Welcome to EMR and EHR

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.