I enjoyed all day at the EHR Summit that’s being held by HBMA in Phoenix. It’s been a really interesting event for me. I had some sound bites from the Ron Sterling keynote queued up, but it’s not connecting to Twitter. So, I’ll see if I can post those tomorrow. Today, I thought I’d post some of my other tweets from the other session. I think you’ll find them interesting, enlightening, thought provoking or some other adjective. I really look forward to the discussion on this post.

EMR software has many versions of the same data. #interesting #EHRSummit11 Think about an HIE as well. They have a version of the data too

HIE’s aren’t good at getting the receiving doctor the second version of a clinical document. #interesting #EHRSummit11

Think about the records retention issues when you switch EHR software companies. Good thought. #EHRSummit11

If you haven’t lost a client to a hospital this year….you will next year. #EHRSummit11 #HBMA

How many EHR companies are billing companies? They have 7 listed on screen. Do you know of others? #EHRSummit11
They have MED3000, Allscripts, Greenway, NextGen, Athena, GE Centricity, Ingenix. Any other EHR companies do billing as well? #EHRSummit11

Shame on you if you hire an EHR Company and don’t check the references. Ask for a list of 10 in that specialty and size. #EHRSummit11

Pre-existing conditions, No lifetime maximum and kids on parents plan for longer are going to increase our insurance costs. #EHRSummit11

Definitely interesting to consider how the healthcare billing industry will be affected by things like ACO’s and concierge. #EHRSummit11

Super bills are going to go away once we get ICD-10. #EHRSummit11 #HBMA

The healthcare billing sales cycle is 12-18 months. #EHRSummit11

Since I’m putting some of my tweets. I also enjoyed a number of the tweets coming out of the ONC Meeting today. Here’s one that really hit me:

RT @INHSbeacon If you’ve seen one CCD, you’ve seen one CCD. Everyone interprets different, we need to find a standard to succeed #ONCMeeting

A number of themes have been prevalent at this year’s AHIMA show, taking place this week in Salt Lake City. Healthcare information management professionals have a number of big priorities – the transition to ICD-10 being the most prevalent, at least from what I’ve seen on the show floor so far. Recruitment is a close second. With a number of colleges and healthcare systems present as exhibitors, it’s obvious there is a need for trained HIM professionals. In speaking with folks from the Region D Health IT Workforce Development Program, part of the Community College Consortia Program, which hopes to train more than 10,500 healthcare IT professionals by the end of this year, it is evident that there are resources out there to train folks, and they are willing to get the word out about it.

AHIMA has recognized this need for job creation. It announced at the show on Monday that it has created the HIM Jobs for America Initiative, and has entered into a public-private partnership with the Department of Health and Human Services and North Shore Medical Labs.

In announcing the initiative, Bill Rudman, vice president, educational visioning at AHIMA and executive director of the AHIMA Foundation, explained that “AHIMA wants to build a partnership with business, academia and the federal government to create the estimated 40,000 jobs required to properly build and maintain a national electronic health records initiative.”

As part of the initiative, AHIMA will provide six hours of free healthcare IT training to healthcare professionals in underserved communities, first focusing on physicians in small practices in North Carolina, Mississippi and Alabama. The program will provide 100 participants with EHR licenses for one year. North Shore will donate electronic health record software and services via Nortec Software, a provider of EHR technology, as well as medical billing and transcription services.

As I mentioned above, the transition to IDC-10 has been THE big theme in the exhibit hall. I’ve noticed solution after solution exhibited at booth after booth created to help physicians make the transition. As John Lynn mentioned in an earlier post, some companies are taking a light-hearted approach in marketing their ICD-10 solutions. Take QuadraMed, for example, which kept attendees happy Sunday night during the evening reception with special ICD-9 and ICD-10 cocktails. Or, as John mentioned last week, Conifer Health, which has quickly run out of its ICD-10 stickers.

All kidding aside, the transition to ICD-10 and the impact the new codes will have on patient care is no joke. Paula Lawlor, RHIA, President of Clinical Revenue Cycle Services HIM at Conifer, spoke with me briefly about what Conifer is doing in the area health information management and clinical revenue cycle services:

I’ll be walking the show floor today, and hope to have a wrap-up of EMR-related technologies for next week’s post.

In case you missed it, I wrote an entertaining (at least I thought it was) post about some of the amazingly specific ICD-10 codes that are out there. I’m headed to AHIMA which starts on Sunday and I’ve had a preview of a vendor, @coniferhealth, capitalizing on some of these codes with some stickers they’re handing out. I’ll embed a picture of one of these stickers at the bottom of this post.

Turns out that not everyone is happy with this light hearted approach to discussing what amounts to a major major shift from ICD-9 to ICD-10. The Wall Street Journal posted some of the responses they got to their original article. Here’s one sample response:

Having a different code for every single artery or the specific bone that’s fractured helps improve continuity of care. A patient who is hemorrhaging can get lifesaving care more quickly when the physician can immediately identify precisely where the broken suture is located. In addition, including the specification that the patient was “bitten by turtle” justifies the patient receiving additional tests or treatments, as turtles carry different bacteria than, say, parrots or turkeys. This and other tidbits of information will support more efficient and effective reimbursement processes.

The benefits we will derive from our global health-care community are tremendous. Once the U.S. finally transitions to ICD-10, we will again be able to share important data with every other civilized country

Although, not everyone is so serious. Arthur Broaderick, M.D. offered the following question, “Doctors closing their practices in droves; is there a code for that?”

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

45. Think about ICD-10 compliance sooner than later
ICD-10 goes into effect October 1, 2013. (barring them postponing it again). Can you imagine if you’ve implemented an EHR and then find out that the EHR isn’t ready to support ICD-10? Sure, we’re still a little ways out, but ICD-10 has been on the docket for a long time coming.

44. Make sure your revenue cycle process is as clean as possible
Cleaner processes are easier to implement. Your revenue is going to take a hit when you first implement an EHR in your office just based on the learning curve of EHR. You don’t want to add to the changes by having to change any issues with revenue cycle at the same time.

43. Don’t underestimate the time necessary to be compliant with 5010
This won’t be as bad as ICD-10 for most practices, but you want to be ready for it.

42. Keep transcription in mind
Make sure you have a good understanding of the costs associated with cutting out transcription. Notice that I said costs and not savings. I already know that you’re aware of the savings of cutting transcription. What you might not have taken into account is the costs of ending transcription. If you’re doing voice recognition then you’re going to need the software, a great microphone, and possibly faster/newer computers. If you’re doing voice recognition there will be more manual corrections that you’ll have to do than in transcription. If you’re cutting out all voice input of data, then just be aware that you may hate “all the clicks” and want to go back to transcription in some form. Is your EMR conducive with that change if you decide to go back to transcription?

41. Watch your insurance claim denials
Of course, most clinics are doing this already. However, a whole new set of claim denials will happen because of how your EMR files those claims. You don’t want to miss out on the insurance money because you can’t handle the claim denials in a timely manner.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

While it’s all well and good to prepare for Meaningful Use compliance, IT departments may be going a bit overboard.  A new survey by HIMSS has concluded that providers are being diverted from critical efforts like the HIPAA 5010/ICD-10 transition by efforts to capture MU bonuses.

It’s hardly surprising, given the tempting candy MU incentives offer, but it’s a bit worrisome too.  After all, preparing for 5010 transactions requires a mountain of work, touching electronic claims, eligibility verification, claim status, referral certification and more.  This is NOT something you can afford to ignore, particularly given the risk of incurring CMS’s wrath.

Consider this:  a full 35 percent of the providers responding to the HIMSS survey this summer said they had no plans at all in place to implement a 5010 readiness project. This despite the fact that they were supposed to begin testing by January 1 of this year.

Instead, HIMSS found, providers are spending much of their time working to qualify for MU money, neglecting the 5010 transition for now.  The HIMSS folks hypothesize that providers are laying low on 5010 now, hoping to squeeze in under the January 1, 2012 final deadline. Hey, maybe if IT leaders stick their heads in the sand long enough, the deadline itself will go away!

In reality, we all know what will happen — the same thing that happens whenever an enterprise punts on a critical initiative. Over the next several months, expect facilities to dump truckloads of money on vendors and tech help. Consultants, start your engines!

A recent Information Week article on EHR adoption had the following quote:

“I think the number one driver [of ambulatory EHR adoption] is the change in reimbursement, the fact that it is becoming so complicated to document the process of care to get paid by the government as well as commercial payers,” said Nancy Fabozzi, a senior industry analyst at Frost & Sullivan and the report’s author. “Everybody thinks that fee-for-service is doomed and we have to have a new system of reimbursing physicians for the quality of care instead of the quantity of care because costs are exploding.”

In an interview with InformationWeek, Fabozzi said another reason for the adoption of ambulatory EHRs is that many providers have practice management systems that are old and need to be updated as they move to ICD-10 and HIPAA 5010 requirements.

It won’t be news to most of you that it’s not government incentive that is driving adoption of EHR software. The market forces are much stronger than any sort of stimulus. Although, the retarding forces of an unknown stimulus are starting to wear off and we should see EHR adoption pick up again soon.

The idea that there will be penalties is a joke. The ongoing (10 years and counting) SGR debacle has thoroughly disgusted physicians who have already begun to reduce or completely eliminate Medicare patients from their practice. If Medicare starts to nickel and dime those still willing to take Medicare patients – for not using e-prescribing, not participating in PQRI (which is cash-negative for those who participate) or not implementing EMR, they’re even dumber than they’ve already demonstrated.

Pile on 5010 implementation, ICD-10 CM implementation, another ongoing PECOS fiasco, the interminable MAC transitions, RACs, PERMs, Z-PICs, HEAT, etc. and Medicare (or Congress) thinks a penalty will motivate physicians to buy new software – or that the doctors will tolerate a payment reduction when their 2010 payments are LESS than their 2000 payments?

I can’t remember where I found this quote. Probably on a LinkedIn forum or something. This voice is actually getting louder. Notice that it doesn’t really talk about whether they want to use EMR software or not. It’s really the start of what could be a huge exodus from Medicare as opposed to a revolution against EMR software. Plus, it highlights the fact that doctors (and people in general) don’t want to be forced to do something. Yes, even something that could be a benefit to them. Of course, that’s why I’ll keep telling doctors to not worry about the stimulus and the penalties and focus instead on the list of EMR benefits.

Joe from Healthcare IT today wrote an interesting post highlighting 5 signs why the healthcare IT (which I translate as EMR) job market is heating up. Here’s a summary of his 5 reasons:
-His Healthcare IT friends that were unemployed are starting to find jobs
-The Healthcare IT and EMR job boards are overflowing with good jobs (I’ve seen lots of jobs on these boards myself)
-The number of projects at clients and potential clients has risen dramatically. Meaningful Use and ICD-10 initiatives are finally starting to happen
-Headhunters are starting to call
-Bloggers, columnists and reporters are writing about “the recovery” and how to get ready for it

Not a bad list. I’m seeing a large number of jobs listed on my EMR and HIPAA job board and even more click throughs to those jobs. I think that’s another really good sign. Although, I think we still have a ways to go, the healthcare job market and healthcare IT in particular has got to be one of the best ones out there right now.

Today’s guest post is from Tony Lavinio, the principle software architect behind Progress DataDirect’s XML Converters and an expert on data exchange. Understanding the integration and data compliance pains experienced by healthcare organizations, Tony and DataDirect have developed a HIPAA toolkit to help Healthcare IT developers alleviate some of the challenges they’re facing with HIPAA 4010 and 5010 and ICD-10 projects.

The government has allocated healthcare providers over $36 billion of ARRA stimulus money to help the adoption of Electronic Health Records (EHRs) and in support of Health Information Exchanges (HIEs). Healthcare providers that coordinate EHR clinical information with administrative data will streamline their health records administration. Those organizations that implement a single, unified IT infrastructure to handle both EHR and administrative data will gain a significant cost saving and, ultimately, improve the quality of patient care.

However, to unify IT infrastructure healthcare providers face the estimated $14 billion challenge of complying with new coding standards. These standards set forth by the United States Department of Health and Human Services on Jan. 15, 2009 specify that X12 Electronic Data Interchange (EDI) transaction definitions for version 5010 – used in conjunction with HIPAA transactions, which are exclusively administrative data transactions – must be completed by January 2013. The new standards also require healthcare providers to comply with an International Classification of Diseases (ICD) standard update, from ICD-9 to ICD-10 by October 2013. The close relationship between HIPAA transaction sets that can directly refer to ICD-9 or ICD-10 codes have health industry IT professionals on the ropes.

The HIPAA 4010 to 5010 upgrade is a positive evolutionary change, improving the efficiency of healthcare data transactions. The ICD-9 to ICD-10 change is much more radical. ICD-9 list was first developed over 30 years ago and over that time has become deeply embedded into systems. Making the ICD-9 to ICD-10 transitions even more difficult is that the list for ICD-10 code updates is approximately 10× the length as ICD-9, with generally no 1:1 mappings between them. Sometimes there are a series of codes, sometimes there are alternatives that will take external information, and sometimes there are no direct alternatives. Healthcare IT professionals must figure out a way to accommodate changes in data when it has been moved, and overcome the fact that new data must be extracted from new sources to augment the legacy data.

With so much data to convert, Healthcare IT professionals struggle to find a logical starting place. Progress DataDirect has given Healthcare IT professionals a way to jump-start their EDI transaction definitions version 5010 and ICD-9 to ICD-10 data conversion projects with the company’s HIPAA/ICD Upgrade Toolkit.  Though each healthcare application is different and will need tweaking, using the examples provided in the Toolkit will make it far easier than starting from scratch. Some of what you’ll find in the starter-kit includes:

• XQuery source for upgrading each of the 10 transaction sets from the HIPAA 4010 to equivalent 5010 version
• 50 sample 4010 files to use with the above
• ICD-9 to ICD-10 maps
• A sample tool to compare the changes between ICD-9 codes and their closest ICD-10 analogs with HTML output
• An XQuery program which will read a HIPAA file containing ICD-9 codes and report on any potential conversion troubles with ICD-10
• An XQuery program to read a HIPAA EDI file and covert it from 4010 to 5010 and from ICD-9 to ICD-10  simultaneously

How it works is DataDirect XML Converters make EDI behave like XML. Then a small XQuery program, which is really good at rearranging XML, is able to transform thousands of EDI and flat-file formats to XML and back with little or no development time or expense or major re-architecting. For more information on transforming data in HIPAA 4010 X12 files and translating ICD-9 codes visit DataDirect’s Blog.