I am told that in order to register for an EHR incentive payment for 2011, I need to:
1. Begin at least to implement by Oct 1 2011.
2. Use the complete 4.1 version and not the modular 4.0.
Have I got that correct ?
Since 4.1 is not yet available as stable version -looks close per developers forum- do you think I can count installation of 4.0 as the preliminary steps to 4.1 in order to qualify for incentive payment ?
Oct. 1 start date may not be necessarily true. In my understanding, that with Medicare, if you implement and report (3 months) this year 2011 or next year 2012 you will still get the full $44K in a 5 year payoff schedule. So, if you are truly overwhelmed for this year, then start it next year. It is just that you will wait longer for your reimbursement as you are delaying it yourself. But if you implement in 2013 then you will get less amount in reimbursement. Check the CMS MU payment schedule. Also, check this out and try to analyze it yourself:
Bob,
The October 1 deadline exists because the CMS does not allow the 90 day reporting period for use to span calendar years.
If all that you have is 4.0 on October 1, then you will not be able to truthfully attest to that you had the required drug-drug and drug-allergy interaction checking enabled for the entire reporting period.
Realistically, if you don’t even have 4.0 installed yet, I think your chances of achieving meaningful use for 2011 are extremely poor.
Given that you state that you are new to OpenEMR, I think you would be doing yourself a disservice by trying to rush to beat the deadlines for 2011.
You could install the development version and have the fully certified software, but the incentive program is not simply about having the software, you have demonstrate the 15 core functions and use 5 of the menu set functions for the 90 day period at the minimum required levels.
Qualifying for the Medicaid program requires that 30% or more of your encounters are with Medicaid patients. If you are a pediatrician 20% meets the requirement, although your incentive payment is reduced for a pediatrician with less than 30%.
If you qualify under the medicaid program, getting the first year incentive is simpler, but most people aren’t going to have the proper patient mix to qualify under the medicaid program.
Good morning from the West Coast,
Thanks for all the input.
The installation process for 4.1 is really a snap. Thanks to those who made it so easy. Up an running in <10 minutes.
I do not see enough medicaid patients to qualify for that program.
So if I use openemr for patient encounters I will satisfy the the 15 core functions and 5 of the menu set functions “automatically” ? I don’t quite see how all that happens if for example I complete an encounter note using SOAP format.
The 4.1 manual hasn’t been published so it’s not clear to me how drug-drug and drug-allergy interaction checking are handled. Is it built in or will I need to arrange something with an outside provider ?
Fortunately I’m now one of the OG’s with a less than full time practice, so making the transition is probably not going to be all that disruptive to patient care.
More…
After more searching, looks like openemr was certified with the use of *additional* software including Newcrop (for prescriptions) and LabCorp laboratory exchange.
So just installing openEMR does *not* result in a system eligible for EHR incentive payment.
Modules to make to interface to lab and rx are available, but I gather they are not open source and/or require some type of “subscription”. Cost not stated.
Anyone have a ball park estimate of the cost of using openemr 4.1 with all the required gizmos to be eliglibile for Medicare EHR incentives in a single doc office ?
I have been trying to ask that basic question in multiple forum threads as well, but it seems to be a big secret. I would like to use the free allscripts electronic prescriptions, but that idea seems to have been dropped despite the interest of other docs. It also seems you have to be signing up for a billing service for some percentage of your billing, to be eligible for lab interface and e-prescriptions. I have checked out the web sites of all the listed players and that information on service cost is not to be found. I understand that the companies involved see the meaningful use dollars as theres to acquire with this, but there are bunches of offices out there that don’t qualify for those incentives under either medicare or medicaid. Think about most pediatric and OB offices and everything overseas. Besides which if you have dealt with the government for very long, you know it is mostly smoke and mirrors, It is distinctly possible that medicare payment gets cut over 30% at the end of the year and the incentive could be dissolved by the “super comittee”. If you think that is too crazy to contemplate, think of congress threatening to default on treasury bonds and getting the US credit rating downgraded. So if the stated idea is to attract offices to this project, I think this stuff needs to be spelled out.
Sorry to vent like this but I thought that the idea of open source was that participation did not equal ownership.
On a more positive note, I would like to openly praise Brady, whoever he is, because it seems to me he is the real deal. Improving healthcare for humanity, one office at a time, without a personal profit agenda. That is a pretty high standard to aspire to.
Yep Cverk,
It’s pretty frustrating that the fact that software other than openEMR is needed for an operational system is not made more clear.
On the other hand, lots of hours of work have gone into this project, and I understand that individuals have made substantial financial contributions to get code written in the past.
I don’t have a problem with making a financial contribution, particularly if it results in the code becoming open source for the community.
In my opinion, it would be more straightforward if there was a way the developers could just say “we need $x to get the rx module done. who can chip in ?”
Thanks for the praise; it came at a good time. Please don’t get too cynical (yet ) about the lack of information regarding the e-prescribing and lab interface. The developer community just recently finished a monumental task to get meaningful use; sort of analogous to when you take care of really sick ICU patient all night (but this was like a year). I think the developer community is now in the phase of picking up some pieces (akin to dictating the notes at the end of the shift) in regards to sorting out the specifics for the e-prescribing and lab interface (I’m guessing they will weigh in here themselves since the vendors offering these services are very involved in the community). Once the official release is out next week, then will be able to begin spending attention towards important non-meaningful use tasks, such as incorporating the free Allscripts prescriptions (there were several developers as I recall that have already put a little time into this, and it’s an option I also have some interest in contributing towards since it is free).
Also, Bob, I’m not a pro, but the pro’s should be able to provide you with an estimate on a proposed feature/model. If you have a module/feature in mind, I’d be happy to provide you some recommendations offline (note I get no compensation for my recommendations; I pretty much base the list of recommendations off whom has the most expertise in the subject area of the feature and whom has a good track record of contributing code back to the community). Then with the estimate, could then see if other contributors are willing to chip in.
I have been looking back on OpenEMR recently, and tried on the Demo site. While it is great achievement to get the MU certification, I could not find some of the very useful functions on the Demo, or maybe i just did not know where to find it. Here is a quick list i can think of:
1. e prescription,
2. fax integration- i understand it is set up to use hylafax, but is this going to be handled inside oemr or need separate frontend software?
3. generating H&P as well as SOAP note into a modifiable file for print/fax, such as pdf, tif, etc, with customizable letterheads, etc.
4. insurance eligibility checking
5. patient appointmet reminder call
6. templates to design/augment various sections of H&P and SOAP note
7. separat follow up bucket for claims that was rejected.
I imagine Bob’s idea is feasibe, maybe there could be a list of features published on line with the cost to develop each of the features, i am sure lots of people would be willing to chip in.
Ahoy Bob and cverk,
OpenEMR is free as in free beer. But some gizmos that are required for the MU incentive money are only available from non open source entities that charge a fee. For example SureScripts is currently THE clearinghouse for e-prescribing and they ain’t in the business of doing that for free. The fees can be small and they will vary with each middleman you assess. This stuff is not under the control of OpenEMR and there is a spectrum of correct answers to your questions. There is not however any attempt to make this a secret. You will notice that the forums avoid endorsing any specific vendor’s solution. Maybe what we need is a web page where vendors could contribute data to a spreadsheet of features and costs?
Jack Cahn MD
OEMR Board
In this case where this is only one vendor supporting a vital feature, I think it would be ok to discuss it openly on the forums (unless others have issues).
Folks,
Sorry, I’ve been so busy in the last weeks that I have not had time to look at the forums much.
The Lab Results does not require an interface to an outside lab, that just makes it easier to "incorporate’ results. Medical Information Integration, LLC results interface is to LabCorp. The cost to support Results-Only LEN is $25/m per facility. However, you have to be approved by LabCorp before they will allow it. We are working a Orders+Results interface with LabCorp and Quest right now ($50/m) and we have a Results interface with Soltas Labs. All of those require the Lab itself to approve access. Nothing I can do about that, the labs have complete control.
E-Prescribing: A partnership of ZH Health Care and Medical Information Integration, LLC (mi-squared) called ZMG created the NewCrop interface for eRx. Setup is simple and the cost is $60/month per prescribing physician. You can contact either justin@zmghealth.com or tony@mi-squared.com or sam@zhservices.com to sign up.
There are other options as well, Phyaura’s version of openEMR is certified and uses RelayHealth, Ensoftek’s version of OpenEMR (DrCloudEMR) is certified and uses DrFirst. And you can attest to using any certified eRX solution, instead of what OpenEMR is certified with, you just lose fully automated integration with OpenEMR
Hope that helps. I’ll get this info posted on the wiki this week as well. Frankly I would have loved to produce a free, opensource solution, but the industry locks all that access down to specific NDA and vendor relationships.
Other developers can (and should) contact the eRX and lab clearinghouses and work with them to provide more options going forward. It just takes time and money.
When an Eligible Provider (EP) ultimately goes through the registration process with CMS for meaningful use, the EP lists whatever software he is using, and can list multiple components. So I believe that one could use both OpenEMR and the free AllScripts ePrescribe to achieve meaningful use. The integration won’t be as tight as ZMGs NewCrop interface, but that was/is the whole point of modular certification, being able to pick and choose different modules if one solution is not complete.
That last idea from Kevin Yeh seems like a good answer for me since I have been entering patients into Allscripts for awhile and have built a database there. Perhaps a future patch would integrate them better as others seemed interested in Allscripts. FYI the free clearinghouse Officeally offers newcrop eprescibing for $30.99/month. So if some of the difference is being donated to developement under the nonprofit OEMR, it would be nice to spell that out on the wiki.
I have had those labs offering my office complete computer systems to go electronic in the past as it would save them money. If I can figure out who the reps are for Labcorp and Quest , it may be worth seeing what they may be willing to do these days. Quest is still bringing me printed results by courrier, so I bet they may be interested in helping out. I am a little unclear on the lab result requirement. Are you saying the offered interface is not neccessary for meaningful use? Maybe if I didn’t have to spend so much time and energy taking care of all the sick patients that the government pays me less than my overhead for, I could make more sense of what they want from me on this stuff.
I have a couple of questions that seem to be unanswered by any of the forum posts. I am trying to trace through and connect the dots from the ONC final rule certification criteria that OpenEMR received and relate that to the attestation process and objectives.
Specifically, I thought, like others did, that OpenEMR would work out of the box. Upon further research, it seems that this is obviously not the case. The issue I am running into is that I am now trying to implement this having made no plans to support an additional monthly expenditure. The cost is not so much my concern, but the letter of the law is. I am trying to see where and what ONC criteria was passed using functionality not present in OpenEMR by default.
My concern is, now that I have OpenEMR, a fully certified EHR for ambulatory use, I feel that if I can get the numerators and denominators, that I should be fine and confident attesting. I have read through the final rules proposed by CMS and ONC, and have found that it seems as though there is a division between ONC and CMS such that certification by ONC enables you to meet the standard of attestation.
A more concrete concern: e-prescribing. If I don’t choose to use newcrop, the standard for e-prescribing is:
“Generate and transmit permissible prescriptions electronically (eRx)”
with a denominator of:
“Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the EHR reporting period.”
and numerator of:
“The number of prescriptions in the denominator generated and transmitted electronically.”
Now, what does generated and transmitted electronically mean? I would assume that the CPOE functionality of “Patient>Summary>Prescriptions>Add>Save>Fax” (adding a prescription and then faxing it over to a non-newcrop entitiy responsible for eprescriptions) would count toward generating and transmitting electronically? If this does in fact count for attestation, then it would seem that openemr does work out of the box (at least for that attestation measure).
Any help would be appreciated. Even to tell me that I am wrong. I am just at my wit’s end trying to implement this through wholly open source means. IF it can’t be done, that’s fine. I just don’t want to NOT be within standards when it comes time for audits. . .
) about the lack of information regarding the e-prescribing and lab interface. The developer community just recently finished a monumental task to get meaningful use; sort of analogous to when you take care of really sick ICU patient all night (but this was like a year). I think the developer community is now in the phase of picking up some pieces (akin to dictating the notes at the end of the shift) in regards to sorting out the specifics for the e-prescribing and lab interface (I’m guessing they will weigh in here themselves since the vendors offering these services are very involved in the community). Once the official release is out next week, then will be able to begin spending attention towards important non-meaningful use tasks, such as incorporating the free Allscripts prescriptions (there were several developers as I recall that have already put a little time into this, and it’s an option I also have some interest in contributing towards since it is free).