Translating the Languages of Mental Health and Medicine

1. Session # I4a October 29, 201110:30 AM Translating the Languages of Mental Health and Medicine Tai J. Mendenhall, PhD, LMFT, CFT Assistant Professor & Coordinator of Behavioral Medicine Education University of Minnesota Medical School Jennifer L. Hodgson, PhD, LMFT Associate Professor, East Carolina University Angela L. Lamson, PhD, LMFT, CLFE Associate Professor & Director of MFT (MS) and MedFT (PhD) Programs East Carolina University Collaborative Family Healthcare Association 13th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

2. Faculty Disclosure I/We have not had any relevant financial relationships during the past 12 months.

3. Need/Practice Gap & Supporting Resources Contemporary calls for integrated care are increasingly facilitating mental health providers’ entry into medical contexts. However, most training programs do not teach the medical language/terminology and structured formats necessary to effectively collaborate with medical colleagues. This workshop will introduce participants to what they need to know to “talk medicine.”

4. Objectives Discuss how contemporary calls for integrated care are quickly advancing mental health providers’ entry into medical contexts, and how this trend is outpacing most established training programs. Introduce common medical terminology and related knowledge that is necessary to read and understand care/visit-records and/or collaborative communication. Outline common formats (e.g., the SOAP format – Subjective, Objective, Assessment, Plan) in which medical charting is carried out. Discuss common electronic medical records and platforms (e.g., Allscripts, gMED) used for inter-professional communication, patient/family advocacy, and billing.

5. Expected Outcome At the conclusion of this workshop, participants will be able to: • Cite medical terminology that is necessary in order to understand medical charts. • Employ standard medical chart-formatting that is requisite for effective communication and collaboration with medical colleagues. • Describe common electronic medical record (EMR) platforms that are necessary for the effective integration of multiple providers’ notes in integrated care/collaboration, patient/ family advocacy and billing. • Communicate verbally with medical providers using language and terminology that is relatable and translatable.

6. Contemporary Calls for Integrated Care • Calls for integrated care are advancing behavioral health providers (e.g., MFT/MedFT, Psychology, Social Work) into medical contexts more today than ever before • Healthcare is outpacing conventional behavioral health training programs • Training regarding language/terminology • Training regarding structured formats of inter-professional communication

7. Can you translate what this physician has said? S: 67 y/o male c/o chest pain and SOB x 2 h. Pain is severe (8 out of 10), centered under sternum, and radiates to the L arm and jaw. Pain woke patient from sleep, and is w/o D with movement or breathing. O: Pt. has a h/o ASHD, MI 1/15/01, HTN, and DM. Meds include ASA, insulin, lasix, and lisinopril. Allergic to PCN. On exam pt is A+O x 4, diaphoretic, and anxious. HEENT: PERL. Neck: – JVD, positive use of accessory muscles. Chest: BS crackles at bases, + retractions. Abdomen: soft, non-tender. Extremities: ¾ edema/clubbing/cyanosis. A: r/o chest pain of cardiac origin P: Oxygen (15L NRB), IV NS TKO, cardiac monitor, monitor V.S., transport position of comfort, NTG x 3 and MS 2 mg IV with decrease in pain from an 8 to a 3, ASA deferred as patient had a dose today.

8. Two Different Worlds, Two Different Languages • Physicians say things like… • MDD, qd, qhs, PRN, b.i.d., t.i.d., iii, ii, i, x, HEENT, A1c, BP, CQI, BPD, c, Cx • Therapists say things like… • cross-generational triangulation, disengaged parent, enmeshed interpersonal boundaries, anger turned-inward, differentiated

9. The American Recovery and Reinvestment Act (ARRA) • The ARRA is the legislation that became law in 2009, also known as the “Stimulus Act.” It authorizes the Centers for Medicare & Medicaid Services (CMS) to provide financial incentives to eligible professionals and hospitals that demonstrate “meaningful use” of certified electronic health record (EHR) technology. • The final regulation outlining the requirements for receiving the incentives was released on July 13, 2010, and defines how the incentive program works. http://www.ama-assn.org/resources/doc/hit/faq-ehr-incentive-programs.pdf

10. ARRA Eligibility • In general, an eligible professional will be considered a meaningful EHR user during an EHR reporting period in a payment year if they: • 1. Use certified EHR technology • 2. Demonstrate electronic exchange of specific information (to the satisfaction of the CMS) • 3. Report on specific clinical quality measures

11. Meaningful Use • “Meaningful use, in the long-term, is when EHRs are used by health care providers to improve patient care, safety, and quality.” —Dr. David Blumenthal, national coordinator for health information technology, U.S. Department of Health & Human Services

12. Example of Meaningful Use Objectives • Record patient demographics • Record and chart changes in vital signs • Maintain active medication allergy list • Maintain an up-to-date problem list of current and active diagnoses • Maintain active medication list • Generate and transmit electronic prescriptions for non-controlled substances • PATIENT COMMUNICATION

13. Medical Language • Context / History • The first written accounts of medical experience are found in the Egyptian Papyri (Clending1). • Global / Latin-based • Process / Efficiency / Brevity • Abbreviations / Acronyms • Like concealing what saying • Universal

14. Common Medical Charting • S.O.A.P. notes • Subjective, Objective, Assessment, Plan • Tracking daily health • Vital signs, intake, output, pupils, limb(s) capability • Intake vs. Progress notes

15. Medical Records & Communication • Electronic Medical Records • Health information and data • Result management • Order management • Decision support • Electronic communication and connectivity • Patient support • Administrative processes • Reporting

16. Records & Communication, con’t • Types/Examples of EMRs • Allscripts • Medicfusion • MedWorxs

17. Records & Communication, con’t • Communicating through the EMR • Colleague-to-colleague “tasking” • Constructing standard case summaries and diagnostic data • In-house vs. cross-site collaboration • Patient/family advocacy • Billing • PCP to patient

18. Medical Abbreviations and Resources • Common Medical Abbreviations: http://bit.ly/nbGpJg • Prescription Abbreviations: http://bit.ly/puCpRv • Flashcards: http://bit.ly/nvYcU4 • Acronym Finder: http://bit.ly/nChCfj

19. How Abbreviated Are You? • Common Medical Terminology • Take quiz • http://www.sheppardsoftware.com/dynamic_MC_med_voc_web.html • Common Medical Abbreviations / Acronyms • Take quiz • http://teacherweb.com/TX/TaylorHighSchool/RoyChampion/response2.aspx

20. Back to that note…Translating Exercise S: 67 y/o male c/o chest pain and SOB x 2 h. Pain is severe (8 out of 10), centered under sternum, and radiates to the L arm and jaw. Pain woke patient from sleep, and is w/o D with movement or breathing. O: Pt. has a h/o ASHD, MI 1/15/01, HTN, and DM. Meds include ASA, insulin, lasix, and lisinopril. Allergic to PCN. On exam pt is A+O x 4, diaphoretic, and anxious. HEENT: PERL. Neck: – JVD, positive use of accessory muscles. Chest: BS crackles at bases, + retractions. Abdomen: soft, non-tender. Extremities: ¾ edema/clubbing/cyanosis. A: r/o chest pain of cardiac origin P: Oxygen (15L NRB), IV NS TKO, cardiac monitor, monitor V.S., transport position of comfort, NTG x 3 and MS 2 mg IV with decrease in pain from an 8 to a 3, ASA deferred as patient had a dose today.

21. Conclusions / Summary • Contemporary calls for integrated health care are facilitating the entry of mental health providers more than ever before • Mental health providers who wish to work in medical contexts must learn how to “speak medicine” • General practices/contexts • Specialized practices/contexts

22. Discussion and Q & A

23. Learning Aids and Resources Henderson, B., & Dorsey, J. (2009). Medical Terminology for Dummies. Wiley Publishing: Indianapolis, IN. Steiner, S. (2003). Quick Medical Terminology: A Self-Teaching Guide (4th edition). Wiley & Sons: Hoboken, NJ. TeacherWeb (2011). Medical Terminology Quiz. Available at: http://teacherweb.com/TX/TaylorHighSchool/RoyChampion/response2.aspx Turley, S. (2010). Medical Language: Immerse Yourself. Prentice Hall: Upper Saddle River, NJ

24. Tai Mendenhall, Ph.D. 717 Delaware St. SE University of Minnesota Medical School Family Medicine & Community Health Minneapolis, MN 55414 mend0009@umn.edu 612-624-3138 Contact Information Angela Lamson, PhD 150 Rivers Building East Carolina University Child Development & Family Relations lamsona@ecu.edu 252-737-2042 Jennifer Hodgson, PhD • 150 Rivers Building East Carolina University • Child Development & Family Relations Greenville, NC 27858-4353 Hodgsonj@ecu.edu 252-328-1349

25. Session Evaluation Please complete and return theevaluation form to the classroom monitor before leaving this session. Thank you!