What’s New December 2008 Happy Holidays
	PLEASE DO THE UPDATE, even if you have done one recently to take advantage of changes made after feedback from our early testers and any bug fixes. If an "admin" login is required, the program will always prompt you but only one person in the office will need to do that "admin" login. Anybody who has done an update in the last several months may already be familiar with some of these changes. We apologize for the long delay since the last email and this long email but your Support and Maintenance dollars have been hard at work. Please absorb the parts of the email that affect you. You might want to read this email with the program open.
	If you have not done an update for a while and cannot login after the update or login is slow, there is an easy fix that will make login faster than ever. Please follow the instructions in the Login Connections Section below to modify the ads.ini file on every machine that runs TheraManager. Still having trouble, give us a call.
	As usual we report many improvements but in particular there are 3 screens where there are visible changes associated with major new features. The first is on the Insurance | Payments Screen where we have added the capability to process Electronic Remittance Advices (ERAs). This feature should save enormous amounts of time and tedious entry from a paper EOB. The second is on the EMR | Medical Record/Notes Screen where we have added 3 extra panels. The third visible differences are on the Prescriptions Screen where the program has been made ready for an electronic prescription capability that is awaiting approval.
	If you are using Print Image for the submission of your CMS-1500 forms, PLEASE migrate to 837 EDI submissions. This is a quicker and more reliable form of electronic transmission, and only involves a phone call to your clearing house and a couple of clicks at the Orgns & Plans Screen. At some point we will discontinue the print image option.
	If anyone still needs the old CMS-1500 form capability please let us know immediately as we plan to remove that.
	Disaster Protection. We cannot overstate the importance of making frequent backups and having backups stored in more than one location. We can tell you about the offices of some of our unfortunate clients that were burnt out, struck by lightning, blown away by tornado, flooded by a hurricane (Katrina), and of course offices that had hard-drive crashes. In about half the cases all data was lost or backups were not current because the users had not made backups or had not kept them off-site. The tornado victim lost his house, computer, patient records and backups, but he is a very large user of the forms and had exported these and kept a copy safe. He has now donated these to you and we are distributing them in the update so that they are available for import at the Form Designer Screen.
	If you lose income from missed appointments or pay an assistant to do phone reminders, you should call us for information on ReminderPro, a cost-effective automated phone reminder system that we sell. This system will also do email reminders or you can do them directly from TheraManager.
	Help Notes Please use them. We have doubled their number and broadened the list of search words. They can be found under Help | Help | Help Notes.
	We may only have one email per office so please read this email yourself and pass it on to your staff, your director, the clinicians, your associates, local colleagues etc.
Login Connections
	Immediately after this update you may not be able to login, but there is an easy fix that will make login much faster than before. We have added rigor to the login process to make it faster and avoid for example a "local login" in a networked environment that locks-out other users and can occur when a user logs in before the server is fully running, or the delay that occurs while the program unnecessarily looks for an internet connection. On login the program now looks for the specified paths to the database and the master tables using the ads.ini file. This file is in c:\Program Files\TheraManager on each machine and can be opened with a right-click and Open with Notepad. Below we show several typical configuations showing the lines that you may need to add. Other lines may have been added, particularly after our use of the database "architect", but these can be safely deleted. If you copy these, do not overwrite your existing paths, ie only add the appropriate "_Info and ServerType" lines for each alias. Note that if you use Master Data on your computer, the server_type will be "local", else if you use it on the server, the server_type will be "remote". Simple Solo User - one computer. [Databases] Main Data =C:\Program Files\TheraManager\Main Data\Main Data.add;D Master Data=C:\Program Files\TheraManager\Master Data;A [Main Data_info] ServerType=local [Master Data_info] ServerType=local Remote Internet only User [Databases] Main Data Internet =\\mybusiness.no-ip.org:6262\Main Data\Main Data.add;D Master Data=C:\Program Files\TheraManager\Master Data;A [Main Data Internet_info] ServerType=internet [Master Data_info] ServerType=local Network Client User with a Main Data Shared Folder on the Server and Local Master Data [Databases] Main Data =\\myserver:2000\Main Data\Main Data.add;D Master Data=C:\Program Files\TheraManager\Master Data;A [Main Data_info] ServerType=remote [Master Data_info] ServerType=local Network Client User with Main Data and Master Data Shared Folders on the Server [Databases] Main Data =\\myserver:2000\Main Data\Main Data.add;D Master Data=\\myserver:2000\Master Data;A [Main Data_info] ServerType=remote [Master Data_info] ServerType=remote Network Client User with Local Master Data and Internet Option [Databases] Main Data =\\myserver:2000\Main Data\Main Data.add;D Main Data Internet =\\mybusiness.no-ip.org:6262\Main Data\Main Data.add;D Master Data=C:\Program Files\TheraManager\Master Data;A [Main Data_info] ServerType=remote [Main Data Internet_info] ServerType=internet [Master Data_info] ServerType=local User on a Networked Server [Databases] Main Data =C:\TheraManager\Main Data\Main Data.add;D Master Data=C:\TheraManager\Master Data;A [Main Data_info] ServerType=remote [Master Data_info] ServerType=remote
	if you are using Vista in a networked environment the paths will read: :[Databases] Main Data=\\myserver:2000\Public\TheraManager\ Main Data\Main Data.add;D Master Data=\\myserver:2000\ Public\TheraManager\Master Data;A
Advantage Database Engine
	Two bugs were discovered in the usually reliable Advantage Database Server. One had the frustrating effect of slowing the opening of tables in a multi-user environment down to a crawl. The other affected encryption of notes. An updated version 8.1.0.38 has just been put on our website that fixes both these problems. We strongly suggest that you do the update on your server. Another bug only affected users of the local engine (ie not networked) who changed the date or name of a note immediately after making a new note. That change worked fine but any text entered immediately after this was not saved. We have added a refresh in the program to avoid this issue.
EMR
	This summer we added 3 extra panels and categories to the EMR Notes making a total of 7 panels.
	The size and position of these panels can be adjusted and remembered with a right-click and Save Screen Configuration.
	Any note can be viewed in any panel by first clicking on the panel and then clicking on the note on the left hand side tree chart.
	The four types of notes at the top of the Medical Records can be renamed and used to suit your needs. They are not locked. They are intended as a running visible record but the full right-click menu works with them. The names associated with these notes can be changed from the popup-menu on a patient-by-patient basis or for everybody . First type the new name into the note, selecting that name and right-clicking Note Rename. If you select Records for All that name will be used for all records for both existing and new.
	The contents of any panel can be printed. In order to print multiple notes, select them on the left-hand tree chart and right-click Print Selection. A dashed line is now printed between individual notes to differentiate them and the patient's Chart ID is printed in the footer if that is used.
	If you want the start times and stop times of an appointment included in the note automatically, create a new note by right clicking EHR/EMR on the the booked appointment on the Appointments Screen.
	We have added a feature that can show the notes in the tree in different colors. The first one will show the existence of any link added to a medical record after the upgrade. We can add more options based on your input.
	TheraManager works well with dictation programs such as Nuance Dragon Naturally Speaking ver 9, or the expensive Medical ver 10. However regular Dragon version 10 refuses to work with EMR programs. This is Nuance playing games and we suggest you take up the issue with them, if you want to use the latest dictation capability in TheraManager and you have no need for a medical dictionary.
	There is a very significant feature available to you when using the notes and is not yet being widely used.. It is buried in the spell-checker and we have created a new help Note (keyword "autocorrect") that explains how to set up your own short-hand. eg " nd " would expand to " It was a nice day .......etc.up to 496 characters.
EMR Forms
	Our tornado victim mentioned above lost everything but his forms, which he has given to us. We are making them available to everybody in this update. All you need to do, is import them at the EMR | FormDesigner Screen using the right click popup menu. These are all forms for mental health so we would welcome any forms and templates for other specialties.
	If you are in the Form Designer, it is important to maintain the correct count for the number of items in a group, or the form will not display properly. This count has always been adjusted automatically when adding a new item, and the program has now been changed so that the count is automatically adjusted when you delete an item.
	When Sub-heading is selected from the popup menu on the forms designer, the sub-heading is now inserted into the records at the selected point. This is also true of a new option to add a New Paragraph record that creates a paragraph and allows for more sophisticated formatting in the form summary.
	Since more people are making forms, we are showing a repeat of the complete list of items in Pronouns column that can be entered into the medical record. We have added a comma option for inserting lists into the summary. If the pronoun field contains text eg "He", "She", "him", "her" "their" etc that is entered. If the pronoun field is blank then the patients name is entered. If the pronoun field is ' then the patients name+" 's" is entered. If the pronoun field is - then a blank is entered. If the pronoun field is first then the first name is entered. If the pronoun field is first' then the first name+" 's" is entered. If the pronoun field is and then and he or and she are used with the appropriate punctuation to link two items in the prose print. In tabular form it will just be He or She. The default is to omit normal items from the prose but if you want them included then uncheck the Normal column.
Accounting
	We have added the capability to process Electronic Remittance Advices (835 ERAs) at the Payments Screen. Instead of entering the insurance remittances and changes by hand from the EOB. This feature should save enormous amounts of time and tedious entry from a paper EOB. The feature is active but should be considered in beta mode. To receive ERAs you must submit your claims electronically and request the ERAs from your clearing house. To use this feature select ERA Entry as the Insurance Payments Mode and click Enter to browse to an ERA file. The file will open in the Explanation of Benefits Grid that has been added to the Payments | Insurance Screen, and the total payment will be entered in the Payment Box. The estimated cpt, allowed and remittance, and the actual are entered in the two rows of boxes at the bottom of the screen. Clicking the Enter Button again will ask you to verify your agreement and will post the new info automatically with the adjustments etc as before. Clicking the Enter Button will do the same for successive records. Once you have verified the process and are resigned to accepting what the insurance organizations give you, you can check the Auto Mode. Remember this is a new feature and it involves ERAs from different insurance organizations, so please review the results carefully and provide us with feedback and info on bugs.
	We have added a new field to cpt codes at the Customization Screen called Supplementary. The content of this field is automatically inserted into the Supplementary Box on the Posting Form and from there to Box 24A on the CMS-1500 form or is inserted into the EDI. It can be used as required. For example it is now required by Medicare to differentiate between injectables.
	We still get calls from our customers who enter an insurance for a patient which by default starts on the day of entry. They then try to post an appointment for an earlier date and are mystified that the patient is identified as "self-pay". The insurance start date must be made no later than the first posting date with this insurance.
	We are providing you with a master list of Insurance plans to be available at the Plans Screen. After doing the Master Data update there is a listing and address information for all the insurance plans available in a new drop down box under "Plan Name" on the Plans Screen
	Along with npi numbers clinicians can have Taxonomy Codes which some insurance companies are requesting on electronic submissions. These taxonomy codes can be added for each clinician and cpt code at the Customization | Codes etc Screen in a new column for each Clinician's List of codes. The electronic file has been modified to include any codes that have been added.
	The names of archived patients by design do not appear on the accounts screens, but an omission caused this to continue after the patients had been reinstated. This has been fixed for all reinstated patients.
	This change should only affect a small number of electronic billers. The Use supervisor as renderer on EDI option has been removed from the Customization Screen and the function is done by insurance organization at the Orgn Screen | NPI (Box24j).
Credit Cards
	The use of credit cards is becoming increasingly popular and our built-in system works very well and has very competitive rates. Coincident with this update you should download new drivers for the swiper from our website, if you have not done so since September 8. The change was required to have the swiper operate on both XP and Vista.
Appointments Screen
	The Booking Form now has a long overdue feature. It shows the patient's balance, if you want it, and puts up a warning message if the account is in collection.
	Added an option to the Delete Menu item that allows all future appointments for a patient to be deleted.
	An All Users Button has been added to Tools | User Settings so that the Appointments Screen colors can be changed for all users since there should be uniformity across an office, but if the use of this button becomes contentious we could move it to the Admin Screen.
	We added the option for multiple bill-payers earlier this year, but its operation at the Posting Form has been improved. The full Multi Bill-payer Dialog is visible when the Posting Screen opens and stays open. It has also been made live, ie.selecting a different bill-payer calculates the corresponding balance on the Posting Form and changing any aspect of the posting causes the appropriate change on the Multi Bill-payer Dialog. The correct bill-payers name is now used on the printed bill. Posting FormPrinting the Appointments has been updated. There is now one set of information, although the format may be changed from portrait to landscape at the Tools | User Options Dialog with options to include openings and/or notes.
	The program has always had an autodialling feature at the Appointments Screen by clicking on a phone number or the associated label. This capability uses the computer's modem port and requires the Phone | Phone On menu item to be checked. However if this menu item is left unchecked then the program will make "softcalls" on your computer using Skype, Yahoo messenger, Vonage or any other VOIP service you have enabled on your computer. There is a Help Note for setting this up under keyword "phone".
Prescriptions
	The prescription writer has been modified and is now awaiting approval for transmitting prescriptions electronically.
	Please read the following carefully if you are registered for prescription writing.
	The layout of the Prescription Screen has been changed to accomodate new features and especially the use of a drug index with unique identifers for the combination of drug, form, dose and route (ie oral, topical etc).
	The present custom mode of selecting and saving meds will remain available but to prescribe electronically, the meds must come from one of two indices that we will provide. The other combination of script parameters including amount, refills regimen etc. are saved in an expanded record and can be selected from the drop down list. We have added search capability to two medication Boxes. You will need to type a few letters and hit Enter to select the corresponding med in the index or your custom list. As a first step your existing lists are modified in the update to reflect the new structure. However when you go electronic and adopt one of the two indices, you will only be able to use your present custom list for writing local paper scripts. New entries with the unique identifiers will be required for electronic prescribing but they will be saved into your custom list and can be used for either paper or electronic transmission. We suggest that you remove any duplicates without an identifier using the Delete Button on the toolbar or better delete your entire current custom list (We will provide an option on the Delete Button to do this) and replace it with meds from the ONE INDEX you plan to use (See below). Sorry.
	We have worked hard modifying our prescription capability to give you the best of both the pre-existing functionality, which is very fast, and the new electronic capability, which is much slower if you use it to compose scripts on the website. Our new capability maintains all the features of the present prescription writer letting you print scripts locally and electronically. Note that controlled substances of type 2 cannot yet be sent electronically. The patient list of meds in TheraManager will be bi-directionally synchronized to the list on the website and the status (pending, sent, finished etc) will be shown in the patient's records. TheraManager's very fast capability of generating repeats will continue to work with electronic scripts. You can keep a custom list of meds for either local or electronic use, for either yourself or for all prescribers in your practice. You will be able to have access to drug interactions, patients' allergies and patients' formularies for a fee. We will also be providing a master list of pharmacies nation wide from which you can select and save a default pharmacy for your patients but this feature will not be available until next year. TheraManager will automatically check for electronic renewal requests from the pharmacy and illuminate the Prescription Button text in red when it receives one.
	You can trial full electronic prescribing using the two indices 'RXNorm' and 'First Data Bank' (FDB) and use the prescriptions website for routing and composing. However you will only be viewing a replica of the real website, only mock patient data will be sent to it, and nothing will be sent to any pharmacy. The drug interaction display will not be available until next week. When you are ready to go live you MUST lock yourself in for the forseeable future to the choice of one of the 2 databases (Sorry). Your decision will be based on which of the 3 following options you want: Option 1. Electronic prescribing using meds taken from the RXNorm index is free, but it is not as complete as the FDB index and you will not have access to drug interactions, allergies or patient formulary information. You may also not be eligible to receive the CMS incentive outlined below, As we understand it a future switch from this index to the FDB index and the associated features will not be available. Option 2. Use the FDB index, which is more complete, easier to use and provides allergy and drug interaction checking. There will be a monthly charge of $20 a month (discounted to $16 for early adopters) for each physician using this index. A later upgrade to option 3 will also be possible Option 3. adds obtaining the patients formulary information to option 2 using the FDB index. The monthly charge for this option is $60 (discounted to $48 for early adopters)..
	Apart from the other benefits of e-prescribing, beginning January 1, 2009, Medicare will offer physician payment incentives of up to 2% for using e-prescribing in 2009 and 2010, with this amount declining slightly over the next three years. Payments for 2009 will be received by practices in 2010. Those physicians who do not adopt e-prescribing for Medicare by 2012, will start seeing their Medicare payments incrementally reduced, up to 2% annually beginning in 2014. Please note that to get these benefits you may need to use the FDB Index.
	Please call us with your choice of option and we will provide you with a new registration. All prescribing clinicians in a group must select the same option. Option1 will require a free registration to go live. Options 2 and 3 require annual registration.
	In summary we believe that we have given you the best and most cost-effective prescription writing possible to meet your needs. Our prescription writer can be all things to all people. It will print scripts locally, transmit electronically and if the pharmacy is not connected electronically, the fall-back will be a faxed script or a printed script. Our interface is very fast and you can keep custom lists of meds and regimen etc, or you can use the web interface to compose the script. We provide full bidirectional synchronization with your TheraManager database and you will receive renewal requests automatically. You can send a prescription to the website and have your staff select the pharmacy and execute the transmission to that pharmacy. The web service we use has connectivity to the largest number of pharmacies and mail-order pharmacies available. The web service we chose has options of basic service for free or full featured services for a competitive fee. Transmissions over the internet are via secure https to conform with HIPPA.
	If you need help please watch the videos or consult the new Help Notes. These help notes are indexed so that they are easy to find and make extensive use of screen shots so they are easy to follow..
	If you need further support or you have suggestions please contact support@theramanager.com or call 908-508-8900.
	If you have never downloaded TheraManager, go to our website and download the FREE Trial. If you have procrastinated from an earlier trial, please download again.