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Webinar Q&A As a follow up to our recent webinar, Key Strategies for EHR Success, Ron Sterling and Kareo have answered the many questions posed by participants.

Q: Will you provide the slides from this presentation? A: Yes, you should have received an email with the link to the recorded webinar and slides. If not, here are the links to the recording and slides. Q: Is there a way that I can get CEU credit? A: To apply for PAHCOM CEUs you have to register and attend the event with your name and email address. To request the CEUs, please email marketing@kareo.com. For more information about PAHCOM, visit their website. Q: One issue we face at my practice is finding the right EHR. Our organization is a child welfare organization that serves clients in the Mental Health Clinic, the Medical Clinic, Foster Care Billing and OMRDD-Residential Billing. We are trying to get a system that can be used across the board. What advice do you have for a company such as ours? A: Your organization obviously has complex needs that go beyond the scope of this event and document. I would strongly recommend looking for a consultant who can assist you in identify exactly what you need and who can help you evaluate software options that might work for those needs. You could also contact similar organizations to identify products that have been successfully as well as products that may not work as well in your particular situation. Q: Is there an export system to switch EHRs? A: Every EHR system and vendor is different and has a different process for conversion from one EHR to another. Conversion is one of the issues you have to consider when looking for a new vendor or software. The cost and amount of data that can be converted will be unique to your situation. Be especially careful to determine the specifics of the conversion effort before you sign any contracts. Note that it is the covered entity (your practice) that is responsible for the integrity of your patient records. For more about making a conversion, read this blog post. Q. What's the recommended time frame to sign the notes with EHR? A: I strongly recommend signing on off the notes as soon as possible. You can’t complete the visit and should not bill the payer until the notes are signed. In addition, delaying the signing of notes can call into question the integrity of the note and practice’s processes. Indeed, practices that do not establish signing standards and time requirements have frequently found themselves with notes that were never signed. Q: What do you think about the free EHR systems on the market today? A: The quality and usability of any EHR has less to do with the cost and more to do with features. Instead of looking at free versus fee-based, I recommend taking the time to identify the features you really need and then testing out products to find the one that works best for you. Kareo and I recently published a white paper to help small practices choose an EHR. You can download it for more information. Q: I am a Physical Therapist. It sounds like buying a PT centric system is secondary to a system with more open architecture that will adapt to the changing environment in healthcare.

Key Strategies for EHR

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A: All specialty healthcare providers are faced with some challenges in choosing an EHR. Many ask about whether to choose a specialty-specific EHR versus a more generic system. I can’t tell you what to choose without knowing more about your specific needs, but I would make the same recommendation as the previous question. Take the time to identify the features that are most important to you and then test out products and compare the usability and features. Choose the one that makes the most sense for your day-to-day practice and patient care needs. Q: Can you elaborate on what design considerations are in place to ensure simultaneous satisfaction not only for physicians but also for patients, administrators and regulators? Especially in terms of system usability and accountability. A: Usability is in the eye of the beholder and is a fairly subjective issue. Accountability is a requirement that is built into EHR products but requires proper use by practices to assure the integrity of the patient records. Usability varies from provider to provider. There are several different types of EHR systems and even more different presentation and navigation strategies that EHRs are built upon. In the final analysis, the providers should understand and be willing to adopt the way the EHR works and presents information. As a practical matter, the smaller practice does not have the time or resources to develop clinical content and setups to match a particular provider’s vision of how an EHR should work. Based on the provider’s research and analysis, the providers should be comfortable with the way the EHR product works and committed to its implementation. If the providers will use the system and the various features designed to address workflow and patient care, then the staff will be trained on the practice’s strategy and the entire practice will be tuned to support and take advantage of the EHR. Accountability depends on effective use of the EHR. If the providers are documenting patient issues and services in the prescribed EHR areas, and the staff is using the same prescribed features according to the practice’s workflow design, then you will have accurate patient records, and maintain the integrity of the patient experience. Similarly, if the patients are directed to using the patient portal to interact with the practice and they get a timely response, you will improve the patient experience and meet evolving care standards. Failure to protect the efficacy of EHR based patient information through standards of use, continuing training and vigilant end of day clinical processes will undermine your patient records and patient service, but not overall.

Q: How do you convince doctors to use the EHR effectively? A: I recommend looking at all the strategic reasons why an EHR is critical. Even if you aren’t that interested in pursuing Meaningful Use (MU) incentives, this program has an impact on you. In addition, the healthcare industry and environment are changing. For example, MU Stage 2 requires you to send some of your referrals electronically. If you can’t do that or you can’t receive electronic referrals from others, it may impact your referral business. While Stage 2 also requires you to communicate electronically with patients, it’s important to note that patients are already starting to expect this. There have been several surveys of patients that show unequivocally that patients want to access their medical record online and receive communications from physicians through the Internet. If you can’t meet these patient expectations and someone else can, you may lose that business. So using an EHR becomes a practical matter of meeting patient expectations, retaining and recruiting patients, and maintaining your referral network whether or not you are interested in Meaningful Use incentives and future penalties. Q: Please explain the Security Risk Analysis for Meaningful Use reimbursement. A: The Security Risk Analysis reviews the compliance of your practice with the HIPAA Security Rules. This Meaningful User Measure is actually required of all practices that store Protected Health Information in electronic form by the HIPAA Security Rules. The Security Risk Analysis measures the physical, technical, and administrative protection of Protected Health Information. Technical protection would include encryption of information and virus protection. Physical protection includes putting workstations in low traffic areas and locking up backup tapes. Administrative security includes having written HIPAA Security Policies, training staff, and appointing a qualified HIPAA Security Officer. If you do not do a proper Security Risk Analysis, you could lose your EHR incentives and be subject to a HIPAA Security penalty. Your Security Risk Analysis should be based on an assessment tool that is customized for your practice. For example, an assessment of a single office practice will be different than a multiple office practice. You may be

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able to get an “out of the box” assessment, but you should customize the assessment for your situation. Using the customized assessment, you identify the vulnerabilities and threats and make changes to address substantial problems. In the event of a significant change to your EHR, (i.e., new hardware, office move, new version of software, etc.) you may need to update the Security Risk Analysis. Of particular note for 2013, the HIPAA Omnibus rules must be implemented by September 23, 2013 and will affect your Security Risk Analysis. Therefore, you should implement the HIPAA Omnibus changes before you complete the Security Risk Analysis for 2013. For more on this topic, read this blog post. Q: What do physicians usually do when switching over from paper chart to the EHR? Do they scan the whole chart or just some of the chart? A: Each practice has to choose the conversion strategy that will work best for them. You can scan the whole chart and attach it to the electronic record, or you can just scan some key pieces of information such as immunization list, face sheet, surgical log). Either way, I recommend also entering some of the most important data into the electronic record so you can see it in the chart and don’t need to open the scanned document. One of the challenges if you opt not to scan the whole chart is that you may have to pull old charts down the road to look up information and maintain continuity of patient care. Q: What strategies do you recommend to minimize workflow impact in transitioning from a paper system to an EHR? A: I recommend planning, analysis, and design as much as possible in advance. This may be more or less complicated depending on your practice. Start with a workflow analysis before implementing an EHR, then look at how that workflow will change with an EHR, and finally prepare for those changes adequately. This might include some customization of templates and additional training for physicians to get comfortable with documenting a visit or doing test visits before actually documenting for real patients. Indeed, each aspect of your workflow needs to be evaluated and reviewed to determine the impact of immediate access to the patient chart on your practice and staff. Q: Why does a scanned record "not work well" in an EHR? A: When you scan a patient record, it is a saved document in the patient chart. So while you can open the scanned document and look back through it, you can’t see that data as part of the patient’s electronic record. For example, you won’t see their past problems, medications, or surgeries on the face sheet of the chart. If you enter some of the key data into the electronic record then you can quickly see it on the EHR’s face sheet and patient history. Even if you choose to scan the entire patient chart, I recommend entering key clinical information selected by your doctors such as allergies, medications, and recent problems or surgeries depending on your specialty. Q: Once all paper from the chart is scanned can that paper be destroyed? A: There are a few factors to consider here. If you scan the patient’s complete paper record, talk to your attorney and malpractice insurance carrier to verify the legal specifics in your state. As soon as allowed by state law, destroy the paper charts which have been replaced by the EHR as the designated medical record for your patients. Q: How do you scan test/lab results into a patient EHR? A: EHR solutions vary and the process of receiving test results is going to vary. There are generally two ways to receive results. One is to get them via fax (physical or electronic) and save the document in the EHR record. The other is through an interface where you receive the results electronically and they are saved directly as specific lab test results (i.e., CBC) into the EHR record. When it is a scanned document, the provider usually has to click on the document and open it to review the results. Whereas, when the results are received and saved directly in the EHR record, the provider can see the specific results in table form compared with similar tests in the patient’s EHR record. Most EHRs provide the option for a laboratory interface that allows you to do electronic lab ordering and receiving of results. Note that receiving lab results is a Meaningful Use Mean Measure in Stage 1 and required in Stage 2. Stage 2 of Meaningful Use also requires labs as part of the Computerized Physician Order Entry measure.

Q: What is the cross over compatibility of one EHR to another (ex Mac to PC)?

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A: The ability to move data from one EHR to another varies widely. The ability to use an EHR on a Mac versus a PC also depends on the software. Some solutions are optimized for use on any device or browser while others are not. You will have to ask this question specifically when investigating software. Q: What about reimbursements for Pay-for-Performance (P4P), (PQRS, Patient Centered Medical Home (PCMH)? A: There are a variety of payment mechanisms and arrangements which will all require some performance monitoring or justification to the plan sponsors. Indeed, PCMH requires an EHR to meet a number of requirements dealing with patient engagement and following up on patient care. The exact payment mechanism will vary. However, you need to use the EHR in an effective and appropriate matter to assure that you gather the information necessary to prove your compliance with the various patient service factors that could affect your payment. Q: I am a consultant. I work with small to mid-sized clinical practices. I also provide assistance with program evaluation regarding specific clinical services. What services do you provide to someone like me? A: Kareo provides everything you need to help you or your clients make their decision. On the website, Kareo provides a detailed overview of both Kareo Practice Management and Kareo EHR. This includes demonstration videos and the ability to sign up for a live demonstration. All plans and pricing are clearly laid out as well. In addition, in the Kareo Help Center, there are a wide range of videos for both solutions that show you, in detail, how to use the software. If you have additional questions, you can speak to a representative at any time via live chat or on the phone at 1-888-775-2736. Kareo also provides a wide range of educational tools designed to help small practices navigate the complexities of healthcare and run their businesses more efficiently. This resource center is a great tool for any small practice. Q: We are a Kareo customer but use Practice Fusion for our EHR. Would you suggest switching, and if so, why? A: While Kareo has a close interface with Practice Fusion, it is not an integrated system. The Kareo EHR is much more integrated with the Kareo Practice Management system. Both EHRs provide many of the tools and features that you need to manage the clinical side of your practice. However, if you would like a solution that is more closely tied together, using the Kareo suite makes more sense. For example, when you schedule patients in the Kareo EHR, they are also scheduled in Kareo Practice Management and vice versa. For a little more detail on the integration of the system, see this video. Q: How do I get faxes into Kareo EHR into the correct chart? A: Kareo EHR offers the ability to scan and upload a variety of types of documents. When you receive a fax, you can scan it and upload it to the patient record. It is very easy to assign the document to the patient chart by selecting the patient’s name. Q: Does Kareo EHR offer a patient communications center? A: Yes, Kareo offers an integrated patient portal as part of the Kareo EHR. The portal allows patients to view their problems, allergies, medications, lab results, and manage their accounts. For more detail on the patient portal, watch this how-to video.

Q: Does Kareo EHR prompt for the 90 day meaningful use measurements? A: Kareo is certified for Meaningful Use and provides the tools you need to attest for Stage 1. Kareo is in the process of preparing for certification for Stage 2, which begins in January 2014. The software does not remind you to start or stop your Meaningful Use reporting. The practice is solely responsible for running the Meaningful Use reports and submitting the data for the timeframe (90 days for year 1, stage 1 or 356 days for year 2, stage 1). For more on how Kareo helps you meet your Meaningful Use objectives, see this how-to video. Q: We run a Cardiac practice. Does Kareo EHR personalize for our practice? A: The Kareo EHR provides 100 clinical documentation templates for the most common primary care diagnoses. These templates can be customized and other templates can be created. To support this process, Kareo offers personalized coaching for template customization.

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Q: Does Kareo EHR/EMR address ICD-10? A: Like many vendors, Kareo is currently in the process of preparing for the rollover to ICD-10 that will take place in October 2014. The software will be ready for this transition.

Q: Does Kareo EHR have the same functions as other EMR's? A: While most EHRs offer the same basic capabilities (i.e., document an encounter, send electronic prescriptions, submit a lab test, create a task), they also all have unique capabilities. More importantly, each one has its own design and workflow. If you are trying to determine which software is right for you, download the Small Practice Guide to Selecting an EHR and use the comparison chart at the back to make sure each product offers all the basic features. Then, consider doing a test run of the software. Kareo allows you to sign up and actually use the software with no commitment or cost by logging in here. Q: Can the office staff type in the messages into Kareo EHR? A: The Kareo EHR offers a task management system that allows you enter tasks and assign them to users in the practice. The users receive a message to complete the task (i.e., a prescription refill). Q: Can we send referrals and pre/prior authorizations through Kareo EHR. A: This feature is not available in the Kareo EHR at this time, but it is planned for a future release. In the meantime, you can export patient summaries for transition of care and then print and fax those to the appropriate provider. Q: Is Kareo EHR compatible with Dragon Medical Dictation software? A: Yes, any speech to text software you have already purchased can be used with the Kareo EHR. You would use Dragon to dictate on the browser platform, but on the iPad, you would use the built-in voice recognition to dictate. Q. Do you have ophthalmology (retina) program? A: Kareo EHR doesn’t have an ophthalmology program. However, we partner with Modernizing Medicine (EMA), which does have an ophthalmology-specific EHR and integrates bi-directionally with the Kareo Practice Management system. You can find out more about the benefits of this solution here. Q: Is Kareo a one-time fee or is it a monthly fee? What are the expected fees and frequency for software updates? Can previous electronic records from SilkOne be transferred to Kareo? A: The Kareo EHR is completely free. There are no set-up or other fees. If you choose to use both Kareo Practice Management and the Kareo EHR, there is a monthly per-provider fee. There are still no set-up, installation, or training costs. All of those services are provided free of charge. The Kareo plans and pricing are clearly laid out on the website and begin at $149 per month per provider. Kareo does provide a demographic import option. You can import CCR files (patient demographics, meds list, allergies and problems) into Kareo one patient at a time. Currently there is no functionality to import these files in batch fashion.

Small Practice & Billing Company Resources Please visit Kareo Resources at www.kareo.com/resources for helpful tools, webinars, whitepapers, and tips for how to help small practices become best practices. You can also view recorded webinars or register for our next event at www.kareo.com/resources. About Kareo Kareo is committed to providing education and insights to small medical practices. We work with in-the-trenches influencers, consultants, and Kareo customers to provide relevant tips on how to successfully manage medical practices and medical billing services. Find out more at www.kareo.com.