"E-M-Are You Serious?"

(a continuation of Nov. 25's post "Is EMR really that scary?")

Doctor: So, IO-- while I like what I'm hearing, I'm skeptical. The sad fact is, doctors have been using paper charts since the beginning of time--

IO: -- well, since the beginning of doctors, and paper...

Doctor: -- right -- and, you have to understand, I've heard horror stories from friends who invested in an EMR system that not only slowed them down and failed to increase revenue, but actually made them lose money. How do I know IO Practiceware won't do that?

IO: Okay, a few things. Of all the systems we've installed since we opened as a company, 100% of our EMRs have benefited the doctors and their practices. Which is to say, to this day, all of our clients use their EMR successfully.

Doctor: E-M-Are You Serious?

IO: Oh yeah.

Doctor: How? Explain.

IO: Where to start? To be honest, most people looking into purchasing EMR don't always know what to look for. Because of this, the touch screen might not at first seem all that crucial to the success of your EMR. But we assure you -- it is. It's just faster. Period.

Doctor: Don't a lot of other companies' EMRs use touch screens as well?

IO: Some do, yes...but beware of impostors! With these other companies' touch screens, the on-screen maneuvering with your finger functions exactly like a mouse, so it isn't any faster. Sometimes it's actually slower.

Doctor: Tricky distinction. How is IO's touch screen different?

IO: Well, our software was programmed specifically to support the touch-screen interface, so when using our EMR, you never have to simulate the act of writing, typing, or using a stylus with drop down screens; this wouldn't speed things up much. Instead, we thought long and hard about the best way to group together observations, diagnoses, and recommendations, such that we lead you from screen to screen, from button to button, anticipating your next move, assisting you in grouping together observations. These systematic and logical groupings, combined with the inherent fastness of using a touch screen to push buttons, helps you to positively fly through your patient's exam.

Doctor: How have you catered your software so specifically to the needs of ophthalmologists?

IO: Well, unlike a lot of other companies that sell EMRs, IO Practiceware was designed exclusively for ophthalmologists. To that end, we've researched extensively the best way to organize our charts so they make the most sense for you -- logical groupings by symptom, possible treatments -- you name it.

Doctor: And do I also have the option of customizing according to my own preferences and methodologies?

IO: You betcha!

Doctor: Whoa, you just sounded like Sarah Palin.

IO: Sorry.

Doctor: So what about imaging?

IO: That's one of the coolest parts! In addition to having all x-rays, printouts, and patient-related images right there at your fingertips, our EMRs have a draw function that not only lets you record your visual observations, but which will interpret your markings on the spot, supplying you with possible diagnoses even before you have to look them up.

Doctor: Wow.

IO: Yep. The whole process is so quick, you might even have time to kill -- which means you'll have to make small talk, maybe ask your patient about his golf swing, or tell some eye-related jokes, or do that trick where your pen disappears.

Doctor: I love that trick.

IO: I know, me too.

Doctor: Okay, now I'm really interested. Tell me more!

(stay tuned for Act III: "Crossing T's and Dotting Eyes")

IO Practiceware Goes Paperless in 2009

In order to provide our customers with the best possible service, IO Practiceware has reinvigorated its commitment to cutting costs and creating an eco-friendly business model by eliminating its use of paper. Mailings, invoices, release memos, and other important informational will be conveyed electronically over email.

While worldwide paper consumption was on the rise throughout the 1980s and ‘90s, in recent years there has been a net decrease of 9 percent in developed countries. The paperless model now pervades a variety of businesses and continues to find new applications – from online banking to electronic boarding passes to (of course) electronic medical records.

A paperless business – like a paperless ophthalmology practice – improves workflow by eradicating wasteful habits, like the unnecessary printing out of correspondences, memos, faxes and other miscellany that cost money, time and efficiency. We at IO Practiceware believe that operating entirely electronically reflects and typifies the goal of our electronic medical records and practice management software, which is to streamline and optimize your practice’s functionality, creating tremendous value that will increase greatly over time.

IO is in the process of collecting official email addresses from its current customers. (If you are a customer who has not yet replied to our e-memo, please be sure to forward or confirm your official email address(es) to fricci@iopracticeware.com.)

IO will continue its efforts to create a cost-effective and green workplace and will keep you abreast of its ongoing developments. We look forward to reporting back on how this change benefits us – and you – in 2009.

(For more on the benefits of our paperless EMR and PMS software, click here.)

E-Prescribing: IO Delivers Incentives to Your Practice

In the coming year, many ophthalmology practices will switch to e-prescribing in order to reap its numerous benefits.  CMS is offering a 2% incentive payment of a practice’s total Medicare reimbursement -- in addition to the 2% PQRI incentive.  Using IO Practiceware’s new e-prescribing EMR software release is simple and increases productivity in the practice. This will mean:

• No more work prescribing drugs than is currently required
  
• No more paper Rxs to print, retrieve, and hand to patients
  
• No more printer jams
  
• Greatly reduced need to order and pay for special Rx paper
  
• Better tracking of medications

IO Practiceware is working in partnership with SureScripts, the largest and best e-prescribing partner; together, the two companies will provide your practice with these services:

• Secure electronic transmission of prescription information. 
  
• Electronic refills. When patients request a refill from their pharmacy, practices receive the request electronically and are able to approve the request with the click of a button.
  
• Formulary and eligibility information will be instantly available.
  
• Drug cautions and interactions will be shown.
  
• In time, complete patient medication histories will be downloadable – saving tech time.

In order for a physician to qualify for the 2% Medicare incentive, he or she will need to prescribe electronically and report on at least 50% of qualified cases throughout the calendar year. This does not mean that practices must begin reporting on January 1, 2009. The 50% is gauged by the total number of patients seen throughout the year.  Thus, you should not worry if your practice does not begin e-prescribing or reporting until the spring; you will still be able to qualify for the incentive payment.

In order to e-prescribe and report, practices must:

• Sign up with IO for this service. The cost of installation is one month’s maintenance. The cost of use is a surcharge of 10% on your Monthly Fee.
  
• Register. IO will do this for you.
  
• Receive training. Before you begin using e-prescribing, we will provide your practice with a training session regarding how the process works.
  
• Use the IO software to e-prescribe. The IO clinical software has been modified so that your front desk can record which pharmacy each patient wants their prescriptions sent to. Otherwise, there are no changes in the way you write Rxs.
  
• Report. Medicare is informed that you are e-prescribing by including a “zero dollar” service code on each claim for which you report an office visit code. 

There are three codes that will be used and IO will automatically put these codes on the claims for you. The codes are:

• G8443 – All prescriptions for this visit were sent electronically through a qualified e-prescribing system.
  
• G8445 – You have a qualified e-prescribing system but no drugs were prescribed during this visit.
  
• G8446 - Some or all drugs prescribed during this visit were printed or were phoned in because of one of the following reasons:
  
• Required by law (Schedule II-V drugs or other state law)
  
• Patient request
  
• Qualified e-prescribing system temporarily unavailable

In short: E-prescribing will soon be available to IO customers, and those who use IO to e-prescribe will find the new incentive translates to a significant increase in revenue.

If you have questions, please feel free to contact us.

Ophthalmic PQRI Measures

IO Practiceware sifted through the 2009 PQRI measures and compiled a list of those that relate to ophthalmology practices that use EMR. Below is a breakdown of measure number, measure description, reporting procedure, diagnosis codes (to combine with office visit code), reporting code, and modifiers on those reporting codes.

By implementing IO Practiceware's EMR software, your practice automatically satisfies measures 124 and 130.

12 - POAG

• Optic Nerve Evaluation
• 365.01, 365.10, 365.11, 365.12, 365.15
• 2027F
• 1P, 3P

14 - AMD

• Dilated Macular Examination
• 362.50, 362.51, 362.52
• 2019F
• 1P, 2P, 3P

18 - Diabetic Retinopathy

• Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
• 362.01, 362.02, 362.03, 362.04, 362.05, 362.06
• 1P, 2P, 3P

19 - Diabetic Retinopathy

• Communication with the Physician Managing Ongoing Diabetes Care
• 362.01, 362.02, 362.03, 362.04, 362.05, 362.06
• 5010F and G8397, or G8398
• 2P, 3P, 8P

117 - Diabetes Mellitus

• Dilated Eye Exam in Diabetic Patient

• 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21, 250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 357.2, 362.01, 362.02, 362.03, 362.04, 362.05, 362.06, 362.07, 366.41, 648.00, 648.01, 648.02, 648.03, 648.04

• 2022F or 2024F or 2026F or 3072F
• 8P

124 - HIT

• Adoption/Use of EMR
• All patient encounters
• G8447, G8448
• No modifiers
  

130

• Documentation and Verification of Current Medications in Medical Record
• All encounters with patients 18 years or older
• G8427, G8430, G8507, G8428, G8429
• No modifiers.
  

139 - Cataracts

• Comprehensive Preoperative Assessment for Cataract Surgery with IOL Placement
• Encounters with patients 18 years or older
• 0014F
• 8P
  

140 - AMD

• Counseling on Antioxidant Supplement
• 362.50, 362.51, 365.52
• 4177F
• 3P, 8P
  

141 - POAG

• Reduction of IOP by 15% OR Documentation of a Plan of Care
• 365.10, 365.11, 365.12, 365.15
• 3284F, 0517F and 3285F, 0517F with 3P and 3285F, 0517F with 8P and 3285F
• 3P, 8P
  

E-Prescribing: Better Than Chocolate

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? Follow these steps:

1. Get to the Alignment screen.

2. If an Elo icon is available in the tool tray at the lower right side of the desktop, click it, then click Align.  Otherwise, go to the Windows Control Panel, double-click Elo Touchscreen and click the Align button on the General tab.

(If no Elo icon, click the "Switch to Classic View" button on the left.)

3. Touch and release the upper left target; the target should jump to the lower right.

4. Touch and release the lower right target; the target should jump to the upper right.

5. Touch and release the upper right target; the target should jump to the lower right.

6. Touch and release the green check mark; the check screen should disappear.

7. The cursor should now jump to the point of touch.

8. If the Elo Control Panel is open, close it and the Windows Control Panel.

For more info, visit Elo's Support Page.

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!

IO IMPLEMENTATION

Preparation: IO Practiceware sends one of its employees down to your practice a week and a half prior to initial training in order to set up and configure your network. This means, basically, IO connects all of your new hardware, makes sure the server and internet connection are functioning. In addition, IO takes all the patient demographics that have been stored in your previous practice management system and converts them into IO's practice management system (though not the clinical portion).

Step One: IO Training. We take a full day to teach the practice management / scheduling portion of the software and two days to teach the clinical. Another half day or so is devoted to the billing portion. We set up a cluster of computers in your practice's waiting room area (or wherever there's room) so that the office staff can learn everything together. (See picture at top.) All of IO's staff, which usually numbers between three and four people, is on hand during these classes to answer any questions that may arise.

Meanwhile, Step Two: Members of the practice note problems or concerns they have, and also begin a log of software preferences -- for example, a working list of "Favorites" (where available in the software) are customized to suit the needs of the specific practice. A good portion of the dialogue about these customizable features occurs during training.

Step Three: IO takes a peek at your pre-existing practice management / scheduling system and converts all upcoming appointments so that you can receive patients, old and new, into the new system as they arrive for their appointments.

Step Four: GO LIVE! This is where things get...hairy, so to speak. But into the fray we venture together, fearless and ready to fight! The most difficult part of "going live" with IO Practiceware's software is the initial workflow disruption. IO Practiceware recommends that practices see somewhere between five to seven patients electronically on the first day. Often, these are patients who are new to the practice -- the reasoning being, it's easier to begin using the clinical software on patients for whom you don't have to cross reference old, paper charts.

There's often a good deal of miscommunication on the first, even second, days of going live. Common questions and points of confusion depend on the practice, but they most often have to do with general anxiety about mistakenly performing redundant tasks -- or, in the effort to eliminate redundancy, neglecting to perform those tasks.

It also takes a day or so for an office staff to get used to the flow of how our practice management system relates to our clinical software -- namely: a patient cannot be seen in the exam room if he or she has not been checked in properly and, conversely, a patient cannot be checked out if his or her clinical chart has not been "closed" in the exam room.

Meanwhile, Step Five: IO looks at your practice's outgoing letter templates and converts them into IO Practiceware; these letters are henceforth generated from the IO exam software.

Meanwhile, Step Six: All patients, old or new, get their picture taken and have their IDs and insurance cards re-scanned into the new system.

Step Seven: IO Practiceware stays at your practice for two weeks after your first "go-live" day. Each day, three or so more patients are seen electronically. The onus of picking and choosing which patients to see electronically becomes transferred from the IO Staff (who have, initially, been the Taskmasters of making sure the practice continue to challenge themselves with the clinical software) to the ophthalmology practice's staff.

Meanwhile, Step Eight: The on-site IO staff keeps a dynamic log of glitches, challenges, and suggestions that present themselves after the first go-live day. We stay late after the last patient is seen to do "clean-up" and to continue to customize the software as best we can.

Step Nine: How to deal with old patient charts? It's really the practice's preference. Many times old billing information is converted so that old procedures and visits are automatically incorporated into the patient's electronic chart. Oftentimes, the office staff will need to take some time to scan old images or chart notes such that they become digital, and accessible through IO's EMR.

Step Ten: Typically, by the time IO Practiceware leaves the transitioning practice, all patients are being seen electronically.

And that, my friends, is a basic play-by-play of an IO Implementation. It is quite an endeavor, and is quite time consuming for the IO Staff. But we feel incredibly strongly that it's most important to get your practice up and running properly, even on the first day, so that you have a working, useful product that will support and enhance your practice.

Any questions? Did I leave something out? Post your comments below.

--FR