DSM will be hosting Razor Insights at it’s Clinton office on February 22nd. Razor is certified, has a shared risk model and has the slickest software we have seen yet. DSM will also be taking the opportunity to show off our new insurance programs which are ready and for which we are now accepting contracts (clearinghouse and scrubber). Please come and meet our newest addition to the DSM staff, Usula Mercer, who is dedicated to the new product. As DSM’s insurance consultant, she will be providing the essential training necessary to effectively use the new software. Certified by the ARHPC as a professional medical coder, Ursula has sixteen years of experience in medical office management. In her words “It is my pleasure to work with your administrative and billing staff to produce a better understanding of how our product can work for you.”
Contact Glen or Pam if you are interested in attending, 601 925-6270.
Unless you talk to your IT people frequently, you may not be aware of the equipment that keeps your network up and running. One of the most important pieces of network hardware is the firewall. Through the years I’ve noticed that quite a few DSM customers use the Cisco PIX 501 firewall. They’re small and work well, but they’re reaching their end of life.
Cisco has stopped selling them years ago, and if you didn’t have an existing service contract for the PIX as of July 28, 2009, then you can no longer purchase coverage for support, maintenance, or replacement. The PIX has been around for a while and it might be time to consider an upgrade to a Cisco ASA.
While I would love to go on about the “neat stuff this” and “cool stuff that”, the ASA’s performance and reliability over the the PIX can be summed up by saying…it has faster performance and better reliability. What does this mean to your average user? Well…not much, really. But to the facility administrator, switching to an ASA means up-to-date Cisco support, greater reliability and security for vendors connecting to your network, faster throughput, and enhanced technology such as the ability to use SSL VPNs for remote access to your network.
Generally speaking, it’s better to modify your network before it crashes. A proactive move to an ASA is a good way to ensure that your hospital or clinic has access to important Web sites, vendors, and our rabidly dedicated support staff here at DSM!
Call me or email me with any questions you might have about switching from the PIX firewall to the ASA
On December 15, I reviewed the ONE Electronic Health Record produced by Razor Insights of Kennesaw, Georgia. No pun intended, but it is “one” sight to see. This unique, patient-centric EHR offers CPOE, Nursing Documentation and Pharmacy Management on the Adobe Flex platform. The product was clearly developed by clinicians with real-world experience. The company is managed by a talented team who have actually led and performed installations, upgrades and rollouts of CPOE, nursing documentation and pharmacy management systems to hospitals. From the first look, it is obvious the level of detail this system offers its users. CPOE leverages the OrderView product from First DataBank that provides comprehensive predefined order sentences to speed medication ordering. Additionally, the system allows for fast conversion of existing paper based order sets into an electronic format, and this is completely integrated with the CPOE functionality. The pharmacy system integrates seamlessly with CPOE and allows for tight formulary control, but accommodates handwritten orders faxed to it as well. Nursing documentation is exceptionally well designed accommodating nursing orders, care plans and assessments.
With healthcare driving to one set of standards and interoperability, the company has created a truly unique product to meet this demand. The system comes preloaded with industry standards such as NANDA, LOINC, SNOMED-CT, DICOM and offers functionality such as medication reconciliation, clinical decision support and reporting. These areas not modules or components, but are part of the system. In fact, the ONE Electronic Health Record is a non-modular system that breaks down the traditional walls of departmental hospital systems. With an exciting user interface that is easy to understand and a 90-day implementation cycle, this product can change achieving meaningful use into a pleasurable and economical endeavor.
The insurance forum last week was well attended. We appreciate everyone’s attendance and input on our new insurance system, slated for general availability (GA) in January 2011. The food, catered by Magnolias Catering and Fine Foods was delicious as usual. We must apologize for not providing photos here in the post, we were too busy enjoying seeing everybody and conducting the forum that we just didn’t think about taking photos until after the fact. One great photo would have been our classroom packed with insurance billers from customer hospitals liking what they were seeing on the screen. The billers had plenty of opportunity to suggest additional enhancements. A follow-up post will include a summary. Some of the suggestions were for improvements to the legacy programs and I can say that one particular request has been completed and will be downloaded on customer servers soon. The request was for detail information by payor. Our resolution was to add the ability to include notes and payments on the “Pay Performance Report”.
Those familiar with the “Pay Performance Report” will recognize the following screen:
By responding to “Print Totals Only” with a blank or “N”, the following screen will appear providing the user the option to choose to print notes and/or payments.
Program updates will be scheduled and sent out in December. If anyone wants this particular update sooner, please call Pam Cleveland at extension 6270 to make your request.
Longtime pharmacy partner of DSM, Health Care Systems of Montgomery Alabama has achieved COMPLETE certification on their EMR product. Many of you have the HCS pharmacy already, thought you might be interested. HCS has a unique approach to implementation as well, utilizing their Medication Reconciliation product to facilitate the CPOE. Anyway, the cert is new and still shows as “modular” on the ONC website, it will be updated in a few days on the ONC site, but until then, HCS has provided the ONC cert number which is CC-1112-107740-2. ONC-ATCB 2011/2012.
I don’t want to steal any thunder, so read the following press release for the news straight from HCS:
As customers make EMR decisions, they should not forget that the decision to upgrade the financial server has probably been on hold for, well, way too long. The good news is there are plenty of reasons to upgrade. Price is the actually the best one, but certainly not the only one:
Encrypted disk – The Hitech act imposes onerous reporting and notification responsibilities on any security breach when the disk is not encrypted. We have installed encrypted disk for our customers, and basically you cannot tell the difference in operation, there is no noticeable difference, it just means that if someone stole any data and tried to put it on another server, they would not be able to read it.
Encrypted tape – Do you mail a tape for off-site backup? Do you take a tape home or offsite. These are all security risks. The new systems can provide encrypted tape backup which will allow these scenarios without a potential security breach.
Elimination of interactive “governor” – “in Birmingham they love the guv’na”(Lynyrd Skynyrd), but nobody with an IBM i-series ever loved the interactive job governor. The governor is gone in the new Power I machines, and good riddance because you can tell it. Not only does the new Power I have an enormous amount of power over the old servers, it doesn’t have the “guv’na”.
Big tape – in Seinfeld you had the “Big salad” episode, on the new Power I you can get the “big tape”. The LTO is a terrific tape drive capable of 800Gb of backup per tape, making it possible to do an ENTIRE system save in under 30 minutes. That has been our experience on our most recent installs.
And more ways….
New and improved RAID – “RAID!” Remember the commercials with insects scrambling for cover, well it’s not that kind of RAID and you already have it on your server. RAID-5 protects the system in the event of a disk failure, keyword “a” disk failure. If two drives fail it means reloading the system, big trouble. With the new Power I, you have the option for RAID-6 which protects your system for up to two disk failures at one time. Sleep good at night, don’t let the bedbugs bite.
V6 Release upgrade – in 7x24x365 operations our customer hospitals normally cannot spare the time for a full system upgrade, but many customers are running on older IBM operating system releases which are no longer supported. If IBM software maint has expired and you have not renewed, which many of our customers have chosen to not renew, the software maint and penalty is expensive. A new system will come pre-configured with the latest operating system upgrade, saving a huge headache of having to upgrade in place and the money for that software maint mentioned previously can be saved.
Large disk capacity – Remember the recent DSH audits for years past? With the big disks you can take the past WITH you. In college we used to talk about “some day computers will have a terabyte of disk”, well that day is here. How many do you want? We wouldn’t sell it without at least one!
Gigabit Ethernet – what kind of bandwidth do you have now? And after EMR implementation? Say goodbye to the 100MB adapter, Power I is Gigabit, with several ports for redundancy.
And last but not least…
Windows 7 Support! Only “supported” with V6 or greater
POWER 7 and Release 7: The incredible new Power7 processors are out along with Release 7 of the operating system. More information will be coming on these announcements.
Like there’s not enough out there to worry about…..
There’s a type of spyware that’s been going around for a few years known as “rogue spyware”. Basically they look legitimate with their Windows-style popups warning you of some impending doom if you don’t immediately scan your computer. If you choose to scan, then the spyware takes over your system, finds some bogus infections, and offers to fix the problem (for a fee, of course).
To the untrained eye, trying to discern whether the infection warning is real or fake is like trying to find the difference between whether it’s live or Memorex! If you get an infection warning on your PC, and the hairs on your neck stand up, and you get that sinking feeling in the pit of your stomach, and an unexplainable anxiety washes over you, and you’re not in a campy horror movie, then call me. I’ll take a quick look at the message and find out if it’s legitimate or bogus.
The latest rogue spyware I’ve encountered is Thinkpoint. Normally, this type of spyware feeds you a steady diet of annoying popups, but doesn’t actually stop you from using your computer. Not Thinkpoint. Oh no! Thinkpoint starts up when Windows boots, hijacks your computer, and keeps you from getting to your desktop.
If you see this screen then, sadly, it’s too late. The fix is pretty simple, but it involves deleting and changing some critical registry entries that, if done incorrectly, could turn your PC into an attractive and rather ineffective paperweight.
Thinkpoint is an extreme case, but that’s not to say that you can’t catch some other malware infection. There are several common sense things you can do to minimize your chances of getting infected.
1. Don’t install unauthorized software on your PC. I know that new Fabio screen saver is irresistible, but do you really know where it’s coming from? Think about it…if a stranger stopped you on the street and offered you a brownie, would you eat it? Same principle!
2. If you do get infected, don’t ignore it. Like running from the cops, it will usually turn out badly. Talk to your IT people or call me if your PC gets infected.
3. Keep your anti-virus running and updated. This one’s pretty straight-forward, so there’s nothing cute to say about it, but if I think of something later I’ll silently pretend you thought it was funny.
4. Keep Windows updated. This one’s pretty straight-forward, too. so…there’s nothing cute yada yada yada…..
Catching some sort of funky malware is a part of using Windows, it seems. So if you find yourself in this position, give me a call at 601-925-6279 and I’ll solve the problem.
Already have a Laboratory Information System that’s working for you? What about a Pharmacy Information System that your pharmacy department likes and uses? How about an ADT and Patient Financial system like HDMS that has years of patient data in it already and everyone already knows how to use? You DO NOT have to replace them to meet meaningful-use…
DSM has partnered with a leading provider of electronic health record (EHR) solutions. Relware, a provider of a natively web-based enterprise software for hospitals called EXR, is working with DSM to offer its clients access to a 100% web-based, configurable, enterprise-wide EHR that will integrate seamlessly with your existing ADT, Lab, Radiology, Pharmacy and other departmental ancillary systems.
We realize that one size does not fit all – this EHR will allow organizations to not only define templates for views, but all users can “personalize” their EHR view to suit their needs, their workflow and their specialty. We believe that if you let the users have input into how the system looks and feels they will be more apt to use it – which in turns drives adoption. Adoption is directly related to meaningful-use.
Not only will your users use it, it will save your organization money. You can save hundreds of thousands of dollars by not replacing existing systems. Not only in the cost of replacement, but also in the disruption of work and retraining of departmental users. Best of all, you have the option of hosting the solution yourself or we can deploy as Software as a Service (SaaS).
EXR was built with Henry Ford Health System in Detroit, Michigan. At Henry Ford they call the EHR project “Care Plus Next Generation” (CPNG) and will support 14,000 registered users across 8 hospitals with a total of 2,900-beds, close to 100 clinics and the 1,100 physician Henry Ford Medical Group. We have brought forward almost 25-years worth of clinical data into the new system. Henry Ford will keep all of their departmental systems in place and put this EHR on top of everything to meet meaningful-use.
DSM’s new insurance programs include a dashboard. We have dashboards in our cars, what’s a dashboard doing in an insurance system? The term “dashboard” is commonly used now to describe what in the past might have been the “menu”, but that term just doesn’t quite cut it for the more modern applications. An automobile’s dashboard organizes and presents information in a way that is easy to read and for that reason the term has been adapted to computer applications that try to do the same thing. OK, now that’s out of the way, let’s look at how the new DSM “dashboard” organizes and presents information in a way that is easy to read.
Just like the “oh” meters in your car, the left side of the dashboard has graphics to tell you things like, how many unfiled claims there are, how many have been filed, how many are unpaid etc.
This dialog box which is part of the dashboard, let’s you choose what you want to see.
Once the user chooses, filed claims for example, then the user specifies what period to review, today, yesterday, a week etc.
If you don’t like pie charts, you can choose a bar chart:
The right side of the dashboard helps you keep up with the work flow, allowing the user the choice of viewing claims that have failed the scrubber, been denied, are unpaid as well as messages the system uses to inform the user of any important situations.
By double clicking on the patients displayed in the “failed scrubber” view, the claim can be reviewed with the results of the scrubbing.
These are just the options that we have added so far, additional options will be added, but we think it’s the way to go, hope you do too!
The DSM programmers didn’t skimp on anything in designing the new programs for 5010. No, really, I mean they didn’t skimp on ANYTHING in 5010. ALL FIELD SIZES ARE TO 5010 MAXIMUM LENGTHS. This “design to the max” philosophy might have been considered a waste in the past, BUT due to new technologies which increase disk sizes, compress transmissions, and compress the backups, our programmers have taken the high road to system design.
Attrition of programs by regulation has always been the bane of healthcare programmers. The problem with regulation requirements is the simple fact that new fields, field lengths, types and how the data is captured cannot always be anticipated by program designers. Typically the regulations come from entities interested only in a particular end result. The assumption is that any obstacles created by their legislation will be overcome without any problem. And if problems do arise, it’s not THEIR problem. Luckily, the regulators are mostly right. The programmers do overcome the problems but the inability to foresee changes has resulted in solutions that would have benefited from “design” rather than “accommodation”. The lack of the ability to foresee requirements has been one of the most limiting factors in healthcare program design. In recent years standards have helped to mitigate this hindrance, but it has not eliminated it. The fact that 5010 is an upgrade within the X12 standard helps a lot, but without committing to a re-design can cause obstacles which cannot be appreciated by the end user.
Our new programs have benefited greatly in the area of supporting file design. After years of experience with submitter ids, taxpayer ids we have designed the supporting files to be able to accommodate changes in these areas that normally only programmers and support personnel have to deal with. This makes our staff better able to react to changes at the intermediary level.
Our Claredi Classic relationship for testing our claim transmissions way in advance of 5010 is another tool in the hands of our programmers. No longer do the programmers have to wait for testing from the intermediary. Instead, changes are tested immediately by mock transmissions to our partner for confirmation or identification of any problem in the format.
An example of the type of solution we are avoiding by re-design would be what I saw often in the year 2000 programming (Y2K) done by some of our competitors’ programmers. When working with their files we often would find a date minus the century, only to find the century for that date in another field in another record. These “accommodation” programming methods even had names, “re-partitioning” and “windowing”. Those were cool sounding names for what were really bad solutions born out of desperation. Believe it or not many of our competitors still have these poor database designs within their products. (Rest easy, all dates in the HDMS product were made to include the century, “re-sizing” is the cool name and it is the ultimate solution). One might say that the year 2000 should have been anticipated, it’s not like legacy programmers didn’t know it was coming. Yes, but most programmers thought they would never face it!
Experience is a dear teacher and we have applied our experience to predict where regulations are going and the programmers have made educated “guesses” with respect to what areas are going to be addressed next by regulation. The “Y2K” accommodations mentioned above might be necessary to transition ICD9 to ICD10 without re-design. The problems most software companies face is that there is no space for the additional characters, just like in the Y2K situation. The new 5010 addresses ICD10 which positions our new programs for ICD10 as well.
Our design decisions will mean the ability to accommodate field changes for years to come, without the need to do re-“partioning” or “windowing”, the euphemisms for legacy work-arounds. But our new design decisions will not cause the new product to run off and leave our legacy applications. Rather, the new browser based graphics make it easier to get to and use the legacy apps.
For example, note the tabs on the top of the insurance screens. Click the “image” tab for images captured in our eBOSS scanning module.
Click the “Eligibility” for eligibility information received from Passport. “Notes” for the account notes that show maintenance changes, FC changes etc.
The most important design difference is the legacy insurance system in use by our customers was designed around clerks building claims as accurately as possible before transmission and the new insurance system is designed around the computer programs building claims accurately for automatic transmission without clerical intervention. Only rejected claims will require attention by the insurance clerks to work the exceptions. That’s where our clearinghouse and claim scrubbing partners come in, to exploit the opportunity to get clean, paying claims through without intervention.