Where Did the Idea of Meaningful Use of Electronic Medical Records Come From?
The American Recovery and Reinvestment Act of 2009 was signed by President Obama on February 17, 2009. The Law includes the Health Information Technology for Economic and Clinical Health Act or the HITECH Act. The HITECH Act establishes programs under Medicare and Medicaid to provide incentive payments for the Meaningful Use of Certified Electronic Health Records technology.
The goal of the HITECH legislation is to improve healthcare outcomes, to facilitate access to care and to simplify care. It is believed that the installation of electronic health records in medical practices is only the beginning. The goals of HITECH will be met when the EHR is used in a meaningful way.
What is Meaningful Use (MU)?
There are three identified components of Stage I Meaningful Use. They are:
- Use of a certified EHR in a meaningful manner such as e-prescribing.
- Use of Certified EHR Technology for the exchange of health information (exchange data with other providers of care or business partners such labs or pharmacies)
- Use of Certified EHR Technology to submit clinical quality and other measures.
The first stage of Meaningful Use is capturing and sharing the data. Meaningful Use Stage II is advanced clinical processes and Stage III is starting to look Meaningful Use of an EHR in the context of improved healthcare outcomes.
There are 25 specific criteria for MU Stage I listed in this article in Healthcare IT News:
[1] Objective: Use CPOE (Computerized Physician Order Entry)
Measure: CPOE is used for at least 80 percent of all orders
[2] Objective: Implement drug-drug, drug-allergy, drug- formulary checks
Measure: The EP (Eligible Provider) has enabled this functionality
[3] Objective: Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT®
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry or an indication of none recorded as structured data.
[4] Objective: Generate and transmit permissible prescriptions electronically (eRx).
Measure: At least 75 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.
[5] Objective: Maintain active medication list.
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient is not currently prescribed any medication) recorded as structured data.
[6] Objective: Maintain active medication allergy list.
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient has no medication allergies) recorded as structured data.
[7] Objective: Record demographics.
Measure: At least 80 percent of all unique patients seen by the EP or admitted to the eligible hospital have demographics recorded as structured data
[8] Objective: Record and chart changes in vital signs.
Measure: For at least 80 percent of all unique patients age 2 and over seen by the EP, record blood pressure and BMI; additionally, plot growth chart for children age 2 to 20.
[9] Objective: Record smoking status for patients 13 years old or older
Measure: At least 80 percent of all unique patients 13 years old or older seen by the EP “smoking status” recorded
[10] Objective: Incorporate clinical lab-test results into EHR as structured data.
Measure: At least 50 percent of all clinical lab tests results ordered by the EP or by an authorized provider of the eligible hospital during the EHR reporting period whose results are in either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.
[11] Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach.
Measure: Generate at least one report listing patients of the EP with a specific condition.
[12] Objective: Report ambulatory quality measures to CMS or the States.
Measure: For 2011, an EP would provide the aggregate numerator and denominator through attestation as discussed in section II.A.3 of this proposed rule. For 2012, an EP would electronically submit the measures are discussed in section II.A.3. of this proposed rule.
[13] Objective: Send reminders to patients per patient preference for preventive/ follow-up care
Measure: Reminder sent to at least 50 percent of all unique patients seen by the EP that are 50 and over
[14] Objective: Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules
Measure: Implement five clinical decision support rules relevant to the clinical quality metrics the EP is responsible for as described further in section II.A.3.
[15] Objective: Check insurance eligibility electronically from public and private payers
Measure: Insurance eligibility checked electronically for at least 80 percent of all unique patients seen by the EP
[16] Objective: Submit claims electronically to public and private payers.
Measure: At least 80 percent of all claims filed electronically by the EP.
[17] Objective: Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and allergies) upon request
Measure: At least 80 percent of all patients who request an electronic copy of their health information are provided it within 48 hours.
[18] Objective: Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies)
Measure: At least 10 percent of all unique patients seen by the EP are provided timely electronic access to their health information
[19] Objective: Provide clinical summaries to patients for each office visit.
Measure: Clinical summaries provided to patients for at least 80 percent of all office visits.
[20] Objective: Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically.
Measure: Performed at least one test of certified EHR technology’s capacity to electronically exchange key clinical information.
[21] Objective: Perform medication reconciliation at relevant encounters and each transition of care.
Measure: Perform medication reconciliation for at least 80 percent of relevant encounters and transitions of care.
[22] Objective: Provide summary care record for each transition of care and referral.
Measure: Provide summary of care record for at least 80 percent of transitions of care and referrals.
[23] Objective: Capability to submit electronic data to immunization registries and actual submission where required and accepted.
Measure: Performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries.
[24] Objective: Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice.
Measure: Performed at least one test of certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies (unless none of the public health agencies to which an EP or eligible hospital submits such information have the capacity to receive the information electronically).
[25] Objective: Protect electronic health information maintained using certified EHR technology through the implementation of appropriate technical capabilities.
Measure: 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.
Have the Details of MU been finalized?
The comment period for the NPRM (Notice of Proposed Rule Making) for Meaningful Use is currently open but will close on March 15, 2010. You can read the NPRM here. Many individuals and organizations have expressed concern that the timeline for implementing EHR and meeting MU criteria is too short for the majority of providers. The American Academy of Family Physicians (AAFP) recently sent a 7-page letter to acting CMS Administrator Charlene Frizzera (see story here) that included the following concerns:
- The administrative burden of reporting computerized physician order entry measures “is excessive to the point of being unachievable for most eligible providers.”
- The rule could require manually entering results from laboratories that don’t have an interoperable interface with the physician’s electronic health record.
- The term “health information” is used throughout the proposed rule, but is never defined.
- A requirement that a patient’s health information be shared with that patient within 48 hours doesn’t take in account that physicians or their staff may not be able to process the information if that 48-hour period includes weekend days.
- There is no incentive for physicians who meet less than 100% of the proposed requirements, so it is an all-or-nothing approach.
The Medical Group Management Association recently surveyed (see Modern Healthcare story here) 445 physician practice administrators in February 2010 with the following feedback:
- Nearly all are aware of the upcoming incentive programs for meaningful use of electronic health records, but fear the programs will reduce physician productivity.
- 68% of respondents expect physician productivity will decrease if all 25 proposed meaningful use criteria are implemented.
- Nearly one-third believe the decrease in productivity will be greater than 10 percent.
- Almost 25% of practices without an EHR doubt some of their providers will ever attempt to qualify for incentives.
- Among practices with an EHR, nearly 84 percent believe some of their physicians will attempt to qualify for Medicare or Medicaid incentives by the end of 2011.
How Do I Comment on the MU Standard?
You can submit your comments on the NPRM on MU here.
You can read comments already submitted here.
How Do I Know if My EHR is Certified?
No EHRs have been certified for the CMS Incentive Program and the certifying bodies have not yet been announced. It seems reasonable that CCHIT will be one certifying body, but there are expected to be others. If your vendor tells you that his EHR is certified before the rule has been finalized and the certifying bodies have been announced, ask him “For what?”
What Does it Mean to Be Eligible? (description courtesy of Everything HITECH)
This term encompasses three general types of payers to establish eligibility: 1) Medicare Fee For Services (FFS), 2) Medicare Advantage (MA) and 3) Medicaid.
For hospitals to be eligible, they can be acute care (excluding long term care facilities), critical access hospitals, children’s hospitals.
For providers, these include non-hospital-based physicians who receive reimbursement through Medicare FFS program or a contractual relationship with a qualifying MA organization. The Act defines the term “hospital based” eligible professional to mean an EP such as a pathologist, anesthesiologist,or emergency physician, who furnishes substantially all of his or her Medicare covered professional services during the relevant EHR reporting period in a hospital setting (whether inpatient or outpatient) through the use of the facilities and equipment of the hospital, including the hospital’s qualified EHR’s (Fed Reg p. 1905). The determining factor is the site of service as to whether the service is hospital based or not. If the EP provides at least 90 % of their services in a hospital inpatient, hospital outpatient or hospital emergency room setting (Point of Service codes 21, 22, 23), then they are considered a hospital based EP and not eligible for EHR incentive payments (i.e. providing substantially all of his or her Medicare covered professional services).
There is a difference between Medicare and Medicaid when it comes to defining an eligible professional for EHR incentive payment purposes. Medicare defines an eligible professional as (Fed Reg p. 1996):
- doctor of medicine or doctor of osteopathy
- doctor of dental surgery or dental medicine
- doctor of podiatric medicine
- doctor of optometry
- chiropractor
Medicaid, on on the other hand, defines an eligible professional as (Fed Reg p. 2001):
- physician
- dentist
- certified nurse-midwife
- nurse practitioner
- physician assistant practicing in a Federally Qualified Health Center (FQHC) or a Rural Health Clinic, led by a physician assistant.
What are the Guidelines for Providing Patients With Their Medical Records Electronically?
Under HIPAA, patients currently have the ability to access their medical records. Meaningful Use does not change HIPAA in that regard. You may charge patients for the expense related to providing paper or electronic medical records. Each state has its own schedule for charging for medical records (state-by-state schedule here.)
Do Eligible Providers Have to be Participating With Medicare to Receive the Incentive Money?
No, the eligibility requirements only relate to the benchmarks for the percentage of Medicaid patients you have, or amount of allowed Medicare charges you have.
Can Eligible Providers Work at Locations Other Than Hospitals and Private Practices and Receive the Incentive Money?
The location where the provider works is not the issue. The issue is whether or not the provider meets the requirements, either for Medicare or Medicaid, to be considered eligible for the program.
It doesn’t matter where the provider accesses the certified EHR. If they meet the eligibility criteria, and they are using a certified EHR, they can collect on the stimulus money.
What Are Health Provider Shortage Areas?
Physicians practicing in determined “health provider shortage” (detailed info here) areas will be eligible for a 10% bonus payment.
How Does This Incentive Relate to ePrescribing or PQRI?
If the PQRI Program is extended in its current form, practices can participate in both PQRI and an EHR Incentive Plan.
If the EP chooses to participate in the Medicare EHR Incentive Program, they cannot participate in the Medicare eRx Incentive Program simultaneously. If the EP chooses to participate in the Medicaid EHR Incentive Program, they can participate in the Medicare eRx Incentive Program simultaneously.
Also, e-prescribing penalties sunset after 2014, so that no physician will be subject to penalties for failing to both e-prescribe and use an EHR!
How Do EPs Get Paid For Meaningful Use of a Certified EHR?
For the first payment year only, all an EP or hospital has to do is to be a “meaningful user” for a continuous 90-day period during the payment year. Hospitals’ payment year is October 1 to September 30 and EPs’ payment year is the calendar year. You must start and complete the 90-day period within the payment year with no overlapping.
Also, if you can qualify as a Medicaid Eligible Provider (or Hospital), are in the process of adopting, implementing or upgrading your EHR and your Medicaid patient volume is at least 30% (Pediatricians only need 20% minimum and Hospitals need 10% minimum), you can collect your incentive money without meeting Meaningful Use criteria.
Attestation forms and forms of other types are most likely the way that EPs will provide information to apply for the incentive funds, although the details have not yet been released.
What Does it Mean to Transition From One Program (Medicaid or Medicare) to Another?
EPs who meet the eligibility requirements for both the Medicare and Medicaid incentive programs will be able to participate in only one program, and will have to designate which one they would like to participate in. After their initial designation, EPs are allowed to change their program selection only once during payment years 2012 through 2014.
To Recap:
How Do I Get My EHR Stimulus Money?
- Decide whether you are an eligible provider for any of the programs.
- If you are, buy a certified EMR (once certification has been defined.)
- Use your EMR in a way that demonstrates your meaningful use of the product.
- Pass “GO” and collect your money.
ARRA (Stimulus Bill) Acronyms
• A/I/U –Adopt, implement or upgrade
• CAH –Critical Access Hospital
• CCN –CMS Certification Number
• CDS –Clinical Decision Support
• CMS –Centers for Medicare & Medicaid Services
• CY –Calendar Year
• EHR –Electronic Health Record
• EP –Eligible Professional
• eRx –E-Prescribing
• FFS –Fee-for-service
• FY –Federal Fiscal Year
• HHS –U.S. Department of Health and Human Services
• HIT –Health Information Technology
• HITECH Act –Health Information Technology for Electronic and Clinical Health Act
• HITPC –Health Information Technology Policy Committee
• HIPAA –Health Insurance Portability and Accountability Act of 1996
• HPSA –Health Professional Shortage Area
• IFR –Interim Final Rule
• MA –Medicare Advantage
• MCMP –Medicare Care Management Performance Demonstration
• MITA-Medicaid Information Technology Architecture
• MU –Meaningful Use
• NPI –National Provider Identifier
• NPRM –Notice of Proposed Rulemaking
• OMB –Office of Management and Budget
• ONC –Office of the National Coordinator of Health Information Technology
• PQRI –Medicare Physician Quality Reporting Initiative
• Recovery Act –American Reinvestment & Recovery Act of 2009
• TIN –Taxpayer Identification Number
To see the full transcript of the CMS Audio Conference Call from February 23, 2010 which this article drew heavily upon, view the handout, or listen to the audio of the call click here.
So you’ve been trying to become employed in healthcare, or you’ve tried to enter healthcare management, or you’re trying to move from one job in healthcare to another. You’ve read my post about my search for a job in healthcare and have been soldiering on, but you’re just not getting anywhere. You might have education, but no experience or you might have experience but no formal education.
Healthcare is no different from any other field. It’s a hodgepodge of what you know and who you know. What everyone is looking for is expertise and authority and that can’t always be demonstrated by a degree or years of experience. A new buzz phrase is “What is your value proposition?” or “How will you pay for your salary and make me (doctor, practice, hospital, health plan) money besides?”
If you want to enter the field or climb the ladder in healthcare management, you need to demonstrate that you have something of value that someone wants. Try some non-traditional ways of gaining expertise and demonstrating value, like the ones I list here. Yes, each of these will take time in addition to your current job, but it has the potential to give you a hand up to your next job. If you don’t currently have a job, you have lots of time to work on the list below, and when potential employers ask what you’ve been doing while unemployed, you have a great answer!
- Blog about the field you want to enter – learn about the field and write about it.
- Write about being in the middle of a transitional field and your experiences along the way – if you’re a compelling writer, I’ll publish it as a series on my blog!
- Create a site of resources for others that already do what you want to do.
- Interview others in the field you want to enter and publish the interviews.
- Ask people if you can shadow them for one day or a half day to understand what they do to see if you’re on the right track (who would say “no”? I wouldn’t.)
- If you haven’t used voice recognition, invest in a basic copy of Dragon and learn it inside and out.
- Learn how electronic health records (EHRs) work. If you’ve never used one, gain experience by finding someone who has one and volunteer your time to write a user’s guide for them, or to use their user’s guide and critique it for them. Do that for as many different EHRs as you can find.
- Think creatively about jobs in a department you want to be in, just not in the job you want to be in – call temp agencies, computer schools, software companies, any healthcare entity going through a conversion, etc.
- Tell everyone (if you’re free to talk about it) what you’re looking for – you never know who might help you find it.
- Volunteer to do an informal project for someone in the field – some topic they need information about but never have the time to do.
- Join the American College of Medical Practice Executives (ACMPE) and pursue board certification and become a Fellow in the college. These credentials are quickly becoming the standard in the field.
- Get a Google Health account and learn how to use it inside and out.
- Get a Microsoft Health Vault account and learn how to use it inside and out.
- Get accounts on any other personal health record (PHR) platform you can find.
- Publish case studies on common problems in other fields and how they were solved, and apply those solutions to healthcare problems.
- Put a chart on your resume showing each skill you have and how it transfers to healthcare and brings added value to your potential employer.
- If you don’t yet, get a Twitter account (free) and start conversations with others in the field.
- If you don’t yet, get a LinkedIn account (free) and join groups that are talking about the things you want to learn about (Twitter will give you more info and friends, LinkedIn will make you more business connections)
- If you aren’t already, sign up for websites that focus on what you are interested in, read them religiously and comment on their posts.
- If you don’t already, get your resume on visualcv.com (still free I think) Add any goodies you can to your visualcv that demonstrate you know your stuff – recommendations, videos, charts, white papers, etc.
- Find someone to mentor you who is well-positioned (locally, regionally and nationally.)
- Volunteer to do some pro bono work for your local professional group – your state MGMA, your state medical society, etc.
- Join Toastmasters and polish your “elevator speech” so you can effortlessly let others know who you are and where you’re heading.
- Let me know what you plan to do, and how I can help.
Best wishes,
Mary Pat
ARRA: American Recovery and Reinvestment Act of 2009, also called “The Stimulus Package” or “The Stimulus Bill.” Of the $850B in the bill, $51B is pegged for the health care industry and $19B of that will be used to incent medical practices to adopt EMRs/EHRs.
CCHIT: the Certification Commission for Health Information Technology is a private organization that certifies EMRs and EHRs based on 475 criteria spanning functionality, interoperability and security. CCHIT does not evaluate ease of use of products, financial viability of the company offering the software; or the quality of customer support offered by the software vendor. Whether or not CCHIT will be THE certifying organization to approve “qualified EMRs” will be announced at the end of the year. (Can be pronounced “SEA-CHIT” or each letter can be pronounced as in “C.C.H.I.T.”)
Comparative Effectiveness: Comparative Effectiveness Research (CER) compares treatments and strategies to improve health. For CER, HITECH provides $300M for the Agency for Healthcare Research and Quality, $400M for the National Institutes of Health, and $400M for the Office of the Secretary of Health and Human Services. (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:
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
