Transcript Challenges and Opportunities: Technical Innovations in Social Work

Challenges and
Opportunities:
Technical
innovations in
Social Work
SWDE
April 14, 2016
Marlene M. Maheu, PhD
Executive Director
TeleMental Health Institute
Arizona State University
[email protected]
619-255-2788
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Legal Info
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WHO I AM: I am a licensed psychologist, not an attorney, physician, marketing
or information technology (IT) professional.
MY GOALS: I hope to inspire you by outlining current and future events in an
educational format. My goal is to help you think through the issues. No
warranty, guarantee, or representation is made as to the accuracy or
sufficiency of the information contained in my presentation for your specific
© in connection with your choices.
circumstance. I assume no responsibility
YOUR PART: Seek documented training for “competence.” Seek written
approval from your legal, regulatory, ethical and malpractice bodies before
offering any online services or programs to consumers. Have your informed,
trusted, local, clinical and legal consultants review all written responses from
the authorities for their full significance.
There is no conflict of interest with any of the parties mentioned in today’s
presentation.
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Definitions
 Behavioral
Health: The Affordable Care Act
requires more attention to mental health and
substance abuse. Behavioral health is the old
term being re-defined to describe both mental
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health and substance use.
 Telehealth: The electronic delivery of medical,
educational, and health care across distance.
Not a specific service, but a way to deliver and
improve existing services.
 Telemental Health and Tele-Behavioral Health
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Telehealth vs. Telemedicine vs. Health Care (&
Antibiotic Medicine) of the 1930’s
Telehealth
Regional
Health
Information
Sharing
Health
Professions
Education
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Administration
Telemedicine
Consumer
Education
Community
Health
Evaluation
Research
Homeland Security
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Mental Illness & Treatment
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Serious Mental Illness:
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Overall Mental Illness
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Adults: Approximately 13 million (5.8%)
Children: Approximately 8 million (10%)
Adults: Approximately 55©million (25%)
Children : Approximately 16 million (20%)
Treatment
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1/3 of adults and 2/3 of children with SMI receive no
services
2/3 of other people with mental health conditions
receive no care
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Substance Abuse
 Substance
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Use Conditions:
Approximately 24 million potential cases/year
Substance Use Care:
Approximately 2.4 million people receive care/year
Treatment
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More than 90% of people with substance abuse
receive NO care
Care that is received comes principally from grants
rather than personal insurance
More substance abusers are housed in our prison
system than are treated in facilities
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Why Behavioral Health?
 Healthcare
recognizing that
behavioral care is
essential to
lowering health
care “spend”
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Readmission Rates by
Frequency
Rank Primary Diagnosis
Medicare
Medicaid
Commercial
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Pneumonia
18.3%
13.3%
9.6%
2
Mood Disorders
20.2%
17.2%
10.2%
3
Osteoarthritis
5.4%
6.0%
3.1%
4
Congestive Heart Failure
25.3%
29.8%
19.7%
5
Cardiac Dysrhythmias
16.6%
18.5%
9.2%
6
Septicemia (except in labor)
22.0%
23.7%
15.7%
7
Coronary Atherosclerosis
15.3%
17.4%
9.0%
8
Childbirth Trauma
0.0%
0.8%
0.6%
9
COPD & Bronchiectasis
21.9%
25.0%
14.4%
10
Nonspecific Chest Pain
12.8%
14.8%
5.0%
15.8%
16.7%
Source: hcupnet.ahrq.gov
9.6%
All
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Implications of ACA for Behavioral Health
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Shorter sessions / more clients/patients
More specific documentation
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Documentation will require proof of interventions being tied to the
evidence-base (“treat-to-target”)
Practitioners will be held accountable for outcomes and paid
accordingly
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Increased reliance on technology
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Required use of electronic health records to measure outcomes
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Decreased reimbursement for free-flowing sessions and non-specific
note-taking
Apps and other self help tools will proliferate
Increased reliance on master’s level practitioners
Increased need for vision / graduate education and professional
education
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Implications of ACA for
Behavioral Health
 Provision
of primary care is essential
 Provision of behavioral health care is essential
 Facilitation of WELLNESS©and RECOVERY
approaches are essential
 Integrated care is an obvious mechanism to
achieve these goals
-
Ron Manderschied, CIMH, 2014
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Implications of ACA for
Behavioral Health
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Implication for SWDE is that students may want to:
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Find placements with health plans, primary care
offices and/or large/small medical facilities
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Focus on:
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Patient-centered homes
Resilience & recovery
Technology
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Electronic Health Records
Telehealth
Remote patient monitoring
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Health & Behavioral Care in 10
Years
Mobile
devices and peripherals
will deliver most health and
mental health care
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 Sensor-based
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information gathering
Mirrors, scales, vests, chairs, mattresses, steering
wheels, exercise equipment, etc.
 Self-report
Patient
portals
 Social support systems
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Health & Behavioral Care in 10
Years
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Mobile devices will be networked into central
database that will correlate all real-time data with
your genetic profile:
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as reported by you, family members, friends and
© environment; and
neighbors who share your
demographics of people who share your habits,
lifestyle, and personal preferences for food, drink,
exercise;
medical conditions and medication;
genomic testing for genedrug interactions and
drug  drug interactions
combined with latest empirical evidence about
each source in real time
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Health & Behavioral Care in 10
Years
 Data
will be complied into
recommendations that will deliver
medications, foods other
ingestible
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substances and behavioral prescriptions
in ways that will help remedy diseases and
problems before they can even be
noticed now.
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Levels of Security
How will such
unprecedented
change happen
in 10 years?
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Levels of Security
What’s the
problem (and of
course, the
solution)?
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URL: www.telehealth.org/ethical-statements
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Smartphones are
the technology of
choice for many
people
Some groups use text
messaging significantly more
than others:
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Children
Adolescents
Young Adults
Hispanic Americans
African Americans
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Issues of Social Justice and Access
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Copyright © 2016 All rights reserved.
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FitBit, JawBone, Apple Watch,
Basis Watch
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Wearables
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Wearable activity trackers, including the next FitBit
or Jawbone is already falling flat
Wearable medical trackers is growing to offer
remote (home) monitoring
© for hospital and
population health patients. They will become
more compact, less expensive and covered by
insurance companies to measure and transmit
information to clinical offices about blood
pressure, glucose, HRV, EEG, etc.
Behavior change professionals at all levels will be
needed to understand, implement and interpret
information from such devices into treatment
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Electronic Health Records
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2nd generation EHRs will provide added
functionality to extend care
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Team-based collaboration including caregivers
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Patient engagement portals
Remote monitoring
ICD-10 transition (October 2015)
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Audits in 2016  Refunds
Tying treatment plan to evidence base
(Paired with HIPAA Compliance audits in 2016)
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Virtual Humans (Avatars)
Virtual Intelligent Agents
 Animated computer characters simulated face-to-face
conversation (USC – Skip Rizzo, PhD)
 Used as virtual coaches, counselors, and for automated
health education and basic behavior change interventions
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Relationalagents.com
Virtual Human Cancer Clinical Trial Assistant (Bickmore, Utami et al. 2013).
(Slide made available by David Luxton, PhD)
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mHealth Augmented Reality
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Augmented Reality (AR) overlays computer-generated graphics
with live video imagery of the physical world to immerse the
patient into a simulated, augmented experience
Behavioral health applications:
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Exposure therapy
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Behavioral activation/Behavior
Training applications
(Luxton, June, Sano, & Bickmore, 2016)
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Integrated Multi-Modal Systems
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Conceptual diagram of Mobilyze! app system adapted from Burns et al (2011), in Luxton et al. (2015).
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Copyright © 2016 All rights reserved.
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Pharma
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“Beyond the Pill” initiatives:
Drugmakers are teaming up with technology
players like Google ($GOOG) and IBM Watson
Health--Novartis ($NVS), Sanofi
($SNY) and Novo
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Nordisk ($NVO) –to marry Big Data record-sifting
with cutting-edge patient-monitoring devices,
developing infrastructure. How will that information
will be made available to the patient & clinician?
Who amongst us will assist these new groups
understand the behavioral health population and
their needs? (Who will serve as the “Bridges”?)
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Levels of Security
The solution
then, is
education and
training in best
practices.
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All
Existing
Legal
and
Ethical
Rules
Apply
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BELLWETHER:
Georgia Composite
Board of Professional
Counselors, Social
Workers and Marriage
and Family Therapists
Proposing a new rule for
telemental health:
1. Definitions
2. Mandatory 6-hour
training
3. Defined
competencies to be
covered by training
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Telemental Health Best Practices
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Legal Issues
Licensing
© (Dynamic)
 Informed Consent
 Mandated Reportin
 Privacy / Confidentiality
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While thousands of clinicians work online, the vast majority to not
understand their legal or ethical mandates.*
*Maheu & Gordon, 2000; Maheu, Glueckauf, Drude, Nelson (pending)
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Telemental Health Best Practices
Ethical Competencies Beyond Legal
Issues
 Intakes
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 Assessment
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Equipment
Telepresenters
Handling Emergencies
While thousands of clinicians work online, the vast majority to not
understand their legal or ethical mandates.*
*Maheu & Gordon, 2000; Maheu, Glueckauf, Drude, Nelson (pending)
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Telemental Health Best Practices
 Liability
Insurance
Reimbursement (which practice
models get reimbursed and related
CPT codes)
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Risk Management
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Documentation
Case notes
 Release of Information Forms
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While thousands of clinicians work online, the vast majority to not
understand their legal or ethical mandates.*
*Maheu & Gordon, 2000; Maheu, Glueckauf, Drude, Nelson (pending)
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Informed Consent
• Represents a “meeting of the minds”
– Information is influenced by many factors, including
• Client/Patient’s capacity
for absorbing information
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• Time limits
• Clinician’s schedule
– Subject matter is often complex and technical
– Clinician thinks she is speaking English
– Client/Patient may be under stress (or may assert so later)
– Mental illness
• Document only serves as important evidence
• Active vs. Static informed consent?
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HIPAA Privacy Rule
 Data
are “individually identifiable” if they
include any of the 18 types of identifiers,
listed below, for an individual
or for the
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individual’s employer or family member,
or if the provider or researcher is aware
that the information could be used, either
alone or in combination with other
information, to identify an individual:
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HIPAA Privacy Rule (cont.)
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2.
3.
4.
5.
6.
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8.
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11.
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18.
Name
Address (all geographic subdivisions smaller than state, including street
address, city, county, zip code)
All elements (except years) of dates related to an individual (including
birth date, admission date, discharge date, date of death and exact
age if over 89)
Telephone numbers
Fax number
Email address
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Social Security number
Medical record number
Health plan beneficiary number
Account number
Certificate/license number
Any vehicle or other device serial number
Device identifiers or serial numbers
Web URL
Internet Protocol (IP) address numbers
Finger or voice prints
Photographic images
Any other characteristic that could uniquely identify the individual
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⑦HIPAA: Have you chosen a service that
provides an “audit trail?”
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⑧ HIPAA: Does the service you have
chosen provide “breach notification
tools?”
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⑨Additional State
Regulatory
Codes for
Privacy/Security
also Apply
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• Include copy in
client/patient
record
• Other Issues
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11. HIPAA, Business Associates &
HITECH
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All Business Associates in
health care must sign an
agreement stating their
adherence to HIPAA
standards
• Transactions
• Security
• Privacy
True for any service you hire
It is now enforced by the
HITECH ACT
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Copyright 2012 TeleMental Health Institute, Inc. All rights reserved.
TMHI Education & Training
Resources
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Other Education & Training Available at TMHI:
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•
http://telehealth.org/webinar
http://telehealth.org/individual/
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http://telehealth.org/courses
http://telehealth.org/graduate
Free sample:
• http://telehealth.org/intro
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Resources Made Available by
our Non-Profit, the Telehealth
Institute
TeleMental Health© Institute
Bibliography:
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www.telehealth./org/bibliography
See many other resources at:
www.telehealth.org
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TMHI’s TeleMental
Health News:
www.telehealth.o
rg/sign-up
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For slides additional resources:
www.Telehealth.org/swde
©
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Questions?
©
TeleMental Health Institute, Inc.
Phone: 619-255-2788
Email: [email protected]