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Meaningful Use Stage 3 may require multifactor authentication


imagesBy Marla Durben Hirsch, Fierce EMR

The healthcare industry is getting a peak at what Stage 3 of Meaningful Use may look like. The Office of the National Coordinator for Health IT's HIT Policy Committee voted Sept. 6 to accept the Privacy and Security Tiger Team's recommendation to require multifactor authentication in certain cases involving remote access to patient protected health information, Healthcare Info Security reports.

The situations that would require such multifactor authentication, according to the Tiger Team, include:

  • Access from outside of an organization's/entity's private network
  • Access from an IP address not recognized as part of the organization/entity or that is outside of the organization/entity's compliance environment
  • Access across a network any part of which is or could be unsecure (such as across the open Internet or using an unsecure wireless connection).

The multifactor authentication would need to meet National Institute of Standards and Technology Level of Assurance 3, NIST 800-63-1, according to the article.

The Meaningful Use Workgroup of ONC's Health IT Policy Committee reported in its Aug. 1 meeting that it will revisit workgroup recommendations in October.

Some of the other proposed recommendations for Stage 3 include the capability of an EHR to receive and review a patient's immunization history supplied by a registry, and the capability of a longitudinal history across multiple settings over a patients' lifetime.

The Federal Advisory Committees on Meaningful Use, the HIT Policy Committee and the HIT Standards Committee, all were created by the American Recovery and Reinvestment Act--the same law that created the incentive program--to assist and advise ONC on health IT.

ONC had expected to present draft recommendations for Stage 3 of Meaningful Use by August, and reconcile them in September/October with the Stage 2 final rule.

First Drafts of Test Procedures for Stage 2 of Meaningful Use


By Marla Durben Hirsch, Fierce EMR

Meaningful Use Stage 2The Office of the National Coordinator for Health IT has posted its first set, or "wave," of draft test procedures and applicable test data files for the 2014 edition of electronic health record certification criteria.

The draft procedures, which are being developed with the National Institute of Standards and Technology (NIST), will be available for public comment for two weeks after being released, according to ONC's website. The first wave covers 14 certifications, including computerized provider order entry, drug formulary checks, smoking status and automatic log off. It also includes draft procedures for the optional accounting for disclosures certification.

Additional "waves" of procedures will be released during September and October.

Once procedures are finalized and approved, they'll be used to test and verify EHRs under the HIT certification program and evaluate EHRs against the 2014 requirements. ONC expects the final procedures to be available in early 2013.

Providers must use certified EHRs in order to meet Meaningful Use and earn the incentive payments. Once the Permanent Certification Program is fully implemented this fall, testing and certification activities will be performed by separate entities. Testing will be performed by Accredited Testing Laboratories (ATLs), and certification will be conducted by ONC-Authorized Certification Bodies.

ONC's final rule implementing Stage 2's certification requirements, published in the Federal Register Sept. 4, also updated the certification program to make it easier and more efficient, and changed the name of the permanent certification program to "ONC HIT Certification Program."    

To learn more:
- here are the draft test procedures
- here's the draft test procedure for accounting for disclosures
- read ONC's certification rule

No Denying the EMR


By: Frank Quinn, MEDCITY News

The past few yearEMR replaces Papers have been more of a topsy-turvy ride for the healthcare industry in the US. Initially backed by then president G.W Bush, electronic medical records have become levers for change today. The economic difficulties and increasing burden of rising healthcare costs have deprived most Americans of quality care. The pursuit of affordable and accountable care is an uphill struggle, but to secure a future for our healthcare system and population health, we must invest today. While healthcare has been notoriously sluggish in adopting IT, today it is breaking new grounds. Rapid expansion of the health IT structure and support has enabled providers to move towards a more efficient and secure platform for care.

However, EMR adoption itself has not been a smooth process. While the reported percentile of adoption stands close to 60%, there are areas where it has struggled to make a mark. Providers have been using the paper record system for ages and now they are actually good at it. Most offices are designed to enable faster access to records, filed immaculately and tracked through reference registers. Electronic medical records though, are still new, untested on a larger scale with untapped potential. ’It is not easy for providers to move to EHRs, despite its customizable and configurable qualities. It takes time to learn and it is not a comfortable process. You lose business, work overtime and often go to bed with a migraine’, shares a practice administrator.

On the other hand, benefits of health IT can no longer be disputed either, ’EMRs along with Health Information Exchanges (HIE) are truly transformational technologies. Today, physicians are looking towards these systems and asking questions such as, how can we add more value? How can we utilize past data and learn from previous encounters? How can we affect population health? It is because IT is enabling them, by providing them with the tools to do it’, says one industry expert.

Healthcare can truly transform with health IT. While it may have yet to win over some naysayers, one thing is for sure, paper in medicine is headed for extinction. ’There is no value to paper, it is perishable, space consuming and inefficient,’ said a Nurse Practitioner. Most providers today echo similar sentiments. Technology is a facilitator, and EMRs are a pathway to better care. Those supporting evidence based practice along with the use of big data understand the value in digitized health information.

View the original article here.

Copyright 2012 MedCity News. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Preparing for new ICD-10 compliance deadline

By, Kyle Murphy, PhD, EHR Intelligenceicd 10

Lost in the fervor of finalized criteria for Stage 2 Meaningful Use was the another important announcement last week by the Department of Health and Human Services (HHS) concerning the delay in the transition to the International Classification of Diseases, 10th Edition (ICD-10). In truth, the news was quite easy to miss — it was part of a rule that focused primarily on unique health plan identifiers. And the Centers for Medicare & Medicaid Services (CMS) was kind enough to send out a reminder yesterday.

Despite the lack of hubbub, the ruling on the compliance date for ICD-10 is perhaps the most important announcement in the last few weeks considering the large number of affected entities. Providers, payers, and vendors will have until October 1, 2014, to comply with the latest set of procedural and diagnostic codes. The one-year delay represents one part of a multi-pronged effort to reduce costs across the healthcare industry.
In anticipation of next month’s AHIMA 2012 Annual Conference, the health information management technologies and services provider Precyse has issued an open letter to the healthcare community concerning how to prepare for the transition from ICD-9 to ICD-10. As part of its recommendations, the company is advising organizations to take a serious look at their education and implementation plans, particularly in three areas: documentation, education, and remediation.
Documentation: The biggest impact of ICD-10 will be felt by those responsible for clinical documentation, providers. These individuals will require more training to achieve the correct amount of specificity in their documentation in order to avoid rejected claims and improve patient care. “Target high volume specialties in your organization most impacted by ICD-10 and train these specialists in proper documentation while training the coding team on accurate coding; then, move to the next specialty for training,” writes President Chris Powell.
Education: Generally, when an organization moves from one system to the next, it tends to undervalue the importance of training by not providing staff with enough time or resources to get comfortable with the new approach to achieving their tasks. Because coding in most cases falls to staff other than providers, it’s crucial that coders and those using their data are made aware of the major and minor changes in their day-to-day activities. “We found additional training needs related to anatomy, physiology and pathopharmacology, as well as opportunities to improve their understanding of coding system logic and principles,” Powell continues, “So we recommend that you perform side-by-side ICD-9 and ICD-10 coding, assessing the documentation and coding gaps and target training based on these findings.
Remediation: “ICD-10 was never just about re-training medical coders–it was and is about having better data about patients and their treatments, affording vast opportunities for improvement in how data are captured and processed,” Powell observes. The implementation of ICD-10 will bring to light inefficiencies in how an organization dealt with previous coding sets, and these ineffective and wasteful practices should lead health IT staff to identify new technologies and methods enabling rather than further burdening providers and coders. “We must develop workflow platforms and applications that allow health care providers to do their jobs more efficiently and effectively. We do not want to add more time and complexity to an already burdensome process,” asserts Powell.
Preparing for ICD-10 is easier said than done. With the wide-sweeping changes set to take place over the next couple of years, it’s more than likely than many affected entities, namely smaller less resourceful practices, will postpone addressing the ICD-10 challenge for quite some day and end up paying for it later.
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CMS releases final Stage 2 Meaningful Use rules


By Greg Slabodkin, FierceGovernmentIT, Freelance Reporter

HIMSS12 Meaningful Use AnnouncementIn its ongoing efforts to promote the use of electronic health records nationwide, the Centers for Medicare & Medicaid Services last week announced the final rule to govern Stage 2 of the Medicare and Medicaid Electronic Health Record Incentive Programs.

Under the Health Information Technology for Economic and Clinical Health Act, doctors, healthcare professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt and "meaningfully use" certified EHR technology. The final rule for Stage 2 of the incentive program--which will begin as early as 2014--is designed to increase health information exchange between providers and promotes patient engagement by giving patients secure online access to their health information.

"The changes we're announcing today will lead to more coordination of patient care, reduced medical errors, elimination of duplicate screenings and tests and greater patient engagement in their own care," said Health and Human Services Secretary Kathleen Sebelius in an Aug. 23 press release.

Since the program started in January 2011, more than 120,000 eligible healthcare professionals and more than 3,300 hospitals have qualified to participate and receive an incentive payment. While those numbers exceed the program's qualification goal set earlier this year, CMS still has a ways to go as 4 out of 5 eligible healthcare professionals are currently not qualified under the program.

With the release of Stage 2 rules, eligible doctors, healthcare professionals and hospitals are looking ahead to the next stage of the Medicare and Medicaid EHR Incentive Programs. According to CMS, Stage 3 will "continue to expand meaningful use objectives to improve healthcare outcomes."

Stage 1 set the basic EHR functionality including the ability to capture data electronically and provide patients with electronic copies of health information.

Read more: CMS releases final Stage 2 Meaningful Use rules - FierceGovernmentIT

5-point strategy to reduce readmissions

By: Steff Deschenes, New Media Producer, Healthcare Finance News

bildeThe Centers for Medicare & Medicaid Services will penalize hospitals for readmissions beginning this autumn. As a result, many healthcare providers are taking a cold hard look at their bottom line in an effort to meet or exceed projected targets for the year. The difficult part, of course, is that each healthcare provider has its own unique challenges. There is no "one size fits all" solution.

It's important to examine the quality of the referral processes in place. Are there any patterns? Is your hospital providing enough information in your referral packets in a timely manner? "Healthcare providers should also identify the source of readmissions, looking at discharge referrals and post-acute provider relationships and performance to see which facilities have the best success records," explained Tom Ferry, CEO of Curaspan Heath Group, a company that helps providers, payers and suppliers improve care for patients. "Can your organization meet with underperforming facilities to discuss steps to improve? You need to know your readmission rates and track them regularly."

Ferry has a five-point strategy for the best practices to reduce readmissions.

1. Think globally about technology.
Don't view technology solutions as purchases that the IT department makes. To be effective, they should be considered investments that align with the common goals of internal and external constituents. For lower readmission rates, that means a shared platform with your community-based partners. It should support timely, meaningful two-way communication about the next, best level of care and services that, for instance, will keep a skilled nursing facility or home care patient from being readmitted. This communication should include the exchange of clinical documentation in order to optimize care coordination.

2. Conduct due diligence beyond the four walls of a hospital.
"Since efforts to lower readmissions depend in part on external care partners, don't make a technology decision in a vacuum," said Ferry. Solutions that advance this strategic initiative must reflect feedback from your post-acute providers and payers. After all, whatever you deploy will have an impact on your partners' performance and ultimately your reimbursement as ACOs, value-based purchasing and other new models of care and reimbursement requiring collaboration take root. Your decision making about technologies to support them also requires collaboration.

3. Forget about "one throat to choke."
No one can do everything, never mind do it all well. If there was one silver bullet for cutting healthcare costs, improving care and driving efficiency, readmissions wouldn't be a problem. Go with a best-of-breed solution that integrates with other superior point solutions. From a technical standpoint, it should be interoperable with all HIS. Additionally, it should come from a vendor that knows how to partner with other vendors. After all, if you're going to create a connected universe in which providers from separate but related levels of care not only communicate but collaborate, you should have vendors that know how to collaborate too. Further, if you want to protect your investment should problems surface, look for a strong SLA – not a one-company panacea. 

4. Deploy technology that drives utilization.
Input from internal and external stakeholders must include assessing whether a product is easy to use and demonstrates immediate, clear benefits. For example, since making a dent in readmissions requires first identifying the issues underlying the numbers, you'll need a system that users readily adopt, generating data necessary for ongoing root-cause analysis – and action. Knowing whether particular nursing homes or physicians are behind a disproportionate number of readmissions, explained Ferry, equips staff for a discussion with those providers, which should drive better outcomes and create more utilization.

5. Keep cultivating relationships with community-based partners.
Controlling readmissions is an ongoing challenge that requires periodic meetings with your post-acutes and payers to review data about how you're doing. "We know from our own customer base that those organizations that regularly review and respond to data cut their annual readmissions to well below the national average," said Ferry, "improving clinical as well as financial outcomes."

Click here for the original article.

Survey: Physician adoption of EHRs continues to climb


By Marla Durben Hirsch, FierceEMREHRs

Physician adoption of electronic health record systems continues to increase at a steady pace, with about half of all physicians overall using one, according to SK&A's latest survey of physician practices.

The number of physicians in the U.S. using EHRs has jumped to 49.6 percent, up from 45.6 percent in January. Perhaps not surprisingly, larger practices were more likely to have adopted an EHR system, with 78.8 percent of groups of 26 or more physician going electronic, compared to solo practitioners, of whom 41.8 adopted.

Adoption rates are relatively equal throughout the country, with 52.1 percent of physicians in the north and 51.6 percent in the south using EHRs. Slightly fewer (45.5 percent) practices in the East are using an EHR, compared to 49.3 percent in the West.

The five specialties using EHRs the most were dialysis, pathology, nuclear medicine, radiology and emergency medicine. General practitioners were in the bottom five of adopters, along with psychiatrists, plastic surgeons, endocrinologists and holistic providers. 

The SK&A survey confirms findings revealed by other studies this summer. A survey published by Physician Practice's in July also found that about half of physicians (54 percent) had implemented EHRs. A Centers for Disease Control & Prevention (CDC) study found, meanwhile, found that 55 percent of physicians had adopted an EHR. 

The original article can be found here.

Key industry trends impacting long-term and post-acute care (LTPAC) providers


healthcare trendsBy: Dan Cobb, Chief Technology Officer, HealthMEDX

The only constant in life is change.  LTPAC providers, which include home care agencies, nursing homes, and rehab facilities, face a number of challenges in the coming months and years.  This blog is designed as a heads-up for topics that will impact the industry (in no particular order).  There are countless other trends, but we’ll focus on three in this posting:

    • ICD-10-CM.  The replacement for ICD-9 diagnosis codes was originally to be required by CMS in October 2013.  But don’t let the delay to 2014 provide an excuse to put off your conversion project.  ICD-10 is an entirely different coding structure from ICD-9.  For example, primary pulmonary hypertension is 4160 in ICD-9, but I270 in ICD-10.  There are 5 times as many ICD-10 codes and they do not match one-to-one with ICD-9.  Your clinicians and billing staff will need the extra time to learn the new language and will likely need to convert existing patient records manually.
    • Meaningful use.   At first glance, meaningful use doesn’t impact LTPAC providers.  Hospitals and physicians are required to demonstrate meaningful use of certified electronic health records to receive adoption incentives and to avoid penalties from CMS.  Stage one of ONC-ATCB (Office of the National Coordinator for health IT – Authorized Testing and Certification Body) meaningful use is in place now.  Stage two (2014) and three (2016) will likely include the requirement for hospitals and physicians to exchange data electronically with LTPAC providers.  LTPAC providers that cannot exchange data that conforms to the meaningful use exchange standards may be shut out from hospital and physician post-acute referrals in the future.   LTPAC software companies are beginning to certify their products to ensure compliance with future exchange requirements. 
    • Care coordination.  There is a growing movement to coordinate care among not only LTPAC providers but with hospitals, physicians and other providers.  A few movements in this area include:
      • The upcoming Continuity Assessment Record and Evaluation (CARE) instrument is designed to eventually replace the MDS for nursing homes, the OASIS for home health and the IRF-PAI for inpatient rehab.  The CARE assessment will begin in the hospital upon discharge.  In LTPAC, additional CARE assessments will take place upon admission, significant change and discharge. 
      • Re-hospitalization penalties for hospitals will add focus to care coordination among hospitals and LTPAC providers. 
      • In addition, Accountable Care Organizations (ACOs) are designed to provide coordinated care for Medicare recipients.  Standards-based health information change will be necessary to coordinate care. 

New data standards, like the longitudinal care plan will emerge to supplement the information that is currently available for exchange.

ICD-10-CM, meaningful use and care coordination are just a few of the many changes taking place in the LTPAC industry.  May we live in interesting times. 

EHR best practices: Planning Meaningful Use workflow

meaningful use 101As any healthcare provider can attest to, figuring out the best ways to map out workflow during EHR implementation can take a lot of the anxiety out of the process. So having a plan to execute workflow activity during adoption, as reviewed here by HITEC LA, can help ensure you’re in for a smooth EHR transition.

Analyze current workflow
Document the practice’s existing paper workflows in all areas of patient care. This includes everything from front desk admissions to prescription management. Here are some examples:
• Appointment scheduling
• Internal messaging
• Patient visit documentation
• Lab results management
• Prescription processing
• Chart migration
• Incoming paper correspondence
• Billing and accounts receivables

Solicit clinician and staff input regarding roles in current paper workflows
Involve everyone who handles paperwork in the analysis and redesign.

Review and finalize documentation of current workflow
Ensure that the final diagram incorporates the entire “paper trail.”

Identify waste and opportunities; then redesign workflow
Recognizing the steps that should be changed to improve office functionality and know your EHR needs. During the workflow redesign, you assign pre-work before meetings or even homework, where personnel may be required to collect additional inputs or data collection following the meeting. This will help prepare them for the transition.

Identify and implement the EHR system and new workflow
Enlist the necessary support and work with the right EHR vendor to implement a system that meets the practice’s needs; ensure proper EHR implementation through staff training on the new workflow. This may not be easy for physicians or nurses who barely ever use computers. Ensure their comfort during the workflow during the transition is a big key to the process. During training, using screen shots and/or live activity will help physicians and nurses get a good feel for EHR as it pertains to their everyday work.

Analyze new EHR workflow and refine as needed
Continue to monitor the EHR-driven workflow and adjust it to optimize efficiencies in your practice. If staff continues to struggle, bring back training staff for a refresher.

Click here to view a workflow chart and see the original article

All HIPAA-covered Entities Must be Compliant with Version 5010


HIPAA 5010The Centers for Medicare & Medicaid Services' Office of E-Health Standards and Services ended its enforcement discretion period for ASC X12 Version 5010 (Version 5010) standards June 30. All HIPAA-covered entities must now be fully compliant with upgraded transaction standards for Version 5010 and NCPDP Versions D.0 and 3.0.

As of July 1, all complaints regarding any HIPAA-covered entity's noncompliance with the updated standards received in CMS' HIPAA Administrative Simplification Enforcement Tool (ASET) will be subject to enforcement action under the existing HIPAA transaction enforcement process.

If you are still experiencing issues regarding use of the Version 5010, D.0 and 3.0 standards in your transactions, refer to your respective clearinghouse and/or payer's website or provider service department for assistance.

For information regarding these updated standards and additional information, visit the Versions 5010 and D.0 & 3.0 page on the CMS website.

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