What is ICANotes?

ICANotes is an EHR / EMR computer program that helps mental health professionals quickly and easily create mental health notes and reports, including progress notes, treatment plans, initial assessments and discharge summaries.

By pushing buttons, clinically appropriate words, sentences or paragraphs are entered into reports or new arrays of buttons are exposed allowing more detailed or more specific clinical details to be entered.

Additional information may be typed, handwritten or dictated into the report, but a thorough, grammatical, individualized report can quickly be created by just pushing buttons.

ICANotes self-codes for E/M procedures. These procedure codes determine re-imbursement.

To best learn what ICANotes is and how it works, please watch some of our selection of videos. Videos

ICANotes is available as an internet based program

ICANotes Internet Version is cost-effective, easily manageable, secure, and accessible to you and all privileged staff via the internet. Instead of storing the program and your patient database on a local computer, your information is stored on our secure servers and accessed through your internet connection.

Your copy of the ICANotes program and your electronic records(EHR /EMR) reside on a server that is maintained and backed up by the ICANotes staff at a state-of-the-art, secure datacenter. You access the program via an internet connection.

The connection is secure and meets HIPAA security standards. (The information transferred over the internet between you and the program is securely encrypted with a 128bit key.) (For more information see ICANotes and HIPAA regulations.)

Groups of users can all simultaneously access the same copy of ICANotes so that all records for a group are in the same "filing cabinet."

With ICANotes Internet Version, you are assured of always using the latest version of the program. Upgrades occur automatically and we take care of back-ups and HIPAA security. Back ups occur three times daily, off site and on site.

For more information see ICANotes and HIPAA Security Standards.

To view our Internet Service Agreement, please click here.

Advantages of an internet based program:

1. Financial: ICANotes is provided for a  monthly fee, per user. There are no large start up expenses and no drain on IT personnel's time. The service can be cancelled at any time. The purchase of a server and server software is not necessary. The maintenance of a network is unnecessary.

     All that is needed is an Internet connection for each user, which often already exists.

2. The ICANotes program and your records are securely available via the Internet from any computer with an internet connection. Individuals or groups that work out of different locations find this very useful and it makes your clinical records highly accessable day or night from anywhere in the world with an internet connection.

3.Groups of users can all simultaneously access the same copy of ICANotes so that all records for a group are in the same database. This means that important demographic, clinical and quality information can easily be obtained from the entire groups data. Also, coverage and supervision is simplified.

4. Because we maintain and "house" the program, the latest features, fixes and modifications are immediately available to you. This means that upgrades and additional maintenance fees are not necessary.

5. ICANotes is easily scalable. Just sign up new members of your group and they can be immediately enrolled. This allows an organization to test ICANotes with just a few users, with out a large financial investment.

Some additional FEATURES:

In addition to its main function, which is assisting you in making your various clinical notes, ICANotes also includes the following features (this is a partial list) :

1. Managed Care Monitor: When you have two authorized sessions or days left, this monitor automatically opens to remind you to obtain further authorization...and reminds you of the phone number to call! Enter the number of sessions or days you have been authorized and you will be reminded again, when two sessions or days are left.

2. AIMs Monitor: After you have completed an initial assessment this monitor will ask if you want to do an AIMs and how often you want to be reminded to do another. An electronic AIMS form is easily completed and printed.

3. Prescription Writer: After you finish your progress note, print prescriptions or send the prescription information to the network printer of your choice...for example, to the printer in the Hospital Pharmacy or the Nurses Station.

4. D/C Summary: This module makes creating a discharge summary quick and easy. It prints a cover page, your Initial psychiatric assessment, all progress notes in a compresse format, and a final page which includes risk factors, final diagnosis, condition at time of discharge, and your instructions to the patient. An optional page for you to dictate or type information into is also available.

Your discharge summary is ready to leave with the patient.

5. Treatment Plan: This module supports 19 common psychiatric problems. The program offers a selection of short term goals, long term objectives, strengths/assets and all the other details that treatment plans require. Interventions for each member of the treatment team are available. Also, there are separate social work and medical/nursing problems with long and short term goals and interventions. .

6. Electronic Signature:  Available at a small additional cost.  When your note is complete you can electronically sign and date it. This electronically identifies you as the author of the note and is legally admissible. This signed note is electronically timed and date stamped and cannot be changed.

You can, however, make changes to your original note. Then, it can also be signed and locked. All signed, locked, and time dated versions of your note can be easily retrieved and read. All alterations to the original note can be followed.

This process is based on digital signature technology and is HIPAA approved.

Electronic signature technology is a necessity if you intend to move to paperless records.

7. Algorithm Support: The University of Texas treatment algorithms are contained within the ICANotes program. An indication that the treatment algorithm is being followed and the stage of treatment can be automatically inserted into the note.

8. Scanned Images:  Scanned image can be easily uploaded and stored in the patient's chart.

9. Appointment Book / Scheduler:  A full featured, Electronic Appointment Book is included in the ICANotes program. It allows the front desk to indicate when the patient has arrived. The clinician can go right from the Appointment Book to the patient's chart. An appointment history for the patient which lists cancelled appointments and no-shows is easily created. Groups can be scheduled as can block out and availability times.

10. E-Prescribing:  ICANotes is now integrated with the E prescription company, Emdeon, so that prescriptions can be electronically transmitted and refill requests received from any pharmacy. Also included in this service is a robust database of drug alerts and interactions and formularies associated with insurance plans. There is an additional monthly fee for this service..

11. Automated Billing:  Billing reports can be generated by ICANotes. These reports, for any range of dates including daily, contain all the contact information needed for billing.. This information can be sent to your biller, your billing software or your billing company. If you would like, ICANotes is integrated with a number of billing companies and the your billing information can be sent directly to one of them. Fees for the billing service depend on the level of service desired..

 
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How much does it cost?

A.  Internet Version

This version of ICANotes is the most popular and most versatile and least expensive way to use the ICANotes program. It is designed for both groups and individual practitioners.

ICANotes Internet Version and your records are housed on ICANotes' Servers in a professional data center. The program is quickly and securely accessible via any computer (in the world) with an internet connection. Your records are accessible to you any time of the day or night.

ICANotes Internet Version eliminates the need for server hardware and software, upkeep on a network and worries about security and back-ups. There is little or no need for IT services.

Also, this solution is provided on a monthly, per user basis so start up costs are negligible. Unlimited Training and support, back-ups, upgrades, and maintenance of the system are included in the monthly fee. The ICANotes company takes the responsibility for conforming to HIPAA standards.

1.  For Prescribing Clinicians:

$150 per month for one prescribing clinician and one office staff user.

A $150 one time start up fee is also required for each clinical user.

Additional prescribing clinicians in the group are $99 per month. The fee for non prescribing clinicians is $69 per month.

Groups of 4 or more clinicians are entitled to one additional free administrative user.

Additional office staff or administrative license cost $39.95 per month.

Special pricing is available for groups in excess of 8 clinical users, please call our business office 866-847-3590 ext. 3 for a quotation.

There is no annual contract. Subscription is on a monthly basis and accounts may be cancelled at any time, with 15 days notice.

The only additional fees are for Electronic Signature Software, if that is desired.  There is a one time fee of $150 and an annual charge of $30 for this feature. The feature is needed if and when the user wants to go all electronic.

 

2. For Non Prescribing Clinicians

$69 per month for one non-prescribing clinician and one office staff user.

A $150 one time start up fee is also required for each clinical user.

Additional prescribing clinicians in the group are $99 per month. The fee for additional non prescribing clinicians is $69 per month.

Groups of 4 or more clinicians are entitled to one additional free administrative user.

Additional office staff or administrative license cost $39.95 per month.

Special pricing is available for groups in excess of 8 clinical users, please call our business office 866-847-3590 xt. 3 for a quotation.

There is no annual contract. Subscription is on a monthly basis and accounts may be cancelled at any time, with 15 days notice.

The only additional fees are for Electronic Signature Software, if that feature is desired. Electronic Signature Software is a one time fee of $150 and an annual charge of $30.

B. Networkable Version:

This version is for the facility or group that prefers to house the ICANotes program on its own Server and to use its own network, rather than the internet.

This version can be simultaneously shared by as many as 250 simultaneous users. It requires a server dedicated just to ICANotes and special server and client software is needed.

The ICANotes company will service and upgrade this version of the program, but back-ups and HIPAA Security, and maintenance of the Server and the network are the responsibility of the facility or group. Upgrades are available as released, approximately every 4-6 months.

Cost depends on the number of users and number of computers being used. Please contact us for exact details. ICANotes Sales 866-847-3590 ext 3.
This option is not practical for those practices with less than 50 users or do not have an IT Dept..

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Does it really self-code?

Yes, it does. ICANotes determines the highest Evaluation and Management (E/M) code (99232, for example) for the site where you are working. This is a Medicare/Medicaid Code.

E/M codes often provide a higher reimbursement than other codes. The E/M code is determined, in part, by the clinical documentation in the note. which ICANotes automatically keeps track of by noting which buttons you have pushed. The program also knows where you have indicated you are working, and whether you are doing an Initial Assessment, a Progress Note, or a Consult.

If you do psychotherapy in addition to Evaluation and Management , ICANotes will automatically code the appropriate Psychotherapy with Medical Evaluation and Management service code (90807, for example).

More Information about Self Coding

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Having all notes in a database means the database may be searched. For example, in a flash all patients on a certain medication can be found. Or, all patients in a certain demographic (ie. Over age 60 or under 17) can be found.

Billing reports are easily and quickly prepared. These can be automatically sent to a billing service (we provide that capacity, ask us about it) or to your own practice management software or medical billing software such as MPM.

Unlike paper records, Electronic notes are secure. Only individuals with passwords and the proper privileges can access the notes.

Electronic records are highly accessible. For the individual clinician working on a laptop or tablet pc, all patient records can be taken home at the end of the day. For the network or Internet user of the program, all records are available at any time from any location with an internet connection.

Electronic Records are less easily lost or damaged, if they are properly backed up. ICANotes Internet Version is Backed-up multiple times a day and daily back-ups and storage at a different site are routine.

Finally, you now have a good reason to buy a laptop or tablet PC!

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How does ICANotes meet the HIPAA Security Standards for Electronic Medical Records?

HIPPA calls for:

1. Individual authentication of users. ICANotes includes UserName/Password protection. Biometric authentication via the use of fingerprint recognition technology can be provided by request.

2. Access Controls: ICANotes is easily set to allow different privileges to
different types of Users. So, for example, a Medical Records staff
member could easily be assigned the privileges to browse and print
records, but not create or alter records. Privileges for other groups are
similarly quick and easy to set or change.

3. Audit Trails: ICANotes keeps a log of the date and time and identity of every person who logs onto the program, and a separate log of which patient notes were accessed, when, and by whom.

4. Protection of Remote Access Points: In addition to fingerprint and/or username/password authentication at each work station, ICANotes
automatically drops the work-station computer from the network,
and/or logs off the program, after a period of idle time.

5. Access establishment and modifications: With ICANotes the creation of new users or the removal of users, the editing of their information, and
the setting or resetting of passwords and privileges is easily performed
by those with the privileges to do so.

6. Alarm and Event Reporting: If the wrong password is entered three times in a row, ICANotes prevents further attempts for 5 minutes and reports the event to the system administrator.

7. Privacy of Psychotherapy Notes: ICANotes permits the recording of separate notes that can be password protected. These notes do not become part of the official record.

8. Prevention of Alteration or Destruction of the Electronic Record: ICANotes provides digital electronic signature and locking of the electronic record.

9. Encryption: ICANotes transmits and receives data that is encrypted with a 128 bit key.

Are Electronic Signatures required by HIPAA?

Electronic records are required by HIPAA to be protected from alteration or destruction. Furthermore, for the electronic record to be legally admissible it must be unalterably locked and signed in a way that can be authenticated. Electronic signature software that legally and electronically identifies the creator of the record and that protects the note from alteration or deletion is therefore required. The only current technology that meets those standards is the digital signature technology. ICANotes contains this capacity to digitally sign and lock records.

How Do Electronic Signatures work?

When ICANotes records are electronically signed they are also dated and locked.  If the note remains unaltered, nothing more need be done. The signed and locked note is the legal note. However, if the note is altered or edited it must be re-signed and re-locked. Then there will be two signed, locked notes in the record; the original note and the altered note, each separately signed and dated. The most recent is considered the legally valid note, although the changes to the note can be followed by reading the notes in time sequence.

Will HIPAA encourage or discourage the movement to Electronic Medical Records?

HIPAA will eventually make electronic medical records and electronic signatures a necessity. Only electronic record keeping can provide the level of security and confidentiality required by HIPAA. As electronic medical records come into use, the insecurity and limitations of the paper chart will become increasingly evident, and lead to its abandonment.

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ICANotes and the Recovery and Reinvestment Act - How It Will Benefit You?

H.R.1—353
TITLE IV—MEDICARE AND MEDICAID
HEALTH INFORMATION TECHNOLOGY;
MISCELLANEOUS MEDICARE PROVISIONS

Q. Who shall get incentives ?
A: Eligible professionals who are “meaningful” EHR users.

INCENTIVE PAYMENTS.— (1) I

(A) IN GENERAL.—

(i) INGENERAL.—Subject to the succeeding sub-paragraphs of this paragraph, with respect to covered professional services furnished by an eligible professional during a payment year (as defined in subparagraph (E)), if the eligible professional is a meaningful EHR user (as determined under paragraph (2)) for the EHR reporting period with respect to such year, in addition to the amount otherwise paid under this part, there also shall be paid to the eligible professional (or to an employer or facility in the cases described in clause (A) of section 1842(b)(6)), from the Federal Supplementary Medical Insurance Trust Fund established under section 1841 an amount equal to 75 percent of the Secretary’s estimate (based on claims submitted not later than 2 months after the end of the payment year) of the allowed charges under this part for all such covered professional services furnished by the eligible professional during such year.

(ii) NO INCENTIVE PAYMENTS WITH RESPECT TO YEARS AFTER 2016.—No incentive payments may be MOUNT.—Subject to clauses (iii) through (v), (ii) A the applicable amount specified in this subparagraph for an eligible professional is as follows:

Q: How much is the incentive and how is it distributed?
A: $15 k the first year, $12 the second, $8 the third, $4 the fourth, $2 the fifth, for a total of $41,000.

(I) For the first payment year for such professional, $15,000 (or, if the first payment year for such eligible professional is 2011 or 2012, $18,000).

(II) For the second payment year for such professional, $12,000.
(III) For the third payment year for such professional, $8,000.
(IV) For the fourth payment year for such professional, $4,000.
(V) For the fifth payment year for such professional, $2,000.
(VI) For any succeeding payment year for such professional, $0.

Q: Any other incentives?
A: Yes, an extra 10% for physicians working in “health professional shortage areas.”

(iv) INCREASE FOR CERTAIN ELIGIBLE PROFESSIONALS.— In the case of an eligible professional who predominantly furnishes services under this part in an area that is designated by the Secretary (undersection 332(a)(1)(A) of the Public Health Service Act) as a health professional shortage area, the amount that would otherwise apply for a payment year for such professional under subclauses (I) through (V) of clause (ii) shall be increased by 10 percent.

Q: Is there a cut off for these incentives?
A: Yes, incentives end in 2014. There are no incentives for eligible professionals who apply in 2014 or subsequently

(v) NO INCENTIVE PAYMENT IF FIRST ADOPTING AFTER 2014.—If the first payment year for an eligible professional is after 2014 then the applicable amount specified in this subparagraph for such professional for such year and any subsequent year shall be $0.

E) P
(i) IN GENERAL.—For purposes of this subsection, the term ‘payment year’ means a year beginning with 2011.

(ii) FIRST, SECOND, ETC. PAYMENTY EAR.—The term ‘first payment year’ means, with respect to covered professional services furnished by an eligible professional, the first year for which an incentive payment is made for such services under this subsection. The terms ‘second payment year’, ‘third payment year’, ‘fourth payment year’, and ‘fifth payment year’ mean, with respect to covered professional services furnished by such eligible professional, each successive year immediately following the first payment year for such professional.

Q: What does “meaningful use of Certified HIT mean?
A: It means what the Secretary defines it to mean, but means that the EHR is certified and that e-prescribing is included.

(i) MEANINGFUL USE OF CERTIFIEDE HR TECHNOLOGY.—The eligible professional demonstrates to the satisfaction of the Secretary, in accordance with subparagraph (C)(i), that during such period the professional is using certified EHR technology in a meaningful manner, which shall include the use of electronic prescribing as determined to be appropriate by the Secretary.

Q: How do you prove you are using Certified EHR in a meaningful way?
A: You can “attest” to it.

(C) DEMONSTRATION OF MEANINGFUL USE OF CERTIFIED TECHNOLOGY AND INFORMATION EXCHANGE.—

(i) INGENERAL.—A professional may satisfy the demonstration requirement of clauses (i) and (ii) of subparagraph (A) through means specified by the Secretary, which may include—

(I) an attestation;

(II) the submission of claims with appropriate coding (such as a code indicating that a patient encounter was documented using certified HER technology);

(III) a survey response;

(IV) reporting under subparagraph (A)(iii); And

Q: Are there separate incentives for Hospitals?
A: Yes.

SEC. 4102. INCENTIVES FOR HOSPITALS.

(a) INCENTIVE PAYMENT.—

(1) IN GENERAL.—Section 1886 of the Social Security Act (42 U.S.C. 1395ww) is amended by adding at the end the following new subsection:

Q: How much is the incentive to a hospital?
A: $2 million from this bill and $2 million from the Federal Hospital Insurance Trust Fund for a total of $4 million.

(n) INCENTIVES FOR ADOPTION AND MEANINGFUL USE OF CERTIFIED EHR TECHNOLOGY.—

(1) IN GENERAL.—Subject to the succeeding provisions of this subsection, with respect to inpatient hospital services furnished by an eligible hospital during a payment year (as defined in paragraph (2)(G)), if the eligible hospital is a meaningful EHR user (as determined under paragraph (3)) for the HER reporting period with respect to such year, in addition to the amount otherwise paid under this section, there also shall be paid to the eligible hospital, from the Federal Hospital Insurance Trust Fund established under section 1817, an amount equal to the applicable amount specified in paragraph

(2)(A) for the hospital for such payment year.

(2) P

(A) IN GENERAL.—Subject to the succeeding subparagraphs of this paragraph, the applicable amount specified in this subparagraph for an eligible hospital for a payment year is equal to the product of the following:

(i) INITIAL AMOUNT.—The sum of—

(I) the base amount specified in subparagraph

(B); plus

(II) the discharge related amount specified in subparagraph (C) for a 12-month period selected by the Secretary with respect to such payment year.

(ii) MEDICARE SHARE.—The Medicare share as specified in subparagraph (D) for the eligible hospital for a period selected by the Secretary with respect to such payment year.

(iii) TRANSITION FACTOR.—The transition factor specified in subparagraph (E) for the eligible hospital for the payment year.

(B) BASE AMOUNT.—The base amount specified in this subparagraph is $2,000,000.

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Electronic Health Records (EHR), Electronic Medical Records (EMR), and Personal Health Records (PHR): What's the difference?

EHR and EMR are often used synonymously. However, a difference was proposed by the National Alliance for Heath Information Technology (an industry led alliance that has recently dissolved) and their definitions created a distinction. Whether their definitions and the distinction it creates will continue and enter into general usage remains to be seen.

Basically, as proposed by NAHIT, EMR are the electronic records created by and accessible to a single clinical entity, such as a doctor's office or a group practice or a hospital. By this definition, ICANotes is an EMR.

Since an individual is likely to be treated by more than one clinical entity (for example, a patient may see a psychiatrist, a dermatologist, and a Family Practitioner) it would be advantageous if all the different EMR records were electronically combined into a "super chart" containing the records of all the different clinicians treating that patient. This super chart is the EHR.

The EHR superchart could contain all the records in the individual EMRs or it could contain just summaries like ASTM s Continuity of Care Record (CCR) or HL7 s Continuity of Care Document (CCD).

How the EHR superchart would be organized and where it would be stored and who would manage it are being debated. Clearly, if the EHR superchart were securely stored and accessible with the patient's permission via the internet, then new providers would have fast access to the patient's entire record, an obvious advantage in case of an emergency. Also, by storing all the patient's clinical records in a single electronic database unnecessary duplication of testing and inappropriate combinations of medications could be avoided. Other efficiencies can be imagined.

PHR is basically synonymous with the EHR superchart. It is an older term, coined before the emergence of computers and was originally conceived of as a record that would be obtained and updated and stored by the patient, perhaps on paper.

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What do the letters "ICA" stand for in ICANotes?

ICANotes is an abbreviation for "Intuitive Computer-Assisted Notes"