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Not just an EMR, but an HIE for mental health

Last month, I asked if anyone has been successful with an EMR for mental health. I wondered if an iPad might make it easier for a psychotherapist to take electronic notes during a session without making the patient feel like the computer was getting in the way, because a desktop PC certainly would be a distraction. I also wondered about where mental health fits in the realm of truly comprehensive EHRs.

(Yes, I make a distinction between EHR and EMR here, since, while it’s important to have a complete medication list to avoid harmful interactions, there’s little reason why an orthopedist or dermatologist would need to know whether a patient had been diagnosed with a mental illness. The same goes for records of sexually transmitted diseases or any other condition that patients may not want a lot of people to know about.)

I got a partial answer on Monday, when I interviewed Justin Bayless, president of Bayless Behavioral Health Solutions, which just launched a portal to share patient records with other caregivers, insurance companies, case managers, educators, probation officers and skilled nursing facilities. (See my story about this in InformationWeek.)

EMRs do indeed have a role in mental health, even if it’s mostly administrative. “It saves therapists a lot of time because it automatically generates forms,” Bayless said of the Credible Behavioral Health Software EMR that Bayless MHS clinicians carry on laptops to treatment sites such as assisted living facilities, nursing homes, schools and community centers. (That’s a quote you won’t see in the InformationWeek story.)

And segmentation of behavioral health information from other parts of a comprehensive EHR won’t be too much of an issue for a while—Bayless believes it could take 10-15 years—since so many providers still use paper right now.  Remember, psychologists, addiction counselors, licensed clinical social workers and any other mental health professionals that aren’t psychiatrists (i.e., anyone without an M.D. or D.O. degree) don’t count as eligible providers for “meaningful use” purposes.

 

May 16, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Blogging by Twitter?

Oh man, I’ve been busy. I filled in as writer of the Midwest edition of Payers and Providers the last two weeks because regular editor Duncan Moore, a former colleague, had been hospitalized. (Get well soon, Duncan.) I’ve been at the Institute for Health Technology Transformation health IT summit in Fort Lauderdale, Fla., since yesterday, and I’ve also had my regular deadlines for InformationWeek and MobiHealthNews.

I moderated two IHT2 conference sessions yesterday, on how health IT underpins Accountable Care Organizations and how business intelligence can create a framework for health information exchange. I haven’t had time to blog about those, but several people seem to have tweeted during those sessions. I therefore present a rundown via Twitter.

@narmi91 #iHT2 FMA #HIE strategy: Simple HIE gives physicians instant value, allows them to dip their tow in the water.

@narmi91 #iHT2 #HIE strategy: Adopt exchange before adopting #EHR. Which would you choose Internet (HIE) or PC (EHR)?

@narmi91 #iHT2 #HIT for #ACO: Primary care medical home is a must for ACO. Paying patients to perform. Also focus on medical assistants & nurses.

@narmi91 #iHT2 #HIT for #ACO: Changing patient behavior: need to engage patients. BCBS has new benefit plan $300-700 cash for manage health and qual.

@narmi91 #iHT2 #HIT for #ACO: Fed/state gov are more on the side of privacy but security always comes down to human behavior.

@narmi91 #iHT2 #HIT for #ACO: Pace of tech adoption in healthcare is much slower than other industries: Privacy & security, care coord, social sci.

@ICALeader Dr Freeman says healthcare is more focused on quality assurance than quality improvement, need multi-disciplinary groups to achieve QI #iHT2

@narmi91 #iHT2 #HIT for #ACO: Quality improvement process can help identify clinical decision support.

@narmi91 #iHT2 #HIT for #ACO: Victor from HRSA – HIE challenges include security issues and not enough discrete data. Most #EHR not designed for qual

@ICALeader Kevin Mather says upside & downside risk must be high & metrics must be measured for quality & cost monthly for ACO success #iHT2 #HIE #ACO

@ICALeader Dr. Freeman reminds #ACO & #HIE not to forget federal healthcare DOD, VA & IHS agencies in effort to coordinate care @ #iHT2 FTL

@bhparrish: Patient-centered #HIE with secure communication will be essential infrastructure for #ACO development. <RT @ICALeader> #iHT2


May 11, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

EMRs for mental health?

I’ve been wondering, has anyone in mental health truly had success with an EMR? I can’t imagine any psychotherapist sitting at a computer typing notes while there’s a patient on the couch. That would be particularly bad for a patient with self-esteem issues.

I imagine that tablets like the iPad may make this a little easier, but what psychotherapists really need is something like a pen tablet (with a stylus rather than touch-screen) or digital ink to mimic taking notes on a pad of paper.

The other issue related to EMRs in mental health is the exchange of notes with other physicians. Will an electronic note from therapist back to the primary care physician wind up in the electronic chart that might get sent, say, to an orthopedist or gastroenterologist? The only thing other specialists really would need to know is the patient’s medication list, not a psychiatric diagnosis or treatment history, right? Segmenting out sensitive parts of an EMR like treatment for mental health and sexually transmitted diseases is something vendors and CIOs have struggled with for years, and I believe continue to struggle with.

In both cases, I’d love to hear your anecdotes here.

April 22, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

David St. Clair on privacy

It’s a few weeks old and you may have seen it elsewhere, but I see no harm posting this commentary from David St. Clair, founder and CEO of care management software company MEDecision. You’ll note that the CNN video he references also appeared on my blog last month.

Consumers Need All of the Facts in the Privacy Debate

By David St.Clair

The economic stimulus package that President Obama has signed contains upwards of $20 billion to create electronic health records for most Americans within five years. The president has been very outspoken in his belief that EHRs are essential to health care reform and that the subsequent savings they’ll generate will help to strengthen the larger overall economy.

Whenever the subject of proliferating EHRs catches the national spotlight, you can bet that debates about privacy aren’t far behind. Indeed the privacy issue has already started to gain some traction in the media. In this video clip, CNN’s Campbell Brown and Elizabeth Cohen examine how easy it is for someone to obtain private medical information online by simply using someone’s Social Security number and date of birth.

While this assessment may be accurate, it’s a bit light on the fairness scale. Brown and Cohen only make a very brief mention of facts like President Obama’s plan to appoint a chief privacy officer and to implement unprecedented privacy controls to safeguard the EHR transformation. Instead they emphasize the more sensational angle implying that electronic health information just isn’t safe. They also seem to downplay the fact that a simple thing like creating a password can protect one’s private information.

I suspect the privacy issue is going to reach a crescendo in the coming months, and it’s very important that Americans have all of the facts. There are unfortunately people in the world who are going to try to illegally obtain and misuse private health information. But that doesn’t mean we should just write off EHRs as a bad idea. We simply need to be vigilant and proactive in incorporating the highest security measures into the planning process — which the president has done. To borrow an analogy from a close colleague: we don’t stop building roads because some people drive drunk. We punish the drunk drivers and continue building roads because of the tremendous benefits they bring to the rest of our law-abiding society. There is too much at stake for the health care system and the nation’s economy to allow over-dramatized and misperceived weaknesses in EHR security to thwart progress.

Additionally, to make the privacy debate a fair one we must ask what’s more dangerous: the potential misuse of information or simply not using information at all? Should we put the privacy of an overwhelming minority of people ahead of safer, more efficient, more affordable and potentially life-saving health care for the overwhelming majority? In reality, the only people who stand to be harmed by an unlikely EMR privacy breach are celebrities and other high profile individuals. Even if someone were to gain access to the average person’s health information, there isn’t much they could do with it, other than cause that person some personal embarrassment. In a very real sense, the question then becomes whether we value the privacy of information more than its potential to help us lead healthier lives.

Without question we must make ensuring privacy a top priority in any plans to implement EHRs. I’m confident that the Obama plan does so and, in fact, I think we’ll see even stronger controls than we may have previously imagined. No EHR is going to come with guaranteed safety, but I would argue that the risk level is the same or less than that associated with online retail and banking transactions. The public needs to understand this. It is up to those of us in the industry to ensure that the facts are clear and readily available. Hopefully the media will choose to report all of them so that Americans can form opinions based on complete information.

March 15, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Deborah Peel on Fox Business

Privacy hawk Deborah C. Peel, M.D., appeared Thursday on the Fox Business Channel to talk about the new privacy protections for EHRs contained in the economic stimulus bill.

The segment is about three minutes long:

March 6, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Does HITECH have teeth? Google may not think so

I was astounded today to read in Modern Healthcare (the fact that I apparently was blacklisted from writing there for reasons never explained to me makes me reluctant to link to the story) that Google says the new privacy and security rules won’t change its PHR plans.

The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted last month as Title XIII of the American Recovery and Reinvestment Act of 2009, strengthens much of the privacy and security language of HIPAA. Some of the language effectively gives business associates the same responsibilities as covered entities when it comes to protecting patient data. Section 13408 specifically includes personal health records.

Reporter Joe Conn, my former boss and an all-round good guy (rare at MHC these days), quotes Google Health Product Manager Roni Zeiger, M.D., as saying the new legislation has no effect on the company’s offering. Zeiger actually said that Google Health, as a service offered directly to consumers, is neither a covered entity nor a business associate under the new law.

Excuse me? I’ve been struck since Day 1 with the arrogance Google seems to be exhibiting with its entry into healthcare (actually, since before Day 1, since Google says CEO Eric Schmidt’s speech to the 2008 HIMSS conference was not technically a product introduction), but it seems to me Zeiger is intimating that the law doesn’t apply to Google.

This is almost as ludicrous as former Vice President Dick Cheney suggesting in 2007 that he was a fourth branch of government.

March 4, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

EHR privacy breaches

There’s been a lot of talk about privacy protections, or lack thereof, in electronic health records, particularly in context of the economic stimulus proposal that includes $20 billion for health IT. CNN had a story Tuesday about the security of payer-generated health records.

Embedded video from CNN Video

Fear mongering or real concern? I think there’s some of both going on here.

Meanwhile, I’m counting the minutes until I get my next round of hate mail for linking to the “liberal media.” Controversy is fun!

February 12, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

More on Allscripts—and the fight over data

Earlier today, I posted news about Allscripts-Misys Healthcare Solutions intending to sell its Medication Services division to an unnamed purchaser for an unspecified amount. I’ve since gotten clarification via e-mail from company spokesman Todd Stein:

“The release is earlier than we would normally have liked because we’re required to reveal all material non-public information about the company prior to undertaking a share repurchase program like the one we also announced yesterday. That’s to ensure that shareholders know everything about the company that they need to know in order to make an informed buy-or-sell decision.”

Indeed, Allscripts announced yesterday a $150 million buyback program and related $150 million increase in its credit commitments.

The company also was named in a Bloomberg story today as one of three firms leading the fight over whether to include greater privacy protections than HIPAA currently affords in the $20 billion health IT section of the economic stimulus legislation. Privacy advocates, including Dr. Deborah Peel’s Patient Privacy Rights Foundation and the American Civil Liberties Union, favor the House version. Business groups, including IT vendors, pharmacy benefit managers and the pharmaceutical industry, prefer the Senate version that allows data mining and direct-to-consumer marketing to continue.

For the record, the other companies named as possible major beneficiaries of the legislation are athenahealth and Quality Systems, the publicly traded parent company of NextGen Healthcare Information Systems.

How do I know this story is a Big Deal? Peel and her cohorts have been very active in keeping the media up to date on developments on Capitol Hill the last couple of weeks, knowing that this could be the last chance for another decade or more to change existing healthcare privacy laws and practices.

February 11, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Google denies lobbying to kill privacy provision

Google today denied a claim by a group called Consumer Watchdog that it was lobbying to kill consumer privacy protections in proposed health IT legislation.

From the Google Public Policy Blog:

Consumer Watchdog wrong on medical records claim
Tuesday, January 27, 2009 at 3:12 PM
Posted by Pablo Chavez, Senior Policy Counsel

Earlier today a group called Consumer Watchdog put out a press release alleging a “rumored lobbying effort” by Google “aimed at allowing the sale of electronic medical records.”

This claim — based on no evidence whatsoever — is 100 percent false and unfounded.

Google does not sell health data. In fact, one of our most steadfast privacy principles is that we don’t sell our users’ personal data, whether it’s stored in Google Health, Gmail, or in any of our products. And from a policy perspective, we oppose the sale of medical information in the health care industry.

We are supportive of strong privacy protections for medical records. Consumers own their electronic medical data and should have the right to easily access their information and control who gets to see it. We also believe in data portability, and we support open standards that enable consumers to control their data and take it wherever they’d like.

We have corresponded with Consumer Watchdog several times over the past few months to hear and address their concerns. It’s unfortunate that they did not contact us before making today’s unfounded statements, because we could have told them that their claims were patently false.

At last year’s HIMSS conference, Google CEO Eric Schmidt said that the company would not attempt to monetize its health product, other than by driving people to the company’s regular search engine.

January 27, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Audio and transcript of meeting on identity theft

In case, as I did, you missed the Office of the National Coordinator for Health Information Technology‘s Oct. 15 town hall on medical identity theft, you can download an MP3 audio recording and a transcript (Microsoft Word document) of the proceedings.

Warning: the MP3 file is a whopping 286 MB. It took me about 7 minutes to download on a typical residential cable Internet connection. It will take you 5 hours and 12 minutes to listen to the whole thing if you’re so inclined.

More details of the ONC-sponsored assessment on medical identity theft are at http://www.hhs.gov/healthit/privacy/identytheft.html

ONC promises a full report sometime this winter on issues related to health IT and identity theft, as well as a recommended roadmap for addressing these issues.

January 5, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.