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What Is the History of EHRs in Healthcare?

Many behavioral health experts now use electronic health records (EHRs) to help reduce errors, improve cost-effectiveness, and better share patient information among providers and facilities.

But what really started this trend? Despite the recent growth in the use of EHRs, this technology has a vibrant history that goes back more than a century.

How Old Are EHRs? Older Than You Think

In the early 1900s, when the Mayo Clinic was still young, Dr. Henry Plummer helped the hospital develop a registration system and uniform medical record for keeping track of patients’ medical information. This system became part of Mayo Clinic’s infrastructure, contributing to its growth as a world-famous hospital. Decades later, Mayo Clinic would become one of the first hospitals to implement an EHR system.

According to Becker’s Health IT and CIO Report, some form of EHR to store patient data has been around since the 1960s. Only a few hospitals and physicians used them, however, since they came at a high cost when the technology was new. Early EHRs were primarily used in government, research, and military health centers.

As the technology developed further in the second half of the 20th century, more physicians used computers in their practices. By 1991, the Institute of Medicine had a goal for all physicians to use computers in their practice by the year 2000. Just because they used computers, however, did not necessarily mean that the practice used a full EHR system. Even when a practice implemented EHRs, compatibility and interoperability among different providers and EHR systems became persistent problems.

In 2004, an executive order under President George W. Bush created the Office of the National Coordinator of Health Information Technology. This led to a call for nationwide EHR use by 2014.

EHR Growth in the Last Decade

President Barack Obama supported the mandate for widespread EHR use, and included EHRs in the American Recovery and Reinvestment Act (ARRA) of 2009. This legislation aimed to modernize the U.S. healthcare system.

ARRA also provided additional funding to providers who adopted EHRs and followed the concept of “meaningful use” by 2014. The idea of “meaningful use” centered on improving quality of care, reducing health disparities, and protecting personal health information.

True to its history of health innovations, the Mayo Clinic also led the way in expanding EHR use. Between 2013-2015, the Mayo Clinic began the process of unifying its various practices to encourage the sharing of information, both inside and outside its health system. In 2015, Mayo Clinic CIO Christopher Ross announced that the system would move to a single EHR. That major change began to go live earlier in 2018.

Between 2001 and 2011, physician use of EHRs grew from 18 percent to 57 percent, according to

Future Developments and Predictions

As patient needs and demands change, so will the needs of healthcare practices. EHR solutions will continue to evolve to meet those needs. Improved communication and interoperability will remain top priorities among providers and EHR companies.

BestNotes EHR software solutions helps behavioral health and addiction treatment professionals save time and money in their practices and provide greater care to patients. Contact us to learn what we can do for you.

date:  Sep 07, 2018
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Three Ways a Healthy Workplace Boosts Productivity

A healthy workplace is characterized by high morale and empowered, encouraged employees. Research shows that such environments help boost productivity, which helps improve a company’s culture, and bottom line, and leads to more satisfied clients.

Here are three examples of what increased productivity looks like in a healthy workplace, with tips on how to achieve them.

1. Lower employee turnover

Healthy workplaces tend to have low staff turnover, since employees are more likely to stick around. Because of this, the company benefits from reduced costs associated with interviewing, hiring, and training new employees. Lower turnover also encourages teamwork by giving staff members plenty of time to get to know each other and learn how to understand each other and work together.

Workplaces can reduce turnover in a variety of ways:
Make sure to hire the right candidates, who suit the company culture and align with its goals and values.
Trust employees to fulfill their roles without micromanaging them.
Offer competitive salaries and benefits, as well as advancement opportunities.
Encourage work-life balance among staff members by providing options such as flexible work schedules, help with elder or childcare, and telecommunication opportunities.

2. Increased communication

Employees who feel encouraged and empowered are more likely to speak up and share opinions. This helps boost creativity and brainstorming because teammates share ideas more freely, which can lead to an increase in productivity. Staff members who are encouraged to express their needs also may be less likely to experience dissatisfaction at work or tension with coworkers.

A company can encourage communication several ways:
Have managers set examples by practicing better, more frequent communication.
Listen to employees and seek to understand them. Include employee suggestions in any efforts to improve the workplace.
Schedule regular team meetings that encourage all participants to speak up.
Set healthy boundaries and encourage work-life balance by limiting communication outside of work hours.
Keep employees updated on projects and outcomes.

3. Greater employee engagement

“Employee engagement” is a general term that includes how passionate employees feel about their jobs, how committed they are to their company, and how much effort they put into their work. Highly engaged employees tend to work harder because they have a strong sense of purpose, which increases morale and teamwork.

There are numerous methods for increasing employee engagement:
Make sure all employees understand the roles they serve and the value they provide.
Provide the right training and tools for team members to do their work.
Make sure the company not only provides training and support for new hires, but also growth and development opportunities for existing employees. This not only helps increase employee loyalty, but makes them better at their jobs and a better asset to the company.
Emphasizing the value of employees’ opinions.
Give staff members recognition and incentives for jobs well done.

Healthy work environments do not happen by accident. They require deliberate effort, although specific methods may differ among organizations. Executives and management must be committed to creating a healthy culture full of happy, productive employees. In turn, these employees will support their companies and be more productive in their work.

date:  Sep 04, 2018
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Idaho is launching a new mental-health program, Youth Empowerment Services (YES), to provide individualized care throughout the state to children with serious emotional disturbance (SED)

YES Created to Address Children’s Needs

YES was created in response to the Jeff D. class-action lawsuit that began in 1980. At that time, both children and adults received mental-health care at State Hospital South. The lawsuit argued that Idaho lacked sufficient treatment, educational, and community-based services, which allegedly violated patients’ rights under the U.S. Constitution, Idaho Constitution, and other federal and state laws.

After three decades of hearings, the Court recommended mediation to develop solutions. This occurred from September 2013 through December 2014, and included parents, patient advocates, health providers, and attorneys. The result of these negotiations became the Idaho Implementation Plan, which led to the creation of YES.

Collaborative, Team-Based Approach

A major focus of YES is collaboration and coordinated care. The program will bring together the Department of Health and Welfare, State Department of Education, and Idaho Department of Juvenile Corrections.

These agencies aim to improve communications between health providers and agencies. This improved communication can help streamline care and prevent duplicate or conflicting treatments. All agencies involved will work toward the same goals for each child.

Under YES, Idaho aims to use a uniform, statewide procedure to identify children and teens with unmet mental-health needs and connect them to the appropriate resources. This will be done with the new Child and Adolescent Needs & Strengths, a standardized, statewide tool to identify children in need, measure functional impairment, communicate about the child’s needs and strengths, and help plan treatment.

What Are Some of the Goals of YES?

State agencies intend to measure and communicate treatment outcomes, which will increase transparency and accountability to patients, families, and other stakeholders. The state also intends to use state resources effectively, and to use Medicaid and other federal funds to the fullest extent available.

YES also encourages children and their families to be involved in care and treatment planning, as well as system improvement. Under the program, children with SED will receive individualized services, and families will be educated on how to use these services.

Through these efforts, Idaho hopes to see improved outcomes for children and teens with SED. These include increased safety at home and in school, reduced hospitalizations and “out-of-home placements,” reduced delinquency, improved mental health and reduced mental disability, and improved functioning among patients with SED.

What Services Will Be Available?

Idaho is implementing YES in stages from 2018 to 2019. The state is in the process of providing YES training for providers and families, and conducting outreach regarding the new program.

Under YES, families will work with several agencies, including schools, family health providers, and the departments of Health and Welfare or Juvenile Justice. Together, the family and agencies will develop a treatment plan based on the child’s individual needs.

Idaho also intends to develop additional community-based services to help meet YES goals. Available services will be listed on the program’s Services and Supports Page.

date:  Aug 27, 2018
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News Roundup: Addressing Addiction Needs in Oregon

The state of Oregon has not been immune to the effects of addiction, including the nationwide opioid crisis. Here is the addiction news making headlines in Oregon.

Oregon Has the Fewest Opioid Overdoses

According to Dr. Jim Shames, medical director for Jackson County, Ore., the state now has the fewest opioid overdoses in the nation. At the same time, however, he points out that there is an increase in heroin and fentanyl overdoses.

Dr. Shames credits several factors with the reduction in opioid overdoses. Oregon has been advocating naloxone training to help limit the effects of overdose. He also notes collaboration among numerous agencies, including the Oregon Health Authority and the Centers for Disease Control, and between lawmakers and healthcare providers.

Oregon’s Medicaid Program Considers Cutting Off Opioids

In the first proposal of its kind, Oregon state officials are considering an end to opioid medication coverage for patients with chronic pain enrolled in Oregon’s Medicaid program. Under this policy, patients enrolled in the state’s Medicaid program who receive opioids for chronic pain would see their doses tapered off to zero over 12 months, starting in 2020. This includes patients who may not show any signs of addiction.

Officials have not disclosed how many individuals would fall under the proposal, but Oregon’s Medicaid covers about 1 million patients. Across the United States, about 10 percent of adults experience chronic pain, defined as having pain every day for the previous three months.

Supporters say this change could help reduce the risk of addiction and overdose. Many patients, however, are already protesting the proposal, arguing that opioids have helped them manage their pain when nothing else worked. Some experts question whether it is really less dangerous for patients to be forced off of opioid use than to depend on them for chronic pain.

Correctional Facility in McMinnville Tries Medication-Assisted Program

Yamhill County Correctional Facility (YCCF) is piloting a medication-assisted treatment (MAT) program designed to help inmates struggling with addiction. YCCF has partnered with the Willamette Valley Comprehensive Treatment Center, a substance abuse facility, to provide these services.

Under the program, MAT and other substance-abuse services are available for any inmate processed through YCCF. Sheriff Tim Svenson and Captain Richard Geist of the YCCF initialized the program earlier this year, and received approval from the Oregon Health Authority.

Under Pilot Program, Portland Library Offers Naloxone Training

Multnomah County Library in Portland this summer launched a pilot program to provide naloxone training to the managers of five libraries. Managers are learning to administer the drug to help reverse the effects of opioid overdose. Under the program, participating locations are able to provide naloxone in spray form.

According to Shawn Cunningham, director of communications and strategic initiative for Multnomah County Library, problems within a community are likely to manifest in public places like libraries. This could make libraries a key location for targeting opioid misuse and getting faster help to individuals who may overdose.

BestNotes is a HIPAA-compliant solution specifically designed for behavioral health and addiction treatment providers. Contact us today to learn more

date:  Aug 21, 2018
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Study Finds U.S. Opioid Use Remains Unchanged

As lawmakers, clinicians, law-enforcement officials, and community leaders seek solutions to the opioid crisis, new research offers discouraging results.

Researchers report in BMJ that opioid use has been largely unchanged in recent years, despite ongoing efforts to reduce the use of opioid pain medications.

Study Population

The study included all commercially insured or Medicare beneficiaries who had medical and pharmacy coverage at any point in 2007 through 2016. The data included 48 million unique beneficiaries, in a wide range of age groups.

For measurement purposes, the researchers translated the milligram of each drug into milligram morphine equivalents (MME). Among their goals, the researchers aimed to determine the average daily opioid dose in MME.

Study Found Disturbing Trends in Opioid Use

Scientists report that opioid prescriptions for commercially insured patients have stayed around 14 percent for the past 10 years. In the same period, the quarterly prescription rate for aged Medicare beneficiaries rose from 11 percent to 14 percent.

Highest use of opioids were among disabled Medicare beneficiaries aged 45-54 years. Of these, 45 percent used prescription opioids from the fourth quarter of 2011 to the fourth quarter of 2013.

Despite the risk of opioid dependency associated with long-term use, most opioids prescribed were for this purpose. Among disabled Medicare beneficiaries, 14 percent of opioid episodes were classified as being for long-term use. This 14 percent accounted for 89 percent of the total opioids dispensed.

During the 10 years included in the study, the average daily observed dose among those disabled Medicare beneficiaries who were prescribed opioids never dropped below 50 MME. While this group is more likely to have significant pain and have an increased tolerance for opioids, it also presents real dangers. At this dose, the chances of overdose are two to four times higher compared to daily doses under 20 MME, the study authors write.

This coincides with reports by the CDC that the United States saw a 30-percent increase in hospital emergency department visits for opioid overdoses from July 2016 through September 2017.

What Can Be Done to Reduce Opioid Overuse

The new study’s researchers point out a need for evidence-based approaches that can make opioid use safer and improve patients’ pain management and abilities to function.

Based on their findings, the study authors suggest that both doctors and patients seriously consider whether long-term opioid use really helps improve the patient’s ability to function and their quality of life. If not, they should consider other treatments that can either supplement or replace the use of opioids.

The CDC supports medication-assisted treatment for patients with opioid use disorder (OUD), and expanded availability of naloxone to counteract overdose. As drugmakers come under fire for their alleged role in the opioid crisis, many companies are working to bring new, non-opioid drugs to market.

Opioids should be prescribed only when benefits outweigh risks, and after considering a patient’s overall needs, drug history, and level of risk. Providers may recommend alternative approaches to help patients experiencing severe pain, such as physical therapy. Providers also should be aware of behavioral health, addiction treatment, and social services that are available to those patients with OUD.

date:  Aug 13, 2018
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