1. And Now You’re a Robot: The Pros and Cons of Your Clinical EHR System Amelia Doty, LCSW Laura Morris, LSW

2. I.Technology Up Until Now II.EHR Policy and Tech Usage III.EHR Practice IV.Clinical Practice Realities V.Maintaining Best/Promising Practice

3. Technology Up Until Now How many handwrite/type notes? How many text with individuals they serve? How many submit paper copies to a supervisor for review?

4. What changed? Fee for Service – getting paid by the minute Technology improved and systems became faster and more powerful Decreased funding for social services = more individuals to serve with less time/resources

5. Electronic Health Care Policies Health Information Technology for Economic and Clinical Health Act (HITECH), February 2009 – Meaningful Use of Technology and Electronic Health Record –New HIPAA regulations for Protected Health Information –Patient access of electronic health information (http://www.healthit.gov/policy-researchers- implementers/health-it-legislation)http://www.healthit.gov/policy-researchers- implementers/health-it-legislation

6. Electronic Health Care Policies Affordable Care Act, March 2010 –New Models of Care Require New Technology (PCMH) –Expanded preventative services –Can’t be denied coverage for pre-existing conditions (https://www.healthcare.gov/)https://www.healthcare.gov/

7. Electronic Health Care Policies – Individual Use Pew Research Internet Project, Update Jan 2014 (n=2,277) ( http://www.pewinternet.org/2014/01/25/the-intersection-of- health-care-social-media-and-digital-strategy/) http://www.pewinternet.org/2014/01/25/the-intersection-of- health-care-social-media-and-digital-strategy/ 90% of US Adults have cell phone and 58% have a smart phone 67% of US Adults check their phones for messages, alerts, or calls even without it ringing or vibrating Pew Tracking for Health Study, Jan 2013 (n=3,014) (http://www.pewinternet.org/2013/01/28/tracking-for-health/)http://www.pewinternet.org/2013/01/28/tracking-for-health/ 60% of US Adults keep track of a health indicator (blood pressure, blood sugar, headaches, or sleep) 1 in 5 use technology to track their health

8. Electronic Health Record and Billing - Practice Substance Abuse and Mental Health Administration, April 2009 5 States have a complete EHR in their state psychiatric hospitals while 18 states have some parts of an EHR. 21 States have full or in part EHR use at Provider Agencies 20 States have agreements to share EHR client-level data between providers but these vary 21 States use e-pharmacy By state (PewTrust): http://www.pewtrusts.org/en/research-and- analysis/blogs/stateline/2014/03/19/electronic-health-records- infographichttp://www.pewtrusts.org/en/research-and- analysis/blogs/stateline/2014/03/19/electronic-health-records- infographic

9. Electronic Health Record and Billing - Practice By targeting data, we can reach the most needy on our caseload AND react to environmental realities: Who are the older adults on my caseload who have diabetes and will struggle with this early fall heat wave? Who had hospitalizations last December around the holidays? Let’s make sure they get a face to face visit and transportation arranged to our holiday party.

10. Use, Efficacy, and Areas of Growth - Use Most of us create progress notes, encounter logs, treatment plans, and track units of service on our EHRs Most of us can log into our EHR from a company office Most of us print documents for signature and then file these originals in paper files

11. The difference between efficiency and efficacy Desktop EHRs have been more efficient than paper but it’s the following EHR solutions that are efficacious and bring us to the next level –Mobile solutions that work anywhere –Electronic signature options –Guest/emergency log in –Linking progress note to treatment plan goals –Protected document exported to email safely

12. Areas of Growth While many EHRs say they are “interoperable” with other systems – this all comes with a price E-Scripts and E-Mars E-Labs Integrating physical health encounter data

13. What about clinical practice? Strengthening the therapeutic alliance with electronics Encouraging PIR advocacy and participation Demonstrating change and outcomes

14. Electronic Health Record and Billing - Practice By having an individuals EHR on hand, we have a live personalized psycho-educational tool: Review medication lists, discuss adverse side effects, and brainstorm personal solutions Use a visit log to demonstrate motivation and commitment to recovery during periods of doubt/relapse Discuss triggers around hospitalizations, create a WRAP, and offer to email the WRAP to supporters

15. Electronic Health Record and Billing – Clinical Practice By using electronic health records, we can: Expand access to care to the most needy Respond to consumer preferences and needs real time

16. What about clinical practice…can a robot do this? Encouraging PIR participation Diagnostics – (My Mood Monitor) Psycho-Social Education – (PTSD Coach) Clinical Treatment – (Beating the Blues) Early Detection of Relapse – (Actigraphy) = smartphone apps can monitor and predict depression triggers Relapse Prevention – (Helius) Promote Consumer Monitoring – (Health Buddy)

17. What about clinical practice…can a robot do this? Challenges Budgeting for technology and INTERNET service Lost in translation – electronic communication does not replace human connection “I’ll get around to using this when I’m less depressed.”

18. What about clinical practice…can a robot do this? Demonstrating change and outcomes Other Scales Beck Anxiety Inventory Beck Depression Inventory Addiction Severity Index

19. What about clinical practice…can a robot do this? Demonstrating change and outcomes Vitals Over Time Beck Anxiety Inventory Beck Depression Inventory Addiction Severity Index

20. What’s Next? EBPs and Data Collection Patient Portal

21. So….are you a robot? TrueFalse The Affordable Care Act gives Consumers access to their health information The HITECH Act has more requirements for Protected Health Information Electronic Health Records can be a psychoeducational tool Electronic Health Records have limits around interoperability Electronic Health Records can help an individual scale their depression symptoms Electronic Health Records can help you do crisis planning and prevention If you have more than one True, you ARE NOT a robot.

22. CONTACT US Amelia Doty, LCSW Clinical Systems Director Email: amelia.doty@rhd.org Laura Morris, LSW Clinical Systems Director Resources for Human Development Email: LauraM@rhd.org amelia.doty@rhd.orgLauraM@rhd.org