A second study analyzed 40 million prescriptions and found that compliance was 10 percent higher when utilizing e-prescribing.  It also indicated that a whopping 28 percent of paper prescriptions never make it to a pharmacy, a phenomenon dubbed “prescription leakage”.  Individuals conducting the study attributed the greater compliance rate of e-prescribing partially to lower out-of-pocket cost:  doctors with e-prescribing are more likely to know a patient’s insurance status and history.  Hence, they often choose to prescribe less expensive medications.

If e-prescribing is truly affecting medication adherence to such a degree the potential ramifications could be colossal, improving patient outcomes and in turn reducing the cost of healthcare to the individual and our nation as a whole.

At SOAPware, we understand the importance of patient compliance to your practice.  Our R(x) manager contains everything you need to utilize in order to satisfy Meaningful Use criteria, while staying on the cutting edge of e-prescribing technology.  SOAPware allows users to view current medications, patient medication history, refill requests, and more…all on one well-organized screen.   Most importantly, SOAPware R(x) ensures patient safety by displaying patient allergies and drug interactions with ease.

The first step is to create a complete backup. SOAPware comes with a backup utility called Data Manager. This tool will allow you to run and create backups of your SOAPware database. You can also setup scheduled backups to run nightly, weekly, and/or monthly. This tool will also allow you to be logged into SOAPware during the backups.

The next step is to make sure the backup you created is a good and complete backup. You can go about this a few ways. The first is to look at the logs that Data Manager creates. You can look through this log to make sure that during the backup that it finished successfully and error free. The second way to verify the backup was successful is to have a separate machine you can restore the backup you just created onto. I recommend you do both to double-check everything.

The last step is to store a copy of your backups in a safe place. After creating and verifying your backups are completed, you will need to put these backups somewhere where you can get to them in a timely manner but also where they will be out of harm’s way. I recommend putting these off site and away from the office.

If you follow these steps, you will be able to sleep better at night knowing all your hard work is safe and available for recovery in case of an unforeseen event.

Since staff members may be unfamiliar with some or all of the functionality of your EHR system, some education on basic and more advanced functionality may need to be done prior to setting your goals for implementation.  For instance, knowing that SOAPware 2012 features a powerful Professional Scheduling management system that allows scheduling across multiple facilities; advanced appointment finding; scheduled report exports; and custom resource scheduling may be exactly the motivation your front office staff needs to get motivated to plan for implementation.

Goals may include:

• Improving charting of work done, from a compliance perspective
• Achieving Meaningful Use documentation standards
• Providing better and more efficient access to data across providers and programs
• Direct electronic connection to labs, eliminating the need for sorting, reviewing and filing faxed paper lab reports
• Improved tracking of patient charges and payments
• Streamlining procedures and making double-work a thing of the past
• Improved reporting capabilities for management

Where do we start?

In setting your goals, it’s helpful to ask:

• What is expected of our new EHR system?
• What do we hope to gain from implementing this EHR?
• What constitutes a successful implementation?  What needs to happen for make the process a success?

These questions should be addressed throughout your practice or clinic organization, not just from a provider or office management perspective.  Consider all of the clinic’s end users.  How will the EHR improve efficiencies throughout the practice, improving both productivity and accuracy?  As a whole, your front desk staff may care that the EHR will make your clinic more productive, improve compliance and reduce medication errors.  However, on an individual basis, a more immediate concern for staff members is how the EHR will impact his/her job.

As your list of goals begins to grow, be sure to ask more goal-related questions:

• Are our goals realistic, positive and doable?
• Are our goals truly related to the EHR implementation?  Remember, implementing an EHR can solve many issues as well as generating significant improvements to your workflows.  What it can’t do is solve all of your clinic’s problems.

Finally, once your goals are clearly established, it is vital to a successful implementation that the goals are articulated by your clinic’s senior leadership to the entire organization.  Clear and consistent communication is vital to the project.  Goals should not be documented at the start and then filed away for the remainder of your implementation.  Staff members should be reminded often of overall goals – post them in common staff areas and meeting rooms as friendly, non-threatening reminders of the shared vision for your clinic’s future.

The first to reach approval will most likely be Meaningful Use Stage 2 regulations.  These will include more security requirements, clinical measurements, longer measurement timelines, and reporting rather than sole attestation.  The Stage 2 guidelines will also require new standards, implementation specifications, and certification criteria that EMR’s will have to meet to support MU.

Those who comply with Stage 2 will be promised incentive payments.  Strangely, these are simply proposed rules and providers will be able to give their opinions about them to the HHS.

The second rules are amendments to HIPPA.   The first of these grants patients the right to view an “access report” of whom has seen their health record.  This proposed mandate is unpopular among many physicians, who hold that the maintenance of all this audit trail data would be enormous while virtually no patients would actually request to see it.  The last of the HIPPA changes seeks to impose stricter security enforcement and breach notifications, and is the most disturbing to many.  Under this regulation, it currently appears that providers would be required to report security breaches of PHI to the patient, HHS, and possibly media:  even if no harm was done.

SOAPware 2011 and 2012 include (3) Meaningful Use Dashboards. Each one having important, but different tools. Our clinical training team has received multiple emails, cases, and phone calls related to confusion on which one to use, how are they used, and where are they found in SOAPware?

Meaningful Use Patient Dashboard

We would like to help clear up some of these questions and uncertainties for our users. Let’s first discuss the Meaningful Use Patient Dashboard. This dashboard is a tool to track compliance for individual patients. However,  it does not include all Meaningful Use measures that are to be met , but has been developed to help guide SOAPware users toward Meaningful Use workflows. The Patient Meaningful Use Dashboard is accessed from the View menu item and can be used when a patient chart is open with a new Face to Face SOAPnote/Encounter; This tool will be grayed out if there is not a new Face to Face SOAPnote created for the patient. When a measure has not been met for a patient, a red “X” will be displayed for the item in the Compliance Details list. A green “√” will be shown for measures that have been met. The Patient Compliance percentage bar will also reflect that the patient is not meeting 100% of the patient-specific Meaningful Use requirements. For more information regarding this dashboard, Click on the provided link: Patient Meaningful Use Dashboard

Meaningful Use Dashboard

The Meaningful Use Dashboard is used for viewing, exporting and trending Meaningful Use statistics for providers. This workspace is located in the SOAPware menu item. When updating provider statistics, this can ONLY run for the current date and will run a snapshot for the previous 90 days from the current date selected. Users cannot select a Snapshot Date in the past and update statistics for that date. It is also very important for the provider to Update Statistics on the final day of their selected reporting period. A green “√” indicates that the item has met the Meaningful Use requirements, and a grey “X” indicates that the item has not met the Meaningful Use criteria. MU items listed in the Snapshot are only items that are tracked in SOAPware and require that you meet a percent threshold. The Meaningful Use Dashboard allows our users to view a graph of the trend for each Meaningful Use requirement that is listed in the dashboard. It will also automatically calculate each Meaningful Use criteria as interpreted by SOAPware. In some instances, providers might interpret a measure differently and has the capability and opportunity to add an Adjustment. Adjustments made will not change the automatic calculation by SOAPware but will track and allow users to print at the time of self attestation. For more information regarding the Meaningful Use Dashboard, Click on the provided link: Meaningful Use Dashboard

Clinical Quality Measures (CQMs) Reporting Dashboard:

How to Use the Clinical Quality Measures (CQMs) Reporting Dashboard: This workspace can also be accessed in the SOAPware menu item. There are (44) Clinical Quality Measures and are sorted by Core, Alternate Core, and Additional measures in the SOAPware CQMs user guide. Shortcuts are also detailed within each measure lesson that will assist with the structured documentation needed to fulfill the CQMs. This guide is designed to walk users through the steps of exporting Clinical Quality Measure data for reporting. Measures can be located in the CQMs dashboard by the measure number and the selection of the reporting periods will be made for the export of each measure. Color coding has been created within this lesson as a guide and visual explanation for reading the XML document that has been exported and saved as a file for each measure. At this time, CMS does not require that the user upload the XML document during the attestation process, but may be a future requirement for Meaningful Use Stages. For more information regarding the CQMs Reporting Dashboard, Click on the provided link: How to Use the CMS Quality Reporting Dashboard

There are plenty of highly technical tasks that can be done to improve the performance of a database.  In fact, technology companies employ people whose sole job is to identify and execute ways of speeding up databases and reducing their size.  SOAPware has encapsulated a few techniques into the Data Manager product.  I can’t claim Data Manager to be a database administrator in a box, but it can routinely run several database improving tasks, including reindexing, vacuuming, and updating statistics.  There is not enough space in one post to describe how each one of these contributes to the speed and leanness of a database, but hopefully there will be in future post to explain these incentives in detail – sugar to help the medicine go down.  Until then, check out SOAPware’s ScreenSteps documentation about setting up or running database maintenance, and remember that your databases are your children.

As soon as I took the job, I informed Brad Hampton, our lead Support Technician at the time, that I had taken another position.  I was so desperate to be in the field of technology I totally skipped over the “is this job good for me” rationality.  Sitting at a mexican restaurant on a Sunday afternoon with my fiance, now wife, I decided to make a desperate call to Brad and ask him if I could get another interview.  I explained the job I took wasn’t what I thought it would be and I would like another chance to interview with SOAPware.  Brad granted me another interview and at that moment I received overwhelming sense of peace.  Calling Brad back was one of the best decisions I’ve ever made concerning my career.

So now lets skip to the part where I’m a SOAPware Support Technician.  Between phone calls I liked to play around with my personal website development.  One day Keith Caselman, support director at the time, saw me doing this and immediately became intrigued that I had knowledge and passion for website development.  The next day he came in carrying a book called “ASP.net for Dummies”, he plopped it on my desk and said “Learn this between calls, I have something I need you to build”.  That is how I was introduced to my first programming job at SOAPware.  I built the very first SOAPware User’s Directory.  It allowed users to sign up to a public directory so they could contact each other if they wished to.

Since then SOAPware has taken me under its wings.  They’ve allowed me to pursue anything I wanted to learn on the job.  I know am a full-time developer on the EMR.  I’m well versed in Object-Oriented Programming, Database Management and .NET development.  I love coming to work every day which is not always an easy thing to find in the technology industry.   We recently decided to redefine our development process using a agile methodology.  It has been a blast to learn a new approach and help build a process from the ground up.  We have an awesome team that’s eager and willing to adapt.  I look forward to the next 10 years of SOAPware.

Of  the patients who were in favor of information sharing, 62 percent wished to give access to their spouse, 23 percent to their children, 15 percent to another family member, and 7 percent to an unrelated person.  Most of those who desired sharing with a family member other than their spouse or partner indicated that the person did not actually live with them.

Primarily, interest was expressed in being able to view medication lists, lab results, and appointment schedules.  Additionally, over 90 percent of patients in a similar study advocated access to read their physicians’ open visit notes.

Physicians were notably less excited about this notion.  Only around 70 percent of participating care-providers thought that access to notes was a good idea.  Furthermore, the amount of advocacy was reduced drastically among physicians participating only in the survey portion of the study:  a meager 33 percent at maximum.  When asked why they were not patrons of this idea, most cited they believed this type of information-sharing would cause patients to worry excessively about their health.  In this circumstance, providing patient access may seem to prove counterproductive.

Because of present regulations restricting heath information exchange, current opinions about this subject are not often evidence-based.   But this climate is slowly changing:  In November 2011, the Health Information Technology Policy Committee made the recommendation that test results should be made directly available to patients.  At this time, thirty nine states prohibit the release of such information without consent of a physician.  However, if this proposal is enacted into federal law, it will trump all state mandates on the matter of health information sharing.   The proposal was closed for comments on November 14, and is expected to be finalized.

As you can imagine, this puts a lot of pressure on QA. Up until now, the developers have been coding for several months on several features and/or bug fixes that likely haven’t been tested by nor had any involvement from the QA department yet; and now QA has only a few months (or less) to make sure the release is fully stable. The months of coding without testing puts the program in a seriously unknown state and often leads to QA running out of time to completely test the software. This can lead to only testing the most important stuff, and can lead to broken features and bugs getting released to the public.

In a scrum methodology however, the Development department and the QA department work closely together to implement bug fixes and new features. This also helps break down the barrier that often exists between developers and testers in a traditional waterfall environment. Part of this process is to break down new features and bug fixes into user stories that fit within smaller iterations (usually two to four week development cycles), and during this iteration developers will code a little bit and then pass that off to QA for testing.  This process helps ensure that each portion of a feature added to or fixed in the program is tested and stable immediately after development. Also, with the testers and developers working more closely together, this allows QA to potentially alert developers of edge cases and bugs before they’re even created.

With these workflows in place, the program as a whole becomes more stable by the end of each iteration. Another major benefit to this process is that at any point the product owners can pull out a stable version of the release and then push that out to clients if need be in a quick manner. These are only a few examples and benefits the scrum process brings to the developers, testers and company as a whole.

Better performance for all SOAPware users.  Not only will this directly affect all SHS customers, but also anyone that uses SMARText, Faxing, or E-Prescribing should see an increase.

Along with the increase of Bandwidth, we have also begun moving SHS sites to a brand new Data Center that we have chosen.  All new SHS sites have for the past 2 months been put on new servers and new systems at this data center.  Starting at the end of this month, we will begin the process of upgrading all SHS customers to the new Data center, which has an input/output speed of up to 400MB/s.  Our completion date for this major project is April 1.

Within the next couple of months you will be contacted about moving all of your services to the new Data Center.  Old systems will be upgrading from Microsoft Windows Server 2003 to Microsoft Windows Server 2008 R2.   The hardware that your server is currently on will be upgraded to brand new, faster systems as well.

We have many performance improvement plans upcoming for the future and are happy to be able to tell you about them.