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21st Century Cures Act and EHR–Compliance in 2022

By Aaron Morein

The 21st Century Cures Act, referred to as the Cures Act, includes new guidelines regarding health information exchange. Non-compliance exposes practices to fines of up to $1 million per violation. The law, passed in 2016, enacted in 2020, had a deadline for compliance extended due to COVID-19.

Let’s take a look at the Cures Act, how it’s relevant to your practice, and how to stay in compliance.

21st Century Cures Act Summary

“The most important bill of the year,” as the Senate health committee chairman referred to it, allocates over $6 billion to health agencies like the NIH, modifies aspects of drug research and development, and makes critical updates to health information policy. At a glance, the Cures Act:

  • Funds initiatives aimed to combat the opioid crisis–increasing access to treatment and overdose reversal drugs, improving prescription drug monitoring, and dependency research.
  • Funds brain disease and cancer research.
  • Facilitates the development and approval process for genetically and variant protein targeted drugs for the treatment of rare diseases.
  • Waives the requirement for researchers to provide human-subjects’ informed consent in clinical testing when the drug or device “poses no more than minimal risk” and “includes appropriate safeguards to protect the rights, safety, and welfare of the human subject.”
  • Expedites the FDA Drug Approval Process. Previously, bringing new pharmaceuticals and devices to market or adding new indications for existing ones required clinical trial data. Companies often bemoan this process. For example, moving from phase I trials to the end of phase III takes around seven years. Costs typically approach $3 billion. Under certain conditions, they may now provide other, less rigorous evidence of safety and efficacy. This includes observational studies, insurance claims data, and even anecdotal data.

Let’s take a look at those provisions relevant to electronic health records (EHR), as well as how to remain in compliance with them.

21st Century Cures Act and EHR

A central focus of the Cures Act was enhancing interoperability, which it defines as:

“health information technology that enables the secure exchange of electronic health information with and…from other health information technology without special effort on the part of the user…[and] allows complete access of all electronically accessible health information for authorized use”.

In order to further ensure interoperability, the act takes special measures to prohibit information blocking, which it defines as:

“a practice by a healthcare provider, health IT developer, health information exchange, or health information network that…is likely to interfere with, prevent, or materially discourage access, exchange, or use of electronic health information”.

Interoperability enhances clinical decision making and reduces duplicate tests, treatments, and medical errors. The Federal Government has focused significant resources to promote the development and adoption of interoperable technology (i.e. EHR) since the turn of the millennium. It is an ongoing process, but it has made significant headway. Information blocking practices diminished the rewards of nation-wide interoperability standards. It is an end-game bug to be dealt with.

Those practices who are found to exhibit information blocking can be exposed to fines up to $1 million per violation.

The text goes on to detail categories of reasonable and necessary activities that do not constitute information blocking. For example, preventing a patient or another person from harm, protecting an individual’s privacy, and protecting EHR’s security are potentially valid reasons to deny a request of access, exchange, or use. The Final Rule outlines a total of eight exceptions–access them here.


Zoobook Systems EHR helps practices stay in Compliance

The Office of the National Coordinator for Health Information Technology (ONC) has prioritized interoperability for nearly two decades now. A priority it remains, as new guidelines and updates will continue to roll out. Practices can struggle to keep up, finding the frequent updates to be confusing.

Compounding the problem, some medical and health record systems themselves have a difficult time adapting to new guidelines. For instance, a large proportion of practices use records formats that are designed not for exchange, but to record only what goes on in their office alone. A common example is the electronic medical record (EMR), which details a patient’s history in one practice or with one clinician.

Moreover, server-based and on-premise EHRs require local IT support to adapt to new guidelines at the expense of productivity.

Zoobook Systems designed EHR systems exclusively for mental health and addiction treatment services. It’s equipped for seamless health information exchange that ensures convenience and compliance. It’s cloud-based, too, meaning automatic software updates keep your practice agile to ever-changing regulations.

No Surprises Act Summary

No Surprises Act Summary

By Aaron Morein

Surprise! In 2020, congress passed the No Surprises Act, which protects patients from unexpected medical bills. Those rules which have been finalized were implemented January 1st, 2022. Providers will need to stay abreast of new rules and modifications coming out later this year. 


Why was the No Surprises Act Passed?

Patients often have trouble understanding their insurance benefits or knowing how much care will cost. In addition, out-of-network providers can operate within in-network facilities. Thus, patients can reasonably use out-of-network services inadvertently and receive a surprise “balance bill”: charges to cover the difference between an out-of-network provider’s billed charge and the amount the health plan paid. Prior to No Surprises, only select states and Medicare and Medicaid had protections for patients against surprise medical bills.

No Surprises Act Summary

No Surprises expands restrictions on out-of-network charges for patients with health insurance. If a health plan holder

  1. receives emergency services from an out-of-network provider,
  2. receives nonemergency services provided by out-of-network providers at in-network facilities, or
  3. requires air ambulance emergency services,

The health plan provider cannot charge more than that service’s median in-network rate.

It further stipulates that patients are entitled to a good-faith estimate of cost of care up front for most healthcare services. Healthcare facilities must provide an easy-to-understand notice of these new protections and a contact whom they may reach out to if they feel these protections have been violated. 

Additionally, this bill provides dispute-resolution opportunities for 

  • Payment disputes between insurers and healthcare providers 
  • Uninsured and self-pay individuals who receive a medical bill substantially higher than the good faith estimate they get from the provider. 
    • For services provided in 2022, patients may file a dispute claim within 120 days of the date of a bill that is at least $400 greater than the good faith estimate. 

How Providers Can Comply

The basic steps you need to take are given here. For more complete descriptions, please access the links below. 

Display a notice of surprise billing protections on your website and in your office. The easiest way to do this is to edit the model notice offered by HHS.

In some circumstances, providers must also display information about the right to receive a good faith estimate. CMS has these requirements posted here 

Ask patients if they have insurance and if they intend to submit claims or to opt-out of their benefits. If they do not have in-network benefits or want to opt-out of them, inform them of their right to a good faith estimate and dispute resolution.

Supply an estimate of the cost of care before providing services. Timeframe requirements are as follows:

  • No later than one business day if the appointment is scheduled more than three days in advance
  • No later than three business days if the appointment is scheduled more than ten days in advance or an estimate is requested without scheduling an appointment.

A good faith estimate may include services for up to 12 months, including an estimated number of services needed during that period. 

Detailed information for good faith estimate requirements are available on the APA services website.

Other new requirements are detailed by the CMS here

New rules are continuing to be updated, so check for announcements here.


Cloud-based EHR & Server-Based EHR - Differences

Cloud-based EHR & Server-based EHR – Differences in 2022

By Aaron Morein

Healthcare providers must decide between two systems for maintaining electronic health records (EHR) and electronic medical records (EMR)–a cloud-based or a server-based system. 

One deciding, and yet often abstruse, factor is security. In recent years, cloud-based EHR has increasingly replaced server-based EHR. By 2017, already two-thirds of health systems and hospitals had adopted cloud-based technology. This industry-wide shift to practice management software has left some wondering how the security of each system compares.

Cloud-based and server-based EHR–what’s the difference?

Cloud-based EHR is accessed through the web and is maintained by a third party known as a software as a service (SAAS) provider. Server-based EHR, also known as on-premise, is stored on a server internal to the practice. Cloud-based EHR is accessible on any device that has a secure connection, whereas server-based EHR is accessible solely from devices within the personal server.

Implementing a server-based system requires hardware and software installation and necessitates a local IT department for regular management and upkeep. On the other hand, a cloud-based system requires neither installation nor IT personnel, since it is internet-based, provides live IT support, and automatically updates. Cloud-based systems therefore are less expensive, less time consuming, and require fewer personnel. 

 The costs associated with server-based EHR come with two primary advantages: (1) non-reliance on internet connectivity, and (2), more control over infrastructure configurations–i.e. where and how data is stored.

How should internet reliability factor in?

Reliable access to EHR is an essential factor of clinical productivity. So, it makes absolute sense for a practice with highly unstable internet connections to avoid web-based EHR that rely on it. However, while cloud-based EHR cannot be accessed without the internet, it will not experience system crashes the way server-based systems do. There’s also less concern for physical security, like disaster and theft recovery and data backup. Both methods have their own potential for interruptions, so there is some gray area. The most remote practices with little to no internet connection will have to  continue using a server-based system for the time being. From there, exactly how unreliable a practice’s internet needs to be to warrant a server-based system depends on factors specific to each practice, like local IT support accessibility and the resources they are willing to invest. For the majority of practices, however, cloud-based systems will provide access to EHR as or more reliably as server-based systems.

Cloud systems

How do cloud-based systems keep EHR secure?

The HIPAA Omnibus Rule, enacted in 2013, requires those cloud-based vendors that store, receive, maintain, or transmit protected health information from health plans, providers, or healthcare clearinghouses enter what’s called a “business associate agreement”. Through this agreement, the vendor becomes contractually liable for this data’s security. Since this update, cloud-based vendors have ramped sophisticated security controls operated by experts. Let’s take a look at what they offer: 

  • Physical security at cloud-service provider plants.
  • Firewalls that establish a barrier between internal and trusted networks and untrusted networks by monitoring incoming and outgoing traffic and filtering traffic based on a set of security rules. 
  • Intrusion detection systems that monitor activity within the network and analyze it for signs of violations of or threats to the security policy. Intrusion prevention systems use this information to preemptively block malicious remote file inclusions, block the offending IP address, and alert security personnel to the threat.   
  • Anti-virus software that prevents, scans, detects, and deletes viruses from the system.
  • Identity and access management which verifies the right users have appropriate access to data.
  • Automatic updates that ensure security by continuously staying ahead of potential vulnerabilities through patch maintenance. This feature also makes complying with changing regulations easy, too.
  • Data encryption which ensures that if a data breach were to occur, it is indecipherable.

The same protective measures are in place regardless of the device one uses. For this reason, cloud-based systems are the only viable way to access EHR remotely without compromising security. This is in contrast to the server-based system, which is only securely accessible within the server–i.e., the practice itself. This affords practices with cloud-based systems the flexibility to accommodate remote and virtual healthcare, while maintaining HIPAA-compliance. Post-pandemic, this is a highly advantageous security feature.

Still, it is understandable why one may be reluctant to let a third-party determine where and how EHR are stored. Patients trust their healthcare providers to protect their personal information, and providers want to honor that trust. People have a tendency to assess risks to be lower if they are under their control. We know that this cannot be true, because it would be impossible for everyone to handle everything better than everyone else. Still, we are guided by this fallacy.

Hypothetically, a practice with a server-based system, absent of budgetary concerns and hellbent on replicating the same degree of impenetrability, could implement and maintain most of these security measures to a similar degree. In reality, it is highly impractical and unlikely.

The Bottom Line

The bottom line is that a cloud-based system is the most secure method for maintaining EHR while also being cheaper and technologically easier.  A server-based system could not be expected to reproduce the same level of  security, given the prohibitive amount of resources it would require. Practices based in remote areas with highly unreliable internet may need to opt for a server-based EHR for the time being. Considering advantages in cost, time, and security, cloud-based EHR is the best choice for most practices.


Female orthodontist using tablet while assisting patient in clinic

Electronic Medical Record (EMR) Vs. Practice Management Software (PMS) : Towards an Integrated EHR Solution in 2022

Information technology and healthcare administration advancements have paved the way for health organizations to improve their efficiency and quality care. To fully leverage the potential of these advancements, healthcare administrators, practice owners and care providers in the market for medical practice solutions must make the best software-related decisions. Recognizing the difference between Electronic Medical Records (EMRs), Electronic Health Records (EHRs) and  Practice Management Software (PMS) is a first step towards that end. 

EHR or EMR. All The Same, Right?


Despite sharing certain characteristics,  EMRs and EHRs  essentially serve different purposes. An EMR is a digital version  of a patient’s medical chart. It contains information such as medical history, diagnoses, medications, allergies etc. An EMR operating medical practice in need of  referral to another provider for example, would not be able to transfer their patient’s medical history electronically  but would have to manually process that instead, which will require time and effort.   This is where the role of EHR as a more advanced  technology-based tool comes in. 

While an EMR’s scope of practice is limited to circulating patients’ medical information within a particular facility, an EHR transcends that to allow  multiple providers  to electronically exchange patients’ information through  real-time access to a common medical records database. In this sense, an EHR constitutes a more holistic reference to  clinical data, giving providers a wider range of patient data and ability to trace the long-term trajectory of a patient’s health information compared to an EMR.

Can Your EHR Do This?


Whereas the basis of  EMRs/ EHRs  lies in their clinical focus of storing essential patient information, practice management softwares (PMSs)  are concerned with the administrative side of operating a healthcare practice. Essentially a PM software  is used to electronically manage all day-to-day financial, administrative, and logistical  tasks that a health facility requires. This  covers front-office tasks like patient check-in, appointment scheduling, and  insurance eligibility verification, as well as back-office tasks like, medical coding and billing, financial analysis, and insurance claiming etc. By allowing all these tasks to be processed in an automated fashion, PMSs work to boost the  administrative efficiencies of any health practice as well as save time and money.

Seeing how  EHR, and PMS deal with different aspects of running a healthcare practice – clinical and administrative – it becomes clear that both are imperative to the efficient  operation of any healthcare facility. While it might be difficult to envision the correlation between these two distinct functions, blending the two systems is a vital  step towards meeting the evolving demands of interoperability and the building of a   complete electronic patient management system

In fact, a  study has identified the lack of an integrated PMS/EHR among the key barriers hindering  successful EHR implementation.  To this end, there are varying degrees to which a PMS can support EHR integration. This ranges from no integration to data interfacing, data integration, and workflow integration. 


EHR/ PMS: Three Modes of Integration 


Having no integration capabilities entails that some basic PMSs can’t interface  with EHRs or exchange any data with them, in which case the same information must be manually input into two separate systems. Other degrees of integration include: 

  • Data interface

Data interfacing is the minimum functionality for an integrated EHR/PMS system. It simply entails  interoperability of the  two separate softwares. Both systems have real-time insight into each other’s data. Patient medical history and treatments captured in EHR can be transferred to the PMS, and insurance and billing  data in PMS can be transferred to the EHR in the same way.  This kind of integration might reduce or eliminate duplicate data, but it is still prone to errors.


  • Data integration

Data integration means that an EHR and a PMS operate under a single, shared database. This  eliminates the need to synchronize changes in  master files and maintain an HL7 interface as a translator between the two systems. Data stored in one system  is simultaneously available in the other. For instance, processing a claim in a PMS can make use of easy access to all the necessary clinical information stored in EHR  for this operation. Similarly, lab tests and medication orders made by an EHR can access required information from the PMS database in real-time.


  • Workflow integration

In addition to having a shared database, EHR and PMS systems can also offer  workflow integration. This entails the ability of clinical and administrative staff to communicate and exchange information. This integrated health record format includes features such as direct messaging between users. This allows physicians for example to communicate vital information with administrative staff which can potentially   enhance the overall clinical process  and reinforces a physician’s long-term care plans.

Benefits that can be achieved through EHR/PMS integration


In general, the primary benefits of integrating your EHR system with a PMS include: 

  • Allowing clinical staff to have access to a single healthcare IT platform to handle all their business and patient related needs, saves time and effort and increases staff productivity.


  • Seamless data exchange between a practice’s departments promotes interoperability, Streamlined coordination, and reduces the rate of clinical errors  since an EHR system automatically retrieves information from a PM software and vice versa.


  • Alleviating the administrative burden of staff repeatedly entering the same data into two separate programs, EHR integrated solutions help clinical staff  invest more time in patient care. As a result, the overall organizational efficiency and clinical workflow of a healthcare facility  are improved.


  • With the shift towards value-based healthcare, Improved patient care that comes with adopting an integrated system minimizes issues related to Revenue Cycle management (RCM).


  • An EHR/PMS solution also simplifies compliance with the government (ex.HIPAA compliance), and insurance reporting requirements which, in turn, increases profits. 




PMS/ EHR solutions have become a rapidly emerging model. However, not all EHRs and PMSs are built the same. Thus, awareness of the above key considerations can bring much needed perspective into finding the right solution for your practice. If you are considering purchasing one or both products, you need to consider opting for an integrated offer or one that can integrate with your existing system depending on your desired level of integration.


Electronic Health Record Implementation Top Challenges and Barriers to Adoption and Use

Electronic Health Record Implementation: Top Challenges and Barriers to Adoption and Use.

Nearly two decades after the emergence of EHRs, the healthcare landscape is seeing more modernization efforts and a noticeable shift towards the adoption of Electronic Health Records (EHRs). Despite this substantial progress in implementing new technology in healthcare, the benefits realized in reality lag behind expectations as EHR software adoption and implementation challenges persist. So, What was a primary barrier to the adoption and implementation of EHRs?

EHR Software Implementation- at What Cost? 

Costs of implementing EHR systems are reportedly one of the top barriers to EHR adoption especially for small to medium-sized practices with no large IT budget. Several studies estimate that the initial costs of purchasing and installing an EHR system range from $15,000 to $70,000 per provider. Additionally, adopting an EHR system in your practice is not a one-time investment.  There are different associated costs  – upfront and regular- that are necessary to reap EHR  benefits including, EHR hardware and software installation, implementation assistance, staff training, and ongoing network fees and maintenance. Having a strategic plan ahead with all these potential fees mapped out is a must for successful EHR implementation and maintenance. 

Lack of Interoperability

The Office of the National Coordinator for Information Technology (ONC) estimates that between 90% and 95% of hospitals and clinical offices have adopted an EHR system. Despite that, data silos remain a significant issue hindering Interoperability (the meaningful exchange and use of clinical data across health organizations electronically through interconnected Health Information Networks (HINs) to improve care coordination). 

 In fact,  results of the 2006 survey and roundtable discussions conducted by the Healthcare Financial Management Association (HFMA) assigned  lack of interoperability a percentage of 50% in terms of the significance of this barrier to EHR use. The existence of a myriad of active, government-certified EHRs, all with different clinical terminologies, technical specifications, and functional customizations contributes to the lack of consistent standards and code sets. Thus, having one standard interoperability format across the healthcare continuum remains one of the most problematic issues with EHRs.

Finding a provider with the most interoperable system however can transform your entire practice. Using its experience of having fully integrated with The New Jersey Substance Abuse Monitoring System (NJSAMS), Zoobook Systems can integrate with state databases or health information hubs to help clinical facilities’ processes run more efficiently.

Additionally, having voluntarily obtained the 2015 ONC-ACB certification from Drummond Labs, Zoobook offers the most interoperability while scoring high on  useability, security, and compliance.


Privacy and Security Concerns 

Whereas increased interoperability and easy flow of electronic patient records across the health spectrum has brought about improved patient care and engagement for many practices, adopting an EHR system comes with a myriad of new responsibilities of safeguarding patient information and upholding patients’ trust. In the context of behavioral health, for example, patients’ mental health information is of very sensitive nature and can be potentially damaging in case of any leakage or unauthorized access.


The reality is,  all electronic systems remain vulnerable to many security threats such as encryption blind spots, malware, phishing, cyber-attacks, etc. Thus, privacy and security issues of patients’ data constitute a major concern for clinicians and patients alike. However, as technology further develops,  health organizations continue to use that to their advantage and strive to meet HIPAA Privacy Rule and Security Rule requirements to protect their user’s data.

To that end, Zoobook Systems takes protecting patients’ data as a serious responsibility. Utilizing a secure data center and network architecture (Amazon AWS servers),  Zoobook is committed to protecting your privacy and  keeping your data safe, secure and compliant.


Zoobook’s 2015 ONC-ACB certification also implies better security for its customers including:

  • End-User Device Encryption
  • Trusted Connection
  • Integrity
  • Authentication, Access Control, Authorization
  • Auditable Events and Tamper-Resistance


Workflow Disruption

From data migration, choosing suitable EHR products and features, to staff training, transitioning from paper-based records to EHR or from one EHR system to another, it becomes clear that EHR implementation processes can be highly disruptive and tedious. The process of data migration, for example, requires moving large batches of data from paper charts or from an older EHR. Not only can this be time-consuming, but it also entails decreased patient admission and less efficient staff performance during the first phase of implementation. This can inevitably lead to losses in clinical productivity and affect revenue rates.

Lack of well-trained clinicians and staff that can lead this process is another issue that adds up to this.  Naturally, with a new EHR, comes a lot to learn and workflows and office protocols to adjust to. Thus, training of staff and all end users must be mandatory for a successful and smooth transition. This transition/learning period might result in a  temporary disruption of workflow for both clinical and administrative staff and possible consequent costs. However, having a good grasp of data migration processes, prioritizing training, and devoting significant staff time to the process can all be critical  determinants of the success of EHR implementation.

Above all, choosing the right vendor partner is crucial to minimize workflow disruptions while adopting or transitioning to a new EHR system. Built for clinicians and administrators by clinicians and administrators, Zoobook will work alongside you to ensure your system is built to your specifications, prepare you for a smooth system go-live and continue to provide support in every step of the way beyond go-live. 

Staff Resistance and De-motivation to Use EHRs

As with any process shift,  many staffs’ initial reaction to a new technology-based system is denial, demotivation and resistance  to change as one study suggests. 

Wondering what can be done to overcome resistance within your organization during EHR implementation ?

The Office of the National Coordinator for Information Technology suggests the following measures to create a more receptive culture to EHR implementation:

  1. Identify the source of resistance to address  staff members  fears and misconceptions about EHRs and emphasizing EHR benefits.
  2. Involve all staff members in making decisions to reinforce the importance of participation of all end users in the EHR implementation process. 
  3. Reinforce the value of every member involved and provide support to those showing resistance.
  4. Address negative behaviors and to objectively negotiate your way  towards mutual understanding and gain.
  5. Listen Schedule regular power meetings to engage everyone in the organization and hear everyone’s opinion. 


The Bottom Line

As with any other process, EHR implementation is not a one-time episode, but rather an ongoing and multi-dimensional enterprise. Challenges facing EHR adoption  are not limited to the initial implementation phase but  can persist long after. Therefore, to realize the full potential of an EHR system, its adoption must be part of a well-designed plan that takes the above mentioned challenges into perspective and continuously works to monitor EHR functionality. This can be done  by  choosing a strong health IT vendor partner to assist your practice throughout the process and connect your efforts with positive outcomes. 



Telehealth Consulting

Data-driven Insights into the Impact of Telehealth During the COVID-19 Pandemic

Since its emergence, COVID-19 has triggered a series of ongoing challenges for the healthcare system across the United States, exposing a number of core deficiencies. While the COVID-19 impact is undeniably devastating, crisis times can also be times for opportunities to highlight existing problems and unlock innovation. Mandatory social distancing, rising demand for care, and the increased cases and hospitalization have all contributed to pushing telehealth to the limelight as the safest, most convenient and interactive system between patients and clinicians in today’s novel complex setting.


Telehealth & Telemedicine: Technology Meets Healthcare


To begin with, it’s important that we define what telehealth and telemedicine mean in the context of this article.

While telehealth can simply refer to the remote provision of clinical care, it is also a broad term that encompasses all components of remote healthcare services. Telemedicine, a subset of telehealth, is defined as  “the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration” according to the Office of National Coordination For Health Information Technology. Types of telemedicine services include video conferencing, mobile apps, remote patient monitoring devices, and electronic health information exchanges between a patient and a provider via email or instant messaging.

Using Telehealth During COVID19

What Are the Implications of Telehealth Adoption and Use for Health Systems and Independent Practices?


As part of the efforts to continue mitigating the risk of spreading COVID-19, save on the use of personal protective equipment (PPE), and care for patients in a safe and effective way, came the urgent need to encourage both patients and providers to utilize telehealth services. Below is a list of the most significant temporary regulatory changes and new reimbursement models associated with telehealth use during COVID-19.

Regulatory Changes for More Flexibility


The Centers for Medicare and Medicaid Services (CMS) and the federal government have modified many regulations on the use of telehealth. In this context, The CARES Act comes with a set of loosened restrictions to expand the use of telehealth. These include:

  • The availability of telemedicine is no longer restricted to patients residing in remote areas. Patients across the country can receive  home telehealth services  in any setting.
  • Previously, providers were required to be licensed in the state where their patient is located. This requirement is  now temporarily waived, meaning that as long as a provider is licensed in their home state,  they can provide telehealth services from home across state lines. State restrictions may apply.
  • Clinicians can provide remote patient monitoring (RPM) services to both new and established patients.
  • CMS has  temporarily expanded the list of services  allowed during the pandemic while also making the delivery of some services via audio-only an option. A full list of allowed telehealth and audio-only services is available on the CMS website.
  • The CMS emergency regulatory waivers have taken a non-enforcement position in temporarily loosening HIPAA privacy standards which opens up the opportunity for a variety of non-telemedicine apps and technologies that support real-time audio-visual features. The Office of Civil Rights (OCR) in particular has stated that there will be no consequent enforcement discretion against providers opting for the use of apps such as Zoom, Skype, or FaceTime which previously did not comply with HIPAA regulations and security rules. This excludes any public facing communication services such as Facebook Live, TikTok, Twitch etc.
  • The Drug Enforcement Administration (DEA) is now permitting clinicians to prescribe controlled substances based on telehealth visits during the pandemic. The Substance Abuse and Mental Health Services Administration similarly issued a set of guidelines around the provision of methadone and buprenorphine for the treatment of Opioid Use Disorder during the COVID-19 emergency.

Improved Reimbursements

Prior to the COVID-19, reimbursement for telehealth and e-health services were only made available to patients in remote areas or in a limited set of circumstances and even then, the compensation rate was nothing near in-person visits. Following the national public health emergency, CMS has issued a waiver to temporarily expand coverage and reimbursement for telehealth services on a fee-for-service basis, meaning that providers will be reimbursed for both virtual and in-office visits at the same rates. Additionally, CMS has also announced increased payments for telephone visits rates from $14–41 to $46–110 per visit to match payment for office visits.

Is Telehealth Just a Pandemic Stopgap then?


Pre-pandemic, telehealth was primarily used to reach and provide care to patients in remote areas and rural regions to facilitate access to healthcare. The recent surge in telehealth, driven by the immediate need to avoid exposure to COVID-19, has expanded telehealth use throughout the U.S. While this may point to the idea that telehealth might just be a pandemic fad, statistics suggest otherwise. Telehealth is here to stay!

Mapping the trajectory of Telehealth since COVID-19:


The last week of March 2020 witnessed a significant increase in the number of telehealth visits compared to the same period in 2019. Since then, telehealth has been rapidly gaining popularity and acceptance from patients and practitioners alike.Mom-and-Daughter-using-Telehealth

Recent data shows that 57% of providers now view telemedicine more positively, and 64% revealed that they are more comfortable using telemedicine compared to pre-pandemic. These favorable attitudes have caused a significant number of healthcare providers of different sizes to have upscaled their telehealth offerings or adopted new remote technologies to their services list to meet patient needs.

On their part, patients have similarly expressed high levels of satisfaction with telehealth services across a wide range of health care needs.  A survey on patient perspective on virtual care revealed that 77% of patients surveyed were completely satisfied with the service they received through telemedicine and e-health services. In the same survey, 75% of respondents said that they expect telehealth as an option moving forward. Interestingly enough, 35% of patients would consider switching to a different provider  for telehealth visits according to The Harris Poll.

These numbers highly suggest a growing patient demand for use of telehealth, underscoring the need for healthcare institutions and practices to upscale their telehealth offerings to meet patients’ needs and expectations. 

Will the Telehealth Momentum Keep Going Beyond the COVID-19 Crisis?


Driven by growing demand for easy-to-access and round-the-clock services, the vision of healthcare in a post-COVID world is already beginning to take shape.  The increased adoption of telehealth services during the pandemic has given patients and providers a peek into the horizon of possibilities that technology can offer them. More than ever, patients now recognize the role of telehealth in improving and managing their personal health and it now has become an expectation that healthcare practices need to live up to. Given the favorable attitudes of both patients and providers, it is anticipated that telehealth will continue to be an instrumental component of healthcare and the next years will see hybrid models of care where telehealth works to complement in-person care depending on growth in funding, adoption, policymaking, and payment regulations.


As an EHR systems provider, Zoobook Systems comes with a telehealth app to help medical practitioners meet their patients from the comfort of their homes. Ready to start teleconsultations? Request a demo today

covid-19 telehealth programs

COVID-19 Telehealth Programs: FCC 2021 Relaunch

The Federal Communications Commission (FCC) recently announced its rollout of the second round of its COVID-19 Telehealth Program. This $249.95 million federal initiative, that has new guidelines, stems from the 2020 $200 million program started by the Coronavirus Aid, Relief, and Economic Security (CARES) Act.

This FCC project “supports the efforts of health care providers to continue serving their patients by providing telecommunications services, information services, and devices necessary to enable the provision of telehealth services during the COVID-19 pandemic.” (see docs.fcc.gov)

New parameters are set for 2021 so that instructions are clearer on how to qualify for reimbursements. Round 2 application and eligibility requirements are still similar to last year’s Round 1 conditions with some changes to make it swifter and more transparent. These changes include:

  • Rating applicants to be more rigorous. This highlights areas that were hit the hardest and segments that have lower income, and there will also be prioritization on Tribal communities and sectors with shortage of healthcare providers. 
  • “Equitable nationwide distribution of funding” (see docs.fcc.gov). The 2020 program only funded 47 states, with the exception of Hawaii, Alaska, and Montana. This year, the COVID-19 Telehealth Program will be more inclusive as there should be at least one applicant to receive funding from the 50 states and the District of Columbia.
  • The abbreviation of application into seven days. This is different from last year where there were 14 rounds of granting awards. The tighter deadline seeks to improve the second round by placing all applicants in equal footing from the set deadline.
  • There will be two phases of awarding for swifter funding and to give more opportunities for applicants to qualify for the second phase through the better provision of information. 

For those considering to apply, it should also be noted that the COVID-19 Telehealth Program is a reimbursement program; it does not grant awards. To receive compensation, providers are required to submit invoice forms and other documentation on their telemedicine expenses.

In this pandemic, people are urged to stay home. Teleconsultation helps bring people to their health care providers without having to visit clinics or hospitals. And as visiting your doctor becomes more difficult, COVID-19 telehealth programs are essential in keeping people safe at home. As an EHR, Zoobook Systems comes with a telehealth app to help medical practitioners meet their patients from the comfort of their homes.

Ready to start teleconsultations? Request a demo today

ehr implementation challenges, ehr interoperability challenges, barriers to implementing electronic health records

Overcoming EHR Implementation Challenges Barriers to Implementing Electronic Health Records

Modernizing your health record system is a good investment. But as much as you want to upgrade, there can be some barriers to implementing electronic health records (EHR). From staff resistance, data migration, and EHR interoperability challenges, moving to digital records may have some roadblocks. So how do you curb EHR implementation challenges? You strategize. And here, we show you how.



Implementing an EHR system will help both your organization and your patients. Clinicians can see medical profiles easier and patients get easy access to their medical history. But before all these, there are some costs to be studied.

Selection, implementation, and optimization are just some of the considerations you need to review. You also need to take note of employee training, hardware installations, assistance in implementation, continuing network fees, and support. In preparing for an EHR comes the realization that it is not a one-time payment move. You have to allocate for maintenance fees in streamlining your data systems.


Staff Resistance

Hesitation is to be expected when there are changes in an environment. Transitioning into an EHR system is especially confusing as it is not only a modification in the system, but also a technological change. In most cases where there is reluctance, staff lack awareness about the comprehensive benefits of implementing an EHR.

Acceptance among staff members is something that can be raised to build trust in the new system. It may be slow, but steady implementation and comprehensive training aids in embracing technological advancement. Ensure your staff that their current practices may be improved with the new system. In fact, their work can be done faster and their workload becomes considerably lighter with an EHR. An important note is that the staff needs to understand that the incoming change will give rise to a better business model and uplifted job satisfaction.


Data Migration

Let’s set it straight—it’s going to be a logistical nightmare. Exporting paper-based documents to digital records is time-consuming and tedious, but there are strategies on how to ease into this change.

One gameplan is to prioritize records. Start with the most recent files until you get to the older ones. The EHR should at least have the most recent records of a patient. Until you get all records on the EHR, you can access older records traditionally.

Another plan of action is to assign a special EHR uploader. This will be your EHR point person who is responsible for syncing all files into the system. This way, you know someone is always on top of all things migration.



This pertains to the sharing of data, whether within the organization or with outside providers. The quality of your interoperability depends on your EHR provider. Make sure you choose a system with good interactivity and one that provides add-ons and customization to help with the exchange of your electronic medical records.


IT Health Experts Assistance

Communication with your IT health vendor should be continuous. Whenever you have concerns or feedback, your EHR provider should be able to assist you. Choose a supplier who you can easily access for updates, like Zoobook Systems. As your consultant who developed an EHR made for clinicians by clinicians, Zoobook collaborates with you and your stakeholders to fulfill your vision.

As there would be in any new endeavor, there will be barriers to implementing electronic health records. The good thing is, you can map out your way in maneuvering through EHR implementation challenges. Whether it be the cost of the system, resistance from the staff, migration hindrances, or EHR interoperability challenges, there’s always a way to come up with a good mitigation strategy.

EHR and patient safety

EHR and Patient Safety: What Improves with an Electronic Health Record

From appointment scheduling to prescription pickups, an electronic health record (EHR) helps with patient-relation processes. It may not be apparent, but this plays an important role in patient safety.

There’s a lot to learn about how EHR and patient safety work together, and here are four ways Zoobook Systems improve a patient’s safety.


Improved Decision Making

Medical conclusions need to be done with precision. With an EHR, clinicians see the full picture of their patient’s health. From test results, vital signs, lab results, and other diagnoses, a patient’s complete medical information is available at a glance.

Doctors and medical staff members can secure the safety of patients with an EHR’s accuracy with information. This is how they can come up with detailed diagnoses, treatment plans, and prescriptions more easily and with reduced errors.


Reduced Adverse Events

From medication to missed diagnoses, it is important for health care providers to minimize adverse events. Being non-discriminatory, EHRs promote patient safety by implementing a system that works for all medical staff.

Prescriptions, for example, are made with available standardized information of the patient’s allergies, current medication, and previous diagnoses. This prevents medication errors that may pose harm to a patient.


Enhanced Integrated Care

There is a risk of misinterpretation when a patient’s medical information is handed from one clinician to another. From doctors, nurses, radiologists, medical technicians, and administrative staff, it is important to have an organized system.

Coordination with different medical staff workers is improved with an EHR, making for safe integrated care. This creates a consolidated approach required by patients with chronic or complex cases, like those in behavioral health, mental health, and addiction treatment facilities, who need an overall health team.


Increased Patient Compliance Rate

Aside from scheduling follow-ups, homecare compliance is important in an ambulatory treatment plan. EHR systems have the option to send alerts and reminders to patients even when they are outside your facility. Whether it’s a prompt for their next appointment or a notification to purchase their prescription, an EHR aids in keeping patients safe with aftercare services.


Easy Access to Historical Information

With improved access to electronic health records, health care providers get a clearer view of a patient’s history. Instead of previous charts being locked away, an electronic system can retain a patient’s full history at the ready for clinicians and medical professionals to review and consult when making decisions.

Record systems improve when you get an EHR, and patient safety is just one of the things that advances with it. Choose an EHR that knows exactly what the patient needs and what is needed from a patient; choose an EHR made for clinicians by clinicians. Zoobook Systems is an insightful EHR that equips health care providers with all important patient information. This reduces medical error and improves record maintenance. 


Ready to minimize risks? Request a demo today.

The Pros and Cons of Electronic Medical Records

The EMR Debate: The Pros and Cons of Electronic Medical Records

Medical records administrators do a lot of work—from patient charting to medicine charting, and all the ancillary documentation, you can sometimes get lost in the paperwork. So what are the concerns and benefits of the public with adoption of the electronic health record (EHR)? Is transitioning from paper to electronic medical records (EMR) documentation worth it? Here, we list down some EHR/EMR pros and cons.


What are electronic medical records?

EMRs are the digital version of a patient’s record. This contains a patient’s medical and treatment history in a particular practice over time.

With electronic documentation, you are able to sort out patient care tasks efficiently. This includes scheduling appointments, arranging follow-ups, updating medical tests, and writing prescriptions.

You may also optimize usage of EMRs with EHR systems (see Differences Between EMR and EHR). For those in the behavioral health, mental health, and addiction sector, there is Zoobook.


What are the benefits of electronic medical records?

  1. With the standardization of files via EMR, access is streamlined making it more efficient to manage internal operations. There will also be fewer documentation errors in a patient’s file due to misspellings or illegible handwriting.
  2. Records are consolidated into one system with customizable features. Depending on your EHR, this may mean the patient’s medical history, billing information, and even staff member records are all kept in one place. 
  3. Backup systems are in place, making it less likely for files to be destroyed or lost.
  4. Since all the patient’s medical records are in one place, it’s hard to omit patient information, especially if you’re relaying details from one health worker to another.
  5. As you keep up with the digital world, medical information is more accessible for you and the patient. Passwords and other safety features help to secure patient privacy.


What are the disadvantages of electronic medical records?

  1. Time-consuming documentation processes might be why electronic medical records are bad. Converting paperwork into EMR can really take a lot of time. Choose an EHR with smart tools to help you with patient intake.  
  2. Not all the members of your staff can work a computer well. This is when user interface and user experience comes into place. Make sure you choose an EHR system that knows how clinicians work.
  3. With the switch from paper to digital, updating computer hardware may be more frequent. Some would think that this is what the greatest risk of facing electronic health records is. Is it a risk you’re willing to take to get all the above benefits?
  4. There can be configuration challenges such as being unable to create templates for each area of practice. It is best to have a system built specifically for your health sector.
  5. There’s a lot of money involved in upgrading from paper to EMR. Aside from upgrading hardware, there’s also the cost of the software. Make sure you choose one that can cater to your needs while keeping it in your budget.

With the advent of a modern solution, medical records administrators shouldn’t be burdened with the distress of patient charting, medicine charting, and other on-paper tasks. And although there are concerns, there are also benefits with public adoption of EMR. In going through this article of EMR pros and cons, there are definitely a lot of things to consider. But one thing’s for suretransitioning from paper to EMR is a lot easier with an EHR like Zoobook Systems.


Are you ready to go paperless?