And the survey says…

Posted on March 7, 2012 by Karen Walters, D.C.

Once again chiropractors in Wisconsin have been surveyed by the Wisconsin Chiropractic Association with regard to the EHR software they use.  And the results might surprise those of you who rely on the hype that abounds in magazine ads and on websites.

Over 100 responses came in for this survey, which includes systems noted at the end of this blog entry. The first thing I noticed was that ECLIPSE users dominated the responses with close to 20% of the total. There was only one response from a Platinum customer. Apparently, chiropractors in WI remain blissfully unaware that Platinum (as decreed on Platinum’s website) is the “#1 chiropractic software worldwide.”

Chiropractors reported costs and rated Support & Ease of Use separately on a 7 point scale where a “7” reflected high praise and a “1” … well, you can guess. It gets interesting when you look at these scores and compare them with how much the doctors paid for each system. (For the record, we’re not based in or near WI and had no ties to or knowledge of this survey.)

Let’s compare a few systems. But first, we’ll ignore costs for the 5 ECLIPSE offices which noted “free upgrade” in the Cost column – the only free upgrades noted in the entire survey – because that would simply skew the results in our favor. So, here’s the table for three systems:

System Average cost Support Ease of Use
Average score Lowest score Average score Lowest score
ACOM/Rapid $14,190 4.75 1 4.5 1
ChiroTouch $11,085 5.08 3 5.16 1
ECLIPSE $2,500 5.53 4 5.53 4
Support was rated on 7 point scale with “1” being “Horrible” and “7” being “Terrific”
 Ease of use was rated on a 7 point scale with “1” being “Difficult” and “7” being “Easy”

I’m sure you’ve noticed that the lowest cost system is also the highest rated?  Also, I only included systems with 9 or more responses. Otherwise, it becomes more difficult to place results in any sort of context. So, with the largest # of reported results, when it came to unhappy chiropractors giving their systems a low score, note that ECLIPSE users were generally a happy group.

Now, let’s discuss those “free upgrades” that 5 chiropractors noted in the cost column. We believe this survey was about Meaningful Use and the $44,000 most doctors crave. Why was ECLIPSE the only software that doctors didn’t have to pay a premium for – even if they already owned it – in order to qualify for Meaningful Use funds? Other companies in this survey often preface news releases by noting their leadership and citing instances where they’re “giving back” to the profession. This is a perfect example – in an independent survey – of how we give back to the profession every day by intentionally keeping prices low. And of course, though we shy away from words like “leader,” ECLIPSE was certified months in advance of the October 1st, 2011 deadline that allowed ECLIPSE users to receive an $18,000 payment during the first year of the program… a claim that products like ChiroTouch can’t make.

To the best of my knowledge, ECLIPSE is the only system that’s been independently reviewed over a course of decades by multiple generations of chiropractors: in 1988 by NYSCA, and in 2001 and 2011/2012 via WCA surveys. Shouldn’t that tell you virtually everything you need to know before you buy a system?

When ECLIPSE debuted in 1985, Logicomp, Parker (Yes… that Parker) and PDR were the hot systems to buy nationwide. Every chiropractor knew this. One of my professors at NYCC enthusiastically endorsed PDR. The Parker rep even flew his own plane to NJ to provide a product demo. And I’ll bet you’ve never even heard of them… because as big as they were… they’re now all out of business. ECLIPSE has demonstrated that it can stay current in your office for your entire career. How many of your colleagues are still on their first computer system?

Systems mentioned in the survey include: ACOM/Rapid, Chart Talk Chiro Quick Charts, Chiro 8000, ChiroAdvantage, Chironotes Complete, ChiroTouch, Clinic Pro, Compulink, CTR-X, EMR Datacenter,Epic, EZ Bis, EZ Notes, Future Health (E-Connect), Lytec, MacPractice, Medicfusion, Medinotes, My EMR Free, Office Ally, Platinum, Practice Fusion, Practice Studio, Quick Practice, Quixote, Vericle, Virtual Office Suite, and WritePad.
All product names mentioned above are trademarks of their respective owners.
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ECLIPSE, Credit Card Processing and The Cloud

Posted on January 4, 2012 by Mike Norworth

In November 2010, I purchased a case of wine as a gift for the upcoming holidays. Rather than wander into my local liquor store, I ordered from winelibrary.com. The recipient was delighted with the gift. And that was the end of it. Until yesterday.

I received a letter from Wine Library informing me that their servers had been breached and that my personal information…

“including your name, credit card information (including the three or four digit code on the back of the card and the expiration date) and website user account information (including passwords, user names, billing addresses, and shipping addresses) was illegally accessed or taken from our website  by computer hackers sometime between October 20, and November 7, 2011.”

This went on for two pages! Of course, they didn’t even know they’d been breached until customers started contacting them. Anyway, perhaps you’re wondering what this has to do with ECLIPSE?

The above scenario can’t happen to ECLIPSE users. ECLIPSE is PCI compliant and doesn’t store credit card numbers locally on your computer, so patient credit card numbers are theft proof in the event your system is compromised. Thus, when you take advantage of automated, recurring credit card processing with flexible payment plans, you don’t have to worry about what happened to me. Because it can’t happen to your patients.

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What happens when the lights go out?

Posted on December 17, 2011 by Mike Norworth

The email excerpt below was sent to physician clients by a cloud based, ONC-ATCB certified company that recently decided to halt business operations:

“After months of effort in an attempt to survive the ongoing economic crisis, Redpine Healthcare Technologies, Inc. (“Redpine”) has made the difficult decision to discontinue business operations.  Effective immediately, Redpine will no longer be able to provide billing services.  In addition, as of the end of the month, Redpine will no longer be able to provide software for the benefit of its customers.”

First… what happens to your data? According to the email:

“Redpine is beginning the process of compiling all provider data from our internal files and will provide that data to you as soon as possible. We recommend discontinuing the use of Redpine software on any new transactions (we may be able to help you with current transactions and all new transactions will be entered into the new system within a matter of days).  We also recommend that you print all outstanding claims currently in your system. While doing this you will want to select “print soap notes” with HCFA, this will give you a complete patient visit record for all outstanding claims.”

There’s hope there… but no guarantees. Notice use of the term “HCFA?” The Health Care Financing Administration changed it name to CMS years ago. Why are they using antiquated terminology? Anyway, I digress. Here are a few points that come to mind:

  • There’s no guarantee that you’ll receive your data in a situation like this. What will you do? Sue a defunct corporation?
  • There was no hint whatsoever that the company would cease operations. Doctors must now scramble to rush new systems into place. If you had control of your data, this wouldn’t be an emergency. You’d be able to look for alternatives in a controlled manner. Better yet, if you were using a program like ECLIPSE, where all the data is exposed via ODBC, you could easily hire a programmer to move some or all of your data to a new environment at your leisure.
  • Timing! Typically, this is the time of year when any outstanding billing needs to be completed before the next calendar year.
  • HIPAA!!! You must have absolute faith that your data will be handled in a HIPAA compliant manner. ‘Cause if it isn’t, it’s your responsibility. A smart move might be to consult an attorney with relevant experience about the possibilities.

And let’s not forget the potential loss of various comments, reminders, and day to day notes with respect to patient care, follow-up, and billing. Also, during any transition to a new system, a variety of patients may ”disappear through the cracks.” And they won’t be noticed until too much time has passed to get them back. So… think about the revenue lost to your practice.

According to the same email:

“We have contacted numerous EHR systems and billing services on your behalf and have found a solution that is consistent with the level of service you are accustomed to, all the while offering an expedient transition process that promises to minimize cash flow disruption.”

Perhaps it’s great that they’re attempting to mitigate the problems you’ll face (which may help the principals avoid lawsuits and/or class action litigation). However, this means that you don’t get the opportunity to make the selection yourself. And they didn’t contact us. But again, I digress.

Anyway, trusting your computing solely to the cloud has the advantage of “anywhere/anytime” computing. Does that outweigh problems like this? Put yourself in the shoes of doctors who have to complete their billing before the end of December (the email we received was dated 12/7/2011). And keep in mind that, outrageous claims and promises aside, this can happen to any company.

ECLIPSE provides a local database and internet accessibility simultaneously. Only you or your power company can turn off the lights.

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Size Matters

Posted on December 7, 2011 by Karen Walters, D.C.

Today, we’ve been receiving calls from doctors who are ready to panic. Here’s an excerpt of the email from their software vendor:

“After months of effort in an attempt to survive the ongoing economic crisis, Redpine Healthcare Technologies, Inc. (“Redpine”) has made the difficult decision to discontinue business operations.  Effective immediately, Redpine will no longer be able to provide billing services.  In addition, as of the end of the month, Redpine will no longer be able to provide software for the benefit of its customers.”

Apparently, many doctors purchased this software as a direct result of an endorsement by a reputedly neutral party. Unfortunately, this is far from atypical. For example, in June 2004, the American Chiropractic Association strongly endorsed a system:

“The American Chiropractic Association (ACA) proudly announces its endorsement and exclusive distribution of Chirocere, an innovative, Web-based service designed to revolutionize the management of chiropractic offices. The new Chirocere service not only reduces overhead costs, but also streamlines clinical and administrative operations for practice of all sizes, leaving doctors of chiropractic free to spend more time caring for their patients.”

Sadly, this was also a short-lived venture and the product and company have been gone for years — with your money. However, such endorsements are common. In fact, we’ve been offered numerous endorsements over the years as well… for a fee. When a speaker at a seminar you’ve attended endorses software, odds are high that some form of compensation is involved. We don’t pay for endorsements. Period. Yet, at any given time, the principals of  major state and national associations use ECLIPSE, and a variety of practice management consultants recommend us to their clients.

A Google search related to Redpine indicates that they’ve likely defaulted on at least $350,000 in taxpayer funds that they accepted from Bay County, FL in exchange for relocating to Panama City, FL — where they were expected to create 410 new jobs by 2015 at an average annual salary of $49,000.

If you review the “Size Matters” video on our website, we’ve warned about this for years. Remember, cool websites can’t answer the phone. There’s a reason you should take a company’s track record into consideration before falling for a sales gimmick or pricing that can’t support a company’s long term growth. ECLIPSE has been around now for better than 25 years. And far from becoming stodgy and shopworn, the software continues to incorporate state of the art enhancements, small & large. More to the point, as a company, we don’t owe money to anyone. And our operations aren’t backed by investors. Doctors have gone out of business while they wait for such snafus to get resolved once their billing is affected. Don’t be one of them. Your software is an integral part of your practice.

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ECLIPSE & ODBC: Under the Hood

Posted on October 20, 2011 by Mike Norworth

From 1985 through 1999, ECLIPSE had a proprietary database – designed by me. Performance was as much as 1000 times faster than competitive products. (I received research credit for some of these innovations as part of my graduate studies in computer science.) Of course, there were trade-offs…

So, 15 years later, in 2000, we moved to a widely used, well-documented, commercial database that specialized in high-performance systems. The new database added a new twist – it was ODBC compliant, which provided an immediate advantage to clients. Today, companies from across the United States have used ODBC to customize ECLIPSE, and some have released  their own complementary products to handle electronic sign-in, allow patients to schedule their own appointments, etc.

With an inexpensive ODBC driver, you can create customized reports, databases and screens to link to and access your ECLIPSE data without waiting for us to fit your needs to our agenda (which is affected by thousands of offices)…  We try to handle “macro” issues – issues that affect all clients (e.g. Meaningful Use certification). ODBC allows you to handle your own “micro” issues – issues more likely to be specific to your office.

For example, one of the unfortunate things I’ve learned after more than two decades handling thousands of clients is that, when it comes to bills & statements, it’s rare that I can find three offices that agree with one another on the perfect statement. In fact, each office’s concept of “acceptable” seems to vary widely. ODBC allows you (if you’re a “power user”) or a professional programmer to create custom statements and reports with nothing from us but a set of specifications. You can even use off-the-shelf products such as Crystal
Reports to interact with most ECLIPSE data. Companies that specialize in creating reports for ECLIPSE can usually be found on the GalacTek website or by calling the HELP Desk.

Among other things, this also means that terms like obsolescence don’t need to enter your vocabulary. (How many of your colleagues have replaced obsolete software over the past 25 years?). An open database means you can add features or port the entire database without worrying about the integrity of your data. And most data — including financial data that relates to the entire practice — can be directly accessed from programs that have an ODBC interface. Finally, an ODBC  interface means you interact directly with ECLIPSE data in real time — which is why 3rd parties prefer it.

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Meaningful Use Certifications: Don’t Get Hoodwinked

Posted on October 18, 2011 by Mike Norworth

ECLIPSE became certified for Stage I as a Complete EHR on July 28th, 2011. We began providing clients with all the tools and information they’d need for compliance way back in January 2011… to ensure they’d meet the October 1st, 2011 deadline. And before the end of 2011, our clients were receiving their $18,000 payments.

Here are some interesting quotes I came across today (well after that 10/1/2011 deadline) among companies that sell software to health care providers. According to Company A’s website:

“The certification authority prohibits us from sharing our specific progress and where in the process we are…”

This one (which refers to CCHIT) sounds good… but it’s an outright lie. We kept our clients informed of our progress throughout the entire year as we proceeded through a series of CCHIT certifications. Here’s another quote:

“Company B  just completed their testing for full ambulatory EHR certification and passed. Call (800) xxx-xxxx for further details.”

This was actually on B’s website. Of course, weeks after this appeared, the government’s Certified HIT Product List (CHPL) still doesn’t list them or their products… which means it’s not possible to achieve Meaningful Use if you currently use their software (a certification# is necessary). And by the way, the CHPL site is updated weekly.

And let’s not forget the fear factor. This next quote from Company C precedes a lengthy treatise trying to convince you that achieving Meaningful Us is too much work and has a high likelihood of failure:

“Buying a certified EHR software WILL NOT make you eligible to be paid back from the stimulus package.”

Scare tactics? At this point in time, most physicians should know a colleague who has either attested or been paid.

Then, there’s this one from Company D:

“Are you looking for a Stimulus Solution?
Our EHR Software is fully ONC-ATCB Certified.”

This company isn’t certified at all and you won’t find them on the government’s list. Instead, they’ve aligned themselves with another product that is certified — a fact which they fail to disclose. Who cares? You should. To make a long story short… during the next round of certifications (Stage II), this is likely to cause a problem for all the doctors who purchased the product… and let’s not forget all the extra support fees and higher product pricing.

So, what’s the point? As always, be careful what & who you choose to believe. Companies can play very loosely with the facts when they want to make sales. Earlier in the year both of these companies made statements either online or at shows to the effect that “Meaningful Use” wasn’t relevant to their clientele (chiropractors). How do I know this? Well, Karen actually spoke with a sales person from company A when she attended a seminar in NJ. He told her that Meaningful Use “didn’t apply to chiropractors” and that other companies were simply “jumping on the bandwagon” to make quick sales. The CEO of company B provided an assortment of ”facts” via the internet to the effect that his clients weren’t affected, funding wouldn’t go through (so you had no chance of getting paid), etc.

Apparently, both companies learned their lesson… but now they’re late to the show. And they’ve both missed the first deadline… which allows easier attestation (for you) during an abbreviated time interval. One of them even has a “guarantee.”

We didn’t make any guarantees. We simply pointed out our 25+ year track record and then met all the deadlines. But consider those guarantees. How likely are you to return a product after you’ve spent months entering data into the software? The answer is “Not likely!” And these companies know this. Now, here’s a question you likely never considered: How responsible is a company to its current clients when it risks lawsuits by making guarantees for deadlines that it may not be able to meet… Hmmm.

By the way, I don’t mention names here because they’re irrelevant. Lots of companies play games like this. And most of you never even learn you’ve been hoodwinked.

Sometimes, the adage ”You get what you pay for” doesn’t even begin to cover the eventual problems that unfold. Ask questions before you purchase. Lots of them. At this point in time, we have clients who began their careers with ECLIPSE, used it as their practices grew, and retired without ever experiencing a hiccup. Can I guarantee that for you? Well… of course not!

Addendum (1/2/2012): Some of the software vendors mentioned above still haven’t achieved certification. Many ECLIPSE users received $18,000 CMS payments in 2011.

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Keeping in touch between visits

Posted on October 3, 2011 by Karen Walters, D.C.

One of the myriad items that differentiate practices with high patient retention rates is how physicians interact with patients between office visits. Doctors can & do take technologies to such extremes that they de-personalize the patient.

For example, do you send birthday cards to patients to help you “keep in touch?” Great! Do you place computer generated mailing labels on the envelopes? Uh Oh! And finally, is the entire birthday card computer generated, or does it have a pre-printed label you created inside the card? If so, you’re sending your patients the wrong message.

Generate a list of birthdays weekly or monthly from ECLIPSE and assign a staff member with good handwriting skills to address the cards & envelopes by hand. Either sign them yourself or have your staff member do it. You’ve managed to both utilize technology and brighten a patient’s day. After 25 years in practice I can assure you that odds are high your patient will both remember and appreciate the gesture… and may be more likely to refer friends.

If that’s beyond your capabilities, consider using a service to mail/email personalized cards. However, I’ve always preferred the method above and believe that — even amongst a generation that does everything online — patients will appreciate that you went the extra mile.

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Meaningful Use Myths

Posted on October 1, 2011 by Mike Norworth

Meaningful Use misinformation seems to accrue on a regular basis. I’ll try to regularly update this area as these questions arise. Some are already answered as separate blog entries in this category.

Myth: The attestation process is difficult and most health care providers will need extensive hand-holding and training to get through it.

The Facts: Myriad ECLIPSE users have already attested and received payments by reviewing our blog entry here and reviewing two sections in our online HELP designed to walk you through the process. Here’s a quote from a client who has been through the process: “our office attested to CMS for Meaningful use on October 19, 2011 and received the full $18,000 on November 30, 2011. It was quick and easy.”

Myth: If you don’t charge a minimum of $24,000 in services in 2011, you’re not eligible for any payments.

The Facts: Your payment will be held until the reporting period is complete or you hit the $24,000 threshold. This allows CMS to avoid issuing multiple payments.

From CMS: How and when will incentive payments for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program be made? Incentive payments for the Medicare EHR Incentive Program will be made approximately four to six weeks after an eligible professional (EP), eligible hospital, or Critical Access Hospital (CAH) successfully attests that they have demonstrated meaningful use of certified EHR technology. Payments to Medicare providers will be made to the taxpayer identification number (TIN) selected at the time of registration, through the same channels their claims payments are made. The form of payment (electronic funds transfer or check) will be the same as claims payments. While CMS expects that Medicare incentive payments will begin in May 2011, payments will be held for EPs until the EP meets the $24,000 threshold in allowed charges.

Myth: If you don’t have certified technology in place prior to December 31st, 2011, you can still attest for a 90 day period that began in 2011 (e.g. 10/1/2011 – 12/31/2011).

The Facts: CMS expects you to have certified technology in place before you begin attestation. Whether they’ll actually check dates after the fact… it’s hard to say. In general, this only seems to be a topic of discussion with vendors pursuing software sales with technology that isn’t yet certified.

From CMS: Do I need to have an electronic health record (EHR) system in order to register for the Medicare and Medicaid EHR Incentive Programs? You do not need to have a certified EHR in order to register for the Medicare and Medicaid EHR Incentive Programs. However, to receive an incentive payment under the Medicare program, you must attest that you have demonstrated meaningful use of certified EHR technology during the EHR reporting period. For the first year of payment, the EHR reporting period is 90 consecutive days within the calendar year for eligible professionals (EPs) or within the Federal fiscal year for eligible hospitals and critical access hospitals (CAHs)…

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Interacting with us via Email

Posted on September 29, 2011 by Mike Norworth

Last night, we attended a dinner party. Larry – who was seated across the dinner table from me – runs an advertising firm with two partners. He proceeded to tell a story about an email he’d received earlier in the day from one of those partners.

As he read, he sensed an underlying tone, which was reinforced by the writer’s use of capitalization. Perturbed, he set it aside. Later, he asked a 3rd party to read the email before he responded. She agreed that his conclusions had merit. Still… he decided that – rather than send back a nasty email of his own – he’d simply speak to his partner about it,
whereupon he learned that his perception was considerably different from his partner’s intent.

The story struck a nerve. I’d had an email situation yesterday as well, and as usual, with a complete stranger. Clients routinely use our website to make suggestions, ask questions, etc.  I often take time from my day to personally respond – a time consuming endeavor. This particular doctor’s suggestion demonstrated that she was unfamiliar with a basic feature – a common problem. We all have similar issues with feature laden software. I responded with information – nothing but the facts. I added CAPS and italics to emphasize specific items. I was trying to be helpful… Her response:

“I’ve taken alot of sarcasm in your response.”

and

“Thanks for the quick response; but you could have removed the attitude.”

I re-read the email. What sarcasm? What attitude? What could she be referring to?

We answer a high volume of email. Perhaps once every few months, someone grossly misinterprets a response. For instance, in 2007, I was exchanging a series of emails with Dr. SK. In the middle of this exchange, he exclaimed: “I am insulted by the way you respond as if I have no idea what I am talking about.” I requested he re-read my
comments and received back the following:

“I appreciate your responses. My wife just reprimanded me for how I responded to you last e-mail. I get a little hot headed when I read into what people tell me. I’m sorry about that.”

Unfortunately, such exchanges are time consuming for everyone. When I take time to personally respond to you, and manage to alienate you in the process, I wonder why I bothered responding at all. But then I recall that your reaction is unusual. So, the next time you interact with us via email (or on the phone), please keep in mind that we’re very busy and have better things to do than antagonize you. Any tone you perceive is your imagination… nothing more. And since better than 99.99% of my email exchanges occur without incident, I would like to think I don’t need to attend an email etiquette seminar.

The irony is that though we go to great lengths to make ourselves available to you, we often can’t win in such situations. When I believe a somewhat detailed explanation might be helpful… you may perceive this as “being defensive.” When I provide facts, you perceive an attitude – as Dr. SK did.  I wish I could provide facial cues, or a disclaimer… Anyway, please, please don’t inject your concept of sarcasm, contempt, ridicule or other negative connotations into my verbiage. Thanks for your consideration.

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ANSI 5010 and ZIP Codes

Posted on September 19, 2011 by Mike Norworth

Once again, it seems I’m writing to correct misinformation doctors are getting en masse at seminars. And once again, keep in mind where my information is coming from. I certified ECLIPSE as ANSI 5010 compliant for electronic claims months ago and have all the official documentation in hand.

Several times in the past week, panic has set in when doctors have been told that all the ZIP codes they submit will have to be converted  to full 9 digit codes. Not true.

Of course, it’s easy to see how such misinformation came to be. So, what’s the story? And what do you need to do? Your address (i.e. billing provider and service facility) must contain a 9 digit ZIP code. This is stated clearly on page 93 of the most recent (February 2011) Consolidated Guide for 837 Professional claims.

So, update the addresses for every provider in your practice that may appear on claims. If you have multiple facilities and treat patients at multiple locations, update those as well. That’s it. It’s not required that you update each patient, guarantor, payer, etc. in ECLIPSE.

If you don’t know your 9 digit ZIP code, you can look it up here.

By the way, ANSI isn’t just about 837. ECLIPSE directly imports 835 electronic remittance, as well as 277 & 999 type acknowledgments. And if the software you use doesn’t create detailed 277 & 999 reports, you have no way of knowing the status of your claims!

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