ADVANCE Perspective: HIM : HIM in the News

AHIMA 2009: Busy Day for All

Lisa Algeo — Tue, 06 Oct 2009 03:06:00 GMT

Well, my feet hurt, my brain hurts and I can barely keep my eyes open at this point, but it was all well worth it. My first day at the AHIMA 2009 conference did not disappoint. Busy is an understatement, and I even got a bit of a cardio workout in-with...(read more)

AHIMA 2009: Off to Grapevine

Cheryl McEvoy — Fri, 02 Oct 2009 14:11:00 GMT

Anytime someone mentions this year's American Health Information Management Association (AHIMA) Convention and Exhibit, I immediately think of the song, "I Heard it Through the Grapevine," because, well, the event's being held in Grapevine, TX. Problem...(read more)

Malicious Use of PHI Lands Woman in Jail

Lynn Jusinski — Thu, 11 Jun 2009 19:02:00 GMT

In a strange case of Internet harassment involving personal health information (PHI), a woman finds herself facing a year in prison for what a judge called "egregious" behavior, according to the Honolulu Advertiser. Rhonda Wong-Fernandez was sent immediately...(read more)

Not Exactly a Ringing Endorsement for EHRs

Lynn Jusinski — Thu, 07 May 2009 16:31:00 GMT

An emergency department (ED) in a facility in Western Sydney, Australia, banned the use of its EHR, going back to paper and pen, after struggling with downtime on the system. While a North South Wales (NSW) opposition health spokeswoman claimed that government...(read more)

The Newest EHR Player: Wal-Mart

Lynn Jusinski — Wed, 11 Mar 2009 13:39:00 GMT

When you look at the signs, it should've been obvious. Wal-Mart started health care clinics in 2006, using eClinicalWorks software as EHRs for its 30 clinics. Last fall, Wal-Mart teamed up with personal health record (PHR) provider Dossia to offer some employees PHRs. Now, Wal-Mart, through its Sam's Club division, will proffer up EHRs, according to The New York Times.

In typical low-price fashion, the nation's largest employer will sell the EHRs for $25,000 for the first physician in a practice, and approximately $10,000 per each additional doctor, according to the Times. Dell will provide the hardware; eClinicalWorks will provide the software. "Wal-Mart says its package deal of hardware, software, installation, maintenance and training will make the technology more accessible and affordable, undercutting rival health information technology suppliers by as much as half," The New York Times reports.

The cost plays nicely into the financial perks in the economic stimulus package, which incents doctors $40,000 to $65,000 per physician over several years to implement and use EHRs effectively.

Francine, a blogger at http://ushealthcrisis.com/, claims that Wal-Mart doesn't understand why only 17 percent of doctors are using EHRs, and why physicians in small practices are the most skittish about implementing electronic records. "This tells me they don't know ONE SINGLE THING about what is stopping physicians from using EHRs, or one thing about how physicians regard themselves (as professionals)," Francine wrote.

Despite these feelings - and I'm sure Francine's not the only one with them - maybe Wal-Mart entering the EHR game will help quell physicians' fears about the high costs of EHRs. Perhaps the prices of other EHRs will drop in an effort to keep up. With the economic stimulus money on the table, and a low cost EHR option, this could be just the thing to get doctors plugged in. Or it could just fizzle out, with physicians balking at buying their EHR system at the same place they could score a box of clementines, a big screen TV or some flip-flops. At any rate, it should be interesting.

HITECH Alters HIPAA

Lynn Jusinski — Thu, 26 Feb 2009 20:29:00 GMT

By now, most of us have heard a few of the details in the economic stimulus package signed by the president Feb. 17. You'll have $13 extra stuffed in your paychecks each week starting April Fool's Day, and money will go toward green initiatives. Did you know that the stimulus will also affect HIPAA?

The Wisconsin Technology Network offers up a nice rundown of how the HITECH Act will alter the provisions of HIPAA. We're working on an article for an upcoming issue on the stimulus package's affect on the HIT/HIM realm, but the above site provides an early peek into how HIPAA will be impacted. Of note, patients affected by carelessness with protected health information will receive a percentage of the penalties.

Another notable change is that business associates will be subject to civil and criminal liability under HIPAA. I wrote about the role of business associates in HIPAA in this article. Hopefully, these new additions to HIPAA will help prevent cases like the one involving Lubna Baloch from happening in the future.

Daschle Won't Be HHS Secretary

Lynn Jusinski — Tue, 03 Feb 2009 18:19:00 GMT

It's back to the drawing board, it seems, for President Obama. After The New York Times wrote an editorial calling for Former Sen. Tom Daschle to step aside as Obama's nominee for Secretary of Health and Human Services, Daschle announced today that he won't be seeking the spot any longer, and stated that he doesn't want to be a "distraction." He asked the president to withdraw the nomination, and Obama accepted. Daschle has dealt with tax troubles and The New York Times also pointed out that he's had dealings with major players in the health care industry, such as UnitedHealth Group and the Mayo Clinic.

Obama will have to choose someone new to nominate for HHS Secretary. What would you like to see the new HHS nominee accomplish, and does anyone stand out as a good fit?

AAPC Pleased With ICD-10 Implementation Date

Lynn Jusinski — Fri, 16 Jan 2009 19:39:00 GMT

The American Academy of Professional Coders (AAPC) scored a victory yesterday when it was announced that ICD-10 implementation would be pushed back from 2011 to 2013.

AAPC took an opposing view to that of the American Health Information Management Association, which advocated for an implementation sooner rather than later. AAPC made efforts to push back the proposed implementation date, and the Final Rule for adoption for ICD-10 does just that.

In a press release, AAPC thanked members for submitting comments on the proposed rule and reasserted its steadfast claim that 2011 is just too soon for ICD-10 implementation. "In the face of opposition from other coding organizations, the AAPC stood firm in its belief that a delay was necessary and in fact would reduce the overall cost of implementation," the press release reads. "The delay of 2 years is a victory for all providers, payers and coders."

AAPC also shunned ideas that coders need to begin training now, citing that 3 to 4 years is too long of a span for coders to retain ICD-10 training. "There are other organizations, coder credentialing and otherwise, that are attempting to get everyone to panic and jump quickly into training," the academy said. "We reiterate that it would be a mistake for any coder to jump into training immediately."

The academy is also devising plans to handle the ICD-10 implementation, and noted that eight regional conferences focused solely on ICD-10 will be held by AAPC in 2013. AAPC will also release an overall plan on handling the implementation, and said that would be out soon.

ICD-10 Final Rule Issued; Implementation Slated for 2013

Lynn Jusinski — Thu, 15 Jan 2009 17:22:00 GMT

The eagerly awaited Final Rules for adoption of ICD-10 will be published in the next few days, and the implementation date has been bumped from 2011 to 2013.

The American Health Information Management Association (AHIMA) released a brief statement today applauding the Department of Health and Human Services (HHS) on approving the Final Rules for adoption of ICD-10.

AHIMA did express unhappiness about the compliance deadline being extended to Oct. 1, 2013, as opposed to Oct. 1, 2011. "This further extension means more years without the data needed to make intelligent data-driven decisions related to all aspects of health care," AHIMA CEO Linda Kloss, MA, RHIA, CAE, FAHIMA said in the statement. "Nonetheless, this extra time gives the industry no excuse for an adequate implementation and compliance. This extra time should be used wisely and the industry needs to start now and not wait."

Kloss also noted that the transition process won't be an easy one, but noted all of the improvements that will come in health information with the adoption of the new code sets. The organization's CEO also said it's working with HHS to help make the transition smooth. Kloss also called on HIT vendors to begin working on the development of new software for the switch to ICD-10.

You can read the final rules here. The final rule will be effective 60 days after its publication in the Federal Register. According to AHIMA's Web site, "Actual posting of the final rules is expected in the Federal Register in the next few days. The 60-day delay in the effective dates come as a requirement of the original HIPAA regulations and were set, to allow Congress a chance to review the rules. AHIMA will publish an in-depth analysis of the final rules in the coming weeks."

ADVANCE just published an in-depth article on ICD-10 implementation, looking at the myths and realities and offering up tips on how to best prepare. You can also view the article in our digital edition.

RAC Permanent Program Delayed

Lynn Jusinski — Wed, 05 Nov 2008 14:08:00 GMT

The Centers for Medicare and Medicaid Services (CMS) announced yesterday that an automatic stay will be imposed on the contract work of the four Recovery Audit Contractors (RAC) program. The stay is required as a result of protests filed with the Government Accountability Office (GAO) by two unsuccessful bidders, Viant Inc. and PRG Schultz, USA Inc., for the RAC program, according to CMS.

The stay will mean that all work for all four contractors will stop until a GAO ruling, which must be made within 100 days, or by early February. CMS stated, in a brief note on its Web site, "The four RAC contracts--and any work under those contracts--are on hold pending the outcomes of the protests."

According to the AHA, CMS noted that it's still preparing for the RAC program throughout the country and said that further details will be posted about the postponement on the CMS Web site.

The automatic stay is more a matter of contractors' complaints over who should've gotten the permanent contracts to do RAC audits. The spat is unlikely to affect the RAC program permanently, and as it stands, work on the RAC program will resume when the matter is settled. According to The RAC Report (subscription required), PRG Schultz, one of the contractors that filed with the GAO, had the lowest percentage of appeals overturned during RAC demonstration. PRG Schultz is arguing that CMS denied it a place in the permanent audits because of its high contingency fee bid. The RAC Report said that CMS put the brakes on all RAC activity on Monday, an even stopped an education session already in progress.

The RAC Report also quoted Joseph Zebrowitz, MD, executive vice president of Executive Health Resources, Newtown Square, PA, who said that planning for the RAC program shouldn't be delayed by facilities because of the automatic stay. "I think it's important that this delay is not because of any question of whether the RACs are fair, or good, or legal," Dr. Zebrowitz said. "The RAC program is unchanged, and there is nothing out there to say that anything is going to be different. [CMS] just can not start when the contractors are in doubt. Once they resolve these complaints, they will start up."

CMS Announces RAC Contractors

Lisa Algeo — Tue, 07 Oct 2008 13:03:00 GMT

On Oct. 6, the Centers for Medicare and Medicaid Services announced the names of the new national Recovery Audit Contractors (RACs). The new RACs are:

Diversified Collection Services, Inc. of Livermore, California, in Region A, initially working in Maine, New Hampshire, Vermont, Massachusetts, Rhode Island and New York.
CGI Technologies and Solutions, Inc. of Fairfax, Virginia, in Region B, initially working in Michigan, Indiana and Minnesota.
Connolly Consulting Associates, Inc. of Wilton, Connecticut, in Region C, initially working in South Carolina, Florida, Colorado and New Mexico.
HealthDataInsights, Inc. of Las Vegas, Nevada, in Region D, initially working in Montana, Wyoming, North Dakota, South Dakota, Utah and Arizona.

Additional states will be added to each RAC region in 2009.

Just a Little Bit of History Repeating

Lynn Jusinski — Wed, 01 Oct 2008 11:29:00 GMT

OK, so maybe it's not exactly the same story, but it's pretty darn close. In a recent article I did, I talked to Marne Gordan, GRC market manager for Armonk, NY-based IBM Tivoli Software, and I asked her if a situation like the Lubna Baloch case could happen again. Absolutely, Gordan said, and sure enough, a similar case recently played out at Grady Memorial Hospital, Atlanta, GA.

The main point of my article was to stress the importance of following the chain of custody when it comes to outsourcing. Know where your data is, and know who is working on it. If you allow for subcontractors in your contract, be sure that you know who they are and that they know your requirements when it comes to patient privacy.

At Grady, a doctor decided to type his own name into Google (come on, we've all done it). He found a bit more than he might've expected-his patients' health information, right there on the Internet.

A few months ago, Grady knew of the breach, but wasn't sure exactly what had happened, and officials said that data may have been stolen. The story became clearer last week, when Grady officials noted that hackers hadn't taken the data of 45 patients-rather, it was an unsteady chain of command that led to the health information being featured on the Internet. The posted data didn't include Social Security numbers, patients' addresses or financial information.

The breach, like the Lubna Baloch incident, came down to transcription. Grady's notes were transcribed by Metro Transcribing Inc., which in turn sent the work to Renee Lella, a Nevada contractor. Lella then sent the work overseas to Primetech Infosystems in India. The Internet site that that firm posted information to was thought to be completely secure; however, the information from the records was freely available on the Internet, where they were posted for a few weeks, according to The Atlanta Journal-Constitution.

After the breach, there's always the period of reflection on what could have/should have been done. On the XLEMR blog, the writer mused that smaller practices would probably not be vulnerable to this type of breach because of a lack of online data, and noted that care when outsourcing is the final lesson from the breach.

On the Medical Quack site, Barbara Duck writes that the breach may mean it's a good time to look to speech recognition soon. "At least that way it is all kept on local servers, but then you have to train physicians how to use it, but some hospitals are doing great and the military is also a big user of speech recognition and it will save money too," Duck wrote.

According to the AlertBoot blog, the whole breach could've been avoided if file encryption was used. This isn't really a surprise, as it's a vendor site, and the blog is from a few months ago, when the whole story wasn't really out yet. Even LifeLock (yes, the guy who puts his Social Security number on trucks and whatnot and has only had his ID stolen, um, a few times), is in on commenting on the breach. LifeLock uses the breach as an example of (of course) how LifeLock can help you (and after reading the blog, I'm still not sure about that one).

I'm not pitching any wares or anything, and I believe it comes down to contract management, like Gordan preached when I interviewed her. Hopefully, Grady had good contract management in place, and as the blame is doled out, Grady might have had an excellent contract, and the outsourcing firms may have slipped up. I found this online: the Nevada contractor involved in the breach advertising for experienced MTs on The Official Website of the Republic of the Philippines. The responses that she received might make some MTs just a bit queasy, all misspellings and poor grammar.

No matter how it pans out or who is eventually blamed for the breach, one thing is unfortunately certain: this probably isn't the last time an incident like this happens. I'd like to hear your thoughts.

EHR Rolled Out at University

Lynn Jusinski — Mon, 15 Sep 2008 12:26:00 GMT

If my grandmother, who I call Nanny J, was confronted with an electronic check-in system in her doctor's office, she most definitely wouldn't approve. This is the woman who actually laughed out loud when I suggested that, instead of snail mailing her a recipe for vegetarian lasagna, I e-mail it. She also flat out refuses to use the handy self check-out line at the grocery store, and when she's forced to, she's that person who just stands there with her groceries, waiting for the store employee to come over and bail her out. She does have quite the affinity for eBay, however.

It makes sense, though, that college and university health systems would be among the pioneers when it comes to patient-centric options like electronic check-in, online billing and appointment scheduling and e-mailed appointment reminders. The University Health Center at the University of Maryland recently rolled out a new system using Point and Click Solutions, a company I interviewed for a story late last year on technology in student health centers.

Students at the University of Maryland will soon be able to plan and follow up on visits via the Web, while the medical records staff will decrease paper and be more environmentally friendly, according to Dierdre Younger, assistant director for operations at the health center, as reported in the school's newspaper.

Back in my day (I graduated college 3 years ago), I remember that my school, a very small one, had a health center that operated with just paper charts, and I have a feeling they are probably not firing up an EHR any time soon, so I'm sure not every single college or university offers these kinds of services, but most of the larger ones do.

I e-mail countless times a day, make a beeline to the self check-out the grocery store and while I don't match Nanny J's eBay prowess, I am a huge fan of Etsy, so I look forward to the day when regular physicians' offices, like some of the tech-savvy school health center offices, offer little perks like letting me e-mail my doctor and schedule appointments online.

Calling All Teams

Lisa Algeo — Fri, 22 Aug 2008 15:58:00 GMT

It's that time again. For the last 8 years, at the end of July, I've reminded you that you've got to be in it to win it. And this year is no exception. It's time to enter your department in the 2008 HIM Team of the Year contest.

If you're chosen by our panel of judges to be the 2008 HIM Team of the Year, you'll be treated to a professional photo shoot and featured on the cover of our Nov. 3 issue. A feature article on your team and its extraordinary accomplishments will be highlighted both in print and online.

As our winners, you'll also receive a stylish celebration! ADVANCE will give your HIM team a night on the town, including dinner and drinks. You'll also receive something to remember: the team will receive a beautiful keepsake plaque of recognition, commemorating your team's achievements. Each team member will receive a certificate of participation, and we'll even provide additional "ADVANCE" goodies from our ADVANCE Healthcare Shop for your whole team.

Last year, entries piled in from across the country-from California to Connecticut-with teams ranging from 4 to 70 members. Any type of team that works in the realm of managing health information is eligible to participate, including transcriptionists, coders and cancer registrars. You don't need to be a big HIM department to enter. Excellent teams can be found in physician practices, long-term care facilities, outsourcing firms and basically anywhere a group of two or more of you are working together to advance the industry.

Last year's winning team, the HIM department from Mary Washington Hospital from Fredericksburg, VA, was treated to dinner at Brock's Riverside Grill in Fredericksburg. Where would you and your team like to go for a celebration?

To nominate your team for this year's award, enter here. But make sure you submit your entry by Sept. 18. It only takes a few minutes of your time, and anyone can enter his or her team; you don't need to be a manager or supervisor. Be sure to get the recognition your team deserves.

Can ICD-10 Finally Be Happening?

Lynn Jusinski — Wed, 20 Aug 2008 13:04:00 GMT

There's some movement on the ICD-10 front. The Department of Health and Human Services (HHS) proposed replacing ICD-9 codes with ICD-10 codes by October 2011.

According to HHS Secretary Mike Leavitt, "We are taking a giant step forward toward developing a health care system that focuses on quality and affordability through the implementation of health information technology. The greatly expanded ICD-10 code sets will enable HHS to fully support quality reporting, pay-for-performance, bio-surveillance, and other critical activities."

Leavitt called the conversion "essential" to developing a nationwide electronic health information network. The HHS press release also states that the ICD-10 codes will help with the implementation of EHRs and will provide added granularity, which will aid in identifying specific health conditions.

The Centers for Medicare and Medicaid Services (CMS) Acting Administrator Kerry Weems called this "the right time" to move to ICD-10, and added that CMS will work with the health care system to make sure that the transition to ICD-10 is a smooth one.

The American Health Information Management Association (AHIMA) has advocated in the past for the use of ICD-10. AHIMA CEO Linda Kloss commented that "We are excited to see that HHS has taken this significant step forward, but now we must see a positive response to the [notice of proposed rule making] so that final rules can quickly be issued and the health care industry can finally get implementation started."

More information on the proposed rule can be found here. The comment period for the proposed rule ends at 5 p.m. ET on Oct. 21.