July 30, 2015 9:47 AM
Posted by: ShaunSutner
While the Obama administration may be nearing lame duck status, its health IT arm, ONC, is still doling out money to people doing things that align with the agency’s goals of the moment.
In this case, ONC announced this week it is releasing more than $38 million to organizations working in health information exchange (HIE) and interoperability; peer learning in population health management; and, in one of ONC’s newest target areas, workforce training for introducing health IT into long-term care facilities, patient-centered medical homes and .
All told, 20 awardees in 19 states, including 12 state-based HIEs, will share three grants funded by the Health Information Technology and Clinical Health Act (HITECH).
“Like interoperability, the success of these programs is a priority but really only a means to an end. These programs and the communities participating in them will help us move toward a world in which health IT and interoperability enable better care and better health,” ONC’s chief medical officer, Thomas Mason, M.D., said in the agency’s blog, HealthITBuzz.
Some efforts funded by the grant money — particularly advancing interoperability, HIE, community peer learning, and workforce development programs — also align with ONC’s Shared Nationwide Interoperability Roadmap and Federal Health IT Strategic Plan, official versions of which are slated to be released soon, Mason said.
The interoperability and HIE grants have these objectives, according to ONC:
- Expand the adoption of HIE technology, tools and services
- Enable the send, receive, find and use capabilities of health information across organizations, vendors and geographic boundaries
- Increase interoperability to support caregiving and decision making
The workforce training programs will cover:
- Population health
- Care coordination
- New care delivery and payment models
- Value-based and patient-centered care
July 28, 2015 11:04 AM
Posted by: adelvecchio
, EHR attestation process
, Meaningful use
, meaningful use audits
The American Academy of Family Physicians (AAFP) didn’t get the response it desired when it sent a letter of concern about the meaningful use audit program to CMS in April. In fact, CMS hasn’t responded to the AAFP at all.
CMS’ silence prompted Reid B. Blackwelder, M.D., AAFP board chair, to address another letter to CMS Acting Administrator Andy Slavitt on behalf of the AAFP’s nearly 121,000 members.
After discussions with its members, the AAFP is questioning whether meaningful use audits are undoing what the original program set out to accomplish, namely lightening the financial requirements of installing and maintaining an EHR system. The group’s central complaint is that meaningful use audits saddle physicians “with unreasonable and burdensome documentation requests which result in additional, significant expenses to be a meaningful user.”
The more recent AAFP letter listed common complaints the group has received from family physicians about being the subjects of meaningful use audits. A lack of communication on the auditor’s behalf was a recurring gripe. Physicians said auditors don’t always follow up their audits or correspond with them in a timely fashion. When the auditors did interact with physicians, the back and forth between the two sides carried on for so long that some physicians were left wondering when their audit had officially ended.
To improve its understanding of the meaningful use audit program, the AAFP asked CMS to answer the following questions:
- What percentage of eligible professionals is being audited?
- What is the pass/fail ratio of meaningful use audits?
- What are the details behind the selection process for an audit?
Undeterred by CMS’ failing to counter its previous correspondence, the AAFP’s letter concluded with a request to meet with CMS to review those questions. A meeting between the two groups would also give the AAFP a forum to explain why the family physicians it represents have categorized the audit process as “disruptive and unhelpful.”
July 23, 2015 3:46 PM
Posted by: klee34
With ICD-10 fast approaching, some healthcare providers won’t be prepared in time. In order to ensure that you aren’t one of them, CIOs need to make sure they’re ready for the less obvious — yet disruptive — effects of ICD-10.
A good way for CIOs to tackle this goal is to plan for the “what if” scenarios, technology researcher firm Gartner said in a report.
CIOs should create contingency plans that address unanticipated consequences that could happen during and after the transition to ICD-10. One approach is to identify areas of vulnerability within the organization but outside of IT. Gartner said that it’s also important to take the effects on other areas of IT into consideration if resources are focused solely on the ICD-10 implementation.
Gartner also suggests preparing for “what if” scenarios by allocating resources and staff to focus on claims processing and provider and member support. And don’t forget to make sure that there is staff dedicated to recovering overpayments.
CIOs will also need to prepare for those providers who are not ready when ICD-10 rolls around. This will likely cause problems in at least the early months of the transition, and Gartner recommends that CIOs work closely with vendors and providers in advance and make sure to agree contractually on how to reconcile process and payment delays. CIOs should also continue to refine claims management and payment after ICD-10 debuts by using analytical tools.
And in case you’re feeling overwhelmed by the approaching Oct. 1 date and the flood of information, a good laugh might help relieve the stress. So take a moment to look at this humorous art inspired by the “most important” ICD-10 codes.
July 23, 2015 1:39 PM
Posted by: ShaunSutner
, patient data privacy
The 4.5 million people who had their health and financial records potentially exposed in a hack of the UCLA Health provider system were not the only victims of the breach, which UCLA officials said they first started looking into nearly a year ago.
Apparently, so was the full intent of the HIPAA breach notification rule that clearly states that breaches must be reported to people who have been affected no later than two months after discovery of the incident.
According to the letter of the rule:
- HIPAA-covered entities such as healthcare providers and their business associates must notify affected people “no later than 60 days following the discovery of a breach” either individually or with “substitute notice” on the organization’s Web site or in the media
- Likewise, media notice must also be given no later than 60 days after discovery of a breach
- Breaches must also be reported to the Department of Health and Human Services (whose Office for Civil Rights enforces HIPAA) within 60 days for breaches involving more than 500 people and, for breaches involving fewer than 500 people, no later than 60 days after the end of the calendar year in which the breach was discovered
Leaving aside the question of whether UCLA should have reported the breach back in the fall or early winter of 2015 after the provider detected suspicious activity in October 2014, the Los Angeles-based health system was at least 10 days late in telling the world about it in a release on July 17, 70 days after UCLA says it confirmed the incursion.
Any lack of promptness or less than full disclosure doesn’t serve health providers or companies hit by breaches well at all, says Stephen Cobb, a senior security researcher with ESET, a Slovakia-based data security firm with a U.S. office in San Diego.
UCLA also said it wasn’t sure whether people’s records were accessed in the breach or whether hackers acquired people’s personal information.
“It appears that the cyberattacker accessed parts of the UCLA Health network that contained personal information, such as names, addresses, dates of birth, Social Security numbers, medical record numbers, Medicare or health plan ID numbers and some medical information (e.g., medical condition, medications, procedures, and test results),” UCLA’s FAQ list on the breach states. “At this time we have no evidence that the cyberattacker actually accessed or acquired any individual’s personal or medical information. Our investigation is ongoing.”
But Cobb said hacked organizations should assume that if their systems were penetrated, then data was likely taken as well.
“I don’t think downplaying it does you any good,” Cobb told SearchHealthIT. “Organizations don’t get that it’s a safe assumption that if someone sees the information, they’ve got the information … that if an intruder is on a system with sensitive information in it, and nothing is between the intruder and the information, you have to assume it’s been compromised.”
A UCLA media spokeswoman declined comment and referred SearchHealthIT to the release and official breach substitute notice. UCLA also directed patients and others possibly affected to three major credit reporting agencies for free credit reports.
Meanwhile, Cobb counsels organizations to be as forthcoming as possible after a breach.
“If you have had a breach, everything you say and do about it affects your brand,” he said.
In its disclosures of the breach, UCLA said it started working with the FBI early in the health system’s investigation in the fall of last year.
Cobb said it is understandable that hacked organizations may want to keep quiet about a suspected breach of their network, and may even be counseled by law enforcement authorities to do so.
Prompt breach notification may not be such a big issue if organizations, including healthcare systems, put more thought, money, training, technology and staff into security and especially security risk analysis, Cobb said.
“If you do it right, you have much less chance of having a breach,” he said. “Healthcare as a sector is playing catch-up on security.”
Referring to the nearly $30 billion providers have receivd under the meaningful use program since 2009 for digitizing health records, Cobb said: “Some health providers got money from the government, and some of that money should have been spent on security.”
July 21, 2015 1:00 PM
Posted by: adelvecchio
, EHR implementation
, health IT tools
Undertaking a health IT implementation will result in numerous interruptions to the workflows of clinicians and associated staff members, though those interruptions frequently don’t involve the new technology system. Two U.S. healthcare organizations — which included one specialty and five primary care providers — accepted funding from the Agency for Healthcare Research and Quality (AHRQ) to see what kind of effect implementing health IT would have on their clinical workflows.
Each organization experienced an escalation in the frequency of interruptions after their technology installations. The two most significant of these events were talking to patients and talking to co-workers, the latter of which rose by an average of more than two instances per hour post-implementation.
A primary conclusion reached in the study was that technology installations and alterations resulted in “a redistribution of clinicians’ and clinic staff’s time, repurposed usage of workspace, increased level of interruptions, multitasking, and off-hours work activities.” The study noted that healthcare staff developed workarounds to address workflows issues and prevent patient care from suffering due to patients getting “lost in the system.” To avoid that failure, staff members went through an extra step and kept paper records to back up the work of the newly-implemented system.
One organization that took part in the study was testing how a new EHR system replaced its former EHR. The second organization added a standardized message center, electronic homepage, computerized provider order entry and e-prescribing on to its current EHR. One of the items measured in the AHRQ study was how much time medical staff spent communicating on computers before and after its health IT implementation. The largest jump in this area was nearly 13%, though medical assistants at that same facility showed 4.56% decrease in computer communication, perhaps reflecting the study’s conclusion about technology forcing employees to shift responsibilities.
Providers at the specialty care clinic spent 40% more time on their computers during work “off-hours” at the end of the study compared to the beginning. However, two primary care facilities showed a reduction in how much time their staff spent on their computers during non-work hours after they completed health IT implementations.
July 16, 2015 10:56 AM
Posted by: klee34
With big data evolving so rapidly within healthcare, even the most engaged and informed patients and healthcare advocates might feel they don’t know enough to truly take part in and evaluate the design of big data in healthcare.
That’s what a new program, recently announced by the Reagan-Udall Foundation for the Food and Drug Administration, hopes to solve for patients and advocates who want to get more involved. The program is called Big Data for Patients (BD4P), and it will provide specialized training for patients and advocates on the emerging field of data science, the foundation said in a press release said. The goal of the program is to equip patient advocates with the knowledge and tools they need in order to effectively communicate with policy makers, scientists, physicians and other patients as part of discussions involving big data in healthcare.
According to the Reagan-Udall Foundation, there is a pressing need for more patients and patient advocates who not only understand the potential benefits and risks of big data in healthcare, but can also give meaningful thoughts on large-scale big data initiatives.
“Big data is an area of growing momentum in the health research space that continues to become ever more complex,” Jane Reese-Coulbourne, M.S., ChE., executive director of the foundation, said in the press release. “As we move toward a patient-centered health care system, there is an increasing demand for the involvement of patients and advocates with greater knowledge and better critical appraisal skills in big data. This program will make data science more relatable and less intimidating for patients, ensuring they are better equipped to actively engage in the design, conduct, and application of research, with a focus on the issues most relevant to them.”
The foundation has been awarded $249,827 from the Patient-Centered Outcomes Research Institute to help launch and implement the BD4P program.
July 15, 2015 4:47 PM
Posted by: ShaunSutner
, Meaningful use
Meaningful use is in the spotlight again, but not necessarily in a good way.
The American Medical Association’s (AMA) call this week to “reboot” government regulation of EHRs is the latest in a series of salvos against CMS’ meaningful use program, with some key healthcare and health IT groups now calling for softening or postponing stage 3 of the program.
Put the College of Health Information Management Executives (CHIME) in the camp of parties agitating for a delay in meaningful use, as the AMA has also proposed.
Leslie Krigstein, CHIME’s interim vice president for public policy, told SearchHealthIT that the group’s position is that too much confusion and uncertainty still surrounds meaningful use stage 2 to go beyond it to stage 3, even though stage 3 won’t launch until 2017.
For example, while CMS in April announced major modifications to stage 2, including rolling back the 365-day attestation reporting period to 90 days and aligning the attestation period with healthcare systems’ fiscal year, Krigstein said none of that has been solidified.
“It’s not final,” Krigstein said. “We need the modification rule. We need certainty.”
Krigstein added that CHIME also maintains that there is also too much confusion about which editions of EHR software is being used to attest, and too many problems with ONC’s certification process. CHIME has called for more emphasis on interoperability in the design of certified EHR systems.
Furthermore, she said too few hospitals have yet attested to stage 2 (with less than 20% attesting to stage 2 in 2014, according to ONC’s Health IT Policy Committee) to think about moving to stage 3. (Read more about CMS’ latest attestation data, including 14 take-away points, elsewhere on SearchHealthIT.)
Therefore, CHIME has called on CMS and asked Congress to delay publication of the final stage 3 rule, now expected before the end of this year, until the end of the 2016 program year. That means stage 3 wouldn’t start until 2018 at the earliest.
As for the AMA, the group, in conjunction with the Medical Association of Georgia, will hold a live-streamed town hall meeting in Atlanta July 20 to air physicians’ dissatisfaction with meaningful use.
“Government requirements have twisted EHR technology so it interferes with face-to-face discussions with patients, requires physicians to spend too much time performing clerical work and creates new costs that divert resources away from patient care improvements,” the AMA said in a release this week. “Meanwhile, the much anticipated benefits of being able to share important patient health care information electronically among providers in different settings have gone unfulfilled.”
July 14, 2015 12:12 PM
Posted by: adelvecchio
, clinical coding
, Coding and documentation
, health information management
Health information management professionals believe proficiency in big data analysis, informatics and data mining will be more important for workers in their positions in the future than they are now. However, members of the same group — composed of 3,370 respondents to an AHIMA study — predict more of their workdays will be spent on teaching and leadership in the coming years, with less time spent on coding.
AHIMA conducted the study to determine the current role of health information management (HIM) employees in healthcare and assess what skills and education they will need to be successful years from now after their roles have shifted.
The authors of the study said that almost two-thirds of HIM employees presently do some work that involves coding. When asked to project their future workloads, respondents to the AHIMA study — 58% of whom were HIM professionals — indicated they will spend less time in the future than today on revenue, business analysis, privacy, analytics, and coding. Coding received the lowest ranking in terms of anticipated future workload.
Respondents likely expect their recent peak in coding responsibilities to diminish in the next few years after their organizations undergo the transition to ICD-10 codes on Oct. 1, 2015. Coding also came in last place, after records processing and administrative duties, where the survey asked what skills would be more valuable to have in the following years in comparison to now. The opinions of employers were solicited as part of AHIMA’s study, and they agreed with the HIM respondents that coding is a beneficial skill in today’s health IT environment, but that its value will decrease in the years to come.
Unsurprisingly, respondents ranked privacy and security, EHR management and data integrity among the most important present and future HIM-related competencies. More versatile capabilities, such as critical and analytical thinking and problem solving, checked in near the top of the list of useful talents for HIM employees to possess now and 10 years down the road.
July 9, 2015 3:18 PM
Posted by: klee34
, telemedicine services
On June 22, Connecticut Governor Dannel Malloy signed a telemedicine commercial reimbursement statute into law, making Connecticut the 28th state to do so. The vote provides a stark contrast to the Texas Medical Board’s new rules released back in April that make it harder for doctors to prescribe drugs remotely and for patients to receive them in Texas.
The Connecticut law requires commercial insurers to cover telemedicine and telehealth services the same for in-person visits. The statute also requires that telehealth coverage must be subject to the same terms and conditions that apply to all other benefits under the patient’s insurance policy. These provisions will take effect January 1, 2016.
According to a blog by healthcare attorney Nathaniel Lacktman at Foley & Lardner LLP, Connecticut’s definition of telehealth is broad. This is important because it means that it does not limit covered telehealth services solely to services performed by a telehealth provider located in a different place than the patient. Remote patient monitoring is also included, meaning remote services are not restricted to telehealth providers.
“This requirement will help ensure Connecticut health plan members enjoy benefits of telehealth services such as remote patient monitoring and connected care technologies,” Lacktman wrote.
The law that Connecticut recently enacted is unique in that the language in the statute makes it clear that insurers are required to cover telehealth services the same as in-person services, while other states’ statutes do not. “This is because some services, such as remote monitoring, do not naturally lend themselves to in-person encounters and are designed to be utilized via telehealth,” according to the blog.
Now that Connecticut has enacted this statute, more than 28 states—plus the District of Columbia—in the U.S. have telemedicine commercial insurance laws, and many other states are currently discussing and developing legislation.