As a result of this wide variability, the individuals with whom we deal in our provision of technical support services range from highly-trained medical and mental health billing/coding specialists and practice business managers to the teenage child or neighbor of the doctor who happened to be in need of a summer job. We are often amazed by the differences…by how much some billing specialists know and how little information others have.

One of the biggest surprises for me is how often highly trained mental health professionals are willing to entrust their businesses to individuals who have no training to do such a job. We are sometimes asked why our software does not do “x” for them. We explain that the software is a tool to be used by someone who knows mental health/medical billing to accomplish the needed tasks. It will not magically do billing for someone who has no idea how to do that job.

My niece works in a medical practice and is studying for the American Health Information Management Association’s (AHIMA) Certified Coding Specialist – Physician Based exam. I went to AHIMA’s site to see what the content is for this certification and was amazed at the breadth of the knowledge required to achieve the certification. The AAPC is a different organization. . . of professional coders. . . that also offers training, certification, support and networking. Both of these are aimed at individuals who work in medical coding and billing.

Some people who work in behavioral health assume that the billing job must be much simpler for mental health because it contains a much narrower range of services than a general medical practice. Just ask any experienced behavioral health billing specialist, and you will find out that it is not simple at all. Just because the range of services provided in behavioral health is much smaller does not mean that the person doing the billing requires less knowledge about billing and collections and dealing with insurance carriers.

Mental health services were “managed” by insurance carriers much earlier than most other specialties. As a result, there are rules and requirements for obtaining authorization for treatment that have a 30 year history. While “parity” was legislated in 2008 and the final rule for implementation promulgated in 2010, implementation has been slow and many consumers are not even aware that their plan might cover mental health services at the same rate they cover general medical care.

To expect someone who has never worked in a health care setting and has not previously done medical or mental health billing to have any idea about parity or treatment authorizations or copays or coordination of benefits or take-backs is just not reasonable. Medical billing is complicated and behavioral health billing has its own subtleties and complexities that are different.

So what is an employer to do? Here are some quick suggestions:

1. Recognize that the person who is doing your billing is running a crucial part of your business. You should expect them to be a business professional.
2. Do NOT expect someone who earns minimum wage to know how to do behavioral health billing. If you find a qualified biller who is willing to work for such a wage, they are selling themselves short.
3. If your staff is struggling with how to bill, get them information. The Center for Medicare Services (CMS) is an outstanding resource. If a claim will pass Medicare muster, it will also pass the requirements of most other insurers.
4. Invest in training for your staff. Having your staff thoroughly learn the software product you are using will earn money for your organization.

This is an arena in which I am sure many of you have experience and opinions. Please share your comments below. If you have additional recommendations for employers, please let us know.

Lots of folks have been waiting to see what kind of fines the OCR would impose upon organizations found responsible for breaches. We are beginning to find out.

On February 14, 2011, HHS entered into an agreement with Massachusetts General Hospital in which the hospital organization agreed to pay $1 million because of the loss of data of 192 patients of one of its outpatient practices. The information lost was on paper and was lost on a subway train. The hospital also agreed to enter into a Corrective Action Plan (CAP) including the implementation of policies and procedures to protect the PHI of its patients.

For those of you who thought these requirements do not affect you if you do not keep any patient information in an electronic form, it is clear that is not how OCR views it. Paper is also vulnerable and OCR is determined to protect that PHI.

The second announced fine was placed on Cignet Health of Prince George’s County Maryland. They were fined $4.3 million. They were accused of denying 42 patients access to their medical records, failed to cooperate with OCR in their investigation of the complaints, indeed failed to reply to OCR’s notifications. OCR determined that “the failure to cooperate was due to Cignet’s willful neglect to comply with the Privacy Rule.”

For those of you who have thought that not keeping records of treatment might be the safest course of action, please think again. If you cannot provide the record when a patient requests it, they have every right to complain and to seek a judgement against you.

Of course, your organizations all have Privacy Policies. Do you know what they are? Do you follow the Procedures that your organization has developed? Does everyone? Part of the requirement is that employees be properly trained in what the policies and procedures are and that their training is regularly refreshed. Oh, and yes, part of the requirement is that the Privacy Officer makes sure the owners of the practice or the Executive Director or Board of Directors is well-informed about how the policies are implemented.

How is your organization doing with the stricter Privacy Rule requirements imposed by the HITECH Act? Please share your thoughts, fears and struggles with these requirements and how they affect your organization. Just enter your comments below.

This is not my first time changing machines. Over the past 30+ years, I have initiated the use of many new computers. As I have gotten older, I have become less good at making the changes and adaptations that must occur in this process. In fact, the last time I got a new desktop computer, I was so loathe to go through the time-consuming process of installing and setting up everything anew that I used a “suitcase” service to backup my old machine and setup the new computer from the image that had been created. As a result, certain registry entries were never properly initiated. I never had a working CD reader/writer in the last computer . . . even though three have been installed. I had mysterious failures and the blue screen of death way too often to make me happy. I won’t bore you with more details; just know that this shortcut method did not work to maximize my use of my new computer, but it did save me time initially.

Accordingly, here are my suggestions about going to a new computer.

1. Don’t use the shortcut methods. They may save time at the front end but they will waste your time maddeningly over the years of your use of the new computer.
2. Do make a complete list of all the programs you use on your current computer.
3. Make sure you have installation CDs and license codes, or that you have downloaded the installer software for your programs to another computer on your network or with which you can share your new computer in order to get setup. Again, be sure you have the license codes somewhere other than on your current machine.
4. Once you have made your list, check again. I was amazed at all the little programs I have downloaded over the years that are crucial to my day-to-day functioning. Do you use a zip program or a pdf creator/viewer or a screen clipping program? Do you have certain simple games that you enjoy for a quick break occasionally? Do you have gadgets or scratch pads or sticky notes or calendars that you rely on? Make a list and find the source of the programs before you make your switch.
5. It is not usually necessary to have an expert set up your new computer for you, but it is very nice if you have the option of their assistance with installing the operating system and the larger/more complicated of your programs. If you are getting a Windows-based computer and buying Microsoft Office, having someone else install those programs for you can be a big time saver.
6. Even if someone else installs these for you, you will still need to set up all your personalizations and special configurations. Your Favorites will be missing, so, if they are important to you print out lists of these things while you are creating your master setup list.
7. If it is possible to continue using your current computer while you are setting up the new one, do so. That way you will be able to continue your work and productivity while all those installation programs are running.

Remember, your new computer is likely to be faster and to have some wonderful innovations that you have been anticipating with excitement. Don’t let yourself get so bogged down in the setup that you forget to enjoy all the new features and power!

Do you have a new computer story that you would like to share? Have you come up with some additional tips for getting started with a new machine that might be a help to someone who reads this blog? Please share your comments below. Thanks for reading.

I attend lots of webinars to try to stay informed about what is happening in our industry. As indicated by the fact that I often write about those webinars, I am often stimulated by them. I am rarely alarmed, but this presentation by attorney Adam Falk was almost frightening. I found myself thinking that, if I were still in private practice of psychology, I would stop accepting Medicare patients. Since I just turned 60 and will become one of those Medicare patients in only five years, that thought was most distressing.

According to Mr. Falk, the Patient Protection and Affordable Care Act of 2010, as part of the attempt to save money by eliminating fraud, has placed new requirements on providers of service large and small, to demonstrate compliance with the law. It is not enough to comply; one must also be able to prove that compliance, hence the need for a formal Compliance Program.

The regulations have not yet been written to determine what must be included in such a Compliance Program, but Mr. Falk strongly suggests the need to be proactive rather than reactive regarding this matter. While compliance programs are to be ‘scalable’ based on the size of the organization and the amount of service provided as part of the Medicare or Medicaid systems, there are certain aspects that are essential.

The biggest danger to provider organizations is that the Affordable Care Act classifies much irregular activity as making a false claim. The penalties for false claims are significant. Fraud is rampant and HHS is tasked with eliminating as much of it as possible to protect the taxpayer’s dollar. The attempts to prevent this fraudulent activity provide the Secretary of HHS with broad authority.

Additionally, providers are required to identify, report and return overpayment by Medicare or Medicaid within 60 days of the provider’s recognition that an overpayment has been received. That recognition applies to the clerk in your accounts receivable department who mentioned the overpayment to a supervisor or to someone in authority. Training staff and providing formal procedures to follow will be an essential part of any compliance program.

I would suggest that you take an hour and listen to Mr. Falk’s webinar. Then start to research what might be required at your organization’s level to comply with the requirements of the law.

*****

I received an email notification today from the Office of Civil Rights indicating that HHS has scheduled a second public discussion on Confidentiality and Privacy Issues Related to Psychological Testing Data. The meeting will be held in Los Angeles on November 18, 2010.

Please share your comments below. Thanks for reading!

They were sure they had a good backup. When their server hard drive crashed, they were distressed but not terrified. Instead of dealing with the loss of all their data, it merely meant that they would need to get a new server and have someone spend time rebuilding the hard drive from installation CDs and all of the backed up data.

That’s when reality set in. Their consultant technician installed our software onto their new server from a CD and went to restore the data. The data folder was empty. He was unable to recreate his client’s practice management data from a usable backup. That is also when the customer’s panic started.

I don’t know if you have ever considered this scenario for your organization. After all, your IT specialist set up a tape or external drive backup for you and the system automatically backs up every day. Sometimes there is a strange error message on the monitor when you remove the tape or you get an email that says an error has occurred, but you don’t really have time to pursue it.

Have you ever tried restoring from one of your recent backups? Do you know that the data are usable? If someone in your organization has never restored one of your current backups to your system and made sure the restored data worked, then your backup process is incomplete and you are at risk for the same kind of upset our customer experienced this week.

Happy ending to this story. . . a hard drive retrieval company was able to pull data off the crashed drive. . . at a cost of $7500! Since that certainly played havoc with the budget, this happy ending is really a mixed one.

If you want reminders about backup procedures and our best thinking about what to consider take a look here and here and here and here. We have not written about this as recently as I thought, but data backup is a subject that we try to remind ourselves and our customers about regularly. Please think about and take action about yours.

Also from the ‘It’ll Never Happen To Me’ department. . . I attended a webinar on the HIPAA and HITECH breach notification requirements a couple of weeks ago. This was done by a company named IDExperts that specializes in guiding companies through the risk assessment process after a breach has occurred. They also have a software product that will walk you through the post-breach risk assessment and track the histories of all breaches. Their take on data security and the risks involved are like this: if you were interested enough to attend the webinar, the question is not if you will experience a data breach, but when. Statements like that always jar me. Since we are not a Covered Entity and have no PHI of our own, I am not too concerned about us experiencing a breach; our procedures are solid and any electronic PHI temporarily in our possession only resides on encrypted computers. Obviously the worry is not small for health care providers, especially large ones.

The concern about security and privacy of PHI has recently been complicated by the fact that HHS has decided to reconsider the final rule on breach notification. After privacy and security groups were distressed and complained to HHS about the methods for deciding whether the release of data presents a risk to involved patients, HHS decided to reconsider the final rule. There is speculation that the rule will be made tougher than it was. Up to this time, the organization that experienced the breach has been responsible for determining the severity of the risk to patients caused by the data loss and whether HHS needed to be notified off the breach. HHS did not indicate when a new rule could be expected.

Who in your organization is responsible for verifying that your backups are usable? When was the last time a test restore of crucial data was done? Would you have any idea how to do this; if not, who does? What is your plan of action if protected health information is accidentally released when it should not have been? Are you convinced it’ll never happen to you?

Please share your comments and your experience so all our readers can benefit from best practices on data backup and protection.

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.