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More Honest Perspective on Meaningful Use Stage 2

Posted on January 8, 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.

There’s been a really strong reaction to this post on One EHR Vendor’s Experience with MU Stage 2 certification. Although, Gabriel Perna pointed out that there was a lot of “I dislike” in the article and not enough like. Of course, part of that was because it wasn’t intended as a journalistic effort to cover both angles, but was a private response turned public. However, I was intrigued by the question of what Michael Archuleta, Founder and CEO of ArcSys, might “like” about meaningful use.

Here’s Michael’s response:

I REALLY like Context Aware Information.

I do like the idea that doctors have to be more timely on providing completed documentation.

I do like the notion that meeting MU provides a sense of continuity and expectations between doctors with different systems.

I do like the fact that documentation standards need to be lived up to within a practice.

I do like the fact that MU has already helped alert real patients to real problems.

I do like the fact that MU provides additional tools to help the doctor provide more information to their patients.

Wish my list were longer.

I recognize my “dislike” list comes across as a lot of whining. But, if there is no leadership or anyone willing to respond to my concerns, then the EMR community will struggle.

Plus, Michael added some more perspective to his previous comments:

Part of the frustration is that I spent 20 years of my life dealing with inconsistencies of the “standards” associated with electronic claims. Each insurance carrier would read the same rules differently and we, the vendors, had to code for zillions of contingencies.

Then the same thing happens with HL7 lab results.

Then we get MU and a whole set of “standards” and “rules”. It sounds like the same old song but on a different radio station.

What are we going to do when the SNOMED advocates feel their codes should trump Rxnorm or LOINC or ICD-10? When I talk with doctors about their understanding of these various coding systems, they are mostly clueless. If they balk at implementing ICD-10, wait until they meet SNOMED. Has anyone laid out the rules with respect to certification of when to use atomic-ids rather than concept-ids? These are but a few of the unknowns that people will encounter.

If I could have implemented and coded all the rules for MU2 before the final rules were published, then I could have asked real questions. But, there was no time, so now I live with the consequences. It is akin to the famous Pelosi statement, “You have to pass the law in order to know what’s in it.”

There is definitely a challenge in the rule making process. I really think that ONC takes the public comments very seriously. The challenging question is whether the right people are making the comments and whether the comments are informed or not.

One EHR Vendor’s Experience with Meaningful Use Stage 2 Certification

Posted on January 3, 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 always love hearing from the CEO of EHR vendors. One that never disappoints is a man that most people in the EHR world have probably never heard of. His name is Michael Archuleta and he’s the Founder and CEO of a company called ArcSys (RedPlanet is their EHR). In response to my article on ComChart not going after meaningful use certification, he sent me a newsletter he recently sent his staff and some other side comments. They provide some real insight into the 2014 certification process and meaningful use stage 2.

Excerpts from the newsletter:

ArcSys has invested heavily in meeting the demands of Meaningful Use Stage 2. Whereas we thought Stage 1 was difficult, Stage 2 has taken substantially more time to meet the requirements.

We are not alone in meeting these challenging complexities. In reading the Internet chatter, there are other vendors who are facing the daunting task at hand.

ComChart Medical Software, has thrown in the towel by saying, “In addition to the Meaningful Use mandates, there continues to be a never ending stream of new mandates such as ICD-10, PQRI, Meaningful Use 2, Meaningful Use 3, SNOMED, ePrescribing, LOINC, Direct Project, health information exchanges etc. As a result of the mountain of mandates, ComChart EMR and the other small EMR companies will have to choose to implement the mandates or use their resources to add “innovative” features to their EMR. Unfortunately, the small EMR companies do not have the resources to do both.”

Obviously, ArcSys does not share this same viewpoint. If we can do it, then it means anyone should have been able to do it, too. We are either smarter (not true) or we had a superior software design from the beginning (probably quite true). The first round of software development has now been completed and we are prepared for certification. Our certifier, the Drummond Group, has a backlog of systems to be tested and have given us a mid-April test date. Having completed this development, we know with great precision what each doctor will have to do in order to meet MU2. And, yes, it will be difficult.

There are 37 testing “points” that we have focused on. It took us two months to do 36 of these points and another two months to do the remaining point (clinical quality measures). Many of the testing points had literally hundreds of scenarios to evaluate. There were situations we would discover after working for weeks that necessitated going back to the beginning and having to start over on retests.

Now for some really interesting bullet points on meaningful use stage 2 certification:

ArcSys has to be the tiniest company on the planet seeking MU2 certification.

Yes, I dislike the extra burdens being placed on providers for MU2.
Yes, I dislike the vague (non-existent?) guidelines on how to properly use SNOMED, Rxnorm, and LOINC.
Yes, I dislike the committees who dream up measures and certification rules that have little relevance to how docs like to treat and interact with patients. Do they really believe MU2 and seeing 40+ patients/day can co-exist??
Yes, I have written every line of code for our product to handle MU2 and I know of flaws and weaknesses the testing tools are ignoring.
Yes, I hate being pulled away from being able to work on software enhancements.
Yes, we were naive in thinking that MU2 would take as much time as MU1 to develop and test. It was easily 10 times more complicated.
Yes, I dislike wading through the Google/JIRC posts to see what other hapless souls like me our stumbling for answers regarding certification.
Yes, it is nearly impossible to read any document produced by HL7.org and find helpful guidelines.
Yes, I dislike the Cypress testing tool.
Yes, I dislike the XML bloat for reporting measures and transporting patient data.

So, why do we continue? Simple. We made a commitment to our client base who likes our service and support. And, in the end, we’ll be as conversant as anyone on the ins and outs of MU2.

How’s that for a real look at some of the nitty gritty EHR vendors face when it comes to 2014 Certification and meaningful use stage 2?

An EMR Vendor’s Approach to Bridging from ICD-9 to ICD-10

Posted on August 6, 2010 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.

In response to my previous EMR and ICD-10 posts, an EMR vendor recently sent me how they plan to address the transition from ICD-9 to ICD-10. Here’s their plan:

1. We are going to have both the ICD-9 and ICD-10 codes reside in the same file in our application. This will allow the charge entry people to enter either code. There will be a field in the ICD-9 that will map to a single ICD-10.
2. We will provide a report to each doctor showing them the frequency of the ICD-9 codes they used over a period of time that they can specify. This report will show the available ICD-10 codes. The doctor can study it, start to change, or ignore it.
3. The staff can opt to let the software map one ICD-10 to the ICD-9 or manually enter the code of their choice.
4. Our electronic claims software will have a flag per insurance carrier indicating whether or not it will accept ICD-10. For those that will, we will map the ICD-9 to the 10 and send that code. If no map identified, we will generate an error edit.
5. At some point down the road, we will use the information collected from billing to update the doctor’s preferred list of dx codes in the EMR.
6. We will have to augment customized programs at each client site that may be doing reports based on ICD-9.

A Look at Moving to ICD-10

Posted on August 4, 2010 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 push to ICD-10 is rapidly approaching. That’s why I was interested to know how EMR vendors were going to get the ICD-10 code list. However, there are going to be a lot of other nuances for EMR vendors to move from ICD-9 to ICD-10.

The following is a short description of some real data around the move from ICD-9 to ICD-10. It’s from a newsletter sent out by ArcSys including some interesting data from a real clinic. It’s going to be interesting to make the transition to ICD-10 along with all the fun things happening around Meaningful Use.

On October 1, 2013, all claims processing needs to be transitioned to the new ICD-10. As you can well anticipate, this will be a major change for the healthcare industry. As a practice, your biggest challenge will be the re-education of the staff on what the new codes are and their associated nuances. Starting January 1, 2011, CMS will start to accept the 5010 claim definition which will allow for the transmission of the ICD-10 codes.

ArcSys will have the software tools in place to assist you in the transition. We can provide you with reports showing the frequency of which ICD-9 codes have been used by each provider. The major problem is that there is no one-to-one mapping—it is one-to-many for numerous codes.

As an example, from an internal medicine group, the number of times that a diagnosis related to diabetes over a one-year period produced the following part of a report:

250.00 703
250.01 81
250.02 145
250.03 27
250.30 1
250.40 16
250.43 2
250.51 1
250.60 43

If you look at the published mapping files as provided from the Centers for Medicare and Medicaid Services, you will find the following “simple” example:

25000 E119 10000
25001 E109 10000
25002 E119 10000
25003 E109 10000
25010 E1310 10000
25011 E1010 10000
25011 E1011 10000
25012 E1169 10000
25013 E1010 10000
25020 E1101 10000
25020 E1100 10000

Thus, ICD-9 code 250.00 maps to E11.9 (Type 2 diabetes mellitus without complications), and 250.20 maps to either E11.01 (type 2 diabetes mellitus with hyperosmolarity with coma) or E11.00 (type 2 diabetes mellitus with hyperosmolarity without nonkeototic hyperglycemic-hyperosmolar coma). Clearly, some “dusting off” of the old textbooks may be necessary to get a better understanding which code might make the most sense. (The 10000 number is a “computer number” that will be used to identify the degree of association between the the ICD-9 and ICD-10. It is far too-complex to describe in the space allotted here.)