When I say the U.S., I do not just mean the U.S. Government. I also mean U.S. and multinational corporations that are loyal only to their bottom line, private U.S. military contractors (otherwise known as mercenaries), the U.S. economy, U.S. buying/consuming habits, and the knowledge, involvement, and activism of the U.S. citizenry.

Daniel Suarez, the author of these books, is a systems consultant and programmer. He knows about the software and devices that run our lives. He has consulted extensively on data security to Fortune 1000 companies. The technology described in his books is all current and real . . . and very frightening. His stories successfully make the point that our identities are so tied into the computer systems that run modern life, that our civilization could not survive without them. As we move toward digitizing our medical and mental health records, we simultaneoulsy decrease errors and increase our vulnerability. Long-term loss of electrical systems in a dozen major cities globally could destroy our entire way of life, including our food distribution system. Even a short-term loss of electricity can throw us into major disarray. But not necessarily . . .

A key element of Freedom^TM, is that sustainable communities that are not totally reliant on centralization of resources can survive even major disruption. Sustainability is defined on Wikipedia as “the capacity to endure.” It is the ability to survive based on a balanced and reasonable use of resources that does not deplete those resources.

Currently, the concept of sustainability is enjoying popularity in some government circles. The EPA, HUD, and DOT have developed a program for developing sustainable communities.  These programs focus on housing and business development in urban and rural areas and how to do it in a way that contributes to the well-being of everyone involved, including wildlife and the earth.

Not-for-profit organizations and think tanks focused on a sustainable future have been appearing over the last decade. Philosophical and spiritually grounded individuals have long taught of the need for changes in how we think and live that will result in our well-being. Even some businesses profess sustainability as part of their business mission.

But without action from concerned, educated, and involved individuals, none of these movements will gain the traction they need to affect how we live.

I have long believed that an informed community is also an activist community. When I take the time to educate myself about the events and issues of the day, I am also motivated to examine those events in light of my own beliefs and values. When the values I hold dear are threatened, I take action. At least, that is what I used to believe. I know a few people who do that, but not very many. I do not share the political values of the Tea Party. I do share their belief that it is the responsibility of citizens to express their opinions and to become involved in the political process . . . after educating themselves about the issues.

I know, I know…you don’t have time to breathe. You already work in healthcare, most of you in the mental health community. You take care of other people as part of how you make your living, you certainly cannot consider taking the time to learn more about what is happening in our country and worldwide so you can become even busier. Getting involved in your community or becoming activist about issues that concern you is just out of the question.

And yet . . . unless more of us take the time to become such activists, we may not have day-to-day activities to be concerned about.

I hope you will read these books when you can. They are very good reads . . . extremely entertaining and very informative. Just view them as a treat to yourself.

Then decide what you need to do.

Our first meeting immediately after the election was highly charged. Staff had been studying President Clinton’s healthcare proposals, and the notion of controlling cost through “managed care.”

President Clinton’s healthcare proposals did not fly, but the industry picked up the notion of controlling costs by managing the care provided to consumers, and psychological practice has never been the same. For private practitioners, “managed care” continues to be a primary obstacle to the practice of psychology. Costs might have been suppressed by managing care, but some would argue that the primary effect of the managed care revolution was the creation of a new industry that made money as the middle-men at the cost of providers. Indeed, after a few years of leveling of the costs of care, the rise has been renewed and expanded.

In mid-November, the Supreme Court of the U.S. agreed to hear an appeal of the Affordable Care Act, our nation’s most recent effort to reform our healthcare system.

The Supreme Court agreed to hear appeals from the United States Court of Appeals for the 11th Circuit in Atlanta, which is the only court to have struck down the individual mandate because it overstepped Congressional authority and wasn’t justified by the constitutional power “to regulate commerce” or “to lay and collect taxes.” FierceHealthPayer, November 18, 2011

According to editor Dina Overland of FierceHealthPayer newsletter, even a complete overturn of the law would have little significant impact. She believes that consumers like the changes the law is mandating and there is no stopping this train.

Mercom Capital Group, in their HIT Report of November 21, 2011, says the same thing about the massive changes in the healthcare arena at large. Basing their conclusions on a report by PwC (PricewaterhouseCoopers, LLC), Mercom reports that health organizations will continue to move forward with changes to their health technology and other innovations because the multiple drivers in the marketplace have finally come to a head. No matter the political or the financial uncertainties, PwC believes this movement will continue. These are changes consumers like, and the movement will continue no matter which market forces might change.

In their HIT Report of November 28, 2011, Mercom reports that Harvard and Aetna will ally to work to improve healthcare costs and quality. The two have formed a research collaborative focused on improving the quality and cost of healthcare. They will use bioinformatics, the interface of computer science and information technology with the fields of biology and medicine, to analyze healthcare data in innovative ways. They will focus on outcomes of various treatments considering quality and cost, factors that predict adherence to medical and drug treatments for chronic diseases, examining how claims and clinical data can be best used to predict disease and follow outcomes, as well as other treatments of data that will emerge over time.

Where is your organization in the midst of this dramatic change in how we manage healthcare? How do you see yourself participating in the sea change that is under way? Where does behavioral healthcare fit into this picture?

Just type in your thoughts below. Thanks for commenting.

I recently finished reading Daemon by Daniel Suarez. I was so fascinated by the ideas in the book that I just downloaded the free chapters of the sequel, FreedomTM and have requested the book from my local library. While I am waiting, I have been thinking and doing some research.

The premise of the book is that a dying computer game writer creates a program (called a daemon) that initiates upon news of his death. The extent of the infiltration of that program into the worlds of the rest of us is amazing. The book explores the worlds of computer and credit card hackers, drug cartels and crime syndicates, and all the government and quasi-government but private organizations potentially involved in these events.

This book is written by a computer systems person who consults to Fortune 1000 companies. His presentation of the events and concepts makes for a very exciting though violent story. It is called a techno-thriller. I call it science fiction….but all the technologies are current, so the events could occur.

I work in a high tech industry. We write software, so I thought I was at least somewhat informed about the technological world. This book revealed to me that I am totally ignorant of this whole realm. That is part of what is interesting to me about it. How can I live and work in the sphere I do and still have no idea about this arena?

Techies find this book and its sequel pretty fascinating. An article written by Josh McHugh in 2008 in Wired magazine talks about how the author got serious credibility in the geek world after self-publishing the book.

An organization called The Long Now Foundation . . . that is focused on encouraging and supporting long-term thinking about and responsible action in our world . . . had Suarez present a seminar about bot-mediated reality to members. As with most things I find interesting, the links I find in the cyber-world about my starting point are equally fascinating!

I have tried not to be a spoiler about Suarez’ books. That may have made this article a bit too vague. I hope you are interested enough to take a look at the links. Maybe it is time for us to balance our focus on the present and too many things to do with thought about the future and where we are taking ourselves.

Please share your comments below. Since I have no history with computer games, please share your experience and insights in that world.

I know that many of you were born after 1980. You have never lived in a world without personal computers. Those of us who are a bit older remember a very different world than the one we live in today . . . and one of the primary differences is the universal presence of personal computing devices.

At this moment I am sitting in my doctor’s office writing this post on my phone. Thirty years ago, I might have been reading a book or a journal. I could not have imagined that I might one day be doing this.

But Steve Jobs could imagine it.

The likes of Steve Jobs and Steve Wozniak and Bill Gates envisioned this world and helped make it real. The rest of us get the daily benefit of their ability to innovate. Some of us even got our careers because of their vision.

When Steve Jobs was working on the Apple I, I was finishing my doctorate in clinical psychology and looking forward to a long career as a psychologist. When my partner and I opened our first private practice in 1980, we had a word processor and bought Kaypro 4 computers. The computer seemed like a fun way to work and a powerful tool, so we bought one for each of our desktops. Within five years, we had started Synergistic Office Solutions and Seth was consulting with psychologists, building computers for them, and ultimately writing software for practice management. Because of the creation of an industry that did not exist when I started graduate school, I am twenty years into a second career. Without Steve Jobs and the work he did, I would not be writing to you . . . even though I have never used an Apple product.

In the next few years, we may see the passing of the personal computer into oblivion as tablets and super smartphones and today unimagined devices are created. But we are likely to remember that there was a very small group of incredibly bright, creative and productive individuals who imagined, innovated and then manufactured machines that have changed our lives.

Thanks, Steve.

Please feel free to share your own thoughts and reflections about Steve Jobs and about the changes in our world he helped create.

You all certainly know about the requirements that HIPAA and the HITECH portion of ARRA placed upon healthcare providers. You must protect the privacy and security of PHI. You must have assessed the risks to the security of your data and have a plan in place for mitigating any potential consequences of security breach.

The problem is that new potential complications arise all the time. This morning’s webinar was about social media and the potential security risks added by use of those media. It was presented by ID Experts, a company that specializes in an online tool that guides you through handling a data breach when it occurs. They believe that one must assume that such breaches will occur. . . and be ready to react at a moment’s notice.

Do you have a social media policy at work? Are you allowed to use Facebook or Twitter from your work computer? What about from your smart phone paid for by your employer? Are you allowed to access your personal email account from the same computer on which PHI are stored? Today’s presenters talked about all the potential downfalls of such capabilities since most social media sites are not encrypted and have marginally protected security.

I left the webinar feeling anxious for our customers who do not pay attention to these matters. What will they do when they have a data breach? What will you do?

Please share your comments…

The rate at which users want to be able to access their work applications remotely has grown geometrically. Fifteen years ago, we were asked about remote access a couple of times a year. Five years ago, that increased to a couple of times a month as many more users wanted to be able to access their software from home. Now, everyone who carries a laptop, or even a smart phone, wants to be able to do everything they need to do for their jobs from wherever they are located with whatever device they have handy.

Whew! If only they realized what an expectation that is! And, all of these expectations complicate the issue of security in ways that those of us who are not very technically savvy cannot imagine. But imagine we must…if we plan to protect PHI, that is.

First, the issue of backup. This is the primary way in which you protect the security and integrity of client information. If you do not have a usable backup from which you could restore PHI in the event of a catastrophe, you are only one step away from having allowed the destruction of your client’s PHI.

Yes, the identifying demographics together with the diagnosis you use to file claims is PHI and is protected under HIPAA. Everything you have in an EMR is PHI. Yes, you are responsible to assure that this information is intact, safe from destruction, and secure from preying eyes (and hacks). Without a usable backup (preferably encrypted) stored in a secure location ready at a moment’s notice to replace data on your computer system, you are not even doing the most basic things necessary to provide protection to your patients. You could probably be demonstrated to be guilty of ‘willful neglect,’ the level of culpability that will generate the highest of fines from HHS and OCR under their HIPAA authority.

If you are not sure of what kind of backup strategy is minimally adequate, take a look at the backup recommendations and product suggestions we make to our customers.

The issue of remote access, especially from handheld devices like smart phones and iPads, is one that concerns me considerably. HIPAA requires that we must provide for the security of PHI while it is at rest (on a computer drive or CD or smart phone) and while it is in motion (being transmitted from one location or device to another).

Access tunnels like a secure VPN or MS Terminal Services are specifically designed to assure the safety and security of the data being transmitted through those tunnels. Those of us who are not very technically sophisticated may assume that the developers of the iPad and smart phones have already taken care of equivalent security for us. Not so, folks. While there are some products that will provide that security, they are not built into those hand held devices and we are on our own to find them.

Do you realize what that means? Do you understand that using your cell phone to access your desktop computer and patient information without adding specific protection assures that your data are vulnerable? There is not built-in security in your telephone or tablet. Even having your client names and phone numbers in your telephone contact list is potentially a breach of their privacy.

No one has volunteered to create a secure environment for your data…that is your job. You must do the research and determine which products will give your PHI the greatest protection.

Not being informed about a problem of insecurity is not considered an excuse by HIPAA. You must know what security your devices use to assure the safety of PHI. Do you have password protection on your phone? Do you have a way of wiping all data from the phone if you lose it or it is stolen? Have you initiated the services that are available to accomplish those purposes?

I know, this has started to sound like a rant. I do not mean to suggest that everyone is acting irresponsibly with client PHI. I do mean to suggest that we take a much too casual attitude toward protection of that PHI…especially when it comes to technologies about which we know little but assume much.

What policies does your organization have in place about use of portable devices and the protection of PHI? Have you found products that are wonderful to accomplish that protection? Will you share their names and your experiences with the rest of us?

Please 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.

The technology, while very useful in operating your GPS or helping you keep track of where your teenager is at this moment, is also a potential privacy threat because it embeds the longitude and latitude of where the photo was taken. 

While many people are not very concerned about this matter, others fear that this is just one more step in the gradual erosion of our ability to protect our privacy. This is largely because most people do not even know about geotags and have no idea that they can be turned on and off. The above-mentioned article by Kate Murphy points you in the direction of controlling who has access to where your photos were taken.

The Web site ICanStalkU.com provides step-by-step instructions for disabling the photo geotagging function on iPhone, BlackBerry, Android and Palm devices.

Those of us who work in the behavioral healthcare world have long been concerned with issues of privacy for our patients and consumers of our services. We work hard to assure that only appropriate individuals have access to their treatment records, demographic and other protected health information (PHI). In fact, the law requires us to assure that only those who have a right to access this information have the ability to do so.

What are the implications for geotags on the issue of PHI? Right now, you need to post a photo on the internet or utilize an application that specifically makes use of the geotagging capability of your device to reveal your location. What happens when that capability is not revealed to you…or when it is revealed in a use statement that is so dense with legalese that you do not even read it? Here is a scenario from a not very distant future.

As a case manager for a community behavioral health organization, I want to be sure that I can always reach persons who use our services in case of an emergency. As a result, I keep a listing of the phone numbers of all my clients in my smartphone. Any time a new client comes in or a current client changes their contact information, I synchronize my phone list with my computer list. It has become so easy to do over my wireless network at home and the office that I am always up-to-date. Besides, having the list with me when I make a home visit means I can confirm my appointments before I head to see the consumer. I only include first name and phone number so confidentiality is protected, and my phone is password-protected.

I know I am not supposed to, but I also use my phone for some of my personal activities. I like to surf the web when I am waiting to see a client or while sitting in the train station. I have not disabled the features of newgoogle that customize the advertisements I get to match the web surfing I do…in fact I kind of enjoy it. I don’t use Twitter very often, but I like to check in every once in a while. And the new video feature is a great way to see where my friends are when they tweet. Last week I tweeted from the train and from the park across the street from my client’s apartment. Sometimes, I insist my kids do video calls with me so I can see where they are. I never thought I would enjoy this new technology so much!

What’s wrong with this picture? Is the client’s PHI actually protected? Do you see any concerns in this scenario? How far are we from someone who telephones us being able to know immediately exactly where we are? Is the casual attitude of many people toward privacy and technology something to be concerned about? Is our ignorance about the technology we use acceptable?

What do you think…am I just a bit paranoid? Is the customer who sent me this article concerned about something that is of no consequence? Where do you stand on the issues around privacy and technology? Please share your comments below.

We have been using a hosted PBX-style telephone system (Onebox) for the last couple of years. This service gives us the general functionality of a PBX system without the cost. We have extension numbers for each phone. We have automated attendants with different messages at different times of the day and night, as well as for Technical Support vs. Sales and Customer Service. We have multiple voicemail boxes at which customers can leave messages. We told the company what we wanted. They set it up for us. We use it.

Our one frustration has been the length of time needed to transfer a call from one person to another within our organization. It takes so long customers sometimes hang up. And sometimes transferring just does not work at all.

In 2009 and 2010 we have been cost saving fanatics. Since long distance telephone calls and numerous telephone lines are among our biggest expenses, we began to research options other than land lines and long distance contracts. About a year ago, we started using Voice over Internet Protocol (VOIP) telephone service through T-Mobile for our outgoing technical support calls. It has mostly done the job at a fraction of the cost of long distance service, so this month Seth started to research moving our entire telephone system to a hosted VOIP solution. After a couple of days of intense research, he decided that we should try Vocalocity, a company that focuses on small businesses.

Then Manon, our lead technical support staff person, left for vacation and my headache began. You see, Seth assists with doing tech support when one of our primary staffers is out. That meant the VOIP project was handed over to me…and oh what a mistake that was….because, remember, I am technologically impaired. Much of my other work has been on hold while I tried to make this work.

Seth had begun to set up our Auto Attendants, but they were not working properly. He emailed our phone system flow chart to a support representative at Vocalocity so they would know what we wanted to accomplish. Then, I needed to work with the support representative to make it happen. Over the course of three days, an excellent representative named Nathaniel worked with me to make changes in the setup of our account. It was much more complicated than either Seth or I realized. There were some things that had to be initiated on their end to accomplish our goals; they were not end user configurable. Finally, on Monday we tested all the work Nathaniel had done and the system appears to do what we want it to in the way we want. It even lets us transfer calls from one extension to another without a long wait time.

Today I called our telephone service provider and had our main line forwarded to the number assigned to us by Vocalocity. Tomorrow I expect to start receiving calls on the new system. We will let you know the outcome.

The moral of this story is this: using new technology may be just the way to save your organization lots of money; however, have your most tech-savvy person work to accomplish the goal. Giving the task to a less-than-patient person who just wants the darned thing to work is not the most effective way to adopt the new technology….no matter how cool the technology is.

What technology implementation stories do you have to share? Has your experience taught you some things about how to most effectively adopt new technology in your organization?

Just enter your comment in the box at the bottom of the page. If you don’t see a box, double click on the title of the article then scroll back down to the box to enter your comment. Please share your experience. I must get better at this!

• 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.

• FierceHealthIT reported a number of interesting items on March 8.

1. 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.
2. 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