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The EMRs You Don’t Hear About

Posted on September 4, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

The best-known EMRs got that way because they target the masses. About a third of the country’s physicians focus on primary care, with the remainder fragmented across dozens of specialties and subspecialties. It’s easy to see, then, why the major EMRs are primary-care centric.

For specialists, the solution is often to use a general EMR and tailor it, with templates and other features, for the field’s common diagnoses and treatments, as well as its workflow. The question is whether the customization is enough. After all, the practice of, say, a nephrologist, who focuses on kidney ailments, doesn’t look much like that of the average family practitioner. And that’s not even considering other health care providers, such as optometrists, who aren’t MDs but who are eligible for meaningful use incentives all the same.

Some providers, then, choose a single-specialty EMR. Sometimes it’s a specific product from a larger health IT company. In other cases, it’s software from a vendor operating in but one niche.

Here are a few specialties with very specific practice patterns and the vendors who serve them with EMRs and practice-management software.

  • Nephrology. Physicians in this specialty deal with conditions and treatments such as kidney stones, hypertension, renal biopsy and transplant. A major part of the workflow is dialysis. One vendor catering to this specialty is Denver-based Falcon, which claims that its electronic notes transfer feature can “bridge the gap between your office EMR and dialysis centers.”
  • Eye care. Care in this field is provided by ophthalmologists, optometrists and opticians. Diagnosis and treatment rely on equipment and techniques unlike those found anywhere else in medicine. If you’ve ever had your eyes dilated, you know this is true. Hillsboro, Ore.-based First Insight created MaximEyes with eye care’s peculiar workflows in mind.
  • Gastroenterology. More commonly referred to as Gastro or GI. Florida based gMed (Full Disclosure: gMed advertises on this site) focuses on GI practices with GI specific problem forms, order sets, history forms, and Endoscopy reports to name a few. Plus, they are the only EHR which reports directly to the AGA registry.
  • Podiatry. These specialists of the foot train in their own schools. Bunions, gout and diabetic complications are among the problems they treat with therapies ranging from shoe inserts to surgery. DOX Podiatry, based in Arizona, concentrates on this field, providing clinical, scheduling and billing and collections modules. Its clinical component starts with a graphic of a foot, allowing the podiatrist to specify the problem area and tissue type. DOX claims that the software can eliminate the need to type reports.
  • Addiction. Chemical dependency and behavioral health providers include a variety of specialists, including psychiatrists, psychologists and counselors. Documentation in the field must account for outpatient, inpatient and residential services and for individual and group counseling sessions. Buffalo, N.Y.-based Celerity addresses the heavily regulated industry with its CAM solution, developed by a clinical director in the field.
  • Oral Surgery. This field is a dental specialty focused on problems of the hard and soft tissues of the mouth, jaws, face and neck. As such, an oral-surgery EMR needs heavy-duty support for the anatomy in play. DSN Software, based in Centralia, Wash., sells Oral Surgery-Exec for this group of providers. You might actually have heard about this one, because I interviewed its creator, Dr. Terry Ellis, in July for a post called “Develop Your Own EMR Crazy, But This Guy Did It Anyway.” In fact, there’s nothing crazy about using an EMR custom-designed for the work you do.

What Would Happen If EMR Incentive Program Was Halted?

Posted on October 11, 2012 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Particularly over the next few months, with the presidential election looming and the aftermath underway, I doubt we’ll see any changes to the Meaningful Use program. But it’s worth asking nonetheless, given the recent request by some Congressmen that HHS halt the MU program, what would happen if MU incentive payments suddenly came to a halt.

Here’s a few observations based on what we know or can easily guess right now:

1. The effects would be very widespread.

As HIMSS notes in its press release opposing the cut:

Recently-released CMS data show that over 2,700 Eligible Hospitals and 73,000 Eligible Professionals have attested to Meaningful Use Stage 1 requirements since the incentive program began in 2011.”

I don’t know what percentage of EPs that represents, but that’s approaching roughly half of all U.S. hospitals, depending on which ones you count. Pulling back incentives would slam the other half.

2. Efforts to bring rural/critical access hospitals on board would stall.

ONC is just kicking off a program to have all 1,000 critical access/small rural hospitals meaningfully using health IT by 2014.  (More to follow on this on our sister site HospitalEMRandEHR.com.) While big hospitals might move ahead on their efforts for other reasons, these smaller hospitals probably wouldn’t have the means to do so.

According to HIMSS data, such hospitals are already way behind when it comes to health IT adoption. A halt in incentive payments could only make this worse.

3. Future incentives would be viewed with suspicion.

I don’t know about you, but if I was promised incentives for taking on a very, very expensive and rigorous process, had them pulled back, then had them restored, I’d lose trust in the Meaningful Use program. ‘Nuff said.

4. EMR adoption would lose momentum.

Hospitals and eligible providers have taken on big expenses and risks to bring on EMRs and supporting health IT, but if they don’t see the promised incentives as being completely predictable, they might slow or stop their efforts. How much so would depend on how committed they already were, of course, but the EMR adoption process would lose momentum.

Incentives are giving many hospitals and EPs an excuse to move forward, and without that many might sit on their hands for a while.

What other effects do you think it would have if the incentive payments stopped flowing for a while?

Final Rule for Stage 2 Brings Some Changes to Stage 1 – Meaningful Use Monday

Posted on September 10, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

Although Stage 2 requirements don’t become effective until 2014, the Final Rule for Stage 2 contains some changes that apply—or can apply—to providers before then, and some that will apply to all physicians in 2014, even those still in Stage 1. These changes fall into 3 categories in terms of timing:  those that are effective in 2013, those that can be adopted in 2013 at the physician’s discretion, and those that are implemented in 2014.

Effective 2013:

  • Conducting a test of the EHR’s capability to exchange clinical information (Stage 1 Core Measure 14) will be dropped from the requirements. It will be replaced in Stage 2 by measures that require actual and ongoing exchange of information.
  • A new exclusion for the ePrescribing requirement is being added for physicians who have no pharmacy within 10 miles that accepts electronic prescriptions.

At Physician’s Discretion in 2013 (and required in 2014):

  • The Vital Signs measure will be restructured to separate the reporting of height and weight from the reporting of blood pressure. This is good news for those specialists who consider some, but not all 3 of the vital signs, relevant to their practice. Along with this change in the measure are revised minimum ages: blood pressure reporting will be required for patients age 3 and over instead of age 2, and height (or length) and weight will be required for all patients, even those under 2.
  • An alternate calculation for CPOE will help physicians—again, likely specialists—who do not prescribe frequently enough to meet the Stage 1 (30%) threshold. The denominator will be limited to “medication orders created by the EP during the EHR reporting period,” instead of “unique patients with at least one medication in their medication list.”

Effective 2014:

  • Currently, in Stage 1, if a provider attests to an exclusion for any menu measures, these measures can be counted towards the menu requirement. In Stage 2, this will no longer be true—excluded measures will not satisfy the menu requirement if there are other measures on which the provider could report instead. This will also apply to providers who are still reporting under Stage 1 in 2014—a change which those providers will likely perceive as inequitable since it did not apply to the earlier attesters. Those physicians who qualify for multiple exclusions—specialists, once again—will find that the menu set is really no longer a menu, as they will be left with few, if any, choices. 

So, while physicians do not have to focus on Stage 2 just yet, they should consider whether they might benefit from the 2013 changes described above.

Meaningful Use Stage 2 Final Rule: What You Need to Know—At Least For Now – Meaningful Use Monday

Posted on August 27, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

Without delving into all the specifics detailed in the 672-page Final Rule for Stage 2, what is important to comprehend—for now—is how Stage 2 raises the bar set by Stage 1 and how it intensifies the focus on health information exchange and patient engagement.

The following are some highlights of Stage 2:

  • The Final Rule not only confirms 2014 as the earliest effective date for Stage 2 (as expected), but it provides additional leeway for providers and for vendors by limiting the Stage 2 reporting period to 90 days in 2014, instead of a full year.
  • EPs must meet or exclude all 17 core measures and must meet—not “meet or exclude”—3 of the 6 menu measures. (Unlike Stage 1, exclusions of menu measures do not count unless the EP cannot find 3 relevant menu measures.)
  • All Stage 1 menu measures except syndromic surveillance become core measures.
  • 5 new menu measures have been added: access to imaging results, family history, progress notes, reporting to cancer registries, and reporting to specialized registries.
  • Stage 2 increases most Stage 1 thresholds.
  • CPOE is expanded to include lab and radiology orders, in addition to prescriptions.
  • Patient portals play an important role as a means of providing patients with access to their medical records. Physicians will have to ensure that at least 5% of the patients they see actually view, download or transmit their health information and that over 5% of the patients seen send them a secure e-mail message containing clinical information, (i.e., not just a request for an appointment.)
  • Clinical summaries of office visits must be available to patients within 1 day, instead of the 3-day timeframe in Stage 1.
  • The Stage 1 measure requiring a test of the ability to exchange clinical data with another provider has been dropped effective 2013, in favor of a more robust 2014 Stage 2 requirement for ongoing exchange of a significantly more extensive data set.
  • EPs will report on 9 of 64 clinical quality measures, and after the provider’s first incentive year, the CQM data must be submitted electronically, rather than by attestation.
  • In an effort to streamline the reporting process, Stage 2 offers opportunities for batch reporting by group practices and for consolidated CQM reporting for PQRS and meaningful use.
  • Penalties and hardship exemptions are defined, establishing October 1, 2014 as the latest date by which an EP can attest for the first time and avoid a 1% payment adjustment in 2015.

More information about Stage 2 will follow in future Meaningful Use Monday posts.

Planning for Stage 3 is Underway – Meaningful Use Monday

Posted on August 20, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

At the HIT Policy Committee’s meeting on August 1st, the Meaningful Use Workgroup presented its preliminary recommendations for meaningful use Stage 3. Giving plenty of advance warning regarding its intentions for Stage 3, the Policy Committee hopes to avoid the type of timing issues that led to the postponement of Stage 2. The committee plans to send its final recommendations to HHS by May 2013, well in advance of the earliest timeline for Stage 3—2016. In light of this schedule, the initial recommendations are being formulated before we know how Stage 2 will be finalized and before we can fully evaluate Stage 1. Hopefully, as the planning process advances, the committee will have the time to take into account the experience of participating providers. 

As outlined in the preliminary recommendations, Stage 3 would intensify Stage 2’s emphasis on interoperability and patient engagement and expand on care coordination, quality and safety, and population health. It would foster a new model of care that is team-based, outcome-oriented, and geared toward population management. To accomplish this, it would include—among other requirements —expansion of clinical decision support, including tracking of compliance; electronic management of referrals; and enabling patients to update or correct information that is in their chart. 

Lest you think that a plan for Stage 3 means that the end is now in sight, sit back and take a deep breath. The plan envisions a Stage 4!

Meaningful Use Infographic – Meaningful Use Monday

Posted on August 13, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It seems that everyone (including myself) love infographics. So, I was really glad to see that Greenway (Full Disclosure: They advertise on the site, but they didn’t ask me to post this. I found it on my own.) put together an Infographic with the Meaningful Use stats. They offer the following important details on the data for the meaningful use infographic:

  • Payment and registration statistics as of May 2012
  • Top Specialties participating in Medicare MU 2011
  • Meaningful Use attestations by Region 2011
  • Money available for Eligible Providers
  • Who is eligible to participate
  • Necessary steps to achieve Meaningful Use

How Should Locum Tenens Attest to Meaningful Use for the Medicaid EHR Incentive Program? – Meaningful Use Monday

Posted on August 6, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


Jessica Shenfeld, Esq. is the founding partner at The Law Office of Jessica Shenfeld, a boutique law firm that caters to physicians’ legal needs. She is also CEO of EHR Incentive Help, Inc., which helps physicians satisfy the Meaningful Use criteria and apply for the Medicare/Medicaid EHR Incentive Program benefits. For more information, visit http://jessicashenfeld.com/healthcare-legal-services/ehr-incentive/.

A reader asked about the best way for a locum tenens to attest to Meaningful Use for the Medicaid EHR Incentive Program. As you may know, the phrase “locum tenens” is Latin for “place holder” or “substitute.” Locum tenentes physicians – like substitute teachers – may receive assignments that vary in length from a couple weeks to many months. As such, a locum tenens physician can work in multiple clinic/office locations over any given ninety-day period. This issue addressed below applies not only to locum tenens, but also to any doctor that works in multiple practice locations and wants to apply for the EHR Incentive Program as an individual eligible professional (EP). The reader’s question breaks down into two separate questions:
1. What location should the doctor use to demonstrate Meaningful Use?
2. What patient data should the doctor use to calculate the patient volume threshold – that at least 30% of the patients the EP treated were Medicaid patients?

The important point to remember is that doctors that work at more than one clinical practice site are NOT required to use data from all sites to support their demonstration of meaningful use and the patient volume threshold.

1. Meaningful Use: Under the Medicaid EHR Incentive Program, an EP must have at least 50% of their of their patient encounters during the EHR reporting period at a practice/location or practices/locations equipped with certified EHR technology capable of meeting all of the meaningful use objectives. In lay terms, that means that in order to receive the Medicaid EHR incentive, a doctor must have had a certified EHR system installed (either adopted, implemented, or upgraded) in at least half locations where they practiced over any 90-day period in the prior calendar year.

2. Patient Volume: In order to be eligible for the Medicaid EHR Incentive Program, at least 30% of an EP’s patients over that same 90-day reporting period must have been Medicaid patients. This calculation is called the “patient volume” calculation, and it may be calculated differently in each state. The answer that applies in New York is that EPs may choose one (or more) clinical practice sites in order to calculate their patient volume. While the calculation does not need to include all practice sites, at least one of the sites from which patient data is drawn must have certified EHR technology. In other words, if an EP practices in two locations, one with certified EHR technology and one without, the EP must include the patient volume from the site that includes the certified EHR technology. In this example, the EP has the choice as to whether he wants to include the patient volume from the site without certified EHR technology to calculate patient volume calculation.

Although the reader asked about the Medicaid EHR Incentive Program, a locum tenens can apply for the Medicare EHR Incentive Program using the framework outlined above with one exception: to establish Meaningful Use, at least half the practice sites where the locum tenens worked over a 90-day period in that same calendar year must have had a certified EHR system capable of meeting the Meaningful Use requirements. The patient volume analysis above applies to both Medicaid and Medicare.

MU Attestation Audits – Meaningful Use Monday

Posted on July 30, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

By definition, attestation is based on the honor system—that is, at least until you find yourself the subject of an audit. CMS has launched its anticipated program, and some physicians who have received an EHR incentive payment recently received a letter from the designated auditing firm, Figloiozzi and Company

Although there is no way to predict which physicians will be audited, providing the information requested should not be too onerous a task for those “lucky” ones who are tapped. Providers are being asked to show proof that they possess a certified EHR and to substantiate the data they reported for the core and menu measures—specifically, via “a report from their EHR system that ties to their attestation.” Since all certified EHRs generate an automated measure calculation report and a clinical quality measure report, that documentation should be readily accessible. It would not surprise me if they are also asked to provide documentation of the security and risk analysis that the practice conducted to ensure HIPAA compliance. For suggestions regarding the type of data to retain to support your attestation, see the Meaningful Use Monday post, MU Attestation: Save Your Documentation.

Based on material published by the auditors and by CMS on its EHR Incentives website, it does not seem that the audits will be so detailed as to require site visits or reviews at the patient chart-level. My sense is that CMS is looking to identify failures to comply with the major requirements—adopting and using a certified EHR to meet the meaningful use measures and reporting accurately on the data generated by that EHR. 

(If you have been audited and would like to share your experience, please post a comment.)

Multi-Site Providers Who Don’t Have Certified EHR in All Locations – Meaningful Use Monday

Posted on July 16, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

A reader asked how a physician meets meaningful use when some of his encounters occur at a nursing home where there is no certified EHR. Specifically, she wanted to know if the physician was expected to bring his own EHR (hardware and software) to the facility to document encounters there. The answer is “no”—he limits his reporting to encounters that take place in the clinic setting. 

A somewhat similar situation is faced by physicians who are affiliated with two (or more) different practices, where not all of the practices(s) are equipped with certified ambulatory EHR technology. In this case, the physician reports on the encounters where a certified EHR is available. The only caveat is that to be eligible for an EHR incentive, the physician must have at least 50% of his encounters at location(s) that do have a certified EHR.

If you have other questions you’d like answered about meaningful use or the EHR incentive money. Please send in your question on our contact us page.

Medicare EHR Attestation When Switching Practices Mid-Year – Meaningful Use Monday

Posted on June 25, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

This week’s post will answer a Medicare question posed by a reader in response to Jessica’s post last week on Medicaid EHR Attestation with Multiple Practices. The reader asked about a physician who switches from one practice to another in the middle of year 2, but the answer below would also apply to a physician who works part-time at two (or more) practices.

“What about a Medicare EP who successfully attested for year one with her former employer and now works with us. Neither employer has enough information to report a full 12 months of info for her. Do we still attest for year two and fail it all or can we skip a year? And is it ok for the first employer to receive the first payment and we claim the rest? So complicated! Thanks for any input/help!!!”

Although the situation does make it more complex to attest, it does not mean that she cannot earn an EHR incentive this year. Incentives are tied to the physician—not the group—via the physician’s individual NPI number, regardless of whether the payment was made directly to the physician or assigned to the group. Therefore, even if the physician assigned payment to his former group last year, it is perfectly acceptable for her to assign payment to her new group this year. 

A physician who successfully attested and earned an EHR incentive in 2011 must report for the full calendar year in 2012 in order to earn the second payment. However, the information does not have to come from just one practice for the entire year. As long as the physician uses a certified EHR at both practices, she would simply have to report on all of the meaningful use requirements with data from both practices, combining the numerators and denominators for each measure when attesting. (For an explanation of how to report, see read CMS’s FAQ #3609.) She would also have to enter both EHRs into the CHPL website and generate a different Certification ID Number. 

If for some reason, the physician does not elect to pursue the 2012 incentive, there is no need to attest and fail this year. She can simply forego the second payment and start again with the third year’s incentive next January.