Before conducting your own risk assessment, you should know the universal elements HIPAA requires that all risk analyses/assessments include.  First, the scope of the analysis must encompass “potential risks and vulnerabilities to the confidentiality, availability and integrity of all e-PHI that an organization creates, receives, maintains, or transmits.” (45 C.F.R. 164.306(a).).  This means that the analysis must take into consideration PHI stored on any type of device and in any location.

Next, according to HIPAA mandates for data collection, your practice must identify and document where all e-PHI is “stored, received, maintained or transmitted.” Once the location of all PHI has been determined, you should document and assess security measures that are already being employed.

Then, HIPAA mandates that a practice determines the likelihood and potential impact of threat occurrence. The security rule requires protections against “reasonably anticipated” threats, which may vary according to your location, practice size etc.  The probability of reasonably expected catastrophes on your list should be estimated and recorded.

The potential impact of threat occurrence will depend on the type of threat and the vulnerability affected.  The potential impact of your listed threats through the exploitation of various vulnerabilities in your information security plan needs to be documented.  Note: make sure to remember that different potential catastrophes may have the same potential impact on PHI: for example, an earthquake and tornado may both result in physical destruction of stored data.

The last required step in a HIPAA compliant risk-analysis is to determine the level of risk “for all threat and vulnerability combinations”.  This simply involves assigning logical risk levels for the likelihood of the different potential threats and the likelihood of different types of impact on PHI. Finally, your security plan/measures should be amended to focus on preventing damage from these scenarios according to their probability. Stay tuned for a sample risk analysis in Part 3.

Those who have already attested for Meaningful Use are undoubtedly familiar with the Core Measure: Conduct a Risk Analysis. Unfortunately, the CMS gave no clear guidelines about what a proper “risk analysis” entails. According to a recent article by Lynn Scheps on the blog site EMRandHIPAA.com, this ambiguity left some practices so anxious that they began hiring consultants to perform their risk assessments, while others simply assumed they had already met all MU requirements because their EMR was certified by the ONC. Later, the CMS clarified that their requirements were not designed to exceed those of HIPAA on the subject of risk assessment.

HIPAA describes a security risk analysis as “the first step in identifying and implementing safeguards that comply with and carry out the standards and implementation specifications in the Security Rule.”.  It (under the security rule) admits that there are numerous ways of conducting a risk analysis, but identifies several universal elements that are required for compliance.   These can be found at http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/index.html, and are fairly straightforward.

The ONC’s 10 step privacy and security program contains guidelines on risk analysis for Meaningful Use . They recommend that practices contact their local Regional Extension Centers or medical associations for help and advice about conducting a risk assessment. You may also visit http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__privacy_and_security/1147 for more security resources. Stay tuned for specific examples of risk assessments in part 2 of this blog.

Medical Providers in Puerto Rico Can Now Use SOAPware EHR Solution

FAYETTEVILLE, Ark., May 23, 2012 — SOAPware, Inc., a leading developer of certified Electronic Medical Records (EMR/EHR) and Practice Management (PM) software, is pleased to announce the release of a newly updated SOAPwareXchange product which interfaces with Inmediata’s PM module. The new interface was designed in response to the growing demand in Puerto Rico for SOAPware’s world-class EHR software.

“Physicians in Puerto Rico are clamoring for SOAPware 2012, and we appreciate their patience as we worked with Inmediata to develop this exciting new interface,” states Randall Oates, M.D., President & CEO of SOAPware. “Adding the Inmediata interface to the SOAPwareXchange system means physicians in Puerto Rico can adopt SOAPware 2012 immediately and take full advantage of our software’s outstanding Meaningful Use functionality.”

“Inmediata is honored in supporting SOAPware and MedicalAIS through the most complete and robust EDI connectivity platform in Puerto Rico, which includes the exchange of claims, eligibility, ERA and eLab order/results information, among others,” said Guillermo Molina, General Manager of Inmediata Health Group. “We look forward to supporting SOAPware and MedicalAIS users with the best of our abilities.”

To meet the strong demand in Puerto Rico for its EHR and services, SOAPware is introducing MedicalAIS (MAIS) to provide on-the-ground attention to SOAPware customers in Puerto Rico along with current Platinum Partner Digital Solutions. MAIS, headquartered in Tampa, Florida, is a member of SOAPware’s elite Platinum Partner reseller group. Platinum Partners provide a full range of SOAPware product sales and support services, including implementation, training and technical support.

Enrico Linscheer, President of MAIS, said, “We are extremely grateful to SOAPware for the trust placed in our company to service the SOAPware user community in Puerto Rico. MAIS is opening a new branch office in Puerto Rico immediately, and we look forward to moving quickly into the marketplace to meet the EHR needs of the medical community.”

Utilizing the streamlined process to Meaningful Use made possible by SOAPware 2012, along with expert assistance from the professional staff at MAIS, will ensure that physicians in Puerto Rico can quickly and efficiently automate their patient record keeping and successfully attest for Meaningful Use in 2012. To promote Meaningful Use attestation using its EHR, SOAPware is offering a limited-time discount of 20% on the purchase of SOAPware 2012 Professional and SOAPware Clinical Suite products.

About SOAPware: Founded by physicians, for nearly two decades SOAPware, Inc. has adhered to a simple philosophy of delivering affordable technology to healthcare providers. Improving healthcare and the quality of life by empowering medical professionals and patients with innovative technology and services is the mission we are committed to achieve. For more information about SOAPware, Inc., visit: http://www.soapware.com. Follow us on Twitter @SOAPware or http://www.twitter.com/SOAPware. Become a fan of SOAPware: http://www.facebook.com/soapware.

About MedicalAIS: MedicalAIS is a SOAPware Platinum Partner, Value Added Reseller (VAR) and a full-service software, hardware and networking solutions provider specializing in Certified Electronic Health Records (EHR), Practice Management, Billing and Scheduling for the medical industry. With extensive hardware / software experience, the professionals at MedicalAIS will determine the best solution for your office needs enabling you to achieve efficiency and bottom line profit. MedicalAIS offers local support well after implementation that will not only guarantee and protect your technology investments, but will also give you tremendous peace of mind. To learn more about MedicalAIS, visit http://www.MedicalAIS.com or call 787-493-0250.

About Inmediata Health Group Corporation: Inmediata Health is headquartered in San Juan, PR; Inmediata is pioneering enhanced efficiency and quality in the healthcare and dental care industries through the application of strategic e-solutions platforms. Inmediata supports real-time adjudication of claims, electronic funds transfers, and a full range of informatics. The result is increased efficiency, seamless interfaces, improved quality and enhanced short- and long-term planning by providers and payers. Inmediata Health supports connectivity for over 13,000 health care providers in all segments, i.e. professional, institutional and dental. Inmediata also offers TPA/BPO services. On the Web at http://www.inmediata.com.

Contact: SOAPware Marketing Department
Andrew Money, Marketing Manager
800-455-7627 x 402
amoney@soapware.com

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The Payor EHR adoption incentive is a one-time, cash incentive that primary care practices can receive from certain private payors chosen by the Maryland Healthcare Commision.   The program allows practices to qualify for a Base Incentive and an Additional Incentive. The Base Incentive is calculated based on the number of payor members per practice, at roughly 8 dollars per payor member, up to 7,500.00 per payor (there are currently 6 participating payors).

An additional incentive may be given to those who make certain achievements within 90 days prior to applying.  Candidates which have worked with a state identified Management Service Organization (ex. Syndicus Inc.) , have demonstrated advanced use of EMRs, or who have participated in a state-selected payor’s outcome improvement initiatives, will receive an additional payment of up to 7500.00

In order to apply, your practice must be a primary care practice (family, general, geriatric, internal medicine, pediatric, or gynecologic practices) and your EMR must be certified by the Office of the National Coordinator. 

For more information contact Syndicus Inc. at help.desk@syndicusinc.com

or go to http://mhcc.dhmh.maryland.gov/hit/ehr/Pages/stateincentive/stateehrincentive.aspx#_Who_Qualifies

Most importantly, the scanner of your choice will need to have a TWAIN driver. This will allow communication between your computer and the imaging device (scanner). The TWAIN driver allows the imaging software to recognize the scanner and transfer the scanned image(s) information from the scanning device to the computer into SOAPware.

What is a TWAIN driver?

Two of the most common scanners used by SOAPware users are Fujitsu and Ambir scanners. Not all Fujitsu scanners have a TWAIN driver, so we caution users to make sure the scanner has this type of driver before purchasing.

Ambir scanners work great for all SOAPware uses, especially for our SCS (SOAPware Cloud Service) users. A remote scanning device can be purchased in addition to the scanner that makes scanning a very simple process when using SOAPware remotely. This is a piece of software that is installed on the local computer and hosted (Cloud) server to connect the lines of “technological communication”.  Learn more about SOAPware integration with Ambir scanners at www.ambir.com/soapware .

Feel free to contact a SOAPware Clinical Trainer at clinicaltraining@soapware.com with any questions. If we cannot answer the tough technical questions, we will look to a resource that can.

The paper filing system generally requires staff members that are specifically dedicated to the task of “finding” charts.  Also, due to the openness of the chart room and the fact that charts can be found almost anywhere in the medical office, paper charts can be viewed by anyone, both authorized and unauthorized personnel.  The chart can be removed, copied, or altered.  The ability to ensure the privacy of patients, employees, VIPs, etc., is virtually impossible.

For retrieval purposes, EMRs distinguish patient information electronically by the patient’s last name, first name, date of birth, SS #, insurance carriers, and many other possible identifiers.  These identifiers allow easy access to patient’s records.  These identifiers allow easy access to patient’s records by using selected criteria.  An electronic chart is never lost, out, or misfiled. It is always exactly where it should be, even if you aren’t. The patient’s record can be opened from any secure access point by any authorized personnel, in or away from the office.  EMRs keeps track of who accesses the chart, which sections were accessed, and what, if any information was viewed, added or deleted.  Security settings can determine who can access which charts, and which sections within each chart.

Paper charts typically contain demographic and insurance information, along with a list of medical problems, medications, and allergies. When this information is changed or information is added, the chart or a note about the changes has to be physically given to the billing or clinical offices for updating their records.  If the information is in the process of being passed from one department to another or if the information is lost before it is documented, the current patient information in the chart could be incorrect.

EMRs maintain this information, and share any updated information wherever it is needed. When updated insurance information is provided and entered by the front desk personnel, that information is electronically passed to the billing office 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 when changing medications or issuing refills or new prescriptions the patient’s electronic medication list is automatically updated.

A paper medical record contains office or progress notes, lab and radiology reports, referral letters, etc., in chronological order, under a tabbed section of the chart. These are located by flipping through section dividers, then by documents, until the desired document is located.

EMRs store progress notes, and provide quick and easy access by document type, date of visit, provider, and many other search criteria.  Most have the ability to browse by diagnosis, procedure codes, and prescriptions as well.  EMRs also store reports, such as scanned images, reports received via an HL7 interface, and even on-line lab information applications. Using common demographic and identifying information, access to specific lab results or other patient reports is crucial to ensure that the correct report goes into the correct patient’s record.

Progress notes in a traditional paper record might be produced by dictation, free handwriting, or form completion.  If dictation is used, generally that patient visit remains undocumented until the transcribed note is returned to the clinic, signed by the clinician, and then filed in the chart.  This procedure applies to other incoming documents.  A paper superbill must follow the patient throughout the office during the visit, and it is passed to each person that comes in contact with that patient.  The clinician provides the final coding and charge information for the superbill, and then it is sent with the patient to the check-out area.  The superbill is then sent to the billing department for manual entry, and the claims are generally submitted manually.

If the superbill is misplaced, the claim or billing for that encounter could be missed.  When charges are sent to the insurance company and the claim is denied or incorrect or insufficient information was submitted, the clinic is notified in writing and the billing department has to resolve these issues generally by mail, thus delaying payment to the clinic.  When insurance payments are received, they are generally in a form of payment that includes several patient payments lumped together.  All of these payments require manual posting to each patient’s account.

EMRs allow the creation of the progress note as the visit is documented, the coding information for that visit is generated during that process, the information is transferred to the billing module, the insurance claim is created, and the claims are electronically submitted to the clearing house or insurance company.  The billing office is notified of any issues electronically and can make the necessary adjustments or changes electronically.  When the payment comes back from the insurance company in a lump sum, the billing software applies the appropriate payments to each patient’s account.

When clinician’s order laboratory, radiology, or other tests, the only way to ensure that the report comes back to the office is to keep a paper copy of the order.  When results are received, someone has to manually look through the folder and match the report to the original order and then mark the ledger that the result is back.

EMRs allow orders to be created within the system, and the results are electronically matched to the original order when they are returned to the system.   A report can be run at any time to list the orders that have not been matched with any results, and this allows the appropriate person to find the results and to ensure they are received in a timely manner.

If medical or billing reports are needed, it is a very tedious process to manually search each patient’s chart or billing records, to obtain this information. EMRs allow users to create reports, with ease and efficiency, using data search criteria that will ensure the accuracy of the information needed.  These are just a few of the ways that an EMR can help simplify the daily tasks of your practice.  If you are interested in switching from paper charting to an EMR and billing system, please consider the SOAPware 2012 Pro EMR and Practice Management software as options.

First of all, what is the “cloud”?

The very term “cloud” lends its underlying phenomenon to being intangible, inexplicable, and extremely intimidating.  There are some variations in the explanations of “cloud-based”, but it is not impossible to describe in laymen’s terms.   The tenet that everyone seems to agree upon is that “cloud-based” describes a solution in which the user accesses software that is securely hosted on vendors’ servers, via the internet. This alone seems simple enough, but all sorts of questions arise when we apply it to the realm of EMR.

Is a “cloud-based” EMR solution preferable?

Ultimately, the answer to this question is up to you.  Because a cloud based system allows the client to utilize software on a vendor’s server, purchasing one’s own software and servers is no longer necessary.  Most EMR companies that offer a cloud solution charge a monthly fee. This may cut down on implementation cost, and allows a practice to “try out” an EMR with less risk.  However, over enough time, the cost of a monthly-billed EMR software service may equal or exceed that of buying the program outright.  Thus, if your practice already has the necessary hardware a “cloud” solution may not save you money in the long run.

A cloud solution may be preferable for those who travel frequently, or see patients at many sites because it is accessible over the internet.  Furthermore, using a cloud EMR solution may alleviate practices from dealing with HIPAA mandates regarding data safety and storage.  In the case of natural disasters and other catastrophic events, cloud hosted data may remain safe while an individual’s localized servers are damaged.  This is because cloud based solutions utilize what is known as a “fail over” system, with multiple servers.  If one server becomes damaged or non-functioning, your service is simply provided from a different one on the network.  Because your data is stored in multiple locations, the probability of its complete loss or damage is extremely low.  However, those who find that it difficult to trust someone else with their data may not see cloud based EMR as a more efficient alternative.

Somewhat ironically, the greatest threat to the viability of a cloud based system in your practice has nothing to do with more complex notions such as value or security.  Instead, it relies solely on your internet connection:  In a cloud based system, no internet equals no EMR.  If your internet service is the least bit questionable, a cloud-based EMR is definitely not for you.

That being said, if you do believe a cloud based system may best suit your practice, we hope you’ll consider SOAPware’s cloud solution.  SOAPware’s hosted EMR is competitively priced, highly customizable, and has endured the test of time with many satisfied clients.

For years, SOAPware has been creating learning tools for most learning styles. We have online manuals for all of our readers and self-starters, remote clinical and practice management training sessions and clinical training workshops for the classroom setting with individual interaction that encourages hands-on teaching methods and on-site trainings so you will not need to leave home, we will come to you!

On-site trainings have proven to be very effective, but it is the most costly of our training options. However, we get to see your clinic set-up, workflows, and your usage of SOAPware to offer our users suggestions, tips and helpful ideas to most utilize the features and functions within SOAPware that will most benefit the staff and patients.

Whether you are coming to SOAPware straight from paper charts or from another EHR, this type of transition can be frustrating and daunting if not approached with all things considered. Most changes or transitions in our lives make things feel a little upside down! Our SOAPware EMR Coach will guide you through this transition by helping you set a reasonable timeline for transition expectations. The SOAPware Learning Center (SLC) provides clinic staff members interactive learning videos before using live for patient care that can be done at their convenience.

We would like to encourage ‘You’ (no finger pointing), to get training early. In our experience, people are more receptive when not feeling under the gun and wanting to pull their hair out because the behaviors and functionalities of the software program have not been learned.

If ‘You’ would like to get training now (before the hair pulling), please contact us at clinicaltraining@soapware.com or 800.455.7627 Extension 5 to discuss what training option(s) would be the most beneficial for your needs. The following links will detail more information regarding the training options.

Remote Training Packages

• Hourly Sessions: http://www.soapware.com/training/  or 1.800.455.7627 Extension 2

*Note: All training sessions are given in 1 hour increments per day or can be split into 30 minute intervals.  Purchased training sessions will expire in 1 year.

Quick Start Learning Guide

• To Purchase the Quick Start Learning Guide  please call Sales at 1.800.455.7627 Extension 2

SOAPware Learning Center

• To Purchase licenses to the SOAPware learning Center please contact Sales at 1.800.455.7627 Extension 2

SOAPware 2012 Workshops

When it comes to selecting the right software for a given activity, there are several things to consider: hardware requirements, functionality, available support, and certainly the price! In general, for each type of software that costs money to license, there is a competing free product out there that can accomplish the same task. However, that doesn’t automatically make the free version the better choice.

Following are some things to keep in mind when choosing between a free piece of software and a paid one:

First, free software often takes more time and know-how to properly configure and use. For example, I’m currently configuring a phone server using a piece of software that requires quite a bit of front-end configuration and testing. This is a slightly daunting task and one that would largely be avoided if I’d purchased a software package. The benefits however, are worth it, as this software allows for total customization and flexibility. A similar paid software product often won’t have that.

Second, free software typically isn’t as feature rich. In the realm of word processors you might end up with fewer fonts or fewer formatting options as compared to Microsoft Word.

Finally, free software doesn’t always have available technical support. If something goes wrong when using Photoshop, you can always contact Adobe’s customer service reps and get your issue sorted out. If something goes afoul when editing using a free photo editor, you’re most likely going to have to start searching an online FAQ (Frequently Asked Questions) page or digging through a lengthy list of forum posts from other frustrated users. Sometimes the answer you’re looking for comes to the surface, but there’s certainly no guarantee.

I realize the above list of considerations makes it seem like I’m trying to champion the use of paid software, but that’s not my aim. Even though you’ll often get a more complete, better supported product if you pay for it, you don’t always need those things. If you simply need to rotate a photo you just downloaded, no need to purchase an expensive Photoshop license, a free editor will handle that superbly.

Just be realistic with what you’re trying to accomplish. Pay for the software if it’s the right thing for the job at hand, otherwise, there are several options available that will help your wallet sleep easier at night, metaphorically speaking of course.

How did SOAPware find you?

Sandra: You might guess there’d be a story behind this.  I moved to Arkansas in 1996.  Before that I had lived in Las Vegas for ten years, and part of my time there I spent teaching orchestras in the public schools.  So when I came here, I had a college degree.  But that was a Bachelor’s in Music Education.  I didn’t feel like a career in music education had much of a chance here, so I decided to go to grad school and work towards a Master’s degree in Computer Science at the U of A.  Some professors thought that was extremely odd, others felt like music and computers go together pretty well.  All in all I got more grief about being an alumnus of U of A’s one-time rival UNLV than my odd change in majors.

At the end of my first semester, my advisor happened to post a sign on his door about a local company looking for programmers.  I didn’t feel like I had much of a chance, but I gave it a shot, and the rest is history

What was SOAPware like when you were hired and what changes have you witnessed?

Sandra: When I was hired on with SOAPware, the company was basically three people.  I interviewed with our current Vice President of Research and Development, Greg Lose, met with current CFO, David Powell, and current President Randall Oates shortly after.  At the time, we were working out of an old house that the company was renting—my office was an entire room in the house.  Later on, as the company grew, there were three or four people working out of that same room.  Now, of course, we have this beautiful facility.  I think we are all very proud of that.  It’s amazing to see how many of us there are when we all get together, and to think where we were those years ago.  Things have changed, but SOAPware has always looked forward, and that’s stayed the same.

What has been your role in SOAPware over the years?

Sandra: When I first hired on, I was hired as a programmer.  But college programming courses did very little to prepare you for programming in Windows at the time—I knew the C++ programming language, but nothing at all about the Microsoft Foundation Classes or Active X technology or any of the other things a person needed to know to start working on SOAPware.  So while I studied those things, I took over tech support.  Previously Greg had handled all of the development and the support of SOAPware, so you can imagine how glad he was to finally start spreading out some of those roles!  Tech support was a fantastic way to quickly learn how SOAPware worked, (at the time we were shipping version 2.5, and it would be basically unrecognizable next to today’s amazing SOAPware 2012) and it also gave me an appreciation of the user’s view of the program that I maintain to this day.  Something that seems perfectly feasible to a programmer in a development environment can ruin a doctor’s entire workflow, and this is easy to forget.

SOAPwareXchange (then DOCSExchange) was my first project with SOAPware.  After that I started work on SOAPwareXchangeHL7, which would use this new-fangled HL7 standard that was just beginning to gain traction.  Over the years I’ve specialized in interface solutions, and along with core SOAPware development work I have developed lots of ways of getting information in and out of SOAPware, including the interface engines, data conversions, device integrations, and more.

In 1999 I found out I was pregnant with my first child.  SOAPware made me an offer I couldn’t refuse: why don’t you start working from home?  Telecommuting was pretty rare at that time, and certainly no one at SOAPware had done that before.  But I’ve been telecommuting since November 1999.

But with all the change that has happened at SOAPware over the years, our core focus has never changed: Make the doctor’s job easier.  Get the doctor’s information where it’s needed, as quickly and seamlessly as possible.  Let the doctor work with the patient, and let the computer handle the rest.

And with a focus like that, things can only get better.

What are some of your best memories here?

Sandra: Back years ago, when we worked in that old house, there was an enormous snooker table in the front room.  We used to all gather around that table in the afternoons to put together our demo packets, and pack up the orders.  Everything was printed in house back then, even our disk and CD labels.  The media was prepared on my computer, because at that time I had the only CD burner in the building.  We were still sending out multi-floppy-disk installation packages at that time.  I still have an original SOAPware 2.5 demo disk

I started working at SOAPware before I got married.  The entire staff of the company at that time came to my wedding.  That seems like a pretty unusual claim to be able to make, but I’m proud to be able to make it.  It’s been bittersweet watching the growth of the company—you know the changes are good, you know that we’re going great places, but you also know that it’s the passing of an era.  But the future is so bright ahead of us, it’s hard to spend too much time looking back.  The work we do here is enormously important, and I’m enormously proud to have been a part of the last fifteen years here.  Here’s to the next fifteen!