Computer Support Network

EHE is here to stay.  The government subsidy is not.

Physicians that have not adopted EHR and achieved ‘meaningful use’ in 2011, have left $18,000 on the table.  Yup, that’s more than 1.5 years’ worth of car payments on a high end BMW or Mercedes.  Physicians that don’t achieve meaningful use’ in 2012 are leaving another $18,000 on the table.  In 2013 it will be $12,000 and by 2014 that number will drop to $8,000.

Physicians that pay a staff to submit insurance paperwork are also leaving money on the table includeing:

• The salaries of all the employees that are submitting claims.
• The insurance companies refusing to pay the first submission 50 percent of the time.
• The time that it takes for the checks from the insurance company to arrive.

Go through those stacks of paper and you’ll find checks that have NOT been deposited.
EHR and PM systems turn the claim refusals into >85% first time claim acceptance.

EHR and PM Systems eliminate the salaries of the clerks hired to submit paperwork.

EHR and PM Systems assist with insurance code changes.

EHR and PM systems reduce the time to get paid to 2 days – electronically.

EHR and PM systems eliminate lost and non-deposited checks.

And physicians that meet meaningful compliance this year, in 2012 receive a check from the government in:

• 2012 for 18k
• 2013 for 12k
• 2014 for 8k

That’s the carrot.   The stick is they are going to reduced Medicare reimbursements by a rising amount each year too. The good is that IT Computer Support of New York will make the cost of converting to EHR lower than the government reimbursement.  The bad is that if you don’t adopt EHR you will lose money – big time.  The ugly is you have to change to a new system, and we all hate change. But if you will change, isn’t it better to change now and reap the benefits earlier rather than later?

- Dan Scolnick
IT Computer Support of New York
President and Chief Technical Officer

Those of you that read my blog know I’m a proponent of Physicians utilizing EHR / PM systems and reaping the benefits while the government is subsidizing it.

ITCSNY specializes in what is called the EDGE. Regardless of what kind of computer technology you use, the edge is where you touch the workstations, i-pads or laptops. It is the LAN (local area network) in the office from the receptionist to the exam rooms to the printers.

When a physician decides to use EHR software, a research must be done. How do you pick the right EHRE software? There are over 100 suppliers. Some write great software. All of them have sales people and large documents of tough to read content. What they all have in common is they take responsibility for the software and assisting the physician to reach ‘meaningful use’, and none of them take responsibility for the technology at the edge.

That means the physician is responsible for the choice, purchase, maintenance and troubleshooting of the equipment that the practice depends on to service patients and make money come in. It also makes the physician responsible for the bureaucratic process to receive the HITEK government reimbursement money.

It makes sense for a physician to join an EHR cooperative, where the choices of the EHR software can be vetted by an independent integrator with experience with the major brands. Where an experienced entity takes responsibility for the WHOLE system operations and integration. Where the physician can get authoritative advice, make smart choices and focus on his or her practice without getting distracted by the technology.

It’s like a group for your technology, billing and government reimbursement wrapped up in one.

If you have 2 or more physicians in your practice,
And you plan to practice for at least the next 4 years,
Then the IT Computer Support of New York EHR cooperative makes sense.

- Dan Scolnick
IT Computer Support of New York
President and Chief Technical Officer

While American households account for most of the new electronics market, they only contribute about 26% to the electronics recycling market. That means an awful lot of electronics still end up in our landfills.  Not only is this wasteful but it also presents serious security concerns for many electronics users who have not adequately cleared their devices of personal information.  The threat is made even more apparent when you take a look at the reseller marketplace.

The security firm AccessData, recently compiled a report on many popular mobile devices such as Apple devices and cellular phones.  The firm discovered that while the devices had had their hard drives seemingly cleared of data, “they were still able to extract Social Security numbers, financial information, GPS locations, passwords, communications and other information that could be used for ID theft and other criminal activity.”

To prevent a similar security breach from happening to you choose an appropriate outlet to recycle or dispose of your electronics.   The Consumer Electronics Association has put together a list of websites to help you choose which route to go. Consumer electronics have different life spans (a smartphone’s is 18 months, while a TV is more than 10 years) and first you should look to extend the life through resale or reuse. See if there’s a worthy home for your small or large electronic devices at a local school, retirement home or community center.   Whichever you choose, make sure that you properly dispose of all personal information first.  If you take proper care of your devices and the data contained within then you and someone else can enjoy your gifts for years to come.

From all of us at IT Computer Support of New York, we wish you a happy and safe holiday season and a prosperous New Year.

- Richard Keene
IT Computer Support of New York
Design and Optimization Department

We hope you all enjoy a safe, healthy and Merry Christmas holiday.

Tim Rains, a director of Microsoft’s Trustworthy Computing group, revealed earlier this week that, “Between one-third and one-half” of all attacks detected and blocked by Microsoft’s security software from the beginning of July 2010 to the end of June 2011 were Java-based.”   Microsoft’s anti-malware technologies blocked more than 27.5 million Java exploits over a 12-month period, many of which had been patched at least a year ago, Rains said.

Not only does this data support the idea that users are slow to apply patches but that many users never apply patches at all.  The fact that hackers and cyber-terrorists continue to target vulnerabilities that have long been corrected speaks volumes on the number of users who are ignorant or indifferent to the dangers.  Part of the reason Java based attacks have become so common is the fact that it is a nearly universal application across all platforms and devices.  Oracle, Java’s parent company reports that that application currently runs on over 3 billion devices.

While many security experts advise against the installation of Java in a corporate environment at the very least regular updates need to be scheduled and user awareness of potential threats needs to be made a priority. Because of the nature of Java, attacks can come in the form of websites, email attachments and even hidden within other software installers.  In most office places Java shouldn’t be a necessity for the majority of users, and if it’s not, always consider that the less software installed in a browser, the less likely an attack will be successful.

Because of the wide array of potential infection points and prevalence of Java across operating systems, it is advisable that system administrators and users should regularly update Java and be diligent about the updates. Additionally, as 64-bit operating systems become more common users and admins should pay extra attention as some systems may be running different versions of Java within a single environment.

- Richard Keene
IT Computer Support of New York
Design and Optimization Department

A strange thing happened on the way to Electronic Medical Health Records and Information Technology.

I have owned and operated an IT consulting company in New York City, for over 25 years. We have three practice areas: government, Fortune companies and small/medium businesses (SMB). Typically there are three types of clients: early adopters, guidance clients and commodity clients. Early adopters recognize the value of technology and are willing to spend more and put up with aggravation in order to gain the benefits of having the technology early on. Early adopters value time and competitive advantage over a dollar spent, as they get more dollars and more time by adopting technologies early in the curve. Guidance clients recognize the value of technology, but don’t want to do the technology themselves. Both early adopters and guidance clients recognize and need quality professional support for the technology that supports their business.

Normal trends show that Fortune companies are early adopters and are willing to spend the time and resources on the “bleeding edge” of technology. Traditionally, we have taken the knowledge learned from the early adopters and spun it out to the guidance clients at a far reduced price and with much less pain. We noticed a new trend in the past year. We have small businesses, specifically doctors, who are playing the part of early adopter. The issue that is new is that they don’t realize they are early adopters. We have found ourselves in a position where we are supporting doctors’ offices that are pushing the envelope forward on technology integration and EMR. Since many doctors are not aware they are early adopters, they expect components that they choose based on what they are attracted to in the marketplace to work, and the task of integrating disparate systems falls on us.

This push is driven harder by the HITECH Medicare EHR incentive program. We noticed certain recurring issues among various doctor/clients of ours going to EHR.

Power/Cooling/Backup/Antivirus/Patching/Upgrades/Physical Space come into play regardless of the EHR software utilized or the office. Also many doctors have multiple offices, and many offices have multiple doctors. The benefits of EHR exist in addition to the HITECH incentives. Fewer staff to do billing, 85-97 percent first time claim reimbursements, electronic payments.

As you might expect, we end up gaining respect and exchanging ideas with the doctors and staff we work with so cooperatively. After a year of solving integration issues with multiple doctors in multiple offices using a wide variety of EHR software and hardware platforms led to a discussion with a doctor who I now consider a friend. Looking at the expense of hardware/software/support I said,
“with the equipment you have for two doctors, we could support 200.” That got me thinking.

If the government thinks the Hardware / Software / Support can be done for 18k per doctor, my company should be able to provide the entire system to a doctor’s office within the reimbursement available from HITECH. We have multiple prototype systems in operational production now that were assembled by the doctors. If we added our expertise early in the design, we could assemble a package that would be simple, reliable and after the HITECH reimbursement, free.
MASS CONFUSION in the marketplace.

There are a number of ways a doctor’s office can implement EMR. If you implement a ‘cloud-based’ system, you can have the equipment in house: thin clients, PC’s, etc… But with our goal of providing a reliable easy-to-work business model based on our experience with the early adopters, how do we provide a highly reliable, fully supported, commercial quality EMR to physicians and make it come in at or under the HITECH incentive?

One thing all of the EMR software providers have in common is that they sell you a cloud, or sell you a piece of software and hand you a piece of paper that is your responsibility. Our goal was to take all of the responsibility for the technology and bureaucracy and just do it for the doctor as part of the package. Our goal is that the doctor should only be concerned with practicing medicine and reaching the target of ‘meaningful compliance’ put forth in HITECH necessary to receive the reimbursement. ITCSNY is responsible for integration of the technology, bureaucratic HITECH paperwork, reliable operation and providing assistance to the doctor to choose the EMR package best suited to his/her practice.

As a result ITCSNY has developed a ‘cooperative’ technology, where the physician joins our EMR co-op and pays a monthly maintenance fee, much like a cooperative apartment. The physician shares the technology with others, but has his own private ‘apartment’ within the co-op. ITCSNY is the “super” and takes care of all of the essential functions such as backup, HIPAA compliance, updates, upgrades, patching, Anti-virus, Anti spam, etc…. There are no additional charges or technical responsibilities for the doctor. ITCSNY has also developed a ‘thin client’ office package, so that offices can be set up with the necessary equipment. All equipment that is fully supported by ITCSNY inclusively is new. We only use commercial quality HIPAA compliant equipment and services.

In summary :

• a. Pay the monthly maintenance.
  b. Achieve meaningful compliance.
  c. Pay the broadband bill (internet access) from each office.
  d. Deposit the reimbursement check from the government.

1. ITCSNY acts as an Independent consultant to assist the doctor to choose which EMR software package to utilize. Since we work with so many, we are in a unique position to provide great advice.
2. ITCSNY provides all the equipment, software and integration services and support, inclusive.
3. If something breaks, we replace it with a new piece.
4. Doctor’s responsibility:

By the way, my early adopter doctor friend called me last week and reported he got his check!

- Dan Scolnick
IT Computer Support of New York
President and Chief Technical Officer

Change is good.  We hear it all the time but when it comes to software I wish someone would step up and say that just because something is new doesn’t mean better.   Now I’m all for security and functionality improvements but the trend in the software industry has been to “modernize” the look of user interfaces.  Almost without exception the reception of these changes has been negative.

Perhaps the biggest offender in recent years has been Microsoft.  Back in 2007 Microsoft released Vista, an operating system that tried to solve the security problems of its predecessor, streamline the user interface and seemingly above all, to be prettier.  Of course we all know Vista was panned by critics and users alike (if a bit harshly in my opinion) and everyone waited for the next iteration.  But instead of Windows 7 let’s look at another product from the same launch period.  MS Office 2007 started a visual trend which sadly plagues all Microsoft products to this day.  Office 2007 introduced the “ribbon” menu, an obtrusive blocky mass of buttons and text that was to replace the traditional menu.  When first released I fondly remember many of my colleagues calling Word 2007, “Baby’s First Word Processor”; a name I remember every time I look up at my menu while writing now.  What made the visual revision so bad though wasn’t that it was ugly but that it was unnecessary and actually removed easy access to functionality that users had used for years.  While the features weren’t completely gone they had been buried under numerous menus and/or now required alternate activation settings.  For most users the changes to the Microsoft Office Suite are the most prominent negative changes but there are examples everywhere.

For about the last year Facebook has been reinventing itself in an effort to stay on top of the social network game.  The problem is that with each new iteration there is an outcry from users even louder than the one before.  Similarly Skype, a program I use daily, has been trying to push itself more as a video chat program and has changed its layout so much as to become completely convoluted for anyone who DOESN’T want to use it for video.  The Skype interface became so bad that I actually rolled back my copy to an older version number and have it set not to update itself.  After browsing the Skype forums I can safely attest that I’m not the only one either.  Changes such as these have actually made the modding communities for each product become more prominent than ever before.  If there is a program feature that has been removed or an interface broken you can almost guaranteed that somewhere there is a programmer who has put it back the way it was.

What can software developers learn from this?  Simple, new features and content are good but don’t force them on your users.  As a rule Google has always gone about rolling out new features in the right way.  When they first introduced Search background images they had an option to turn it off not a day after it launched.  Similarly, they have recently opened up the option to test the new layout for Gmail and are actively requesting feedback.

While I would be happy to go back to the Windows 98 Start menu, reinstall Word 2003 and boot up Media Player Classic I suspect there are some of you who actually like the changes.  So where do you stand?  Let me know in the comments below.

- Richard Keene
IT Computer Support of New York
Design and Optimization Department

Happy Halloween from everyone at IT Computer Support of New York!

- Richard Keene
IT Computer Support of New York
Design and Optimization Department

Apple released its much-anticipated MAC OS X Lion operating system back in July with over a million downloads in the first day.  Lion is an electronic download only, available for $30.00 from the online App Store.  This new operating system touts many new features and designs which Apple claims will make the user experience simpler.

Now that some of the new release hype has worn off let’s see how the OS stacks up.

Preparation

Prior to downloading Lion I performed a full Time Machine Backup of my MacBookPro and also created a bootable image using Carbon Copy Cloner in case I needed to revert back.  Once this house cleaning was complete I downloaded Apple OS X Lion from the App Store.  Since it was about 3.75GB in size this took about 45 minutes to download using my home ISP connection.  Prior to going through with the installation I copied the Lion installation file to a bootable DVD in case I ever need to reinstall.

Installation

Installation was a breeze and it took about 45 minutes to complete.  All my data and settings remained in tact with no issues.

First Impressions

When the computer rebooted I was greeted by a new and sleeker looking login screen, which immediately removes any doubt that this is a new operating system.

One of the top new features introduced is Gestures which allows a user to use the trackpad for zooming, swiping pages and various shortcuts.  Upon first login you are introduced with a quick tutorial on the Gestures feature.  After testing this for a few minutes it was easy to see how this can become quite handy but will take some getting used to.

With Lion Apple has reversed the traditional way of scrolling calling it ‘Natural Scrolling’.  This scrolling feature now mimics the iPad scroll on a touchscreen, so when you want to move up on a page you need to scroll down on your mouse and vice-versa.  For Apple Mac/iPad users this can be annoying but acceptable, for users that switch between PC and Mac this reverse scrolling feature can be a deal breaker since it changes the way we’ve used this feature since we learned computers.  Fortunately ‘Natural Scrolling’ can be disabled in the System Preferences returning the scrolling action back to default.

Full Screen mode for applications has been highlighted in Lion, basically it allows any application to go into full screen mode with a click of a mouse.  What makes this feature beneficial is that it allows the application to take up the entire screen(even hiding the operating system toolbar) so you can concentrate on the task at hand.

The Mail, Calendar and Contacts applications have been completely revamped and now look/feel like the versions on the iPad.  The Mail application is especially refreshing since its simplified interface and new look make it easy to work with email.  Conversations view has been added to allow for easier email management and a connection to Exchange Servers 2010 is supported.  Since we use Exchange 2010 at work I’ve been battling with finding an acceptable email client since moving to the Mac platform.  I tried Outlook 2011 and the old Mac Mail programs but these would perform sluggishly and didn’t offer the true Outlook experience you get with the PC version so I used Outlook Web Access instead.  Now with the new Mail program I will attempt to finally use a true email client but the verdict is still out.

Autosaving and Versions has been introduced with Lion, which allows you to revert back to a document draft like you can with TimeMachine.  The operating system automatically saves a version of the document in the background.  The concept is good but it only seems to work with Apple applications, I tried with MS Office and the Versions option was not available.

I tested all my daily applications and they all worked except for Java which I had to download from Apple.  To my relief BootCamp(Windows XP dual boot partition) also worked flawlessly.

Verdict

It’s clear with the release of Lion that Apple is pushing the look and feel of its iPad IOS unto the Mac operating system.  Features such as Gestures, Natural Scrolling and LaunchPad is evidence of the direction Apple is heading into with its operating systems.

The fact that I was able to perform this major operating system upgrade with no issues, my data/applications intact and my XP dual boot partition in working order makes this a success.  I would never have thought to perform a similar upgrade going to from XP to Vista or Windows 7, always opting to perform a clean installation instead to avoid compatibility issues.

Lion offers no noticeable advantage in performance over its predecessor but its 250 new features and upgraded Mail application should provide users with plenty of reasons to upgrade.  It will take months to truly evaluate Lion and discover all the new features but in the meantime there’s plenty to keep us busy.

Related Articles:

Get your Mac ready for Lion

Burning a Lion Boot Disc

Apple OS X Lion 250 Features

IT Computer Support of New York recently hosted a series of Lunch and Learn presentations on Cloud Computing.  The first batch of presentations was a big success so we are now opening signups to a larger audience.

The Cloud events are free “lunch and learn” presentations that are split into two demographics.  The first has a focus on medical practices and details the benefits of Cloud Computing and provides EMR stimulus information.  The second of the Cloud presentations provides a general overview of security concerns and benefits for financial institutions.  If there is enough interest we have plans to further broaden our topics to cover general business practices.

IT Computer Support of New York will continue to host monthly presentation on cloud now through the end of the year.  The next presentations will be held on October 19^th (Financial) and October 20^th (Medical).  If you are in either the medical or financial industries and would like to learn more or reserve a seat call us at 212-242-2949 and ask for Bill Checklowski.  While we will be hosting more “lunch and learn” events in coming months space is limited and if our last events were any indication will fill quickly.

For more information view our invitation flyers online at the following links:

Medical

Financial