09/09/2013
RESPONSES / COMMENTS (EMR)
RE: Genius Solutions Billing Software
From: Carla-Ruth Poma
I have been a long-time user of Genius Solutions. As a billing service located in Michigan, I believe that their reputation here is among the best of the best. They have a great product and their service and support is terrific and very reasonably priced. I use Availity as my clearinghouse for Palmetto claims and NGS DME claims, which is free. Currently, I have no out-of-state clients, but would use Availity if I did. I have used Genius for non-Michigan based clients and it performed beautifully. It is my understanding that they have passed ICD-10 testing requirements.
Disclosure: I have no financial interest in Genius Solutions or Availity.
Carla-Ruth Poma, South Lyon, MI, Mmbsinc@aol.com
09/06/2013
RESPONSES / COMMENTS (EMR)
RE: McKesson EHR Software and Outsourced Billing? (Carl Solomon, DPM)
From: Joseph A. Megara, III, DPM
Although I do not have experience with McKesson's EHR product, I am currently using TRAKnet EHR software as well as the TRAKnet RCM billing service. I have used MediSoft and MediNotes in the past which have integrated EHR and billing. For several years prior, I also used billing software that did not have EHR integrated (Wisdom by Cerner) as well as 3 other independent billing companies.
Since I changed to combining the two TRAKnet services, my life has become easier. I really like the fact that the services are run by podiatrists. It seems like they understand the pitfalls we face more than other companies. Integrating the RCM services makes my billing much easier because everything is encompassed in one "system". They’ve also provided me with answers to any questions I’ve had regarding coding and reimbursement.
For me, customer service is key, and both TRAKnet services have been excellent with that. They have also reviewed my code utilization and have made suggestions that have optimized my revenue stream. Right now, my charting is easier, billing turn-around is generally out within 24-48 hours, my cash flow has increased, and my aggravation has decreased. Overall, I wish I had done this years ago.
Joseph A. Megara, III, DPM, Thorofare, NJ, footcaremegara@comcast.net
09/05/2013
RESPONSES / COMMENTS (EMR)
RE: McKesson EHR Software and Outsourced Billing (Carl Solomon, DPM)
From: Pat Straub
We have been using McKesson’s Practice Partner EHR with their in-house billing software package successfully and happily since 2010. Our practice, along with another local podiatry practice, diligently looked at all of the products being offered at the time. We both felt the McKesson Corporation with its longevity in the medical field would be in it as a partner to our practices for the long haul. Although we do not utilize their outsourced billing product, I can tell you that McKesson has been stellar in supporting their products and making sure we are provided with the tools and education needed in this ever-changing world of electronic medical records and billing.
There are a lot of good EHR systems out there and deciding which product to go with can be a hard decision. By doing your homework like you are, you will be able to decide confidently on the system that will best fit your practice. Both our practices are so thankful we chose McKesson’s Practice Partner product; by doing so we rest easy knowing they are going to get us where we need to be, when we need to be there.
Pat Straub, Office Mgr., Allan Rothschild, DPM, Dunedin, FL, awrdpm@aol.com
08/09/2013
RESPONSES / COMMENTS (EMR)
RE: Security Risk Analysis Cost (Mark Aldrich, DPM)
From: Pamela Blustein
In order to comply with Core Measure 15 of Meaningful Use – Security Risk Analysis- there are several steps that need to be taken. The Department of Health and Human Services in its Guide to Privacy and Security of Health Information -The Office of the National
Coordinator of Health Information Technology (page 9), delineates these 5 steps:
Reviewing existing security of PHI, Identifying threats and vulnerabilities, Assessing Risks for likelihood of impact, Mitigating security risks, and...
Editor's note: Ms. Blustein's extended-length letter can be read here.
07/30/2013
RESPONSES / COMMENTS (EMR)
RE: Security Risk Analysis Cost (Michael Brody, DPM)
From: Mark J. Tuccio, DPM
Dr. Brody is spot on with his assessment. I posted many months ago that attestation to Meaningful Use was a huge trap with regard to meeting core measure 15. It seems that the chicken has come to roost for many who were unlucky enough to be selected for a Meaningful Use audit.
For those who are now concerned with this measure, Practice Fusion has a “Privacy and Security Toolkit” that will help with the documentation needed for conducting an EHR security and risk analysis. The government website also contains...
Editor's note: Dr. Tuccio's extended-length letter can be read here.
07/29/2013
RESPONSES / COMMENTS (EMR)
RE: Security Risk Analysis Cost (Mark Aldrich, DPM)
From: Michael L. Brody, DPM
Your security risk analysis involves much more than vulnerability and penetration testing. A proper security risk analysis looks at physical, administrative, and technical measures to protect your data. Penetration testing is only looking at one aspect of technical vulnerabilities.
Under the HIPAA regulations, you must do everything that is reasonable to protect your data. The question becomes "What is the risk of a hacker penetrating your network to obtain data?" If you look at the ONC 'wall of shame' that list large HIPAA breaches, you will see that most are due to human error or devices being physically stolen or lost. A very small percentage of breaches are due to an electronic break-in.
Therefore, the take away from this is that it is reasonable to determine that the probability of a cyber attack resulting in a breach is low, and you are better served spending that same money on physical and administrative measures. You can close a lot more gaps that are of higher risk in that manner and that is what a risk analysis is all about - determining what risks have a high likelihood of being exploited and closing those potential gaps in your security.
I do not recommend spending the money on this test until you have addressed the issues that have historically been shown to result in large breaches.
Michael L. Brody, DPM, Commack, NY, mbrody@tldsystems.com
06/29/2013
RESPONSES / COMMENTS (EMR)
RE: TRAKnet Charges (Marge Portela, DPM)
From: Michael DiGiacomo, DPM, Kevin K. Lam, DPM
I am a TRAKnet user and have been very pleased with the system compared to Epic, which my medical center uses to many physicians' dismay. I happily pay the fees needed to continue this service and prefer not having to issue checks. That this company is now in the control of our colleagues is comforting.
Michael DiGiacomo, DPM, Oakland, CA, mddpm2003@yahoo.com
The problem I see is that we have been jumping from podiatry program to podiatry program, Medinotes, now TRAKnet, etc. While it is great for ease-of-use, the problem with companies going out of business due to a narrow market is inevitable. If you only target one market, your base will be low. We are currently looking at Practice Fusion (Free), Kareo (free EMR), Athena (free). The last two make money on the PM side.
While podiatric-specific EMR was great back before the days of meaningful use and...
Editor's note: Dr. Lam's extended-length letter can be read here.
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.
06/22/2013
RESPONSES / COMMENTS (EMR)
RE: EHR Hi Tech Audit (Daniel D. Michaels, DPM)
From: Ken Schenley
The Medicare stimulus is not for everyone, and neither is Certified EHR. We have always expected that by attesting to Meaningful Use, and requesting a large “stimulus” from CMS, the floodgates would open on serious Medicare audits. We at Quick Notes have felt from the very beginning that it simply may not be worth it for podiatrists to pay a fortune for Certified EHR, spend valuable time trying to meet Meaningful Use (compared to helping/treating your patients)… and then dealing with audits! More important may be the simple approach to improving and protecting your office with great patient care, complaint documentation, and appropriate billing.
Disclosure: I am executive Vice President for Quick Notes EMR.
Ken Schenley, ken@qnotes.com
06/20/2013
RESPONSES / COMMENTS (EMR)
RE: HITECH EHR Meaningful Use Audit
From: Daniel D. Michaels, DPM
Dear Colleagues,
Our office would like to share the experience we encountered during an audit from Medicare for HITECH EHR Meaningful Use. Bottom line - use exact dates on the letter from your EMR company proving you have met meaningful use.
On January 11, 2013, we submitted our Attestation report for 2012. It was our understanding that once the submitted information was complete, there would be a 30-60 day window for the stimulus monies to be disbursed. At the end of March, there were still no monies received; therefore, we contacted CMS and...
Editor's note: Dr. Michaels' extended-length letter can be read here.
05/17/2013
RESPONSES / COMMENTS (EMR)
RE: Dragon Problem (Rob Eells, DPM)
From: Marc Katz, DPM
The main feature that is important with Dragon is the fact that you can do macros, and it navigates through your note via commands. If you master all of the commands and tricks, it is a powerful tool that you will not find in any other program. Take the time to read the manual and blogs out there so you can see how powerful Dragon can be. Of course there are other options for speech recognition, but that is only a small part. The cost of Dragon is a drop in the bucket when you look at the efficiency gained in your practice when the program is used to its full extent. So I respectfully disagree, but it is pretty cool that the iphone works that well.
Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com
05/15/2013
RESPONSES / COMMENTS (EMR)
RE: Dragon Problem (Craig Breslauer, DPM)
From: Brian Homer, DPM
I started using DNS Medical v.4 in 1999. Over the years, I have encountered countless issues with each subsequent version as DNS is a very unstable program. I am currently using v.11 and, believe me, it is far from flawless.
My saving grace has been a gentleman by the name of Lunis Ornicutt who owns and operates knowbrainer.com, which is a voice recognition software company. You can speak to Lunis directly and aside from his wealth of knowledge, you can also post your questions/issues on his website where several willing members are more than willing to help resolve your issues...AT NO CHARGE! I have no affiliation with knowbrainer.
Brian Homer, DPM, Clawson, MI, drbhomer@gmail.com
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
