New ICANotes Chart and Note Security

ICANotes Chart and Note Security:



Chart Security:

Background: In a typical group practice all staff members, both clinical and non clinical, have access to patient's charts and can read the notes in the chart and make new notes. This is necessary and desirable when there are multiple clinicians treating the patient, when clinicians cover for one another, and when non-clinical staff must leave messages in the chart, print notes, record prescriptions called-in, etc.
In ICANotes this is Default Chart Security. (see below)

In some group practices where, for example, independent practitioners share some office and administrative functions but otherwise maintain private or separate practices, it is often desired that the entire chart be inaccessible except to clinicians who are assigned to that case.
In ICANotes this is Complete Chart Security. (see below)


Default Chart Security is the security automatically set in ICANotes. It means that everybody with an ICANotes username and password can go to the Chart Room and then go to the face of a patient's chart. They can go to the finished note and print it. They can go to the demographic section and make changes or add information. They can make a new clinical note or non-clinical note, such as a message.

Extra Privacy: An extra security setting called Extra Privacy can be created for certain charts by an Assigned Provider. This setting creates a password that is required when a non Assigned Provider attempts to access the chart. Assigned Providers will not be asked for this password.

Extra Privacy might, for example, be used when the patient is a celebrity or a public figure or any time a stricter level of confidentiality is desired.

Extra Privacy can be set in the Demographics section of the patient chart.

Please note: The Group Administrator has the ability to access a password protected chart without entering the password. This is a safeguard in case the clinician in custody of the password is not available and there is an emergency which requires that the password protected chart be accessed.

Under Default Chart Security the only reason to assign providers to the case is to allow access under Extra Privacy. Staff can be made Assigned Providers in the demographics section of the chart at the bottom under the heading "Assigned Providers." Staff can also be assigned to a case by the Group Administrator from the Settings and Directories section of the program, Caseload tab.


Complete Chart Security: With this security setting in place only certain members of the group can access certain charts. Of course, if individuals cannot access a chart then they cannot print any notes in that chart, cannot make changes in the demographics section, and cannot make a clinical note or a message to leave in the chart. If a staff member does not have the privilege to see a chart they will also not be able to view or print finished notes from a report.

Under Complete Chart Security the privilege to access a chart is limited (with one exception) to Assigned Providers. Staff can be made Assigned Providers in the demographics section of the chart at the bottom under the heading "Assigned Providers." Staff can also be assigned to a case from the Settings and Directories section of the program, Caseload tab.

Please note that the person who first creates a chart is automatically an Assigned Provider. That person must indicate who else is an Assigned Provider, so that those additional staff will be able to access and enter the chart. Any Assigned Provider can assign others to access the chart.

The exception mentioned above is for individuals designated as a Group Administrator. A Group Administrator has access to all patient's charts. Individuals can be designated (or removed) as Group Administrators by contacting ICANotes support.

When there is a search for a patient, a schedule is printed, or certain reports are created under Complete Chart Security the names of non assigned patients and some demographic information will be visible. However, the chart cannot be accessed from the report or schedule and notes of non assigned patients cannot be printed.

If your group desires Complete Chart Security, please contact our Support Desk at support@icanotes.com.


Note Security:

Please Note: The following is a change. Heretofore, a note's owner or anyone assigned to a case could enter the work area of an existing note. This is not longer the case. Please see below.

With two exceptions, the only person, clinical or non clinical, who can have access to the work area of an existing note is the clinician who created the note: the "owner" of the note. (The owner of the note can be changed at the bottom of Finish Initial or Progress Note Part 2) The first exception to this rule are instances where supervision is involved, in which case both the owner of the note and the supervisor may enter the work area of the note, work on the note, and co-sign it. A supervisor can be designated by the Group Administrator in the Settings and Directories section of the program, Personal Info tab.

Treatment Plans are another exception to the rule that only the owner of a note can enter a note's work area. Nobody "owns" a Treatment Plan and all staff can enter the work area of a Treatment Plan under Default Chart Security. Under Complete Chart Security all Assigned Providers can enter the Treatment Plan.


Additional New Security Settings:

Calendar and Patient Accounts: By default these sections of the program are accessible to all staff. However, access to these areas can be limited to only certain personnel. If you wish to limit access to these areas please contact ICANotes Support.

Incentive Payments to Qualified Users of EHR: What Is the Latest Information?

Dear ICANotes User,

Here is the latest information about the incentive payments to qualified users of Electronic Health Record systems.  We will keep you informed as new information becomes available. Please feel free to ask any questions you may have.

Background

The Federal Government is eager to promote the use of EHRs. It believes that their use will improve the quality and decrease the expense of medical care. Toward that end it made incentive payments to users of EHRs part of the American Recovery and Reinvestment Act of 2009. (HITECH is the part of ARRA describing the incentives.)

How Much Money? Eligible users of EHRs will receive as much as:

$18,000 in 2011
$12,000 in 2012
$ 8,000 in 2013
$ 4,000 in 2014
$ 2,000 in 2015
$ 0 in 2016

Total: $44,000

This incentive payment is calculated as 75% of Medicare or Medicaid payments. So, to receive the full $18,000 incentive payment in 2011 the clinician would have had to have received at least $24,000 in Medicare charges. ( 75% of $24,000 is $18,000.) Medicaid has a slightly different payment schedule.

Besides incentives for eligible users (the carrot), there are penalties for Medicare and Medicaid providers who do not use EHRs. In 2015 "payment adjustments" will be imposed on eligible providers who are not meaningful users of EHRs.

Who is Eligible?

Only clinicians who are Medicare or Medicaid providers are eligible.

Medicare: A Medicare Eligible Provider is defined as a doctor of medicine or osteopathy, doctor of dental surgery or dental medicine, doctor of podiatry, doctor of optometry or a chiropractor who is not hospital-based.

NOTE: A Medicare Eligible Provider is considered hospital-based if 90% or more of the EP's services are performed in a hospital inpatient or emergency room setting.

Medicaid: A Medicaid EP is defined as a physician, nurse practitioner, certified nurse-midwife, dentist, or physician assistant who furnish services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant. To qualify for an EHR incentive payment, a Medicaid EP must not be hospital-based and must meet one of the following criteria:

- Have a minimum 30% Medicaid patient volume*
- Have a minimum 20% Medicaid patient volume, and is a pediatrician*
- Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals
 

NOTE: A Medicaid EP is considered hospital-based if 90% or more of the EP's services are performed in a hospital inpatient or emergency room setting.

* Children's Health Insurance Program (CHIP) patients do not count towards the Medicaid patient volume criteria.

For more information about eligibility click here.

When Do Payments Start?

For eligible clinicians who can demonstrate meaningful use the payments will start as early as May of 2011.

What is Meaningful Use?

The most important part of Meaningful Use is that the eligible clinician has been using a Certified EHR system. ICANotes will be a Certified EHR in the near future. For more information regarding the status of certification see below.

Also, the clinician wanting to demonstrate Meaningful Use will have to show that the Certified EHR was used for at least 90 consecutive days in 2011 (which is whyeligible providers can't apply until April 2011 and payments can begin as early as May 2011.)

Also, use of E-Prescribing (which is available thru ICANotes) must be demonstrated for a certain percentage of patients.

Finally, as noted above, a Medicaid Provider who wants to be reimbursed through that program must demonstrate a certain percentage of Medicaid patients.

How Will Clinicians Demonstrate Meaningful Use?

For the first year, 2011, all that will be required is the clinician's attestation that the meaningful use criteria have been met.

What is the Status of Certification for ICANotes?

ICANotes is preparing itself for the certification process, which has not yet started for any behavioral health software. Recently the standards ICANotes and other behavioral health software will have to meet were released. As this is written we are waiting for the release of information about how the standards will be tested. Also, the government is currently considering the credentials of the agencies that will administer the certifying tests.

It is currently expected that testing can start by November. ICANotes expects to apply for the test and achieve certification by the end of 2010.

What sort of Standards Will ICANotes have to Meet?

As a relatively mature EHR ICANotes will have no trouble meeting the criteria for certification. Here are some examples of the test criteria:

Maintain an active medication list. More than 80% of patients have at least one entry recorded as structured data. ICANotes already maintains an active medication list.

Maintain an active medication allergy list. More than 80% of patients have at least one entry recorded as structured data. ICANotes already maintains an active medication allergy list.

Record smoking status for patients 13 and older. More than 50% if patients age 13 or older have smoking status recorded as structured data. ICANotes already records smoking status in the medical history (under Health and Behavior.) The data will have to also be stored in separate fields (as structured data) but this is an easy modification to make.

Record patient demographics (sex, race, ethnicity, date of birth, preferred language, and in the case of hospitals, date and preliminary cause of death in the event of mortality). More than 50% of patients’ demographic data must be recorded as structured data. ICANotes already collects extensive demographic data, all as structured data. A field for preferred language will soon be added.

There are 25 standards of this sort.

We will keep you informed as new information becomes available.

 

 

www.icanotes.com