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Top 4 HIT Challenges and Opportunities for Healthcare Organizations in 2015 – Breakaway Thinking

Posted on January 15, 2015 I Written By

The following is a guest blog post by Mitchell Woll, Instructional Designer at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Mitchell Woll - The Breakaway Group
Healthcare organizations face numerous challenges in 2015: ICD-10 implementation, HIPAA compliance, new Meaningful Use objectives, and the Office of the National Coordinator’s (ONC) interoperability road map.  To adapt successfully, organizations must take advantage of numerous opportunities to prepare.

Healthcare leaders must thoroughly assess, prioritize, prepare, and execute in each area:

  1. Meaningful Use Stage 2 objectives require increased patient engagement and reporting for a full year before earning incentives.
  2. The ONC’s interoperability road map demands a new framework to achieve successful information flow between healthcare systems over the next ten years.
  3. There are 10 months left in which to prepare for the October 1 ICD-10 deadline.
  4. HIPAA compliance will be audited.

1. Meaningful Use
For those who have already implemented an EHR, Meaningful Use Stage 2 focuses new efforts on patient access to personal health data and emphasizes the exchange of health information between patient and providers. Stage 2 also imposes financial penalties for failure to meet requirements.

CMS’s latest deadline for Stage 2 extends through 2016, so healthcare organizations have additional time to fulfill Stage 2 requirements. Stage 3 requirements begin in 2017, so healthcare organizations should take the extra time to build interoperability and foster an internal culture of collaboration between providers and patients. For Stage 3, Medicare incentives will not apply in 2017 and EHR penalties will rise to 3 percent.

CMS has also proposed a 2015 EHR certification, which requests interoperability enhancement to support transitions of care.  Complying with this certification is voluntary, but provides the opportunity to become certified for Medicare and Medicaid EHR incentive programs at the same time.

Meaningful Use Stage 2 and the ONC roadmap require that 2015 efforts concentrate on interoperability. Healthcare organizations should prepare for health information exchange by focusing efforts on building patient portals and integrating communications by automating phone, text, and e-mail messages. After setting up successful exchange methods, healthcare organizations should train staff how to use patient portals. The delay in Stage 2 means providers have more time to become comfortable using the technology to correspond with patients. Hospitals should also educate patients about these resources, describing the benefits of collaboration between providers and patients. Positive collaboration and successful data exchange helps achieve desired health outcomes faster.

2. Interoperability
The three-year goal of the ONC’s 10-year roadmap is for providers and patients to be able to send, receive, find, and use basic health information. The six and ten-year goals then build on the initial objectives, improving interoperability into the future.

Congress has also shown initiative on promoting interoperability asking the ONC to investigate information blocking by EHRs. Most of the ONC’s roadmap for the next three years is similar to Meaningful Use Stage 2 goals.

Sixty-four percent of Americans do not use patient portals, so for 2015 healthcare organizations should focus on creating them, refining their workflows, and encouraging patients to use them. Additionally, 35 percent of patients said they are unaware of patient portals, while 31 percent said their physician has never mentioned them. Fifty-six percent of patients ages 55-64, and 46 percent of patients 65 and older, said they would access medical information more if it were available online. Hospitals need their own staff to use and promote patient portals in order to conquer the challenges of interoperability and Stage 2.

3. HIPAA Compliance
In 2015, the Office of the Inspector General (OIG) will audit EHR use, looking closely at HIPAA security, incentive payments, possible fraud, and contingency plan requirements. Also during the HIPAA compliance audit, the Office of Civil Rights (OCR) will confirm whether hospitals’ policies and procedures meet updated security criteria.  Healthcare organizations should take this opportunity to verify compliance with 2013 HIPAA standards to prepare for upcoming audits. Many helpful resources exist, including HIPAA compliance toolkits, available from several publishers. These kits include advice on privacy and security models. Healthcare organizations and leaders can also take advantage of online education, or hire consultants to help review and implement the necessary measures. It’s important that action be taken now to educate staff about personal health information security and how to remain HIPAA compliant.

4. ICD-10 Deadline
The new ICD-10 deadline comes as no surprise now that it was delayed several times. In July 2014, the US Department of Health and Human Services (HHS) implemented the most recent delay and set a new date of Oct. 1, 2015, giving hospitals a 10-month window to prepare for the eventual ICD-10 rollout. Because healthcare organizations are more adaptable than ever, they can use their practiced flexibility and experience to meet these demands successfully.

As Health Information and Management Systems Society (HIMSS) suggests, communication, education and testing must be part of an ICD-10 implementation plan. Informing internal staff and external partners of the transition is a crucial first step. ICD-10 should be tested internally and externally to verify the system works with the new codes before the transition. Healthcare organizations should outline and develop an ICD-10 training program by selecting a training team and assessing the populations who need ICD-10 education. They should perform a gap analysis to understand the training needed and utilize role-based training to educate the proper populations. Finally, organizations should establish the training delivery method, whether online, in the classroom, one-on-one, or some combination of these to teach different topics or levels of proficiency. In my experience at The Breakaway Group, I’ve seen that the most effective and efficient education is role-based, readily-accessible, and offers learners hands-on experience performing tasks essential to their role. This type of targeted education ensures learners are proficient before the implementation. As with any go-live event, healthcare organizations must prepare and deliver the new environment, providing support throughout the event and beyond.

Facing 2015
These challenges require the same preparation, willingness, and audacity needed for prior HIT successes, including EHR implementation and meeting Meaningful Use Stage 1 requirements. ICD-10, HIPAA compliance, Stage 2, and interoperability all have the element of education in common. Healthcare organizations and leaders should apply the same tenacity and discipline to inform, educate, and prepare clinicians for upcoming obligations.

Targeted role-based education will best ensure proficiency and avoid comprehensive, costly, and time-consuming system training. Through role-based education, healthcare organizations gain more knowledgeable personnel who are up to speed on new applications. These organizations probably already have at least a foundation for 2015 expectations, and they should continue to recall the strategies used for prior go-live events. What was successful? It’s important to plan to replicate successful strategies, alleviating processes that caused problems.  This is great opportunity to capitalize efforts for organizational improvements. Healthcare leaders must let the necessity of 2015 government requirements inspire invention and innovation, ultimately strengthening their organizations.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

Ring in 2015 – Ring Out MD Myths about ICD-10

Posted on January 7, 2015 I Written By

The following is a guest blog post by Wendy Coplan-Gould, Founder and President of HRS Coding.

Physicians see ICD-10 as a mixed bag of distraction, expense and long-term advantages. They’ve heard grossly exaggerated messages about ICD-10’s complexity and cost. Confusion has led to complacency and obstinacy across physician practices and medical groups.

Conversely, some physician practices and medical groups eagerly await ICD-10’s ability to accurately describe their high-risk patients, improve data mining capabilities, and demonstrate complexity of cases. The opportunity for cleaner data, better quality scores and greater patient safety are three more physician-friendly benefits of ICD-10 as described in my previous ICD-10 post on EMR & HIPAA.

Recent research conducted with a 20-physician focus group, and presented during AHIMA’s 2014 Convention & Exhibit, revealed three common themes with regard to physician perceptions of ICD-10 and its effect on their practices.

Physicians are concerned about the following:

  • How specific their clinical documentation has to be for correct ICD-10 code assignment.
  • Obtaining accurate reimbursement under ICD-10.
  • Receiving ICD-10 training from the hospitals they serve.

With the advent of a new year, now is the time for hospitals and healthcare systems to dispel physician myths about ICD-10 and actively engage practices—one medical group at a time.

Five ICD-10 Realities and Physician Engagement Strategies

Is ICD-10 as difficult for doctors as once portrayed? The resounding answer for 2015 is “no.”

When introduced one physician office at a time, the implementation of ICD-10 is relatively easy. Consider these proven strategies to foster greater physician buy-in for ICD-10.

  • Most physicians will only use a small subset of ICD-10 codes—dramatically decreasing the amount of time required for training and preparation (1-2 days). Target training efforts toward the 80 percent of diagnosis and procedure codes that are used repeatedly within each practice or specialty.
  • When hospitals focus on improving EHR documentation templates, physicians are more productive, efficient and engaged in ICD-10 efforts. Foster inclusion by helping physicians build better documentation templates across all EHR applications.
  • Physicians learn best from other physicians. Find physician documentation champions within each specialty and make ICD-10 learning fun.
  • The best way to minimize claims denials and ensure proper reimbursement for both hospitals and physicians under ICD-10 will be the avoidance of non-specific codes. Focus on helping physicians document better and give them tools such as real-time documentation aides and prompts to create more succinct, accurate and complete clinical documentation.
  • Physician practices must also be included in end-to-end testing for ICD-10. Be sure to include them within your organization-wide testing plans. Even when testing is only for payer acknowledgement, it provides segue for physician practice coding and billing staff to practice submitting ICD-10 codes.

Blaze a New Path with Physicians in 2015

Last year left many hospitals feeling defeated regarding ICD-10 and their physician preparedness efforts. Money was spent and staff resources were exhausted. Congress dealt a devastating blow to ICD-10 budgets, timelines and implementation teams.

But the ship hasn’t sailed. There is still time to actively engage your medical staff in preparing for ICD-10. Erase your original message to physicians that ICD-10 is difficult and expensive. Replace it with knowledge gleaned over the past two years, recent physician research, and new implementation timelines based on specialty.

By focusing on the clinical data advantages of ICD-10 and bolstering physician productivity and efficiency, hospitals can blaze a new path toward the new code set—one practice at a time.

About Wendy Coplan-Gould
Wendy Coplan-Gould is the embodiment of HRS. She has led the HIM consulting and outsourcing company since 1979, through up and down economies and every significant regulatory twist and turn of the last three decades. Long-time clients and new clients alike are on a first-name basis with her and benefit from her focus on excellence, reliability and flexibility. She has been published in the Journal of AHIMA and other recognized publications, as well as conducted countless professional association presentations.

Prior to starting HRS, Wendy served as assistant director, then director, of Health Information Management at Baltimore City Hospital. She also was associate director of the Maryland Resource Center, which provided data for Maryland’s Health Services Cost Review Commission, an early adopter of the Diagnosis Related Group (DRG) methodology. Wendy is available via email: wendy@hrscoding.com.

Top 10 Google Searches in 2014 – What Would Be Healthcare IT’s Top Searches?

Posted on December 16, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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.

Each year Google releases it’s top trending searches in the US and the world. This list isn’t the most frequently searched terms (according to Google the most popular searches don’t change) but is a year versus year comparison of what terms were trending in 2014.

US Trending Searches:
Robin Williams
World Cup
Ebola
Malaysia Airlines
Flappy Bird
ALS Ice Bucket Challenge
ISIS
Ferguson
Frozen
Ukraine

Global Trending Searches:
Robin Williams
World Cup
Ebola
Malaysia Airlines
ALS Ice Bucket Challenge
Flappy Bird
Conchita Wurst
ISIS
Frozen
Sochi Olympics

Pretty interesting look into 2014. Also amazing that a mobile app (Flappy Bird) made the list for the first time. There’s two healthcare terms: Ebola and ALS Ice Bucket Challenge. I wondered what this list would look like for healthcare IT. So, I decide to take a guess at what I think would be the trending healthcare IT terms of 2014:

ICD-10 Delay
EHR Penalties
Wearables
Meaningful Use Stage 2
Epic
Obamacare
FHIR
Cerner-Siemens
HIPAA Breaches
Patient Engagement

What do you think of the list? Would you order it differently? Are there terms you think should be on the list?

Five Commonly Overlooked ICD-10 IT Transition Strategies

Posted on December 1, 2014 I Written By

The following is a guest blog post by Daniel M. Flanagan, Executive Consultant, Beacon Partners.
Daniel M. Flanagan, Executive Consultant, Beacon Partners
While some organizations have relaxed their approach to ICD-10 readiness given the October 1, 2015 extension, recent polls show that the majority of healthcare organizations remain woefully unprepared.  About 60% of healthcare systems and 96% of physician practices have not begun end-to-end testing according to recent surveys conducted by the College of Healthcare Information Management Executives (CHIME) and Navicure, a leading claims clearinghouse. A lack of testing puts the ICD-10 transition at the greatest risk of failure.

ICD-10 readiness planning should remain a top priority because conducting a comprehensive gap analysis and the resulting remediation work will correct system vulnerabilities that will improve revenue cycle performance today.  However, systems performance improvement is time and resource-intensive and cannot be achieved at the last minute.

Below are five often overlooked transition planning steps:

  1. Update and complete your IT system inventory. We have helped several healthcare organizations prepare for ICD-10 and a common vulnerability is the absence of a complete and accurate IT inventory. Nearly one-third of organizations do not keep an inventory, and, of those that do, most are inaccurate. Many contain systems that are no longer in use and fail to reflect new or recently upgraded applications. Only a few organizations have had a complete IT inventory that accurately reflects all systems requiring end-to-end testing.  We often discover code-sensitive “orphan” applications and systems implemented by end-users without the IT department’s review and approval, which must be added to the inventory. An accurate IT inventory is critical to determine the extent of testing required, and to budget the time and expense needed to complete it.
  1. Review the number and functionality of all interfaces. Revenue cycle interfaces often contain the most critical code processing gaps and represent an organization’s greatest transition risk. For example, workflow analysis sometimes reveals unreliable processing of ICD-9 codes by billing system or other interfaces.  Extensive remediation is needed after the readiness assessment is completed in such cases.  Highly unreliable manual systems are also often used to process code, which impacts work that should be handled electronically. When conducting a workflow analysis, we sometimes find that experienced revenue cycle system end-users disagree about the design and functionality of long-standing systems and interfaces. Friction can arise between end-users and IT application specialists when interfaces do not work or appear not to work properly. Such issues can often be resolved quickly and objectively when a workflow analysis is performed early in the readiness planning process.
  1. Enlist the support of system end-users early to identify performance gaps and devise solutions. Readiness requires that any system that stores, processes, or uses diagnosis codes be identified and tested. However, it is easy to overlook some important performance gaps. In the majority of cases, end-users can readily identify performance gaps and recommend potential, practical solutions.  End-users can also be valuable in identifying potential solutions.  Involving end-users as early as possible in transition planning can avert wasted time.  For instance CDI, case management, as well as QA operating and reporting systems are heavily code-driven, but can be tough to “see,” especially if work is performed on paper. Enlisting end-users to identify code-impacted systems is a great way to ensure nothing is missed.
  1. Set a date to begin testing and verify that payers, clearinghouses, IT vendors, and others tied to your revenue cycle are ICD-10 compliant. End-to-end testing is vital to confirm ICD-10 readiness. Without testing, problem areas are not recognized and will not get fixed, which places the transition at the greatest of failure. Request that each payer and vendor confirm system compliance in writing and set a date when testing will begin.  In addition, we always recommend that our clients call and, if possible, visit key payers to confirm their readiness.   A payer’s inability to commit to a testing date is a warning sign that warrants immediate follow-up.
  1. Align transition efforts and resources with top priority goals. Transition planning will highlight performance improvement opportunities across a range of systems — including IT, revenue cycle, clinical documentation, quality assurance, and EMR.  The variety of performance improvement opportunities sometimes results in an organization creating more goals than needed for a successful transition. Supplemental initiatives can be overwhelming to achieve with restricted resources in a limited timeframe.  The key is to identify “mission critical” transition objectives and allocate scarce resources accordingly.  Define clear objectives and create a detailed plan to monitor progress for achieving each goal.  For example:
    • Revenue cycle performance: Create benchmarks and dashboards for Key Performance Indicators (KPIs) that routinely report system performance now and after ICD-10 go-live.
    • IT: Validate system interfaces and upgrades, and perform testing to ensure confirmation of claim submission data flow. Testing results will provide valuable guidance to remediation efforts.
    • Clinical documentation: Establish a Clinical Documentation Improvement Program (CDIP) to audit provider documentation and coding. The initiative should be designed to provide ongoing training, as well as measure progress while ensuring data integrity, medical necessity, and billing compliance.

Although the deadline may have shifted, healthcare organizations need to stay on track to make the necessary IT and systems changes needed to optimize performance now and in the future.

About Daniel M. Flanagan
Daniel M. Flanagan is a seasoned healthcare executive with 28 years of leadership experience in the health system, physician practice and managed care fields. His primary interest has been performance improvement, especially in revenue cycle operations, improvement plan development and implementation and strategic planning, budgeting and implementation. Mr. Flanagan understands the challenges posed by today’s environment and is experienced in helping clients identify and capitalize upon opportunities to improve organizational performance.

Five Reasons to be Thankful for ICD-10

Posted on November 30, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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.

The following is a guest blog post by Wendy Coplan-Gould, RHIA, Founder and President of HRS Coding.

It’s Thanksgiving weekend—a time for reflection and gratitude. Thoughts typically turn to family, friends, health, and life’s many other blessings. In addition to all of these, this Thanksgiving I suggest that the healthcare industry also include ICD-10 in our list of godsends. Here are five reasons why:

Reason #1:  To Code New Diagnosis, Procedures and Devices

The current ICD-9 coding nomenclature was developed in the 1970s. The healthcare industry can’t afford for this same system to be capturing data in the 21st century. We need the ability to specifically code new diseases, procedures and devices. For example, U.S. healthcare providers are unable to precisely code Ebola in ICD-9. That’s true.

There is no specific code for the diagnosis of Ebola in ICD-9, only a general code 078.89, other specific diseases due to viruses. In ICD-10, the code is A98.4, Ebola virus disease. This is the kind of data specificity that our nation needs and ICD-10 delivers.

Reason #2: To Help Keep Patients Safe through Better Data

ICD-10 also helps the healthcare industry capture and track data, and use it to ensure the safety of our patients. The inability to have specific data at our fingertips can be crippling to an institution and result in erroneous decisions based on faulty or imprecise data. Be thankful for ICD-10’s ability to accurately pinpoint diagnoses—and support more precise, exact patient care.

Reason #3: To Reduce Costs

Hospitals are strapped for money. Costs must be reduced whenever and wherever possible. ICD-10 will help hospitals properly bill for the services they deliver. With ICD-10 fully implemented and clinical documentation more granular, hospitals will experience fewer payer denials, claims audits and reimbursement appeals. Valuable time, money and resources will be saved over the long run.

Physician practices also have reason for thanks. New data published on the Journal of AHIMA website earlier this month suggests that the estimated costs, time and resources for offices to convert are “dramatically lower” than original estimates. According to the article, the actual conversion cost for a small practice ranges from $1,900 to $5,900, which is 92 to 94 percent less than initially predicted, resulting in a faster return on investment for your ICD-10 efforts.

Reason #4: To Improve Quality Scores and Performance Rankings

Setting aside zany codes and implementation barriers, ICD-10 is a blessing for quality reporting and performance scorecards. ICD-10’s code granularity works hand in hand with improved clinical documentation across all disciplines to help organizations achieve more accurate quality scores and competitive rankings. This is good news for hospitals and physicians alike.

For example, in ICD-9-CM, there is only one code (427.31) for atrial fibrillation.  In ICD-10-CM, physicians must specify the atrial fibrillation as paroxysmal (I48.0), persistent (I48.1) or chronic (I48.2), providing the specificity for a secondary diagnosis that can affect severity of illness scores and impact quality measures.

Reason #5: To Strengthen Hospital-Physician Relationships

ICD-10 is a bull’s-eye for governmental delay. And physician groups are usually the archers behind Congressional action against ICD-10. As recently as this week, physicians were pushing legislators to delay ICD-10 yet again. However, the tide may be turning.

In an effort to help their laggard physicians, many hospitals are reaching out to assist practices and groups in four key areas:

  • ICD-10 assessments
  • clinical documentation reviews
  • technology upgrades
  • physician-coder education

Helping physician practices with ICD-10 is an olive branch that must be extended to realize the full potential of ICD-10. Savvy organizations are using ICD-10 as a pathway to better hospital-physician relationships. Finally, AHIMA, MGMA and AMA have offered resources specifically designed to clear up common misconceptions and concerns physicians have about ICD-10.

No More Delays

It is estimated that the last delay cost the healthcare industry approximately $6.8 billion in lost investments, not including the cost associated with missed opportunities for better health data to improve quality of care and patient safety as mentioned above. Everyone from CMS to AHA, AMA, MGMA and HIMSS has endorsed the move to ICD-10 on October 1, 2015.

The rallying cry from hospital executives, IT directors and clinical coders is clear—no more delays! Even payers are pushing for the October 2015 date with a new consortium featuring Blue Cross Blue Shield of Michigan and Humana leading the charge. As Dennis Winkler from Blue Cross Blue Shield of Michigan states, “ICD-10 is good for the industry. . . . It is in everyone’s best interest to work together and ensure readiness across the board.”

Be Thankful

In Mitch Albom’s 2009 New York Times best seller, Have a Little Faith, the author asks an 82-year-old rabbi to identify his secret to happiness. “Be grateful” is what the rabbi repeatedly claims to be the only true route to happiness.

So next time your executives, staff or physicians are complaining about the transition to ICD-10, remember the five reasons described above . . . and be thankful.

About Wendy Coplan-Gould
Wendy Coplan-Gould is the embodiment of HRS. She has led the HIM consulting and outsourcing company since 1979, through up and down economies and every significant regulatory twist and turn of the last three decades. Long-time clients and new clients alike are on a first-name basis with her and benefit from her focus on excellence, reliability and flexibility. She has been published in the Journal of AHIMA and other recognized publications, as well as conducted countless professional association presentations.

Prior to starting HRS, Wendy served as assistant director, then director, of Health Information Management at Baltimore City Hospital. She also was associate director of the Maryland Resource Center, which provided data for Maryland’s Health Services Cost Review Commission, an early adopter of the Diagnosis Related Group (DRG) methodology. Wendy is available via email: wendy@hrscoding.com.

6 Thanksgiving ICD-10 Codes

Posted on November 27, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 thought it fitting that AdvancedMD sent me 6 ICD-10 codes to be thankful for. Healthcare Humor…who doesn’t enjoy that? Happy Thanksgiving!

Y93.G3 Activity, Cooking and Baking
Ah, the turkey is roasting and the potatoes are boiling. And Cousin Carl just chopped the end of his finger off while preparing the veggie tray. He will earn this ICD-10 code, along with W26.0, Contact with Knife, to forever remember this year’s Thanksgiving…and that nasty scar.

W61.42 Struck by Turkey / W71.43 Pecked by Turkey / W61.49 Other Contact with Turkey
Thanksgiving isn’t Thanksgiving without a turkey. If three is a terrible mishandling of dinner’s main dish, or if a still-flapping gobbler enacts revenge, ICD-10 has three codes that are perfect for the season’s avian-related incident.

W21.01 Struck by Football
Another Thanksgiving staple is the good ol’ American sport of football. Usually, unless there is cheering for opposing teams, televised football games are safe enough. But a well-intentioned family flag-football game can result in a quick trip to the emergency room.

R63.2 Polyphagia (Overeating)
Parrots aren’t the only ones to watch out for this season. If a vampire or zombie takes their costume a bit too seriously, this code will record the chomp.

Y04.0 Assault by Unarmed Brawl or Fight
Black Friday shopping has become just as much a part of Thanksgiving as stuffing and pumpkin pie. But this mass hysteria for great deals doesn’t come without risks—especially when there are two shoppers and only one great bargain up for grabs. Get your extreme shopping skills up to snuff or Y04.0 and Y92.59, Other trade areas (mall) as the place of occurrence of external cause, may be jotted in your electronic health records.

W21.01 Lack of Adequate Sleep
No matter how we choose to celebrate Thanksgiving, few of us escape the meal prep, early morning shopping and family togetherness without a mild case of exhaustion. For those who try to do it all, there is an ICD-10 code for that.

Now I’m off to recover from my W21.01 and R63.2. Although, let me tell you, I had one of my best Turkey Bowl days ever. So much fun! Happy Thanksgiving everyone.

What Were The Best Practices and Benefits of Implementing a CDI Program at Baystate?

Posted on October 28, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 recently sat down with Walter Houlihan, Director of Health and Information Management and Clinical Documentation at Baystate Health, and Steve Bonney, EVP of Business Development and Strategy at RecordsOne to talk about the CDI (Clinical Documentation Improvement) program at Baystate Health. In the video below Walter and Steve talk about the savings that Baystate Health has received from their CDI program including how Walter has used dashboards, metrics and quality to convince senior management to increase Walter’s CDI staff from 4 FTEs to 10 FTEs so that they can review 100% of patients.

Steve and Walter also talk about how they use technology to make those 10 employees more efficient and make it possible for their CDI employees to work remotely.

How is your CDI program working? What technology are you using to make your CDI efforts more efficient? Have you had the success that Walter has had getting buy in from senior management?

Funny ICD-10 Codes Have Ruined the ICD-10 Branding

Posted on October 17, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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.

The people at online physician community, QuantiaMD, recently sent me a list of the top 3 “Crazy ICD-10 Codes” that they got from their community. It was quite interesting to learn that when they asked their community for these codes, they yielded double the participation the company typically sees. No doubt, physicians have globbed on to these funny and crazy ICD-10 codes. I’ll be honest. I’ve gotten plenty of laughs over some of the funny ICD-10 codes as well. Seriously, you can’t make some of this stuff up. Here’s a look at the top 3 crazy ICD-10 codes they received (and some awesome color commentary from the nominators):

1. W16.221 – Fall into bucket of water, causing drowning and submersion. I didn’t realize mopping the floor was so dangerous!
2. 7. Z63.1 – Problems in relationship with in-laws. Really, Who does not?
3. V9733xD – Sucked into jet engine, subsequent encounter. Oops I did it again.

While these codes are amazing and in many respects ridiculous, they’re so over the top that they’ve branded ICD-10 as a complete joke. For every legitimate story about the value of ICD-10 there have probably been 10 stories talking about the funny and crazy ICD-10 codes. You can imagine which story goes viral. Are you going to share the story that talks about improvement in patient care or the one that makes you laugh? How come the story about their being no ICD-9 code for Ebola hasn’t gone viral (Yes, ICD-10 has a code for Ebola)?

Unfortunately, I don’t think the proponents of ICD-10 have done a great job making sure that the dialog on the benefits of ICD-10 is out there as well. Yes, it’s an uphill battle, but most things of worth require a fight and can easily get drowned out by humor and minutiae if you give up. If ICD-10 really is that valuable, then it’s well worth the fight.

My fear is that it might be too late for ICD-10. Changing the ICD-10 brand that has been labeled as a joke is going to be nearly impossible to change. However, there are some key people on the side of ICD-10. CMS for starters. If you can get the law passed, then the ICD-10 branding won’t matter.

One thing I do know is that doing nothing means we’ll get more and more articles about Funny ICD-10 codes and little coverage of why ICD-10 needs to be implemented. I encourage those who see the value in ICD-10 to make sure their telling that part of the story. If you don’t have your own platform to share that part of the story, I’ll be happy to offer mine. Just drop me a note on my contact us page.

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 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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.

Practical Application of Watson with EHR

Posted on July 24, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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.

Ever since Watson made its debut on Jeopardy, I haven’t been able to not check out what Watson was doing next. No doubt what Watson did on Jeopardy was impressive. However, it’s one thing to do what it did on Watson. It’s another thing to commercialize the Watson into something useful.

I’d long been hearing that Watson was going to be great for healthcare IT and that healthcare would really benefit from the technology. However, everything I saw felt very conceptual as opposed to practical and implemented. So, I was really interested in talking with Modernizing Medicine about their EHR integration with Watson.

You can find my interview with Daniel Cane and Dr. Michael Sherling, Founders of Modernizing Medicine, talking about Watson and some of the other cool ways they’re trying to help doctors make use of the data in an EHR in the video below. Plus, we even talk ICD-10 and MU 2 delay as well.

Note: Modernizing Medicine is a Healthcare Scene advertiser.