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.
- 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.
- 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
On March 2, the Office of the National Coordinator for Health Information Technology (ONC) announced a plan to approve organizations to certify electronic health record software programs. ModernHealthcare.com reported the announcement of this new plan by ONC head, Dr. David Blumenthal, at the big meeting of the Health Information Management Systems Society (HIMSS) occurring in Atlanta this week. The rule being developed will create a system for temporary testing and approval of products that meet the ARRA “meaningful use” criteria as well as a permanent structure for such certification. This is a process for certifying the certifiers.
Since the passage of ARRA last year, there has been rampant speculation about whether the Certification Commission for Health Information Technology (CCHIT) would be the only certifying body approved by HHS. Many who have felt that CCHIT is too closely tied to the large players in the medical EMR community have believed that diversification in the certification community should be a given.
Currently, CCHIT is the only organization designed to certify EMRs. Prior to ARRA, the certification was to a particular set of standards, features and functionalities decided upon by CCHIT as necessary for any electronic medical record program to call itself a player. In the past few months, CCHIT has added an ARRA certification to meet the requirements of “meaningful use” so that providers could qualify for ARRA funds. Unfortunately, the “meaningful use” definition is not yet finalized…and the cost of the ARRA certification is significant.
This cost of certification by CCHIT has been the primary concern for small software vendors. Those of us who have limited financial resources and small development staff have been worried that the fees and methodology of CCHIT would prevent us from obtaining certification for our products. Dr. David Kibbe, senior advisor to the American Academy of Family Physicians Center for Health IT is one of the critics. As reported by Neil Versel at FierceEMR, Dr. Kibbe believes that the cost and complicated nature of the CCHIT certification method stifles innovation and the development of new technologies.
This announcement by ONC may well open the playing field significantly. Whether the stimulus funds are worth the cost to achieve “meaningful use” is a separate issue that eligible providers will need to determine for themselves. Since these incentives are largely aimed at primary care providers, not many behavioral health organizations are likely to be impacted or even eligible for funds. But we must assume that the move toward EMRs in the general medical world will increase the pressure upon behavioral health providers to follow suit.
On January 29, 2010, the federal departments of Health and Human Services, Labor and Treasury released their ”guidance” on the Wellstone-Dominici Mental Health Parity Act. The National Council discussed some of the contents of the Interim Final Rule (IFR) in their February 4 Public Policy Update. The IFR goes into effect April 5, 2010 and applies to policies with plan years that start on July 1 or later.
Since some insurance carriers have already begun changes in their policies and claims filing procedures in an attempt to meet the requirements of law, it is possible that procedures just put in place may be changed. For example, Blue Cross/Blue Shield of Florida, a company that had a limit of 25 sessions per year for psychotherapy with no authorizations required for most plans, in January started to require authorization for all mental health services. According to the information provided by The National Council, this may need to change again.
Group insurance plans for groups of 50 or more may need to carefully match how they manage medical/surgical and mental health/addictions benefits. It is not just the “quantitative limits” that must be the same; the “non-quantitative limit” also must be the same. The IFR forbids plans from using specific non-quantitative limits unless similar restrictions exist for medical/surgical benefits: medical management, prescription formulary design, “fail-first” or step therapies, and prior authorization.
The National Council has continued discussion of the IFR in several articles on their web site. Take a look at their press releases, policy issues and resources, and slides and recording from a recent health care reform webinar. The National Council does a wonderful job of staying on top of and advocating for issues of this sort and should be on your radar all the time.
The American Psychological Association also advocated strongly for this law and information about its implementation can also be found at the APA web site. More detailed and current information about the IFR has been shared with state psychological associations and should be available to APA members who are connected with the practice organization. The email I received through Florida Psychological Association contained a thorough analysis of the IFR along with examples and hypotheticals. A quick read of this article suggests that it will not be a simple matter for a provider or a consumer to determine if their insurance carrier is following the rule. I am hopeful that simpler guidelines will follow.
Dr. Ronald Manderscheid’s article in Behavioral Healthcare Magazine suggests that this law is just the first step in our move toward parity in payment for mental health and substance abuse services. Four other doors need to be opened more widely to assure true parity: 1. the extension of insurance benefits to more individuals and the extension of the rule to more policies; 2. clear statement of what determines medical necessity for access to care; 3. improving scope and quality of the care accessed; and 4. expecting the outcome of care to be at least as good as in the medical/surgical realm. This law brings us a long way toward the goal of equity, but we as advocates have a long way to go to assure that consumers of mental health care can actually get the care they deserve.
What effect do you think the parity law will have on your organization? Do you foresee a big impact or a small change? Please share your comments below.
On Sunday night our book club met to discuss Richard Dawkins’ Greatest Show on Earth. While I had a bit of difficulty with his style of writing, the data Dawkins presents in explication and support of evolution is exhaustive. Even with such overwhelming evidence, he reports that a full 44% of Americans surveyed in 2008 do not believe that evolution occurred. They deny the fact that all life forms on earth, including humans, descended from some common ancestor; Dawkins calls them 44% ‘history-deniers.’
On Saturday night, we finally saw Avatar. Among the themes explored in this movie was the strong prejudice that exists today against science and scientists. Technology…the practical outcome of scientific endeavor… is valued. Everyone on that space settlement was a technician of some sort. But the science that got them there and the science allowing the use of real avatars was denigrated by the majority.
A few weeks ago, I wrote about behavioral health professionals use of evidence based treatments. Behavioral health professionals and psychologists in particular are generally well-trained scientists, having a good understanding of the scientific method plus training in critical judgement of research. One goal of this education is to choose the soundest methods of providing care. And yet, large numbers of psychologists indicate that they do what they “believe” is best for their clients rather than what scientific research indicates is likely to provide the most effective course of treatment.
Numerous writers and commentators have bemoaned the state of science education in this country. At one time the U.S. was generally regarded to be the place to get the best education in science. Students from across the world came to the U.S. to study. Some stayed, some returned to their home lands to teach others. A 2007 article in the Christian Science Monitor ranked U.S. high school students 29th in the world in science literacy. While others would argue this figure, the common perception is that we have slipped as a nation in our interest in, and understanding of, science.
Simultaneously, we have become technology addicts. I would venture to say that many young people who are technology drones have never really thought about the science that went into creating the devices they cannot live without. Nor do they care that they do not know about the science. Just make sure that they continue to have access to their toys and to the technological infrastructure that supports them.
I believe this trajectory puts us as a nation in a very vulnerable position. Technological innovations are only one aspect of scientific endeavors. The knowledge gained from pure science is one of the things that keeps me most in touch with my creativity and my humanity. Take a listen sometime to Science Friday, an NPR program and podcast that weekly explores a whole variety of science topics and themes. It is impossible for me to listen to more than two or three of these shows without coming away with a book I want to read. I referenced one of these shows in my article on Evidence Based Treatment.
Those who provide behavioral health care services are unlikely to find the bulk of their work taken over by technology. There will be technologies that facilitate treatment and technologies that become treatments, but the bulk of human services will still be provided by humans. Assuring that we are good scientists, or at least can judge when a study is good science, is a worthwhile goal for behavioral health providers of every stripe.
How do you rate our science literacy? Are you interested in or bored to tears by science? Do you see science as relevant to your life…as a human being or as a provider of services?
Please enter your comments by clicking on the title of this article and typing in the box at the bottom of the page.
I am on my way back from two and a half days in Phoenix where approximately 40 SATVA (Software and Technology Vendor Association) member representatives, EMR users, and industry IT experts met to find a way for behavioral healthcare providers to exchange patient information using the electronic Continuity of Care Document (CCD). The CCD is the mechanism specified by current healthcare IT initiatives for the communication of critical patient information between providers. Ideally a care provider could rapidly get up to speed on a patient’s status by requesting and receiving a CCD from another care provider already familiar with the patient.
I first heard the term “continuity of care” in a healthcare seminar I took back in graduate school in the early ‘70s. It was an obvious, common sense concept that patients could receive better care at lower cost if providers were able to continue care already started by another provider, rather than starting over, duplicating care already rendered by the previous provider. Continuity of care requires that meaningful, usable information pass from provider to provider. Almost 30 years later, every patient in the US is familiar with the challenges of getting even simple demographic data, much less meaningful health records, transferred from one doctor to another. Well, the CCD might just be a solution to that problem.
Our meeting started with a demonstration of the creation of a CCD by the system of one SATVA member, and the display and subsequent import of that CCD by the system of another SATVA member. These are the exact capabilities that are mandated by 45 CFR, Part 170, HHS’s recently published Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology (Interim Final Rule).
Required or not, systems that are actually doing CCD interchange today are few and far between. To our knowledge, there are NO behavioral health EMR systems that do. Nevertheless, the technical proof of concept was convincingly demonstrated at our meeting — a valid CCD was created, and the generic medical information contained therein was displayed and “consumed” by another system.
In many respects, the technology is the easy part. The challenge that faced our group was to define a standardized way that behavioral health providers can represent their unique domain information within the CCD to allow accurate import by a receiving system. Think, for example, of the five-axis DSM diagnosis — something that exists only in our family of behavioral/mental health specialties. Ultimately, the DSM five axis profile turned out to be the focus of our group’s efforts.
The standard CCD contains sections for identifying information (technically called the Header section), Problems, Procedures, Family History, Social History, Payers, Advance Directives, Alerts, Medications, Immunizations, Medical Equipment, Vital Signs, Results, Encounters, Functional Status, and Plan of Care. A given CCD can contain one or more of these sections, in any order. In this context, the Problems section is normally intended to contain a list of diagnoses, but it is flexible enough to include other information including findings and observations, which means that “problems” in the behavioral health sense could be included when necessary to convey significant information that diagnosis alone could not.
One of the most important aspects of the CCD and related electronic documents is that they must rigidly adhere to standardized sets of coded descriptions that are included in the specification of these documents. For example, when diagnosis codes and descriptions are included in the Problems section, they must be either ICD-9 (until supplanted by ICD-10) or, better, the more universally used SNOMED-CT. The latter includes everything in the ICD, plus a great deal more, and is preferred. Before you get too worried, all the vendors present agreed that it would not be difficult to modify our products to take the sting out of SNOMED for you. Likewise, in Medications, drugs should be listed with their RxNorm codes, and in Results, labs should include LOINC codes. The use of these specific coding systems avoids ambiguity that could potentially result in misunderstandings and serious harm to patients.
The CCD is rendered in XML, a cousin of the HTML code that sits behind the content and presentation of the typical web page. As a result, the CCD can be displayed by any modern web browser. Without getting too technical, the CCD uses a related style sheet that determines the way the CCD data is displayed on screen. As a result, any CCD that you receive can easily be formatted to display in any way you like! Let’s say that you want the Alerts section (which contains important information such as allergies, adverse drug reactions, and perhaps such information as dangerousness) displayed in a bold red font in the top right corner of the page. You can modify your organization’s CCD style sheet to make it so. Thereafter, EVERY CCD you display will have the desired information in the desired font and position. It doesn’t matter who sends it. Compare that to searching through several inches of paper records that bear no resemblance to anything you do in your own organization. See what a breakthrough this would be? Below is the very same CCD, but displayed with two different style sheets. The fancier one is courtesy of Brett Marquard of Alschuler Associates, LLC.
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Returning to the meeting, after considerable discussion the group determined that we could, in fact, communicate our beloved DSM axes within the existing CCD specification, with no need for extension or new templates (another component of the document specification). This conclusion was nothing short of huge! The fact that we can get what we need without having to go hat-in-hand to the standards bodies to plead for inclusion of something new means that implementation can go forward on a much faster schedule. Our goal now is much more modest – just an Implementation Guide that describes how and where to put our unique stuff.
If you are still with me, and are curious, we determined that Axes I, II, and III diagnoses will go into Problems, along with additional specific diagnostic criteria (as findings or observations) when necessary. Axis IV will go into Social History, and Axis V will, of course, go into Functional Status.
This initial core group of stakeholders expects to add supporters over the coming months, complete a well-tuned CCD Implementation Guide for Behavioral Healthcare Providers, and put it into use in the field. In the meantime we will move forward, with the expectation of obtaining official adoption by the relevant standards bodies.
The Software and Technology Vendor Association (SATVA) is hosting the first Behavioral Health Interoperability Conference for behavioral health electronic medical records software next week. SOS is among the member organizations who will be attending the conference along with other behavioral health software vendors, some vendor clients, representatives of The National Council (NCCBH), MHCA, and others.
SATVA has been active in national efforts to keep behavioral health treatment within the mainstream of the conversation about health care technology and reform. Since the behavioral health community is such a small part of the overall health care picture, a non-profit organization consisting of vendors of technology products, working with other behavioral health advocacy organizations stands a better chance of having an impact.
In September 2005, following the broad call of the Institute of Medicine of the National Academies (IOM) for increased use of electronic health records to increase the quality of health care, SATVA and SAMHSA co-sponsored a Summit on EHRs in the behavioral health community. This initial activity laid the foundation for the development of a profile for standards for behavioral health EHRs, a necessary precondition for developing interoperable products.
The Behavioral Health Interoperability Conference is a natural outgrowth of the progressive work of SATVA and its members to advance the quality and quantity of behavioral health services provided by members’ clients with consumers of care the ultimate beneficiary of all our efforts.
Synergistic Office Solutions, Inc. is proud to have been a member of SATVA since 2004.
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.
The cold temperatures across the nation this week have had some individuals scoffing at the notion of global warming. On the other hand, most scientists explain that extremes of weather are part of the whole pattern of global warming; these freezing temperatures are the other side of the extreme heat we experienced this summer and fall.
The American Psychological Association’s (APA) report on global climate change is a thorough examination of our current understanding of human attitudes, emotions and behavior relevant to climate change. Whether or not you have seen the movie “An Inconvenient Truth“, you might benefit from reading the introductory section (pages 24-30) of the APA report which does an excellent job of reviewing the background of the intersection of human systems and earth systems, and how human behavior impacts earth systems.
Section 1 of the report explores how people understand the risks presented by climate change. One of the primary challenges in changing behavior is to understand the perspective of the person whose behavior we are trying to change. Any psychotherapist worth his or her salt will tell you that a good assessment of the individual with whom one is proposing to work is essential to effective therapy. The nature of the assessment is less important than its outcome…an understanding of the experiences and motivations of the potential consumer of services, along with a sense of their strengths and limitations. The beliefs and points of view of that person, about their problems and about their power to impact those problems, is crucial in designing a treatment plan.
So before we design a climate behavior treatment plan for our families, our neighbors and our communities, we must understand how they perceive the potential risks of global climate change. Psychological research leads us to believe that the impacts of distant or rare events tend to be underestimated. From pages 6 and 7 of the APA report, we learn that
…small probability events tend to be underestimated in decisions based on personal experience, unless they have recently occurred, in which case they are vastly overestimated. Many think of climate change risks (and thus of the benefits of mitigating them) as both considerably uncertain and also as being mostly in the future and geographically distant, all factors that lead people to discount them. The costs of mitigation, on the other hand, will be incurred with certainty in the present or near future…. Yet, emotional reactions to climate change risks are likely to be conflicted and muted because climate change can be seen as a natural process and global environmental systems perceived as beyond the control of individuals, communities, and quite possibly, science and technology.
Accordingly, when we communicate about the potential risks to humans of global climate change, we must recognize that different human responses will result based upon the individual’s perception of the risk to them and theirs posed by climate change. If the risk is seen as low and completely outside their control, no change to current behavior will occur. Even if the danger is seen as high, if it is seen as outside the ability of the individual to have an impact, there will still be no change in behavior.
Based on this understanding of how people behave in the face of risk, we must assure that our interventions allow people to experience a sense of efficacy and empowerment. We need to believe that the things we are doing to affect climate change can possibly have the effect we seek. Without such a belief, we will not likely take action.
For most of us, the source of information about climate change has been media reports of the observations of climate scientists. Few of us have personally seen melting glaciers or arctic ice. Psychological research on risk communication is important in this regard. What is the most effective way to communicate about climate change to inform individuals and communities and to empower them to take action? Just how should we be communicating the reports and projections of climate scientists to maximize change in human behavior? Will we be successful in enlisting the media as educators rather than as sensationalists or naysayers?
The summary of section 1 of the APA report (p 48-49) clearly states these issues.
Feeling (or not feeling) vulnerable and at risk in the face of climate change seems to be instrumental in moving (or not moving) people to action (see section 4), and thus the sources of these feelings are in need of further study. Research in cognitive psychology suggests that certain perceived characteristics of climate change (e.g., that it is “natural,” not new, and in principle controllable) may lead citizens as well as policy makers to underestimate the magnitude of the risks. Other psychological research provides additional hypotheses related to emotional reactions to climate change such that the absence of feeling at risk may be a psychodynamic reaction (see section 3), the result of psychic numbing or denial in the face of overwhelming and uncontrollable risk (see section 4 and 5). These explanations are not necessarily mutually exclusive, though sometimes contradictory in elements of their hypotheses (e.g., is climate change seen as a controllable or uncontrollable risk?). Such contradictions need to be resolved by empirical investigations.
The ability of different educational interventions in shaping perceptions, attitudes, and action related to climate change should also be a topic of empirical research (see section 6). Existing knowledge about the relative impact of direct personal experience vs. more abstract statistical information on the perceptions of risk in domains like financial decisions or with the relative effectiveness of emotional vs. analytic processes in prompting protective action can guide the design of different educational interventions about likely climate change scenarios and their repercussions and about the pros and cons of different courses of adaptation to climate change and/or mitigation of greenhouse gas emissions.
If you have not yet taken a look at the APA report, you should do so. Set aside some time to focus on the issues facing us as behavioral and psychological experts, then share your perspectives here. To enter your comments, just click on the title of this article and type in the box at the bottom of the post.
As a psychologist trained 30 years ago in a Boulder-model scientist practitioner training program in clinical psychology, the ability to critically evaluate research and to determine its application to the treatment of my patients was an essential part of my practice and of my outlook on clinical psychology. That initial training fed my early interest in Cognitive Behavioral Therapy. I still have vivid recollection of attendance at my first two-day workshop conducted by Jeff Young (Jeffrey E. Young, Ph.D.) on Beck-style Cognitive Therapy of Depression, a workshop that had profound impact on the treatment I provided. Even my later identification as a Feminist Therapist and my questioning of programmed, patriarchal methods that elevated the therapist above the patient was always tempered by the need to use the scientific method in my practice and in my life. (I’ll credit George Kelly’s ‘man, the scientist’ and Franz Epting, Ph.D. for that.)
As I have mentioned previously, I have been retired from active practice since 1993. Imagine my surprise to learn this past November that clinical psychologists value their own experience and the guidance of their colleagues more than they do the dictates of science. In fact, according to the authors of Current Status and Future Prospects of Clinical Psychology: Toward a Scientifically Principled Approach to Mental and Behavioral Health Care by Timothy B. Baker, Richard M. McFall, and Varda Shoham, some clinical psychology training programs are downright anti-scientific. They believe the solution to this ‘problem’ is a new system of accreditation for training programs. NPR’s Science Friday aired an episode on this topic on December 4, 2009. The show, entitled The Science of Clinical Psychology, is a quick way to get a sense of the much longer paper.
This paper and the PR blitz surrounding it including an article in The Washington Post by the authors, has received strong reaction from practicing psychologists, directors of training programs in clinical psychology and divisions of the American Psychological Association (APA).
While some would describe the Baker, McFall, Shoham article as politically motivated and an attempt to wrest accreditation away from the APA, it seems to me that focusing in a defensive fashion on political motivations accomplishes little. Perpetuation of the ad hominem arguments used in the paper will not get us very far. Perhaps we should focus instead on the notion of scientific support for mental health and behavioral treatments, how clinical research might be encouraged, how evidence-based treatments (EBTs) might be most effectively promulgated, and whether psychologists are alone in their hesitance to adopt EBTs.
In his December editorial in Current Psychiatry Online, Henry A. Nasrallah, M.D. suggests that psychiatrists also could benefit from self-evaluation regarding their use of EBTs. Below is an excerpt from Dr. Nasrallah’s article:
PSYCHIATRISTS’ TRACK RECORD
The Schizophrenia Patient Outcomes Research Team5 assessed how the treatment of 719 patients with schizophrenia conformed to 12 evidence-based treatment recommendations. Overall, <50% of treatments conformed to the recommendations, with higher conformance rates seen for rural than urban patients and for Caucasian patients than minorities.
A study using data from the National Comorbidity Survey6 found that only 40% of respondents with serious psychiatric disorders had received treatment in the previous 12 months, and only 15% received care considered at least minimally adequate. Four predictors of not receiving minimally adequate treatment included being a young adult or African-American, living in the South, suffering from a psychotic disorder, and being treated by physicians other than psychiatrists.
Finally, a recent survey of psychiatrists’ adherence to evidence-based antipsychotic treatment in schizophrenia7 showed: 1) mid-career psychiatrists more adherent than early or late-career counterparts; 2) male psychiatrists more adherent than female; 3) those carrying a large workload of schizophrenia patients more likely to adhere to scientific literature.
It would appear that psychologists and psychiatrists all need a stronger push toward use of EBTs.
In the world of community behavioral health, Medicaid and Medicare are pushing providers of care to the chronically mentally ill toward use of EBTs. SAMHSA has an entire section of its web site dedicated to EBTs. SAMHSA’s National Registry of Evidence-based Programs and Practices (NREPP) contains a searchable database of interventions for the prevention and treatment of mental and substance use disorders. The database currently contains 150 entries along with a method for submitting programs for review and inclusion in the database. The NREPP has the potential for becoming a clearinghouse for effective behavioral health treatment interventions.
How does your organization approach the issue of evidence-based treatments? What is your take on the current controversy in the field of clinical psychology? How do you imagine we ought to move forward in advancing scientifically-tested approaches to mental health treatment? Given the costs of health care, this seems like an extremely important issue for all providers of behavioral health services to address.
Please enter your comment by clicking on the title of the article and typing in the box at the bottom of the page.
I’ve mentioned here pretty often than I am not a technology sophisticate. I use technology every day in my work life, but I am a slow-adopter. For some of you, this article may be so old-hat that you will ask “Kathy, where have you been?” But I know there are others out there like me, so here goes anyway.
My mother-in-law had back surgery in Miami early this month. Since my 89-year-old mother lives with us, it has been impossible for me to go down to see her since the surgery. This past weekend, we arranged to skype a conversation so she could talk to me and my mom and we could “see” how she is doing. That word I just used…”skype” did not exist as a verb until August 2003 when a group of Estonia-based developers released the first version of what became Skype.
So what in the world is a skype? It is a company that created a technology that allows one computer to make voice and video calls to another computer free of charge. It also allows one to make phone calls from your computer to land lines and cell phones for a very low charge. Of course, it is the free-of-charge calls to other computers, especially video calls, that makes it so exciting. The process of doing this has become “to skype” or “we skyped.”
The technology allows high quality computer connections without going through a telephone service. As long as you have a high-speed internet connection, there are no voice/video delays. As long as your web cams are decent quality, picture and voice quality are excellent…and Skype has built-in tools to help you improve quality if you are having any difficulty.
But here’s the rub…Skype has become so popular that our Sunday morning attempt to connect was unsuccessful. The servers were all busy! So what’s a computer video newbie to do? Well, use Google Chat instead, of course.
SOS has recently switched all of our email to a Google corporate account. This gives us access to a number of other tools…Google Chat is one that we have used in-house for instant messaging. While I only learned about this through our Google account (I told you I am technology-impaired), this tool is also available to anyone who wants to use it…just check out the link above. I had not input the settings correctly before this weekend, so we combined old-fashioned cell phone technology with Google Chat computer video. There was a lack of synchronization between our cell phone service and the video, but now that I have my webcam microphone set up as the sound source it will be synced on future calls.
Yahoo! Messenger has provided similar service and functionality for years, and for Microsoft fans, Windows Live Messenger also allows these same capabilities. Ichat is a similar service used by Apple aficionados.
I must tell you that I do not have much interest in using this technology for work, but for personal contacts with family members who live far away, these are wonderful tools. My assessment of this may change over time. For many of you, the time may be now. Video conferencing is a wonderful way for scholars and far-flung colleagues to work together. It is also a fantastic way to provide behavioral health services to remote and home bound clients.
Several months ago, a Florida psychology listserv to which I belong was the setting for considerable discussion about remote provision of services. While some of the practitioners were hesitant to consider providing psychotherapy via computer video, some have already begun doing so. Community behavioral health organizations are actively considering such services for rural clients and others who require case management but are not readily available for visits. Over time, providing low-income, seriously mentally ill individuals with an inexpensive computer, internet service and webcam could save thousands of dollars in case manager travel and time costs, not to speak of hospitalization costs when deterioration not noticed on a telephone call but readily apparent on a video conference, is beginning.
The biggest push for these services may come from Medicare, Medicaid and other payers. A December 2008 article from the American Telemedicine Association details Medicare’s authorization for payment for remote services. These are provider and location-of-recipient dependent, so check out the details before you decide to start billing Medicare for such services. Since psychotherapy is a covered service for the purposes of telehealth, I expect more practitioners will begin to provide these services. I hope more abundant research on comparative efficacy will follow.
Has your organization begun providing any services remotely using video conferencing? What methods do you use? What benefits and limitations do you experience? If you are not already providing services in this fashion, what might it take to move you to do so?
Please share your comments by clicking on the title of this article and entering your comments in the box at the bottom of the page. Thanks for participating in the discussion!
I sat down Monday morning to write this week’s blog post. I was intent upon writing about American Psychological Association’s (APA) recent report on climate change and what the psychology community can do about it. I had previously glanced at the executive summary of the report and was excited to learn what the entire report recommended. Unfortunately, I must have been a bit too tired when I started out in my reading. I was only on page three when my eyes glazed over.
I do have a history with APA; I have been a member for 30 years. I joined as soon as I was eligible after completing my Ph.D. In the early 1990’s I served on two different committees within APA—the Public Information Committee and the Committee for the Advancement of Professional Practice. I have read more than my share of scholarly papers and APA organizational documents. Since retiring from the practice of psychology in 1993 and moving to full-time involvement in the business of psychology billing and clinical record software, I have become more removed from scholarly work and more involved in the action orientation of the business world.
Psychology and Global Climate Change: Addressing a Multi-faceted Phenomenon and Set of Challenges, while perhaps intended to be a call to action, is actually a carefully written and documented organizational treatise on the psychological phenomena involved in this crisis, the psychological research and knowledge which are applicable to these events, and recommendations for the role APA as an organization and psychologists as professionals and individuals can and should play as this crisis unfolds. It is what I should have expected, but not what I hoped it would be.
In order to make this document useful, I believe it needs to be broken down into parts and digested in that fashion. Accordingly, over the next few months, I am going to take each section of the report and tell you about what is in that section. I hope this will have the result of helping us glean the recommendations of the APA and determining what constructive actions individual mental health professionals and behavioral health community organizations can take.
The APA Climate Change Task Force considered six questions:
- How do people understand the risks imposed by climate change?
- What are the human behavioral contributions to climate change and the psychological and contextual drivers of these contributions?
- What are the psychosocial impacts of climate change?
- How do people adapt to and cope with the perceived threat and unfolding impacts of climate change?
- Which psychological barriers limit climate change action?
- How can psychologists assist in limiting climate change?
In examining these questions, they reviewed the psychological literature to focus areas in which additional research might be useful and in which current data might enhance the work of climate scientists. By way of this report, the task force attempted to create bridges between the climate science community and the psychological community.
It is also clear from these questions that the authors were considerably concerned about what the psychosocial effects of climate change might be. Since those of us who work with individuals, families and communities about various emotional and behavioral health concerns will undoubtedly need to address these impacts, it behooves us to be prepared…at least with knowledge.
Finally, the task force recommended that specialists in behavioral and psychological research adopt the following principles in an attempt to maximize the value and use of psychological principles in climate change work:
- Use the shared language and concepts of the climate research community where possible and explain differences in use of language between psychology and this community.
- Make connections to research and concepts from other social, engineering, and natural science fields.
- Present psychological insights in terms of missing pieces in climate change analysis.
- Present the contributions of psychology in relation [to] important challenges to climate change and climate response.
- Prioritize issues and behaviors recognized as important climate changes causes, consequences, or responses.
- Be cognizant of the possibility that psychological phenomena are context dependent.
- Be explicit about whether psychological principles and best practices have been established in climate-relevant contexts.
- Be mindful of social disparities and ethical and justice issues that interface with climate change.
If climate change continues and has even some of the potential impacts that are predicted, mental health and behavioral specialists will be deluged with people caught in and reacting to those impacts. What can you and your organization do to prepare for addressing the fallout of some of these impacts? What would be the result of a Katrina-equivalent in your community? What knowledge and expertise do you need to gain?
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