EMR and HIPAA

April-18-2014

11:36

I’ve regularly seen the divide (sometimes really wide) between the programmer and technical people in an organization and the healthcare professionals. For example, a healthcare IT company recently emailed me about an issue they had with their main developer. They asked the insightful question, “Is it possible to find quality developers who are not, shall we say, “difficult”?”

There’s no simple answer to this question, but let me first suggest that this divide isn’t something that just happens between tech people and non-tech people. I’m sure many doctors feel the same way when dealing with other people who try and do their job. It turns out, people are hard to work with in general.

That disclaimer aside, tech people do like to think they’re in a tribe of their own. Check out this video which definitely comes from a programmer perspective and illustrates the divide that often exists.

Just the fact that the programmer feels like they’re considered a “code monkey” describes a major part of the issue. Much like I wrote about today on EMR and EHR, one of the keys is making a human connection as opposed to treating a programmer like a code monkey that’s just there to do your bidding. While there are exceptions, most people respond to someone who deeply cares about the individual and works to understand their needs as much as the project’s needs or their own needs.

The reason I think there’s usually a big divide between the healthcare people and the tech people is that it’s a real challenge for these two groups to connect. The healthcare people don’t want to talk about Battlestar Gallactica and Game of Thrones and the tech people don’t want to talk about Dancing with the Stars and The Voice. Yet, this is what needs to happen to build trust between the two different groups. It’s a rare breed that enjoys both.

If all of this fails, then try the nuclear option. Bring donuts. Most people can relate to donuts.

April-17-2014

11:23

By refusing to pay for readmissions within 30 days of discharge from a hospital, Medicare has sent a strong message across the healthcare industry: < 30 day readmissions should be avoided at all costs. As a result, providers and vendors are doing everything in their power to avoid < 30 day readmissions.

This seems like a simple way to reduce costs, right? Well, not quite…

The vast majority of costs of care delivery are fixed: capital expenditures, facilities and diagnostics, 24/7 staffing, administrative overhead, etc. In other words, it’s extremely expensive just to “keep the lights on.” There are some variable costs in healthcare delivery – such as medications and unnecessary tests – but the marginal costs of diagnostics and treatments are small relative to the enormous fixed costs of delivering care.

Thus, Medicare’s < 30 day readmission policy doesn’t really address the fundamental cost problem in healthcare. If costs were linearly bound by resource utilization, than reducing readmissions (and thus utilization) should lead to meaningful cost reduction. But given the reality of enormous fixed costs, it’s extremely difficult to move down the cost curve. To visualize:

Screenshot 2014-04-14 23.46.37

Medicare’s < 30 day readmission policy is a bandaid – not a cure – to the underlying cost problem. The policy, however, reduces Medicare’s outlays to providers. Rather than reduce (or expand, depending on your point of view) the size of the pie, Medicare has simply dictated that it will keep a larger share of the metaphorical pie for itself. Medicare is simply squeezing providers. One could argue that providers are bloated and that Medicare needs to squeeze providers to drive down costs. But this is intrinsically a superficial strategy, not a strategy that addresses the underlying cost problems in healthcare delivery.

So how can we actually address the fixed-cost problem of healthcare? Please leave a comment. Input is welcome.

April-16-2014

11:05

The following is a guest blog post by Jennifer Bergeron, Learning and Development Manager at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Jennifer_web

If you’ve ever traveled to a country that doesn’t speak your native tongue, you can appreciate the importance of basic communication. If you learn a second language to the degree that you’re adding nuance and colloquialisms, you’ve experienced how much easier it is to explain a point or to get answers you need. What if you’re expected to actually move to that foreign country under a strict timeline? The pressure is on to get up to speed. The same can be said for learning the detailed coding language of ICD-10.

The healthcare industry has been preparing in earnest to move from ICD-9 coding to the latest version of the international classification of diseases. People have been training, testing and updating information systems, essentially packing their bags to comply with the federal mandate to implement ICD-10 this October — but the trip was postponed. On April 1, President Barrack Obama signed into law a bill that includes an extension for converting to ICD-10 until at least Oct. 1, 2015. What does this mean for your ICD-10 travel plans?

Despite the unexpected delay, you’ll be living in ICD-10 country before you know it. With at least another year until the deadline, the timing is just right to start packing and hitting the books to learn the new codes and to prepare your systems. For those who have a head start, your time and focus has not gone to waste, so don’t throw your suitcases back into the closet. The planning, education and money involved in preparation for the ICD-10 transition doesn’t dissolve with the delay – you’ve collected valuable tools that will be put to use.

Although many people, including myself, are disappointed in the change, we need to continue making progress toward the conversion; learning and using ICD-10 will enable the United States to have more accurate, current and appropriate medical conversations with the rest of the world. Considering that it is almost four decades old, there is only so much communication that ICD-9 can handle; some categories are actually full as the number of new diagnoses continues to grow. ICD-9 uses three to five numeric characters for diagnosis coding, while ICD-10 uses three to seven alphanumeric characters. ICD-10 classifications will provide more specific information about medical conditions and procedures, allowing more depth and accuracy to conversations about a patient’s diagnosis and care.

Making the jump to ICD-10 fluency will be beneficial, albeit challenging. In order to study, understand and use ICD-10, healthcare organizations need to establish a learning system for their teams. The Breakaway Group, A Xerox Company, provides training for caregivers and coders that eases learning challenges, such as the expanded clinical documentation and new code set for ICD-10. Simply put, there are people can help with your entire ICD-10 travel itinerary, from creating a checklist of needs to planning a successful route.

ICD-10 is the international standard, so the journey from ICD-9 codes to ICD-10 codes will happen. Do not throw away your ICD-10 coding manuals and education materials just yet. All of these items will come in handy to reach the final destination: ICD-10.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

April-15-2014

13:19

I’ve written regularly about the need for secure text messaging in healthcare. I can’t believe that it was two years ago that I wrote that Texting is Not HIPAA Secure. Traditional SMS texting on your cell phone is not HIPAA secure, but there are a whole lot of alternatives. In fact, in January I made the case for why even without HIPAA Secure Text Messaging was a much better alternative to SMS.

Those that know me (or read my byline at the end of each article) know that I’m totally bias on this front since I’m an adviser to secure text message company, docBeat. With that disclaimer, I encourage all of you to take a frank and objective look at the potential for HIPAA violations and the potential benefits of secure text over SMS and decide for yourself if there is value in these secure messaging services. This amazing potential is why I chose to support docBeat in the first place.

While I’ve found the secure messaging space really interesting, what I didn’t realize when I started helping docBeat was how many parts of the healthcare system could benefit from something as simple as a secure text message. When we first started talking about the secure text, we were completely focused on providers texting in ambulatory practices and hospitals. We quickly realized the value of secure texting with other members of the clinic or hospital organization like nurses, front desk staff, HIM, etc.

What’s been interesting in the evolution of docBeat was how many other parts of the healthcare system could benefit from a simple secure text message solution. Some of these areas include things like: long term care facilities, skilled nursing facilities, Quick Care, EDs, Radiology, Labs, rehabilitation centers, surgery centers, and more. This shouldn’t have been a surprise since the need to communicate healthcare information that includes PHI is universal and a simple text message is often the best way to do it.

The natural next extension for secure messaging is to connect it to patients. The beautiful part of secure text messaging apps like docBeat is that patients aren’t intimidated by a the messages they receive from docBeat. The same can’t be said for most patient portals which require all sorts of registration, logins, forms, etc. Every patient I know is happy to read a secure text message. I don’t know many that want to login to a portal.

Over the past couple years the secure text messaging tide has absolutely shifted and there’s now a land grab for organizations looking to implement some form of secure text messaging. In some ways it reminds me of the way organizations were adopting EHR software a few years back. However, we won’t need $36 billion to incentivize the adoption of secure text message. Instead, market pressures will make it happen naturally. Plus, with ICD-10 delayed another year, hopefully organizations will have time to focus on small but valuable projects like secure text messaging.

April-14-2014

14:57

Editor’s Note: The following is an update to a previous EMR and HIPAA blog post titled “EMR Companies Holding Practice Data for “Ransom”.” In this update, James Summerlin (aka “JamesNT”) offers an update on EHR vendors willingness to let providers access their EHR data.

Over the years I have been approached with questions by several solo docs and medical groups about things such as the following:

  • Migrating to a different PM or EMR system.
  • Merging PM’s or EMR’s such as when a practice buys out another practice.
  • Interfacing the EMR and PM.
  • Custom reports.
  • More custom reports.
  • LOTS MORE CUSTOM REPORTS!!!

And there have been plenty of times I’ve had to give answers to those questions that were not favorable.  In many cases, it was with some online EMR or PM and the fact that I could not get to the database and the vendor refused to export a copy to me or the vendor wanted thousands of dollars for the export.  With the on-premises PM and EMR systems, getting to the data was a matter of working my way around whatever database was being used and figuring out what table had what data.  Although working with an on-premises PM or EMR may sound easier, it too often isn’t.  The on-premises guys have some tricks up their sleeves to keep you away from your data such as password protecting the database and, in some cases, flat out threatening legal action.

A few years back, I wrote a post on a forum about my thoughts on how once you entered your data into a PM or EMR, you may never get it back.  You can see John Lynn’s blog post on that here.

My being critical of EMR and PM software vendors is nothing new.  I’ve written several posts on forums and blogs, even articles in BC Advantage Magazine, about how hard it can be to deal with various EMR and PM systems.  Much of the, at times, downright contemptuous attitudes many PM and EMR vendors have towards their own clients can be very harmful.  Let’s consider three aspects:

  • Customization.  Most of the PM/EMR vendors out there would love to charge mega-bucks to write custom reports and so forth for clients.  However, this isn’t all it’s cracked up to be.  First, most clients simply aren’t going to pay the kind of money many PM or EMR companies want to charge.  Second, custom reports have to be maintained.  Eventually, you have all these clients running around needing changes to their reports and the PM or EMR vendor simply can’t get to them all in a timely manner without hiring lots of technical (read: EXPENSIVE) staff which turns what was once a money-making ordeal into a money losing one.  And, of course, the client’s suffer since they can’t fine-tune their practice to the degree needed in today’s challenging economy.
  • Interfacing.  What happens if a client wants to interface encounters and demographics from their EMR to their PM system and then interface dollar amounts and so forth from the PM system with receivables and expenditures in Quickbooks or other financial software into a series of reports that give a total view of how the practice is doing?  We are talking about the ability to, day-by-day, forecast incoming receivables from carriers and patient payments (within certain limits, of course), with expected expenditures (payroll, taxes, etc.) from the accounting software to get a financial outlook for the practice for the next few weeks or even months for long-term planning.  A PM or EMR vendor, already dealing with HIPAA or meaningful use, may not want to get involved in that kind of hard-core number crunching, yet the practice is demanding it.
  • A second part to interfacing.  Getting the EMR and PM vendors to get along.  Often what you see is the EMR vendor has a certain way they do an HL7 interface and the PM vendor has a certain way they do an HL7 interface and if they don’t line up properly, you’re just out of luck.  Either it works with reduced functionality or it doesn’t work at all and neither vendor will budge to change anything.  And that’s assuming they both use HL7!

In situations like those above, the best way to resolution is for the practice to perhaps obtain its own technical talent and build its own tools to extend the capabilities of the data contained within the various databases and repositories it may have such as the databases of the PM and EMR.  Unfortunately, as I have reported before, most PM and EMR systems lock up the practice’s data such that it is unobtainable.

At long last; however, there appears to be a light at the end of the tunnel that doesn’t sound like a train.  Some of the EMR systems that doctors use are beginning to realize that creating a turtle shell around a client’s data, in the long run, doesn’t do the client nor the PM/EMR vendor any good.  One such EMR I’ve been working with for a long time is Amazing Charts.  Amazing Charts has found itself in a very unique situation in that many of its clients are actually quite technical themselves or have no problem obtaining the technical talent they need to bend the different systems in their practices to their will.  The idea of having three or four databases, each being an island unto itself, is not acceptable to this adventurous lot.  They want all this data pooled together so they can make real business decisions.

Amazing Charts; therefore, has decided to be more open regarding data access.  Read only access to the Amazing Charts database is soon to be considered a given by the company itself.  Write access, of course, is another matter.  Clients will have to prove, and rightly so, that they won’t go spelunking through the database making changes that do little more than rack up tech-support calls.  Even with the caution placed on write access this is a far jump above and beyond the flat out “NO” any other company will give you for access to their database.  I consider this to be a great leap forward for Amazing Charts and, I’m certain, will set them apart from competition that still considers lock-in and a stand-offish attitude the way to treat clients who pay them a lot of money.

Perhaps one day other PM and EMR vendors will see the light and realize the data belongs to the practice, not the vendor, and will stop taking people’s stuff only to rent access to it back to them or withhold it altogether.  Until then, Amazing Charts seems to be leading the way.

Blog url: 
http://www.emrandhipaa.com/

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