“HIT Policy Update With John Halamka, MD”healthsystemcio.com/presentation/policyupdate-2013q4-webinar.pdf · Meaningful Use Changes •Stage 2 is now a three year cycle beginning

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Event # 661 748 825

“HIT Policy Update With John Halamka, MD”

A Complimentary Webinar From healthsystemCIO.com

Sponsored by Hyland Software, developers of OnBase

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Event # 661 748 825

Housekeeping

• Moderator – Anthony Guerra, editor-in-chief, healthsystemCIO.com

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http://healthsystemcio.com/presentation/policyupdate-2013q4-webinar.pdf


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Agenda — 45 Minutes

• 20 minutes: John Halamka, MD, CIO, Beth Israel Deaconess Medical Center

• 5 minutes: A Word From Our Sponsor: Julie McDonald, Business Analyst, Hyland Software

• 20 minutes: Q&A w/John Halamka


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“HIT Policy Update With John Halamka, MD”


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The Regulatory Agenda

• HIPAA Omnibus Rule

• Affordable Care Act

• ICD10

• Meaningful Use Stage 2

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The HIPAA Omnibus Rule Timeline

• February 17, 2009 - The American Recovery and Reinvestment Act of 2009 (ARRA) was signed into law. ARRA includes the Health Information Technology for Economic and Clinical Health (HITECH) Act, which mandates the US Department of Health and Human Services to develop new regulations related to the HIPAA provisions.

• September 23, 2010 - The Interim Final Rule goes into effect requiring Covered Entities to notify patients when a breach of their unsecured, protected health information occurs.

• January 1, 2012 - Deadline to begin using the ASC X12 Version 5010 Transaction Standards October 1, 2013 - Transition to ICD-10 code sets for medical diagnosis and inpatient procedures.

• January 17, 2013, the U.S. Department of Health and Human Services (HHS) releases the Omnibus Final Rule, implementing the changes required by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.

• March 26, 2013 – The Omnibus Final Rule takes effect.

• September 23, 2013 – Covered Entities, Business Associates, and subcontractors must be in compliance with most provisions under the Final Rule.


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HIPAA Omnibus Rule Issues

• Accounting of Disclosures

• Pay out of pocket information release restrictions

• Enforcement

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Enterprise Security Planning


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Affordable Care Act

• The Affordable Care Act will realign incentives with pay for quality instead of pay for quantity.

• Redundant and unnecessary testing will become a cost not a profit center.

• Tracking patient care across the care continuum will be a key element of risk management.

• Health Information Exchange will be essential to meeting these demands.

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ICD-10

• Delays unlikely

• Testing is a concern

• The value of ICD-10 is markedly increased with clinical documentation improvement and computer assisted coding methodologies

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ICD-10 Project Risks

Category Risk Description Risk Impact Prob Impact Action Plan

Edu/CDI Lack of engagement in ICD-

10 remediation effort from

physicians

Physicians under-educated &

unprepared for ICD-10; impacts rev

cycle through claim delays and

denials, and audits.

High High Mandatory physician training, Ongoing

training may need to occur for high impact

areas.

Edu/CDI Loss of Coders/Validators Backlog of claims (DNFB) will

increase

High High Contracting with multiple coding firms;

implementation of career ladder

Finance AR and DNFB not minimized

going into ICD-10

Predicted increase in AR will

materially affect cash position of

organization; DNFB impact will

increase number of bills not

submitted within allowed window

High High Collaboration between PFS and HIM to

identify how coding productivity can be

increased, and identify gaps and delays in

receivables

Finance Payers, Partners and

Trading Partners are not

ready for ICD-10 at date of

compliance

Delays processing of claims; delays

payments; may exceed filing

deadlines; affects cash position

Med High Participate in MHDC collaborative testing

program; Identify ICD-10 requirements

between vendor/BIDMC charge systems

and individual billing vendors; work with

vendors to remediate potential issues

Tech Other priorities prevent

remediation of key systems

Delays testing, increases risk at go-

live

Med High Document amount of effort spent on other

priorities

Work-flow Resistance to transition of

outpatient billing from paper

fee tickets to on-line system

Continued use of paper fee tickets

that cannot adequately support

broader range of ICD-10 diag codes;

impacts productivity, increased risk

of claim audits

Med High Roll-out outpatient billing system prior to

ICD-10 compliance date so that physicians

can become familiarized before

transitioning to new code set


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Meaningful Use Changes

• Stage 2 is now a three year cycle beginning in 2014

• Stage 3 begins in 2017

• The certification program moves from a waterfall approach to an agile approach.

• No changes to 2014

• No delays for hospitals or professionals

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Original Timeline (note 2016)


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Planning for the FutureTopic

Topic Description and

NotesStatus Result

Image ExchangeStandards to support image

exchange

Assigned to the Clinical Operations

WGHigh

Data Transport

Additional standards to support

transport of data to and from

patientsTASK COMPLETED High

Quality reporting and

measurement

Standards which support flexible

platforms for measuring and

reporting quality

High

Referral WorkflowStandards to support closed loop

referral workf1owHigh

Record Locator ServicesStandards which support Record

Locator ServicesHigh

Care PlansStandards to record care plans/care

teamHigh


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Planning for the FutureTopic Topic Description and Notes Status Result

Lab OrdersContent Gaps (Lab Orders) Clinical Operations WG reported out

during June HITSCMedium

Digital SignatureStandards Supporting Digital

Signature

CMS presented to HITSC on July

17; Medium

TerminologyContent Gaps (Terminology)

Medium

Parsing and record sharing

Improvements to standard to

facilitate unambiguous parsing,

longitudinal record sharing, and bulk

record sharing

Medium

Advanced DirectivesStandards to record advanced

directives/care preferences Medium

APIs

Standards for application

programming interfaces supporting

modular application integration

Medium

CDS

Standards for clinical decision

support, both knowledge

representation and application

programming interfaces (APIs) for

query/response to knowledge

resources

Medium


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TopicTopic Description and

NotesStatus Result

Defect ReportingStandards which support defect

reporting to PSOs Medium

Registry Support / SDC

Standards needed for registry

support including structured data

capture and transmission to third

party repositories

Medium

Query/Response of PDs

and Patient Identity

Standards which support

query/response of provider and

patient identity in directoriesMedium

Planning for the Future


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Topic Topic Description and Notes Status Result

Query/Response Consent

Management

Standards which support consent in

a query/response architecture such

as granular patient privacy

preferences hosted in a managed

service ("pull") and sent as part of

the request for records ("push")

Medium

Data Segmentation for Privacy

Standards supporting data

segmentation for privacy

P&S WG and COWG reviewed DS4P

Project, which upon completion was

handed work over to HL7 to develop

standard; DSTU scheduled for Sept

release.

Medium

Clinical Documentation for New

Payment Models

Standards for clinical documentation

supporting new payment models

(includes ICD10, smart problem lists,

computer assisted coding)

Medium

Local and Targeted Queries

Standards which support query of

data within organizations and

targeted query for patient data

Medium

Planning for the Future


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My Personal Opinions

• Need to consolidate our gains and extend the timeframe for Stage 2 attestation from 1 year to 18 months

• Need to simplify certification to focus on interoperability

• Stage 3 needs to be focused on outcomes, not prescriptive EHR functionality and should be created only with input from stage 2 experiences

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HIT Policy Update Julie McDonald, RN BSN,

Business Consultant, OnBase by Hyland


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The OnBase Role in Computer-Assisted Coding• Allow coders to view all scanned and EMR native documents within the

Computer-Assisted Coding software• History & Physical

• Operative Reports

• Discharge Summaries

• Limit HL7 Interfaces

• Predefined solution allows for rapid deployment with minimal facility bandwidth

• Manage system-wide upgrades easily


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The Key to Success?


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Hyland Software: http://www.hyland.com/

Julie McDonald RN, BSNHealthcare Business [email protected](216) 386-9406Cleveland, Ohio

Follow us….Facebook: https://www.facebook.com/HylandSoftware

Twitter: https://twitter.com/HylandSoftwareHyland Blog: http://blog.hyland.com/category/healthcare/

http://www.hyland.com/

mailto:[email protected]

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http://blog.hyland.com/category/healthcare/


Event # 661 748 825

Q&AClick on the Q&A panel located in the lower right corner of your screen,

type in your questions in the text field and hit send. Please keep the send to default as “All Panelists.”

[email protected]

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Event # 661 748 825

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Documents

“HIT Policy Update With John Halamka, MD”healthsystemcio.com/presentation/policyupdate-2013q4-webinar.pdf · Meaningful Use Changes •Stage 2 is now a three year cycle beginning