Practice Fusion Blog

Practice Fusion EHR Updates: New Prescription Library, Patient List Filters and Document Tools

Practice Fusion — 2009-07-16T02:00:00-07:00

Practice Fusion is constantly working to improve your experience and save you time. Based on our user feedback we have made the following improvements to our EHR today.

New Prescription Library
A more robust listing of commonly used medications and the ability to add custom medications.

NDC-based list of medications from the FDA
Medication list is constantly updated with the latest information
Easy search function lets you filter by route and strength
Improved display of patient information and drug allergy information
Simple tools for adding a custom medication

Patient List Filtering
Filter quickly through your most commonly accessed patient records or extend your search to your complete patient list. Watch a tutorial explaining the new search system.

Fast and intuitive access to the patients you've recently seen and are planning to see
Improved search tools to help you locate patients from large lists
Consistent search format across the system

Improved Document Tools
One-screen function for uploading, viewing, downloading and signing documents.

Doctors and RN's can sign documents in the same flow as adding them to a chart

Stay up to date on the latest EHR news!
Connect with Practice Fusion online anytime.

Ready to try the new features? Login to your Practice Fusion account now. Not yet using the Practice Fusion EHR? Sign-up for a free training.

Alert! FTC to Implement Red Flag Rule August 1

Practice Fusion — 2009-07-15T05:05:42-07:00

The Federal Trade Commission (FTC) is going ahead with plans to apply its new “Red Flag Rule” regulations to physician practices beginning August 1.

According to the Rule, practices that accept health insurance or permit patients to pay in installment plans must implement written policies and procedures that protect against identity theft before that date, or risk being docked up to $2,500 for each “knowing violation.”

Medical identity theft occurs when a perpetrator uses someone’s identifying information, such as name, Social Security number, insurance coverage data or credit card number, without that person’s knowledge or consent to obtain or make false claims for medical products or services.

A “red flag” is a pattern, practice or specific account or record activity that indicates possible identity theft.

The American Medical Association has objected to the FTC’s claim that a physician is a “creditor” and hence subject to the Red Flag Rule. It is attempting to delay or prevent implementation of the Rule to physician practices.

The AMA has nevertheless prepared a guidance document and sample policies for physician practices. These can be found here and here.

Contact your local Board of Registration in Medicine or the AMA for more information.

Glenn Laffel MD, PhD, Sr. VP Clinical Affairs

“Computerized Physician Order Entry” – what does it all mean?

Practice Fusion — 2009-07-14T14:47:47-07:00

“Computerized Physician Order Entry” (CPOE) has become a bit of a buzz-word in Heath IT circles, stemming from a focus on this in the emerging national Health IT policy. One of the areas of “meaningful use” described in the health IT Meaningful Use Matrix encourages the use of CPOE. Exactly how to measure usage, however, is a bit problematic – how can you determine the percentage of “orders” which could have been done electronically that were, in fact, done that way? How do you capture a denominator, given that “orders” not done electronically were presumably done via paper or other manual methods, and would not be available to be counted by electronic systems.

Much of the desire to have CPOE be a national “meaningful use” criteria stems from a study in the journal Radiology which show that CPOE, when combined with Decision Support (DS) significantly reduces the growth in utilization of high-end imaging (MRIs and PET scans). The data is quite compelling that such systems make a real difference.

Further complicating this issue is that Computerized Physician Order Entry means different things in an inpatient vs. outpatient setting. Filling out a “physician’s orders” sheet is a familiar workflow in an inpatient setting, where a ward clerk takes entries from the order sheet and turns them into directives for care (imaging, pharmacy, nursing, etc.) – replacing this workflow with a CPOE system is an easy transition, mimicking traditional workflows. It also creates a framework where decision support (DS) can be introduced, and data-driven “standing order sets” for specific situations can be called upon.

In an outpatient setting however, there is no equivalent of a “physician’s order” sheet. Instead, physician directives are handled through a variety of messages. A messaging system serves as the platform for response to incoming messages (e.g. handling patient incoming phone calls, or incoming requests for refills from pharmacies), as well as outbound work-orders (e.g. follow-up appointment scheduling, ordering imaging studies, ordering lab tests, issuing prescriptions [de novo or refills], nursing orders, referrals).

Therefore, when defining “CPOE” for an ambulatory EHR, specific order types (message types) should be defined in the certification criteria – radiology/imaging requests, lab order requests, electronic prescribing, referral generation, follow-up scheduling, etc. Additional message types in an ambulatory setting (e.g. responding back to patient phone calls or emails) may also exist, though not strictly “CPOE” in this sense. Such a messaging platform can subsequently serve as the place where decision support (DS) can be introduced.

This field, motivated by powerful incentives and compelling data, is evolving as the Health IT Policy Committee starts translating “meaningful use” into certification criteria, and defining exactly what and how CPOE is to be measured. The window of opportunity for input into this process is certainly here, and Practice Fusion will remain an active participant in this discussion.

Robert Rowley, MD

Chief Medical Officer

Practice Fusion, Inc.

Docs Dig ePromotion

Practice Fusion — 2009-07-13T05:26:39-07:00

Just 2 years ago, Big Pharma fielded 102,000 sales reps. That number has already dropped to 92,000 and it’s headed to 75,000 by 2012, according to Chris Wright, a principal at ZS Associates.

The cuts will save $3.6 billion for the beleaguered pharmaceutical companies, who are well aware that sales force effectiveness is way down.

Nowadays, only 37% of the drug reps who visit medical practices get to place products in the sample cabinet, and a measly 20% speak directly to a physician. About 25% of physicians belong to a practice that bans reps altogether.

That’s why Big Pharma has become so bullish about ePromotion, a phrase describing 3 techniques by which drug makers communicate with and educate physicians about their product offerings without having to rely on Sid the Drug Rep.

The ePromotion trio includes virtual details, which include audiotapes, videotapes, texts and emails (but no live communication), video details, which involve chat or telephone-assisted Internet sessions in which participants can communicate directly with a representative, and virtual events which include webinars, CME events, conference calls and group discussions.

Big Pharma’s enthusiasm will no doubt be increased by the results of a new survey indicating that physicians’ attitudes toward ePromotion are becoming increasingly positive.

SDI reached these conclusions after performing its Annual Study of ePromotion, the eighth such iteration of the query.

The Study showed that 67% of surveyed physicians expressed a positive overall attitude about ePromotion, up from 62% the previous year.

73% of these physicians felt ePromotion by Big Pharma was equal or superior to face-to-face promotion by drug reps, as compared with 68% the year before.

The average time spent per physician, per ePromotion event was 18 minutes.

With each passing year, “we have seen acceptance toward ePromotion among physicians increase,” said Jason Fox, Associate Director at SDI. “The results of this survey underscore a growing opportunity for the two groups to interact more regularly.”

Glenn Laffel MD, PhD, Sr. VP, Clinical Affairs

EMR Data to Support Clinical Research

Practice Fusion — 2009-07-09T09:47:02-07:00

The US Department of Veterans Affairs has decided to crack open its EMR, allowing scientists to query de-identified patient information in the hopes of improving care for conditions ranging from posttraumatic stress disorder to MRSA, cancer, and heart failure.

Matthew Samore, a physician-epidemiologist from the VA Salt Lake City who will be involved with the project, held out hope the so-called Consortium for Healthcare Informatics Research "will not only inform new guidelines but help resolve some conflicts in current guidelines.

The VA Medical System is among the largest in the nation. Only VA-associated scientists will be granted access to the gold mine, but everyone will benefit once they publish their findings.

Samore told AMedNews he hoped the VA project would demonstrate how data-mining techniques could be applied in other systems, while positing that since most health providers cannot share data with each other, it would be years before most systems could match what the VA could do today.

Pam Matthews, a senior director of health care information systems at HIMSS echoed this assessment. “The VA is a closed system. When you apply (what they are doing) to the commercially available products, their data model, their software model may be different," she told AMedNews.

Samore then mentioned something about Health Information Exchanges, a work-around solution that evolved along with the legacy client-server EMR systems used in many hospitals.

Web-based technology, such as that used by Practice Fusion, eliminates health data exchange problems by securely storing patient medical records in a central location. This data is always available to every health professional that needs it, simply by accessing a secure location on the Web.

Centrally located data obviates the need to define, communicate and implement technologies necessary to exchange data between legacy client-server systems. It is safe, secure and HIPAA compliant.

The VA begins its project under a cloud of scrutiny caused by its failure to protect patient privacy in a number of instances, including the heist of a laptop containing data on 26 million vets. This kind of thing would never happen with a Web-based solution, since the data are stored off-site.

Glenn Laffel, MD, PhD, Sr. VP Clinical Affairs; Matthew Douglass, VP Engineering

How Can Healthcare Software be Free? Chris Anderson has the Answer

Practice Fusion — 2009-07-08T12:05:32-07:00

Chris Anderson, editor-in-chief at Wired, author of The Long Tail and all around tech guru, has a new book out called Free: The Future of a Radical Price. On page 104, Practice Fusion's electronic health record application is featured as a case study:

How can Healthcare Software be Free?

Since November 2007, thousands of physicians have signed up to receive free electronic health record and practice management software from San Francisco-based start-up Practice Fusion. Enterprise software for medical practices can cost $50,000. How can one company give away its e-record system at no charge?

Freemium + advertising. Tapping the freemium model, Practice Fusion offers two versions of its software: a free one that serves ads (a la Google AdSense), and an ad-free one that costs $100 per month. Of the first 2,000 doctors to adopt Practice Fusion's e-record system, less than 10 percent opted to pay. But the real revenue lies elsewhere...

Sell access to your data. Using free software, Practice Fusion attracts a critical mass of users (doctors) who, in turn, create a growing database of patients. Medical associations conducting research on specific conditions require longitudinal health records for a large set of patients. Depending on the focus of a study (think: white, middle-aged, obese males suffering from asthma), each patient's anonymized chart could fetch anywhere from $50 to $500. A physician typically sees about 250 patients, so Practice Fusion's first 2,000 clients translates to 500,000 records. Each chart can be sold multiple times for any number of studies being conducted by various institutions. If each chart generates $500 over time, that revenue would be greater than if Practice Fusion sold the same 2,000 practices software for a one-time fee of $50,000.

You can download the audiobook version of Anderson's new book for free (of course) online.

The Pros and Cons of Remotely Hosted EHRs

Practice Fusion — 2009-07-08T09:31:47-07:00

Information Management has a in-depth article today about the pros and cons of remotely hosted EHRs. One of Practice Fusion's users in Atlanta is featured in the piece:

Looking for a low-cost option, David Wyatt, M.D., settled on free software from Practice Fusion Inc., San Francisco. The catch? Every time he accesses the software remotely via the Internet, it displays advertisements at the bottom of the page for medications and other products. "The ads are inobtrusive; they don't bother me in the least," says Wyatt, medical director of WeightLoss MD, Atlanta.

The physician, who practices with one partner, is considering franchising his business. He doesn't use a practice management system because he doesn't accept insurance payments. "Offering a free EHR to our franchisees is very attractive," he says.

Having patient records accessible via the Internet, rather than paper charts, is far more practical for the practice, which already has three locations 30 miles apart, the physician says. "We don't even think about where the information is," he says. "We know it's always available."

What are the most important pros and cons of using online electronic health record programs when it comes to your practice? Share your comments below.

Practice Fusion is Hiring!

Practice Fusion — 2009-07-06T17:19:13-07:00

Join Practice Fusion's rapidly-growing team! We've just posted two openings for engineers in our San Francisco office:

Practice Fusion is a fun, fast growing startup company providing cutting-edge SaaS based software that meets the critical needs of today's $1 trillion healthcare market. We provide a revolutionary software application for physicians and patients that is core to their medical practices. Practice Fusion’s flagship software is used by doctors and their staff for all aspects of their patient service and practice management activities.

Practice Fusion has received multiple awards and extensive national and international media coverage including the Wall Street Journal and New York Times. We are seeking motivated, top tier talent who are ready to role up their sleeves and join a team that is revolutionizing the delivery of core software solutions to the healthcare industry.

Learn more about the job opportunities with Practice Fusion today!

Is there a Doctor in the Mouse?

Practice Fusion — 2009-07-02T06:02:19-07:00

Prompted by increasingly permissive reimbursement policies, digital office visits--in which patients and physicians use computers to manage clinical issues that traditionally necessitate an office visit--are growing faster than biceps on steroids.

Big Insurers from Aetna to WellPoint are experimenting with such programs, which are a time-savers for everyone and less expensive than a schlep to the doctor’s.

“If…there is payment for it, we will see many more primary-care physicians doing it,” Ted Epperly told the Wall Street Journal. The president of the American Academy of Family Physicians said that at the moment, about 3% of his organization’s members offer digital office visits.

Physicians agree that the new format is best reserved for simple stuff; colds and flu, urinary infections, back pain and sleep disturbances for example.

Even in such instances, some offer the option only to patients they know, mostly as a hedge against malpractice.

And no physician in her right mind would go this route for symptoms that could spell trouble, like chest pain--any kind of pain really--or abdominal symptoms, which are notoriously difficult to diagnose without a physical exam.

The field is still in shake-out mode, with many formats for the interaction being tried in many venues across the country. The simplest approach is using secure, HIPAA-compliant email . Practice Fusion will support this activity as part of its Patient Health Record scheduled for release in Q1, 2010.

In another format, patients must complete symptom-specific algorithms in advance of the actual interaction. The snazziest approach involves live, online visits using Web video, chat or a phone conversation routed for privacy purposes through a secure computer system.

In a joint experiment of the latter approach, American Well and the Hawaii Medical Service Association combined to offer such services to enrollees, who pay a $10 co-pay for the privilege.

For non-insured online visits, the going rate around the country seems to be about $20-35 a steal when compared to the cost of the old-fashioned schlep.

Glenn Laffel, MD, PhD, Sr. VP Clinical Affairs

Big O Bobs, Weaves on Public Plan

Practice Fusion — 2009-06-25T12:42:44-07:00

During Tuesday’s press frolic, the Big O put some mustard on his pitch for a public option, dismissing as “not logical” suggestions that a government plan would sink Big Insurance faster than the Titanic.

He followed quickly with a favorite refrain, which is that good, old-fashioned competition from a public plan would be an “important tool to discipline insurance companies.”

Then, in a denouement worthy of at least runner up at a Harvard Law Debate Club, he triple-dog-dared anyone to come up with a better plan that met his 2 etched-in-stone requirements. “Reform has to control costs and it has to provide relief to people who don’t have health insurance or are underinsured,” he said.

Big Insurance, destined in this match to play Smokin’ Joe to the Big O’s Ali, released a wild haymaker of its own 2 hours before the Big O even showed up.

“We do not believe it is possible to create a government plan that could operate on a level playing field,” quoth Karen Ignagni, president of America’s Health Insurance Plans, and Scott Serota, president of the Blue Cross and Blue Shield Association in an open letter to the Senate.

“Regardless of how it is initially structured, a government plan would use its built-in advantages to take over the health insurance market,” the letter continued.

No doubt the Big O smirked when he read that.

Meanwhile, Kent Conrad, the intrepid Senator from North Dakota has created a stir with his suggestion that nonprofit consumer-owned cooperatives could be an alternative to the government plan. He foresees the Feds forking over $3-4 billion to jumpstart the co-ops, after which time they would sink or swim on premiums and investment income, just like Big Insurance.

The Big O knows he can live with this or any approach that covers most everybody without breaking the bank, but this day he was on offense.

“If private insurers say that the marketplace provides the best quality health care, if they tell us that they’re offering a good deal, then why is it that the government — which they say can’t run anything — suddenly is going to drive them out of business?” Obama asked.

Dr. Spock himself couldn’t have asked a more logical question.

Glenn Laffel, MD, PhD, SVP Clinical Affairs