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A Few Thoughts After AHIMA About the HIM Profession

Posted on September 30, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This year was my 4th year attending the AHIMA Convention. There was definitely a different vibe this year at AHIMA than has been at previous AHIMA Annual Convention. I still saw the humble and wonderful people that work in the HIM field. I also still saw a passion for the HIM work from many as well. However, there seemed to be an overall feeling from many that they were evaluating the future of HIM and what it means for healthcare, for their organization, and for them personally.

This shouldn’t really come as a surprise. Think about the evolution that’s been happening in the HIM world. First, they got broadsided by $36 billion of stimulus money that slapped EHR systems in their organizations which questioned HIM’s role in this new digital world. Then, last year they got smashed by a few lines in a bill which delayed ICD-10 another year. It’s fair to say that it’s been a tumultuous few years for the HIM profession as they consider their place in the healthcare ecosystem.

While a little bit battered and scarred, at AHIMA I still saw the same passion and love for the work these HIM professionals do. I might add, a work they do with very little recognition outside of places like AHIMA. In fact, when EHR systems started being put in place, I think that many organizations wondered if they’d need their HIM staff in the future. A number of years into the world of EHRs, I think it’s become abundantly clear in every organization that the HIM staff still have extremely important roles in an organization.

While EHR software has certainly changed the nature of the work an HIM professional does, there is still plenty of work that needs to be done. We’d all love for the EHR to automate our entire healthcare lives, but it’s just not going to happen. In fact, in many ways, EHR software complicates the work that’s done by HIM staff. Remember that great HIM modules, features, and functions don’t sell more EHR software (more on that in future posts). Sadly, the HIM functions are often an afterthought in EHR development. We’ll see if that catches up with the EHR vendors.

As I’ve dived deeper into the life and work of an HIM professional, I’ve seen how difficult and detailed the job really can be. Not to mention, the negative consequences an organization can experience if they don’t have their HIM house in order. Just think about a few of the top functions: Release of Information, Medical Coding, Security and Compliance. All of these can have a tremendous impact for good or bad on an organization.

What is clear to me is that the HIM professional has moved well beyond managing medical records. If done well, the HIM functions can play a really important part in any healthcare organization. The challenge that many HIM professionals face is adapting to this changing environment. I see a number of real stand out professionals that are doing phenomenal things in their organization and really have an important voice. However, I still see far too many who aren’t adapting and many who quite frankly don’t want to adapt. I think this will come back to bite them in the end.

A Little #AHIMACon14 Twitter Roundup

Posted on September 29, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’m in San Diego today at the AHIMA Annual Convention. It’s a great event that brings together some really passionate and wonderful Health Information Management professionals. There’s been some interesting Twitter activity at the event. Here’s a roundup of some of the interesting tweets:

Some really great insights. I’d love to hear your thoughts on the tweets above.

The Future of Healthcare IT Publishing

Posted on September 26, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

During today’s #HITsm chat, Karen DeSalvo joined the chat and asked what healthcare IT will be like in 2024. Brian Eastwood, Senior Editor at CIO.com, tweeted the following:


The topic was of interest to me as a health IT blogger myself. However, this was my response:


This of course led to Brian and I contributing to a series of possible 2024 Health IT Headlines we have to look forward to:

I’m pretty sure this wasn’t what Karen DeSalvo had in mind when she asked the question, but I thought it was fun to think about these possible headlines. Plus, I think there’s a fair amount we can learn from thinking about the future in this type of headline fashion. What do you think the healthcare IT headlines will say in 2024?

The Medication List Said, “Raised toilet seat daily”

Posted on September 25, 2014 I Written By

The following is a guest blog post by Lisa Pike, CEO of Versio.
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With over a third of healthcare organizations switching to a new EHR in 2014, there is a lot of data movement going on. With the vast amount of effort it took to create that data, it’s a valuable asset to the organization. It can mean life or death; it can keep a hospital out of the courtroom; and it can mean the difference between a smooth-running organization and an operational nightmare.

But when that important data needs to be converted and moved to a new EHR, you realize just how complex it really is.

During a recent conversion of legacy data over to a new EHR, we came across this entry in the Medication List:  Raised toilet seat, daily.

Uh, come again??

How about this one?  “Dignity Plus XXL [adult diapers]; take one by mouth daily.”  What does the patient have, potty mouth?

Now, while we may snicker at the visual, it’s really no joke. These are actual entries encountered in source systems during clinical data migration projects. Some entries are comical; some are just odd; and some are downright frightening. But all of them are a conversion nightmare when you are migrating data.

Patient clinical data is unlike any other kind of data, for many reasons. It’s massive. It requires near-perfect accuracy. It’s also extremely complex, especially when you are not just migrating, but also converting from one system “language” to another.

Automated conversion is a common choice for healthcare organizations when moving data from legacy systems to newly adopted EHRs. It can be a great choice for some of the data, but not all. If your source says “hypertension, uncontrolled,” but your target system only has “uncontrolled hypertension,” that’s a simple enough inconsistency to overcome, but how would you predict every non-standard or incorrect entry you will encounter?

Here are some more actual examples. If you’re considering automated conversion, consider how your software would tangle up over these:

SOURCE SYSTEM SAYS COMMENTS
346.71D  Chm gr wo ara w nt wo st ???
levothyroxine 100 mg Should be mcg. Yikes!
Proventil Target system has 20 choices
NKDA (vomiting) NKDA= no known drug allergies.
Having no allergies causes vomiting?
Massage Therapy, take one by mouth twice weekly ???
Tylenol suppositories; take 1 by mouth daily Maybe not life-threatening, but certainly unpleasant
PMD
(Pelizaeus-Merzbacher disease)
Should have been PMDD
(premenstrual dysphoric disorder)
Allergy:  Reglan 5 mg Is patient allergic only to that dosage, or should this have been in the med list?
Confusing allergies and meds can be deadly.
Height 60 Centimeters or inches? Convert carefully!

 

These just scratch the surface of the myriad complexities, entry errors, and inconsistencies that exist in medical records across the industry. No matter how diligent your staff is, I guarantee your charts contain entries like these!

When an automated conversion program encounters data it can’t convert, it falls out as an “exception.” If the exception can’t be resolved, the data is simply left behind. Even with admirable effort, almost no one in the industry can capture more than 80% of the data. Some report as low as 50%.

How safe would you feel if your doctor didn’t know about 20% of your allergies? What if one of those left behind was the one that could kill you? What if a medication left behind was one you absolutely shouldn’t take with a new medication your doctor prescribed? Consider the woman whose aneurysm history was omitted during a conversion to a new EHR, so her specialist was unaware of it. She later died during a procedure when her aneurysm burst. I would say her family considered that data left behind pretty important, as did the treating physician, who could be found liable.

Liable, you say?

That’s right. The specialist could be found liable for the information in the legacy record because it was available….even if it was archived in an old EHR or paper chart.

You can begin to see the enormity of the problem and the potentially dangerous ramifications. Certainly every patient deserves an accurate record, and healthcare providers’ effectiveness, if not their very livelihood, depends on it. But maintaining the integrity of the data, especially during an EHR conversion, is no trivial task. Unfortunately, too many healthcare organizations underestimate it, and clearly it deserves more attention.

There is good news, however. With a well-planned conversion, using a system that combines robust technology with human expertise, it is possible to achieve 100% data capture with 99.8% accuracy. We’ve done it with well over a million patient chartsIt isn’t easy, but the results are worth it. Patients and doctors deserve no less.

Lisa Pike is the CEO of Versio, a healthcare technology company specializing in legacy data migration, with a proven track record of 100% data capture and 99.8% quality. We call it “No Data Left Behind.” For more information on Versio’s services or to schedule an introductory conversation, please visit us at www.MyVersio.com or email sales@myversio.com.

Outsourcing Claim Creation Infographic

Posted on September 24, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

You know I’m a sucker for an infographic. You can see my Health IT Infographic collection on Pinterest. I found the following infographic interesting since I’d describe it more as a sales infographic. It makes the case for outsourcing claim creation. I’d love to hear your thoughts on the infographic or on outsourcing claim creation. What do you think?

Outsourcing Claim Creation Infographic

Full Disclosure: ClinicSpectrum is a sponsor of the “Cost Effective Healthcare Workflow Series” on this site, but this post is not a sponsored post.

Has the Google Glass Hype Passed?

Posted on September 23, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It seems to me that the hype over Google Glass is done. Enough people started using them and many couldn’t see the apparent value. In fact, some are wondering if Google will continue to invest in it. They’ve gone radio silent on Google Glass from what I’ve seen. We’ll see if they’re planning to abandon the project or if they’re just reloading.

While the future of Google Glass seems unsure to me, I think the idea of always on, connected computing is still alive and well. Whether it’s eyeware, a watch or dome other wearable doesn’t matter to me. Always on, connected computing is a powerful concept.

I’m also interested in the telemedicine and second screen approaches that have been started using Google Glass in Healthcare. Both of these concepts will be an important part of the fabric of health care going forward.

I still remember the wow factor that occurred when I first used Google Glass. It still amazes me today. I just wish it were a little more functional and didn’t hurt my eyes when I used it for long periods.

What do you think of Google Glass and the category of always on computing?  Do you see something I’m missing?

What’s the Black Market Value of a Health Record?

Posted on September 22, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Somewhere in the past, an article put the value of a health record at $50. I’m really not sure who or what wrote the original article or set the price at $50, but that value has been perpetuated in article after article on the internet. Yes, that’s one of the features of the internet. It perpetuates misinformation (kind of like an EMR).

When people make the claim that a compromised health record is worth $50, they usually then say that it’s more valuable than a credit card which is only worth $5 (probably something else that’s debatable). When I hear this, I’ve always wondered how they got the $50 price tag. The reality is that the value of a health record is only what someone is willing to pay. You can say something has a certain value, but without a market to validate that people will consistently pay that price, then does it really have that value?

I’ve always wanted to dig into the black market of health records to try and validate the $50 price tag that everyone likes to claim for health records. However, there are some obvious reasons why I don’t want to dig around in the black market of health records. So, I’ve avoided touching that story.

The good news is that HIStalk discovered a great story by Krebs on Security that puts a value on the health record. Here’s an excerpt from the story:

How much are your medical records worth in the cybercrime underground? This week, KrebsOnSecurity discovered medical records being sold in bulk for as little as $6.40 apiece. The digital documents, several of which were obtained by sources working with this publication, were apparently stolen from a Texas-based life insurance company that now says it is working with federal authorities on an investigation into a possible data breach.

When you read the rest of the article, it’s amazing the sophisticated methods they’re using to sale, pay for and distribute these records. Reminds me of how many incredible things society could create if these smart people turned their efforts to good instead of bad, but I digress.

I love the last line of the article, “Incidentally, even at $8 per record, that’s cheaper than the price most stolen credit cards fetch on the underground markets.”

Like most markets, prices fluctuate based on supply and demand. So, I’m sure we could find various prices for health records. However, I hope we can do away with the blanket statement that health records are worth $50 and worth more than credit cards. Articles like this illustrate why I’m not sure that’s the case.

What Healthcare Must Plan for in Q4

Posted on September 19, 2014 I Written By

The following is a guest blog post by Ben Quirk, CEO of Quirk Healthcare Solutions.
Ben Quirk
In some ways, 2014 turned out to be not quite as cataclysmic. The early announcement of delaying the adoption of ICD-10 and the more recent announcement to allow hospitals/CAHs and Eligible Professionals participating in CMS’ Meaningful Use programs to attest using their existing Certified Electronic Health Record Technology (CEHRT) took the pressure off healthcare providers scrambling to upgrade their CEHRT to a version that was both ICD-10 and MU-compliant. However, this is only a temporary reprieve through the end of 2014 and there are other priorities that must be addressed before the year ends.

Navigating the ever-evolving healthcare environment will seem much less daunting if you focus on these four areas:

  • Meaningful Use
  • Value-Based Payment Modifiers
  • Transparency
  • Open Enrollment for ACA

Meaningful Use (MU)

If you were not able to upgrade to the 2014 Edition EHR, you will still be able to attest for MU using 2013 criteria. This provides reprieve from the 2014 criteria that requires the implementation of and patient enrollment in a patient portal.

In order to be MU-ready, your organization must proactively:

  • Determine your strategy based on the final rule. Gather data and be prepared to attest for MU by the deadline for the MU program you participate in..
  • Create an audit binder which should include screenshots of required EHR configuration during the reporting period. Should you get an audit 2 years from now, you can refer to this binder for accurate information.
  • Prepare a statement citing why you should be allowed to opt out of those MU measures that you think do not pertain to your practice. Auditors will ask for this on any audit preformed.

All organizations should be prepared to start collecting data for MU 2 by January 1, 2015. This includes having a strategy around the implementation of a patient portal and patient enrollment, sharing data amongst community and other healthcare providers, and radiology interfaces.

Value-Based Payment Modifier

The current Value Based Payment Modifier for providers who serve Medicare beneficiaries is a descendent of the Physician Quality Reporting System (PQRS). It is a way to keep the ACA cost-neutral, but there are some important things you need to know about this newer system. Value-Based Payment Modifier takes claims, Meaningful Use, and physician quality data and rates the quality of care you provide against your peers. Consequently,

  • When you report your Clinical Quality Measures or any clinical data to CMS, make sure your thresholds demonstrate that your practice is providing high quality care.
  • If your practice suffered from vendor problems with data accuracy in the past, this should be fixed.

Transparency

Transparency is something all providers should be aware of. Although available only in a few markets right now, all patients will soon be able to look up information about physicians before deciding where they would like to have their medical procedures done. For instance, if a patient decides to have an ACL repair, s/he can go online to compare exact costs and quality measures (based on the Patient Quality Reporting System) for ACL repair. Practices need to be aware that their prices and quality are being reported publicly. The implications go beyond losing reimbursement. You can actually be delisted from an insurance network. To ensure that your practice remains a viable option for patients:

  • Market your own practice and post your own prices.
  • Make sure you are reporting good quality data.
  • Use sources such as MGMA or OPTUM to see what providers in your area are charging and how you compare.
  • Determine how your reimbursement ranks vs. your competitors on the Medicare website and ensure data accuracy.

Open Enrollment for the ACA

November 15 marks the beginning of the second Open Enrollment period for the Affordable Care Act and there is no indication that this time around will be any easier than the first. Patients will be choosing plans, dealing with things very unfamiliar, and perhaps unaffordable, to them, like deductibles. This directly impacts clinics and the bottom line, especially with those patients who cannot pay their share of the costs. Last year, patients became the number one payor for many practices, even more than insurance companies, because so much revenue came from deductibles. That all resets January 1, but there are things you can do to avoid a possibly painful Q1 of 2015:

  • Check and confirm all patients’ eligibility, what plan they are on, and what their deductible is prior to their scheduled appointment, preferably through an automatic batch eligibility service. Keep this information in the practice management system.
  • Notify patients about their deductibles before they come into the clinic, and make sure to collect payments upfront, or keep a card on file.

The healthcare industry as we knew it for the past many years has ceased to exist. As we move into a new era of integrated delivery systems and a greater emphasis on value-based rather than volume-based reimbursements, the industry is going to remain in a state of flux before it stabilizes once again. The only way organizations are going to survive in this shifting landscape is by anticipating and planning for the next change so that they can stay ahead of the curve. The more an organization knows, the better it can be prepared to confront any potentially negative impact of the ever-evolving nature of the industry.

About Ben Quirk
Ben Quirk is CEO of Quirk Healthcare Solutions, a consulting firm specializing in EHR strategic management, workflow optimization, systems development, and training. The company’s clients have enjoyed remarkable success, including award of the Medicare Advantage 5-star rating. Quirk Healthcare presents a weekly webinar series, Insights, to inform clients and the general public about government programs and industry trends. Mr. Quirk is also Executive Director of the Quirk Healthcare Foundation, a learning institution which fosters innovation in the healthcare industry.

5 Elements of an Effective HIPAA Audit Program Infographic

Posted on September 18, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This week is National Health IT Week (#NHITWeek), but I think it might be better to call it National Health IT Infographic week. I’m not complaining. I love a good infographic. For example, I posted the Rise of the Digital Patient Infographic and the Healthcare IT Leadership Infographic – A 25 Year History already this week. I figured I might as well round out the week and post an infographic on EMR and HIPAA as well. Coalfire sent me the following infographic looking at HIPAA audits. I don’t think most people realize the HIPAA audits that are coming. HIPAA audits have had a slow start, but I think the momentum is growing. If you’re an organization that ever touches healthcare data, you better be ready. Enjoy the HIPAA audit infographic below.
5 Elements of an Effective HIPAA Audit Program

What If Meaningful Use Were Created by Doctors?

Posted on September 17, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s safe to say that meaningful use is growing through its challenges right now. My post yesterday about killing meaningful use and the new Flex-IT Act should be illustration enough. While it’s easy to play Monday Morning Quarterback on meaningful use, I think it’s also valuable to consider what meaningful use could have been and then use that to consider how we can still get there from where we are today.

Many of you might have read my post on The Purpose of the EHR Incentive Program Accordign to CMS. CMS clearly stats that the purpose of the EHR incentive money and meaningful use is to move providers towards advanced use of health IT to:

  • Support Reductions in Cost
  • Increase Access
  • Improve Outcomes for Patients

This has very clearly been CMS’ goal and it’s reflected in what we now know today as meaningful use. Let’s think about those from a physician perspective.

Support Reductions in Cost – So, you’re going to pay me less for doing the same work?

Increase Access – So, you’re going to send me patients who can’t pay their bill? Or does this mean I have to do more work making my records accessible?

Improve Outcomes for Patients – Every doctor can support this. However, many are skeptical (with good reason) that the various elements of meaningful use really do improve outcomes for patients.

If I were to step back and think what a doctor might consider meaningful use of an EHR system, this might be what they’d list (in no particular order):

  • More Efficient
  • Improved Care
  • Increased Revenue

More Efficient – Will the technology help me see patients more efficiently? Will it allow me to spend more time with the patient?

Improved Care – Will the technology help me be a better doctor? Will the technology help me make better use of my time with the patient?

Increased Revenue – Will the technology help me get paid more? Will the technology lower the cost of my malpractice insurance and reduce that risk? Will the technology create new revenue streams beyond just churning patient visits?

I’m sure there are other things that could be listed as well, but I think the list is directionally accurate. When you look at these two lists, there’s very clearly a major disconnect between what end users want and what meaningful use requires. With a lot of the EHR incentive money already paid out, this divide has become a major issue.