In addition to getting help from others, I am trying to implement some of the suggestions that I have read about. While resources are available, many of us do not find them in time to be of real assistance to us.

One decision I have made is that it is time to set priorities and to follow through on them. I will be going to the medical equipment store today to look at hospital beds. On Thursday,  we will get an order from the doctor for home health care assistance. Hopefully, on Friday I will be able to get input about sitters and the like.

In the meantime, I will need to put this blog on hiatus. If I can get some of my co-workers to do a post, there will be something here. If I get inspired and have some found time, I will do a post. Otherwise, I will leave you until things quiet down on the home front.

Thanks for reading. Hope to talk to you again soon.

The HIPAA Omnibus Rule has finally been released. According to FierceHealthIT, HHS released the Omnibus Rule to simplify compliance actions that must be taken by affected entities.

The four rules that combine to create the omnibus final rule include:

• Modifications to the HIPAA Privacy, Security, and Enforcement Rules mandated by the Health Information Technology for Economic and Clinical Health Act, and certain other modifications to improve the rules, which were issued as a proposed rule on July 14, 2010.
• Changes to the HIPAA Enforcement Rule to incorporate the increased and tiered civil money penalty structure provided by the HITECH Act, originally published as an interim final rule on Oct. 30, 2009.
• A final rule on Breach Notification for Unsecured Protected Health Information under the HITECH Act, which replaces the breach notification rule’s “harm” threshold with a more objective standard and supplants an interim final rule published on Aug. 24, 2009.
• A final rule modifying the HIPAA Privacy Rule as required by the Genetic Information Nondiscrimination Act (GINA) to prohibit most health plans from using or disclosing genetic information for underwriting purposes, which was published as a proposed rule on Oct. 7, 2009.

Read more: HHS unveils final HIPAA omnibus rule - FierceHealthIThttp://www.fiercehealthit.com/story/hhs-unveils-final-hipaa-omnibus-rule/2013-01-17#ixzz2JZe5a824

Ascertaining the impact of this Omnibus rule could be a while in the making, but HIPAA commentators have begun their assessments. I will be attending a webinar hosted by IDExperts on February 6 in an attempt to start to understand just what has been changed and to try to get an idea about how that affects us and our customers.

On January 30, FierceHealthIT indicated that providers must attend to at least four areas:

Monetary penalties aside, four areas of the rule that will have a significant impact on providers are:

• A change that makes business associates and their subcontractors liable for breaches of personal health information
• An enhanced right for patients to obtain electronic copies of their records
• An enhanced right for individuals to request restrictions regarding disclosure of their PHI
• A change to the breach notification rule in which any disclosure of PHI is presumed to be a breach

Read more: Handling HIPAA: 4 new provisions providers must know - FierceHealthIT http://www.fiercehealthit.com/special-reports/handling-hipaa-4-new-provisions-providers-must-know#ixzz2JZmdjFI7

That fourth area, the breach notification rule, is one that could affect anyone who handles PHI. Any disclosure of PHI is presumed to be a breach.

When the Interim Final Rule was released in 2009, the notion of assessing whether any significant “harm” had occurred to those whose data had been lost or viewed inappropriately was introduced. David Harlow, author of HealthBlawg discussed the current change in FierceHealthIT. The bottom line for Mr. Harlow is this:

… the default assumption is that any irregular release of PHI is a breach, with no subjective standard of harm getting in the way. The covered entity or business associate unfortunate enough to have suffered this breach may either (a) immediately acknowledge that it is, in fact, a breach, and rev up the notification machinery (notice to data subjects, the federales–possibly for posting on the Wall of Shame–and the press, as appropriate, based on the size of the breach) or (b) decide that a risk assessment is necessary, and begin its assessment of at least the four factors highlighted in the regulation.

Read more: Uncertainties surround new HIPAA breach notification rule – FierceHealthIThttp://www.fiercehealthit.com/story/guest-commentary-uncertainties-surround-new-hipaa-breach-notification-rule/2013-01-29#ixzz2JZiJrwSa

What impact will this have on you and your organization? If you allow PHI to be released contrary to your policies and to the law, how will you proceed? Do you know? Who is your Privacy Officer? Do they know?

Time to wake up the HIPAA education machinery again! …or for the first time if you do not have such machinery in place.

This morning, my partner Seth mentioned his concern that the focus on the possible mental health issues of individuals who want to own and carry guns potentially presents a whole raft of HIPAA concerns. After all, how do we define mental illness? And who has a right to know what diagnoses have been applied to which people? How do background checks access this information?

Also this morning, a feminist therapist friend shared a link that I had to pass on to you. The speech to which this link will direct you is written by Paula J. Caplan, Ph.D. Dr. Caplan is an articulate and often entertaining psychologist who frequently points her sharp and well-focused eye on the inequities of our culture. She too has concern about how we utilize the issue of so-called mental illness to divert ourselves from the issues of violence in our culture.

Please take a look at her speech on stopping gun violence given yesterday. I would love to hear your comments.

This morning I received an email from the Office of Civil Rights listserv on HIPAA Privacy and Security. It contained a link and reference to a letter of clarification written by Leon Rodriguez, Director of OCR.

In light of recent tragic and horrific events in our nation, including the mass shootings in Newtown, CT, and Aurora, CO, I wanted to take this opportunity to ensure that you are aware that the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule does not prevent your ability to disclose necessary information about a patient to law enforcement, family members of the patient, or other persons, when you believe the patient presents a serious danger to himself or other people. 

The HIPAA Privacy Rule protects the privacy of patients’ health information but is balanced to ensure that appropriate uses and disclosures of the information still may be made when necessary to treat a patient, to protect the nation’s public health, and for other critical purposes, such as when a provider seeks to warn or report that persons may be at risk of harm because of a patient. When a health care provider believes in good faith that such a warning is necessary to prevent or lessen a serious and imminent threat to the health or safety of the patient or others, the Privacy Rule allows the provider, consistent with applicable law and standards of ethical conduct, to alert those persons whom the provider believes are reasonably able to prevent or lessen the threat.

Given all the discussion about mental health interventions related to the perpetrators of the recent violence, Director Rodriguez clearly felt it was necessary to remind healthcare providers of all stripes that the law does not prevent them from involving the authorities when they believe an individual is potentially dangerous.

I was educated in the Tarasoff era. It was controversial, but clear, that mental health providers have a clear duty to protect the intended victim of a violent action to be committed by one of their patients. That protection may well include the duty to warn the potential victim. Given the occurrence of mass killings in recent years, it is easy to wonder if we all ought to behave as if we have at least a moral responsibility to notice and to notify the authorities about the potentially dangerous behavior of others.

As a former mental health provider, I worry about the tendency of our country to blame violent behavior on mental illness. As research in the area indicates, the relationships among mental illness, drug abuse and violent behavior are complicated, at best. Social factors such as ‘poverty, family history, personal adversity, and stress’ also feed into this complex equation.

On January 15, 2013, President Obama presented proposals to control the sale of certain kinds of guns and the ammunition they use. He also proposed a whole raft of other actions that will hopefully make our awareness and ability to intervene before violence occurs an easier job.

The knee jerk reaction of the NRA and other defenders of the ‘right to bear arms’ has been loud, and people seem to quickly line up in one camp or the other. That is why I was so struck by the post of a Friend of a Friend on Facebook that I shared his statement on our SOS page. You may not be able to get to it unless you are a registered user of Facebook, but if you are, please take a look. This is a well thought out, rational, and personal reaction to some of the responses to the President’s proposals.

One of those proposals is that teachers and others who interact with young people need to learn more about the mental health issues that might help them identify youngsters who are in need of assistance. Linda Rosenberg, President and CEO of The National Council for Community Behavioral Health shared her take on President Obama’s proposals.

As part of his recommendations to protect our communities from gun violence, President Obama today rightly called for Mental Health First Aid training to help teachers and staff recognize the signs of mental health disorders in young people and find them appropriate care.

The youth version of Mental Health First Aid is an evidence-based training program to help citizens identify mental health problems in young people, connect youth with care, and safely deescalate crisis situations if needed. The program, focusing on youth ages 12 to 25, provides an ideal forum to engage communities in discussing the signs and symptoms of mental illness, the prevalence of mental health disorders, the effectiveness of treatment and how to engage troubled young people in services.

Mental Health First Aid has become a major push for The National Council. Information and resources are readily available.

After all is said and done, we get to the bottom line. What should people do if they find themselves in an active shooting situation? This is not a thought most of us want to entertain, but first-responder agencies have always believed that being prepared for an emergency greatly increases a person’s chances of surviving a dangerous situation. With a grant from the Department of Homeland Security, the Houston Police Department has prepared an excellent video about surviving an active shooter event.  

Events like the Sandy Hook School shootings stir up primal reactions for most of us. It is important that we not shut those reactions down. Instead, we need to open ourselves to many possibilities of how we and our communities need to intervene to assure that we and our children are as safe as is reasonably possible.

Please share your comments, experiences, concerns below.

My proposed solution to the challenges facing my aging brain is something Seth and I named ‘Google Brain’. It is the chip that will be implanted into our brains to be augmented by Google’s outrageous computers and search capabilities. While I have no advance knowledge of Google working on such a project, I have hope that they are doing so…and that it will be available while I can still benefit from it. They are even welcome to the name I have chosen for their project!

Several things have popped into my awareness lately to make me hope my fantasy will one day be a reality.

At the beginning of January, some psychology colleagues on a technology listserv of which I am a member mentioned an episode of 60 Minutes in which a young man successfully participated in a stair-climbing event in a 103-story Chicago building. This man has a prosthetic leg that he controls by his thoughts.

Another colleague responded indicating that there are many projects in the works that extend that same technology. Neuroscience has become the ‘hot’ research field related to mental health and behavior. It has many practical applications, but can seem so complicated as to be off-putting to some. That is why a video explaining some of the technology and research tools being used is so delightful. This is a clear and visually appealing explanation of semantic mapping in the brain, something that has fascinated me since the very early brain research demonstrated the storing of memories in particular regions of the brain, and their recall through electrical stimulation during brain surgery. The use of fMRI to advance this purpose is very exciting. These are important arenas for behavioral health providers to be informed about. It might well be the future of this field.

We certainly are approaching what many of us thought might be the distant future. Verizon together with cellphone producer HTC has started to communicate the image of humans enhanced by technology with their Droid DNA phone and ads. Google released their new Google Glasses in 2012. These are glasses enhanced with computer, camera, and internet connectivity. When I wrote about two books that used these glasses and fMRI in 2011, I knew the technology was available somewhere but did not know it would soon be here for the rest of us to start to access.

I love finding out about technologies like this that may be available to all of us in my lifetime. Maybe I will even be able to make and carry out New Year’s resolutions again with the help of some of these tools-in-the-making. Are there things in your world that provide the same kind of  excitement and hope for you? New tools, new toys, new ideas? Please share your comments below.

Often in  a circumstance like this, it becomes clear that the perpetrator experienced mental health issues that were inadequately addressed. The behavioral health community jumps to the defense of the mentally ill immediately citing the very low incidence of violence caused by the mentally ill. Rather than become defensive, I think we need to be open to hearing and acting upon other perspectives on such tragedies.

My niece is an educator. Yesterday, in her blog, she posted a take on these events that we should all consider. Please take a look at her post, One Educator’s Response to the Sandy Hook School Shooting.

Please feel free to share your comments here and at Kami’s blog.

The number of mobile devices we utilize to conduct our businesses has expanded beyond belief. What can we do to make sure that our patient data is not at risk if we utilize these devices to access their information? As providers of behavioral healthcare services, we have special responsibility to protect the sensitive information related to the care of our clients.

The U.S. Department of Health and Human Services is very concerned about the spread of these devices and their innate insecurity. They have developed a special section of their healthit.gov web site to focus on these privacy and security needs.

The HHS video on the topic focuses on five issues:

1. Lost mobile device
2. Stolen mobile device
3. Downloaded virus or malware
4. Shared mobile device
5. Unsecured Wi-Fi network

Take a look when you get a chance and learn more about how to protect PHI when using mobile devices. And don’t forget, encryption gives you ‘safe harbor’ under HIPAA, even if you were to experience a data breach.

Does your organization have policies about using mobile devices to access PHI? How do you manage your experience with mobility? Please share your comments below.

Then I read a new issue of FierceHealthPayer, an industry newsletter for Healthcare Plan Executives. This issue had two separate articles and a commentary that made me wonder how we will possibly get to affordable healthcare in this country.

The first article reported that the American Medical Association (AMA) has reviewed health plans across the country and opined that 70% of commercial insurance markets are anti-competitive. This means that in 70% of the locales in this country, the vast majority of the health insurance is provided by one company. One of the primary arguments of the insurance industry and their Congressional supporters against a single payer national health plan is that competition is necessary in order to achieve quality and control costs. If that is so, we will not get to affordable care or adequate quality given this current anti-competitive situation.

The second article discusses the trend toward self-insurance on the part of large employers. There has been a steady increase since 2006 in the number of large employers who are managing administrative costs and avoiding variable state laws by self-insuring. In 2011, approximately 60% of workers were covered in a self-insurance program run by an employer. Small employers generally do not have this option. The risk of self-insuring for a small group is much greater than the outrageous cost of group coverage through one of the major insurance companies. Self-insurance often tries to control costs by limiting benefits.

The final item that grabbed my attention is a commentary in this same newsletter. The editor reported on the confused state of smoking cessation coverage among private insurers. She pointed out the requirement in the Affordable Care Act for such coverage and the indications by surveyed insurers that they do include smoking cessation coverage.

Yet when Georgetown researchers studied 39 health plans, they found that none of them took all of these vitally important steps: clearly stated that tobacco cessation treatment is covered; provided coverage for individual, group and phone counseling and tobacco cessation medication; provided treatments with no cost-sharing for members; and provided access to treatment without members having to meet prerequisites.

Read more: Why wouldn’t insurers cover smoking cessation? – FierceHealthPayer

These are the factors that are most likely to result in successfully quitting the use of tobacco products. You would think that insurers would want to have this particular benefit in their plans and that it be used. After all, the direct medical costs and productivity losses caused by smoking-related illnesses each year is almost $200 million.

The juxtaposition of these four items today reminds me of my personal conclusion…we need a single-payer national healthcare system if we are ever going to get our costs under control and provide quality healthcare services to most U.S. residents. Just by removing the 22% growth in earnings posted by the five major insurers in 2010, we might get a start on controlling some of the costs involved. Standard benefits across the country would make the system easier and more consistent for employers with workers in multiple states. And real implementation of preventive measures like smoking cessation would make all of us healthier.

And now I will wait for the comments….

According to Medicare.gov, nearly 66 million Americans are caring for an elderly, seriously ill or disabled friend or family member. Within our organization, 1/5 of us work full-time and are also primary caregivers. I was surprised to learn that we are exactly representative of the rest of the U.S. The 66 million indicated above is about 21% of the approximately 315 million people living in this country. Just look around you. If you are not the one-in-five yourself, one of the four people who sits near you at work is likely to be.

Medicare is concerned enough about this state of affairs that it has dedicated a section of its website to providing information and resources for caregivers. This includes documents and videos as well as links. If you are caring for someone who is on Medicare, knowing what services Medicare covers can be most helpful, and having access to additional resources can be a lifesaver!

One of the links on the Medicare.gov site takes you to a Department of Health and Human Services Eldercare locator. This is aimed at helping you find specific kinds of services near to your home when the person you care for is elderly. Many caregivers never look for assistance because they assume none is available. That is not necessarily the case. Learning to reach out and ask for help is an essential survival skill.

Those of us who currently work in the behavioral health field or have done so in the past are always attuned to mental health issues in our clients. Unfortunately, we often overlook those same issues in our own family members, friends and co-workers. According to the National Family Caregivers Association, family caregivers often experience major depression.

Family caregivers suffer from major depression much more frequently than the rest of the population. That’s a fact. When a family caregiver suffers from depression, there are two people at risk – the family caregiver and the family member or friend for whom she or he cares.

Learning to identify depression and deciding to seek assistance is essential to self-care. Just as you would assure that a client is getting appropriate services to treat depression, it is important that you reach out to the caregivers in your life who may be in need of support and similar services.

As baby-boomers become ‘senior’ citizens, the numbers of those needing assistance and of caregivers providing that help will increase dramatically. Now may be the time to learn about available resources and to provide them to those caregivers you know.

Please share your experience. Just enter your comments below.