Evaluating Chiropractic Software: Practice Management Expertise

In 2012 & 2013, ECLIPSE once again topped independent surveys by multiple state chiropractic associations. You can read about one of those surveys here. The other was conducted by the North Carolina Chiropractic Association (NCCA) earlier this year. According to the survey, ECLIPSE was the top system preferred (of 21 systems listed). And, according to the NCCA, “ECLIPSE was strongly recommended by 71% of the people surveyed.” (That percentage includes the entire survey group – not just ECLIPSE users. And, for the record, we’re not based in those states.)

So, how does this happen? One factor that few doctors recognize is unparalleled practice management expertise, which we seem to provide as a natural part of “technical support” to clients on a routine basis.  Everyone tends to forget that when you buy software, there’s so much more to it than pre-sales hype and testimonials.  So here are just a few actual examples of the type of scenarios our HELP Desk handles daily.  Please note the variety:

Case #1: Using CMT Codes 98940, 98941 & 98942

This past January, a doctor called our HELP Desk, upset because all his ChiroCare claims were being rejected. He indicated that he was “losing thousands of dollars every week.” He further noted that he is the “chief insurance person for…” a large, well-known Midwest-based practice management firm.  At our request, he provided his clinical documentation. It was immediately apparent that he was improperly documenting & coding his visits. We subsequently confirmed this directly with ChiroCare and provided him with our findings and a solution within two days. We not only explained exactly what he was doing wrong, we explained how to do it right. And this is a doctor who gets paid as an “expert” to provide practice management advice on this specific subject to our colleagues.

This past week, a doctor in MO requested help interpreting his Medicare appeal & denial. He apparently doesn’t have many Medicare patients and was unfamiliar with how to document the 98941 code submitted on his claims. We explained how to document & use CMT (his diagnoses documented 1 region — lumbar) along with Medicare P.A.R.T. We also gave the doctor some relevant links to read on the ACA website.

Case #2 Chiropractic / Physical Therapy Services

An RN called from a client office, gravely concerned that her office would be audited for “committing fraud.” She further noted that she had worked for Medicare’s investigational division, had issued audits as part of her job, and had testified in court.  This all came out while she argued her position – which was that a key provider degree type used in her office needed to be added to ECLIPSE for claim submission. We simply provided the CMS ANSI documentation to the effect that she was mistaken and helped her get her claims out in a timely manner.

Case #3: HIPAA Violation

A doctor called the HELP Desk after a patient had been accidentally deleted from the computer system. It seemed to be a simple problem. And he didn’t realize that he could have set user permissions to avoid it. But it turned out to be a bevy of HIPAA violations. Staff had sat a patient (let’s call him John) in front of one of their computer workstations. And the current user was logged in and apparently had permission to do anything. John, who has Trisomy 21, promptly deleted another patient. And the office was blissfully unaware of the potential violations. Just a decade ago, practice management consultants across the USA were basing many of their seminars on HIPAA. We advised this doctor about proper office procedures, HIPAA requirements, creation of a HIPAA Compliance Manual & appointment of a HIPAA Compliance Officer.

Case #4 OSWESTRY

This past week, it became apparent during a conversation that a doctor was unfamiliar with the OSWESTRY formula. We explained the formula and how the scoring of an OSWESTRY form works in detail. (OSWESTRY forms in ECLIPSE are scored automatically.)

Case #5 What does the HELP Desk know, anyway?

Years ago, a doctor in Binghamton, NY called the HELP Desk with questions about Medicare changes in that part of NY. The HELP Desk Director called Mike for a quick explanation (the changes were brand new) and relayed them to the doctor. Hours later, Mike got another call from the #2 at Markson Management Systems (MMS) with the same question. (At that time MMS was one of the largest chiropractic specific practice management firms nationwide.) Curious, Mike asked why. As it turns out, the doctor didn’t believe the “computer guys” and sought an answer from the consultants she paid thousands of dollars to annually for advice. To this day, she has no clue that both responses ultimately came from the same person!

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Meaningful Use Audits

The rumors began the moment the law (ARRA) was passed in 2009, intensified as testing protocols were created, and continued through the implementation process. Some physicians simply couldn’t get past those rumors, and decided to avoid the cash incentives provided by the Meaningful Use program. An unfortunate choice. However, if you received incentive payments, the audit program is here. And with it, some unexpected confusion.  The audit process is not difficult. The most important items that an auditor may initially request include proof that you owned the certified technology you purchased during the attestation period , a copy of the report you printed from your certified EHR, some screenshots, etc. But those items certainly aren’t confusing, and as an ECLIPSE user, you knew from your HELP to save such reports rather than discard them. So, where does the confusion lie? Just a few short years ago, it’s likely that you attended one or more seminars with regard to maintaining HIPAA compliance within your facility. Perhaps you received C.E. credits. Perhaps your staff attended. You learned some of the protocols you were expected to follow to ensure protection of Patient History Information (PHI). You also learned that this was an ongoing process. It’s likely you appointed a HIPAA Compliance Officer within your practice and created a HIPAA Compliance Manual at that time. Your HIPAA Compliance Manual might have contained wording to the effect of:

Risk Analysis and Management: Little Ferry Chiropractic Center (LFCC) conducts thorough assessments of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of electronic protected health information held in its computer systems on a regular basis. When LFCC’s Compliance Officer believes risks exist, the Compliance Officer addresses each risk and completes a mitigation report. LFCC has implemented security measures to reduce risks and vulnerabilities to a reasonable and appropriate level to comply with the HIPAA Security Rule. These measures are described in detail…

In other words, you’ve been doing risk assessments for years now. During attestation, for item #15, you attested that you have…

conducted a review or security analysis per 45 CFR 164.308(a)(1) and have implemented security updates as necessary, corrected security deficiencies as part of your risk management process.

Now that we’ve established that you’ve been doing this all along…  let’s visit some of the protocols you’ve certainly implemented & checked in your office:

  •  It’s likely that you purchased, maintain a subscription to, and routinely check software from companies like Symantec to prevent malware (e.g. viruses) from entering your system.
  • You routinely remind employees not to leave Post-It notes on a computer monitor with user names & passwords. And your HIPAA Compliance Officer checks this from time to time.
  • If there’s a door between your waiting room and front desk, you’ve ensured that door is always locked from the waiting room side. If your front desk and charts are accessible from the waiting room, you’ve established a procedure that ensures all employees log out when they leave the desk and/or a protocol that ensures the front desk is always attended by at least one staff member.
  • Within your software you’ve assigned appropriate permissions based on job title to limit access to PHI as appropriate.
  • Perhaps you’ve called the HELP Desk to discuss potential security vulnerabilities and how to address them.
  • You’ve ensured appropriate Windows  permissions on your computers or network to limit access.
  • You password protected your routers if you have a network. And if you have a wireless network in your office, you’ve also setup appropriate encryption protocols so your data can’t be intercepted.
  • You’ve established backup procedures in the event of a hardware failure or natural disaster.
  • If you routinely email PHI, you password protect & encrypt attachments prior to sending.

This is just a short list of many items routinely implemented & addressed in your practice as part of HIPAA compliance. During the audit process, if you’re asked to provide proof of your security risk assessment, simply provide appropriate pages from your HIPAA manual, along with the steps that are part of your daily/weekly/monthly routine (and were likely repeated at the time of attestation). You should have a signed, dated copy that corresponds to your attestation period.

Here are some related links:

And some samples:

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The Encounter vs. The Audit

For most D.C.’s, audits tend to be both rare and frightening. When a large insurance company contacted Dr. H at his Kentucky clinic, requested myriad patient records, and asked for reimbursement of substantial fees, I have no doubt he was ready to panic.

Following his audit, both the auditor and insurance company representative jointly called him. According to Dr. H:

  • They reversed all monetary requests.
  • They complimented him on his thorough SOAP. In fact they said his notes were “a pleasure to read.”
  • They further noted that whatever product he was using “set a new bar” when it came to documentation.

Wow! Dr. H later pointed out in his email to us:

“Although I do try to keep thorough notes, the encounter program reminds you of details and makes translation into a formal soap note extremely brief & user friendly.”

Before we continue, let’s consider a detail that may have escaped your scrutiny. Many doctors who use SOAP software have been through audits… and their documentation has substantiated the charges. But how many audit stories have you heard where the professionals involved said the documentation was simply the best they’ve ever seen? Or offered an unsolicited opinion about the doctor’s software? (And remember, these are professionals who scour documentation day in & day out, looking for both mistakes and fraud.)

I’d bet never.

Until the mid-1990’s, requests for documentation by an insurance company or outside auditor generally meant copies of the doctor’s “travel cards.” These cards allowed the doctor to quickly note the facts – just the facts – of each visit. And then demand grew for a new concept – electronic notes. But electronic notes got off to a different start than the travel card concept and typically resembled a narrative. As we entered a new century, travel cards gave way to lengthy, computer generated SOAP notes for each visit. Of course, those of us who reviewed our colleagues’ notes for various insurers during this period thought the source was obvious. So, companies that developed clinical documentation software created a new holy grail… randomization. Of course, anyone who does IME reviews can distinguish “canned notes” without much practice. But, by 2010, a request for documentation resulted in a lengthy series of visit-by-visit narratives. And doctors now looked for these workarounds as features! The goals: Press the fewest buttons; generate the most text; make each note look different so it appears “authentic.”

The Encounter was designed to conform to concepts as mandated in the American Recovery & Reinvestment Act (ARRA) of 2009, which places repeated emphasis on storing electronic health records as “structured data.” Structured data refers to a simple & direct association between a type of data – such as a patient’s last name, and the field in which it is stored. Internationally, governments are trying to move everyone away from verbose narratives towards concepts such as SNOMED & LOINC because studies show that this affects physician ability to get to “what they need” from a chart (crucial info may be missed or is hard to find).

We built our nationwide reputation with our billing & scheduling software. And though this is our third generation SOAP (and we were the first to automatically co-generate SOAP and bills) some D.C.’s may assume that – when it comes to clinical documentation – our strengths lie elsewhere. Or that ECLIPSE isn’t expensive enough to do the myriad things it does so well.

You can attend seminars where the lecturer got a free car to recommend the software he touts (Oh yes! True story) or watch glowing video testimonials for over-hyped products, but ECLIPSE is still the only software in the chiropractic marketplace that repeatedly tops independent polls… and now you know the auditors are impressed too. Of course, it’s still up to you to actually document each visit. And with that in mind, here are just a few quotes from doctors who use the Encounter:

“The Encounter – which is a completely new design – allows me to handle my notes in seconds… a feat rare among friends & colleagues with various SOAP systems.”
— Dr. RS, New Jersey 

“I feel it’s by far the best software on the market. We have implemented it into a very busy office and its not just the speed in which you can enter a note but the quality of note along with its integration with the rest of the software. I have demo’ed everything and really wanted to say thank you for Encounter.”
Dr. JP, New Jersey

“Thank you. Also just playing around found the PLAN and ADL’s to add into the exam that is great so far I love it. Just to let you know my other office (which I don’t own or have any decision making) just bought **** to integrate with *****. IT was over $12,000 and I like the Eclipse notes better. Thanks again.”
— Dr. MB, Wisconsin

“PLEASE let your long time subscribers know that you already have EHR on your system BECAUSE when I was looking I saw that you put ***** on your affiliates pages and I bought their system. I am VERY UPSET that I have been working with them for over 10 months and still do not have a workable system. I then found out that I had EHR all along on your Eclipse System (I’ve been using your software since 1999) I found your EHR to be much easier, intuitive and infinitely cheaper.”
— Dr. KJ, Oregon

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And the survey says…

Once again, D.C.’s in Wisconsin have been surveyed by the Wisconsin Chiropractic Association with regard to the EHR / chiropractic software they use.  And the results might surprise those of you who rely on the hype that abounds in magazine ads and on websites.

Over 100 responses came in for this survey, which includes systems noted at the end of this blog entry. The first thing I noticed was that ECLIPSE users dominated the responses with close to 20% of the total. There was only one response from a Platinum customer. Apparently, chiropractors in WI remain blissfully unaware that Platinum (as decreed on Platinum’s website) is the “#1 chiropractic software worldwide.”

Chiropractors reported costs and rated Support & Ease of Use separately on a 7 point scale where a “7” reflected high praise and a “1” … well, you can guess. It gets interesting when you look at these scores and compare them with how much the doctors paid for each system. (For the record, we’re not based in or near WI and had no ties to or knowledge of this survey.)

Let’s compare a few systems. But first, we’ll ignore costs for the 5 ECLIPSE offices which noted “free upgrade” in the Cost column – the only free upgrades noted in the entire survey – because that would simply skew the results in our favor. So, here’s the table for three systems:

SystemAverage costSupportEase of Use
Average scoreLowest scoreAverage scoreLowest score
ACOM/Rapid$14,1904.7514.51
ChiroTouch$11,0855.0835.161
ECLIPSE$2,5005.5345.534
Support was rated on 7 point scale with “1” being “Horrible” and “7” being “Terrific”
Ease of use was rated on a 7 point scale with “1” being “Difficult” and “7” being “Easy”

I’m sure you’ve noticed that the lowest cost system is also the highest rated?  Also, I only included systems with 9 or more responses. Otherwise, it becomes more difficult to place results in any sort of context. So, with the largest # of reported results, when it came to unhappy chiropractors giving their systems a low score, note that ECLIPSE users were generally a happy group.

Now, let’s discuss those “free upgrades” that 5 chiropractors noted in the cost column. We believe this survey was about Meaningful Use and the $44,000 most doctors crave. Why was ECLIPSE the only software that doctors didn’t have to pay a premium for – even if they already owned it – in order to qualify for Meaningful Use funds? Other companies in this survey often preface news releases by noting their leadership and citing instances where they’re “giving back” to the profession. This is a perfect example – in an independent survey – of how we give back to the profession every day by intentionally keeping prices low. And of course, though we shy away from words like “leader,” ECLIPSE was certified months in advance of the October 1st, 2011 deadline that allowed ECLIPSE users to receive an $18,000 payment during the first year of the program… a claim that products like ChiroTouch can’t make.

To the best of my knowledge, ECLIPSE is the only system that’s been independently reviewed over a course of decades by multiple generations of chiropractors: in 1988 by NYSCA, and in 2001 and 2011/2012 via WCA surveys. Shouldn’t that tell you virtually everything you need to know before you buy a system?

When ECLIPSE debuted in 1985, Logicomp, Parker (Yes… that Parker) and PDR were the hot systems to buy nationwide. Every chiropractor knew this. And each proclaimed itself to be the best chiropractic software available. One of my professors at NYCC enthusiastically endorsed PDR. The Parker rep even flew his own plane to NJ to provide a product demo. And I’ll bet you’ve never even heard of them… because as big as they were… they’re now all out of business. ECLIPSE has demonstrated that it can stay current in your office for your entire career. How many of your colleagues are still on their first computer system?

Systems mentioned in the survey include: ACOM/Rapid, Chart Talk Chiro Quick Charts, Chiro 8000, ChiroAdvantage, Chironotes Complete, ChiroTouch, Clinic Pro, Compulink, CTR-X, EMR Datacenter,Epic, EZ Bis, EZ Notes, Future Health (E-Connect), Lytec, MacPractice, Medicfusion, Medinotes, My EMR Free, Office Ally, Platinum, Practice Fusion, Practice Studio, Quick Practice, Quixote, Vericle, Virtual Office Suite, and WritePad.
All product names mentioned above are trademarks of their respective owners.
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ECLIPSE, Credit Card Processing and The Cloud

In November 2010, I purchased a case of wine as a gift for the upcoming holidays. Rather than wander into my local liquor store, I ordered from winelibrary.com. The recipient was delighted with the gift. And that was the end of it. Until yesterday.

I received a letter from Wine Library informing me that their servers had been breached and that my personal information…

“including your name, credit card information (including the three or four digit code on the back of the card and the expiration date) and website user account information (including passwords, user names, billing addresses, and shipping addresses) was illegally accessed or taken from our website  by computer hackers sometime between October 20, and November 7, 2011.”

This went on for two pages! Of course, they didn’t even know they’d been breached until customers started contacting them. Anyway, perhaps you’re wondering what this has to do with ECLIPSE?

The above scenario can’t happen to ECLIPSE users. ECLIPSE is PCI compliant and doesn’t store credit card numbers locally on your computer, so patient credit card numbers are theft proof in the event your system is compromised. Thus, when you take advantage of automated, recurring credit card processing with flexible payment plans, you don’t have to worry about what happened to me. Because it can’t happen to your patients.

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What happens when the lights go out?

The email excerpt below was sent to physician clients by a cloud based, ONC-ATCB certified company that recently decided to halt business operations:

“After months of effort in an attempt to survive the ongoing economic crisis, Redpine Healthcare Technologies, Inc. (“Redpine”) has made the difficult decision to discontinue business operations.  Effective immediately, Redpine will no longer be able to provide billing services.  In addition, as of the end of the month, Redpine will no longer be able to provide software for the benefit of its customers.”

First… what happens to your data? According to the email:

“Redpine is beginning the process of compiling all provider data from our internal files and will provide that data to you as soon as possible. We recommend discontinuing the use of Redpine software on any new transactions (we may be able to help you with current transactions and all new transactions will be entered into the new system within a matter of days).  We also recommend that you print all outstanding claims currently in your system. While doing this you will want to select “print soap notes” with HCFA, this will give you a complete patient visit record for all outstanding claims.”

There’s hope there… but no guarantees. Notice use of the term “HCFA?” The Health Care Financing Administration changed it name to CMS years ago. Why are they using antiquated terminology? Anyway, I digress. Here are a few points that come to mind:

  • There’s no guarantee that you’ll receive your data in a situation like this. What will you do? Sue a defunct corporation?
  • There was no hint whatsoever that the company would cease operations. Doctors must now scramble to rush new systems into place. If you had control of your data, this wouldn’t be an emergency. You’d be able to look for alternatives in a controlled manner. Better yet, if you were using a program like ECLIPSE, where all the data is exposed via ODBC, you could easily hire a programmer to move some or all of your data to a new environment at your leisure.
  • Timing! Typically, this is the time of year when any outstanding billing needs to be completed before the next calendar year.
  • HIPAA!!! You must have absolute faith that your data will be handled in a HIPAA compliant manner. ‘Cause if it isn’t, it’s your responsibility. A smart move might be to consult an attorney with relevant experience about the possibilities.

And let’s not forget the potential loss of various comments, reminders, and day to day notes with respect to patient care, follow-up, and billing. Also, during any transition to a new system, a variety of patients may “disappear through the cracks.” And they won’t be noticed until too much time has passed to get them back. So… think about the revenue lost to your practice.

According to the same email:

“We have contacted numerous EHR systems and billing services on your behalf and have found a solution that is consistent with the level of service you are accustomed to, all the while offering an expedient transition process that promises to minimize cash flow disruption.”

Perhaps it’s great that they’re attempting to mitigate the problems you’ll face (which may help the principals avoid lawsuits and/or class action litigation). However, this means that you don’t get the opportunity to make the selection yourself. And they didn’t contact us. But again, I digress.

Anyway, trusting your computing solely to the cloud has the advantage of “anywhere/anytime” computing. Does that outweigh problems like this? Put yourself in the shoes of doctors who have to complete their billing before the end of December (the email we received was dated 12/7/2011). And keep in mind that, outrageous claims and promises aside, this can happen to any company.

ECLIPSE provides a local database and internet accessibility simultaneously. Only you or your power company can turn off the lights.

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Size Matters

Today, we’ve been receiving calls from doctors who are ready to panic. Here’s an excerpt of the email from their software vendor:

“After months of effort in an attempt to survive the ongoing economic crisis, Redpine Healthcare Technologies, Inc. (“Redpine”) has made the difficult decision to discontinue business operations.  Effective immediately, Redpine will no longer be able to provide billing services.  In addition, as of the end of the month, Redpine will no longer be able to provide software for the benefit of its customers.”

Apparently, many doctors purchased this software as a direct result of an endorsement by a reputedly neutral party. Unfortunately, this is far from atypical. For example, in June 2004, the American Chiropractic Association strongly endorsed a system:

“The American Chiropractic Association (ACA) proudly announces its endorsement and exclusive distribution of Chirocere, an innovative, Web-based service designed to revolutionize the management of chiropractic offices. The new Chirocere service not only reduces overhead costs, but also streamlines clinical and administrative operations for practice of all sizes, leaving doctors of chiropractic free to spend more time caring for their patients.”

Sadly, this was also a short-lived venture and the product and company have been gone for years — with your money. However, such endorsements are common. In fact, we’ve been offered numerous endorsements over the years as well… for a fee. When a speaker at a seminar you’ve attended endorses software, odds are high that some form of compensation is involved. We don’t pay for endorsements. Period. Yet, at any given time, the principals of  major state and national associations use ECLIPSE, and a variety of practice management consultants recommend us to their clients.

A Google search related to Redpine indicates that they’ve likely defaulted on at least $350,000 in taxpayer funds that they accepted from Bay County, FL in exchange for relocating to Panama City, FL — where they were expected to create 410 new jobs by 2015 at an average annual salary of $49,000.

If you review the “Size Matters” video on our website, we’ve warned about this for years. Remember, cool websites can’t answer the phone. There’s a reason you should take a company’s track record into consideration before falling for a sales gimmick or pricing that can’t support a company’s long term growth. ECLIPSE has been around now for better than 25 years. And far from becoming stodgy and shopworn, the software continues to incorporate state of the art enhancements, small & large. More to the point, as a company, we don’t owe money to anyone. And our operations aren’t backed by investors. Doctors have gone out of business while they wait for such snafus to get resolved once their billing is affected. Don’t be one of them. Your software is an integral part of your practice.

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ECLIPSE, SQL & ODBC: Under the Hood

From 1985 through 1999, ECLIPSE had a proprietary database – designed by me. Performance was as much as 1000 times faster than competitive products. (I received research credit for some of these innovations as part of my graduate studies in computer science.) Of course, there were trade-offs…

So, 15 years later, in 2000, we moved to a widely used, well-documented, commercial database vendor that specialized in high-performance systems. The new database added a new twist – it was SQLODBC compliant, which provided an immediate advantage to clients. Today, companies from across (and outside) the United States have used SQL & ODBC to customize ECLIPSE, and some have released  their own complementary products to handle electronic sign-in, allow patients to schedule their own appointments, interact with social media, etc.

With an inexpensive ODBC driver (or a Server based version of ECLIPSE with SQL), you can create customized reports, databases and screens to link to and access your ECLIPSE data without waiting for us to fit your needs to our agenda (which is affected by thousands of offices)…  We try to handle “macro” issues – issues that affect all clients (e.g. Meaningful Use certification). ODBC allows you to handle your own “micro” issues – issues more likely to be specific to your office.

For example, one of the unfortunate things I’ve learned after more than two decades handling thousands of clients is that, when it comes to bills & statements, it’s rare that I can find three offices that agree with one another on the perfect statement. In fact, each office’s concept of “acceptable” seems to vary widely. SQL & ODBC allow you (if you’re a “power user” or a professional programmer) to create custom statements and reports with nothing from us but a set of specifications. You can even use off-the-shelf products such as Crystal Reports to interact with most ECLIPSE data. Companies that specialize in creating reports for ECLIPSE can usually be found on the GalacTek website or by calling the HELP Desk.

Among other things, this also means that terms like obsolescence don’t need to enter your vocabulary. (How many of your colleagues have replaced obsolete software over the past 25 years?). An open database means you can add features or port the entire database without worrying about the integrity of your data. And most data — including financial data that relates to the entire practice — can be directly accessed from programs that have an ODBC interface. Finally, a SQL/ODBC  interface means you interact directly with ECLIPSE data in real time — which is why 3rd parties prefer it.

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Meaningful Use Certifications: Don’t Get Hoodwinked

ECLIPSE became certified for Stage I as a Complete EHR on July 28th, 2011. We began providing clients with all the tools and information they’d need for compliance way back in January 2011… to ensure they’d meet the October 1st, 2011 deadline. And before the end of 2011, our clients were receiving their $18,000 payments.

Here are some interesting quotes I came across today (well after that 10/1/2011 deadline) among companies that sell software to health care providers. According to Company A’s website:

“The certification authority prohibits us from sharing our specific progress and where in the process we are…”

This one (which refers to CCHIT) sounds good… but it’s an outright lie. We kept our clients informed of our progress throughout the entire year as we proceeded through a series of CCHIT certifications. Here’s another quote:

“Company B  just completed their testing for full ambulatory EHR certification and passed. Call (800) xxx-xxxx for further details.”

This was actually on B’s website. Of course, weeks after this appeared, the government’s Certified HIT Product List (CHPL) still doesn’t list them or their products… which means it’s not possible to achieve Meaningful Use if you currently use their software (a certification# is necessary). And by the way, the CHPL site is updated weekly.

And let’s not forget the fear factor. This next quote from Company C precedes a lengthy treatise trying to convince you that achieving Meaningful Us is too much work and has a high likelihood of failure:

“Buying a certified EHR software WILL NOT make you eligible to be paid back from the stimulus package.”

Scare tactics? At this point in time, most physicians should know a colleague who has either attested or been paid.

Then, there’s this one from Company D:

“Are you looking for a Stimulus Solution?
Our EHR Software is fully ONC-ATCB Certified.”

This company isn’t certified at all and you won’t find them on the government’s list. Instead, they’ve aligned themselves with another product that is certified — a fact which they fail to disclose. Who cares? You should. To make a long story short… during the next round of certifications (Stage II), this is likely to cause a problem for all the doctors who purchased the product… and let’s not forget all the extra support fees and higher product pricing.

So, what’s the point? As always, be careful what & who you choose to believe. Companies can play very loosely with the facts when they want to make sales. Earlier in the year both of these companies made statements either online or at shows to the effect that “Meaningful Use” wasn’t relevant to their clientele (chiropractors). How do I know this? Well, Karen actually spoke with a sales person from company A when she attended a seminar in NJ. He told her that Meaningful Use “didn’t apply to chiropractors” and that other companies were simply “jumping on the bandwagon” to make quick sales. The CEO of company B provided an assortment of “facts” via the internet to the effect that his clients weren’t affected, funding wouldn’t go through (so you had no chance of getting paid), etc.

Apparently, both companies learned their lesson… but now they’re late to the show. And they’ve both missed the first deadline… which allows easier attestation (for you) during an abbreviated time interval. One of them even has a “guarantee.”

We didn’t make any guarantees. We simply pointed out our 25+ year track record and then met all the deadlines. But consider those guarantees. How likely are you to return a product after you’ve spent months entering data into the software? The answer is “Not likely!” And these companies know this. Now, here’s a question you likely never considered: How responsible is a company to its current clients when it risks lawsuits by making guarantees for deadlines that it may not be able to meet… Hmmm.

By the way, I don’t mention names here because they’re irrelevant. Lots of companies play games like this. And most of you never even learn you’ve been hoodwinked.

Sometimes, the adage “You get what you pay for” doesn’t even begin to cover the eventual problems that unfold. Ask questions before you purchase. Lots of them. At this point in time, we have clients who began their careers with ECLIPSE, used it as their practices grew, and retired without ever experiencing a hiccup. Can I guarantee that for you? Well… of course not!

Addendum (1/2/2012): Some of the software vendors mentioned above still haven’t achieved certification. Many ECLIPSE users received $18,000 CMS payments in 2011.

Posted in Evaluating Software | Comments Off on Meaningful Use Certifications: Don’t Get Hoodwinked

Keeping in touch between visits

One of the myriad items that differentiate practices with high patient retention rates is how physicians interact with patients between office visits. Doctors can & do take technologies to such extremes that they de-personalize the patient.

For example, do you send birthday cards to patients to help you “keep in touch?” Great! Do you place computer generated mailing labels on the envelopes? Uh Oh! And finally, is the entire birthday card computer generated, or does it have a pre-printed label you created inside the card? If so, you’re sending your patients the wrong message.

Generate a list of birthdays weekly or monthly from ECLIPSE and assign a staff member with good handwriting skills to address the cards & envelopes by hand. Either sign them yourself or have your staff member do it. You’ve managed to both utilize technology and brighten a patient’s day. After 25 years in practice I can assure you that odds are high your patient will both remember and appreciate the gesture… and may be more likely to refer friends.

If that’s beyond your capabilities, consider using a service to mail/email personalized cards. However, I’ve always preferred the method above and believe that — even amongst a generation that does everything online — patients will appreciate that you went the extra mile.

Next, text messages can be a great way to remind a patient that she missed her appointment 30 minutes ago. But, a day or two later, you need to consider the possibility that she may be indifferent — as opposed to forgetful. In order to avoid losing the patient, a personal call by a doctor or trusted staff member allows for the possibility of intervention to explain why care should be continued, or explore other issues. (The patient may not feel she’s improving, may have concerns about the cost of care, etc.) Though this may take the longest… it’s also most likely to provide the best returns.

Posted in Practice Management | Comments Off on Keeping in touch between visits