ECW Implementation Guide

© Copyright eClinicalWorks, Westborough, MA. All rights reserved. Oct 09 Page 1 of 34

IMPLEMENTATION GUIDE

eClinicalWorks

112 Turnpike Road

Westborough, MA 01581

eClinicalWorks Implementation Guide


CONTENTS

SECTION 1: WELCOME ................................................................................................ 4

Hello and Welcome to eClinicalWorks! ................................................................................................................... 4

SECTION 2: IMPLEMENTATION ................................................................................... 4

Roles and Responsibilities ........................................................................................................................................... 4

eClinicalWorks ......................................................................................................................................................... 4

Practice ..................................................................................................................................................................... 5

Project Timelines ......................................................................................................................................................... 6

Kick-Off Call ................................................................................................................................................................ 8

Billing Support ............................................................................................................................................................. 8

Billing Discovery Call .............................................................................................................................................. 8

Billing Discovery Follow-up .................................................................................................................................... 9

Clearinghouse ........................................................................................................................................................... 9

Patient Statements ................................................................................................................................................... 11

Insurance Eligibility ................................................................................................................................................ 11

Electronic Remittance Advice (ERA) ..................................................................................................................... 12

Data Migration ........................................................................................................................................................... 12

Data Migration ........................................................................................................................................................ 12

System Setup Spreadsheet ........................................................................................................................................ 13

System Setup Spreadsheet (SSS) with Data Migration ........................................................................................... 13

System Setup Spreadsheet (SSS) without Data Migration ...................................................................................... 14

Labs ............................................................................................................................................................................. 14

Interface Overview ................................................................................................................................................. 14

Optional Integration Features .................................................................................................................................. 15

Midmark Devices .................................................................................................................................................... 15

Welch Allyn Devices .............................................................................................................................................. 16

MedicScan .............................................................................................................................................................. 16

Dragon NaturallySpeaking...................................................................................................................................... 16

Patient Portal ........................................................................................................................................................... 17

eClinicalMessenger ................................................................................................................................................. 18

eClinicalMobile ...................................................................................................................................................... 18

Appointment Reminder Systems ............................................................................................................................ 19

ePrescribing ............................................................................................................................................................ 20

Patient Education .................................................................................................................................................... 20

Physician Reference ................................................................................................................................................ 20

CodeCorrect ............................................................................................................................................................ 21

UpToDate ............................................................................................................................................................... 21



SECTION 3: INFRASTRUCTURE & SETUP ................................................................ 21

Hardware................................................................................................................................................................. 21

FaxServer ................................................................................................................................................................ 22

Install Check ........................................................................................................................................................... 22

Installation .............................................................................................................................................................. 23

SECTION 4: TRAINING ................................................................................................ 24

Training Overview .................................................................................................................................................. 24

EMR System Build ................................................................................................................................................. 24

eCW 101 Training .................................................................................................................................................. 24

System Configuration/ Workflow Redesign ........................................................................................................... 25

Testing .................................................................................................................................................................... 25

Study Aids/Cheat Sheets ......................................................................................................................................... 26

Onsite Training ....................................................................................................................................................... 26

Training Recommendations .................................................................................................................................... 27

Post-Training .......................................................................................................................................................... 29

SECTION 5: POST GO-LIVE SUPPORT ..................................................................... 30

Transition to Support .............................................................................................................................................. 30

2009 Holiday Schedule ........................................................................................................................................... 31

2010 Holiday Schedule ........................................................................................................................................... 31

Labor Rates ................................................................................................................................................................ 32

eClinicalWorks Labor Rates ................................................................................................................................... 32

Additional Notes ........................................................................................................................................................ 33

TAMPER RESISTANT PRESCRIPTIONS ........................................................................................................... 33



Section 1: Welcome

Hello and Welcome to eClinicalWorks!

Headquartered in Westborough, Mass., eClinicalWorks™ is a privately-held leader in ambulatory clinical solutions. The company’s unified Electronic Medical Records (EMR) and Practice Management (PM) system manages patient flow from check-in to check-out and streamlines processes regardless of practice size, specialty and number of locations. Its Patient Portal allows patients and doctors to communicate easily, safely and securely over the Internet, and eClinicalWorks Electronic Health eXchange (eEHX) is the fabric behind clinical integration systems becoming community-wide projects. eClinicalWorks has an established customer base of more than 30,000 medical providers across all 50 states. Thank you for selecting eClinicalWorks.

Section 2: Implementation

Roles and Responsibilities

eClinicalWorks

Project Manager

� Develop, manage and coordinate detailed project plans

� Work with the project lead to manage day-to-day action items

� Responsible for providing the required documentation needed for each phase of implementation

� Coordinate with eCW departments to achieve key milestones

� Organize project status updates

� Perform risk management checks

Implementation Manager (Large Practices only)

� Develop, manage and drive overall implementation plan for the practice



� Manage relations with external vendors and monitor key performance indicators

� Support project manager in maintaining the project schedule

� Provide application expertise and guidance

� Coordinate gate reviews and project status updates

Note: If you are not able to reach your Project Manager or Implementation Manager at their extension and do not wish to leave a voicemail in their directory, you may call 508-475-0600 to leave a voicemail in the general mailbox.

Practice

Note: For small practices, one person can be assigned to multiple roles; however, it is strongly advised that large practices assign different individuals for each role listed.

Project Lead

� Lead the practice on EMR adoption

� Responsible for the overall success of the EMR adoption & rollout

� Communicate and collaborate with eClinicalWorks PM/IM to meet scheduled timelines, milestones and deliverables

� Manage expectations with other external vendors

� Mitigate internal and external risks

� Work to achieve project milestones

Clinical Champion

� Lead the practice towards EHR adoption

� Own, manage and customize database content based on practice workflow

Workflow Coordinator

� Oversee schedule and organize meetings for the EHR process redesign, including workgroup schedules and documentation

� Complete workflow documentation and follow-up on outstanding questions between meetings

� Ensure all of the day-to-day details of current practice procedures are present in the workflows and ensures that adapted workflows are staff-friendly

Practice IT Manager

� Own, manage and support the IT infrastructure of the practice and adhere to eCW standards



eCW-Certified Trainer (Large Practices only)

� Attend eCW training certification course in Westbourough, MA to learn eCW’s training curriculum

� Organize and oversee training during go live

� Train new staff and physicians on an ongoing basis after go live

Lab Manager

� Collaborate with eCW and labs

� Own, manage and support lab interface communications, testing and go live plans

Billing Lead

� Work directly with the Billing/Practice Management System Manager to facilitate their billing requirements

� Own, manage and customize database content based on practice workflow (billing-specific)

� Responsible for PM data content, claims testing and overall practice management workflow in new system

Project Timelines

The following Implementation Timeline is a guideline, for a typical implementation. Each practice has its own individual requirements; therefore, it is only a suggested standard, not a guarantee.

Typically, the Go-Live date is scheduled between 12-16 weeks after the Kick-off Call. This timeline is dependent upon the size and scope of the project.

Week 1: Schedule Kick-Off Call - Your project manager will contact you to schedule a Kick-Off Call. Immediately after, you will receive a follow-up welcome email (including the Implementation Guide, Technical Guide, hardware requirements and Analog Fax Solutions).

Perform Kick-Off Call – A Kick-Off Call will be performed by your project manager (and additional support, as needed). He/she will help you to make choices with integration features and provide milestone dates as part of the Implementation timeline. Shortly after, you will receive any required documentation as a follow-up to the Kick-Off Call



Weeks 2: Billing Discovery Call - During this call, your billing manager will answer a series of questions to inform eCW about your billing processes.

Clearinghouse Enrollment, Data Migration and Lab Interface – The clearinghouse enrollment, data migration and lab interface processes begin and continue through implementation. Data Migration and Lab Interface are optional.

Week 2-6: Hardware Approval – Provide hardware specifications to eClinicalWorks for review and approval.

Return IT Inventory & Checklist – Complete and return the IT Inventory & Checklist from the Technical Guide.

Attend System Setup Spreadsheet Training – During this call, a billing specialist will assist you on providing your practice’s billing information on the System Setup Spreadsheet (SSS); required for billing data.

Week 5-7: Install Check – An installation specialist will remotely connect to your network to ensure that it meets the specifications for the installation of the eClinicalWorks application. Setup files will be downloaded at this time.

Week 9-12: Application Installation – An installation specialist will remotely connect to your network to install the eClinicalWorks application and other integration features onto your server, configure the workstations and install the faxserver.

Initial Data Migration – A data migration specialist will remotely connect and load your System Setup Spreadsheet and perform an initial migration of your patient and appointment data.

Week 10-11: Attend Billing & System Setup Training – Once your data is loaded into eClinicalWorks, a billing training specialist will work with you to ensure that the billing and system information is set-up correctly.



Attend EMR Build Sessions – Prior to your onsite training, an EMR build training specialist will guide you in getting started with customizing your EMR system.

Final Data Migration – Perform a final migration of patient and appointment data, if required.

Weeks 12-14: Onsite Training and Go-Live

Weeks 12-16: Attend mandatory billing follow-up trainings

Weeks 22-28: Lab interface completion

Kick-Off Call

The Kick-Off Call is an introduction to the implementation process. During this call we will discuss the overall implementation timeline, specific practice requirements and integration features.

eClinicalWorks suggests the following people be available for the Kick-off Call:

� From the practice:

� Project Lead

� Clinical Champion

� IT Manager/Specialist

� From eClinicalWorks:

� Project Manager

� Implementation Manager (as needed)

� Technical Architect (as needed)

After the Kick-Off Call is complete, your Project Manager will send a follow-up email message recapping the implementation choices and schedule.

Billing Support

Billing Discovery Call

Shortly after the initial kick-off call with your project manager, eClinicalWorks will conduct a Billing Discovery call with your billing



manager. This call will take approximately one hour and will be conducted by an eClinicalWorks Billing Specialist. The purpose of this call is for our billing experts to understand your internal billing processes, policies and workflow. The information gathered during this call will be used to prepare our on-site trainers to best train your practice on billing.

Billing Discovery Follow-up

As a follow-up to your Billing Discovery Call, you will receive a document outlining your top ten government and commercial payers.

eClinicalWorks will require copies of HCFAs for your top ten payers, which may or may not include all government payers; HCFAs will need to be collected for all government payers as well. These are necessary for sending test claims prior to your onsite training. This is mandatory for all existing practices.

If you plan to enroll with Emdeon as your clearinghouse, we will need a copy of your NPI confirmation letter(s) for each of your providers. In order to ensure that there is no human error on the enrollment paperwork, we also require the EOBs for each of payers you would like to be enrolled with.

The HCFAs & EOBs supplied to eCW must be copies of real patients (not “test” patients) and must include real patient & insurance information. All information provided to eCW is confidential and protected by HIPAA.

Clearinghouse

Clearinghouses save you time and money by accelerating the process of claim submission. You can submit claims electronically to the clearinghouse, which, in turn, submits them electronically to insurance companies.

The Importance of Making an Early Decision for a Clearinghouse

You can choose from a variety of clearinghouses, depending on your geographical region and other factors. The clearinghouse choice is important and changing clearinghouses mid-stream is not recommended. You must also take into consideration that it may take up to 10 weeks for some government payer applications to be approved.

NPI Number

All providers are now required to have a National Provider Identifier (NPI) number.



A health care provider can obtain a NPI number by submitting an application for an NPI-either on paper through the postal service or electronically over the internet. After the application is successfully processed, the healthcare provider will be notified of its NPI number.

In an effort to ensure that the data submitted to the National Plan and Provider Enumeration System (NPPES) for organization health care providers is accurate, CMS initiated an NPPES - Internal Revenue Service (IRS) data match to ensure that the legal business name (LBN) and employer identification number (EIN) in NPPES are consistent with IRS data. [Courtesy of CMS]

CMS will mail out letters to organization health care providers that have an EIN/LBN combination in NPPES that are different from the information maintained by the IRS. These letters request that the health care providers review and update their LBN and/or EIN in NPPES. If health care providers can not furnish data that are consistent with the IRS, we will deactivate the National Provider Identifier in NPPES. CMS will continue to match these health care provider data in NPPES against IRS data to ensure the accuracy of NPPES data. [Courtesy of CMS]

More information and education on the NPI can be found through the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS website. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203. [Courtesy of CMS]

Note: All current and past CMS NPI communications are available by clicking "CMS Communications" in the left column of the www.cms.hhs.gov/NationalProvIdentStand CMS webpage. [Courtesy of CMS]

Clearinghouse Choices

The most common clearinghouses currently used by eClinicalWorks customers are Emdeon and Gateway EDI.

Should you choose another clearinghouse, please contact the clearinghouse directly to enroll. Your Project Manager should be notified of all approvals you receive from your specified clearinghouse.

eClinicalWorks has certified many clearinghouses, and the list of certified clearinghouses continues to grow. For a complete list of clearinghouses, please refer to the Customer Care Portal at http://support.eclinicalworks.com.



Note: If you have moved within the past year and have not notified the payers, you must do this before eCW can begin your enrollment.

Patient Statements

Printing Patient Statements

As part of the eClinicalWorks software, you are able to print Patient Statements. The statement can be configured with the Patient Statement cycle, dunning messages and number of days before the statement goes to collection. These statements are printed on 8 ½ x 11 paper and use Number 10 Left Window envelopes.

ePatient Statements

As an alternative to printing your patient statements manually, you may choose to add the services of Emdeon’s ExpressBill or Gateway EDI’s Electronic Patient Statements. The benefit of these services is that the office staff can better utilize their time with other priorities versus printing and stuffing envelopes. Both services will print, stuff and mail your patient statements.

If you already use ExpressBill or Gateway EDI, or would like to add ExpressBill or Gateway EDI to your eClinicalWorks installation, inform the Project Manager and he/she will begin the enrollment process.

Insurance Eligibility

Insurance Eligibility is an optional service provided by Emdeon and Gateway EDI clearinghouses. eCW works with these clearinghouses enroll the practice with this feature.

The objective of this feature is to help the practice verify the patients’ Insurance Eligibility for the visit scheduled and the procedures to be performed on that visit. The failure to check the Insurance Eligibility often results in the practice not getting paid or payment delayed by the payer as the procedure is not approved by them for the patient based on their subscription model, etc. The regular way of verifying the Insurance Eligibility is to call the payer with all the patient insurance details and get the information from the payer representative. This takes time from the employee in the practice to be on the phone until he/she gets the required information. The Insurance Eligibility through eClinicalWorks helps them to verify it online with no need for a phone call.



Electronic Remittance Advice (ERA)

Electronic Remittance Advice (ERA) is an additional service provided by the Emdeon & Gateway EDI clearinghouses.

ERA allows the practice to electronically receive remittance advice files while eliminating the need for paper EOBs. More importantly, ERA helps the practice to minimize paper-handling errors and lost information. ERA allows the practice to more efficiently monitor the payments that are being received for their services.

ERA files are received into eClinicalWorks; they can then be reviewed and posted to the proper patient accounts.

For further information on Emdeon’s ERA, please visit

www.emdeon.com

For further information on Gateway’s ERA, please visit

www.gatewayedi.com

Data Migration

Data Migration

eClinicalWorks offers a data migration service as a large part of the implementation process. The data migration involves extracting your data from your existing practice management system and moving it to eClinicalWorks in two separate increments (initial and final). eClinicalWorks can extract and migrate much of your existing data, including, but not limited to the following types of data:

� Patient Demographics

� Appointment Information

� Insurances

� Patient Insurances

� Guarantor Information

� Pharmacies

� Referring Provider Information

There are two options eClinicalWorks offers for gathering data for migration. The first option, which most clients prefer, is having eClinicalWorks extract from their current practice management system. The second option is having the client provide the data. The following lists what is required for each method:



eClinicalWorks Extracts

� Inform eClinicalWorks of Application/System name

� Practice must install TightVNC on the machine that will be used for data extraction.

� Inform eClinicalWorks with an Admin username/password on system

� Inform eClinicalWorks of location of data on system (path or directory)

Client Provides Data

� Prepare data and supply in Excel format in eClinicalWorks’ Data Migration Template

� Send files to Project Manager via email, CD, or FTP (password-protected files)

Once the extraction is performed, regardless of method, the data is reviewed by eClinicalWorks to ensure that the data can be migrated successfully. A Data Evaluation Plan will be provided and a conference call arranged to discuss the findings of the evaluation.

It is also at this point that a System Setup Spreadsheet will be generated and provided to the practice for training, review and completion.

Standard data migrations are usually completed within 3-4 days. This time is spread over the course of your Implementation, including the many steps in which our Data Migration Team performs to ensure the integrity of your data.

Once the final migration is completed, any and all further changes will need to be tracked on paper or entered into eCW.

Important! eClinicalWorks cannot migrate binary, encrypted, or scrambled data.

Important! eClinicalWorks does not migrate financial information (such as prior claims, outstanding AR, etc.).

Important! The final migration of data includes only patient demographics and future appointment updates.

System Setup Spreadsheet

System Setup Spreadsheet (SSS) with Data Migration



As previously mentioned, as a method of preloading data into the application, eClinicalWorks will populate a System Setup Spreadsheet (SSS) based on the data provided during the initial extraction/migration phase. This data includes provider & staff information, facility, insurance, patient insurance, pharmacy and referring provider information. You may also add your custom fee schedules to the SSS, if you wish.

While eClinicalWorks preloads this information, it is the client’s responsibility to review and update the SSS according to the recommendations of the eCW billing specialists. eClinicalWorks will provide training for this purpose.

Upon completion of the spreadsheet, an eClinicalWorks billing specialist will review and approve the information provided. The SSS will then be uploaded to eClinicalWorks at the point of initial migration.

If the SSS is not approved, the project manager will send the SSS back to the practice with further direction. It is imperative that the practice make all updates and return the SSS to eCW in a timely fashion. Without a completed SSS, the initial migration will be postponed, jeopardizing the remaining implementation dates, including onsite training and go-live.

System Setup Spreadsheet (SSS) without Data Migration

If the client does not wish to do data migration from their current practice management system, it is still possible to preload the provider & staff information, facility, insurance, pharmacy, referring provider and custom fee schedule information by populating a System Setup Spreadsheet.

eClinicalWorks will provide a blank SSS template as well as SSS training to assist you in preparing the System Setup Spreadsheet.

Upon completion of the spreadsheet, an eClinicalWorks billing specialist will review and approve the information provided. The SSS will then be uploaded to eClinicalWorks 2-3 days after the application is installed.

Labs

Interface Overview

eClinicalWorks can be integrated directly with many major labs such as Quest or Labcorp to transmit data electronically.



The lab interfaces may be Uni-directional or Bi-directional.

In order for eCW to have all the lab tests that your practice frequently transmits to the lab company, eClinicalWorks’ lab programmer will be sending you a Lab Compendium Spreadsheet for you to forward onto your labs. Please have your lab complete this template and return to your lab programmer.

Timeframe

The following general rules apply for lab interface lead times:

� 10-12 weeks lead time required from the date of approval (by the lab) for currently interfaced labs

� Up to 6 months lead time required for hospital or local labs, in which eClinicalWorks has never interfaced with before

Historical data will be available for select clinical measures through historical laboratory data migration (or through data preloading at the practice level). Please refer to the “Training” section of this document for specific recommended preload elements.

Cost

There is no cost for reference lab interfaces (from eCW) to the End User/Practice.

For a list of labs that eClinicalWorks has developed interfaces with, please refer to the Customer Care Portal at http://support.eclinicalworks.com.

Note: Lab approval and signoff is needed by eClinicalWorks to begin your lab implementation; approval may be volume-based. You may be required to sign an agreement with the lab(s) of your choice prior to their authorization of the interface.

Optional Integration Features

Midmark Devices

eClinicalWorks has developed an interface with Midmark EKG, Spirometer, Vitals and Holter devices.

The interface is billable at $750 and includes configuration on one computer. Any additional computers requiring an interface with the device are billable at $100 per hour.



Visit www.midmark.com for further information on their product offerings and purchase details.

Welch Allyn Devices

eClinicalWorks integrates with several Welch Allyn Spot Vital Signs devices, Spirometers, Ambulatory Blood Pressure devices, EKG, and Stress Test machines.

The interface is billable at $750 and includes configuration on one computer. Any additional computers requiring an interface with the device are billable at $100 per hour.

Visit www.welchallyn.com for further information on their product offerings and purchase details.

MedicScan

eClinicalWorks is compatible with the MedicScan OCR. MedicScan scans insurance cards as a document which can be attached to Patient Documents. The OCR reader gives the capability to scan in license information directly into the patient demographics.

Card Scanning Solutions’ web page allows for eClinicalWorks users to purchase the scanners at discounted prices. That page can be found at http://store.card-reader.com/t-eclinicalworks.aspx. There you will find the supported simplex scanners; model numbers MCSCO-ECW & MDSCO2000R-ECW, as well as the supported duplex scanners; model numbers MDSCO800DX-ECW & MDSCO3000D-ECW.

There are no additional charges for the interface with any of the MedicScan devices.

Dragon NaturallySpeaking

Dragon NaturallySpeaking Medical 10 is transcription software offered by Nuance that many of eClinicalWorks providers are currently using to assist with their transcription needs.

There is no charge from eClinicalWorks for the integration of Dragon NaturallySpeaking; however, it must be purchased separately and installed prior to the eClinicalWorks software installation. It is also recommended that you practice using Dragon as it will take some time for it to become used to your voice. For more information on Dragon NaturallySpeaking Medical 10, visit www.1450.com/eclinicalworks.



Patient Portal

The Patient Portal provides an innovative tool for sharing information and communicating with your patient.

Certain medical record information such as lab tests, diagnostic imaging tests, immunization alerts, and prescription alerts are displayed on the home page on the Patient Portal. The home page is specific to a patient, and is based on the user name and a password used to log in to the Patient Portal.

The portal offers you the flexibility you need to set up your practice so that the information you want displayed on the Patient Portal reflects your communication needs. You set up lab profiles, reminder and alert messages, and standard visit types and times. You can define how messages are routed to your practice and the frequency with which information is uploaded and downloaded to and from the Patient Portal.

Functions of the Patient Portal are as follows:

� Messages: Send/receive messages to/from doctor’s office. Received Faxed Medication request to Pharmacy

� Appointments: Request a new appointment and view upcoming appointments

� Medication: Request a prescription refill from pre-populated list of currently refillable prescriptions

� Labs: Request a lab; review and examine lab reports

� Statements: Examine current and past statements

� Demographics: Enter or modify personal information and other demographic information

� Reminders: Receive reminders from doctor’s office about when the next immunization or lab is due

� Referrals: List of prior referrals and ability to request new or existing referrals.

� Receive an email for reminders, upcoming appointments and statements.

� Access to Instant Medical History which provides an online question and answer solution to patients about a problem they are experiencing (ex: sore throat, back pain, etc.). The results of these questionnaires will be recorded within the Virtual Visit progress note.

For further information on the Patient Portal options, please contact your project manager.



eClinicalMessenger eClinicalMessenger is a new voice messaging service that enhances communication between the doctor and the patient. This new product utilizes Voice-over-Internet Protocol (VoIP), enabling your practice to send voice messages to patients. This is a more powerful take on phone messaging service, as it is integrated into the eClinicalWorks® solution. eClinicalMessenger is extremely dynamic, interactive and customizable to practice, doctor, and patient preferences.

Benefits of eClinicalMessenger are as follows:

� Integrated with the EMR product version 8.0. � Interactive: Bi-Directional capabilities to allow patients to confirm

appointments over the phone and based on the response, appointment status is automatically updates in the EMR

� Customizable: Type of Reminder, Preferred Time to Call, Preferred Phone Number (Cell, Landline), Caller ID Number and more can be configured to Practice/Doctor/Patient preferences

� Hosted Solution: eClinicalWorks’ redundant server provides a reliable and secure environment. No extra software or hardware is needed and the whole solution is hosted by eClinicalWorks

� Efficient: Saves staff time spent making reminder calls, and messaging templates are available for quick communication

eClinicalMobile eClinicalMobile allows users to access patient information from a hand–held device that has standard Web browser capabilities, currently supporting iPhone®1, Blackberry Storm®, and T-Mobile G1 with Google®2 anywhere at any time. The screen has been optimized for hand-held devices and loads quickly because only pertinent data is accessed. Users are able to access schedules, write prescriptions, and access encounters with the peace of mind that the data is encrypted and hosted on a secure gateway. eClinicalMobile provides user name and password as part of the log-on security function. Once logged in, icons are displayed for ease of use in choosing your function.

Capabilities of eClinicalMobile are as follows:

� Labs: � View lab results � Upload to the Patient Portal � Make notations



� ePrescription: � Refill medication � Order new prescriptions � Send to pharmacy

� Display Scheduling: � View past and future appointments � View patient medical summary

� Messages: � Full message capability

� Telephone Encounter: � View assigned encounters � Document action taken � Reassign

� View Patient Hub: � Patient progress notes � Lab and diagnostic history � Medical summary

� Charge Capture: � Create charge at the point of service

Appointment Reminder Systems

eClinicalWorks has the ability to interface with certain appointment reminder systems. These systems automatically deliver appointment notifications, recall notices, and/or medication reminders for patients. The following is a list of systems eClinicalWorks interfaces with:

TeleVox (most commonly used) www.televox.com

ReminderPro www.julysoft.com

PhoneTree www.phonetree.com

Tavoca www.tavoca.com

Smile Reminders www.smilereminder.com

There is no charge for the interface with any of the above systems. Please contact the company directly for pricing and any additional information. The practice is responsible for enrolling directly with the company and notifying their Project Manager that they have enrolled.



ePrescribing

ePrescribing is an extra feature of eClinicalWorks that allows you to electronically exchange prescription information (new prescriptions and refill authorizations) with your local pharmacies. This not only provides a more secure and accurate way of managing your patient’s prescription information, but it can also save your practice significant time when managing prescription refills. ePrescribing allows connected pharmacies to send requests for prescription refills to your eClinicalWorks EMR. This is a more efficient and less cumbersome method than managing them by fax and phone. ePrescribing uses a secure network – The Pharmacy Health Information Exchange™, operated by SureScripts-RxHub®, to facilitate this exchange. Over 95% of the nation’s pharmacies are enabled to connect to this network, with 2/3 of those currently processing prescriptions electronically.

ePrescribing enrollment is done by eClinicalWorks. Please note the following information:

• Physicians can sign up for ePrescribing and start using it as soon as they go live on eCW, if they wish. Please ensure that you have reviewed our training material on how to send new prescriptions electronically, how to manage electronic refill requests, and when to expect requests for these refills to be sent to you electronically.

• For providers who currently use an application to prescribe electronically, the enrollment is fairly quick; an eCW Enrollment Coordinator will provide you with a Change of Vendor form to be filled out and returned for processing.

• For providers who are new to ePrescribing, the enrollment may take a few weeks.

Patient Education

eClinicalWorks integrates with A.D.A.M. for updated patient education information.

A.D.A.M. develops consumer health information for the health care and education markets. Physicians may print out or e-mail QuickSheets to patients as an educational follow on to the office visit.

Visit www.adam.com for further information on their educational services.

Physician Reference



eClinicalWorks is now offering an integration with SkyScape, which allows for the incorporation of physician reference data based on various reference libraries.

For further information on SkyScape’s reference libraries, please visit www.skyscape.com.

The cost of SkyScape varies by reference library; please contact your Project Manager for further information as a separate agreement will be required.

CodeCorrect

CodeCorrect is a product and service that checks for correct coding of physician claims. Their service provides “revenue cycle management” such that physicians are more likely to receive timely payment for services provided. The function that CodeCorrect performs is also commonly known as “scrubbing.” Please visit www.medassets.com for further information on CodeCorrect.

UpToDate

eClinicalWorks has a direct integration with the UpToDate clinical information tool. UpToDate allows clinicians to easily access answers to their day-to-day clinical questions, based on specialty.

There is no charge from eCW for the integration of UpToDate, however a subscription with UpToDate is required. For further details on the features and subscriptions of/for UpToDate, please visit http://www.uptodate.com/home/direct/ecw.html.

Note: Optional Integration Features may be added at any time.

Section 3: Infrastructure & Setup

Hardware

Proper hardware and network configuration is crucial to the success of your eClinicalWorks system. eClinicalWorks provides every client with a Hardware Requirements document that states the minimum requirements needed for the network. The client should review this document with their IT specialist to ensure proper ordering or upgrading of equipment. For further information on the hardware refer to the Technical Guide.



Once the client has determined all the components to their network, eClinicalWorks asks that you provide this information to your project manager for review. This way eClinicalWorks can make sure that all equipment meets specifications for the practice and nothing has been overlooked.

The network (including the server, workstations, tablets, laptops, modems, analog phone lines, printers and scanners) must be fully installed prior to the Install Check, so that during the Install Check, eClinicalWorks can confirm all equipment specs and network speeds are within specifications.

FaxServer

eClinicalWorks has an integrated feature that enables the client to fax information such as prescriptions, progress notes, lab/diagnostic imaging orders, and results directly from the software environment.

Clients should do an analysis of the number of faxes sent and received on a daily basis. If you have multiple locations, this analysis should be done at each location. Client should monitor what type of documents they are sending out (referrals vs prescriptions) as well. If you plan to use SureScripts-RxHub, this will decrease the number of faxes sent significantly as your prescriptions will be done electronically.

eClinicalWorks needs for the client to provide the provider(s) signature(s) in a .jpg format for training.

Please save these signatures in a folder on your server entitled “eCW Signatures” and be sure to let your trainer know where to find this folder. Your trainer will set your system up to print the provider’s signatures for prescriptions, progress notes, referrals, etc. If you would like a copy of the default prescription format, please ask the Project Manager.

Refer to the Analog Fax Solutions for further details on eClinicalWorks faxing requirements.

Note: Please refer to the Technical Guide for more detailed information.

Install Check

The Install Check is performed by eClinicalWorks, typically 5 - 7 weeks before onsite training, to ensure the network meets specifications and all hardware and devices are ready for Installation. eClinicalWorks remotely connects to the client’s network via



TightVNC (a remote desktop sharing program) or a Remote Desktop Connection (RDC) to perform this important step in the Implementation process. The following is a list of what is verified during the Install Check:

� Check server power & network connectivity

� Verify that all network components, machines, and software are configured correctly and in working order

� Verify systems are according to eClinicalWorks hardware specifications (processor speed, memory, hard drive space, operating system, routers)

� Verify all Service Packs are installed

� Test the scanner

� Test the analog line, modem & FaxServer (no VOIP lines)

� Verify all outgoing ports are open if part of a hospital network

� Verify that you can FTP from other FTP servers

� Verify that all machines are able to connect to the internet

� Check for speed between the server and client machines (workstations, laptops, tablets)

� Test the speed between multiple locations

� Load setup files

The Installation team uses the information from Technical Guide – IT Checklist & Inventory during the Install Check. It is crucial that the client completes and returns the IT Checklist & Inventory no later than two weeks prior to the scheduled Install Check. If this document is not received on time; the Install Check will be cancelled. This may then affect the remaining implementation dates.

Also, eClinicalWorks requires that the IT specialist be available at the practice during the Install Check, which typically lasts two hours.

Installation

The installation of eClinicalWorks is performed approximately 3 - 4 weeks before onsite training. The eClinicalWorks Installation team will remotely connect to the client’s Network and install the software on the server and all the clients on the network via Tight VNC or RDC.

eClinicalWorks requires that the IT specialist be available at the practice during the installation, which typically takes approximately 8 hours.



Depending on the number of servers and client machines which require eClinicalWorks to be installed on, the installation could take more than one day. eCW can complete installations in one day when there is 1 server and up to 10 client machines. Additional clients will need additional time. eClinicalWorks will teach your IT individual how to install the client software.

Section 4: Training

Training Overview

The eClinicalWorks Training Program is designed to impart a working knowledge of all eCW functionality that applies to your practice's needs and facilitate the integration of the eCW EMR/PM system.

Opportunities are provided to work hands-on with the program, allowing participants a chance to experiment with what they have learned in fictitious scenarios. Workflow-related scenarios are discussed throughout the training to identify the best possible integration of the eCW software.

EMR System Build

Prior to your onsite training, eClinicalWorks will provide an online EMR System Build session. The purpose of this is to help you prepare for the onsite training by showing you the ways in which you can get started with your EMR customizations.

EMR System Build is intended for the clinical lead of your practice and/or those involved in the customization process of your EMR system.

eCW 101 Training

“Super users”—technically-proficient front-line staff who will support

other staff on the EHR during training, go live and beyond—are critical players in the success of any EHR project. To ensure they have adequate knowledge of eCW and a sense of ownership in the project, it is important to identify them and train them on the system early, and involve them in workflow redesign and EHR configuration.

To begin building the necessary knowledge base, eCW will prepare your super users and subject matter experts to configure the system with an in-depth five-day training (includes one day on practice



management and two days for EHR) which will review the system’s features and configuration requirements. Following this training, your staff will have enough understanding of the system to begin work with the eCW Implementation Manager to redesign the 14 core workflows and to plan the system configuration. This training can occur as soon as the current practice workflows have been mapped and the practice has an eCW training server in place.

System Configuration/ Workflow Redesign

Proper system configuration will assist staff in successfully following practice policies and procedures, and will ensure that the practice can collect and monitor the information it needs to properly conduct business. The practice is responsible for entering required information (such as provider schedules), reviewing the system to ensure that the appropriate fields and reports are available, and configuring custom fields.

As the practice super users redesign workflows, the eCW Implementation Manager will assist them in identifying areas of the system that need configuration and will provide them with configuration options, based on best practices from other implementations. For each area of configuration, the practice will identify someone responsible for designing and configuring that area. During the testing stage, process owners will review these settings and sign off on the final configuration.

Testing

System testing offers a final chance to review the redesigned workflows and configuration and to ensure revised practice workflows can be successfully adapted to site-specific staffing and

procedures. At this point, the process owners—practice staff who take responsibility for ensuring the new workflows will meet required

legal and procedural standards—should sign off on the final plans. The super users and project lead should also spend at least a half day at each site that is going live to test the workflows, ensure the appropriate templates and settings are available to the staff who will be using them, and check to make sure hardware is properly placed and functioning.

In addition to the workflows, successful testing will include:

� Submission and receipt of payment of claims to each of the practice’s primary payers



� Order, collection, processing and receipt of lab results from the practice’s primary lab

� Audit of all users that are entered into the system (to ensure all users have eCW accounts and all providers have eCW licenses) and a list of security permissions set by role

Study Aids/Cheat Sheets

“Cheat sheets” are procedural guides that outline particular steps within the workflows in detail so front-line staff can use them for reference. For example, within a workflow for patient check-in, cheat sheets might be required to outline how to check patient demographics, scan insurance cards, and update insurances. These guides can be adapted from eCW user manuals or the “help” section of the system, but should be adapted to the practice so they reflect policy and procedural decisions that were made during the workflow redesign. Please note that it is the client’s responsibility to define these study aids.

Onsite Training

In order to best utilize the trainer's time with your practice, it is recommended that you not have a full load of patients scheduled during training. Some patients are recommended after a few days of training, but patients should be scheduled for double the time typically allocated for each visit type.

Training hours are either 8:00 AM – 5:00 PM or 9:00 AM – 6:00 PM with a one hour lunch break. Additional hours on-site are billed at $100/hr.

The following general topics are fully covered during the training:

• All Office Members

o System Overview

o Patient Lookup

o Patient HUB

o Telephone Encounters

o Messaging

o Document Management

o Faxing

• Front Office



o Patient Registration

o Appointment Scheduling

o Patient Check In/Out

o Scanning at Registration

o Scanning in Patients' Charts

o Running Letters

• Mid Office (MAs/Pas/NPs/Nurses and Providers)

o Monitor Patients in the Practice.

o Progress Notes

o Lab, Imaging, Procedures and Immunization Flow

o Referrals

o Alerts/Recalls

o Templates

o Flow sheets

o eCliniforms

o eClinisense

o EMR build and customization

• Back Office

o Billing set up

o Claim Processing

o Claims Submission and Clearing House Reports

o Payment Posting

o Accounts Lookup

o Collection Management

o Statements

o Reports

Training Recommendations

The following minimum number of hours should be allocated to work directly with the trainer:

Staff Department No. of Training Hours



Providers - 3 sessions of 4 hours each = 12 hours

Nursing Staff - 2 sessions of 4 hours each = 8 hours

Billing Staff - 3 sessions of 4 hours each = 12 hours

Front Office Staff - 2 sessions of 4 hours each = 8 hours

• In addition to the hours allocated above, it is recommended that each staff member spend additional time on their own during the week getting familiar with the software.

• Each provider session with the trainer must consist of at least four consecutive hours uninterrupted by seeing patients.

• Work with the Project Manager to discuss the best scenario for your practice.

• Providers need to spend time getting familiar with their tablet PCs prior to training.

• It is strongly advised that staff have basic computer training prior to training.

• Any practice letters, forms, or other documents should be given to the trainer on day 1 of the training so that they can be entered or duplicated in the eClinicalWorks system.

• Billing setup must be performed in order for the Provider sessions to run smoothly. Ensure that Billing staff are available on the first day of training.

The Office Manager should separate staff into the groups outlined in the schedule and identify which staff members will attend each session

Trainers will bring in a Checklist for the Office/Practice Manager or Doctor to sign upon completion of training. Trainers in turn will give one copy to the practice and submit one copy to the Project Manager at eClinicalWorks.

Note: eCW provides a comprehensive training on the software during the week before go live, along with standard eCW user guides. It is the practice’s responsibility to communicate their training expectations to eCW, develop any customized training materials they will need for their staff (for example, outlining how practice-specific policies and procedures will change with the EHR), and ensure that



eCW trainers understand how these materials should be incorporated into the overall training.

Post-Training

Follow-Up Sessions

Within the following weeks of your go-live, eClinicalWorks will provide mandatory follow-up training sessions, at no additional charge. These sessions are geared toward billing; including claims submissions, payment posting, generation of patient statements, collections and billing alert recalls and are scheduled during your implementation.

Product Documentation

� Available on the Customer Care Portal (http://support.eclinicalworks.com)

� Includes comprehensive documentation on the EMR, Front Office, Billing, Administration, New Releases, and Patient Portal. The EMR Guide includes documentation on SureScripts-RxHub as well.

Videos

� The new videos include Payment Posting, NPI, HCFA and UB92 Alignment. A new one will be available soon for Processing Statements.

� The SureScripts-RxHub video that is on our portal is a sales demonstration/overview of SureScripts-RxHub. It is NOT for training purposes.

Webinar Training

� Available on the Customer Care Portal (http://support.eclinicalworks.com)

� There are quite a few training classes that are available through Webinars. Practices should attend these as they will find them to be quite informative!

� Please refer to the portal for updated class schedules

eCW Newsletter

� Clients should sign up for the newsletter at www.eclinicalworks.com. This is how you will find out info on new versions, new documentation, new training opportunities, new videos, updates on support processes, etc.



� There are many places for you to sign up from, but the easiest is for them to click on the Help menu in eClinicalWorks and there is an option for sign-up.

eCliniWiki

� A collaborative and perpetually refreshing repository of information on specific eCW-related topics built by our eCW users

� Registration for the eCliniWiki is done from the Customer Care Portal (support.eclinicalworks.com) to ensure that all users of the eCliniWiki are also users of the eClinicalWorks product.

Users Group

� A forum where fellow eCW users share their experiences, advice and other tricks and tips

� Join a Users Group at http://www.ecwusers.com.

� Monitored, but not moderated by eClinicalWorks staff.

Section 5: Post Go-Live Support

Transition to Support

During your onsite training, you will be introduced to your Strategic Account Manager (SAM). The SAM is assigned to your practice for 16 weeks to help provide you the assistance you need while you go live on the eClinicalWorks system.

Your SAM will be your main point of contact post go-live. He/She will assist you with support concerns, points of escalation and to ensure that your claims and payments are processed with minimal errors or exceptions. The SAM will conduct a Support Kick-Off Call when training is completed. It is during this call that all support protocols will be outlined with you/your practice. The SAM will also conduct three evaluations throughout the 16-week go-live period to ensure both EMR and PM adoption at your practice.

eClinicalWorks offers 24/7 support. You may contact support by logging your support request through the web at http://support.eclinicalworks.com or by calling your SAM at 508-836-3663.

When problems are reported, eClinicalWorks will adhere to the following schedule to resolve the issues:



Severity Description Response Time

Resolution

P0

Critical/Show stopper. System cannot function or suggested alternative has drastic impact on the productivity.

1 Hour 4 Hours

P1

Minor error. System can function. Clear work around available.

24 Hours 5 Days

P2 Functional Enhancement 48 Hours Next Upgrade Release

2009 Holiday Schedule

eClinicalWorks observes the following holidays; therefore, there will be no support staff available on these days:

New Years Day January 1, 2009

Memorial Day May 25, 2009

Independence Day July 3, 2009

Labor Day September 7, 2009

Thanksgiving November 26-27, 2009

Christmas December 25, 2009

2010 Holiday Schedule

eClinicalWorks observes the following holidays; therefore, there will be no support staff available on these days:

New Years Day January 1, 2010

Memorial Day May 31, 2010

Independence Day July 5, 2010

Labor Day September 6, 2010

Thanksgiving November 25-26, 2010

Christmas December 24, 2010



Labor Rates

eClinicalWorks Labor Rates

The following table reflects assessed fees if a task is to be cancelled before the allotted time; if additional trainings and installations are requested other than outlined in your contract; or if custom work is requested. In the event this agreement contradicts the master agreement between eClinicalWorks and customer, the master agreement will supersede this document.

Item Rates

Database Customization $100/hr OR $750/day (Estimate to be

provided by Database team)

Database COPY/SPLIT/Cleanup $750/day (Estimate for number of days

will be provided by DM team)

Additional Data Migration

Post-Initial / Final Migration

$750/day (Estimate for number of days

will be provided by DM team)

System Setup Spreadsheet Reload

(If requested by practice or initial

information provided was incorrect)

$500/load

ExpressBill® Patient Statement

Customization

$150/hr programming fee

Specialty Forms/Smart Forms

New form(s) or customization to existing

form(s)

$750/day (Estimate for number of days

will be provided by Development team)

Project Manager On-Site Visit $1000/day per person + $250 per diem

+ airfare

Server Failure/Reinstall $750/day (Estimate for number of days

will be provided by Install team)

Cancellation/Rescheduling of

Installation

Within five (5) business days of

scheduled date

$250 per incident

Devices

See eCW Approved Device List

$750 interface fee for first computer

$100/hr (1-hr minimum) for additional

computer installations

Item Labor Charge

Additional Install Time

Examples:

$750/day

OR



NOTICE: PRINTING TAMPER-

Additional Notes

TAMPER RESISTANT PRESCRIPTIONS

As of April 1, 2008, all printed Medicaid prescriptions must be printed on tamper-resistant paper. The eClinicalWorks application can

� Hardware not ready at the time

of initial install

� Additional client installations

� Fax Server / Digiboard® re-

installs

� eCW server reinstalls

� Non-Prod server(s) install /

upgrade

� Client / server network

reconfiguration or re-

installation

� Dragon® configuration

� Non-eCW appointment

reminder systems

� Un-install server/client

� Re-installs of eBO,

eClinicalMobile, or

eClinicalMessenger

$100/hr (1-hr minimum; Estimate for

number of days will be provided by the

PM)

Technical Architect Billable Services

Network Architecture Review Package

$150/hr (Estimate for number of hours

will be provided by the TA)

Additional On-Site Training

(e.g., eCW 101, additional training for

new functions / versions)

$750/day per person + $250 per diem

+ airfare

Additional Remote Training

(e.g., Bubble Sheet, New Employee

Training, etc.)

$100/hr (1-hr minimum) OR $750/day

per person

Cancellation / Rescheduling of

Training

Within ten (10) business days of

scheduled date

$100 per ticket plus $750 per trainer

per week



accommodate printing to tamper-resistant prescription paper as required.

eCW currently supports printing to different printers and the application can be configured by practices to prompt the prescriber to choose the appropriate printer that contains the special tamper-resistant paper (or allows time for paper to be changed in a single printer in use by the practice).

eCW also supports printing of one prescription per 8 ½" x 11" sheet of paper, which appears to be the predominant size of tamper-resistant paper available. Testing of tamper-resistant papers on standard LaserJet printers is currently in process, and the results will be communicated to all eCW clients when complete.