Electronic Prescribing(e-Prescribing) in Las Vegas
I’m not afraid to say that I live and work in Las Vegas. I don’t think I would call it completely home, but possibly home for now. Well, my third favorite Healthcare IT blog Just recently posted an interesting link to the local Las Vegas newspaper. I will admit that it is really the only newspaper that people read in Las Vegas. There are a few other that try to challenge, but really it is all about the Las Vegas Review Journal or “RJ” as it is affectionately known. I digress. Neil points out that an article on what the RJ called news is in his opinion stale news since he personally wrote about the same story in October in a Health IT World article. It’s interesting what can be considered “stale” news to one might be great news for another.

More importantly I was grateful that Neil pointed this article out to me since I’m very interested in getting Allscripts for free. I’ll have to see how it integrates with my EMR package and how Allscripts works, but I’ve wanted to use it for a while. One other problem I may have with Allscripts is that we have our own pharmacy. I wonder what is involved in getting Allscripts to work at our pharmacy. Does the e-Pescribing in Allscripts integrate with our pharmacy software ProPharm from Kalos Inc? These are all questions that I’ll have to be looking at soon. I’m also interested in how the alternative works when a pharmacy is not Allscripts compliant. I’ve heard it just sends through the fax which is something I’ve been looking into myself as an interim solution. Now if I could just find the time to work on all these fun projects. Thanks Neil for pointing it out to me. I guess I should have become part of the healthcare IT blogosphere sooner.

EMR Money in Rochester, NY
I recently ran into some other EMR news in my wife’s home town of Rochester, NY. I’m always interested in what’s happening there since I’m sure we’d consider moving there one day if the opportunity is right(despite Kodak pretty much leaving Rochester). The EMR article’s first line went as followed:

Two local coalitions will use $4.6 million in state grants to expand the use of electronic medical records. They hope the result will improve the quality of care for patients.

However, as I delved into the article I found that almost no amount of the money is going towards actual doctor’s implementations of EMR. In fact, almost all the money is going towards the development of an RHIO in Rochester. I think this is a great thing I can’t wait to see what a full working RHIO looks like. This type of money should give them a good start. Maybe some of you could disagree and say that RHIO’s are EMR. However, I would disagree with you. I will agree that RHIO’s are linked to an EMR and that an RHIO is very beneficial when you have an EMR. I’ll even say that an EMR becomes infinitely more important when there is an RHIO available. However, an RHIO is not an EMR. So, I was disappointed to read what I thought was a bunch of cash to support a nice EMR project in the Rochester area turn out to be a bunch of money for an RHIO. Maybe I should start working with an RHIO in the Las Vegas area. Is there one? I best find out.

If you are implementing an EMR you need to understand the difference in types of interfaces. Unfortunately I bet this is a significant misunderstanding that occurs when discussing interfaces in an EMR purchase. Maybe this opinion is biased because that is what happened to my clinic. After a few long discussions we finally understood the questions we should have asked rather than assuming we knew how an interface works.

The assumption that was made by my clinic(thankfull not me since I hadn’t been hired) was that the interface would be bi-directional. What does that mean? That means that when a Pharmacy is ordered by a Doctor the script would automatically be available in the Pharmacy program(one direction). Then, when the script was filled it would post the charge back to your EMR(second direction). The assumption was made that this would just happen without considering a few questions. First, what happens when someone doesn’t want to fill their script at our pharmacy? Then, the Pharmacy database is filled with a ton of scripts that they never needed to fill. Also, what happens when a drug is filled in your EMR that isn’t available in your Pharmacy program? How does your HL7 interface match a prescribed drug with the drug in the pharmacy database which has enough inventory? How does the interface pass the charge back when someone brings in a pharmacy from another doctor?

For those of you familiar with HL7 interfaces you know that many of these things can be solved. In fact, I hope that somebody will post some ideas on the best ways to accomplish this. However, these are important things to consider and discuss when purchasing an interface. In many cases the “mythical” concept of it all just working may leave you with a uni directional interface.

Not that a uni-directional interface is bad. The fact is that my clinic currently have two uni-directional interfaces. One direction patient information and insurance eligibility is passed. The other direction charges get passed back. This has worked out quite well even though we expected a bi-directional interface.

The moral of the story is to Ask Questions and then Ask MORE Questions! You aren’t an expert on HL7 and you have the right to know what your vendor means by an HL7 interface.

I imagine there are other options than HL7, but so far I haven’t seen any. So, I’ll assume for now that there aren’t any until someone corrects me.

A recent article described a fascinating way of allowing people to pick up pharmacy refills using a kiosk machine. What a great idea!! I can really see how this could save you some money and really takes service to the next level. Their is definitely some risk involved with the process, because of what is required to authenticate that you are giving the drug to the correct person. I hope they have some sort of video surveillance or other security methods in order to satisfy all the HIPAA regulations(or whatever regulations pharmacies are required to follow). Either way there could be some serious consequences if those drugs were picked up by the wrong person. Also, what happens to the counseling that the pharmacist gives? I guess that is gone.

I really enjoyed a quote from the Asteres Company Website who is the creator of these kiosk machines.

The best customer service begins with choice.
There are times when we need personal attention
and there are times when every minute counts.

I for one am very grateful for companies like these. I’m not sure if it’s the same company, but I love renting DVD’s from a machine for a much cheaper price.

I saw a really good survey about the technical systems that University Health Centers in the Sun Belt region are using. It covered Medical Clinic Systems, Electronic Medical Records, Appointments made by email and online, Pharmacy systems, Mental Health Systems, Wellness Education Systems(not many of these), Laboratory, Digital X-ray and Computer portals. I twas interesting to see the variety. In fact, there was a lot more variety than I would have expected. Pyramed seems to have a good Medical Clinic System(I assume this is appointments and billing probably) because so many University’s had it. This could also because it is only the Sunbelt region. Medicat seemed to have the most listed for EMR with a variety of other choices. QS/1 seems to be the pharmacy of choice.

I was a little disappointed that this was just a subset of the US. I would love to see a similar survey for the entire US. I also wish it was in excel rather than PDF, but that was even more important for the jobs part of the survey. Here’s a link to the tech report.

My desire is to post things I find of importance related to HIPAA and EMR. My personal experience is in College Health so I will focus on posting items related more specifically to College Health. However, I will try to incorporate any aspects of EMR and HIPAA because I think best practices across the industry are important to know. Please feel free to post all you want if you find some good information that I haven’t seen and correct me if I’m wrong. This is my best knowledge from my research and is not guaranteed in anyway.

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