Psychiatric EHR Data Sharing a Must For Quality Care of Mental Health Patients

Among the many common myths in the healthcare world, it is also believed that like other illnesses, mental health patients do not need antibiotics, labs and physicals. This myth has been further strengthened because of the way data of mental health patients are recorded in the Psychiatric EHR.

Even Obama’s Affordable Care Act could not make much of a difference in treatment of mental health patients’ data. Unfortunately, data entry, collection and sharing are given secondary importance for psychiatric patients. Our mind and body make us whole, then why is there a gap in dealing with psychiatric data and other EHRs.

According to a study by National Council for Community Behavioral Health patients suffering from mental illness have a higher chance of dying earlier than general population. This is mostly in case of cardiac and diabetic patients, who haven’t been provided with adequate mental health services after a surgery or prolonged illness. This study emphasizes on the issue of equal treatment of mental health patients and psychiatric EHR data sharing.

Adam Kaplin, MD, assistant professor of Psychiatry and Behavioral Sciences and assistant professor of Neurology at Johns Hopkins University has laid emphasis on mental health rehabilitation of cardiac and diabetic patients. Dr. Kaplin said these patients usually experience a depression spell after they have been operated on. He said, “As an example, whether or not you have depression following a heart attack is as big as or bigger than any other risk factor as to whether you are going to die in the year following that heart attack.”

Access to mental health records

Despite making progress in healthcare technology, particularly electronic documentation, there is a wide chasm in psychiatric patients’ data collection and sharing with non-psychiatric physicians. The lack of data sharing is a huge obstacle in providing quality healthcare to patients.

Although integration of electronic data sharing and patient care is considered as the solution for healthcare problems, but the adoption of EHRs in psychiatric facilities is quite dismal. Only 44% of top hospitals have adopted Psychiatric EHR, among which only 28% share their patient data with non-psychiatric physicians.

Reasons for lack of data sharing

Physicians have highlighted two main obstacles in sharing of psychiatric records, which is hurting patients.

  • Stigma of mental health issues in the society is the most important reason. Psychiatrists refrain from sharing data with non-psychiatric physicians from fear of stigmatizing the patient. Usually, patients do not feel comfortable in revealing their mental health history and medication to other physicians during the record making. As a result, patients have been harmed due to clash in effect of medication.
  • The fear of stigma also forces psychiatrists and behavioral therapists to avoid EHR adoption, as patients don’t feel comfortable in keeping electronic records. There have been incidences of data hacking in hospitals, which comprises patient privacy. Therefore, fear of data leak keeps patients away from psychiatrists who have implemented EHRs at their practice.
  • There is slow adoption of health technology among psychiatric hospitals because they are not eligible for Meaningful Use incentives.

In order to make a difference in lives of mental health patients, it is necessary that psychiatrists and behavioral therapists adopt EHRs and share data with non-psychiatry physicians to keep patients away from any harm.

How Freedomland Became A ‘Health Care’ Center

My parents were in their early 40s in 1969, the year we moved to the massive Co-op City housing development in the Bronx. My brother and I were preteens.

When it was completed a few years later, Co-op City had more than 15,000 apartments, most of them in high-rises scattered across 300 formerly swampy acres that had once been the Freedomland amusement park. Within a few years, the community’s schools and shopping centers appeared. Most of Co-op City’s occupants were working-class laborers and civil servants, drawn mostly from elsewhere in the borough. Direct and indirect subsidies made their new apartments affordable.

My brother and I both left for college within a decade. Our parents stayed until 1990, when they retired, departed for the suburbs of central New Jersey and rebuilt their lives around the activities of the local senior citizens’ center. But many of their peers stayed in Co-op City, and quite a few of the kids my brother and I grew up with ended up staying with their parents, or inheriting apartments when their parents died.

For thousands of people like my parents, Co-op City became a “naturally occurring retirement community,” also known as a NORC. The survivors of their generation who have stayed put, now advanced far into old age, have had the benefit of family, friends, familiar neighborhood institutions and a host of social services to sustain them. The phenomenon of this open-air retirement home that came into being quite by accident has been apparent for more than a decade. The New York Times wrote about it as far back as 2002. (1)

In New York, Medicaid pays for a lot of the services these people need. To the extent that Medicaid is a low-income health care program, this is not necessarily surprising. Yet what makes New York’s situation different is that Medicaid often covers even those services that don’t have much to do with health care as most people understand it. In literature about the “Health Homes” initiative, introduced in 2012, the state’s Medicaid administrators described the function of a “care manager,” an individual who coordinates those seeing to an individual’s medical, behavioral health and social service needs. The theory is that by making sure people can live independently in their own homes, Medicaid saves money on hospital costs, ambulance rides, repetitive doctor visits and, most of all, nursing home care.

The same thing is happening in the mental health arena. Several years ago, New York expanded Medicaid coverage to provide housing for individuals with mental illness. In addition to the Health Homes program, New York also offers “supportive” housing that combines subsidized housing with a host of services, including medical, but also legal, career and educational, among others. Keep people off the streets and make sure they take their meds and get regular meals, the theory goes, and you’ll ultimately save money on emergency room and other acute-care costs.

Brenda Rosen, the director of the organization Common Ground, which runs a supportive housing building called The Brook, told NPR, “You know, we as a society are paying for somebody to be on the streets.” (2) And the outgoing New York State commissioner of health published an article in December 2013 arguing that housing and support services are integral to health, so Medicaid should help support the costs.

The state may be on board, but the arguments in favor of these programs haven’t made much headway with the federal government, which normally shares Medicaid expenses with the states. The feds won’t pay for these housing services, on the grounds that housing is not health care. Bruce Vladeck, who formerly administered the federal Medicaid (and Medicare) programs, said, “Medicaid is supposed to be health insurance, and not every problem somebody has is a health care problem.” (2)

That’s true. Not all care that leads to better health is health care. Good nutrition, having the time and place to get a full night’s sleep, and access to clean air and water are all essential for health, but we do not expect health insurance to pay for these things. Providing housing to people who need it is what we used to call social work, and most people don’t view social workers as health care providers.

But it is easier to gain political support for providing health care – with its image of flashing ambulance lights and skilled professionals dressed in white – than for subsidized housing for the aging or the disabled, especially the mentally disabled. So it is easier for Gov. Andrew Cuomo’s administration to organize these services under the label of Medicaid Health Homes. They are not homes at all in any traditional sense. Care managers are typically not doctors or nurses, but they are trained in social services or health care administration. Health Homes is a potentially worthwhile initiative that comes with clever, voter-ready branding.

The approach itself is not nearly as novel as the marketing. We have known for decades that good community support, including safe housing and close supervision for people who need it, is a lot less expensive than parking people in hospitals, nursing homes and other institutions. As New York State Medicaid Director Jason Helgerson pointed out when arguing in favor of Medicaid-funded housing support, Medicaid (and taxpayers) bear the cost of long, expensive hospital and nursing home stays. Giving people support to stay in their own homes is also a lot more humane in many, if not most, cases.

The challenge is to develop and market these programs in ways that sustain public support in the face of their predictable abuse. People misusing a service does not make it bad, but it does make it harder for politicians to defend. Disability insurance is also a good thing, but the Social Security disability program is just a couple of years away from going broke, in large part because of the wave of malingering that accompanied and followed the recent recession. Offer a benefit and people will want to use it, even if they are not genuinely part of the target population.

Well-supported housing with an effective array of social services for people who need them can do a lot of good, and can save society significant money as long as we are not prepared to make people in need survive on their own. NORCs can make excellent places for the elderly to live out their days, and housing for mentally ill and developmentally disabled people can keep them safely off the streets and out of the ERs.

But the feds are right that efforts to do so are not health care. It’s human care. If we don’t manage it effectively – keeping the malingerers out and holding costs at sustainable levels – some humans are going to be left on their own, no matter what we call it.


1) The New York Times, “Haven for Workers in Bronx Evolves for Their Retirement”

2) NPR, “New York Debates Whether Housing Counts As Health Care”

Behavioral Health and Sensitivity – Finding Balance

Good behavioral health and real balance depend on sensitivity and goodness. Human beings don’t become human because they are able to think. What gives us our humanity is our capacity to feel other people’s pain.

We must cultivate goodness in our hearts in order to become really human. Without sensitivity and goodness, we will never attain wisdom, nor will we find peace.

This is why the wise unconscious mind that produces our dreams is constantly trying to help us become more sensitive. All dream messages work like warnings for our human conscience, and at the same time, like stimuli that wake up our senses.

I’m going to explain how I arrived at these conclusions. As a writer, I could study and relate many scientific discoveries that basically showed us the same truths. As a poet and philosopher, I could analyze these findings and sincerely criticize them, without any hypocritical or selfish intention.

However, what really helped me find out the truth about our mental and behavioral health, was the fact that I had to fight against craziness myself. I continued Carl Jung’s research in the unknown region of the human psyche through dream interpretation. This was how I discovered the roots of the human absurdity. After discovering the anti-conscience, the wild and primitive conscience that occupies the biggest part of our brain, I found explanations for all mysteries.

The anti-conscience is our animal and violent personality, which refuses to change its behavior. This is why it generates mental illnesses within the human side of our conscience.

However, the anti-conscience pretends to belong to the human side of our conscience, which it frequently invades, sending us various absurd thoughts. These wild thoughts seem to be generated from our human mind, when in fact, the anti-conscience is not human. It is totally absurd. It is also totally cruel, because it is an indifferent animal.

This is why whenever someone becomes mentally ill they are violent, immoral, and cruel, even when this is not apparent. In grave cases their violence is clearly visible. They are not themselves. They are dominated by their wild nature.

However, they cannot understand that they are under the control of their sneaky anti-conscience. They believe that their horrible actions are the result of their own lack of balance. Everyone around them has the same false impression.

However, the truth is that whenever human beings are violent, immoral, cruel, or totally indifferent to human suffering, they are dominated by their wild conscience. They are not responsible for their actions.

This means that we have to completely change the way our world functions. Nobody should go to jail for committing crimes. Nobody should be condemned by everyone else when they lose their minds. They need psychotherapy. The anti-conscience possesses great negative energy. It can easily destroy a person’s human conscience through craziness.

We must show compassion to those who are controlled by their wild and violent nature. On the other hand, we must seriously face the truth, and care about saving the new generations from mental illnesses and mental disorders.

Now we know that the anti-conscience is responsible for the formation of all mental and behavioral abnormalities observed in human beings. Thus, we must help everyone get rid of this primitive content before losing their human conscience; especially young people.

Dream therapy is a revolutionary healing method that will completely change the way we live our lives. It will put a definitive end to violence, craziness, indifference, and to all the horrors that mark our absurd civilization. This is how we will finally find peace and happiness that last forever.

Behavioral Health Based On Dream Interpretation

Since we have inherited a wild conscience that occupies the biggest part of our brain (anti-conscience) and our human conscience is under-developed and one-sided, we cannot understand the real meaning of goodness. For example, we believe we must be rewarded whenever we show goodness to someone else, but real goodness doesn’t depend on payment.

We have to be generous and helpful without expecting anything in return. However, this is very hard for us because we are selfish and lazy. We tend to be influenced by our evil and absurd anti-conscience, and our idiotic conscience doesn’t have a global vision of our reality.

On the other hand, our ego always wants to be in a superior position. Our ego is the center of our human conscience and controls our behavior when our conscience is strong.

Therefore, we tend to prefer what is bad instead of understanding the value of goodness. For example, we pretend to be good, but we want to be paid with favors whenever we do favors for others.

Everyone pays for our goodness. They understand their position. They pretend to be good too. This is an invisible social law.

This theater is not based on real goodness.

We are natural actors who are always trying to hide from the world our negative thoughts. These thoughts are sent by our anti-conscience. They seem to be smart, but they are misleading absurd thoughts that will bring dangerous consequences.

This is why while we are pretending to be good, in parallel we also are thinking that we are wasting our time, and we want to do something else. The contradiction existent between our real thoughts, our words, and our behavior clearly reflects our absurdity, but we cannot understand this fact.

In order to protect yourself from the dangerous influence of your anti-conscience you have to follow dream therapy. The scientific method of dream interpretation is a serious translation from images into words, which accurately transcribes the unconscious words. All dreams are produced by the wise unconscious mind discovered by Carl Jung.

The unconscious mind is God’s mind and must be respected. This was what I concluded after continuing Jung’s research.

If you want to understand the real meaning of goodness and its power, you have to translate the meaning of your dreams according to the scientific method. God is the best teacher and psychotherapist you could find.

You must stop believing you have advantages in life by being false in numerous occasions. You also have to understand all the dangers you are exposed to whenever you are hypocritical.

Hypocrisy reflects craziness, even though it is not considered a sign of absurdity by the crazy world. The definitions of the world cannot help you understand what mental health really is. You have to learn how to find balance by developing all your psychological functions. You also must have an introverted and extroverted attitude at the same time.

The divine unconscious mind will teach you the meaning of goodness, which represents sound mental health. You will verify that evilness generates absurdity and despair. Only goodness can help you preserve your sanity.

Real goodness is not a theater, and it is not a job. You have to be generous with everyone around you, without expecting anything from them. Your help must be secret, and not announced to the world. You cannot use your goodness in order to be admired and feed your ego.

Real goodness is based on a series of behavioral rules that cannot be theoretically learned. You indispensably have to pass through a process of psychotherapy in order to stop being hypocritical.

You have to be trained, so that you may always show wise behavior instead of being controlled by your animal nature. You also have to understand the advantages of always being morally correct. Without understanding the positive effect of goodness you won’t show real goodness to anyone.

The divine unconscious mind will show you how to stop being bothered by your anti-conscience and become a perfect human being. Then, you will evolve without limits.

Why Most Private Provider Behavioral Health Organizations (PPBHO) Fail 1: Don’t Hire Right!

Over the next few weeks I will present a series entitled, Why Most Private Provider Behavioral Health Organizations (PPBHO) Fail. Although this series is dedicated as a resource for PPBHO to promote success in a changing and challenging industry, many of the principles can be applied to any business, organization or individual. I encourage you to assess your organization honestly, and complete the action items after each topic. So let’s get started with the first reason PPBHO fail. They don’t hire right.

There are two main reasons that contribute to the “don’t hire right” concept that will ultimately lead to failure. Many PPBHO start out by hiring family and friends who may not possess the needed skill set for the industry. This is a practice that I have witnessed in several states. Many are often so excited to have a business and their way of “giving back” is by hiring family and friends who are often times unskilled and unfamiliar with the requirements of the industry.

The second and most prevalent issue is desperation hiring. PPBHO will often hire people who are not a good fit for the organization from the beginning. The interview process is flawed, and if references occur they are not thorough. Candidates are not asked behavior based questions during an interview, their responses are not evaluated effectively and they often confuse years in the industry or having a professional license with being a “good match” instead of comparing the experience and skill level with the demands of the current competence level that is required. If I had a dollar for every time I heard a client say, “This person will be a great fit” and then several weeks to months later I’m asked, “How can I get this person out of here as soon as possible.” PPBHO spend a lot of time, money and effort with desperation hiring. State mandates, and the demands of the clinic usually drive this activity however, consumer care suffers if an agency is always trying to fill a vacancy with the right person. PPBHO can increase their hiring effectiveness by following these steps and developing a plan of action.

1. Identify your prime candidate. What traits, skills, abilities, and temperament must they have to be considered for the position? You cannot stop at the license or the certification just because you need it. If you do, you have now gone back to desperation hiring mode. Make a list of what that candidate will look like and how they will fit into your organization.

2. Develop interview questions around what your needs are and ask the candidate to give you examples. Ask them to tell you about their successes and how they have increased audit scores, consumer retention and consumer census. I’ve conducted many interviews for clients and I am amazed at how candidates evade questions during interviews. This is your first red flag!

3. References are critical to the hiring process. It is imperative to have a solid reference process in place. Regardless of the position, in order to make sure that the candidate is the right fit for your organization you must go below the surface and dig deep on references. Reference questions should be just as detailed as the interview questions to ensure you are about to make the right decision and most importantly, make sure you are speaking to someone who can provide honest feedback about the candidates present or past performance. Keep in mind that references are provided by the candidate so it’s perfectly fine during our “digging expedition” to ask the provided reference for another reference and when you speak with that person ask them as well. This will help you to determine if you are about to make the right choice. Go below the surface and you will always find confirmation.

4. Finally, think outside of the box! John Treace, a contributing editor for Inc. Magazine states, it’s fine to mix it up during the interview because candidates will walk into the office prepared to answer your questions. However, in order to separate the winners from the losers you must be creative. Treace suggests, if the position requires evening work, hold the interview late on Friday evening.

It is perfectly fine to have the candidate conduct a group, teach a class, conduct a meeting or assessment, and even write something that shows their knowledge of the industry. Make the interview process as creative and interactive as you want the selected candidate to be when hired.

Remember it cost more money to rehire and train than it does to retain. Invest the time on the front end; it should minimize the headaches on the back-end. ACTION ITEMS: Assess your current strategy. Develop a corrective action plan, avoid desperation hiring!