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Wireless Health, HIPAA, and Patient Engagement – Around Healthcare Scene

Posted on September 30, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

EMR and HIPAA

Wireless Health Data Collection Innovations Getting Hot

Some of the newest health data innovations are wireless. From a chip that can test blood sugar levels to an ECG that connects to a cell phone through blue tooth. The possibilities are endless when it comes to wireless devices.

HIPAA Infographic

HIPAA violations happen frequently. Some are criminal, others civil. This infographic explains some of the most common reason for HIPAA violations, and the penalties associated with them. Last year, over 12,000 companies have either been investigated or had issues resolved concerning HIPAA violations. Definitely an interesting infographic to look over.

Hospital EMR and EHR

FCC Says Wireless Health Should Be “Routine” Within Five Years

An announcement from the FCC pushes for mHealth to be a standard practice in the medical world by 2017. Some doctors are hesitant to implement mobile devices, so this may be difficult for some to grasp. The FCC is working to make this easier, by doing things like working with the FDA to help with creating and introducing devices into the market.

Happy EMR Doctor

Patient Engagement: Who are the Real Targets?

While creators of health technology claim they are trying to reach patients most, what does that mean? Many people who would benefit from these types of technology are lower class, however, upper class people are probably more likely to embrace it. Should companies invest more time in discovering who target markets are?

Smart Phone Health Care

Traqs: One Tool to Rule Them All

Having trouble keeping track of all the health apps and devices that are being created? Traqs, a new device, does it for you. This innovation can track multiple devices and create graphs about activity on them. It makes it much easier to take control of your health and exercise devices.

Upcoding, Presidential Debates, and MU Incentives– #HITsm Chat Highlights

Posted on September 29, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Every week, HL7 Standards, hosts a #HITsm Tweet Chat and poses four questions “on current topics that are influencing healthcare technology, health IT, and the use of social media in healthcare.” It’s always a great discussion and also a great chance to meet a wide variety of people that are passionate about healthcare IT.

In case you missed it, or are curious about what went on this week, we’ve put together the list of topics with some of the best responses for each topic. There were some interesting topics this week, as well as some great responses. If you have any opinions on any of these topics, feel free to continue the discussion in the comments. This chats take place every Friday at 11AM CST. You’ll find members of Healthcare Scene regularly participating in the chat under some of the following Twitter accounts: @techguy@ehrandhit@hospitalEHR, and @smyrnagirl.

Topic One: Big debate now about EHRs sparking upcoding if not fraud. What’s your take? Will inverse be true with digitized health system?

 

 

 

Topics Two: 59% of IT execs say staff shortages harm earning of MU incentives. What is long-term impact if feds HIT education lag demand?

 

 

 

 

Topic Three: What would you ask Obama or Romney about HealthIT, reform law, or healthcare in general during the Oct. 3 debate? 

 

 

 

 

Topic Four: Health IT projects: Which ones are you postponing until after the election? 

 

EMR and EHR Advertising

Posted on September 28, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s that time of the year when we recognize all the great companies that have been supporting the work we do here at EMR and EHR. We have a really amazing list of advertisers that make the writing we do here on EMR and EHR possible. As you’ll see from the list below, many of them have been advertising with us for many years. They’re support is greatly appreciated since its what makes it possible for us to provide pure unadulterated EMR and EHR content.

New EMR and EHR Advertisers
ABBY USA – ABBY is a fascinating company that provides some really interesting business process and data capture solutions. I first came across ABBY when I was in college working at a document management company, so they’ve been doing this stuff for a long time. While most of us would love to think that in the EHR world we would be able to get rid of paper, that’s just not the reality of EHR. If you want to be a truly paperless office, then you need to get a great document data capture process in place. If you have this problem, check out what ABBY FlexiCapture has to offer.

Quest Quality Solutions – I was first introduced to Quest’s Health IT Quality Solutions program at HIMSS this year. While most of you know, that I’m generally anti-certifications, I’m not against highly focused certifications like this one that have very specific goals and benefits. The idea that Quest would work with EHR vendors to ensure the quality of the lab data they receive and send is a good thing. As we’ve seen, not all EHR software are equal, but if they’re getting their lab data processed incorrectly that’s a big problem. If we don’t solve the health data quality issues now, then EHR will continue to perpetuate the bad data through the system. So, I hope that Quest Quality Solutions will help to improve the quality o the EHR lab data.

Renewing EMR and EHR Advertisers
Practice Fusion – Advertiser since 4/2010
Ambir – Advertiser since 1/2010
SOAPware – Advertiser since 7/2010
Amazing Charts – Advertiser since 5/2011
DrFirst – Advertiser since 1/2012
Cerner – Advertiser since 9/2011

Check out our EMR and EHR advertising page for more information on supporting EMR and EHR. I actually have a special two website ad package I’m doing through the end of the month. For more details, drop me a note on our contact us page.

Top 5 Revenue Cycle Management Issues

Posted on September 27, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Like Jennifer, I’m going to be heading to AHIMA 2012 as well. She correctly identifies that ICD-10 is a major AHIMA topic and Upcoding is the topic de jour, but another topic which I think continues to sit under the radar at AHIMA is revenue cycle management.

In many ways this makes sense when you consider that the ICD-10 has such an influence on revenue. Upcoding is all about revenue. Even healthcare documentation is dominated by a discussion of its impact on revenue (Yes, we could discuss why this should be about patient care in a future post). While many don’t want to admit it, humans need to get paid to survive and they want to get paid as much as they can get. Last that I checked doctors were human.

What then are the challenges that doctors face with revenue cycle management (or revenue integrity which many like to call it)? Here’s a great list of RCM challenges as listed by Ruth Zwieg on LinkedIn:

1. Managing the revenue cycle of a practice starts with good Practice Management (PM) software; one that has an easy to use scheduling tool for the front desk and that can determine insurance eligibility before the patient arrives so that the practice can collect the correct co-pay and/or out-of-pocket expenses up front before seen by the physician. This increases A/R and saves time instead of spending resources collecting after the fact which is time consuming and expensive.

2. The PM software must be easy to integrate with their existing or new EMR so that the physician group can show meaningful use and get that incentive money. Many practices still think they have to get new Practice Management software when they start looking at EMRs and many EMR companies try to sway them this way so they can get the sale for their PM software and their EMR.

3. ICD-10 – Need I say more – you have written about this in detail. Some Practice Management systems have a coding assistant built in but most do not. Coding correctly determines payment.

4. Staff training is very important from the beginning of the revenue cycle (scheduling, verifying insurance) to managing the patient once he/she checks in to when the physician sees them to check out and billing/collecting. Just like every other business, time has to be managed and time is money, especially a physician’s time. The more efficient the staff and their use and understanding of the software, the more patients the physician can see.

5. Many hospitals have and still are purchasing physician practices because the physician either does not know the business side of running a practice or just wants to be on salary and get rid of the headaches. Billing for physician practices is different than hospital billing. Hospitals are realizing that their hospital staff may not be doing the best job of that. In addition, the hospitals are realizing that their hospital system’s EHR does not have the desired functionality that a physician group needs or worse, they have multiple physician practices all using different EMRs that the hospital now has to manage or integrate into one.

I find this list really interesting and does speak to many of the revenue challenges healthcare faces. If we could solve these five challenges we’d have done a lot of good for doctors.

Battle of the AHIMA Buzzwords: Upcoding vs. ICD-10

Posted on September 26, 2012 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

I’m heading to Chicago this weekend for the annual AHIMA show. It will be my second time attending, and last year’s experience will be hard to beat. I stayed at the Grand America hotel, which has now spoiled me for days when it comes to tradeshow accommodations (or vacation accommodations, for that matter). The show was in beautiful Salt Lake City, which literally was a breath of fresh air every time I walked from the hotel to the convention center. The show floor was bustling, attendees were friendly and chatty, and exhibitors were eager to talk about their latest offerings in the world of coding, transcription and health information management, with a dash of healthcare IT thrown in for good measure. And how can I forget the great networking off the show floor? Those HealthPort folks sure know how to karaoke!

Needless to say, AHIMA set the bar high in Utah, and I’m eager to see if my experience in Chicago will live up to it. The time definitely seems right for talking to providers and vendors about ICD-10, of course; but I believe ICD-10 has met its match in the EMR-related buzzword “upcoding.” You may have seen it mentioned in the major news outlets in recent days, read John’s post about EHR Incentive Increasing Medicare Costs, or come across this statement from the government:

“There are … reports that some hospitals may be using electronic health records to facilitate “upcoding” of the intensity of care or severity of patients’ condition as a means to profit with no commensurate improvement in the quality of care.

“False documentation of care is not just bad patient care; it’s illegal.”

The government obviously means to let providers know that inappropriate documentation will result in legal action, but there is another side to this story in that some providers claim they aren’t “upcoding,” but rather more accurately documenting care now that they have the technology to do so. For hospitals that are struggling financially, implementing new EMR/billing technology may simply allow them to clean up their documentation and billing methods. Seems to me that it’s pretty easy to immediately go from red to black if you’re used to using paper, but now have all kinds of efficient technology at your fingertips.

At any rate, the upcoding conundrum has, for me, elucidated the link between coding and documentation, the EMR and a healthcare facility’s fiscal health. Harold Gibson makes a number of good points around this relationship is his recent blog, “Medical Documentation Specialists can do Better Medical Billing:”

“The medical record is the basis for every financial transaction that follows its creation. EHRs have the advantage of being instantly accessible to a credentialed medical coder or biller at any location. The value of EHRs cannot be underestimated, nor can computer assisted coding software, but they are not a panacea for the elimination of billing errors.”

I hope to find out as I walk the show floor next week how vendors and providers alike are trying to get past this problem. If you have any insight, please share them in the comments below, or, if you’ll be at the show, grab me on the show floor for a quick chat.

Also, if you’re in Chicago and/or at AHIMA 2012, then be sure to come by the AHIMA Tweetup on Monday, 10/1 5:30-6:30. Swissotel, Friedman Marketing suite.

EHR Incentive Increases Medicare Costs

Posted on September 25, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

There is a major trend happening in healthcare that was covered pretty well in The New York Times. That’s right. EHR doesn’t often get much play in the major journals, but this is a really big deal. Plus, I’ve had doctors write into me about the subject as well.

The key finding that The New York Times article discusses is that Medicare costs have gone up substantially for those using an EHR. This is happening because doctors are upcoding more than they’d done previously. It’s a bit ironic to me that this is going to be a major problem for Medicare since 6 years ago when I first started writing about EHR software one of the major reasons to implement an EHR was to increase your revenue by upcoding.

I’ll never forget the first time I saw the challenge of coding first hand. I was at AAFP sitting at a table of physicians who were there to discuss EHR. This older lady and a gentleman shared with the group that they were chronic under coders. It felt a bit like an AA meeting where these doctors were finally coming clean on their habits. The rest of the doctors in the group just nodded their head since they knew that under coding was a major issue in healthcare.

What Medicare or the administration didn’t seem to realize is that the cost of Medicare is based on this under coding. Doctors have been under coding for so long that it just became part of the cost structure. Little did those in Congress think that by spending $36 billion on EHR (or whatever number you prefer) they’d actually cost Medicare billions of extra dollars. I bet the CBO didn’t plan for that in their budget projections.

This new trend in upcoding begs the question on whether doctors are doing this legitimately or if this is a form of fraud and abuse that’s being made possible by EHR. In a completely unscientific way, I suggest that probably 95% of the upcoding that’s happening is legitimate. Plus, a large portion of the 5% upcoding fraud and abuse would have been happening regardless of EHR. Why do I believe that so little of the upcoding is legitimate?

It goes back to that experience at AAFP where I heard doctors talk about their under coding habits. There was an underlying tension in their statements that they would love to bill more, but they had a number of underlying fears that made them choose not to code higher. First was fear of audit. The last thing any doctor wants is an audit and if under coding will avoid the dreaded audit, then it is the price to pay for that comfort. Second, I’ve heard doctor after doctor talk about times a patient examination should have been at a higher coding level, but their documentation didn’t match that higher level code. The doctors chose to under code the visit as opposed to documenting the normal findings in the visit which would allow them to code at a higher level.

EMR doesn’t do much for the first fear described above. However, EMR often makes it possible for a doctor to code a normal finding in the EMR that they wouldn’t have taken the time to code in a paper chart. I expect that this accounts for a good portion of the upcoding we’re seeing. Combine that with easy chart reviews and EMR coding engines and you see Medicare costs increasing by billions of dollars thanks to EHR. Oh the unintended consequences of government intervention.

Consumers Hungry For Online Health Data Access

Posted on September 24, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

We may be at a major tipping point, folks. It seems that consumers are becoming eager to interact with both their doctors and their health data online, after years of fear and disinterest.  In fact, it seems that doctors  may be lagging behind.

A new survey from Optum Institute, a part of health insurer UnitedHealth’s Optum division, took a look at attitudes across several major stakeholder groups, including 1,000 physicians, 2,870 U.S. adults and 400 U.S. executives.

Optum found that three out of four patients were interested in accessing their health records online through EMRs, and more th an 60 percent wanted to connect with doctors via e-mail or other Internet vehicles.

And that’s not all. According a summary of the study in MedCityNews:

  • 76 percent of patients are willing to go online to view test results
  • 65 percent want appointment reminders via email
  • 62 percent of patients want to communicate online with their primary care physician

Meanwhile, physicians don’t seem to be keeping up. Only 40 percent of physicians said they had the ability to allow patient EMR access or communicate securely via the Internet.

Why such a gap? Apparently, many of the doctors Optum surveyed have only basic EMRs in place which don’t support patient data access or communication.  For example, only 46 percent of physicians’ EMRs offer patient-specific information to help them make decisions and manage their health.

It’s hard to tell from a survey like this whether patients merely like the idea of greater connectivity, or are ready to insist that their doctors get on board.  So I wouldn’t go out on a limb at this point and suggest that doctors will lose patients if they don’t get their EMRs souped up quickly.

This does suggest, however, that when physicians make patient data access easier and begin to communicate online, they’ll certainly make some new fans.

Primary Docs See Hope For Stronger Financials With EMR

Posted on September 21, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Apparently, some primary care physicians are optimistic about the financial impact EMRs will have on their practice, according to a new survey.

Vendor Hello Health recently completed a survey of 100 practicing physicians without EMRs to discuss their attitudes about key business issues.  Not surprisingly, 37 percent of respondents said EMR adoption was their number one challenge at present; an equal percentage said that financial issues were their biggest worry.

Here’s what, to me, is the most interesting part of the study.  Among doctors for whom practice financial health was a primary concern, 51 percent felt that implementing an EMR would help solve their problems.

Their theory was that EMRs would help by improving coding and documentation to substantiate claims, as well as improving efficiencies and reducing costs.

Of doctors who didn’t think EMRs would help their financial situation, 46 percent felt that the systems would lead higher costs and overhead, and 15 percent felt productivity would decrease.

Now, I’m going to go all cynical on y’all.

I was pretty surprised to read that some doctors feel EMRs will actually improve their financial situation. Sure, improving coding and documentation itself is certainly a worthy financial goal.  The thing is, that’s not exactly what EMRs are designed to deliver.

As for improved efficiencies and reduced costs, well, I don’t find that very credible at all.  Not that some practices don’t achieve this goal,  but if the respondents  had anything near-term in mind they’re likely to be quite disappointed.

Realistically, if I wanted to invest in technology that improved my coding, I’d go with a computer-assisted coding or souped-up billing system. And I’d begin gunning my ICD-10 engines right away. Getting psyched about my pending EMR is nice, but probably setting oneself up for a letdown.

Things EMR Doctors Never Say

Posted on September 20, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Here’s a quick look at Things EMR Doctors Never say (maybe I’ve been watching too many late night shows):

“I’m so glad to be doing meaningful use!”

“I can’t wait until ICD-10 makes my life easier.”

“I wonder when that ACO model is finally going to kick in. I can’t wait.”

“I miss trying to read Dr. Smith’s handwriting.”

“I wish I could go and ask HIM for a chart pull.”

“I miss hiding behind the pile of paper charts on my desk.”

“I love this fax machine.”

“I miss the coffee stains on the paper charts.”

“I love the mix of EHR, EMR, HIE, ACO, ONC-ATCB, ICD-10, 5010, BI, with the RCM cherry on top.”

I’m sure I missed some. Please add more in the comments and I’ll add them to the list.

Patient Experience Key to Unlocking Engagement Potential

Posted on September 19, 2012 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

I enjoy my day job, fortunately (it actually encourages my blogging-on-the-side habit), and I love it even more when our product marketing manager, Jessica Clifton, rolls into town from up North to spend a week or so with our team plotting, planning and catching up. Yesterday found us finalizing a new report, “10 Trends in Hospital Patient Experience,” before the dismissal bell rang at 5 p.m. As I read over it with my editor’s hat on, I realized that if hospitals want to not only increase patient satisfaction, but also more easily meet Stage 2 Meaningful Use requirements pertaining to electronic patient communication, then diving into patient experience/satisfaction surveys are a good place to gain insight into both.

Let me back up a bit. First, let’s review the Stage 2 requirements pertaining to digital patient engagement, as so nicely compiled by Brian Ahier:

  • Use secure messaging to communicate with patients on relevant health information
  • Use Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient
  • Provide patients the ability to view online, download, and transmit their health information within 4 business days of the information being available
  • Use clinically relevant information to identify patients who should receive reminders for preventative/follow-up care
  • Provide clinical summaries for patients for each office visit

Now, let’s take a look at some of the common categories covered in patient experience surveys:

  • How often did doctors communicate well with patients?
  • How often did nurses communicate well with patients?
  • Were patients given information about what to do during recovery at home?

While the national average of patient responses for these particular questions were in the 77 to 83 percent range, other categories of patient experience didn’t fare so well. Our report found that “Patients rated staff explanation of medications (prior to administering) most poorly, with 20 percent of those surveyed indicating it sometimes or never occurred. Seventeen percent of patients surveyed reported not being given instruction on at-home recovery care.”

I’ve obviously cherry-picked those survey sections having to do with patient communication, and I’ve done so to highlight the opportunities providers have to begin meeting their electronic messaging quota in the areas patients seem to need it most.

I’d be interested in hearing from providers as to how they are going to go about increasing their digital engagement with patients. Did the latest batch of patient surveys provide any insight? Please share your experiences below.