Last month I told you about a novel I had read that fascinated me. Now I am here to tell you that both the first book, Daemon, and its sequel, FreedomTM , are must-read books for individuals who are concerned about the way the U.S. is moving . . . . or not moving.
When I say the U.S., I do not just mean the U.S. Government. I also mean U.S. and multinational corporations that are loyal only to their bottom line, private U.S. military contractors (otherwise known as mercenaries), the U.S. economy, U.S. buying/consuming habits, and the knowledge, involvement, and activism of the U.S. citizenry.
Daniel Suarez, the author of these books, is a systems consultant and programmer. He knows about the software and devices that run our lives. He has consulted extensively on data security to Fortune 1000 companies. The technology described in his books is all current and real . . . and very frightening. His stories successfully make the point that our identities are so tied into the computer systems that run modern life, that our civilization could not survive without them. As we move toward digitizing our medical and mental health records, we simultaneoulsy decrease errors and increase our vulnerability. Long-term loss of electrical systems in a dozen major cities globally could destroy our entire way of life, including our food distribution system. Even a short-term loss of electricity can throw us into major disarray. But not necessarily . . .
A key element of FreedomTM, is that sustainable communities that are not totally reliant on centralization of resources can survive even major disruption. Sustainability is defined on Wikipedia as “the capacity to endure.” It is the ability to survive based on a balanced and reasonable use of resources that does not deplete those resources.
Currently, the concept of sustainability is enjoying popularity in some government circles. The EPA, HUD, and DOT have developed a program for developing sustainable communities. These programs focus on housing and business development in urban and rural areas and how to do it in a way that contributes to the well-being of everyone involved, including wildlife and the earth.
Not-for-profit organizations and think tanks focused on a sustainable future have been appearing over the last decade. Philosophical and spiritually grounded individuals have long taught of the need for changes in how we think and live that will result in our well-being. Even some businesses profess sustainability as part of their business mission.
But without action from concerned, educated, and involved individuals, none of these movements will gain the traction they need to affect how we live.
I have long believed that an informed community is also an activist community. When I take the time to educate myself about the events and issues of the day, I am also motivated to examine those events in light of my own beliefs and values. When the values I hold dear are threatened, I take action. At least, that is what I used to believe. I know a few people who do that, but not very many. I do not share the political values of the Tea Party. I do share their belief that it is the responsibility of citizens to express their opinions and to become involved in the political process . . . after educating themselves about the issues.
I know, I know…you don’t have time to breathe. You already work in healthcare, most of you in the mental health community. You take care of other people as part of how you make your living, you certainly cannot consider taking the time to learn more about what is happening in our country and worldwide so you can become even busier. Getting involved in your community or becoming activist about issues that concern you is just out of the question.
And yet . . . unless more of us take the time to become such activists, we may not have day-to-day activities to be concerned about.
I hope you will read these books when you can. They are very good reads . . . extremely entertaining and very informative. Just view them as a treat to yourself.
Then decide what you need to do.
In 1992, when Bill Clinton was elected President of the United States for the first time, I was a member of the Committee for the Advancement of Professional Practice (CAPP) of the American Psychological Association. CAPP is charged with general governance oversight of the Practice Directorate, the part of APA responsible for promoting “the practice of psychology and the availability and accessibility of psychological services, providing resources and services to practicing psychologists in all settings and to the public.”
Our first meeting immediately after the election was highly charged. Staff had been studying President Clinton’s healthcare proposals, and the notion of controlling cost through “managed care.”
President Clinton’s healthcare proposals did not fly, but the industry picked up the notion of controlling costs by managing the care provided to consumers, and psychological practice has never been the same. For private practitioners, “managed care” continues to be a primary obstacle to the practice of psychology. Costs might have been suppressed by managing care, but some would argue that the primary effect of the managed care revolution was the creation of a new industry that made money as the middle-men at the cost of providers. Indeed, after a few years of leveling of the costs of care, the rise has been renewed and expanded.
In mid-November, the Supreme Court of the U.S. agreed to hear an appeal of the Affordable Care Act, our nation’s most recent effort to reform our healthcare system.
The Supreme Court agreed to hear appeals from the United States Court of Appeals for the 11th Circuit in Atlanta, which is the only court to have struck down the individual mandate because it overstepped Congressional authority and wasn’t justified by the constitutional power “to regulate commerce” or “to lay and collect taxes.” FierceHealthPayer, November 18, 2011
According to editor Dina Overland of FierceHealthPayer newsletter, even a complete overturn of the law would have little significant impact. She believes that consumers like the changes the law is mandating and there is no stopping this train.
Mercom Capital Group, in their HIT Report of November 21, 2011, says the same thing about the massive changes in the healthcare arena at large. Basing their conclusions on a report by PwC (PricewaterhouseCoopers, LLC), Mercom reports that health organizations will continue to move forward with changes to their health technology and other innovations because the multiple drivers in the marketplace have finally come to a head. No matter the political or the financial uncertainties, PwC believes this movement will continue. These are changes consumers like, and the movement will continue no matter which market forces might change.
In their HIT Report of November 28, 2011, Mercom reports that Harvard and Aetna will ally to work to improve healthcare costs and quality. The two have formed a research collaborative focused on improving the quality and cost of healthcare. They will use bioinformatics, the interface of computer science and information technology with the fields of biology and medicine, to analyze healthcare data in innovative ways. They will focus on outcomes of various treatments considering quality and cost, factors that predict adherence to medical and drug treatments for chronic diseases, examining how claims and clinical data can be best used to predict disease and follow outcomes, as well as other treatments of data that will emerge over time.
Where is your organization in the midst of this dramatic change in how we manage healthcare? How do you see yourself participating in the sea change that is under way? Where does behavioral healthcare fit into this picture?
Just type in your thoughts below. Thanks for commenting.
I am feeling particularly grateful right now.
We spent the past weekend working hard for our bicycling club’s annual fundraiser, the Horrible Hundred. I have written about our work on this ride in the past, but this year I have been feeling especially grateful for our wonderful team. Without them . . . their willingness to work very hard for a long day for no apparent reason other than a job well done, and their ability to overlook and laugh at the foibles of their co-leaders . . . we would never have been able to organize a successful ride rest stop for eight years.
I am also grateful that this is our last year organizing that project.
Focusing on gratitude got me started in a direction I should go more often. With the annual Thanksgiving holiday just ahead, I was encouraged to look further. I took a quit trip to the web site for The Happiness Project, Gretchen Rubin’s bestseller, and sure enough . . . she is exploring the notion of gratitude this week . . . with a focus on thankfulness for things that do not happen. A quick search of her site revealed about 40 entries in which gratitude is explored in some fashion. After all, having an attitude of gratitude is considered by many to be a key ingredient of happiness.
In fact, a quick Google search of the word gratitude comes up with over 56,600,000 results. That number amazed me! It is not quite so many hits as a Google search for the word ‘greed’ produces (it comes in at 58,200,000 quick results), but it is still a well-mentioned concept in our culture.
The number of hits on ‘greed’ suggests that we might need to improve our focus on gratitude to become better human beings. I get irritated with those greedy folks and their sense of entitlement. I am very grateful for those in my life who have an ongoing sense of awe at the beauty of the world and the goodness of others. They remind me that not everyone . . . maybe not even most people . . . believe that the world owes them anything.
- I am thankful for my family and friends who are always there when I need them….and even when I don’t.
- I am grateful for my co-workers who have been with us for so long and keep on producing so our customers have outstanding software and great support.
- I really appreciate those of you who are our customers, who use our products and recommend us to your friends and colleagues.
- I am thankful that there are a few people in addition to our customers who like to read what I have to say.
- I am profoundly grateful that we live in a beautiful place where we feel connected to nature daily.
- I am thankful that I have found yoga practice, and that I have so far to go to get anywhere near maximum benefit from it. There is only upside!
- I so much appreciate that I will see well-loved family members in just a couple of days.
What role does gratitude play in your life? Is it important in your day-to-day view of the world? For what are you most grateful? What do you do to practice gratitude?
Please share your thoughts and experiences with the rest of us. We will be most grateful. And do have a wonderful Thanksgiving holiday.
Do you play multi-player interactive games on the internet? How involved are you in the world of those games? Have you ever wondered how those games relate to the real world…or if they do?
I recently finished reading Daemon by Daniel Suarez. I was so fascinated by the ideas in the book that I just downloaded the free chapters of the sequel, FreedomTM and have requested the book from my local library. While I am waiting, I have been thinking and doing some research.
The premise of the book is that a dying computer game writer creates a program (called a daemon) that initiates upon news of his death. The extent of the infiltration of that program into the worlds of the rest of us is amazing. The book explores the worlds of computer and credit card hackers, drug cartels and crime syndicates, and all the government and quasi-government but private organizations potentially involved in these events.
This book is written by a computer systems person who consults to Fortune 1000 companies. His presentation of the events and concepts makes for a very exciting though violent story. It is called a techno-thriller. I call it science fiction….but all the technologies are current, so the events could occur.
I work in a high tech industry. We write software, so I thought I was at least somewhat informed about the technological world. This book revealed to me that I am totally ignorant of this whole realm. That is part of what is interesting to me about it. How can I live and work in the sphere I do and still have no idea about this arena?
Techies find this book and its sequel pretty fascinating. An article written by Josh McHugh in 2008 in Wired magazine talks about how the author got serious credibility in the geek world after self-publishing the book.
An organization called The Long Now Foundation . . . that is focused on encouraging and supporting long-term thinking about and responsible action in our world . . . had Suarez present a seminar about bot-mediated reality to members. As with most things I find interesting, the links I find in the cyber-world about my starting point are equally fascinating!
I have tried not to be a spoiler about Suarez’ books. That may have made this article a bit too vague. I hope you are interested enough to take a look at the links. Maybe it is time for us to balance our focus on the present and too many things to do with thought about the future and where we are taking ourselves.
Please share your comments below. Since I have no history with computer games, please share your experience and insights in that world.
Several years ago, I signed up with the federal Office of Civil Rights online Privacy listserv so I would get notifications about HIPAA. I have been delighted with that subscription over the years. If you are an organization that provides healthcare services, you too should subscribe.
Today I received a new sort of notice from the listserv…one aimed at informing as many individuals as possible about an upcoming test of the federal Emergency Alert System.
Date: Thu, 3 Nov 2011 12:11:48 -0400
From: “OS OCR PrivacyList, OCR (HHS/OS)” <OCRPrivacyList@HHS.GOV>
Subject: First Nationwide Test of the Emergency Alert System; November 9 at 2pm EDT
FIRST NATIONWIDE TEST OF THE EMERGENCY ALERT SYSTEM
Test to Take Place November 9 at 2 p.m. EDT
We need your assistance in notifying everyone about the November 9th nationwide test of the Emergency Alert System. Please help distribute this to all your stakeholders, as far and wide as possible, to ensure the entire community is aware that
As part of our larger efforts to strengthen our nation’s preparedness and resiliency, the Federal Communications Commission (FCC) and the U.S. Department of Homeland Security’s Federal Emergency Management Agency (FEMA) will conduct the first nation-wide test of the Emergency Alert System on November 9th at 2pm Eastern Standard Time.
The national Emergency Alert System is an alert and warning system established to enable the President of the United States, if needed, to address the American public during emergencies. It is another critical communications tool that can protect the public and strengthen our nation’s resiliency. The National Weather Service, governors, and state and local authorities also use parts of the system to issue more localized emergency alerts. The test is an important exercise in ensuring that the system is effective in communicating critical information to the public in the event of a real national emergency.
This national test will help federal partners and EAS participants determine the reliability of the system, as well as its effectiveness in notifying the public of emergencies and potential disasters both nationally and regionally. The test will also provide the FCC and FEMA a chance to identify improvements that are needed to build a new, modernized, and fully accessible Emergency Alert System.
To support the disability community, FEMA has developed a toolkit that will allow you to reach out to your constituents and local partners. The toolkits, attached here in multiple formats, allow you and your organization to quickly disseminate information about this test.
In addition, we’re also releasing two new videos created to support the outreach efforts of our disability community partners. FEMA Administrator Craig Fugate has long been a champion of the whole community and ensuring that FEMA represents the diversity of the people we serve. In one video, Neil Mc Devitt, from FEMA’s Office of Disability Integration and Coordination joins Administrator Fugate in outlining the need for the upcoming Emergency Alert System test and the accessibility challenges posed by the test. The video has American Sign Language, open-captions, and is voiced throughout. We’re also happy to provide a Spanish version of the message with open-captions.
If you have additional questions for FEMA-Office of Disability Integration and Coordination questions, please contact our office at
Office of Disability Integration and Coordination
* FEMA Administrator’s Message – http://www.fema.gov/medialibrary/media_records/6407
* ASL Video: http://www.fema.gov/medialibrary/media_records/6407
* Spanish Video: http://www.fema.gov/medialibrary/media_records/6408
Please share this information with your constituencies, colleagues, friends, and families. Remember, on November 9th at 2pm ET, “Don’t stress; it’s only a test.”
I was fascinated at using the HIPAA listserv for this purpose. As I read through the notice, it became clear that FEMA is quite concerned about insuring that disabled individuals of all sorts receive notice of this test so they are not alarmed when the test occurs. Using a listserv that reaches healthcare providers is actually an excellent use of this list. After all, most disabled individuals are in touch with healthcare providers.
Please feel free to pass this information…or even this blog…on to your clients. It is important that consumers of behavioral health and other health services realize that the event scheduled for Wednesday, November 9, 2011 at 2pm is a TEST of the Emergency Alert System.
Good for you to know it too!
Thanks for reading and sharing the information in our blog.
I have been thinking a good deal lately about how to motivate myself and others in my life. When I was a psychotherapist, I spent lots of time helping patients understand their motivations and utilizing those motivations to help them create change in their lives. Knowing what drives us to do things is important to achieving any of our goals or satisfaction in our lives. Of course, my patients were in my office because they felt the need for change. They already had motivation, albeit a negative one…they were in pain…an internal state that they wanted to get rid of. But they did not know how to make change in their lives; they needed a different set of skills. That is what psychotherapy is good for.
I have not looked at the work on motivation in a long time. In order to write this article, I did what everyone who uses a computer today does….I Googled it. I repeatedly came upon the name of one individual and had to get more information about him. After all, he is not even a psychologist or other researcher.
Daniel Pink is a bestselling author who was at one time Al Gore’s chief speechwriter. His book, Drive, explores the psychological research on motivation and performance. And he finds that business and many people at large have ignored the results of this important research. We treat employees as if they must be rewarded or punished to try to motivate them to perform well…using the proverbial carrot and stick. The research, however, shows that rewards result in poorer performance if any degree of cognitive skill is needed to accomplish a task. Autonomy, mastery, and purpose are the motivators we need to understand.
I have checked Drive out of the library and plan to read it right away. I will let you know the details of what I learn. In the meantime, you can find out some of Dan Pink’s thoughts on motivation and what we do wrong by listening to his TED talk (18:40). If you want a bit more detail, you can listen to him talk to American Psychological Association members at the 2011 Psychologically Healthy Workplace Awards (38:36).
How do you motivate yourself? How do you motivate others? What secrets have you learned about motivating patients? What motivates you to read this? How can I motivate you to make comments?
Please share your thoughts below. Thanks.
According to a newsletter aimed at the insurance industry, 70% of comments made about health insurers on social media sites in the past year were negative. FierceHealthPayer reports:
It’s time to face the facts–the American public dislikes health insurance companies. And that’s putting it mildly, considering that 70 percent of all opinions and comments about insurers posted on social media sites in the last year were negative.
(Read more: Insurers should take to social media to combat negativity – FierceHealthPayer http://www.fiercehealthpayer.com/story/insurers-should-take-social-media-combat-negativity/2011-10-07?utm_medium=nl&utm_source=internal#ixzz1aYo3DrmA
I can understand some of that negativity. This past summer brought major upheaval for me as I searched for affordable health insurance for our employees. I asked our insurance agent early on to get us quotes. I was appalled at what came back from the company who provides our plan. As a small group (only 8 members plus one spouse) we are subject to huge variations in cost and are very limited in benefit choices. Health insurance is our second largest expense.
I interviewed employee leasing companies and other groups that claim to make you part of a larger group so you can benefit from lower pricing structures. Unfortunately, none of them were able to save us enough money to justify the severe limitation in benefits or the cost of membership. We ultimately bought a plan that increases copays and deductibles, but maintains most of the benefits we had….we think. How the insurer will choose to interpret those benefits when one of us actually needs to take advantage of them remains to be seen.
My experience is no surprise. Employers across the nation were faced with a 9% average increase in family premiums in 2011 while many of us were presented double digit increases, in spite of the recession.
The article mentioned above suggests that insurers should get involved in social media to combat their negative perception by the public. They should
Create a social media policy and then get out into the social world and establish a strong, positive presence. Tweet some healthful recipes, post exercise tips on Facebook, make announcements on Google+.
Whatever your specific strategy, though, make sure you monitor all social media sites for comments made about your company and then contact the poster to try and resolve the problem. Even if you can’t fix the particular issue, say because someone is griping about the lack of universal health insurance, you’ll have made an effort to connect with the public, which over time just might change their perception of the industry. - Dina (@HealthPayer)
In other words, they should get their marketing people to work in the social media sphere. Don’t do anything real to correct the negative perceptions of the public, just do your best to appear to care and to look good. Don’t let anybody realize that one of the major reasons the cost of healthcare is so high in the U.S. is because of the part played by the cost of health insurance.
I was rather distressed by that recommendation. Don’t do anything real…just do your best to appear as if you care about these negative perceptions.
I wonder what your experience is with health insurers. Does your organization provide health insurance for your employees? Is everybody satisfied with their plan and the cost of it? Have you ever made a negative comment about your health insurance on Facebook or Twitter? Ever made a positive one?
Please share your comments below.
I was a little surprised at my reaction of sadness Wednesday night when I heard of Steve Jobs death. I have never used an Apple computer or any other Apple product, so I could not be considered a fan by anyone’s definition. And yet, I feel a real loss.
I know that many of you were born after 1980. You have never lived in a world without personal computers. Those of us who are a bit older remember a very different world than the one we live in today . . . and one of the primary differences is the universal presence of personal computing devices.
At this moment I am sitting in my doctor’s office writing this post on my phone. Thirty years ago, I might have been reading a book or a journal. I could not have imagined that I might one day be doing this.
But Steve Jobs could imagine it.
The likes of Steve Jobs and Steve Wozniak and Bill Gates envisioned this world and helped make it real. The rest of us get the daily benefit of their ability to innovate. Some of us even got our careers because of their vision.
When Steve Jobs was working on the Apple I, I was finishing my doctorate in clinical psychology and looking forward to a long career as a psychologist. When my partner and I opened our first private practice in 1980, we had a word processor and bought Kaypro 4 computers. The computer seemed like a fun way to work and a powerful tool, so we bought one for each of our desktops. Within five years, we had started Synergistic Office Solutions and Seth was consulting with psychologists, building computers for them, and ultimately writing software for practice management. Because of the creation of an industry that did not exist when I started graduate school, I am twenty years into a second career. Without Steve Jobs and the work he did, I would not be writing to you . . . even though I have never used an Apple product.
In the next few years, we may see the passing of the personal computer into oblivion as tablets and super smartphones and today unimagined devices are created. But we are likely to remember that there was a very small group of incredibly bright, creative and productive individuals who imagined, innovated and then manufactured machines that have changed our lives.
Please feel free to share your own thoughts and reflections about Steve Jobs and about the changes in our world he helped create.
On September 22, 2011, I attended a webinar sponsored by the Business Operations for Behavioral Health Collaborative, a SAMHSA-funded joint venture of the National Council for Community Behavioral Healthcare, the National Association of Community Health Centers, NIATx, and the State Associations of Addictions Services (SAAS). The topic of the webinar was Health Information Exchange and Behavioral Health.
This is an area that has interested and concerned me for quite a while. As developers of software for behavioral health providers, SOS has for years been monitoring developments in the arena of Health Information Exchange (HIE). This is the method by which Electronic Medical Record (EMR) software will exchange information among providers and healthcare organizations. The HIE is both the process of exchanging information and any repository of that information for easy access by those with rights to the data.
This is the bugaboo that has always bothered me as well as my colleagues in the behavioral health software trade association to which we belong (Software and Technology Vendors Association). SATVA members are committed to assuring that our products share information only as the law allows and as consumers wish.
Work is currently in progress to assure that a universal method of acquiring patient permission for release of their information is part of any HIE. Such a method would undoubtedly allow a patient to specify providers to whom their treatment and diagnosis information can be released and any providers to whom it cannot be released. But what happens when a patient changes their mind?
Here’s a hypothetical example that jumps into the future by a few years, when all or most healthcare providers have EMRs and are connected into their regional HIEs.
John D. is admitted to the Emergency Room of a local hospital after a panic attack that he interprets as a heart attack. Among the papers that he signs is a release for the ER to access any information in the regional HIE about his health conditions. Since he is not thinking very clearly as he is sure he is dying from a heart attack, he signs everything put in front of him. After he is medicated, stabilized and sent home, he wonders about what he signed and which of his health information will now be available to whom. Does he really want his optometrist to know that he was treated with an anti-anxiety medication and prescribed an antidepressant (which he decided not to take)? Is it necessary for his urologist to have this information? What does he do to protect just that ER visit information and keep it from being sent on to other providers?
And what do our mental health and substance abuse patients do to secure their sensitive information?
This process concerns me because of my experience that once a piece of information has been entered into some large electronic database, getting it out may be near to impossible. Several years ago, I attended a conference in New Jersey. I rented a car, drove to the city in which the conference was held, returned the car and paid my bill in a timely fashion, and returned home.
The next time I needed to rent a car was three months after Katrina flooded New Orleans when my mother and I returned to check on her home and attend the funeral of one of my uncles. For some reason, the car was reserved in my mother’s name…the airline tickets were purchased with her card…even though I had placed my name on everything. The rental agency manager noticed something wrong when we picked up the car; there was a block on my account even though there was no balance. She overrode the block, gave me the keys to the car, and we were on our way. I did not give it another thought.
In several return visits to New Orleans, I again rented cars from the same company and always wound up with a car, not even knowing there continued to be a block on my account. Each time the agent or manager overrode the hold and gave me the keys. In November 2010, we arrived in New Orleans on a Sunday. The agent and assistant manager decided they did not have the authority to override the block on my account and there was no one they could contact to clear it. They refused to rent a car to me and offered no solution. They gave me a phone number I could call on Monday, but did not even offer my 90 year old mother and me transportation to another agency. I cursed and swore I would never rent from their unprofessional agency again and called my brother to come pick us up. Fortunately, he was thinking clearly enough to suggest that we go across the highway to a different company and rent a car there.
I did call the company the next day and eventually got the written apology and clearance of my account that I requested. It took six years for this correction of an error to happen.
What processes will we insist be put in place to assure that patients can change their minds about release of information or correct errors or enter corrected information into their records? What kind of advocacy will be required? What do mental health and substance abuse providers need to do to assure that the privacy of their patients’ sensitive information will be handled as they choose?
Please share your thoughts about HIE and EMRs and where we are going with this process.
Are you a Jeopardy fan? If you are, I am sure you know that in January of 2011, IBM’s supercomputer, Watson beat two of Jeopardy’s all time money winners, Brad Rutter and Ken Jennings. Watson is an Artificial Intelligence that can understand questions posed to it in natural ‘human’ language.
WellPoint, a BlueCross collaboration, is the largest provider of health benefits in the country. Their plan is to utilize Watson to sift through their patient databases to make diagnosis and treatment recommendations to WellPoint physicians.
This idea is not at all far-fetched and certainly a reasonable way for IBM to make some money off their huge research and development investment in Watson. They have also purchased some other companies that position them well for movement into the medical sphere.
Over the last four years, IBM has spent more than $7.8 billion to acquire database analytics specialists Cognos and SPSS, both formerly public, as well as data warehouse company Netezza, along with other private companies. In the first half of 2011, IBM spending on research and development exceeded $3.15 billion.
—International Business Times, 9/19/2011
What WellPoint is proposing to do is a starting point for a task all EMR’s will ultimately need access to and participation in. In order to meet the requirements for ARRA stimulus funds, eligible providers will need to utilize their EMR’s to help them make clinical decisions.
Clinical Decision Support (CDS) is a process whereby the physician gets notices and alerts from their software to assist them in making clinical choices that are based on data and evidence rather than memory and intuition. The Centers for Disease Control and Prevention (CDC) hopes to see public health organizations utilizing population data and statistics to guide their choices. They believe this will be one of the most impactful effects EMRs can offer the public health. The Office of the National Coordinator for Healthcare IT (ONC) wants to see individual physicians using Clinical Decision Support to advise their patients. Clearly, WellPoint plans for this level of intervention: physicians will have access to the data Watson can provide to assist them in making diagnoses and recommending treatments.
We talked in this blog about some of the potential benefits of CDS back in 2009. Since then, research on the benefits of supported clinical decision making has continued. A Google Scholar search of ’decision support emr’ results in 16,800 hits. There have also been noted some shortcomings, most notably a phenomenon called ‘alert fatigue‘, wherein a provider gets so many alerts and notices that they stop attending to them or turn them off altogether. Obviously, we have lots to learn about how to present information to healthcare providers so they can use it most effectively for the benefit of their patients. WellPoint has decided to dive right in!
What do you think about being diagnosed by a computer? Will it be more effective or less so? What is the relevance of CDS for behavioral health?
Please share your thoughts below.
Last week I asked you if you were using a Personal Health Record (PHR). I got only one response…from a college friend who is a technical writer. John is involved with a PHR company called medkaz. This company believes that all electronic medical records should be driven by and owned by the patient. Accordingly, they have developed a thumb-drive based product that the consumer will carry around with them. It is fully encrypted, so the privacy of the patient is guaranteed.
I believe the idea is that the patient will bring their personal record with them when they visit a doctor. The doctor can download relevant information of the patient’s choosing into their own electronic medical record (EMR) system. At the end of the visit with the patient, they will upload their note onto the patient’s thumb drive. The doctor can subscribe to this system themselves, but even if they do not, they will be able to use the patient’s information. This is one way to make sure that the people treating you have the most current medical information about you.
Over the course of the last few weeks, the reason for concern about what information health systems have and how they manage it again came into the public light. The Stanford Hospital in Palo Alto, CA reported that 20,000 records of emergency room patients had been revealed online by their collection agency…one of their Business Associates. The information had been posted on a web site for just short of one year. One of the affected patients saw the posting of the information and reported it to Stanford Hospital and Clinics.
According to IDExperts, there is good reason for concern about the security of medical data. The street value for a stolen medical identity is $50. Using that information, a Medicare or Medicaid or other insurance fraudster can file claims for services never provided….and often get paid.
In other news this week, the White House has proclaimed September 11-16, 2011 to be National Health Information Technology Week. The purpose of the proclamation is to call attention to and educate the citizenry of the benefits of and need for Health IT that will protect the privacy of the patient and involve patients in their health care.
Finally, the Office of the National Coordinator for Health Information Technology (ONC) has announced their new website, HealthIT.gov, designed to become the leading national resource on health IT for both consumers and health care professionals. The goal of the site appears to be to encourage personal responsibility for one’s health and health care through wise use of technology and coordinated efforts with one’s providers.
It was a busy week! Is there news you would like to share?
In August, the National Coordinator for Health IT, Dr. Farzad Mostashari, spoke about the need for a ‘targeted strategy’ to involve consumers in eHealth. He is concerned that all of the efforts being expended to acquire EMRs and for eligible providers (EPs) to achieve meaningful use of those EMRs must become more patient-centered.
One provision of the meaningful use requirements that will become increasingly important is the need to be able to provide an electronic version of the medical note to the patient. While there are a variety of ways by which this can be accomplished, Personal Health Records (PHRs) and Patient Portals into the provider’s EMR are two.
My own insurer provides a PHR on their website. I can enter lots of personal information about myself and my health if I choose to do so. Superficially, it appears this information can be accessed only by me, but I do not believe this is the case. The insurer can likely access the information too. Since it is mostly info they can get from my claims (and the claims history is available on the page), I am not too concerned about it, but I have been somewhat careful about entering things. If I were not pretty healthy, I think I would enter nothing.
The PHR to which I have access is a proprietary one. In August, Google removed their hat from the ring by discontinuing Google Health as a service effective January 1, 2012. Microsoft is well-entrenched in the healthcare arena, so I believe they will keep their product, Microsoft HealthVault, around. I wonder of what use these will be until providers can send information to the PHR for the patient.
For the last few weeks, I have been working with our web designer on re-writing our website. Now that so many people access the internet from their smart phones, we want to be sure the site works well on mobile phones and tablets. This focus has me wondering about a few things. I hope you can clear up some of these for me.
- How many of you use a PHR?
- Do you feel secure storing your personal medical information online?
- Do you use a smart phone for email?
- If so, for what other purposes do you use the smart phone?
I am hoping I will get some comments and responses from you. I wonder how many of you feel comfortable with the speed with which our lives are moving into ‘the cloud’.
Please jump in now. This inquiring mind really wants to know!
I have been struggling with a topic for this week’s blog. The only thing that has come across my path that feels compelling is the hummingbird who showed up at our coral honeysuckle on Sunday. Unfortunately, integrating that ruby throat into my article does not seem like an easy task.
Sometimes, I feel like I have run out of ideas. When that happens, I am reminded of feelings I experienced as a child and young adult. I knew I was not an artist and felt myself also to be not creative.
It took many years before I learned that my creativity takes forms different than that of artistic individuals. At some point in the process of doing psychotherapy with some very difficult clients, I realized that most of my creativity takes the form of what I will call creative alternativism. Generating possibilities…especially possibilities for different types of behavior and different kinds of thinking…was the primary manifestation of that creativity. Helping my clients find different ways to be in the world in order to overcome their pain and problems was the most important way I expressed that creative urge.
I have since realized that I often apply that process to myself as well. Since I can be a pretty rigid person when it comes to my own thinking and behavior, I have found that I need to make systematic efforts to implement the alternatives I generate for myself. I may well come up with many ideas about how to change my behavior, but I need structure to implement those changes.
Three years ago, I knew that adding yoga into my fitness efforts would benefit my arthritic joints and relieve some of my stress. Signing up for a yoga class was the structure that allowed me to make that a regular part of my activities. After three years, I have found other structures to help me extend that one class to two and now into a daily practice. I need and use structure to implement the possible changes I creatively generate for myself.
I had an email this week from a colleague I have not seen in years. I was delighted to learn that for the past year, she has been painting! At age 60, she took a pastels class at her local community college. She was hooked on the medium and has found a new outlet for her creativity. In my experience, she has always been creative. She has been a psychologist and psychotherapist for her entire professional life. She has researched and written and published…an aspect of her professional creativity; and now, she paints!
I am delighted to know that a new aspect of creative expression can manifest itself at any age, as long as we are open to it.
How do you express your creativity? Do you manage to do this within your professional life? Does the place you work benefit from your creative endeavors, or is it just for you?
Please share your thoughts about creativity, regenerating it, and keeping our lives…and blog topics…fresh.
I am sure many of you remember the reports dating back to 2005 that celebrity patient files were being viewed by casual lookers…employees who had access to the University of California at Los Angeles (UCLA) Health System electronic medical record (EMR) but who had no legitimate reason to view those records. Well, the Department of Health and Human Services (HHS) Office for Civil Rights (OCR) has entered into an agreement with UCLAHS to settle potential HIPAA violations for $865,500. Additionally, UCLA has made a commitment to correct gaps in their security, to improve their policies and procedures to better safeguard patient information, and to adequately educate their employees.
In a separate case, FierceHealthPayer reported that WellPoint will pay $100,000 to the state of Indiana because they waited several months before notifying Indiana officials of a security breach that could have exposed the data of 32,000 members.
For me, the important issues here are the following:
- OCR is serious about data breaches and safeguarding patient protected health information (PHI).
- State laws are just as important as Federal law. You must know and follow those local regulations as well as HIPAA and HITECH.
- The cost of a data breach is significant and would put many small provider organizations out of business.
Have you reviewed your security and privacy practices and policies this year? Are you confident that your PHI practices are solid and that your employees are using the procedures as written? How do you review these and how do you educate your employees?
Please share your experiences and concerns about data privacy and security with us below.
This morning I read an editorial (An ounce of prevention could heal a pound of pain) by Dina Overland of the FierceHealthPayer newsletter. She decided to use her platform as the editor of a newsletter that is aimed at insurance payers to directly address those payers about prevention of healthcare problems and diminishing future costs. She focused on an area that behavioral health and substance abuse professionals work in often . . . pain.
Ms. Overland’s review of the Institute of Medicine’s (IOM) report on pain and prevention cited some facts I had not heard.
If that’s not jarring enough, here are some more staggering facts: The United States spends $2 trillion on healthcare, but only 4 cents of every dollar goes to prevention and public health, despite being among the best tools to reduce spending. For every $1 invested in prevention, we save $6 in projected healthcare costs, says Sen. Tom Harkin (D-Iowa), who participated in the Department of Health and Human Services (HHS)’s announcement
of its guidelines to incorporating prevention throughout the healthcare industry.
I could not help but think about the number of people who would never have become substance abusers if their chronic pain had been addressed and treated at an early stage. How many behavioral health clients have you treated for depression after years of experiencing intractable pain?
The IOM and HHS see the coordination of care among primary care providers and specialists as the best way to address early intervention and prevention of pain. What role should mental health and substance abuse providers play in this coordination? How many of your patients also experience chronic pain? Where do behavioral health providers fit in?
Please share your thoughts and comments below. What role do you want to play in diminishing healthcare costs? Who should we see when it hurts?
According to a June 14, 2011 report by Government Health IT News, consumers’ confidence in the safety of their data in electronic health records (EHRs) is a prerequisite to the successful adoption of electronic means of recording and sharing health records. So says Dixie Baker, chair of advisory Health IT Standards Committee’s privacy and security workgroup and senior vice president and chief technology officer for health solutions for SAIC. Feeling assured that their information is safe and secure and going only where it is supposed to go will allow the public to support their health care providers in moving to electronic medical records (EMRs).
In fact, Government Health IT News reported on June 24 that the Office of the National Coordinator for Health IT (ONC) plans to contract with a vendor “to explore and evaluate methods to electronically obtain and record from patients their informed consent about sharing their health data.” The solicitation focuses heavily on the matter of educating patients about disclosure and consent for release of information.
In substance abuse and behavioral health settings, requirements beyond those encoded by HIPAA and HITECH are mandated in federal and state laws. 42 CFR Part 2 applies to any provider or provider organization holding itself out as a provider of alcohol or drug abuse treatment and to federally assisted alcohol or drug abuse programs. Special “handling” of the record is required, especially when it comes to re-release of the information obtained. It is not acceptable for a provider to receive information from an alcohol abuse program, incorporate it into their EMR and then release it on to other providers of the patient, without the specific consent of the patient.
The legal complexities are immense. Members of the Software and Technology Vendors Association (SATVA) who work with these issues all the time, have been wrestling with the kind of consent that could be used to disclose records and appropriately specify the degree to which such disclosure is authorized by the patient. Anasazi Software has shared a memorandum of understanding about privacy and security issues related to health information exchange (HIE) in California drafted at their expense. California and some other states have even more restrictive laws than 42 CFR Part 2.
The conclusions in this document lead SATVA members Anasazi Software, Valley Hope Association, and Sequest Technologies to work together to develop and demonstrate to SAMHSA a solution for managing automated electronic health information disclosure. The standardized consent for health information disclosure that they developed could go a long way toward assuring consumer control of their record, at least as that record is represented by the Continuity of Care Document (CCD).
This kind of cooperative effort is one of many reasons of why we at Synergistic Office Solutions are proud to be members of SATVA.
In a previous life, when I was actively involved in the American Psychological Association (APA), I was for three years a member of and one year the chair of the Public Information Committee of the APA. Prior to that, I hosted a live, call-in television show for two years. Frankly Speaking with Dr. Kathy Peres was entirely focused on educating the public about psychological matters. I believe that public education about how mental health issues affect our day-to-day lives is a significant responsibility of all professionals and organizations that provide services in the behavioral health arena.
Given that belief, I was very pleased today to receive an email from the APA announcing a new series of videos and podcasts by APA CEO, Norman B. Anderson, Ph.D. You can view the introduction and the first two installations in the series This is Psychology, one on bullying and another on children’s mental health.
APA invites you to place these links on your own professional web sites and to share them and the information they contain as broadly as possible.
Last week, I wrote about potential problems with use of social media in your organization. Public education of this sort. . .including sharing of the information created on Twitter and FaceBook is one arena in which I think social media has the potential for more power than in any other area of our professional lives.
How does your organization participate in education of the public about behavioral health issues? Please share your initiatives and activities here so others can communicate them more broadly for you.
I am not sure why I continue to attend free webinars about data breaches. They mostly serve to make me extremely anxious for our customers. . . especially for those who have not created a data security plan or have thought minimally about their responsibilities for protecting the privacy of their patients’ Protected Health Information (PHI).
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 holiday last Monday made it difficult to get to my blog. As each new item that I needed to handle came up, I found myself thinking about what I had hoped to write. Thinking about it was all I managed. No matter how much I thought, I did not discipline myself to leave all the other items aside and write.
Self-discipline is not one of the things I have been short on in my life. I was raised and educated in a setting that strongly taught the need for and benefits of taking responsibility for my own thoughts and actions and shaping them to the way I wanted and needed them to be. The last ten years have included many times when it was harder than ever before to focus myself and move forward, but because I have long known the methods that are most effective for me to achieve self-discipline, I have been able to do so. Taking personal responsibility is second nature for me (except, of course, in the areas where I have complete blind spots!).
For me, this self-discipline has resulted in a strong tendency to take action. . . in pretty much any situation in which I deem action to be necessary. If I have allowed a few extra pounds to creep on, I act to reduce my caloric intake and increase my activity. If I am driving or walking somewhere and have become lost (and don’t happen to have a GPS with me), I ask for directions. If a cause in which I believe is being threatened, I make contributions and write emails. I have always seen it as my responsibility to take action when I could and when it was necessary.
I am currently reading Jon Kabat-Zinn’s book Wherever You Go There You Are. . . one small section at a time. This week, the following paragraph struck me:
What is required to participate more fully in our own health and well-being is simply to listen more carefully and to trust what we hear, to trust the messages from our own life, from our own body and mind and feelings. This sense of participation and trust is all too frequently a missing ingredient in medicine. We call it “mobilizing the inner resources of the patient” for healing, or for just coping better, for seeing a little more clearly, for being a little more assertive, for asking more questions, for getting by more skillfully. It’s not a replacement for expert medical care, but it is a necessary complement to it if you hope to live a truly healthy life—especially in the face of disease, disability, health challenges, and a frequently alienating, intimidating, insensitive, and sometimes iatrogenic healthcare system.
Developing such an attitude means authoring one’s own life and, therefore, assuming some measure of authority oneself. It requires believing in oneself. (My italics)
Most individuals who work in behavioral healthcare are expert at helping others to mobilize their inner resources. This is a large part of what psychotherapy is about. For the seriously mentally ill, helping them see that they have inner resources is significant. . . and a major contributor to the process of recovery.
I have a great deal of difficulty with the large number of people who see the things in their lives going wrong and who feel they can do nothing or who choose to take a passive rather than an active posture. . . but gladly complain about all that is wrong. Listen to talk radio, stand around the metaphorical office ‘water cooler’, shake their heads saying ‘what is this world coming to?’. . . and then go on with their own little lives as if nothing else matters.
I am currently watching this budget debacle unfold in state legislatures (I live in Florida) and Congress. As we all know, the recession and unemployment have resulted in significantly lower tax revenues at every level of government. We have allowed those who represent us to pass laws virtually exempting the wealthy and large corporations from taxation while they rake in the profits. The rest of us continue to pay our sales and property and income taxes, but the working and middle classes just do not earn enough or pay enough in taxes to support the level of government spending that we have all demanded.
The decisions that are being made will most likely result in the deconstruction of the ‘safety net’ that has for the past twenty years provided some minimal care for the chronically mentally ill. As usual, those least able to speak up for themselves will pay the price. . . for the mortgage crisis, unfunded wars, and irresponsible tax cuts.
What is the responsibility of each one of us for the upcoming deconstruction of Medicaid, and possibly Social Security and Medicare? How do you feel about sitting around and complaining vs taking action? Who’s job is it, anyway? Please share your comments below.
A discussion with my coworkers recently reminded me of the wide variability in the size and nature of the organizations that utilize our software products. Behavioral Health organizations range from solo, part-time psychologists, psychiatrists, social workers and professional counselors in private practice to large community-based organizations that provide inpatient, outpatient, intensive outpatient, and home-based care to those requiring mental health and substance abuse treatment.
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:
- 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.
- 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.
- 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.
- 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.