Manage My Practice

I learned about this product on Twitter (if you’re not on Twitter yet, you’re missing out on a lot of the conversation!) and I thought it was too great not to pass it on.

BEDSCAPES “turn cubicle curtains into a nurturing therapeutic patient-friendly bedside comfort zone for the relief of pain, anxiety and insomnia.” BEDSCAPES are special bedside curtains used to create a “comfort cocoon” in patient rooms that have no visual access to the outside world or to nature. Patients can choose from a number of calming nature scenes printed on fire-retardant washable fabric, and to further enhance the experience, can choose to listen to recorded sounds (water, birdsong, wind) associated with the nature scene to complete the wonderful ambiance.

It has been proven (more…)

An excellent article on EHRs and CCHIT was pointed out to me recently and I thought I’d pass it along to my readers. To answer the question “What is CCHIT?”, the site SoftwareAdvice says this:

CCHIT is a private, non-profit organization formed to certify EHRs against a minimum set of requirements for functionality, interoperability and security. It was founded in 2004 by three industry associations ( HIMSS, AHIMA and the Alliance (no longer in operation.)) It was subsequently funded further by the California Healthcare Foundation and a group of payers (e.g. United HealthGroup), providers (e.g. HCA) and software vendors (e.g. McKesson). In 2005, CCHIT was granted a $2.7 million contract by the Department of Health and Human Services (HHS) to support its mission. A number of other medical associations have since supported CCHIT. Despite the HHS contract, CCHIT is not an extension of the federal government.
(more…)

I wrote this article for the Physician Office Managers Association of America (POMAA) March/April 2009 Newletter. If you don’t know POMAA, check out their website.

Each of us have areas of expertise based on our experience, our education and what we find interesting and fun. IT knowledge and skills are no longer optional, however, and I suggest every medical practice manager learn as much as possible about the following five areas. Your work life and the life of your practice may depend on it!

Skill 1: Email Etiquette and Management

Email can rule your work life if you don’t make good choices with your messages. Managers need to know how to use the Rules Tool (Outlook) to automatically move messages into folders, and how to turn emails into Tasks and Appointments. Work communication can succeed or fail if you don’t have the basics under your command. Knowing how to archive your email will not only save you time when looking for important information, but will save you from the frustration of searching through hundreds of emails. Here are the basics of email management:

1. Most organizational experts recommend looking at your email twice a day, and turning off the setting that notifies you immediately when you have new email. Email can be very addictive, and can suck your time away from projects and other work.
2. Just like paper, try to only touch an email once. Once you read the email, decide whether to delete it, answer/forward it and delete it, or do something else with it like dragging it to the task list or calendar. Don’t get caught in the ugly cycle of reading it once, and going on to the next email without doing anything about it. If you do that, you’ll end up with lots of emails that you have to read again…and maybe a third time.
3. Never put anything critical (of a criticizing nature) in an email. If you need to have that type of conversation with a colleague, pick up the phone. A critique to an employee is best done in person, with a follow-up email for the file.
4. Always check your outgoing email for tone. The best tone for business email is professional. This means a greeting, a message, a “thank you” and footer with your full name, title, and contact information. Some organizations are more formal, and some are less formal, but I would err on the side of being more professional. You can always set your email signature to include the greeting and thank you and your name, so all you have to do is complete the middle.
5. For emails that do need to be saved for reference, make subfolders under your Inbox to place reference email. Even better, copy the email to a Word document, and delete the email.
6. Have high priority (your boss or bosses) and low priority (listservs, subscriptions) email automatically come into their own folders. The low priority email can wait and the high priority email can be dealt with first.
7. Group emails with jokes, homespun wisdom, clever tests and unbelievable pictures are a waste of your time. If you need a break from work, go for a walk, but get rid of the group emails. They take personal and server email space and can border on or be outright offensive, causing a problem if you don’t nip it in the bud. Remember that email is legally discoverable.
8. Be careful about answering emails off the top of your head, possibly when you’re angry, or rushed. If you need to delay answering an email because of your mood, drag the email over to the task list and set the to-do for tomorrow.

Skill 2: Understanding Medical Office Software

Acronyms come and go, but the basic software that supports medical practices remains the same. Practice Management Systems (PMS) typically include registration, scheduling, billing and reporting as one component. Today’s systems are built around the billing function, with scheduling and registration supporting the ability to generate electronic claims and post payments back to the transactions. Because billing is becoming more standardized, it is the reporting that can make or break a practice.

Electronic Medical Records (EMR) are sometimes referred to in a broader sense as EHR (Electronic Health Records) and range from the simplest of systems which act as a repository for the electronic chart to the most sophisticated systems which may include digital imaging, e-prescribing, complex messaging, medication reconciliation, and test alerting, among others. EMR and PMS can be totally integrated, or can interface with each other, populating the other uni-directionally or bi-directionally. Those mangers with a deeper understanding of their own software systems will find it easier to implement pay for performance measures such as PQRI and e-prescribing, and will not have to rely on vendors to educate them.

PACS is Picture Archiving and Communication System and allows easy indexing and retrieval of images. PACS exists primarily in radiology and surgical specialty offices, but as more hospitals extend EMR and PACS privileges to physician offices, managers will need to understand something about the technology.

Other systems that will interface to your system are transcription, outsourced billing systems, data warehouses, claims clearinghouse, electronic posting systems, and web services interfaces. Get or make a graphic representation of your software and hardware system/network so you can talk knowledgeably about it and understand the effects of adding new servers, workstations or software modules.

Skill 3: Using Technology to Stay Current in Your Field

Magazines, newspapers and even television news is losing favor as people find the latest and most in-depth news on the Internet. For physician office managers, news and important information is available through websites, newsletters, newsfeeds, webinars, podcasts, listservs and blogs.How does a manager sift through all these options and stay current with the demand of running a day-to-day practice?

One of the most important ways to consolidate this information is to subscribe to a feedreader or email from websites you like and have the news come to you (called “push technology”), instead of you checking the website every few days or whenever you remember (aka “pull technology”). These are the programs that will eventually do away with most, if not all, of your magazine subscriptions. You know that guilty pile of professional magazines that you have in your office or at home that you have scanned but still plan to read in-depth? Gone!

Most websites offer email or RSS options to their users. An email option asks you to enter your email address and will email you when new information is available, typically offering the full content inside the email itself. This is ideal for anyone who has these emails automatically placed into an email subfolder to read later.

RSS stand for Really Simple Syndication and is a way to push the content of many sites into a feedreader, which is an organizer of website feeds. There are many feedreaders available at no cost and adding a new website feed to your personal feedreader is as simple as clicking on the orange RSS icon on the website page and identifying the feedreader you use. The nice thing about using RSS is that you can group sites into categories you decide upon, it is easy to add new sites and drop sites that you find a waste of your time, and you do not clog up your email program with lots of emails.

Webinars and podcasts are another way to stay current. Many webinars are free and allow you to dip your toe into the pool of knowledge on a particular topic. Webinars with a fee attached are usually longer and more in-depth, and can replace the traditional go-to conference which has become a budget breaker for many practices.

eBooks are quickly becoming the way to get just the information you want when you want it. Most eBooks are reasonably priced (some are free) and can be stored or printed.

Skill 4: Online Patient Interactions and Web 2.0 Applications

Patient interactivity via practice websites is growing exponentially. Many practices are using web functionality to communicate with their patients via secure messaging. This allows bi-directional communication such as:

1. Request an appointment (patient) or appointment reminders (practice)

2. Send statements; patients pay online with a credit card (practice & patient)

3. Inform patients of test results (practice)

4. Create personal health records (patient)

5. Request a prescription refill (patient)

6. Virtual office visits (practice & patient)

7. Complete registration via fillable .pdf forms and download to practice management system (practice & patient)

8. Request medical records; send an electronic copy of same (practice & patient)

9. Complete a history of present illness prior to the on-site visit (patient)

10. Ask & answer questions for the doctor, nurse, or staff (patient & practice)

If you’re not looking into ways to communicate with your patients electronically, start now. Web 2.0 is now more typically referred to as social networking, social media or new media. What started out as a way for friends to communicate with each other is now an amazing, ever-expanding ability to connect/market to businesses, patients and referrers. Very few medical practices are using social media, but they should, because it is the way of the future, and in many cases, very affordable.

Skill 5: Knowledge Management and Retention

Most medical offices try hard to document processes such as “How To Make An Appointment For Dr. Jones,” but find it difficult to keep up with documenting changes to those written protocols. Documentation is crucial for operations in that it supports job performance and consistency, and is a basis for training new employees. The traditional documentation method for most practices is use of Word documents, which can create an immediate usability logjam. Due to cost, Microsoft Office is not installed on many workstations, and many office employees are not trained to use Word, so the onus for original creation of and changing of protocols falls to one person. Changes in healthcare are happening so quickly that it is not reasonable for one person to be able to update all documentation, unless they are dedicated to it on a full-time basis.

Better and more affordable solutions are becoming available. Speech recognition and office wikis are two possibilities for documenting office processes. Speech recognition (you may already be using it for your transcription) is a very affordable solution, but it does take time to train the program to recognize your voice. If you are not used to dictating, it may also be a learning curve, but it is one that will pay dividends down the road. Doctors can use it to help you by dictating their preferences, such as appointments, patient intake, room set-up, procedure set-up, patient phone protocol and after-hours call contact protocol.

Private wikis are another good bargain in the marketplace, as many are available at no cost, and may be installed and managed on the web. Wikis need at least one person to function as editor. Since you can have your entire staff work on documentation, the staff becomes very invested in the process of keeping the wiki fresh and up-to-date.

There are other free or low-cost project management web programs that can also be used to track changes and remind staff to document changes later. The one area that is most important for tracking changes and managing knowledge in the practice is in billing. Many practices are held hostage by their billers as their knowledge is so specific and proprietary that the manager feels s/he could not recoup it if they left. No practice should be vulnerable based on knowledge any single employee has, including the manager.

I am very interested in technology that creates value in medical office practices. If you are using something new and different in your practice, please email me and let me know. Also, if you have any questions about the ideas I discuss in this article, I am glad to answer them: marypatwhaley@gmail.com.

I think WalMart selling EMRs is a good thing and here’s why.

1. This challenges standard thinking about EMR vendors. You can’t deny that this has given all of us a lot to think about as far as what company can sell what products to what customers.
2. This demystifies EMRs and will do a lot to educate the public about EMRs and will most likely start patients asking practices if they use an EMR.
3. This will break open the discussion about price and allow more open comparisons between EMRs. Regardless of whether you think the advertised price is a bargain or not, Wal Mart gives everyone a benchmark by saying “This is our price for an EMR.”

Here’s a great article on the announcement/leak and an interview with eClinicalWork’s Girish Kumar, and lots and lots of interesting comments!

I just LOVED this TED talk by Pattie Maes. She demonstrates the “Sixth Sense”, the wearable tech that changes everything. After I saw this, my mind just raced with all the ways this technology could change the healthcare experience!

What are your thoughts?

And, today, from the Medical Group Practice Association (MGMA), encouragement to get signed up with HCNN so as not to miss an important alert this week:

The Health Care Notification Network (HCNN) is scheduled to communicate an important prescribing alert this week. This online alert will be distributed via the HCNN in advance of traditional paper-based alerts to approximately 600,000 physicians, targeting the following specialties:

- Emergency Medicine
- Family Medicine
- General Practice
- Internal Medicine
- Neurology

Unregistered members can enroll to view this alert and other alerts at any time but will continue to receive paper-based alerts until they are registered for the HCNN.

Many medical societies, medical liability carriers, patient advocacy groups, and other health care industry organizations support HCCN “because it improves patient safety and decreases practice liability.” At some point in the future, medical liability carriers may offer discounts to their clients who are registered with HCNN.

To register with HCNN, click here.

To go to the HCNN Frequently Asked Questions, click here.

I am very pleased to have had the opportunity to interview Ester Horowitz, the founder and CEO of M2Power, Inc., and the voice of sanity among the current confusion surrounding the Red Flags Rules.

The Federal Trade Commission (FTC) states that the Red Flags Rule:

was developed pursuant to the Fair and Accurate Credit Transactions Act (FACTA) of 2003. Under the Rule, financial institutions and creditors with covered accounts must have identity theft prevention programs to identify, detect, and respond to patterns, practices, or specific activities that could indicate identity theft. The Rule applies to creditors and financial institutions.

Most medical practices have been identified as creditors under the Red Flags Rule. The FTC defines a health provider as a creditor if they “bill consumers after their services are completed. Health care providers that accept insurance are considered creditors if the consumer ultimately is responsible for the medical fees.” Note that being a creditor is not linked to whether you take credit cards or not.

Creditors then must determine if they have “covered accounts.” The FTC states that “A covered account is used mostly for personal, family, or household purposes that involves multiple payments or transactions. This includes continuing relationships with consumers for the provision of medical services.”

Horowitz has written an excellent article on the Red Flags Rule and is receiving calls weekly from medical practices asking her for guidance. She notes that many practices are having trouble distinguishing between the new Red Flags Rule and the existing HIPAA standards, and practices may think that compliance with HIPAA meets the criteria for the Red Flags Rule. Horowitz says emphatically, “There is a distinct difference between PHI (Protected Health Information) and what the Red Flags Rule considers “identity” information.” Although there may be some overlap in HIPAA and the Red Flags Rule, existing HIPAA programs will not be sufficient to keep a practice from incurring fines, if identity theft is traced to the medical practice.

Horowitz outlines the fines as follows:

Employee or Customer information lost under the wrong set of circumstances may cost a company or practice:

Federal and State Fines of $2500 per occurrence
Civil Liability of $1000 per occurrence
Class action Lawsuits with no statutory limitation
Responsible for actual losses of Individual ($92,893 Avg.)

Note the word “employee” in the paragraph above. The medical practice is responsible for the information contained in “employee applications, payroll data, W-2, social security numbers, drivers licenses, and credit cards, military records, and birth certificates” as well as information derived from consumers.

What are the requirements of the Red Flags Rule? A creditor with covered accounts must:

1. Develop a written program, approved by its board of directors, that identifies warning signs and suspicious activity of possible identity theft.
2. Develop measures to prevent identity theft must be implemented.
3. Mitigate damages from instances of identity theft.
4. Ensure that staff is be trained/retrained periodically.

How does one detect identity theft? It is rarely easy, therefore one typically only finds out after the fact. For medical practices, asking for picture ID each and every time the patient is seen might be the only way to determine identity. It would make excellent sense for insurance cards to have photos on them, however, we are all changing insurance policies so often now that this does not seem feasible. Some practices routinely copy the new patient’s driver’s license. Others take photos of the patient and store them in the paper record or digitally in the EMR.

Horowitz points out that fake IDs are quite common, as your teenagers could probably tell you. With the number of people losing insurance coverage when they lose their jobs, can we expect in new black market in fake insurance cards?

The other problem that Horowitz describes is that of mixing care for two different people, one the actual person and the second the identity thief. She notes that practices have a “medical responsibility to find and treat the right person.”

I asked Horowitz about the issue of using the social security number as a patient identifier in medical practices. Many practices require the pateint’s social security number, as it still is the single most useful number for matching patient identities and for collection purposes. She said “Use of the social security number in healthcare is not going away any time soon. Remember that Medicare cards still use the social as its basis. Practices must do everything in their power to limit the exposure to that number and to protect it.”

Horowitz also noted that every system devised will have its thieves – something like “build it and they will break it.” She feels that the critical piece is to have monitoring systems in place to be alerted to the first signs of identity theft so that the ramifications can be minimized. She suggests that practices educate their employees as to the devastating (financial and emotional) effects of identity theft, and encourage personal monitoring programs. Whether a practice decides to provide these programs as an employee benefit is a decision each will have to make. Providing coverage for employees would certainly be a strong indicator of proactive intent to protect the employee if an employee’s identity was stolen from information housed with the employer. Horowitz also recommends that practice provide patients with literature about identity theft (not required by the Red Flags Rule), and especially let the patients know if any process in the practice will be changing (e.g. showing a photo ID at every visit.)

As for the new compliance programs for Red Flags, Horowitz can provide a customized program, employee education, and a monitoring model so the practice is ready for the May 1, 2009 deadline for having the program in place. The deadline is less than 55 days away – do you have your program in place?

More about Ester Horowitz:

Ester Horowitz is founder of M2 Power Inc, and serves as practice marketing and business advisor for the medical industry working with doctors, chiropractors, LCSWs and other health professionals. She helps implement marketing & business actions plans within the professional codes of ethics, HIPAA, and fraud and abuse compliance obligations. Her nationally acclaimed publications focus on the business of medicine and include such articles as The Death of Dr. CEO, How to Find $50,000 in Your Practice, What Does Buying, Selling, and Growing a Practice Have in Common, When Selling a Practice What is Important to Know, a video Raising Capital, and her book The Blatant Truth of Owning a Medical Practice: Rx for Practice Owners.

It seems only yesterday we got along just fine using words like “photography” and “cable television” without the world “digital” in front of them. They were “analog” technologies, but they didn’t need to be marketed as such, because there was no point – there was no marketing buzz on the term, and no alternative. Nowadays the word “digital” is everywhere and is accompanied by a very positive connotation. It seems if you are selling something “digital”, it is a superior, more technologically advanced product or service, and it probably lies on the cutting edge of its field. Digital is an old buzzword, maybe even a little past its prime, but it is still used heavily to promote what are already standard, mainstream technologies. If you Google the word “digital” the search engine returns around one billion web results. Compare that to “health care” which gets only a tenth of that.

“…But, what does digital mean?…”

Good question! Digital is a word I imagine few can give a succinct, straight definition for. For all the triumphs and innovations of the “digital revolution”, I doubt that there are a lot of people who can define the term’s root-word.

Let’s talk about theory here for a while, in abstract terms.

Imagine a two clocks on the wall of your office. Both are set to the correct time, and are the same model, except for one small difference. The clock on the left is always moving. The second hand of the clock sweeps around the dial in one long stroke, as do the minute and hour hands, although much slower.

The clock on the right is not always moving. It jumps second to second in a “tic-toc” style, and when the minutes, and hours are finished those hands jump as well. Both clocks represent the same piece of information- what time it is- but they have two different ways of representing how the time changes from moment to moment.

The clock on the left is one constant motion, and so it never stops to tell you “exactly” what time it is, but does tell you when the time is between seconds (not very useful, but remember we’re being theoretical). The clock on the right is much more specific (you can tell exactly what time it is, to the second), but never reports time in the intervals between the seconds.

This distinction, between a continuous flow of information, and a constant drip-drip-drip of individual pieces of data is the difference between analog signals and digital signals.

The clock on the left is analog- it provides a continuous “signal” (flow of information)- what time it is. The clock on the right is digital- it provides a continuous series of “points” of information, with periods in between each point with no information being produced (the moment between each second’s “tic”)

Back to the real world

You remember music records, right? They were flat, circular pieces of vinyl that could be put into a primitive version of what looked like a large CD player. If you had electricity, you could plug this “record” player, or “turntable” into a power outlet, and attach it to a set of two speakers using pieces of wire. The player would turn the record at a constant speed, and then the listener would carefully place a delicate needle attached to a mechanical arm on the record player onto the surface of the vinyl and under optimum conditions, sound would be produced through the speakers. There were all manner of musical groups that made these records, and they could played at parties or by yourself for solo enjoyment. The whole affair was quite charming.

Record players work by having the needle run gently over the “grooves” of the record, which are imprinted on the vinyl in such a fashion that the vibrating needle will quietly reproduce the recorded sound. Then the record player electrifies and amplifies the sound, and boom- party time!

There are no “gaps” in the record when it is playing. Even while the record is silent, the needle is running over an empty groove that isn’t vibrating the needle. Even when the signal is blank, it is part of the entire record, and it’s continuous playback. Record players therefore, are an “analog” technology.

I grew up with compact discs. Compact discs are actually very similar to vinyl records in how they operate. A CD player spins the disc at a constant speed, but instead of a needle running over the grooves, a laser (Light Amplification by the Stimulated Emission of Radiation) is focused onto the grooves, and is reflected back onto one of two sensors, which then create a series of data points that are turned into music. But the key difference is in how that sound data is represented. Instead of a continuous flow of sound, a CD is comprised of billions and billions of these tiny data points. Every second of sound on a CD is 44,100 individual pieces of data that tell the CD player what sort of noise to make. Even though you don’t hear “skips” in between pieces of data, the sound is actually a series of noises that are 0.0000226 seconds long. CDs are digital technology then, because they rely on many individual pieces of data rather than one long stream of information.

Is digital better than analog?

Well, let’s stay with the record player vs. CD player discussion. Listening to the same recording on the two different players produces two distinct sonic experiences. If you’re not a huge music fan, but like to hear tunes from time to time you might not even notice it. But if you’re a music fanatic who takes his sound quality very, very seriously, then you probably notice a lot of differences. The analog record is going to have “signal noise” where electrical and environmental interference distorts and slightly interrupts the signal- the slight hiss you hear in the backgroud of a record, and the loss of audio quality as the signal fades in strength over time. Never mind the pops and scratches that come with the wear and tear of handling and playing the record. Purists insist however, that the analog signal provides a certain “warmth” and some talk about the presence of a “soul” to the music that can’t be found in digital.

Of course, this isn’t to say that CDs sound bad. In fact, without the signal loss and interference, many everyday listeners think CDs sound far superior to records. The digital signal means a “cleaner”, “brighter” sound that comes from listening to only the music, and not the noise in the background. However, something is lost with CDs, literally. Like the brief moments of time between the jumps of the second hand on the clock on the right in our earlier analogy, the tiny moments between each of the 44,100 tiny pieces of sound aren’t recorded or played back on CD. These microscopic little pieces of music that aren’t on the CD lead some audiophiles to call digital sound “cold” and slightly “empty”.

The bottom line is this however. Most music that is being made today is being sold on either CDs or MP3 downloads (learn how to start using MP3s in my earlier Learn This Now post here), and not vinyl records. Even disc jockeys that play in clubs rarely use real vinyl anymore. So even if you think CDs sound a little worse than vinyl, chances are you already use digital music almost exclusively, and will continue to do so.

What should I know going forward?

The truth is, there aren’t many traditional analog technologies still in use. Radio and television broadcasts are still analog, but with the rise of Satellite Radio services like Sirius and XM, and the coming American Digital Television transition, even those are on the way out.

The important thing to remember is that just because something says “digital” it isn’t necessarily a huge leap over an old technology, or even particularly new. But now that you know what digital and analog means, you are empowered to decipher any such attempts at newfangled tomfoolery. Stay tuned to ManageMyPractice.com for the resources you need to stay ahead of the curve. Cheers!

Note from Mary Pat: The change to digital technology has tremendous implications for healthcare. Think about telemedicine, electronic health records, and sharing of all information digitally. Expect some significant changes down the road in medical records between Obama’s stimulus plan and dollars for HIT and the transition to digital technology.