Quality Care Metrics in Health Services: Mental Health, Assisted Care, Group Homes

A while ago I posted a discussion on several mental health and counseling groups, seeking  comments on quality metrics for Mental Health.  The topic was prompted by the verbiage in recently passed federal  health care legislation where paragraph after paragraph kept including  the term quality care.

Based on feedback and discussions we have arrived at and implemented the following quality features: divided into two groups:

Practice: 

• Audit trail: event driven records of all activities in the practice
• User defined Templates – throughout to assure consistency and quality of comments while still enabling  case specific modification.
• Spell checking of all notes and comments to assure professionalism and readability.
• Built in drug and diagnosis code templates – to avoid errors
• Notes that are locked on completion to avoid tampering
• Program compliance tracking to assure complete and timely performance
• Forms management to print correct form on demand
• Document management to scanned documents and files to be attached and achieved with case
• Bar code document tracking – issued, received checked in , checked out
• Data Slice technology that restricts  case information access  to assigned personnel
• Integrated accounting and  billing to assure accuracy
• e-signatures to assure locked documents are signed
• e-prescriptions integrated with  meds management to assure accuracy

Care:

• Consistency of care case notes about the client: what works and what doesn’t that are shared with clinical workers assigned to the case
• Best practice notes: based on diagnosis and treatments but without client reference to be shared with all practice professionals at level
• Statistical Subjectivity Goal Charting : to graphically depict clinician assessment of treatment history effectiveness
• Consumer satisfaction survey on exit — aggregated to client and clinician satisfaction index — measure consumer assessment of effectiveness

These are some of what we have come up with if you have comments and or can think of more we can do please advise.   We being a  provider  of an integrated suite of practice management, scheduling, accounting and billing  software for: mental health, assisted care, personal care and group homes,  were interested in making sure that we could support these quality care initiatives.  We are proud of our software and what we have done but recognize that you are the experts and we support your needs.

learn more:  www.findsocialservicesoftware.com/hsg.aspx

First hand experience report on Windows 7 Ultimate upgrade installation over Windows Vista Business

1.)    Platform HP dual core Pavilion dv6000  – 2GB memory 120GB HD

2.)    The software recommended downloading a running the Upgrade Advisor, which I did.

1. First thing it told me was that it wanted 16GB free space and I only had 15GB.
2. It then recommended that i
   •   Un-Install Google tool bar

Which Windows 7 continued to see as installed even after removal

•  
  • Un-Install SQL 2008
  •  Un-Install Trend  Micro
  • De-Authorize I-Tunes

Nice attempt on their part to prevent using up authorization tokens.  Which  would not go away even when I tried to de-authorize it

•  
  • Upgrading driver to Intellipoint mouse/ keyboard
  • Indicated that the HP extra buttons on the laptop may not work afterwards

3.)    Had to download and SQL 2008 SP1 since 2008 Standard failed to load with an error.  – System did report incompatibility and advise that SP1 would have to be added after the fact but failed to install anyway.

4.)    Installation itself  took a long time  4+hours –  not counting the  SQL download and reinstall

•  
  • Immediately after completing the system ran slower that Vista
  • Although the processor was not very busy.
  • After a couple of reboots and opening stuff the performance ratcheted up to faster that Vista Business – perhaps it w as indexing ??
  • Intellipoint keyboard extras no longer worked

This went off with little or no difficulty.  The software made reasonable demands and the patches to upgrade components were already in place and only needed to be downloaded.

This machine is a software development machine and has SQL 2005, SQL 2008, Visual Studio 2008, all of office, and hundreds of applets. and so far everything is up and running.  

All in all having previously upgraded this same platform to Vista Business and spending 3 days working with Microsoft to get it running again.   Windows 7 is an overwhelming success.

www.advantecis.com   www.findsocialservicesoftware.com

If Big is bad — why is cloud computing good?

The general adage is that:

• big corporations are bad
• big government is bad
• putting all you eggs in one basket is bad
• monopoly is bad  – ask AT&T
• no competition is bad
• a single source of supply is bad
• treating all your customers in locked step: my way or the highway is bad
• being totally dependent on a single point of possible failure is bad

And:

• diversity is good
• multiple suppliers is good
• competition is good
• treatment of each customer as a unique individual is good
• not being overly dependent on others is good

 

Then why does putting all your data and all you business knowledge, being totally dependent on a select handful of really large multinational players, make any sense.  Sure its all about the money, economy of scale,  never mind that a  breach or failure results in millions people being at risk and yoru entire business being at risk.

From a technological point of view Clound computing sounds great.

But shouldn’t proprietary data should remain proprietary.  Not all businesses should/can  operate exactly the same and a couple of really large firms or the government should know all your business.

What do you think..?? 

 

New Business Technology puts the squeeze on Small and Mid Size Firms

Using  technology  to cope with today’s ever changing business pressures varies with business size.

Current trends in business technology in general are smaller, faster, cheaper, free on the internet.

Business of all size are and have been rushing to get there.

• Large companies throw together teams to investigate and implement technology to their advantage.
  • They have the benefit of large budgets and resource pools.
  • Maintaining their operations and customers is not a problem simply because of their depth of resources.               
• Mid sized firms  can outsource for  limited adoption of technology
  • have more limited resources
  • operations and customer maintenance is not significantly affected because they can bring in some resources
  • can use “free” tools but typically do not want to host the “free” advertising associated with free tools
• Small companies have to try to find a way to adopt new technology themselves or utilize so called “free” tools on the web.
  • have typically neither resources or money
  • have overhead and customers to keep happy
  • Have day to day operations/services  to maintain
  • Have to live with the free advertising to get the free tools
• Start ups can carve out a niche and  spend hundreds or thousands of man days developing a specific solution that they can provide cheaper, faster, slicker.
  • Startups have little to no overhead and need only do one thing really well.
  • No current customers to keep happy. 
  • may have deep pockets if they are lucky enough to have an “angel”
  • on the down side they have little to no revenue

Two points can be made from the above observations:

1.  So called “free” internet resources to adopt technology to your business are not “free”. The adage ” there is  no such thing as a free lunch” could not be more true. Utilizing free tools with or without the advertising takes paying for help to implement or hundreds of hundreds of hours  to first implement and configure and then constant on going attention to feed the content and or tweak the configuration .  Don’t get me wrong the internet “free” tools, and low cost services are great. but  they are in no way free.
2. The small to mid- sized firms that create jobs and hire people are being squeezed by new technology more than the Large and startup firms.

We at AdvanTec Information Systems, LLC  recognize this and work with the small and mid- sized firms to help them adopt and adapt to new technology.

www.advantecis.com   www.findsocialservicesoftware.com

New technology — causes a new look at mobile business applications

Historically business has wanted field deployed personnel to capture data at the point on customer interaction for at least the last 20 years.

There have been and continue to be many variations and ways of achieving this end.  To date all have been relatively expensive. 

They historically  broke down into three classes of use:

      Paper and transcribe

• inexpensive to implement   ↑
• costly to maintain – data transcription ↓
• possible transcription errors ↓
• latency — delay from collection to system input ↓

      Batch capture and upload

• device expense  ↓
• latency  – delay from collection to system input  ↓
• communications availability  ↓

       Real time interaction

• communications availability ↓
• communications cost  ↓

 At the same time the internet has matured enabling direct customer involvement on the web reducing the need for field personnel in many areas / industries. (e.g. routine sales calls) 

Industries where the services are being performed (at least in part) by the field personnel still need mobile data devices.  (e.g route sales, home health care, inspection / estimation services,  delivery, field sales,  etc)

Time and technological improvements have vastly reduced the cost and availability of mobile devices and communications.  Thus causing a resurgence of interest in mobile solutions.

Now we can affordably combine the best of all of these improvements to provide Hybrid Mobile solutions that:

• capture while offline  — costs ↓ 
  • notebooks
  • netbooks
  • pocket hotspots
• are real time when connected online — counnications costs ↓ 
  • smart phones (blackberry, IPhone, IPod touch)
  • WIFI
  • 3G/4G networks
• upload off line captured data whenever you go on line — communications avaialbility ↑ 
  • Public WIFI
  • Home internet widespread
• and deliver local hard copy or on screen advices via the internet.  ↑

 Our ATEC2GO, AT-e-Commerce  and e-Server Modules enable these mobility solutions for our clients. Call one of our consultants or agents to discuss how AdvanTec Information  Systems, LLC can enable your field personnel and improve your process and bottom line.

High-Variety – Business Models: Provide high value to your clients.

Manufacturing – Sales – Supply — Service

 High-Variety Manufacturing:

The term High-Variety Manufacturing refers to businesses that are in: mass customization, Job Shop, made to order, build to order, High-mix-low-volume.  These businesses have similar needs and issues: Job specific work orders, tracking, and variability in costs of goods and labor. My definition would not exclude standard made to stock operations – short and long run for the sake of completeness.

 High-Variety Sales:

It used to be that a firm did one or two modes of sales: Inside sales – Field Sales, Retail Stores – Cash-n-Carry, Wholesale – Standard: order- ship-bill, Supply Center – Counter Sales

 In today’ world companies need to be able to address many different modes of sales to keep up: Standard, Brokered, Counter, Retail, POS- Pick Up, E-Commerce, re-Supply, Special Order,  configuration, Remote/Mobile,  Affiliate Sales, Sales Agents, MFG Rep,  Job/Project,  EDI

 High-Variety Supply:

In like fashion firms that used to depend of a single of source(s) of supply are increasingly using: multiple vendors, manufacturing, contract manufacturing,  real inventory, virtual inventory, made to order, and logistics firms to a handle fulfillment.

 High-Variety Service:

Where a single work process used to accommodate work assignment and tracking now there can be a many different work order flow processes thorough out a company as well: Made to Order -MTO, made to Stock -MTS, Maintenance -MNT, Pick-UP-PUP, Deliver-DEL, Process -PRO, Refurbish- REF, Repair – REP, Service – SVC, Warranty – WAR, Install-INS, Engineer, Furnish, Install -EFI, Remove – REM, Assemble – ASS, Dissemble -DIS.

 Each firm may not need or do all of these but increasingly each firm is doing more and more of these.   

 Mid range firms, in particular, are being squeezed from the bottom and the top. One pony firms are nipping at their heels  by doing one thing and doing it cheaply to the exclusion of all else.  Big firms have the resources to provide all things to all people and are chomping off the top of the mid range market.

 Flexibility and adaptability are the key to economic survival, Small- Mid range firms need to have affordable tools to provide each and all of these modes of operations as needed to remain competitive and viable.  We all know that it is not about price alone, it is about value.

 Value = Price + Quality + Service

 Our Industrial Edition provides the tools, affordability, and flexibility to enable your business to provide high Value to your clients.

www.advantecis.com

Social Networking Evolutionary Not Revolutionary!

I was thinking about social networking and how to use it to promote business. It occurred to me that it is not a revolutionary new thing. If we look back on in recent history we can see many examples.

100 years ago there were town parades and fairs and holiday events where people got together and socialized.  Since then we have grown more and more disparate, not knowing our neighbors not getting out, doing our own thing.

We had the country store where people came together, throughout the day sitting in rockers on the front porch or around the pot belly stove, hung out and socialized.  This gave way to the backyard fence,  the street corners where kids hung out, the malls, the coffee shops (Starbucks), teens on phones in the sixties and seventies, which gave way to chat rooms, instant messaging, ubiquitous cell phones, texting and now social networking (face book,  twitter, etc).

A similar parallel exists with letters to the editor, contributions to periodicals like family circle, readers digest and blogs today.

Both of these revolutionary new mediums Social Networking and Blogs are really just the logical adaptation (evolution) of people hanging out and expressing their opinions.  The rrevolutionary part is that now they can be heard by millions instead of just a few. The pity is that bad ideas get just as much or maybe even more attention than good.

The other thing worth noting is that the old country store used to be the older folks hanging out, today all the socializing seems to be done by a younger and younger crowd.  Sure they are the ones adopting the new technology but recently I read an article that the internet is now used by 70% of the population relatively independent of age.  It is just matter of time before someone comes out with senior versions of Twitter – “Twaddle”, “Prattle”, “Jabber”, “Blabber”, ”Utter”, “Palaver”.

The more things change the more they stay the same.

Economic issues Impact on Health Care

Economic issues Impact on Health Care

Cutbacks in Medicaid Funding!

• More people applying to Medicaid – due to economy.

“Though many of the proposed Medicare cuts and the ones already in progress are frightening and difficult, at best, to deal with, the thought of more Medicaid cuts puts more pressure on the people that need the program most.”

“The problem is that rather than helping keep the benefits for people, once someone has lost them, the state and county end up paying untold thousands of dollars for emergency room visits that take the place of doctor visits. Keeping people on Medicaid and allowing new ones to get on it save the state and county money, short term and long term.”  The Medicaid and Medicare Center   (http://medicare-medicaid.com/tag/medicaid-cutbacks/)               june30th, 2009

Unemployment

• 10% unemployment is roughly a 5% increase in unemployment over “normal” and therefore causes a comparable 5% decrease in income tax revenue.
• Less revenue in state coffers for (Medicaid) matching funds – due to lower tax revenues
• Unemployment is projected to grow to 10.1 percent by 2/2010 and stay there for a while.

“Looking ahead to next fiscal year, the outlook is that FY 2010 almost certainly will be a very difficult year, with the potential for widespread program cutbacks and provider rate cuts that will affect millions of Medicaid beneficiaries.”  The Kaiser Commission on Medicaid and the Uninsured. January 2009

Federal Stimulus Program misses the mark!

American Recovery and Reinvestment Act of 2009 (ARRA)

• Section 5001: Increased Federal Medical Assistance Percentage (FMAP)
• Section 5001 of the ARRA provides eligible States with an increased Federal Medical Assistance Percentage (FMAP) for 27 months between October 1, 2008 and December 31, 2010
• Even though the Recovery Act provides more federal money the problem is that it requires the states to come up with more money to qualify and the states are stretched thin already by reduced tax revenue.

 

What does the future hold?

• Economic indicators show that the recession has bottomed out and started a rebound.  The banking, Wall Street, and housing industries are picking up.
• Unemployment is a lagging indicator and will not show improvement till later.
• Additional provisions and expenditures of the Stimulus package will go into effect in 2010 and may provide additional help to the economy.

So things should continue to improve.

But what can Service Providers do in the meantime?

All businesses (including health services) consist of the following three components.

• Labor: Professional Services – patient contact hours (labor)
  • Labor can be automated – for tracking and monitoring but professional contact hours cannot be eliminated.  They can be optimized and made more efficient but when it comes to the physical care services they still must be performed by people.
  • Plant:  Physical Goods and Facilities: drugs, materials, clinics, and associated utilities
    • Drugs and materials can be negotiated and cost reductions from bulk purchasing
    • Facility expenses can be reduced by providing services remotely or off-site reducing the amount of physical facilities required.
    • Administration:  Paperwork, compliance, documentation, management, tracking, error prevention, fraud prevention, privacy protection, reporting, certification, training, communications, scheduling, billing, accounting, etc.
      • Administrative  overhead which is a very significant expense is the most fertile area where expenses can be reduced with Information Systems Technology

 

We provide IT solutions for Home Health, Mental Health and Group Homes that can improve your operations and reduce your expenses.

• Schedule / sign up for a webinar on our Human Services solutions
• Call to set up a session with one of our consultants to work up a demonstrable return on investment model (ROI)

We may not be able to totally offset the impacts of the economy and funding cuts but we assuredly can help.

www.findSocialServiceSoftware.com     www.advantecis.com