ECLIPSE Blog

Perhaps it shouldn’t be a surprise that – even at this late date – many chiropractic & medical physicians are still unfamiliar with the government incentive program for Meaningful Use. So, here’s a very brief overview of the highlights:

• If you treat Medicare patients in your practice, over the next several years, the government will reimburse you more than usual… up to $44,000 per provider over the entire period. The project will proceed in three stages that have progressively more stringent requirements. We’re currently in Stage I – which has the most relaxed participation requirements.
• What’s the goal? As part of the American Recovery & Reinvestment Act (ARRA) of 2009, the federal government wants to improve the efficiency of the health care  system. Years ago, CMS (then HCFA) began offering incentives to doctors who  submitted claims electronically. Now, the goal is to make sure you can share addtional information electronically with CMS (e.g. quality reporting), your patients (e.g. their health records), and public agencies such as the CDC (e.g. immunization data). All these changes are expected to make patient care more efficient & effective.
• In order to qualify for the incentive payments – which are based on the total Medicare or Medicaid fees you charge during the year – you must have certified software. As an ECLIPSE user, you’ve already met the first qualification. The second qualification is up to you. You must meet a series of criteria in your office, which you can read about in detail here. Most criteria are relatively easy to meet via small adjustments to your office procedures.
• It’s likely that you send electronic claims now. Years ago, electronic claims were
  the exception rather than the rule. The current incentives are the government’s
  way of encouraging across-the-board adoption of systems that can share information over the shortest possible time span.
• In a few years, CMS will begin to phase in penalties for providers who haven’t yet adopted certified technology.
• For more information, visit the related CMS site.
• Finally as of this date (9/14/2011), we know of at least one office in UT that has notified us as follows via email. Here are two excerpts: “… The initial process of getting required information entered is time consuming but Eclipse’s quick data entry options speed the process up. Not only have we attested but we have passed the attestation which means for us the check is the in the mail …” and “… So, for those who doubt, doubt no more.  We used Eclipse, we qualified for meaningful use, we where able to run reports for the clinical quality measures, we attested, we passed and now we are waiting for payment…”
• Update: As of December 2011, myriad ECLIPSE users have already received payments of $18,000. For instance, according to Sylvester Chiropractic Centre in NJ: “… 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. And best of all, we received our payment during the first year of availability because ECLIPSE was certified before all the initial deadlines.”

You should be able to find the answers to most questions in the 63 page CMS attestation
guide by visiting two screens in ECLIPSE. If you’re unfamiliar with the term “Meaningful Use,” read a brief overview here. Though it shouldn’t be necessary, an educational CMS video that explains the process step-by-step can be viewed here. You can also read a CMS FAQ document here.

• From the Reports menu, select Patient List. Press F1 for HELP and read about Automated Measure Calculation. This section contains extensive instructions on each and every Meaningful Use measure, how you can meet the requirement in ECLIPSE, and how you can check which patients meet the criteria for that measure for high percentage measure requirements.
• From the Reports menu, open the Audit folder, and select NQF/PQRS Measures. Press F1 for HELP and read detailed information about each of the measures, how they’re assessed for different patient populations, and how you can get the information you need to manually enter the numerator and denominator values for the measures you choose.

It seems many of you remain confused about some of the other information in this guide.
So, let’s start with security. Bear with me since I’m handling these out of order… Let’s review (15 of 15) on page 28 of the guide. You must attest that you have

conducted a review or security analysis per 45 CFR 164.308(a)(1) and have implemented security updates as necessary, corrected security deficiencies as part of your risk management process.

Now, ECLIPSE is certified as a “Complete EHR.” Therefore, it’s certified on all the security measures. Ergo, you can’t implement ECLIPSE in a non-secure way. Hopefully, since the implementation of HIPAA, you’ve regularly reviewed your office security protocols to avoid potential HIPAA violations. So, you should simply be able to indicate “Yes” to the measure.

Next, let’s discuss steps 8 & 9. Step 8 indicates:

“Implement drug-drug and drug-allergy interaction checks.”

Step 9 indicates

“Maintain an up-to-date problem list of current and active diagnoses.”

First, I should point out a very important difference between these two steps. ECLIPSE tracks “step 9” for each of your patients. This step, as you can see on page 19 of the guide, requires a numerator and denominator. In other words, Step 9 has a reporting requirement – step 8 does not.

Let’s pursue a tangent for a moment. As an example, consider email access in ECLIPSE. ECLIPSE can send email, text messages, or bulk email on demand. In fact, the various email features of ECLIPSE are enabled whether or not you have an email account or use the internet. In contrast, consider that your ability to provide educational materials must be specifically enabled by us for your office (we reprogram your sentinel to allow access as per our agreement with the content provider).

Now, if you’re a chiropractor, and you don’t prescribe or review your patient’s drug
regimens, features relevant to step 8 are enabled in ECLIPSE regardless of whether you subscribe to prescription services. Of course, like email, if you want to actually use these features of your program (which you’re welcome to do), you must setup an
account with the service provider.

This is actually a good opportunity to touch upon a related subject. Some of the items we report on are part of the normal HIPAA audit trail we maintain for your patient data. Thus, when you send an email from a patient’s folder, we track it. When you open that patient’s folder, we track it. When you add a problem, we track that too. Our audit trails have helped prosecutors bring convictions, and I’ve personally become involved in audits & investigations across the country where the audit trails we maintain have occasionally helped protect targeted health care providers. Now, since I’ve been discussing steps 8 & 9, this would be a good time to point out that there is absolutely no verbiage or requirement whatsoever with regard to Stage I auditing (by you or us) of an item such as “Implement drug-drug and drug-allergy interaction checks.” If you’re concerned about fraud, don’t claim you’re using a certified version of ECLIPSE when you’re running a copy that’s actually several years old. That will catch up with you by next year.

Most of the remaining parts of the guide are reasonably straightforward and can be handled by referencing the HELP as noted above. It’s unfortunate that some of the existing verbiage has created unreasonable concerns among some health care providers — which isn’t helped by the many “consultants” who like to lecture on the subject. It’s beginning to remind me of 1999, when doctors I know were raiding their bank accounts to make sure they had cash when the banks failed as part of the Y2K debacle. Of course, if all the banks failed, who would actually have any use for cash? We’d be back on the barter system.

As a computer professional with over 25 years of experience in health care, I spent months moving ECLIPSE through the maze to get it ONC-ATCB certified as a Complete EHR with CCHIT. I personally certified ECLIPSE on every possible measure, plowing through extensive test scripts and getting interpretations of test criteria from CCHIT and other sources.

Yesterday, a doctor told us that – when it comes to Medication Reconciliation (170.302j) – he’d rather take the word of all the “experts” he’s seen at seminars who indicated that he must perform medication reconciliation for all his patients.

So let’s examine the facts. First of all, once you own certified technology, the only things you’re responsible for reporting are covered in 170.302n – Automate measure calculation and 170.304j – Calculate and Submit Clinical Quality Measures. You may report on a subset of these – depending on your degree and scope of practice.

Next, let’s examine Appendix A from the CCHIT Automate measure calculation
test script. Here’s the only section that references medication reconciliation:

“The EP, eligible hospital or CAH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation”

Thus, medication reconciliation is performed if a patient meets one of 2 conditions:

• The patient was referred by or otherwise transitioned from another physician to your care.
• You think it’s necessary.

And the requirement for Stage 1 is as follows:

“The EP, eligible hospital or CAH performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP…”

In other words, it’s not required that you actually perform any medication reconciliations unless your practice derives patients from physician referrals (or the patient switched doctors – which falls into the “you think it’s necessary” category in real life). And for patients who meet the criteria, if you perform the reconciliation for just over half of them, you’ve satisfied the requirement. Certified technology should handle both of the above situations and ECLIPSE is directly certified to perform medication reconciliation without 3^rd party tools that require a subscription.

So… finally… how do you perform a medication reconciliation in ECLIPSE? Let’s return to the CCHIT test script language I used for the certification:

“Select an existing patient record and display two or more medication lists as separate lists. One list must be a current medication list in the patient’s electronic record.  Compare the two lists.”

ECLIPSE maintains a medication list internally as part of the patient’s EHR on the History tab. Simply right-click for the context-sensitive menu, change the view and compare. You’ve just performed a medication reconciliation.