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

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

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

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

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

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

Unfortunately, it was a frustrating week. Because none of us had used Gmail before or had much experience with the Google system, we had to muddle through. All of us keep a large number of old emails so we can document and have reference to a variety of communications. That meant we had to upload our emails to Google and then synchronize them with Outlook if we intended to continue to use Outlook for email (as most of us did). This took a few days to do because of false starts and because of the length of time needed to upload and to synchronize. And then we needed to learn the new system!

The primary problem for me was that this interfered with my day-to-day work. It is difficult to get my usual tasks done and to include anything extra, but adding something this big into the mix was a major disruption. I am like many other people I know…I believe that you don’t fix it if it ain’t broke! My email worked just fine. Occasionally, I  delete old emails from the READ and SENT boxes. I try to keep on top of the INBOX, but that is much harder for me to manage. I have lots of rules in Outlook to transfer some incoming mail directly to other mailboxes so I can do quick scans of large amounts of content, but I am not really very good at it. So my email had not been well maintained to start with…and now I need to learn a new system…and also try to do the maintenance I have so far managed to avoid.

Not my favorite things!

In fact, I think about maintenance of any kind and know these are my least favorite things in life. Today I had the oil in my car changed. I know this is essential to keeping the car running well. I know that periodic maintenance is what will keep my warranty intact. But I hate to take the time to do it.

The same is true with the small, repetitive maintenance tasks of life. I hate housework. I love a clean orderly house…but please do not ask me to clean it. I will do the garden maintenance, but I will do it in my own time. As a result, my garden always has lots of weeds…of course, I have lots of gardens, so there is too much to keep up and also to co-run a business. But that does seem often to be the case with these kind of tasks…there is never really enough time to do them and to do the rest of life.

Add to this the fact that no one actively appreciates the person who does the maintenance, and the difficulty of keeping it done increases. These are all things that are just supposed to get done silently and invisibly in the background without the rest of us being affected by the process. Women have traditionally been the doers of these tasks at home; many of us resent that fact and the lack of appreciation that goes along with it. In fact, now that so many of us must work outside the home just to make ends meet, lots of these jobs that our mothers did just don’t get done.

As I struggled through the week, I found myself thinking about our customers. Every time we have an update of our software, we encourage our users who have current Support/Update contracts (maintenance agreements!) to download the update and install it. Not only have our developers worked hard to fix issues that users have discovered, but they have also added new features that make our software a very powerful tool for behavioral health billing and clinical record keeping.

Inevitably, many of our users do not install the updates. Doing so disrupts their work flow…they need to make time to download and install. If they have a network system, the time involved is not insignificant. The fact that doing the update will also do maintenance on their database is irrelevant. The new features and fixed problems do not matter. If things were going smoothly…please don’t fix it!

It is not at all uncommon for someone to call with a problem in their database who has not updated their software for a couple of years or more. And now they may even have corruption in the database. And sometimes no backup! They do not believe us when we tell them that installing updates, even though an interruption of their work, performs maintenance on the database that can prevent problems down the line. Just like with a car…or a house…or a garden.

So what is the solution to this avoidance of maintenance tasks? How do we manage to find the time to perform the actions in life that will keep things running smoothly? Some of our customer organizations have a managing partner or a Chief Operating Officer whose job is to make sure that the operational side of the business is a well-oiled machine. If you read our user group discussions, you will regularly see input from some of those managers. But how can the rest of us build regular maintenance of those things we use every day into our lives so we do not feel so interrupted by those processes?

Please, your suggestions and input would be greatly appreciated by this person who struggles with ongoing maintenance of anything in life! What do you to do keep it all going?

I do not know what the total attendance at this ICD-10 webinar was, but judging by some of the questions asked, the range of participants was huge. The program was aimed at providers, payers (insurance companies), clearinghouses, application vendors, and anyone else who might be affected by the transition from ICD-9 to ICD-10.

Those of you who have no idea what I am talking about might want to start to get some information about this transition. Federal law and HHS rules require that we move from the ICD-9 and CPT-IV to the ICD-10; the deadline for doing so has been moved to October 1, 2013. It will be very interesting to see if we actually get there in time.

We who work in behavioral health have fairly minimal changes to make. The number of diagnostic codes and procedure codes utilized in mental health claim filing (and upcoming behavioral health EMRs) is minuscule compared to the larger health care arena. Software like ours will require minimal modification; but in the general and specialty medical world, the changes will be massive.

Not only are different diagnostic codes required, but the ICD-10 is also a procedural nosology that most of the rest of the world has been using for many years. It allows a much more finely-grained statement of both diagnoses and procedures utilized. Many believe that data obtained from use of the more specific codes is part of what will allow health care cost savings in the future.

The biggest challenges will involve learning the new code sets and translating our current data into something akin to the new codes. I say ‘something akin to’ because there is not a one-to-one mapping from the ICD-9 and CPT-IV to the ICD-10. In fact, the logic of the two systems is quite different. Reports are that CMS is working on a general equivalence map (GEM) between the two systems. Work will continue on testing and tweaking the GEMs for at least three years after the 2013 deadline.

Private market mapping and consulting also exists. Last week, 3M Health Information Systems announced the release of their own mapping tool in a Healthcare Informatics article. While insurers and clearinghouses and hospital systems may make use of these proprietary tools and consulting services, it is likely that the CMS GEMs will work for many of the rest of us.  

I can feel the chill going up and down the spines of professional coders. In just a few years, they will need to be fluent in another language. My niece just finished a program to be a coder and is now studying for her certification. She will be able to just keep right on studying to be ready by 2013. This is not encouraging for someone who has been coding for 30 years, but for a youngster, being newly fluent in ICD-10 will be a very salable skill.

What preparations do you foresee your organization making to get ready for ICD-10? Have you begun to consider this process? Tell us what you think. Just enter your comment by clicking on the title of this article and typing your thoughts in the box below.

First I must tell you that I resisted doing this for about a year. Seth and Manon had both expanded their world view as had two of our programmers before I decided it was something that might be useful. This simple solution is adding a second monitor to your desktop.

Okay, okay…I know. What could you possibly need with a second monitor? After all, your desktop is already hopelessly cluttered with stacks of paper (at least, if it is like mine it is) and there is no available real estate for adding something as silly as a monitor. That is what I thought. Then I added one.

Now I am able to spread the six or eight applications that I keep open all the time across two screens so I can see and use multiple programs at one time. This is especially useful if I am working in bookkeeping and spreadsheets simultaneously. I can go back and forth from one program to the other by turning my head and clicking. In the past, I could only view a small window into each application if I wanted both on my screen at one time.

One Monitor

You can see how scrunched things are above.  Below is the image of two monitors, side by side. My two open programs shown overlapping on the screen above have now gone to five open programs plus Google Sidebar. I still have several other items in my program tray that are not currently maximized, but with the two monitor arrangement, I can easily see my multiple tasks at one time.

Two Monitors

This is especially useful for those of you who keep a product (like SOS Software or some other mental health billing software) active on your computer all the time. You need it there ready in case you have a phone call from a client, so you can check someone in when they arrive to see their psychotherapist, so you can enter their payment when they leave. But today you are also actively writing letters in your word processor, you are working on spreadsheets you have created by exporting some of your reports from Office Manager, and you are occasionally checking your email. With two monitors, all those tasks can be visible at one time!

To add the second monitor, you need to be sure you have adequate inputs on the computer box. Then use the Windows Control Panel > Display Properties > Settings to select which monitor is primary and to verify the appropriate settings. Just Google ‘dual monitors xp’ or ‘dual monitors vista’ without the quotation marks to get guidance from Microsoft about just what to do in your operating system.

We all have too much to do, so finding the most efficient and cost effective ways to get that work done is very high priority. Let us know what kind of steps you have taken to increase your efficiency. Have you considered multiple monitors?

To enter you comments, just click on the title of this article and enter your thoughts in the box at the bottom of the page.

I am a firm believer in synchronicity. I think of Carl Jung and his notion of synchronicity (an acausal connection of events in time) often as I experience the unexpected confluence of events. This weekend was no exception.

1. On Friday, I had time (for the first time in weeks) to tune in to HubSpot TV, a podcast done by staff members of the Internet Marketing firm whose products and services I use. They mentioned this issue of social media utilization and the possible need to keep one’s “identities” separate. One of their blogs addressed the issue on Friday and the author lays out some considerations.
2. On Friday evening, my partner, Seth Krieger, suggested that I write a blog on social media and professional vs. personal concerns.
3. On Sunday I got the Friend requests I mentioned above.
4. This morning I looked at two print newspapers I receive: The New England Psychologist ran an article featuring input from Thierry Guedj, Ph.D., “Psychologists navigate use of online social networking sites“; and The National Psychologist included John Grohol, Psy.D.’s article “How ‘tweet’ it is: Social networking using Twitter”. Both of these psychologists explore some of the concerns unique to providers in the behavioral health community.

This confluence of events was impossible for me to ignore. I have found myself thinking about these issues often over the past several months. Since I began use of social networking as a way to spread our business presence more broadly on the Internet, the differences between personal and professional presence have been playing around the periphery of my mind.

While I have not seen clients for the last 16 years, I was trained as a psychologist and saw patients in a private practice and in a CD program setting from 1978 to 1993. I am well aware that boundary issues are confronted regularly by psychotherapists charged with providing a safe space in which consumers of their services can deal with issues ranging from relatively minor personal problems to serious chronic mental health issues. Protecting that ‘space’ is part of building trust and of maintaining the privacy of the client.

The sanctity of that space is challenged regularly, sometimes by the spill-over of the therapist’s life into the therapy. Personal illness and family deaths are regular intruders, but many others exist. I hosted a live, call-in television show on psychology topics from 1981 to 1983. Some of my clients were proud of the public education work I was doing; others felt that they lost a part of me that they owned and were not happy to share me with the public. As a feminist psychologist treating lots of women, it was not unusual to cross paths with a client in the ‘real’ world. Prior agreements about how or whether to greet in public aside, face-to-face interaction outside the therapy space was often a cause for discomfort for me and for the client.

Those challenges to privacy are part of the physical community in which we live. Now we add the complication of a virtual world in which massive quantities of information, both personal and professional, are available to anyone who bothers to Google us. Factor into that the fact that we have no idea which information the client has. Each form of social media provides different challenges.

1. blog: A weblog, or blog, can be an excellent way for you to provide useful information to your own clients and to many others who see your blog articles. But if you go out there into the blogosphere and take a look at the material available, you will find that the writing styles are much less formal than other published documents, especially journal articles. Because of that informality, there can be a tendency to slip into personal revelation.

Potential benefits: Great way to become more known in your community, to educate and share valuable information with your clients, and to provide a community service through public education.
Potential risks: Informal style of blogs can lead you to share more personal information than you would usually do in journals or in direct contact with your clients.

2. Facebook: When I started to use Facebook, I intended that use to be purely personal. My nephew’s wife invited me to join first. I resisted. When an age-mate with whom I share a book club and a social sphere invited me, I joined. Facebook has been great fun! I have connected with classmates, friends and family members. As with many people in my age group, my postings are rather tame. They do reveal personal relationships and history. I was a little conflicted when business associates asked for ‘friend’ status, but decided that I do not live a wild and crazy life and there is little about me on Facebook that I am not comfortable sharing with customers and other business associates.

Potential benefits:Facebook is a great way to keep up with new family photos and to stay in more frequent contact with friends and family members who are far away.
Potential risks: If you do live a wild and crazy life and do not want your clients to know that, do not give ‘friend’ status to those clients.

3. LinkedIn: LinkedIn is the only one of the social networking sites I use that is designed for professional purposes. It is professional networking, par excellence. If you want to connect with other colleagues, this is the place to do it. If you are looking for a job, this is certainly the place I would start. There are headhunters who frequent the site looking for the most qualified individuals for their position postings. You can join groups that meet your interests and connect there with other folks who have like concerns. 

Potential benefits: LinkedIn is a great place to network with other professionals. It is designed for peer-to-peer connections.
Potential risks: If your clients/patients are other professionals, you might run into them here and need to make some decisions about who your network should include or exclude.

4. Twitter: Twitter is something else. I am still not sure about Twitter. I use it in a purely professional way. In fact, the name under which I tweet is @SOS_Software. The people I follow are other professionals who have similar interests. Those other folks are great sources of information. The tweets I find most useful are about articles, blogs and news that is relevant to my professional world. Most of the people who follow me are also interested in healthcare and software. Sometimes, I get a follow from someone who seems totally unrelated to anything in which I am interested. I blocked the clearly pornographic Follow that appeared last week.
     The way I use Twitter is totally contrary to the way most young people use it. To folks who are used to text messaging for everything, Twitter is a way to disperse text messages much more broadly. You can let everyone in your network know your status all at one time. To me, this is useless. To many others it is an essential part of staying connected.

Potential benefits: This is an excellent way to disperse a communication to a large group of people at one time. You could use Twitter to communicate educational information to all of your clients at once.
Potential risks: Twitter is like Facebook. Everybody who follows you sees everything. If you intersperse personal messages with your professional ones, everybody who follows you still sees all of it.

What do you think about these social networking sites? Do you use them? Does your organization use them to keep in touch with consumers? What do you see as the potential benefits or glaring weaknesses of being connected 24/7?

One last word of advice: If you decide to jump into the sphere of social networking, decide whether you are going to do so as a professional or for your personal needs. Once you decide, choose your networking sites accordingly. If you want to do both, you might be best served by having two different social networking identities.

The other listserv members addressed three issues: recovery of the data from the hard drive, backup of the data, and re-creation of the records from scratch. Because of our experience with customers losing data due to computer failure, I focused yet again on data backup and database recovery. Added to my thoughts this time are the HIPAA requirements for securing protected health information (PHI) and the increased penalties in the HITECH portion of the stimulus bill (ARRA) for breach of privacy and security of PHI.

It is likely that you all remember that HIPAA requires healthcare providers (including psychiatrists, psychologists, social workers, mental health counselors, and community behavioral health organizations) to have in place procedures for securing the PHI of their patients. Most mental health workers with whom I am familiar focus on the privacy aspect of this protection; they see it as their responsibility to assure that the consumer’s information remains private. HIPAA also mandates that providers and their organizations have in place plans to protect the security of their physical data.

The National Institute of Standards and Technology (NIST) has produced Special Publication 800-66-Revision 1, “An Introductory Resource Guide for Implementing the HIPAA Security Rule.” A quick search of this document finds that the words “loss of data” are mentioned on pages 38, 77 and 98. The first mention is in a table describing the necessary contents of the Contingency Plan for data security, including a Data Backup Plan. The sections of this document that focus on the Contingency Plan and the Disaster Recovery Plan are the ones most concerned with electronic data storage.

If your organization, including your private practice of psychology or psychiatry, does not have a Contingency Plan and a Disaster Recovery Plan, however brief, you are living dangerously. And, of course, you must implement your plan to secure your PHI, not just have a plan.

How does this pertain to you? Let’s start with your data backup plan. What is it? Who in your organization is responsible to implement it? What are the consequences if it is not implemented?

One of our customers,   W. E. (Bill) Benet, Ph.D., Psy.D., Clinical Psychologist, Gainesville, FL  WEBenet.com | Assessment Psychology.com describes his experience and current backup strategy.

“I mentioned Eco Data Recovery in my previous note because I had to use their service a number of years ago after the hard drive on my main office PC mechanically failed and became inaccessible while backing up to a tape drive, corrupting the data on the tape. Fortunately, Eco was able to recover all of the data from the hard drive, by disassembling it in a ‘clean room’ and scanning the data off the individual platters. Luckily, the data on the hard drive hadn’t been corrupted, but it very easily could have been, and I would have lost years of billing records and reports.”

“But what about data that has become insidiously corrupted without being immediately obvious?”

“Today, I employ a simulated RAID backup strategy involving nightly network backups to two external USB drives, as well as from one PC to the other, AND continuous 24/7 incremental offsite backups, using Carbonite. Hopefully, if corrupted files are discovered days or weeks later, those incremental backups will save the day, at least for a while.”

Here at SOS Software, we all too often run into an organization where the principals thought they had an excellent data security plan, only to find out that their plan had not been effective or had not been implemented by the person(s) who were responsible to do so.

One of the obstacles we run into is the common belief that “it can’t happen to us.” We all know this is magical thinking; of course, it can and does.

Another often-believed myth is ”I don’t really need to worry about data on my PC; data can always be recovered from a hard drive if there is a problem.” While this belief is sometimes true, it often is not. If the files lost when a computer crashes are in a complex, proprietary relational database, they sometimes are totally irretrievable. They are not text files where parts can be grabbed and some sense made of the data.

Our product uses Sybase ASA as its engine because that database creates a transaction log that can allow us to completely recreate every keystroke the user made…if the log file is intact. In fact, we use Sybase because of this capability to completely recreate the database if it is necessary to do so. As long as we have a usable starting point, we can restore the entire database from the log file…if we have an intact log file.

Two problems can intervene. 1. With our products as with many others, if the backup is done while the database is running, certain of the files are not backed up because they cannot be accessed completely. Some backup software products will tell you they can back up even when the program is running. That is not true with SOS products. 2. Hard drives often fail gradually becoming literally “flaky” over time. If key sectors of the log file are lost, it is impossible to recreate the database from the log, even if there has been no overwriting of the database.

Also, sadly, even folks who believe they responsibly make backups, never test those backups to assure they can be restored properly, and they often use the same backup medium overwriting old backups. If the hard drive has been gradually failing, destroying parts of the files as it goes, then backups of those bad files become bad too…all of this over time with no noticeable degradation of performance of the database.

Then the catastrophe occurs…a power surge or some other event causes a crash of the hard drive and the database will not restart when the computer is rebooted!

As indicated by comments on my post of November 19, 2008, The Indispensable Data Backup, among my readers are many folks who are sophisticated computer users who are responsible enough to use multiple methods of backing up their patient data. Using a rotating system of backing up with permanent, non-incremental backups created periodically and stored off-site, is crucial. The strategy we recommend is in document 125 on our main web site.

If you have never tried restoring from one of your backups, you have not completed the process. Unverified backups are useless backups. Useless backups equal insecure PHI. How big a risk taker are you?

Please add your comments by clicking on the title of this article and typing in the box at the bottom of the page.

We spent the holiday weekend at the Georgia Tandem Rally, our favorite organized bicycling event. This year, 102 tandem teams from 15 states rode the tandem-friendly, hilly terrain around Athens, GA. During the 135 miles of riding, I had plenty of opportunity to reflect on why I enjoy riding a tandem bicycle so much…especially in the company of other tandems.

Tandem bicycling used to be the venue of the middle-aged, but younger folks with children riding along have become much more common participants. The result of the addition of these younger riders to the mix is a wonderful continuum in strength, speed and power. Even those of us who have never been fast (having started our tandem careers around our half-century birthdays), are able to be carried along by the power and enthusiasm of the younger riders. There are few more fun things for this otherwise very slow cyclist than a double pace line of tandem bicycles moving quickly along a traffic-free country road. We are all made stronger and faster by the quick moving youngsters and no one feels bad when we drop back to do our own thing at our own slower pace. Variation in team strength and endurance is part of what makes this kind of riding fun; each individual tandem is a successful team riding to their own particular tune.

In fact, the dramatic variation in tandem teams reminded me strongly of the similar variation among our customers. We have in our mix many solo providers, even more mid-sized groups, and a significant number of large groups and small to mid-sized agencies. Mental health providers are notoriously independent types; even when they work in groups and agencies they find or found organizations that fit their personal styles. In the 24 years we have been doing our business, we have been amazed at the varied ways in which our customers utilize the tools we provide…behavioral health practice management and EMR software. Indeed, I would venture to say that we have no two customer organizations who use our products identically. Discussion on our user group will readily confirm this observation.

This same variety exists in the arena of software providers. There are companies large and small providing products that also vary markedly in capabilities and in price. Those of us who are small benefit greatly from working with our larger competitors; we are swept along in the tide of change adding the essentials to our products so our smaller customers can continue to meet the ever-more-complex requirements placed upon all provider organizations, no matter their size.

Given all of this variety, I find myself wondering how many behavioral health practitioners will actually need certified Electronic Medical Records (EMR) in order to provide their services and to be able to share their records with other providers electronically. When I look at the list of functionalities and interoperability criteria required of certified products in the ambulatory health arena, I wonder what proportion of our customers could even begin to make use of all those features and communication capabilities…and how many actually require those feature sets in order to do their jobs well. They might be required by funding sources to purchase certified products, but if they are not part of an integrated healthcare organization, they are unlikely to actually need such products.

I spent a good deal of time participating in a work group that developed a behavioral health-specific profile for software products that conforms to the major criteria in the ambulatory EMR set. That conformance profile was adopted by HL7. I must say that the profile includes comprehensive feature sets for the most complex of behavioral health community organizations. It is significant overkill for most individual and group providers.

The Certification Commission for Healthcare Information Technology (CCHIT) has a work group developing criteria and test scripts for certification of behavioral health EMR products. While a draft of these criteria is due by August 2009, this certification will not be available until 2010 at the earliest, and possibly later. This timing and the limited funding available in ARRA to behavioral health providers makes it unlikely that most mental health provider organizations will be able to qualify for ARRA funding to buy behavioral health-specific products. 

My question to myself and to you is, does that really matter? If Behavioral Health certification were in place today, how many of you would be shopping for a certified behavioral health EMR to implement immediately? How many of you have even begun to think about whether and how this whole move to electronic medical records will impact your practice of psychology? of psychiatry? your community organization?

My experience of our customers, of the successful teams of people who currently provide mental health services in various settings in the U.S., is that you will continue to do so with or without certified EMRs. You will find behavioral health electronic medical record products that fit your budget, your workflow and your way of providing services, and that can share essential information with other providers and the healthcare system at large, whether or not the products used by your communication partners are certified.

Please add your comments by clicking on the title of this article and entering your thoughts in the box at the bottom of the page.

3.7 percent of the participants in a 2006 survey performed by the Federal Trade Commission indicated that they had discovered they were victims of identity theft during 2005. This amounts to approximately 8.3 million U.S. adults who found that someone had inappropriately tried to use their personal information. We all know that number is not going down.

In November 2007, the Federal Trade Commission (FTC) issued a rule to help prevent identity theft. For those organizations to whom it applies, the Red Flags Rule must be implemented by May 1, 2009. Obviously, you need to determine right away if the rule applies to you. You should not assume that it does not apply.

According to the April 23, 2009 Public Policy Update of the National Council for Behavioral Healthcare, the Red Flags Rule was written to require organizations to be on the lookout for warning signs of identity theft, to do what is possible to prevent the crime, to mitigate the effects of the crime if it occurs, and to have a formal, written plan that they follow to these ends.

Many healthcare organizations felt that the HIPAA requirements for the protection of sensitive patient information were adequate and that they should not be required to adhere to the Red Flags Rule. The American Medical Association (AMA) argued that position to the FTC. Unfortunately, the FTC ruled that the AMA’s arguments did not fly. If a healthcare provider regularly defers payments for goods or services (that is, if they routinely allow clients to receive services now and pay off the charges over time), then they are a creditor under the terms of the rule and the provider organization must therefore comply. It is highly likely that the billing practices of most psychologists, psychiatrists, social workers and many community behavioral health organizations will require that they be considered creditors under this rule, and must comply with the rule.

It is possible that you already take most of the actions that the rule requires; however, the rule mandates that you have a written policy and that you implement a program to protect and monitor patient information for possible identity theft.

Please take a look at the 17-page guide to determine how this rule applies to you.

Have you already drafted and implemented such a plan to protect your clients from identity theft? If you have, are you willing to share a bit of your experience?

Oh no, I can hear you say. She had a computer crash and did not have a backup! But, you see, I did have a backup. I am an avid Windows Live OneCare user. My computers are backed up weekly…and all of the data produced on both machines is backed up daily on our network, which is, in turn, backed up several different ways. I did not lose any data, but I was still faced with the ordeal of getting my computer back to where I need it to be so that I can be productive. So what happened?

I have become the victim of an infamous catch-22. I had complete and incremental Windows Live OneCare backups of my computer…but I could not run Windows Live OneCare in order to restore my backed up files.  Even if I could restore the files backed up by OneCare, chances are that Windows would still be broken to the point of unusability. My computer even has built-in recovery support, so I had a complete backup of the machine stored on the hard drive. But the problem was in the operating system (OS)…Windows itself had become corrupted. And here’s the kicker…I bought the laptop with Windows Vista pre-installed, so I did not have CDs from which I could reinstall the OS, and the built-in recovery program on the hard drive would not run.

Once we had tried all the restore options we thought we had in place here locally with no success, I called Lenovo for support. They determined that I needed to reinstall Windows and sent me CDs with which to accomplish that task. Before getting to this point, I had easily spent three days trying to recover from the fatal problem; Seth had spent two additional days of his weekend trying to do the same. This was just the beginning.

The CDs from Lenovo arrived while I was at the SATVA meeting and Seth started the installation process for me while I was away. When I returned, I spent another day monitoring the computer while it completed all the necessary updates. Then I began the time-consuming process of re-installing the software I use on the machine. That was last Monday. I got Microsoft Office installed along with a couple of smaller programs I use all the time. 

Next I performed what we have decided is a crucial step to keep this total waste of time from happening again in the future…I created an “image” of the hard drive including all the programs and registry settings for everything I had installed up to this point. An image backup differs from the usual file backup in that it is a bit for bit copy of the hard drive, a snap-shot of the entire hard drive at a specific point in time. It can be restored without the need to install Windows first.

While we used an inexpensive “techy” Linux-based program to do this image, there are many excellent products on the market. Some traditional backup programs, such as current versions of NovaBackup, also include image backup capability. I had not yet installed all the programs I use, but we were still uncertain about the stability of my computer, so we wanted to be sure to have an image of the hard drive sooner rather than later. I will repeat this step when I have completed installation of all of the programs I use and do not want to have to reinstall the next time something like this happens.

Twenty days later, I am almost back to where I started. Today I am installing the last of my frequently-used software. I cannot even imagine where I would be if most of my data were not stored daily to our network and backed up each night. At least I have been able to access most of my data files once reinstalling the program that created the files. I am fortunate that I also run a desktop computer from which I can operate most of my critical computer functions. The original purpose of this dual computer capability at my desk was multi-tasking and minimizing wait times, but during recovery I have been able to keep up with email and customer contacts and bookkeeping because all of that is done on my desktop computer. I will create an image of that machine tonight! I did that immediately after we originally setup the computer, but the image has not been updated since then. As I have learned, that is a disaster waiting to happen!

It does not matter what you use your computer for. If you do mental health billing or medical billing; if you use the system for a behavioral health EMR or for a psychiatric clinical record; if you are the bookkeeper and maintain the financial records for your organization; if you are a home user who maintains emails and pays bills and shops on the Internet…you need more than a backup. If your computer is used for crucial functions of any kind, or if your time is limited and you don’t want to spend days rebuilding your machine’s contents, you need more than just regular backup of your data. You need an image of your hard drive and you need it somewhere other than on the hard drive of your computer!

The lesson learned from this experience is that we cannot afford the down-time and rebuilding time that it takes to get a machine functioning again after a crash. Data backups are not enough. We are now developing a schedule for regular imaging of each computer in the SOS network. Perhaps you will do the same without needing to go through this experience first hand.

Feel free to share your experiences with computer crashes and restorations. Do you have particular image and/or backup software to recommend? Let us know what you think. Just click on the title of this article and enter your comment in the box at the bottom of the page.

Our practice has always aspired to provide excellent quality. What business hasn’t? This article is meant to stimulate discussion as how to address and improve the quality of clinical practice.

We emphasize two points in hiring: 5 years of solid clinical work and very good people skills. If we can’t imagine a range of patients connecting with you, we are not hiring you. The next step is to monitor how well the therapist holds patients. Billing software with decent reporting capabilities can be an invaluable resource here.

Patients who stay in treatment tend to get better, and as they improve, they’ll refer others. In contrast, therapists who lose 40% of new referrals by the 3rd session usually are doing so out of errors of omission or commission. Our billing software allows us to mine the data that tells us what percent of new referrals continue with each therapist after the 3rd session. Granted, this is a blunt assessment tool; and so we have searched for other means of assessment.

After my car is in the shop for service, I get a call asking, “How did we do?” We tried something similar with a patient satisfaction survey sent to patients whose last treatment session was more than six weeks ago. (This assumes that a six week break from treatment meant the client was done with treatment for now). Unfortunately, the return rate was only 10% even though we provided stamped return envelopes or used email. Our next attempt will be to put the survey in waiting rooms with large signs encouraging completion. We want to keep the surveys out of the treatment session as many believe this could change the nature of the treatment session.

There are numerous satisfaction surveys out there. I find the ones constructed by insurance companies are particularly bad, not to mention self-serving. They see success as getting patients out of treatment ASAP. We constructed our own survey, yet it doesn’t seem to get at the heart of the matter: what was specifically helpful or not helpful in the therapy session. What did the therapist do (commit) or not do (omit) that made the treatment better or worse?

Our next survey version will pose these open-ended questions. I hope that this will generate the type of quantitative and hearty data that can complement the qualitative data from our billing software—and ultimately be beneficial to therapists.

Our goal is to identify what happens in a therapy session that makes a therapist “good”. Then we can give the therapist concrete, usable feedback that encourages improvement. We want people who are interested in this type of feedback, whether they are a therapist, secretary, psychiatrist, and, yes, even the owner!

I welcome your feedback.

Vince Bellwoar, Ph.D.
http://www.springfieldpsychological.com