text:
Electronic Health Records: A Guide to EHR Selection, Implementation and Incentives
- Kristin Blankenship
- 3 years ago
- Views:
1 Electronic Health Records: A Guide to EHR Selection, Medicare EHR Meaningful Use Incentive Payment Process and how to prepare for selecting/implementing an EHR system. The ASCRS/ASOA Guide to EHR is a centralized, one stop source of information about EHR, Meaningful Use, the Medicare EHR Incentive Payment Process, and how to prepare for selecting/implementing an EHR system. Copyright 2012 by the American Society of Cataract and Refractive Surgery. All rights reserved. 0 Updated April.
2 TABLE OF CONTENTS I. 5 Step Guide to EHR Implementation p II. EHR Vendor Selection Checklist p III. Imaging Considerations for Ophthalmology p IV. Medicare EHR Incentive Program Guide p V. Stage 1 Meaningful Use Requirements p VI. Stage 2 Meaningful Use Requirements p VII. Resources p.34 For timely updates on the incentive programs and other important issues affecting your practice and your patients, visit the ASCRS Government webpage and continue to read the Washington Watch Weekly, published every Friday. Questions can be directed to Jenny Liljeberg, associate director of regulatory affairs, at pg. 1
3 5 STEP GUIDE TO EHR IMPLEMENTATION Introduction If you are reading this, you are taking a step in the right direction when it comes to implementing Electronic Health Records (EHR). Doing so properly can lead to improvements in practice efficiency, reductions in manual processing costs, increases in revenue, and help raise the level of care you provide to your patients. However, failing to plan ahead and go through a step-by-step process can produce a frustrating and costly experience. Gathered here are steps that practices must consider to help facilitate successful EHR selection and implementation. It is important to plan ahead and understand exactly what you intend to achieve with health IT. 10 COMMON EHR IMPLEMENTATION PITFALLS 1. EHR software isn t or can t be customized to meet practice needs 2. Lack of 100% buy-in by doctors or unrealistic expectations 3. Electronic workflows not well-defined in advance 4. Not enough practice time for staff &doctors 5. No plan for continuous investment in software updates, training, system development or equipment upgrades 6. Underestimating initial cost of going electronic 7. Lack of measurable goals 8. Doctor s use of EHR is not made mandatory 9. Lack of thorough investigation and analysis of software applications, imaging capabilities or equipment interfaces 10. If doctors don t use it, nothing else matters! A physician-focused, specialist-oriented, efficient EHR will be key to a physician s ability to meet the increased reporting demands, satisfy patient needs, and run a financially successful practice. pg. 2
4 Step 1: Advance Preparation Do not underestimate the time and resources required to implement an EHR system. Evaluate your daily practice operations that will be affected: Provider workflow Front desk workflow Impact on IT infrastructure Billing Revenue/expense mix To best deal with the inevitable changes, begin by: 1. DEFINE YOUR NEEDS What do you want EHR to do for you, your patients and your practice? Reduction of paper Reduction in transcription expenses Better access to charts More legible data Improved tracking and reporting capabilities Achieve the efficiencies by carefully planned implementation and use of the EHR system Meaningful Use - using certified EHR in ways that can be measured significantly in quality and in quantity. Seamless communication: All activity about the patient is centralized What are your constraints? Cost IT resources Clinical/practice staff support Project management skills/ Internal expertise 2. DETERMINE PRACTICE READINESS Are the physicians and staff supportive of EHR adoption? Is there a physician leader committed to making health IT work for your practice? Is there an office administrator committed to making health IT work for your practice? How does EHR implementation fit with other practice priorities? 3. TALK TO YOUR PEERS Take advantage of resources offered by ASCRS and ASOA in helping you determine what kind of EHR might be the best fit for your practice size/type/location. pg. 3
5 4. MAP OUT YOUR WORKFLOW PROCESSES List daily, weekly, and monthly tasks and duties (rank them by complexity). Calculate completion times for each task; understand which tasks could easily become electronic. Practice mock clinics or at a minimum, conduct a few model patient visits. Identify snags and slowdowns walk the charts through each handoff and document where modifications are needed. 5. PERSONNEL ROLES Depending on practice size and skill sets, one person may fulfill more than one role, but generally key roles include: Physician/Executive leader defines and sells vision; identifies requirements and selects health IT system; helps build and enhance health IT; resolves conflicts. Project Manager assists with health IT system selection; manages coordination of software, hardware, special projects and training activities; helps train and troubleshoot. IT analyst (may be subcontracted) builds and supports health IT network, deploys hardware (servers, PCs, printers, scanners, electronic faxing, etc.); performs software configuration, hardware configuration, special projects such as interfaces. If you have multiple locations, ensure that members of those office teams are represented, so the broader practice needs are taken into consideration. 6. BUDGET To minimize surprises, develop a detailed budget outlining expenses in each category: Health IT software and related services (includes interface, necessary software updates/upgrades) Hardware/network and related services Internal labor expenses (time spent on training, data-entry, template development, workflow redesign, etc.) Additional implementation expenses such as scanning, space redesign, room set ups and viewing stations Temporary decline in provider productivity Financing expense Equipment upgrades Step 2: System Selection and Installation There are many choices of hardware that you ll need to make throughout the office: hardwired desktop computers, mobile notebooks, touch screens or tablet devices at the workstations. Look and test the latest models. Compare the advantages and disadvantages with each set up. Also consider who will be using them and how they will be used: pg. 4
6 Consider the following when selecting an EHR vendor: EHR must be certified for all stages of meaningful use by certified technology vendors, particularly if you plan to participate in a federal EHR incentive program. Research and create a short list of vendors that meet your technical requirements. ASK COLLEAGUES THE RIGHT QUESTIONS: 1. When did you install your EHR? 2. How long was the installation/implementation process? 3. How would you describe the installation/implementation process? 4. Was the system as user friendly as the demonstration by the salesperson? 5. How many patients per hour/per day did you (and your partners) see before the installation/implementation of your EHR? 6. How many did you see after? 7. Approximately how much more time do you devote to entering exam data into your EHR now compared to how you documented exams before you began using an EHR? 8. How do you like the quality of the EHR-generated exam notes? 9. Have you had to hire scribes to enter data for you? If so, how many and what is their annual cost? 10. Has your EHR completely eliminated the paper charts in your practice? 11. Given your practice s experience with your EHR, would you recommend it to a similar practice? Prepare technical requirements from your workflow analysis and other practice needs and match them to the products and services a vendor(s) offers. Develop evaluation criteria to maintain consistency when ranking vendors (e.g., cost, usability, and integration with current technology, depth of training and technical support). Involve representatives from all areas of your practice in the decision process. Prepare for health IT vendor demonstrations with detailed questions and requirements. Ask for and follow up on referrals, testimonials and recommendations from vendors. Consider doing your own independent site visits to observe clinic workflow and system performance. Additional questions and concerns to consider during this step: Evaluate your network (wired vs. wireless) to make sure the new devices can actually connect to the new system. Tablets and mobile devices are very useful, but only if they are able to readily connect to the network. Will you need ergonomic arms? These allow monitors, keyboards and mice to be clamped onto a desk top or mounted to a wall to enable them to swing out or tilted to a more convenient surface. Will you use scribes? What is the best equipment for them to use? pg. 5
7 What is the imaging functionality? Does it allow the user to manipulate or view multiple images? To help you manage and become more familiar with all of the new hardware (and software) you will be adding to your office, do what most IT companies do: Set up a test environment to test the use of all of the products and peripherals together; server, workstation, printer and scanner. You can also use this set up to view and practice on the software. Finally, install all of the hardware you re going to be deploying about a month prior to going live. This will give you and your staff the opportunity to become accustomed to computer use and the technology. It also ensures that you have the performance speed and reliability you need in order to go live and operate efficiently. Security: As you setup your EHR system, carefully consider who on your staff should have access to which data and who maintains it. This will allow you to set up the appropriate login rights to maintain security. Equipment Interfaces: How do you want data transferred from equipment? Are you utilizing interfaces? There are a number of equipment interfaces available that facilitate paperless entry. Do you want to replace equipment that is too old to interface? Or do you want to continue with data entry? Backup System: Have multiple methods of backup and recovery. Test your backup system several times before going live. Step 3: Implementation/Right Fit You will work closely with your health IT vendor during the implementation phase to determine your implementation strategy and schedule. Plan your exam room and office setup according to your office workflow. Make a diagram and change, or accommodate the flow of information from task-base to task-base. Create a plan for how to handle paper charts and a system for archiving records. Paperless timeline examples include: No scanning plan to pull paper charts three times after full use of EHR is accomplished. Date stamp each time used and after the third pull, file it. Have the provider identify key portions of chart to scan during patient s first electronic visit, scan it and file. Pull next week s appointments and scan key portions before patient s first electronic visit, give chart to provider for first visit only, then file. Prepare and practice a business continuity plan in case of a natural disaster or power outage. Determine how you will work with your staff and your patients in implementing a new process. Consider how long you may need vendor-provided technical support and trainers on-site after implementation. Plan financially to use them for an additional period of time, if you believe your practice will need it. pg. 6
8 MAKE SURE IT IS THE RIGHT FIT: One of the certain roads to EHR failure is to try and force your practice to adapt to software designed to support the average practice. As you evaluate systems, seek out solutions which are flexible and allow you (not just your EHR vendor) to easily customize all parts of the software. Once your EHR software is installed, and before you go much further down the path installing it on everyone s computers, have your Implementation Team evaluate what customization will be required to your EHR software by taking the following steps: Thoroughly review your software exam screen set up. It s essential that all stakeholders spend time going through all parts of the EHR software, including reviewing: All exam layouts All drop-down lists, libraries and pop-up s The optional EHR Notes sections where additional information can be entered such as Optical Recommendations, Test Findings, etc. Assessment & Plan pick lists Complaints and HPI list Templates for all testing procedures Any other information generated by your EHR software, including printouts, exam summaries, and letters PATIENT & STAFF AREAS: Have a good understanding of what the patient and staff flow will be when the EHR system is functioning in your existing space. This is essential for planning where to place the new EHR equipment. COMPUTER PLACEMENT: Computers will need to be in a convenient location in the office so that staff can easily look up or enter data into the record. Some practices find it helpful to have two monitors. Also, consider if you need printers where staff members will be handing printed materials to patients. ADDITIONAL POWER & NETWORK INFRASTRUCTURE Depending on where the hardware needs to be placed, will you need to run any additional electrical and network wiring? Will other work areas need to be created? Exam room considerations how will the computer be located to maintain eye contact with the patient? Does your network infrastructure meet the system requirements? Do you need to add resources due to increased demand on network and servers? PERFORM A DETAILED ANALYSIS OF YOUR CURRENT PROCESSES: Pay attention to and look for steps, actions, and sub-processes that you would ordinarily take for granted. Analyze the flow of data, paper documents, and patients. These are all interrelated and lead to either an efficient or a sloppy practice. pg. 7
9 Look for opportunities for improved efficiency. Use the tools available in your EHR system to design new work flows and develop a plan to transition to them. Spend the time to actually shadow patients through the practice. Do this for a number of different appointment types. Be detailed in your analysis and document every action or process. Watch for peripheral hardware or systems that might have to interact with your new system, including bar code printers, bar code readers, printers and external data transfer. The next step is to create new processes which take advantage of the things you do well and incorporate new processes, (or altered processes) to help improve efficiency and allow you to incorporate electronic data flow. Let one of your goals be to handle things only once and input data only once. Accept that your staff WILL have to do things differently, and it will take time for them to get comfortable with the changes. Consider making changes to your physical facility to best accommodate EHR and electronic data flow (see further facility considerations in the next section). Now is a good time to consider upgrading diagnostic equipment. This is especially important if your current equipment does not support some level of integration with your EHR software. Think about physical changes in your exam lanes to accommodate computers / monitors. Since the data is now going to be electronic, you might need to make computers available in more places and available to personnel who might not have needed their own computer in the past, a small investment compared to the efficiency gains. Keep in mind that implementing EHR is a work in progress and improved processes will continue to evolve as you gain experience. Step 4: Training/Maintenance Many practices will encounter problems with: 1) Lack of planning or lead time. 2) Not enough training. 3) Not enough time for training. 4) Resistance to change. CREATE A COMPREHENSIVE TRAINING PLAN: Who needs to be trained? Who will be posting and coding the exam visits? Is your clinical staff trained to do this? Who will do the training? Doctors and staff should practice familiarizing themselves with the program from their home PCs or before or after hours on the office computers using vendor-supplied online and tutorial training. It is also suggested that the office have several computers available so that staff can practice, using actual patient charts. It is helpful to have some space dedicated for ongoing EHR training. pg. 8
10 SCHEDULE PRACTICE SESSIONS: Once you ve customized your EHR system, you can then begin to have all clinical staff practice with real patient data. A good method is to meet in the afternoons and use paper charts generated during the day as examples for your practice sessions. The practice sessions accomplish several things: Identify problems or areas of confusion, and then implement necessary changes. Become proficient with the use of the EHR module without the added pressure of having a patient sitting in front of you in the exam chair. Get real medical record info loaded into the EHR records. Improve speed and accuracy. For detailed application-specific training, it is well worth the investment to bring in your EHR vendor. Go through your complete patient flow using a simulated patient and real data. This step is going beyond entering the data into the EHR, and taking it to the point of practicing through the entire patient visit. You should also simulate different kinds of visits, especially if your practice has a number of specialists go through a glaucoma visit, a retina evaluation, a new patient general visit, etc. Step 5: Go Live EHR is an Ongoing Process, Not an Event Have your vendor trainer, the in-house trainer or power user, and project manager present at your go live day. Schedule lightly for the first week or so allowing for more time between patients. Some practices choose to use EHR initially only for new patient visits or some other sub-set of their full patient load; but this isn t necessarily the best method. If you ve gone through all the considerations in this document, planned accordingly, practiced appropriately, and lightened your schedule, you should have few problems entering all patients visits into the EHR right from the start. Have a contingency plan when problems occur with the EHR or something else that you haven t planned for. Try to avoid falling back on paper charts if you can, but if you must, enter data on paper and then complete the EHR at the end of the day. Display signage in the office to explain the use of a new computer system. OTHER RECOMMENDATIONS FOR MANAGING YOUR EHR PROJECT INCLUDE: pg. 9 Clearly define the goals for what you want the EHR to do and make decisions based on these goals. Be realistic. If the physicians are not computer savvy it will take time. Take small steps. Ensure your Project Manager sets aside the specific time to: coordinate pre-implementation decisions, schedule regular meetings with the implementation team and perform all of the other tasks needed to keep the project moving forward.
11 Consider visiting other practices with the software of choice to discuss their implementation experience. Welcome staff and physicians to voice their concerns and fears about the implementation process so that they can be taken into consideration. Create a positive environment and get everyone excited about the implementation. Develop a timeline that everyone can access, so that everyone knows where you are in the process and everyone knows what they re supposed to be doing. Maintain ongoing training and development activities to gain maximum performance from your investment. Post training schedules and encourage participation. CONCLUSION The Goal of a Successful EHR Implementation: To achieve meaningful use, but also: Revenue, profitability, productivity, efficiency, data management capabilities, improving quality of care and patient satisfaction. A workflow analysis and redesign plan is the apex of data migration from paper charts to an EHR system. This redesign strategy begins by analyzing how information in your medical practice moves between departments to ensure operational and clinical tasks are completed and documented. Everyone s role is IMPORTANT on both the paper and EHR side. A workflow analysis ensures that key information will be transferred into the EHR and available to the providers and professionals in a secure and manageable format. EHR can be successfully implemented ONLY when physicians are totally committed to the task. Moving from a career of practicing medicine using paper charts to documenting everything on a computer isn't a small change. It is a sea of change! The physicians have to be the driving force behind it, or the EHR implementation will fail. A temporary drop in patient volume during EHR implementation is no reason to avoid EHR technology, especially with government incentives for adoption and looming penalties for non-compliance. More importantly, ICD 10 is around the corner. And with some careful planning of the implementation, training and workflows, the impact on physician productivity at go live can be mitigated. pg. 10
12 QUESTIONS TO ASK WHEN SELECTING A VENDOR: Vendor 1 Vendor 2 Vendor 3 Ophthalmology Specific Customization and Support? Is your EHR system designed specifically for ophthalmologists and is it an identifiable area of focus for your company? How many ophthalmologists use your system? Do you employ support staff that are trained and certified in ophthalmology? What certification/education/training do they have? Describe the training and support you offer to ensure that our practice will be successful? How many trainers will I have available for implementation, Going Live and follow up? Is there and extra charge? (Two trainers preferred - one for front office and one for back office) Can I add data fields? Patient Demographics Medical Records Eyewear orders Contact Lens Orders Claim information Can I add objects to the screens? Check boxes Data entry fields with pick lists Memo fields that hold an unlimited amount of documentation Can I attach rules to those objects that will automatically perform functions for me, including: Make sure the data is correct Limit pick list options based on conditions or findings Populate one or more other fields to save me time and key strokes Perform a calculation Launch a website Create a report Write a letter Can I define my own audit report? Charts with missing information Information entered incorrectly Bonus opportunities Can I customize patient documents? Examination reports Patient letters pg. 11
13 Referring physician letters Education materials Can I create my own reports, including: Financials Appointments Staff Productivity Doctor Productivity Trend Analysis Does it allow different screens based on job responsibility? What level of expertise is needed to maintain EHR templates and how user friendly is the process? Certified for EHR and erx Incentive Programs? Are you ONC ATCB CCHIT Meaningful Use Certified for all Stages? (satisfies EHR system requirements for Medicare/Medicaid incentives) Will your EHR system satisfy all stages of Meaningful Use (Stages 1, 2, 3 and beyond)? Will your staff be readily available to interpret and properly process all reports with regard to Meaningful Use and EHR incentive program requirements? Will your EHR system convert to ICD-10, and at what stage of beta testing is your company? Is your e-prescribing system completely integrated with the EHR? For example, can it send and receive patient medications & allergies to the prescribing system? Can Rx refill requests be received electronically? General Questions How many years of EHR implementation experience do you have? Will your system support my ASC? Do you offer integrated patient web registration? (Patient Portal) Do you offer a comprehensive hosted solution? ASP/Cloud based or is your system server based? What financing options can you offer me to help minimize cost? Do you offer complete revenue cycle management to accelerate my cash flow, including: Direct electronic claims Automated remittance posting Real-time insurance eligibility verification Collection analysis pg. 12
14 What type of image management system does your software include or does it require a third party vendor to effectively manipulate and manage images? What are your customer support hours? Is there an added cost for after hours? IMAGING CONSIDERATIONS FOR OPHTHALMOLOGY Planning for EHR includes consideration of how your practice will handle image management. The EHR products may handle imaging, although you will want to closely scrutinize the sophistication of the software application which is included, or they may work with a partner product that the practice will need to purchase. To begin, assess how important quick access and manipulation of imaging is to your practice. Consider what portion of your visits includes images that are part of your patient evaluation, or history and treatment plan? What is your current equipment inventory and how is it used? Is any of your equipment outdated and unable to be integrated? Is your infrastructure and network ready for images? With the use of digital radiology images in practices, patients are familiar with digital imaging as part of a modern practice. There are industry standards for imaging: DICOM (Digital Imaging and Communications in Medicine) and IHE (Integrated Healthcare Enterprise). These standards are being adopted in the area of ophthalmology. The image standards and the IHE interoperability standards are core to having your electronic health record system and imaging services work together and your practice workflow efficient. By selecting products which are compatible with your equipment purchases that use these standards, you are protecting your investment for ongoing development and improvements. The instruments, along with practice management EHR and imaging systems must work together to support the workflow. Vendor discussions should include interoperability industry standard HL7 messaging, DICOM transactions and workflow support. Establish a baseline with an inventory of the instruments and equipment that are installed at the practice. Develop a plan to connect each instrument to the EHR or imaging system. There are various technical tactics to accomplish this objective. Items to be included in the instrument inventory are: Equipment Name Equipment Location Volume of use per day Manufacturer Model Number Software Version Network Connection Print output Considerations include: Planned upgrades Age pg. 13
15 Replacement life cycle Location changes Selection and Implementation: Do you want to have your EHR vendor handle your imaging process? This approach focuses your selection on EHR and Imaging products that can effectively do both. The findings from your assessment about the volume and kind of imaging you do will be a key factor in your strategy choice. Large volume practices will likely want to have an EHR and specialized imaging product. Considerations include: 1. Vendor Background and Strategy & Experience in working with EHR 2. Vendor Implementation of how images are captured, viewed, stored, and accessed 3. Infrastructure recommendations for fast and reliable access 4. Obtaining and checking references for practices of similar size and scope Moving To Viewing all the data gathered from all the different types of devices & instruments at one viewing station. Fundus Imaging, OCT, Corneal Topography, Perimery, HRT, etc. From Printed reports from each instrument or separate viewing of imaging. Ability to interpret and annotate. Flexible viewing capabilities. Provider preferences are anticipated by the systems. Ability to access and utilize instrument software from the imaging system anywhere, anytime Ability to compare prior images- central database identifies each image, and knows where it is stored. Storage is in the protected data center with professional data management. Images available anywhere, anytime Once a patient is registered, all the appropriate procedures are scheduled, at the instrument, with accurate patient information Legacy electronic instruments (non DICOM standard) require an integration technical strategy. Standards reduce propriety & expensive custom software upgrades Charge Capture and chart documentation are tied together for accurate revenue capture. Technical Support software upgrades will not break interfaces, vendor to vendor specifications and testing process is in place. Secure seamless access to both systems Interpretations are printed on paper reports or results re-entered in the EHR. Manual entry and matching of instrumentation and electronic reporting for EHR. Hands on at the instrument only Image archive and history is at each instrument. Image storage has protected health information at each instrument. Little back up. No central listing. Staff key in patient identification at each instrument. Patient mismatches or spelling errors must be corrected. Legacy instruments are obsolete Interface development for every type of instrument Charges for image services may be missed or incomplete. Instruments are managed separately from your IT systems. Separate security log-in and tracking for each system pg. 14
16 Sample Functional Check list for Product Evaluation How is the image directly (electronically) identified/matched to the patient in the EHR? How is the image labeled to match the patient in the EHR if not done electronically? Is there a patient list shared with the EHR? Is there a work list for the tech (at the equipment)? Does the work list status tie to the EHR (order)? How is the labeling of the image handled? How does that labeling appear in the EHR? How do changes in the image labeling move between the Image System and the EHR? Can notes or comments be made on the image? By the tech or provider? Can you draw or add pointers to the image? By the tech and provider? Are the notes or comments about the image stored with the image or with the report? Is there an associated audit log? How is the interpretation report handled in the Image system? How is the interpretation report handled in the EHR system? Can the images be easily reviewed with the patient? How are images available for any referring doctor reports or consultations? Viewing- Does the tech need to arrange the images for the doc? Viewing- Are the images automatically arranged and easily accessible for the provider? Viewing-Are there individual provider/user preference settings available for each provider? Viewing-Preferences follow provider/user to all locations Viewing-How will images from prior visits be available? Viewing- How will images from prior visits at other locations be available? Viewing- Side by side comparisons of images How will images be accessed and utilized in the surgical centers? Photos of a surgical patient taken with a camera? Charge capture- Matching of Instrument testing performed to charges Interpretation stored where? Interpretation Report completion tracking? How do I search to find an image? Where is the image stored? Image accessibility from all locations and by remote access? Is the image compressed? Is the viewer considered web friendly? Is there remote access? Security/Log in Audit features Customer service/support hours local/national? pg. 15
17 THE MEDICARE EHR INCENTIVE PROGRAM The Medicare EHR Incentive Program started in 2011 and will continue through The program will provide incentive payments to eligible professionals (EPs) who demonstrate Meaningful Use of Certified EHR technology. To qualify for Medicare EHR incentive payments, EPs must successfully demonstrate and attest to meaningful use for each year of participation in the program. To be eligible to receive the maximum incentive payment ($44K), EPs must have begun participation by October 1, 2012, and be meaningful users for 90 consecutive days. The incentive is based on an amount equal to 75% of their allowed Medicare Part B charges for covered professional services based on claims submitted no later than two months after the end of the payment year. Eligible Professionals Doctor of medicine or osteopathy Doctor of dental surgery or dental medicine Doctor of podiatry Doctor of optometry Chiropractor Overview REGISTER - You can register before having an EHR system installed. Make sure you have enrollment records in the appropriate systems. You ll need: A National Provider Identifier (NPI) An enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS) ** Register for the EHR Program even if you do not have an enrollment record in PECOS (which is required for all Medicare eligible professionals). CERTIFIED TECHNOLOGY Use certified EHR technology. To receive incentive payments, make sure the EHR technology you're using or are considering buying will be certified for all stages of meaningful use by the Office of the National Coordinator for Health Information Technology. MEANINGFUL USE Be a Meaningful User. You have to demonstrate meaningful use for a consecutive 90-day period your first year. ATTESTATION To get your EHR incentive payment, you must attest (legally state) through Medicare's secure Web site that you've demonstrated "meaningful use" with certified EHR technology. pg. 16
18 PAYMENT The Medicare EHR Incentive Payment will be made approximately 4 to 8 weeks after an EP meets the program requirements and successfully attests they have demonstrated meaningful use of certified EHR technology. REGISTRATION A step by step registration guide is available on the ASCRS EHR webpage under Government Relations/Hot Topics and via this link: Third Party Registration Designation: EPs are now permitted to allow a practice manager, administrator, or any third party to register in their place. Users registering or attesting on behalf of an EP must have an Identity and Access Management System (I&A) web user account (User ID/Password) and be associated with the EP's NPI. CERTIFIED TECHNOLOGY EHR technology must be tested and certified for meaningful use by an Office of the National Coordinator (ONC) Authorized Testing and Certification Body (ATCB) in order for a provider to qualify for EHR incentive payments. ASCRS has a dedicated EHR/Meaningful Use webpage with resources to assist you, including a portal to the ONC Certified HIT Product List (CHPL) a comprehensive listing of Complete EHRs and EHR Modules that have been tested and certified by an ONC-Authorized Testing and Certification Body (ONC-ATCB). Whether you just want to browse various types of Meaningful Use certified EHR systems or are ready to select or implement a system, ASCRS can provide you with the resources to help guide you through the process. ATTESTATION To attest for the Medicare EHR Incentive Program in your first year of participation, you will need to have met meaningful use for a consecutive 90-day reporting period. If your initial attestation fails, you can select a different 90-day reporting period that may partially overlap with a previously reported 90-day period. During attestation, CMS requires each eligible professional provide a CMS EHR Certification ID or Number that identifies the certified EHR technology being used to demonstrate meaningful use. This unique CMS EHR Certification ID or Number can be obtained by entering the certified EHR technology product information at the Certified Health IT Product List (CHPL) on the ONC website: If a physician achieves meaningful use in one year, but does not achieve it the subsequent year, that skipped year counts toward the maximum program years allowable. For example, if a physician achieves Year 1 meaningful use in 2011, but not in 2012, CMS considers 2012 the physician s second year of program participation. Therefore, is Year 3 for the physician. pg. 17
19 PAYMENT Incentives are based upon the individual physician s Tax ID (TIN) number. The incentive payment follows the provider. During the registration process, you must provide one TIN under which you would like the incentive payment to be made. Incentive payments will be made approximately 4 to 8 weeks after an EP successfully attests that they have demonstrated meaningful use of certified EHR. Payments will be held until the EP meets the $24,000 threshold in allowed charges. EPs have 60 days following the reporting period to submit claims for allowed charges. Incentive payments will be made electronically on a rolling basis by a single payment contractor as they determine that an EP has demonstrated meaningful use for the applicable reporting period, and has reached the threshold for maximum payment. CMS will deposit payment in the first bank account on file. It will appear on your bank statement as "EHR Incentive Payment. EP S WORKING IN MULTIPLE GROUPS In cases where the EP is associated with more than one practice, EPs must select one TIN to receive any applicable EHR incentive payment. In the case of a qualifying EP who furnishes covered professional services in more than one practice, estimated allowed charges are determined based on claims submitted for the EP's covered professional services across all such practices. MEDICARE PAYMENT ADJUSTMENTS/REDUCTIONS - Payment Reductions Begin in % reduction for not meeting meaningful use requirements % reduction for not meeting meaningful use requirements 2017 and each subsequent year 3% reduction for not meeting meaningful use requirements (subject to increase annually at the discretion of CMS.) To avoid the -1% 2015 payment reduction, the EP must attest no later than October 1, 2014 (must begin 90 day EHR reporting period no later than July 1, 2014.) EPs must continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years. pg. 18
20 Calendar Year Electronic Health Records: A Guide to EHR Selection, REPORTING PERIODS AND INCENTIVE PAYMENTS FIRST PAYMENT YEAR 2011 Stage 1 (90 days) $18,000 REQUIREMENTS FOR EACH PAYMENT YEAR TOTAL PAYMENT Stage 1 Stage 1 Stage 2 Stage 2 Stage 3 $44,000 (Full Year) (Full Year) (90 days) (Full Year) (Full year) $12,000 $8,000 $4,000 $2,000 $ Stage 1 (90 days) $18,000 Stage 1 (Full Year) $12, Stage 1 (90 days) $15,000 Stage 2 (90 days) $8,000 Stage 1 (90 days) $12, Stage 1 (90 days) $12,000 Stage 2 (Full Year) $4,000 Stage 2 (Full Year) $8,000 Stage 1 (Full Year) $8, Stage 3 (90 Days) $0 Stage 3 (Full Year) $2,000 Stage 2 (Full Year) $4,000 Stage 2 (Full Year) $4,000 Stage 3 (Full Year) $0 $44,000 $39,000 $24,000 $0 INCENTIVE PAYMENTS Maximum Total Amount of EHR Incentive Payments for a Medicare EP First CY EP Receives an Incentive Payment and later 2011 $18, $12,000 $18,000 $8,000 $12,000 $15, $4,000 $8,000 $12,000 $12,000 $ $2,000 $4,000 $8,000 $8,000 $ $2,000 $4,000 $4,000 $0 TOTAL $44,000 $44,000 $39,000 $24,000 $0 pg. 19
DEMONSTRATING MEANINGFUL USE STAGE 1 REQUIREMENTS FOR ELIGIBLE PROVIDERS USING CERTIFIED EHR TECHNOLOGY IN 2015 The chart below lists the measures (and specialty exclusions) that eligible providers mustMore information
DEMONSTRATING MEANINGFUL USE STAGE 1 REQUIREMENTS FOR ELIGIBLE PROVIDERS USING CERTIFIED EHR TECHNOLOGY IN 2014 The chart below lists the measures (and specialty exclusions) that eligible providers mustMore information
MEANINGFUL USE STAGE 2 2015 FOR ELIGIBLE PROVIDERS USING CERTIFIED EMR TECHNOLOGY STAGE 2 REQUIREMENTS EPs must meet or qualify for an exclusion to 17 core objectives EPs must meet 3 of the 6 menu measures.More information
MEANINGFUL USE STAGE 2 REQUIREMENTS FOR ELIGIBLE PROVIDERS USING CERTIFIED EMR TECHNOLOGY On August 24, the Centers for Medicare & Medicaid Services (CMS) posted the much anticipated final rule for StageMore information
Demonstrating Meaningful Use Stage 1 Requirements for Eligible Providers Using Certified EMR Technology
Demonstrating Meaningful Use Stage 1 Requirements for Eligible Providers Using Certified EMR Technology The chart below lists the measures (and specialty exclusions) that eligible providers must demonstrateMore information
Meaningful Use Stage 1:
Whitepaper Meaningful Use Stage 1: EHR Incentive Program Information -------------------------------------------------------------- Daw Systems, Inc. UPDATED: November 2012 This document is designed toMore information
Ophthalmology Meaningful Use Attestation Guide Stage 1 2013 Edition
Ophthalmology Meaningful Use Attestation Guide Stage 1 2013 Edition Ophthalmologists can register for the Medicare electronic health record (EHR) incentive program on the CMS website: https://ehrincentives.cms.govMore information
Stage 1 vs. Stage 2 Comparison for Eligible Professionals
Stage 1 vs. Comparison for Eligible Professionals CORE OBJECTIVES (17 Total) Stage 1 Objective Stage 1 Measure Objective Measure Use CPOE for Medication orders directly entered by any licensed healthcareMore information
Meaningful Use - The Basics
Meaningful Use - The Basics Presented by PaperFree Florida 1 Topics Meaningful Use Stage 1 Meaningful Use Barriers: Observations from the field Help and Questions 2 What is Meaningful Use Meaningful UseMore information
Stage 1 vs. Stage 2 Comparison Table for Eligible Professionals Last Updated: August, 2012
Stage 1 vs. Stage 2 Comparison Table for Eligible Professionals Last Updated: August, 2012 CORE OBJECTIVES (17 total) Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure Use CPOE for medicationMore information
Presented by. Terri Gonzalez Director of Practice Improvement North Carolina Medical Society
Presented by Terri Gonzalez Director of Practice Improvement North Carolina Medical Society Meaningful Use is using certified EHR technology to: Improve quality, safety, efficiency, and reduce errors EngageMore information
Meaningful Use Objectives
Meaningful Use Objectives The purpose of the electronic health records (EHR) incentive program is not so much the adoption of health information technology (HIT), but rather how HIT can further the goalsMore information
Incentives to Accelerate EHR Adoption
Incentives to Accelerate EHR Adoption The passage of the American Recovery and Reinvestment Act (ARRA) of 2009 provides incentives for eligible professionals (EPs) to adopt and use electronic health recordsMore information
Meaningful Use Cheat Sheet CORE MEASURES: ALL REQUIRED # Measure Exclusions How to Meet in WEBeDoctor
Meaningful Use Cheat Sheet CORE MEASURES: ALL REQUIRED # Measure Exclusions How to Meet in WEBeDoctor 1 CPOE (Computerized Physician Order Entry) More than 30 percent of all unique patients with at leastMore information
Meaningful Use Criteria for Eligible Hospitals and Eligible Professionals (EPs)
Meaningful Use Criteria for Eligible and Eligible Professionals (EPs) Under the Electronic Health Record (EHR) meaningful use final rules established by the Centers for Medicare and Medicaid Services (CMS),More information
Meaningful Use Qualification Plan
Meaningful Use Qualification Plan Overview Certified EHR technology used in a meaningful way is one piece of a broader Health Information Technology infrastructure intended to reform the health care systemMore information
E Z BIS ELECTRONIC HEALTH RECORDS CERTIFICATION AND THE HITECH INCENTIVE PROGRAM The Incentives On July 13, 2010, the U.S. Department of Health and Human Services finalized the Electronic Health RecordMore information
Practice Partner Product Mappings to the ARRA/HITECH Stage 1 Meaningful Use Requirements for Eligible Providers
Product Mappings to the ARRA/HITECH Stage 1 Requirements for Eligible Providers Number CORE SET (These objectives are to be achieved by all eligible professionals in order to qualify for incentive payments.)More information
The EHR Incentive Program
The EHR Incentive Program Summary of the Centers for Medicare and Medicaid Services (CMS) Final Rule on Meaningful Use On July 13th, the Centers for Medicare and Medicaid Services (CMS) released its finalMore information
Medicaid EHR Incentive Program Dentists as Eligible Professionals. Kim Davis-Allen, Outreach Coordinator email@example.com.
Medicaid EHR Incentive Program Dentists as Eligible Professionals Kim Davis-Allen, Outreach Coordinator firstname.lastname@example.com Considerations Must begin participation by Program Year 2016 Not requiredMore information
STAGE 2 of the EHR Incentive Programs
EHR Incentive Programs A program administered by the Centers for Medicare & Medicaid Services (CMS) Eligible Professional s Guide to STAGE 2 of the EHR Incentive Programs September 2013 TABLE OF CONTENTS...More information
VIII. Dentist Crosswalk
Page 27 VIII. Dentist Crosswalk Overview The final rule on meaningful use requires that an Eligible Professional (EP) report on both clinical quality measures and functional objectives and measures. WhileMore information
Meaningful Use - Stage 1. And. Practice Maximus
Meaningful Use - Stage 1 And Practice Maximus The following explains how Practice Maximus certified EHR module allows user to achieve meaningful use objectives for Stage 1. Eligible Professionals (EP)More information
Stage 2 Meaningful Use What the Future Holds. Lindsey Wiley, MHA HIT Manager Oklahoma Foundation for Medical Quality
Stage 2 Meaningful Use What the Future Holds Lindsey Wiley, MHA HIT Manager Oklahoma Foundation for Medical Quality An Important Reminder For audio, you must use your phone: Step 1: Call (866) 906-0123.More information
Guide To Meaningful Use
Guide To Meaningful Use Volume 1 Collecting the Data Contents INTRODUCTION... 3 CORE SET... 4 1. DEMOGRAPHICS... 5 2. VITAL SIGNS... 6 3. PROBLEM LIST... 8 4. MAINTAIN ACTIVE MEDICATIONS LIST... 9 5. MEDICATIONMore information
EHR Incentive Program Focus on Stage One Meaningful Use. Kim Davis-Allen, Outreach Coordinator email@example.com October 16, 2014
EHR Incentive Program Focus on Stage One Meaningful Use Kim Davis-Allen, Outreach Coordinator email@example.com October 16, 2014 Checklist Participation Explanation Program Updates Stage OneMore information
STAGES 1 AND 2 REQUIREMENTS FOR MEETING MEANINGFUL USE OF EHRs 1
STAGES 1 AND 2 REQUIREMENTS FOR MEETING MEANINGFUL USE OF EHRs 1 Requirement CPOE Use CPOE for medication orders directly entered by any licensed health care professional who can enter orders into theMore information
EMR Name/ Model. meridianemr 4.2 CCHIT 2011 certified
EMR Name/ Model EMR Vendor meridianemr 4.2 CCHIT 2011 certified meridianemr, Inc Core Set of Measures Objective Stage 1 Objectives Stage 1 Measures EMR Module/ Feature 1 Use CPOE for medication ordersMore information
An Introduction to the Medicaid EHR Incentive Program for Eligible Professionals
EHR Incentive Programs A program administered by the Centers for Medicare & Medicaid Services (CMS) An Introduction to the Medicaid EHR Incentive Program for Eligible Professionals cms.gov/ehrincentiveprogramsMore information
Core Set of Objectives and Measures Must Meet All 15 Measures Stage 1 Objectives Stage 1 Measures Reporting Method
Core Set of Objectives and Measures Must Meet All 15 Measures Stage 1 Objectives Stage 1 Measures Reporting Method Use Computerized Provider Order Entry (CPOE) for medication orders directly entered byMore information
Meaningful Use. NextGen Ambulatory EHR Path to. At NextGen Healthcare, we are ready to help. you demonstrate Meaningful Use.
NextGen Ambulatory EHR Path to Meaningful Use At NextGen Healthcare, we are ready to help you demonstrate Meaningful Use. With our award-winning, certified EHR, our commitment to client partnerships, andMore information
Stage 1 vs. Stage 2 Comparison Table for Eligible Hospitals and CAHs Last Updated: August, 2012
CORE OBJECTIVES (16 total) Stage 1 vs. Stage 2 Comparison Table for Eligible Hospitals and CAHs Last Updated: August, 2012 Stage 1 Objective Use CPOE for medication orders directly entered by any licensedMore information
Stage 2 Meaningful Use
Stage 2 Meaningful Use Stage 2 Topics Overview 2014 Reporting Changes Medicaid Provider Eligibility Measures Overview Core Objectives Comparison Menu Objectives Comparison Clinical Quality Measures 2 HighMore information
Achieving Meaningful Use Training Manual
Achieving Meaningful Use Training Manual Terms EP Eligible Professional Medicare Eligible Professional o Doctor of Medicine or Osteopathy o Doctor of Dental Surgery or Dental Medicine o Doctor of PodiatricMore information
IMS Meaningful Use Webinar
IMS Meaningful Use Webinar Presented on: May 9 11:00am 12:00pm (PDT) May 13 12:00pm 1:00pm (EST) This Webinar Will Be Recorded! Please send questions that you may have after the session to: email@example.com information
Meaningful Use. Medicare and Medicaid EHR Incentive Programs
Meaningful Use Medicare and Medicaid Table of Contents What is Meaningful Use?... 1 Table 1: Patient Benefits... 2 What is an EP?... 4 How are Registration and Attestation Being Handled?... 5 What areMore information
Medicaid EHR Incentive Program. Focus on Stage 2. Kim Davis-Allen, Outreach Coordinator firstname.lastname@example.com
Medicaid EHR Incentive Program Focus on Stage 2 Kim Davis-Allen, Outreach Coordinator firstname.lastname@example.com Understanding Participation Program Year Program Year January 1 st - December 31st. YearMore information
EHR Meaningful Use Guide
EHR Meaningful Use Guide for Stage I (2011) HITECH Attestation Version 2.0 Updated May/June 2014 in partnership with 1-866-866-6778 firstname.lastname@example.com www.medicfusion.com/platinum Medicfusion EMRMore information
BEGINNER MEDICAID EHR INCENTIVE PROGRAM FOR ELIGIBLE PROFESSIONALS. » An Introduction to: Last Updated: April 2014
01 BEGINNER» An Introduction to: MEDICAID EHR INCENTIVE PROGRAM FOR ELIGIBLE PROFESSIONALS Last Updated: April 2014 Table of contents How to use this guide... 2 1. Program basics... 5 What is the MedicaidMore information
Contact Information: West Texas Health Information Technology Regional Extension Center 3601 4 th Street MS 6232 Lubbock, Texas 79424 806-743-1338
Contact Information: West Texas Health Information Technology Regional Extension Center 3601 4 th Street MS 6232 Lubbock, Texas 79424 806-743-1338 http://www.wtxhitrec.org/ Grant award - $6.6m Total numberMore information
Meaningful Use 2014: Stage 2 MU Overview. Scott A. Jens, OD, FAAO October 16, 2013
Meaningful Use 2014: Stage 2 MU Overview Scott A. Jens, OD, FAAO October 16, 2013 Overview General Overview of Stage 2 MU in 2014 Core Objectives for Stage 2 Menu Objectives for Stage 2 Complete summaryMore information
AAP Meaningful Use: Certified EHR Technology Criteria
AAP Meaningful Use: Certified EHR Technology Criteria On July 13, 2010, the US Centers for Medicare and Medicaid Services (CMS) released a Final Rule establishing the criteria with which eligible pediatricians,More information
Achieving Meaningful Use with Centricity EMR
GE Healthcare Achieving Meaningful Use with Centricity EMR Are you Ready to Report? GE Healthcare EMR Consulting CHUG Fall Conference October 2010 Achieving Meaningful Use with Centricity EMR The EMR ConsultingMore information
An Overview of Meaningful Use: FAQs
An Overview of Meaningful Use: FAQs On Feb. 17, 2009, President Obama signed the American Recovery and Reinvestment Act of 2009 (ARRA) into law. This new law includes provisions (known as the HITECH Act)More information
Meaningful Use. Stage 1
Meaningful Use Stage 1 Core Objectives Must Meet all 13 Objectives 1. CPOE for Medication Orders 2. Drug Interaction Checks 3. Up-To-Date Problem List 4. E-Prescribing (erx) 5. Active Medication List 6.More information
Meaningful Use Guidelines: Radiologists
Meaningful Use Meaningful Use (MU) criteria allows providers to demonstrate that they are using certified EHR technology in ways that can be measured significantly in quality and in quantity. Many assumeMore information
Stage 1 Meaningful Use for Specialists. NYC REACH Primary Care Information Project NYC Department of Health & Mental Hygiene
Stage 1 Meaningful Use for Specialists NYC REACH Primary Care Information Project NYC Department of Health & Mental Hygiene 1 Today s Agenda Meaningful Use Overview Meaningful Use Measures Resources PrimaryMore information
A Guide to Understanding and Qualifying for Meaningful Use Incentives
A Guide to Understanding and Qualifying for Meaningful Use Incentives A White Paper by DrFirst Copyright 2000-2012 DrFirst All Rights Reserved. 1 Table of Contents Understanding and Qualifying for MeaningfulMore information
Ophthalmology Meaningful Use Attestation Guide Stage 2 2014 Edition
Ophthalmology Meaningful Use Attestation Guide Stage 2 2014 Edition Physicians who first participated in meaningful use in 2011 or 2012 must move on to Stage 2 in 2014. For 2014 only, physicians will attestMore information
to the Medicare and Medicaid
With the changes made in the final rule, earning the EHR incentive is still not easy, but at least it s easier. A Physician s Guide to the Medicare and Medicaid EHR Incentive Programs: The Basics DavidMore information
Lunch and Learn IFAF 09/24/11. Michael L. Brody, DPM
Lunch and Learn IFAF 09/24/11 Michael L. Brody, DPM Disclaimers Sammy Sponsor of this presentation PICA Biomedix All Pro Imaging The Brave New World of HIT Today s Topics: PQRS E-Rx EMR Health InformationMore information
Attachment 1 Stage 1 Meaningful Use Criteria
Core Set of Objectives and Measures Must Meet All 15 Measures Stage 1 Objectives Stage 1 Measures Reporting Method Use Computerized Provider Order Entry (CPOE) for medication orders directly entered byMore information
Agenda. What is Meaningful Use? Stage 2 - Meaningful Use Core Set. Stage 2 - Menu Set. Clinical Quality Measures (CQM) Clinical Considerations
AQAF Health Information Technology Forum Meaningful Use Stage 2 Clinical Considerations Marla Clinkscales & Mike Bice Alabama Regional Extension Center (ALREC) August 13, 2013 0 Agenda What is MeaningfulMore information
Meaningful Use of Certified EHR Technology with My Vision Express*
Insight Software, LLC 3050 Universal Blvd Ste 120 Weston FL 33331-3528 Tel. 877-882-7456 www.myvisionexpress.com Meaningful Use of Certified EHR Technology with My Vision Express* Eligible ProfessionalMore information
MDeverywhere, Inc. Presents 2014 CMS EHR Incentive Program Requirements: What Providers Need To Know
MDeverywhere, Inc. Presents 2014 CMS EHR Incentive Program Requirements: What Providers Need To Know Presented by: Kristen Heffernan Director Product Management & Marketing, Henry Schein MicroMD AgendaMore information
hospital s or CAH s inpatient or professional guidelines
EMR Name/ Model EMR Vendor XLEMR/XLEMR-2011-MU XLEMR Objective 1 Core Set of Measures Use CPOE for medication orders Use CPOE for medication orders More than 30% of unique patients directly entered byMore information
Medicare Electronic Health Record Incentive Program
Medicare Electronic Health Record Incentive Program The American Recovery and Reinvestment Act (Recovery Act) of 2009 provides for incentive payments for Medicare eligible professionals (EPs) who are meaningfulMore information
Meaningful Use Updates Stage 2 and 3. Julia Moore, Business Analyst SMC Partners, LLC July 8, 2015
Meaningful Use Updates Stage 2 and 3 Julia Moore, Business Analyst SMC Partners, LLC July 8, 2015 Stage 2 Requirements 2015 EPs beyond 1st year of MU must report on a full year of data EPs in 1 st yearMore information
EMR Name/ Model. Cerner PowerChart Ambulatory (PowerWorks ASP)
EMR Name/ Model EMR Vendor Cerner PowerChart Ambulatory (PowerWorks ASP) Cerner Corporation Core Set of Measures 1 Use CPOE for medication orders directly entered by any licensed healthcare professionalMore information
MEDICARE EHR: PREPARING FOR 2015. Community Counts Practice Effectiveness Web Series ION June 26, 2014 Risë Marie Cleland Oplinc, Inc.
MEDICARE EHR: PREPARING FOR 2015 Community Counts Practice Effectiveness Web Series ION June 26, 2014 Risë Marie Cleland Oplinc, Inc. Important to Remember The information provided in this presentationMore information
MICROMD EMR VERSION 9.0 2014 OBJECTIVE MEASURE CALCULATIONS TABLE OF CONTENTS PREFACE Welcome to MicroMD EMR... i How This Guide is Organized... i Understanding Typographical Conventions... i Cross-References...More information
Meaningful Use Updates. HIT Summit September 19, 2015
Meaningful Use Updates HIT Summit September 19, 2015 Meaningful Use Updates Nadine Owen, BS,CHTS-IS, CHTS-IM Health IT Analyst Hawaii Health Information Exchange No other relevant financial disclosures.More information
MEETING MEANINGFUL USE IN MICROMD -STAGE TWO- Presented by: Anna Mrvelj EMR Training Specialist
MEETING MEANINGFUL USE IN MICROMD -STAGE TWO- Presented by: Anna Mrvelj EMR Training Specialist 1 Proposed Rule On April 15, 2015 CMS Issued a new proposal rule for the Medicare and Medicaid EHR IncentiveMore information
Meaningful Use 2015 and beyond. Presented by: Anna Mrvelj EMR Training Specialist
Meaningful Use 2015 and beyond Presented by: Anna Mrvelj EMR Training Specialist 1 Agenda A look at the CMS Website Finding your EMR version Certification Number Proposed Rule by the Centers for MedicareMore information
MEANINGFUL USE Stages 1 & 2
MEANINGFUL USE Stages 1 & 2 OVERVIEW Meaningful Use is the third step in the journey to receive funds under the CMS EHR Incentive Programs. Meaningful Use (MU) is the utilization of certified electronicMore information
What GI Practices Need to Know About the Electronic Health Record Incentive Program. Joel V. Brill, MD, AGAF Lawrence R. Kosinski, MD, MBA, AGAF
What GI Practices Need to Know About the Electronic Health Record Incentive Program Joel V. Brill, MD, AGAF Lawrence R. Kosinski, MD, MBA, AGAF Disclosures Joel V. Brill, MD AGAF AGA Registry ExecutiveMore information
MEANINGFUL USE. Community Center Readiness Guide Additional Resource #13 Meaningful Use Implementation Tracking Tool (Template) CONTENTS:
Community Center Readiness Guide Additional Resource #13 Meaningful Use Implementation Tracking Tool (Template) MEANINGFUL USE HITECH s goal is not adoption alone but meaningful use of EHRs that is, theirMore information
Cash for Clunkers. Meaningful Use: No Cash for Clunkers. EHR Certification & Meaningful Use
Meaningful Use: No Cash for Clunkers EHR Certification & Meaningful Use ANCO/MOASC Business of Oncology: 2010 and Beyond October 28, 2010 Cash for Clunkers 2 1 NO Cash for Clunkers 3 What is a clunker?More information
Meaningful Use Stage 2. Presenter: Linda Wise, EMR Training Specialist
Meaningful Use Stage 2 Presenter: Linda Wise, EMR Training Specialist 1 AGENDA 2 Agenda Meaningful Use in Review Moving Into Stage 2 Meaningful Use Learning the Requirements Understanding the MeasuresMore information
EHR Meaningful Use Guide
EHR Meaningful Use Guide for Stage I (2011) HITECH Attestation Version 2.0 Updated May/June 2014 7500 Six Forks Road, Suite 200 Raleigh, NC 27615 1.866.643.7778 email@example.com 1 Ge ng Started ThisMore information
EHR Meaningful Use Guide for HITECH Attestation
EHR Meaningful Use Guide for HITECH Attestation in partnership with EHR for Chiropractors Getting Started This guide will help ensure that you meet or exceed the core and menu objectives required for HITECHMore information
Psychiatrists and Reporting on Meaningful Use Stage 1. August 6, 2012
Psychiatrists and Reporting on Meaningful Use Stage 1 August 6, 2012 Quick Overview Functional Measures Providers (tracked by NPI) must report on 15 core objectives and associated measures and 5 objectivesMore information
Health Care February 28, 2012. CMS Issues Proposed Rule on Stage 2 Meaningful Use,
ROPES & GRAY ALERT Health Care February 28, 2012 CMS Issues Proposed Rule on Stage 2 Meaningful Use, ONC Issues Companion Proposed Rule on 2014 EHR Certification Criteria On February 23, 2012, the CentersMore information
EHR Incentive Program Stage 2 Objectives Summary CORE OBJECTIVES (You must meet all objectives unless exclusion applies.)
EHR Incentive Program Stage 2 Objectives Summary CORE OBJECTIVES (You must meet all objectives unless exclusion applies.) TARGETING CANCER CARE Objective Objective Description Measure/Attestation RequirementMore information
Where to Begin? Auditing the Current EHR System
Chapter 1 Where to Begin? Auditing the Current EHR System After implementation, allow for a period of stabilization, so physicians and employees can gain more comfort using the electronic health recordMore information
Understanding Meaningful Use Stage 2
Understanding Meaningful Use Stage 2 Miranda Ladue, Manager, Product Management Adam Plotts, Manager, Product Management Copyright 2011 Allscripts Healthcare Solutions, Inc. Agenda Review MU Timeline MUMore information
Stage 2 of Meaningful Use Summary of Proposed Rule
Stage 2 of Meaningful Use Summary of Proposed Rule Background In order to receive incentives for the adoption of electronic health records (EHRs) under either the Medicare or Medicaid (Medi-Cal) incentiveMore information
Meaningful Use: Registration, Attestation, Workflow Tips and Tricks
Meaningful Use: Registration, Attestation, Workflow Tips and Tricks Allison L. Weathers, MD Medical Director, Information Services Rush University Medical Center Gregory J. Esper, MD, MBA Vice Chair, NeurologyMore information
STAGE 2 MEANINGFUL USE CORE AND MENU MEASURES FOR ELIGIBLE PROFESSIONALS CORE MEASURES must meet all CPOE for Medication, Laboratory and Radiology Orders Objective: Use computerized provider order entryMore information
FAQs for AMDA Members on the Medicare and Medicaid Electronic Health Record Incentive Programs, Including Medicare Payment Adjustments
FAQs for AMDA Members on the Medicare and Medicaid Electronic Health Record Incentive Programs, Including Medicare Payment Adjustments Long Term Post-Acute Care Providers I am a physician or nurse practitionerMore information
Meaningful Use Stage 2 Administrator Training
Meaningful Use Stage 2 Administrator Training 1 During the call please mute your line to reduce background noise. 2 Agenda Review of the EHR Incentive Programs for Stage 2 Meaningful Use Measures and CorrespondingMore information
Quest to Attest 2014 Stage 1 Meaningful Use. Brett M. Paepke, OD Advisor, Stage 1 Meaningful Use
Quest to Attest 2014 Stage 1 Meaningful Use Brett M. Paepke, OD Advisor, Stage 1 Meaningful Use Goals Discussion of MU and the Incentive Program Analysis of Stage 1 Objectives Summary of RevolutionEHRMore information
Texas Medicaid EHR Incentive Program
Texas Medicaid EHR Incentive Program Medicaid HIT Team July 23, 2012 Why Health IT? Benefits of Health IT A 2011 study* found that 92% of articles published from July 2007 to February 2010 reached conclusionsMore information
EHR/Meaningful Use 2015-2017
EHR/Meaningful Use 2015-2017 The requirements for Meaningful Use attestation have changed due to the recently released Medicare and Medicaid Programs: Electronic Health Record Incentive Program Stage 3More information
ASA Analysis and Recommendations for Meaningful Use Requirements, Stage 1 A Roadmap to Potential Achievability for Surgical Anesthesiologists
This chart reflects the applicability and potential achievability of MU requirements for an anesthesiologist who: - Provides surgical anesthesia and writes fewer than 100 outpatient prescriptions per yearMore information
A Beginner s Guide to Meaningful Use. Stage 1 for Doctors of Optometry
A Beginner s Guide to Meaningful Use Stage 1 for Doctors of Optometry Meaningful Use and EHRs 2 There s been a lot of talk about implementing EHRs and meaningful use in eyecare practices. But there isMore information
It s where we drive Quality Improvement and Get Money to aid in our ability to provide quality patient care
Leslie H. Perkins Leslie H. Perkins It s where we drive Quality Improvement and Get Money to aid in our ability to provide quality patient care The American Recovery and Reinvestment Act (Recovery Act)More information
If there are still unanswered questions, let us know and we'll go to CMS to get you the exact answers.
Your Top 10 EHR, Meaningful Use Questions Answered By Physicians Practice Staff Over the last few months, a number of you have responded to our blogs and articles in Physicians Practice with your questionsMore information
Electronic Health Records [EHR]
Be Successful with EHR Electronic Health Records [EHR] 7 Best Practices to Help Ensure the Success of Your EHR Implementation Inside... you will find proven processes, tools, and techniques for implementingMore information
Meaningful Use: It s Not Too Late For 2015!
Meaningful Use: It s Not Too Late For 2015! Jeffrey D. Lehrman, DPM, FACFAS, FASPS, FAPWH APMA Coding Committee Expert Panelist, Codingline.com Fellow, American Academy of Podiatric Practice ManagementMore information
Medicare and Medicaid Programs; EHR Incentive Programs
Medicare and Medicaid Programs; EHR Incentive Programs Background The American Recovery and Reinvestment Act of 2009 establishes incentive payments under the Medicare and Medicaid programs for certainMore information
Achieving Meaningful Use
ARRA INCENTIVE FOR ELIGIBLE HOSPITALS On July 13, 2010, the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) issued theMore information
Meaningful Use Stage 2
Meaningful Use Stage 2 Presented by: Sarah Leake, HTS Consultant HTS, a division of Mountain Pacific Quality Health Foundation 1 HTS Who We Are Stage 2 MU Overview Learning Objectives 2014 CEHRT CertificationMore information
MicroMD EMR version 7.6
MicroMD EMR version 7.6 H I T E C H M E A S U R E C a l c u l a t i o n s MICROMD EMR HITECH MEASURE CALCULATIONS VERSION 7.6 TABLE OF CONTENTS PREFACE Welcome to MicroMD EMR... i How This Guide is Organized...More information
Eligible Professionals (EPs) Purdue Research Foundation
Understanding STAGE 2 Meaningful Use and the Incentive Program Eligible Professionals (EPs) About Incentives Eligible Professionals report during a calendar year Eligible Professionals can only attestMore information
Thank You to Our Sponsors! CMS EHR Incentive Requirements. CMS EHR Incentive Programs. CMS EHR Incentive Programs. Steps to Get Started 3/15/2012
Thank You to Our Sponsors! AOA EHR Preparedness Program EHR Incentive Programs and Meaningful Use Update Jay W. Henry, O.D., M.S. Philip J. Gross, O.D. CMS EHR Incentive Programs Provide incentive paymentsMore information
Meaningful Use Stage 2 MU Audits
Meaningful Use Stage 2 MU Audits Presented by: Deb Anderson, CPHIMS HTS Consultant HTS, a division of Mountain Pacific Quality Health Foundation 1 CEHRT Certified Electronic Health Record Technology (EHR)More information
Stage 1 Meaningful Use - Attestation Worksheet: Core Measures
Stage 1 Meaningful Use - Attestation Worksheet: Core Measures Core Measures Objective # Objective Title / Explanation Goal Attestation Response - Values below reflect reponses of most radiologists ExplanationMore information
Modified Stage Two Meaningful Use with Final Rule Quick Reference Guide
Modified Stage Two Meaningful Use 2015-2017 with Final Rule Quick Reference Guide To qualify for Stage 1 or 2, a provider must meet: 10 objectives, Including 2 consolidated public health measures ReportingMore information
Meaningful Use in 2015 and Beyond Changes for Stage 2
Meaningful Use in 2015 and Beyond Changes for Stage 2 Jennifer Boaz Transformation Support Specialist Proprietary 1 Definitions AIU = Adopt, Implement or Upgrade EP = Eligible Professional API = ApplicationMore information


text:
About the Society
SHD History
SHD History
Sanford Bederman - Reflections
Thomas L. Goldstein - Reflections and Reassessments
Barbara McCorkle - People and Places
John Parker - Reflections
Norman Thrower - Personal Reminiscences
Carol Urness - A Personal Journey
How to Join
Terrae Incognitae
Terrae Incognitae
Terrae Incognitae
Terrae Incognitae
Terrae Incognitae
Terrae Incognitae
Terrae Incognitae
Terrae Incognitae
Terrae Incognitae
Terrae Incognitae
Terrae Incognitae
Terrae Incognitae
Ordering Back Issues
Notes for Contributors
Books for Review
Style Sheet
Past Editors
Student Prize
SHD Fellows
SHD Fellows
Thomas Sander
Carla Rahn Phillips
Francis Herbert
Dennis P. Reinhartz
John Logan Allen
Peter van der Krogt
Ralph Ehrenberg
Carol Louise Urness
Sanford H Bederman
David Buisseret
Louis De Vorsey
Arthur Holzheimer
Barbara Backus McCorkle
Jenkins Garrett
Virginia Garrett
John Parker
Norman J.W. Thrower
David Beers Quinn
SHD News
Members Area
Society Shop
Society Newsletter
Society Newsletter
Number 10, Summer 2010
Number 9, August 2009
Number 8, June 2008
Number 7, May 2007
Number 6, May 2006
Number 5, May 2005
Number 4, May 2004
Number 3, May 2003
Number 2, May 2002
Number 1, June 2001
Annual Meeting
2018 Annual Meeting
2018 Annual Meeting Registration
2018 Annual Meeting Abstracts
2018 Annual Meeting Accommodation
2018 Annual Meeting Schedule
2017 Annual Meeting
2017 Annual Meeting Accommodation
2017 Annual Meeting Schedule
2017 Annual Meeting Abstracts
2016 Annual Meeting Schedule
2016 Annual Meeting Abstracts
2015 Annual Meeting Information
2015 Annual Meeting Abstracts
2014 Annual Meeting
2014 Meeting Abstracts
2014 Annual Meeting Photogallery
2013 Annual Meeting
2013 Annual Meeting Program
2013 Meeting Abstracts
2013 Annual Meeting Photos
2012 Annual Meeting
2012 Meeting Abstracts
2012 Annual Meeting Photos
2011 Annual Meeting
2011 Annual Meeting Abstracts
2011 Annual Meeting Photos
2010 Annual Meeting introduction and program
2010 Annual Meeting Abstracts
2010 Annual Meeting optional tour
2010 Annual Meeting Photos
Previous Annual Meetings
Thomas F. Sander
Fellow of the Society for the History of Discoveries
Thomas F. Sander was born 70 years ago in Baltimore where he spent his youth and received his undergraduate education. He attended Loyola University Maryland 1962-1966 and graduated with a BS in Political Science and Sociology. While in college he began to show his budding interest in the military by joining Pershing Rifles which, according to their web site, is "the nation's premier undergraduate military honor society." He also joined Scabbard and Blade whose mission it is to develop military officers.
Tom joined the Army in 1966. The Army quickly recognized his abilities and from 1970-1972 sent him to American University where he obtained a MA in International Studies, specializing in European Affairs. In 1984 Tom attended University of North Carolina at Charlotte and obtained a MA in Political Geography. From 1985-1987 he attended the US Army War College where he received a Diploma in National Security.
Tom's military postings have included Washington DC, Fort Holibird Maryland, Fort Bragg North Carolina, Fort Leavenworth Kansas, Vietnam, Turkey, Germany, England and The Netherlands. Tom served in Vietnam for two years from battalion to corps level; he received two Bronze Star Medals. For much of his career he was a Foreign Area Officer (Western Europe). Upon retirement he was awarded the US Army Legion of Merit. He also received the Netherlands Ministry of Defense Medal of Merit (in Gold) for his over three years of service in that country as a military attaché; he was a key planner of the US participation in the country's nationwide commemorations of the 50th Anniversary of the end of World War II.
Tom retired from the Army as a Colonel in 1996 after 30 years of distinguished service. He then started 19 years, and still counting, of volunteering his services to the history of discoveries and cartographic community. He joined the Society for the History of Discoveries within a year of retiring from the Army, and was on the SHD Council by 2005. In 2006 and 2007 he was Vice-President and arranged the SHD meetings in Portland Oregon in 2006 and Chicago in 2007. Tom was SHD President from November 2007 to October 2009. He has served the Society as Web Content Manager since 2000; the website's success as a worldwide "public face" of our Society is due to his work in acting as the sole point of contact for all materials appearing at the site. In addition, Tom has reached out to other individuals and groups and publicizes the activities of SHD and
Terrae Incognitae
on various electronic mailing lists.
Tom also is very active with the Washington Map Society. He served as Vice-President in 2000-2001 and President 2001-2002. He has been editor of
The Portolan: the Journal of the Washington Map Society
since 1997. As editor, Tom changed the thrice-yearly
The Portolan
from a black-and-white, to a multi-colored publication, increasing its size from approximately 40 pages in each issue to 80 pages. Membership in the Washington Map Society has increased by more than thirty-three percent. Sixty percent of the membership lives outside the Washington Metropolitan area, and fifteen percent live outside the United States. Many members join just to receive
The Portolan
which can be found in over 50 libraries around the world including The British Library in London, Cambridge University Library, Bodleian Library in Oxford, The National Archives in Kew, National Library of Scotland in Edinburgh, and Trinity College in Dublin. The Washington Map Society has honored Tom with a Lifetime Membership Award.
For his service to the Society for the History of Discoveriesas an officer, for his numerous years of service as the "public face" of SHD to the general public as SHD Web Content Manager, and for his years of service as publicist of SHD events on the Internet, we honor Thomas F. Sander and name him a Fellow of the Society for the History of Discoveries.
Fifty-Sixth Annual Meeting of the Society for the History of Discoveries
London, England
July 9, 2015
Prepared by John W. Docktor
Photo by Jeanne Sander
All original content, translations and code
Copyright ©
The Society for the History of Discoveries
1999 - 2015. All rights reserved.

subset: commoncrawl


text:
Getting a great stand is our No. 1 job in the spring and the new Furrow Cruiser from Copperhead Ag offers a way to get it done. You can either outfit your closing wheels with the toothed ring, or buy the units complete and ready to mount. The company says its less aggressive design allows use on both sides of the furrow, and the crumbling and firming action provides enhanced seed-to-soil contact. Price for the add-on ring is $130 per row. Complete wheels are $200 per row. For more information, call (605) 261-7294 or www.copperheadag.com.
Hide comments


text:
Whether you like it or not, WordPress subscription plugins do their job in a perfect manner, not just do it. As a fact, they do it so well resulting in almost 500% increase in transfer rate completely due to right WordPress popup plugin.
If you are in pursuit of the best WordPress popup plugin fit your website, you will realize sooner that all the available ones are not similar.
All the WordPress popup plugins differ from each other in terms of features, which is annoying as if by any chance, you choose a substandard one you will be irritated to fix it according to your usage.
Here we are writing about few best WordPress popup plugin which help you in collecting more and more email.
Best WordPress subscription plugins
1. SumoMe(Free/paid)
Founded by Noah Kagan, has grown immensely in its follower's base. Slowly becoming one of the best WordPress popup plugins for marketing website. Its broader approach is its biggest USP. It has different modules for social media, heat maps, scroll maps, etc.
The last builder feature of some features WordPress email popup namely list builder. Displays popups on clicks, time triggered. The settings can adjust the color, text and other elements. With built-in analytics.
It offers a great feature of free charge, front end from editing, with great analytics, multiple pop creators. With only a single option of the template in the free version, another SaaS solution for WordPress plugin.
[button link="https://wordpress.org/plugins/sumome/" size="big" align="center" target="_blank" icon="momizat-icon-mail"]sumome popup plugin[/button]
2. ConvertPlug
A WordPress plugin very similar to optinMonster. But it has more it than just being a WordPress popup plugin. It is meant for hefty usage with a comfortable dash to grab from. It's completely a WordPress email plugin with nothing like sumome.
It has some good popup templates, all the popup variations you need to make your page attractive, with time-bound popup triggers. Equipped with built-in analytics, split testing, popup importing and with its very own built-in contact manager.
See below different templates of popup convertplug provide.
It is easy, to begin with, works with custom fonts. The only drawback is that it is not multi functional on different sites. It is needed to be installed on every side as a plugin.
Useful for those who have an only 'email approach' then you want this as an only WordPress email plugin. It is $26 for a lifetime membership comparatively cheap in its segment.
Here you can not only build email list building but also have option social sharing popup,promo popup and contact popup.Visit once I am sure you will like this popup.
[button link="https://www.convertplug.com/" size="big" align="center" target="_blank" icon="momizat-icon-mail"]convertplug popup plugin[/button]
3. Rapidology( 100% free WordPress plugin)
The center blade of a trident, it is just not a WordPress email plugin. The plugin delivers all the necessary accessories a website owner needs complimenting it with a very easy approach.
It features six different email option forms, template library having more than 100 options, completely customization, inbuilt stat and analytic ability, multiple triggers, integrated with popular email providers, a range of filters at your disposal.
All forms available though no front-end form editing option available, few bug present. though, It is hard to categorize as to who can use it and who can't.
You can add 6 Types of Email List-Builders to Your Website like slide in, popup, protected content, inline,widget and blow content. So it is worth to use this plugin.
[button link="https://www.rapidology.com/" size="big" align="center" target="_blank" icon="momizat-icon-mail"]Rapidology popup plugin[/button]
4. ThriveLeads
Like Bloom. It comes with different options grades like sidebar, slide-in, in content, poster footer forms. Content and the full-screen option is its biggest USP. It has exit intent technology for popups. It comes with a pre-built template library.
Templates can be customized on a visual composer. It gives you access to create lead groups and lead codes. Resulting in random campaigns with a different option.
The list is not it to WordPress popup plugins there are much more to the list. These are few from the lot. You have many more options available. So, happy hunting.
[button link="https://thrivethemes.com/leads/" size="big" align="center" target="_blank" icon="momizat-icon-mail"]thrivethemes popup plugin[/button]
Hope you like this post and surely use any of the above given popup plugin.


text:
Hotel Elegance Rooms
The hotel has a capacity of 57 beds divided into single and double rooms, some of which can have 1 or 2 extra beds. The hotel also offers a superior suite, a presidential suite, and a disabled room. The tastefully decorated rooms and suites feature a private bathroom, satellite TV, telephone, safe, air-conditioning, minibar, and Internet access.
The sports and relax centre offers entertainment, golf simulator, bowling, billiards, and hockey. There is also a hairdressing, beauty and massage parlour.


text:
The Saadi dynasty, which dominated much of Morocco in the 16th and 17th centuries, is closely identified with Marrakech, and some 60 members of the ruling family are now permanent residents. Assuming your reverence for long-dead Moroccan sultans is limited, the main reason for visiting the Saadian Tombs is the outstanding decorative work on the buildings which house them. Stunning geometric mosaics, minutely detailed stonework and serene courtyards evoke comparisons with the Alhambra.
The more important tombs are arranged in three rooms, including the magnificent Hall of Twelve Columns, with lower-ranked notables resting in the garden. The site was sealed at around the same time that El Badi Palace was destroyed and was only rediscovered in 1917. Faithful restoration ensures this jewel of Moroccan architecture continues to delight, and it is one of the most visited sites in Marrakech.
The Saadian Tombs can be reached on foot from Djemaa el Fna (allow 15 minutes) or by horse-drawn carriage (calèche).


text:
You have no items in your shopping cart.
Be the first to review this product
In stock
Microstream Intubated FilterLine® H Set - Adult/Pediatric Long (13 Ft)
* Required Fields
Email to a Friend
A full array of etCO2 sampling lines that fit every patient and meet every clinical need.
Use spaces to separate tags. Use single quotes (') for phrases.


text:
Calculating the penalty: factors to take into account when abating a penalty
When calculating the penalty you think is appropriate you should reduce the maximum 100% penalty to take into account the following abatements
|Type of abatement
|Reduction allowed
|Disclosure (IHTM36181)
|To take account of any disclosure and its completeness
|Up to 20% (or up to 30% in exceptional circumstances (IHTM36183))
|Co-operation (IHTM36191)
|To recognise the taxpayer's co-operation with our enquiries and the extent to which the necessary information was made quickly available.
|Up to 40%
|Gravity (IHTM36201)
|To take account of the gravity of the offence
|Up to 40%
The above percentages are shown in leaflet IHT 13, together with a brief description. You should always be prepared to explain how you have arrived at what you regard as the appropriate abatements. You will normally be able to point out that your suggested figure represents a substantial reduction of the maximum penalties for which formal action could be taken.
The deduction you allow under each heading should be based on a separate and realistic appraisal of that particular abatement factor alone. Any links between the abatement factors should be ignored. This means that a taxpayer whose offences are serious but who makes a full and spontaneous disclosure followed by maximum co-operation will qualify for full reductions for disclosure and co-operation with an appropriately high loading for gravity. Another taxpayer, having offended less seriously, may in the absence of disclosure and co-operation end up with a higher percentage loading.
The objective is to encourage and reward immediate disclosure and willing co-operation leading to a speedy settlement, while at the same time recognising the degree of seriousness of the offence. This means that a taxpayer who has made a genuine attempt to put things right as quickly as possible will get a greater abatement than someone whose admissions have been less than frank and co-operation has been reluctant or withheld. Any doubt concerning the level of abatement for disclosure and co-operation should be resolved by reference to this objective.


text:
When I built my first Tubescreamer clone (built with a great circuit board from DIY Effects) I was very pleased but left with a few issues that at the time I could not be bothered to fix.
Firstly, the paint finish I used on the enclosure did not turn out very well. I used Rustoleum, and sprayed it on way too thick (because I was impatient…lesson learned). It looked cool, but it didn't wear well.
Secondly, the DC power connector I originally bought for it turned out to be the wrong size. I only discovered this when I got hold of a power supply, and it didn't fit. In fact, it was at this point that I tried to use what I thought was an adapter for a smaller power connector. Little did I know that although the adapter fit, it was actually a polarity inverter too; so I blew up 3 JC4558 chips in the process.
So I decided to try an enclosure from Mammoth Electronics, who can provide a painted an drilled enclosure for around $10. Ridiculously cheap.
Getting on with it
The rehousing process was very easy; mostly a case of taking the old one apart and carefully assembling it all back into the new enclosure. I did have to redo the LED as the DIY Effects PCB allows you to solder it directly to the board, and let it just stick through the enclosure. I couldn't do that with the new enclosure and still have it line up with the hole, so I attached wires to the LED and then soldered those to the board. Nice and easy.
Clipping with MOSFETs
Months ago, after I built my OD2 which uses plain diodes for clipping, I decided to change this OD to use MOSFET clipping. SLW had mentioned it in the excellent PDF file that lays out instructions for building the pedal, and he rated it highly. I was able to purchase the parts easily, and after doing the necessary physical modification (i.e. cutting off most of the mounting lug) the mod was trivial. But what a result in terms of sound! You'll hopefully hear in the MP3 file below that it has a wonderfully soft clip. It's as if it has rounded edges. Like an overdriven Marshall, but without the harshness. It does definitely get harsh if you turn the tone all the way up, and responds very well to tone adjustments on the guitar itself. In the clip you'll hear a variety of pickups and guitar tone control settings (and sadly a lot of repetitive playing).
The setup was:
- My own build of an AX84 P1 Extreme, with a 6V6 for the output section.
- Tokai Les Paul with a 1961 Gibson PAF in the neck, and a modern Seymour Duncan JB in the bridge.
- 2×12 cab with Celestion G12T-75
- SM57 microphone
- Recorded in Logic on a Mac. And a touch of reverb in the master output channel.


text:
YREKA, Calif. --A gold caper is under investigation in Siskiyou County.
Thieves got off with $3 million in gold stolen from the courthouse in Yreka. Police say two men broke into a display case around 1 a.m. Wednesday. The theft was discovered just after 7:00.
Some of the historic nuggets were found near Yreka nearly 100 years ago. The collection was also shown at the World's Fair in San Francisco in 1939.
KGO-TV San Francisco, CA contributed to this report.


text:
- This event has passed.
Bayford test
August 12
- Date:
- August 12
Event Navigation
About Ambition Motorsport
Ambition Motorsport has been operating for over 15 years. Founded in January 2004, the team quickly became one of the leading kart teams in the South East of England. We specialise in welcoming new drivers into the world of karting.
Contact Us
Ambition Motorsport UK,
Unit E1, St George's Business Park,
Castle Road, Sittingbourne,
Kent, ME10 3TB
[email protected]
Opening Hours
Mon & Tues – Closed
Wed to Fri – 8am till 5pm
Sat & Sun – 6am till 6pm


text:
Deerfield Park District Summer Sampler Concert Series
Deerfield | Website
This event occurred in the past.
Map | Find Parking
A collection of artists playing on Sunday evenings. Mitchell Park is located just south of Mitchell Pool. Have the kids bring their suits and swim at Mitchell Pool prior to the concert. Bring blankets, chairs and a picnic dinner or purchase pizza and drinks on site.


text:
The interface that separates a crystalline solid phase from another phase usually displays anisotropic properties associated with the underlying crystalline symmetry of the solid phase. This anisotropy is characterized by the dependence of interfacial properties, such as surface tension or attachment kinetic coefficients, on the local orientation of the interface. For the understanding and eventual control of many materials processing techniques, it is frequently necessary to take into account the effects of such interface anisotropy. An example is the preferred growth directions that are observed during dendritic solidification via free growth from a single-component supercooled material, or during the directional solidification of a binary alloy. In general, the crystalline anisotropy affects the shape of the interface that separates the various phases, and so can play a fundamental role in establishing the degree of solute inhomogeneity, grain size, and defect structure that determine whether a given product is accepted or rejected for commercial use. The study of anisotropic interfaces is an area in which NIST materials scientists have made a number of important fundamental contributions.
Diffuse interface models of phase transitions, wherein the region separating distinct phases is represented by a zone of finite thickness rather than a mathematically sharp interface of zero width, have also been an areas of active NIST research recently; models of this type in materials science were developed by Cahn and Hilliard in the late 1960's. Diffuse interface theories that effectively incorporate the effects of interface anisotropy have been developed recently, but to date they have been limited to cases of mild anisotropy. For sharp interface models, it is well known that energy-minimizing shapes can exhibit corners or edges if the surface tension anisotropy is large enough; by forming the edge or corner, the overall surface energy is reduced by omitting certain high-energy orientations all together. A diffuse interface model of a highly-anisotropic system then faces a serious complication: the model must reconcile the smooth variation of the diffuse interface along the direction normal to the interface with the corner or edge singularities that occur in the transverse directions along the interface.
In the early 1970's Cahn and Hoffman introduced a useful construction, the so-called -vector, to characterize equilibrium shapes and missing orientations of sharp interfaces. We have recently shown how the -vector can be generalized to describe in a similar fashion the treatment of anisotropic diffuse interface models as well. The generalized -vector is useful in simplifying the construction of numerical algorithms for anisotropic diffuse interface models, and is also quite useful in asymptotic analyses of diffuse interface theories that relate them to sharp interface theories. In particular, a generalized -vector has also been found for multiple-order-parameter models of atomic ordering in solid-solid phase transitions, where the anisotropy of interphase and antiphase boundaries has recently been shown to lead to missing orientations in kinetic growth shapes. In future work, the study of anisotropy in multiple-order parameter models will be broadened to include crystals with symmetries other than face-centered-cubic structure, and will incorporate more c omprehensive thermodynamic descriptions in order to better model realistic phase diagrams.


text:
Monday, June 6th, 2011...3:07 pm
10% off at Bottlehood
Jump to Comments
Last Christmas, I included Bottlehood's recycled wine bottle tumblers in almost every gift guide I made. Now I have a set of eight amber ones of my own! This is the first time I've ever seen them discounted, so I wanted to share code DADDY for 10% off at Bottlehood.com. (In celebration of Father's Day.) Offer good through the 19th. If you get a set, let me know! Enjoy!


text:
Fantastic Dog and Cat Sitting Service has provided professional and reliable pet care services in Seattle since 1998. We offer an alternative to kennels and the stress of being boarded by offering personalized attention to your pet's needs and well being. Services offered include individual, private, and group walks, pet sitting for dogs and cats, and overnight care.
Fantastic Dog and Cat Sitting Service provides the highest level of quality in home pet care service designed to meet the specific needs of your pet. From dog walking and cat sitting to dealing with special medical issues and physical disabilities, the happiness and well being of your pet is our highest priority.
Summary of dog and cat services: Seattle Dog Walking with safe practices and expert skill. Pet Sitting Seattle - versatile skills with all your loved pets at affordable rates uncommon for this area: Only $20 per visit for walking services (for 1 dog, slightly more for multiples). Areas covered and specialties: Ballard dog walker, especially around the areas of Fremont Seattle, Greenwood, University District, Queen Anne, Magnolia Seattle, Greenlake, Capitol Hill, Ballard, and many more. See Areas of Service Page for more details. For this company, cat sitting in Seattle is a specialty, one of the first companies offering this level of attention for cats, gives you the chance for Seattle pet vacations without worry for your pets. Dog Walker Seattle - a best friend to man's best friend. Pet sitter Seattle Specialty - looking for a pet sitter? You've found the best. Can handle dogs and cats in the same visit.
For appointments, special requests and rates, contact Dan MacDonald at:
National Assoc. of Professional Pet Sitters
Pet Sitters International Dog Service Network
Angie's List 2008, 2010, 2011 Superior Service Award
copyright ©2014 fantastic dog & cat sitting service


text:
Hey guys!
I ordered G. Souls debut album Coming Home a few weeks ago and it just arrived in the mail today! Enjoy my unboxing video. I bought this album from Soompi, it is signed, and it comes with an exclusive photo!! Go buy an album and support G.Soul!
Subscribe to my Channel
Follow on Instagram Twitter and Vingle @KpopJunkiesTV


text:
As of October 2015, a fair rate for cat sitting would be about $9.50 per hour. That is a base rate that most people charge for watching a cat, but it might be higher depending on any other services that the cat might need.
Several factors determine what cat sitters charge for their service, including the amount of care, geographical location, additional responsibilities and experience. Rates may be higher if there is more than one cat or if the cat needs grooming. Cat sitters in big cities and suburbs tend to have higher rates than sitters in rural areas. Also, a sitter might charge more if they have a lot of experience, special certifications or licensing.


text:
Delivery Information
Spend $200 & get free delivery to most of Australia
Click here for all Australian freight rates
- Melbourne 3-4 working days
- Sydney 4-5 working days
- Brisbane 4-6 working days
- Adelaide 4-5 working days
- Perth 5-10+ working days
For express service, call 1800 069 295 for a quote.
International deliveries click here We cannot ship to all countries.
There are currently no reviews for this product.
2002 O'Donohoe's Tom's Drop Mourvedre Shiraz
Subscribe to stock alerts
Please enter your email address to receive stock alerts for this product:
- Closure: Cork
The vineyard is cropped exceptionally low for a Riverland vineyard with water-stressed yields at less than two tonnes per acre. Very deep crimson colour with deep crimson hue. Top notes of mocca and dark chocolate followed by spice and liquorice. The front of the palate displays some interesting flavour concentration – spiced, mixed berries over a layer of liquorice allsorts. Good palate weight with fine dry tannins followed by an aftertaste of mixed berries, spice and confectionary. Dry tannins persisting.
Cellar 2-3 years. (2005-2006)
Alc./Vol. 14.5%
Rating: 88/100
Value: XXX/5


text:
Project: A study on the presence of proteolytic enzymes in te excretion/secretion products from ruminant gastrointestinal nematodes and their potential use in serodiagnosis and/or immunisation.
- Abstract
- For the collection of excretion/secretion products in a convenient amount, the fourth stage larvae and adult parasites will be cultured in vitro. From the E:S material collected, proteolytic activity will be examined using a technique of substrate electrophoresis on PAGE gels. Later on their potential use in serodiagnosis and immunisation will be screened.


text:
Using products with natural ingredients is not only good for you, but it's good for the planet too! That's why I always turn to companies like Acure Organics for all my skincare and haircare needs. This is why I was exited to test out the Moroccan Argan Stem Cell & Argan Oil Shampoo from Acure. This intense formula is completely natural, but still infuses hair with moisture, repairing and strengthening all hair types.
The first thing I noticed when I tried out the Moroccan Argan Stem Cell & Argan Oil Shampoo shampoo and conditioner combo is the wonderful scent. It has a sweet fragrance that is invigorating without being overpowering. It reminds me of amaretto. The shampoo creates a generous lather even with just a small quarter sized amount, and leaves hair soft, clean, and vibrant. The conditioner did not leave my hair feeling greasy or heavy like other brands, but still made it easier to get out all the tangles. After just a few days of using these products, I saw a marked improvement in the condition of my hair. There are less split ends, its much healthier and thicker, and it really shines. But I think the best part about this line is that is uses all-natural ingredients. Of course, they are also affordable and they work great. You can't ask for more than that.
In addition to providing great results, these haircare products also offer several other perks. They are color safe, gluten free, and paraben free. They are also vegan friendly, and of course, they are never tested on animals. The shampoo & conditioner all only a few of the fantastic beauty products you can find from Acure Organics. Here are a few more items I love.
If you'd like to learn more about Acure and all the amazing, all-natural products they offer, be sure to visit their website of follow them via their social media. Do the best for yourself and for the environment, and try out Acure Organics today.
Connect with Acure