1. Dental Electronic Health Records: The Revolution has Begun
Mike Uretz Seattle, WA
Executive Director, DentalSoftwareAdvisor.com Dental Software Editor, Dental Products Report
Copyright © 2015 Michael Uretz. All rights reserved

2. Unauthorized recording, copying, or reproduction of any part of this program without written permission is prohibited by applicable copyright laws

3. Thank you for supporting EHR education !!!

5. What’s Driving the EHR Revolution?
1. Looming state mandates

9. What’s Driving the EHR Revolution?
1. Looming state mandates
2. Changing payer requirements
3. Time consuming clinical documentation
4. Referral communication and coordination of care
5. Growing demand for online access
6. Increased risk and litigation
7. Expansion of HIPAA

10. New HIPAA Omnibus Rules
The Department of Health and Human Services (HHS) calls the HIPAA Final Rule the “most sweeping changes” to the Privacy and Security Rules since they were first implemented.
Updated regulations went into effect March 26, 2013 with compliance required by September 23, 2013.

11. What is the maximum penalty for violations under the new HIPAA rules?

12. HIPAA Omnibus Summary of Major Changes
1. Increased liability and penalties (tiered structure)
2. Modified breach reporting processes
3. More liability for business associates (updated BAAs)
4. Increased patient rights for receiving electronic PHI
5. Limitations on sale of PHI
6. Limitations on use of PHI for marketing

13. Examples of Protected Health Information (PHI)
1. Treatment plans and follow-ups
2. Images and radiographs
3. Patient referrals
4. Insurance and payment information
5. Provider-provider, provider-patient communications
6. Prescription information
7. Reminders with PHI

14. Million Dollar Question
How do we communicate and collaborate in a HIPAA complaint manner?

15. Traditional email and cloud storage services are not HIPAA COMPLIANT

16. Secure server based communications are
HIPAA COMPLIANT
Mobile
Outlook

17. HIPAA Compliant Care Coordination

18. MS XP RIP
April 8, 2014
HIPAA

19. Technical Partner HIPAA Questions Awareness, Education, Administrative
1. Will you sign a Business Associate Agreement?
2. Does your data center have a HIPAA Report on Compliance?
3. Does everyone having access to database had awareness, education and training on HIPAA regulations and compliance?
4. Do you have a process to keep updated on HIPAA legislation?
5. Do you have policies and procedures regarding data breaches?
6. Do you have a Service Level Agreement (SLA) to ensure standards are met?
7. Do you address HIPAA compliance in your standard contracts?

20. Technical Partner HIPAA Questions Data Storage, Management, and Disposal
1. Do you store PHI outside of United States?
2. Can you provide detail on your back-up and recovery processes?
3. Do you continually test your back-up and recovery processes for reliability and accuracy?
5. Describe your back-up sites?
6. Do you have redundancy, mirrored data, and failover?
7. What is the procedure to permanently delete data?

21. Technical Partner HIPAA Questions Audit Logging
1. Do you have a system to record and audit changes to data?
2. Do you have a system to prevent data destruction/deletion?
3. Do you implement mechanisms to verify that PHI has not been altered or destroyed in an unauthorized manner?
4. Do you have a system to record and audit who has accessed and modified data?

22. Technical Partner HIPAA Questions Privacy, Security, Access
1. Do you implement technical security measures to guard against unauthorized access to PHI?
2. Do you implement physical security measures to guard against unauthorized access to PHI?
3. Do you implement mechanisms to verify that PHI has not been altered or destroyed in an unauthorized manner?
5. Do you implement automatic terminate of an electronic patient session after a predetermined time of inactivity
6. Do you have policies and procedures for data breaches?
7. Do you utilize separate database and application servers?

25. What’s Driving the EHR Revolution?
1. Looming state mandates
2. Changing payer requirements
3. Time consuming clinical documentation
4. Referral communication and coordination of care
5. Growing demand for online access
6. Increased risk and litigation
7. Expansion of HIPAA
8. Financial penalties and Accountable Care

26. “ I wanted to know if you can discuss the Medicare issues regarding EHR compliance and PQRS reporting. We were told by our software vendor that their software is not Medicare EHR compliant, nor is it able to do the PQRS reporting. I am subject to, and have already been charged, the fee reductions for this.
Second, I am in the middle of trying to do ACO [Accountable Care] reporting for a hospital-based HMO I am a part of.  What I thought would be a relatively easy process has turned into a very costly nightmare.  Again, my software is not set up to do this.”

27. Medicaid Based EHR Incentive Program
Over $9 Billion in provider payments

28. Medicare Based EHR Incentive Program
Over $20 billion in provider payments

29. Meaningful Use Non-Compliance Penalties

30. PQRS Non-Compliance Penalties

31. Up to 7% Medicare Reduction

34. What’s Driving the EHR Revolution?
1. Looming state mandates
2. Changing payer requirements
3. Time consuming clinical documentation
4. Referral communication and coordination of care
5. Growing demand for online access
6. Increased risk and litigation
7. Expansion of HIPAA
8. Financial penalties and Accountable Care
9. Staying competitive

35. How do you choose the right EHR for your practice or group ?

37. Building Your House 1. Discuss Features with Architect
2. Prioritize features
3. Submit feautures/specs to list of Contractors
4. Reduce contractor list based on response
5. Review contractors’ previous work
6. Select preferred contractor and negotiate price
7. Structure and negotiate contracts/agreements

38. Evaluating and Selecting EHRs
1. Analyze needs and requirements
2. Develop detailed vendor request for proposal
3. Submit RFP to list of vendors
4. Reduce vendor list based on RFP responses
5. Conduct comprehensive vendor demos
6. Select vendor of choice and negotiate deal
7. Structure and negotiate contracts/agreements

39. Determining your requirements
“If you don’t know what you want,
or don’t communicate what you
want, you reduce your chances of
getting what you want.”
GAUSE

40. House Feature prioritization

41. EHR Feature Prioritization

42. Evaluating EHR technology
1. Cloud or server based technology

43. What is a major benefit of using cloud based dental software?

44. Benefits of the Cloud 1. No internal IT 2. HIPAA liability shared
3. EHR updates and patches installed
4. System updates and patches installed
5. System performance optimized
6. Monthly payment models

45. What are some potential risks with using cloud based dental software?

46. Risks of the Cloud 1. Dependant on cloud vendor for operation
2. Database resides with hosting center
3. System can go down
4. Cloud vendor can limit access
5. Backups reside at hosting center

47. Evaluating EHR technology
1. Cloud based computing
2. Proprietary or standard databases
3. Mobile device support *

48. Evaluating EHR technology
1. Cloud or server based technology
2. Proprietary or standard databases
3. Mobile device support
4. Web portals *

49. Patient Portal Technology Web Example 1

50. Evaluating EHR technology
1. Cloud or server based technology
2. Proprietary or standard databases
3. Mobile device support
4. Web portals
5. Interoperability and Health Information Exchange

52. Evaluating EHR technology
1. Cloud or server based technology
2. Proprietary or standard databases
3. Mobile device support
4. Web portals
5. Interoperability and Health Information Exchange
6. New or old technology

53. Request For Proposal: Tying it all together
1. Vendor business and organizational profile
2. Software Features and Requirements
3. Technology & IT Considerations
4. Interfaces & Third Parties
5. Implementation and Training
6. Support
7. Detailed pricing
RFP Example

54. Request for Proposal Benefits
1. “Apples to apples” comparison
2. Preparation for Demos
3. Little financial investment
4. Legal Document
5. Illustration of Vendor Commitment

56. Vendor Demos 1. Prioritize features from RFP
2. Develop cases and scenarios
3. Be in Charge!

57. What to look for … Questioning Understanding Enthusiasm
Listening
Questioning
Understanding
Enthusiasm
Problem Solving
Content Knowledge
Discussion of Options

58. What to watch out for Demo…
Canned Approach
Poor Listening
“I’ll Get Back to You”
Techno Geek
Promised Features
Just as you have blueprints and plans for house…

59. What is the common term for software features that have been promised by the vendor but never seem to be available?

60. Determining EHR Feature Requirements
1. Clinical dashboards and intuitive navigation *

62. Determining EHR Feature Requirements
1. Clinical dashboards and intuitive navigation
2. Structured data and customized templates *

63. What is structured data and its importance in our clinical documentation?

70. Determining EHR Feature Requirements
1. Clinical dashboards and intuitive navigation
2. Structured data and cutomized templates
3. “Next Generation” coding databases*

71. Mark W Jurkovich DDS, MBA, FACD, MAGD
Past President Minnesota Dental Assn.
Member MN eHealth Committee
Chairperson International Health Terminology Standards Development Organization (IHTSDO) Dentistry Special Interest Group (SIG)

73. Determining EHR Feature Requirements
1. Clinical dashboards and intuitive navigation
2. Structured data and cutomized templates
3. Diagnosis code integration
4. Clinical decision support *

74. Determining EHR Feature Requirements
1. Clinical dashboards and intuitive navigation
2. Structured data and cutomized templates
3. Diagnosis code integration
4. Clinical decision support and evidence based protocols
5. Task and workflow management

75. Determining EHR Feature Requirements
1. Clinical dashboards and intuitive navigation
2. Structured data and cutomized templates
3. Diagnosis code integration
4. Clinical decision support and evidence based protocols
5. Task and workflow management
6. Point of care eligibility and claims scrubbing *

76. Determining EHR Feature Requirements
1. Clinical dashboards and intuitive navigation
2. Structured data and cutomized templates
3. Diagnosis code integration
4. Clinical decision support and evidence based protocols
5. Task and workflow management
6. Point of care eligibility and claims scrubbing
7. ePrescribing *

78. Why ePrescribing?
1. Improved patient care
2. More streamlined workflow
3. Reduced provider risk and liability
… And looming state mandates

79. A Cornucopia of Functionality
1. Templated medication prescribing (order entry)
2. Real time alerts (drug drug, drug allergy, etc.)
3. Decision support (dental specific drug information)
4. Consolidated med lists (medication reconciliation)
5. Patient compliance monitoring
6. Reports

80. Dr. First (Dentimax)
Allscripts (Schein)
Dosespot (Planet DDS)
New Crop (MacPractice)
MD Toolbox (QSI)

82. EPCS Hard and Soft Token (VIP Access)

83. A Cornucopia of Functionality
1. Templated medication prescribing (order entry)
2. Real time alerts (drug drug, drug allergy, etc.)
3. Decision support (dental specific drug information)
4. Consolidated med lists (medication reconciliation)
5. Patient compliance monitoring

85. A Cornucopia of Functionality
1. Templated medication prescribing (order entry)
2. Real time alerts (drug drug, drug allergy, etc.)
3. Decision support (dental specific drug information)
4. Consolidated med lists (medication reconciliation)
5. Patient compliance monitoring
6. Reports

88. Next Generation Software Features
1. Clinical dashboards and intuitive navigation
2. Structured data and cutomized templates
3. Diagnosis code integration
4. Clinical decision support and evidence based protocols
5. Task and workflow management
6. Point of care eligibility and claims scrubbing
7. ePrescribing
8. Image integration *

89. Determining EHR Feature Requirements
1. Clinical dashboards and intuitive navigation
2. Structured data and cutomized templates
3. Diagnosis code integration
4. Clinical decision support and evidence based protocols
5. Task and workflow management
6. Point of care eligibility and claims scrubbing
7. ePrescribing
8. Image integration
9. Rules based alerts, recalls, appointments

90. Determining EHR Feature Requirements
1. Clinical dashboards and intuitive navigation
2. Structured data and cutomized templates
3. Diagnosis code integration
4. Clinical decision support and evidence based protocols
5. Task and workflow management
6. Point of care eligibility and claims scrubbing
7. ePrescribing
8. Image integration
9. Rules based alerts, recalls, appointments
10. Real time patient education *

91. Determining EHR Feature Requirements
1. Clinical dashboards and intuitive navigation
2. Structured data and cutomized templates
3. Diagnosis code integration
4. Clinical decision support and evidence based protocols
5. Task and workflow management
6. Point of care eligibility and claims scrubbing
7. ePrescribing
8. Image integration
9. Rules based alerts, recalls, appointments
10. Real time patient education
11. Referral management and care cordination

92. Don’t Pay Retail

93. How to Get the Best Price
1. Vendor needs you
2. Good timing
3. Know the market
4. Be special !!!

94. The Hidden Costs

95. Avoid Nickel and Diming…
1. Interfaces (Imaging, devices, etc. )
2. Third party subscriptions
3. Claims processing
4. Web portal
5. Report development
6. EHR incentive capabilities
Let’s look at one aspect of a support clause…

96. …Including Your Contract!

97. Dr. Murphy’s Law
“If anything can go wrong, it will”

98. What is a Software License?
A contract between a licensor (vendor) and a licensee (you) that grants permission to use a specific software product subject to a license contract.
Some of the areas that Dr. Murphy should have thought about…

99. The $100K Word… *
Vendor grants to customer a nonexclusive and nontransferable license to use software for Customer’s own business purposes.

100. The $100K Word… *
Vendor grants to customer a nonexclusive and nontransferable PERPETUAL license to use software for Customer’s own business purposes.

101. What if you sell your practice?
Vendor grants to customer a nonexclusive and nontransferable (except in the case of a sale, merger, or transfer of a substantial portion of customer assets to a successor) PERPETUAL license to use software for Customer’s own business purposes.

102. Don’t give away the farm…
Notwithstanding anything contained herein to the contrary, nothing herein shall prohibit vendor from using non-Individually Identifiable Health Information on an aggregate basis that it may develop new products and services for vendor or third-parties. Vendor may aggregate the results of such data via data mining and may sell its analysis to providers and research analysts.

103. Warranties and Guarantees
1. System meets specifications
2. Disabling code, Trojan horses, and bad stuff
3. Transition assistance
4. EHR incentive eligibility

104. LIMITATION OF LIABILITY *
THE CUMULATIVE AGGREGATE LIABILITY OF VENDOR AND ALL OF ITS AFFILIATES TO CUSTOMER FOR ALL DAMAGES ARISING UNDER OR RELATED TO THIS AGREEMENT SHALL NOT EXCEED …

105. LIMITATION OF LIABILITY
EXEPT IN THE CASE OF GROSS NEGLIGENCE OR WILLFUL MISCONDUCT THE CUMULATIVE AGGREGATE LIABILITY OF VENDOR AND ALL OF ITS AFFILIATES TO CUSTOMER FOR ALL DAMAGES ARISING UNDER OR RELATED TO THIS AGREEMENT SHALL NOT EXCEED …

106. Payment and your rights… *
If any payments remain unpaid more than 30 days beyond invoice date we will immediately suspend access to support services

107. Payment and your rights…
If any undisputed payments remain unpaid for more than 30 days beyond invoice date we will suspend access to support services after an additional cure period of 30 days

108. Where’s the REAL support?
Phone calls to company support team are given high priority, but there are only so many ears to go around. Company cannot commit to a timeframe for resolution, but will use all efforts to provide a by-pass or fix the problem as expeditiously as possible

109. Maintenance and Support
1. Response Times
2. Resolution Times
3. Problem Escalation & Triage
4. Penalties and Credits
5. Upgrades and New Releases

110. Cloud Contracts 1. Performance guarantees with penalties
2. Termination for Chronic poor performance
3. Backup processes and guarantees
4. Transition assistance
4. Own your data !!!

111. Contracts & Implementation

112. Contracts & Implementation
1. When will project start?
2. Is there any vendor accountability?
3. You have a right to a good project manager
4. Make sure there is a plan !!!
Let’s discuss the importance of partnership

113. Where’s the Incentive?
All orders require a 50% deposit upon execution of agreement. The remaining balance is due upon installation.

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115. Complimentary follow-up consultation:
Mike Uretz
Mention Code: CSOMS2015
Workshop Materials:
Copyright © 2015 Michael Uretz. All rights reserved