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    Dr. Marcinko is originally from Loyola University MD, Temple University in Philadelphia and the Milton S. Hershey Medical Center in PA; as well as Oglethorpe University and Emory University in Georgia, the Atlanta Hospital & Medical Center; Kellogg-Keller Graduate School of Business and Management in Chicago, and the Aachen City University Hospital, Koln-Germany. He became one of the most innovative global thought leaders in medical business entrepreneurship today by leveraging and adding value with strategies to grow revenues and EBITDA while reducing non-essential expenditures and improving dated operational in-efficiencies.

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Patient Health Information Data Processing and Storage

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******

The Doctor Will “SEE” You Now!

OR … Not!

[By staff reporters]

A Medical Office Exam – FROM THIS EMR VISIT!

Your privacy is not protected.

We  use Electronic Health Records.

paper

[Courtesy Dr. DK Pruitt]

A Medical Office Exam – TO THIS PMR VISIT!

***

Assessment

Beware – No medical specialty is immune! Which office visit style do you prefer? Are we “Back to the Future?”

Conclusion

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***

Are Paper MRs Safer than EMRs?

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Paper is Safer!

1-darrellpruitt[By Darrell K. Puitt DDS]

“Ransomware Attacks Can’t Hide from HIPAA Anymore – Hospital and health system executives are on notice: Come clean about ransomware attacks as early as possible or be prepared to face sanctions.”

By Scott Mace, for HealthLeaders Media, July 19, 2016.

http://www.healthleadersmedia.com/technology/ransomware-attacks-cant-hide-hipaa-anymore#

Dean Sittig, a clinical informatics professor at University of Texas Health Science Center and the Houston UT-Memorial Hermann Center for Health Care Quality and Safety, tells HealthLeaders,

The new HHS guidance is going to really ratchet up people’s attention, because now you’re also talking about big fines from the government, as well as the effects of the ransomware.”

***

ext

***

Show Me the Money?

“Survey: Nearly Three Quarters of Physicians Say They Haven’t Seen ROI From Electronic Records.”

By Matt Goodman: [Dallas/Fort Worth Healthcare Daily, July 21, 2016]

http://healthcare.dmagazine.com/2016/07/21/survey-nearly-three-quarters-of-physicians-say-they-havent-seen-roi-from-electronic-records/

Conclusion

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***

Inviting Patients to Read Their Doctors’ Notes

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OVER HEARD IN THE DOCTOR’S LOUNGE

DEM white shirt

By Dr. David E. Marcinko MBA CMP™

In an OpenNotes study, researchers examined the impact on patients and doctors when patients were allowed access to their doctors’ notes via a secure Internet portal.

Through the use of surveys, patients’ benefits, concerns, and behaviors, as well as physicians workload, were measured.

The Study

Beth Israel Deaconess Medical Center (BIDMC) in Boston, Geisinger Health System (GHS) in Pennsylvania, and Harborview Medical Center (HMC) in Seattle were selected for this quasi-experimental year-long study.

The study included 105 physicians and 13,564 of their patients. Patients were notified when their notes were available, but whether or not to open the note was at their own discretion. The authors analyzed both pre- and post-intervention surveys from the physicians who completed the study; 99 physicians submitted both pre- and post-intervention surveys. Of the patients who viewed at least one note, 41 percent completed post-intervention surveys.

***

Physician Executive

***

Almost 99 percent of patients at BIDMC, GHS, and HMC wanted to have continued access to their visit notes at the completion of the study; no physician elected to end this practice.

Assessment

Although a limited geographic area was represented, the positive feedback and clinically relevant benefits demonstrate the potential for a widespread adoption of OpenNotes.

Moreover, it may be a powerful tool in helping improve the lives of patients.

Citation: Inviting Patients to Read Their Doctors’ Notes: Author(s): Delbanco, T; Walker, J; Bell, SK and Darrer, JD et al: American College of Physicians, Annals of Internal Medicine, October 2012

Open Notes, a grantee of the Robert Wood Johnson Foundation, was developed to demonstrate and evaluate the impact on both patients and clinicians of fully sharing (through an electronic patient portal) all encounter notes between patients and their primary care providers.

Conclusion

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bmp

http://www.BusinessofMedicalPractice.com

***

Altered Medical Records – OLD SCHOOL!

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ON ALTERED RECORDS

By Dr. David Edward Marcinko MBA CMP®

http://www.CertifiedMedicalPlanner.org

DEM white shirtThe health care provider should not alter the medical record under any circumstances.

The office, clinic or hospital must zealously guard its medical records from alterations by physicians or members of the nursing staff.

Even an inconsequential alteration will throw the validity of the entire record into question. If an entry must be changed, a single line should be drawn through the entry, taking particular care to make sure that the original entry is clearly legible. The new entry should be written above or next to the old entry, and the date of the new entry, as well as the name of the person making the entry, should be recorded. The entry must also be signed by that person.

Juries are very intolerant of altered medical records; and even innocent mistakes, such as the loss of a few pages of a record, will be construed as an intentional cover-up. Under no circumstances should materials such as liquid paper or other opaque liquids be applied to the record in order to correct any entry.

Assessment

The health care provider should not alter the medical record under any circumstances.

Conclusion

Is there an emerging migration back to paper medical records?

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 Harvard Medical School

Boston Children’s Hospital – Psychiatrist

Yale University

Announcing the Philosophic Medical Records Revolution

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Enter the Revolution

DEM blue

By David Edward Marcinko MBBS MBA CMP®

http://www.CertifiedMedicalPlanner.org

Enter the CMPs

To understand the MR revolution that has occurred the past decade , place yourself for a moment in the position of third-party payer.

You want to know if Dr. Brown actually gave the care for which he is submitting a bill.  You want to know if that care was needed.  You want to know that the care was given to benefit the patient, rather than to provide financial benefit to the provider beyond the value of the services rendered.

Can you send one of your employees to follow Dr. Brown around on his or her office hours and hospital visits?

Of course not!  You cannot see what actually happened in Dr. Brown’s office that day or why Dr. Black ordered a CAT scan on the patient at the imaging center.  What you can do is review the medical record that underlies the bill for services rendered from Dr. Blue.

Most of all, you can require the doctor to certify that the care was actually rendered and was indicated.  You can punish Dr. White severely if an element of a referral of a patient to another health care provider was to obtain a benefit in cash or in kind from the health care provider to whom the referral had been made [Stark Laws].  You can destroy Dr. Rose financially and put him in jail if his medical records do not document the bases for the bills he submitted for payment.

This nearly complete change in function of the medical record has precious little to do with the quality of patient care. To illustrate that point, consider only an office visit in which the care was exactly correct, properly indicated and flawlessly delivered, but not recorded in the office chart.  As far as the patient was concerned, everything was correct and beneficial to the patient.  As far as the third-party payer is concerned, the bill for those services is completely unsupported by required documentation and could be the basis for a False Claims Act [FCA] charge, a Medicare audit, or a criminal indictment.  We have left the realm of quality of patient care far behind.  Shall we change it back to the way it was?  That is not going to happen.

***

273_1

***

Instead, practitioners must adjust their attitudes to the present function of patient records. They must document as required under pain of punishment for failure to do so.  That reality is infuriating to many since they still cling to the ideal of providing good quality care to their patients and disdain such requirements as hindrances to reaching that goal.  They are also aware of the fact that full documentation can be provided without a reality underlying it.

“Fine, you want documentation?  I’ll give you documentation!”

Some have given in to the temptation of “cookbook” entries in their charts, or canned computer software programs, EHR [electronic medical record] templates, listing all the examinations they should have done, all the findings which should be there to justify further treatment; embedded “billing engines” not with-standing. We have personally seen records of physical examinations which record a patient’s ankle pulses as “equal and bounding bilaterally” when the patient had only one leg; hospital chart notes which describe extensive discussion with the patient of risks, alternatives and benefits in obtaining informed consent when the remainder of the record demonstrates the patient’s complaint that the surgeon has never told her what he planned to do; operative reports of procedures done and findings made in detail which, unfortunately, bear no correlation with the surgery which was actually performed.

***

EMRs

***

Whether electronic medical records (EMR) will really be helpful, in the future, is still not known.

In fact, according to Ed Pullen MD, a board certified family physician practicing in Puyallup WA, electronic health records are defined primarily as repositories of patient data [much like paper records].

But, in the era of meaningful use [MU], patient-centered medical homes, and Accountable Care Organizations [ACOs], mere patient data repositories are not sufficient to meet the complex care support needs of clinical professionals. These complaints arise because EHR systems are being used as clinical care support systems, which means they should enhance the productivity of clinical professionals and support their information needs, not hinder them [personal communication, and DrPullen.com]. 

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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 Harvard Medical School

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Yale University

HISTORIC PURPOSE OF MEDICAL RECORDS and S.E.S.

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An iMBA Inc., Review

***

DEM white shirt

[By Dr. David Edward Marcinko CMP® MBA]

***

As little as a hundred years ago, detailed medical records were likely to have been compiled by medical researchers such as Charcot and Hughlings-Jackson. The medical record was an aide memoire for detecting changes in patients’ conditions over time, solely for the benefit of the physician in treating the patient.

As health care became more institutionalized, medical records became a communications device among health care providers.  Doctors made progress notes and gave orders.  Nurses carried them out and kept a record of patient responses.  A centralized record, theoretically, allowed all to know what each was doing.  The ideal was that if the doctor were unable to care for the patient, another physician could stand in his or her shoes and assume the patient’s care.

***

stack_of_file_12

***

Enter Third Parties 

Then pressures from third party payers occurred. As insurance and then government programs became larger players in the compensation game, they wanted to know if the care they were paying for was being delivered efficiently.

  • Why were these tests ordered?
  • Why weren’t these studies done?
  • Why had the patient remained hospitalized after his temperature had returned to normal for so many hours and no pain medications had been required?
  • Why couldn’t this pre-operative work be done on an outpatient basis?

Though the real push behind these questions was the desire to save money, utilization review also directly contributed to better patient care. A patient who was being given inefficient care was getting substandard care as well. Utilization review was mainly retrospective; denial of compensation was rarely imposed, and suasion by peers was the main effector of change.  Though “economic credentialing” was shouted about, it rarely showed itself in public.

PP-ACA

Even health reform which openly admitted economic incentives as one of its motivators preferred to find some other reason for deciding not to reimburse, or admit Dr. Jones to its narrow panel of ACA, or other “skinny” network providers, or not renewing Dr. Smith’s contract an HMO. The medical record remained essentially a record of patient care which was good or not, efficient or not.  If the record wasn’t complete, the doctor could always supplement it with an affidavit, use information from somewhere else, or provide explanations.

***

 train station

***

Socio Economic Status

Today, the concept known as Socio Economic Status [S.E.S.] is conceptualized as the social standing, or class of an individual or group. It is often measured as a combination of education, income and occupation. Examinations of socioeconomic status often reveal inequities in access to medical resources, plus issues related to privilege, power and control. SES is increasingly being considered as another payment component [CPT® codes] to medical providers, as reflected in the paper medical record, EMR and elsewhere. 

Assessment

Have you encountered any Socio Economic Status initiative in your clinic, hospital or other medical institution?

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

***

[PHYSICIAN FOCUSED FINANCIAL PLANNING AND RISK MANAGEMENT COMPANION TEXTBOOK SET]

  Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™  Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

[Dr. Cappiello PhD MBA] *** [Foreword Dr. Krieger MD MBA]

***

Inviting Patients to Read Their Doctors’ Notes

Join Our Mailing List 

About OpenNotes

[By Staff Reporters]

In an OpenNotes study, researchers examined the impact on patients and doctors when patients were allowed access to their doctors’ notes via a secure EHR Internet portal. Through the use of surveys, patients’ benefits, concerns, and behaviors, as well as physicians workload, were measured.

***

ME-P electronic typewriter

***

The Players

Beth Israel Deaconess Medical Center (BIDMC) in Boston, Geisinger Health System (GHS) in Pennsylvania, and Harborview Medical Center (HMC) in Seattle were selected for this quasi-experimental year-long study.

The Study

The study included 105 physicians and 13,564 of their patients. Patients were notified when their notes were available, but whether or not to open the note was at their own discretion. The authors analyzed both pre- and post-intervention surveys from the physicians who completed the study; 99 physicians submitted both pre- and post-intervention surveys. Of the patients who viewed at least one note, 41 percent completed post-intervention surveys.

***

eHRs

***

The Results

Almost 99 percent of patients at BIDMC, GHS, and HMC wanted to have continued access to their visit notes at the completion of the study; no physician elected to end this practice. Although a limited geographic area was represented, the positive feedback and clinically relevant benefits demonstrate the potential for a widespread adoption of OpenNotes. Moreover, it may be a powerful tool in helping improve the lives of patients.

Citation: Inviting Patients to Read Their Doctors’ Notes: Author(s): Delbanco, T; Walker, J; Bell, SK and Darrer, JD et; al: American College of Physicians, Annals of Internal Medicine, October 2012.

***

patient

***

Assessment

Open Notes, a grantee of the Robert Wood Johnson Foundation, was developed to demonstrate and evaluate the impact on both patients and clinicians of fully sharing (through an electronic patient portal) all encounter notes between patients and their primary care providers.

More: SOAP[IER] eMRs [Beware the Alphabet Soup Switcher-Roo]

Even More:

Building a Better Electronic Health Record

Free Our Health Records: Get Your Health Records
and Help Save Lives

 

Conclusion

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Socio Economic Status, Payment Reform and Medical Records

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Yet Another Component of the Medical Record?

[Dr. David Edward Marcinko MBA CMP™]

http://www.CertifiedMedicalPlanner.org

Dr David E Marcinko MBAHistorically, medical records [paper or electronic] were previously used to aid in the quality of medical care.

Now they are also the basis for payment for services, not as a record or reflection of the care that was actually provided, but as a separate justification for billing. The lack of appropriate documentation now no longer threatens just non-payment for services but risks civil money penalties and criminal charges.

Enter S.E.S.

Today, the idea known as Socio Economic Status [SES] is conceptualized as the social standing, or class of an individual or group. It is often measured as a combination of education, income and occupation. Examinations of socioeconomic status often reveal inequities in access to medical resources, plus issues related to privilege, power and control.

Assessment

SES is increasingly being considered as another payment component [CPT® codes] to medical providers, as reflected in the paper medical record, EMR and elsewhere.

***

eMRs

[Electronic Medical Records]

***

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Conclusion

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Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)* 8

Medical Records [Time Benefits versus Financial Benefits]

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Paper versus eMRs [Organization – InterOperability – Accessibility]

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MRs

Assessment

Chapter 13: IT, eMRs & GroupWare

Conclusion

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About PAPERbecause.com

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Paper is Good … Pass it On

Domtar is committed to the responsible use of paper.

They are also committed to communicating paper’s place and value to the businesses and people that use their products every day. Paper is a sustainable, renewable, recyclable, plant-based product that connects us in so many ways to the important things in life.

  • Great ideas are started on paper.
  • The world is educated on paper.
  • Businesses are founded on paper.
  • Love is professed on paper.
  • Important news is spread on paper.

That’s why they love paper.

Assessment

But, does this include paper medical records?

Visit: http://www.paperbecause.com/

Conclusion

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Physician Advisors: www.CertifiedMedicalPlanner.org

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EHRs – Still Not Ready For Prime Time

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At Least … Not Yet!

By David K. Luke MIM, Certified Medical Planner™ candidate

www.CertifiedMedicalPlanner.org

Since Feb 17, 2009 when President Obama signed into legislation the Health Information Technology for Economic and Clinical Health Act (HITECH) as a part of the 2009 stimulus package, the incentives were promised for the adoption in health care practices of Electronic Health Records (EHRs).

The Carrot and the Stick

The incentives payments for “meaningful use” range from $63,750 over 6 years by Medicaid to maximum payments of $44,000 over 5 years for Medicare. The penalty for not adopting by Medicare will be 1% of Medicare payments in 2015, increasing to 3% over 3 years. Stimulus money is granted based on meaningful use of an EHR system.

The Reality

Stories are rolling in by early adopters now that give cause for a prudent physician to rethink implementation anytime soon of an EHR for his/her practice. Here is a sampling:

  • EHRs can be hacked and doctors will be held accountable. A total of 385 breaches of protected health information affecting over 19 million records have been reported since August 2009 (Redspin Breach Report 2011). Redspin also reports that industry estimates have put the value of a stolen health record on the black market at about $50 per record. For me, this is the biggest red flag for implementing an EHR now. Vendors are offering solutions in the form of data “masking”, but this could increase the cost of the systems.
  • EHRs have stringent audit requirements under the HITECH Act. Health care organizations are expected to monitor for breaches of PHI. Audit logs must be kept. Audit strategy, process, and implementation tools must be used to meet stage 1 meaningful use criteria. Sanctions to employees for not following protocol. Healthcare facilities leave themselves vulnerable to individual and class action lawsuits when they do not have a strong enforcement and audit program in place for their EHR.
  • EHRs are expensive to implement, both in terms of money and in terms of time. Dollar costs range from free (Practicefusion) to $50,000+ for such EHR vendors as Allscripts or eClinicalWorks + ongoing maintenance costs. But don’t’ forget the time investment. Even small EHR systems can take 2 years to implement. I have just witnessed a client’s large pediatric practice literally crippled with the initial time investment required for staff and physicians to learn the system. Half staffing the front desk and other areas so employees can go to training has caused a drain on both patient and employee morale.
  • Legal concerns are still unanswered regarding EHRs. Currently the debate is still on about who owns the electronic data. The EHR vendor will tell you that you do. HIPPA gives the patient the right to see their record or chart, and the right to have a physical copy of their record based on a reasonably cost for copying and postage. Typically doctors share medical records with other health care providers as a professional courtesy. Empowered patients think they own their records. According to a reference regarding an HIMSS white paper, a patient owns the data in a Continuity of Care Document and has the ability to input and access that information.
  • Obtaining meaningful use stimulus payments is not a given. I met with a physician owner client a few months ago in Arizona that has implemented an EHR for their pediatric practice and was hoping to receive the stimulus payment for stage one by completing the 20 criteria needed. After plowing through the 31-page “Arizona Medicaid EHR Incentive Program” guide provided by The Arizona Health Care Cost Containment System Administration or AHCCCS, which is the Arizona arm of Medicaid he turned in his application, which was denied. His initial reaction was that the program did not have the funding in Arizona, but that seems not to be the case as a number of large payments have been made now in the state. Banner Healthcare, which operates the largest hospital system in the state with thirteen inpatient facilities, reported a total of $12.4 million in Medicaid booty for implementation of its NextGen Healthcare EMR systems in 2011. It appears that there is a learning curve involved here and the smaller practices will catch up while the hospitals currently seem to have better systems in place to capture the stimulus money. An entire MU industry has emerged to help physicians such as my client perfect their stimulus applications.

Risk vs. Reward

In the investment world I am always comparing risk vs. return when managing my client’s portfolios. At times in the marketplace, for various reasons, it just does not make economic sense to make certain investments as the possible risks far outweigh the potential return. An easy example now is the investment in “safe” longer-term treasury bonds. With a near 40-year low in interest rates, the 30-year treasury today yields 3.18 %. Yet if interest rates rise 1% in the marketplace, that 30-year treasury can drop 12%. A 2% rise can result in a fall of 22% in value. It would take 7 years accumulating 3.18% to offset the loss in value caused by a 2% rise in rates. I do not think rates are going up 2% tomorrow, but I just do not like the risk/reward spectrum here. Likewise, the biggest concern currently I have with EHRs is data breeches, as mentioned above, and the stiff penalties involved currently. Paper systems look a whole lot cheaper and safer when considering the ease at which a data breech can occur with electronic data. Fines, criminal sentencing, and disciplinary action by licensing boards are risks not worth taking considering current history on data breeches. Losing your license or your business or personal freedom because of an employee’s careless actions is not worth it. Lest you think I exaggerate, consider the following examples from the past few years enforced by the Office for Civil Rights (OCR), the enforcement side of the US Department of Health and Human Services that enforces HIPAA, and by employers and licensing boards:

Incident: A terminated researcher at UCLA School of Medicine retaliated by accessing UCLA patient records (many celebrities) 323 total times over the next four weeks.

Penalty: 4 years in prison for the terminated researcher for violating HIPAA Privacy Rules

Incident: Thirteen staff members at UCLA hospital accessed Britney Spears’ medical records without authorization.

Penalty: UCLA fired the 13 individuals, suspended another six.

Incident: A doctor and two hospital employees accessed the medical records of a slain Arkansas TV reporter. Details were leaked to the press of her attack.

Penalty: All pled guilty to misdemeanors for violating HIPAA privacy rules and were sentenced to one-year probation. The three all were curious about the case and “peeked” at the patient’s record as employees of the hospital, even though she was not their patient. The doctor’s privileges were suspended by the hospital for two weeks; he was fined $5,000 and ordered to perform 50 hours of community service by speaking to medical workers about the importance of patient privacy. The two other employees were terminated.

Incident: Cignet denied 41 patients, on separate occasions, access to their medical records when requested.

Penalty: Initial violation was $1.3 million. OCR concluded that Cignet committed willful neglect to comply with the Privacy Rule and fined an additional $3 million.

Incident: 57 unencrypted computer hard discs containing PHI of more than one million people was stolen from a storage locker leased by Blue Cross Blue Shield of Tennessee (BCBST).

Penalty: OCR fined BCBST $1.5 million in settlement. The fact that BCBST secured the information in a leased data closet that was secured by biometric and keycard scan in a building with additional security was not enough. BCBST also spent $17 million in investigation, notification and protection efforts and had increased future compliance costs.

Incident: Health Net discovered that nine portable hard drives that contained PHI and personal financial information of approximately 1.5 million people were missing. The hard drives in question went missing from an IBM-operated datacenter in Rancho Cordova, California.

Penalty: The complaint alleged violations of HIPAA. Connecticut Insurance Commissioner wins a $375,000 fine for failing to protect member information and not reporting in a timely manner just months after the Connecticut AG won a $250,000 settlement for the breach. Vermont’s AG jumps in and gets a settlement of $55,000 to the State because 525 Vermonters were on the lost drive.

Incident: WellPoint / Anthem Blue Cross became aware that its customers’ health applications and information website, which contained up to 470,000 applicant’s information, was potentially publicly accessible when an applicant alerted the company that altered URLS after an upgraded authentication code could allow access to other people’s information.

Penalty: WellPoint / Anthem agreed to the terms of a class action lawsuit filed in California that will provide $1.5 million in general settlement, with an additional donation of $250,000 to two non-profit organizations aimed at protecting consumer’s rights, $150,000 donated to Consumer Action and $100,000 donated to the Public Law Center in Orange County. WellPoint / Anthem also agree to pay $100,000 to the state of Indiana for the data breach that exposed 32,000 state residents. A 2009 Indiana law requires companies to notify the state of certain data breaches within a certain period that was not met.

An Investment?

I bring up these examples to make a point. The EHR vendor will talk about your EHR being an “investment”. You cannot have an ROI if you lose money. Notice that most cases were due to careless, innocent lapses of judgment. Also in many cases actual damages either did not occur or were hard to prove. The new HITECH act extends HIPAA to allow the states’ attorney general to also bring actions, which adds more salt to the wound. Some of these cases do not appear to be done yet either as far as the lawyers are concerned. Also, notice that even when the health care provider regarding storing the data exercised extreme care (BCBST with biometric, keyscan leased lockers and Health Net employing IBM’s “secure” datacenter), the health provider was sued and fined. Smaller medical practices I believe are even more susceptible to EHR data breaches, where bad password management practices and website maintenance problems are more common and often protocols and training are not firmly in place.

Assessment

The widespread use and integrated implementation of EHRs are going to happen, no doubt. Your practice will eventually have one. 2015 is still a few years off before the first 1% Medicare penalties hit. Tell the EHR vendor to call back in 2014 once the kinks are worked out. Waiting two more years may not prevent a costly incident due to the vengeful fired employee or due to a careless slip in protocol. Those landmines will always be there.

But, two more years will allow the EHR stakeholders more time to improve their product, namely the security and encryption of the data in case of a breach, and two more years will allow the OCR and the state AG’s to fill up on the low hanging fruit and make their point.

Conclusion

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The Sick Cost of Medical Paperwork – Maybe?

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[By Staff Reporters]

If there’s one thing Americans can agree upon 100%, it’s that the cost of helath care is completely insane. Costs are far higher in theUSthan in any other industialized nation, and even health care reform hasn’t been able to reel them in yet.

But, where is all the money going, exactly? Hundreds of billions are going straight into the paper shredder. Brought to you by Medicaltranscription.net

 

Conclusion

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Understanding the Medical Records R[e]Volution

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It’s Not All about Electronic Records

By Dr. David Edward Marcinko; MBA, CMP™

[Editor-in-Chief]

Introduction

To understand the medical records revolution that has occurred this decade, put your self for a moment in the position of a third-party payer; ie; a private insurance company, Medicare or Medicaid etc.

For example, you want to know if Dr. Joel Brown MD actually gave the care for which he is submitting a [super] bill or invoice. You want to know if that care was needed. You want to know that the care was given to benefit the patient, rather than to provide financial benefit to the provider beyond the value of the services rendered.

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Of Doubts and Uncertainty

Can you send one of your employees to follow Dr. Brown around on his or her office hours and hospital visits?  Of course not! You cannot see what actually happened in Dr. Brown’s office that day or why Dr. Black ordered a PET scan on the patient at the imaging center. What you can do however, is review the medical record that underlies the bill for services rendered from Dr. Blue. Most of all, you can require the doctor to certify that the care was actually rendered and was indicated. You can punish Dr. White severely if an element of a referral of a patient to another health care provider was to obtain a benefit in cash or in kind from the health care provider to whom the referral had been made. You can destroy Dr. Rose financially and put him in jail if his medical records do not document the bases for the bills he submitted for payment.

The Payment Paradigm Shift

This nearly complete change in function of the medical record has precious little to do with the quality of patient care. To illustrate this medical records evolution/revolution point, consider only an office visit in which the care was exactly correct, properly indicated and flawlessly delivered, but not recorded in the office chart. As far as the patient was concerned, everything was correct and beneficial to the patient. As far as the third-party payer is concerned, the bill for those services is completely unsupported by required documentation and could be the basis for a False Claims Act [FCA] charge, a Medicare audit, or a criminal indictment.  We have left the realm of quality of patient care far behind.

mobile EHR health

Provider Attitude Adjustments Required

Instead, medical practitioners must adjust their attitudes to the present function of patient records.  They must document as required under pain of punishment for failure to do so. That reality is infuriating to many since they still cling to the ideal of providing good quality care to their patients and disdain such requirements as hindrances to reaching that goal. They are also aware of the fact that full documentation can be provided without a reality underlying it. “Fine, you want documentation?  I’ll give you documentation!”

Computer Charting and eMRs

Some doctors have given in to the temptation of “cookbook” entries in their charts, canned computer software programs or eMRs listing all the examinations they should have done, all the findings which should be there to justify further treatment.  Many have personally seen, for example, hospital chart notes which describe extensive discussion with the patient of risks, alternatives and benefits in obtaining informed consent when the remainder of the record demonstrates the patient’s complaint that the surgeon has never told her what he planned to do; operative reports of procedures done and findings made in detail which, unfortunately, bear no correlation with the surgery which was actually performed.

Assessment

Whether electronic medical records (eMRs) will be helpful regarding fraud prevention, in the future is still not known. But, it is at best naive and more frequently closer to a death wish to think that a practitioner can beat the system, with handwritten notes, computer generated records, or fabricated eMR documentation.

Conclusion

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SOAP[IER] eMRs [Beware the Alphabet Soup Switcher-Roo]

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Medical Records not a Reflection of Reality – Are Reality Itself

[By Dr. David Edward Marcinko; MBA, CMP™]

[By Hope Rachel Hetico; RN, MHA, CMP™]

Now more than ever, inadequately documented medical charts can mean civil and criminal liability to the sloppy and/or unwary practitioner.

Medical records were previously used to aid in the quality of medical care. Today, they are also the basis for payment for services, not as a record or reflection of the care that was actually provided, but as a separate justification for billing.

History

As little as a hundred years ago, detailed medical records were likely to have been compiled by medical researchers such as Charcot and Hughlings-Jackson. The medical record was an “aide memoire” for detecting changes in patients’ conditions over time, solely for the benefit of the physician in treating the patient.  As health care became more institutionalized, medical records became a communications device among health care providers. A centralized record, theoretically, allowed all to know what each was doing.  The ideal was that if the doctor were unable to care for the patient, another physician could stand in his or her shoes and assume the patient’s care.

Payer Pressures

Then, according to our friend and colleague William “Duffy” LaCava PhD Esq, came pressure from third party payers. As insurance and government programs became larger players in the compensation game, they wanted to know if the care they were paying for was being delivered efficiently. Though the real push behind these questions was the desire to save money, utilization review also directly contributed to better patient care.

Utilization review however, was mainly retrospective; denial of compensation was rarely imposed, and suasion by peers was the main effector of change. Though “economic credentialing” was shouted about, it rarely showed itself in public. Even managed care which openly admitted economic incentives as one of its motivators, preferred to find some other reason for deciding not to admit Dr. Jones to its panel of providers or not renewing Dr. Smith’s contract with the MCO. The medical record remained essentially a record of patient care which was good or not, efficient or not. If the record wasn’t complete, the doctor could always supplement it with an affidavit, use information from somewhere else, or provide explanations.

A Paradigm Shift

This nearly complete change in function of the medical record had precious little to do with the quality of patient care. To illustrate the point, consider only an office visit in which the care was exactly correct, properly indicated and flawlessly delivered, but not recorded in the office chart. As far as the patient was concerned, everything was correct and beneficial. As far as the third-party payer is concerned, the bill for those services is completely unsupported by required documentation and could be the basis for a False Claims Act charge, a Medicare audit, or a criminal indictment.

IOW: We have left the realm of quality of patient care far behind in the current e-medical record debates.

An Attitude Shift

In this contemporary age [circa 2010 and beyond], medical practitioners must adjust their attitude to the present function of patient records. They must document as required under pain of punishment for failure to do so. This new reality is infuriating to many doctors since they still cling to the ideal of providing good quality care to their patients and disdain such requirements as hindrances to reaching that goal. They are also aware of the fact that full documentation can be provided without a reality underlying it.

So, in the modern era of eMRs; some doctors think … and frustratingly say outright: “Fine, you want documentation?  I’ll give you documentation!”  Hence e-MR diarrhea!

APSO needs to replace SOAP in eMRs?

But, according to Dr. Ed Pullen, writing for the Health Care Blog www.TheHealthCareBlog.com,

Consultants have known for years that their referring physicians do not want to look through the entire history and physical exam documentation to get to the assessment and plan. Most consultants make notes to their referring physicians with the Impression and Plan/Recommendations at the top. . 

So, now the entire legal world knows that referring physicians do not want to look through the entire history and physical examination documentation to get to the medical assessment and treatment plan. WOWSA! As the patient, how would you feel about this statement? Furthermore he states that:

When a physician reviews a prior progress note, the information they usually want to see the assessment and plan.  Much less often they need to know the details of the patient’s history, examination, review of systems, etc. In a paper chart it is just a movement of the eyes to find the desired part of the note, and it makes little difference whether the needed information is on the first few lines, or at the end of the note.  The traditional progress note format is the SOAP note: Subjective history first, Objective information like vital signs, physical exam and test results next, Assessment including the diagnosis and documentation of the thought process and decision making third, and the Plan of treatment last.  This reads in a logical fashion, and has become the standard format in most paper patient charts.  In an EMR note reviewed on a computer monitor, the traditional SOAP note simply does not work.  The history of present illness, past medical history, family, and social history, and review of systems, and physical exam more than take up the available space on a monitor. 

To which we agree as the traditional SOAP format of medical charting was developed by Dr. Lawrence Weed in 1968. More formally, it is known as the Problem Orientated Medical Record [POMR]. However, the concept was updated about 20 years ago by adding the extension SOAP[IER], which may work a bit better:

I = Intervention
E = Evaluation
R = Revision

Of course, nurses know this, but doctors still may not. Or; they know but do not execute – a much graver offense.

On the APSO Format

Ed further states that:

Simply making an APSO note instead of a SOAP note, i.e. putting the Assessment and Plan first, and the Subjective history and Objective information later can make reviewing notes much more efficient.  This simple change can be done easily in most eMRs, and just requires thinking about the different work process using a computer monitor to look at information.

Note: APSO = Assessment, Plan, Subjective and Objective

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So, Let’s Change the eMR – But Not Bad Physician Behavior?

Well maybe; maybe not! The thought process here seems to be that if the physician behavior is wrong [not reading the entirely legible e-note], let’s change the electronic algorithm instead. To which we say, let’s change bad physician behavior; or doctor – PLEASE READ THE DAMN NOTE.

eMRs – A Malpractice Litigator’s Dream

Regardless of the above, whether electronic medical records will be more helpful, or even read and reviewed in the future, is still not known. Nevertheless, it is at best naive and more frequently closer to a death wish to think that an unscrupulous practitioner can beat the system, with handwritten notes; computer generated records, or fabricated eMR documentation. And, we do politely disagree when Dr. Pullen opines that:

eMRs also can easily make a document that does a good job of producing a document that can stand up to legal scrutiny. Although there is little data to prove it, some experts believe use of an EMR can reduce liability.

In fact, after serving as expert medical witnesses thru three decades, beginning during the early digital medical records revolution, we believe that eMRs will actually increase medical liability as astute plaintiff attorneys and skilled litigators portray them as canned, automated and robotic notes – not at all relative to the real patient. We’ve seen it before, and it will successfully happen again, as sympathetic jurors buy the argument – en mass.

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For example, we can just imagine a sly attorney admonishing the lay jury–

“My client, Mrs. Smith, is a human being – a patient – she is not an electronic template. Like you, she exits in the real world, not the virtual world of manipulated bits and fabricated electronic bytes. And, by the way doctor, did you even read the notes. After all, according to Dr. Ed Pullen, consultants have known for years that their referring physicians do not want to look through the entire history and physical exam documentation to get to the assessment and plan.   

Of course, like some other experts, we also believe that eMRs actually hinder the patient-physician relationship and communication channel.

http://www.kevinmd.com/blog/2010/03/emr-conversion-physician-communication.html

Assessment

MD-TraderIn almost an ironic return to the original reason for medical records, False Claims Act suits have been maintained on the basis that the care actually provided to patients was not good enough in quality to justify the claims being submitted. In other words, if the care provided fell below the standard of care provided, not only did the practitioner commit medical malpractice, but he or she also submitted a false claim!

Therefore, always remember that medical records are not a reflection of reality – they are the new reality [personal communication “Duffy” LaCava].

Conclusion

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Why eMRs Won’t Improve Patient Care or Reduce Costs

Deus Ex Machina – NOT

By Staff Reporters

Question

Have electronic medical records made a difference in patient care?

Answer

According to a new study looking at the digital medical record adoption of 3,000 hospitals, electronic records have made little difference in healthcare costs or the quality of medical care.

Assessment

That’s discouraging, considering that the government is investing billions of dollars into the technology.  

Related posts from Kevin Pho MD:

Conclusion

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Notice of Healthcare Privacy Practices Explained

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NPP “Game Changer” Replaced Use of Consents

Dr. Mata

[By Richard J. Mata; MD, MS]

In its most visible change, the privacy regulations of HIPAA require covered health entities to provide patients with a Notice of Privacy Practices (NPP).

The NPP replaces the use of consents, which are now optional, although they are recommended.

The NPP outlines how PHI is to be regulated, which gives the patient far-reaching authority and ownership of their PHI, and must describe, in general terms, how organizations will protect health information.

THE NPP Specifics

The NPP specifies the patient’s right to the following:

  • gain access to and, if desired, obtain a copy of his or her own health records;
  • request corrections of errors that the patient finds (or include the patient’s statement of disagreement if the institution believes the information is correct);
  • receive an accounting of how their information has been used (including a list of the persons and institutions to whom/which it has been disclosed);
  • request limits on access to, and additional protections for, particularly sensitive information;
  • request confidential communications (by alternative means or at alternative locations) of particularly sensitive information;
  • complain to the facility’s Privacy Officer if there are problems; and
  • pursue the complaint with DHHS’s Office of Civil Rights if the problems are not satisfactorily resolved.

A copy of the NPP must be provided the first time a patient sees a direct treatment medical provider, and any time thereafter when requested or when the NPP is changed. On that first visit, treatment providers must also make a good faith effort to obtain a written acknowledgement, confirming that a copy of the NPP was obtained. Health plans and insurers must also provide periodic Notices to their customers, but do not need to secure any acknowledgement. Most Health Information Management departments that oversee the clinical coding of medical records also manage the NPP documentations and deadlines, but this may vary from hospital to hospital, or office to office.

Assessment

HIPAA requires no other documentation from the patient in order for information to be used or disclosed for basic functions, like treatment and payment, or for a broad range of other core healthcare operations. State laws may nonetheless require some kind of consent/authorization form from the patient for these purposes [It is common for institutions to claim, incorrectly, that HIPAA does].

Conclusion

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Dr. Pruitt Invites Dr. Cohen to Discuss eDRs

Where is the ADA’s Representative?

By Darrell K. Pruittpruitt; DDS

He or she should have been talking with me long ago. I have the audience and I’m giving you that opportunity I promised you, Dr. Donald Cohen.

Rest Easy

I’m aware that I possibly make you uncomfortable, considering how “unprofessionally” I’ve publicly treated lesser devoted HIPAA consultants. Rest easy! As soon as I read your article, I could tell that you’re different from your colleagues I’ve met. First of all, like me, you’re a dentist. That’s very important. Secondly, your credentials are impressive and reveal that compliancy is not a hobby for you like it is for others. Nobody can accumulate a history as impressive as yours without professional dedication. The last point, and the most important of the three, you seem honest about HIPAA compliance.

A Professional

It wasn’t lost on me that in your article you were professionally non-judgmental of the Rule. Instead of trying to justify a defenseless law, your job is to help dentists comply with the mandate as it is written or risk significant fines. Like tax-collecting, someone’s got to do the job of delivering bad news. You have a legitimate purpose to be involved in the dental industry, even if what you teach makes little difference at all if a dentist’s records are breached. I argue that following the inevitable bankruptcy from a breach, HHS fines are hardly a deterrent. And that is the issue: eDRs containing patient identifiers are too risky for the marketplace.

Electronic Dental Records

I think you would have to agree that eDRs are going nowhere until records are safe, and encryption is not going to be sufficient to protect dentists against dishonest employees. Ambitious bureaucrats in waiting, such as HIPAA consultants Travis Criswell, Sharalyn Fichtl, Kelly Mclendon and Olivia Wann – not a dentist among them – hooked their careers to the HIPAA mandate to avoid the tough sales jobs competition otherwise demands in the free market. All four share an authoritarian misconception that since it is the law, dentists will be forced to purchase their products – even if they are utterly senseless. I think we both know that they are oh so wrong. I promised earlier to give you an opportunity to publicly support truth in eDRs if you so choose. Perhaps we could rationally discuss in front of everyone how dentists can wriggle free of the approaching mess. There is no pressure here, other than this is public invitation. Since you haven’t made unrealistic claims about eDRs like others have, I am not interested in hounding you further. I simply ask you to consider responding to the article I posted in your name on PennWell titled “Dr. Donald Cohen’s opportunity.”

http://community.pennwelldentalgroup.com/forum/topics/dr-donald-cohens-opportunity

Assessment

I sincerely appreciate the respect you have shown me, and I pledge to afford you the same. Of all the consultants I have approached with my concerns about HIPAA and eDRs, you are the first to even acknowledge a problem simply by posting my concerns. I think you have the courage to face the realities of the marketplace, while others foolishly think dentists are a captive market.

Note: I submitted this to be posted following an August 28th press release posted by HIPAA consultant Dr. Donald Cohen titled, “Dentists Should Know about New HIPAA Rules.”

http://www.dentalblogs.com/archives/administrator/dentists-should-know-about-new-hipaa-rules/comment-page-1/#comment-35672

If you are interested in discussing the topics of interoperability with fax machines, de-identified eDRs and security that surpasses paper records, in front of you is the opportunity to address your largest audience yet, Dr. Cohen. I’m self-syndicated.

Note: Do you realize that if Dr. Cohen takes me up on the offer, this will be the first time two dentists have openly discussed eDRs on the Internet? Do you think it’s about time?

Conclusion

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My Favorite Health 2.0 Experience from McDonalds

Meet the Schwieterman’s

By Dr. David Edward Marcinko; MBA, CMP™biz-book

Back in 2005, we published the second edition of our popular textbook: the Business of Medical Practice. And, we are now working on the third edition. At the time however, I was fortunate to have a colleague from the Microsoft Corporation pen our Foreword, now reprinted below for your review.

Link: http://www.springerpub.com/prod.aspx?prod_id=23759

 

What a Family Tradition!

My favorite story came from Dr. Thomas Schwieterman, a fourth-generation physician working in the same medical office his great grandfather established in 1896 in the town of Mariastein, Ohio. From those same historic environs, Schwieterman has used Microsoft Access to create his own physician assistant application.

The Schwieterman Family Physicians practice kept him so busy that he was wondering how he could keep up with his patient caseload. Schwieterman wanted a faster way to handle prescriptions, provide medical information, and record data for his patient records. He walked into a McDonald’s restaurant one day and had an idea.

The Epiphany

“I ordered a cheeseburger and fries and watched the person at the counter touch the screen of the cash register a few times, and realized the order was getting transferred back to the food preparation area, and that by the time I paid, my order was ready,” he said. “I thought to myself: ‘That’s what I need!’” He searched for commercially available solutions, but when he couldn’t find an exact match for his needs, and when he found prices steep for a small private practice, he decided to create his own – using Access. He also called upon a friend with a Master’s Degree in electrical engineering to help on the coding. His creation boosted his income by 20 percent – “Which was important because we pay more than $60,000 a year for malpractice insurance even though our clinic has never been sued since it was founded 107 years ago.”

Assessment

What my friends at Microsoft especially like about this story is that when Dr. Schwieterman’s colleagues tried his program, liked it, and suggested he try to sell it, he put together a PowerPoint presentation – and landed a partnership agreement with a major healthcare supply and services corporation to market his ChartScribe solution.

Conclusion

So, the pressures facing physicians are great, but so are their resources. Information technology is one resource, this book is another, but the greatest of all is the innate curiosity and drive to discover and create that seems to be so much a part of those who are drawn to this noble profession.

Ahmad Hashem; MD, PhD

Global Healthcare Productivity Manager

Microsoft’s Healthcare Industry Solutions Group

Microsoft Corporation

Redmond, Washington 

Conclusion

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ME-P Healthcare Reform Survey?

Off-Road Touring with Dr. Marcinko [Part V]

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

About Marquette, Michigan

As our ME-P readers are aware, Marquette Michigan has a population of 20,714, and is the UP’s largest community. In addition to being a population center, it serves as the regional center for education, health care, and outdoor recreation. This regional draw is particularly evident due to Northern Michigan University and Marquette General Hospital [MGH]. Naturally, during my recent tour there, I was able to visit both small and large medical practices, clinics and hospitals. Everywhere, the topic of conversation was the Obama Administration’s vision of domestic healthcare reform. And so, after unofficially asking local residents on their feelings in the matter, we are pleased to offer this survey to all readers and subscribers to our Medical-Executive Post.

Bell Medical

 

About Off Road with Dr. Marcinko

These sporadic off-road segments will continue through-out my 2009 summer promotional tour. On the one hand, formal attendance at several engagements was a bit sparse because of the death of several recent celebrities and entertainer types. On the other hand, local book stores and sponsors noted a spike in our CD and book sales, as well as interest in our online www.CertifiedMedicalPlanner.com program and premier quarterly guide: Healthcare Organizations [Journal of Financial Management Strategies] www.HealthcareFinancials.com

Part IV: https://healthcarefinancials.wordpress.com/2009/08/13/off-road-touring-with-dr-marcinko-part-iv/ 

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

 

 

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About Practice Fusion and Free eHRs

A Web Based Concept in the Clouds

By Staff ReportersOpen

Practice Fusion is a firm that reports to address the complexities and critical needs of today’s healthcare environment by providing a free, web-based electronic Health Record (eHR) application to physicians.

America’s Fastest Growing EHR community

Practice Fusion is also a fast growing electronic Health Record community. Founded in 2005, they are rapidly expanding and adding new users regularly. Over 18,000 physicians and practice managers in 50 states currently use Practice Fusion’s electronic Health Record.

Online and Free

Practice Fusion stands out in a marketplace dominated by complicated, expensive and often inefficient eHR services. Their user-friendly eHR is reported to be activated in less than five minutes, with no downtime or extensive training; eliminating the difficult conversion process that has become an industry-standard.

Secure and Reliable

The firm understands the mission-critical nature of their application. Practice Fusion’s electronic Health Record is developed for the highest levels of security and performance with world-class data centers equipped with best-in-class technology to securely house sensitive data.

Assessment

Although Practice Fusion is a young company, they are led by a well-established team of healthcare and technology veterans. Practice Fusion is directed by a group of investors and medical practitioners who believe in the power of electronic Health Records. Investors include Band of Angels, Salesforce.com and Felicis Ventures. So, give the site a click, and tell us what you think! www.PracticeFusion.com

Conclusion

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Feds Propose Educational Website on ePHRs

Site Aimed at Consumers

[By Staff Reporters]

Conference RoomAs reported by Mary Mosquera on May 22 2009, the Office of the National Coordinator for Health Information Technology (ONCHIT) just proposed developing a Web site for consumers. The site is to contain facts about electronic-personal health record systems and their privacy policies. It aims to help consumers and patients make informed decisions.

http://govhealthit.com/articles/2009/05/22/feds-propose-phr-website.aspx?s=GHIT_260509

Assessment

The Department of Health and Human Services [DHHS] Agency information collection request, for a 30-days public comment period, is also located here.

http://edocket.access.gpo.gov/2009/E9-12023.htm

Conclusion

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On the Patient Friendly Google Health Initiative

Join Our Mailing List

Data Integrity and Health 2.0 Accuracy Concerns Linger

google3

[By Staff Reporters]

According to its’ website, and mission statement, Google Health aims to put patients in charge of their digital health information. It’s safe, secure, and free.

Triple Play of Benefits

Google Health purports to:

  • Organize health information all in one place.
  • Gather medical records from doctors, hospitals, and pharmacies.
  • Share information securely with family members doctors and caregivers, etc.

Google says members are always in control of how data is used. It will not sell information. Members decide what to share, and what to keep private.

Link: privacy policy

Blogsite

Google health was launched in the spring of 2008. Since then, it even maintains its own blog-site, which stated on 3/4/09.

 “We continue to learn a tremendous amount since launching Google Health in the spring of 2008. We’re listening to feedback from users every day about their needs, and one issue we hear regularly is that people want help coordinating their care and the care of loved ones. They want the ability to share their medical records and personal health information with trusted family members, friends, and doctors in their care network”

Link: http://googleblog.blogspot.com/2009/03/google-health-helping-you-better.html

Good thing too!

A Cautionary Tale

However, privacy advocates worry about the vast amount of data that Google is redacting. Growing consumer market clout means the early-adopter patient who cares about digital records, and eHRs, may have fewer choices in the future. And, for medical professionals, what does this say about CCHIT, Allscripts and the Military, etc; or, the emerging Wal-Mart eMR initiative for doctors?

Assessment

For example, when one now [in]famous patient named Dave deBronkart – a tech-savvy kidney cancer survivor – tried to transfer his medical records from Beth Israel Deaconess Medical Center to Google Health, he was stunned at what he found.

Read this Link: http://www.boston.com/news/nation/washington/articles/2009/04/13/electronic_health_records_raise_doubt

Is MSN’s Health Vault any better?

Channel Surfing the ME-P

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Conclusion

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The Case Against Inter-Operable eHRs

Let the Conversation Begin

pruitt1

By Darrell Kellus Pruitt; DDS

If someone says computerization in dentistry is inevitable, remind them that the metric system is inevitable as well.  Sometimes inevitable takes a long time though – even when it makes sense.  Interoperable dental records don’t.

Contrary to what healthcare IT stakeholders promise to win financing from a newbie Obama administration, interoperable eDRs will increase my cost of providing care, increase my liability as a businessman and endanger my patients’ health and welfare. Those are just three of many reasons why I intend to firmly stand in the way of their adoption until security problems are resolved to my satisfaction. I dare not grow discouraged, for there are far too many depending on me. 

If my grandchildren are to benefit from the miracles of trusted Open Source Evidence Based Dentistry, we must not allow today’s temporary collection of reckless stakeholders to burn consumers’ trust in eDRs even once. 

It is for these reasons that I watch very closely for the mention of eHRs on the Internet.  I am particularly alerted to danger when someone tells lawmakers that they have their own special plans for my patients’ dental records – without first discussing them with me.  I’m funny that way about my Hippocratic obligations and I don’t care what anyone thinks.

The Professor and IT Advocate

Valerie Powell, PhD., a professor of informatics at Robert Morris University, began commenting about dentistry and eHRs on ModernHealthcare.com in April.  She has posted five comments.  Her most recent appeared on November 25, and it was in response to my counterpoint titled “Dentistry EHRs not necessarily inevitable.”

http://modernhealthcare.com/article/20081124/REG/311249951

I continued my point-by-point critique of her uninformed ideas right here on the Medical Executive-Post in an article titled “Dental eHR Controversy Continues.”

https://healthcarefinancials.wordpress.com/2008/11/28/much-more-on-dentistry-and-the-ehr-controversy/

Valerie Powell never returned a response.

www.HealthDictionarySeries.com

Today, Powell’s name popped up on my google-alert.  She was interviewed for an article posted on the Pittsburgh Tribune-Review, written by Allison M. Heinrichs and titled “Experts lobby to add key dental data to medical records.”

http://www.pittsburghlive.com/x/pittsburghtrib/s_603452.html

She and her lobby went over my head.  That was wrong, as well as foolish.

I must say this in defense of her courage, however. In the last two years, Valerie Powell PhD., is the only person in the US who is publicly pushing for interoperable health records in dentistry.  She continues to hopefully plod along even though there are no longer any dentists promoting them – from what I can tell.  The ADA long ago gave up on unwittingly pushing dentists to go paperless. In fact, because of the palpable resentment among membership over being misled about the NPI number, the ADA Department of Dental Informatics [ADA-DDI] no longer even suggests that members sign up for them.  Just ask the department for yourself at NPI@ada.org

Tell them I sent you. They know who I am.

Even the eHR debate that limped along on PennWell was seemingly unnoticed by not only representatives from the ADA Department of Dental Informatics [ADA-DDI] but also by software vendors whose very market awaited their responses.  There still must be a dozen or so unanswered questions about eHRs in dentistry featured on this thread.  Does it not seem strange to anyone else that dental software firms are not tripping all over each other to get the names of their products in front of thousands of dentists for virtually no cost?  Transparency on the Internet certainly beats traditional advertisement if a business can tolerate the matching accountability.

Other than Dr. Powell, why do you think healthcare IT stakeholders are so shy?  And when they do speak up, why do they continue to over-stretch worn out rationalizations rather than offer tangible reasons for eHR adoption in dentistry? 

For example, the lame Hurricane Katrina excuse for digitalization of dental records was stupid even before it was approved by some committee as a talking point.  For anyone here in west Texas, it sounds really, really silly.  Here is another almost extinct slow-moving talking-point I like to lampoon, “Someone can steal paper charts just as easily as they can steal digital records.”  Is there anyone in the nation who can argue that point successfully?  Please step forward; Your audience awaits. 

Recently, I heard a fresh, incredible reason why dentists should computerize – malpractice protection.  Someone who really should have known better told me with a straight face that there are not only more negligence lawsuits filed in dentistry than digital privacy breaches, but that if a dentist has a paperless practice, almost all malpractice lawsuits could be prevented.  I find it hard to believe that a dentist could be so naïve.  Or worse, that a dentist would assume a colleague is so naïve.

Regardless of bald lies mixed in with irrelevant talking points, some rationalizations for connectivity are better than others.  But that still does not mean dentists must computerize their practices to accomplish worthy goals.  For example, one thing Dr. Powell understands on a professional level is the importance of dental health in overall health.

“The research shows that there is a close relationship between diabetes and periodontal disease, also with stroke, respiratory disease, and kidney disease. Some research shows that certain oral diseases are associated with conditions that lead to low birth weight.  And yet dentists and physicians aren’t communicating. I really don’t believe we’re going to get an optimal improvement in clinical care until we take care of this problem.”

Valerie Powell, PhD [Piittsburgh Tribune-Review]

Dr. Powell’s goal is sound, and I cannot argue with her about the urgent need for better communications between all healthcare providers.  In fact, with the sudden downturn in the economy, it so important that we quickly gain control of the expensive and preventable chronic illnesses she mentions, that the nation cannot afford to wait until dentists are paperless.  That could be decades.  The $25 billion bailout that the healthcare IT industry is requesting will be squandered in part for political favors by members of Dr. Powell’s lobby.  I call that churning profits.  That was the old, inefficient way of doing things in dentistry.

We need something now and we need something that will cost virtually nothing.  We need a system for better communications that can be erected in less than six months and will allow taxpayers to keep their $25 billion.  Above all, in order to make this work, we must avoid HIPAA as much as possible.

I’ve put some thought to the serious problem that Dr. Powell describes.  I think I have found a hybrid solution that will not require dentists to become HIPAA-covered entities to communicate more effectively with physicians’ computers.  In fact, physicians also don’t have to be covered entities.  And no, it is not a person-to-person phone call – an increasingly underrated form of communication in my opinion that also does not require HIPAA’s involvement. 

Do you know what the solution is yet? 

Keep reading. There’s more. A solution?

My solution would allow e-prescribing to occur in dentistry, without the dentist having to “volunteer” for a dangerous NPI number.  This would help Glen Tullman, the shy CEO of Allscripts – a monster stakeholder in e-prescriptions.  Otherwise, poor Glen is fresh out of ideas.

http://community.pennwelldentalgroup.com/forum/topics/glen-tullman-ceo-of-allscripts?page=1&commentId=2013420%3AComment%3A22103&x=1#2013420Comment22103

Committees just do not creative thinkers make.

That’s not all! The hardware necessary already exists in most dental offices, and can be obtained for less than $200 at any electronics store.  And just wait until my solution is combined with state-of-the-art voice-recognition capabilities.  All communications with physicians and pharmacies could be done chair-side in the presence of the dental patient without having to store their identifying information digitally anywhere.  All that is needed is a universally acceptable paper format and an acknowledgement that paper is going nowhere soon – thank goodness. 

So what is the revolutionary idea?  It is so simple it will knock you down.

(Drum roll)…  Make eDRs and eMRs compatible with common fax machines as a requirement for ONCHIT accreditation.

Wow!  Now how difficult was that?

Assessment

I invite Dr. Valerie Powell, Dr. Franklin Din, or anyone else interested in finding a solution rather than funding, to discuss with me problems with my idea.  I happen to think it is a cheap, common sense solution that will give us all the benefits Powell promises without excessively endangering anyone other than dental software vendors looking for bailout money. Another difference is my plan has a chance in hell of working www.HealthcareFinancials.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. What do you think? What is your plan? Let the conversation begin.

Note: Dr. Pruitt blogs at PenWell and others sites, where this post first appeared.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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