How do I post my comments?

Many of you have asked, so here is the direct link to CCHIT's public comments forum. In order to submit, you first have to register a username and password.

CCHIT public comments forum begins Monday

Remember that one time I decided to be really obnoxious and chastise the physician constituency for not speaking up about the ongoing EMR Certification process? Well, I stand by my obnoxiousness! Because now you actually have a forum to make yourself heard. Observe, the latest from the Certification Commission's newsletter:

"The first 30-day public comment period of the 2011 development cycle will open Nov. 16 – Dec. 15, 2009. Comment will be accepted for the first round of criteria for additional electronic health record (EHR) Comprehensive certifications not included in the Commission’s Oct. 7 launch of CCHIT Certified® Comprehensive and Preliminary ARRA certification programs.

These expanded areas include Clinical Research and Dermatology criteria (optional add-ons to the current Ambulatory EHR certification) and Behavioral Health EHR criteria - both standalone and as an optional add-on to the current Ambulatory EHR certification. Comment will only be taken through the Commission’s Web site."

Feel free also to share comments below, or email me with questions. Up next: stay tuned for a summary of the latest on certification guidelines.

--FR

Live Blogging from AAO 2009!

Or, We've Been So Busy We Haven't Had Time for Blogging!
Or, The Bottom Line Is: Everybody Loves EMR!

Dear Poor, Neglected, Though Ever-Constant, Blog Readers,

So much to say, so little time, as I write this now while sitting at booth 2964 at AAO 2009. That's right, live blogging! (Although, admittedly, because of limited internet access, I won't be able to publish this post until I go upstairs... But let's pretend it's totally live.)

Live blogging -- which is to say, the instantaneous transmission of information -- is perhaps emblematic of what we at IO Practiceware perceive to be a new era of doctors and their staff embracing technology! Which is to say: it looks like the ophthalmology community is finally (dare I say it?) embracing EMR!!!

Quite the revelation, I know. And, sure, maybe it's slightly premature. But I'm going to roll with it. It's like when you really, really, really like a boy and right after he kisses you you blurt out that you want to marry him and have his babies, only to find that it was way too premature, and way too effusive, and, uh, on second thought, he doesn't really feel the same way, and, uh, let's be friends.

But let's put aside my relationship issues. Let's instead talk more about this new climate of EMR warm and fuzzies. That's right: warm and fuzzies. We at IO Practiceware have been so pleased by the positive feedback we've been getting from the health care community, and especially those of you who have been following our product for a while, and especially especially those of you who have decided to take the plunge and implement our software.

Indeed, we have always suspected that the slow-turning gears of EMR acceptance would finally come full circle, but it's quite amazing to encounter affirmative feedback firsthand.

Why is this the case, you ask? Good question. We suspect that, most generally, EMR has become less scary. More specifically, with the newly-released CCHIT guidelines, the whole concept of certification has become more or less demystified (...much more on this topic in the next post...). What's more-- the practice landscape is now replete with success stories. EMR is no longer associated with failure, no longer the harbinger of doom. Instead, it is the gateway to the future! It is truth! It is beauty! It is freedom!

Bohemian maxims aside, AAO 2009 has been awesome. Thank you to all the folks (current customers included!) who have helped keep our spirits high. And, to those of you who want to join the party, be sure to check out our company website. Click here to contact us. We would be happy to set up a demonstration for you.

More to come soon!

It's good to be back.

--FR

Coming Attractions: AAO Joint Meeting, Oct 24-27

(A sneak peek of what's coming up after the New York Retina Congress)

American Academy of Ophthalmology, Oct. 24-27, 2009
San Francisco | The Moscone Convention Center
IO PRACTICEWARE EXHIBITING AT BOOTH 2964

Click here for a complete list of exhibitor "virtual booths." IO Practiceware's is listed under the letter "I" -- or you can scroll through to page number 10 (we are the first listing at the top).

CCHIT Town Call's anticipated gist: "HURRY UP."

Hate to say, "I told you so," but CCHIT's latest take on the long road to EMR adoption goes a little something like:

HURRY UP.

Their latest statement, released earlier today, urges health care providers not to wait until Spring of 2010 to begin adoption, because this will most likely prevent them from establishing meaningful use by the 2011 deadline. Press release excerpted below:

“We are concerned that providers could not achieve meaningful EHR use in 2011 if they wait until Spring 2010 – the expected date of HHS final approval of requirements – to begin adopting this technology,” said Mark Leavitt, M.D., Ph.D., Commission chair. “CCHIT has analyzed the recommendations of the Federal HIT Advisory Committees and is preparing to offer new paths to certification beginning this October. We invite vendors and developers to join us on a Town Call as we finalize the details of this process.”

CCHIT's Town Call, the latest in a series of group web conference whose intention is to incorporate the thoughts and concerns of doctors, practice administrators, as well as EMR vendors, will be hosted on September 3 at 1PM EST. Complete information on how to join the discussion listed below.


DATE: 9/3/2009
TIME: 1:00pm EST / 12:00pm CDT
WEB CONFERENCING: Information on how to link up online available here.

AUDIO: To use computer audio, you need speakers and microphone, or a headset.

To use telephone conferencing:
US/Canada Dial-in #: (866) 900-5706
Conference ID: 27236682

IO Practiceware to Exhibit at ASRS's Retina Congress 2009, New York City

Hello, dear, friendly, and inexusably neglected, Blog readers!

Let it be here writ that IO Practiceware, paragon of EMR vendor-ship and goodwill toward ophthalomology, will be exhibiting at the upcoming ASRS Retina Congress of New York.

Will you be in attendance? Here are all the details you need to know:

The American Society of Retina Specialists (ASRS) Presents
RETINA CONGRESS 2009
September 30 - October 4, 2009
Sheraton New York Hotel and Towers
IO PRACTICEWARE EXHIBITING AT BOOTH 230

Booth number 230, is, for your information, a corner booth! And corner booths are reserved only for the most illustrious and popular individuals. It's like how Jack Nicholson always sits in one of the front rows at the Academy Awards. (Here is a complete ASRS booth floorplan.)

If you are not already signed up to attend the meeting, registration has unfortunately been closed to newcomers. But there's always next year or, if you'll be in San Francisco in October, AAO 2009.

Smartphone Survey Results

From Softwareadvice.com:

Last week, Software Advice set out to answer the question: Which smartphone will own the healthcare market?

Doctors, nurses, students and many others in the healthcare industry responded to our survey.

You can find those results here.

Reductive Positivity Amidst the Mire of Uncertainty

Dearest Readers,

Sure, sure, sure, we're all like, "What's going to happen with EMR?" "What if I don't get my incentive payment?" "Why won't Craig call me back?"*

(*This concern may, in fact, apply only to me.)

Friends, I have the answer: We must accentuate the positive. Because my last post was a real downer. And because things could always be worse. You could, for example, be Amy Winehouse. And -- what's more -- there have been some truly encouraging developments in the past few months with respect to EMR certification:

1) CCHIT is working around the clock alongside ARRA to define meaningful use for EMR vendors. Sure, it's still half-baked, but we can nevertheless smell its cake battery goodness emanating from the kitchen into the living room as we watch cartoons with our baby brother and fight over the remote control. And, sooner or later, Mom's gonna call us in for dessert. And by "Mom" I mean CCHIT/ARRA, and by "dessert" I mean we'll know for sure what the heck "meaningful use" means. And then lots of $$$ for you and your practice via the stimulus package's incentive payment plan.

2) Who am I really to push you to make a decision before you're ready, but: when you think about it, there is actually no reason to fret about the impending certification criteria. As I wrote in this article, EMR vendor compliance is an absolute, unconditional, take-no-prisoners, definite MUST. As in, vendor survival will depend solely on this compliance. As in, no need to delay. As in, what are you waiting for? As in, I won't hold it against you if you continue to wait, but there are some extremely important reasons why you shouldn't, like this one, for example.

3) IO Practiceware continues to be awesome. If you're not part of an ophthalmology practice, I'm sorry IO can't offer you our ophthalmology-specific software -- but if you are, you can smile broadly and pat yourself on the back for choosing the field in which the best EMR vendor in the universe has chosen to specialize. And then you can buy our software. (Why are we the best EMR vendor in the universe? Here are a few reasons why.)

So there it is folks, as promised. Reductive positivity. Because, in the words of the atomic particle: "I was pretty bummed yesterday when I lost my electron -- but you know what? Now I'm more positive."

--FR

Not Enough EMR to Go Around?

Did you not have your dose of Cold Hard Truth this morning? Well, here's a pill or two:

There is an impending capacity overload for EMR vendors. IO Practiceware and, from what we've heard, our competitors have been working around the clock to accomodate the ever-growing surge of interest from practices planning to adopt EMR systems.

And while we will continue to provide the best possible service for every practice that's been queued up for a 2009 implementation, there's no freaking way we'll be able to support this level of interest if it grows at a more steeply exponential rate. Which means we'll have to cap off the volume of our customer base, and increase in the number of implementations per quarter at a much more steady, deliberate, and slow-moving pace. Which means some potential customers will, sadly, lose out.

The EMR industry as a whole -- and IO Practiceware in particular -- is having difficulty imagining how the EMR industry can satisfy the coming demands. Delivery times are lengthening, not only for IO, but for others in the industry. And the unfortunate reality for buyers is that practices that persist in twiddling their thumbs will ultimately lose out. Because, quite frankly, there won't be enough EMR to go around!

Think Christmas, Tickle-Me-Elmo, Ferbie. Same idea. Except, like, way, way more important.

If you're a prospective buyer, identify what's holding you back, and then demand that your questions be answered. IO Practiceware understands the Buyer's Dilemma with respect to CCHIT, but we've made our response pretty clear. (Article here.)

So: no pressure. Actually-- yeah, pressure.

Survey on Smartphones from SoftwareAdvice.com

Do you use a Smartphone? You might want to post your two cents via this survey from SoftwareAdvice.com that closes Tues. July 28 @ 5PM. From the accompanying article:

The smartphone industry is on fire. iPhone, Blackberry, Palm Pre and Google are all in the hunt for dominance. We want to know one thing: Which phone will become the device of choice for healthcare providers?

Briefly: "Meaningful Use" Response from CCHIT

After the ONC (Office of the National Coordinator) published its Meaningful Use guidelines and objectives (available here, with annotation), CCHIT responded with a cover letter assessing the value and anticipated shortcomings of those guidelines.

IO Blog commentary coming soon...

EMR: The Buyer's Dilemma

Catch-22. Cart-before-the-horse. Chickens-before-they-hatch.

Pick an idiom. It seems from your email messages that any of the above encapsulates the conundrum of buying an EMR system before it has been certified. And we at IO Practiceware feel your pain. But we'd also like to put you at ease. But not in a sleazy way, involving low lighting or Barry Manilow music. Because, c'mon, Barry Manilow makes you uncomfortable, and you know it.

You may have many reasons to delay your EMR decision until next year or beyond, but concerns about CCHIT certification should not be one of them. IO Practiceware -- and all other EMR vendors -- have no choice but to follow the ARRA rules. It's true that certain consultants and other industry figures say that practices must wait until vendors get certified -- but this presumes that there's a high level of uncertainty and/or ambiguity surrounding the process and guidelines for certification. But there simply is not. Companies can either choose to take the necessary steps or choose not to.

For everyone's sake, we choose: certification.

And, it's like, um, obvious. Not only are we being compliant for our customers' sake, but getting certified is an unconditional must if we -- or any company -- hope to remain on the market as a viable EMR vendor.

IO Practiceware will be certified as an EMR-C ("Comprehensive"), as opposed to -M ("Module"), by CCHIT for the 2011-2012 period -- which is the soonest possible period for all vendors. (There is no freestanding 2009-2010 certification. In fact, all currently CCHIT certified vendors must be re-certified for the new period.) Testing will begin in September 2009, and we are gearing up for this process by developing all the necessary enhancements for our software. (Here is an article that breaks down the timeline in greater detail.)

So, believe it or not, you can start to breathe easy. In a world of relative uncertainty and inexplicability -- where haircuts like this achieve national celebrity -- CCHIT certification should be a comfort, not a source of angst. Given the recent revisions to its criteria, CCHIT has become a means by which EMR can achieve high functionality, uniformity, and interconnectivity. Vendors like IO Practiceware, committed to the success of customers and the EMR industry, will do what it takes, get certified, and work to improve American health care.

--FR

More on CCHIT from ModernHealthcare.com

Article on exploring the effects of the new meaningful-use criteria.

The Latest from CCHIT: "New Paths to Certification" (Recap)

If you didn't have time to take part in today's Town Call with CCHIT (or, if you did, and would like a pared-down recapitulation), here is a list of major points worth knowing:

There are now three paths to certification, and three different certification types therein:

• 1) EHR-C - which stands for EHR Comprehensive
• 2) EHR-M - which stands for EHR Module
• 3) EHR-S - which stands for EHR Site

All three constitute certification, but differ in their requirements.

Comprehensive - "Rigorous certification of comprehensive EHR systems that significantly exceed minimum Federal standards requirements." Needs to meet all of the Meaningful Use Objectives.

Module - "Flexible certification of Federal standards compliance for EHR, HIE, eRx, PHR, Registry and other EHR-related technologies." Needs to meet one or more of the Meaningful Use Objectives. Applies to many specialty-specific EMRs.

Site - "Simplified, low cost certification of EHR technologies in use at a specific site." Applies to "any physician office, clinic, hospital, other facility or network that has self-developed or assembled an EHR from various sources and wishes to apply to ARRA incentives."

Process of Applying for ARRA Incentive Payments

• Certification by CCHIT allots various certification "codes" to the EHR vendor -- which apply specifically, and exclusively, to that vendor, and vary depending on the corresponding status (EHR-C versus -M versus -S have different codes) . These are then conveyed to the health care provider upon usage.
  
• Health care provider submits these codes in their ARRA incentive payment application.
• Health care provider must also submit additional "measure data" required for ARRA's own definition "meaningful use" (separate from CCHIT criteria).
  

Other Info / Points of Clarification

• Providers do not apply to CCHIT for the incentive payment; they apply to HHS. The means by which this will be done is still unclear, and has not yet been stipulated. Will it be a contractor? An online site? Via regional extension centers? What we do know is it will be through some government-named body that will 1) accept CCHIT codes and provider application; 2) assess, reject or accept quality measure data; 3) send or withhold the incentive check.
  
• EHR-M status can be awarded to groups of vendors. If certification is awarded to a group of vendors, they collectively must cover all (as opposed to one, or a few) Meaningful Use Objectives.
• Certification awarded in two year increments.
• Certification no longer "locked" into a software's parent version; all upgrades that maintain the previously approved Meaningful Use Objectives maintain those corresponding approval codes.
• A provider's site can be certified as EHR-S, even if the EHR software has not been approved as EHR-C or EHR-M. If a site uses an EHR-C or EHR-M, then it is certified as an EHR-S. The converse, however, is not true: EHR-S does not confer -M or -C certification status onto the software in use.
• CCHIT testing will begin in September of 2009. There will be no freestanding certification for 2009-2010. All testing will be geared toward the ARRA requirements for the upcoming 2011-2012 period. In other words, there will be no maintenance of any old CCHIT certification. (Click here for more on ARRA timing.)

If you have additional questions, you can email dwilson@cchit.org, me, or you can submit your comment below.

Complete CCHIT Presentation slide show available here.

CCHIT Hosts "Town Call" Web Conference June 16 & 17

Tired of seeming complacent? Well, here's a chance to make yourself heard:

CCHIT to Propose New Paths to Certification

CCHIT has announced two Town Call web conferences on June 16 and 17 to gather stakeholder input on new paths to certification of electronic health record (EHR) technologies, with the goal of supporting more rapid, widespread adoption and meaningful use under the American Recovery and Reinvestment Act of 2009 (ARRA).

To join the calls:

Tuesday, Jun 16, 2009 1 PM EDT / 10 AM PDT
“New Paths to Certification: Dialog with the Open Source Community”
Dial-In Number: (866) 900-5706
Conference ID: 15249954

Wednesday, Jun 17, 2009 11 AM EDT / 8 AM PDT
“New Paths to Certification”
Dial-In Number: (866) 900-5706
Conference ID: 15316708

For more information, see CCHIT Town Calls.

Be sure to tune in!

"Meaningful use" criteria slated for June 16

Briefly: much buzzed-about meaningful use criteria will supposedly be released by the federal government on June 16. These criteria will apply to ambulatory and in-patient EMRs.

Jury out on specifics of stimulus in New York

Because my company is based in New York I've gotten a lot of queries about how the national total of $19,000,000 allotted toward health care technology will be available to the state of New York. The best answer I can give is: check out the New York State Senate's page, which includes a helpful breakdown of national funding versus New York funding, arranged by application and area of impact.

But next to "Health Information Technology" for New York? A looming and conspicuous: "TBD."

So, stay tuned and check back. I'll convey the details as soon as I know them.

--FR

Practice Management Blog! (And you thought you'd seen it all)

Because we niche Bloggers need to stick together, let me plug a little gem of a weblog that my colleague came across recently while listlessly browsing the internet. It's called Manage My Practice, and, in the words of editor Mary Pat Whaley, it "provide[s] healthcare executives and medical practice managers [with] a place to find resources and information."

Mary isn't joking around, and, as a Board Certified Healthcare manager and a Fellow in the American College of Medical Practice Executives, she certainly knows her stuff.

We at IO Practiceware are tech-y types, so we're particularly stoked about the "Technology Answers" section. But the whole site is a wealth of information. With topics that span from "Innovation" to "Reimbursement," Manage My Practice tips you off on the latest in several corners of healthcare, from Medicare to swine flu to Twitter.

Way to go, Mary; keep up the good work!

--FR

Patients say, "EMR is A-OK"

Check out this recent article from ScienceDaily, which recounts Beth Israel Deaconess Medical Center's qualitative poll of patients about their opinions on EMR use. The basic gist is that patients are willing to sacrifice some standards of privacy in exchange for better, streamlined communication with their medical care professionals.

CCHIT: Docs, What Matters to You?

Few credible articles begin with sweeping generalizations, but here I go (again): Doctors are acting as mere bystanders while regulatory groups -- for whom physician's needs are not paramount -- decide the future of electronic medical records. And the world. (How's that for sweeping?)

But, seriously, here's what's been going on: Docs receive pronouncements from the government, or other organizations like CCHIT, that will not only determine the fate of health care IT, but which will radically influence their day-to-day lives as medical practitioners. In the meantime, there's a lot of fretting, twitching, Googling, and conjecturing about what is to come. It's an insidious kind of self-disenfranchisement: doctors proactively (and rightfully) strain to listen to the cacophony of voices that have something to say about EMR, but are then reluctant to disagree with what they're hearing. And most of the time these voices do not address or accommodate the specific needs of ophthalmologists -- the ones who will actually have to come in contact with the new technology.

Docs, it's time to take matters into your own hands!

Okay, so I work for an EMR company. If you're a doc, there are probably some trust issues here. But, in all seriousness, it's become apparent to my colleagues and me that, without fail, the issues that concern doctors about electronic health records do not align with the issues prioritized by the higher ups.

And why should they? Apples and oranges, folks. Doctors want an EMR that will work for them: something that is fast, usable and will not compromise their work flow or productivity. In turn, EMR vendors are working to develop products that will respond, specifically, to these challenges.

The government, on the other hand, presumes the blanket success of the EMR industry to be a foregone conclusion. As such, health care higher-ups have preemptively -- and prematurely -- devoted their efforts to the regulation and proliferation of the industry.

But -- what industry? C'mon.

Consider CCHIT-certification. Nearly all stipulated criteria thus far have revolved around issues external to individual practices -- issues like auditing or interconnectivity. There's nothing inherently bad about tackling these issues, but it's a total cart-before-the-horse scenario. The timeline has been curiously inverted, such that less-pressing issues garner precedence over other measures that would ensure usability.

Take, for instance, the requirement that EMRs support DICOM images. Fine. It's something that, if uniformly adopted, would foster standardization and, eventually, interconnectivity. The problem is: almost no (or at least, very few) ophthlamic machines create DICOM images. There's no so-called "community network" to move these images around in. So why, then, make this a pressing issue for 2009?

The need for more doctor involvement in the regulation of EMR is clear. How can you get the ball rolling? Write to ASCRS. Write to AAO. It's at least a start. Make sure that your interests are being met. Create pressure so that the issues that matter in the exam room (speed, interoperability with practice management systems, etc.) are prioritized.

EMR is still in its infancy. In order to serve doctors and to succeed as an industry, we should be most concerned with enhancing and streamlining actual usage. Of course, IO Practiceware believes deeply in the importance of interconnectivity with other practices -- but it should be Stage 2, as opposed to Stage 1, of the CCHIT certification process.

Stage 1: Let's make it happen.

--FR

Email the author

EMR is the Horseless Carriage of the New Millenium

Dear Blog Readers,

I am stuck on a train. The engine has stopped working. In times of crisis and/or intense boredom my thoughts naturally turn to electronic medical records. I dedicate the following unfounded and under-researched article to all the EMR-skeptics out there (you know who you are).

Presenting,

E.M.R. is the Horseless Carriage of the New Millenium, or
GOOD IDEAS PEOPLE* THOUGHT WERE BAD
UNTIL THEY REALIZED THAT THEY WERE GOOD
*In some instances, "people" may, in fact, mean only me.

• Horseless carriages or, as we now call them, cars. Yes, hopefully you saw this coming from the title.
• The American Revolution. I think of IO Practiceware as the rebel army and myself as General George Washington. The British correlative is, um, paper charts.
• Rihanna's mullet-esque haircut. I was destroyed by it at first, but now I see its many merits.
• Bikini waxes. Like EMR because momentary burning sensation precedes lasting silky smoothness.
• Telling my sister Santa doesn't exist.
• Shuffleboard. I have no evidentiary basis for saying this, but if you've seen the sport played I'm sure you'd agree that early on someone must have been skeptical about its potential for widespread appeal. But how wrong they were.
• Indigo-colored nail polish. I have received many compliments and I don't believe them to be disingenuous.
• The internet. Right?
• Baby carrots.

And to round things out, here are a few
BAD IDEAS PEOPLE* THOUGHT WERE GOOD
UNTIL THEY REALIZED THAT THEY WERE BAD
*Same rules apply.

• Clear-colored Coke.
• Younger men.
• This article.

Sincerely,
FR

Nuts and Bolts of an IO Implementation

Besides its staff being inexplicably and distractingly attractive, one thing that sets IO Practiceware apart from other electronic health record companies is its commitment to customer service.

Yeah, sure, you've heard the phrase "customer service" more times than you've heard mention of swine flu, or Susan Boyle, or whether Susan Boyle has swine flu, in the past few weeks. But here at IO Practiceware, when we say "customer service," we mean it!

One prime example of just how extensively IO Practiceware's blood, sweat, and streaming river of tears go into supporting its customers is the infamous IO Implementation -- or, as I like to call it, OPERATION: WE DON'T SLEEP, SO YOU CAN.

I participated in my inaugural on-site implementation one week ago at a three-doctor retinal practice in Central Florida and realized that many of you would probably be curious to know what the heck goes on. I have therefore decided to record my experiences in a way that's significantly more illuminating than, say, my ASCRS 2009 Diary, which was purely an exercise in indulgence and irrelevance.

So: if you'd like a play-by-play of what its like transitioning to IO's EMR system, read on!

Continue reading "Nuts and Bolts of an IO Implementation"

Three Weeks, Three Links

Dear Faithful Blog Reader,

I have been neglecting you for the past three weeks, and for this I am deeply sorry. As an act of contrition, I offer you one EMR-related link for each week of my remission:

1) You've probably heard this one already, but in case you haven't: Obama promised to create an interconnected EMR system for veterans. Hooray! Read more...

2) Only 1 in 4 doctors knows about the $44,000 (per doc) incentive payment awarded to those practices that adopt electronic medical records. If you're the 1 in 4 who's still in the dark, read this.

3) Is there a future for Mac in electronic health record development? Read this post from the Software Advice blog, which describes the potential success of a not-yet-developed-but-so-called "iTablet" -- a portable, touchscreen-based device (hmm...sound familiar?) that could have widespread applicability in Health Care IT. [Oh, look! My own horn; let me toot it: in espousing the benefits and usability of the hypothetical iTablet's touchscreen, Software Advice's article more or less reiterates my own arguments in favor of IO Practiceware's touchscreen-based system. Booyah!]

Paper Medical Records "Blowing in the Wind"

Those of you who have nightmares about the Big Brother dystopia that will be wrought on our planet when electronic medical records make significant headway should check out this article from Richmond, VA's WTVR.com, which describes how yesterday morning a large pile of paper charts were "blowing around" a Babies R Us parking lot.

In conclusion: paper is cool for things like funny hats, not patient charts.

Days 2 & 3: Joyous, Excruciating ASCRS Conference Continues

How can I possibly impart to you the perplexing reality that is working a vendor Booth at the San Francisco ASCRS show?

I will now quote Britney Spears, in rapid succession, without explanation or qualification:

1. "I have always wanted to travel across seas, like, to Canada and stuff."

2. "If I had a bad show and I know it, don't tell me I had a good show. I hate that. I guess because I'm 17, people think I don't see stuff like that.”

3. "I think it's stupid when you see guys with big necklaces. I think that's the biggest turn off in the world. Who do they think they are?"

4. "I'm rich - freaking RICH."

--FR

IO Travel Journal: Tales from the ASCRS Ghetto

Greetings, faithful Blog readers! I write to you now from my comfortable and quintessentially flamboyant San Francisco hotel room, while wearing giraffe-print bath robe, in anticipation of Day 2 of the ASCRS conference.

Yesterday was alternately joyous and excruciating - joyous because I had the pleasure of meeting many of you and excruciating because I was in four-inch pumps. I failed to take adequate notes on the goings on of the show, but I will be sure to do so today and will report back with due diligence. Yesterday, the play-by-play went something like:

8:50 AM Walked to Moscone Center in heels. Ouch.
9:10 AM Began setting up our Booth.
9:55 AM Befriended some nearby ASCRS compatriots. Stole their candy.
10:55 AM Dear God, these heels.
12:01PM SHOW OPENS! Flood of visitors to Booth 3032! Like bees to honey! Like sharks to blood! Like me to the restroom when it was time to get picked for sports teams in seventh grade!
...Yada yada yada yada lots of interest, holy cow, I don't think I've said the acronym "EMR" more times in a row and with such high-pitched inflection....
4:55PM Why were high heels invented?
6:00PM Celebratory dinner of paella and tapas with the IO Team. Sangria. Lots of Sangria.

Hope to see you all today. More Blogging to come...

--FR

(Picture: "Felicia Gives ASCRS the Thumbs Up")

News Article: A Patient's Perspective

Take a look at this recent article from The Huffington Post about electronic medical record use -- written from a patient's perspective.

Author Elizabeth Rigley says she's mostly impressed with her doctor's system (she doesn't name the vendor), but also has some concerns. Among them:

• "The patient does a lot of the typing" [during check-in]
  
• "Sick patients typing on the same keyboard = germs"
• "I hadn't considered that it can take a really long time for a doctor, who rarely typed before as a part of this job, to type in the facts you are telling him. For someone who types quickly, this can be a little excruciating to witness."

Do you see a trend? Using a keyboard for information input is, in a word, problematic.

But this is hardly an unavoidable consequence of EMR. On the contrary, IO Practiceware can actually help you gain speed in the exam room. How?

Two words: Touch Screen!

To learn more, check out this article, this FAQ, or visit our company website.

Opinion: EMR not a cure-all, but an enabler

In a recent US News and World Report blog article by Avery Comarow, the author writes that

...about one fourth of more than 175,000 medication errors registered in 2006 "involved some aspect of computer technology as at least one cause of the error." Mislabeled bar codes, confusing screen displays, and physicians overriding warnings on the screen about a drug were among the examples cited. Bad health IT, or bad use of it, can kill as effectively as low-quality care of any kind.

Hm. This seems like a false attribution to me. "Computer technology" (a vague phrase, indeed) is cited as being "one" component that led to various errors - but Mr. Comarow does not stipulate how or under what circumstances.

To this I say, briefly: Physicians who choose to override computerized pharmaceutical warnings are not doing so because they are hampered by the supposed impediments of EMR, but are rather persisting in what seems to be a lack of vigilance and responsibility on the part of that individual provider. EMR will continue to manifest these oversights, but one cannot attribute those kinds of errors - which are perhaps more prevalent, though less documented, with the use of paper charts - to Health IT.

Electronic health records is not a cure-all - to say this short changes the arguments in favor of EMR. EMR can, and will, enable health care providers to achieve the utmost in interoperable, fluid, and unified care - but only if those providers share a common commitment to its success.

Emeril says, "Visit IO Practiceware at Booth 3032!"

IO Practiceware will exhibit its software at Booth 3032 (see above) at the American Society of Cataract and Refractive Surgery's 2009 Congress and Symposium this coming April 3-8 in San Francisco, CA.

We'll be demonstrating many of our new features, including:
1) New e-prescribing software - in partnership with SureScripts, our software delivers to your practice Medicare's 2% incentive. (Read more...) 2) New PQRI software - providing you with better automation for reporting PQRI measures. 3) New image management software - enabling you to view multiple images on your electronic chart, between visits, and across several diagnostic tests and images -- which essentially means better comparative capabilities. 4) New financial management and scheduling software. Based on customer feedback, we have revamped these key features to provide you with a clearer economy of information, more accessible references for faster payment posting, and clearer streams of display.

Finding booths at ASCRS can be tricky, so write down our number! 3032! 3032. Yes: 3032.

As a mnemonic: envision Emeril Lagasse violently yelling, "Booth 3032!" while throwing spices into a steaming cauldron.

Interest in EMR Explodes!

That's right, you heard me! EMR and health care IT use has more than doubled in five years, a new American College of Physician Executives survey says. According to a core group of 10,000 ACPE members, use of electronic medical records has skyrocketed from 33.1% to 64.5%, and only 5.9% of participants said they were not preparing for future implementation.

For those who had not yet adopted EMR or were reluctant to begin planning, "cost" was cited as the primary concern. Indeed, physicians and their practice teams can become overwhelmed if they consider EMR systems as being revenue-negative.

In response, IO Practiceware hopes you will read this recent post on EMR cost vs. EMR value.

And then we hope you will join us in the EMR revolution!

(Source: ModernHealthcare.com's "Doc use of IT up; money still key issue")

Is Wal-Mart off the Wall(-Mart)? Thoughts on EMR Cost

Wal-Mart, beloved and reviled omnivendor, plans to sell "affordable" EMR software to smaller practices that are loath to invest in "higher costing" systems. Hardware, software, installation, maintenance and product training will be available through Sam's Club for a price that, apparently, undercuts competition by 50%.

Well, I don't know whether I should clap my hands together like a jolly newborn or claw at my own skin while listening to this song.

Because, on the one hand: Nothing could be a clearer harbinger of widespread EMR use and adoption than to see Wal-Mart jump on the proverbial EMR-bandwagon. And that's nice.

But, on the other hand: What?!?!?!

If practices reluctant to adopt EMR are willing to invest in systems simply because they're cheap, we suspect these practices are laboring under some major misconceptions about the value and function of EMR.

Thus, we would like to offer our two cents regarding EMR cost versus EMR value. (Since our specialty is ophthalmology, we will speak about our experiences in that particular field -- though we believe you can apply our points more broadly to other specialties.)

When considering the switch to EMR, a practice should calculate the value of the EMR system. How?

Read more...

(Cited: FierceHealth IT's article on Wal-Mart's EMR Marketing.)

For the Record: AAO on CCHIT

For those interested, here is the American Academy of Ophthalmology's official stance on CCHIT with respect to eye care:

The 2007 Ambulatory EHR Criteria represent basic requirements that the Commission and its workgroups believe are appropriate for many common ambulatory care settings. CCHIT acknowledges that these criteria may not be suitable for settings such as behavioral health, emergency departments, or specialty practices and our current certification makes no representation for these. Purchasers should not interpret a lack of CCHIT Certification as being of significance for specialties and domains not yet addressed by CCHIT Criteria.

Currently, there is no eye care specialty CCHIT certification. The current process for testing is not designed for eye care only EHR vendors, and they cannot participate in the process. A lack of current CCHIT certification does not have significance for eye care specialty needs. Current CCHIT certification means that the system satisfies basic ambulatory care needs. Practices need to look at different systems and how they best meet your needs in delivering eye care services.

From Flora Lum, M.D.
Quality of Care and Knowledge Base Development, AAO

Get with the Times, NYTimes: A Letter from Our CEO

In response to the New York Times' Article "How to Make Electronic Medical Records A Reality":

While it is undeniable that the adoption of electronic medical records (EMR) is hard, the solution selected by the City of New York to endorse one product and spend a great deal of resources on that one product only makes the problem worse. There are many reasons why adoption is difficult, but the most important one is value creation for the practice. Regulatory uncertainty adds to the confusion and uncertainty about adopting EMR.

If all EMRs unquestionably created value for a practice, all other problems would not matter very much. The truth is that many EMRs on the market today slow down doctors in the examination room and either add to or are neutral as to the administrative burden of the practice. In addition, a general-purpose EMR is not the best solution for most medical specialties. Better EMRs that do indeed create clinical and administrative efficiencies are slowly gaining acceptance -- as experience validates the value they create in the medical practice and word gets around. The worst possible thing governments can do at this point is to adopt a "One Size Fits All" mentality, select a single EMR product to cover all medical specialties and to make it the "official choice." This will stifle innovation and slow the process of value creation that competition fosters. This is a good time to let “a thousand flowers bloom."

Government can help the adoption of EMR by dealing with the regulatory environment. Government programs, agencies, and quasi-governmental agencies such as the Certification Commission for Healthcare Information Technology (CCHIT), the primary association certifying EMRs, need be to sensitive to the need to create value in practices as they regulate EMR. An example of poor priorities is to set future public benefits before present need of value creation. Currently, CCHIT certification requires that EMRs communicate with (mostly non-existent) central data repositories, but not that they support practitioner workflow in the exam room by efficient recording of data or help practices with patient communication or insurance billing. If medical practices do not get value from EMRs, they will not implement them and any value that improved communications can offer will not be realized. Government regulation and policy should not eliminate innovators from the EMR field by well-meant but overly burdensome requirements; they should foster value creation by supporting many solutions for the varied and complex needs of the different specialties in the medical world.

While value creation for practices must come first, the regulatory environment must be clear as well. Practices are reluctant to purchase EMRs from companies that may not meet regulatory rules. Therefore, a clear regulatory path is essential to promote EMR adoption. Congress and/or Medicare needs to enact national standards for EMR that clearly state what regulations will be implemented and when.

Government programs designed to help practices implement EMRs are doomed to fail if the EMRs don’t create value for practices.

Sincerely,

Gregory Leopold

Got comments? Post them below!

How Much Will IO Cost You? A Letter from our CEO

Dear Friends of IO Practiceware:

In this otherwise challenging economic time, one bright spot for physicians is the new economic stimulus bill. The bill instructs Medicare to pay physicians who use electronic medical records (EMR) a total of $47,000 each (over a five year period). This means that your purchase of our software is now nearly or completely free. The cost of an outright purchase will be returned to you over five years. If you lease the software, you'll have no out of pocket expense at all.

To receive an estimate tailored to your practice, please email us with the following information:

• Approximate number of patient encounters each month
• Number of offices with significant patient volume
• Do you dispense glasses? if so, at how many locations?
• Which diagnostic test equipment do you use (imaging, lensometers, OCTs, etc.)

The bottom line is: IO's software increases your revenues 2-5% and lowers your costs 5-20% -- even without additional incentives. With the new incentive, it's pretty much an economic no brainer.

Our implementation calendar is filling up, but we can always make room for your practice.

If you'd like to start working with us to improve your bottom line, give us a call or send us an email.

Regards,

Gregory

Health Care IT: The Latest from the Obama Team

By now you've probably caught wind of Obama's advocacy of health care IT -- exciting news for doctors and EMR vendors alike. According to President Obama, our shared goal of improved efficiency, connectivity, and cost-effectiveness is achievable through widespread EMR adoption.

Most recently, Congress has approved of allocating $19 billion toward health care IT -- specifically, transforming paper charts into their electronic form -- as part of a greater $100 billion push for better, more widespread health care coverage. (Read more...)

Moreover, Congress has declared that physicians who use electronic medical records are eligible for up to $44,000 in incentive payments, which will be delivered over a four or five-year period as of 2011. Early birds who begin using EMR by December 31, 2010 or 2011 are eligible for an $18,000 first-year payment, followed by $12,000, $8,000, $4,000 and $2,000 in subsequent years. If practices begin use by December 31, 2012, payments in years 2-5 are the same, but their first-year payment is reduced to $15,000. The reception of this EMR incentive, however, will preclude physicians from collecting additional money for e-prescribing. As for penalties, those who do not adopt HIT incur a 1 percent penalty in their Medicare fee schedule payments in 2015, 2 percent in 2016, 3 percent in 2017, and 3 percent every year beyond that.

Now, ladies and gentlemen, we continue to speculate on how exactly, in practical terms, the Obama team will aid in the implementation of this plan for digitized health records. Indeed, IO Practiceware believes in the value of some form of standardization for EMRs -- to enable and promote practice interconnectivity -- but is wary of the roadblocks posed by CCHIT's limited definition of a "certified" EMR system.

In the meantime, we applaude the Obama administration for encouraging EMR adoption through monetary incentive, enabling the emergence and implementation of specialty-specific EMRs like IO Practiceware.

What do you think? Contact Obama's team or write to your state's senator.

In the meantime, you can check out some related articles: Obama's Big Idea: Digital Health Records, from CNN.com or our previous Blog post on Obama.

IO Practiceware to Exhibit at ASCRS 2009

IO Practiceware will exhibit its software at the American Society of Cataract and Refractive Surgery's 2009 Congress and Symposium this coming April 3-8 in San Francisco, CA. Come visit our booth (number 3032), where we'll be showing off our software, answering questions, and performing live demos. And elaborate tap dances.* We will also be dressed like the Osmonds.*

(*Subject to change.)

Moreover, we'll be demonstrating many of our new features, which include:

• New e-prescribing software - in partnership with SureScripts, our software delivers to your practice Medicare's 2% incentive. Read more...
  
• New PQRI software - providing you with better automation for reporting PQRI measures.
  
• New image management software - enabling you to view multiple images on your electronic chart, between visits, and across several diagnostic tests and images -- which essentially means better comparative capabilities.
• New financial management and scheduling software. Based on customer feedback, we have revamped these key features to provide you with a clearer economy of information, more accessible references for faster payment posting, and clearer streams of display.

Again, IO Practiceware's station will be located at Booth 3032. Finding booths at ASCRS can be tricky, so for an easy mnemonic, just remember:

Booth = (F - 4) x 58, if F = the square root of 3166.924.

Or just write down "3032."

Hope to see you there!

Frequenty Asked Questions

Everything You Always Wanted to Know About IO Practiceware*
*But Were Afraid to Ask

Q: Is IO Practiceware an internet-based system or does it utilize a server on the practice site?

Q: Your big-button touch screen design is fast, but does it limit functionality?

Q: Why are there no dropdowns?

Q: Why doesn't IO use templates like other EMRs?

Q: In the event of an extremely anomalous patient or finding, does the doctor have the option of typing in notes?

Q: Will IO Practiceware let me e-prescribe and collect Medicare's incentive in the coming year?

Q: Does IO Practiceware supply its own practice management system?

Q: Should I buy IO Practiceware's practice management system or interface with my existing PMS?

Q: Does IO Practiceware use an external system to manage its images, or is this included in the system?

Q: Are there additional fees for updates, upgrades, customer service, hardware and network, or is this included in the pricing?

Q: I would like to get a price quote from IO Practiceware - what information should I send to you about my practice?

Q: If a doctor wants to order a medical work-up, how does he/she print out the specific tests to avoid actually writing it out by hand?

Q: Do you have a sample CD of your software that I can play around with before I purchase your product?

Q: Why do you need to "supervise" my playing with your software?

Q: How much does IO Practiceware cost?

Q: How do I submit an FAQ?

Click here any link above to see its corresponding answer.

Spotlight on IO Practiceware in Ophthalmology Management

Ophthalmology Management, a monthly magazine distributed both online and in print, has featured IO Practiceware in its February Technology and Technique section. The article zooms in on New Jersey-based ophthalmologist Ron Sachs as he recounts his experience transitioning to IO's electronic medical records and practice management systems.

Dr. Sachs offers some general info on IO's improvement of his practice's workflow, noting specifically the benefits of IO Practiceware's billing system (included in the software), his practice's ease of transition, and, most importantly, the fact that IO Practiceware was tailor-made for ophthalmologists -- and only ophthalmologists.

The article also quotes Charles Reing, M.D., one of the doctors who helped design IO Practiceware. He believes confidently that IO's software offers 95-98% of what eye care physicians and their staff are looking for in an EMR system.

Which is to say: we're not perfect -- but we're pretty darn close.

Click here to read the full article in Ophthalmology Management.



Related links: Dr. Reing's article in the Review of Ophthalmology about choosing IO Practiceware (2006).

EMR-phobia: Winding and Unapologetic Musings About How Everyone Is So Freaking Scared of EMR

You may have asked yourself: who exactly writes IO Practiceware's Blog? Is it an actual person, or a hapless team of subhumans who must submit to the deranged and senseless dictates of one omnipotent, EMR-obsessed ruler?

Does/do this/these person/people really think he/she/they is/are funny?

All valid questions, but ones that must remain unanswered. (That is, er, unless you email me yourself. Minor loophole.) And in order to kindle this fire of ambiguity (?), I'm going to relay to you an anecdote from my night out tonight...

While wearing an outfit that can best be described as hipster-meets-mariachi-band (think black skinny jeans and sequined vest), I attended a musical theater cabaret show at Don't Tell Mama in midtown Manhattan. One of my good friends from elementary school (who, incidentally, proposed to me in the third grade) was entertaining on stage. 55 minutes of musical-theater-song-stylings short, it was a rollicking good time.

THE POINT IS. Afterwards when I said hello to my friend's parents -- whom I hadn't seen in years -- I told the dad (who, you should know, is a doctor) that I was in the EMR business.

Here's where it gets freaky-tastic, folks. That's right: freaky-tastic. No sooner had the fated acronym "E-M-R" left my lips than had Dr. Dad broken into a cold, EMR-induced sweat and begun to make a bee-line for the Christmas light-cabled doorway.

"Dr. Dad, wait!" I yelled. He stopped and spun around to face me. "What's EMR ever done to you?!" I cried, in tears. We held intense, unflinching eye contact for about fourteen minutes. Finally, Dr. Dad agreed to sit down and talk it out.

Here's where the drama dies down a bit; what ensued was a basic, run of the mill back and forth about the pros and cons of electronic medical records. (Which is to say, I schooled him! OH BAM!)

But I will not get into the minutia. I write this self-described "Winding and Unapologetic" "article" not to parse apart the common arguments for and against EMR, but rather to convey to you the harrowing knee-jerk reaction of a doctor who is EMR-phobic, and to reflect on the experience.

I do not blame the man for being so staunchly opposed to EMRs; they have a bad rep, and for good reason! Dozens of EMR systems have slowed doctors in the exam room and caused them to lose precious time and money. Furthermore, docs are worried that a new health care IT era means the ultimate ascendancy of a Big Brother-esque figure, whereby all people's health records will be instantly accessible to all kinds of crazies.

In response, I could say:

Read this.

Or this.

Or this.

And, unrelatedly, take a look at this.

But I won't. Instead, I say: Friends, Romans, countrymen! Like all things unknown, EMR systems are scary! But, please, know: you are not alone! IO Practiceware would like to help you! We believe in collaboration, and disclosure, and a freeflow of information that enables, as opposed to compromises, our customers and their practices.

So: when you feel yourself breaking into a cold sweat and making a metaphorical bolt for the metaphorical exit, take a deep breath and don't shut the door on EMR just yet.

Give us a call. At the very least, we'll have a seat and talk it out.

Squeaky wheels seek CCHIT oil

CCHIT's timeline for EMR certification excludes ophthalmology-specific EMRs like IO Practiceware until the year 2011. While we in the Eye Care community have an overwhelming urge to go Chuck Norris on CCHIT, we're going to first try peaceful resistance.

If you believe in the value of specialty-specific EMRs, make your voice heard! Post comments below.

To start the dialogue, here is a letter from Gregory Leopold, CEO of IO Practiceware:

Some of the most innovative EMRs are specialty-specific. This is certainly true in ophthalmology. While it may be self-serving to say so, it is true that non-specialty specific EMR have generally failed to supply ophthalmology practices with the tools they need to record their exams properly and cost effectively. The American Academy of Ophthalmology has been working with a group of ophthalmology-specific EMR companies to develop scripts for CCHIT certification for ophthalmology-specific EMR vendors. The work on these scripts has been completed and they could be used immediately to certify ophthalmology specific EMR companies.

While we appreciate CCHIT’s willingness to work with us in this area, the timeline for completion of the CCHIT certification process for eye care – which is currently set for 2011 – is unacceptable. Other EMR vendors in the AAO sponsored group share my concern and disquietude.

It is crucial that the timeline be moved to 2009 – or that some sort of arrangements are made for ophthalmology-specific EMR companies to receive some sort of “in progress” certification that allows us to participate in a marketplace that increasingly shuts out non-CCHIT certified products.

Either let us in now or tell the world that it’s OK for us to be “in the process”. It would be a great disservice to the cause of EMR if CCHIT were to drive some of the most innovative EMR companies out of business because it could not certify them promptly.

If our respectful protestations don't get CCHIT's attention, we may have to resort to Article B: a diatribe of semi-vulgar, though pun-obscured expletives entitled, "Cut the *BULLCCHIT*" (stay tuned).

Touch Pad Technology, or, Our Superiority Complex

Let's be honest: at IO Practiceware, we think we're pretty awesome. Why?

Three words: Touch Screen Interface.

"Touch Screen" = self-explanatory. "Interface" = our software's ability to communicate between chart displays and information tables, creating a system of truly integrated data entry, retrieval, revision and review.

But what make's IO Practiceware's Touch Screen Interface better than other companies'? Why the self-described "superiority complex?"

Well, apart from the fact that all our employees are ridiculously and inexplicably attractive, our software was designed as touch screen software -- which is to say, to support touch screen data entry. Other companies that "use" touch screens usually do not offer software that is properly designed for this form of input. Which means that it doesn't make much of a difference whether or not you use your finger, a mouse, a pencil, a herring bone - it's all just as slow (even slower!) than paper charts.

So how does IO Practiceware remain a shining beacon of truth and beauty?

Read more to find out...

IOInfo: How To Clean Your Touch Screen

Let's face it: all that touching can make you feel...dirty.

So get cleaning!

Any standard glass cleaner can be used to clean the IO Touch Screen, but be sure to avoid products containing ammonia.

Always spray the glass cleaner on the cloth or towel first and then clean the Touch Screen. Glass cleaner sprayed directly on the monitor could possibly leak inside a non-sealed unit and cause damage.

Dirt and fingerprints do not affect the operation of a properly sealed AccuTouch or IntelliTouch touch display.  

Which means if you clean your IO Touch Screen effectively, you'll never have to wash your hands or trim your nails again!   Your patients may object, but your Touch Screen won't.

IOInfo: Calibrating Elo Touchscreens

Over time, your Elo touchscreen may require calibration.  Often this becomes apparent when the mouse or pointing icon does not appear in the location where you touched the screen -- which often becomes apparent when your doctors or techs shout expletives from the exam room.

To protect the innocence of young children in the waiting room, all you need to do is calibrate your touch screen! 

How? 

Read more...

Yes We Can: Under Obama, Bright Future for Health Care, EMR

We all knew President-Elect Barack Obama looked great in his skivvies, but some were skeptical about his proposed health care plan. To what extent, we still wonder, will Obama advocate for better health technology? How much money will he allocate toward facilitating widespread adoption of EMR systems?

On Thursday afternoon the Harbinger of Hope proposed a preliminary outline for a $100 billion package for healthcare, and at the top of this agenda is a plan to bestow new incentives onto practices that use electronic medical records. It seems he has great faith in the future success, and necessity, of EMR.  Says Obama:

To improve the quality of our health care while lowering its cost, we will make the immediate investments necessary to ensure that, within five years, all of America's medical records are computerized. This will cut waste, eliminate red tape and reduce the need to repeat expensive medical tests.

Read more...