Translating the Languages of Mental Health and Medicine

Tai J. Mendenhall, PhD, LMFT, CFTAssistant Professor & Coordinator of Behavioral Medicine Education

University of Minnesota Medical School

Jennifer L. Hodgson, PhD, LMFTAssociate Professor, East Carolina University

Angela L. Lamson, PhD, LMFT, CLFEAssociate Professor & Director of MFT (MS) and MedFT (PhD) Programs

East Carolina University

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Session # I4aOctober 29, 201110:30 AM

Faculty DisclosureI/We have not had any relevant financial relationships

during the past 12 months.

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.”

ObjectivesDiscuss 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.

Expected OutcomeAt 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.

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

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 originP: 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.

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

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

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

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

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

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

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

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

Records & Communication, con’t

• Types/Examples of EMRs– Allscripts– Medicfusion– MedWorxs

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

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

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/Roy

Champion/response2.aspx

Back to that note…

Translating ExerciseS: 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 originP: 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.

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

Discussion and Q & A

Learning Aids and ResourcesHenderson, 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

Contact InformationTai Mendenhall, Ph.D.717 Delaware St. SEUniversity of MinnesotaMedical SchoolFamily Medicine &

Community HealthMinneapolis, MN 55414mend0009@umn.edu612-624-3138

Angela Lamson, PhD150 Rivers BuildingEast Carolina UniversityChild Development & Family

Relationslamsona@ecu.edu252-737-2042

Jennifer Hodgson, PhD150 Rivers BuildingEast Carolina UniversityChild Development & Family

RelationsGreenville, NC 27858-4353Hodgsonj@ecu.edu252-328-1349

Session Evaluation

Please complete and return theevaluation form to the classroom monitor

before leaving this session.

Thank you!