Crisis Management: How to Deal with Disaster

If your agency is located in the Northeastern United States, you no doubt dealt with (or are still dealing with) the impact of Hurricane Sandy. Below, we’ve listed two tips for agencies recovering from Sandy or thinking about their own disaster preparedness strategies.

Cloud EHR: You may be able to access your EHR or case management system from any web browser, but where is it hosted? If you host it on-premise at your agency, you’ll still be out of luck if you lose power. That’s why if you live in a disaster-prone area (or just consider yourself extremely risk-averse!), upgrading to a cloud hosted EHR solution might be the right decision for you. These solutions are usually hosted in redundant data centers, meaning that if a disaster hits one part of the country, your system is backed up and operational from a different location.

Definitely ask your prospective vendor, whether they offer these types of hosting solutions if this is something you’re concerned about.

Fundraising Post-Disaster: This article, featured in Behavioral Healthcare, speaks to what agencies should expect from an operational standpoint after a disaster and how to approach fundraising. While initially, many agencies should expect to see increased demand for shelter services as people evacuate affected areas, the real impact of a disaster comes later. This is because relief agencies often only stay in the area temporarily, and so when they leave, agencies should expect to see more people coming to them asking for counseling and support as the long-term impact of the disaster sets in.

Thus, when seeking donations in the wake of a disaster, it’s important to remind your donors what exactly they’re supporting, so ensure that you are advertising the good you are doing through your website, social media, or other public-facing channels.

 

What other tips do you have for providers dealing with disaster?

 

How Stage 2 Applies to You!

As you may have heard last week, the federal government released the final rule for Stage 2 of its Meaningful Use program. The rule – effective for those participating in 2014 (or potentially later), has already had the opportunity to be commented on by the public, and according to Farzad Mostashari, will encourage ‘maximum flexibility’ while setting standards around interoperability.

Two key highlights include:

• Reassurance that no providers will be required to follow Stage 2 requirements before 2014 (ensuring you have time to get your EHR in order!).
• Going along with that, it allows current “2011 Edition Certified EHR Technology” to be used until 2014. It also further outlines the certification criteria for the certification of EHR technology, so agencies can ensure their systems qualify them for incentive payments.

Both of these points are great for the human services industry. This allows providers some time to adopt and ensure they are meaningfully using their Stage 1 certified EHRs. This enables them to focus on reporting on outcomes and data-driven care by relying on the data they are now collecting, which makes attesting to Stage 2 (which places a greater focus on Health Information Exchange) a few years from now significantly easier.

You can find a CMS fact sheet on the final rule here. Additionally, if you’d like to read the rule in its entirety (and have the time on your hands to wade through 650 pages), you can access that here.

EHRs and Patient-Centered Care

“Patient-centered care’ is another buzzword that’s been floating around the healthcare reform discussion. Today, I want to address the main concepts underlying patient-centered care and how the industry as a whole – regulators, vendors and providers – are making it a reality.

Patient-centered care is defined by the Institute of Medicine as “Health care that establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients’ wants, needs, and preferences and that patients have the education and support they need to make decisions and participate in their own care.

Typically, this boils down to four key attributes:

• “Whole-person” care: This is typically what Accountable Care Organizations (ACOs) and other up-and-coming care delivery models try to address. By caring for the whole patient – physically and mentally – health care costs can be driven down, and people can be treated proactively rather than reactively.
• Coordination and communication: This applies to the providers communicating among themselves and with the patient as well. It means considering patients’ cultural traditions, personal preferences and values, family situations, social circumstances and lifestyles during treatment. This is especially important for many people who seek out behavioral health or social services, so ensuring your agency’s custom forms are recording this information – and that the information is readily accessible in a central database – is critical for making this a reality..
• Patient support and empowerment: Also extremely important for those working in the behavioral health & human services field. Giving your consumers the power to check their appointment schedules online, sending appointment reminder alerts via text or email are easy ways to make them feel more in control of their treatment. If you don’t operate an EHR, make this a priority in the functionality requirements of your RFP for prospective vendors. If you do have an EHR and don’t currently do this, ask your vendor whether it’s possible.
• Ready access: Is it easy to schedule appointments at your agency? Do the people you serve know how to find everything they need? A consumer portal built-in to your EHR system that you encourage your consumers to take advantage of can be useful here.

The efficient use of EHR has the potential to improve your organization’s approach to patient-centered care. Additionally, because ACOs and other payment models that encourage patient-centered care rely on health information exchange (the ‘coordination and communication’ part), it will be especially critical to operate an EHR that supports both patient-centered care and health information exchange. This gives you the opportunity to kill two birds with one stone, so be sure to educate yourself and ask your prospective software vendors whether their product is going to meet your needs.

Guest Article – Breaking Down Barriers to Health IT

Hello everyone! Today we are featuring our very first guest article, and I’m looking forward to reading all of your comments!

Today’s piece is written by Janice Stewart, who is the Vice President of Information Technology at Northeast Parent & Child Society, a large child and family services and behavioral health agency in New York State.

Breaking Down Barriers to Health IT

In June 2012, the National Council for Community Behavioral Health Care published a report on HIT Adoption and Readiness for Meaningful Use in Community Behavioral Health. Of their more than 2000 surveyed members, only 21% of respondents are using EHRs with no more than 2% ready to meet Meaningful Use requirements by the end of this year.

The report presents many key findings regarding the barriers behavioral health organizations (BHOs) will have to overcome to implement health IT and achieve Meaningful Use, with 30% of responding organizations identifying “upfront financial cost” as the leading roadblock to implementation. Among the many other barriers, approximately 9% of surveyed agencies cited “workforce issues” as significant – specifically, the lack of dedicated staff to properly select and implement technology, manage the project and maintain the systems.

For many community BHOs, funding constraints relegate the development of an advanced technology program to the status of a luxury, and they manage to get by with a minimum of resources, including an IT workforce.  That “minimum resource” approach will need to change with HIT and EHR adoption, regardless of the size of the organization. BHOs have traditionally utilized technology as information collection systems created to alleviate manual tasks and accumulate data for administrative, financial, and compliance purposes, or because an external regulatory body requires it. However The EHR is not there to simply collect data – first and foremost, the EHR is a tool for the behavioral health worker to undertake clinical practice, with the ultimate goals being interoperability and information exchange to improve quality care coordination. The strategic goals of HIT are based on data derived from the real time activities of end users – clinicians and practitioners – whose primary objective is to facilitate behavioral health care.

Consequently the clinician’s faith in the new tools is critical to strategic success. The National Council’s report finds that 7% of agencies see “provider resistance” as a barrier. Informed technical support will be essential as providers experience a complete shift in conventions of practice, adjusting to changes in how they treat, how they document, and to some extent the very language they use as organizations standardize data elements during EHR implementation. Equally, building and supporting the EHR workflow requires not only technical skills, but strong business analysis capabilities to coordinate the cerebral process model of behavioral health treatment with a logic-based information technology model. It’s meshing the two approaches that creates success in the form of worker acceptance and satisfaction, which are mission critical to successful HIT adoption.

Regardless of the size of the organization or whether the system is hosted in the cloud, the implementation, management and support of HIT and HIE does require dedicated staff with more than just technical skill sets. HIT requires a continuum of true integrators who can:

• support the clinical workforce toward the organizational goal of integrated healthcare
• understand current and emerging technology, security and privacy, and
• respond to clinical advances, regulatory changes and integrated healthcare strategy.

As part of their overall plan, the Office of the National Coordinator for Health Information Technology (ONC) has funded the Health IT Workforce Development Program to train a new workforce of Health IT professionals. With a shortage predicted as overall adoption increases, BHOs will be competing for adequate resources.

Organizations such as the National Council are strongly advocating to create awareness, and to affect needed change to the eligibility rules that are hindering Community BHOs from adopting HIT because of major upfront financial barriers. Their June report stimulates awareness of many other hindering factors as well, such as critical workforce and acceptance issues.

As Behavioral Health Organizations prepare for HIT, they must recognize that with its adoption, technology becomes fundamental to practice. Therefore they must adequately plan for and fund the talented internal and/or consultative workforce resources that are a key requirement of success.

Proactive Compliance – Defend Yourself from Audits!

One of a behavioral health organization’s greatest fears is the dreaded audit – whether it’s from your state Medicaid agency, department of child and family services, department of mental health, or even the climactic HIPAA audit.  These HIPAA audits, for example, are made possible through the American Recovery and Reinvestment Act of 2009 which established the Meaningful Use program. The Department of Health and Human Services (HHS) Office of Civil Rights (OCR) is working with KPMG, LLC to conduct pilot audits that will run through the rest of this year.

This article from Behavioral Healthcare outlines a few suggestions for preparing for these HIPAA audits, since penalties and settlements for HIPAA violations often amount to over $1 million. Penalties for failing other audits can also be high as well, so developing a long-term, proactive compliance strategy is critical since many auditors don’t give providers a lot of notice before an audit.

So what are some good ways to prepare?

• Operate a single, centralized database: this is especially important if you manage geographically distant facilities. Being able to connect to a single database with all of your information in one digital place reduces the likelihood of inaccurate or inconsistent data and also encourages data integrity over the long term.
• Automate what you can: hopefully your EHR system enables you to automate many tasks that can often fall through the cracks during busy times. For instance, can you set up your system to send automated alerts to caseworkers if a client assessment is overdue? How about for other tasks and upcoming deadlines? This ensures that if supervisors are too busy to remind them, nothing is overlooked.
• Validations are performed prior to billing: does your system ensure you have all the data you need before you submit a billing claim? Some systems include features that don’t allow your finance staff to submit billing runs until all contractually required information is in the system and in the right format. This can prevent denied claims and really keeps your agency’s compliance in check.

Hopefully these tips help you in your journey to proactive compliance!

Can Less EHR Customization be a Good Thing?

There’s no question that EHR customization is good. In your software evaluation process, it’s important to ensure that your prospective EHRs support the programs you operate and can be configured to your agency’s specific program needs. Additionally, it’s critical that your EHR and financial management system can effectively record and organize the data you need to report to your specific funders, as the type and format of data that they require varies by state and program type.

However, some providers go one step further and ask: can we customize this EHR’s workflows and procedures around our existing business processes? For robust EHR and financial management systems, the answer is usually yes, and for niche agencies that provide extremely complex and intensive services, the answer to this question is a crucial one.

For most agencies however, it may be wise to take a step back and ask instead: is there a reason why the system is designed the way it is? Why are its built-in processes, such as the way it handles treatment plans and workflows,  different from how we currently operate?

In this case, it’s important to remember that leading vendors with extensive experience in the human services market have been working with providers for many years to optimize their business practices, improve efficiency, and ultimately enable the agency to serve more people and provide a higher quality of care. Thus, it’s likely that best practices from their experience implementing and supporting their numerous customers are already built into the system.

That being said, you should definitely make sure this is the case rather than choosing an out-of-touch vendor!

When you are choosing an EHR system, you may want to ask these questions to yourself and to your prospective vendor:

1)      If our current agency’s business processes are different than what’s built into the EHR we are implementing, is it worth revisiting how we do business? Can this software facilitate a change that improves the way we operate?

2)      Do we trust that our vendor has the expertise to build best-practices into the system?

A good way to get an answer to number 2 is to talk with your current or prospective software provider and ask whether they have developers, trainers and implementers who have previous experience in the human services field. Additionally, it is also worth asking how heavily does customer feedback influence the design and evolution of their software? This way, you can ensure your agency always remains at the forefront of your industry.

Do you have any experience with these issues? The Spotlight would love to hear your thoughts on the matter! Feel free to comment below or shoot an email to editor@humanservicesspotlight.com

 

 

National Council’s Hill Day Outcome – New Legislation!

A few days before the Supreme Court upheld the Patient Protection and Affordable Care Act, around 600 people attended the National Council’s 2012 Public Policy Institute and Hill Day, an event consisting of sessions and workshops on federal behavioral health policy, followed by visits to lawmakers to advocate for the priorities of the behavioral and mental health fields.

A recently introduced bill was certainly influenced by Hill Day, and that is the Behavioral Health Information Technology Act (H.R. 6043). Much like its counterpart in the Senate (S.539), this bill will add community mental health centers, psychiatric hospitals, residential and outpatient mental health treatment facilities and substance abuse treatment facilities to the list of organizations eligible for federal incentive payments.

Currently, you can receive incentive payments for the adoption of health information technology if you have a psychiatrist or nurse practitioner on staff, but both bills would extend incentive payments for electronic health records to certain types of behavioral health organizations that are not currently eligible.

This bill had expired in a previous session of Congress, so hopefully it will gain more traction this time around!

Supreme Court Upholds Affortable Care Act – How Will This Affect Your Agency?

Today, the Supreme Court of the United States upheld the Patient Protection and Affordable Care Act (often referred to as ‘Obamacare’) by a 5-4 vote. The concurring opinion describes the controversial ‘individual mandate’ for purchasing health insurance as a tax rather than as the government ‘forcing’ people to purchase insurance. Additionally, the court has ruled that the Medicaid expansion as part of the Act is constitutional, but that the federal government is not able to require that states accept those funds.

So how does this affect the behavioral health and human services industry? As this piece written by Ron Manderscheid for Behavioral Health Magazine argues, Obamacare represents an increased focus on person-centered and preventative care. This means that primary care practices will have a greater incentive to work closely with community behavioral health and social services organizations, as these types of agencies have more experience with regular and proactive patient engagement.

As explained in last week’s post, this all ties into Accountable Care Organizations and health homes. Manderscheid echoes that sentiment, stating that many clients receiving public funds require social services in addition to medical care.

Ultimately, this means primary care needs to improve how their electronic health records interface with electronic health systems used in behavioral health and human services. It will be interesting to see whether this idea gains more media exposure and popularity now that the Supreme Court has made its ruling.

The Hidden Costs of On-Premise Deployment

When a provider begins to determine its EHR needs during its software evaluation process, one of its biggest decisions is whether to install its new software on-premise or have it hosted in the cloud. One of the main reasons people choose an on-premise deployment model is that everything is under your agency’s control and is hosted on your site. However, while this control can be appealing, there are some hidden costs associated with this model.

With an on-premise solution, your agency is responsible for managing your server hardware, security and data recovery, maintenance, and upgrading the software. Even if your agency already owns the necessary technological infrastructure for an on-premise deployment, if a later version of your EHR software requires an updated version of Microsoft SQL server or a new operating system, it is your agency’s responsibility to ensure you have the funds to upgrade – a potentially costly expense.

Since a cloud solution is hosted elsewhere, whether by your vendor or a third-party, you are not responsible for software upgrades or infrastructure improvements.

Make sure you are aware of  these hidden expenses when choosing your hosting model!

National Council’s 2012 Same Day Access Multistate Initiative Accepting Applications

The National Council for Community Behavioral Healthcare recently announced they are accepting applications for their Same Day Access Multistate Initiative. This program is a great opportunity for community behavioral health organizations (CBHOs) to create and utilize new policies, procedures and techniques to improve their business processes.

Organizations selected to participate in this initiative will:

• Be given tools to assess and redesign current intake and assessment procedures
• Develop better intake and assessment forms
• Create standardized process flows to better use staff and client time

Applications are due June 6, so get yours in early!

This skills and tools you will develop while participating in this initiative nicely complement the ongoing changes in health reform, which ultimately encourages behavioral health providers to create more standard, quantifiable processes.