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ICD-10 Provider Progress Concern to Payers

HDN reported on the results of a TriZetto Group survey

A stunning 86 out of 100 responding health care payers in the fifth of a series of periodic surveys on ICD-10 readiness worry that providers won’t be ready by the October 2013 compliance date to submit claims using ICD-10 codes. Only 9 percent of surveyed payers have begun testing provider submitted data.

That compares with a 75 percent rate of payers worried about provider progress in a survey taken during the third quarter of 2010.

Additional insights from the February 2011 survey  include:

• As of February with 11 months until the HIPAA 5010 transactions deadline, 47 percent of surveyed payers have built or mapped 4010 to 5010 files;
• Only 9 percent of surveyed payers have completed 5010 trading partner testing; and
• Health insurers increasingly are more receptive to receiving ICD-10 assistance from vendors with infrastructure modifications, strategic planning, care management upgrades and testing.

Oracle Transcription is providing state of the art applications to support new clinical documentation and workflow needs.

Health I.T. Competency Exams

The Office of the National Coordinator for Health Information Technology ONC has awarded $116 million in funding for an impressive number of Health IT Workforce Development Program  initiatives.  The ONC  underscored the need for the country moving toward a more technologically advanced health care system, providers are going to need highly skilled health IT experts to support them in the adoption and meaningful use of electronic health records.
This includes a “Health I.T. Professionals Competency Examination,” a series of six exams to enable individuals to demonstrate their skill level in various roles and to enable health care organizations and vendors to assess the skills of their I.T. staffs.

The exams are designed to align with roles and training provided under the ONC-sponsored community colleges training program and are open to graduates of the program and individuals already in the workforce. Employers, for instance, could use the exams to identify additional training needs for existing staff, according to ONC. Individuals also could take one or more exams on their own to burnish their credentials.

The six areas covered in the exams are clinician/practitioner consultant, implementation manager, implementation support specialist, practice workflow and information management redesign specialist, technical/software support staff, and trainer.

Vouchers for free exams, on a first-served basis, are available at hitproexams.org for 27,500 U.S. health I.T. workers. Eligible individuals include those trained through the community college program and others with relevant experience, training or education. ONC has selected 230 sites across the nation where the exams will be offered. Individuals unable to obtain a voucher can pay $299 for an exam. The cost for re-taking an exam for the same role or an additional exam is $199.

Oracle Transcription is committed to leadership in the clinical data management sector as well as to training and education.

New Study on the Real Cost of Launching an ACO

While ACOs hold the promise of patient and quality-centric healthcare, and heralds a bold new vision for the delivery of health services, another study sets a chilling impact on its lofty ambitions.

This time a study commissioned by the American Hospital Association estimates start-up costs for establishing an accountable care organization to be many times higher than estimates from the Centers for Medicare and Medicaid Services.

Joseph Goedert of HDM reported on a May 13 letter from AHA to CMS Administrator Donald Berwick, M.D. Where he stressed that  “The analysis indicates that the per organization investment required to put in place and sustain the elements necessary for success is considerably higher–$11.6 to $26.1 million–than the $1.8 million estimated by CMS in its proposed rule for start-up and one year of operating expenses,” according to

HDM further reports that the AHA suggests that the shared savings that providers would get from an ACO need to be higher than what CMS has proposed. “As we will discuss further in our forthcoming comment letter, CMS should adjust the shared savings rate in recognition of these costs in order to encourage and enable participation in this important program.”

The study, from McManis Consulting in Greenwood Village, Colo.,  is enlightening as it identifies 23 different capabilities that must be harnessed “to achieve the desired transformation in care delivery,”  Those capabilities stretch across four broad categories: network development and management; care coordination, quality improvement and utilization management; clinical information systems; and data analytics.

Oracle Transcription is a leader in clinical documentation.

Liberating Data by the Department of Health and Human Services

We were happy to participate in a gathering of community health leaders in Chicago on April 27.

Todd Park, the chief technology officer at the Department of Health and Human Services, stole the show with a strong message about the role federal government is looking to play (or not play) in accelerating the deployment of new technologies for better care and self-management.
This is acheived in part by freeing vast troves of historical data to the industry and encouraging the development of new applications. HHS has sponsored competitions inviting software developers to design new applications for consumers and providers.

The meaningful use EHR adoption incentive program is merely the beginning. Park added that . “There has never been a better time to innovate in health I.T.”
The underlying agenda is to progressively transform the healthcare system from fee-for-service reimbursement to performance and quality standards.

Park pointed to an HHS Web site, healthdata.gov, as a portal to the various efforts with access to data banks to support them. “It’s the uber-warehouse,” Park said.

He did remind us that technology is not a panacea: without education, training and self-management “technology will only help us document our failures.”

Oracle Transcription is a leader in work flow management. Call us for all your clinical documentation needs.

EHR as Source for Future Quality Reporting

The Centers for Medicare and Medicaid Services issued a rule on May 5 in connection with proposes changes to the hospital inpatient payment system and long-term care prospective payment system for fiscal 2012. They are entertaining the day in the very near future where hospitals will no longer have to abstract from patient charts quality measures required under the Hospital Inpatient Quality Reporting program. CMS suggested that at a future date, such as 2015, CMS and hospitals will be able to switch to complete EHR-based reporting of all chart-abstracted measures to CMS for the Hospital IQR Program, and we intend to work diligently toward this goal,”  Chart abstractions in the near future will be a thing of the past.
CMS invites public comment on a number of new quality measures and issues.

Oracle Transcription is a leader in  clinical documentation.

Structured Document Management Evolution

We are grateful to Gary Baldwin of HDM for reminding us that the core underpinning to the meaningful use strategy is predicated on “structured data,” (The End of Document Management? – May 10, 2011). The structuring standard of medical data brought about by the federal mandates has many advantages the least of which is easy access, mining and analysis.

Baldwin reminds us that document imaging systems may well become the most hapless children of this revolution as it is relegated to a secondary role even if they “reduce storage costs associated with maintaining bulging files, and well-indexed files can serve as a stepping stone to more fully blown EHR systems”.

The future is well grounded in interoperability, and imaging operations should be considered passé.

Janie Tremlett, senior vice president, strategic and clinical services, for Concordant, is cited as saying that  “We recommend that practices bite the bullet and develop an incremental strategy to enter patient data into the EHR and rely less on document management. They will see the benefits of doing that.”

Contact us at Oracle Transcription for a full suite of clinical documentation solutions.

Vendors Adopt Direct Project

Joseph Goedert  of HDM reported that  two software vendors have released products that support the Direct Project, a federally funded initiative that produced free, downloadable secure e-mail software for exchanging clinical information.

Medicity, with its health information technology platform, and UNIVAL Inc. has built a new modular technology platform, enables users to exchange data with any provider using Direct-compliant technology. Secure communication protocols allows for the  exchange of data between electronic health records systems, data registries and HIEs, as well as enable HIEs to offer Health Information Service Provider services to their communities.

HDM further indicated that as an HISP, a health information exchange can assign and administer a health domain address, similar to an e-mail address, for each provider in the HIE. These providers then can exchange data with any providers or patients registered with a HISP in the nation. State HIEs in Colorado and Ohio will be among the first using the technology.

Oracle Transcription can help you with all your clinical documentation communication needs.

BayScribe Announces Availability of Structured, Coded Data with CDA output

Oracle Transcription’s  partner Bayscribe announced this week that several key relationships and enhancements to the BayScribe Clinical Documentation System (CDS)including the ability to offer coded data via C32 output through its partnership with Intelligent Medical Objects® (IMO®). IMO is the leader in clinical interface terminology and will manage all terminology term changes and updates for BayScribe. This partnership provides the addition of billing and reporting codes to BayScribe documents, which will provide users of the BayScribe Care Team

Dashboard easy access to information to improve the timeliness of document turnaround and the quality of patient care across a healthcare organization. Steve Bonney, Vice President of Business Development at BayScribe made the announcement. The press release reported that “The future of the Clinical Narrative is brighter today. The ability for physicians to document patient encounters through the use of traditional methods like dictation and handwriting took a leap forward with our integration with IMO.” Through this strategic relationship with IMO, BayScribe reinforces its position as the leader in providing innovative ways to meet the clinical documentation needs in this challenging and advancing healthcare information technology (HIT) environment.

The partnership with IMO brings a new solution not previously available in the clinical documentation market that supports an organization’s need to expand the accessibility of discreet data within a patient’s medical record. Melinda Watman, VP of Strategic Partnerships at IMO stated, “BayScribe’s vision of producing a codified transcribed document is critical in meeting the efficiencies and requirements for Meaningful Use and Core Measurement reporting. Healthcare organizations are able to capture the coded data without imposing workflow changes on clinicians.

The final piece of the unstructured documentation puzzle is the generation of a C32 CDA-formatted document (Clinical Document Architecture). The CDA is the de facto standard for exchanging Meaningful Use data with EHRs and, with the addition of the coded data from IMO, BayScribe expects to be the first Clinical Documentation System to generate Level-3 C32 output. IMO-coded documents deliver guaranteed billable ICD-9-CM codes as well as SNOMED, CPT, RxNORM, LOINC, HCPCS and other coding vocabularies. Additionally, through IMO, BayScribe documents will have seamless integration of ICD-10- CM codes available October 2011, two full years ahead of the mandated switchover date.

A copy of the press release can be downloaded from the Bayscribe website.

Call Oracle Transcription for a demonstration of these new technologies. You can reach us at (301) 929-9100, or toll-free (800) 983-3581

Analytics Taking Center Stage

Analytics appears to be the new mantra in health care. We all know that everything starts the point of encounter with the proper recording of clinicians assessment, and its accurate transcription and collation with other data sets to produce a picture of a condition or a prognosis. Now with new tools, technologies and approaches new insights can be drawn that can benefit the consumer, the community and the providers. In the end everyone comes out a winner.

The expanding the scope and power of analytics is a by-product of the massive amounts of data that technologies are giving us access to. Federal government health data initiatives designed to liberate vast amounts of data, the synchronization of performance-based programs with the digitization of health records at the personal and community level are affording us the opportunity to develop new scripts, metrics and actionable data sets, as well as creating new therapies and identifying areas where training and recertification of physicians and nurses may be needed. In the end we are aiming for efficient and efficacious systems, and this will all traslate in the optimization of the of the business of health care.

In the end analytics will feed real-time decision support systems for physicians and  real-time
disease monitoring for public health officials. Furthermore, the conversion to ICD-10 promising much more granular health data tracking and analysis.

Institutions can use clinical intelligence tools as well as business intelligence rules to assist in the timely decision support they are looking for. The opportunities range from resource allocation (beds and staff) to selecting to treat patients whose treatment costs the most. Office applications like

Crystal Reports and Excel spreadsheets cannot keep up.

In the end the key to effective clinical data analytics is not in the technology but in the human
analysis of what’s being tracked. Challenges remain with diverse data types and lack of

Standards and data barriers. These can take many forms such as proprietary data models, hierarchical data structures. Even different products from the same health care systems vendor
sometimes can’t talk to one another, let alone tie into a data visualization tool or analytic database.  Dashboards and other data visualization tools could aid in monitoring how patients react to treatments.

Health care software vendors have yet to agree on a set of standards upon which to build
their products. While the Health Information Technology is pushing interoperability standards more work must done to free the data and transform it into workable information.

Contact Oracle Transcription for all your clinical documentation needs.

Healthcare Security Regulations for Email

Healthcare IT security regulations extend to HCO’s business partners, and that encompasses a wide variety of players including hosting firms, accountants, and medical transcription. They are all subject to HIPAA security regulations and other data privacy regulations simply by having HCOs as customers or partners.

Failure to comply to the regulations, or worse, suffering a breach will expose you to severe penalties, notification requirements, enfacement fiats and public scrutiny.

Report of security breach notifications, investigations and penalties are almost a daily news item, and while security breach instances can come in many forms, we must not overlook emails as a source of risk and oversight.

Email is widely used throughout the industry. With the digitization of health records, emails and file transfer protocol will be widely used, but steps must be taken to ensure that they are properly secured since too much vital or confidential information is vulnerable. It is simply too easy and open to believe that tone is protected.

HIPAA sets out strict regulations establishing standards for exchanging healthcare information and ordered HCOs (“covered entities” or CEs) to encrypt email containing confidential patient data.

In addition the American Recovery and Reinvestment Act (ARRA) of 2009, includes new, stiffer regulations for protecting patient data in email. Moreover certain  states such as Nevada and Massachusetts have recently passed their own laws for data security and data breach notifications impacting HCO with patients in those states.

HIPAA
As a core underpinning to the healthcare system is the easy and secure flow of information, medical records need to be made more portable (hence the ‘Portability’ in the act’s title). Accordingly HIPAA sets out new terminology and Electronic Data Interchange (EDI) code sets for transmitting data, as well as  data security and privacy considerations.
Three sets of rules need to be taken into account, namely:
o The EDI Rule (162.1000): which establishes standard health information terminology and electronic code sets. The EDI Rule mandates that HCOs use ICD-9.
o The Security Rule (164.306): which establishes safeguards to protect the confidentiality, integrity, and availability of electronic protected health information (PHI). This requires security policies and practices dealing with:

• Access control
• Audit controls
• Authentication
• Transmission security
• Training

o The Privacy Rule (164.502): which orders HCOs to protect the privacy of patient data and defines the allowable uses and disclosures of PHI, in contrast to “de-identified” health information3 (PHI) is any information in the medical record or designated record set that can be used to identify an individual and that was created, used, or disclosed in the course of providing a health care service such as diagnosis or treatment.4 PHI includes not only a patient’s name, address, phone number, and Social Security Number (SSN), but also dates (such as hospital admittance and discharge dates), and health plan beneficiary numbers.

Penalties and Enforcement
The penalties for violating HIPAA’s security rule are high. Fines and jail time are provided for as detrrents to poor practices. In February 2009, levied a $2.25 million fine against CVS. (For its part, CVS denied any wrongdoing, but agreed to settle the case.)7

ARRA
Under the Health Information Technology for Economic and Clinical Health Act (HITECH), which Congress included in the overall ARRA legislation, the scope of HIPAA was broadened to cover all business associates of HCOs. Now these organizations will face the same civil and legal penalties that doctors, hospitals, and insurance companies face for violating the HIPAA Privacy Rule. Note that HITECH not only changes how fines will be levied, it also increases the fines that can be imposed.

Data Breach Notification Rules
New data breach notification rules that apply to HCOs and business partners have also been introduced. Notification delays and the scope of dissemination is well described. No one can hide – the victims need to know and the bad news will be widely broadcasted by the culprit and HHS.

The impact on client trust and business prospects will be severe

Other Data Breach Notification Laws
In addition to the new HIPAA privacy and security regulations one must follow closely state rules and regulations, in particular the California law, the Security Breach Notification Act (SB 1386), which took effect in 2003.  The notification threshold is set at one.  The same standard applies to the Illinois statute that was promulgated in 2006. As of the summer of 2009, forty-four U.S. states have enacted data breach notification laws.

The FTC has proposed a new security breach notification law for electronic health information applicable to  to entities not covered by HIPAA such as online vendors such as WebMD and Google that sell online services .

Requirements for Secure Email

Here are some hard and fast rules to satisfy the new standards:

Establish automated and sweeping secure mail detection solutions that automatically encrypts and delivers to a valid recipient, as well as block for review improper emails You cannot rely on your employees – the margin of error is too low. This identity information such as social security numbers and driver’s license numbers, as well as diagnostic codes and admittance dates. This will require to integrate “smart identifiers” to recognize problem communication.
Apply rigorous encryption technologies calling on digital certificates or identity-based encryption

Cloud email filtering for outbound email can be executed by security controls, including Transport Layer Service (TLS) encryption, the use of the Sender Policy Framework IDs as an anti-forgery safeguard, and stringent physical security controls certified by auditors to comply with best practices for SAS70 Type II

Record Retention Requirem: Documentation that must be retained includes:
o Policy or procedural documentation: Including notices of privacy practices, consents, authorizations and other standard forms
o Patient requests: Such as requests for access, amendment or accountings of PHI disclosures
o Complaints: Documentation related to the handling of patient and/or HCO employee complaints
o Training: Including processes for and content of workforce training.

Archiving solutions must satisfy administrative, physical and technical requirements

Contact Oracle Transcription today toll free at (800) 983-3581