Registration and Attestation Videos

For doctors and staff wondering exactly how to register or attest to Meaningful Use, these nifty videos from CMS will show you how easy it is! They walk you through the process step by step. If you’re wondering what the process is like, these two videos should answer your questions. (Reminder: you can register for EHR Incentives even before selecting an EHR system!)



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Why Use The OpenEMR?

In their search for an affordable and practical EMR solution, many practices have heard about the OpenEMR, a free downloadable EMR certified for Meaningful Use and currently used all over the world. A democratic open-source software, the OpenEMR is downloaded 3,700 times a month and constantly improved by an international team of programmers and developers. So how did this project get started, and how can using the OpenEMR benefit your practice?

The OpenEMR was originally released to the public in 2002 through the OEMR Foundation, a nonprofit group with a mission to provide electronic medical record software for all patients regardless of location or socioeconomic status. As a worldwide system, it was designed to be robust, flexible, and easy to use by doctors from New York City to rural Africa. Since its release, the number of OpenEMR users has grown quickly; SourceForge, an open-source site, reports that the OpenEMR is downloaded 3,700 times a month. The OpenEMR is used by practices in the U.S., Sweden, Israel, India, Puerto Rico, Australia, and Kenya, and is considered so integral to worldwide healthcare that the Peace Corps will begin using it in 2013. Templates can be easily customized for specialties using the OpenEMR, making it even more flexible.

So why should your practice use the OpenEMR? There are a few important reasons. The first is that because it’s open-source software, programmers and physicians all over the world are constantly updating and improving the code. Additional software is also donated by major companies as well, making the OpenEMR an outstanding and best-in-class system. Because it’s not a private company, you don’t have to worry about the vendor going out of business or being unable to meet Meaningful Use Stage 2 requirements.

The OpenEMR is also relatively risk-free; when doctors switch EMRs, they are typically charged tens of thousands of dollars to migrate their data because the vendor doesn’t want them to leave. But data migration is easier and cheaper for the OpenEMR because no single company has an interest in holding your data hostage.

The OpenEMR is also the best free EMR for busy doctors seeking to save time or rural clinics which don’t always have reliable Internet access. Many free EMRs are web-based and require huge amounts of bandwidth, slowing down computer programs. Furthermore, these free EMRs assume that all practices have high-speed Internet, which isn’t always the case; of America’s 4,000 rural clinics, many do not have reliable Internet. The OpenEMR can be downloaded easily and operated on a clinic server, which is a terrific option for rural practices all over the world.

Lastly, it’s an EMR which provides doctors with independence. By downloading and integrating and OpenEMR, practices now own their electronic medical records system- and their own practice data. There’s no worry about having data sold, traded, or viewed by a large corporation, and no fear about practice data held hostage if the doctors want to switch to another vendor. In a changing age, using the OpenEMR is one less thing to worry about.

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Is Meaningful Use The Only Reason for an EMR?

Over 30% of United States physicians currently use an electronic medical record system, and the rate of adoption is growing quickly.  The biggest push for adoption has been the Meaningful Use (MU)  carrot-and-stick legislation, which promises doctors $44,000 (Medicare) or $63,000 (Medicaid) over several years with an eventual penalty for failing to adopt an MU-certified systems. Meaningful Use has spurred adoption of EMRs / EHRs and therefore the entire Healthcare Information Technology industry, which has grown tremendously since this legislation was passed. 

However, not all physicians who use an EMR are attesting to Meaningful Use.  Only 42% of EMR users have attested; 17% are planning to, while 39% have absolutely no intention of attesting. This means that about one-third of EMR users adopted an EMR for reasons other than Meaningful Use.  While the $44,000 sounds great, we’d like to emphasize that there are other reasons to adopt an EMR and other ways to streamline practice workflow productivity while increasing revenue. 

Realistically, we suggest that practices adopt an EMR only when they’re ready to learn a whole new computerized entry system. This means setting aside time out of the workday for doctors and staff alike. When you first learned to drive, you drove slowly. You had to take time out of your day to learn how to drive- time you could have spent working on homework or at a job. EMRs are no different. But just like a car, they can make your life easier once you’ve learned to use one. The highest EMR success rate comes from practices who decided to adopt an EMR in order to stay competitive and provide the best service and outcomes for their patients.  We applaud these practices that took a bold step to participate in healthcare modernization at their own pace. After all, you know your practice better than the government does.

Meaningful Use isn’t bulletproof, either. Like any law, it can be appealed or revised. The attestation process is daunting to many doctors, especially those in small practices. Furthermore, the requirements for Meaningful Use will change over the next few years; if you’re adopting an EMR solely to meet Meaningful Use, you’re dependent on shifting government policy to achieve those checks.  Your expectations will be disappointed; your practice may even lose money. And while Meaningful Use offers significant funds, we’d also like to emphasize that Meaningful Use is not the only way to save money. Practices can streamline their front end and back end billing systems to save thousands of dollars; switching from a high percentage to a low flat fee can provide savings equal to Meaningful Use incentives. Even e-prescribing provides its own, albeit smaller, set of incentives.

Lastly, we’d like to throw in a word of caution about vendors guaranteeing doctors $44,000. Meaningful Use has multiple stages; no EMR is currently certified past 2013. Any vendor guaranteeing the $44,000 is essentially guessing that their product will be certified. It may get certified. Or it may not. The company could even fail, or be sold or traded, before Stage 2 vendor certifications are passed. Then what? We recommend that doctors exercise skepticism when looking at Meaningful Use guarantees and look at the contract terms very carefully. Don’t jump the gun prematurely to sign a EMR contract, because it’s impossible to guarantee that your new EMR will meet certain standards when those standards haven’t been defined yet.

We definitely recommend that practices adopt EMRs to streamline workflow. But we suggest that practices look at one of these systems only when they’re ready- and not solely to meet shifting federal Meaningful Use standards.

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Meaningful Use Stage 2 Unleashed!

After a weeks-long delay, CMS officials and policymakers finally announced the new guidelines for Meaningful Use Stage 2 last week. They laid the groundwork for Stage 2 back in 2010, but changed and updated some rules which will go into effect in 2014. So what changes did they make, and how will it impact your practice?

CMS is placing a greater emphasis on patient engagement; one of the Stage 2 criteria is for 50% of patients to have online access to their health records and demonstrate that 10% had actually viewed these records. Patients must be able to view, download, or send these records whenever they feel it is necessary. The impact on your practice? Patients will now transmit records electronically instead of lugging bulky paper charts around. This means your practice will actually save time by downloading the patient’s record instead of tediously entering data.

There’s also a major focus on interoperability and the fast, convenient sharing of patient data. EMR vendors now have to include clinical terminologies such as LOINC and SNOMED into their software so that data can be shared more easily. If your practice isn’t using one of these terminologies, you’ll probably have to learn it, which could take time; however, you’ll soon be able to access your patient’s information much more quickly than before.

As always, in the quest to become a completely electronic field, Meaningful Use Stage 2 increased the percentage of reporting requirements. While Stage 1 required using CPOE for 30% of all lab orders and medications, Stage 2 demands that 60% of all lab orders and medications are placed using CPOE. Likewise, 50% of all discharged patients must receive an electronic prescription and 50% of all patients must have their demographic data recorded. The recording of smoking status and vital signs gets bumped up to 80% of all patients. This means that your practice must become accustomed to asking most patients this information and recording it; this should become fairly routine after a while.

Physicians now have to report more requirements- there are 12 reporting criteria for regular clinicians and 24 for hospitals- and also report cases to public health agencies where applicable. This means that physicians will now have to generate lists of cancer cases, immunization records, and other data sets. Some EMRs will begin generating these lists automatically; others will not. Make sure your EMR is geared towards this future requirement in order to save your practice valuable time!

This is just a sample of the Meaningful Use Stage 2 requirements; a full list can be found here. (For anyone who doesn’t want to read the whole thing, here’s a cheat sheet.) We’ll have more to come on the impact of these guidelines on your practice!

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eDoctor, Inc. Salutes African-Americans In Medicine

In honor of Black History Month, we’d like to spotlight a few African-American medical professionals who contributed greatly to the field of modern medicine.  Their inventions helped improve quality of care and save countless lives;  as a company dedicated to both doctors’ needs and innovation, we’d like to learn from their creative thinking to improve the field of Healthcare IT.

Ever had a blood transfusion?  Then you can thank Dr. Charles Drew, a leading authority on blood transfusions who developed methods of storing and processing plasma in blood banks. Educated at Amherst, McGill, and Columbia, Dr. Drew began researching the properties of blood plasma while earning his doctorate at Columbia in the 1930s. When World War Two broke out, Dr. Drew directed the Blood for Britain project, in which Americans donated blood to help British soldiers overseas. It was the first major transfusion project and the precursor to the American Red Cross Blood Bank. While Dr. Drew’s blood transfusions saved thousands of Allied soldiers on the battlefield, he still encountered discrimination in the workplace; he resigned his position in 1942 over the ruling that African-American blood would have to be stored separately from that of white Americans. He went on to become a surgeon and professor of medicine before dying in 1950.

Cataract surgery used to involve a lot of grinding and drilling- until Dr. Patricia Bath, a New York opthalmologist, patented a laser probe in 1988 to remove cataracts painlessly and accurately.  The first African-American female doctor to receive a patent, Dr. Bath’s quest to end blindness led her to found the American Institute for the Prevention of Blindness.  Dr. Bath battled poverty and racism but prevailed to become a leading expert in opthalmology and corneal transplants, restoring sight to patients who had been blind for decades.

Siamese twins conjoined at the head had never been separated before 1987, when Dr. Ben Carson- the Director of Pediatric Neurosurgery at Johns Hopkins Hospital- led a 70-person team over 22 hours to successfully separate the Binder twins in a groundbreaking surgery.  He also conducted the first intrauterine surgery to relieve cranial pressure on a hydrocephalic fetus and a hemispherectomy on a young girl suffering from constant seizures.  As the youngest director of a major division at Johns Hopkins, Dr. Carson’s brilliant three-dimensional visualizing skills have helped him save the lives of many children. He has currently received over 61 honorary doctorate degrees and written four bestsellers.

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MIPPA Incentives: An Office Manager’s View

How hard is it for practices to receive Medicare MIPPA e-prescribing incentives?  Is the switch to e-prescribing difficult or time-consuming for front offices?  We asked office manager Tobie Paradis of Dr. Leonard Glaser’s practice in Southington, CT, a busy internal medicine clinic with over 7,000 active patients.

How long have you had e-prescribing?

“We’ve had it for four years now.  We began receiving MIPPA incentives after the first year.”

How was the MIPPA attestation process? Was it difficult to receive incentives?

“Not at all.  At the beginning, we thought it would be just another burden for the front office.  But after getting into it, it’s just a simple G-code.  Once the front biller gets used to it, you just add it to the billing code.  It’s very simple, actually.  Now it’s just part of our daily billing routine.”

Was it hard to learn for the front office?

“No, it wasn’t.  Adding the code is very simple.”

Was the transition to e-prescribing difficult?

“At first, like anything new, some people had a difficult time adjusting, but it’s really saving us a lot of time now.  It’s great because with Surescripts, you can look up the patient histories and get the alerts for contraindications.  Dr. Glaser uses an iPad to prescribe, but the staff uses desktop computers.  I can’t picture our office without e-prescribing.”

Which part of the e-prescribing process has saved you the most time and money?

“Printing out and hand-writing prescriptions took a lot of time, as did pharmacy callbacks. Looking up patient medication histories instantly also saves us a huge amount of work.”

We swear we didn’t ask her to say this, but. . .

“The customer service with eDoctor is incredible.  Even if we had a problem on weekends, eDoctor was there to answer questions.”

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What’s Preventing EMR Interoperability?

The rosy goal of EMRs / EHRs is to present the doctor with the patient’s entire information in one place and in a digital form.  If a patient enters a specialist’s office, the specialist should be able to pull up the patient’s complete medical history, securely sent from the primary care provider, on a computing device.  But the reality is that the specialist will have to sift through pages and pages of faxed transcripts instead of electronically accessing the patient’s record.  Why is this happening?  It should be as easy as just sending a Word document via email.  The issues are complex in addressing many inherent legacy system issues as well as new social and legal issues.

There are many reasons why EHR interoperability hasn’t happened yet.  One is that data is stored and shared using a framework called HL7, or Health Level Seven.  In use since the 1980’s, HL7 has gone through different versions over the years, but a specific national standard for HL7 data exchange has never been determined.  Different hospitals have modified HL7 versions for their own use, meaning that two hospitals using HL7 2.x may in fact be using two incompatible systems.  Furthermore, while some countries use HL7 version 2.x, other countries have moved on to HL7 3.x- meaning that data cannot be shared electronically with “standard” mapping from one system to another system.

Another reason is lack of cooperation among vendors.  Many EHR vendors actually own their doctors’ patient data, which can then be sold to major pharmaceutical companies for a hefty sum.  (Don’t worry. Here at eDoctor, your data is yours.)  If the data is shared with another vendor’s EHR, the original vendor has just shared a valuable commodity.  Therefore, EHR vendors who potentially sell patient data had a reason not to make their systems interoperable: they’d lose money.  It’s the patients who really lose on this one; while their private (aggregated) data is being sold, their doctors can’t access their full health records quickly and conveniently.

A third reason is that there is no national standard for patient data exchange.  EHR vendors didn’t have a standard to meet, so they chose HL7 with PHR (Patient Health Record) to meet specific needs.  While much attention was paid to EHR adoption, and huge amounts of money offered to providers who qualified for Meaningful Use, the issue of whether EHRs could communicate with each other just got lost in the mix- until now.  More and more physicians are using EHRs and finding it frustrating that their systems aren’t compatible for data exchange. Meaningful Use Stage 2 is supposed to address this issue in coming years.

There are a few steps to facilitating patient data exchange.  HIEs, or Health Information Exchanges, are usually small nonprofit or community-run groups which collect patient data for a certain region or state; however, these groups are few and far between.  Enabling HIEs are groups called RHIOs, or Regional Health Information Organizations, which typically gather patient information across multiple hospitals in an area or set standards for system interoperability.  However, these groups are in their infancy and not tied together by a national standard for data exchange.

The issues of EHR interoperability are complex and reflect where we stand as a society. We are still in our infancy when it comes to dealing with interoperability of such private data.  There are many legal challenges ahead concerning ownership, privacy, and security concerns.  Seamless patient data exchange and EHR interoperability would streamline workflow and increase patient safety, giving doctors more relevant information and more time to spend with patients. But we’re hopeful about interoperability.  One day, it will come, but expect some bumpy rides along the way. We have a long way to go!

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What’s Your Practice Data Worth?

Adopting an EMR can be a major change for your practice.  There are new systems to learn for both doctors and staff, and a new way of entering data. Usually the last thing on a doctors’ minds is whether or not they get to own their practice data and whether they’ll have an exorbitant data migration fee if they ever switch EMR vendors.  The EMR technology itself, most vendors claim, is the most important part of the process, glossing over any questions about data or ownership.

Data is actually the most important part of the EMR system.  Your patients’ information is the whole reason these systems exist in the first place; to store, organize, and streamline medication histories and lab results so that medical decisions can be made with complete knowledge.  If it’s late at night and an unconscious patient lands in the hospital, software alone won’t help determine what medications that patient is taking; the answer lies in the patient’s data.

As such, it’s critically important that practices own their data.  Physicians who don’t ask about data ownership may find that their patient data is being aggregated and sold without their knowledge, a practice which often makes patients uncomfortable.  Worse, EMR vendors can charge thousands of dollars for data export- sometimes more than the EMR originally cost- to doctors seeking to transition from one system to another.  This makes doctors hesitant about adopting an EMR; if it doesn’t fit their practice style, they’ll have to pay thousands of dollars to switch to another one.

When providers choose an EMR, we recommend that they ask about data ownership and export.  Not every EMR will fit every practice, and your best bet is to find a sensible data export plan in case your practice wants to choose another system.  Before you lock into a contract, read the fine type and make sure you get to keep your own data!

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Interview with Dr. Samuel Slonim: “If I Can Imagine This, Someone Can Do It”

What steps would you like to see for healthcare reform?  Today we interviewed Dr. Samuel Slonim, an eDoctor client who believes strongly in major changes for the healthcare system. Dr. Slonim attended medical school at the University of Southern California and completed his residency at the San Jose Family Practice. He has owned his own family practice since 1985. His practice website features not only helpful resources for patients, but proposals for healthcare reform based on Dr. Slonim’s recommendations after almost 30 years of family practice experience.

I understand that you are in favor of healthcare reform. What changes would you like to see?

“I think that the best way to reduce unnecessary spending is to have patients pay a percentage for all the care they get.  There would be limits or maximums paid for any one service and per patient and family per year.  Those with lower incomes would pay a smaller percentage and have smaller limits or maximums.  This would lead patients to think about what they are purchasing (office visits, labs, X-rays, medicines, procedures) and have them consider the cost in choosing various alternatives.  This way we wouldn’t need formularies, HMO authorizations, etc.

“I’d like to see technology also used to improve access to educational materials for providers and patients and to improve communications between patients and providers and between providers.  I would propose someone or organization(s) make a Healthcare IT system that everyone could use – it would be made available for free to everyone.  From day one, patient privacy protection would be built in, but also the ability to easily and seamlessly share data.  There would be different modules for doctors, hospitals, insurers, pharmacies, laboratories, X-ray providers, and patients, but all would share the same data.  Individual users would be able to customize the data and screens to their liking.  There would be four main functions: 1) EMR (including e-prescribing), 2) billing, 3) communications, and 4) education.

“One of the problems with the current IT “system” is that different vendors’ programs do not communicate with each other effectively, if at all.  They talk about setting up standards but I think it would be difficult due to the complexity of medical information.  For example, I read that they want a system to be able to put a patient’s EMR data into a file that could be sent to another system.  This would be like scanning a document.  Sure, you can import it into your system, but you probably couldn’t use the data in your system – for example, labs scanned in couldn’t be put into a table or graph of a patient’s results over time.

“If a system was made that everyone would use for free, the priorities would be improving quality of care, sharing of information (where relevant), and patient privacy.”

Who should create this universal EMR system?

“This could be government and/or a consortium of businesses.  Keep in mind that businesses are looking for ways to control health care spending.  I mentioned that the IT software would include billing – imagine the savings just from everyone being on the same billing system.  The government is currently giving out around $20 billion in incentive payments for doctors to buy EMRs – I think [a universal EMR] would have been a better use for that $20 billion.  Obviously some people don’t trust the government and others wouldn’t trust private businesses.  I mentioned that privacy protection would be a major priority.  I’d also say that in my experience, most of my patients are more concerned that their information does not get to their physician than they are about privacy leaks.  The current communications among health care providers are short of optimal.

“I made my own practice management software by learning how to use and create a data base.  One thing I learned is that if you think of something you’d like the data base to do, you will find a way to do it.  So I believe this idea can be achieved – there are certainly a lot of smart people in technology out there.  If I can imagine this, someone can do it.”

What changes would you like to see for e-prescribing?

“It would be nice to be able to enter medicines without having to enter a pharmacy.  This would allow patients to go to any pharmacy – they often change pharmacies, or may travel and forget or run out of medications.  This leads to physicians rewriting prescriptions.  In the universal IT system I propose, prescriptions would be part of the EMR – once entered, it would also go in the record listing current medicines, documentation of what was prescribed, etc.

“The ability to e-prescribe scheduled drugs would be terrific.  I prescribe a fair amount of chronic pain medications and stimulants for ADD.  These have to be hand written every month (or write 2 prescriptions once for 2 months).  This adds up to a fair amount of time that could be saved if it could be done electronically.  I could spend more time with patients and maybe even go home a little earlier!”

How do you think increased use of technology will affect health care?

“I think it has potential. It’s helping some, but has a lot more potential. I’d say it’s a mild to moderate positive at the moment.”

To read more about Dr. Slonim’s vision for healthcare reform, click here

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