FEBRUARY 2019

E PACIS PRESS

Heart to Heart Talks

Heart Health Issue

INSIDE THIS ISSUEINSIDE THIS ISSUEINSIDE THIS ISSUEINSIDE THIS ISSUE

“Consumers are expected to spend an average

$136.57 on Valentine's Day, from cards to candy

and jewelry”

This Month 1

Cardiologist Update 2

Apple Watch 3

Tips and Tricks 4

Your Patients 5

Things to Know 6

PACIS Tickets 7

Windows Support 8

MIPS 8

PACIS Calendar 8

FebruaryFebruaryFebruaryFebruary seems like the perfect month to discuss matters of the heart.

Now don’t expect relationship counseling from Dr. Laura. The heart issues we discuss in this issue of ePACIS ePACIS ePACIS ePACIS are ones that affect your patient’s health as well as topics clinicians and staff should find useful.

We will look at Apple and their ECG device and how this new APP is both helping patients and assist-ing providers in good heart health.

We review the reasons you tell your patients to not smoke, eat properly, get regular exercise etc. Many long time patients still don’t listen to your sage advice.

We hear from leading Cardiolo-gists and expert NextGenNextGenNextGenNextGen users in our network discussing high risk hypertensive patients and manag-ing that population.

And of course we discuss develop-ments in electronic medical rec-ords, our monthly PACISPACISPACISPACIS tips and tricks and more.

PAGE 2 E PACIS PRESS

Slide Bar

IPA Specialist Perspective

Hypertensive patients and managing risk

Alex Durairaj MD Alex Durairaj MD Alex Durairaj MD Alex Durairaj MD

R. Fernando Roth MDR. Fernando Roth MDR. Fernando Roth MDR. Fernando Roth MD

Interventional CardiologistsInterventional CardiologistsInterventional CardiologistsInterventional Cardiologists

Foothill CardiologyFoothill CardiologyFoothill CardiologyFoothill Cardiology

As you are aware, CV disease is one of the leading causes of death and disability in our country. Managing risks is a primary responsibility for those physicians caring for these pa-tients. Studies have shown that over half the population is not treated for high blood pressure and cholesterol, even when they are being seen by a health care provider.

Given the enormity of the problem and the limited time we specialists have for dealing with urgent and high level problems (acute ischemic events, valve surgeries, heart failure, etc.), it would be of great benefit to enlist the help of our respected colleagues in the primary care field, where most of these patients are first seen.

The first thing we tell our hypertensive patients is to check their blood pres-sure in the morning, after using the restroom, in a warm and comfortable room before taking any medications or eating or drinking. They should sit in a comfortable chair with a back for support with their feet flat on the ground. The arm should be supported on a table and the cuff should be the correct size. Three values should be taken with the first one discarded (it is always elevated and should not be counted). The last two readings should be averaged. Although the goal is 120/80 or less, we generally start medications for anyone over 130/80.

Salt restriction, weight control, exer-cise, DASH diet, and avoidance of excess alcohol or caffeine (and NSAIDS) are important first steps.

A first line treatment with a long acting ARB (irbesartan) in combina-tion with amlodipine is an excellent choice. Adding a long acting thia-zide (indapamide or chlorthalidone) can be used instead or in combina-tion, especially in the African Ameri-can population. Check electrolytes in a week to avoid adverse side effects of low potassium or sodium.

Up to 20% of resistant hypertensives have a high aldosterone state and respond nicely to spironolactone or eplerenone (again, avoiding those with CKD). Vasodilating beta block-ers can be used as a last choice, or as a first choice for patients with heart failure or ischemic heart dis-ease.

Checking a renal arterial duplex, screening for sleep apnea, and checking a 24 urine for VMA and metanephrines would be helpful first steps in evaluation of second-ary causes of hypertension. These can and should be ordered by pri-mary care doctor.

Foothill Cardiology is always availa-ble for questions and guidance. We are happy to see your more difficult patients who might have secondary causes of hypertension.

Foothill Cardiology has been both a HCP IPA Preferred Specialist and PACIS/NextGen client for over 10 years.

http://foothillcardiology.com/index.html

PAGE 3 E PACIS PRESS

Slide Bar

Apple Watch electrocardiogram app

What’s New in Heart Tech

On September 12On September 12On September 12On September 12 Apple announced that the redesigned Apple Watch Series 4 will feature an electrical heart rate sensor that can take an electrocardiogram using a new ECG app.

According to Apple’s press release, the new Apple Watch will allow wearers to take an ECG reading right from the wrist via elec-trodes and the electrical heart rate sensor build into the watch. With the app, users can receive a heart rhythm classification within 30 seconds, notifying users whether the heart is beating in a normal pattern or whether there are signs of atrial fibrillation.

The ECG app determines the presence of atrial fibrillation or sinus rhythm on a classifi-able waveform. The ECG app is not recom-mended for users with other known arrhyth-mias.

Technologies like the Apple Watch, which allow continuous or periodic monitoring, can help doctors identify intermittent arrhythmias that are difficult to capture on the short-term monitors that are typically used. In addition, the Apple Watch Series 4 can provide clini-cians with real-time heart rate which can aid in providing exercise and medication pre-scriptions while motivating patients to adhere to their workout routines

The FDA also noted with a disclaimer that the data generated by the ECG app is for “informational use only” and “the user is not intended to interpret or take clinical action based on the device output without consulta-tion of a qualified healthcare professional.”

Since the sensor and its ability to record ECGs and classify the heart rhythm is FDA-approved, it will begin to find its way into the practice and potentially into the electronic health record. It will help to create heightened awareness about rhythm disturbances and atrial fibrillation.

The ability to detect abnormal heart rhythms, especially when patients are just out living their daily lives can have im-portant implications.

This is potentially important because some of the arrhythmias that the Apple Watch may be able to identify, such as atrial fibrillation, can have life changing consequences, such as stroke, if not identified and addressed in time for medical attention.

https://www.apple.com/shop/buy-watch/apple-watch

PAGE 4 E PACIS PRESS

PACIS Tips and Tricks to take to heartPACIS Tips and Tricks to take to heartPACIS Tips and Tricks to take to heartPACIS Tips and Tricks to take to heart

Electronic Health Records

Health Promotion Plan TemplateHealth Promotion Plan TemplateHealth Promotion Plan TemplateHealth Promotion Plan Template

You can access the HTN Health Promotion Plan link in the Vital Signs Vital Signs Vital Signs Vital Signs panel or from the Vital Signs template.

Open a patient chart

To launch the Health Promotion Plan Template, navigate to the Intake template, expand the Vital Signs pane and click on the Health Promotion Plan .

1) 1) 1) 1) Click Click Click Click thethethethe dropdropdropdrop----downdowndowndown arrowarrowarrowarrow andandandand select the select the select the select the HTN PlanHTN PlanHTN PlanHTN Plan

2. Click in the diagnosis field. In the diagnosis search window click on patient diagnosis and select a diagnosis

3. Click in the Diet field, then select a diet plan

4. Click in the Physical Activity field, then select a activity

5. Click in the Referrals field, then select a referral type

6. Click in the Lifestyle field, then select a lifestyle.

7. Click add. The plan will appear in the grid.

PAGE 5 E PACIS PRESS

Slide Bar

Know your patients by heart

In Practice

Even todayEven todayEven todayEven today, many patients still need to be reminded that there are warning signs to be keenly aware of regarding heart disease and the all the risk factors that exist. As a provider or a staff member, it is always good to be aware that many in your patient population don’t always ad-here to your advice once they leave the exam room. Some still have to be con-vinced about the following warning signs:

Family history. Family history. Family history. Family history.

Suggest your patients do their homework and check out their family tree and ask questions of family members about their health history. Heart disease has a strong genetic component. Grandpa only lived to 59? Exactly.

High Blood PressureHigh Blood PressureHigh Blood PressureHigh Blood Pressure.

As you know, if you and your patients are noticing a trend and their blood pres-sure is creeping up, or just high, it is im-portant that they get it under control. Patients should know their numbers and maybe should buy a home monitor so they can call in then use the portal to communicate to you if they notice an alarming number.

High Cholesterol.High Cholesterol.High Cholesterol.High Cholesterol.

Increased cholesterol does not always cause symptoms and can be difficult to manage. Getting cholesterol under con-trol is one of the leading factors to con-sider when discussing a treatment plan.

Ask patients if they understand the differ-ence between good cholesterol and bad cholesterol…most don’t. One day a test like a CT Angio might be standard to check stenosis in heart arteries but until costs lower and that day arrives, the cho-lesterol and diet lecture is needed and maybe the Lipitor brochure too.

History of Preeclampsia. History of Preeclampsia. History of Preeclampsia. History of Preeclampsia.

According to the Preeclampsia Foun-dation, research has shown that women who have had a history of preeclampsia-high blood pressure during pregnancy or in the postpar-tum period-have double the risk of heart disease. The risk may be even higher for those that deliver preterm babies or suffer from this condition more than once.

Congenital Heart Disease in Congenital Heart Disease in Congenital Heart Disease in Congenital Heart Disease in ChildhoodChildhoodChildhoodChildhood.

One common misconception of those that were born with congeni-tal heart disease (CHD) is that once it is structurally fixed as a child, con-tinued care is not needed. This is not true. In fact, the quality of life of those adults that had CHD surgery as a child is significantly increased by just having a routine check up with a specialized cardiologist during adulthood.

Exercise Exercise Exercise Exercise

In the age of the internet is seems to be a tougher assignment to get pa-tients to exercise. Younger folks tend to think they will live forever and don’t see a need to join a gym, eat right, or adhere to a fitness regi-men.

Older patients may suffer from aches and pains that prevent them from adhering to a strenuous pro-gram. So, how about this compro-mise – remind them about good old fashioned walking.

Their grandkids can help them figure out the Apple Watch.

Smoking. Smoking. Smoking. Smoking.

We know it is like banging your head against the wall but If your patient is a smoker or has been a smoker in the past, patients still have to be reminded that it was bad and still is bad to be a smoker, period. Smoking at any time in the life of your patient raises the risk of heart disease and is an overall major risk factor. Yes, cigars count.

DiabetesDiabetesDiabetesDiabetes

As providers know all too well, adults with diabetes are two to four times more likely to have heart disease than those adults without diabetes. The American Heart As-sociation lists diabetes as one of seven ma-jor controllable risk factors of heart disease. Sorry, no heart shaped candy for them.

PAGE 6 E PACIS PRESS

PACEMAKERS AFFECTED BY COMMON HOUSEHOLD APPLIANCES

Things to know

Please join us as we demo the NextGen mobile with Dr. Please join us as we demo the NextGen mobile with Dr. Please join us as we demo the NextGen mobile with Dr. Please join us as we demo the NextGen mobile with Dr.

Pacemakers could be affected by com-mon household appliances, electrical tools and more when used in close proximity to each other, according to research published by the American American American American Heart Association.Heart Association.Heart Association.Heart Association.

Researchers tested the impact of elec-tric and magnetic fields exposure gen-erated from household appliances on 119 patients who had pacemakers. The patients were exposed to common ex-posure frequencies, with EMF increased until the pacemaker started to sense failure.

The researchers found that the pace-makers, when programmed to the maximum sensitivity, are still able to stand up to everyday life, including power lines, household appliances, electrical tools and entertainment electronics, according to the AHA release. As long as the EMF-emitting device is held at least at forearm’s length dis-tance or 12 in. away, the risk of elec-tromagnetic interference is reduced.

Women and men with heart attack symptoms may get different treatment from EMS

Believe it or not, women are more likely than men to die of coronary heart disease, and past research has found that they are less likely to re-ceive evidence-based therapies for heart attacks.

Now, researchers from the George Washington University (GW) have ex-amined the care that women and men with heart attack symptoms receive from emergency medical services (EMS) after a 911 call and found that women with chest pain were less like-ly to receive aspirin, be resuscitated, or be transported to the hospital in am-bulances using lights and sirens.

They analyzed EMS responses for pa-tients age 40 and up with chest pain or cardiac arrest (more than 2 million during the study period) and exam-ined medications and treatments rec-ommended by the

American Heart Association American Heart Association American Heart Association American Heart Association guide-lines for possible cardiovascular events or cardiac arrest: aspirin, elec-trocardiogram, and cardiac monitor-ing for chest pain, and resuscitation and defibrillation for cardiac arrest.

They also examined use of lights and siren to transport patients, and time intervals between EMS dispatch and arrival at the hospital.

The suggestion is that there may be an underappreciation of the risks women experience by the EMS pro-fessionals. The study notes that the EMS industry needs to address addi-tional research and education in this area with the aim of ensuring both men and women receive optimal treatment.

https://www.whijournal.com/article/S1049https://www.whijournal.com/article/S1049https://www.whijournal.com/article/S1049https://www.whijournal.com/article/S1049----3867386738673867(18)30298(18)30298(18)30298(18)30298----6/fulltext6/fulltext6/fulltext6/fulltext

Source: George Washington University.

PAGE 7 E PACIS PRESS

Can’t open a PACIS ticket? Bless your heart. Let’s review:Can’t open a PACIS ticket? Bless your heart. Let’s review:Can’t open a PACIS ticket? Bless your heart. Let’s review:Can’t open a PACIS ticket? Bless your heart. Let’s review:

Support Tips

When calling in a ticket:When calling in a ticket:When calling in a ticket:When calling in a ticket:

• Make sure you have all the details on your issue, such as error num-ber, module being used, patient examples.

• ·If calling for another user, make sure you know the users availability in case that user is needed on the phone.

• A ticket number will be provided to you while you are on the phone, keep this ticket number handy until the issue is resolved.

• Please be in front of a computer when calling in your ticket – we will be transferring you to a technician while on the phone to work the issue.

When emailing in a ticketWhen emailing in a ticketWhen emailing in a ticketWhen emailing in a ticket

• First, do not email in urgent tickets – always call!

• The email subject line should be a brief description of the actual issue – this ensures the ticket gets routed to the correct technician.

• Other items that must be included with your ticket notes:

o Your first and last name

o Your phone number with extension

o Your practice name and location

Include as many details on the issue you are having as possible, such as error number, module be-ing used, encounter number for us to review.

• ·Add any other team members you would like included in the ticket on the cc line.

• When calling to check on your ticket, please have your ticket number handy (which is sent back to you when you submit an email request).

2175 Park Place

El Segundo, CA 92234

Help desk: 310.793.5430 option 3

WWWW EEEE ’’’’ R ER ER ER E ONONONON T H ET H ET H ET H E WEBWE BW E BW E B

WWWWWWWWWWWW . P A C I S . C OM. P A C I S . C OM. P A C I S . C OM. P A C I S . C OM

E PACIS PRESS

February Issue 2019

For more information on Windows 7 replacement click below For more information on Windows 7 replacement click below For more information on Windows 7 replacement click below For more information on Windows 7 replacement click below

https://www.medtechsolutions.com/platform/mts-cloud/windows7support/

PACIS Training Calendar available

Find the PACIS 2019 Training Calendar todayFind the PACIS 2019 Training Calendar todayFind the PACIS 2019 Training Calendar todayFind the PACIS 2019 Training Calendar today::::

Nextgen Icon > PACIS Announcement folder Announcement folder Announcement folder Announcement folder on Nextgen server > PACIS Training folderTraining folderTraining folderTraining folder

⇒ Go to nextgen icon on your desktop

⇒ Look for the PACIS Announcement folder PACIS Announcement folder PACIS Announcement folder PACIS Announcement folder on the Nextgen Server

⇒ Look for PACIS Training folderPACIS Training folderPACIS Training folderPACIS Training folder, open the folder

MIPS UPDATE—time to get at the heart of this

Deepthi Rajaraaman from e2o Health Deepthi Rajaraaman from e2o Health Deepthi Rajaraaman from e2o Health Deepthi Rajaraaman from e2o Health has been working with PACIS 2018 MIPS Eligible Providers to assist them in choos-ing their submittal measures. Below are the Next Steps in the process.

Confirm with Deepthi which MIPS catego-ries you plan to submit through NextGen, and finalize the measures to be submitted. Nancy Mauge will verify these measures are configured in the HQM Portal.

PACIS will create your Practice Acknowl-edgement Packet from your Measure Con-figuration Report in the HQM Portal.

Your Practice Acknowledgement Packet Practice Acknowledgement Packet Practice Acknowledgement Packet Practice Acknowledgement Packet will be sent to your practice for review. Your lead provider will need to initial each measure to be submitted and sign the acknowledgement page to confirm the measures attached in the packet are those to be submitted.

In addition, if your practice is submitting PI (formerly ACI), you will need to com-plete and return the self-attestation por-tion of the acknowledgement packet.

Once your lead provider has completed and signed the Practice Acknowledgement Packet, please email the packet to Nan-Nan-Nan-Nan-cy.Mauge@healthcarepartners.com or cy.Mauge@healthcarepartners.com or cy.Mauge@healthcarepartners.com or cy.Mauge@healthcarepartners.com or fax to 310fax to 310fax to 310fax to 310----793793793793----5467, attention: Nancy. 5467, attention: Nancy. 5467, attention: Nancy. 5467, attention: Nancy.

Nancy will configure your selected Self-attestation measures approved in your completed packet once the packet is re-turned.

During February and early March, NextGen will be working through any possible HQM Portal submittal issues found by early sub-mitters. Based on previous years we can expect several HQM Portal HQM Portal HQM Portal HQM Portal Upgrades dur-ing this time. Mid-March PACIS will run your final 2018 MIPS report and send these to you for your final approval to sub-mit.

PACIS will submit your 2018 MIPS PACIS will submit your 2018 MIPS PACIS will submit your 2018 MIPS PACIS will submit your 2018 MIPS measures through NextGen in mid-March, well before the final submittal date of April 2 2019. A screen shot of your sub-mittal confirmation will be sent to you.