Electronic Health Records

Phase I Meaningful Use for Pediatric Practices: The Need to Change or Modify Practice Processes

May 18, 2012 in Blog, Healthcare Protocols and other Tech by support Team  |  Comments Off on Phase I Meaningful Use for Pediatric Practices: The Need to Change or Modify Practice Processes

I was on the phone with one of our valued customers this morning discussing Phase I Meaningful Use and the details on the “how” related to Meaningful Use. The overall goal of Health and Human Services is that providers utilize a certified E.H.R. in a meaningful way. A group of individuals invested months of discussions and feedback to obtain a list of parameters. One challenge for the group is to provide a universal list that applies across all fields of medicine. Some of the parameters in Pediatrics only apply to a certain segment of the population. For example, smoking status is for patients greater than 13 years of age. There are core measures that each provider needs to meet the benchmark for all these measures during the 90 day period being measured as well as selecting a list of 5 of the 10 menu measures.

A good E.H.R. system should provide a simple manner for a physician and/or Practice Administrator to evaluate performance of each of these benchmarks as well as very easily ‘drill down’ to identify how to correct/update patient data associated with the measure. How to use a meaningful use dashboard should take minimal training and review. The E.H.R. vendor should be able to guide an individual in the practice on the process via a web meeting or teleconference. So if you selected the ‘right’ E.H.R. system for Pediatrics, using the software and monitoring meaningful use should be straight forward.

The ‘tough’ part of Meaningful use: Changes to how the practice operates. For example, most practices did not record language, race and ethnicity as part of their intake/demographics. This needs to be captured for over 50% of patients seen during the 90 day measurement period for Phase I. If your E.H.R. system is well design, the practice should be able to click on a link and show the patients that do not have this information during the 90 day period. The most efficient way to enter this information is to capture the data when the patient visits the office. The “ah-ha” moment for many individuals is when they first run a meaningful use report, then they make the changes to their office flow and intake forms as needed.

Some questions to ask related to Meaningful use and your Pediatric Practice: Are we entering all medications in the system and sending medications via electronic prescriptions? Do we list the problems for each visit and maintain the patient problem list? Are we maintaining our Medication list and Allergy List? Does our standard protocol for demographics include recording smoking status of patients >13 years of age? Do we record vitals on each visit? Can we connect to the immunization registry? Are we connected to the lab companies that we send the majority of our labs?
This is not meant to be an a complete list of questions but a list to stimulate thinking around meaningful use. There are many resources, websites and references to obtain detailed information. Good luck on meeting Phase I Meaningful Use!

Customer Service and Pediatric Practice Management

May 11, 2012 in Blog by support Team  |  Comments Off on Customer Service and Pediatric Practice Management

I had a HORRIBLE customer service experience with a technology company this week. During business hours, I waited on hold for 29 minutes prior to a representative being available. After about 20 minutes on the phone with the customer service representative, it was obvious that she did not understand the issue
or how to resolve. She asked for another 20 minutes to check out some aspects of the issue but was unsure if she would be able to resolve the issue (technical issue with a phone they support for us). At this point I was extremely frustrated and needed to take charge of the call to provide options to her (she should have provided the options to me). She did not have an understanding of the problem for us – unsure if it was lack of listening skills or lack of knowledge. Investing more of my time on hold would have increased my frustration so we terminated the call with no resolution – missed opportunity. What could have this organization done differently? Plenty. First, no customer should wait more than 5 minutes to speak to a customer service representative. Management needs to be on the hook for staffing as well as monitoring customer service. Second, the company posted a ‘green light’ on their systems while the customer representative stated there is a major problem with their systems. The internal processes and procedures need to align when there is a problem. There are other items this company could do to further the customer service experience after they can move to an acceptable/basic level. Although we are not perfect, we are on the pursuit of perfection each day which causes continuous improvement of a ‘good’ customer experience. Constant re-engineering of processes and methods should be the norm with all organizations including the investment of people and resources.

How does this relate to Pediatric Practice Management? Pediatric practice management requires good customer service. When a patient calls during business hours, they need to be able to speak to a live person without waiting for more than a few minutes or receive a voicemail that they can leave a message when the question relates to a bill or other administrative function (e.g. follow-up on insurance information). Also, patients need to be able to leave a message any time after hours (this saves them time). We have picked up clients for which the previous billing service did not provide this level of service. Appropriate level of service is critical to managing the revenue cycle and the revenue cycle is a ‘team’ effort.

Could your ‘free’ Electronic Medical Records (EMR/EHR) cost you thousands of dollars a year? (A review of some free systems includes PracticeFusion, Mitochon, etc.)

November 29, 2011 in EHR Selection by support Team  |  Comments Off on Could your ‘free’ Electronic Medical Records (EMR/EHR) cost you thousands of dollars a year? (A review of some free systems includes PracticeFusion, Mitochon, etc.)

How does a company that provides a free electronic health record system make money? Do they need to make money? Why should I care if they do not charge my pediatric practice to use their system? Advertising to you while you use a system is one way for a free EMR vendor to generate a small amount of revenue; another method is to sell your treatment patterns and patient data to health plans and other organizations. By agreeing to a well written user agreement, a free EMR company will request you to authorize them to do both. The free system containing a user agreement to provide a company the right to sell your data to payers and other organizations could potentially cost you personally thousands of dollars in reduced income per year. This cost could be substantial even with the promise of using a free system.

The “free” EHR Company might be sharing each of your charts, patients, and billing practices with some of the insurance plans. Imagine your Health Insurance plan being able to audit all your charts and know where
they can pull back payments for what they believe is not enough documentation (they have the file, how easy is it to look before sending the request back for a retraction of money). Of course, the health plans will not audit your charts and show all the visits for which the practice “under coded” visits. This under coding is the loss of revenue to the practice. Additionally, with a list of all your patients listed in the “free” EHR system for which the insurance company has access rights to the data, an insurer will be able to calculate what percent of your revenue if from their insurance company versus other plans. This provides a Health Insurance plan data so they have the opportunity to determine/forecast how to minimize your fee schedule. I could see insurance carriers using sliding scales to determine the amount of pay increase or even decrease payments for a practice. Image an employee from a health plan whom receives a bonus for decreasing payments to providers know that 40% of your practice is with their insurance plan, why not decrease your practice’s payment by 10%?

There are other risks with a “free” EHR company selling your data. One risk is that a health plan or other organization will know the breakdown of the number of patients for each disease. For example, maybe you are very aggressive at identifying and treating ADHD to a point that you do not miss a signal diagnosis as well as treat patients with the most innovative methods. This ability has made you the “go to” pediatrician in the practice and/or community. However, since your “free” EMR allows your data to be sold, a health plan or other group might label you as an “over user” of ADHD medications. Do they send you letters directly to address their concerns or do they develop a list to ‘report overuse’ which in fact is not really overuse based on your patient profiles. The problem is, this list might not be accessible to you or known to you and who knows what they will do with the list (do they lower reimbursements or audit higher for Pediatricians on this list?).

The “free” EMR Company might advertise that they store your data in a secure manner. They should advertise how they make money as well as that users of their system provide them the authority to sell your data to organizations that have their own agenda (e.g. insurance companies). I believe many physicians whom ‘gave away’ their rights to their data are not aware of the potential risks to their income and the way they practice medicine. The user agreement is found when you sign up and there is a prompt that states you agree to their user agreements (you can click to review). If you are not sure, before using a system, ask for a signed letter stating that the company will not sell your data.

How do you know if a ‘free’ EHR company has the right to sell your data? REVIEW the USER AGREEMENT. If the user agreement is more than 7 pages, usually this is a reason to be very concerned (some agreements that allow the ‘free’ EHR company to sell as much of your data as possible have greater than 15 pages). Our user agreements are usually 4-5 pages, we only provide access to the data to the users of the practice as well as our staff (we maintain the servers and data files), we maintain the data with triple backup and use firewall systems designed for commercial grade systems. We do not sell your data and do not have any right to sell your data. Our interests are to serve our pediatric practices.

http://www.healthleadersmedia.com/page-1/TEC-249477/Free-EMRs-Too-Good-to-be-True