EHRs Play Signifcant Role in HIPAA Omnibus Rule

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.

No Denying the EMR

By: Frank Quinn, MEDCITY News

The past few years 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.

Save the date, Full EHR by 2014

Full EHR by 2014, means that hospitals need to implement Electronic Health Records in their practice to ensure effective administration of the healthcare sector; the current federal procedures require that hospitals and other healthcare institutions should adopt the EHR/EMR systems by 2014. The implementation process includes:

Planning for transition and staff training

To successfully implement the EHR; each hospital needs to plan for transition from paper to electronic systems. The most essential thing is to ensure that the personnel are well prepared for this transition; there should be adequate training of all the staff that is expected to use the systems. People skills such as communication, leadership, and staff training are mandatory to successfully implement it. This therefore calls for an effective change management and reshuffle in various departments to ensure there is a new information managing paradigm in healthcare.

System acquisition

The organization must make the decision of whether to use the integrated systems strategy or to employ the `best of breed’ approach early enough. Other decisions that the organization should make is whether to look for commercial vendors or to produce the clinical IT system personally to cut on costs.

The organization then moves to the process of actual acquisition of the system; the decision on what acquisition process to use should be made carefully. This is ensure that the organization acquires the best system to fit their needs.

Implementing the system

Implementing the system requires the help and support of every member of the organization; every member of the staff should be familiar with their role in implementing the system. Staff cooperation therefore, ensures that the system work well; system control and evaluation also becomes easy.

After the system has been put in place and it becomes operational; any errors should be identified and corrected.

 EHR benefits and acquiring market share.

Having the right EHR not only makes the organization acquire efficiency but it also helps them to gain a market share in terms of technological progress.          

They improve the documentation of hospitals records with legible and organized data through integrated practice management softwares.

They improve the E&M coding accuracy and comply with audit regulations by ensuring correct data, procedures and diagnosis codes.

The systems reduce billing errors and assure privacy of financial reports of a hospital; they eliminate any loss of charges, make coding easy and increases hospital revenue.

Hospice Documentation and the Electronic Medical Record

By: Amy Walrod, RN, Product Analyst, HealthMEDX, LLC

In December 2008 hospice regulations went through a major overhaul.  Prior to 2008, the regulations had not been updated for 20+ years.  Several agencies were forced to shop for a solution and forgo their paper documentation system with the need to standardize the data collection and reporting as a major driving factor.

In 2008 we were introduced to the QAPI (quality assurance/performance improvement) initiative.  This regulation was a challenge for hospice agencies and forced many to transition from paper to an electronic medical record.  The need to track, trend and report on clinical and operational outcomes was overwhelming to many.

During this time the industry was faced with increased regulatory scrutiny.   RAC and ZPIC audits were more and more common among hospice providers.  Agencies had to learn how to navigate regulatory compliance in day to day operations.  As a result of the regulatory climate, hospice providers are focused on clinical documentation to ensure data elements are being tracked and clinical eligibility is clearly recorded.

These regulatory changes have made an electronic medical record a necessity in most agencies.  A paper based documentation system has become inefficient.  The need for standardization, enhanced communication, improved efficiency and regulatory compliance has made electronic documentation the tool of choice within the hospice agency.

Hospice agencies are challenged to focus on the changing regulations while maintaining high quality care.  The electronic medical record helps by recording consistent data and outcomes while also assisting the clinician support eligibility by using evidenced based protocols.

EMR vs EHR – What is the Difference?

By Peter Garrett / ONC Office of Communications , and
Joshua Seidman PhD / Director Meaningful Use

What’s in a word? Or, even one letter of an acronym?

Some people use the terms “electronic medical record” and “electronic health record” (or “EMR” and “EHR”) interchangeably. But here at the Office of the National Coordinator for Health Information Technology (ONC), you’ll notice we use electronic health record or EHR almost exclusively. While it may seem a little picky at first, the difference between the two terms is actually quite significant.The EMR term came along first, and indeed, early EMRs were “medical.” They were for use by clinicians mostly for diagnosis and treatment.

In contrast, “health” relates to “The condition of being sound in body, mind, or spirit; especially…freedom from physical disease or pain…the general condition of the body.” The word “health” covers a lot more territory than the word “medical.” And EHRs go a lot further than EMRs.

What’s the Difference?

Electronic medical records (EMRs) are a digital version of the paper charts in the clinician’s office. An EMR contains the medical and treatment history of the patients in one practice. EMRs have advantages over paper records. For example, EMRs allow clinicians to:

• Track data over time
• Easily identify which patients are due for preventive screenings or checkups
• Check how their patients are doing on certain parameters—such as blood pressure readings or vaccinations
• Monitor and improve overall quality of care within the practice

But the information in EMRs doesn’t travel easily out of the practice. In fact, the patient’s record might even have to be printed out and delivered by mail to specialists and other members of the care team. In that regard, EMRs are not much better than a paper record.

Electronic health records (EHRs) do all those things—and more. EHRs focus on the total health of the patient—going beyond standard clinical data collected in the provider’s office and inclusive of a broader view on a patient’s care. EHRs are designed to reach out beyond the health organization that originally collects and compiles the information. They are built to share information with other health care providers, such as laboratories and specialists, so they contain information from all the clinicians involved in the patient’s care. The National Alliance for Health Information Technology stated that EHR data “can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization.”

The information moves with the patient—to the specialist, the hospital, the nursing home, the next state or even across the country. In comparing the differences between record types, HIMSS Analytics stated that, “The EHR represents the ability to easily share medical information among stakeholders and to have a patient’s information follow him or her through the various modalities of care engaged by that individual.” EHRs are designed to be accessed by all people involved in the patients care—including the patients themselves. Indeed, that is an explicit expectation in the Stage 1 definition of “meaningful use” of EHRs.

And that makes all the difference. Because when information is shared in a secure way, it becomes more powerful. Health care is a team effort, and shared information supports that effort. After all, much of the value derived from the health care delivery system results from the effective communication of information from one party to another and, ultimately, the ability of multiple parties to engage in interactive communication of information.

Benefits of EHRs

With fully functional EHRs, all members of the team have ready access to the latest information allowing for more coordinated, patient-centered care. With EHRs:

• The information gathered by the primary care provider tells the emergency department clinician about the patient’s life threatening allergy, so that care can be adjusted appropriately, even if the patient is unconscious.
• A patient can log on to his own record and see the trend of the lab results over the last year, which can help motivate him to take his medications and keep up with the lifestyle changes that have improved the numbers.
• The lab results run last week are already in the record to tell the specialist what she needs to know without running duplicate tests.
• The clinician’s notes from the patient’s hospital stay can help inform the discharge instructions and follow-up care and enable the patient to move from one care setting to another more smoothly.

So, yes, the difference between “electronic medical records” and “electronic health records” is just one word. But in that word there is a world of difference.

 

HealthMEDX's VisionReceives ONC-ATCB 2011/2012 Certification

January 4, 2012 – HealthMEDX announced today that HealthMEDX Vision 7.1.10, is 2011/2012 compliant and was certified as an EHR Module on January 3, 2012 by the Certification Commission for Health Information Technology (CCHIT®), an ONC-ATCB, in accordance with the applicable Hospital certification criteria adopted by the Secretary of Health and Human Services. HealthMEDX Vision 7.1.10 was also certified as an EHR Module in accordance with the applicable Eligible Provider certification criteria.  The 2011/2012 criteria support the Stage 1 meaningful use measures required to qualify eligible providers and hospitals for funding under the American Recovery and Reinvestment Act (ARRA). 

“This certification was a focus area for HealthMEDX.  We feel these certifications mean a lot for our clients and for our industry” stated Dan Cobb, Chief Technology Officer at HealthMEDX.  “Addressing these types of certification standards is crucial to the success of the organizations utilizing the HealthMEDX Vision solution.”

You can read the entire press release here, which includes all the certification criteria that HealtMEDX Vision, Version 7.1.10 meets.

Early EMR adopters get a break; tougher criteria delayed to 2014

By Charles Fiegl, amednews staff. Posted Dec. 12, 2011.

Washington -- Physicians meeting criteria in 2011 to earn federal electronic medical record incentives will havemore time before the Dept. of Health and Human Services requires them to satisfy tougher standards for attaining additional bonuses.

The move is being viewed by physicians and health policy observers as a goodwill gesture by the Obama administration toward EMR early adopters. Doctors and hospitals who currently meet stage 1 meaningful use criteria would be able to vie for bonuses for an extra year under the same requirements, HHS Secretary Kathleen Sebelius announced on Nov. 30. These bonus recipients would not need to upgrade their EMR systems to comply with stage 2 standards until 2014, instead of 2013 under the initial plan.

The delay of stage 2 affects only physicians and hospitals who met stage 1 criteria in 2011. Doctors who will report meeting stage 1 requirements for the first time in 2012 will still be expected to meet stage 2 requirements starting in 2014. Before the new policy change, those who waited until 2012 to adopt would have had a later upgrade deadline but still would have been eligible to receive the same total bonus amounts as the early adopters.

Oct. 3 was the last day a physician could begin a 90-day reporting period for 2011, according to the Centers for Medicare & Medicaid Services. Physicians who met the requirements will have until Feb. 29, 2012, to register and attest to receive a bonus for 2011. Physicians can earn up to $44,000 over five years from the Medicare program or up to $63,750 over six years from Medicaid.

The American Medical Association applauded HHS for adding more flexibility to the incentive program by delaying stage 2. "We continue to urge HHS to fully evaluate stage 1 and develop solutions to increase physician participation rates prior to finalizing requirements for stage 2," said Steven J. Stack, MD, chair-elect of the AMA Board of Trustees.

Organized medicine groups have said that early proposals for requirements under the second phase of the EMR bonus program, if adopted, could dissuade physicians from using EMRs.

In a February letter, the AMA and 38 other organizations urged HHS to make the proposed requirements less rigorous and burdensome. For instance, physicians would need to use an electronic note system and ensure patient access to record portals under stage 2, a mandate many consider difficult to attain.

Public health studies have shown that more doctors want to participate in the EMR adoption program. A study from the Centers for Disease Control and Prevention found 52% of office-based physicians plan to register and attest to meeting program requirements for 2011, which is an increase from the 41% who planned in 2010 to do so. The total portion of physicians who have adopted EMRs also is at 34% in 2011, up from 17% in 2008.

"We are pleased that recent data show there is a high interest among physicians to take advantage of the available incentive payments through the government's [electronic health record] incentive program, but we remain concerned that this increase in EHR adoption will not occur unless the program maintains sufficient flexibility in later stages," Dr. Stack said.

Sebelius spoke about the EMR program and the CDC report during a forum held at Cuyahoga Community College in Cleveland on Nov. 30. The incentive program was created by the 2009 economic stimulus package. Since then, 50,000 new health information technology jobs have been created, she said.

Sebelius said the changes made by HHS would make it easier for physicians to earn incentives and hopefully create more jobs.

"When doctors and hospitals use health IT, patients get better care and we save money," she said. "We're making great progress, but we can't wait to do more. Too many doctors and hospitals are still using the same recordkeeping technology as Hippocrates."

Spurring EMR adoption

The announcement did not surprise those following the program, said Robert Tennant, senior policy adviser for the Medical Group Management Assn. The delay had the support of HHS National Coordinator for Health Information Technology Farzad Mostashari, MD, and was recommended by the office's Health IT Policy Committee in June.

EMR vendors, hospitals and physicians had opposed the 2013 stage 2 deadline for early adopters, the policy committee said in its recommendation. The stage 2 requirements are expected to be finalized in June 2012. That timeline would have given vendors only a few months to design, develop, test and release new products and upgrades before the beginning of the 2013 reporting period in October 2012. Doctors and hospitals also would have been expected to learn new system functionality and reporting requirements quickly.

To read the entire article, click here.

 

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Potential HIPAA 5010 Road Blocks that Could Hold Up Reimbursements

Jackie Griffin, client services director at Gateway EDI
HDM Breaking News, December 2, 2011

Recently, the Centers for Medicare & Medicaid Services announced they will not take enforcement actions against HIPAA covered organizations that are not 5010-compliant until March 31, 2012. This may sound like you have an extended deadline to become 5010-compliant. But, it is simply advising that there will be a 90-day grace period before enforcement actions will be taken.

The reality is that 5010 is already here. To avoid a traffic jam and potential melt down, the industry began the conversion ahead of schedule to work out the kinks before the official transition date. This means providers may already be experiencing an increase in claim rejections. Monitor your rejection reports for these top five potential road blocks that could hold up your reimbursements.

1. Billing Provider Address

5010 guidelines require providers to enter the billing provider as a physical address. If a PO Box or lock box address is necessary for payments and correspondence from payers, it must be reported as a pay-to address. This rule applies to both professional and institutional claim formats.

2. Ambulance Claims

In 5010, ambulance suppliers who submit medical transportation claims will be required to report the pick-up and drop-off locations for ambulance transport. You will also be required to report the number of patients transported in the same vehicle for ambulance or non-emergency transportation services. There were previously no designated fields for this information, so you will want to ensure that these fields are added to your claims.

3. Drug Reporting

5010 professional claims for injectable medications must include additional drug information and qualifiers, such as NDC code, quantity, composite unit of measure and prescription number, in addition to the HCPCS code. 

4. Zip Code

In 5010, providers must submit a nine-digit ZIP code when reporting billing provider and service facility locations. Providers should work with their software vendors to ensure they can capture the full nine digits for the billing provider and service facility addresses.

5. Anesthesia Minutes

In 5010, anesthesia services must be reported as minutes. Units may only be reported for anesthesia services when the code description includes a time period or indicates that the time is assigned to a primary code.

The resolutions to these data entry changes are rather technical. I encourage your office to work closely with your practice management software vendors and other billing partners, so you continue to get reimbursed in a timely manner.

 

The EMR and EHR market to hit 80% saturation in U.S. by 2016

IDC: EMRs/EHR market to hit 80% saturation in U.S. by 2016

Written by Luke Gale, November 28, 2011

The market for EHRs/EMRs will presumably expand as more healthcare organizations, encouraged by financial incentives included in American Recovery and Reinvestment Act (ARRA), adopt the technology. Research from IDC Health Insights estimates an adoption rate of more than 80 percent by 2016, up from less than 25 percent in 2009, and predicts a competitive EHR/EMR market that values vendors’ responses to providers’ needs.

“With over 150 vendors currently offering Office of the National Coordinator for Health IT (ONC)-certified technologies for meaningful use, EMR/EHR buyers face an overabundance of options,” said research director Judy Hanover, of Framingham, Mass.-based IDC Health Insights.

The market researcher’s recent report, "IDC MarketScape: U.S. Ambulatory EMR/EHR for Midsize and Large Practices 2011 Vendor Assessment," predicted that successful EMR/EHR vendors will be defined by their ability to provide quality customer support services, create products with a wide range of functionality perceivable to users, demonstrate financial sustainability and build devices interoperable with other technology.

The report identified midsize and large ambulatory practices, or those with more than 20 providers, as healthcare organizations that are particularly poised to benefit from EMR/EHR adoption.

“Large practices also see economies of scale that accrue with process efficiencies upon EMR/EHR introduction as improvements to charge capture, documentation and billing practices enhance revenue for the practice, driving return on investment,” researchers wrote.

IDC researchers cautioned EMR/EHR buyers against rushed purchasing decisions, suggesting that they consider barriers to EMR/EHR implementation that include cost, clinician acceptance, potential workflow disruption and incompatibility with technologies currently in use.

Additionally, the report advised EMR/EHR buyers to consider usability when selecting a product, but concluded that healthcare organizations also implement staff-wide planning and training processes to ease the transition. http://www.cmio.net/index.php?option=com_articles&view=article&id=30649

Meeting the IT needs ahead in Long-Term Care

John Andrews- December 1, 2011- The need for advanced information technology systems in long-term care is descending upon the industry with startling speed. After years of sitting at the back of the adoption curve, skilled nursing operators must now face the IT issue head-on. With all the vendors and choices available, it is an intimidating prospect for most.

In fact, anyone who is unfazed by the process of selecting an IT system probably isn't taking it seriously enough.

That will be a major challenge for the year ahead. IT represents a major outlay of cash and operators must be certain about how a system will enable their mission while keeping them in compliance with the goals of MDS 3.0, RUG-IV, HIPAA privacy regulations, accountable care organizations and electronic health record interoperability.

Long-term care operators need to determine whether these goals can be met with a single enterprise-wide product or with separate systems that are compatible themselves and with others outside the organization. And while there is no easy one-size-fits-all answer, proper due diligence in researching system costs and capabilities can help provide guidance in making the right decision, IT specialists say.

Greg Goodale, marketing manager for HealthMEDX, has spoken to many long-term care providers about the type of system they need and says he has noticed some distinct patterns.

“From a vendor perspective, there is nothing more telling than the questions received from prospective clients researching a system,” he said. “The needs are evolving for providers in regards to information technology. The value of a system goes beyond simple documentation in an electronic format.

“They want and require a system with intelligence and the ability to make real strides with regards to efficiency and workflow automation. The biggest need is a solution that addresses as many areas as possible, but more importantly, one that can easily be adopted. If an IT solution is not easy to learn for the end-user, it's not going to be successful.”

Among the most common functions that need to be automated are resident information and census, minimum data set, patient accounts (including billing and accounts receivable) and general financials. Point-of-care and electronic medical records systems also are considered integral to adopting full-scale automation in long-term care facilities.

To read the entire article click here.