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What is FHIR and How Does it Affect Your EHR?

For behavioral health providers that use electronic health records (EHRs), interoperability is becoming increasingly important.

Many behavioral health and addiction treatment patients receive care from different providers. These providers may all use different EHR systems, and yet must all access and understand the patient’s health data. Data also need to be structured and standardized to be useful to machine-based processing.

The Fast Healthcare Interoperability Resource (FHIR, pronounced “fire,”) is a standard for exchanging electronic healthcare information. It is becoming a popular option to improve interoperability.

EHR standards may seem complicated and intimidating, but providers that exchange data with each other can benefit from learning about FHIR basics.

What is FHIR?

HL7 International, a not-for-profit standards developing organization, developed FHIR to address the challenges of sharing complex healthcare data. HL7 designed FHIR to be used on its own, but may also be paired with existing standards.

FHIR is designed to allow data access in a way similar to how we use URLs to access web pages. Consider how each individual web page has a specific URL. Anyone who uses a standard browser (such as FireFox or Chrome) and a standard operating system (such as Windows or Mac) can access that same page and perform the same tasks with that URL.

FHIR is built to do something similar with healthcare data. Different health data elements, or “resources,” are tagged with a unique identifier, similar to a URL. The FHIR standard is designed to help developers build standardized applications that act as a “browser” that allows access to data no matter what EHR “operating system” is used.

How is FHIR used?

“FHIR resources can be used to build documents that represent a composition: a coherent set of information that is a statement of healthcare information, including clinical observations and services,” HL7 explains. “Documents built in this fashion may be exchanged between systems and persisted in document storage and management systems.”

FHIR is designed specifically for web-based use. FHIR-based apps can be used with any FHIR-capable EHR. This means it can be applied to mobile apps, cloud communications, and EHR-based data sharing. Currently, most usage of FHIR-based apps involves expanding EHR functionality and allowing patients to download and use their own health records.

According to HIMSS, several projects are examining the use of FHIR to improve interoperability:

The Argonaut Project, between HL7 and several healthcare organizations and vendors, aims to develop protocols and tools to expand health information sharing using FHIR
The Health Services Platform Consortium is focused on building an open platform based on FHIR to allow rapid development of healthcare applications

FHIR is not yet in full use, but it shows promise in helping EHR vendors and healthcare providers achieve better interoperability and care coordination. Because of this, behavioral health providers looking to adopt a new EHR system should make sure the solution you choose incorporates FHIR for current or future use.

Use an EHR that accommodates current standards

Behavioral health providers can help their practice achieve greater interoperability by choosing an EHR system that follows appropriate standards.
BestNotes offers EHR and CRM solutions tailored specifically for behavioral health and addiction treatment providers, with features that help you collaborate and exchange information with those who need it. Contact us today to learn more or schedule a demo!

date:  Aug 12, 2019
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Anorexia Could Have Genetic and Metabolic Components, According to a New Study

Anorexia nervosa, more commonly called simply anorexia, is an eating disorder characterized by restricted eating that can cause low body weight, usually combined with distorted body image and a strong fear of gaining weight. Many people with anorexia don’t recognize how underweight they become, or how harmful their condition can be to their overall health.

It is believed that anorexia affects between 1-2 percent of women and 0.2-0.4 percent of men. Since anorexia has one of the highest mortality rates of any psychiatric illness, treatment is essential.

No direct cause of anorexia has been established, although there are many potential risk factors:

Perfectionist personality
Obsessive-compulsive personality traits
Social, cultural, or peer pressure to maintain a certain weight
A first-degree relative who had anorexia
Severe emotional stress

Current treatment approaches for anorexia

Anorexia treatment usually includes several approaches, given the complexity of the disease. Hospitalization may be required for severe cases, followed by careful, supervised weight gain.
Like most other eating disorders, anorexia is largely considered a psychiatric issue. People with anorexia are believed to be struggling with emotional problems, and associate their weight with their self-worth. Therefore, individual and family-based counseling is also recommended to help establish healthy eating patterns and behaviors and change distorted beliefs and thoughts about eating and weight.

New anorexia research, however, suggests that there are also genetic factors involved in the disease. These factors may not only be mental, but metabolic, as well, and so treatment may need to account for these additional factors.

What does the new anorexia study show?

In a new study published in Nature Genetics, researchers at King’s College London and the University of North Carolina at Chapel Hill looked at data from 16,992 cases of anorexia nervosa and 55,525 controls. Data came from individuals in 17 countries.

This genome-wide association study identified eight significant genetic loci, or locations. The data showed significant genetic correlations between anorexia and metabolic traits, lipid traits, and body measurements. This overlap occurred independent of genetic effects that influence body-mass index.

These findings indicate that providers may want to avoid assuming that metabolic abnormalities are a direct result of the eating disorder that will go away once anorexia is treated and weight has been regained. Addressing both the metabolic and psychiatric symptoms in patients with anorexia may lead to better results.

Results also showed that the genetic basis of anorexia overlaps with other mental-health issues. These included obsessive-compulsive disorder, depression, anxiety, and schizophrenia. Some of the genetic factors associated with anorexia also were associated with physical activity, which may explain why people with anorexia tend to be more active.

Based on their findings, the researchers suggested that anorexia may need to be reconsidered a hybrid, “metabo-psychiatric disorder” rather than just a mental illness. The study authors noted that future, new treatments may need to incorporate both metabolic and psychological risk factors.

What does the new anorexia study show?

In a new study published in Nature Genetics, researchers at King’s College London and the University of North Carolina at Chapel Hill looked at data from 16,992 cases of anorexia nervosa and 55,525 controls. Data came from individuals in 17 countries.

This genome-wide association study identified eight significant genetic loci, or locations. The data showed significant genetic correlations between anorexia and metabolic traits, lipid traits, and body measurements. This overlap occurred independent of genetic effects that influence body-mass index.

These findings indicate that providers may want to avoid assuming that metabolic abnormalities are a direct result of the eating disorder that will go away once anorexia is treated and weight has been regained. Addressing both the metabolic and psychiatric symptoms in patients with anorexia may lead to better results.

Results also showed that the genetic basis of anorexia overlaps with other mental-health issues. These included obsessive-compulsive disorder, depression, anxiety, and schizophrenia. Some of the genetic factors associated with anorexia also were associated with physical activity, which may explain why people with anorexia tend to be more active.

Based on their findings, the researchers suggested that anorexia may need to be reconsidered a hybrid, “metabo-psychiatric disorder” rather than just a mental illness. The study authors noted that future, new treatments may need to incorporate both metabolic and psychological risk factors.

EHR for behavioral health providers

Eating disorders like anorexia can be complicated for behavioral health providers to treat. The right EHR solution can help you track patient progress and coordinate care with other specialists for optimal results.
BestNotes EHR software was designed with you in mind. Contact us today to learn more about how we can help strengthen your practice.

date:  Aug 07, 2019
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Five Things to Ask Before You Sign a New EHR Vendor

Choosing and adopting a new electronic health record (EHR) system is no small feat for any behavioral health or addiction treatment provider. Whether you’re choosing your first EHR or switching to a different solution, here are five questions to ask any EHR vendor you consider.

1. What is your implementation strategy?

How long should implementation take? Will the new EHR be rolled out gradually, or launched all at once? Does the vendor provide training, tutorials, demos, regular updates, and easily accessible support? Which staff members will need to use the EHR?

Each implementation is different, but your EHR vendor should help you create an implementation plan and schedule, understand what to expect, and minimize setbacks.

2. What additional fees do you charge?

Many behavioral health providers have been burned by hidden fees associated with a new EHR. For example, some EHR software companies add fees for certain tech support features. Make sure your budget isn’t being drained by examining the fine print of any agreements and cost estimates before you make a final decision.

3. How do you incorporate patient outcomes in your EHR?

The Joint Commission, a non-profit organization that accredits nearly 21,000 U.S. healthcare organizations and programs, requires its behavioral health members to use standardized methods to assess patient outcomes. This helps providers and patients create individual care plans and better evaluate patient outcomes.

The right EHR solution can help you track patient outcomes in different ways. This may include creating and managing patient progress notes, recording and sharing lab results, and managing intake assessments and discharge summaries.

4. What is your security strategy?

Data security and HIPAA compliance are important for your behavioral health practice, and should be equally important to your EHR vendor. Ask about how patient records are encrypted and saved, and how the vendor protects against data breaches.

Here are some things to look for:

Data transmission between user computer and the cloud should be encrypted
Vendors should provide a regular backup schedule; with BestNotes, for example, user notes are saved as they are made, with regular backups performed nightly
Whether the vendor uses penetration testing, which involves hiring experts to deliberately hack into their system to identify weak points

5. Do you belong to any national associations or follow specific industry standards?

An EHR vendor that joins a national association demonstrates a dedication to uphold standards within their industry. For example, BestNotes is a member of the HIMSS Electronic Health Record (EHR) Association, which aims to accelerate health information and technology, promote interoperability, and improve healthcare quality through EHR use.

BestNotes is also a member of the National Association of Addiction Treatment Providers, which is committed to providing advocacy, training, and other support to maintain the “highest quality of addiction treatment.”

Switch to an EHR made just for you

BestNotes EHR and CRM solutions are built specifically for behavioral health and addiction treatment professionals. Whether you are just launching your practice or looking to expand, we have the features you need to streamline your administrative tasks, boost your revenue, and improve your patient outcomes. Contact us today to learn more or schedule a free demo!

date:  Aug 05, 2019
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News Roundup: Medicaid Expansion Across the United States, July 2019

The Affordable Care Act (ACA), widely known as Obamacare, allows for expanded Medicaid coverage for low-income Americans. So far, 36 states and the District of Columbia have adopted Medicaid expansion. In other states, the debate continues in numerous forms. Here’s some of the latest news on Medicaid expansion across the nation.

Kentucky Plans to Expand School-Based Health Services Under Medicaid Plan

Kentucky’s Cabinet for Health and Family Services is partnering with the Kentucky Department of Education to work toward amending the state’s Medicaid plan. This would expand physical and mental healthcare access to students in schools by allowing for the payment of qualifying services.

Under the proposed amendment, Kentucky school districts would be able to use federal Medicaid funding to expand access to school-based healthcare for students enrolled in Medicaid. This includes mental health services and health screenings. Currently, students can only receive these services if they are covered by an Individual Education Plan under Medicaid.

North Carolina Still in a Budget Stalemate Due to Medicaid Expansion Conflict

North Carolina has not had a state budget for most of July, with Gov. Roy Cooper facing off against Republican lawmakers over including Medicaid expansion in the budget.
Cooper wants to expand Medicaid across the state, but has expressed a willingness to consider a compromise. He has already vetoed one budget proposal, while Republicans try to build up enough votes to override it.

Fewer Psychiatrists Accepting Medicaid Patients

Despite greater coverage of mental health services under Medicaid expansion across the country, research shows that fewer psychiatrists are accepting Medicaid patients. Writing in JAMA Psychiatry, researchers report that the percentage of psychiatrists accepting Medicaid as payment declined from nearly 48 percent in 2010-2011 to 35 percent in 2014-2015.
The findings demonstrate that expanded coverage does not always lead to expanded access. This may also increase demand for other clinicians besides psychiatrists who accept Medicaid for behavioral health services.

Study coauthor Adam Wilk of Emory University suggests that a shortage of behavioral health providers may affect how existing providers do business. They may accept more patients with private insurance, or opt out of insurance completely. Lower fees, reimbursement delays, and administrative burdens make Medicaid less appealing for behavioral health clinicians.

Small Florida Counties Worried About Medicaid Expansion

Florida is one of the 14 states that have not yet expanded Medicaid coverage under ACA. A political committee called Florida Decides Healthcare, however, is working to put a constitutional amendment before Florida voters in 2020. The amendment would require the state to expand Medicaid to include adults under age 65 who earn less than 138 percent of the federal poverty level. Currently, that amounts to $29,435 for a family of three, or $17,276 for an individual.
Some of the state’s smaller counties, however, are worried about how the state will cover the additional cost. Many residents in poorer Florida counties are concerned that they could see higher tax bills under proposed Medicaid expansion.

Behavioral Health and Addiction Treatment EHR for Providers Nation-Wide

Behavioral health and addiction treatment providers may see greater demand in states that expand Medicaid. A comprehensive EHR solution can help you keep up with demand.

BestNotes EHR and CRM solutions help behavioral health clinicians and staff save time, offer effective services, and grow their practice. Contact us today to find out more, or request to schedule a free demo!

date:  Aug 05, 2019
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How behavioral health providers can address workplace loneliness

As mental health and workplace wellness get more attention from the media and the general public, loneliness is emerging as a specific concern Loneliness not only affects quality of life, but creates problems at work, even among behavioral health staff.

What causes workplace loneliness?

In spite of open-office plans and increased connectivity, workers are lonelier than ever. This makes sense when you consider that technology has decreased the need for face-to-face interaction. Plus, more employees are working remotely, including in telehealth.

Behavioral health and addiction treatment professionals specifically face stress from helping individuals with complex, difficult needs. Privacy rules and other ethical boundaries limit clinicians’ ability to express concerns about patients or colleagues.

Staff also struggle with heavy administrative workloads and unique regulatory burdens, which may contribute to feelings of isolation. All this adds up to a strong potential for loneliness among behavioral health workers.

What are some effects of workplace loneliness?

CNN Business recently pointed out that workplace loneliness contributes to a variety of problems:

Reduced productivity, which can increase stress for individuals and hurt a bottom line
Lonely people may isolate themselves, potentially limiting workplace connections, communication, and teamwork
The spread of negative feelings and attitudes, reducing morale and increasing turnover

What are possible signs of workplace loneliness?

Loneliness can be difficult to recognize, especially if a person is trying to avoid appearing weak or feeling embarrassed. Signs to watch for among employees and coworkers include:

Falling productivity, including increased failure to meet deadlines
Lack of participation in meetings or social events without apparent reason
Limited or no response to group messages
Appearing tense or irritable with coworkers or clients
Taking more sick days than usual
Appearing to deliberately avoid interaction

What should behavioral health leaders do about workplace loneliness?

Loneliness has wide-reaching effects beyond the individual, so office managers and other behavioral health leaders should take steps to combat workplace loneliness.

Make sure new providers or administrative staff receive a personal onboarding experience, including thorough introductions and ongoing support.

Follow up with employees. Months after being hired, keep checking in periodically to make sure they feel connected and their needs are being addressed.

Show appreciation. Many employees feel lonely when they feel that they are not making a difference or their work is unnoticed. Gestures can be small, such as a short email or note to say thanks, or publicly acknowledging them for a job well done.

Encourage occasional outside gatherings, such as happy hours, employee lunches, holiday parties, or other casual get-togethers. Make sure everyone is explicitly invited.

Deliberately solicit employee input to keep them engaged. This is important for remote workers who may occasionally feel forgotten or isolated.

Communicate face-to-face when possible, rather than sending a message.

Make small efforts to get to know people, such as asking about their families or interests.

Encourage communication and teamwork with the right EHR

You don’t have to do without health IT to combat workplace loneliness. With the right EHR solution, behavioral health and addiction treatment providers can communicate more effectively, encourage teamwork, and boost productivity.

BestNotes EHR was developed specifically to help behavioral health practices stay streamlined and cost-effective without sacrificing employee well-being. Contact us today to learn more about how BestNotes can help you improve your care, track patient outcomes, and boost practice revenue.

date:  Jul 23, 2019
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