Yes your practice can start receiving Federal incentives for EHR implementation now through Section 132 of the Medicare Improvement of Patients and Providers Act of 2008 (MIPPA). The incentive benefit is as follows:

	2009	2010	2011	2012	2013	Beyond
Incentive	2%	2%	1%	1%	0.5%	None
Penalty	None	None	None	1%	1.5%	2%

This incentive is separate from, and is in addition to, the quality reporting incentive program authorized by Division B of the Tax Relief and Health Care Act of 2006 – Medicare Improvements and Extension Act of 2006 (MIE-TRHCA) and known as the Physician Quality Reporting Initiative (PQRI). R&D MedTech's software partner has integrated e-prescribing capability, so your practice can be eligible to start receiving e-prescribe benefits upon the completion of implementation of our EHR.

In general an "eligible professional" for the e-prescribing incentive includes the following: Physician, physical or occupational therapist, qualified speech-language pathologist, nurse practitioner, physician assistant, clinical nurse specialist, certified registered nurse anesthetist, certified nurse mid-wife, clinical social worker, clinical psychologist, registered dietitian, nutrition professional, and qualified audiologist.

The e-prescribing incentive is similar to the Physician Quality Reporting Initiative in that reporting periods are one year in length. The incentive is based on the covered professional services furnished by the eligible professional during the reporting year.

The government said Medicare is expected to save up to $156M over the five-year course of the program in avoided adverse drug events. The HHS pointed out estimates that as many 530,000 adverse drug events are reported every year by Medicare beneficiaries while the Institute of Medicine said that more than 1.5M Americans are injured each year by drug errors.

More than 140,000, or about 23% of all office-based doctors, nurse practitioners, and physician assistants in the U.S. currently use electronic prescribing technology, according to the executives of the e-prescribing company SureScripts (Health IT News). If the current pace of adoption is maintained, the officials predict that the number of active e-prescibers in 2009 will more than double from the 74,000 e-prescribers reported at the end of 2008 (Monegain, Healthcare IT News, 10/5/09). Eighty-four percent of retail pharmacies and six large mail-pharmacies are linked to the network (Goedert, Health Data Management, 10/5/09).

For more information on this topic, contact R&D MedTech at 918-682-2285.

The American Recovery and Reinvestment Act of 2009 (AARA) amended Section 179 of the Tax Code to increase the small business expense for qualified property to $250,000 through December 31, 2009 with a 50% bonus depreciation. Thus, a medical practice can expense the full cost (up to $250,000) of its equipment/medical software purchase that purchased by 12/31/2009. Prior to the Economic Stimulus Act, the expense limit was $128,000.

For example, your practice can expense the full amount of a $75,000 EHR software purchase including software and hardware – and reduce your practice’s taxable income. So, if your taxable income is $100,000 prior to your EHR purchase of $75,000, your taxable income is reduced to $25,000.

Additionally, Section 179 of the Tax Code allows for bonus 50% depreciation. For example, the purchase price of software and hardware for EHR was $300,000. You would write off the first $250,000 and then get a bonus write off of $25,000. So your first year total write off is $275,000.

On December 1, 2009, senators Landrieu and Snowe introduced S.2822 which would make tax benefits permanent. Read more. The Obama Administration has indicated support for this extension. Read more.

For more information, contact R&D MedTech at 918-682-2285.

On February 17, 2009, President Obama signed into law the American Recovery and Reinvestment Act of 2009 (AARA), HR.1. The Act aims to stimulate the economy through investments in infrastructure, unemployment benefits, transportation, education, and healthcare. It includes over $30B (and up to $45B) of direct adoption incentives are available for "meaningful use" of certified EHRs. Specifically, $17.7B in Medicare incentives and $12.4B in Medicaid incentives are available from 2011 to 2016. Providers will not be able to seek reimbursement from both Medicare and Medicaid programs.

The stimulus act provides three broad criteria for demonstrating that a professional or institution is a "meaningful EHR user". They are:

• Meaningful use of certified EHR technology
• Information exchange
• Reporting on measures using EHR

However, the specific definitions of "meaningful use" and "certified" are being crafted by the Office of the National Coordinator for Health Information Technology (ONC) and are expected in late 2009. The ONC, part of the Department of Health and Human Services (HHS), also must ensure that standards are uniform so that information can be shared by different information technology systems.

The timetable is tight, as financial incentives will start flowing in 2011.

On the Medicare side, healthcare providers who meet the ONC’s criteria for meaningful use of certified EHRs and other health-related information technology could receive as much as $44,000 (or $48,400 if the physician is located in an area designated one of health professional shortage). Incentive payments to eligible professionals begin in January 2011 and phase out in 2016. EHR systems adopted after 2015 do not qualify for incentives, and providers who aren’t using approved EHRs by 2015 face financial penalties. Section 1861(r) defines the eligible professionals for this Medicare incentive to include: Physicians, Dentists, Podiatrists, Optometrists, and Chiropractors.

On the Medicaid side, states will oversee reimbursements to eligible providers who purchase computers and software to use and share EHRs. Since Medicaid is administered and partly funded by the states, the criteria for participation could vary from state to state. More information is expected soon, as incentive payments are to begin in 2011. The maximum amount will be $63,750. There is no penalty clause on the Medicaid side. The Medicaid “eligible professional” includes: Physicians, Dentists, Certified Nurse Mid-Wives, Nurse Practitioners, and Physician Assistants.

For more information on this topic, contact R&D MedTech at 918-682-2285.

R&D MedTech’s EHR product partner – Greenway Medical is not only a leader technologically with a 2008 CCHIT certification and has already heavily invested in research and development for the comprehensive 2011 CCHIT, but Greenway Medical is also a leader in Washington, DC in shaping Health IT policy.

A certified EHR system is important because of stimulus act’s requirement for a certified system. The Federal Government has chosen CCHIT at the primary independent certification body for certifying EHR systems that qualify to receive Federal stimulus incentives. On September 9, 2009, the Certification Commission for Health Information Technology (CCHIT) announced that it would launch two certification programs. The first is “CCHIT Certified 2011,” which is an updated version of its comprehensive EHR certification program. The second of which is called the “Preliminary ARRA 2011”, which focuses on just the standards for qualifying systems under the American Recovery and Reinvestment Act (ARRA).

By pursuing the comprehensive certification path (“CCHIT Certified 2011”), vendors can begin applying for certification testing in September 2009, and when ready, the testing process should be completed in 90 days or so for each vendor. Then they can begin selling the “certified product” to clients thus allowing the providers to immediately apply for stimulus funds. R&D MedTech’s EHR software partner has chosen this option, so our clients will have confidence that their practice will be immediately eligible for stimulus incentives.

In the second approach, (“Preliminary ARRA 2011”) the vendor will only be certified for certain modules of the “meaningful use” requirements. Thus, it is not a complete solution for stimulus funding because CCHIT will include a certification label indicating which meaningful use objectives the modular system supports. This program aims to help health care providers evaluate which systems or combination of systems will meet all of the necessary meaningful use criteria.

Providers should note that timing is important, for instance if a vendor has a CCHIT certification earlier than 2008, they may have more updates to make before they may be eligible for the 2011 comprehensive certification. Additionally, those vendors who wait until the government standards are finalized according to the published government schedule at the end of calendar 2009, risk waiting until later to apply for certification, because the vendors may not be able to respond in time to complete certification testing for their providers to purchase, implement and qualify for full funds outlined under the ARRA stimulus legislation.

Greenway’s leadership on Health IT policy is a huge advantage for our clients because we often shape policy or know about policy before many of our competitor products. Greenway’s Government Affairs team has spearheaded leadership and collaboration with policy makers to provide a strong foundation for growing our nation’s health information technology investments and infrastructure. Greenway has testified and/or formally addressed Congress as well as both Presidential Administrations on 12 occasions since 2005.

Each year, Greenway renews its commitment to innovation and industry-leading activities, acting in an advisory/leadership capacity on public policy and state and federal legislation for:

• Certification Commission for Healthcare Information Technology (CCHIT)
• Healthcare Information Technology Standards Panel (HITSP)
• Healthcare Information and Management Systems Society (HIMSS)
• Electronic Health Record Association (EHR Association)
• Health Information Security and Privacy Collaboration (HISPC)
• National Governor’s Association (NGA) Health Information Protection Taskforce
• Integrating the Healthcare Enterprise (IHE)
• Clinical Data Interchange Standards Consortium (CDISC)
• National Quality Foundation (NQF)
• National Committee for Vital and Health Statistics (NCVHS)

For more information on this topic, contact R&D MedTech at 918-682-2285.

Yes, The Stimulus funding requires "certification" and Greenway is certified by CCHIT, the only currently recognized EHR certification process. In fact, we guarantee it.

With $30 billion of stimulus funds for EHR, the federal government hopes to create a digital healthcare infrastructure that reduces costs and improves quality. While many have their eyes on the carrot, the big stick of penalty payments is actually much more of a incentive for physicians to comply, according to an analysis from the PriceWaterhouseCoopers' Healthcare Research Institute.

Physicians who are Medicare providers will be financially penalized in two ways for not implementing EHR. First, through the penalties under the e-prescribe language contained in Section 132 of the Medicare Improvement of Patients and Providers Act of 2008 (MIPPA). Second, under the HITECH language of the American Recovery and Reinvestment Act of 2009 (AARA). Currently, there are no direct financial penalties from Medicaid. However, it is expected that some states will either follow Maryland’s lead, which requires private health insurers to provide incentives in reimbursements to providers, or the private health insurance companies will follow Medicare’s fee schedule that may include penalties for not using EHR as a matter of course.

e-Prescribe Penalties: In 2009 and 2010, physicians who successfully e-prescribe may receive a bonus payment of 2 percent of their overall Medicare reimbursement. In 2011, however, the reward for e-prescribing will begin to phase out, while a penalty for not e-prescribing begins in 2012. The e-prescribing bonus payment will be 1 percent in 2011 and 2012, and 0.5 percent in 2013. The penalty for not e-prescribing will be a reduction in Medicare reimbursement by 1 percent in 2012, 1.5 percent in 2013, and 2 percent in 2014.

Timeline Chart for e-Prescribe incentives and Penalties

	2009	2010	2011	2012	2013	Beyond
Incentive	2%	2%	1%	1%	0.5%	None
Penalty	None	None	None	1%	1.5%	2%

Stimulus Penalties for EHR: Physicians that do not demonstrate meaningful use of EHR technology by 2014 will not only forego incentive payments, but will also be penalized by a reduction in Medicare payments. If an eligible professional is not a meaningful user of certified EHR technology during 2015 or any subsequent payment year, the Medicare fee schedule amount will be reduced by 1% percent in 2015, 2% percent in 2016 and 3% percent in 2017 and in each subsequent year. In addition, the secretary of the Department of Health and Human Services (the "secretary") has discretion to continue to decrease the fee schedule amount up to 5% in 2018.



Side-by-Side Timeline of Provider Incentives and Penalties for e-Prescribe & Stimulus

	Eligible Professionals		Eligible Professionals
Reporting Year	e-Prescribing Incentives	e-Prescribing Penalties	EHR Incentives	EHR Penalties
2009	Yes	No	No	No
2010	Yes	No	No	No
2011	Yes	No	Yes*	No
2012	Yes	Yes	Yes*	No
2013	Yes	Yes	Yes*	No
2014	No	Yes	Yes	No
2015	No	No	Yes**	Yes
2016	No	No	Yes	Yes (continues)
*Professionals receiving EHR incentives cannot receive eRx incentive.
**Incentives continue for 5 year or through 2016 whicever is earlier. No incentives are started after 2014.

Private Health Insurance Reimbursements: Even the health insurance industry has admitted it looks to Medicare when making payment policy decisions. As The New York Times August 18, 2007 reported, “Medicare will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, a move they say could save lives and millions of dollars. Private insurers are considering similar changes, which they said could multiply the savings and benefits for patients… Susan M. Pisano, a spokeswoman for America’s Health Insurance Plans [AHIP], a trade group, said, ‘Private insurers will take a close look at what Medicare is doing, with an eye to adopting similar policies.’”

Most providers only know about the cost savings benefits and Federal stimulus incentives associated with EHR implementation. However, we believe that not only is there a huge new opportunity for additional for new revenue for your practice that was not available with paper records, but it will generate huge new healthcare opportunities for your practice’s patients. That revenue stream is leveraging EHR to engage in clinical trials. Our initial case studies show it may bring a small practice as much as an additional $100K per year in revenue with no additional costs.

More than 75% of healthcare executives say aggregated data from electronic health records will be their organization’s most valuable asset during the next five years, according to a report released in September 2009 by PricewaterhouseCoopers. Researchers found that many surveyed organizations already use secondary EHR data to some degree including:

• 66% of drug companies
• 65% of healthcare providers, and
• 54% of health insurance firms (Goedert, Health Data Management, 10/1/09)

Many executives said they expect EHR data mining to help them:

• Detect fraud
• Evaluate drug efficacy
• Identify health patterns, and
• Reduce medical errors (Gardner, InformationWeek, 10/01/09)

R&D MedTech’s software partner Greenway Medical is a leader in this new application of EHR for clinical trials with its PrimeResearch tool. As a physician, Primeresearch provides your practice access to a vast network of clinical studies, quality/safety initiatives, and composite (clinical + financial) analytics that lead to more efficient processes, improved patient care and increased practice revenue.

As a Sponsor or Contract Research Organization (CRO), PrimeResearch provides you near real-time access to an unparalleled source of HIPAA compliant longitudinal clinical data. This data is available for Disease Analysis, Feasibility, Pharmacovigilance, Outcomes, Comparative Effectiveness, Site Selection, and Pre-screening of Patients as well as any Ad Hoc Reporting.

As an Electronic Data Capture (EDC) solution, PrimeResearch provides your practice with an unequaled clinical research interoperability strategy by being the first EHR company to utilize Retrieve Form for Data Capture (RFD) at the point-of-care in a live environment. This means that the EHR portion of PrimeSuite can natively submit standards based on pre-fill data to an EDC solution as well as access a view of the EDC’s electronic Case Report Form (eCRF).

Key Benefits for Physicians

Facilitate participation in clinical studies:

• Supply a network of trials, studies, and registries
• Collect and maintain metrics to help bolster site selection
• Make clinical research participation a revenue source
• Available within the PrimeResearch Network
  o Phase I-IV trials
  o Post marketing surveillance
  o Patient registries
  o Peri- and post approval research
  o Safety and surveillance monitoring

As a physician, there is NO COST or OBLIGATION to join the PrimeResearch Network.

For more information on this topic, contact R&D MedTech at 918-682-2285.

A patient-centered and coordinated approach to healthcare could save billions, according to a survey of leading healthcare providers, patients, payers, and technology leaders. The survey released on September 18, 2009, by the Massachusetts Medical Device Industry Council (MassMEDIC) and Cambridge Consultants, a technology product design and development firm shows that a focus on patient well-being will improve overall health outcomes. In addition, the survey indicates care coordination will reduce wasteful spending in defensive medicine, inefficient claims processing, medical errors and emergency room services.

The findings come on the heels of an August 2009 report issued by PriceWaterhouseCoopers’ Health Research Institute, which found that wasteful spending in U.S. healthcare is estimated at $1.2 trillion annually, comprising more than half of the $2.3 trillion spent in total.

The greatest areas of excess, according to the report:

• $210 billion in defensive medical practices such as redundant, inappropriate or unnecessary tests and procedures;
• $210 billion caused by inefficient healthcare administration; and
• $100 billion for the care necessitated by preventable conditions

In many cases, the report says, healthcare specialists are motivated to employ tests or procedures based on concern over liability or increasing their income over the needs of a patient. Of the survey respondents who were familiar with the connected health approach, 75% predicated that this new preventative practice could cut healthcare costs by up to 40 percent.

An integrated connected health approach advocates an end-to-end solution, giving patients control, as well as responsibility, connecting them with a wide network of healthcare professionals and online tools. This integration can be achieved through a range of technologies, beginning with electronic medical records.

For more information on this topic, contact R&D MedTech at 918-682-2285.

The most comprehensive case study to date conducted under contract for the Centers for Medicare and Medicaid Services found that small- to medium-sized physician offices that implement Electronic Health Records (this study included many EHR software products and was not exclusive to Greenway Medical's PrimeSuite product), on average, realize a $108,500* return on investment per physician over a five-year EHR implementation period. A five-physician practice maximizing its EHR investment can see more than a $1 million return over five years in the cost savings alone not including any government stimulus incentives or additional new revenue streams from EHR implementation. Read more

EHR cost savings Per Physician Per Year over 5-Year Implementation Period


R&D MedTech's flagship EHR product PrimeSuite is proven to deliver a documented cost savings of $21,600 to $81,500 annually per physician post-implementation.

An independent post-implementation study on the Greenway PrimeSuite EHR product revealed that your practice is more likely to be in the maximum cost savings category of the government study than in the average or minimum band (Read more) because it concluded that a four doctor practice could see a $183,945 annual bottom line improvement after implementing PrimeSuite.


*These cost savings and additional revenue do not include Medicare or Medicaid incentives for implementing EHR

Tools for your Practice to calculate your EHR Cost Savings
R&D MedTech has electronic tools available to instantly calculate the amount your practice can expect to save through EHR implementation. Please contact our office to receive these free tools or have our service representative walk you through them.

For more information, contact R&D MedTech at 918-682-2285.

Undercoding and non-billing is a fertile opportunity for physicians to increase revenue. For instance, in 2004, a CMS study reviewed about 160,000 claims from 2003 and uncovered $1 billion in underpayment, mostly by Part B carriers. According to the agency, 83.1 percent of all underpayment dollars were for E&M codes, and downcoding by one level was common. Nearly one-third of underpayment dollars resulted from these codes: 99241, 99212, 99211, and 99201. Read more

EHR software can increase revenues by facilitating capturing of charges for all services provided by the physician thereby avoiding lost revenues. In a case study (Nick Fabrizio, July 2005, QIO Presentation quote), a family medicine physician while seeing same number of patients increased revenues by $3000 per month due to timely visit documentation and automated charge capture. A study of fourteen small practices in the September/October 2005 edition of Health Affairs found that each physician could raise his/her revenue by as much $42,000 per year with increased coding levels resulting from implementation of EHR.

EHR Improves charge capture: When traditional paper charts are used, many services performed in a physician’s office are lost and never billed. The billing staff may either completely leave out an E&M Code or may erroneously enter fewer units, all resulting in lower billing and therefore lower reimbursements to a physician. The study ("How Many Problems Do Family Physicians Manage at Each Encounter? A WReN Study," Beasley JW, Hankey TH, Erickson R, et al., Annals of Family Medicine, 2004;2:405-410), which looked at 29 family physicians and 572 patient visits, reported that doctors frequently neglect to code for mental health and substance abuse problems, presumably out of concern for patients' privacy. Physicians documented 137 mental health and substance problems, including tobacco use, but only 58 related diagnoses appeared on the subsequent bills.

Maximizes Billing: When using paper charts, to be on the safe side of the law, many physicians down code (use a lower billing code), rather than use an appropriate level of code. Providers who use EHR software can increase revenues by using System recommended E&M billing codes that are based on the service accurately documented within the EHR, without the fear of an audit. Undercoding—especially on E&M codes—is all too common. Doctors tend to "play it safe" by coding all visits 99212 or 99213, when, in reality, many office visits are level 4 or even level 5. Assuming a 99214 pays approximately $30 more than a 99213, and the typical doctor undercodes three visits a day, that's about $90 per day per doctor in lost earnings. Medical Economics Magazine has estimated that physicians, who routinely down-code to avoid audits, lose an average of $40,000 annually.

Why do doctors undercode? Some may not know the rules. Others may be too rushed. But most doctors say they drop a level to "stay in a safe coding zone" and avoid government scrutiny. Practice management experts have long suspected that undercoding is a widespread problem, and now a recent study offers proof. The study ("How Many Problems Do Family Physicians Manage at Each Encounter?) found that while physicians managed an average of 3.05 problems per visit, they recorded only 2.82 in the chart and even fewer on the bill—just 1.97.

"Doctors are sometimes already up to a level 3 visit before they even touch the patient who has chronic diseases in addition to a chief complaint," says C. Nancy Noonan, a consultant from Yellow Springs, OH. For example, say a hypertensive, insulin-dependent diabetic presents with a troublesome cough. You see that the vitals and glucose reading are within normal limits, so treatment for HTN and diabetes requires no adjustment. You examine the patient and note in the chart a diagnosis of an upper respiratory infection. You don't think to document that you've made a considered decision not to change his regimen. In fact, nontreatment is part of medical decision making, says Noonan. That visit could legitimately have been coded 99214, but instead, it will get a 99213.

Optimizes reimbursement process: EHR software allows physicians to produce adequate supporting documentation that complies with CMS guidelines and supports the appropriate level of service to be billed. Accurate coding speeds up the reimbursement process and results in fewer rejected claims from insurance companies. Even better, an EHR helps produce clean claims the first time, significantly reducing the number of rejected claims!

Increases Physician productivity: When physicians do not use EMR, they have to spend several minutes per encounter, first dictating and then reviewing the transcript before signing the same. With an EMR, progress notes are automatically generated which can be signed electronically from home or work, with no pulling or filing of charts. The time saved can be used to see a few more patients each day. Further, the medical records storage space released as a result of implementing an EMR System can be used to add more consultation rooms. As a result, practices are able to generate more revenue with the same fixed costs in the same amount of time.

Increases Services with Health Maintenance Reminders: EMR Systems provide computerized checks and reminders which enable reminders to be sent to all patients who are overdue for recommended services, or who are coming up on their annual check-ups. This helps the physician to deliver enhanced patient care, while at the same time increasing service volume and revenue.

For more information, contact R&D MedTech at 918-682-2285.

An estimated 85,000 medical lawsuits are filed annually, which include those against hospitals and individual physicians. One of the highly-touted benefits of electronic health records (EHRs) is the potential to help prevent malpractice incidents and medical errors. By providing better documentation, automatically checking for medication errors and drug interactions, providing failsafe systems to track test results and follow-up with patients, EHRs can dramatically reduce the risk of malpractice.

Malpractice insurance carriers are increasingly offering discounts to doctors for using an EHR in their practice. The theory is that the EHR system will reduce risk by helping to eliminate some of the most common reasons for claims within a practice. These often have to do with oversights on patient record reviews (e.g. reading x-rays) or notifying patients of prescription refills. The EHR discounts generally run in the region of 2½ – 5% of the premium.

In one effort to quantify the impact of EHR on medication errors, a study published in the Journal Health Affairs in 2005 estimated that computerized physician order entry (CPOE) could eliminate 200,000 adverse drug events in hospitals, and two million adverse drug events in the ambulatory setting. A study of claims from 1990 to 1999 found that adverse drug events represented 6.3% of claims, and were preventable in 73% of the cases. For those lawsuits due to diagnostic errors, not prescribing errors, the EHR systems reduce claims and improve defensibility.

In 2007, the Certification Commission for Healthcare Information Technology (CCHIT) published an article advocating for lower malpractice insurance premiums for physicians who implement certified electronic health record (EHR) systems. CCHIT asserted that physicians using certified EHR systems enhance the quality and safety of their care through:
• Improved aggregation, analysis and communication of patient information;
• Diagnostic and therapeutic decision support
• Prevention of adverse events (such as safeguards against prescribing drugs which interact with the patient's current medications)
• Clinical alerts and reminders; and
• Enhancing research on clinical quality improvement.

These factors could be helpful in decreasing frequency of claims. CCHIT also states that physicians who use EHRs may improve defense of liability claims, by improving medical record documentation (including documentation of the informed consent process). If the physician's insurer is better prepared to defend the case, because of improved documentation provided through the EHR, results of settlement negotiations and jury trials may be more favorable, thus decreasing severity of loss.

A study reported in the Archives of Internal Medicine in 2008 provides some support for the position that adoption of EHRs can decrease malpractice exposure. Researchers surveyed physicians practicing in Massachusetts about EHR adoption, and linked the survey data to physician profile data from the Massachusetts Board of Registration in Medicine. The study found that physicians who used EHRs were less likely to have paid malpractice claims than physicians who did not use EHRs, and that within the physician group that used EHRs, physicians who were characterized as high users had lower rates of claims than physicians classified as low users.

Typically, most of the major medical malpractice insurance providers have language in the policy that to receive premium credits of 2% to 5%, a physician group must meet the following requirements: The EHR system must be certified by the CCHIT, the recognized certification authority for EHR systems. The physician group must have implemented or plan to implement the latest vendor updates for their system. At least 75% of the physicians in the group must be using the EHR. The group must have been using the EHR for at least a year.

If your medical liability provider does not allow for an EHR discount, R&D MedTech will connect you with some referrals. Please contact us for more information, 918.682.2285.

EHR tool’s can be leveraged to help save lives in numerous ways. Examples run the gambit from improved patient accountability of preventative care to drug interaction alerts to a reduction in the length of hospital stays.

Improved adherence to preventive measures - Certain studies have suggested that electronically generated reminders for screening and follow-up increases adherence by 10% to 15%. EHR tools can provide this electronic reminder functionality. For instance, an EHR program that cut cardiac deaths by 73 percent has also kept patients healthy two years later according to a Kaiser Permanente program in Denver. This program linked coronary artery disease patients and teams of pharmacists, nurses, primary care doctors and cardiologists with an EHR to help keep the patients healthy two years after they left the program by keeping in touch with their caregivers electronically. The two-year randomized trial of 421 patients found that patients discharged from the program kept their lipid and blood pressure levels at controlled, healthy levels by receiving electronic reminders.

Reduction in hospital stays and long-term care admissions - Evaluations of users of EHR services have found:
  a) 34% to 40% fewer emergency room visits
  b) Over 32% fewer hospitalizations and up to 60% fewer hospital days
  c) 47% reduction in long term care admissions.

Improvement of quality of patient care - E-health improves care by ensuring medications are appropriate and even making it possible to keep track of and respect patients' end-of-life treatment choices. In addition, individuals suffering from chronic conditions are often frustrated by the need to repeat their medical histories each time they see a new care provider. Both patients and their providers face challenges in keeping track of complex medication histories, challenges that could lead to medication errors.

Prevention of Drug Interactions - E-prescribing tools for medications with the necessary decision support tools built into EHR’s could reduce adverse drug events by two million annually, preventing approximately 190,000 hospitalizations. Drug interaction alerts in electronic prescribing tools can help improve patient safety and reduce costs in ambulatory settings, according to a study published (Sept 2009) in the Archives of Internal Medicine, HealthDay News/Modern Medicine reports. The researchers found that drug interaction alerts occurred for 7.3% of prescription attempts. Of those, physicians overrode the alerts in 91.1% of cases. Despite the high override rate, investigators estimate that the electronic alerts helped avert about 402 adverse drug events in this study. For example, accepted alerts probably prevented:

• Three deaths
• 14 permanent disability cases
• 31 temporary disability
• 34 emergency department visits
• 39 hospitalizations, and
• 267 physician office visits

The study predicted that care providers encountered 331 alerts to prevent one adverse drug event. It also estimated that the alerts might have helped save about $402,619 by curbing adverse reactions.

For more information on this topic, contact R&D MedTech at 918-682-2285.

Electronic Health Records could help reduce the rate of hip fractures in the U.S. by 25%, according to a Kaiser Permanente Study published in the November 2009 issue of the Journal of Bone and Surgery.

Kaiser’s Healthy Bones Program uses HealthConnect EHR system to collect patient data, including anti-osteoporosis medication, bone density scans and fragility fractures. The initiative then aggressively targets patients at risk for hip fractures through the EHR system to ensure they receive the necessary bone density screenings and medications.

Researchers followed 650,000 patients enrolled in the osteoporosis management program of Kaiser Permanente’s Healthy Bones Program from 2002-2007. They found that hip fractures were reduced by 38%, preventing 970 hip fractures in 2007. In addition, the study found that annual bone density screenings increased by 263% and that the number of people on anti-osteoporosis medications increased by 153%.

Time is your enemy in a decision to purchase EHR

The more we talk to physicians and practice managers, the more we realize how the uncertainty of the “meaningful use” rule and the “certified” system requirements in the stimulus package and HITECH Act are delaying their decision to purchase an EHR. However, these concerns are overblown and will end up costing most practices money by delaying. Remember, that for physicians, ARRA bonus payments start in 2011, and therefore to capture those dollars your EHR needs to be up and running (and able to demonstrate “meaningful use”) by the end of 2010. But your practice is saying: “Wait a minute…’meaningful use’ hasn’t been completely defined yet. There should be plenty of time….”

In order to provide peace of mind to our client practices, R&D MedTech, guarantees that its system will be certified and available for your practice to be eligible for all of the stimulus incentives. So if you purchase your EHR from us you have nothing to worry about, but for the sake of argument, let’s discuss why waiting to purchase is not a good business decision.

Why Not to Wait on “Meaningful Use” to be finalized?

If you haven't yet purchased an EHR, you have quite a bit of work ahead of you just to be where you need to be on January 1st, 2011. Physician practices that have yet to select or implement an EHR system should get a move on. Those who wait until next year will face a "high risk" of failing to achieve "meaningful use" of health IT in time for the 2011-12 federal incentives, Mark Leavitt, chairman of the Certification Commission for Healthcare Information Technology, warned at the annual AHIMA conference on Monday in Grapevine, Texas. "You're dreaming if you think you can achieve it in less than a year," Leavitt said. Achieving meaningful use of an EHR system will take at least 18 months, if not two years, he warned.

"Just buying a certified EHR is not meaningful use," noted Mark Leavitt, MD, chairman of the Certification Commission for Healthcare Information Technology. But, he added, there's really no mystery about what meaningful use will mean in the near future. "The major parameters are actually written into the bill," said Leavitt, one of dozens of industry insiders who recently testified on meaningful use before the National Committee on Vital and Health Statistics. "It has to be a certified EHR, it has to include e-prescribing, it has to be able to exchange information and it has to be able to report quality data." "I'm not sure if we have to know more than that - if you are a provider - to be able to make a technology investment now," he added.

Dave Roberts, HIMSS' vice president of government affairs, was even more emphatic. "This is the time to get started with whatever you're doing," he said. "Don't wait until you know all the details." Like Leavitt, Roberts said the key points of "meaningful use" are already known and noted that at HIMSS09 in Chicago, an analyst from the Congressional Budget Office equated "meaningful use" with Stage 4 of the EMR adoption model. Roberts said he expects a pretty simple definition to be in place first. "We believe the bar should be set fairly low initially and raised over time," he explained. For instance, the ability to exchange data between two distinct providers implies the existence of a health information exchange. Since some providers may not be in an area in which a functional exchange is in place by 2010, it would be hard to require that in the definition.

The "Meaningful Use" timeline below gives some very real estimates of time to achieve "Meaningful Use" by 2011. There's no doubt that many practices could move faster than this, but in our experience, this is something your practice absolutely doesn't want to rush if you don't have to. Unfortunately for most, it won't be long before people are rushing to make EHR a reality in their practice.

Timeline	Activity
December 2009	CMS will issue a Notice of Proposed Rulemaking (NPRM) regarding meaningful use, then provide a 60 day public comment period.
December 2009	The Office of the National Coordinator (ONC) will issue an Interim Final Rule (IFR) regarding certification criteria and standards. A public comment period of 30-60 days will follow and the final rule on certification criteria/standards will be issued by Spring.
December 2009	The ONC will issue an NPRM defining the Certification process. A public comment period of 30-60 days will follow and the final rule on the certification process will be issued by Spring. CCHIT will likely be one of several conformance testing organizations, coordinated by NIST, that will certify products using the new ONC criteria.
March 2010	CMS will issue a final rule on meaningful use.
March 2010	ONC will issue a final rule on certification criteria standards.
March 2010	ONC will issue a final rule on certifying organizations.
Six Months – Vendor Selection	Time your practice is researching EHR vendors, putting together a selection committee, viewing demos, getting buy-in, and making a decision on a EHR vendor.
Five Months – Preparation to go-live	Time your practice is working to prepare to go-live by improving workflow, ordering hardware, and standardizing processes.
Six-Twelve Months – Deployment	This is how long it will realistically take to “meaningfully use” your EHR. Your practice will need to be e-prescribing, documenting electronically, and have the ability to report on various items.

Product Certification
The argument to wait, until the federal government has defined the EHR product certification process and the body doing the certification, no longer has merit for two reasons. First, R&D MedTech and Greenway Medical will guarantee that its product will be certified under the stimulus language. Second, the government has nearly finalized the certification criteria and recognized CCHIT as one of the certification organizations.

R&D MedTech Guarantee
Our guarantee removes the uncertainty that the Federal Stimulus Incentive Program has created about whether the Electronic Health Record (EHR) that your practice is selecting will meet the “meaningful use” and “certification” requirements under the HITECH Act. This is important because the government is offering a significant amount of stimulus money to physicians over the next few years for “meaningful use” of an EHR. As your business partner, we want your practice to be in a position to maximize that benefit.

We are so certain that our product (Greenway Medical’s PrimeSuite) can make your practice eligible to get these Federal Stimulus dollars that we’re guaranteeing that as long as you meet the required billing thresholds for either Medicare or Medicaid, and if you use our product in a "meaningful way" you will be eligible for the Federal Stimulus incentives.

How can we guarantee you’ll be qualified for HITECH Act incentive payments? Because our software partner, Greenway Medical is a leader on Health IT mandates from Washington, D.C, since it chairs several of the industry policy committees. Additionally, Greenway Medical has not only already made a substantial investment into complying with all of the federal requirements, but was one of the first EHR firms to apply to CCHIT, the federally recognized certifying body for EHR software for stimulus reimbursement, to move from its CCHIT 2008 certification to the important CCHIT 2011 certification. Finally, our solution generally enables seamless communication across the healthcare community, which is important if the true vision of EHR is to be realized.

Lost Benefits from waiting

Waiting to buy could mean a delay in qualifying for incentives.
ARRA provides federal incentives of up to $44,000 per physician over five years. However, the biggest benefits will come in the first years, meaning that the faster providers can show meaningful use, the more lucrative the incentive. The first incentives will be paid in 2011 based on 2010 performance. By 2015, physicians who are not using certified EHRs could be penalized by Medicare.

Why wait for the immediate benefits of installing an EHR System?
Every day that passes is lost cost savings from practice process improvements/insurance discounts and more importantly lost revenue through better coding/clinical trials.

Practice Process Improvements: A Federal Government study found EHR for a single physician yielded savings in the following way over five years: Year One -26,600, Year Two $41,300, Year Three $31,400, Year Four $85,100, Year Five $85,100. Thus, the total cost savings for a single physician resulting from EHR is $270,375.

More Revenue Through Better Coding: A study of fourteen small practices in the September/October 2005 edition of Health Affairs found that each physician could raise his/her revenue by as much $42,000 per year with increased coding levels resulting from implementation of EHR. Thus, $42,000 multiplied by 5 years is $210,000.

Malpractice Liability Insurance Discount: Malpractice insurance carriers are increasingly offering discounts to doctors for using an EHR in their practice. The theory is that the EHR system will reduce risk by helping to eliminate some of the most common reasons for claims within a practice. These often have to do with oversights on patient record reviews (e.g. reading x-rays) or notifying patients of prescription refills. The EHR discounts generally run in the region of 2 – 5% of the premium. Read more

e-Prescribe Stimulus (2009-2010): While the government does not quantify the e-Prescribe benefit in dollars but rather provides percentages and allows a practice up to 2% of its total Medicare billings, in the November 15, 2008 issue of Entrepreneur, CMS Adminstrator Kerry Weems noted that the average e-prescribing primary care doctor stands to collect between $2000 and $3000 in bonuses for 2009 and 2010.

Tax Incentive: The American Recovery and Reinvestment Act of 2009 (AARA) amended Section 179 of the Tax Code to increase the small business expense for qualified property to $250,000 through December 31, 2009 with a 50% bonus depreciation. Thus, a medical practice can expense the full cost (up to $250,000) of its equipment/medical software purchase that purchased by 12/31/2009. There is potential this benefit will be extended beyond 2009. Read more

Clinical Trial Revenue: There is a huge new opportunity for additional new revenue for your practice that was not available with paper records and it will generate huge new healthcare opportunities for your practice’s patients. That revenue stream is leveraging EHR to engage in clinical trials. Our initial case studies conservatively show it may bring a small practice as much as an additional $100,000 per year in revenue with no additional costs. Some case studies show as much as $700,000 for a 2 doctor family practice per year.

EHR Resource Shortage Risk

Potentially, the longer your practice waits to get started, the more challenging it will be achieve meaningful use in practice by 2011 because of vendor demand. So smart practices are anticipating this surge on limited health IT resources and are obtaining commitments and hiring staff now before the real competition for resources begins.

For instance, vendors know that everyone will want to have their EHR up and running in time to capture the incentives in 2011. They know that a typical implementation will likely run 12 months or more. They only have a finite number of implementation teams available–and the queue for customers awaiting implementation is growing (and perhaps is already booked well into 2011 for some vendors). So when your practice calls to buy that EHR they have selected but have delayed purchasing, will you be told that the vendor doesn’t have the resources to do the implementation imediately, and that you’ll have to wait? Or will the vendor sell the EHR, and worry about the implementation later? And if the latter is the case, what will that vendor do to get you implemented in order to meet the 2011 deadline to demonstrate meaningful use to be eligible for stimulus money?

If providers delay their acquisition of an EHR until the federal government issues a definition of "meaningful use," they're wasting valuable time.

For more information, contact R&D MedTech at 918-682-2285.

On January 15, 2009, the U.S. Department of Health and Human Services (HHS) released a final rule that will facilitate the U.S.’s ongoing transition to an electronic healthcare environment through the adoption of a new generation of diagnosis and procedure codes and updated standards for electronic healthcare transactions.

This rule replaces ICD-9-CM code sets now used to report healthcare diagnoses and procedures with greatly expanded ICD-10 code (International Classification of Diseases, 10th Edition) sets, with a compliance date of October 1, 2013. Adoption of the ICD-10 code sets is expected to:

• Support Medicare’s value-based purchasing initiative and antifraud and abuse activities by accurately defining services and providing specific diagnosis and treatment information;
• Provide the precision needed for a number of emerging uses such as pay-for-performance and biosurveillance. Biosurveillance is the automated monitoring of information sources that may help in detecting an emerging epidemic, whether naturally occurring or as the result of bioterrorism;
• Support comprehensive reporting of quality data;
• Ensure more accurate payments for new procedures, fewer rejected claims, improved disease management, and harmonization of disease monitoring and reporting worldwide;
• Allow the U.S. to compare its data with international data to track the incidence and spread of disease and treatment outcomes because the U.S. is one of the few developed countries not using ICD-10; and
• ICD-10 will also improve claims processing and payment, and through the use of healthcare technology that utilizes ICD-10 assist healthcare practitioners in making treatment decisions by more precisely matching diagnoses and procedures to the appropriate code.

ICD-9-CM is widely viewed as outdated because of the limited ability to accommodate new procedures and diagnoses within the established hierarchy of the coding system. ICD-9-CM contains only 17,000 codes, and Volume 3, which contains the hospital inpatient procedures codes, has been running out of available space for several years, resulting in placement of procedure codes outside of the clinical hierarchy where they appropriately belong. By contrast, the ICD-10-CM and ICD-10-PCS code sets contain more than 155,000 codes and can accommodate a host of new diagnoses and procedures. The additional codes will facilitate the implementation of EHR because they will allow for the provision of more detail that will, in turn, enhance EHR utility for providers and patients. This granularity will also help to improve efficiencies by helping to more precisely identify specific health conditions and provide a richer set of information about the patient for research and treatment.

The estimated cost for a 10 physician practice to move to ICD-10 by 2011 could be more than $285,000, according to a study released on October 10, 2008 by Health IT researcher Nachimson Advisors. These expenses include:

• Total training expenditures estimates -- $4,745
• New claim form (superbill) software -- $9,990
• Practice management and billing system software upgrades -- $15,000
• Increases in claim inquiries and reduction in cash flow -- $65,000
• Increased documentation costs -- $178,500

However, all of these costs could be avoided if a practice chooses to implement our product. R&D MedTech’s software partner -- Greenway Medical Technologies is ready for the implementation of ICD-10 codes based on the Clinical Vocabulary enhancements introduced with PrimeSuite 2008. These changes enabled us to handle the combination of ICD-9 (the current 9th Edition codes) and ICD-10 during the transitional period. We are prepared to deliver the ICD-10 implementation project in two parts in order to have this functionality delivered prior to the following deadlines:

ANSI X12 5010 Transactions Standard - January 1, 2012 ICD-10 Implementation - October 1, 2013

NOTE: The ANSI X12 5010 Transactions Standards are the industry standards for Electronic Data Interchange (EDI) transactions sets for electronic claims, eligibility/benefits, claim payment/advice (aka electronic remittance advice) and related transactions. The 5010 versions of these transactions include support for the ICD-10 implementation.

For more information on this topic, contact R&D MedTech at 918-682-2285.

With $30 billion of stimulus funds for EHR, the federal government hopes to create a digital healthcare infrastructure that reduces costs and improves quality. While many have their eyes on the carrot, the big stick of penalty payments is actually much more of a incentive for physicians to comply, according to an analysis from the PriceWaterhouseCoopers' Healthcare Research Institute.

Physicians who are Medicare providers will be financially penalized in two ways for not implementing EHR. First, through the penalties under the e-prescribe language contained in Section 132 of the Medicare Improvement of Patients and Providers Act of 2008 (MIPPA). Second, under the HITECH language of the American Recovery and Reinvestment Act of 2009 (AARA). Currently, there are no direct financial penalties from Medicaid. However, it is expected that some states will either follow Maryland’s lead, which requires private health insurers to provide incentives in reimbursements to providers, or the private health insurance companies will follow Medicare’s fee schedule that may include penalties for not using EHR as a matter of course.

e-Prescribe Penalties: In 2009 and 2010, physicians who successfully e-prescribe may receive a bonus payment of 2 percent of their overall Medicare reimbursement. In 2011, however, the reward for e-prescribing will begin to phase out, while a penalty for not e-prescribing begins in 2012. The e-prescribing bonus payment will be 1 percent in 2011 and 2012, and 0.5 percent in 2013. The penalty for not e-prescribing will be a reduction in Medicare reimbursement by 1 percent in 2012, 1.5 percent in 2013, and 2 percent in 2014.

Timeline Chart for e-Prescribe incentives and Penalties

	2009	2010	2011	2012	2013	Beyond
Incentive	2%	2%	1%	1%	0.5%	None
Penalty	None	None	None	1%	1.5%	2%

Stimulus Penalties for EHR: Physicians that do not demonstrate meaningful use of EHR technology by 2014 will not only forego incentive payments, but will also be penalized by a reduction in Medicare payments. If an eligible professional is not a meaningful user of certified EHR technology during 2015 or any subsequent payment year, the Medicare fee schedule amount will be reduced by 1% percent in 2015, 2% percent in 2016 and 3% percent in 2017 and in each subsequent year. In addition, the secretary of the Department of Health and Human Services (the "secretary") has discretion to continue to decrease the fee schedule amount up to 5% in 2018.



Side-by-Side Timeline of Provider Incentives and Penalties for e-Prescribe & Stimulus

	Eligible Professionals		Eligible Professionals
Reporting Year	e-Prescribing Incentives	e-Prescribing Penalties	EHR Incentives	EHR Penalties
2009	Yes	No	No	No
2010	Yes	No	No	No
2011	Yes	No	Yes*	No
2012	Yes	Yes	Yes*	No
2013	Yes	Yes	Yes*	No
2014	No	Yes	Yes	No
2015	No	No	Yes**	Yes
2016	No	No	Yes	Yes (continues)
*Professionals receiving EHR incentives cannot receive eRx incentive.
**Incentives continue for 5 year or through 2016 whicever is earlier. No incentives are started after 2014.

Private Health Insurance Reimbursements: Even the health insurance industry has admitted it looks to Medicare when making payment policy decisions. As The New York Times August 18, 2007 reported, “Medicare will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, a move they say could save lives and millions of dollars. Private insurers are considering similar changes, which they said could multiply the savings and benefits for patients… Susan M. Pisano, a spokeswoman for America’s Health Insurance Plans [AHIP], a trade group, said, ‘Private insurers will take a close look at what Medicare is doing, with an eye to adopting similar policies.’”

The stimulus bill expands the reach of privacy and security rules implemented under IPAA to cover “business associates” and “covered entities”. R&D MedTech has measures in place to comply with new and existing HIPAA requirements.

• A covered entity is a health plan, health care clearinghouse (billing services, community health information system and the like), or a hospital or physician who transmits health information in electronic form.
• A business associate is someone who, on behalf of a covered entity, performs an activity involving the use of disclosure of individuals' health care information. That includes the performance of legal, actuarial, accounting, consulting, data aggregation, management, administrative, accreditation, or financial services to or for a covered entity.

Under the stimulus bill, several HIPAA security provisions now apply to business associates in the same manner that those provisions apply to covered entities. That means business associates of covered entities will now have an affirmative duty to protect the confidentiality of electronic protected health information created, received, maintained or transmitted in performing services for or on behalf of covered entities.

Thus, your practice’s “business associates” will need to implement written policies to, among other things, prevent, detect, contain and correct security violations of electronic information, and develop safeguards to limit access. While HIPAA already requires business associates and covered entities to enter into a written contract, be sure that you are not relying on an old agreement that does not take into account this new law.

Also under the stimulus bill, if in the course of their relations a covered entity will be disclosing protected health information to a business associate and/or allowing the business associate to create or receive such information on its behalf, the business associate may use and disclose the information only if such use or disclosure complies with the written contract requirements under the privacy provisions of HIPAA.

Additionally, business associates now have an affirmative duty, and this duty must be stated in the written contract. Under the new law, if a business associate is aware of a pattern of activity or practice of the covered entity that constitutes a material breach of the covered entity's obligations under the contract, the business associate must take reasonable steps to cure the breach. However, if the business associate takes reasonable steps and such steps are unsuccessful, he or she must either terminate the contract with the covered entity (if feasible) or report the problem to the Secretary of Health and Human Services.

For more information, contact R&D MedTech at 918-682-2285.

New digital technologies are helping to transform traditional relationships between patients and their health care providers. For example, more patients are starting to use the Internet as a major source of for health information. Almost three-quarters of U.S. adults have looked up health information online and about two-thirds do so regularly. This trend likely will continue to grow over time and gradually alter the way patients and physicians interact (Bakhtiari, HealthLeaders Media, 9/24/09).

Patients also are starting to show more interest in communicating with their health care providers via email, online chat sessions, remote monitoring tools and web portals. Although some health care providers are hesitant to use such tools because of misdiagnosis risks and privacy concerns, recent research shows that patients prefer physicians who use online communication channels. In fact, a 2009 survey by the Deloitte Center for Health Solutions found that about 55% of patients would like to email their physicians and about 68% are interested in remote monitoring devices. Meanwhile, about 78% of seniors and 75% of chronic disease patients said they are interested in remote monitoring.

Experts say the patient of the future will expect healthcare providers to use electronic health records. Patients also are likely to demand access to their own EHR’s. In addition, empowered consumers likely will push for portable EHRs that can be easily shared with other physicians and health care facilities (Shaw, HealthLeaders Magazine, September 2009).

For more information on this topic, contact R&D MedTech at 918-682-2285.

Seventy-five percent of U.S. adults believe that a fully implemented health IT system will have a positive outcome on health care quality and access for patients, according to a new survey commissioned by the Career College Association and TechAmerica and conducted by Harris Interactive.

Sixty-four percent of U.S. adults said they believe that a fully implemented health IT system, which is an integrated EHR, will have a positive outcome on the healthcare costs for patients. The survey found that 44% or U.S. adults have experienced or noticed health IT applications being used in their doctor’s office or hospital.

For more information on this topic, contact R&D MedTech at 918-682-2285.

R&D MedTech gives its clients the best of both worlds of a tailored customer experience with the corporate reach-back of Greenway when needed. Typically, because our overhead is lower, we are able to contain our costs and give our customers larger discounts in the total price of a Greenway implementation. Read more about the R&D MedTech advantage.

Yes. As part of becoming a certified business alliance partner with Greenway, we were required to have our trainers, technical staff, and business development staff complete rigorous training followed by shadowing sessions of Greenway staff in order to obtain both their individual Greenway certifications as well as our company Greenway certification.

We are a customer focused company that believes in offering the highest quality of support to our clients. Support is performed through phone, email and in real time face to face depending on the situation. Both our help desk and servers are located in Oklahoma so you will be supported from a person in the U.S.

Our help desk metrics are closely monitored so we will ensure that each client’s need is resolved promptly and satisfactorily.

Implementation and training includes workflow analysis, hardware analysis, customizations and web training. We are able to take most customers live within 60 days of contracting. After go live the transition period depends upon the practice, personnel and the ramp-up method selected. However, most practices are fully using Greenway within 90 days of implementation.

R&D MedTech specializes in helping implement phased transitions for physicians and staff, customized to their needs and timetables. Multiple methods of data entry and a variety of input devices may be used. It's also easy to add features and applications to the Greenway software platform.

The best analogy we can offer you is of a Bank. Like Banks, we are custodian of your data. We have responsibilities and requirements that are more stringent than you would have with your own data. As a bank is responsible to take your care your money, so are we responsible to protect your data as a professional and responsible custodian. Second, with increasing compliance requirements from HIPAA, a doctor has responsibility towards protecting the privacy of patient health information particularly in the area of information security. HIPAA regulations put technology related security burdens on doctors who are not technology security professionals. Thus, a doctor would be become liable if the data from the server were to be hacked, or the servers were stolen, or the IT guy took the hard disk for repair and lost it in transit, etc. This is all the more reason that doctors should leave the data security in the hands of technology experts. R&D MedTech will provide your practice with physical and electronic security measures to keep your data safe and in compliance.

Regulations for protecting patient information have always existed; there are dozens of state laws designed to safeguard patient privacy. Years before HIPAA announced its final privacy ruling, CMS, then known as HCFA, released an Internet Security Policy which specified the conditions for transmitting sensitive patient information: "It is permissible to use the Internet for transmission of CMS Privacy Act-protected and/or other sensitive CMS information, as long as an acceptable method of encryption is utilized to provide for confidentiality and integrity of this data, and that authentication or identification procedures are employed to assure that both the sender and recipient of the data are known to each other and are authorized to receive and decrypt such information."

R&D MedTech is committed to maintaining compliance with state laws, CMS policy, and the new HIPAA guidelines. Our services were designed to provide a high level of security for confidential patient information. We ensure that our data is maintained in a safe and secure manner by including features to prevent unauthorized access. The following points summarize the requirements for providers regarding their obligations to The HIPAA Privacy Rule, while utilizing the services of R&D MedTech. Effective as of April 14, 2003: As defined by HIPAA, our clients are “Covered Entities”, and R&D MedTech is a Business Associate” (see Privacy Rule 160.103). As a Business Associate, we are required to safeguard your “Protected Health Information” (PHI) and ensure it remains confidential. We cannot do anything with your data that you do not specifically allow us to do. We must notify you immediately if any PHI is inadvertently released, and are held responsible for your information while it is in our control. Covered Entities must have a written “Privacy Policy” and provide this policy to their patients. After you’ve given your patients notice of your policy, a “Covered Entity” may share PHI with a “Business Associate” , (i.e. R&D MedTech) for purposes of performing healthcare operations. You do not need to obtain each patient’s written consent when you perform specific healthcare operations such as transmitting a copy of your data to R&D MedTech.

Written contracts with your Business Associates must include specific HIPAA terms. Our agreement maintains that R&D MedTech will be in compliance with all state and federal laws, including HIPAA, and that these are the minimum standards we will use in protecting your information. Simply put, our contract says that the PHI provided by your office will only be used by R&D MedTech to enable you to perform certain healthcare operations, and except for this use, we will keep your information confidential. The bottom line is that protecting patient information has been mandatory for many years. HIPAA has increased Federal penalties for non-compliance and added to the required documentation which will make it a more enforced rule throughout the industry. If you’d like more information, or have questions, please contact us. We look forward to working with you. For your reference, a complete copy of The Final Rule of the HIPAA Privacy Standards is available here.

R&D MedTech’s EHR product partner – Greenway Medical is not only a leader technologically with a 2008 CCHIT certification and has already heavily invested in research and development for the comprehensive 2011 CCHIT, but Greenway Medical is also a leader in Washington, DC in shaping Health IT policy.

A certified EHR system is important because of stimulus act’s requirement for a certified system. The Federal Government has chosen CCHIT at the primary independent certification body for certifying EHR systems that qualify to receive Federal stimulus incentives. On September 9, 2009, the Certification Commission for Health Information Technology (CCHIT) announced that it would launch two certification programs. The first is “CCHIT Certified 2011,” which is an updated version of its comprehensive EHR certification program. The second of which is called the “Preliminary ARRA 2011”, which focuses on just the standards for qualifying systems under the American Recovery and Reinvestment Act (ARRA).

By pursuing the comprehensive certification path (“CCHIT Certified 2011”), vendors can begin applying for certification testing in September 2009, and when ready, the testing process should be completed in 90 days or so for each vendor. Then they can begin selling the “certified product” to clients thus allowing the providers to immediately apply for stimulus funds. R&D MedTech’s EHR software partner has chosen this option, so our clients will have confidence that their practice will be immediately eligible for stimulus incentives.

In the second approach, (“Preliminary ARRA 2011”) the vendor will only be certified for certain modules of the “meaningful use” requirements. Thus, it is not a complete solution for stimulus funding because CCHIT will include a certification label indicating which meaningful use objectives the modular system supports. This program aims to help health care providers evaluate which systems or combination of systems will meet all of the necessary meaningful use criteria.

Providers should note that timing is important. For instance, if a vendor has a CCHIT certification earlier than 2008, they may have more updates to make before they may be eligible for the 2011 comprehensive certification. Additionally, those vendors who wait until the government standards are finalized according to the published government schedule at the end of calendar 2009, risk waiting until later to apply for certification, because the vendors may not be able to respond in time to complete certification testing for their providers to purchase, implement and qualify for full funds outlined under the ARRA stimulus legislation.

Greenway’s leadership on Health IT policy is a huge advantage for our clients because we often shape policy or know about policy before many of our competitor products. Greenway’s Government Affairs team has spearheaded leadership and collaboration with policy makers to provide a strong foundation for growing our nation’s health information technology investments and infrastructure. Greenway has testified and/or formally addressed Congress as well as both Presidential Administrations on 12 occasions since 2005.

Each year, Greenway renews its commitment to innovation and industry-leading activities, acting in an advisory/leadership capacity on public policy and state and federal legislation for:

• Certification Commission for Healthcare Information Technology (CCHIT)
• Healthcare Information Technology Standards Panel (HITSP)
• Healthcare Information and Management Systems Society (HIMSS)
• Electronic Health Record Association (EHR Association)
• Health Information Security and Privacy Collaboration (HISPC)
• National Governor’s Association (NGA) Health Information Protection Taskforce
• Integrating the Healthcare Enterprise (IHE)
• Clinical Data Interchange Standards Consortium (CDISC)
• National Quality Foundation (NQF)
• National Committee for Vital and Health Statistics (NCVHS)

For more information on this topic, contact R&D MedTech at 918-682-2285.

R&D MedTech supports Greenway Primesuite in a way that combines the best of both architectures. Generally, due to security and ease of use considerations this software is created as a rich client for Windows and uses a small-footprint SQL database. These considerations make Greenway software an ideal fit for a small to medium office. Greenway is, however, available remotely for those practices and doctors that choose this access method. By using a hybrid model, we’ve substantially decreased risk due to connectivity and other issues and preserved the dependability, features and customizability of client-based software.

You own and have exclusive access to your data. Your data is securely maintained in your database. Optionally, we can remotely back it up for you on a nightly basis, saving you the administrative burden of this task and adding to your data security/business continuity protocol.

We’d be delighted to answer your questions and schedule a demonstration. Just submit our demonstration registration form here.

In 1998, in Carrollton, Georgia, nearly 100 physicians, clinicians, practice administrators, hospital executives and community leaders recognized the need for a long-term solution to rising healthcare costs, medical errors and decreasing patient safety. Knowing that electronic health records (EHRs) would become the epicenter of our healthcare delivery system, these stakeholders created Greenway Medical Technologies, now an industry-leading healthcare solutions provider. With various healthcare experiences and expertise, this group developed ambulatory solutions to improve the delivery of healthcare for the consumer, the provider and the payer. Greenway's leadership presented a focus on reducing healthcare costs while improving quality, outcomes, and ensuring results. Since its inception, Greenway Medical has been involved with leading the healthcare IT movement.

Greenway Medical Technologies takes pride in our customer’s experiences which allows our customer base to grow throughout the country. Greenway has over 28,000 healthcare providers and professionals who represent more than 1,100 practices that are located in 48 states across America in addition to the District of Columbia. Our clients represent a very wide array of fields and specialties. Our software is also easily customizable for your practice. If needed, personalizing your templates, diagnosis, symptoms and other information is a snap.

A large library of clinical exam templates ensures that your practice won't spend months setting up initial templates - a key productivity killer in clinical charting software implementations. Some of the 30+ specialties and subspecialty templates within Greenway's template more than 3000 clinical charting templates library include: Allergy and Immunology, Cardiology, Cardiovascular and Thoracic Surgery, Dermatology, ENT, Endocrinology, Family Practice, General Surgery, Gastroenterology, General Surgery, Hand Surgery, Internal Medicine, Nephrology, Neurology, Neurosurgery, Obstetrics and Gynecology - ObGyn, Ophthalmology, Orthopedics, Pain Management, Pediatrics, Pulmonary Medicine, Rheumatology, and Urology.

Greenway is CCHIT 2008 Certified. Greenway was also CCHIT 2007 Certified. Greenway believes that it is important to meet certification requirements each and every year.

No, although there may be a transition period. R&D MedTech can help you with your transition strategy. There are several approaches to data migration.

You own and have exclusive access to your data. Your data is securely maintained in your database. Optionally, we can remotely back it up for you on a nightly basis. Saving you the administrative burden of this task and adding to your data security/business continuity protocol. In fact, we would be happy to send the data to your practice's office on a weekly basis on a back up tape.

Greenway already has interfaces in place for most labs and practice management systems. We will also write HL7 interfaces to any lab, practice management system, hospital or other system as needed.

Computerized physician/provider order entry (CPOE), is the process of computer entry of medical orders for the treatment of patients under the licensed provider’s care. These orders get communicated over a network to appropriate staff or departments to be carried out. There is little argument these days that using a computer entry system reduces errors, decreases delay in order completion, and simplifies inventory and billing. And studies show additional benefits of reducing errors and costs when you combine CPOE with clinical decision support tools.

The current recommendations from the HIT Policy Committee to meet meaningful use have CPOE front and center, especially for providers. The 2011 objectives call for eligible providers to be using CPOE for 100% of their orders. Hospitals must be using at least 10% of all their orders through CPOE and by 2013 they too must be using 100% for all their orders. So what exactly are these "orders" included in the "all" and how should they be entered?

• Medication - Electronic prescriptions are now known as ePrescribing. The CPOE directly transmits prescriptions to the pharmacy. Additional features consist of drug interaction information and alerts from stored prescription history and allergies.
• Laboratory - Bidirectional transmission allows providers to order labs through the CPOE and receive results back. The results can be received directly into patient records.
• Procedure - Tracking and storing history of patient procedures.
• Diagnostic Imaging - A work in progress feature that is being debated on how providers should have access to images as well as reports. Currently this IT feature is described as primitive at best with links that open web viewers. Look for picture archiving and communication systems (PACS) to take control of this debate.
• Immunization - A CPOE should store patient history of immunization, alert on needed immunization, and have a reporting interface to state registries.
• Referral - Providers refer patients to another doctor or specialist for examination and possible treatment for something that is either out of his specialty or something he wants another opinion on. Referring specialist information would be stored in the computer system.

These will be key features to evaluate when selecting an EHR. Although the 2011 requirement does not include electronic interfaces to receiving entities, systems that have any of the capabilities now have a head start. R&D MedTech can assist your practice in meeting the CPOE objectives through the use of our Greenway Medical software PrimeSuite and PrimeExchange tools.

For more information on our software’s CPOE functionality, contact us at R&D Medtech at 918-686-0660.

Pricing has several variables depending on the size of the practice, number of locations of your practice, any additional features you are interested in adding to your basic Primesuite package and your decision of whether to have a hosted or client server solution. R&D MedTech helps you choose the best option for your practice. Because of R&D MedTech’s low cost of living location in the middle of the country, our overhead is low and our rates are very competitive.

If physicians need to finance this investment, we can accommodate that as we have already educated a handful of financial institutions on our product so you don’t have to explain how to collateralize this investment to your local bank. Our financing is very competitive and we would be happy to provide you with information on that option.

Please contact our sales office to get an estimate based on your practice’s individual needs or request more detailed information on financing options 918-682-2285.

Yes. We can provide you with a demonstration on how we leverage either the Dragon Naturally Speaking tool or our Prime Mobile tool for dictation capability as well as usage of the stylus pen on a computer tablet for PC point and click input.

Yes! Going paperless requires a certain amount of practice discipline, but pays off in both quality of patient care (24 hour access to complete patient records) and practice efficiency. Let us show you how we can develop a plan at the pace your practice is comfortable with to move to a paperless environment.

Yes, however, electronically filed claims are easier for insurance companies to handle, reduce “lost in the mail:” errors, cheaper for a practice to issue and usually result in faster payments. No lost in the mail, no printer mis-feed, no misaligned fields, etc. excuses.

Greenway’s Primesuite EHR allows your office to go entirely paperless, if you choose. Images, labs, radiology reports and documents of all types can be stored and integrated with your patient records.

R&D MedTech's EHR software tool, Greenway Medical's PrimeSuite, is an "integrated" system. It is classified as "integrated" because its practice management and chart/electronic medical record modules share a common database.

"Interfaced" systems are technologically inferior to medical software that has been developed from the ground up by a single vendor, on a single platform, and utilizing a single database – otherwise described as "integrated" electronic medical records and practice management systems.

Interfaced systems may include products offered as a package that have both scheduling/billing and charting/EMR, but were developed by disparate vendors on different platforms, tied together by a separate application. Although generally transparent to the practice, there are questions of data integrity; patient safety (for example, a patient’s practice management/billing record does not match the clinical record and lab results get overlooked); system performance; future development and upgrades; and even the vendor’s commitment to the long-term development and enhancement of the product.

In order to identify whether a system is integrated or interfaced system, your practice should ask the following questions: • Did the same company develop the billing and charting sides of the software, or was the “integration” a result of a merger, purchase, or acquisition?
• Is there a single login for the billing and charting? If you have to log in twice to access billing/scheduling and charting, you typically are not looking at a truly unified system.
• Is there a common database throughout the application or do demographics have to be entered twice?

We’d be delighted to answer your questions and schedule a demonstration. Just submit our demonstration registration form here.

In theory, and by definition, there is a difference and it should play into any provider’s clinical software selection. At the same time, marketing messages and technical terminology have clouded healthcare providers’ understanding of the software definitions. Recently, the National Alliance for Health Information Technology (NAHIT), established definitions for electronic medical records (EMR), electronic health records (EHR), and personal health records (PHR). NAHIT is a senior leadership organization dedicated to leveraging the power of health IT to improve the US healthcare system.

EMR: The electronic record of health-related information on an individual that is created, gathered, managed, and consulted by licensed clinicians and staff from a single organization who are involved in the individual’s health and care.

EHR: The aggregate electronic record of health-related information on an individual that is created and gathered cumulatively across more than one health care organization and is managed and consulted by licensed clinicians and staff involved in the individual’s health and care. By these definitions, an EHR is an EMR with interoperability (i.e. integration to other providers’ systems).An EHR will provide a more comprehensive view into a patient’s health and history by pulling information from other systems, providing clinical decision support and alerting providers to health maintenance requirements. It will help providers report and measure quality indicators for pay-for-performance incentives.

PHR: An electronic, cumulative record of health-related information on an individual, drawn from multiple sources, that is created, gathered, and managed by the individual. The integrity of the data in the ePHR and control of access to that data is the responsibility of the individual. To be most effective, a PHR should include cumulative health information ranging from past and current illnesses, demographics, allergies, prescriptions and more. Given the nature of the PHR, it’s the individual’s responsibility to decide what information is stored, and who has access to it.

Pricing has several variables depending on the size of the practice, number of locations of your practice, any additional features you are interested in adding to your basic Primesuite package and your decision of whether to have a hosted or client server solution. R&D MedTech helps you choose the best option for your practice. Because of R&D MedTech’s low cost of living location in the middle of the country, our overhead is low and our rates are very competitive.

If physicians need to finance this investment, we can accommodate that as we have already educated a handful of financial institutions on our product so you don’t have to explain how to collateralize this investment to your local bank. Our financing is very competitive and we would be happy to provide you with information on that option.

Please contact our sales office to get an estimate based on your practice’s individual needs or request more detailed information on financing options 918-682-2285.

The following is summary table of the estimated cost savings and new revenue possible with the implementation of Greenway Medical’s EHR. While this information is available in many places (including our website) about cost savings, federal stimulus incentives, tax breaks, malpractice insurance discounts and potential new opportunities related to EHR, we thought it would be helpful to put all in one place, so physicians have the opportunity to see it rolled up.

In order to compare “apples-to-apples”, we have calculated these numbers for a single physician. If your practice has multiple providers, then you can easily multiply the number of providers in your practice by the estimates to arrive at your own estimates.

Type of Cost Savings / New Revenue	Average Dollars Per Physician over 5 years
Practice Process Improvements	$270,375
More Revenue Through Better Coding	$210,000
Malpractice Liability Insurance Discount	$25,000
E-Prescribe Stimulus (2009-2010)	$6,000
Medicare/Medicaid Stimulus	$44,000/$63,750
Tax Incentive	$250,000
Clinical Trial Revenue	$500,000
In-House Pharmacy Revenue	$360,000
Total	$1,665,375

Yes. We can provide you with a demonstration on how we leverage either the Dragon Naturally Speaking tool or our Prime Mobile tool for dictation capability as well as usage of the stylus pen on a computer tablet for PC point and click input.

More and more patients are expecting computerized applications in health care. Recent surveys indicate most consumers prefer doctors with whom they can communicate online and who have practice Web sites. An EHR is becoming an indispensable tool for modern clinicians. Read more

Yes! Going paperless requires a certain amount of practice discipline, but pays off in both quality of patient care (24 hour access to complete patient records) and practice efficiency. Let us show you how we can develop a plan at the pace your practice is comfortable with to move to a paperless environment.

Yes, however, electronically filed claims are easier for insurance companies to handle, reduce “lost in the mail:” errors, cheaper for a practice to issue and usually result in faster payments. No lost in the mail, no printer mis-feed, no misaligned fields, etc. excuses.

Greenway’s Primesuite EHR allows your office to go entirely paperless, if you choose. Images, labs, radiology reports and documents of all types can be stored and integrated with your patient records.

R&D MedTech supports Greenway Primesuite in a way that combines the best of both architectures. Generally, due to security and ease of use considerations this software is created as a rich client for Windows and uses a small-footprint SQL database. These considerations make Greenway software an ideal fit for a small to medium office. Greenway is, however, available remotely for those practices and doctors that choose this access method. By using a hybrid model, we’ve substantially decreased risk due to connectivity and other issues and preserved the dependability, features and customizability of client-based software.

You own and have exclusive access to your data. Your data is securely maintained in your database. Optionally, we can remotely back it up for you on a nightly basis. Saving you the administrative burden of this task and adding to your data security/business continuity protocol. In fact, we would be happy to send the data to your practice's office on a weekly basis on a back up tape.

"Interfaced" systems are technologically inferior to medical software that has been developed from the ground up by a single vendor, on a single platform, and utilizing a single database – otherwise described as “integrated” electronic medical records and practice management systems.

Interfaced systems may include products offered as a package that have both scheduling/billing and charting/EMR, but were developed by disparate vendors on different platforms, tied together by a separate application. Although generally transparent to the practice, there are questions of data integrity; patient safety (for example, a patient’s practice management/billing record does not match the clinical record and lab results get overlooked); system performance; future development and upgrades; and even the vendor’s commitment to the long-term development and enhancement of the product.

In order to identify whether a system is integrated or interfaced system, your practice should ask the following questions: • Did the same company develop the billing and charting sides of the software, or was the “integration” a result of a merger, purchase, or acquisition?
• Is there a single login for the billing and charting? If you have to log in twice to access billing/scheduling and charting, you typically are not looking at a truly unified system.
• Is there a common database throughout the application or do demographics have to be entered twice?

We’d be delighted to answer your questions and schedule a demonstration. Just submit our demonstration registration form here.

Computerized physician/provider order entry (CPOE), is the process of computer entry of medical orders for the treatment of patients under the licensed provider’s care. These orders get communicated over a network to appropriate staff or departments to be carried out. There is little argument these days that using a computer entry system reduces errors, decreases delay in order completion, and simplifies inventory and billing. And studies show additional benefits of reducing errors and costs when you combine CPOE with clinical decision support tools.

The current recommendations from the HIT Policy Committee to meet meaningful use have CPOE front and center, especially for providers. The 2011 objectives call for eligible providers to be using CPOE for 100% of their orders. Hospitals must be using at least 10% of all their orders through CPOE and by 2013 they too must be using 100% for all their orders. So what exactly are these “orders” included in the “all” and how should they be entered?

• Medication - Electronic prescriptions are now known as ePrescribing. The CPOE directly transmits prescriptions to the pharmacy. Additional features consist of drug interaction information and alerts from stored prescription history and allergies.
• Laboratory - Bidirectional transmission allows providers to order labs through the CPOE and receive results back. The results can be received directly into patient records.
• Procedure - Tracking and storing history of patient procedures.
• Diagnostic Imaging - A work in progress feature that is being debated on how providers should have access to images as well as reports. Currently this IT feature is described as primitive at best with links that open web viewers. Look for picture archiving and communication systems (PACS) to take control of this debate.
• Immunization - A CPOE should store patient history of immunization, alert on needed immunization, and have a reporting interface to state registries.
• Referral - Providers refer patients to another doctor or specialist for examination and possible treatment for something that is either out of his specialty or something he wants another opinion on. Referring specialist information would be stored in the computer system.

These will be key features to evaluate when selecting an EHR. Although the 2011 requirement does not include electronic interfaces to receiving entities, systems that have any of the capabilities now have a head start. Take time to review these features and be sure to see a demo on how these work in a system. Users say that your staff spends most of their time in these functions.

For more information on our software’s CPOE functionality, contact us at R&D Medtech at 918-686-0660.

The stimulus bill expands the reach of privacy and security rules implemented under IPAA to cover “business associates” and “covered entities”.

• A covered entity is a health plan, health care clearinghouse (billing services, community health information system and the like), or a hospital or physician who transmits health information in electronic form.
• A business associate is someone who, on behalf of a covered entity, performs an activity involving the use of disclosure of individuals' health care information. That includes the performance of legal, actuarial, accounting, consulting, data aggregation, management, administrative, accreditation, or financial services to or for a covered entity.

Under the stimulus bill, several HIPAA security provisions now apply to business associates in the same manner that those provisions apply to covered entities. That means business associates of covered entities will now have an affirmative duty to protect the confidentiality of electronic protected health information created, received, maintained or transmitted in performing services for or on behalf of covered entities.

Thus, your practice’s “business associates” will need to implement written policies to, among other things, prevent, detect, contain and correct security violations of electronic information, and develop safeguards to limit access. While HIPAA already requires business associates and covered entities to enter into a written contract, be sure that you are not relying on an old agreement that does not take into account this new law.

Also under the stimulus bill, if in the course of their relations a covered entity will be disclosing protected health information to a business associate and/or allowing the business associate to create or receive such information on its behalf, the business associate may use and disclose the information only if such use or disclosure complies with the written contract requirements under the privacy provisions of HIPAA.

Additionally, business associates now have an affirmative duty, and this duty must be stated in the written contract. Under the new law, if a business associate is aware of a pattern of activity or practice of the covered entity that constitutes a material breach of the covered entity's obligations under the contract, the business associate must take reasonable steps to cure the breach. However, if the business associate takes reasonable steps and such steps are unsuccessful, he or she must either terminate the contract with the covered entity (if feasible) or report the problem to the Secretary of Health and Human Services.

An Electronic Medical Record Should Still be a Medical Record

The casual and blanket use of a fairly specific term to describe any software tool used in patient care overlooks the functionality promised by true electronic medical records. One of the easiest ways to illustrate the differences is to first visualize a traditional paper chart for comparison purposes.

Paper Medical Records	Electronic Medical Records
A paper patient record is identified by name, some kind of medical record number, and other identifiers that make it easier to find in the filing system.	An EMR provides distinct identifying information for each patient, and identifiers to locate the digital record among any number of other records.
Paper charts typically contain demographic and insurance information, along with a list of medical problems, medications, and allergies. These must be readily updated and should stay current and accurate.	An EMR maintains this information, and shares any updated information wherever it is needed. When updated insurance information is provided, that information is automatically passed to billing so that the information is consistent and current, without the need for duplicate data entry. In addition, clinical information such as problem lists and medication lists are readily updated without duplicate data entry, so that changing medications within the charting application automatically updates the patient's medication list.
A paper medical record contains office or progress notes in chronological sequence. These are "browsed" by literally flipping through pages, until the desired entry is located.   Progress notes in a traditional paper record might be produced by dictation/transcription, free handwriting, or form completion.	An EMR stores progress notes and provides quick access by date of visit, provider, or other search criteria and the ability to browse by diagnosis and prescription.   A full function EMR automatically creates the progress notes as the visit is produced.
Laboratory and radiology reports, as well as correspondence, are filed in more or less chronological order. Access to specific entries is no more efficient than it is with progress notes.	An EMR stores reports in any number of ways to provide rapid access and quick reference, such as scanned images, direct lab result posting, even on-line lab information applications. Using common demographic and identifying information, access to specific lab results or other patient reports is highly efficient and useable.
If a paper chart is filed correctly in the medical records system, a staff member must go to the stacks of charts and, using some quick identifier code, locate the correct last name. The first name is located and confirmed, then the chart is "pulled", but not before a placeholder is inserted, in order to 1) make re-filing easier and 2) record where the chart is headed. The issues surrounding finding a chart that is "out" somewhere, or has been incorrectly filed, are easily imagined.	An electronic chart is never lost, out, or misfiled. It is always exactly where it should be, even if you aren't. That is to say that an electronic record may be accessed from any point in a healthcare facility that has access to medical records.
In a paper chart system, a healthcare provider typically writes a paper prescription for the patient to take to a pharmacy. There are often one or more added steps, such as: consulting a reference for the commonly prescribed drugs for a given condition verifying the prescription form or strength verifying the patient's allergy status checking for potential drug interactions verifying the patient's formulary requirements Once this information has been satisfactorily obtained, the paper prescription is handed to the patient. It is then necessary for the provider to document the process that just took place, including the negative potential for drug interactions and allergies, as well as the drug, form, strength, quantity, and directions for the prescribed drug.	Electronic medical records with robust clinical decision support offer reference information regarding optimal treatment, such as treatment guidelines or "best practice" standards. An EMR with prescription writing capability performs the allergy and drug interaction checking, or at least provides a quick reference for manually checking, when the desired drug is selected. In addition, an EMR with electronic prescribing capability can send the prescription to a designated pharmacy directly, while at the same time documenting the prescribing process and updating the patient's medication record.