Dear Praxis Clients,
It is with great pleasure that we announce the highly anticipated upgrade to the new Praxis® EMR v7, a revolutionary application that facilitates MACRA/MIPS/PQRS and all future Merit Based and Quality Payment Programs. With Praxis v7, you will not only participate and attest for quality reporting programs, but you will do so with close to 100% performance and with very little effort. Once Praxis learns your quality measures, your reporting will be automated. This is a major feat. No other EHR can do this. In fact, we believe they are working in the opposite direction by adding even more data fields and pick-lists to their templates. MIPS, PQRS, etc. are impossible to handle well without an artificial intelligence engine like the Praxis Concept Processor. No doctor has the time to play data entry clerk. Templates simply cannot do the job.
If you plan to attest for MIPS this year, please let us know immediately (Email us today at: email@example.com )
It is important you read this document to be ready prior to October 1, 2017.
In order to attest for MIPS this year you must use Praxis v7 for a total of 90 days this calendar year.
Therefore, to be clear, October 1st is the last day you may download Praxis 7 to begin attesting this year, notwithstanding CMS hardships and/or extensions that have been offered each year since the inception of Meaningful Use.
Attesting clients will be upgraded on a first come first serve basis. However, please keep in mind that being the first to upgrade will expose you to any potential problems newly released software versions typically experience. Of course, all errors and bugs that we have detected have been resolved. However, note the words "we have detected." As our manual disclaimers explain, we know what we know but we don't know what we don't know! Our support group will be on alert to detect and fix any issues reported by you, so please report any problem you may experience as soon as possible via: Praxis Live Support (Click here to access Live Support)
The reasons for the delay in releasing Praxis 7 are clearly explained at the bottom of this document.
Quality Payment Program - MACRA/MIPS 2017
We are pleased to inform you that Praxis completed the third wave of ONC (CMS) HITECH 2014-2015 Examination (yes, it's a combination of both years). This Monday, September 18th, we are scheduled to complete the technical certification exam. Keep in mind, over the next six months we will be releasing minor updates, but our certification requirements will be met with this new version.
If you are not planning to attest, we recommend you wait to upgrade to v7. Do not upgrade immediately unless you need to attest this year.
Training Webinar on Praxis v7 & Quality Reporting
We are planning an important Quality Reporting webinar to outline the new features with Praxis v7 on Monday, September 25 at 12 PM EST, particularly in relation to the handling of Quality Measures and Automatic Measure Calculations. Praxis v7 can be used effectively without learning these new features, and therefore you do not need to wait for the webinar prior to upgrading, but if you plan to attest for MIPS this webinar will be particularly helpful.
The webinar will also be recorded and available for your reference. Further training videos will be released with explanations on additional features. We will contact you with the dates and times for the training webinar shortly and we will also post this information at our support website.
Important New Features
Praxis v7 comes with the following major features:
Dramatically improved Practice Advisories will generate the codes needed to attest with MACRA/MIPS/PQRS and any other program following the unique Praxis Reynolds 3 R's approach (see below). Without a doubt, Praxis v7 comes with the most powerful Practice Guideline Engine available in Medicine today. It will allow you to score close to 100% on attestations with almost no effort on your part. As you know, the Practice Advisories in Praxis function to:
a) Advise you at the point of care.
b) Chart on your behalf and carry out the Quality Measures that you, we, or others create on of your behalf. All you do is agree.
c) Code your performance in the background when you activate the guideline so you get credit for your attestations.
All three actions are handled at the same time: there is nothing for you to do and no "Meaningful Use Dashboards" to check over your shoulder. We call them "Meaningless Use Dashboards!"
In addition, the new Practice Advisories in Praxis v7 allow you to create your own practice guideline algorithms with computer processing speed, something that we believe will improve the quality of medicine you practice with no extra effort. If you search Google, you will be amazed at how many practice guideline algorithms you can find:
Figure 1. Practice Guideline Algorithms. Example in Cardiology. No matter what your specialty, you will find a large number of them available by typing your specialty in Google and selecting "Images." In Praxis it is faster to reproduce such branching algorithms for your practice (or create them anew) than have someone draw them out like in the examples above. Selection of a given PA Line item can be made to trigger related PAs depending on the conditions of the patient, just like in the diagrams display above. With Praxis you can formulate your own Practice Advisories within seconds or use the ones we have made for MIPS.
The Datum+ feature in Praxis enables special markups inside the editor windows that grab specific parts of your note and transfer them automatically into discrete data fields. This allows the population of Summary Records for interoperability and all other required forms via Praxforms. Finally, Nursing Task Agents can be linked to codes (SNOMED, LOINC, CPTs) so that when your assistant clicks "done" on a Nursing Task Agent, the appropriate SNOMED or LOINC code will be sent to get you paid for merit based performance. This is also something that no other EHR can do. As you know, many performance indicators are based on outcomes which demand patient compliance and not just your order or referral.
Figure 2. The Nursing Task Agents may be linked to CPT/HPCS/SNOMED/ICDs/LOINC and NDC Codes. When the recepient clicks "Done" the codes are generated so you can send performance reportsr MIPS/MACRA. This enables your staff "follow up" on patient compliance for outcome type attestations.
For more information on these features, please read our white paper on Datum+, and also the groundbreaking article by Clayton Reynolds, MD, "The Three R's of Health Care Quality". Doctor Reynolds, a fellow Praxis user, is both Board Certified in Endocrinology and with the American Board of Quality Assurance and Utilization Management. Doctor Reynolds has developed what we believe is the solution to the reporting dilemma burdening providers today.
... And, don't forget our special training webinar on the new Praxis v7 features on Monday, September 25 at 12 PM EST.
We will send you information on how to connect to the webinar later this week and it will also be placed on the Customer Support / Live Chat portal.
2. Patient Portal/Patient Kiosk.
The new Patient Portal allows patients to register by simply clicking on an automated email that is sent upon the initial contact with your clinic, making the portal registration process straightforward. In this way, your patients may receive information and questionnaires as soon as they make an appointment over the phone prior to their first visit. Patients will also be able to electronically sign agreements and consent forms prior to being seen, enabling a waiting room Kiosk. All forms can be sent automatically sent to the Portal after the patient contacts your office.
3. New Interoperability Engine.
Praxis EMR's powerful agents, which had been expanded to cover the Portal in the previous version, are being once again improved to send and receive documentation to and from other clinics, hospitals, and providers through secure email via DIRECT technology. Praxis Agents will now automate and personalize information on your behalf by learning from your assessment. Medical Summaries and messages will be sent and received from other EHRs over various networks. Eventually faxing technology will be obsolete!
Please note: HIPAA requires an individualized security certificate, and we are currently working with a security certificate company that will provide it to you upon request.
4. Bidirectional Laboratory Interface
We are delighted to inform you that LabCorp has just certified Praxis v7 for the two way Laboratory transmission. Client demand for this new feature is expected to be strong, so if you wish to be added to this new lab feature, please email our Director of Client Services, Thomas Parri-Hughes at: Thomas.Parri-Hughes@praxisemr.com In most cases, there is no additional cost for this feature. After LabCorp is tested, we will add all other major labs.
Features Coming Soon
The most exciting aspect of Praxis v7 however has not been mentioned.
Now that we have finished complying with Federal certification regulations, we can focus our energy, our passion, and our entire development team on improving Praxis with just your needs in mind (See our last section below for a full explanation). We are finally free to work for you. Our focus now will not be to new features, but rather on improving current features based on your feedback. The coming months will be very exciting for all Praxis users.
A simple example is the Medications feature.
Our older clients will recall that the medication module was easier to use before than it is today. For years, prescription writing was the best part of Praxis. Your assessment would bring them forth instantly and you were done.
Figure 3. Praxis EMR 1997 (version 2.19). Note how clear and simple the prescriptions were instantly generated. As true today, your assessment triggered all the medications. However, they were written exactly how you wanted them to be written. Nothing more was needed, and of course, the prescriptions looked very clean.
Then came the age of ePrescribing and things began to change. Every EHR company including Praxis must use the same interoperability vendor (Surescripts) to transmit medications to the pharmacy electronically. This vendor is a de facto monopoly connecting every EHR to every pharmacy. And, pharmacies don't just want to see words you write but also the complex codes behind them, representing combinations of brand names, generic names, dosages, dose forms, amounts, refills, substitutes; the list seems endless. As a provider you have no time to deal with any of this.
The reason for this requirement, by the way, is that computers do not understand the human language. Computers only understand codified language that allows pharmacy robots to dispense your prescriptions automatically, without human intervention, decreasing pharmacy cost and error. But what about you, the sender of the prescriptions? The assumption is that all EHRs are based on templates, so you are supposed to pick from a huge list of drugs and dosages for every patient and for every encounter. However, Praxis works differently. It learns from your own past and specifically from your past similar assessment, so we cannot just switch your medication list every time the vendor demands it.
At issue is how to make Praxis perform quickly and efficiently, send the numerous required codes and fields to the pharmacy, and yet not trouble your eyes and waste your time. In other words, how do we hide the codes safely. Sounds easy, right? This is a tall order. Also, Praxis will link with Surescripts to receive a patient's current medication list derived from other providers.
We can't wait to get started!
Improved Routing Slip to your Billing Application
With the divorce of the Diagnosis from the Assessment that began in the last version, a number of coding issues arose. One is that the relationship between CPT codes and Modifiers that are linked to the diagnoses and not the assessment, but are triggered by the assessment. We have received excellent feedback from you on how to solve this issue of business logic, and it is one of the first things to be completed in the coming weeks. Of vital importance are the linkages between CPT codes and modifiers so you receive the maximum possible reimbursement for your services.
Chronic Care Management (CCM) - Extra Earnings on Chronic Patients
Chronic Care Management is an important part of healthcare. The new federal regulations place a significant burden on your staff in a Primary Care Clinic. An example is checking for compliance on orders. Yes, clicking on "Done" in the Nursing task is very straight forward, but what happens if the report does not get back to your clinic on time? Well, your assistant is supposed to find out what happened, call the patient, call the other clinic to request the report, etc. But, who has the time to do this? Your clinic does not have this time, or do they?
Actually, this is good news: What if every time you or one of your assistants opened a patient-related agent while making that phone call, reviewed an incoming laboratory, or checked the medical record on a patient to follow up on one of these issues, a clock went on and kept track of the total time spent doing all these things for your patient? There is a special CMS payment cover for this burden. If you see Medicare patients who present with two or more chronic illnesses, and you and/or staff spend more than 20 minutes per month on these issues, you are entitled to receive $49 dollars per month per patient additional earnings without ever seeing those patients in your office. This amounts to an average of $12,000 dollars per provider each month in additional revenues. Moreover, your high MIPS performance guided by your Practice Advisories should earn you additional revenues. We will be providing you with a special query that will list all patients with the total time spent on each patient every month.
Practice Advisories triggering Agents
As we fine tune Practice Advisories, they will get progressively more powerful and easier to use. Soon PA line items, when activated, will be set to automatically activate your Plan elements, such as Prescriptions, Treatments, Referrals and SOAP-Agents, including your Nursing Task Agents. So, if you agree with the incoming line item PA, your orders are activated and carried out on your behalf without having to remember to either generate them, or to chart them. No other EHR can do any of this.
The Praxis Scheduler
Figure 4. The New Praxis EMR Scheduler
The Praxis Scheduler has been re-designed, and will start beta testing next week. As soon as it is approved by our beta clinics, it will replace the current one in your system. The new scheduler takes into account available rooms and resources that we believe you will find most useful. It will also link with solutions that contacts patients via email, phone and message systems. If you wish to try the new beta test module, please let us know and we will be most happy to provide it for you. (We want to thank Doctor Steven Boas for his great feedback on this new scheduler!)
Electronic prescribing of controlled substances (EPCS)
Electronic prescribing of controlled substances (EPCS) was legalized over the last few years at the national level by the Drug Enforcement Agency (DEA), and since then all 50 states have followed suit.
The problem with EPCS was never a technical issue, since it is handled by Surescripts with the same interface we have today. It is a bureaucratic problem that involves a DEA certification. Thus, we are now evaluating a number of vendors to integrate this feature with one or more of the EPCS vendors so as not to delay this process further.
In addition to improving the vaccinations module over coming months (see next), we are now releasing the new vaccination registry protocol as required by the CDC for MIPS. The CDC has done an excellent job integrating each state's various vaccination protocols into one. As you might know, each state uses a unique protocol with "minor" differences from the CDC. We will first connect with the immunization registries of Florida, Georgia and California. In addition, our vaccination module will be revamped after getting wonderful feedback from our Pediatricians. You will be most happy. The following 47 states will be added per client request.
More Good News for Children's Docs
In addition to the improved vaccine module, we plan to add the Z-score calculation right into Datum+ so that it automatically appears in your note (Thank you, Doctor Steven Elliot, Doctor Ron Emerick and others...). In addition, we will add the automatic weight calculator. Currently Medications has one you get to by right clicking on the drug, but it is not automatic.
Automatic Referrals and Interoperability with RHIOS, HIEs and ACOS.
As mentioned, this new release comes with a powerful a interoperability engine that allows you to send messages to other doctors and clinics via secure DIRECT messaging (see https://www.healthit.gov/policy-researchers-implementers/direct-project). Praxis will link this to Datum and Agents to electronically send your referrals on the fly.
For example, if you enter "Dear «Contacts.Cardiology.FirstName»," Praxis will transform this Datum element into "Dear George", where "George" is the Cardiologist for this patient. But, where did the name and related info to send the secure email comes from?
Take a look:
Note that the actual contact is added to the patient record. This contact list is available in your Praxis today and can be classified any way you wish. Thus, Datum will allow you populate the information automatically via Datum so you can send your referral the Progress Note and Discrete Data (CCDA) via Direct Email as directed by your assessment of the case.
Moreover, this information will also be sent and received from Health Information Exchange systems such as RHIOS and ACOS. Currently, we are working with a NYU and the Geysinger Clinic, two large RHIOS, to get started.
Please understand that this kind of interoperability is not just wonderful for you and for your clinic, but vital for Praxis, as it will allow providers to use Praxis in larger clinics and hospitals co-existing with other EHRs. The day of the EHR monopoly is over. We strongly feel that you as a provider should be free to choose your own solution and not be mandated by the powers-that-be. We love our major competitors, they are babysitting our future clients!
Running Nursing Notes for ERs and Urgent Care
In fast paced clinical settings such as ER and Urgent Care, the patient needs to be monitored by the nursing staff while being seen. Praxis will include a new window tab where the clinical staff may enter vital signs or other clinical parameters, including their comments while you are seeing the patient. All clinical staff will be able to enter information at the same time, and each additional each entry made will be marked by the date, time and user who did it. At the end of the visit, this running tab will be incorporated into the patient's chart under the Progress Note. (Thank you, Doctor Winnie Banks, from the Cayman Islands, for this great and simple idea).
Clinic-Wide Comments Inherited with Diagnoses
The split between the Official Diagnoses and personal Assessments allows for an useful new feature that enables sharing clinic wide comments among providers. Thus, when a new provider sees one of the clinic's patients, he or she can inherit all the Diagnoses entered by the other providers on that same patient and view, modify an add to the incorporated comments found within each such diagnosis. This is very similar to how PSI works today, but is Diagnosis related.
This feature is particularly useful in clinics where providers are constantly seeing each other's patients. (Thank you, Doctor Daryoush Kashani from Los Angeles, for this great idea!)
Improving the speed of Praxis
It turns out that Praxis leaves a trail of unwanted data in RAM (Random Access Memory) that, after a while, slows down the system and the server must be rebooted. This is a diagnostic problem similar to that a pericardial effusion where you need to find the source so your patient does not go into congestive failure from decreased cardiac output. With millions of lines of codes, this not an easy thing to resolve. We have assigned a dedicated team to explore the etiology of this problem and to fix it. For those of you who find Praxis running slow, please know that this is a number one priority for us.
More features on the way
We love to hear your feedback and requests to improve Praxis. If there are features that you would like to see improved or added to Praxis please write to us.
The plan is to release mini upgrades frequently over next eight months to consistently improve Praxis. In the last six months of next year, we need to revisit the federal regulations again for 2019, no way around it!
Why did this certification take us so long, and why did we need to bypass your other important requests to do this?
The Federal Government created a convoluted and daunting body of regulations whose implementation by competing EHRs created havoc in medical practices everywhere. The problem, we submit, is not to be found with the regulations themselves. The actual regulations are reasonable and even lofty in their intention: to reduce the cost of healthcare and improve medical quality. But, the devil is the details, and in this case, in the arbitrary time lines set by the government to implement these regulations. This created the nightmare with EHRs we see today. Predictably, most of our competitors rushed to comply with the regulations, with horrible results. Their rushed certifications came at a grave expense to practicing physicians in terms of usability and to patients in terms of safety.
This recent study from the AMA, published this week could not be more telling:
You may have also learned that eClinicalWorks, a major competitor, was just fined 155 million dollars after cheating on this same certification. To be fair to eClinicalWorks and probably other potential infringers that took shortcuts to certify for Meaningful Use, we do not believe that this was a matter of greed, since for a very small fraction of that cost they could have hired an army of additional programmers, if an army of programmers could develop a better solution faster. However, in this business faster is not better, it is usually far worse. To put it in medical terms: If a surgeon can operate on a patient in 14 hours, then 14 surgeons will not do so in one hour, they will probably kill the patient! Software works the same way.
At Praxis your satisfaction with usability has been our foremost concern. We have been unwilling to release an inferior product simply to comply with federal regulations in the arbitrary times set by the government. Indeed, your user experience has been our overriding concern for and we will never compromise our passion to develop a great EMR for you, simply to make more money.
Fortunately, the government has agreed with vendors and providers nationwide to delay the implementation of these regulations, and has relaxed the attestation timelines. In fact, Doctor John Fleming, the new Deputy Chief of Health Information Technology appointed by President Trump in March of this year, happens to be a fellow Praxis EMR client. More importantly he has owned a Family Practice clinic for many years. As a practicing Physician, Doctor Fleming experienced the EHR problem first hand. Doctor Fleming, like most of you, has been on the receiving end of these new regulations, and he surely understands the dramatic issues involved.
By the way, if you wish to know the MU regulations we had to pass to certify, here they are (please take an aspirin before reading them!)
2015 Edition (Praxis certified in the areas you need to attest for 2017, such as eCQMs and their related security requirements.)
You may not notice many differences in the look and feel of Praxis v7. Most of the new features are found under the hood. We worked very hard to keep them hidden so as not to affect usability. That is why the new Praxis may appear remarkably similar to the old one. The drive behind our improvements has been clear: to reduce the noise imposed by the regulations, and make it easy for you to comply with them. In other words, to make these regulations as unobtrusive as possible for you.
Please take advantage of the Praxis training videos and Manuals:
Once you understand the key principles of concept processing, learning Praxis is intellectually exciting. If you use Praxis properly it will save you hours every day and hundreds of hours per year. More importantly, it will improve your practice of medicine and reduce your personal stress. This alone is worth putting some time into doing it right. If Praxis does not seem efficient at first, we ask you to review these videos when you have time (never when you get interrupted). Please feel free to contact us for anything that is not clear after viewing them. We value your feedback.
Our goal at Praxis has been to create a medical tool that dramatically improves your professional life and the lives of providers everywhere. Along the way, we hope to save you time, lower your stress, and ease the requirements of clinical quality reporting. As your EHR, we strive to act as a buffer between you and a growing Healthcare bureaucracy that every day demands additional requirements that further burden your busy professional life. How to satisfy the Federal Government's need for data collection without wasting your time and turning you into a data entry clerk has been our main focus. Praxis v7 is the result. With these latest Meaningful Use mandates behind us, we look forward to working for YOU again, and to the many new Praxis features ahead!
Richard M. Low, MD
Infor-Med Corporation - Praxis Electronic Medical Records
15760 Ventura Blvd 7th Floor, Encino, California 91436, USA
Direct: (818) 963-9146 Office: (818) 592-2900 x 5
Direct fax: (818)743-7759