Modular Certification

The AuroraEHR is certified as a modular EHR: it provides the capability to comply with many of the Meaningful Use measures, and works in tandem with other companies to provide the capability to comply with the other measures. A list of the specific measures for which ICSA has certified AuroraEHR follows:

• Computerized provider order entry {170.314(a)(1)]
• Drug-drug, drug-allergy interaction checks [170.314(a)(2)]
• Demographics [170.314(a)(3)]
• Vital signs, body mass index, and growth charts [170.314(a)(4)]
• Problem list [170.314(a)(5)]
• Medication list [170.314(a)(6)]
• Medication allergy list [170.314(a)(7)]
• Clinical decision support [170.314(a)(8)]
• Electronic notes [170.314(a)(9)]
• Drug-formulary checks [170.314(a)(10)]
• Smoking status [170.314(a)(11)]
• Image results [170.314(a)(12)]
• Family health history [170.314(a)(13)]
• Patient list creation [170.314(a)(14)]
• Patient-specific education resources [170.314(a)(15)]
• Transitions of care -- receive, display, and incorporate transition of care/referral summaries [170.314(b)(1)]
• Transitions of care -- create and transmit summary care records [170.314(b)(2)]
• Electronic Prescribing [170.314(b)(3)]
• Data portability [170.314(b)(7)]
• Clinical quality measures -- Capture and export [170.314(c)(1)]
• Clinical quality measures -- Import and calculate [170.314(c)(2)]
• Clinical quality measures -- Electronic submission [170.314(c)(3)]
• Authentication, access control, and authorization [170.314(d)(1)]
• Auditable events and tamper-resistance [170.314(d)(2)]
• Audit report(s) [170.314(d)(3)]
• Amendments [170.314(d)(4)]
• Cancer case information -- ambulatory setting only [170.314(d)(5)]
• Emergency access [170.314(d)(6)]
• End-user device encryption [170.314(d)(7)]
• Integrity [170.314(d)(8)]
• Ambulatory setting only -- clinical summary [170.314(e)(2)]
• Immunization information [170.314(f)(1)]
• Transmission to immunization registries [170.314(f)(2)]
• Transmission to public health agencies -- syndromic surveillance [170.314(f)(3)]
• Automated measure calculation [170.314(g)(2)]
• Safety-enhanced design [170.314(g)(3)]
• Quality management system [170.314(g)(4)]

Clinical Quality Measures:

• Closing the Referral Loop: Receipt of Specialist Report [CMS#50v2]
• Hypertension: Improvement in Blood Pressure [CMS#65v3]
• Documentation of Current Medications in the Medical Record [CMS#68v3]
• Preventative Care and Screening: Body Mass Index (BMI) Screening and Follow-Up [CMS#69v2]; Diabetes: Hemoglobin A1c Poor Control [CMS#122v2];
• Diabetes: Urine Protein Screening [ CMS#134v2]
• Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention [CMS#138v2]
• Controlling High Blood Pressure [CMS#165v2]
• Use of Imaging Studies for Low Back Pain [CMS#166v3]

In addition, through our partners Bridge and MD Toolbox we are certified to comply with:

• View, Download, and Transmit to 3rd Party [170.314(e)(1)]
• Secure Messaging [170.314(e)(3)]

Compiled by Laura Rowe

EHR Certification

We are very pleased to announce that Rexpert's integrated electronic health record, AuroraEHR, is now officially certified! We passed the rigorous testing on November 20, 2014 and are now listed as a certified EHR on the ICSA Labs website.

What does this mean, you ask?

Meaningful Use requires physicians and practices to use EHR technology that is certified according to the standards set by CMS (Centers for Medicare and Medicaid Services) and ONC (Office of the National Coordinator for Health Information Technology). If physicians want to avoid the penalties associated with not complying with Meaningful Use, they must use a certified EHR.

These standards ensure that the EHR is secure enough and capable of all necessary functions to assist a physican in complying with Meaningful Use criteria. More importantly, they get at the reasons Meaningful Use is implemented in the first place: assuring all patients of quality healthcare. A certified EHR, like our AuroraEHR, gives both physicians and patients confidence that all patient data is kept confidential, maintained securely, and can be transmitted securely to other systems when appropriate.

We've worked hard to make our system extremely flexible and set up all the groundwork so that the workflow is customized to your practice and the way you see your patients.

If you'd like to take a look at what we have to offer, we'd be happy to do a demo!

Compiled by Laura Rowe

Junk Records

Are you daily searching through a list of accounts, continually scrolling past records entered in error, just to get to the ones you are actually looking for?

There is a quick fix for this!

Any list which sorts alphabetically will automatically put entries beginning with an *, a #, or other character that is not a letter or number at the top. If your infrequently used records have been marked with asterisks, this is where they will be (annoyingly) sorted.

If you would like a "junk" record to sort to the bottom of the list, simply type 'ZZZ' at the beginning of the last name.

This will automatically send the record to the bottom of the list, where it is easy to find if needed but will no longer get in your way.

Compiled by Laura Rowe

Computer Health Tips

According to the American Academy of Orthopaedic Surgeons (AAOS), “Regular computer users perform 50,000 to 200,000 keystrokes per day… frequent computer use that involves awkward postures, repetition, and forceful exertions may be related to nerve, muscle, tendon, and ligament damage.”

There are three ways to prevent injuries from frequent computer use: use a properly set-up workstation, use correct posture, and take frequent rest breaks. We’ve put together a list of easy and inexpensive ideas for improved computer use health. These ideas are courtesy of the Oregon Occupational Safety & Health Administration (orosha.org).

• Maintain a neutral posture by adjusting your computer workstation to fit your body. 
• Adjust your chair before starting your shift and again after lunch. Your body changes throughout the day and so should your environment.
• Place a pillow behind your back to create lumbar support if the back on your work chair won’t adjust. 
• Arrange workstation so that items you frequently use are within close reach. 
• Use books to raise your computer monitor if necessary so you’re looking at the top third of the screen.
• Place the document holder right next to the monitor so only your eyes move and not your head. 
• Avoid holding the phone with your neck. This places a lot of stress on your neck muscles. 
• Tape gauze around your pen to reduce your gripping pressure. 
• Move your computer monitor away from the window to reduce glare, which can lead to eyestrain.

For help with evaluating your computer workstation, download the PDF from Oregon OSHA.

MU Stage 2

We are well on our way to becoming a certified EHR. As part of this process, we must comply with all measures of Stage 2 of Meaningful Use, including Measure 3. This measure states that 80% of “all unique patients seen by the Eligible Provider (EP) have demographics recorded as structured data.” The demographics that must be reported by the EP include preferred language, sex, race, ethnicity, and date of birth. For race and ethnicity demographics, the EP must follow current federal guidelines. According to the White House’s Office of Management and Budget Statistical Programs and Standards, there are to be at least “five categories for data on race” and “two for data on ethnicity.” The standard goes on to say that, “respondents shall be offered the option of selecting one or more racial designations.” This means that EPs must use specific race designations and be able to report on patients that self-identify as multiple races.

The Rexpert Account Registration program already captured the required demographics for each unique patient except for "patients that self-identified as multiple races". This option has been updated in our recent release. We now include Race 1 and Race 2 in the account registration screen and we show both races selected in the Demographics tab of Account Inquiry.

What does this mean for you? It means that your patient registration forms will need to be updated, if they haven’t been already, to include the option for a patient to select more than one race. You should do this regardless of the EHR you are using: they all fall under the same requirements.

Check out the CMS website to learn more about Meaningful Use Stage 2. 

Contributor: Mel Johnson

New Data Center

In the next few months, we will be making an exciting change to our technology structure. We will be moving all of our Rexpert servers to a state-of-the-art data center 30 miles outside of Philadelphia. Some of the improvements we will enjoy as part of this move are:

• Network/Internet redundancy
• Power redundancy: UPS systems provide power during generators startup; generators power entire building within 15 seconds
• Cooling redundancy: two cooling systems with 24/7/365 professional service in the event of an emergency
• Fire detection and suppression: building is solid block with no windows into the data center; full fire detection installed throughout the building
• Raised floors: Provides flood protection and optimal cooling
• Strong security measures: RFID Card access to the building and biometric access to the data center

With our current data solution, almost all Rexpert outages were traced back to power or Internet issues; these issues are addressed with the top-notch redundancy plan in the new data center. As a matter of fact, this data center was able to remain completely operational during Hurricane Sandy and the recent ice storms.

The move started in March 2014 and the full transition will take about 90 days as we will be moving one database at a time. In addition to the data center upgrade, we are upgrading each server supporting Rexpert before moving into the new data center. We are upgrading from Hewlett Packard mid-range servers to high availability Intel servers. So far, 8 databases (out of the 18 databases that we manage) are already running on this new technology and will easily transition to the new data center.

We do have a contingency plan if we encounter any issues during the transition. All data migration happens outside of business hours and, with the exception of planned outages, this move will not impact user activity.

If you have any questions about the new data center or our upgrade plans, please contact Client Services.


Contributors: Jim Sullivan and Mel Johnson

ICD-10 Delayed

Less than a month ago, we posted a blog declaring that ICD-10 would not be delayed and to make all possible preparations for the October 1, 2014 launch. Well, as life goes once something has been proclaimed as final, there has been a delay of at least one year for ICD-10 and the other changes to the Medicare/Medicaid billing process. The next launch deadline has not been announced but there are some things you can do to keep yourself and your practice ready for when it happens.

1. Don't procrastinate. Just because there was a delay this time doesn't mean that there will be yet another delay. Make sure all departments, especially your technology department, are making their preparations. 
2. Make training and re-training plans. If you have already started training your staff on ICD-10, don't stop now. Get everyone ready for the change and schedule a refresher training right before release. 
3. Test, test, and test again. It can take months to finalize testing for a change of this magnitude. We've already started the testing process with CMS and we will continue testing as scheduled in July and possibly have more testing with Emdeon in the near future. 

If you have any questions about the ICD-10 delay, please contact Client Services. 

Contributors: Mel Johnson and Christine Parker

New Rule

Starting on January 6, 2014, Medicare implemented edits to verify that ordering/referring providers have current Medicare enrollment and are of a provider type that is eligible to order or refer for Medicare beneficiaries. The edit is required when ordering/referring for Part B clinical laboratory and imaging, DME, and Part A HHA claims.

The billing process now requires a new form (HCFA 02/12) and a valid National Provider Identifier (NPI) to verify current Medicare enrollment. Providers have until April 1, 2014 to start using the new form. Until that time, providers may continue to use form CMS 1500. Claims that are submitted by non-eligible providers or non-eligible provider types will be denied.

If you order or refer items or services for Medicare beneficiaries and you do not have a Medicare enrollment record, you need to submit an enrollment application to Medicare. You can do this using Internet-based PECOS or by completing the paper enrollment application (CMS-855O) found on Medicare’s website.

For Part B providers and suppliers who submit claims to carriers, you may encounter the following payment posting errors:

N264
 Missing/incomplete/invalid ordering provider name

N265
 Missing/incomplete/invalid ordering provider primary identifier

These N codes are the alert that the referring provider is not a registered CMS provider. 

More information about provider eligibility and enrolling with Medicare can be found here.

Please contact Client Services if you have any questions, or if you're not sure that your practice is set up correctly for the new regulations.


Contributors: Mel Johnson and Christine Parker

Mobile Scheduler

Do you need an easy way to view your schedule? The Rexpert™ Mobile Scheduler View has just what you’re looking for. This website is accessible from any computer, laptop, tablet, or smartphone web browser.

Once we have this service activated for your practice, go to the URL which we will provide and enter the username and password which we will give you. If you are accessing the Rexpert™ Mobile Scheduler View from a smartphone, you can call patients directly from the display by tapping their phone numbers. We have two blog posts in our archives that might also be of some help: how to use the mobile functions and how to login using the voice recognition feature on Android phones.

The Mobile Schedule can also show you all appointments for a particular location, or all appointments for the entire practice, depending how your access is configured.

We've put together a short YouTube video to demonstrate the login process and the schedule view.

Interested? Contact Client Support using the Contact Us button to get access to your existing login or to set one up.

Contributors: Mel Johnson and Kylie McKenzie Soder

PQRS Registry

In May of 2013, we posted a blog with an introduction to the Physician Quality Reporting System (PQRS). One of the many changes happening in healthcare this year involves PQRS. According to Medicare Guidelines,

“Those that report satisfactorily for the 2014 program year and receive an incentive will also avoid the 2016 PQRS payment adjustment.”

This means that eligible professionals (EPs) that meet the reporting requirements can earn a payment incentive *and* avoid a payment penalty of up to 2%. If an EP cannot meet the reporting requirements, there are still steps that can be taken to avoid payment penalties.

Last year, to avoid any Medicare or Medicaid payment penalties, providers only had to send one measure for one patient. This year, providers are required to send 3 measures at 50% of the eligible patients just to avoid payment penalties.

As you can see, the requirements are significantly increased this year. Although there are several ways to report PQRS, we strongly recommend that our clients use the PQRS Registry because of the increased requirements and the ease of tracking that this program offers. All of our clients, no matter which state they are in, can use NJ HiTec for PQRS reporting. Registration for NJ HiTec runs about $400 and it makes it easy for individual EPs to track their own status for incentive or penalty. To register, please visit http://www.njhitec.org/pqrs/ and choose the “click here to register” option. Once you register, please let us know so that we can call you about PQRS with instructions on your next steps.

For more detailed information on PQRS measure codes, please visit:

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/MeasuresCodes.html. Client Services can also help you select reporting measures. 

Contributors: Mel Johnson and Christine Parker