The Office of the National Coordinator for Health IT's Beacon team recently released its first guide to help interested stakeholders learn from the experiences of the Beacon communities in implementing electronic health records.
The first guide, "Improve Hospital Transitions and Chronic Disease Care Management Using Admission, Discharge and Transfer-Based Alerts" is "designed for communities that have a stated goal to reduce avoidable ED visits, avoidable hospitalizations, and preventable readmissions and have identified the implementation of ADT-based alerts as a potential strategy to achieve the goals," according to the authors. The guide covers practical information, such as systems, overview, use of message fields and workflow issues.
The guide is the first of six guides expected to be rolled out in 2013. Other topics to be covered include patient engagement, measurement data and public health. The guides are intended for use by stakeholders of all sizes.
The Beacon Nation project, funded by the Hawai'i Beacon Community, promotes innovation in health IT by gathering and disseminating lessons learned from the 17 Beacon communities. The Beacon Community program is a federally funded project designed to increase efficiency, quality and sustainability of health care though health IT and is slated to end in 2013.
It's one of several programs sponsored by ONC to help the industry transition to EHRs. Other programs include health IT workforce development programs and the funding of the regional extension centers.
To learn more:
- read the learning guide (.pdf)
- learn about ONC's programs
Read more: ONC guide aims to help providers use EHR alerts to reduce readmissions - FierceEMR http://www.fierceemr.com/story/onc-guide-aims-help-providers-use-ehr-alerts-reduce-readmissions/2013-06-10#ixzz2WCckwOEI
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By Marla Durben Hirsch
National Coordinator for Health IT Farzad Mostashari (pictured) has advised providers to take better advantage of their electronic health record systems to improve processes and patient care, according to an article in Government Health IT.
Mostashari, speaking at ONC's Health IT Policy Committee meeting last week, noted that many providers don't have the knowledge to take advantage of these tools.
"We're about halfway through the process of computerizing and digitizing America's hospitals and doctor's offices, and we're about 5 percent of the way through changing workflows and redesigning care to take advantage of those technologies," he said.
Mostashari recommended that providers take three steps to reap more benefits from their EHRs:
- Reach out and engage patients more effectively, starting with those that don't obtain follow up care, but are the most likely to need it
- Redesign processes and workflows, such as using automation and getting patients to obtain follow up tests before returning to the physician's office
- Use protocol-based automatic defaults, such as the use of a statin if a patient's attempts to lower his blood pressure by diet and exercise don't work after a year
The Health IT Policy Committee and the Health IT Standards Committee were both created by the American Recovery and Reinvestment Act to provide health IT recommendations to ONC. Meetings and committee agendas are open to the public.
To learn more:
- read the Government Health IT article
- listen to the meeting and read the materials
Read more: 3 steps for improving EHR effectiveness - FierceEMR http://www.fierceemr.com/story/3-steps-improving-ehr-effectiveness/2013-05-15#ixzz2TUFW0Sqf
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By Marla Durben Hirsch, Fierce EMR
he Centers for Medicare & Medicaid Services continues to shed light on how the Meaningful Use Incentive Program works, issuing a new frequently asked question, and updates to two more last week, according to Health Data Management.
The new FAQ addresses the fact that states must fund 10 percent of the non-federal share of HITECH administrative expenses. In its answer, CMS clarified that states have several funding options: they can fund through legislative appropriations to their Medicaid agency, intergovernmental transfer, certified, public expenditures, permissible healthcare-related taxes and donations. States must submit their proposed strategies to CMS for review and approval.
The two updated answers to FAQs both involve eligible professionals. CMS clarified that the medical specialty codes for the specialty-based determination for granting of the hardship exception are diagnostic radiology (30), nuclear medicine (36) interventional radiology (94), anesthesiology (05) and pathology (22).
It's an exciting era for healthcare. Aside from the propagation of new devices and technologies that one can spot in any hospital corridor, the very way healthcare will be delivered is under reconstruction. Accountable care organizations (ACOs) link practices under a common standard of payment and care. While they are becoming the norm for how the business and oversight of healthcare is practiced, there are still a lot of wrinkles to iron out. Mike Detjan, vice president of service lines and Greg Chittim, director of analytics and performance, at Arcadia Solutions spoke with Healthcare IT News about three ways that analytics will play a major role in making ACOs functional and profitable.
1. ID heterogeneous data and make it an effective asset. The core idea behind an ACO is that many small practices and organizations, banded together, will be able to provide a wider range of services to a higher standard of care. What happens when each one of those practices has a different EHR system? It's like trying to get a room full of people that all speak different languages to talk to each other. "When you're trying to look at an organization as a whole, how do you normalize that information," asks Detjen. "Having a platform that can normalize that and integrate it is essential." He says having a system that can pull in the diverse streams of information and churn out reliable analytics is necessary because it can build trust across an ACO. "If you don't have the trust in the data, then you don't have a chance to drive change," he says.
2. Understand early wins in a program and establish momentum. With any new change or development, people are going to want to see results and are going to want a reason to continue. It's just good business to be able to show progress and rally troops for the next initiative. This is where analytics can be a powerful tool. Chittim says the first "big win" an analytics-touting ACO can look for is the success and quality of the data being captured itself. He says an ACO feeding good data in to its analytics engines will be the source for all other potential changes. "Making sure that you're improving data quality upfront is a quick win," he says. "The quality of data is pushing up to the analytics is accurately reflecting the quality of care." When it can be demonstrated that the data driving analytics is sound, it can be leveraged to promote and track any number of "performance improvement sprints," says Chittim, who says one can look at analytics to solve two questions: "What's our problem?" and "Where are we now?" as changes are made.
3. Drive engagement with the provider network. There is no element of healthcare that can be described as "set it and forget it." Analytics is an ongoing task, say Detjen and Chittim, and recognizing it as such gives its users the power to drive substantial change over time. One important trick is knowing how to use the data that analytics provides. Detjen cautions against using it to bully. "The physicians out in the field are independent thinkers," he says. "They have their own opinions ... they're the ones out there touching the patients every day." To bring the full force of analytics to bear, he says, "You need a very systematic program that touches the doctors on a regular basis and gives feedback." This way, a constant back-and-forth is kept going, where the input from practitioners informs the analytics that track the quality of care they provide – and vice versa. Chittim describes this as "collaboratively designing where you are when where you want to go, and collaboratively designing how we're going to get there." It all boils down to quality data, open and continuous communications and a desire to leverage new technology to improve care. "Having a trusted set of data," says Chittim, "and teams working together within a healthcare ecosystem – that is what we need to do in order to change healthcare in this country."
You can find the original article here.
By Marla Durben Hirsch, Fierce EMR
While the patient privacy, breach notification and other provisions of HIPAA's final omnibus rule, unveiled last week, have received a lot of attention, a number of important provisions that directly affect electronic health records and related health information technology have received little fanfare. They include:
- Health information exchanges (which the rule calls health information organizations) and electronic prescribing gateways will be considered business associates and thus directly subject to many of HIPAA's privacy and security provisions. The obligation applies upon creation of the business associate relationship, not when a business associate agreement is signed. A personal health record vendor may or may not be a business associate, depending on the services that the vendor is providing to the covered entity.
- Business associate agreements are necessary despite this new direct liability [i.e. EHR vendors that qualify as business associates need to sign these contracts]
- A provider does not have to use an EHR to comply with the new rule, but if the provider does use an EHR, patients have the right to obtain copies of their records in electronic format, in a form requested by the patient. If that format is not available, then the format provided shall be as agreed upon by the provider and the patient. The provider can only charge the patient the labor costs involved.
- The final rule sets 30 days (down from 60) for providers to provide patients with access to their records, but "encourages" providers to take advantage of their technologies and provide them sooner, considering that the Meaningful Use program contemplates much faster access than 30 days.
- If a covered entity belongs to a HIE, and the HIE suffers a breach, the covered entity is the one obligated to notify patients. However, since multiple covered entities may be involved due the data sharing inherent in an HIE, the covered entities may delegate to the HIE the notification obligation since that way a patient will only receive one notice.
The U.S. Department of Health & Human Services itself acknowledged the relationship between the new HIPAA requirements and health IT, specifically referring in its announcement the need to protect patient information "in an ever expanding digital age."
The HIPAA omnibus rule is slated to go into effect March 26.
Medical billing errors account for $68 billion in healthcare spending each year. And medical experts estimate that between 40 and 80 percent of all medical bills contain errors. If you’re a physician practice, these medical coding errors can cost you a lot of money--and they may lead to your practice getting audited. As such, it’s important to understand how to avoid making high-risk coding errors that will make it more likely for your practice to be audited.
Software Advice, an online resource medical billing software, recently hosted a Q&A with medical coding expert Betsy Nicoletti, MS, CPC. Nicoletti is a nationally-known expert on medical coding and co-author of Codapedia.com. She holds a Masters of Science in Organization and Management from Antioch University New England, and recently published a medical coding book titled, “Auditing Physician Services: Verifying Accuracy in Physician Services and E/M Coding To Protect Medical Practices.”
The Q&A session covers important considerations for physicians practices such as:
- Common high-risk evaluation and management (E/M) coding errors doctors make;
- Prevalent reasons high-risk compliance problems occur;
- Potential consequences of making high-risk coding mistakes; and,
- How to perform self-audits to prevent a legal audit of your practice.
You can read the full Q&A session over on The Profitable Practice at: Avoiding Coding That Leads to Audits: A Q&A With Betsy Nicoletti.
Planning for ICD-10: Working with Clearinghouses and Billing Services
All claims for health care services provided on or after October 1, 2014, must contain ICD-10 codes. As you prepare for the ICD-10 transition, contact any third-party billing services that you use to make sure they are actively planning for ICD-10.
As you reach out to your clearinghouse or billing service, you may want to ask:
- Are you prepared to meet the ICD-10 deadline of October 1, 2014? Where is your organization in the transition process?
- Can you verify that you have updated your system to Version 5010 standards for electronic transactions? (Only systems with Version 5010 can accept ICD-10 codes; systems with the older, Version 4010 standards cannot accommodate ICD-10.)
- Who will be my primary contact at your organization for the ICD-10 transition?
- Can we set up regular check-in meetings to keep progress on track?
- What are your plans for testing claims containing ICD-10 codes? How will you involve your clients, such as my practice, in that process?
- Can my practice send testclaims with ICD-10 codes to see if they are accepted? If so, when will you begin accepting test claims?
- Can you provide guidance or training on how my clinical documentation will have to change to support ICD-10 coding?
- Do you anticipate any pricing changes for your services due to the switch to ICD-10?
If you do not currently use a clearinghouse or billing service, you may want to enlist one to help you with your transition. Consider asking other health care providers in your area if they have established relationships or contacts they recommend. Act soon so you have plenty of time to select the service that best meets your ICD-10 needs and budget.
Keep Up to Date on ICD-10
Visit the CMS ICD-10 website for the latest news and resources to help you prepare.
For practical transition tips:
By Frank Irving, PhysBizTech
An update from the Centers for Medicare & Medicaid Services (CMS) reminds providers that you should be meeting regularly with your ICD-10 project team to discuss transition activities, challenges and needs.
CMS offers the following tips for holding in-person or conference calls to check in with your team.
For starters, establish a day and time when the meeting will occur each month (e.g., the first Tuesday of the month at 1 p.m.). Consistency in scheduling will reinforce that ICD-10 is a priority for your practice. Of course, as the transition date approaches, you should consider switching to more frequent meetings – weekly or bi-weekly.
To ensure good use of everyone's time:
- Create an agenda. Distribute it prior to the meeting to help keep the discussion on track. The agenda will also help team members prepare their individual updates.
- Reserve time for questions. Encourage team members to ask questions at the end of the meeting to clear up any uncertainties.
- Take notes and draft action items. Following each meeting, circulate key takeaways and action items. This will keep everyone informed about important decisions and individual responsibilities.
Post-meeting discussions should focus on:
- Progress on transition activities. This will keep the team up to date on assigned tasks. You may also want to use this time to set deadlines and goals for completing task activities.
- Upcoming educational activities. Share information about local events or online training sessions that may benefit the team. Consider sharing ICD-10-related articles to keep team members informed about the latest news.
- Best practices. Perhaps you've heard about a novel way to address part of your transition to ICD-10. Disseminate that information and discuss how it could be applied in your group's implementation plan.
- Challenges. Freely talk about any challenges the team has encountered – and brainstorm ways to overcome those obstacles.
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By Maria T. Bounos, RN, MPM, CPC-H, Business Development Manager, Wolters Kluwer Law & Business
More than ever the burning question remains, “Why ICD-10?”It feels like “heartburn” for most but the increase in hesitancy to adopt this new system appears to be directly related to the
announcement of the impending October 2014 delay in the implementation date. The reason for ICD-10 is more than the frequently-stated reasons: “older data structure” or “we’re running out of space for new codes” and let’s not forget that ICD-9 hasn’t kept pace with current medical practice. All of these reasons are very true and important; but let’s not forget about the reasons like disease management programs, quality outcomes and device recalls.
To better understand where I am going with this, just ask any primary care physician (PCP), “How many asthma patients they have in their practice”? They could easily answer that
question by searching their ICD-9-CM code files. But then ask, “How many of those have persistent asthma that is moderate or severe”? PCPs have no way to answer that question without doing a retrospective record review or prospectively asking every asthma patient clinically oriented questions. If the ICD-10-CM system was already in use in this country, a simple computer search for subcategories J45.4- and J45.5- would provide a quick answer. Unfortunately, to date, there is no cure for the disease of asthma but with ICD-10, asthma patients would benefit from and probably welcome better managing a disease that limits
their physical activity. Other chronic diseases could benefit from the same intervention if it was easier to identify the severity of the “at-risk” patients in the organization, practice or hospital population.
To understand more about why we need ICD-10 and to learn about the author, click here.
By Marla Durben Hirsch, Fierce EMR
The National Institute of Standards and Technology has taken another step to help the healthcare industry safeguard information contained in electronic health records, issuing a guide to help organizations conduct risk assessments.
The publication outlines a step-by-step process to identify both threats and vulnerabilities within EHRs and other information technology, including:
- how to prepare for risk assessments;
- how to conduct risk assessments;
- how to communicate risk assessment results to key organizational personnel; and
- how to maintain the risk assessments over time.
The guide is written broadly, and can be used not only by healthcare organizations but also financial institutions, government agencies and other entities, according to NIST's announcement.