HITFusions, a HealthFusion^® Blog

5010 Update — How the Government and Blues have botched the 5010 claims transition (Where is my check, and how do I make payroll?)

History: Per The Centers for Medicare & Medicaid Services (CMS) website, on January 16, 2009, Health and Human Services (HHS) published two final rules to adopt updated HIPAA standards; in one rule, they officially adopted the X12 Version 5010 for claim submission and related transactions. They mandated compliance by January 1, 2012. CMS still states on their website that this 3 year timeframe, “gives the industry enough time to test the standards internally, to ensure that systems have been appropriately updated, and then to test between trading partners before the compliance date.” This statement is anything but the truth as it relates to many health plans, and especially the Government and Blue plans.

In another rule, HHS modified the standard medical data code sets for coding diagnoses by adopting the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10). They mandated the start date for the cut-over to ICD-10 as October 2013.

On November 17, 2011, the CMS Office of E-Health Standards and Services (OESS) reported that they would not enforce compliance with the HIPAA 5010 transaction set until after March 31, 2012 (big mistake). They also announced that the 90-day delay would not affect the implementation date for the ICD-10 coding system change, which as of that date remains October 1, 2013 (another big mistake).

The Current State of the 5010 Claims Format Transition: On Friday, February 3, 2012 the Medical Group Management Association (MGMA) authored a scathing letter to the HHS Secretary, Kathleen Sebelius, outlining significant problems with reimbursement of claims following the transition to the HIPAA 5010 transaction sets. In the letter MGMA reports that many providers have not been paid by Medicare and TRICARE (we also see this pattern with many large Blue plans) since as far back as November 2011. Whether you are using HealthFusion® or another clearinghouse or practice management system, you may be impacted by the problems outlined in that letter. MGMA’s letter is an obvious indicator that the 5010 payment issues are industry-wide — affecting providers that use hundreds of different billing and clearinghouse systems. Yet the Government and Blue plans’ initial reaction has been to point their fingers at the practice management and clearinghouse industry. Recently they have been slowly taking responsibility for the problems they have created. I am certain that the overwhelming majority of the payment issues that providers have been experiencing are related to the payer community and I have the evidence!

Major Payment Problems Details (most of the list is per MGMA – the comments are mine)

1. Billing systems and clearinghouses show no problems during testing but claims are rejected once the production phase starts — During the testing process many of the payers created test environments. To get certified for 5010, vendors were required to test against the payers’ test environment. Files that passed testing ended up failing in production; how could this happen? The Government and Blue plans were late to setup their testing; they created long lines for their constituents to test. They did not provide proper examples of their reports in time for the industry to accurately map to those reports, or they changed the report format at the last minute. Most clearinghouses and billing software systems wanted to test months prior to the deadline, yet they had to rush at the end of 2011 because the Government and Blue plans were way behind schedule with regard to modernizing their systems for 5010.


2. Crosswalk national provider identifier numbers are not being recognized — Medicare unilaterally and mistakenly "unlinked" some providers from their enrollment database. While the majority of Medicare providers remain linked properly, we believe thousands of doctors have been unilaterally “unlinked”. The history on this issue is as follows: Over the past several years the Medicare Fiscal Intermediaries have been changing territories — they are now referred to as Medicare Administrative Contractors (MACs). During those territory reassignments, the linkages for enrollments via all clearinghouses have been lost for many, but not all providers. CMS mandated that, as of the first of this year, if a lost linkage was associated with a provider, that the MAC was no longer authorized to pay a claim for that provider. This was just plain stupid, trying to fix lost linkages at the time when the industry was already challenged by the 5010 transition does not make any sense. In fact, from the middle of December to January 5th, most every provider was impacted by a similar Medicare error.



Medicare has defined a claim error type that they like to call a "496 edit". In Medicare payer reports the error looks something like this:

*** Batch, Reject ***

LAST NAME, FIRST NAME

*** Batch, Reject ***

25.00

CLAIM REJECTED

STATUS CODE: A8:496:85

Acknowledgement / Rejected for relational field in error.

Submitter not approved for electronic claim submissions on behalf of this entity.




Many providers stopped receiving this error after January 5, 2012, but we believe thousands of other providers continue to receive this error, and they remain unilaterally unlinked from the Medicare enrollment database. Guess what happens when you are not linked to the enrollment database — you got it, no payment. To make matters worse, Medicare’s response to this issue was to stonewall the clearinghouses and billing system vendors. Most Medicare representatives that we contacted denied the issue, and their response was reminiscent of Soviet-style misinformation, their position was that these providers were never enrolled. An absurd response! They knew they were getting hundreds of calls with similar issues and we had the proof, enrollment paperwork and check numbers for claims as recently as December of 2011. If the providers were not enrolled, how could Medicare have paid last year and not this year? Their initial solution was that providers needed to re-enroll. We objected vehemently, because any further delays, especially a long enrollment process, was not acceptable. We needed to reach level 3 support at Medicare, and that is where we finally got the truth. Medicare assumed responsibility, did not point the finger back to the vendors, and agreed to a much more streamlined approach to re-linking providers to facilitate payment. The problem is that this never should have occurred. Enrollment database updates are not what we bargained for with 5010, and Medicare should never stop paying when they know the error is in their system and not with the provider. It just is not fair and has far reaching implications on patient care — which I will discuss later in this blog.

3. Medicare contractors are losing claims — Medicare has a centralized claim editing system called the Common Edit Module; it is programmed with all of the claim edit rules shared by the various Medicare Administrative Contractors. The Common Edit Module has become its own version of the “Roach Motel” — claims make it in but they never make it out. Medicare has admitted that at times the Common Edit Module has become “overwhelmed” and malfunctioned, causing claims to randomly get lost.


4. Sporadic payment of re-submitted claims are occurring with no explanation for rejections — Payers may deny a claim without a rational rejection reason, and then when the same claim is resubmitted the claim will be miraculously paid. Most good billing professionals are trained not to blindly resubmit claims, instead they are trained to try to understand the reason for the rejection, correct the claim, and then resubmit. When billing staff recognize that random resubmission sometimes works, they may blindly resubmit large batches of claims and “pray” for some payment. In the context of a practice that is desperate for proper payment because of payer payment delays, these resubmitted claim batches are further overwhelming payer systems. Payers have created a loop that self perpetuates and creates even more chaos.


5. Call hold times of one to two hours are being experienced when contacting Medicare contractors — Payers that have botched the 5010 transition also did not plan for the increased call volume associated with the transition. Of course if they were paying claims correctly, if they would have not unilaterally “unlinked” doctors, or used 5010 to squeeze in new “rules” that they did not propagate or make part of the pre-5010 testing process, call volumes would be much lower. It is almost impossible to get a good answer from many payers regarding rejections. At HealthFusion® we have hired temporary employees whose job is just to phone a payer and wait on hold for hours, then when a person answers they pass the phone to one of our customer care professionals. Many times the payers do not accept calls at all because they are overwhelmed. The majority of the time when we do get a person and not voicemail, the “help” our staff receives is not useful or accurate. We see these long call hold times in most every state and across several payer types, but it is of course the worst with the Government and Blue payers. Medicare has reported that call volume has tripled since the transition to Version 5010. The fact that payer hold times are at least one to two hours is proof that the 5010 transition issues are industry wide (no single vendor could cause these types of hold times). Click on the following link for an audio example of a payer's 5010 transition voicemail.


6. Government and Blue payers have sporadically stopped paying claims or issuing reports for days at a time — We have observed many bulletins from payers that they have simply stopped paying claims, delayed claim processing, or have delayed reporting on claims. These delays imply that those payer systems are overwhelmed or require reprogramming — either way, they were not ready for the 5010 transition. Below is a recent example of a communication that indicates a processing delay issue — we have received many communications that are similar to this one:




7. Secondary payers are not ready — This month Medicare sent a bulletin (MLN Matter Number: SE1137) that explained the delay in COB processing when a patient’s supplemental payer has moved into 5010 production. For 30 days after that payer’s cut-over, providers need to file the affected claims directly with their patients’ supplemental payers, and they cannot rely on the standard automated crossover system that was in place prior to 5010. Basically, in this communication, Medicare is admitting that the traditional crossover claims system is not working for many payers, and is delayed for others.


8. Other observations made by MGMA regarding payment problems include:
• Older submitted validation information is not being transferred.
• Claims are being denied for not having a description in the claim, although CMS did not send a notice of correction until Jan. 27.
• Unsuccessful claims processing with no rejection reason cited is occurring, despite using a submitter that was approved by CMS.
• Pay-to-address data fields are being stripped from the claim, and other address issues have emerged.

How widespread is the problem? Since thousands of providers have not been paid by certain payers as far back as November 2011, some providers have been forced to take out lines of credit simply to meet payroll and other expenses. We have noticed that certain government payers are now quietly owning up to their problems, and they’ve stopped blaming the providers or clearinghouses. They are starting to provide better answers and guidance than they did in the middle of January, but there is still a long way to go. We noticed that just this week one of the nation’s largest clearinghouses issued a bulletin that reported they had identified almost 100 production issues that required IT fixes. We see this type of activity in most every large clearinghouse — the rush to make up for poor testing environments and guidance provided by payers during the 5010 pre-production timeframe. Providers need to understand that every billing system and clearinghouse that is submitting in 5010 format has already been certified by the payer or their trading partner. One would think that if you passed testing then the claims submitted in production would be paid. In fact, it is the responsibility of those payers to pay claims that would have passed their pre-production testing, this is not happening. Payers are finding new and inventive ways to not pay claims, in some instances rejecting batches of thousands of claims because they want to reject a single claim within the batch.

What next? CMS realized (or should have) that there was a problem with the largest payers in the country, Government and Blue payers, with regard to the 5010 transition. Last summer CMS should have postponed 5010 until January 2013. This is a classic case of the fox minding the hen house, the government policing themselves. The Government payers and the Blues (which as far as I’m concerned are as bureaucratic as the government payers) were the least prepared and CMS had to know; yet they let 5010 proceed. Then in November they announced a short delay until March (no penalty for staying 4010 for an extra 3 months). This was too little too late. The payers are like ocean liners and most could not reverse course “on a dime”, they were already committed to 5010. They had to know they were unprepared for 5010, but their systems were at least partially programmed for 5010, and like an ocean liner headed into a hurricane they could only move straight into the storm and pray.

CMS must provide more transparency — Example: On January 25, 2012 they hosted a national provider call “Subject: Medicare FFS Call on HIPAA 5010 — Question & Answer Session”. On this call CMS admitted that they are having problems processing large batches of claims and that these large batches are contributing to the bottleneck at the Common Edit Module, which is delaying processing and reporting. Several clearinghouses complained about Trailblazer/PGBA/CGS denying claims for not being associated with Submitter ID (the unlinking issue captioned above). Others reported that Noridian/EDISS are not processing requests in a timely manner; they have not been responsive to linking ERAs to provider clearinghouse accounts. Some have waited up to two months to go live on ERA. Highmark was singled out for rejecting claims for the lack of rendering provider in situations where the rendering provider is not required per the 5010 rule. CMS has yet to publish any documents related to this call. In the past CMS has published audio versions of their Q&A sessions. Why is this call a secret?

Medicare must not create further complications with regard to the 5010 transition — CMS decided to move MAC assignments from Cigna Government Services (CGS) to Noridian on February 1, 2012. That move impacts Medicare in the states of Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming. Now providers are further burdened to make sure that during this move they visit the Noridian “Total OnBoarding” web portal to verify that Noridian has updated their profile information correctly, and make sure that they are confirmed to send 5010 837P (5010A1)-Health Care Claims Professional and receive 835 (5010A1)-Payment Advice. This was the wrong time to change MAC assignments and further burden providers with new administrative tasks.

MGMA is asking for further delay in enforcing 5010 until June of this year, that recommendation simply won’t help any payer that has already has committed to 5010. In addition, the process of downgrading claims from 5010 to 4010 is fraught with its own set of issues that we are currently observing and may make the issues worse. We do agree with the rest of MGMA’s recommendations to HHS, some of which are listed below:

1. Instruct the MACs to immediately provide advance payments for physician practices that are struggling to meet the Version 5010 mandate.
2. Permit clearinghouses and health plans to accept and adjudicate Version 5010 claims that do not have all of the required data content, but that have sufficient data content to be successfully adjudicated. HHS should encourage providers and health plans to concentrate strictly on the most critical data content requirements of the electronic claims and other transactions. Medicare should announce that, assuming the claim contains sufficient data to be adjudicated, minor errors in the claim will not trigger an automatic rejection.
3. Instruct the MACs to expeditiously adjudicate all outstanding claims, both electronic and paper.
4. Instruct the MACs to take all appropriate steps to ensure that they can accept and adjudicate Version 5010 claims in batch mode.
5. Instruct the MACs to take all appropriate steps to ensure that call centers are manned appropriately and that they are able to answer incoming provider questions in a timely manner.

We also agree with the AMA that the ICD-10 transition scheduled for October 2012 should be postponed. ICD-10 should not proceed until such time that the industry has time to recover from the 5010 debacle. Providers cannot bear the burden for another round of poor preparedness related to a transition to yet another new standard. The payer community cannot police itself, and we call for an independent certification of payers prior to the introduction of any new standard related to physician payment. CMS should also recognize that the industry is gearing up for Meaningful Use Stage 2 in 2014, just 3 months after the scheduled transition to ICD-10; introducing two new standards within such a short time period is a disaster waiting to happen.

As a physician that had to make payroll and pay expenses, I can assure that HealthFusion’s® primary mission is to facilitate payment for our constituents. Each day we make a breakthrough with the payers, and just last week our team “freed up” thousands of claims that were inappropriately rejected by payers. We continue to work hard with our trading partners, and the payers and I believe that we will see steady improvement in payment this month, BUT the payers must cooperate and follow the recommendations made by MGMA. We call for a Congressional investigation of the botched CMS 5010 transition. If Congress had enough time to investigate the use of steroids in baseball, then they have time to investigate this important physician payment issue. I know firsthand, that as well-meaning as physicians are, they can’t provide care without fair reimbursement. We share MGMA’s concern that if payers continue to withhold payment, those disruptions will ultimately interfere with patient access to quality care.

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What Do I Do With My Paper Chart? — The Middle of the Road Makes the Most Sense

Many healthcare providers who are transitioning from paper charts to electronic health records (EHRs) need help understanding how to work with the paper charts they built over their many years in practice. There are three approaches:

Scan all your paper charts and upload the scanned charts to the EHR

— This approach is the most expensive approach. Typically, if a practice wants to take this approach, they outsource the scanning to a third party and have every piece of paper scanned and uploaded into the EHR. The main advantage to this approach is that the paper chart becomes obsolete and can be stored offsite. The major disadvantage to this approach is the cost of scanning and uploading — usually a practice will pay between five and ten thousand dollars to the scanning company for the use and time it takes them to open each chart and high-speed scan every single SOAP note and test result. Since the complete chart is available in digital format, the user never has to reference a paper chart, but the provider may have to wade through pages of scanned data to find the specific records that reflect the milestone events that best summarize the patient’s medical history.
Rating: Effective – Very costly

Scan nothing and carry the paper chart into the exam room

— Physicians that promote this method still like the feel of the paper chart and frankly have trouble making the commitment to an EHR in the early stages of adoption. The advantage of this method is that no scanning is required. The disadvantage is obvious; the EHR never tells the complete story regarding the patient history, especially with regard to certain milestone events that impacted the patient’s health. The physician is committed to two systems all of the time for an indefinite period of time. The practice never gets the opportunity to save money by reducing chart pulls; the first visit is easier with this method — just pull the chart, the subsequent visits become more expensive with each additional chart pull. With Web-based EHR systems like MediTouch EHR®, providers can securely view patient records anywhere they choose, but they cannot have a copy of the paper chart with them at all times, so this method does not appeal to the mobile healthcare professional.
Rating: Least Effective – Least costly in the beginning, but expensive over time

Scan only what you need

— This approach is based on the premise that you don’t need to scan every piece of paper in the chart, the assumption is that you don’t need to see everything that happened in the past. With this method your staff scans “just enough”, based on the provider’s decision to competently care for the patient, and no more. Most practices find that scanning less than 10% of the paper chart gives them the data they need to provide the excellent care that their patients expect. The typical method requires some minor preparation the day before the patient is seen. The provider marks what records require scanning or the practice creates a “formula” for every chart. Formulas work in some cases, but provider input always helps to streamline the process. Scanning and sorting documents “in the cloud” with MediTouch EHR® is simple because users can upload files in bulk (not one patient at a time), and then sort them into the appropriate chart once they are uploaded. There is clearly some work involved in preparing a patient file the day before a visit. We also recommend populating the allergy and medication lists the day before to help the practice meet the Meaningful Use requirements for those list types (scanned images of those lists don’t meet the government Meaningful Use measures). The problem list can be populated from the office visit SOAP note, so we do not recommend spending time on that one the day before. One of the great features of MediTouch EHR® is that the medication list can be imported from the Surescipts® database, so manual entry is minimized. Even with the process automation built into MediTouch®, offices should anticipate several minutes per patient, preparing the EHR for a visit — but only the first time a new patient is seen. This time investment reaps great rewards for the office because, when the patient returns for the next visit, there is no chart pull. In addition, all of the workflows related to adding lab results and incoming faxes to the chart are streamlined. The net result is that with regard to handling the chart, EHRs reduce work for the staff over time, but on the first visit an investment must be made.
Rating: Most Effective – Least costly over time

Medication History List Import Screen

Most experts agree that paper charts will play a role in most practices for a few years after the adoption of electronic medical records. Do not rush to become completely paperless at the start of implementation — very few practices need to or can afford to make that change in just a few weeks. Take your time on moving away from paper completely and try to populate the chart with just enough data, such that when you move from office to office, or office to home, that you can understand your patient’s health and render sound medical decisions based on the use of the EHR alone. With MediTouch® bulk scanning, incoming fax handling and the creation of problem lists and medication lists is easy — HealthFusion® makes the transition from paper simple and less time consuming. Remember moving to an EHR should not reduce your revenue — make sure that your staff takes a few minutes per patient to prepare in advance, so that your patient flow remains stable, or even grows!

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Cloud-Based vs. Client Server — What Is the Best EHR Infrastructure?

MediTouch® is an EHR based on HealthFusion’s® private Pure Cloud™ technology. Our team had a choice when we developed the MediTouch EHR®. We could have adopted either the more traditional client-server model or the more modern Web-based, cloud infrastructure. For our team the choice was simple – The Cloud won hands down. The purpose of this blog is to discuss why we made the decision to develop our physician office software: EHR, billing, scheduling, clearinghouse, and patient portal based on MediTouch® Pure Cloud™ technology. I will also try to review what some of the proponents of client-server systems promote as benefits, and evaluate the merits of the client-server case.

Since we are pitting our cloud technology, Pure Cloud™, against the traditional client-server model in a battle for the best EHR platform, I thought it would be helpful to research what others are saying about the benefits of each system. I simply Googled “cloud vs. client server EHR” and reviewed the first group of entries. You can do the same. The first 4 entries included 2 blogs from authors that did not seem to have a pre-formed opinion, one blog from a company that sells only client-server EHRs, and another company that seems to be pushing the cloud.

In a cloud-based EHR system, a practice’s data is stored on external servers and can be accessed via the Web, requiring only a simple computer with an Internet connection. In the case of MediTouch® that computer can be Mac® or Windows®, desktop or laptop, Windows® tablet or iPad®.

Client-server systems store data in-house, requiring that a server, hardware, and software be purchased, installed, and maintained in the physician’s office. While in-house servers have traditionally been the norm, more practices are increasingly switching to the cloud.

Let’s discuss the Pros and Cons and see if the MediTouch® team has found solutions that overcome some of the Cons of a cloud-based EHR system.

First the Pros — Per the table above, with a cloud-based system your practice does not need to purchase any software or hardware; you simply subscribe to the system. With MediTouch® there is no EHR start-up fee or training fee. We will train your staff every day, every month, and every year you subscribe to our software. Client-server companies will sell your office a week of intensive training, you will need to cancel patients, shut down your office, and make sure that you never hire a new employee, because they will charge for additional training, especially one or two years into your lease with the vendor.

• With the cloud, your practice does not have the responsibility of maintaining expensive hardware. Your responsibilities related to data backup and your HIPAA legal liability for your data are reduced to zero.


• It is easier for cloud EHRs to support your group. Our J.D. Power and Associates® award-winning customer care team can use our advanced tools to securely “see into” your practice’s MediTouch® account, via the cloud, to troubleshoot any problems and offer assistance with Meaningful Use, electronic prescribing, or charting.


• Data servers require maintenance, backup, and security — most physicians understand that they should not place a server in a closet or an unsecured storage room, and that it is best to have a professional on staff to assist with these server-related tasks. If you do not have a large practice that can afford a full time IT professional, then the cloud always wins. Even if you do have a sophisticated IT team, we still think the cloud is a better solution. In large practices with IT professionals already on-staff, those professionals often play an important role in implementing the MediTouch EHR® system and defining the new workflows for dozens of users across many physical locations.


• If the physician is mobile (what doctor isn’t?), then a cloud EHR is really the only fast and easy way to access patient records from multiple locations – including home and when traveling.


• Client-server systems do not work natively on the iPad®; so if you are one of the 80% of the doctors who believes you will ultimately use a mobile tablet, then the cloud is by far the best choice. With the cloud you don’t need to upload new patches, updates, or code sets.

We love the cloud — so I can keep spouting the Pros related to cloud computing, but let’s take on the Cons.

The Cons to Cloud Computing — MediTouch® Overcomes Most All of Them

• Customizability limited — Just not true with the MediTouch® system. Our system is more customizable than most client-sever systems. With MediTouch® you can customize each portion of the SOAP encounter, create customized touch-forms, care plans, and blueprints (templates) with the MediTouch® Grand Central easy charting system.


• Latency or lag time accessing information across the Web/slower response time — Have you seen our pages refresh; they redraw as fast as client-server pages, and most all of our pages redraw in sub-second timeframes. We are fast – and, by the way, were you ever on a Windows® computer that was slow, of course you were. Client-server does not always equal speed, in fact a physician recently switched to MediTouch® from Greenway® (client-server EHR) because his system was too slow and ours is much faster!


• Patient information may be compromised if co-mingled with other clients — This depends on the way your vendor sets up their database and the level of expertise of their programmers. HealthFusion® has been “in the cloud” for 13 years, and we have never had a provider from one practice see the data from a client in another practice. It is easy to prevent co-mingling of data, you should know this based on your own intuition; if co-mingling was a major issue then not a single soul would perform online banking interactions or shop on Amazon®!


• At the mercy of the vendor regarding backups, security — This is true and this is a matter of trust. You need to ask yourself, who is better equipped to house and backup your data? Our team of IT professionals that house your data in specialized redundant data centers protected by biometric access devices in addition to lock and key, or your staff that are experts in medical care, but may not be experts in HIPAA data security and backups. With MediTouch® your data is backed up to 2 distinct physical locations - I don’t know of any practice that can boast that type of redundancy.


• Captive client - host controls your data — With MediTouch® this is not true - you are always in control of your data - you can download any chart with just a couple of clicks and store it in an electronic format. Alternatively, you can subscribe to our “Download My Patient Records” service that stores your data in the secure HIPAA compliant Amazon® Cloud for secure download to your office computer in an encrypted format weekly.
• Practice may find it difficult to function if there is an Internet outage — We agree with this statement; although even in the client-server world, connections to the outside world via the Internet (such as lab connections) have now become an important part of the EHR experience. Our suggestion to users is, if their Internet provider (ISP) has frequent outages, buy a cellular-based “Wi-Fi” card from their local cellular provider. Those cards cost around $50 per month, they can connect 5 computers, they won’t go down when or if your ISP is down, and they are also great when you and your family travel!


• May not be viable for rural practices with limited Internet options — We agree with this, if you cannot get a reasonably fast internet connection, whether it is via cellular, DSL, or Cable - then do not use a cloud solution. But there are very few practices that cannot connect to the Internet at a decent speed these days.


• Practice can lose data if vendor goes out of business — HealthFusion® / MediTouch® has been in business for 13 years and is “here to stay”. Our business just keeps getting better and bigger. For doctors that have that fear, we provide the “Download My Patient Records” service. It makes those docs that worry about this issue feel much more comfortable. With “Download My Patient Records”, your data sits on the Amazon® Cloud in addition to ours, so even if our Pure Cloud™ was “shut down” the data would still be available to our users on the Amazon® Cloud.


• May be impractical for uploading larger imaging files — Your practice should not have many large files, it is a waste of storage to save images that are very large in size. Our users upload documents in just seconds and are able to save and view tens of thousands of documents without any delay. We even have clients that upload video files; the user clicks “upload” and walks away, takes care of a patient or answers a phone, and returns to find their file uploaded. MediTouch® users can login while the files are uploading and continue to use our system during the upload; so whether they are large or small files, MediTouch® is up to the challenge.


• More expensive over the long haul or, “I won’t ever own my system with HealthFusion®, but I will own ‘my client-server system’ in five years.” — Another “old wives tale”. Simply not accurate and here’s why:

In five years you will maybe own a system (if there is no tail on your lease), but it will be an old system. In five years your client-server vendor will be selling you the next and latest version of their system — How else will they stay in business? In fact, when you own software, especially in a dynamic industry such as electronic health records, I can assure you that the system you have 5 years from now will be very different than the system you have today.

Remember each time you buy software, let’s use Windows® as an example, you own it, but you don’t own the next major version. With Windows® you may not have purchased every new version, they usually come out every 3 years, but I can assure you that you are not working on the original DOS Microsoft® version or Windows® 3.0. Microsoft® has a lot of cash in the bank right now, and the way they made that money is every few years they make their old software obsolete. I can assure you that will be exactly what happens to you if you buy software on a 5 year lease. With HealthFusion® you are always getting the latest version, and you won’t ever pay a fee to upgrade to the next major version — like you would if you bought a server-based system.

Either way I can assure you that 5 years from now you will continue to make payments on EHR software — isn’t it best to go with a Web-based system that is updated every 2-3 months and that does not require a 5 year commitment. Remember, with our system it is much easier to opt out; that means that each month we must work hard to continue to earn your business, purchased client-server systems earn your business one time for five years, with our system we must continue to perform every month, every year — the bar is higher for us and that is better for you.

MediTouch® Pure Cloud™ Beats All Comers

In the battle between MediTouch® Pure Cloud™ technology and traditional Client-Server models, it is clear that the Pros of the cloud clearly beat the Cons. Unless you are a rural clinic that cannot get relatively fast Internet speeds, MediTouch® has overcome all of the Cons of the cloud and leverages all of the Pros to deliver the best EHR infrastructure in the business; we simply knock the socks off of the client-server model.

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EHR Start-Up — Let Your Patients Do the Heavy Lifting

I speak with many providers who are converting from paper record documentation to EHRs (Electronic Health Records). One of the challenges for medical practices is converting the patient medical histories and medication list to “true data” in the EHR. The term “true data” means information that can be stored and retrieved in a database. The power of EHRs is that information can be searched, stored, and retrieved as data. Sometimes these concepts can be confusing. An example of the difference between “true data” and the scanned image of a paper note is that the information on the patient note cannot be queried, reported on, or stored in a standard patient PHR (Personal Health Record). As part of the Meaningful Use initiative, the government has pretty much mandated that information is stored and retrieved as data.

As paper patient records are migrated to an EHR, every type of EHR requires the practice to translate their paper information to electronic lists in the EHR. This task can be time-consuming for a practice, and most EHRs do not provide simple solutions that make these tasks easier. With MediTouch EHR® and the YourHealthFile® Patient Portal, your patients can assist you in the initial creation of mandated data lists, such as Medication Lists and Patient Histories (Medical, Surgical, Family, Social, Immunization, and Allergy).

Most physicians are uncomfortable handing their EHR system to the patient and saying, “Begin charting for me.” EHR interfaces can be too complex, and while the physician may benefit from patient input, unsupervised patient-generated health record data simply does not work.

With MediTouch® and the YourHealthFile® Patient Portal, we believe we have found the correct balance between patient input and physician supervision. This combination provides a very powerful way to interact with your patient, and makes the beginning of the electronic charting process fast and easy.

With YourHealthFile® the patient can enter all of their history information, and also update it as needed. Below is an example of a patient who added a new allergy, “Bee Pollens”, to the patient portal. Note: The allergy that the patient added is highlighted in yellow — it is not yet part of the official EHR.

In the MediTouch EHR® the provider is notified that the patient has suggested that a new allergy should be added to the official patient record in the EHR. The provider can choose to “Accept” (add) the new allergy to the patient’s allergy list or “Dismiss” the allergy if they decide it is not clinically appropriate.

The provider is in complete control of what becomes a permanent part of the EHR. This method of working with patient authored data and moving it from pending to permanent status is unique to the MediTouch® system and is a real time saver.

With MediTouch EHR®, we strive to make the adjustment from paper to electronic fast and simple. Patients really want to be part of the process, let them assist you. Turn on the YourHealthFile® Patient Portal and fast-track the start-up and maintenance of your EHR.

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Patient Portal and EHR Integration — Patient Self-Service, Save Time and Generate More Revenue

This is the first of several blog posts on the advantages of using patient portals that are integrated with electronic health records.

I have previously blogged about how patient portals can change the way lab test results are communicated to patients in our blog titled, “I'm Texting Nobody about Nothin'" — A patient portal changes the way we communicate.

Since the time when I wrote that blog, we have become more interested in how patient self-service can turn traditional workflows into more efficient, revenue enhancing ones. Our motivation — the local frozen yogurt store. Of course the next question is — what does frozen yogurt have to do with EHRs and medical office workflows?

For years my wife and I have visited the local frozen yogurt store for a late night snack. Over the years buying yogurt has become more complicated (just like healthcare). It used to be a choice between vanilla and chocolate – now there are many more flavors and dozens of “add-ins” such as candy, sprinkles, or fruit. The traditional frozen yogurt store’s workflow means two lines. One line for the first employee to ask me; what size I want (I usually order a small cup), what flavor I would like, then to dispense the yogurt, add my favorite candy and take the yogurt to the cashier. And, another completely separate line to pay for the yogurt. Sometimes they add just the right amount of candy, but other times I wish they would add a little more. I am not really in control. Other times the line to pay for the yogurt is too long, so it begins to melt before I pay.

A new yogurt store just opened up with a single line, it is based on self-service, and it is putting the old frozen yogurt shop out of business. Here’s how it works; they only have one size container – the extra large cup. I walk over to the frozen yogurt machine and fill it with as much yogurt as I want (somehow it is always way more than that small cup I used to order). Then I throw a bunch of candy in and mix it all up. I am in complete control. They weigh it, I pay, and they keep the line moving so my frozen yogurt never melts. Since I usually buy more yogurt than I used to (can anyone resist filling the extra large cup?), the new yogurt store makes more money per person then the old store. I watch the customers — they love doing the work that the employees at the traditional yogurt store used to do.

Change Your Workflow – Reduce Your Overhead and Increase Your Profitability

The new frozen yogurt store has created a win-win situation by changing the traditional workflow to one that involves the consumer. They make more dollars per customer, as they have grown they have had to hire less employees (just cashiers), and the customers love participating in the creation of their own, personalized frozen yogurt snack.

What if we could do this with medical office workflows? What if the patient interacted with the EHR in a way that gave them some control (with supervision) over the content of their health record? Can an EHR company create the same type of win-win that the new frozen yogurt store did? Of course the answer is yes.

With the YourHealthFile® patient portal, many of the tasks performed by the medical team, including the physician, can now be performed at home or at an office kiosk by the patient. Patients love to participate in their healthcare; they want to understand and interact with their personal health record and find new ways to communicate with your medical practice.

The federal government has a keen interest in patient participation in their personal health record. They are pushing healthcare providers to give patient’s greater access to their medical records. In fact The Department of Health and Human Services (HHS) announced in September, proposed changes to federal laws that would give patients direct access to laboratory test results without having first to talk with the physicians who ordered the tests. Many physicians are skeptical about that level of empowerment; they are concerned that reporting test results without the context of a doctor's explanation will increase patient concern and erode the physician-patient relationship. Other physicians see more patient empowerment as more work for them. I understand their point of view; physicians play an important role in assisting their patients in processing complex medical information. Just providing data to patients is not the solution to patient empowerment, and it will slow doctors down.

Empower Your Patients Through the YourHealthFile^® Patient Portal

Providers need an organized way to empower their patients — they need an online patient portal that promotes self-service and easy interaction between the medical practice and the patient. With the YourHealthFile® patient portal we have found the happy medium of patient self-service and empowerment, with the proper amount of physician supervision and expert advice. We have created the same win-win that our local frozen yogurt store has — a balance that streamlines front office workflow, and actually incorporates patient created chief complaint and medical history data directly into the electronic health record.

Stay tuned for more blogs on the YourHealthFile® patient portal and the concepts and methods we use to promote patient self-service as a way to reduce overhead and increase profitability.

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Get Ready to Be Profiled by CMS — Practice with PQRS Because Your Economic Future Is at Stake

When politicians from both sides of the aisle tell you that they are going to cut Medicare payments, especially to doctors that are not providing “value” to the Medicare program, every provider in the country should listen. Now is not the right time to ignore this issue and hope it will go away. It is not going away; in fact, the Obama administration is accelerating the “value-based purchasing program” that is part of the Patient Protection and Affordable Care Act (PPACA) that was passed by Congress and signed into law by President Barack Obama on March 23, 2010 (a major part of what is now colloquially referred to as OBAMA-CARE).

The Center for Medicare and Medicaid Services (CMS) explains that the value-based purchasing program will transform Medicare from a passive payer to an active purchaser of higher quality, more efficient healthcare. “The Affordable Care Act directs CMS to provide information to physicians and medical practice groups about the resource use and quality of care they provide to their Medicare patients, including quantification and comparisons of patterns of resource use/cost among physicians and medical practice groups.”

Sounds good — information is always helpful, right? Wrong, this is not only about information, it is about payment. “Section 3007 of the Affordable Care Act mandates that, by 2015, CMS begin applying a value-based payment modifier under the Medicare Physician Fee Schedule (MPFS).”

• Both cost and quality data will be used to calculate payments for physicians
• Doctors will be compared to their peers
• Every payment will be adjusted up or down based on a single modifier that CMS chooses for a practice
• Not just a flat rate 1 or 2 percent change in payment

What the Affordable Care Act Means to You

The way the new law works is, beginning in 2015 some medical practice groups or physicians will be subject to a modifier that will change their payment schedule when compared to their peers. By 2017 every provider will be subject to the value-based payment modifier. CMS has not (and maybe will not) provide data on who will be subject to adjustments in 2015 as opposed to the 2017 deadline.

Now you may be thinking – Perhaps I’ll get lucky and they won’t pick me until 2017, and that is over 5 years from now; why worry about something that is 5 years away?

The Obama administration has one more trick up their sleeve. They want to “influence” physician behavior sooner rather than later; they really want to unilaterally accelerate this part of the Affordable Care Act (how else can we afford to pay for insuring all of the uninsured). Here is their solution: the measurement year for the 2015 value-based payment modifier is now 2013, approximately just one year from now. They anticipate that physicians will “be on their best behavior” during the measurement year. So in effect, since providers don’t know if they will be part of the 2015 group or the 2017 group, every provider must prepare to be profiled in 2013. If you believe in the “sentinel effect” (the theory that productivity and outcomes can be improved through the process of observation and measurement), then the Obama administration has accelerated the anticipated savings built into the Affordable Care Act by way of a creative, but not necessarily fair, implementation of the law.

Most of the large medical associations are pushing back against this acceleration, and with good reason. It has become the habit of CMS to de-couple measurement from payment, as they have done with the eRx initiative (measure in 2011 and penalty in 2012). Now this de-coupling has been stretched to a 2-year lag.

The question we are all asking, how is CMS going to profile a doctor? The specifics of how Medicare will calculate payment adjustment modifiers are due in 2012, just months before the measurement period begin. CMS has been piloting some of the value based reporting with medical groups over the past 2 years. Below is a sample summary of data that CMS has used to demonstrate their “physician report card”. The full sample can be viewed on the CMS website.

An Example of Medicare's Physician Report Card

Practice for the Future

For the past several years the government has been experimenting with quality reporting via the PQRS program. PQRS has had very little impact on physician incomes. Change is coming. It is time to get ready. This year we advise all of our doctors to “practice for the future with PQRS”. Get ready to get measured in ways that you could have never envisioned when you applied to medical school. Get your workflows in place now, monitor your chronic care patients closely, and report to PQRS - you won’t be sorry in a year or two.

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iOS 5 Is Here, and So Are the Benefits for MediTouch^® Users

Before we begin the content of today’s blog, like most users of Apple® technology, we mourn the death of Steve Jobs. His inventiveness has been an inspiration to all members of the MediTouch® Team, we will all miss him, but we also remain confident that the iPad® will remain a great solution for healthcare providers.

On Tuesday, October 4th, Apple® held their highly anticipated Let’s Talk iPhone® event with newly crowned CEO Tim Cook. Tim began his keynote address by touting many of the statistics we at HealthFusion® have been emphasizing:

• The iPad® is the #1 undisputed tablet in the world, accounting for three quarters of all tablets sold
• iOS is the #1 mobile operating system in the world, accounting for 43% of the market
• CEO Tim Cook stated, “Over 80 percent of the hospitals in the US are now testing or piloting iPads®.”

While the throngs of Mac® devotees tuned into the event may have been a bit discouraged by the lack of an iPhone® 5, we at HealthFusion® were excited to see the final iteration of the iOS 5 mobile operating system, available for free download to the general public starting October 12th. As we discussed in a previous blog post, iOS 5 Coming this Fall — What Does It Mean for MediTouch® Users?, as certified iPad® developers, we have been privileged to have the opportunity to preview and test Apple’s® new iOS 5. All of the iOS 5 features we forecasted in our previous blog have come to fruition, most with capabilities that have surpassed our expectations, but there is one additional feature we believe will benefit our MediTouch® users — HTML 5 Rich Text Editor.

HTML 5 Rich Text Editor

While many people may be unfamiliar with the term, most people use a rich text editor on a daily basis without even knowing. Essentially a rich text editor is a Web-based word processor; the editors are utilized by many email providers, such as Gmail® and Yahoo®. However, in past iterations of iOS, rich text editing was not supported; even Google® couldn’t find a solution to provide it for their Gmail® users. Therefore, MediTouch® users were unable to edit signed encounters and library templates directly on their iPad®. With iOS 5, MediTouch® users will be able to document directly on their iPad® using a rich text editor (we’ve selected CKEditor®); that means no more having to use a laptop or desktop to edit already signed encounter notes. Starting October 12th, with the release of iOS 5, text editing will be able to be completed directly on the iPad®.

Our iPad® development team has been testing the iOS 5 Beta for months. The team will be testing the golden master copy of iOS 5 this week to ensure that it is safe for our users and ready for the October 12th launch date.

Enjoy iOS 5 and What It Means for MediTouch®

iOS 5 will be available for free download to the general public starting on October 12th. As certified iPad® developers, our iPad® development team at HealthFusion® has had the opportunity to test and experiment with iOS 5 prior to its release, and we are excited by its potential. The transition to iOS 5 for MediTouch® users will be seamless, and we hope to introduce and incorporate new features now possible through iOS 5 in the near future. We are excited about Apple’s® new mobile operating system and what its potential means for MediTouch® users; we hope you share our enthusiasm and enjoy iOS 5.

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Free EHR Software — Be Careful, a Real Catch-22

Free EHR software is a Catch-22! “Catch-22” is a phrase coined by Joseph Heller in his novel by the same name, first published in 1961. It was required reading my senior year in high school (confession; I may have used the Cliffs Notes). It is considered one of the great literary works of the twentieth century, and the phrase "Catch-22" has become part of the American lexicon, commonly used to describe a no-win dilemma like, “heads I win, tails you lose”.

Using advertising-supported enterprises is now part of our everyday ritual. We all use Google® and read our local papers online — those companies now make much of their money from ad-supported revenue. With ad-supported enterprises, users agree to be subjected to advertising, or have their data mined, or both, for the right to use or their service. In many industries, such as “web search”, this model makes sense and in fact, in some cases, is helpful to the consumer.

This advertising model has now migrated to the EHR space. There are several companies that will provide EHR services “for free”, in return for being allowed to advertise to you — the physician — and sell your data to third party data mining companies. They hype the fact that they make the majority of their money from advertising to physicians and selling your data after the PHI has been redacted.

Let’s study the model a little closer and see if there is really value in the “free” ad-based EHR.

First of all, the most popular advertising-based free EHRs do not come complete with a practice management system and clearinghouse. They have recommended partners who charge around $300 for those required services, compared to the integrated MediTouch® product that may save a doctor around $200 per month. The real question is whether this “savings” is worth the hassle, the lack of features and integration challenges; we think not.

The more important issue with ad-based, free EHRs relates back to the Catch-22, no-win dilemma that physicians need to come to grips with when choosing a “free” EMR. There are only two scenarios that can develop with regard to a “free” EHR.

Scenario #1: The “free” EHR Company works with an advertiser, as an example — a pharmaceutical company. A banner ad for a drug is presented on a medication or ePrescribing screen, when in the exam room the doctor reads the ad, then clicks on the ad, and is “influenced” by the ad. The doctor prescribes the drug that was advertised by the pharmaceutical company. This is exactly how advertising should work: an advertisement is presented, the ad occupies the attention of the user, it influences behavior, the advertiser sells product, and in this case that sale partially pays for the use of the service — the “free” EHR. Something is very wrong with this scenario!

1. In the exam room the doctor’s attention should be focused exclusively on the patient. Frankly, I don’t want to seek medical advice from a physician that is distracted from my care by anything or anyone, especially when I am one-on-one with my doctor in the exam room.
2. Physicians should be making medical decisions based solely on what is in the best interests of the patient. At the point of care doctors should not feel bombarded with ads for treatments that may be more costly or less effective than what is best for the patient. What is the chance that the banner ad is coincidently for a treatment that is the best one available? Unlikely.

I have spoken to doctors that believe that these types of distractions and financial influences, for the sole purpose of financing a couple of hundred dollars per month, are unethical and pose a liability risk.

Scenario #2: The “free” EHR Company presents banner ads to physicians, and even though the ads may be distracting, the doctor is never influenced by the ad. The advertiser does not get a “result” for the ad space they buy.

After reading Scenarios #1 and #2 I think the Catch-22 should be obvious.

This is an actual slide shown to prospective investors of a prominent free EHR company.

Note their advertisement and message prompt at the bottom, denoted by the red arrow.

First, if doctors are distracted by ads, and even worse influenced by them, they are teetering on a fine line from an ethical and liability perspective. Could that kind of moral compromise really be worth a couple of hundred dollars per month?

Second, if doctors do not “click”, advertisers will find out quickly that their ads don’t sell their products. Advertisers are capitalists and they will abandon sponsorship of the “free” EHR. The “free” EHR companies readily admit that ad revenue is the key to their success. If doctors act ethically, the resulting lower ad revenues will result in lower company revenues (many ad-based EHRs presently lose money and are financed by venture capital).

Those “free” EHR companies will then have one of three choices:

1. Go broke
2. Start charging doctors to compensate for the lack of advertising sales — their user agreement allows for this provision
3. Sell to another company that charges for EHR services

In addition, some of the “free” EHR companies are not equipped with simple methods to download patient records from their data centers to a machine owned by the provider (MediTouch® does). If they go broke how do you retrieve your data?

Many of these “free” EHR companies really cost more because they can slow down the provider, and they don’t have a set of features that make it easy for the provider to manage patient care efficiently. Many don’t support:

1. iPad® optimization
2. Drawing on images
3. Fully integrated experience across the EHR/Billing/Scheduling/Clearinghouse/Patient Portal
4. Flow sheets
5. Longitudinal patient record
6. Blueprints or templates
7. Meaningful Use report cards

There is no free lunch. “Free” EHRs are not free; in fact, they are expensive. They require a costly ethical compromise — a bet that the great ad-based EHR experiment will work, and a gamble that settling for fewer time-saving features will not lower your practice's productivity. Is that risk really worth a couple of hundred bucks a month?

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EHRs Do Have a Meaningful Use — Especially for Those with Diabetes

According to the American Diabetes Association, there are 25.8 million people in the United States with diabetes, or 8.3% of the population (11.3% of the adult population). Even more alarming, is the fact that another 79 million American adults (35% of the population) have a condition known as prediabetes, a precursor to diabetes. With nearly half of all adult Americans at risk of developing diabetes complications, it makes perfect sense that this demographic and chronic disease would be a focal point for electronic health record (EHR) implementation, and its effect on the standard of care and patient outcomes across all insurance types, even the uninsured.

Randall Cebul, M.D., of Case Western Reserve University, and colleagues had the same thought, so they conducted a year-long survey comparing medical practices in the Cleveland, Ohio area that use EHRs versus traditional paper records, including safety-net practices. Dr. Cebul’s results were published in The New England Journal of Medicine:

“From July 2009 through June 2010, data were reported for 27,207 adults with diabetes seen at 46 practices; safety-net practices accounted for 38% of patients. After adjustment for covariates, achievement of composite standards for diabetes care was 35.1 percentage points higher at EHR sites than at paper-based sites (P< 0.001), and achievement of composite standards for outcomes was 15.2 percentage points higher (P= 0.005).

EHR sites were associated with higher achievement on eight of nine component standards, including:

• Receipt of glycated hemoglobin (HbA1c) values
• Testing for urinary microalbumin
• Prescribing an ACE inhibitor or an angiotensin receptor blocker (ARB)
• An eye examination for diabetic retinopathy
• Giving a pneumococcal vaccine

Outcomes standards included:

• Achieving an HbA1c below 8%
• Blood pressure below 140/80 mm Hg
• LDL cholesterol below 100 mg/dL or having a statin prescription
• a body mass index (BMI) below 30 kg/m²
• Nonsmoking status

Across all insurance types, EHR sites were associated with significantly higher achievement of care and outcome standards and greater improvement in diabetes care. Results confined to safety-net practices were similar."

Essentially, the results from Dr. Cebul’s survey indicate, rather definitively, what we at HealthFusion® have always said: the government’s Meaningful Use incentive program for EHR adoption can improve the quality of care for everyone, across all insurance types. These results may conflict with some available studies that claim the implementation and use of electronic health records have little to no quality-related advantages over traditional paper records. However, many of these studies have limited data sets, rely on old data, or simply neglect to include all insurance types, especially the uninsured. And, with one in six Americans now living in poverty, the discrepancy in insurance coverage is sure to increase and become a more vital statistic for Meaningful Use.

If EHR implementation can help patients across all socio-economic levels better manage and even overcome a chronic disease like diabetes, it certainly seems like that really is the definition of Meaningful Use. Give MediTouch EHR® a try, and see what Meaningful Use can mean for your practice and the health of your patients.

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Primary source: New England Journal of Medicine

The eRx 2011 Saga Continues — Avoid penalties: adopt MediTouch EHR^® and register for the Medicare EHR incentive program.

This blog is the third in a series of blogs related to the bureaucracy of the Medicare eRx program.

On February 24, 2010, in our blog titled, The Electronic Prescribing (eRx) Incentive Program — A lot of stick, not too much carrot, we discussed how the 2011 e-Prescribing (eRx) program was not properly aligned with the more encompassing Meaningful Use incentive program. The conclusion at the time was that users of certified EHR technology were unfairly required to report the Medicare e-Prescribing G-codes on at least 10 claims between January and June of this year (2011), in addition to reporting the eRx measure when attesting to Meaningful Use. At the time, our medical team responded to this requirement by providing the codes in our procedure coding section of the SOAP note, creating a reminder for our users, and making it simple for them to express these codes on at least 10 claims.

On July 12, 2011, in our blog titled, The eRx Incentive Program an Update – A welcome dose of Medicare common sense, we presented the good news that Medicare was planning on amending the eRx rule, and that certain waivers or exceptions would be created that would impact users that did not enter the required G-codes on 10 claims in the first half of 2011.

Now, Medicare has provided more information on who qualifies and how to claim an exception from the 2012 eRx penalty.

In the interest of saving our readers time – if you billed the appropriate G-codes in the first half of this year feel free to stop reading, you will not be penalized in 2012, and for 2011 you have already met the Medicare eRx requirement.

If you did not bill the G-codes on 10 claims in the first half of this year – Medicare has provided more clarity on how to claim exceptions to avoid the 1% penalty next year in a recent blog titled, Greater Flexibility in e-Prescribing Means Greater Success.

In this blog, the authors confirm that a qualified electronic prescribing system for the purpose of the Medicare eRx Incentive Program includes certified EHR technology like MediTouch EHR®. In addition, the following new exceptions to the 2012 penalty were added:

1. Eligible professionals who register to participate in the Medicare or Medicaid EHR Incentive Program and adopt certified EHR technology
2. Eligible professionals who are unable to electronically prescribe due to local, state, or federal law or regulation
3. Eligible professionals who have limited prescribing activity
4. Eligible professionals who have insufficient opportunities to report the e-prescribing measure due to limitations of the measure’s denominator

These four new exceptions supplement the existing two exceptions:

1. Eligible professionals or group practices in rural areas with limited high speed internet access
2. Eligible professionals or group practices in an area with limited available pharmacies for electronic prescribing

The most important new exception for MediTouch® users is the new exception for doctors that register to participate in the Medicare or Medicaid EHR Incentive Program and adopt certified EHR technology.

Medicare is extending the deadline for requesting exemptions to November 1, 2011, and they plan on allowing providers to report exemptions to the 2012 eRx payment adjustment via a Web-based tool.

Medicare has not yet posted that Web-based exception tool, and we still do not know specifically what providers will be asked to attest to when completing the Web form. We will let our readers know when the tool is posted and the final details of claiming exceptions are clarified.

There is not much of a window for providers to claim an exception, since the deadline is less than one month away. We do know this – if you do not want to be penalized in 2012, and you have not already met the 2011 requirement, the clock is ticking. We suggest you adopt MediTouch EHR®, and that you register action for the EHR incentive program on the Medicare Website without delay!

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iOS 5 Coming this Fall – What Does It Mean for MediTouch^® Users?

At the recent Worldwide Developers Conference (WWDC) earlier this summer, Apple® and Steve Jobs announced the upcoming release of their newest operating system, iOS 5, coming this fall. With over 200 new features built into iOS 5, this release is far from just iteration.

The iPad® development team at HealthFusion® is following the new iOS changes closely, and we are reviewing each exciting new feature. As certified iPad® developers, we have been privileged to have the opportunity to preview and test Apple’s® new iOS 5. The new operating system has many new features; most of them will make playing on the iPad® more fun, but a few will enhance the MediTouch® user experience. The operating system upgrade due out in the fall will work with the iPad® or iPad2®.

iOS 5 and MediTouch^®

The following are just a few of the new iOS 5 features we believe can benefit MediTouch® users:

• Tabbed Safari^® Browser – Apple® has implemented tabbed browsing in Safari® to mirror desktop web browsers. With the implementation of tabs, users are able to navigate between pages and sites instantly, with one click. MediTouch® users will be able to easily tab between our web application and another website, like a medical knowledge or research site for example (see image below).

• Faster Page Scrolling – Now, Apple® has made it easier for developers like MediTouch® to leverage the fast (accelerated) scrolling you may have noticed on certain websites – this will make charting faster.
• Airplay^® – Display wirelessly on HD televisions using an iPad2® and Apple TV®. Airplay® enables a patient to experience the same view the physician sees on their iPad®, without looking over their shoulder; further improving the overall physician-patient interaction and experience.
• Camera and Photos – With iOS 5, the Camera and Photos applications have become more robust, eliminating the need for additional photo applications. With autofocus and autoexposure the camera becomes even easier to use. And, with the addition of edit and crop, auto-enhance, and red-eye removal, there is no need to switch between multiple applications. Add MediTouch’s® latest feature, MediDraw®, to the equation, and the documentation, manipulation, and viewing of patient findings becomes even simpler.
• iCloud^® – Like HealthFusion’s® Pure Cloud™ technology, Apple® has moved their focus to cloud computing. Apple® utilizes iCloud® in iOS 5 to provide wireless, over-the-air updates without the need to sync with a computer. There is no longer a need for traditional computers to update the iPad®; a physician can chart and run their practice without ever having to sync their iPad® to iTunes® on a standard computer. Now, just like MediTouch®, the iPad® is ready to use out of the box.

Fun with iOS 5

While the iPad® and MediTouch® are the perfect all-in-one EHR solution for any practice, we understand that most physicians also use their iPad® for enjoyment away from the office. So we have reviewed a couple of the features we thought might be of interest outside the office:

• Reminders – A new feature that will allow you to keep better track of important dates, events, or lists. While MediTouch’s® patient scheduling and tracking of patient flow keeps you on schedule at the office, Reminders will do the same while you’re away. It merges seamlessly with other programs, such as Outlook®, iCal®, and iCloud®, meaning Reminders will automatically be pushed to all Apple® devices. Also, location-based Reminders can prompt you when arriving or leaving a particular destination, like home or the grocery store for example (see image below).

• Game Center – While the iPad® is a tool for physicians in the office, at home it can be a great source of entertainment. As the world’s most popular gaming platform, the improved Game Center brings more game choices and increased social networking capabilities.

Stay Tuned for iOS 5

The more we test Apple’s® iOS 5, the more impressed we are with its stability and speed enhancements. After the iOS 5 release in the fall, we will again review the new features and enhancements of the operating system, and advise MediTouch® users on the ideal time to upgrade. But if our testing is indicative of what’s to come in the fall, we are confident that iOS 5 will be yet another advancement for Apple® and the MediTouch® software suite.

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Meaningful Use Stage 2 – Why worry? We got you covered.

In a prior blog on Meaningful Use Stage 2 (MU2) we compared the current timeline and the proposed new timeline to Stage 2. We concluded that it was probable that MU2 would be delayed by one year from a start date of 2013 to a more reasonable start date of 2014. The question is, what challenges does the next Meaningful Use Stage pose, and how does it compare with MU Stage 1? Those questions were answered, in part, just a couple of months ago.

On June 16, 2011, the HIT Policy Committee conveyed their recommendations to CMS (The Centers for Medicare & Medicaid Services) on the new requirements for Stage 2 of Meaningful Use. These are only recommendations, but they do provide the road map to Stage 2. Typically, these recommendations are not adopted verbatim, but if history is any indicator, these proposed policies will compromise the majority of the Meaningful Use Stage 2 final rule when it is published in the summer of 2012. In fact, according to National Coordinator for Health IT, the ONC Chief, Farzad Mostashari, if the past is any indication of the future, the final rule on Stage 2 is, going to look a lot like, what the (HIT) Policy and Standards Committees recommend.

MU2 is not a revolutionary change when compared to MU1. Most of the changes are incremental, and the MU Stage 2 measures recommended by the HIT Policy Committee fall into one of four basic categories. For each category we supply one or more easy to understand examples. For a complete review of the HIT recommendations, readers may refer to the HIT Health IT Policy Committee’s Recommendations to the National Coordinator for Health IT.

Four Meaningful Use Stage 2 Change Categories

1. Measures unchanged from Stage 1

• Maintain active medication list for >80% of all unique patients – In Stage 1 the threshold is 80% and in Stage 2 the proposed threshold stays at 80%

2. Measures unchanged from Stage 1, except in Stage 2 they are now Core not Menu

• Implement drug-formulary checks with access to at least one drug formulary – this was a Menu measure (not always required) in Stage 1, and in Stage 2 it is proposed to be a Core (always required) measure. MediTouch® already supplies drug formulary checks.

3. Measures with higher thresholds in Stage 2 than in Stage 1

• Record and chart vital signs for >80% of all unique patients – In Stage 1 the threshold was 50%, now the threshold is higher

4. New measures unique to Stage 2

Many of the new measures are focused on what the HIT committee defines as Advanced Care Processes. Some examples of these new measures that contribute to those processes include:

• Recording a list of patient care team members
• Providing a longitudinal care plan
• Secure messaging with patients

The HIT committee believes that this stage (mandating more Advanced Care Processes) is part of a continuum of more advanced use of EHR technology to ultimately achieve “Better Outcomes”. The HIT committee displays that concept in the graph below.

In their graph, the HIT committee shows that each time they add more measures, the level of difficulty becomes greater; this is where we disagree. They don’t take into account the innovation of EMR vendors, like MediTouch®, and the experience that users gain with electronic tools over time.

For quality reporting there will be more measures to report on, and more measures to choose from. There is a strong possibility that there will be a set of Core Quality measures, and then a set of measure categories; providers may need to report on one measure from each category from the quality wheel on the right (feels like a game show).

MediTouch^® Simplifies MU Stage 2

We predict that meeting Meaningful Use Stage 2 will be relatively easy for MediTouch® Meaningful Use Stage 1 users. With Meaningful Use Stage 1, we made the road to success simple and easy to track with our Meaningful Use Report Card™. In fact many of our providers have already attested via the CMS process and some have already “cashed their checks”. We have been tracking the progress of the HIT Policy Committee, and many of the changes they are proposing are already built into MediTouch®. The bottom line, our work on MU2 has already started; so when 2014 begins our users will have all the tools to make the transition to Stage 2 hassle free. Our advice – focus on Meaningful Use Stage 1, with MediTouch EHR® it's easy money; by the time Stage 2 comes around any incremental changes will be a “no-brainer”.

Schedule a Demo Today and Make MU Stage 2 Far Easier

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Working in the Cloud — Advantages of a Cloud-Based EHR

The terms cloud-based, cloud software, cloud-computing, in the cloud, and a bevy of other “cloud” phrases have slowly permeated everyday language. In fact, many businesses have been using cloud-based software for years, such as MediTouch®, and only now are the industry giants, like Apple® and Amazon®, adopting the cloud-based language and software. But what does all this terminology really mean? Essentially, all of the “cloud terminology” means the same thing – the software and associated files are stored on an off-site data server hosted by the software provider or another third-party, making all software and files accessible anywhere there is an internet connection; these days that’s just about everywhere.

Electronic Health Record (EHR) systems essentially fall into two categories: client-server or cloud-based. A cloud-based EHR system stores a practice’s data on external servers that can be accessed through any internet connection. On the other hand, client-based systems store data in-house, meaning a data server, hardware, and software must be purchased, maintained, and stored directly in the physician’s practice. As a rule of thumb, anything “cloud” related applies to web-based software and file storage; the two terms are essentially interchangeable. While client-based EHRs used to be the norm, many practices are now converting to, or opting for cloud-based EHR offerings due to the many advantages.

Now that you have a better understanding of this cloudy terminology, you’re probably wondering what the advantage is to being “in the cloud”? While the terminology may be a bit convoluted, the utility, application, and overall advantages of cloud-based software and data storage are currently unparalleled.

Cloud-Based EHR Advantages

• Implementation – Cloud-based EHRs, like MediTouch®, run and operate on the web, and can be accessed anywhere there is an available internet connection. This means there are no expensive data servers or other hardware to purchase and maintain. So the initial EHR implementation costs are kept to a minimum and physicians are able to use their systems sooner; with MediTouch EHR® you can begin charting the first day you log in.


• Cost Savings – While the initial implementation costs are kept at a minimum with cloud-based EHRs, the savings don’t stop after the system is installed. Instead of paying exorbitant maintenance costs, licensing fees, and additional bills, for most cloud-based EHRs you merely pay a small monthly fee, like a utility bill, called Software as a Service (SaaS).


• Reduced IT Requirements – With no on-site data servers to purchase and maintain, and no IT consultants to pay, there are instant IT reductions from a client-based EHR. In addition, all files and software reside in the cloud, and any installation, migration, or updates are completed by the SaaS provider, with MediTouch® all are included as part of your subscription.


• Accessibility and Collaboration – With cloud-based systems, all data is stored on the web, so information can be accessed from anywhere there is an internet connection; allowing healthcare personnel and their patients to access records outside of the office. With a client-server system, data is only accessible in the office; so any access must be tethered to in-house hardware or routed through remote access software – think of an EHR crawling along at the speed of a remote application like WebEx® or Go-To-Meeting®.


• Safety and Security – Digital records are safer than their paper predecessors. Web-based, cloud EHRs are better than their client-server counterparts. Cloud-based systems must be HIPAA compliant with top-level data encryption, and in the event of a fire or catastrophic disaster, web-based data is stored in data centers at multiple locations with bank-level security; ensuring its safety and security. During the Hurricane Katrina floods, many practices with client-server systems suffered permanent, unrecoverable data loss due to their in-office system’s servers – with client-server systems, your patient data is only a disaster away from destruction. MediTouch EHR’s® cloud-based system is certified by the Drummond Group®, and accredited by the Electronic Healthcare Network Accreditation Commission (EHNAC), a group that audits compliance with HIPAA regulations.


• Scalability – Without the IT woes associated with client-server EHRs, practices large and small can easily use an Electronic Health Record. And, with a cloud-based EHR, adding more physicians or locations is simple, since there is no additional hardware to deal with. Thanks to web-based EHRs, like MediTouch®, small practices can now grow without massive expenses.

Lose the Tether and Join the Cloud

Most people already allow much of their sensitive data to be stored in the cloud, many without even knowing it; so the cloud is really nothing new or foreign. By alleviating cumbersome and costly client-server EHR systems, physicians are able to save money, time, and space. In addition, web-based, cloud EHRs provide better data accessibility and security. Cloud-based EHR systems seem like the obvious choice for any practice. Give MediTouch EHR® a try, and witness the wonders of the cloud for yourself.

Schedule a Demo Today and See What the Cloud Can Do for You

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MediTouch^® — The Only EHR Choice

I recently read an article by Houston Neal of Software Advice. In the article, Houston details the leading web-based and Mac-based Electronic Medical Record (EMR) software, including MediTouch EHR®.

Houston is certainly right, “Apple is winning in healthcare.” As we have detailed in our previous blog, iPad® Tablet Adoption for EMR Use – No Really Means, Not Yet, physicians have adopted iPads® at a rate five times higher than the general public. While other competitors are playing catch-up, scrambling to adapt their EMR offerings to Apple® operating systems, MediTouch® was designed and built from the beginning with Apple’s® operating system and market prowess in mind. While Houston’s article is an improvement on past EMR vendor lists, he still fails to capture the uniqueness of MediTouch EHR®.

List of Features that Make MediTouch® Unique:

• A powerful, all-in-one system, fully integrated with our world-class EHR, Practice Management, and Clearinghouse solutions.
• Platform independent, so it runs on any Apple® or Windows® computers, including tablets, and is ideal for the touchscreen iPad®
• Pre-loaded with specialty specific findings, meaning you can start charting on the first use.
• The leading cloud, web-based Electronic Health Record (EHR); so it works anywhere with Internet access (which is almost everywhere).
• SureScripts® Certified Electronic Prescribing.
• Meaningful Use Certified, complete with a Report Card^™ to help keep you on track to earning $44-64K in Medicare and Medicaid stimulus incentives.
• No EHR start up fees. Easy to deploy without breaking the bank, and simple to adapt to your workflow and style.
• Draw directly on patient images or anatomical outlines using MediDraw^®, either with your finger on the iPad®, or using a mouse on a desktop or laptop.
• Leap beyond templates with revolutionary, customizable technology, allowing you to maintain eye contact with your patients throughout every office visit.
• Connect to all the major labs, and share the results with your patients via our patient portal.
• Automatic updates of all codes, medications, and formulary.
• Backed by live, U.S.-based customer service, and recognized by J.D. Power and Associates® for “an Outstanding Customer Service Experience” two years running!

While Houston’s article covers web-based and Mac-based EMR’s, MediTouch® really straddles both lists. While MediTouch® is iPad®-native — it was designed and built for the Apple® iPad® and its operating system — it also works across multiple hardware platforms, including Windows® PCs, desktops, laptops, other tablets, and smartphones.

Of the nine web-based EMRs listed in Houston’s article, only six are Meaningful Use (ONC-ATCB) certified, including MediTouch®. Of those six, only four, including MediTouch EHR®, work across multiple specialties. And of the four, only one, MediTouch EHR®, is web-based and native to the Apple® iPad® operating system, while also working on other hardware, such as Windows® PCs.

Software Advice and Houston Neal are correct, web-based and Mac-based EHRs are the premier solutions on the market. However, why limit yourself to one or the other when you can have both with MediTouch EHR®? MediTouch® is built to handle the wide-range of computers your practice currently employs, as well as the leader in tablet computing, the Apple® iPad®. At HealthFusion®, we want every member of your practice, no matter the size, to have access to their EHR through their current computer or handheld device. MediTouch® is web-based and built to run on a variety of Windows® and Apple® platforms, from basic desktops to the iPad®, and almost everything in between.

Schedule a Demo Today, and See for Yourself Why MediTouch® Really Is the Only EHR Choice

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Draw on an Image — Because a Picture is Worth a Thousand Words

We have all heard the adage, “A Picture is Worth a Thousand Words,” and for today’s blog I decided to research this common-sense proverb. Is it a famous quote, who first said it, and why? The history of this axiom is murky, but there are those who attribute the essence of this wise saying to Napoleon. Napoleon has been quoted as stating, "Un bon croquis vaut mieux qu'un long discours," or, "A good sketch is better than a long speech". I explained to my kids that my research had led me to believe that Napoleon could indeed be the inspiration for this maxim. They quickly responded that Napoleon was most famous for saying, “Do chickens have large talons?”
The cultural divide is getting deeper; I of course meant the Emperor Napoleon Bonaparte, and they were referring to the more infamous Napoleon Dynamite. Whether it was Napoleon Bonaparte or another, it is widely accepted that the phrase is meant to convey the concept that, a complex idea can be conveyed with just a single image.

For years physicians have been sketching simple drawings to convey their physical exam findings. Many, including myself, would use a simple sketch as part of the progress note to document a finding that was simpler to draw than to explain with words. The added benefit was that when I reviewed my notes, it was faster to look at the sketch and know exactly what my findings were, rather than read one or two paragraphs of text.

A simple, clinical example is the use of a drawing to mark a skin cancer finding on the nostril. I may have drawn a simple sketch that looked like this:

With the conversion to EHR, physicians need a way to draw on anatomical images and pictures of their patients. Sketching on a piece of paper and uploading to the chart is too time consuming. Drawing saves time and often speeds the creating and deciphering of encounters.

The MediTouch® team has provided an eloquent solution to this challenge and, like all of our solutions, it is flexible; meaning it can be used on the native iPad® browser or any computer. In fact, we are the only EMR company that offers this type of drawing solution on the native iPad® browser — MediDraw^®.

Let me tell you more about how MediDraw^® works. Over 100 anatomical outline images are associated with the physical exam section of our SOAP encounter note. When the “get me an image” icon is tapped, the user is provided with anatomical drawings that match the most likely image for the body part in context. In addition, the user can draw on a picture of a patient finding that was uploaded to the chart via a smartphone. Yes, MediDraw^® works on outlines of anatomical body parts and patient pictures.

Now let’s look at the MediTouch® way to document the skin cancer finding on the left nostril, using MediDraw^®

Draw Directly on a Patient Image

Draw Directly on an Anatomical Outline

It’s fairly obvious that these images are superior to my free-hand drawing!

For most EHRs, drawing is either not possible or too time consuming. MediTouch EHR® has created a fast and unique drawing tool, MediDraw^®, that works great on the iPad® or any other computer. Now, encounter creation with MediTouch® has just gotten faster and more precise. Napoleon would be proud!

Take Our Drawing Tool For a Test Drive…

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Meaningful Use 2 Rumors of Delay Until 2014 – A reward for 2011 early adopters

For the past several months rumors have been circulating that Meaningful Use Stage 2 (MU 2) will be delayed until 2014 – a one-year delay. This delay will impact 2011 adopters, since they will not be required to adopt the new MU criteria until 2014, instead of the current rule that requires 2011 attesters to adopt MU 2 in 2013. This delay will also impact all of the other healthcare constituents, including EHR vendors. EHR vendors will have an extra year to build any improvements into their software required by the new MU 2 rules.

Farzad Mostashari, M.D.

In June, the Health IT Policy Committee, in a 12 to 5 vote, recommended delaying by one year (until 2014) Stage 2 of the Meaningful Use program for those providers complying with Stage 1 criteria in 2011. They were reacting to the many concerns from providers and electronic health record (EHR) vendors that 2013 was too aggressive a target for MU 2. The Health IT Policy Committee sent a letter to Farzad Mostashari, M.D. (he recently replaced Dr. David Blumenthal), the National Coordinator for Health IT, that the current schedule for compliance with Stage 2 objectives in 2013 posed, "a nearly insurmountable timing challenge," for those who attested to Meaningful Use in 2011.

The delay to 2014 seems inevitable, since early this month Dr. Moshashari said that he approved of the recommendations by the Health IT Policy Committee for delaying MU2 until 2014. This was the confirmation that the healthcare industry was anticipating, regarding approval of the HIT advisory group’s recommendation by government policy makers.

Mostashari’s view is that providers who attest to meaningful use in 2011 should be rewarded, and by delaying the onset of stage 2 the government will be encouraging more providers to attest in 2011, since they no longer have to be early adopters of MU 2. He stated to the HIT committee, “The last thing we want to do is provide a disincentive towards attesting for meaningful use in 2011. We recognize that not accepting your recommendation to delay the start of stage 2 could negatively impact provider participation rates in the EHR incentive program in 2011.”

Does this sound like spin? It does to me, and it definitely demonstrates poor planning by the government. It is already July and to demonstrate MU for 2011 providers have just 3-4 months to get started for this year. Is this change in policy really going to change the course of MU adoption this year, probably not, the damage has already been done. The government spooked many providers by making MU 2 criteria vague and the adoption schedule for MU 2 too close to MU 1. They have already forced too many providers to the sidelines for this year because those providers did not trust that there would be ample time to prepare for MU 2. The truth is that the government is out of touch with the provider community. Their initial MU 2 recommendations do very little to simplify the practice of medicine for providers, and they are bumping up against a lot of resistance from providers and EHR vendors. They are buying some more time for everyone, including their own policy makers, to get MU 2 right.

Instead of recognizing that their MU 2 proposed guidelines (we will review in a future blog) need to be more provider-friendly, Mostashari recently remarked that, by giving providers and vendors additional time, requirements for stage 2 can be more rigorous. Is this any way to motivate the provider community?

He also remarked that, “… it makes sense to maintain the current expectations for those first attesting to meaningful use in 2012 so that all providers attesting to meaningful use in 2011 or 2012 would attest to stage 2 in 2014. Essentially, there is no “break” for 2012 first year adopters.

This delay was inevitable, because, at the onset of the MU program, the MU2 measures were never finalized. In fact, The Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare and Medicaid Services (CMS) anticipate releasing their proposed rules on meaningful use of electronic health records (EHRs) and standards along with certification criteria by the end of 2011 or early 2012, accepting public comments about it, and finalizing it next summer. Based on that schedule it would have been impossible for providers and vendors to “gear up” in just six months for a 2013 MU 2 start date.

Recap

• Meaningful Use Phase 2 was originally slated to start in 2013.
• Previously only providers that were recognized MU users in 2011 had to start MU 2 in 2013.
• Previously providers that started 2012 had until 2014 to start MU 2.
• The government has not finalized the requirements for MU 2 yet.
• The government may not finalize MU 2 requirements until the summer of 2012.
• It appears that because of these delays that MU 2 will be delayed until 2014.
• Whether a provider starts MU 1 in 2011 or 2012, they will both start MU 2 in 2014.
• Some providers delayed starting MU 1 in 2011 because they feared a hurried start of MU 2.
• Now providers that are ready to start MU 1 in 2011 will have the time they deserve to prepare for MU 2.

Timeline View of Recent Meaningful Use Events

It appears everyone can now take a deep breath and not feel hurried regarding Meaningful Use Stage 2. But there are still many questions that must be answered about MU 2. In a future blog we will discuss the preliminary recommendations regarding MU 2, and how they will impact the provider community. This delay gives the provider community the opportunity to push for EHR standards that help to simplify the practice of medicine, and I hope we take advantage of it. In the meantime, the best news is that being an early adopter of MediTouch® technology means that you will have extra time to prepare for MU 2 – great news for our providers that are cashing their checks this year!

Schedule a Demo Today

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EHR Vendors Can Lead the Way on Quality – Can we really wait for the government to innovate?

Many of the ways that EMRs relate to public health issues have been closely linked to government mandate, especially with the advent of Meaningful Use. Even before Meaningful Use, providers and EHR vendors were mostly in reaction mode, responding to the PQRS (formally PQRI) and the eRx (electronic prescribing) incentive programs. When I read the blogs of the large EHR vendors, I have noticed a persistent push-back on new regulations or requirements. Some of the resistance to follow the government’s lead is well deserved. There are at least 5 Meaningful Use Measures that were legislated as part of the HITECH Act that are confusing or “not ready for prime time”. I have also observed that, with Meaningful Use part 2 – due in 2013, many vendors are pushing for less change not more; we will blog on Meaningful Use 2 soon.

The real question is, why can’t EHR vendors innovate without government intervention or incentive? At MediTouch® our medical team believes we can. We recently demonstrated the way we lead innovation during a topical public health challenge, the Whooping Cough outbreak (in some states).

According to the Centers for Disease Control (CDC):

Pertussis (Whooping Cough) is an endemic (common) disease in the United States, with periodic epidemics every 3 to 5 years and frequent outbreaks. In 2009, nearly 17,000 cases of pertussis were reported—and many more cases go unreported. The primary goal of pertussis outbreak control efforts is to decrease morbidity (amount of disease) and mortality (death) among infants; a secondary goal is to decrease morbidity among persons of all ages.

From January 1 through December 31, 2010, 9,477 cases of pertussis (including ten infant deaths) were reported throughout California. This is the most cases reported in 65 years. In Michigan, an increase in pertussis was first observed in the second half of 2008, continued throughout 2009, and has continued to date throughout 2010. This is on top of a long term rising trend in the reported number of pertussis cases since about 1990. In Ohio, Columbus Public Health (CPH) and Franklin County Board of Health (FCBH) responded to an outbreak of pertussis during 2010. For 2010 year-to-date, there were 964 cases reported by Columbus and Franklin Counties.

Experts now recommend that adults and adolescents receive a Tdap booster vaccine to protect against whooping cough. It is especially important for those in contact with infants younger than 12 months of age. The Tdap booster is recommended, instead of the previously recommended Td (tetanus-diphtheria) booster. In many states, the Tdap booster is required before an adolescent can begin middle school in the fall. In fact, every physician in California recently received a reminder from the state’s public health officials regarding the immunization of adolescents, and the school requirements for this fall when the new school year begins.

Even though the recommendation for Tdap has changed, many of the standard quality measures have not been updated to meet the challenge of the recent Whooping Cough endemics, but MediTouch® has. Based on the new requirements, our medical team has responded and developed a clinical quality measure that works seamlessly with our Health Maintenance module. Now, every provider that opts in for reminders regarding our adolescent vaccine measure will be reminded to vaccinate their middle school age patients against whooping cough on time, for the start of school.

Our medical team’s responsiveness is a good sign for providers who use our system, or are considering adopting our iPad® friendly EHR. It proves that we have our eye on innovation. Innovation, not government regulation, is essential to the type of workflow enhancements that save practices money and generate revenue for the practice. The $44k – $64k in government incentives are just part of the positive economic impact of EHRs on provider practices. Ultimately, it will be the non-regulated innovation of EHR vendors that will transport the provider community to the EHR Promised Land – higher quality, lower costs, and increased revenue.

By implementing our latest clinical quality measure, Immunizations for Adolescents - updated for the latest requirements related to Whooping Cough, we prove that innovation means higher quality, lower costs, and increased revenue. Providers are now reminded at the point of care about the latest vaccine requirement, which translates into higher quality and reduced cost. In addition, their practices can use the opportunity to contact patients eligible for the vaccine during the summer months, when their practices tend to slow down a bit. Healthy patients, compliance with the latest vaccine regulations, and increased revenue – everybody wins. I’ll take innovation over regulation anytime!

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The eRx Incentive Program an Update – A welcome dose of Medicare common sense

Several weeks ago we authored a blog entitled, “The eRx Incentive Program – A lot of stick not too much carrot”. The essence of the blog was that the Medicare eRx, “quality initiative was poorly aligned with other government programs, especially ones that are intentioned to reward early adopters of EHR technologies.”

Let's recap the government eRx program – from our prior blog

The eRx program for 2011 will pay a meager 1% of their Medicare Part B PFS covered professional services. Contrast that amount with the EHR incentive program, up to $18,000, and it is clear that providers should be focused on the EHR incentives and not the eRx program.

1. The government sponsors an eRx incentive program (1% in 2011)
2. The government sponsors an EHR incentive program (up to 18k in 2011)
3. If you are in the EHR program you cannot qualify for the eRx incentive
4. Meaningful Use EHR users can be penalized 1% in 2012 even if they e-prescribe with their certified EHR

If you planned on targeting the EHR incentive program, you still could have been penalized in the eRx program, even though the Government Meaningful Use EHR program included similar, if not stricter, e-prescribing regulations when compared to the less comprehensive eRx incentive program.

The government offered a “work around” for EHR users – who just had to remember to include special G-codes on at least 10 claims and avoid the 2012 penalty related to the eRx incentive program. Busy work, silly and time-consuming, and certainly not aligned with the government’s ultimate interest, which is accelerated adoption of comprehensive EHR products.

MediTouch® responded quickly and installed a tool that, with a single click per encounter, assisted providers in passing the proper G-code to Medicare, so they could avoid the 2012 eRx penalty.

Now that the mad rush to add G-codes to at least 10 claims is over (the January – June 2011 deadline), the government has finally seen the light of day. They have proposed a new rule, we expect will be officially adopted sometime this summer, which offers certain “waivers” to the current eRx bill. Guess what? – the policy makers back in Washington figured out what every doctor and medical association knew many months ago: the eRx incentive rule needed a dose of adjustment, especially with regard to alignment with the Meaningful Use EHR incentive.

Now with the new eRx rule, G-code or no G-code, meaningful users of EHR technology won’t be penalized by the eRx incentive program in 2012. That’s great, but way too late. The government’s relationship with the physician community is tenuous at best; let’s face it most docs do not trust the Medicare program and they are skeptical of all government programs. It took at least a year for Medicare to cure the mal-alignment between the eRx and Meaningful Use incentive programs. In the meantime it cost the government credibility, and it was expensive for providers that were trying to avoid 2012 Medicare payment penalties, because every one of those docs had to train their billing staff to add the G-codes. Now that those providers who are tracking for Meaningful Use have added those codes, they have quickly come to the realization that the entire process was an exercise in futility.

In a recent article on the front page of the AMA News, government officials have promised to do a better job of re-examining regulations that are burdensome and costly to the provider community. The AMA News reported that:

“An initial review of the rules has determined that some regulations appear to be redundant and unhelpful,” said Jack Lew, director of the White House Office of Management and Budget. "It will be asked if some of these actually benefit patients or are they a matter of bureaucratic, anachronistic rules," Lew said.

In addition, the AMA News reported that Medicare is looking at the following potentially burdensome rules. They include:

• Requirements to provide translators for Medicare and Medicaid patients with hearing impairments or limited English proficiency.
• Misaligned incentive programs, such as EMR meaningful use and the physician quality reporting system.
• Overlapping claims reviews by auditors, such as Medicare administrative contractors and recovery audit contractors.
• Various Medicare documentation requirements.
• The prohibition on the use of Medicare consultation codes.
• Burdensome Medicare enrollment requirements.

The government needs to act quickly on aligning incentives and cutting through red tape as it relates to providing regulatory relief for providers. We are at the early stage of EHR adoption, and widespread EHR adoption is key to saving the Medicare program (I want to get my benefit someday). Building trust with the physician community is essential to accelerating EHR adoption, and embracing EHR technology is essential to saving money and more importantly, lives. Let’s hope this eRx issue was just a small bump on the road to EHR adoption, and not the large pothole it appeared to be just a few weeks ago.

Our team has worked diligently with providers in an attempt to build trust in the Meaningful Use program in order to facilitate EHR adoption, and these types of bureaucratic mistakes are, at the very least, counter-productive for all constituents of the healthcare delivery system. The fact that MediTouch® users have started to bank their Meaningful Use incentive dollars has worked wonders to reinforce what our team has been proclaiming for months – the government is ready and willing to make good on their Meaningful Use EHR promises.

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Take a Picture with Your Smart Phone or iPad2® – It’s a Practice Builder

Last week I was at a family event to celebrate Father’s Day. Aside from the fact that some relatives looked a little older and some a little plumper, I noticed a change when compared to last year’s Fathers Day celebration – no traditional cameras. This is the first time in years we had a celebration without a single device solely dedicated to taking pictures. There were of course many cameras – too many to count, since most everyone now has a camera and photo feature built-in to their smart phone. I posed for pictures taken with Blackberry’s®, Android® devices, iPads®, and of course iPhones®. Everyone was taking pictures, and at the end of the event my email inbox was full of memories.

Let’s face it – there is nothing more convenient than taking a picture with a smart phone or an iPad2®. In fact, the iPhone® alone has become the most common source of uploaded pictures at the commonly used picture-viewing site, Flickr®.

For years plastic surgeons have been using photographs of patients, or their clinical findings, to show patients “before and after” results. In addition, a small number of physicians have used cameras to document clinical findings for comparison upon future visits, to document complex findings, or for medical-legal purposes. Having a picture of clinical findings is always helpful, and patients love to see visual evidence of their improvement.

The problem has always been, taking pictures of a patient’s clinical findings is time consuming – it required many extra steps. Even with adoption of Electronic Medical Record technologies – most EMR vendors make the upload process of photos time consuming and complex – too complex for providers to perform in the exam room or at the bedside.

With MediTouch® Advanced Document Management it is simple to get a picture of your patient into the appropriate patient chart – it takes 30 seconds, and this set of screen shots shows you how simple it is. No EHR vendor can rival the simplicity and speed of our patient, image documentation process.

We will use the iPad2® as our image-capturing device, and I have taken a picture that documents a patient’s acne. (Simulation)

The Simple MediTouch® Process

1. I have been assigned my practice’s unique MediTouch EHR® email address and saved it as a favorite contact – so when I send an email my MediTouch EHR® email address “pops up” like any other favorite contact.
2. I have placed the patient’s unique chart number in the subject field (no name or date of birth required). Note: there was no use of any PHI – so we can feel comfortable that our process is HIPAA compliant.
3. I have attached the picture.
4. When I click “Send” – this image is sent to the patient’s chart and can be filed – Simple!

To the right is a view of the patient’s image as it appears in the patient’s MediTouch® document file. The image can be easily incorporated into any encounter note.

 

Later, after treatment, I can instantly create before-and after photos; contrasting the previous picture with a new picture of the same patient, now with a much-improved complexion.

When I speak with doctors who are not accustomed to documenting encounters using images, many of them are skeptical of the value of making a patient image part of the encounter record. We at HealthFusion® believe that using images, and sharing them with your patients, is a real practice builder. There is nothing better or more powerful then reinforcing your successful care with pictures that document the positive results of your treatment; plastic surgeons have been doing it for years. Now with MediTouch® Advanced Document Management, in just seconds any practice can document using patient images, making their documentation more precise and improving the overall patient experience.

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Get Onboard MediTouch® Grand Central – Zip through encounters at warp speed

Many physicians resist EMR adoption because they believe that they can complete a paper chart faster than an electronic one; we understand. I recently ran into a doctor that showed me his progress note for a patient with a sore throat. It read as follows:

• S. Sore Throat
• O. Throat erythema
• A. Pharyngitis
• P. Amoxil x 10d

Without opining on the completeness of this encounter note, the fact is that this doctor’s chicken-scratched, handwritten note could be completed in several seconds. The status quo may be hard to compete with, but the status quo may not be optimal. This encounter note would be difficult to code with any reasonable E/M code, creating more work for the doctor than the amount of time he must have spent on this encounter.

As clinicians and as an EMR vendor, we are not ready to accept what most EHR vendors profess – they explain away their slow charting process by rationalizing that they can enhance productivity by:

1. Saving time, tracking patient data
2. Helping organize patient encounters
3. Enhance physician documentation

Organization saves time, but it is not an excuse for EMR systems and products that slow encounter speed to a halt. Providers need to quickly move through encounters, and they should not have to enter phrases and care plans repeatedly. Much of what physicians do or say, they have probably done or said before in a prior encounter; but only parts or segments of that prior encounter may apply to the patient they are currently treating. Providers need a way to fit together the jig-saw puzzle pieces of prior encounters, in order to help them build their current chart note. They need MediTouch® Grand Central – the best way to interconnect all of a provider’s best thoughts and observations for repurposing in a new encounter.

With MediTouch® Grand Central, every time a provider creates a new encounter, they can save that encounter for reuse as a MediTouch® Encounter Blueprint for just a single patient, either for themselves exclusively or for their entire practice. With patients who are seen regularly for chronic diseases, their encounter changes vary subtlety over time – a great example of a time to create a patient specific MediTouch® Encounter Blueprint. Other times, providers may decide that for certain patient complaints, the charting is nearly identical for all of their patients, a great time to create either a provider or practice-wide Encounter Blueprint.

One of the great features of MediTouch® Grand Central is that Blueprints can interconnect. For a new chart note there may be a set of findings for the Chief Complaint and HPI from one Blueprint, that should be combined with a set of physical exam findings from a different Blueprint. Interconnecting Blueprints is simple with Grand Central; by interconnecting the appropriate Blueprints, providers can customize their documentation for a specific patient encounter by re-using portions of prior encounters without having to create new findings or text from scratch.

Interconnecting Blueprints is a great feature, but let us assume that a Blueprint is nearly exact in accurately documenting the current encounter, but some portions need to be tweaked to precisely depict the clinical findings of the patient who is currently being treated. Blueprints link to all of the vast, structured data creation methods already built into MediTouch®; to customize a Blueprint the user can utilize the current encounter creation infrastructure they are used to using from building past encounters, “from scratch.” MediTouch® Grand Central is completely integrated with all of the great features already built into our EHR. That means we built Grand Central to work on the iPad®, requiring very few keystrokes to unleash the power of encounter creation with Grand Central.

Repurposing your hard work is an important requirement of EHR systems, and no system does that faster and easier than MediTouch®. Speedy encounter creation requires a system that reuses your prior work, and that can apply parts or all of that work to a future encounter. Do not accept the typical “EHR vendor speak” about all of the great reasons why it is a good idea for you to work harder and longer hours because EMR use is inevitable. Reject any EHR that requires you to do “homework”. Instead, your goal should be to chart at the point of care, in the exam room with your patient, just like the “old days”. MediTouch® Grand Central makes that goal a reality – on the iPad®, or on any standard hardware device.

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iPad® Tablet Adoption by Doctors for EMR Use – No really means; not yet

Several years ago I was at a physician CME meeting and I asked my doctor buddies if they had purchased a smartphone, a phone with email capabilities, internet browsing, etc. I showed them my early version Blackberry®, and these were some of the comments:

“What do I need that for? – I have an answering service.”

“I work all of the time – now you want me to carry my work with me.”

“I already carry a beeper; do I really need another work related device?”

Recently, I met up with some of those very same doctors at still another conference – guess what? They were showing off their iPhones®, Android®, and Blackberry® devices. What a difference a few years makes in adoption of new technology! We were speaking about the ease of conversion to new smartphone technology. My physician associates all explained that they spent an hour or so at the local AT&T® or Verizon® store, paid a couple of hundred bucks, and they were out the door with the latest technology. The cell phone retailer was even able to convert their contacts and appointments to display perfectly on their new smartphone devices. Even though they were late adopters of this new, highly functional, and even fun technology, there were really no penalties or drawbacks.

With EMR technologies, my physician cohorts do not have the same luxury as they had with smartphones. This time around they need to play it safe and purchase an EMR that is built for the latest trend in computing – the mobile tablet, specifically Apple’s® iPad®. Some providers may believe that they will never use an iPad® in their practice; they also probably did not believe they would ever get email on their phone. Those providers should continue to use the hardware platform they are most comfortable with today, but purchase MediTouch® because as they become more comfortable with new tablet technologies, they will eventually convert from their current hardware platform to a mobile tablet.

In fact, a recent study, authored and conducted by QuantiaMD® (an online physician-to-physician learning collaborative), found that the overwhelming majority of physicians are charting on a mobile tablet, or believe it is likely they will be charting on a mobile tablet in the future.

© 2011, Quantia Communications, Inc.

With MediTouch EHR® they can “hedge their bet”, because our software works on all of the standard hardware platforms (laptops and desktops), and also on Apple’s® iPad® tablet. Our universal approach matches the workflow of medical offices; some users are “on the go”, not tethered to a desk – they require a mobile computing platform; while others, such as billers and schedulers, spend almost 100% of their time at a workstation and should be using desktop computers.

According to the AMA News, “One year after Apple® launched its first iPad tablet computer, 27% of primary care and specialty physicians own an iPad® or similar device -- a rate five times higher than the general population, according to a report by the market research firm Knowledge Networks.”

Physicians have adopted iPads® at a greater rate than the general population, but most are not using them in clinical practice. They are not using iPads® as the hardware solution for their EMR software because most EMR companies do not offer effective hardware support on the iPad® platform. In fact, MediTouch® is the only Meaningful Use Certified EMR, native to the iPad® software, and hardware platform. We have compared ourselves to the largest and most prominent EMR software vendors, as well as to EMR vendors that provide downloadable iPad® EMR applications.

The majority of the most prominent EMR products can only display their software on the iPad® over a network using slow-running, remote access software (think of running your EMR through webinar software like Webex® or Go-To-Meeting®). The EMR application is not actually running on the iPad or the iPad® browser. Instead, the remote access application is allowing you to view the application, as if you were at a desktop or laptop. This approach will allow you to access their old-fashioned, EMR but the experience is slower and not optimized for iPad® use and touch.

Downloadable iPad® App EMRs have limited functionality. Physicians can perform basic tasks, such as capture billing charges, view a patient record, or track patient schedules. But, they don’t offer a complete set of features that other EMRs offer. They don’t work on multiple hardware platforms. Most importantly, iPad® EMR Apps don’t have ONC-ATCB certification. Therefore, these applications cannot achieve Meaningful Use, and users cannot access the $44,000 – $64,000 in HITECH Act incentive funds.

We have compared MediTouch® to the largest and most prominent vendors, as well as to other vendors that sell downloadable iPad® EMR apps in the following table:

When choosing an EMR there is really just one choice – MediTouch EHR®.

If one follows the history of smartphone adoption, then it is reasonable to conclude that most every provider will be migrating to a mobile tablet technology like the iPad®; it’s really only a matter of time. Migrating EMR data is not as simple as moseying over to the Verizon® or AT&T® store and leaving with all your data in a new EMR system. EMR migration could cost a provider tens of thousands of dollars, and take months of time.

One can only conclude that even providers who are skeptical of tablets today, MUST LEAVE THEIR OPTIONS OPEN. Today’s physicians need a tablet that is Meaningful Use Certified, which can work on any hardware platform, and that does not require servers or remote access software; they require software that works natively with iPad’s® web browser. Physicians need to play it safe and adopt a flexible solution, because they need to plan for the day when everyone is working on a mobile tablet. That day is fast approaching, and there is only one way to plan for the inevitable – ADOPT MEDITOUCH EHR® TODAY!

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MediTouch® Provider Uses iPad® to Get Stimulus Payment For $18,000, towards $44,000 – Why not you?

HealthFusion® is proud to report that our first MediTouch® physician user has received their initial payment of Meaningful Use Incentive Funds as part of the Centers for Medicare and Medicaid Services (CMS) Stage 1 Electronic Health Record Meaningful Use Medicare Incentive Program.

MediTouch EHR® user, and Ear, Nose and Throat specialist, Mark Uzansky, D.O. of Livonia, MI became one of the first physicians in the nation to receive $18,000 in stimulus funds, successfully using HealthFusion’s MediTouch EHR® to complete the first phase of the CMS Incentive Program.

Dr. Uzansky achieved Meaningful Use by using the MediTouch® Web-Based Integrated Solution. The MediTouch® system facilitated management of all of Dr. Uzansky office requirements including the billing, scheduling, clearinghouse and electronic health records, including electronic prescribing. Meaningful Use EHR charting was performed predominantly via fingertip touch input on an Apple® iPad®. Using this technology to achieve meaningful use is a first in the industry!

Dr. Uzansky stated, “As an ENT specialist, my practice required an EHR that would allow for primary care charting as well as specialty charting. The MediTouch self-customization was easy to set up and being an Internet based system, my charts are secure, HIPAA compliant, and I can access my charts anywhere in the world."

The 2009 HITECH Act, “the stimulus package”, provides for $19.2 billion in federal incentives to encourage physician adoption of EHR (electronic health record) technology. The law is a major advancement toward improving health care quality, while reducing costs and medical errors. According to the HITECH Act, physicians are eligible to receive up to $44,000 from Medicare, over five years, in total incentives per physician for Meaningful Use of a certified EHR starting this year. Medicaid Providers may receive close to $64,000 starting this year. Dr. Uzansky qualified and received the $18,000 stimulus check by demonstrating just 90 continuous days of Meaningful Use with the MediTouch EHR®. Dr. Uzansky is also eligible to receive an additional $12,000 check next year and the balance over the following 3 years by continuing to utilize MediTouch® in his daily practice.

This payment represents the first of many payments that we expect MediTouch® users to achieve. Every day our system is tracking, managing, and reporting on the Meaningful Use process, so that MediTouch® physicians meet the government guidelines. With MediTouch® we manage to get our providers prepared for reporting Meaningful Use, without a lot of alarms and pop-ups that distract the physician from the most important part of their practice – their patients.

MediTouch’s® cloud-based solution is able to track, in real-time, the progress of our entire physician user database, and adjust our program such that our eligible providers can collect incentive dollars free of stress and hassle. To assist those eligible providers in qualifying for stimulus funds, MediTouch® translates provider data into an easy to understand Meaningful Use Report Card™, which enables those eligible providers and staff to understand their performance and meet the CMS reporting requirements.

There will be additional stages to Meaningful Use (Stages 2 and 3) and MediTouch® is committed to rapidly adopt any new measures that the government mandates for those new stages. Our software was certified for Meaningful Use Stage 1 within the first 30 days of the certification program and our providers can expect the same level of commitment from MediTouch® for the next stages. Our doctors won’t need to be retrained or purchase new software to achieve the next stage of Meaningful Use, our web based solution updates automatically!

It is great that our first provider has banked his initial Medicare Meaningful User Incentive Payment, but rest assured, the MediTouch® team will not rest until all of our providers receive their entire incentive payment over the next 5 years!

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The Longitudinal Patient Record – A virtual "MRI" of your patient's medical record

With EHR adoption there is an opportunity to improve the health of your patient population. There are certain tasks that become more accurate when the processing power or formatting of an EHR is leveraged. This is one in a series of articles that explains how the “Holy Grail” of improving quality at the point of care is achieved with MediTouch EHR^®. See our prior post on MediTouch Health Maintenance.

When speaking to providers that are considering the move to EHR from paper charts we commonly hear that they feel that it may be challenging for them to find the mission critical data required to make clinical judgments efficiently and accurately. Those providers have an almost sentimental attachment to their paper chart. With the paper chart they “know where everything is”. To a layperson the paper chart may appear cluttered and so 20^th century. To the provider that paper chart is a familiar resource chock full of medical data. There is a very good reason why physicians may feel this way.

When it comes to giving a doctor a fast and easy way to look at all of the clinically significant data relating to a patient most EHR vendors don’t get it right. It’s a little like the three bears, some offer too much, some too little but most don’t get it “just right”. Some EHRs provide a single screen with so much data that the important data just doesn’t stand out and trying to find the clinically significant data is dizzying. Other vendors spread out the data such that there is no central place to review all of the data in an organized fashion. A recent article in the DO magazine featured a physician that understandably explained, “Moving from screen to screen is the most frustrating thing with this system. With a paper chart, I quickly flipped through it to get from one part to the next.” Also, because (the doctor) is focused on the computer screen while recording data, eye contact with patients is compromised.

Extracting clinically significant lab results from electronic lab result transmissions is especially challenging. Consider that the provider must filter through multiple panels and each panel may be comprised of dozens of results. One lab order could mean dozens of individual results. Easy to review one time, but not easy to retrieve upon subsequent visits.

Providers need a solution that is “just right”, a single screen that presents the user with an easy to read synopsis of all of the patient’s history, medications, and clinically significant findings and events. They need MediTouch EHR’s^® Longitudinal Patient Record and Interactive Timeline. With our Longitudinal Patient Record, providers can just glance at a single screen and learn everything they need to know about their patient in a “heartbeat”. They can scroll an interactive timeline that provides an innovative graphical view of events relative to the patient’s medical status. Any lab results that are marked clinically significant will display on the record and become part of the interactive timeline. No more searching for pertinent lab results.

We find it ironic that many doctors believe that their paper chart is more organized than their electronic record. If you asked a layperson what should be easier to digest they would obviously say that the computerized data should be simpler. The fact that providers such as the one quoted in today’s blog still long for their paper chart reflects the failure of most EHR vendors to recognize the mechanics of point of care clinical decision making. Viewing your patient’s history, medications, and clinical findings at a glance speeds up the encounter and is paramount to providing quality healthcare. The MediTouch^® Longitudinal Patient Record is yet more evidence of our medical team’s commitment to our physicians’ goal of providing high quality healthcare.

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Electronic Prescribing of Controlled Substances (EPCS) — Sorry not yet ready for primetime

There's not a week that goes by that we don’t receive a comment from a physician that goes something like this; “We love the ePrescribing module in MediTouch EHR – we wish we could use it on all prescriptions (controlled substances also)”. We thought it would be a good idea to “clear the air” on why there are two workflows for prescribing and why providers should not hold their collective breath on a change in the status quo. Let’s start with some background on prescribing of controlled substances.

The New Law
On June 1, 2010 the government enacted the Electronic Prescriptions for Controlled Substances law. The purpose of the EPCS law is to revise DEA regulations to provide practitioners with the option of writing prescriptions for controlled substances electronically. The new regulations are an addition to, not a replacement of, the existing rules. The goal of the new regulations is to provide pharmacies, hospitals, and practitioners with the ability to use modern technology for controlled substance prescriptions while maintaining a tight system of controls on controlled substances. In fact you may have received a letter from the DEA that said a law was passed that allowed for EPCS. Legally there is now a path to EPCS but it is just the first baby step toward that goal. The letter that most providers received was misleading because it raised the expectation of providers that EPCS was possible immediately and that was just not true although with the passage of the law now EPCS is (theoretically) possible.

About Controlled Substances
The Drug Enforcement Agency (DEA) provides national rules for prescribing controlled substances, also known as scheduled drugs. There are 5 schedules, reflecting the drug’s abuse potential. “1” is for drugs that are felt to have no therapeutic use such as heroin and, in practice, is never used. “2” is strong narcotics such as Dilaudid or morphine as well as other drugs with a high abuse potential such as Adderall, an amphetamine drug used for ADHD. Schedule “3” includes weaker narcotics such as Vicodin or codeine. “4” and “5” include a wide variety of drugs such as Valium and Ambien. (A few states add other drugs such as Soma, a muscle relaxant.)

Today, Schedule 2 substances still must be handwritten and cannot be called in to the pharmacy. Schedule 3,4,5 can be “called in” or manually signed and then manually faxed. No scheduled drug can be electronically faxed or transmitted via Surescripts. DEA regulations specifically disallow any use of a stamped bit-map signature on a controlled substance prescription. Nonetheless, some e-prescribing systems do work that way. Per the DEA, the pharmacist and the doctor are breaking the law and are both liable for use of a bit-map stamped signature.

Three New Types of Certification
The new regulations specify 3 types of “certification: Doctors, eRx software and pharmacies.

Doctors
Each prescriber (doctor or midlevel) will need to be “identify proofed.” This may be as simple as referring to hospital credentialing or may require a visit to a police station or other government agency. The prescriber will be given a unique ID that will be entered into the prescribing system and forwarded to the pharmacy as required. A third party will probably administer this and there will be a cost to the provider for becoming identity proofed initially and for bi-annual updates. We expect the cost to be a few hundred dollars.

e-Prescribing software
Each system, including MediTouch must build infrastructure to support the DEA workflow and technical requirements. An example of workflow: a unique ID must be manually entered for each session of EPCS. This means that, when a scheduled drug and a pharmacy able to receive are selected, the prescriber will obtain a code number, possibly via text message, that must be entered to proceed. This may prove to be very time consuming; unfortunately the DEA has required a workflow that is awkward to the point that many prescribers may choose to stick to the current processes. We are still waiting for specifics on what will be required. In addition MediTouch must be audited by a company meeting national auditing standards, equivalent to an industry standard such as the NIST SAS 70, and certified as meeting all DEA requirements.

Pros - Now there is a law that permits EPCS – the first baby step. Behind the scenes more baby steps are being taken by SureScripts and the nations’ pharmacies. One day it will happen.

Cons - The national network is not ready for EPCS and it won’t be in the short term. When it comes, it will add to the expense of ePrescribing and take longer than a non-scheduled eRx.

Our advice – don’t throw out your printer, pen or fax machine just yet.

This blog was written with content supplied by Larry Susnow M.D. of NewCrop Rx.

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Meaningful Use Incentives — Locked for Payment

They said it could not be done but we proved them wrong! Back in 2009 when the American Recovery and Reinvestment Act of 2009 (aka the stimulus package) was enacted the legislation that funds the EHR Meaningful Use (MU) incentive program we made the following predictions:

Prediction #1 - The program would start and pay as scheduled – CMS has come through and although there were many skeptics, this is one time CMS and the Feds have performed – they have actually started paying the 44 – 64 thousand per provider

Prediction #2 - CCHIT would lose their monopoly on EHR certification – now there are six authorized certification bodies listed on the ONC (Office of the National Coordinator) website

Prediction #3 - Apple would invent a stretched out iPhone like device that would be perfect for physician mobile computing – the iPad was release 14 months later

Prediction #4 - The American Osteopathic Association, the second largest medical association in the country, would see the value of the MediTouch EHR and its Osteopathic Module and “adopt” MediTouch as its exclusive EHR partner

Prediction #5 - MediTouch, the product that we were optimizing over one year in advance of the release of the iPad, would be certified by an ONC testing body within the first 30 days that testing began

Prediction #6 - MediTouch would create a unique Meaningful Use Report Card that would assist providers in reporting the required MU measures to CMS

Prediction #7 - On the first week of attestation MediTouch users would successfully report the required measures on the CMS website aided by our Meaningful Use Report Card. Those user have concluded their reporting process with the summary message from CMS – "LOCKED FOR PAYMENT"

We have been right every step of the way. Now our users are reaping the benefits. Trust MediTouch, we have had our finger on the pulse of mobile EHR computing and MU. We predicted the creation of the iPad and therefore our product was optimized for touch before the iPad was even released. Now we’ve proved that we can help our providers navigate all of the tortuous steps toward obtaining Meaningful Use dollars. MediTouch users are poised to receive checks for their first $18,000 next month, are you?

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Procedure and Diagnosis Pre-Coding — Can your EHR make your billing team coding angels?

In our last blog we discussed how important suggestive Evaluation and Management (E/M) coding is for physicians. MediTouch EHR simplifies E/M coding but unlike many EHRs our system also has additional automated methods that work with your billing team to assist with other non-E/M procedure codes and even diagnosis codes. MediTouch EHR is a completely integrated EHR/Billing/Clearinghouse system and because of that level of integration it can make coding at the point of care simpler for doctors. Before a provider even sees a patient, much, if not all of the encounter can be pre-coded.

How does pre-coding work?
For years our practice management system has supported the concept of claim templates — pre-coded claims that code themselves for visits that are repetitive. If you see patients for repetitive visits or if your staff knows how you code for certain visit types then pre-coding via claim templates makes coding simple. Your staff simply saves a favorite claim as a template and associates it with an encounter in your schedule.

Another way that our system can pre-code for you is to associate diagnosis codes with our Chief Complaint (CC) and History of Present Illness (HPI) forms. There are hundreds of CC/HPI forms and most all are associated with a set of diagnosis codes. Select a form and you are instantly coding the diagnosis. No other EHR can do that!

When you are coding an encounter in the MediTouch EHR the codes associated with pre-coded claim templates and or CC/HPI forms will display in the “Suggested Codes” portion of the corresponding diagnosis and procedure coding sections. If the suggested codes are appropriate, simply click the codes and add them to the encounter.

Pre-coding works. It reduces the amount of work and narrows the selection of codes for the provider when the encounter concludes. Pre-coding and suggestive E/M coding are the perfect marriage of coding automation techniques. Let MediTouch EHR and your billing staff suggest codes when you need to complete your encounter – yes there really are angels watching over your claims.

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Evaluation and Management Coding — May we suggest a code?

Many physicians do not know how to code. It's hard to believe that a task that physicians execute many times each day is performed improperly over and over again. Pretty bold statement, but I have the evidence, at least as it relates to family docs. In 2001 the Journal of the American Board of Family Medicine published a study on the Accuracy of CPT Evaluation and Management Coding by Family Physicians. In general the study showed that physicians were chronically undercoding! It is counter-intuitive that doctors would be "cheating" themselves. There is of course a logical explanation. First of all, physicians are under-trained with regard to coding, especially Evaluation and Management coding. Doctors are usually not trained in medical school on how to code properly and when coding rules change they are too busy to enroll in billing classes. In addition physicians are terrified of over-coding. They abhor the possibility that they will be negatively profiled or penalized by insurance companies. Doctors recognize that insurance companies try to view their coding through the prism of the old-fashioned bell curve. Providers are resigned to the fact that no matter how hard they work and how much time they spend with a patient they can not bill E/M codes accurately for the excellent service they provide. Physicians are usually not shy about billing for their hard work, but why do they become timid with regard to E/M coding?

In 1997 CMS, the Center for Medicare & Medicaid Services published a 51-page guide on how to use CPT codes to bill the Evaluation and Management part of a patient encounter. That document presents the doc with a complex set of rubrics that an auditor could use to rate the level of an E/M visit. I have read this document and even if a doctor was able to process all of the information in that document at the point of care (which they can’t without a computer) I believe that the document still would not provide a physician with all of the data required to make the proper choice of an E/M code. What CMS "conveniently" does not include in the document is the auditor worksheets that a Medicare auditor would use to "rate" an encounter’s E/M value.

In our blog on Health Maintenance we spoke to the fact that issues like preventive care require multi-tasking during the patient encounter. Evaluation and Management coding falls into the same category; it is an additional task but surely not the primary reason why a patient is visiting with the provider. I never heard a patient say "Hey Dr. Jones can you make my medical problem better and also I’d like a 99215 code while you're at it." Thinking through the complex rubric associated with E/M coding "bites at the ankles’ of medical providers. Here is the logic that the provider must perform if they code E/M without the assistance of an EHR.

Skip this part if you don’t have that Starbucks on your desk that I often refer to

I just examined this patient and now I must code for E/M — I will start now:

There are 8 elements related to the History of Present Illness (HPI) — what elements did I ask about and how many did I perform? Next, there are 14 organ systems to review with the patient — Review Of Systems (ROS) — how many did I review and are they all documented in my note? There are three types of other histories that I get credit for: Past Medical, Family and Social History (PMFS) — how many did I review and did I make a notation in my chart that I reviewed or updated them. There is a rubric of just the history portion of the note which includes the HPI, ROS and other histories PMFS — now I can rate the level of the history portion of the E/M coding. I am now just one quarter of the way there.

Next is physical exam. What parts of the body did I examine and did I document the way CMS wants me to — how many elements in each part of the body did I examine? I need to count them, make sure they are the elements I can claim "credit" for and compare them with another complex rubric the one designed for rating the level of physical exam. Half-way there.

Next is medical complexity —How much data did I review? What is the patient’s risk of morbidity or mortality? How many diagnoses does the patient have and how severe are they? Three quarters of the way there.

Finally I need to determine whether this is a new visit or an established visit and then take the values from the history, physical exam and medical complexity rubrics and place them in a final rubric to assist me on choosing an E/M code. Simple!

It is impossible for a provider to perform the above captioned analysis at the point of care. It is really unfair to the patient to require their provider to concentrate on these complex coding rules when the provider should really be focused on their care. Undoubtedly it is easy to understand why physicians under-code. They cannot be accurate because they cannot process this amount of data at the same time they are caring for patients. They know they can't be accurate so they under-code. Physicians need an EHR to track and count all of the elements that comprise each portion of the encounter and then compare them to the CMS rules. MediTouch EHR can do that in just seconds and then MediTouch can suggest the appropriate E/M code. If the care was performed MediTouch knows it and gives the provider "credit" for their hard work. No more under-coding, the suggested code will display in the procedure coding module of our system. MediTouch displays the entire calculation (how the code was deduced) and can assist the provider in understanding why an encounter meets the CMS criteria for a specific E/M code. There are times that doctors have provided certain E/M related services, but they neglected to document them in the encounter note, now they can add that documentation to the note and the system will automatically re-calculate an updated code.

We make coding simple and with MediTouch Evaluation and Management Suggestive Coding providers can focus on patient care and let our automated tools do the rest.

Be sure to read our upcoming blog on other ways MediTouch works with your practice to suggest codes for procedures and diagnoses.

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MediTouch^® Health Maintenance — Fill my shopping cart with quality

With EHR adoption, there is an opportunity to improve the health of your patient population. There are certain tasks that become more accurate when the processing power or formatting of an EHR is leveraged. This is one in a series of articles that explains how the “Holy Grail” of improving quality at the point of care is achieved with MediTouch EHR^®.

The other day as I was leaving for work, my wife asked me to look in the refrigerator and pick up any of the usual staples that we might need on my way home that day. "Of course," I replied, took a quick look (but did not make a shopping list), and out the door I rushed on my way to work. On my way home, I parked the car at the local supermarket, and with the best of intentions, I walked into the market ready to re-stock our fridge. Then the mobile phone rang; it was an important work contact that I had been playing "telephone tag" with. I took the call as I walked into the store and began to multi-task. I was focused on the call, but I was sure that I could recall the inventory of our refrigerator, fill the shopping cart, and most importantly, complete this important call. It should come as no surprise that when I returned home, my recollection of our food inventory proved to be incorrect. I had missed some items, and it was too late, I was now miles away from the store. When I was at the store, I was focused on the urgent task, the important phone call, and I realized that as well intentioned as I was, I did not complete all of what I set out to do. What I really needed was a computerized food inventory system and what would have even been better was an automated way for the groceries to miraculously appear in my cart. That seems like a magical idea, and it may be impossible with regard to grocery shopping, but with MediTouch^® Health Maintenance, computerized quality measure inventory and management is not just possible: it is finally here.

Every Patient is Unique – There is never enough time!
Every patient has his or her own unique "inventory" of Health Maintenance Measures that are keyed to quality healthcare. Sometimes, patients are specifically scheduled for "well" visits, but most of the time, patients are seen for either an acute healthcare concern or the treatment for one or more chronic conditions. When the patient presents for care, the practitioner may be focused on the chief complaint in the same manner that I was focused on my phone call. From a time and accuracy perspective, it is challenging for providers to squeeze the health maintenance analysis into the appointment slot allotted for a typical encounter, especially when that encounter is focused on the treatment of an acute complaint. Yet, according to most P4P (Pay for Performance) programs such as PQRS or Meaningful Use, it is the provider's responsibility to provide health maintenance analysis and advice if one of the E/M (Evaluation and Management) codes for acute or chronic care is billed. Even if the provider has the time, since many quality measures could apply to a single patient, providers need help performing the analysis. As an example, a 65-year-old diabetic female could have at least 15 distinct measures to track. Tracking measures is not as simple as a Yes / No checklist, since many factors contribute to how a specific measure is applied to the patient's unique medical profile. In the example of the 65-year-old diabetic female patient, understanding each quality measure in not enough; the provider needs to process what medications the patient is taking, the medical problem list, what tests or procedures have already been performed, and then apply them to each measure. Many measures support one or more reasons for medical exclusion. Medical exclusion means that there is a documented medical reason (in the chart) as to why the patient did not meet any of the measure values. Without help, it is almost impossible to track, document, and order the proper procedures to meet the growing list of quality measures that may apply to a specific patient.

How Do Providers Meet the Challenge?
I have asked providers how they were meeting the challenge of performing and documenting Health Maintenance. Some providers just skip participating in P4P programs because the time and effort required to comply will never equal the incentive dollars paid. Another group of providers has a team of nurses that perform chart audits that help them report on compliance with quality benchmarks at the end of each reporting year. Finally, there are providers that choose a small group of patients and report via a Web-based tool, also usually at the end of the reporting year. Not one of these common solutions meet the standard of the "Holy Grail" for quality; analysis and action at the point of care - when the patient is in the exam room. In my shopping list example, it was too late to pick up the required groceries once I returned home from the market.

Who Formulates These Quality Measures?
Quality measures, benchmarks, and decision support statements are formulated by organizations that are widely recognized as experts on the measurement of provider performance with regard to the scope of healthcare and service. These experts include the AMA, NCQA, and NQF, and their measure formulations are published nationally. In addition, CMS as part of the Medicare PQRS and Meaningful Use programs, choose measures published by these experts and include them in their incentive programs. As I have stated in other blog posts, every provider should keep in mind that these "incentive programs" eventually morph into "penalty programs." Unless you are retiring soon, your practice cannot afford the pay decrease associated with those "penalties."

Recap

1. Patients have their own unique “inventory” of Health Maintenance opportunities.
2. Providers are challenged to perform Health Maintenance during encounters for acute care.
3. Quality measures are keyed to P4P incentive / penalty programs.
4. The analysis of how measures are applied to a specific patient is complex.
5. This complexity makes it difficult to track, document, and provide guidance at the point of care.
6. Providers need an automated system to assist them with Health Maintenance.

The MediTouch^® Solution
The MediTouch Health Maintenance module "gently" reminds the provider when there is an opportunity to complete one or more quality measures. The MediTouch system uses coding performed by the provider and/or data captured via interfaces to automatically match the metrics of the quality measure to the unique treatment and medical exclusions for a specific patient. This data is calculated on-the-fly so that the data is accurate and up-to-date. MediTouch Health Maintenance works with the standard quality measures published by respected quality organizations and adopted by influential P4P programs such as PQRS and Meaningful Use. In fact, our system will automatically format reports in a manner that makes it easy to participate in those P4P programs (see our blog post on PQRS). Most importantly, the system is fast and allows the physician to provide health maintenance guidance at the point of care. Now, even if there is an acute problem that is the major focus of your attention, it is simple to include the appropriate health maintenance advice as part of the encounter.

When shopping for an EHR solution, make sure your vendor has an easy way for your practice to track health maintenance measures and report them to P4P programs. Remember, it should be as simple as throwing a loaf of bread into your shopping cart.

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iPad 2™ is Here — To upgrade or not to upgrade: that is the question

iPad™ 1 was a revolutionary product. For most medical provider users, it was the best hardware available for mobile healthcare computing. Now, Apple^® has released the next version just before the iPad's first birthday! However, before we get to our iPad 2™ review, let's explore a little bit about our history with the iPad™.

MediTouch EHR^®'s history with the iPad™ goes back to one year prior to the iPad™ 1 release, so for our company, this is begins our third year of engineering the best EHR product for use with the iPad™. Back in March 2009, we heard that Apple was going to make a new product, a mobile tablet. That's all we knew, but we were confident in Apple's ability to create a revolutionary new device. We guessed that it would be like a large iPhone™, and we started testing with Apple's mobile browser. On the first day iPad™ 1 was released, MediTouch^® was iPad™-compliant!

I just got my hands on the new iPad 2™, and there are many new "cool" features, but for our purposes, the question is, "What new features will impact the user experience with MediTouch EHR?" For a full review of the iPad 2™, see David Pogue's (New York Times) or Walt Mossberg's (Wall Street Journal) reviews.

New Processor and More RAM

Some users compare the speed of the iPad™ browsing experience to a traditional computer and find the experience slower. The truth is that the iPad™ 1 does render pages slower than most desktop or laptop computers. For iPad 2™, Apple^® has made three changes that could improve the user's Web browsing experience. Apple has upgraded the processor to their new dual core A5 processor, doubled the amount of RAM, and then they upgraded the Safari Web Browser software. The Safari Browser upgrade is part of an upgrade to the iPad™ operating system. The new operating system is available to all iPad™ 1 users also, and I expect the next time you try to sync your iPad™, you will be prompted to upgrade to the new operating system.

The newest standards for Web browsers are based on the latest version of HTML called HTML5. When creating Web applications, our engineers program to the latest standards and expect the latest browser software to comply with the standard. The latest iPad™ Safari browser does not disappoint — it is compliant with the latest standards. From a speed perspective, the combination of the new hardware and upgraded software makes the iPad 2™ a clear winner with regard to mobile browser speed. A company called Sencha compared the speed of the iPad 2™ to the iPad™ 1, the Samsung Galaxy Tab™ and the Motorola Xoom™ tablet computers — see the scorecard below (source: Sencha.com):

In general, the iPad 2™ wins the speed war. We also tested MediTouch on the iPad™ 1 running the new 4.3 OS against the iPad 2™ running the same OS, and MediTouch pages loaded faster on the iPad 2™. Without special testing equipment, most MediTouch customers and users that try the iPad 2™ and compare it to the iPad™ 1 will notice the improved browsing speed of the iPad 2™. We compared the iPad 2™ browsing speed to desktop computers, and the iPad 2™ is still slower than the latest desktop computers, but faster than some older desktops.

Rear Facing Camera

Now, you can take pictures on the iPad 2™ and send those pictures via email. The pictures are of a high enough quality such that they are appropriate to use for documentation of medical conditions (as in the case of a rash or laceration). Wouldn't be great if you could email those pictures directly to a patient chart? Stay tuned!

Conclusion

If you don't have an iPad™ and you want one, soon your only choice will be the iPad 2™, as iPad™ 1 inventories will soon be exhausted. For folks that own the iPad™ 1 and want a faster browsing experience and a camera to take photos that could assist in documentation, upgrading to iPad 2™ may make sense.

I am sure there is an employee, child, spouse or friend that would gladly take that iPad™ 1 hand-me-down!

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I Spoke to My iPad™ Today — Star Trek, The Jetsons... Pretty close

Over the past few years, I have tested dictation software, and while the software has improved steadily, the input methods were cumbersome. The extra steps of putting on a headset, training the software, etc. made the process too complicated for me.

I recently downloaded Dragon Dictate for the iPad™ and started toying around with the app. I wanted to see if it could be a partial solution for users of our MediTouch EHR^® software. I was surprised to learn that there is no training with Dragon Dictate for the iPad™. Even better, I did not need to put on a headset. I just pressed record and began speaking to the iPad™. It was a liberating experience!

Dragon Dictate for the iPad™ requires a connection to the Internet because, unlike its Windows-based sister product, all of the translation is done in the "cloud": the app is just the interface to transmit the voice file to Dragon Dictate's Web servers. Since MediTouch^® is also a cloud-based application, I was excited to see how they could work together.

Apple^® does not allow Dragon Dictate to run inside of its Safari Web browser, and they treat Dragon Dictate as a separate app that cannot run simultaneously with their Web browser. Each time a user wants to dictate, the user must use the Apple^® "Home" button to navigate to the Home screen on the iPad™, open Dragon Dictate, then press record, and begin the dictation. The Dragon Dictate app has a copy text feature, and after copying the text, the user must navigate back to the Home screen and then navigate back to the browser. The browser did not lose its connection to MediTouch, so I was able to double tap in any MediTouch text area and paste my dictation into MediTouch EHR. If you're thinking, "That sounds like a lot of steps," I would agree with you. But guess what? It only added around 10-15 seconds to my dictation process — and when compared to using the keyboard, I was still ahead on time!

I was surprised to find out that Dragon Dictate for the iPad™ recognizes many medical terms. It got "theophylline", "metastasis", and "ampicillin", but it did not recognize some more complex medical terms such as "thoracentisis". When a mistake is made, the iPad™ text editing is somewhat cumbersome and, because there is no training of Dragon in this version, the same error could reoccur in a future transcription.

My interest is to try to optimize ways for physicians to interact with MediTouch EHR, so can Dragon Dictate for iPad™ become a useful tool for MediTouch users? The answer is yes. A good example could be in the History of Present Illness (HPI) portion of the SOAP encounter note within MediTouch. Many times a patient's HPI is too complex or specific to be documented via pre-loaded interview questions or favorites. That type of HPI may require many lines of text to accurately document the encounter, and this type of situation is when Dragon Dictate for iPad™ could be helpful and faster than the virtual keyboard on the iPad™...

Oh, and did I mention that Dragon Dictate for the iPad™ is FREE.

Here is a quick review of my findings when I tested Dragon Dictate for the iPad™:

• Free software
• Faster than keyboard for lengthy data entry tasks
• Recognizes many (but not all) medical terms
• No headset or training required

• Extra steps to dictate, copy and paste the transcription
• Editing text on the iPad™ is cumbersome
• No training also means no easy way to teach Dragon Dictate new words...

I believe every MediTouch user should download Dragon Dictate for the iPad™ and use it when structured pre-loaded content does not provide the solution required for a specific encounter. It does not replace structured data, and therefore the solution, for every portion of every SOAP encounter note.

Blog Note: This is the first of a series of blog posts on how certain hardware and software solutions interact with MediTouch EHR. In our next post on these topics, we will review the new iPad 2™ and the new iOS operating system for iPads™.

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The Electronic Prescribing (eRx) Incentive Program — A lot of stick, not too much carrot

It is simple to blog about how the government creates frustration for providers. It is easy pickings, and frankly, I have tried to refrain from the constant, depressing rhetoric that I see on other healthcare blog sites. That said, it is time to make an exception for the Electronic Prescribing (eRx) Incentive Program.

Let's review the eRx quality incentive program. The eRx program was created as part of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA; PDF link). That program established a five year program of incentive payments to eligible professionals when they electronically prescribe or eprescribe for Medicare patients seen in their offices. So far it sounds good, right? More incentives for doing the "right" thing... but then things got complicated.

The next year, the American Recovery and Reinvestment Act of 2009 (aka the "Stimulus Package") was enacted, and that law also includes the Electronic Health Records/EHR incentive (MU) program (for "Meaningful Use" of an EHR under the Health Information Technology for Economic and Clinical Health (HITECH) Act). The question is, "Do these two programs play well together?" and the answer is no.

If you participate in the EHR incentive program (MU), you are not permitted to obtain any incentive payments in the eRx program, even though you must attest to using electronic prescribing as part of your Meaningful Use of the EHR. So, no carrot there.

The eRx program for 2011 will pay a meager 1% of medical providers' Medicare Part B Physician Fee Schedule covered professional services. Contrast that amount with the EHR incentive program (up to $18,000 in the first year; $44,000 over five years), and it is clear that providers should be focused on the EHR incentives and not the eRx program.

Incentive and Penalties for the eRx Incentive Program by Year

This table accurately reflects the eRx program incentives, but it is misleading!

Let's do a quick recap before I explain why it is misleading:

1. The government sponsors an eRx incentive program (1% of Medicare Part B PFS in 2011)
2. The government sponsors an EHR incentive program (up to $18,000 in 2011)
3. If you are in the EHR incentive program, you cannot qualify for the eRx incentive.

Here is where things get complicated. If you plan on targeting the EHR incentive program, you can still be penalized in the eRx program. Yes, even if you are trying to "do the right thing" and adopt an EHR, the eRx program can penalize you! If it sounds crazy, please read this excerpt from the Medicare website:

In November, the Centers for Medicare & Medicaid Services announced that, beginning in calendar year 2012, eligible professionals who are not successful electronic prescribers based on claims submitted between January 1, 2011 - June 30, 2011, may be subject to a payment adjustment on their Medicare Part B Physician Fee Schedule (PFS) covered professional services. Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes CMS to apply this payment adjustment whether or not the eligible professional is planning to participate in the eRx Incentive Program.

What Medicare is saying is that each provider, whether they are in the EHR incentive program or the eRx program, must prove that they are electronic prescribers during the months of January-June 2011. If a provider does not prove that they are an eprescriber during the first six months of 2011, they will be penalized in 2012. The "payment adjustment" (penalty) will be 1% of the covered professional services in 2012.

OK, so how do you prove that you are a successful electronic prescriber? You must add a G-code (procedure code) that tells Medicare that you prescribed electronically during an encounter to at least 10 of the corresponding claims between January-June 2011 to avoid that penalty in 2012.

Time for another recap:

1. The government sponsors an eRx incentive program (1% of Medicare Part B PFS in 2011)
2. The government sponsors an EHR incentive program (up to $18,000 in 2011)
3. If you are in the EHR incentive program, you cannot qualify for the eRx incentive
4. If you choose to participate in the EHR incentive program, you can still be penalized by the eRx program
5. The penalty for not "proving" that you are a successful electronic prescriber is 1% of 2012 Medicare revenue
6. To avoid penalties in 2012, a provider must add a special G-code to at least 10 claims in the first half of 2011
7. The special G-code should only be added to claims that reflect an encounter that included ePrescribing
8. In future years, the penalties for not proving that you are a successful electronic prescriber are 1.5% in 2013 and 2% in 2014.

Practically speaking, if you want to participate in the EHR (MU) incentive program and you don't want to incur an eRx penalty, what should you do? With MediTouch EHR^®, we have developed and provided a tool that, with a single click per encounter, will assist you in passing the proper G-code to Medicare so that you may avoid the eRx penalty.

The eRx program should be modified by Medicare so that any provider that is part of the EHR incentive program is exempt from having to report on 10 claims in the first part of this year. We hope that Medicare reconsiders their policy on penalizing providers who are well intentioned and participating in a program that already includes ePrescribing. Until such time, with just a few clicks in the MediTouch^® system, providers can avoid eRx penalties.

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I Want to Hold Your Hand — The Meaningful Use (not the Beatles) Version

When we say we want to hold your hand, we mean that we stand ready to do everything we can to make your path to Meaningful Use (MU) payment simple. The truth is that we cannot use the MediTouch EHR^® system for you, but we know that when you work with MediTouch^®, your path to Meaningful Use payment will be straightforward.

With regard to Meaningful Use, the naysayers have already reared their ugly heads. On January 6, 2011, Medical Economics declared that 90% of all providers that purchased EHR are not tracking to receive MU payment. In 2011, the measurement period for MU is only 90 days, so I ask, "Is it really time for providers to panic?" The answer is no. There is plenty of time for providers to adopt and implement an EHR and comply with MU.

There are some very interesting data points discussed in the above captioned Medical Economics article. They basically provide a list of reasons why providers may not be tracking toward MU payment. Let's review some of those reasons, and see how they apply to MediTouch EHR:

1. 93% said they (doctors) lacked substantive support from their EHR vendors.
   
   

   The HealthFusion MediTouch team stands ready to support your EHR implementation, and our Meaningful Use Report Card™ provides the necessary feedback required to meet the CMS MU objectives. For most measures, Meaningful Use is "built in" to our system.

2. 89% said they delayed implementation because of the cost of additional support from EHR vendor/consultants.
   
   

   There is no additional implementation fee for getting started with MediTouch, and third party consultants are not required to successfully implement our software. That's the beauty of our Web-based, iPad™-ready software.

3. 77% said they lack available and/or trained staff to properly implement an EHR system.
   
   

   No additional office staff is required to start charting with MediTouch EHR. Get your login credentials, and you can start the very next day.

4. 69% said they are unprepared and underfunded to rectify difficult system interfaces.
   
   

   No new system interfaces need to be implemented when your practice subscribes to the all-in-one HealthFusion Practice Management, Clearinghouse and MediTouch EHR system. With our integrated system, your billing, payer communication and clinical interfaces always "speak to each other."

When your practice adopts MediTouch EHR, you have already overcome most of the so-called "obstacles" to a successful path to MU payment. The problems that plague other providers should not be a challenge for your practice when you partner with HealthFusion. Our message to providers is simple: Adopt and implement now — there is a plenty of time and a clear path to MU payment in 2011 with MediTouch EHR.

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"I'm Texting Nobody about Nothin'" — A patient portal changes the way we communicate

I knew the way we communicate with each other was changing the day I sat at the dinner table with my boys, and I realized I was staring at the tops of their heads as they were looking down at their phones. They of course were deeply involved in mission-critical texting sessions. I innocently asked them who they were texting. The answer was, "Nobody." I fell into the trap of following up with, "About what?" The answer of course was, "Nothin'!" Yes, communication is changing, and not just in our personal lives but also in the way medical providers use technology to communicate with our patients.

For years, our profession has had the challenge of communicating medical record information easily with our patients, especially those test results. EHR technology is changing the way we communicate that information to our patients. Let's focus on test results. I can't count how many times I have heard a friend who recently visited their doctor go on to complain about not receiving any information regarding their test results. Test results fall into three basic categories. The first category is results that are "really bad news". The second is test results that are extremely complicated to understand or that require a new treatment plan. The third is normal test results or test results that are abnormal but are the status quo. I think we would all agree that, for the first and second categories, a patient visit is required to explain the results and provide counseling or additional treatment if appropriate. For the third category (which represents the largest number of test results for most professionals), there is now a new method of communication: the patient portal.

HealthFusion^® has created a patient portal (YourHealthFile.com) that communicates test results electronically to patients from the MediTouch EHR^® system. Many times, healthcare professionals are too busy to contact each patient to let them know their results are within normal limits or are within the range of expected values based on their clinical condition. A portal is the ideal way to communicate that category of test results that used to require a phone call or a letter to the patient. In addition, now every patient has access to their results should they need to see a specialist regarding their condition.

With MediTouch^® and YourHealthFile®, when the provider is reviewing the test results, they can send a patient message along with the result with just a single click so that the patient understands what the next step is. The patient can then view their test results and the patient message together on the same portal screen. What used to take providers several minutes per patient now takes just a second!

Technology is changing communication everywhere, and the communication between patient and doctor is no exception. The MediTouch patient portal, YourHealthFile.com, facilitates patient/provider so that every patient can have a deeper understanding of their test results and medical record content.

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Does Your Eye Doctor Have a Scale?

The holiday season — with all of its culinary temptations — is upon us, and the one doctor I like to visit this time of year is the eye doctor. They never weigh me! Most eye doctors (ophthalmologists and optometrists) do not need to routinely measure weight to provide high quality care.

One of the core quality measures related to the Meaningful Use computes how many patients had their BMI calculated. Well, for most eye doctors, that score would be very low or zero. Does that mean that eye doctors cannot participate in the EHR Meaningful Use incentive program? Of course not. In the final meaningful use rule, the government addresses this issue and similar types of issues.

On page 44,409 of the Final Rule (July 2010), the government states:

We note that to qualify as a meaningful EHR user, EPs need only report the required clinical quality measures; they need not satisfy a minimum value for any of the numerator, denominator, or exclusions fields for clinical quality measures. The value for any or all of those fields, as reported to CMS or the States, may be zero if these are the results as displayed by the certified EHR technology. Thus, the clinical quality measure requirement for 2011 and beginning in 2012 is a reporting requirement and not a requirement to meet any particular performance standard for the clinical quality measure, or to in all cases have patients that fall within the denominator of the measure.

What is our interpretation of the rule captioned above? Essentially, providers that don't match to a Meaningful Use quality measure are still eligible to participate with any EHR vendor that is certified and that can create a quality file on behalf of that provider. The provider should not be concerned if they report zero patients that match the measure. There is NO performance standard with regard to any of the clinical quality measures. The only performance standard is that your EHR vendor creates a clinical quality file (2011). MediTouch EHR^® will do that for all providers and all specialties when they enroll with our EHR system for meaningful use.

What does this mean? Specialists that may not match some of the clinical quality measures can still participate in the EHR meaningful use incentive program, and most importantly, I don't have to worry about getting weighed next time I visit the eye doctor!

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The Government is Paying Me to Save Money — One of a series of posts related to how EHRs can help your practice's bottom line

Careful implementation of EHR technology should make the use of EHR systems like MediTouch EHR^® a money saver with or without government incentives, according to a recent article in Medical Economics. The MGMA (Medical Group Management Association) reports that EHRs have been reported to improve the financial outcomes of a medical practice. They report significant savings in transcription costs. Even for practices that do not use transcription services, there is still room for savings. As an example, the article reports savings related to medical records administration.

The piece also mentions some of the costs related to implementing EHR technology. One of the great features of MediTouch EHR is that implementation costs are negligible because, with MediTouch^®, there are no start up costs, training fees, or expensive servers to buy. Long term savings, negligible start up costs, and government incentives make now the time to begin using MediTouch's Web based solution.

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The EHR Superhighway — One of many posts on truly connecting the healthcare industry

Many medical providers are eager to adopt MediTouch EHR^® technology, and as soon as they get started, they realize they want more! Providers report that it is easy to use MediTouch^®, but they want to be connected to all of their healthcare partners. They want to jettison their fax machine, their printer and become 100% electronic — and who can blame them? The average doctor may have between 20 and 30 local healthcare partners, and those partners more than likely will be on disparate systems. Adding to the connectivity complication, patients are mobile and may seek care in two or more geographic locations (think snowbirds).

Can we look to the Meaningful Use measures and the government-led EHR adoption program for assistance with universal connectivity issues? Not really, at least not in its first iteration. Most of the connectivity measures that are defined in Meaningful Use are rudimentary, point-to-point connectivity measures that accomplish very little compared to the expectations of physicians and their patients.

One great feature of MediTouch EHR is that is Web-based, so that sharing data is a lot simpler than on traditional client-server or turnkey technology. It is much simpler to communicate with others when using systems like MediTouch, which is always connected to the Internet when compared to these unconnected client-server systems. Think back to the days prior to the Internet and how hard it was to share a file with a friend... The government does not mandate that EHRs become Web-based, but we think that they should: it would help facilitate data exchange and the full promise of EHR technology.

In a future blog post on the EHR Superhighway, we will explore simple steps the government can take to assist providers in connecting to their partners and constituents.

More to come.

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Meaningful Use: How do I know I met the government-mandated measures?

Many EHR vendors are working with "Office of the National Coordinator for Health Information Technology Authorized Testing and Certification Bodies" (ONC-ATCBs). The ONC-ATCBs (currently Drummond Group, CCHIT, and InfoGard Laboratories) will test and certify that EHRs are compliant with the standards, implementation specifications, and certification criteria defined in the Meaningful Use Incentive Program and now finalized by the Secretary of Health and Human Services. We believe that most quality EHR software vendors will be able to achieve Meaningful Use Certification since the bar for certification has been lowered based on the changes in the final rule. If the government approves enough ONC-ATCBs, then there may be hundreds of certified vendors in 2011. Finding a vendor that is certified will be easy: they are all listed at the ONC's CHPL (Certified HIT Product List). Once a provider finds and contracts with a certified EHR vendor, the next step is to use the EHR in a "meaningful" manner (more on that in a future blog post) for a 90-day period of time (the measurement period).

What happens next? At the end of a relevant measuring period, the provider must attest that they have met 20 of 25 measures on a CMS website (this website is in the process of development by CMS). This is not as simple as raising your right hand and swearing that you tried to meet the measures. Very specific data (e.g. percentage of patients with at least one problem listed on a structured problem list) must be entered on the CMS website. How is a provider to know what their denominator (number of patients seen) and numerator values (patients with a structured problem list) are? The government in the Final Rule suggests that offices manually track each measure. Can you imagine how much work that places on the office staff and the provider? We have a better solution. The answer is a Meaningful Use Report Card. MediTouch^® has already created the first Meaningful Use Report Card™ system. We will supply that report card to every provider that uses the MediTouch system. When it is time to collect your incentive payment, you need to be prepared to attest to 20 measures, so make sure you have all of data required to facilitate that process.

Finding a certified EHR is just the first step on the road to collecting Meaningful Use incentive payments ($44K for Medicare providers, $64K for Medicaid providers, over a five year period). EHR vendors must provide all of the data that they possibly can to make it easy for a provider to attest to the Meaningful Use Measures.  How is your Meaningful Use Report Card going to turn out?  We hope you pass with flying colors!

Post Script: HealthFusion's MediTouch EHR^® has been certified as well — read the press release.

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Perhaps the Most Important EHR Feature: Ease of Use at the Point of Care

In April 2010, The New York Times explored An Unforeseen Complication of Electronic Medical Records. This article chronicled the frustration of a physician burdened with using a "mouse and keyboard centric" electronic health record system in her office-based practice. The physician comes to the realization that most physician office exam rooms are just not built for old-fashioned laptops or PCs. Where do I sit? Do I need to install a shelf? The physician realized that with her EHR/EMR system, it was too difficult to chart and communicate with her patient simultaneously.

The story reinforces a recent anecdote related to us at HealthFusion by one of our physician friends. The doctor explained that when he recently needed orthopedic care, he went to a physician friend of his. He reported that, during the entire office visit, he could only see the back of the treating physician's head... There was no eye contact, and these guys are friends! The physician profiled in The Times article concluded that the only way to "fix" her problem was to see her patient without the EHR — and then chart with the EHR outside of the exam room. This technique is what we call HOMEWORK. The physician uses a paper record to jot down notes, and then later enters data into a computer, a method that she admits is inefficient (we believe this approach also negatively impacts quality of care).

Another physician friend of ours also acknowledged that he couldn't maintain eye contact with his patient and chart at the same time. He said that he simply explains to his patients that they no longer can expect the same level of non-verbal communication that they had prior to his adoption of EHR, but that his commitment to the EHR is for the greater good. We all know what that "greater good" includes: improved information sharing and data retrieval. This physician made the decision to sacrifice some of the goodwill he had established with his patients for the greater good of EHR adoption.

The question that HealthFusion's design team asked when we developed the MediTouch EHR^® solution was direct: Can we offer physicians a system that encompasses all of the great data sharing and retrieval benefits of EHRs without sacrificing the traditional physician/patient experience? Could our design team develop a system that requires no homework and facilitates eye contact and non-verbal communication? We knew that in other industries (e.g. fast food), data capture and eye contact can occur simultaneously, but could those principles be tweaked for the EHR/HIT industry? The answer is YES!

With MediTouch's TouchChart^® technology, the physician can record physical exam data that can be entered on a touch screen computer like the Apple iPad™ in just seconds (or on any tablet, laptop, or traditional desktop Mac or PC). The physician can assume the standing or sitting position (no change there from their paper charting routine). Our TouchChart technology is highly customizable, and the software charts in full sentences that sound exactly like you. The system is pre-loaded with hundreds of TouchPhrase^® defaults and physical exam descriptors, and most providers who deploy MediTouch EHR change very little of our pre-loaded content. In fact, most users can begin charting immediately after starting out with the MediTouch system.

Remember, always look for an EHR that facilitates non-verbal communication and eye contact. These types of communication techniques are practice builders that no physician can afford to ignore. Additionally, do not accept any EHR that does not make point of care charting simple, otherwise you should be prepare to spend your weekends doing more HOMEWORK.

Thanks for reading.

Post Script: If you are not already a MediTouch user, make sure you demo our EHR , and take a look at our TouchChart technology. With MediTouch EHR, we believe you will be convinced that your practice's adoption of EHR technology will mean faster (not slower) workflows. At HealthFusion, we like to say that we don't want any EHR getting between you and your patient!

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