Information provided by Health Train Express and Digital Health Space is informational only. We do not endorse specific solutions. Inclusions are provided as reference only. Readers should consult with their own consultants for further details.


Tuesday, August 27, 2013

Is Health Insurance Racketeering?

 

I am a firm believer that the Affordable Care Act will be bad for America.  Many others firmly believe that as well. Without going into great detail the facts can easily be found in many places I and others have referenced for the public.

The law insures a stable platform for insurers, and despite being required to spend 85% of the premium dollar on patients it solidifies their positions and markedly reduces competition in the market place.  Lobbyists and organized medicine (AMA) passed this law ignoring most physician’s opinions.  Only about 150,000 MDs belong to the AMA out of over 800,000 MDs in the U.S.A.To add to that many of the members are students and trainees who receive large discounts for membership.

The A.M.A. holds the copyright to  the CPT codes which are mandatory for billing insurers and Medicare/medi-cal actually covered by a copyright held by the American Medical Association, which refuses to allow any free or open distribution of the codes (known as Current Procedural Terminology (CPT)). That's because the AMA makes about $70 million per year "licensing" the codes.

On the other hand,

The ICD-10 is copyrighted by the World Health Organization (WHO)External Web Site Icon, which owns and publishes the classification. WHO has authorized the development of an adaptation of ICD-10 for use in the United States for U.S. government purposes. As agreed, all modifications to the ICD-10 must conform to WHO conventions for the ICD. ICD-10-CM was developed following a thorough evaluation by a Technical Advisory Panel and extensive additional consultation with physician groups, clinical coders, and others to assure clinical accuracy and utility.

While all physicians are highly motivated to care for all, the sad fact is that Obama care will not provide any sort of guarantee.  It is very complex and also fatally flawed financially and administratively. There are other fundamental flaws in the system not addressed by the Affordable Care Act.

American physicians and healthcare providers are not ready to be bull-dozed anymore by insurers, HHS, CMS and other governmental agencies.  We are fast approaching a ‘non-violent’ disruption of the current paradigm in healthcare. No physician is going to self destruct in the short or long term.

Some physicians are reticent to express their strong convictions for fear of alienation and/or reprisal by some other physicians and hospitals or government agencies. For instance in Massachusetts it is mandatory for an MD to accept Medicare to hold a medical license in that state.

Health insurers and Medicare/medical have developed “provider panels” who have agreed to arbitrary one way standards.. Insurers have no inherent legal right to set standards. Those duties are assigned to state medical boards and specialty boards. These boards are qualified to certify and license physicians as specified in state laws.

Insurers have a self interest to their shareholders and themselves to guarantee a profit.

It is redundant for an insurer to repeat the process of “credentialing” providers other than asking for documentation.  Furthermore it is even more ridiculous to attempt to supervise what providers can order or prescribe for diagnosis and/or treatment.  Our confounding event is when the insurance company won’t pay for the required service.  Unfortunately the insurers never speak  directly to their insured to tell them this directly. The message is usually given to the doctor, hospital, lab or imaging facility.  Insurance companies like to pass the buck.

 Available at Amazon

Many patients discover the costs of tests and procedures in non hospital facilities are much less than a hospital. Often 75% less than what is quoted to an insured patient.  There are several reasons for this. First hospitals are subject to  a litany of regulations and requirements which create significant expenses. Hospitals are subject to regulations and standards which may or may not add quality or value to your hospital care.  We all know about the $100.00 aspirin tablet, or a liter of salt water for $ 500.00. Really ?!  The hospital covers it’s fixed overhead much more than it needs to cover the non-reimbursed patients expenses, the losses they suffer at the hands of Medicare and medi-cal, the recapture of overpayments from Medicare years after the fact.

Despite the ACA having been passed and it is the law as some say..Prohibition was also a law that backfired and caused much harm and developed an underground market (black market)

Is  U.S. health care headed in the same direction?

 

Note: This article will be tagged for key words shortly

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Google Doc in the Office

 

Google  (click for locations)

Or is it Doctor Google ?

Either you are a lover or a hater of all things Google.  Google however has some things right. It is a platform of interconnectivity for workflow and also social media use.  The Google Apps cover a wide range of functions

In adopting EMR, HIT workflow becomes a critical component of your day. In the past  year I have gradually adopted Google apps as a central core for my operations. While not perfect it is cheap, runs on the cloud which can be an asset or a liability, and is also available to most of my contacts.

The most useful apps I find are Gmail, Google Search, YouTube videos, Chrome and it’s menu of apps (developed by countless open source programmers) and featured as plug ins. From a  user standpoint this is exceptionally functional for many reasons I will go into a bit later.

You can seek out more details on the Google Apps page.

             

A particularly strong point is the chrome/android OS connection which brings mobile health applications to the same playing field. The variety of functions extends to Google voice, and social media.  Google +, although late to the social media niche has some unique features which include tight integration with mail, video, and maps,

For the future, first it was ‘Big Search’ and now it will be ‘Big Data’  Google has the resources and skills to develop analytics to extract the information that HHS and CMS and others want so badly to manage health care and improve outcomes.

http://upload.wikimedia.org/wikipedia/commons/6/69/Viegas-UserActivityonWikipedia.gif

Google even interfaces with mHealth and ph8ysicians as well as hospitals should learn how business uses smartphone technology to serve consumers and patients.

ThinkwithGoogle.com offers knowledge of how mobile is used, much of which applies to mobile health applications

Digital Matters in health choices, where to  find a doctor,

What are the treatment options? 

 

Where are centers of excellence or what hospital has the best outcome,least cost and more.

The strength of all these is that it is open source software and it can be integrated with other open source applications at relatively little expense unlike proprietary systems currently dominating electronic health.

In an era of health reform  focused on  reducing costs it would be foolish to add prohibitively expensive information technology when other means are available. 

Almost all of the above has no cost, other than thin client hardware. It operates in the cloud.

The very agencies and regulatory bodies have done little if anything to allow time and market pressure to develop an efficient and user friendly system. 

Those who make the rules should also follow them.

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Monday, August 26, 2013

HIPAA Challenges

 

Oh for the day when medical records were on paper. In the blink of an eye, now millions of electronic medical records can be ‘carried off"’ to anywhere. This has become apparent in recent and repetitive reports of privacy and confidentiality breakdowns. Advocate Health reports the second biggest HIPAA breach ever.  Advocate Health System announced that the theft occurred at one of its Advocate Medical Group administrative building in Park Ridge, Ill. on July 15.

In the second biggest HIPAA breach ever reported, one of the nation's largest healthcare systems is notifying more than four million patients that their protected health information and Social Security numbers have been compromised after the theft of four unencrypted company computers.

Patient names, addresses, dates of birth, Social Security numbers and clinical information – including physician, medical diagnoses, medical record numbers and health insurance data — were all contained on the computers, officials say. 

This is the second big HIPAA breach for Advocate Health System. In 2009, company officials notified 812 patients that their protected health information had been compromised following the theft of an employee's unencrypted laptop.

This breach stands as the second biggest HIPAA breach ever reported, according to HHS data – just behind the TRICARE Management Activity breach which impacted more than 4.9 million patients back in 2011. 

Texas HIPAA blunder affects 277K

This time it was not an electronic medium that was breached. Texas Health Harris Methodist Fort Worth is notifying some 277,000 patients that their protected health information has been compromised after several hospital microfilms, which were supposed to be destroyed, were found in various public locations.

Texas Health Fort Worth had contracted with Toronto-based Shred-it to destroy the confidential patient information, but the microfilms were not actually destroyed, as had been agreed upon in the contract, officials say. Instead, a local resident found a portion of the microfiche in a nearby park in May. Additionally, three other sheets of microfiche were found in two other public areas.

The records on the microfiche contained patient names, addresses, dates of birth, medical record numbers, clinical information, health insurance information and in some cases Social Security numbers

These breaches are only two of many inadvertent breakdowns in health information security.

In 2011 a TRICARE Management Activity breach impacted more than 4.9 million patients back in 2011, in which a Lost Military Backup Tapes Results in HIPAA Violation Affecting 4.9 Million. TRICARE, the Defense Department’s healthcare program, reported what may be the largest health information breach documented in HIPAA history since the HITECH Act was established in 2009. Nearly 4.9 million patients of San Antonio area military hospitals and clinics have been affected by the loss of data backup tapes. These tapes contained an archive of sensitive information dating from Sept. 7, 2011, back to 1992.

Vernon Guidry, a spokesman for Science Applications International (SAIC), the organization that reported the breach, has confirmed that it was “not an electronic breach” but “a loss of magnetic storage media.”

The Federal Office of Civil Rights administers HIPAA, and reports its findings here:

The breaches result in fines and penalties as well as civil damages for civil rights violations.

Apparently the federal government has interdepartmental conflict over legalities of sharing protected information.

As yet no one has addressed this issue with the Affordable Care Act in which it is proposed that the IRS administer and enforce the Individual and Employer Mandates .

 

HIPAA/HITECH Act Enforcement: 2003-2013

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Wednesday, August 21, 2013

How Far has Health Information Exchange Progressed, or Has IT ?

.

The Indiana Health Information Exchange has what is most probably the longest track record in H.I.E.  If time is of the essence for a product or service to mature, the IHIE certainly fills this space.

Well before the advent of ONCHIT, HITECH, and a garden full of eponyms, acronyms, and glossaries of several pages in length, The Reigenstreff Institute in Indiana provided a nidus of expertise for a brave new world.

IHIE connects more than 25,000 healthcare providers in 17 states delivering services that make patient information available when and where it is needed.

 

IHIE began unceremoniously in the day when no one knew the term HIE. It began and is still a private for profit organization born well before government deemed it necessary to stimulate HIXs with short lived goals and non sustainable business models. (This sounds much like the Affordable Care Act).  The dirty word here according to  HHS is "for profit’. For profits need not apply for HHS grants.  And most will be doomed to fail without strong leadership and vision.

Already the first generation of successful health information exchanges are into HIX 2.0. 2.0 will leverage HIX capacity and interoperability to include the  Accountable Care Organizations which include multi-disparate medical clinics/offices and hospitals.  The diagnostic and treatment outcome paradigms will be measured cross platform transforming data into big data and to feed the giant analytic algorithm.

The task of administering an ACO is formidable, traversing differing specialties,hospitals and  physical space. 

The Health Information Exchange will likely morph into serving another infrastructure for Affordable Care

 

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Tuesday, August 20, 2013

The Complete Guide To College Students & Healthcare Reform (or the Affordable Care Act…What now?)

 

College is an exciting time in a young adult’s life and many feel that they’re invincible. Besides, who else can stay up until 4am, eat 3 pieces of pizza, and ace

an exam the next morning? However, even though students are young and generally suffer fewer illnesses and accidents than older people, the college environment places them at an increased risk, so health insurance is a necessity.

student health 300

What if the campus infirmary cannot provide a level of care necessary for the student?  The information here was sourced from ‘Insurance Quotes”.

Thanks to

Desiree Baughman

Desiree Baughman

 

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Monday, August 19, 2013

Health Train Express and Digital Health Space

 

As new media evolves we here at  Health Train Express and Digital  Health Space realize that our content can and will be more  accessible with expansion of our presence in video and audio content to supplement our blog posts.

New Media  today is far more that blogging, tweeting, or written content.  It encompasses the rich spaces  of audio, and video.  Some of us absorb content differently much like the multi-pronged approach to education. In the next several weeks the content of Health Train Express and Digital Health Space will be offered on YouTube Video, and mp3 using ‘Sound Cloud.  Readers will now be able to receive important comments and opinions on health IT, health  reform as well as general Health and Wellness  Events.  The content will be from over 200 of our usual sources.

Whether you are on the bus, commuting to work, at the beach we will be available, as long as it is daylight in Southern California (even weekends). Using your smart device, listen to or watch….This is your chance to be the center of information for your colleagues.

Simulcasts:       

   

Google Events   YouTube video         Vimeo       Zoom.us      Facebook;

     Sound Cloud--mp3, mp4    uStream,      Livestream

The audio portion of  YouTube  recordings can be extracted using Format Factory

       

In addition to those platforms we have expanded to Pinterest and Newsana. Pinterest is a poster-like presentation platform which seizes your visual attention and directs you to the deepdyve of the content.

Newsana, in a similar vein, offers an attention-getting meme, lyric and related link.

Until the 1980s media relied primarily upon print and analog broadcast models, such as those of television and radio. The last twenty-five years have seen the rapid transformation into media which are predicated upon the use of digital technologies, such as the Internet and video games. However, these examples are only a small representation of new media. The use of digital computers has transformed the remaining 'old' media, as suggested by the advent of digital television and online publications. Even traditional media forms such as the printing press have been transformed through the application of technologies such as image manipulation software like Adobe Photoshop and desktop publishing tools.

The power of new media is that it does not require ‘scaling’ or increasing sales of print documents, nor using different ‘old media’ models. We are witnessing the evolution of a universal interconnected network of audio, video, and electronic text communications that will blur the distinction between interpersonal and mass communication and between public and private communication"

 

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Friday, August 16, 2013

The Height of Idiocy and Incompetence

 

HIMSS Says Start Stage 2 On Time And Give It Time To Work

Adopting an approach that encourages continued progress while simultaneously acknowledging short-term obstacles, HIMSS recommends launching Stage 2 Meaningful Use on-schedule and extending Year 1 of the Meaningful Use Stage 2 attestation period through April 2015 and June 2015 for EHs and EPs, respectively.  This would encompass 18 months in which EHs and EPs can attest to Meaningful Use requirements for one quarter.

Data from the more than 5,400 hospitals in the HIMSS Analytics database indicate clear challenges for eligible hospitals and tethered ambulatory care facilities preparing for Meaningful Use Stage 2.  These data show:

  • Up to 68 percent of eligible hospitals, and
  • 41 percent of tethered ambulatory facilities

have purchased the necessary software to attest to the 2014 Certification requirements, but there are concerns that many may still be waiting for the necessary upgrade to the certified version.

HIMSS shared its position on extending the deadline for Meaningful Use Stage 2 attestation in an Aug. 15 letter to U.S. Department of Health and Human Services Secretary Kathleen Sebelius; Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner; and, National Coordinator for Health IT Dr. Farzad Mostashari, MD, ScM.

Farzad Mostashari is now a lame duck, having resigned leaving the rest of us with “Hope and Change’.  While I can praise him for devotion to an IT cause he has bailed out for unknown reasons.

 

 

HHS mandated Meaningful use implementation in an unrealistic schedule. Unfortunately it is interwoven with other mandates such as physicians and hospitals qualifying for EMR and HIT incentives. HHS does not even guarantee it will work as predicted, but they still require implementation to receive incentives. 

Medical practices will be required to submit  MU stage II and not know if it even works or if they will receive incentives as promised.  Submissions will probably be lost and/or improperly processed. Again pass the buck to providers, who will be fined and not receive incentives after already investing hundreds of millions of dollars in Health IT.  The only ones who gained were HIT vendors, and insurance companies and Medicare who will maybe reap data, that probably will sit on a server in Utah to be analyzed by non-existing analytic software

If this is an indication of how the Affordable Care Act will work health care is in for a not so big surprise.  Physicians and Hospitals already realize this, and there is much being written about it for the past 12 months, building now to a sense of total frustration and almost an apathetic approach to letting the plan go on, break down, cause financial losses and worsen care for patients..

We are now told, don’t worry we don’t know how or if it works, but we should progress and find out , after the fact.  This  sound much like the proclamation of the highest democratic leaders  in congress. We heard this before……we won’t know what is in it until we pass it.

Basically the Affordable Care Act was passed on a hope and a dream as a  political expediency and with an unrealistic goal and approved by our President with that in  mind.  President Obama's campaign rhetoric of “Hope and Change” was largely an empty promise. Yes, it promised change for the less fortunate in America…..at the expense of the nations overall financial health. Regardless of how the Supreme court ruled on the constitutional validity of the employer and individual mandate, Justice Roberts and his band of cronies voted that it was constitutional throwing it back to Congress to correct their incompetence.  Basically he refused to have the judicial system correct congressional incompetence.

Almost all of us want to provide a social health system that cares for everyone. It affects everyone to see a parent or family member and themselves  neglected by a broken health system, and fantasize that the whole of the ACA will be better than the parts.

This parallels the false and delusional analysis and refusal to deal with the national debt other than print more money.  In fact the Global dependency on the US Dollar underwriting of the financial  system is about to cease, being inherited by other countries such as the Chinese Yuan, the Euro-dollar (which is even weaker.  Perhaps this fact will evolve into banks refusing us credit completely very soon. 

The Affordable Care Act must be put on indefinite hold until it is totally reviewed by competent professionals without financial interest and those not involved with it’s passage in the first place.

The Affordable Care Act will worsen our credit worthiness. President Obama’s plan appeals to those who need hope and change (which may or may not occur, depending upon who you talk to.  A vast majority of Americans are more than uneasy with the plan.

Why were the Democrats in such a hurry to pass a bill they did not read? Political gain !!

Health Train Express and Digital Health Space will continue the message.

Wake up, stop drinking the ‘Kool Aid’, stop believing the  utter and absolute truth that our government has completely broken down.

Start writing your democratic leaders and overwhelm them with public opinion.

Perhaps we need a ‘Million Man March’ in D.C. and fill the Capital Mall, shut down Washington D.C. and maybe, just maybe President Obama and our worthless congress will get the message.

 

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Saturday, August 10, 2013

#ABC News

 

Today thus far has been an extremely active day for health care social media #hcsm .

Tweet chat, #abcdrbchat from ABC news is  number six on the twitter trend list this AM at 10:30 AM Pacific time. It appears that there were  many tweeps  from non health related sites in this chat.

And here is how to join any tweetchat.

Anyone who thinks #social media is not relevant to #medicine is about to become a  #dinosaur.

Some of the most popular hash tags revolve around #emr #hitsm #hcsm #d4pc #mhealth  Check the web site  Symplur for all the tags relating to health care and medicine.

During the past year physicians have engaged in social media with increasing frequency.

Despite these positive upticks there are those who are reticent to engage in social media.

Here are some things you may have experienced:

In the past year have you experienced:

          Nausea, due to keeping up with the rapid changes in the social media space ?

Y or N

Anxiety, due to the looming threat of an online flare up surrounding your organization?  Y or N

Frustration, due hospital exec rejecting your social media ideas?

Familiarize yourself with three targeted tracks in healthcare communications

1. PR and Marketing

2. Employee Communications

3. Social Media for Medical Professionals

 

Paul Sonnier at Digital Health lists the growing number of Digital Health Events between June 20113-June 2016 which number more than sixty.

During August;

HIMSS ASIAPAC13 Greater China eHealth Forum

National Forum on Data & Analytics in Healthcare @ Gaylord National R

Mobile Healthcare: Innovations in Telemedicine @ The George Washin

Digital Health Days – Stockholm

Digital Health Days - Stockholm @ Stockholm | Sweden

Aug 21 – Aug 22 all-day Conference Digital Health Europe

August 26, 2013 (Monday)

NIH-UCLA Summer Institute on Mobile Health (mHealth) Technology Research

NIH-UCLA Summer Institute on Mobile Health (mHealth) Technology Research @ Los Angeles | California | United States

Aug 26 – Aug 30 all-day California Course Los Angeles United States

August 27, 2013 (Tuesday)

BIOCOM’s 7th annual DeviceFest Conference @ Sheraton Carlsbad

BIOCOM's 7th annual DeviceFest Conference @ Sheraton Carlsbad | Carlsbad | California | United States

Aug 27 @ 8:00 am – 6:30 pm California Conference Diagnostic Medical Device San Diego United States

August 28, 2013 (Wednesday)

The Quantified Patient @ athenahealth's Visitor Center (Building 400)

The Quantified Patient @ athenahealth's Visitor Center (Building 400) | Watertown | Massachusetts | United States

Aug 28 @ 6:00 pm – 9:00 pm Big Data Consumer Digital Health Health IT Healthcare Massachusetts Medical Device United States Wearable Tech Wellness big data HealthcareSocialMedia healthstartup mobile Wearables

This unique event will feature forward thinking entrepreneurs, researchers and companies who are redefining healthcare through the use of self-tracking systems, behavior change psychology, and [...]

August 29, 2013 (Thursday)

Seattle Health Innovators Meetup @ SURF Incubator

Seattle Health Innovators Meetup @ SURF Incubator | Seattle | Washington | United States

Aug 29 @ 5:30 pm – 8:15 pm Accelerator Digital Health Healthcare Life Sciences Meetup Precision Medicine United States Wasghington Wellness

The purpose of the Seattle Health Innovation Forum is to support the individuals actively making health innovation happen. This community draws on entrepreneurs in businesses, [...]

 

For the Schedule for the remaining portion of 2013 and beyond […….] events.

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Thursday, August 8, 2013

Does The Open Letter have a place in Health Care?

 

Wrong !                                              Correct !

             

Hospital mergers, acquisitions and the development of integrated hospitals systems is one of the results of the Affordable Care Act’s model for Accountable Care Organizations.  It will become a fundamental business practice.

An ongoing themes of  mergers, acquisitions and cooperative agreements will create different organizational culture clash.

These clashes apply to group practices and hospitals.  Executives of these entities are faced with a myriad of tasks, not the least of which is human interaction with can be unpredictable if not guided with introductory process as well as implementation guidelines.

Perhaps medicine can take a lesson from mergers such as Amazon and the Washington Post, as well as Tony Hseih of  Zappos.  The common theme was their guiding hand.

Likewise the pen of Jeff Bezos on the Post purchase outlined openly the acquisition  and his goals.

Mergers or acquisitions often take place in the setting of economic changes, anxiety and fear. The number one concern for employees is whether they will have a job.  Fear and anxiety can lead to a loss of productivity, loss of faith, trust and loyalty. The Open Letter should address all of these factually and honestly.

Frequently health care organizations merge or acquire to accomplish one of the following;

1. Increase market share

2. Consolidate many administrative functions, with a possible reduction in work force.

3. Provide complimentary services, or add a center of excellence

4. Improve asset/liability ratio, to acquire financing or to expand physically.

5. Close a competing facility or expand physical locations.

 

 

An Effective Open Letter

So what does a great open letter take? If you are looking to use this form of communication as a leader to offer your point of view in a more powerful and emotional way, there are three elements that should to be at the top of the list:

  1. Humanity – Great open letters have a human tone of voice. They don’t use corporate speak and actually sound like something that a leader might say in a conversation as opposed to an investor presentation. They express emotion and feelings, and share a personal point of view.
  2. Timeliness – An open letter is usually delivered in response to a piece of news or announcement. As a result, the timing of getting that letter out is often vital. Having it completed and published early ensures that conversation and media attention will incorporate the views shared in the letter. Also, having it done early is essential to demonstrate that the viewpoint is a proactive one, and not in response to some sort of crisis or criticism.
  3. Visibility – The final element is making sure the letter is published in a place where it is highly likely to be seen and shared. Bezos publishing on the homepage of Amazon or on  Washingtonpost.com are obvious choices … but sharing your open letter through an op-ed piece on another website, or on a highly visible corporate blog that is easily found from your company homepage can both be good choices.

As more companies use the Internet and social media to communicate a corporate point of view directly to their audiences, using the open letter will become a more and more important element of corporate communications. There may be a time soon when any communicators developing a media engagement and public relations strategy for corporate announcements or product launches will need to consider an “open letter strategy” as a part of their efforts.

Social media strategy will be an important vehicle for these ‘open letters’.

 

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Monday, August 5, 2013

October Residency Approved for AMA PRA Category 1 Credits™

 

This amazes even me. The original skeptic and cynic whose attitudes and social media mores and ethics carefully developed an honed after 40 years of practicing medicine.  God bless the United Social Media of Medicine (U.S.S.M). 

The goal for Social Media Residency is that participants will develop a plan for strategically applying social media tools in their work. Download Sample Agenda/Curriculum, and see the Social Media Residency page for more background on the program.

See the Social Media Week page for an overview of the entire week's events, and for links to where you can register.

How relevant is social media to physicians?   The title speaks to it all.  This amazes even me. I mean I have been working at this for years, and I never imagined I would earn CME courses.  Will I be ‘grandfathered’ as a certified social butterfly?

Will I have to meet CME requirements annually to participate on twitter, Facebook or Google plus, as well  ?  Since I have about ten years of experience on social media I want to nominate myself to be on the     ‘Board’ of the Joint Commission of Social Media in Medicine’. My credentials include a self-nomination’ as expert in social media, SEO, semantics, entrepreneur, one of the original founding users of Google plus and a pioneer of Hangout heavens.

Mayo Clinic

Social Media Week

Mayo Clinic designates this live activity for a maximum of 11.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Note: To applicants:

There are two parts to this examination:

1.Written: Participant will converse on four social media sites simultaneously.

2.Oral examination: Google  hangout with 9 other social media (all certified by the board.) (meaning me !) Participants will have the option of choosing  Zoom.US Google Hangouts, Skype or Facebook for this portion of the examination. Note: All participants are bound by the EULA of the host media.

There is a fee, REGISTER HERE

choose your method of payment.

Requirements are broadband internet and a modern computer capable of video, a webcam and either a Mac, any brand of tablet, or Window PC. Note Windows Vista or above.

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