Aiden Spencer

Aiden Spencer is a health IT researcher and writer at CureMD who focuses on various engaging and informative topics related to the health IT industry. He loves to research and write about topics such as Affordable Care Act, electronic health records, revenue cycle management, privacy, and security of patient health data. You can get in touch with him on Twitter @AidenSpencer15

Healthcare professions are associated with honesty.

In the 16th annual Gallup Poll of most and least trusted professions, 

 nurses have high or very high honesty and ethical standards, ahead of military officers with 71%. Grade school teachers come third with 66% saying they are highly trustworthy. Medical doctors and pharmacists both scoring high with an excess of 60% saying they have high or very high honesty and ethical standards.

Compare this with business executives, the people that are largely behind those bureaucratic impediments. Only 16% of responders indicated they trust business executives.

You can’t purchase trust, and no matter how good a physician’s website, blog, advertising, and public relations, healthcare has earned the trust of the majority of Americans. And that speaks volume about how the profession conducts itself. Despite efforts a public press that looks for scandal and corruption and is happy to highlight physicians behaving badly, the public trust remains strong.

At the same time, it also means that patients have high expectations as to how healthcare professionals conduct themselves and their small or 

. They are prepared to give their trust in return for being open and honest with providers.

The fact that trust cannot be purchased also highlights an important truth that trust needs to be earned. To further this “trustworthiness” discussion, it is important that we examine the factor that establishes trust, how physicians are able to cater to it and further improve their status, and why nurses are better at it.

The first factor that not only facilitates trust but also garners trust—may it be any relationship, professional or personal&mdash;is communication. It is of paramount importance that there is effective communication. Which simply means that the intended message is received by the desired party and is understood exactly the way it was intended to be. Physicians have a lot at stake in this particular factor.

Physicians cater to numerous patients and have the challenge of explaining health issues to the patient and making him or her aware of resources will be involved. In all of this, what is important is to make sure that there is honesty involved. Nothing will damage that trusting relationship more than actions that the patient may perceive as taking advantage of him or her. 

Regrettably, this happens when there is lack of communicators or breakdowns in communications about their care or the financial aspects of their care. Physicians who don’t know what they are talking about or who are exploiting the patient’s resources don’t fare well. So, complete transparency in terms of communication with the patient is required to ensure a satisfactory level of trust.

Maintaining trust requires openness about patient financial responsibilities. The days of “not your responsibility” are over. This is known as fiduciary responsibility. This responsibility is not only concerned with administration duties but also an ethical point of view. At any given opportunity, money is 1 of the factors where the true capability of trust is measured. A provider would not want to make an impression that an increase in care is not for sincere reasons. Physicians need to give an apt solution that is affordable and does not create a perception that a particular patient is being manipulated for revenue maximization.

The information a physician communicates externally is only as good as the internal communication. The office needs to be trained to be upfront about patient costs. What plans is the office contracted with? What the patient’s copay and deductible responsibilities are? No patient should be surprised about their bill, like finding out that “accepting their insurance” actually means the office is not contracted, meaning the patient has no coverage. Know, as well, if there are any routine services that the office provides that are not covered by a patient’s plan, and make sure the patient knows about the cost, and the medical necessity before the service is provided.

In conclusion, while the medical profession has taken hits for the failings of the health system and its rising costs, physicians are still accorded a high level of trust. This speaks to the integrity of the individual physician in his or her relationship with patients.

Trust is a valuable commodity, and once lost, cannot be regained.

Articles

The fact that trust cannot be purchased highlights an important truth: trust needs to be earned. And healthcare professionals have earned it.

Trust&mdash;Doctor, You Have It

Last year brought one weather disaster after another. With 2017 in the past, it is best to take a bit of time and figure out how your medical practice is prepared should 2018 be the year a disaster hits your practice.

Are you ready to survive and quickly recover? Remember, the longer your practice is out of business, the greater the impact on your income and the income of your employees.

Does it cover what might occur? Flood insurance was thought unnecessary by many in New York City before Hurricane Sandy. Do you have such coverage? And what about income replacement? Many physicians have thought about their own ability to practice with disability coverage, but what if your office is closed due to fire, wind, or water? Do you want to add such coverage? At what level, and to provide for whom?

Also, it is a good idea to periodically make sure your property and causality insurance provides the coverage for your office, as equipped now. Some practices have not updated in years, and then, when disaster strikes, they find their coverage inadequate for the new equipment that has been added.

Whether destroyed, damaged, or just inaccessible, do you have a back-up plan to allow you to practice until you can rebuild or relocate? You might want to speak with colleagues and build a mutual aid pact, allowing each of you to share each other’s space on a temporary basis if one is dislocated. Better to draft an agreement now, before there is the stress that comes with a disaster. You may have to see patients in the evenings and on the weekends to accommodate the sharing, but better to get the income flowing than to be without any.

You might also have a meeting with your hospital to see if they would be willing to create a disaster plan that includes the temporary relocation of physician practices to buildings on the campus, and under its disaster plan for heat, lights, and power. It would be a solid benefit of hospital staff privileges to know that you have a place to practice following a disaster.

 or practice management system, you have your disaster program in place. You can access your data/medical records from anywhere, even a temporary space. If you have a server-based system, you need to make sure that it is physically secure to the extent you can. Get it out of the cellar and have a daily back up with offsite storage.

If there is any takeaway from these destructive storms, it is that those practices that have not embraced electronic record keeping, especially cloud-based storage, have suffered, at times, irreparable damage. The rest—from space to equipment&mdash;is easily replaced, but information&mdash;billing and medical information lost&mdash;can result in the end of your practice.

Periodically, you should be updating all the means of contacting your staff, phones, cell, and internet. And have that contact list with you, or in multiple places. You will need to be able to marshal your staff to help you overcome whatever has occurred, to let them know what is happening with the practice, and their employment. And, of course, let your patients know.

If you have a cloud-based system with your schedule and records, you can contact your patients if their care/appointments are impacted. If you’re still on paper, then when there is a storm warning, take a few days of your schedule printed out with patient contact information home with you and with your key staff.

In anticipation of an announced storm warning, you should not only stockpile what you need for your family, but also recognize that suppliers’ ability to distribute will likely be limited—stock up as needed for your practice. Depending on your location and situation, you may want to consider such preparedness as a generator for home and office. While some suppliers are good about exchanging spoiled vaccines, others are not. Keeping a refrigerator going may help avoid a loss. And it might not be a bad idea to check with your supplier as to their exchange policy such circumstances.

The rule of thumb is to have 6 months of after-tax income liquid as a personal contingency. For your practice, you might think in terms of a line of credit, set up and available, to be drawn upon. After a disaster is no time to start tying to put together an application for a loan. A line of credit is appropriate in good times, and bad. See your friendly banker.

That personal emergency fund may be needed to ease the disruption of your income while your practice regains its volume and billing/payments start flowing again. Now, remember while a disaster may strike, there is no guarantee that your payers will waive timely filing rules. Often times they do if an area is declared a disaster area, but if it is a personal disaster—a fire, for example&mdash;be sure to send certified correspondence to a payer to advise them of what has happened and ask them for an extension of the timely filing rules. Payers are likely to be understanding when advised before they receive bills that should be denied for lack of timely filing. And have a ready appeal if they are not responsive.

While no one wants to dwell on a disaster hitting them, some relatively easy preparation can make such an occurrence just a disruption and less of a disaster.

Disaster Planning for Your Office&mdash;Are You Ready?

	eClinicalWorks is due to pay $155 million to settle a claim alleging that the company violated the False Claims Act, as announced by the Department of Justice (DOJ) on May 31. Repercussions have been felt far and wide according to a Reaction Data survey conducted by Research Cloud. The scandal has raised red flags for the whole industry, with the government now exploring reexamination of the whole system amidst growing suspicion of other offenders.

The company was accused of withholding information, including the fact that its software was not conducive to the criteria specified for certain standardized drug codes. Electronic Health Record (EHR) vendors are required to meet conditions under the American Recovery and Reinvestment Act’s HITECH Act, which specifies certain criteria to allow for reimbursement according to the meaningful use program. 

The DOJ claimed that eClinicalWorks falsely

 obtained its certification by providing inaccurate information to its certifier.

The DOJ asserted that eClinicalWorks failed in several areas including:

		Opting to add 16 drug codes to its software rather than enabling access from a complete database

		Inability to accurately record user actions with audit log functionality

		Inaccurately recording diagnostic imaging orders and drug-drug interaction checks

		Failing to satisfy the requirements for data portability to allow doctors to transfer data to other EHR systems

eClinicalWorks has claimed that they settled the dispute to avoid litigation costs and are not prepared to accept that their customer program was unlawful. However, those that have heard about the dispute are now much more apprehensive when choosing an EHR provider.

The survey conducted by Research Cloud gathered information regarding providers’ awareness of the settlement, its impact on current eClinicalWorks customers, the likelihood of recommending eClinicalWorks to a peer or colleague before and after the settlement, as well as other factors.

The survey reveals that approximately 35% of healthcare professionals are now more suspicious of all 

 after learning about the scandal. This is a very unfortunate situation as the actions of a few are now negatively affecting the whole market. It also reveals that 41% of eClinicalWorks’ current customers were not aware of the scandal at all, with only 14% following the news regularly at that time. Non-customers were even more uninformed as 61% reportedly were unaware of the scandal; only 4% had been following it closely.

What did customers say regarding their future relationships with eClinicalWorks? 48% of customers said that they would reevaluate upon the completion of their contracts, and 22% said this occurrence did not affect their relationship. Only 15% claimed that they would be sticking with eClinicalWorks, 11% planned to switch to a new vendor once their contracts end, and 4% wanted to terminate their contracts early.

The survey found that 71% of non-customers said that they were unlikely to consider eClinicalWorks in the future, 27% had lost some level of confidence in their current EHR vendors. This is obviously bad news for the EHR industry, specifically for vendors who have gone to great lengths to build strong reputations and ensure favorable relationships with their clients.

This illustrates how important it is for EHR vendors to operate with integrity, transparency, and adhere to the highest ethical standards as contrary behavior affects the whole market.

eClinicalWorks is due to pay $155 million to settle a claim alleging that the company violated the False Claims Act, as announced by the Department of Justice on May 31.

eClinicalWorks EHR Scandal on the Rise

This article was co-written with Sarah Lisovich, a Chicago-based health information technology (IT) strategist at 

 with more than 20 years’ association with healthcare IT vendors and the effects of their systems on medical practices.

As technology becomes a standard tool in more professions, the resources used become more accessible, more protected, and allow the ability to more efficiently track progress and changes over time. That is why more health centers, including urgent care centers, are moving away from paper records and adapting to electronic medical records (EMRs).

What is the difference between EMRs and electronic health records (EHRs)?

While EHRs collect data information such as the patient’s medical history and allow other medical professionals to provide patient information, EMRs simply contain standard medical information that is gathered in a provider’s office.

More and more facilities are switching to EMRs for practicality. For instance, with an implemented EMR system, urgent care clinics are able to track data, progress, and issues over time for a better understanding of patient information. This information may include progress on blood pressure readings, vaccinations, and more. In addition, using an EMR will make scheduling appointments easier, as it includes the ability to identify when patients are due for checkups and screenings. More than anything, the point of bringing in EMR is for better productivity and better customer satisfaction.

Can your urgent care center benefit from implementing an EMR? Before splurging on the first EMR system you come across, it is important to know what to look out for to make the best decision for your urgent care center. Follow the 7 steps below for a smooth transition.

Understand where the data can be stored  

One of the main assets of using an EMR is to gather and share data. When choosing an 

, check whether or not you would have the ability to share data between systems.

Would the EMR system connect with your billing system or with a nearby hospital? Ensuring that this feature will be included may speed up processing for doctors, patients, as well as front office staff who may have to handle such data. With EMRs, once a patient has entered data into the system, the information can be matched up and does not need to be entered again.

Consider an EMR program with Application Service Provider Technology (ASP)

Using ASP can cut costs and time that may otherwise be spent on servers or tech support. Making sure this is an element of an EMR will help to secure data through the vendor, which will not only create an efficient system in your urgent care center, but will put doctors, workers, and most important patients at ease knowing that their files are safe.

In addition, ASP will ensure that your software is updated, so you don’t have to worry about falling behind. While some providers claim they offer ASP, not all actually do. Be sure to double check and understand the implications of what is offered and how to put it in motion before signing up.

Check how medication information can connect

Let’s be honest. We are all busy. It would be impossible for doctors to remember or keep track of all medications a patient is taking or has taken. Often, it is impossible (or at least difficult) for patients to come into the office every time they need a new prescription or a refill. With the right EMR program, these concerns are a thing of the past.

An EMR system should allow doctors to upload medication history and keep track of the medications that a patient is currently taking. If someone is taking more than one medication, this feature allows doctors to understand how the medications may interact before prescribing them, which is crucial to make certain of for 

. Following this step, an EMR system must have the ability to send electronic prescriptions to pharmacies so that patients do not need a paper slip to receive their medication.

As mentioned above, when selecting an EMR program, a fanciable feature is the ability to track appointments and make them when the patient sees fit. Some EMR solutions can alert patients via email, phone, or other means when an appointment needs to be made, which can save your urgent care center a load of time and keep the system running smoothly and quickly, and patients do not need to feel the pressure of making a follow up appointment directly after their appointment, but rather when they are ready, comfortable, and certain.

Knowing the provided features is not enough. Be sure you have a good understanding of the layout and the style of preloaded notes used in each specific EMR. The size and type of facility you provide may require a different set of preloaded data than another facility. Try to minimize the data preloaded into templates as not to overwhelm workers adjusting to the new system, but make certain that all aspects needed are provided for the most efficient turnaround.

EMR systems should come with support. In a case of assistance is needed, it is important to understand the support that is offered along with your EMR program. Have a good grasp on how to contact them, where they can be contacted, and when.

Along with considering support, check in with the team members who will be interacting with the EMR software. Getting a read on their comfort with the system implementation may help you pick a system that comes complete with the support needed to back your team up. In addition, some EMR systems offer training. If this is the case, find out how that training may take form. Make sure that room is cleared for this implementation, and whoever may need contact to the support has it.

Before signing up for everything and even before considering too many options, take inventory of where your urgent care center is and where you want it to be. While many vendors may sell the illusion of efficiency, look closely into their claims and make sure they are able to deliver. It is acceptable to ask a vendor for a list of references. They should be able to prove their worth before they gain your trust, time, and money.

Utilizing EMR software is a chance for your team to work more efficiently, and your patients to leave happier, healthier, and have less stress throughout the process of dealing with healthcare—an already stressful process. Understanding the possibilities of productivity that an EMR may provide, prioritize what it is that your urgent care center needs most, and make sure your team is prepared for the change. EMRs mean progress, and with the right EMR software, your urgent care center can end up on top.

As technology becomes a standard tool in more professions, the resources used become more accessible, more protected, and provide the ability to more efficiently track progress and changes over time.

Aiden Spencer

Articles

Trust—Doctor, You Have It

Disaster Planning for Your Office—Are You Ready?

eClinicalWorks EHR Scandal on the Rise

7 Steps for Selecting an Urgent Care EMR

Aiden Spencer

Articles

Trust&mdash;Doctor, You Have It

Disaster Planning for Your Office&mdash;Are You Ready?

eClinicalWorks EHR Scandal on the Rise

7 Steps for Selecting an Urgent Care EMR

Trust—Doctor, You Have It

Disaster Planning for Your Office—Are You Ready?