ECLIPSE, SQL & ODBC: Under the Hood

Posted on October 20, 2011 by Mike Norworth

2020 Update: ECLIPSE now includes custom statement design software with  Client/Server versions.

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 SQL & ODBC 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 by contacting 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

Posted on October 18, 2011 by Mike Norworth

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.

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Keeping in touch between visits

Posted on October 3, 2011 by Karen Walters, D.C.

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.

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Meaningful Use Myths

Posted on October 1, 2011 by Mike Norworth

Meaningful Use misinformation seems to accrue on a regular basis. I’ll try to regularly update this area as these questions arise. Some are already answered as separate blog entries in this category.

Myth: The attestation process is difficult and most health care providers will need extensive hand-holding and training to get through it.

The Facts: Myriad ECLIPSE users have already attested and received payments by reviewing our blog entry here and reviewing two sections in our online HELP designed to walk you through the process. Here’s a quote from a client who has been through the process: “our office attested to CMS for Meaningful use on October 19, 2011 and received the full $18,000 on November 30, 2011. It was quick and easy.”

Myth: If you don’t charge a minimum of $24,000 in services in 2011, you’re not eligible for any payments.

The Facts: Your payment will be held until the reporting period is complete or you hit the $24,000 threshold. This allows CMS to avoid issuing multiple payments.

From CMS: How and when will incentive payments for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program be made? Incentive payments for the Medicare EHR Incentive Program will be made approximately four to six weeks after an eligible professional (EP), eligible hospital, or Critical Access Hospital (CAH) successfully attests that they have demonstrated meaningful use of certified EHR technology. Payments to Medicare providers will be made to the taxpayer identification number (TIN) selected at the time of registration, through the same channels their claims payments are made. The form of payment (electronic funds transfer or check) will be the same as claims payments. While CMS expects that Medicare incentive payments will begin in May 2011, payments will be held for EPs until the EP meets the $24,000 threshold in allowed charges.

Myth: If you don’t have certified technology in place prior to December 31st, 2011, you can still attest for a 90 day period that began in 2011 (e.g. 10/1/2011 – 12/31/2011).

The Facts: CMS expects you to have certified technology in place before you begin attestation. Whether they’ll actually check dates after the fact… it’s hard to say. In general, this only seems to be a topic of discussion with vendors pursuing software sales with technology that isn’t yet certified.

From CMS: Do I need to have an electronic health record (EHR) system in order to register for the Medicare and Medicaid EHR Incentive Programs? You do not need to have a certified EHR in order to register for the Medicare and Medicaid EHR Incentive Programs. However, to receive an incentive payment under the Medicare program, you must attest that you have demonstrated meaningful use of certified EHR technology during the EHR reporting period. For the first year of payment, the EHR reporting period is 90 consecutive days within the calendar year for eligible professionals (EPs) or within the Federal fiscal year for eligible hospitals and critical access hospitals (CAHs)…

Myth: I attended a seminar and was told I can always use zero as a value for any measure’s numerator and still successfuly attest.

The Facts:  Do the math. When a measure has a numerator and denominator, the denominator indicates how many patients in your practice it was possible to meet this objective for.  The numerator specifies the number of patients for whom this objective was actually met. A zero means you haven’t met the objective for anyone. Thus, if you attempt to do this for non-excluded measures, your attestation will fail.

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Interacting with us via Email

Posted on September 29, 2011 by Mike Norworth

Last night, we attended a dinner party. Larry – who was seated across the dinner table from me – runs an advertising firm with two partners. He proceeded to tell a story about an email he’d received earlier in the day from one of those partners.

As he read, he sensed an underlying tone, which was reinforced by the writer’s use of capitalization. Perturbed, he set it aside. Later, he asked a 3rd party to read the email before he responded. She agreed that his conclusions had merit. Still… he decided that – rather than send back a nasty email of his own – he’d simply speak to his partner about it,
whereupon he learned that his perception was considerably different from his partner’s intent.

The story struck a nerve. I’d had an email situation yesterday as well, and as usual, with a complete stranger. Clients routinely use our website to make suggestions, ask questions, etc.  I often take time from my day to personally respond – a time consuming endeavor. This particular doctor’s suggestion demonstrated that she was unfamiliar with a basic feature – a common problem. We all have similar issues with feature laden software. I responded with information – nothing but the facts. I added CAPS and italics to emphasize specific items. I was trying to be helpful… Her response:

“I’ve taken alot of sarcasm in your response.”

and

“Thanks for the quick response; but you could have removed the attitude.”

I re-read the email. What sarcasm? What attitude? What could she be referring to?

We answer a high volume of email. Perhaps once every few months, someone grossly misinterprets a response. For instance, in 2007, I was exchanging a series of emails with Dr. SK. In the middle of this exchange, he exclaimed: “I am insulted by the way you respond as if I have no idea what I am talking about.” I requested he re-read my
comments and received back the following:

“I appreciate your responses. My wife just reprimanded me for how I responded to you last e-mail. I get a little hot headed when I read into what people tell me. I’m sorry about that.”

Unfortunately, such exchanges are time consuming for everyone. When I take time to personally respond to you, and manage to alienate you in the process, I wonder why I bothered responding at all. But then I recall that your reaction is unusual. So, the next time you interact with us via email (or on the phone), please keep in mind that we’re very busy and have better things to do than antagonize you. Any tone you perceive is your imagination… nothing more. And since better than 99.99% of my email exchanges occur without incident, I would like to think I don’t need to attend an email etiquette seminar.

The irony is that though we go to great lengths to make ourselves available to you, we often can’t win in such situations. When I believe a somewhat detailed explanation might be helpful… you may perceive this as “being defensive.” When I provide facts, you perceive an attitude – as Dr. SK did.  I wish I could provide facial cues, or a disclaimer… Anyway, please, please don’t inject your concept of sarcasm, contempt, ridicule or other negative connotations into my verbiage. Thanks for your consideration.

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ANSI 5010 and ZIP Codes

Posted on September 19, 2011 by Mike Norworth

Once again, it seems I’m writing to correct misinformation doctors are getting en masse at seminars. And once again, keep in mind where my information is coming from. I certified ECLIPSE as ANSI 5010 compliant for electronic claims months ago and have all the official documentation in hand.

Several times in the past week, panic has set in when doctors have been told that all the ZIP codes they submit will have to be converted  to full 9 digit codes. Not true.

Of course, it’s easy to see how such misinformation came to be. So, what’s the story? And what do you need to do? Your address (i.e. billing provider and service facility) must contain a 9 digit ZIP code. This is stated clearly on page 93 of the most recent (February 2011) Consolidated Guide for 837 Professional claims.

So, update the addresses for every provider in your practice that may appear on claims. If you have multiple facilities and treat patients at multiple locations, update those as well. That’s it. It’s not required that you update each patient, guarantor, payer, etc. in ECLIPSE.

If you don’t know your 9 digit ZIP code, you can look it up here.

By the way, ANSI isn’t just about 837. ECLIPSE directly imports 835 electronic remittance, as well as 277 & 999 type acknowledgments. And if the software you use doesn’t create detailed 277 & 999 reports, you have no way of knowing the status of your claims!

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What is Meaningful Use?

Posted on September 14, 2011 by Mike Norworth

Perhaps it shouldn’t be a surprise that – even at this late date – many chiropractic & medical physicians are still unfamiliar with the government incentive program for Meaningful Use. So, here’s a very brief overview of the highlights:

  • If you treat Medicare patients in your practice, over the next several years, the government will reimburse you more than usual… up to $44,000 per provider over the entire period. The project will proceed in three stages that have progressively more stringent requirements. We’re currently in Stage I – which has the most relaxed participation requirements.
  • What’s the goal? As part of the American Recovery & Reinvestment Act (ARRA) of 2009, the federal government wants to improve the efficiency of the health care  system. Years ago, CMS (then HCFA) began offering incentives to doctors who  submitted claims electronically. Now, the goal is to make sure you can share addtional information electronically with CMS (e.g. quality reporting), your patients (e.g. their health records), and public agencies such as the CDC (e.g. immunization data). All these changes are expected to make patient care more efficient & effective.
  • In order to qualify for the incentive payments – which are based on the total Medicare or Medicaid fees you charge during the year – you must have certified software. As an ECLIPSE user, you’ve already met the first qualification. The second qualification is up to you. You must meet a series of criteria in your office, which you can read about in detail here. Most criteria are relatively easy to meet via small adjustments to your office procedures.
  • It’s likely that you send electronic claims now. Years ago, electronic claims were
    the exception rather than the rule. The current incentives are the government’s
    way of encouraging across-the-board adoption of systems that can share information over the shortest possible time span.
  • In a few years, CMS will begin to phase in penalties for providers who haven’t yet adopted certified technology.
  • For more information, visit the related CMS site.
  • Finally as of this date (9/14/2011), we know of at least one office in UT that has notified us as follows via email. Here are two excerpts: “… The initial process of getting required information entered is time consuming but Eclipse’s quick data entry options speed the process up. Not only have we attested but we have passed the attestation which means for us the check is the in the mail …” and “… So, for those who doubt, doubt no more.  We used Eclipse, we qualified for meaningful use, we where able to run reports for the clinical quality measures, we attested, we passed and now we are waiting for payment…”
  • Update: As of December 2011, myriad ECLIPSE users have already received payments of $18,000. For instance, according to Sylvester Chiropractic Centre in NJ: “… our office attested to CMS for Meaningful use on October 19, 2011 and received the full $18,000 on November 30, 2011. It was quick and easy. And best of all, we received our payment during the first year of availability because ECLIPSE was certified before all the initial deadlines.”
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Getting Started With the Encounter: FAQ

Posted on September 9, 2011 by Mike Norworth

Existing clients often ask similar questions about the Encounter. Here are some answers:

  • There is no extra charge for the Encounter. It’s included with full functionality in every version of ECLIPSE so you can easily track your clinical documentation / S.O.A.P. electronically along with all your other patient information.
  • The Encounter is a robust, flexible and customizable solution for chiropractic & physical therapy documentation/SOAP notes. Here’s an independent case study of a multi-doctor, multi-site practice that uses the Encounter in real time to see 10,000 patients monthly.
  • Auditors prefer the Encounter’s data centric approach as compared with other systems that provide lengthy narratives for every visit. Don’t get bogged down in decades old archaic approaches that randomize text, create narratives, and have become DHHS audit targets where the pretty picture you clicked to create the note can’t rescue you from trouble.
  • We protect you from common audit targeted software features that you may not even be aware of.
  • The Encounter can be extensively customized “on-the-fly” inclusive of determining what you see in daily notes vs. exams.
  • The Encounter can be as efficient & fast as you want it to be. Here’s unsolicited feedback from a chiropractor in Kentucky immediately following training: “I worked on some of the notes last night. One of the main ones I did was a PIP patient… I love it ! This system, especially with the fact that it is Windows-based… was so much faster than what I had used before. I really love the interface where you can very easily transition from inside the note you’re working on to any other screen to review any other information in the patient’s file. I have to tell you… as you know I used one of the more expensive EHR programs before, and usability as well as the speed blows the socks off of it. I don’t mean to compare or knock the other one but that is the only example that I have and I’m really blown away about this.”
  • Our KIOSK software — which loads subjective data directly to Encounters — is free (if you maintain a subscription), provides a graphical user interface that includes VAS controls, forms (e.g. OSWESTRY, Neck Index), and allows any # of patients to simultaneously fill & send data to ECLIPSE without exposing your existing database to as yet undiscovered HIPAA security flaws.
  • Yes, we’ve done SOAP before. The Encounter is a new design based on over a decade of feedback. Here’s a quote from one of your colleagues who uses it daily: “I’ve been using the ECLIPSE EHR to scan EOB’s (among other things) for years, have all my SOAP in ECLIPSE and have worked through subsequent generations of SOAP as they improved the product. 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.”
  • Since the user interface is consistent with the rest of ECLIPSE, there’s virtually no learning curve. Of course, with experience, you’ll be able to complete clinical documentation faster. Most users report that they can complete standard follow-up visits in well under a minute.
  • It’s reasonably simple to get started. Download the latest update. Access the Encounter on the patient’s EHR tab. Press the F1 key to review the HELP. The HELP screen quickly takes you step-by-step through the basics. From either the HELP screen or the ECLIPSE Help menu, access & view the training videos. If you still have questions, ask us about training.
  • Yes… you can run it on an iPad. We recommend you use the Encounter with a PC, tablet or touch screen. We prefer wireless tablets. Call the Help Desk for details.
  • Any supporting document can be imported or scanned, then annotated and included with your Encounters in one simple PDF to accompany paper or electronic bills. Translation: Scan in a patient’s blood work, attach the radiologist’s x-ray findings, put a sticky note with circles and arrows on each, and bundle it all with your bill(s).
  • Though you already know the user interface, the data layout will certainly take some time for you to master. So, here’s an unsolicited quote from a doctor running a busy multi-disciplinary facility in an urban NJ environment to demonstrate that it just may be worth your while: “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.”
  • And finally, here’s another unsolicited quote from a doctor in OR who has used ECLIPSE for years and had tried to implement a nationally distributed, well-known, SOAP program: “PLEASE let your long time subscribers know that you already have EHR on your system BECAUSE when I was looking I saw ***** 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.”
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Meaningful Use: Navigating the Attestation Guide

Posted on September 8, 2011 by Mike Norworth

6/29/2017: Please note that this article was published in 2011 & pertains to MU Stage 1. It’s not relevant to current Stages 2,3 & MIPS.

You should be able to find the answers to most questions in the 63 page CMS attestation
guide by visiting two screens in ECLIPSE. If you’re unfamiliar with the term “Meaningful Use,” read a brief overview here. Though it shouldn’t be necessary, an educational CMS video that explains the process step-by-step can be viewed here. You can also read a CMS FAQ document here. Finally, you must enroll with PECOS prior to registering on the CMS website. You can enroll here. A 2015 updated CMS “tip sheet” is available here with the most current information.

  • From the Reports menu, select Patient List. Press F1 for HELP and read about Automated Measure Calculation. This section contains extensive instructions on each and every Meaningful Use measure, how you can meet the requirement in ECLIPSE, and how you can check which patients meet the criteria for that measure for high percentage measure requirements.
  • From the Reports menu, open the Audit folder, and select NQF/PQRS Measures. Press F1 for HELP and read detailed information about each of the measures, how they’re assessed for different patient populations, and how you can get the information you need to manually enter the numerator and denominator values for the measures you choose.

It seems many of you remain confused about some of the other information in this guide.
So, let’s start with security. Bear with me since I’m handling these out of order… Let’s review (15 of 15) on page 28 of the guide. You must attest 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, ECLIPSE is certified as a “Complete EHR.” Therefore, it’s certified on all the security measures. Ergo, you can’t implement ECLIPSE in a non-secure way. Hopefully, since the implementation of HIPAA, you’ve regularly reviewed your office security protocols to avoid potential HIPAA violations. So, you should simply be able to indicate “Yes” to the measure. Read more about the security measure and audits here.

Next, let’s discuss steps 8 & 9. Step 8 indicates:

“Implement drug-drug and drug-allergy interaction checks.”

Step 9 indicates

“Maintain an up-to-date problem list of current and active diagnoses.”

First, I should point out a very important difference between these two steps. ECLIPSE tracks “step 9” for each of your patients. This step, as you can see on page 19 of the guide, requires a numerator and denominator. In other words, Step 9 has a reporting requirement – step 8 does not.

Let’s pursue a tangent for a moment. As an example, consider email access in ECLIPSE. ECLIPSE can send email, text messages, or bulk email on demand. In fact, the various email features of ECLIPSE are enabled whether or not you have an email account or use the internet. In contrast, consider that your ability to provide educational materials must be specifically enabled by us for your office (we reprogram your sentinel to allow access as per our agreement with the content provider).

Now, if you’re a chiropractor, and you don’t prescribe or review your patient’s drug
regimens, features relevant to step 8 are enabled in ECLIPSE regardless of whether you subscribe to prescription services. Of course, like email, if you want to actually use these features of your program (which you’re welcome to do), you must setup an
account with the service provider.

Note: This blog entry was originally created in 2011, and DHHS has since clarified requirements to the extent that all subscriptions required by your certified technology must be maintained by providers seeking incentive payments under MU guidelines.

This is actually a good opportunity to touch upon a related subject. Some of the items we report on are part of the normal HIPAA audit trail we maintain for your patient data. Thus, when you send an email from a patient’s folder, we track it. When you open that patient’s folder, we track it. When you add a problem, we track that too. Our audit trails have helped prosecutors bring convictions, and I’ve personally become involved in audits & investigations across the country where the audit trails we maintain have occasionally helped protect targeted health care providers. Now, since I’ve been discussing steps 8 & 9, this would be a good time to point out that there is absolutely no verbiage or requirement whatsoever with regard to Stage I auditing (by you or us) of an item such as “Implement drug-drug and drug-allergy interaction checks.” If you’re concerned about fraud, don’t claim you’re using a certified version of ECLIPSE when you’re running a copy that’s actually several years old. That will catch up with you by next year.

Most of the remaining parts of the guide are reasonably straightforward and can be handled by referencing the HELP as noted above. It’s unfortunate that some of the existing verbiage has created unreasonable concerns among some health care providers — which isn’t helped by the many “consultants” who like to lecture on the subject. (See my discussion of Medication Reconciliation as an example.) It’s beginning to remind me of 1999, when doctors I know were raiding their bank accounts to make sure they had cash when the banks failed as part of the Y2K debacle. Of course, if all the banks failed, who would actually have any use for cash? We’d be back on the barter system.

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