What’s New January 2010
	First all our staff belatedly wish you all a Happy and Prosperous New Year and thank you for your good wishes.
	We have been very busy and there is much that is new with several major enhancements to report. In particular our method of storing and displaying billing data has been significantly revised. This was not a simple process and caused inconvenience to a few of you for which we apologize. The conversion is now complete. We have also completed full certification for sending prescriptions directly from the program interface to any pharmacy. We have added a means that allows for supervising the writing and locking of notes that will be of interest to the directors of group offices, who may wish to monitor their clinicians notes in order to improve the quality of healthcare within their group practices.
	Please do an update especially if you did one later than 9/23/2009 and have not done one this year to make sure that you have the latest billing changes. If an "admin" login is required please be very patient and do NOT discontinue this while the hourglass is visible or you see "Not Responding".
	We have just added a large customer in Rehabilitation who do a lot of case work with multiple case workers per patient, need copies of patient schedules, supervisory approval of medical records etc. We have added features to the program to accommodate these needs, which also makes the program suitable for a whole new class of groups and adds some features that have also been requested over the years and will be of interest to our present group users.
	We have been disappointed not to see a rush to adopt the "Kiosk" capability for new patient self-checkin and checking forms in the waiting room. This capability could save enormous amounts of expensive and tedious work. Any old computer in the waiting room is all you need to get going, as long as it is networked to the database. Please call for more info on a limited time 2 for the price of 1 deal.
	Some of you are beginning to ask about "approved" EMR that may lead to reimbursements in 2011. The situation at present is that the unofficial organization that was "awarding CCHIT certification" stopped doing that early last year. The government has just rushed out an "Initial Set of Standards for public comment " within hours of their first deadline on December 30. The link is The initial set of Standards...for EHR Technology. The 3 main areas appear to be electronic prescriptions, lab tests and inter-operability (communicating records electronically). When this gets finalized, how it will be implemented and how or if the rules will apply for non-MD clinicians are left to the imagination. Electronic prescribing with all the bells and whistles is the most difficult to implement and we have done that already. We will continue to work to meet any deadlines to make TheraManager certifiable whatever that finally means.
	One or two of you picked this up so here is the full story. Some of Dr Mike's earlier work was awarded the Nobel Prize in Physics last year but not he. One link to the technical side of the ensuing controversy is The Nobel Prize and its Discontents or more on Dr Mike at Comment on Award
Billing
	We have wanted to simplify the database structure for billing for a long time, but this turned out to be even more difficult than we had thought, because we merged the records in 2 tables and had to be aware of the way we had done things over the last 10 years as well as how different offices had done things during this time. The process is now complete and we have incorporated some new features into the billing side of the program.
	On the Accounts | CPT Records Screen there is a new grid with an explicit link from each CPT record to all the billing and payments records associated with that CPT record. This grid will show the normally hidden deferred billing record prior to the insurance payments as estimated at the time of posting..
	We have also modified the billing records to make them easier to read for office staff and patients alike. For estimated billing we have changed our previous way of including an adjustment in the same record as an insurance payment. From now on If the estimated insurance payment is incorrect, then an adjustment record will be added that charges or credits the patient the difference and zeroes any insurance receivable. Additionally when voiding an incorrect insurance payment, the original record will return to its original state. That is not true for the record from a deferred bill after all the insurances have been paid.
	We sometimes receive questions about formats for the bills. The settings for the bill formats are on the admin | Corporate Screen.
	We have added some new columns to the Transaction Screen, like "Allowed", "Regular Charge", "Units" along with group totals for these columns and others.
	This is a reminder to start using Electonic Remittance Advices from your clearing house for much faster entry of Insurance Payments if you are not doing so already.
Grids
	As we look at your screens, we see that very few of you are making use of the capabilities of the new grids. Grouping and filtering can be very useful as described in the last newsletter. A feature that should be used is under Tools | User Options in the system menu. When Open Screens with Customized Grid is checked, the grid configuration will be saved on closing the screen and will reopen with that same configuration next time. You can move the columns, change the column widths, and set up grouping on the grid. You can also change the column heading, the column width, the column color and even whether the column is visible or not using Grid Settings | Grid Editor on any of the popup menus. Because of the multiplicity of screen geometries and sizes, and your preferences, there is no way that we can do this automatically for you, so please take a few minutes to make your grids look neat and tidy and select the columns that you want to view, or we shall be forced to give you a failing grade.
Electronic Prescriptions
	The certification process required by Surescripts to allow direct writing of electronic scripts and renewals from within TheraManager has been very protracted but is now completed and the official release date will be later this month. Alex has done an excellent job in developing the very complex code to send and synchronize scripts, and receive acknowledgemts and renewals.
	This has been a very expensive process for us but it does put us into a select group of top EMRs. Our pricing strategy will change accordingly and we will quadruple our prices. OK just joking!! but anyone who wishes to use the TheraManager program interface will be required to pay the annual subscription that includes all the features shown below, which may reduce your malpractice insurance, and give you Medicare credits. Writing scripts and renewals using the TheraManager Prescription Screen and sending them (at least from your viewpoint) directly to the pharmacy Automatic indication of waiting renewals requested by pharmacies and sending those renewals from the TheraManager Screen. The FDB database which populates the TheraManager Prescription Screen with available doses, forms, generic name and type of medication, and is updated monthly. Automatic creation of your own custom list of meds within TheraManager from the database. All scripts synchronized and stored in the TheraManager database as well as that of our partner for complete records for each patient. Interaction checks including drug-to-drug and drug-to-disease interactions, food and drug allergies.. Formularies based on the patients' insurance plans, which can save your patients money. Drug Monographs for your technical education. Patient Notes in multiple languages, to inform your patient and save you time explaining. National List of Pharmacies updated daily for electronic transmission . Remote browser capability (Any computer or internet-connected PDA or smartphone) for responding to out-of-the-office medication requests.
	Anybody currently registered for the full subscription will, without additional charge, magically find a new E-Send button on their Prescription Screen after an update later this month (date to be announced). We were required to add a Review Screen before the final transmission but its use is very intuitive.
	Renewals (and failed transmissions) will blink on the lower status bar. Click the Renewal Button on the Prescriptions Screen to review the pending renewals. Click on each pending renewal to check for a match with prior scripts. The yellow color and text shows mismatch information. You may deny, renew or modify at your discretion
	We encourage those few who who elected to use the RXNorm database to change to the full subscription service.
EMR
	When opening the EMR Notes Screen, you will notice that the unlocked/writable note is now high-lighted with a green border. This note is in Edit mode and is ready to take entries from keyboard, tablet-handwriting or dictation.
	We have added the capability to store files very conveniently in the database. This means that you can open a note in MS JOURNAL on a TabletPC or MS WORD from the popup menu on the Notes Screen, hand-write a note in JOURNAL or WORD and it is saved automatically when you close JOURNAL or WORD.
	We are currently developing the workflow for doing this with an 8 1/2" x 11' electronic clipboard either free-standing or tethered to your PC. The image can be stored directly in our database or hand-writing recognition can be done first in the computer. Our goal with TheraManager as you know is always to make everything easy and seamless. This will be a fantastic boon to inveterate hand-writers, regardless of whether their hand-writing is clear enough for hand-writing recognition, or just "scribble" to be stored directly as electronic images, without the fuss of scanning.
	We have also added the capability to work with a template with dropdown menus and store the result in the EMR. We will include 3 or 4 examples in the update that were donated by a new user in mental health.
	We have also included new forms in the updates that were donated by users of TheraManager, but it is up to you to import them into the Forms Screen and check them out or adapt them.
	In order to lock notes you must now have a right assigned to do so at the the admin | Users Screen.
	We have added a feature that allows for a hierarchy of appoval and locking of notes in group practices. To see how this works enter 0 1, 2 or 3 in the the Require Approvals Box on the admin | Corpoate Screen | Corporate Preferences, assign Lock Note at the admin | Users Screen. Go to the Notes Screen and click the View All (Binocular) Button on the Toolbar and the Review Appointments with Notes Form will popup. There are various combinations of records to review, including appointments without notes, notes that are not approved or are unlocked etc. Notes can then be approved or locked according to whether the user has the appropriate right to do so.
Case-Workers, Clinical-team Members
	The program is now designed to accommodate up to six multiple case workers/clinical team members for a given patient. When a new patient entry is created at the Patients Screen, that patient is assigned to the clinician who is currently selected. To change this or to assign additional clinicians/case-workers/clinical team members go to the new screen Patients | Other. Also at this screen up to 8 stake-holders can be assigned, but they must first be entered at the Contacts Screen.
	Other features that have been added and support the use of case-workers/clinical team members are discussed under Appointments Screen below and EMR above.
Appointments Screen
	Multiple calendars have been added to the Appointments Screen, but the number will depend on your screen resolution.
	Booked appointments with Repeats are now distinguished on the Appointments Screen. They are shown with a horizontal stripe, to suggest that they extend in time. This stripe had been used for appointments with a note being written, but this has now been changed to a vertical stripe, which we feel suggests vertical integration with the EMR and points up to the EMR Button. We will also be adding a diagonally cross-hatched booked appointment to indicate multiple bookings but this has not been done yet.
	Meetings for all the case workers for a given patient can now be booked by checking the Case Checkbox on the Book Other Form.
	The appointments for all case-workers/clinical team members for a given patient can be seen on the Appointments Screen by clicking the new Case Button under the Calendars. This will open the All View with only the calendars for the appropriate case-workers/clinical team members in view
	A new feature under View | Appointments by Patient on the System Menu allows a selected patient's appointments to be displayed and printed.
	We have put in a restriction for some groups or maybe single clinicians who want to impose discipline on themselves and not post appointments without a note having been written. The feature is enabled with the No Posting Appointments without a Note Checkbox on the admin | Corporate Screen.
	The way of viewing cancelled appointments has been changed. It is impossible to overlay two appointments and be guaranteed to view or have access to them on the graphical scheduler, so when an appointment is cancelled, it can now only be viewed graphically by clicking the little blue arrow button under the calendars, else it is visible in the List View. Cancelled appointments will continue to stay in the patient's record.
	We had automatic dialing through a phone modem built into the program but phone modems have all but disappeared except for a very high priced one, so we have replaced this feature in the program with internet dialling, which requires you to be set up a Yahoo or Skype account to make calls for 1c/minute.
Non-billable Time
	In all specialties there is non-billable time, but especially in those such as child psychiatry, there is a lot of "non-billable time" spent talking to parents, school councillors, treatment centers, other mental health providers etc and this can now be recorded on the Appointments Screen. Bring up the Booking Form for an Other Appointment, select the time spent and check the Non-Billable Checkbox. The "appointment" will show in a purple color. These non-billable "appointments" can be grouped on the List View Screen and the minutes are summed in the group Footer.
	If you want to trial the program, register, need support on a topic that's not in the Help Notes, or you have suggestions please contact support@theramanager.com or call 908-508-8900.