Practice Fusion Blog

Top 10 reasons to choose Practice Fusion

1. It's Free - Practice Fusion is the only 100% Free EHR system on the market today. 
2. $44,000 - In a very short time Physicians will become eligible to receive up to $44,000 from the Federal Government for adopting and showing meaningful use of a qualified EHR system.
3. Hosted - Being web-based and a hosted "Software as a Service" click here to learn more, Practice Fusion relieves you of the cost and burden of having and maintaining your own servers, network, security, etc.  All you need are internet connected PC's and you're ready to go!
4. Data Security - All data in the Practice Fusion system belongs to you.  We can export the information for you at any time.  Practice Fusion uses the latest technology to keep your data safe and secure.  To learn more about the security benefits built into Practice Fusion please click here.
5. Simplicity - Our engineers have made Practice Fusion one of the easiest to use EHR packages in the industry.  Log into your Practice Fusion account and see for yourself.  See something that needs improvement?  Send us an email and we'll incorporate your feedback.  At Practice Fusion we're committed to being the best EHR system on the market.
6. Community - From the moment you start using Practice Fusion you'll be able use and share templates with other Physicians in your area of expertise.  Our plan, philosophy and product are built around the idea that the community matters.  We're planning on leveraging the community to help you and your practice grow and connect with important resources when you need them.
7. Training - When you join the Practice Fusion community we make a commitment to fully train you and your staff.  We offer free, live trainings for as long as you use our product.  Whether you have a new employee, need to take a refresher course or just want to get caught up on the latest features, we're always there to help out.
8. ePrescribe and electronic labs - We've been listening to your feedback and we've heard you loud and clear: ePrescribe and Electronic Lab results are on the way!
9. Data imports - Do you have a spreadsheet with all your patient data?  Maybe you have an old legacy system with your patient information and/or you have it all stored in your billing software?  If you have demographic data on your patients then starting and using Practice Fusion just got a whole lot easier.  We import the data for you and get you setup within 24 hours so that you can hit the ground running.
10.  A lifetime of free upgrades - We add new features to our product every week.  Most of our work in improving the system comes directly from our user community.  You'll never have to pay more with Practice Fusion to use the latest software!

To log into your account click here.

 

If you have misplaced you login information please email support@practicefusion.com and we will be happy to assist you.

 

 Thank you!

The Practice Fusion Support Team
support@practicefusion.com

Practice Fusion illustrates the advantage of a SaaS-based EHR

Practice Fusion just released a collection of 25+ enhancements to its EHR. Many of these enhancements were part of the roadmap towards adding the features needed to allow physicians to make use of an EHR that provides “meaningful use” and thus become eligible for ARRA stimulus moneys. Many other of these enhancements were in response to feature requests from the user community – 67 different users had made feature requests that were addressed in this release. A few points deserve to be underscored here:

 

1). There are several major feature-sets that are being developed concurrently which are part of the pathway towards becoming a “certified EHR” (the definition of which is evolving – more on that subject in a later blog post). However, Practice Fusion also continues to collect input and suggestions from the user community. This not only makes product-development responsive and organic, but also helps create an EHR that is more-and-more usable. EHRs need to be excellent products that enhance (not hinder) in-office workflows – we have championed the criteria for selection of an EHR as “Usability, Interoperability, Affordability.” This sort of user-driven enhancement process allows Practice Fusion to evolve into the kind of tool that maximizes usability, based on “in the field” experience.

 

2). Practice Fusion is able make product improvements and upgrades that benefit everyone, all-at-once, by virtue of being a web-based software-as-a-service (SaaS) product. It does not require new downloads or upgrades in order to implement. Upgrades do not involve additional costs, or the need for on-site consultants. The whole issue (often a nightmare) of “version control” – i.e., making sure everyone is using the same, newest version of a product – is not an issue with a web-based product. The kind of seamless feature-set enhancement deployed this week illustrates the intrinsic superiority of a SaaS-based product over something locally installed.

 

Robert Rowley, MD

Chief Medical Officer

Practice Fusion, Inc.

On Twitter: #practicefusion

Medical Records Retention and EHRs

How long should medical records be retained, whether on paper or electronically? Does keeping records indefinitely increase one’s exposure to liability? These questions have occasionally arisen, and deserve commentary.

 

The most important reason for keeping medical records is for coordination of care with other health professionals. It is also an important way of documenting care when defending against malpractice allegations – sometimes, malpractice allegations can be quite incomplete in their presentation of facts, and a well-documented medical record is the best defense a physician has against such claims.

 

There are minimum time frames which obligate a physician to retain records – seven years for adults in most instances is common, though other circumstances may require longer retention. The main driver here is the statute of limitations for filing malpractice actions. Even if there is record-keeping older than the statute of limitations, it is not open to subpoena if it is past the statue of limitations. The California Medical Association has concluded that, while a retention period of at least 10 years may be sufficient, it recommends that records be retained indefinitely, or, in the alternative, for 25 years. A good summary by a malpractice insurance carrier can be found here.

 

Like with most EHRs, Practice Fusion is able to keep electronic health record data indefinitely, in electronic form. This does eliminate the economic burden of maintaining old records for long periods of time. Having good longitudinal medical records data not only serves continuity of care, it provides long-term defense for physicians against malpractice allegations.

 

Robert Rowley, MD

Chief Medical Officer

Practice Fusion, Inc.

How long should medical records be retained, whether on paper or electronically? Does keeping records indefinitely increase one’s exposure to liability? These questions have occasionally arisen, and deserve commentary.

 

The most important reason for keeping medical records is for coordination of care with other health professionals. It is also an important way of documenting care when defending against malpractice allegations – sometimes, malpractice allegations can be quite incomplete in their presentation of facts, and a well-documented medical record is the best defense a physician has against such claims.

 

There are minimum time frames which obligate a physician to retain records – seven years for adults in most instances is common, though other circumstances may require longer retention. The main driver here is the statute of limitations for filing malpractice actions. Even if there is record-keeping older than the statute of limitations, it is not open to subpoena if it is past the statue of limitations. The California Medical Association has concluded that, while a retention period of at least 10 years may be sufficient, it recommends that records be retained indefinitely, or, in the alternative, for 25 years. A good summary by a malpractice insurance carrier can be found here.

 

Like with most EHRs, Practice Fusion is able to keep electronic health record data indefinitely, in electronic form. This does eliminate the economic burden of maintaining old records for long periods of time. Having good longitudinal medical records data not only serves continuity of care, it provides long-term defense for physicians against malpractice allegations.

 

Robert Rowley, MD

Chief Medical Officer

Practice Fusion, Inc.

A common EHR decision question: “Do you have templates for my specialty?”

A common question that many practitioners have when looking for a suitable EHR for their practice is this: will it have features needed for my specialty? Is it a general-purpose EHR system, or is it specialty-specific? And what kinds of features in a specialty-specific product are missing in a general-purpose one? Is that important?

More specifically, where physicians often start to differentiate EHR options available to them is by looking at templates. Are there templates suitable for my specialty? This question, seemingly straightforward on the surface, is actually more complex than would appear. That is because “templates” mean different things in different EHR systems.

 

The simple answer

The simple answer for Practice Fusion is “yes.” Practice Fusion offers many universally-needed features, like medications, prescribing, summary information, document management and messaging. But at the same time, Practice Fusion includes a Template Library, which contains a collection of over 130 different templates, grouped into specialties, so that every specialty has tools apropos the common (as well as unique) workflows for that specialty. The Template Library grows continuously, as users in different specialties offer their own templates for distribution in the community. By grouping templates into Template Categories, and associating the categories with different specialties, Practice Fusion is able to auto-populate your own template collection, based on your declared specialty, on first-use of the system – you can always search for any template from the complete library if you so need.

 

More about templates

EHRs of all types have grappled with the balance of structured data on the one hand (which is searchable and lends itself better to interoperability) and descriptive, narrative text on the other hand (which is more readable by practitioners, and familiar to all). “Templates” are ways of trying to capture chart data for note creation – and their use and character depends on how the underlying EHR is created. Some EHRs are extremely “template driven,” meaning that a template is a form on a screen with lots of items to click, which create data in tables associated with each such template. This approach favors “structured data” as the most important thing – queries across each data element is possible, but the system often loses in “usability” and physicians complain that it takes them longer to chart using the EHR than it did before (thus impacting their productivity). Also, since the very-granular data created is so template-centric (it has even been referred to as “structured data over-kill”), it is difficult to import or export data between different installations of the EHR that use different collections of templates. Further, custom-creation of templates by users on-the-fly is nearly impossible.

 

Practice Fusion takes a different approach when it talks about “templates.” In Practice Fusion, usability and quickness of note-creation are centrally important, so that using the system will not result in the productivity slow-down experienced by users of other EHRs. “Templates,” as used by Practice Fusion, are collections of sentences and phrases commonly used in creating chart notes about certain types of visits. These kinds of templates are tools that allow for simple sentence-picking, and can be mixed-and-matched at will. The sentences chosen can be modified as desired, and supplemented with free text as well. These templates are stored in a Template Library, and can be individually modified as needed. New templates can be created and stored by the user without difficulty.

 

The result of the Practice Fusion approach to “templates” is a quick and easy way to build narrative chart notes, particularly the “S” section of a SOAP note – HPI, PMH, ROS, FH, SH, etc. The note is easily readable by other practitioners, and has the ability to capture truly descriptive narrative often highly important in describing a clinical situation, which might not be well captured in the stiffer click-driven templates of other EHRs. The challenge with this approach, of course, is the use of standard terminology and structured data for querying and interoperability. That is why the template usage approach implemented by Practice Fusion is mainly for parts of the note that should be narrative (e.g. HPI – history of present illness); other elements, like diagnoses, medications, prescriptions, immunizations, allergies, vital signs, etc., are structured and discrete, and lend themselves quite nicely to usable queries, reports, and interoperability.

 

Conclusions

“Templates” mean different things to different EHR systems. Physicians who ask the question “do you have templates for my specialty?” are asking a more complex question than meets the eye. There are EHRs in the marketplace – established, large, expensive ones included – which are very stiff and template-centric, and can negatively impact usability. Practice Fusion has tried to learn from these lessons, and offer a different approach to templates, which is more flexible, user-modifiable, and quicker, yet at the same time can create chart notes with sufficiently structured data elements where robust report-creation and interoperability are achieved.

 

Robert Rowley, MD

Chief Medical Officer

Practice Fusion, Inc.

Vulnerabilities of EMR systems

For a medical practice, an EMR is a central, vitally-important system – once paper charts have been abandoned, the EMR system must be completely reliable. If it goes down, conducting ordinary business is extremely difficult. Thus, identifying potential points of failure and implementing safeguards to avoid catastrophic system-down situations is very important.

Locally-housed systems

Traditional EMRs have been built as client/server systems, which means that the data, and “core” of the system are housed in local servers within the practice. Inside the office, local workstations are connected to a local server in a Local Area Network (LAN); access to the system from outside the LAN require an internet connection and (depending on the software) some secure way of connecting to the server. Therefore, with these traditional “EMR 1.0” systems, the following vulnerabilities can be identified, and safeguards must be put in place to minimize each type of risk:

 

1. Server failure. Hard drives within the server can fail. Therefore one should not invest in a low-end server, but instead one should have a redundant hard-drive array that mirror each other, in order that failed drives can be swapped out without service disruption.
2. Network failure. Hardware failure within a LAN is of low-likelihood, though a LAN router should have enough unused “open” connections that could be used in case a particular connection goes dead. More likely than a hardware failure, however, is a software malfunction that affects the system – a viral infestation or a failed compatibility with software platform upgrades could cause the whole network to fail. Generally, good IT support will be needed to make sure recommended upgrades to anti-viral software and other upgrades are carried out smoothly.
3. Data loss. Any of a number of issues can result in loss of data – software failures, hard drive failures, etc, can result in the all-critical database becoming corrupted. Data backup needs to be addressed – it can be on internal local backup media, or can be on external backup via an internet connection. Database backups must be set to occur on a regular schedule, so that if a “system-restore” needs to take place, the resulting state is as current as possible.
4. Environmental catastrophe. Local power failures can result in a server and system failure – local battery backup (an Uninterruptable Power Supply) should at least be on the server so that a controlled shut-down can be done should a prolonged power outage occur. Though one does not like to think of these things, catastrophic events do occur – building fires, hurricanes, tornadoes, earthquakes. Granted that medical service from an office won’t take place during such catastrophic events, but once the event passes, re-building the system will needed. The hardware and software will need to be recovered, and the data will need to be re-loaded. Hopefully, the data backup storage is not destroyed by the same environmental catastrophe.
5. Internet failure. The current world infrastructure of the internet has become very reliable, and the availability of broadband is essentially ubiquitous. And though internet connection is not very likely to go down, it can go down temporarily. For a locally-hosted, LAN-based EMR, this only affects connection from outside the LAN – depending on the practice (e.g. a multi-office group running off a single shared server), however, this can be very important.

Hosted, web-based systems

Practice Fusion is a hosted, web-based system, and therefore many of the above-mentioned vulnerabilities are not present. The servers are remote, with industrial-level redundancies, multi-site backup, and automatic data backup – these are no longer the responsibility of the physician practice to manage. Since a LAN is not required – one only needs internet-connected computers – LAN-failure issues are not important.

The only real vulnerability is internet failure. Again, in the current era, such failure is rare. Nevertheless, it is wise to have a backup plan. If the internet connection is via DSL, or cable, or T1 lines, there should be some backup in the unlikely event of a temporary failure. A Bluetooth-to-cell phone connection to the internet is an option; a cell-phone or satellite-based plug-in device is potentially a handy backup to have on hand “just in case.” Some geographic areas have public wi-fi networks, and using these networks is quite easy, given that most modern laptop and notebook computers have built-in wi-fi capability as a standard.

 

Conclusions

Practice Fusion, as a hosted, web-based “EMR 2.0” solution, has dramatically fewer vulnerabilities – fewer points of failure – than traditional locally-installed EMRs. The entire local infrastructure needed to run these older client/server systems not only add hidden layers of cost to the EMR, but also present additional points of failure which need to be addressed. The simplicity of Practice Fusion – all you need is an internet connected computer – reduces the vulnerabilities dramatically. And even the vulnerability of internet connectivity is one which can be fairly-easily mitigated with some simple planning.

 

Robert Rowley, MD

Chief Medical Officer

Practice Fusion, Inc.

Strategies for Scanning Old chart Documents into Your EMR

One of the strategic issues facing medical practices that are moving from paper charts into an EMR is the question of what to do about old paper chart information. Should there be an exhaustive attempt to scan all the old charts and import them into the EMR? Some practices have elected to do this. Or, should one be more selective, and if so, then what sort of selectivity should be applied?

 

In practical application, the older the data in the chart becomes, the less useful it is for day-to-day medical decision-making. An exhaustive scanning and importing of old chart information is probably wasteful of time and resources, and may delay implementation of the EMR into your practice. Yet there is some information that in indeed useful – items like old EKGs (for comparison to future ones), old mammography reports, or colon cancer screening reports (or any other HEDIS data point that can be the basis of good medical practice as well as Pay For Performance reporting) – these sorts of selected items may well be good to have in the EMR at the outset.

 

Some practices have hired a medical abstractor clerical person to go through all the old charts and pull out the selectively-desired items for mass scanning. That can be daunting and expensive. Another approach (one which I believe is more practical) is to pull the paper chart when seeing the patient (just like always), and use it alongside the EMR. Then the desired “old” pages can be pulled from the paper chart as-you-go, set aside for scanning and importing into the EMR, and then the paper chart can be retired to off-site storage. Over time, the number of patient visits for which there is still an “un-retired” paper chart diminishes.

 

One can always retrieve an old paper chart from offsite storage for looking through detailed entries (e.g. if your records are subpoenaed several years after-the-fact), but over time the frequency with which this comes up becomes vanishingly small. After about a year, it is likely that you will seldom need or see your old paper charts.

 

 

Robert Rowley, MD

Chief Medical Officer

Practice Fusion, Inc.

One of the strategic issues facing medical practices that are moving from paper charts into an EMR is the question of what to do about old paper chart information. Should there be an exhaustive attempt to scan all the old charts and import them into the EMR? Some practices have elected to do this. Or, should one be more selective, and if so, then what sort of selectivity should be applied?

 

In practical application, the older the data in the chart becomes, the less useful it is for day-to-day medical decision-making. An exhaustive scanning and importing of old chart information is probably wasteful of time and resources, and may delay implementation of the EMR into your practice. Yet there is some information that in indeed useful – items like old EKGs (for comparison to future ones), old mammography reports, or colon cancer screening reports (or any other HEDIS data point that can be the basis of good medical practice as well as Pay For Performance reporting) – these sorts of selected items may well be good to have in the EMR at the outset.

 

Some practices have hired a medical abstractor clerical person to go through all the old charts and pull out the selectively-desired items for mass scanning. That can be daunting and expensive. Another approach (one which I believe is more practical) is to pull the paper chart when seeing the patient (just like always), and use it alongside the EMR. Then the desired “old” pages can be pulled from the paper chart as-you-go, set aside for scanning and importing into the EMR, and then the paper chart can be retired to off-site storage. Over time, the number of patient visits for which there is still an “un-retired” paper chart diminishes.

 

One can always retrieve an old paper chart from offsite storage for looking through detailed entries (e.g. if your records are subpoenaed several years after-the-fact), but over time the frequency with which this comes up becomes vanishingly small. After about a year, it is likely that you will seldom need or see your old paper charts.

 

 

Robert Rowley, MD

Chief Medical Officer

Practice Fusion, Inc.

Stepping Stones to EMR adoption

You have your new EMR up and running… now what? How do you get from a paper-based office to an e-office? It can seem like a daunting task – like trying to get from one bank of a river to the other, and the river seems too wide to cross in one giant leap (even if you are enthusiastic). You need stepping stones to get from here to there.

One of the challenges of EMR implementation is that every workflow in a physician’s office that touches a patient’s chart – in other words, everything – needs to be re-thought when that chart is no longer on paper. And a surprising number of activities touch a patient’s chart – not only chart note creation, but also in-house messaging, prescription refill management, lab test review, importing information from the “outside world” into the chart, etc.

It is probably best, while getting used to an EMR system, to run in tandem for a while, and keep the old paper charts alongside the electronic ones. That transitional phase might be referred to as a “computer-assisted paper chart.” You can start simply by using the EMR to create chart notes, then print them out for placement in the paper chart. You would still use the paper chart as a way of tracking the patient through the office – putting the chart on the exam room door, on in a desktop stack to know who is to be seen next. Subsequently, you could add in-house messaging, so that when staff fields phone calls from or about patients, the Messaging module of the EMR would be used (instead of “sticky paper” notes). Front office staff can simultaneously use the Scheduling module of the EMR for making appointments and checking patients in. Later, once you feel comfortable with the “live” use of the EMR, you could use the EMR directly to know where the patient to be seen is.

By carrying out a step-by-step implementation plan (it will require some strategic planning at first), you could postpone needing to use wireless laptop or notebook computers (instead of paper charts) to carry around into patient exam rooms – instead you could have a desktop to do charting, and carry the paper chart with you. Later, you could make the transition to use wireless portable machines instead of the paper chart as part of your daily workflow. There are multiple paths across the stepping stones from the “paper bank” to the “e-bank” of the river, and the modular design of Practice Fusion will be flexible enough to allow you a pathway that makes sense for you.

 

Robert Rowley, MD

Chief Medical Officer

Practice Fusion, Inc.

You have your new EMR up and running… now what? How do you get from a paper-based office to an e-office? It can seem like a daunting task – like trying to get from one bank of a river to the other, and the river seems too wide to cross in one giant leap (even if you are enthusiastic). You need stepping stones to get from here to there.

One of the challenges of EMR implementation is that every workflow in a physician’s office that touches a patient’s chart – in other words, everything – needs to be re-thought when that chart is no longer on paper. And a surprising number of activities touch a patient’s chart – not only chart note creation, but also in-house messaging, prescription refill management, lab test review, importing information from the “outside world” into the chart, etc.

It is probably best, while getting used to an EMR system, to run in tandem for a while, and keep the old paper charts alongside the electronic ones. That transitional phase might be referred to as a “computer-assisted paper chart.” You can start simply by using the EMR to create chart notes, then print them out for placement in the paper chart. You would still use the paper chart as a way of tracking the patient through the office – putting the chart on the exam room door, on in a desktop stack to know who is to be seen next. Subsequently, you could add in-house messaging, so that when staff fields phone calls from or about patients, the Messaging module of the EMR would be used (instead of “sticky paper” notes). Front office staff can simultaneously use the Scheduling module of the EMR for making appointments and checking patients in. Later, once you feel comfortable with the “live” use of the EMR, you could use the EMR directly to know where the patient to be seen is.

By carrying out a step-by-step implementation plan (it will require some strategic planning at first), you could postpone needing to use wireless laptop or notebook computers (instead of paper charts) to carry around into patient exam rooms – instead you could have a desktop to do charting, and carry the paper chart with you. Later, you could make the transition to use wireless portable machines instead of the paper chart as part of your daily workflow. There are multiple paths across the stepping stones from the “paper bank” to the “e-bank” of the river, and the modular design of Practice Fusion will be flexible enough to allow you a pathway that makes sense for you.

 

Robert Rowley, MD

Chief Medical Officer

Practice Fusion, Inc.