Category: Cloud Hosted EMR

accounts receivableCloud based EHRCloud hosted EHRCloud Hosted EMRCloud hosting

Cloud-Based versus Server Based EHR Comparison

Since the onset of the COVID-19 pandemic, small, independent health care practices have changed workflows to accommodate telemedicine visits with patients. Some physicians, providers, and staff may also work from home occasionally. Although a hectic time, telemedicine has helped practices cope with quarantines and social distancing requirements, while also adapting to changing patient needs. With a provider’s ability to treat patients remotely comes a necessary workflow requirement of continuing the ability to access patient health records quickly and securely. Implementing an appropriate electronic health records system for your practice delivers to your providers and staff the tools to work safely outside the confines of your practice’s walls.

Health care practices can choose from multiple technologies to access EHR remotely, although a server-based system requires an additional remote access infrastructure. The difference between a cloud-based electronic health records (EHR) system and a server-based EHR system is mostly in where the programming and data reside. Both methods are similar in that functionality and essential features attempt to accomplish the same processes. Both systems collect patient information, maintain accurate health records, organize and compile data into informative and sharable formats, and facilitate effective communication with medical providers, payers, and patients. The health care practice controls and manages all aspects of a server-based system. EHR system developers manage cloud EHRs programming and data. The cloud system eliminates the practice’s need to maintain internal servers, monitor backup procedures, or to develop redundancy and resiliency protocols that ensure continuity of service and reliable access to stored data. 


UPFRONT COSTS

Cloud systems have the advantage here. EHR is much more complicated than simple practice management or billing system. For a server-based system to work correctly and speedily requires a practice purchasing one or more servers. Keep in mind, the premise of our discussion includes your ability to work from a remote location. Don’t ask a single computer to act as an application server, data server, and remote access server, and also work well. A cloud-based system eliminates the server(s) requirement.


MONTHLY COSTS

Both types of EHR systems have ongoing monthly or annual costs for services, support, and software updates. For a cloud-based system, you’re still paying for server infrastructure hosted by the software developer, just monthly instead of upfront. You may see a more substantial monthly cost with cloud systems than server systems, especially for practices with more physicians, providers, and users.


TOTAL COST OF OWNERSHIP (TCO)

TCO is tricky. For larger practices, especially, you may experience a lower TCO over three to five years with a server-based system. But that assumes the need for only basic maintenance requirements and no major server failures during the period. Any major networking and server issues can quickly eat into the savings. Plus, what many models don’t figure in is the need to replace your server(s) after four or five years, adding a new expense. The edge for the total cost of ownership costs usually goes to server-based systems, but only barely, and not without risks.


CASH FLOW IMPLICATIONS

You may have heard the expression “cash flow is king.” Despite a possible advantage in TCO, a server-based system still requires a tremendous up-front cash outlay. Cloud systems provide the benefit of predicting and knowing your monthly cash flow needs in advance.


DATA AND SYSTEM CONTROL

A server-based system provides you complete control over your systems and data. With that control is the requirement to secure your data and protect your systems adequately. If the Internet is down, a server-based system still works in the location where the server resides. If you have people working remotely from the server, they are unable to work on the network. With a cloud-system, anyone without Internet is down, but not all locations are necessarily offline. Plus, you have backup options available in instances where Internet access is temporarily lost. 


RCM COMPANIES

Revenue cycle management companies that perform billing, coding, collection, and other services on behalf of health care practices can leverage a cloud-based EHR to accommodate a provider’s clinical record keeping needs and the RCMs billing needs. All users can access integrated clinical and billing data from various remote locations with a cloud-based EHR. Cloud-based systems give RCM companies an opportunity to continue supporting practices when the transition toward electronic health records.


The crisis facing independent health care practices is leading more practices to adopt EHR. No one solution meets the needs of every healthcare-related company. Sunrise Services can help you with figuring out the best options for your office, and the associated costs to meet your needs and goals. Reach out to Sunrise with your questions, concerns, and goals. We’ll help create a plan suitable for your practice.

Navigating eRx in Medisoft Clinical
MedisoftElectronic Medical RecordsEMREHRelectronic patient record

Navigating eRx in Medisoft Clinical v11.2.1

Sunrise Services recently concluded Medisoft Clinical upgrades to version 11.2.1. The latest version incorporates a new ePrescribing module based on an enterprise service. One tremendous advantage of the enterprise version is the elimination of downloading, installing, and managing insurance formularies and drug interactions. Instead, Medisoft Clinical incorporates these features into the service!

NOTE:  This article is for Version 11.2.1 only. If you have not updated to version 11.2.1, please contact us so we can guide you on any requirements to upgrade

As the lead Medisoft Clinical support technician for Sunrise Services, I’ve experienced with you, first-hand, how any change in a feature can affect your workflow. Therefore, I’ve compiled some of the most common questions, issues, and confusions clients experience with the new eRx service:

When you look under the ‘RX/Medication’ tab in a patient chart, you may notice several different status codes.  You must look at the entire picture to get an understanding of what the status is for the selected prescription.

Pending – The prescription has not yet left the system. No action required unless the status changes to ‘Error’,

Queued – The order is in the system and queued up to send to Surescripts and the pharmacy.  If the RX remains queued for more than 10 minutes, contact support to investigate.

Verified – The pharmacy received the prescription and confirmed receipt with a message sent through Surescripts.

Error – The prescription did not make it to the pharmacy, resulting in an error message received from Surescripts or the pharmacy. If the error message appears to be one you can remedy, correct it yourself. Otherwise, or if in doubt, call Sunrise for support.

Completed – The Rx was put in the system for a different provider and is complete. Completed prescriptions occur when you perform a ‘Medicine Reconciliation.’ Remember to remove the medicine when it is no longer active.  Just highlight the medication and move to ‘Historical.’

Sent – You’ve received no additional information from Surescripts or the pharmacy after sending the prescription.


Let’s take a closer look at the ‘Sent’ status:

If you created a paper Rx, then it is ok to have a ‘Sent’ status. On a printed prescription, the system has no way to validate whether the pharmacy received the order, so the system marks it as “sent” to indicate completeness. 

If you made an Electronic Prescription, or eRx, and the status is stuck on ‘Sent,’ then you must investigate further. The ‘Sent’ status indicates the prescription did not make it to the pharmacy, or the pharmacy sent back a denial.  You’ll see this status typically when a refill request is filled and is older than 14 days.  When you have a refill request present on the eRx Worklist, it’s in your best interest to address it as soon as possible.

If the eRx status has a sent Status, usually after about 10 minutes, you can see any associated errors by doing the following:

  • Click on Maintenance > Setup > Prescriber Management.  The Prescriber Management window will open. 
  • Click on Message History (Bottom Right).  Insert the patient’s last name and click on Search. 
  • If the status is ‘Error,’ click on the eye icon on the right to open the raw message where you can find the denial reason. 
  • If you see no reason provided, it is more than likely that the refill request is out of the date scope for the pharmacy.  To rectify, remove the eRx from the medication list and make a new one.  You should have a new status in under 5 minutes. 

NOTICE: Any eRx refill request received in the Worklist that does not have a corresponding Medication in the current medications list will result in a pop-up box. To rectify the problem, you can match the refill request from the medication on the left to a medication in the drop-down list, OR you may deny the request and select the Proceed button. The pharmacy will receive a denial request. You may also deny the eRx now and submit a new medication.

If, after you perform these steps, you require further assistance, please call Sunrise Services Support line @ 502-538-4665.

Medisoft Clinical’s latest upgrade includes several other advancements to help in your staffs’ daily workflow.

A new Prior Auth button is available in the eRx Worklist: Click the ‘Prior Auth’ button to access the CoverMyMeds ePA Dashboard.  For more information on enrollment, contact Sunrise Services support.

When you discontinue medication and select either Adverse reaction or Allergic reaction as the discontinue reason, a new section expands to enter details about the reaction. Select the severity from the drop-down options and type or select the reaction description.

A CCDA based on selections clicked in the clinical summaries is now sent to Updox (Patient Portal). Make your selections within the Special Features section of the Configuration drop-down.

The most significant changes in the new RX process are behind the scenes.  No longer is Medisoft Clinical using the PMSI application, but rather the more stable PMSI Interoperability service. This change frees up memory and allows the program to operate at a premium level.

For additional information on Medisoft Clinical’s new features and how to incorporate them into your workflow, give Sunrise Service’s support team a call at (502) 538-4665.

AttestationCloud Hosted EMRCloud hostingEHRElectronic Medical Records

Using templates in your EHR? Make sure they are updated for ICD-10!

The follow article, written by Cathie Wilde pertains to any EHR that is “template driven”.  As we approach (hopefully) adoption of ICD-10 codes, looking at how your templates are coded is one of those great first steps a practice can take to begin it’s transition to ICD-10.

 Published from ICD-10 monitor:
 “Templates can either enhance documentation necessary for coding and data quality, or they can hinder things by restricting options and failing to prompt physicians to document specific information. However, templates cannot be overlooked when it comes to ICD-10. This is particularly true if a hospital relies more heavily on templates to capture structured data. Many hospitals may use templates for certain diagnoses, orders, or visit types and allow physicians to dictate information for everything else.

Regardless of a hospital’s specific use of templates, one point remains clear: the templates must be updated to accommodate the details necessary for ICD-10. At a minimum, these details include laterality, specificity, and etiology. The number of physicians who could be using a specific template at any given time — or even over a short period of time — could be significant. If one template is not updated correctly to accommodate ICD-10, data quality and reimbursement could be compromised.

Health information management (HIM) directors cannot assume that electronic health record (EHR) vendors will handle this effectively and in a timely manner. Instead, take the following steps to ensure that all updates will be made:

1. Take an inventory of all current templates in use. Are some of these templates used more frequently than others? Can any of them be retired if not in use? Ask for input from coders — what information is typically missing from the templates? Can you add or revise this information during the ICD-10 update? Work with your EHR vendor to make these changes before tackling ICD-10 updates.

2. Form a committee to address ICD-10 template updates. This committee, which can be a subcommittee of the ICD-10 implementation committee, should include coders, clinical documentation improvement (CDI) specialists, a physician champion, and an EHR representative. Compile a list of all diagnoses and procedures that require greater specificity in ICD-10 and cross-check this list with any templates that are in use. Ensure that each and every reference to these diagnoses and procedures is updated to accommodate ICD-10 specificity and other requirements.

3. Tie your template update efforts to your query update efforts. As CDI specialists review queries to ensure the implementation of updates for ICD-10, they can easily use this information to review templates in light of ICD-10 changes. If templates ultimately capture all of the relevant information that coders need, a query may not even be necessary.

4. Review templates after updates have been made. Set a deadline for all template updates to be completed. Then manually review each template to ensure that updates have been entered correctly.

5. Educate physicians. Physicians don’t need template-specific training; however, let physicians know that the updated templates exist when performing specialty-specific ICD-10 training. Reiterate that the templates exist to make physicians’ jobs easier by prompting them to document what’s necessary and pertinent to ICD-10 in the most concise way.

Clinical areas for review

Consider focusing on the following templates that require new and more specific documentation in ICD-10:

Obstetrics-related templates

  • Specific trimester: The majority of codes in Chapter 15 (Pregnancy, Childbirth, and the Puerperium) feature a final character that indicates the trimester of the pregnancy. Assignment of this character is based on the provider’s documentation of the patient’s trimester during the admission/encounter. Templates should include the weeks of gestation at the time of admission and/or delivery.
  • Fetus identification: ICD-10 requires a seventh character to denote multiple gestations, when applicable. This character identifies the fetus for which the complication code applies. Templates should provide an option for this character.
  • Multiple gestation placenta status: ICD-10 features a combination code for multiple gestation and identification of the number of placentas and amniotic sacs. Templates should capture this information as well.

Trauma-related templates

  • Glascow coma scale: This scale denotes the degree of consciousness and is used commonly with head trauma cases. The score can function as an indicator for testing or treatment as well as predict the duration and outcome of the coma. Templates for head injuries should specifically include this information.
  • Gustilo classification: This classification applies to open fractures of the long bones, including the humerus, radius, ulna, femur, tibia, and fibula. The classification system groups open fractures into three main categories and three subcategories defined by these characteristics: mechanism of injury, extent of soft tissue damage, and degree of bone injury or involvement. Templates for open fractures should include this information.
  • Salter-Harris classification: This classification includes nine types of fractures that occur along the epiphyseal (growth) plates in bones that have not reached full maturity. With these types of fractures, plates are still open and filled with cartilaginous tissue. These fractures are common among children. Templates for these fractures should include information related to the Salter-Harris classification system.

Wound-related templates

  • Severity: In addition to specific location and etiology of non-pressure skin ulcers, ICD-10 also requires physicians to document the severity of the ulcer as follows:
    • Limited to breakdown of skin
    • With fat layer exposed
    • With necrosis of muscle
    • With necrosis of bone

Any and all wound templates should include these designations. Pressure ulcer templates should continue to include the stage of the ulcer.

Nutrition templates

  • Obesity: In addition to the current body mass index documentation on nutrition orders/templates for obesity, ICD-10 includes additional codes for obesity due to excess calories, drug-induced obesity, and morbid obesity with alveolar hypoventilation. Templates should be updated to include these designations. “

About the Author

Cathie Wilde, RHIA, CCS, is the director of coding services for MRA. Ms. Wilde has been active in the healthcare industry for more than 30 years. Her previous positions have included assistant director of HIM, DRG coordinator at the Massachusetts Hospital Association, and DRG validator at Blue Cross Blue Shield. She has extensive experience in ICD-9-CM and CPT coding, auditing, data analysis, development and testing of coding products, specialized reporting, and in-service training. As director she is responsible for overseeing the coding division, providing the strategic direction of MRA as a local industry leader of quality coding, auditing, and denial management services. Ms. Wilde is an American Health Information Management Association (AHIMA)-approved ICD-10-CM/PCS trainer.

AttestationCloudCloud based EHRCloud hosted EHRCloud Hosted EMR

New CMS rule allows flexibility in certified EHR technology for 2014

The Department of Health and Human Services (HHS) published a final rule on August 29, 2014, that allows health care providers more flexibility in how they use certified electronic health record (EHR) technology (CEHRT) to meet meaningful use for an EHR Incentive Program reporting period for 2014. By providing this flexibility, more providers will be able to participate and meet important meaningful use objectives like drug interaction and drug allergy checks, providing clinical summaries to patients, electronic prescribing, reporting on key public health data and reporting on quality measures.

“We listened to stakeholder feedback and provided CEHRT flexibility for 2014 to help ensure providers can continue to participate in the EHR Incentive Programs forward,” said Marilyn Tavenner, CMS administrator. “We were excited to see that there is overwhelming support for this change.”

Based on public comments and feedback from stakeholders, the Centers for Medicare & Medicaid Services (CMS) identified ways to help eligible professionals, eligible hospitals, and critical access hospitals (CAHs) implement and meaningfully use Certified EHR Technology. Specifically, eligible providers can use the 2011 Edition CEHRT or a combination of 2011 and 2014 Edition CEHRT for an EHR reporting period in 2014 for the Medicare and Medicaid EHR Incentive Programs; All eligible professionals, eligible hospitals, and CAHs are required to use the 2014 Edition CEHRT in 2015.

These updates to the EHR Incentive Programs support HHS’ commitment to implementing an effective health information technology infrastructure that elevates patient-centered care, improves health outcomes, and supports the providers that care for patients.

The rule also finalizes the extension of Stage 2 through 2016 for certain providers and announces the Stage 3 timeline, which will begin in 2017 for providers who first became meaningful EHR users in 2011 or 2012.

See the full press release here:  http://cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-08-29.html

See the EHR Incentive Programs 2014 CEHRT Ruke: Quick Guide here:  http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/CEHRT2014_FinalRule_QuickGuide.pdf

See the CEHRT Flexibility Decision Tool here:  http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/CEHRT_Rule_DecisionTool.pdf

Kelly Meeks

Sunrise Services, LLC

http://www.sunrize.com

CloudCloud based EHRCloud hosted EHRCloud Hosted EMRCloud hosting

Practice Choice EHR

 

McKesson Practice Choice Web Image - Product Name (Color)

 

McKesson Practice Choice™ is a cost-effective Web-based electronic health record (EHR) and practice management (PM) solution inspired by small, physician practices just like yours.   Intuitive and efficient, McKesson Practice Choice does more than maintain records and protect cash flow; it has the power to improve the quality of your patient interactions.
When care is your priority and simplicity is your choice

With 20+ years developing PM and EHR technologies, McKesson understands the juggling act of the small, physician practice, and is committed to utilizing technology to make your life easier, flexible and more efficient. That’s why McKesson Practice Choice is more than an EHR product — it’s a comprehensive, full-practice solution.
Utilizing a SaaS (Software as a Service) model, McKesson Practice Choice allows physician practices to exchange data with other practices, patients, HIEs, hospitals, pharmacies, labs and payers. These connections help to streamline care coordination, to enhance patient care, and to position your practice for the future direction of healthcare.
One solution for your entire office

Simplify your administrative overhead and learning curve with just a single solution: choicepic

• Electronic Health Record (EHR)
• Practice Management (PM)
• Patient Portals
• Patient Health Maintenance Tracking
• e-Prescribing
• Claims Management

One Choice for Connecting Providers, Payers and Patients

Progress Notechoice2 Featuring Smart Note Technology

Spend less time charting and more time interacting with your patients, as everything you enter automatically flows data into all pertinent fields throughout a chart.

• Document on a single screen while pulling and pushing
data from anywhere in the patient’s chart.
• Search codes using natural terminology and view
cross-sectional chart summaries.
• Create a template that suits your note-taking preferences

Billing and Schedulingchoice3

Utilizing intuitive drag and drop technology and simple organiza

tio

n,

McKesson Practice Choice brings needed efficiencies to a busy front office.


Meaningful Use Dashboard and Reporting

From a single screen, gauge your progress in real time for both core and selected requirements, and gain an instant view of your practice’s performance. Also, customizable controls allow you to observe detailed performance levels of every member of your practice.

Need more information?  Call us at 888-880-0384 or visit us on the web at http://www.sunrize.com.