Electronic Health Records: What Consumers Should Know about Cummins’ New System

December 30, 2020 Mark Wilhelm

Have you ever given much thought to your personal health records?

If you’re like most people, then this isn’t a subject that comes up often in your day-to-day life. However, the detailed records kept by your various health care providers play a vital role in your overall well-being. These records help providers track the progress of your health and any treatments you’ve received, which keeps everyone up to date so they can provide you with the best possible care.

These records have traditionally been kept in the form of paper documents and patient charts, but this is beginning to change as computer technologies become ever more pervasive. Many health care providers are now using digital versions of patient forms, known as electronic health records, or EHRs, to do everything from document consent to treat to return lab results and store medical information.

Here at Cummins, we have recently adopted an EHR system in order to better serve our consumers. However, this new system brings a few important changes to the way our consumers can engage with their care. In this blog post, we explain how EHRs enable better person-centered care for consumers and what changes you should expect as a result of our new system!

The Ins and Outs of EHR

As we mentioned above, an electronic health record is essentially a digital or electronic version of the paper charts in your health care provider’s office. You can think of it like a virtual filing cabinet, not unlike the “files” stored on a computer. The information in an EHR can be stored and accessed using specifically-designed software applications.

HealthIT.gov explains, “EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care.”

For example, an EHR may include the following information about a patient:

Medical history
Diagnoses
Prescribed medications
Current treatment plans
Immunization records
Allergies
Radiology images
Lab and test results

EHR software can automate and streamline the data information and retrieval that care providers must perform, and most importantly, allow them to easily share this information with providers at other health care organizations. HealthIT.gov continues, “EHRs are built to share information with other health care providers and organizations—such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics—so they contain information from all clinicians involved in a patient’s care.”

How EHRs Benefit Health Care Consumers

The features and functionality of an EHR can improve a consumer’s care experience in several important ways.

First, EHRs can improve quality of care by helping providers adhere to evidence-based guidelines for treatment. One 2011 review of EHR systems states, “EHRs, especially those with clinical decision support tools, have been empirically linked to an increased adherence to evidence-based clinical guidelines and effective care. Despite the best intention of providers, various factors may result in patient encounters that do not adhere to best practice guidelines. Some reasons for this nonadherence include i) clinicians not knowing the guidelines, ii) clinicians not realizing that a guideline applies to a given patient, and iii) lack of time during the patient visit.”

Second, the digital nature of EHRs makes it easier for health care providers to share forms and information with each other. For example, this means that your therapist can share updates on your treatment and any new medications you may be taking with your primary care physician and any other clinicians you see. According to the U.S. Department of Health & Human Services, “When doctors, pharmacies, labs, and other members of your health care team are able to share information, you may no longer have to fill out all the same forms over and over again, wait for paper records to be passed from one doctor to the other, or carry those records yourself.”

Finally, EHRs give consumers an opportunity to take increased ownership over their care. Most EHRs include a “patient portal” through which consumers may access their care records, receive test results, review their treatment plan, and communicate with their care team. These features give consumers more ways to take control of their care, which can help to ensure that it is truly centered on the individual.

“EHRs and other health IT developments tend to make many patients more active participants in their own health care,” HealthIT.gov concludes.

Getting Started with Cummins’ New EHR System

Using Cummins’ new EHR will require you to familiarize yourself with the Patient Portal. The EHR system we use is called Streamline, and you’ll need to create a patient account on Streamline in order to begin using the portal. You can follow the steps below to get started.

Logging into Your Patient Portal

To access the Patient Portal, you’ll need to use the Google Chrome web browser on your mobile phone, tablet or PC. If you don’t have Google Chrome, you can download the browser by visiting https://www.google.com/chrome/ and clicking the “Download Chrome” button.

From the Google Chrome browser, you can either:

Navigate to https://www.cumminsbhs.org/ and click the MyLink icon in the top right corner of the screen if you are on desktop, or find it in the menu sidebar if you are using a mobile device
Navigate directly to https://cbhsc.smartcarenet.com/CBHSmartcareProd/Login.aspx

Updating Your Password and Security Questions

The first time you log into the Patient Portal, you’ll need to reset your password and choose your security questions. At the login screen, enter the username and password you were given by your care provider.

If you’ve forgotten your username and password, please make sure you have your personal information and identification number available, and then call our Centralized Access Department at (888) 714-1927. At the automated menu, press 5 to speak with other departments, then press 2 for Business Records & Health Information System.

After entering your username and password, click the Login button. You will see this message:

Click the OK button, and then you will see the following form:

Enter the password you were given in the “Old Password” field, and then enter a new password of your choice in the “New Password” and “Confirm Password” fields. Then click the OK button.

This will return you to the login screen with your username and new password pre-filled in the fields:

If for some reason your username and new password are not pre-filled, simply enter them in the fields. Then click the Login button.

You will then be presented with a form that asks you to select and answer three security questions:

Click the Save button when you’re finished, and you’ll be redirected to the Patient Portal homepage, which looks like this:

Changing Your Preferences

Once inside the Patient Portal, you can change your password, security questions, and contact preferences at any time. To do so, click the “My Office” tab at the top left of the screen, select “My Work” from the left-hand menu, and then select “My Preferences.”

You will be directed to the following screen:

After making any desired changes, click the green Save button in the top right corner.

Completing Registration Documents

Finally, new Cummins consumers will need to complete several forms inside the Patient Portal before their first appointment.

Adult consumers will need to complete the following forms:

Consent for treatment
Consent for virtual services
Physical health screening
PHQ-9
GAD-7

Child consumers (ages 5–11) will need to have the following forms completed by their parent or legal guardian:

Consent for treatment
Consent for virtual services
Physical health screening
Youth – CRAFFT
Parent Vanderbilt
Youth Symptom Checklist

Adolescent consumers (ages 12–17) will need their parent or legal guardian to complete the following forms:

Consent for treatment
Consent for virtual services
Physical health screening
Youth – CRAFFT
Parent Vanderbilt

In addition, adolescent consumers will also need to complete these forms by themselves:

PHQ-A
GAD-7

All of these forms can be found on the Patient Portal homepage. Make sure you’ve selected the tab with your name at the top left of the screen, then examine the left-hand menu and click on the form you’d like to fill out.

Electronic health records, like any new technology, can take some getting used to for both providers and consumers of behavioral health care. However, they’ve been shown to significantly improve quality of care, and they empower consumers to take greater control over their own health care!

We’re very excited to be using Streamline EHR to improve the services we provide here at Cummins Behavioral Health! If you have any questions about the new system, feel free to contact our Centralized Access Department at (888) 714-1927.

Tips for Nutrition and Healthy Eating During the Holiday Season

December 24, 2020 Mark Wilhelm

The end-of-year holidays have arrived, and for many people, the holiday season is closely connected to food.

Those of us who celebrate Christmas typically bake cookies, pies, and other sweets and cook traditional Christmas dinners featuring an abundance of hearty dishes. Celebrants of Hanukkah eat a variety of fried dough or fried potato treats like sufganiyot, latkes, and fritas de prasa, and they might also prepare feasts with roast goose. And although New Year’s Eve is often associated with alcoholic beverages, some Americans choose to celebrate the New Year by eating pork, cabbage, black-eyed peas, and lentil soup.

With all this food around, many people worry about gaining weight due to holiday-related eating. However, the effect of the food we eat goes beyond our waistline. As we’ve previously discussed on our blog, nutrition can also have a significant impact on our mental health. This is because the same nutrients that change our bodily functioning also affect the chemical processes in our brains, which can lead to changes in cognition and emotion.

Just as a little overindulgence won’t hurt our bodies in the long run, neither will it severely impact our mental health—but a consistently poor diet over a long period of time can be quite damaging to our physical and mental health. That’s why it’s important to be mindful of what and how much we eat, especially when we’re tempted by an abundance of delectable dishes.

In this blog post, we highlight several nutritional facts you should keep in mind to practice healthy eating throughout the holiday season!

Binge Eating and Mood Disorders

It’s very easy to overeat during the holidays, and many people end up consuming more calories than normal. Eating large amounts of food in a short period of time is known as “binge eating,” which isn’t particularly dangerous to our health if we only do it once in a while.

However, some people may feel the urge to binge eat more frequently, as often as one or more times each week. When this is the case, they may suffer from binge eating disorder, which the Mayo Clinic defines as “a serious eating disorder in which you frequently consume unusually large amounts of food and feel unable to stop eating.” People with binge eating disorder may feel that they can’t control how much they eat, and they may feel shame or disgust with themselves after binging.

It’s not surprising, then, that binge eating disorder tends to co-occur with mood and anxiety disorders. A person who has binge eating disorder may eat in order to improve their mood, but the resulting guilt about their actions may end up worsening their mood instead. Even people who experience depression alone may feel negatively about themselves after a period of binge eating, even if they only overeat a single time.

For these reasons, people who suffer from binge eating disorder or a mood or anxiety disorder should be cautious about overeating during the holidays.

Fatty Foods and Brain Health

For many years, nutritionists and dietitians have been sounding the alarm about high-fat diets and their harm on the human body. Most notably, diets that are high in cholesterol, saturated fats and trans fats are heavily associated with heart disease, which is the leading cause of death for both men and women in the U.S. These same “bad” fats can also cause irregularities in our brains.

The brain, like the rest of the body, actually needs a certain amount of dietary fats for healthy functioning. Medical writer Dr. Maria Cohut notes, “The brains of mammals, including humans, actually need certain fatty acids—such as omega-3—to function correctly. Humans bodies, in particular, cannot synthesize fatty acids on their own, and so they need to absorb these nutrients from food. However, not all fatty acids are as healthful, and the overaccumulation of fatty acids in the body can lead to health problems.”

For example, some research has linked fatty acid buildup in the brains of laboratory mice with symptoms of depression. “It seems the high levels of palmitic acid in the hypothalamus alter a signaling pathway that researchers associate with traits of depression,” Cohut writes. “Thus, in mice at least, the researchers were able to confirm that the absorption of certain dietary fats has a direct impact on brain-signaling pathways that influence the development of depression.”

Other research has shown that high-fat diets can cause inflammation in the hypothalamus, which may send signals that cause us to eat more and gain weight. All of which is to say that we should limit our consumption of highly fatty foods like red meat, processed meat, butter, palm oil, pastries, and full-fat dairy products.

Sugar, Cognition, and Cravings

Sugar, like fat, is an essential part of any diet. In fact, it’s an especially important nutrient for our brains. “The brain uses more energy than any other organ in the human body and glucose is its primary source of fuel,” writes Dr. Joel Fuhrman. But like many other dietary nutrients, too much sugar can be a bad thing for both our bodies and our minds.

Once again, higher levels of sugar consumption have been scientifically linked to higher instances of depression among the general population. And among people who have type 2 diabetes, elevated blood sugar levels have also been associated with feelings of both sadness and anxiety.

In addition, excessive amounts of sugar can have negative effects on our cognitive functioning. For example, studies have found that some diabetics suffer from decreased cognitive performance that may worsen over time, leading to deficits in learning, memory, and motor speed. Fuhrman adds, “Even in those without diabetes, higher sugar consumption is associated with lower scores on tests of cognitive function. These effects are thought to be due to a combination of hyperglycemia, hypertension, insulin resistance, and elevated cholesterol.”

Finally, research suggests that sugar may activate the brain’s reward center in much the same way as alcohol and other addictive substances, which means that eating large amounts of sugar might make it harder to resist the craving for more. This is all the more reason to eat fewer sugary treats than we might like to this holiday season.

It’s hard to avoid a bit of unhealthy eating during the holidays, but we should always try to keep our health in mind as we celebrate! We encourage you to limit your dietary fats and sugars, avoid excessive overeating, and adhere to your regular diet as much as possible to help manage your mental health and wellness this holiday season.

On behalf of all of us at Cummins Behavioral Health, we wish you a very happy holiday season and a prosperous New Year!

Crisis De-Escalation: Tips and Advice for Defusing Difficult Situations

December 16, 2020 Mark Wilhelm

Think back to the last time you witnessed another person become very upset or agitated. What caused them to feel this way, and what did they do in response? Did you or another person attempt to calm them down? What did you try, and how effective was it? Was the situation defused successfully, or did it escalate?

When someone is extremely annoyed, angry or afraid, they may react with hostility toward the person or situation that caused these feelings. This can often lead to conflict between two or more people, which might include verbal argument or even physical violence. In some situations, the person may enter a state of crisis, which Merriam-Webster dictionary describes as “a [sudden and violent] attack of pain, distress, or disordered function.”

A person who is in crisis may be especially dangerous during a conflict. Because they are highly agitated, they may act on their emotions without stopping to consider the consequences, which could bring harm to themselves or others. Knowing how to effectively calm a person in crisis— known as crisis de-escalation or intervention—is a highly valuable skill in these situations.

However, de-escalation can be a complicated task. The intervening person must be able to assess the situation and react in a way that will disarm it rather than inflame it. They must understand what has upset the person in crisis and know which words and actions have the best chance of calming them down.

To learn more about crisis de-escalation, we spoke with Carmen Bergman, MSW, LSW, a school-based therapist in Fort Wayne, IN. Bergman is a Master-level instructor of Nonviolent Crisis Intervention, a popular de-escalation model taught by the Crisis Prevention Institute. As an experienced trainer in the CPI model, Bergman explained how someone can identify when a crisis is developing, what they can do to defuse that crisis, and how they can stay calm and focused during the difficult work of de-escalation.

Spotting the Signs of Crisis

To begin, it’s important to note that the goal of de-escalation is to defuse crises before they reach the point of physical aggression or violence. “When you talk about nonviolent crisis intervention, some people immediately think of holding skills and how to protect yourself from physical attacks. But that’s only a small chunk of it,” Bergman explains. “All the rest is about preventing escalation to the point where it becomes physical.”

Under the Nonviolent Crisis Intervention model, also known as the CPI model or simply CPI, the person doing de-escalation must think about the safety and well-being of everyone involved in a crisis situation. Bergman says, “The main philosophy is care, welfare, safety and security for all. It’s not just for the person who’s in crisis and the person handling the crisis; it’s also for any people who are witnessing the event.”

The first element of successful de-escalation is early identification that a crisis may be developing. Many factors go into this process, but it largely involves being aware of the person’s behavior and the larger situation at hand. Bergman explains some of the things she considers when looking for signs of crisis: “I’m assessing what’s in the room and who is in the room. I’m assessing nonverbal communication, because it’s not what someone says, but how they say it. I’m looking at facial expressions, I’m looking at body language, I’m looking at the spatial piece, like how close they are to me and how close I am to the exit. I’m also looking at how they’re speaking—their tone, their volume, and their cadence.”

Once we’ve assessed the potential for crisis—or how far the crisis has already progressed—we can begin to determine the appropriate response. Bergman illustrates what this might look like:

“As I’m collecting all this information, I use what’s called the ‘decision-making matrix’ to assess the situation. Whether it’s somebody I’ve worked with before or somebody I’ve never worked with before, I take all the information that’s coming in and continually use the decision-making matrix to assess: Do I just need verbal de-escalation? Or do I need to use disengagement skills, like protecting myself if somebody tries to hit or kick me, or if they’re grabbing at me? Or is it to the point where there’s immediate risk of harm to myself or others? Do I need to use a holding skill?”

Strategies for Verbal De-Escalation

Whenever possible, de-escalation should begin with a conversation between the person in crisis and the person attempting to intervene—otherwise known as verbal de-escalation. As always, the goal is to defuse the situation by making the agitated person feel heard, understood and respected.

The way we speak to a person during de-escalating is just as important as the words we say to them. “When I teach de-escalation, I talk about paraverbal and nonverbal communication. Paraverbal communication is the tone, the volume and the cadence,” Bergman explains. “For example, I immediately ask everybody, ‘Who speaks sarcasm as a second language?’ Because if you approach someone with sarcastic, dry humor to try to lighten the mood, it’s going to make it worse. Put the sarcasm away and just use very natural, even-keeled, even-toned patterns of communication.”

The volume of our speech is also important in these situations, and we can even use it to help lower the level of tension. Bergman says, “Sometimes if somebody is screaming and yelling, I’ll bring my volume down a notch, and sometimes they’ll match me. And I’ll bring it down a bit more, and they’ll match me again until we’re having a nice, even, calm conversation.”

Other strategies for verbal de-escalation include: lowering yourself to the other person’s eye level if you are taller than them, which can make you appear less threatening; persuading them to sit down with you, which can help them feel more calm; and standing beside them rather than across from them, which can make the conversation feel less confrontational.

It’s also important to remember that the individual in crisis may respond negatively to your de-escalation attempts, so you should try not to take any insults or aggression personally. Bergman explains,

“We talk about rationally detaching and not taking it personally. You know, it’s not about you. Sometimes we can get very egocentric, like, ‘If you don’t respect me, I don’t have to respect you.’ That’s kind of like two fools arguing; nobody wins in that situation. There have been times when I’ve taken it personally, and I needed to step back and take a breath. It’s not about me, but it became about me when I let that power struggle happen. If I’m met with rudeness and disrespect, I’m going to still respect the other person as a human being, because that’s who I am, and that’s my character.”

Staying Centered During De-Escalation

Unfortunately, crisis de-escalation can be very stressful work. It can be difficult to deal with aggression and negativity without reflecting it back to the person in crisis. Therefore, we need to know how to manage our own emotions and mental well-being in order to stay focused and effective during de-escalation.

Self-awareness is the first component of this. In order to regulate our emotions, we need to monitor how we feel and understand what things are likely to upset us. Bergman says, “What makes you anxious? What are the things that make you fearful? What are you worried about?” Once we know the answers to these questions, we’ll be better prepared to handle upsetting words and actions without becoming agitated.

Self-care is another vital part of maintaining resilience. Dealing with other people’s crises is mentally and emotionally taxing, which is why we must find ways to replenish that spent energy. Bergman refers to this as “refilling your Care Cup”: “We’re absorbing so much negative energy that we need to do something positive to fill up our Care Cup. We’re pouring so much out that if we don’t fill it up again, we’re not going to be useful anymore.” Normal wellness behaviors like getting plenty of sleep, eating a health diet, exercising regularly and practicing mindfulness can help with this.

Bergman points out that de-escalating with a team can be an excellent option if others are available to help. In these situations, one person can lead the de-escalation while the others provide support as needed. “When you respond as a team, sometimes the leader is the first person who arrives, sometimes it’s the person who has the best rapport with the individual, and sometimes it’s just the person who is most competent and confident,” Bergman says.

Finally, sometimes the best we can do just isn’t good enough. When this happens, it’s best to cut our losses and let someone else take over, if possible. “When I teach, I talk about ‘tap outs,’ “ Bergman explains. “If somebody is starting to add fuel to the fire—if you’re trying to de-escalate, but the person is mad at you—have somebody else step in. It’s not that you aren’t doing your job well enough. It has nothing to do with you. It’s just what’s best for that person at that moment.”

Conflict and crisis can be frightening and stressful when they occur. A person who is experiencing an emotional crisis may pose a danger to themselves and others, which is why proper de-escalation is so important.

We encourage you to use the information and strategies in this blog when attempting to de-escalate someone who is in crisis. However, you shouldn’t hesitate to seek out professional assistance when necessary. If you ever feel overwhelmed or afraid for your safety while attempting de-escalation, get help from someone with more training and experience handling difficult situations!

With the right help, crises can be de-escalated and individuals who experience them can get the behavioral health care they deserve!

For advice on handling other types of difficult situations, we recommend reading our blog posts on Conscious Discipline and domestic violence intervention below!