe.
Today I received a new sort of notice from the listserv…one aimed at informing as many individuals as possible about an upcoming test of the federal Emergency Alert System.
Date: Thu, 3 Nov 2011 12:11:48 -0400
From: “OS OCR PrivacyList, OCR (HHS/OS)” <OCRPrivacyList@HHS.GOV>
Subject: First Nationwide Test of the Emergency Alert System; November 9 at 2pm EDT
FIRST NATIONWIDE TEST OF THE EMERGENCY ALERT SYSTEM
Test to Take Place November 9 at 2 p.m. EDT
Dear Colleagues;
We need your assistance in notifying everyone about the November 9th nationwide test of the Emergency Alert System. Please help distribute this to all your stakeholders, as far and wide as possible, to ensure the entire community is aware that
As part of our larger efforts to strengthen our nation’s preparedness and resiliency, the Federal Communications Commission (FCC) and the U.S. Department of Homeland Security’s Federal Emergency Management Agency (FEMA) will conduct the first nation-wide test of the Emergency Alert System on November 9th at 2pm Eastern Standard Time.
The national Emergency Alert System is an alert and warning system established to enable the President of the United States, if needed, to address the American public during emergencies. It is another critical communications tool that can protect the public and strengthen our nation’s resiliency. The National Weather Service, governors, and state and local authorities also use parts of the system to issue more localized emergency alerts. The test is an important exercise in ensuring that the system is effective in communicating critical information to the public in the event of a real national emergency.
This national test will help federal partners and EAS participants determine the reliability of the system, as well as its effectiveness in notifying the public of emergencies and potential disasters both nationally and regionally. The test will also provide the FCC and FEMA a chance to identify improvements that are needed to build a new, modernized, and fully accessible Emergency Alert System.
To support the disability community, FEMA has developed a toolkit that will allow you to reach out to your constituents and local partners. The toolkits, attached here in multiple formats, allow you and your organization to quickly disseminate information about this test.
In addition, we’re also releasing two new videos created to support the outreach efforts of our disability community partners. FEMA Administrator Craig Fugate has long been a champion of the whole community and ensuring that FEMA represents the diversity of the people we serve. In one video, Neil Mc Devitt, from FEMA’s Office of Disability Integration and Coordination joins Administrator Fugate in outlining the need for the upcoming Emergency Alert System test and the accessibility challenges posed by the test. The video has American Sign Language, open-captions, and is voiced throughout. We’re also happy to provide a Spanish version of the message with open-captions.
If you have additional questions for FEMA-Office of Disability Integration and Coordination questions, please contact our office at
Marci Roth
Director
Office of Disability Integration and Coordination
* FEMA Administrator’s Message – http://www.fema.gov/medialibrary/media_records/6407
* ASL Video: http://www.fema.gov/medialibrary/media_records/6407
* Spanish Video: http://www.fema.gov/medialibrary/media_records/6408
Please share this information with your constituencies, colleagues, friends, and families. Remember, on November 9th at 2pm ET, “Don’t stress; it’s only a test.”
I was fascinated at using the HIPAA listserv for this purpose. As I read through the notice, it became clear that FEMA is quite concerned about insuring that disabled individuals of all sorts receive notice of this test so they are not alarmed when the test occurs. Using a listserv that reaches healthcare providers is actually an excellent use of this list. After all, most disabled individuals are in touch with healthcare providers.
Please feel free to pass this information…or even this blog…on to your clients. It is important that consumers of behavioral health and other health services realize that the event scheduled for Wednesday, November 9, 2011 at 2pm is a TEST of the Emergency Alert System.
Good for you to know it too!
Thanks for reading and sharing the information in our blog.
I have been thinking a good deal lately about how to motivate myself and others in my life. When I was a psychotherapist, I spent lots of time helping patients understand their motivations and utilizing those motivations to help them create change in their lives. Knowing what drives us to do things is important to achieving any of our goals or satisfaction in our lives. Of course, my patients were in my office because they felt the need for change. They already had motivation, albeit a negative one…they were in pain…an internal state that they wanted to get rid of. But they did not know how to make change in their lives; they needed a different set of skills. That is what psychotherapy is good for.
I have not looked at the work on motivation in a long time. In order to write this article, I did what everyone who uses a computer today does….I Googled it. I repeatedly came upon the name of one individual and had to get more information about him. After all, he is not even a psychologist or other researcher.
Daniel Pink is a bestselling author who was at one time Al Gore’s chief speechwriter. His book, Drive, explores the psychological research on motivation and performance. And he finds that business and many people at large have ignored the results of this important research. We treat employees as if they must be rewarded or punished to try to motivate them to perform well…using the proverbial carrot and stick. The research, however, shows that rewards result in poorer performance if any degree of cognitive skill is needed to accomplish a task. Autonomy, mastery, and purpose are the motivators we need to understand.
I have checked Drive out of the library and plan to read it right away. I will let you know the details of what I learn. In the meantime, you can find out some of Dan Pink’s thoughts on motivation and what we do wrong by listening to his TED talk (18:40). If you want a bit more detail, you can listen to him talk to American Psychological Association members at the 2011 Psychologically Healthy Workplace Awards (38:36).
How do you motivate yourself? How do you motivate others? What secrets have you learned about motivating patients? What motivates you to read this? How can I motivate you to make comments?
Please share your thoughts below. Thanks.
According to a newsletter aimed at the insurance industry, 70% of comments made about health insurers on social media sites in the past year were negative. FierceHealthPayer reports:
It’s time to face the facts–the American public dislikes health insurance companies. And that’s putting it mildly, considering that 70 percent of all opinions and comments about insurers posted on social media sites in the last year were negative.
(Read more: Insurers should take to social media to combat negativity – FierceHealthPayer http://www.fiercehealthpayer.com/story/insurers-should-take-social-media-combat-negativity/2011-10-07?utm_medium=nl&utm_source=internal#ixzz1aYo3DrmA
Subscribe: http://www.fiercehealthpayer.com/signup?sourceform=Viral-Tynt-FierceHealthPayer-FierceHealthPayer)
I can understand some of that negativity. This past summer brought major upheaval for me as I searched for affordable health insurance for our employees. I asked our insurance agent early on to get us quotes. I was appalled at what came back from the company who provides our plan. As a small group (only 8 members plus one spouse) we are subject to huge variations in cost and are very limited in benefit choices. Health insurance is our second largest expense.
I interviewed employee leasing companies and other groups that claim to make you part of a larger group so you can benefit from lower pricing structures. Unfortunately, none of them were able to save us enough money to justify the severe limitation in benefits or the cost of membership. We ultimately bought a plan that increases copays and deductibles, but maintains most of the benefits we had….we think. How the insurer will choose to interpret those benefits when one of us actually needs to take advantage of them remains to be seen.
My experience is no surprise. Employers across the nation were faced with a 9% average increase in family premiums in 2011 while many of us were presented double digit increases, in spite of the recession.
The article mentioned above suggests that insurers should get involved in social media to combat their negative perception by the public. They should
Create a social media policy and then get out into the social world and establish a strong, positive presence. Tweet some healthful recipes, post exercise tips on Facebook, make announcements on Google+.
Whatever your specific strategy, though, make sure you monitor all social media sites for comments made about your company and then contact the poster to try and resolve the problem. Even if you can’t fix the particular issue, say because someone is griping about the lack of universal health insurance, you’ll have made an effort to connect with the public, which over time just might change their perception of the industry. - Dina (@HealthPayer)
In other words, they should get their marketing people to work in the social media sphere. Don’t do anything real to correct the negative perceptions of the public, just do your best to appear to care and to look good. Don’t let anybody realize that one of the major reasons the cost of healthcare is so high in the U.S. is because of the part played by the cost of health insurance.
I was rather distressed by that recommendation. Don’t do anything real…just do your best to appear as if you care about these negative perceptions.
I wonder what your experience is with health insurers. Does your organization provide health insurance for your employees? Is everybody satisfied with their plan and the cost of it? Have you ever made a negative comment about your health insurance on Facebook or Twitter? Ever made a positive one?
Please share your comments below.
I was a little surprised at my reaction of sadness Wednesday night when I heard of Steve Jobs death. I have never used an Apple computer or any other Apple product, so I could not be considered a fan by anyone’s definition. And yet, I feel a real loss.
I know that many of you were born after 1980. You have never lived in a world without personal computers. Those of us who are a bit older remember a very different world than the one we live in today . . . and one of the primary differences is the universal presence of personal computing devices.
At this moment I am sitting in my doctor’s office writing this post on my phone. Thirty years ago, I might have been reading a book or a journal. I could not have imagined that I might one day be doing this.
But Steve Jobs could imagine it.
The likes of Steve Jobs and Steve Wozniak and Bill Gates envisioned this world and helped make it real. The rest of us get the daily benefit of their ability to innovate. Some of us even got our careers because of their vision.
When Steve Jobs was working on the Apple I, I was finishing my doctorate in clinical psychology and looking forward to a long career as a psychologist. When my partner and I opened our first private practice in 1980, we had a word processor and bought Kaypro 4 computers. The computer seemed like a fun way to work and a powerful tool, so we bought one for each of our desktops. Within five years, we had started Synergistic Office Solutions and Seth was consulting with psychologists, building computers for them, and ultimately writing software for practice management. Because of the creation of an industry that did not exist when I started graduate school, I am twenty years into a second career. Without Steve Jobs and the work he did, I would not be writing to you . . . even though I have never used an Apple product.
In the next few years, we may see the passing of the personal computer into oblivion as tablets and super smartphones and today unimagined devices are created. But we are likely to remember that there was a very small group of incredibly bright, creative and productive individuals who imagined, innovated and then manufactured machines that have changed our lives.
Thanks, Steve.
Please feel free to share your own thoughts and reflections about Steve Jobs and about the changes in our world he helped create.
On September 22, 2011, I attended a webinar sponsored by the Business Operations for Behavioral Health Collaborative, a SAMHSA-funded joint venture of the National Council for Community Behavioral Healthcare, the National Association of Community Health Centers, NIATx, and the State Associations of Addictions Services (SAAS). The topic of the webinar was Health Information Exchange and Behavioral Health.
This is an area that has interested and concerned me for quite a while. As developers of software for behavioral health providers, SOS has for years been monitoring developments in the arena of Health Information Exchange (HIE). This is the method by which Electronic Medical Record (EMR) software will exchange information among providers and healthcare organizations. The HIE is both the process of exchanging information and any repository of that information for easy access by those with rights to the data.
This is the bugaboo that has always bothered me as well as my colleagues in the behavioral health software trade association to which we belong (Software and Technology Vendors Association). SATVA members are committed to assuring that our products share information only as the law allows and as consumers wish.
Work is currently in progress to assure that a universal method of acquiring patient permission for release of their information is part of any HIE. Such a method would undoubtedly allow a patient to specify providers to whom their treatment and diagnosis information can be released and any providers to whom it cannot be released. But what happens when a patient changes their mind?
Here’s a hypothetical example that jumps into the future by a few years, when all or most healthcare providers have EMRs and are connected into their regional HIEs.
John D. is admitted to the Emergency Room of a local hospital after a panic attack that he interprets as a heart attack. Among the papers that he signs is a release for the ER to access any information in the regional HIE about his health conditions. Since he is not thinking very clearly as he is sure he is dying from a heart attack, he signs everything put in front of him. After he is medicated, stabilized and sent home, he wonders about what he signed and which of his health information will now be available to whom. Does he really want his optometrist to know that he was treated with an anti-anxiety medication and prescribed an antidepressant (which he decided not to take)? Is it necessary for his urologist to have this information? What does he do to protect just that ER visit information and keep it from being sent on to other providers?
And what do our mental health and substance abuse patients do to secure their sensitive information?
This process concerns me because of my experience that once a piece of information has been entered into some large electronic database, getting it out may be near to impossible. Several years ago, I attended a conference in New Jersey. I rented a car, drove to the city in which the conference was held, returned the car and paid my bill in a timely fashion, and returned home.
The next time I needed to rent a car was three months after Katrina flooded New Orleans when my mother and I returned to check on her home and attend the funeral of one of my uncles. For some reason, the car was reserved in my mother’s name…the airline tickets were purchased with her card…even though I had placed my name on everything. The rental agency manager noticed something wrong when we picked up the car; there was a block on my account even though there was no balance. She overrode the block, gave me the keys to the car, and we were on our way. I did not give it another thought.
In several return visits to New Orleans, I again rented cars from the same company and always wound up with a car, not even knowing there continued to be a block on my account. Each time the agent or manager overrode the hold and gave me the keys. In November 2010, we arrived in New Orleans on a Sunday. The agent and assistant manager decided they did not have the authority to override the block on my account and there was no one they could contact to clear it. They refused to rent a car to me and offered no solution. They gave me a phone number I could call on Monday, but did not even offer my 90 year old mother and me transportation to another agency. I cursed and swore I would never rent from their unprofessional agency again and called my brother to come pick us up. Fortunately, he was thinking clearly enough to suggest that we go across the highway to a different company and rent a car there.
I did call the company the next day and eventually got the written apology and clearance of my account that I requested. It took six years for this correction of an error to happen.
What processes will we insist be put in place to assure that patients can change their minds about release of information or correct errors or enter corrected information into their records? What kind of advocacy will be required? What do mental health and substance abuse providers need to do to assure that the privacy of their patients’ sensitive information will be handled as they choose?
Please share your thoughts about HIE and EMRs and where we are going with this process.
Are you a Jeopardy fan? If you are, I am sure you know that in January of 2011, IBM’s supercomputer, Watson beat two of Jeopardy’s all time money winners, Brad Rutter and Ken Jennings. Watson is an Artificial Intelligence that can understand questions posed to it in natural ‘human’ language.
WellPoint, a BlueCross collaboration, is the largest provider of health benefits in the country. Their plan is to utilize Watson to sift through their patient databases to make diagnosis and treatment recommendations to WellPoint physicians.
This idea is not at all far-fetched and certainly a reasonable way for IBM to make some money off their huge research and development investment in Watson. They have also purchased some other companies that position them well for movement into the medical sphere.
Over the last four years, IBM has spent more than $7.8 billion to acquire database analytics specialists Cognos and SPSS, both formerly public, as well as data warehouse company Netezza, along with other private companies. In the first half of 2011, IBM spending on research and development exceeded $3.15 billion.
—International Business Times, 9/19/2011
What WellPoint is proposing to do is a starting point for a task all EMR’s will ultimately need access to and participation in. In order to meet the requirements for ARRA stimulus funds, eligible providers will need to utilize their EMR’s to help them make clinical decisions.
Clinical Decision Support (CDS) is a process whereby the physician gets notices and alerts from their software to assist them in making clinical choices that are based on data and evidence rather than memory and intuition. The Centers for Disease Control and Prevention (CDC) hopes to see public health organizations utilizing population data and statistics to guide their choices. They believe this will be one of the most impactful effects EMRs can offer the public health. The Office of the National Coordinator for Healthcare IT (ONC) wants to see individual physicians using Clinical Decision Support to advise their patients. Clearly, WellPoint plans for this level of intervention: physicians will have access to the data Watson can provide to assist them in making diagnoses and recommending treatments.
We talked in this blog about some of the potential benefits of CDS back in 2009. Since then, research on the benefits of supported clinical decision making has continued. A Google Scholar search of ’decision support emr’ results in 16,800 hits. There have also been noted some shortcomings, most notably a phenomenon called ‘alert fatigue‘, wherein a provider gets so many alerts and notices that they stop attending to them or turn them off altogether. Obviously, we have lots to learn about how to present information to healthcare providers so they can use it most effectively for the benefit of their patients. WellPoint has decided to dive right in!
What do you think about being diagnosed by a computer? Will it be more effective or less so? What is the relevance of CDS for behavioral health?
Please share your thoughts below.
Last week I asked you if you were using a Personal Health Record (PHR). I got only one response…from a college friend who is a technical writer. John is involved with a PHR company called medkaz. This company believes that all electronic medical records should be driven by and owned by the patient. Accordingly, they have developed a thumb-drive based product that the consumer will carry around with them. It is fully encrypted, so the privacy of the patient is guaranteed.
I believe the idea is that the patient will bring their personal record with them when they visit a doctor. The doctor can download relevant information of the patient’s choosing into their own electronic medical record (EMR) system. At the end of the visit with the patient, they will upload their note onto the patient’s thumb drive. The doctor can subscribe to this system themselves, but even if they do not, they will be able to use the patient’s information. This is one way to make sure that the people treating you have the most current medical information about you.
Over the course of the last few weeks, the reason for concern about what information health systems have and how they manage it again came into the public light. The Stanford Hospital in Palo Alto, CA reported that 20,000 records of emergency room patients had been revealed online by their collection agency…one of their Business Associates. The information had been posted on a web site for just short of one year. One of the affected patients saw the posting of the information and reported it to Stanford Hospital and Clinics.
According to IDExperts, there is good reason for concern about the security of medical data. The street value for a stolen medical identity is $50. Using that information, a Medicare or Medicaid or other insurance fraudster can file claims for services never provided….and often get paid.
In other news this week, the White House has proclaimed September 11-16, 2011 to be National Health Information Technology Week. The purpose of the proclamation is to call attention to and educate the citizenry of the benefits of and need for Health IT that will protect the privacy of the patient and involve patients in their health care.
Finally, the Office of the National Coordinator for Health Information Technology (ONC) has announced their new website, HealthIT.gov, designed to become the leading national resource on health IT for both consumers and health care professionals. The goal of the site appears to be to encourage personal responsibility for one’s health and health care through wise use of technology and coordinated efforts with one’s providers.
It was a busy week! Is there news you would like to share?
In August, the National Coordinator for Health IT, Dr. Farzad Mostashari, spoke about the need for a ‘targeted strategy’ to involve consumers in eHealth. He is concerned that all of the efforts being expended to acquire EMRs and for eligible providers (EPs) to achieve meaningful use of those EMRs must become more patient-centered.
One provision of the meaningful use requirements that will become increasingly important is the need to be able to provide an electronic version of the medical note to the patient. While there are a variety of ways by which this can be accomplished, Personal Health Records (PHRs) and Patient Portals into the provider’s EMR are two.
My own insurer provides a PHR on their website. I can enter lots of personal information about myself and my health if I choose to do so. Superficially, it appears this information can be accessed only by me, but I do not believe this is the case. The insurer can likely access the information too. Since it is mostly info they can get from my claims (and the claims history is available on the page), I am not too concerned about it, but I have been somewhat careful about entering things. If I were not pretty healthy, I think I would enter nothing.
The PHR to which I have access is a proprietary one. In August, Google removed their hat from the ring by discontinuing Google Health as a service effective January 1, 2012. Microsoft is well-entrenched in the healthcare arena, so I believe they will keep their product, Microsoft HealthVault, around. I wonder of what use these will be until providers can send information to the PHR for the patient.
For the last few weeks, I have been working with our web designer on re-writing our website. Now that so many people access the internet from their smart phones, we want to be sure the site works well on mobile phones and tablets. This focus has me wondering about a few things. I hope you can clear up some of these for me.
- How many of you use a PHR?
- Do you feel secure storing your personal medical information online?
- Do you use a smart phone for email?
- If so, for what other purposes do you use the smart phone?
I am hoping I will get some comments and responses from you. I wonder how many of you feel comfortable with the speed with which our lives are moving into ‘the cloud’.
Please jump in now. This inquiring mind really wants to know!
I have been struggling with a topic for this week’s blog. The only thing that has come across my path that feels compelling is the hummingbird who showed up at our coral honeysuckle on Sunday. Unfortunately, integrating that ruby throat into my article does not seem like an easy task.
Sometimes, I feel like I have run out of ideas. When that happens, I am reminded of feelings I experienced as a child and young adult. I knew I was not an artist and felt myself also to be not creative.
It took many years before I learned that my creativity takes forms different than that of artistic individuals. At some point in the process of doing psychotherapy with some very difficult clients, I realized that most of my creativity takes the form of what I will call creative alternativism. Generating possibilities…especially possibilities for different types of behavior and different kinds of thinking…was the primary manifestation of that creativity. Helping my clients find different ways to be in the world in order to overcome their pain and problems was the most important way I expressed that creative urge.
I have since realized that I often apply that process to myself as well. Since I can be a pretty rigid person when it comes to my own thinking and behavior, I have found that I need to make systematic efforts to implement the alternatives I generate for myself. I may well come up with many ideas about how to change my behavior, but I need structure to implement those changes.
Three years ago, I knew that adding yoga into my fitness efforts would benefit my arthritic joints and relieve some of my stress. Signing up for a yoga class was the structure that allowed me to make that a regular part of my activities. After three years, I have found other structures to help me extend that one class to two and now into a daily practice. I need and use structure to implement the possible changes I creatively generate for myself.
I had an email this week from a colleague I have not seen in years. I was delighted to learn that for the past year, she has been painting! At age 60, she took a pastels class at her local community college. She was hooked on the medium and has found a new outlet for her creativity. In my experience, she has always been creative. She has been a psychologist and psychotherapist for her entire professional life. She has researched and written and published…an aspect of her professional creativity; and now, she paints!
I am delighted to know that a new aspect of creative expression can manifest itself at any age, as long as we are open to it.
How do you express your creativity? Do you manage to do this within your professional life? Does the place you work benefit from your creative endeavors, or is it just for you?
Please share your thoughts about creativity, regenerating it, and keeping our lives…and blog topics…fresh.
I am sure many of you remember the reports dating back to 2005 that celebrity patient files were being viewed by casual lookers…employees who had access to the University of California at Los Angeles (UCLA) Health System electronic medical record (EMR) but who had no legitimate reason to view those records. Well, the Department of Health and Human Services (HHS) Office for Civil Rights (OCR) has entered into an agreement with UCLAHS to settle potential HIPAA violations for $865,500. Additionally, UCLA has made a commitment to correct gaps in their security, to improve their policies and procedures to better safeguard patient information, and to adequately educate their employees.
In a separate case, FierceHealthPayer reported that WellPoint will pay $100,000 to the state of Indiana because they waited several months before notifying Indiana officials of a security breach that could have exposed the data of 32,000 members.
For me, the important issues here are the following:
- OCR is serious about data breaches and safeguarding patient protected health information (PHI).
- State laws are just as important as Federal law. You must know and follow those local regulations as well as HIPAA and HITECH.
- The cost of a data breach is significant and would put many small provider organizations out of business.
Have you reviewed your security and privacy practices and policies this year? Are you confident that your PHI practices are solid and that your employees are using the procedures as written? How do you review these and how do you educate your employees?
Please share your experiences and concerns about data privacy and security with us below.
This morning I read an editorial (An ounce of prevention could heal a pound of pain) by Dina Overland of the FierceHealthPayer newsletter. She decided to use her platform as the editor of a newsletter that is aimed at insurance payers to directly address those payers about prevention of healthcare problems and diminishing future costs. She focused on an area that behavioral health and substance abuse professionals work in often . . . pain.
Ms. Overland’s review of the Institute of Medicine’s (IOM) report on pain and prevention cited some facts I had not heard.
If that’s not jarring enough, here are some more staggering facts: The United States spends $2 trillion on healthcare, but only 4 cents of every dollar goes to prevention and public health, despite being among the best tools to reduce spending. For every $1 invested in prevention, we save $6 in projected healthcare costs, says Sen. Tom Harkin (D-Iowa), who participated in the Department of Health and Human Services (HHS)’s announcement
of its guidelines to incorporating prevention throughout the healthcare industry.
***
I could not help but think about the number of people who would never have become substance abusers if their chronic pain had been addressed and treated at an early stage. How many behavioral health clients have you treated for depression after years of experiencing intractable pain?
The IOM and HHS see the coordination of care among primary care providers and specialists as the best way to address early intervention and prevention of pain. What role should mental health and substance abuse providers play in this coordination? How many of your patients also experience chronic pain? Where do behavioral health providers fit in?
Please share your thoughts and comments below. What role do you want to play in diminishing healthcare costs? Who should we see when it hurts?
