Health IT
During the last few years I’ve had some key conversations with many hospital executives and healthcare IT professionals, among them: CEOs, CIOs, CMIOs, COOs, architects, strategists, etc. Most of the conversations have been around the topic of how to get the data required for being or becoming an effective ACO, or simply a provider highly conscientious of the well-being of their cared ones even beyond the walls of their facilities. Some of these providers weren’t aware of the ACO conversations since they didn’t participate in the CMS roundtables but they understood that the healthcare model had to drastically change.
The Journey of a thousand miles towards an ACO begins with one step.
Healthcare organizations are coming to realize that the programs stimulated by the ARRA – HITECH Act, Meaningful Use (MU) and Accountable Care Organizations (ACO), require something that they don’t have in sufficient quantities, the desired type or in the right format: “Data”.
In this post we’re going to focus primarily on the ACO analytics side of things although some of the same principles are applicable to Meaningful Use at its various stages.
I hope everyone is as excited this year as they were last year when the #HIT100 crowd-sourcing nomination was first launched just for fun during the 2011 4th of July weekend. At least I am.
Surprisingly, even to me, #HIT100 was the perfect summer thunderstorm. Participation was massive and it kept going through the month of July as if were never to end.
For those of you whom are new to the #HIT100 contest, this is just a way for the entire #HealthIT and #HITsm communities to reward those that have, for the past year, been supporting healthcare information technology through social media. Specifically those that have contributed with articles, books, blogging, tweeting, forming social networks and by just simply giving their best to improve healthcare one grain (or tweet) at a time.
Last year the tallying got a bit challenging because the rules were a bit too simple. This created difficulties in my being able to keep up with everything while at the same time performing my daily job.
In order to simplify the nomination counting, there will be some restrictions on how nominations will be counted.
1. The nomination is a simple tweet that should be written as follows: “I nominate @tweet_handle to the #HIT100 list. #HealthIT #HITsm” (omit the quotes in the tweet),
2. Only one twitter handle may be nominated in one tweet,
2. Simple RTs will be counted but “thank you” or “TY” RTs will not nor will RTs of RTs, so keep it simple,
3. The first round will be for the first top 250 nominees and this round will last 7 days or until the stream slows down,
4. From the first round the top 100 nominees will be listed on the #HIT100 list,
5. The second round will be executed the same way but only those that showed up in the #HIT100 list can be nominated,
6. The second round count will narrow down to the first 5 of the #HIT100 list. These 5 are this years champs!,
7. Last but not least, you must have lots of fun!
I’m looking forward to this years champs.
Does anyone remember who the top 5 were last year?
Regards,
@theEHRGuy (Michael Planchart)
Chad Johnson from the HL7 Standards blog reached out to interview me for his “5 Hot Topics in Healthcare Interoperability” post. It resulted in an outstanding article.
CCD is an acronym that stands for “Continuity of Care Document”. The CCD is a file that uses Extensible Markup Language (XML) format, which could have one of 3 different structure levels. I will explain the various structure levels in Part III of this blog series. A CCD contains patient related information that could be electronically exchanged between healthcare providers, as well as, shared with the patients themselves.
The CCD template, derived from the American Society for Testing and Materials (ASTM) Continuity of Care Record template or ASTM E2369-05 Standard Specification, or simply stated the CCR. The CCD is constrained by the HL7 (Health Level Seven) Clinical Document Architecture (CDA). The CDA adheres to the HL7 V3.0 Reference Information Model or RIM.
In the first post of this 2 part blog we explored the big challenges with the demands that the ARRA HITECH and other compliance and regulatory impositions have impacted Healthcare IT: HIPAA’s Version 5010 conversion, ICD-10 migrations, Meaningful Use of EHRs and their Attestation and Accountable Care Organizations. We also briefly touched the popular topic of the imminent end of the world in 2012 according to the Mayan calendar prediction.
If you read carefully you would have noticed that my predictions, well, they have some small glitches now and then, or you may call them “bugs” due to my software developer background. So at the end of this blog we’ll have to revisit the end of the world prediction. Sorry folks.
The Outrageous, the Outraged and the Courageous: Another Attempt to Halt the Healthcare IT Evolution
The Outrageous
On February 2nd 2011 the American Medical Association wrote to the Secretary of the U.S. Department of Health and Human Services, Kathleen Sebelius, to urge her to immediately halt the Health Insurance Portability and Accountability Act (HIPAA) mandate to implement ICD-10.
The AMA wasn’t only asking to immediately halt an endeavor that had officially started on January 16, 2009, over three years ago, when HHS published one of several final rules but they are also asking to re-evaluate the penalty program timelines related to Meaningful Use (MU) of Electronic Health Records, e-Prescribing and Physician Quality Reporting System (PQRS).
I would have been more amenable to read something like “reassess the timeline or extend the timeline due to significant concerns of our constituent members” but to immediately halt the program? Could someone please explain to me why we should halt any national Healthcare IT project?
They should have asked to immediately halt incentive payments as well! Why? Because we, the U.S. taxpayers, are actually paying physicians across the entire United States to implement and meaningfully use an Electronic Health Record system to keep our health data in a digital format that can be easily and safely transmitted between myriad providers and so that we, as patients, can have access to it as well. It’s not financial aid from the government that is paying for the Meaningful Use of Electronic Health Records but it’s us the People of the United States that are paying for it.
From what I also understood by reading between lines they want to be paid to implement ICD-10. Sorry docs, us rabbits are running out of carrots! Under the same reasons why shouldn’t we go ahead and pay for their mobile tablets as well because in my opinion it would abide to the same logic?
The AMA claims the difficulty of transitioning from the ICD-9 13,000 diagnosis codes to the ICD-10 68,000 diagnosis codes. Maybe the five-fold arithmetic expression raises eyebrows to some but the truth is that the scarce 13,000 codes used by ICD-9 have created an undecipherable conundrum of clinical data throughout several decades. Most clinicians and clerical staff would choose a diagnosis code based on the expected reimbursement amount and not on the actual clinical diagnosis and how could this be considered sane in a scientific realm? A lot of healthcare data used in claims processing is absolutely unauditable. It’s actually a toss and start over rather than a transition. We don’t want to deal with the cluster of conundrums created by all the garbage that has gone into the databases since garbage in=garbage out (GIGO).
AMA is clear to state that it’s not just a technology project and that’s because they are well aware that the Health IT technologists can solve the problem and I know this because I am a Health IT technologist and I know there is no technical impediment to solving the ICD-9 to ICD-10 transition. There may be semantic interoperability issues in the conversion but that can happen with any transition from any coding system to another.
Another outrageous event was the unclear response by the acting CMS Administrator, Marilyn Tavenner, who on Tuesday, February 14th indicated to the reporters that the CMS will re-examine the time-frame. Further exacerbation came along when the Secretary of HHS announced the intent to delay the ICD-10 compliance date on February 16th. Responding so quickly to pressure from one letter seems like a sign of weakness from a leader.
The Outraged
Many of us are outraged. Many of us stood mostly silently and briefly tweeting 140 characters at a time what we were thinking in protest to the unfolding of the ICD-10 debacle. Most of us were expecting the HHS Secretary to adopt a strong position defending the interests of her Constituents, We the Patients of the United States of America. What was perceived was that there is some extra-caution due to the re-election climate in the air, there is fear to uphold the interests of the Constituents.
Many of us are outraged as citizens, tax-payers, patients or relatives of seriously-ill patients. We should be since it’s our hard-earned money going to waste. We have never had an opportunity to transform our wasteful healthcare system as the one we are living today. We don’t want to miss this opportunity since it may take decades before it could happen again.
We are outraged because it’s always the same story. Powerful groups of healthcare in the US will claim many reasons they have to not implement technology. They’ll claim too much work, workflow disruption, physician <-> patient intrusion, not enough reimbursement, no incentives, etc …
But the truth is that many have made great strides in ICD-10 conversions so who is the AMA actually advocating for?
Continuing the use of ICD-9 is continuing to put the lives of many at risk. Who is responsible for the deaths or injuries caused by improper coding?
I wanted to write this blog before but I was also waiting for some other organizations with muscle to cry-out loud and they finally did. I call these groups “The Courageous”.
The Courageous
When I first read The American Health Information Management Association’s (AHIMA) request to urge HHS to move forward with ICD-10 plans and to not delay the compliance date I finally felt relief from my outrage.
HIMSS also raised their voice and recommends not delaying the ICD-10 implementation.
There is too much to lose here. Meaningful Use stages 2 and 3 depend on quality data and ICD-9 does not fulfill this requirement.
Many will start speaking up in defense of the ICD-10 transition and hopefully HHS will listen to our shouts.
Readers, we are paying for the transformation of the U.S. healthcare system out of our pockets. Don’t let special interest groups steal this opportunity from us.
Courageous, raise your voices!
