ICANotes EHR EMR for Psychiatry and Mental Health

Normal ICANotes Security Settings

noreply@blogger.com (Sandy Crowley) — Mon, 12 Sep 2011 15:08:00 +0000

Anyone in a group can access a chart, look at the face of a chart, and go to a finished note and read it...just as would be possible with a paper chart in a filing cabinet.

Anyone can make a new note and electronically sign it.

Only assigned providers can go to a note made by somebody else and electronically sign it (i.e., co-sign it).

Anybody can assign themself to a case.

The Principal Provider is just a clinical title, suggesting who you might want to talk to about the care of this patient when notes have been made in the chart by a number of different clinicians.

Only a Supervisor (assigned in the Documents and Settings section of the program) can enter the work area of another clinician, make changes, and re-compile the note. The name at the bottom of the note will always be the person compiling the note.

New Features for Dietitians and Eating Disorders

noreply@blogger.com (Richard Morgenstern) — Mon, 25 Jul 2011 18:09:00 +0000

A number of enhancements have been made to ICANotes for use by dietitians and for those working with patients with eating disorders. They are as follows:

1. There is now a work area for dietitians. It can be reached from the chart face, center bottom, "Dietitian's Note".

This work area contains sections regarding the patient's current weight and BMI, the patient's current diet, and notes regarding the patient's meal behavior, response to the program, goals, and mental status.

The finished note is titled a Dietitian's Note on the Chart Face.

2. There are now sections of the program where the patient's intake of food, behavior during meals and fluid intake and output can be entered. It is anticipated that these factors will be entered by technical staff, rather than by nurses or dietitians, although any discipline can, of course, use these new work sections.

These new sections are entered from the Behavior buttons, which are both on the work areas Progress Note, Prescriber and Progress Note, Non Prescriber. Once in the Behavior sections (there are two, one for In Patients and one for out Patients), there is a section called "Dietary Intake" with a See List button. The See List is a shrub where information about the patient's behavior during meals, the amount and type of food and calories eaten, and fluid intake and output can be entered.

Your suggestions regarding refinement or enhancements to these new work areas are, of course, welcome. Also, if you have any questions about how to use these new features please feel free to contact us.

The ICANotes Team

866-847-3590

support@icanotes.com

Group Therapy Session Remarks

noreply@blogger.com (Richard Morgenstern) — Sun, 15 May 2011 21:53:00 +0000

There is new functionality in the Group Therapy section of the program.

In any Group Therapy session there is certain information that is the same for every group member's note.

For example, the type of group, the members present, and the therapists interventions should not have to be entered individually into each group members note.

Now, there is a way to create "Session Remarks" that can be added to each group member's note.

From the group therapy work area you can now push the "Session Remarks" button. That will now take you to a new work area where these session remarks can be created. You simple have to highlight the group for which the remarks are being created and then create the remarks by pushing, what else, the " add Session Remarks" button. A shrub will appear which will allow basic information about the group to be entered into the Session Remarks field. In addition to the shrub, user buttons are available and, of course, additional information can be free texted into the note. Then, on returning to the patient's group therapy work area the Session Remarks can be added to each patient's group therapy note with a single push of the "add Session Remarks" button.

The part of the program where session remarks are created can also be used to create new group and assign membership to the group. So, this area can also be reached using the Settings and Directories button on the face of one of the small filing cabinets. In Settings and Directories Shared by All Staff tab / Therapy Groups sub tab, new groups can be created and members assigned to those groups.

The ICANotes Team

Scales for Outcome Measurement in Psychiatry

noreply@blogger.com (Richard Morgenstern) — Wed, 11 May 2011 22:27:00 +0000

Recently we asked ICANotes users for suggestions for outcome measurements. .

Here is a list of the suggestions we received: (The comments we received are below)

Thank you all for these suggestions. We will look at all these scales and see if we can use them.

If there are other suggestions we welcome them. However, please keep in mind that it is not the test itself that will appear in ICANotes. Instead, there will be a way to enter the results of the test. To see how this works, please see the Psych. Testiing section of the program, reachable from PN1, second column.

Test results that are a number range (eg 1-5 = Mild Depression, 6-10 = Moderate Depression, etc) work best.

Here are the scales or tests that were suggested:

BSI-18
ORS and SRS
Beck Depression Inventory (Already in ICANotes under Psych Testing, PN 1, column 2)
Short Form, Conners Scale, Parent rated
YMRS
Likert Scale 1-5
GAF (a number of users suggested using this Axis V scale for outcome measurement and a number asked that it be
graphed.)
CGAS
PHQ-9 (Already in ICANotes under Psych Testing, PN 1, column 2)
GAD-7
ASRS
BPRS
Y-BOCS (Already in ICANotes under Psych Testing, PN 1, column 2)
Beck Anxiety Inventory (Already in ICANotes under Psych Testing, PN 1, column 2)
CGI
CDI
Vanderbilt
QOLI
MyOutcomes
Burns Depression Checklist
Burns Anxiety Inventory
Obsessive Compulsive Inventory
Penn Inventory of Scrupulosity
HBIPS-5

Here are the comments we received:

"A couple of outcome measures that I have used within the school setting are as follows:
When discussing appropriate eye contact, the student will demonstrate appropriate eye contact with other students are talking on 3 out of 4 occasions.
When discussing appropriate classroom behavior, the student will identify appropriate classroom behaviors during 3 out of 4 trials.
I'm not sure if this is what you are looking for, but here they are if you need them!
Nori C. Mora, Ed.D.

"Hello
In fact, we just purchased the Brief Symptom Inventory - 18 (BSI-18) from Pearson for this very reason. Although we have not yet used this in our clinic, questions asked cover all the key points that the insurance is asking for. The test is measurable and is nationally recognized. We would love to see something similar to this be incorporated into ICA Notes!!!
Sincerely
Katie Gillies
Administrator"

"the work of barry duncan and scott miller is compelling. (ORS-outcome rating scale, and SRS-session rating scale) duncan and miller used to collaborate but have gone their separate ways. here are sites for both:
http://heartandsoulofchange.com/measures/
http://www.scottdmiller.com/?q=node/57
here is a site that has incorporated these scales:
https://www.mentalhealthpros.com/video/login/login_tutorial.htm" (Paula Tanis)

"likert scale 1-5 how effective was today's session? Do you feel session decreased symptoms?" (Dr. Cuellar)

"Becks Depression Scale
Shortform Connors Scale Parent rated
YMRS Young Mania Rating scale" (Kimberly Cotton)

"No expert on outcome measures here, but from working in mental health for county agencies I understand the GAF is important.
If you could also give us a CGAS (Childrens Global Assessment Scale) in addition to the GAF you provide us that would be very helpful.
It might also help to graph out the GAF and CGAS over time, but I'm not sure.
Thank you!
Ann Childers MD"

"I would like to be be able to graph the PHQ-9, the GAD-7, The ASRS for ADHD, the BPRS, liebowitz social anxiety scale and the Y-BOCS scales as a starting point." (Dr. Berger)

"Are you referring to rating scales? I have found the PHQ-9 very quick to administer and effective. The GAD-7 is helpful as well.
Jeff Benzick MD"

"I would like to see the CGI scale.
Thanks,
Tina"

"Dear ICANotes Team:
Could you develop a system for tracking readmissions within 30 days of discharge." (Vista U/N: utilizationreview)

"Also, re: monitoring and outcomes, we are being told that one area being closely scrutinized by JCAHO as well as State Health and CMS is that of simultaneous use of two or more neuroleptic agents, particularly at discharge. This is an area we have started to monitor very closely. It's cumbersome to do manually. I'll forward the criteria when I get them from our P.I. person." (Norm Snyder)

"This is a very difficult problem in psychiatry, as there are not many measurable outcomes that correlate with quality of care. I spent 15 years on the Board of Mountain Pacific Quality Health, who are the Medicare Quality Improvement Organization for Hawaii, Montana, Wyoming, and Alaska, and we never could come up with much in the way of quality measures for psychiatry. Quality measures are easiest for chronic management of diseases such as diabetes and asthma with clear guidelines for tests and procedures that represent optimal care. Much of the outcomes in psychiatry are subjective and not easily measured. The national quality standards (HEDIS) use two measures - length of time patients started on antidepressants for newly diagnosed depression stay on their medications, based on pharmacy records, and whether or not patients hospitalized for depression are seen in outpatient follow-up within 30 days of discharge. On the first, the data are often bad, since patients may or may not take meds they pick up, many patients are given samples that don't show up on pharmacy claims, and for various reasons health plan data often show patients as "newly diagnosed depression" when they are actually long established patients, have mixed depression and other diagnoses, etc. On the second measure, patients hospitalized for depression are a very small part of most of our outpatient practices. These two "measures" therefore fail to accurately reflect quality for well over 90% of what we do. I don't know of anyone who has come up with better measures for psychiatry either.
This whole scheme to track "outcomes" and reward "quality" and implement "pay for performance" is unfortunately misguided and fails to take into account the fact that at least half of health care is too complex to allow meaningful measures of "quality" or "outcomes" via standardized tools. This is even more true for psychiatry than for many other specialties.
Steve Kemble"

"The PHQ (Patient Health Questionaire) has been a good measure for depression symptoms. There is a child/teen version.
The Vanderbilt is a good child assessment for ADHD symptoms.
The Child Depression Inventory (CDI) is also a good child rating for depression." (Lori Lowans-Wells)

"Here is an idea: build buttons into the assessment portion which would indicate improvement, e.g. for depressive dx, anxiety sx, psychotic sx, manic sx and GAF button.
Gather data from those buttons in some kind of printatlbe report, e.g. Jane Doe had depression which improved over a 6 month period, GAF went from 50 to 75. The buttons are the key to making it easy." (Dr. DeLisle)

"compliance with medication" (Dr. Trachtenberg)

"Beck's Depression Inventory (and Anxiety) are quick and simple to score measures." (Dr. Machado)

"For psyche I use the GAF on Axis V." (Arleta Brown)

"It would be great if the outcome measure could be specific to the pathology being addressed in treatment (e.g. BDI) rather than an all encompassing measure. Beck measures we have found to be particularly helpful." (Todd Bennett)

"QOLI (quality of life inventory) is a brief yet helpful scale that
would be easily built into the system" (Loren Malkasian)

"I don't have a good outcome measure, since the symptomatology is so
broad in my patient population. One thing I would love to see,
though, is the ability for the patient to rate their response
independent of our clinical session. Could they be on a separate
computer, enter into ICANotes somewhere and independently fill out the
survey/questionnaire. Then when I see them, I have the results for
our session and part of the clinical record longitudinally. This
would save time in session and increase the objective collection of
data versus rater biases (mine)
John R. Whipple, MD
Lawrence, KS"

"Your "outcome measure' idea interests me. I would be willing to offer
statistical consultation. Knowing what type of data is to be analyzed
will guide both development and refinement of the "measurement
instrument" you seek to create. For example, the data as input to the
clinical notes is nominal and not continuous in its scalar properties,
this must be considered in instrument development. Also,when designing
a measurement instrument it is critical to construct it so it has
statistical power, the latter "power" is a technical mathematical
question. Again, for example, depending on whether one uses nominal or
continuous data one must select the correct nonparametric or
parametric statistical tests, and the "power" is influenced by the
former selection. The consultation is offered gratis, although I do
not have the time to develop the "outcome measure(s)" themselves.
Notice that the plural "measures" was used, for it must also be
considered that the many different populations you serve may have
different types of data. Please keep me abreast of your development,
and good luck! it's a great idea if well thought out and properly
constructed." (John Vicedomini, PhD)

"I would love something that would graph data in the form of a line
graph." (Renee Terrasi)

"I utilize My Outcomes. Perhaps a link can be integrated into each
account so an assessment can be "opened" while one has a chart open.
See https://www.myoutcomes.com/
This service costs less then $125 / year for a solo practitioner. It
is convenient, helpful and VERY easy to use. Also evidence based.
Contact:
Lowell Kasden or Caitlin Carlson
MyOutcomes®
Danya International, Inc.
8737 Colesville Road, Suite 1100 | Silver Spring, MD 20910
Phone: 240-645-1584 Fax: (240) 645-0970
www.danya.com | www.myoutcomes.com
If you're interested in learning more, please tell Lowell or Caitlin
that I recommended you.
John" (John Duggan)

"At our practice, we regularly use the Burns Depression Checklist,
Burns Anxiety Inventory, Obsessive-Compulsive Inventory-Revised, and
the Penn Inventory of Scrupulosity as repeated measures. We would very
much like to be able to somehow have those score integrated into
ICANotes. I would be glad to send you copies of the checklists if you
want to view them.
Ted" (Ted Witzig)

"Yes, these would be very helpful. I tend to use the GAF scores as a
way to measure outcomes but if you all could convert these scores into
a graph form it would be much easier to show our patients there
improvement or lack thereof. Also, I have come up with depression,
anxiety, PTSD and ADD patient reported scales but I have found that
these are time consuming, paper intensive and they then have to be
scanned. I would love for you all to integrate these into your program
so that patients can complete these online or on a PC in our waiting
room. Good luck." (Emanuel Martinez, MD)

"From Liz:
I cannot say that this is either effective or easy to use but we are
under significant pressure to document to HBIPS- 5. This is affecting
all inpatient psychiatrists and the goal is to document on discharge
(only) any patient who leave with a prescription for more than one
Antipsychotic agent. The criteria for the psychiatrist to do this
legitimately are very rigid and not easily achieved. There must be
documentation in the medical record that this patient has failed three
separate trials of monotherapy before going to the use of two agents.
I have been fooling around with the program and trying to come up with
a work around that will be an accurate account of the patient's
history with neuroleptic medications and that is clearly visible to
the provider as the notes are being made each day. Falling back on
the med log works but only in a limited way. Right now I have turned
the Notes and Risk Factors pink box on PN 2 into my mini-medication
tracking for the sickest patients. I can add any neuroleptic drug to
the ongoing list and jot down the reason it failed and know that I
have a "live running record" that will always populate the future
progress note of these ill patients. Plus, by using this box ONLY for
HBIPS-5 documentation, at discharge I am reminded that the this
patient requires specific documentation inside the DC summary. The
pink box being next to the "turn this note into a DC summary" button
is great.
There are some flaws as expected in a work around. But, for some
odd reason, administration is having fits since I am not using the box
for the specific reason Ira labeled it for. Tracking this stuff is an
administrative nightmare and I would be glad to talk to anyone who
wants to take this on.
As for other outcomes, the HBIPS documentation has maybe 10 areas
that require documentation. I think some of those areas are specific
to pharmacy and maybe nursing.
You guys know me, never a short answer.
Thanks, Liz" (Liz Lobao)

"Two Links for HBIPS: 5. from Liz
Specific criteria for HBIPS-5
http://manual.jointcommission.org/releases/TJC2011A/MIF0120.html
Link below is the big, ugly picture.
http://manual.jointcommission.org/releases/TJC2011A/HospitalBasedInpatientPsychiatricServices.html
Ira, I have no idea if you are following this specific mess but the
practice period is over and the results will be posted quarterly on
the web. Citizens will look and see if a specific psychiatrist as
pass the quarterly inspection. The entire subject annoys me to no
end, it is way too government telling docs how to practice medicine.
Anyway, it this is not the type of feedback you were looking for, I
recommend the DELETE button..
Having a tracking device for HBIPS would be a strong selling point for
the inpatient crowd.
Liz :-)".

Step-By-Step Guide to ICANotes and Meaningful Use

noreply@blogger.com (Richard Morgenstern) — Sat, 26 Feb 2011 13:56:00 +0000

Which Buttons Do I Push?

A Step-by-Step Guide to Achieving Meaningful Use

(More detailed information about how to use ICANotes to achieve meaningful use is contained in the document "Meaningful Use and ICANotes" which is on our blog entry for February 1st

First, lets make a Complete Psychiatric Evaluation and make sure to use the features that help achieve Meaningful Use.

1. Demographics: Be sure to include the following demographics. They are all on the main demographic page:

Ethnicity, Race and Preferred Language

You need to record these demographic items for 80% of your patients.

2. Medical History: Tobacco Use: In the Medical History use the button "Health and Behavior" and the second Column button "Tobacco." Record the patient's smoking habits.

You need to record this information for 50% of patients who are 18 or older.

3. Medical History: Drug Allergy: In the Medical History section use the button "Adverse Drug Reaction" and record the patient's drug allergy history, even if negative.

You need to record this information for 80% of your patients.

4. Mental Status Exam: Vital Signs. In the MSE use the button "Constitutional/Vital Signs. Record, at minimum, the patient's blood pressure, height, and weight. The program will automatically calculate the BMI and these numbers are stored in the Log area, where they are also graphed.

You need to record this information for 50% of your patients.

5. Finish Initial: Problem List: The problem list is your diagnoses. So, make a diagnosis in the Finish Initial Screen.

You need to make a diagnosis for 80% of your patients.

6. Finish Initial: Active Medication List: Order a medication, or indicate "No Medication Ordered"

You need to enter something in the medication fields for 80% of your patients.

7. Finish Initial: Medication Reconciliation: You can access the Medication Reconciliation form from the Finish Initial screen.

You need to use the Medication Reconciliation form for 50% of your patients.

8. Finish Initial: Electronic Prescribing: To use electronic prescribing, you need to sign up for this service. If you are signed up there will be a button on the Finish Initial so you can access and use Electronic Prescribing.

You need to prescribe 40% of your prescriptions using Electronic prescribing.

9. Finish Initial: Patient Education Forms: When you compile your note you may be offered patient education information.

You need to print 10% on these forms and make them available to your patients.

10. Preview Page: Clinical Summary: On the preview screen push the button "Create Clinical Summary".

Clinical Summaries are used to meet a number of meaningful use measures.

You need to make a clinical summary electronically available within three days to 50% of patients who request them. You can indicate that the patient requested a summary and when it was sent electronically on the Preview screen.

You need to make a clinical summary electronically available within four days to 10% of your patients, whether they request them or not. The date the summary was sent to the patient should be recorded on the Preview screen.

You need to give a clinical summary to your patients for 50% of their office visits. This does not have to be electronically transmitted, so you can print the clinical summary for the patient and give it to them during their visit. Again, when the record was made available to the patient can be recorded on the Preview screen.

Now, lets make a Progress Note and make sure to use the features that will help achieve meaningful use.

In Progress Note Part One: Many of the features that were used in the Initial Assessment can also be used in Progress Note Part One. These include:

1. Medication Allergy: An adverse drug reaction can be documented using the Drug Reactions button on the top of column two.

2. Smoking Status: This can be recorded in the "Behavior" portion of the program.

3. Vital Signs: These can be recorded using the button, "Vital Signs" in column two.

4. Incorporate lab results: Enter lab results using the button, "Test Results" in column one.

In Progress Note Part Two: Here too many of the features that were used in the Initial Assessment can also be used in Progress Note Part two. These include:

1. Problem List: If you didn't make a diagnosis previously, you can make one here in PN 2.

2. Medication List: If you haven't already, you can order medications here in PN 2.

3. Incorporate Lab Results: Lab tests can be ordered from PN2, section 2, using the button, "Lab Requisitions".

4. Medication Reconciliation: The button to reach this section of the program is on PN 2, upper right.

5. Patient Summary Record for Referrals: Make a referral or request a consult using the "Referral" button on PN2, section 2.

6. E Prescription: As noted in the Initial Evaluation section above, to use electronic prescribing, you need to sign up for this service. If you are signed up there will be a button on the PN2 so you can access and use Electronic Prescribing.

7. Clinical Summaries: A Clinical Summary can be made by using the button, "Compile this Note" at the bottom right of PN2 and then, on the Preview Screen, using the button, "Create Clinical Summary".

Again, the Clinical Summary is used to meet a number of Meaningful Use measures, as follows:

Chart Face: Patient Reminders: Patient Reminders: To create a patient reminder, use the "Set or See Reminder" button on the chart face. Use the "New" button to set a reminder and indicate that it is a patient reminder. Set the date of the reminder, who it is to be sent to and why.

Once the reminder to the patient has been made, the ICANotes program must be informed. Do that by returning to "Set or See Reminder", opening the reminder in question by clicking on it, and indicating in the appropriate fields that the reminder was done and

Meaningful Use and ICANotes

noreply@blogger.com (Richard Morgenstern) — Fri, 18 Feb 2011 14:55:00 +0000

How to Achieve Meaningful Use

With ICANotes

As you make your notes using ICANotes, there are 16 measures that will be automatically calculated to determine if you are using electronic health records in a meaningful way. To get your incentive payments you will have to attest that you have met these measures.

In the ICANotes Reports menu please view the Meaningful Use report as you read this document.

In this document I will explain to you what you have to do to meet the Meaningful Use criteria. Many items are very easy to achieve by just doing what you normally do or by doing what is good practice.

1. Up To Date Problem List: The "Problem List" is the diagnoses you make for the patient. It’s as simple as that. When you do an initial evaluation and arrive at one or more diagnoses in the Finish Initial section for at least 80% of your patients, you have achieved this meaningful use measure.

2. Active Medication List: This measure is also very simple. Either order medication for your patient or indicate "No Medication ordered". If you take either of these steps for 80% of your patients, you will achieve this measure.

3. Active Medication Allergy List: Do you ask your patients if they have a history of Adverse Drug Reactions, or if they are "allergic" to any medications? Very likely you do. Their answer can be recorded in two places.

a. Initial or Complete Examination: Medical History. Use the shrub button "Adverse Drug Reactions."

b. Progress Note: Use the button at the top of column two, "Drug Reactions."

In either case, indicating what the adverse drug reaction is or indicating that there is no such history for 80% of your patients will achieve this measure.

4. Record Demographics: This measure is also very easy to achieve. When a new chart is begun and demographics are entered just be sure to include the following for 80% of your patients: ethnicity, race, and preferred language. That's all there is to it.

5. Patient Specific Education: This is new. When you make certain diagnoses for your patient, order certain medications, or record certain test results, you will automatically be offered the ability to print out a sheet providing educational resources for the patient. By simply printing those sheets for just 10% of your patients, you will achieve this meaningful use measure. The sheets contain links to web sites that we feel contain correct and useful information.

6. CPOE: Computerized Physician Order Entry is what this acronym stands for. This measure is to ensure that you can use your EHR to order whatever medications, lab tests, and imaging the patient needs. This measure is only concerned with the ordering of medications, so it is essentially the same as #2 above. Either order medication for your patient or indicate "No Medication ordered" and you will easily meet the 30% requirement of this measure.

7. Vitals, BMI, and Growth Chart: This may not be something you have been routinely doing. To meet this measure you are simply asked to record the Blood Pressure, Height, and Weight for 50% of your patients. ICANotes will automatically calculate the BMI and in the Patient Logs will create graphs of these vital signs if you wish to see them. That's all there is to this measure.

8. Record Smoking Status: Do you routinely ask and record your patient's smoking status? It can be recorded in the Medical History using the shrub buttons "Health and Behavior" and "Tobacco." While making a progress note, it can be recorded in the "Behavior" section. If you record the smoking status of 50% of patients 18 or older you will meet this meaningful use measure.

9. Incorporate Lab Results: This measure is to determine that the tests (chemistries, imaging etc) you order with ICANotes have their results recorded in ICANotes. To order tests use the "Lab Requisition" button on PN2, section 2. To enter test results, use the "Test Results" button on PN1, column 1. If 40% of the tests you order have their results recorded, you will meet this measure.

How to Make a Clinical Summary: The ability to make a clinical summary of your patients' conditions is an important and useful new feature in ICANotes. The summary contains information about your patients’ diagnoses, medications, drug allergies, recent test results, and medical conditions.

A number of meaningful use measures start by making a Clinical Summary. Here's how to do it. After you compile a note push the button called, "Create Clinical Summary" on the Preview Screen. That's it.

If you wish to have the summary included as part of your chart, then push the button "Compile This Note." We'll explain below when to push the button, "Compile This Note and Create a CCR."

This Clinical Summary can be sent to other providers when you request a consult or it can be put into a medical repository like Microsoft's HealthVault where it can, with the correct password, be accessed by other health professionals or by the patient. Giving the patient access to their Clinical Summary has proven to be good practice. Making this basic information available to other medical practitioners improves quality of care and helps avoid testing duplication.

How to Create an Account with Microsoft's HealthVault: In order to electronically share Clinical Summaries with your patient, both you and your patient should go to the HealthVault web site and create accounts for yourselves. It’s easy to do. Go to http://www.healthvault.com/personal/index.aspx?WT.mc_id=M10011215&WT.ad=text::healthvault.com::GoogSrch::HvPHp::Goo&WT.srch=1&WT.seg_1=HealthVault%20com&rmproc=true and push the button "Create a Free Account."

Important: When your patients create an account they need to add you to the account. Alert your patient that during the sign up process they need to do the following: When they arrive at their HealthVault Home page they should push the "Sharing" tab. Then, push the "Share with Someone You Trust" button. The patient should enter you as a person they trust and must include your email address. When asked to select your sharing level, they should indicate "Custodian". This will give you full access to their account, including the ability to upload documents into the patient's HealthVault.

10. Electronic Copy of Patient Health Information: This measure concerns itself with how quickly patients who request a copy of their Clinical Summary receive it electronically. You get credit for this measure if 50% of the patients who request a clinical summary have electronic access to it within 3 days.

Here's how to make a Clinical Summary electronically available to a patient: Make a Clinical Summary, as described above, and push the button, "Compile This Note and Create a CCR." CCR stands for Continuity of Care Record. It is your Clinical Summary in a standard format that can be electronically sent to HealthVault, other medical storage sites, or any location that has software set to receive and display it.

When you push the button "Compile This Note and Create a CCR", it puts a copy of your clinical summary, in CCR format, into the documents section of the patient's chart and into the patient's section of the upload site.

You will make a copy of the patient's Clinical Summary available to the patient by downloading it from the Upload site and then uploading it to the patient's HealthVault account

To download the CCR from the upload site, go to the patients chart on the upload site (Mozilla Firefox works best), identify the CCR, right-click on its image, and choose "Save File." It will download to your Downloads folder (or, if you prefer, to your desktop.)

Then, sign in to your HealthVault account and switch to your patient's account (you have been made a Custodian of that account (see above), so the patient's name will appear in your HealthVault home page. Once you are in the patient's account, click on "Add, View, or Edit Information." Indicate that you want to add a CCR document to the account, locate the CCR on your desktop, and upload it. That's it. The patient's CCR document is now the latest entry in his or her HealthVault account.

There is one more thing to do. You need to let the ICANotes program know that a summary has been posted in the patient's HealthVault account. Please go to the Preview screen for the patient's note. On the right border, you will see a check box for "Patient Requests a Summary" and "Date Summary Sent to Patient." Check the box and select a date. The program now has all the information it needs to correctly calculate this measure for you.

11. Medication Reconciliation: A medication reconciliation is simply the process of listing the medications the patient is taking at the time of your initial evaluation, deciding whether those medications will be continued, stopped or have their dosage altered, writing additional orders now that the patient is under your care, and arriving at a combined list of the medications you have continued and the new orders you have written.

ICANotes makes this process easy. First, create your medication orders as usual. Then, on PN2 upper-right or Finish Initial upper-right, there are buttons labeled "Medication Reconciliation". Use the Medication Reconciliation form to enter the medications, both OTC and prescribed, that the patient was taking prior to coming under your care. Indicate if you wish to continue, stop, or change the dosage of those medications. Then, push the button "Click Here to Reconcile the Two Lists." The resulting medication list, on both the Reconciliation form and on your clinical note will be the combined list of all medications being continued or newly ordered.

To achieve meaningful use, 50% of your patients should have their medications reconciled using the Reconciliation Form.

12. Patient Summary Record for Referrals: This measure asks a simple question: when you make a referral to another clinician do you send a Clinical Summary?

First, fill out a Referral form. The "Referral" button is on PN2, section 2. After filling out the Referral Form, make a Clinical Summary and include it with your referral form or make it available to the consultant, however you wish. Then, let the program know that the Clinical Summary was provided to the consultant by selecting a date in the "Date Summary Sent to Provider" field on the right margin of the Preview screen. That's it. Do this for 50% of your referrals and you will receive meaningful use credit for this measure.

13. Timely Access: This measure also involves making a Clinical Summary electronically available to your patient by posting it on his or her HealthVault account. Unlike #10 above, it doesn't matter if the patient has requested a Clinical Summary; all this measure requires is for at least 10% of your patients to have had Clinical Summaries posted within four days of your evaluation.

Directions for creating HealthVault accounts and how to post a clinical summary are above.

Please note that the summaries you post at a patient's request in #10 do count for this measure. Also, please note that no matter how many times you see a patient, if you just post a summary once, you will get credit for that patient toward your 10% requirement.

Once the Clinical Summary has been posted on the HealthVault account, you must fill out the "Date Summary Sent to Patient" field on the Preview screen so that the ICANotes program can calculate this measure for you (Please note that ICANotes is working on a simpler way to make Clinical Summaries electronically available to your patients. We will let you know when this new feature becomes available.)

14. Generate and Transmit E-Rx: Meaningful use requires that you use an e- prescription system and that 40% of your prescriptions be e-prescribed. If you use one of the e-Rx companies that ICANotes is integrated, with this measure will be automatically calculated for you, and meeting this measure will be easy.

15. Clinical Summaries: This measure again involves making a Clinical Summary available to your patients. This measure requires that a Clinical Summary be made available for 50% of every out-patient clinical contact, within four days. However, this summary does not require that the Clinical Summary be made available to your patient electronically. So, if you will simply print a Clinical Summary and give it to your patient (perhaps on their way out, or mail or fax it to them) within four days of the contact, you will meet this measure.

Please note: you need to let the program know when the Summary was given to the patient. You can do that by indicating the date in the "Date Summary Sent to Patient" field on the Preview screen.

16. Patient Reminders: This measure is odd because it only applies to patients who are younger than 5 or older than 65. In any case, it asks that you provide "appropriate" reminders to 20% of those patients.

To create a patient reminder, use the "Set or See Reminder" button on the chart face. Use the "New" button to set a reminder and indicate that it is a patient reminder. Set the date of the reminder, who it is to be sent to and why.

For example, you might send a reminder in one week to an office staff person to remind Mr. Jones (who is 65+) to get a lithium level. The office staff person would use the patient's preferred means of communication (set in Demographics) to remind Mr. Jones.

New Features: Calender and Demographics

noreply@blogger.com (Richard Morgenstern) — Tue, 21 Dec 2010 01:01:00 +0000

New Calender Features:

1. It is now possible to make a short note that will appear when an appointment is made for a patient. The note appears in the Event Details window, where you ordinarily pick the type of appointment, length of appointment, etc. Messages such as, "Balance overdue. Discuss w. patient before making an appointment" explains the utility of this feature.

This message may be added by entering the Patient Demographic section, Patient Info tab., bottom left, "Calender Note." What you enter there will appear whenever an appointment is being made for the patient.

Unfortunately, this new feature does not work for Groups.

2. An Appointment reminder can now be printed for the patient. It contains the date and time of the appointment, the clinicians name, and the appointment's location. The "Print Reminder" button on the Event Details window in the scheduler will perform this function.

New Patient Demographic Field

In Patient Demographics, Other Contacts tab there is a new field "Patient Prefers Confidential Communication via"; It is a drop down. This will be used on the upcoming Patient Reminder Lists required for certification and will indicate how the patient wishes to be informed of confidential medical information. It will automatically be included in Patient Reminder Lists.

Smoking Status and Cessation Counseling:

noreply@blogger.com (Richard Morgenstern) — Sat, 18 Dec 2010 19:18:00 +0000

One of the requirements for ICANotes to become a certied EHR is that it address the issue of tobacco use.

The first requirement is that the Patient's smoking status be determined. That can be done during an Initial or Complete exam in the Medical History using the shrub button "Health and Behavior" and then the secondary Shrub Button, "Tobacco." Note that the third column buttons that are then revealed allow you to both record the patient's tobacco use or history and indicate if any cessation counseling has been done at that time.

In Progress Notes the patient's smoking status can be indicated using a new section in the Behavior part of the program, accessible from the Behavior button on the lower part of column 1 in Progress Note Part 1.

During Progress Note creation, cessation counseling efforts can be documented using a new section of the Psychotherapy, Patient Focused on... layout. It can be accessed using the Psychotherapy button in Progress Note Part 1, near the top of column 2. Then, continue to "Today Patient Focused on..."

What percentage of your patient's that were queried about tobacco use and what percentage of those that were using were counseled regarding cessation are numbers that will help you achieve meaningful use. If you want to know these percentages the ICANotes program will calculate them for you. In the reports menu select Clinical Quality Measures. On that page select the third item to calculate tobacco use assessment and tobacco cessation interventions.

The ICANotes Team

Certification Update

noreply@blogger.com (Richard Morgenstern) — Sat, 18 Dec 2010 18:24:00 +0000

The dates that ICANotes will be tested for Certification have been moved to February 8 and 11, 2011. This move was requested because of our decision to seek certification for both ambulatory settings and hospitals. Since the incentive payments only require 90 consecutive days of use during 2012 there is still ample time for all qualified clinicians to demonstrate meaningful use in 2011 and begin to receive their first year incentive payments.

Please remember: at present only clinicians who prescribe and are enrolled in the Medicare or Medicaid programs are eligible for the incentive payments.

Clinicians seeking incentive payments will have to attest that they are using a Certified EHR and that they are performing certain functions on a certain percentage of their patients. For example, that "My practice enters patient demographics (including date of birth, preferred language, ethnicity, and gender) for at least 50% of my patient population."

ICANotes will be able to create reports indicating exactly what the percentage of use is for the various criteria, to help you determine your meaningful use.

After ICANotes is certified we will begin providing information and support regarding how to meet meaningful use criteria for those clinicians who qualify for the incentive payments.

Assigned Providers, Group Administrators, Note Owners, and Supervisors: What can they do?

noreply@blogger.com (Richard Morgenstern) — Tue, 02 Nov 2010 17:40:00 +0000

What can an Assigned Provider do? (Assigned Providers are set in the Demographic Section when the chart is first created)

A. Under Default Chart Security: (Where everyone in the group can see a chart and its finished notes and can make a new note)

   1. Set Extra Privacy (password protection) for a chart
   2. Access the pw protected chart without entering the password
   3. Assign other group members as Assigned Providers

B. Under Complete Chart Security: (Where charts cannot be seen by everybody)

   1. Can see a chart and its finished notes
   2. Can make a note

3. See items in A above

What can a Group Administrator do? (Group Administrators are set by ICANotes)

   1. Can access a password protected chart without entering a password, in case of emergency
   2. Can see any chart, under Complete Chart Security

What can a Note Owner do? (Owner is automatically set when a new note is made)

   1. Go to the work area of a note and work there

2. SIgn a note

What can a Supervisor do? (Supervisors are set by Group Administrators in the Setting/Directories section of the chart)

1. Go to and work in the work area of a note that is owned by the person being supervised.

2. SIgn a note that is owned by the person being supervised.

New ICANotes Features: Nov. 1, 2010

noreply@blogger.com (Richard Morgenstern) — Sun, 31 Oct 2010 18:39:00 +0000

1. AIMS Monitor Modifications:

The AIMS section can now be accessed using buttons on the PN2 or Finish Initial Screens. When AIMS monitoring is set the face of the button will show when the next AIMS is due

The AIMS scale is by default set to normal or, if this is repeat AIMS, to the last AIMS findings.

Once the latest AIMS is completed it can be printed and/or copied into the latest progress note, in the MSE section.

You can be reminded when to do the next AIMS or set a repeat reminder. The next AIMS can be set manually or you can go to the Reminder section of the program, which will be set to remind you to do an AIMS. All you have to do is set the next date and the subsequent interval. The reminder will be sent to your internal messaging in-box.

2. Vital Signs Graphing: Vital signs in the Vital Signs Log, can now be graphed. Height and weight are graphed against a background of normal graphs for children and adolescents.

New Features as of 10-20-10

noreply@blogger.com (Richard Morgenstern) — Wed, 20 Oct 2010 02:19:00 +0000

New Features in ICANotes:

As ICANotes prepare for certification, development is occurring rapidly, and you may be noticing new features. Here are some of them:

Diagnoses may now be categorized as Active, Inactive, Chronic or Resolved. Explanations of what these categories mean are contained in the ? above the column. Note that a Resolved problem is a cured problem and that problem will not be carried forward to subsequent notes.
There have been a number of changes to our Logs. First of all, more items are being logged. Diagnoses are now being logged, and the diagnoses log can be screened so that you can, for example, see just the active diagnoses. Test results and reports of adverse drug reactions are also being logged.
AIMS results are also being logged. In addition, when the AIMS is complete it will be copied into the MSE. Also, if you wish you can go right from the completed AIMS to the Reminder Screen where it can be set to remind you when to do subsequent AIMS.
The Reminder Screen has been enhanced so that you can now set recurrent reminders. For example, you can set Reminder to do an AIMS every three months until a certain date.
On the Preview Screen, after compiling your note, there is a new button called “Create a Clinical Summary.” The Clinical Summary contains the patient's latest diagnoses, medication orders, allergies and adverse drug reactions, and most recent lab results. This summary can be printed and given to the patient or (soon) sent to another clinician or sent to a medical repository like Google Health or Microsoft HealthVault. There, it can be accessed in an emergency or at any time by the patient.
If you order Clozaril you will see a new category of message. This message does not alert you to a potential adverse drug reaction or a dangerous interaction. Instead, it provides clinical information about how to monitor patients receiving Clozaril.

Other imminent changes include the logging and graphing of vital signs.

The ICANotes Team

Initial Psychiatric Exam: What You Need to Achieve a Higher Code

noreply@blogger.com (Richard Morgenstern) — Sat, 09 Oct 2010 20:28:00 +0000

When doing an Initial Psychiatric Examination in a hospital setting, there are three possible E/M codes: 99221, 99222 and 99223.

In order to achieve the higher codes, 99222 and 99223, three conditions have to be met.

The first is that you have to do a Comprehensive History

In order to do a Comprehensive History, you must do, among other things, a symptom review in at least two other systems (besides the psychiatry system.) ICANotes makes it easy to do a symptom review in the Constitutional and Musculoskeletal systems. Then, if all the other systems (cardiovascular, pulmonary etc) are normal, a simple statement that "All other systems are normal" will suffice for the other systems. If all the other systems are not normal you can go to the Detailed ROS, record the abnormal history findings, and then use the "All other systems normal" button.

The second condition is that you have to do a Comprehensive Exam.

To do a Comprehensive Exam you must record at least 4 mental status elements (eg: mood, affect etc). In addition, you must do an exam in two other systems. ICANotes makes it easy for you to do a Constitutional Exam and a Musculoskeletal Exam. You may, if you wish, examine and record your exam findings in other systems by using the Physical Exam button on the MSE screen.

The third condition is that you have indicated that the complexity of the case or the level of complexity of medical decision making is at least moderate or high. Typically, this is warrented if the patient is in a hospital. Complexity can be set using a button on the HPI screen. Definitions of what is meant by moderate or high complexity are found on the Show Me Coding screen.

If your History and your Exam are Comprehensive and your Complexity is moderate, you will code a 99222. If your complexity is high, a 99223.

Is this complicated? Yes, but don't blame ICANotes! We are just following CMS rules. And CMs rules when it comes to E/M coding.

Ira

New Drug Allergy Functionality

noreply@blogger.com (Richard Morgenstern) — Tue, 07 Sep 2010 14:10:00 +0000

As part of current development to meet Certification standards the following improvements in Drug Allergy reporting have been developed:

1. When making an Initial Evaluation, in Medical History, when the Adverse Drug Reactions shrub button is pushed it opens a new layout where drug allergies and adverse reactions can be entered. This information is entered in the Medical History portion of the note and also entered into a new Adverse Drug Reaction Log. When the note is compiled the information is written to the Adverse Drug Reaction field on the front of the chart.

2. When making a progress note there is now a Drug Reactions button on PN1, right column. This takes you to the new Adverse Drug Reaction layout where a new adverse drug reaction can be entered or an existing drug reaction can be made "Inactive" (when, for example, the patient made a mistake when reporting an adverse drug reaction.) When an existing Adverse Drug Reaction is made "Inactive" an explanation is required.

The new adverse drug reaction information is included in the History portion of the note and also entered into a new Adverse Drug Reaction Log, and when the note is compiled the Adverse Drug Reaction field on the front of the chart will be updated.

3. Please note: The Adverse Drug Reaction field on the front of the chart is a list of current, known adverse drug reactions. The new Adverse Drug Reaction Log is a history and chronology of all recorded Adverse Drug Reaction entries, including changes of status from active to inactive. The first time you go to the new Adverse Drug Reaction screen you will be shown the current contents of the old Adverse Drug Reaction field on the front of the chart. Be sure to record any existing ADRs in the new system so they will not be lost when the field on the chart face is updated.

New ICANotes Chart and Note Security

noreply@blogger.com (Richard Morgenstern) — Mon, 16 Aug 2010 18:00:00 +0000

ICANotes Chart and Note Security:  

Chart Security:

Background: In a typical group practice all staff members, both clinical and non clinical, have access to patient's charts and can read the notes in the chart and make new notes. This is necessary and desirable when there are multiple clinicians treating the patient, when clinicians cover for one another, and when non-clinical staff must leave messages in the chart, print notes, record prescriptions called-in, etc.
In ICANotes this is Default Chart Security. (see below)

In some group practices where, for example, independent practitioners share some office and administrative functions but otherwise maintain private or separate practices, it is often desired that the entire chart be inaccessible except to clinicians who are assigned to that case.
In ICANotes this is Complete Chart Security. (see below)

Default Chart Security is the security automatically set in ICANotes. It means that everybody with an ICANotes username and password can go to the Chart Room and then go to the face of a patient's chart. They can go to the finished note and print it. They can go to the demographic section and make changes or add information. They can make a new clinical note or non-clinical note, such as a message.

Extra Privacy: An extra security setting called Extra Privacy can be created for certain charts by an Assigned Provider. This setting creates a password that is required when a non Assigned Provider attempts to access the chart. Assigned Providers will not be asked for this password.

Extra Privacy might, for example, be used when the patient is a celebrity or a public figure or any time a stricter level of confidentiality is desired.

Extra Privacy can be set in the Demographics section of the patient chart.

Please note: The Group Administrator has the ability to access a password protected chart without entering the password. This is a safeguard in case the clinician in custody of the password is not available and there is an emergency which requires that the password protected chart be accessed.

Under Default Chart Security the only reason to assign providers to the case is to allow access under Extra Privacy. Staff can be made Assigned Providers in the demographics section of the chart at the bottom under the heading "Assigned Providers." Staff can also be assigned to a case by the Group Administrator from the Settings and Directories section of the program, Caseload tab.

Complete Chart Security: With this security setting in place only certain members of the group can access certain charts. Of course, if individuals cannot access a chart then they cannot print any notes in that chart, cannot make changes in the demographics section, and cannot make a clinical note or a message to leave in the chart. If a staff member does not have the privilege to see a chart they will also not be able to view or print finished notes from a report.

Under Complete Chart Security the privilege to access a chart is limited (with one exception) to Assigned Providers. Staff can be made Assigned Providers in the demographics section of the chart at the bottom under the heading "Assigned Providers." Staff can also be assigned to a case from the Settings and Directories section of the program, Caseload tab.

Please note that the person who first creates a chart is automatically an Assigned Provider. That person must indicate who else is an Assigned Provider, so that those additional staff will be able to access and enter the chart. Any Assigned Provider can assign others to access the chart.

The exception mentioned above is for individuals designated as a Group Administrator. A Group Administrator has access to all patient's charts. Individuals can be designated (or removed) as Group Administrators by contacting ICANotes support.

When there is a search for a patient, a schedule is printed, or certain reports are created under Complete Chart Security the names of non assigned patients and some demographic information will be visible. However, the chart cannot be accessed from the report or schedule and notes of non assigned patients cannot be printed.

If your group desires Complete Chart Security, please contact our Support Desk at support@icanotes.com.

Note Security:

Please Note: The following is a change. Heretofore, a note's owner or anyone assigned to a case could enter the work area of an existing note. This is not longer the case. Please see below.

With two exceptions, the only person, clinical or non clinical, who can have access to the work area of an existing note is the clinician who created the note: the "owner" of the note. (The owner of the note can be changed at the bottom of Finish Initial or Progress Note Part 2) The first exception to this rule are instances where supervision is involved, in which case both the owner of the note and the supervisor may enter the work area of the note, work on the note, and co-sign it. A supervisor can be designated by the Group Administrator in the Settings and Directories section of the program, Personal Info tab.

Treatment Plans are another exception to the rule that only the owner of a note can enter a note's work area. Nobody "owns" a Treatment Plan and all staff can enter the work area of a Treatment Plan under Default Chart Security. Under Complete Chart Security all Assigned Providers can enter the Treatment Plan.

Additional New Security Settings:

Calendar and Patient Accounts: By default these sections of the program are accessible to all staff. However, access to these areas can be limited to only certain personnel. If you wish to limit access to these areas please contact ICANotes Support.

Incentive Payments to Qualified Users of EHR: What Is the Latest Information?

noreply@blogger.com (Richard Morgenstern) — Sat, 07 Aug 2010 03:29:00 +0000

Dear ICANotes User,

Here is the latest information about the incentive payments to qualified users of Electronic Health Record systems. We will keep you informed as new information becomes available. Please feel free to ask any questions you may have.

Background

The Federal Government is eager to promote the use of EHRs. It believes that their use will improve the quality and decrease the expense of medical care. Toward that end it made incentive payments to users of EHRs part of the American Recovery and Reinvestment Act of 2009. (HITECH is the part of ARRA describing the incentives.)

How Much Money? Eligible users of EHRs will receive as much as:

$18,000 in 2011
$12,000 in 2012
$ 8,000 in 2013
$ 4,000 in 2014
$ 2,000 in 2015
$ 0 in 2016

Total: $44,000

This incentive payment is calculated as 75% of Medicare or Medicaid payments. So, to receive the full $18,000 incentive payment in 2011 the clinician would have had to have received at least $24,000 in Medicare charges. ( 75% of $24,000 is $18,000.) Medicaid has a slightly different payment schedule.

Besides incentives for eligible users (the carrot), there are penalties for Medicare and Medicaid providers who do not use EHRs. In 2015 "payment adjustments" will be imposed on eligible providers who are not meaningful users of EHRs.

Who is Eligible?

Only clinicians who are Medicare or Medicaid providers are eligible.

Medicare: A Medicare Eligible Provider is defined as a doctor of medicine or osteopathy, doctor of dental surgery or dental medicine, doctor of podiatry, doctor of optometry or a chiropractor who is not hospital-based.

NOTE: A Medicare Eligible Provider is considered hospital-based if 90% or more of the EP's services are performed in a hospital inpatient or emergency room setting.

Medicaid: A Medicaid EP is defined as a physician, nurse practitioner, certified nurse-midwife, dentist, or physician assistant who furnish services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant. To qualify for an EHR incentive payment, a Medicaid EP must not be hospital-based and must meet one of the following criteria:

- Have a minimum 30% Medicaid patient volume*
- Have a minimum 20% Medicaid patient volume, and is a pediatrician*
- Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals

NOTE: A Medicaid EP is considered hospital-based if 90% or more of the EP's services are performed in a hospital inpatient or emergency room setting.

* Children's Health Insurance Program (CHIP) patients do not count towards the Medicaid patient volume criteria.

For more information about eligibility click here.

When Do Payments Start?

For eligible clinicians who can demonstrate meaningful use the payments will start as early as May of 2011.

What is Meaningful Use?

The most important part of Meaningful Use is that the eligible clinician has been using a Certified EHR system. ICANotes will be a Certified EHR in the near future. For more information regarding the status of certification see below.

Also, the clinician wanting to demonstrate Meaningful Use will have to show that the Certified EHR was used for at least 90 consecutive days in 2011 (which is whyeligible providers can't apply until April 2011 and payments can begin as early as May 2011.)

Also, use of E-Prescribing (which is available thru ICANotes) must be demonstrated for a certain percentage of patients.

Finally, as noted above, a Medicaid Provider who wants to be reimbursed through that program must demonstrate a certain percentage of Medicaid patients.

How Will Clinicians Demonstrate Meaningful Use?

For the first year, 2011, all that will be required is the clinician's attestation that the meaningful use criteria have been met.

What is the Status of Certification for ICANotes?

ICANotes is preparing itself for the certification process, which has not yet started for any behavioral health software. Recently the standards ICANotes and other behavioral health software will have to meet were released. As this is written we are waiting for the release of information about how the standards will be tested. Also, the government is currently considering the credentials of the agencies that will administer the certifying tests.

It is currently expected that testing can start by November. ICANotes expects to apply for the test and achieve certification by the end of 2010.

What sort of Standards Will ICANotes have to Meet?

As a relatively mature EHR ICANotes will have no trouble meeting the criteria for certification. Here are some examples of the test criteria:

Maintain an active medication list. More than 80% of patients have at least one entry recorded as structured data. ICANotes already maintains an active medication list.

Maintain an active medication allergy list. More than 80% of patients have at least one entry recorded as structured data. ICANotes already maintains an active medication allergy list.

Record smoking status for patients 13 and older. More than 50% if patients age 13 or older have smoking status recorded as structured data. ICANotes already records smoking status in the medical history (under Health and Behavior.) The data will have to also be stored in separate fields (as structured data) but this is an easy modification to make.

Record patient demographics (sex, race, ethnicity, date of birth, preferred language, and in the case of hospitals, date and preliminary cause of death in the event of mortality). More than 50% of patients’ demographic data must be recorded as structured data. ICANotes already collects extensive demographic data, all as structured data. A field for preferred language will soon be added.

There are 25 standards of this sort.

We will keep you informed as new information becomes available.

www.icanotes.com

Official Web Site for the EHR Incentive Program

noreply@blogger.com (Richard Morgenstern) — Mon, 28 Jun 2010 12:24:00 +0000

The Centers for Medicare and Medicaid Services has launched the official Web site for the Medicare and Medicaid EHR Incentive Programs to provide the most up-to-date, detailed information about the programs.

The Medicare and Medicaid EHR Incentive Programs will provide incentive payments to eligible professionals and hospitals as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology.

The site provides information on who is eligible for the programs, how to register, meaningful use, upcoming EHR training and events.

The link to the website is: http://www.cms.gov/EHRIncentivePrograms/

IPad and ICANotes; User's Experiences

noreply@blogger.com (Richard Morgenstern) — Thu, 03 Jun 2010 15:51:00 +0000

We asked ICANotes users about their experiences using ICANotes on the IPad. Here are their responses to date:

1. "it's been a good experience but the cloud program recently did an upgrade 2 weeks ago, and since that upgrade, the cursor doesnt show when you are typing and is difficult to know where you are in the page.

I have spoken to the programer from the cloud program and told me that the problem will be fixed in thenext update. I havent really used the program due to the amount of time it takes finding the cursor, and knowing where you are typing.

Thanks for all your support.

Brando."

2. Hi, just letting you know that since the last update for the program that runs icanotes on the ipad, thecursor is not blinking or visible, and is difficult to know where you are supposed to type. This just started since the last update this saturday on the program to run icanotes on the ipad. Before this update, thecursor was visible and blinking like is suppossed to.

Thank you for your assistance. This is not a glitch of icanotes, i thinkis a glitch from the program running icanotes for the ipad.

(I find that using the selection tool (it looks like an arrow) helps me
keep track of where the cursor is.
Dave)

3. "I have the Eee PC T9. I have stopped using ICANotes on it as the font is too small and difficult to read. If I increase the font then the notes do not fit on the screen and I have to scroll from left to right to access allthe buttons/tabs.

Zafeer"

4. "I am using the iPad with your recommended remote access app. In general, the program works fairly well. I use the iPad and remote access for the initial psychiatric evaluation.

Comments: Response is much better with WiFi than with 3G. There are sometimes delays with 3G that make it difficult to figure out where you are in the program, particularly since the touch screen is so sensitive. It's easy to get several steps ahead of yourself, and difficult to recover where you were.

5. A couple of problems:

1. Once you enter a tab, the view shifts so that you cannot see the "buttons" along the left side of theprogram. This makes it difficult to step through the symptom list for various disorders.

2. The orientation of the view does not readily fit the iPad screen. The problem is that scroll bars are underthe iPad "dock", so it's very difficult to scroll the view so needed buttons are accessible.

I hoped this would be a time save, but so far it hasn't turned out that way. I'm in the field all day, and was hoping this would eliminate the need for taking notes and later transcribing them into ICANotes. I"ve made it through several intake assessments, then been able to clean up typing errors before electronically lockingthe note. On other occasions, the response has been so slow it was easier simply to take notes and transcribe later.

I have two more intakes scheduled for today, so we'll see if I can learn how to manage the remote access better.

Carl Stephens"

6. "Hello ICANotes Team,

I have used the app for the ipad and I am basically satisfied with being able to get in. However once in, theprogram screen will not open completely in the landscape position. Difficult to work in the system but it is good for review and when I am not at my desk. As I experience things I will let you know.

Dennis O'Brien"

7. "I have an HP notebook and love it. It works fine with ICAN. otherwise, can't help. BW"

8. "I been using the iPad with icanotes for approx 2 months now, with fairly good success. I have several different offices that I travel to during the week, and it has negated the need to carry my laptop. I also have been able to turn my droid phone into a wifi hotspot, which gives me access to records anywhere I have a verizon 3G signal. My only complaint is that the touch sensitivity is somewhat lacking and accuracy is affected. I often have to press a button several times before it detects it, although I am getting better with being able to touch it in the just the right place. I would consider it to be a great supplement to my desktop computer for records keeping, but definitely not a replacement. Having mobile/portable access to the system has been invaluable, but my desktop is still best for serious note writing sessions. I would love to see an actual iPad app, that is optimized and designed for the iPad, but the RDC option is great for now. " Trevor Wilkerson

9. "I have been using my iPad with mixed results. First there was the issue of a "screen on roller skates." When trying to enlarge the screen I would find it moving all over the place. Yesterday I had a very difficult time entering information. As I clicked on a field I could not type anything most of the times. Then, when successful, I was not able to make any corrections to my entries.

Using my iPad is the main reason for getting ICANotes. I hope these glitches can be corrected.

Dr. Gerry Machado"

Have Regulators Underestimated Cost of EHR Systems?

noreply@blogger.com (Richard Morgenstern) — Sat, 29 May 2010 01:44:00 +0000

A recent article of interest in Psychiatric News from May 2010.

Proposed federal regulations to implement a massive federal initiative aimed at convincing physicians to adopt digital patient record systems may prove “untenable” for many small-practice and solo-practice physicians, according to comprehensive reviews of the regulations submitted to the government by APA and other physician groups.

Article continues...

Among the many concerns highlighted by the AMA letter was that federal regulators have underestimated the high cost to physician practices of EHR adoption and ongoing overall HIT system maintenance. Officials at CMS estimate that EHR system adoption or upgrades of existing systems to meet federal standards will cost on average about $54,000 per physician employee in a practice, while annual maintenance will cost an average of $10,000 per physician employee.

Once the regulations are finalized, the federal program will provide “incentive payments” of up to $44,000 over five years to physicians who show “meaningful use” of qualified EHR technology (Psychiatric News, March 20, 2009).
But both the federal cost estimates and proposed payments could be dwarfed by the true cost to physicians of HIT systems that would comply with all of the proposed regulations.

Of course, ICANotes EMR software for Psychiatry professionals can help with costs. Click here to learn more about ICANotes EHR EMR software for Psychiatry, Psychology and other Mental Health professionals.

EHR Reimbursement Proposal Troubles Psychiatrists

noreply@blogger.com (Richard Morgenstern) — Sat, 29 May 2010 01:37:00 +0000

Interesting article published in Psychiatric News earlier this year.

In December 2009 federal health regulators in the Centers for Medicare and Medicaid Services (CMS) proposed regulations to implement the $19 billion physician and hospital reimbursement program created under the American Recovery and Reinvestment Act of 2009 (PL 111-5). The law provides “incentive payments” of up to $44,000 over five years to physicians who show “meaningful use” of certified electronic health record (EHR) technology (Psychiatric News, March 20, 2009).

The proposed CMS regulations list 25 areas of data that physicians must collect from their patients and record in the EHR systems to show meaningful use of them and thereby qualify for the federal funds.

However, psychiatrists who reviewed the proposed regulations are concerned that they require physicians to collect patient data focused on primary care treatment and not necessarily mental health care, such as charting changes in a range of vital signs.

Read the full article here

ICANotes now available on iPhone and iPad

noreply@blogger.com (Richard Morgenstern) — Wed, 12 May 2010 04:33:00 +0000

ICANotes compatibility with iPhone and iPad has arrived!

Learn how to get ICANotes for your iPhone or iPad using the following instructions:

1. Visit the Apple App Store

2. Purchase the Wyse PocketCloud application

3. Run Wyse PocketCloud on your iPhone or iPad

4. Tap the + to add a new connection

5. Enter "ICANotes" as the connection Nickname

6. Enter "ineternet.icanotes.com" as the Host

7. For Username, append "internet\" to your ICANotes username (make sure you use a back slash and not a front slash). You can also enter your password.

8. Select Save

9. Once you are connected, the screen will appear teal-green and you will have to scroll down to tap OK at our legal disclaimer.

The screen shots below should be used as a guide:

Take a look at our "How To" videos

noreply@blogger.com (Richard Morgenstern) — Wed, 03 Mar 2010 03:07:00 +0000

Take a few minutes and view the video library on our website. We have a number of instructional videos intended to help users and prospective customers learn about all of the features and capabilities of the ICANotes EMR / EHR Software for Psychiatry professionals.

If you are a YouTube user, visit the ICANotes YouTube Channel where we are regularly adding new videos from our library.

Our newest video, "How to Use Emdeon E-Prescribing" is available here

http://www.youtube.com/user/ICANotes

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noreply@blogger.com (Richard Morgenstern) — Wed, 24 Feb 2010 02:58:00 +0000

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Visit our Website

noreply@blogger.com (Richard Morgenstern) — Sat, 30 Jan 2010 05:21:00 +0000

To learn more about our Electronic Health Records software for psychiatry, psychology, substance abuse, and other mental and behavioral health clinicians, please visit our website at www.icanotes.com.

We offer a free "test drive" of the software as well as numerous instructional videos to see our software's potential to save you time and money.

HIMSS Webinar: The ARRA: The Act’s Impact on ONC, the National eHealth Collaborative, CCHIT and HITSP , prepared by Ira Morganstern, M.D.

noreply@blogger.com (Richard Morgenstern) — Wed, 11 Mar 2009 18:03:00 +0000

HIMSS Webinar: American Recovery and Reinvestment Act of 2009: The Act’s Impact on ONC, the National eHealth Collaborative, CCHIT and HITSP

Prepared by Ira Morganstern, M.D.

3-11-09

Here are some pearls I gleaned:

1. The actual amount to be spent on incetives for health information technology under the American Recovery and Reinvestent Act of 2009 is $36 billion. The government is counting on saving $ 16 billion which is why the net amount proposed is only $20 billion. This explains, in part, how the discrepancy between the number of active physicians and the amount of incentive money proposed will be met.

2. The American Recovery and Reinvestment Act of 2009 calls for the "meaningful use" of Electronic Health Record software. What does "meaningful use" mean? It probable includes e-prescribing, integration with the laboratory, and measures of Quality of Care. Towards these ends, ICANotes is implementing e-prescribing imminently and is looking for a partner that will cooperate in the integration of laboratory and icanotes databases. This two way integration will include the sending of lab requests from ICANotes to the laboratory and the importation of laboratory results into the patient record.

Quality of care measurement will involve the incorporation into ICANotes of outcome measurement tools, which is planned.

3. To get full incentive benefits a physician has to be using EHR in 2011, as we know. How long should the user have been using in order to be considered a "meaningful user."? Good question. One panelist thought EHR should have been in use for 6-12 months.

4, The requirement that every patient be in an Electronic Health Record has been proposed for 2014,

5, While CCHIT has not yet been officially designated the certifying body for electronic health records, there is no other agency ns sight who could perform the function and scant time to develop another such agency.

Ira Morganstern, M.D.