Guest guest Posted January 6, 2008 Report Share Posted January 6, 2008 Amen Gordon! Can we do a short present on "off the shelf" do it yourself integration at the June Rochester summit? Matt in Western PA Dr LevinFamily MedicineWestern PA, east of PittsburghSolo since Dec 2004Residency completed 1988User of SOAPware since 1997User of Appointmentquest.com for online appointment scheduling since May 2007User of RelayHealth for secure email with patients since June 2007Technology and Practice Management consultancyContributing Volunteer Editorial staff of Family Practice Management at AAFPOffice Fax Musings on EMR The whole field of EMR is vast and chaotic.My comments below are not meant as a blanket indictment of the EMR creators or vendors. They are responding to the demands of the market. Nor are EMR creators & vendors uniform in their product, pricing, quality, support.The problem is that - like The Invasion of the Body Snatchers - U.S. has been consumed from the inside out by administrative trivia masquerading as health care and sucking the life out of us all.EMR first and foremost is a vehicle for coding and claims. The game seems to be to enhance our ability to "win" at the E & M documentation and coding game so we can justify codes that bring greater payment. I'd say that 90+% of all EMR functionality is aimed at this issue.If we didn't have to spend such an immense amount of our time justifying our work to insurance clerks, I think that most of us would find the current approach to electronic records irrational and not worth the cost.If one accepts this perversion of health care as "justification of administrative trivia to satisfy clerks" then one chooses EMR based on the ability to simplify capturing that trivia in a manner that is minimally difficult to you. This means that the best EMR is one that suits your personal style of practice and modes of computer interaction.If you dictate well, type poorly, but can stand correcting mistakes, choose an EMR that facilitates voice recognition technology.If you like checklists, are facile with a mouse, and have a quick processor, consider an EMR with drop down menus and check lists.If you type well and can use macros, consider EMRs that have text input capability.To truly get the feel of an EMR means spending some time with it, and you'd be best off going to a practice with the EMR in use and getting your hands on to a computer.There are some general questions that would be helpful to answer in advance:1: Who owns the patient data?As you may have seen on the listserv, some have been burned when switching EMR to find that the data is difficult or expensive to extract or in the worst case is held hostage to large fees.2: How can I use the tool to assess quality of care?Most will blow smoke in answer to this question. Almost all have some report generating capability, but the reports are built on the typical quicksand of ICD9 and CPT4 codes and are of very questionable value. If the EMR has good QI functionality it usually means that you have to enter data into structured fields - work that most find prohibitively laborious.3: What are the fees?Like mobile phone companies, EMR vendors are very inventive when it comes to obtaining money and no two contracts are alike. Most will ask for all the money for a multi-year contract up front, but many will agree to lease over time with monthly fees. Check out all the fees and keep asking "are there any other fees?" Ask this at least five times.4: Can my patient lab values be downloaded directly into structured data fields at no cost to me?The variation in response to these issues has lead good docs in many directions. Pamela Wible in Eugene OR uses a $99 file creating software on her Mac. Many on the Practiceimprovement list use Amazing Charts at a fraction of the cost of the big vendors. Some elect the all encompassing big solutions like GE's Centricity, while employed docs are usually forced into monster vendor solutions like Epic or Touchworks.Putting all rantings aside, I recommend an approach championed by Clemensen and others: use simple off the shelf components that will work as a unified whole (with effort on your part and/or hired help of an IT support person). This is a very inexpensive solution that allows you to swap out any parts that don't work well for you. The monolithic vendor solution locks you into that vendor. If they have parts that don't work well for you (a common experience), you're stuck.Gordon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2008 Report Share Posted January 6, 2008 An IMP approach to ideal IT will definitely be part of IMP camp 2008. Gordon Save the date! IMP Camp 2008 Rochester NY June 20 & 21 At 12:04 PM 1/6/2008, you wrote: Amen Gordon! Can we do a short present on " off the shelf " do it yourself integration at the June Rochester summit? Matt in Western PA Dr Levin Family Medicine Western PA, east of Pittsburgh Solo since Dec 2004 Residency completed 1988 User of SOAPware since 1997 User of Appointmentquest.com for online appointment scheduling since May 2007 User of RelayHealth for secure email with patients since June 2007 Technology and Practice Management consultancy Contributing Volunteer Editorial staff of Family Practice Management at AAFP Office Fax Musings on EMR The whole field of EMR is vast and chaotic. My comments below are not meant as a blanket indictment of the EMR creators or vendors. They are responding to the demands of the market. Nor are EMR creators & vendors uniform in their product, pricing, quality, support. The problem is that - like The Invasion of the Body Snatchers - U.S. has been consumed from the inside out by administrative trivia masquerading as health care and sucking the life out of us all. EMR first and foremost is a vehicle for coding and claims. The game seems to be to enhance our ability to " win " at the E & M documentation and coding game so we can justify codes that bring greater payment. I'd say that 90+% of all EMR functionality is aimed at this issue. If we didn't have to spend such an immense amount of our time justifying our work to insurance clerks, I think that most of us would find the current approach to electronic records irrational and not worth the cost. If one accepts this perversion of health care as " justification of administrative trivia to satisfy clerks " then one chooses EMR based on the ability to simplify capturing that trivia in a manner that is minimally difficult to you. This means that the best EMR is one that suits your personal style of practice and modes of computer interaction. If you dictate well, type poorly, but can stand correcting mistakes, choose an EMR that facilitates voice recognition technology. If you like checklists, are facile with a mouse, and have a quick processor, consider an EMR with drop down menus and check lists. If you type well and can use macros, consider EMRs that have text input capability. To truly get the feel of an EMR means spending some time with it, and you'd be best off going to a practice with the EMR in use and getting your hands on to a computer. There are some general questions that would be helpful to answer in advance: 1: Who owns the patient data? As you may have seen on the listserv, some have been burned when switching EMR to find that the data is difficult or expensive to extract or in the worst case is held hostage to large fees. 2: How can I use the tool to assess quality of care? Most will blow smoke in answer to this question. Almost all have some report generating capability, but the reports are built on the typical quicksand of ICD9 and CPT4 codes and are of very questionable value. If the EMR has good QI functionality it usually means that you have to enter data into structured fields - work that most find prohibitively laborious. 3: What are the fees? Like mobile phone companies, EMR vendors are very inventive when it comes to obtaining money and no two contracts are alike. Most will ask for all the money for a multi-year contract up front, but many will agree to lease over time with monthly fees. Check out all the fees and keep asking " are there any other fees? " Ask this at least five times. 4: Can my patient lab values be downloaded directly into structured data fields at no cost to me? The variation in response to these issues has lead good docs in many directions. Pamela Wible in Eugene OR uses a $99 file creating software on her Mac. Many on the Practiceimprovement list use Amazing Charts at a fraction of the cost of the big vendors. Some elect the all encompassing big solutions like GE's Centricity, while employed docs are usually forced into monster vendor solutions like Epic or Touchworks. Putting all rantings aside, I recommend an approach championed by Clemensen and others: use simple off the shelf components that will work as a unified whole (with effort on your part and/or hired help of an IT support person). This is a very inexpensive solution that allows you to swap out any parts that don't work well for you. The monolithic vendor solution locks you into that vendor. If they have parts that don't work well for you (a common experience), you're stuck. Gordon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2008 Report Share Posted January 6, 2008 That is a very US centric point of view. Outside the USA we don't have to do coding yet EMR usage is much higher in other countries. > > > > > > > EMR first and foremost is a vehicle for coding and claims. The game > seems to be to enhance our ability to " win " at the E & M documentation > and coding game so we can justify codes that bring greater payment. > I'd say that 90+% of all EMR functionality is aimed at this issue. -- Graham Chiu http://www.synapsedirect.com Synapse-EMR - innovative electronic medical records system Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2008 Report Share Posted January 6, 2008 So what sorts of features to users of EMRs really value if they don’t have to code? Are they better than we (they’d almost have to be) at setting up systems that allow for sharing of info important for patient care across practice settings? Pharmacies seem to have pretty consistent online access to insurance information. Why can’t we (doctors and hospitals) do better at placing med lists, allergy lists and so forth in some “virtual” location that is accessible from anywhere? Annie From: [mailto: ] On Behalf Of Graham Chiu Sent: Sunday, January 06, 2008 3:39 PM To: Subject: Re: Musings on EMR That is a very US centric point of view. Outside the USA we don't have to do coding yet EMR usage is much higher in other countries. On Jan 7, 2008 5:58 AM, L. Gordon wrote: > > > > > > > EMR first and foremost is a vehicle for coding and claims. The game > seems to be to enhance our ability to " win " at the E & M documentation > and coding game so we can justify codes that bring greater payment. > I'd say that 90+% of all EMR functionality is aimed at this issue. -- Graham Chiu http://www.synapsedirect.com Synapse-EMR - innovative electronic medical records system Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2008 Report Share Posted January 6, 2008 RE purpose of EMRs. USA EMR commercial focus has been coding; there are more practical and clinically focused EMRs in our country too, and many of us use them (SOAPware, Amazing Chart, and others) to good effect. Matt in Western PA Solo FP since Dec 2004 In practice since 1988 Re: Musings on EMR That is a very US centric point of view. Outside the USA we don'thave to do coding yet EMR usage is much higher in other countries.On Jan 7, 2008 5:58 AM, L. Gordon <gmooreidealhealthnetwork> wrote:>>>>>>> EMR first and foremost is a vehicle for coding and claims. The game> seems to be to enhance our ability to "win" at the E & M documentation> and coding game so we can justify codes that bring greater payment.> I'd say that 90+% of all EMR functionality is aimed at this issue.-- Graham Chiuhttp://www.synapsedirect.comSynapse-EMR - innovative electronic medical records system Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2008 Report Share Posted January 6, 2008 Exactly, and one of the reasons to explore Synapse. Gordon At 03:38 PM 1/6/2008, you wrote: That is a very US centric point of view. Outside the USA we don't have to do coding yet EMR usage is much higher in other countries. On Jan 7, 2008 5:58 AM, L. Gordon < gmoore@...> wrote: > > > > > > > EMR first and foremost is a vehicle for coding and claims. The game > seems to be to enhance our ability to " win " at the E & M documentation > and coding game so we can justify codes that bring greater payment. > I'd say that 90+% of all EMR functionality is aimed at this issue. -- Graham Chiu http://www.synapsedirect.com Synapse-EMR - innovative electronic medical records system Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2008 Report Share Posted January 6, 2008 I think the main reasons people use EMRs outside the US are: 1. saving space 2. easy location of medical notes 3. legible prescriptions and notes 4. HL7 results and not really for sharing patient data with other medical practices. When I get a referral, it is often a dump of their medical notes, and a typical documented encounter is often just a few lines of text. I.e. you don't get a 5 page treatise on a sore throat ... just a couple of lines. I have never seen a templated encounter in their notes. > So what sorts of features to users of EMRs really value if they don't have > to code? Are they better than we (they'd almost have to be) at setting up > systems that allow for sharing of info important for patient care across > practice settings? > -- Graham Chiu http://www.synapsedirect.com Synapse-EMR - innovative electronic medical records system Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2008 Report Share Posted January 6, 2008 Lou Spikol, even though you're almost not official anymore, will you post the pdf you were going to send on what you thought the 21st century EMR should really be able to do, if it didn't have to fulfill the arcane billing/coding/medicolegal/(P4P) 'prove you did it' functions that we are saddled with in the US? wouldn't it be great if there was some sort of online repository function that the patient and any healthcare provider/pharmacy/hospital could get into and update information on? Medications, active and inactive problem list, immunizations, allergies would be a lovely start. It's sad, but despite huge initial infusions of cash, the information RHIO highway is just not about to emerge or materialize anytime soon in the US, is it? Lynn > > > > > > > > > > > > > > EMR first and foremost is a vehicle for coding and claims. The game > > seems to be to enhance our ability to " win " at the E & M documentation > > and coding game so we can justify codes that bring greater payment. > > I'd say that 90+% of all EMR functionality is aimed at this issue. > > -- > Graham Chiu > http://www.synapsedirect.com > Synapse-EMR - innovative electronic medical records system > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2008 Report Share Posted January 6, 2008 Annie Not really related to this, but perhaps our function of our population ( about 4 million ) is that we have a national network setup by a private company some years ago. Each doc has their own address and can send encrypted medical data to anyone else on this network. Laboratories send their HL7 results to docs in this way. Specialists often send reports back to FPs that way too. It costs about $40 per month to stay connected. > to code? Are they better than we (they'd almost have to be) at setting up > systems that allow for sharing of info important for patient care across > practice settings? -- Graham Chiu http://www.synapsedirect.com Synapse-EMR - innovative electronic medical records system Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2008 Report Share Posted January 6, 2008 Should this IMP Camp Date be put on the Calendar ? http://health.groups.yahoo.com/group//cal Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2008 Report Share Posted January 6, 2008 Very well said. I'm using the multicomponent model. It is basically a somewhat expanded version of what Pamela Wible did. But I store the data in the files in an XML format, which allows you to add some structure to what would otherwise be only text. I also programmed a " server " that works over my network, so whatever I can see and change on one computer, I can see and change on any of my other computers or from home. The chief value of the EMR to me is that I really need it to remember what I need to remember about my patients from one visit to the next. I need to remember who they are, what they look like, what their concern was on the last visit, what we discussed, what plans we made, what meds they are on, how many kids they have, what their hobbies are etc. It is very EMBARASSING if I do not remember these things when they come in from one visit the next. The FEAR of this embarassment is the main motive I have for keeping medical records. As an IMP, I do value the ability to integrate my note writing with E & M coding and ability to generate and submit the detested, but never the less required billing form myself, instead of having to hire people to do it for me. If I worked in a big group like Kaiser, I probabably wouldn't care at all about the coding. I never knew anything about coding for about 25 years out of my years of practice, and was able to function fine in the practice settings I was in. But as an IMP, it has become unfortunately more necessary to learn about it. I actually think it should be fairly easy to keep track of quality measures that Gordon feels are the sine qua non of IMP practice on a population of patients with my open source system. The main reason I think this would be relatively easy is that we really don't know very much about what defines quality yet. The quality measures that have been proven to work are actually relatively few. Like if you look at the current push in the hospital on MI care, pneumonia, the parameters can be reduced to a pretty simple check off sheet, which means it can be computerized pretty easily. I actually would put the ability to exchange medical records from one EMR system to another pretty far down on the list of important EMR features. I think the reason the government and politicians feel it is so important is that for various reasons (like they are the 3rd party payor etc.), they want to " be involved " in our activities and monitor (and probably control) what we are doing. Caldwell > > The whole field of EMR is vast and chaotic. > My comments below are not meant as a blanket indictment of the EMR > creators or vendors. They are responding to the demands of the > market. Nor are EMR creators & vendors uniform in their product, > pricing, quality, support. > > The problem is that - like The Invasion of the Body Snatchers - U.S. > has been consumed from the inside out by administrative trivia > masquerading as health care and sucking the life out of us all. > > EMR first and foremost is a vehicle for coding and claims. The game > seems to be to enhance our ability to " win " at the E & M documentation > and coding game so we can justify codes that bring greater payment. > I'd say that 90+% of all EMR functionality is aimed at this issue. > > If we didn't have to spend such an immense amount of our time > justifying our work to insurance clerks, I think that most of us > would find the current approach to electronic records irrational and > not worth the cost. > > If one accepts this perversion of health care as " justification of > administrative trivia to satisfy clerks " then one chooses EMR based > on the ability to simplify capturing that trivia in a manner that is > minimally difficult to you. This means that the best EMR is one that > suits your personal style of practice and modes of computer interaction. > > If you dictate well, type poorly, but can stand correcting mistakes, > choose an EMR that facilitates voice recognition technology. > If you like checklists, are facile with a mouse, and have a quick > processor, consider an EMR with drop down menus and check lists. > If you type well and can use macros, consider EMRs that have text > input capability. > > To truly get the feel of an EMR means spending some time with it, and > you'd be best off going to a practice with the EMR in use and getting > your hands on to a computer. > > There are some general questions that would be helpful to answer in advance: > 1: Who owns the patient data? > As you may have seen on the listserv, some have been burned when > switching EMR to find that the data is difficult or expensive to > extract or in the worst case is held hostage to large fees. > 2: How can I use the tool to assess quality of care? > Most will blow smoke in answer to this question. Almost all have some > report generating capability, but the reports are built on the > typical quicksand of ICD9 and CPT4 codes and are of very questionable > value. If the EMR has good QI functionality it usually means that you > have to enter data into structured fields - work that most find > prohibitively laborious. > 3: What are the fees? > Like mobile phone companies, EMR vendors are very inventive when it > comes to obtaining money and no two contracts are alike. Most will > ask for all the money for a multi-year contract up front, but many > will agree to lease over time with monthly fees. Check out all the > fees and keep asking " are there any other fees? " Ask this at least five times. > 4: Can my patient lab values be downloaded directly into structured > data fields at no cost to me? > > The variation in response to these issues has lead good docs in many > directions. Pamela Wible in Eugene OR uses a $99 file creating > software on her Mac. Many on the Practiceimprovement list use Amazing > Charts at a fraction of the cost of the big vendors. Some elect the > all encompassing big solutions like GE's Centricity, while employed > docs are usually forced into monster vendor solutions like Epic or Touchworks. > > Putting all rantings aside, I recommend an approach championed by > Clemensen and others: use simple off the shelf components that > will work as a unified whole (with effort on your part and/or hired > help of an IT support person). This is a very inexpensive solution > that allows you to swap out any parts that don't work well for you. > The monolithic vendor solution locks you into that vendor. If they > have parts that don't work well for you (a common experience), you're stuck. > > Gordon > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2008 Report Share Posted January 6, 2008 Good idea. Done G At 05:28 PM 1/6/2008, you wrote: Should this IMP Camp Date be put on the Calendar ? http://health.groups.yahoo.com/group//cal Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2008 Report Share Posted January 7, 2008 Gordon, Not that many years ago you talked about how great Alteer was and how it allowed you to open your micropractice. What made you change your mind so drastically? Your article about Alteer and how great EMR is was part of why I went that route. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of L. Gordon Sent: Sunday, January 06, 2008 11:58 AM To: -yahoogroups.com Subject: Musings on EMR The whole field of EMR is vast and chaotic. My comments below are not meant as a blanket indictment of the EMR creators or vendors. They are responding to the demands of the market. Nor are EMR creators & vendors uniform in their product, pricing, quality, support. The problem is that - like The Invasion of the Body Snatchers - U.S. has been consumed from the inside out by administrative trivia masquerading as health care and sucking the life out of us all. EMR first and foremost is a vehicle for coding and claims. The game seems to be to enhance our ability to " win " at the E & M documentation and coding game so we can justify codes that bring greater payment. I'd say that 90+% of all EMR functionality is aimed at this issue. If we didn't have to spend such an immense amount of our time justifying our work to insurance clerks, I think that most of us would find the current approach to electronic records irrational and not worth the cost. If one accepts this perversion of health care as " justification of administrative trivia to satisfy clerks " then one chooses EMR based on the ability to simplify capturing that trivia in a manner that is minimally difficult to you. This means that the best EMR is one that suits your personal style of practice and modes of computer interaction. If you dictate well, type poorly, but can stand correcting mistakes, choose an EMR that facilitates voice recognition technology. If you like checklists, are facile with a mouse, and have a quick processor, consider an EMR with drop down menus and check lists. If you type well and can use macros, consider EMRs that have text input capability. To truly get the feel of an EMR means spending some time with it, and you'd be best off going to a practice with the EMR in use and getting your hands on to a computer. There are some general questions that would be helpful to answer in advance: 1: Who owns the patient data? As you may have seen on the listserv, some have been burned when switching EMR to find that the data is difficult or expensive to extract or in the worst case is held hostage to large fees. 2: How can I use the tool to assess quality of care? Most will blow smoke in answer to this question. Almost all have some report generating capability, but the reports are built on the typical quicksand of ICD9 and CPT4 codes and are of very questionable value. If the EMR has good QI functionality it usually means that you have to enter data into structured fields - work that most find prohibitively laborious. 3: What are the fees? Like mobile phone companies, EMR vendors are very inventive when it comes to obtaining money and no two contracts are alike. Most will ask for all the money for a multi-year contract up front, but many will agree to lease over time with monthly fees. Check out all the fees and keep asking " are there any other fees? " Ask this at least five times. 4: Can my patient lab values be downloaded directly into structured data fields at no cost to me? The variation in response to these issues has lead good docs in many directions. Pamela Wible in Eugene OR uses a $99 file creating software on her Mac. Many on the Practiceimprovement list use Amazing Charts at a fraction of the cost of the big vendors. Some elect the all encompassing big solutions like GE's Centricity, while employed docs are usually forced into monster vendor solutions like Epic or Touchworks. Putting all rantings aside, I recommend an approach championed by Clemensen and others: use simple off the shelf components that will work as a unified whole (with effort on your part and/or hired help of an IT support person). This is a very inexpensive solution that allows you to swap out any parts that don't work well for you. The monolithic vendor solution locks you into that vendor. If they have parts that don't work well for you (a common experience), you're stuck. Gordon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2008 Report Share Posted January 7, 2008 Hi all - I find I have to disagree with Gordon's musings. This is nothing new - Gordon and I went through residency and chief residency together and even practiced together for a few years before I moved from Rochester to Ithaca, New York and he moved on to IMP work. Gordon is a wonderful rabble rouser, and makes us look at things in a new way. But sometimes he is over the top and I think this is one of those times. I don't think that 90% of all EMR functionality is aimed at billing. I use Practice Partner, which I describe to prospective clients as a Cadillac. It has more features than I need and is more expensive than Amazing Charts - but I have used it for seven years and I am happy with it. It is not perfect - but it is better than good enough. And in my perspective, most of my EMR is used for organization. I need information to care for my patients and my EMR allows me to organize it much better than any paper chart. All the good things that we all know about EMRs - like access to the chart from home, direct entry of labs and Xrays, the ability to graph information and compare data, the ability to write and fax Rx with a medication cross check - those are the patient oriented parts and the parts that make it easier and more efficient to practice medicine. So I think that all of us would agree that EMRs are better than paper charts. So how much is related to billing? Actually not that much. Practice partner has three components - scheduling, records, and billing. The billing allows me to send claims to the clearinghouse efficiently. Even if I worked under a single payer system, I would have to send these codes and diagnoses to the billing system - so that is nothing special. I recognize that the billing system is complex - there are dozens of different ways to bill vaccines in New York State - but that is not the fault of the EMR. In fact, the EMR allows me to bill more accurately in this complex system. But the function that allows me to do that - what practice partner calls quicktext and other programs call shortcuts - is more useful for doing notes. The shortcuts do allow me to document better - and that helps billing and malpractice - but it also serves as a reminder system for me. If a pap smear is overdue, it pops up in my face when I open the chart. The cholesterol is pulled directly into the note for me, the reminder to ask about a Health Care proxy or DNR is built into the system. Computers are good at doing repetitive things and good at providing reminders - and that is how I use my EMR. I use the functions to help me take better care of patients. And as I said, practice partner is not perfect. In order to do a really intricate search (all diabetics with LDL over 100 who haven't had a visit in three months), most users export the data to a different database search engine and manipulate the data there. And that is the future of medicine - being proactive and finding those people who need flu shots and asthma visits and better BP control. The other future of medicine is using technology to connect better with your patients - for convenience like them scheduling their own appointments and for teaching like use email and web sites to get them needed information - and then getting paid for the extra time it takes to educate them. I do agree with Gordon's final comments - " Putting all rantings aside, I recommend an approach championed by Clemensen and others: use simple off the shelf components that will work as a unified whole (with effort on your part and/or hired help of an IT support person). This is a very inexpensive solution that allows you to swap out any parts that don't work well for you. The monolithic vendor solution locks you into that vendor. If they have parts that don't work well for you (a common experience), you're stuck. " but I also want to offer another perspective here as well. There is another family doc in Ithaca who is starting an IMP style practice in February and came to me to talk about my system. I steered him towards Amazing Charts as a lovely solution for a single doc as suggested by this listserv. However, going back and forth, he is seriously thinking about joining my system (connecting from is office via the internet and running his patients, schedules, and billing through Practice Partner). I have to admit that it holds several attractions for him - the most important is that it is already set up. The labs and Xrays are already downloading from the local hospital. The scanning system is already up and running (yes people in Ithaca still use paper to send consults). The faxing is directly into the computer so consults that are faxed are easily " linked " to the chart. The billing is in place - both the coding in the notes and the processing by my biller. And maybe most important to him - he will have an ally to work on the next level of projects. I can walk him through the templates he wants to create, he can help me set up a web site and an interactive patient portal (already built into Practice Partner - for an additional cost of course). so EMRs are not evil - they are next level of care. and they are just billing machines. I'm not naive - I'm actually very business savvy - and billing is just a minor part of the EMR in my practice. I would love to have a single payer system - it would make my life much less complicated. But that is not the EMRs fault. Loehr, MD At 11:58 AM 1/6/2008, you wrote: The whole field of EMR is vast and chaotic. My comments below are not meant as a blanket indictment of the EMR creators or vendors. They are responding to the demands of the market. Nor are EMR creators & vendors uniform in their product, pricing, quality, support. The problem is that - like The Invasion of the Body Snatchers - U.S. has been consumed from the inside out by administrative trivia masquerading as health care and sucking the life out of us all. EMR first and foremost is a vehicle for coding and claims. The game seems to be to enhance our ability to " win " at the E & M documentation and coding game so we can justify codes that bring greater payment. I'd say that 90+% of all EMR functionality is aimed at this issue. If we didn't have to spend such an immense amount of our time justifying our work to insurance clerks, I think that most of us would find the current approach to electronic records irrational and not worth the cost. If one accepts this perversion of health care as " justification of administrative trivia to satisfy clerks " then one chooses EMR based on the ability to simplify capturing that trivia in a manner that is minimally difficult to you. This means that the best EMR is one that suits your personal style of practice and modes of computer interaction. If you dictate well, type poorly, but can stand correcting mistakes, choose an EMR that facilitates voice recognition technology. If you like checklists, are facile with a mouse, and have a quick processor, consider an EMR with drop down menus and check lists. If you type well and can use macros, consider EMRs that have text input capability. To truly get the feel of an EMR means spending some time with it, and you'd be best off going to a practice with the EMR in use and getting your hands on to a computer. There are some general questions that would be helpful to answer in advance: 1: Who owns the patient data? As you may have seen on the listserv, some have been burned when switching EMR to find that the data is difficult or expensive to extract or in the worst case is held hostage to large fees. 2: How can I use the tool to assess quality of care? Most will blow smoke in answer to this question. Almost all have some report generating capability, but the reports are built on the typical quicksand of ICD9 and CPT4 codes and are of very questionable value. If the EMR has good QI functionality it usually means that you have to enter data into structured fields - work that most find prohibitively laborious. 3: What are the fees? Like mobile phone companies, EMR vendors are very inventive when it comes to obtaining money and no two contracts are alike. Most will ask for all the money for a multi-year contract up front, but many will agree to lease over time with monthly fees. Check out all the fees and keep asking " are there any other fees? " Ask this at least five times. 4: Can my patient lab values be downloaded directly into structured data fields at no cost to me? The variation in response to these issues has lead good docs in many directions. Pamela Wible in Eugene OR uses a $99 file creating software on her Mac. Many on the Practiceimprovement list use Amazing Charts at a fraction of the cost of the big vendors. Some elect the all encompassing big solutions like GE's Centricity, while employed docs are usually forced into monster vendor solutions like Epic or Touchworks. Putting all rantings aside, I recommend an approach championed by Clemensen and others: use simple off the shelf components that will work as a unified whole (with effort on your part and/or hired help of an IT support person). This is a very inexpensive solution that allows you to swap out any parts that don't work well for you. The monolithic vendor solution locks you into that vendor. If they have parts that don't work well for you (a common experience), you're stuck. Gordon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2008 Report Share Posted January 7, 2008 On Jan 7, 2008 5:06 PM, Cayuga Family Medicine wrote: > > I don't think that 90% of all EMR functionality is aimed at billing. I use I think he was referring to the requirement to generate copious notes to justify the level of billing, and not the billing per se which is a PMS function. > And as I said, practice partner is not perfect. In order to do a really > intricate search (all diabetics with LDL over 100 who haven't had a visit in > three months), most users export the data to a different database search Synapse can do this But I would have thought most users would get a copy of Crystal Reports and query the database with that. > engine and manipulate the data there. And that is the future of medicine - > being proactive and finding those people who need flu shots and asthma > visits and better BP control. The other future of medicine is using > technology to connect better with your patients - for convenience like them > scheduling their own appointments and for teaching like use email and web > sites to get them needed information - and then getting paid for the extra > time it takes to educate them. > Good luck with the getting paid ... -- Graham Chiu http://www.synapsedirect.com Synapse-EMR - innovative electronic medical records system Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2008 Report Share Posted January 7, 2008 That's on the tentative agenda as part of a tech workshop. More info to follow soon.... Sharon Sharon McCoy , M.D. Renaissance Family Medicine Irvine, CA Practice history: Solo/Solo, membership IMP out of my home office since Nov. 2006 sabbatical in Siena, Italy for one year 2005-6 academic practice & teaching University of California, Irvine, 2001-2005 large group practice (including OB), Orange, CA, 1995-2000 small group practice (including OB), Seattle, WA 1994-1995 Residency University of Washington, Seattle, WA 1991-1994 At 09:04 AM 1/6/2008, you wrote: Amen Gordon! Can we do a short present on " off the shelf " do it yourself integration at the June Rochester summit? Matt in Western PA Dr Levin Family Medicine Western PA, east of Pittsburgh Solo since Dec 2004 Residency completed 1988 User of SOAPware since 1997 User of Appointmentquest.com for online appointment scheduling since May 2007 User of RelayHealth for secure email with patients since June 2007 Technology and Practice Management consultancy Contributing Volunteer Editorial staff of Family Practice Management at AAFP Office Fax Musings on EMR The whole field of EMR is vast and chaotic. My comments below are not meant as a blanket indictment of the EMR creators or vendors. They are responding to the demands of the market. Nor are EMR creators & vendors uniform in their product, pricing, quality, support. The problem is that - like The Invasion of the Body Snatchers - U.S. has been consumed from the inside out by administrative trivia masquerading as health care and sucking the life out of us all. EMR first and foremost is a vehicle for coding and claims. The game seems to be to enhance our ability to " win " at the E & M documentation and coding game so we can justify codes that bring greater payment. I'd say that 90+% of all EMR functionality is aimed at this issue. If we didn't have to spend such an immense amount of our time justifying our work to insurance clerks, I think that most of us would find the current approach to electronic records irrational and not worth the cost. If one accepts this perversion of health care as " justification of administrative trivia to satisfy clerks " then one chooses EMR based on the ability to simplify capturing that trivia in a manner that is minimally difficult to you. This means that the best EMR is one that suits your personal style of practice and modes of computer interaction. If you dictate well, type poorly, but can stand correcting mistakes, choose an EMR that facilitates voice recognition technology. If you like checklists, are facile with a mouse, and have a quick processor, consider an EMR with drop down menus and check lists. If you type well and can use macros, consider EMRs that have text input capability. To truly get the feel of an EMR means spending some time with it, and you'd be best off going to a practice with the EMR in use and getting your hands on to a computer. There are some general questions that would be helpful to answer in advance: 1: Who owns the patient data? As you may have seen on the listserv, some have been burned when switching EMR to find that the data is difficult or expensive to extract or in the worst case is held hostage to large fees. 2: How can I use the tool to assess quality of care? Most will blow smoke in answer to this question. Almost all have some report generating capability, but the reports are built on the typical quicksand of ICD9 and CPT4 codes and are of very questionable value. If the EMR has good QI functionality it usually means that you have to enter data into structured fields - work that most find prohibitively laborious. 3: What are the fees? Like mobile phone companies, EMR vendors are very inventive when it comes to obtaining money and no two contracts are alike. Most will ask for all the money for a multi-year contract up front, but many will agree to lease over time with monthly fees. Check out all the fees and keep asking " are there any other fees? " Ask this at least five times. 4: Can my patient lab values be downloaded directly into structured data fields at no cost to me? The variation in response to these issues has lead good docs in many directions. Pamela Wible in Eugene OR uses a $99 file creating software on her Mac. Many on the Practiceimprovement list use Amazing Charts at a fraction of the cost of the big vendors. Some elect the all encompassing big solutions like GE's Centricity, while employed docs are usually forced into monster vendor solutions like Epic or Touchworks. Putting all rantings aside, I recommend an approach championed by Clemensen and others: use simple off the shelf components that will work as a unified whole (with effort on your part and/or hired help of an IT support person). This is a very inexpensive solution that allows you to swap out any parts that don't work well for you. The monolithic vendor solution locks you into that vendor. If they have parts that don't work well for you (a common experience), you're stuck. Gordon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2008 Report Share Posted January 7, 2008 Over time I've become increasingly dismayed by how much time we spend documenting for the sake of coding and billing, and the dawning recognition of how little this effort has to do with real patient care, and how much it distracts us from the real work we could be doing for our patients. This has less to do with the EMRs -as I noted before the creators and vendors are responding to the marketplace and not setting the policy - I am gagging on the bezoar of minutia I'm supposed to swallow as if it were steaming helping of good old health care. Gordon At 10:42 PM 1/6/2008, you wrote: Gordon, Not that many years ago you talked about how great Alteer was and how it allowed you to open your micropractice. What made you change your mind so drastically? Your article about Alteer and how great EMR is was part of why I went that route. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [ mailto: ] On Behalf Of L. Gordon Sent: Sunday, January 06, 2008 11:58 AM To: -yahoogroups.com Subject: Musings on EMR The whole field of EMR is vast and chaotic. My comments below are not meant as a blanket indictment of the EMR creators or vendors. They are responding to the demands of the market. Nor are EMR creators & vendors uniform in their product, pricing, quality, support. The problem is that - like The Invasion of the Body Snatchers - U.S. has been consumed from the inside out by administrative trivia masquerading as health care and sucking the life out of us all. EMR first and foremost is a vehicle for coding and claims. The game seems to be to enhance our ability to " win " at the E & M documentation and coding game so we can justify codes that bring greater payment. I'd say that 90+% of all EMR functionality is aimed at this issue. If we didn't have to spend such an immense amount of our time justifying our work to insurance clerks, I think that most of us would find the current approach to electronic records irrational and not worth the cost. If one accepts this perversion of health care as " justification of administrative trivia to satisfy clerks " then one chooses EMR based on the ability to simplify capturing that trivia in a manner that is minimally difficult to you. This means that the best EMR is one that suits your personal style of practice and modes of computer interaction. If you dictate well, type poorly, but can stand correcting mistakes, choose an EMR that facilitates voice recognition technology. If you like checklists, are facile with a mouse, and have a quick processor, consider an EMR with drop down menus and check lists. If you type well and can use macros, consider EMRs that have text input capability. To truly get the feel of an EMR means spending some time with it, and you'd be best off going to a practice with the EMR in use and getting your hands on to a computer. There are some general questions that would be helpful to answer in advance: 1: Who owns the patient data? As you may have seen on the listserv, some have been burned when switching EMR to find that the data is difficult or expensive to extract or in the worst case is held hostage to large fees. 2: How can I use the tool to assess quality of care? Most will blow smoke in answer to this question. Almost all have some report generating capability, but the reports are built on the typical quicksand of ICD9 and CPT4 codes and are of very questionable value. If the EMR has good QI functionality it usually means that you have to enter data into structured fields - work that most find prohibitively laborious. 3: What are the fees? Like mobile phone companies, EMR vendors are very inventive when it comes to obtaining money and no two contracts are alike. Most will ask for all the money for a multi-year contract up front, but many will agree to lease over time with monthly fees. Check out all the fees and keep asking " are there any other fees? " Ask this at least five times. 4: Can my patient lab values be downloaded directly into structured data fields at no cost to me? The variation in response to these issues has lead good docs in many directions. Pamela Wible in Eugene OR uses a $99 file creating software on her Mac. Many on the Practiceimprovement list use Amazing Charts at a fraction of the cost of the big vendors. Some elect the all encompassing big solutions like GE's Centricity, while employed docs are usually forced into monster vendor solutions like Epic or Touchworks. Putting all rantings aside, I recommend an approach championed by Clemensen and others: use simple off the shelf components that will work as a unified whole (with effort on your part and/or hired help of an IT support person). This is a very inexpensive solution that allows you to swap out any parts that don't work well for you. The monolithic vendor solution locks you into that vendor. If they have parts that don't work well for you (a common experience), you're stuck. Gordon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2008 Report Share Posted January 7, 2008 The insurers expect that you should be remunerated appropriately when you deliver better outcomes based on EBM etc. Yet, the whole insurance system is delivering a lower outcome for the USA compared with other countries. There appears to be a disconnect here ... don't the insurance execs suffer with some cognitive dissonance? > > > > > > > Over time I've become increasingly dismayed by how much time we spend > documenting for the sake of coding and billing, and the dawning recognition > of how little this effort has to do with real patient care, and how much it > distracts us from the real work we could be doing for our patients. > > This has less to do with the EMRs -as I noted before the creators and > vendors are responding to the marketplace and not setting the policy - I am > gagging on the bezoar of minutia I'm supposed to swallow as if it were > steaming helping of good old health care. > > Gordon -- Graham Chiu http://www.synapsedirect.com Synapse-EMR - innovative electronic medical records system Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2008 Report Share Posted January 7, 2008 Not as long as they are busy counting their millions, Graham. I would like to tell you what they suffer with but it would not be polite. Love Jean Re: Musings on EMR The insurers expect that you should be remunerated appropriately when you deliver better outcomes based on EBM etc. Yet, the whole insurance system is delivering a lower outcome for the USA compared with other countries. There appears to be a disconnect here ... don't the insurance execs suffer with some cognitive dissonance? On Jan 8, 2008 7:33 AM, L. Gordon < gmoore@idealhealthn <mailto:gmoore%40idealhealthnetwork.com> etwork.com> wrote: > > > > > > > Over time I've become increasingly dismayed by how much time we spend > documenting for the sake of coding and billing, and the dawning recognition > of how little this effort has to do with real patient care, and how much it > distracts us from the real work we could be doing for our patients. > > This has less to do with the EMRs -as I noted before the creators and > vendors are responding to the marketplace and not setting the policy - I am > gagging on the bezoar of minutia I'm supposed to swallow as if it were > steaming helping of good old health care. > > Gordon -- Graham Chiu http://www.synapsed <http://www.synapsedirect.com> irect.com Synapse-EMR - innovative electronic medical records system Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2008 Report Share Posted January 7, 2008 I'm not too au fait with how things work yet in the USA. Here we bill patients directly. If they have insurance, they make their own claims. Not our business. Why can't that work the same way in the USA? You produce an itemized bill of work done .. the patient can surely verify if a ROS was done or not etc. > Not as long as they are busy counting their millions, Graham. > > I would like to tell you what they suffer with but it would not be polite. > > Love > Jean -- Graham Chiu http://www.synapsedirect.com Synapse-EMR - innovative electronic medical records system Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2008 Report Share Posted January 7, 2008 Yea, they’re in misery all the way to the bank! From: [mailto: ] On Behalf Of Graham Chiu Sent: Monday, January 07, 2008 3:06 PM To: Subject: Re: Musings on EMR The insurers expect that you should be remunerated appropriately when you deliver better outcomes based on EBM etc. Yet, the whole insurance system is delivering a lower outcome for the USA compared with other countries. There appears to be a disconnect here ... don't the insurance execs suffer with some cognitive dissonance? On Jan 8, 2008 7:33 AM, L. Gordon wrote: > > > > > > > Over time I've become increasingly dismayed by how much time we spend > documenting for the sake of coding and billing, and the dawning recognition > of how little this effort has to do with real patient care, and how much it > distracts us from the real work we could be doing for our patients. > > This has less to do with the EMRs -as I noted before the creators and > vendors are responding to the marketplace and not setting the policy - I am > gagging on the bezoar of minutia I'm supposed to swallow as if it were > steaming helping of good old health care. > > Gordon -- Graham Chiu http://www.synapsedirect.com Synapse-EMR - innovative electronic medical records system Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2008 Report Share Posted January 7, 2008 From Drain, Gordon, I certainly love seeing the evolution of your thinking. Thanks for including us. Joanne, the Old MD from Drain. ( I remember the look on your face when I said to you "most credentialing is just BS ) "L. Gordon " wrote: Over time I've become increasingly dismayed by how much time we spend documenting for the sake of coding and billing, and the dawning recognition of how little this effort has to do with real patient care, and how much it distracts us from the real work we could be doing for our patients.This has less to do with the EMRs -as I noted before the creators and vendors are responding to the marketplace and not setting the policy - I am gagging on the bezoar of minutia I'm supposed to swallow as if it were steaming helping of good old health care.GordonAt 10:42 PM 1/6/2008, you wrote: Gordon,Not that many years ago you talked about how great Alteer was and how it allowed you to open your micropractice. What made you change your mind so drastically? Your article about Alteer and how great EMR is was part of why I went that route. Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [ mailto: ] On Behalf Of L. Gordon Sent: Sunday, January 06, 2008 11:58 AMTo: -yahoogroups.comSubject: Musings on EMR The whole field of EMR is vast and chaotic.My comments below are not meant as a blanket indictment of the EMR creators or vendors. They are responding to the demands of the market. Nor are EMR creators & vendors uniform in their product, pricing, quality, support.The problem is that - like The Invasion of the Body Snatchers - U.S. has been consumed from the inside out by administrative trivia masquerading as health care and sucking the life out of us all.EMR first and foremost is a vehicle for coding and claims. The game seems to be to enhance our ability to "win" at the E & M documentation and coding game so we can justify codes that bring greater payment. I'd say that 90+% of all EMR functionality is aimed at this issue.If we didn't have to spend such an immense amount of our time justifying our work to insurance clerks, I think that most of us would find the current approach to electronic records irrational and not worth the cost.If one accepts this perversion of health care as "justification of administrative trivia to satisfy clerks" then one chooses EMR based on the ability to simplify capturing that trivia in a manner that is minimally difficult to you. This means that the best EMR is one that suits your personal style of practice and modes of computer interaction.If you dictate well, type poorly, but can stand correcting mistakes, choose an EMR that facilitates voice recognition technology.If you like checklists, are facile with a mouse, and have a quick processor, consider an EMR with drop down menus and check lists.If you type well and can use macros, consider EMRs that have text input capability.To truly get the feel of an EMR means spending some time with it, and you'd be best off going to a practice with the EMR in use and getting your hands on to a computer.There are some general questions that would be helpful to answer in advance:1: Who owns the patient data?As you may have seen on the listserv, some have been burned when switching EMR to find that the data is difficult or expensive to extract or in the worst case is held hostage to large fees.2: How can I use the tool to assess quality of care?Most will blow smoke in answer to this question. Almost all have some report generating capability, but the reports are built on the typical quicksand of ICD9 and CPT4 codes and are of very questionable value. If the EMR has good QI functionality it usually means that you have to enter data into structured fields - work that most find prohibitively laborious.3: What are the fees?Like mobile phone companies, EMR vendors are very inventive when it comes to obtaining money and no two contracts are alike. Most will ask for all the money for a multi-year contract up front, but many will agree to lease over time with monthly fees. Check out all the fees and keep asking "are there any other fees?" Ask this at least five times.4: Can my patient lab values be downloaded directly into structured data fields at no cost to me?The variation in response to these issues has lead good docs in many directions. Pamela Wible in Eugene OR uses a $99 file creating software on her Mac. Many on the Practiceimprovement list use Amazing Charts at a fraction of the cost of the big vendors. Some elect the all encompassing big solutions like GE's Centricity, while employed docs are usually forced into monster vendor solutions like Epic or Touchworks.Putting all rantings aside, I recommend an approach championed by Clemensen and others: use simple off the shelf components that will work as a unified whole (with effort on your part and/or hired help of an IT support person). This is a very inexpensive solution that allows you to swap out any parts that don't work well for you. The monolithic vendor solution locks you into that vendor. If they have parts that don't work well for you (a common experience), you're stuck.Gordon Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2008 Report Share Posted January 7, 2008 Graham, There are some on the listserv who are not billing insurance at all, and make the patient responsible for dealing with their insurance co as you suggest. Pamela Wible from Eugene, OR is one and there are others. I think Pamela is charging pretty much the same as people are getting reimbursed from insurance companies, i.e., about $120 or $130 for a CPT 99214, which is the code used for the bulk of most doc's office rechecks, I think. Others are doing a boutique type of practice and I think some have figured out how to bill insurance in addition to charging yearly practice membership " dues " . Some people are charging a flat rate of $50-$60 per patient, with no insurance billing. One doc on the listserv is doing this and wrote an article about it for (I think) Family Practice Management Magagzine -- I just can't find the post on the listserv right now, but I found the article quite fascinating from a few months ago. He is seeing about 16 patients a day 4-5 days a week and doing quite well financially. Jerry > > I'm not too au fait with how things work yet in the USA. > > Here we bill patients directly. If they have insurance, they make > their own claims. Not our business. > > Why can't that work the same way in the USA? You produce an itemized > bill of work done .. the patient can surely verify if a ROS was done > or not etc. > > > > Not as long as they are busy counting their millions, Graham. > > > > I would like to tell you what they suffer with but it would not be polite. > > > > Love > > Jean > > -- > Graham Chiu > http://www.synapsedirect.com > Synapse-EMR - innovative electronic medical records system > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 8, 2008 Report Share Posted January 8, 2008 Happy new year to all. The physician Jerry was refering to is Brain Forest in Apex, NC. His clinic is less than an hour from mine, so I paid a visit before he wrote the article. He owns his space and an extra unit which he leases out. He did not include any cost of rent or upfit costs in his article. He is promoting a SEED program to help people set up following his model and he will get 5% of all the gross charges for the next 15 years or so, regardless of where you practie. I do not have any contract with him. His article is http://www.aafp.org/fpm/20070600/19brea.html Here is his site http://prosites-bforrest.homestead.com/ Helen To: From: parkjerryw@...Date: Mon, 7 Jan 2008 23:50:24 +0000Subject: Re: Musings on EMR Graham,There are some on the listserv who are not billing insurance at all,and make the patient responsible for dealing with their insurance coas you suggest. Pamela Wible from Eugene, OR is one and there areothers. I think Pamela is charging pretty much the same as people aregetting reimbursed from insurance companies, i.e., about $120 or $130for a CPT 99214, which is the code used for the bulk of most doc'soffice rechecks, I think.Others are doing a boutique type of practice and I think some havefigured out how to bill insurance in addition to charging yearlypractice membership "dues".Some people are charging a flat rate of $50-$60 per patient, with noinsurance billing. One doc on the listserv is doing this and wrote anarticle about it for (I think) Family Practice Management Magagzine --I just can't find the post on the listserv right now, but I found thearticle quite fascinating from a few months ago. He is seeing about16 patients a day 4-5 days a week and doing quite well financially.Jerry>> I'm not too au fait with how things work yet in the USA.> > Here we bill patients directly. If they have insurance, they make> their own claims. Not our business.> > Why can't that work the same way in the USA? You produce an itemized> bill of work done .. the patient can surely verify if a ROS was done> or not etc.> > > > Not as long as they are busy counting their millions, Graham.> >> > I would like to tell you what they suffer with but it would notbe polite.> >> > Love> > Jean> > -- > Graham Chiu> http://www.synapsedirect.com> Synapse-EMR - innovative electronic medical records system> Watch “Cause Effect,” a show about real people making a real difference. Learn more Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 8, 2008 Report Share Posted January 8, 2008 So, the reason this is not done more frequently is consumer resistance? > > > > > > > Graham, > > There are some on the listserv who are not billing insurance at all, > and make the patient responsible for dealing with their insurance co > as you suggest. Pamela Wible from Eugene, OR is one and there are -- Graham Chiu http://www.synapsedirect.com Synapse-EMR - innovative electronic medical records system Quote Link to comment Share on other sites More sharing options...
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