Montana gets its EHR money back

[caption id="" align="alignleft" width="175" caption="Gov. Brian Schweitzer (D-Mont.)"][/caption]

HELENA, MT – The Montana Senate voted to restore the $35 million in federal incentives for electronic medical records for hospitals and community health centers across the state this week.

The Montana legislature initially denied the state's Department of Health and Humans Services (DPHHS) the authority to accept and distribute the money to hospitals four times on party-line votes – making it the only state to do so.

But, under pressure from Gov. Brian Schweitzer (D-Mont.) and healthcare providers from across the state, the Senate voted 45-5 for the motion on March 28.

Earlier this month Schweitzer warned lawmakers that they were increasing the cost and lowering the quality of healthcare in Montana by refusing funding for electronic health records technology.

The state has 47 critical access hospitals in smaller communities across the state, and almost all will likely qualify for the funding, according to the governor.

"Electronic health record systems save money and improve care through eliminating the need for duplicative testing," Schweitzer said.

Click here to see votes on the HIT funding.

This article was originally posted at http://ping.fm/xZ0vB

Apple?s iPad: Is it a perfect e-learning tool?

Apple’s iPad has been a pathbreaker of sorts in the technological field. They were many naysayers during its launch regarding its utility, but I suppose the tremendous success of the product have shut up their mouths. The craze and euphoria has not died yet, and with the launch of iPad 2, the buzz is getting stronger. And the all-important question comes to the fore: can the iPad serve as an ideal classroom teaching device?

I strongly feel that iPad will have a part to do. It is sure to displace one-to-many teaching pedagogies in favor of interactive one-to-one studying and learning and will encourage much more participation from students.

To drive home my point about the iPad will have a role in online education for children, here is some news. It has been seen by many that those children who haven’t learned to read or write or even operate a mouse are able to operate the iPad with tremendous speed. According to an article published in Ad Age in June 2010, “How the iPad Became Child’s Play – and Learning Tool,” there were many toddlers as who were as many as 18 months old only who were trying to provoke interaction from TV sets and PC monitors as if they were touch screens like that of the iPad. This indicates clearly that the next generation will find it very easy to respond well and interact with the intuitive device.

In another study related to e-book reading, a survey result released by Student Monitor revealed that out of 1200 college students who were participants in the survey and interested in e-readers, more than 46% of them opted for iPad as the preferred e-reader rather than 38% of them who favored Amazon’s Kindle. This indicates that iPad is known among the adolescents to be much more conducive and intuitive than the Kindle.

Educators today are stressing on the need for contextual learning and user participation. Digital whiteboards have failed to encourage interactivity, and is also less on computing power. The laptop is comparatively bulky too and can be problematic to handle sometimes. The iPad then serves to be the perfect device for comfortable online learning and acts as a useful tool for referencing, collaborating, and content creation. The best part is that of the choice for personalized content for students.

Some of the kinks are there: it does not support web pages which have Flash, it does not have a telephone, it does not have a camera and it also does not have USB slots or memory card slots although there is support for dongles. These limitations are somewhat deterrent for its use but once there are updates to the device, I don’t really see a problem for the iPad to be used as a e-learning device!

About emPower

emPower  is a leading provider of comprehensive Healthcare Compliance Solutions through Learning Management System (LMS). Its mission is to provide innovative security solutions to enable compliance with applicable laws and regulations and maximize business performance. empower provides range of courses to manage compliance required by regulatory bodies such as OSHA, HIPAA, Joint commission and Red Flag Rule etc. Apart from this emPower also offers custom demos and tutorials for your website, business process management and software implementation.

Its Learning Management system (LMS) allows students to retrieve all the courses 24/7/365 by accessing the portal. emPower e-learning training program is an interactive mode of learning that guides students to progress at their own pace.

For additional information, please visit http://www.empowerbpo.com .

Rent Watch: Landlord can require permission for roommate

Question: I have rented a three-bedroom unit for two years. About eight months ago, I lost my job and could no longer pay my rent. Rather than be evicted, I found a roommate who now pays half the monthly rent.
From the beginning, my roommate has written a separate check for his half of the monthly rent and I write my own check for the other half. I give both checks to the rental office, which is the place designated for payment in my rental agreement.

When I took the two checks to the office last week, the new resident manager told me she would not accept the checks. She said I was in violation of my rental agreement. She showed me a copy of the agreement, which does prohibit subletting without management's written permission. Is there anything I can do?
Answer: A landlord has the right to prohibit subletting or require advance written consent. If the management wants to enforce this clause, you could be given a three-day notice to remove your roommate or face an unlawful detainer action for eviction.

You have one potential defense to the assertion that you are in violation of the rental agreement. If you can show that the community's management allowed the roommate to occupy your unit and did not take timely action to require the roommate to vacate, you can assert that management's inaction constituted a waiver of its right to enforce the clause prohibiting sublets. Knowingly accepting a rent check from your roommate over a period of months is strong evidence of waiver.

Even if you have a strong defense, fighting an unlawful detainer can be costly in terms of time and money. If the court rejects the defense, you will have an eviction on your record, which will seriously limit your ability to rent in the future.

As an alternative, you could contact your local mediation program to see whether a resolution can be reached. For example, you and your roommate could reach an agreement to add the roommate to the rental agreement or you could negotiate an agreement allowing you or the roommate a reasonable time to vacate.
Eichner is director of Housing Counseling Programs for Project Sentinel, a Sunnyvale, Calif., mediation service. To submit a question, go to http://www.housing.org.

Bainbridge HomeShare program fills a need for affordable housing

By Tristan Baurick

Kitsap Sun
BAINBRIDGE ISLAND — A Bainbridge affordable-housing group wants homeowners to rethink a housing arrangement they likely abandoned in college.

Taking on a roommate benefits both owner and renter — especially during hard economic times, according to the Housing Resources Board (HRB), which manages the county's only roommate-matching program.
HRB program specialist Penny Lamping said a roommate can help cover a mortgage, provide companionship and chip in on house chores. In return, the homeowner provides below-market-rate housing for a person hit by hard times.

"Some people take a roommate because they have a big house to themselves and they want to share," Lamping said. "Some do it to exercise a social consciousness."

HRB's roommate-matching program, called HomeShare, was created two years ago, but it's getting renewed emphasis as the gap widens between the typical rental rate and the amount people can afford.
"We're getting phone calls all the time, but they can only afford $200 to $500 (per month)," said HRB Executive Director Ken Balizer.

Even the homes HRB manages are typically beyond that range.
HRB is also trying to boost the HomeShare program because the city greatly reduced its financial support, making it difficult for HRB to build new homes or lower the rent on existing ones.

HRB conducts background checks on rental applicants and matches them with homeowners, thereby streamlining and easing the search process for both parties.

Bainbridge homeowner Holly Hall has been renting a room to a young woman for the last 15 months.
"I lived by myself and really wasn't using half my house, so I thought it was worth a try," she said. "It's really worked out well so far."

Until recently, HRB board member Kim Hendrickson rented a room to a Peruvian woman. The arrangement took some financial pressure off Hendrickson's family and gave her kids an early introduction to Spanish, she said.
Hall said opening one's home to a renter isn't without sacrifices. Sometimes chores go undone, and a previous renter had trouble paying the rent during a family emergency.

"You have to be clear and articulate in terms of rent and house cleaning," she said.

Some renters do maintenance, pet watching or provide in-home care for elderly homeowners to supplement rent.
HRB has a list of nearly 20 people seeking homes through the HomeShare program. The list of homeowners offering a room is nearly as long, but HRB is having trouble finding homeowners who will go lower than $600.
Hall said the monthly income is nice, but she doesn't expect it to make her rich.
"It's not about the income," she said. "It's about doing something good for somebody else."

Does a New EHR Mean Switching Practice Management Systems?

Four years ago, pediatrician Jeffrey T. VanGelderen and his partner at the Children's Medical Group of Saginaw Bay in Michigan were looking for an EHR for their practice. Before shopping, they had a difficult decision to make: Find an EHR compatible with their current practice management system or buy an EHR and at the same time, buy a new management system designed to work with it.

In an effort to increase compatibility between the two systems, VanGelderen and his partner chose the latter option, going with brand new systems. They first investigated the EHR offering from their management system vendor, and found it user-friendly, but not as robust as the newer software from another company.

"In a lot of cases like ours, practices already have a management system in place and have had it there for a long time," he says. "When you make the decision to go to an EHR and fully integrate it, you usually go to another [management system]."

In 2008, Children's Medical Group debuted its new practice management system and less than nine months later, had its EHR online with the two systems working collaboratively together.
VanGelderen says the result has been great. The cost of the two new systems already has been more than made up for, he says, and in fact, the new systems have freed up staff time through better efficiencies in the software.

"We are using that time for better quality of care, like follow-ups and identifying patients who need well checks, and our nurses are doing more patient education versus paper shuffling," he says.

If you are considering implementing an EHR at your practice and want one that works with your current management system, how much of an investment should you make? Our experts weigh in with two trains of thought.

Assess your needs

You wouldn't make a big capital investment in a medical device without a little research on cost, use at your practice, and training, right? Well, our experts say when it comes to weighing a potential relationship between your practice management system and an EHR you also need to do your homework.

Fred Pennic, a healthcare IT consultant and technology blogger, says if you like your current practice management system, make a complete assessment of what it will mean to bring an EHR online also. This includes ensuring you have the proper resources to support it, in terms of IT staff or other employees, knowing what your licensing agreement will cost you, and estimating training hours required to get any new system up and running.

You also need to weigh the pros and cons for your practice, adds Don Sickle, a former EHR specialist with national consulting firm Welch Allyn. Sure your current system is all paid off and familiar to staff, but does it also have lingering problems that require tricks and shortcuts by your staff — costing time and money just to get it to work? If so, perhaps it is time for an upgrade, Sickle says.

If you are ready for an EHR, both Pennic and Sickle advise taking the same first step as Children's Medical Group — call your current practice management system vendor to inquire about its EHR offering. If you are happy with one of the vendor’s products, you may like a companion that works similarly and is more likely integrated than two systems from two different vendors.

Sickle, who was also president of advisory firm EHRInsider, says two different vendors means more "interfaces" between products so they can communicate, which isn't always a good thing.

"Interfaces are all links in a chain, and eventually, one of them will be weak somewhere at some point," he says. "The key is to have as few links in this technological chain as possible."

When calling your existing practice management system vendor to inquire about its EHR offering, Sickle advises inquiring how long the vendor has had the product in place and whether the EHR was purchased from an out-of-business company — making it less likely to work seamlessly with your practice management system. Just because it is from the same vendor doesn't mean the systems will work together in perfect harmony.

If the vendor does have a product you are happy with, schedule a Web demo, Sickle says, or even an onsite visit to your practice so you can learn more about the EHR and how it will fit into your practice's current operations.

Time for a change

But what if, during that assessment, you find that your current practice management system is not as efficient as when you bought it years ago? Then it may be time for a change.

Margret Amatayukul, president of Margret/A Consulting in Schaumburg, Ill., says when it comes to getting practice management systems and EHRs to work together, the answer is simple:

"You cannot find an EHR today worth its salt that will really integrate well with an old practice management system," she says.

So practices hoping for harmonious integration between an EHR and practice management system should at least consider buying both products new, she says.

"You should not be closed-minded about being open to looking into a new practice management component that makes sense for you," Amatayukul says. "Keep an open mind, even if you are dead set against it."

Now that you are ready to shop for some technology, try to hit as many EHR vendors as possible. Where is the best place to do that? Trade shows, says Sickle. Check for local and national trade shows where multiple vendors will talk to you and provide you with lots of literature on their products.

Take the 10 to 20 in-person visits and make a shorter list of vendors, about five or six, and set up Web-based demos for you and some of your key staff. From there, choose the two or three you want to do an in-depth demo that will include how the practice management and EHR components work together effectively.

Learn from others

More likely than not, you are not the first practice to make a big investment in a new practice management system and EHR at the same time. So to best gauge how your new products will work together, talk to those who've already done it, say our experts.

Get references directly from your potential new vendor partner, Amatayukul says, and be specific — ask for a similar-size practice making the same decisions you are.

"Don't take 'we've done a lot of these' as an answer from a vendor," she says. "They need to dig deep in terms of how many have you done on my version [of the system] and in the same size and type of practice I am. …Vendors often have references for EHRs, but don't get references for [management system] conversion. If the vendor can't come up with a reference exactly like yours, steer clear because they don't have the experience."

VanGelderen agrees, saying it is very important to see demos, but also talk to other practices.

"I have several colleagues in the medical field who opted for one system or another simply because it was more compatible with what they had," he says. "But often times, that doesn't work well if you don't have a good system. You want to be sure the system has everything to offer and the flexibility you need for your practice."

Again, just because the systems can talk to each other doesn't mean they are always the best fit, VanGelderen warns. He recalls a neighboring practice that placed compatibility over function and as a result, did not get the most from its EHR.

"You don't just want to pick something because it is an easier fit with your management system," he says. "You may lose [capabilities] on the EHR side, which is why you are making the switch in the first place."

Where do you want to go?

Marlin Moyer, program director for information technology with Pennsylvania-based Geisinger Health System, also warns small- and mid-size practices against just looking at an EHR without even considering the impact on their current practice management system.

He says going with a non-integrated system means your practice has to have the manpower in your office or the money for consultants to get those two systems talking and working together, "and that goes with significant maintenance."

At a minimum, Moyer says, get the "front end" of your management system — like scheduling, patient registration, follow-up appointments — synched to your EHR and you can live with a separate billing system.

Geisinger, which employs more than 800 physicians in 42 Pennsylvania counties, developed its own EHR in the mid-1990s to work with its in-house management system. An important part of the system's work was to adapt its operations to the EHR and not vice versa.

"Practices try to make the technology work with their current work flow versus looking at the bigger picture," Moyer says. "Look at what you want … with a combined EHR and management system. Are you looking to just get something that meets 'meaningful use' guidelines or to transform your practice, become more innovative, and take things to the next level? It's looking at where you want to be in 20 years, not 'do I want to get the incentives offered right now.'"

This article was originally posted at http://ping.fm/7lTJf

Which OSHA Regulations Require Written Plans?

If OSHA Compliance came to your door, what’s one of the first things the inspector might ask to see? The answer is . . . your Hazard Communication Plan. Is your written plan up for that kind of scrutiny? How about your other safety and health plans? Are you sure you have all the required written plans you need in place?

Not all OSHA regulations require written plans, but many do. The question is which ones? Take a look at the bulleted list of general industry regulations requiring written plans. For your convenience, we’ve put them in order from most-violated down to least-violated plans, according to the latest OSHA statistics:


*  Hazard communication – 1910.1200(e)
*  Lockout/tagout (energy control procedures)- 1910.147(c)(4)
*  Respiratory protection – 1910.134(c)(1)
*  Process safety management – 1910.119(d),(e)(1),(f)(1),(j)(1),(l)(1),(m)(4),(o)(3)
*  Personal protective equipment (hazard assessment) – 1910.132(d)
*  Bloodborne pathogens – 1910.1030(c)
*  Emergency action plans – 1910.38(b)
*  Permit-required confined spaces – 1910.146(c)(4)
*  Hazardous waste operations and emergency response – 1910.120(b)(1),(l)(1),(p)(1),(q)(1)
*  Electrical safety (assured equipment grounding conductor program and lockout/tagout procedures for work with energized parts) – 1910.304(b)(3)(ii) and 1910.333(b)(2)(i)
*  Fire prevention plans – 1910.39(b)
*  Laboratory standard (chemical hygiene plan) – 1910.1450(e)
*  Commercial diving operations (safe practices manual) – 1910.420
*  Powered platforms for building maintenance (emergency action plan) – 1910.66(e)(9)

When OSHA considers a safety or health hazard to be serious, the agency usually requires written documentation of the steps an employer takes to counteract the hazard. You can see that the above list covers some of the most serious hazards faced by workers today, including, but not limited to, chemical exposures, process explosions, fire, electrocution, and bloodborne pathogens.

As an employer, not all of these plans will necessarily be applicable to your workplace, so you’ll want to review the scope and applicability of these regulations to see if your company falls under any of them. For the applicable ones, make sure your written plans meet all the OSHA-required elements specified in the regulations.

This article was originally posted at http://ping.fm/TtYUH

Hospital chief pleads guilty in case over firing of Texas nurses

Stan Wiley, former hospital administrator of Winkler County Memorial Hospital, Kermit Texas, pleaded guilty to abuse of official capacity for his role in the firing of two nurses who had complained about a doctor to the Texas Medical Board, according to the Texas attorney general's office.

Wiley was sentenced to 30 days in the Winkler County Jail by visiting Judge Robert H. Moore III as part of a plea deal in which he has agreed to cooperate in the prosecution of three other defendants, according to a news release from the attorney general’s office, which is prosecuting the case because the Winkler County District Attorney recused himself from the proceedings.

Also being prosecuted are former Winkler County Memorial Hospital physician Dr. Rolando Arafiles, Winkler County Sheriff Robert Roberts and Winkler County Attorney Scott Tidwell. Arafiles recently was fined $5,000, publicly reprimanded and required to undergo training and oversight by the state medical board .

Wiley, Arafiles, Roberts and Tidwell were indicted in January for allegedly retaliating against two nurses who had reported Arafiles to the state medical board in 2009 for actions they believed were endangering hospital patients.

The two nurses, Anne Mitchell and Vickilyn Galle, settled with Winkler County for $750,000 in August, according to their attorneys.

This article was originally posted at http://ping.fm/xdFhr

Study: Many Physicians Eligible for Incentives but Lack EHRs

Many physicians are eligible for federal incentive payments for the meaningful use of electronic health records but lack a basic EHR system, according to a study published in the journal Health Affairs, Healthcare IT News reports.

Under the 2009 economic stimulus package, health care providers who demonstrate meaningful use of certified EHRs can qualify for incentive payments through Medicare and Medicaid. Eligibility for the incentive payment programs is based on the number of Medicare and Medicaid patients seen.

For the study, researchers used data from the 2007 and 2008 National Ambulatory Medical Care Survey to gauge EHR use by nonfederal, office-based physicians (Merrill, Healthcare IT News, 3/8).

Key Findings

Overall, researchers found that nearly 83% of office-based physicians are eligible for either the Medicare or Medicaid incentive program. They noted that:

• About 76% of physicians could qualify for the Medicare incentive program; and
• About 15% could qualify for the Medicaid incentive program.

Physicians must choose to participate in either the Medicare or the Medicaid incentive program. Because the Medicaid program likely would offer higher incentive payments, researchers assumed that most physicians eligible for the Medicaid program would pursue it (Conn, Modern Healthcare, 3/8).

The study also found that:

• 70.5% of physicians are eligible for either the Medicare or Medicaid incentives, but do not have a basic EHR system;
• 14.6% of physicians are not eligible for incentives and do not have a basic EHR;
• 12.1% of physicians are eligible for incentives and have a basic EHR; and
• 2.8% of physicians are not eligible for incentives and have a basic EHR system (Healthcare IT News, 3/8).

In addition, researchers found that eligibility for the EHR incentive programs varied by medical specialty. For example, 91% of general practice, internal medicine and family practice specialists are eligible for incentives, compared with 53% of pediatricians.

Recommendations

Researchers recommended that policymakers broaden eligibility requirements for the incentive payments to help more specialists qualify for the programs (Modern Healthcare, 3/8).

The study authors wrote that "if after the HITECH incentives have been implemented, research reveals that physicians still are not generally using EHRs and that further incentives would lead to commensurate gains in the quality and efficiency of care, there would be stronger basis for recommending changes in the incentive structure" (Healthcare IT News, 3/8).

This article was originally posted athttp://www.ihealthbeat.org/articles/2011/3/8/study-many-physicians-eligible-for-incentives-but-lack-ehrs.aspx#ixzz1G713uzI0

Accelerating the Use of Electronic Health Records in Physician Practices

North Shore Hospital System on Long Island in New York recently announced that it will pay an incentive of up to $40,000 to each physician in its network who adopts its electronic health record (EHR) — paying 50% of the cost to physicians who install an EHR that communicates with the hospital and 85% of the cost if the physician also shares de-identified data on the quality of care.1 This payment would apparently come on top of the $44,000 incentive that the American Recovery and Reinvestment Act of 2009 (ARRA) has authorized Medicare to pay each eligible health care professional who uses certified EHRs in a meaningful manner. “Meaningful use” is still being defined, but the overarching goal is to improve the population’s health through a transformed health care delivery system with the use of EHRs to improve local processes, foster quality measurement, and increase communication. North Shore’s announcement is a sign of the continuing acceleration of EHR adoption by physicians’ offices2 and hospitals.3 Support for information systems is exempted from the Stark amendment to the Omnibus Budget Reconciliation Act of 1989, which prohibits hospitals from offering physicians incentives for providing referrals or admissions. The exemption for information technology acknowledges that the likelihood of additional referrals may be part of the motivation for hospitals to form closer links with community physicians through EHRs. Another benefit to hospitals from supporting the use of EHRs by physicians who are linked to them by geography, academic appointment, or practice pattern is the enhanced ability to manage the quality and outcomes of care. For example, if financial penalties and incentives are to be imposed on the basis of rates of readmission, then the more closely aligned a hospital is with the physicians who provide its patients’ postdischarge care, the greater the benefits it will reap.

The cost–benefit calculus behind physicians’ adoption of EHRs is also changing. Financial incentives are one element. The prices of EHRs have come down as the volume of software licenses being sold has increased. A second factor is that the time investment associated with data entry, which has long represented a major obstacle to adoption, has been reduced as systems have improved in performance and become more flexible with regard to individual preferences for data entry, including free text, templated data entry, dictation, speech recognition, and freehand graphic input. System usability has also improved, thanks to competition and customers’ resistance to cumbersome products. Third, the addition to EHR systems of capabilities beyond documentation, including coding functions, the ability to create and export bills, the automated creation of consultation and patient letters, electronic prescribing, and task tracking, now translates into greater time savings for users. And a fourth factor is the increasing emphasis on quality of care, since payment for quality requires documentation of quality.

Other trends favoring EHR adoption include the emerging consensus that alignment of hospitals and physicians is necessary to provide higher-quality care and service for patients as they move among providers and traverse levels of care, as well as the recognition that information transfer is an important component of care given by multiple providers. Younger physicians — and some older ones — are more comfortable and function more efficiently and effectively in an electronic-information environment than in a world of paper records.

Some obstacles persist, of course. EHR products remain expensive to install and maintain — cost issues that should not be underestimated. The decision by North Shore to provide a financial incentive as well as the software license suggests that many physicians still do not believe that current-generation EHRs will offer a return on investment directly to physicians.

Wide dissemination of EHRs requires public trust. The sharing of patients’ information — which has been common practice for decades for the purposes of billing, treatment, and public health — has come into the public eye because of the risks associated with vastly expanded sharing and the newfound ability to easily and quickly transfer many patient records simultaneously. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) created a framework for defining privacy, breaches of privacy, and penalties. The ARRA further defined privacy breaches and increased the penalties for them. One of the challenges to setting policy in this area is that electronic privacy and its relative importance are still being defined. The capability of providing a secure electronic environment for patient data — like the capability of providing reliable data storage — is beyond the reach of most individual physician practices. Truly secure and reliable EHRs are currently feasible only for larger organizations with centrally supported technological capabilities. This may be one reason why the rate of adoption has been much higher among large practices (see graph).

Shea_F1

Rates of Adoption of Electronic Health Records According to Practice Size.

The percentage shown above each bar is the proportion of physicians who work in a practice of the given size. The green portion of each bar represents the percentage of physicians in a practice of a given size who have adopted at least basic electronic health records (EHRs), and the yellow portion represents the percentage of physicians who have not adopted EHRs.2 For each practice size, the percentage of physicians who have not adopted EHRs relative to the total number of physicians in practice is shown at the bottom. Physicians in the smallest practices account for more than 50% of those who have not yet adopted EHRs, whereas physicians in the largest practices account for only about 3%.

Exchanging information requires that EHRs share common standards. Work is ongoing at organizations for standards development and facilitation such as Health Level Seven (HL7), which have been providing practical standards for decades. The ultimate in interoperability would be a single EHR for all health care providers, but the disadvantage of this model would be a loss of competition among vendors — a factor that has presumably contributed to increased usability and lower cost. Moreover, interoperability among disparate EHRs may actually increase competition and innovation if it makes it easier for health care providers to change vendors by populating a new system with an old system’s data. Innovation is not predicated on competition alone, however. Increasing funding for EHR research and development — as opposed to implementation and evaluation — may produce evolutionary and revolutionary improvements in EHRs.

The next major step in EHR deployment is a concrete definition of the requirements — in terms of meaningful use, information sharing, and reporting of quality measures — for physicians to receive ARRA incentives. The federal Health Information Technology Policy Committee has submitted recommendations4 to the National Coordinator of Health Information Technology; the Centers for Medicare and Medicaid Services published draft rules on December 30, 2009, and this publication will be followed by a period for public comment before a final set of rules is issued. Clarity on federal incentives for physicians to adopt EHRs will allow these incentives to be aligned with those offered by state governments, provider organizations, and commercial payers. Poorly aligned incentives may have unintended consequences, such as increases in health disparities or incentives for specialty-specific silo systems.

Electronic interaction between hospitals and physicians is just the beginning. Patients are also interacting electronically with the health care system, exchanging information with providers through secure patient portals and patient-based health records. More active transactions, such as remote case management by nurses for patients with chronic diseases,5 may occur through telemedicine. Some possibilities that will be advanced by phys icians’ adoption of EHRs include the use of cell-phone technology for messaging, the capability of moving data from home monitoring devices to cell phones and upstream to EHRs, yet-to-be developed software capabilities that will allow EHRs to manage these uploaded data streams within clinical workflows, and the effective provision of out-of-office care.

Medical Transcription Software Means Greater Efficiency

For a long time medical transcription has been a growing field. It allows medical professionals to leverage their time by dictating the information that needs to be included in a patient file into some type of audio format. It is then taken by a transcriptionist for conversion to a text format. These software is making the job easier for transcriptionists and in the end it provides a service not only to medical professionals but to patients as well.

The most current medical transcription software utilizes speech recognition technology. This software can automatically take something that has been delivered in an audio file format and convert it to text. The transcriptionist will then review the text and generally also the audio file to ensure accuracy and the ability of someone to comprehend the data that has been delivered.

The improvements in the software have not only included the ability to recognize speech and convert it to text but also the methods that are used for the gathering of information. Audio files are currently being reduced in size and improved in quality so that the software can be even more effective, and the file size can be even smaller. This translates into faster download times and quicker turnaround.

Some people may believe that the advancements in medical transcription software will spell the end of the transcription field. This is simply not the case, as there will always be in need to have somebody who is versed in medical terminology to ensure that the text sent back to the patient file can be understood by anybody who reads it. Someone using this software will continue to need to make the end product something usable.

Part of the reason that there will always be a need for medical transcriptionists is that no matter how good the transcription software might be there may be errors or omissions on the part of the medical professional that is providing the information in the first place. The fact that these software can increase the output of the transcriptionist only means that the information will get back into the patient’s file quickly, that the transcriptionists will have the luxury of taking more time to ensure that quality text is sent back.

Medical transcription software will continue to allow physicians to leverage their time and provide them with more accurate and accessible patient files. The fact that the increased productivity of the transcriptionists will result in more current patient files will mean that patients receive better quality medical care. Transcription companies will be able to streamline their processes and handle greater volume for increased profitability.

For the work of a transcriptionist, these software can be a powerful aid. It is not, and may never be a replacement for the medical transcriptionist but instead a tool that allows them to be more efficient. There will always be discrepancies in the spoken word of a medical professional and the fact that many medical terms sounds so much alike will always have a need for somebody to review the final product.

Medical transcription software is changing the transcription industry, and medical transcription software that can increase productivity is a must. Keep pace by learning what a good medical transcription software program can do for your company.

Medical Billing Software ? A Consideration For Your Staff and Patients

Medical billing software has become an office staple in many doctor and dentist offices nation wide. With the time saving and convenient application, your office is given the capability to run smoothly at high efficiency. This gives your staff the freedom to devote more of their time to the most important people to your practice, your patients. So, what should you expect from such an important investment?

The medical billing software that you choose should be feature rich. From initial installation to delivering the capability for prompt insurance payments, the software you choose should meet all of your office needs. Your software should excel in it’s user friendly formatting by providing shortcuts, error detectors, and quick and easy input recovery. All in all, being able to effectively manage your patient accounting, file claims – whether electronically or by mail, track insurance claims, and manage accounts receivable should be standard features, not optional.

The kind of company that backs up its product is an excellent measure of a quality software. Is your chosen dealer going to aid you in the installation, train you and your staff in applying it, and continue supporting your needs by being available to answer your questions down the road once you’ve made your purchase? If your chosen software dealer cares about their clients you can be assured they care about providing a quality product.

Another measure of dependable medical billing software and the company that backs it is if they offer discounted upgrades. If you have an older version of their software, will they accept your older version back for the updated version at a lower price? You shouldn’t have to take a mortagage out on your practice just to stay up to date with how quickly technology progresses. With the consideration of discounted upgrades in exchange for returns, this tells of a company that truly cares about their clients.

Your staff is free to focus on your patients with medical billing software. Gone are the days of having to physically store patient files in space hoarding shelves, trying to find misplaced or lost files, refiling incorrectly filed insurance claims, and delayed insurance payments. Medical billing software is exactly what every medical and dental practice needs to provide their customers the courtesy of immediate and accurate billing information. Your staff will also thank you for your consideration to their efforts for meeting the needs of each patient that comes through your door.

EMR Software Helps Physicians be More Productive

Without the help of technology, keep any kind of records can be a nightmare. Over time, the mountain of records just keep building and building, until the entire system becomes unmanageable. Records get lost or buried, and they become impossible to find. This happens to many businesses that require record keeping like medical practices or financial companies. Aware of the benefits presented by technology, many medical practices are starting to adopt Electronic Medical Records systems. Such systems allow medical records to be filed away electronically so that they can be retrieved quickly and efficiently by anyone who needs access to the information. In general, there are 3 types of EMR software solutions that a medical practice can choose to adopt. 1) Web based software solutions. 2) Custom built solutions 3) Off the shelf, standalone solutions. Web based software solutions. Web based software is easy to adopt. There is usually minimal installation and integration issues, and all you need is an Internet connection and you will be able to access the information you want to. The problem with web based software solutions is that since it is on a public network, there is always the concern of security. Medical records are private and sensitive information. So they should be kept as securely as possible. And the Internet hardly appears to be the ideal place. Custom built solutions. Custom built software solutions give you exactly what you want. You have full control over how the software works. Since you have the best understanding of how your business works, designing your custom built software seems to make sense. However, custom built software solutions often cost a lot more than other types of software solutions. That’s because the solution is developed solely for you. Also, there is the development time frame to think about. A custom built software can take months or sometimes years to perfect. Off the shelf, standalone solutions. Given the drawbacks of the first two software options, off the shelf standalone solution seems to be the logical choice. The pricing is definitely much more affordable, and you get to use the software immediately. Standalone EMR software may be developed by a programming language such as Java. They work on multiple operating systems like Windows, Mac, and even Linux. There are no additional components required, and all you have to do is to install the software in the computers. Established EMR software often has a more comprehensive feature list. That means there is no need for you to define your own feature list. You just install and use. Some features that you should look out for include Automated data backup, E&M code suggestor, Intra-office instant messaging (great for communications), Patient scheduler, Patient tracker, Problem list and more. When choosing EMR software, you can always evaluate the software by requesting for a trial period and access to any demo materials available. That way, you can make better decisions down the road.

The Advantages of Electronic Prescribing

Are you a doctor searching for better ways to treat your patients? Do you want to address administrative duties in an efficient and timely manner? E-prescribing software offers a viable solution. The benefits of electronic prescription have been aiding doctors for some time now while more doctors are realizing the benefits of such a system and implementing the software into their practices. What are the benefits of e-prescribing software? Read on to find out more.

Display of pertinent, patient information A patient’s prior and present information is important to the medical process. A doctor needs to know of their prior history and present state in order to treat them properly. Electronic prescribing software indicates if the patient is eligible for care according in regards to the patient’s insurance policies. Furthermore, the software makes doctors aware of patient-medication histories and pharmacy-fill histories.

Real-time support tools Doctors are certain as to how their prescribed medicines will influence the patient, but they also need to know how other medications and patients allergies will react while taking the doctor-prescribed medication. The software serves as a decision-support tool for doctors. In addition, the e-prescribing system can check for appropriate dosages and duplicate forms of therapy.

Efficient communication with pharmacies There are many parties who play a crucial part in the healthcare process. Doctors must maintain good communication with a patient’s pharmacy to ensure they are getting extraordinary care. Using the e-prescription software, a doctor can access renewal requests from pharmacies, renew medications for multiple patients, and write a prescription from an often-used ‘favorite’ list. Furthermore, a doctor can send electronic prescriptions to a patient’s pharmacy of choice (including mail-order pharmacies).

More benefits…

* Satisfies MIPPA requirements, which qualify physicians for annual bonuses

* Clinical information displayed during prescription process

* Real-time clinical decision support tools

* Access renewal requests from pharmacies

* Send prescriptions electronically to the patient’s pharmacy of choice

* Securely share patient data with other treating physicians and send/receive referrals

* Patient information protected by strict privacy and security measures

Cost-Effective and Reliable Medical Transcription Service

Medical transcription services are available for all specialties such as radiology, orthopedics, cardiology, and more.

With increase in the number of patients opting for quality medical care, hospitals and clinics find it hard to maintain their medical records and reports up to date. The pragmatic solution to this problem would be to rely on cost-effective and reliable medical transcription service. A number of transcription companies have now emerged in view of the increased demand for medical transcription in the industry.

The advantages of hiring a reputable transcription company are the low turnaround time, reduced expenditure and assured security. These companies offer services to all English speaking countries such as the US, Canada, UK and Australia. Transcription services are available for all specialties such as radiology, cardiology, orthopedics and more.

Medical transcriptionists are specially selected and trained to excel in their work. These professionals make use of the latest technology and infrastructure to offer the best possible service. Clients are assured of the quality and accuracy of the processed work as every medical transcription company would necessarily have a dedicated team of quality analysts and proofreaders. Peace of mind is assured as the work is processed and sent within the stipulated time period and security protocols comply with HIPAA

Cost-effective and reliable medical transcription service substantially reduces the workload of a physician or surgeon so that they get more time to focus on their patients instead of worrying about office work. It is advisable to assess the productivity and efficiency of a medical transcription company before engaging in a long term contract. This will allow you to frame a general idea of what you can expect form them in future. It is essential to ensure that they undertake any volume of work lest you find difficultly in the later stages.

CMS and ONC Issue Regulations Proposing a Definition of ?Meaningful Use? and Setting Standards for Electronic Health Record Incentive Program

The Centers for Medicare & Medicare Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) encourage public comment on two regulations issued today that lay a foundation for improving quality, efficiency and safety through meaningful use of certified electronic health record (EHR) technology. The regulations will help implement the EHR incentive programs enacted under the American Recovery and Reinvestment Act of 2009 (Recovery Act).

A proposed rule issued by CMS outlines proposed provisions governing the EHR incentive programs, including defining the central concept of “meaningful use” of EHR technology. An interim final regulation (IFR) issued by ONC sets initial standards, implementation specifications, and certification criteria for EHR technology. Both regulations are open to public comment.

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

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

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

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

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

The CMS proposed rule and fact sheets, may be viewed at http://ping.fm/3uAaN

ONC’s interim final rule may be viewed at http://ping.fm/mnpWq In early 2010 ONC intends to issue a notice of proposed rulemaking related to the certification of health information technology.

Choosing The Right Software For Your Practice

If you have an in-house medical billing system and the necessary staff to handle the workflow, using medical billing software can dramatically improve the productivity and revenue cycle of your practice. Software can help automate the labor-intensive parts of the medical billing process and considerably speed up time-consuming (and error-prone) tasks such as patient data entry, claims submission, and payment application.

There are many good software applications that are available on the market and choosing the right one can be a daunting task if you don’t know what to look for.

Below are some features to check for when doing your research:

Medical Codes

One of the biggest advantages of using billing software is that you can eliminate cumbersome paper manuals on coding. Medical billing software gives you and your staff the ability to quickly search and insert billing codes with the simple click of a mouse. This vastly simplifies the process of claims preparation.

It is important however, to ensure that the medical billing software comes with an exhaustive and updated list of CPT, ICD, and HSPCS codes with a reliable system for periodically updating this list. Most software companies provide annual updates that can be bought for a small fee and installed either through a disc or downloaded from an online location.

It is also advisable to test-run the software to check for ease of use. The software should ideally offer a simple graphical interface for creating claims with easy search options and point-and-click functionality for choosing codes from a list.

HIPAA compliance

Apart from improving efficiency and reducing the number of errors, medical billing software can also help your practice meet HIPAA regulations related to individual privacy and security of healthcare information. There are many tools employed by different software development companies to meet these regulations. While these tools may not make your practice 100% HIPAA compliant, they can make a significant contribution. Most good medical billing software applications have several or all of the following tools built in:

Data encryption – This ensures that any information transferred online is intelligible only to the authorized recipients. 128-bit encryption is considered the industry standard.

Multi-level user authentication – This includes measures such as password protection, role-based access to restricted areas of the software/database, and automatic (timed) log off in case a workstation has been idle for some time.

Audit trails – Audit trails are records of all system activities including login information, files accessed, changes made to patient data, etc. These records are crucial for internal security audits.

Scheduled backups – These are necessary to prevent data loss. Most medical billing software comes with scheduled backup systems that allow you to periodically download critical patient data onto your hard drive or other secure location.

Claims Management

Electronic claims transmission not only speeds up the payment cycle but also reduces the number of rejected claims. Medical billing applications come with several time & cost saving features that can help practices improve their claims management system.

Visual Editors

Visual editors allow users to create and edit insurance claims forms through a graphical interface. Users can quickly add notes, make changes and submit claims at the click of a mouse.

Error Correction

This feature helps in minimizing rejected claims by highlighting missing information, mismatched ICD/CPT codes, and invalid insurance policy numbers, etc. before a claim is submitted for processing. This is a big time-saver and naturally reduces the possibility of claims being declined due to incorrect/incomplete forms.

Claims Submission

Submitting claims electronically can save hours of labor, reduce the number of rejected claims, and also speed up claims processing. Some insurance companies delay paper claims to up to 28 days, while electronically submitted claims can take just 24-48 hours.

Depending on the medical billing product you choose, there are several methods available for submitting claims electronically. One option is to send all claims to a clearinghouse. The clearinghouse will then forward the claims to the appropriate insurance carriers. This may, however, turn out to be expensive because of the per claim fee charged by the clearinghouse. Costs can be reduced by submitting claims directly to Medicare and Medicaid and processing the remaining through a clearinghouse.

Another option is direct online billing at the websites of the insurance carriers. Although there are no additional fees involved in this method, you must be an in-network provider with the relevant carrier to be able to submit claims at the carrier’s website.

Revenue Management

Medical billing software can significantly improve the payment cycle of any practice. This is through the account receivable module that comes with most software applications. This module helps practices keep track of payments received and payments outstanding. The software application also helps with faster payment applications to specific claims/charges, tracking how much of a payment remains to be applied, reporting payments receivable, automatic calculation of the write-off amounts, tracking billing, and other activities for improving the A/R cycle.

When choosing medical billing software, it is advisable to look for applications that either have these accounting features built-in or allow for easy integration with external accounting software such as Quicken or Peachtree. It’s also a good idea to thoroughly test the software to see if it has all the features required for your particular practice.

Medical Scheduling

Many software packages come with medical appointment schedulers that allow for easy management of patient appointments. Multiple features such as making or editing appointments, viewing daily, weekly, monthly appointments, viewing relevant patient demographics along with appointment details, scheduling recurring/multiple appointments, etc., can make these schedulers very useful for busy practices.

Trial period and Training

Most medical billing software developers offer trial versions of their software. Some also include on-site training for staff members who handle billing for a practice. These features give you the opportunity to not only check if the software has all the features advertised but also to test the suitability of the application for your particular practice. The usual trial period is of 30 days and provides you ample time to thoroughly test the software.

Technical support

As with all software applications, you and your staff would need ongoing technical assistance for the correct use and maintenance of the medical billing software. It’s therefore important to choose a vendor who can provide the necessary installation, training, and technical support. Most vendors provide an initial period of free support and then monthly or annual paid services.

There are many other features that can be compared and considered when deciding on the perfect medical billing software for your practice – software applications are constantly evolving to include more and better functionalities – but keeping these basic features in mind can help you make a reasonable choice.

Survey finds 4 in 10 doctors use an EHR

By, Molly Merrill

ATLANTA – Four of every 10 office-based physicians use electronic health records, according to 2009 preliminary estimates by the Centers for Disease Control and Prevention.

The estimates are based on the CDC’s National Ambulatory Medical Survey (NAMCS), an annual nationally representative survey of patient visits to office-based physicians that collects information on the use of electronic medical records or electronic health records. A supplementary mail survey was also conducted in 2008 and 2009.

According to the estimates for 2009, 43.9 percent of physicians reported using full or partial EMR/EHR systems (not including systems used solely for billing) in office-based practices. About 20.5 percent reported having systems that meet the criteria of a basic system, and 6.3 percent reported using a fully functional system.

A basic system is defined as having patient demographic information, patient problem lists, clinical notes, orders for prescriptions and viewing laboratory and imaging results. Systems defined as fully functional also include medical history and follow-up, orders for tests, prescription and test orders sent electronically, warnings of drug interactions or contraindications, highlighting of out-of-range test levels and reminders for guideline-based interventions.

The survey indicates that from 2007-2008, physicians’ use of any EMR system increased by 18.7 percent and the percentage of physicians reporting having systems that meet the criteria of a basic system increased by 41.5 percent. Researchers conclude that the 2009 preliminary estimates did not change significantly from 2008.

Researchers say data from the 2009 NAMCS will be combined with the mail survey to obtain a final 2009 estimate.

HIMSS Analytics looking to go international with its EMR Adoption Model

CHICAGO – HIMSS Analytics EMR Adoption Model is gaining interest internationally, according to Dave Garets, the company’s CEO and president.

HIMSS Analytics, a not-for-profit subsidiary of the Chicago-based Healthcare Information and Management Systems Society, collects IT data on every non-federal hospital in the country and some hospitals in Canada through an annual study that tracks the implementation and adoption of electronic medical record applications.

Garets said the HIMSS Analytics EMR Model, which rates hospitals on a scale from 0 to 7, is garnering interest in some European and Middle Eastern countries and Australia. With slight modifications, he said, the model has the ability to work on an international level.

“The model has gotten international acceptance because it is a standard way of doing it,” he said. “It makes sense to most everybody.”

When data indicates a hospital has reached Stage 6, HIMSS Analytics contacts the CIO to make an independent validation. Garets said half of those phone calls lead to a determination that the hospital isn’t at Stage 6 yet.

“What’s striking about Stage 6 hospitals is the amount of different vendors that are represented. It’s a very nice thing because it shows it’s not the software, it’s what you do with it,” said Garets.

When a hospital’s data suggests it has reached Stage 7 – the highest level of the model – HIMSS Analytics performs an on-site visit. Garets said nothing is off limits during this visit, and HIMSS Analytics officials have the freedom to look at the hospital’s IT systems in action.

Garets said only one hospital has not met the Stage 7 requirements after a site visit.

“As more healthcare organizations move toward EMR implementation, the Stage 7 hospitals offer valuable best practices focused on using EMR applications to improve patient safety, clinical outcomes and patient care delivery efficiency,” said Mike Davis, HIMSS Analytics’ executive vice president.

Study: Implementing EHR, e-prescribing is challenging, but beneficial over time

Benefits from EHR and e-prescribing investments come under very broad, diverse categories but are very individual and specific to the retrospective context of an investment, according to a study by the European Commission. There is no single correct strategy for implementing EHRs and e-prescribing systems, yet the results of the study give grounds for optimism in the success, value and deployment of interoperable EHR and e-prescribing systems after a few years.

The European Commission investigated the qualitative socio-economic impact of interoperable EHR and e-prescribing systems in 11 practice cases in Europe, the U.S. and Israel to provide insight into factors surrounding successful EHR and e-prescribing deployment. Nine of the cases also underwent a quantitative evaluation of their socio-economic impacts.

“Decisions to invest in EHR and e-prescribing systems should [involve the adoption of] strategies that fit their local or regional setting and be designed to succeed by meeting clearly identified, measurable needs,” concluded the Commission.

The socio-economic gain to society from interoperable EHR and e-prescribing systems eventually exceed the costs, according to the commision. While it found that a typical development can reach an annual socio-economic return (SER) of up to 400 percent, it can take at least four–and up to nine–years before initiatives produce their first positive annual SER.

According to the European Commission, it can take an average of nine years to realize a cumulative net benefit. “Plans to invest in EHRs and e-prescribing systems should have a clear focus on achieving changes at the right time,” the commission reported. Longer time scales are generally associated with a lower risk of failure, according to the report.

In the study, the average distribution of costs were allocated from citizens (2 percent), providers (11 percent), health provider organizations (80 percent) and third parties (7 percent). The average distribution of benefits were dispursed between citizens (17 percent), providers (17 percent), health provider organizations (61 percent) and third parties (5 percent).

“From a systematic perspective, no single or small group of benefits comprise a sufficient reason for investment in EHR and e-prescribing systems,” the report found.

The total value of invested financial and non-financial resources at the evaluated sites was extremely wide with 42 percent of these expenditures on information and communication technologies.

According to the organization, an opportunity exists for all EHR and e-prescribing systems to facilitate a productive dialogue between users and information and communication technology experts before spending large sums of money on actual solutions. “Continouous engagement with healthcare professionals from the outset is essential and time-consuming, but must not be avoided,” stated the report. “If it is, it has bigger costs downstream.”

Another potential opportunity is to use interoperability as a prime driver of benefits. “Without the meaningful hearing and exchange of information, the gains would be marginal and not justify the cost of investments,” said the report.

43.9% of Office-Based Physicians Used EHRs in 2009, CDC Finds

More than 40% of office-based physicians used electronic health record systems in 2009, according to the latest National Ambulatory Medical Care Survey from CDC’s National Center for Health Statistics, MedPage Today reports.

The latest findings suggest that EHR adoption has increased significantly during the past decade, up from 18% in 2001.

Survey Details

For the report, NCHS interviewed 3,200 physicians and sent mail surveys to an additional 2,000 doctors (Walker, MedPage Today, 1/8).

Researchers used the surveys to estimate that 43.9% of office-based physicians were using EHRs in 2009. Of those, they note that:

* 20.5% reported having EHRs that included basic features such as clinical notes, laboratory results and prescription orders; and
* 6.3% reported using fully functional EHRs that included additional features such as digital reminders, drug interaction alerts and electronic order transmissions (Merrill, Healthcare IT News, 1/11).

2008 Survey

In 2008, the survey found that:

* 17% of physicians had basic EHRs; and
* 4.4% had fully functional systems (MedPage Today, 1/8).

The report notes that the number of physicians using any EHR system increased by 18.7% between 2007 and 2008. During the same period, the number of physicians using basic systems increased by 41.5% (Healthcare IT News, 1/11).