Connecting devices to your EMR-Part1

[This is the first of a three post series.  The first post will discuss components.  The second post will discuss data.  The third post will discuss buying strategies]

One of the trends for 2012 is connecting devices to electronic medical record (EMR) software.  The ability to connect devices such as EKG machines and vital sign machines to EMRs is nothing new.  But the compatibility between devices and EMRs has been limited.  Now thanks to the increasing EMR installation base, increased reporting requirements, and technical improvements, the market is primed for this next technical uplift in the medical practice.

To help shed some light on what it takes to connect and share data between a device and EMR, we’ll focus on three aspects.  First we’ll look at the component parts we’re working with.  Second, we’ll discuss the data itself.  Finally, we’ll look at some purchasing strategies.

Component parts

Three main components are: 1. the device providing the data; 2. the software into which you want the data transferred; and 3. the interface between the device and the software

The device

This can be any number of devices; blood pressure monitor, EKG, radiology.  The device will need to have a means of exporting data.  This is typically through a port (think USB or serial port like on your computer), or wireless transmission such as Bluetooth. 

If the device can export data, the manufacture will typically include in the technical specification the words USB, Serial port, Bluetooth, or that ever the format is.  These specs are usually available on the box the device came in, its user manual, or the manufacture’s website.   Not all devices have this capability, so be sure to check the tech specs.

The interface

The interface is simply a translator between the sending device and the receiving software.  The two parts to an interface are: 1. the physical or wireless interface; and 2. the software interface.

The physical interface is the conduit which allows data to exit the device and be received by the computer.  It may be as simple as a USB cable, or it may require a special proprietary cable or dongle from the device manufacturer.  If the connection is wireless, such as Bluetooth, the device will have that capability build in.  Note that the computer to which the device is attached also needs the same type of port or Bluetooth capability.  Be sure to check the specs of your computer to make sure it’s compatible.

The software interface is what allows the EMR software to interpret the data sent by the device.  The best case scenario is that your EMR software has a built in interface for your device.  If that’s not the case, then you’ll need to acquire or purchase the software interface from either the device vendor, EMR vendor, or a third party vendor.

Why all the variation with interfaces?  Because even though all vendors talk about standards, there are still gaps between vendors.  Interfaces require lots of cooperation and coordination among device manufactures and EMR companies.  Add to that the multitude of device platforms (EKG, vitals, radiology et al), different EMR platforms (client/server, thin client, cloud), and shifting computing device platforms (computer, laptop, tablet, iPad, iPhone, Android et al).  There are lots of moving parts.

Finally, some devices simply are incompatible with certain EMR software, meaning they don’t have a viable interface.  Even within the product line of a device vendor, different devices may require different interfaces or be incompatible.  That is why it’s important to check the compatibility of the specific device you want to use with the specific software you will send data to.  This includes confirming the specific device version, interface version, and EMR software version or build.

The software

In our context of a medical practice, we’ll focus on receiving information from a device into our electronic medical record (EMR).  EMRs are being improved so they can receive data from a wider array of devices and vendors.  Most of the focus from the device vendor side has been on the acute care setting, with scant attention paid the ambulatory side.  But buyer options are improving all the time. 

This is the part where I need to help you be a better EMR owner.  If you ask your EMR vendor, “can I interface my EMR with XYZ Company’s blood pressure machines?”, you’re asking the wrong question.  The correct question should be, “Can I interface my model A, version B, XYZ Company blood pressure machine with your current software?  Will the next version of your software continue to support my device?”  And finally, “Is support of this interface included in my existing maintenance and support contract, or is there an extra cost?  Is support provided by your company, or an outside vendor?”

Don’t be surprised if you get different answers from different people at your EMR vender.  Interfaces have typically been a victim of lost ownership within EMR companies.  The Support teams don’t typically work with them much, implementation teams don’t do much with them, sales typically has an outdated list of available interfaces, and communication between EMR and device venders is often strained.  If you can’t get satisfaction from the sales, implementation and support teams, request that they get an answer from an interface analyst working with your software or device.  And don’t be put off if they won’t share that person’s contact information with you, most software companies don’t want customers in direct, uncontrolled contact with analysts and programmers.  If they did, analysts and programmers would have customers contacting them all the time with suggestions, complaints and break/fix issues.

Now that we have looked at the component parts involved with connecting a device to an EMR, next time we’ll look at the data that is received in the EMR.

Getting social during a winter storm–Part 3

 [This is the final post of a multi-post series on using Twitter and Facebook in your practice.]

What Twitter/Facebook won’t do for you

Your practice still needs to call patients to reschedule, or they need to call you.  And Twitter/Facebook won’t reduce all the stray calls.  However, your posts should initially have at least an incremental effect on reducing your call volume, which should grow over time as patients and staff get more knowledgeable and comfortable with it.

What you don’t need to do

Just because you set up an account for Twitter or Facebook doesn’t mean you need to post constantly.  Most practices can get away with just posting open/close status.  However, you could also use it to announce new providers, new services and changes in hours.  

Marketing with Twitter and Facebook

If you get customers in the habit of checking your website or social media sites, you have the potential to turn these resources into marketing opportunities.  However, that's a larger topic than I’m writing about here.  If you’re interested in starting a social media campaign, I suggest you Google “social media marketing medical practice” and look at some of the resources out there.  After that you can think about what resources you’ll need to marshal if you decide to move forward.  Like any media campaign or project, get your ducks in a row before venturing out.

What you absolutely should not do

Don’t hold conversations with patients via Facebook or Twitter.  These are public sites and anyone could potentially see posts.  Carefully consider who in the office has rights to post to these accounts, and those that do post should be fully trained on how and what to post, as well as HIPAA and other regulatory concerns. 

Who posts or tweets for the practice?

Carefully consider who has authority to post and tweet on behalf of the practice.  Any communication will be out there, somewhere, forever.  Even if you delete it, assume it still lives somewhere out on the internet. 

Closing words

I hope this little series has given you some things to ponder.  I haven’t laid out every piece of information regarding how to post and when to post, most of this I’m assuming you can figure out on your own.

If you’d like more information on this topic, or have other questions or problems to discuss, feel free to reach out to me at (515) 249-9011 or email me.

Straight ahead,

Bob

Get social during a winter storm-Part 2

Getting social during a winter storm – Part 2

[This is the second post of a multi-post series on using Twitter and Facebook in your practice.]

What are Twitter and Facebook?

Twitter is a website (www.twitter.com) where users sign up for an account, and then post messages (tweet) of up to 140 characters in length.  These are usually public messages; therefore anyone can view a specific user’s tweets (for an example, click on this link: www.twitter.com/boboakley).  In order to make posts easier for users to search for, tweets can include a hashtag, or pound symbol (e.g. #icd10).  When a Twitter user finds another user whose tweets they want to stay updated with, they can “Follow” that user.  By “Following”, a user will see that other user’s tweets on a list of tweets from people they follow, and they can opt to receive email notifications of new tweets.  Twitter can be accessed via computer, iPad, iPhone, and Smartphone.   Finally, a person does not need to have a Twitter account in order to read tweets.  If you followed the link above to my Twitter account, you can read all my tweets.  However, in order to “Follow” (receive notification of tweets), a user does need an account.

Facebook (www.facebook.com)  is a community where users can post status updates, pictures and other information about themselves.  Users then “Friend” others, which has the effect of letting their “friends” be notified when a Facebook page is updated with a post or whatever.  This should be considered a public space, just as Twitter is publically accessible.  Click this link to see my page:  www.facebook.com/boboakleyconsults

How Twitter and Facebook are different than email and phone

The primary functional difference (for your practice) between Twitter, Facebook, email and phone is that for Twitter and Facebook you don’t need a patient’s contact information in order to reach out to them.  The patient can simply go to your Twitter or Facebook page and get the information they need.  They also have the option to sign up to receive an email notification when you tweet or post.  The effect of this is that it frees you from the need for patient record access in order to reach out to them as a group.

Other features/advantages

Patients can quickly and easily access both Twitter and Facebook from home, office (in most cases), and smartphones.  Because of this convenience, patients receive some peace of mind when they know your office open/close status early in the day without having to battle that busy signal. 

Your staff can get a little more control of rescheduling because they aren’t handling as many calls.  If you stay open during bad weather, you should see a reduction in calls from patients wondering if you’re open.  If you’re closed, in your tweet/post you can state that you’ll contact patients to reschedule.  This should reduce the number of frantic incoming calls as well.  Finally, overall stress to your staff can be reduced by gaining more control over the rescheduling process. 

In our next post in this series, we’ll look at what Twitter and Facebook won’t do, and some cautions on use and control.

Impact of ICD-10 delay on small practices; ICD-11?

HHS Secretary Sebelius announced her agency's intent to push back the compliance date for ICD-10.  What's the impact on solo or small group practices?  Probably not much at this point, other than pushing back the implementation timeline.  However, one thing to watch is the ICD-9 code freeze that is in place for 2012.  The ICD-9 code set is to be essentially frozen with the 2012 edition, allowing for limited revisions in 2013, and totally frozen thereafter since it will not be the go forward code set.  And ICD-10 is essentially frozen starting in 2012 and a couple of  years thereafter during the transition.  Already there is speculation on whether the U.S. should skip over ICD-10 and start with ICD-11.

Here's a link to the Sebelius announcement:  Link .  This morning the link hasn't been working, I'm assuming it's because it's getting a zillion hits. At some point it should work.  You can also google "icd-10 delay" and find lots of chatter.

Stay tuned, folks.

Interesting WSJ article: More Doctors 'Fire' Vaccine Refusers

Interesting Wall Street Journal page 3 article which cites a study of Connecticut pediatricians where "30% of 133 doctors said they had asked a family to leave their practice for vaccine refusal."   Here's a link to the full story: Wall Street Journal article

Get social during a winter storm–Part 1

[This is the first post of a multi-post series on using Twitter and Facebook in your practice.]

6:30am – Fall out of bed, rouse kids, get everyone's clothes ready, pack lunches. 

7:00 - Open the front door to get newspaper, greeted with a stinging wind and face full of snow.  “Oh, boy, are the school buses running, will school start on-time, will work be open?  Traffic will be crazy this morning, and I’ll probably have to do the work of that new guy from Florida because there is no way he’ll be able get out of his driveway without hurting someone.”

7:15 – “Hmm, is the doctor open?  They never answer the phone before 7:45, I’ll call later.” 

7:50 – You call doctor while the car is warming up, but get a busy signal.   

8:05 – You're late for work because you’re stuck in traffic.   You notice on your cell phone that the doctor’s office called when you were avoiding the dope that got stuck in the left lane.  “Really?  You call me while I’m driving in this crazy traffic?”

And so the phone tag begins.

When bad weather strikes, call volume to the office goes up.  Even if you stay open, patients check in to see if you’re open, if you’ll be closing early, and when you’ll be closing.  Or maybe they thought you’d be closed, so they are calling to reschedule.  Whatever the reason for the call, it’s a stress for everyone.

Have you considered using Twitter and Facebook to let your patients know if you’re open or closed during a weather event?  I’ll present ideas on using these social media in ways patients and staff will appreciate. 

I’ll start by explaining how you could use Twitter and Facebook, explain how it is different from email and phone calls, and finally how it can augment standard phone calls and email notifications.

Setting the stage

Prior to any weather events, you’ll want set up your Twitter/Facebook account(s).  In a later post I’ll discuss this in more detail.  Next you’ll want to educate patients and staff that you have a Twitter/Facebook page and that they can reference it for open/close updates.  Be sure to include links to your Twitter/Facebook pages on your website home page so patients and staff can easily find them.  Include an explanation that they should click those links for open/close updates.  Also consider adding it to your phone answering system or answering service.

The day of the storm

The day of the weather event, go to your Twitter/Facebook page and make a quick post, such as, “Our office is open today (February 14, 2012).  For local weather and traffic information you can follow this link: [insert your link(s) of choice]”.  Or if closed, “Our office is closed today due to snow.  If you have an appointment today, we will call you to reschedule.  If you have not been contacted by 11am, please call our office at XXX-XXX-XXXX.”

Linking your Twitter and Facebook accounts allow you to post to one, and have it appear on both.  So you can tweet your closure and it will automatically appear on your Facebook page, and vice versa.

In the next post we’ll look at how using Twitter and Facebook are different from email and phone calls.

ICD-10 Project Planning for Solo Practices – Part 4

[Note: On 2/16/2012, the 10/1/2013 deadline was suspended by HHS.  Look to later posts for the new deadline-updated 3/5/2012]

Now that we’ve looked at some of the components of our ICD-10 project, let’s get them organized.

Project components

So here’s a general list of things to complete for the ICD-10 conversion.  Your list may be different.

• Budget for ICD-10 conversion; training, operational changes, software uplifts, etc.
• Communication plan
• Staff training on ICD-10 code set and new documentation requirements; clinical staff, office staff, providers
• Super bill updated
• Training and job aids updated
• Practice management software upgraded with new ICD-10 code set
• Practice management software updated with new ICD-10s codes as used by practice
• EHR software upgraded with ICD-10 code set
• EHR software updated with ICD-10 codes as used by practice
• Other software/hardware updated as needed per office survey
• Non-HIPAA covered payer conversion timeline defined and plan in place
• Vender ICD-10 conversion plans defined in writing and plan in place
• Vender contracts reviewed and updated as needed
• Payer contracts reviewed and updated as needed
• Insurance policies reviewed and updated as needed
• Operational plan for reduced provider and biller efficiencies post-October 1
• Assessment of cash flow needs and challenges post-October 1

Timeline

For each of the items above, you’ll need to put them into a timeline.  If you don’t have project management software such as Microsoft Project, you can use an electronic spreadsheet such as Microsoft Excel.  One way to set it up is as follows.  [Note: Columns go across the screen, Rows go down the screen.]

Label column  “A”  as “Date”, then across the other columns list the  components such as Training, Super Bill update, EHR Update, and so on.  In the first field below “Date”, enter 3/1/2014, in the next field down enter 2/15/2014, then 2/1/2014, and so on until you get to 3/1/2012.  This will create a backwards counting calendar listing the first and fifteenth of each month.  Later, after your draft is completed, you can resort it so 2014 is at the end, and add additional dates as needed.  But for initial planning purposes, I find it helpful to think backwards from a project “live” date.  Also, you might want to highlight in red or yellow the row with the date “10/1/1013”, our “go-live” date.

Now you’re ready to fill in the dates for each step of each component. You’ll probably find that as you go through  the various components you’ll move other component pieces around, which is okey.  That’s the whole idea of this.  And don’t be afraid to put in a lot or a little information in the fields.  This is a planning document; you won’t be graded on it!  It is a living, breathing plan.  The key here is to get an initial plan in front of you.

Closing thoughts

Unless something changes, every medical practice, hospital, and health insurance payer is making the conversion to ICD-10 on October 1, 2013.  Those medical practices that plan ahead and don’t wait until the last minute will be fine.  Those that wait too long may have trouble getting the outside assistance they need from consultants, venders, and payers due to a high demand for services.  While poor planning probably won’t shut down a practice, it could have a very real impact on cash flow.

If you’re reading this and would like more information on what I can do to help you with your ICD-10 conversion or other issues at your practice, email me at info@boboakleyconsults.com, or call (515) 249-9011.

Straight ahead,

Bob

Michael Jordan on failure

I’ve missed more than 9,000 shots in my career.  I’ve lost almost 300 games.  Twenty-six times I’ve been trusted to take the game-winning shot and missed.  I’ve failed over and over and over again in my life.  And that is why I succeed.

–Michael Jordan

[source: excerpted from Forbes magazine article “Thoughts on Basketball”, February 13, 2012 issue.]

Innies and Outties in the Workplace

Personality dynamics cause stress at some point in all workplaces.  Throw in the hectic pace of a medical practice, the high stakes decision making, and typically wide ranging backgrounds of staff, and stress is a given.  That is why I’m always on the lookout for interesting articles on human interaction and social science to share with clients.

With that in mind, the February 6, 2012 edition of TIME magazine has an interesting article authored by Bryan Walsh titled “The Upside of Being an Introvert (and why extroverts are overrated).”  In the article Mr. Walsh explains how introverts and extroverts are different, why both are important to a business and have a role in organizational structure, and finally how introverts deal with their condition in an increasingly extroverted world.

Introverts, he explains, have energy drained from them during social interaction.  Their sensitivity to stimuli makes them expend energy as they try to isolate and protect themselves from the over-stimulation of social interaction.  Extroverts, however, receive energy from these social interactions because they are naturally less sensitive and therefore crave the stimulation.  And he cites laboratory studies where researchers measure brain activity to support the thesis.

This isn’t new, of course.  I seem to remember years back in a college sociology class learning somewhat the same thing.  But I think the new nuance, as least for me, is the article’s explanation of how “innies” and “outies” (as the article refers to introverts and extroverts at one point) function in the world and function outside their natural state.

Mr. Walsh presents to the reader Harvard’s Brian Little ( “research psychologist …superstar academic lecturer…and serious introvert”)  drawing upon Mr. Little’s academic work and introversion.

“…he [Little] pushes through the constraints of his temperament because the social value of lecturing and speaking—of truly connecting with his students —trumps the discomfort his introversion can cause him.  Little calls this phenomenon Free Trait Theory: the idea that while we have certain fixed bits of personality, we can act out of character in the service of core personal goals.  The key, he explains, is balancing three equal but very different identities.  There’s our mostly inborn personality, the one that wants us to be introverted or extroverted; that’s the biogenic identify.  There are the expectations of our culture, family and religion–the sociogenic identity.  And then are our personal desires and our sense of what matters—the ideogenic identity.”

Who do you think in your office is an introvert or extrovert.  And don’t confuse shyness in introversion, they are different things.  Mr. Walsh includes 20-question quiz where readers can assess their intro/extro tendencies.  The quiz is excerpted from the book , Quiet: The Power of Introverts in a World That Can’t Stop Talking, by Susan Cain, Crown Publishers. The quiz can be accessed here: Quiz 

ICD-10 Project Planning for Solo Practices – Part 3

[Note: On 2/16/2012, the 10/1/2013 deadline was suspended by HHS.  Look to later posts for the new deadline-updated 3/5/2012]

In the last post on ICD-10 project planning for the solo practice, we looked at what the first few months might look like.  Today we’ll discuss the changes we need to anticipate in order manage those situations.

Learn ICD-10

Depending on your practice specialty and the number of diagnosis involved, this may be relatively easy, or more involved depending on the volume of codes you use.    

So who needs ICD-10 training?  Well, anyone who is documenting patient information or is working with charges and claims.  This means pretty much everyone in the practice needs training.  But different roles will need different training.  To account for this, the practice should survey each job function to determine what information is being dealt with related to ICD-9/ICD-10, then train to that situation.  ICD-10 requires greater knowledge of medical terminology, anatomy, pathophysiology and pharmacology.  Do your medical assistants have the necessary knowledge to properly use ICD-10?  How do you plan to assess their preparedness?  How to you plan to train them, and pay for the training?

Cross reference ICD-9 to ICD-10 codes

Every ICD-9 code currently used by the practice will need to be cross referenced to ICD-10.  A good place to start is to acquire a GEM (general equivalency mapping) document.  Of importance here is the word “equivalency”.  It is important to remember there is not a 1-to-1 relationship between ICD-9 and ICD-10 codes.  One ICD-9 code may have three or more ICD-10 equivalents, and some ICD-10 codes don’t have an ICD-9 equivalent.  The code you use will depend on the specifics of a given situation and/or the policy of a specific payer. 

You may also want to do a reimbursement mapping.  CMS provides documents which present a single recommended mapping of an ICD-10 diagnosis or procedure code to a single ICD-9-CM alternative.  This includes all ICD-10-CM/PCS codes, but not all ICD-9 codes.

For GEMs and other conversion tools, CMS provides them on their website for free.  Many private vendors also offer them for a fee.

Review forms

Any form dealing with patient information should be reviewed and updated if needed.  Billing sheets, patient history forms, referral letters, lab orders, whatever.   Do you have order forms for durable medical equipment?  Don’t forget to update those if needed.

Update software

It should go without saying that EMR and practice management software will need to be updated.  Do you have assurances from the vendor on that update?  If not, when will they provide it to you in writing?  Survey the practice for other software which may need updating.  If you have an outside billing vendor, survey them to make sure they will be up to date in time. 

Review reference materials and how-to guides

It’s common for practices to have internally created reference materials and how-to guides for employee use and training purposes.  Review those for possible changes.

In 2013, don’t throw away your ICD-9 code books.  Until all claims with ICD-9 are processed, you may need them.  And staff may continue to need them for years to come because ICD-9 codes will continue to be in the billing and medical record system.  Don’t assume a biller hired three years from now will know that 707.03 is decubitus lower back ulcer.  They may only know it as L89.44.  

Review contracts and vendors

Review payer contracts for requirements regarding ICD-10.   Any mention of ICD-10 in that malpractice insurance policy?  Has your outside billing vendor given you a written timeline for their ICD-10 conversion? 

Have you thought about ICD-10 diagnosis requirements for lab tests?  Will your lab vendor(s) provide you with that data?

What about covered diagnosis for patients?  You’ll need to be sure you know how payers handle the transition so you can update patient charts with the appropriate ICD-10 code.

Review when payers are switching to ICD-10

Non-covered entities, such as worker compensation insurers, are not required to make the switch from ICD-9.  It is anticipated most will convert to ICD-10 in order to make things easier in the long run.  But you should determine if and when those you participate with will make the transition.

Process changes

Will ICD-10 change any of your internal processes?  Don’t assume it won’t.  Again, survey the practice to determine for sure.

Budgeting for the change

The transition from ICD-9 to ICD-10 presents many opportunities to take money out of your pocket.  And for most practices there will be some economic impact.  Cost containment can be aided by actively managing the transition and reducing variables which are out of your control.  For example, what if some of your payers struggle with the transition and payment processing is slowed down?  Well, you can anticipate that by building up a reserve fund to avoid cash flow issues.

Also, consider the effect on your employee productivity.  It is widely anticipated that billers will lose efficiency for a few weeks or months as they learn to code and process claims with ICD-10.  If your biller is 10-30% less efficient, what is the impact on your practice?  Will you need to budget for overtime?

Will you be as efficient completing your encounter notes with the increased documentation requirements?  Will the biller or medical assistant need to come back to you more often and request more detail in order to support the diagnosis code?

How are you training your staff?  Self-study, online class, AAPC ICD-10 Bootcamp?  Are you going to run the office through some scenarios so everyone can practice in a coordinated way? Will you do this on a Saturday; close the office on a Friday?  Have you budgeted for this?  What about vacations during those times?

Next Steps

Hopefully I have given you some things to ponder.  This isn’t a complete list, but should spark your thought process.  Next time we’ll give further shape to these things by discussing how to manage the process and put together a timeline.