Over the next few months, SETMA will be deploying a number of new functions for the benefit of our patients and of the Southeast Texas community. You will be hearing more about:

• SETMA's recognition by the National Committee for Quality Assurance (NCQA) as a Patient-Centered Medical Home. At present only 3/10ths of 1 percent (0.3%) of practices in America are so designated and as of March, 2010, there was only one other in Texas.
• SETMA's submission of an application for NCQA's Diabetes Recognition award. SETMA's performance data, which is published on our website, shows that all three of SETMA's clinics meet the high standards for the care of diabetes required for this designation.
• SETMA's becoming an affiliate of Diabetes Center of Excellence at Harvard University. The designation will officially be "Joslin Diabetes Center affiliate at Southeast Texas Medical Associates, LLP." SETMA is the first primary care/multi-specialty practice in the United States to be so designated. A ribbon cutting to officially announce this will be held in September.
• SETMA's results from the Accreditation Association for Ambulatory Health Care (AAAHC) survey in August, 2010, for SETMA being a Patient-Centered Medical Home. To our knowledge, SETMA will be the first to seek patient-centered medical home review from both NCQA and AAAHC.

In addition, you will be hearing about:

• The Center for Medicare and Medicaid Services" (CMS) publication of its 865-page Final Rule for "Meaningful Use of Certified Electronic Health Records Technology." Over the next few years, practices will be rewarded for adopting electronic patient records.(EMR). Starting in 2015 practices which do not, will be penalized. There are 24 functions required for a practice to demonstrate "Stage I Meaningful Use" of an EMR. SETMA does all 24.
• CMS' new preventive health initiatives where Medicare will catch up with Medicare Advantage and begin paying for preventive health care which they have previously expected but refused to pay. SETMA already provides these services but will expand our scope in order to meet the standards established in CMS's 1250-page proposal for 2011 changes in Medicare and Medicaid.
• Phytel which is a function by which SETMA will be able to communicate extensively with our patients about their healthcare needs with opportunities for them to improve their health.
• The Physician Quality Reporting Initiative (PQRI) which has been voluntary from 2007 to 2014, but starting in 2015 will be mandatory. Healthcare providers who do not report quality performance standards by 2015 will have their reimbursements decreased. SETMA has participated in PQRI for the past two years and currently reports on more than 200 quality standards.
• NextMD which is a secure web portal through which SETMA's patients can communicate with their heath care provider, complete portions of their own medical record, request appointments and medication refills, see their laboratory results, maintain their own "personal health record," and participate in self-guided health education programs.
• CHS (Community Health Services) which is NextGen's community health solution whereby the entire medical community can communicate and share health data through a secure connection. While SETMA is making this available, SETMA will not own the function and SETMA will not own the data. Any and all healthcare entities hospitals, physicians, clinics. County and other health departments and offices can participate and share health information in a HIPPA-compliant and secure environment. This will be a not-for-profit means of improving the quality of healthcare available to all of our community.

Piece by piece, I want to introduce these subjects and also to alert any of our healthcare colleagues who are unaware of the challenges which we will all face in the next five years.

Using NextMD

NextMD requires that SETMA enroll you.   There is no cost to the patient for using NextMD. There are two requirements for enrollment:

• You must have an email address and
• You must request that we give you access

When you request enrollment, SETMA will give you a code. An e-mail will be sent to you which will detail how to use the token to set-up your NextMD account. Your NextMD account becomes your own personal health record which is accessible only by you. Your NextMD personal health record is automatically linked to your SETMA-based electronic-medical-record (EMR) chart. The following are some of the things you can do on your account.

Communicating with your healthcare provider

NextMD allows secure, protected and private communication between you and your healthcare provider. You simply log into NextMD and follow the simple instructions to send a message.   Because this message is not e-mailed to anyone, but is placed on a secure, password-protected website, it cannot be viewed by anyone but you. Your message will be delivered directly to your healthcare provider's workflow for review. 
The following is an example of what a message from a patient in NextGen would look like. This may look complex but it is really easy.

This note will be delivered to your healthcare provider's EMR workflow. He/she will know that the message is an e-mail communication and that it is from you. Your healthcare provider will respond to your message. The following is what the message would look like.

SETMA's standard will be that every patient e-mail note will be responded to every day. Once the provider responds, you will be sent an e-mail notifying you that you have a response. That message is HIPPA compliant and reveals nothing about your healthcare or health condition. That e-mail will look like this:

You will then log on and read your healthcare providers response. If you have additional questions you just send another note.

The NextMD account is much like a credit card account.  Your credit card company will often send you an e-mail to let you know that something is ready for your review but you must then log into the credit-card secure site to view the information.  This is a security measure so that un-encrypted information about the patient's healthcare is not being sent thru email.

Medication Refills and Appointments

NextMD will also allow you to make online requests for appointments and prescription refills. After logging into their NextMD account, you can view your current medication list and select the medications for which you would like to request a refill.  The request is then delivered to workflow just as if a pharmacy sent an electronic prescription request.  SETMA can approve or deny the refill and a message indicating our response will be sent back to your NextMD account.  You will then receive a notification via email that you have received a response to your refill request.

Appointments work very similarly.  You can login into NextMD and request an appointment with a provider at a given time or range of time.  The request is then sent to the appointments workflow group for scheduling and the patient is notified once the appointment is scheduled.

In the future, we will actually post your healthcare providers appointment schedule which will show his/her availability and you will be able to request a specific appointment. When that request is acceptable, you will receive an e-mail stating that you have an appointment at the time you selected.

Your Personal Health Record

NextMD will allow you to complete questionnaires and fill out templates online before coming to the clinic. SETMA can put EMR templates on your personal health record that we create. You can document the reasons for your upcoming visit or any symptoms you may be experiencing.  Our clinical staff can then review that template in the exam room with you and make changes to it if necessary and then add it to your medical record for that visit. The following is an example of a template which you could fill out.

Filling Records Request Electronically

NextMD will allow us to provide information from your EMR record to your NextMD account. For example, if you call to request an immunization record, a nurse can log into your chart, open the immunization record and tell the EMR to "push" the immunization record to your NextMD account.  The next time you access your NextMD account, you will have the document available to view or print if you desire.

We can do this with any document that is generated in the EMR, chart notes, discharge summaries, prescription sheets, transfer of care documents, disease management follow-up notes, etc.

Lab Work, Medication Lists

Your personal health record will make available to you:

• Your current medication list
• Your drug-drug allergies, your personal drug allergies
• Your Preventive Health Log of what you need and what you've had
• Your Screening Health Log of what you need and what you've had

As you become more familiar with this tool, you will be able to study about how to help yourself with your health, what the terms used by healthcare providers mean and what you should do to improve your health. Health resources will be made available to you and alerts will be sent out to you about new opportunities for learning about your health.

This is a new day in healthcare; you are in charge which means you have to be informed, involved and interested. Get your NextMD account set up today. Call SETMA and ask for your access code. We are looking forward to this new opportunity for you and for us.