EHR Guru

Archive for August, 2011...

Filed under EHR_Billing_Hardware and more

Around our office we now joke by saying ‘Meaningful Poop’ instead of ‘Meaningful Use’. This is because the topic is confusing and unclear and rules are based on what the individual practice performs which means you really should consider hiring a consultant to help you with all aspects of Certification.

Qualifying for the Meaningful Use

Trying to figure out what you need to do to meet the requirements for an EHR refund, can be described about like how you find a needle in a haystack. Sure, all the information is out there, but interpreting it or even just finding it, isn’t as easy as it really should be. Therefore, I’ve compiled some information here to try to make things a little clearer for everyone. * Since each HER software is going to be a little different in how they record and calculate these objectives, I will focus on the general objectives and it will be up to your software provider to guide you in how their products meets the objectives.
Let’s begin with the core objectives. To simplify, I will not mention the objectives that could excluded for chiropractors. The core objectives required are as follows: implement drug/drug and drug/allergy interaction checks, maintain an up-to-date problem list, and active medication list, active medication allergy list, and keep record of smoking status ages 13+. Also, provide patients with an electronic copy of the health information, be able to exchange key clinical information, and make sure health information is protected. You’ll need to record demographics such as preferred language, gender, race, ethnicity, and date of birth, and provide clinical summaries for patients and implement one clinical decision support rule. You’ll also need to record ambulatory clinical quality measures and be able to exchange key clinical information. Although this may be optional if you’ve met enough other objectives, you could record and chart changes in the vital signs and track smoking status for patients 13 years or older if your software currently has these capabilities. The following will assist you in understanding their meanings.
Drug/drug & drug/allergy interaction checks – Eligible professionals (EPs) must attest YES to having enabled drug-drug and drug-allergy interaction checks for the length of the reporting period to meet this measure.

Problem List – A list of current and active diagnoses as well as past diagnoses relevant to the current care of the patient.
Active Medication List – A list of medications that a given patient is currently taking. Not all of this information will need to be updated or even be needed by the provider at every patient encounter. This is especially true for patients whose encounter frequency is such that they would see the same provider multiple times in the same EHR reporting period.
Allergy list– A list of medications to which a given patient has exaggerated immune response or reaction to substances that are generally not harmful. For patients with no active medication allergies, an entry must still be made to the active medication allergy list indicating that there are no active medication allergies. An EP is not required to update this list at every contact with the patient.

Electronic copy of Health information – Information that must be provided electronically is limited to that information that exists electronically in or is accessible from the certified EHR technology and is maintained by or on behalf of the EP. At a minimum, this would include the elements listed in the ONC final rule at 45 CFR 170.304(f) for EPs. All data needed to diagnose and treat disease.

Electronic exchange of clinical information – Performed at least one test of certified EHR technology’s capacity to electronically exchange key clinical information. Clinical information must be sent between different legal entities with distinct certified EHR technology and not between organizations that share a certified EHR technology. Distinct certified EHR technologies are those that can achieve certification and operate independently of other certified EHR technologies. The exchange of information requires that the eligible professional must use the standards of certified EHR technology as specified by the Office of the National Coordinator for Health IT, not the capabilities of uncertified or other vendor-specific alternative methods for exchanging clinical information.

Protect electronic health information – Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.
To view 45 CFR164.308(a)(1) see

Record demographics listed above – If a patient declines to provide all or part of the demographic information, or if capturing a patient’s ethnicity or race is prohibited by state law, such a notation entered as structured data would count as an entry for purposes of meeting the measure. In regards to patients who do not know their ethnicity, EPs should treat these patients the same way as patients who decline to provide race or ethnicity— identify in the patient record that the patient declined to provide this information.

Provide clinical summaries – An after-visit summary that provides a patient with relevant and actionable information and instructions containing the patient name, provider’s office contact information, date and location of visit, an updated medication list, updated vitals, reason(s) for visit, procedures and other instructions based on clinical discussions that took place during the office visit, any updates to a problem list, immunizations or medications administered during visit, summary of topics covered/considered during visit, time and location of next appointment/testing if scheduled, or a recommended appointment time if not scheduled, list of other appointments and tests that the patient needs to schedule with contact information, recommended patient decision aids, laboratory and other diagnostic test orders, test/laboratory results (if received before 24 hours after visit), and symptoms.

Clinical quality measures – For requirements and electronic specifications related to individual ambulatory clinical quality measures, EPs should refer to:

Clinical decision support rule implemented – HIT functionality that builds upon the foundation of an EHR to provide persons involved in care processes with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care. CMS will not issue additional guidance on the selection of appropriate clinical decision support rules for Stage 1 Meaningful Use. This determination is best left to the EP taking into account their workflow, patient population, and quality improvement efforts.

Next, let’s take a look at the menu set objectives. There you will see the following (again, excluding the objectives for which chiropractors are exempt): implement drug formulary checks, generate lists of patients by specific conditions, use certified EHR technology to identify patient-specific education, send reminders to patients and provide patients with timely electronic access, performs medication reconciliation, and finally, provides summary of care records for each transition of care or referral. Again, the following will help you understand their meanings.

Drug formulary checks – Eligible professionals (EPs) must attest YES to having enabled this functionality and having had access to at least one internal or external formulary for the entire EHR reporting period to meet this measure. An EP who writes fewer than 100 prescriptions during the EHR reporting period can be excluded from this objective and associated measure. EPs must enter ‘0’ in the Exclusion box to attest to exclusion from this requirement.

Patient lists – Eligible professionals (EPs) must attest YES to having generated at least one report listing patients of the EP with a specific condition (conditions listed in the active patient problem list) to meet this measure. This objective does not dictate the report(s) which must be generated. An EP is best positioned to determine which reports are most useful to their care efforts.

Patient specific education – Certified EHR technology is certified to use either the patient’s problem list, medication list, or laboratory test results to identify the patient-specific educational resources. These or additional elements can be used in the identification of educational resources that are specific to the patients needs. Education resources or materials do not have to be stored within or generated by the certified EHR.

Patient reminders – More than 20 percent of all patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period. EP will use their Patient lists to find these patients.

Timely electronic access for patients – Information that must be provided electronically is limited to that information that exists electronically in or is accessible from the certified EHR technology and is maintained by or on behalf of the EP. At a minimum, certified EHR technology makes available lab test results, problem list, medication list, and medication allergy list.

Medication reconciliation – The process of identifying the most accurate list of all medications that the patient is taking, including name, dosage, frequency, and route, by comparing the medical record to an external list of medications obtained from a patient, hospital, or other provider. An EP who was not the recipient of any transitions of care during the EHR reporting period.

Transition of care summary – The EP can send an electronic or paper copy of the summary care record directly to the next provider or can provide it to the patient to deliver to the next provider, if the patient can reasonably expected to do so.

Percentages, numerators and denominators have been excluded in this document so please refer to for full details on each objective.

*The information provided here is provided only as a guideline and is annotated. It is up to you, as a professional, to perform due diligence to verify what is necessary for you to receive the refund.

Comments (0) Posted by Alex Niswander on Monday, August 15th, 2011

Filed under EHR_Billing_Hardware and more

I received this question today from a doctor and thought the response was worth sharing.

It is honestly an unknown as far as when are we “absolutely” required to use EHR.

Most would say the government and medicare (I guess they are one of the same right) would like you to have already implemented and started using an EHR system. The goal of last year’s stimulus incentive announcements was to motivate doctors to get out of the early 1900s of using notebook paper charts and become current with other industry. Almost every major industry has been using computer systems since the mid-late 90s (banking, housing, accounting, legal, etc).

Although I don’t think they will technically ‘force’ you to move to EHR, but I think they have some ways they can strongly encourage you to do it.

The first way is to reduce medicare payments for those who are not using a certified EHR. This I believe is scheduled to start in 2014. This is the year most are saying ‘you have to have software by this time’. Now if you don’t do much medicare, or you dont care about losing 1% of a $20 medicare adjustment.. then this isn’t much incentive at all.
I think the 2nd step would be insurance payments would also be reduced for those not using an EHR. They could also increase the amount you lose for those not compliant.

So they could really push you to do this by taking away your money and essentially ‘force’ you to move and make your normal income.

A more drastic step from insurance could be to no longer pay for providers not using EHR. This would be a big step, but a very effective one to get 90% of doctors to make the move.

For those small cash practices, there is likely no real way you could be ‘forced’ to buy EHR. However it might be challenging to get referrals and continued patient visits when everyone else in town has EHR.

Have a great weekend.

Comments (0) Posted by Alex Niswander on Friday, August 12th, 2011

Filed under EHR_Billing_Hardware and more

We have all been so confused on this topic and I plan to spend some time hashing this out and breaking down the confusion.
I wanted to share some info I recently found on the subject. There are 15 required ‘core’ items however you can be ‘exempt’ from some of them if things are out side of your scope of practice.
The main ones being e-prescribing, lab submissions and computerized order entry. The other core objectives are required to record and attest to during your application process.
Out of the “Elective” measures you must have 5 of the 10, and there are a few that you are exempt from here (those being medication reconciliation, immunization, and surveillance data to public health agencies.

So that makes 12 core items and 5 menu, plus there are a few reports and things to generate from your EHR system.

I found someone that did a great job of explaining this and I wanted to share her website. I have actually never spoken to her, but felt her breakdown and explanation of the meaningful use stuff was quite good. Please review her site and contact her if you have questions that she may be able to help you with:

Next week I will spend time better addressing this topic. I also have some great PDFs on this so feel free to contact me about this. Our website is in my bio and you can contact me from there in an effort to avoid spam.

Comments (0) Posted by Alex Niswander on Thursday, August 4th, 2011

Filed under EHR_Billing_Hardware and more

Hello Everyone,

While I am new to Chiropractic Economics Blog, I have been blogging and writing e-newsletters for a number of years now. With the recent growth of our company I finally have time to focus on writing and sharing information, which is one of my favorite parts of my job.

My goal is to post blog messages about once a week, however I am of the old mindset that if I don’t have something worthwhile to say you won’t be reading anything from me that week. Does that mean you will always find what I write worthwhile? I sure hope so!

I will share relevant information to you about how to make your practice better with technology. Regardless of your computer level you should be able to take some good things away from my posts. Our topics will range from billing to scheduling to EHR to Websites, to Search Engines, to Phone Systems, to Marketing and maybe even to 1971 fastback mustangs if we are talking cars and have time (ok probably not the cars, but yes to the rest).

After high school I worked my tail off working 2 jobs to pay for college and after a decade in the software business I still have a great wife (the same one actually), 3 children and most Saturdays the neighbors will see smoke rolling from my custom BBQ smoker which in my mind produces some of the most mediocre pulled pork in town, but since I don’t charge for it no one ever complains!

My relevant experience: In a nutshell I worked with EMR (Electronic Medicare Records) software before anyone knew what it was and late night infomercials on “becoming a transcriptionist at home” were still popular. The vendor I worked for later was sold to Allscripts who is today one of the “big dogs” in medical healthcare record software. In March of 2006 I was downsized thus allowing me to take the plunge and start my own EMR software with a focus on Chiropractors.

Why Chiropractic you ask?

Because I like pain? Or maybe I like beating my head against the wall? Some who work in our industry might say yes to both!

In all seriousness one of my first customers at the prior company was a local Chiropractor. We became good friends and he taught me a lot about this industry and I shared his view that no serious Chiropractic software businesses had taken enough interest in the needs of Chiropractors.

Since starting the company it has been the best ride of my life.

Please stay tuned for good things!

Comments (1) Posted by Alex Niswander on Monday, August 1st, 2011