SMART has an extensive history in supporting influential substance abuse treatment providers. Learn more in our EHR software news about partner stories about how this tool can transform patient care.


Join the SMART team June 13th at COMPA SYMPOSIUM: DISCUSSIONS ON CHANGING FEDERAL METHADONE REGULATIONS at Robbins Auditorium – Albert Einstein College of Medicine Bronx, NY for a SMART EHR Software demo. SMART Management is excited to be exhibiting and to sponsor this groundbreaking COMPA event.  This half-day symposium brings together providers and policymakers to analyze federal opioid treatment program (OTP) regulations, discuss the impact possible changes may have on the delivery of services in OTPs, and consider solutions to make the OTP system more flexible, safe, and patient-centered.

COMPA is a leading resource to the opioid addiction treatment field and renowned non-profit membership organization dedicated to treating addiction through the use of pharmacotherapy as a part of a comprehensive bio-psycho-social approach to treatment.   COMPA works with state and federal agencies to develop guidelines and policies to protect patients and ensure treatment providers’ compliance. COMPA NY membership strives to increase public awareness and access to medication-assisted treatment.

Showcasing advantages of 100% Paperless Cloud-based EHR System  

EHR platformSMART’s exhibit features our Cloud-Based EHR, powered by Amazon Web Services (AWS). This powerful platform is HIPAA compliant, helping covered entities process and store protected health information. With hackers threatening organizations of all sizes, security is a top priority. AWS has built-in audit and data integrity controls, malware protection, encryption, backup and storage, automatic log-off, and contingency operations for emergencies or disasters.

SMART Software 100% Paperless EHR improves efficiency for New York Opioid Treatment Programs.

SMART has worked over the last 30 years to create a complete clinic management system designed to streamline admissions, billing, inventory and more so you deliver the highest quality patient care. Serving several New York multi-clinic enterprise organizations, the SMART System has developed specific functionality and features for New York clinics.  Our integration with Lighthouse Central Registry NY Automated Reporting and has streamlined the flow of key emergency dosing data while improving workflows and eliminating double data entry.  SMART offers fully integrated PAS Forms, 822 Treatment Plans, Billing Module which supports APG Rules and an overall EHR that support OASAS Compliance.  The SMART System is designed to improve workflows for opioid treatment programs with business and regulatory rules built right into the system to optimize your operational efficiency while reducing risk and errors.

What medications does SMART Management’s EHR support?  

SMART’s flexible configuration options allow tailoring of every EHR implementation to the providers’ unique requirements. Such as automating dispensing and inventory management of methadone, Suboxone, Subutex, Zubsolv, and generic buprenorphine/naloxone films and tablets. Use of Vivitrol (injectable naloxone) is also supported. The medication management and dispensing module use automation and built-in checks and balances to simplify medication management and virtually eliminate medication errors. Auto patient check-in queue, dose verification signature, ID verification, and automated nursing notifications help to limit the risk to both the patient and the agency.

Additionally, inventory management reports enable quick and accurate information gathering, improving inventory control. Moreover, SMART’s Electronic Health Record Software provides the tools and automation to be ready for DEA audits at a moment’s notice.

What is included in SMART’s 100% Paperless EHR?  


Beyond medication management, the SMART Solution includes modules for admissions, clinical and medical, drug testing, and an optional add-on insurance billing module. As a complete clinic management tool, SMART’s EHR provides the automation and reports capabilities necessary to streamline OTP operations. From admissions to discharge, this software system helps organizations become some of the most effective and efficient in the industry. Visit us at COMPA for your own SMART EHR Software Demo to see why some of the most influential opioid treatment providers choose SMART or request your demo today.

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Addiction Fears Rise as Physicians Prescribe More Opioids for COVID-19 Survivors

Health experts claim that COVID-19 survivors are at risk for a potential second pandemic. Since physicians prescribe these patients a high rate of pain pills, going through a second pandemic of addiction to opioids is a very real possibility. Nature put out a new study that found COVID-19 survivors at Veterans Health Administration facilities had distressingly high rates of opioid use that came from helping them deal with lingering illness symptoms.


They found that around 10% of survivors went on to develop a condition known as long COVID. They began struggling with disabling health issues for six months or more after their initial diagnosis. For every 1,000 so-called long COVID patients doctors treated at these Veterans Affairs facilities, physicians wrote nine more opioid prescriptions than they normally would have. Additionally, they wrote 22 additional benzodiazepine prescriptions, including addictive pills to treat anxiety like Xanax.


Previous studies also found that COVID-19 long haulers or survivors experience a myriad of health problems that persist for months. The study’s lead author, Dr. Ziyad Al-Aly, found that these COVID-19 survivors are using more addictive prescription medications. Dr. Ziyad Al-Aly is very concerned that even a very small increase in people using addictive opioid medications can and will lead to the opioid crisis resurging due to the big number of COVID-19 long haulers. To date, more than three million of the 31 million survivors end up developing long-term symptoms. These symptoms can include depression, fatigue, anxiety, shortness of breath, and brain fog.


The study also found that several survivors also reported bone or muscle pain. The jump in prescribing opioid medications was surprising due to the very valid concerns about their risk for addiction. Dr. Al-Aly studied over 73,000 patients at Veterans Affairs facilities for his study. He said that the physicians are supposed to think twice about prescribing opioids for the pain.


Dr. Aly-Aly also believes that physicians need to act before it’s too late. The last thing we want is to have another opioid epidemic or a suicide crisis. But, there is a silver lining. Since 2012, new opioid prescriptions have been on the decline as physicians learned more about the medication’s addictive qualities. However, Brandeis University’s medical director of opioid policy research, Dr. Andrew Kolodny, said that doctors in the United States still write prescriptions for drugs like codeine, Vicodin, and OxyContin than doctors outside of the United States.


They also found that some patients who develop an addiction to these opioid medications switch to heroin. This is due to the fact that they either couldn’t get opioids from their doctors via prescription or it was cheaper. The CDC found that overdose deaths continue to rise because drug dealers are now spiking their heroin supply with fentanyl. Fentanyl is a very strong synthetic opioid. During August 2019 and August 2020, more than 88,000 people died due to an overdose. This caused health experts to advise physicians to stop prescribing these opioid medications for long-term usage.


President of the Society of Critical Care Medicine, Dr. Greg Martin, says that COVID-19 patients that get hospitalized due to the illness tend to get much more medication to help control anxiety and pain. This is especially true for those in the intensive care units. For example, patients who end up on ventilators get sedated to help keep them comfortable. Dr. Martin voiced concerns about the findings of this study because the study suggests that COVID-19 survivors are continuing to use medications unnecessarily once they get out of the hospital to help treat persistent symptoms.


Some surviving patients say that they are experiencing bone and muscle pain for the first time when they previously had none. However, other patients say that COVID-19 intensified their preexisting pain sensations to whole new levels.


One such patient is Rachael Burnett. She is a chronic pain patient who has experienced ongoing, chronic pain in her feet and back for over 20 years. This pain stems from a warehouse accident where she used to work. In April 2020, Burnett was diagnosed with COVID-19. Since she received that diagnosis, she claims that her chronic pain is 10 times worse than it originally was. She also claims that her pain spread to her spine and to the area between her shoulder blades.


At the time, Burnett was already prescribed extended-release OxyContin twice every day to help manage her pain levels. Due to her increased pain, her physician prescribed her a second medication called oxycodone. This opioid can help relieve your pain straight away. In December 2020, Burnett was reinfected with a second round of COVID-19.


Dr. Martin said that physicians should recognize that new or an increase in pain levels can be a part of long COVID. He proposes that physicians have to find a non-narcotic treatment option for this pain, just like they would with any other type of chronic pain. The CDC has a list of alternatives to opioid medications. These alternative therapies include biofeedback, physical therapy, antidepressants, over-the-counter anti-inflammatory drugs, and anti-seizure medication. These therapies can help reduce or relieve nerve pain.


Additionally, Dr. Al-Aly thinks that the United States has to come up with a viable strategy to cope with the patients who have long-term symptoms of COVID-19. He believes that it’s much better to prepare in advance than to get caught off guard in a few years when physicians see a surge in opioid usage. Dr. Al-Aly noted that the study he performed might not accurately capture the full picture of COVID-19 survivors’ needs. For example, most of the patients in the VA system are male while women make up the biggest portion of long COVID-19 patients in most other studies.


The director and founder of the Scripps Research Translational Institute, Dr. Eric Topol, said that Dr. Al-Aly’s study made it very clear that healthcare facilities in the United States aren’t ready to meet the three million long COVID-19 patients’ needs. He believes that we need a lot more intervention that will help to effectively treat these survivors. Dr. Al-Aly believes that COVID-19 long haulers may need treatment for years, and that this treatment is going to be a very large burden on the entire healthcare system.

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Group Telehealth: Opening the Door for Clinical Advantages and Operational Efficiency

SMART Management understands the effectiveness of group model delivery of clinical services. As a management company, formerly managing the Discovery House programs, SMART took an innovative and aggressive approach developing a robust Group Model for the delivery of clinical services, shifting away from a more predominant model consisting of nearly all individual sessions.A well-structured group program, with some clinics offering up to dozens of sessions per week and over 20 specialized group topics, proved to be well received by patients and associates and had an overall positive impact.

SAMHSA’s TIP 41 Substance Abuse Treatment-Group Therapy is a trusted resource outlining the advantages of Group Therapy. With Telehealth service delivery gaining increased momentum nationally, the latest SMART Telehealth Group Feature is the perfect opportunity to expand/develop an enhanced Group Therapy Model at your facility. In addition to the clinical benefits outlined below, making a connection with patient in a group setting is more critical than ever in these times of isolation.

The increase in stress and relationship between Mental Health issues and Substance usage is well-documented. A Fully integrated, HIPAA compliant SMART Group Telehealth Feature will set your clinic apart, creating that irreplaceable face to face group dynamic.

In addition to the clinical benefits, there are tremendous efficiencies with remote associates providing Group Sessions from the safety of their homes. The ability to schedule up to 16 attendees through the SMART Scheduler with automatic notifications and reminder messaging via e-mail and text, your clinical associates should be able to increase direct service hours and access to critical services more readily.

Treating adult clients in groups has many advantages, as well as some risks. Any treatment modality—group therapy, individual therapy, family therapy, and medication—can yield poor results if applied indiscriminately or administered by an unskilled or improperly trained therapist. The potential drawbacks of group therapy, however, are no greater than for any other form of treatment.

Some of the numerous advantages to using groups in substance use treatment are described below (Brown and Yalom 1977; Flores 1997; Garvin unpublished manuscript; Vannicelli 1992).

Groups provide positive peer support and pressure to abstain from substances of abuse. Unlike Alcoholics Anonymous (AA), and, to some degree, substance use disorder treatment program participation, group therapy from the very beginning elicits a commitment by all the group members to attend and to recognize that failure to attend, not being on time, and not treating group time as special all disappoint the group and reduce its effectiveness. Therefore, both peer support and pressure for abstinence are strong.

Groups reduce the sense of isolation that most people who have substance use disorders experience. At the same time, groups can enable participants to identify with others who are struggling with the same issues. Although AA and treatment groups of all types provide these opportunities for sharing, for some people the more formal and deliberate nature of participation in process group therapy increases their feelings of security and enhances their ability to share openly.

Groups enable people who abuse substances to witness the recovery of others. From this inspiration, people who are addicted to substances gain hope that they, too, can maintain abstinence. Furthermore, an interpersonal process group, which is of long duration, allows a magnified witnessing of both the changes related to recovery as well as group members’ intra‐ and interpersonal changes.

Groups help members learn to cope with their substance abuse and other problems by allowing them to see how others deal with similar problems. Groups can accentuate this process and extend it to include changes in how group members relate to bosses, parents, spouses, siblings, children, and people in general.

Groups can provide useful information to clients who are new to recovery. For example, clients can learn how to avoid certain triggers for use, the importance of abstinence as a priority, and how to self‐identify as a person recovering from substance use disorder. Group experiences can help deepen these insights. For example, self‐identifying as a person recovering from substance use disorder can be a complex process that changes significantly during different stages of treatment and recovery, and often reveals the set of traits that makes the system of a person’s self as altogether unique.

Groups provide feedback concerning the values and abilities of other group members. This information helps members improve their conceptions of self or modify faulty, distorted conceptions. In terms of process groups in-particular, as specific themes emerge in a client’s group experience, repetitive feedback from multiple group members and the therapist can chip away at those faulty or distorted conceptions in slightly different ways until they not only are correctable. The very process of correction and change is revealed through the examination of the group processes.

Groups offer family‐like experiences. Groups can provide the support and nurturance that may have been lacking in group members’ families of origin. The group also gives members the opportunity to practice healthy ways of interacting with their families.

Groups encourage, coach, support, and reinforce as members undertake difficult or anxiety‐provoking tasks.

Groups offer members the opportunity to learn or relearn the social skills they need to cope with everyday life instead of resorting to substance abuse. Group members can learn by observing others, being coached by others, and practicing skills in a safe and supportive environment.

Groups can effectively confront individual members about substance abuse and other harmful behaviors. Such encounters are possible because groups speak with the combined authority of people who have shared common experiences and common problems. Confrontation often plays a part of substance abuse treatment groups because group members tend to deny their problems. Participating in the confrontation of one group member can help others recognize and defeat their own denial.

Groups allow a single treatment professional to help a number of clients at the same time. In addition, as a group develops, each group member eventually becomes acculturated to group norms and can act as a quasi‐therapist himself, thereby ratifying and extending the treatment influence of the group leader.

Groups can add needed structure and discipline to the lives of people with substance use disorders, who often enter treatment with their lives in chaos. Therapy groups can establish limitations and consequences, which can help members learn to clarify what is their responsibility and what is not.

Groups instill hope, a sense that “If he can make it, so can I.” Process groups can expand this hope to dealing with the full range of what people encounter in life, overcome, or cope with.
Groups often support and provide encouragement to one another outside the group setting. For interpersonal process groups, though, outside contacts may or may not be disallowed, depending on the particular group contract or agreements.

The SMART Telehealth Group Feature helps you to carry on providing the tremendous benefits of Group Therapy, even if meeting in-person is difficult, especially during a public health emergency (PHE). The United States Department of Health and Human Services has already extended the COVID-19 PHE into April 2021 and, with that action, expressed its intent to continue such renewals to year-end or into early 2022. For more information on our substance abuse EHR software, contact us today.

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Telehealth Changes Made Permanent

It appears that the recent spending bill approved by Congress makes the provision of telehealth services permanent. The recent spending bill approved by Congress on December 21, 2020 does a lot to make the provision of telehealth services permanent.  

The new rule allows physicians to provide their first telehealth service to a patient as long as the patient’s last in-person visit was within the past 6 months. The law gives the Secretary the ability to determine eligibility beyond that six-month period. The Secretary has to establish their rules on a calendar year basis, so we shouldn’t have any worries for calendar year 2021.

Based on how that section of the bill is worded, it is apparent that telehealth services to mental health patients will be able to continue receiving telehealth services, even from their home, and that a telehealth service will actually be paid at the same rate as an in-person visit. For SMART and our partners, this is the most important provision of the bill because that was the major barrier to continue telehealth use post-pandemic.

What’s Beyond the Horizon for Telehealth?

Healthcare IT News surveyed 14 Chief Information Officers regarding ways that innovation could fill existing gaps in virtual care. Here’s what they offered in their responses:
Remote monitoring devices: Today we can measure pulse, temperature and oxygen but innovation in devices that can analyze blood, etc., would “bring telehealth to the next level”.
Complete patient engagement: Allow patients to fully interact with a shared screen to make selections, ask questions, interact with images, draw on the screen…a fully-interactive experience with the provider.

Artificial Intelligence: One CIO envisioned an “AI bot” to triage the patient before determining whether a provider should join the call; not based on preset questions, but more of a conversational exchange.

Peppa Pig?: For pediatric telehealth platforms a child would likely be more comfortable interacting with a beloved TV character than a doctor.
User-friendly technology:

One CIO noted that some patients have difficulty navigating the technology. and suggested improvements to make the user interface more friendly. Another envisioned a natural language translator which allows the provider to speak in English, allowing the patient to hear in their preferred language. Add others to the call: If a patient’s support system is not within their home, allowing the patient to pull-in family or others to join the call and offer what he termed “remote help”.

Virtual consult rooms: Two CIOs suggested to allow multiple providers (such as an internist, cardiologist and nutritionist to participate in a call with a patient to simultaneously discuss a health problem. Each would participate, documenting their own notes, offering the patient a “total healthcare experience”. Voice recognition: Using voice recognition for a provider to be able to automatically capture and transcribe notes into the patient’s record. The provider would only need to edit and sign the note later.

Predictive analytics: One CIO envisioned a full “clinician cockpit” with “analytic insights”, sensory and Internet of Things (IoT) data to “take timeliness, efficiency and positive patient outcomes to a new level”.

Everything!: When asked what feature they would like to see most, One CIO responded with “Why have to choose? A digital journey should afford synchronous, asynchronous, with voice, with video, with physiological monitoring, all in a single too. The elements of the tool that are enlisted will depend upon patient choice and clinical need. Today, these are many (largely) different tools.” Contact us today to keep up to date with these and other substance abuse EHR software news.

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Telehealth Is Here to Stay, But Its Future Is Uncertain

Google defines a paradox as “a seemingly absurd or self-contradictory statement or proposition that when investigated or explained may prove to be well founded or true”. Let’s take a closer look at the topic of telehealth to get an understanding as to why this is truly a paradox.


It started in the 1960s when “telemedicine” was introduced as a form of healthcare. It was initiated by the needs of the National Aeronautics and Space Administration (NASA) to be able to monitor patient health remotely. According to the American Academy of Family Physicians (AAFP):

  • Telemedicine is the practice of medicine using technology to deliver care at a distance. A physician in one location uses a telecommunications infrastructure to deliver care to a patient at a distant site.
  • Telehealth “refers to a broader scope of remote health care services than telemedicine. Telemedicine refers specifically to remote clinical services, while telehealth can refer to remote non-clinical services.

In the 1970s, Kaiser Foundation International partnered with Lockheed to create “a remote monitoring system capable of providing healthcare delivery”. The pilot program was integrated into a specific rural location without many medical services, enabling providers to send patient information from remote monitoring devices to a distant hospital or medical facility.

Over the next 40 years, telehealth did see some growth, but was consistently hindered by financial, regulatory and technological barriers to wide-spread adoption. It was the American Recovery and Reinvestment Act (ARRA) of 2009 and the HITECH Act both instituted reforms that helped to advance technology into the last decade.

In March of 2010, President Obama recognized that part of the technological barrier was the lack of access to affordable broadband services which are the backbone for telehealth. He proposed the “Connecting America: The National Broadband Plan” which was intended build and improve “medical networks that facilitate remote patient monitoring, electronic health records, and other technology-based health services such as telemedicine”.

The Affordable Care Act of 2010 and the creation of Accountable Care Organizations (ACOs) established the need for care coordination between multiple providers serving the same patients. Tools for remote monitoring are considered important to care coordination, which is why these are credited with further advancing the adoption of telemedicine.

According to, telemedicine visit volume grew from 350,000 visits reported in 2013 to approximately 7,000,000 visits reported in 2018. That is an average growth rate of over 1.1 million telehealth visits per year.

When the COVID-19 pandemic struck, stay-at-home orders were issued in virtually every state that had the adverse side effect of preventing patients from receiving the healthcare services they needed. The United States Department of Health and Human Services (HHS) realized this and enabled the use of telehealth by reducing the financial, regulatory and technological barriers. To learn about substance abuse EHR software, contact us today.

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Case to Care Management

According to the National Council for Behavioral Health, the changing healthcare marketplace is requiring case managers to become care managers.

Is this happening? Is it a new concept? What’s the difference? Is it related to Health Homes? How important is this for the treatment of persons with substance use disorder? Spoiler alert! This article doesn’t provide the answers. It does provide some history, context and perspectives that could help you formulate thoughts on what the National Council’s proposed paradigm shift might mean for you and your organization.


The notion of “Case Management to Care Management” first gelled for the National Council sometime prior to March of 2013. By then they had already developed an integrated care training program titled entitled “Making the Transition From Case to Care Management”.

In March 2013 the National Council engaged Afia, a Michigan consulting firm which “works with health and human service agencies to generate ideas, implement solutions, and positively impact their futures”, to provide those trainings to behavioral healthcare organizations in more than 20 states.

The National Council’s BH365 blog post by Joan Kenerson King on November 10, 2015, which she titled “On the Road with Case to Care”, provided some context around the applicability of the concept and the purpose of the training.

Their BH365 blog on April 19, 2019 cemented the concept to substance use disorder treatment in their post titled “Introducing an Integrated Care Culture? We Can Help”.

In January 2020 the National Council’s sales and marketing team published an email blast promoting their “Case-to-Care” training.

Since then the COVID-19 pandemic has caused most organizations to refocus their energies on keeping their patients in treatment, providing all the services their patients need and navigating the revenue cycle process to get reimbursed for the services they provided.

Hopefully, we are on the downside of this pandemic and can again raise our gaze to what the future holds.


According to AJ Case Management, the term “case management” has “been around longer and is a more established approach to rehabilitation”. Through their lens, they consider case management “broader” than care management because it “focuses on the care of the patient and creating a smooth transition between different treatments and stages of care”.

The National Council’s perspective, however, is that care management is the broader of the two concepts. They consider care management from the perspective of integrated care, where the paradigm is to manage both physical and mental health of the patient.

The Affordable Care Act (ACA) of 2010 established “Health Homes” to coordinate care for chronic conditions, which certainly includes persons who suffer from substance use disorders.

By 2012 both Rhode Island and Vermont had Health Home programs in place within substance use disorder treatment facilities. Since then, according to the Kaiser Family Foundation, at the end of 2015 there were 20 states reporting health homes in place and that continues to grow.

In November 2016 the Surgeon General’s Report on Alcohol, Drugs and Health mentions “substance use disorder” 137 times, which establishes that integrated care was already well entrenched in the field of substance use disorder treatment at the time

So, when considered in that context, it is understandable why the National Council’s perspective on care management is at a higher level than case management. And why AJ Case Management considers its case management to be at a higher level than the care management that focuses on coordination of individual services. The expertise needed, role responsibilities and tactics for each of these three roles are considerably different.


The Substance Abuse and Mental Health Services Administration (SAMHSA) established that “individuals with behavioral health needs may die decades earlier than those without, largely due to untreated and preventable physical, chronic illnesses like diabetes, high blood pressure and obesity”. We can infer from SAMHSA’s assertion that helping a patient manage their other chronic illnesses as well as their substance use disorder could substantially extend that patient’s life.

Joan Kenerson King, in her “On the Road with Case to Care” post in 2015 states it well: “We are experts at helping people find ways to live in the community in the face of potentially disabling symptoms and economic challenges. However, we often don’t recognize how successful we are, or that those same skills can transfer to the whole health model of care: helping someone manage both physical health issues and address some of the accompanying lifestyle changes that are needed.”

Anyone involved or familiar with substance use disorder treatment knows that a significant barrier to treating the “whole person” is the stigma associated with the substance use disorder treatment. The 42 CFR Part 2 regulations help to reduce the stigmatizing effect of exposing a person’s substance use disorder treatment by requiring the patient’s explicit consent to disclose specific data and by severely limiting those disclosures and disallowing re-disclosure.

This presents challenges, but they are not insurmountable. as Joan Kenerson King closes her blog post, “Upgrading case managers’ skills gives behavioral health organizations a competitive edge in promoting services across the health care system. One person, one team, one organization at a time – leveraging their own resources, working at what can be changed – we have more power than we know.


Having read this far, you are likely not surprised by any of the history or the perspectives. What you should still be pondering, though, is the National Council’s proposed paradigm shift of “Care versus Case Management”.

Afia asserts that “it’s not enough to transform case management – there has to be an agency culture in place to support whole health and wellness”. It truly is a change in paradigm shift for the entire organization, not just the case manager’s position. They offer an insight they title “5 Ways to Walk the Integrated Healthcare Walk”. To illustrate the organizational change, it calls for:

  1. An environment that supports quitting tobacco
  2. Getting rid of unhealth food (e.g. in vending machines)
  3. A professional waiting area that reflects the message of good health
  4. Clinical services that have embedded health strategies as a natural part of treatment
  5. People who provide behavioral health treatment practice good health strategies

While it would change how we work, making this paradigm shift might increase our potential to save lives, which is why we all do what we do.

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Psychosocial Supports in Medication-Assisted Treatment

The value of psychosocial supports in patients’ recovery has been studied for years and proven effective.  It is again reflected in the findings of a 2012 research study which concluded that “The clinical community has a growing array of psychosocial interventions with a strong evidence base available for the treatment of SUDs.”

Some common examples of such psychosocial supports are patient-advocacy groups, self-help groups, individual and group counseling, case management, medication management, cognitive behavioral therapy, skills training, contingency management, and behavioral interventions.

A 2018 study conducted by West Virginia University (formerly WESTAT) was intended to highlight different models of psychosocial supports in MAT for OUD. The study was the subject of July 2019 Issue Brief published by the Health and Human Services (HHS) Assistant Secretary for Planning and Evaluation (ASPE). 

The ASPE brief asserts that “Medication-assisted treatment (MAT) is a whole-patient approach to the treatment of opioid use disorder (OUD) that combines the use of medications and psychosocial supports” and “MAT effectively treats OUD by decreasing opioid use and opioid-related overdose deaths”.

The study sought to answer these three research questions:

  1. What psychosocial components of MAT are the most important to support positive patient outcomes in OUD treatment?
  2. What types of psychosocial support are providers currently using in practice?
  3. What factors facilitate or impede medical providers’ implementation of psychosocial support in MAT?

The research was conducted through site visits to five substance use disorder treatment providers. Two of the clinics are in West Virginia and one each in Connecticut, Pennsylvania and New Mexico.

The specific programs were chosen for their “diversity in geography, clinical setting and programmatic structure, as well as their strong emphasis on psychosocial services”. Each of the programs was in an integrated setting that offered both medical and behavioral care. Two were relatively new. One had just recently redesigned its entire approach to treatment just a few months prior to the visit.

The researchers’ goal was to gather as much data as possible regarding which psychosocial supports were implemented in the various medication-assisted treatment programs and how they were used.

In their report the researchers noted these important similarities between the five programs:

  • All programs provided medication-assisted treatment.
  • Each program recognized a “phased or stepped approach as patients move from initial engagement and progressed into longer-term recovery”.
  • They all reported making use of evidence-based practices such as cognitive-behavioral therapy and motivational interviewing.
  • All offered both medical and mental health services in the same facility.
  • Four provided all psychosocial supports on-site; one provided medical and mental health services but collaborated with a community-based agency for substance use counseling.
  • All five recognized the high rate of co-occurring medical and behavioral comorbidities.
  • All programs incorporated urine testing.
  • All used psychosocial supports.

Even with all programs sharing those similarities, though, the clinics were too diverse in their programmatic approaches to psychosocial supports in medication-assisted treatment. The specific supports used and to what degree varied widely across treatment settings. This resulted in the researchers being unable to achieve their goal.

Was the study a failure? No. It provided even more evidence that psychosocial supports are a valuable resource in the treatment of substance use disorder. It also justifies further research across a larger population in order to determine “how best to align treatment models to specific populations” and “how to adapt treatment models to different settings”

It also contributed to the Substance Abuse and Mental Health Services Administration (SAMHSA)’s response to the 21st Century Cures Act. The very first item in SAMHSA’s $5.6 billion proposed budget for Fiscal Year 2020 is for an investment to “Expand access to care for opioid use disorders (OUD) through continued investment in FDA-approved pharmacotherapies for OUD, also known as Medication-Assisted Treatment (MAT) in conjunction with psychosocial supports, expanded community supports, and strategies to prevent opioid abuse through evidence-based prevention approaches, including the use of the life-saving opioid overdose antidote, naloxone”.

The SUPPORT for Patients and Communities Act, which was written into law on October 24, 2018, also set out to combat the opioid crisis by advancing treatment and recovery initiatives. Specifically:

  • Requiring the Centers for Medicare and Medicaid Services (CMS) to research whether access to treatment could be improved by increasing the federal-matching rate for state expenditures related to the expansion of opioid use disorder treatment. (HR 5477)
  • Providing added incentives for Medicaid health homes for patients with substance use disorder. (HR 5810)
  • Instructing CMS to evaluate the utilization of telehealth services in treating substance use disorder. (HR 5603)
  • Providing access to medication-assisted treatment through Medicare in bundled payments for “holistic service” (HR 5776, section 2)
  • Allowing providers certified in addiction medicine or addiction psychiatry to immediately start treating 100 patients, eliminating the initial 30 patient cap. This rule, specifically, notes that “Medications, such as buprenorphine, in combination with counseling and behavioral therapies, provide a whole-patient approach to the treatment of opioid use disorder.” (HR 3692)

Going back to that 2012 study, another one of its conclusions was that cost was a significant barrier to providing necessary psychosocial supports.

There is certainly continuity from that original 2012 study, through widely accepted use of evidence-based psychosocial supports in treatment, the enactment of the 21st Century Cures Act of 2016, the SUPPORT for Patients and Communities Act of 2018, the 2018 WESTAT study and culminating with SAMHSA’s budget calling for an investment in treatment in conjunction with psychosocial supports.

It will certainly be interesting to see how SAMHSA’s plans unfold and whether past and future research teams muster an effort to further their research. For now, evaluate which of the evidence-based psychosocial supports might best your organization and your patient population. 


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Patient Identification, a Problem In Need of a Solution

For a facility that treats a couple hundred patients, each of whom is known to the staff, proper patient identification is only a concern for new patients and identical twins. For large, multi-site treatment providers uniquely and properly identifying patients is a real challenge.

It’s estimated that 8% of all the medical records in the United States are duplicate records, in spite of the fact that many large organizations already use Enterprise Master Patient Index (EMPI) solutions minimize patient identification errors.

The problem is exponentially larger across the spectrum of healthcare in general. Consider that every individual patient must be properly identified by every one of their treatment providers, by each of their insurers, within each software system, at each level, up to and including the national level for specific requirements such as pandemic reporting to the CDC.

The monetary cost of patient misidentification is estimated to be over $6 billion annually across the U.S. healthcare system. This 2016 report provides some non-monetary quantifiers:

  • Misidentification is the cause for 30% of medical errors and 35% of all denied claims.
  • 86% of respondents to the report’s survey witnessed a medical error attributed to misidentification.
  • Identity fraud due to stolen or shared identification cards impacts 2.3 million patients each year which is expected to grow at a rate of 20% annually.

It is remarkable that prior to 1996 the authors of the Health Insurance Portability and Accountability Act (HIPAA) foresaw this problem and proposed solving it by requiring use of a unique health identifier for every patient. That mandate was later overruled due to concerns about patient privacy and uncertainty as to whether it would actually help.

Though it was still in discussion as late as 2019, one industry expert suggests that a national patient ID won’t solve the problem, citing that the it is “fundamentally the result of proprietary systems unwilling to integrate or communicate”. He proposes that the solution will require a societal-level solution using “an algorithm-based enterprise master patient index (EMPI), augmented with other technologies, and combined with policies to improve data quality at point of capture”. If that sounds complicated, it is. 

While waiting for society to solve the problem collaboratively, there are things that every provider can do today to improve patient identification internally. Among them:

  1. Implement policies and procedures to improve data collected at time of admission.
  2. Require at least 3 identifiers to be used at every contact and provision of service.
    1. Those might be the patient’s family and given names, address, date of birth, sex, medical record number, individual healthcare identifier, etc.
  3. Ask patients directly to verify their identifiers at every point of contact.
  4. If your organization uses multiple software systems, consider implementing an internal EMPI to ensure that identification is consistent and is maintained across those multiple internal systems.
  5. Leverage data from central patient registries to ensure consistency between organizations.

SMART integrates with central registries in certain locales and can be integrated with others and with EMPI solutions using SMARTBridge™. While these are added-cost solutions, the benefits they offer provide substantial value and reduce both risk and costs of dealing with patient misidentification. For the best in substance abuse EHR software news, keep checking back. 

substance abuse ehr software

Protect Your Patient Data – Someone Is Phishing for You!

What is “phishing“? It’s fraudulent attempts by criminals to steal computer accounts and passwords. The term was coined in the early 1990’s when the internet was young, with only a few million user accounts. Most people today have multiple accounts, providing billions of potential targets today.

Make no mistake, regardless of who you are, the size of your organization or the strength of your technology resources, you are under attack. How can we be so sure? Experience, and taking into consideration the value of the prize: one patient’s medical record could fetch $1,000 on the “dark web“.

Even small, neighborhood clinics are targets now. An unfortunate example is a small ear-nose-throat practice in Battle Creek Michigan that fell victim to a ransomware attack in early 2019, rendering their systems inoperable, losing years of patient data and forcing them to close their doors.

Spam filters and internet security software do improve safety. None can protect you against 100% of the threats. This is especially true for “zero-day threats” and non-computer-based attacks such as cell phone text messages. The strongest protection available is a “human firewall“. It’s you!

The most common form of phishing is done with very realistic-looking, seemingly appropriate emails:

  • Have you received one that looked convincingly like it was from Linked In asking you to confirm your identity?
  • How about one from UPS or FedEx telling you your package was on the way, containing a link to check its status?
  • Did you get one from what looked like your organization’s Information Technology staff, telling you that systems had been compromised and you must change your password!

The realism of these emails is astounding, but there is one simple thing you can do to defeat them:

  • Never click a link directly! Always hover over any link with your mouse and look at the bottom left of your screen to see the actual link. Here are some examples of things to look for: 
    • (the domain is “lnkedin” rather than “linkedin”)
    • (http is NOT secure; the domain not
    • (your company’s site name doesn’t end in “.ru”!)

In general, don’t trust any link you receive in email, text message, or in a document…like this one! The links here are “legit” but use them to practice the hover technique before clicking any of them.

For text messages, it’s usually not possible to confirm the link. Rather than tap on it, avoid it. Enter the actual site address in your browser and access the needed feature from there. For example, if you do need to track a package, visit and click the “Tracking” link.

The COVID-19 pandemic has actually increased the volume of phishing attacks. Stay safe, be vigilant, protect your data.