Archive for the 'Industry Events' Category

ICD-10 Readiness: Implementation & Producing Results

This piece is the second of a two part series discussing the transition to ICD-10.

 

As I mentioned before, the healthcare industry is rapidly moving closer to the October 1, 2013 compliance date for ICD-10. As that date draws closer, organizations will need to actively take action to successfully be compliant.  The Centers for Medicare and Medicaid Services (CMS) is actively providing resources to assist in achieving this success.

Before I share another tool that CMS is offering as support to the transition, I wanted to reflect upon some rather humorous information regarding the new ICD-10 codes. Last week, I read a blog from EMR and HIPAA that made me aware of the fact that the ICD-10 code volume has expanded and now includes some “off-the-wall” codes.

One example the article shared was “V91.07XA, “burn due to water-skis on fire”. I would say that’s fairly specific!  After reading this, I was encouraged by curiosity to dig for more interesting codes. After browsing the ICD10 code listing, I did manage to find some more codes that amazed me.

In tribute to the Southeast United States:

  • W5803XA Crushed by alligator, initial encounter
  • W5803XD Crushed by alligator, subsequent encounter
  • W5811XA Bitten by crocodile, initial encounter
  • W5811XD Bitten by crocodile, subsequent encounter

I come away from those codes wondering what the actual number of times the code W5803XD will be used.

The fact that these codes have increased in volume and in specificity, to me, seems to have far more benefit than harm as we transition to using ICD-10 codes. But before we see the end result of this transition, we have to endure the transition and arrive to October 2013 with only success. One tool CMS is offering to assist is the Implementation Widget.

Implementation Widget

CMS offers a “timeline widget” that users can download to their desktop of mobile device.  Once downloaded by a user, that person can share the application through email, social media, or post in a website. The purpose of the widget is to “identify and take action on the benchmarks you will need to ensure smooth transitions to” the ICD-10 compliance date. HIMSS News summed it up perfect indicating that it would help organizations:

  • Understand what should be done right now to prepare for the switches to 5010 and ICD-10
  • Know the steps needed to take in the future and when
  • Stay on top of approaching transition deadlines to help manage the implementation process

The widget first prompts for a selection among four choices: Vendors, Payers, Large Providers, or Small Providers.  Each category differs in the output of the timeline, benchmarks, and necessary actions suggested by CMS to act upon.  A full timeline can be downloaded in each category. The timeline, viewed as a PDF file, indicates the suggested immediate actions/goals, then broken down by quarter up to the deadline. However, users can step through the timeline using the widget, making the experience more visually appealing as it breaks down the timeline piece by piece.

The goals and action points are clean, concise bullet points set to guide the organization in the direction of a successful compliance. Here’s an example of the bullet points for Venders listed of Actions to take immediately:

  • Identify staff to receive training and develop training materials (5 months)
  • Establish organization’s implementation chart (6 months)
  • Determine product requirements (8 months)
  • Estimate budgets.  Budgets should include all costs associated with implementation including software, software licensing, hardware procurement, development, and staff training costs (8 months)
  • Conduct product re-engineering analysis (6 months)
  • Start product/solution development (9 months)

Each action point has a timeframe given. That timeframe is the estimated total duration needed for that action point.

The information presented in this tool should prove to be a valuable resource to organizations. I am interested to hear feedback from organizations whether they are using this tool or not, and if so, how the information is helping steer them successfully to compliance.

Another key ingredient to the October 2013 compliance date will be the incorporation of the ICD-10 codes to vendor systems. This will certainly affect systems such as the EHR and PM systems. Hopefully soon, the various vendors will begin (if they haven’t already started) to incorporate plans to swap the ICD-9 codes to ICD-10. Organizations will need to pay close attention to any vendor communications, as vendors will surely indicate release dates and material that correspond to the ICD-10 implementation.

As we move closer to the deadline, CMS will certainly provide more information on the ICD-10 transition. Visit their Latest News page to sign up for notifications, industry updates, attend teleconferences, and obtain other valuable resources.

One common and important theme from the CMS resources is training.  Proper and well established training inside each organization will prove to be a crucial step to ensure a smooth transition to using ICD-10 codes.  Training is the most powerful force behind deciding the level of success to using any new or updated information and procedures.  An organization that chooses to invest more in training will certainly have a higher return on that investment.

Galen Healthcare Solutions offers project management and training solutions. Contact us to find out how Galen might assist in the ICD-10 transition.

ICD-10 Readiness: Background & FAQ

This piece is the first of a two part series discussing the transition to ICD-10. The ICD-10 transition should be a high priority concern in healthcare.

Today, the healthcare industry is rapidly moving closer to the compliance date for ICD-10. That date is October 1, 2013.  As that date draws closer, organizations will need to actively take action to successfully be compliant.  The Centers for Medicare and Medicaid Services (CMS) is actively providing resources to assist in achieving this success.

FAQ Fact Sheet

CMS posted a downloadable PDF FAQ “transition basics” fact sheet indicating sixteen question and answers.  This tip sheet gives an excellent and informative overview to the transition to ICD-10.

Among these Q/A’s are:

    • What does ICD-10 compliance mean?
      • ICD-10 compliance means that all Health Insurance Portability and Accountability Act (HIPAA) covered entities are able to successfully conduct health care transactions on or after October 1, 2013 using the ICD-10 diagnosis and procedure codes. ICD-9 diagnosis and procedure codes can no longer be used for health care services provided on or after this date
    • What is the transition to ICD-10 happening?
      • The transition is occurring because ICD-9 codes have limited data about patients’ medical conditions and hospital inpatient procedures. ICD-9 is 30 years old, has outdated and obsolete terms, and is inconsistent with current medical practice.
      • Also, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full.
      • A successful transition to ICD-10 will be vital to transforming our nation’s health care system.
    • What type of training will providers and staff need for the ICD-10 transition?
      • Training should take place in late 2012 or early 2013 for most staff. Training needs will vary for different organizations. For example, physician practice coders will need to learn ICD-10 diagnosis coding only, while hospital coders will need to learn both ICD-10 diagnosis and ICD-10 inpatient procedure coding.
      • Look for specialty-specific ICD-10 training offered by societies and other professional organizations. Take into account that ICD-10 coding training will be integrated into the CEUs that certified coders must take to maintain their credentials.
      • ICD-10 resources and training materials will be available through CMS, professional associations and societies, and software/system vendors. Visit http://www.cms.gov/ICD10 regularly throughout the course of the transition to access the latest information on training opportunities.

As we move closer to the deadline, CMS will certainly provide more information on the ICD-10 transition. Visit their Latest News page to sign up for notifications, industry updates, attend teleconferences, and obtain other valuable resources.

The second part of this series will discuss implementation and producing results.  Look for that piece next week!

“You know my methods, Watson”: IBM’s Watson to enter the Healthcare world

Technology in healthcare is taking a huge step forward. Wellpoint, Inc has announced that they will be using a commercial version of IBM’s Watson supercomputer.

Not too long ago, a room full of computer hardware once computed at a power less than what our cell phones currently do. Now, a room full of computer hardware will equate to a computing entity with the intelligence to assist physicians with medical decisions.

You may know Watson best for its performance on the Jeopardy game show. Watson demonstrated swift decision making after indexing over 200 million pages of data. Watson would only answer if the system crossed a certain confidence threshold.  The confidence threshold was a predefined percentage set inside the system. When Watson referenced the data, it determined the percentage to which it was sure the top three answers were correct. If the percentage of the top answer crossed the confidence threshold, Watson would signal for the answer. The IBM machine proved itself successful against two humans competing in the game show by winning both rounds.

Certainly physicians and members have much to gain from the assistance of a machine that can reference millions of pages of data to ascertain a diagnosis or treatment.  While physicians may always hold the upper hand to interpret the context of the situation for a presenting patient, Watson’s assistance can certainly supplement any decision using vast amounts of data in a quicker time frame.

In an article posted by EMR and HIPAA, it noted that “One of the keys in the AP article above and was also mentioned by Dr. Nick from Nuance was that the Watson technology in healthcare would be applied differently than it was on Jeopardy.  In healthcare it wouldn’t try and make the decision and provide the correct answer for you. Instead, the Watson technology would be about providing you a number of possible answers and the likelihood of that answer possibly being the issue.” The article later went on to state:  “Saying that perhaps 25 percent of all healthcare errors are errors of diagnosis, Kohn [IBM Chief Medical Scientist Dr. Marty Kohn] noted how getting the diagnosis right can prevent all kinds of unnecessary complications and spending. “Of course, if you’ve made the wrong diagnosis, picking the right course of treatment becomes a challenge,” Kohn said.

So how might this affect the EHR world? The electronic EHR would be used as a reference for the Watson system. Previous prescriptions, orders, lab results, presented problems, among others, would all contribute to Watson ascertaining a confidence threshold.  Once a confidence threshold is reached or passed, the system would suggest a route of possible treatment, or determine a possible diagnosis.

With the advances in accuracy, these decisions can come back to the EEHR and certainly provide more efficiency and cost savings for the practice. The technology undoubtedly proves to be a win-win situation for all players in the healthcare industry.

 What do our readers think?

The Galen Healthcare Solutions Experience

With ACE just a month away, the excitement is growing as we prepare to reconnect with our colleagues, clients, and old friends.   While ACE is the Allscripts Client Experience, it is also an invaluable opportunity for us to share the “Galen Experience” with new colleagues, new clients, and new friends.   But what is it about the Galen Experience that differentiates us from our competitors?      

I think it can be summed up in two words:  Service Excellence.  We believe in what we are doing and we know that the success of our clients is a direct reflection on Galen as a company and as individuals.  We all strive for continuous improvement; we are never satisfied with the status quo.  Our environment encourages and requires the highest level of knowledge sharing.  Our clients benefit by having a Galen specialist working directly with them plus the knowledge, wisdom and experiences of the other 60+ experts on the Galen team.  Whether you need a project manager, an implementation consultant, an interface analyst or a conversion expert – we have the industry’s best.

Our focus is always on our clients’ needs and we have a passion for their success.  Just a few things we’ve heard over the last several months from our clients: 

“The Galen conversion team was able to successfully extract and convert the data, such that our patient demographic and discrete clinical data was available seamlessly within Allscripts EHR on day one. The technical expertise and support from Galen was impressive.” – Donna Lyles Basden, Director of Physician Network Support Services, Lexington County Health Services District

“I just wanted to take a moment to tell you what a pleasure it has been working with [Galen] on the v11 upgrade project for New Mexico Department of Health….incredibly knowledgeable and supportive… …We not only met our deadlines, but had one of the smoothest v11 upgrades I’ve heard reported.  Congratulations on a job well done!” – Jan Frey, Director of Clinical Solutions at MedNetwoRx

 “…we have had lots of laughs and fun together through this process.  Thanks to them and Galen for helping to make our 11.2 upgrade a success.”   –Emily Lazaros, Allscripts Application Manger at UMass Memorial Health Care

We have had a busy summer already and much success with conversions, go lives, and helping guide our clients towards Meaningful Use through the Enterprise EHRTM Version 11.2 upgrade and stimulus set implementations.  With a myriad of happy clients we are excited to share these experiences with you.  Don’t you want to be a part of the Galen Experience?  If you are attending ACE make sure you stop by the Galen booth #601!    

Hope you are enjoying the summer and we look forward to seeing you at ACE!

– Erin Sain, VP, Field Services

HL7 & Meaningful Use Hands-on Workshop: CDA R2 track

Ever wonder who designs and develops Health Level 7 (HL7)?  Well HL7 international is based out of Ann Arbor, Michigan and they hold various workshops around the country.  I recently had the chance to attend the HL7 Education Summit at the Hilton Suites Chicago Magnificent Mile over March 15th and 16th, 2011.  (All images and information were taken from HL7 Educational Summit presentations).

The Clinical Document Architecture (CDA) second release (R2) workshop was a very informational, hands-on experience.  Not only did it allow me to obtain a deeper understanding of CDA but gave me the opportunity to meet other members of the EHR/HL7 world.  In addition, the workshop gave me the opportunity to meet some of the key contributors to HL7 standard, including Calvin Beebe of Mayo Clinic, Diego Kaminker of Kern IT, and Keith Boone of GE Healthcare.  I can personally say that they are a bunch of very bright individuals and I am glad they are developing such an important standard.

CDAs don’t replace v2.x HL7 field delimited messages, and instead compliment them.

CDAs are very informational and pack a lot of information.  However, they were not developed to replace the v2.x HL7 field delimited message.  The main advantage of a CDA is that it is human readable and does not require an accompanying style sheet or specification to interpret as opposed to the v2.x HL7 field delimited messages which require a specification.  So you may be asking yourself, why do we still use v2.x HL7 messages?  Well for one, they are much less bulky than a CDA.  And provide an easy, streamlined way of entering data into EHRs.  I have provided an example of each below to show you the main differences.  As you can see, it is much easier for humans to understand CDAs and how it may be easier to enter data using v2.x HL7 field delimited messages:

CDA                                                                                   v2.x HL7 field delimited message

CDA Resources

CDA’s can be used not only as a CCD (Continuity of Care document), but to send lab results, immunizations, allergies, and much more! CDA is the basic template and the number of schema (set of rules, A.K.A. schematrons) determines the constraints.  A CCD can be used to send a plethora of information.

  • A great tool to build CDAs is MiniCDA, you may be able to find it online.  It was developed by Diego Kaminker, one of the HL7 presenters.
  • A great XML editor is Oxygen, it allows you to associate schematrons, i.e. constraints to your CDA.
  • If you would prefer to validate your CDA using an internet-based program, the CDA validation site is a good resource.
  • A great resource for general information about CDAs is CDA tools
  • Once you have created a CDA, a great place to locate various LOINCs to validate the CDA is Regenstrief LOINC Mapping Assistant (RELMA),
  • And finally, Integrating the Healthcare Enterprise (IHE), is a great healthcare integration resource.

NEHIMSS Presentation: Integration of HIT & Medical Devices

Were you aware that the moment the IS staff plugs a USB connector into a medical device to send data from it to another device, the organization could become the manufacturer of a completely new medical device and subject to recently announced Medical Device Data System regulations from the FDA? Were you aware that devices that collect and store data from a blood pressure cuff for future use or that transfer thermometer readings to be displayed at a nursing station for future use are considered an MDDS product and thus governed by the FDA?  Well if you didn’t know, you are not the only one as neither did I until attending the latest New England HIMSS (NEHIMSS) Monthly Event and Social Tuesday evening at the Papa Razzi in Wellesley, MA.  Rick Hampton did a phenomenal job of running through the rules and regulations surrounding “Integration of HIT & Medical Devices.”  Rick is a Clinical Engineer who has helped write several international standards, including the latest on risk management of integrated HIT and medical networks.  He works for Partners HealthCare as their Wireless Communications Manager.

Rick outlined the trend in increasing attention being paid to HIT integration efforts over the past few years.  The latest are new FDA rules from February 15, 2011, which specified “Medical Device Data Systems are off-the-shelf or custom hardware or software products used alone or in combination that display unaltered medical device data, or transfer, store or convert medical device data for future use, in accordance with a preset specification.”  He then discussed how the new standard, IEC 80001-1, was written to help hospitals perform proactive risk management when creating these integrated systems.

Currently, Electronic Health Records (EHRs) are granted an exception from being considered a medical device, however one might anticipate the day when they are considered as such and are regulated the same as a Laboratory Information System (LIS) or Radiology Information System (RIS). For an interface analyst such as myself, the implications are that there will be liability in the exchange of unsolicited results (for instance) between the LIS and the EHR. For those Allscripts users, this also brings into question the applicability of the regulations on the Allscripts Universal Application Integrator (UAI), which provides Allscripts Enterprise EHR the ability to interface with third party applications. An example would be a Welch Alynn Vital device.

A great question was posed from a HIT project manager in the audience who inquired about where this all fits in the scheme of all of the potentially competing projects in the enterprise (HIPAA 5010 EDI, ICD10 and MU come to mind), and also, where does it come into play in terms of the project to get the necessary departments together to discuss compliance? Often times the clinicians, end-users or decision-makers have already procured the software/solution/system and simply hand-off to IT to implement, and unfortunately it is too late by that point to perform the necessary risk assessment and ensure compliance.

Additionally, Rick provided a great link for organization’s to participate in the AAMI/ACCE/HIMSS Risk Analysis Survey to ensure compliance. This survey is intended to obtain baseline information from healthcare delivery organizations about the application of risk management during the healthcare technology life-cycle (eg. acquisition, deployment, use, modification and retirement).

On a side note, this was my first NEHIMSS meeting which I attended as a member. The group has historically been very gracious in allowing non-members to attend free of charge, but to me it made sense to invest $30 for a chapter membership (essentially a drop in the bucket). Not only do I get great exposure to topics and presentations I normally wouldn’t have access to, but I also get the opportunity to network and form contacts with fellow members of the HIT industry.  To me, that is a $30 well spent (by Galen of course ;) .

Lastly, for those project managers out there, be sure to register for the 5th Annual New England HIMSS/PMI-NH Project Management Symposium, hosted at the Sheraton Portsmouth Harborside Hotel in Portsmouth, NH. There are some great speakers presenting who will surely offer valuable insight into their experiences with initiatives that directly impact the healthcare organization today (Patient Portal, PM’s role in an EMR implementation, Project Managing a 5010 and ICD-10 upgrade, and HIE implementation to name a few). CPHIMS Credits will be offered for this event as well!

The Healthcare Information System Mosaic

Our clients environments are both sophisticated and complex, often times with different vendors in the fold for the different healthcare information systems that are utilized by the organizations. For those clients that are Managed Service Organizations (MSOs) or have different sub-entities, this is even more pronounced. Consider for a moment a scenario where an Integrated Delivery Network (IDN) consists of four physician groups under its umbrella. Some of these physician groups were added via acquisition – and as such were using existing systems such as EHRs or PMs from vendors different than those of the organization they were joining. The following mosaic illustrates such a case:

Given the graphic above, one can appreciate the complexity involved with the following core enterprise organizational functions:

  • Interoperability – Most systems do not easily interoperate with one another and thus require interfaces to be developed to facilitate communication between the systems
  • Patient Matching – uniquely identifying a patient across the enterprise in a system-agnostic fashion.
  • Reporting and Analytics – Each of the systems may have different database technologies at their core, and additionally the structure of the data is sure to be different.  This creates a challenge in reporting metrics to exhibit adherence to meaningful use criterion for instance or to
  • Trust – Which patient data should be shared across which systems?

A recent presentation at a NEHIMSS last month illustrated these points above and did a great job of communicating how Partners Healthcare is addressing the Healthcare Information System (HIS) mosaic via their COMPASS project. The COMPASS project is an aggressive initiative which implements a common administrative system and processes to streamline revenue cycle management and help manage costs through a “holistic, patient-centric, workflow-driven approach.”

The efficiency of the mosaic of systems (ala Claude Shannon for those EE nerds out there) is subpar at best. But this is the environment organizations find themselves. The alternative would be to consolidate to utilize one vendor across all systems ala the COMPASS project. However, some vendor systems are better at functions than others and the cost for conversion may be prohibitive or in some instances not feasible. For those organizations seeking out advice or recommendations for healthcare information systems, check out the folks at Software Advice as they offer great resources.

Contact us today if your organization seeks assistance with data conversion or integration of healthcare information systems.

Notes from the 2010 VITL Summit in Burlington Vt

Last Wednesday I attended the VITL Summit ’10 in Burlington Vermont.  VITL is non-profit “public charity” that operates as a partnership between the public and private sectors; VITL receives funding from the federal and state governments, as well as the Vermont Health IT Fund.

As part of the HITECH Act (Health Information Technology Extension Program) VITL became a Regional Extension Center (REC) and received $6,762,080 in Round 1 funding from the ONC.  RECs provide: training and support services to assist doctors and other providers in adopting EHRs, information and guidance to help with EHR implementation and technical assistance as needed.

The Summit Key Note speaker was Dr. David Blumenthal, the national coordinator for health IT.  Vermont Governor Jim Douglas was also there to emphasize how important the topic is to the state.  Dr. Blumenthal’s speech touched on a variety of topics and as expected, stressed how important the adoption and use of EHRs is to the future of how doctors practice medicine.  An interesting personal note Dr. Blumenthal shared was about his daughter who is currently in Residency.  Her current rotation had her moving from a practice that used an EHR to a practice that did not.  Her immediate response… ‘how could someone possibly be affective without an electronic system in place?’; an opinion father and daughter obviously share.  Along those lines, he suggested that new doctors, fresh out of medical school, would know nothing other than an electronic practice.

Additional notes from Dr. Blumenthal’s remarks;

  • Dr. Blumenthal is an self-proclaimed “non-geek”, with a house in South Pomfret, VT.  He believes Vermont serves as a model for how EHR/HIE programs could be designed and thinks VT has a unique, competitive edge because of its collaborative spirit and natural desire to exchange information.
  • Some reasons he thinks EHRs develop better doctors;
    • 24/7 Information access – problems, meds, history, etc
    • “See” what’s been done – even if you weren’t around when it happened
    • Knowing/receiving result more quickly
    • Decision support
    • Interaction checking – allergies, meds
  • The big benefits of adoption – (most, if not all are oft repeated by those in our industry)
    • Reduce costs – an important point for many of the individuals participating in the conference.  Short term improvements in terms of reducing operational costs of a practice (efficiencies), longer term.. see next bullet.
    • Increase the quality of care – this was a point he expressed a number of times.  He pointed out that perhaps not in phase 1 of MU, but long term (phases 2 and 3), this was the ultimate goal.  I.e. EHRs would improve patient outcomes, remove redundancies and ultimately affect overall patient health.
  • 3 Barriers of EHR adoption (+1 more)
    1. Financial
    2. Logistical/technical – especially for smaller practices.. there is a tendency to think it’s too difficult or time consuming
    3. Sharing – Will sharing patient data be accepted?  Will it actually hurt my practice?
    4. Trained workforce – Dr. Blumenthal mentioned that many more colleges and universities are now developing disciplines in Healthcare IT (including some in Vermont!)
  • Meaningful Use will be here before you know it…
    • Practices will have 2 years, from Oct 1st , to pick an EHR and meet MU requirements for reimbursement.  DO NOT wait.  Time will pass quickly and inevitably a bottleneck will develop.

In a separate presentation, VITL’s HIE offering was discussed.  Connection to an Exchange like this one will eventually be a requirement for all those participating in the MU program.  VITL’s exchange is run by GE and like other HIE’s, employs a hub and spoke model to connect practices and make the exchange of patient data possible.  Besides the physical network making the connections and the software platform running the exchange, HIE policy will play a large part in how information is shared.  Whether individual patients choose to participate, what privacy rules are in place and how security is managed will all play a central role in an HIE.

An interesting part of the Summit was the presence of all the big vendors; GE, McKesson, Greenway, NextGen, Athena, Cerner, Medent, eClincalWorks and of course Allscripts.  The interesting part came from being able to go from both to both and see one application after the next.  Seeing and feeling the dramatic differences in how they each work, look and perform.

This year’s event was sold out and overall seemed like a big hit with everyone in attendance.  Great job VITL!

Win with Galen

This year at ACE everyone was a winner with Galen!  Our booth was alive with activity as folks stopped by to see Galen Healthcare Solutions Wiki demos, VitalCenter Demos, to learn about Galen services and to take a spin on our Galen Slot Machine.  Tons of prizes were given out including entries to win an iPad, $10 in Mandalay Bay Casino Chips, and our Spin and Win Grand Prize of $200 in casino chips!   The last day of the ACE event we had a drawing for a free iPad!

We want to say special congratulations to all of our winners!!!

Susan Schimpf, from CapitalCare Medical Group, won the $200 Spin and Win Grand Prize

Melissa Singh, from North Shore Long Island Jewish, won in the drawing for the free iPad!

Over FIFTY $10 casino chips prizes were given to Galen slot machine winners and to those faithful followers caught out and about wearing their “Win with Galen” stickers!

Thanks to all of those that participated – we had a blast!

Community Connection

What a week!  As with returning from any trip to Las Vegas, it seems to take forever to settle back in to the normal routine.  This time it seems that the “magic”, however you want to define it, of Las Vegas was simply overshadowed by the excitement of ACE. 

For us here at Galen it was a great time to see old friends and clients, as well as, meet new friends and clients all in a setting that facilitated learning, sharing and connecting our collective community; of course, having a little bit of fun along the way doesn’t hurt.

By far the most rewarding part of ACE is connecting with our clients and hearing about the successes our people have made, both on an individual level as well as a community level.  There is nothing more rewarding than hearing a client’s success story and being able to share with our group the service that someone from Galen provided.

In the coming year, we look forward to our continued contributions and learning from our people, clients and community.  Nothing contributes to innovation more than a passionate community.

It was great to see all of our old friends, and we look forward to making new ones.

Matt Nice

« Previous PageNext Page »