ICD-10 Delayed. Unbelievable!!!!

An hour or so ago the Senate decided to delay ICD-10 by a year. They are expecting the President will sign it into law. I am not sure if this is good or bad but it does give us some breathing room.

Nextgen Odds & Ends

Upgrade
Our Go Live date for 5.8 is 5/19/14. Our Go Live Date for KBM 8.3 is 6/9/14. The usual time between upgrade is 12 weeks. We are pushing Nextgen to do the two upgrades closer together to shorten the pain & get us up & running before the summer. This will give us the summer to start dual coding with ICD-10. Remember the Go Live Date for ICD-10 is 10/1/14!!! This will give us almost 4 months on the new system.

Annette & I are having weekly phone conversations with our project manager, Judy, to help us move forward with the upgrades. Please let us know if you have any questions you wish us to ask.

Vital Sign Machines
Michele will place the order this week for the 2 other vital sign machines. These were OK'ed by exec committee ~ 1 year ago. Sandie Martin reported to us today that there is universal agreement among the staff at OMN that the vital signs machine saves them significant time. The biggest issue with the vital signs machine, at this time, is the wait to get to it.

NextPen
Exec committee approved Adair & myself for the trial of Nextpen. This is a pen that parents can use to fill out forms that we generate. The information obtained by the pen can be downloaded into the computer with a simple docking station. The Nextpen can capture family history & social history. It can capture anything that requires structured data.We are going to trial this to see if it can lessen the staff work flow. I will keep you posted.

Patient Portal
We have been given the go ahead to order Patient Portal. We will start this process but expect the upgrades to happen first.

Patient Photos
We have asked Nextgen to send us the information needed to start taking pictures of our patients at their yearly physicals to add to the patient demographic bar. It turns out that, not only is it cute but, it cuts down on computer generated order errors when the provider can see the picture of the patient they are placing orders. The pictures will be taken at the front desk.

Labs: Best Practice for Ordering

With the impending closure of our lab, we have started to look at best practices for ordering labs and resulting them. This is a work in progress. Sandy Martin will be meeting with Laura and Pam to figure out best work flows.

I have looked at a number of different options for ordering labs. I believe the best option is to order from the lab section of My Plan.

The reason for this is that if that if you order from here, it shows up in Check Out. The Check Out staff can then make sure it is done in house or can task it to a Lab Group (we are setting up) saying that the patient will have it drawn at an outside lab. This Lab Group will then follow up to make sure the labs are drawn. If the labs are not drawn within two weeks they will task the provider.

The second reason to order the labs this way is because it will show up in Provider Test Action. PTA will allow you to result the labs and close the loop. If you order the labs from the Test Tube Labs site, the labs neither show up at Check Out or Provider Test Action (PTA).

Here are some screen shots

My Plan / Labs can be order from the top Lab tab
or from Labs under My Plan Lab Orders

If you click on the Lab tab at the top of My Plan, the lab template will open
Note: if lab is not displayed, click on "blue menu links"
i.e. chemistry, hematology, etc. to display more labs

Ordered labs show up in the Lab Order grid at the bottom of the page (status)

Labs ordered this way show up in Check Out
and a requisition can be printed from this area

These labs also show up in Provider Test Action (PTA) under Lab Orders
and can be resulted from here

Click on highlighted Lab Order in PTA
to open the result box
Click on "Received:", " Completed:" and "Interpretation"
in right upper corner to result the lab.
Save and Close

Resulted Lab shows up in PTA

Highlight the Lab of interest and click Add to Note below the grid
to drop it into Action Detail Notes.
From here you can Task it to someone to complete or
you can add a "My Phrase" saying that you contacted the family/sent letter/etc.

NextGen Access from Home!

Remote Desktop Connection

Lesley is now connected!

You can be connected too. We hope.

Jane is working on getting a group of people together to install Remote Desktop & VPN for home access. If you are interested contact Jane or let me know. We will meet you at home whenever it works for you.

Mobile Access 

a lite version of NextGen

If you would like to access NextGen on the go (while you round), please contact me. We have purchased 5 licenses, we can purchase more if there is interest.

 

New Patient ID Bar in 5-8, 8-3

With our next upgrade 5.8/8.3 the demographic bar will contain a lot more information!

In addition to the standard Name, DOB, Gender, it will contain address, contact info, Insurance info, allergies, problems, medications, PCP and rendering provider.

If there are allergies, problems or meds,  a number will display indicating that there is information in that category. You will be able to hover over each of these to see more detail. You will also be able to quickly access different templates & modules with a single click on the demographic bar.

Here is how it will look:

Click to Enlarge

PVIX Meeting

Yesterday Jackie, Michele & myself met with the representative from PVIX(Pioneer Valley Information Exchange). PVIX will be our local HIE(health information exchange) & it is sponsored by BMC. This exchange, like most, is very early in it's implementation process. Currently only CIS practices are connected, though there are a number of big players getting ready to come on-line later this year.

Being connected to an HIE is part of MU2. It will allow us to send & receive information & correspondences in a secure way.

The HIT representative we spoke with (sorry I forgot his name) says he has built other HIEs & has worked with Nextgen on those projects. He thought that we should be in good shape with connecting  since Nextgen has all the required technology. He said that once we sign the agreement to join it usually takes 5-6 months for them to get us connected. PVIX will not only connect us to local providers & hospitals but will act as the Last Mile Connection to the Mass HiWay, which will ultimately connect us with providers throughout the State. Obviously this is the dream. Perhaps we will see it before we retire.

Here is the connection to their website:

http://www.pvix.org

When Should You Replace Your EHR

I borrowed this from an Ophthalmology Article I was reading. I have attached the link to the whole article. I thought it was a pretty thoughtful & discussed issues we are struggling with now.

Here is a section of it:

When Should You Replace Your EHR? 

So the big question for practices that are dissatisfied with their EHR system is this: When is it practical to replace your system - and when is it not?

Start by asking yourself the following questions about the system:

Can the issues be resolved through remediation and/or some type of new approach?

More often than not, the failure can be corrected, or some reasonable compromises and workarounds can resolve the issue. The last thing that vendors want is for their customers to fail in using their software. Most responsible vendors take complaints very seriously and will do what is necessary to correct the issues. Before considering uninstalling the product, first exhaust all efforts to work with the vendor to correct the problems.

Can the issues be resolved through development and/or technical improvements?

No software is perfect. Most vendor improvements involve input from users who are experiencing issues. A good vendor considers an issue an opportunity to enhance or improve the product. It can take time for the vendor to make needed improvements, but the wait will be worthwhile when you begin to see progress.

Is the vendor responsive and concerned about the issues?

Vendor responsiveness is one of the more important elements to consider because much of the outcome depends on the vendor╒s willingness to take responsibility for ensuring your success with the system. It will be very difficult to remediate the problems if the vendor fails to lead the charge. If that is the case, an alternative course of action (discussed later) may be needed.

Does the practice bear some responsibility for the failure?

In fairness to vendors, not all EHR failures are their fault. Some practices are just not prepared to undergo an EHR transformation. Some practices have even discovered saboteurs who feel the EHR system threatens their job security. Others may have failed to fully train clinicians on use of the software, thus creating inefficiencies and challenges. If you feel the practice has not done all it can do, you owe it to yourself to address these internal issues before abandoning your EHR system.

Has the product (or version) been commercially discontinued?

Often, the failure is due to the product becoming obsolete or outdated. The practice must keep its software up to date. The current version generally incorporates all necessary improvements. Continuing to use an outdated version of an EHR system is one of the fastest ways to fall behind, experience unwanted threats or limit the practice╒s ability to attest to meaningful use of an EHR system.

http://www.aao.org/yo/newsletter/201207/article02.cfm

Deleting Resolved or Inaccurate Chronic Conditions

To remove a chronic condition you can do a couple of things. If it was a true condition that has since resolved, ie febrile seizures, you can double click on the condition & open it. Once opened you click on resolve & you get the option to just resolve it or to resolve to PMHx. If you resolved to PMHx it will move over but alas you still have to delete from chronic conditions.

If it was never a chronic condition & was added by mistake, you can just click on the  Dx to highlight it then you right click & a drop down appears & you press delete. Easy.

EHR Divorce: A Few Interesting Articles

Read more

Nearly one-third of practices want to replace their EHRs, study finds - See more at: http://medicaleconomics.modernmedicine.com/medical-economics/news/nearly-one-third-practices-want-replace-their-ehrs-study-finds#sthash.GDe4q1oX.dpuf

Nearly one-third of practices want to replace their EHRs, study finds - See more at: http://medicaleconomics.modernmedicine.com/medical-economics/news/nearly-one-third-practices-want-replace-their-ehrs-study-finds#sthash.GDe4q1oX.dpuf 

Nearly one-third of practices want to replace their EHRs, study finds.
Read More

Electronic Health Record sellers face make-or-break year of client ultimatums and revolts, reveals 2013 Black Book Survey
Read More

Office EHR - Odds & Ends

Some of you may have noted that not all of the instructions on My Plan are printing out on the document. This is my fault. I asked Annette to change something because I thought I could make it clearer  to order follow ups. The result was not what I expected, so I asked her to undo it. Alas, somehow undoing it broke the My Plan instructions, so now only the top 3 instructions are printing.

Anyway, we are aware of it. Annette has a call with the template person at Nextgen today & hopefully it will be fixed.

Update on check out: Most of the providers at OMN are using the check out process. The Check Out staff feel like it is going very well.  Lots of families have commented on liking the Patient Plan. We will try to get all of OMN up on check out soon,  We can then get rid of the orange paper flags.

We are starting to work on the logistics of Check Out in SHO. Sandie Martin will set up a training schedule with a number of staff in both offices to learn/cross train on Check Out. This should happen over the next month.

Remember, for MU2, patients have to get their Patient Plans within 1 day of their visit. MU1 gave us 3-4 days.

Annette has set up a "Check Out Task group". We are training the Check Out staff to check their tasks throughout the day. Having this task group will allow you to task them for things like; scheduling appointments for someone you just spoke to on the phone or such.

At Check Out patients are given the usual HPA sick note. If you wish for them to get a different note, such as; "please excuse Joey for 5 days", the preferred workflow is for you to write this note in the computer & generate it. Let the family know to ask the Check Out staff to look for the note. The note will be easily found in the right hand navigation bar. You do not need to print  the note yourself.

HPA & ENT Associates are planning to start a users (? support) group where interested providers & IT staff can work on Best Practices for EHR use. Also to work on MU2 and how to transfer data between practices.

PVIX will be coming to the office to discuss joining their local information exchange next week. Jackie & I will meet with them. This is the local HIE associated with BMC. If we join with them they will also connect us to the Mass HIway. Obviously we can only join once we know which EHR we will be using because an interface will need to be created. Will keep you posted.

Last update. Cindy Mover will have a phone conversation with us at 12:30 pm today to discuss what a conversion to a new EHR would involve. She is a Practice Consultant who helps clients do conversions. She has worked with us & with Nextgen. A few of the partners had thought it would be helpful to talk with somebody about what a conversion looks like. Please join us if you are able.

Meaningful Use Check in Nextgen

Just a reminder that there is a Meaningful Use check list located in the left hand navigation bar. If you wish to see it  you just click on it and it will tell you what you are missing for Meaningful use on that patient. This is all MU1 stuff though.

2014 EHR Certification

EHRs must be 2014 ONC Certified to meet MU2 qualifications. This is because the government has raised the bar for what it expects the EHR to do. Systems that met MU1 standards will not meet MU2 standards unless they are ONC 2014 certified.

The government plans to keep raising the bar making it harder & harder for vendors to stay on the Meaningful Use track. Who will be left standing? It is hard to know, but the companies that are the most financially fit & have the largest market share are most likely to weather the storm. More on this in future posts.

Meaningful Use Stage 2 - PPT Presentation from Center for Medicare & Medicaid Services (CMS)

I am enclosing a PowerPoint on the requirements for MU2.
It is very well done and easy to follow.
These are the things that we need to accomplish this year if we want to achieve MU2 and get the incentive payments.
Please look at it at your leisure and let me know what you think.

View PPT:  Eligible Professional’s Guide to STAGE 2 from CMS

EHR Vendor Market Share by Practice Size

Click to enlarge

Medicaid EHR Incentive Payment Schedule for Eligible Professionals

click to enlarge

Patti's Excellent Adventure & Other Trips

Patti is off to Dr Tyminska's office to look at the Athena EHR software.
Jackie is trying to set up a trip to Springfield Medical Associates to see E-Clinical.
Dave Gottsegen is interested in seeing Medent EHR & he may set up an appointment to evaluate this system at a friend's office in Belchertown.
Stay tuned. Updates to come.

Croup - My Plan

Fixed. I tested it today & it seemed to work. Give it a try & let me know.

My Plan for Croup - We are Fixing it

I tried to use My Plan for Croup today & , oops! I got the My Plan for Thrush instead...

Not Good,

Have no fear, will fix it in the morning.

Good night!

Sunday Cartoon - Enjoy

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