substance abuse ehr treatment

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. 

 

Resources used:

https://aspe.hhs.gov/basic-report/psychosocial-supports-medication-assisted-treatment-site-visit-findings-and-conclusions

https://aspe.hhs.gov/system/files/pdf/262011/OptimalIB.pdf

https://aspe.hhs.gov/basic-report/optimal-utilization-psychosocial-supports-medication-assisted-treatment-opioid-use-disorder-issue-brief?mkt_tok=eyJpIjoiWm1VMFpqRTVPRE0wWldJMCIsInQiOiI1NHRDXC9cLzlZWkw1d2lLeHlsVmd0bllRRlEyODZWaTFDNkc3MXdOa2xTd25Ja2ZsaDZLM21Xczc1ZHNPV09ZbVgrM0VYdUoxYnJVSFM5WGNZQTl6S0tXZFVSdU9pQVV5NkdqRHpVWHRROG5oNjZEblwvQ0hjQVl6WkV4ZXpKeXIzZCJ9

https://www.govtrack.us/congress/bills/115/hr6/summary

https://www.congress.gov/bill/115th-congress/house-bill/5477

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362794/

substance abuse ehr software

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: 
    • https://confirm.lnkedin.com (the domain is “lnkedin” rather than “linkedin”)
    • http://tracking.fedex.xt77yq.com (http is NOT secure; the domain not fedex.com)
    • https://IT.yourcompanysite.ru (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 https://fedex.com and click the “Tracking” link.

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

Substance Abuse EHR Software,

Rapastinel Being Researched for Treatment of Withdrawal

Symptoms Associated with Opioid Dependence

What is Rapastinel? It was originally developed by Naurex as an alternative to the antidepressant drug Ketamine which has a number of adverse side-effects and a potential for abuse. Unfortunately, soon after acquiring Naurex in 2016, Allergan was soon met with a disappointment as the drug failed in its clinical trials. SMART offers substance abuse EHR software that helps streamline opioid dependance clinics. 

While it failed as an antidepressant, there is renewed interest in it as a potential treatment for withdrawal symptoms associated with opioid use disorder, as described in this Duke University research abstract:

Pharmacotherapies, such as buprenorphine and methadone, are used to treat those dependent on opioids. However, these commonly used pharmacotherapies are opioid partial agonists and agonists, so the patient remains in an opioid-dependent state throughout treatment.

Treatment requires long-term tapering with buprenorphine or methadone, during which withdrawal symptoms can occur. These limitations show a clear need for a non-opioid pharmacotherapy. SMART can help your treatment center streamline efforts with substance abuse EHR software

Drugs that target the NMDA receptor have been proposed as alternatives to opioid-targeted pharmacotherapies. The NMDA receptor is involved in the maintenance of opioid dependence and its blockade may reverse the neuroadaptive changes induced by opioid dependence. 

Regulation of the NMDA receptor could accelerate treatment of opioid dependency (Glass, 2011).

Ketamine, an NMDA antagonist, has potential as a treatment, but has associated side effects and potential for abuse. Rapastinel is a novel drug marketed as an antidepressant, and it acts as a partial agonist of the NMDA receptor complex. The negative side effects reported with ketamine have not been reported with rapastinel (Moskal et al., 2016). Since rapastinel acts as a partial agonist and has no reported side effects, it may be a more tolerable treatment option for those dependent on opioids.

Current research is limited only to rodents, but the Duke study is hopeful that the continued success of their research will earn the drug clearance for human trials. Those who provide outpatient medication-assisted treatment with methadone and buprenorphine know the efficacy of the treatment. We also know that only a fraction of those who have opioid use disorders actually receive specialty treatment for it. Why is that? Stigma plays a big part. Others simply “don’t want to be in treatment for life” or, at the very least, are concerned about withdrawal symptoms that come with short-term non-medication-assisted therapies.

AddictionCenter.com, an informational web guide for those who are struggling with substance use disorders, states that “A supervised detox is the first step to treating any type of addiction”. According to NIDA, “When people addicted to opioids like heroin first quit, they undergo withdrawal symptoms (pain, diarrhea, nausea,and vomiting), which may be severe. Medications can be helpful in this detoxification stage”; and “While not a treatment for addiction itself, detoxification is a useful first step when it is followed by some form of evidence-based treatment”. 

Medication-assisted detox treatment is not a new concept. It's widely available, relying mostly upon methadone, buprenorphine and naltrexone. Consider a new drug that is effective, non-addictive, has no risk of abuse and no reported side effects. That could be a game-changer in terms of bringing people who need opioid use disorder treatment into treatment. Might Rapastinel might be that drug? Contact SMART today to learn more about how our substance abuse EHR software offers the leading technology and research to help bring hope back for those suffering from the grips of this disorder, and the facilities dedicated to saving lives during this ongoing epidemic. 

substance abuse ehr software

The Future of Healthcare: What Can We Expect by 2025?

In May, 2019, well before the entire healthcare world shifted its attention to the coronavirus pandemic, two New England trade organizations had convened for their annual Spring conferences: the American College of Healthcare Executives (ACHE) of Massachusetts and the New England chapter of the Health Information Management Systems Society (HIMSS). Both shared the same central theme, “human benefits”.

Industry expert Kathy Sucich, Director of Marketing for Dimensional Insight in Burlington, MA, attended both conferences and wrote “we will be able to tackle some big issues in the years ahead”. In her May 2019 article for HealthIT Answers she shared these highlights from what speakers at the conference said they would like to see in healthcare by 2025. Her first two points describe problems needing solutions.

The latter two contribute to the solutions:

1. Capturing the patient’s voice is important:

She notes that “Healthcare organizations should see their patients as human beings, which is not the case right now” and offers this example of how this is changing: Beth Israel Lahey Health (BILH) will be looking to patient feedback to measure their success “by the difference we make in people’s lives”. She also thoughtfully included consideration the supply chain and billing, neither of which are seen as needing to be patient-focused yet have a definite impact on the patient’s overall experience.

2. Providers need to better understand social determinants of health:

As defined by the CDC, social determinants of health (SDOH) are “the circumstances in which
people are born, grow up, live, work, and age”. She writes that SDOH impact patient’s health as well as their quality of care and that understanding SDOH would help close the gap on the health disparities they cause.

3. Data Literacy is critical:

Health data growths at a rate of 36% annually. That’s astounding. If a bank account earned that
much interest, a $5,000 deposit 20 years ago would be worth $2,343,000 today!
Artificial intelligence and machine learning endeavors demonstrate that data can also have a
huge positive impact in point-of-care decision support and other areas. To reap the benefits, organizations will have to both aggregate their data and develop the knowledge and expertise to act on it.

4.  Big tech companies could make a big impact

Amazon, Google, Apple and others are anticipated to make significant positive contributions to
healthcare over the next few years, but they could also disrupt the industry. She cites Amazon,
which has a supply chain that could cause an impact on hospital purchasing.

The problems are not new. Consider these philosophical maxims from William Osler (1849-1919), a Canadian-born physician, which are over 100 years old:

1. “The good physician treats the disease; the great physician treats the patient who has the
disease”.

2. “It is much more important to know what sort of patient has a disease than what sort of disease a patient has”.

Osler’s maxims are just as pertinent today. The first indicates that the patient comes first. The second speaks to social determinants of health. In the substance abuse treatment industry, providers typically “walk the talk” when it comes to both. We do put the patient first. It is also widely accepted that “social determinants of health are increasingly recognized for their important influence on health outcomes”. (Williams, et al, Jul 2019) As Sucich points out, human benefits include not only the patient but also the physicians who treat them. A Mayo Clinic reports that 44% of physicians experience symptoms of burnout and a New England Journal of Medicine survey showed that 95% of medical professionals agree burnout is an issue ( Etactics, Nov 2019 ). The top two factors of burnout are administrative tasks and too little time with patients, both strongly influenced by demands of technology. ( PatientPop, Aug 2019 )

At SMART, we are proud of our history of prioritizing human benefits with our substance abuse EHR software, having always put the patient first and prioritized our associate’s satisfaction. Why is it, then, that for more than a decade the healthcare industry at large has dedicated itself to the advancement of technology rather than the human elements? It’s the need for data.

In order to treat the whole person, all their providers need to know the whole person. That requires all of them to both gather and share of data, which requires technology. Congress, realizing that, enacted the HITECH Act in 2009 which resulted in a feeding frenzy for the $18 billion of funding for the adoption and use of technology, mostly within primary care, hospitals and large medical organizations.

After more than a decade, it’s finally safe to say that “the technology exists”. Now is the time for the healthcare world to shift its focus back to human benefits, something that has always been important for those who care for patients suffering from substance use disorder. Our substance abuse EHR software puts the focus back on human benefits.

substance abuse ehr treatment

MAT or MBT?

In March 2019, the National Academies of Sciences, Engineering and Medicine released a report titled “Medications for Opioid Use Disorder Saves Lives”. It can be read for free online here or purchased as an eBook from The National Academies Press.

The 156-page report arrives at these seven conclusions (sourced directly from the report linked above):

 

  • Opioid use disorder is a treatable chronic brain disease.
  • U.S. Food and Drug Administration–approved medications to treat opioid use disorder are effective and save lives.
  • Long-term retention on medication for opioid use disorder is associated with improved outcomes.
  • Lack of availability or utilization of behavioral interventions is not a sufficient justification to withhold medications to treat opioid use disorder.
  • Most people who could benefit from medication-based treatment for opioid use disorder do not receive it, and access is inequitable across subgroups of the population.
  • Medication-based treatment is effective across all treatment settings studied to date. Withholding or failing to have available all U.S. Food and Drug Administration–approved classes of medication for the treatment of opioid use disorder in any care or criminal justice setting is denying appropriate medical treatment.
  • Confronting the major barriers to the use of medications to treat opioid use disorder is critical to addressing the opioid crisis.

 

If you’re reading this, you most likely have experience in the provision of OUD treatment services and were nodding your head in agreement at each one of the conclusions as you read it.

Evidently, Mark Parrino, President of AATOD, agrees…to a point. In his May 2019 analysis of the report he says that the report is both “thoughtful and comprehensive” and suggests “the report has great value and should be widely read“.

However, he also expresses disapproval of the term “Medication-Based Treatment”, as it pertains to opioid use disorder, and disagrees with some of the report’s recommendations for which he says are “divorced from the evidence stated in the report and there are contradictions in different sections of the recommendations“.

Over 15 years ago, the Substance Abuse and Mental Health Services Administration (SAMHSA) coined the term “Medication Assisted Treatment” (MAT) indicating that clinical support services should be used in conjunction with the medication.

While the report projects an understanding that opioid use disorder is a complex disease and not simply a neurological disorder, Mr. Parrino notes that “Like most complex illnesses, it has a number of behavioral components.” and asserts that “this represents a contradiction in the approach of medication being the treatment“.

As for the report’s recommendations, he specifically disagrees with this assertion in the report’s assertion in its seventh conclusion that a major barrier to treatment is “Current regulations around methadone and buprenorphine, such as waiver policies, patient limits, restrictions on settings, and other policies that are not supported by evidence or employed for other medical disorders.

Mr. Parrino suggests “The true limitation to access to the availability of OTPs are based on zoning board restrictions, legislative interventions, moratoriums on opening new OTPs and the lack of third-party reimbursement.

Agree or disagree with its recommendations, one thing this study’s conclusions do is prove that these are not just beliefs of people involved with opioid use disorder treatment…they are facts.

 

substance abuse ehr software

SMART Software COVID-19 Support Announcement

As COVID-19 makes its way across the globe, it’s affecting our communities in different ways. One that is acutely affected is the healthcare community. As we continue to monitor Coronavirus (COVID-19) developments closely, the health and well-being of our clients, partners, and our employees is of utmost importance to us. As a partner to your business, we also understand the critical need to limit any impact this health event could have on our service to our clients. We are focused on our preparedness efforts to maintain a safe work environment for our staff while also sustaining business operations.

Our leadership is working to ensure our ability to continue essential work and deliver the products and services you rely on. We plan to continue to serve you 24/7, as you serve your patients through this time of crisis. We have a plan in place that is managed by a dedicated team who are committed to keeping our operations running smoothly so that we can provide you with the best possible service. This is an unprecedented situation. We are following the lead of the CDC with regard to important COVID-19 containment precautions, such as limiting travel and maintaining social distance.

Our plan includes the following:

  • We have ensured that our staff can work from home as needed in order to prevent the spread of any illnesses so that we can continue to provide support 24/7 for all customers.
  • All Tier 1 and Tier 2 customer support teams are able to perform their roles remotely while still maintaining proper levels of security and privacy.
  • We ask that you continue to use our Software Support portal to submit incidents. We will continue to operate as normal.

https://support.smartmgmt.com/

We hope you, your families, and staff stay healthy through this time. If you have additional questions, please contact your Partner Success Manager.

In the case of an emergency, please call 800.942.4540 or 401.780.2300.

substance abuse ehr software

Alexa! Remind Me to Take my Medication at 6:00PM Everyday

The Health Information Management Systems Society, HIMSS, has been publishing tidbits for over a year now regarding how “connected home assistants” like Amazon Alexa, Apple Siri and Google Assistant are making their way into the healthcare space.

One year ago, Consumer Intelligence Research Partners (CIRP) released estimates that reported the number of “smart speakers” installed in the U.S. reached 66.7 million by the end of 2017 and grew by 78%, rising to 118.5 million units installed by the end of 2018 across 28% of the 128 million households in the U.S. Projections are that 75% of households will have a smart speaker installed by 2025.

The apps that drive this technology are installed on smart phones and tablets. Nearly 266 million people in the U.S. have a smart phone and that’s expected to grow to 285 million by 2023.

Couple the large-scale availability of the technology with cloud solutions setting a new paradigm with privacy and security and the expansion of these services  into the healthcare sector seems to be a natural migration.

Imagine your iPhone or Android phone vibrating at 6:00PM with a reminder for you to take your medication. Or, consider being able to say “Siri! Add an appointment in my calendar for 8:00AM on October 12 for my physical exam with Dr. Smith.” and then automatically receiving an alert on your phone one week prior to that reminding you to get your bloodwork done.

As for the technology making its way into substance abuse treatment, we’re not quite there yet, but the study referenced in this Technology Networks article indicates that the future could be promising. One could imagine the usefulness of this technology not only for getting at-risk people help at the moment they need it, but also keeping patients in treatment engaged with their treatment and their treatment provider.

Substance Abuse EHR Software

Does 42 CFR Part 2 Need an Overhaul?

A March 4, 2020 post from the Pennsylvania Recovery Organizations Alliance, backing up earlier posts on March 2 and one from November 2019, refueled the discussion as to whether 42 CFR Part 2 should be made more compatible with HIPAA.

Some believe that, while the 2018 revisions to 42 CFR Part 2 provided some modernization of the 1975 law, it didn’t go far enough. A case in point is an October 2019 letter to SAMHSA penned by Maeghan Gilmore, Chair, Partnership to Amend 42 CFR Part 2:

“Care coordination and case management are essential for whole-person, integrated approaches to care, which have been proven to produce the best outcomes for patients. However, these activities depend on the effective and timely sharing of information. Including care coordination and case management under the definition of health care operations in Part 2 would reduce the likelihood of barriers or delays, promoting more integrated care for patients…that it 42 CFR Part 2 should align with HIPAA to ensure that all of a patient’s treatment providers have access to their entire health record.”

An earlier attempt at overhauling 42 CFR Part 2 was the bipartisan Overdose Prevention and Patient Safety Act (H.R. 6082 (115)). This bill passed the House in 2018 but later died in the Senate for fear that “it would discourage patients from seeking SUD treatment for fear of facing discrimination or potential legal consequences”.

In April, 2019, a new bipartisan bill to amend 42 CFR Part 2 regulations was introduced in both the House and Senate. Nearly a year later this latest attempt has yet to make it past the status of “introduced” in either house.

It’s likely to meet the same fate as the last attempt, for reasons best articulated by Alison Knopf of the Addition Treatment Forum, in her November 2018 blog post. She asserts that the proposed bills put the 42 CFR Part 2 regulations “under siege”.

For this Congress, anyway, it’s unlikely that any changes to 42 CFR Part 2 regulations will be made. Depending on the results of the November 2020 elections, though, that could change in the 117th Congress. Time will tell. If you are looking for more information on substance abuse EHR software, reach out today. 

Substance Abuse EHR Software

Six Ways SMART’s EHR Increases Productivity

 SMART’s EHR software, powered by Amazon Web Services, is a cloud-based solution designed to help manage outpatient substance abuse treatment programs, primarily for treatment of opioid use disorders (OUDs) using medication-assisted treatment (MAT).

The SMART EHR aids in enhancing the effectiveness and efficiency of the treatment program through its patient-centered design, “100% paperless” capability, workflow automation, enhanced communication across the multi-disciplinary team and vital management-level reporting to support accreditation and regulatory compliance.

The implementation process for new software partners is fast and efficient, intended to get your treatment team up and running quickly, with virtually no down-time, resulting in a successful startup and future success. The process begins with a kick-off meeting followed by a full needs assessment, system settings evaluation, installation, training, go-live with on-site assistance, post-installation training and the eventual transition to customer support and account management. Our partners enjoy SMART’s unparalleled support services, available 24x7x365 with 5-to-5 coverage on weekdays. “We’re here when you’re there”.

SMART’s EHR will help you:

1. Save on resources:

SMART’s platform saves on operational and equipment costs, virtually eliminates software update costs, scales as needed and substantially reduces the burden on your IT resources.

In compliance with HIPAA HITECH and 42 CFR Part 2, SMART’s EHR utilizes fully encrypted data management and provides safe and secure access by authorized individuals anywhere. Risk is minimized while maximizing access, availability, efficiency and disaster recovery in a way that is simply not possible with on-premises solutions.

Ours is a high-performance solution developed with a deep, experience-based understanding of substance abuse treatment. Its ease of use and speed at accessing patient data allows staff to monitor and manage productivity, meet accreditation and regulatory requirements and ensure patients receive the services they need when they need them, even in emergency situations.

2. Increased admissions efficiency:

SMART’s ability to provide a “100% paperless” patient record plays a vital role in enhancing patients’ access to treatment. The intake process is based upon SMART’s own three-phased approach of removing barriers to treatment, initiating treatment and keeping the patient engaged for that critical first 90 days.

The pre-admission process helps increase intake capacity with its customizable screening questionnaire. It gathers all the necessary contact and insurance information, schedules intake appointments and computerizes required intake forms with appropriate signatures.

The screening tool helps to determine whether each patient who presents for treatment is a good fit for the services offered by the facility. Referrals to other agencies can be made and tracked should the patient require a different level of care.

3. Streamline medication administration while reducing risk

SMART’s dosing feature supports medication assisted treatment (MAT) with methadone and buprenorphine-based medications. The software supports split dosing, flexible take-home schedules (including planned leave such as vacations) and scheduled automated increases or decreases over time.

To virtually eliminate medication errors, the medication administration process employs up to 6 factors of identification for each patient, including the patient’s digitized signature. Individual dose amounts are calculated from the patient’s active medical orders at the time of dispensing with automatic label generation for take-home doses.

The medication administration process is supported by a comprehensive inventory management and reporting system, in full compliance with DEA regulations. Barcode scanning is also offered to facilitate compliance with the FDA’s latest drug supply chain regulations.

4. Promoting collaboration among the team and sharing of patient information.

SMART EHR’s patient chart helps promote patient recovery by keeping the entire treatment team updated on each patient’s status. Among the data collected are:

  • Problem statements, in the patient’s own words
  • Interpretive and diagnostic assessments using a fully customizable questionnaire
  • Treatment plans
  • Direct services such as Individual and Group sessions
  • Medical Orders
  • Urine drug screens
  • Medical problems, conditions and diseases (ICD-10 and DSM-5)
  • Allergies
  • Prescribed medications
  • Infectious diseases
  • Vital signs
  • Treatment alerts and notifications
  • Billing and collections data
  • …and more

5. Controlling lab costs and accelerating availability of drug screening results

SMART’s EHR aids in guiding treatment decisions based on toxicology screening results for oral fluid or urine samples.

Fully randomized toxicology screenings can be scheduled at the patient level for intervals from weekly to the minimum 8 times per year required by federal regulations.

Lab results for toxicology screens as well as GC/MS confirmatory tests are recorded in the patient’s chart as soon as they are available. This is typically within 24 to 48 hours but could be sooner, depending upon the lab’s capabilities.

Available reports include specimens due, positive results, negative results, summaries by drug category, statistical summaries and more.

6. Maximizing revenue opportunities

SMART’s patient billing system manages both self-pay patients and patient responsibility for third party payers’ unpaid balances. Self-pay patients are billed automatically with balances constantly monitored and regular alerts to remind patients when payments are due.

SMART’s integral and comprehensive 3rd party billing automatically bills for services provided and eliminates the need for a clearinghouse by directly generating EDI files certified by Optum Insight to be fully compliant with HIPAA 5010 standards.

Revenue cycle management tools and reporting support both cash- and accrual-based accounting methods, manage aged accounts receivable, help minimize time-to-payment and maximize collection percentages.

SMART’s EHR helps staff organize and conduct daily operations, increasing productivity and enhancing the attainment of executive level goals. Enhance the performance of your treatment programs, improving both business and treatment outcomes.

Increase admissions capacity, realize the efficiencies of paperless charts, streamline patient dosing while reducing risk, promote collaboration amongst your team, control costs, accelerate laboratory results and maximize revenue. Contact SMART today.