Showing posts with label EMR. Show all posts
Showing posts with label EMR. Show all posts

Saturday, December 8, 2012

Top 5 reasons why understanding your EMR reports are valuable

9:31 PM Aditya


EMR techniques have totally changed the medical market and the scientific advantages are unarguable. EMR can generate income and cut expenses. Here is a list of top 5 reasons why understanding EMR reports are valuable:
  • ·         Digital lab interfaces
  • ·         Patient Portal
  • ·         Storage space and safety
  • ·         Electronic Prescribing
  • ·         Save Time


Digital Lab Interfaces- Lab connections remove guide procedures and allow lab outcomes to be sent electronically- straight into the EMR.

Patient Portal- Patient Portal allows patients to recover medical care details from their company at any point of time. In addition patients also have the ability to pay expenses, make sessions, modify census, set pointers, etc. Features like this are the purpose why EMR techniques are in the long run of medical care.

Storage and Safety of this program are completely web-based. That means the protection of patient details has never been, well, more protected. Patients and suppliers have protected access to their details which outcomes in better interaction, in-turn decreasing mistakes. The other significant advantages with web-based EMRs are more effective for back-up and problems restoration. 

Electronic Prescribing- this is an essential one. This program will aware the doctor for allergies or of medicines that will communicate adversely with other medicines that the affected person takes. This will reduce hospitalizations and assist in saving life.

Save Time: Doctors can finish the entire details from a single note and deliver retrievable details immediately across the details. Now doctors will have a lot of time they need to pay attention to more significant things, like patient care.

The benefits described above are just a few the significant benefits of EMR other than Significant Use. The opportunities of EMR are just about limitless. One of the most significant benefits is a finale of everything above: quality of care. The main point here is that EMR improves the performance of methods and allows the doctor to pay attention to the most critical facet of his job, looking after for patients. In addition to the advantage described above, our workplace can almost completely remove costs from emailing and shifting individual information such as lab outcomes, medications, consultation pointers, etc. Also, delivering claims electronically decreases mistakes and gets compensated quicker.

These are just the key ways our exercise can advantage from EMR, but the opportunities are truly limitless. Using an EMR program should not be a pressure on physicians; EMRs were designed to help doctors provide better care. We should not buy an EMR because we are compelled to, but because we think it can drive efficiency, income, and individual care.

Monday, October 8, 2012

Does the MU incentive out-way the cost of an EMR?

8:43 AM Aditya


Because of MU or meaningful use incentives, many companies are quickly setting up digital health information without handling the individuals and procedure modification that will make sure long-term success. To post-pone workflow changes and procedure upgrades can cause re-work that costs far more than meaningful use of motivation expenses. Despite the current difficulties, there are many effective companies that are doing well and are quite innovative in their use of digital wellness information or EMR’s. They are now able to innovate and make aggressive advantage. Below are some factors that can exceed MU incentives.

Focusing on technological innovations

The stress to live quickly is essential and we certainly want to restore some of our investment dollars through meaningful use rewards. But appropriate style does not have to be delayed. It is a matter of having the know-how and concentration to decrease danger and improve benefits in our venture plan.  We should make sure to avoid these stumbling blocks that can wipe-out our MU payments.  Focus only on technological innovation compared to workflow style. Instead, we should know what to get out of our EMR and then style for it. We should develop our electronic wellness information to improve individual proper care results, fulfill and stand above change. Too many companies today are building their EMR’s with a team who do not have full knowledge of the medical proper care company. While these technologists are vital to achieve, they must associate with the company and scientific management of the company.  Workflow style has to be done by the individuals who perform on a regular basis as they know the details better and will be attributed for modification and program usage. But if the workflow is not developed properly, our meaningful use objectives are at risk. The proper workflow needs a doctor and health professional involvement at every step of the way.

Workflow Style 

Workflow style is not basically moving from one process to another. Workflows include business specifications, individual proper care results, company rules and traditions, decision-making and interaction methods. Our achievements are relying on appropriate style by the appropriate individuals. Technology investment strategies alone will not generate EMR profits but our individuals will.  These individuals’ investments go beyond basically teaching our team to learn the setting up applications; it requires knowledge on company specifications, authority development and modifies management best methods. Such investment strategies are only but not also requiring investment strategies of time, energy and authority involvement. Develop a control lifestyle that involves workers and places a high concern on their growth. The wall between the medical proper care company and medical proper care IT is coming down so abilities on both factors need to advance to remain aggressive in this modifying fast market. Our existing professional group and our EMR group need information about what is technologically possible.

Live versus Adoption

Transformation happens when the company details the individual issues. This requires strategy and interaction around the changes that will happen because of incorporation. The projects, individuals, and functions are all suffering from the EMR.  An effective adopting program guarantees the software is used in the way the execution is designed and is also on the direction to the company's perspective and objectives. Change control is the biggest insurance to make sure the company defines guarantees advantages as incorporation, care provider cooperation, enhanced individual proper care, performance upgrades, MU conformity, ACO etc. To be effective, technological innovation modify must be equalled up with program adopting and requisite end-user actions modify.  Due to the routine of go live, this is often put on automated but it actually requires continuous perform and dedication to develop new routines. 

Wednesday, April 4, 2012

What is ePrescribing?

10:36 AM Nrip Nihalani

ePrescribing(Electronic prescribing ) is the computer-based electronic generation, transmission and filling of a medical prescription,in effect automating the prescribing processes. E-prescribing allows a physician, nurse practitioner, or physician assistant to electronically transmit a new prescription or renewal authorization to a community or mail-order pharmacy.

Along the way, the system offers instant access to patient medication history, formulary coverage and decision support, helping you make the best possible medication choice for patients.

ePrescribing is a viable solution to counter shortcomings of the current paper-based prescribing processes that are in large part responsible for these errors

Benefits of ePrescribing:

  1. Improved patient safety and overall quality of care
  2. Reduces phone calls and call-backs to pharmacies.
  3. Eliminates faxes to pharmacies.
  4. Streamlines the refill's requests and authorization processes.
  5. Offers true Provider Mobility
  6. Improves reporting ability
  7. Increases patient compliance.
  8. By checking with healthcare formularies at point-of-care, generic substitutions and generic first-line therapy choices are encouraged thus reducing patient costs.
  9. Increases patient convenience by reducing patient trips to the pharmacy and reducing wait times.
Useful Aids:








Tuesday, March 13, 2012

Terminologies profiling IT usage within Healthcare

8:12 AM Nrip Nihalani

Health Telematics
Health Telematics is a composite term for health-related activities, services and systems, carried out over a distance by means of information and communications technologies, for the purposes of global health promotion, disease control, and health care, as well as education, management, and research for health.


eHealth
E-health is the combined use in the health sector of electronic communication and information technology (digital data transmitted, stored and retrieved electronically) for clinical, education and administrative purposes, both at the local site and at a distance.

mHealth
mHealth (also written as m-health or mobile health) is a term used for the practice of medicine and public health, supported by mobile devices. The term is most commonly used in reference to using mobile communication devices, such as mobile phones, tablet computers and PDAs, for health services and information. The mHealth field has emerged as a sub-segment of eHealth

Telemedicine
The delivery of health care services, where distance is a critical factor, by health care professionals using information and communications technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interest of advancing the health of individuals and their communities.

Electronic Medical Record (EMR)
An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization.

Electronic Health Record (EHR)
An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization.

Personal Health Record (PHR)
An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.

Health Information Exchange (HIE)
Health information exchange (HIE) is the electronic movement of health-related information among organizations according to nationally recognized standards. It refers to the process of reliable and interoperable electronic health-related information sharing conducted in a manner that protects the confidentiality, privacy, and security of the information.

Integrated EHR
This refers to an EHR that is integrated with practice management software. Typical choices include purchasing a fully integrated product which performs all the functions of practice management software, or a stand-alone EHR which is compatible with an existing practice management system.

Disclaimer: The definitions have been used as is from multiple sources.

EMR’s for Simplified Patient Record Management

7:33 AM Nrip Nihalani

Effective management of patient records and other related documents is a critical factor in many clinical practices. Like the patients themselves, documents can come from a variety of sources. Some are for administrative and financial management, some are patient charts, and some are diagnostic while some are external reports provided by professionals at hospitals and labs. 

Maintaining the Patients Medical records is an area of key concern for any Medical professional and is also one of the reasons for an EMR being deployed. EMR’s have the ability to improve the productivity of a practice simply by effectively automating the practice workflows related to Medical Records.

Using EMR’s will help Practices by providing quick access to the records, easy searching of records, tracking symptoms and responses over time and even simplify the process the delivering the record and associated information to patients and external doctors. 

There are numerous benefits provided by EMR’s purely in terms of patient record management which lead to direct financial savings for the practice. 

  • It will cut down the time taken for average patient visit and therefore help to increase the number of patients served daily. The reduction of time is because of ease of locating previous records, setting appointments, auditing the information and co-ordination rather than because of paper entry being replaced by a computer which actually may increase the time marginally.
  • Also it may help in cutting the cost associated with photocopy, faxing, courier or any other related work. Integrated EMR’s can avail of secure emails to patients as well as the ability to provide the information to patients on encrypted Flash Drives/Memory Cards
  • Reduce Real Estate requirements for a practice due to reduction in physical storage requirements for patient health information.
  • Significant decrease in record administration time and expenses.
  • Since the digital availability of patient data provides the possibility of tracking symptoms and study responses to treatment over time easily, doctors can carry out more analysis and research than they could otherwise leading to more and better publications.

Tuesday, December 20, 2011

Top 10 mistakes that Doctors make in choosing medical software

12:44 PM Nrip Nihalani

Choosing which program to buy to run your medical practice has never been easy. Earlier , it was because there were very few programs available. Today, ironically, it is because there are too many !  Doctors are very confused as to which program they should buy – sometimes, too much choice can be as bad as too little !

Doctors have some special character traits which software producers need to be aware of !

a. To be able to treat a patient and be confident that your decision is right requires tremendous self confidence, which means doctors often have a big ego. Many take the approach that they are always right - even in a field like computer technology !
b. Doctors have a tremendous thirst to learn. Years of med school training allows you to pick up knowledge quickly and most doctors who want to buy software are quite knowledgeable about computers. However, sometimes a little knowledge can be dangerous , and often what doctors know about computers and software leaves a lot to be desired
c.     Doctors are pressed for time, and hence their decisions are based on the fact that “anything that does not gel with me is going to hamper me”. Rather than try to improve their workflow with the help of computers, they’d rather stick to their old dysfunctional habits, even if this hampers their efficiency.

Doctors who wish to enhance their practice and provide better care and service to their patients by using technology are on the right track. Unfortunately, they don’t always go about it the right way.  Some of the important mistakes doctors make are highlighted below.

1. Wanting too many bells and whistles:
Some doctors want their software to do everything for them - even pay their taxes (Just joking ! ). Sometimes putting too many things in your software tends to delay its deployment and make it too complicated to use . Often, some doctors will end up not buying any program at all, because it does not have everything which they want – which means they deprive themselves of a great opportunity of improving their efficiency in 80% of their practice. For example , some doctors want the entire drug database of 15000 drugs in their software! Now you know you will never use even 1/100th of these. There are enough online resources to give you these details when you do require this esoteric information. Why load this redundant data in your software and make it slow by cramming it with stuff you will never use ? It’s much more sensible to have a small efficient intelligent drug database which you can grow over time. That’s what we recommend at Technical Dr. Stick to the basics - your aim is to improve your practice - not to solve the world healthcare crises.

2. Trying to save a penny:
It’s a simple fact of life that investment reaps rich rewards. Why haggle over a few dollars and try to find the cheapest option ?  Negotiating is great, but choosing quality, support and peace of mind is far more important than trying a save a few bucks. It’s easy to get a local company to make a simple, unsupported database for you to manage your patient’s addresses. However, in the long run it makes more sense to invest a little more in good software – preferably from a company which is completely focused on the healthcare space. Medical practice is a complex domain , and an software engineer who doesn’t spend time understanding this cannot make a good product. This is why the early successful packages were created by doctors because they did have the right idea. However, they did not have the savvy to remain uptodate with the latest technology. Please stop acting like a miser in choosing a package. Every doctor I know earns enough to invest in a good package which will enhance his practice. Choose your vendor carefully – after all, you want them to be your partners for life, and for this, they need to make enough profit ?.



3. Thinking someone else understand your business:
A lot of doctors tend to put too much trust in what their software vendor is doing for them. They feel he is the computer expert, and know what he is doing ! If a custom built package is being made, unless you provide the vendor with adequate knowledge on your processes, templates , wants and need, the program will never do what you want it to. Garbage In, Garbage Out. I know doctors who just give a brief outline of what they want and leave it at that. Now the vendor is left scratching his head because he does not really understand what is required of him . He muddles through – but what he produces is not what the doctor wanted, which means a lot of time, money and energy is wasted – and the cycle needs to be repeated again. If you want a custom built solution, you need to be very closely involved. You cannot delegate this. You need to provide all the information required personally. More importantly , you need to review and ask for updates from time to time. Often, the project gets needlessly delayed because the doctor realizes  that this was not what he wanted only after the complete package is delivered to him.


4. Losing sight of the basics – KISS :
Your primary aim is to improve your productivity, and you should always keep this in mind! Anything else should come later. For example, we have clients who request Accounts integration in their software.. But delaying an order or cancelling an order based on just this one feature is unjustified. Nice to have is not the same as “essential” – and adding too many features just results in “bloatware”. It is a mistake to want your software to do too many things right from the start. Get what is essential, and build from there.

5. Waiting for something better:
Doctors often keep on waiting for something better to come along. Unless you don’t jump in the water, you aren’t going to learn how to swim ! Some of the best run private hospitals have been early adopters of technology. Today they might still be using legacy systems , but they are much better run than non IT friendly setups. It’s true that software will evolve over time, but you cannot wait for perfection. At Technical Dr, we study and add new items to our list daily – after all, software is always a work in progress, which gets improved and polished incrementally. However, just because you want a Mercedes does not mean you should continue driving a cycle to work ! It is a mistake to wait when you can always upgrade if you want to later on !


6. Thinking your staff shares your vision:
Many good doctors buy the perfect software and then find that it does not help them manage their practice at all . Often  they blame the software for being unfriendly or useless . Most  doctors fail to understand that their staff is one of the key stake holders in this process. Unless the staff uses the software, it is bound to fail. The software may be the best in the world, but if it is not used properly  , it isn’t living upto its potential. Doctors need to be firm and to share their vision for the software with their staff. It is a mistake to assume that software will be easily adopted by support staff, nurses and fellow doctors. Provide lots of training – and if some members refuse to use this, you need to take them to task.


7. Not nurturing innovation:
The biggest stake holders in this industry are the doctors. It is important for them to nurture innovation. Sometimes it is valuable to take a risk or allow a software company to go that extra mile in providing a feature which will change the process flow of your clinic. Doctors who refuse to try out products which provide extra features or new age ideas because they do not understand its utility are closing the door on innovation. A doctor who asks me to block some modules to save money because he feels he will not use them is basically closing his own mind to the potential of using new processes to improve his practise . Do not buy the module in the beginning, but keep an open mind.  Even when doctors do not ask for the SMS or Email Plug-in , we still leave it on the User Interface, because just seeing that button there will make them wish it was active when they want to send out a report or reading instantly. Once they see the value, they can always buy the module later on.

8. Underestimating the complexity of your needs:
Running a clinic is like running a small business. It’s a complex enterprise, and often doctors overerestimate their ability to do a good job. Ideally, you should be focused on taking care of your patients, so your staff can run the clinic. If you find you are spending time on routine administrative tasks, this means you are wasting your time and money. There are only 24 hours is your day – learn to use them sensibly. A good software program will help you to improve your productivity and that of your staff, if you use it to its fullest extent. An integrated program will allow you to do all the tasks needed to ensure your clinic runs smoothly - manage appointments, accounts, inventory, medical records and referrals. Don’t get stuck buying a cheap program which was designed for a small shop – you will end up being unhappy and dissatisfied.

9. Delaying a decisions:
The single biggest mistake a doctor makes in buying software is when he delays his decisions – whether it is thinking about his needs; talking to the vendor; spelling out his requirement; installing the program ; or getting training for his staff. As a result, the vendor is frustrated; the doctor is confused ; the staff is anxious ; and patients continue to remain unhappy. Start small – but start today !


10. Disregarding the hardware:
Hardware always complements your software. As much as the software vendor may try to make his solution lithe (for example, Technical DR products can run on any Windows and Unix system, and even an AMD netbook processor) , if you want the best results, invest in good hardware. Do not be afraid to upgrade your hardware to help enhance the productivity of your medical software – PCs have become very inexpensive these days !

11. Not providing enough time for training.
While doctors understand that learning a new medical procedure can take time, unfortunately, they are not willing to invest the same time in training their staff – and themselves – in learning how to use the software properly.  This can cause a lot of frustration and when this happens, many doctors just give up on the idea of using any software at all, because they feel their staff is too stupid.

Tweaks to make your PC experience better as a Doctor

12:41 PM Nrip Nihalani

Today a lot of Doctors are waking up to using the computer, maybe to surf the net, or they own a website or better still have an EMR solution. Below are some tips to help you make your time spent on the PC better.  These include some mundane ideas and thoughts and also some personal insights in what works best. So make your PC experience a good one, because it’s going to last you a life time.

a. Use the Internet: Today almost every PC is bought with the thought of going online. However for those who are hesitant, it is important to remember the usage and experience far outweighs the ghost of virus attacks and vulgar content. From the EMR software point of view, maximum benefit can be derived from our packages by those who have the Internet to send SMSes, Emails or get support directly online.

b. LAN connection in a clinic: For any clinic which is not a single doctor no receptionist, it is ideal to get a LAN connection with another PC to help manage the work. The efficiency of handling patients and workload multiples manifold by the simple move. Creating a LAN is simple enough and your local computer guy will be able to have it running within minutes. Wiring may take some time if it is elaborate or you can go the wireless way. Our EMR solution works best when used with a LAN connection, clearly dividing the workflows for doctors and receptionists/nurses who can handle the non clinical transactions.

c. Syncplicity/Dropbox: These softwares are simply fantastic. Most of us have nightmare about viruses and PCs crashing and losing all our information! Now with auto backup softwares that can never happen. Select which folders, drives and PCs you would like to back-up, it automatically syncs it to a virtual representation of your folders online. These can now be downloaded or accessed with a password by you anytime. The whole solution is secure and does not need a huge bandwidth.

d. Virtual memory:  Most computers use not just the RAM but also some part of the hard disk space as memory to run applications. This is called virtual memory as it is an extension of the RAM space into the hard disk. Lot of times your PC may appear slow despite having a decent RAM or gives a pop up saying Virtual Memory Low.  For application that use caching, paging and other virtualization techniques they require adequate virtual memory space.  Ideally your Virtual Memory should be set to 1.5*RAM.

The following procedure is based on Windows XP Professional.
1.    Go to right-click My Computer and choose Properties.
2.    In the System Properties dialog box, go to Advanced tab.
3.    Click Settings button that is from the Performance frame.
4.    Once the Performance Options shows up on the screen, go to Advanced tab.
5.    Under the Advanced tab, click the Change button from the Virtual Memory frame to access to the Virtual Memory setting.

Then the Virtual Memory dialog box appears on the screen. In there, you are able to check how much the Virtual Memory you set. If you would like to modify the size of Virtual Memory, follow the procedure that is shown below.
1.    In there, select the drive letter that is used to install the Operating System.
2.    Choose the option that says, "Custom Size:"

Once you choose that option, the setting for Initial Size and Maximum Size become available for you to set. Initial Size (MB) means the actual size of Virtual Memory, and Maximum Size (MB) means the maximum size of Virtual Memory that is allowed to use.

e. Clean Up the Temp Folder: A large section of your hard disk gets blocked over time by the Temp Folder where, partially downloaded files, applications in progress, copy pasted data is stored in parallel.
C:\Documents and Settings\{NAME OF USER ACCOUNT}\Local Settings\Temp, clear this Folder out from time to time.  A similar exercise can be carried out with the Temporary Internet Files located in the Windows Folder.

f. System Restore – Another handy little service that can get your computer back up and running sometimes, but again takes up a lot of extra space that is not needed is System Restore. But System Restore only recovers Windows files, not any of your data. So having System Restore enabled on any other drive other than your C drive (where Windows is installed) is completely useless. Hence keep it turned off.

To fix this one, right click on My Computer and choose Properties. Click on the System Restore tab, you will see all the drives on the computer, if you have a C and a D drive, turn it off for D drive. For system restore, a value between 2% to 4% will be fine in terms of space. The default 12% wastes loads and loads of space!

g. Use a Local Mail Option: Use a local mail option like Outlook, Outlook Express, Thunderbird, Eudora to sync your mails offline from multiple sources so you access them at any time. Even Google Mail provides this option now. Just go to the Offline Tab in your settings and read up about it.

h. Clean with CCleaner: CCleaner is a tool used to clean your PC. IT description on its site is given below – “CCleaner is a freeware system optimization, privacy and cleaning tool. It removes unused files from your system - allowing Windows to run faster and freeing up valuable hard disk space. It also cleans traces of your online activities such as your Internet history. Additionally it contains a fully featured registry cleaner. But the best part is that it's fast (normally taking less than a second to run) and contains NO Spyware or Adware!” So download it today and get your PC cleaned for free.

i. Out with the toolbars: Usually most people end up having numerous toolbars on their application windows. This is most common in browsers, but also tends to happen in Office applications where all the various tools are now on an ever descending bar. The user experience is diminished if half your seeable and workable space is cluttered with objects which take up your attention and are not even used. So my suggestion, for browsers uncheck all the external toolbars from Yahoo, Google and what not, these not only take space but also cause pop-ups and headaches. In case of MS Word or MS Excel, stick to the basic tools on the window, remove the unnecessary, they can be accessed any time anyway. These extra toolbars also cause delays in loading the software or browser.

j. A Free Desktop: Keep a neat clean desktop. It slows down start up and makes you and your PC sluggish to have uncountable number of items on your desktop. My suggestion is create a folder called Desktop items in your documents and create a shortcut on the desktop and dump everything in that. This is if the habit it too hard to shake off.  I find it much easier and quicker to work if the Desktop is clean or at least cleaned once in a week to make it fast and simple.

k. Use Bookmarks: Use bookmarks, stars, favorites and other such little programs to make your life on the net simpler. Why run around to search for the pages already found or remember the long URL which you never will. Just a single click to bookmark them and they are stored forever.

Saturday, November 5, 2011

What is Meaningful Use?

1:56 PM Nrip Nihalani

The purpose of the Healthcare IT incentive program is not static adoption of EHRs. The program has been devised in a manner that incentivizes only the “meaningful use” of your EHR system. Simply put, your practice will be eligible for the $44,000 incentive payment ONLY if it is able to actively utilize the EHR for improving the quality of care by satisfying certain federally set criteria. These criteria are called “Meaningful Use Objectives”.

Meaningful Use objectives have been defined in order to allow the progress of Healthcare IT and its impact on the National Healthcare System to be measured in terms of quality and quantity. It encourages the active adoption and implementation of health information technology by rewarding practices that are able to successfully incorporate the EMR in their daily workflow, using it to their full potential for delivering higher standards of healthcare.  

Meaningful Use is a phased program. It consists of three stages and the successful implementation of each stage is linked to incentive payments to be received for meeting the requirements of that stage.   

Stage 1: Data Capture (2011-2012)

This stage focuses on electronically capturing patient health information in a structured digital format using your EHR and utilizing this information for clinical purposes as well as communicating it for care coordination to other providers. If your first year of payment is 2011, you must satisfy the requirements of this stage in your first and second years of payment, i.e, 2011 and 2012, to receive the incentive payment.

This stage divides the objectives into two groups:

   1. Core group of 15 mandatory objectives
   2. Menu Set of 10 objectives from which physicians can choose any 5

Stage 2:  Data Aggregation and Exchange (HIE) (2013-2014)

This stage builds on the objectives of Stage 1 to focus on using health information technology to improve the quality of healthcare at the point of care. It also involves electronic and digital exchange of structured medical information among providers. This includes computerized physician order entry or CPOE and electronic transmission of diagnostic test results and other data required for clinical and medical support services.

Stage 3: Data Use to Improve Outcomes (2015)

Stage 3 focuses on utilizing the structured medical data made available in the earlier stages to improve healthcare quality and outcomes. This stage lays emphasis on the macro aspect of the healthcare system by encouraging support for national high priority conditions, emergency medical crises, self management tools for patients, access to patient medical databases and improvement in overall standards of healthcare delivery and population health.

Given below is a list of the Core and Menu Set Criteria required to be satisfied in Stage 1.

15 Core Criteria

[1] Objective: Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines.
Measure: CPOE is used for more than 30% of all unique patients with at least one medication in their medication list seen by the Eligible Professional (EP) have at least one medication order entered using CPOE. (Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period)

[2] Objective: Implement drug-drug and drug-allergy interaction checks.
Measure: The EP has enabled this functionality for the entire EHR reporting period.

[3] Objective: Maintain an up-to-date problem list of current and active diagnoses.
Measure: More than 80% of all unique patients seen by the EP have at least one entry or an indication that no problems are known for the patient recorded as structured data.

[4] Objective: Generate and transmit permissible prescriptions electronically (eRx).
Measure: More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.

[5] Objective: Maintain active medication list.
Measure: More than 80% of all unique patients seen by the EP have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data.

[6] Objective: Maintain active medication allergy list.
Measure: More than 80% of all unique patients seen by the EP have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data.

[7] Objective:  Record the following demographics: preferred language, gender, race, ethnicity, date of birth. 
Measure: More than 50% of all unique patients seen by the EP have demographics recorded as structured data.

[8] Objective: Record and chart changes in vital signs: height, weight, blood pressure, calculate and display body mass, plot and display growth charts for children 2-20 years, including BMI.
Measure: For more than 50% of all unique patients age 2 and over seen by the EP, height, weight, blood pressure are recorded as structured data. (Exclusion: Any EP who either see no patients 2 years or older, or who believes that all three vital signs of height, weight and blood pressure have not relevance to their scope of practice.)

[9] Objective: Record smoking status for patients 13 years old or older.
Measure: More than 50% all unique patients 13 years old or older seen by the EP have “smoking status” recorded as structured data. (Exclusion: Any EP who sees no patients 13 years or older)

[10] Objective: Report ambulatory quality measures to CMS or the states.
Measure: Successfully report to CMS (or States) ambulatory clinical quality measures selected by CMS in the manner specified by CMS (or States).

[11] Objective: Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule.
Measure: Implement one clinical decision support rule.

[12] Objective: Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and allergies) upon request.
Measure: More than 50% of all patients who request an electronic copy of their health information are provided it within three business days. (Exclusion: Any EP that has no requests from patients or their agents for an electronic copy of the patient health information during the EHR reporting period.)

[13] Objective: Provide clinical summaries to patients for each office visit.
Measure: Clinical summaries provided to patients for more than 50% of all office visits within three business days. (Exclusion: Any EP who has no office visits during the EHR reporting period)

[14] Objective: Capability to exchange key clinical information (for example, problem list, medication list, allergies and diagnostic test results), among providers of care and patient authorized entities electronically.
Measure: Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information.

[15] Objective: Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.
Measure: Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.

Menu Set Criteria
Given below is the Menu Set of 10 objectives from which physicians can choose any 5. One of the 5 must be either Objective 9 or 10.

[1] Objective: Implement drug formulary checks.
 Measure: The EP has enabled this functionality and has access to at least one internal or external formulary for the entire EHR reporting period.

[2] Objective: Incorporate clinical lab-test results into EHR as structured data. Measure:  More than 40 percent of all clinical lab tests results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified E HR technology as structured data. (Exclusion: An EP who orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period.

[3] Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.
Measure: Generate at least one report listing patients of the EP with a specific condition.

[4] Objective: Send reminders to patients per patient preference for preventive/follow-up care.
Measure: More than 20 percent of all patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period.  (Exclusion: An EP who has no patients 65 years old or older or 5 years old or younger with records maintained using certified EHR technology.

[5] Objective: Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP.
Measure: At least 10 percent of all unique patients seen by the EP are provided timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health information subject to the EP’s discretion to withhold certain information.  (Exclusion: Any EP that neither orders nor creates any of the information listed during the EHR reporting period.)

[6] Objective: Use certified E HR technology to identify patient-specific education resources and provide those resources to the patient if appropriate.
Measure: More than 10 percent of all unique patients seen by the EP are provided patient specific education resources.

[7] Objective: The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation.
Measure: The EP performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP.  (Exclusion: An EP who was not the recipient of any transitions of care during the E HR reporting period.)

[8] Objective: The EP who transitions his/her patient to another setting of care or provider of care or refers his/her patient to another provider of care should provide summary care record for each transition of care or referral.
Measure:  The EP who transitions or refers his/her patient to another setting of care or provider of care provides a summary of care record for more than 50 percent of transitions of care and referrals.  (Exclusion: An EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period.)

[9] Objective: Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice.
Measure: Performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP submits such information has the capacity to receive the information electronically). (Exclusion: An EP who administers no immunizations during the EHR reporting period or where no immunization registry has the capacity to receive the information electronically.)

[10] Objective: Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice.
Measure: Performed at least one test of certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which an EP submits such information has the capacity to receive the information electronically). (Exclusion: An EP who does not collect any reportable syndromic information on their patients during the EHR reporting period or does not submit such information to any public health agency that has the capacity to receive the information electronically.

(Source: http://www.osteopathic.org/inside-aoa/advocacy/regulatory-issues/Documents/meaningful-use-objectives.pdf)

References:

http://missourihealthconnect.org/FAQRetrieve.aspx?ID=45267

http://www.osteopathic.org/inside-aoa/advocacy/regulatory-issues/Documents/meaningful-use-objectives.pdf

http://www.emrandehr.com/2010/08/30/meaningful-use-resource/

Sunday, September 18, 2011

Difference Between Medical Billing Software and EMR

12:37 PM Nrip Nihalani

Medical billing and EMR software systems are often designed to have overlapping features that improve the functionality and usability of the systems in order to make them a “one-stop-solution” for a practice’s medical IT needs. As a result, medical billing software and EMRs end up being interchangeably used discounting the primary objectives of each of the systems.

Medical Billing Software vs. EMR

Many EMR companies are going the whole way to provide doctors with a single, comprehensive solution that will help them achieve Meaningful Use by incorporating crucial features like clinical notes, patient information and history, medication/prescription/drug allergies, diagnosis/treatments/procedures, patient scheduling, appointment reminders, e-prescribing, electronically available results, scans and reports, patient education resources, clinical decision support as well as full-fledged medical billing programs.

Specialized medical billing software on the other hand, is particularly programmed to maintain and keep detailed records of tests, procedures, examinations, diagnoses and treatments conducted on patients. It combines this medical information with the patient’s policy details to formulate a complete medical record that is used to generate bills. 

The software electronically submits these bills to the patient as well as the health insurance company for payment. Before a bill can be submitted to the policy provider, it has to be coded based on Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-9/ICD-10) protocols. Medical billing software systems are programmed to automatically assign these codes based on the patient’s medical record. After reviewing the bill, the insurance company sends the appropriate payment (or notice of denial) notifying the patient and practitioner via an Explanation of Benefits (EOB) letter which is added to the patient’s medical billing record by the software. In case of a dispute, rectification of bills with errors or missing information and follow up on claims, the software will update the patient’s medical record and billing details with the revised information. 

Medical billing and coding software is thus equipped to seamlessly and accurately handle all complex processes and correspondence involved in medical billing.

A typical base package of medical billing software would contain features that are restricted to medical billing and accounting functions like patient recordkeeping, claims processing, electronic claims submission, receivables management, patient billing and accounting integration. However, many software providers extend their scope to include features like practice management, scheduling and other administrative and clinical functions that are generally a part of EMR software systems.

Therefore, the difference between medical billing software and an EMR is that of core functionality. While medical billing software focuses on a practice’s medical billing procedures and billing-related administrative and financial processes, features of an EMR are primarily concentrated on clinical functions, records and outcomes. 

Medical billing software may serve clinical EMR functions in addition to electronic billing and coding for greater versatility. The same is true for EMR systems that incorporate specialized medical billing and coding program features to supplement their clinical applications.

References:

Thursday, September 8, 2011

How Technology Can Improve The Work Life Balance For A Physician

12:50 AM Nrip Nihalani

Doctors and healthcare professionals are not strangers to poor work life balance. A very strong culture surrounds this industry that perceives a doctor wishing to lead a healthy personal life as a sign of weakness. 

It is not uncommon to see doctors resign to the demands of the job and the medical culture system, leading to unhealthy suppression of their personal goals and requirements. No doubt that for some medical professionals, the passion for work overrides the stress and the burning out, but for others, constantly trying to cope with the unwritten but powerful psychological contract of “if you cannot work 18 hours a day and seven days a week, you don’t belong here” can be very overwhelming.

It’s usually only a matter of time until physicians begin to deal with ill health, depression, reduced efficiency and quality of work, lack of focus, fatigue-related medical errors, struggling personal and professional relationships and severe job dissatisfaction to the extent that many end up reconsidering their decision of being in the medical profession submitting to “maybe I’m not wired for this!”

Yes, there are caps on the number of duty hours for doctors. However, the increasing influence of consumerism on the national healthcare system and the growing demands of federal policies call in for greater accountability, increased bureaucracy and a ton of paperwork and administrative chores left to be performed by physicians themselves. This corporatization of work structure compels them to digress from their primary job of providing healthcare to completing clerical and managerial work that now ends up taking the best of their time and productivity, defeating the very idea of Meaningful Work.

In such a situation and keeping in mind the perfectionists that doctors are, one way for them to strike a healthy work life balance without compromising on their productivity or performance would be to focus the best part of their energy and work day on their actual job – that of being good clinicians and reduce the amount of time, effort and personal attention they put into peripherals like paperwork, clinic management and other administrative functions. 

This article aims to suggest help on how physicians may save time on these subordinate activities by using technological tools that will enable them to complete the same tasks quickly and efficiently, leaving them more personal time and a better organized work day.

7 Must-Use Technological Tools for Physicians

1.) Email
Physicians must leverage the power of this simple tool to reach out and connect to their patients without having to extend their workday. Communicating via email can be less intrusive and time consuming as opposed to personal telephone calls as it allows for multitasking, automation, bulk mailing and standardization of regularly used content.

Appointment reminders, medication alarms, direction maps and instructions can be sent out to patients through an automated, pre-programmed system that monitors all your email communication.

2.) Medical Website

In a world where people turn to the Internet for nearly everything, having a web presence not only helps you reach out to a global audience but is also a time saver for functions like briefing new patients about your practice, answering FAQs, providing critical information, clinic details, directions and patient support. For physicians looking to set up a website, a good place to begin would be http://www.websitesordoctors.in

3.) Spreadsheet programs like Microsoft Excel

If you haven’t already discovered the treasures of Ms Excel and still go the old pen and paper way to record your administrative activities, insurance, tax, bank and financial details, stocks, inventories and everything that makes up your practice, you are missing out on a tool that can transform your work day and save you a ton of time and trouble. Ms Excel is simple to learn, easy to use and will spoil you for convenience once you’re in the habit of using it. For free online training in Ms Excel, visit http://office.microsoft.com/en-us/excel-help/CH010369467.aspx.

4.) PDAs and Smartphones 

A personal digital or data assistant (PDA) can be used to save all your information paperlessly, in one single place. This information is portable and can be made available on your laptop, phone and other devices. PDAs can be used to store patient contacts, records, medical and other information, drug databases, crucial spontaneous notes, treatment information etc. E-books, medical databases, research and information can also be stored and accessed. You can use them to schedule your day, post reminders for important tasks and have all the information you need in the palm of your hand whenever you need it.

5.) Medical Software such as an Electronic Medical Record(EMR)

EMRs collect and consolidate all patient information into a single integrated system that can be accessed at the click of a mouse. Without having to look through heaps of paper files, EMRs allow for quick and convenient access to the patient's medical history, list of medications, drug allergies, test results and information, helping physicians make faster, accurate and more informed medical decisions, diagnoses and treatments. They also enable instant and simultaneous EMR sharing with other care providers, saving on a whole lot of time that would otherwise be spent in viewing, reviewing and communicating results with other practitioners.

6.) Smartphones/Tablet PCs 

Smartphones are poised to be the next big thing in Healthcare IT. The power of portable information and being connected on the go is sure to lend physicians greater autonomy and flexibility of work schedules. Smartphones and tablets can be synchronized with your office and home computers, PDAs etc and can be used to access this and other medical information from any place in the world. You can effectively use them to do your day’s reading or wrap up pending documentation and record work while commuting or even at home. A good article on using smartphones to improve your practice can be read at http://emrmeaningfuluse.blogspot.com/2011/08/how-can-smartphone-help-you-in-your.html

7.) Videoconferencing and Tele-consultations

Physicians can use videoconferencing tools like Skype to provide tele-consultations to patients based in remote locations. They can also carry out pre-appointment screenings, post-appointment follow ups and monitoring from home, saving themselves and their patients commuting time and making for a shorter work day. To learn more about videoconferencing and Skype, visit http://emrmeaningfuluse.blogspot.com/2011/09/using-skype-to-help-your-practice.html

These technological tools can be used to reduce the time and effort spent on administrative functions (and certain clinical functions too!). If a routine break up of your day is say 70% of seeing patients and 30% of filing paperwork and records, you can use these tools to work on bringing down the 30% average or even taking it home (easier for solo practitioners) as all the information is digitally available to you, wherever (and whenever) you choose to use it. 

Yes, taking work home is a debatable idea for many families but for physicians, it is really a case of being home at a good hour at least physically vs not being there at all. The trick here is to not get into a habit of “staying connected” all the time, using technology to only accomplish what is required for the day and switch off once you’re done.

References:


Wednesday, August 24, 2011

What Is Telemedicine?

3:12 AM Nrip Nihalani

The American Telemedicine Association defines Telemedicine as "the use of medical information exchanged from one site to another via electronic communications to improve patients' health status."

The term "telehealth", "e-health" and "telemedicine" are often used interchangeably, the difference being that telemedicine involves using information technology primarily for the delivery of clinical services while telehealth and e-health also include the provision of non-clinical healthcare services like tele-education and tele-training for continuing medical education, practice management, research and administration.

Telemedicine is practiced when medical services like health consultations, diagnoses, procedures, patient report analysis, monitoring and so on, are electronically provided by practitioners to patients based in remote locations using telemedicine technology and equipment.

Types of Telemedicine

There are three primary types of telemedicine – Store and Forward, Remote Monitoring and Two-way Real-time Telemedicine.

Store and Forward Telemedicine includes healthcare services for non-emergency situations that can be provided offline, without requiring the presence of the provider and the patient at the same time. It involves the remote patient passing on his medical data like medical history, EMR, scans, reports, past diagnoses etc to the provider who assesses his health status based on the given information and reverts accordingly without carrying out a personal, real-time examination of the patient.

Remote Monitoring includes a telemedical facility actively monitoring patients over remote locations using telemedicine equipment and devices. It is an effective way of monitoring vital signs like ECGs, blood glucose levels, respiratory rates etc for volatile health issues like cardiovascular diseases, asthma and diabetes that require constant care and vigilance.

Two-way Real-time Telemedicine provides consultations, diagnosis and treatment over real-time videoconferencing, live transmission of diagnostic images/videos, phone conversations and other synchronous interactive telemedicine technology where the practitioner and patient remotely connect and interact with each other at a given time with a local doctor as an intermediary.

Besides these, some facilities also provide emergency telemedicine and disaster restoration tele-support services.

Benefits of Telemedicine

Telemedicine services aim to replace or at least equal traditional clinic visits, face-to-face consultations and visiting nurses, save costs and provide better care in locations where the quality of healthcare is not up to the mark. So far, around 50 medical subspecialties have adopted telemedicine with radiology turning out to be a heavy user. Teleradiology is widely used to electronically transmit x-rays, CT scans and other images to remote providers for evaluation and assessment.
Other branches that have resorted to telemedicine to improve their quality, reach and accessibility are dermatology, ophthalmology, psychiatry, cardiology and pathology.

Telemedicine technology allows patients to avail of quality consultations, monitoring, electronic housecalls, testing, diagnosis and treatments from remote locations that may lack the required medical services, connecting patients and practitioners via an integrated, global healthcare system. With telemedicine, practitioners can provide improved diagnoses and better treatments due to comprehensive digital data that is available to them offline and over the web. Follow-ups and monitoring patients becomes easier and more efficient owing to automated active monitoring devices that provide continual and constant connectivity between the two parties. As for patients in remote or under-served areas, telemedicine gives them access to world-class medical services without having to travel or shift base. This not only helps them gain valuable medical advice and treatment from top medical specialists but also saves on their travel expenses, unnecessary hospital visits and in many cases, cost of medicines and expensive health facilities.

Equipment and Facilities Required for Telemedicine

A successful telemedicine program requires specialized telemedicine equipment and facilities. For seamless and uninterrupted delivery of remote medical services, medical devices, peripherals and software solutions supported by expert telemedicine professionals, customer care personnel and training staff must be incorporated within a compatible system that functions according to an effective, tested workflow model.

The following facilities and equipment are usually needed to provide telemedicine services:
- Tele-consultation rooms
- Patient engagement facilities like beds, scopes etc
- Desktops/ Laptops/ Tablet PCs
- Internet Connectivity and Broadband Devices, Routers
- Printer
- Film Scanner
- Digital Camera
- Video Conferencing Kit
- Specialized Tele medicine software for your subspecialty
- Non-invasive pulse and blood pressure unit
- Digital ECG
- Digital Microscope
- Glucometer and Haemogram analyzer
- Mobile vans (in case of mobile or emergency telemedicine centres and ambulatory care sites)

Telemedicine Delivery Channels

Telemedicine services can be provided over four main channels:

1. Point-to-point telemedicine where patients and providers (hospitals, clinics) are connected over private networks directly or through an independent practitioner as an intermediary.
2. Patient is connected to a specialty care provider through tele-videoconferencing for a real time consultation over a home connection.
3. Active tele-monitoring for housebound patients over specialized tele-monitoring systems.
4. Direct web-based telemedicine services and patient-care.

Telemedicine Support in the USA

Despite its numerous benefits, telemedicine has a long way to go before it finds a viable place in the country’s mainstream medical system. The government supports the adoption of telemedicine with a number of incentives and federal grants. The American Telemedicine Association provides more information on federal funding for telemedicine at http://www.americantelemed.org/


References: