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The coronavirus has pushed everyone inside for the foreseeable future, which has forced people to adapt to a new way of living and a new way of working. Industries such as the service industry and its employees have been decimated by the social distancing guidelines, which has put many employees on unemployment. However, the health industry as a whole has been called into action at unprecedented levels, and there have been many adjustments, to put it mildly. Direct line medical workers are shorthanded due to losing workers from exposure to the virus. Job boards have posted vacancies recruiting help to manage the crowds of people flooding into medical facilities, and Governors have been pleading for government assistance in recruiting more supplies such as sanitary gloves, N95 masks, and ventilators.

Larger states such as California were fortunate to receive equipment but had to improvise as Governor Gavin Newsome said, “170 ventilators that came from the national stockpile directly” to Los Angeles county were “not working.” But, he added, “rather than pointing fingers, authorities in California transported the ventilators to a facility to get them fixed by San Jose-based Bloom Energy.” While other smaller states such as South Dakota have had to creatively seek out equipment due to unforeseen circumstances according to South Dakota Gov. Kristi Noem, “We were for two weeks requesting reagents for our public health lab from [Centers for Disease Control and Prevention], who pushed up to private suppliers, who kept canceling orders on us.”

These types of audibles have become the new normal for legislators and healthcare professionals. Those who are working in the health industry but are not on the front lines are still being forced to adapt to managing and organizing projects without in-person contact or remotely from home. Many administrators in the medical field do not enjoy the freedom to information and access to colleagues they did a few weeks ago, which has required the implementation of new communication strategies and means of accessing patient data. The healthcare industry as a whole has to rethink how patients are cared for.

While the hospitals are frantically treating patients, and lobbying for emergency equipment, the mental health field was modifying how the treatment was administered. When workforces were whittled down to only life-essential personnel, the mental health industry field continued to work diligently to support patients in a variety of ways. Inpatient clinical staff have been forced to incorporate protocols to include recommendations from the CDC while continuing to treat patients. Most non-emergency related residential services have transitioned to a work from a home model, with minimal visits to the office for staff members and no in-person contact with clients, except for the mental health crisis, and emergency contingencies.

While these modifications were absolutely necessary to ensure continuity of care for mental health clients, changes to the way care is administered have provided a new set of obstacles for clinicians and therapists to perform their duties. Working remotely introduces new variables into the environment that interfere with securing the privacy of medical records information, limits certain types of case management with other clinicians, and removes many billable services a lot of non-profits depend on to continue servicing clients. There are benefits for remote video conferencing with clients, such as the client being in their natural environment for sessions will allow for a more authentic session with less reactivity from the client. However, being in the natural environment may trigger certain behaviors or evoke responses that, although useful for the clinician to observe, maybe emotionally harmful to the client. Therapists are limited in their resources to reduce clients through video conferencing, so the first session or two may take some time to establish some comfort in this new arrangement.

Maintaining privacy at home

Medical professionals know how important following HIPAA guidelines are for securing their clients’ privacy. When at home, safeguards implemented at the office have to be replicated to shield from outside sources. Children are at home being homeschooled, significant others are walking around the house, and more people are video conferencing to stay in touch with friends and family, which opens more wandering eyes to any information left in plain view. Therefore

The Website Total HIPAA Compliance recommends employers and employees abide by the following guidelines.

• Encrypt home wireless router traffic using WPA2-AES. This is a pretty standard configuration, and most routers these days come pre-configured.
• Change default passwords for wireless routers to something difficult. This provides an extra layer of protection.
• Make sure that all devices accessing your network are properly configured by IT. Devices must be encrypted, password-protected, and installed with software firewalls, and anti-virus software is installed.
• Require that employees use a VPN when they access the company’s Intranet remotely.
• All PHI must be encrypted before being transmitted. This can either be through the company’s Intranet or using internal email encryption.
• Encrypt and password-protect any personal devices employees use to access PHI.
• Have your IT department or vendor configure personal devices before allowing them access to the network. Specify what brands and versions of personal devices can access the company data.
• Employees should not allow any friends, family, etc. to use devices that contain PHI.
• Have each employee sign a Confidentiality Agreement to assure the utmost privacy when handling PHI.
• Create a Bring Your Own Device (BYOD) Agreement with clear usage rules.
• Employees who store a hard copy (paper) PHI in their home office needs a lockable file cabinet or safe to store the information.
• Employees need a shredder at their location for the destruction of paper PHI once it is no longer needed. The company needs to specify when it is ok to dispose of any paper records.
• Employees must follow the organization’s Media Sanitization Policy for the disposal of all PHI or devices storing PHI.
• Make sure employees disconnect from the company network when they are done working. Usually, IT configuring timeouts take care of this.
• Employees cannot copy any PHI to external media not approved by the company. This includes flash drives and hard drives. You may require all PHI to stay on the company network.
• Keep logs of remote access activity and review them periodically. IT should disable any accounts inactive for more than 30 days.
• Mandate that any employees in violation of these procedures will be subject to the company’s Sanction Policy and/or civil and criminal penalties.

For more information on recommendations regarding maintaining HIPAA compliance, visit https://www.totalhipaa.com

Collaborating with other professionals and clients remotely

With personal health information being sensitive, and the pandemic prohibiting in-person contact, the collaboration between other health professionals has changed. Each entity will have its own protocol for how to provide team-wide support during these times, and questions for specific cases should be answered by direct supervisors. With insurance billing protocols requiring direct contact with other health professionals when preforming case management, most meetings are taking place through video conferencing sessions and phone calls.

When working from home, be mindful of your surroundings and who is within earshot of your home office space when discussing sensitive client information. Make sure others in the house are far away from your space, the door to your workspace is closed, and you are talking at a volume acceptable for your colleague to hear but not everyone in your home. If you are multitasking as a home school teacher and attempting to provide client care, make sure you have implemented a system to reduce interruptions from your children, for suggestions on how to develop successful strategies for teaching homeschool and working, see the previous blog, Productivity during the shutdown.

If other obligations in the home are going to require your attention, be mindful when scheduling a meeting with your colleagues or clients. To prevent the possibility of exposing a client’ s personal health information or a colleague’s privacy unnecessarily, don’t schedule a meeting if you anticipate you cannot offer your uninterrupted attention. If needed, use textual prompts, or a written sign on your workspace to communicate to your housemates during non-emergency situations that you are busy in a meeting and cannot be bothered. On the chance there is an emergency, have a plan established for how you will respond to any various contingencies that may arise. Understanding, not everything can be foreseen, conduct brainstorming sessions with those in your home about not only what constitutes an emergency, but also what emergencies may come up. Attempt to develop as many plans as possible for any situations that may arise, and empower others in your home when able with solutions on how to manage the crisis, and how you will be notified and be involved.

Inform your clients and colleagues in the beginning if you are wearing multiple hats from home and prepare them for any interruptions you may anticipate. Also, give your colleagues and clients a voice in the matter. If, despite your efforts, you have multiple interruptions from your children, and whomever you are meeting with seems distraught, or displays negative body language, offer them a way out. Show sincere contrition, but don’t show frustration with the situation, no matter how upset you may be. If you are put out with your children interrupting you, or a technical issue with your computer, remember the person meeting with you is the one whose frustration needs to be validated. Positively reinforce them for their patience, ask if another time works better, and apologize for the issue. Thank them for their flexibility during this unusual time and reaffirm your commitment to providing them the proper attention they deserve.

Time Management

Philosopher Henry David Thoreau said, “It’s not enough to be busy, so are the ants. The question is, what are we busy about?” Working remotely from home is full of distractions and time-wasting pitfalls. For many, home is the place they are used to working their other job as a parent, a partner, or just a normal person seeking refuge from their job. Home is full of tasks, pets, and freedom that does not exist at work. Being mindful of what obstacles you have at home is crucial to successfully accomplish your job-related tasks during the hours you are required to complete them. You won’t have your supervisor walking past your door as a reminder to stay on task, so it will be an individual effort to stay on track and be organized each day.

According to William Shakespeare, “Time and the hour run through the roughest day.” Therefore, it is essential to have a schedule and an organizational system that will keep you productive and prepare you for any contingency that may arise. The days won’t stop, so it is best to be ready for them. For anyone who is not accustomed to working remotely, there may be some anxiety to the new structure and multi-tasking other responsibilities while attempting to complete arduous projects with other colleagues, or performing therapy with clients. The best way to prevent compounding more anxiety on top is to be organized and have a system that works for you.

Each individual has a unique learning style and working technique. Take advantage of some of the new freedom of being in your home environment to develop a workspace that fits you, and most importantly, make you physically and emotionally comfortable. Don’t use a steel folding chair facing a wall if you know you won’t get any work done. After guaranteeing your workspace meets all the criteria for HIPAA compliance, find a chair or a makeshift standing desk area that you can productively work an eight-hour workday in. Situate yourself near a window if you need light, and make sure you have enough lamps and other stimuli that ensure you can read the information you are responsible for without being laborious on your eyes. Put some pictures in your space that don’t distract you, but make you feel happy and joyous.

Use motivational quotes to kick your inspirational side into gear. Maybe It is Charles Darwin informing you, “A man who dares to waste one hour of life has not discovered life.” Or, perhaps, you need Kobe Bryant to remind you, “If you are afraid to fail, then you will probably fail.” Whichever learning style fits you the best, make sure you have plenty of reinforcement to keep you powering through each day with a sense of purpose.

Because medical billing is crucial to many positions in the medical field, those who are working remotely need to be aware of what is billable time, and what is not. There also needs to be an individualized data collection system to trap the time accurately. Don’t just assume the system you use at the office will work; this is a different environment with different variables, so take all those into account before implementing it. There will be huge vacancies of billable time for residential clinicians due to the loss of billable drive time to administer direct services. Those time gaps will need to be filled, and that time will need to be reflected in the data log created to manage virtual meetings and phone calls.

Be transparent with yourself about your system and make changes when needed. Provide some flexibility to make small adjustments to avoid major overhauls, and always be forward-thinking about possible intrusions to your workspace. Within reason, try and keep the same structure to your work schedule each day as you had at the office, and avoid lazy shortcuts, like waking up ten minutes before work, rolling out of bed and punching the time clock half asleep because you are at home. You don’t have to wear your Sunday best, or even put forth the amount of effect you were in the mornings to get yourself together. But, keep in mind you may still interface with people all day, and beyond looking presentable, you want to be alert and ready to work.

Create a schedule that allows enough time for breakfast and hygiene in the mornings, but also enough time to plan your day with your family. Alert them to any times that are off-limits for interruptions, and schedule a lunch break together so you can collaborate and discuss your days at school and work if applicable. Designate a time you are off the clock and barring an emergency, stick to it. Know when you are at work and when you are at home. Try to distinguish the differences between your tasks to prevent overlap and train your mind to discern when it is appropriate to engage in certain activates such as watching television, checking social media, and when it is time to keep those devices off.

In your home domain, it will be up to you to succeed, but don’t be afraid to discuss what is successful about working at home, and what is not working with your colleagues. Take tips from them, and offer suggestions based on your experiences. This type of teamwork is imperative to keeping social connection through this unprecedented time in our history. Teamwork is essential, and encouragement in all areas helps us become more rounded. Kobe Bryant said it perfectly, “The most important thing is to try and inspire people so they can be great in whatever they do.”