11-inch-and-below screens are typically reserved for mini-notebooks/netbooks; typically machines powered by an Intel Atom processor. These machines usually have small screens, relatively small hard drives, and shrunken keyboards to match, so they are usually positioned as a "companion": an additional machine for someone who already has a desktop or laptop. The advantage of these machines is that they tend to be lightweight and inexpensive. Disadvantages: They aren't fast; they sometimes can't handle HD video very well; and the small keyboard and display make tasks like word processing less convenient than with their larger brethren.

13-inch displays represent what I think of as the sweet spot among today's notebooks. These machines tend to be lighter than the larger machines, but are still big enough to have full-size keyboards, though many lack an optical drive. They are quite mobile, but they often have slower processors and higher price tags than 14- and 15-inch laptops.

14 and 15-inch displays represent the mainstream, accounting for most of the notebooks you'll see. The least expensive full-featured notebooks fall into this category; you'll pay more for faster processors and thinner designs. I recommend picking up the machines and noting the difference in weight and screen size. Often, this makes a bigger difference in your perception of the machine than any of the specs.

16 and 17-inch displays are usually found on "desktop replacement" notebooks, where the large screen is typically designed for content creation, Blu-ray playback, or for gaming. I typically find the 17-inch models just too big to travel with, but know people who carry them around for LAN-based gaming.

How important is gaming? If gaming is very important to you, then look for a 15-inch-or-larger display and a machine that includes a discrete graphics processor (either ATI Radeon or Nvidia GeForce.) A Quad Core processor is probably the fastest you'll find here, but battery life is likely to be an issue. You'll get the best battery life if the machine can switch between integrated and discrete graphics.

If you're more into casual gaming, again, a discrete graphics processor is fine, but many machines with AMD integrated graphics will be good enough. Intel's integrated graphics are suitable for Web browsing and productivity, but not ideal for gaming.

How important is performance? For video transcoding, the latest ATI and Nvidia graphics products offer some advantages, just as in graphics. For typical web browsing and productivity, that doesn't matter much yet (though some Flash use of GPUs is coming), so you might be better off with an integrated graphics solution. Again, you'll find a quad-core Intel Core i7 mobile processor is probably the fastest you'll find here; but battery life is likely to be an issue. You'll get the best battery life if the machine can switch between integrated and discrete graphics. Among dual-core solutions, in general, I've found the Intel processors to be a bit faster at compute-intensive applications and the AMD solutions to be a bit better at graphics, but either way, today's machines handle the basics pretty well. (See some of my test results here.)

Notebook computers with 4GB of memory and the 64-bit version of Windows are now commonplace. There's very little reason to go beyond that these days. In fact,a 2GB system with a 32-bit version will be nearly as fast as long as you aren't doing a lot of multitasking.

How important is battery life? Among full-featured laptops, you'll typically get the best life from either an Intel "ultra low voltage" processor, typically found on 13-in machines; or from a machine with a larger than normal built-in battery (like Apple's MacBook Pro line.) Both are somewhat more expensive option than normal, but that may be worth it to you. If it's only occasionally important, you might be better off with a normal laptop, but an extra battery (not an option on the Apple products, but typically available otherwise.)

Among mainstream 14-and 15-inch Windows laptops, you'll typically get 2-3 hours of real use on a single battery, depending on what you are doing. (I find the battery life numbers the retail stores and most web sites quote to be wildly optimistic.) In general, I've found better battery life on Intel-based dual-core laptops than on AMD-based ones.

After choosing the type of machine, there are a host of little things that should help you choose among brands. If you want a Mac, I'd typically recommend the 13-inch MacBook for relatively inexpensive and relatively portable (though you can find lighter and more affordable Windows machines in this class) or the 15-inch MacBook pro with switchable graphics for content creation and some gaming.

Among Windows machines, you have a lot more choices. I suggest you spend at least a couple of minutes typing on the keyboard, because you'll be surprised how much they differ. I tend to like "full-travel" or traditional keyboards more than "chicklet" keyboards, but it's a matter of personal preference. I also like a touch pad that is centered between the G and H keys, fairly close to the space bar, because I want to be able to use either thumb while keeping my hands on the keyboard for touch typing. I have relatively small hands, and you'd be amazed at how many laptops make it hard.

Make sure the machine you buy has enough ports - you will likely find yourself using a USB port at least on occasion, for an external hard drive, or to connect a phone or music player. An eSATA connection provides a faster way of hooking up a hard drive. You want 802.11n, for connecting to a wireless local area network. Some people also want a connection for a wireless wide area network - essentially the same network used by smart phones - and while this feature is usually not expensive, the data plans can add up quickly. It's about the only real use for an "ExpressCard" slot that's left.

Many people want Blu-Ray; and if you do get that, make sure you also get an HDMI out connection, so you can attach the machine to a large screen TV. But a VGA out port is also needed, if you plan to connect to a standard external monitor or projector.

I recommend a system with a built-in memory card reader, so you can easily bring in pictures from a digital camera; the best systems can read lots of formats, from SD to to Memory Stick; but SD and microSD are probably most useful, and I'm seeing that in the most cameras and phones.

Also, among laptops, design matters, particularly if you'll be carrying the machine around a lot. That's completely personal taste; some people like colors, designs, and textures; others prefer a more basic look. Dell offers a bunch of designs you can pre-order; for many other systems, you can order a printed "skin" that goes over the PC. It's never mattered enough to me to do this, but other people like it.

A lot of this, then, comes down to personal taste. It's worth spending a bit more time looking closely at the machine you want to buy to make sure you get the one that's right for you.]]> http://blogs.pcmag.com/miller/2009/11/laptop_buying_advice_some_thin.php Tue, 01 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1011 Health Information Exchange Regional Extension Center
In a nation of 300 million residents over 3.5 million square miles, there are 193 HIEs in various stages of development, according to eHealth Initiative, a Washington-based industry advocacy organization. By self-attestation, 57 of the HIEs are operational. Most HIEs don't have a sustainable business model, and getting a critical mass of regional stakeholders to cooperate in exchanging their data remains an extremely difficult proposition.

There are other reasons that many observers say HIEs should not be relied on as an anchor of an eventual national health information network, the vast, interconnected system ballyhooed by the federal government. Some argue that a network tantamount in scope - namely, the network of claims clearinghouses - already exists and also could handle clinical transactions. Or, mandated use of data standards and the Continuity of Care Document, a standardized summary of care, coupled with a now-mature Internet infrastructure, could do most of the work that HIEs are supposed to do. In one state where several HIEs are developing, the government is helping fund tests of an alternative model, called health records banks.

On the flip side, fueled by several years of momentum, and recently $300 million in funding via the American Recovery and Reinvestment Act - plus matching state funds - the number of HIEs is growing. One hundred and fifty HIEs responded to eHealth Initiative's survey this year, up from 130 in 2008. The organization then confirmed that 43 HIEs that responded to the 2008 survey but not this year's were still functioning for a total of 193. The 57 reported operational HIEs this year that are actually delivering test results, care summaries and other information was a 36% increase from 2008, which was 31% higher than 2007. And in 2009, 67 HIEs responded to the survey for the first time, compared with 18 a year earlier.

Further, a wide range of HIE models have emerged to meet local needs, and there are several established and proven models to copy. HIEs exchanging laboratory and radiology reports, and outpatient and emergency episodic data, increased significantly in the past year, according to the survey. And hospitals increasingly are realizing that better communication with physicians is good health care and good business, and HIEs can help them link with physicians.

So, does reliance on HIEs to form the network-of-networks mean a national health information network is doomed to fail? Or, are HIEs progressing at good speed and proving to be the model that will work? The Obama Administration, embroiled in deliberations to develop rules that will govern its national health I.T. strategy under ARRA, did not respond to requests to interview Chief Technology Officer Aneesh Chopra and David Blumenthal, M.D., the National Coordinator for Health Information Technology. For others, let the debate begin.

Lay of the Land

Consultant Michael Mytych is a wary proponent of HIEs. "I believe the HIEs can play a very important role, but if they're not set up and are not properly funded, we'll be in big trouble," says the principal of Health Information Consulting LLC, Menomonee Falls, Wis.

Mytych calls the data exchange work already being done in regions across the nation "the Wild Wild West of HIE." The different initiatives are trying to do the same thing, only in a hundred different ways. Asked if HIEs are the right or wrong road to a national network, he adds, "We'd better come to a conclusion pretty quickly because with 193 HIEs out there, there's a lot of money being spent."

For a national health information network to succeed, HIEs need uniformity in handling patient identity and consent, content checking, the Continuity of Care Document and a host of other issues, he contends. "Some of them aren't even paying attention to the need in their own market for EHRs to exchange data with each other."

That's a real problem because Mytych doesn't see many HIEs offering the opportunity to exchange information in discrete data elements that can be uploaded into physician EHRs. And it still is not easy to pull data out of many hospital information systems. HIEs often make laboratory results, medication lists, patient histories and other information available in view-only mode. But if physicians are using this information as part of their clinical decision making process, HIEs have to find a way to get the data into EHRs, he says.

National HIE standards - not just for moving data but for policies such as handling patient consents and behavioral health records - are needed across the board, Mytych believes. He notes that the New York City region has multiple HIEs. "What if specialists have to participate in all of them? That's a lot of coordination to do."

A federal mandate to use a standards-based, machine-readable Continuity of Care Document would be a big step toward showing the value of HIE, Mytych contends. He believes another mandate is necessary but doesn't see policymakers willing to pull the trigger to make it happen. "If the government really wants a national health information network, it would have a national patient identifier. That itself would save billions of dollars."

A Working Model

After exchanging clinical messages for a decade, the HealthBridge HIE serving the greater Cincinnati region is proof that with the right business model, a regional effort can succeed.

Some 5,600 licensed physicians are in HealthBridge's service area. In a typical month, the HIE pushes 3 million lab results, transcribed documents and notifications of admission, discharges and ER visits to more than 5,000 of the doctors, says CEO Robert Steffel. Ninety-six percent are delivered electronically via e-mail, fax or an inbox on a portal. One-third of these 3 million messages comprise discrete data elements that go directly into the EHRs of 1,300 physicians.

Steffel recalls HealthBridge being built on the ashes of three failed community health information networks during the 1990s. Today's HIEs, he contends, are not yesterday's fatally flawed CHINS.

"When I look at what happened to CHINS, that was all about having a proprietary system with a vendor driving it," he notes. "But it turns out you can't buy collaboration from a vendor."

HealthBridge succeeded, Steffel says, because its fee-paying member organizations saw the business advantage of joining. "We were able to go to hospitals and have them outsource results delivery to us." He concedes that HealthBridge's model may not work in rural regions because of economies of scale. The biggest role that states can play in HIE initiatives, he adds, is to support rural connectivity.

Collaboration among stakeholders, however, remains elusive in many regions of the nation. Organizations want to see the clinical value and return on investment before joining an HIE, but the HIE needs enough early adopters to get to the point where it can show value and ROI.

Many HIEs still fail because good intentions aren't supported by a workable business plan, says John Osberg, president of Informed Partners, a Marietta, Ga.-based consulting firm. "You need a business reason that is the foundation for the initiative, and few of the HIEs I've seen have a business reason for being there," he contends. "I don't believe altruism will get you there."

Emerging HIEs need a focused effort to document return on investment, says Jennifer Covich, COO and Interim CEO of eHealth Initiative. And many HIEs need help doing that because the organizations are just trying to sustain themselves. "They don't have the resources to document ROI," she adds. "We need private and public support for documenting best practices and ROI. There are a lot of organizations out there that can learn from each other - they don't need to make the same mistakes." Stimulus funds, Covich hopes, will help accelerate HIE efforts and development of test beds so mistakes can be avoided.

Health Internet?

While the Bush Administration viewed HIEs as the base for a network-of-networks to build a national health information network, that view has changed in recent years. "It's not realistic to think you can just cover the nation with hundreds of disconnected HIEs," Covich says.

She believes, however, that HIEs can serve as a starting point and could help form the foundation of a national infrastructure. For now, HIEs are helping stakeholders figure out a myriad of issues - such as data ownership, access rights and security - associated with widespread health information exchange among disparate organizations.

Over time, Covich sees the nation developing more Web-based systems. The idea of using the existing high-speed Internet infrastructure as a "Health Internet" that continues to mature and is available to more areas of the nation is getting plenty of attention these days.

Two top I.T. officials of the Obama Administration, CTO Aneesh Chopra and HHS CTO Todd Park, in late September attended an invitation-only meeting in Boston with about 100 industry stakeholders. The officials floated the idea of a "Health Internet" to not only serve health care organizations but also consumers.

"They are focusing on messaging and application layers to allow the secure transmission of health information among stakeholders," says meeting participant John Moore of Chilmark Research.

A Health Internet would involve adoption of a standard service-oriented architecture, tailored to the health care environment, but similar to what's used on major online retail sites such as Amazon, Moore explains. A consumer placing a book order on Amazon, for instance, can track the status of the order and real-time shipping status via UPS from the Amazon site. To enable this, Amazon sends out a service call on behalf of the consumer to UPS. This service call - a query and a response by authorized users via the Internet - could be modified for health care needs, Moore contends.

Private and public HIEs would be some of the spurs that would provide data and potentially other services on the Health Internet. But the Health Internet won't have all pertinent information that is needed for clinical and financial decision making, quality and public health reporting, and other needs "for a long time," Moore says.

Dropping the term "national health information network," would help build understanding and momentum for a Health Internet, Moore says. "People can get their hands around the 'Health Internet.'"

Network Already Here?

Across the nation, claims clearinghouse and other electronic data interchange vendors each year electronically transmit billions of claims and related financial/administrative transactions among providers and payers.

Some of these organizations believe the national health information network already exists for financial transactions and that network also could move clinical transactions. "We're wanting to get the message out that we have the track record, connectivity and move millions of transactions a day," says Doug Bilbrey, president of The Cooperative Exchange, a consortium of 12 such vendors. He's also executive vice president at The SSI Group Inc., Mobile, Ala.

Cooperative Exchange members believe the health care EDI network could be the anchor for a national health information network, Bilbrey says. "We believe the infrastructure is built, and it's an industry able to do it now. We have the connectivity and standards in place, we simply need to do it."

Policymakers and health care stakeholders need to make a national network a simple process, and that's what EDI vendors offer, Bilbrey contends. "I don't care what your records look like as long as they can be packaged in a communications protocol and read by the receiver."

Right now, policymakers are unaware that such national connectivity is "right under their noses," Bilbrey contends. He acknowledges that there hasn't until recently been a grassroots advocacy effort by EDI vendors. "Most of us don't have lobbyists in D.C.; we see ourselves as service providers."

Members of The Collective Exchange are starting to reach out to members of Congress and others to get their message heard. "We're optimistic that at some point, we'll get to someone in a policymaking position who will realize we don't have to start at the beginning," Bilbrey says. Cambridge, Mass.-based Navicure Inc. is not a member of The Collective Exchange but supports the effort to raise the visibility of EDI vendors.

Navicure in August sent letters to the governors of all 50 states offering to make its NaviNet Health Information Exchange network - a recent modification of its existing EDI network - available at no cost to state HIEs and regional ones that are state-designated entities. The company would generate revenue via transaction fees paid by HIE users. A month after sending the letters, the company had received responses of "active interest" from several states, says Brad Waugh, CEO.

Navicure offers Web portals to health insurers to enable providers to conduct such electronic transactions as eligibility, referral and claim status. Insurers pay the transaction fees. The company doesn't seek to replace HIEs, but to provide complementary services that states can implement quickly and at no cost to bring immediate value to HIEs. "We provide transaction sets to help providers get paid," says Del Richmond, marketing manager.

The Hard Part

HealthBridge's Robert Steffel has been impressed with the Obama Administration's health information technology strategy and the massive amount of stimulus funding that goes with it. "There has been a focused, diligent and honest effort to figure out how to do this and do it well." But Steffel doesn't believe all the money will be spent well. "HIEs are very hard to do. Money's not the hard part; it certainly is a barrier, but collaboration is the hard part."

Others say it's too early to know whether the money being thrown at HIEs and other I.T. initiatives will be well spent. "My concern is there's a lot of money going into the system very quickly and the system isn't used to that, so there's a lot of opportunity for mistakes to be made," says Moore of Chilmark Research.

For Navicure's Del Richmond, $300 million is good seed money for HIEs, "but if you're at Ground Zero you'll exhaust most of it on planning before you have anything. So the jury's still out on how wisely that money will be spent."

Covich of eHealth Initiative notes that some emerging HIEs that are angling to receive stimulus funds to become regional extension centers. Most are not prepared to assist providers in adopting EHRs, she contends. "An organization in the early planning phase would not be able to do this. But there is a small group of advanced, operational HIEs that are equipped to do this and could do it very well."]]> http://www.healthdatamanagement.com/issues/2009_73/HIE_RHIO_EHR_Internet_ARRA_stimulus-39440-1.html Tue, 01 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1012 Telehealth
Two-minute video available here or click image below.

]]> http://www.healthtechnica.com/blogsphere/2009/11/30/introducing-telehealth-from-emory-heart-vascular-center/ Tue, 01 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1013 Healthcare Colorado
The Denver-based hospital system has invested more than $350 million in IT over the past 12 years. Officials said collecting and monitoring data has been key to pinpointing areas for improvement.

"Our goals have been to improve patient care quality and safety, while at the same time increasing efficiency and controlling costs, and we're achieving those goals," said Patricia Gabow, MD, the CEO of Denver Health. "Although Denver Health is Colorado's largest uninsured and Medicaid provider, we remain financially sound, and a large part of our fiscal strength can be attributed to our innovative and widespread use of technology. We believe there is no healthcare facility in the nation that's done as broad and deep a transformation as ours."

The system is comprised of a medical center, a regional Level I trauma center, a 911 system, family health centers, public school clinics, Denver Public Health, a poison and drug center, an inmate healthcare program and the Rocky Mountain Center for Medical Response to Terrorism.

EMC Consulting, a Hopkinton, Mass-based consulting and IT service, has helped Denver Health in reaching some of its key technology initiatives. New additions to the network include:

• An Eligibility ReVerification System (ERV), an automated process for collecting patient information and submitting claims. According to officials, the ERV system has helped Denver Health recover more than $28 million in revenue since its deployment in 2004.
• HealthDoc, an automated system for reporting tests and results for communicable and sexually transmitted diseases. Health officials said it has cut the time required to get reports to patients from more than four days to less than one.
• VAX TRAX, an immunization tracking, vaccine administration and inventory management system. Officials say the system has helped improve Denver Health's pediatric vaccination rates from about 60 percent of one-year-olds to 92 percent.

"Healthcare delivery is all about technology – we're gathering every bit of information that we can, about everything that we do in the clinical perspective, and it is all going in a data warehouse, because if you can measure it, you can improve it or fix it," said Gregg Veltri, the CIO of Denver Health. "Through our partnership with EMC, we're using the data in very innovative ways to eliminate waste and manual processes and become more streamlined and cost effective."]]> http://www.healthcareitnews.com/news/denver-health-aims-all-digital-environment Tue, 01 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1014 Legislation
1:45-minute video available here or click image below.

]]> http://www.thedoctorschannel.com/video/2675.html Tue, 01 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1015 Healthcare Technology
2-minute video available here or click image below.

]]> http://www.thedoctorschannel.com/video/2675.html Tue, 01 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1016 Healthcare
Research shows that stress and unhealthy behaviors contribute to some of our country’s biggest health problems such as obesity, heart disease and diabetes. This stress can also build up inside the body and manifest as back pain, neck pain or headaches...making matters even worse.

Doctors of chiropractic are experts in spinal adjustment and other manual therapies that can relieve the aches and pains caused by holiday stress. They also provide nutrition counseling, exercise recommendations, ergonomic tips and other advice to promote good health year-round.

The American Chiropractic Association (ACA), in an effort to promote health and wellness this holiday season, offers “12 Days of Health and Wellness,” a campaign designed to give consumers tips on ways to manage the holidays more healthfully. Each day focuses on a different topic such as choosing nutritious foods, getting enough sleep, and stretching after tree-trimming or gift wrapping to help ease back pain.

“The holidays are synonymous with frenzied activities, parties, shopping and stress, so it is imperative that people take steps to address these issues in healthier ways,” said ACA President Rick McMichael, DC. “It’s the perfect time to use ACA’s tips to take control of your health and to discover chiropractic’s natural approach to wellness. A doctor of chiropractic can customize a wellness program that’s right for you.”

Look for fact sheets, audio public service announcements and additional links to helpful information at www.acatoday.org/12days.]]> http://www.acatoday.org/press_css.cfm?CID=3691 Tue, 01 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1017 Health Information Exchange
Jim Borland, special adviser for health information technology for the SSA, has said that since the exchange with MedVirginia started in February, the organization reduced the average time it takes to process disability applications from 83 to 32 days.

This has the potential to greatly improve the efficiency of the SSA, as the agency sends more than 15 million requests each year to physicians and hospitals for medical records of disability applicants, and the number of applications for fiscal year 2010 is expected to increase by 27% from 2008. This will save the SSA staff time and money, but will also assist physician offices because their employees won’t need to find, scan and send paper files.

The SSA has partnered with Microsoft to test HealthVault personal health record in the disability claims process. Microsoft HealthValut is becoming a leading resource for PHRs in both the private and public sectors. The Mayo Clinic and New York Presbyterian Hospital also utilize the HealthVault applications.]]> http://www.ehrscope.com/blog/national-health-information-exchange-making-progress/ Wed, 02 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1018 Healthcare Technology Regional Extension Center
HHS will soon be offering $220 million in grants to qualified local governments and non-profits that are building healthcare exchange and fostering meaningful use of IT in their communities, Blumenthal said. An additional $10 million will go toward covering the administrative costs of the grant program, and $5 million will fund technical assistance.

The grants will support the Beacon Community Cooperative Agreement Program and be funded from the American Recovery and Reinvestment Act (ARRA). Combined with other recently-announced federal healthcare IT programs, they total 75 percent of the $2 billion allotted under ARRA for healthcare IT, according to Blumenthal.

Sebelius said the program's goal is to help Americans live healthier lives. By supporting communities on the forefront of using healthcare IT, the federal government hopes to provide models – or beacons – for the rest of the country.

Blumenthal said HHS his looking for "all types of communities," including rural, urban, towns, counties, geographical regions, wealthy and underserved populations, to apply for grants.

The program will focus on improving health in the grant communities, with emphasis on using healthcare IT to improve measurable healthcare statistics such as a decrease in smoking rates, reduced hospital readmission rates, a lower number of people with obesity and high blood pressure, improved care for people with diabetes, and decreased healthcare disparities among populations, according to Blumenthal.

Grantees will be encouraged to use existing federal resources and programs that already promote health information exchange at the community level. Close coordination with the Regional Extension Center Program, State Health Information Exchange Program and the national Health Information Technology Research Center (HITRC) will ensure that lessons learned are shared, Blumenthal said.

Blumenthal said some healthcare organizations have inspired the country with their use of healthcare IT to improve care, but "we haven't had a city or a town be inspiring – in its entirely – by elevating its performance with healthcare IT."]]> http://www.healthcareitnews.com/news/sebelius-blumenthal-announce-new-community-hit-grants Wed, 02 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1019 HIPAA
1. Identifies who this section applies to: Covered Entities and Business Associates.

2. Defines the time frame as to when breaches should be reported to individuals, and depending on severity, mass media, and the Department of Health and Human Services (HHS).

3. The type of information that must appear in the notification letters.

4. Definition of Unsecured Protected Health Information. Note that the HITECH Act delegated the final definition to the HHS vis a vis a “guidance”. The guidance was issued on 4/27/2009 in the Federal Register.

5. Requires HHS to report to Congress no later than 12 months after the date of enactment the nature of the breaches that occurred.

6. Time period of when the final regulations go into effect.

Section 13402 of the HITECH Act sets a very important precedent and provides notice to the healthcare industry that the Federal government is serious about securing health records. Another purpose of the HITECH Act is to incentivize healthcare providers to move from paper to electronic records. Confidence in the security of those electronic records is crucial to the adoption of electronic health records and in general, is good public policy.

It should be noted that Congress essentially delegated the details of how the breach notification law is to be executed (know as a rule) to HHS. In August, 2009 HHS issued the interim final rule on breach notification and the rule went into effect in September, 2009. However, enforcement will not officially start until February, 2010, although HHS reserves the right to enforce the rules prior to February, 2010 as it sees fit.]]> http://www.hipaa.com/2009/12/six-primary-goals-of-the-hitech-breach-notification-requirement/ Wed, 02 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1020 Practice November/December issue of Annals of Family Medicine that analyzed medical practice costs associated with pay-for-performance, or P4P, programs found that participation in quality-reporting programs clearly requires resources with measurable costs. This finding was particularly true for small practices.

The study "Cost to Primary Care Practices of Responding to Payer Requests for Quality and Performance Data" looked at eight practices in North Carolina that were participating in at least one of four quality-reporting programs:

• CMS' Physician Quality Reporting Initiative, or PQRI;
• Improving Performance in Practice, a state-based quality improvement initiative;
• Bridges to Excellence, a not-for-profit organization that designs and creates programs to encourage quality improvement in primary care; and
• Community Care of North Carolina, an integrated Medicaid program.

The Agency for Healthcare Research and Quality, or AHRQ, provided funding for the study. According to Jacqueline Halladay, M.D., M.P.H., an assistant professor in the department of family medicine at the University of North Carolina at Chapel Hill and the study's corresponding author, in 2006, AHRQ identified practice costs as one of the barriers holding back quality data reporting in primary care.

Although hospitals already are engaged heavily in quality reporting, primary care practices have been slow to follow suit, said Halladay. By conducting the study, "We hoped to offer some insights into what the issues and costs are to primary care practices that collect and report quality data," said Halladay. "We felt that such information was important to consider as (quality improvement) programs develop and participation in them evolves from a voluntary exercise into a requirement for reimbursement."

Study Methods
Of the eight practices examined in the study, four were small primary care offices, one was a large group practice, one was a rural nonprofit organization, another was a rural community health center and the last was a small teaching facility.

Although Halladay acknowledged the study's small sample size, she said the study was "preliminary work" undertaken to get physicians and stakeholders to think about practice-level cost issues. The researchers' most important accomplishment was the creation of "cost categories" to help physicians judge potential costs before committing to any quality-reporting initiative, said Halladay.

Researchers visited practices between January 2008 and May 2008. Halladay and her team discovered that most practices got involved with quality improvement work to enhance patient care and didn't consider what their participation would cost the practice. "It was really interesting to go through the process and show them (physicians and administrators) the dollar values," said Halladay, calling it an "eye-opening" experience for practices.

The study found that among the eight practices surveyed, P4P program costs per full-time clinician ranged from less than $1,000 to about $11,000 during the implementation phase. Average costs per clinician during the maintenance phase ranged from less than $100 to about $4,300. Practice costs varied by program characteristics, the level of on-site assistance provided, the experience level of practice personnel and the extent of data system problems encountered.

Major practice expenses included planning, training, registry maintenance, visit coding, data gathering and entry, and modification of electronic systems.

Small Practices Pay Steeper Price
The study authors singled out small primary care practices as taking an "especially hard hit" from program participation costs. They noted that two of the single-physician practices recorded the highest per-clinician costs for each of the three programs for which comparisons could be made.

Researchers found that small practices often needed to hire outside consultants for help with the P4P reporting processes and incurred significant costs in doing so. The solo physicians also reported that they worked on P4P projects after hours, meaning those activities did not directly affect the practice's cash flow but cost physicians personal time.

Overall, Halladay said she was struck by the "deep and profound problems with electronic interoperability," and she noted that practice administrators and staff members spent a lot of time and money getting health information technology systems to cross-communicate.

According to the study, "The lack of interoperatibility among information technology systems was a major problem. It was not only a large component of participation costs, but also a major source of variation between practices participating in the same programs."

Pointers for Programs, Participants
Study researchers concluded that physicians' attitudes toward P4P initiatives were "fairly negative," and suggested that organizations attempting to gain physicians' acceptance should offer financial incentives "that allow practices to at least recoup their costs."

Halladay advised physicians to consider forging relationships with quality improvement organizations willing to shoulder some of the work and costs. For example, some programs offer hands-on training to office staff on use of computer systems or teach staff about quality improvement principles. Sharing the workload eases the stress level and the time commitment for physicians and their staffs, according to the study.

Physicians also need to employ a "common sense" approach when assessing how much change their practice -- and their staff members -- can handle, especially when considering engaging in multiple P4P initiatives, said Halladay.

"We found that the most satisfied practices were the ones that carefully limited how many new programs they tried to implement at once," she said. "They kept an eye on their staff's morale and energy levels and made decisions accordingly."]]> http://www.aafp.org/online/en/home/publications/news/news-now/practice-management/20091201p4p-costs.html Wed, 02 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1021 Healthcare Technology
Durability. Having hundreds, if not thousands, of patients, family and friends using the same touch-screen application can take its toll on the hardware. In these types of installations, standard PCs or touch-screens will not hold up in the long run. Such installations require systems that have industrial-grade components, meant to run continuously around the clock. At the same time, having an experienced vendor with a track record of superior service/support of these systems helps decrease downtime and increase the overall life of the kiosks.

Integration. Given the uniqueness of the health care industry, peripheral devices (e.g., privacy filters, card scanners, signature pads) are often required to facilitate patient check-in, patient surveys, wayfinding or other self-service functions. It is not recommended to place these devices on a cabinet, or inside a stand, and leave wires or access ports exposed, as users may disconnect the devices, damage the cabling or, worst case, hurt themselves. Self-service hardware that fully integrates peripherals -- so there are no exposed ports, wires or cables -- helps mitigate the risk of public intrusion and prolongs kiosk utilization.

Patient security and protection. Healthcare-specific additions, such as HIPAA Privacy Touch screens, help medical facilities protect patients' personal and medical information. These integrated touch screens are optically clear when viewed directly in front of the system, but the screen darkens when viewed from the left or right at an angle, reducing the ability for others to read what's being displayed.

The system must focus on patient protection using antimicrobial technology, or some other type of infection control for the kiosk. Antimicrobial treatment helps protect the unit from cross-contamination of a wide variety of bacteria and fungi.

Case study

One example of a hospital taking advantage of durable, fully integrated, secure solutions is Sebasticook Valley Hospital (SVH).

The hospital serves population of approximately 30,000 people in central Maine, providing a wide variety of outpatient services and more than 20 specialty services. Last April, SVH became the first hospital in Maine to offer a kiosk check-in service. Partnering with KioHealth, SVH implemented the HealthPass Kiosk System, offering patients a safe, private and easy alternative to traditional check-in. According to Peggy Romano, CIO for SVH, the overall goal of the kiosk project is "to provide a streamlined check-in process for all patients at all points of care within [the hospital]."

Initial installation included two free-standing kiosks, with branding specific to SVH and signage overlays to help drive kiosk usage. Each system includes healthcare-specific devices: electronic signature pad, two-sided insurance card scanner, HIPAA Privacy touch screen and antimicrobial-treated exterior surfaces. As the HealthPass Kiosk System works in conjunction with SVH HealthPass (a barcode patient ID card), the kiosk also integrates a barcode swipe reader, allowing for reduced check-in time.

The kiosks, pre-configured with KioHealth Patient Check-in software, are currently used for the ED, Lab and Radiology departments. Patients can sign forms, edit demographic information, scan ID cards or insurance cards, and confirm arrival, all via self-service kiosks. In the back office, staff can view a patient queue/Web board, which alerts staff that a patient has arrived, tracks wait time and highlights patients based on their workflow (e.g., changes in demographics). Nearly all established patients can check in with the kiosk, including walk-ins. In fact, patients who forget their HealthPass card can check in by manually providing name, date of birth and other key identifiers required for security. A lot of intelligence occurs behind the scenes, but, for the patient, check-in is simple to understand and easy to work through.

Results

The HealthPass Kiosk Project is growing, both in number of units and expansion of functionality, including: (1) expanded scheduling functionality; (2) additional kiosk hardware, including desktop models and possibly hand-held tablets; and (3) completion of patient forms and other automated functionality.

At the time of this article's publication, SVH will be nearing six months using the kiosks. The system is easy to use for patients, easy to administer, and keeps information confidential. According to Romano, "We have had positive feedback from patients using the HealthPass Kiosk. Using the SVH HealthPass card not only helps maintain positive patient identification with a simple swipe device, but it enhances SVH branding as well."

The system provides automated reporting and metrics for waiting room time, from the point of check-in to being seen in the ED, Lab or Radiology. In addition, the Lab and Radiology departments can view who has checked in through the kiosks immediately upon the patient's swipe of their HealthPass Card. These alerts help staff identify who is in the waiting room so patients can be attended to more quickly, leading to reduced wait times and improved patient satisfaction.

The SVH Kiosk has seen wide adoption rates in the patient population, particularly those patients who have standing orders and repeat visits (lab, radiology). In fact, SVH plans to install the HealthPass Kiosk at all SVH check-in locations, and its physician clinics, Sebasticook Regional Family Care, later this year.

Kiosk Applications for Health Care Facilities

We have all been trained to serve ourselves-- from using automatic teller machines for banking transactions to pumping our own gas, checking ourselves out at the grocery store and checking ourselves in at the airport. It's been going on for years, and for good reason. It makes economic sense.

The same reasoning applies to health care. A growing percentage of the population would prefer to handle tasks such as registration, check-in and bill payment themselves rather than wait for assistance. For providers, the efficiencies to be gained will translate into real savings. Utilizing self-service kiosks in health care can streamline processes and improve patient satisfaction while reducing overhead expense and improving cash flow.

Health care is one of the last consumer industries where self-service has not been embraced in a major way. With the imminent, widespread adoption of electronic health records (EHRs), self-service technology has never been more relevant. In fact, one of the areas for consideration by the HIT Policy Committee noted in the HITECH Act (part of the economic stimulus package known as the American Recovery and Reinvestment Act) is "self-service technologies that facilitate the use and exchange of patient information and reduce wait times."

Practical applications

The applications for self-service in health care include health record access, financial record access, bill payment, patient check-in and registration (including electronic forms and driver license and insurance card scanning), wayfinding and surveys.

Wayfinding is the most common kiosk application found in health care today. A wayfinding kiosk can provide patients with detailed directions or a map to help them get from one point to another. One reason the wayfinding solution is so popular is because it can be implemented standalone without the need for integration with other systems. Providers may elect to start with wayfinding and then expand to other kiosk applications.

Patient registration and check-in kiosks have the greatest potential for immediate impact and return on investment. Key benefits include the following:

Elimination of paperwork. The registration process for most providers is extremely paper-intensive with privacy, consent, financial and other legal forms being used in some combination for every registration. Forms-related expense for registering patients at a hospital or clinic can run as high as $5 per patient registration. That includes the cost of pre-printed forms, paper, toner, printer hardware, printer maintenance and scanning the completed forms into an electronic medical record (EMR) or EHR system. All of this expense can be eliminated with a patient registration kiosk that offers digital forms with an electronic signature pad. Automating the registration process also furthers the goals of EHRs by presenting all required forms and ensuring that all signatures and other form data are collected and saved in the EHR in one seamless process.

Reduction in staff time and increased patient throughput. The justification for self-service registration and check-in kiosks can be found by studying the success of the retail and airline industries. Retail stores typically use one cashier for every four to six self-serve checkout lanes. The other cashiers -- or in this case patient registration staff -- can be redeployed to other duties. Organizations that have deployed self-service kiosks find the average time required for patents to complete their registration to be one to two minutes depending on the features being used. When properly implemented, efficiencies can be gained with both the reduction of full-time equivalents (FTEs) and increased patient throughput.

Improved patient satisfaction. Recent surveys have shown that people are increasingly aware and sensitive to time spent -- or wasted -- waiting in lines. In addition to improving efficiencies for the provider, the use of self-service kiosks can improve patient satisfaction by reducing wait times and putting the patient in control. This can translate into a competitive advantage if the patient registration experience is faster and more convenient with one provider as compared to the competition. Another feature that can improve the patient experience is support for multiple languages for those patients not fluent in English. This kiosk feature allows patients to select their language before beginning the registration process. For providers who serve a diverse patient population, multiple language support is critical for providing a safer and more effective experience.

Increased accuracy of patient data. One of the leading causes of delayed payments for hospitals and clinics is inaccurate billing information, with millions of dollars spent each year in write-offs and rebilling. Providing patients with the ability to actually see the information that is on file and immediately correct any mistakes will increase billing accuracy and decrease payment delays. In addition, features that automatically verify the accuracy of address and insurance information can be integrated into the kiosk solution. This capability eliminates the need for duplicate data entry and ensures a seamless flow of accurate patient information straight from the point of registration.

Increased collections. Having the kiosk ask for required co-pay and deductable payments each time a patient registers and providing a convenient means for patients to pay using credit and debit cards results in increased collections. This process eliminates the expense of traditional paper invoices. The kiosk offers a consistent, professional message and eliminates the potential conflict of employees having to ask friends and family for payment. It also provides for more timely payments. Studies have shown that more than half of the revenue patients are responsible for paying never gets collected. With the percentage of revenue patients are responsible for paying on the rise, the need to collect at time of service has never been greater.

Improving the patient experience

Even with all of these benefits, you may be wondering if self-service will actually work for your patients. Experience indicates that it will. A recent patient self-service kiosk pilot showed that more than 95 percent of patients who began the kiosk registration process were able to complete their registration without help, and almost 100 percent said they would use the kiosk again. Those results were achieved with half of the kiosk users being over the age of 55.

Compared to other high-profile projects such as EMR/EHR and specialized clinical applications, self-service kiosks are simpler to implement, relatively inexpensive and have a faster acceptance rate. In addition, they are low-maintenance and can be selectively deployed to the departments most likely to benefit from their use. With vendor-based support available for both the software and hardware components, strain on IT resources should be minimal. Self-service kiosks represent one of those rare opportunities for health care IT (HIT) executives and management to quickly implement a solution with immediate, measureable results.

HIT has been, and continues to be, a central and vital component in the delivery of quality patient care. The recent economic stimulus bill and pending health care reform legislation places an even greater emphasis on the role that HIT will play in the future of health care. While EHRs have received a majority of the attention, self-service kiosk applications are an important component of a comprehensive HIT strategy. If you are looking for an easy way to improve the patient experience and save money while increasing collections, self-service kiosks are the answer.]]> http://health-care-it.advanceweb.com/Article/What-You-Should-Know-About-Kiosks.aspx Thu, 03 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1022 Medicare Practice
Fragmentation on billing!! Now why can’t all of this come together with insurance and Medicare agreeing on the darn billing codes and make a mess out of this for everyone?

A little collaboration would be extremely nice in instances like this, so what happened to the idea of cutting down the administrative rhetoric for the doctors?

This looks like a case of smoke and mirrors from this angle of reform.

Click here or image below for 2:24-minute review of consultation codes.

Medicare has eliminated the consultation codes. Now you will have to bill using regular office visit codes and hospital admit codes. Medical practices stand to loose revenue. This episode of the Medical Billing Minute explains the Medicare changes.]]> http://ducknetweb.blogspot.com/2009/12/no-more-medicare-consultation-codes.html Thu, 03 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1023 Medicare PQRI
One comment that HHS received in response to an earlier version of the physician fee schedule suggested that HHS ask the Certification Commission for Healthcare Information Technology to include PQRI reporting capabilities in its EHR testing program.

"Any EHR quality data submission will be required to comply with all current regulations regarding privacy and security. 'Meaningful use' criteria will be reviewed as they are finalized and we will endeavor to align our work in the future, as appropriate," HHS said in the final PQRI rule. "However, since meaningful use criteria has not yet been finalized, this comment is currently beyond the scope of this final rule," the department explained.]]> http://www.fierceemr.com/story/cms-asked-align-pqri-stimulus-reporting-requirements/2009-12-03 Fri, 04 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1024 Practice
The UPD, which went national in 2003, protects physicians from having to repeatedly fill out paper-based physician credentialing applications, and, judging from UPD user rates, the tool has caught on with U.S. physicians. According to CAQH statistics, 55 percent of practicing U.S. physicians now use the UPD. That's 445,838 physicians out of the 809,139 physicians who are registered with the Federation of State Medical Boards.

In addition, said Davis, those numbers may be artificially low because some states and large physician groups use alternative approaches to data collection.

Rhode Island physicians head the list of state users with a 99 percent UPD registration rate. Other states at the top include Tennessee and Kentucky (88 percent each), Vermont (87 percent), and Delaware (86 percent). Hawaii anchors the bottom of the chart with just 2 percent of its physicians enrolled.

The AAFP supported CAQH's endeavor early on, and, in 2004, it was the first physician organization to endorse the UPD. Recently, the Academy reiterated its support in a letter to CAQH Executive Director Robin Thomashauer.

"The significant reduction in paperwork associated with the UPD is alleviating a significant source of dissatisfaction and cost among the participating physician practices," wrote AAFP Board Chair Ted Epperly, M.D., of Boise, Idaho. "The streamlining of this previously onerous task is a major reason for the widespread adoption of UPD by physician practices and other health care professionals throughout the nation."

Epperly noted that the Web-based UPD system "saves time and paperwork hassles and gives physicians more time to concentrate on what's most important -- their patients."

Beth Plummer, the credentialing coordinator at College Park Family Care Center in Overland Park, Kan., handles credentialing applications for 50-60 physicians. The work involved eats up about 60 percent of her day, but she said the UPD saves the practice dollars in terms of staff hours.

According to Plummer, it takes as long as 45 minutes to complete a paper credentialing application for a staff physician. She can complete the same work in less than 10 minutes using the UPD tool.

"CAQH has made credentialing smoother by creating some uniformity to the credentialing process," said Plummer. "The UPD is a huge time saver; I wish all insurance companies used it."

According to Davis, the UPD is free to physicians because participating organizations pay a fee for access. However, physicians own and manage their credentialing data.

Davis said 13 states designate or require that payers use the UPD to streamline provider data collection. The Medical Group Management Association estimates that the UPD has saved more than $80 million a year and eliminated more than 2 million paper credentialing applications since its inception.

Physicians must be registered with one of the more than 550 participating organizations before they can enroll in the UPD system, said Davis. If the insurers with which a physician has contracts haven't signed on as UPD users, the physician should call and ask why not, said Davis.]]> http://www.aafp.org/online/en/home/publications/news/news-now/practice-management/20091202upd-caqh.html Fri, 04 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1025 Colorado EHR
Denver Health and Hospital Authority may be a safety-net facility, but the Colorado healthcare system has spent a whopping $350 million plus on health IT over the last 12 years. When you invest that much money over more than a decade, you're a believer in technology. But you don't throw that kind of money around unless you reap a tremendous amount of ROI. And Denver Health, which is expected to spend nearly $360 million in services in 2009 alone as the state's largest provider for the uninsured and Medicaid patients, has seen administrative efficiencies and improved quality of care. Denver Health and Hospital Authority is planning on adding more applications to make its systems and processes even more efficient, which will create cost savings and deliver higher quality of care for its patients.

This year, the Healthcare Information and Management Systems Society (HIMSS) awarded the 2009 Public Health Davies Award of Excellence to Denver Public Health, a division within Denver Health and Hospital Authority. The award validated the healthcare system's use of health IT, particularly its EHR.

Gregg Veltri, Denver Health and Hospital Authority's CIO, summed it up nicely and succinctly: "Healthcare delivery is all about technology - we're gathering every bit of information that we can, about everything that we do in the clinical perspective, and it is all going in a data warehouse, because if you can measure it, you can improve it or fix it." You can't measure how well you're doing with paper records, or at the very least you can't measure how well you're doing without a lot of man power. Denver Health and Hospital Authority gets it: Use data innovatively to "eliminate waste and manual processes and become more streamlined and cost effective." That about says it all, in my opinion.

Without naming names, I will say it appears that Denver Health and Hospital Authority chose an IT consulting firm that successfully shepherded it through the years-long, several hundred applications implementation. This partner helped the healthcare system assess where it needed automation across its facilities. So there's another vote for choosing your IT partners, be they infrastructure or services, wisely, and to carefully map out a strategy.

Hopefully more healthcare systems will step forward and share their success stories.]]> http://www.ehrwatch.com/blog/denver-health-reaps-roi-health-it Fri, 04 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1026 Practice
Experts say your practice can foster the first scenario and make the latter less likely by asking the staff how they want to celebrate and doing so in a way that reflects the values of the practice.

"There's enough stress on everyone. You don't want to add to it," said Demetrian Dornic, MD, medical director of the Eye Specialists of Carolina in Raleigh, N.C.

"We look at our employees as very valuable. I want them to feel appreciated."

This can manifest in different ways. Last year, employees at the East Tennessee Medical Group in Alcoa decided to forgo a holiday party and contributed those funds to Habitat for Humanity.

"We're going to celebrate by giving to the community," said Ron German, the group's chief executive officer. "Our employees have donated their time and their money, and these ideas are from the bottom up. They are not from the physician-owners." The group also contributes throughout the year to several other organizations chosen by the staff.

Spreading good cheer
Plans made only by the boss, as well-meaning as the intent may be, can lead to a holiday party no one appreciates.

Crystal Reeves, a consultant with Coker Group in Atlanta, gave the example of a Las Vegas physician who threw a lavish party at a casino, complete with limousine transportation for staffers. Employees were less than thrilled. Staff members had to dress up and were uncomfortable with the ostentatiousness.

In 2004, 5,822 people ended up in emergency departments with holiday decorating injuries. "He thought he was doing something wonderful for his staff. It didn't come across as positive," Reeves said. "It's important to ask staff members what they want to do to avoid a lot of disappointment on both sides."

If staff opt for a gift exchange, it should be with small tokens of appreciation. And participation in any "secret Santa" or grab bag gift program should be voluntary. Expensive presents given publicly to some and not to others can give rise to resentment.

In addition, anything that can be converted to cash, such as gift certificates given by an employer to an employee, must be reported as income, and taxes on it must be paid.

Dreaming of a day off
When many staffers request time off, deciding who gets it can be a source of strife. The end of the year may be especially problematic for scheduling, as practices can be busy with patients wanting to see the doctor before their health care deductible resets. Add in respiratory illness season, made busier because of influenza A(H1N1), and many waiting rooms will be filled.

Experts suggest establishing a rotating system for time off, based on seniority, a lottery or other means, but not adopting a first-come, first-served approach. Staff will be happier because everyone will, in theory, have a fairer chance at getting prime time off.

For medical practices that are open on Dec. 25 and Jan. 1, experts suggest allowing employees to take off one or the other or providing a floating holiday. Ask for input from the staff. Some employees prefer to work on Christmas and New Year's Day and take a different day off.

Beginning to look a lot like ...
Experts also say that care needs to be taken in decorating and expressing holiday cheer.

"If [employees] want to wear Christmas sweaters, that's fine," said German of the East Tennessee group. "You have got to have a little levity in your work place."

But it's important to remember that not everybody celebrates Christmas. While the majority of Americans do, some observe Hanukkah, St. Nicholas Day, Boxing Day -- or nothing at all.

Everyone likes a party, but religious overtones may make some uncomfortable. Mandating employee participation in something that could be viewed as a religious event also might run afoul of anti-discrimination statutes, experts said.

Decking the halls
Beyond the emotional impact, holiday decorations also present potential risk of injury or infection.

Experts say it's important to know when to call in professionals to hang decorations. If a staff member breaks a bone after falling from a chair while trying to hang holiday lights, the season can turn particularly miserable.

Influenza was widespread in 32 states as of Dec. 1, 2009. No numbers are available on how many employees have been hurt decking the halls of physician practices, but an analysis in the CDC's Morbidity and Mortality Weekly Report estimated that in 2004, 5,822 people ended up in the emergency department as a result of injuries sustained while hanging holiday decorations.

"We have maintenance people hang decorations," said Randy Stevens, MD, a family physician and medical director of the Center for Occupational Health in Terre Haute, Ind. "We don't require anyone else to climb ladders or stand on a table."

The influenza pandemic that is hanging over this holiday season means that additional thought needs to be given to infection control. To reduce flu spread, the American Academy of Family Physicians recommends removing anything that patients may share, such as toys and magazines, from the waiting room. Holiday decorations that invite touching could fall in this category. The Centers for Disease Control and Prevention reported that influenza was widespread in 32 states as of Dec. 1.

The holidays don't have to be fraught with peril. Experts say if they are marked in a way that reflects the staff, there should be plenty of comfort and joy. Celebrations are also an opportunity to connect with patients.

For instance, Reeves said, the staff at one pediatric oncology practice marked the holidays by giving each patient a small gift. "It made it a special occasion," she said.

The children "were going through a lot, and this was a wonderful time to address their other needs."

The print version of this content appeared in the Dec 14, 2009 issue of American Medical News.

How to ensure unhappy holidays
Experts identify several ways practices can make the holiday season less merry for employees, whether they're falling while decking the halls or you're acting like a Scrooge:

• Start playing Christmas music in October, or even earlier.
• Refuse to hire professionals to decorate the office. Make staff climb chairs or rooftops to hang lights and garland.
• Make the décor a tripping hazard or a vector for spreading infectious diseases.
• Expect staff to exchange expensive gifts -- and give particularly pricey ones to managers and physicians.
• Give staff gift cards that could be considered taxable income.
• Start the holiday party while patients are still in the office.
• Ban personal expressions of holiday cheer, such as Christmas sweaters or holiday pins.
• Don't ask staff for input on how they want to celebrate.
• Don't show staff any appreciation for the past year.
• Assume that everyone celebrates Christmas.
• Assume that someone in your practice celebrates a specific December holiday.
• Pretend the holidays don't exist. Bah! Humbug!]]> http://www.ama-assn.org/amednews/2009/12/07/bil21207.htm Mon, 07 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1027 Practice
As AMA Executive Vice President and CEO Michael Maves, MD, MBA, told the Association's House of Delegates at its Interim Meeting in November, the "critical juncture at which we stand" is not just about what is happening right now in Washington. The AMA's Strategic Plan for 2010, approved by the AMA house, spells out principles that Dr. Maves called "a broad view of what's good for medicine, for physicians and for your patients."

The plan identifies five core commitments:

Access to care: The Association has long sought to expand access through its Voice of the Uninsured campaign and other initiatives, including ways to address physician shortages. Any federal legislation that passes likely will include some expansion of health insurance coverage, so specific strategies would build upon those details. The Strategic Plan calls for the AMA to work within organized medicine and to build coalitions with patients and employers. It also calls for developing a national physician work force strategy.

Quality of care: The AMA will maintain its focus on systems that improve quality through effective and efficient measures, definitions and reports. Among the strategies is an expansion of measures under the AMA-convened Physician Consortium for Performance Improvement, as well as integration of those measures into practices. The AMA will advance the use of health information technology through solutions that assist in quality improvement and informed decision-making.

Cost of care: Addressing the doctor's role relating to cost and value in health care spending is an important task for next year. The AMA plan calls for progress in this area while keeping third parties, such as insurance companies and government, from interfering in the physician-patient relationship. The AMA pledged that its efforts on the physician's role in cost will not detract from the Association's ongoing actions to address medical liability, insurance company bureaucracy and other contributors to the rising cost of care.

Prevention and wellness: The Association will use its voice -- and work with other medical societies -- to help educate physicians and seek legislative support in the areas of improving public health and reducing overall costs through prevention and wellness. Part of that work is identifying strategies that can influence healthier patient behaviors, encourage preventive interventions and enable the effective treatment of chronic conditions -- all at an appropriate cost and with a fair payment to the physician.

Payment models: Specific opportunities and challenges to reshape the payment system will be defined in large part by what happens with health system reform, although the effort to repeal the sustainable growth rate formula and replace it with one that more closely aligns rates with physician costs is an ongoing struggle. The plan also calls for the AMA to develop and disseminate tools that doctors can use to help themselves adapt as payers adopt any payment policy changes.

As Dr. Maves described it, health system reform is "only the latest battle, not the last battle." The AMA's Strategic Plan is designed so that no matter what happens in Washington, D.C., the physician's voice will be heard on the most important issues affecting doctors and their patients.]]> http://www.ama-assn.org/amednews/2009/12/07/edsa1207.htm Mon, 07 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1028 Practice
Many patients are asking for a vaccine that is becoming available more slowly than expected. Those sickened by respiratory pathogens are looking for care. And practice staff may be out ill.

But those who run medical practices say several strategies can help manage the volume more effectively.

"We have had to change our protocols," said Eileen Szanyi, director of operations at Finger Lakes Medical Associates in Geneva, N.Y. The multispecialty group has a staff of 120 and 22 physicians.

For example, Szanyi added a hotline with recorded information on the availability of both seasonal and H1N1 vaccine. Updated regularly, it has reduced the number of calls staff needs to answer.

According to the Centers for Disease Control and Prevention, the number of people with influenza decreased slightly in the first week of November, although activity was still widespread in 46 states. As of Nov. 17, more than 47 million doses of H1N1 vaccine had been allocated, meaning they were ready to order.

Szanyi's office also has been referring ill callers to a triage nurse before scheduling any appointments. Some callers are told to stay home and given instructions on the symptoms that should trigger them to come in.

Parents seeking routine medical care for their children are being asked to delay these appointments until respiratory illness season is over in spring.

But "if the parent needs [the appointment] before the insurance runs out or the insurance changes, if the child needs it for day care or for school, we're going to put them in," said Szanyi.

Saying "no" to patients could mean they switch to another practice, but Szanyi says this is not a significant concern. "We try to explain to people that we're having a national health crisis," she said. "And I don't think any one else is doing it any better than we are."

Other options for dealing with the increased patient load include opening up schedules for more same-day appointments.

At Laguna Beach Community Clinic in California, patients now have to wait four to six weeks for routine care. The clinic used to schedule four routine appointments an hour, but that is now down to three. This makes it easier to squeeze in walk-ins, which has increased from 400 a month to 650.

Staff also have been asked to adjust their work hours. Part-timers are having to work more hours. Temporary staff have been called in. Doctors are coming in on days off.

"We're all working a little bit harder to get through the season," said Thomas C. Bent, MD, the clinic's medical director and chief operating officer. He is also president of the California Academy of Family Physicians, although he was speaking personally.

Experts suggest creating annual strategies, include sending out notices in the fall reminding patients of the impending busy season.

Practices should recommend that patients make appointments for routine or elective procedures before their deductibles are reset at the beginning of the year and before they run out of time to use money in flexible spending accounts.

"The most important thing is to acknowledge that it is coming and to anticipate what it is going to mean for your practice," said Tannus Quatre, principal and consultant with Vantage Clinical Solutions in Bend, Ore.

Policies should be in place to encourage staff to take time off if they are sick to reduce spread to other workers and patients. It's also a good idea that these policies state that vacation time must be staggered.

"We ask that not everybody take a vacation during the worst time of the year," Dr. Bent said. "Most people are cooperative."]]> http://www.ama-assn.org/amednews/2009/12/07/bica1207.htm Mon, 07 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1029 Practice Medicare
"Without such a delay, we anticipate payment denials, re-submissions and appeals that could create claims backlogs, cash flow problems and increased costs that could lead some physician to avoid Medicare patients," wrote Michael D. Maves, MD, AMA executive vice president, in a Nov. 25 letter to Jon Blum, director of the Center for Medicare Management of the Centers for Medicare and Medicaid Services.

The impact will be even worse "if Congress has not acted to prevent a scheduled 21.2% cut in the conversion factor that is scheduled to take effect on Jan. 1," he wrote.

Maves wrote that without a delay to educate doctors and consider the implications of the change, "two potential unintended consequences" will occur.

"First consulting physicians may stop accepting Medicare patients referred for consults. Second, more and more consultants may stop interpreting the findings in the medical record in a report back to the referring physician.

"Each scenario presents significant care coordination concerns and while CMS says it will be on the lookout for any unintended impact the new policy could have on care coordination, some real damage to individual patients could occur while CMS is still in monitoring mode."

Maves told Blum that "physicians will experience claims denials, audits and repayment demands, and conflicts with secondary payers simply for following the rules that CMS has laid out. Increased frustration and costs for physicians, payers and patients seem sure to follow."

Under current CMS rules, the CPT code for consultation calls for reimbursement that is between $20 and $50 higher than for a comparable office visit.

CMS officials has not responded to requests for comment.

Mapes met with CMS officials Nov. 24 about the elimination of CPT codes 99241-99244 for office or other outpatient consults and 99251-99255 for outpatient consultations. "Rather, CMS has instructed physicians to bill using the new or established patient codes instead."

Physicians who are concerned about the change say the elimination of these codes will necessitate substitution of evaluation and management codes, which pay significantly less.

"Unless the January deadline is moved back significantly, we do not see how Medicare will have sufficient time to educate physicians about the new modifier or to develop and widely distribute guidance —including a crosswalk —on how to use the visit codes. Time is also needed to educate secondary payers and provide them with enough time to handle impacted crossover claims."

Maves wrote that CMS rejected the AMA's CPT code panel's new language that would have clarified how consultation codes should be applied. "CMS apparently is rejecting this effort because there was not ‘universal agreement' among physicians on what the appropriate policy should be.

"Yet CMS' substitute policy has far less acceptance among physicians and has not been subjected to the cross-specialty scrutiny that could have identified and avoided some of the confusion and concerns the new policy has engendered among physicians."

The AMA's House of Delegates in November called for a repealing the new policy altogether.]]> http://www.healthleadersmedia.com/content/243062/topic/WS_HLM2_PHY/Deleting-Medicare-Consult-Code-Could-Hurt-Patients-Say-Doctors.html Mon, 07 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1030 Practice
This Modern Physician Video News segment is produced in association with The Doctor's Channel. The 2-minute video is available here or click image below.

]]> http://www.modernphysician.com/article/20091123/MPVIDEO/311239948 Mon, 07 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1031 Legislation Healthcare Technology
The agenda also lists the dates for starting Medicare incentive programs as Oct. 1, 2010, for hospitals and Jan. 1, 2011, for physicians. This could be an indication that the start dates for incentives for the meaningful use of electronic health records are not slipping.

The semi-annual regulatory agenda identifies actions the department intends to take. Deadlines for anticipated actions are not always accurate. But in the updated agenda, the following HITECH rules remain scheduled for publication in December 2009:

• RIN: 0991-AB58, an Interim Final Rule with comment period to establish an initial set of data standards, implementation specifications and criteria for certification of electronic health records;
• RIN: 0991-AB59, An Interim Final Rule with comment period establishing certification programs for health information technology; and
• RIN: 0938-AP78, a Proposed Rule to establish policies and procedures for the Electronic Health Record Incentive Program under Medicare and Medicaid, including definitions for the meaningful use of EHRs.

Proposed rules to implement enhancements to the HIPAA privacy rule under HITECH also are on the near-term agenda.

HHS' Office for Civil Rights is on tap during December to publish a proposed rule governing business associates, restrictions on certain disclosures and sale of health information, breach notifications, improved health privacy education, and enhanced enforcement of the privacy rule, among other provisions.

ONC, according to the regulatory agenda, remains on schedule to publish a proposed rule in February to implement new privacy rule provisions to account for disclosures of protected health information.

Other expected rulemaking includes:

• A Health Resources and Services Administration final rule in December to require that each state has in effect a system of reporting, to the National Practitioner Data Bank, of disciplinary licensure actions against health care practitioners and entities.
• A Food and Drug Administration proposed rule in March 2010 to require electronic package inserts for human drug and biological products to ensure up-to-date safety and efficacy information.
• A FDA proposed rule in June 2010 to require standards-based electronic submission of data from studies evaluating human drugs and biologics.
• A FDA proposed rule in September 2010 to require electronic registration and listing of medical devices.

Two other long-delayed rules are still pending, with dates for future action still undetermined. They are establishment of a unique identification system for medical devices, and standards for the electronic claims attachments transaction.

The HHS semi-annual regulatory agenda is available at http://reginfo.gov. Click on Current and Past Agendas, and select Department of Health and Human Services in the search box.]]> http://www.healthdatamanagement.com/news/HITECH_rules_meaningful_use-39471-1.html Mon, 07 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1032 e-Prescribing
Key medical organizations have endorsed a timely transition to ePrescribing, and a growing number of health plan sponsors are supporting ePrescribing programs that put the technology into physicians' offices. Finally, the merger between major networks SureScripts and RxHub is setting the foundation for uniform ePrescribing standards. As a result of these and other efforts, an estimated 100 million ePrescriptions were "written" in 2008, a 300 percent increase from 2007.

Given that ePrescribing can save lives, improve the quality of patient treatment and reduce medical costs, this is certainly an auspicious time for our health care system. Much has been made of the benefits that electronic health records can deliver in terms of efficiency and clinical improvements. Although much progress has been made, strong leadership and additional measures are needed to fully embed ePrescribing to handle the 4 billion prescriptions written annually in the United States.

According to the Institute of Medicine (IOM), preventable medication errors result in 7,000 deaths each year, and 1.5 million people are injured annually as a result of medication errors. About half a million of those errors are Medicare patients who fill their prescriptions on an outpatient basis -- a figure that helped spur policy makers into action.

The errors cost our health care system billions of dollars as a result of extended hospital stays and procedures to undo the harm inflicted by medical errors. Some of these errors occur because we continue to use an outdated approach -- a slip of paper -- to transmit prescriptions from doctor to pharmacy. By converting to ePrescribing, the IOM concludes that the nation could eliminate many preventable medication errors.

ePrescribing in practice

Recognizing the importance and value of ePrescribing, key stakeholders including employers, health plans and pharmacy benefit managers have united on various fronts to increase the adoption of this technology among health care providers. From a doctor's perspective, ePrescribing can help improve patient safety while lowering costs for their patients and their practice.

Through ePrescribing, doctors are alerted when a prescribed medication may cause a potential interaction with another drug the patient is taking, if a patient has a known allergy to the medication, or if the FDA has issued any black box warnings for the drug. It also eliminates the problem of illegible handwriting, which has often been the cause of medication errors.

Additionally, physicians are made aware of what is covered by a patient's prescription plan as they write the prescription. Electronic prescriptions can also provide suggestions for lower cost alternatives for patients concerned with their medication expenses. The technology also saves time, which means doctors don't have to deal with various coverage issues, and receive fewer phone calls and faxes to clarify what was prescribed.

While physician practices have been slow to adopt this technology, clinical organizations are recognizing its benefits. The American Academy of Family Physicians and other leading medical practice groups launched a national portal in March 2008 (www.getrxconnected.com) to help doctors transition from paper prescribing to ePrescribing. A study in the Archives of Internal Medicine also supports the notion that clinicians using electronic prescribing systems are more apt to prescribe lower cost drugs. Researchers writing the report estimated that electronic prescribing could save $845,000 annually per 100,000 insured patients filling prescriptions.

Health plan sponsor initiatives have been instrumental in getting the technology implemented within their physician networks. One such program that has shown tremendous results is the Southeast Michigan ePrescribing Initiative (SEMI). In 2005, the Big Three automakers -- General Motors Corp., Ford Motor Co., and Chrysler -- along with Michigan health plans and Medco spearheaded the formation of SEMI.

While SEMI's primary objective is to encourage the adoption of ePrescribing in the greater Detroit metropolitan area, the program is also analyzing the impact of the technology on patient safety and prescription drug costs. To date, more than 3,000 physicians have elected to participate in SEMI. With SEMI support, each physician selected the ePrescribing technology that best suited the needs of their medical practice.

Based on data from a national third-party report, SEMI results have been impressive. In 2005, the number of ePrescriptions issued to retail pharmacies in the Detroit area was only 130,000. By 2007, that number has skyrocketed to almost 2.2 million, representing an increase of 1,600 percent in three years. SEMI has been instrumental in driving Michigan to fifth place in the national ranking of states' ePrescribing use.

A 2008 survey of 500 SEMI physicians found that ePrescribing helps them practice better medicine; testament that clinicians are embracing the technology. The survey also revealed that three out of four respondents strongly believe that ePrescribing improves patient safety.

Data from SEMI support this. Since the launch of the program, 1.28 million drug safety alerts have been sent to physicians about possible risks associated with a drug they prescribed and 40 percent of those prescriptions were changed as a result, potentially averting serious adverse drug events and the associated medical costs that could have been incurred.

There is also compelling evidence that ePrescribing helps reduce prescription drug spending by increasing the use of lower-cost medicines. At the point of prescribing, physicians receive patient-specific information about the cost of available generics and plan-preferred drugs, which allows physicians to help patients save money. In some respects, this also can help overcome the cost of drugs as a patient compliance barrier. An analysis of Henry Ford Medical Group, a SEMI program partner, found that ePrescribing by its 900 participating doctors would save more than $4 million annually through improvements in generic dispensing rates, reduced medication errors and improved clinical and physician workflow.

SEMI's comprehensive approach has been instrumental to the medical community's adoption of the technology. One of SEMI's fundamental operating principles has been that physicians have to have "skin in the game" in order to embrace the new technology. As such, SEMI does not give ePrescribing to physicians, but it subsidizes some of the initial installation costs. In addition, SEMI provides training to participating physicians and their staffs to ensure that ePrescribing becomes an integral part of the medical practice's operations.

The bottom line is that SEMI is a working parable of success; a program that should serve as a prototype for other communities.

Setting technological framework

While the benefits of SEMI help demonstrate ePrescribing's worth, advocates of this technology have touted its clinical benefit and have demonstrated how sloppy handwriting can harm patients.

Drug stores and pharmacy benefit managers had competing programs for electronic prescribing. This competition between the retail drug stores' Surescripts and the pharmacy benefit managers' RxHub left many physicians on the sidelines. On a certain level, it is understandable. People using technology do not want to be stuck with the "losing" standard, essentially forcing them to pay for the same technology twice if one standard fails in the marketplace.

That is no longer a problem. In July, SureScripts and RxHub agreed to a merger that would combine the strengths of RxHub's patient identification and benefit information with SureScripts' focus on routing the order from the physician's office to the pharmacy. This scale can also help providers of electronic health records meet connectivity standards. This merger can extend the reach of ePrescribing programs to more than 200 million patients across the United States.

The bottom line

Research has shown that ePrescribing can generate essential improvements for the Medicare Part D Program. During the 2008-2017 budget cycle, ePrescribing is expected to reduce federal health expenditures by as much as $29 billion. Given that American seniors account for 42 cents of every dollar spent on drugs, measures taken to reduce medication costs would have a significant impact on the nation's health care spending.

Much of this thinking led Congress and President Bush to approve a law last year to encourage Medicare physicians to convert to ePrescribing. Beginning this year, physicians will receive a bonus for adopting the new technology that could offset a portion of their acquisition cost. Doctors that adopt electronic prescribing will get a 2 percent incentive in 2009 and 2010, a 1 percent incentive in 2011 and 2012 and a .5 percent incentive in 2013. However, those prescribers who fail to adopt electronic prescribing will see reimbursement fall one percent in 2012, 1.5 percent in 2013 and a full two percent in 2014.

In the 2006 Preventing Medication Errors report, the IOM recommended that, in order to reduce errors, improve patient safety and decrease health care costs, clinicians should be "writing" prescriptions electronically by 2010. Collectively, we have made tremendous progress on transitioning the health care system to the new technology.

However, given that many clinicians remain entrenched in the 20th century by handwriting their prescriptions, we must continue to devote strong leadership and resources to the ePrescribing cause. Momentum is propelling greater use of ePrescribing -- a change this nation needs and deserves. It can save money, but more importantly it supports and strengthens the number one rule of medicine: Do no harm to the patient.]]> http://health-care-it.advanceweb.com/Article/The-Tipping-Point-for-ePrescriptions.aspx Tue, 08 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1033 Health Information Exchange
Gov. Jim Doyle last week signed an executive order creating the the Wisconsin Relay of Electronic Data for Health (WIRED) Board, a 14-member commission tasked with developing plans for funding, infrastructure, rules, oversight and accountability of a health information exchange by June. The Milwaukee Journal Sentinel reports that the state is in line to receive $9.4 million in federal stimulus funding to support HIE activity.

In Pennsylvania, the Governor's Office of Health Care Reform issued a strategic plan for a proposed Pennsylvania Health Information Exchange (PHIX) by recommending that the state take advantage of infrastructure of the Delaware Health Information Network, which has been live since March 2007. That strategy could shorten implementation time by up to 18 months, according to the plan. "The PHIX governance would have complete control over policies, functionality, implementation priorities, product branding, legal framework and revenue model," the plan says.

There's no word about whether Delaware is open to such an arrangement.]]> http://www.fiercehealthit.com/story/more-states-jump-hie-bandwagon/2009-12-07 Tue, 08 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1034 Practice Practice Management
"Outsourcing your billing does not mean you have to give up any control no matter where the billing service is located," says Gerry Malloy, MGMA member and CEO of Global Health Management Services, LLC. "Some may think I am biased because I own a medical billing service, however I was a practice administrator for 25 years. I understand the importance of maintaining control."

Today's technology is much more advanced, allowing for daily reports via the Web and dashboards customized for your rules and benchmarks. Plus, your vendor's software won't take up space on your computers or incur capital costs.

Malloy says above all, communication is the key to maintaining control and getting the best service from your vendor. Just as you would supervise an in-house billing department, you still need someone to oversee the outsourced billing service. And being fully involved with the vendor ensures your expectations will be met.

Is it time to outsource?

"In my conversations with physicians, one of the things they tend to say the most is 'Look, I just want to practice medicine. That's it,'" says Frank Cohen, a healthcare data analyst, certified Six Sigma Master Black Belt and author. One way to help physicians concentrate more on medicine and less on business is to outsource.

"This may be controversial, but if you want to practice medicine and have as little business modeling going on in the practice as possible, I think it's something to consider," Cohen says.

But remember: Outsourcing is no substitute for your knowledge about the process. "You still have to be able to understand the claims and billing process so you can audit what the billing company is doing to make sure they're in fact collecting what they're supposed to be in the proper way," he says.

Tips for outsourcing billing

MGMA members weighed in on this issue in the MGMA Member Community. Here's their advice:

• Establish performance standards which, if not hit, reduce your fee to the vendor.

• Ensure you have full integrated access to the data and reporting.

• Insist that dedicated people work on your accounts.

• Measure your key accounts receivable (A/R) indicators against best practice benchmarking numbers on a monthly basis.

• Ask for the days in A/R and A/R greater than 120 days for their existing clients.

• If you outsource, at some point you may have to bring the service back in-house at some point. Ask yourself, could you afford it?

Editors note: Looking into outsourcing your billing and collections? Give PrimaryData a call at 720-226-9270 to review your options.]]> http://blog.mgma.com/blog/bid/28807/Should-your-medical-practice-outsource-billing-and-collections Tue, 08 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1035 Healthcare Technology
Click here or image below to view 1-minute video.

]]> http://www.thedoctorschannel.com/video/2696.html Tue, 08 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1036 Community Health
The administration will spend about $509 million to repair, rebuild or replace jaded community health center facilities, which serve more than 17 million patients. Officials also expect to spend $88 million to help community health centers upgrade to electronic medical records and other health information technologies. The changes should help the centers care for more than 500,000 additional patients in underserved communities.

As part of the same announcement, President Obama asked HHS Secretary Kathleen Sebelius to begin a three-year trial on how community health centers might improve care for Medicare patients. As many as 500 centers may participate in the initiative.]]> http://www.fiercehealthcare.com/story/administration-budgets-600m-community-health-centers/2009-12-09 Wed, 09 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1037 Healthcare Technology
Wouldn't you know, Epocrates Essentials came out on top. Bowman says that product, used by literally hundreds of thousands of practitioners, can replace multiple drug, laboratory and infectious-disease reference books. Other popular apps include medical calculators, two guides for advanced life support and Unbound Medicine's Nursing Central database. Another helps nurses migrate data from their old Palm PDAs to the iPhone.]]> http://www.fiercemobilehealthcare.com/story/epocrates-tops-nursing-mags-list-iphone-apps/2009-12-08 Wed, 09 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1038 Medicare Nov. 25 Federal Register (452-page pdf) and will accept public comments until Dec. 29.

According to a CMS press release, more than 1 million physicians and nonphysician health care professionals are paid under Medicare's fee schedule, and its rules cover more than 7,000 types of services in physician offices, hospitals and other health care settings.

Pay Increase for Primary Care

In the Nov. 30 letter, (6-page pdf) AAFP Board Chair Ted Epperly, M.D., of Boise, Idaho, says the fee schedule "demonstrates CMS' continued recognition that a high quality, efficient health care system must rest on a foundation of primary medical care."

Epperly thanks CMS for recognizing that primary care physicians should get a pay raise, as well as for the agency's efforts to "help establish a foundation on which meaningful and sustainable health care system reform can be built."

Epperly says the AAFP supports several key policy changes in the rule that will improve payment for primary care physicians. Those proposals include

• Changes that relate to the use of Physician Practice Information Survey data in CMS' practice expense methodology;
• Increases in the assumed utilization rate of diagnostic equipment that costs more than $1 million;
• Tweaks to the malpractice relative value unit, or RVU, methodology;
• Increases in work RVUs for the initial Medicare preventive physical exam; and
• Elimination of consultation codes, except those for telehealth services.

The Academy also is pleased with increases in work RVUs for new and established office visits and initial hospital and nursing facility visits.

"These policies will improve payment for primary care physicians," says Epperly, noting that FPs will see an estimated 4 percent increase in their Medicare allowed charges in 2010, all other things being equal.

"This will help ensure that all Americans have access to a personal physician who can ensure they get the right care at the right time in the right place," he adds.

Looming Medicare Pay Cut

Despite his praise for certain components of the fee schedule, Epperly parses no words when expressing the Academy's anger at the overall slashing of Medicare physician payments in 2010.

"Like our counterparts throughout the physician community, family physicians are outraged that the final rule must implement a 21.2 percent Medicare physician pay cut for 2010," says Epperly. He asks Congress to permanently address the flawed sustainable growth rate, or SGR, formula on which Medicare physician payment is based "before these drastic payment cuts go into effect on Jan. 1, 2010."

Physician Quality Reporting Initiative

Epperly commends CMS for revising incentives for electronic prescribing and the Physician Quality Reporting Initiative, or PQRI, saying the improvements will encourage physicians to adopt electronic health records. But he also points out the flaws in the programs and advises CMS to monitor the programs and "correct their shortcomings rapidly."

In particular, the "AAFP has serious concerns about the PQRI's technical effectiveness and data accuracies," says Epperly.

Practice Cost Particulars

In addition, the Academy does not favor mandatory physician participation in specialty-specific cost data collection efforts, such as cost surveys or cost reports. Rather, the Academy "supports practice expense RVUs that are based on the actual resources, both direct and indirect, which physicians use to provide services," says Epperly.

"Unless CMS is prepared to pay physicians on the basis of their actual practice costs, we see no reason to require physicians to submit cost reports to Medicare," he adds.

Epperly touches on Medicare physician payment for telehealth services, home health services, and motor and sensory nerve conduction studies. He also discusses payment for H1N1 vaccine administration, including CMS' creation of a special "G" code, G9141, to cover administration of the vaccine to Medicare beneficiaries.

The Academy prefers that CMS delete the "G" code, says Epperly, and instead use CPT code 90470. The CPT code was created by the CPT editorial panel and pays physicians a higher rate for administering the H1N1 vaccine than does Medicare's G9141 code.

"Duplicate codes make no sense and are an administrative hassle for our members," he adds.

Epperly notes the Academy's support for CMS' proposal to remove physician-administered drugs from the calculation of allowed and actual expenditures as it sets the 2010 conversion factor, and he commends CMS for finalizing its proposal to remove drugs from the calculation of the SGR beginning with 2010.

The action "will help reduce the cost of a permanent fix to the problem posed by the SGR," says Epperly, and it will make a positive update in the fee schedule conversion factor "far more likely in the future." ]]> http://www.aafp.org/online/en/home/publications/news/news-now/government-medicine/20091208cms-2010-ltr.html Wed, 09 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1039 HIPAA
Exploring HIPAA and HITECH Act Definitions: Parts 11-15, include definitions from:

• American Recovery and Reinvestment Act of 2009 (February 17, 2009, pp.258-259),
• Health Information Technology for Economic and Clinical Health Act,
• Title XIII—Health Information Technology,
• Subtitle D—Privacy,
• Section 13400—Definitions.

Breach
(A) In General—The term ‘breach’ means the unauthorized acquisition, access, use, or disclosure of protected health information which compromises the security or privacy of such information, except where an unauthorized person to whom such information is disclosed would not reasonably have been able to retain such information.

(B) Exceptions—The term ‘breach’ does not include—

1. Any unintentional acquisition, access, or use of protected health information by an employee or individual acting under the authority of a covered entity or business associate if—
a. Such acquisition, access, or use was made in good faith and within the course and scope of the employment or other professional relationship of such employee or individual, respectively, with the covered entity or business associate; and
b. Such information is not further acquired, accessed, used, or disclosed by an person; or
2. Any inadvertent disclosure from an individual who is otherwise authorized to access protected health information at a facility operated by a covered entity or business associate to another similarly situated individual at same facility; and
3. Any such information received as a result of such disclosure is not further acquired, accessed, used, or disclosed without authorization by any person.
[Note: The definition of 'breach' in the enabling regulation is different in several respects from the statutory definition above, including introduction of consideration of risk of harm to the individual:

Breach means the acquisition, access, use, or disclosure of protected health information in a manner not permitted under subpart E [Privacy of Individually Identifiable Health Information] of this part [45 CFR 164: Security and Privacy] which compromises the security or privacy of the protected health information.

(1)(i) For purposes of this definition, compromises the security or privacy of the protected health information means poses a significant risk of financial, reputational, or other harm to the individual.

(ii) A use or disclosure of protected health information that does not include the identifiers listed at § 164.514(e)(2) [Implementation Specification for the Limited Data Set standard], date of birth, and zip code does not compromise the security or privacy of the protected health information.

(2) Breach excludes:

(i) Any unintentional acquisition, access, or use of protected health information by a workforce member or person acting under the authority of a covered entity or business associate, if such acquisition, access, or use was made in good faith and within the scope of authority and does not result in further use or disclosure in a manner not permitted under subpart E of this part.

(ii) Any inadvertent disclosure by a person who is authorized to access protected health information at a covered entity or business associate to another person authorized to access protected health information at the same covered entity or business associate, or organized health care arrangement in which the covered entity participates, and the information received as a result of such disclosure is not further used or disclosed in a manner not permitted under subpart E of this part.

(iii) A disclosure of protected health information where a covered entity or business associate has a good faith belief that an unauthorized person to whom the disclosure was made would not reasonably have been able to retain such information.

See Department of Health and Human Services, Office of the Secretary, “45 CFR Parts 160 and 164–Breach Notification for Unsecured Protected Health Information; Interim Final Rule,” Federal Register, v. 74, n. 162, August 24, 2009, pp.42767-42768.]

Business Associate
Has the meaning given such term in section 160.103 of title 45, Code of Federal Regulations [CFR]:

“(1) Except as provided in paragraph (2) of this definition, business associate means, with respect to a covered entity, a person who:

1. On behalf of such covered entity or of an organized health care arrangement (as defined in § 164.501 of this subchapter) in which the covered entity participates, but other than in the capacity of a member of the workforce of such covered entity or arrangement, performs, or assists in the performance of:
a. A function or activity involving the use or disclosure of individually identifiable health information, including claims processing or administration, data analysis, processing or administration, utilization review, quality assurance, billing, benefit management, practice management, and repricing; or
b. Any other function or activity regulated by this subchapter; or
3. Provides, other than in the capacity of a member of the workforce of such covered entity, legal, actuarial, accounting, consulting, data aggregation (as defined in § 164.501 of this subchapter), management, administrative, accreditation, or financial services to or for such covered entity, or to or for an organized health care arrangement in which the covered entity participates, where the provision of the service involves the disclosure of individually identifiable health information from such covered entity or arrangement, or from another business associate of such covered entity or arrangement, to the person.

(2) A covered entity participating in an organized health care arrangement that performs a function or activity as described by paragraph (1)(i) of this definition for or on behalf of such organized health care arrangement, or that provides a service as described in paragraph (1)(ii) of this definition to or for such organized health care arrangement, does not, simply through the performance of such function or activity or the provision of such service, become a business associate of other covered entities participating in such organized health care arrangement.

(3) A covered entity may be a business associate of another covered entity.”

Covered Entity
Has the meaning given such term in section 160.103 of title 45, Code of Federal Regulations [CFR]:

“(1) A health plan.

(2) A health care clearinghouse.

(3) A health care provider who transmits any health information in electronic form in connection with a transaction covered by this subchapter.”]]> http://www.hipaa.com/2009/12/exploring-hipaa-and-hitech-act-definitions-part-11/ Wed, 09 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1040 Legislation Regional Extension Center EHR
"At ONC, we're making tremendous progress to achieve our goals and today, I wanted to provide a quick update and an important new announcement.

"Although I'm often out front in communicating our goals and progress, there is an entire organization - plus numerous collaborating agencies, our federal advisory committees, and other stakeholders - behind me working harder, and faster than ever, to get the right pieces in place to meet very aggressive timelines.

"You have seen evidence of that work already with our announcements of major grant programs to help establish health information exchange and grow the health IT workforce. And you'll see even more in the weeks and months ahead as we roll out new projects.

"Already, we're on the way to getting the Regional Extension Centers and the State Health Information Exchange program established early in 2010. In fact, on a technical assistance call on Friday about the extension center program, we announced that, due to a strong response for applications, there will be approximately 30 extension center awards made in January and the remainder in March. This should assure support is in place for providers looking to become meaningful users of EHR systems leading up to 2011.

"Of course, this isn't all we're doing. You will see meaningful use criteria (from CMS) in a matter of weeks. We also anticipate publishing in early 2010 our proposed plans for establishing a new certification program, which we believe will enable most vendors to have their products certified by 2011. And there will be a number of other awards and programs rolling out between now and the end of the first quarter. This past week's announcements of the Beacon Community Program and additional workforce training grants continue to build the needed foundation for electronic health records throughout the nation.

"We're working hard and we're working fast, but we're also working smart and ensuring that the necessary programs and standards serve as a sound foundation."

The blog is available at http://healthit.hhs.gov/blog/onc/.]]> http://www.healthdatamanagement.com/news/stimulus_meaningful_use_certification_EHR-39481-1.html Wed, 09 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1041 Technology
“Dragon Dictation takes the messaging experience on the revolutionary iPhone to a whole new level,” said Michael Thompson, senior vice president and general manager, Nuance Mobile. “Dragon Dictation is also incredibly natural and intuitive. Users will soon find they’re speaking more than typing using the power of speech to communicate even faster, whatever they’re doing and wherever they are."

With the Dragon Dictation App, spoken words are instantly transcribed using the world-renowned power of Dragon NaturallySpeaking speech recognition, giving anyone the power to simply “say anything” up to five times faster than typing. Dragon Dictation allows users to speak anything from a one-line text message or status update for Facebook, to a multi-paragraph e-mail. For instance, simply say, “We should meet at the restaurant at 7 and then go to the movies. I’ll pick up Scott in Cupertino after he gets off work. See you then.” Users can start and stop as needed or just speak free form to capture a quick brainstorm idea or reminder. It’s completely up to you.

The Dragon Dictation App is available for free for a limited time from the App Store on iPhone or at http://itunes.apple.com/us/app/dragon-dictation/id341446764?mt=8.

Click here or the image below to get to the Dragon Mobile Apps website.

]]> http://www.nuance.com/news/pressreleases/2009/20091208_dragonDictaton.asp Wed, 09 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1042 Practice
New and revised codes for services that require equipment

Let's start with some good news: Getting paid for services that have traditionally required complex or expensive equipment or are most often provided by subspecialists should be easier with the introduction of new and revised codes for reporting these new services. However, the good news comes with a caution: These codes reflect a significant change in health care delivery and, as such, payment for them may be subject to coverage determination decisions by local payers and Medicare carriers. Payers may establish specific guidelines that must be followed when providing these services (for example, some payer policies allow payment of nerve conduction studies only when an electromyography is also performed). Before investing in equipment necessary to provide the following services, check with your common payers to determine if their plans provide coverage:

• 95905 Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, each limb, includes F-wave study when performed, with interpretation and report;
• 0203T Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone) and sleep time;
• 0204T Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation and respiratory analysis (e.g., by airflow or peripheral arterial tone);
• 95806 Sleep study, unattended, simultaneous recording of heart rate, oxygen saturation, respiratory airflow and respiratory effort (e.g., thoracoabdominal movement).

You should note that HCPCS code S3905 can be reported for the services now described by code 95905 (motor and/or sensory nerve conduction), and HCPCS codes G0398-G0400 are also used to report unattended home sleep testing of Medicare beneficiaries, the service now described by code 95806.

Other notable new codes and revised descriptors

Luckily, not all of the changes in 2010 are as complex as those just described. Several of the year's changes are minor but are still worth noting.

Nursing facility care. The descriptors of codes 99304-99310 and 99318 for reporting nursing facility care have changed to include time spent on the patient's unit or floor. Previously, these codes only included physician/patient face-to-face time. Now these codes recognize the time physicians spend on chart review, documentation and communication with the patient's family. Remember that time spent off the patient's floor is considered pre- or post-service work and is not included in floor time.

Venous wounds. New code 29581 finally provides an easy way to report the application of multi-layer venous wound compression system. This new code allows for differentiation from the single-layer Unna boot.

Injectables. The description of code 90378 for respiratory syncytial virus prophylaxis now indicates that it is for reporting a recombinant monoclonal antibody rather than an immune globulin. Also, code 90379 has been deleted because the product the code represented is no longer available.

Vaccines. Code 90669 for the pneumococcal conjugate vaccine now indicates that it is used to report a 7-valent pneumococcal conjugate vaccine. New code 90670 should be used to report the 13-valent version. The 13-valent product is marked in the CPT book with the "lightning bolt" symbol, which indicates that it is pending FDA approval.

New code 90644 is not listed in this year’s CPT manual but will be effective on Jan. 1. This code can be used to report the new Hib-MenCY-TT vaccine (combination meningococcal conjugate vaccine, serogroups C and Y, and hemophilus influenza b vaccine, tetanus toxoid conjugate, four-dose schedule, when administered to children 2 to 15 months of age, for intramuscular use), which is pending FDA approval.

And finally, you should note that the code descriptors for some vaccines and toxoids now include age and “preservative free” designations. These are not intended to reflect a product’s licensed indication but rather to assist in differentiating between similar products and services. Of course appropriateness of a vaccine for an individual should be determined by the product’s prescribing information and clinical judgment, and not by CPT descriptors.

Changes to consultation codes

The consultation codes in this year’s CPT manual are unchanged from last year, but the Centers for Medicare & Medicaid Services (CMS) has eliminated these codes from the Medicare Physician Fee Schedule for 2010. For consultations provided in the outpatient setting, physicians should report new or established patient visit codes, and codes for initial hospital care or initial nursing facility care should be used instead of consultation codes for those sites of service. CMS will also create a new modifier to identify an admitting physician’s charge for initial hospital care. Private payers have not yet stated how they will react to this change.

Because family physicians tend to use the consultation codes infrequently and CMS is shifting some of the payment value from the consultation codes to the E/M codes that will be used in place of them, most family physicians will not lose revenue as a result of this change, and some may experience a slight increase. Look for more on this change in FPM’s “Getting Paid” blog at http://blogs.aafp.org/fpm/gettingpaid. We’ll post updates there about the new modifier and any further instructions from CMS as soon as we receive them.

Code resequencing

CPT has created a new way to boggle your mind (as if the coding part wasn’t hard enough). It is called resequencing: the new process for handling the addition of a code for which no sequential code number is available. The new codes that appear out of numerical order are preceded by the # symbol. In addition, a note appears where each code would have appeared if it were in numerical order. This can be confusing, so here’s an example to help:

There are new codes, guidelines and revisions for reporting the excision of soft tissue and bone tumors this year. Unfortunately, code numbers weren’t available in the section of CPT where they were needed. To allow for the new codes without renumbering the entire section of codes between 21550-21632, CPT 2010 lists the new codes as follows:

21550 Biopsy, soft tissue of neck or thorax
21552 >Code is out of numerical sequence. See 21550-21632<
21554 >Code is out of numerical sequence. See 21550-21632<
Δ 21555 Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cm
# 21552 3 cm or greater
Δ 21556 Excision, tumor, soft tissue of neck or anterior thorax, subfascial (e.g., intramuscular); less than 5 cm
# 21554 5 cm or greater

Appendix N in the CPT manual lists all of the codes that have been resequenced.

Here's to 2010

This completes the CPT coding update for 2010. CPT is an ever-changing system, but we’ll do our best to keep you up-to-date and informed. I hope this helps you begin the new year with coding clarity, confidence and robust reimbursement!]]> http://www.aafp.org/online/en/home/publications/journals/fpm/preprint/fpm.html Fri, 11 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1043 HIPAA
The Healthcare Information and Management Systems Society conducted a survey of 150 hospital information technology executives and 26 business associate firms. Under HIPAA, business associates are any organizations that handle patient health information for purposes other than treating patients.

The survey found a third of the business associates were unaware that HIPAA privacy and security requirements had been extended to cover their organizations.

The survey, commissioned by ID Experts, a data breach prevention company headquartered in Beaverton, Ore., was conducted both by telephone and online in August and September.

Only 42% of the business associates interviewed said they were aware that beginning in 2010, consumers are guaranteed prompt access to an electronic copy of their own health records. Sixty-eight percent of the health care organizations interviewed were aware of this change.

Fifty percent of business associates and 67% of health care organizations were aware that individuals could restrict disclosure of their records when they pay for their own medical services.

Of the survey respondents, 57% said they would renegotiate contracts with business associates. Another half said they would monitor their business associates' performance when it comes to security issues. Forty-seven percent said they would terminate agreements in the event of a breach.]]> http://www.ama-assn.org/amednews/2009/12/07/bisf1211.htm Fri, 11 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1044 Community Health
The administration plans to give almost $509 million to repair, rebuild or replace federally designated community health centers. From coast to coast, the centers serve more than 17 million patients, about 40 percent of whom have no health insurance, according to the Globe.

As much as $88 million more will go to health care facilities to transfer their medical records to electronic format and to upgrade technologies, according to figures provided before President Obama's announcement on Wednesday, Dec. 10.

Obama also asked Health and Human Services Secretary Kathleen Sebelius to begin a three-year trial on how to improve care for Medicare patients at community health centers. The administration anticipates as many as 500 health centers would participate, the Globe reported.

"Because community health centers already provide comprehensive health care to people who face the greatest barriers to accessing care, these demonstration projects have the potential to support and improve the care delivered not only to Medicare beneficiaries, but also to others who rely on community health centers for primary care," Sebulius said in prepared remarks.]]> http://health-care-it.advanceweb.com/Article/Dec-11-2009-600-Million-Allocated-to-Improve-Community-Health-Centers-Technology.aspx Mon, 14 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1045 Practice
"Everybody is renegotiating their leases," said Tom Dalcolma, a partner in Street Sotheby's Medical Realty Advisors in Columbus, Ohio. "It's clearly a tenants' market."

The real estate slump, combined with tighter credit, means that fewer medical office buildings are being built. But after a previous construction boom, there is still more supply than demand.

So rents are creeping downward, and vacancy rates are going up. These are the conclusions of the Medical Office Research Report published by the real estate investment company Marcus & Millichap. The report looked at the second half of 2009.

For physicians who rent space, this means it's a good time to look for a better deal. But those who lease to others might need to take extra steps to keep tenants happy.

The report said the market for medical office buildings is "much more stable than traditional office properties." But vacancy rates have gone up and are expected to continue to increase, despite the fact that fewer medical office buildings are being built and some projects have been canceled. Approximately 10.1 million square feet of medical office space are scheduled for completion this year, a decline of 30% from 2008. Only 7 million square feet are expected to be built in 2010.

"We have seen a little bit of a dip in occupancy, but not a lot," said Gordon Soderlund, senior vice president for strategic relationships with DASCO Companies, a medical building developer and manager in Palm Beach Gardens, Fla. "Physicians generally don't move that often, and a lot of hospitals have suspended capital projects."

Rents down nationwide
Rents also went down in most areas of the country, because fewer practices are expanding into new space. Some practices are becoming smaller while others are closing.

These market changes have resulted in a decline in the average asking price for medical office building rent. Nationally, the per square foot costs declined from $24.90 in the third quarter of 2008 to $23.90 in the third quarter of this year, according to Marcus & Millichap. Only rents in Texas inched up, from $22.67 to $22.86. Near term predictions are for average rents nationally to go down further, to $23.42. The difference between asking rents and the amount physicians actually pay is unknown.

Many experts say it's a good time for renters to ask the landlord to renegotiate your lease, even if there is still time left on it. Landlords may be amenable to locking in a lower rate if the lease is extended, although they can be understandably hesitant. Long-term leases can be attractive to future investors, but reduced rents cut the value of the building, making it more difficult to sell or refinance. Those who negotiate medical office leases say if the landlord won't lower the rent, physicians may be able to get lower property-related expenses or other perks.

"There are other benefits [owners] can bring to the table," said Ken Scheper, finance director of Alliance Primary Care in Cincinnati. He is renegotiating several leases for his medical group.

Landlords might be willing to throw in a few months of free rent, provide money to update the space, cover common-area maintenance charges, or pay for something like a golf or health club membership.

"If you lower the rents, you are actually devaluing the building," Soderlund said. "A two-year membership at a golf course -- that may not even get documented or show in the lease itself. It's not being deceptive, because a landlord is still collecting these rents, but they happen to offer some incentives or concessions to keep a tenant."

Time to look elsewhere -- or expand?
If the lease cannot be changed, experts say, it might be worthwhile to shop for other spaces that may be inexpensive enough to justify buying out the remainder of the existing lease. It also may be a good time to think about expanding the practice space, experts said, because new developments might require lower commitments of time and money.

For example, on Oct. 15, Oaks Development Group announced the launch of a physician incubator space in a 20,000-square-foot medical building under construction in Palm Coast, Fla. Incubator spaces, common in industry and high-tech fields, are intended to provide an economically supportive environment for new business start-ups.

The Oaks project includes eight offices, totaling 2,200 square feet, that have been designed as shared space equipped with the basics, such as exam tables and high-speed Internet. Only a one-year commitment is needed, rather than the standard five- or 10-year lease many practices sign. Plus practices can rent an office for as little as two half-days a week.

Various office-sharing arrangements are common among practices or with hospitals, but many experts say such an arrangement with a developer is unusual.

"We saw a lot of physicians reluctant to commit to a long-term lease. This allows them to put their toe in the water and see what revenues are going to be like," said Charlie Barker, Oaks' director of development.

While this is one example of how national medical office trends may work to the advantage of physicians who rent, physicians who own medical office space are on the other end of the equation.

For owners, now more than ever, customer service is key. "First and foremost, [owners should] make sure that they are very, very in tune to the needs of the tenants," Soderlund said. "If your service is the top quality, they will be more likely to renew, and it will be harder for them to leave."

Experts recommend that owners make sure exteriors, entranceways and lobbies are maintained. Carpeting may need to be replaced regularly because of heavy foot traffic. Periodic tenant surveys also may help identify needs.]]> http://www.ama-assn.org/amednews/2009/12/14/bil21214.htm Mon, 14 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1046 EHR Extormity was the first to be certified! BD

SEEDIE Offers Twitter Optimized ARRA Certification Program

SEEDIE, the Society for Exorbitantly Expensive and Difficult to Implement EHR’s, is embracing the 140 character model developed by Twitter as a central component of its new ARRA Certification program. “Since ARRA meaningful use criteria are not yet finalized, we decided this was the ideal time to launch a certification program around those criteria,” said SEEDIE executive director Sal Obfuscato. “In that spirit, we have developed a 140 character pledge that EHR vendors are expected to tweet. This cutting edge electronic attestation, along with a certification fee of $30,000, will result in the coveted SEEDIE Platinum Certification seal.”

The tweet-able statement reads:
We glanced at not yet finalized ARRA meaningful use criteria and hereby attest our EHR looks promising! So who do I make the check out to? EHR vendor Extormity was among the first in the healthcare IT community to tweet their ARRA certification. According to Extormity CTO Oliver Brindle, “We decided to get certified before the criteria are finalized, as we’re pretty sure we won’t be able to meet the actual criteria any time soon.” You can sign up to follow SEEDIE on Twitter at http://twitter.com/SEEDIEORG

About SEEDIE
SEEDIE, the Society for Exorbitantly Expensive and Difficult to Implement EHR’s, is a healthcare IT standards organization that is completely funded and operated by a select group of proprietary electronic health record vendors. Unlike independent, objective, professional organizations created to help medical professionals select and implement interoperable EHR solutions, SEEDIE promotes healthcare IT systems that play well in the sandbox if, and only if, it is in the best interests of a particular vendor. Learn more at www.seedie.org.]]> http://ducknetweb.blogspot.com/2009/12/seedie-society-for-exorbitantly.html Mon, 14 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1047 Telehealth
He oversees care coordination telehealth through most of the Rocky Mountains for the Veterans Administration, and he has learned the ingredients of success well. (Picture from Global Media.)

While the rest of the medical community flounders about trying to figure this out, here is what he says you need to make it work:

• A robust Electronic Health Record.
• A network that can handle the necessary bandwidth.
• Digital video systems that are simple to use but support a range of peripherals.
• A system integrator who can put it all together.
• Clinical staff in remote locations who know tech but are even better with people.

The VA is fortunate in that its VistA EHR has been around for decades. But that only gets you part of the way there. “We also have a closed network, we have a firewall, we have broadband to all our clinic end points. We have the luxury of solid bandwidth and the ability to do video over IP.”

Beyond these institutional advantages, Lowe has standardized on Tandberg (now Cisco) codecs and cameras from Global Media of Scottsdale, Arizona.

“They have a cart system that can incorporate the codec, monitors, a computer, and all the peripherals, and they have a great cable management system that helps in small clinical spaces.”

All these systems are maintained through a system integrator who can do installation and maintenance throughout the region.

“It’s the integration of all these pieces that’s the difficult part. A lot of companies make carts and cool innovations, but trying to assemble them into something that works for a clinician, at very remote locations with untrained clinical staff…it needs to be highly usable and highly reliable.”

Several elements must be supported. The camera must have a wide variety of remote controls and you want to support a variety of peripherals like a digital stethoscope, an otoscope, even an ophthalmoscope, for taking remote measurements.

Finally, you need clinical staff in the remote office. Lowe says that at the VA this is a GS-7 rated, health tech, usually with a community college background. The ability to deal with the technology is important, but Lowe has also found people skills vital. “They are the hands and senses of the remote provider.”

Once the system is in place doctors can do many kinds of evaluations from a very long way away.

“We do a lot of tele-mental health. We do a lot of patient education, which is a huge part of health care, educating on diabetes, smoking cessation, and nutrition. We do pre-surgical evaluations, and post-surgery follow ups. We do tele-endocrinology, wheelchair and prosthetic evaluations, even speech therapy.”

Lowe and the VA have built this system out of need. With so many patients so far from a VA center, they can either do telehealth or let clients slip through the cracks.

But what he has found is that, with proper equipment and properly trained staff, he has a productivity gold mine. Doctors can provide a lot of services, efficiently, including wellness calls they might not otherwise be able to make.

And that’s what drives down health care costs. It’s not the equipment, but the human connection that counts. A remote clinical check-up has trained people on both ends of the line, and more people in support.]]> http://healthcare.zdnet.com/?p=3099 Mon, 14 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1048 EHR
Click here or image below for 7:30-minute overview of Dragon Medical and EHRs.

]]> http://www.youtube.com/watch?v=8E64uyue-TE Mon, 14 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1049 Legislation
Military service men and women need to rely on access to treatment for painful and disabling joint and back disorders and be provided the highest level of care possible Rick McMichael, DC, president of ACA, said in testimony before the United States Senate Veterans Affairs Committee hearing on S. 1204, legislation introduced by Sen. Patty Murray (D-Wash).

According to recent U.S. Department of Veterans Affairs statistics, nearly 52 percent of the service men and women returning from Iraq and Afghanistan are

seeking care due to musculoskeletal ailments including back and joint pain, which is commonly caused by injuries from combat, heavy gear, motor vehicle accidents, and blast injuries. McMichael noted that doctors of chiropractic offer expert conservative care but more is needed.

Chiropractic care has been available within the Veterans Administration system for many years, but Congress took action when it became apparent that the VA had failed to take any reasonable steps to provide veterans with chiropractic care and pushed for chiropractic care to be integrated into 36 major treatment facilities.

Despite this progress, McMichael stated, there is still an overwhelming majority of veterans denied access to chiropractic care at approximately 120 major Veterans Administration facilities.]]> http://www.chiroeco.com/news/chiropractic-news.php?id=8683 Tue, 15 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1050 EHR
The digital record funding comes from the Health Resources and Services Administration from its pool of $1.5 billion in stimulus money to update buildings and systems at the 1,100 health centers nationwide, according to a Dec. 9 news release. Those centers serve 17 million uninsured or underinsured people.

The $88 million will go to Health Center Controlled Networks, which are electronic networks established by three or more health centers to share core business functions. About 53 such networks now exist.

Earlier this month, the Health and Human Services Department announced it would provide $235 million in stimulus funding to communities that can serve as "beacons" demonstrating the meaningful use of health IT.

In addition, the administration announced that Medicare will operate a three-year Medical Home demonstration project for 500 federally qualified health centers.

The Medical Home is a concept in which a primary care doctor, such as a general practitioner, manages care for a patient. In such practices, each patient has an assigned doctor to help coordinate specialists to provide integrated care.

Assuming the Medical Home project is successful, it could be a feature of health care reform to help manage costs as well as to improve quality, said Dr. David Kibbe, a health care consultant.

“In the Bush administration, almost no one was willing to talk about the costs of care,” Kibbe said. Now there is an emerging consensus, he said, “that physicians should be paid for delivering quality care rather than on the quantity of care they provide.”]]> http://fcw.com/articles/2009/12/14/stimulus-funds-to-pay-for-electronic-health-records-at-federal-centers.aspx Tue, 15 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1051 HIPAA
Exploring HIPAA and HITECH Act Definitions: Parts 11-15, include definitions from:

• American Recovery and Reinvestment Act of 2009 (February 17, 2009, pp.258-259),
• Health Information Technology for Economic and Clinical Health Act,
• Title XIII—Health Information Technology,
• Subtitle D—Privacy,
• Section 13400—Definitions.

Disclose
The terms ‘disclose’ and ‘disclosure’ have the meaning given the term ‘disclosure’ in section 160.103 of title 45, Code of Federal Regulations [CFR]:

“The release, transfer, provision of, access to, or divulging in any other manner of information outside the entity holding the information.”

Electronic Health Record
An electronic record of health-related information on an individual that is created, gathered, managed, and consulted by authorized health care clinicians and staff.

Health Care Operations
Has the meaning given such term in section 164.501 of title 45, Code of Federal Regulations [CFR]:

“Health care operations means any of the following activities of the covered entity to the extent that the activities are related to covered functions:

(1) Conducting quality assessment and improvement activities, including outcomes evaluation and development of clinical guidelines, provided that the obtaining of generalizable knowledge is not the primary purpose of any studies resulting from such activities; population-based activities relating to improving health or reducing health care costs, protocol development, case management and care coordination, contacting of health care providers and patients with information about treatment alternatives; and related functions that do not include treatment;

(2) Reviewing the competence or qualifications of health care professionals, evaluating practitioner and provider performance, health plan performance, conducting training programs in which students, trainees, or practitioners in areas of health care learn under supervision to practice or improve their skills as health care providers, training of non-health care professionals, accreditation, certification, licensing, or credentialing activities.

(3) Underwriting, premium rating, and other activities relating to the creation, renewal or replacement of a contract of health insurance or health benefits, and ceding, securing, or placing a contract for reinsurance of risk relating to claims for health care (including stop-loss insurance and excess of loss insurance), provided that the requirements of § 164.514(g)[1] are met, if applicable;

(4) Conducting or arranging for medical review, legal services, and auditing functions, including fraud and abuse detection and compliance programs;

(5) Business planning and development, such as conducting cost-management and planning-related analyses related to managing and operating the entity, including formulary development and administration, development or improvement of methods of payment or coverage policies; and

(6) Business management and general administrative activities of the entity, including, but not limited to:
(i) Management activities relating to implementation of and compliance with requirements of this subchapter;
(ii) Customer service, including the provision of data analyses for policy holders, plan sponsors, or other customers, provided that protected health information is not disclosed to such policy holder, plan sponsor, or customer;
(iii) Resolution of internal grievances;
(iv) The sale, transfer, merger, or consolidation of all or part of the covered entity with another covered entity, or an entity that following such activity will become a covered entity and due diligence related to such activity; and
(v) Consistent with the applicable requirements of § 164.514,[2] creating de-identified health information or a limited data set, and fundraising for the benefit of the covered entity.”
[1] “(g) Standard: Uses and disclosures for underwriting and related purposes. If a health plan receives protected health information for the purpose of underwriting, premium rating, or other activities relating to the creation, renewal, or replacement of a contract of health insurance or health benefits, and if such health insurance or health benefits are not placed with the health plan, such health plan may not use of disclose such protected health information for any other purpose, except, as may be required by law.”
[2] “Other requirements relating to uses and disclosures of protected health information.”]]> http://www.hipaa.com/2009/12/exploring-hipaa-and-hitech-act-definitions-part-12/ Tue, 15 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1052 PHR
Implementing a personal health record (PHR) entails gathering as much information about your past and current health and organizing it in such a way that it can be easily retrievable and reproducible for circumstances that might require its use. The starting point is to choose a personal health record which will allow you to enter typed information as well as information and official documents such as x-ray reports, laboratory reports and electrocardiograms. Ideally, the program should have a resource to allow you to learn more about your medical condition(s) and should be secure and encrypted with password protection of your personal data.

Other desirable features include the ability to store health information about your family members as well as yourself, technical support in using the program, ease of transferring information into it and from it to your health care provider(s) and flexibility in the reproduction of the data.

All these factors considered, a local computer-based personal medical records software application is probably the most logical choice. After choosing a personal medical records software program and installing it on your computer the next step involves locating and gathering all the paper documents you may have in your home or elsewhere containing information about your health. These documents can include immunization records, prescription drug labels, prescription receipts, written instructions from your doctor(s), notes taken by you during doctor visits, office records you may have from your current or previous physician(s), hospital bills, prescription receipts, and copies of superbills from your doctor(s).

Once you have gathered as much information as possible pertaining to your health it should then be entered into the appropriate sections and subsections of the personal health record. The basic informational entry process will require typing, but if you want to include actual official reports such as x-rays, laboratory tests, or electrocardiograms, those documents can be scanned, then copied and pasted into your PHR.

If you are fairly technical and want to have some fun creating your personal health record dictating the information using one of the speech recognition software programs such as Dragon NaturallySpeaking or ViaVoice is an alternative which is also more efficient than typing. If you do not want to buy a speech- recognition software program and you have one that came with your computer this would be a good time to learn to use it.

If you are even more technical and want to be even more efficient in implementing your personal health record you can dictate your health information into a digital recorder, transcribe it through the voice editor software program that comes with the digital recorder into a word processor program such as Microsoft Word or one that comes with the speech recognition program, then copy and paste it into your PHR. The latter method allows you to document information for entry into your health record in real time, such as when you come across stored records in your home or if you dictate notes during doctor visits.

After you have entered as much health-related information about yourself as you have available, then fully explore the personal health record program, going through all the tabs and sub tabs to see if there is any other information you can retrieve and enter at a later date. You might need to obtain some of this information from your health care provider(s), but since it is not yet commonplace for patients to share the responsibility of maintaining a health record it might be necessary for you to explain to your doctor(s) the benefits of having a personal health record, so as to ease any possible concerns of you being litigious.

Also, begin making journal entries regarding new symptoms or developments that need to be discussed during impending doctor encounters. Once implemented, the maintenance and updating of your personal health record should motivate you to be more involved in your health care and hopefully improve your health.]]> http://health.newsm8.com/how-to-implement-a-computer-based-personal-health-record Tue, 15 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1053 Technology
Backup
The concept of backing up data is about making a copy of the entire system, that is, all data, the operating system, and all applications. This “copy everything” approach is designed to restore a system with its data in the event of a disaster or business disruption. When the data is copied onto a backup media, it is stored in random order and is not indexed so that the data can be easily accessed and isolated outside of the system. Disaster recovery backup copies should be made solely for the purpose of restoring the operating system or application and its associated data only in the event that a disaster destroys the system.

Archiving
Archiving, on the other hand, entails “moving” data from a production system to a near- or off-line solution. The data, with its associated metadata, is physically moved, and it is deleted from the production environment to allow the production system to optimize capacity for current business needs. The archived data is organized and indexed for easy access and retrieval. Archives are created so that inactive data that must be retained to fulfill retention requirements is properly preserved and indexed until its retention is met.

Keep ‘Em Separated
Keeping the processes for backing up and archiving media separate provides several benefits to the company. The first is compliance. There is no requirement to retain backup media for long periods of time. The driver for how long a company keeps backup media is based on the business’ need. How far back would a company need to go to restore a system and its data if a disaster occurs? IT would restore the most recent backup media because it has the most current work product. There is no need to retain backup media for extended periods of time, whereas the archive has a defined period of time it must be retained for retention and compliance.

The data in an archive should be retained according to legal requirements and business needs. Those retention needs should be spelled out in the company records retention schedule and are based on the categories of information being preserved. Once data is in an archive for retention, it is no longer on the production system and must be indexed in order for the data to be found.

Second, it is more cost-effective for operations to recycle backup media on a frequent basis: Holding backup media as archives means that you are copying the applications--and possibly the operating system--over and over while taking up valuable media space. These multiple copies of system data are not necessary. If your argument is that you are only making incremental copies, then you are not copying the whole record on the backup anyway. Shorter cycle times for backups and reuse of media reduces costs for an IT operation. Archiving only the information needed also assures that media resources are being used wisely.

A third reason for separating the processes of backup and archiving is for improving response times to discovery requests. Short backup cycle times where the media is being recycled will prevent a company from having to go back beyond the most recent media to preserve backup tapes for discovery. Information relevant to litigation, audits, or investigations that is indexed in an archive is faster to find, access, and use in developing a list of responsive documents for production. The difference in time can range in days depending on the amount of information that has to be considered in review. Courts have refused to accept a dual standard set where parties had accessed backup media for their own needs, by allowing them to serve as archives, but objected to doing so for discovery. Continuing to use backup media for both disaster recovery and archiving increases the company’s risk to increased discovery costs.

Separating the processes for creating backup media and archives also involves a partnership with IT and RIM. The team approach for protecting or preserving electronic information must align with other requirements the company has for managing its information assets. The processes developed must be consistent and repeatable--followed as the normal course of business.

By creating separate and distinct processes for backup versus archives, a company can save money, improve response times to discovery requests, and more effectively select a technology that meets the specific demands of the process for ongoing improvement.]]> http://www.aiim.org/infonomics/archives-vs-backups.aspx Tue, 15 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1054 EHR
Too Soon To Calculate EHR Effectiveness
As one might expect, this study has caused many healthcare executives, IT professionals, and clinicians to question the value of EHR technology and the government stimulus designed to drive EHR adoption. There are now some serious doubts that EHR technology will deliver any cost savings to the healthcare system in the United States, let alone the $100 billion in annual savings estimated by some.

My plea to any new EHR doubters is that this study is extremely premature and, in some areas, a bit misleading. First, since standards for meaningful use of EHRs have yet to be established, there is no way to tell whether or not the EHR facilities reviewed by the study are using the technology effectively. As we all know, poor implementation of technology will generate roughly the same results as deploying no technology at all. Second, numerous factors contribute to a hospital's average length of stay and, in my opinion, an EHR isn't one of the top contributors to this calculation. The same argument can be made for the heart failure category as well. Finally, according to HIMSS (Health Information Management Systems Society), less than 1% of all U.S. hospitals have achieved Stage 7 EMR (electronic medical record) adoption. According to HIMSS, Stage 7 adoption represents a complete EMR — one where CCD (continuity of care document) transactions are shared electronically and data continuity exists enterprise-wide. Much of the cost savings and operational benefits of EHRs (e.g. the sharing and exchange of medical records electronically among internal hospital departments as well as with outside hospitals and administrators) will be realized only when many more hospitals are effectively leveraging complete EMR systems. With this in mind, evaluating the effectiveness of EHRs en masse at this point is kind of like planting a few apple seeds, watering them for a few days, and being surprised when these efforts don't produce a fruit-bearing tree by week's end.

When implemented correctly, EHRs do have the potential to save the healthcare industry a lot of money. However, these cost savings won't be immediate. Instead, they will come over time, gaining momentum year over year as more and more healthcare facilities begin to leverage the technology in "meaningful" ways. The effectiveness of EHRs today are best examined by taking a closer look at the individual hospitals that have successfully deployed EHRs and can demonstrate the monetary and operational gains realized as a result of the technology. These hospitals are out there, and they should be the models for which the "meaningful use" standards are based. This approach should provide other healthcare facilities with a blueprint for EHR implementation and help propel us to a point where the effectiveness of EHR technology can be accurately measured industry-wide.]]> http://www.healthcaretechnologyonline.com/article.mvc/Dont-Lose-Faith-In-EHRs-0002 Tue, 15 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1055 Practice Primary care exception

Q I work in a residency setting and we use the primary care exception rule that lets residents bill up to level three without attending physician presence. Two questions: 1) How do we bill inpatient services with the GE modifier using the exception, and 2) Can we use the exception on preventive services like 99397?

A As to the inpatient service portion of your question, the exception rule states that “the services must be furnished in a primary-care center located in the outpatient department of a hospital or another ambulatory care entity.” So no, there is no case where you would use GE for an inpatient service, only GC. If residents are involved in inpatient care, the attending must meet the presence requirements and document it. If a resident sees the patient without attending presence, it is not a billable service.

The second question involves preventive services. According to the CMS guidelines: “Medicare may grant a primary care exception within an approved GME program in which the teaching physician is paid for certain E&M services the resident performs when the teaching physician is not present. The primary care exception applies to the following lower- and mid-level E&M services: 99201, 99202, 99203, 99211, 99212, 99213.

Effective January 1, 2005, the following code is included under the primary exception: Healthcare Common Procedure Coding System code G3044: Initial Preventive Physical Examination: face-to-face visit, services limited to new beneficiary during the first six months of Medicare enrollment.”

The rules here pretty clearly define which codes can and can’t be used. That last sentence says “code” — singular. I’m interpreting that to mean the other preventive service codes 99381-99397 are not eligible for the exception. That does not mean they can’t be provided by a combination of resident and attending physicians and billed with a GC.

Critical care code

Q Can I bill a critical care code if a patient becomes seriously ill while in my office?

A Yes, you just have to meet the requirements for critical care, which is a timed code. The reason we don’t see much of it in the office is that the minimum time for reporting a critical care service is 30 minutes — and usually, the patient is transported elsewhere by then when they become critically ill in the office.

The CPT manual defines it as “direct delivery of medical care for a critically ill or injured patient. A critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration in the patient’s condition.” There are no site-of-service restrictions.

Prescription drug management

Q My coder tells me that when I use a prescription medication on a new problem that I automatically qualify for moderate level decision making. I’m a pediatrician, and for me this fits a lot of what I feel are lower level problems. Am I under-coding my services if I bill 99213 with some prescriptive management?

A Not necessarily. Your coder is referencing the decision-making tables that Medicare and other payers may use to determine the level of medical decision making. Technically he or she is correct, but that may not save you in a medical necessity review. Your instinct seems to me to be much more in tune with medical necessity.

One of the three tables gives points for the number of problems dealt with: one point for each established stable problem, two points for a worsening established problem, and three points for a new problem. We talked about these in the last issue. There is no issue with a new problem getting you three points, or moderate complexity, in this table.

The sticky point is the part about writing for a prescription medication. Your coder is correct that the entry “prescription drug management” is listed in the “moderate” section. But using this to determine the level of risk is interpreting the table somewhat mechanically, seemingly without a good grasp of medical necessity.

The mere presence of prescription drugs does not necessarily qualify for moderate complexity. CMS has indicated that writing a prescription for a seven- or 10-day supply of an antibiotic is not considered to be a moderate level of complexity. At least one Blue Cross company has indicated that prescription drug management involves more than the use of prescription drugs. It may mean a change in regimen, the addition of an agent, or the worsening of a problem. In other words, any prescription is not a guarantee that a payer will see this your way.

Consider the entry in the first column of the table, Presenting Problem, under low level decision making. It says “acute uncomplicated illness or injury; e.g., cystitis, allergic rhinitis, simple sprain.” Does the new problem that you were describing fit into this category? If so, you might be more accurate — as you indicated — with the low level decision making associated with a 99213.

I’m not trying to diminish your work in any way. I am only saying that a medical necessity review may find the problem more of a low level one, despite the fact that a prescription was written. Remember that those tables were in use as far back as 1990 — almost 20 years ago. The ink may not have changed on the page, but the interpretation may have moved away from the literal.]]> http://www.healthcaretechnologyonline.com/article.mvc/Dont-Lose-Faith-In-EHRs-0002 Tue, 15 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1056 Technology
Second Life is a 3D virtual world that uses avatars, moveable icons representing people, to interact through free voice and text chat. During the winter trimester, the Northwestern clinical education department will administer a Second Life beta test that will allow students to conduct virtual interviews with patients in an online simulated clinical training environment.

“This is a rare opportunity because students will be able to interact with unique patient populations of varying ethnicities and abilities,” said Lynne Hvidsten, DC, associate dean of clinical education. “The students can more routinely interact with patients that have disabilities or conditions such as multiple sclerosis — patients they are apt to see in practice, but have little opportunity to experience in a classroom.”

Glori Hinck, DC, assistant professor and pioneer of this program, spoke about Second Life at a technology conference in Australia last summer. Since then, she has been working to integrate the technology into an active education program.

Mary Berg, MA, assistant professor, coordinates the chiropractic rotation experiences for the T8 students. “We had about five to 10 students interested in participating in the rotation on Second Life. We know that Second Life may not be for everybody, but we are encouraged by this initial response.”

Hvidsten, Hinck, and Berg currently use Second Life and avatars as a means of interacting with each other from separate locations. “It’s like having a conference call with avatars,” said Hvidsten. To learn more about Second Life, check out a brief introduction created by Dr. Hinck here or the image below for 7:30-minute video.

]]> http://www.chiroeco.com/news/chiropractic-news.php?id=8895 Wed, 16 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1057 EHR
Those concerns were noted in two articles published in the January 2010 issue of JAMIA. The January publication, JAMIA's premiere issue, is one of 30 specialty titles published by the BMJ (British Medical Journal) Group, UK.

One study is based on views of more than 1,000 family practice and specialist physicians in Massachusetts who were asked whether they thought electronic health information exchange would drive down costs, improve patient care, free up their time and preserve patient confidentiality. They were also asked whether they would be willing to pay a monthly fee to use the system.

The responses showed widespread support for the use of HIE, even though a little more than half are using EHRs.

Eighty-six percent of those surveyed said HIE would improve the quality of care, and seven out of 10 think it would cut costs. Three out of four indicated it also would save time.

But 16 percent said they were "very concerned" about potential breaches of privacy, while 55 percent said they were "somewhat concerned."

The authors said the responses indicate a lower level of concern than those expressed by physicians in the UK, but suggest that this might change if more breaches occur.

Despite their overall enthusiasm, physicians said they wouldn't support the suggested $150 monthly fee, and nearly half were unwilling to pay anything.

Privacy concerns higher in mental health

The second study suggests that mental health professionals have significant concerns about the privacy and security of data on EHRs.

Of 56 responding psychiatrists, psychologists, nurses and therapists (120 who were sent the survey) based at one academic medical center, 81 percent said they felt the system permitted the preservation of "open therapeutic communications." Most also said electronic records are clearer and more complete than paper versions, although not necessarily more factual.

When it comes to privacy, 63 percent are less willing to record highly confidential information in an electronic record than they would on a paper record.

More than eight out of 10 said if they were to become a patient, they would not want their mental health records to be routinely accessed by providers.

The authors said previously published surveys of patients have reflected a lack of confidence in tight security, and that people with mental health issues already face stigmatization.

While the narrative data of patients' life histories and experiences inform clinical decision-making in psychiatric care, the threat of security breaches makes them vulnerable to potential misuse or misinterpretation, the authors said.

Adoption of EHRs has been slower than anticipated, the authors said. "Designers of future systems will need to enhance electronic file security and simultaneously maintain legitimate accessibility in order to preserve confidence in psychiatric and other (electronic health record) systems," they concluded.]]> http://www.healthcareitnews.com/news/privacy-breach-worries-still-dog-electronic-health-records Wed, 16 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1058 Practice
I realize that money for training falls by the wayside with increased financial pressures. And reductions in personnel make it difficult to find time. This is where your creativity comes into play. The only factor that limits strengthening and growing your staff is your imagination.

Here are six creative ways to make an investment in your practice's staff:

Throw a lunch and learn.
Tried and true, this is a great way to build camaraderie and provide training at the same time. Dial into a Webinar or bring in a speaker. MGMA on-demand Webinars are a great place to start.

Form a journal club.
Several practices I've consulted with have done this recently. Select articles from various healthcare, business or management publications, like the MGMA Connexion, and provide them to your management team. Have the team read the articles and discuss them on a weekly or biweekly basis. It's up to you to facilitate the conversation, but many great ideas can arise from these team discussions.

Teach conflict resolution as situations arise.
So two front desk staffers are arguing over the lunch schedule. Each comes to you complaining about the other. Use this as a "teachable moment" to bring the two staffers together and coach them through resolving this conflict. This approach will "teach them to fish" rather than "giving them a fish," helping them mitigate future problems themselves.

Provide financial counseling.
Let's face it: Everybody is under some sort of financial pressure these days. Your staff members are no different. Show them that you care about them as people by arranging private financial advice or even debt counseling for them at the practice. If you can lessen the stress at home, you can improve the performance at work.

Promote health and wellness.
Why not make special arrangements for your staff to join a local athletic club or gym at a reduced rate? This is a great way to show them that you care about their well-being. Plus, healthy employees mean fewer sick days – great for you and your employees!

Step away from your desk.
One of the best things you can do for your employees is to interact with them in the workspace. Managing by walking around (MBWA) is perhaps more appropriate today than ever; in Engaging Physicians: A Manual to Physician Partnerships, Stephen Beeson, MD, calls it "rounding on the staff." It helps open communications between administration and staff and allows you to assess needs, recognize good work and build stronger bonds.

If you take the time to develop and enrich your staff, your employee satisfaction will grow, patient satisfaction will increase and the workday will become far more enjoyable – even in these trying times.]]> http://blog.mgma.com/CMS/UI/Modules/BizBlogger/rss.aspx?tabid=120571 Wed, 16 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1059 Healthcare Technology
About 200,000 medical labs operate in the United States, including 8,500 in hospitals, 5,200 commercial labs and about 115,000 in clinicians' offices. Most fail to use standards when reporting test results, even when exchanging them electronically, Micky Tripathi, co-chair of the Information Technology Policy Committee's information exchange work group, told the Health Information Technology Policy Committee. The panel is in charge of setting policies for electronic health records.

Labs that have electronic message systems use thousands of custom message formats and operate with a software-based clinical vocabulary that can include as many as 40,000 terms, said Tripathi, who is president and chief executive officer of the Massachusetts eHealth Collaborative.

To ensure the success of a national electronic health record system, Tripathi said labs should strictly adhere to electronic messaging standards developed by the Health Level Seven standards organization and should not add personalized tweaks to their software. Labs also should limit their clinical vocabulary to between 400 and 700 terms, which would cover more than 90 percent of the work they do, he added.

The HIT Policy Committee, a federally chartered advisory group to the Health and Human Services Department, adopted the work group's recommendation that HHS' Office of the National Coordinator for Health Information Technology should require national standards for lab messaging and vocabulary. But David Blumenthal, the national coordinator for health IT, said he could not require the standards because HHS Secretary Kathleen Sebelius has the authority only to adopt standards, not issue them.

In addition, federal regulations should be changed to ensure that patients have speedy access to lab results, said Deven McGraw, director of the Health Privacy Project at the Center for Democracy and Technology, and the other co-chair of the information exchange work group.

A national electronic health record system will require the exchange of data among all clinicians and hospitals through the National Health Information Network.

To do so, HHS or another organization will need to create a phone book for the national network to serve as an automatic directory service that looks up a patient and then electronically directs the patient's health data to clinicians, said David Lanksy, president and CEO of the Pacific Business Group on Health and co-chair of the policy committee's national health information network work group.

Lansky said the electronic records network also must ensure that it can protect health records, including secure routing and authentication between parties exchanging clinical information.]]> http://www.nextgov.com/nextgov/ng_20091215_3680.php Wed, 16 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1060 Healthcare Technology here]]> http://www.microsoft.com/industry/healthcare/healthtechtoday/ Wed, 16 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1061 EHR
Collecting meaningful analytics data for reporting was nearly impossible.

"We realized it was time to introduce new technology into our practice," said James Hewitt, CIO at Springfield Clinic. "We knew that paper medical charts were no longer efficient for our growing practice. We needed to consolidate multiple paper patient charts into a unified digital record that would be easy to use and easily accessible anywhere, any time."

In response, Springfield Clinic organized an Oversight Committee to evaluate the practice's automation needs and available electronic health record (EHR) alternatives. "The participating clinicians and administrative staff identified several requirements for our practice," explained Hewitt. "A primary goal was to find a vendor with long-term viability and a commitment to EHR."

'Mini-bang' implementation

The committee evaluated numerous solutions. "Because we are a multi-specialty clinic, we needed an EHR that was flexible enough to adapt to the specific and complex requirements of each specialty," Hewitt said. "We also needed a light-weight, browser-based option so our numerous outreach locations would have quick access to the system."

By the end of 2005, Springfield Clinic selected the Enterprise Electronic Health Record from the Chicago-based Allscripts. Hewitt and his staff began work on their implementation strategy.

"We opted for a 'mini-bang' approach, meaning we would bring up only one clinic at a time, but include every aspect of the facility," Hewitt said. "We selected our Hillsboro Medical Center practice as a pilot because it is one of our smaller sites and the home base of one of our physician champions."

After installing a wireless network infrastructure with stable connectivity back to the main office, an implementation team began software setup and testing. "We deployed four nurses and one IT staffer to Hillsboro, who initially focused on existing workflow patterns," said Hewitt. "The group paid particular attention to processes deemed highly efficient because we didn't want the EHR to decrease physician productivity. We wanted to customize individual clinician workflows to maximize each provider's EHR use and enhance the provider experience."

Two weeks before the go-live date, physicians received eight hours of one-on-one training. Nurses participated in four hours of instruction and both groups were required to pass a proficiency test.

"In June 2006, the Hillsboro office went live," Hewitt reported. "Staff was using Tablet PCs to document chart information, input prescriptions and order tests. We provided the paper charts for the first two days, and then staff said they didn't need them anymore."

Though providers reduced their patient loads initially, within two days physicians began returning to a normal schedule. All providers reached pre-EHR levels within two weeks.

For the next several weeks, the implementation team worked with Hillsboro clinicians to further customize workflows and fine-tune the implementation process. At the end of the pilot period, Springfield Clinic began scheduling full clinic go-lives every two weeks. Every Springfield Clinic medical specialty group is now fully utilizing the EHR.

"The transition to an EHR allows us to maintain just one record for each patient, no matter how many Springfield Clinic providers the patient sees," Hewitt said. "With proper credentials, any of our providers can access a patient record anywhere they have Internet access."

Since all clinical data is now stored electronically, Hewitt has ready access to a wealth of analytical information. "In just a few quick steps, I'm able to create reports that include clinical information on our entire patient population," he said. "The abundance of readily accessible data gives us the opportunity to track information required to qualify for pay-for-performance and HEDIS awards."

Reduced costs

The success of the EHR implementation spurred Springfield Clinic to consider other technologies for reducing practice costs and improving efficiencies. "We wanted to give our patients an alternative to all the paperwork we historically required at every patient appointment," Hewitt said. "We thought a medical kiosk for patient check-in would eliminate patient frustration and reduce our overhead at the same time."

Springfield Clinic partnered with Allscripts and the two co-developed the Allscripts Patient Kiosk solution. The kiosk integrates Fujitsu PalmSecure palm vein authentication to ensure patient confidentially and security.

"Patients can use the kiosk to check in, pay their co-payment, and verify and update their personal information," Hewitt explained. "They love it because it gives them more control over their information and the PalmSecure technology eliminates their security concerns."

Between the full EHR implementation and the addition of 50 patient kiosks, Springfield Clinic has reduced its practice overhead. Health information management staffing has decreased from 160 to 45 full-time employee equivalents, saving the practice almost $3 million a year in salary and benefits. Millions of dollars in transcription costs have been eliminated now that providers are inputting chart notes via Tablet PCs. Removing the paper chart has also helped Springfield Clinic re-purpose 22 medical records storage areas throughout its sites.

Hewitt said the new technologies have improved efficiencies and provided a strong return on investment. "Not only have we been able to get rid of 45 million sheets of paper, we've reduced costs in multiple areas and netted a $4.5 million return on investment [ROI] in the first year," said Hewitt. "We fully expect a $35 million ROI over the next five years."]]> http://health-care-it.advanceweb.com/Article/Ambulatory-EHR-Implementation.aspx Thu, 17 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1062 Legislation EHR
Dr. David Blumenthal, the national coordinator for health IT, yesterday asked the advisory Health IT Policy Committee to defer until January a decision on whether to allow temporary variations in those standards to be used.

The policy committee had recommended providers start using in 2011 a single set of national standards for communicating electronically with labs, one of the tenets of the administration’s meaningful use policy to encourage the use of health IT.

But at its meeting yesterday, the panel wrestled with and stopped short of stripping a phrase that would have allowed providers to depart from those standards until 2013.

That exception had been introduced in Sept. by HHS’s Health IT Standards Committee, which had recommended specific messaging and vocabulary standards for 2011 but allowed for temporary variations for local codes and existing lab interfaces in 2011 and 2012.

“The practical effect is that there would be a standard, but non-standard transmissions would not disqualify someone from being a meaningful user until 2013,” Blumenthal said.

The standards set are Health Level 7, version 2.5.1, for lab content exchange, and Logical Observation Identifiers Names and Codes (LOINC), Unified Code for Units of Measure (UCUM) and Systematized Nomenclature of Medicine--Clinical Terms (SNOWMED CT) for clinical lab vocabularies.

A workgroup of the Policy Committee urged that there be no variations to the standards in 2011; instead it recommended instituting a glide path or roadmap to enforcement by 2013.

Blumenthal said both the policy and standards committee should work to craft an agreement on whether to prohibit variations to the standards requirement.

Allowing variations even of a single standards set will continue to keep provider costs high to install those options in their electronic health record systems, said Micky Tripathi, co-chair of the policy committee’s information exchange work group, and also president and chief executive of the Massachusetts eHealth Collaborative.

“Labs are the Achilles heel of meaningful use,” he said, adding that most lab results are still delivered through letter and fax.

Neil Calman, a committee member and president and chief executive officer of New York’s Institute for Family Health, described how the current approach to multiple standards and lab interfaces was eating up resources.

“We have five lab interfaces, and it’s an expanding nightmare. We use up days just setting them up,” he said. It’s also a huge quality issue when the lab reports don’t come back in the right presentation to the right record.

“If we can smooth this over, people will be able to put systems in place and become meaningful user much easier,” Calman said.

In addition to setting national lab standards, the policy committee also recommended that ONC create implementation guides for providers to establish the standards in their systems and for vendors to incorporate them in new EHRs for certification.

To assert some oversight of the standard, the committee also recommended that the Centers for Medicare and Medicaid Services develop a survey and certification letter for labs that would explain how lab information should be presented in EHRs and health information exchanges using the standards. CMS would describe how the standards would meet the Clinical Laboratory Improvement Act (CLIA), which governs labs.]]> http://govhealthit.com/newsitem.aspx?nid=72733 Thu, 17 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1063 Medical Home
Care management tools are most widely used in groups with over 50 physicians and group/staff model HMOs.

In Expectations Outpace Reality: Physicians' Use of Care Management Tools for Patients with Chronic Conditions from the Center for Studying Health System Change (HSC), researchers found that physicians' use of tools varies widely even among those measures that have been proven to be effective.

HSC surveyed 7 care management tools:

• Written materials for patient education
• Nurse managers to coordinate care
• Non physician educators
• Group visits
• Reports for physicians on quality of preventive care they deliver
• Reports for physicians on quality of care they deliver to patients with chronic conditions
• Patient registries.

The most widely used tool is written materials, used by 75% of physicians overall--85% of doctors in groups over 50 physicians, and 96% of doctors in group or staff model HMOs.

The least-likely used tool among all physicians is group visits (with only 20% of physicians using this method). Group visits, however, are widely used (68%) by doctors in group/staff model HMOs.

One of the most striking differences in care tool utilization is with nurse managers and non physician educators, used overall by 31% and 50% of physicians. In group/staff model HMOs, however, nearly 9 in 10 physicians use these physician care-extenders to manage and educate patients with chronic conditions.

The data source for this survey is the HSC 2008 Health Tracking Physician Survey, drawn from the AMA master file of active physicians.

]]> http://www.healthpopuli.com/2009/12/size-matters-physician-adoption-of-care.html Thu, 17 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1064 Practice
And, he asked, “Is it O.K. if I call you ‘Barbara’?”

Sure, she told him. They set to work on the first patient, and after she handed her son an instrument he needed, he graciously said, “Thanks, Mom.”

This got me thinking of how, in my own career, I have always been addressed as “Dr. Valinoti.” Freshly minted M.D.’s, some as young as 25, get a title of respect while seasoned nurses in the hospital are Betty, Kaye or Nancy.

I remembered the absurdity of this situation when, as an intern, I was addressing critical care nurses with decades of experience by their first names while they deferentially called me “Doctor.” These were women who had started their careers when I was still playing with Barbie dolls, yet where were their professional titles? Like most things in medical training, I got used to it, and it became second nature.

One thing I am still getting used to, though, is when patients call me by my first name. There seems to be a void in this area of etiquette: How does one address one’s physician? It is almost always an older patient who will use my first name, in a friendly, offhand way. And, I have observed, these patients are usually men. It might seem natural if I have had a long-term relationship with these people, caring for them over the years, but often these patients seem to make a decision at the outset to be on a first-name basis with me. I wonder about these people. Are they trying to be chummy? Is it a power thing, making them feel less vulnerable while they sit half naked on the exam table? Do they just call everyone by their first names?

At first I thought that perhaps this was a phenomenon particular to female physicians. For example, a colleague with whom I worked was a distinguished physician in the community, yet, she said with a sigh, “All my patients call me ‘Sally.’ ” Clearly, she did not insist on this with her patients; it had just evolved.

But the male physicians in my practice have described the same situation. I remember being on call for the practice one night and speaking to a patient of another physician in my group. She went on in detail about the tests and treatment she was receiving from Adam, her doctor. After the conversation, I assumed that she was his personal friend.

“No,” he told me the next day. “I really just only met her.”

Regardless of whether I am “Anne Marie” or “Dr. Valinoti” to a patient, I rarely call a patient by his or her first name. As a rule, patients who are my senior are always “Mr./Ms./Dr.” Patients I meet for the first time are always addressed by their title, even teenagers (it seems silly, I know). Although many patients introduce themselves by their first name, I would never presume to address them as such without their specific permission. And even then, frankly, I find it hard to call a man old enough to be my father “Frank” or “Jim.” It is akin to my habit of still addressing old friends of my parents by their formal titles.

A study published in The British Medical Journal looked at the question of patient preferences regarding how doctors address them. Interestingly, most patients surveyed, particularly those younger than 65, preferred that their physicians call them by their first name.

But doctors do this at their own peril. A physician friend of mine experienced this firsthand when he made the mistake of calling a woman of a certain age by her first name during a visit. “That’s Mrs. White, thank you,” she told him, icily.

“I never forgot that one,” he said, remembering how he sheepishly finished her exam.

It is helpful for me to think about the doctor-patient relationship from time to time, especially in terms of how my patients and I communicate. The importance of effective communication in that setting cannot be overemphasized. Accurate diagnosis and treatment of medical ailments depend on the doctor’s clear understanding of the entire person who sits before her. A good internist will recognize dozens of subtleties during a simple face-to-face interview — subtleties that cannot be detected by the most sophisticated and expensive scans.

As medical costs climb skyward in our country, there is growing recognition that excellent primary care might be the foundation of a more accessible, affordable health care system. Great primary care doctors are, by necessity, great communicators. And, let’s face it: all communication starts with what we call one another.]]> http://www.nytimes.com/2009/12/15/health/15case.html Thu, 17 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1065 HIPAA
Exploring HIPAA and HITECH Act Definitions: Parts 11-15, include definitions from:

• American Recovery and Reinvestment Act of 2009 (February 17, 2009, pp.258-259),
• Health Information Technology for Economic and Clinical Health Act,
• Title XIII—Health Information Technology,
• Subtitle D—Privacy,
• Section 13400—Definitions.

Health Care Provider Has the meaning given such term in section 160.103 of title 45, Code of Federal Regulations [CFR]:

“A provider of services (as defined in section 1861(u) of the [Social Security] Act, 42 U.S.C. 1395x(u)), a provider of medial or health services (as defined in section 1861(s) of the [Social Security] Act, 42 U.S.C. 1395x(s), and any other person or organization who furnishes, bills, or is paid for health care in the normal course of business.”

Health Plan
Has the meaning given such term in section 160.103 of title 45, Code of Federal Regulations [CFR]:

“Health plan means an individual or group plan that provides, or pays the cost of, medical care (as defined in section 2791(a)(2) of the PHS [Public Health Service] Act, 42 U.S.C. 300gg-91(a)(2).

(1) Health plan includes the following, singly or in combination:
(i) A group health plan, as defined in this section.
(ii) A health insurance issuer, as defined in this section.
(iii) An HMO, as defined in this section.
(iv) Part A or Part B of the Medicare program under title XVIII of the Act.
(v) The Medicaid program under title XIX of the Act, 42 U.S.C. 1396, et.seq.
(vi) An issuer of a Medicare supplemental policy (as defined in section 1882(g)(1) of the Act, 42 U.S.C. 1395ss(g)(1)).
(vii) An issuer of a long-term care policy, excluding a nursing home fixed-indemnity policy.
(viii) An employee welfare benefit plan or any other arrangement that is established or maintained for the purpose of offering or providing health benefits to the employees of two or more employers.
(ix) The health care program for active military personnel under title 10 of the United States Code.
(x) The veterans health care program under 38 U.S.C. chapter 17.
(xi) The Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) (as defined in 10 U.S.C. 1072(4)).
(xii) The Indian Health Service program under the Indian Health Care Improvement Act, 25 U.S.C. 1601, et.seq.
(xiii) The Federal Employees Health Benefits Program under 5 U.S.C. 8902, et.seq.
(xiv) An approved State child health plan under title XXI of the Act, providing benefits for child health assistance that meet the requirements of section 2103 of the Act, 42 U.S.C. 1397, et.seq.
(xv) The Medicare+Choice program under Part C of title XVIII of the Act, 42 U.S.C. 1395w-21 through 1395w-28.
(xvi) A high risk pool that is a mechanism established under State law to provide health insurance coverage or comparable coverage to eligible individuals.
(xvii) Any other individual or group plan, or combination of individual or group plans, that provides or pays for the cost of medical care (as defined in section 2791(a)(2) of the PHS Act, 42 U.S.C. 300gg-91(a)(2)).

(2) Health Plan excludes:
(i) Any policy, plan, or program to the extent that it provides, or pays for the cost of, excepted benefits that are listed in section 2791(c)(1) of the PHS Act, 42 U.S.C. 300gg-91(c)(1); and
(ii) A government-funded program (other than one listed in paragraph (1)(i)-(xvi) of this definition):
A. Whose principal purpose is other than providing, or paying the cost of, health care; or
B. Whose principal activity is:
(1) The direct provision of health care to persons; or
(2) The making of grants to fund the direct provision of health care to persons.”

National Coordinator
The head of the Office of the national Coordinator for Health Information Technology established under section 3001(a) of the Public Health Service Act, as added by section 13101.]]> http://www.hipaa.com/2009/12/exploring-hipaa-and-hitech-act-definitions-part-13/ Thu, 17 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1066 Healthcare
The society's Institute for Good Medicine said 96% of Pennsylvania households it polled are likely to put out cookies and milk for Santa on Christmas Eve. A medium-sized chocolate chip cookie, made with butter, has 75 calories, and a cup of 1% milk has 100 calories. Santa's overall caloric intake was computed by multiplying 4.5 million cookie-and-milk-offering households in Pennsylvania with the 175 calories in each snack.

That assumes Santa eats only one cookie per household, and that he isn't tempted by other treats Pennsylvanians told the Institute they put out for him: ham sandwiches, whiskey and beer.

The poll is part of the society's annual campaign to highlight a Christmas tradition as a way to teach a health lesson to those who don't park reindeer on the roof.

"Thanks to the magic of Christmas, [Santa] can avoid putting on that much weight," said medical society spokesman Chuck Moran. But most people aren't so fortunate, and will put on one pound for every 3,500 calories consumed but not burned.

"The average person gains 1.4 pounds per year, one pound of which is often gained over the holidays because of overeating," said Pennsylvania Medical Society President James Goodyear, MD. "There's no better time than right now to adopt the Santa Snack Plan -- to help Santa and yourself not only on Dec. 24, but also all year."

The Santa Snack Plan is a way to cut down Santa's (and your) unhealthy eating, such as the strategy modeled by the small percentage of Pennsylvanians who said they would leave carrots, apple slices and celery sticks for St. Nick.

Santa's Snack Plan, as noted by the society, also includes taking only small tastes of less healthy food. In Santa's case, the society said, he often takes only one bite of each cookie, and saves the rest for the elves back at the North Pole.

Finally, the society's plan calls for being active. Along with Christmas magic, Santa burns off cookie weight by carrying enormous bags of toys, and climbing up and down chimneys. While the society doesn't recommend that regimen for non-North Pole residents, it said people can follow Santa's off-season program of brisk walking, such as he does to check on the elves' progress, and other exercise, such as work with reindeers-in-training.]]> http://www.ama-assn.org/amednews/2009/12/14/prsg1218.htm Fri, 18 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1067 EHR
Read on…

One of the main advantages of electronic medical records is that it helps in centralizing the data of your patient. Not long in the past, a receptionist working in a clinical practice could leave for the day, only after finding and arranging the records, that are committed to the papers of the patients on the next day’s appointments’ list. If she failed to do so, or if she failed to turn up on time due to some kind of emergency, then what would rule the medical practice. Confusion! She is the one who knew, precisely, which stack of records contains the bunch of papers that represents so and so patient. The use of electronic medical records gets over this problem. Let’s go over the other electronic medical records benefits.

What are the Advantages of Electronic Medical Records?

In its digital form, the electronic medical records offer you an opportunity to run a clean and paperless clinic. If you decide to go digital, you may find that there are two options available to you.

Standalone Software

The first option is to ask a computer programmer to develop a standalone software for you, which you could install in the computer in your office. In this case, your patients’ data, in its electronic form, will be stored on the computer system in your office. You will have to take care of the data. The data safety, proper backing of the data to protect it from getting lost and virus problems will be the responsibility of your clinic, since the data is present at your end.

Online Software

Else, you could use an online EMR software. If you choose this option, your patients’ data will be stored on the Internet. It will be stored in the computers maintained by the IT company which is providing their online software to you, naturally for a monthly fee. This IT company and the computer experts employed by it, will take care of the data and deal with your problems while using it.

Electronic Medical Records

Electronic medical records, which are also referred to as EMR, contains private and medical data related to your patients. It may also contain information, such as their past medical history, substances or drugs they are allergic to, the treatments or medical procedures they underwent in the past. The data may also inform you which medications the patient is currently on and the transcription notes etc. Comprehensiveness in the patients’ data is one of the advantages of electronic medical records.

Speed of Retrieval of Electronic Medical Records

You can retrieve your patient’s records within a few seconds. All you have to do, is to type his or her name in the form that the EMR software has presented to you. Bingo! the records are right in front of you within no time. And the most important thing is that you are not struggling to decipher someone else’s handwriting, in order to read what kind of therapy or treatment your patient underwent in the past. The availability of your patient’s medical records in one place, which can be viewed in detail, is also one of the advantages of electronic medical records.

If you decide to go for online EMR software, you will find that you can access your patient’s data not only by sitting at your office but from anywhere in the world through the Internet. Of course, you must provide it with proper passwords and identify yourself. You can download electronic medical records to your PDA or palmtop and can refer to it as and when it suits you.

Safety

Your patient’s data is important and you have every right to worry about it. Will it be safe in its digital format? Yes, it will be. You must have heard about the computer system crashes and the computer viruses causing damage to the data. These may have made you suspicious about the reliability and safety of the electronic medical records. With proper backup systems and latest anti-virus, you can overcome this obstacle.

Data Format

When you use papers to commit your patients records on it, you do so in the fixed format. The format that is printed on the paper. It is not the case with the electronic medical records. You can key in data in one format and can retrieve it in another, in a form more suitable to you.

Integration and EMR Software

You can digital form of your patients data to the reference information which can be stored on your computer or on the Internet. The EMR software can help you by providing additional information about a drug, such as dosages for children and adults. Which drugs are contraindicated in which conditions and so on. The EMR software can not only help you out with your patient’s data but it can also provide information on the ICD.9, HIPAA, HCFA 1500, and the latest CPT code books. It may also help you in studying a condition by producing a 3-D images for you, by taking input of 2-D images that are already present in your patient’s data. The software also handles the medical transcription notes, as well as SOAP notes, which you can use to your own advantage. The customer support to medical billing services can also be made available to you and your patient by the EMR software. This may result in the speedy settlement of medical billing and claims for you because of the proper co-ordination with the insurance companies over medical insurance. In short, the ability of EMR software helps you centralize your resources can be counted as one of the advantages of electronic medical records.

Electronic Data and EMR Software

Electronic data generated by the systems monitoring your patient, is processed and analyzed for errors by the the EMR software. This software can sound or raise an alert, if it comes across an event needing immediate medical intervention. It can transmit the relevant data in the form of an email or warn you by sending a message to your pager or mobile. It can also accept data from the laboratory analyzer in a electronic form directly and thus, avoiding the chance of erroneous data being fed to it by a computer operator. In case of online EMR software, which you will use the database to store your patients’ data in, and support to it will be provided by the IT company.

Primarily, it is you who is going to benefit by converting to electronic medical records. It will help your staff to be more efficient by saving their time. Your patients’ data in its digital form will always be at your fingertips and not be dependent on the mindless activity of searching for it every day. It seems that the benefits of an electronic medical record (EMR) are nothing but a bag of goodies. But, are they real for you? The decision is yours. With the world going digital, it is up to you to decide, whether to take heed of the advantages of electronic medical records.]]> http://electronicmedicalrecord.wordpress.com/2009/12/18/advantages-of-electronic-medical-records/ Fri, 18 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1068 Medicare
In a notice outlining the project, HHS said the database - which could be expanded to include other types of health records - would broaden the data field against which to conduct comparative effectiveness research.

The "all-payer, all-claims database would allow for greater power in analysis," HHS said in the Dec. 15 notice posted on the government's Federal Business Opportunities site. "Claims data, especially if established in a manner where it can be linked to other data over time, can be a powerful tool for comparative effectiveness research and ultimately improve care for all Americans," the notice said.

A number of databases exist with long-term patient information that can support its research, but each has limitations, HHS said.

The Centers for Medicare and Medicaid Services Integrated Data Repository (IDR), Chronic Conditions Warehouse (CCW), and Medicaid claims files (MAX) databases include data only on the Medicare and Medicaid populations, according to the notice.

In addition, state-based all-payer, all-claims databases are limited geographically in scope and by variations in design across different states. And private databases may include information on a more demographically diverse population but are still fragmented and often inaccessible to researchers due to cost.

A new database, "if developed well would be a representative sample of the population and could be built upon over time," according to HHS.

HHS will first award a contract with a vendor to conduct a design study.]]> http://www.healthcareitnews.com/news/hhs-build-claims-database-comparative-effectiveness-research Fri, 18 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1069 Technology FireFound add-on for the Firefox browser adds tracking and remote wipe features that can help with lost or stolen computers.

The free utility works in conjunction with a FireFound username and password, which you choose the first time you start Firefox with the add-on installed. It uses the Firefox Location-Aware Browsing feature, which in turn relies on the Google Location Services, to guess your computer's physical location. When the location changes, FireFound sends its new location to your account.

From then on, you can log in to your FireFound account from any computer and check the FireFound-enabled browser's location history. If your computer is lost or stolen, you can also activate an "emergency data protection" feature that will prompt anyone who next starts the FireFound-enabled browser for the username and password.

A failed FireFound login will clear out your private Firefox data, such as passwords, browing history and cookies. You have to first choose what will be deleted when you enable the emergency feature. Since the option will delete your data, you should of course be careful to only enable it if your computer is actually lost or stolen. Successfully entering the username and password will turn off the feature, but you (or whoever has your laptop) will only get one chance. Type carefully.

Also, although you can install FireFound on multiple browsers, it doesn't separate which location data comes from which browser. If you turn on the emergency data protection, the first browser that fires up (and only that browser) will get the password challenge.

Despite its limitations, FireFound is a nice tool that can be of serious benefit if you want to keep your private browsing information out of the hands of a laptop thief. The add-on won a grand prize in Mozilla's Extend Firefox 3.5 contest.]]> http://www.computerworld.com/s/article/9142499/Don_t_Lose_Everything_When_You_Lose_a_Laptop Mon, 21 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1069A Technology
Soon, if clinical application developers are successful, physicians will be able to run diagnostic blood tests and view and send radiology scans directly from their mobile phones. The potential market is huge: More than 60% of physicians use smartphones, and that number is expected to grow to more than 80% by 2012, according to Manhattan Research's 2009 Taking the Pulse survey, which provides an overview of the latest trends in physicians' use of technology.

"The diagnostics part is exciting, and it is, I would say, cutting edge," said Joseph C. Kvedar, MD, founder and director of the Center for Connected Health, the telemedicine division of Partners HealthCare in Boston.

This expanded smartphone use was displayed at the recent annual meeting of the Radiological Society of North America. Asim Choudhri, MD, a radiologist at Johns Hopkins University School of Medicine in Baltimore, presented findings from a study he conducted on using a mobile version of the medical image viewing software OsiriX and an iPhone to diagnose appendicitis.

The study found that in 125 total viewings of pelvic and abdominal x-rays (25 cases examined by five radiologists each), an accurate diagnosis was made 124 times. "That matches with established variations between readers on a full-sized [picture-archiving and communication system] work station," Dr. Choudhri said.

Dr. Choudhri anticipates that doctors, often quick to adopt applications they find useful, will use the system anyway. That's why he conducted the study.

Although tools like this do not replace traditional diagnostic tools, Dr. Choudhri said, they can help with diagnosis in areas without immediate access to a lab. They also could expedite consultations with an off-site physician.

Other researchers are conducting tests that not only would allow the exchange and sharing of data and images but also would adapt the phone itself to act as a microscope to create images.

Daniel Fletcher, PhD, associate professor of bioengineering at the University of California, Berkeley, led a group of student researchers who designed a microscope that works with a cell phone camera. The group published a study online in PloS One in July about using the technology in the field to diagnose malaria and tuberculosis.

The next step will be an effectiveness field test, which Fletcher plans to start in the summer of 2010.

Fletcher admits that the quality of microscopic images on cell phones will never be as accurate as with standard lab equipment. "It only has to be good enough," he said. The goal is to make sure the diagnostic accuracy is close to current standards, so that screenings can be conducted in remote areas where the closest lab could be several hours away. The technology also would allow patients to self-monitor some conditions.

Aydogan Ozcan, PhD, an assistant professor of electrical engineering at the University of California, Los Angeles, has developed a device that allows a camera-equipped cell phone to make a holographic image for cell-based analyses on any type of body fluid.

Ozcan spun his creation off into a company, Microskia, that is in the preliminary stages of commercializing the product. Microskia CEO Neven Karlovac, PhD, said the device likely will cost less than $20 and be easy to use. Plans are for the product to be ready for the market by late 2010.

While these products claim to accurately create, send and receive images, there are some limitations that need to be worked out before they go mainstream. For example, looking at a 2-inch cell phone screen is not optimal.

Dr. Choudhri said that in his research, the screen size affected some measurements' accuracy. Although very close, those measurements were not spot-on, he said, which they need to be in some clinical cases.

But if people using the tool are aware of this limitation, the cell phone can be used to assess the most urgent needs. Then exact measurements can be verified on a full-size screen as soon as possible, he said.

Cell phone networks also present limitations. "As of right now, data transfer over a cellular network is not fast enough for this to be a valuable tool," Dr. Choudhri said. But that will pick up as the networks improve.

Dr. Kvedar said the general public's use of smartphones also needs to improve before cellular solutions become mainstream. Although adoption is growing very rapidly, outside of physicians, more people use regular cell phones than use smartphones.

Much of this technology's promise comes from patient home monitoring. The next step would be to create a secure, private network on which to exchange data so that people actually would use it and trust it, Dr. Choudhri said.]]> http://www.ama-assn.org/amednews/2009/12/21/bica1221.htm Mon, 21 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1070 HIPAA
The rules didn't start to become enforceable until the privacy compliance date of April 14, 2003, but healthcare providers, insurers, vendors, data processors and pretty much everyone else that handled personally identifiable health information--whether on paper or computer--have had to consider HIPAA since proposed regulations began to appear in 1998.

The code sets for EDI transactions, which became mandatory on Oct. 16, 2003--even though CMS wasn't fully ready to accept such transactions then--were supposed to represent the heart of administrative simplification. They were intended to standardize billing, insurance eligibility checking, remittance advice, electronic payments and other communications. But HHS continued to allow private insurers to include their own addenda to each code, wiping out true standardization.

There were other headaches and criticisms, too. Privacy advocates complained about the May 2002 modifications to the privacy rule, which allowed disclosure of protected health information without patient consent for the purposes of "treatment, payment and healthcare operations." Some vendors of practice management and hospital information systems--particularly companies that also owned lucrative clearinghouses--took their time in making their products capable of producing standard HIPAA transactions. CMS let the NPI compliance date slide several times by allowing for contingency plans. And all along, the various parts of HHS and the Department of Justice that had jurisdiction over HIPAA have been lax with their enforcement.

As the decade ends, HIPAA keeps evolving. The American Recovery and Reinvestment Act, enacted in February 2009, effectively removes the "treatment, payment and healthcare operations" exemption in the absence of patient consent. It requires covered entities to notify patients of certain privacy and security breaches and calls on HHS to develop tougher regulations. Perhaps most significantly, ARRA for the first time gives states the authority to enforce HIPAA regulations.

Meanwhile, as providers look toward "meaningful use" of electronic health records to earn Medicare and Medicaid bonus payments starting in 2011, they also have to prepare to switch to the ANSI X12 version 5010 standards for HIPAA transactions by Jan. 1, 2012. The HIPAA work continues.]]> http://www.fiercehealthit.com/story/1-hipaa-regulations/2009-12-20 Mon, 21 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1071 Practice
In June 2008, she earned the Certified Administrator in Physician Practice Management (CAPPM) credential from the American Academy of Medical Management in Atlanta, a designation granted after completing 60 hours of continuing education courses and passing a rigorous exam. To maintain her credential, she’ll have to complete additional classes every three years on a variety of topics, including marketing, physician recruitment, employee retention, profit and loss statements, billing and coding, and growth strategies. That’s fine with McGriff. “I’m a lifelong learner,” she says, noting she is simultaneously working towards her master’s degree. “In this field, you need to stay current with what’s going on. Having that certification makes me more marketable from a personal standpoint, as well.”

Indeed, for those managing the business of medicine, continued education is part of the job description. New billing procedures, shrinking profit margins, digital record keeping, and compliance with ever-changing federal regulations have made it imperative that administrators seek training throughout their career that will bring their practice — and their professional status — to the next level.

Yet, among the alphabet soup of credentials that exist, how do you decide which letters after your name will serve you best?

Will the Fellow of the American College of Medical Practice Executives (FACMPE) designation look best on your resume? How might getting the Certified Medical Manager (CMM) credential from the Professional Association of Health Care Office Management (PAHCOM) help your practice succeed? Do you need a master’s degree?

Consider a master’s

“The first question you need to ask yourself is whether you want to stay with this practice and grow with them or do you see employment opportunities elsewhere that may give you more flexibility,” says John Lloyd, president and chief executive of the Commission on Accreditation of Healthcare Management Education, which accredits college and university master’s degree programs. A bachelor’s degree, supplemented with healthcare management courses from training academies and trade groups, he notes, may suffice for those in smaller practices, but those looking to branch out or manage larger groups usually need a higher degree. “The minute you begin to say, ‘I want to be part of something bigger,’ you have to consider a master’s degree,” says Lloyd. “The department of medicine at Georgetown University, for example, will immediately say, ‘Show me your master’s degree.’ If you don’t have it, your door will be shut.”

A master’s degree, he adds, gives you more flexibility across the spectrum of healthcare industries. “If you get tired of being in private practice you can go into a hospital setting, insurance, biotechnology, or pharmaceuticals.”

Such sentiment is confirmed by the Bureau of Labor Statistics, which notes in its most recent Occupational Outlook Handbook that a master’s degree in health services administration, long-term care administration, health sciences, public health, public administration, or business administration “has become the standard credential required for most generalist positions in this field.” It notes, however, that a “bachelor’s degree is sometimes adequate for entry-level positions in smaller facilities and departments. In physicians’ offices and some other facilities, on-the-job experience may substitute for formal education.”

Selecting the right certification

Certifications, of course, are less involved and far more affordable — though many require membership in the trade organization that administers them, plus several years experience managing a medical practice before you can sit for the exam. Deciding which is right for you depends largely on your career aspirations.

The CMM, for example, is generally favored by those who plan to remain in smaller practices with 10 or fewer physicians. The exam is designed to test your knowledge, skills, and effectiveness at managing a practice in which the physician owner is also the front-line care provider. It focuses on 18 areas of core competencies, ranging from financial management to human resources. The CMM exam costs $385, plus membership in PAHCOM, another $165. “It’s a good way to document your competency in the eyes of your employer and yourself, while distinguishing yourself as a professional,” says PAHCOM executive director Richard Blanchette.

The gold standard for those who work in large group practices or healthcare networks, meanwhile, is the FACMPE, which requires members to pass a 175-question objective exam and an essay exam (both of which cost $165). The exam is designed to assess on-the-job knowledge of factual information, problem solving techniques, written communication skills, and general management principals.

The CAPPM credential falls somewhere in between, with the average test taker managing a practice with 12 physicians. The 150-question test, however, covers a broad spectrum of topics relevant to all practice settings. “We believe that you must be well-developed in all areas if you are to be thoroughly trained and certified,” says Roger Bonds, chief executive of the academy and a former practice administrator with a master’s degree in business administration. “It’s designed to help you with the job you have today, but also to prepare you for jobs you may have in the future.” The CAPPM costs $259, plus the $378 membership fee. To sit for the exam, you must have at least 18 months experience in the field, and the certification itself will not be dispensed until the 24-month mark.

To help professionals chart their continuing education course, a handful of societies formed the Healthcare Leadership Alliance (healthcareleadershipalliance.org), which created a competency directory that identifies skills important across diverse professional roles within healthcare management; including leadership, communications, professionalism, business knowledge, and knowledge of the healthcare environment.

Skills for the future

Donna Knapp, practice administrator for both Pulmonary Medicine Associates (a 12- physician private practice) and Sierra Hospitalists in Reno, Nev., says she would not be where she is today without her master’s degree in healthcare administration and her FACMPE credential. “Nowadays,” she says, “things change so quickly that you’ve got to be able to think on your feet and going through the credentialing process helps you do that.”

The benefits of continuing education, of course, include not just the ability to improve your job performance, but the opportunity for higher pay. According to PayScale.com, a Seattle-based firm that tracks compensation data, average salaries for those with a master’s degree in business administration (MBA) are $10,000 to $20,000 higher than salaries for those with a bachelor’s or business administration degree.

A survey by the Tepper School of Business at Carnegie Mellon University in Pittsburgh, Pa., further notes the median starting salary in 2008 for a full-time MBA graduate in the pharmaceutical, biotechnology, and healthcare industries was $100,000 nationwide.

Credentials look good on your business card, of course, but they should be part of a larger plan to improve your managerial expertise and set yourself apart as an employee. Before deciding which course work to pursue, consider both your practice’s immediate needs and your long-term career goals.

“My degree and FACMPE give me a lot of confidence to know that I can do the job; that I have the skills I need,” Knapp says. “And if I don’t know the answer I know how to find it.”]]> http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/1433.htm Mon, 21 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1072 HIPAA
Exploring HIPAA and HITECH Act Definitions: Parts 11-15, include definitions from:

• American Recovery and Reinvestment Act of 2009 (February 17, 2009, pp.258-259),
• Health Information Technology for Economic and Clinical Health Act,
• Title XIII—Health Information Technology,
• Subtitle D—Privacy,
• Section 13400—Definitions.

Payment
Has the meaning given such term in section 164.501 of title 45, Code of Federal Regulations [CFR]:

“(1) The activities undertaken by:
(i) A health plan to obtain premiums or to determine or fulfill its responsibility for coverage and provision of benefits under the health plan;
or
(ii) A health care provider or health plan to obtain or provide reimbursement for the provision of health care; and

(2) The activities in paragraph (1) of this definition relate to the individual to whom health care is provided and include, but are not limited to:
(i) Determinations of eligibility or coverage (including coordination of benefits or the determination of cost sharing amounts), and adjudication or subrogation of health benefit claims;
(ii) Risk adjusting amounts due based on enrollee health status and demographic characteristics;
(iii) Billing, claims management, collection activities, obtaining payment under a contract for reinsurance (including stop-loss insurance and excess of loss insurance), and related health care data processing;
(iv) Review of health care services with respect to medical necessity, coverage under a health plan, appropriateness of care, or justification of charges;
(v) Utilization review activities, including precertification and preauthorization of services, concurrent and retrospective review of services; and
(vi) Disclosure to consumer reporting agencies of any of the following protected health information relating to collection of premiums or reimbursement:
(A) Name and Address;
(B) Date of birth’
(C) Social Security number;
(D) Payment history;
(E) Account number; and
(F) Name and address of the health care provider and/or health plan.”

Personal Health Record
An electronic record of PHR identifiable health information (as defined in section 13407(f)(2)[1] on an individual that can be drawn from multiple sources and that is managed, shared, and controlled by or primarily for the individual.

Protected Health Information
Has the meaning given such term in section 160.103 of title 45, Code of Federal Regulations [CFR]:

“Individually identifiable health information:

(1) Except as provided in paragraph (2) of this definition, that is:
(i) Transmitted by electronic media;
(ii) Maintained in electronic media; or
(iii) Transmitted or maintained in any other form or medium.

(2) Protected health information excludes individually identifiable health information in:
(i) Education records covered by the Family Educational Rights and Privacy Act, as amended, 20 U.S.C. 1232g;
(ii) Records described at 20 U.S.C. 1232g(a)(4)(B)(iv); and
(iii) Employment records held by a covered entity in its role as employer.”

[1] PHR Identifiable Health Information “means individually identifiable health information, as defined in section 1171(6) of the Social Security Act (42 U.S.C. 1320d(6)), and includes, with respect to an individual, information—(A) that is provided or on behalf of the individual; and (B) that identifies the individual or with respect to which there is a reasonable basis to believe that the information can be used to identify the individual.” [HITECH Act, p.156]]]> http://www.hipaa.com/2009/12/exploring-hipaa-and-hitech-act-definitions-part-14/ Tue, 22 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1073 Technology
Why would a physician be interested in Twitter? Because it has several potential uses to foster communication with your patients and promote your practice.

One such use would be sharing practice information, eg, weather-related office closings, a special your practice is running on sports physicals for back-to-school week, or a link to a story about a recent clinical trial relevant to your type of practice. Medical journals and organizations use Twitter to tweet links to stories of interest as they first become available. Teaching hospitals are even using Twitter to tweet the teaching points and details of surgeries in progress.

As you browse Twitter, you will notice that there are several types of users. Organizations like large companies and government agencies use Twitter to disseminate information quickly to large groups of people. For example, the Centers for Disease Control and Prevention (CDC) has several feeds that you can follow, including one on pandemic H1N1 flu. This is a great way to stay up to date on the latest flu information and treatment recommendations. Likewise, news agencies and media outlets use Twitter to provide links to breaking news stories.

In this regard, Twitter is similar to subscribing to a Really Simple Syndication (RSS) feed, which is a type of streaming text-based news feed. One distinction between Twitter and RSS is that Twitter can also be easily used by individuals who tweet back and forth with their groups of friends and colleagues to share what they are doing in real time. In addition, RSS feeds are typically set up to be received in an email program or Web browser; Twitter can be run from a mobile device like a smartphone without involving an email account. Unlike emails that continue to accumulate until you read or delete them, tweets can be read as you like, or just ignored. They do not build up!

How to Start Using Twitter

Twitter (www.twitter.com) allows users to post text-based messages of 140 characters or less, which are referred to as "tweets." To use Twitter, you simply sign up at its Website. Registration is free; all that is required is to choose a user name and a password to sign in to your account. Twitter users can post tweets via the Web, or via a cell phone.

Although there is no fee to use Twitter itself, you may incur charges from your cell phone carrier if you tweet via your phone's Short Messaging Service (also known as "text messaging"). If your phone can also access the Internet, you may be able to find an application for your phone that uses the Web to access Twitter instead of using Short Messaging Service, thereby avoiding messaging fees.

Once you have signed up, you can start posting tweets. They will appear to other users who either view your homepage on Twitter or who have elected to "follow" you. Your tweets appear prefaced by the "at" sign and your user name. For example, a tweet from me would start with "@AndyPDANP," followed by the content.

Twitter poses the question, "What are you doing right now?" Users post as much -- or as little -- as they want. You can also sign up to "follow" other Twitter users. You will have a profile page on Twitter's Website; you can add information about yourself to this page and even customize the look to some extent.

Advice From a Well-known Blogger

Some doctors have made active use of Twitter and now find it indispensable.

Kevin Pho, MD (http://www.kevinmd.com/), a leading physician blogger and Twitter user (@KevinMD), shared some valuable insights. He noted that a lot of adults already use the Internet for obtaining health information anyway; physicians can use social networking tools like Twitter to steer patients to sources of online medical information that are reliable.

According to Pho, Twitter has many advantages over other social networking tools like practice Websites and blogs. His take on Twitter's advantage? "Immediacy. Twitter has more of a real-time conversational feel to it than a blog or Website and is much easier to update. You don't have to write an article or create a new Web page; you just post a short tweet, and it's instantly available to your followers."

Twitter is similar to an instant message, except that Twitter broadcasts your message to all your followers at once. Pho also noted that Twitter has a place in emergency and disaster scenario reporting. He cites as an example of the 2008 terrorist attacks in Mumbai, India; much of the breaking news' details of that occurrence were reported by street-level tweeters directly from the scene of the events as they unfolded.

Pho estimates that physician Twitter users number in the low thousands. Although Twitter is fairly new, he notes that it has entered the mainstream and is here to stay as a complementary piece of social networking as a whole. Pho offered the following tips for physicians using Twitter:

1. Patient privacy is paramount. Do not discuss individual cases or provide patient advice via Twitter.

2. Use Twitter to point your patients to trustworthy online health information sources.

3. Use Twitter as a tool to promote your practice's brand. More and more patients are using Twitter; those who do are likely to feel positive about their physicians using it as well. More than just a fad, Pho says that Twitter is here to stay and offers tremendous potential.

4. Remind your patients using Twitter: Be careful whom you follow. Anyone can sign up for Twitter claiming to be a physician.

Watch Out for Twitter Pitfalls

If you have decided to use Twitter, there are some key guidelines that can make it more effective for you, and there are also land mines to avoid.

• You can make your Twitter profile public or private. If it is public, anyone can see your profile page and read your tweets, whether they follow you or not. If your profile is private, only your followers see your tweets, and only those you approve can follow you.

• Be careful what you write! Tweets posted while your profile is public remain public forever, even if you later change your profile to private. Do not post anything that might come back to haunt you if it were read by a patient, a patient's attorney, a prospective employer, or a licensing board.

• Consider whether you will use Twitter personally or if your practice will have an account. Will you have a staff member assigned to tweet practice information, or will you do it yourself? Remember, Twitter's advantage is the ability to get a message from you to all your followers quickly. If it is a time-sensitive message, eg, "the office won't open until 10 AM today due to bad weather," it is better if that gets tweeted sooner than later.

• Do not get drawn into 2-way tweets back and forth with your patients. It is time consuming, it is not private, and it is not reimbursable! To prevent this, allow your patients to follow you, but do not follow them in kind; if you do, it enables direct messaging between you and that user. Stick with using Twitter to communicate general information to your patient group as a whole.

• Consider posting your Twitter policy on your Website to avoid any misunderstandings with your patients regarding what you will (and will not) be doing via Twitter. You can also use Twitter to advertise new services and share lengthy information by posting a tweet that points followers to your Website for the details, eg, "@AcmeFamMed: Holiday hours in effect, details at http://acmefammed.com/hours." (Note: these are not real names; they are examples for this article.)

• If you need to post a link to a story that is too big to fit the 140-character limit, use a uniform resource locator (URL)-shortening Website like http://bit.ly or www.notlong.com. These free sites allow you to paste a long link into a box; they generate a short link in return. When users click on the short link, they are redirected to the original site.

• Besides using Twitter on the Web, there are applications available that allow you to use Twitter on your smartphone. Some of these applications are free, whereas others have a nominal cost.

• Pay attention to who's following you. Within a few days of getting my Twitter account, I noticed a few "followers" that were obviously spam and/or adult oriented. I promptly blocked and removed those followers and reported them to Twitter for spam; (there are links on your profile page to do this, so it is easy. Now I check my profile every week or so to make sure I am not acquiring spam.

Twitter can prove to be a useful and enjoyable tool once you get used to it, and if you follow the appropriate guidelines. Today's physician should consider giving it a try.]]> http://www.medscape.com/viewarticle/713889 Tue, 22 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1074 Practice Management
The InstaMed Platform and Network product achieved CORE Phase I certification in June of this year. Phase II certification allows the company to deliver increased access to a significantly expanded set of consistent patient administrative information in response to electronic inquiries, such as real-time eligibility and claim status. This data is critical to initiating and completing the healthcare payment cycle.

Bill Marvin, President and CEO of InstaMed stated, "CORE Phase II certification solidifies our commitment to improving electronic data exchange. This accomplishment demonstrates our innovation and leadership, as we are one of the first clearinghouses to achieve this level of certification."

A nonprofit alliance of health plans and trade associations, CAQH launched CORE to create an industry driven solution that supports all payers and enables consistent provider access to patient insurance information before or at the time of service using any electronic system. The organization has brought together more than 100 industry stakeholders, including InstaMed, to collaborate on its multi-phase set of uniform business rules to achieve that goal. CORE participants provide coverage for over 130 million lives, or more than 75 percent of the commercially insured plus Medicare and Medicaid beneficiaries.

To date, CORE has created and promulgated two phases of rules, which are built on national standards such as HIPAA. The CORE rules address data critical to the healthcare revenue cycle, including patient eligibility and benefits, patient financial liability for various service types, patient deductibles/co-pays and patient accumulators. These rules also cover specific requirements for exchanging that information, including system connectivity, system availability, patient identification, claim status, maximum response times (batch and real-time) and the consistent use of standard acknowledgements.

Robin Thomashauer, CAQH Executive Director stated, "By achieving CORE Phase II certification, InstaMed is demonstrating its leadership role in simplifying healthcare administrative transactions. This accomplishment shows a true commitment to improving communication between providers and payers, which directly and favorably impacts the industry."

Editors note: PrimaryData utilizes InstaMed within the implementation and integration with the MEDfx practice management system.]]> http://newsblaze.com/story/2009122208070200001.pnw/topstory.html Tue, 22 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1075 Medical Home Community Health
President Obama announced the creation of the PCMH demonstration project during a Dec. 9 White House press conference. The purpose of the project is to "evaluate the benefits of the medical home model of care that many of our health centers aspire to," said Obama.

According to a White House press release, Obama directed HHS to implement a demonstration project that would evaluate the effect of the medical home practice model on access, quality and the cost of care.

"Because community health centers already provide comprehensive health care to people who face the greatest barriers to accessing care, these demonstration projects have the potential to support and improve the care delivered not only to Medicare beneficiaries, but also to others who rely on community health centers for primary care," said HHS Secretary Kathleen Sebelius in the press release.

CHCs deliver care to more than 20 million patients at about 7,500 sites throughout the country, but only about 8 percent of health center patients are Medicare recipients, according to Dan Hawkins, senior vice president for public policy and research for the National Association of Community Health Centers, or NACHC.

The CHC medical home demonstration will be a separate and distinct project from a three-year Medicare medical home demonstration project created as part of the Tax Relief and Health Care Act of 2006 and involving about 400 practices, 2,000 physicians and 400,000 Medicare beneficiaries. CMS still is waiting to receive final approval to conduct that medical home demonstration project.

CMS plans to start soliciting applications for the CHC demonstration project in the spring with the goal of implementing the three-year project in 2011, according to the White House press release. The agency will pay participating health centers a monthly care management fee for each Medicare beneficiary they enroll into the demonstration. The agency also will provide a payment for any other covered Medicare services the centers furnish. The White House has not said how many centers will participate or how much they will be paid for serving as medical homes.

To participate, CHCs will need to demonstrate that their clinic sites have the capacity to deliver continuous and coordinated care across providers and settings, including improving access to care by expanding service hours, facilitating and following up on referrals, and managing medications provided by different physicians, according to the press release.

During the Dec. 9 press conference, Obama said the idea behind the medical home is "very simple -- that in order for care to be effective, it needs to be coordinated."

"It's a model where the center that serves as your medical home might help you keep track of your prescriptions or get the referrals you need or work with you to develop a plan of care that ensures your providers are working together to keep you healthy," Obama said.

AAFP President Lori Heim, M.D., of Vass, N. C., who attended the press conference, said, "There is no doubt in my mind the president understands the value of the medical home. The president can articulate the value of primary care, and he can articulate the value of the medical home because he understands it and he believes in it."

Hawkins, of NACHC, said most CHCs already serve as PCMHs by their inherent role. "We believe the vast majority of CHCs already exhibit many or most of the features of a medical home," said Hawkins. "The centers provide continuous care even through changes in health or insurance coverage status, and they take steps to make sure care is accessible."

The real question is whether the centers make a difference in the health of their patients, Hawkins said. Numerous studies have documented the effectiveness of the centers in improving quality and reducing costs, findings acknowledged by the president, he noted.

"Studies show that people living near a health center are less likely to go to the emergency room and less likely to have unmet critical medical needs," said Obama during the press conference. "CHCs are proven to reduce ethnic and racial disparities in care. And the medical expenses of regular CHC patients are nearly 25 percent lower than those folks who get their care elsewhere."]]> http://www.aafp.org/online/en/home/publications/news/news-now/government-medicine/20091222chc-demo-project.html Wed, 23 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1076 HIPAA
Exploring HIPAA and HITECH Act Definitions: Parts 11-15, include definitions from:

• American Recovery and Reinvestment Act of 2009 (February 17, 2009, pp.258-259),
• Health Information Technology for Economic and Clinical Health Act,
• Title XIII—Health Information Technology,
• Subtitle D—Privacy,
• Section 13400—Definitions.

Secretary
Secretary of [U.S. Department of] Health and Human Services.

Security
Has the meaning given such term in section 164.304 of title 45, Code of Federal Regulations [CFR].

“Security or Security measures encompass all of the administrative, physical, and technical safeguards in an information system.”

State
Each of the several States, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.]]> http://www.hipaa.com/2009/12/exploring-hipaa-and-hitech-act-definitions-part-15/ Wed, 23 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1077 Telehealth
According to the U.S. Department of Health and Human Services’ Administration on Aging, the 65-and-over population will increase to 55 million in 2020 (up 36 percent for the decade). By 2030, that will grow to about 72 million, almost twice the 2007 number. By 2030 those among us who are age 65-plus will represent more than 19 percent of the population.

Statistics show that the older we are, the more care we require. And the trend is for families to do all they can to enable their loved ones to remain at home – to age in place – for as long as possible. Care management companies are adopting home health monitoring technology to support families in this effort.

SeniorBridge provides personalized care management and healthcare services to people with complex, chronic health conditions, allowing them to avoid having to live in a nursing home or other residential facility.

From Pilot to Ongoing Program

According to Jackie Morrison, SeniorBridge’s senior vice president of clinical services and quality management, the average age of the company’s clients is 84, and more than 50 percent have some degree of memory impairment. She told us that the company is strongly embracing the concept of “telemedicine” to strengthen the level of care provided to their clients … and are implementing it in conjunction with their team care approach.

They began with a pilot program early in 2009 utilizing a home health monitoring system to provide daily remote patient monitoring and disease management. They continue this in partnership with Cardiocom, an industry leader in the development of telehealth devices.

Typical SeniorBridge clients have a history of frequent hospitalizations, perhaps some cardiac history, and because they have some cognitive impairment they also have a caregiver present at least during the day when the monitors would be used. Another type of client would be someone who still may be able to self direct, perhaps has a history of cardiac disease and/or fluctuating blood pressure, and some level of medication compliance issues.

Patient Parameters, Monitoring and Benefits

According to Morrison, “Our goal is that this program, along with our model of care management in the home, will help our patients stay independent longer and be more compliant with the medications and the medical regime the physician has provided them with,” Morrison said.

Parameters are set up in the system for each patient’s specific condition, including all of his or her medications and dosages. A small monitoring unit is provided for the patient’s home, and once this unit is activated it provides spoken instructions, prompting the patient through the steps of a home health check. SeniorBridge uses specific devices that plug into this main monitoring unit. Monitoring and reporting can be done with or without a home health aide or caregiver present, depending on the level of care and supervision the particular patient requires. The simple instructions enable them to monitor their blood pressure, respiratory rate, heart rate and weight. SeniorBridge has plans to add collateral devices to measure blood sugar (glucometer) and oxygen levels (pulse oximeter).

The system also reminds patients to take their medications. The majority of the SeniorBridge clients take as many as five medications a day, with some patients taking as many as 15 or 20.

All data collected by the home monitoring devices are transmitted securely over the phone line to a call center. If the data reflects a deviation from the pre-programmed parameters, the call center nurse contacts a SeniorBridge care manager immediately to report an alert for a particular client. The care manager will speak directly with the patient to determine if the monitoring was done correctly and if additional care will be required.

If the patient doesn’t log on and follow the instructions on a given day, that triggers an alert to the call center and the caregiver. SeniorBridge asks all of their clients to log in daily by 11 a.m., so there would be time for an intervention with the physician if necessary.

The system generates reports from the live data that can be used by the care managers and the physicians involved. In analyzing the data, medications and/or care may be increased or decreased according to the trends measured.

“Home health monitoring has many benefits for all of our patients,” Morrison said. “Both those more complex cases with dementia, and for those who only have early stage Alzheimer’s, or no dementia, and are still able to self-direct.”

She said that in addition to enabling the patient to remain at home longer, the system provides quantitative data to increase quality of care. Home health monitoring allows SeniorBridge to work collaboratively with the physician in reducing hospitalizations and unscheduled ER and physician office visits. It also provides the family with an extra level of reassurance and security.]]> http://smart-products.tmcnet.com/topics/smart-products/articles/71549-telemedicine-plus-smart-devices-home-health-monitoring.htm Wed, 23 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1078 Healthcare
In a recent MGMA Webinar (free for members) I explored 15 strategies that practices should consider during these changing times:

1. Separate your personal political views from the assessment of how a practice can prepare for health reform legislation. Whether you agree with the rationale for the proposed legislation or not, the practice's response will likely be the same.

2. Recognize that health reform may or may not be passed into law. This is an opportunity for the practice to select a leader who can:
• Monitor the public discussion - Educate staff and physicians on the potential impact of legislation
• Observe the perspective of payers, government, and providers
• Describe the potential bias displayed in the "push polls" and commercials

3. Know that reform will come not instantly, but with a timetable that will range from 2010 to 2015 and beyond. The practice's preparations need to be on the same timetable as the legislation.

4. Review and improve internal data collecting, tracking and reporting procedures.

5. Evaluate the practice's investment in and use of health technologies, such as electronic health records, electronic prescribing systems and patient chronic disease registries.

6. Assess the practice's current ability to report quality metrics.

7. Identify best practices to reduce costs and improve quality.

8. Evaluate strategies to increase provider productivity.

9. Review administrative and billing procedures so insurance claims are paid correctly and promptly.

10. Evaluate the administrative performance of Medicare and commercial insurers who have the largest market share.

11. Develop a strategy for how to address increased patient demand.

12. Assess whether the current number of physicians and the mix of services are what the practice should have under a transformed healthcare system.

13. Assess how nonphysician providers are used in the practice and whether the practice should recruit additional nonphysician providers.

14. Determine how the practice could recruit new or replacement physicians.

15. Evaluate possible partnerships with hospitals and other medical groups to access capital, increase organizational clout, and perhaps qualify as an Accountable Care Organization.]]> http://blog.mgma.com/blog/bid/29225/15-strategies-to-prepare-for-a-transformed-healthcare-system Wed, 23 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1079 EHR
Because the government now mandates US healthcare practices make the switch to digital record-keeping in the coming years, EHR is one technology all DCs will become quite familiar with in the near future. While the push for digitizing health records has caused lots of controversy, and the legislation is still in the process of being fine tuned, the fundamental reason for the move has been to modernize our country's healthcare system.

The recent political firestorm over healthcare reform has—if nothing else—revealed that our nation's healthcare system is in need of repair. Although EHR is being implemented separately from the pending healthcare legislation, digitization of medical records is seen as a major step forward in updating and streamlining the country's healthcare system. Supporters of EHR claim that such a move will not only make medical professionals' jobs easier and more efficient, but the technology is also purported to save huge amounts of money and perhaps even save patients lives.

This series of articles will look at the leading benefits of EHR for both doctors and patients. In this first article, we'll discuss some of the most valuable benefits digital records will bring to practicing DCs.

EHR Benefits for DCs

Portability. EHR allows all of a patient's records to be instantly available at any doctor's office, clinic, or hospital that is using the system. No more wasted time and money on copying, mailing, and faxing records.

Increase compliance with third-party payers. Built-in reminders and alerts automatically notify DCs to help prevent errors in coding and/or billing. Moreover, the EHR system is automatically updated with all of the latest standards and requirements, ensuring your practice will be safe from audits now and in the future.

Save space. Paper records and the filing systems they're stored in take up huge amounts of space, while EHR are all conveniently stored online.

Save money. EHR will lower administrative costs, saving DCs from having to hire extra staff to work with filing, coding, and transcription. Increased savings will also come from less spending in office supplies, like paper, file folders, charts, toner, etc.

Save time. DCs and their staff will no longer have to search through mountains of paperwork to find patient records and documents. DCs will be able to focus the majority of their time treating patients rather than dealing with excess administrative duties.

HIPPA Compliance. EHR software is designed to be 100-percent compliant with all HIPPA regulations. Moreover, any future changes in the law will be automatically updated within the system.

Decreased errors. In addition to providing medical records that are easy-to-read and interpret, EHR systems also come with error alerts to prevent and correct mistakes.]]> http://www.chiroeco.com/chiropractic/news/8921/1100/moving-to-ehr-benefits-both-dcs-and-patients-part-i/ Mon, 28 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1080 Medicare Practice
CMS is deleting several consultation codes -- 99251 to 99255 and 99241 to 99245 -- and replacing them with the CPT codes noted below.

Cynthia Hughes, C.P.C., an AAFP coding specialist, said physician services currently billed as consultations should be reported as initial hospital care or initial nursing facility care (CPT codes 99221 to 99223, or 99304 to 99306) in inpatient settings and as office or other outpatient evaluation and management services (CPT codes 99201 to 99215) in outpatient settings.

CMS published instructions for physicians on the new system in a recent issue of MLN Matters, (9-page pdf) the agency's online newsletter dedicated to informing participating health care professionals about Medicare news.

"If physicians admit patients to the hospital after Jan. 1, they will have to append the CPT code for the initial care charges with the newly created "AI" modifier to indicate that they are the admitting physician," said Hughes.

Hughes said she gleaned two key points of interest from a CMS conference call on the issue. Physicians should note that

• Medicare patients cannot be billed for consultation services even when the patient is provided with an advance beneficiary notice, and
• Medicare Advantage and Medicaid plans will make their own determinations as to whether they will pay for services reported with consultation codes.

The question of how to handle billing when Medicare is the secondary payer on the claim is addressed in the MLN Matters article beginning on page 5. Hughes urged AAFP members to share the article with office staff whose duties include billing, coding or compliance.]]> http://www.aafp.org/online/en/home/publications/news/news-now/practice-management/20091223rev-cpt-codes.html Mon, 28 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1081 Healthcare Top 10 Health Industry Issues in 2010, puts healthcare cost control at the head of the list as the overarching theme for the year ahead.

"Healthcare typically lags trends in the business cycle by a year or more. While flat may be the new growth for other sectors of the U.S. economy, the recession could hit healthcare in 2010," said David Chin, M.D., partner and leader of PricewaterhouseCoopers' Health Research Institute. "The primary emphasis for all healthcare organizations in the year ahead will be on reducing costs and creating greater value in the health system, a focus that will have a domino effect from one sector to another and redefine roles, responsibilities and relationships."

Each year, PricewaterhouseCoopers' Health Research Institute publishes its top issues across all health industry sectors. The report includes trends affecting insurers, hospitals, physicians and other providers, pharmaceutical and life sciences companies, as well as the growing number of non-traditional market participants converging into the healthcare space. This year's top 10 issues are:

1. Intense effort to reduce healthcare costs -- No stone will be left unturned. Hospitals, physicians, and other providers will look to squeeze every penny out of their operations and supply chains, renegotiating purchasing agreements and contracts with suppliers on everything from food services to medical devices and pharmaceuticals. Payers will look to reduce benefit-related administrative costs. Expect employers to increase audits of employee dependents to weed out those who are no longer eligible for coverage.

2. Aftermath of health reform -- While 2009 was a year of watch and wait on health reform, healthcare organizations will be busy in 2010 absorbing the potential first waves of regulatory changes. These include major insurance market and payment reforms, dozens of new agencies and grant programs, reimbursement and pricing pressures, increased oversight, tax changes and the overall implications of increased coverage and consumer demand. PricewaterhouseCoopers expects the trend in the United States to mirror that of European countries in which major reform initiatives and their concomitant regulations will be a recurring process.

3. Government accelerates change through rewards and penalties -- 2010 will be a double-bonus year for physicians who act quickly to take advantage of government incentives to adopt electronic medical records and e-prescribing. Those who do not will face potential penalties later. This new carrot and stick model of accelerating change represents a shift in the government's role as a "passive payer" to an "active buyer" of healthcare and its move from volume-based payments to value-based purchasing.

4. Focus on fraud and mistakes -- Healthcare organizations will need to tighten internal controls and raise the bar on compliance as the government goes after fraud and mistakes in 2010. Health reform is banking on as much as $1.6 billion in savings from healthcare fraud prevention and recovery to bend the curve on cost growth. The Obama administration has boosted its fraud and abuse budget for 2010 by 50 percent, and a significant portion is dedicated to prosecution and enforcement. Pharmaceutical executives now face jail time for off-label marketing violations. CMS' Recovery Audit Contractor (RAC) program is analyzing patient and financial records seeking evidence of Medicare overpayments, and demanding restitution.

5. Technology and telecommunications sectors become leading players in healthcare -- With a huge boost from the 2009 stimulus package for broadband funding and healthcare IT expansion, technology and telecommunications companies are aggressively capturing a growing share of the healthcare business. Beginning in 2010, the convergence of healthcare with technology and telecommunications companies, as well as other new market participants, will change the regulatory rules, the basis for competition and the way health services are delivered.

6. Big pharma joins the healthcare delivery team -- The role of pharmaceutical and life sciences companies will evolve from manufacturer/supplier to full partner on the healthcare delivery team as its focus shifts from lab-based outcomes to promoting prevention and patient outcomes. In 2010, expect to see greater alignment of incentives between pharmaceutical companies, payers and providers. There will be an increase in collaborations among pharmaceutical and life sciences companies with one another as well as retailers and other organizations to address education, clinical effectiveness, product safety, wellness and compliance.

7. Physician groups to rejoin health systems -- The percent of hospitals employing physicians has nearly doubled since 1994, and PricewaterhouseCoopers expects the trend will continue in 2010 as physicians seek greater stability and electronic connectivity. The realignment of physician groups with hospitals, including new models such as accountable care organizations (ACO), will require all providers to re-evaluate their relationships, operational infrastructure, payer contracting and overall funding models.

8. Alternative care delivery models to emerge -- As the health system continues to struggle with costs and capacity, traditional care delivery models will give way to alternative models of care outside of physicians' offices and hospitals. Expect to see an increase in the number and scope of services offered by work-site and retail health clinics and home health services as well as other technology-enabled delivery such as e-mail, telehealth and remote patient monitoring.

9. H1N1 elevates emphasis on readiness for public health outbreak -- Another wave of H1N1 flu in 2010 will put pressure on healthcare organizations, public health officials and employers to re-evaluate readiness for a major public health outbreak. They will need to reassess vaccine supplies and distribution, communication channels, bed capacity, sick leave policies and the role of funding mechanisms and contingency plans.

10. Community health becomes new social responsibility -- In 2010, a new social responsibility for community health will emerge among employers, healthcare leaders and community leaders, with a major boost in funding from the government. Stimulus funding is providing grant money and other incentives for the development of evidence-based clinical and community-based prevention and wellness strategies to address chronic disease rates. A growing number of states and municipalities are creating policies and forming alliances to promote sustainable healthy lifestyles in entire communities.

A full copy of PricewaterhouseCoopers' Health Research Institute's Top 10 Health Industry Issues in 2010, including implications for healthcare organizations is available online at www.pwc.com/us/top10.]]> http://www.prnewswire.com/news-releases/squeezing-costs-out-of-healthcare-tops-pricewaterhousecoopers-list-of-health-industry-issues-in-2010-79482792.html Mon, 28 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1082 PQRI Medicare
The Centers for Medicare & Medicaid Services released 2008 data for the pay-for-reporting effort on Nov. 13, and even though more physicians participated and bonuses increased compared with the previous year, successful participation in the program remained just more than 50%.

More than $92 million in 2008 PQRI incentive payments were distributed to about 85,000 physicians this fall, with the average individual bonus coming in at about $1,000. But approximately 70,000 physicians who submitted data for 2008 did not qualify for any additional pay, even though many practices thought they did everything required.

"The system doesn't tell you if the code qualifies with what you have sent," said Adeline Hart, a medical coder and biller with a four-person ophthalmology practice in Tinton Falls, N.J. "You can't see what you did wrong. It just says that this is for reporting purposes only."

CMS does issue feedback reports to physicians, but they arrive only when payments are distributed, long after physicians have the chance to correct any reporting mistakes. The agency has said every participant gets a report, though some practices said they have not yet received any for 2008.

Hart said CMS should work toward issuing real-time or even monthly feedback reports, so a practice would have time to make corrections.

"There's no place to go for an answer," said Hart. "There's no follow-through. It shouldn't be this hard to do reporting."

Past surveys by the American Medical Association and the Medical Group Management Assn. uncovered a large number of complaints about the process practices need to use to access information about their PQRI payments and feedback reports. In addition to advocating for more expeditious feedback, the AMA is also pressing CMS to add an appeals process for those physicians who fail to qualify for bonuses and who feel that a detailed review of their participation is warranted.

The potential of registries
Physicians participating in PQRI in 2008 had the choice for the first time to report quality data through a qualified medical registry, which would then report that data on their behalf to CMS.

Only 8% of participants attempted to send their data via a registry. However, of that subset, 96% met the requirements for satisfactory reporting and qualified for an incentive payment. This accounted for 17% of the overall payments made for the 2008 program year. PQRI allowed reporting through 31 registries in 2008, increasing to 74 in 2009.

"There is a lot of potential in reporting PQRI information through registries. You can engage your registry all year long. Many can even provide interim feedback during the year. You can also engage your registry after the fact, when the year is done," said Michael Rapp, MD, director of the CMS Quality Measurement and Health Assessment Group.

Some practices have heard about the registries but aren't sure how to connect with them. "Setting up with a registry requires more time and research, and it seems very confusing to me," said Janet Scoffield. She's the PQRI coordinator with a small dermatology practice in southwest Montana that consists of three dermatologists and a nurse practitioner.

Scoffield echoed the call for more timely feedback.

"We have no idea if our 2009 claims-based submissions will be successful because, apparently, there is no way to follow results -- only on the remittance notice where it states it's been entered," Scoffield said. "I didn't think there were any barriers to participation once we sorted out what measures applied to our practice."

Changes for 2010
Dr. Rapp said it is not feasible for CMS to generate real-time feedback reports, due to the amount of time it takes to process data received through PQRI. CMS does staff a help desk that can be reached via phone or e-mail, and payment disputes can be discussed with someone at the agency, he added.

CMS has expanded the number of national provider calls it schedules on PQRI. The agency has also added 12 educational resources to its Web site since the beginning of 2009, and it has added e-mail as one of the ways to receive feedback reports.

For 2010, CMS will begin accepting data from qualified EMR products for 10 individual PQRI measures. Physicians can count their submission of EMR-based measures toward their eligibility for an incentive payment. In previous years, such submissions were considered voluntary and did not count toward bonuses.

Effective Jan. 1, 2010, large practices of 200 or more physicians or other eligible professionals can submit quality information through a group option, which CMS anticipates will cut down on the number of physicians filing multiple reports on the same patient.

"One of the difficulties previously was the PQRI was limited to individual reporting, so physicians practicing in groups would sometimes have to report on the same patient, which could be duplicative," Dr. Rapp said.

The potential bonus payment for 2010 will remain at 2%, but the number of total available quality measures has increased to 179. The program is set to run through 2010 unless Congress extends it again.]]> http://www.ama-assn.org/amednews/2009/12/28/gvsa1228.htm Tue, 29 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1083 HIPAA
Exploring HIPAA and HITECH Act Definitions: Parts 11-15, include definitions from:

• American Recovery and Reinvestment Act of 2009 (February 17, 2009, pp.258-259),
• Health Information Technology for Economic and Clinical Health Act,
• Title XIII—Health Information Technology,
• Subtitle D—Privacy,
• Section 13400—Definitions.

Treatment
Has the meaning given such term in section 164.501 of title 45, Code of Federal Regulations [CFR]:

“The provision, coordination, or management of health care and related services by one or more health care providers, including the coordination or management of health care by a health care provider with a third party; consultation between health care providers relating to a patient; or the referral of a patient for health care from one health care provider to another.”

Use
Has the meaning given such term in section 160.103 of title 45, Code of Federal Regulations [CFR]:

“With respect to individually identifiable health information, the sharing, employment, application, utilization, examination, or analysis of such information within an entity that maintains such information.”

Vendor of Personal Health Records
An entity, other than a covered entity (as defined), that offers or maintains a personal health record.]]> http://www.hipaa.com/2009/12/exploring-hipaa-and-hitech-act-definitions-part-16/ Tue, 29 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1084 Technology
What about your diabetic patients with hemoglobin A1c levels over nine who are due for a foot exam? Or your female patients overdue for a mammogram?

It’s data like this that your practice must have at the ready for pay-for-performance program reporting. Medicare and private payers are increasingly developing programs to reward physicians based on clinical benchmarks, marking a move away from visit-based service delivery to one of population management. As more payers embrace this approach, practices are looking to technology to help them manage the complex reporting requirements.

Imagine the time and energy it would take to comb through hundreds of paper charts, flipping through each one looking for test results and visit details, and then calling each patient for appointments.

“It’s virtually impossible to readily comply with a P4P program without technology,” says management consultant Bruce Kleaveland. “It’s very, very difficult to get your arms around the parameters and manage it.”

Most EHRs can be configured to run such reports, as long as you have the system fully implemented and are prepared to tailor your work flow accordingly.

But some practices are finding the standard EHRs limiting. Practices and vendors are taking the technology to the next level, adding additional management tools and databases — one doc dubbed the approach “EMR 2.0” — to meet the requirements and become P4P champs.

First stop: EHRs

At Valley Medical Associates in Springfield, Mass., the four physicians and three nurse practitioners are using the practice’s Allscripts EHR to meet the requirements of the Medicare Care Management Performance (MCMP) demonstration, a pilot program for reporting on different measures for Medicare patients.

They are able to run reports based on the program’s requirements, generating lists and reminders.

“We are using our electronic record to be able to document when things are being done and then pull reports off and contact patients to make sure they get [the procedures] done,” says family practitioner P.J. Helmuth.

EHRs allow practices to take an otherwise essentially impossible task — one that would involve endless hours weeding through paper records — and convert it into a two- or three-hour job. “It allows you to take a more proactive disease management and preventive care management approach to the delivery of healthcare,” Kleaveland says.

EHRs can help practices in two major ways, according to Kleaveland. The first is in setting a basic metric by which to track patients’ progress, such as blood sugar levels for diabetics. An EHR can generate reminders and notifications for the physician while the patient is in the office. (Mrs. Jones, have you had your foot exam?)

Second, physicians can tailor the EHR’s templates based on the particular pay-for-performance program. This modification is necessary, considering that each program has different requirements and the metrics continue to evolve. Most CCHIT-certified systems will allow practices to tailor the templates for the program’s criteria, Kleaveland says. He adds “A given provider might have relationships with multiple insurance companies, and the multiple insurance companies don’t always have the same P4P programs. One very legitimate challenge for doctors in complying is their ability to understand the specifics of each program.”

At Helmuth’s office, they’ve had to add a few extra steps to be able to generate reports. Much patient care happens outside of their office — mammograms and colonoscopies, for starters — so his staff has to enter those results into the system (rather than scan them in) so they can become reportable, Helmuth explains. “We have made some changes to work flow to improve numbers and accommodate that,” he says. For the most part, their EHR accommodates their needs, or they can create work-arounds to get the job done.

Another option: registries

Clearly, some practices are finding that EHRs aren’t without their limitations.

EHR systems tend to be more focused on visit documentation, Helmuth says, rather than reporting and disease management functions. “It’s not just being able to run a report; it’s also disease management, and how easy it is to find out which diabetic has not had an eye exam and how to communicate with patients,” he says.

Not all EHRs have those capabilities, and many have limited configuration abilities for each program, says Jonathan Niloff, a physician and CEO of MedVentive Inc., which provides quality measurement software.

Further, not all EHRs are networked together (hence Helmuth’s added steps of input), and lab results are a key piece of the reporting requirements, Niloff says.

Enter the clinical decision support system, more broadly known as a patient registry.

A disease or patient registry is a tool that collects the data on patients with a similar condition, such as diabetes or those who need mammograms.

The information can come from the practice’s EHR, claims, manual entry, or even lab reports, depending on the practice and the software used.

Practices eyeing this type of software should understand what data sources it can take, as well as what communication functions it has, Niloff says, adding that registry systems have different features and capabilities.

“The key thing is a good registry is not just a collection of information, but has built-in rules and logic and can send reminders to the physicians or the patients in an automated way.” Niloff says.

Many registry systems can communicate across multiple practices, because they are not platform-specific and can share information across EHRs or even in the absence of an EHR. Although the registry program would ideally connect with your EHR for patient data, Niloff adds, practices without EHRs can opt for these systems as a less expensive and less disruptive alternative.

“Because [registries] are so focused on P4P programs and quality improvement, the good systems are very configurable, have a lot of flexibility, and can match the guidelines to P4P programs on a payer-specific basis,” he says.

(But again, using a registry without an EHR means an added labor-intensive step to manually enter data into the system, Kleaveland notes. EHR plus registry is a great way to go, and many practices program the EHR to feed data to the registry.)

Ray Fredette, CEO of CentMass Association of Physicians, an Independent Physicians Association, has been using a claims-based registry system to check patients’ compliance with Health Plan Employer Data and Information Set (HEDIS) measures, a program developed by the National Committee for Quality Assurance. The MedVentive system CentMass uses tracks patients for 54 primary-care physicians in five managed-care programs.

“We produce packages quarterly for each primary-care physician that include a list of patients who are due for interventions, a chart insert for each patient, and a letter for that physician to send to each patient,” Fredette says.

Because it’s a claims-based registry system (a paid claim means the test is no longer overdue), there is a two-month lag in data, so patients may receive letters about tests they have already received, he says. “There will be redundancy there, and we are trying to figure out how to deal with that,” Fredette says, adding that despite their limitations, EHRs have much more current data. Ideally, EHRs would have preventive modules for pay-for-performance programs, Fredette says, adding, “We are doing the best we can with a claims-based system.”

Not all EHRs and registries rely on claims-based reporting, and some say claims-based reporting isn’t ideal. Many of those systems don’t have the vocabulary to properly code inputted clinical information, says Maria Rudolph, a vice president at e-MDs Inc. and an executive committee member of the EHR Association. So practices are left using ICD-9 and billing codes to report for pay-for-performance programs. With claims data, “you can’t easily track why something happened clinically because all you are seeing is the billing code,” she says.

EHR vendors, she says, are beginning to incorporate the clinical nomenclature known as SNOMED CT for clinical coding, but it’s not widespread, presenting a technical challenge for practices adopting P4P programs.

Whether you use an EHR or a registry or both, there isn’t yet a perfect system for participating in a P4P program, so it’s important for practices to work with their vendors to understand the capabilities of each system.

Providers who are considering purchasing an EHR and planning to participate in a P4P program should talk with their vendors to make sure the data is organized in a way that can be more easily exported, Niloff said. Think of it like storing data in an Excel spreadsheet versus several PDF files — one format allows for more meaningful searching and sorting.

Further, practices should make sure their vendors are willing to help them add a registry system on top of the EHR they are using.

“Get a commitment from the vendor that they will help you work with other clinical decision support tools, in being able to extract data in an easy fashion,” Niloff said.

A page from the business book

When faced with the need for quality measurements reporting — and recognizing the shortcomings of his EHR — Simeon Schwartz, president of Westmed Medical Group in White Plains, N.Y., looked to other industries for help.

The buzz, he found, was around business intelligence, a term that basically refers to the approach and the tools used by companies to get a handle on the business landscape. Think decision making supported by data mining and number crunching — just the sort of approach medical practices need for P4P reporting.

The three hallmarks of business intelligence, Schwartz explains, are taking the data out, translating it, and re-indexing it for reporting.

Westmed wanted to participate in a regional medical home pilot that offers $5,000 to $10,000 for primary-care physicians who achieve level two or level three medical home status. His practice has 45 pediatricians and internal medicine physicians who agreed to participate.

Eventually, Westmed’s physicians would be tracking more than mammograms and colonoscopies. “Ultimately, you need to do this for hundreds of things. Then all of a sudden, you have a management nightmare of trying to coordinate 15 or 20 parameters for 150,000 people,” says Schwartz.

For this, the physicians needed more than the EHR they have been using for seven years, even though he described his group as “a relatively advanced” user of GE Centricity.

P4P requires a completely different data model than EMRs or EHRs (depending on your term of choice), and Westmed needed to move beyond a transaction system to a population-management system, Schwartz says. “None of this stuff is built into any EMR. This is what we would coin as EMR 2.0.”

Taking a page from the business industry, Schwartz acquired a separate business intelligence system: When the patient data from their EHR is fed into it, the system reorganizes it and readies it for reporting. Physicians can interact with it using a Web-based dashboard to slice and dice the data. A separate system translates, analyzes, and distributes the data based on the chosen quality metrics. Schwartz’s organization is ahead of the curve with this business intelligence system, which he said is not yet available for commercial use.

Schwartz is quick to note the challenges of P4P — from ensuring you have reports from referrals and lab results entered into the EHR to changing the culture of primary-care physicians for the new paradigm.

But, he says, payment reform is on the horizon and practices should be ready for the transition. Not only does he expect it to pay off big for physicians, but he also believes it’s a necessary shift in patient care. As his organization looked into becoming a medical home, Schwartz realized how important it was to change their paradigm of patient care to one that was focused on quality of care.

“This is really the way people should be taken care of. There is a clear imperative to physicians that responsibility transcends visits,” he says. “As a large healthcare organization that was committed to delivering quality care, we basically needed to not accept the status quo.”]]> http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/1437.htm Tue, 29 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1085 EHR
Current commercial ambulatory care EMRs facilitate care coordination within a practice by making information available at the point of care but are less helpful for exchanging information across physician practices and care settings, according to the study supported by the Commonwealth Fund.

Clinicians identified many areas where both the design of EMRs might be altered, and office care processes modified, to improve EMRs' support for tasks involved in coordinating patient care, according to the study.

Additionally, while current commercial EMR design is driven by clinical documentation needs, there is a heavy emphasis on documentation to support billing rather than patient and provider needs related to clinical management, the study found. And, current fee-for-service reimbursement encourages EMR use for documentation of billable events -- office visits, procedures -- and not for care coordination, which is not a billable activity.

"There's a real disconnect between policy makers' expectations that current commercial electronic medical records can improve care coordination and physicians' experiences with EMRs," said HSC Senior Researcher Ann S. O'Malley, M.D., M.P.H., coauthor of the study with HSC Senior Researcher Joy Grossman, Ph.D.; HSC Research Assistant Genna R. Cohen; former HSC Research Analyst Nicole M. Kemper, M.P.H., and HSC Senior Researcher Hoangmai H. Pham, M.D., M.P.H.

The Journal of General Internal Medicine article, titled "Are Electronic Medical Records Helpful for Care Coordination? Experiences of Physician Practices," is based on a total of 60 interviews? 52 physicians and other staff at 26 small and medium-sized physician practices with commercial ambulatory EMRs in place for at least two years; chief medical officers at four EMR vendors; and four national thought leaders active in health information technology implementation.

"This work emphasizes that improving care coordination will not happen with technology alone," said Commonwealth Fund Vice President Anne-Marie Audet, M.D. "What is needed is a redesign of care processes and work flow; clinicians will also need to adopt new ways of working and communicating within practices and across organizations."

Other key study findings include:

• EMRs may have unintended consequences for care coordination, such as creating information overload that complicates providers' efforts to discern key clinical information. And managing information overflow from EMRs is a challenge for clinicians.

• Clinicians believe current EMRs have limited ability to capture dynamic planning and the medical decision-making process in a way that supports future coordination needs?present EMRs focus on linear (moment-in-time) documentation while care coordination is dynamic and ongoing.

• Maximizing the potential of an EMR for coordination involves ongoing evolution of clinical care processes as well as clinician input on EMR design modifications and standards for data exchange to support those processes.

• Modifying reimbursement to encourage coordination of care by clinicians will likely drive clinicians to demand better EMR functioning to support coordination.

• Simply creating incentives to adopt EMRs as they currently exist, given the confines of the current payment system, may result in EMRs being designed for billing purposes primarily rather than for clinical relevance to patients and care coordination.

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation's changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded in part by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research.

The Commonwealth Fund is a private foundation supporting independent research on health policy reform and a high performance health system.]]> http://www.scienceblog.com/cms/gap-exists-between-vision-emrs-improve-care-coordination-and-clinicians-experiences-28804.html Wed, 30 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1086 Practice
Over the past six months, many physicians have approached me to learn more about non-clinical career opportunities because they want to leave clinical medicine. It's quite unfortunate to see so many physicians disheartened by the practice of medicine. We need good physicians to serve the public. We need capable and willing physicians who will accept Medicare and Medicaid.

What's going to happen in the setting of health care reform? We're going to have more patients out there who will demand medical care, but we'll have fewer physicians in the workforce.]]> http://www.medicineandtechnology.com/2009/12/physicians-are-burning-out.html Wed, 30 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1087 Practice
Here’s how to start:

1. Place paper recycling bins in administrative parts of the office, and plastic/glass recycling bins in kitchen and break areas. Find out from your building manager or municipal office the easiest way to get those recyclables picked up.

2. As light bulbs burn out, replace them with LED bulbs or other long-lasting, efficient alternatives. Install motion sensors so that lights come on when someone enters a room and go off automatically when the room is empty.

3. Switch to a programmable thermostat, so you can save both money and energy by limiting heating and cooling during off-hours and weekends.

4. Whenever possible, buy products made of recycled materials. Easy targets are paper towels, toilet paper, tissues, and printer paper. The higher percentage of post-consumer material used, the greener the product is.

5. Use green, nontoxic cleaning products and ask your cleaning service to do the same. Many non-green cleaners and disinfectants emit harmful toxic chemicals that worsen air quality. Green ones work just as well without the side effects.

6. Replace paper patient gowns and drapes with cloth ones. Yes, you may need a laundry service — but it’s still cheaper over time.

7. Consider reusable clinical tools where appropriate. Easy-to-use sterilizing systems work great.

8. Swap the paper cups and plates and plastic utensils in your office kitchen for reusable glasses, mugs, dishes, and silverware (found cheap at a dollar store or in a box in your basement).

9. When renovating or redecorating the office, choose greener options, such as nontoxic (or low-VOC) paint, furniture made from sustainable materials, and PVC-free exam tables.

10. Institute a medication disposal program in your office for your patients’ unused drugs and samples as a way to keep more of these drugs from being flushed into the water supply.

11. Consider investing in an EHR and e-prescribing system. This will save reams of paper and file folders, and ultimately trim your practice’s supply costs.

12. Get staff involved by creating a “green team” to lead greening efforts, and encourage staff to bike, take the bus, or carpool to work.]]> http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/1438.htm Wed, 30 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1088 Medicare EHR
A proposed rule issued by CMS outlines proposed provisions governing the EHR incentive programs, including defining the central concept of “meaningful use” of EHR technology. An interim final regulation (IFR) issued by ONC sets initial standards, implementation specifications, and certification criteria for EHR technology. Both regulations are open to public comment.

“Widespread adoption of electronic health records holds great promise for improving health care quality, efficiency, and patient safety,” said, National Coordinator for Health Information Technology David Blumenthal, M.D., M.P.P. “The Recovery Act’s financial incentives demonstrate Congress’ and the Administration’s commitment to help providers adopt and make meaningful use of EHR technology so they can give better care and their patients’ experience of care will improve. Over time, we believe the EHR incentive program under Medicare and Medicaid will accelerate and facilitate health information technology adoption by more individual providers and organizations throughout the health care system.”

“These regulations are closely linked,” said Charlene Frizzera, CMS acting administrator. “CMS’s proposed regulation would define and specify how to demonstrate ‘meaningful use’ of EHR technology, which is a prerequisite for receiving the Medicare incentive payments. Our rule also outlines the proposed payment methodologies for the Medicare and Medicaid EHR incentive programs. ONC’s regulation sets forth the standards and specifications that will enhance the interoperability, functionality, utility and security of health information technology.”

CMS and ONC worked closely to develop the two rules and received input from hundreds of technical subject matters experts, health care providers, and other key stakeholders. Numerous public meetings to solicit public comment were held by three Federal advisory committees: the National Committee on Vital and Health Statistics (NCVHS), the Health IT Policy Committee (HITPC), and the Health IT Standards Committee (HITSC). HITSC presented its final recommendations to the National Coordinator in August 2009. These recommendations, along with all other input were considered to help inform the development of the regulations announced today.

The IFR issued by ONC describes the standards that must be met by certified EHR technology to exchange healthcare information among providers and between providers and patients. This initial set of standards begins to define a common language to ensure accurate and secure health information exchange across different EHR systems. The IFR describes standard formats for clinical summaries and prescriptions; standard terms to describe clinical problems, procedures, laboratory tests, medications and allergies; and standards for the secure transportation of this information using the Internet.

The IFR calls for the industry to standardize the way in which EHR information is exchanged between organizations, and sets forth criteria required for an EHR technology to be certified. These standards will support meaningful use and data exchange among providers who must use certified EHR technology to qualify for the Medicare and Medicaid incentives.

Under the statute, HHS is required to adopt an initial set of standards for EHR technology by Dec. 31, 2009. The IFR will go into effect 30 days after publication, with an opportunity for public comment and refinement over the next 60 days. A final rule will be issued in 2010. “We strongly encourage stakeholders to provide comments on these standards and specifications,” Dr. Blumenthal said.

The Recovery Act established programs to provide incentive payments to eligible professionals and eligible hospitals participating in Medicare and Medicaid that adopt and make “meaningful use” of certified EHR technology. Incentive payments may begin as soon as October 2010 to eligible hospitals. Incentive payments to other eligible providers may begin in January 2011.

The proposed rule would define the term "meaningful EHR user" as an eligible professional or eligible hospital that, during the specified reporting period, demonstrates meaningful use of certified EHR technology in a form and manner consistent with certain objectives and measures presented in the regulation. These objectives and measures would include use of certified EHR technology in a manner that improves quality, safety, and efficiency of health care delivery, reduces health care disparities, engages patients and families, improves care coordination, improves population and public health, and ensures adequate privacy and security protections for personal health information.

The proposed rule would define meaningful use for the Medicare EHR incentive programs. It proposes one definition that would apply to eligible professionals participating in the Medicare fee-for-service and the Medicare Advantage EHR incentive programs as well as a proposed definition that would apply to eligible hospitals and critical access hospitals. These definitions also would serve as the minimum standard for eligible professionals and eligible hospitals participating in the Medicaid EHR incentive program. The rule proposes that states could request CMS approval to implement additional meaningful use measures, as appropriate, but could not request approval of fewer or less rigorous meaningful use measures than required by the rule.

This rule proposes a phased approach to implement the proposed requirements for demonstrating meaningful use. This approach would initially establish reasonable criteria for meaningful use based on currently available technological capabilities and providers’ practice experience. CMS will establish stricter and more extensive criteria for demonstrating meaningful use over time, as anticipated developments in technology and providers’ capabilities occur.

CMS provides a 60-day comment period on the proposed rule. “The definition and requirements for demonstrating meaningful use of EHR technology are proposals. CMS welcomes and will give serious consideration to comments that improve our proposal while achieving the goals Congress established for the EHR incentive programs,” Frizzera said.

The CMS proposed rule and fact sheets, may be viewed at http://www.cms.hhs.gov/Recovery/11_HealthIT.asp.

ONC’s interim final rule may be viewed at http://healthit.hhs.gov/standardsandcertification. In early 2010 ONC intends to issue a notice of proposed rulemaking related to the certification of health information technology.]]> http://www.hhs.gov/news/press/2009pres/12/20091230a.html Thu, 31 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1089 Medicare EHR
CMS released the long-awaited proposal for meaningful use late Wednesday afternoon, beating the statutory deadline of Dec. 31 by one day. The Office of the National Coordinator for Healthcare Information Technology issued a companion interim final regulation relating to electronic data standards and certification of EHR products. The agencies will accept public comments on the respective plans for the next 60 days before finalizing the regulations in the spring.

The lengthy rules published today several subtle differences from earlier plans. Physician practices will only have to enter 80 percent of orders electronically, down from the 100 percent called for in recommendations issued last summer. The threshold for hospital use of computerized physician order entry is just 10 percent. In a brief conference call with reporters, CMS officials did not explain this discrepancy. For 2011 and 2012, hospitals would not have to be able to transmit orders electronically to pharmacies, labs or imaging centers and physcians will not have to record progress notes in the EHR. The standards will ratchet up in 2013 and 2015, however.

Federal officials now estimate the total cost of the program at $14.1 billion to $27.3 billion over the next 10 years, depending on provider participation. "I think that it's important to understand that this is a voluntary program," Jonathan Blum, director of CMS' Center for Medicare Management, said during the conference call. CMS says the figures are based on expected gross outlays minus any payment reductions for not achieving meaningful use in later years. The range does not consider expected efficiency gains from EHR usage.

For more information:

• Read this HHS press release

• See the CMS proposed rule on meaningful use of EHRs (556-page pdf)

• See the ONC interim final rule on standards and certification (136-page pdf)]]> http://www.fiercehealthit.com/story/meaningful-use-require-5-cds-rules-not-progress-notes-2011/2009-12-30 Thu, 31 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1090 Medicare EHR
The following list of 25 Stage 1 Meaningful Use criteria for eligible providers was taken from the proposed rule: "Medicare and Medicaid Programs; Electronic Health Record Incentive Program." A second list, for eligible hospitals, is provided here. You can download the full 556-page document at http://www.federalregister.gov/OFRUpload/OFRData/2009-31217_PI.pdf

[1] Objective: Use CPOE.
Measure: CPOE is used for at least 80 percent of all orders

[2] Objective: Implement drug-drug, drug-allergy, drug- formulary checks.
Measure: The EP has enabled this functionality

[3] Objective: Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT®.
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry or an indication of none recorded as structured data.

[4] Objective: Generate and transmit permissible prescriptions electronically (eRx).
Measure: At least 75 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.

[5] Objective: Maintain active medication list.
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient is not currently prescribed any medication) recorded as structured data.

[6] Objective: Maintain active medication allergy list.
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient has no medication allergies) recorded as structured data.

[7] Objective: Record demographics.
Measure: At least 80 percent of all unique patients seen by the EP or admitted to the eligible hospital have demographics recorded as structured data

[8] Objective: Record and chart changes in vital signs.
Measure: For at least 80 percent of all unique patients age 2 and over seen by the EP, record blood pressure and BMI; additionally, plot growth chart for children age 2 to 20.

[9] Objective: Record smoking status for patients 13 years old or older.
Measure: At least 80 percent of all unique patients 13 years old or older seen by the EP “smoking status” recorded

[10] Objective: Incorporate clinical lab-test results into EHR as structured data.
Measure: At least 50 percent of all clinical lab tests results ordered by the EP or by an authorized provider of the eligible hospital during the EHR reporting period whose results are in either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.

[11] Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach.
Measure: Generate at least one report listing patients of the EP with a specific condition.

[12] Objective: Report ambulatory quality measures to CMS or the States.
Measure: For 2011, an EP would provide the aggregate numerator and denominator through attestation as discussed in section II.A.3 of this proposed rule. For 2012, an EP would electronically submit the measures are discussed in section II.A.3. of this proposed rule.

[13] Objective: Send reminders to patients per patient preference for preventive/ follow-up care.
Measure: Reminder sent to at least 50 percent of all unique patients seen by the EP that are 50 and over

[14] Objective: Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rule.
Measure: Implement five clinical decision support rules relevant to the clinical quality metrics the EP is responsible for as described further in section II.A.3.

[15] Objective: Check insurance eligibility electronically from public and private payers.
Measure: Insurance eligibility checked electronically for at least 80 percent of all unique patients seen by the EP

[16] Objective: Submit claims electronically to public and private payers.
Measure: At least 80 percent of all claims filed electronically by the EP.

[17] Objective: Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and allergies) upon request
Measure: At least 80 percent of all patients who request an electronic copy of their health information are provided it within 48 hours.

[18] Objective: Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies)
Measure: At least 10 percent of all unique patients seen by the EP are provided timely electronic access to their health information

[19] Objective: Provide clinical summaries to patients for each office visit.
Measure: Clinical summaries provided to patients for at least 80 percent of all office visits.

[20] Objective: Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically.
Measure: Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information.

[21] Objective: Perform medication reconciliation at relevant encounters and each transition of care.
Measure: Perform medication reconciliation for at least 80 percent of relevant encounters and transitions of care.

[22] Objective: Provide summary care record for each transition of care and referral.
Measure: Provide summary of care record for at least 80 percent of transitions of care and referrals.

[23] Objective: Capability to submit electronic data to immunization registries and actual submission where required and accepted.
Measure: Performed at least one test of certified EHR technology's capacity to submit electronic data to immunization registries.

[24] Objective: Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice.
Measure: Performed at least one test of certified EHR technology's capacity to provide electronic syndromic surveillance data to public health agencies (unless none of the public health agencies to which an EP or eligible hospital submits such information have the capacity to receive the information electronically).

[25] Objective: Protect electronic health information maintained using certified EHR technology through the implementation of appropriate technical capabilities.
Measure: Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308 (a)(1) and implement security updates as necessary.]]> http://www.healthcareitnews.com/news/eligible-provider-meaningful-use-criteria Thu, 31 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1091 Medicare EHR
The feds released plenty of details late today, in this 556-page proposed rule that lays out what doctors (a.k.a. “eligible professionals”) and hospitals will have to do to qualify for the money.

On the off chance that you don’t have the time or interest to read 556 pages, we suggest you skip to Table 2 on p. 103, which lists the criteria docs and hospitals will have to meet in the first phase of the roll-out.

The stuff there is largely what the people we talked to were expecting. Among the requirements: File prescriptions and submit insurance claims electronically; give patients electronic access to their health information; use computerized systems to enter at least some of doctors’ and nurses’ orders; track patients’ medications electronically; and record vital signs and lab test results electronically.

Sharing electronic information between different medical practices and hospitals isn’t something that happens very often; the meaningful use guidelines seem to recognize this. When the program kicks in, in fiscal year 2011, doctors and hospitals only need to say that they “performed at least one test” of their system’s ability to “electronically exchange key clinical information.”

Mike Valentine, EVP of the health records company Cerner, told the Health Blog that “they’re setting a much lower bar for interoperability and sharing” information, and a somewhat higher bar for the way docs and hospitals use electronic systems internally.

The stimulus bill specified that incentive payments — which can top more than $40,000 for a single doctor over several years and could total more than $20 billion nationwide (see p. 449) — would be tied to meaningful use of certified systems. Now that there’s some clarification on meaningful use, one key question remains about certification: Just who is going to do it?

The feds did release this proposed rule today regarding certification criteria. But Scott Decker, president of the EMR shop NextGen, pointed out to us that it’s still not clear what body will be doing the certifying.

There is an existing certification group, but the feds haven’t said for sure whether that group will be the key for getting a stimulus-ready system. “The lack of a certification body at this stage is a problem,” Decker said.

The proposed rules are, like the Health Blog, open for public comment. Final rules are expected next year.]]> http://blogs.wsj.com/health/2009/12/30/how-to-get-20-billion-for-using-electronic-medical-records/ Thu, 31 Dec 2009 09:01:00 MST http://www.primarydatacorp.com/#1092 Practice
According to "Transcription Services: Steady Demand in a Volatile Market," 43% of hospitals and medical clinics sent transcription work out of the country in 2009. That's up from 35% that did so in 2008.

"Times are tight, and people are very sensitive about their budgets," said Mike Smith, KLAS's general manager. "Some institutions find the cost savings are warranted."

Offshore companies charge an average of 13 cents per line of copy, while domestic ones charge an average of 15 cents.

Turnaround time between offshore and U.S. companies wasn't much different, although time zone differences can sometimes be an advantage.

"In India, they are working while you are asleep," said Lorin Bird, KLAS's operations manager.

Overseas medical transcription companies scored lower on quality because of missing words, grammatical errors, misspellings and problems understanding colloquialisms. In addition, some health care institutions hesitate to use offshore companies because of security concerns.

The report found that 44% of institutions expected dictation volume to increase because of the expected growth in patient volume and because physicians will be required to document more. But about 16% planned to use fewer outside services because more physicians are using electronic medical records and more offices are implementing speech-recognition software.]]> http://www.ama-assn.org/amednews/2009/12/28/bise1231.htm Mon, 04 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1093 HIPAA
• Construct a breach notification policy
• Update business associate (BA) contracts
• Find all BAs in the system
• Educate staff members about HITECH Act
• Determine if encryption is necessary to safeguard data flowing through network

That's a pretty good snapshot at the HIPAA checklist these days, in light of new federal laws and regulations in the past year and a compliance date looming in February (when BAs must comply with the security rule; and when OCR will enforce breach notification).

However, those same HIPAA officers should add one more "to-do" to that checklist: Comply with HIPAA's internal sanction regulation. Covered entities must have an internal sanctions policy for HIPAA violations.

Some facilities may have rock-solid policies that have been battle-tested. Others need some work, especially in light of new federal sanctions for HIPAA violations, including monetary fines that could total millions at the discretion of the HHS secretary.

HITECH placed violations into tiers:

• Tier A is for cases in which offenders didn't realize they violated the Act and would have handled the matter differently if they had
• Tier B is for violations "due to reasonable cause, and not to willful neglect," though HHS still must define "reasonable cause"
• Tier C is for infringements that the organization corrected, but were due to willful neglect
• Tier D is for violations due to willful neglect that the organization did not correct

The lower the tier, the higher the monetary fine, all controlled by the HHS secretary.

Dena Boggan, CPC, CMC, CCP, HIPAA privacy/security officer, St. Dominic Jackson Memorial Hospital, Jackson, MS, says covered entities should consider the HITECH tiers when shaping their internal sanctions policy.

Boggan also spoke at an HCPro, Inc.-hosted an audio conference, "HIPAA Internal Sanctions: Adapt Your Policy to Comply with the HITECH Act," Thursday, December 3.

"Be ever-vigilant in watching for new developments in the year to come," Boggan told HealthLeaders Media. "And be flexible when revising existing policies and procedures so that you not only meet the obligations of the current language revisions, but you are also able to quickly address any additional additions, deletions, or changes to your policies to comply with these ever-changing regulations."

Nancy Davis, privacy/security officer, Ministry Health Care, Sturgeon Bay, WI, and the other speaker on the audio conference, tells HealthLeaders Media, "I would stress that the development of written guidance to address the severity of the incident and the appropriate sanction level goes a long way in promoting consistency when applying HIPAA sanctions to all members of the work force."]]> http://www.healthleadersmedia.com/content/TEC-244314/Stay-Vigilant-to-Comply-with-HIPAAs-Internal-Sanction-Regulation.html Mon, 04 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1094 Practice
Although some uncertainty persists, particularly with one major obstacle remaining for healthcare reform legislation, in 2010 providers should start getting a clearer picture about the future of healthcare. Reform will likely pass, the economy will hopefully recover, and the tea leaves will be a little easier to read.

Adapting and preparing for these changes will be the big challenge for the coming year. I'm reminded of the Charles Darwin quote: "It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change."

That will hold true for physicians and hospitals as today's theoretical healthcare system changes become reality very soon. Today's biggest and most profitable medical groups aren't guaranteed success in the future; the best clinicians in today's system won't necessarily be the best in tomorrow's. But providers and organizations that anticipate structural changes and make adjustments early will find themselves ahead of the pack as others struggle to keep up.

Here are a few steps physicians can take in 2010 to prepare:

1. Get close to hospitals. This has been sound advice for a while, and physician employment and tighter alignment aren't exactly new trends. But if the federal government moves forward with plans to bundle payments and shift toward accountable care organizations, closer relationships will become an absolute necessity. Building those ties now will benefit both physicians and hospitals. Even though healthcare reform didn't include the promised realignment of incentives through a new payment system, the powers that be have been pretty explicit about the models they're considering. The days of fee for service are numbered.

2. Embrace technology. I'm not just talking about electronic health records, although 2010 will be a busy year for practices that want to be eligible for the first HITECH funds in 2011. But as I hinted at in the Dec. 17 issue, 2009 may have marked the beginning of a dramatic shift in how physicians practice. Social networking, smart phones, and other technologies have opened up new ways of communicating and sharing information, and this trend is unlikely to wane in 2010. Technology obviously shouldn't supplant traditional clinical skills or become a crutch, but the physicians that quickly learn to enhance their fundamental skills with new tools will thrive in the coming years.

3. Re-evaluate all finances and contracts. Although reformers fell short in areas of cost containment and quality improvement, if the current legislation passes they will have succeeded in significantly expanding access to healthcare. The financial implications of that are still unclear. Yes, there will be provider shortages and struggles. But David Gans, vice president of innovation and research for the Medical Group Management Association, thinks there will also be opportunities for doctors. The new "unlimited demand" for physician services may give them more leverage when negotiating contracts with insurers, and 2010 may be the year to revamp payer mix and take a closer look at practice finances.

4. Educate and work with patients. Look to Dave deBronkart—or ePatientDave—for an example of the patient of the future. He's tech-savvy and engaged in his own care, and perhaps most important, he wants to work with his physician. Doctors that embrace this partnership model and educate and listen to patients will have happier patients and perhaps better outcomes. It will be a challenge to do this while managing traditional patients, but 2010 is a perfect year to ramp up patient education efforts. With millions of Americans gaining access to insurance for the first time, there will be an influx of patients with low health literacy. Helping these patients learn to navigate the health system will actually be a big help to the practice.

These priorities may obviously change if healthcare reform fails during the final vote or we see a double-dip recession. No one can completely predict the future. But that doesn't mean you can't be ready for it.]]> http://www.healthleadersmedia.com/content/PHY-244304/Physicians-Must-Adapt-Evolve-in-2010.html Mon, 04 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1095 Practice
Redesigning your statements won't guarantee results, but it will improve your chances of collecting from patients, which is more important than ever these days. Research reveals that 30 percent of the average U.S. medical practice's revenue will be collected from patients in 2013, up from 12 percent in 2007. For dermatologists performing non-covered and cosmetic services, double these percentages. Any improvement in collections falls directly to your bottom line — and, frankly, it's an effort you can't afford not to make.

Here are 10 recommendations to re-engineer your statements:

1. Print the initial statement at check-out. Not only will you save postage, but patients will no longer be able to claim they never received the statement (a common excuse from those whose accounts end up in collections). If you can't facilitate printing statements at check-out, then at least mail them when they are due instead of sending them in batches spread throughout the month in a cycle based on alphabetical order.

2. Remove the boxes. Statements often display a horizontal row of boxes to illustrate the account's age — the first box indicating a "current" account at zero to 30 days due; the second, 31 to 60 days; the third, 61 to 90 days; and so forth. Seeing the amount move from box to box unchanged does little to motivate patients. Continue telling patients the age of the account, but don't rely on little boxes that are so easy to ignore. Speaking of boxes, don't leave the "amount due" box empty; fill in the full amount due. Otherwise, you are inviting the patient to enter a lesser amount.

3. Tighten the cycle. If you're still sending six statements to patients, you're wasting your money. If patients haven't paid by the third statement, they're not going pay at all. Remember, you've already asked them multiple times, including your pre-visit and time-of-service collections efforts. Supplement your verbal collection efforts by sending just three statements — one when the balance is due (at day "zero," not 30 days after the disposition of the account is determined), another statement at 30 days, and complete your statement cycle at day 60. If payment hasn't been received by 75 days after the balance became due, send a collection letter, not another statement.

4. Craft a collections letter strategy. Make your collections letter concise. State a specific due date, not something vague like, "payment is due in 15 days." Sign the letter, "Judy," so that when patients call for Judy, you'll know they are responding to a collections notice. That will cue you to send those calls to your best collector. When patients call to say they can't pay, don't automatically initiate a proposal for a payment plan. Instead, ask "What can you pay now?" Offer to take credit card information over the phone (it may be all you're going to get from this account). Then, ask "How much more time do you need on the balance?" Those questions put the onus on the patient to act. Patients who feel they're in control are more likely to make some attempt at payment.

5. Reconsider the sequencing of statements. There's no reason why you must wait 30 days to send another statement; mail semi-monthly instead of monthly. Transmit statements every day instead of the traditional once-a-week, mid-week mailing. This reduces the likelihood of getting a bolus of calls the following Monday, driving everyone in the business office crazy.

6. Attend to returned mail. The cost is high if your staff fails to process returned mail; statements will continue going to the incorrect address until the accounts are suspended or corrected. Let the post office do some of the detective work. Just print "address service requested" on the front of the envelopes so you will get notice of the forwarding address on file at the United States Postal Service (USPS) whenever someone has moved. It's inexpensive; contact your local USPS branch to get started.

7. Accept credit cards. In addition to requesting the patient enclose a check, delineate a section on your statement to enter credit card information. Credit card payments do cost you a few percentage points, but making it easier for the patient to pay will, in the end, make it more likely that you'll collect.

8. Be creative. Handwrite the patient's address. Stamp the envelope with a stamp, not a meter. Print on colored paper. Consider using an invitation-sized envelope. These ideas won't necessarily mean you'll get paid, but being creative ensures that your mail will at least be seen, instead of wallowing at the bottom of the stack of bills.

9. Add financing fees. Inform patients at registration of your intent to add a fee — flat fee or interest — to the third statement. Add the fee only if you can automate it; you certainly don't want your staff manually calculating and keying in fees on your statements. Be sure to check with the insurance companies with whom you participate about finance charges. If they prohibit statement charges, negotiate for it at your next contract renewal. If you do implement fees, recognize that they are a collection tool, not the latest and greatest way to make money. If patients call after receiving a statement charging them an extra fee, explain that you'd be delighted to waive the fee if they take care of the balance with a credit card number — right then and there.

10. Go online. Most industries rolled out online payment years ago. Don't be fazed by the technology leap you may have to make; implementing online bill payment is a must. While there is a cost to executing the system, the pay-off is significant. Cash flow is improved (consider that payments come in immediately, versus three to five days through the mail), staff time is saved (manual posting is eliminated) and variable costs drop to zero (postage and supplies are no longer needed).

The time is right for a redesign of both your billing statements and your approach to billing patients. Your efforts will make it easier for patients to pay and reduce billing and write-off costs for you. Best of all, your dermatology practice will be better off financially over the long term because it knows how to collect the money it has earned.]]> http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Patient-statements-Its-time-to-overhaul-your-decad/ArticleStandard/Article/detail/648407 Mon, 04 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1096 Practice
I felt crushed by the pressure to have as high a number as possible. Trouble was, my daily load — 25 patients a day — wasn’t very high in comparison to others. I remember learning about a legendary family doc in our community who was reported by many to see 70 patients a day. One of my partners was cranking through upwards of 40 — even through a painful divorce.

Was I the only family doc who felt uncomfortable seeing more than 25? Any more than that and I wouldn’t be able to continue to call all of my patients back — an obsessive but patient-appreciated ritual that had become my trademark. Beyond 25, I couldn’t research unusual patient presentations and I couldn’t personally coordinate care to make certain the ball wasn’t dropped somewhere. And the hours? Anything more than 40 and I couldn’t take care of myself well enough to take care of my patients and really be there for them in their times of need.

I realized that 3,500 was no longer a number with which I could be associated because it kept me from being the doctor I knew I could — and wanted — to be. So I left traditional, volume-based medicine to retool myself and my practice into one that centered on patients. I embarked in a new direction hoping to find, create, or perhaps, just stumble into an environment where even simple-minded, slow-moving doctors like me could practice good medicine and gain professional satisfaction.

I wasn’t exactly sure what I was getting into, but I needed to find a new number that would work for me, and for my patients. With that mission, my practice morphed quickly into a retainer-based practice which we now know as “concierge medicine.”

Sometimes I get asked about the ethics of “abandoning” patients. My answer? It’s not a matter of ethics, frankly; it’s a matter of effectiveness. I wonder, who established that one physician should be the medical home for 3,000 to 5,000 patients, and why is that the ethical high ground from which all physicians should be judged? If another doctor can offer an effective medical home for 3,000 patients, more power to ’em. I couldn’t and I won’t.

Six years later, I have found my number — 300 — and I have found my peace. Want to find yours? Here’s how to begin figuring that out:

• Shrink to grow. Consider the idea that to be a better doctor and grow professionally as a physician, you may first need to reduce your patient volume.

• Just say no. As physicians, particularly as primary-care physicians, we are hard-wired to take all comers, to be “yes” people and to “work it in.” Give some thought to how this mindset — collectively built over decades — has contributed to our current access problems. Set boundaries and stick to them.

• Make it a zero-sum game. Time is finite. We can no longer “just see more patients.” Do today’s work today.

Take-away thought: If we give to Peter, we must rob from Paul. If we give to both Peter and Paul, we will probably keep one of them waiting, and ultimately, we rob ourselves.]]> http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Patient-statements-Its-time-to-overhaul-your-decad/ArticleStandard/Article/detail/648407 Mon, 04 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1097 EHR
Those grants are available for 5 years, and if obtained starting in 2011, they could amount to as much as $64,000 per practice for psychiatrists whose patient mix is at least 30% Medicaid recipients. That figure falls to $44,000 for physicians who cannot meet the Medicaid percentage and who see Medicare patients, with no specific percentage of the latter being designated.

There is also a penalty for physicians who do not meet the meaningful use definition. It comes into play after 2016; the Medicare fee schedule for professional services is reduced by 1% in 2015, by 2% in 2016, by 3% for 2017, and by between 3% to 5% in subsequent years.

The grants were authorized by the American Recovery and Reinvestment Act (ARRA)—which is the stimulus bill Congress passed last winter. Sebelius will set interim requirements based on recommendations from 2 new advisory committees that were established by the ARRA: a health information technology policy and a standards committee. The meaningful use requirements will be different, in part, for office-based physicians and hospitals, but they will have escalating requirements in 2011, 2013, and 2015.

The ARRA gave HHS some guidelines as to what the meaningful use definition should include. The overriding requirement is that a physician be able to exchange certain categories of patient data electronically with other providers and to report quality measures to the HHS and Centers for Medicare and Medicaid Services (CMS).

Complying with a meaningful use definition may have some general and specific challenges for psychiatrists. To begin with, it looks likely that all physicians would have to use computer physician order entry (CPOE) for all patients. In 2011, CPOE would have to perform certain basic tasks. For example, it would need to be able to implement drug-drug, drug-allergy, drug-formulary checks; maintain an up-to-date problem list of current and active diagnoses; and generate and transmit permissible prescriptions electronically. In addition, certain quality measures would have to be reported to the CMS. Those would include, on the basis of the policy committee’s final recommendations, percentages of:

• Diabetic patients whose glycosylated hemoglobin levels are under control

• Hypertensive patients whose blood pressure is under control

• Patients with dyslipidemia whose LDL levels are under control

• Smokers to whom smoking cessation counseling and other measures are offered

At meetings with HHS officials this summer, and in comments, the American Psychiatric Association (APA) pointed out that the elements of the meaningful use definition were shaped for generalists—not specialists such as psychiatrists, for whom some of the requirements might pose serious adherence problems. For example, about the reporting of quality measures, none of those endorsed by the policy committee included mental illnesses. “Additionally, there are some quality measures which could be incorporated into primary care and some specialty settings which were not included on the committee’s proposal, such as those pertaining to major depressive disorder,” said James Scully Jr, MD, medical director and chief executive officer of the APA in a letter to HHS this summer.

It is not that quality measures for psychiatrists do not exist. They do. The New York State Office of Mental Health has developed a decision support and quality improvement system for what in that state are called “Article 31” hospitals, which are for psychiatric patients. The Psychiatric Services and Clinical Knowledge Enhancement System affects only psychiatrists at those hospitals.

According to Hao Wang, PhD, deputy commissioner, chief information officer, office of mental health, state of New York, the state weeds through Medicaid data for indications that psychiatrists at Article 31 hospitals may be outside the boundaries of good practice in 2 areas in which the state has developed quality indicators: polypharmacy and cardiometabolic syndrome indicators. Psychiatrists who appear to need some help in those 2 areas are required to report to the state office of mental health to ensure they are improving their stats. Wang suggests that those 2 quality indicators have utility beyond psychiatrists and could be used by HHS if it wanted to make its quality measures reporting definition more relevant to psychiatric practice.

Wang stated what everyone already knows: that psychiatrists—and physicians more broadly—have not exactly flocked to EHRs. But psychiatrists may have a particular disincentive, Wang explained, “because they can’t find a good behavioral health care product.” He added that hospitals are more concerned about patients with physical conditions, because they generate more revenue. And EHR vendors have responded to that by producing systems that have little utility for physicians who see high percentages of patients with mental health conditions.]]> http://www.psychiatrictimes.com/display/article/10168/1482754 Mon, 04 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1098 Practice
Doctors, hospitals and payers need to adopt an updated version of the International Classification of Diseases code sets, ICD-10, by Oct. 1, 2013.

As a prerequisite to the ICD-10 move, entities by Jan. 1, 2012, need to adopt updated electronic transaction standards, known as 5010, under the Health Insurance Portability and Accountability Act. The original compliance dates were much sooner -- April 1, 2010, for HIPAA 5010 and Oct. 1, 2011, for ICD-10 -- but were moved back due to a regulation released last January by the Bush administration in its final days in office.

Despite having the additional time to get up to speed, the AMA is worried that physicians are still facing a costly and aggressive time line for implementing ICD-10.

"The AMA strongly supports upgraded HIPAA transactions to improve the efficiency and effectiveness of the health care system," said Nancy Spector, the AMA's director of electronic medical systems. But the move to ICD-10 "will impact many business processes within a physician's practice, including documentation of a patient's visit, research activities, public health reporting, quality reporting and administrative transactions."

Spector made the comments during a Dec. 10, 2009, meeting in Washington, D.C., held by the National Committee on Vital and Health Statistics, an advisory committee that makes recommendations to the Dept. of Health and Human Services. The AMA has also reached out to a handful of organizations that are necessary partners for ensuring a successful transition to ICD-10, hosting a stakeholder meeting on Dec. 4, 2009, with America's Health Insurance Plans, the BlueCross BlueShield Assn., the American Dental Assn., and the Healthcare Billing and Management Assn., among others.

At that meeting, the AMA outlined its plans for physician outreach in 2010 and discussed barriers to implementation, the most notable of which is cost. According to estimates by the Medical Group Management Assn., the average cost of upgrading to ICD-10 for a three-physician practice will be $84,000.

Spector said the AMA has concerns as to whether physicians will realize the projected return on investment for the initiative. "Because 50% of physician practices have fewer than five physicians, and yet account for 80% of outpatient visits, the AMA is very sensitive to issues that impact physicians' resources, costs and reimbursement," she said.

AHIP supports the code set upgrade but is also asking for more time, said association spokesman Robert Zirkelbach.

Throughout 2010, the AMA intends to develop an ICD-10 fact sheet series to give an overview of the process and to compare the new code sets to ICD-9. The document will also review concepts such as crosswalking, which involves transferring and applying some of the codes from the older system to the newer one. In addition, the Association will be developing an ICD-10 implementation tool kit, as well as a code set conversion tool.

The Centers for Medicare & Medicaid Services has developed a national standard system for crosswalking, called general equivalency mapping, that health care organizations can follow. But CMS has not mandated the use of that system, which could potentially cause problems, said Robert Tennant, a senior policy adviser with MGMA. Tennant was present at both of the December policy meetings discussing ICD-10 and 5010.

"The inevitability is that we will have to use these crosswalks," said Tennant. "But the health plans may say it's up to them to decide how to map these codes."

Zirkelbach said insurers are aware of those concerns and that AHIP will be trying "to bring more uniformity to the process."

Tennant did credit CMS with attempting to connect with stakeholders to maintain an open dialogue as it presses forward. He said the agency does not appear willing to commit to any contingency plans nor to extend the deadlines any further, meaning Medicare will be ready to start testing the 5010 transaction standards by Jan. 1, 2011.

Federal officials and other ICD-10 proponents say the upgrade must happen because the current system is nearly 30 years old, and its approximately 16,000 procedure and diagnosis codes are insufficient. ICD-10 has roughly 155,000 codes, including about 68,000 diagnostic codes.]]> http://www.ama-assn.org/amednews/2010/01/04/gvsc0104.htm Mon, 04 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1099 Hardware
Apple will announce the tablet later this month but the shipping date could change as plans have not been finalized, the report said, citing people familiar with the matter.

The new device will come with a touchscreen sized about 10 inches to 11 inches and the company is working on two different finishes for the tablet, the report said.

Rumors about an Apple tablet have been floating for more than a year, and the Financial Times in December reported that Apple had reserved a location in San Francisco on January 26 for the possible launch of a tablet.

Financial analysts have said that the launch of a tablet-like device from Apple was imminent. The device is expected to be a larger version of the iPhone on which users can listen to music, play games, watch video or read electronic books. Kai-Fu Lee, a former Apple employee and previously the president of Google in China, recently blogged that the tablet would come with 3D graphics and a price tag below US$1,000.

Apple reportedly has already made deals with service providers to deliver content to the device. Apple's purchase of streaming music provider Lala.com in December has also been linked to the tablet PC.

Enthusiast Web sites have speculated that the device may be called the iSlate, after MacRumors discovered that the islate.com domain name was owned by Apple.]]> http://www.computerworld.com/s/article/9143059/Apple_may_ship_tablet_in_March_report_says Tue, 05 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1100 EHR
The government on Dec. 30 released for a proposed rule defining meaningful use of EHRs and an interim final rule that sets initial standards, implementation specifications and certification criteria for EHR technology. Both rules are available for viewing in a draft format at federalregister.gov/inspection.aspx. They will be published in the Federal Register on Jan. 13 with a 60-day comment period effective at that time.

The meaningful use rule includes about two-dozen requirements that eligible providers and hospitals must meet to qualify for incentives. "Overly burdensome requirements and needlessly complex administration will only discourage physician participation in the program and the implementation of EHRs," contended William Jessee, M.D., CEO and president of the Medical Group Management Association in a written response.

The following is a statement from the Rick Pollack, executive vice president of the AHA, expressing a number of serious concerns with the rules:

"America's hospitals have serious concerns that the new health information technology rules severely limit hospitals' ability to access federal financing for health information technology that is used to improve patient care. Moving toward broader adoption of electronic health records (EHRs) is an important goal and helping hospitals, doctors, nurses and other caregivers is essential in getting us there. While health information technology holds great promise in improving care, widespread efforts toward adoption will be hindered unless key provisions in these rules are addressed.

"Under the American Recovery and Reinvestment Act of 2009, only hospitals that are considered 'meaningful users' of EHRs can receive much-needed financial assistance. America's hospitals believe the proposed definition of 'meaningful use' is a worthy goal, but it should be a destination point, not a starting point. Today, many hospitals are using clinical systems that reduce medication errors, track quality and outcome measures, and collect basic patient health information using computer technology. The intent behind the stimulus funds was to recognize the important efforts hospitals and physicians have undertaken to improve care and to stimulate greater use of health information technology and EHRs. However, the rules released yesterday create a stringent definition of 'meaningful use' that doesn't recognize these important efforts and would unfairly penalize many hospitals. A more commonsense approach would reward the progress hospitals and physicians already have made toward adopting EHRs.

"In addition, the 'meaningful use' rule also fails to recognize how modern hospitals are organized and how care is delivered. Simply put, the eligibility requirements for hospitals and physicians are too restrictive. For example, health information technology payment incentives unfairly exclude physicians who practice in outpatient centers and clinics owned by a hospital. An alternate approach that recognizes all non-hospital physicians and the myriad of physician-hospital relationships would go a long way toward ensuring patient care is better coordinated and adoption of health information technology is rewarded.

"America's hospitals strongly embrace health information technology and want to accelerate its use to improve care. However, as proposed, the current regulations may actually make it more difficult for hospitals and doctors to adopt health information technology. Unless significant changes are made and timelines reexamined, it is unlikely that the vast majority of hospitals can meet the proposed standards, making them ineligible for this important funding, and also subject to penalties for not being in compliance. We urge CMS to make changes to these regulations that would advance the adoption and use of clinical information technology to improve care for patients and communities.]]> http://www.healthdatamanagement.com/news/meaningful_use_stimulus_EHR_HITECH_certification-39604-1.html Tue, 05 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1101 Technology
The machines represent a fast, convenient way of dispensing prescription drugs at pharmacies after hours, in community clinics with limited staffing and in rural locations that lack pharmacists. They also can free up pharmacists from the drudgery of counting pills to allow for more direct patient counseling. "The greatest benefit that this system has is that it's freeing the pharmacist up from what they call the technical aspects of the job," Don Waugh, co-founder and CEO of PCA Services, a Canadian firm that makes such kiosks, is quoted as saying in SelfServiceWorld. "Our pharmacists aren't doing that; they're actually having a one-on-one session with the patients and reviewing not just this drug, but all drugs they're on and doing more counseling."

There are, of course, concerns about the chance of prescription drugs falling into the wrong hands. Laurence Cohn, president and CEO of another kiosk manufacturer, eAnytime, says the Huntington Beach, Calif., company has worked closely with the DEA, drug companies, large medical clinics and state pharmacy boards to protect against unauthorized access. "You have to have a very safe system and a very accurate system," Cohn tells SelfServiceWorld. "We designed a foolproof system."

That's a strong claim, but both eAnytime and PCA Services report having backlogs of orders for their products.]]> http://www.fiercehealthit.com/story/patient-facing-kiosks-automate-prescription-dispensing/2010-01-04 Tue, 05 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1102 EHR
Robert Plovnick, M.D., M.S., and Director of the Department of Quality Improvement and Psychiatric Services at the American Psychiatric Association (APA), noted his concerns when he addressed the House Small Business Committee in July 2008.

“Electronic health information exchange could erode patient trust and impede clinical care if it facilitates dissemination of sensitive information without sufficient precautions being taken to protect privacy,” he said. “Second, a significant percentage of APA members operate in solo, private practices in which the up front costs of implementing a health IT [information technology] or EHR system present a considerable barrier to adoption.”

Dr. Plovnick has ample reason to be concerned. While many of the larger behavioral healthcare agencies have designated information technology staff, solo providers or small private practices may find difficulty in converting from paper to EHR. Many of the smaller practices do not or, more importantly, cannot employ support staff, let alone IT staff. Conversely, providers at large healthcare agencies don’t have to spend as much time on the intricacies of the conversion. Rather, they can focus more on patient care while their IT staff works with the more time-consuming details of the EHR conversion.

Although many in the behavioral health industry support the idea of EHRs, not everyone will come out a winner in regards to the American Recovery and Reinvestment Act of 2009 (ARRA). This requires all healthcare providers and agencies to utilize EHRs by 2011. For the behavioral health arena, health information technology (HIT) funding will be allocated to the human services sector. Much of the public mental health services, as well as addiction services, are not eligible for federal funding as defined by the ARRA eligibility requirements.

Over 500 agencies and organizations in the mental health and human services field completed a 2009 survey that gauged the readiness of EHR implementation in behavioral health. Not surprisingly, cost was cited as the main reason many were not progressing with EHRs at the same rate as that of general healthcare. In response to the survey results, Mark Covall, president and CEO of the National Association of Psychiatric Health Systems said, "Health information technologies can help serve more patients more effectively and better meet the growing need for psychiatric services. The significant investment that has already been made by providers is evidence of the field's commitment to technology. But we can't keep up unless dollars are available on par with the rest of healthcare.”

The survey results showed that primary care spends twice as much than behavioral health services on HIT and three times more on IT employees. Moreover, less than half of all behavioral health services providers are currently utilizing EHRs. The picture becomes grimmer when considering budget cuts most of these providers expect in the coming years, and an increase in patients is anticipated with a decrease in reimbursements. Yet according to the study, if funding became available, behavioral healthcare providers and agencies would be able to spend more on developing their HIT capabilities such as EHRs.

As far as e-prescribing, or electronic prescriptions, general healthcare providers rarely utilize this cutting edge IT feature. Even fewer psychiatrists are believed to provide prescriptions by way of electronics. The Drug Enforcement Administration does not endorse e-prescribing of controlled substances, and this is another barrier to the usage of e-prescribing as noted by behavioral healthcare providers. These, of course, include Schedule II-IV drugs for which Chuck Klein, PhD and Netsmart’s Director of Clinical Services relates, “In behavioral health, this is a big issue. A lot of stimulants used with children are Schedule II.”

Another concern of EHR in behavioral health has to do with defining children’s healthcare standards within IT. Health Level Seven (HL7), an IT standards development organization, recently passed such standards. Safe and effective care of children is paramount the utmost importance, according to Andrew Spooner, MD, Cincinnati Children’s Medical Center and co-chairman of the HL7 Group. HL7 is also a main resource for the Certification Commission for Healthcare Information Technology.

"As vendors develop EHR systems for the care of children,” said Dr. Spooner, “they will want to conform to the Child Health Functional Profile, found under http://xreg2.nist.gov, in order to better equip clinicians in any setting to care for children."

HL7’s standard of care for children was approved by the American National Standards Institute, and HL7 will continue to identify child health certification criteria within EHR systems.

One of the many considerations in the successful transition from paper to ER for the behavioral health setting is maintaining confidentiality under all circumstances. The nature of behavioral health is especially sensitive, and most patients naturally want all of their information to remain completely confidential. Trust is essential in developing the behavioral specialist’s relationship with the patient, and the patient’s progress is largely dependent on that bond. A Harris Interactive poll in March found that 17 percent of patients withheld information from their health care professionals because of worries the information might be disclosed.

“These rates are likely to be even greater if information exchange is electronically enabled,” said Zebulon Taintor, M.D., vice chair of the Department of Psychiatry at New York University. IT may have a ways to go so that all EHR formats and usage are conducive to the essential level of trust needed between the patient and the caregiver.

Still another concern about EHRs in behavioral health was voiced recently by Linda Rosenberg, M.S.W., President and CEO for The National Council for Community Behavioral Healthcare. She said, “Note that the current federal definitions of behavioral health providers are not as inclusive as we would like and we are committed to improving and expanding existing definitions.”

Despite these barriers to EHR integration, some strides are being made. According to a recent report from the Substance Abuse and Mental Health Services Administration (SAMHSA), 46 states are currently incorporating or preparing to incorporate EHRs in state psychiatric hospitals, and are planning to integrate their use in the community mental health sector.

Other good news for behavioral healthcare and EHR was noted by Don Hevey, CEO of the Mental Health Corporations of America. He said, "Information technology is a dynamic and evolving force in behavioral health and human services. If we can break down funding barriers, more providers will be able to realize the benefits of full system acquisition and implementation, and the impact of information technology on the efficiency and effectiveness of service delivery will increase significantly."

Arguably, the government incentives, which will provide funding to Medicare and Medicaid providers under the ARRA in order to increase IT capabilities, have shed a more positive light on the EHR emergence within the behavioral health arena. For some, however, funding isn’t the driving force behind EHR implementation.

Some, if not most, behavioral healthcare providers acknowledge the advantages of a fully-integrated EHR system. Fewer medical errors are anticipated and immediate medical information during emergencies and return appointments will not only be cost effective, but it will help ensure a delivery of care where there is much less of a delay when treating patients. During emergencies or non-emergent situations, time is of the essence, and the potential for much more effective and efficient patient care is one of the greatest advantages of EHRs by behavioral healthcare providers.

In order for EHRs to meet the goal for substance abuse and mental health treatment, behavioral health information must coincide with the entire IT system. Today, EHRs are based on a primary care or medical model, and experts in the behavioral health field say there must be a unique set of standards for a national EHR system that accommodates the behavioral branch of health care.

Dr. Kevin Hennessy, SAMHSA’s Science to Service Coordinator, concurs. “Developing a consensus around standards in health information technology for behavioral health will influence the design of the overall national system. And that requires various segments of the field speaking with one voice to the larger community of experts working on system design."

SAMSHA has implemented the Behavioral Health Treatment Standards Work Group, which provides a forum to discuss how mental health and substance abuse fits into the national health information system.]]> http://hitconsultant.blogspot.com/2010/01/state-of-ehr-and-behavioral-health.html Tue, 05 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1103 Practice
THE CRUCIAL FIRST CALL

When patients make that all-important first call, your scheduler should be prepared to explain what is special about the practice. Susan Keane Baker, a practice management expert in New Canaan, Connecticut, and author of Managing Patient Expectations: The Art of Finding and Keeping Loyal Patients, recommends that schedulers use the phrase "which means that" to illustrate how various features of your practice benefit patients. A few examples:

• "We have office hours on Saturday mornings and Tuesday evenings, which means that you don't have to take time off from work to keep your appointment."
• "We have free parking behind our building, which means that you don't have to bother looking for parking or feeding a meter."
• "We have a lab in our office, which means that you won't have to make a separate appointment and drive somewhere else for your blood work and urinalysis."

Beyond "which means that," it's important for staffers to anticipate questions and respond appropriately. And whether or not patients ask, they need to know up front what payment methods are accepted and whether copayments are collected prior to or after a visit. "In many smaller practices, appointments are usually made by front-desk folks who are involved in 20 other tasks, which often prevent them from giving first-time patients the information they need," says Kenneth T. Hertz, a principal with the Medical Group Management Association Health Care Consulting Group.

In addition to being advised what to bring, first-time patients should be informed why various items are necessary, says Hertz, who is based in Alexandria, Louisiana. "Many people get annoyed when the appointment clerk asks 'What insurance do you have?' Patients need to understand that a practice asks this question so that it can verify benefits and coverage prior to the patient's visit, thus sparing the patient—and the practice—aggravation down the road."

Hertz and Baker recommend providing new patients with a checklist of items they should bring along. In addition to their insurance card, the list might include:

• Photo ID
• Prescription and non-prescription medicines the person is taking
• List of questions for the doctor
• Referral authorization (if needed).

Put the checklist on a "new patients" section of your website, along with a patient history form, a document authorizing the practice to obtain prior medical records, and other forms that the patients can download and fill out prior to the appointment. A good website will also contain directions to the practice and a photo of the building, so that patients are less likely to drive past.

Ask your appointment clerk to provide the practice's web address and specific instructions on how to find and download needed forms. If you don't have a website or the new patient doesn't have access to the internet, mail the forms in advance or instruct the patient to arrive a few minutes before her scheduled appointment to take care of paperwork.

THE WAITING ROOM AND BEYOND

A comfortable, inviting, well-lit waiting room pleases all patients, but it's especially important for making that all-important initial impression on new patients. Baker quotes a Polish proverb: "A guest sees more in an hour than the host sees in a year." Accordingly, Baker advises dusting and polishing areas that are frequently neglected: The reception desk countertop, windowsills, knobs on the waiting room TV set, and telephones that patients have access to.

Ken Hertz's cardinal rule: No dead plants. He also stresses the need to keep artificial plants clean, make sure the paint on the walls is fresh and fingerprint-free, and that the walls feature artwork that is easy on the eyes. Instead of signs regarding billing and insurance issues, use signs that help patients feel a bit more cared for. Some possibilities: "Did we remember to validate your parking?" and "Please buckle your seatbelt. We want to see you again."

The consultants recommend individual seating rather than couches—and especially not benches, which might give your waiting room the look and feel of a bus station. Arrange comfortable, sturdy chairs—preferably with arms, for the benefit of frail patients—in small groups and at right angles to each other. In addition, it's thoughtful to include a few "size-friendly" chairs for larger patients; these are chairs that look like the others in your office, but are several inches wider.

Have plenty of reading material on hand, and strive to keep it current. An inexpensive way to do this is to subscribe to a daily newspaper or two. Or you can follow Baker's suggestion and institute a "Bring a magazine, take a magazine" policy, where you encourage patients to help themselves to magazines that interest them and replace them with other periodicals.

Practice information brochures, on your website and in your waiting room, increase new patients' comfort level, especially if the brochure includes brief biographies of the physicians and other members of the practice. Information brochures—as long as they're to the point and kept up to date—can be great marketing tools because they're often picked up by people who accompany patients to visits.

HELPING NEW PATIENTS FEEL AT HOME

Ask new patients to arrive about 15 minutes early for a brief orientation session and to finish filling out paperwork, if necessary. This is a good time to tell them more about the practice and to answer questions. "We develop a sense of belonging when we know how things work," says Baker. "An introductory meeting helps get patients' anxieties out of the way and enables them to focus on the medical aspects of the visit."

Begin the orientation with a friendly greeting. Baker's suggested wording: "Hello, Mrs. Daily. I'm Jean Jones, Dr. Smith's practice manager. We spoke on the phone last week. It's so nice to meet you. Dr. Smith will be with you in about 15 minutes. Meanwhile, I'd like to spend a few minutes talking with you about our practice and answering your questions." This is a good time for patients to learn about the practice's prescription-renewal policy, whether certain problems are typically handled by a physician's assistant or nurse practitioner instead of the physician, where the restrooms are located, and so forth.

If your schedule permits, take some extra time with new patients. A surefire new-patient pleaser, Baker says, is the question "What's most important to you in your relationship with a new physician?" If, say, the response is "My former primary care physician allowed me to e-mail him whenever I had a question," you can respond by giving the patient a card with your e-mail address on it or explaining why you prefer not to communicate with patients via e-mail. (One possible response: "I understand why you like having e-mail access to your physician. But I prefer to speak with patients on the telephone so I can answer several questions at once and we don't have to wait for several e-mails to go back and forth.")

As the visit ends, sow the seeds for an ongoing physician-patient relationship by inviting the patient to call whenever she needs you. Then send a follow-up letter (see box at right for a sample letter) thanking the patient for selecting your practice and provide a mechanism for feedback.]]> http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Rolling-out-the-red-carpet/ArticleStandard/Article/detail/598231 Tue, 05 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1104 Practice
“Informed consent is already mandatory for all health care professionals in Connecticut and the chiropractic profession fully supports a patient’s right to be informed of the benefits and risks of any type of health care treatment – not just chiropractic treatment,” said ACA Vice President Dr. Keith Overland, who practices in Norwalk, Conn. “Legislation or regulations governing informed consent should apply to all health care providers in equal measure.”

“Limiting new informed consent regulations to one treatment or one health care professional is not in a patient’s best interest and would leave patients with less information, not more,” Dr. Overland added. In respect to informed consent, it is ACA’s position that there is no substitute for a confidential, in-person discussion between a doctor and a patient. Each patient has his/her own individual questions and circumstances that deserve individual attention.

“A regulation or a signature on a consent form is not a satisfactory substitute for individual attention and discussion,” said Dr. Overland.

The American Chiropractic Association, the International Chiropractors Association, the Connecticut Chiropractic Association, the Connecticut Chiropractic Council and other chiropractic organizations have policies that support informed consent for chiropractic treatments; chiropractic colleges teach informed consent to their students; and doctors of chiropractic are expected to inform patients of the material benefits, risks and options for contemplated treatment and document this in writing.]]> http://www.acatoday.org/press_css.cfm?CID=3731 Wed, 06 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1105 Telehealth
The magazine bases that conclusion in part on a recent report from Accenture that says consumer health electronics, predictive modeling and low-cost Internet connectivity to enable better decision making will transform chronic disease care. The story also quotes an Ingenix Consulting executive, who believes EHRs will drive growth in wireless monitoring technologies.

"One big benefit of EHRs is the e-visit," says Ingenix Consulting Managing Director Larry Leisure. "Imagine a patient and doctor having an email conversation with bio-monitoring equipment transmitting data. They can have a conversation with shared information available to both. It enables patients and physicians to have a different relationship. Think about the cost avoidance in that."

Here at FierceMobileHealthcare, we believe EHRs won't start to show their full potential to improve the quality and efficiency of care until medical devices can automatically populate patient records and trigger clinical decision support. We take issue with Computerworld's characterization of Google Health and Microsoft HealthVault as "online EHRs," though.

For more information:

• Have a look at this Computerworld story • Download the Accenture report on chronic care (.pdf)]]> http://www.fiercemobilehealthcare.com/story/telehealth-poised-growth-ehr-integration-2010/2010-01-05 Wed, 06 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1106 Technology http://www.fiercehealthcare.com/story/spotlight-iphone-app-tracks-high-acuity-cases-harried-docs/2010-01-05 Wed, 06 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1107 EHR
]]> http://www.ehrtv.com/rebecca-wiedmeyer/ Wed, 06 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1108 Medicare http://www.kaiserhealthnews.org/Daily-Reports/2010/January/06/CMS-Satisfaction-Survey.aspx Wed, 06 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1109 Technology
GDoc Creator gives you a great deal of control over your PDF conversion. You can create a single PDF for the entire document or one for each page; you can crop documents and convert the cropped area; you can add a watermark to the PDF; and plenty more.

If you use Office 2007, Microsoft makes available a free download that can convert Office files to PDFs, but gDoc Creator offers more options for conversion than does the Microsoft add-in. Microsoft's add-in creates the PDFs slightly faster, though. If you don't care about options such as creating individual PDFs for each page of a document, you'll be fine with the Microsoft add-in. But if you want more options, gDoc Creator is a better choice. And if you use Office 2003, you'll want gDoc Creator in any case, because Microsoft doesn't have a free PDF converter for that version of Office.

Note that the software also downloads a trial version of gDoc Fusion, which has more powerful capabilities than gDoc Creator. With gDoc Fusion you can create one PDF for each page instead of a single PDF for the entire document; you can crop documents and convert the cropped area; you can add a watermark to the PDF. Also, the first time you use gDoc Creator, you will have to fill in your name and e-mail address to send to the developer, although you will not have to pay for it.]]> http://www.computerworld.com/s/article/9143159/PDF_Converter_GDoc_Creator Wed, 06 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1110 Technology
David Warden, owner of information technology consulting firm Elite Circle Computing in Mechanicsburg, Pa., and a Multiple Sclerosis patient, co-developed the application, called i-Inject. It enables patients to track their rotation of injection sites, set medication reminders, run reports on their medication inventories and use, and e-mail their physicians.

The application is available for $14.99. More information is available at i-inject.com.]]> http://www.healthdatamanagement.com/news/mobile_multiple_sclerosis_ipod_iphone-39618-1.html Thu, 07 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1111 EHR
Last Wednesday the Centers for Medicare and Medicaid Services (CMS) announced the definition of meaningful use of electronic health records (EHR) technology and criteria for achieving it, while the Office of the National Coordinator for Health Information Technology (ONC) proposed an interim final rule, which indicates the technological standards required. If passed, the guidelines will unlock incentive payments set aside in President Obama's Health Information Technology for Economic and Clinical Health (HITECH) program, part of the American Recovery and Reinvestment Act of 2009.

The CMS proposed rule defines a meaningful EHR user as "an eligible professional or eligible hospital that, during the specified reporting period, demonstrates meaningful use of certified EHR technology in a form and manner consistent with certain objectives and measures presented in the regulation," and meaningful use as the employment of certified EHR technology that "improves quality, safety, and efficiency of health care delivery, reduces health care disparities, engages patients and families, improves care coordination, improves population and public health, and ensures adequate privacy and security protections for personal health information."

HIMSS president and CEO H. Stephen Lieber issued a statement Monday that called for further analysis and public comment.

"On first read of the proposed regulations, HIMSS believes that there is much more to applaud than criticize," remarked Lieber in the statement. "We now have clarity of what technology functions constitute a qualified electronic health record; we now have a multi-year road map of future expectations; and we have certainty about many of the standards necessary to support practitioners' ability to improve patient care."

Lieber indicated that the guidelines did not stipulate a "single standard" and instead supported a free-market approach to EHR technology, which may prove problematic in meeting the objectives set by CMS and the ONC.

"Such restraint will have ramifications for health care, as will the necessary establishment of initial provider performance requirements that will ultimately drive quality improvements," noted Lieber. "We have much work to do within health care regarding simple adoption, well before we can achieve meaningful use of the IT. This foundational work -- while required -- will likely result in provider uncertainty about which IT products to adopt, costs through adoption of ever-maturing IT over time, higher costs associated with a need to support multiple standards, and somewhat delayed improvements in patient outcomes and costs."

The guidelines and interim final rule are now in a 60-day comment period. Final rules are expected to be announced sometime this year.]]> http://www.dotmed.com/news/story/11196 Thu, 07 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1112 EHR
The Ann Arbor, Mich.-based association supports the phased approach under which first-year meaningful use criteria will apply to hospitals whenever they are eligible to receive Medicare incentives. "However, the current schedule places pressure on hospitals that delay in implementing electronic health records, because by 2015, all hospitals and eligible providers would need to meet Stage 3 criteria to avoid payment penalties," according to a CHIME statement.

Providers need adequate time to understand the impact of new clinical systems and implement them, says David Muntz, senior vice president and CIO at Baylor Health Care System in Dallas. "My primary concern is the time and effort required to achieve successful organizational change management."

Other concerns of CHIME include:

• As a whole, proposed reporting requirements will be burdensome as many measures will require gathering information that spans electronic and paper-based systems;
• Hospitals will need to develop substantial new reporting capabilities as only nine of 35 proposed quality measures currently are used in the Medicare pay-for-reporting program;
• The regulations indicate that physician practices that qualify for stimulus funding no longer will be eligible for the 2% bonus under Medicare's Physician Quality Reporting Initiative; and
• Hospital-based physicians are not eligible under the proposals to receive stimulus payments. "That creates a disincentive for healthcare systems and teaching programs from investing in ambulatory records systems for these physician groups," according to CHIME.

The organization's initial analysis is available at http://cio-chime.org/chime/pressreleases/pr1_7_2010_9_02_01.asp.]]> http://www.healthdatamanagement.com/news/stimulus_meaningful_use_certification_EHR-39622-1.html Thu, 07 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1113 Healthcare www.hschange.org/CONTENT/1101/).

The study, funded by the Robert Wood Johnson Foundation and released Dec. 16, 2009, analyzed data gathered from more than 4,700 physicians in the center's 2008 Health Tracking Physician Survey. The nationally representative mail survey polled doctors, who provide at least 20 hours per week of direct patient care, on the types of management tools used by their practices.

Physicians were asked if their practices use: written materials for patient education; nurse managers to coordinate care; nonphysician educators; group visits; reports for physicians on the quality of preventive care; reports for physicians on the quality of overall care for patients with chronic conditions; and patient registries.

Overall, 47% of physicians said their practices used two or fewer of the care management tools, while only 4% used six or all seven of the resources.

Most practices, 75%, reported using written materials. However, this may reflect expediency rather than effectiveness, said a co-author of the study, Emily Carrier, MD, senior health researcher for the center, a nonpartisan policy research organization.

"If you're a busy physician, giving an educational pamphlet to your patient is quick and easy. But most researchers think it's less powerful than other, more demanding interventions [which] we found were used much less often," Dr. Carrier said.

Less frequently used were group visits (20%) and nurse managers (31%).

The study highlighted a correlation between practice size and care management tools, with physicians in solo and smaller group practices less likely to use them. The study noted that small practices likely didn't have the financial resources, although insurers and others are beginning to pay for some of these services under a medical-home model.

"Some care management tools are expensive to implement and only make financial sense in larger practices where economies of scale exist," the report stated. "Offering individual practices modest per-patient incentives to adopt care management tools does not address the problem that many of these practices are simply too small to support additional staff or other resources on an ongoing basis."]]> http://www.ama-assn.org/amednews/2010/01/04/prsc0107.htm Thu, 07 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1114 Health Information Exchange
As the name suggests, Mirth MUx is intended to help healthcare providers with the data-exchange requirements of the federal regulations for meaningful use of EMRs. The open-source system facilitates secure exchange of clinical information over the Internet, following standards such as HL7, DICOM, ANSI X12 and the Continuity of Care Document. "[It] eliminates the cost and inefficiency of one-off, point-to-point connections by releasing a standard NHIN-enabled gateway configuration," Redwood MedNet Project Manager Will Ross says in a statement from Mirth.]]> http://www.fierceemr.com/story/n-calif-hie-deploys-open-source-interoperability-software/2010-01-07 Thu, 07 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1114A Healthcare set of 70 measures this week that guide the standardization of electronic data for quality improvement. The measures combine data from two or more electronic sources, such as administrative claims or pharmacy systems.

The measures also cover 16 conditions, including bone and joint conditions, cardiovascular disease, asthma and respiratory illness, and diabetes.

The steering committee on clinically enriched administrative data sources at the NQF created three levels by which to rate measures concerning electronic data, where the data are from, and their complexity.

• Level one includes data from one electronic administrative data source, such as claims data. This is the type of data that many quality improvement projects currently rely on.

• Level two measures rely on merged data from multiple electronic administrative data sources.

• Level three data will use electronic data that have been enriched with clinical data, for example a lab result.

After reviewing more than 200 measures, the steering committee selected 70. Of that number, 55 measures are considered level two, and 15 are considered level three. The committee did not select any level one measures.

The set of 70 measures synchronizes many measures that health plans are already using and the NQF anticipates that using this standard set will making improving the quality of care easier and more efficient. Although there are fewer level three measures at this point, as the use of electronic medical records become more common, the NQF hopes to add more to this category.

8-page pdf list of endorsed measures is available here.]]> http://www.healthleadersmedia.com/content/TEC-244574/National-Quality-Forum-Endorses-Electronic-Data-Measures-for-Quality-Improvement.html Thu, 07 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1115 Technology http://www.healthleadersmedia.com/content/PHY-244572/Twitter-advice-for-doctors.html Thu, 07 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1116 Healthcare
The American Academy of Family Physicians, American College of Obstetricians and Gynecologists, and American College of Physicians have also approved this adult immunization schedule for 2010.

"The...ACIP annually reviews the Recommended Adult Immunization Schedule to ensure that the schedule reflects current recommendations for the licensed vaccines," write Carol Friedman, DO, from the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention in Atlanta, Georgia, and colleagues. "In October 2009, ACIP approved the Adult Immunization Schedule for 2010, which includes several changes. A bivalent human papillomavirus vaccine (HPV2) was licensed for use in females in October 2009."

Changes in the 2010 schedule from the previous schedule include the following:

• Revision to the HPV footnote now states that HPV2 has been licensed for use in women. For women aged 19 through 26 years, either HPV2 or quadrivalent (HPV4) can be used for vaccination. ACIP has also used a permissive recommendation for use of HPV4 in men.

• Revision to the measles, mumps, rubella (MMR) footnote now notes in the beginning of the footnote that adults born before 1957 generally are immune. Further revisions clarify which adults born during or after 1957 do not need 1 or more doses of MMR for the measles and mumps components.

• New interval dosing information states that a second dose of MMR should be given 4 weeks after the first dose. Another revision to this footnote highlights that women in whom rubella vaccination is not documented should receive a dose of MMR. A new section added to this footnote provides guidelines for vaccinating healthcare personnel born before 1957 routinely and during outbreaks.

• Revision to the influenza footnote has added the term seasonal to differentiate seasonal from pandemic influenza.

• Revision to the hepatitis A footnote now includes an indication for administering this vaccine to unvaccinated persons who expect to be in close contact with an international adoptee.

• Revision to the hepatitis B footnote now includes schedule information for the 3-dose hepatitis B vaccine.

• Revision to the meningococcal vaccine footnote explains that the meningococcal conjugate vaccine is preferred for adults not older than 55 years and that the meningococcal polysaccharide vaccine is preferred for adults who are at least 56 years or older. For adults previously vaccinated with meningococcal conjugate vaccine or meningococcal polysaccharide vaccine, revaccination with meningococcal conjugate vaccine is recommended. The revised footnote also offers a new example of who is at increased risk, and additional information explains who does not need to be revaccinated.

• Revision to the selected conditions portion of the H influenzae type B footnote now elucidates which high-risk persons can receive 1 dose of H influenzae type B vaccine.

In an accompanying editorial, Robert H. Hopkins Jr, MD, and Keyur S. Vyas, MD, from the University of Arkansas for Medical Sciences in Little Rock, note that changes in each year's schedule are driven by advances in knowledge of vaccines and vaccine-preventable disease. They discuss changes in recommendations for HPV, influenza, MMR, hepatitis A, meningococcal disease, and H influenzae type B.

Drs. Hopkins and Vyas also offer possible strategies to improve vaccine administration rates, which are currently measured as evidence-based quality indicators. These include mandatory vaccination; standing orders for vaccination for persons meeting specific criteria; electronic medical record reminders; and provision of vaccination rate feedback to individual providers, with or without associated incentives.

"Vaccines have been demonstrated to be among the most effective strategies for preventing illness in individuals as well as for protecting the health of the public," Drs. Hopkins and Vyas write. "Unfortunately, deaths from vaccine-preventable illnesses still occur in the United States....The importance of immunization cannot be overemphasized; it should be imparted directly to our patients, as well as to students and residents early in their training, as an essential component of the comprehensive care of adults in ambulatory and inpatient settings."

Study Highlights

• HPV2 was recently licensed for use in women aged 19 through 26 years to reduce the risk for cervical cancer in young women.

• This vaccine is now an option for use and protects against the 2 strains of HPV associated with more than 70% of cervical cancer, but it does not contain the 2 strains that account for genital warts.

• The ACIP recommends the use of either this HPV2 vaccine or the HPV4 vaccine in young women to reduce the risk for cervical cancer.

• The ACIP also gave a permissive recommendation for the use of HPV4 vaccine to reduce the risk for genital warts in men, but questions remain about the cost-effectiveness of vaccination in men.

• The influenza vaccination recommendations are now noted as seasonal influenza recommendations to distinguish them from pandemic influenza vaccines such as the 2009 H1N1 or other vaccines.

• At-risk groups including adults exposed to measles and mumps in an outbreak, healthcare workers, students in postsecondary education institutions, and international travelers should receive 2 doses of the MMR vaccine.

• The interval between the 2 doses is 4 weeks for measles and mumps.

• Healthcare facilities should consider MMR vaccination for unvaccinated workers born before 1957 who do not have laboratory evidence of immunity.

• Women who do not have documentation of rubella vaccination should receive a dose of MMR.

• Hepatitis A vaccination is recommended for unvaccinated persons who will be providing day or home care for international adoptees.

• This is because more than 99% of international adoptees are from countries with endemicity of hepatitis A infection, and adoptees younger than 5 years are likely to be asymptomatic.

• Meningococcal conjugate vaccine is preferred for adults 55 years and younger with indications.

• The meningococcal polysaccharide vaccine is recommended for adults 56 years and older with an indicated condition.

• The hepatitis B vaccine footnote now includes information for the 3-dose hepatitis B vaccine.

• There is now no recommendation for the H influenzae type B vaccine in persons older than 5 years.

• 1 dose of the H influenzae type B vaccine is not contraindicated, but neither is it routinely recommended for unvaccinated persons with sickle cell disease, leukemia, HIV disease, or splenectomy who have not been previously vaccinated.]]> http://cme.medscape.com/viewarticle/714650 Fri, 08 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1117 Healthcare
There are 3 revised schedules describing current guidelines for use of US Food and Drug Administration (FDA)–licensed vaccines: one for children from birth through age 6 years, one for children and adolescents aged 7 through 18 years, and a catch-up immunization schedule for children and adolescents who start late or fall behind with scheduled vaccinations.

Noteworthy changes in the 2010 schedule are a new recommendation for influenza A (H1N1) 2009 monovalent vaccine, a recommendation to revaccinate children who remain at increased risk for meningococcal disease with meningococcal conjugate vaccine (MCV4), recommendations on combination vaccines, and recommendations for the recently licensed bivalent human papillomavirus (HPV) vaccine in girls and the quadrivalent HPV vaccine in boys.

Specific changes from last year's recommendations for vaccination with FDA-approved vaccines include the following:

• A footnote refers to ACIP recommendations regarding use of influenza A (H1N1) 2009 monovalent vaccine.

• Only children 6 months or older should receive trivalent inactivated influenza vaccine (TIV), and only those 2 years or older should receive the live attenuated influenza vaccine (LAIV). Healthy children aged 2 to 6 years may receive either TIV or LAIV. However, children aged 2 to 4 years who have a history of wheezing in the preceding 12 months should not receive LAIV.

• The dose of TIV is 0.25 mL for children aged 6 to 35 months and 0.5 mL for those at least 3 years old. For children younger than 9 years given the influenza vaccine for the first time, 2 doses should be given 4 weeks apart. Children who received a single dose of influenza vaccine the previous season should be given 2 doses, separated by 4 weeks or more.

• Children who remain at increased risk for meningococcal disease because of persistent complement deficiency, asplenia, or other conditions should be revaccinated with MCV4. Children who received the initial MCV4 dose at ages 2 through 6 years should receive a dose of MCV4 after 3 years. If the first dose was given at age 7 years or older, children should be revaccinated after 5 years. These children should then be revaccinated with MCV4 every 5 years.

• Children not previously vaccinated with MCV4 should be given this vaccine at age 11 or 12 years or between ages 13 and 18 years. College freshmen living in a dormitory who have not previously received MCV4 should be given this vaccine.

• Combination vaccines are usually preferred to separate injections of the equivalent component vaccines. Updated recommendations regarding the inactivated poliovirus vaccine series are that the final dose should be given on or after the fourth birthday and at least 6 months after the previous dose. Children receiving 4 doses before age 4 years should receive an additional (fifth) dose at ages 4 through 6 years.

• Updated recommendations describe use of the recently licensed bivalent HPV vaccine in girls and the quadrivalent HPV vaccine in boys. Girls not previously vaccinated against HPV should receive the bivalent HPV series at ages 13 through 18 years. For catch-up, the second and third HPV dose should be given at 1 to 2 months and at 6 months after the first dose. The minimal interval for vaccination is 4 weeks between the first and second doses, 12 weeks between the second and third doses, and 24 weeks or more between the first dose and third dose.

• Revisions to most of the footnotes for the individual vaccines offer additional information and explain recommendations provided in the schedules.

• The guidelines note that clinically significant adverse events after vaccination should be reported to the Vaccine Adverse Event Reporting System or at 1-800-822-7967 1-800-822-7967. Details of ACIP recommendations for individual vaccines, including recommendations for children with high-risk conditions, are available on the Centers for Disease Control and Prevetion's Web site.

Study Highlights

• Updated immunization recommendations for ages 0 to 6 years include the following:
◦ Revaccination with MCV4 is recommended for children who remain at increased risk for meningococcal disease.
◦ A dose should be administered after 3 years for those who received the vaccine at ages 2 to 6 years and after 5 years for those who received it at age 7 years or older.
◦ Additional MCV4 doses are then given every 5 years.
◦ Combination vaccines are preferred to separate injections of single vaccines.
◦ The final dose of the inactivated poliovirus vaccine series should be administered on or after the fourth birthday and at least 6 months after the previous dose.
◦ An additional fifth dose should be administered at ages 4 through 6 years.
◦ The minimal age for administration of the TIV is 6 months; for the LAIV, the minimal age for administration is 2 years.
◦ In healthy children aged 2 to 6 years, either vaccine may be used.
◦ LAIV should not be given to children aged 2 to 4 years with a history of wheezing in the previous 12 months.
◦ Children receiving TIV should receive 0.25 mL if aged 6 to 35 months and 0.5 mL if 3 years or older.
◦ Children younger than 9 years who receive the influenza vaccine for the first time should receive 2 doses separated by 4 weeks.
◦ Children vaccinated with only 1 dose of influenza vaccine the previous season should also receive 2 doses at least 4 weeks apart.
◦ Recommendations for use of the monovalent influenza vaccine are available separately as a footnote.

• New recommendations for ages 7 to 18 years include the following: ◦ The MCV4 should be administered at age 11 or 12 years or between the ages of 13 and 18 years if not previously administered.
◦ The MCV4 should be administered to college freshmen living in a dormitory who have not received the vaccine.
◦ The MCV4 should be administered to children aged 2 to 10 years with persistent complement deficiency, asplenia, or conditions placing them at high risk for meningococcal meningitis.
◦ An additional dose of MCV4 should be administered to children at increased risk after 3 years (eg, if first administered at ages 2 - 6 years) or after 5 years (if first dose was administered at 7 years or older).
◦ Children younger than 9 years who receive the influenza vaccine for the first time should receive 2 doses separated by 4 weeks.
◦ Children vaccinated with only 1 dose of influenza vaccine the previous season should also receive 2 doses at least 4 weeks apart.
◦ Recommendations for use of the monovalent influenza vaccine are available separately as a footnote.

• Catch-up immunization for ages 4 months to 18 years include the following:
◦ Recommendations for the MCV4 vaccine are as given above.
◦ The bivalent HPV series should be administered to girls at age 13 through 18 years if not previously administered.
◦ For catch-up, the second and third dose of HPV vaccine should be administered at 1 to 2 months and 6 months after the first dose.
◦ The minimal interval between the first and second doses of HPV vaccine is 4 weeks.
◦ The minimal interval between the second and third doses of HPV vaccine is 12 weeks.
◦ The third dose of HPV vaccine should be administered at least 24 weeks after the first dose.]]> http://cme.medscape.com/viewarticle/714531 Fri, 08 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1118 Legislation EHR
Last week, the federal government released proposed rules describing how health care providers can demonstrate meaningful use of certified EHRs to qualify for incentive payments under the 2009 economic stimulus package.

CCHIT Certification: A Good First Step?

In a recent report, research firm KLAS found a great deal of variation in gaps between current EHR functionality and the recently proposed meaningful use rules.

The firm noted that EHR vendors with up-to-date CCHIT certifications were the closest to meeting the meaningful use requirements.

KLAS also found that most vendors fell short of the meaningful use criteria in areas that CCHIT certification does not emphasize, such as health data exchange and in-depth reporting.

Questions Remain

Despite its apparent similarities with meaningful use requirements, CCHIT certification is not a guarantee that an EHR system will enable users to qualify for incentive payments, according to federal officials.

Following the release of the proposed meaningful use rules, National Coordinator for Health IT David Blumenthal said it would be "premature to talk about the implications of any particular set of certification criteria that CCHIT or anybody else has put forward or will put forward".

The Office of the National Coordinator for Health IT is scheduled to release additional guidance on the EHR certification process later this year.]]> http://www.ihealthbeat.org/articles/2010/1/8/cchit-offers-promise-but-no-guarantee-of-meaningful-use.aspx Mon, 11 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1119 Technology
A few of the reasons why machines may have fallen victim to infection include late operating system patching, hardware patching conflicts and the use of removable media (such as removable thumb drives or flash drives), which could contain worms or other malicious software intended to do damage to computer systems, often called "malware."

One U.S.-based hospital made national news during the Conficker outbreak when a machine in its care rebooted itself mid-surgery. Citing patient welfare, the hospital disabled all automatic updates on more than 8,000 machines. Although this may have proven to be an immediate solution to the problem, it left the hospital's entire network vulnerable to malicious exploit.

The point is, medical practices and other healthcare organizations today juggle a vast array of vendor products, services and equipment, making it imperative to understand how each piece works alone, as well as how they all work together. While IT administrators have historically been tasked with such concerns, everyone now must take new Department of Health and Human Services (HHS) and Federal Trade Commission (FTC) policies into consideration.

A safer network

Research has shown that IT security is considerably underfunded within the healthcare industry, yet many new security regulations are now required. For that reason, everyone is looking for cost-effective network security solutions that are reliable and secure.

Placing controls in a practice is becoming increasingly important, not only because of the latest federal enactments, but because the variety of malware—spyware, adware, viruses, trojans, worms and phishing schemes—is on the rise. Today, innovative techniques are attempted on virtually every site on the Internet.

Office staff might not recognize the scams and click what appears to be a harmless link, e-mail or Web site. Clicking the link can infect their machines and possibly harm the entire organization. The effects can be costly.

The good news is that security itself doesn't need to be expensive. As any good doctor would say, "prevention is always the best medicine." And cheaper, too. A practice can maintain sound security by developing—and following—a comprehensive set of policies and using appropriate solutions when possible.

Education is key to security

One key aspect to every network's security is education. To use a popular cliché: A network is only as strong as its weakest link. It is of utmost important that each person on the network understand best practices and current threats.

A good security training program should be tailored to meet the specific needs of an organization as a whole, while also providing a focus on the management team, administration, technical staff and other work groups. Training programs should cover the overall importance of security, policies and procedures, the responsibilities of people within the organization, usage policies, account and password selection criteria, as well as social engineering prevention.

Continuing the education program is also important as it helps update employees on the latest issues and threats. Several vehicles may be used to keep employees informed, including e-mail updates, e-newsletters or internal Web sites.

According to Clyde Williams, infrastructure systems manager of Southeast Alabama Medical Center, stopping spam, viruses and other "Internet pollution" from impacting e-mail operations is crucial to any organization's productivity.

Once internal security policies are in place, organizations could consider alternative, cloud-based IT security solutions to help alleviate costs associated with on-premise hardware. Today, a growing number of companies are turning to hosted solutions as an alternative to managing applications on their own servers within their own environment. Aside from being a cost-effective solution, many organizations find that software-as-a-service (SaaS) provides a viable solution.]]> http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Malware-can-infect-a-medical-practice-weaken-its-s/ArticleStandard/Article/detail/650667 Mon, 11 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1120 HIPAA
Physicians make widespread use of laptops, home-computer links, smart phones, smart cards, USB flash drives and PDAs. E-prescribing systems link physicians and others directly to pharmacies. A contemporary physician's Blackberry typically contains far more patient information than the locked filing cabinets of previous years.

Unfortunately, all of this health care data—ranging from medical diagnosis and treatment codes, to names, addresses, birthdates, social security numbers, bank and credit card accounts—has enormous value to identity thieves who exploit open networks and Wi-Fi systems.

Within the context of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 all "covered entities" that collect private health information must comply with specific administrative, technical and physical security standards and procedures for "electronic protected health information."

Most health care entities are familiar with the federal HIPAA privacy rules. They constitute an extensive and detailed attempt by the federal government to protect the privacy of personal medical information in electronic form. The rules seek a pragmatic balance between the need to protect personal health information and the growing need to disclose personal health information for treatment, payment, public health, research, and other socially beneficial purposes. It is important, however, to also note that HIPAA is a "floor" and does not pre-empt a growing patchwork of currently existing state confidentiality and notification requirements.

Under certain circumstances, health care entities may now be responsible for third-party mishandling of sensitive information. These third-party data breaches currently account for nearly half of medical-related data breaches.

Starting in February, HIPAA amendments within the Health Information Technology for Economic and Clinical Health Act (HITECH) mandate that all "business associates" of caregivers must also come into compliance with the same administrative, technical and physical security standards protecting electronic protected health information within covered health care entities. Also, for the first time, third-party business associates risk the same civil and criminal penalties for privacy violations as faced previously by covered entities alone.

Another regulatory change to affect health care facilities are mandatory consumer "red flags," data-alert requirements established under the federal Fair and Accurate Credit Transactions Act (FACTA). The federal Red Flags Rule, to be enforced starting in June, requires certain health care providers to develop written programs to spot warning signs of suspicious requests for consumer data. (See related article.)

There are no specific mandates under the new regulation, but suggested guidelines include account monitoring, automatic password changes, account access limitations, providing free commercial credit monitoring services, or closing and reopening affected accounts. Ensuring the integrity of online data requires an effective combination of administrative, physical, and technical safeguards. Security policies (and infrastructure) should be based upon highest anticipated risk.

In order to meet these and other legal obligations, health care providers should closely examine current infrastructure risks and, unfortunately, plan also for worst-case scenarios.

In the event of a major data compromise, who will bear the costs of system restoration? What about negative publicity and lawsuits? What constitutes due diligence before and after a data-compromise? What steps should management take post-breach to retain goodwill while minimizing legal liability? Before seeking answers to these questions, it is useful to examine current infrastructure risks and understand, at least in part, the cyber-underwriting challenge.

The cyber-risk climate

The Internet has been the greatest boon in history for interpersonal communications, international commerce, and the perpetration of criminal theft and fraud. Cyber crooks use the Web to obtain goods, services and cash while exploiting time lags in discovery and investigation.

Under normal circumstances, identity theft can go undetected for months, or might never be detected at all. Cyber theft has high profit margins and incurs little or no danger of prosecution, even when detected. For example, in financial services, the vast majority of transactions with credit cards, debit cards, ATMs and even mortgage transactions, occur online in virtual anonymity without risk of apprehension normally associated with face-to-face transactions. A system compromise at a major medical facility can adversely affect thousands of patients, employees, business partners and other stakeholders.

In addition to post-compromise notifications and indemnification, there may be other disruptions including coordination with credit bureaus, assistance to law enforcement, and upgrades and repairs to information systems. Another concern is class-action lawsuits.

Despite recent legal reforms, victims of an institutional data breech are far more likely than other classes of plaintiffs to share jurisdictional "commonality of issues" requirements triggering federal jurisdiction. Besides litigation costs, mass-tort lawsuits expose facilities to potentially disruptive and intrusive pre-trial discovery. Clearly, the risks of data-intrusion and theft must be reduced to absolute minimums.

Pinching pennies is a poor business strategy when any significant system compromise yields a zero return on investment. Access to data should be limited to persons with valid needs for access. Employees must be properly screened, trained, supervised, and disciplined. HR gatekeeprs must ensure that systems are immediately firewalled when employees are terminated or resign. Third-party business arrangements (whether or not they fall under HIPAA) must be based upon a shared commitment to privacy. Risk assessment must be uncompromising and include the possibility of system audits by trusted outside agents.

In the event of a criminal data compromise, call your local police department immediately. The sooner law enforcement is involved the more effective they can be. Local police may seek the assistance of the FBI or U.S. Secret Service. If there has been theft of private patient data from the mails, contact the Office of the United States Postal Inspector.

Regardless of disclosure statutes, all affected customers must be notified promptly and be specifically advised what steps they should take to protect their accounts from misuse. If a data breach involves more than 500 persons, HIPAA/HITECH requires appropriate local media outlets to be notified. In your media releases, always make sure you point out what steps your organization is taking (and have already taken) to alleviate the situation. ]]> http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/HITECH-ratchets-up-HIPAA-accountability/ArticleStandard/Article/detail/650660 Mon, 11 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1121 EHR
CCR stands for the Continuity of Care Record (CCR). In the near future, this may be a required document that must be offered to patients after doctor visits, describing what happened at their doctor visit and what will happen next. The proposed ‘meaningful use’ standards include the use and interoperability of CCRs; and therefore, any physician considering purchasing an EHR and seeking Federal incentive payments should enquire about this functionality in potential EHR products.

ASTM, one of the largest voluntary standards development organizations, has been heavily involved in developing standards for the CCR. The CCR standards proposed to HHS by ASTM present … “a way to create flexible XML documents that contain the most relevant and timely healthcare information about a patient and to send these records electronically from one caregiver to another and to patients in the hope of creating better coordination and quality of care.”

ASTM E2369, Specification for Continuity of Care Record, was included as a patient summary record standard in Interim Final Rule, document 45 CFR Part 170 RIN 0991-AB58, published by HHS on December 30, 2009. The ASTM CCR standards will be used for developing effective and timely electronic messaging of health care records, and it has been adopted as a standard for structured summary health record exchange included in new regulations associated with ARRA/HITECH Act.

With this in mind, Health IT professionals are looking at these standards in the development of EHRs. EHRs must support a CCR and also the functional ability for this CCR to be shared between different electronic medical/health record systems and medical offices/facilities. Medsphere is currently creating a CCR that can be output as a version of an Adobe PDF file- a format that can be stored, printed or faxed- but also supported by encryption to protect privacy and security of patients’ medical information. As ‘meaningful use’ criteria nears final ruling, many other companies may be following suit.

While the ‘meaningful use’ standards and requirements are not finalized and still open for public comment, requirements for CCR functionality may not be set in stone; however, it is promising that some aspect of the CCR will be a standard supported by final ‘meaningful use’ criteria. It may be just another acronym in healthcare, but the CCR could pose interesting challenges for Health IT professionals and medical providers, who must work to ensure that specific aspects of medical encounters can be captured, be interoperable with Personal Health Records, and be shared between the healthcare systems at large.]]> http://www.ehrscope.com/blog/what-is-the-ccr/ Thu, 14 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1122 EHR
The European Commission investigated the qualitative socio-economic impact of interoperable EHR and e-prescribing systems in 11 practice cases in Europe, the U.S. and Israel to provide insight into factors surrounding successful EHR and e-prescribing deployment. Nine of the cases also underwent a quantitative evaluation of their socio-economic impacts.

“Decisions to invest in EHR and e-prescribing systems should [involve the adoption of] strategies that fit their local or regional setting and be designed to succeed by meeting clearly identified, measurable needs,” concluded the Commission.

The socio-economic gain to society from interoperable EHR and e-prescribing systems eventually exceed the costs, according to the commision. While it found that a typical development can reach an annual socio-economic return (SER) of up to 400 percent, it can take at least four–and up to nine–years before initiatives produce their first positive annual SER.

According to the European Commission, it can take an average of nine years to realize a cumulative net benefit. “Plans to invest in EHRs and e-prescribing systems should have a clear focus on achieving changes at the right time,” the commission reported. Longer time scales are generally associated with a lower risk of failure, according to the report.

In the study, the average distribution of costs were allocated from citizens (2 percent), providers (11 percent), health provider organizations (80 percent) and third parties (7 percent). The average distribution of benefits were dispursed between citizens (17 percent), providers (17 percent), health provider organizations (61 percent) and third parties (5 percent).

“From a systematic perspective, no single or small group of benefits comprise a sufficient reason for investment in EHR and e-prescribing systems,” the report found.

The total value of invested financial and non-financial resources at the evaluated sites was extremely wide with 42 percent of these expenditures on information and communication technologies.

According to the organization, an opportunity exists for all EHR and e-prescribing systems to facilitate a productive dialogue between users and information and communication technology experts before spending large sums of money on actual solutions. “Continouous engagement with healthcare professionals from the outset is essential and time-consuming, but must not be avoided,” stated the report. “If it is, it has bigger costs downstream.”

Another potential opportunity is to use interoperability as a prime driver of benefits. “Without the meaningful hearing and exchange of information, the gains would be marginal and not justify the cost of investments,” said the report.]]> http://electronicmedicalrecord.wordpress.com/2010/01/13/study-implementing-ehr-e-prescribing-is-challenging-but-beneficial-over-time/ Thu, 14 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1123 EHR
HHS’ Health Information Technology Policy Committee convened to discuss possible missed opportunities, areas needing clarification and other gaps in the proposed rule, which was released on Dec. 30, 2009.

HHS’ proposed regulation sets terms for the distribution of at least $17 billion in economic stimulus law funding for certified EHR systems. It describes how physicians and hospitals can be eligible for the money if they become meaningful users of such systems. A separate interim final rule laid out the terms for certification and technical standards.

Both regulations were published in the Federal Register today after being previously released for discussion. The public has 60 days to comment.

Physician progress notes are generally narrative notes written by doctors to describe a patient’s concerns. Some doctors have been advocating for inclusion of such narratives within digital health records as a valuable tool for understanding and properly diagnosing a medical condition or injury. Typically, commercial digital record systems do not offer such a narrative, but instead allow doctors to check various boxes on a template to describe a patient’s condition.

In a recent survey of 17,000 doctors nationwide, 94 percent said including patient narratives is very important for EHRs, and 96 percent voiced concerns about losing valuable patient information without the narrative. The Dec. 31, 2009, survey was released by Nuance Communications Inc.

HHS’ lack of a provision ensuring capture of the physician narrative within certified digital health record systems could be one of the “missed opportunities” in the regulation, according to testimony presented by Paul Tang, co-chairman of the panel’s workgroup on meaningful use and chief medical information officer of the Palo Alto Medical Foundation, and George Hripcsak, workgroup co-chairman and bioinformatics professor at Columbia University.

HHS also apparently missed a chance to set up indicators within the rule regarding substitution of generic drugs, and for use of certain high-cost imaging tools for diagnosis, according to Tang and Hripcsak.

Other areas needing further clarification include specifying when digital medication records must be reconciled among providers, and how long digital records on patient medications, problem lists and allergies should be maintained, among other concerns, Tang and Hripcsak indicated in their testimony.]]> http://fcw.com/articles/2010/01/13/hhs-electronic-health-records-ehrs-physician-notes.aspx Thu, 14 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1124 Health Information Exchange
Looming EHRs and HIEs, which should help facilitate access to and retrieval of timely clinical data on patients, can cut back dramatically on expenses. A single-clinician practice, for examples, wastes thousands of dollars a year dealing with referrals, consults, radiology and other orders alone. Integrating exchanges to be more than storage devices for clinical information could be a great step toward productivity and profit improvement across healthcare.

In this market, business advantage may mean acquisition. Lawson, for example, recently announced a $160 million deal to acquire Healthvision, a Dallas-based company providing integration and application technology and related services to hospitals and large healthcare organizations. MEDecision also plans to expand its HIE strategy this spring by unveiling new products related to its acquisition last year of HxTechnologies, Inc., a provider of HIE technologies.

The HIE market is heating up, said Scott Storrer, MEDecision CEO in an interview with InformationWeek. "We're adding over a 100 employees to support that growth," he said.]]> http://www.fiercehealthcare.com/story/hie-market-heats-state-grants-looming-emr-deadline/2010-01-13 Thu, 14 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1125 Hardware
"Apple has been going around targeting their first major paying customer for the device, which is not the average consumer, but the Healthcare industry (sorry fan bois, you're not first priority here). This is a move widely overlooked by the media, since Apple has generally tried to own the consumer arena, and besides the film industry, hasn't dominated enterprise," Jason Wilk writes at the tinyComb blog. Wilk claims that he got this tip from his father, who golfs with Cedars executives.

Wilk reports that the Apple tablet will cost about $1,000, far less than the $2,199 retail price for the Motion Computing C5 Mobile Clinical Assistant, which already is more than two years old, and thus should break the market wide open. There are some flaws in this reasoning, since Intel's Mobile Clinical Assistant platform is designed specifically for the healthcare industry, with bacteria-resistant casing that's easily sanitized, among other features. But never underestimate the power of Apple's design. When's the last time someone ditched an iPod for a Zune?]]> http://www.fiercemobilehealthcare.com/story/apple-said-be-targeting-hospitals-mac-tablet/2010-01-12 Thu, 14 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1126 EHR
These data come from the National Ambulatory Medical Care Survey (NAMCS) which is conducted by the National Center for Health Statistics (NCHS) in the CDC. The NAMCS measures activity in physician offices including patient visits and other aspects, including use of EMRs and EHRs.

What does it mean for an EMR/EHR to be fully "functioning?" First, a well-used system covers the basics including patient demographics, problem lists, clincal notes, Rx orders, and lab and imaging. Beyond these functions, which comprise the "basic system" which covers most of those practices that use an EMR or EHR, are the following applications: medical history and follow-up, orders for tests, Rx and test orders sent electronically, warnings of drug interactions, out-of-range test levels, and guideline reminders.

By 2009, the survey found that 43.9% of physicians reported using some or all of their EMR/EHR systems. 20.5% of doctors had systems that met the basics, and 6.3% had full functionality.

Health Populi's Hot Points: The gap between basic and fully functioning, and between using "any" EMR/EHR -- that is, the 43.9% estimate for 2009 -- is essentially the obstacle course that represents the journey toward meaningful use, broadly speaking. This is clearly a marathon, not a sprint, for providers who seek to apply for a part of the $20 billion stimulus funding earmarked for EMR/EHR adoption.

It is necessary but not sufficient for EMR/EHR vendors to offer outstanding, reliable products. Those vendors who offer a high-level of service which enables providers to get to full usability will be the trusted partners in the tag-teams that get meaningful use right. Thus, it's hardware, software and service that will blend into a recipe for success.

Don't be fooled by the 43.9% -- we're not even close to that when we ponder a meaningful percent of providers using HIT fully. Recent publications that have dissed the productivity and impact of EMRs/EHRs in practice can point to the fact that a plethora of physicians don't yet take full advantage of important features such as drug-drug interactions and electronic ordering for tests. When they do, they'll get both a lovely ROI out of their investments along with providing better patient care.

]]> http://www.healthpopuli.com/2010/01/while-4-in-10-us-docs-are-using-emrehr.html Thu, 14 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1127 EHR Medicare
In its proposed rule for meaningful use, announced Dec. 30, the Centers for Medicare and Medicaid Services incorporated many of the suggestions for quality objectives and measures that the Committee recommended be included in the rule.

But CMS dropped from the list recommendations that physicians generate progress notes for each patient visit, document the recording of advanced directives for the elderly and develop information resources that are easy for patients to understand.

Some committee members believe by rejecting the suggestions CMS is missing opportunities to generate significant and useful care information that will be difficult to obtain otherwise.

“It’s probably a moment in time when we have an opportunity to fundamentally change the kind of quality reporting that is done,” said Dr. Paul Tang, co-chairman of the committee’s meaningful use work group, who spoke at a committee meeting Jan. 13.

Tang, said, for example, that most of the quality measures approved by CMS still rely on claims data rather than the richer, more immediate clinical data that an electronic health record could collect.

“We have been tethered to whatever data has been available, and that data typically has been claims and administrative data,” said Tang, who is also chief medical information officer of the Palo Alto Medical Foundation. “Most of the existing endorsed quality measures are based on that kind of data.”

Tang also said he disagreed with CMS’s decision to drop progress notes from the list of required quality measures. “The rationale from CMS was that it wouldn’t contribute to care coordination, (but) there certainly is a lot of feeling (in the meaningful use workgroup) that it may,” he said.

Another of his concerns was CMS’s decision to include a large group of optional quality measures from which providers could choose to report depending on their specialties. A better approach might have been to have physicians focus on a few quality measurements that could be documented well, Tang said.

The workgroup also took odds with CMS about how often problem list reports should be updated in the EHR. The workgroup understood the original recommendations to mean that “to maintain a problem list, it was every time you see that patient” Tang said. “In the NPRM, it’s one time that there must be one or more problems.”

Tony Trenkle, director of CMS’ Office of e-Health Standards and Services, said CMS made some changes and deletions from the policy committee recommendations, fine-tuned others but made sure each objective had a measure.

“They were our best shots,” he said.

In considering comments by individuals and organizations on the proposed rule, CMS will look for detailed explanations why a meaningful use definition or requirement needs to be clarified or changed, Trenkle said.

He advised those who wished to comment on the proposed rule to include detailed, logical explanations for why they believe a requirement needs to be clarified or changed.

“You need to explain why it’s a bad idea and what would accomplish the same or better result,” he said. For instance, if the definition for a hospital eligible physician is wrong, the commenter should provide the reason on a national scale, describe the better alternative and back it up with data if possible. “You can’t take what’s in the NPRM and modify it. If it’s not a logical extension, we cannot change it in the final rule,” he said.

The policy committee will submit comments to CMS by March 1.]]> http://www.govhealthit.com/newsitem.aspx?nid=72956 Fri, 15 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1128 EHR
You need something installed and proving its value by October 1 of next year or no 2011 stimulus check. You’re being pressed for a decision by vendors, your accountant and the government.

What you should be looking for?

I don’t have a pat answer for you. Instead, I have a checklist, based on interviews conducted over the last year, of some things you need to ask about.

1. CCRs in English — A Continuity of Care Record (or Continuity of Care Document) is what you will be handing each patient when they leave you after all this is done. The document will mainly be prepared by your EHR software, based on inputs you give it while the patient is with you. It’s not too much to ask that these documents be written in English, simple English a patient can understand, not medical gobbledygook.

2. Interoperability — Your state, city, or region is going to build an exchange for health records. What standards will it be using, and will the data you generate from your EHR be compatible, so you can send records to a hospital or get records from a specialist? No waffling — yes or no.

3. Security — Not just passwords, or encryption, or even audit trails. You need to be able to perform a risk assessment on your system — or have someone else do it — at any time. You need procedures that your own people understand for this process.

4. On-site training — Everyone on your staff needs to not only learn how to use this stuff (you included), but know they can get support, in English, whenever they need it. This is a question best answered by talking to other customers. Get references. Buy those references a drink, or three. Get the straight poop on this, because it’s key.

5. Commitment — Maybe this won’t work. Any IT engagement starts as just that. It may become a marriage with time, maybe a dysfunctional one. But you need to know how you can get out of it before you go into it. Try before you buy works for me.

Note that in this list I didn’t talk about speeds and feeds. I didn’t talk about operating systems, or your client devices (ooh — a tablet! An iPhone!). I didn’t talk about open source vs. proprietary, or even whether you should be buying gear or using Software as a Service (SaaS).

You need to look at this decision strictly from your own point of view.

• What’s in it for me? How will this drive improvements to the way I practice?

• What’s in it for my patients? How will this help them understand what they need to do, and change habits?

• What do I have to do, as opposed to what do I want to do? Do what you have to do for the 2011 stimulus, and the 2013-2015 wish lists will take care of themselves.

The meaningful use guidelines, on which public comment has now begun, are not telling you to buy hardware, software or services. They are telling you to get the data you need to improve your practice and your patients’ outcomes.

Before you start fighting any alligators, make certain you keep that drained swamp at the top of your mind.

Good luck, and let me know how it goes.]]> http://healthcare.zdnet.com/?p=3203 Fri, 15 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1129 Healthcare Technology Health IT to Support the Doctor-Patient Relationship" begins on Jan. 14 at noon CST and continues each Thursday through Feb. 4. The program is advertised as a "learning lunch" series, but for physicians who are unable to view the webinars in real time, the two hosts are making the sessions available as archives through TransforMED's Web site.

Each session lasts one hour and is formatted for 45 minutes of presentation time from experts specially selected for the session. Each session's presentation is followed by a 15-minute question-and-answer period.

In chronological order, the webinar sessions will cover

• Using technology to support patient-centered care,
• Preparing a practice for health IT,
• Selecting the right technology and developing implementation strategies, and
• Teaching patients to use technology to manage their personal health care.

TransforMED President and CEO Terry McGeeney, M.D., M.B.A., encourages physicians to register online, read about the presenters and become familiar with the learning objectives for each week's presentation.

McGeeney says the webinars are an opportunity for physicians to glean valuable information from experts without having to leave their offices. "The sessions will introduce practice leaders to the tools necessary to successfully embrace health IT and will help practices meet 'meaningful use' criteria for electronic health records, (or EHRs)" as set forth by the federal government, says McGeeney.

"In the wake of the American Recovery and Reinvestment Act of 2009, more practices are considering implementing EHRs, utilizing electronic prescribing and exploring other forms of health IT," says McGeeney. "This webinar series will help articulate a vision of how health IT is transforming the practice of medicine, facilitating patient-centered care and improving health outcomes."

TransforMED is a wholly owned subsidiary of the AAFP. Its foremost mission is to help primary care physicians make practice changes that will help them transition to patient-centered medical homes, and McGeeney says use of health IT within a practice is a necessary part of that process.]]> http://www.aafp.org/online/en/home/publications/news/news-now/practice-management/20100111tmed-webinars.html Fri, 15 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1130 EHR Regional Extension Center
The good news is that the interim final rules and proposed regulations published in December are unlikely to change significantly when they’re finalized this spring. It’s already clear that to receive federal incentives in 2011, you’ll need an EHR that meets the published requirements for security, privacy, and interoperability. To demonstrate that you are using the EHR meaningfully in that year, you must employ your system to prescribe electronically and be able to exchange data with other providers, submit quality data to CMS or your state (if you’re applying for Medicaid incentives), and make copies of your electronic records available to patients upon request.

All of this is known, yet physicians have not been beating down the doors of software vendors. Until December, they could plausibly argue that they didn’t want to purchase an EHR until they knew what was required. Despite the guarantees that vendors were offering — and continue to offer — some observers say that that uncertainty effectively froze the market.

Now, it appears that other concerns are inhibiting physicians, including the requirement that they invest in EHRs before receiving any subsidies. Some are also worried that they’ll have to spend more on EHRs later as the government raises the ante to qualify for incentives.

Willarda Edwards, an internist and president of the National Medical Association, says, “When I talk to my colleagues, they’re seeing what I’m seeing. I can’t afford to make that initial investment and also be able to keep up with the changes that might be required for interoperability with other systems. That will require me to upgrade, and I can’t afford that.”

At the opposite end of the spectrum, Jeff Kagan, an internist in Newington, Conn., is confident that his three-provider practice will more than recoup the cost of the EHR it plans to buy through tax write-offs and government incentives. The biggest uncertainty at this point, Kagan says, is how much productivity his practice will lose during the EHR transition period — a concern he shares with many other doctors.

Family physician Chris Peine of Eagle, Idaho, is acquiring an EHR to improve his documentation and make his practice more efficient, not because he hopes to win a government subsidy. “I wanted to make the decision based on the needs of my practice and not on the financial incentives offered by the government,” he says. “Because frankly, I’m not sure when or if I’ll get a check for this. If I do, it will be nice. But for now, I’m making my decision based on what’s right for my practice.”

That’s the right reason, says Steven Waldren, MD, director of the Health Information Technology Center of the American Association of Family Physicians. Nevertheless, he strongly urges physicians to buy an EHR as soon as possible if they want to receive the maximum funds available from Uncle Sam — $44,000 per physician from Medicare or $64,000 from Medicaid, if at least 30 percent of revenue comes from the Medicaid program.

“If you want some money to offset the cost of an EHR, it’s going to take you six months to a year from the time you sign a contract until you’re live as a meaningful user, and before that, it will take six months to a year from when you start the search process to signing a contract,” Waldren says. “So if you don’t do that now, you won’t be ready to pull the trigger by 2011.”

Physicians who are ready to take the plunge need information about what’s happening in the market and what the government rules require. Here’s a basic guide to qualifying for federal EHR subsidies under the American Recovery and Reinvestment Act (ARRA).

Meaningful use maze

To refresh your memory, nonhospital-based physicians who use qualified EHRs meaningfully are eligible for government payments from 2011 to 2015, with the incentives diminishing over time. Those who apply after 2011 may also receive some payments, but the total will be less. Physicians who do not demonstrate meaningful use of an EHR by 2015 will have their Medicare payments cut by 1 percent in the first year, 2 percent in 2016, and 3 percent in 2017 and each year thereafter.

Providers can report on their meaningful use of EHRs for any 90-day period during 2011; thereafter, the reporting period for a particular year will be the full calendar year. Incentive payments can begin as early as 2011 and will end after 2016.

Two advisory bodies of the Department of Health and Human Services (HHS), the Health IT Policy Committee and the Health IT Standards Committee, spent most of 2009 devising criteria for meaningful use and certification of qualified EHRs. The meaningful use criteria for 2011 will be easier to meet than the 2013 criteria, which will become more stringent in 2015.

The most important thing to realize about meaningful use is that nobody can guarantee you will satisfy those requirements. While many vendors include such guarantees in their contracts — and one vendor, athenahealth, even says that if you don’t receive government money, it will refund up to six months’ worth of EHR payments — the fact is that it’s up to you to learn how to use the EHR and do what’s required. On the other hand, if you don’t have an EHR that can enable you to meet the government criteria, you won’t achieve meaningful use, no matter what you do.

Some vendors say that the functionality of their EHRs already meets or exceeds the meaningful use criteria. But it’s a good idea to know what those are before choosing a product. There are two sources for that information, both available online, which should be considered together: CMS’ Notice of Proposed Rulemaking on the EHR incentive programs and the Office of the National Coordinator of Health IT’s Interim Final Rule on standards and EHR certification. The certification criteria for qualified EHRs mirror the meaningful use requirements, which are summarized in a grid starting on page 103 of the Notice of Proposed Rulemaking (NPRM). Physicians who are going to apply for Medicaid incentives should be aware that the Medicare meaningful use criteria are the floor for what states will require, but individual states may add other requirements.

CMS’ document also includes a list of quality measures that combine metrics from CMS’ Physician Quality Reporting Initiative (PQRI) and the National Quality Forum. These include outcomes measures such as the percentage of diabetic patients with HbA1c under control and with blood pressure under control. To gather information like this, you need some kind of analytical program within your EHR, and maybe also a disease registry that keeps track of which patients need certain services and when they need them. The latter type of functionality will also help you meet two other requirements: compile lists of patients by their conditions and send reminders to at least half of patients over 50 years old for follow-up and preventive care.

In 2011, you’ll also have to use clinical decision support tools, such as drug interaction alerts, and maintain up-to-date lists of problems, medications, and allergies. You will have to prescribe electronically 75 percent of the time; you or your staff will have to record patient demographics, vital signs, and smoking status. And at least 50 percent of lab results must be incorporated into your EHR in structured form, meaning that they must be received electronically through lab interfaces.

However, you will not have to use the EHR to enter progress notes in the typical pick-box format. While that may change in the future, says National Coordinator of Health IT David Blumenthal, right now having physicians enter their progress notes electronically is not necessary to meet the objectives of meaningful use. (Of course, you must still document visits, but you can dictate, type, or use voice recognition software.)

You will be required to give patients access to a portion of their electronic health records, including lab results and medication, problem, and allergy lists. One way to do that is to transfer the data to a personal health record (PHR) that’s part of a patient Web portal. (An increasing number of EHR vendors offer such portals.) For purposes of interoperability, all qualified EHRs must also have the ability to generate and receive either a clinical summary known as the Continuity of Care Document (CCD) or a similar format called the Continuity of Care Record (CCR). Either of these could be printed out for patients, sent to them online, or transferred to their PHR.

The requirement that your system must be able to exchange clinical data with other providers presents additional challenges. In 2011 and 2012, you will have to prescribe electronically, receive some lab results, and transfer clinical summaries as part of referrals. Sending electronic prescriptions to pharmacies is not hard to do, because the Surescripts network already connects practices with the majority of pharmacies if their EHRs allow that. Lab interfaces are trickier, says Waldren, because they’re all different and labs won’t necessarily pay for them. Your local hospital, likewise, may not pay for interfaces to its lab and other systems unless you belong to a sizeable group. A vendor will usually charge extra for writing its side of the interface.

Multiple EHR certifying bodies

In a simpler time, the Certification Commission on Health Information Technology (CCHIT) was the only certification game in town. But no more. HHS has decided that there should be multiple certification bodies to ensure that the big software vendors will have less influence on the process. So far, just one organization — the Fort Worth, Texas-based Drummond Group — has emerged to challenge CCHIT, but more may follow.

To signify that an EHR is qualified for government subsidies, CCHIT and its rivals will have to certify that it meets the criteria established by HHS. But the criteria in the interim final rule are related only to meaningful use requirements, which are a subset of EHR functionality. So CCHIT is offering 2011 certification to vendors selling comprehensive EHRs that meet certain functional criteria as well as the government requirements.

“We think a lot of [EHR] buyers need and want the extra assurance,” states CCHIT chair Mark Leavitt.

CCHIT is also certifying incomplete EHRs or non-EHR products for components of HHS’ certification and meaningful use requirements. The government is open to this approach. The interim final rule specifies that a provider can use either a complete EHR or a combination of “EHR modules” to satisfy the meaningful use criteria.

“To support meaningful use, you don’t need what CCHIT currently certifies as a comprehensive EHR,” says Waldren. “You don’t need all those functions.” Of course, if you have multiple products, they must all work together smoothly, and it will be difficult to collect quality data unless your EHR allows you to document vital signs, medications, problems, and lab results in discrete, searchable categories.

CCHIT forecasts that any EHR that receives its comprehensive 2011 certification will meet government standards, and it promises to recertify products at no cost for any criteria the government adds later on. Greg DeBor, a health IT consultant with CSC, says he believes that even products certified by CCHIT in 2009 will suffice. And Bruce Kleaveland, a Seattle-based consultant, says that buying a certified product from a vendor with a good track record poses a very low risk for physicians.

Regional extension centers

Some vendors believe there will be a sudden rush of orders after the final rules are published, as physicians scramble to get EHRs in time to qualify for the incentives. Leading firms such as Allscripts and Sage Software are ramping up to accommodate the expected demand. For example, Sage, which makes the Medical Manager and Intergy systems, recently added classroom training to its Web-based and onsite programs to stretch its resources further. Nevertheless, Lindy Benton, Sage’s chief operating officer, acknowledges that there is a shortage of technical personnel to provide training and implementation. In addition, vendors are not equipped to offer basic support services to a large volume of small practices, although Sage has a distributor network that can bear some of that burden, Benton says.

Glen Tullman, CEO of Allscripts, says he expects many hospital systems to provide implementation and support services to small practices. He cites the North Shore LIJ healthcare system on Long Island, N.Y., which has offered to supplement the government subsidies with its own financial and technical aid for community physicians that buy an Allscripts EHR. But a recent survey indicated that only a small percentage of hospitals nationwide are moving in this direction.

The ARRA legislation also calls for the creation of health IT regional extension centers to help physicians implement EHRs. Each of the HITRECs, as they are known, will have to help 1,000 primary-care doctors achieve meaningful use over a two-year period to get its full government grant. Altogether, the HITRECs are eligible for up to $598 million in government funds.

The government plans to fund about 70 HITRECs. The first group of 30 awards were expected to be announced in late January and the remainder in March. DeBor says he believes that applicants for the HITREC grants will probably include regional health information exchanges (RHIOs), Medicare-contracted quality improvement organizations, state agencies, and locally dominant healthcare systems. For example, the New Mexico Health Information Collaborative, a statewide health information exchange, intends to operate a HITREC in conjunction with the New Mexico Medical Review Organization, a quality improvement organization, and the New Mexico Primary Care Association.

Unfortunately, the HITRECs are going to have the same limitation that the software vendors have: not enough trained technicians on the ground. Charlie Jarvis, vice president of healthcare services and government relations for NextGen, says, “There’s a tremendous shortage in the workforce. The government has talked conceptually about that but hasn’t really addressed it.”

In November 2009, the Office of the National Coordinator of Health Information Technology (ONC) announced that it would provide $70 million to 70 community colleges to establish six-month, non-degree training programs for health IT technicians. In addition, ONC is offering $10 million for the development of course materials. But it is unclear whether this program, funded for two years, will be able to train enough people rapidly enough to make a real difference in helping practices implement EHRs by 2011.

The HITRECs could hire consultants to put on mass training sessions for small practices, Jarvis notes. But he and other experts agree that there’s still a certain amount of work that has to be done individually with each practice.

“If the market moved as quickly as the government wanted it to, you would have chaos,” Jarvis says, “because the government has underestimated the amount of change that’s required within any physician office when it becomes automated. And it’s not something that will go away because you put a few thousand dollars in front of doctors. It takes more than money: it’s time, it’s effort, it’s education, and it’s cultural change. These things don’t happen overnight.”]]> http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/1442.htm Fri, 15 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1131 EHR Medicare
A proposed rule issued by the Centers for Medicare & Medicaid Services outlines provisions governing EMR incentives and details what constitutes meaningful use of the technology -- a prerequisite for receiving any bonus dollars. A separate, interim final regulation issued by the Office of the National Coordinator for Health Information Technology sets initial standards and certification criteria for the use of approved EMRs.

Both rules were posted in the Federal Register on Jan. 13 and will be open for public comment for 60 days. Numerous organizations, including the American Medical Association, said they were reviewing the rules and plan to offer comments.

At stake is an estimated $14.1 billion to $27.3 billion in net Medicare and Medicaid incentive payments that the government expects to pay over 10 years. The money was made available through the economic stimulus package signed into law in early 2009.

For stage 1, which begins in 2011, CMS proposes 25 objectives for physicians and 23 objectives for hospitals to meet to be deemed meaningful EMR users. Stages 2 and 3 will expand the list in 2013 and 2015, and the added requirements will be proposed through future rulemaking. Hospitals and physicians failing to adopt EMRs and meet the objectives by 2015 will face Medicare penalties.

Each stage 1 objective has a corresponding measure attached to it. For example, an objective for physicians to generate and transmit prescriptions electronically requires doctors to submit at least 75% of all prescriptions electronically using certified EMR technology. Other 2011 objectives include using computerized physician order entry, maintaining patient medication allergy lists and recording patient demographics.

The interim final regulation issued by the national coordinator's office describes the standards that must be met for EMRs to be considered certified. The regulation describes standard formats for clinical summaries and prescriptions, standard clinical terminology, and standards for the secure transmission of information over the Internet.

David Blumenthal, MD, the national health information technology coordinator, said the combination of certification and federal dollars would help drive EMR adoption.

Concerns with time

In response to the new rules, some health care organizations cheered the government for taking a long-overdue step toward EMR system interoperability. "We're encouraged by the rules, because it's saying to our industry we're going to have a defined set of data points so that we can achieve interoperability," said American Academy of Family Physicians President Lori Heim, MD, who noted that the majority of her academy's members already have adopted EMRs. "We generally think the meaningful use rules are going to be acceptable and positive for primary care."

The Healthcare Information and Management Systems Society said the proposed regulations present an opportunity to develop a multiyear road map of future expectations.

"There is a lot of work for our membership to do, but at the same time, this is what they have been expecting," said Tom Leary, senior director of federal affairs at HIMSS. "There will be some challenges, though, with getting to an EHR adoption level that is consistent with the stage 1 level of meaningful use."

While the AMA is still reviewing the new rules, it previously had said that some EMR objectives recommended by a federal advisory board for inclusion in the CMS proposed rule appeared too aggressive and inflexible. The Association said it was unreasonable, for instance, to expect physicians to meet EMR objectives on using computerized physician order entry and reporting ambulatory quality measures by the 2011 deadline -- two recommendations that were incorporated into the proposed rule.

"The AMA is committed to EHR adoption that streamlines physician practices and helps them continue providing high-quality care to patients," said AMA Board of Trustees member Steven J. Stack, MD. "We have provided ongoing input this year on standards for the use of EHRs and have stressed the importance of realistic time frames for adoption, the removal of extraneous requirements that would delay successful adoption and reasonable reporting requirements."

Rick Pollack, executive vice president of the American Hospital Assn., cited similar themes. "America's hospitals have serious concerns that the new health information technology rules severely limit hospitals' ability to access federal financing for health information technology that is used to improve patient care."

Pollack said hospitals could be unfairly penalized by the rules. In addition, payment incentives might unfairly exclude physicians who practice at outpatient centers and clinics owned by a hospital, he said.

Marc Probst, a member of the Health Information Technology Policy Committee, the advisory board that made the rule recommendations, said the version released largely followed the intent of the committee's working groups. However, he echoed some of the worries about timing.

"At the pace defined, I think there are many hospitals, clinics and physician practices that may not be capable of achieving meaningful use, and it may negatively incent some from even trying," said Probst, who is also chief information officer with Intermountain Healthcare, a nonprofit system of hospitals and clinics based in Salt Lake City. "Essentially, if they are not well on their way to implementing an EHR solution, many may struggle with the technical and operational requirements."]]> http://www.ama-assn.org/amednews/2010/01/18/gvl10118.htm Mon, 18 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1132 Practice
The concept of participatory medicine, where patients take a more active role in their care, can enhance the physician-patient relationship and allow physicians and patients to bring their own expertise and knowledge to the table to produce the best outcomes.

At its most basic level, participatory medicine means shared decision-making and deep patient engagement. Because of the rise in technology use -- as well as an increase in out-of-pocket health care expenses -- this has gone well beyond the traditional tell-me-where-it-hurts conversation between patient and doctor in the exam room.

The business benefits of a participatory approach, especially as it relates to technology, have not been well documented. But proponents say adopting a participatory model of care can increase patient satisfaction, save time, reduce costs and improve care. Experts say the model of care also could lower liability risks for physicians. And patients who have a better understanding of their illnesses are likely to be healthier.

Technology such as social networking sites, e-mail, personal health records, home monitoring devices and patient portals have made communication between patient and doctor not only more convenient but also more meaningful.

Patients are able to do more independent research, making them better informed. They can compare costs, exchange information with other patients, and bring that knowledge back to their physicians. Technology even can allow physicians to monitor a patient's health without a visit to the office, creating more time to see sicker patients.

Alan Greene, MD, clinical professor of pediatrics at Stanford University School of Medicine in California and the president of the Society for Participatory Medicine, said physicians have many misconceptions about what it means for patients to share in decisions about their care.

Physicians "are afraid this is something that will cost them time and money, and it will create arguments with patients," Dr. Greene said. "But when this is done correctly, it's something that actually makes a richer and deeper conversation and really leverages the expertise of the physician in a more powerful way than before and can actually save time and money."

History of participation

Many point to the 1999 Institute of Medicine report, "To Err is Human: Building a Safer Health System," as the foundation for the participatory medicine movement. The report concluded that hundreds of thousands of patients die each year from preventable errors, though the figures were disputed by many.

A year later, a second IOM report, "Crossing the Quality Chasm: A New Health System for the 21st Century," was published. It laid out six specific improvement aims. These included more effective use of technology such as computerized physician order entry systems and electronic decision support tools. Another strategy was to make health care more patient-centered.

At the time of the second report, the Internet had become a household staple for millions of Americans. Like-minded patients were creating online communities to support and educate one another. As online information improved, patients were becoming more educated and feeling more empowered.

In 2007, Dave deBronkart was diagnosed with stage IV kidney cancer. His physician prompted him to join online communities for cancer patients to gather knowledge he could share with his care team. "What I found and what I continue to hear today ... is that there's a lot of information developed in the last few years that is not yet in the hands of every oncologist in the world," said deBronkart, a software technology professional in Nashua, N.H.

Yet a common concern for physicians is that patients will bog down the office visit by arriving with a stack of information they printed from a Google search.

Gail Gazelle, MD, assistant clinical professor of medicine at Harvard Medical School in Boston and president of MD Can Help, a patient advocacy practice, says if patients arrive with too much data, the physician simply can set limits. "Blame it on the HMO, blame it on your insurance company, blame it on whomever," she said, "but just tell the patients, 'They just don't give me the time to look at this kind of stuff. Do you think you could distill it for me and we can talk about it?' "

Isabel Hoverman, MD, an internist in Austin, Texas, has found that Internet research has made patients better prepared for their office visits. "As computer access has gotten broader, patients are able to sift through material and many times will access good sources of information to be able to ask you better questions," she said. Many of Dr. Hoverman's patients have given her material that she has shared with other patients.

"There are things that have not changed and will probably never change: Patients really respect their doctors, and they really trust their judgment," said Ted Eytan, MD, MPH, a family physician and medical director for delivery systems operations improvement for the Permanente Federation in Washington, D.C., a national association of regional Permanente Medical Groups. "Participatory medicine is actually about engaging the patient in their health in new ways. It's not intended for the patients to take over the interactions."

New education efforts are helping to eliminate some of the confusion over what is and is not participatory medicine. A new journal for patients and physicians, the Journal of Participatory Medicine, was launched recently by the Society for Participatory Medicine, of which Dr. Greene and deBronkart, now a patient advocate, are founding members.

The Joint Commission has started a campaign called "Speak Up," aimed at empowering patients to be more involved in their care.

Making the case

Developing this model of care likely will involve process and work-flow changes, staff buy-in and possible technology investment. Many early adopters already had health information technology in place, and the participatory approach was carried out, in part, by using it.

Proponents of participatory medicine admit that the business case for taking this approach has not been well documented.

A recent study in the December 2009 issue of Arthritis Care & Research found that increased patient responsibility for medical decisions decreased their likelihood to accept risky treatment options.

What this means for quality and cost savings is open to interpretation, but Dr. Gazelle knows that patient engagement can lead to lower costs without sacrificing efficacy. And now that patients are paying more out of pocket, they are more open to discussing costs.

For example, a patient came to her insisting she be given an MRI because of information she found online. When Dr. Gazelle told the patient that an ultrasound would be one-third the cost and would produce the same results, the patient went with the ultrasound.

When physicians openly discuss treatment options with patients, the patients understand that you are "not withholding something because of cost, you are not denying it, you are explaining to them," Dr. Gazelle said. When given all the facts, patients and doctors usually reach a well-informed, mutual decision.

Taking this approach also could help reduce liability risk, said Dr. Mohammad Al-Ubaydli, CEO of Patients Know Best, a U.K.-based technology company that developed a fully integrated personal health record system that works with a practice's electronic medical record.

When patients and physicians look at information together -- and stop errors earlier -- patients are less likely to sue, said Dr. Al-Ubaydli. "Lawsuits tend to happen when something is done to the patient without the patient's knowledge, and they find out about it a long time afterwards and no one apologizes for it."

Once patients understand more about their conditions, they take more responsibility for managing their health, experts say. And the more a patient's care can be managed without coming into the office, the more time is saved for sicker patients.

This doesn't equate to a loss to the practice, said Daniel Sands, MD, MPH, an internist at Beth Israel Deaconess Medical Center in Boston who also serves as director of the Internet business solutions group for Cisco Systems. "You are now billing at a higher intensity level," he said. In addition, several insurers now pay for online consults, which means physicians could create a new revenue stream from an activity done during their downtime.

Dr. Al-Ubaydli suggested starting with 10 to 20 chronically ill patients with whom you have a good relationship. He also recommended that the patients be people who work full time, as they will better appreciate the time saved with online consults and e-mails. Once the practice has adapted to the work-flow changes, it can slowly add patients to the list of those with whom they communicate electronically.

The effort could have other benefits as well. "Patients who feel they can have open communication with their doctors, patients who feel their doctors treat them as adults in a mutually respectful way, those are the people who are going to like their doctors more," Dr. Sands said. "They will tell others, 'My doctor is the best, you've got to go to see my doctor.' This will set you apart from a competitive standpoint."]]> http://www.ama-assn.org/amednews/2010/01/18/bisa0118.htm Mon, 18 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1133 Practice
If you don’t, you are not alone. Thousands of practices have effectively delegated their entire financial operations to third parties. Should you? Let’s take a look at the pros and cons.

First a quick description. The in-vogue name for these financial third parties is “revenue cycle outsourcers,” also known as billing services. Instead of hiring staff to do your billing, you delegate it to the revenue cycle outsourcing firm who manages the entire operation, including coding and review, electronic claims submissions, collections, and financial reporting. The revenue cycle outsourcer’s fees are based on a percent of collected receipts. The more you make, the more they make.

The pros of outsourcing

What’s the case for revenue cycle outsourcing? Here is what the outsourcers would say:

• Medical billing is complex and best handled by experts. Most offices have to deal with multiple plans and therefore multiple payment schedules, different benefits, and variable rules. Medical billing is also a moving target — plan rules change frequently and even CPT codes are updated annually. It’s hard to keep up. The implications of doing this job poorly are significant. Over-coding (or coding at a higher level than the documentation supports) is a polite term for fraud. Under-coding (or what some docs will call defensive coding) can cost practices millions of dollars in lost reimbursements that they have legitimately earned. There is also the time consuming rework required for claims that are denied because your billing clerk made a mistake on the original claim. A core benefit to outsourcing is that you are dealing with a bank of professionally managed experts who are focused solely on billing. Because billing services are paid on a percentage of collections, they are strongly incentivized to perform well.

• In-house billing is time consuming for physicians and clinical staff. Dealing with insurance companies takes both physician and other clinical staff time. According to a study by Lawrence P. Casalino, MD, PhD, of Weill Cornell Medical College, physicians spend three hours a week or nearly three weeks per year on these activities, while nursing staff spend more than 23 weeks per physician per year. There also appears to be a disproportionate burden of these tasks on the smaller practice. The same study noted physicians in solo or two-physician practices (particularly primary care) spent “significantly more hours interacting with health plans than physicians in practices with 10 or more physicians.” Moving to a billing service won’t eliminate practice interaction with health plans — but it should significantly reduce physician time spent on haggling over unpaid claims.

• Managing internal billing operations is a pain in the neck. The care and feeding of an in-house billing staff is not trivial. In addition to salary and benefits, a billing staff requires oversight to insure that they are performing optimally. They will also be prone to any of the normal unspoken overhead of employees — illness, variable job satisfaction, hiring and firing, and ability to mesh with other staff members.

Now for the cons

So what are the downsides of outsourcing your billing?

• It’s not free. As noted above, revenue cycle outsourcers — quite cleverly — typically bill as a percentage of receipts collected. For high reimbursement specialties such as cardiology, billing services will typically charge in the 4 percent to 5 percent range; for primary care, percentages may bump up to the 8 percent to 10 percent level. The billing service’s fees typically are inclusive and incorporate any claims-clearinghouse fees that you might pay if you were doing it yourself.

• You don’t have total control. Transferring your billing operation to a third party may be uncomfortable for some physicians who revel in the smell of superbills. Some physicians simply prefer to have tighter control over their finances. And while a large number of billing services are local mom and pop operations that allow you to connect in person, increasingly the service is being offered by large corporations serving a nationwide clientele — which makes face time less likely. Do you feel comfortable with delegating your daily financial operations to someone you are likely never to meet in person? If the answer is no, outsourcing may not be a good fit.

Weigh the options

We’ve established the pros and cons. Now, how do you decide? Here are some guidelines:

• Compare hard costs. This is a pretty straightforward exercise; calculate the expense of doing it yourself (salary and overhead of your billing staff, amount of time you are spending on billing, third party fees for claims clearinghouses, billing related supplies such as claim forms) versus the revenue cycle fees. According to the recent survey of the American Academy of Professional Coders, the average salary in 2009 for certified coders was $44,750, which varied depending on location and experience level. Add 20 percent for benefits and overhead and you have a cost of $53,700.

• Compare soft costs and intangibles. This represents elements such as the hassle factor of hiring and managing staff to do your billing versus the loss of daily oversight. You should also assess your overall comfort level and expertise with medical billing. It is hard to be an effective manager of an in-house billing operation if you don’t understand what you are managing. There is also a labor pool issue. Is it difficult to find competent billing staff in your location? You may have a brilliant financial manager now, but if she decided to move on, would you be able to easily replace her?

• Compare effectiveness. This is a little trickier, because it involves making a judgment call regarding your own operation, as well assessing the potential effectiveness of a third party with whom you have not used. In terms of assessing your own operation, here’s simple question: Are you receiving reports on a regular basis? Along with having reports on gross charges, write-offs, bad debt, and refunds, you should know the relative age of your accounts receivable, the average time it takes from patient visit to filed claim, your denial rate for claims, plus checks and balance reports that reconcile payments received with payment entry and daily receipts.

All of these will give some indication of the effectiveness of your billing staff. Armed with this data, you can benchmark your practice against the revenue cycle firm of your choice. They should be able to provide some their performance data on practices like yours. This will allow to you compare effectiveness — and help you make the final decision.]]> http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/1441.htm Mon, 18 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1134 Health Information Exchange
The "gateways" or clearinghouses enable providers and other trading partners to establish connections with payers. The Cooperative Exchange has developed a collaborative environment among organizations that transmit a percentage of the health care electronic transactions through its member organization. Each year, claims clearinghouses and other electronic data interchange vendors electronically transmit billions of claims and related financial/administrative transactions among providers and payers.

The clearinghouse industry currently provides health information exchange (HIE) platforms that have evolved over the past 30 years, connecting the majority of all health care providers, health plans and many other health care entities such as pharmacies and labs.

Currently, the infrastructure allows for the secure transfer of millions of health care transactions each day amongst all of the health care constituents in both batch and real-time modes, according to the Cooperative Exchange. The infrastructure is extensible, allowing it to evolve to meet the current and future needs of the industry, such as the addition of new health care transactions (e.g., quality measures, patient summaries) and regulations. It is a proven and known health exchange model that provides value to each constituent and is based on a variety of sound business models.

For consumers, there is a lack of connectivity (patient-to-provider), privacy and authorization issues and lack of timely and basic awareness of their own medical records. The Cooperative Exchange provides a portal strategy, security, opt-out capabilities along with awareness and educational (e-learning) programs.

For providers, there is a lack of connectivity (peer-to-peer) and implementation of standards, multiple communication systems through complex and broken channels and an overall lack of simplicity around the transfer of data. The Cooperative Exchange can provide connectivity through point-to-point connections, portal content management, an implementation strategy, defined standards, interface capabilities and seamless communication systems.

For the payer/employer, there is a lack of connectivity (payer-to-payer), no unified portal strategy and disparate legacy systems. The Cooperative Exchange can also provide unified state-of the-art technology, transport and translation capabilities and portal capabilities all through the existing infrastructure and technology.

For health care information technology (HIT), there is a lack of connectivity (HIT-to-HIT), different platforms, different standards (major cause of interface issues) and non-existent or inadequate workflow and methodology. The Cooperative Exchange enables transparent utility and connectivity by enabling standards and format conversion normalization.]]> http://health-care-it.advanceweb.com/News/In-the-News/The-Cooperative-Exchange-Assures-that-NHIN-is-Functional-Secure.aspx Tue, 19 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1135 EHR
For "Ambulatory EMR: On Track for Meaningful Use?" KLAS interviewed more than 1,400 providers about 26 EMR vendors, in order to assess each application's readiness to meet meaningful use requirements, based on the guidance provided by the HIT Policy Committee in July 2009. Among the study respondents, the vast majority believe their EMR will help them meet the proposed government requirements, with Epic, NextGen and athenahealth customers expressing the most confidence, and SRSsoft and Amazing Charts clients expressing the least.

Despite the confidence, however, providers also noted a number of functional areas that are still lacking. Foremost among those were EMR reporting tools, patient access to medical records and the ability to share key clinical data.

The KLAS study also looked at EMRs in regard to other proposed requirements, such as the digital transmission of pharmacy orders. Of all the products in the report, only Allscripts Enterprise had 100 percent of interviewed clients able to digitally transmit qualifying orders. Greenway and e-MDs earned the highest marks for functionality in this area, while MED3000 was considered the most challenged.]]> http://health-care-it.advanceweb.com/News/In-the-News/Report-Health-Care-Providers-Confident-in-Meeting-Meaningful-Use-Deadlines.aspx Wed, 20 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1136 EHR
I called them health reform in action. They put you and your doctor on the same page. You can show it to your family, you can understand it. It’s a good thing.

Now there is better news, from the HL7 blog. The two groups working on this stuff, HL7 and the ASTM, have agreed on a technical standard. The good people at HL7 want me to know this is called a Continuity of Care Document (CCD).

CCR or CCD, you can call it genofsky if you like. The point is we now have structured XML standards resulting in an interoperable system for delivering a standardized document to patients. It’s all now mapped into HL7’s Clinical Document Architecture, making it relatively simple for vendors to implement.

This is technical but it is a very big deal. Doctors will be able to deliver a standard output no matter what Electronic Medical Record (EMR) system they choose.

Since the CCDs will also be computer files, they can be exchanged with other doctors, clinics, and hospitals, reducing duplication of services and the nagging questions you get each time you see a different physician.

One can argue that it’s about time. But this is what happens when a lot of people start with a blank sheet of paper and everyone decides they need to own that paper.

Medical practices, and forms, are complex. The format needs to adjust to any specialty, and to any step in a health care process. It’s complicated.

But now we may start to see benefits.]]> http://healthcare.zdnet.com/?p=3228 Thu, 21 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1137 Practice
Medicare rules usually dictate that a locum tenens cannot provide services for longer than 60 days. The regular physician generally pays the locum tenens a fixed-rate, per diem amount, with the locum tenens having the status of an independent contractor rather than an employee. The regular physician may submit the claim using the Q6 modifier (services furnished by a locum tenens physician).

Additionally, the regular physician must keep on file a record of each service provided by the locum tenens along with the locum tenens’ National Provider Identifier. It is a good practice to retain a current copy of the locum tenens’ malpractice coverage.

However, for commercial carriers, networks, and third-party administrators (TPA), the answer is not so simple, and is one that requires a bit of advance research, when possible.

Each company has its own policy for billing for locum tenens. ACA strongly advises practices to contact the provider relations department of each carrier with which the regular doctor is contracted, and ask for its policy on billing for locum tenens.

For example, some carriers require that the locum tenens be a participating provider with their plan in order for services to be reimbursed.

Although calling each carrier does require some investment of time for practice staff, it is important for practices to perform due diligence in order to be properly reimbursed for services provided by locum tenens.

If you have any additional questions regarding locum tenens billing, please contact ACA’s Insurance Relations Department at insinfo@acatoday.org.]]> http://www.chiroeco.com/news/chiropractic-news.php?id=8911 Thu, 21 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1138 Practice
More than 125 chiropractors signed up for ChiroTV Network over the weekend launch and more followed the following day.

ChiroTV Network is a free service to all chiropractors made possible by many sponsors and advertisers. It gives chiropractors an opportunity to

help educate and market patients on the reception area TV. You can also customize the scrolling ticker on the bottom of the screen to promote your practice!

It will help build your practice, generate referrals, sell more products and services, and make more income.

Sign up for your free Subscription at www.ChiroTVNetwork.and begin using this incredible new service.]]> http://www.chiroeco.com/news/chiropractic-news.php?id=8912 Fri, 22 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1139 Practice
IBM announced in December 2009 that its lending arm, IBM Global Financing, has entered into financing agreements with four major health information technology companies -- Siemens Healthcare, Lavender and Wyatt Systems Inc., Healthcare Management Systems Inc. and SCC Soft Computer -- to provide loans to hospitals, labs and physician practices adopting health IT systems.

Richard Dicks, general manager for IBM Global Financing in North America, said IBM's move is an attempt to help physicians adopt technology today while they wait for government funding. Incentives of up to $44,000 per physician under the federal stimulus package don't offer help with upfront costs. To qualify, physicians must already have the technology and be able to demonstrate meaningful use of it.

Since the introduction of the American Recovery and Reinvestment Act last year, many technology vendors have begun offering financing options -- otherwise available only to hospitals -- to small physician practices. The programs are designed so payments are deferred until practices start collecting stimulus funds.

IBM will provide financing for a variety of clinical and practice management systems from the four vendors that use IBM technology. Eligible systems range from fully functional EMRs to health IT solutions for specialty practices. Financing also will be offered for IBM's infrastructure and health care consulting services when bundled with packages purchased by one of the four vendor partners.

GE Healthcare, one of the first health IT companies to offer physicians financing tied to stimulus funds, announced that it is expanding its financing program to include GE's Centricity Business Suite.

When it started the financing program in summer 2009, the company said it was making $100 million available for the program. It recently reported that it already has seen $140 million in sales financed through the program. The company said many customers were looking to move beyond EMRs and adopt health IT to help improve efficiencies in other areas of their practices. Therefore, it decided to expand the financing program to include nonclinical systems.

The latest entry into vendor financing is UnitedHealth Group-owned Ingenix, which plans to offer physicians zero-interest financing on its CareTracker product. The financing would be arranged through OptumHealth, a United-owned bank. Also, Allscripts-Misys Healthcare Solutions was expected to announce its own vendor financing program in January.

Editors note: PrimaryData has great financing options on healthcare information technology solutions available today.]]> http://www.chiroeco.com/news/chiropractic-news.php?id=8912 Fri, 22 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1140 Practice
That included janitorial services, medical and office supplies, and promotional and marketing materials, which Solinsky bundled into a single provider for a reduced bulk rate. His efforts paid off. Overall, Solinsky estimates he has saved the practice between $100,000 and $200,000 a year. “It’s really just a matter of looking at every piece of the practice and not being afraid to question every vendor,” he says.

Indeed, when it comes to managing costs at medical practices, it’s rarely a single line-item that throws the budget out of balance. More often, it’s a series of smaller, seemingly insignificant wastes and missed opportunities that contribute most to poor performance.

From inadequate coding to unnecessary referrals, such infractions are easy to overlook. But, for the most part, they’re also easy to fix. Here’s a look at some of the most common ways an otherwise functional office burns money.

Squeaky wheel

As Solinsky can attest, everything is negotiable. If you haven’t solicited new bids from your suppliers and insurance providers in the last year, you’re paying too much. “Get a new bid every year from your vendors and tell them that you’re trying to save money,” says Susan Childs, president of Evolution Healthcare Consulting in Raleigh, N.C. “If a competitor is going lower, ask if they can match it. Be a squeaky wheel.”

If you haven’t done so in the last year, start shopping around for lower health insurance premiums, bundled phone and Internet service, laundry and cleaning services — even bookkeeping and accounting costs. Indeed, this is where the lackluster economy can work to your advantage. “Some of your contracts are longer term and may be difficult to break, but it’s not unheard of to let your landlord know your lease is nearly up and you’re going to be looking,” says Cindy Dunn, a consultant for MGMA Healthcare Consulting Group. “Look at all your contracts to find out when they’re up for things like copiers, printers, and fax machines. Keep a spreadsheet and start talking to your network of peers to find out who they use and what they pay.”

Check, too, with your professional association or trade group to find out if there are any purchasing cooperatives available, which offer group discounts on office and medical supplies. The American Academy of Orthopaedic Surgeons, for example, offers its purchasing group free to members and estimates it can save most practices 15 percent or more.

Above all, Debbie Preite, office manager of Greenhouse Internists in Philadelphia, advises don’t be afraid to play hardball. “There’s a lot of competition out there now and you have to take advantage of it,” she says. “We won’t buy a flu vaccine until we shop around and get the best price. I’ll get one company to give me their price, then I call up their competitor and say, ‘I’m getting it for $12. What can you do for me?’ They’ll give it to me for $11 and then I call back the first company, which lowers their price to $10. You have to wheel and deal a little, but it works. And you only have to do it once. Once you’ve got that price it’s locked in.”

The same is true of your managed-care contracts. “If you haven’t negotiated in two years you’re losing money and they do not play catch-up,” says Childs, who worked with one practice that hadn’t looked at its contracts in nine years. “They won’t bring you to what you should be. They’ll give you a minimal increase based on your old rate. You have to stay on top of that.”

Likewise, don’t be afraid to dump an insurance company or IPA that underpays, says Keith Borglum, a healthcare business consultant for Professional Management and Marketing in Santa Rosa, Calif. That goes for companies with low reimbursement schedules and those that never seem to pay what they owe. “Most primary-care practices have overhead of at least 60 percent to 65 percent,” he says. “If you have an insurance plan that pays at less than that, you’re losing money on every patient you see from that plan. Plus, that patient prevents another patient with a better plan from being seen.” Most practice-management software these days can generate reports on average reimbursement per plan. “It’s under the ‘reports’ section that nobody ever looks at,” says Borglum. “You can also have your biller review your explanation of benefits. It’ll become clear immediately which plans pay the least.”

Focus on productivity

For many practices, the biggest sources of waste are simple inefficiencies. If you’re not maximizing the number of patients you’re seeing every day, for example, you’re giving yourself a pay cut, says Borglum. He estimates that for the average family practice, missing one fee-for-service visit per day amounts to roughly $15,000 in annual losses (assuming 210 days of patient visits at $72 a pop.)

His advice? Set productivity goals and get your staff on board. “If you’re looking for an extra visit per day, communicate that,” he says. “In the best practices, doctors meet with their receptionists, medical assistants, and billers once a week to talk about productivity and give them an opportunity to come up with their own ideas [to improve efficiency].” Any ideas the staff generates on their own will not only get better buy-in, but help motivate them to look for other ways to save.

Donna Weinstock, practice management consultant for Office Management Solution in Northbrook, Ill., notes bonus structures can help. “Employees don’t care enough because they don’t have an incentive to save the practice money, but if you put programs in place to encourage savings, it provides that motivation,” she says. Bonus systems come in all shapes and sizes. For example, you can give each staff member a flat dollar amount (from $10 to $50) for each day they increase revenue by a certain percentage. You can also reward staff for overhead cost reductions, or for squeezing in an extra patient per day. “Make it office-wide so everyone works together instead of giving individuals bonuses which makes it feel competitive,” says Weinstock.

Other ways to boost efficiency? Delegate all duties that do not require a physician’s license so the docs can focus on higher-reimbursement, more complex patient cases. Stop running up and down the hallway to fetch supplies or chase lab reports. That goes for everyone on staff, says Borglum. Don’t let nurse practitioners, who command a higher salary, tackle administrative tasks that lower-paid employees can handle. “Most solo and small-group practices don’t need licensed nurses, and if they have them, they under-use them,” he says.

Quit giving away business

According to Childs, many practices repeatedly miss out on income opportunities when they refer patients out for ancillary services such as pathology labs, ultrasounds, medical diagnostics, pharmaceuticals, and physical therapy. “If you’re referring something out all the time, stop to consider whether it’s something you can do in-house,” she says. “That’s income that you’re essentially losing.”

Indeed, new patient services can boost your bottom line significantly, partly because they allow physicians to charge both a professional fee for their expertise and a technical (or site) fee to compensate for overhead. How much? The Medical Group Management Association’s 2009 Cost Survey for Orthopedic Practices reveals orthopedic surgery groups’ realized net revenue (after operating costs) for physical therapy services of $96,420 per therapist. For MRI services, those groups realized $60,246 per physician, while diagnostic radiology brought in $42,791.

Yet, for all their profit potential, ancillary services are no panacea. Practices considering new product lines should first conduct a feasibility study by tracking their referrals over the last 12 months to gauge potential demand, says MGMA consultant Nick Fabrizio. They should also consider the competition from local hospitals and outpatient centers, and contact their largest payers to find out how much they reimburse for in-house ancillaries — since some payers contract exclusively with national labs.

More tips

Here are other key strategies for boosting your efficiency and saving money:

Keep score. To rid your practice of waste, of course, you first must find out where you stand. Cost survey reports from the MGMA and the National Society of Certified Healthcare Business Consultants provide a benchmark for average overhead costs, charges, collections, relative value units, and staff compensation. “You can use these yardsticks to determine if you’re within range,” says Childs. “It may confirm that you’re doing beautifully, but you need to know either way.”

Avoid undercoding. Borglum estimates many practices lose $50,000 to $100,000 a year in “pure cash profit” because they undercode. In some cases, they’re even aware that they’re doing it. “Most doctors undercode for fear of being reprimanded by Medicare, even if they know they’re right,” he says. “They’re deathly afraid of being audited, and they don’t want the hassle of being denied and having to appeal.” All doctors should keep handy a cheat sheet of the most common codes, and take coding classes several times a year to stay current. “You can delegate some of it to your staff, but no one else really knows what went on in the exam room and that may make the difference between a 99213 and a 99214,” he says. If you feel your practice chronically undercodes, or inaccurately codes, which is just as costly, hire an independent consultant to conduct an analysis of your coding history. “You can also just swap with a colleague across the street and ask them to look at 10 of your codes and you look at 10 of theirs,” says Borglum.

Go easy on overtime. Overtime is another cardinal sin in medical practice management. Paying staff members 150 percent of their salary even a few times a week can amount to a major drag on your bottom line. If you find yourself repeatedly falling into the overtime trap, consider whether inefficiencies or inadequate staffing are to blame. Bear in mind, too, that the doctors in your practice may be contributing to overhead excess as well. “This happens when doctors don’t stay on schedule or fail to delegate tasks that cause them to get off schedule,” says Judy Capko, a healthcare consultant and author of “Secrets of the Best-Run Practices.” “This can result in a substantial increase in what is already the biggest expense on the income statement.” Track overtime closely, she advises, and evaluate the causes behind it so they can be remedied in short order. You might just find it’s cheaper to hire another part-time or full-time staff member, which has the added benefit of relieving your overworked team.

Consider outsourcing. Your practice administrator may spend untold hours helping your staff manage their 401(k) issues, insurance benefits, and payroll problems — complex topics in which they often have limited expertise. Consider outsourcing, which can save your practice big bucks even after the 2 percent to 3 percent administrative fee you’ll likely pay. “One practice I worked with saved $52,000 a year by outsourcing their employee benefits, and they were also able to deliver better benefits at a lower cost to their employees, including long-term disability insurance,” says Rosemarie Nelson, an MGMA consultant. “Very few administrators can be experts in finance, and HR, and clinical purchasing, and everything else. This creates an opportunity for your administrator to delve more deeply into things like billing relationships and new-patient products that can really deliver benefit back to your practice.” You can outsource your benefits piecemeal or in full. “It’s such a chore every year at open enrollment time to go out and shop these plans and put together a benefit plan which may or may not include eye care, or dental coverage, or prescriptions,” says Nelson. “All of that time spent researching plans is a wasted resource.” And worse, your administrator may dread the process so greatly that she’ll pay the higher annual rates just to avoid shopping for new coverage.

Collect those copays. You’re leaving cash on the table if you don’t collect copays before each patient visit. (Failing to do so is also a violation of your payer contracts.) Post a sign in your office to alert patients that all copays must be made before they will be seen and make sure your staff follows through. The minute patients walk out your door, that $20 copay becomes cost-prohibitive to recover — requiring more in resources (staff time and postage paid) to collect than it’s worth. In many cases, copays can be the difference between being profitable and non-profitable on a procedure.

Make use of your technology. Just because you invested six figures on high-tech upgrades doesn’t mean you’re efficient. It doesn’t even mean you’ve made an improvement. Without proper training and a commitment to implementation, you’re not only wasting the money you spent to purchase the product, but you’re denying your practice the opportunity to reap the rewards. “I equate this to going shopping at one of the big discount warehouse clubs and buying large, economy-size products because they’re such a bargain, and then having to throw away half the box because you can’t use it all,” says Nelson. “You pay more by using less.”

Staff training is critical if you are to get the most from your new EHR system, e-prescribing software, or practice management product. “I work with one primary-care group that can’t keep up with their referrals so they end up hiring a temporary person, which gets them caught up for awhile, but then they fall behind again,” says Nelson. “It’s because their staff person spends all day on the phone trying to get authorizations. When I told them they could do this all online they said they like to talk with a live person, but they usually end up leaving messages anyway.”

It’s the same with lab results, Nelson adds. “Almost every imaging group in the country has their reports available online because it’s fast and efficient, but we don’t train our nurses how to get them, so everything takes two to four minutes longer.” If it’s something your nurses are doing 10 times a day, that’s 40 minutes they could save by doing it all online, which would make them available to support the providers and see another patient.

Become a landlord. If you’ve got available space, or even an empty room, you might also consider taking on tenants to help defray overhead costs. At Atlanta Orthopedic, Solinsky says his practice subleases space to a chiropractor and a podiatrist who work part-time, they not only share their space, but his staff. “We have an extra room where we keep a chiropractic table when he’s here, which is a source of income for the practice,” says Solinsky, noting they also sublease space at their newest building to a rheumatology group that operates independently with their own staff. “We sometimes refer our arthritic patients to them,” says Solinsky, noting such subleases must be done at fair market value to avoid running afoul of Medicare and Stark laws.

In a rising cost environment marked by declining reimbursement, physicians can no longer afford to tolerate waste. By scouring your practice for opportunities to drive revenue and reduce expenses, your practice will be far better positioned to weather the economic downturn and whatever else regulators and third-party payers throw your way. “Look for everything and don’t be afraid to ever put anything out for bid,” says Solinsky. “It takes a little time, but in this economy every dime is worth a dollar.”]]> http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/1445.htm Mon, 25 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1141 Medicare
When asked to rate their satisfaction on a 10-point scale, 87 percent of patients in the study gave their doctor of chiropractic a level of 8 or higher. What’s more, 56 percent of those patients rated their chiropractor with a perfect 10.

Contributing to that satisfaction was the attention given to patients’ needs and the accessibility of chiropractic care. Patients reported that doctors of chiropractic listened to them carefully and spent sufficient time with them. Some 95 percent said they had to wait no longer than one week for appointments.

“Doctors of chiropractic everywhere should feel pride in these patient satisfaction results and in being part of a profession that still sees the great need for spending time with patients and truly listening to them,” said Dr. Rick McMichael, president of the American Chiropractic Association (ACA). “It’s clear that patients deeply value the time their chiropractic providers spend with them and the expert care that DCs offer.”

The pilot, known as a “demonstration project” in Congress, was conducted from April 2005 to March 2007 throughout the states of Maine and New Mexico, and also in Scott County, Iowa, 26 counties comprising the Chicago metropolitan area, and 17 counties in central Virginia.

Current chiropractic coverage under Medicare is limited to spinal manipulation. Under the demonstration project, however, chiropractic care was expanded to include diagnostic and other services, such as X-rays, examinations, physical therapy and rehabilitation services.

The final report to Congress also includes information on the costs of expanding chiropractic services in the demonstration sites. The report indicates that in all but one of the demonstration sites, patients’ health care costs were not significantly changed by expanding coverage of chiropractic services. In contrast, a cost increase was found in the Chicago metropolitan area. Further research into the reasons why the results in Chicago differ from the rest of the demonstration project sites is needed to better understand these findings.

“We already know that Medicare costs in general tend to be higher in Chicago than other similar areas of the country. We must find the underlying cause of the cost difference found in the chiropractic demonstration project and determine whether it had anything at all to do with the expansion of chiropractic services,” Dr. McMichael noted.

To further analyze the results of the demonstration project, ACA is creating a taskforce of Medicare experts and researchers who will review the report and develop a response for the Centers of Medicare and Medicaid Services.

To view the report online, visit www.acatoday.org/pdf/demo_report.pdf.]]> http://www.acatoday.org/press_css.cfm?CID=3762 Tue, 26 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1142 Practice
The Housing Assistance Tax Act of 2008 requires companies that process electronic payments to gather data on these transactions in 2011 to report them to the IRS in 2012.

According to proposed regulations issued by the agency Nov. 23, 2009, small businesses, including medical practices, that collect at least $20,000 of revenue by way of credit or debit cards or carry out at least 200 of these types of transactions will receive a 1099-K form from their processor.

The forms, which will need to be provided to the IRS, are similar to the various 1099s that medical practices receive from insurance companies.

Electronic payments would have been reported previously as cash. This new requirement was taken as part of the agency's efforts to ensure that business tax returns do not miss any income.

"The new law gives us an important new tool for closing the tax gap and also provides business taxpayers better documentation to compute and report their income and expenses," said IRS Commissioner Doug Shulman, in a prepared statement. "The IRS will work closely with stakeholder groups to ensure a smooth implementation of this new program."

Experts say that those who fill out the tax forms for medical practices need to ensure that the total income reported to the IRS is greater than or at least equal to that collected electronically and tracked on this new form.

"This change should not really affect honest practices at all," said Gary Bode, a certified public accountant in Wilmington, N.C., who specializes in working with medical practices.

The IRS has scheduled a public hearing on the implementation of this change Feb. 10 in Washington.]]> http://www.ama-assn.org/amednews/2010/01/25/bisc0127.htm Wed, 27 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1143 EHR
First of all, the devices themselves are better. And, healthcare providers have more choices than ever before (I have four Tablet PCs on my desk right now). There are excellent Tablets available from most major manufacturers including ones made expressly for clinicians such as the devices offered by Motion Computing, Panasonic, Tablet Kiosk and other vendors.

Of course, it’s not really so much about the device as it is what you can do with it. First and foremost, these are full-function computing and productivity solutions (unlike that shiny new Apple). Tablet PCs more closely mimic the familiar patient chart. They can be used, digital pen in hand, without feeling intrusive in the physician-patient encounter. They accommodate multi-modal data input including keyboard (when docked), digital inking, point and click, voice and even touch including multi-touch with Windows 7. The inherent speech engine in Windows Vista and Windows 7 is so good, it is even possible to do excellent speech recognition dictation if you are willing to put in a little effort up front. When connected wirelessly to a corporate network or the Internet, Tablet PCs provide instant access to the information you need, when and where you need it. They can also run all of the other applications you might want to use in your office or home.

All of this functionality hasn’t been lost on clinicians. Just yesterday I was contacted by Dr. Alan Rosenbach. Dr. Rosenbach runs a very successful solo dermatology practice in the Los Angeles area. He called me because he wanted to share his enthusiasm for his Tablet PC running Microsoft Office OneNote. He said for the last three years, he has been using OneNote as the official EMR for his office. He does all of his chart notes and tracks all of his patients with OneNote. He uses a Tablet PC from Fujitsu. He makes extensive use of digital inking for both data entry and illustrations on clinical findings. He also embeds photos in his patients’ “charts” and attaches transcriptions and other documents to each patient’s record. Most remarkably, he says, OneNote has never gone “down” for even a second. And of course, he loves the low, low price.]]> http://blogs.msdn.com/healthblog/archive/2010/01/27/a-right-sized-emr-tablet-pc-microsoft-office-onenote.aspx Wed, 27 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1144 Legislation EHR
But what does this new IFR mean to EHR certification? Join Kris Rebillot as she examines the impact with CCHIT Chair Mark Leavitt, MD, PhD, and CCHIT Executive Director Alisa Ray.

Listen to 4-minute podcast here.]]> http://www.acatoday.org/press_css.cfm?CID=3762 Thu, 28 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1145 Health Information Exchange
The SSA and MedVirginia, a health information exchange organization, went live with the collaboration in February 2009 by using the Nationwide Health Information Network (NHIN) to perform the exchanges. MedVirginia gets its data from various health plans and hospitals in the state. IBM Corp. is the contractor assisting with the project.

The goal was for MedVirginia to electronically share patient medical data with the SSA to help the agency make disability support determinations. The exchange has reduced by almost half the processing time for such rulings, from 84 days to 46 days, a news release said.

The increased speed for making determinations resulted, in many cases, in more disability income that provided additional revenue to health plans, hospitals and other care providers using the health exchange, wrote the authors of the SSA study, which was released on Jan. 26.

“This is revenue that the facility would not necessarily collect otherwise. These data are suggestive of one area of potential provider value in using the NHIN for the exchange of medical information with SSA for disability determination,” wrote Sue Feldman and Thomas Horan of the Kay Center for e-Health Research, Claremont Graduate University.

Some of the revenue generated is considered a recovery for care that otherwise would have been uncompensated, the report said.

“The practical side of uncompensated care cost recovery was described by an interviewee from MedVirginia as a patient who ordinarily would not have generated any revenue, but because of a benefit determination that resulted in health benefits (Medicare or Medicaid), did generate revenue,” the report said.

The SSA-MedVirginia collaboration faced two major technical challenges, the authors said. The first was achieving interoperability between MedVirginia’s clinical repository system and its gateway to the NHIN. Initially, MedVirginia used a proprietary gateway, but it reconfigured the system to conform to the Federal Health Architecture’s open source Connect gateway several months into production. The decision to change was made because Connect was viewed as a more sustainable model, the authors wrote.

The second technical challenge was identifying a technical standard that would accommodate an image of an authorization form.

Editors note: MEDfx and NHIT have been key participants in developing solutions for MedVirginia.]]> http://fcw.com/articles/2010/01/28/medvirginia-ssa-nhin-pilot-project.aspx Thu, 28 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1146 Healthcare Technology
While state data breach notification requirements are prevalent, only two states (California and Arkansas) have specified medical information in the definition of "personal information." In addition, the HIPAA security standard only denotes encryption as "addressable," meaning HIPAA-covered entities need to evaluate encryption as a security option and document their decision.

As a result, thousands of healthcare-related businesses are finding themselves struggling to keep pace with the rapid implementation of the HITECH Act breach notification requirements and safe-harbor provisions. The Act itself is complex, with multiple references to multiple guidelines and rules in multiple copies of the Federal Register, leaving health care providers, insurance companies and their business partners working hard to find accurate information about what they must do.

Understanding your options

The HITECH Act was enacted in February 2009 as part of the American Recovery and Reinvestment Act. While the thrust of the legislation was to improve the health care system by providing federal support for moving to electronic patient health records, legislators were also careful to ensure that provisions were included to promote efforts geared toward ensuring confidentiality and privacy of patient health data. In addition to data breach notification requirements for all HIPAA covered entities, the HITECH Act also extended HIPAA requirements beyond the traditional covered entities of "payers, providers and clearinghouses" to their business partners.

To navigate this new maze of requirements, this list of a few simple rules will help health care organizations get started in understanding their options, risk and requirements.

1. The only way to eliminate the breach notification requirement is to encrypt or destroy the information:
• The Department of Health & Human Services (HHS) released guidance in August 2009 that states the only two ways to protect information is to encrypt or destroy it, leaving encryption as the only available method to gain safe harbor.

2. Update your information -- encryption has gotten easier but it requires a strategy to keep it simple:
• Encryption for enterprise systems has experienced numerous technical advances since the HIPAA security standard was finalized in 2003. Today, it is possible to secure information without large performance, application re-architecture or management costs. However, without creating a forward-looking strategy prior to adopting encryption, you can easily create a large amount of encryption management complexity. HIPAA covered entities and their business partners should ensure that focus is placed on learning the benefits and challenges of different encryption approaches, getting updated on the state of the art of encryption today and understanding what they are getting into from a key management perspective before they deploy.

3. There is real risk to patient health data beyond lost laptops:
• In 2008 and 2009, there were multiple large scale security breaches of patient health data, with the largest impact breaches resulting from both internal and external attacks on database and file servers. When devising your personal health information encryption strategy, ensure that you cover information repositories both in the data center and in distributed environments.

4. Determine your risk appetite:
• As previously mentioned, only two states included patient health data in data breach requirements, but the early results are staggering. In the first five months after health care data breach notifications were required in California, 800 cases were reported. This indicates a high probability of data breaches for health care organizations that do not encrypt their patient health data. In addition to breach notification costs, customer loss, class-action lawsuits and brand damage are costly effects of data breach disclosure. As your organization evaluates the cost of encryption, be sure to include the cost of notification, cost of customer loss, cost of potential class-action lawsuits, cost of remediation and cost of potential fines in your return-on-security-investment model.

5. The HIPAA compliance impacts are uncertain, but expect pressure from public outcry:
• While the HITECH data breach notification requirements are new, there is certainly enough history of how data breach notifications impact regulatory compliance measures. While data breach disclosure laws typically do not require any proactive security measures, publicity resulting from data breaches exposes weak security measures and almost always catches the attention of regulatory bodies that do in fact require security. In short, it's best not to look at HITECH data breach notification requirements in a silo, but to understand that other regulatory compliance measures being scrutinized as a result is a highly probable impact. HIPAA may have been lightly policed in the past, but expect the combination of public data breaches and funding for regulation to create some change.

6. If you haven't reviewed your documentation on the "addressable" HIPAA security requirement of encryption yet, do so now:
• When the final HIPAA security rule was published in 2003 after years of debate, data encryption was an "addressable" requirement. Addressable requirements for the HIPAA security standard mean that an organization needs to evaluate whether or not it should meet that requirement, make a determination, document the determination and implement the decision. Due to light policing of the HIPAA security standard and lack of manageability of encryption solutions based on the state of the art in 2003, most organizations chose not to encrypt. For all the reasons stated above -- technical advancements, public data breaches, demonstrated risk -- organizations should immediately undertake the project to revisit their decision of encryption as an addressable requirement.

Summary of provisions:

• Before the amended California breach statute took effect on Jan. 1, 2009, only Arkansas included medical information in the definition of "personal information" triggering breach notification obligations.
• Breaches of medical information that did not involve financial information often went unreported.
• California amended statute to include both "medical information" and "health insurance information" in 2008.
• The HITECH Act imposes breach notification requirements on all HIPAA covered entities, business associates, personal health record (PHR) vendors and PHR-related entities.
• For HIPAA covered entities and business associates: HHS issued its interim final rule on Aug. 24, 2009, effective Sept. 23, 2009.
• For PHR vendors and PHR related entities, the Federal Trade Commission (FTC) issued its final rule on Aug. 25, 2009, effective Sept. 25, 2009. (Note that the FTC will use its "enforcement discretion" and full compliance will not be required until Feb. 22, 2010.)]]> http://health-care-it.advanceweb.com/features/article-4/the-implications-of-hitech.aspx Fri, 29 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1147 Practice
After graduation, I decided to forgo the boxing gloves or pretending to be a therapist. Meeting anger with anger escalates the encounter, and I cannot instantly change a patient’s ability to handle stress. Instead, I now try to meet patients in the middle through negotiation, realizing that spending an extra five or 10 minutes with an angry patient may save the day’s schedule in the long run.

If I could write a primer on “handling angry patients,” it would go something like this:

• Keep your perspective straight. The anger usually isn’t about you — even if the patient believes it is.

• Assess your safety. Do you need a witness? Should you leave the door open? Is this a matter best handled by security or the police?

• If at all possible, sit. Sitting tells the patient you have all the time in the world to solve this problem (although we all know you do not).

• Acknowledge the anger. “I feel like you are angry,” is an honest way to start the conversation. Alternatively, “I feel our communication has broken down” can help the patient feel heard and steer the conversation toward resolution and not just go-nowhere venting.

• Get to the real source of concern. Did the nurse have to stick the patient three times for venous access? Is she afraid she will die? Probe gently but persistently to get to the core issue.

• Then, stay silent and listen. The complaint may be 100 percent valid, completely insane, or — more likely — somewhere in between. But you won’t know unless you let the patient talk.

• Ask what he would like for you to do; then negotiate. If he demands high-dose narcotics, offer him a milder analgesic that makes you more comfortable. If he demands instant test results, offer to call and find out when the final report may be available. Don’t do anything medically unreasonable or inappropriate. You are, after all, the doctor.

• Offer an alternative outlet. Depending on the issue, you may not be the appropriate person to resolve your patient’s anger. The office manager can often help the patient feel her concerns are being addressed.

• Once again, remember that the anger isn’t about you…most of the time anyway.

In the end, some patients won’t be pacified. They may, indeed, need cognitive therapy to work through their issues, but unless you are a psychiatrist, that’s not for you to address in a 15-minute time slot. Staying calm and focusing on resolving the problem will serve both you and the patient best.

Afterward, I recommend you treat yourself to a little pampering — a mani-pedi, an hour at the driving range, or whatever “pampering” means to you. Why? Because you can count on another angry patient in a few days, weeks, or months, waiting to tell you what-for. Be ready by keeping your emotional reserves fully charged.]]> http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/1453.htm Fri, 29 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1148 Practice
The good news is that you don’t have to don a clown suit to make them smile. Mostly it comes down to respecting your patients as people with names and schedules and worries. Here are seven small but mighty ways you can make your patients happy they chose your practice:

1. Be on time.
Nothing makes patients feel more frustrated than still being in your waiting room 30 minutes after their appointment time or spending 15 extra minutes waiting in a thin gown in an exam room. Feeling like you respect their time by keeping on schedule is sure to please your patients. Plus, for you and your staff, it relieves the stress of constantly apologizing to irritated patients for your lateness.

2. Enter the exam room prepared.
It is comforting for patients to feel like they are not a number, that they will be heard and cared for. That comfort is lost when you come into the exam room and have to look in the chart or laptop for the patient’s name and reason for the visit. Take that extra minute before you walk into the exam room to review the chart so you can greet the patient by name and show awareness of his symptoms.

3. Follow-up and communicate.
If your patient has had lab work or testing, was referred to a specialist, or presented with significant symptoms, make time to call her to follow up. See how she’s doing and report on any lab or test results. This helps patients feel secure that your practice is concerned about their health and didn’t forget them as soon as they left the office. Your staff can help with follow-up calls as well.

4. Offer a little reassurance.
Perhaps your patient has just received her diagnosis and is armed with a slew of questions and confusions about her condition. It can feel lonely and overwhelming. Take a minute to acknowledge that and reassure her that she’s not alone. Remind her that you and she are a team, and together you can work to find the right treatment options.

5. Don’t forget the small talk.
If you’re running behind schedule, you may be tempted to rush through a visit, but don’t telegraph that desire to your patients. Take a few minutes to chat with each patient. Try breaking the ice with chitchat about the weather, the holidays, his family — something other than the information in the chart. The exchange will put your patient at ease, and he will surely appreciate the friendly — and human — approach.

6. Give your waiting room some TLC.
Ever taken a good hard look at your waiting room? It might be worth adding a few extra touches to bring a smile to your patients’ faces. Consider adding a kids’ corner stocked with games, toys, and books. Update your magazines. Add a live plant or two. It’s also a nice gesture to have a couple dispensers of anti-bacterial gel available, especially around flu season.

7. Set a friendly tone.
Treating your staff with kindness will encourage them to do the same with each other and with patients. Dole out the smiles and friendly gestures to set a tone for the office. Have front desk staff greet patients upon arrival, as well as maintain politeness and patience over the phone. Smiles from you and your staff will reap smiles from your patients and keep them coming back.]]> http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/1451.htm Fri, 29 Jan 2010 09:01:00 MST http://www.primarydatacorp.com/#1149 Practice
"It helps to cover the costs," said Dr. Fuisz. "Subleasing has many benefits to our practice."

Physicians sharing space with physicians or other health care professionals is not a new concept. But those in the medical office real estate business say interest in subleasing is growing. The transition to electronic medical records is leaving empty rooms where paper charts were once stored. Also, declining reimbursements and recessionary pressures are leading physicians to seek ways to reduce fixed costs.

"I've seen more physicians looking to keep their overhead down and looking to sublet their space out or looking to sublet space from other physicians," said Paul Wexler, president of Corcoran Wexler Healthcare Properties in New York. "It makes a lot of sense for people on both sides of the transaction."

This means physicians increasingly are taking in the professional equivalent of a roommate. And like with a roommate, the best match will be someone whose activities mesh with your own.

"You want someone who will be complementary to the practice," said Tim Rorick, senior managing director of FirstService Williams Commercial Real Estate in Stamford, Conn. "An orthopedic surgeon could rent space to a physical therapist, but you don't want a pain-management physician right next to a pediatrician."

Expansion potential

There is potential for conflict when the renter serves a patient population that has different needs and behaves in different ways. But when that population meshes with your own, the arrangement can not only provide a financial boost to the practice, but also can make it easier for patients to access recommended care. For instance, Dr. Fuisz rents space to a podiatrist and a cardiologist, and offers her patients the option of being referred to these physicians. "It's really very convenient for patients," she said.

Such arrangements should not run afoul of various state and federal anti-kickback statutes as long as the rent paid is comparable to that for similar spaces in the area, and there is a written, signed lease lasting at least a year, experts said.

Physicians are allowed to charge a subtenant for both the cost of the actual office space and use of the common areas, but the size of the space and the time allotted need to be fixed. For example, an arrangement that allows a physician to use an office every Wednesday for eight hours, paying the same rent no matter how many patients are seen, is generally considered legal. One in which the hours vary widely or the rent is well above or below the cost of similar spaces would not.

"There are a lot of compliance issues you have to be aware of when you have a referral relationship," said David Biehl, a partner/director in the law firm Garfunkel Wild in Great Neck, N.Y., who has advised physicians on these types of deals. "The most important issue is that the cost of the space has to be at fair-market value. You cannot underpay. You cannot overpay."

Physicians who refer patients to subtenants are not required to offer information about the arrangement. But because of regulations governing referrals, it may be prudent. "It's good practice to avoid the appearance of impropriety," Biehl said.

Referrals are one way that leasing a portion of another physician's office space can offer the potential to expand the patient population. Cross-coverage is another.

Ari Weitzner, MD, an ophthalmologist in New York, had his own office for several years. Because his surgery schedule meant he wasn't in the office every day, he looked for another ophthalmologist to share his space.

During his search, he found other physicians in the same situation and decided to be the renter instead. He now subleases space in Manhattan and Brooklyn several days a week. He shares receptionists but has his own office manager. He also sees patients of his physician-landlords when they are not available.

"It really reduces your overhead," said Dr. Weitzner. "And sharing space with someone in your specialty increases your patient load."

Getting down to logistics

Experts say the first step for physicians looking to sublease space is to read the original lease agreement and determine if this is allowed. Some contracts prohibit the practice; most require that the property owner or manager be informed.

There also may be limitations on who may sublease the space. A hospital that owns a medical office building, for example, may spell out the type of health care professionals it will allow.

"Physicians really have to be very knowledgeable about what their current lease says," said Donna F. Jarmusz, senior vice president of the health care real estate developer Alter+Care in Skokie, Ill.

The next step is to determine the structure of the subtenant arrangement. Will the subtenant have access to a specific room 24 hours a day, seven days a week? Or will use be limited to predetermined hours and days?

For instance, Dr. Weitzner is only in his offices when the other physician is not. The cardiologist and the podiatrist at Dr. Fuisz's practice occupy the same office at different times.

Those looking to rent space also need to consider what other services will be provided. What equipment will subtenants be allowed to use? Will staff be shared? Dr. Fuisz's staff greets patients for the cardiologist and the podiatrist, but the subtenants handle their own appointment schedules and billing.

"You want to be very clear about what is included," Dr. Fuisz said.

There's also the important question of the type of health care practitioners who will work well together. For example, Dr. Weitzner prefers to share an office with others in his specialty. "I need such specialized equipment."

Dr. Fuisz is looking for health care professionals who could serve her patient population, such as a dermatologist or another internist. She would also like to share space with a psychiatrist so patients could access mental health care without the possible stigma attached to a dedicated facility, but she is not convinced her office is quiet enough to be suitable.

A pediatrician, on the other hand, would not be a good fit, she said. Her patients would see little benefit, and might not appreciate children in the waiting room. "We're sort of adult-centric."

The waiting room issue raises another consideration. Can the space accommodate additional patients that a new professional may bring in?

After those questions have been tackled, the search for office mates can be conducted through professional networking or advertising in local medical society newsletters. Realtors who specialize in medical space should be able to help. Dr. Weitzner also launched a for-profit Web site called ShareMedicalSpace.com in October 2007 to facilitate matches.

Check out your match

Once a connection has been made, due diligence is important. Both parties should check references and ask about professional reputations.

If one party does not pay rent, everyone involved can be left in a difficult situation. It can require legal action to oust a subtenant who does not pay rent. And a subtenant who has paid rent can be evicted along with a landlord who has not.

Most physicians who sublease their space charge a one-month deposit and collect rent from their tenants monthly.

More common than payment issues, however, is subtenants spreading throughout the office.

"We call that 'scope creep' or 'space creep.' It's like water that spreads into the space available," said Bill Lichwalla, president and CEO of real estate consultants Plante Moran CRESA, based in Detroit. One solution may be increasing the rent as more space is being used. "It's so important to have really good expectations memorialized in a sublease agreement."

Subleases should not be written for a longer span than the original lease covers. In addition to spelling out what the rent includes, the sublease should also outline how the contract can be terminated. Most involved in these arrangements suggest a one- to four-month notice that allows for a fairly easy exit.

"My feeling is: If I'm not happy or the other doctor is not happy, we do not need to do this." said Charles Bier, MD, a solo internist in Washington, D.C., who is looking for fellow internists to share his 3,000 square-foot space and replace a subtenant who left.

Dr. Bier is also considering the possibility that subleasing can be a first step to a more involved financial relationship. He'd like to find someone younger with whom to partner and then take over his practice when he retires.

Some of the physicians who have responded to Dr. Fuisz's ad have the potential to become partners in the practice, and finding a new one is her eventual goal.

"If the right physician were to come along, my preference would be for them to join the practice," said Dr. Bier. "That would be great, but, to start out, they will simply be subletting."

Looking to rent out space?

• Read your original lease to determine whether subleasing or sharing space is allowed.
• Decide what parts of your office you want to lease and for what periods of the day or week.
• Publicize your need for a subtenant through professional networking, medical society publications or various Web sites.
• Find a physician or other health care professional who could benefit your patient population.
• Have a written sublease agreement that lasts at least a year.
• Charge fair-market rent.
• Determine what additional services will be provided.
• Spell out how the contract can be terminated if necessary.
• Check a potential subtenant's references.
• Inform patients referred to a subtenant of the nature of the relationship.

Looking for space to rent?

• Look for an office through professional networking, medical society publications or various Web sites.
• Find a space that will be available for the hours you need.
• Pick a location that will allow you to expand the patient population you can serve.
• Assess whether your practice will fit in with the one already in the space.
• Sign a written agreement that lasts at least a year.
• Ask what additional technology or administrative services will be provided.
• Ensure the contract can be terminated easily if necessary.
• Check a potential sublandlord's references.
• Call the building landlord to ensure that the physician subleasing space to you is up to date on his or her payments.]]> http://www.ama-assn.org/amednews/2010/02/01/bisa0201.htm Mon, 01 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1150 PQRI Key Points

• One way to submit PQRI data is to add the appropriate PQRI measure to the service claim when it is submitted. The second submission method is to use a PQRI registry.

• Some PQRI measures reported for 2010 will require submission through a registry, so now may be a good time to evaluate that process.

Q: Our multi-location primary care practice has been attempting to submit our Physician Quality Reporting Initiative (PQRI) data with each encounter. We have devised a PQRI sheet and attach a copy to each encounter form to make it easier for our physicians to mark the measures appropriate to visits. Also, we have educated our providers and support staff about group measures specific to our specialty. Nonetheless, an internal audit elicited that we probably are missing data for 40% to 50% of our encounters. The codes are either missed at submission or are not picked up by the carrier. Can we resubmit the claims with the appropriate PQRI information? If so, what is the time limit for submitting 2009 data?

A: Two types of PQRI measures exist, and there are two ways to submit them. Individual measures are quality measures that may be a part of a group measure. Specialty practices more often, but not always, submit individual measures rather than group measures. Group measures address groups of quality measures for a particular diagnosis.

An example of a group measure is diabetes mellitus. Some of the measures applying to diabetes are an HgA1c level checked at regular intervals, with results falling into specific value ranges; monitored and controlled blood pressure; and having a dilated eye examination every year to check for diabetic retinopathy. Those measures all are connected to the diagnosis of diabetes, but some of them may be reported individually by specialty providers such as endocrinologists or ophthalmologists.

One way to submit PQRI measures is to add the appropriate measure to the service claim when it is submitted, as you have been attempting to do. The second submission method is to use a PQRI registry.

With claims-based reporting, the window of opportunity to submit the PQRI measure ends when the claim is submitted. No opportunity exists to resubmit the claim with the correct PQRI information attached unless the carrier has failed to pick up the measure or its "claims scrubber" eliminated the entry because of a "0" charge and you can document that it was submitted correctly.

A registry may be able to scan your data if you are using electronic medical records and have the opportunity to "correct" a claim for missing PQRI information before the system sends the file to CMS electronically for the year.

The number of registries has more than doubled in the past year, from 32 to 74. Not all registries are equal, however. Some report both individual and group measures, whereas others report only one or the other. All charge a fee.

The Centers for Medicare and Medicaid Services (CMS) requires that registries be qualified and has posted a list of qualified registries for the 2009 PQRI at http://www.cms.hhs.gov/PQRI.

Some PQRI measures reported for 2010 will require submission through a registry, so now may be a good time to evaluate that process.

Same-day Consultations

Q: Our ophthalmology group has several subspecialists. We are having problems getting reimbursed for multiple consultations on the same day. For instance, a glaucoma specialist may evaluate a patient for suspected glaucoma (a consult request from an optometrist) and during that evaluation may see a suspected retinal tear. Our retina specialist's claim for a consultation will be rejected if he sees the patient on the same day as did the glaucoma specialist. Any suggestions?

A: CMS does not recognize certain subspecialties. The agency considers retinologists to be ophthalmologists and, therefore, will not recognize multiple consultations on the same day. After January 1, CMS does not plan to recognize consultations either in an inpatient or outpatient setting.]]> http://medicaleconomics.modernmedicine.com/memag/Modern+Medicine+Now/How-to-decipher-PQRI-protocol/ArticleStandard/Article/detail/644705 Mon, 01 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1151 Practice
This embrace of technology could bode well for the coming push to adopt electronic medical records. "We find that those physicians connecting with their patients online are more likely to be accessing the Internet during patient consultations and using various forms of health IT across the board," Manhattan Research's director of research, Erika S. Fishman, says in a company statement. "As we work to remove the barriers to physician adoption of online communication with patients, and each party becomes more comfortable with exchanging health information online, we could see a parallel movement in use of electronic medical records and personal health records."

Among specialty physicians, dermatologists and medical oncologists are the most likely to communicate online with patients. Neurologists, endocrinologists and specialists in infectious diseases also have relatively high rates of electronic communication.]]> http://www.fiercehealthit.com/story/report-more-physicians-communicating-online-patients/2010-02-01 Tue, 02 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1152 EHR
The CDC's National Center for Health Statistics said an estimated 43.9% of doctors are using full or partial EMRs, up from 34.8% in 2007 and 41.3% in 2008. The use of what was described as "fully functional" systems also went up from 3.8% in 2007 and 4.4% in 2008, to 6.3% in 2009. The survey did not include systems used for billing.

Experts said the survey showed that while more physicians are embracing health information technology, it's not a full embrace. Doctors are starting slowly, with individual functions such as electronic prescribing.

"There's definitely progress and the question is, is it fast enough," said Anne-Marie Audet, MD, vice president for the Program on Quality Improvement and Efficiency at the Commonwealth Fund. The organization's own study of physician EMR use, released in November 2009, found usage rates similar to the CDC study.

Experts don't expect the numbers found in the CDC study to accelerate significantly, despite the presence of a maximum $44,000-per-physician tax incentive through the American Recovery and Reinvestment Act, and other incentives from Medicare and Medicaid set to begin in 2011.

More than 20% of physicians have a basic EMR system; about 6% have a fully functioning EMR. "One thing the stimulus has done is it's gotten [the vendors] a lot more phone calls," said Bruce Carlson, publisher of Kalorama Information, a market research firm in New York that focuses on health information technology. "A lot of questions, but only a limited amount of buying."

Carlson said barriers to adoption for physician practices, including a disruption to work flow and a preliminary loss of productivity, are so strong that "the stimulus alone is not going to push the issue." But vendors are creating systems that will produce a quicker return on investment, which is more of a motivator than the incentive funds, he said.

Carlson said many physicians have adopted EMRs because they were attracted to relatively simple functions such as e-prescribing and computerized physician order entry. Generational and geographic factors also play into whether a physician adopts a system, experts said.

That explains why there is a large gap between the percentage of doctors who reported having an EMR system and the percentage of physicians who said they have only what is defined as a basic system -- one that includes patient demographic information, patient problem lists, clinical notes, prescriptions orders, and lab and imaging results.

For example, only 20.5% of office-based physicians had what the CDC termed a basic system. That was up from 16.7% in 2008 and 11.8% in 2007. A fully functional system, which still hasn't reached a double-digit percentage of doctors, has everything that a basic system includes, plus more, such as warnings of drug interactions or contraindications, medical history and follow-up, and orders for tests.

Impacts on adoption

Dr. Audet said many office-based physicians have been persuaded by various research showing that EMRs could make billing more efficient and drive up revenue. Adding to the financial benefits were reimbursements for quality reporting and e-prescribing for Medicare and Medicaid patients, she said.

With government incentives starting in 2011 for EMR use, adoption rates are expected to rise, said Chun-Ju Hsiao, PhD, a researcher who helped write the CDC study.

Kalorama's Carlson said incentives will have an impact but won't be the primary driver that will close the gap between those who use EMRs and those who don't. And, he said, the incentives will have even less of an impact on closing the gap between basic and fully functional EMR use.

A December 2009 report by the market research firm, which interviewed health IT vendor executives, found that the market for EMRs was $12 billion in 2008 and is expected to rise to $25.4 billion by 2013. But the majority of the increase represents sales to hospitals.

A trend of practices being purchased by hospital groups that buy, or heavily subsidize, EMR systems for the practices has helped push physician adoption, experts said.

Many experts have said that even with the incentives, the cost of a system -- and the loss of revenue a practice can expect when installing and adjusting to it -- still have many physicians believing an EMR is an expensive investment with little return.

Dr. Audet agreed that incentives are not going to lead to an overnight interest in adoption. But that doesn't mean they won't be effective.

"If we only see a 10% increase in adoption during the first wave of incentives," she said, "I don't think we should say, 'Well, this is a failure.' Actually, it would be pretty good. But it's going to inform the next wave."

EMR use by physicians

While overall use of electronic medical records has increased, office-based physicians are using them in limited ways, according to a survey by the Centers for Disease Control and Prevention. "Overall use" includes anyone with an EMR. "Basic system" means one with a minimum of six certain functionalities. "Fully functional" means a system with functionalities beyond a basic system.

Note: 2009 numbers are estimated. Other years' numbers are based on response to mail and in-person surveys.

Source: National Ambulatory Medical Care Survey, National Center for Health Statistics, Centers for Disease Control and Prevention, released December 2009.]]> http://www.ama-assn.org/amednews/2010/02/01/bil20201.htm Tue, 02 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1153 Healthcare Technology
With all the noise around HITECH during the past year, it would be easy to miss a number of major issues-all affecting provider revenue streams-coming up fast in the electronic data interchange arena. For instance, the Jan. 1, 2012, compliance date for the HIPAA 5010 transaction sets for claims and related transactions is less than two years away. But the Department of Health and Human Services expects providers and payers to be done with internal testing by the end of 2010. Necessary software purchases need to be made by mid-2010. Providers also this year need to analyze the affect of the changeover on business processes. They also need to talk with vendors and insurers about their schedules for internal mediation and external testing.

There's a lot of work to get ready for 5010 and it doesn't all fall on claims management software vendors and clearinghouses, says Larry Watkins, managing consultant at Ingenix Consulting, a unit of revenue cycle management vendor Ingenix Inc., Eden Prairie, Minn. "The approach in the industry is that, 'My vendor and clearinghouse will take care of me,' that's very much what we're hearing now," he contends. "We're also hearing it from 'experts' who should know better."

Most changes from adoption of 5010-such as providing substantially more benefit information on insurance eligibility responses and better support for automated posting of remittance advice-will affect business processes more than technology ones, Watkins adds. "So, we are very concerned of the rhetoric in the industry that this is an I.T. problem."

Still, providers need to ensure their claims management vendor and clearinghouse are on top of 5010 compliance work, says Jim Denny, president and CEO at Navicure Inc., a Duluth, Ga.-based claims clearinghouse.

Provider compliance with 5010 "will be very dependent on the partners you have," he contends. "The partners should anticipate compliance won't be uniform on time and be able to handle everything."

Denny believes the government could ease 5010 migration and reduce problems by taking a staged approach to compliance. Insurers should be the first to certify compliance, followed by vendors and then providers, he advocates.

While the 5010 transactions will tighten up HIPAA-mandated claims formats that were supposed to serve as standards-but never did-there are other efforts to truly standardize electronic claims and related transactions (see story, this page).

Also on the horizon is the October 2013 deadline for transitioning from the three-decade-old ICD-9 diagnosis and procedure code sets to the vastly expanded ICD-10 code sets. These codes will affect a wide variety of information systems within an organization, impacting the documentation of care in clinical systems, the coding of financial transactions, and the aggregation of data in analytical systems. Providers and payers, observers say, need to start serious work on ICD-10 migration during 2010.

Further, a coding problem with Medicare's electronic prescription incentive program could cause providers to question the government's credibility when it comes to electronic payments. That credibility gap could impact industry expectations around the massive federal stimulus plan. Whether the forthcoming "meaningful use" EHR incentives will be paid as promised could be called into question.

Another issue on the EDI front worth noting is Minnesota's mandate, which became effective in three stages during 2009, to use electronic claims and related transactions (see story, this page).

The ICD-10 Challenge

With the coming deadline to migrate to the ICD-10 code sets, awareness is growing in the industry that preparations need to start in earnest this year.

"Payers are very aware of the deadlines," says Laurine Johnson, senior health information management consultant at Ingenix Consulting. "I see more payers getting prepared than providers."

It isn't that provider awareness is lacking, but more that they don't know how to get started, adds Watkins of Ingenix. Providers are intimidated with ICD-10 because they are starting to understand that the migration from ICD-9 encompasses so much of their business. "We get folks scratching their heads saying, 'How big is this? It feels big but I'm not sure.' After we educate them, they are overwhelmed."

Still, some providers continue to believe that ICD-10 is an information technology issue-their vendors simply need to increase data fields "and we're on our way," Johnson notes.

To start with, adoption of ICD-10 will affect nearly all information systems in an organization and many of its processes. The biggest impact, Watkins says, will be in such areas as clinical and financial documentation, billing, coding, and reimbursement contracts between providers and payers.

Physicians will have to document care to a far more granular level using ICD-10. That's why Watkins advises organizations to start getting clinicians this year to think about the terminology of the new code set. "Doctors don't document in codes, but in terminology," he says. So they need to change their terminology to be consistent and granular with ICD-10. "We're seeing some providers starting to analyze how to improve the documentation process," he adds.

The documentation challenge, Johnson notes, is even bigger for ICD-10 procedure codes because they are even more granular and anatomically involved than the diagnosis codes.

Where to Start?

In addition to preparing clinicians to document more comprehensively, providers during 2010 should inventory every information system to assess which ones use ICD-9, Johnson says. "That includes medical students using faculty-issued software, so you have to assess research areas."

Organizations also must assess the ICD-9 data they have-some of it decades old. They must decide how to maintain that data and for how long. "How much of it do you translate? Five years? Ten years?" Johnson asks. "If translated, how does that impact hardware and software and how do you do the translation?"

Providers also need to assess how migrating to ICD-10 will affect increasing use of data analytics technology. "How dependent are you today on analytical data based on ICD-9?" Watkins asks. "What in payer contracts are reimbursable decisions being based on ICD-9? You'll have to renegotiate contracts for ICD-10."

Most importantly, providers this year need to create awareness and educate all in the organization-from the board all the way down, she adds. The board, with its fiduciary responsibilities, must this year understand the costs of transitioning to ICD-10.

And above all, providers should not bank on a further delay in ICD-10's deadline, which previously was extended by two years. The Centers for Medicare and Medicaid Services last March made clear it believes the Oct. 2013 compliance date is achievable, Watkins notes. "I don't think people should count on a delay."

Trench Work Starts

There's no delaying at Citizens Memorial Hospital in Bolivar, Mo., where ICD-10 compliance efforts are starting to gear up.

The hospital is transitioning to an upgrade of its core clinical/financial hospital information systems from Westwood, Mass.-based Meditech. Once that's settled, then hospital officials will start talking with Meditech and other vendors about ICD-10 remediation and testing schedules, says Tricia Campbell, director of revenue cycle at the 74-bed facility.

Because the hospital's ambulatory and home health systems come from vendors tightly affiliated with Meditech, a small number of vendors are responsible for much of the I.T. at Citizens Memorial. But Campbell is confident the vendors will do well in adopting ICD-10 into their systems, particularly because Meditech has numerous clients in Canada, which already has moved to ICD-10.

A top job for the first half of 2010 is to educate the board and get appropriate ICD-10 migration funding for the next fiscal year that starts July 1. The hospital also will look for a new inpatient DRG coder because the present coder is of retirement age and has made clear that she won't stay around to learn the new code system.

An inventory of the IDC-10 migration work and development of training programs also are on tap for 2010. Campbell presently estimates that more than half of the organization's 1,500 employees will be affected.

Confusing Codes

A lesser coding issue, but still with potential ramifications, lies within Medicare's electronic prescribing incentive program that began in 2009. Margret Amatayakul, president of MargretA Consulting in Schaumburg, Ill., worries that one particular glitch could cause participants to not get their 2% bonus Medicare payments.

And that could cause providers to not trust that they'll really get the forthcoming incentive payments for meaningful use of electronic health records under the American Recovery and Reinvestment Act, she fears.

"I believe the incentive for meaningful use will be real," she says. "But will it go only to people who are savvy and hooked up with people in the know?"

At issue is the use of three specific "G codes," which are a series of Medicare quality measurement codes, when e-prescribing while providing certain treatment services. These include office visits, office consults, mental health services, diabetic self-management training, and pelvic and breast exams.

If an electronic prescription was generated, or simply attempted, a G code is put in a field on the claim for services to document the use of e-prescribing. There is a code for reporting if a qualified e-prescribing system was used for all prescriptions during the visit. A second code applies if a qualified system was available but no prescriptions were generated during the visit. A third code is used to indicate an electronic prescription could not be generated because of legal prohibitions, or other reasons. So, all three codes count toward getting an e-prescribing incentive payment even if an electronic prescription was not transmitted or even written.

The glitch is that along with the appropriate G code, the claim also must have a dollar value for the G code placed in a specific field. But G codes aren't diagnostic or procedure codes so they don't have dollar values.

Putting a penny, $.01, in the field solves the problem. But many prescribers don't know this, Amatayakul says. Further, many claims clearinghouses aren't checking to make sure there is a dollar value associated with the G code, she adds.

To make matters worse, remittance advice for all claims properly generated and processed with the G code show that the code was denied. This could cause providers to believe that all the claims that document they properly e-prescribed, or tried to, won't qualify for a bonus payment.

CMS' Response

The G code is being denied for payment because it is a quality data code, notes Daniel Green, M.D., acting director of the division of ambulatory care and measures management in the Centers for Medicare and Medicaid Services' Office of Clinical Standards and Quality. But the remittance advice also should include a specific code-N365-that indicates the G code was received and recognized by CMS. It's that code that providers should be looking for on their remittance advice, he adds.

Successful electronic prescribing participants will get their 2009 incentive bonus-on all Medicare-covered Part B charges and not just charges for specific services where they reported a quality data code-in a lump sum payment during 2010.

Claims processing systems weren't designed for reporting quality data, says Michael Rapp, M.D., director of the quality measurement and health assessment group in CMS' Office of Clinical Standards and Quality. Consequently, there has been a learning curve to use the claims systems for quality reporting for both CMS and professionals, he adds.

That curve started with Medicare's PQRI pay-for-reporting program.

Getting Technical

And CMS will be looking for technical issues that could prevent proper reporting on e-prescribing incentive payments, Rapp adds. A review of 2007 PQRI reporting submissions resulted in a re-run for those that did not originally qualify, and checks were sent to more than 3,000 additional providers, he notes.

CMS is making the e-prescribing program less complicated in 2010, Rapp notes. In 2009, an individual eligible provider had to have a qualified e-prescribing system and report a G code in at least 50% of the cases where the measure was reportable.

Looking ahead

In 2010, a provider only has to have a required system and report one G code indicating that they electronically prescribed (and put in a penny value), for a total of 25 appropriate office visits or services to get the 2% bonus payment. Eligible providers also must have at least 10% of their total Medicare Part B charges comprised of CPT codes for appropriate visits or services, a requirement that has not changed from 2009.

Further, group practices also can participate and earn an incentive payment equal to 2% of the practice's total estimated Medicare Part B allowed charges. Medicare will accept e-prescribing reporting via qualified registries-intermediary organizations that collect and report data-and electronic health records systems.

"I think you can see that we made the requirements fairly easy to meet," Rapp says. "So, do this for 25 office visits during 2010, put a penny value in and check the remittance to ensure that payment was denied on the G code."

Finding the Core to Standardization

An industry effort to tighten existing standards for electronic claims and related transactions gained steam during the latter part of 2009 as House and Senate health reform bills included mandates that went far beyond the standards mandated under the Health Insurance Portability and Accountability Act of 1996.

The bills called for adoption of "operating rules" that would augment the HIPAA standards. These rules come from the Committee for Operating Rules initiative of CAQH, a Washington-based health payer advocacy group. Stakeholders across the industry have spent several years developing rules that would, in essence, standardize the HIPAA standards.

HIPAA mandated standard transaction formats but left lots of leeway for insurers to require additional information that supports their proprietary ways of doing business. For example, many insurers have "companion guides" that explain how they want their transactions. The guides are additional, payer-specific rules beyond the standards mandated under HIPAA that govern required data elements within electronic claims and related transactions.

The goal of CORE is to reach industry consensus on transaction sets that will enable health care electronic data interchange transactions to be conducted as easily as an ATM transaction. CORE started with Phase I of an electronic eligibility/benefit determination transaction. The recently completed Phase II of CORE further tightened the eligibility/benefit determination transaction and included claims status. Participants now are developing prior authorization and remittance transactions in Phase III.

The insurers certified as able to conduct Phase I CORE transactions represent more than 70 million Americans, says Gwendolyn Lohse, managing director of CORE and deputy director of CAQH. These insurers include private payers representing 75% of the commercially insured market, Medicare and a handful of Medicaid plans.

Phase II transactions now are being activated with all Phase I insurers committed to get certified. Three payers--Harvard Community Health Plan, Aetna and WellPoint--are certified with a handful of others expected to certify during the first quarter of 2010, Lohse says. Fifty practice management and electronic data interchange vendors are at the CORE table with more than 20 certified in Phase I and "a number" of them going through certification for Phase II, she adds. "We're seeing vendors pick up for a few different reasons."

For instance, Aetna now is requiring its EDI vendors to become CORE-certified, Lohse notes. And medical societies increasingly are recommending to their members that they place CORE compliance requirements in requests for proposals.

The CORE initiative could benefit the industry, but by themselves, the operating rules won't be the answer to standardized electronic data interchange, says Jim Denny, president and CEO at Navicure Inc., a Duluth, Ga.-based claims clearinghouse. CORE, like HIPAA, will tighten electronic data interchange standards only to the extent that the requirements are enforced, he notes. "The technology is the easy part.

EDI: The Law in Minnesota

Legislation enacted in Minnesota in 2007 to mandate standards-based electronic transmissions of claims, eligibility and remittance advice transactions took effect during 2009. So far, according to the state Department of Health and the Minnesota Medical Association, the law is working well.

The requirement for electronic eligibility transactions took effect on Jan. 15, with claims following on July 15 and remittance on Dec. 15. There have been some bumps in compliance and non-HIPAA covered insurers, such as property/casualty and workers' compensation, were given a one-year extension on the eligibility mandate, says Janet Silversmith, director of health policy at the Minnesota Medical Association. "We remain very supportive of the law and have heard no complaints from members," she adds. "If anything, our membership is interested in further expanding uniformity to other transactions and business needs."

A coalition of industry stakeholders developed uniform "companion guides" for the transactions. This standardizes the information in the transactions that insurers can require.

Enforcement of the mandates are complaint-driven and state regulators strive to reach informal resolution of problems that arise, says David Haugen, director of the center for health care purchasing improvement in the state health department.

So far, the state isn't finding insurers trying to get around the uniform companion guides and demanding additional information on transactions, Haugen adds.

Nor are regulators finding other reasons to become more heavy-handed with enforcement. "By and large, I think this has worked very well," he notes. "There's been very good efforts to come into compliance." Adds Jim Golden, director of the health policy division at the Minnesota Department of Health: "Our experience is when people have complaints, they aren't shy about giving us a call."

Providers like the uniform compliance guides that give a single way to conduct transactions with all payers, Golden says. And insurers say the mandate has succeeded in boosting the use of electronic claims and related transactions.

"Payers anecdotally tell us their electronic claims have shot up," Haugen says. "We will work with plans as they close their books on the year to get a better sense of this."

The department as 2009 ended did not yet have a good sense of the number of providers in the state that have moved away from paper transactions. But there is some evidence that large numbers of those who were on paper have moved to EDI, Haugen says.

Paper claims remain in the system, but many of them come from workers' compensation and the medical business of property/casualty and auto insurers, Golden notes. Also, challenges to move to EDI remain with the smallest provider organizations, such as chiropractors and mental health professionals, he adds. "They just need a little more time to work through this. We want to see a good faith effort."]]> http://www.healthdatamanagement.com/issues/18_2/edi_claims_revenue_coding_hipaa_transactions-39694-1.html Wed, 03 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1154 EHR
That's the question posed and pondered by Aviv Shachak and Alejandro Jadad of the University of Toronto, published in this weeks Journal of the American Medical Association (JAMA).

The opportunity is to build a people-centered health system, they say, the kind envisioned in the IOM's report, Crossing the Quality Chasm.

Drs. Shachak and Jadad propose 7 building blocks to use when adopting EHRs that will help the U.S. get to the Holy Grail of people-centered health:

1. Use tools to promote health, not just deal with acute disease.
2. Make it interoperable and integrated.
3. Use multimedia to ensure usability and clear communication.
4. Support virtual interactions.
5. Integrate available social networking tools.
6. Promote optimal health outcomes and resource appropriately.
7. Adopt open and collaborative systems, and balance privacy, learning from the successful models such as PatientsLikeMe and the Genetic Alliance.

The authors conclude that these components would help optimize the $20 billion spend on EHR adoption included in ARRA stimulus funding.

Health Populi's Hot Points: As health citizens take on more responsibility for making clinical care decisions and financial outlays for themselves and their families, they need data liquidity: the free movement of information. Think of data liquidity as an underpinning for a consumer-driven health market. In addition, transparency and useful, usable tools add to the well-oiled machine that enable participatory health.

That's, ultimately, what a people-centered health system should be about, and what Dr. Shachak and Dr. Jadad are proposing. These seven pillars would make the difference between EHR adoption that serves doctors and payers, and EHR adoption that enables participatory health.]]> http://www.healthpopuli.com/2010/02/ehrs-in-era-of-social-networks.html Wed, 03 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1155 HIPAA
Two weeks from today, on Wednesday, February 17, 2010, Business Associates of Covered Entities must comply with the HIPAA Security Rule. For the first time Business Associates will be regulated by the federal government. Section 13401 of Subtitle D (Privacy) of the HITECH Act (42 USC 17931) states that “[t]he additional requirements of this title that related to security and that are made applicable with respect to Covered Entities shall also be applicable to such a Business Associate and shall be incorporated into the business associate agreement between the business associate and the covered entity.” [Public Law 111-5, p.260] In addition, penalties that apply to Covered Entities also will apply to Business Associates for noncompliance with the provisions of the Security Rule.

The next day, Thursday, February 18, 2010, a new restriction on disclosure of protected health information goes into effect that impacts Covered Entity health care providers. According to Section 13405 of Subtitle D of the HITECH Act (42 USC 17935), a health care provider must honor a patient request to restrict disclosure of protected health information to a health plan for purposes other than carrying out treatment (namely, payment or health care operations) if the patient pays the health care provider out of pocket in full.

Finally, on Monday, February 22, 2010, enforcement of the Breach Notification Rule goes into effect for “failure to provide the required notifications for breaches” of unsecured protected health information discovered on or after the February 22 date. [74 Federal Register 42757, August 24, 2009]. The Breach Notification Rule applies to Covered Entities and Business Associates, provides obligations for each regarding compilation and reporting of information pertaining to a breach by either party, and requires “incorporation [of those obligations] into the Business Associate Agreement between the Business Associate and the Covered Entity.” (42 USC 17934)]]> http://www.hipaa.com/2010/02/new-hipaahitech-act-rules-require-compliance-in-february/ Thu, 04 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1156 Health Information Exchange Colorado
The addition of the two communities is part of the QHN's next phase of expansion, said QHN officials. The overall goal, they said, is to provide data exchange capabilities to more than 20 hospitals and physicians in Western Colorado.

“We are delighted that the physicians of Aspen and Montrose have joined the network,” said Dick Thompson, Executive Director and CEO of the not-for-profit QHN. “Our expansion plan for Western Colorado has been facilitated by funding from the area providers and from the generous support of the Colorado Health Foundation. Their support and leadership validates the vision of QHN’s founders and improves the ability of area physicians to delivery high quality care.”

QHN is using the Elysium Exchange platform, developed by San Jose, Calif.-based Axolotl, to facilitate the data exchange between the Colorado providers. Officials from the two new member hospitals said that by having the ability to exchange health data, the care at each facility is expected to improve.

“Aspen Valley Hospital is dedicated to delivering extraordinary health care. We are continually working to improve outcomes and want to offer our physicians and medical staff state-of-the-art technology to help them provide the best possible patient care,” said David Ressler, CEO of Aspen Valley Hospital (AVH). “Thanks to the financial support of the Aspen Valley Hospital Foundation, we are able to implement this new technology. We see a high value in providing our area physicians with timely access to complete patient information at the point of care. It helps them better serve their patients.”

“At Montrose Memorial Hospital, we recognize that patients benefit from the timely exchange of clinical information among all health care providers in our regional area,” said David Hample, CEO of Montrose Memorial Hospital (MMH). “Now that we are connected to the QHN network, we are extremely pleased to have made it a lot easier for our physicians to securely receive and share patient information electronically with other area practices and hospitals. We want to improve patient satisfaction and reduce costs and our QHN connection can help us do that.”

The data model is expected to provide physicians with the ability to aggregate medical history into a single longitudinal patient medical record for timely diagnosis and treatment of patient problems, said QHN officials. QHN is going to provide a CCHIT-certified electronic medical record to those providers who aren't currently using one in order to incorporate more healthcare organizations in the network.]]> http://www.healthcareitnews.com/news/colorado-hie-expands-aspen-and-montrose Thu, 04 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1157 e-Prescribing
It is projected that Walgreens will fill more than 45 million electronic prescriptions in 2009, compared with 15 million filled in 2008. The company expects growth to continue with help from financial incentives in the federal stimulus package, which encourages hospitals, doctors and others to adopt electronic health records, of which e-prescribing is a key component.

“With the federal stimulus package providing $19 billion in incentives to adopt electronic health records, doctors will gain easier access to software that makes electronic prescribing possible,” said Don Huonker, Walgreens’ senior vice president of healthcare innovation.

There is the potential for e-prescribing to increase even more. Currently, the U.S. Drug Enforcement Agency does not allow doctors to electronically prescribe controlled substances. Walgreens officials are advocating extending e-prescribing to controlled substances since controlled substances currently account for about 15- percent of all medications prescribed.

E-prescribing can increase safety and efficiency, but if electronic prescribing of controlled substances is allowed, it will have to be done carefully and securely. The easier it is to prescribe and obtain these drugs, the easier it may be for people and providers to abuse them.]]> http://electronicmedicalrecord.wordpress.com/2010/02/05/the-e-prescribing-boom/ Fri, 05 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1158 EHR
David Blumenthal, MD, the national coordinator for health information technology spoke at the 18th National HIPAA Summit in Washington DC, where other federal officials and stakeholders said the adoption of healthcare IT is urgent.

"History has shown that things that improve healthcare become part of what is used," Blumenthal said. "I propose to you that in a few years doctors will all support EHRs," he said. "Using EHRs will become a core competency for physicians. And once we've established that, it will be considered an absolute requisite."

Blumenthal compared the kick-off of federal incentives for meaningful use of electronic health records in 2011 to boarding an escalator. "I think we're going to see the upward slope of the adoption curve within a year or two; but it will be difficult to predict the slope," he said.

Carolyn Clancy, MD, director of the Agency for Healthcare Research and Quality, said the usefulness of health data will naturally drive healthcare IT adoption.

"Information is the lifeblood of medicine," she said. "Clinicians are trained to look at patients one at a time. But, what's missing is aggregated information."

Andy Slavitt, CEO of Ingenix said, "One of the saddest parts of our jobs is that no one is asking the questions they once wondered about, but thought there were no answers to. Answers are available, they just aren't getting to doctors. "

Steven Stack, an emergency physician and a member of the American Medical Association's board of trustees said the use of HIT could be both a blessing and a curse. "Doctors don't know how much they don't know. They have no idea they practice differently than other practices."

On the other hand, rules that would determine how a physician must practice should leave room to allow for varying circumstances, especially in the ER, where duplicative tests are most often the norm due to urgency and limited access to patients' medical history.

"There's a lot going on in the trenches that is the only thing that keeps this flawed healthcare system going day in and day out," he said.]]> http://www.healthcareitnews.com/news/blumenthal-ehrs-will-become-absolute-requisite-docs Fri, 05 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1159 EHR
"There's a whole bunch of obstacles that are making us hesitate," says Paul Speckart MD, a San Diego internist in a five-physician practice. "We're in a different spot than the large hospital-owned clinics and practices, in that all of the EMR burden falls squarely on our shoulders."

For starters, he says, doctors aren't sure the systems they buy will be "interoperable" with their hospitals or will meet certification standards. And they're not sure the government will make good on its promise to provide stimulus reimbursement.

And what if they need interoperability with several hospitals where they have staff privileges, but those hospitals are on different systems?

"We get promises that there will be bridges. But who's going to be making these bridges, and who's going to be paying for these bridges?" he asks. He says the large Scripps hospital system, where he has staff privileges, has not said it intends to provide that for independent practices.

The estimated cost, he hears, is "between $60,000 to $80,000 to start, plus the maintenance. That's a lot of money," when doctors are facing possible Medicare pay cuts of 21.5% in March.

Speckart, whose practice now has some electronic systems to exchange imaging, pharmacy, and lab reports, believes that EMR systems have great potential to improve quality of care because of their reminders and communication with hospitals.

"But you have to remember, we feel like we're at the battlefront, and people are shooting at us day and night. We're not interested in great grand performance, because we're worried the next shot will get us. You open the doors and hope you survive until the doors close at night."

Steve Waldren, director of the Center for Health Information Technology for the American Academy of Family Physicians (AAFP), agrees that many of his 95,000 member doctors are delaying implementation because of worries about buying the wrong system.

"Once the creation of CCHIT (the Certification Commission for Health Information Technology) was announced, we saw a drop in adoption in our members. There's so much uncertainty. We still don't have the regulations on how the certification process will be governed. So there's no way [a vendor] can say they have a certified product or not," he says.

Waldren expects the AAFP to send a list of concerns to the federal government to request changes in the meaningful use guidelines announced Dec. 31, within the 60-day comment period.

"We're very excited about moving to meaningful use, but we have concerns that some of the reporting burdens aren't necessary to achieve meaningful use. We want everyone to focus on the quality outcomes, and managing those instead of managing workflow in process," he says.

And then there's the concern about reimbursement, and whether physician practices will be able to install systems to get the greatest percentage of stimulus funds available at the front end.

Speckart says, "A lot of people are worried that, in fact, Washington is inoperable, and the things they say and make us adhere to are not being backed up by the support they've promised us."

And then there's the chatter from a few early adopter colleagues that the impact on them has been "economically devastating," Speckart says.

"You hear that their experience is very checkered, with stories that are much different than the ones you hear from the salespeople. Doctors say 'We're struggling with it,' or 'The system is finally coming around.' You're advised that your office can handle about half the patient load for the first month and the next month, two-thirds, but that it will be three or four months before you're able to resume full patient care."

And then there's the question of what good it will do. "The EMR people will tell you that your coding will improve, but the experience of most clinicians is that it doesn't save money; it doesn't balance out in cost."

Instead, Speckart says, "The money it will save benefits the medical management companies and insurance companies and the government."

Joseph Heyman, a solo practitioner in Amesbury, NH, and a member of the American Medical Association board of trustees, understands concerns of physicians, such as Speckart. He adopted EMR in 2001, and now reaps the benefits. For starters, he has more room in his office because he doesn't need storage space for paper charts and says he now spends more time with his patients.

But, he acknowledges, "Many physicians are worried. They don't know where to start. It's not an easy thing to switch to, especially if there's workflow interference."

Like the AAFP, the AMA intends to issue a letter to the federal government asking for changes in the guidelines and timelines for "meaningful use" compliance.

"We're concerned about how quickly people are going to be required to do some of these things. And we're concerned about measurement reporting for specialties that don't have measures," he says.

For example, Heyman says, currently the meaningful use guidelines call for compliance in stages. "But we think that there should be some percentage of success in one stage before you more onto the next stage."

And of course there are very few hospitals that are offering bridges to physician practices today, which is a goal of EMRs. "That's a major issue. They have to have a vehicle to send the information through to the hospital or to another physician.

He says the AMA is working with Compuware Covisint, a medical record platform and exchange developer, to offer basic EMR service to AMA members, with upgrades that will cost varying amounts. "The AMA is intent upon providing solutions for its members, which will make it possible for members to do this in the easiest way possible," Heyman says.

For Speckart, there is one other major concern: The loss of the precious human connection with patients.

"You'll get patients who enjoy the fact that you have access to electronic records. But then there's the patient who wants to talk with you about the really grave issues that are affecting him and his family—and there you are pounding away at the computer."

Editors note: PrimaryData can help provide understanding of meaningful use requirements - give us call.]]> http://www.healthleadersmedia.com/content/TEC-246032/Many-Small-Practice-Physicians-Putting-off-Meaningful-Use-Guidelines.html Fri, 05 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1160 Medicare
Obama's proposal, unveiled Feb. 1, sets aside $371 billion over a decade to pay for the cost of preventing Medicare pay cuts under the sustainable growth rate formula. But the funding would only be enough to turn annual reductions into rate freezes, not to fund pay raises. Also, the president left the specifics of how to prevent the cuts up to Congress, said Jonathan Blum, director of the Centers for Medicare & Medicaid Services Center for Medicare Management.

"There's lots of different ways to reform physician payment in the long term," Blum said. Health and Human Services Secretary Kathleen Sebelius said she was confident Congress would prevent the cuts, which are scheduled to begin with a 21.2% reduction on March 1.

American Medical Association President J. James Rohack, MD, said the AMA "commends President Obama for recognizing that permanent reform is crucial to preserving physician care for current and future seniors who rely on Medicare." The AMA has urged Congress to pass a long-term overhaul that results in cost-based physician rate increases, not freezes.

Obama's $911 billion fiscal 2011 Dept. of Health and Human Services budget proposal also calls for several one-year spending increases, including $250 million more to fight health care fraud, a $290 million increase for community health centers and $1 billion more for biomedical research through the National Institutes of Health.

Obama asked for these hikes and others, despite pledging to freeze federal spending for three years starting in fiscal 2011. He exempted Medicare, Medicaid, Social Security and national security spending from the pledge -- more than 80% of the federal budget, according to Steve Bell. He is a former staff director and chief of staff for retired Sen. Pete Domenici (R, N.M.) and a visiting scholar at the Bipartisan Policy Center, a think tank focused on middle-ground solutions in health care, the budget and other areas.

"He deserves credit for even wanting to do that, which will draw great opposition from Congress -- especially the appropriators," Bell said.

Republicans criticized Obama for proposing a budget with a $1.3 trillion deficit, one of the biggest in history. "The president's new budget is like the last one -- more spending, more taxes and more debt -- at a time when the national debt has reached an alarming level," said Sen. Lamar Alexander (R, Tenn.), chair of the Senate Republican Conference.

Obama said on Feb. 1 that previous legislation -- including the 2001 and 2003 tax cuts and the Medicare drug benefit -- created much of the debt he faced when he entered office. He also inherited a deep recession, said Peter Orszag, PhD, director of the White House Office of Management and Budget.

"If we had taken office during ordinary times, we would have started bringing down these deficits immediately," Obama said.

House Appropriations Committee Chair David Obey (D, Wis.) said his panel would adhere to the president's fiscal 2011 spending targets. "We will not exceed his requested level for appropriations, but we will also not exempt any department or activity from review ... because none of them are without waste."

Medicaid funding extension

Obama's budget plan would help states by providing a six-month, $25.5 billion extension of enhanced Medicaid funding through June 2011. This would continue support from the most recent stimulus package, which increased the federal share of Medicaid by a total of $87 billion through the end of 2010.

"This is the president's statement that two more quarters [of federal assistance] are absolutely essential," Sebelius said. State Medicaid directors, governors and policy experts have warned that significant Medicaid cuts will be necessary if the stimulus act's Medicaid funding expires.

But the administration has not decided if it will support continuing the enhanced Medicaid funding beyond June 2011, the end of most states' fiscal years, said Cindy Mann, director of the CMS Center for Medicaid and State Operations. Medicaid enrollment typically remains high until an economic recovery is well under way, according to policy analysts. Although the administration's budget proposal assumes stronger economic growth, it still projects unemployment to be at about 8% at the end of 2012, Orszag said.

Health programs expanded

Obama's HHS budget also would help maintain health coverage through community health centers. It calls for a 13% increase for the facilities in fiscal 2011.

The additional funding would help create 25 new sites for health care access in communities without existing centers. It also would expand access to the more than 1,200 community health centers in the U.S., Sebelius said.

Medical research also received significant support from Obama. The boost to $32.2 billion "is the largest proposed funding increase for NIH we have seen in a president's budget in eight years," said Mark O. Lively, PhD, president of the Federation of American Societies for Experimental Biology. The budget also adds $208 million for research on the comparative effectiveness of different medical treatments and drugs, and for translating research findings into treatments, among other work.

The Obama budget proposes raising funding for the Health Care Fraud and Abuse Control program to $1.7 billion. This would allow an HHS/Justice Dept. anti-fraud task force to work in 13 additional cities.

Sebelius said the administration is working aggressively to hire a CMS administrator, the highest-ranking position still vacant at HHS. CMS has been without a permanent administrator since Mark B. McClellan, MD, PhD, left in October 2006. "We hope to have someone named in the not-too-distant future," Sebelius said.]]> http://www.ama-assn.org/amednews/2010/02/08/gvl10208.htm Mon, 08 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1161 EHR
Visit ReachMD at www.reachmd.com for their Podcast on the new federal rules. Registration may be required.]]> http://www.reachmd.com/xmsegment.aspx?sid=5182 Mon, 08 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1162 Technology
• Consumers want more convenience and control;
• 37 percent surveyed said they were "extremely" or "very" interested in using a self-service kiosk to help them check in for medical appointments more quickly; and
• More than 43 percent said they have chosen one medical provider over another because he/she offered self-service.

These results suggest that consumers are not only comfortable with self-service kiosks, but also are using the availability of the technology as a differentiator when making decisions about health care services. Therefore, if your health care organization provides kiosk technology now -- before it becomes mainstream -- you may have a distinct competitive advantage.

In health care, there are basically three different areas in which kiosk technology has been successfully deployed: self-service, pharmacy and health kiosks. Self-service kiosks provide consumer information and front/back office functionality by interfacing with registration, scheduling and financial systems. Pharmacy kiosks provide convenient services such as refill requests and after-hours prescription pickup. Health kiosks offer health-specific functionality and imbedded FDA-approved clinical devices that can be interfaced to a personal health record or an electronic medical record.

Let's look at each area in more detail.

Self-service kiosks

Wayfinding assistance is the most common self-service kiosk application offered in the health care environment. Busy consumers can access department/ physician/ provider directories, maps and directions to places within the facility. You find these in major entrances and lobbies, etc. Another common functionality in self-service kiosks is patient registration, patient information verification, preliminary triage in the emergency department, and patient check-in and queuing. In other words, once patients find their way to your office, they can quickly check themselves in and verify the accuracy of their demographic and insurance information. This is not just convenient for them -- it's a quality-assurance process in the revenue cycle. One outdated policy number can hold up a reimbursement payment for weeks or months.

It's no surprise that patients report being frustrated with long wait times associated with their health care appointments. Imagine how patient satisfaction would increase if a kiosk could help reduce wait times in half, which some organizations have done. Some kiosks offer a feature that tracks the patient flow process from the time a patient arrives to the time he/she leaves. These kiosks track wait times and other metrics, and the data is used by staff to identify bottlenecks, improve workflow and maximize patient throughput -- resulting in a better patient experience. Kiosks with this functionality are most commonly utilized in emergency departments, laboratories, large clinics and outpatient areas.

Besides check-in and registration, other self-service kiosks features can help improve patient satisfaction and give provider offices feedback for continuous improvement. These include, but are not limited to:

• Appointment viewing and scheduling;
• Access to personal health records;
• Online statements and electronic payments;
• Consumer satisfaction surveys;
• Presentation of information in multiple languages;
• Language translation services;
• Access to education materials and health care Web sites; and
• Ability to electronically read and sign general-consent consumer rights, HIPAA privacy notices and Medicare utilization forms.

Pharmacy kiosks

Pharmacy kiosks are another offering that health care organizations should consider when trying to attract and retain consumers. In one market research survey,2 72 percent of consumers said they are more likely to shop with a retailer that gives them the flexibility to interact easily via a kiosk self-service channel versus a retailer that does not. According to a 2008 study by pharmacy research firm Wilson Health Information, LLC,3 consumers cite convenience, price and service as most important to pharmacy consumer satisfaction. Key contributors to this satisfaction are short lines, convenient pharmacy hours and after-hours prescription pickup. Seventy percent were interested in the ability to pick up and drop off their prescriptions via self-service kiosk. Survey participants reported these conveniences as key reasons to use one pharmacy over another.

Health kiosks

In addition to self-service kiosks, there are kiosks designed to help consumers monitor and improve their actual health. These health-related kiosks allow users to conveniently monitor their condition, set personal health goals, and measure and track their results. Clinics, physician practices and health centers that provide kiosks in locations convenient to the consumer see an increase in consumer satisfaction, as well as requests for additional services as the consumer becomes more informed about his/her health condition.

You are probably most familiar with the earliest and simplest form of a health kiosk -- the one that can measure your blood pressure. Many of these kiosks can still be found in drugstores and grocery stores. The health kiosks of today are more technologically advanced. They are self-contained, Internet-enabled units equipped with a touch screen, speakers and FDA-approved biometric devices such as a blood pressure cuff, EKG reader, scale, etc. They can measure temperature, pulse, blood pressure, weight, body composition, blood oxygen, glucose and other signs such as pulse oximetry and spirometry. Some provide eyesight and hearing screening, stress tests, diet plans, consumer education, phone- and video-enabled coaching, telemedicine, etc. Information about smoking, heart disease, diabetes, stroke, cancer, depression, asthma, exercise and weight management, domestic violence, HIV/AIDS, and sexually transmitted diseases are available by simply touching the screen.

Many health care organizations encourage their patients to take an active part in their health by offering a rewards program. Patients who use the kiosks and meet their specific health goals earn points applicable to gift cards or other rewards. What consumer wouldn't be satisfied with his/her healthcare provider after receiving a reward for health improvement?

Data collected can be maintained in a personal health record available to the consumer on demand. Results can be displayed or printed, or in some kiosks, downloaded via USB port. The patient can then share the information with his/her provider during an office visit.

Health care organizations use health kiosks to make their practice more efficient and to reduce input error. Kiosk data can be sent directly to the patient's electronic health record for the physician or other care provider to access and verify during the office visit. Time saved by utilizing a kiosk for taking blood pressure and performing other activities means the physician can spend more time talking with the patient. Patient satisfaction becomes a byproduct of a well-functioning process.

Research shows that consumers enjoy the convenience of self-service and are more than likely to do business with companies that offer it. Although less than 10 percent of health delivery organizations have implemented patient kiosks, the experience of early adopters show that kiosks are an effective tool for improving service and efficiency while meeting rising consumer expectations. The result is a more satisfying health care experience for consumers and more efficient operations for organizations.

Important considerations

While kiosks may perform some of the administrative duties of the front desk, they won't eliminate the need for administrative staff. First, some administrative staff members will need to act as "kiosk ambassadors" to introduce and assist users with the technology. Second, some consumers may not be able or willing to use a kiosk. Third, kiosks are meant to supplement resources for a better consumer experience. There are situations that can only be addressed by knowledgeable, friendly staff. The human factor cannot be taken from the patient satisfaction equation.

Most benefits will only be realized if the kiosk is integrated with scheduling, registration and billing systems at a minimum, and with a fully functional EMR for the best outcome. Otherwise, the kiosk will force staff to deal with paperwork on the back end as opposed to the front end.

The kiosk applications need to be HIPAA-compliant and contain safeguards that track who enters data and when. It must also include programs that protect against identity theft. The health care industry has had a substantial increase in targeted theft of medical information, up 85 percent from January 2007 to January 2008.4 Theft of medical information has resulted in credit card fraud, and theft of credit card information has resulted in medical information mistakes.

A company that processes credit card transactions, such as those using kiosks, has the responsibility to adhere to the standards described in the Payment Card Industry Data Security Specifications, otherwise known as the PCI DSS 1.1 standard. To demonstrate adherence, health care organizations must address their procedures, security policies and technical infrastructure. Briefly, this means that an organization must use and update anti-virus software; install and maintain a firewall configuration to protect cardholder data; protect cardholder data using certified PIN entry devices and encrypting access to data stored on point-of-service devices and servers; encrypt transmission of cardholder data across any open public networks; restrict access to cardholder data by business need-to-know basis; use unique user IDs and encrypted passwords; restrict and track physical access to card data; and test all security systems and processes on a regular basis. Once an organization becomes compliant, it must meet ongoing requirements to maintain compliance. A kiosk vendor should be able to assist the health care organization in meeting these requirements.

Kiosk hardware must also meet Americans with Disabilities Act (ADA) Section 508 regulations, which establish requirements for electronic and information technology. ADA laws ensure that hearing and visually impaired individuals and persons with physical disabilities who may be confined to a wheelchair must have equal access in the same manner as an individual who has no physical disability. This means that an accessible kiosk is one that can be operated in a variety of ways and does not rely on a single sense or ability of the user. This applies to the kiosk, touch screen and other peripherals, such as biometric devices, keyboard, bill acceptor, printer, etc. Consult the ADA Accessibility Guidelines for the best relevant guidance available.

Here are some attributes that you should consider when selecting a kiosk:

• Meets all HIPAA and ADA Section 508 regulations;
• Complies with the Joint Commission on Accreditation of Healthcare Organizations by providing and documenting consumer information;
• Uses FDA-approved devices;
• Supports branding and /or addition of logo;
• Supports messaging/advertising display;
• If a prescription pick-up kiosk, provides 24/7 pharmacist consultation;
• Supports multiple kiosk platforms (tablet, wall-unit, sit down, etc.) to allow organizations to offer input alternatives to consumers;
• Can withstand environmental conditions such as dirt, vibrations, magnetic fields, power surges, high and low temperature and humidity, spills and rough handling;
• Presents an all-in-one integrated design, which avoids need to purchase separate pieces;
• Includes a presence sensor that activates the kiosk when user approaches;
• Includes a privacy panel;
• Provides sizable screen, and quality graphics and audio;
• Provides printer for receipts, medical information, coupons, etc.;
• Enables magnetic stripe and/or barcode scanning for user authentication and payment entry;
• Provides instructions and education in multiple languages;
• Includes USB port for downloading personal health information;
• Provides Ethernet, Wi-Fi or wireless broadband connectivity; and
• Uses standard HL7 messages to interface with EMR and practice management applications.

Health care organizations are leveraging health kiosks to minimize errors, save provider time and improve efficiency. This not only leads to higher consumer satisfaction, but also to higher physician and staff satisfaction and a competitive advantage.]]> http://health-care-it.advanceweb.com/Features/Top-Story/Kiosks-Self-serve-Patient-Satisfaction.aspx Tue, 09 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1163 PQRI
Two issues cited by respondents are the arduous process for accessing feedback reports, and a lack of satisfaction with the reports, says the organization.

MGMA research indicates that of responding practices that attempted to participate in the 2008 PQRI, 48 percent were able to successfully access their feedback report, compared with 51 percent the previous year. Additionally, 60 percent of the practices that accessed their 2008 reports were dissatisfied or very dissatisfied with the presentation of information, and 67 percent were unhappy with the 2008 PQRI report’s effectiveness in providing guidance to improve patient care outcomes, it says.

For more information or to download the report, click here.]]> http://www.healthcare-informatics.com Thu, 11 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1164 EHR
"History has shown that things that improve healthcare become part of what is used. I propose to you that in a few years doctors will all support EHRs," Blumenthal said at the 18th National HIPAA Summit in Washington, according to Healthcare IT News. "Using EHRs will become a core competency for physicians. And once we've established that, it will be considered an absolute requisite."

The national coordinator then said EHR adoption will take an escalator-like trajectory once federal financial incentives kick in next year. "I think we're going to see the upward slope of the adoption curve within a year or two, but it will be difficult to predict the slope," Blumenthal said.

Another top HHS IT booster, Agency for Healthcare Research and Quality Director Dr. Carolyn Clancy, said that the pace of adoption will depend on how useful electronic health data is to physicians. "Information is the lifeblood of medicine," Clancy told the gathering. "Clinicians are trained to look at patients one at a time. But, what's missing is aggregated information." AHRQ, of course, is in charge of comparative-effectiveness research, and thus will be providing such aggregated information to help establish standards of care.]]> http://www.fierceemr.com/story/blumenthal-says-docs-eventually-will-all-support-ehrs/2010-02-11 Thu, 11 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1165 Legislation Regional Extension Center
The awards will help make health IT available to more than 100,000 hospitals and primary care physicians by 2014, and train thousands of people for careers in health care and IT. This Recovery Act investment will help grow the emerging health IT industry, which is expected to support thousands of new jobs ranging from nurses and pharmacy technicians to IT technicians and trainers.

The more than $750 million in HHS grants Secretary Sebelius announced are part of a federal initiative to build capacity to enable widespread meaningful use of health IT. This assistance at the state and regional levels will facilitate health care providers' efforts to adopt and use electronic health records (EHRs) in a meaningful manner that has the potential to improve the quality and efficiency of health care for all Americans.

Of the $750 million-plus investment, $386 million will go to 40 states and qualified State Designated Entities (SDEs) to facilitate state health information exchanges (HIEs), while $375 million will go to an initial 32 non-profit organizations to support the development of regional extension centers (RECs) which will aid health care professionals as they work to implement and use HIT -- with additional HIE and REC awards to be announced in the future. RECs are expected to provide outreach and support services to at least 100,000 primary care providers and hospitals within two years.

"Health information technology can make our health care system more efficient and improve the quality of care we all receive," Secretary Sebelius said in a statement. "These grant awards, the first of their kind, will help develop our electronic infrastructure and give doctors and other health care providers the support they need as they adopt this powerful technology."

The more than $225 million in DOL grant awards Secretary Solis announced will be used to train 15,000 people in job skills needed to access careers in health care, IT and other high growth fields. Through existing partnerships with local employers, the recipients of these grants have already identified roughly 10,000 job openings for skilled workers that likely will become available in the next two years in areas like nursing, pharmacy technology and information technology.

The grants will fund 55 separate training programs in 30 states to help train people for secure, well-paid health jobs and meet the growing employment demand for health workers. Employment services will be available via the Department of Labor's local One Stop Career Centers, and training will be offered at community colleges and other local education providers.

"The Recovery Act's investments are making a positive difference in the lives of America's working families," Secretary Solis said in a statement. "The investments will ensure thousands of workers across the nation can receive high-quality training and employment services, which will lead to good jobs in health care and other industries offering career-track employment and good pay and benefits."

The HHS and DOL awards are part of an overall $100 billion investment in science, innovation and technology the Obama administration is making through the Recovery Act to spur domestic job creation in growing industries and lay a long-term foundation for economic growth.

In addition to the 10,000 jobs the DOL grantees expect to fill with freshly trained workers, the health IT extension centers are expected to hire more than 3,000 technology workers nationwide in the months ahead. Overall, the administration investments in health IT and training will help significantly expand an emerging industry expected to support tens of thousands of secure, well-paid jobs nationwide.]]> http://health-care-it.advanceweb.com/News/In-the-News/Nearly-1-Billion-Recovery-Act-Grants-Awarded-to-Advance-Use-of-Health-IT.aspx Fri, 12 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1166 Technology
In the survey, more than 60 percent of respondents are either in the process of deduplicating or have plans to deduplicate their primary, backup or archive data in the coming year. Respondents had to be investigating, evaluating, or using some form of deduplication to be included in the survey.

"The tipping point for spending on deduplication solutions stems from larger projects around improving storage performance, virtualizing servers and disaster recovery," said Laura Dubois, program director for Storage Software. "The importance of deduplication and the opportunities it presents were validated by the public bidding war waged in 2009 between EMC and NetApp for deduplication heavyweight Data Domain."

Firms with more than 6 petabytes (PB) of disk storage place higher priority on storage performance as a driver, and 57.5 percent of survey respondents said their organizations are currently implementing deduplication or have already deduplicated primary data including virtual servers. Overall, deduplication usage and plans are comparable for backup and primary data, and only slightly lower for archived data. Additionally, users' satisfaction with deduplication technology is highest in the areas of performance, overall system and management.

Other key findings from IDC include:

• Areas for deduplication improvement include implementation, ROI and vendor commitments;
• EMC ( including Data Domain) and NetApp dominate hardware-based deduplication;
• EMC, Symantec and IBM dominate software-based deduplication;
• More than 32 percent of respondents were able to or will eliminate tape as a result of deduplication, with 59 percent of respondents citing they have or will reduce tape; and
• Deduplication for backup shows greatest opportunity for firms with 5,000 to 9,999 employees and 6 to 49 PB of disk storage.]]> http://health-care-it.advanceweb.com/News/In-the-News/IDC-Demand-for-Storage-Efficiency-Drives-Deduplication.aspx Mon, 15 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1167 PQRI
The concept, at least, is simple:

PQRI requirements apply to services billed under a certain set of CMS claim codes. You create a report based on the eligible claim codes you used during the year. PQRI dictates how frequently each claim code can appear on the report- codes linked to periodic care for chronic conditions, like diabetes mellitus, can be reported perhaps only once per year per patient; whereas codes linked to specific care for acute conditions, like heart attack or stroke, can be reported as many times as you used them. Once you have the report, you assess whether or not you met the PQRI care requirements associated with each claim code on your report. Your rating will be a ratio of the all requirements you met to all the claim codes you listed.

Easy, right? Much more so when a computer does it for you. EHRs have awesome reporting capabilities, and as EHRs increase in strength and prevalence, quality assessment practices of every stripe will become standard throughout the industry. So cash in while incentives are still being offered!]]> http://www.ehrscope.com/blog/2009-pqri-deadline-looms/ Mon, 15 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1168 Legislation
The vote cleared the way for President Obama's signature and will ensure the federal government has the capital necessary to avoid defaulting on its financial obligations. Statutory pay-go generally requires lawmakers to find money in the budget to pay for any new mandatory spending or tax cuts. Several legislative priorities are exempt from the new requirements, such as the extension of some tax cuts from the Bush administration, thereby allowing Congress to run up the federal deficit to pay for them.

Legislation to prevent Medicare physician pay cuts also would receive a partial exemption. Up to $82 billion worth of higher Medicare pay to doctors could be approved without the need to find offsets. This corresponds to a five-year freeze of current Medicare rates that would be followed by additional rate cuts.

Lawmakers must still approve separate legislation to reverse upcoming pay reductions, starting with the 21.2% cut. If Congress passes any bill with a price tag larger than that for a five-year freeze, additional offsets would be required. At this article's deadline, lawmakers were considering attaching a short-term Medicare payment patch to a pending national job creation bill.

The House on Feb. 4 voted 217-212 to raise the federal debt limit, then voted 233-187 to approve statutory pay-go. The Senate had passed the debt limit piece with attached pay-go provisions by a 60-39 vote on Jan. 28.

The American Medical Association has stated it will not support any more temporary patches of the sustainable growth rate formula that determines Medicare pay, whether for one year or five years, and it is calling on Congress to enact permanent reform.

The House has passed a long-term Medicare pay overhaul with a projected 10-year cost of about $210 billion, roughly $130 billion more than the proposed pay-go exemption. The AMA wants the Senate to accept the House measure rather than take up any new short-term bill.]]> http://www.ama-assn.org/amednews/2010/02/15/gvse0216.htm Tue, 16 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1169 Telehealth "The use of mobile phones as telehealth gateways has had a surge of interest over the last couple of years," InMedica market research analyst Neha Khandelwal said. "We anticipate that cellular service providers will play an increasingly important role in the long-term future of the telehealth market."

The study also predicted that there will be more health hubs to help manage diseases like chronic obstructive pulmonary disease, and that the more telehealth is embraced, the more jobs that will be available for nurses and other health professionals.

"This gives a two to three year window for the current market barriers to be overcome, including demonstrating the benefits of telehealth on a large scale to health insurance companies," says InMedica.]]> http://www.fiercemobilehealthcare.com/story/healthcare-providers-will-be-using-more-telehealth-technology-2012/2010-02-16 Tue, 16 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1170 Health Information Exchange
For the new report, "Health Information Exchanges: The Reality of HIE Adoption," KLAS validated 89 live HIE organizations that use commercial technologies to share patient data that is being viewed by doctors. Additionally, all of the HIEs included in the study had to be exchanging data among facilities that are not owned by the same organization. In total, the KLAS report highlighted the commercial HIE technologies of 22 vendors, most of which have one, two or three validated sites.

Software vendor Axolotl has the most live HIE clients in the acute-to-acute space, where two or more hospitals or health systems are sharing patient data. KLAS validated seven live acute-to-acute HIE organizations using Axolotl technology. Providers cited the company's flexible technology and the expertise of its staff with the HIE process as key reasons for selecting Axolotl. Epic also had seven validated acute-to-acute sites. However, KLAS reported, Epic is a unique case in that its Care Everywhere application currently only connects Epic software customers.

Among acute-to-ambulatory HIEs, where at least one hospital or health system is sharing data with a clinic, lab or other ambulatory facility, Medicity's Novo Grid was the leader, with 22 live sites. According to providers, the Novo Grid solution is simple but effective, typically funneling lab results from hospital labs and reference labs to ambulatory sites. RelayHealth also had a relatively strong showing in the acute-to-ambulatory space, with eight validated live HIE organizations using its technology.

"It's no great surprise that, so far, the most successful HIEs are those with the least complex approaches," said Jason Hess, KLAS general manager of clinical research and author of the HIE report. "The eclectic way that clinical information is structured, stored, labeled and shipped makes it very difficult for vendors to connect all of the discreet data elements. In the majority of cases, HIE vendors are opting to pass around packets of information without necessarily taking ownership of what is in the packet.

"However, that approach does create some manual intervention with almost every transaction, whether clicking on an icon to see the data, going into a portal to look at it, or opening a separate folder on a PC, especially for a physician without an EMR," Hess said.

Providers also reported a number of administrative challenges they encountered deploying an HIE. Topping the list of challenges were IT governance concerns regarding privacy, security and patient consent, as well as the financial viability and sustainability of the HIE. In fact, KLAS found that more than 70 percent of the 89 validated sites in the report are funded with state or federal grants.]]> http://health-care-it.advanceweb.com/News/In-the-News/KLAS-Report-Examines-Benefits-of-HIEs.aspx Wed, 17 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1171 Telehealth
VA’s home telehealth program cares for 35,000 patients and is the largest of its kind in the world. According to the department's plans, it would grow to $163 million in fiscal 2011, more than twice the $72 million spent in fiscal 2009.

But without a broader federal strategy, VA’s leap into telehealth is, to some degree, a leap of faith.

It’s not that VA has gone too far; rather, other federal agencies possibly have not gone far enough. Federal policy-makers have not yet taken a comprehensive look at this technology. The government’s approach has been piecemeal, with various programs initiated for payers, providers and regulators. Federal regulations and reimbursements for telehealth practices are not cohesive, said Jonathan Linkous, executive director of the American Telemedicine Association.

“In telehealth, the federal government needs to educate, coordinate and get out of the way,” Linkous said.

Telehealth, defined broadly as the electronic communication of medical data as a means for providing care to a patient, has been around for decades. It includes the use of phones, computers and other devices, with or without video or images, to allow patients in remote locations to consult with medical specialists.

Advocates say telehealth is cost-efficient and improves care. “You can lower costs, improve outcomes and expand access to care,” said Dr. S. Ward Casscells, former assistant secretary of Defense for health affairs and a practitioner of telehealth.

VA, the Indian Health Service and the Defense Department all offer some telehealth services, as do many hospitals and clinics. Last year’s economic stimulus package set aside $7 billion for broadband, a portion of which will be devoted to rural telemedicine.

Because of that stimulus and federal programs, Timothy Deal, senior analyst at research firm Pike & Fischer, forecasts the U.S. telemedicine market will reach $3.6 billion by 2014, up from $855 million in 2009.

One area in which VA and others have advanced telehealth is in mental health. Training and protocols for online psychological practice are well-established, said Marlene Maheu, a clinical psychologist in San Diego who leads the Telemental Health Institute. “Telehealth is more research-based than many other forms of medicine,” she said. However, she cautioned that the Internet is spawning new types of clinics that purport to offer telehealth services that might not conform to protocols.

Although telehealth holds much promise, adoption has been hampered by potential legal liabilities, difficulties in receiving reimbursements for care delivered remotely, and legal complications regarding telemedicine practices that cross state lines.

Critics also worry about possible negative effects on patient care. VA’s inspector general recently investigated two deaths at a Colorado VA hospital that occurred while the patients were being monitored by cardiac telemetry, a form of telemedicine. “We substantiated the allegation that there were competency and training issues with medical support assistants and registered nurses assigned to telemetry,” the IG wrote in the report dated Jan. 21. The report also notes that hospital managers had been informed of the telemetry problems before the deaths but had taken no action.

VA managers agreed to evaluate the telemetry program in Colorado to ensure safety, and Linkous and Casscells said it was likely an isolated incident. However, more of the same can be expected, Deal predicts. “The rapid growth of the telemedicine industry will leave gaps in training and/or policy among its practitioners, which could spark an increase in litigation,” he said.

VA’s foray into telehealth could be a life-saver for some patients in remote areas who otherwise would not receive timely care. But it also carries risks. “If the transition from legacy services to modern ones disrupts patient care, I expect to see some patient backlash,” Deal said. "There will be growing pains, and people need to understand this."

If telehealth expands dramatically at VA, it should happen within a broader context. The time is ripe for VA, DOD and the Health and Human Services Department to work together on a telehealth strategy.]]> http://fcw.com/articles/2010/02/22/home-page-health-it-telehealth.aspx Wed, 17 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1172 HIPAA
Here are the appropriate authorities:

Section 13401 of Part 1 (Improved Privacy Provisions and Security Provisions) of Subtitle D (Privacy) of the HITECH Act (pp. 260): Application of Security Provisions and Penalties to Business Associates of Covered Entities

(a) Application of Security Provisions. Sections 164.308 [Administrative Safeguards], 164.310 [Physical Safeguards], 164.312 [Technical Safeguards], and 164.316 [Policies and Procedures and Documentation Requirements] of title 45, Code of Federal Regulations, shall apply to a business associate of a covered entity in the same manner that such sections apply to the covered entity. The additional requirements of this title that related to security and that are made applicable with respect to covered entities shall also be applicable to such a business associate and shall be incorporated into the business associate agreement between the business associate and the covered entity. [42 USC 17931]

(b) Application of Civil and Criminal Penalties. In the case of a business associate that violates any security provision specified in subsection (a), sections 1176 and 1177 of the Social Security Act (42 U.S.C. 1320d-5, 1320d-6) shall apply to the business associate with respect to such violation in the same manner such sections apply to a covered entity that violates such security provisions. [42 USC 17931]

NOTE: Effective the day after of enactment of the HITECH Act (February 18, 2009), financial penalties were substantially increased for noncompliance with HIPAA standards, which cover policies, procedures, actions, assessments, and documentation requirements discovered during a compliance audit or complaint investigation.

Section 13423 of Part 2 (Relationship to Other Laws; Regulatory References; Effective Date; Reports) of Subtitle D (Privacy) of the HITECH Act (pp. 276): Effective Date

Except as otherwise specifically provided, the provisions of part 1 shall take effect on the date that is 12 months after the date of the enactment of this title. [42 USC 17953]

Today marks the beginning of direct federal regulation of business associates’ compliance with the HIPAA Security Rule.]]> http://www.hipaa.com/2010/02/today-february-17-business-associates-must-be-in-compliance-with-hipaa-security-rule/ Wed, 17 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1173 Practice
For patients, already anxious about their health, even during well visits, it can be particularly unsettling to hear voices raised or accusations flying. It may be a receptionist dealing with a patient who has just been informed that his copay was raised. It could be an office manager confronting a billing clerk over a documentation error. It could be a physician assistant's personal troubles spilling into the work place.

Whatever the reason, conflict is a cancer in the healing environment. It has to be contained.

For years, Terri Levine, president of North Wales, PA—based Comprehensive Coaching U, has parachuted into stressed out physicians' offices to negotiate an end to hostilities.

"I've never seen a business, a corporation, a physician office, that doesn't have conflict," Levine says. "People are people. There is conflict in our experience. It's part of humanity." By far, she says, the most prevalent form of conflict is among coworkers.

Because of the serious nature of the work in physician offices, even on the best of workdays, stress—the seed corn for conflict—will always be present.

"There is more stress that we find particularly in medical doctor practices than in any others," Levine says. "In a retail store, you mess up, you don't ring up the right order. In a physician's office, you can be dealing with serious life-and-death issues. And the other thing is that most physicians are Type A personalities. Just by the nature of who they are, they can create stress even if they don't open their mouths."

Conflict isn't always about screaming matches at the front desk.

"Sometimes one employee could be angry with another and could be withholding information, being quiet, not giving them everything they need, forgetting to give important data and messages," Levine says. "Anger. Talking behind the other employee's back. Sarcasm. Those are the warning signs that something needs to be handled. Usually it is underneath the surface and you have to look for it because it can become a shouting match."

Paula M. Comm, a practice administrator at PRA Behavioral LLC, serving the northwestern suburbs of Chicago, says the head psychiatrist at the practice has a zero tolerance policy toward workplace conflict. "He hates conflict, and he really practices what he preaches," Comm says. "Especially in a psychiatric practice, you don't want someone coming to the window and feeling the tensions that are going on within the office because it's so apparent."

Comm says she is aggressive in sniffing out workplace tension. And one of the best ways to do it, she says, is to get out of your office and stand in the hall and listen.

"I go up there and just stand. I can get a feel for what is going on immediately. I can tell by the tone, by the attitude. I have an office manager beneath me who isn't attuned," Comm says. "So, I will go in and stand up there and go to her office and say, 'Do you know that it's tense up there?' And she will say 'what do you mean?' "

Levine says one major reason for conflict is personality differences. "We have different beliefs and different philosophies. We have different stories and programs based on our past experience," she says. "Even though I understand my job is to do X, I am still a human being bringing my own personal stuff into the workplace. I'm not going to like everybody else's personality and I may not understand exactly what I need to be doing or there might not be the same communication style between a couple of employees."

Levine says personality profiling plays a prominent role when she coaches employees at physician offices.

"Let's say I find out somebody is a director type. They give quick information; they don't like to converse. If I understand that person's style, I can use behavioral flexibility and talk to them in that way," she says. "If someone is more of a relater, they like to socialize, chit-chat. Then again, we teach how to be more behaviorally flexible in that area."

Levine says many of the employees she coaches are surprised to learn of their personality type, but their coworkers aren't.

"I was with a group last month and one person came out to be a director. The rest of the group was all saying 'Yup!' and the person said 'I didn't think I was like that.' Then as we went through specific examples of how a director behaves, she said 'Yes, that is me.' "

Levine says the way to reduce physician office conflict is not to hire the same types of people, but to make sure each employee understands one another's personality traits.

"We need a combination of personalities in the office. It's better to have all different personalities. If you've got a patient who needs TLC, get the relater our there, not the director," she says. "If you understand how your coworkers function in the world, you can have some behavioral flexibility toward them and some more understanding of who they are."

Levine says there are "three common denominators" in conflict resolution that facilitate that flexibility.

"First, be more understanding of how other people react. Second, increase group cohesion and mutual 'Let's work together to figure out the conflict.' Third, use your improved self-knowledge to understand what happens to you when you feel conflict," she says.

When employees come to her with a complaint about a coworker, Comm says she encourages them to meet face-to-face to constructively to resolve the problem.

"The worst thing is one employee complaining to me about another employee. When I confront that employee, that employee will say 'Why didn't she just tell me in the first place? Why did she have to go to you?' It's kind of like 'I'm telling Mom!' "

"The first response out of me is 'Have you spoken with her directly?' Because that is how you develop healthy relations. You talk to each other directly, because sometimes instant messaging can be misinterpreted," Comm says.]]> http://www.healthleadersmedia.com/page-2/PHY-246722/Every-Practice-has-Conflict-But-Only-Some-Handle-it-Well Thu, 18 Feb 2010 09:01:00 MST http://www.primarydatacorp.com/#1174 EHR
For the study, Accenture’s Innovation Center for Health and Institute for Health & Public Service Value and Harris Interactive surveyed 1,000 physicians in practices with fewer than 10 practitioners.

Of the survey respondents, 15% were currently using EHRs and 85% were not.

Of the respondents younger than age 55, 80% said that they plan to purchase EHR systems within two years (Johnson, HealthLeaders Media, 3/2).

Motivations for EHR Purchasing

When asked about major factors driving EHR adoption:

• 61% cited federal penalties for non-adoption; and
• 51% cited federal incentive payments (Mearian, Computerworld, 3/2).

The survey also found that 75% of non-users said they would be interested in purchasing an EHR system from a local hospital if the facility partially subsidized the purchase. Most non-users expect a hospital or health network to subsidize about 50% of the cost for an EHR system.

EHR Expectations

The survey also found that physicians have high expectations for EHR systems. According to the survey:

• 67% expect EHRs to improve billing and other administrative processes;
• 62% expect EHRs to make it easier to order and view imaging and test results;
• 59% expect EHRs to facilitate medication management;
• 55% expect EHRs to boost care coordination with other clinicians; and
• 51% expect EHRs to improve patient care (HealthLeaders Media, 3/2).]]> http://electronicmedicalrecord.wordpress.com/2010/03/10/survey-many-non-ehr-users-plan-to-purchase-systems-within-2-years/ Wed, 10 Mar 2010 09:01:00 MST http://www.primarydatacorp.com/#1175 e-Prescribing
Eighteen percent of prescriptions are not being sent electronically while e-prescribing is being used by one in four prescribers, according according to Surescripts, located in Alexandra, Va. Growth was seen in the use of prescription benefit, prescription history and prescription routing that support the e-prescribing process as well as in adoption by prescribers, payors and pharmacies between 2008 and 2009, the company said.

The report tracked the status of e-prescribing adoption, use in the U.S. and measures the growth of e-prescribing across a number of categories. Included in Surescripts analysis were:

• Prescription Benefit Information: The number of electronic requests for prescription benefit information went from 79 million in 2008 to 303 million in 2009.
• Prescription History Information: The number of prescription histories delivered to prescribers grew more than five-fold, from 16 million in 2008 to 81 million in 2009.
• Prescriptions: By the end of 2009, approximately 18 percent of eligible prescriptions were prescribed electronically compared with just 6.6 percent at the end of 2008. The number of prescriptions routed electronically grew from 68 million in 2008 to 191 million in 2009.
• Prescribers: The number of prescribers routing prescriptions electronically grew from 74,000 at the end of 2008 to 156,000 by the end of 2009, representing 25 percent of all office-based prescribers.
• Pharmacies: At the end of 2009, approximately 85 percent of community pharmacies and six of the largest mail-order pharmacies in the U.S. were able to receive prescriptions electronically.

Drivers of e-prescribing in 2009 included government incentives through programs such as the Medicare Improvements for Patients and Providers Act and Health IT for Economic and Clinical Health Act, according to Surescripts. Additional drivers included the broadening of certification programs by Certification Commission for Health IT, increased adoption by large clinics and health system, government and nongovernmental organization education and awareness programs and state-and-regional-level initiatives.

To support the continued growth of e-prescribing, Surescripts recommended supporting the development of regional health information exchanges, promoting more focus on the utilization of e-prescribing technology, encouraging the Drug Enforcement Administration to finalize rules permitting the electronic transmission of prescriptions for controlled substance and advocating for the improvement in the maintaining of prescriber and pharmacy directories.

"For the incentive program to succeed, the meaningful-use criteria must be practical and achievable," said William F. Jessee, MD, FACMPE, MGMA president and CEO. "If the final rule mirrors those outlined in the current proposal, there is a significant risk that the program will fail to meet the intent of the legislation, and that a historic opportunity to transform the nation's health care system will be missed."]]> http://electronicmedicalrecord.wordpress.com/2010/03/10/surescripts-e-prescription-use-rises-181-in-2009/ Wed, 10 Mar 2010 09:01:00 MST http://www.primarydatacorp.com/#1176 Telehealth Healthcare Technology
The National Broadband Plan makes 11 recommendations for using high-speed broadband networks to increase the use of electronic health records, health data exchange and telemedicine, or “e-care.”

E-care is defined by the FCC as the electronic exchange of information — data, images and video — help the practice of medicine and advanced analytics. E-care also is referred to as telehealth or telemedicine. When applied in mobile devices, it is sometimes called "MHealth" or "mobile health."

For telemedicine, the FCC also calls for the federal government to expand reimbursements and to remove barriers to adoption by updating regulations to for device approval, credentialing, privileging and licensing.

“Congress and the Secretary of Health and Human Services (HHS) should consider developing a strategy that documents the proven value of e-care technologies, proposes reimbursement reforms that incent their meaningful use and charts a path for their widespread adoption,” the plan states.

The FCC suggests working with the Food and Drug Administration to clarify regulatory requirements and the approval process for “converged” devices that are used both for communications and health care.

The plan has garnered the support of the American Telemedicine Association.

"These changes will greatly improve the quality of care, lower costs and improve access to healthcare to all Americans," said Jonathan Linkous, chief executive of the association. "We encourage Congress and the Administration to approve and implement these recommendations without delay.”

The plan also sees creating a Health Care Broadband Infrastructure Fund to subsidize health care delivery locations where existing networks aren't sufficient. In addition to hospitals, clinics and doctors’ offices, the broadband grants should be made available to nursing homes, health care administrative offices, health care data centers and other locations, the plan said.

The FCC also recommended that the Indian Health Service get up to $29 million a year to upgrade its broadband services.]]> http://fcw.com/articles/2010/03/16/fccs-national-broadband-plan-pushes-health-it-and-telemedicine.aspx Tue, 16 Mar 2010 09:01:00 MST http://www.primarydatacorp.com/#1177 EHR
"For the incentive program to succeed, the meaningful-use criteria must be practical and achievable," said William F. Jessee, MD, FACMPE, MGMA president and CEO. "If the final rule mirrors those outlined in the current proposal, there is a significant risk that the program will fail to meet the intent of the legislation, and that a historic opportunity to transform the nation's health care system will be missed."

The MGMA research also highlights the specific criteria that many respondents say would be "difficult" or "very difficult" to achieve. These include:

• The proposed requirement that 80 percent of all patient requests for an electronic copy of their health information be fulfilled within 48 hours (45.9 percent), and

• The proposed requirement that 10 percent of all patients be given electronic access to their health information within 96 hours of the information being available (53.5 percent). ]]> http://health-care-it.advanceweb.com/News/In-the-News/MGMA-Meaningful-Use-Requirements-Could-Decrease-Provider-Productivity.aspx Fri, 19 Mar 2010 09:01:00 MST http://www.primarydatacorp.com/#1178 Health Information Exchange
Located near Philadelphia, Doylestown Hospital, a 208-bed facility, is on the leading edge of community benefit and involvement through the creation of the Doylestown Clinical Network (DCN). DCN is a health information exchange (HIE) that seeks to advance patient care through collaborative data-sharing among area physician practices and our hospital.

Our path down this road began in the late 1990s, when community physicians approached the hospital for help after realizing that billing systems for its practices could not make the Y2K transition. We decided to set up a separate applications services provider (ASP) organization, through which our medical staff could purchase a new practice management (PM) system at cost(should we say at "fair market value")?

The next step came shortly afterward, when the practices expressed interest in obtaining electronic health record (EHR) technology. Once again, we successfully negotiated 50 licenses for an EHR. The first practice to go live on the EHR -- a large cardiology group -- did so in 2002, followed by a family practice in 2006 and 12 other practices by 2009.

These ventures underscore the proactive nature of our physician community. Indeed, the physicians themselves were the drivers when, in 2006, they advanced the idea of an HIE. With so many practices already utilizing EHRs, the next logical question became, "What if we all shared patient data?" It seemed an obvious way to provide better care to their patients.

These physicians are not employed by Doylestown Hospital. Many, in fact, operate in direct competition with each other. But they come here when seeking care for themselves and their families. Their community commitment is evident in their ability to put aside differences in order to improve overall patient safety and quality of care. The medical staff recently adopted a "compact" that formalizes its community- and patient-centric focus.

The need for connectivity

On a broad scale, questions abound regarding the future shape of health care in this country. But one thing is already clear: Information technology is viewed as a common bridge across which patient data must move to all providers who need it.

Many of us remember when, about 10 years ago, the Institute of Medicine (IOM) released a landmark publication, "To Err is Human: Building a Safer Health System." It revealed the unacceptably high costs -- both economic and clinical -- of a fragmented health care system driven by a core focus on acute, episodic illness. The IOM made this important observation: "When patients see multiple providers in different settings, none of whom has access to complete information, it becomes easier for things to go wrong."

As a community hospital, we have taken that message to heart. We have asked, "What if patients see multiple providers in different settings, but they all have access to complete information?" Obviously, such an idea cannot truly take root in a paper-based environment. But with the emergence of the EHR, PM systems and other technology, the concept of HIE now has become feasible.

An increase in patient safety and clinical workflow -- coupled with a decrease in redundant or unnecessary testing and administrative hassles/costs -- are some of the overarching goals sought by the DCN through the sharing of up-to-date patient records. They are accomplished by:

• Faster access to reliable patient information (e.g., lab results, radiology reports) at the point of care;
• Improved monitoring of care plans, preventive services and diagnostic tests;
• Easier collection and reporting of health quality and disease management measures;
• Better medication reconciliation (e.g., drug-drug or drug-allergy); and
• Simplified referral, admissions and discharge procedures.

In addition, benefits to the bottom line also are becoming increasingly prevalent. The American Recovery and Reinvestment Act of 2009 (ARRA), for example, provides individual physicians with up to $44,000 in incentives to purchase, install and upgrade health information technology -- contingent upon its "meaningful use."

Even without government incentives, however, the primary selling point of an HIE for the Doylestown clinicians is the potential to more easily provide better informed, higher-quality care. With the HIE, a local cardiologist can place a patient on Coumadin therapy, for example, and monitor INR measurements obtained by the patient's primary care physician (PCP). Without the HIE, such data exchange generally is not possible unless: (1) both practices are part of a group that shares a common record or (2) both physicians manually request and submit the information.

That's why, in 2006 -- several years before ARRA offered the promise of financial incentives -- Doylestown Hospital and an initial group of forward-thinking practices set the course toward a HIE.

Selection and implementation

Doylestown Hospital takes advantage of revised Stark laws to help practices with the cost of an EHR. Our ability to subsidize makes an EHR financially viable for many. But, in return for our cost assistance, the practices must agree to share relevant data. That sets a basic foundation for the DCN.

To start our endeavor, we created two physician-run committees -- the Administrative/Executive Committee and the Clinical Content Committee -- tasked with structuring policies and procedures for participation in the DCN. They decided, for instance, that the first phase of operation would be to focus on labs, demographics, allergies, medications and problems, while use of a referral application to push other clinical documents would come later.

Committee members also decided on an informed-consent policy. Each practice must explain to its patients what the DCN is, what information is shared, and who has access to it. Patients may "opt out" if they do not wish to participate. To date, only a small number of patients have opted out.

It took about six months for the committees to define the DCN from a policy and content standpoint. Meanwhile, they began their search for an HIE solution and interoperability platform that would link together -- virtually and seamlessly -- the hospital, practices and external diagnostic providers. They selected the NextGen Health Information Exchange (HIE) from NextGen Healthcare. The product dovetails with the NextGen Practice Management and NextGen EHR systems, which many were already using, but a more important factor was the ease with which NextGen HIE allows data exchange among practices without the NextGen EHR - or even any EHR at all.

Furthermore, we wanted to be able to pull clinical, demographic and quality measure reports from across the HIE. NextGen HIE allows data to be reported into the patient record in discrete elements, aiding data extraction. Consider another PCP/cardiologist example: The patient sees her PCP, who enters allergy and medication information into the record. The cardiologist accesses that information during the patient's next visit, before placing her on an ACE inhibitor -- a fact now available to the PCP. Because all of the information is captured as discrete data elements, it can be pulled into outcomes reports for clinical studies, pay-for-performance programs, or any number of other uses. There is no need for the time-consuming, error-riddled process of re-entering data.

We discovered that data-sharing is fairly uncomplicated from a technology standpoint. We ran into far fewer problems than one might expect as interfacing got underway. Instead, one of the toughest aspects of pulling together the DCN has been convincing external diagnostic providers to participate. It took about six months of discussion, for instance, before one vendor agreed to sign on board.

Once it did, though, the DCN became active with its first practice in March 2007. We now have 85 participating providers -- with plans to link another 100 providers -- and three lab connections: Quest, LabCorp and the Doylestown Hospital lab.

Benefits to cost, patient care realized

Physicians have been pleased with the transparency of the DCN data-sharing activities, as no extra steps or workflow alterations are needed. Results from the hospital information system, for example, populate the framework of each practice's EHR in the manner its clinicians are accustomed to seeing.. We anticipate that our current six full-time IT equivalents will support all 180 providers we eventually hope will participate.

But the clinical benefits, of course, are the prime focus of the DCN. So far, in the ambulatory setting, 136,726 distinct clinical items have been imported -- about 1.84 data notifications each hour. Physicians have imported allergy information 12,961 times, medication data 92,596 times and diagnosis details 31,168 times.

Physicians now have point-of-care access to a complete list of lab, radiology and endoscopy studies each patient has already gone through, as well as a current problem list that notes each condition as "resolved" or "unresolved." This allows clinicians to provide more accurate diagnoses -- without wasting time or resources on redundant testing to diagnose problems providers in other practices already have evaluated.

In a handful of cases, the system has alerted providers to potential drug-seekers by informing them that the patient had already received the drug they were requesting from another provider. More commonly, clinicians check patient profiles for potential drug-drug or drug-allergy contradictions.

Such benefits aid Doylestown Hospital in its continuing mission to provide top-quality patient care. We were the only Philadelphia-area hospital to receive all three cardiac specialty excellence awards -- for cardiac care, cardiac surgery and coronary intervention -- from HealthGrades in 2009. In addition, we are one of only 53 hospitals in the country to receive five stars for both patient safety and satisfaction. And we were recently named a Microsoft Healthcare Users Group (MS-HUG) 2010 Innovation Awards winner in the category of Interoperability/HIE.

We still have much work to do, bringing more patients and providers into the network. But as the DCN expands, we hope an even more robust information flow will enable all participating practices to work together toward the common benefit of each and every one of the patients in our community.]]> http://health-care-it.advanceweb.com/Features/Article-2/HIE-Connection-Promotes-Quality-Care-Community-Focus.aspx Wed, 24 Mar 2010 09:01:00 MST http://www.primarydatacorp.com/#1179 EHR
On Feb. 26, CHIME filed its comments with the Centers for Medicare & Medicaid Services (CMS) regarding the EHR Incentive Program. CHIME's ONC letter closely parallels its comments to CMS. The Ann Arbor, Mich.-based organization has 1,400 members representing CIOs and other top information technology executives at many of the nation's largest hospitals.

In its comments on the interim final rule, CHIME emphasized the importance of certification for supporting providers' efforts to achieve meaningful use, saying it gives "health care providers a degree of assurance that the products they purchase will perform as promised.certification is meant to support providers, not pose an additional burden."

CHIME's comments place most of the responsibility on vendors that develop IT products, which it says builds on past experience in the health care IT space. The organization also urges ONC to provide more lead time as it creates future certification criteria, so as to provide more time for providers to implement new and upgraded systems in the future.

Previously, in its comments to CMS on meaningful use regulations, CHIME had requested that a "grandfathering provision" be implemented to grant certification to products that have already been certified by the Certification Commission for Health Information Technology.

CHIME noted that further clarification is needed in ONC's interim final rule, particularly in describing how certification will apply to organizations that use multiple clinical systems as components to an overall EHR system.

CHIME supports wording in the rule that requires only certification of individual EHR modules.

CHIME's comments ask ONC to support a single standard for patient summary records; the current interim rule allows use of either the Health Level Seven (HL7) Clinical Document Architecture (CDA) Release 2 (R2) Level 2 Continuity of Care Document (CCD) or the ASTM Continuity of Care Record (CCR) to electronically exchange a patient summary record.

According to CHIME, medication reconciliation requirements in the interim rule need to be adjusted so that providers can meet the requirement if clinical systems can "display simultaneously two or more medication lists and provide tools for the clinician to perform medication reconciliation and create a single medication list."

For reporting quality data, CHIME advises against using the CMS Physician Quality Reporting Initiative (PQRI) 2008 Registry XML Specification, and the related implementation specifications, the PQRI Measure Specifications Manual for Claims and Registry. Instead, it suggests the continued development of quality data reporting standards, which are in process by HL7.

CHIME also seeks a standards-based approach for submitting data to public health agencies. Current proposals for submitting data provide wide latitude to agencies for determining the format in which they want to receive data.

In addition, CHIME commented on privacy and security standards included in the interim rule, particularly in areas of encryption and decryption of data, verification of data to ensure it hasn't been altered in transit, and cross-enterprise authentication.]]> http://health-care-it.advanceweb.com/News/In-the-News/CHIME-Issues-Comments-on-Interim-Final-Rule-on-Standards-Certification.aspx Wed, 24 Mar 2010 09:01:00 MST http://www.primarydatacorp.com/#1180 e-Prescribing
According to the study's authors, demonstrating improvements in safety with electronic prescribing is important to encourage its use, especially among community providers in solo and small group practices who mostly write prescriptions by hand.

"We found nearly two in five handwritten prescriptions in these community practices had errors," said Dr. Rainu Kaushal, the study's lead author and associate professor of pediatrics, medicine and public health, and chief of the division of quality and medical informatics at Weill Cornell Medical College. "Examples of the types of errors we found included incomplete directions and prescribing a medication but omitting the quantity. A small number of errors were more serious, such as prescribing incorrect dosages."

To evaluate the effects of e-prescribing on medication safety, researchers looked at prescriptions written by health care providers at 12 community practices in the Hudson Valley region of New York. The authors compared the number and severity of prescription errors between 15 health care providers who adopted e-prescribing and 15 who continued to write prescriptions by hand.

The providers who adopted e-prescribing used a commercial, stand-alone system that provides dosing recommendations and checks for drug-allergy interactions, drug-drug interactions and duplicate drugs. All the practices that adopted e-prescribing received technical assistance from MedAllies, a health information technology service provider. The study noted that, without extensive technical support, it is difficult for physician practices to achieve high rates of use of electronic prescribing and subsequent improvements in medication safety.

In total, the authors reviewed 3,684 paper-based prescriptions at the start of the study, and 3,848 paper-based and electronic prescriptions written one year later. After one year, the percentage of errors dropped from 42.5 percent to 6.6 percent for the providers using the electronic system. For those writing prescriptions by hand, the percentage of errors increased slightly from 37.3 percent to 38.4 percent. The researchers also found that illegibility problems were completely eliminated by e-prescribing.]]> http://health-care-it.advanceweb.com/News/In-the-News/Study-Electronic-Prescribing-Significantly-Reduces-Errors.aspx Thu, 25 Mar 2010 09:01:00 MST http://www.primarydatacorp.com/#1181 EHR
On Feb. 26, CHIME filed its comments with the Centers for Medicare & Medicaid Services (CMS) regarding the EHR Incentive Program. CHIME's ONC letter closely parallels its comments to CMS. The Ann Arbor, Mich.-based organization has 1,400 members representing CIOs and other top information technology executives at many of the nation's largest hospitals.

In its comments on the interim final rule, CHIME emphasized the importance of certification for supporting providers' efforts to achieve meaningful use, saying it gives "health care providers a degree of assurance that the products they purchase will perform as promised.certification is meant to support providers, not pose an additional burden."

CHIME's comments place most of the responsibility on vendors that develop IT products, which it says builds on past experience in the health care IT space. The organization also urges ONC to provide more lead time as it creates future certification criteria, so as to provide more time for providers to implement new and upgraded systems in the future.

Previously, in its comments to CMS on meaningful use regulations, CHIME had requested that a "grandfathering provision" be implemented to grant certification to products that have already been certified by the Certification Commission for Health Information Technology.

CHIME noted that further clarification is needed in ONC's interim final rule, particularly in describing how certification will apply to organizations that use multiple clinical systems as components to an overall EHR system.

CHIME supports wording in the rule that requires only certification of individual EHR modules.

CHIME's comments ask ONC to support a single standard for patient summary records; the current interim rule allows use of either the Health Level Seven (HL7) Clinical Document Architecture (CDA) Release 2 (R2) Level 2 Continuity of Care Document (CCD) or the ASTM Continuity of Care Record (CCR) to electronically exchange a patient summary record.

According to CHIME, medication reconciliation requirements in the interim rule need to be adjusted so that providers can meet the requirement if clinical systems can "display simultaneously two or more medication lists and provide tools for the clinician to perform medication reconciliation and create a single medication list."

For reporting quality data, CHIME advises against using the CMS Physician Quality Reporting Initiative (PQRI) 2008 Registry XML Specification, and the related implementation specifications, the PQRI Measure Specifications Manual for Claims and Registry. Instead, it suggests the continued development of quality data reporting standards, which are in process by HL7.

CHIME also seeks a standards-based approach for submitting data to public health agencies. Current proposals for submitting data provide wide latitude to agencies for determining the format in which they want to receive data.

In addition, CHIME commented on privacy and security standards included in the interim rule, particularly in areas of encryption and decryption of data, verification of data to ensure it hasn't been altered in transit, and cross-enterprise authentication.]]> http://health-care-it.advanceweb.com/News/In-the-News/CHIME-Issues-Comments-on-Interim-Final-Rule-on-Standards-Certification.aspx Wed, 24 Mar 2010 09:01:00 MST http://www.primarydatacorp.com/#1182 e-Prescribing
The rule is similar to the DEA’s 2008 proposed regulation for e-prescribing, but it adds the option of using a biometric identifier, such as a fingerprint or iris scan, to authenticate the identity of the user of the e-prescribing system.

Under the rule, doctors would be able to electronically prescribe controlled substances such as morphine and other painkillers. Currently, doctors must use paperwork and fax machines for those substances. If they choose to prescribe other drugs electronically, the physicians have to maintain separate paper and electronic record systems, which many choose not to do.

The DEA on March 24 issued the 334-page Interim Final Rule on Electronic Prescriptions for Controlled Substances. It is expected to be officially published in the Federal Register on March 31, followed by a 60-day comment period.

“The regulations provide pharmacies, hospitals, and practitioners with the ability to use modern technology for controlled substance prescriptions while maintaining the closed system of controls on controlled substances dispensing,” the interim final rule states. “Additionally, the regulations will reduce paperwork for DEA registrants who dispense controlled substances and have the potential to reduce prescription forgery.”

The e-prescribing regulations also have the potential to reduce errors and help doctors and hospitals integrate their records, the document said.

The rule covers drugs and other substances that have a potential for abuse and street use, including opioids, stimulants, depressants, hallucinogens, and anabolic steroids. At the same time, the drugs have legitimate usages in medical care and in some practices make up a significant percentage of prescriptions, the DEA said.

The DEA in 2008 published a Notice of Proposed Rulemaking for e-prescribing of controlled substances that described a two-factor authentication rule. The new interim final rule maintains two factors while adding the possibility of a biometric.

In the new regulation, users of e-prescribing systems for controlled substances would have proved their identities with two of the following three factors: something you know (password); something you have (token) or something you are (biometric).

“Authentication based only on knowledge factors is easily subverted because they can be observed, guessed, or hacked and used without the practitioner’s knowledge. In the interim final rule DEA is allowing the use of a biometric as a substitute for a hard token or a password,” the IFR states.

The DEA said it is seeking further comments on alternatives to two-factor authentication while also encouraging e-prescribing.]]> http://fcw.com/articles/2010/03/26/dea-e-prescribing-regulation-controlled-drugs.aspx Fri, 26 Mar 2010 09:01:00 MST http://www.primarydatacorp.com/#1183 EHR
A new paper in the New England Journal of Medicine by Dr. Gorden Schiff and Dr. David W. Bates of Brigham and Women's Hospital and the Harvard School of Public Health in Boston examines how clinical documentation in electronic health records can help reduce diagnostic errors.

"Although clinical documentation plays a central role in EHRs and occupies a substantial proportion of physicians' time, documentation practices have largely been dictated by billing and legal requirements," they write. "Clinicians need to take back ownership of the medical record as a tool for improving patient care; such a move could have many benefits, including reducing the frequency of diagnostic errors."

According to Schiff and Bates, EHRs can help physicians make more accurate diagnoses by:

• Organizing and filtering patients' medical history and test results;
• Facilitating collaboration between clinicians and patients;
• Allowing for constant refinement and updating of patient data; • Improving communication in ordering tests and tracking results;
• Providing clinical decision support to make sure physicians ask the right questions and consider the right diagnoses; and
• Improving follow-up and patient education.]]> http://www.fiercehealthcare.com/story/study-proper-ehr-documentation-can-reduce-diagnosis-errors/2010-03-29 Mon, 29 Mar 2010 09:01:00 MST http://www.primarydatacorp.com/#1184 Practice
The two organizations interviewed 1,000 physicians regarding pain points and frustrations relating to the business of medicine, reimbursement protocols, government’s hand in healthcare, and other variables that stand to threaten the delivery of quality care, they say.

Some other key findings include the following:

• 62 percent of physicians are pessimistic about their ability to practice independently or in small groups in the future
• 64 percent agree that clinical decisions are based more on what payors are willing to cover rather than what they think is best for patients
• 64 percent say the current healthcare climate as somewhat or very detrimental to their delivery of quality care
• 54 percent disagree that more active government involvement in healthcare regulation can improve outcomes; less than a quarter feel otherwise
• 49 percent believe a shift from fee-for-service to pay-for-performance will have a positive impact on quality of care; however, 53 percent believe pay-for-performance will have a negative impact on the effort required to get paid
• 77 percent agree that time spent with payors and third parties inhibits their ability to spend time with patients
• 81 percent expressed a favorable opinion on EHRs, yet only just 51 percent feel EHRs are designed with them in mind
• 54 percent agree that EHRs slow down the doctor during patient exams]]> http://www.healthcare-informatics.com/ Mon, 29 Mar 2010 09:01:00 MST http://www.primarydatacorp.com/#1185 Legislation
Earlier this month, the Senate voted to delay the physician pay cut of 21.2% in Medicare reimbursement until Oct. 1. But the House did not take up the action, and as a result, the previous decisions by both chambers still stand. And that's April 1.

Some congressional officials have said it is likely that Congress may decide on the bill retroactively. The House doesn't vote again on legislation until April 13, according to the House calendar.

But J. James Rohack, MD, president of the AMA, said in a statement released on Friday, "It is unconscionable for elected officials to play politics with seniors and military families who rely on them to preserve their ability to see the physician of their choice."

"Members of Congress eager to spend a two-week holiday with their families have left America's military families and seniors to fend for themselves through their inaction on a known threat to the Medicare and TRICARE programs," Rohack stated. "On April 1, a 21% Medicare cut to physicians begins. Congress' failure to act on permanent repeal of the broken Medicare physician payment formula has put access to healthcare for seniors and military families in jeopardy."

The physician pay cut issue has been dependent continually on congressional action, much to the consternation of physicians. On Dec. 19, Congress voted to delay the scheduled payment cut until March 1. Both houses then extended it a month.

Specifically, the Medicare payments were scheduled to be cut across the board in accordance with the sustainable growth rate (SGR) formula.

The proposed delay ostensibly is to give Congress time to adjust the SGR formula. SGR links Part B Medicare reimbursement to the gross domestic product. The formula has led to proposed large cuts annually, which physicians have successfully worked to delay.]]> http://www.healthleadersmedia.com/content/PHY-248666/AMA-Blasts-House-for-Not-Voting-on-Doc-Pay-Cut.html Mon, 29 Mar 2010 09:01:00 MST http://www.primarydatacorp.com/#1186 Healthcare
Try to imagine how the practice of medicine will transform in the next 10 to 20 years — not an easy exercise considering recent healthcare reform efforts and scientific discoveries make even a six-month view into the crystal ball a little cloudy.

Will there be high-tech full body scans, an iPad in the hand of every practitioner, and hologram versions of yourself being beamed into the homes of your patients?

Not likely, but rising costs and increasing demands on the healthcare system will surely force a transformation in the role of today’s physician. More than just universal EHR adoption or smartphone use, the practice of the future is likely to reinvent the care-delivery model, rethink reimbursement, and retool technology.

Here, some of healthcare’s innovative thinkers and practitioners aim to reimagine the doctor of the future, as signaled by some of the innovations taking root today.

A new way to deliver care

The traditional, one-size-fits-all, office visit model of medicine has reigned for decades. Physicians are locked into a system that requires they see patients in their office every 15 minutes, and alternatives like e-mail consultations have been slow to catch on.

Healthcare has been stuck here because of the payment structure, says David Moen, a physician and medical director of care model innovation at Minneapolis-based Fairview Health Services. Moen’s job is to rethink the traditional model and find ways to make the alternatives work. The current financial structure limits this innovation, he says, and fails to take into account patient engagement and drive efficiencies.

But at Fairview, they are initiating care reform, Moen says, which will in turn inform payment reform. Moen says the future of care includes different delivery models (think phone, Internet, and group visits), a greater focus on patients’ behavior, and a far more team-oriented approach.

“This is probably the most opportune time in decades for physicians to provide leadership to the change taking place,” he says.

Online visits

Moen’s colleague, Eric Christianson, an emergency department physician at Fairview, has been trying his hand at what some believe will become a new tier for healthcare delivery: online visits.

As part of a pilot program with BlueCross BlueShield of Minnesota, Christianson has started seeing some patients via the Internet, using a Web cam and a telephone. Already, after only about 40 visits, Christianson says he can see how this method would make him more efficient, and give him some flexibility in his schedule.

“It seems to me to be a very common sense, logical step,” he says. “The technology is out there. There are still things that need to be worked on, but as it’s being developed and being refined, it’s clear to me that it could be utilized for betterment of patient and physician experience.”

Not only will the online care model extend healthcare access to people in rural or underserved areas, but it can offer the physician a unique way to control her schedule. Imagine spending half of the day in the office seeing patients, then returning to work — perhaps from the comfort of your home — in the evening after your child’s softball game or dinner with the family. Any down time between patients, such as a last-minute cancellation, can be filled with another appointment.

A patient can go online to find out which physicians are available for an online visit, says Roy Schoenberg, CEO of American Well, which provides the online system.

The physician can review records, communicate, and write a prescription — and actually get paid (albeit less than for an office visit).

Minnesota is one of only a few areas using the online care model, but Schoenberg envisions the system evolving to allow for other disciplines to participate and for physicians to consult with each other.

Christianson also sees the mode taking off. “There’s no question that online care is something that is going to grow,” he says. “This is just another layer we can utilize and help with the efficiencies of the whole system.”

Group visits

Perhaps the ultimate move toward more efficiency would be seeing more than one patient at a time. Imagine if you could corral a half-dozen of your patients with similar conditions into a single visit, allowing you or your staff to give the information and guidance once. For some physicians, this is already a reality, and many see group visits as a new model for the practice of the future.

Although group visits have been around for several years, the concept is gaining in popularity, and more payers are beginning to reimburse for them.

The concept started around patients with a similar condition, such congestive heart failure, who are in a rehab program, says Erica Drazen, managing director for the emerging practices division of CSC Healthcare Group, a planning and performance improvement consulting firm in Waltham, Mass. In a group visit, there may be a facilitated discussion about diet or exercise, after a nurse or physician has evaluated each patient individually.

“Patients listen to what is going on with every patient, as well as talk amongst themselves,” Drazen says, which provides them with greater insights into their condition and builds support among the group.

“As you hear questions and answers, you learn a lot about yourself,” she says. “Patients love the visit experience.”

Surprisingly, privacy concerns don’t seem to be a barrier to such visits, Drazen says, and of course any exam is done in a separate room.

This can allow the physician to be more efficient, and it also gives her some insight into the condition she might not otherwise get in one-on-one visits.

Group visits tend to be limited to organized systems of care, such as an HMO or large clinic that allows for reimbursement, Drazen says, but “where they are introduced, they spread pretty quickly.”

Rather than being uncomfortable for patients with chronic illnesses, group visits can be empowering, says David Ehrenberger, a family-practice physician at Bloomfield Family Practice, which has conducted group visits and is participating in a patient-centered medical home pilot project.

“That group dynamic is extremely powerful,” he says.

Beyond concierge

For some physicians, the answer to declining reimbursements has been a migration to so-called concierge medicine, in which patients pay a retainer fee for highly personalized care and greater access. The benefits for physicians are clear — no more payer headaches and more time to care for patients. Many, however, reject the idea of asking patients to pay even more for care and dropping those who can’t afford it.

But like other models of care delivery, the concierge model is sure to evolve, and Susan Wilder thinks she has tapped into the future of concierge.

Wilder, a primary-care physician at LifeScape Medical Associates in suburban Phoenix and a well-known advocate for patient-centered healthcare, practices what she calls hybrid concierge. Only those patients who want to pay for the extra access (usually about 5 percent) do so, allowing the physician to continue to see the other patients as well. As medicine adapts to be more patient-centric, Wilder says, this hybrid concierge model can be one solution.

Wilder likens the model to the airline business: customers who want to pay first-class rates for additional services can do so, but you’re not going to kick the coach passengers off the plane.

“We hold the keys to our own shackles,” Wilder says, adding that physicians are responsible for allowing the rising overhead and declining reimbursements. Physicians have accepted the current payer-centric system, and it’s time to take control of the practice and try something different, she argues.

Wilder says she was ready to abandon medicine entirely, as she found she was unable to devote the appropriate time and energy to her patients. The hybrid model gives her flexibility without locking her into one model that might not be sustainable in the future. Her practice isn’t based solely on concierge patients (who may opt out of the model if it becomes too costly), or on insurance plans, whose reimbursement rates are declining.

“We really tried to think ahead, and we really are patient centered,” she says.

Team approach

Many healthcare practitioners and observers predict a major shift in the role of the traditional solo or small practice primary-care physician as the main provider. The primary-care doc won’t go away, but instead take the helm as the care organizer, coordinating care increasingly provided by midlevel providers such as nurse practitioners and physician assistants, a model already being explored in the patient-centered medical home pilots.

“The physician plays a central role, as a team leader, not as the central provider,” says Harry Jacobson, who served as vice chancellor of health affairs at Vanderbilt University and director of Vanderbilt University Medical Center. “Medicine is a team sport, and we need to find a way to learn how to train people as teams.”

This shift will be predicated by the increase in demand for primary care and the shortage of primary-care physicians. As the healthcare system begins to reward outcomes and focus on prevention, a care coordinator will emerge. That coordinator will come up with the plan and delegate how it’s executed.

“That person needs to be a physician, because the medical care of patients will be more complex,” says Aaron Michelfelder, a family practice doctor and head of curriculum development for Loyola University Chicago Stritch School of Medicine.

The entire healthcare workforce will evolve, mainly because technology will expand the capabilities of midlevel professionals and prompt physicians to take on new roles, says Jason Hwang, a primary-care physician and executive director of healthcare at the Innosight Institute, a nonprofit think tank focused on healthcare and innovation.

Hwang predicts that technology will enable this shift in duties via a process the business world calls “disruptive innovation” through “commoditization of the work or the experience.” New technologies commoditize skill by making the job more easily taught and performed, Hwang says. This is true in any industry: As new tools are developed, lower-level professionals can perform a skill once relegated to the more highly trained.

In healthcare, “what was done by specialists will be done by generalists, and what is done by generalists will be done by nonphysicians,” he says.

Of course, some primary-care physicians will be more interested in taking on the position of the care coordinator, as seen already in patient-centered medical home pilots, rather than the duties of the specialist. But Hwang issues a warning about that path. “If technology can help physicians coordinate care better, you could imagine it wouldn’t take long for that same piece of software technology [to] help a nurse practitioner coordinate care. If you are progressing down that path, and you’re placing all your eggs in the primary-care basket, it’s time-limited.”

Tech tools of the future

The root of physicians’ transforming role is technology, for both diagnosis and for organizing the exponentially growing amount of patient information.

“The physician of the future is going to be faced with making decisions with so many data points that they cannot make the best decisions without computer-assisted support,” says Jacobson.

You think there’s pressure to adopt EHRs, e-prescribing, and patient registries now? In the next decade or two, healthcare information technology promises to become even more advanced — and necessary. The burgeoning field of personalized medicine that is using patients’ genetic information to better tailor treatments and protocols to each individual patient will continue to grow, meaning even more information.

Having an EHR that collects and presents that information for the physician is just half the battle, Jacobson says. Then the information will need to be better organized in a way that is useful for decision support.

Most experts envision the current push for EHR adoption and integration to continue. The CDC’s National Center for Health Statistics says that about 44 percent of doctors are using full or partial EHRs, up from about 41 percent in 2008. But only 6.3 percent were using systems described as “fully functional.”

With the federal government’s initiative aimed at encouraging all practices to achieve so-called “meaningful use” of EHRs, that number may rise steadily over the next several years, but there is still a long way to go. So if you’re imaging a future of physician holograms beaming in for exams, think again. More likely, the next 10 or 15 years mean more EHRs and more integration of systems so they can better share data.

“Right now our EMR cannot talk across healthcare institutions,” says Loyola’s Michelfelder. “The first thing is that it’s going to be a lot easier for us to take care of patients because we are going to have better access to records.”

Emerging technologies will also expand the options for where patients are seen. Doctors will be less tethered to the hospital and able to perform more procedures in the office, making care more convenient and accessible, Hwang says. For example, MRI machines, portable ultrasounds, and EKG machines can be brought out of the hospital and into the doctor’s office.

Similarly, online visits, like those already being tested by Christianson in Minnesota, will free up physicians to see patients and consult with other physicians regardless of their location.

Finally, technology will enable patients to take a more active role in their care, says Fran Turisco, a research principal for CSC’s Emerging Practices group. More patients will have access to home-monitoring technologies that allow them to be more proactive in their own care.

“We are finding that there are things like the iPhone with an unbelievable number of applications on it to help [patients] adhere to medication schedules,” Turisco says.

But those applications will only be useful if you connect all the dots, Turisco says, making sure the patient and the entire healthcare team is tapped into the same software to coordinate care.

So what happens to the smaller practices that are resisting the adoption of technology or who don’t envision a day when they will communicate online with their patients or other providers?

“Their days are numbered,” Hwang says, noting that around the corner there will be another business model — say, a retail clinic or larger integrated health system — that is connected and moving light years ahead of the old model.

Payment shift

Trying to predict when all these changes will happen really becomes a study in physician reimbursement. Perhaps unsurprisingly, for any new care-delivery model or technology to take hold, there will have to be a change in the current reimbursement structure.

“The primary constraint of change is not necessarily technology, but how the financing mechanism for primary care reimbursement will be evaluated and modified going forward,” says Alex Hunter, president of EthosPartners, a healthcare and management consulting firm in Suwanee, Ga.

And it’s going to take more than federal EHR incentives, Hunter says. It will take real reimbursement reform.

So what will it look like?

“There are 544 people in the House and Senate who are debating that today,” Hunter says, adding that ultimately, the reimbursement system will focus on qualitative management of patients’ health and outcomes.

Already payers are starting to reimburse for less traditional models of care, such as e-mail consultations and group visits.

Several experts predict an even greater increase in the number of physicians opting for hospital employment. Integrated health systems like Kaiser Permanente will dominate the employment landscape, as physicians seek refuge in steady salaries, and younger physicians reject the private practice path for more stability.

These integrated health systems can also more easily bear the heavy load of financing the technology, and support full integration of the electronic systems, he says.

What’s clear is the fee-for-service model’s days are likely numbered. Another option could be more of a lump-sum, per-capita model.

“I definitely see the piecemeal system going by the wayside,” Hwang says. “Ordering a McDonald’s hamburger or your typical retail purchase — that’s the only instance where a piecemeal rate really works.”

Creative thinking

In the future, the private-practice physician will be operating a truly independent business free from insurers. Or there won’t be any private practices; instead virtually all physicians will work as employees in hospitals or health systems. The role of the primary-care physician will evolve into that of team leader — the hub of the care management team, coordinating with a number of midlevels and specialists for each patient. Or the primary care physician will go the way of the dodo.

Depends on whom you ask.

But what’s clear is that change is coming. The current landscape is starting to transform, and the future promises a continued acceleration and utilization of technology and a greater focus on patient outcomes.

As a physician who has embraced the less traditional model of care known as hybrid concierge, Wilder suggests all physicians start planning for the future by deciding their true values and goals. Talk with family and friends, or hold focus groups to find out what your patients value, she says.

“Then,” she says, “think creatively about how you can come up with a model practice.”]]> http://www.healthleadersmedia.com/content/PHY-248666/AMA-Blasts-House-for-Not-Voting-on-Doc-Pay-Cut.html Tue, 30 Mar 2010 09:01:00 MST http://www.primarydatacorp.com/#1187 Healthcare Technology
"We understand the potential and benefit of having these devices in the marketplace, but we would like to make sure that they perform in a way that would lead to [their] safe and effective use and that the public is protected," Dr. Alberto Gutierrez of the FDA's Center for Devices and Radiological Health, tells radiology news site AuntMinnie. Since MIMvista designed the app, called Mobile MIM, as a diagnostic product, the company is making plans to conduct clinical trials--even though Mobile MIM already carries a European seal of approval and is available in the UK, Australia, Hong Kong, Singapore and India.

The disposition of other image viewers isn't so certain. AuntMinnie contacted other medical imaging app developers, and none said they had heard from the FDA about their iPhone products.

"When we launched our Exam-PACS for iPhone, we made it very clear that it was not intended for diagnostic purposes, only for review," says Ed Heere, CEO of CoActiv Medical Business Solutions. "The iPhone, because of its size and resolution, will never lend itself to diagnostic interpretation to radiology and cardiology as we understand it today," he added.

But with Apple's larger, higher-resolution iPad ready to hit the market next week, all bets are off.]]> http://www.fiercemobilehealthcare.com/story/fda-ruling-mobile-image-viewers-could-shake-iphone-app-market/2010-03-30 Tue, 30 Mar 2010 09:01:00 MST http://www.primarydatacorp.com/#1188 EHR
Cambridge, Mass.-based NaviNet, America's largest real-time healthcare communications network, conducted the survey via email earlier this month, targeting physician practices with 10 or fewer physicians. The survey generated 269 responses.

NaviNet compared its March 2010 survey with one conducted in August 2009 and found that EMR implementation was higher than expected among this segment. In 2009, only nine percent of respondents from provider practices with 10 or fewer physicians reported that they planned to implement EMRs within the next six months. Six months later in 2010, 12 percent are currently implementing.

EMR PLANS UP

The survey found that 17 percent of respondents say their offices will implement a new EMR by end of 2011. Of those, 68 percent will do so within the next 12 months. If EMR adoption follows previous growth rates, the industry can expect an even higher percentage of practices implementing EMRs than predicted, NaviNet projects.

The percentage of respondents with no plans to implement an EMR has decreased significantly, the survey found. In 2009, 31 percent reported they had no plans to implement EMR. In 2010, only 21 percent say the same.

ADOPTION DRIVERS

The NaviNet survey indicates that nearly twice as many provider offices' IT buying decisions are driven by concern about not being reimbursed versus the potential to earn incentives.

In 2010, when respondents were asked what external factors were influencing their offices' decisions about changes to technology, 53 percent said CMS mandates––a 14 percent spike over 2009.

Administrative concerns continue to be a pressing issue for providers, more so than clinical concerns or potential financial incentives. Nearly the same percentage of respondents in 2009 and 2010 cited the need to manage their practices' administrative overhead more effectively as a driver behind IT adoption––44 percent in 2009, 45 percent in 2010.

The survey results show that the opportunity to receive incentives from ARRA after meeting the CMS criteria for "meaningful use" of technology is becoming more important; in just six months the percentage of respondents that said ARRA was driving technology adoption more than doubled––12 percent in 2009 to 27 percent in 2010.

MEANINGFUL USE

That said, the survey found that in 2010 most practices are still unsure or unaware of meaningful use reporting requirements and nearly half of practices say ARRA will not impact their technology buying decisions:

• Only about one quarter (26 percent) of respondents said that they plan on following CMS' guidelines for meaningful use to qualify for incentive payments provided by ARRA; • More than 60 percent (63 percent) said they were unaware or unsure of what the meaningful use reporting requirements are; and • Nearly half of respondents (48 percent) said that meaningful use requirements will not impact their EMR buying decisions.

"The NaviNet survey results are encouraging, as they suggest that small physician practices are getting more serious about HIT adoption," said Brad Waugh, president and CEO of NaviNet. " Furthermore, it is also encouraging to see federal incentive programs having more of an impact on IT adoption. However, it is clear that opportunities remain for education about how to meet Federal requirements. Providers would benefit from knowing that a wide variety of IT solutions, in addition to EMRs, will satisfy their office's business requirements and also the clinical criteria for Meaningful Use. Many physicians already have these solutions in their offices—so additional investment could be minimal or unnecessary."

ADOPTION BARRIERS

In 2010, nearly 50 percent of NaviNet survey respondents said that cost remains the biggest barrier to EMR adoption. Other barriers cited by respondents were:

• Forty-six percent of physicians said they are not ready to pursue adoption; • Twenty-seven percent of practices say they do not need an EMR; and • Twenty-six percent of practices do not how they will achieve return on investment.

Click here to view graphs from the study.]]> http://www.healthcareitnews.com/news/sunny-outlook-small-practice-emr-adoption-meaningful-use-cloudy Wed, 31 Mar 2010 09:01:00 MST http://www.primarydatacorp.com/#1189 Legislation Medicare
But for the second time this year, the Centers for Medicare and Medicaid Services (CMS) has stepped in, buying doctors more time.

As it did at the end of February, CMS has instructed contractors to hold claims for services performed on or after April 1 for the first 10 business days of the month. That will give Congress time when it returns on April 12 to pass legislation pushing back the cut, mandated by the often-criticized Medicare physician payment formula known as the sustainable growth rate (SGR).

"Under the Medicare law, we're [normally] not permitted to release payment for 10 business days from the date of receipt," explained agency spokeswoman Ellen Griffith. "So if we receive a claim on April 1 for a service performed that day, we can't pay it before April 15." However, CMS would normally start processing the claim right away in anticipation of that April 15 release date, she said.

But if CMS did that and then Congress changed the law, "we'd have to go back and reprocess those claims based on whatever Congress did, which is very expensive," Griffith said. "The goal is to avoid paying the claims based on the cut if Congress is going to do something again."

If Congress does act any time before April 15, CMS will immediately call off the hold and instruct its contractors to start processing again, she added. And if Congress doesn't act, CMS will begin processing the claims on a rolling basis.

On March 10, the Senate passed a $138 billion bill that would, among other things, put off planned cuts to Medicare reimbursements until Oct. 1, but the House failed to act on the measure.

Physician groups have grown increasingly tired of the steady stream of short-term fixes and are lobbying hard for a permanent repeal of the SGR.]]> http://www.medpagetoday.com/PracticeManagement/Reimbursement/19313 Wed, 31 Mar 2010 09:01:00 MST http://www.primarydatacorp.com/#1190 Healthcare Technology
Here’s the show rundown for April:

• Our guest is someone I met earlier this year in London. He is a real-life British Knight who serves the Queen as one of England’s premier thought-leaders in health. Sir Muir Grey holds the title of Chief Knowledge Officer for the National Health Service. Learn how he is leading the crusade for patient empowerment.

• If you are a fan of the TedTalk series, you may have run across our next guest, Bill Davenhall, of ESRI. Bill had a devastating heart attack at the age of 50, causing him to ask, “Why is this happening to me?” What he learned about the connection between where we have lived and the status of our health may shock you.

• I first met Dr. Joel Robertson shortly after I joined Microsoft. We’ve stayed in touch over the years. A friend’s loss prompted him to develop powerful software that is helping clinicians around the world reduce medical errors by guiding them to a correct diagnosis. Soon, consumers may also be able to use this powerful technology that runs on a cell phone.

• IT has become a strategic resource for hospitals and health systems these days. Being a successful health system CIO is no easy task. But one CIO who is always setting the mark for his peers is Sharp Healthcare’s Bill Spooner. He was recently honored by HIMSS as “CIO of the year”.

• One day your cell phone may provide guidance on the status of your health. Dr. Suzanne Smith of STAR Analytical Services is studying the acoustics of cough and developing software that may help you decide if and when you need to see a doctor.]]> http://blogs.msdn.com/healthblog/archive/2010/03/31/microsoft-health-tech-today-april-program-watch-it-now.aspx Thu, 01 Apr 2010 09:01:00 MST http://www.primarydatacorp.com/#1191 Colorado
The letters, which included copies of the records, urged patients to report violations of federal medical information privacy rules. The stolen information included patients' medical records, including names, date of birth and Social Security numbers, according to published reports from local media outlets. Boulder Community Hospital has installed lockable recycling bins; two of eight bins were not locked, according to one report.

The hospital also has informed the Department of Health and Human Services' Office for Civil Rights of the data breach and has hired risk management firm Kroll Inc. to assist in investigating the incident.

"We learned that while we have good policies for protecting patients' information, those policies weren't really being followed," a hospital spokesperson told Denver's ABC News affiliate. The spokesperson told the Boulder Daily Camera newspaper that the hospital would assume all liability for any items that may be purchased using a patient's information.]]> http://www.healthdatamanagement.com/news/breach-theft-notification-clinic-40063-1.html Thu, 01 Apr 2010 09:01:00 MST http://www.primarydatacorp.com/#1192 Colorado
Gov. Bill Ritter’s office said Thursday that it had received notice from the Centers for Medicaid and Medicare Services that it had given its OK to the hospital provider fee. Receiving that approval means that the state can match each dollar collected by the fee with one from the federal government and double the amount it raises through the plan.

“This is a great day for Colorado. We have made significant progress on the road to thoughtful reform by providing coverage for 100,000 mothers, children, people with disabilities, and other Colorado residents,” Ritter said in a news release. “This will pay off in both fiscal and personal health for our state and its residents and will be accomplished without additional costs to the General Fund.”

Ritter has estimated that the fee will raise $600 million a year when fully implemented and, when combined with the federal match money, will add $1.2 billion a year to the state’s funding of public insurance programs. However, projections issued late last year by the Colorado Department of Health Care Policy and Financing said that the fee will generate only about two-thirds of what was expected during its first year.

The fee will go into place on May 1, and eligibility for families will expand on that date as well. Parents in a family of four can make as much as $22,000 a year and be eligible for Medicaid, and children and pregnant women in a family of four that makes as much as $55,125 in annual income will be eligible for CHP-Plus.]]> http://www.bizjournals.com/denver/stories/2010/03/29/daily49.html Thu, 01 Apr 2010 09:01:00 MST http://www.primarydatacorp.com/#1193 Technology
What's next?

Well, you can forget the run-up, the hype, questions about what consumer pigeonhole it fits into, or even whether it will Change the World As We Know It. That's all history.

Now what do you do? And do with it?

Those are just the first of the questions you'll have about Apple's media tablet, so like a good story, that's where we'll start.

Can I still get one Saturday? Yes, but you may have to stand in line.

All of Apple's U.S. stores will have a limited supply of iPads for sale to walk-in customers Saturday starting at 9 a.m. local time, and Best Buy stores that stock Apple hardware will have an even more limited number (reportedly, just 15 for each store, five each of the three storage configurations).

IPads that have been reserved by others but have not been picked up by 3 p.m. will be returned to sale inventory at that time by each Apple store.

So if you did reserve an iPad for in-store pickup, make sure you're there by 3 p.m.

What's in the box? Not a heck of a lot. There's the iPad, of course, and Apple's typically terse "documentation," which is nothing more than a small booklet. Also included is a tiny power adapter and a six-foot cord, and a cable to connect the iPad to a Mac's or PC's USB port.

How much does it cost to get on the Internet? Do I have to use AT&T? Slow down, buddy. Unless you're Marty McFly, the iPad you have only connects over Wi-Fi.

So, if you're at home, your Web surfing over the wireless network adds nothing to your monthly nut. Out and about? Stay within range of a hot spot -- and here, payment mileage may vary -- to stay on the Internet.

Flash, no Flash, I'm not a freakin' camera. What Web sites work with the iPad? Good question. Apple's feud with Adobe over Flash is famous. (CEO Steve Jobs reportedly called Adobe "lazy" for not optimizing Flash to suit Apple's requirements or taste.)

Sites that stick with Flash will sport swaths of blank real estate on the iPad, but some sites have revamped to support HTML 5 instead. Apple posted a short list of what it dubbed "iPad ready" sites Thursday that includes CNN, The New York Times, Flickr and Major League Baseball.

There are, of course, tons more that will look just fine on the iPad. Others, just as obviously, may stink.

Will iPhone apps work on the iPad? Yes, but they'll appear in the center of the display and in actual iPhone size -- in other words, tiny. At your option, you can double the size of an iPhone app, which makes it not only larger but likely a bit "jaggy," what with the way the mode simply enlarges pixels.

Has Apple stocked the App Store with iPad-specific software? Naturally.

In fact, iPad apps started to show up before the tablet hit consumers' hands. By Thursday's end, more than 2,000 iPad-specific apps, ranging in price from nothing to $9.99 (and some higher), had appeared in the App Store within iTunes.

From our admittedly unscientific survey, iPad paid-app prices will be much higher than those for the iPhone. The most frequently listed paid app prices seemed to be $4.99 and $6.99.

Here's hoping that app developers don't try to stick customers with a 5X price jump.

Does my iPad have a hard drive? Negative.

Instead, it uses NAND-based memory to duplicate the functions of a spinning hard disk, which would suck up enough power to send battery miser Steve Jobs over the edge. All your applications, videos, photographs, downloaded music, movies, television programs and other data goes into the flash memory.

Depending on how much money you decided to throw at Apple, your iPad has 16GB, 32GB or 64GB of storage space. Each step up costs you $100.

Compared to a new Mac or PC, the iPad's storage is Lilliputian: The low-end MacBook Pro, for example, has a 160GB hard drive, while the cheapest iMac sports 500GB. But it's in line with the capacity of its closest cousin, the dinky iPod Touch.

Can I print from the iPad? No. Apple didn't stick a USB port in the tablet.

You'll have to shunt what you want to a print to a PC or Mac using e-mail, or sync the iPad using iTunes or MobileMe, then print from there.

I want to read some books. What do I do? Apple's supposed to add its free iBook app to the App Store on Saturday. Install it and you'll be able to purchase e-books from the limited stock -- limited compared to Amazon.com's e-book inventory, at least -- that Apple has put together for the launch.

Last week, Amazon announced it would rewrite its Kindle software -- already available for the iPhone, as well as for the Mac and PC -- for the iPad, but it didn't disclose a date. As of late Thursday, the Kindle iPad app hadn't appeared.

And how does the iPad do as an e-reader? We don't know yet. We haven't put hands to one long enough to find out. So no comment for now. Wouldn't be prudent.

Can I watch movies, TV? Of course.

You can rent movies or purchase television episodes from iTunes, or, if you're a Netflix member, download the free app to stream movies and TV shows to your iPad.

ABC has also posted viewing software (ABC Player) on the App Store, the only major television network to have done so by late Thursday.

Can I do real work on my iPad? Depends on how you define real (as opposed to fake work, which for us means a nap or ESPN), but you can write and crunch numbers and craft soul-sucking presentations if you buy the three apps that make up the iPad version of Apple's iWork suite.

Apple has used a way-back machine to return to the days of the unbundle, when suites weren't collections with a single price but an agglomeration of separately purchased programs that worked together, more or less. In other words, you buy the three applications -- Pages, Numbers and Keynote -- separately from the App Store. Price: $9.99 each.

Of course, if you're a numbers person and wouldn't know a gerund from a gradated background, you pay for only what you want and the hell with the rest.

There's no camera on the iPad, so how do I get photos onto the thing? Out of the box, the sync cable is your friend: Use it and iTunes to synchronize collections on your computer with the iPad.

By the way, you'll need to update your Mac or PC to iTunes 9.1 -- Apple slipped that out Tuesday -- to sync with the iPad and organize the books you buy with the iBook app.

If there's $29 burning a hole in your pocket, you can spring for the iPad Camera Connection Kit. One of the two adapters accepts a camera's SD memory card; the other links your camera's USB cable with the iPad. Too bad the kit doesn't ship until later this month.

I tried the on-glass keyboard and hate it. What do I do? The iPad also syncs with Bluetooth keyboards, so if you have one of those, you should be able to link to and use it without any trouble.

Apple sells a combination keyboard and iPad dock -- called, not surprisingly, the iPad Keyboard Dock -- that also includes an audio jack for connecting the iPad to speakers or a stereo system. It costs $69. While some reviewers have received a dock, Apple's not shipping to the rest of us until late this month.

An Apple-branded Bluetooth keyboard -- basically, the same keyboard as in the dock -- also costs $69 and is available now.

I have a MobileMe account. Can I add the iPad to the list of my devices to sync? Yes, you can.

To MobileMe, Apple's sync and storage service, the iPad is just another device. You can sync the mail, contacts and calendar on the iPad with your iPhone, Mac or PC; use MobileMe's 20GB iDisk to store documents, like those you create with the iWork apps; register with the Find My iPad feature; and remotely wipe a lost or stolen tablet.

If you don't have a MobileMe account, you can try the service for 60 days free of charge.]]> http://www.computerworld.com/s/article/9174639/The_iPad_s_here_now_what_? Fri, 02 Apr 2010 09:01:00 MST http://www.primarydatacorp.com/#1194 Medicare
Beginning the second week of November, 2009 PQRI feedback reports will be available. Providers can access their feedback reports through the Physician and Other Health Care Professionals Quality Reporting Portal at www.qualitynet.org/pqri, or by contacting your Carrier/MAC.

For more information, visit www.cms.gov/MLNMattersArticles/downloads/SE0922.pdf.]]> http://www.chiroeco.com/news/chiropractic-news.php?id=10395 Fri, 29 Oct 2010 09:01:00 MST http://www.primarydatacorp.com/#1195 EHR
The report, based on a survey of MGMA membership, found that EHR-equipped practices not owned by hospitals or integrated delivery networks had $178,907 in higher median revenue per FTE physician in 2009 than similar practices without an EHR. Though operating costs were $105,591 higher per doctor with an EHR, the net result was $49,916 greater operating income for each FTE physician.

Multispecialty practices owned by hospitals or IDNs did nearly as well, reporting a mean $42,042 higher operating margins with EHRs than without, according to the MGMA, which released the study Monday at the organization's annual conference in New Orleans.

Benefits tend to rise over time, as well. Independent practices that have had EHRs more than five years had operating margins 10.1 percent greater than practices in their first year of EHR usage. That is largely because the highest implementation expenses tend to occur in the first year, after which time practices often see costs go down for transcription and medical records staff.

"Adopting an electronic system can be costly and time consuming, and understanding the impact it will have on the practice is critical," said MGMA President and CEO Dr. William F. Jessee said in a prepared statement. "While the implementation process can be very cumbersome, these data indicate that there are financial benefits to practices that implement an EHR system."

Still, Jessee said he expects many practices to struggle in their quest to earn Medicare and Medicaid incentive payments for "meaningful use" of EHRs starting in 2011.]]> http://www.fierceemr.com/story/mgma-ehrs-improve-bottom-line-physician-practices/2010-10-28 Fri, 29 Oct 2010 09:01:00 MST http://www.primarydatacorp.com/#1196 Practice
Despite the cost, expanse, and overwhelming transformation payers and providers will have to undertake to achieve ICD-10 compliance, ultimately it will be a boon for both healthcare in America and those organizations that serve up that care.

In a white paper, Joseph Nichols, MD, principal at Health Data Consulting, highlights myriad ways that healthcare organizations can leverage ICD-10 to improve their business. Here they are:

1. More appropriate contracting
2. More precise payment
3. Better definition of severity, risk, and case mix
4. Improved measurement of quality, efficiency, and outcomes
5. Better network management
6. Better fraud and abuse detection
7. Better risk prediction
8. Competitive advantage
9. Compliance

“Because of the critical nature and pervasive use of these codes for most business and analytic activities, the magnitude of the changes to the industry will be dramatic and out shadow the impact of HIPAA and Y2K combined,” Dr. Nichols writes in the white paper available here.]]> http://www.healthcareitnews.com/blog/nine-ways-icd-10-will-better-your-business Fri, 29 Oct 2010 09:01:00 MST http://www.primarydatacorp.com/#1197 EHR
That way, patients would have easy access to their own health information, and physicians wouldn't have to spend so much time putting together records requests. The people at the Jan. 27 meeting even came up with a term to describe what they imagined: the "blue button."

Only nine months later, that concept has gone from what-if to reality. Even though, technically, what's being used isn't a button, and it isn't blue.

Two federal organizations have implemented virtual blue-button icons on their patient portal websites that, when clicked, give patients the real-time ability to download their own health information. Meanwhile, the concept is gaining steam in the private sector.

The Dept. of Veterans Affairs and the Dept. of Health and Human Services' Centers for Medicare and Medicaid Services worked together to develop their own versions of the blue button on their respective patient portals, MyHealth.va.gov and MyMedicare.gov. Because both organizations serve different roles -- the VA provides health care while HHS manages payment for care -- the two blue-button programs offer different things. The VA has a complete medical record for each patient, and CMS provides claims information. But gauging from the response, both provide a service patients find useful.

"CMS has long been interested in helping beneficiaries be more engaged in their health care," said Lorraine Doo, senior policy adviser of eHealth standards and services for HHS. The blue button was a way of letting the patients know what data CMS has on them, she said.

Experts say most physicians aren't yet ready to add their own version of the blue button to their websites. For one thing, the physicians' electronic medical record systems probably don't have the capability to provide a blue-button link between their EMRs and their sites.

Still, members of Connecting for Health and others are pushing for widespread adoption of the blue button as physicians face "meaningful use" requirements, passed under the 2009 economic stimulus package, that give patients the right to receive their medical records electronically upon request. The blue button would be a convenient way for physicians to satisfy this requirement, as they could direct all patients with Internet access to the Web to obtain the information.

"The time is fairly opportune to increase awareness for this potential," said Josh Lemieux, director of personal health technology for the New York-based Markle Foundation, which sponsors Connecting for Health. The American Medical Association is one of the collaborative's members.

Driving demand

According to results from an October survey conducted by Connecting for Health, 70% of the public and 65% of doctors agree with the blue-button concept.

Many EMR systems allow for patient portals that provide access to patient records in a read-only format. But they do not allow records to be downloaded or uploaded to another system, such as a personal health record.

Stage 1 meaningful use requirements for EMRs say only that systems must allow for patients to receive electronic versions of their records. (Meeting meaningful use allows physicians to collect incentive payments under Medicare and Medicaid.) But the rules do not specify how those data are delivered, said Sue Reber, spokeswoman for the Certification Commission for Health Information Technology, one of three organizations named by the HHS Office of the National Coordinator for Health Information Technology as an official EMR testing and certification site.

"In most cases, it is not a blue button, because in general the request is going through the physician, and they are going to create that kind of electronic copy for the patient," she said.

Because patients are being asked to share in making more of their health care decisions, having the ability not only to access the information but also to download it will become increasingly important. As demand for data access grows, the demand to make access easier also will grow, Lemieux predicted. Eventually, vendors will feel pressure from those demands and create blue-button applications, he said.

After the VA and HHS launched their blue-button systems, Markle and the Robert Wood Johnson Foundation held a contest for developers to submit ideas for applications that convert data downloaded from one of those sites into useful health tools. Taking the top prize in October was Adobe, which developed an application that converted health data into a pdf file that could be shared with physicians or caregivers.

"Downloading your information is only the first step to making use of it," said Carol Diamond, MD, MPH, managing director of Markle's health care program, in a prepared statement. "The real winner of this challenge is the consumer, because so many different approaches and ideas emerged to help patients put their information to good use."

Privacy concerns

Despite the growing interest from the public, however, there hasn't been much of a demand for widespread adoption of the blue button, in part because many people haven't thought to ask for electronic copies of their records.

The Connecting for Health survey found that 83% of the public have never asked for their records in electronic format. And the majority of physicians surveyed said patients rarely (27%) or never (67%) have asked for electronic records.

Lemieux thinks the lack of interest could be because the concept of downloading medical records as easily as one would download a song is too foreign for most people to grasp. Patients are used to a process of making a formal request for their records, paying a nominal fee per page to have them printed, then waiting several days to receive them. The idea of reducing that process to the act of pushing a button seems too simple -- and dangerous, he said.

More than 80% of both the public and physicians said privacy safeguards were an important part of any federally funded health information technology program. Concerns include making sure the person accessing the records is authorized to do so, and making sure the records aren't harvested by machines developed to "data scrape," or crawl websites to obtain aggregated data.

A policy paper -- whose member co-signers include the AMA -- published by Connecting for Health in August addresses many of those concerns, with recommendations for privacy controls that can be implemented into any blue-button system.

The controls include "challenge response tests" that ensure the person accessing the information is a human -- similar to when a user is asked to type in a string of letters to access a webpage; authentication systems to help ensure that a person logging in is authorized to do so and that he or she understands the possible security implications of downloading that information; and pop-up warnings the patient must read and acknowledge by clicking "OK" before the records can be downloaded. But, the policy paper warns, the pop-ups can't be too intrusive or even too scary looking, or people won't use it.

With its set of specific recommendations for how blue buttons could be implemented in a safe and secure way, Markle is calling on HHS to make it a priority in its health IT efforts. The organization also is calling on private organizations to include blue buttons in any new system procurement contracts.]]> http://www.ama-assn.org/amednews/2010/11/01/bil11101.htm Mon, 01 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1198 Hardware
• Effectively eliminate data loss and user dependency
• Centrally manage all backups
• Easily deploy with minimal network impact
• Intuitive, easy to configure and use dynamic interface

Dell Online Backup and Restore allows you to automatically back up data from desktops and laptops to a highly secure off-site datacenter, helping save time and expense.

• Secure user data – Easily restore data after drive failures, user error, viruses or theft.

• Centralized backup management – Centrally manage backup policies and deployment for your entire PC environment.

• User independent – Run backups while the user works, without requiring user interaction.

• Minimal network impact – Stores only incremental changes and synchronizes each file only once, even if stored in multiple locations.

Designed for distributed environments – Back up and restore PCs around the globe over the Internet whether or not they are on the corporate network.]]> http://www.dell.com/content/topics/global.aspx/services/saas/online_backup_restore Mon, 01 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1199 Medical Home
A September/October issue of Annals of Family Medicine, analyzes a strategy for improving and sustaining mental health results in chronically depressed patients by providing small amounts of flexible, targeted follow-up care. Patients who received interventions that included self-monitoring tools and follow-up phone calls from a care manager were more likely, a year and a half later, to have symptoms that were in remission and to have fewer reduced-function days than those receiving usual primary care treatments.

The depression interventions were introduced in five family care practices at the University of Michigan Health System. Here are the specifics:

• 728 enrollees were compared to 78 control patients receiving usual care for 18 months
• At the end of the study 49.2% of 120 enrollees who completed 18-month assessments were in remission
• At the end of the study 27.3% in the control group were in remission

The interventions were not telephone therapy, says Michael Klinkman, MD, a professor of family medicine at the University of Michigan Medical School and lead author of the study. The key was to keep patient in treatment. "Patients have a human contact, somebody who can help them become more actively involved in their own care."

With this care management approach, physicians can closely monitor if a patient's condition is worsening. In many cases, patients simply don't follow up—in this case, physicians take the initiative.

For this study, a care manager worked in collaboration with doctors' practices, rather than on the side or independently. That helped make the family practice office a home base for all of a patient's medical needs—a medical home.

That's not accidental: The intervention fits "exactly into the context of the patient-centered medical home," Kinkman says.

It's a patient-centered, rather than a disease-centered approach, he adds.

"As this program has developed over the years, we increasingly realize that its core components—patient activation, self-management instruction, goal-setting and priority-setting, and individualized follow-up—work on the person level, rather than the disease level," he explains. When we began, it was difficult to get outside support for interventions that were not disease-based. As the concept of the PCMH has taken hold, it's a natural extension of the program since the majority of the patients referred to the DPC program have more than one condition.

How to reimburse physicians for such services remains a challenge. "We've struggled with this for the past five years. The problem has been the mismatch between the cost of the program—-paid for by the practice—and the benefit, which only partly accrues to an insurance company in the short to intermediate term, and partly accrues to the employer," Kinkman says.

A variety of "mix-and match" approaches are emerging, he says, but the best solution will come from global reimbursement (vs. fee-for-service) for primary care practices "that implement the patient-centered medical home and use tools like we have developed here to support care for chronic illness.," he says. But, he adds, there is a lot of work to do to build public support for that type of change in primary care.

The approach isn't limited to depression, he says, It can also serve as a model for treating other types of chronic conditions, he says.

The paper addresses this explicitly: "All methods developed for this project were intended to be transportable to disease management programs for other chronic health conditions. By integrating care management tools and personnel across several related conditions (e.g., depression, diabetes, and heart failure), it should be possible to achieve the scalability that will make integrated disease management feasible in the patient-centered medical home." The findings "should provide valuable guidance to the development of chronic care management programs for the primary care setting."

A pilot is now underway. "We are just now extending this program into community primary care settings, and find—no surprise—that the primary care clinicians and practices are very open to extending the program to include patients with depression plus other conditions as the first trial of patient-centered chronic disease support," he said.]]> http://www.healthleadersmedia.com/content/PHY-258419/PatientCentered-Care-May-Aid-Chronic-Depression.html Mon, 01 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1200 Hardware Healthcare Technology
Indeed, a poll of the 1,000 or so webinar participants found that about one-third already are adopting iPads in their organizations and another third intend to do so in the next six months. But how many healthcare organizations actually have a plan for deploying iPads? "Nobody's sure what they're going to do with it, but they know they need it," said Reed.

In developing a mobility strategy, Reed recommended paying particular attention to service management of devices and the technology life cycle. "What you're really doing is you're changing around business processes and how your hospital systems work," Reed said. "You need to understand and think about a full-service management approach."

Reed identified four "vectors" of managing mobile devices: the user community; the device portfolio; mobile platforms and the underlying infrastructure; and, of course, applications. "We believe every medical setting is going to have to deal with this by 2013," Reed said, according to CMIO. "As you get into this space, you'll be hearing more and more about mobile service management."

He also said that you're likely to hear more about competing products, such as the forthcoming Android Wave tablet operating system. "One of the biggest challenges [with] the iPad today is it's not really medical-ready," Reed said. "It's not sealed, it's not sterilizable, it's not a ToughBook, it's not hardened. There's a lot of interest in Android for these hardened devices, suitable for infectious disease scenarios and things like that."]]> http://www.fiercemobilehealthcare.com/story/himss-webinar-many-are-using-ipads-healthcare-few-have-deployment-strategies/2010-11-02 Tue, 02 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1201 Medicare
We are now less than a month away from a proposed 23.6 percent cut in Medicare reimbursements thanks to the much maligned, yet very much alive, sustainable growth rate (SGR) formula. If you really want to look ahead, we are less than two months away from an additional 6.5 percent cut scheduled to take effect as soon as we ring in 2011.

The president of the American Medical Association, Cecil B. Wilson, told Kaiser Health News that if doctors see a 30 percent cut without any action by Congress as of Jan. 1, 2011, "this will be a catastrophe." The AMA is seeking a 13-month moratorium on any Medicare cuts to work with Congress to overhaul the entire payment formula.

Noting that the proposed cut comes during what will be a lame-duck session of Congress, Wilson told KHN that the 13-month delay gives the AMA a chance to work with the new Congress "to develop a means of getting rid of the formula, putting in a formula or a payment mechanism that recognizes increased costs of care."

Other medical groups are also pushing for change, but preparing for what could face both doctors and their patients.

At the MGMA annual conference in New Orleans, the group's president William F. Jessee, discussed the results of a member survey taken in August, looking at how practices responded to the June cut and anticipated responses to what might come in December.

Regarding the June cut, 37.3 percent of MGMA member practices delayed purchasing an HER; 31.7 percent cut the number of administrative staff; 29.5 percent cut the number of appointments for new Medicare patients; and 27.5 percent cut the number of their clinical staff.

In anticipation of the next round of cuts, 49.5 percent said they would stop seeing new Medicare patients — a statistic Jessee said "we are starting to take personally" — and 27.5 percent said they will cease treating all of their Medicare patients. The majority — 76.6 percent — said they would delay the purchase of new clinical equipment and/or facilities.

"Christmas and New Year's will be a fascinating time," said Jessee.

Today, all the political wrangling for seats in Congress ends. Tomorrow, the medical community turns up its campaign, calling upon those either new or returning to the House and Senate to do something to help both doctors and their patients.

After criticism of Congress by many medical groups in June to delay action for six-months, essentially "kicking the can down the road," they claimed, maybe one more swift boot is what's needed to focus on a real solution to the formula once and for all.

The clock is ticking doctors. Can you stop it in time? Can you buy a few more hours?

Election Day may end at midnight tonight, but your campaign is just beginning.]]> http://www.physicianspractice.com/blog/content/article/1462168/1711344 Tue, 02 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1202 Practice
What can you do to fight back? In some cases, there is not much you can do. Your contract with any given payer stipulates that it makes the policies and by signing the contract you agree to abide by those policies, even though they are likely to change as soon as you sign.

However, you should always complain to the payer if you disagree with a policy change. Why? Because if you don't, your silence equals acceptance. I have seen payers overturn their policy changes when sufficient numbers of network providers complained about the change. In some cases, policies are changed without the payer understanding the impact on its network. Feedback from providers is therefore very important in getting harmful policy changes overturned, or at the least, putting payers on notice that frequent changes are no longer going uncontested.

Where to start?

So how do you file a complaint with a payer? If you don't have an assigned representative, don't waste your time trying to track one down. Instead, go directly to the medical director at the plan. How do you find one of those? The simplest way is to Google the payer's name to bring up its corporate Web site. Call the main phone number and ask who the medical director assigned to your region is, and for her contact information. In nearly every case you will reach a live person, and they will usually provide you with the information you need. If you can't get the information you need, send your complaint to the attention of the payer's CEO at the corporate address. It will make its way to the right person pretty quickly. Call, write a letter, or send an e-mail — however you file your complaint, just make sure to do it.

Timely processing

In other circumstances you have clear rights, particularly when it comes to claims being paid promptly. In just about every state, payers must pay clean claims in a timely manner or face fines from state regulators. Timely payment is anywhere from 15 days to 120 days, but averages 30 days to 45 days in most regions. (To see what the Prompt Pay rules are for your state, click here.)

If you haven't received payment from your payer by the time the payment window in your state expires, use your state’s process and file a complaint with that regulatory body. Why? Because it will help get you paid. Once a complaint against a payer is initiated, the state regulatory organization opens an inquiry with the payer. The payer has a short period of time in which to research, respond, and correctly pay the claim before a regulatory fine kicks in. Often, filing an inquiry is enough to prompt the payer to remediate the problem at the source, making recurrence unlikely.

Do your homework

Before you file a complaint, make sure to take the time for due diligence on your part. You don't want to complain and then find out the payer never received the claim, or had processed it properly according to its rules. So how should you proceed?

• First find out if the claim was received.

• Then determine if the denial or nonpayment is due to a policy change (you can look up policies on most major payers' Web sites).

• If it is (and you don't agree) then file your complaint directly with the insurance company.

• If it is not due to a policy change and the payer is just slow to pay, or has created a billing process problem, then file your complaint with the appropriate state regulatory organization promptly.]]> http://www.physicianspractice.com/pearls/content/article/1462168/1713346 Thu, 04 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1203 Healthcare Technology
"As the survey results indicate, one-quarter of the sample population would not qualify for 'meaningful use' incentives based on not having a process to conduct risk analysis," Lisa Gallagher, senior director of privacy and security for HIMSS says, according to Infosecurity. "With almost 80 percent of respondents indicating that they would share electronically stored data outside of their organizations, healthcare organizations must ensure that proper security protections are operative and based on an ongoing risk analysis process."

The third annual HIMSS Security Survey also found that 17 percent of medical practices relied exclusively on external resources--consultants--for information security. Not a single hospital didn't handle at least some of its security operations internally.

One area where practices and hospitals alike are lacking is mobile technology security. Mobile device encryption was the technology least likely to be in use at responding organizations. Email encryption and single sign-on technology also have not been widely accepted.

And only half of the respondents said they validate patient identity by requiring a government-issued ID to check against a master patient index.]]> http://www.fiercehealthit.com/story/one-third-medical-practices-havent-done-security-risk-assessments/2010-11-08 Mon, 08 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1204 Medicare
"While Congress has provided temporary relief from these reductions every year since 2003, a long-term solution is critical," said Donald Berwick, CMS administrator.

"Broad physician participation in Medicare is essential to ensuring that beneficiaries continue to have access to care, and physician engagement is critical to our efforts to strengthen the quality of care," Berwick said. "Medicare needs to be a strong, dependable partner with physicians – and that means the SGR must be fixed. The administration supports permanently reforming the Medicare payment formula."

According to CMS officials, the final rule with comment period continues recent efforts by the CMS to improve the accuracy of Medicare Physician Fee Schedule payment rates by implementing Affordable Care Act mandates to identify and revise payment for misvalued services.

It also addresses concerns about potential physician self-referral by requiring physicians who provide computed tomography, magnetic resonance imaging or positron emission tomography scans in their own offices to notify patients that they may receive the same services from other suppliers in the area.

The rule will also implement key provisions in the Affordable Care Act to expand preventive services for Medicare beneficiaries.

The final rule will appear in the Nov. 29 Federal Register, and CMS will accept comments on certain aspects until Jan. 2, 2011. ]]> http://www.healthcarefinancenews.com/news/cms-final-rule-cut-2011-medicare-pay-physicians Tue, 09 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1205 Medicare EHR Meaningful Use To qualify for EMR stimulus money we need $24,000 in allowable medicare charges per physician. I am not sure whether we have to show the $24,000 over a period of 1 year or 90 days. Can you please clarify?

This is a great question. The short answer is you have the entire year to accrue the $24,000 in allowable Medicare charges that’s required to get the full EMR stimulus money in year 1 (you get paid 75% of your Medicare allowable charges up to the cap for that year).

The confusion between the 90 days and the full year stems from the meaningful use requirements. While the allowable charges can be accrued for the entire year, you only have to show meaningful use for 90 days (at least for meaningful use stage 1) of the year.

I heard one person tell me that means they can wait until October 1st to start showing meaningful use. While this is technically true, you are a brave person if you don’t start showing meaningful use until that date. I’d personally shoot for April or May. That way if you run into any troubles, you still have some room to correct any mistakes.]]> http://www.emrandhipaa.com/emr-and-hipaa/2010/11/09/emr-stimulus-question-and-answer-time-period-for-medicare-allowable-charges/ Tue, 09 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1206 Practice Technology
About 169 million U.S. adults (or 72 percent of all adults) went online to research a health question in 2010, compared with 63 million in 2002, according to Manhattan Research's Cybercitizen Health U.S. survey, which asked more than 8,000 adults about their media consumption and Internet behavior.

Consumers' online research activity has given rise to a more empowered patient, who doesn't necessarily accept what the doctor diagnoses or recommends for treatment. In fact, information found online may lead the patient to skip seeing a doctor. Some 99 million U.S. adults did at least one of the following after finding health information online:

• Challenged their doctor's treatment or diagnosis.
• Asked that their doctor change the treatment.
• Discussed information found online at an appointment.
• Used the Internet instead of going to the doctor.
• Made a healthcare decision based on online information.

Among the most web-empowered patient groups are consumers with mental health or pain-related conditions. Meredith Ressi, vice president of research at Manhattan Research isn't surprised. "In the absence of clear diagnostic measures for these conditions, it is often up to consumers to advocate for themselves to get the help they need," she said in a press release.]]> http://www.fiercehealthcare.com/story/online-health-information-could-supplant-doctors/2010-11-09 Tue, 09 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1207 Telehealth
With the dawn of the Internet and the availability of high speed broadband connectivity, telemedicine became not only more affordable but far more practical. Codecs improved to the point that delivering high quality voice and video over the Net have become commodity technologies built into just about every PC. But providing a telemedicine service is a bit more complicated than establishing a point to point audio-video connection between two parties. Ideally, you also need a communication and collaboration platform to organize and manage the connectivity.

This week on Microsoft Health Tech Today, my special guest is Ron Emerson, global director of healthcare for Polycom. Find out how working together, Microsoft and Polycom are defining a new generation of eHealth, telehealth and telemedicine possibilities. Building on each company’s strengths, it is one of those better together stories that is creating quite a buzz in the industry. By using Microsoft Lync, a communication and collaboration platform that brings together VOIP, messaging, e-mail, video and web conferencing all nicely integrated with the company’s information worker productivity solutions, Polycom is able to provide a seamless telemedicine experience. Polycom offers dedicated clinical workstations with high definition audio and video capture capabilities. The units also connect to a myriad of diagnostic tools such as otoscopes, fundoscopes, stethoscopes, and other clinical devices. This creates an end to end telemedicine capability that leverages the best of each company’s technologies.

On the show, we’ll demonstrate a coast to coast telemedicine session using Polycom’s clinical workstation and some of the diagnostic tools that one might typically need when examining a patient. You’ll be able to appreciate not only the ease by which this is done, but also the high quality of the diagnostic images and collaborative capabilities of the platform. It is really quite remarkable and definitely not your grandfather’s telemedicine.

You can watch the promo for our show right here on HealthBlog. On Tuesday, November 9th, stop by the Microsoft Health Tech Today landing page where you’ll be able to watch the entire demonstration and interview. Health Tech Today is the on-line video series at the intersection of health and information technology. We launch a new program every Tuesday. I hope you enjoy the show.]]> http://blogs.msdn.com/b/healthblog/archive/2010/11/08/microsoft-lync-polycom-not-your-grandfather-s-telemedicine.aspx Tue, 09 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1208 Medical Home
The mp3 podcast is available here, free enrollment required.]]> http://www.reachmd.com/ Tue, 09 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1209 Colorado Regional Extension Center
More than $640 million was allocated from the Health Information Technology for Economic and Clinical Health Act, a part of the 2009 economic stimulus package, to create 62 regional extension centers across the country. The centers develop their own models for advising physicians on health information technology issues. Although some received grants as early as February, many received funding only in September, leaving little time to recruit physicians.

A survey published in September by Washington, D.C.-based eHealth Initiative found that many RECs, including the early awardees, are struggling to sign on physicians. But two centers -- CO-REC, the Colorado REC managed by the Colorado Regional Health Information Organization, and the Mississippi Regional Extension Center, operated by eQHealth Solutions -- have found early success, and their similarities may explain why.

Both centers credit their relationships with the physician community before receiving their REC designations as key.

In July, CO-REC set a goal of signing up 600 physicians within six months. By October, it had exceeded that goal, with more than 800 physicians signed on. As of this article's deadline, the number of physicians signed on with CO-REC numbered more than 900.

Mississippi REC has been recognized by the Office of the National Coordinator for Health Information Technology, with more than 600 physicians signed on.

The Colorado Regional Health Information Organization contracted with six other groups to help deliver services, said Robyn Leone, director of CO-REC. Those groups are paired with clients they had relationships with, such as the Colorado Community Health Network, the membership arm of the Federally Qualified Health Centers, which is contracted to work only with FQHC centers.

"Our numbers of having 920-plus providers enrolled speaks to the fact that these six organizations have their stakeholders and the knowledge they bring to a certain part of the provider community," Leone said.

Diane Jones, vice president for policy and programs at the eHealth Initiative, said several RECs planned to use subcontractors to handle the workload. She wondered if the subcontractors with local connections might have better success. "Part of the challenge is building the trust," she said.

Experience a plus
Robert Johannessen, corporate director of communications for eQHealth, which operates the Mississippi REC, said his organization had previous experience working with the physician community. The group was a federally contracted vendor through the federal Doctor's Office Quality-Information Technology program, which relied on the Centers for Medicare & Medicaid Services Quality Improvement Organizations to help physicians choose and implement IT systems, across the border in Louisiana, where eQHealth is located. EQHealth is also the QIO for Mississippi.

Sean Marchiafava, chief information officer for eQHealth, who has spent time with other RECs in regional conference calls, said many of the centers haven't yet defined what their service model will look like, so physicians are reluctant to sign a contract.

Leone says the services each REC offers will depend on the organizations' experience. REC awardees include universities, existing health information exchanges and some QIOs. Each will approach the work differently depending on the skills they bring, she said.

Meanwhile, Mississippi and Colorado offer their services at no charge, which the centers also believe has contributed to their success. The organizations behind these RECs are using their grant money and funds from other businesses to underwrite the free services.

"RECs aren't seen as particularly helpful for some physician practices, because the information they provide is limited, and in many cases they are charging for it," said Brenda Gleason, president of M2 Health Care Consulting, which has offices in Denver and Washington, D.C.

Leone said the decision to offer the services for free was based on the organization's altruistic point of view coming into the project. She said the business model was built around the commitment to offer the services at no charge, but she said physicians are informed that there are limits to what can be offered.

Cathy Davis, executive director of the Kansas City Quality Improvement Consortium, one of several subcontractors hired by the REC covering Kansas City, Mo., said her group, which is just getting started, decided not to charge after it saw the problems other RECs were having when they decided to do so.

Davis said that as a subcontractor, her organization is taking a cut in the amount of money it is paid from the REC grantee to provide services for free.

Though physicians can't dictate how their local RECs operate, there are things they can do to help ensure that centers accomplish their mission of helping primary care physicians.

Each RECs has goals to meet in terms of how many practices they need to sign on. If those goals are not met, they don't get paid. Therefore, they have an incentive to sign up doctors. But Davis said there's nothing wrong with a physician asking, "What's in it for me?"

She said the REC should be able to articulate how it is going to help each physician, given individual circumstances.

Gleason advises doctors to check back with the RECs if they decided they don't have much to offer right now. "As time goes by, and there is more pressure to enlist physicians, benefits could be added down the road. Decide now, and put a reminder on your calendar to check back in three months and six months to see if anything has changed," she said.

Jones, of the eHealth Initiative, said she plans to conduct a survey in early 2011 that is similar to the one published in September.

But the survey will look at specific challenges some RECs face and some lessons learned from those considered successful. February will mark the one-year anniversary of the HITECH Act, and she said it would be a good time to check back in with the RECs to see how far along each one has come.]]> http://www.ama-assn.org/amednews/2010/11/08/bica1108.htm Thu, 11 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1210 Medicare Practice
The new HCPCS codes and the specific products for which they should be used are:

• Q2035 for Afluria,
• Q2036 for Flulaval,
• Q2037 for Fluvirin,
• Q2038 for Fluzone, and
• Q2039 for influenza virus vaccine, split-virus, when administered to individuals 3 years of age and older -- for intramuscular use (not otherwise specified).

Certain other vaccine codes still are valid 2010-2011 flu vaccine codes, so physicians should use CPT codes 90655-90657, 90660 and 90662 when they use vaccine products represented by those codes.

According to Cynthia Hughes, C.P.C., an AAFP coding specialist, CMS has deemed CPT code 90658 a "nonpayable" code.

"Any physician who uses CPT code 90658 for dates of service after Dec. 31 will see that portion of the claim denied," said Hughes. "If practices start right away, they'll have the rest of this month and next to make changes to their billing forms and programs," she added.

Hughes attributed the coding changes to wording in the final 2011 Medicare Physician Fee Schedule (2,023-page pdf). The rule allows Medicare to base vaccine payments on the average wholesale price of each vaccine.

"Medicare has assigned 'Q' codes to each individual product this year to account for variances in manufacturers' pricing of their influenza vaccine product," said Hughes, adding that this step should help ensure physicians are paid fairly for products that may have significant cost differences.

Hughes noted that private insurers may make independent decisions about whether or not to adopt CMS' coding changes.]]> http://www.aafp.org/online/en/home/publications/news/news-now/practice-management/20101109qcodes.html Thu, 11 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1211 Practice
There can be several reasons for this behavior. The most obvious is insurance participation. I may participate in more insurance plans than another retina specialist, but I haven’t changed my participation in plans in more than five years. Perhaps the doctors themselves are noticing me on the Web? Doubtful.

Or, it may be my Web site. I have great rankings for my Web site for my specialty, especially locally. When patients search for a retina specialist, my name is unavoidable. All due to high rankings of my sites.

Patients have become more discerning and go to the Internet to check out the docs before making a decision. Their primary source for health information is the Internet. While my referring docs may give them my name, a Google search is likely to be performed before actually making an appointment. It is reassuring for patients to see me online, even after their doctor has referred them.

While I do track most sources of referrals, there are those that escape our detection. Certainly we have direct referrals from the Web, those patients who are looking for a retinal specialist and find me only due to the Web page and its rankings.

The ones who escape our detection are those patients where I am referred as a potential specialist, validated on the Internet by searching my name and then make an appointment. More and more, patients won’t bother making an appointment with a doctor who has no Web presence.

More and more, the Internet is becoming the primary referral source. Just another reason to start looking at the Web in your marketing strategy.]]> http://www.physicianspractice.com/blog/content/article/1462168/1720999 Thu, 11 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1212 Healthcare Technology
It’s not a long trip.

It’s really based on two open source projects:

• CONNECT, which defines interoperability standards for exchanging health data, and
• DIRECT, which defines network standards for moving the data.

How do you get on to these networks? Well, the meaningful use guidelines for that sweet, sweet stimulus cash include interoperability requirements, like those used in CONNECT. So it’s not just cash, it’s standards. And I’ve written about the rapid progress of DIRECT before.

A trial of all this has already begun.

With a secure connection you should be able to e-mail your doctor, and they should not fear e-mailing you. Faxing will go away. You will be able to have your records downloaded to a secure location you control. And when a hospital or another doctor needs your record, the doctor’s office should be able to get it to them.

It’s a problem with lots of layers. Identity. VPN design. File standards. Interfaces. All of which have to work on top of the IP protocol.

Oh, and Fred notes that NHIN no longer stands for National Health Information Network. It stands for Nationwide Health Information Network.

That’s because the bureaucrats who came up with the acronym failed to do a complete trademark search. Turns out a Fort Worth company holds the old trademark for their e-prescribe system.

That’s not a big deal.

What is a big deal is that the Health Internet is coming on fast. Right now my regular doctor can get prescriptions to my pharmacist and records to the hospital where he has privileges. When my wife needed some imaging done recently, she just showed up at the right time, handed in her insurance card, and was out within minutes.

As that network is linked to other networks via NHIN standards, as the people who build networks and software come to adopt the CONNECT and DIRECT projects into their software, change will come swiftly.

It’s easy to be cynical about something that has been delayed a long time, but that’s the thing about computing. It doesn’t work and doesn’t work until it all works, then suddenly it works and we don’t have to think about it.

Figure five years at the outside.]]> http://www.zdnet.com/blog/healthcare/how-we-get-to-the-health-internet/4180 Thu, 11 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1213 EHR Regional Extension Center
Scott Patch, MD, practices in Yarmouth, Maine, and is part of a multi-specialty medical group called InterMed P.A., which has been using an EMR for about five years and is considered a “paperless” environment.

Patch says when a practice is considering moving to an EMR the whole organization has to “buy-in.” In other words, everyone has to be onboard – even staff at check out. There is a “redistribution of work” said Patch. "There is going to be more and new work. For us it was our check out staff that required more training,

The hardest part is maintaining good communication, said Patch. That is why it is important to identify a plan and choose a physician champion. “There is nothing more powerful” than choosing another doctor for this role, as doctors tend to listen to other doctors, he said.

Part of an EMR plan is assessing what your practice does and doesn’t do well, said Patch. “The EHR represents a fundamental change to the way the office handles the movement of patients and information,” he added.

This is where document management comes in. “Scanning is not the answer to everything,” said Patch, noting that “preloading is more important for productivity; if you favor preloading it is much more efficient down the road.”

Preloading, he explained, is having someone enter key data about the patient’s medical history, like medications, allergies and immunizations, into their chart before an appointment. Patch said it's helpful to determine beforehand a list of items that are important to preload. For his practice it's a list of ten. If a doctor has to go back to a paper chart to find something, then the chances that they are going to use the electronic one are slim, he said.

“If you are scanning, remember structured data,” Patch also advised. “Capturing structured data is the most important part of the EMR.” Any data for which you can generate a report is important for reimbursement and patient tracking, he said -- this is why standardization is a key benefit of implementation, and why having the lab interface with your EMR is important.

Finally, Patch said to be prepared for the EMR transition to take months, not weeks, and to make sure to listen to the feedback of your staff and have a good relationship with your vendor.]]> http://healthcareitnews.com/news/tackling-emr-planning-and-preloading Fri, 12 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1214 EHR Regional Extension Center
Bernard Mohr, a partner at the firm, said he grew up next to a farm with milking cows. The stools the farmers used to milk the cows were three-legged. He explained that they found that a stool with three legs was actually "much more stable on uneven ground than a four-legged stool."

The stool, Mohr said, is a metaphor for a different model for managing the transition to an EMR.

According to Mohr and Robert (Bob) Laliberte, who teaches the UNE Project Management Program and is also a partner at Innovation Partners International, the three legs of the "stool" of an EMR implementation are: life-giving properties, hopes and aspirations and first steps. If you can identify those three components then you'll have a better chance at having a successful transition to your EMR, they said.

Mohr and Laliberte asked the 30 providers in attendance to pair up in groups and identify the life-giving properties or the core values that give their practices vitality and that, "if not retained during the transition to their EMR, would irreparably worsen the situation."

"Autonomy is important for me," said one doctor. "And feeling like I am doing something that matters – helping people. If I end up just playing with medical records that would be the pits for me." I don't want to spend more time with a machine than the people I am trying to help."

Laliberte told attendees they had to think of an EMR as a possibility rather than a burden. He asked providers to think about "exciting possibilities" that the technology could bring to their practices.

Providers agreed that improved quality of care and patient satisfaction were at the top of the list. They also said it was important that providers have improved satisfaction was well.

"In the end, the most important thing is that you are making a difference for your patients, that is what it is all about," said one attendee.

The last question attendees had to answer was, "what is the smallest step you could take in the next week to start moving toward your desired future?"

Attendees said identifying their goals and visions for the technology as well as talking to other providers about their experience could be possible action items for them.

Remember, said Laliberte in closing: "the EMR is at the service of the patient."]]> http://healthcareitnews.com/news/three-legged-stool-model-emr-transition Fri, 12 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1215 Cloud
Cloud computing refers to a number of technology solutions that share three characteristics: They run on the Internet; use shared resources such as storage, processing, memory and network bandwidth with other users; and are "on-demand," meaning capabilities such as network storage can be adjusted virtually without an IT staff tearing apart your computers and adding hundreds of feet of wires and cords.

There are three types of services offered on the cloud:

• Software as a Service (SaaS), which has the capability to use Internet-based applications such as an EMR.
• Platform as a Service (PaaS), which has the capability for developers to deploy their applications on a cloud infrastructure -- for example, smartphone applications.
• Infrastructure as a Service (IaaS), a fully outsourced computer infrastructure that includes networks, databases, processing and other software.

For purposes of small physician practices, they probably will be looking at SaaS services that are offered on a community cloud, meaning it is shared by several organizations. There are issues to consider before making the jump to the cloud.

Cost

Experts say there are many advantages to going with a cloud-based solution, and the No. 1 advantage cited -- and the one most likely to get attention from potential consumers -- is cost.

"You don't have to worry about having servers, you don't have to worry about going out and hiring or contracting with an IT guy to maintain this for you. All that is now controlled by someone else, and you don't have to deal with it," said Mark Gilmore, president and co-founder of Wired Integrations, an integration company based in San Jose, Calif. "So that is definitely a pretty good trade-off to small offices doing that type of thing."

Generally, all physician practices would need to use a cloud-based EMR system are workstations with computers that have an Internet connection. Because the infrastructure is maintained outside the practice, upgrades or downgrades to the network -- for increased or reduced bandwidth and data storage, for example -- can be made on an as-needed basis at any time.

Pinning a cost on cloud computing can be difficult, because it depends on your needs, and it can change if you need more storage. However, it's generally acknowledged in tech circles that cloud-based programs tend to be less expensive and more flexible for your needs.

Speed and storage

But just like with any storage system, the advantages don't come without pitfalls that could cost you more in the end. And one of those pitfalls is speed.

Gilmore said that although the systems are flexible in terms of growth needs, some first-time cloud users might be disappointed with the speed at which systems run on the cloud.

32% of the health care industry is using cloud-based applications."If you're moving a particular service that you currently have housed internally, that might be running on a server or two, and you push it out to the cloud, out through the Internet, you're not going to be getting the same type of response that you have running it internally," he said.

Bandwidth is the speed at which data can be transferred electronically and is measured in megabits. Gilmore said most internal networks run at 100 megabits, and the average Internet connection is 1 megabit.

Although the cloud allows the flexibility for the bandwidths to be increased, people's expectations usually aren't set before adopting a cloud-based system. They may find themselves making upgrades right away that could cost a few hundred dollars more a month, Gilmore said.

But the needed speed, as well as the amount of storage you require, can be adjusted at any time, which is an advantage.

"It has certain elasticity," said Dadong Wan, senior research scientist with Accenture Technology Labs, the research and development arm of the global management consulting firm Accenture. "So that means if your practice grows over the years, you can pay a little bit more, and if it shrinks, you pay a little bit less. It's flexible in that regard."

Maintenance

Let's face it -- you went to medical school to keep patients healthy or fix their health problems. You didn't go to learn how to keep your IT infrastructure healthy or fix a crashed hard drive. Therefore, physicians might find cloud computing attractive because it's a virtually maintenance-free infrastructure. Vendors take care of all maintenance off-site, and very little has to be done in-house.

But experts say a potential downside is that because the systems are being run off-site, as a client, you are at the mercy of the vendor when and if things go wrong. These are issues that need to be resolved in a service level agreement, or SLA, which is basically a contract spelling out the vendor's obligations.

"If this is a mission-critical application for the doctors, meaning they can't live without it, how is this cloud vendor set up for disaster recovery?" Gilmore asked. "How is their primary location set up in case of a fire or has a power outage? Does the site go down, or does it go to some other location that is up and running?" These are questions that must be answered in the SLA, he said.

SLAs should include a time frame for how outages are handled. Most cloud vendors have a primary location and one or more backup locations. These backup facilities can take over and keep clients online when the primary location is knocked off-line.

Leslie Spasser, an attorney with LeClaireRyan in Virginia Beach, Va., said she advises clients to inquire about the location of the secondary facility. She said location can matter for many reasons, including natural disasters such as hurricanes and floods, that could put both primary and backup locations off-line if they are located too close together. Something else to consider is whether facilities are outside your state or country, where the same privacy laws might not be in effect.

Access

Assuming the systems are running smoothly, a big advantage to cloud-based computing is access. When data are in the cloud, they can be accessed from nearly anywhere using any Web-enabled device. As more physicians adopt smartphone or tablet computers, Wan said, this flexibility will become extremely valuable.

However, Spasser said doctors need to know that easy access still must be secure access.

First and foremost, vendors should be able to articulate how they ensure compliance with security and privacy laws, she said.

"As you go out and look at cloud computing solutions, you still have the responsibility to ensure your vendor complies with HIPAA," she said.

Data protection and ownership

Along with securing the data, the vendor must ensure that practices have access to the raw data when they need it or when a patient requests it, which is required under the Health Insurance Portability and Accountability Act. This means not only guaranteeing that outages don't knock practices off-line, but also that practices have the ability to give patients their files in a usable format upon request.

Gilmore said clients' ability to back up their data is limited with cloud solutions. When data are accessed at the practice, they are generally in a read-only format that allows physicians to add to the databases, but not download what is in the files. Therefore, any contract with a vendor should include a clause that not only requires that the vendors back the data up, but also fully provide your archived data within a specified amount of time when requested.

Another contractual issue that needs to be resolved is ownership of data. In the event you break ties with the company, or the company goes out of business or is acquired by another firm, you want to be able to keep your data. The contract not only should guarantee the transfer of data, it also should specify the format in which it is transferred, Spasser said.

Having data stored somewhere else can be a major psychological barrier. Wan said the shift from paper files, which you can physically see and touch, to electronic files makes many people uneasy, even when data are stored on servers in their office, let alone on a cloud.

Despite the uneasiness many feel about storing data off-site, the cloud can be safer to store private information than an in-office server, analysts said. Servers in physician practices run the risk of being stolen. Even though the data presumably would be backed up at a practice, many cloud system providers have multiple backup facilities, so the data are less likely to become permanently lost if something goes wrong.

A survey by Mimecast, a cloud-based EMR vendor, found that many in the medical industry consider cloud computing a viable option. It found that 32% of the health care industry is using cloud-based applications, and 73% of those are planning to add more applications to the cloud in the future.

Who uses cloud computing?

A national survey found that 36% of respondents use cloud-based solutions for data storage, and that 73% of health care organizations that do so want to put more data on the cloud.

Portion of industry using cloud-based solutions
• Technology 53%
• Financial services 41%
• Legal/professional services 37%
• Retail 35%
• Health care 32%
• Manufacturing 32%
• Education 29%
• Energy 24%
• Government 19%]]> http://hitconsultant.blogspot.com/2010/11/specialty-article-cloud-computing-is-it.html Fri, 12 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1216 Medicare Meaningful Use
Question: How will eligible professionals (EPs) and eligible hospitals apply for incentives under the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program?

Answer: Information on registration for EHR incentive programs will be available toward the end of 2010 on our website at http://www.cms.gov/EHRIncentiveProgram. Registration for the Medicare EHR Incentive Program will begin in January 2011 and will be available online. Registration for the Medicaid EHR Incentive Program may also begin in January 2011, but the timing will vary by State.

Question: A number of measures for Meaningful Use objectives for eligible hospitals and critical access hospitals (CAHs) include patients admitted to the Emergency Department (ED). Which ED patients should be included in the denominators of these measures for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs?

Answer: Our intent is to include in the denominator visits to emergency departments (EDs) of sufficient duration and complexity that all of the Meaningful Use objectives for which the ED is included would be relevant. We also want to encourage integration of the inpatient and emergency departments by including inpatient admissions that occur through the ED. Therefore, we are clarifying the following specifications for including ED services in the denominator for measures associated with Stage 1 of Meaningful Use objectives for eligible hospitals and critical access hospitals (CAHs):

• The patient is admitted to the inpatient setting through the ED. In this situation, the orders entered in the ED using certified EHR technology would count for purposes of determining the computerized provider order entry (CPOE) Meaningful Use measure. Similarly, other actions taken within the ED would count for purposes of determining Meaningful Use

• The patient initially presented to the ED and is treated in the ED's observation unit or otherwise receives observation services. Details on observation services can be found in the Medicare Benefit Policy Manual, Chapter 6, Section 20.6.

Question: Who can enter medication orders in order to meet the measure for the computerized provider order entry (CPOE) meaningful use objective under the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs? When must these medication orders be entered?

Answer: Any licensed healthcare professional can enter orders into the medical record for purposes of including the order in the numerator for the measure of the CPOE objective if they can enter the order per state, local, and professional guidelines. The order must be entered by someone who could exercise clinical judgment in the case that the entry generates any alerts about possible interactions or other clinical decision support aides. This necessitates that CPOE occurs when the order first becomes part of the patient's medical record and before any action can be taken on the order. Each provider will have to evaluate on a case-by-case basis whether a given situation is entered according to state, local, and professional guidelines, allows for clinical judgment before the medication is given, and is the first time the order becomes part of the patient's medical record.

Question: In a group practice, will each provider need to demonstrate meaningful use in order to get Medicare and Medicaid electronic health record (EHR) incentive payments or can meaningful use be calculated or averaged at the group level?

Answer: Yes. Medicare and Medicaid incentive payments are made on a per EP basis, not by practice. Each EP will need to demonstrate the full requirements of meaningful use in order to qualify for the EHR incentive payments. We made this clear in the preamble to the final rule when we declined to adopt alternative means for demonstrating meaningful use on a group-practice level (75 FR 44437).

The FAQs and additional information are available at https://www.cms.gov/EHRIncentivePrograms/.]]> http://www.healthdatamanagement.com/news/meaningful-use-cms-hitech-frequently-asked-questions-41337-1.html?ET=healthdatamanagement:e1500:143120a: Fri, 12 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1217 EHR new poll found that 97% of respondents say physicians, hospitals, labs and health IT systems should not sell or share personal health data unless they obtain patient consent, Healthcare IT News reports.

The poll -- conducted by Zogby International for Patient Privacy Rights, a watchdog group -- surveyed more than 2,000 U.S. adults to gauge consumers' views on health care IT, privacy and health information access.

Key Findings

According to the poll:

• 98% of respondents oppose allowing insurance companies to share or sell health information without receiving consent;
• 91% say that they want the power to decide who can see and use their electronic health information; and
• 78% report that they would be somewhat likely or very likely to use a website that lets users choose who can view their health information.

Patient Privacy Rights' Suggestions

Patient Privacy Rights supports the creation of a "one-stop shop" website where patients can make decisions about who views their electronic health information.

The group describes the website as a "do not disclose" list, similar to the national "do not call" list. Health care organizations would need to explain to patients how the information would be used to receive consent (Miliard, Healthcare IT News, 11/11).]]> http://www.ihealthbeat.org/articles/2010/11/12/survey-most-individuals-want-control-of-personal-health-data.aspx Sat, 13 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1218 Medicare
However, the rule calls for Medicare physician payments to be slashed by 25% -- 23% on Dec. 1 and 2% on Jan. 1, 2011. These payment cuts could be avoided if Congress intervenes, as it has since 2002 and is expected to do so again.

The American Medical Association and others in organized medicine have voiced their support for a permanent fix to the sustainable growth rate formula, which is part of the system to determine Medicare payments. CMS officials also believe a new system is vital to the long-term sustainability of the program. Whether lawmakers agree is yet to be seen.

"Broad physician participation for Medicare is essential to ensuring that beneficiaries continue to have access to care, and physician engagement is critical to our efforts to strengthen the quality of care," said CMS Administrator Donald M. Berwick, MD. "Medicare needs to be a strong, dependable partner with physicians -- and that means the SGR must be fixed. The [Obama] administration supports permanently reforming the Medicare payment formula."

Since 1992, Medicare has paid for services of physicians and other suppliers according to the Medicare Physician Fee Schedule, under which the relative value unit system determines pay for individual services.

CMS' final 2011 physician fee schedule provides a 10% incentive payment for primary care services. The final 2011 fee schedule implements provisions called for under the Patient Protection and Affordable Care Act that CMS says expands beneficiary access to preventive services. The rule provides coverage under the traditional fee-for-service program for an annual wellness visit beginning Jan. 1, 2011. During this yearly visit, doctors will be able to more easily update a patient's care plan; screen for impairments; measure height, weight and blood pressure; and adjust for other tests based on the person's medical and family histories.

Medicare will cover certain preventive services that no longer will require out-of-pocket patient payment, including screening mammographies and colonoscopies. Medical industry experts approve of the new benefits for Medicare patients provided under the health reform law.

"To have preventive services available at no cost to people with Medicare is not only an improvement to the Medicare program, but also encourages both providers and patients to think about health care in a new way," said Joe Baker, president of the Medicare Rights Center, a nonprofit consumer organization based in New York City. "By encouraging people to take steps to prevent illness, the law promotes efficient, higher-quality, patient-centered care."

Primary care incentives
CMS' final 2011 physician fee schedule provides a 10% incentive payment for primary care services. Family physicians, general internists, geriatricians, pediatricians, nurse practitioners, clinical nurse specialists and physician assistants for whom primary care services represent 60% or more of their Medicare physician fee schedule-allowed charges in a prior period are eligible for the payment.

"The fee schedule launches an important investment in our primary care system and reinforces the primary care infrastructure that will support a high-performing and efficient health care system," said Roland Goertz, MD, president of the American Academy of Family Physicians. "Research consistently shows that such a system yields both improved outcomes for patients and cost efficiencies for everyone."

Dr. Goertz said the final 2011 fee schedule rule was changed so that 80% of family physicians would be eligible for incentive payments, up from about 60% in the proposed rule, which CMS released in June.

The rule includes a provision that allows physician assistants to order post-hospital extended care services in skilled nursing facilities and another provision to pay the same Medicare rates to certified nurse-midwives as physicians.

Addressing surgeon shortages
The health reform law calls for a payment incentive program to improve access to major surgical procedures that are furnished by physicians in Health Professional Shortage Areas between Jan. 1, 2011, and Dec. 31, 2016. To be eligible for the 10% incentive payment, the physician must be enrolled in Medicare as a general surgeon and be based in a ZIP code in a CMS-designated professional shortage area.

The agency is using the same list it has employed under the existing shortage area bonus program, something the American College of Surgeons would like to see fixed.

"The areas that are designated now are for primary care and mental health, so they might not actually be general surgeon shortage areas," said Bob Jasak, ACS director for regulatory and quality affairs. "We appreciate CMS implementing the incentive provision, but we'll continue working with them to create a specific geographic designation for general surgeon shortage areas."

The health reform law requires CMS to identify and make adjustments to relative values for multiple services that are frequently billed together. As a result, the agency finalized a policy to reduce by 50% payments for the second and subsequent studies billed by a physician for a patient who uses ultrasound, CT or MRI imaging services on a single date of service.

In a statement, the American College of Radiology said it was "very disappointed" that CMS finalized this policy. If a patient has two imaging studies done on the same day, "it in no way justifies a 50% reduction," the statement said.

The final rule will appear in the Nov. 29 Federal Register. CMS said it will accept comments on certain aspects of the rule until Jan. 3, 2011.]]> http://www.ama-assn.org/amednews/2010/11/15/gvsa1115.htm Mon, 15 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1219 Meaningful Use
At a recent meeting of the American Academy of Ophthalmologists, David Blumenthal, MD, national coordinator of health information technology for the Department of Health and Human Services, pointed to exceptions to the meaningful use final rule that can enable specialists to qualify for incentive funds.

These exceptions were put in place because some meaningful use objectives are not applicable to every provider’s practice. As a result, when choosing which of the “menu item” objectives to focus on, those that are not applicable to that specialty are counted as meeting meaningful use requirements. For example, dentists do not perform immunizations. Therefore, under the exceptions rule, a dentist who is an eligible provider would be recorded as meeting the meaningful use of the menu item “Immunization Data to Registries.” Chiropractors would be noted as having met the e-prescribing requirement by virtue of the fact that they do not engage in e-prescribing.

To date, the ONC has not issued a formal statement for specialists aiming to meet the standards. However, Blumenthal has spoken publically a number of times stating that specialists could claim exceptions to rules that do not apply to them and that claiming exceptions is acceptable to meeting the requirement.

Specialists who would like to be eligible for meaningful use incentive money can look to DrFirst’s EMR/EHR Partners – over 130 strong – who can provide them with the right health IT to meet the unique needs of their practice and specialty. Click here to view our Partners list.]]> http://blog.drfirst.com/drfirst/meaningful-use-program-its-not-just-for-pcps-anymore/ Wed, 17 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1220 Meaningful Use
According to American Medical News, Blumenthal told last month's meeting of the American Academy of Ophthalmology that specialists can claim an "exception" to each rule that doesn't apply to their specialty and still get credit for meeting that specific objective. He was backed up by Dr. Derek Robinson, medical director for HHS Region V, covering Illinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin.

Sign up for our FREE newsletter for more news like this sent to your inbox!

For example, three of the "core" measures of meaningful use that all providers must be able report on are blood pressure levels, whether patients over 13 use tobacco products and adult weight screening. "You may say that one of these or all three of these may not be part of your scope of practice," Robinson said, amednews reports. It is possible to report zero as both the denominator and numerator for the quality measure if that specific item is outside a physician's scope of practice.

Still, some specialists would like to see separate requirements for them as part of the Medicare and Medicaid EMR incentive program. "The final rules provided a more reasonable path for physicians to become meaningful users of EMRs, but the AAOS still believes separate meaningful use criteria need to be developed for surgical specialties," Dr. Thomas C. Barber, MD, a member of the EMR project team for the American Academy of Orthopaedic Surgeons, tells amednews.]]> http://www.fierceemr.com/story/blumenthal-specialists-may-claim-exceptions-certain-mu-measures/2010-11-18 Thu, 18 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1221 Cloud
But IBM is convinced that the future of health care is in the clouds, and it has been moving steadily, if quietly, in that direction for some years now.

The importance of its deal with the National Marrow Donor Program, which Dave Rosenberg of CNET wrote about yesterday, is that it’s a demonstration of what can be done with cloud-sized databases and processing power.

IBM’s new deal in Puerto Rico is a beta test of something it can quickly roll out nationwide.

What this means for clinics and hospitals is that most of the gear does not need to be in your office. Collecting EMR data on your patients by hand, and turning a hard drive into your file room, is not the future.

This will be a relief to many doctors who find such systems to be an enormous pain, despite the promise of that sweet, sweet stimulus cash. What they want is actionable advice on what to do for their patients. What they want is an end to the current paper-based runaround.

That’s what IBM plans to deliver. The company is working hard on increasing analytics processing speed, because medicine produces great rafts of data that must be tied to other rafts in order to get everyone down to the sea.

In health care, clouds have to be private, they have to be secure, and they have to be managed, or they’re no good. Local offices are clients, not servers, so it’s interfaces that matter there. An iPad for everyone is fine with IBM –they got out of the client space years ago.

IBM is not wrapping this with a bow and going on TV with it because they want it to work before they sell it to the mass market. But it’s clear that they want medical data to live in the cloud, not in the office or hospital, and that they want to be delivering answers, not data.

Which is just what the doctor ordered.]]> http://www.zdnet.com/blog/healthcare/ibm-convinced-clouds-are-the-way-to-health/4211 Fri, 19 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1222 Medicare
The Physician Payment and Therapy Relief Act of 2010 was introduced by Senate Finance Committee Chair Max Baucus (D, Mont.) and ranking member Charles Grassley (R, Iowa). They also have agreed to work together to pursue a 12-month patch before the monthlong postponement in the pay cut expires.

The House is not expected to take up the Senate bill until after Thanksgiving. Congress returns from the holiday break on Nov. 29, at which time the House is expected to vote.

House leaders introduced their own legislation on Nov. 18 that would extend physician Medicare payments by 13 months and provide a 1% update through the end of 2011. That bill was introduced by a group led by Rep. John Dingell (D, Mich.) and several other House Democrats.

Without an extension, physicians would be hit with a 25% reduction in Medicare payments over the next two months -- 23% on Dec. 1 and an additional 2% on Jan. 1, 2011. Even if the Senate legislation is passed by the House, physicians still would face a 25% cut on Jan. 1 unless Congress steps in again.

The American Medical Association applauded the Senate for moving quickly on a bill once Congress returned from the elections on Nov. 15, but it emphasized that the House still must act on its legislation to avert the cuts.

"This is a short-term reprieve, and the AMA is urging Congress to pass a one-year fix as soon as they return from the Thanksgiving holiday," said AMA President Cecil B. Wilson, MD. "Delaying the 25% cut to the end of 2011 will inject some stability into the Medicare program for patients and physicians and provide lawmakers with time to develop a long-term solution to the broken physician payment system. Now the U.S. House must act on the legislation passed by the Senate before the Dec. 1 deadline to preserve health care for America's seniors."

Dr. Wilson said patients and physicians helped spur action this week by making more than 10,000 calls to lawmakers. The effort culminated with the AMA's "White Coat Wednesday" on Nov. 17, a day the AMA advocated for physicians to call their legislators.

According to an AMA poll released Nov. 8, 94% of adults believe the Medicare pay cuts pose a serious problem to seniors, and 81% say Congress should act immediately to stop the reductions. Among those 55 and older, 98% said the problem was serious, and 91% called for prompt congressional action.

The one-month extension in the Senate bill would be paid for using the Medicare savings from a new Centers for Medicare & Medicaid Services policy that reduces payments for multiple therapy services provided to patients in a single day. The bill also would lower that reduction to therapists to 20% from 25% and save $1 billion, Baucus and Grassley said. It's estimated that a patch through the end of 2011 would cost $17 billion.]]> http://www.ama-assn.org/amednews/2010/11/22/gvl11122.htm Mon, 22 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1223 Telehealth
Many of his patients have Alzheimer's disease or other forms of dementia. Using teleconferencing technology, he is able to see and talk with patients, nursing home staff and family members.

"I live in a state that has not a lot of people, but a lot of area," said Dr. Magnuson, a psychiatrist specializing in geriatrics and an assistant professor at the medical center. "We have a lot of isolated places. We just had a big patient population out there that wasn't being seen."

Nationwide, telemedicine increasingly is being used to bridge gaps in access to care in rural and other medically underserved communities that have a hard time recruiting physicians. The technology provides primary care physicians and patients a vital link to specialists at large urban medical centers.

Telemedicine also is good for the well-being of communities, because the lab work, imaging and pharmacy services are done locally, said Debra Lister, MD, director of the Coffee Regional Medical Center Walk-In Clinic in Douglas, Ga.

"The patients stay in the community and don't get lost to an outside specialist," she said. "And local doctors keep control of their patients."

Telemedicine ranges from patient consults by phone, e-mail or interactive video to surgeons using remote-controlled robots to operate on patients thousands of miles away. "Whether the doctor's in the next room or 3,000 miles away is irrelevant," said Gary Capistrant, senior director of public policy for the American Telemedicine Assn.

The practice is used nationwide, and many rural hospitals have some telemedicine connection, Capistrant said. A few of the most common applications are psychiatry, radiology, pathology and neurology. But the technology has been slow to spread to some areas that are resistant to change or lack broadband infrastructure.

Telemedicine will become more common, however, as the country moves forward with health system reform, which will require that services be made available to patients regardless of geographic barriers, said Curtis L. Lowery, MD, chair of obstetrics and gynecology and director of the Center for Distance Health at the University of Arkansas for Medical Sciences.

89 of Nebraska's 93 counties have a shortage of mental health professionals. The Centers for Medicare & Medicaid Services is making changes to promote telemedicine. In June, the agency proposed new policies that would make it easier for hospital officials to credential physicians who provide telemedicine services at their facilities. And in January 2011, CMS will expand Medicaid coverage for remote services, including disease management training for patients with diabetes or kidney disease.

Reliance on providing care from afar will increase due to expected shortages of physicians. By 2020, the nation may be an estimated 91,500 physicians short due to expansion of coverage to more than 30 million uninsured Americans and increased demand from an aging population.

Without enough doctors to deliver care, many rural health facilities increasingly will be staffed by nonphysicians, such as advanced practice nurses. And because nonphysicians lack a broad medical education, they will need the support of specialists via telemedicine, Dr. Lowery said.

"This is going to be a huge tool in trying to manage health care reform," he said. "The role of subspecialists becomes more important."

Health reform also means an increased focus on efficient and cost-effective care, said Alan Morgan, chief executive officer of the National Rural Health Assn. Policymakers will work to remove barriers to expansion of telemedicine such as inconsistent payment structures, he said.

Ensuring access to care
Douglas is a town of about 11,500 in southern Georgia, more than two hours southeast of Macon and 50 minutes from the nearest interstate. The Coffee Regional Medical Center Walk-In Clinic sees about 1,000 patients a month from Douglas and surrounding communities.

About 30 to 40 patients use the clinic's telemedicine services monthly. As part of the Georgia Partnership for Telehealth, they're able to access specialists who aren't available locally, including dermatologists, endocrinologists and pediatric cardiologists.

"It's so far for our people here to get to a specialist," Dr. Lister said. "Some of these people just can't travel -- some of our elderly and poor people couldn't have made the trip. An awful lot of them would not have received care."

Telemedicine requires collaborative relationships, and having a statewide agency to assist in building those relationships helps. For example, the Georgia Partnership for Telehealth is a 5-year-old nonprofit corporation formed to promote telemedicine and build networks statewide. It has grown from 42 facilities to 171 in the last two years and includes hospitals, clinics, jails, child advocacy facilities and senior centers, said Paula Guy, the partnership's executive director.

Telemedicine also is used to boost efficiency in emergency care, when getting patients the care they need quickly can mean the difference between life and death.

The University of Mississippi Medical Center has had its TelEmergency program for eight years. The system makes emergency physicians available around the clock to 13 rural hospitals via remote, said Bob Galli, MD, the program's director and a professor of emergency medicine at UMMC. "Like so many poor, rural states, we have such a hard time recruiting physicians. This is a great way for the university, as the only academic medical center in the state, to extend its reach."

The University of Arkansas for Medical Sciences offers rural emergency departments access from afar to specialists in high-risk pregnancies and burn experts, said Dr. Lowery, a maternal fetal medicine specialist. The medical center's stroke program provides 24-hour access to a neurologist so that emergency physicians can get the consult they need to administer potentially lifesaving tissue plasminogen activator to stroke patients within the medicine's time constraints.

One of the most common uses of telemedicine is for psychiatry, because it doesn't require physical contact with a patient.

The University of Nebraska Medical Center matches psychiatrists with about 37 hospitals around the state. The effort is part of the Nebraska Statewide Telehealth Network, which connects all 83 of the state's nonprofit hospitals, said Dale Gibbs, network chair and director of outreach and telehealth services at Good Samaritan Hospital in Kearney, Neb.

Of Nebraska's 93 counties, 89 have a shortage of mental health professionals, said Laura Meyers, consultant to the network and grant project manager with DKG Consulting. In addition to geography, the state's harsh winters make travel difficult for patients who must drive 250 miles or more to see a specialist.

"There are only six to eight months a year you can do that," said Dr. Magnuson, a psychiatrist at UNMC. "It really imposes a huge burden on these families and on these facilities."

Offering patients access to care in their own communities saves money on both ends and improves patient compliance, said Wanda Kjar-Hunt, program manager for telehealth at Good Samaritan. "They won't miss as many appointments, because they don't have to travel."

Cutting costs and extending reach
Many agencies use telemedicine to streamline services, reduce costs and improve patient care.

The Dept. of Veterans Affairs began offering mental health services remotely more than 30 years ago and has expanded services to other specialties greatly in the last 20 years, said Adam Darkins, MD, MPH, chief consultant for telehealth services with the Veterans Health Administration. Nationwide, 140 of 153 VA hospitals have telemedicine capabilities.

More than 300,000 people received telemedicine care through the VHA in 2009. About 48,000 chronic disease patients are being monitored remotely in their homes through technology that allows physicians to track patients' health indicators, such as blood glucose level and heart pressure.

Such monitoring has allowed the VHA to significantly reduce hospital admissions, Dr. Darkins said. The technology will become even more common as chronic disease rates rise, he added.

"The closer you can get to real-time collection and real-time analysis, the better you can control a disease process, as opposed to the traditional model where we only collect information when they come into the office," said Wes Valdes, DO, a wound care specialist and medical director for telehealth at the University of Illinois College of Medicine, which has offered telemedicine services for about a decade.

But telemedicine has limitations, including the types of care that can be provided and the fact that many medical centers house telemedicine facilities separate from other care centers.

Physicians and patients typically must leave regular patient care areas to go to designated rooms that house the communications equipment, Dr. Valdes said.

As technology continues to improve, having the capability readily available through handheld devices, such as smartphones and iPads, will make it more convenient and more likely for physicians to participate.

Other barriers to expanded use of telemedicine include the cost of the technology and payment structures, said Brock Slabach, MPH, senior vice president for member services with the National Rural Health Assn. Payment for telemedicine is inconsistent nationwide. Though several states require insurance companies to pay for such care, many insurers and policymakers are still working out how to pay for remote services.

At its Annual Meeting in June, the American Medical Association's House of Delegates approved a policy asking national specialty societies to develop telemedicine practice parameters. The policy says that medical boards should require physicians practicing telemedicine in their states or territories to have full, unrestricted licenses there.

But medical licensing by state makes it difficult for physicians to provide telemedicine across state lines, because doctors have to maintain licenses in each state, said Deanna Larson, vice president of quality initiatives at Avera Health, a health system that offers telemedicine services in Iowa, Minnesota, Nebraska, North Dakota, South Dakota and Wyoming.

Telemedicine's potential is far from being realized, but it never will replace traditional in-person doctor visits completely, physicians say. "It can't replace all health care," Dr. Darkins said. "There is an obligate need to why people need face-to-face care."]]> http://www.ama-assn.org/amednews/2010/11/22/prsa1122.htm Mon, 22 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1224 Healthcare Technology
The data comes from an analysis of Good Technology's user base, which includes more than 4,000 enterprise customers, whose iPad deployments range from one to more than 1,000 iPads.

"We took a close look at our customers who have deployed iPad devices so far," said John Herrema, senior vice president of corporate strategy at Good Technology. "We found that the financial services sector dominated, accounting for 36 percent of Good's iPad activations to date. The technology sector came in second at 11 percent, followed closely by healthcare at 10 percent. We believe these industries are embracing the iPad because its unique design makes it easier to perform time-sensitive, mission-critical tasks."

One reason the iPad is being adopted in the industry is because hospitals' current mobile devices have become a "barrier" due to their size, weight and battery life, said Nick Volosin, ISS director of technical services at Kaweah Delta Health Care District in California. The hospital is considering using the iPad in areas like pharmacy, emergency, dietary, home health, hospice, clinical engineering/bioMed and for private practice physicians and nursing supervisors.

According to feedback from the hospital's emergency department the iPad is also a potential cost saver. The emergency department estimates that it could trade a COW (computer on wheels), which costs $7,500, for three iPads, costing $1,500.

Kaweah Delta Health Care District is also looking into having the iPad work with a barcode scanner for a portable device for MAK (Medication Administration Check), which helps prevent medication errors, said Volosin.

Electronic medical records applications that are specifically designed for the iPad could be another reason why adoption in the healthcare industry may see more growth. Experts predict that the iPad could even be a "game changer" for EHR adoption.

According to one study, sales of tablets to the healthcare industry could reach $63 million by 2013.]]> http://www.healthcareitnews.com/news/healthcare-sector-among-top-adopters-ipad Mon, 22 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1225 EHR
Now, years later, in the world of EHRs, there seems to be a push-back against the “cut and paste” concept. I know this is out there for two reasons: one, because I have read a blog or two citing it, and two, because I have enjoyed doing it myself. In the cut-and-paste world of computerized documentation, it’s addictively efficient. Gutenberg, the inventor of the printing press which allowed mass production of books and changed the world, would be proud. The responsibility for using such powerful efficiency does fall to the individual health provider to carefully review, edit, add and subtract documentation to ensure current accuracy. However, if done correctly, it allows careful preservation of a summary of what came before.

For this, I have some personal recommendations. First, actually DO the editing, don’t just cut, paste, and sign. Second, go back and refine the previous note for word choice and economy. Otherwise, you will create endless run-on documentation that is unprofessional in appearance and a burden for your colleagues to wade through later. From a billing perspective, it facilitates and supports that you have actually reviewed the patient’s previous history rather than just asking them what’s going on today. I find that cutting and pasting the old plan prompts me to consider everything I was trying to accomplish after the last visit and promotes holding the patient accountable for getting all of their previous orders accomplished. If something was not followed up on by the patient despite my recommendation, then this definitely gets documented in the current note. And then, of course, I ask them to “try, try again.”

I find nothing inherently wrong in this process and my patients get the benefits of an accurate portrayal and review of their conditions with appropriate follow up evaluation and managent. So cut, paste, edit, and save your evenings for yourself, rather than dictating entirely new notes that regurgitate the same old information. Work smart, while still working hard.

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.]]> http://www.emrandhipaa.com/emr-and-hipaa/2010/11/22/is-cut-and-paste-in-ehr-software-really-such-a-bad-thing/ Tue, 23 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1226 Health Information Exchange
In the just-released preliminary results of the 2010 AHRQ Medical Office Survey on Patient Safety Culture, practices reported problems with the accuracy, completeness or timeliness of patient data at least half the times they've exchanged electronically with other healthcare entities in the past year. Specifically, the 470 medical offices surveyed said they had HIE problems 55 percent of the time with outside laboratories or imaging centers, 50 percent of the time in transactions with other medical offices, 52 percent of the time with pharmacies and in 58 percent of exchanges with hospitals, CMIO reports.

Many of the participating medical offices are far along with health IT implementations. Some 82 percent of those surveyed said they had fully implemented electronic appointment scheduling and 59 percent reported having electronic access to lab or imaging test results for their patients. A small majority said they had EMRs in place, while 41 percent had electronic ordering capabilities, with 37 percent saying they had fully implemented CPOE for tests, imaging or medical procedures.

Some of the non-IT findings may be more shocking, though. An eye-opening 86 percent of respondents said they used the wrong chart for a patient at least once in the previous 12 months and 70 percent said they have had incidents of medical information being scanned, filed or entered into the wrong patient's record. The survey did show better results on other quality measures, but 44 percent still said they neglected to update at least one patient's medication list in the past year.]]> http://www.fiercehealthit.com/story/ahrq-survey-practices-continue-struggle-hie/2010-11-22 Tue, 23 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1227 Healthcare Technology Hardware
I've spent the past few months using an iPad for things like e-mail, Web browsing, viewing photos, writing/note taking, CME activities, file sharing, and last but definitely not least, reading e-books. I hope that you will find my observations useful.

For me, hardly a day goes by without the need to print something. I quickly discovered that printing is simply not part of Apple's concept — so they didn't provide for it. There are some apps that supposedly allow printing (under limited circumstances) but they are quirky, hard to configure, and generally unreliable. (Translation: Are you a network technician? And were you prescient enough to have bought the right printer?) In practice, I’ve found it easier to transfer anything I need to print to some other computer where I can finish the job. This is a real bummer. The “instant on” nature of the iPad would make it an ideal way to quickly print a restaurant coupon, CME certificate, boarding pass, etc. Perhaps a future version will correct this deficiency.

E-mail on the iPad works pretty well, except I've found that many attachments, including forwarded e-mails are not readable. Also, I like to organize my e-mail into folders. I've got about 350 of them. Unfortunately there is no way to create a new folder on your e-mail server from the iPad. Some folders are inexplicably invisible. It's one more thing I have to remember to do later elsewhere.

Web browsing is reasonably functional, except as you may have heard, there is no Flash player. Most of the CME sites (and many others) depend on Flash. If you really need to view a site that uses Flash, it becomes one more thing to remember to do later. The browser on the iPad does not offer to remember user names or passwords for Web sites. Storing passwords on a device that is easily lost is probably not a good idea, but I am getting a bit tired of typing my user name over and over for sites I visit regularly. If a web link takes you to a PDF file, it will display fine but there is no way to save it from Safari. There are other apps that will do this (more later) but you have to copy the URL, start the other app and re-enter the URL and to wait for the download again. You will also discover that the “print” links on many Web pages (that are useful for viewing a page with fewer ads and buttons) don't work; presumably Apple ignores them as part of the anti-printing agenda.

When it comes to viewing photos, videos and playing music, the iPad is a big iPod. If you like the way the iPod works for photos and music you will like the iPad. If you find managing the transfer of content into the device difficult and non-intuitive you will not feel any different about the iPad.]]> http://www.physicianspractice.com/mobile-health/content/article/1462168/1710176 Tue, 23 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1228 Healthcare Technology Hardware
There are several ways to get information into an iPad when writing, taking notes, and composing long email messages:

• The most iPad-like approaches to input are custom apps in which you point and click. Apps like this are great for ordering a book or maybe even writing a prescription. They could even work for PA or nurse practitioner encounters like a wound or anticoagulant check. Unfortunately I have only seen one app that provided a satisfactory method of documenting a patient's history by point-and-click and it does not and could not work on the iPad.
• Use an external keyboard. This approach requires some sort of stand or case to hold the iPad upright, in addition a keyboard. It’s really difficult to balance a keyboard and an upright iPad on your lap. A small Windows laptop costs less than an iPad plus a keyboard.
• Use the on-screen keyboard. It's fine for short messages — very short messages.
• Use an app that will recognize handwriting and printing on the screen. I tried one. It's very slow and it required writing so large that I was limited to one or two words at a time, then there is a wait while it processes. I used the app for about 15 minutes and abandoned it.
• There is an app by Dan Bricklin (of Visicalc fame) that captures what you write on the screen as an image. It has many slick features for dealing with magnification and capturing a continuous flow of writing. Unfortunately, it does not convert handwriting to text and the primary way to get the notes out of the iPad is to have them converted to a PDF and then e-mail them to yourself. After reading about this one on their Web site, I didn't bother to try it.

My recommendation for writing is to stick to the on-screen keyboard and try to keep the amount down to a paragraph, or better yet, a sentence.

The mechanisms that Apple has provided for getting files and other content in and out of the iPad are cumbersome and offer limited functionality. There are several Web-based services that allow sharing information between all your computers whether they are PCs, Macs, or iPads.

Evernote is a free Web service that allows you to create notes and text documents. Sections of the text can be encrypted (but strangely, not on the iPad version) which is useful for protecting passwords and the like. Regardless of where you create a note, they are all synchronized to the Web service and then to all your other computers. Another service is offered by Dropbox. Instead of focusing on notes, Dropbox is designed to synchronize an entire folder on your computer with the web service and your other devices. There is no encryption on this one, just a password, so don't put anything really sensitive out there.]]> http://www.physicianspractice.com/mobile-health/content/article/1462168/1733214 Tue, 23 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1229 Practice
• 37 percent of respondents experience a 20 percent rejection rate on first-time preauthorization requests for test and procedures, with 57 percent having a 20 percent rejection rate for first-time preauthorization of drugs;

• 46 percent have difficulty getting approval from insurers on 25 percent or more of preauthorization requests for tests and procedures, with 58 percent having the same problem with drugs;

• Almost two-thirds of respondent physicians often wait several days to receive preauthorization for tests and procedures, with 13 percent waiting more than a week, and the rates are higher for drugs;

• About two-thirds also say it is difficult to determine which tests, procedures and drugs require preauthorization; and

• 75 percent believe an automated preauthorization process would be more efficient.]]> http://www.healthdatamanagement.com/news/ama-survey-physicians-preauthorization-payers-edi-41399-1.html Wed, 24 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1230 e-Prescribing
In 2009, of the 1.63 billion prescriptions written in the U.S., 190 million prescriptions — or 12% — took place electronically, according to the results of an annual audit of e-prescribing usage conducted by Surescripts, which operates the largest e-prescribing network in the U.S Still, the total e-prescriptions in 2009 climbed significantly from the 68 million and 29 million, respectively, that took place in 2008 and 2007.

Approximately 200,000 U.S. clinicians, or about 1-in-3 office-based physician, nurse practitioner, and physician assistant in the U.S., used e-prescribing at least once a month last year, according to Surescripts.

With the federal government’s push for the adoption and meaningful use of health IT, Surescripts projects that e-prescriptions will grow to 300 million in 2010, said a spokesman.

The U.S. Health and Humans Services Department’s “stage one” meaningful use criteria–for which healthcare providers can become eligible for financial rewards — includes several objectives that are supported by e-prescribing systems.

Those objectives include maintaining active patient medication lists; generating and transmitting permissible prescription electronically; implementing drug formulary checks; and performing medication reconciliation between care settings

In addition to evaluating usage of e-prescribing systems to transmit patient drug orders to pharmacies, Surescript’s audit this year also for the first time evaluated usage of two important E prescription functionalities — confirming patient’s prescription insurance eligibility prior to sending the order and electronically cross referencing patient’s medication history with pharmacies and payers.

With those new audit measures in mind, Surescripts also ranked e-prescription usage in each state. Massachusetts ranked first among states in e-prescribing, with 11 million prescriptions sent electronically by Bay State clinicians in 2009, representing about 32.3% of all prescriptions that were processed in the state.]]> http://electronicmedicalrecord.wordpress.com/2010/11/25/e-prescribing-use-continues-to-grow/ Thu, 25 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1231 Practice HIPAA
The mp3 podcast is available here, free enrollment required.]]> http://www.reachmd.com/xmsegment.aspx?sid=4480 Fri, 26 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1232 Medicare
The House approved the measure -- the Physician Payment and Therapy Relief Act of 2010 -- with a voice vote. The Senate unanimously approved the bill on Nov. 18.

American Medical Association President Cecil B. Wilson, MD, thanked Congress for enacting the patch before the Dec. 1 deadline. However, he called on Congress to act in early December to delay a 25% pay cut scheduled to take effect Jan. 1, 2011. The AMA and others are seeking another patch through 2011 so the next Congress will have time to adopt a permanent solution to Medicare's sustainable growth rate formula.

"It is crucial that Congress act well before the Jan. 1 deadline so there are no disruptions in care for seniors," Dr. Wilson said. "The oldest baby boomers will ring in the new year as the first of their generation to turn 65 and will begin relying on Medicare. Congress is responsible for ensuring that the baby boomers can see a doctor through Medicare by enacting long-term reform next year of the broken Medicare physician payment system."

The one-month patch, estimated to cost $1 billion, will be paid for using the Medicare savings from a new Centers for Medicare & Medicaid Services policy that reduces payments for multiple therapy services provided to patients in a single day, according to the authors of the measure, Senate Finance Committee Chair Max Baucus (D, Mont.) and Sen. Charles Grassley (R, Iowa), the panel's highest-ranking GOP member.

Delaying the 25% Medicare physician pay cut through the end of 2011 would cost $17 billion, according to Baucus and Grassley, who are working on a bill to delay the cut by one year.

The same day as the House vote, the Connecticut State Medical Society issued a survey showing that doctors would stop seeing patients unless a pay cut were averted. It was the latest survey by a medical organization to say that physicians may be forced to limit or stop treating Medicare patients.

Nearly one-third of Connecticut physicians said they would be forced to limit the number of new Medicare or Tricare patients they see, according to the Connecticut society's statewide survey of 360 physicians. The survey, conducted in November, showed that 19% of physicians would stop seeing Medicare and Tricare patients altogether. Tricare is the program that delivers health care for members of the military and their dependents and military retirees.

"Just because 94% of Connecticut physicians participate in the Medicare program doesn't mean that every patient has access to the care they need right now," CSMS President David S. Katz, MD, said in a statement. "Many physicians already limit the appointment slots for Medicare and Tricare patients."

Connecticut has about 562,000 Medicare patients and 50,992 military members and their families in Tricare, according to the CSMS.]]> http://www.ama-assn.org/amednews/2010/11/29/gvsc1129.htm Tue, 30 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1233 Healthcare Technology
"While there are many success stories, progress in using IT to improve patient care and cut costs has been slow. Research suggests that healthcare IT has a long way to go to match the hype," the magazine notes. "Not all healthcare providers have electronic records, many organizations can't share their records with other facilities unless they're affiliated with one another, and even those that can share with others outside their networks often have translation problems because there's no single data standard to facilitate the smooth transfer of information."

Nineteen years after the IOM report and 11 years after publication of the seminal IOM tome on medical errors, "To Err Is Human: Building a Safer Health System," many top health IT professionals still are talking like we're still in the early stages of health IT delivering on its potential to save lives and cut costs. "This is really going to take a lot of work and a lot of evolution. It's going to take a little bit of carrot, a little bit of stick and time to get there," William Spooner, CIO of Sharp HealthCare in San Diego, tells Computerworld.

"Getting hospitals to start using EHRs is critical," adds Ashish Jha, associate professor of health policy and management at the Harvard School of Public Health. "Paper-based medical records lead to hundreds of thousands of errors each year in American hospitals and probably contribute to the deaths of tens of thousands of Americans. This is not acceptable. There is overwhelming evidence that EHRs can help, yet the expense and the disruption that implementing these systems can cause has forced many hospitals to move slowly."

Health IT won't realize its full potential until analytics software can mine EMR databases to identify trends and help clinical leaders refine best practices, but interoperability and patient trust stand in the way. "[S]till unresolved are questions about how patients' records will be handled--and how they want their records handled," Computerworld reports. "Should they be able to opt into a system of shared electronic records, or should they have to opt out? And who will be the owners and custodians of the information--the patients themselves, or the caregivers or facilities that created the data?"

Even with federal incentives to adopt health IT, it could take 10 to 15 years before health information exchange is widespread, according to Dr. Peter Gabriel, director of informatics at the University of Pennsylvania School of Medicine's Department of Radiation Oncology.]]> http://www.fiercehealthit.com/story/health-it-still-far-its-potential/2010-11-29 Tue, 30 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1234 EHR
Complex steps, performed by an MD or nurse, include:

1.Design of surgical procedure
2.Location of procedure
3.Choosing preoperative labs, imaging, consultations (i.e., cardiology)
4.Interpreting results of the above testing
5.Communication with the referring physician and preop consultants
Simple steps consist of generating the paperwork to reflect the medical decisions made in the complex steps:

1.Chart notes documenting need for surgery and surgery design
2.Initiate preop workflow with appropriate staff (i.e., surgery scheduling)
3.Preoperative History and Physical
4.Informed consent forms
5.Preop and postop orders – implementation of above complex decisions
6.Preop and postop patient instructions and other supporting information
With these thoughts in mind I began creating a set of body-site specific templates with the sole purpose of initiating and directing the above workflow steps from a single computer screen. We have been using 2 of these templates for about 6 months; I would describe the results as a good first attempt. This project is one of the few done by a physician that directly addresses workflow as well as documentation.

Three challenges make this process slow and laborious.

The first challenge is to automate the simple steps as fully as possible while leaving the complex steps in full control of the physician. This is much more difficult than it sounds. Too much automation will usurp control of clinical decision making from the physician; too little results in failure to fully leverage the EMR technology and may make the workflow more cumbersome than it was to start with.

The second challenge is making the templates user-friendly, which in this case means doctor-friendly. That means getting rid of all the screen clutter and “white noise”, keeping only what is useful and necessary. Many of the EMR’s built-in, “hard-wired” screens fail to do this well.

The third challenge is getting the code written correctly so the template interfaces properly with the EMR itself. This includes trivial but maddening issues such as preventing duplicate actions from duplicate button clicks. This also becomes frustrating when the template you are creating attempts to overcome shortcomings of the EMR itself.

Currently my conclusions are:

1.The effort is worthwhile. Although the workflow engine is far from perfect and far from finished, it is quite useful “in the trenches” taking care of patients in a busy clinic. Every time I use the workflow engine I save $6.50, my estimate of what I would pay our staff to do the paperwork by hand.
2.Some of the grunt work required to design and write a workflow engine is unavoidable. An EMR that is flexible enough to write useful custom workflow engines must by definition require a high level of effort to customize.
3.Software improvements are required in order to make workflow engine creation practical for most practices. My IT experience is about as good as you will find among non-IT-professionals (35 years) but my skills are pushed to the limit making these templates. That is unacceptable. Notwithstanding conclusion #2, the situation can and must be improved.]]> http://www.wiredemrdoctor.com/2010/11/29/our-first-emr-workflow-engine/ Tue, 30 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1235 Meaningful Use
Since July, you've likely been staring at the list of 25 meaningful use objectives set forth by CMS as mouthwatering tidbits to choose from in order to access incentive funding under Stage 1. Perhaps you've already made your choice of what 15 required core objectives and 5 additional objectives from a list of 10 that your practice can achieve and you are ready to order.

But wait. CMS has now published a 44-page "EHR Core and Menu Measures" document putting a little meat on the bones of their objectives through greater explanation of exactly what they expect you to do in return for proper payment.

For example, perhaps you've looked at the list of 10 added objectives and have your eye on "Generate lists of patients by specific conditions." Seems easy, but what does that really mean? How many lists? Which patients?

According to CMS's new document, the full objective is actually: "Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach." Still what you thought you were ordering?

CMS notes that this measure is to generate "at least one" report listing patients of the EP [eligible professional] with a specific condition. It defines "specific conditions" as those listed in the "active patient problem list." Hmm, still sound appetizing?

The federal body also informs those seeking incentives by meeting this particular objective, there is no dictated reports that must be generated as an eligible professional "is best positioned to determine which reports are most useful to their care efforts." Also, the report "could cover" every patient in your EHR, "or a subset of those patients," and that the report generated is required "to include only patients whose records are maintained using certified EHR technology."

Did you lose your appetite yet? Are you rethinking your choice? Do you need a few more minutes?

The new document is great in that finally, there is some guidance and clearance from CMS on their 25 objectives that have been out for almost five months. But, like the restaurant menu analogy, does it tell you what you want to know in a manner that helps you make the best decisions or has it confused you even more?

Given the fact that any set of edicts from a government body have to be fully detailed, vetted, vetted again, and then released, should CMS have issued their EHR Core and Menu Measures at the same time as the 25 core objectives?

Look over the document, see if the page or more description of the four to five word objective phrases really mean what you thought for months and let us know what you think. We'll be back to take your order shortly.]]> http://www.physicianspractice.com/blog/content/article/1462168/1740262 Tue, 30 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1236 EHR
Bayonne Medical Center, a 278-bed acute-care hospital located in Hudson County, New Jersey, completely changed its clinical systems after it was acquired back in 2008. The big move to being a Meditech shop comprised implementing its financial and core clinical systems, including an electronic health record (EHR).

The hospital replaced its enterprise content management (ECM) system with Hyland Software's OnBase suite in February 2010, with the goal of integrating its ECM system and its emergency department information system with its core Meditech systems. Once the integration is complete, business and clinical users will have a seamless experience accessing appropriate patient data through its Meditech EHR system.

In a world of proprietary IT systems, hospitals will gravitate to health IT applications that can be integrated with any major core system. Healthcare software vendors need to understand provider demand for easy integration, regardless of the core IT vendor or system.

Healthcare software vendors also need to understand that when hospitals upgrade their core systems under one major vendor, which includes EHR, accounts payable, human resources and other administrative systems, their products need to be flexible enough to work in the new environment.

While there is great demand and an obvious reason for wanting a one-vendor partnership and one-stop shopping experience when it comes to core health IT systems, best-of-breed software that is flexible, vendor neutral and easily integrated and upgradeable will prove to be the better option.]]> http://www.healthcareitnews.com/ecm-system-all-ehr-vendors Tue, 30 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1237 Meaningful Use
Introduction

Various factors such as growing and ageing population, parity between developed and developing countries, increased chronic diseases and a worldwide shortage of medical professionals has put substantial pressure on traditional healthcare industry. This scenario resulted in people looking for quality healthcare services online. Slowly, e-health emerged. It is a system of medical care that offers management of professional healthcare services through the internet and other modern communication technologies. The term not only means technical development but also encompasses a new way of thinking, an innovative attitude, and a promise to provide healthcare irrespective of local and international barriers.

E-Health and Quality

Quality has improved a lot in e-health services compared to traditional healthcare system. Earlier, physicians and clinics had to spend a considerable time searching for patient’s historical health data. Most of the work was performed on paper and access was limited. E-health offers EMR (electronic medical record) facility that enables doctors to quickly access any new patient’s previous medical records. This is just one example of how e-health has improved the quality of medical care dispensed to the patients.

The primary drivers behind the success of for e-health services are the technology and quality on offer. There are, however, secondary benefits of e-health such as lower healthcare costs and easy access. When it comes to quality in e-health, no international or common guidelines have been laid out by any agency. Still, the niche offers more quality than conventional healthcare services.

Most of the quality maintenance frameworks of e-health incorporate some key dimensions: of care:

Treatment effectiveness

Quality channels of prescription delivery

Patient and public acceptability

Technical system’s efficiency

Quality Data Management and Access

Efficient healthcare information management is essential for the success of e-health systems. More and more specialists and large players are increasingly opting for e-health services to reach out directly to their patients. Besides organizations, patients are also contributing to the quality of data management. They now have the ability to easily transfer and access the clinical data from various communication channels.

Another major development in patient care in e-health systems is the ‘Electronic Health Record’.

As far as quality is concerned, the aim here is to develop comprehensive health information for a large portion of the population. Some would argue that data security is a major hurdle in HER’s success but will be sorted out with time. The implementation of this system on a state/federal level unlocks the potential of access of these records by multiple entities such as specialists and distant multi-specialty hospitals. Such a system, though presently in nascent stage, has the potential to dramatically increase healthcare quality in e-health realm.

Quality in Computerized decision-support systems

These systems have improved physician’s access to important clinical information. In e-health, the use of these systems has meant an improvement in healthcare quality. This software use a warehouse of medical information and an conclusion mechanism (artificial logic) to produce patient specific output. The quality of output depends on software sophistication and information in medical data warehouse. With more money being pumped into the development of high-tech software, hospitals will offer more quality to their patients.

Future of Quality maintenance in e-health

• Although, e-health offers much technological advancement, it still has a large way to go. When discussing the e-health future, many say that the technological tools will soon be adopted on a large scale.
• Door-to-door healthcare services with quality intact won’t be a distant dream.
• However, some of the technologies are quite complex and often confuse people instead of helping them.
• Let’s discuss some of the future developments in e-health keeping the quality perspective in mind.
• The Electronic Health Records will be able to record and transmit multi-media files like retinal scans and heart sounds.
• The use of paper will be reduced drastically. Telemedicine and e-prescribing will be integrated into the e-health spectrum.
• Most importantly, future will witness a legal framework being laid out for the quality maintenance of the e-health services.
• This will contain all the requisite guidelines and code of ethics to be followed in e-health industry.]]> http://www.healthtechnica.com/blogsphere/2010/11/29/how-e-health-can-affect-quality-in-clinical-setting/ Tue, 30 Nov 2010 09:01:00 MST http://www.primarydatacorp.com/#1238 Health Information Exchange
The open source reference model of the standards and services that enable connectivity, which will be available as both Java and .NET formats, will be deployed first in a series of pilots to test it for real-world use, according to Arien Malec, coordinator of the Direct Project, the new name for the old NHIN Direct, a project of the ONC.

The Direct Project is a streamlined version of the nationwide health information network standards set (NHIN), and will offer physicians and small practices the ability to conduct basic health record exchanges. For example, a primary care physician who is referring a patient to a specialist can use the Direct Project to send a clinical summary of that patient to the specialist, and to receive a summary of the consultation.

"As we test out the specifications and learn more from the demonstrations, we'll have more vendor support," he said.

Overall, the Direct Project is a set of technical tools and services that will enable providers to share secure messages, such as patient referrals and care summaries, in one-to-one "push" exchanges with other providers, labs, registries and patient personal health records (PHRs). The sender and receiver are usually known to each other in these simple exchanges, which work somewhat like an e-mail exchange over a health-specific Internet.

"The goal is for universal addressing and secure transport for care processes, which would be a major upgrade from paper and fax," Malec said in a Nov. 29 online presentation sponsored by the National eHealth Collaborative, a public-private partnership that works to foster health information exchange.

If patients had Direct Project addresses, providers could send the patient's data to a PHR, or the patient could transmit information from a PHR to a longitudinal record, Malec said.

The concept of a universal address can serve a variety of tasks, he said. "The ability to have and to control an address that is a pointer to your data home, a universal address, can be akin to an identifier."

The name change from NHIN Direct to the Direct Project will provide a stable name as ONC plans to rename the NHIN. The Direct Project name also demonstrates that some forms of simple exchange occur outside the NHIN, Malec said.

The Direct Project is the collaborative and voluntary work of more than 50 provider, state, health information exchange and health IT organizations. More than 200 participants have contributed to the project, he said. "The Direct Project will broaden exchange, while NHIN Exchange and the Connect software stack will deepen exchange."

Large healthcare organizations and federal agencies, such as Kaiser Permanente and the Department of Veterans Affairs, participate in the NHIN using the comprehensive set of tools and standards incorporated in the Connect gateway for exchange. Federal agencies developed the Connect software, a representation of the NHIN, and released it to the private sector.]]> http://www.healthcareitnews.com/news/first-models-nhin-completed Wed, 01 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1239 Regional Extension Center
The largest initiative, which snagged $677 million of those funds, is the Health Information Technology Regional Extension Centers program.

Under the program, a nationwide network of 62 RECs has been created to provide heavily subsidized help for at least 100,000 small and safety-net primary care providers, as well as critical access and small rural hospitals, to adopt and achieve meaningful use of EHRs.

The REC services, delivered hands-on and through the Web, include workflow and practice pattern assessments, guidance and technical assistance to aid with implementation, training and use of best practices, and help after go-live to become meaningful users.

The idea of having federally-supported, specialized centers to help an industry accelerate adoption of technology is not a new concept-it happened a century ago with agricultural extension centers, notes Paul Wilder, director of health I.T. adoption at the New York e-Health Regional Collaborative (NYeC), a public-private partnership operating one of two RECs in New York State. Then, as with now in the health care field, the programs were launched in response to a technology disconnect within an industry, he explains.

The health I.T. extension centers are not-for profit organizations that will provide technical and process-change services themselves, contract the services out to other not-for-profit entities, or a combination of both. The RECs are required to provide a core set of services but there will be differences in the depth of services and how they are delivered. Many of the RECs in the fall of 2010 were gearing up to offer the services. All RECs should be fully operational by the start of 2011, says Charlie Jarvis, vice president at EHR vendor NextGen Healthcare Information Systems, Horsham, Pa., which like many vendors is working with multiple RECs across the nation.

As they roll out services, centers also must start developing business plans to become self-sustaining by mid-2012 when the federal grant funds that currently subsidize services run out. Federal funds could be available for "minimal" support for two more years. But center officials say fees charged to providers after the grants end will remain well below commercial rates as their mission remains not-for-profit.

During 2009, not-for-profit organizations, many of them already operating as health care research or service organizations, geared up to apply for REC grant funding and offer a variety of technical and consultative services to designated providers. In two rounds of funding in February and April 2010, two-year federal grants were awarded to 60 RECs, with two more selected and funded in September, along with more funds for two Florida RECs to expand their service areas.

The metrics for measuring if $677 million in taxpayer dollars were well spent will, in some cases, be easy. The two-year metric in Iowa, for instance, is to assist 1,200 primary care providers and 87 hospitals in achieving meaningful use of EHRs.

If those numbers are met, the metrics for success are met, says Kim Downs, senior director of operations for IFMC, the quality improvement organization for the state and its REC operator.

The same is true for the NYeC Regional Collaborative: the straightforward goal is to serve 5,107 primary care providers, Wilder says. For other RECs, the metrics are a little more relaxed. "We will feel successful each time a provider reaches meaningful use," says Kimberly Lynch, operations manager for the Michigan Center for Effective IT Adoption, or M-CEITA.

Some RECs, particularly if they were awarded federal funds in February, were contacting providers by early summer. But the bulk of RECs in the fall of 2010 were just starting to reach out to providers.

Only 14 of 46 RECs responding to a survey in June and July by advocacy group eHealth Initiative reported they had signed contracts to provide services to providers. That number may seem low, but to Wilder it's impressively high.

The survey, he notes, was started two to four months after RECs were awarded federal grants, and the survey was conducted right before the final meaningful use rules came out.

NYeC, for instance, got its grant in February and started physician outreach in May, but didn't start seeing sign-ups for its services until July. "If I offered you a service I can't yet achieve, why would you play me a dime until you saw what I could offer?" Wilder asks.

Different game plans

While all RECs have the same mission, how they will deliver services will vary. Many of the RECs have partnered with not-for-profit entities to provide some or all of the services.

The Colorado Regional Extension Center in Denver, or CO-REC, is different from most because virtually all of its actual services to physicians will be done by partner organizations.

The REC has two employees-director Robyn Leone and program coordinator Kearin Schulte-and doesn't expect to hire more. CO-REC is acting as an administrative pass-through entity, sending funds to six organizations across the state that will provide actual services, overseeing the organizations' progress and conducting outreach programs to providers.

The six entities providing services include two quality improvement organizations, two management services organizations, the state office for rural health, and the Quality Health Network health information exchange in western Colorado. CO-REC is a unit of the Colorado Regional Health Information Organization, which is developing a statewide HIE.

The model of CO-REC essentially being an oversight body was developed to leverage the experience and existing relationships with physicians that the six partner organizations have, Leone says. This will let the organizations "hit a higher amount of providers out of the gate," she adds.

Consequently, CO-REC expects to serve about 65 percent of targeted primary care providers over two years, compared with a goal of about 50 percent for many RECs in regions that don't have multiple support networks already operating, she notes.

The support organizations in Colorado also are helping get the REC message out to physicians quickly. About 800 providers enrolled for REC services within the first three months after enrollment opened, Leone says. That's well-above the goal of 600 providers after six months and all 800 providers were receiving services as of mid-October.

CO-REC's early focus is on serving practices that already have EHRs to assess users' knowledge of meaningful use requirements and assess gaps in compliance. The goal is "to get Medicare incentive checks flowing in the state as fast as we can," Leone says.

Like many RECs, Colorado is building a suite of online tools to assist providers in addition to on-site help. These now or soon will include information about health information exchange and meaningful use, an EHR readiness assessment and meaningful use gap analysis, a privacy and security checklist, and a list of approved EHR vendors with preferred pricing information, sample contracts and bi-directional interfacing to laboratory, radiology and ADT systems.

Other REC models

Like Colorado, RECs across the nation are partnering with others to provide services to physicians, but many of these RECs also will provide the services themselves.

In Michigan, M-CEITA is a project within the Altarum Institute, an Ann Arbor-based not-for-profit health care research organization. M-CEITA itself will serve physicians in Western Michigan and has partners for other regions of the state.

These include MPRO (Michigan's quality improvement organization) in the heavily populated southeast, the Lansing-based Michigan Public Health Institute serving the central region, and the Upper Peninsula Health Care Network, a consortium of providers and insurers, serving the north. The REC, if necessary, will subcontract with other entities to fill in local gaps.

All total, up to 50 full-time equivalent employees have been hired by the four main organizations with a few more expected, says M-CEITA operations manager Lynch. The focus in the fall of 2010 was to conduct a scope of the upcoming work with physicians and get the organizations fully up and running with their REC work. Stakeholders also are looking to the future and studying how the REC can evolve to meet other needs, such as compliance with health care reform requirements.

Michigan REC received a $19.6 million grant to serve 6,000 physicians and $432,000 to serve about 36 targeted hospitals. All RECs received some start-up funding after grants were awarded, and will receive additional funds after achieving specific milestones during the next two years. The Kresge Foundation in Troy, Mich., provided MCEITA with a $1 million grant to assist with start-up activities. "That helped stretch the federal grant and has been very helpful to us," Lynch says.

NYeC Regional Collaborative, serving all of New York except New York City, has about a dozen "agents," or partner organizations. Project managers, which are those that will provide the actual services, will first meet with providers over the phone to collect basic information on the practice and its readiness for using EHRs. Managers then will come to provider offices to assess their status for meeting meaningful use, and see the workflow and office layout. Then they may remotely consult having seen the practice and established a relationship, but be back onsite for plan assessment, implementation, templates and customization, and go-live, says director Wilder.

They'll also be back for a "redesign" service after go-live to support the transition from an EHR user to a meaningful EHR user. And that's just the minimal amount of in-person help providers likely can expect, Wilder says. "I fully believe most practices will have help there more often."

IFMC in Iowa will fund 20 to 25 new positions for REC services. The organization received $5.5 million in HITECH funding to service physicians and another $1 million for hospitals. It initially drew down $500,000 for administrative activities and program set-ups, which included initial hires, says Downs, the senior director of operations.

The REC will be onsite at clinics to provide technical assistance to providers as they conduct practice assessments and a gap analysis. Responsibility for EHR implementation and training will fall on the practices and their vendors, although IFMC will advocate providers' needs to vendors. Further, IFMC staff members will become super users and can be onsite at go-live if necessary. Help for hospitals will be less hands-on and more geographically-based through Web and regional seminars.

Selecting vendors

Regional extension centers spent much of 2010 gearing up operations, which included hiring personnel, firming partnerships with various organizations that will assist or promote REC services, and making their services know to physicians and hospitals through outreach programs.

But an early achievement of many RECs during the year was the selection of "endorsed," "recommended," "preferred" or "partner" electronic health records vendors, generally five to 10 companies.

One of the terms of receiving HITECH funds requires RECs to develop some type of group purchasing service that can help accelerate physician selection and adoption of EHRs. RECs have responded by naming a limited number of vendors that they believe would best serve priority primary care physicians. In essence, the RECs are conducting due diligence on vendors and presenting providers in their service area with a list of finalist candidates. The idea is to significantly speed the vendor selection process as physicians adopt EHRs on a fast-track.

However, some RECs when issuing to vendors their requests for proposal, showed that they as much as physicians needed a better understanding of the meaningful use program. It was evident in some RFPs that there still is a gap in full knowledge of the federal rules for certified EHR under the meaningful use program, says Rebecca Hellman, vice president of marketing for vendor MedPlus Inc., Mason, Ohio.

There was an assumption by some RECs that certification from the Certification Commission for Health Information Technology meant meaningful use certification, and this was before CCHIT and other entities began certifying under the meaningful use program.

Whether a REC calls its selected vendors "endorsed," "recommended," "preferred" or "partner" doesn't matter, REC leaders say. There is no standard level of services that an "endorsed" vendor will deliver over a "preferred" vendor.

Consequently, providers need to get clear answers from their REC on service commitments and other terms that selected vendors have agreed to. Some RECs have no formal commitments with selected vendors other than the REC has vetted the vendors. Consequently, these vendors will sell, implement and train, then the REC will take over and support a practice toward becoming a meaningful user.

Some RECs require vendor integration services only to the degree that their EHR can connect to the state health information exchange, while others want more comprehensive integration that includes bi-directional interfaces to laboratories and radiology centers. Some RECs require vendors to provide price discounts on their technologies and services, and some require vendor onsite personnel at go-live. RECs may even resell and/or remotely host the EHRs of one or more selected vendors.

IFMC, which is Iowa's REC, asked vendors to give service preferences to physicians in the state but could not ask for preferred pricing, says director Downs. Because IFMC also is the state's quality improvement organization, the Centers for Medicare and Medicaid Services has determined it would be a conflict of interest for quality improvement organizations to be involved in group purchasing activities. The state has asked the feds to reconsider and permit QIOs that serve as RECs to get preferred pricing from. Asked for comment, CMS issued the following statement: "CMS is analyzing this issue and it would be premature to discuss any specifics."

Working out the details

About three-quarters of RECs responding to the eHealth Initiative survey in mid-2010 said that price and total cost of ownership was the most important criteria for selecting vendors. Other top criteria included willingness to guarantee meaningful use functionality, a local implementation presence and software hosted via the application service provider model.

Just as there are differences in what a REC-approved EHR really means, there are variations in the selection processes, says Jarvis of NextGen.

Some RECs require an on-site demonstration of the EHR while others are satisfied with a Web demo. Some deep-dive on functionality; others want only a surface view. Some RECs formalize the relationship with a two-page memorandum of understanding while others present a 40-page contract. In general, the federally awarded REC grants for physician services averaged just shy of $5,000 per provider to be served during the next two years. On a case-by-case basis, the government will consider "minimal" additional funding after that time.

So like the statewide health information exchanges being funded under the HITECH Act, RECs must develop a sustainability plan if they want to be around after the grant funds run out. But a federal REC grant requires a match of about 11 percent, so organizations right out of the gate need to raise some money.

For many RECs, that means charging physicians a nominal fee for services that could run into the tens of thousands of dollars if provided by a traditional for-profit consulting firm. In Iowa, the fee is $300 to $1,200 per provider with a 50 percent mark-up if a provider is not using a selected EHR product. The fee level is lowest if a practice already has an EHR, at the mid-point for a hybrid electronic-paper environment and at the high-end if the practice is paper-based or has automation but is starting over.

The NYeC Regional Collaborative fee is $750, and it's $500 in Michigan. Colorado's fee is zero, Leone says, as its partner organizations, including Colorado RHIO, are picking up the tab for matching funds.

The federal grant supports small and safety net primary care providers but in two years there will remain a lot of other primary care and specialty practices that will need help reaching meaningful use, Wilder says, including targeted practices that didn't take advantage of the subsidized services. "We believe they will need and be willing to pay for a level of services."

But after two years, RECs likely will have to substantially raise their fees although leaders insist the mission will remain not-for-profit and their fees will remain considerably below those of for-profit firms. Wilder in New York doesn't think his REC's fee will reach $5,000, but even that would be cheap as he estimates similar for-profit costs could be $10,000 to $15,000.

Further, physicians automating and striving for meaningful use in two years may not need as much professional help as their peers who are going through the process today, Wilder believes. "It's an interesting dynamic when 50 percent of primary care providers have adopted EHRs, as providers support each other," he says. "One provider can call another for help as a high tide starts to raise all ships."

While RECs in general don't yet have a firm plan for sustainability, some are taking steps now toward that goal. Iowa in January 2011 will start offering non-subsidized services to specialists and other physicians not covered under the REC grants. These services will be part of its sustainability plan, Downs says, as she expects REC services will be needed for some time.

There will be plenty of physicians still adopting EHRs in two years, she notes, "and the curve just gets steeper in meaningful use Stages 2 and 3, so the need for assistance will remain." Fees for non-subsidized services had not been determined as of mid-October.

In Colorado, CO-REC has to decide if it wants to remain in business when the federal grant ends, Leone says. "We know the six partner organizations must be sustainable. Our plan may or may not include the continuation of CO-REC and the organizations will have to decide if they want to continue after two years."

While health information exchanges run by state-designated entities try to get out of the starting blocks, HealthInfoNet in Maine has a head start on many of the state initiatives. This summer it completed a large scale, one-year demonstration program of its HIE platform that now will expand to serve the entire state.

Fifteen of the state's 39 hospitals participated through four delivery systems and a rural hospital, along with a multi-specialty group practice. About 1,100 clinicians participated, with 600 to 700 of them physicians. The biggest lesson learned was "follow the workflow," says HealthInfoNet CEO Devore Culver. "We started with docs in ER and rapidly discovered the real users were triage nurses."

MaineHealth, the largest delivery system in the state, recently linked its pharmacies to the HIE to support medication reconciliation processes. But soon after ending the demonstration, HealthInfoNet started a three-month process of stepping back to re-engineer its information systems. The need for a revamp was the other big lesson of the demonstration. "Our structure was too expensive and our approach too complicated," Culver says.

Now, the HIE is taking out its existing clinical data repository, master patient index and health data dictionary. There were some performance issues, but cost was the primary reason, Culver explains. "The vendor was not able to get near to a price point that others could offer."

Consequently, Santa Monica, Calif.-based Orion Health will provide HealthInfoNet's interface engine, clinical data repository and presentation layer to electronic health records systems.

The Initiate Systems unit of Armonk, N.Y.-based IBM Corp. will supply master patient index and master provider index applications. And Denver-based Health Language will handle data mapping and standardization functions.

The software switch significantly improved HealthInfoNet's finances. In mid-2009, Culver estimated a cost of $12 million to expand statewide and another $6 million needed annually for operations. Now, that $12 million cost is cut by 40 percent. The HIE still needs $6 million annually, but only for the next two years until the new software licenses are paid for. In year three and beyond, it will need $4 million annually to fund core data exchange functionality.

The funds will come from subscriptions, but HealthInfoNet, like other state HIEs, will have to find revenue from providers beyond hospitals and physician practices, Culver says. He'd like to bring in community pharmacies to support medication therapy management initiatives, which the pharmacies can get paid for under the Medicare Part D program.

Additional revenue could come from other provider segments that will be part of the care team as the medical home model of treatment expands. And Culver hopes insurers finally will get off the sidelines and support HIEs.]]> http://www.healthdatamanagement.com/issues/18_12/regional-extension-centers-start-to-roll-41420-1.html Wed, 01 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1240 Legislation
The rule requires businesses to take specific steps to minimize identity theft. The compliance date for the rule has been extended several times times as various industries contest their inclusion, and several medical associations previously filed a lawsuit to prevent the Federal Trade Commission from extending the rule to physicians.

The Senate-passed bill, S. 3987, is on a fast-track. It was introduced and approved by unanimous consent on Nov. 30, and referred to the House Committee on Financial Services. The bill clarifies "creditors" who must comply with the rule. In effect, it exempts providers and others who permit payment to be deferred.

The House has previously passed similar legislation and must approve S. 3987 during the lame duck session or the bill must be reintroduced in 2011. The present compliance date for the Red Flags Rule is Jan. 1, 2011. What follows is text of the bill as passed by the Senate:

SECTION 1. SHORT TITLE.

This Act may be cited as the `Red Flag Program Clarification Act of 2010'.

SEC. 2. SCOPE OF CERTAIN CREDITOR REQUIREMENTS.

(a) Amendment to FCRA- Section 615(e) of the Fair Credit Reporting Act (15 U.S.C. 1681m(e)) is amended by adding at the end the following:

`(4) DEFINITIONS- As used in this subsection, the term `creditor'--

`(A) means a creditor, as defined in section 702 of the Equal Credit Opportunity Act (15 U.S.C. 1691a), that regularly and in the ordinary course of business--

`(i) obtains or uses consumer reports, directly or indirectly, in connection with a credit transaction;

`(ii) furnishes information to consumer reporting agencies, as described in section 623, in connection with a credit transaction; or

`(iii) advances funds to or on behalf of a person, based on an obligation of the person to repay the funds or repayable from specific property pledged by or on behalf of the person;

`(B) does not include a creditor described in subparagraph (A)(iii) that advances funds on behalf of a person for expenses incidental to a service provided by the creditor to that person; and

`(C) includes any other type of creditor, as defined in that section 702, as the agency described in paragraph (1) having authority over that creditor may determine appropriate by rule promulgated by that agency, based on a determination that such creditor offers or maintains accounts that are subject to a reasonably foreseeable risk of identity theft.'

(b) Effective Date- The amendment made by this section shall become effective on the date of enactment of this Act.]]> http://www.healthdatamanagement.com/news/red-flags-rule-senate-physicians-identity-theft-41451-1.html Thu, 02 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1241 Technology
This is yet another reason more and more patients will be turning to the Internet for their health concerns.

The difference between 4G and broadband (cable, fiber optic, satellite, DSL) is that 4G has wireless connectivity. 3G, although slower, has been around for several years and has defined the niche of the “smart” phones. Smart phones, like iPhone and Blackberry, for instance, can connect to the Internet, send/receive data, and stream video. 3G enabled mobile connectivity. Though somewhat clunkier and slower than broadband, 3G defined the “smart” phone.

Connectivity to the Internet will be enhanced, too. Uploading Web sites as we surf the Internet will occur at blinding “broadband” speeds. While we don’t expect great video quality now, we do get frustrated with slow refresh rates on our handheld devices and computers. 3G can be a turn-off due to its slower speed.

My son Grant and I just purchased a mobile 4G hotspot from Sprint/Clear a couple of weeks ago as his Ethernet broadband is pretty finicky at school.

Simply put, a small device about the size of a hockey puck can now provide a WiFi hotspot for up to five devices within range. The device captures the 4G signal and then connects to his laptop or smart phone. Wireless connectivity at broadband speeds will be available anywhere. These hotspots are portable and the signal is transmitted wirelessly.

With the enhanced 4G speeds, our utilization and dependence on these mobile devices will only increase as they become more reliable and versatile... and therefore more useful.

For physicians, most of this technology remains above our heads. There can be some advances in telemedicine due to the mobility, but keep in mind, physicians as a group don’t function in “real time.”

4G means portable and mobile connectivity at broadband speeds. 4G means more utilization for our patients.]]> http://www.physicianspractice.com/blog/content/article/1462168/1745545 Thu, 02 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1242 Telehealth EHR
Recording and charting changes in vital signs has been identified as one of the core areas that will be measured for meaningful use incentives.

The white paper details progress on these efforts, and finds that just one-third of the hospitals surveyed indicated they had an active interface between medical devices at their organization and their electronic medical record (EMR).

Those hospital respondents with such an interface in place, meanwhile, indicated the ability to automatically chart data from the device directly to the EMR as the primary reason.

The research, conducted from June 2009 to June 2010, explored the number of types of devices in place at an organization, not the overall number of devices present. The survey included data from 825 U.S hospitals responding to questions about medical devices in general and how/if these devices are integrated into the EMR environment.

“The transfer of data directly from a medical device to the EMR can reduce potential medical errors and improve patient care because no manual transfer of data takes place,” said John H. Daniels, vice president, healthcare organizational services, for HIMSS. “Such data integration also improves workflow by saving time for clinical staff, a valuable benefit when looking at nursing shortages in healthcare.”

The devices included in the survey are:

• cardiac output monitors
• defibrillators
• fetal monitors
• electrocardiographs
• infant incubators
• infusion pumps
• intelligent medical device hubs
• interactive infusion pumps
• physiologic monitors
• ventilators
• vital signs monitors

Other findings from the study include:

• Most hospitals relied on the Wired LAN connection as the sole method of connectivity between EMRs and medical devices.
• Only 8 percent of respondents reported that their hospital relies solely on wireless connections.
• None of the hospitals in the sample report use all 11 medical devices tracked by the research.
• Thirteen percent use 10 of the devices and another third use nine of the devices. Nearly a quarter (23 percent) use eight of the 11 devices. Less than 10 percent of the hospitals in this sample have deployed five or fewer of these devices.
• Defibrillators are the most widely deployed device type with 99 percent of the hospitals reporting them in use.
• More than 90 percent of hospitals use physiologic monitors (97 percent), electrocardiographs (97 percent) and vital signs monitors (94 percent).
• Least frequently deployed are intelligent medical device hubs; only 11 percent of the hospitals in this sample reported using this type of device.

While saturation exists in electrocardiographs, defibrillators, physiologic monitors, ventilators and vital signs monitors, with at least 90 percent of the market using this technology, market growth opportunities exist for:

• interactive infusion pumps,
• fetal monitors,
• infant incubators, and
• the limited number of hospitals now interfacing their devices and EMRs.

With requirements for meaningful use Stages 2 and 3 released over the next three to five years, more hospitals are expected to develop interfaces between their EMRs and medical devices since medical device interoperability is one of the meaningful use Stage 3 goals outlined to achieve and improve performance and support patient care processes.

“The benefits of utilizing intelligent medical devices to provide safer care are clear,” said Anthony Shimkin, vice president of marketing at Lantronix. “Lantronix is committed to meeting the device connectivity needs of hospitals while supporting their drive toward achieving meaningful use goals.”

Read the white paper, Medical Devices Landscape: Current and Future Adoption, Integration with EMRs, and Connectivity, on the HIMSS Analytics website.]]> http://www.healthcareitnews.com/news/himss-analytics-gauges-device-data-charting-and-emr-integration Thu, 02 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1243 Health Information Exchange
The Direct Project, the new name for NHIN Direct, is a set of technical tools and services that will enable physicians and small practices to exchange secure messages in a one-to-one "push" with other providers and labs through the Internet. It's designed to offer physicians and small practices the ability to conduct the basic health record exchanges, such as referring a specialist or sharing patient summary data, required in the first stage of meaningful use.

The Office of the National Coordinator announced the first version of the Direct Project software Nov. 29. Arien Malec, coordinator of the Direct Project, then described the initial reference implementations of the Direct Project that would enable physicians to exchange information with a simple install and technical configuration.

The Health IT Standards Committee met Nov. 30 with exchange vendors such as Verizon and Covisint to begin its task of evaluating the activities and harmonized standards needed for the Direct Project.

It will analyze the Direct Project's technical descriptions of how it is to be deployed to make sure that the specifications meet the design requirements for "simple, direct, scalable and secure transport for the little guy," said John Halamka, MD, co-chair of the standards committee.

The vendors described their "push" products and services at the meeting and all included some concept of a routing method, a provider directory, certificate management for identification, auditing, and acknowledgement of message delivery, he said.

Identity and trust are foundational in those, and there is a set of technologies and management processes that ensure identity and provide a trust fabric that are essential attributes, said Halamka, who is also CIO at Beth Israel Deaconess Medical Center.

The Direct Project provides end-to-end encryption between networks to ensure security and privacy but allows for flexibility for how those networks connect, according to Malec. The Direct Project community selected common e-mail standards - the Simple Mail Transport Protocol (SMTP) in Multipurpose Internet Mail Extension (MIME) format - for its secure transport.

"But we probably should be directing our energy to policies and technology platforms that will allow us to scale trust," he said.]]> http://www.healthcareitnews.com/news/vendors-policymakers-discuss-push-messaging Thu, 02 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1244 EHR Meaningful Use
"Given the importance of provider order entry, it is not surprising that the federal government's promotion of health information technology--via the HITECH provision of the American Recovery & Reinvestment Act and related meaningful use rules for implementation of an electronic health record--places so much emphasis on using computerized physician order entry. However, considering the complexity of adopting CPOE and the challenges any organization faces when changing a core process, it's also not surprising that so few hospitals have taken on CPOE," write John Glaser and Dr. M. Kent Locklear in a Hospitals & Health Networks online exclusive.

"HITECH effectively has put CPOE in a prom dress, requiring those who wish to pursue stimulus dollars to get ready for the big dance."

Glaser, the CEO of Siemens Healthcare Health Services, and Locklear, the director of physician strategy for the same Siemens IT division, explain just how critical CPOE can be. "In fact, it could be argued that this process, generally referred to as provider order entry, is the most important process in an inpatient setting. When performed properly, it drives care quality and efficiency. When flawed, it leads to patient safety problems," they say.

It also happens to be an "exceptionally complex" undertaking, according to Glaser and Locklear. "In a typical hospital, a provider must make decisions regarding hundreds of medications, procedures and laboratory tests, sometimes all in the same day. These decisions must occur in the right sequence and be continuously adjusted based on a patient's progress. The execution of this process involves dozens of staff members and intricate workflows."

With this in mind, they offer a list of 10 important steps gleaned from hospitals that have been successful in embedding suitable clinical content into evidence-based order sets and proper alerts, without overdoing it. "At its heart, CPOE implementation is a clinical project involving information technology, not the other way around," Glaser and Locklear write. "It is incumbent on vendors to deliver software that supports the clinical workflow and to facilitate implementations that leverage the benefits of the technology. By establishing a true partnership for success among vendors, their customers and consultants alike, we all win--the ultimate goals being safer patient care and improved clinical outcomes."]]> http://www.fierceemr.com/story/exceptionally-complex-cpoe-key-part-meaningful-use/2010-12-02 Thu, 02 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1245 Medicare
The plan, bearing the title "The Moment of Truth," comes from the bipartisan group called the National Commission on Fiscal Responsibility and Reform that President Barack Obama appointed earlier this year. Its cochairs are Alan Simpson, a former Republican senator from Wyoming, and Erskine Bowles, the president of the University of North Carolina system and a chief of staff to President Bill Clinton during the president's second term. Most of the commission's 18 members are Democratic and Republican members of Congress.

The commission was charged with voting on a proposal for deficit reduction by December 1, but that vote has been postponed until Friday. The commission, meanwhile, released its report yesterday to comply with its deadline. Any plan approved by the commission — which will require 14 of 18 votes — goes to Congress for its consideration. Whether the commission or Congress can agree on the drastic changes envisioned for the federal budget and sacred-cow programs such as Social Security and Medicare remains to be seen.

The commission report calls for achieving almost $4 trillion in deficit reduction through 2020. Of that amount, 57% would come from spending cuts; 26% from revenue increases, in part resulting from repealed tax breaks; and 17% from net interest savings.

This economic weight-loss program largely resembles an outline released by commission cochairs Simpson and Bowles on November 10. That first document recommended "modest reductions" in Medicare reimbursement for physicians, as opposed to the 25% cut currently scheduled for January 1, but did not specify an amount. Today's full-fledged report provides numbers.

Beyond a pay freeze through 2013 and a 1% pay cut in 2014, the commission report calls for a revamped formula for setting Medicare pay in 2015 that stresses care coordination and rewards providers for the quality — not quantity — of their services. This formula would replace Medicare's notorious "sustainable growth rate" (SGR) formula that will trigger the 25% pay cut next year unless Congress acts this month to avert it.

The report's "doc fix" for the Medicare reimbursement crisis also addresses the issue of "phantom savings" in a federal budget based on massive SGR cuts "that will never occur." The report insists that these phantom savings — close to $300 billion — must be offset with real savings elsewhere.

The report also says lawmakers need to find money to offset the loss of premiums that individuals are expected to pay for long-term care insurance under a section of the healthcare reform law called the Community Living Assistance Services and Support (CLASS) Act. CLASS, says the report, is unsustainable and should be repealed or reformed — hence the need to make up for the program's premium revenue in the budget.

Caps on Noneconomic and Punitive Damages Take Lower Profile

To replace phantom SGR savings as well as CLASS premium revenue, the report recommends a long list of frugalities that will reduce federal healthcare spending by nearly $400 billion from 2012 through 2020. These measures, first described in the outline released by Simpson and Bowles last month, range from trimming Medicare payments for graduate medical education to implementing medical malpractice reforms.

Simpson and Bowles originally trumpeted caps on noneconomic and punitive damages in malpractice cases as a component of their tort reform, much to the delight of organized medicine and political conservatives, who have championed such limits over the years. In contrast, Congressional Democrats have traditionally opposed malpractice caps, viewing them as an infringement on a person's constitutional right to a trial by jury.

Perhaps reflecting a philosophical clash among Democratic and Republican members of the commission, the report released today seems to make the subject of caps more of a footnote. It recommended 5 measures that lawmakers should pursue:

• Allow courts to subtract workers compensation payments and other outside benefits for injured parties from jury awards.
• Impose a statute of limitations, perhaps up to 3 years, for medical malpractice cases.
• Eliminate joint-and-several liability rules that can make one of several defendants liable for the entire amount of damages, regardless of his or her share of responsibility for them.
• Create specialized "health courts" to try malpractice cases.
• Give legal protection — "safe havens" — to providers who follow best practices of care.

"Many members of the Commission also believe that we should impose statutory caps on punitive and non-economic damages," the report goes on to say, "and we recommend that Congress should consider this approach and evaluate its impact."]]> http://www.medscape.com/viewarticle/733474 Thu, 02 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1246 EHR
"A well-thought-out chart abstraction strategy--the process of entering or 'populating' the electronic chart with clinical data from the traditional paper record or other sources--is one technique that mitigates the loss in productivity and increases provider acceptance," says a newly released issue brief from the California HealthCare Foundation. The paper is the first of a planned series of issue briefs on lessons learned from the California Networks for Electronic Health Record Adoption (CNEA) initiative, a program that dates to 2006.

The CNEA participants were successful, the brief says, because they, for the most part, had cohesive strategies to define the data that had to be entered into the EHR, including when the data should be entered and by whom. "Balancing cost with utility is fundamental to developing the approach that works best for each health center," the paper says.

Most chose to include information on: patient medical and surgical history; diagnostic history; recent consultations; allergies; the most recent progress note; medications; immunizations; alcohol and tobacco use; and indicators for health maintenance and disease management. Some migrated data by scanning, others by importing files from legacy systems and some via manual data entry, and participants found advantages and disadvantages with each method.]]> http://www.fierceemr.com/story/report-chart-abstraction-eases-transition-paper-ehr/2010-03-11 Thu, 02 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1247 Practice
A study funded by the Robert Wood Johnson Foundation and released in October by the Center for Studying Health System Change (HSC) found that only 6.7 percent of office-based physicians routinely e-mail patients about clinical matters. A separate study by the California HealthCare Foundation cited by HSC found that 50-70 percent of adults who do not communicate with physicians or nurses by e-mail want to.

HSC said doctors cited the lack of reimbursement, potential increased workload, data privacy and security concerns, medical liability issues and the uncertain impact on quality as the main reasons they do not use e-mail to communicate with patients.

As baby boomers retire and healthcare reform extends insurance coverage to the previously uninsured, demand for medical practices' services will grow. Where demand is great, new organizations will spring up to meet it – case in point, retail health clinics. In other words, as demand grows, competition for patients is likely to grow.

Providing healthcare services that are convenient for and desired by patients will position your organization for the future. However, you can meet "consumer" demand through patient portals on your Web site, e-mail appointment reminders and other features without increasing your providers' anxiety – and it doesn't require assigning a nurse or physician to read a barrage of e-mails every day.

One of the best ways to meet patients' demand for greater communication is to establish a secure portal on your practice's Web site that allows patients to request prescription reissues/refills, receive test results and request appointments, says MGMA Health Care Consulting Group Principal Rosemarie Nelson, MS.

You can supplement this service by using e-mail for appointment reminders with a return receipt confirmation that allows your staff to verify that the reminder was read, Nelson says. You can also remind patients of annual visits or screening tests. Clinical administrative support staff can manage the transactions. The benefits for the practice include:

• Greater communication with patients minus the deluge of e-mails for physicians to read
• Fewer phone interruptions for nurses, creating more time for them to spend with patients on site
• 24-hour access to schedulers and caregivers for patients
• Structured questions that provide physicians with accurate patient information

Increased electronic communication with your doctors and/or practice is something many of your patients probably want. Meeting this demand might help you retain and attract patients, ensuring that your practice remains a step ahead of your competition.]]> http://blog.mgma.com/blog/bid/51884/Meet-patients-demand-for-greater-communication Fri, 03 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1248 Meaningful Use Practice
Beacon Partners announced the results of its ARRA Preparedness and Sustainability study as the first deadline of July 2011 approaches for healthcare organizations to achieve meaningful use in order to obtain maximum ARRA incentive money.

"Right now there is a lot of emphasis on getting as much ARRA incentive money as possible," said Ralph P. Fargnoli, Jr., president and CEO of Beacon Partners. "Healthcare organizations are under a lot of pressure as such, but what about down the road when that money is no longer a factor? The results of this study provide a good glimpse as to how well healthcare organizations are preparing for the long-term sustainability of their investments after the ARRA incentive dollars are gone."

Key findings of the study include:

• Forty-five percent of respondents have not applied for any federal or local grants, which is a viable way in which to ignite the process of initiating Health Information Exchanges (HIEs) to attain meaningful use.

• In a step towards sustaining their overall IT investment, the majority of healthcare organizations have built IT expenditures into their financial plans for the coming years to help support patient care, clinical quality and safety as part of their annual spending, tactical planning and strategic multi-year plans.

• Most healthcare organizations (more than 80 percent) will either maintain or increase their IT investments if they are awarded the meaningful use incentive payments.

• Fifteen percent of respondents have operational HIEs. Nearly 60 percent of the respondents have HIE plans in development and more than 20 percent are in the pre-planning stages.

• More than 40 percent of respondents have plans to enhance their physician and patient portals, which are crucial to the development of a sound and secure infrastructure at any healthcare organization.

• In their efforts to achieve meaningful use, quality reporting is the biggest concern among 73 percent of respondents.

"In those efforts to achieve meaningful use, quality reporting is a major concern," notes the Beacon report. "Lack of quality reporting is largely due to the fact that the efforts required to transform current workflow into an EHR will require significant technology and human resources."]]> http://www.healthcareitnews.com/news/quality-reporting-top-concern-healthcares-top-execs Fri, 03 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1249 Medicare
For struggling primary care physicians, these changes should be warmly received. Yet they are still not well known, even though they begin next month, in part because the details them have just recently been finalized through the regulatory process—but also because Medicare has done its usual sub-par job of communicating changes to providers.

Medicare patients will love the annual wellness exam, during which physicians (nonphysician providers such as NPs and PAs are also eligible) are to draw up an individualized prevention plan for patients to include “a written screening schedule for the next [five] to 10 years, based on recommendations of the U.S. Preventive Services Task Force and the Advisory Committee on Immunization Practices,” according to the American College of Physicians. Find out more about what’s to be covered here. The exams figure to be lengthy, but the Centers for Medicare and Medicaid Services (CMS) said it will pay for them as level-4 visits. In 2010, Medicare paid $131.37 for a 99204 (new patient) and $92.37 for a 99214 (established patient).

Patients who’ve already had the Welcome to Medicare exam can get the new wellness exams starting Jan. 1. Others must first get the Welcome to Medicare physical; they would then be eligible for the annual wellness exam the following year, and each year thereafter.

CMS also said that in 20011, it will begin paying a 10 percent bonus to family physicians, internists, geriatricians, pediatricians, NPs, PAs, and certain clinical nurse-specialists “for whom primary care services represent 60 percent or more of their [Medicare physician fee schedule] allowed charges in a prior period.”

Primary care practices, get ready for the onslaught of appointment requests you’ll likely be getting this month and next, as millions of seniors begin to realize that the wellness exams are available. The changes are part of health reform, and several things are striking. First, this is genuinely good news for the primary care specialties that need all the help they can get, but I don’t think very many people — patients and providers alike — know about this new benefit. I’m wondering how many of you were even aware that Medicare would begin offering annual wellness exams on top of its Welcome-to-Medicare physical. How prepared are you to begin providing them, and billing for them? (Note: Speaker and consultant Betsy Nicoletti is offering a Webinar on getting ready for the new benefit on Tuesday. We have no role in the Webinar and I can’t vouch for it, but I can say that Betsy is a contributor to Physicians Practice and has been a source for years.)

And I’m curious to see how perceptions of health reform will be affected (if at all) by the slow dawning of public awareness of benefits like this. Medicare patients will love this new visit, but will they even realize that it comes courtesy of “Obamacare,” or will they just see it as an unrelated administrative decision by Washington bureaucrats? It’s clear that the Obama administration has done a terrible job of explaining exactly what people will be getting, benefits-wise, as a result of reform. Instead, officials have been more focused on the various “abuses” of the private insurance industry that will be prohibited under reform, like insurance rescissions and lifetime coverage caps. It’s all fine and good that those things are going away, but the fact is that very few people (in percentage terms) were ever affected by them in the first place. Yet eliminating them — along with covering the uninsured — were the primary selling points for reform. Both laudable goals, but both are problems that affect a minority of citizens. This new wellness benefit, on the other hand, will be available to every single Medicare beneficiary and will be among Medicare’s most popular benefits right from the start. And most people are unaware of it, or only dimly aware.]]> http://www.physicianspractice.com/blog/content/article/1462168/1747220 Fri, 03 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1250 Medical Home this paper, Sarah T. Corley, M.D., F.A.C.P., and Charles W. Jarvis, F.A.C.H.E., both of NextGen Healthcare, examine the PCMH model and share numerous examples of physician practices that used health information technology to maximize its benefits. A foreword is included from Newt Gingrich, Former Speaker of the House; and Founder, Center for Health Transformation.

Originally published in Paper Kills 2.0: How Health IT Can Save Your Life and Your Money, this article was updated in October 2010 and reprinted with permission by the Center for Health Transformation.]]> http://www.physicianspractice.com/physician-compensation-survey/content/article/1462168/1749184 Mon, 06 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1251 Medical Home
In a survey of 498 primary care physicians in the state, the Connecticut State Medical Society found that 57% of doctors were using open- or advanced-access scheduling, 39% had electronic medical record systems and 33% had registries of patients with chronic diseases.

Open-access scheduling significantly cut patient wait times for appointments from an average of 15.3 days to 9.9 days, according to the report.

But widespread implementation of the medical home is hindered by a variety of factors, including the small size of most Connecticut medical practices, said the report published in the November-December issue of the journal Connecticut Medicine.

"The majority of physicians in our state are in small or solo practices, and the kind of coordinated care that is the hallmark of the medical home approach can require more administrative support than these practices can provide," said CSMS President David S. Katz, MD.

Seventy-five percent of the state's family physicians practice in groups with fewer than five doctors. Elements of the medical home, such as having an EMR system and hiring additional health care professionals to coordinate care, "come with costs that are very difficult for a small practice or small business to bear," said report co-author Audrey Honig Geragosian, a spokeswoman for the medical society.

Installation of medical records alone can cost about $20,000, she said. "That's a big chunk of change to lay out, and our small practices may not have access to that kind of capital at this point."

Use of elements of the medical home model varied by specialty. For example, open-access scheduling was least common among internists, while pediatricians had the lowest use of EMRs, according to the report www.csms.org/upload/files/Primary%20Care%20survey/CSMS%202009%20PrimaryCareSurvey-Medical%20Home.pdf. Adoption of medical homes is still in its infancy in Connecticut, the report said.]]> http://www.ama-assn.org/amednews/2010/12/06/prse1207.htm Tue, 07 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1252 Health Information Exchange
Salt Lake City-based Medicity has considerable market share among emerging state HIEs, and regional and proprietary HIEs. In total, the company says it serves more than 760 hospitals, 125,000 physician users and 250,000 end users.

Aetna believes the acquisition will help the company save money through better care coordination while increasing its software revenue. The company's ActiveHealth Management disease, case and utilization management subsidiary already operates a Web-based platform--significantly enhanced this past summer--to offer a range of data to physicians and patients.

The CareEngine decision support system previously used data from claims submitted to health plans, laboratories, pharmaceutical benefit management firms, and personal health records from ActiveHealth to identify gaps in care and patients appropriate for disease management programs. In partnership with IBM Corp., ActiveHealth recently built the Collaborative Care Solution around CareEngine to also pull data from electronic health records systems, as well as pathology and radiology systems, and to make information accessible via the Web. The new platform is designed offer a more robust data set to analyze and enable clinicians and patients to view.

Now, Medicity will augment ActiveHealth's offerings with the HIE capability to deliver decision support data while also improving care collaboration. The acquisition is a strategic response to regulatory changes, such as the health reform law, as providers move toward new care and payment mechanisms, such as accountable care organizations.

Aetna's buy of Medicity follows the recent acquisition of HIE vendor Axolotl Corp. by the Ingenix subsidiary of UnitedHealth Group, which includes one of the nation's largest insurers. That acquisition legitimized HIE involvement of payers and Aetna now is reacting, says John Osberg, principal at Informed Partners LLC, a Marietta, Ga.-based consulting firm.

Upon closing, Medicity will operate as a separate business within Aetna under its existing leadership. More information is available at medicity.com.]]> http://www.healthdatamanagement.com/news/acquisition-hie-payer-medicity-aetna-41478-1.html Tue, 07 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1253 Hardware
The article, "The iPad in the Hospital and Operating Room," was written by Felasfa M. Wodajo, MD, senior editor, iMedicalApps.com and assistant professor, orthopedic surgery, at both VCU School of Medicine, Inova Campus and Georgetown University Hospital.

Georgetown surgeons are using the iPad to access in real time patient X-rays, CT scans, and laboratory data during surgical procedures. Wodajo writes that the technology could also be beneficial in teaching residents and "bypassing hospitals' restrictive networks to access remote files and office electronic medical records (EMRs) using the cellular 3G networks."

Wodajo explains in the article how he copies computed tomography (CT) or magnetic resonance imaging (MRI) images from a patient's CD ROM to the iPad using two free resources called OsiriX and Dropbox. His workflow looks like this:

1.Insert patient's CD ROM in computer and open with OsiriX
2.Identify key images of interest
3.Export images as JPEGs into a folder on computer
4.View images in Dropbox app in iPad

Wodajo's only complaint is that there isn't a way "to organize images into albums once they are uploaded that would be preserved when the iPad is synchronized with iPhoto."

The iPad allows the surgeons to have access to key patient data in the OR but also on the wards, says Wodajo. The article details how Henry Feldman, MD, Beth Israel Deaconess Medical Center in Boston, successfully used the iPad as his primary computing device for a week as an attending at the hospital.

"The secure wireless network handoff was amazing. As I roved around it was seamless ... and the best example is that I would use the elevator ride to catch up on news/tech websites, and every time the elevator doors would open it would reconnect and download some more prior to the door closing," wrote Feldman.

In his article Wodajo comments on Felman's experince, saying, "we should remember that Beth Israel has a sophisticated Web interface for all their major clinical applications, making the transition to using an iPad fairly seamless."

In conclusion, Wodajo says, "the iPad clearly has the potential to be very useful in the hospital and in the operating theater. The same features which make the iPad great for surfing the web, such as looking at images and viewing video, nicely translate into the operating room."]]> http://www.healthcareitnews.com/news/ipad-goes-or Tue, 07 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1254 Medicare
A bipartisan group of four Senate leaders on Dec. 7 had proposed a one-year delay to the 25% Medicare physician pay cut scheduled to go into effect Jan. 1, 2011, and the full Senate followed suit and passed the bill by unanimous consent.

Senate Finance Committee Chair Max Baucus (D, Mont.), Sen. Charles Grassley (R, Iowa), Senate Majority Leader Harry Reid (D, Nev.) and Senate Minority Leader Mitch McConnell (R, Ky.) took the lead in crafting the bill, coming up with a deal that allowed the legislation to go to the Senate.

If the House approves the legislation and it is signed into law, a 25% cut in Medicare physician pay scheduled for Jan. 1, 2011, would be avoided. It would be the fifth time in 2010 that Congress has passed legislation averting a cut in Medicare physician pay, which was mandated under the sustainable growth rate formula.

Since 2002, the formula, based on the economy and Medicare spending, has resulted in negative updates, which Congress has overrode.

President Obama has lent his support to the current Senate bill, which keeps pay at its present level, including the 2.2% increase that physicians received when Congress overrode an SGR-mandated pay cut in June. Obama said he hopes a permanent fix of the Medicare payment system would be reached in 2011.

"I encourage Congress to act quickly on this proposal," Obama said. "This agreement is an important step forward to stabilize Medicare, but our work is far from finished. For too long, we have confronted this reoccurring problem with temporary fixes and stop-gap measures. It's time for a permanent solution that seniors and their doctors can depend on, and I look forward to working with Congress to address this matter once and for all in the coming year."

The American Medical Association congratulated the Senate for its bipartisan action. The AMA and others are advocating that with the Medicare pay cut averted, lawmakers spend 2011 coming up with a long-term solution for SGR.

"Stopping the cut for one year will inject some much-needed stability into the system for seniors and physician practices, who have spent this year in limbo because of five short-term delays," said AMA President Cecil B. Wilson, MD. The delays include the 2010 overrides and a two-month patch passed in December 2009 that covered January and February 2010.

"The AMA will be working closely with congressional leadership in the new year to develop a long-term solution to this perennial Medicare problem for seniors and their physicians," Dr. Wilson said. "This one-year delay comes right as the oldest baby boomers reach age 65, adding urgency to the need for a long-term solution before this demographic tsunami swamps the Medicare program."

Dr. Wilson urged the House to pass companion legislation quickly before the Jan. 1, 2011, deadline. The House could vote on the bill as soon as Dec. 9.

The delay in Medicare cuts is expected to cost $19.2 billion and would be paid for by expanding Internal Revenue Service recoveries under the national health system reform law. The law offers subsidies based on income to people who sign up for coverage through the health insurance exchanges spelled out by the legislation. If a person earns more than he or she projected that year, the IRS can collect a limited amount of the subsidies paid. The bipartisan agreement would raise that limit, increasing the subsidies the IRS can recover.]]> http://www.ama-assn.org/amednews/2010/12/06/gvsf1208.htm Thu, 09 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1255 Practice
Growth Survey Research conducted the poll for San Francisco-based EHR provider, Practice Fusion. It polled 183 primary care medical providers, 74 percent of which were primary care/family practitioners, 22 percent were pediatricians and 4 percent Ob-Gyns. Nearly half of the physicians surveyed had more than 30 physicians in their referral network with 19 percent reporting having over 100.

"Poor communication between medical providers can have deadly results for patients," said Ryan Howard, CEO of Practice Fusion. "Missing patient information contributes to the 195,000 deaths from preventable medical errors each year in the U.S.

"Electronic health records have the potential to make the referral process much more streamlined," he said.

The survey's key findings:

• The majority of medical practices surveyed reported that they either call the other provider or give information to the patient when making a referral.
• Only 16 percent of respondents said they use an electronic process to send patient records for referrals.
• Providers who use an electronic process to generate referral letters reported significantly more satisfaction with their referral method than those who reported calling other providers.

According to a recent study about 22 million people are referred to another doctor every year. According to referral patterns in U.S. primary care, providers are sharing patient information through:

• fax (28 percent)
• phone (20 percent)
• patient (19 percent)
• mail (four percent)

Gaps in the exchange of patient information after the referral is issued are problematic, and can lead to increased healthcare costs due to duplication of services. Another problem is that providers issuing referrals often do not receive feedback about the patient's visit with a specialist.]]> http://www.healthcareitnews.com/news/survey-only-16-percent-docs-refer-patients-electronically Thu, 09 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1256 Practice
Without a doubt there will always be a place in the market for entrepreneurial physicians who want to control their practices. If controlling practice operations does not always need to include owning practice assets then it is certain that physicians will continue to have the option to run their own show. This will especially be true in larger single or multispecialty practices that can afford professional management and have diversified their services so that they can benefit from revenue that does not require physician effort. Somewhat at risk are the small practices that require day-to-day management by the physician. Economics are working against this model. As the physician supply tightens, hospitals bid starting salaries for physicians higher than small practices can afford, and the costs of supplies, rent, utilities, and staff will likely grow faster than reimbursement. The combination of these forces will make these types of practices attractive only to those who value control more than income.

Now for the longer answer. There are dramatic changes in how healthcare will be purchased in our future. Regardless of the outcome of the debate over the recent healthcare reform legislation there can be no argument that the classic fee-for-service model cannot be sustained if Medicare is to survive and insurance premiums are to be affordable by working Americans. The Accountable Care Organization is on the horizon, although it is still unclear what these networks will look like and exactly how they will function. What is known is that networks of providers will receive bundled payments to provide the care needed by a defined population. If that care can be delivered efficiently then the network wins. Inefficient care (or poor quality) means potential failure. How does this impact private practice? Hospitals will surely be the drivers behind the formation of integrated networks and they will assume that their employed physicians will serve as the engine. Innovative groups of physicians will quickly learn how to manage care and these groups will become indispensable in a shared-savings environment. The physician groups, even though they are private, will be sought out and will be able to negotiate attractive relationships with hospitals while they maintain their independence.

So what is the message in all of this? Physicians need to start exploring now what they want their future to look like. If control of their practice is important then they need to invest in the technology and key resources that will allow them to become a key part of the changing care process. Those who want control in the traditional fee-for-service world may need to seek settings that will allow this model. Boutique practices, practices in rural settings, and some subspecialties may be the most viable. You may have to trade income for the life you want.

If you are tired of the business of medicine but are adamant that you want a say in how things run then it might be the time to broker discussions with the local hospital system about the creation of a physician-governed practice network.

If you are willing to accept that the definition of private practice may have to change then there is no doubt that there is a robust future for private practice.]]> http://www.physicianspractice.com/pearls/content/article/1462168/1752472 Thu, 09 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1257 Health Information Exchange
Moore, an IT analyst with the health technology analyst firm, ultimately foresees more deals like these occurring--although probably not on such a grand scale--because of what he calls the "digitization of the sector" thanks to the Health Information Technology for Economic and Clinical Health (HITECH) Act.

"Administrative and clinical data will increasingly become co-mingled as healthcare/payment reform takes hold," he writes. "The solutions available today to assist with managing that data and delivering it where it is needed, when it is needed are still immature. Acquisitions such as this and others to come will focus on addressing this need/opportunity."

In the meantime, the deal has ramifications for both parties. For Aetna, it means access to a network of more than 760 hospitals and 125,000 doctors that CEO Mark Bertolini says will improve the quality of patient care. "[H]aving ownership of Medicity may allow Aetna the opportunity to obtain much better, timely and accurate population health data to more effectively manage risk and concurrently create more personalized benefit plans for their customers," Moore writes.

And while Medicity now gets the clout of a big-name behind its brand, Moore warns that it must be aware that the move could turn off both current and perspective customers. "[T]here is that thorny issue of payers being so close to clinical data," he writes. "Medicity will likely lose several prospects to competitors and several current customers may rethink their relationship ... going forward."

Still, the big picture is what captivates Moore.

"As new payment models are introduced and [integrated delivery networks] move to an [accountable care organization] model, diagnosis-related groups [DRGs] will expand their definition in both directions, and these ACOs will need solutions to help them more effectively manage risk across an expanded definition of care," Moore writes. "This likely will force closer relationships between ACOs and payers, as a payer's core competency is, indeed, managing risk, and ACOs look to tap that expertise."]]> http://www.fiercehealthit.com/story/aetna-medicity-deal-beginning-end-independent-hie-vendors/2010-12-08 Thu, 09 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1258 Healthcare Technology
In a letter to President Barack Obama accompanying the 108-page report, Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward (PDF), the council’s co-chairmen, John Holdren and Eric Lander, fully endorsed the potential benefits of health IT.

The widespread use of the technology and its attendant available data will help clinicians diagnose and treat patients, help patients take better control over their health, streamline public health monitoring, enhance the ability to conduct clinical trials, pare costs and create "new high-technology markets and jobs."

To achieve these objectives, the chairmen said, PCAST has concluded "it is crucial that the federal government facilitate the nationwide adoption of a universal exchange language for healthcare information and a digital infrastructure for locating patient records whole strictly ensuring patient privacy."

PCAST recommends that the Office of the National Coordinator for Health Information Technology at HHS and the CMS "develop guidelines to spur adoption of such a language and to facilitate a transition from traditional electronic health records to the use of healthcare data tagged with privacy and security specifications," the chairmen said.

Holdren is the assistant to the president for science and technology and director of the White House Office of Science and Technology Policy, according to his biography on the White House website. He was previously a professor of environmental policy and director of the program on science, technology and public policy at the Kennedy School of Government at Harvard University and president and director of the Woods Hole Research Center. Lander is founding director of the Broad Institute of the Massachusetts Institute of Technology and Harvard and was one of the leaders of the Human Genome Project, according to his White House biography. He is a professor of biology at MIT and professor of systems biology at Harvard Medical School.]]> http://www.modernhealthcare.com/article/20101208/NEWS/312089965/# Thu, 09 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1259 EHR
Research published in the December issue of the Archives of Pediatric & Adolescent Medicine indicates that the vast majority of pediatric hospitals in the U.S. "lack the minimum functionalities needed for a basic EHR." Just 2.8 percent of the 108 children's hospitals responding to a survey led by Mari M. Nakamura of Children's Hospital Boston have what could be considered a "comprehensive" EHR. Another 17.9 percent have "basic" EHRs.

Only 15.7 percent of respondents said they exchange health information electronically, while 34.3 percent have "comprehensive implementations" of CPOE for medications, with the majority lacking "many forms" of clinical decision support.

Not surprisingly, cost is the most common reason why EHRs are so scarce in children's hospitals. "The two most common barriers to EHR adoption identified by children's hospitals were inadequate capital for purchase and maintenance cost," the study says. "Correspondingly, the most frequently cited facilitators were reimbursement for EHR use and financial incentives for implementation."

The results actually suggest children's hospitals outstrip adult hospitals when it comes to EHR adoption, but the researchers say nearly three-fourths of respondents were major teaching hospitals, which tend to have more advanced IT than community hospitals. Also, they did not attempt to determine whether the EHRs were effective in improving care or reducing costs.]]> http://www.fierceemr.com/story/less-3-percent-childrens-hospitals-have-comprehensive-ehrs/2010-12-09 Fri, 10 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1260 e-Prescribing Annals of Internal Medicine.

William H. Shrank, MD, MSHS, of Brigham and Women's Hospital, Boston, and co-authors at Harvard University, the University of North Carolina at Chapel Hill, and CVS Caremark identified prescriptions bottled at a particular retail pharmacy chain for patients insured by a certain pharmacy benefits manager (PBM) between July 1, 2008, and September 20, 2008. They used pharmacy data to determine whether prescriptions were picked up or returned to stock, and they used PBM data to determine past and subsequent dispensing at any other pharmacy.

Of the 10.35 million prescriptions of 5.25 million patients studied, 3.27% were abandoned, 1.77% were returned to stock, and 1.5% were returned to stock at the pharmacy but within 30 days were filled (or a prescription in the same medication class was filled) at a drug store. The researchers found that prescriptions delivered electronically were almost 65% more likely to be abandoned than those that had not been electronically delivered.

The authors suggest that when physicians prescribe electronically, they print reminders for patients to help them remember to pick up their prescriptions; doing so could increase the likelihood that patients will adhere to intended therapy regimens. To help decrease the chance of prescription abandonment, the note could indicate the location of the pharmacy to which the prescription was sent, especially in urban areas, where multiple outlets of retail pharmacy chains may exist.]]> http://www.modernmedicine.com/modernmedicine/Modern+Medicine+News/Patients-more-likely-to-abandon-e-prescriptions-th/ArticleStandard/Article/detail/698485 Fri, 10 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1261 Practice new policy in an effort to help physicians maintain a positive online presence and preserve the integrity of the patient-physician relationship.

"Using social media can help physicians create a professional presence online, express their personal views, and foster relationships, but it can also create new challenges for the patient-physician relationship," said Mary Anne McCaffree, MD, an AMA board member. "The AMA's new policy outlines a number of considerations physicians should weigh when building or maintaining a presence online."

The new policy, adopted in November at the organization's semi-annual policy-making meeting in San Diego, encourages physicians to:

• Use privacy settings to safeguard personal information and content to the fullest extent possible on social networking sites;

• Routinely monitor their own Internet presence to ensure that the personal and professional information on their own sites—and content posted about them by others—is accurate and appropriate;

• Maintain appropriate boundaries of the patient-physician relationship when interacting with patients online and ensure patient privacy and confidentiality is maintained;

• Consider separating personal and professional content online; and

• Recognize that actions online and content posted can negatively affect their reputations among patients and colleagues and may even have consequences for their medical careers.]]> http://www.modernmedicine.com/modernmedicine/Modern+Medicine+News/AMA-adopts-new-social-media-policy/ArticleStandard/Article/detail/698498 Fri, 10 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1262 Practice
"Medical practices have to stay current," said Peggy Stilley, director of audit services at the American Academy of Professional Coders. "They have to know what is changing and how it is changing."

As of Jan. 1, 2011, medical practices need to use the Healthcare Common Procedure Coding System's "Q" codes for the vaccines provided to Medicare beneficiaries instead of the Current Procedural Terminology code of 90658.

"Q" codes differ according to the version of the vaccine used. They are:

• Q2035 for Afluria.
• Q2036 for FluLaval.
• Q2037 for Fluvirin.
• Q2038 for Fluzone.
• Q2039 for any other flu vaccine not specified.

The HCPCS code of G0008 continues to apply to the administration of this immunization.

Though some insurers will want the HCPCS codes for vaccine administration, others will require CPT coding, some of which will change at the beginning of the year. Codes 90460 and 90461 are to be used to report immunization administration services to people under 18, but 90471, 90472, 90473 and 90474 can continue to be used for people who are older or when physician counseling is not provided. How these apply depends on the age of the patient, the type of vaccine used and what other immunizations are given at the same time.

The code 90662 was added for the high-dose version of Fluzone, since it is now available for people 65 and older. Codes for intramuscular versions of vaccines -- 90655, 90656, 90657 and 90658 -- remain the same, as does 90660 for the FluMist intranasal vaccine.

The codes for the H1N1 influenza vaccine, 90663, and its administration, 90470, should not be used this season. All doses have expired and should be discarded.

"Just forget about H1N1 for now," said Cindy Hughes, a coding and compliance specialist at the American Academy of Family Physicians. "For those who are coding, it doesn't make any difference."

The ICD-9 code for administering the vaccine -- V04.81 -- remains unchanged for all patients. When pneumococcal and influenza vaccines are administered together, the ICD-9 code is V06.6 -- "need for prophylactic vaccination and inoculation against streptococcus pneumoniae and influenza."]]> http://www.ama-assn.org/amednews/2010/12/06/bisd1210.htm Fri, 10 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1263 EHR
The national survey and six month study was conducted by CDW Healthcare, a provider of technology solutions for the healthcare marketplace, and part of the public sector subsidiary of CDW LLC. CDW Healthcare's "Physician Practice EHR Price Tag" study is based upon a survey of 200 physician practices that have not yet adopted an EHR throughout the United States, secondary research on physician practice workflow and CDW Healthcare's internal data on EHR solutions.

According to the study, inclusive of equipment, software, services, training time and potential lost revenue, physician practices are looking at a price tag of $120,000 per physician for an EHR.

The study revealed that physician practices are focused on the costs associated with EHR adoption, citing their primary concerns as hardware/software costs (66 percent), time associated with staff training (52 percent) and workflow readjustment (43 percent). Although physicians' top concern is hardware and software, the CDW Healthcare study found that year one expenses associated with that category of cost will likely make up just 12 percent of total EHR adoption costs.

CDW Healthcare found that lost revenue will be a far larger drain on physician practices than hardware and software costs. Physician practices said they expect patient encounters to fall by an average of 10 percent in the first year, equating to a total average revenue loss of more than $100,000 per physician. Although 10 percent is the survey average, nearly 40 percent of respondents said they expect patient encounters to fall by 25 percent or more in the first year, representing the possibility of greater potential revenue loss.

"Survey responses indicate that physicians are worried about the costs of hardware and software components when they should focus on implementing a complete solution that reduces the time lost to workflow changes," said Bob Rossi, vice president of CDW Healthcare. "While a typical practice will have a greater investment than expected, the payoff will be significant."

Some studies have estimated that using an EHR can increase patient encounters by as much as 30 percent. Using a more conservative measure of a 15 percent increase in patient encounters, the "Physician Practice EHR Price Tag" study estimates that practices may be able to gain as much as $151,000 per physician per year in new revenue once adoption is complete.

"The most important factor in reducing the cost of EHR implementation is accelerating through the workflow changes," said Rossi. "The quicker practices can reach full adoption, the quicker they will reach the positive side of the cost curve."

Based upon a snapshot of the average physician practice's IT infrastructure, CDW Healthcare also identified opportunities to either speed adoption or reduce costs:

• Upgrade vs. Replace: The average age of physician practice workstations is less than three years, with 20 percent less than one year old, CDW Healthcare's survey found. As such, practices may achieve better results by upgrading existing workstations with system memory, drive space, backup processes and wireless access points to extend the lifecycle of existing workstation deployments
• Protect yourself: Notably, 30 percent of respondents did not use antivirus software and 34 percent did not use network firewalls. To protect IT investments and patient information, physician practices moving to EHRs will need to significantly improve their security and business continuity profiles
• Train and train some more: Twenty-two percent of survey respondents indicate that they will spend at least 10 hours training staff to use the new EHR system. Because training programs are included in the cost of many EHR software packages, practices should take advantage of every training opportunity as a way of accelerating adoption

Click here to read the full copy of CDW Healthcare's Physician Practice EHR.]]> http://www.healthcareitnews.com/news/study-speedy-implementation-key-reducing-ehr-costs-docs Mon, 13 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1264 e-Prescribing
A patient's medication history, which shows which prescriptions were filled at area pharmacies as well, helps Hashey in a number of ways. He can use it to check on patient compliance, to see what prescriptions other physicians have written for his patients, and to detect "shoppers" who are after controlled substances. And when he writes an electronic prescription, the medication history operates in the background to alert him to potential drug interactions.

Hashey also likes his ability to do rapid refills and to obtain formulary information through his e-prescribing software. Overall, Hashey says, electronic prescribing is "the best part of the EHR for efficiency, work flow, and error prevention."

Al Juocys, who practices family medicine in Rochester, Mich., also loves his e-prescribing application, which is separate from his EHR. Juocys's e-prescribing application can be used with a patient portal that allows patients to view their medications and request refills online. The program also notifies patients when prescriptions are sent to pharmacies so that they can go pick them up.

Neither of these features is available within his current EHR, Juocys points out. Also, he was reluctant to use the EHR's e-prescribing module because his EHR vendor would have charged him a hefty fee for connecting with pharmacies through Surescripts. That link is included in his e-prescribing application's cost.

The downside of not using an e-prescriber integrated with his EHR is that every time Juocys writes a new prescription or a refill, he has to re-enter the information into his EHR's medication list. (He doesn't consider that a bother, however.) If you're considering getting into e-prescribing, a standalone application or one that's part of a bundle of connectivity services might be a good choice. The cost is substantially less than that of an EHR; it can help your office gain efficiency; and it can prepare you for the work flow changes that a full EHR will entail.

On the other hand, if you're going to get an EHR eventually, there are numerous advantages to using e-prescribing as part of an integrated system, including the automatic transfer of patient demographic data from your practice management system and the ability to view lab results when you're prescribing. The key is to make sure that the EHR you buy has a robust e-prescribing application. Here's a brief sketch of the landscape and some factors to consider in your decision.

Rapid adoption of e-prescribing

By the end of this year, according to Surescripts, about 200,000 physicians, physician assistants, and nurse practitioners will be prescribing electronically. That number represents nearly a 25 percent increase from the 156,000 clinicians who were e-prescribing at the end of 2009. The number of electronic prescriptions written this year is expected to hit 300 million, compared to 190 million in 2009.

Of the clinicians who prescribe electronically, 77 percent do so within EHRs, up from 70 percent in 2009. The high percentage of EHR use for e-prescribing can be ascribed partly to vendors' upgrades of existing customers so that they can send their prescriptions online to pharmacies, says Kevin Hutchinson, the former president of Surescripts. Hutchinson, who is currently CEO of Prematics, a vendor of standalone e-prescribing software, also notes that many standalone products that connect with Surescripts have either been broadened into "lite" EHRs or incorporated into some of the leading full-featured EHRs.

On the other hand, 80,000 prescribers, including 50,000 doctors, have downloaded a free standalone e-prescribing product, sponsored by the National ePrescribing Safety Initiative (NEPSI). That's according to Lee Shapiro, president of Allscripts, which makes the software. In addition, he notes, many hospitals and integrated delivery systems are sponsoring a slightly different Allscripts e-prescriber for their staff doctors. Some health plans are sponsoring other e-prescribing solutions, including Prematics. So there are inexpensive choices out there that don't require you to get an EHR.

Another advantage of a standalone product is that Medicare is now offering an incentive for e-prescribing. Nevertheless, fewer physicians are now considering standalone e-prescribing applications, practice management consultants say. Most doctors are more interested in the government incentives for showing meaningful use of qualified EHRs, which begin next year. With $44,000 to $64,000 per physician on the table for achieving meaningful use, Medicare's 2 percent bonus for physicians who prescribe electronically — which turns into a penalty in 2012 if you don't e-prescribe — looks like chump change.

"It's good if doctors are thinking about getting an EHR, because it will prevent that penalty for not e-prescribing," says Rosemarie Nelson, an MGMA consultant. "But they're focused on the $44,000."

To show meaningful use, physicians will have to attest that they're sending at least 40 percent of their "permissible" (non-controlled substance) prescriptions electronically. Nelson suggests that doctors look for EHRs or standalone applications that will automatically count qualified prescriptions for them and create a report. Referring to the 90-day period in 2011 in which physicians must demonstrate meaningful use, she says, "You don't want to wait the 90 days and find out that you didn't qualify for the incentive."

Shapiro says it's no big deal if your EHR doesn't count electronic prescriptions. If doctors e-prescribe routinely, he says, they'll easily surpass the minimum. "Providers aren't going to count patients and decide that since they already met that level today, they are not going to e-prescribe for the rest of the day."

Controlled-substance app coming

Physicians have long groused about the legal ban on prescribing controlled substances electronically, which creates a dual work flow for them. In June, the federal Drug Enforcement Administration (DEA) adopted new rules that permit the process, but pharmacy groups have requested clarifications.

The sticking point in the addition of controlled substances to e-prescribing is the lack of a standardized protocol for authentication. DEA has specified the general requirements, but Surescripts is working out the details in conjunction with pharmacies and the leading EHR and e-prescribing vendors. Once that's done — assuming that certain states don't throw up additional roadblocks — the vendors should be able to quickly add the necessary fields to their applications, and physicians could prescribe controlled substances online. Shapiro thinks that this will happen sometime in 2011.

How to get started

Let's say you've decided you want to prescribe electronically, but you're not ready to make the leap to an EHR. Where do you begin?

The first step, according to Cindy Dunn, a senior MGMA consultant, is to understand what's involved. "Whether you buy the e-prescribing software or get it for free, you still have to put a computer network in your practice," she points out. "You have to get computers and you have to create a work flow to utilize this electronic piece. It's more than just purchasing the software. You're going to have to change what you do within your practice."

Installing a computer network and wiring offices can be costly, Dunn notes. Also, she says, outside IT support can run $150 to $200 an hour. Free e-prescribing software might entail extra charges for a Surescripts connection or upgrades. In a small practice, however, e-prescribing need not cost a fortune, Nelson says. The license fee for standalone e-prescribing software isn't expensive — for example, she points out, an average vendor charges roughly $600 per provider per year for its program and a Surescripts connection.

A small office can set up the required gear fairly easily, according to Nelson. If your nurse already uses a desktop PC, she says, you just need a portable device that you can carry from one exam room to another. A computer tablet or laptop will set you back about $1,000, and you can buy a business-grade wireless network and have it installed for under $1,000. If you have two nurses who share a computer, you might have to spend $600 on a second PC. An average vendor might charge about $500 for a one-time download of patient demographic data from a practice management system. So, if you don't mind entering the demographic and insurance data for new patients into the e-prescribing application, you can put together an e-prescribing system for around $3,000.

MGMA estimates manual prescribing costs are about $15,000 per provider per year, including the labor expense of office staff fielding calls from pharmacies. By shifting staff around or even reducing the number of FTEs, Nelson says, a practice can recoup the initial cost of e-prescribing within six months.

Brave new world of iPads

More and more doctors are using iPads and smart phones in their clinical work. These devices, which have plenty of computing power for e-prescribing, can connect with the Internet via either Wi-Fi or a cellular network. That means that a doctor could prescribe electronically without access to a wireless network.

But Nelson points out that there are security problems involved in working outside the practice's computer network. Not only does the browser need to have a secure connection, but patient data that remains in the iPad or smart phone memory must also be erased regularly. In addition, she points out, you can't download demographic data from a practice management system or share data with a partner unless your device is on the network.

Most doctors who prescribe through their EHRs are still using old-fashioned wired PCs or laptops or tablets that are wirelessly connected to a network. If you decide to use an iPad for e-prescribing, you can select the Wi-Fi option and stay in the network.

Other features to look for

A robust e-prescribing application, whether standalone or part of an EHR, should include good decision support features. These would include the ability to choose medications from a comprehensive therapeutic list and to check the drug you want to prescribe against the patient's other medications for potential adverse interactions. Hashey likes his EHR's e-prescribing drug-disease checker, which warns him, for example, not to prescribe NSAIDs to a patient with stomach ulcer.

Physicians tend to dislike overactive alerts in e-prescribing programs, notes Dunn. But Hashey says that in his EHR, he can adjust the level of alerts, and he's moved them to the highest level so they can't slow him down.

You should also make sure that your e-prescribing program can be connected with Surescripts so that you can send prescriptions online to pharmacies. This virtually eliminates the chance of error at the pharmacy, because the pharmacist doesn't have to manually enter your prescriptions into her system. Since pharmacists can also send refill requests online, it reduces the work for your staff and the burden on your phones.

Surescripts, which says that it links medical offices to 90 percent of the pharmacies in the country, provides medication histories and benefit and formulary information for about two-thirds of U.S. patients. But less than a quarter of e-prescribing applications that can send scripts online to pharmacies are capable of downloading both patient histories and formularies, according to Surescripts. Hutchinson says all of the major EHRs can do this, but this is an area where due diligence would serve you well.

Electronic prescribing can be one of the most rewarding and effective ways of moving your office toward paperless systems, and is one of the easiest applications to master. Whether you e-prescribe in an EHR or do it with standalone software, you'll reduce the chance of prescribing errors, make your office more efficient, and please your patients by having prescriptions ready to pick up at the pharmacy when they arrive. But remember that e-prescribing will require changes in your office processes. As Hutchinson says, "It's not just about the software, it's about the work flow."

In Summary

The big question around e-prescribing is not whether you should do it, but how your practice should do it. Should you choose a less-expensive, standalone e-prescribing application or an e-prescribing module that is integrated into your EHR? Here are some points to consider:

• If you are already considering purchasing an EHR to qualify for the government incentives, it might make sense to use an e-prescribing module within your new system.

• If you don't plan on moving to an EHR in the near future, adopting standalone e-prescribing software can help you get your practice inexpensively outfitted to help prepare you for later technology adoptions.

• With either choice, making sure you have the proper computer equipment, network connections, and new work flows in place is crucial to e-prescribing success.]]> http://www.physicianspractice.com/eprescribing/content/article/1462168/1755974 Mon, 13 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1265 Accountable Care Organizations
The establishment of accountable care organizations for Medicare and Medicaid beneficiaries is called for by the recently passed health system reform legislation, and the Centers for Medicare & Medicaid Services is currently writing the rules for these entities. The hope is that ACOs will rein in escalating health care costs, but medical societies have expressed concern that they will accelerate consolidation and squeeze out small practices.

"CMS should adopt policies that facilitate physician-led ACOs and do not inadvertently bias participation in favor of large health systems and hospitals," said American Medical Association President Cecil B. Wilson, MD.

The AMA on Dec. 2 sent a comment letter to the Centers for Medicare & Medicaid Services with its recommendations. They were based on guidance adopted Nov. 9 at its Interim House of Delegates Meeting in San Diego.

Four large primary care medical societies on Nov. 19 released principles on this subject.

The "Joint Principles for Accountable Care Organizations" was released by the American Academy of Family Physicians, the American Osteopathic Assn., the American College of Physicians and the American Academy of Pediatrics (www.aafp.org/online/en/home/media/releases/2010b/aco-jointprinciples.html).

"The [ACP] believes that the current dominant payment system within our health care system -- [fee for service] -- needs to be changed to one that is better aligned to promote improved quality, efficiency and care coordination/integration," wrote Fred Ralston Jr., MD, ACP's president, in an e-mail. "The ACO, at least in theory and from some evidence developed by the CMS Group Practice Demonstration project, may be such an approach. The College and the other primary care organizations support its further exploration."

The "Joint Principles for Accountable Care Organizations" also state that ACOs should be structured to allow for strong leadership by physicians and other health care professionals. Relationships between the various parts of an ACO should be transparent. Incentives should be provided to patients and their families to encourage participation in health and wellness activities, and nationally accepted and validated clinical measures should be used to track performance and efficiency.

The AMA's guidelines are similar.]]> http://www.ama-assn.org/amednews/2010/12/13/bisd1214.htm Tue, 14 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1266 EHR
How wonderful it would be if you could utter those words once your transition to electronic health records (EHRs) was complete.

Now that "meaningful use" has been more clearly defined, it's time to start thinking seriously about how your practice will convert from its current records system to one that meets the requirements of meaningful use defined earlier this year in the final rule issued by the Department of Health and Human Services through the Centers for Medicare and Medicaid Services.

To qualify for incentive bonuses, practices will need to achieve certain core measures along with additional measures that providers may choose to implement within the next year or 2. As a result, practices will be seeking out certified vendors in far greater numbers as we approach 2011. Few vendors will be able to handle the influx of business that appears to be just over the horizon. Practices should begin the transition process as quickly as possible to avoid being caught in the projected backlog.

Although no conversion will ever be completely issue-free, many steps can be taken to prepare for an EHR transition that will lessen the trauma of going from paper to electronic records or from one electronic system to another certified system.

The key steps include:

• making a plan;
• defining your team;
• using available resources;
• choosing a vendor;
• pre-implementation projects;
• implementation projects; and
• post-implementation projects.

MAKING A PLAN

Making a plan starts with defining your practice needs. What are short- and long-term goals for the practice? For example, in the next 2 to 5 years, will you need to look at:

• adding services that will bring in more patients;
• adding a new provider or extender;
• retirement of an existing provider; and/or
• adding a location.

DEFINING YOUR TEAM

By making everyone a member of the transition team and working together toward a common goal, you can eliminate the resistance sometimes experienced during times of significant change and ensure you are ready for the transition.

Be sure to represent every area of your practice:

• providers;
• front desk staff;
• clinical staff;
• billing staff; and
• medical records staff.

USING AVAILABLE RESOURCES

The Health Information Technology for Economic and Clinical Health (HITECH) Act has created not only incentives for the adoption and meaningful use of EHRs, but also resources that are available to assist providers with the transition.

These resources are available through the establishment of regional extension centers (RECs) to provide consulting services, education, and other assistance to providers for the adoption of EHRs and the achievement of meaningful use.

Although REC dollars provide support in the transition process, the funds cannot be used to purchase an EHR system. Other opportunities may provide discounts or assistance with the purchase of a system. Many hospitals are choosing "preferred" vendors that will offer significant discounts to physician practices. Typically, most hospitals choose vendors on the basis of compatibility with hospital software systems, so care should be exercised in choosing such a system simply on the basis of the discount.

Any software vendor should go through the screening process you create, even if offered by the hospital. Instances have occurred in which physicians have purchased software from a "preferred vendor" only to find out that the EHR system could not perform all the functions necessary in an office setting. In addition, there have been cases in which the system that is implemented looks nothing like the demo the practice saw and getting it set up is more difficult and/or expensive than anticipated because the vendor charged significant fees to make the system look like the practice thought it should look. In some cases, the EHR was so difficult and/or expensive that the practice ended up purchasing a different system altogether after months of transition upheaval.

HOW TO CHOOSE THE HER THAT'S RIGHT FOR YOUR PRACTICE

Certification is the first step. If a vendor has never been certified by the Certification Commission for Health Information Technology or another approved certification body specifically for the EHR program under the HITECH Act—walk away. Even if the company is "working on it," it will be so far behind the certified systems out there that it will impact your ability to meet meaningful use criteria.

In addition, it will do no good to prepare extensively for the transition to an EHR system if your current software vendor can't support the changes. Many vendors have enjoyed significant market share in the past from the practice management perspective but simply will not be able to attain certification for their systems.

Use your team to create a list of important functions for your practice. Resources and guidance are available at http://healthit.hhs.gov. If you are close to a hospital and have a need for data exchange, make sure the system you choose is capable of such an interface.

Remember: You get what you pay for. Price isn't everything over a period of years—as the practices mentioned earlier that purchased "preferred vendor" software recommended by the hospital found out. If the price seems too good to be true, it probably is.

PRE-IMPLEMENTATION PROJECTS

Create a project plan and itemize all the information that must be collected for the transition. Items such on this checklist will be required to build or transfer information:

How the process will be implemented:

• 1 provider at a time; or
• all providers.

Process that will be used to get records into the system:

• work from a schedule; or
• alphabetical.

The paper to electronic information transfer will include (depending on the current and new systems, some information may be imported):

• patient demographics;
• providers complete with national provider identifier (NPI) numbers;
• locations complete with NPI numbers;
• a database of the practice's (or provider's) most prescribed drugs;
• a referring doctor file with addresses, fax numbers, phone numbers, and NPI numbers;
• summary of the patient's clinical chart, including: medications, allergies, past diagnoses, histories, immunizations, prenatal history; and forms used by the practice.

In addition, decisions need to be made about what to scan into the EHR:

• scan all records;
• scan only current records;
• define a current record;
• 1 year's worth of patient visits, tests, etc., with selective additional information as determined by the patient's primary physician in the practice;
• 3 years' worth of data; or
• the entire chart.

Calculate the amount of time required for scanning. If the goal is to be live on your EHR system by January 1 and it is going to take 90 days just to scan charts, you can't start December 1.

Take a large box and fill it with the charts you plan to scan after segregating the information in the chart that you will not be scanning, according to the criteria you have selected. Count the number of charts in the box. Average the number of sheets to scan per chart within the box. Track the time it takes to scan the pages in the box that you have selected to be scanned, considering preparation of the pages (removal of paperclips, staples, etc.). Measure the rest of the charts into segments representing the box and multiply by the time required to scan 1 box. If other documents or folders of information will require scanning not in the chart, apply the scan time per page or per folder and add it to the time already calculated for scanning. Doing so will give the total scan time required to scan charts.

Make preliminary arrangements for additional staffing to keep your process on target.

Determine which selective items (besides "core" requirements) need to be met for meaningful use.

ELECTRONIC TO ELECTRONIC

To convert electronic files to a new EHR system, work with your vendor to create a conversion plan. Important considerations include:

• what information will be converted;
• creating a plan to gather information that will not be converted and verify patient demographic information;
• what the cost will be;
• how much time will be needed to create information not converted; and
• determining which selective items (besides "core" requirements) will be met for meaningful use.

IMPLEMENTATION PROJECTS

During the implementation phase, it's important to focus on the following items:

• re-engineer the practice workflow plan to take into account the EHR and reallocation of staffing resources;
• allocate existing staff for scanning activities;
• bring on additional staffing for scanning activities as needed;
• write policies and procedures for the EHR that address:

◦ documentation of patient demographics;
◦ documentation standards for patient visits (what needs to be documented);
◦ standards for the provider completion of patient records;
◦ provision for health records to patients upon request;
◦ protection of history of present illness information; and
◦ security of workstations in rooms or tablets.

• address recharging station processes and locations (if applicable);
• work with physicians to develop templates for patient visits and for scheduling;
• develop forms—patient information, off-work slips, back-to-school slips;
• develop continuity of care template for exchange of key clinical information among providers and patient-authorized entities;
• investigate your state immunization registries and make arrangements for interface;
• scan in patient education materials;
• set up e-prescribing capabilities and drug interaction information;
• set up fax server; and
• set up interfaces with hospitals, labs, and equipment providers.

POST-IMPLEMENTATION PROJECTS

At the post-implementation phase, you're in the home stretch. You'll want to make sure you:

• fine-tune any interfaces (e-prescribing, labs, etc.);
• perform internal chart reviews to ensure necessary documentation is being captured;
• adjust provider templates as needed;
• schedule provider in-services on coding, documentation, and the use of the system to capture required data; and
• fine-tune practice operations to ensure that patient access and flow are not impacted negatively by the EHR implementation.

Following these steps can help ease your practice's transition to EHRs and help you maximize their potential.]]> http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Easing-the-transition-to-electronic-health-records/ArticleStandard/Article/detail/699151 Wed, 15 Dec 2010 09:01:00 MST http://www.primarydatacorp.com/#1267