Home Forums Discussions General Discussion Exporting notes as PDFs??

Hi everyone,

We just received a "request" for patient records from Altegra Health, acting as an agent for UPMC, for a "Medicare Risk Adjustment Review". We have 39 patients that qualify.

They will be sending someone to our office. They want us to create one PDF file per patient, with progress notes for all encounters for 2012.

I imagine that there is an easier way to do this, but at the moment all I can think of is to print the encounters, then scan as PDFs. Am I overlooking the obvious?

Thanks. Gene

Hi Gene;
We use a Free Software - CutePDFWriter. Once installed, it generates a virtual printer name "CutePDFWriter". We select what we need to print as PDF and send thoes files to this printer. It then converts all pages to one PDF file and asks for where to save it. Select location, give it a name and click SAVE. A PDF file is just created.
We then can either send it via our fax or e-mail attachement or upload to patient's portal.
Hope this will help.

I'll second CutePDF, and since I learned about it from Wendell, I have to point out that "Did I mention that it is FREE?"

IF you use Updox, you can print to Updox to collect and assemble the document pages in the order you fashion, and also make it a single PDF.

You could then send it through the portal as a PDF, so that you get a read receipt and they have to use their own resources to print.

1. Explain to the "agent" that your record copying fee is $25 per chart (or whatever you think is fair). They may initially balk at this; we had one such "agent" refuse several times, only to return to "negotiate" and eventually to agree to pay. We recently deposited the $425 check for the 17 records. Remember: this is not the carrier you are dealing with; it is a for-profit and the cost of this comes from their hefty fee.

2. Go to "Previous encounters". On the left you can either select "progress notes only" (which will give you progress notes from all dates) or select "all encounters" which allows you to shorten the time frame to one year, but includes messages and addenda.

3. As described above, "print to" Updox or Paperport if you have them, or cutepdf or one of the other free pdf creators.

4. Put the files in a folder and either burn the folder to a CD or flashdrive (a 1gb drive costs about a dollar and is quicker; especially if you don't have a burner in the office).

5. When they come to your door, hand them the disc or drive and suggest that they use it in their own laptop; or better yet, just take it and review it back at their office. (Do not let them near AC).

Jon,

A bit off topic, but do you have the agent sign any thing to release you from any HIPAA violation if the aforementioned disc or flashdrive gets lost with all the patient data?

That is a good idea - a Chain Of Custody document that releases you from responsibility.

Of course, you could encrypt it, send it to them, and send them the key after they pay.

I definitely agree with not letting them near the database.

I agree with all of the above, hand them a disk, after collecting a fee. Make sure that they have documents to show that they are a business partner of medicare and that you are allowed to share information with them. No documentation of their HIPPA status, no records. Don't even ask until you get the money

Jimme,
I don't believe we have been doing so, but it sounds like a good idea to have them sign a receipt for the records, in whatever form. I like Indy's encryption idea, too. Encrypted chart copies are free; the encryption key is $25/chart, to be provided after the check clears.

Very interesting. I'm ignorant as to how to encrypt the documents. Is there some easy way?

Neil
solo practitioner.

Jon,

The reason I am bringing this up is that we have traditionally provided a desk for the MEDICARE ADVANTAGE folks to review the paper charts, and do their thing. As we transition forward as an office we have talked about providing a desktop with view only e-records available for these folks in the future. I like the idea of how you are doing things except for the potential HIPAA violation. If the agent loses "his" thumbdrive in the airport bar or next year when his kid sees the thumdrive on his dad's dresser and loses it at school with your name and patient data, will a signed release be enough to keep you from being penalized?
I am all for receiving compensation for providing the records to the necessary entities, but I think of the article you provided a while back about the poor doc in Korea that got his lap top stolen and had to pay 10,000 dollar per HIPAA breach which was in the millions for the fine. I think as time moves forward there will likely be more of these breaches and docs perceived to have the deep pockets will be the ones easiest to extract fines from.
The encryption would likely solve this issue.

Neil/ Jon/Indy,
I have the same question - how do you encrypt these created PDF documents thru CutePDF writer?
Bala

Jon,

I was re-reading what I said before and did not mean to imply you are doing anything wrong. My concern is that the agent who becomes the custodian of the records on the thumb drive may inadvertently create a HIPAA breach, by losing it. However, the perceived custodian of the records on hand on the thumb drive or CD, would be you.
However, I think if you have a signed legal document on hand relinquishing you of being the caretaker of the records, in addition encryption of the records with a key to unencrypt once payment received, and a record of the transaction all documented the likelihood of being penalized would be significantly reduced if not nullified.
Also, it sounds like there are CD shredders, like paper shredders, so a CD might be the best device to use to put the records on as there will be a higher likelihood of being shredded once the agent is done with the CD. Also sounds like CD burners are reasonably inexpensive.
Just some further thoughts I had, but also my office manager showed me today where small offices are being targeted for HIPAA violations, and some small office in Idaho just got a 50,000 dollar fine.
So Gene thanks for asking about this as we all can learn from this. Personally, this is all new to me, and maybe I am being too paranoid, but just trying to figure how to best CMOA on this issue.

Jimmie, I didn't take it as a criticism. We generally give these as CD's, and if they are picked-up, we get a signature from the rep so I would think they take on the responsibility for the breach if it is lost. We have not been encrypting them, but it seems like a smart idea.
I figured that I would leave the encryption answer to one of the more tech-savvy on the board. I know there are several free products that allow you to encrypt a disc or drive.

We have gotten more calls and inquires about encryption in the new year, and so I've added that to the list of topics that I'll cover in more detail in a series of blog posts.

There is a whole industry out there for Health IT security, and the government is fanning those flames with "We're here from the Government, and we're not here to help you".

It is easy enough to point you to the free and enterprise tools out there, but that is going to produce another steep learning curve. Communicating this through a few blog posts will break it down into what a solo/group Doc and/or Practice Manager needs to know, and then each practice can decide what path they want to pursue.

One of the Physicians who visits the board reached out with his circumstances, and is willing to cooperate in a case study as we will benchmark some of the tools out there to get him to the "Warm Brick" approach.

To extend the conversation above, we could go one better, and use one-time keys that they would have to contact a key-broker and pay each time they wanted access to the info.

Just curious, anyone charge commercial insurance companies for records request for HEDIS purposes. Or, is there any time we can or can not charge a contracted insurance company for records that they request. I understand we need to send records if requested for the purposes of our own charges but what about other times?

I use another FREE program called PDFreDirect (http://www.exp-systems.com). Similar to CutePDF, the program will install a "printer" for your computer... print your documents to that and when you have all parts of the chart printed to that, save it as a single PDF... near the upper right corner of the PDFreDirect window is a box you can select to apply a security password for the file before you save it. Then any time the file is opened it will ask for the password before allowing access. The program is extremely easy, useful, and best of all (again) free.

Just discovered another program called primoPDF which will also allow you to put print to PDF and password lock the document. They are somehow related to Nitro PDF. Warning, their installer defaults to putting a lot of crap on your computer if you are diligent.

That should be if you AREN"t diligent, (took to long to correct so made a new listing)

Also, remember all of you ScanSnap Users should have 2 copies of Acrobat Standard.

We charge for all records, including Medicare Advantage, HEDIS, etc. If they do not want to pay, they send someone in to review the records. I have a user name for them that is read only.

I would like a clear direction on encrypting records. In my wish list, it would be built in to AC whenever we transfer records.

Has anyone use the file encryption utility built into AC?
Does this work to encrypt records to be sent?

I haven't used it but it would appear to meet requirements.

The question becomes must you use the same utility to decrypt files or will any AES 256 "unencryption" program fit the bill?