THE SOLUTION IS EMRx A state of the Art system that delivers on quality, price, support, ease of use, and impact on productivity.

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1 Getting Ready for an EMR/EHR The bedrock of a successful EHR implementation is preparation. Unfortunately, there is no one best EHR program. Each product functions a little differently, with its own strengths and weaknesses. Your selection will depend on how you prefer to practice medicine and what you can afford to spend. One of the most frequent causes of frustration is the difficulty of setting up the EHR and getting it to work for you. Implementing an EHR in your practice is not the end of the road, but rather it's just the beginning of your journey. The concept of usability is defined as the ease with which people can use a particular product to accomplish defined goals. The lack of usability has been a major cause of dissatisfaction with EHR systems. It has been estimated that one in every three EHR adoptions fail, with poor usability likely a major contributing factor Unfortunately, the true experience of an EHR's usability only occurs well after an EHR contract is signed, training has completed, and the light patient load has ended. That is when the seriousness of poor EHR usability becomes apparent. The physician is then faced with an expensive unusable system. To compensate, many physicians end up using templates, macros, and preset lists. This may help alleviate the slowdown caused by an EHR's poor design, and the resulting patient notes may be full of data. So how can a physician avoid ending up with an EHR that may be unusable? THE SOLUTION IS EMRx A state of the Art system that delivers on quality, price, support, ease of use, and impact on productivity EHR User Satisfaction Survey, published in the November/December 2009 issue of Family Practice Management, provides a troubling look at how physicians rate many of the best-known EHRs. This survey's final question asked 2,012 family physicians if they agreed or disagreed with the following statement, I am highly satisfied with this EHR system. Astoundingly, nearly 50% of all respondents said that they would not agree. With the current rate of physician dissatisfaction, EHR adoption rates will likely remain low despite the government incentives. Perhaps most ironic is that federal financial incentives to adopt EHR systems may contribute to delays in improvements in EHR usability. Rather than allowing competition to reward vendors who produce better software at lower prices, the stimulus money encourages physicians to purchase mediocre software at inflated prices.

2 The EHR is the goal towards which clinical information systems have been evolving since their inception. Even so, EHR systems remain uncommon in many practice settings. Fewer than 3% of American hospitals have robust EHR systems, while fewer than 15% of physicians use EHRs on a regular basis. Introduction to Electronic Health Record Systems Early efforts at building what became EHRs began in the 1960s with the COSTAR system, developed by Barnett at the Laboratory of Computer Science at Massachusetts General Hospital. Subsequent efforts at Duke University and the Regenstrief Institute at Indiana University Medical Center have all given rise to robust EHR systems that contain data for thousands of patients. While there is no formal model or standard architecture for EHR systems, these pioneering systems provided a basic model for current hospitalbased and ambulatory EHR systems that has been emulated by current products. Whereas EHR systems offer similar features and functions across care settings, they differ significantly in how that functionality is assembled. EHR systems that support hospitals and integrated delivery systems are virtual systems created by pooling and sharing data between many component systems. Outpatient systems are usually self-contained applications in which all functions are built on top of a single, shared database. The ability of an EHR system to support advanced features such as decision support, sophisticated reporting, and coded data entry is determined by the level of integration of its component systems. The Electronic Health Record Concept. The growing interest in EHRs has been paralleled by an increase in the number of attempts at defining what they are. When perusing publications concerned with EHRs and associated technologies, one is quickly struck by the number of terms used to describe them. Over the years EHRs have been referred to by a number of terms: electronic medical record, electronic patient record, electronic health record, computer-stored patient record, ambulatory medical record, and computer-based medical record. Unfortunately, the definitions are conceptual and do little in the way of providing a technical, engineering, or scientific view of EHRs that could be used for either designing systems or reviewing products. In 1991 the Institute of Medicine (IOM) published a landmark report, The Computer-Based Patient Record: An Essential Technology for Health Care, which focused attention on important EHR concepts. One of its more valuable contributions was in the area of terminology. It defines the computer-based patient record (CPR) as an electronic patient record that resides in a system designed to support users through availability of complete and accurate data, practitioner reminders and alerts, clinical decision support systems, links to bodies of medical knowledge, and other aids. Further amplification was later provided by one of the report s editors, Richard Dick, PhD, who describes the CPR as a representation of all of a patient s data that one would find in the paper-based record, but in a coded and structured, machined-readable form. Dick further notes that, Clinical documentation is completed via computer and is coded within the patient s CPR. Stored data are indexed with sufficient detail to support retrieval for patient care delivery, management, and analysis. Regarding the features of EHRs and EPRs, Dick writes:

3 WHAT IS THE ELECTRONIC HEALTH RECORD? The perspective offered by Dick relates the CPR, EPR, and EMR along a continuum based on, among other factors, the level of granularity of stored data. A true CPR requires that every data item be uniquely coded and Individually searchable; an EPR/EMR does not. EPR/EMR systems only Require that the data be in electronic form. The CPR report, while providing a conceptual framework for discussion of electronic record systems, proved to be less useful when evaluating real world products. That task fell to Key Capabilities of EHR Systems, a report published by the Institute of Medicine in Building on the work of the 1991 report, it offered a more practical definition of EHRs. The report states: An EHR system includes: 1) longitudinal collection of electronic health information for and about persons, where health information is defined as information pertaining to the health of an individual or a health care provider to an individual; 2) immediate electronic access to person- and population level information by authorized, and only authorized, users; 3) provision of knowledge and decision-support that enhances the quality, safety, and efficiency of patient care; and 4) support for efficient processes for health care delivery. This definition of an EHR system encompasses all of the concepts and functionality proposed originally for the CPR; thus, we will use EHR system (EHR) as the official term for this text. The 2003 report identified eight core areas for which EHR systems should provide supporting features/functions while recognizing four basic types of EHR care settings (hospitals, nursing homes, ambulatory care, community-personal health record). The functionalities identified to support ELECTRONIC HEALTH RECORDS CORE FUNCTIONAL AREAS IDENTIFIED BY THE 2003 IOM REPORT _ Health information and data _ Patient support _ Results management _ Electronic communication and connectivity _ Decision-support management _ Reporting and population health _ Order entry/management _ Administrative processes these eight core areas were further expanded and developed by Health Level 7 organization (HL7) into a standard by which commercially available products could be evaluated and eventually certified by the Certification Commission for Health Information Technology (CCHIT). The 2003 report acknowledges that EHR technology develops incrementally and that for a given setting or a particular product, EHR features and functions will vary over time. Therefore, many products will have advanced features in some areas while being relatively deficient in others: today s EHR products are seen as the progenitors of tomorrow s comprehensive EHR systems. CREDIT: JEROME H CARTER MD

4 US GOVERNMENT INTEREST In 2002, the government accountability office determined that the U.S. healthcare system could reduce costs by $332 billion over the next 10 years if healthcare providers update their technology. The report outlined estimated administrative savings from three general actions, with multiple options under each. The three general actions are: required use of common technology and information standards, with enhanced interoperability and connectivity; use of advanced system-wide techniques to improve payment speed and accuracy; and streamlined provider credentialing, privileging and quality-designation processes. The option detailing the elimination of paper checks and paper remittances in favor of electronic funds transfer and electronic remittances was estimated to save $109 billion, by far the biggest savings. The second-largest savings would come from implementing a national system to monitor and flag questionable health claims, and would save an estimated $47 billion, the report says. UnitedHealth estimated that these actions would generate administrative savings, of which 50 percent would go to hospitals and physicians, 30 percent to commercial payers and 20 percent to Medicare and Medicaid. However, UnitedHealth says the government could institute policies to take a larger share to help pay for reform programs US GOVERNMENT/MEDICARE/MEDICAID INTERVENTION The nation s healthcare system is undergoing a transformation in an effort to improve quality, safety and efficiency of care, from the upgrade to ICD-10 to information exchanges of EHR technology. To help facilitate this vision, the Health Information Technology for Economic and Clinical Health Act, or the "HITECH Act" established programs under Medicare and Medicaid to provide incentive payments for the "meaningful use" of certified EHR technology. The Medicare and Medicaid EHR incentive programs will provide incentive payments to eligible professionals and eligible hospitals as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. The programs begin in These incentive programs are designed to support providers in this period of Health IT transition and instill the use of EHRs in meaningful ways to help our nation to improve the quality, safety and efficiency of patient health care. NOTE: This is a new program, and it is separate from other active CMS incentive programs, such as Physicians Quality Reporting Initiative (PQRI), Reporting Hospital Quality Data for Annual Payment Update

5 Proposed Rule: Stage 1 Meaningful Use Criteria Objectives Eligible Professionals Use CPOE for orders directly entered by authorizing provider Implement drug drug, drug allergy, drug formulary checks Maintain an up to date problem list of current and active diagnoses based on ICD 9 CM or SNOMED CT Generate and transmit permissible prescriptions electronically Maintain active medication list Maintain active medication allergy list Record demographics: ing BMI Record smoking status for patients 13 years and older Incorporate clinical lab test results into EHR as structured data Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, and outreach Report ambulatory quality measures to CMS or the State Send reminders to patients per patient preference for preventive/follow up care Implement 5 clinical decision support rules relevant to specialty or high clinical priority, including diagnostic test ordering, along with the ability to track compliance with those rules Check insurance eligibility electronically from public and private payers Submit claims electronically to public and private payers Measures Eligible Professionals: CPOE is used for at least 80% of all orders Functionality is enabled At least 80% of all unique patients seen by the eligible professional or admitted to the hospital have at least one entry (or an indication of none recorded) as structured data At least 75% of all permissible prescriptions written by the eligible professional are transmitted electronically using certified EHR technology At least 80% of all unique patients seen by the eligible professional have at least one entry (or an indication of none if the patient is not currently prescribed any medication) recorded as structured data At least 80% of all unique patients seen by the eligible professional or admitted to the hospital have at least one entry (or an indication of none if the patient has no medication allergies) recorded as structured data At least 80% of all unique patients seen by the eligible professional or admitted to the hospital have demographics recorded as structured data At least 80% of all unique patients 13 years or older seen by the eligible professional or have blood pressure and BMI recorded; additionally, plot growth chart for children age 2 20 At least 80% of all unique patients 13 years or older seen by the eligible professional have smoking status recorded At least 50% of all clinical lab tests ordered whose results are in a positive/negative or numerical format are incorporated in the certified EHR technology as structured data Generate at least one report listing patients of the eligible professional with a specific condition For 2011, provide aggregate numerator and denominator through attestation For 2012, electronically submit measures Reminder sent to at least 50% of all unique patients seen by the eligible professional that are age 50 or over Implement 5 clinical decision support rules relevant to the clinical quality metrics the eligible professional is responsible for Insurance eligibility checked for at least 80% of all unique patients seen by the eligible professional or the eligible hospital At least 80% of all claims filed electronically by the eligible professional

6 Proposed Rule: Stage 1 Meaningful Use Criteria Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies) within 96 hours of the information being available to the eligible professional Provide clinical summaries for patients for each office visit Capability to exchange key clinical information (for example problem list, medication list, allergies, diagnostic test results), among providers of care and patient authorized entities electronically Perform medication reconciliation at relevant encounters and each transition of care Provide summary care record for each transition of care and referral Capability to submit electronic data to immunization registries and actual submission where required and accepted Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities At least 10% of all unique patients seen by the eligible professional are provided timely electronic access to their health information Clinical summaries are provided for at least 80% of all office visits Performed at least one test of certified EHR technology s capacity to electronically exchange key clinical information Perform medication reconciliation for at least 80% of relevant encounters and transitions of care Provide summary of care record for at least 80% of transitions of care and referrals Performed at least one test of certified EHR technology s capacity to submit electronic data to immunization registries Performed at least one test of certified EHR technology s capacity to provide electronic syndromic surveillance data to public health agencies (unless none of the public health agencies to which an eligible professional submits such information have the capacity to receive the information electronically) Conduct or review a security risk analysis and implement security updates as necessary STAGE 2 Beginning 2013: Encourages the use of HIT for the continuous quality improvement at the point of care and the exchange of information in the most structured format possible, such as the electronic transmission of orders entered using CPOE [computerized provider order entry], and the electronic transmission of diagnostic test results [such as blood tests, microbiology, urinalysis, PFT s and other data needed to diagnose and treat diseases]. STAGE 3 Beginning 2015, focuses on promoting improvements in quality, safety and efficiency, focusing on decisions support for national high priority conditions, patient access to self management tools; access to comprehensive patient data and improving population health. Separately issued rules for HIPAA compliant transactions and code sets and e-prescribing are incorporated into the meaningful use criteria

7 The Hitech Act provided for incentives to eligible professionals (EP) and hospitals that have adopted Certified EHR Technology and can demonstrate that they are meaningful users of the technology. HHS has published the proposed rule governing the criteria for meaningful use. Extracts of key elements of the proposed rule follow. In Stage 1 beginning in 2011, meaningful use criteria focuses on electronically capturing health information in a coded format; using that information to track key clinical conditions and communicating that information for care coordination purposes (whether that information is structured or unstructured), implementing clinical decision support tools to facilitate disease and medication management and reporting clinical quality measures and public health information. The rule specifies criteria for Stage 1 only and will be the criteria used for all payment years until updated by future rulemaking. It is intended as new criteria are established in 2013 and 2015, that the Stage 1 criteria is applied to the first payment year. Stage 2, beginning in 2013, encourages the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible, such as the electronic transmission of orders entered using computerized provider order entry (CPOE) and the electronic transmission of diagnostic test results (such as blood tests, microbiology, urinalysis, pulmonary function tests and other data needed to diagnose and treat disease). Stage 3, beginning in 2015 focuses on promoting improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data and improving population health. Separately issued rules for HIPAA transactions and code sets and e-prescribing are incorporated into the meaningful use criteria: The adoption of the new HIPAA transactions (5010) and ICD-10 code sets are required as part of the Stage 2 and 3 criteria, following the originally published dates leading to ICD-10 implementation starting October 1, The use of NCPDP SCRIPT Version 8.1 or 10.6 for e-prescribing is required. For the first year only, the EHR Reporting period means any continuous 90-day period during that calendar year in which the EP or eligible hospital demonstrates meaningful use of certified EHR technology. Subsequent years require reporting for the entire calendar year. While this suggests that an EP has until October 1, 2011 to begin meaningful use and still receive an incentive for payment year 2011, such a delay by the EP puts at risk the incentive if the provider fails to meet the related performance criteria (for example CPOE used for 80 percent of all EP orders and 10% of all hospital orders) in the final 90 days of For Medicaid incentives in the initial payment year, the EP or eligible hospital may demonstrate that they have engaged in efforts to adopt, implement or upgrade certified EHR technology. For Medicaid incentives in subsequent payment years, they must demonstrate that they are meaningful users of the certified EHR technology, in a similar manner to the criteria under Medicare, but with states having the option to add additional objectives or to modify how the existing objectives are measured. Despite the federal government's pledges of financial incentives and eventual penalties, adoption rates of electronic health record (EHR) systems remain stubbornly low. When a product or service is still underutilized, even after being subsidized by public funds, we have to ask ourselves why Similarly, The 2009 EHR User Satisfaction Survey, published in the November/December 2009 issue of Family Practice Management, provides a troubling look at how physicians rate many of the bestknown EHRs. This survey's final question asked 2,012 family physicians if they agreed or disagreed with the following statement, I am highly satisfied with this EHR system. Astoundingly, nearly 50% of all respondents said that they would not agree.

8 Health Reform Implementation and the Doctor! Did you know that: % bonus for using e-prescription % bonus to primary care physicians who treat large number of Medicare patients? [end 2015] 10% bonus to general surgeons in health preferred shortage areas? [end 2015] 1% incentive payment for participating in PQRI % incentive bonus for participation in PQRI 2013 Enact national rules to Standardize/streamline health Insurance claim processing requirements Raise Medicaid payments for primary care physicians using Federal funding to 100% of Medicare rates 2015 Punish Physicians: reduce Medicare Physician payments by 1.5% for those who are not participating in PQRI and EMR. This goes to 2% after % in maintenance of certification

9 In 1999, Fred Taute, MD, MBA, set out to create something that was still in the consideration stage: a powerful, yet cost effective, web-based practice management software system for the medical community. [PracticeAdmin+ABS+e-cast] =EMRx was the eventual result of Dr. Taute s vision. Today EMRx offers a whole host of software solutions in addition to our original HIPAA compliant medical billing and practice management software. Yet, we continue to operate according the same core principles- to provide powerful webbased software solutions to the medical community at a cost effective price. CCHIT certified EHR software, our accounts receivable workflow automation software, and digital document management software are just some of the solutions we offer to medical practices and medical billing services. Do you need a software development partner you can trust to have your best interests in mind? Contact EtloGMS today for information about[ P/A/ABS]=EMRx web-based software solutions Our new web-based Electronic Medical Records (EMR) system has the flexibility to work hand-in-hand with any practice s current work flow and is fully integrated with iclaim. This state-of-the-art system gives medical providers the tools they need to effectively document and manage each step of A WEB-DELIVERED EMRx with the flexibility to work hand-in-hand with any Practice work flow EtloGMS, EMRx delivers on the promise of one complete system for the medical practice. It gives you the tools you need to effectively document and manage each step of the patient encounter, and unlike most EHR systems, our EMR/EHR is designed with the flexibility to meet your unique workflow and personal preferences- not force you to adopt a rigid, unfamiliar, template-driven workflow model. Our system is HIPAA compliant, CCHIT/ONC certified, and continues to upgrade in accordance with CCHIT specifications to stay current. Our Manager Specialty EMR/EHR applications typically include: e-prescribe-electronically prescribe medication for pickup at your patient s pharmacy Schedule appointments electronically Document/Image Management Lab Orders Interface Electronic Super-bill Multi-Lingual Patient Education materials Multi-Specialty screens Remote Access to Patient Charts Voice Dictation Broad medical knowledge base Professionally formatted documentation Progress notes, consult and referral and more.

10 Are you thinking about High Cost??? EMR does not have to be expensive, tedious, or a major disruption to your normal office routine. In fact, effective and meaningful use EMR should be a clinical workflow enhancement, allowing you to apply your specific discipline to the EMR, not force you to conform to someone else s idea of digital charting and exam documentation Since your search for the most practical way to qualify for meaningful use EMR can be tedious, and confusing, EtloG Management Services through its partners at ABS is offering a three day practice demonstration of our web-based, affordable, and easy-to-implement EMRx Many EHR/EMR systems cost as much as eighteen to fifty thousand dollars for a set up and additional monthly service or maintenance fee of five hundred to seven hundred dollars. At EtloGMS, your set up fee can be less than five thousand dollars and far less monthly access and maintenance fee with life-time support. Best of all, one set up fee is good for as many offices as you can run, and above all there is no long term commitment, meaning you can go month to month. THE TIME IS NOW Now is the time to transform your office to a paperless office Now is the time to quit worrying and let ETLOGMS work for you Now is the time to start focusing on growing your practice/business Now is the time to step into the 21 st century of payment processing THE SOLUTION: EMRx

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