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