Our two-person family practice is shooting for the 2011 Medicare incentive with OpenEMR. Here’s how we plan to do it:
1. OpenEMR 4.1 installed, up and running one week before the October 3, 2011 deadline. While we figured we may have to switch electronic prescription providers, we stuck with Allscripts (the free version) for now as a modular way of satisfying the ERx requirement. We printed out a certification code for the combination of Allscripts and OpenEMR 4.1 and registered with Medicare.
2. Our support staff sees that all legacy information (diagnosis, mediations, allergies, smoking history, demographics) are entered before the patient is seen. This involved some training and engagement.
3. Doctors enter visit-specific information concurrently with each visit. One doctor types directly and the other uses voice recognition software.
4. Lots of handouts are printed and documented to get to the required threshold for educational material. We mostly cut and paste into Word Pad to give patient-specific educational material. I’m giving a lot of minimally useful information just to be sure to meet the goal.
5. Every patient is given a summary of the visit. We have been printing the visit note, less some of the specific content. To save postage, we give at the time of encounter. If not feasible, we mail within the 3 day window.
6. We printed out the detailed and specific requirements to which we must attest and put them in a three ring binder. At the front of the binder, we summarized the requirements of each item. Any actions toward attaining each specific requirement are documented in the pages after the requirements for that item.
7. We picked at least 5 of the 10 optional items to attest. We are signed up with the Pennsylvania immunization registry, so we called them to set up HL7 interchange and sent in the registration forms. They hadn’t heard of OpenEMR, but I told them it’s legit and that we get credit for testing. We verified that the items we picked were officially supported by our combination of EMR software modules. I think the immunization interchange will qualify for public health requirement. We figured out how to use the syndromic surveillance application but have not yet found an appropriate place to send the information.
8. We have sought other providers with whom to test electronic data interchange. It appears that fax interchange will -qualify, perhaps even if the other side does not have an approved EMR. We found that if you set up a fax printer, EMR will print to that fax, and that is an electronic interchange, isn’t it? We’re trying to connect with a hospital based medical practice but may have to sent to a nursing facility to prove this capability.
9. We have signed up, personally, for Microsoft Health Vault. This is a service that allows uploads of digital information from doctors for patient access. While I have been signed up for Google Health, it looks like they’re going to shut down on 12/31/11.
10. We are reviewing the specific security requirements and coming up with the required site security plan etc. One of our enhancements will be des3 encryption of daily backups on DVD. Early in the quarter we will document our efforts toward compliance with the security requirements.
11. Both doctors will meet every Saturday morning during the fourth quarter of 2011 to review progress toward certification, to make sure nothing is left out and that we will be able to attest properly at the end of 2011.
It is a truly daunting task. I applaud you. By sharing your experience of course you reduce much of the work for others. They will never realize what you did to get this information this far along.
Lets make OEMR the best! The better it is, the more doctors will use it. The more doctors that use it, the better it will be.
tnx for the in-depth steps to make the different implementations so clear. Anybody has some more suggestions on how to make it even more acceptable? Keep us informed indeed. Hope you found the way to attack this problem, the road filled with (w)holes but within reach of acceptaion of incentives.
Pimm (Not an US general Pratitioner, but the steps you are taking better informed about the way to go for better Electronic Patient Records and QUALITY!
It lists openemr as a participant, but I have not found any info that way in the forums. It also looks like in windows at least you can possibly address a few other issues through microsoft. I know this is heresy for the linux crowd, but it may be worth a look. A free windows live account appears like it would allow you to sync up to 5 gb online for cloud backup using a thing called mesh,allow a total of 25 gb of file storage, allow remote access to an office computer, and securely e-mail patient records via healthvault . It doesn’t seem too far fetched that such an email system could be the answer for lab integration, patient summarys, etc for meeting not only current but future meaningful use requirements? Anybody out there know more about this or have any user experience?
I’m working really hard to go away from paper to electronics, and now it seems I have to print up a bunch of stuff for patients at each visit, or mail it to them later. Is this typical government nonsense to triple paperwork for no benefit, or am I missing something on how to meet these requirements.I’m sure every kid with a sore throat is helped by a detailed summary of their visit on paper somewhere.
The clinical summary is a requirement that has to be met for 50% of office visits. http://www.cms.gov/EHRIncentivePrograms/Downloads/13_Clinical_Summaries.pdf
Electronic portal access to a clinical summary is also acceptable. However, printing clinical summaries at the time of visit seems to be the easiest way to achieve that requirement with OpenEMR at this time.
If you swab the kid’s throat and send off for cultures that would be an appropriate piece of information to give the mom on a piece of paper. Did you start antibiotics? If you ePrescribed, then mom might want a paper copy of the plan to refer to. Sure it’ll be on the bottle at the pharmacy, but who reads those things?
I have been thinking about how to meet the clinical summary requirement and had an idea that might work for lots of people. I was thinking I would post a notice on my office web site offering to send by mail to the address of record a clinical summary as a paper based PHR (personal health record) to those patients who send a request for such to our office e-mail. I am guessing there would be few requests and it would not cause us to hold up office workflow while these were composed and printed for patients at the office. It would be a fusion of the options listed in the requirement, and likely would be easy to accomplish.
Anybody out there see how such a service would not meet the requirements? It seems if a portal earns it, this would earn it.
If you were to install a full blown electronic patient portal on your web site and less than 50% of your patients use the portal to access a clinical summary, it seems you still make the requirement. If you are dealing with medicare patients that would likely be less than 5%. So it seems the only difference to mailing in response to a request would be timing, which isn’t mentioned. It is only mentioned that it would be available by 3 business days, not that they have it in hand by then.
I interpreted the rule to say that 50% of the encounters need to result in a printed form handed to the patient or mailed promptly. I do EMR entry at time of patient visit, so I can print out the form and hand it to the patient before leaving. I use the printed EMR note with all meds, allergies, treatments (originally dental issues before modification) but none of the encounter note details.
The other doctor is coming up to speed and does notes after patient is gone. In that case, because we do chronic care, we have support staff print out a similar form BEFORE he sees the patient. It is clipped to the front of the chart and serves as a conversation piece to summarize and verify meds, allergies, diagnoses, treatments during the visit. Notations and changes can be made by hand. The patient takes it home. This way it becomes a useful tool.
Too bad, according to the Colorado Foundation for Medical Care, you are right. You have to either hand or mail a clinical summary on paper or run a patient portal to make the criteria. It seems pretty stupid, but we are talking about the federal government after all.