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Health Information Governance of 3rd Party Vendors

Posted on August 26, 2015 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 love when my eyes are opened to an issue that I haven’t heard people talking about. That’s what happened when I heard Deborah Green from AHIMA say that health information governance includes your third party vendors. I’m not sure how many organizations realize this and treat it appropriately.

What’s ironic is that we definitely do this with HIPAA. This is particularly true in the HIPAA omnibus world. Healthcare organizations have a certain expectation around security and privacy when it comes to their third party vendors. It’s a major part of every RFP I’ve ever seen in healthcare.

Why then don’t we treat information governance with third parties the same as we do with HIPAA?

My guess is that some organizations do, but they haven’t really thought about it in this way. It’s an informal part of how they deal with third party vendors. For example, how are third party vendors storing your organization’s health data? Do they dispose of it properly? etc etc etc. These are all great health information governance questions that we’re asking ourselves, but are we asking our third party vendors these questions as well? Should we be asking them?

One challenge I think we face is that we assume that if we’re paying a vendor to do something, that the vendor is going to do it the right way. We assume that a paid service is going to be done in the best way possible. I’m sure your experience like mine is that just isn’t the case. Was it Reagan that said, Trust but verify? That seems appropriate in this instance.

What’s clear to me is that health data is going to become more and more valuable to healthcare organizations. Making sure you have a handle on that data is going to be an important part of ensuring your financial future. That includes making sure that your third party vendors use good health information governance principles as well.

Transferring Custody of a Chart to the Patient – Could That Drive Patient Engagement?

Posted on August 11, 2015 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 wrote about the concept of health information disposal and how we’re going to have to reevaluate how we approach disposing of patients charts in this new digital world. Plus, EHR vendors are going to have to build the functionality to make it a reality. However, some replied to that article that in this new world we shouldn’t ever dispose of charts.

We’ll leave that argument for that article (or in the comments) and instead discuss another concept that Deborah Green from AHIMA told me about. Deborah suggested that one possible solution for digital chart disposal would be to transfer custody of the chart to the patient. I think that terminology might not sit right with some people since the patient should have access to the chart regardless. However I think the word custody has a slightly different meaning.

When a healthcare organization is ready to dispose of an electronic chart based on their record retention laws (which usually vary by state), then it’s the perfect time to give patients the opportunity to download and retain a copy of their paper chart before it’s destroyed. In that way, the healthcare organization could worry less about deleting the electronic chart since they’ve transferred “custody” of the chart to the patient.

This removes the responsibility of storing the patient chart from the healthcare organization and puts it on the patients that want to have their entire medical chart. The perfect custodian of the patient chart is the patient. At least it should be.

I wonder if a healthcare organization informing patients that their old charts will be deleted would be enough to actually drive patient engagement and download of their electronic record. While meaningful use has required the view, download and transmit of records by patients, most people have been gaming that requirement without patients really getting the benefit. I have a feeling that patients hearing the words “deleted chart” would wake a lot of them up from their slumber. They wouldn’t know why they’d want the paper chart, but I imagine many would take action and preserve their medical record. Once they download the chart, it would be the first step towards actually engaging with their health data.

What do you think? Is transferring custody of the electronic record the right approach to health information disposal? Would this drive a new form of patient engagement? Would it wake up the sleeping giant which is involved patients?

HIM Departments Need More Support

Posted on July 16, 2015 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

As both a contributor to this blog, and an assertive, activist patient managing chronic conditions, I get to see both sides of professional health information management.  And I have to say that while health data management pros obviously do great things against great odds, support for their work doesn’t seem to have trickled down to the front lines.  I’m speaking most specifically about Medical Records (oops, I mean Health Information Management) departments in hospitals.

As I noted in a related blog post, I recently had a small run-in with the HIM department of a local hospital which seems emblematic of this problem. The snag occurred when I reached out to DC-based Sibley Memorial Hospital and tried to get a new log-in code for their implementation of Epic PHR MyChart. The clerk answering the phone for that department told me, quite inaccurately, that if I didn’t use the activation code provided on my discharge summary papers within two days, my chance to log in to the Johns Hopkins MyChart site was forever lost. (Sibley is part of the Johns Hopkins system.)

Being the pushy type that I am, I complained to management, who put me in touch with the MyChart tech support office. The very smart and help tech support staffer who reached out to me expressed surprise at what I’d been told as a) the code wasn’t yet expired and b) given that I supplied the right security information she’d have been able to supply me with a new one.  The thing is, I never would have gotten to her if I hadn’t known not to take the HIM clerk’s word at face value.

Note: After writing the linked article, I was able to speak to the HIM department leader at Sibley, and she told me that she planned to address the issue of supporting MyChart questions with her entire staff. She seemed to agree completely that they had a vital role in the success of the PHR and patient empowerment generally, and I commend her for that.

Now, I realize that HIM departments are facing what may be the biggest changes in their history, and that Madame Clerk may have been an anomaly or even a temp. But assuming she was a regular hire, how much training would it have taken for the department managers to require her to simply give out the MyChart tech support number? Ten minutes?  Five? A priority e-mail demanding that PHR/digital medical record calls be routed this way would probably have done the trick.

My take on all of this is that HIM departments seem to have a lot of growing up to do. Responsible largely for pushing paper — very important paper but paper nonetheless — they’re now in the thick of the health data revolution without having a central role in it. They aren’t attached to the IT department, really, nor are they directly supporting physicians — they’re sort of a legacy department that hasn’t got as clearly defined a role as it did.

I’m not suggesting that HIM departments be wiped off the map, but it seems to me that some aggressive measures are in order to loop them in to today’s world.

Obviously, training on patient health data access is an issue. If HIM staffers know more about patient portals generally — and ideally, have hands-on experience with them, they’ll be in a better position to support such initiatives without needing to parrot facts blindly. In other words, they’ll do better if they have context.

HIM departments should also be well informed as to EMR and other health data system developments. Sure, the senior people in the department may already be looped in, but they should share that knowledge at brown bag lunches and staff update sessions freely and often. As I see it, this provides the team with much-needed sense of participation in the broader HIT enterprise.

Also, HIM staff members should encourage patients who call to log in and leverage patient portals. Patients who call the hospital with only a vague sense that they can access their health data online will get routed to that department by the switchboard. HIM needs to be well prepared to support them.

These concerns should only become more important as Meaningful Use Stage 3 comes on deck. MU Stage 3 should provide the acid test as to whether whether hospital HIM departments are really ready to embrace change.

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.

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.

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 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’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.

To ICD-10 Delay or Not To ICD-10 Delay

Posted on March 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.

UPDATE: It looks like this bill has passed the house with a voice vote. I believe it still needs to be passed by Congress and not be vetoed by the President.

UPDATE 2: Late on 3/31/14, the Senate passed the bill which delays ICD-10 by a vote of 64 – 35. Barring a veto from the President, the bill will go forth and the ICD-10 implementation date will be moved to October 1, 2015. All of the discussion for the bill was around the SGR fix with no conversation around the ICD-10 delay. It’s unlikely that the President would even consider a veto of this bill.

We’d already stoked the ICD-10 delay fires in Kyle Samani’s post on “Why ICD-10?” before the news came out yesterday that a one year ICD-10 delay was put in an SGR bill. Word on the street was that the bill would be put up for a vote today. However, I hear now that the vote on the bill is going to be delayed at least until tomorrow.

The reports are saying that this bill was developed by John Boehner and Harry Reid which likely means they have enough votes to make it a reality. I read that Nancy Pelosi said on CSPAN that the bill wasn’t perfect, but needed to be passed. My only question is whether the delay in voting is because they’re still trying to cull votes for the bill or something else.

As I suggested in my post linked above, my guess is that congress is hearing from both those for delaying ICD-10 and those who oppose delaying ICD-10. I bet they consider the response a wash and so it won’t sway them either way. Plus, I bet that most in Congress are only talking about the SGR portion of the bill without much discussion on the ICD-10 delay.

This decision is going to cut many people. Let me share a few of the comments I’ve read.

First, from the LinkedIn AHIMA group, here’s a coder perspective on the delay:

I think of the coder who is a single mom struggling from pay check to pay check who had to spent $500 (or more) to take a course and another $60 on the proficiency exam, spent time away from caring for her family to prepare for the implementation only to have the rug pulled right from under her. The $560 is likely her discretionary income for the month. Who is thinking or her?

Don’t tell us there will absolutely be NO delays, allow us to spend our hard earned money to prepare, and then say “just kidding– we are going to tease you with another year — make you spend more money — promise no delays — then change our mind again!” “Oh, and the check is in the mail.” Yes ladies and gentleman, this is our government working “for the people.” And I ask, why does Congress even care about ICD-10? Do they even have a clue what they are voting for or against? They are trying to quietly slip it into a bill so that no one notices. I could be wrong, but it sounds like the work of a single lobbyist and Senator/Congressman. I would like to know the name of the person who put that language into the bill. Democracy at its finest!

Now a perspective that is likely shared by the thousands of ill-prepared practices and hospitals (although, my guess is that it was their larger organizations that lobbied for it, not the individual practices and hospitals that aren’t prepared):

As bad an idea as it is, a majority of practices, and a significant number of hospitals, health systems and other providers are, or feel, very un-prepared for the transition, and so have lobbied for delay. D.C. insiders say it’s a done deal.

On the other side is the prepared health IT vendors that think that a delay is letting the ill prepared off the hook. One EHR vendor sent me an email with this message:

This really is a pain to a vendor like us that is all ready to launch and take good care of our clients with ICD-10. Everything we programmed came out great and we are ready to go.

This feeling doesn’t just apply to health IT vendors that have procrastinated, but to all the procrastinators:

Why prolong the inevitable, again? The procrastinators should be penalized, not the rest of us who’ve been preparing for it.

What we all want most is certainty. HHS came out with certainty during HIMSS when they said that there would be no more delays with ICD-10. Unfortunately, HHS doesn’t control congress.

I’ve been reading a lot of reports that a delay in ICD-10 would cost billions of dollars. I’m not sure I trust those numbers, but it’s no surprise that those numbers don’t take into account the impact and cost of ICD-10 being implemented. Personally, I see costs in ICD-10 going forward and costs in ICD-10 being delayed. I’m not sure we can quantify either number accurately.

Obviously, this is a fast moving story, so I’ll update this post with any updates as I get them. Feel free to leave comments with updates as well.

3 Suggestions for Dealing with Healthcare Audits

Posted on November 14, 2013 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.

While at AHIMA 2013, one of the big topics people were discussing was all of the audits that the HIM staff are having to deal with on an ongoing basis. Everyone that I talked to said that there is no end in sight when it comes to the various audits. In fact, most were predicting even more audits to come.

I sat down with Dawn Crump, VP of Audit Management Solutions from HealthPort, to find out some suggestions for organizations trying to deal with this wave of audits in healthcare. Check out the video below to hear those suggestions (plus, she throws in a fourth and fifth bonus suggestion):

How is your organization dealing with all of these audits? Have you formalized and streamlined the process in your organization? Do you have an easy way to track all of your audits? Do you know the financial impact of these audits on your organization?

Timeline for Healthcare Organizations to Train for ICD-10 – ICD-10 Tuesdays

Posted on November 12, 2013 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.

Right as the AHIMA exhibit hall was closing (literally they turned out the lights on us), I pulled out my video camera and got the following interview with Garry Huff, MD, CEO and President of Huff DRG Review Services. In the video, Dr. Huff addresses the challenge of training doctors on ICD-10. As a doctor, he offers a unique perspective on what works and what doesn’t work when training doctors on ICD-10. Plus, he looks at the timeline organizations should plan for training doctors on ICD-10.

I really love Dr. Huff’s approach to teaching doctors ICD-10. They realize that doctors have limited time and attention span. They have doctors from a specific specialty training that specialty. They do a gap analysis on the training needs so they can focus that training on what each specific provider needs to learn.

Dr. Huff also suggested that a doctor can be trained on ICD-10 with this type of specialty and provider specific training in 30 minutes to an hour. Is this enough time to train doctors on ICD-10?

Prediction: AHIMA 2013 Will Be ICD-10 All Day All the Time

Posted on October 25, 2013 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 will be my third year in a row attending the AHIMA Annual Conference (I think they call it the AHIMA Convention) which starts on Monday in Atlanta. I’m particularly excited for this year’s event because I have so many healthcare IT friends in Atlanta. Plus, I always have a great time at the event and learn a lot.

This year we’ll actually have three different Healthcare Scene bloggers (Jennifer Dennar, Mandi Bishop, and myself). So you can be sure to get some really varied coverage from the event from a number of different perspectives.

As I consider all the pitches I’ve gotten and think about the work of AHIMA, I can already tell that AHIMA 2013 is going to be dominated by one topic: ICD-10.

I honestly don’t think it’s even going to be close. I believe this is a very good thing. Hopefully the focus of attention on ICD-10 a little less than a year out from the ICD-10 implementation date is a good thing for the industry. You can be sure I’ll be doing what I can to help people better understand how they can prepare for ICD-10 and some of the tools out there.

Assuming I’m not too overwhelmed with all the AHIMA ICD-10 talk, next week I’d like to start a weekly series of posts on ICD-10. It feels right to call it ICD-10 Tuesdays. So, look forward to that series in the future.

Also, Agency Ten22 is holding the third annual tweet up at AHIMA on Tuesday evening. You can find more details and RSVP here. I’m reminded of the first tweetup. Beth from Agency Ten22 told me she had a nice suite. I told her I’d bring some Twitter friends and the AHIMA tweetup was born. Big thanks to Beth and her team for carrying on the tradition.

Finally, the rest of my travel for this year is booked. I’ll be at the Digital Health Conference (20% discount if you use the code HCS) in NYC in November and at the mHealth Summit in Washington DC in December. I hope to see many of you at one of these events.