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04/07/2012
RESPONSES / COMMENTS (EMR) - PART 1
RE: EMR Survey
From: Brent Rubin, DPM
It's about time someone asked our profession about their experiences with EMR! I recently noticed an ad in PM News requesting our input for a survey on EMR. As I look for help selecting an EMR system, I have yet to find a current and comprehensive report that is specific to podiatry EMR. The APMA website posts results of its EMR survey of its members conducted in 2007, with only 87 respondents. I'm no statistician, however, I must question how pertinent that survey is today.
Are there truly a lack of comprehensive studies done on EMR in podiatry, or are we, as a profession, too apathetic to respond to such surveys? Or, maybe I'm just not that good at Google searches. I would like to know what experiences my colleagues have had with EMR before I make any decisions. Perhaps, if we all take the time to fill out the survey, we will all benefit from knowing the day-to-day reality relating to EMR.
If you missed taking the survey, click here.
Disclaimer: I have no affiliation with DecisionPoint or their survey
Brent Rubin, DPM, Bradenton FL, brentlrubin@hotmail.com
Other messages in this thread:
06/24/2013
RESPONSES / COMMENTS (EMR) - PART 1B
RE: EHR Hi Tech Audit (Ken Schenley)
From: Steven J. Kaniadakis, DPM
I tend to agree with the post from Ken Schenley. First and foremost be pro-active. Welcome an audit. My background, education, and experience as a proud and practicing DPM dictates that each and every podiatrist is taken as a whole in the hearts and minds of the public. "We're all in the same boat." Podiatrists need to become connected to those who are users of new technology. Yet, enable yourself as a practicing podiatrist with tools to maintain some feeling of choice and independence.
Select tools that might enable yourself to maintain the movement yet not lose all sense of your right to continue to utilize your own judgment about your own practice, business, and medically-related practices. Otherwise, I know from experience (good and bad ones), you doctor, might be "adrift and out to sea without a rudder."
Disclosure: I am owner of the House DR electronic super-bill .
Steven J. Kaniadakis, DPM, St. Petersburg, FL, stevenkdpm@yahoo.com
06/24/2013
RESPONSES / COMMENTS (EMR) - PART 1A
RE: EHR Hi Tech Audit (Ken Schenley)
From: Michael Brody, DPM
Mr. Schenley states that Certified Technology is not for everybody. I strongly disagree. The first thing we each need to understand is that Meaningful Use is NOT about us as doctors, Meaningful Use is about us as patients and all of the patients that we treat. Meaningful Use has been designed to be a benefit to patients on each and every level. As a result of this focus, there are tools available to us to allow us to have more information at our fingertips to make better clinical decisions at the point of care; for example alerts when we prescribe medications that might interact with other medications that a patient is taking. But let us look at the “BIG” picture.
With Meaningful Use, whenever a patient...
Editor's note: Dr. Brody's extended-length letter appears here.
05/14/2013
RESPONSES / COMMENTS (EMR) - PART 1B
RE: Dragon Problem (Craig Breslauer, DPM)
From: Mark K. Johnson, DPM
It sounds like your files may still be corrupted OR your microphone has a defect which is introducing problems into the speech recognition. Try installing your Dragon Medical 9.5 disc in REPAIR mode. Check your microphone. Create a new user file with Best Match III as a choice if
you can. Retrain your common custom words or phrases by selecting "custom" in vocabulary editor. Form another USER with a different microphone. Any viruses or spyware on your computer?
Consider upgrading to Dragon Medical 10 if all else fails -- we currently use 11 (Dragon Medical Practice Edition) and are pleased. Other resources for your problem would be Lunis at Knowbrainer.com or Dr. Larry Kosova in Chicago.
Mark K. Johnson, DPM, West Plains, MO, DDR004@centurytel.net
05/14/2013
RESPONSES / COMMENTS (EMR) - PART 1A
RE: Dragon Problem (Craig Breslauer, DPM)
From: John M. Wray, DPM
If Dragon is used over a server, it may drop text. An easy solution is to use a Dragon feature called "Dictation Box". The dictation box is opened and your dictation is done within the Dragon program, and then transferred to your EHR or other document. I use the Medical version of Dragon with a Power Mic which allows me to control these function from the microphone.
John M. Wray, DPM, Chicago, IL, jmwraydpm@gmail.com
05/13/2013
RESPONSES / COMMENTS (EMR) - PART 1B
RE: Dragon Problem (Craig Breslauer, DPM)
From: Brad Makimaa, DPM
We have 8 offices and 6 doctors, and countless computers, all with EMR and Dragon. We have had numerous problems with Dragon (we thought they were Dragon's fault). The bottom line is that the computer's operating system has to be happy with your EMR and both have to be happy with Dragon.
We usually wait to upgrade to the latest Windows as most everything is not compatible with that as it first comes out. Check with your EMR vendor and with Dragon for compatibility issues and recommendations. This fixed nearly all issues. Some minor tweaks in settings are easily addressed with Dragon's help. We currently have no issues with the new Dragon in all computers, and it is faster than before.
Brad Makimaa, DPM, Key West, FL, drmak3@comcast.net
05/13/2013
RESPONSES / COMMENTS (EMR) - PART 1A
RE: Dragon Problem (Craig Breslauer, DPM)
From: Marc Garfield, DPM
Check the Dragon website for compatibility with your newer computer’s soundcard, or consider buying an external sound card approved by Nuance. Note that not everything they approve is necessarily the best. But If they do not review it, it may not work well. support.nuance.com/compatibility/Search.asp?PRO=DNS&CID=10
Marc Garfield, DPM, Williamsburg, VA, mgarfield1@cox.net
04/18/2013
RESPONSES / COMMENTS (EMR) - PART 1B
RE: EMR Compatibility with Dragon Voice Recognition (Ken Schenley)
From: Ken Katz
Dragon has always worked well with SammyEHR and other Sammy Systems Products. The secrets to successful use have to do with the speed and memory in the computer used for dictation. You would not dare to take away Dragon from Sammy users that use it, as they absolutely love the freedom it provides. That said, it should be only a part of the documentation process. If you think that Dragon is fast, it’s nothing compared to the coupling of it with our smart templates.
Ken Katz, President, ICS Software, Ltd., kenkatz@icssoftware.net
04/18/2013
RESPONSES / COMMENTS (EMR) - PART 1A
RE: EMR Compatibility with Dragon Voice Recognition (John Scheffel, DPM)
From: Marc A. Katz, DPM
Open Dragon. On the Dragon bar, select, "Tools-Options-Commands", uncheck "enable HTML support". Restart Dragon. You should now be able to dictate directly into your program. There is no need for Dragon pad or transfer, or cutting and pasting. This works well on server-based office programs and cloud programs. I prefer the USB 3-1 TableMike. Or consider the Sennheiser headset with Andrea sound card.
Marc Katz DPM, Tampa, FL, dr_mkatz@yahoo.com
04/17/2013
RESPONSES / COMMENTS (EMR) - PART 1B
EMR Compatibility with Dragon Voice Recognition (John Scheffel, DPM)
From: Ken Schenley
Dragon Voice Recognition (and other dictation solutions) can be an extremely valuable tool to help with your documentation. Whether it is your only method of dictation, or used as a supplement to another charting or dictation solution, it provides you with a great way to express yourself in your notes.
As said before, you should contact your current, or future, EMR/Charting Vendor, and ask about implementation and ease-of-use. For example, the QNotes Office Solution from Quick Notes is a truly simple EMR that works extremely well with voice recognition, whether or not you use the portable Quick Notes iPad/Touchscreen. Simply find a patient, add a new note, and dictate! It’s as easy as that!
Disclosure: I am Executive Vice President at Quick Notes.
Ken Schenley, Cooper City, FL, ken@qnotes.com
04/17/2013
RESPONSES / COMMENTS (EMR) - PART 1A
EMR Compatibility with Dragon Voice Recognition (John Scheffel, DPM)
From: Ed Wiebe, DPM
I have been using Dragon dictation 11.5 to supplement Practice Fusion EMR. I upgraded to 12.5 and when it wouldn't work, I contacted Dragon. They say it works with everything except any EMR program, and the fix is to upgrade to Dragon Medical for $1,600. Needless to say, I went back to 11.5, which by the way, only works with older versions of Adobe Reader, not the new versions. Nuance/Dragon put a "bomb" in their 12.5 version so they can sell their $1,600 medical version.
Ed Wiebe, DPM, Flagstaff, Arizona, elw520@Hotmail.com
04/16/2013
RESPONSES / COMMENTS (EMR) - PART 1B
RE: EMR Compatibility with Dragon Voice Recognition (John Scheffel, DPM)
From: Pete Harvey, DPM
I use Dragon Medical 10. There is also a Dragon Medical 11. It is important to also use the Nuance PowerMic. These are all divisions of the original Dictaphone company. You can say “Open Dictation Box” almost anywhere in any program. Dictate to the box, then hit the transfer button or say “transfer”. However, the problem can probably be resolved with settings. Go to TOOLS>OPTIONS>and review all tabs. If this gets confusing or doesn’t work, call the people who sold you the program, or better yet, call your EMR directly, and they should be able to resolve the problem.
Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com
04/16/2013
RESPONSES / COMMENTS (EMR) - PART 1A
RE: EMR Compatibility with Dragon Voice Recognition (John Scheffel, DPM)
From: Richard A. Simmons, DPM
A suggestion would be to dictate with Dragon Voice Recognition into a standard word processing program (e.g., Microsoft Word), then copy/paste that transcription into the EMR. You did not mention if your EMR is onsite or in the cloud; this could make the difference. Sometimes using Dragon across the internet into a cloud EMR is a very slow process. If your EMR is onsite, the problem may be with the amount of available RAM of your server. An IT specialist could help you determine this. Personally, I use my old Medinotes program to transcribe, then copy/paste into Practice Fusion. This allows me to have a copy available onsite as well as the EMR in the cloud.
Richard A. Simmons, DPM Rockledge, FL RASDPM32955@gmail.com
04/15/2013
RESPONSES / COMMENTS (EMR) - PART 1B
RE: EMR Compatibility with Dragon Voice Recognition (John Scheffel, DPM)
From: Michael Brody, DPM
Based upon your post of having trouble with Dragon and your EMR, I strongly recommend contacting your EMR vendor. Most EMR products have been built with methods that provide better tools for using voice dictation than you are currently using. For example, in SamNotes, the Sammy EMR product, the workflow to create a note using voice dictation is just three easy steps. First, you select the new note feature, then you select the Blank note feature which opens up a box that has the patient's name and the date of service, and finally you activate your voice dictation software so that you can start dictating directly into SamNotes.
When you call your current vendor, please tell them what you want to do and have them demonstrate an easier workflow to allow you to easily dictate your note. If your current software does not have a good workflow and you wish to continue to use voice dictation, I recommend that you start shopping for a new EMR product.
Disclosure: I am the Chief Compliance Officer for Sammy Software.
Michael Brody, DPM, Commack, NY, mbrody@tldsystems.com
04/15/2013
RESPONSES / COMMENTS (EMR) - PART 1A
RE: EMR Compatibility with Dragon Voice Recognition (John Scheffel, DPM)
From: Larry Kosova, DPM
Dr. Scheffel is finding out that trying to implement speech recognition into his EMR slows down his productivity. This is a fault of his EMR program. There are EMRs that are made for speech. I use Textalk Enterprise. Most other EMR companies say that you can use speech, but perform as badly as Dr. Scheffel is experiencing. Most software programmers for EMRs have no clue how to program their EMRs effectively. If you had an issue with Dragon, they could not help you. They will tell you that you can use Dragon, but don't come to them if you run into issues.
First you need to go to your EMR company and ask them to help you construct a template in a logical fashion. A simple idea: instead of "clicking" , use the tab key to logically go through your template and use speech to fill it in. You can also use speech commands like "click 1" with 1 being in a field, i.e. <1> and using <2>, etc., to fill in your template. Most good EMRs that use speech will have 25 or so commands embedded in their system. Maybe you need to get that list, if they have it.
You should also ask your EMR company for a demonstration of the use of Dragon with their EMR. Hopefully, this was done prior to purchase.
Larry Kosova, DPM, Chicago, IL, lkosova@yahoo.com
12/13/2012
RESPONSES / COMMENTS (EMR) - PART 1A
RE: Stage 2 Meaningful Use (Bill Lockner, DPM)
From: Alan Bass, DPM
The confusion is between the stage and the year. There will be 3 stages to meaningful use, but we are currently still in stage one, and those eligible providers who began in 2011 will have just finished year 2 of stage one. 2013 will be the third year of stage one with stage 2 beginning in 2014. Currently, all the parameters remain the same with some of the thresholds changing in 2014 with the beginning of stage 2. You can attest for year 2 at the beginning of 2013, and attest for year 3 at the beginning of 2014.
Alan Bass, DPM, Manalapan, NJ abassdpm@optonline.net
10/13/2012
RESPONSES / COMMENTS (EMR) - PART 1- B
RE: Allscripts Myway Termination (Henry Slomowitz, DPM)
From: Marc Garfield, DPM
If I am not mistaken, the Allscripts Myway was acquired upon buying Mysis Myway and used to convert Eclipsys users. Eclipsys EMR acquired and was used to convert Medinote users. Mysis actually bought the product from Imedica which is now Aprima. Aprima still makes their version of the product. It may be worthwhile to have a large group discussion with Aprima about a conversion deal. This would minimize a disruption in the workflow for these users. The products were intended to “evolve” separate pathways. So I do not know how much you will be able to import templates, but it may be worth looking into.
I am not a lawyer, but...
Editor's note: Dr. Garfield's extended-length letter can be read here.
10/13/2012
RESPONSES / COMMENTS (EMR) - PART 1- A
RE: Allscripts Myway Termination (Henry Slomowitz, DPM)
From: Elliot Udell, DPM
Dr. Slomowitz's story is once again an example of how certain physicians will be left holding the short end of the stick by leasing high-priced EMR systems. This is why doctors such as myself have gravited toward free programs such as Practice Fusion. With meaningful use payments, a market has been created where certain companies can charge doctors "sky is the limit" prices for their programs. The government certifies these programs and in essence forces doctors to buy these programs but does not protect doctors who are financially harmed by a company either going out of business or taking a negative turn as described by Dr. Slomowitz. The only thing we can do to protect ourselves is to limit what we invest in EMR programs until the market stabilizes to the point where there is safety in what we are buying.
Elliot Udell, DPM, Hicksville, NY, Elliotu@Aol.com
09/12/2012
RESPONSES / COMMENTS (EMR) - PART 1
RE: EMR Incentive Payments (Cynthia Ferrelli, DPM, NMD)
From: Alan Bass, DPM
The amount of an incentive you receive is based upon 75% of your allowable Medicare charges up to $24,000. So, if you bill Medicare $24,000 in Medicare allowable charges, you will receive the maximum amount allowable in year one or $18,000.
• Year 1: $15,000 ($18,000, if 1st year 2011 or 2012)
• Year 2: $12,000
• Year 3: $8,000
• Year 4: $4,000
• Year 5: $2,000
• Last payment year will be in 2015
Alan Bass, DPM, Manalapan, NJ abassdpm@optonline.net
08/11/2012
RESPONSES / COMMENTS (EMR) - PART 1- B
RE: EMR Stimulus Money (Frank Lattarulo, DPM)
From: Bruce Krell, DPM, Alan Bass, DPM
Click Here. Follow the directions and within a few short weeks, a check will arrive in your mail box. Attached to it will be the biggest risk you will ever undertake in your career.
Bruce Krell, DPM, Chandler, AZ, footdoc352@cox.net
Reporting your Meaningful Use and Quality Measures for your CMS incentive is actually pretty simple. The first thing is you must have your PECOS username and password in order to register. You will also need the 15 digits unique ID number for your EHR program. Registration for the CMS incentive program is done here. Once you register, you will be able to the attest with your data. Just print them out and have them next to you when you go to attest. You will be filling in the numbers from your reports (numerators and denominators). Remember, for the meaningful use measures, your numbers must exceed the thresholds set, while for quality measures, you must just have findings for the 3 Core quality measures and 3 additional ones.
I attested for my first year incentive last year and received my first year incentive check 8 weeks after attesting.
Alan Bass, DPM, Manalapan, NJ, abassdpm@optonline.net
08/11/2012
RESPONSES / COMMENTS (EMR) - PART 1- A
RE: EMR Stimulus Money (Frank Lattarulo, DPM)
From: Joshua Kaye, DPM
Simply completing a 90-day period of reporting does not necessarily result in your receiving the CMS stimulus funds. The charting must be accomplished to show MU (meaningful use). Most software programs will automatically let you know when the required MU criteria have been met. Once you have achieved MU, then you need to complete the required documentation on this webpage. You can find helpful information at cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprograms/ or by calling CMS at 888.734.6433.
You will be required to copy the same numerators and denominators generated from your EMR program into the CMS website. Once that is completed, the CMS website should notify you immediately if you are successful. If successful, you will then receive your incentive funds in about eight weeks.
Joshua Kaye, DPM, Los Angeles, CA, jk@joshuakaye.com
07/26/2012
RESPONSES / COMMENTS (EMR) - PART 1
RE: Meaningful Use Help for APMA Members
From: Michael L. Brody, DPM
Many doctors are having trouble and delays receiving their meaningful use incentive payment. Most of these problems were caused by issues with PECOS, or differences between Tax ID during registration and attestation. If you are having trouble or delays with your payment, please email me the information requested below, and I will utilize contacts at CMS to help. In order to assist you with this, please provide me with the following information. Please note the items with an *are REQUIRED.
* Your Name
* Your Email Address
* Your Phone Number
* Your Individual NPI
* Your APMA Number
* The registration ID you received when you registered to receive the meaningful use incentive payment
* The confirmation number you received when you attested for meaningful use
Any Group NPI numbers you may have
Any reference numbers you received when calling the help desk to find out about your payment.
Michael L. Brody, DPM, Commack, NY, mbrody@tldsystems.com
04/12/2012
RESPONSES / COMMENTS (EMR) - PART 1
RE: E-Prescribing Program (Alan Meyerberg, DPM)
From: Marc Garfield, DPM
It is these types of issues that trouble me about 5010, ICD 10, ICD 11, MU, and PQRS. We all accept this garbage from government mandates/incentives; then we find out later that the fine print is: third-party payers win and you lose. On my EMR discussion board, Dr. Meyerberg’s issue is a growing problem. In coming years, there will be additional 2% penalties for not submitting PQRS adequately and properly, in addition to eRx penalties. MU penalties will be up to 5%.
What makes it more interesting is that many secondaries kick out the G8553 and PQRS codes and make you resubmit your secondary claims. The fact that they changed the eRx codes a couple of years ago also adds to the challenge of a process in which there is no recourse for correction despite actually using the eRX on nearly every Rx you write.
Marc Garfield, DPM, Williamsburg, VA, mgarfield1@cox.net
04/06/2012
RESPONSES / COMMENTS (EMR) - PART 1
RE: Voice Recognition Software and EMR/EHR (Greg Caringi, DPM)
From: Stephen Musser, DPM, John Parmelee, DPM
I use the Medical Dragon version with the Epic EHR program and really like it. I've been very satisfied.
Stephen Musser, DPM, Cleveland, OH, ly2drmusser@gmail.com
I have used both Dragon 10 Medical Professional and am currently using Dragon 11 Medical Professional. The professional version allows you to use bookmarks so you can navigate through your templates with your voice or keyboard. I have not found a significant difference between the 10 and 11 versions. Most EMRs require you to use at least version 10. Get a good microphone since the one that comes with Dragon is not very good. I use the VXI TalkPro USB 1. Dragon works well with AllScripts and allows for full text control. Not all EMR's allow full text control with Dragon, which I find unacceptable. I just wish the billing part of AllScripts was better.
John Parmelee, DPM, Seattle, WA, parm15@msn.com
04/05/2012
RESPONSES / COMMENTS (EMR) - PART 1
RE: Voice Recognition Software and EMR/EHR (Greg Caringi, DPM)
From: Adnan Shariff, DPM
You will, at the minimum, need Dragon 11.5 professional. You will lose a lot of functionality if you go with a lower version than that. I also recommend the podiatry vocabulary with that. There are some EMRs that require to use the more expensive Medical version which has no additional benefits to the end-user. Nuance is the maker of Dragon, and they have a list on their website for which EMRs require the medical version. However, I can say that my program is on the list and Professional version works fine.
Adnan Shariff, DPM, Northbrook, IL, adnanshariff@yahoo.com
04/04/2012
RESPONSES / COMMENTS (EMR) - PART 1
RE: Voice Recognition Software and EMR/EHR (Greg Caringi, DPM)
From: Mark K. Johnson, DPM
I use the newest Dragon Medical Small Practice Edition (Dragon 11) with Traknet. As a Dragon user since 2002, I have seen major improvements in its accuracy. Dragon Medical also has podiatry and orthopedic surgery vocabularies built in. However, ONLY Dragon Medical 10 or Medical 11 will integrate with EMR, to my knowledge; and not all EMRs are compatible with even the medical version of Dragon. Consult your EMR software vendor for a serious voice recognition web demo AND refer to Dragon gurus such as Knowbrainer.com or Dr. Larry Kosova.
Mark K. Johnson, DPM, West Plains, MO, DDR004@centurytel.net
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