ideaman911 wrote on Wednesday, September 09, 2009:
Sam & Peter;
Since I am not a prescriber, I am dependent on the feedback from those who are. What I wrote and suggested is based on that feedback. A "modest fee" for one person can be exhorbitant for another, since it seems it would be based on the number of prescribers, rather than the number of prescriptions written.
Home Care is a reality of the healthcare community which has been sadly overlooked by the people in Washington as they redistribute wealth from providers to those Washington determines are the best. They never asked. Whatever my beliefs about a “single payer” system, you need only look at the fact that CMS is the regulator for both Medicare and Medicaid, both of which are “single payer”. Neither uses the others’ form, and there is no forwarding by Medicare when Medicaid is the secondary. Medicaid, unlike Medicare, accepts no NP as having a specialty, yet at the same time promulgates rules which insist that ONLY an NP in Psyche can care for a patient with a psyche ICD. So I have no illusions about whether government will make the system workable, especially for those least able to afford it. I was under the impression that OpenEMR was especially valuable for small and non-profit organizations. So ANY designed-in costs are a contrary consideration.
I have configured many, and advised on their usage on the forums, for the G844x codes for the medicare Incentive for e-Rx. There are three codes which can be described as a) All scripts for an encounter were submitted as e-Rx, b) e-Rx was available but NO scripts were needed, or c) e-Rx was available but was unused for SOME of the scripts because of State, DEA or other regulatory rules, or because the patient wished to have a paper script. Those G codes must be submitted with a zero, or minimal if zero is not possible, dollar charge (OpenEMR must use $.01) on the same claim as the service code(s) for the encounter. ANY of the three will result in the N365 acknowledgement code from Medicare. And by the way, Medicare even recognizes the lower cost and at least as good outcomes from Home Care vs institutional, and pays a higher amount to offset the lower frequency of visits and higher costs for those providers.
As to the question of the drug interactions, the FDA database provides that. Its data is free, and frequently updated without any effort on our part, which would be the useful way for OpenEMR users to utilize it as well. But it could still stand-alone. I have not seen the “private formularies” requirement you mention, but I have a LOT of concerns about the individual providers’ actually keeping those records up to date. The Fed may have an unlimited budget for data inputs, as evidenced by the regular mailings from Medicaid (paid for by the only 20% of “allowed” 50% unpaid by Medicare for psyche they cover as “full” when they actually do pay). But if it is hard to get providers to even use EMR/EHR systems right now, which at least give THEM some benefit, imagine trying to maintain any listing purporting to include ALL private payers’ formularies. How? Even Surescripts will eventually decide it is too expensive for little benefit.
And as to the generics issue; Allscripts will accept the ENTRY of generics, it simply does not provide them in the listing of the brand name meds as an alternative, again as I understand it from the person who actually uses Allscripts. She says it does not give the generic equivalent for brand-name prescriptions. And if you are entering to the Allscripts, then "screen grabbing" to post to your own EMR/EHR, did you develop that widget or someone else? It will almost certainly be different for another e-Rx portal. But it implicitly requires full-time connectivity to Allscripts, which still blows you off after THEY determine you are finished, thereby requiring a login (again). What do those logins cost you? My approach would allow the reverse - put the info into OpenEMR, where YOU need it to properly care for your patient, then post to the e-Rx portal or print the state required paper at YOUR convenience, and as automatically (read - you can do other things while it processes in the background) as possible, with a single login. And STILL be fully usable for House Calls.
I have no problem using code developed by others - it saves me having to learn to do it myself at the very least. But my reason for looking at OpenEMR in the first place WAS its ability to stand alone, precisely because that was what my wife & client needed. And I AM COMMITTED to its use and making it the most functional it can be for my client base. That is why I have and am making revisions to suit the specific needs of my clients, the prime advantage of Open Source based OpenEMR.
Unlike Washington, though, the concepts of compromise & truthiness DO exist in my vocabulary
Joe Holzer Idea Man
http://www.holzerent.com