EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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ICD-10 Implementation Vital for Value-based Care Payments

ICD-10 Implementation Vital for Value-based Care Payments | EHR and Health IT Consulting |

When the SGR bill was passed by the Senate without any ICD-10 implementation delays, the proponents of the new coding set rejoiced. Not only did passage of this bill bring about a stronger formula for Medicare reimbursements but it also meant that the ICD-10 implementation would most likely take place by the scheduled deadline of October 1, 2015.

When President Obama signed the Medicare Access and CHIP Reauthorization Act of 2015 into law on April 16, the legislation moved American physicians away from fee-for-service payments toward value-based care and accountable care delivery, according to the Healthcare Information and Management Systems Society (HIMSS).

Additionally, the new SGR bill includes innovative objectives for establishing the meaningful use of certified EHR technology. These payment models will be key for improving population health outcomes throughout the country. The volume-based payment reductions under the prior sustainable growth rate formula will now be altered with a new annual payment update of 0.5 percent through 2019.

By 2019, doctors will be able to choose their reimbursement method among two options: the Merit-Based Incentive Payment System or the Alternative Payment Model. While the Merit-Based Incentive Payment System will depend upon the performance of physicians, doctors who choose the Alternative Payment Model must utilize certified EHR technology standards and authorized quality measures as well as assume financial risk.

The overall push toward value-based care among the federal government, patient advocacy groups, and healthcare providers will require the medical industry to quickly and efficiently transition to the ICD-10 coding set. Documenting patients’ medical histories as well as accurately reporting and coding diagnoses and treatments is vital in the quest to pay for value and enhance population health outcomes across the sector.

The Coalition for ICD-10 also reports on the importance of the ICD-10 implementation in the move toward value-based care, as ICD-9 codes do not have the same capabilities as the newer coding set. While the healthcare community supports the SGR reform bill, many physician groups are still against the ICD-10 implementation and are hoping for additional delays.

However, a move toward measuring and paying for value-based care is not possible without transitioning to a modernized form of diagnostic and procedure coding. In order to accurately measure the value of a healthcare service, it is vital to have the detail available in the ICD-10 coding set, the coalition explains.

One example of the subpar quality of ICD-9 codes involves putting two patients with similar conditions but differing symptoms under the same code while ICD-10 accounts for a variety of divergence among patients. Essentially, ICD-10 codes will include key information about patients and record their medical history more accurately with additional detail.

“Despite opposition to ICD-10 by some physician groups and a few isolated state medical societies, there is general recognition in the medical community that a modern and precise coding system like ICD-10 is essential for measuring and paying for value,” the Coalition for ICD-10 stated. “ICD-9 represents medicine of a bygone era. It cannot support a move to measuring and paying for value. To meet the demands of SGR there can be no further delays in the ICD-10 implementation date.”

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State Hospitals Go Digital for ICD-10 Compliance Deadline

State Hospitals Go Digital for ICD-10 Compliance Deadline | EHR and Health IT Consulting |
In order to prepare for the ICD-10 compliance deadline by October 1, medical facilities will need to integrate revenue cycle and EHR systems that follow the new coding set. The State of Washington Department of Social and Health Services (DSHS) recently announced their association with health IT supplier Cerner Corporation to revolutionize their revenue cycle systems and EHR technology in order to better align with ICD-10.

Recently Victoria Roberts, Deputy Assistant Secretary at DSHS, and Justin Dickey, Consulting Practice Director at Cerner, spoke with to discuss their collaboration further and better prepare providers for the ICD-10 compliance deadline. The two individuals began by discussing how the collaboration will lead to better preparedness for the ICD-10 transition.147504495

“In Washington state, we have two state hospitals that are each about 100 years old and a much newer child study and treatment center. Within those 100 years, these facilities have all worked very independently. They are still very dependent on paper systems,” Roberts explained. “This project is allowing us to really look at how to work with continuity between hospitals, develop more consistent policy and practice, and bring the hospitals into the current century.”

Justin Dickey added: “Our teams are coming together to focus on standardizing workflow and developing a standardized tool set with the Cerner Millennium clinical and revenue cycle platform. More than technology, this is a lot about organizational change management and making sure we have the training programs in place to facilitate the use of the tool set we’re delivering.”

The integration of these health IT tools such as the revenue cycle system will play a key role in improving patient safety and quality of care. Victoria Roberts expanded on this goal.

“The biggest [part of this] is how we share information across shifts and across wards about individual patients,” Roberts said. “One of the things that I’ve been pushing forward is finding a way [to help] nurses and mental health technicians immediately see through the Cerner system the alerts they need to pay attention to.”

“Right now in our facilities, we continue to use white boards and white boards aren’t always updated as they should be. Sometimes things happen at 10 o’clock in the morning that don’t get communicated to the shift that comes at 3 o’clock in the afternoon. The hope is that through the Cerner system that information can be entered into the EHR and then communicated out through the alert board.”

Roberts went on to explain how allergy and medication alerts play a role in helping physicians provide safe care. Cerner representative Justin Dickey mentioned that “a task-driven clinical workflow allows [Cerner] to ensure they’re leading clinicians down the right path and also to have a mechanism that measures the quality of documentation as care is progressing through the organization.”

While the health IT tools are used in collaboration to increase the quality of care, they are also impacting the revenue cycle and ensuring that the document quality of claims are up to high standards. The two individuals went on to speak about solutions they’re incorporating to prevent any issues once the ICD-10 compliance deadline takes hold.

“One of the [solutions] we’re dependent on is the dashboard report,” Roberts said. “This allows us to understand the workflow and how well different staff are adopting to the model.”

“Our toolset has a physician dashboard that allows us to zero in on clinicians’ usability experience,” said Justin Dickey. “It identifies the areas where we may need to increase training and assist [promoting] workflow. The dashboard helps track problem areas and gives a tool set that shows what to focus on and issue remediation.”

While incorporating new health IT systems is necessary for the ICD-10 transition, providers are also concerned about other areas with regard to the upcoming ICD-10 compliance deadline. Many fear delayed payments and claim rejections from the Centers for Medicare & Medicaid Services (CMS). Victoria Roberts and Justin Dickey spoke about best practices to follow in order to avoid these issues during the ICD-10 compliance deadline.

“From the state perspective, it’s really anticipating and planning for the training curve that will take for the staff to support the implementation. We’re going from a primarily paper system to an electronic system with staff who rarely have need to even check e-mail,” Roberts explained. “It’s figuring out how to invest and support the staff during the transition.”

Justin Dickey added that Cerner is “helping define those workflows and giving the tools necessary to manage denials and throughput [as well as] giving a visual of what’s happening through the care process and payment process.”

The new EHR systems that DSHS will be using include a diagnostic assistance tool that includes natural language clinicians can easily understand. It provides a simple way to find the right diagnostic coding at the needed specificity instead of forcing physicians to search through a large variety of codes.

“The natural language helps clinicians choose and navigate down to the appropriate level of specificity within the ICD-10 code set,” Justin Dickey mentioned.
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ICD-10 Compliance, Stage 2 MU Prompt More IT Adoption

ICD-10 Compliance, Stage 2 MU Prompt More IT Adoption | EHR and Health IT Consulting |
The healthcare industry is on track for spending billions of dollars on health IT products throughout 2015. With the ICD-10 compliance deadline looming in October, most providers are looking to adopt advanced IT systems that incorporate the new ICD-10 coding set.

Almost 60 percent of polled hospitals leaders stated they will be focusing on transitioning to ICD-10 compliance throughout 2015, according to a report from peer60. Some typical IT products many may be purchasing include revenue cycle management, population health management, patient engagement, EHR, and ICD-10 migration systems.147504495

The researchers also broke down the surveyed hospitals by size and found that the bigger organizations are more likely to invest in health IT technology over the next year due to having more resources to spend. However, the report also discovered that very small hospitals are more likely to purchase an EHR system when compared to larger medical facilities.

It is likely that larger hospitals already have EHR systems set up and are looking toward health IT than can better coordinate care, engage patients, and provide analytics. Additionally, every hospital with over 1,000 patient beds was planning on purchasing a major IT solution in 2015.

EHR vendors are likely to remain busy throughout this year, as 27 percent of surveyed hospitals are looking to either replace a current EHR system or install a new one in the ambulatory care setting. Additionally, 31 percent of those looking to replace a system are undecided on whether to purchase from their previous vendor. This means that around one in ten hospitals will be changing their EHR vendor.

The data analytics market is also emerging among health IT systems. Despite it being a new avenue, 26 percent of hospital leaders said they are planning to buy an enterprise analytics suite in 2015, with 30 percent of these tools being first time purchases. Chief Information Officers (CIOs) were the key positions that were looking to incorporate analytics systems in their healthcare facilities. Additionally, 25 percent of those who already have analytics products are looking to update and replace their systems with more enhanced features. Nonetheless, 40 percent of the survey takers are unsure whether they will be renewing their data analytics software.

With Stage 2 Meaningful Use requirements calling for greater patient engagement and the creation of patient portals among medical facilities, the healthcare sector is poised to incorporate more patient-centric solutions. However, the report found that 40 percent of hospital leaders have not picked a patient engagement strategy as of yet. Regardless, 48 percent of hospitals will be addressing patient engagement in 2015.

Others in the industry are already choosing replacement products to increase patient engagement at their facilities. With many looking to leave their current health IT vendor, there is definitely a market for product replacement aimed toward improving the patient-doctor relationship. Smaller hospitals are still considering their options.

Along with data analytics and patient engagement, more providers are looking for health IT products that improve population health management. All of these resources should move the healthcare sector toward enhancing the quality of care and patient safety over the coming years.
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ICD-10 Implementation Deadline Causes Concern among Providers

ICD-10 Implementation Deadline Causes Concern among Providers | EHR and Health IT Consulting |

The ICD-10 implementation deadline is set for October 1, 2015 and doesn’t seem to be changing. While previous ICD-10 deadlines have been postponed, the Centers for Medicare & Medicaid Services (CMS) among other federal agencies seem to be focused on sticking to this particular ICD-10 implementation deadline.

For instance, both the House and the Senate passed the H.R. 2, the Medicare Access and CHIP Reauthorization Act, which repeals the Sustainable Growth Rate (SGR) formula but did not include any ICD-10 delays. The Journal of AHIMA reported that the bill was seen as a real challenge by ICD-10 proponents, as previous SGR legislation in 2014 led to a last minute ICD-10 postponement. However, this time, October 1, 2015 still stands as the current ICD-10 implementation deadline.

“Passage of this historic legislation finally brings an end to an era of uncertainty for Medicare beneficiaries and their physicians—facilitating the implementation of innovative care models that will improve care quality and lower costs,” AMA executive vice president and CEO James L. Madara, MD, said in a statement. “Patients will be able to get the care they need and deserve.”

While the ICD-10 implementation deadline stands still, this does not ensure that all physicians and providers are ready to transition to the new coding set yet. A new survey from NueMD shows that many small medical practices may not be ready to completely move over to the ICD-10 coding system by October, according to a company press release.

NueMD surveyed around 1,000 medical practices, billing firms, and other healthcare industry professionals. Most of the respondents came from small and medium-sized medical practices. The survey results illustrate that only 11 percent of respondents are “highly confident” their staff will be sufficiently trained by October 1 to transition toward the ICD-10 coding set. Also, 35 percent of respondents claimed they were “not at all confident” that their staff will be ready for the ICD-10 transition.

On top of this, only 13 percent stated they are “highly confident” their organization will be equipped to transition to the new coding set. Additionally, about one out of three respondents said they are “not at all confident” that their business will be ready for the coming ICD-10 transition.

About two out of three respondents are either “highly” or “significantly” worried about claims processing after October 1 while 70 percent of those polled feel that their finances as well as their operations will be at least “somewhat” negatively affected after the ICD-10 implementation deadline.

One very interesting finding from the study is that, when asked “Which of the following statements best describes your feelings about the new coding standards for ICD-10?” one out of three respondents said, “There should be no transition to ICD-10.” The type of concerns that more than half of respondents have regarding their business after the ICD-10 implementation deadline include claims processing, software upgrade costs, payer testing, training/education, and the compliance timeline. CMS will need to keep these issues in mind as it continues to prepare the healthcare industry for the coming ICD-10 implementation deadline.

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Is Creating an App Culture the Key to EHR Interoperability?

Is Creating an App Culture the Key to EHR Interoperability? | EHR and Health IT Consulting |

Nationwide interoperability is at the forefront of the current dialogue about health IT infrastructure across the United States.

The Office of the National Coordinator for Health Information Technology (ONC) recently unveiled the first iteration of its long-term vision for enabling shared nationwide interoperability within ten years. Last week, the plan week drew criticism from members of Congress about where exactly the $35 billion in funding from the Health Information Technology for Clinical and Economic Health (HITECH) Act went.

While the debate among members of the federal government rolls on, the private sector is moving forward with its own plans. The most recent comes by way of the Healthcare Services Platform Consortium (HSPC), which strives to solve the interoperability problem in the healthcare industry by creating an environment and culture to support the development of medical applications..

In a one-on-one interview with, Intermountain Healthcare CMIO and HSPC Board Chair Stan Huff, MD, provided details about the consortium’s efforts to enable the EHR interoperability of medical applications through the use of an application programing interface, Substitutable Medical Apps & Reusable Technology (SMART), and use of HL7 standards and specifications, Fast Healthcare Interoperability Resources (FHIR).

As Huff notes, the creation a medical apps ecosystem would enable widespread interoperability and tremendous scalability for innovation health IT solutions. What is the status currently of HSPC? What kind of work is underway?

Stan Huff: Right now we’re working on getting the business set up. We finalized membership agreements and we have now received actual membership dues for benefactor members from Intermountain Healthcare. Other money is currently on the way. From a technical point of view, we’re working on getting a development sandbox set up so that people can have a place to come and be able to develop either services or applications against the services that are compliant with the Healthcare Services Platform Consortium specifications.

EHRI: What is technical approach and why is it significant?

SH: The technical approach that we have taken with HSPC is that our initial strategy is using the SMART on FHIR approach as our way of integrating with and interacting to store and retrieve data from EHRs. Much of the technical work, especially around the FHIR services, is a specification of FHIR profiles that get you to true interoperability around those services.

One thing that needs to happen to get to true interoperability is to specialize or create profiles on those objects that take them from being more or a less an abstract class of things, like observation, and specialize it so that by adding attributes and by extension and constraint turning it into a laboratory observation or even more specifically a quantitative lab observation.

EHRI: How does the SMART on FHIR mesh with Intermountain’s own approach:

SH: For a long time, we created our own healthcare information systems, and a key part of that has been the development of advanced decision support modules as well as other kinds of useful applications. We have a 150 of those advanced clinical decision support applications depending on how you count. We realized as an organization that there is an opportunity to do 5,000 things and we have to do that many if were are going to improve the quality and cost of care we provide. The things we have done are high volume that are the obvious low-hanging fruit areas and we need to move away from rules that just apply to common infections, diabetes, and heart attacks to heart failure, parathyroid disease, and the next thousand diseases that also need advanced clinical decision support but we’re not doing anything for right now.

For us to get to a point where we can actually apply clinical decision support at the level of one to two thousand things, we have to change the paradigm. It can’t be a situation where we are just trying to create that knowledge and those executable programs within Intermountain Healthcare. We have to be a part of a community that includes Regenstrief, Mayo Clinic, Kaiser Permanente, Columbia Presbyterian, Vanderbilt — I could go down the list — and is creating that kind of knowledge in an executable form so that it is directly shareable amongst the institutions. I don’t mean that that would happen without money changing hands. Whether we buy them, share them or barter and trade the ones we have and the ones that others have, we have to get into a position where we can share rather than having to recreate those applications at our site.

EHRI: How do the different members of HSPC stand to benefit of this approach to interoperability:

SH: We want to make more applications available to everyone and if we can do that in a way that that application actually shareable — that exact same application can run as part of Epic, Cerner, Allscripts, athenahealth, etc. — then it’s huge benefit. It meets an unmet need but above and beyond that you have created an app store-like environment where the motivation for people to create new and useful applications and you have created a marketplace that doesn’t depend on any single vendor but is actually vendor independent. It has the potential to dramatically change the quality and cost of software that would be available to healthcare enterprises.

Some of the motivation for Cerner, Epic, and others to participate in this has been their realization that there’s a large unmet need for applications that they’re not sure how they would ever fill. You talk to the people who have the systems. For the most part they say it is doing what they said it was — we can admit patients, take care of patients, document, place orders, qualify for incentive money for meaningful use — but pretty much everybody has a list of like-to-have’s.

EHRI: What goals has HSCP set for itself moving forward?

SH: My near-term goal is to get some of these standards-based applications up and being used at scale in a production system so that it’s not demonstration anymore but actual clinical use. We’re in a situation where within three to six months we should have some of these standards-based applications running in production at Intermountain Healthcare accessible to Cerner, which is our current partner for EHR. And then we want to expand and obviously have that same sort of production use of these services at other institutions so that we can verify that this strategy is really going to work.

In the real near term, we’re all heads-down creating applications and services to support demonstrations at HIMSS. Even though that is very important for getting the word out to people about what we’re doing, the more substantial milestone would be production use of these services in an actual clinical setting. Right now, much of our attention is focused on HIMSS because we’re going to do some demonstrations there to show software that is working across Cerner, Epic, and some smaller companies as well.

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ICD-10 Acknowledgement Testing Checklist for Providers

ICD-10 Acknowledgement Testing Checklist for Providers | EHR and Health IT Consulting |

While ICD-10 acknowledgment testing is available any day of the year up until October 1, 2015, CMS is taking the first week in March to host another dedicated opportunity for providers.  The testing weeks serve as way to gather data about the way providers send their sample ICD-10 claims to Medicare and allow providers to ensure that their claims can be accepted by the adjudication system without any technical glitches.

Those organizations that have not participated in previous testing weeks are encouraged to join in during the next chance on March 2 through 6, or the final scheduled occasion at the beginning of June.

In order to successfully submit claims for ICD-10 acknowledgement testing, direct-submit healthcare organizations, including providers and clearinghouses, will need to keep the following questions, tips and, requirements in mind.

What is ICD-10 acknowledgement testing?

Acknowledgement testing is the most basic form of assurance that a claim can be accepted by a Medicare Administrative Contractor (MAC) for later adjudication.  It should not be confused with end-to-end testing, in which a claim is processed through all Medicare system edits in order to produce electronic remittance advice (ERA).  Acknowledgement testing simply provides a yes or no answer to the question of whether or not the sample claim can be accepted.

Providers are encouraged to use ICD-10 acknowledgement testing as a basic way to ensure that they are on the right track with their ICD-10 preparation.

How do I participate?

Information about acknowledgement testing will be provided on your local MAC website or by your clearinghouse.  Any provider that submits electronic Medicare fee-for-service claims is eligible for participation.  There is no registration required.  For more information on eligibility, click here.

ICD-10 acknowledgement testing does not test initial connectivity to the MAC system, nor does it ensure that your internal systems are capable of producing, accepting, storing, or transmitting codes.  Internal preparations for the generation and transmission of ICD-10 codes should already be completed before MAC testing.

How do I prepare my sample claims for submission?

Ensure that you have enough claims coded in ICD-10 to represent your typical submissions spectrum.  CMS reminds providers that claims must have the “T” in the ISA15 field to indicate the file is a test file.  Use a valid submitter ID, national provider identifier (NPI), and Provider Transaction Access Numbers (PTAN) combinations.  Claims that contain invalid identifiers will be rejected.

Be sure that the claims do not include future dates of service.  All claims must be dated before March 1, 2015 in order to be processed. Claims must also have an ICD-10 companion qualifier code or they will be rejected.

Providers may engage in “negative testing” by submitting purposely erroneous claims in order to confirm that the MACs will catch defects or incorrect information.

What information will I receive from my MAC?

Test claims will be assigned a 277CA or 999 acknowledgement as confirmation that the claim was accepted or rejected by the system.  The test will not confirm that the claim would be paid under ICD-10, nor will testers receive any remittance advice.  The MACs and the Durable Medical Equipment (DME) MAC Common Electronic Data Interchange (CEDI) will have extra staff available to take calls from providers who have questions about the process or their results.

Providers will need to engage in full end-to-end testing with their payers if they wish to receive information about their coding accuracy or payment rates.  While CMS has scheduled end-to-end testing for April 2015, participating providers have already been selected.  Providers are still encouraged to engage in end-to-end testing with their private payers as soon as possible.

What do I do next?

During prior acknowledgement testing, CMS has released basic data on acceptance rates several weeks after the dedicated testing period.  But providers participating in the opportunity do not need to wait until then to take action based on their own results.  With a mere seven months until October 1, 2015, organizations that experienced unexpected denials from acknowledgement testing should work with their ICD-10 preparation teams or consultants to resolve internal or coding errors quickly.

Healthcare organizations should also make sure that they are coordinating with their major payers to conduct additional, more robust testing of ICD-10 claims.  Providers should continue to utilize clinical documentation improvement programs, revenue cycle contingency planning, and coder training and education during the last few months of preparation in order to combat potential negative impacts from the new codes.

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