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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.

The Tyranny of “Time” – EHR Efficiency Has a Lifecycle

Posted on November 5, 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 love when you can find a picture, chart or graph that describes an important concept. I saw that during a CHIME Fall Forum focus group that was led by Heather Haugen from The Breakaway Group. During the focus group, Heather put up the following slide to describe the level of optimization a hospital experiences during the lifecycle of an EHR.

EHR Adoption Optimization Lifecycle

The key element in the above graph is the trough that happens after the initial adoption. I think the slide into that trough of EHR inefficiency is as steep as what’s shown on the graph, but the dip in efficiency definitely occurs. In fact, I think that the path to inefficient EHR use is slow and that’s why many healthcare leaders don’t notice when it happens.

The solution to this problem is to create a program in your organization that manages upgrades, provides ongoing training, and regular workflow assessment and optimization. I imagine most organizations weren’t worried about this when they slapped in their EHR to meet meaningful use. However, now they’re all going to have to take a deep look into solving this long term problem.

Full Disclosure: The Breakaway Group is a sponsor of the Breakaway Thinking series of blog posts on EMR and HIPAA.

Killing Meaningful Use and Proposals to Change It

Posted on September 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.

Isn’t it nice that National Health IT Week brings people together to complain about meaningful use? Ok, that’s only partially in jest. Marc Probst, CIO of Intermountain and a member of the original meaningful use/EHR Certification committee (I lost track of the formal name), is making a strong statement as quoted by Don Fluckinger above.

Marc Probst is right that the majority of healthcare would be really happy to put a knife in meaningful use and move on from it. That’s kind of what I proposed when I suggested blowing up meaningful use. Not to mention my comments that meaningful use is on shaky ground. Comments from people like Marc Probst are proof of this fact.

In a related move, CHIME, AMDIS and 15 other healthcare organizations sent a letter to the HHS Secretary calling for immediate action to amend the 2015 meaningful use reporting period. These organizations believed that the final rule on meaningful use flexibility would change the reporting period, but it did not. It seems like they’re coming out guns blazing.

In even bigger news (albeit probably related), Congresswoman Renee Ellmers (R-NC) and Congressman Jim Matheson (D-UT) just introduced the Flexibility in Health IT Reporting (Flex-IT) act. This act would “allow providers to report their Health IT upgrades in 2015 through a 90-day reporting period as opposed to a full year.” I have yet to see any prediction on whether this act has enough support in Congress to get passed, but we could once again see congress act when CMS chose a different course of action like they did with ICD-10.

This story is definitely evolving and the pressure to change the reporting period to 90 days is on. My own personal prediction is that CMS will have to make the change. I’d love to hear your thoughts.

Happy National Health IT Week!

Will The Government Shutdown Lead to the Meaningful Use Stage 2 Delay?

Posted on October 10, 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.

It seems like every healthcare organization that exists has called for a delay to meaningful use stage 2. I’ve predicted before that I think that meaningful use stage 2 will have some sort of delay. I feel even more confident in that prediction thanks to the government shutdown.

With so many people not working at ONC, I think there’s a practical question of whether they can really be ready for MU stage 2. However, maybe even more powerful is that the government shutdown now gives ONC an excuse for why the delay should happen. They can blame the delay on the government shutdown and not on something else. Let’s call it the straw that broke the camel’s back.

Although, Farzad Mostashari at CHIME 2013 disagreed. Here’s the tweet I sent during his keynote presentation:

It was nice of Farzad to retweet it as well. I think he really believes this statement. I was sad he didn’t reply or retweet my other tweet:

If I were a betting man (which I’m not despite living in Vegas), I’d bet on a MU stage 2 delay. However, Farzad did place that seed of doubt in my prediction. Farzad made a good case for why some parts of meaningful use stage 2 we can’t wait on anymore. However, with him no longer as leader we’ll see if they can hold the course with no delays.

Digital Health Conference in NYC

Posted on September 5, 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.

dhc_2013_header_580px
As most of you know, I’ve been working with the New York eHealth Collaborative (NYeC) for the past couple years on their Digital Health Conference. They buy some advertising on my websites, and I get the chance to attend an amazing event. I love this event, because NYeC has a great connection with the local community of doctors and hospitals and so the event is chalk full of those working in the trenches of healthcare. I expect this year to be no different.

The good news is that once again they’ve given readers of my websites a 20% registration discount. Just use the code HCS when registering at www.DigitalHealthConference.com.

They’ve lined up two keynote speakers for the event: George C. Halvorson, Chairman, Kaiser Permanente and Jim Messina, National Director, Organizing for Action; Campaign Manager, 2012 Obama Re-Election Campaign; Deputy Chief of Staff to President Obama. I like the mix of someone deeply rooted in healthcare and also someone who likely understands healthcare politics really well.

Along with the keynotes, I’m told they are looking at about 1200 attendees at the event. They’ve also published the full agenda of speakers. I look forward to seeing many of my readers at the event.

Along with the Digital Health Conference, I’ll be attending a number of other Healthcare IT conferences this year. Influential Networks has created a calendar of Fall health IT events where you’ll find myself and other influencers. Right now I have MGMA, CHIME, Healthcare Payments Processing & Compliance Summit, AHIMA, and the Digital Health Conference on my dance card. I may add mHealth Summit as well. Should make for an exciting fall conference season.

Let me know if you’ll be at any of these conferences. I always love to connect with readers in person.

Healthcare Groups Want Meaningful Use Evaluated Before Stage 3

Posted on January 16, 2013 I Written By

Katherine Rourke 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.

Though the final rules for Meaningful Use Stage 3 aren’t due to take effect until 2016, ONC has already made the draft rules available for public comment.  And comments, to be sure, the agency is getting.

While various groups have chosen their own details to critique, the general consensus seems to be that ONC is getting ahead of itself and ought to give Meaningful Use Stage 1 and 2 a good hard look first.

Accordng to a nice summary from iHealthBeat, here’s where some of the major healthcare groups stand:

* The American Hospital Association is recommending that ONC fund a comprehensive evaluation of MU generally, and while it does, hold off on finalizing Stage 3 recommendations.

*  CHIME, too, is asking ONC to evaluate the existing Meaningful Use program to decide whether achieving stage 3 is realistically possible by 2016.

* The Federation of American Hospitals is also arguing that ONC needs to evaluate current Meaningful Use requirements.  Also, in its letter to ONC, the group argues that the existing structure of two years per stage doesn’t cut it.

* The AMA weighed in with its own recommendation that ONC evaluate Meaningful Use as is before moving ahead. It also suggested changing some thresholds to  make them more reachable; greater flexibility in program requirements; change the certification process to address usability; and improve HIT’s capability to share patient data.

Personally, I think the idea of doing an extensive Meaningful Use evalulation sounds like a good one, and I hope ONC actually does so.  When you’re setting new standards that affect so many providers, why not gather some data on how existing standards work?

Hospital CIO Jobs

Posted on October 18, 2012 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 past couple days, I’ve been at the CHIME Fall CIO Forum in Palm Springs. This is my first time attending the event and it’s been an eye opening experience to say the least. It’s an amazing experience to have casual conversations with many in the healthcare IT industry and particularly with hospital CIOs.

While chatting with a former hospital CIO who now is on the vendor side, he made this fascinating observation:

I travel around and talk to a handful of CIOs every week as part of my job. When I meet with these hospital CIOs and hear about the challenges they face in their institution, I don’t get the feeling “That’s a really swell place to work. I want that job.”

In this current economic climate, it’s hard for anyone to feel really bad for a well paid hospital CIO (Yes, some are better paid than others). I acknowledge that many around the country would argue that a hospital CIO should be glad to have a job, and one that pays above the national average salary.

This general economic argument aside, I think it’s worth noting the challenging situation that many hospital CIOs face. Regardless of how much someone is paid, that doesn’t change the enormous challenge that most hospital CIOs confront every day.

Yes, we could start with the list of alphabet soup including: meaningful use, EHR, ACOs, 5010, HIE, and ICD-10 to name just a few. However, that’s just the beginning of what they’re dealing with in their jobs. Another major one worth mentioning is managing the budgets. It’s a complex, high pressure job whenever money is involved. Add in all the various maintenance, people management, process management, etc etc etc and the hospital CIO has a tough job.

This has never been more clear to me than at CHIME where the hospital CIOs all come and commiserate. I don’t think we should feel bad for these hospital CIOs and I don’t think they’re asking us to do that either. Although, it’s worth acknowledging that hospital CIOs face a tough and challenging job and I don’t see that changing any time soon. I appreciate those that are willing to take up the challenge and that perform so well in the face of such a changing environment.

Workforce and Regional Extension Center Challenges in HITECH Act

Posted on November 10, 2009 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 just read one of the best blog posts I’d read in a long time. So much so that I just had to post part of it a link to it on my site. The post is called “Far From Shovel-Ready” by Anthony Guerra. I think you all should go and read the entire post. It’s well thought out and well written. I don’t know Anthony Guerra personally, but our paths have regularly crossed on the internet. I hope one day to have the pleasure of meeting him (maybe at HIMSS?).

His blog post starts out with this statement, “Legislation that took weeks to write will wreak havoc for years.” I’m not quite as certain as Anthony that it WILL wreak havoc. However, I’ve been warning of the possibilities of problems for a while now.

He describes the main points of his post like this:

My unpalatable HITECH morsel of the moment centers, generally, around the lack of healthcare IT workforce necessary to make the legislation’s goals a reality and, more specifically, the bizarre market dynamics that will be precipitated by the half-baked Regional Extension Center (REC) farce.

You can read the article for the rest of the details. However, those interested/worried/concerned about the workforce shortage in healthcare IT will enjoy this part of the article:

This means the fight for healthcare IT talent, which everyone agrees is heating up, will get doubly vicious, with hospitals, large practices, vendors and consultancies — and now 70 RECs — competing on what will be an uneven playing field for scarce talent.

Why uneven? Because the RECs will be able to pay fantasy wages, taxpayer funded wages, to woo the cream of your healthcare IT workforce.

At the recently held annual CHIME conference, I spoke to the CEO of a boutique HIT consultancy who said he, “needed 50 people TODAY,” but had no idea where they would come from. John Glaser, Ph.D., CIO at Partners Healthcare and senior special advisor to ONCHIT, recently wrote that those who employ healthcare IT talent must be sure their wages are fair and their work fulfilling, as poaching season is fast approaching.