pediatrics

Incorrect Perceptions and Misinformation on Health IT Technologies

February 14, 2011 in EHR Selection by support Team  |  Comments Off on Incorrect Perceptions and Misinformation on Health IT Technologies

Physicians, in my opinion, have the most important job in the Healthcare system.  They make decisions every day on diagnosis and treatments for patients.  They are required to complete college, Medical School, and Internship/Residency.  For Primary care, this is 11-12 years of education after High School in a very competitive environment.  Additionally, Physicians attend Continuing Medical Education (CME) events to further their depth of knowledge.

My wife, a board certified Pediatrician, recently attended a CME event on the Medical Home.  During the 4+ hour CME event, topics related to Health IT were raised.  Since I am so ‘buried’ in HealthIT, I lose perspective of the importance of discussing some of the common questions and misperceptions. Listed below are a few of these misperceptions that occurred at this CME Event:

  1. One of the attendees whom achieved Medical level III certification (impressive) for their practice still does not utilize an E.H.R. (They do all the follow-up/tracking via paper!).  Their practice is moving to the same system as the hospital because they were led to believe that interoperability is best when using the same computer system as the Hospital.  There was no discussion/ understanding that future Health Exchanges will allow providers to exchange information with multiple hospitals, labs, other providers, etc.  This means that all a practice needs to do is use an ONC-ATCB Certified Product E.H.R., e.g. PhysicianXpress, to connect their practice to a Health Exchanges.  This Pediatric practice made a good decision for the hospital but not necessary their practice.
  2. One of the speakers explained that there are two types of systems, server based and web-based.  She stated that their system was server based and raised the concern if the internet is unavailable a practice would not be able to access a web based product.  She also brought the obstacle to insure the company has enough technology people available to support the practice (Their practice purchased client-server system years ago which requires IT support individuals on staff).  The speaker, unfortunately, provided some misinformation (might be due to the confusing or incorrect information available).  The speaker, whom practices in a large multi-specialty group, did not understand that if the ‘internet goes down’ she has the same problem as a web-based EHR since their server-based E.H.R. is located in a different location than her office where she sees patients.  Additionally, all server based systems need the internet to send e-Prescriptions, check formulary information, conduct eligibility, lab orders as well as other interoperability links.  This means this physician, with a client-server system, is dependent on the Internet to access her patient records, send prescriptions, etc (similiar to a web-based E.H.R.).  Additionally, their practice needs to pay for the cost of redundancies, IT support (IT employees of the multi-specialty group or contract an external company), and maintenance of connections.  With  cloud-based technology, a practice only needs to maintain an internet connection; they can carry an IPad or similar device that runs off a 3G or 4G network as back up.  Like a server based system, both cloud-based technology and server based systems need the internet to send Electronic Prescriptions, connect with multiple offices, send laboratory orders, etc.  Unlike server based-systems, a practice does not need a ‘high-level’ IT professional on staff (or as a consultant) for the practice (additional cost to the practice).  

Analysis of the EHR Complete ONC-ATCB Certified Health IT Product List

January 5, 2011 in Blog by support Team  |  Comments Off on Analysis of the EHR Complete ONC-ATCB Certified Health IT Product List

As of today there are >110 certified ONC-ATCB complete EHRs listed on the ONC Certified health it product list (http://onc-chpl.force.com/ehrcert). As a continuous student of Health IT (I have been in healthcare for over 20 years) I invested a few hours to briefly review every EHR system listed on the 2011\2012 ONC-ATCB complete certification list (as of 1/5/11). During this review I identified the website, phone number, city/state of each ONC-ATCB certified EHR as well as provided a few notes (e.g. EHR for a particular specialty of medicine). I applaud ONC for clarifying the standards for certification and providing one certified product list. About 20% of the certified products state on their product website claim that they are specialized to a particular specialty of medicine vs. a system for all specialties of medicine. Medicine is such a complicated field with wide variations on the function of each specialty. Currently, specialty EHR systems that achieved ONC-ATCB certification include:

  • Pediatrics (1 system – physicianXpress)
  • Ophthalmology/optometry (7 systems)
  • Urgent care (1 system)
  • Mental health (1 system),
  • Orthopedics (1 system)
  • Urology (2 systems)
  • Oncology (2 systems)
  • Podiatry (1 system)
  • OBGYN (1 system),
  • Radiology (1 system)
  • Emergency medicine (1 system)
  • Cardiology (2 systems)
  • College health (1 system)
  • Plastic surgery (1 system).

If you have an internal medicine or multiple-specialty group, there are over 80 systems that are generalist for all areas of Medicine.

Where does a provider start? If you practice in one particular field of medicine (e.g. Pediatrics), recommend first evaluating the ONC-ATCB certified EHR systems in that specialty. These vendors spend 100% of their time optimizing the system for your specialty as well as staying up to date on the changes in that specialty. If there are multiple vendors with E.H.R. products in that specialty, look at each system.

Some vendors have not stayed up to date on the new technology and are trying to update ‘dated’ technology to meet the functional requirements. Unlike consumer electronics where it is usually easy to evaluate if a vendor has been investing significant money and years of time on Research in new technology, it is more difficult in the field of Health IT. Some vendors spend the majority of their time, money and focus on optimizing the revenue stream from their legacy systems. Their sales team promotes how many systems they have installed (usually include all the ‘dated’ systems). If we compare this to the consumer electronic world, it would be like a company that sells the old picture tube television stating that there are more picture tube televisions installed in the market than flat screens (plasma, LCD) – although this sales tactic usually does not work in consumer electronics, Health IT vendors have had good success quoting the number of installs (no matter how dated the technology).

The business and medical rules in medicine change continuously. For this reason, a system used for revenue cycle management and EHR should be ‘fluid’ and update continuously. Systems built on ‘old’ client server technology are not ‘fluid’ due to the system design (updates need to be scheduled and can be disruptive). This is why each industry (including Healthcare) is heavily focused in cloud computing. Look at all the major software companies to see that cloud computing is their focus. If you are interested to receive a copy of the excel file that lists the certified products as well as the contact information and focus of EHR, feel free to e-mail me at Ken@physicianxpress.com.

Follow-up to December 2, 2010 Experience with Five Managed Care Organizations (Aetna, IBC, Highmark, Cigna, United Healthcare)

December 23, 2010 in Blog, Uncategorized by support Team  |  Comments Off on Follow-up to December 2, 2010 Experience with Five Managed Care Organizations (Aetna, IBC, Highmark, Cigna, United Healthcare)

It has been about three weeks since I contacted the top five managed care organizations for a customer of ours. The purpose of my initial call was to obtain their current agreement and fee schedule for their top five payers. I started as if I had no experience or contacts in the field to see how long it would take to obtain the proper information. Here is the update by managed care plan:

  1. Aetna: The Physician Network Account Manager on 12/2/10 stated that I would receive the information via e-mail within 3 business days. I called at the end of the third business day to check on the status. She did not call me back until I called again and sent and an e-mail to her as a follow-up (10 business days after our original call). After some further back and forth via e-mail (few hours), I was able to obtain a copy of the agreement as well as fee schedule.
  2. IBC: Independent Blue Cross (IBC) – the office had to request the information, sign a document, follow-up with the representative. IBC provided the agreement and fee schedule by 12/17/10.
  3. Highmark: The most disappointing of the five carriers. After a few phone calls and e-mails the network representative provided a general mailbox (estprovcred@highmark.com) for contract and fee schedule requests. She stated would only take 1-2 business days. I followed up after 10 business days and still have no response or information. The Network Representative is out of the office from 12/23/10 until 1/3/11 due to the holidays. I left a message and will need to follow-up again in a few weeks.
  4. Cigna: The representatives (888-992-4462) stated there is no provider representative and could only provide a fax for this information. Cigna would not expect a Pediatric Office to not provide the name of their doctors or not to provide the location of their doctors when they need help, why do they avoid their providers when requesting simple information related to contracting? The woman on the phone stated that we need to send an urgent fax (866-463-6175) and that there might be a provider representative that would call us back. We sent the fax, as instructed, 10 business days ago, no one called as of yet. Today, at the main number, they instructed me to send another fax to the same number.
  5. United Healthcare: The Network Manager (obtained proper information by calling 877-842-3210) was good at providing the fee schedule and initial follow-up. He was available we I called or followed-up within a few days. There were a few additional codes missing from the fee schedule for which I requested the information and he was able to obtain after a telephone call.

The commitment to follow-up on contractual items is very inconsistent with the Health Plans (even if the representative states they will follow-up). Due to this, the burden of follow-up is on the provider’s office or the company that works for the provider’s office.

Electronic Health Record (E.H.R.) Incentive Programs for Pediatricians

December 10, 2010 in Blog, Uncategorized by support Team  |  Comments Off on Electronic Health Record (E.H.R.) Incentive Programs for Pediatricians

The HITECH Act has an Electronic Health Record (EHR) incentive program paid via either Medicare or Medicaid. Since Pediatricians do not have Medicare Patients, their opportunity to participate is via the EHR incentive program provided by the Medicaid program. The Medicaid program starts as early as 2011 and eligible providers in a Pediatric Group (MD, DO, NP) can each receive up to $63,750 over a six year period. Unlike Medicare, eligible professionals have until 2016 to implement a certified E.H.R. system and still qualify for the maximum incentive. The HITECH act has recommendations to the state of the threshold for this incentive money. A provider must have at least 20% of their total patient volume be via Medicaid/Managed Medicaid/Children Health Insurance Program (CHIP) Patients during a 90-day measurement period. If a provider has 20% Medicaid volume during a 90-day period, they are eligible for up to $42,500 over a six-year period. If a provider has over 30% volume during a 90-day measurement period, they are eligible for up to $63,750 over a six-year period. Note that the “up to” is dependent on maintaining these thresholds each year as well as implementing a certified EHR system to show meaningful use. The table below provides a summary by year.

Medicaid Eligible Professional (20% – 30% Medicaid/Managed Medicaid/CHIP vol.)

Medicaid Volume

Year

20%-30%

>30%

1

$14,165

$21,250

2

$ 5,667

$ 8,500

3

$ 5,667

$ 8,500

4

$ 5,667

$ 8,500

5

$ 5,667

$ 8,500

6

$ 5,667

$ 8,500

Total

$42,500

$63,750

Medicaid, different than Medicare, is administered by the state. The state Medicaid programs are required to verify the eligibility of the provider as well as disperse the payments. Per the CMS.gov website: “The Medicaid EHR Incentive Program is voluntarily offered by individual states and territories and may begin as early as 2011, depending on the state.”

The question and answer section on the CMS website related to the Medicaid EHR program I found to be a useful resource (22 pages). One of the questions is if the State Medicaid program needs to verify the “installation” or “signed contract” of a certified EHR . The answer on the CMS website concludes that: “Thus, a signed contract indicating that the provider has adopted or upgraded would be sufficient.”

There are details to verify and implement to insure eligibility and then receive disperse these funds. I recommend that each office invest some time learning about the HITECH act. Also, having a knowledgeable EHR vendor and/or consultant should greatly reduce the detail knowledge needed within each office.

http://www.cms.gov/EHRIncentivePrograms/

https://www.cms.gov/apps/media/press/factsheet.asp?Counter=3793&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date

EHR vs EMR

December 7, 2010 in Blog, Uncategorized by support Team  |  Comments Off on EHR vs EMR

Most in the medial field know the acronym EHR (Electronic Health Record) and EMR (Electronic Medical Record) but many do not understand the difference between the two. The National Alliance for Health Information Technology defines these two as follows (2008):

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

Electronic Health Record: an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff across more than one healthcare organizations. The United States government via Health and Human Services/Office of the National Coordinator provides incentives via the HITECH Act to move the nation toward adoption of Electronic Health Records. On July 13, 2010, HHS provided a clarification of the benchmarks providers must demonstrate to receive the incentive payments for adopting a “certified EHR”. This document is over 850 pages in length that highlights some of the details of meaningful use. Many thought leaders, providers, and policy makers believe that Moving away from a primary “paper-based” system to an “Electronic Health Record” will improve quality and reduce costs of the health care system. Making the transition requires time, money
and effort.