Getting Started with EHR Implementation

Registration for the ARRA’s EHR Incentive program opened on January 3, 2011. There are three steps you must complete to qualify for the EHR stimulus package under the Medicare or Medicaid program:

  • Implement and use certified EHR technology
  • Demonstrate Meaningful Use
  • Attest for Incentive Payments

Although becoming HIPAA and HITECH compliant is not an explicit requirement, it is implied in the ability to demonstrate the meaningful use (MU).

While implementing EHR and demonstrating MU may seem complex, the hardest part may be getting started. You do not need to have the EHR technology implemented in order to register for the incentive program, implementation can be done after the registration. It is important to note that there are some deadlines to meet to receive the maximum stimulus funding under the Medicare program, so you should get started as early as possible.  An important date to note is October 1, 2011 – this is the last day for eligible professionals to begin their 90-day reporting period for calendar year 2011 for the Medicare EHR Incentive Program.

To help eligible providers understand various aspects of the incentive program, the Centers for Medicare and Medicaid services (CMS) provides detailed up to date information on their website.  You can also register for their listserve which helps eligible providers stay on schedule by notifying the subscribers of upcoming deadlines, new information, FAQ documents, updates on new developments and questions and concerns gathered by CMS from eligible providers.

Another resource is your local technology Regional Extension Center (REC), which is an authorized extension of Health Information Technology Extension Program of HITECH act.  The goal of the program is to provide outreach and support services to at least 100,000 priority primary care providers within two years. The REC offers technical assistance, guidance, and information on best practices to support and accelerate health care providers’ efforts to become meaningful users of Electronic Health Records (EHRs). For Chicago, CHITREC focuses on 606xx zip and offers various information and resources related to EHR.

Register at NetFunction website to learn how we can help you with your EMR and HIPAA/HITECH compliance.

Savings extended to 2011 – Don’t wait to be Proactive

Saving cost is always an important part of a good business plan, but in this sluggish economy, it is even more important than ever before.  To help you save money the IRS has extended the Section 179 tax incentive through 2011.  To take full advantage of the tax savings, you should plan your equipment purchases and include it in the budget now, instead of waiting for the end of the year.

Planning your equipment purchases and including them in the budget now will allow you to take full advantage of the savings instead of waiting for the end of the year. Up to $500,000 can be used to purchase “property” which can be written off as an expense. The “property” can be anything used for business purposes such as machinery, computers, software, office furniture, vehicles, or other tangible goods.

Here are some technology investments you should consider that will provide efficiency and productivity, not only for this year’s tax savings but also for the long term savings, efficiency and productivity:

Core Network – The core IT network is the plumbing that supports both, voice and data communications.  We utilize the network for much more than just sharing resources like printer and fileserver.  We are running line of business applications like CRM which improve productivity; we are utilizing social media, multi media, and other web based applications to communicate with clients and generate demands for our products and services.  To ensure that these and other line of business applications are providing the productivity gains and efficiencies, the core network needs to be able to support the performance and scalability requirements.    A reliable and efficient network improves performance, security and stability of business applications allowing them to do more in less time.

SecuritySecurity has become ever more important in our highly connected, social media driven network.  Most of us are actively utilizing social media and online applications for a variety of purposes, from personal and business communications to marketing and financial transactions. Some businesses in industries like healthcare and retail have to meet regulatory compliance, such as HIPAA and PCI.   Implementing technology which can secure your application, data and users can help your company stay secure and meet your particular regulatory compliance.

Firewall – A firewall is the most rudimentary security control every IT network must have.  However, previous generation firewalls provide protection based on application-port combination, which means they identify applications via the port they access. However, the current browser based applications are delivered over default port 80 and others don’t consistently use the same port. The firewall needs to be able to identify applications such as Twitter, Facebook, IM and others to protect the network and users against the threats delivered through them.  Upgrading your regular firewall to an application aware, unified threat management (UTM) firewall can significantly improve your network protection.

Servers and Workstations – Servers and Workstations are the workhorses; they run the applications and serve the user’s requests.  Previous generation servers and workstations were power hungry and inefficient compared to the latest generation of computers.  By replacing older servers and workstations with “Energy Star” certified servers and workstations you can realize significant savings in energy costs over a year.  Some studies suggest as much 60% savings in energy costs over a period of a year.

Virtualization – Server virtualization has arrived and has been accepted as efficient solution providing cost savings, reliability and productivity.  If you have more than a few servers, you can realize significant energy cost savings, higher reliability and availability by virtualizing them  and consolidating the physical servers.

Telephone System, VoIP and Unified Communications – If you are using older telephone systems, you can significantly improve collaboration with your employees and communications with your clients by upgrading your system to the latest VoIP and unified communications (UC) system.  VoIP and UM are not hype; VoIP and UC systems increase efficiency and productivity by integrating voice, email, fax, CRM and other line of business, point applications; VoIP and UC system can also reduce local and long distance costs and operational cost as a part of the converged network.

Applications – Applications need to be upgraded periodically, not only to ensure we continue to receive vendor support, but also to improve productivity and security.  If you haven’t upgraded your line of business applications, such as Email, CRM, ERP and database servers in a while then you can realize higher productivity, efficient utilization and greater security by upgrading them to the latest version.

Backup, Restore and Business Continuity – How are you currently backing up your data? Are you still using tape backup?  Have you tested the restorability of your data?  Tape based backup is prone to errors and data restoration can be complicated if you have to restore from multiple tapes.  If one of the tapes is damaged all of data becomes non-restorable.  With increasing amount of data being stored on variety of mobile devices, having a proper backup, restore and business continuity solution is critical for any business.  Upgrading your current backup to a disk based backup with offsite data storage can significantly simplify backup, restore and business continuity process and provide efficient protection in the event of a disaster.

As you can see there are many areas of technology you can invest in and take advantage of the tax savings offered by Section 179 which will help you improve core efficiency, provide higher productivity and reduce costs.

Please consult with your accountant to verify the specific equipment and software and the amount which qualify for Tax incentive.

Year End Tax Savings

We are all in a festive mood as 2010 draws to a close. Christmas is only a couple days away and New Year only 8 days away.  However, for many business owners (myself being one), the business is always on our mind. As business owners we are always looking for ways to make our business more efficient by improving productivity and reducing costs.

One way to reduce cost comes in the form of tax savings – Section 179 from the IRS.  According to the recently updated Small Business Jobs and Credit Act of 2010, the Federal Government upgraded a tax deduction,  allowing you to buy up to $500,000 in machinery, computers, software, office furniture, vehicles, or other tangible goods and significantly reduce your taxable income on current year’s tax return by treating qualifying equipment as an expense rather than a capital expenditure.

Computer equipment and off-the shelf software fall under this Section 179 category. If you have been waiting to upgrade your firewall, networking equipment, servers and computers then this is the right time to act as you can expense your purchase and realize a significant tax savings. You can use the Tax Savings Calculator to estimate how much you can save on your equipment purchase.

Additionally, many vendors like Cisco, Trend Micro, Wireheadtec and others are offering significant discounts if you purchase hardware and/or software before year end. The vendor discounts coupled with tax savings can add up to be a sizable savings for any business.

As an added incentive, NetFunction is offering 10% discount on implementation services if you purchase the hardware and/or software from us.  Visit our website for addition information.

Please consult with your tax professional to ensure that your purchase will qualify for the Section 179 tax incentive.

© NetFunction Inc. and Adventures in HIT and BIT, 2010.

Eligibility for ARRA Stimulus Money

The American Recovery & Reinvestment Act (ARRA) provides $20 billion in incentives to eligible professionals to implement certified EMR technology.  However, to qualify for the incentive package a provider must first be eligible to participate in the program and then has to demonstrate “meaningful use” of the certified EMR technology.

To qualify, you must first be eligible to participate in the program.   There are two programs to choose from, Medicare and Medicaid, and they have slightly different requirements.

To be eligible for Medicare program, you must be a:

  • Doctor of medicine or osteopathy
  • Doctor of dental surgery or dental medicine
  • Doctor of podiatry
  • Doctor of optometry
  • Chiropractor

To be eligible for Medicaid program, you must be a:

  • Physicians (primarily doctors of medicine and doctors of osteopathy)
  • Nurse practitioner
  • Certified nurse-midwife
  • Dentist
  • Physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant.

There are additional requirements to be eligible.  CMS provides a flowchart which you can use to determine your eligibility.  If you qualify for both programs, CMS suggests that you should apply for the Medicaid program.

If you are eligible for and select the Medicare program, you can qualify for up to $44,000 of the incentive money.  The incentive is paid over five (5) years.  The incentive will provide you with maximum amount if you start the qualification early, which means in 2011 or 2012; if you wait till 2013 to qualify, you will lose $5000 of the $44,000 and if you wait to qualify in 2014 you will lose $20,000.  There is no incentive money if you qualify in 2015 or thereafter.

There is additional incentive if you predominantly provide services in areas designated as Health Professional Shortage area – your amount of the annual EMR incentive payment limit for each payment year will be increased by 10%.

If you are eligible for and select the Medicaid program, you can qualify for up to $63,750 per doctor. You must adopt, implement, upgrade or demonstrate meaningful use of certified EMR technology in the first year of participation and then demonstrate meaningful use in years 2-6 of participation. For calendar years 2011-2021, you can receive up to $63,750 over 6 years. Incentive payments will be made by the State based on the calendar year.

It is important to note that beginning in 2015 Medicare eligible professionals who do not successfully demonstrate meaningful use will have a payment reduction in their reimbursement. The payment reduction will start at 1% and increase up to 5% for every year that you do not demonstrate meaningful use.

Hospital-based physicians and Medicaid eligible professionals will not be subject to payment reduction. However, if you are also a Medicare Fee-for Service provider and cannot successfully demonstrate meaningful use, you will be subject to payment reduction in your Medicare reimbursement, even if you never received an incentive payment or only participate in the Medicaid incentive program.

The incentive payments are provided based on individual practitioners. In a medical practice, each individual eligible professional may qualify for an incentive payment if they successfully demonstrate meaningful use of certified EMR technology. However, an individual may only qualify under one practice only, regardless of how many locations they provide the service.

Eligible professionals providing 90% or more of their services in a hospital inpatient (Place Of Service code 21) or emergency room (Place Of Service code 23) setting are not eligible for incentive payments.

Registration for Medicare and Medicaid incentive program begin on January 3, 2011; more information can be found at the CMS Registration and Attestation web page.

Register at NetFunction website to learn how we can help you with your EMR and HIPAA/HITECH compliance.

© NetFunction Inc. and Adventures in HIT and BIT, 2010.

For 2015 and later, Medicare eligible professionals who do not successfully demonstrate meaningful use will have a payment reduction in their Medicare reimbursement. The payment reduction starts at 1% and increases up to 5% for every year that a Medicare eligible professional does not demonstrate meaningful use. Hospital-based physicians and Medicaid eligible professionals are not subject to possible payment reductions. However, if you are also a Medicare Fee-for Service providers and cannot successfully demonstrate meaningful use, you will have a payment reduction in your Medicare reimbursement starting in 2015, even if you never received an incentive payment or only participate in the Medicaid EHR incentive program.

Security for Web 2.0

Technology has always been about making our lives easier and one area it has had a significant impact on is communications and collaboration.  Can you imagine our lives without mobile phones, email, text messaging and social media. I am sure we all know people (I know a few) who claim they cannot live without Internet.  Businesses have reluctantly accepted social media tools as they have seen how it helps the employees become more productive, helps improve communications with customers and vendors and helps improve sales.

As the technology has facilitated business communications and collaboration, it has also facilitated security exploits.  A Osterman Research conducted in 2009 found that 55% of large and midsized organizations had been infiltrated by a Web exploit within previous 12 months.  According to Kaspersky Labs security bulletin, “infecting via the Web has, over the past few years, become the main method used to infect victim machines”.  Small and Medium businesses face these same security exploits as they are surfing the same Internet, however they may not have proper resources to secure their networks.

Cybercriminals are one step ahead and are already taking advantage of the social networks and its trust based model. According to Kaspersky Labs security report, “The likelihood that a member of a social network will launch a file or click on a link sent to him/her by a “friend” is approximately 10 times greater than if the file or the link arrives via email”.

A proper defense in-depth security solution should be deployed to ensure effective security in an organization because it takes a comprehensive approach to address the three variables in an organization – People, Technology and Operations.

A Firewall is an essential part of any security solution, but a traditional firewall may not be enough to remediate the security threats posed by Web 2.0.  The new social media applications are utilized over the web browser and the security threats within can bypass the traditional detection techniques.

In order to effectively secure the perimeter a next generation, Unified Threat Management (UTM) Firewall is necessary.  A next generation UTM firewall integrates best-of-breed security and productivity solutions; it integrates key security applications – firewall, VPN, intrusion prevention, and antivirus and antispam, content and application filtering – into the single, efficiently managed solution.  So what’s next generation – it would additionally identify applications delivered over standard web browser; it would identify malicious applications which port hop to evade detection.  This application identification functionality combined with UTM functionality would provide a robust and efficient solution at the perimeter; additionally,  it would consolidate point solutions and reduce administrative and operative cost.

© NetFunction Inc. and Adventures in HIT and BIT, 2010.

Healthcare IT

So HIPAA and HITECH compliance are underway. Fines and penalties have been levied on organizations who fell victim breaches and data loss. Office of Civil Rights (OCR) and Attorney General’s office (AG) can pursue fines on behalf of the people; since they will be allowed to keep portion of fines they collect, we can expect increased compliance efforts from both agencies.

Larger hospitals, clinics and associated practices are already in the process of ensuring compliance (or have plans to get started soon) but what are the smaller, independent clinics and practitioners in the underserved communities doing to ensure compliance? They also need to meet the same compliance requirements, however, they do not have the same resources as their larger counter parts.

Then there is the EMR/EHR portion, which is not really a part of HIPAA and HITECH, but part of American Recovery and Reinvestment Act (ARRA) which provides up to $44,000 per doctor for Medicaid and $63,000 per doctor for Medicare – yes, that’s per doctor and not practice. How can the smaller clinics and practices ensure that they qualify to receive the portion of the $20 billion of the incentive?

Much information is available on the Internet about HIPAA and HITECH compliance, and ARRA EMR incentive.  In an effort to prevent digital divide we will try to distill the information and provide relevant content to help smaller clinics and practices working  within underserved communities to meet HIPAA and HITECH compliance and implement EMR solution.

© NetFunction Inc. and Adventures in HIT and BIT, 2010.

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