Guest post by: Baskar Mohan, Director, Healthcare Practice, Virtusa Corporation
The health care industry is currently looking at ways to leverage existing assets and projects to reduce time and the financial burden of ICD-10 implementation. Most health care organizations view Business Process Management (BPM) as an important strategy to help them stay competitive and attract new customers in a highly de-regulated market. In this blog, we will look at how BPM can help payers with their ICD-10 implementation.
As outlined in the five areas below, re-imbursement management is one example of where BPM can be effectively leveraged for ICD-10 implementation.
Claims Submission: Claims submission applications need to be remediated for ICD-10. Some of these applications are still green screen, lack real estate and are cost prohibitive. Leveraging the rules capability of BPM will enable the rapid building of applications. This will also ensure that data is cleansed before it enters the EDI systems thereby reducing the number of rejections.
Claims Adjudication: It is estimated that claims first pass rate will reduce significantly due to ICD-10 implementation. Leveraging BPM workflow and rules capabilities to build a wraparound system to monitor and automate adjudications will help manage adjudications more effectively.
Claims Payment: Using BPM, coding payment rules can help provide businesses with the power to change them without going through long development cycles, thereby bringing flexibility to adapt or change as per market conditions.
Fraud Detection: BPM can be used along with other data mining tools to thwart fraudulent claim submissions including un-bundling of claims and other fraud practices. Creating a more robust workflow to route suspicious claims to experienced adjudicators and reviewers will help create a good ROI for ICD-10 implementation.
Pay for Performance: The recent shift has indicated that more Payers including Medicare & Medicaid are moving toward pay-for-performance. Complex rules to build these payment schedules can be built using BPM as most of them have to be re-visited for ICD-10 compliance.
Apart from the above benefits, ICD-10 implementation can be hassle free and effective when combined with BPM, a technology that will make life easier for everyone including IT and business. In my upcoming blog posts, I will focus on product development, care management, network management and risk management so stay tuned!
Q&A with Steven Ferguson, Patient Management Officer, Hello Health
1. What unique challenges do small physician practices face compared to their larger counterparts in regard to EMR adoption?
Independent small physician practices (1-5 doctors) differ significantly in their approach to shopping for, and acquiring, EMR products. The big boys, especially when you are talking 50 or more physician practices typically have committees and consultants involved in the selection process.; That means the eventual users of the technology are often times not directly involved in the tire kicking process that goes on before a vendor is signed. With a small practice, most often the user IS the buyer - and this changes everything.
Doctors in any size practice are typically very busy. Small practices are essentially small, independent businesses, where doctors are providing care, and also carrying out numerous administrative tasks as well (I know of one solo practitioner who even cleans his exam rooms each evening). The result is that these practitioners have very little time to commit to researching and test-driving EMR products. Remember, there are literally hundreds of EMRs to choose from. As a result, doctors have to rely on word of mouth and Google searches to narrow their search. This can leave doctors frazzled. Studies have shown that when consumers have too much choice, they often make no choice at all. This applies to EMR shopping.
So what does this mean for small physician practices? It means that vendors have to earn the trust of the physician. I think that simply selling an EMR system, and then walking away puts the doctor in a vulnerable position - remember, their livelihood depends on this new system operating effectively. A better approach is for the physician to enter into a partnership with an EMR company. Both entities need to have some skin in the game. Both need to be able to work together to make the implementation, and essentially the practice transformation a success.
The large practices set aside budget, earmarked not only for purchasing an EMR, but also for finding the best EMR in the first place. The solo practitioner usually doesn’t have cash on hand to throw at this sort of endeavor. As a result, you are seeing some EMR vendors offering their products for free. This may work well for doctors who don’t mind using a system with pharma advertising embedded in the user interface. However, Hello Health takes it a big step further and helps doctors make more money with an ad-free, subscription-based technology solution.
2. As a vendor, why did you choose to focus on this part of the market?
Small, independent primary care practices need help. They face shrinking reimbursements and higher overhead and we’ve heard this many times over. Hello Health has always been about keeping the independent practice independent. We survey physicians regularly and their main concern is safeguarding their autonomy. They would much rather work for themselves instead of for the institutions we associate with large practices and hospitals. I think control plays a large part in their drive to remain independent. Control over how they practice medicine.
From the beginning we realized that primary care was feeling the pinch more than most specialists. We also understand that family medicine is more relationship-based than what you have with your average orthopedic surgeon, for example. Patients see their family doctors on a regular basis and from this, relationships are formed that may last years and years. There is value in these relationships, for both sides. Doctors get to know their patients, their patients’ families and most importantly their health as it changes with age.
We asked people what they would like to improve with their family doctors and the responses skewed overwhelmingly toward better communication. From this we developed our strategy for patients:
i. improve communication channels between patients and their doctors
ii. provide better care
We asked doctors what they would have to accomplish in order to secure their independence, and by in large they indicated that they needed to improve their finances. Accordingly, we developed our strategy for doctors:
i. make doctors more money
ii. provide better care
iii. put back time in their day
So far our strategy has worked. Doctors see how the Hello Health business model can improve their bottom line and patients, after having used our communications tools say they can’t imagine going back to a ‘traditional’ practice.
3. How will the recent $10M in funding Hello Health received be used? Will you be expanding your offerings?
The new funding will go a long way in helping us ramp up our sales and marketing efforts. We are currently active in New York, New Jersey and surrounding states, as well as Atlanta. We recently added sales professionals to cover the Southwest and mid-Atlantic regions. Because Hello Health seeks to build a partnership with each and every practice, our marketing, sales, training and implementation efforts are intensive. We are not just another vendor to a new practice. We are a partner. Getting into the details of how we partner with a practice is an interview in and of itself.
We have practices in 25 states, so our reach goes beyond our sales territories. Doctors hear about us at conferences, find us online and via our social networking presence, which we continue to refine.
4. National Coordinator for Health IT leader, Farzad Mostashari, M.D., said last week that technology alone won’t spur patient engagement because “it’s a two-way street” - patients need access to their data, but physicians also need access to patient data coming from medical devices and the like.How does Hello Health help to accomplish this bi-directional conversation that is so important to the patient / physician relationship and how do these roles need to evolve as technology becomes more widely available?
Hello Health has been at the forefront of bidirectional data exchange. From the day we went live in our first practice, our patients have always had access to their data. With each release we’ve made the patient experience better by introducing even more ways to exchange data, like our shared document library.
Dr. Mostashari is absolutely right when he says, “it’s a two-way street” but I would argue that outside of our Hello Health practices, we’ve never really had that bi-directional conversation, so the population at large doesn’t even really know how important it could be to the patient/ physician relationship.
There’s no question that the technology exists today to easily provide patients access to their data, and conversely for patients to send data to their doctors. You don’t have to look any further than the WellBox solution within the Hello Health platform and Qualcomm Life to see what possibilities exist. The bigger question, that I don’t think anyone has a ‘real-world’ answer to is, who’s going to pay for this?
There will always be a small segment of the population who are proactive and curious enough to capture and track bio-data - and that’s great. Movements like Quantified Self (QS) seem to be gaining momentum and there is interest from the VC community. However, QS represents the extreme, and is not necessarily linked to any specific disease monitoring. They are the innovators and early adopters and I respect them for taking their health seriously. For the rest of us, consumer products like Nike Fuelband and FitBit are making inroads into our everyday lives.
But let’s say a patient is hypertensive and is monitoring their blood pressure at home. They can easily communicate this data to their physician during regular visits, and that works ok because the doctor is getting paid for that encounter. Now let’s say that the patient has a Bluetooth BP cuff and their readings can be sent automatically into the cloud on a daily basis. Let’s even say that the doctor has a dashboard where he or she can go to check on all of their hypertensives’ BP on a daily basis. This is also good, right? You would think so, but unfortunately the doctor isn’t getting paid for the time he or she spends checking this data. Neither is their nurse practitioner. And who pays for the Bluetooth BP cuff? The reimbursement mechanisms will have to change if Dr. Mostashari’s vision is to be realized.
5. Case studies of success (i.e., utilizing remote visits, etc)? What are examples of this technology in action?
Two of our earliest customers in Manhattan represent great success stories. One runs an internal medicine and hematology practice in Mid-Town Manhattan. The other has a similar practice on the Upper East Side.
Both doctors tout the merits of digitizing their practices, and for many of the same reasons. Initially, both doctors considered staying the course with paper-based charts and schedules, feeling that they would be well served by these time-honored tools. However, requests from patients for improved communication methods soon had both of them looking for alternatives. What convinced them to try Hello Health was not just the intuitive EMR, or the value of the patient’s portal, but rather how the platform was able to tie the functionality together to provide synergy and thus more value.
Dr. Colleen Edwards sums it up best when she says, “One of the unintended benefits I’ve found is the e-mail conversations that you have, or instant messaging conversations or telephone conversations, now automatically become part of the medical record. That’s a huge improvement for me.” Stated another way, it’s not enough to have an EMR, provide secure messaging and conduct virtual visits. All of these things have to be tied together. The message thread becomes much more valuable if the provider can save it automatically to the patient’s chart or attaches it to a specific visit note.
When doctors start getting paid for all of the work they do, a curious thing happens - patients start respecting their time, and doctors start making more money. During a recent interview, Dr. Edwards stated: “The feature of Hello Health that really tweaked my interest was the ability to bill for remote services, or virtual services. As an internist, I do a lot on the telephone that I wasn’t getting reimbursed for. Whether it’s a straightforward urinary tract infection or sinusitis, or someone wanting to discuss their headaches over the telephone, I was making 10 phone calls like that a day that I wasn’t getting reimbursed for, and I thought I should. And it got to the point where I thought I was being abused. I was so responsive, I always return my phone calls, and then having this ability to actually capture a little income, and make the patients realize that my time isn’t free and it’s valuable, really made my antenna go up.”
At Hello Health, when we hear stories like this we can’t help but smile. This was our goal from day one — use technology in a way that makes doctor’s lives easier, and more rewarding while at the same time providing valuable tools to patients that enhance their relationship with their doctor.
Even with the possibility that the Oct. 1, 2013 deadline for transitioning to ICD-10 codes could change, experts say providers should keep the transition train moving.
Below is the transcript to last week’s live chat with James Truesdale, Partner at The Kiran Consortium Group, LLC and past program director for the ICD-10 Mandate at the Georgia Department of Community Health, where readers were able to ask questions and share their own thoughts about moving to ICD-10 codes.
Have other questions about the transition to ICD-10 codes? Visit the HIT Exchange Q&A forum and ask now!
Chat transcript: March 28, 2012
11:31 Jenny Laurello: Welcome to the Health IT Exchange Live Chat on The Business Implications of ICD-10! We will begin with our chat leader, James Truesdale, Partner at The Kiran Consortium Group, LLC and past program director for the ICD-10 Mandate at the Georgia Department of Community Health, at 11 ET.
11:00 Jenny Laurello: We will begin momentarily. Please ask your questions in the text box below and James will respond to as many as time will allow. Please use #HITExchange as the hashtag on Twitter!
11:01 Jenny Laurello: And we’re live! Welcome to James Truesdale, Partner at The Kiran Consortium Group, LLC and past program director for the ICD-10 Mandate at the Georgia Department of Community Health, who is here to answer all of your toughest ICD-10 implementation questions!
11:02 James Truesdale: Thanks for having me today! I am excited to be here!
11:02 Jenny Laurello: First question for you James: How do I get my CEO and CFO to understand the real impact of the switch to ICD-10 so they can prepare for the accounts payable problems that might occur?
11:06 James Truesdale: It is best to explain the impact of the changes quantitatively rather than qualitatively. This approach can be accomplished by running testing scenarios to see impacts to claims processing. The foregoing would be accomplished by establishing the appropriate test beds with emphasis on historical claims data, benefits data and Reimbursement data. Essentially, these activities would help to validate payment and benefit neutrality post conversion. This will enable the CEO and CFO to prepare for accounts payable issues.
11:07 Comment From Cole Alexis: Is there any advantage at all to waiting to implement ICD-10 coding at the last possible minute and still meet the (new) deadline)?
11:11 James Truesdale: That approach could be problematical. Let me tell you why.
11:13 James Truesdale: I do not see an advantage to waiting until the last minute to implement the ICD-10 coding. There will be substantial testing necessary to validate the new codes which will require lots of coordination with both your internal and external stakeholders. Additionally, you will need to ensure your coders are familiar with the new codes. Hence, you do not want to wait until the last minute to train your staff to undertake any changes to bill payments. Therefore, you want to implement as soon as it is feasible.
11:14 Comment From Steve Sisko: In regards to Jenny’s intro question, I would also suggest to you C-suite that a monitoring plan be developed. This would include collecting baseline data on cost pre-ICD-10 with frequent post-ICD-10 analysis to detect cost variation at the earliest point in time. This information will allow for further analysis and action to be taken to validate the coding for accuracy and, if needed, take action to correct coding or modify pricing.
11:14 Comment From Steve Sisko: Also, develop a baseline for your firm’s key measures and reports. Compare pre-implementation and post-implementation measurements to determine the impact of the transition. Significant variations in measure should be validated before releasing the reports to ensure inaccurate data is not being reported.
11:15 Comment From Cole Alexis: I certainly don’t advocate waiting! However, do you know of any healthcare providers that expect to implement ICD-10 coding and processing and yet intend to postpone their implementation date for reporting as long as possible?
11:17 James Truesdale: Steve, Yes, that is a good approach. It provides good insight into the potential impacts to the organization from an As-Is To-Be perspective
11:18 Comment From Steve Sisko: And if you wait until the last minute and need external help, then good luck finding resources - at least any that you can reasonably afford. :’)
11:19 Jenny Laurello: Will the delay give software vendors more of a reason to drag their feet and we’re going to be in another fire drill 6 months out before the eventual deadline, whatever CMS sets it at?
11:22 James Truesdale: Yes, some vendors will drag their feet. We all love to procrastinate! However, smart vendors who are behind will take this time to play catch-up. Those who are moving toward ICD-10, it might best for them to spend time ensuring their systems changes have been properly tested and validated. Without a doubt some vendors will not use this time wisely while others will prepare themselves for this transition.
11:22 Comment From ErnieCIO: I had just convinced my CFO to sign off on additional budget for ICD-10 resources, and then it gets delayed so I am sounding like chicken little in meetings about the ICD-10 transition. Any advice on convincing him to stay the course for the implementation? In this chat we all know it’s coming, but to him it looks…like less of a priority
11:27 James Truesdale: Ernie, I will emphasize the financial impact of not being ready for ICD-10. There is also a tremendous strain on resources across the industry. So, any time invested in those current resources will be lost. You do not want to re-orientate your team to the project nor lose critical resources to other projects. You must speak to the pain points of not staying on course as well as the likelihood of losing resources to other project. As you are aware, there are many competing HIT projects that Health Care organizations are trying to address simultaneously.
11:28 Comment From Cole Alexis: @ErnieCIO: If the delay does not materially affect your choice as to whether you are meeting the needs with inhouse vs. outsourced resources, moving ahead is the right thing to do. I think the focus of your message back to your CFO should be Risk management. Very few of the other initiatives on your plate have such wide sweeping change impacts on your organization.
11:30 Comment From SanFranMan: I work in a hospital billing department, working in ICD-10. Some of our smaller payers seem to be behind in testing and implementing ICD-10 transaction capability. Is that true all across the U.S.?
11:34 James Truesdale: Not sure if this is true across the US. However, many organizations are hampered by what to do to address the changes. For payers, the true impact is not fully understood, so it appears they are still trying to figure things out. The changes to ICD-10 will allow payers to take a second look at their existing contracts so to evaluate the financial impact to their organizations. This analysis takes times to complete causing an apparent delay across the industry.
11:35 Jenny Laurello: Note: James will respond to as many questions as time allows. Please submit in the text box below, where we will then select and push live (we are seeing the Qs, but not all can be published). Thank you!
11:35 Comment From ErnieCIO: Cole, so you’re saying I can put it in terms like: “ICD-10 brings a ton of risk — like making a big bottleneck in accounts payable. The delay just gives us more time to analyze and mitigate more risk than we otherwise would have.” Something like that?
11:35 Comment From Steve Sisko: In regards to project delay: If a project was started and put on hold, I’d make sure that any information and efforts already completed and/or underway were properly mothballed so as to minimize any restart time. And you might consider moving forward with some aspects of the ICD-10 effort that can be used with other projects - there are a lot of synergistic efforts that can provide immediate value for ICD-10 and longer term value for other projects and the business in general.
11:36 Jenny Laurello: James, do you think that ICD-10 will be delayed even further? I know it’s speculating, but what is your opinion on that? Advice for providers?
11:38 James Truesdale: Yes, I do believe the ICD-10 will be delayed but for no longer than a year. Because, a delay that goes beyond a year will cause many of the organizations that have efforts underway to lose both resources and momentum. My advice to providers is to take this time to focus on Clinical Documentation and Training of staff given the significant impact to these areas.
11:39 Comment From Cole Alexis: @ErnieCIO, yes but ideally you should be working with your CFO to prioritize initiatives in terms of not only revenue impact, capital expenditures and cost savings. Typically, ICD-10 has huge training impacts, much more so than other initiatives.
11:39 Comment From Steve Sisko: What do you think are some of the efforts that could be outsourced vs. kept for in-house staff? (for the provider-side, not payer)
11:43 Comment From Cole Alexis: @Steve - Change management and training are the obvious choices. Most providers will have a hard time providing just-in-time training and quality testing with inhouse resources.
11:45 James Truesdale: Steve, I think you can outsource testing because it is not a core activity for the organization. You also want to demonstrate to your organization that your changes have been properly vetted and validated.
11:46 Comment From Willie Williams: How do you see tools playing a major role in assisting with the conversion from ICD-9 to ICD-10?
11:51 James Truesdale: Willie, I see tools playing several roles especially with regards to assessing the potential impact of transitioning from ICD-9 to ICD-10 so that key information is captured, analyzed and then used appropriate. The use of online tools for training of the new codes sets will be key given the shortage of ICD-10 Training resources. Last, given the detailed nature of the endeavor, the use of automated remediation tools as well as on-line training solutions will also play a vital role in this process.. Essentially, tools will assist the industry in understanding the potential impact as well as moving the US toward ICD-10 compliance in a structured manner.
11:52 Jenny Laurello: How is your previous employer dealing with the ICD-10 delay, since you led that implementation for the Georgia Dept. of Community Health?
11:56 Comment From Steve Sisko: @ Willie Williams There are also some financial modeling tools that risk-bearing providers and providers paid via DRG’s, case rates, etc. can use to model impacts to contracts and revenue streams.
11:57 James Truesdale: They are moving full steam ahead with ICD-10 for several reasons. They are working on several competing efforts that complement the activities associated with completing ICD-10, namely Meaningful Use as it pertains to providers. They are continuing to use this time to educate both internal and external stakeholders about the project and the impacts to the various groups. They are also making sure the requirements that have been gathered have been properly vetted so that all impacted groups have been accounted for.
12:01 Jenny Laurello: Please note: this will be our last question
12:01 Jenny Laurello: What are the main areas of impact in the revenue cycle?
12:02 James Truesdale: There will be increased payment delays from payers as well as overall decreased cash flow. Last, there will be increased documentation requests to substantiate medical necessity.
12:04 Jenny Laurello: Thank you all for your time and questions, and thank you to our wonderful chat leader James! The chat transcript will be available here immediately afterward. Have a great day!
12:06 Anne Steciw: Thanks for participating everyone! We look forward to having you join us during our next chat.
After sitting down and chatting with two of the University of Pittsburgh Medical Center’s champions for the organization’s Technology Development Center (TDC), it is clear that the health system is making great strides in terms of health IT adoption and industry collaboration. From utilizing voice recognition and clinical language understanding (CLU) technologies, to relying on mobile health technology and vendor collaboration to expand the continuum of care, UPMC has been able to utilize the power of the TDC to “make strategic investments in technology that will rectify health care’s biggest dilemma of aggregating and translating an abundance of data into actionable knowledge.”
In this HIMSS 12 interview, Rasu Shrestha, M.D., VP of medical information technology and a radiologist at UPMC, and Rebecca Kaul, president of UPMC’s TDC, share their expertise on the ways in which their clinicians are currently utilizing CLU and working with vendor partners at the TDC to break down the barriers of care and utilize electronic data and technology to its highest potential.
In the video below, Shrestha and Kaul discuss the following:
Apple’s Siri has seemed to make voice recognition and NLP almost famous amongst consumers. Can you talk about the different considerations that need to be made when looking at voice recognition in action health care (i.e., what is the difference between CLU powered solutions and NLP solutions such as Siri?)
How can CLU help health care orgs improve clinical efficiency, drive appropriate reimbursement and meet upcoming ICD-10 needs?
In the long term, how do you see mobile health technology, voice-command / speech recognition or otherwise, continuing to push the envelope in terms of clinical decision support, relying on mHealth integration with EHR for increase in care quality / error reduction?
Dr. Rasu Shrestha is VP of medical information technology and a radiologist at UPMC. He invented an electronic system that lets clinicians see imaging studies from across our facilities, in addition to helping lead the way in some of our new technology efforts involving natural language processing (with partner Nuance).
Rebecca Kaul is president of UPMC’s Technology Development Center. The TDC is where UPMC is spending time and resources developing the next-generation of healthcare IT solutions with industry partners such partners as Alcatel-Lucent and Nuance, with a particular focus on telemedicine, natural language processing, mobility and advanced imaging.
This week I had the chance to listen to a webinar highlighting the recently released report on The Financial Impact of Breached Protected Health Information. Released on March 5, the “PHI Report” has already been downloaded by more than 1,700 users, with its goal being to help health care organizations both assess security risks, as well as build a business case for protected health information (PHI) security processes, procedures, technologies and executive buy-in.
Created through the PHI Project, a collaboration on behalf of the American National Standards Institute (ANSI), in partnership with Shared Assessments and ISA, the publication takes an extensive look at why organizations are breaching PHI information - and, interestingly enough, at three times the rate of other industries, such as banking and finance. It also includes step by step guidance for organizations to calculate the true cost of a data breach using the “PHIve,” or PHI value estimator, an approach based on the success of prior, similar initiatives, such as ASNI’s 2008 Financial Impact of Cyber Risk report.
For this project, the group honed in specifically on health care, bringing together over 100 CIOs, CFOs, chief compliance officers, chief security officers and general counsel from various health organizations to ask and discuss 50 key questions on what must be done to ensure the security of PHI data. What they discovered was chief privacy and compliance officers were quick to bring up the changes in liabilities and initiatives that they felt needed to be done based on their work so far and to ensure compliance at the federal level. Unfortunately though, without the proper financial language and hard figures to support it – i.e. in the absence of CFO speak — it can be nearly impossible to communicate the value of these projects and create a business case for investment.
To rectify this enterprise language barrier and help IT and security leaders build a case for resource allocation, the project’s subcommittees began working with a team of professionals to define the PHI ecosystem (i.e., anyone who generates, stores, recovers, distributes or in any way handles an electronic record). They also worked to identify the main elements threatening PHI security; in this instance as garnered through the case studies of 40 recent health care data breaches. From this, they determined the top four areas threatening the privacy and security of PHI data are:
Humans: People pose the greatest risk to the breach of PHI, including malicious insiders, non-malicious insiders, outsiders and state-sponsored cyber crime. Of the cases studied in the report, almost half involved an organizational insider, with 90% of those being deliberate.
Evolving stakeholder groups in the market: BAs and subcontractors, cloud service providers and virtual visits / telemedicine
Method of PHI access, capture or transmission: Lost or stolen media
Intrusion: Through the dissemination of data, mobile devices and wireless devices
With the number of threats and vulnerabilities that exist in the ecosystem, coupled with the hard and fast proof via the growing list of data breach poster children on the OCR’s site, it was clear to the group that they needed to develop a series of standards, safeguards and controls for organizations to implement and follow. And while each organization’s compliance program will vary depending on specific security requirements, the report identifies three universal aspects that anyone can use:
1. Policy: The culture of the organization is established at the top, and the importance of privacy and security programs at the enterprise level needs to be communicated through the creation and enforcement of policies.
2. Procedures: It’s one thing to establish a policy, but it’s another thing to follow it. Clearly outlined procedures ensure the effectiveness of key controls and that everyone is working under the same set of established, enforced rules and guidelines.
3. Technologies: As required by the Security Rule, organizations must have access and audit controls, as well as transmission security technologies in place. Without the technology to help ensure the security of the electronic data, the policies and procedures are merely a start.
After an organization establishes its security policy, determines an agreed upon set of actionable procedures and has implemented the proper technical controls and safeguards, the next step is packaging this information and using it to enhance their business case for resources.
As detailed in the report, the PHIve Method details the steps necessary to calculate the true cost of a data breach:
Step 1: Conduct a risk assessment for each PHI home - Assess risks and vulnerabilities to develop applicable safeguards and controls for each stakeholder in the “PHI home,” which the report defines as “any organizational function or space (administrative, physical or technical) and/or any application, network, database or system (electronic) that creates, maintains, stores, transmits or disposes of ePHI or PHI.”
Step 2: Determine a “Security Readiness Score”- Determine the likelihood of a data breach and assign a “security readiness code.”
Step 3: Determine the cost of “relevance”- Taking into consideration type of business (CE vs. BA), size of breach, likelihood of harm, type of data, as well as age and income of affected individuals.
Step 4: Determine the impact: Calculated as Relevance * Consequence = Impact.
Step 5: Calculate the total cost of a breach - Refers to the total cost of a data breach, calculated by adding up all adjusted costs for various PHI homes. The report also identifies ranges of impact, which go from “severe,” impacting greater than 6% of revenue, to “insignificant,” affecting less than 2% revenue impact.
In the age of EHRs and electronic data exchange, organizations must make investing in their IT security and data protection initiatives a top priority. With the growing market attractiveness of patient medical information — with one medical record being worth $50 as compared to just $1 per social security number – and the growing number of vulnerabilities in the ecosystem, a solid risk assessment is simply a small component of the larger framework that makes up health IT security preparedness.
In this Health IT Exchange community executive webcast, James Truesdale, Partner at The Kiran Consortium Group, LLC and past program director for the ICD-10 Mandate at the Georgia Department of Community Health, shares his expertise on the business implications of ICD-10. Highlighting the true costs associated with the transition and how providers must prepare, James speaks to ways in which providers can keep the transition train moving forward, despite delays at the federal level to the enforcement of the original Oct. 1, 2013 deadline.
And be sure to join us from 11:00 - 12:00 ET onWednesday, Mar. 28 for an interactive Live Chat with James, who will be on hand to answer your most pressing ICD-10 questions and guide industry stakeholders through a successful migration.
What: Live Chat - The True Cost of ICD-10 Migration: Keeping the Transition Train Moving When: Mar. 28, 2012; 11:00 - 12:00 ET Where:Right here! Check back in this post for the Live Chat to begin at 11:00 ET on 3/28 How: Sign up for a reminder by clicking on the Live Chat window below (second window, below the webcast)
Guest post by: Wendy Whittington, MD, MMM, Chief Medical Officer, Anthelio Healthcare Solutions, Inc.
In the recently released stage 2 MU proposals, CMS sought to correct some problems with the menu choice for providing patient education materials. I don’t think they quite made it, though, and I’ll tell you why. First, let’s examine the requirement.
Patient-specific education resources identified by Certified EHR Technology are provided to patients for more than 10 percent of all office visits by the EP. More than 10 percent of all unique patients admitted to the eligible hospital’s or CAH’s inpatient or emergency departments (POS 21 or 23) are provided patient- specific education resources identified by Certified EHR Technology.
At first blush it sounds as if the CEHRT (certified EHR technology) will store the patient education information, but that’s not the case. To further explain, CMS said that the CEHRT must be used to identify the resources, not necessarily store them. They indicated that the patient education resources from the National Library of Medicine, for example, can be queried by the CEHRT. The technology hook is that the CEHRT should identify the resources based on the patient’s problem list, medication list or laboratory results. There are choices about the delivery of the information. Paper, of course, is included, but so is an electronic copy, or an electronic link through a patient portal or PHR.
The measurement, 10%, was chosen because of language and literacy issues. These exist, to be sure, and need to be addressed, but MU is a staged process and CMS clearly thought it was too soon for higher numbers. The National Library of Medicine provides primary resources in both Spanish and English and also offers links to other languages. They have a wealth of audio and video materials, as well as some easy-to-read materials.
I think the problem will be with asking the CEHRT to select materials based on the patient’s information. How will the technology know which of the patient’s problems, medication or tests are the most important for them to receive information on today? How will the provider review the materials and decide if they are accurate and relevant for this patient? I’d be surprised if there are any algorithms like those used by Match.com to take into account the patient’s needs, age, language, reading level and interest in the materials. For example, how will the patient who is taking Cymbalta for fibromyalgia feel when the computer presents patient education materials on depression?
For the most part, patients do this matching pretty well for themselves. According to the Pew Research Center, eight in ten internet users have looked online for health information. [1] We hear more every day about e-patients and online patient communities. Certainly, social media is having a huge impact in this area - more, I think than a computer-selected hand-out from a physician’s office.
The other possibility that worries me is that the provider may meet the 10% threshold by giving information to the patients who need it the least. Anyone (or maybe any computer) can select a pamphlet for someone who has had well-controlled hypertension for years. AHRQ says that low health literacy is linked to more emergency room visits, hospitalizations and higher risk of death. [2] That is what needs to be addressed! While I agree whole-heartedly with the goals of patient education and health literacy, I don’t think this core measure is going to get us there.
Guest post by: Dr. Andres Jimenez, CEO, ImplementHIT
Voice recognition is a powerful tool, and I have literally seen it transform the lives of physicians with one month’s worth of unsigned notes after a single training session. However, as good as voice recognition software is these days, a lot can go awry if the following considerations aren’t made from an IT implementation perspective.
Training
I have studied clinical adoption of health IT very carefully over the last six years as part of my Ph.D. work in the area, as well as in my former role of clinical director of content and training for Allscripts, and today in my current role as CEO of ImplementHIT. What we have found is that training quality that can typically make up 20-25% of the total implementation costs is indirectly related to productivity loss, which often accounts for another 20% of total implementation costs if not more. As training quality goes up, productivity loss goes down. It seems logical, but notice I said training quality, not training time, which does not have the same relationship. In fact, I have commonly seen too much training be the main reason for poor implementations of voice recognition technology. Why? Because the key barrier to voice recognition adoption is getting past the accuracy hurdle, and knowing how to leap that hurdle is rarely retained when too much training is provided to users of voice recognition prior to implementation.
Several large academic institutions that have successfully rolled out voice recognition to 1000 or more users have shown that 99% accuracy is possible, rather consistently across large user bases. Although with the latest versions of voice recognition software you can achieve 95% accuracy with about 60 minutes of training, a 5% error rate will disable a clinical practice. Furthermore, because checking for 5% worth of errors while dictating can cause physicians to say a couple of words at a time, check the output of text, dictate another few words, check the output of text; you get poorer overall recognition accuracy. This is because the latest versions of voice recognition software rely on the context of spoken sentences to select each word correctly. Speaking fluently in full sentences actually improves accuracy whereas constant error checking even 5% of the time worsens accuracy.
So what should you do? It’s simple — stick to the basics! In an ambulatory setting voice recognition can easily be the tool to help your organization achieve the dream of surpassing pre-implementation productivity levels. This occurs when physicians use advanced features such as macros; however, when they are first getting started, only show them how to train the voice recognition software to learn how to interpret correctly when it makes mistakes. Have the clinicians repeat correcting commonly misinterpreted words 20 or 30 times in a row until they automate the basic sequence of steps (usually 5-6). Then, once they go live, if they notice a mistake they don’t have to search for the manual to remember how to correct Dragon.
Correcting your voice recognition software consistently for about 2-3 weeks will get your users to 99% accuracy. After those 2-3 weeks not only have they passed the accuracy hurdle, they can easily learn more intermediate and advanced features of their software and you are home sweet home!
Hardware
I am not an electrical engineer, nor a recording studio professional, but I know enough about the process of getting the sound of your voice into the processing engine in your computer. The two main components are the microphone, and the connection of the microphone to your computer (USB, Bluetooth) or analog via a sound card. Voice recognition software must process a lot of information from your voice to achieve high accuracy levels, and wired USB is certainly preferred.
This works fine when using a fixed work station, but is probably a JCAHOTM violation when using a mobile device and roaming from exam room to exam room. New laptops with the latest Bluetooth technology can support enough throughput from a high quality microphone to the computer to allow high accuracy levels. However, when hospitals are purchasing laptops or tablets in bulk without having voice recognition requirements in mind, the latest Bluetooth is one of the first things to get cut to minimize costs. The sound card is usually another area of savings, although when it comes to wired solutions analog connections are typically getting phased out for USB connections to the computer.
Another important hardware consideration when it comes to voice recognition software is PC RAM and processor speed. Obviously, the more the better, as it can decrease latency times between your spoken words and text production by the software. Although I have not seen many studies related to this, I do believe high latencies cause disruption in the dictation flow from physicians.
Speaking from experience in my own clinical practice, it is easier to flow your dictation when you see text-produced sentences at a time as opposed to paragraphs because of a slow computer. Remember, as discussed above, disruptive dictations and speaking in short phrases versus sentences negatively impacts overall accuracy. If you want the minimum technical requirements, you should have an Intel Pentium4 or later or AMD Athlon 64 1 GHz or later processor. At minimum 1 GB of RAM for Windows Vista, or 2GB RAM for Windows 7 32-bit [BC1] and 64-bit. Lastly, at least 512 KB of L2 Cache is needed, which is essentially memory separate from the processor chip and holds commonly used data that is accessible faster than main memory. I can’t emphasize enough that these are minimum requirements!
There are several other important considerations from an IT implementation perspective that should be made when looking into voice recognition in health care, such as clinical workflow and EHR integration. Overlooking any of these can result in low utilization and ultimately failure. Hopefully, the tips and advice posted above can help you prevent such an outcome. Stay tuned on tips and advice on clinical workflow and EHR integration to come in a future blog post.
Dr. Andres Jimenez is CEO of ImplementHIT, a leading Health IT training firm and creators of the OptimizeHIT training platform, which is rapidly becoming the “new standard in health IT training”. Dr. Jimenez is a Nuance physician advocate, and is still clinically active using voice recognition for all his clinical documentation.
In this Health IT Exchange video interview, I had the pleasure of chatting with HIMSS’ HIE Symposiumspeaker, Dr. Doug Fridsma, Director of the ONC’s Office of Standards and Interoperability, who discusses his main takeaways from the Symposium and also shares his insight on how MU stage 2 will continue to promote health IT interoperability, EHR adoption and the digitization of health data for increased quality and care coordination.
While at HIMSS 2012 this year, I had the opportunity to connect with two of the conference’s resident CFO experts, Keith Campanelli, CFO and practice administrator of Austintown Pediatrics, and Don Longpre, CFO of North Ottawa Community Hospital, who spoke to “health IT solutions that help CFOs weather the reform storm” at the conference’s co-located Summit for Health Information & Financial Technology.
In this Health IT Exchange video interview, Keith and Don share their thoughts on the evolving role of the provider CFO and discuss how they’ve been able to successfully balance the requirements of health IT funding management with the everyday tasks associated with maintaining a healthy revenue cycle. With Austintown Pediatrics reducing both patient payment processing time and bad debt by 50%, and North Ottawa Community Hospital accelerating patient payments by 44%, both gentlemen share their impressive organizational stories and explain how advances in revenue cycle management technologies and banking information systems can create operational efficiencies, streamline processes, achieve cost savings and reengineer the revenue cycle from the front to the back.
ICD-10, BPM, Business process management for ICD-10
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