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In a recent post by John Lynn on the EMR and HIPAA blog, he broached the subject of off-site backup services, and suggested some solutions for medical practices that need a way to back up their patient data.

Nuesoft has nothing but respect for Lynn and the EMR and HIPAA blog, but we can’t help but feel that this post missed the mark a bit. Rather than encouraging medical practices to look for quick and easy fixes to the pesky backup problem, why not remove backups from the health information technology dialogue? Data backups are a by-product of client server technologies of the 1990s. To truly reach the level of widespread health information technology adoption that the government is envisioning, then we need to look toward more modern and viable HIT solutions.

Most EMR solutions installed in medical practices are client server models. While users of some of these client server systems may opt for a backup solution like those described in Lynn’s blog, the vast majority will handle backups themselves. Let’s be realistic – how many doctors have the time or the expertise to adequately replicate data and ensure that it is completely secure (and HIPAA compliant) and fault tolerant? To do so requires a practice’s main server and its database to be replicated via a back up server within the same network, or connected via a wide area network, and then monitored constantly. The answer is, most doctors aren’t equipped or staffed to handle back ups, and the result is that the back ups just won’t get done – or at least not to a level that is adequate or truly secure.

Nuesoft wonders, in this push for broad EHR adoption, why aren’t more people concerned about the fault tolerance issue and discussing it openly? EHRs are truly mission critical applications. Timely access to information by a provider can have life or death consequences. Consider this: there are 161,200 medical practices in the United States. If we assume that a conservative 45 percent of these practices adopt a client server EMR under HITECH, and that a mere 1 percent of those EHR systems go down and leave users without access to patient data, think of the number of practices – and patients — that would be impacted! Providers would be without access to patient charts, and would lack the ability to review drug allergy or interaction information, medical history, or other critical components of the patient record.

This is a frightening – albeit realistic picture of the potential risk that client server models, with their many shortcomings, pose to the health care system. It’s time to stop talking about ways to help physicians compensate for client server technologies, and embrace emerging technology models such as Software as a Service (SaaS), or cloud computing, which are better suited to a mission critical environment. Even in the event that a SaaS program is temporarily unavailable, the data is safe, whereas with a client server scenario the loss is more often than not a permanent loss and the downtimes are much lengthier. The HITECH Act gives us the perfect opportunity to usher in new technologies like SaaS that will expand interoperability and relegate legacy technologies to a thing of the past.

Today marks the start date for many of the new HIPAA rules that were propagated as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. The revised rules include a new public/media relations component, updated restrictions and provisions for accounting and disclosures of protected health information, and increased civil and criminal penalties for violators.

HIPAA previously applied only to covered entities (i.e. health care providers, health insurance companies and clearinghouses). One of the biggest changes under the HITECH rules is that business associates, or third party service providers that handle PHI of covered entities, must now comply directly with HIPAA, and will be held liable for security breaches of patient files or information stored in their systems.

In general, the revisions give HIPAA “sharper teeth,” with stiffer penalties for violators and mandatory audits by the Department of Health and Human Services (HHS). Penalties now range from $100 to $50,000 per violation, with a maximum in any one year ranging from $25,000 to $1.5 million. The new law requires HHS to investigate complaints, impose penalties for willful neglect and conduct periodic audits of both covered entities and business associates to ensure they are in compliance with the rules.

For more tips on how your practice or company can remain in compliance review Nuesoft’s HIPAA fact sheet, and tune in on March 1 to our HIPAA podcast. Visit the Nuesoft Web site for details.

Welcome to 2010! Nuesoft has made its resolutions and one of them is to participate whole-heartedly in social media.  In keeping with that resolution, we aim to bring you the most up-to-date information and case studies demonstrating how social media has worked in the healthcare industry. As the online world moves full steam ahead you may find it difficult to navigate, and we hope to assist you with a few tips to grow your practice.

In full force for about the last three years, social media has revolutionized the way that consumers interact and gather opinions on various topics. Not being involved in some way is not an option. The last thing you want is for the conversation to happen, and your practice not be mentioned. Consumers trust the online opinions of others who appear to be “just like me”.

As you embark on your social media journey, begin by listening. You’ll hear what consumers are saying and can find out what questions they have for doctors and about doctors. You’ll also encounter other health practitioners;’ discussions of relevant topics, like technology, research results, pharmaceutical news, best practices, and more.

By inserting yourself into these conversations – be it on Twitter, blogs or elsewhere online – you can name drop your practice and brush up on the latest industry dialogue about topics important to you. Eventually, after earning trust in the various online communities, you will begin to see growth in your patient base and gain referrals from your virtual peers. A great post by Neil Versel on Medscape Today explains some of the main reasons doctors are turning to online platforms and lists some of the pitfalls associated with participating.

Moreover, social media is inexpensive. You don’t have to go buy special software or hire a specialist (although you can). Rather, sign up in under a minute and start learning what your customers (patients) are saying. This year make an effort to be more involved in the online world. It could be just the medicine your practice was looking for!

Be sure to check back with us throughout the year as we post more tips and strategies for making the move into social media for your practice.

Earlier this week marked the opening of the 60-day window for public comment about the HHS’ “meaningful use” rules.  Input from practitioners and other stakeholders will help to refine the final version, which is expected to be completed in Spring of 2010.

Since the Health Information Technology Policy Committee’s July 2009 meeting, many practitioners have been feeling uneasy about moving forward with what could potentially be a large financial and human resource investment without more definite and final criteria defining meaningful use. The December 2009 updates do not significantly change the committee’s earlier direction. Variations are minor, and include the ability to implement drug-drug/drug-allergy checks, e-prescribe and check insurance availability electronically.

While the clarifications are much welcomed, many providers (and some in the health information technology community) see a long road ahead in achieving meaningful use. The first step will be adoption, and providers are reticent to adopt unless they see the potential for a better workflow and improved outcomes for their patients.

End users: now’s the time to weigh in. You can accept the government’s initial effort and be subservient to the criteria, whether they are realistic or within reach. Or, make sure that the seeds are planted now for you to eventually cultivate technologies that remove complexity, are user friendly and have the greatest impact on patient care.

An EHR is like a good pair of shoes – you want them to fit right or you are going to feel the pain. And let’s face it, selecting the right electronic health record (EHR) for your practice is not an easy task – particularly for practitioners who may not have IT expertise. Plus, there are more than 400 providers of EHR/EMR products on the market today. It’s important to exercise caution and perform a thorough due diligence, but where should you start?

Nuesoft Technologies believes we have an amazing product that will truly improve your practice’s efficiencies and profitability, but we only want you to buy our software if it’s the “right fit” for you. We’ve got the insight of nearly 20 years of experience in the field of health information technology. But don’t just take our word for it. We encourage you to follow the suggested outline provided by Dr. Robert Lamberts in the Nov. 2009 issue of Physician’s Practice magazine. Lamberts successfully implemented an EHR in his office. Although he recognizes the fears and concerns of his peers, he also describes the positive impact the software has had on his practice.

Lamberts’ recommends that those considering purchasing an EHR start by first identifying any broken processes in their practice. What causes the most frustration to staff? To patients? Where is the most time wasted? Where is the greatest exposure to malpractice risks? Where is your office losing money? Improperly coded claims? Under-billing? Low volume? Over-staffing? Look at the whole practice – front and back office, not just at the providers.

Next, Lamberts recommends that you visualize what your “fixed” processes would look like. This is where you will develop your shopping list for that perfect pair of shoes! So what were your “fixes”? Never needing to search for lost charts – with an EHR, your charts are always a click away. Answering telephone inquiries – with charts immediately available, response times are much quicker. Improperly coded claims causing a delay in payment – with claim scrubbing capabilities you can get paid more quickly.

Now you are ready to start approaching vendors and looking for the practice management and EHR solution that best fits the needs of your practice. If the vendor does not suit you, cross them off your list and continue to the next vendor. And don’t forget to demo the software. Have a vendor representative walk you through how the software works, and ask lots of questions! Once you have a shortlist of vendors, consider the following and make your decision.

1. What is involved in product implementation?
2. Is the implementation process disruptive to your day-to-day operations?
3. What kind of training is available?
4. What is the response time if you have problems next week or next year?
5. How long has the company been around?
6. What are the hardware requirements – will it require you to buy new systems?
7. Who is responsible for data back-ups?
8. How will the data be securely stored to protect your patients’ privacy?
9. How often will the software/hardware need to be upgraded and what will this cost?
10. Is the solution scalable as your practice grows?

By now, you have a couple of vendors who are standing out from the rest. You like their graphic user interface, the functionality meets the needs of your practice and you are starting to get excited about how the new practice management and EHR solution can help your practice. Now it’s time to get references and ask your peers what they think about the software. Here are some questions you can ask:

1. How smooth was the implementation?
2. How well was training conducted?
3. What do you like best about the software?
4. What do you like least about the software?

Hopefully this has helped to further narrow your selection. The last bit of advice that Lamberts provides is to look at the purchase as a chance to improve your practice rather than an unwelcome expense. Remember that you get what you pay for and you shouldn’t waste your time on products that don’t meet the needs you identified at the beginning of the process. Focusing on cost first could rule out some of the best products and minimize your chance to find the best solution that maximizes your potential gains – giving you a shoe that just doesn’t fit.

Reference Link:
http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/1425.htm

Source: November 2009 issue of Physicians Practice.

With public attention on the ARRA stimulus funds in recent months, physicians have been feeling the pressure to adopt electronic health records. The vision is that in the next couple of years, the technology will be advanced enough to exchange health data freely between systems. Yet there is some skepticism from many in the health care industry that the lack of infrastructure and data sharing standards means that the day of sharing patient records between providers, labs and hospitals is a lot further off than the current administration is hoping.

The announcement last week therefore that Florida will be putting Medicaid patient histories online was a welcome indication that other stakeholders are willing to get involved to put the necessary health data infrastructure in place. If practices know that payers and government agencies are invested in coordinating these efforts (and actions speak louder than words here), it will reassure physicians that they won’t be left alone to arrange dozens of interfaces with a myriad of other systems. If other states adopt Florida’s example, it would almost certainly speed health IT adoption by the smaller players that are currently ambivalent about making such a large investment in a technology that is still young. In fact, the inability of some smaller practices to afford EHRs at all has been another issue that has troubled advocates of health care technology. The Medical Group Management Association (MGMA) voiced the concern back in July that those practices without the purchasing power of larger medical groups would in effect be penalized for their inability to show meaningful use. This stumbling block to widespread EHR adoption may soon be removed if Senator Kerry’s proposed legislation to make smaller practices eligible for business loans to buy health IT is passed.

There is still a long way to go, but perhaps these and other measures will give physicians  confidence that the current path of health care enhances the chance that they will spend more time treating patients and less time tracking down information.

The “red flags” rule is now scheduled to take effect on June 1, 2010, after another delay announced earlier this week by the Federal Trade Commission as it considers new legislation that would exempt small businesses, including medical practices, from compliance. The rule mandates the creation of identity theft prevention programs, and will apply to any organization that can be considered a creditor with “covered” accounts (i.e.-commercial accounts that involve multiple transactions). Most providers, many medical billing companies and some health plans are expected to comply.

The American Medical Association, American Academy of Family Physicians and other industry groups have weighed in against the rule, on the basis that physicians do not meet the definition of creditors. A completely sensible argument. But medical practices need to proactively engage in some agreed-upon set of identity theft prevention practices. It’s in the best interest of consumers, not to mention practice owners, who’ll otherwise pay the price through legal costs, or through the provision of services for which they would never collect payment. Incidences of medical identity theft are increasing – enough to raise the gander of the government, which commissioned a study to assess and evaluate the scope of the problem. And smaller medical practices (which account for nearly 80 percent  of all U.S. practices) may be more vulnerable, as thieves could perceive them to be lower risk targets based on the assumption that they lack the sophisticated security procedures of hospitals or larger health care organizations.

Despite the widespread outcry from industry groups, the actual impact on a practice for complying with the red flags rule may be minimal. The new rule would simply buttress state privacy laws that already require health care organizations to respond to breaches of certain patient information. In addition, there is a great deal of overlap between the proposed FTC regulations and HIPAA, which applies to medical practices or other entities that are conducting electronic transactions.

Medical practices concerned about compliance can learn more at: http://www.ftc.gov/bcp/edu/pubs/articles/art11.shtm or http://www.ama-assn.org/ama1/pub/upload/mm/368/red-flags-rule-edu.pdf.

Drs. Kibbe and Klepper this week posted a characteristically thoughtful post on The Health Care Blog concerning the uncertainty surrounding EHR adoption and its role n health care reform. Their argument: that physicians do not know what level of Medicare reimbursement to expect next year as the SGR, which calculates Medicare reimbursement rates in an eccentric way, was not part of the package that was voted on earlier this month. Additionally, critical terms for ARRA incentive payments such as “meaningful use” and “certified EHR” have yet to be defined, plus there is a general lack of confidence about whether adopting an EHR is going to bring a sustainable return on investment, no doubt partially due to the still-evolving technology and the much publicized challenges of creating a nationwide system that is truly interoperable.

Their post was not anti-EHR exactly; more of a jumping-off point for a discussion about whether these factors can be corrected and what the major industry players should do, given the environment. Kibbe and Klepper are right on the money in their description of the current climate, but what they fail to note is that this confusion and uncertainty is short-term and is likely to be resolved (for the most part) in a matter of months. While it is regrettable that Medicare reimbursement is up in the air at the same time as some important definitions upon which ARRA incentives rely, let’s not forget that these definitions should all be hammered out by the second quarter of 2010.

Whether you see an intrinsic value in EHRs, interoperability is really the facet of health IT that will make them almost indisputably worth using, bringing better quality of care to the nation at the very least, with or without the cost savings for physicians that many say will also follow. Yes, interoperability is a big challenge, but there are a lot of parties invested in making it happen, from the government to hospitals to vendors such as GE, who this week announced they were launching technology to aid with setting up health information exchanges. This is encouraging because if interoperability is an issue attractive to businesses, progress is likely to be a lot quicker .Added to this, the price of EHRs is almost certainly going to decrease, driven by software as a service (SaaS) vendors, who can offer a lower-cost, lower-risk option to smaller practices. This will in turn aid interoperability, because these Internet-based solutions tend to be designed using data standards such as XML, and it will also help confidence in the security of EHRs.

In short, now may indeed be, as Kibbe and Klepper say, an uncertain time for physicians; but big changes are difficult to bring about without such a period of flux. While it may mean in the short term that physicians are slower to adopt EHR technology, there are too many players involved with too much invested for things to simply revert to the paper-based status quo. When the dust settles, we can only hope the nation’s health care will be the better for it.

The exchange of lab data is included in the draft of the meaningful use criteria, but as the HIT Policy Committee workgroup heard on Tuesday, exchange of data between laboratories and electronic health record systems in practices and hospitals will be a challenge to implement on a large scale for two main reasons. One is the lack of standards – there are not even standard naming conventions for orders, let alone existing standards for data exchange. And the second reason is that varying state laws will hamper direct access to test results. Some states only permit laboratories to release results to the physician or other person that ordered the test, meaning that if a patient is referred to a specialist, the specialist would have to access the test results via the other physician rather than directly from the laboratory.

Without data standards, interfaces between lab systems and EHRs are a long way from “plug and play”, as one of the professionals that testified before the committee explained. Planning, coding and testing means most interfaces cost about $5,000 and take about three months to complete – which makes them resource- and cost-prohibitive for the smaller hospital and independent labs that actually perform the majority of lab tests in the U.S. Even if the EHR vendors foot the bill (and they often do), without proper IT resources on the lab company’s side, it can be a slow process, particularly if this same process has to happen dozens of times with each different EHR vendor.

The Policy Committee has yet to release its recommendations, but summaries of the meeting seem to point to one common-sense conclusion – that standards are required before exchange of lab data can feasibly be considered part of the definition of meaningful use. This probably comes as no surprise to most in the industry, particularly the HIT Standards Committee, which has previously met on this very subject and whose Co-Chair, Dr. Halamka, has already suggested a set of suitable standards for lab data exchange.  However, the other part of the knotty problem; how to reconcile differing privacy requirements between states, is a legal headache that may prove harder to resolve. As interoperability in health care is explored in greater depth and we move into an era in which data-sharing across state and national borders becomes ever more common, expect this issue to become an ongoing part of the dialogue.

Nuesoft Technologies Inc this week announced the winners of the fall round of its College Health Scholarship Program, which awards grants of up to $5,000 to health and counseling centers so that they can automate their operations using Nuesoft Xpress. Find out which schools were the lucky winners and read more about the scholarship program here.