Dr' Alan Faustino, MD

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• Dr. Alan Faustino, MD

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Why use an EHR/EMR?

• More efficient for staff and physicians
• There is no paperwork
• Each patients chart is legible
• No longer have to search for charts
• Entire office is at your fingertips
• Physicians are able to run a more efficient
  practice
• ROI (return on investment) has been shown to save
  thousands per year, per practice.
• State/Federal Governments are sending out large
  incentive packages to practices.

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Federal Government Incentive Plan

• Physicians with approved EHRs in place before
  2011 or 2012 will be eligible for the maximum
  Medicare incentive payments allowed by the
  stimulus. They will receive bonuses equal to 75
  of their allowed Medicare Part B charges up to
  a sliding cap in each of the five years after
  adoption. The maximum of 18,000 in the first
  year phases down to 2,000 in the fifth year for
  a total five-year bonus of up to 44,000 for
  early adopters
• Doctors who wait until 2013 or 2014 to have EHRs
  in place will be eligible for smaller bonuses.
  The 2013 adopters can capture a maximum of
  39,000 over four years, while the 2014 adopters
  can claim up to 24,000 over three years.
  Medicaid will have its own five-year bonus
  schedule that will offer as much as 64,000 to
  eligible physicians who dont claim Medicare
  bonus money.
• Once the chance for bonuses end, Medicare starts
  penalizing physicians who have not responded to
  the incentives. Doctors who have not adopted an
  EHR before 2015 and who fail to obtain a hardship
  exemption will see a 1 CUT TO THEIR Medicare
  pay, a reduction that phases up to 3 for 2017
  and remains each year after that.

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New Jersey Government Incentive Plan

• New Jersey enacted the New Jersey Health
  Information Technology Act in January 2008.
• A key provision of the law calls for
  establishing a secure, integrated, interoperable
  statewide electronic health information
  infrastructure, which must comply with all state
  and federal privacy requirements and link all
  components of the healthcare delivery system.
• The implementation of a CCHIT Certified EHR
  makes physicians eligible for a bonus of 50 per
  patient per year as long as they also meet
  thresholds for care of certain chronically ill
  populations in their practice, evidence that the
  EHR is being put to productive use.
• Physicians using a CCHIT Certified EHR also can
  gain recognition as a medical home provided they
  also meet thresholds for clinical care the
  designation can be accompanied by incentives of
  up to 125 per patient per year.

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The Independence at Home Act(S. 1131, H.R. 2560)

• The Independence at Home act 9S. 1131, H.R.
  2560) uses proven home-based primary care teams
  to address the number one cost and quality
  problem faced by Medicare- 10 of Medicare
  beneficiaries account for 66 of Medicare costs.
  These beneficiaries, suffering from multiple
  chronic diseases, have poor outcomes because
  Medicare does not pay for the coordination of
  their care. Improved healthcare for patients with
  high-cost chronic disease has been identified
  as a top priority for health care reform by the
  Senate Finance Committees April 21 Roundtable
  on Reforming Medicares Health Care Delivery
  System and the HELP Committees drafts
  affordable Health Care Choices Act (at section
  201). The IAH Act is paid for entirely by the
  savings it achieves.
• Further, the IAH Act holds providers and
  practitioners who voluntarily participate
  strictly accountable for three types of results-
  minimum savings to Medicare of 5, improved
  outcomes and patient/caregiver satisfaction. IAH
  organizations that meet those performance
  standards will be allowed to share in savings
  beyond 5 on an 80/20 basis. So if IAH
  organizations do not achieve savings, they do not
  get paid. The IAH Act also includes a budget
  neutrality failsafe mechanism.
• Accordingly, the IAH Act will generate savings,
  that could amount to 14 billion a year, to be
  used to pay for other health reform measures such
  as the SGR fix or preventive care. So the IAH Act
  helps fund health care reform than adding to its
  cost.

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• The IAH program begins with a 3-year pilot in
  the 13 state and the District of Columbia where
  the Medicare costs for treating the severely
  chronically ill are the highest plus 13 other
  states where the need is the greatest. These
  highest cost states are New Jersey, California,
  New York, Massachusetts, the District of
  Columbia, Maryland, Louisiana, Connecticut,
  Nevada, Texas, Florida, Illinois, Rhode Island,
  and Pennsylvania where the per capita Medicare
  costs for these beneficiaries range from 45,000
  to nearly 60,000 each year. So the IAH Act
  targets the highest cost Medicare beneficiaries
  in the highest cost states.
• The IAH Act uses physician and nurse
  practitioner directed house calls teams that have
  proven effective in hundreds of locations across
  the country in reducing health care costs and
  improving outcomes for this high cost patient
  population. For example, the Veterans
  Administrations Home-Based Primary care program
  has been operating for more than 30 years, has
  over 130 locations in 48 states and has reduced
  hospital days by 62, nursing home days by 88
  and costs by 24 for high cost patients with
  multiple choronc disease. Other IAH-style house
  calls programs have been achieving comparable
  results in some cases for decades in Boston, MA
  Richmond, VA Chicago, IL New York City, NY
  Washington, DC Indianapolis, IN northern
  Nevada, Philadelphia, PA and San Diego, Ca among
  other areas. Thus, there are hundred of shovel
  ready house call programs restricted by
  Medicares failure to pay for good results that
  are ready and willing to meet the needs of high
  cost chronically ill beneficiaries if reimbursed
  based on the results they achieve.

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• The IAH Act is completely compatiable ith
  Accountable Care Organizations, the Medical Home
  and incorporates Transitional Care to reduce
  rehospitalizations over any length of time rather
  than just 30-60 days after a hospital discharge.
  The IAH Act BUILD ON WHAT WORKS. Without the IAH
  Act, however, there will be little incentive for
  ACOs and Medical Homes to address the needs of
  this high cost beneficiary population that
  accounts for the majority of Medicares costs,
  nor will there be a requirement for Medicare
  savings.
• The IAH Act has been endorsed by a broad range of
  consumers, providers and technology
  organizations. For more information, contact, Jim
  Pyles, American Academy of Home Care of Home Care
  Physicians and the IAH Coalition, [phone],
  jim.pyles_at_ppsy.com

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Why use NextEMR?

• NextEMR is a revolutionary ambulatory Electronic
  Medical Record system (EMR) or Electronic Health
  Record (EHR) system that is centralized and
  entirely Web-based.
• Completely designed by physicians and office
  staff.
• Been in use for 2 years.
• NextEMR will meet CCHIT and HIPPA certifications
  for 2009.
• It will be designed to be user-friendly,
  intuitive, organizational, feature rich,
  flexible, and customizable.
• Intended to be a complete management solution for
  healthcare practices of any size or
  configuration.
• Customers will be able to sign up online,
  purchase a subscription, and manage their account
  online.
• Patients will be able to log into this website to
  gain access and securely download their latest
  medical information any time, anywhere from
  virtually any device connected to the internet.
• NextEMR iPhone application

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• NextEMR Online Community forum, chat and
  professional directory. Searchable directory by
  name, specialty, or department.
• Instant Messaging System (IMS). Users will be
  able to see everyone within their practice that
  is currently online in their Contact List. If the
  recipient of a message is offline, the recipient
  will receive the message upon logging in. We may
  also be able to integrate the system with AOL,
  gTalk, MSN, etc.
• User able to upload practice logo, which will be
  put on all PDF reports.
• Ability for custom presets for user permissions.
  User will be able to save, edit, and delete
  custom presets. Temp plates.
• Offline Windows/Mac application, designed to be
  installed on laptops in case an Internet
  connection is not available. The program will
  then automatically sync with the online software
  once an Internet connection is available.

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EHRs/EMRs Statistics
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nextEMR Statistic

• There are no setup fees, purchase fees, nor
  training fees.
• 249 per month per physician for BETA testers
  who convert to full time user.
• Otherwise, 299 per month per physician if you
  had not done BETA testing.

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NextEMR Specifications

• Project will be based on already existing EMR3
  software, with the following modifications
• The software will be heavily modified to meet the
  2009 CCHIT certification requirements for
  ambulatory EHRs (as of 5/29/09).
• a) A non-technical overview to the 2009 CCHIT
  requirements
• http//www.x2websites.com/cchit/2009overview.pdf
• b) An concise guide to the 2009 CCHIT
  requirements
• http//www.x2websites.com/cchit/2009guide.pdf
• c) 2009-2010 Final Criteria
• http//www.x2websites.com/cchit/2009final.pdf
• II. Support for the HL7 v2.x standard. The
  software will meet Health Level Seven
  requirements (as of 6/18/09).
• III. The software will be aesthetically improved
  and modernized, specifically to eliminate
  boxy-ness.
• IV. The software will be tested to work with full
  functionality in IE7, Firefox 3, and Safaris 3.

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Patient Portal

• Patients will have access to their medical
  records at anytime.
• Patients will have the ability to send their
  medical records to anyone online.
• Patients will have the ability to make an
  appointment online.
• Patients will have the ability to ask for
  prescription refills online.
• iPhone compatible for any patient

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Healthcare Professional Portal

• A healthcare professional will be able to access
  a patients medical information through the
  Healthcare Professional Portal.
• To give someone permission to access a patients
  file, a Provider or Office Administrator
  simply has to go to the patients file and click
  Grant External Access.
• That will generate and provide a code for the
  user to give to the professional.
• The professional will simply type that code into
  the portal and gain read-only access to that
  patients file.
• The code is only valid for 72 hours by default
  (this is configurable in Settings).

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Practice Portal

• Progress Note drafts will be automatically saved
  every 15 seconds. If the browser window is
  closed, or the session is timed out, the user
  will still be able to pick up where he/she left
  off.
• User permissions, according to CCHIT
  specifications, will be made to be more flexible.
  The Office Administrator will be able to set a
  users permissions individually. There will be
  presets to choose for your convenience.
• Users can be designated with one or more of the
  following labels Provider, Medical Assistant,
  Billing, and Reception (and possibly a few
  others).

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Task Management System

• Every user will have tasks that are assigned to
  him/her. Tasks can be created and assigned by
  anyone and to anyone. When creating a task, there
  will be an option for the task to be assigned to
  the following designations Medical Assistant,
  Billing, Provider, and Reception. If one of these
  is chosen, and there is more than one user with
  the chosen designation, the task will be assigned
  to the user with the least number of uncompleted
  tasks.
• Tasks will have the option to snooze, which
  will remove the task from the list until x days
  later (30 by default and configurable in
  Settings)
• The Office Administrator will be notified if
  there are uncompleted tasks in the system more
  than x days old (30 by default and configurable
  in Settings)

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• The Reminder System will be able to create
  tasks for Schedules, x number of days, before
  they are actually due (90 by default and
  configurable in Settings)
• The patients file will have the following
  tabs, and the information populated as
  appropriate
• Profile (demographics and other information)
• All (a chronological history including all notes
  and activity related to the patient account)
• Notes (Notes and Progress Notes will be merged)
• Diagnoses
• Plans
• Procedures
• Labs
• Files
• Reminders (will show for all items due soon, or
  past due)
• Appointments (will show future appointments
  scheduled)
• Billing (will show all billing items associated
  with patient)

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• The Reminder System will be improved so that it
  can automatically track the occurrence of a few
  different tasks, including scheduling
  appointments, or procedures/tests such as EKGs.
  Once the task is done, it will be marked as
  completed automatically and be removed from the
  list.
• Any tests that need to be done can be scheduled.
• Any procedures that need to be done can be
  scheduled.
• Standards for specific disease states, can be met
  through this system.
• I.E. Diabetes, chf, etc.
• Account Activity will be made searchable.

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Upcoming Features

• Within 6 months a revolutionary and comprehensive
  billing application will be released that will
  essentially do away with the need for a full time
  biller in any physicians office.

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Works Cited

• CCHIT. Incentive Programs available in New
  Jersey. CCHIT.com. 2009. CCHIT.com. 24 June
  2009.
• Silva, Chris. Practices Paperless before 2012
  could maximize Medicare bonuses. amednews.com.
  2009. American Medical News. 24 June 2009.
• http//www.ama-assn.org/amednews/2009/03/16/gvsa0
  316.htm