Healthcare data management

Wendi Klein, Director of Marketing & Communication, North America, A2iA

Since reform and regulation have stirred the industry, it has become an even more complex environment, though the goal is to streamline processes. In the wake of healthcare reform, healthcare IT has been forced to comply with new regulations, and healthcare IT needs have shifted. The U.S. government has set forth dates and deadlines by which providers and payors must meet certain milestones, placing emphasis on obtaining meaningful use of patient data, the availability and recovery of data to increase productivity and enhance patient care, as well as the industry’s transition from ICD-9 to ICD-10.

Given this complex and changing environment, healthcare IT providers must focus on implementing solutions that will meet users’ needs today and in the future, while maximizing existing spending to deliver an ROI. But with so many vendors trying to make a name for themselves, how can one stand out from the competition yet still deliver technology that meets government mandates?

CCHIT certified solutions, for example, are becoming more and more common since this is how the Department of Health and Human Services deems a system a "qualified EMR." However, many CCHIT solutions today still require manual document sorting and data entry because of the complex nature of healthcare documents. Hospitals and clinics alike are looking for ways around this, as it is no secret that manual document handling is a time consuming and expensive task, and even allows for breaches in privacy with the involvement of third-parties.

By partnering with technology companies that provide advanced indexing and data lifting capabilities, CCHIT certified solutions can address these pain points by removing the human interaction and allowing for higher levels of productivity, consequently differentiating themselves from the competition. By allowing complex and even handwritten documents such as provider notes, clinical documentation, lab results or prescriptions to enter the workflow, automatic routing to EHR, EMR or PM solutions can occur, and the data can be automatically located and lifted. Tangible results are seen almost immediately, and the CCHIT solution stands out from seemingly similar applications by providing a greater level of automation for all documents, regardless of their type or complexity.

Once these complex documents are incorporated into the EHR, EMR or PM solution, the next steps, like coding and billing, can occur. According to a recent study, between 5 and 15 percent of a coder’s time is spent reading health information, and 50 percent of a record clerk’s time is spent looking for information. ICD-9 is currently an accepted set of codes to be used for reporting diagnoses and procedures on healthcare transactions, although it must be replaced by ICD-10 no later than October 2013.

Because ICD-10 contains nearly 5 times as many codes and sub-codes, the conversion from ICD-9 to ICD-10 is predicted to decrease productivity by a minimum of 25 percent for three to six months after the transition as coders adjust to new methodology, and become a more costly endeavor than Y2K in terms of both time and money.

Although the deadline to transition to ICD-10 is not until 2013, many have already started to look for solutions to counteract the predicted loss of efficiency. Computer Assisted Coding, or CAC solutions, can help, but many are still asking, “How will coders remain productive as they learn the new codes and sub-codes so that providers can submit and receive payments, and payors can process claims, at the same level of accuracy and speed that they are today?”

Because of these fears and the anticipated decrease in efficiency, there is a large opportunity for technology that can aid in the transition process. Newer, advanced solutions can bring greater levels of automation, help to increase processing times and accuracy, and even save money. By enhancing CAC solutions with capabilities that can automatically locate and lift medical terms and diagnoses from both printed and handwritten documents, such as providers notes and clinical documentation, the research process is sped up and manual labor decreased as codes are automatically assigned. All coded documents can then be indexed and routed with virtually no human interaction to the appropriate EHR, EMR or PM solution, speeding productivity, guaranteeing automation, and aiding in the research and coding process.

Healthcare data management is a complex world, and no one knows what changes are on the horizon. Current solutions can certainly aid in productivity, but combining them with the capabilities of newer, advanced technology, today’s pain points can be lessened, automation improved, and tomorrow’s fears calmed.

What do you think?

Consolidating patient records

By Mark Brousseau

As they move to electronic medical records (EMRs), one challenge for healthcare providers is how to consolidate electronic access to all of a patient’s documents.

Citizens Memorial Healthcare, which is made up of a hospital, 25 clinics, five long-term care facilities and a cancer center, has licked this problem by using ImageNow from Perceptive Software to tie together documents not captured in its Meditech 5.6 EMR system, including EKGs, radiology reports, outside lab results, wound and surgical photos and registration photos. This integration has allowed Citizens Memorial Healthcare to create a shared medical record across its enterprise.

In its EMR environment, regardless of visit, a patient’s documents are organized under a common number. To access documents related to an account that were not captured at the point-of-service by the EMR, the provider launches ImageNow in the background, allowing documents from either application to be displayed in the EMR system. To speed retrieval, ImageNow indexes documents in several categories; for instance, physicians can view patient diagnostics without having to look through registration documents. Documents also can be retrieved across accounts.

Electronic documents are created at the point-of-registration or via scanning later.

For primary care physicians that don’t have a way to get their EMR records into Citizens Memorial Healthcare’s system, ImageNow provides the ability to “scrape” data off of incoming faxes. As faxes come in to Citizens Memorial Healthcare, they are placed in a workflow queue where an employee triggers the technology.

“Our long-term goal is to have a true interface with Meditech for these documents. But we don’t have that in place now. ImageNow has provided that availability,” Tim Roberts, IS specialist, Citizens Memorial Healthcare, said yesterday during a presentation at Perceptive Software’s Inspire 2011 user conference in Las Vegas.

From Healthcare to Baseball

Posted by Mark Brousseau



Chuck Garcia of BOK Financial, Kendall Brown and Gordon Sellers of Systemware, Serena Smith of FIS, Mark Brousseau of IAPP-TAWPI, and Alan Beaney of Systemware take in a Boston Red Sox game after attending the Healthcare Payments Automation Summit.

The Mid-Term Elections and Healthcare Reform

Posted by Mark Brousseau


Even if Republicans win majorities in Congress this fall, it's unlikely that they will be able to repeal the recently passed healthcare reform legislation, Dennis G. Smith, managing director of the Medicaid practice at Leavitt Partners, said during a keynote presentation this morning at IAPP-IARP-TAWPI’s Healthcare Payments Automation Summit (HPAS) at the Boston Sheraton.

“Nobody is talking about the Republicans winning veto-proof majorities,” Smith said, adding that even if the Republicans did win big, repealing the legislation would only put the country “right back where we started, with the same problems. And when I travel around the country, employers are telling me that they are fed up with the current healthcare environment.”

Against this backdrop, significant changes in the healthcare reform law “really depends on whether Obama pivots, and does what Clinton did in the 1990s,” Smith said. “But Obama is far more ideological than Clinton was.”

So what changes can Republicans push through Congress if they were to win majorities as a result of the mid-term elections? One tool available to them is the Congressional Review Act, which allows Congress to veto regulations. They also can cut appropriations for certain mandates. “Even entitlements are subject to appropriations,” Smith notes. Congress can also demand a budget summit, which has occurred about every 12 years, Smith said.

But healthcare industry stakeholders shouldn't wait on Congress. “If you expect to be on the winging team when healthcare reform goes into effect, now is the time to prepare,” Smith concluded.

Tommy Thompson Addresses HPAS

Posted by Mark Brousseau

This morning, former Wisconsin Governor Tommy G. Thompson delivered the opening keynote address at IAPP-IARP-TAWPI's Healthcare Payments Automation Summit (HPAS) in Boston. Weaving his experiences as a four-term governor and the Secretary of the Department of Health and Human Services with his recent experiences in the private sector, Thompson told the standing-room only crowd that it's unlikely that healthcare reform will achieve the cost-saving objectives advertised by the Obama Administration, or that hospitals will be ready to meet new federal mandates for health information exchanges, without financial support from the federal government.



WAUSAU Financial Systems Executive Vice President and member of the IAPP-IARP-TAWPI Board of Directors Kathy Strasser greets former Wisconsin Governor Tommy G. Thompson before his keynote presentation this morning at HPAS.










IAPP-IARP-TAWPI President and CEO Tom Bohn greets former Wisconsin Governor Tommy G. Thompson before his keynote presentation at HPAS this morning.












Eric Jones (right), chairman of the IAPP-IARP-TAWPI Board of Directors, and Kathy Strasser, executive vice president at WAUSAU Financial Systems and member of the IAPP-IARP-TAWPI Board of Directors, greet former Wisconsin Governor Tommy G. Thompson before his keynote address this morning at HPAS.










Former Wisconsin Governor Tommy G. Thompson addressing HPAS this morning.

Solving the Revenue Cycle

By Mark Brousseau

Banks are well positioned to help “solve” the healthcare revenue cycle, thanks to the keystone revenue cycle data that flows through banks every day, Benchmark Revenue Management CEO Tyson McDowell said at the Medical Banking Project Boot Camp in Atlanta this afternoon.

“Banks can solve operational improvement issues for hospitals, while solving transparency and risk management issues for themselves,” McDowell told attendees. He said banks should “grow-up” their healthcare revenue cycle solutions and extend into denial management, denial avoidance, and services that back up their healthcare customers’ revenue cycle workers with “on-demand” talent.

Today, many banks offer lockbox services, patient payment solutions and extended lockbox services.

“The revenue cycle improvement market is exploding due to permanent financial pressures,” noted McDowell. “While the official definition of the revenue cycle is all of the administrative processes related to collecting all fees owed for services to patients, a more practical definition would be: a near futile attempt to collect all the monies owed in a world with thousands of moving parts.”

“A hospital really has no idea how much money it’s going to get paid,” McDowell said. “Hospitals and, to a lesser extent individual doctors, are getting it from all sides. Healthcare providers need to protect themselves. And denial and payment data is the keystone for solving the revenue cycle.”

Banks have unique access to this information, McDowell said, and they offer value-added services like lockbox. “Banks are in a position to provide new services for healthcare. And it comes from the data. The hospital needs someone to tell them why they need to spend money on an improvement.”

McDowell concluded that banks are starting to move in the direction of new healthcare services.

The Other Story at HIMSS

By Mark Brousseau

While Electronic Health Records (EHR) and the impact of the recent definition of the meaningful use requirements will be hot topics at next week's HIMSS Conference in Atlanta, HERAE CEO Jim Ribelin thinks a program underwritten by the new HIMSS Medical Banking Project bears watching.

The project, called Designing the Healthcare Financial Network of the Future, is "right on target," Ribelin says. "The program will assemble key stakeholders to discuss what a strong financial network for healthcare could look like. A future that doesn’t siphon 20 cents of every healthcare dollar spent, and works to advance the balance between responsible financial management and clinical needs of patients," Ribelin says. The program's objective is to determine how the healthcare system can enhance value, reduce costs, and empower the shift from simple disease management to improved health for consumers, while at the same time creating better business models for the healthcare providers.

"EHRs are receiving a lot of attention, but the payment system, where a lot of new processes are in place with standards and systems defined such as bank ACH transactions, HIPAA 835s and ERA files, provides a real opportunity for significant change. A chance to create a network that will reduce costs and create efficiencies without negative impact on patient care,” says Ribelin. “Fix the healthcare payment system, create a strong financial healthcare network and the industry would see a savings of resources without sacrificing quality healthcare.”

What do you think?

Healthcare Standardization

Posted by Mark Brousseau

Standardization of industry practices is critical to the strength of the healthcare market. Lee Barrett, executive director of the Electronic Healthcare Network Accreditation Commission (EHNAC) explains:

As the healthcare industry continues to evolve to meet regulations and requirements outlined in ARRA, HITECH and HIPAA, more than ever, there’s need for standardization of industry practices and optimization of stakeholder cooperation. Coupled with the complex issues surrounding interoperability, privacy, security and access is the fact that healthcare networks, financial service firms, payer networks, e-Prescribing and other solution providers and vendors need to overtly demonstrate their readiness, competence and capability to address these issues and comply with a complex web of regulations.

When any industry goes through the process of defining the standards to which industry participants should adhere, that industry becomes stronger in its own operations and earns greater respect from affiliated and external stakeholders. This is precisely the case with the electronic healthcare transaction industry.

EHNAC, or the Electronic Healthcare Network Accreditation Commission, is focused on establishing, developing, updating and filtering the criteria that define whether organizations operating in the healthcare electronic transaction industry receive accreditation or not. Through a dialogic process, that builds on stakeholder recommendations, insights and comments, EHNAC develops and promotes criteria for best practices, which focus on simplifying administrative processes, maintaining open competition and enhancing operational integrity.

In January, EHNAC announced the finalization and adoption of program criteria for 2010. This announcement concluded a 60-day public comment period for the following programs:

1. ASPAP-EHR – Application Service Provider Accreditation Program for Electronic Health Records
2. ePAP – e-Prescribing Accreditation Program
3. FSAP EHN – Financial Services Accreditation Program for Electronic Health Networks
4. FSAP Lockbox – Financial Services Accreditation Program for Lockbox Services
5. HNAP EHN – Healthcare Network Accreditation Program for Electronic Health Networks
6. HNAP Medical Biller – Healthcare Network Accreditation Program for Medical Billers
7. HNAP TPA – Healthcare Network Accreditation Program for TPAs
8. HNAP-70 – Healthcare Network Accreditation Plus Select SAS 70© Criteria Program
9. OSAP – Outsourced Services Accreditation Program

In addition, the commission developed draft criteria for Health Information Exchange (HIE) entities. In February, this draft criteria was released for 60-day public comment and review and will be finalized during the second quarter 2010.

The issues addressed through the criteria review and approval process become increasingly complex, as the industry responds to specific provisions in the federal acts. Criteria for accreditation programs today address health data processing response times and security; privacy and confidentiality for financial service providers; and e-Prescribing timeliness and security. As regulatory guidelines become more complex, industry participants are called on to make sure their operations are simplified, secure and compliant.

Accreditation also simplifies the process of discerning between those who are adhering to industry standards, and those who are not.

Best Practices for Gateway EDI

Posted by Mark Brousseau

For Gateway EDI, EHNAC accreditation shows the way to best practices. EHNAC Executive Director Lee Barrett explains:

As one of the fastest-growing providers of healthcare electronic data interchange, Gateway EDI processes transactions for more than 10,000 medical offices representing 50,000 providers in all 50 states. Gateway EDI also connects to more than 3,000 payers and offers services ranging from standard claims processing and status reports to more advanced capabilities such as technology for flagging rejected claims.

Founded in 1983, Gateway EDI has continuously pursued innovations, business practices and opportunities to improve its services. In 2006, just such an opportunity arose through a relationship with the Electronic Healthcare Network Accreditation Commission (EHNAC).

“Our initial interest in EHNAC was prompted by a state of Maryland requirement,” recalls Dave Cheli, chief information officer, at Gateway EDI. “But the accreditation process proved to be a real eye-opener for us.”

An industry veteran, Cheli was already familiar with EHNAC’s work, which dates to the early 1990s. Though the Gateway EDI team knew generally what to expect, they were pleasantly surprised with the advantages of achieving full accreditation in March 2006.

“It provided a great framework for bringing together a wide range of security, privacy and operational aspects,” says Cheli. “Seeing it all from EHNAC’s perspective in a comprehensive overview was an interesting experience. It shined some light on some aspects of our business where there had been missing pieces.”

Taking a closer look
Transaction auditing serves as a case in point. Gateway EDI manages more than 15 million transactions a month, and the EHNAC criteria require that electronic health networks demonstrate the ability to produce detailed audit trails for all of them.

“Most clearinghouses handle millions of transactions on a monthly basis,” says Cheli. “You might think you can account for every transaction, but EHNAC forces you to show that you can. When you start looking at reports and doing the research, you learn more about your business. For us, the process highlighted some areas where we were able to shore up our capability to reconcile every single transaction.”

In addition to these operational enhancements, EHNAC accreditation has impacted the customer service side. “As a result of our original accreditation in 2006, we added some processes that have benefitted our clients, such as closer monitoring of customer service status,” says Cheli.

In response to marketplace trends, Gateway EDI has grown its business on the strength of value-added services and strong support. And in the years since it began working with EHNAC, Gateway EDI has further built on that advantage. In May 2008, Gateway EDI was included in the “Ambulatory EDI Claims Clearinghouse” report published by KLAS, the Orem, Utah-based research firm (www.KLASresearch.com) specializing in monitoring and reporting the performance of healthcare vendors.

Gateway EDI’s results included 100 percent positive commentary regarding the vendor relationship, and perfect scores, 100 percent, for Would Recommend to a Friend or Peer, and Services Delivered within Budget/Cost. With most Gateway EDI customers “feeling well taken care of”, Gateway EDI earned an 89 overall rating score, a functional strength rating of 4.5 out of 5.0., and first-place for practice management integration. It also captured the top rating in several categories, including “Quality of Services Staff” and “Real Problem Resolution.”

Standards as best practices
As a self-governing non-profit, EHNAC maintains a comprehensive set of publicly-available standards criteria covering privacy and confidentiality; technical performance; business practices; physical, human and administrative resources; and security.

The EHNAC standards development process is fully open and transparent. Based on years of research, it’s the result of continuous input from electronic health networks, payers, hospitals, physicians, consumer groups, financial services firms, security organizations and vendors.

“Because it’s built on years of studying the industry and it’s so broad based, the EHNAC criteria have essentially become a collection of best practices,” says Cheli.

A credible process
EHNAC’s accreditation process, which is based on these established standards, begins with a candidate organization’s submission of an in-depth self-assessment. Later, an EHNAC site reviewer visits to evaluate the accreditation candidate more closely. This hands-on approach helps companies identify issues as well as opportunities.

“In 2006 and again, with our re-accreditation in 2008, the EHNAC assessor spent time understanding our processes. They’ve asked a lot of insightful questions and shared some wonderful tips with us,” says Cheli. “For example, this year we got some very valuable advice on improving our disaster recovery and business continuity measures.”

An operational catalyst
Cheli believes that EHNAC has served as a sort of catalyst, helping Gateway EDI expand privacy and security measures, make decisions about business practices and set meaningful operational objectives. “We now have a lot of people setting departmental goals and monitoring performance metrics that are built around EHNAC criteria,” he says. “Getting a set percentage of claims out in a certain time frame, for example, is now crystallized for us as a monthly goal. And we’re more meticulous about monitoring against those goals.”

“Would we have gotten there without EHNAC driving a lot of this?” Cheli asks. “Probably. But not as quickly. EHNAC is the only organization that provides a comprehensive accreditation service for clearinghouses. HIPAA-related issues are just a part of the overall criteria. They look at it from a total operational perspective.”

Truth in advertising
One also can see the results of Gateway EDI’s efforts with a quick visit to its website. Gateway EDI customers have an average overall error rate of only seven percent. Ninety-eight percent of customer service calls are answered directly by a real person. Gateway EDI solves 92 percent of customer questions on the first call.

And prospects can rest assured that these claims about claims are real. In addition to performance standards and policies and procedures, EHNAC accreditation encompasses “truth-in-advertising” criteria. So statements like these are verifiable.

What began as a requirement has become a resource for Gateway EDI — and relationship, too. “The people behind EHNAC are experienced, smart and very passionate about what they do,” says Cheli. “They’ve been extremely supportive of us, and our relationship has been wonderful.”

e-Prescribing Accreditation

Posted by Mark Brousseau

Below is an article from Lee Barrett, executive director of the Electronic Healthcare Network Accreditation Commission (EHNAC) on the importance of accreditation for e-prescribing stakeholders:

EHNAC Advocates Third-Party Accreditation for e-Prescribing Stakeholders

By Lee Barrett

As pharmacy continues to play an ever-important role in patient care, pharmacists progressively maintain access to sensitive patient information. Added to this, there is increased incidence of electronic prescribing, at the encouragement of federal agencies like the Department of Health and Human Services. e-Prescribing has even been referred to as the “on-ramp” to the healthcare information highway. All of this means that pharmacy continues to play an integral role in readying the healthcare industry for complete reliance on electronic health records, and in the imperative protection of patient health information. In response to this repositioning of the industry, state Boards of Pharmacy seek to hold organizations that have access to this information to high standards. As such, pharmacists are required to respond to the patient’s right to privacy.

The Electronic Healthcare Network Accreditation Commission (EHNAC) represents a wide range of stakeholders in its peer-driven effort to advance healthcare through electronic transaction standards, and is positioned to assist pharmacy in ensuring they are protecting patient privacy rights. The accreditation services offered by EHNAC facilitate improved business processes and expanded market opportunities for electronic health networks, payer networks, financial services firms and e-prescribing and other solution providers.

As the healthcare industry evolves toward increased electronic exchange of clinical data, it becomes more critical that trading partners and their customers such as payers, providers, pharmacies and other stakeholders can rest assured that the networks and applications in use are functioning appropriately, but also that they are well protected. Toward this end, EHNAC’s e-Prescribing Accreditation Program (ePAP) helps demonstrate the operational integrity of e-prescribing transaction networks, electronic health record systems, e-prescribing solution providers, and any other electronic health network or company that manages e-prescribing transactions on behalf of its customers.

Through ePAP, EHNAC assessors review an organization’s electronic and fax-based transactions across five main categories of criteria, including privacy and confidentiality; technical performance; business practices; resources; and security. ePAP accreditation from EHNAC also gives an e-prescriber’s customers confidence that all necessary standards for transaction timeliness, security and privacy with new prescriptions and renewals are met or exceeded.

With the health of the pharmacy industry and patients at stake, there is urgent need to secure patient privacy as e-prescribing increasingly becomes standard practice among healthcare providers.

What do you think?

Consumers Want Electronic Health Information

Posted by Mark Brousseau

Deloitte’s 2009 Survey of Healthcare Consumers includes some interesting data regarding consumer interest in electronic health records:

… 9 percent of respondents have a computerized personal health record (PHR) compared to 8 percent in 2008

… 57 percent want a secure Internet site that would enable them to access their medical records and pay medical bills, among other things

… 42 percent want access to an online personal health record connected to their doctor’s office

… privacy and security of health information is an issue: 38 percent are very concerned versus 24 percent who are not at all concerned

… 60 percent believe that the government should set standards for how medical information is collected, stored, exchanged and protected, while other view this as a role for health plans (21 percent) and employers (5 percent); 14 percent say no entity should set standards

What do you think? Post your comments below.