EMR Designed For Physicians By Physicians

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1 EMR Designed For Physicians By Physicians Focused on the Practice PegasusEMR has a unique heritage in the medical software industry. It was designed by a team of Physicians who, along with a team of process Engineers, produced an Electronic Medical Record (EMR) software application that has superior performance characteristics and an easy to use interface. PegasusEMR is not an appendage of a large hospital-based system. Those systems focus most of their efforts on managing the supply chain of the hospital. Our solution was built from the ground up to help the Physician improve patient care, patient safety and increase productivity. How it works PegasusEMR utilizes several software modules to improve the manual processes in a repetitive, clinical work environment. It is an integrated solution that provides more information and improvements faster and more accurately than competitive products. Benefits of PegasusEMR Reduces duration and effort between functions Eliminates manual and high risk steps Reduces errors associated with patient encounters Increases employee efficiency, moral and retention Increase in productivity and decrease in claims denials associated with documentation and charge entry errors Decrease costs associated with handling of paper records. Allows for documentation of clinical services (evaluation, daily treatment notes, patient progress reports, and discharge summaries) and charge entry PegasusEMR is an open architecture system built on state of the art technology We are HL7 compliant Fully integrated with Microsoft office products At the heart of the system There are 6 critical modules that power PegasusEMR. On the following 6 pages, we have presented a fairly in-depth summary of the modules as well as their features and benefits. Please review them and call us if you have any questions.

2 PegasusEMR Exam Workflow Module Exam Manager Window: Lists all exam workflows (templates) available to the physician. Select patients by chart number or name View data from previous patient encounters, forms submitted for the patient, as well as medication, allergy and problem history Manage Prescriptions create new prescriptions, view previous prescriptions, and renew prescriptions Patient Examination Pages (workflow): Exam Pages and Workflows are customized for the physician and accessed by user name and password. Customized pages capture only the key data or points of interest about the patient Selections are made through a simple point and click process of check boxes, drop down menus, and dynamic list boxes Selections/data can be carried forward from the patient interview and examination to the physician recommendation/plan Surgical alerts are established and displayed on the final document to create an alert for medications that affect surgery At any point, a preview of the verbalized document can be reviewed Data captured in previous patient visits can be viewed and/or brought forward with a simple point and click of the mouse or touch pen on a Tablet PC Digital dictation can be recorded and saved on any page/template as a digital WAV file Once the examination is completed the physician can electronically submit the information to the transcription department as an ASAP or Standard request % less dictation All documentation is available for preview before the patient leaves Information from previous visits can be viewed in seconds No more tape recorders, tapes going bad, transcriptionists running to get an ASAP and sorting through all the other dictation Customized pages/workflows easily updated and modified Page are extremely easy to utilize; only relevant data is captured CPT Billing will be maximized because of explicit documentation no more interpretation All patient data is stored and available for queries, research and audits

3 PegasusEMR Forms Module Forms Manager Window: Select patients by chart number or name Lists all Forms (templates) available to the user View data from previous forms submitted for the patient Form Pages (templates): Automates Forms used by Physician and office staff. This greatly reduces call backs, the effort to manually complete each form as well as the costs associated with pre-printed forms. Customized pages pull patient demographics from existing applications, such as practice management or imaging applications. Selections are made through a simple point and click process of check boxes, drop down menus, and dynamic list boxes Only the data selected will be printed on the Form for easier viewing At any point, a preview of the Form can be reviewed Once the Form is completed it will be electronically submitted to the server and imported into electronic patient records or available for print, fax, or Reduction in time spent completing forms, number of call backs, costs for pre-printed forms, and errors from the manual effort in filling out each form Only the data/items selected will be printed minimizing confusion and in many cases reducing the size of the form Calculations can be built into the page Images can be inserted and edited Electronic submission of forms into electronic patient records and the ability to fax directly from the computer reduce staff time in paper handling (as well as errors) All patient data is stored and available for queries, research, and audits.

4 PegasusEMR Charts Module Chart Manager Window: List all available folders in the Chart Select patients by chart number or name Chronological view or category view reduces effort to find specific documents Maximize / Minimize images for easy viewing View patients Medical, Billing, General Alerts Customized tracking items allow instant access to predefined list of patients data, such as Phone Calls, Surgical Histories, Treatment Histories or Medication history. File Cabinet Window: List all non-patient data, such as Credentialing, EOB, HR Reports or Equipment Tracking Documents can be faxed or printed as required from the File Cabinet Chart Manager is a total imaging system. All patient office records can be scanned, freeing up office space and allowing documents to be accessed with ease. A patient s chart can be accessed by multiple users No need to wait for the medical record clerk to locate the chart Frees up office space used for paper charts All recent documents can be viewed Chronologically Scan insurance cards and driver s license for easy patient identification Chart Manager can be customized by office so folders correspond with today s charts Used with the Fax Manager, incoming faxes are moved quickly into the patient s chart Documents for sign-off are sent to the physician s Task Basket and still accessible in the chart All business records can be imaged and access to certain folders can be assigned accordingly

5 PegasusEMR Scheduler Module Patient Appointments: All appointment information can be entered thru the use of drop down lists and text fields Appointments can be color coded according to Type/Status Multiple office locations can designated by color System allows the user to check in, check out, and assign a room number with the ability to color code these options to track the patient throughout the office Rescheduling and canceling are done quickly and tracked thru the appointment history Surgical Appointments: Scheduler is customized for each office and allows scheduling of patient appointments, surgeries, and user schedules. All surgery information can be entered thru the use of dropdown lists and text fields Surgeries can be color coded Rescheduling and canceling are down quickly and tracked thru the appointment history Pre-op testing, pre-certs and hospital reservations can be attached to the surgery appointment to confirm all pre-requisites are completed. Surgical assistants can be assigned when appointment is made and surgery will show on both physicians schedules Other Appointments: Office closed, meetings and out of office schedules can be set up as needed on one or multiple schedules Days off and lunches can be set up as recurring events for up to 6 months in the future Schedule is visible to all users Physicians can know the location of a patient at a glance View number of appointments by physician on a day s schedule Appointment history shows all patient appointments including cancellations Schedules can be viewed by Month, Week, Days, Current Dayn and Surgical Waiting list, consults, exam status and printing options are available. Track number of patients referred by specific physicians

6 PegasusEMR Billing Manager Billing Manager : Billing manager utilizes state of the art concepts and procedures to reduce data entry requirements for billers by 70-80%. This reduction allows billers to focus on payer issues, verification and collections. Unique procedures reduce data entry by an estimated 70-80%. Chemotherapy billing calculation are completed by the system allowing a typical 8 hour billing cycle to be completed in 2-3 hours. Single Claim window provides access to all data required to generate a claim Patient Claim status window provides instant access to status of patient claims Auto-posting sends claims to alternate payer and/or set to patient responsibility Automated line posting eliminate data entry required for manual posting of line items Procedure Payment analysis at the point of posting, enables the users to address underwater claims immediately Manage procedure referrals and authorizations Eligibility tracking and prioritization Payer / Patient Credit management and reconciliation Dynamic patient statement management Elimination of manual calculation of chemotherapy appointments Elimination of paper fee tickets means no lost billings System manages referral and authorizations remaining Multiple statement schedules allows balancing of incoming payments Claim Statuses displayed by Last User, Status and Balances allows user to prioritize focus based on dollar amount User can produce a detailed underwater claim list by payer in order to facilitate reimbursement by individual payers.

7 PegasusEMR Transcription Module Word Document: Transcriptionists will continuously type in a single Word document, regardless of the file being created, for multiple patients The Word document is then saved and ready for processing and tracking Import Transcription Files: Saved files are processed by the Transcription Manager; Sorting, Counting Lines/words, verifying patient name and account number, identifying highlighted text, inserting templates (i.e. letterhead) and attaching to electronic patient record or making available for print/fax/ View Imported Transcription Files: Transcriptionists will focus on listening to dictation and typing instead of searching for patient records; opening new documents; inserting templates/letterhead, and manually managing ASAP or Standard dictation submissions. Allows you to view the documents created and correct any errors found by the Transcription Manager Only review the documents with errors (i.e. invalid chart number, highlighted text, etc) Reconcile Out-sourced Transcription/Track Statistics: Print a voucher report to reconcile out-sourced transcription invoices Track Doctor Stats -= view the number of lines/words submitted by each doctor for transcribing Transcription Stats view the number of lines/words each transcriptionist produces Greatly increase the efficiency of transcriptionists Eliminates the time consuming transition of searching through patient records, opening new documents, inserting templates, and typing in individual patient files Tracks the productivity of in-house transcriptionists and doctors Tracks the line/words submitted from out-sourced transcription services; produces a voucher for reconciliation

8 PegasusEMR Protocol Module Protocol Management: Manage Protocols by disease state Define required medical test by protocol Define required pre medications by protocol Lists treatment references and internal administration notes Define standard dosing procedures by medication Specify unique Tasks for specified treatment View Protocol utilization by Date / Indication / Treatment Status (Complete/Held/Successful/Active) Drill down into listed treatments Protocol Compliance: Filter Treatment progress by a wide variety of variables, such as, Date of Death, Date of Dx, Last office visit, First office visit, Last chemo treatment to name only a few options Instantly view any patients treatment summary or flowsheet from the protcol management window Protocol Modules provides a practice with the control and insight into protocol utilization and compliance never before seen. Standard Labs and Diagnostics are difficult to miss. System will continually notifiy user that a specific test is required for the current treatment being used Standard NCCN references ensure documenation and knowledge is passed through the system to all users Reporting and Filtering functions provide a unique insight to providers for successful treatments Ease of treatment location ensures provider acceptance and utilization of system.

9 PegasusEMR Inventory Module Inventory Management: Manages Inventory by Station Inventory included Medication / Procedures / Tasks Electronic tracking of Administration Notes, Premedication notes, Reaction procedures, Billing notes, Lifetime maximum dosages and many other control points Document dependencies allow automated capture of day when a drug is Administered, Ordered, Held etc. Medication Utilization by Site provides instant access to required volumes by location Define required/assign codes by inventory item (medication/procedure) by insurance class Unit of Measure conversions perform all calculations for medication Dosing calculation are automated through patient treatments Location rules for Administration, Ordering and Scheduling Point of Sale: Inventory manages any inventory items required by the practice. Rules processing allows a practice to controls medication dosing, billing, administration and reaction procedures. Inventory Items can be setup as Point of Sale (POS). This allows a practice to sell specific items if required Automated billing of POS ensures proper tracking through Practice Billing system Internal procedures for Administration/Reaction and patient acknowledgements are available at the click of a button during administration Reduced medication volume on hand due to accurate plotting of treatments. No more multiple hours of nursing time to calculate medication volumes required Automated Billing Approval tracking by Insurance Class Locate all affected patients for medication shortages and move and notify patients from a single point Tracking of required lab values by medication ensure medication is not administered with outdated lab values No manual calculations of medication doses Location rules for specific medication ensure locations where medications can be administered

10 PegasusEMR Chemotherapy Module Chemotherapy Management: All treatments are plotted out in the schedule up to 180 days and/or thru completion of the next cycle Rescheduling/Moving of treatment days are managed by the system when a nurse moves or holds a single day Chemotherapy Calendar provides a consolidated 4 week schedule for patients with nursing notes and oral medication schedules Automated notifications for calculations dependent on Weight and/or specific lab values Internal documentation for Administration and Reaction procedures. No more searching through manuals Dynamic generation of Chemo Administration codes Scheduled Labs / Studies: Chemotherapy manager allows Nurses to focus on Nursing tasks and not Billing and/or Inventory functions. Required Labs prompt nursing for values prior to administration Billing approval by Insurance Class captures potential loss due to insurance denials Maximum Dose warnings for specified medications Automated tasks for treatment ensure future compliance to NCCN guidelines Automated prompting for missing waiver forms and patient acknowledgement forms for specified medications Automated scheduling enables a nursing resource to plot and schedule a patients treatment plan and provide a single page appointment schedule to the patient Elimination of billing errors through dynamic coding generation Instant access to medication requirements by day for the next 45 days Managing nurse can view instant status of all patients currently receiving treatment Nursing Evaluations captures standard values for Nausea, Pain and other practice defined variables.

11 PegasusEMR - Implementation At PegasusEMR we will spend a significant amount of time helping you to plan and organize the implementation of PegasusEMR long before the hardware is delivered and the software is loaded. Why? Implementation planning and execution is the foundation to a successful project. We have developed a phased implementation approach that is sensitive to your time issues and business concerns. We pace the project to your ability to schedule the required Physicians, Assistants and practice management personnel. PegasusEMR implementation has 4 phases: Phase one is dedicated to gathering critical practice information to help us configure our software to match your current business flow. There are a significant number of failures of first time EMR system installations and 95% of those failures can be traced back to poor implementation planning and execution. Phase two is the training phase. Key personnel within the practice are given in-depth training. Scheduling is flexible to minimize interruptions to the practice. Phase three is the go live phase. Hardware is installed, software is configured and you begin to use PegasusEMR in real-time. Phase four is the post installation phase. PegasusEMR Implementation Specialist meets with key practice members to review progress and resolve issues. This happens 30 days after installation and then at 90 days intervals for 18 months. Of course, we are just a phone call away for more immediate issues. Of course, this is just an outline of our implementation plan. Your PegasusEMR representative can give you extensive detail and flow charts. We Invite you to see a demonstration of PegasusEMR. Just give us a call and a representative will schedule an appointment at your convenience.

12 PegasusEMR - Testimonials Julie Breedlove (Billing Manager, 7 Doctor - Vascular Surgeons) SSG began developing a truly integrated Billing system for our practice. After working with the SSG designers we developed a seamless billing system that provides intuitive controls for posting of charges while eliminating over 90% of the data entry required for posting of charges. Dr. Jeffrey Glazer (Gynecology Physician, 1 Doctor, 1 Nurse Practitioner) The Exam Manager took me approximately 2 months to become proficient with the product. After the two month period I feel my exam documentation time has been reduced by over 80%. As time goes by the ease of use and understanding of the features continues to grow. Dr. Richard Mitchell (Director, 7 Doctor Vascular Surgeons) Only successful satisfied clients enable a software company to continue to improve and provide the necessary tools to meet the ever changing challenges in the medical industry. The Exam Manager has helped to make the physician more efficient, but since it is customized to each physician, we have also been able to keep the high quality of dictation to assure the best patient care. Dr. Matthew Offut (5 Doctor Primary Care physician) The Exam templates have been customized to fit our practice and allow new physicians to come up to speed very quickly. PegasusEMR has improved the efficiency of our entire staff, cut costs/overhead, and allow us to provide better patient care. Julie McClure (1 Doctor 2 Nurse Practitioner, Oncology) The PegasusEMR complete system has truly enabled us to become a paperless office. The seamless physician to billing communication as well as the automated chemotherapy billing has effectively eliminated billing errors associated with chemotherapy billing. The Procedure analysis tool has enabled our practice to recoup over 90k from payer errors and incorrect reimbursements due to outdated pay schedules.

13 PegasusEMR - Testimonials Dr. Akshaya Patel (5 Doctor Primary Care physician) PegasusEMR was already installed with the practice when I was hired. Within two weeks I felt I was very proficient with the product and was able to complete all exams electronically. Carla Heller (Medical Records Manager, 5 Doctor Primary Care) Organization and management of chart medical records has reduced our chart retrieval by 100%. Documents scanned into the system are instantaneously provided to the physicians with virtually not manual tracking of documents. Dawn Dircksen (Medical Assistant, 6 Doctor Primary Care) PegasusEMR process engineers continually monitor clients systems to identify new and improved processes and procedures to enhance productivity. The PegasusEMR color coding enables us to view and determine the number of patients checked in and waiting for a room, X-Ray or Labs without sitting at the computer and counting images or appointments. The automatic notification process in the scheduler enables staff to know where a patient is in the process at all times. Melissa Hardin (Transcriptionist 7 Doctor Vascular Surgeons) The transcription process has been improved by allowing the providers to point and click and dictate their findings and / or plans. The PegasusEMR transcription manager provides an efficient process for a transcriptionist to transcribe and have the data loaded to the exams seamlessly. The integrated Fax Management system automatically builds a fax package with the requested documents by the provider. Once the transcribed data is complete the process is automatically released to the referring providers.

14 PegasusEMR Oncology Case Studies Oncology Case Study Overview PegasusEMR was requested by Oncology Physicians Resource (OPR) to provide costs effective simple solutions to provide Chemotherapy functions and Inventory management for oncology offices. The WANTS The anticipated need was to provide new inventory software in order to reduce the expense of existing equipment. In addition, to provide a basic documentation tool for chemotherapy tracking. The NEEDS PegasusEMR engineers quickly determined that the primary requirement (need) was to reduce the risk factors associated with chemotherapy management, inventory tracking and associated billing. Risks Factors PegasusEMR process engineers worked with several oncology groups through Michigan and Ohio to determine the NEEDS vs. the WANTS for the Oncology industry. During an 18 month period, PegasusEMR identified numerous significant errors of unacceptable risks associated with chemotherapy management. Dosing Calculations Dosing was done primarily by hand. It was/is difficult at best to ensure the correct weights are available as well as the correct lab results. Once calculations were complete, a second resource would spend time to verify the calculations. Inventory Tracking Inventory was primarily based on Min/Max quantities. In order to eliminate the Min/Max the nursing staff would need to spend significant time weekly to determine the upcoming volumes required. Billing Calculations Chemotherapy calculations were completed in 1 of 2 methods. 1) Nurses would determine the Billing codes via standard KITS, 2) Billers would review all nursing documentation and perform calculations on each treatment to determine correct administration codes.

15 PegasusEMR Oncology Case Studies Risks Factors (Cont d) Treatment Scheduling Chemotherapy scheduling was communicated between Nursing and the Front desk schedulers. This resulted in constant communication back and forth due to the complexity of the chemotherapy treatments. Day 2 may be 20 minutes, Day 3 may be 3 hours. Identified Errors Understand the errors listed below are real life scenarios. These errors are not the result of unskilled resources but are the direct results of inefficient manual processes. Incorrect Billing (Nursing) Nurses are and should be responsible for Medications, Administration and Patient care. They should not be required to know and be familiar with which codes to use for each insurance or which code to use for 120 minutes vs. 180 minutes. Incorrect Billing (Billers) Consistent errors were found by Experienced billing departments due to the number of calculations being performed. Any person when calculating 40 treatments in a day will transpose 120 vs. 180 resulting in loss revenue of $50 per occurrence. If this happens on 1 time a week, this is a $200 / month loss to the practice. Incorrect Dose Calculations Several examples were found where doses were calculated on Old lab details or Old vitals information. The user believed they had the correct data; however, the current system was not conducive to the user having the correct information. Other examples included dosing based on Expired lab results. An example of this process involved a Creatinine value that was 18 days old. Incorrect Treatment Schedules Chemotherapy treatments can become extremely complex when patients are experiencing delays due to blood counts being too low/high for treatment and the general health of the patient is not conducive to treatment. Errors were discovered where patients may have received extra Cycles of treatments due to this complexity level.

16 PegasusEMR Oncology Case Studies PegasusEMR Solutions Scheduling PegasusEMR provided a two stage approach. The first stage was to eliminate the complexity of chemotherapy scheduling to allow a non-nurse level resource to schedule the treatments. This was accomplished by linking Future Labs, Office Appt, Preferred Times, and Duration required for the appointments. This processed solved the immediate problem for non-nursing to schedule chemotherapy. The next stage provided a scheduling system that was so user intuitive and efficient that a Nurse level resource could complete all schedules and print a chemotherapy calendar for the patients. Billing The key solution to the billing issues was to first remove inappropriate functions from the users. Nurses should not be determining billing codes and billing should not be reviewing the detailed nursing notes to determine what was done. The PegasusEMR solutions were the first to develop a Dynamic Chemotherapy Billing generator. Our designers were told many times that this COULD NOT BE DONE. The current billing generator has been in use for over 2 years. The primary benefit is the computer will never make a simple mistake between 120 minutes and 180 minutes. Additional requirements were needed to insure chemotherapy documentation is complete. Several tools were generated to allow the users to compare what was Pulled from inventory and what was Administered to patients. Dose Calculations The next solutions was to automate the dose calculations, and insure the most recent and valid Vitals and Lab results were available. Several key rules exists which ensure doses are recalculated when a patients weight changes by +/- 10%. The user can view all dose calculation based on industry standards to compare the valid doses. Recalculation of doses are handled via percentages of the original order. This provides the consistencies required between treatments. Incorrect Treatment Schedules PegasusEMR provided a seamless and automated process to allow the nursing staff to Move/Hold treatment dates for future dates. PegasusEMR maintains the Relationships between all future treatment dates, Lab test and Diagnostic orders. This allows the nurses to not maintain in process notes to verify that these functions are completed.

17 PegasusEMR Oncology Case Studies PegasusEMR Oncology Summary This has been a summarized case studied based on the three criteria requested by OPR. Several additional features and functions were/have been added over the past several months to further enhance and improve the efficiencies in the chemotherapy offices. These enhancements include billing features to ensure correct payment at the drug level, additional rules, dependencies and authorizations related to chemotherapy treatment to ensure reimbursement from payers and detailed verification functions to handle the increased changes in patient coverage. PegasusEMR provides an Estimation process which communicates to the billing department the anticipated billing for any given patient for the next 3-6 months. This process allows the biller to ensure that the 20-60k treatments have the insurance verified based on the Risk factor of the patients insurance. Thank you for your time reviewing this case study. If you would like more information or a detailed presentation, please contact our office for a PegasusEMR presentations. Alan Geyer CEO / PegasusEMR

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