Posts Tagged electronic health record

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How Do You Get That Stimulus Money for Using an Electronic Medical Record? (You Register!)

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Note: see my latest post on registering and attesting for the EHR Incentive Program here.

Registration opens on January 3, 2011 for the Medicare and Medicaid EHR Incentive Programs

  1. Register as soon as possible after January 3, 2011.
  2. You can register before you have a certified EHR, but you will have to have an EHR when you attest.
  3. You can register even if you do not have an enrollment record in PECOS.
  4. A link to the Incentive Registration will be available here when it is published.
  5. Not all states will be ready to participate in the Medicaid program on January 3rd.  Information by state is here.

What do you have to have to register?

  1. A National Provider Identifier (NPI) All eligible professionals, eligible hospitals, and critical access hospitals (CAHs) must have a National Provider Identifier (NPI) to participate in the Medicare and Medicaid EHR Incentive Programs.
  2. An enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS) All eligible hospitals and Medicare eligible professionals must have an enrollment record in PECOS to participate in the EHR Incentive Programs. Eligible professionals who are only participating in the Medicaid EHR Incentive Program are not required to be enrolled in PECOS. If you do not have an enrollment record in PECOS, you should still register for the Medicare and Medicaid EHR Incentive Programs.
  3. CMS Identity and Access Management (I&A) User ID and Password
    • Eligible Professionals: Eligible professionals can use the same User ID and Password they use for the National Plan and Provider Enumeration System (NPPES). This is also the same User ID and Password that is used to access PECOS.  If you do not have an active User ID and Password for NPPES or PECOS, request them here. You will need your type 2 NPI, your Taxpayer Identification Number (TIN), and your address from IRS Form CP-575. You will also need to mail a copy of IRS Form CP-575 as directed.
    • Hospitals/Critical Access Hospitals: Authorized Officials can use the same User ID and Password they use to access PECOS.  If you do not have an Authorized Official with access to PECOS, request a User ID and Password here. You will need your type 2 NPI, your Taxpayer Identification Number (TIN), and your address from the IRS Form CP-575. You will need to mail a copy of the IRS Form CP-575 as directed.  Additional hospital staff will need to request access to the “EHR Incentive Programs” application here and be approved by the Hospital’s Authorized Official.

What else do you need to know about registration?

Hospitals:

  1. Hospitals that are eligible for EHR incentive payments under both Medicare and Medicaid should select “Both Medicare and Medicaid” during the registration process, even if they plan to apply only for a Medicaid EHR incentive payment by adopting, implementing, or upgrading certified EHR technology. Dually-eligible hospitals can then attest through CMS for their Medicare EHR incentive payment at a later date, if they so desire. It is important for a dually-eligible hospital to select “Both Medicare and Medicaid” from the start of registration in order to maintain this option.
  2. Hospitals that register only for the Medicaid program (or only the Medicare program) will not be able to manually change their registration (i.e., change to “Both Medicare and Medicaid” or from one program to the other) after a payment is initiated and this may cause significant delays in receiving a Medicare EHR incentive payment.

Eligible Professionals:

  1. Eligible professionals eligible for both the Medicare and Medicaid EHR Incentive Programs must choose which incentive program they wish to participate in when they register.
  2. Before 2015, an eligible professional may switch programs only once after the first incentive payment is initiated. Most eligible professionals will maximize their incentive payments by participating in the Medicaid EHR Incentive Program.

The Electronic Health Record (EHR) Information Center is open to assist the EHR Provider Community with inquiries.

Hours of operation are:
8:30 a.m. ”“ 4:30 p.m. (Central Time) Monday through Friday (except federal holidays)
1-888-734-6433 (primary number) or 888-734-6563 (TTY number)

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Posted in: Electronic Medical Records, Headlines

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Digging Into the Details of “Certified EMR” & Tips For Buying an EMR

Steps to digging under the meaning of EMR certification: 

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  1. Click to see the most recent alphabetical list (by product name not company) of all products certified here.
  2. Find the company or companies you are using or are considering using.
  3. Check that the exact name of the product is what you have or might purchase.
  4. Check to find out if a module or part of the product is certified or if the complete product is certified.
  5. Check to make sure the version of the product is the version you have or will have.

If you have questions about each company’s exact criteria met, you are in luck!  On the ONC site here, you can click on each company’s detail (“View Criteria”) on the far right column labeled “Certification Status” to see what they have and don’t have.  Compare this to how you are anticipating using your EMR to meet meaningful use.  The more check marks a company has, the better-equipped they are (and more flexible) to meet your practice needs and to qualify for the stimulus money.

The ONC site with the Certified Health IT Product List (CHPL) is Version 1.0.  Version 2.0 is now being developed and will provide the Clinical Quality Measures each product was tested on, and the capability to query and sort the data for viewing. The next version will also provide the reporting number that will be accepted by CMS for purposes of attestation under the EHR (“meaningful use”) incentives programs.

You can tell ONC what you think would be helpful in the new version by emailing your ideas to ONC.certification@hhs.gov, with “CHPL” in the subject line.

If you’d like a list of just outpatient/medical practice EMR products or just inpatient / hospital products, I’ve split the big list into two smaller printable lists here:

Medical Practice / Outpatient

Hospital / Outpatient

Tips On Buying An EMR

To-do list book.

Remember that meeting meaningful use does not tell the whole story – if you are shopping for an EMR be prepared to go beyond a product’s certification status to consider:

  • Flexibility – does it make the practice conform to it or can it conform to the practice? How?
  • Templates and best practices – are you starting from scratch in developing protocols, templates and cheat sheets for your practice, or does it have a storehouse of examples to choose from or tweak?
  • Built for the physician, or the billing office, or the nurses, but doesn’t really meet the needs of all three? Make sure the functionality is not too skewed to one user group, but if it is, it should be somewhat skewed to the provider.
  • Interface and integration with your practice management system. Does the information flow both ways? Do you ever have to re-enter information because one side doesn’t speak to the other?
  • Interface with other inside and outside systems: Labs, imaging, hospital systems, ambulatory surgical center systems?
  • Built-in Resources: annual upgrade of HCPCS and ICD codes, drug compendium (Epocrates), comparative effectiveness prompting?
  • Mobile applications – EMR on your providers’ phones?
  • Data entry systems – laptops, notebooks, tablets, iPads, smartphones, voice recognition?
  • Hosting – in your office? at the hospital? at the vendor’s data center? in the cloud of your choice?
  • What’s the plan for ICD-10? Will they provide practice support and education for the change or will they just change the number of characters in the diagnosis code field?
  • Price, including annual maintenance and additional costs for training, implementation, on-site support during go-live, and additional licenses for providers or staff.

Posted in: Electronic Medical Records, Headlines, Medicare & Reimbursement

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CHIME Publishes 2 Free Guidebooks for Implementing EHRs, the HITECH Act and Getting the Stimulus Money

CHIME is the professional organization for chief information officers and other senior healthcare IT leaders.

CHIME has produced a CIO-oriented publication providing details on how organizations should focus their efforts to implement EHR systems that will qualify for stimulus funding payments through the HITECH Act. The 80-page guidebook is available free to the public and can be downloaded here.

Also, the American Hospital Association (AHA) and CHIME have worked collaboratively to create a guidebook for CEOs on the HITECH Act and meaningful use implementation. The handbook entitled, “Health Care Leader Action Guide on Implementation of Electronic Health Records”, provides a readable, actionable, step-by-step guide designed to assist CEOs and other C-suite executives in the EHR implementation process. The 22-page guide is available free to the public and can be downloaded here.

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Posted in: Electronic Medical Records

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And We’re Off! Meaningful Use Notes from the CMS & ONC Press Briefing July 13, 2010

I was fortunate enough to be listening by phone to the historic (yes, historic) announcement of the final meaningful use rules by Kathleen Sebelius, Secretary HHS; Don Berwick, MD, new CMS Administrator; David Blumenthal, MD, national coordinator for health information technology at HHS; Regina Benjamin, MD, Surgeon General and a surprise speaker, Regina Holliday, artist and activist for patient rights.

Kathleen Sebelius

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The memorable quotes I wrote down were:

Kathleen Sebelius: “When electronic health records are well-designed and implemented correctly, they can be a powerful force for reducing errors, lowering costs, raising quality of care, and increasing doctor and patient satisfaction.” That is the best one-sentence description of “Why EHR?” I’ve ever heard.

Don Berwick: “If it’s (EHR) so good, why doesn’t everyone use it? Because it’s HARD.” There is a little slice of honesty that you won’t get from most EHR vendors.

David Blumenthal: “We are only as good in treating patients as the information we have.” Wow, an admission that could rock the medical world if we stopped and thought about it.

Regina Holliday: “I will not stop until we all have the right see our own information.” Regina’s Medical Advocacy Blog is here. Her lauded mural “73 Cents” refers to how much per page she was told by the hospital medical records department she would have to pay to get a copy of her husband’s records while he was still in that hospital.

The Meat: Specifics of Stage 1 Meaningful Use (2011 and 2012)

Meaningful use includes both a core set and a menu set of objectives that are specific for eligible professionals and hospitals.

For Eligible Professionals (definition here), there are a total of 25 available meaningful use objectives. 20 of the objectives must be completed to qualify for an incentive payment. 15 are core objectives that are required, and the remaining 5 objectives may be chosen from the list of 10 menu set objectives.

For Hospitals, there are a total of 24 available meaningful use objectives. 14 are core objectives that are required, and the remaining 5 objectives may be chosen from the list of 10 menu set objectives.

Stage 1 (2011 – 2012) sets the baseline for electronic data capture and information sharing.

Stage 2 (est. 2013) and Stage 3 (est. 2015) will continue to expand on this baseline and be developed through future rule making.

Summary Overview Of Meaningful Use Objectives

(full article from New England Journal of Medicine here)

As I am sure you expect, there will be much more information to come.

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Posted in: Electronic Medical Records, Medicare & Reimbursement

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Healthcare Fatigue – Are You,Your Staff and Your Physicians Unusually Stressed?

Note: I am republishing this to my email subscribers because none of the links worked the first time around. I’ve fixed everything now – so sorry for the error – must have been healthcare fatigue!

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I’ve noticed that a lot of people in healthcare seem unusually tired and even, if I dare say so, somewhat cranky.  This includes me.  I’ve decided we’re all suffering from healthcare fatigue – fatigue from dealing on a daily basis with so much change, uncertainty, and financial stress.  Here’s my top ten list of healthcare management stressors accompanied by posts I’ve written that discuss the topic or suggest resources for the challenge.

10. Red Flags Rules – on again, off again, patients don’t want to have their pictures taken or let you copy their driver’s licenses.

Information Security Wordle: NIST HIPAA Securi...

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9. HIPAA – don’t be fooled, HIPAA is not something we handled years ago and it’s taken care of; there are new requirements and penalties associated with HIPAA breaches.  HIPAA is a biggie and something that now infiltrates almost every facet of healthcare.

8.  Employment Uncertainty – both for you and your staff – the aftermath of layoffs can be even more demoralizing to those who didn’t lose their jobs.  Also, many healthcare entities are still freezing raises.  If I hear one more time “we’ll just have to do more with less” I might just scream.

The first day of Summer Vacation

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7. Unrealistic Workloads – directly related to #9, most staff and managers have much more work to do than they did just two years ago. Couple that with the ability for managers to be available and work by computer, phone, text message, email or Skype 24/7 and you have fatique that you understand only when you truly, truly stop and wind down for more than three days at a time.

6.  Hospitals Buying Practices – this could be a good thing or a bad thing, but as you and I know, change is completely unnerving to most people.  Hospitals have very different cultures than private practices and trying to marry the two takes skill, patience and excellent leadership.

An electronic medical record example

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5.  Stimulus Money for Using EMRs – it’s a big decision and many practices are very nervous about purchasing an EMR.  Many think that meaningful use components are unrealistic and even more are fearful of the inevitable productivity drop when the EMR is implemented and for months afterwards.

4. Unhappy Patients – lots of patients are also trying to do more with less (argghhh!) and are avoiding coming to the doctor whenever possible.  The front desk staff and the phone staff in particular are getting a lot more heat when they inform patients they’ll have to make an appointment.

3.  PECOS – be glad if you don’t know what PECOS stands for, or be very, very afraid.

2. Medicare Reimbursement – this year has been as exhausting as watching a single point of ping pong played for hours – there will be cuts, there won’t be cuts, there will be cuts, there won’t be cuts.  Gird your loins as the November 30 deadline looms for the next potential cuts.

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1. The Bottom Line – we have RAC audits, more pre-certification and pre-authorization and pre-notification requirements, more denials, high deductible plans, formularies and 50 other things that are making it difficult to know which hoop to jump through to get paid.  Expenses continue to go up, reimbursement continues to go down, and the healthcare world spins faster and harder, making us all wonder when it will, or if it ever will slow down.

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Posted in: Day-to-Day Operations, Leadership

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Learn This: What is the Free Electronic Medical Record (EMR) Called VistA?

© Iofoto | Dreamstime.comVistA, (Veterans Health Information Systems and Technology Architecture) which was originally developed in the 1970’s by the Veterans Administration, is an open-source (meaning that the code is available for others to collaborate upon and improve) clinical documentation system that is used by all the 160-plus VA hospitals in the United States, plus all of their outpatient ambulatory clinics. Providing care to over 4 million veterans, employing 180,000 medical personnel and operating 163 hospitals, over 800 clinics and 135 nursing homes , about a quarter of the nation’s population is potentially eligible for VA benefits and services because they are veterans, family members or survivors of veterans.  The VistA system has been in use by the Veterans Administration for more than 20 years, and as such is one of the most mature electronic medical records in existence.

As the Veterans Administration does not bill third-party payers, VistA is not a billing system.   VistA was released to the public through the Freedom of Information Act by the Veterans Administration and today is publicly available on CDs for a nominal fee.  Althought the software is free, there is a cost to install, implement and maintain it.

WorldVistA

WorldVistA was formed to extend and collaboratively improve the VistA electronic health record and health information system for use outside of its original setting. The system was originally developed by the U.S. Department of Veterans Affairs (VA) for use in its veterans hospitals, outpatient clinics, and nursing homes. WorldVistA has a number of development efforts aimed at adding new software modules such as pediatrics, obstetrics, and other functions not used in the veterans’ healthcare setting.

WorldVistA seeks to help those who choose to adopt the VistA system to successfully master, install, and maintain the software for their own use. WorldVistA will strive to guide VistA adopters and programmers towards developing a community based on principles of open, collaborative, peer review software development and dissemination.

For more information on VistA, click here for the Wikipedia entry.

Posted in: Electronic Medical Records, Learn This: Technology Answers

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