By now I think most of us in healthcare IT have either spent time reading the requirements for Stage 1 of meaningful use. Others have listened to the many webinars that are helping hospitals and physicians understand “42 CFR Parts 412, et al” and “45 CFR Part 170”– the fancy name on the Federal Register documents we should all be familiar with.

So what’s missing and will we see it in Stage 2? What about Stage 3?

The incentive is for hospitals and physicians to implement an EHR. So let me emphasize this – Electronic Health Record. But the big clinical piece, CPOE, does not an EHR make. Nor does it even qualify if you want to call it an EMR. Show me the big piece of the puzzle. The next stages – hopefully Stage 2 – will call for clinical documentation. Electronic charting by all practitioners will give some real meaning to the electronic chart. And complete the picture with resulting. Not sure what good it is to have an electronic order go to the lab or radiology if clinicians have to chase down a paper chart so they can see a result.

Granted, these things are usually implemented hand in hand, but if organizations and physicians look for the easy way (aka, the cheap way) out we will never see the intent of President Bush’s and President Obama’s call to digitize medical records. Are there other modules to be implemented? Of course there are. Think ahead. Don’t wait for Stage 2 and Stage 3. Do the right thing. Get a strategic plan that will guide your organization through all the components that will make up an Electronic Health Record.

Jeff Kerber
Director, General Consulting
http://www.inteck-inc.com/arraservices.html

I often ask my clients “Are you in Denial about your Denials” whereby the following questions are asked:

* Are you maximizing your commercial and managed care recovery?
* Do you track Denials by payor and the Reasons for Denials?
* Do you know what your Denial Rate is?
* Do you know what your Denial Recovery Rate is?
* Have you established a Remittance Management process?
* How quickly do you turn your denials back into cash?

In the January 25th issue of Health Leader Media Finance their is an article titled “Denials Bleed You: Four Ideas to Fix It” by Karen Minich-Pourshadi. In her article she states that claims and denials and underpayments are one area that few CFO’s would dispute they could always use improvement and that 90% of denials may be preventable through improved execution of verification, authorization and documentation. She also offers four ideas to fix it which I believe are worth reading because they are the exact same ideas that I have been telling CFO’s and Managed Care Directors for years. They are not that difficult to implement and there are several consultants like myself that will help with implementation and methods to stop the bleeding. But then again I wonder if CFO’s are now believing that the current Health Care Reform Bill will stop the bleeding.

Bruce Jacobs
Director, Financial Management Services
http://www.inteck-inc.com/fms.htm

I read more and more about patient customer service, patient satisfaction to maintain and attract patients and try and create loyalty to their particular hospital. In reading these varied articles I think about what the cost associated with doing this might be and I don’t think to many organizations have been able to assign a cost associated with customer service and patient satisfaction and loyalty.

Why? Because the tools to do this are in my opinion not available or intangible at best. Also I am not sure how wonderful the hospital is to patients in the area of customer service and satisfaction, isn’t the real determining factor a patients physician who directs their patients to a particular facility. I have seen many doctors admit their patients to many different hospitals because I believe there are certain perks, needs or relationships that they prefer at one hospital over another. Of course this costs money and I don’t know of any hospital that has tracked what it takes to get a Physician to admit patients exclusively to their hospital. I believe this cost can be tracked but CEO’s and CFO’s need to think about this and see if they or some vendor can achieve the cost of customer service, patient loyalty and satisfaction.

Bruce Jacobs CPA
Director, Financial Management Services

With the excitement of Navin R. Johnson (Steve Martin) in the 1979 film “The Jerk” I was thrilled to see the government release the definition of meaningful use at the end of 2009. The nearly 600 page document was as big as the phonebook that contained Navin R. Johnson’s new listing and made him “somebody” and the reading just as captivating. And just like the phonebook, the ending was a real letdown – all we got was Stage 1 and the promise of two more stages.

OK, I’m being a bit of a pessimist here. Stage 1 is a great start. Hopefully hospitals and eligible providers (now affectionately known as EP) will get off the respective backsides and get moving toward demonstrating meaningful use. Any organization or provider still hesitating about starting should have a great reason. Try looking at things from this perspective: would your organization be implementing and EHR if not for the incentive money or threat of penalty if there is no EHR? In most cases, I believe your answer would be in the affirmative. Next question: is your timetable being rushed because of the incentive money? In this case, your answer SHOULD be in the affirmative.

It doesn’t make sense to leave the EMR priority unadjusted and leave “free” money on the table. We’ve all done the math and incentive dollars aren’t going to cover the cost of acquisition or implementation. But it sure will help – especially in a group practice setting where each physician could be considered an EP, thus multiplying the benefit. Waiting for Stage 2 and Stage 3 to be released could leave your organization with a nearly impossible task ahead depending on when you start implementing. Your organization might have to achieve Stage 1 compliance and then jump right to Stage 3 – or worse, start at Stage 3!

Take at look at this table… then decide for yourself. Don’t hesitate, there is money to be lost.

Jeff Kerber
Director, General Consulting
Inteck, Inc.
http://www.inteck-inc.com/LP/LP_meaningfuluse.html

This is the question on many hospitals minds. For in 2010, the Joint Commission has significantly shortened the list of National Patient Safety Goals (NPSGs). The number has been reduced from 20 in 2009 to 11 in 2010. Regardless, it would be most efficient and effective if your hospital’s HCIS can address and insure that these goals (download the goals here) are being satisfied. How do you plan to do it?

Compliance with the NPSGs and the UP is non-negotiable. Every hospital must be able to document how their HCIS is meeting these NPSG and UP goals, and be fully prepared to demonstrate it during any Joint Commission survey. If you are unsure how your system is supporting this, or how to make your system responsive you should contact a consulting firm with experience. For your initial efforts Inteck has created a comparison chart to get you started thinking about these goals.

Donald Jacobs
President
http://www.inteck-inc.com/JointCommissionGoals2010.html

What should be considered when granting access to a HCIS? How should we as a facility come to our conclusion?

Most, if not all, HCIS systems have an access granting component. When granting access to end users, facilities should take into consideration their current practices, patient care flows, roles of the end users, as well as current HIPAA guidelines. One area of universal concern is access to behavioral health patient information. Within the continuum of patient care, it appears to make sense for care providers to have full access to these patients, but do they need access after the patient leaves their direct care? This level of need is one of the defining factors of granting access. For instance, take a case of a behavioral health patient admitted from the emergency department. Once the patient leaves the ED, providing the care practices support completion of the chart at the end of the ED visit, reasonably there should not be further need for the ED physician to still access the chart of the admitted behavioral health patient. The staff who now need access to that patient information are the behavioral health staff. Careful documentation of roles, work flows and review of information access policies will help facilities come to sound conclusions regarding end user access to confidential patient information, and should be a major task of any HCIS project plan.

Mary Helen Thome
Director, MEDITECH Services Division
http://www.inteck-inc.com/meditechservices.htm

As the use of the internet increasingly becomes a community blackboard, how does that affect the risk of privacy violations for provider’s patients? What are implications when a hospital employee has their picture taken with a patient and posts it on their Facebook? People are talking about patients they cared for on a private site with people who have no right to know. There’s data that demonstrates this is an increasing risk.

Eighty deans from medical schools that are members of the Association of American Medical Colleges were recently surveyed about medical students’ behavior on social networking sites and blogs. Results were reported in the Sept. 23 issue of the Journal of the American Medical Association. According to a summary of the survey, 60% of medical schools in the U.S. responded, and 60% of them “reported incidents of students posting unprofessional online content.” Thirteen percent of the deans cited violations of patient confidentiality. When people get into social networking sites, they become very comfortable with the people they are talking to. They lose perspective and the lines blur and they want to talk about what they do and they want it to sound exciting, so they often go a little too far. There are many new opportunities for violating privacy and every hospital has to take action.

Some alternatives are blocking employee access to the Internet, implementing restrictive policies or providing intensive training, or a combination of all of them. For example, the technical support from within the IT department can prevent employees from accessing social networking and other inappropriate Web sites at their work computers. This includes shopping on eBay, “friending” people through Facebook, or entering other Internet worlds. This can minimize the potential for security and privacy violations.

A second way is through the establishment and implementation of general ethics and compliance standards. Employees need to be reminded that they are privy to patients’ most confidential information and that’s a sacred trust. Discussions should be held using examples like videos and pictures and sharing patient information and its inappropriateness on social networking.

Employees should not be allowed to photograph clinical areas unless there are business purposes and management has preapproved the project. For example, there have been incidences of employees using their cell phones to take pictures of semi-public areas and inadvertently including a patient.

There have been incidences that employees respond on their Web sites to patient comments on the care they received while in the hospital. They meant well and didn’t think this violated HIPAA. Hospitals need very clear policies and training.

So, just when you think you have all of the appropriate security controls in place and are compliant with the laws, technology brings something else that had never been considered. How do you address social networking in your organization?

Donald M. Jacobs
President, Inteck Inc.
http://www.inteck-inc.com/

Source:
“Report on Patient Privacy”, Volume 9, Number 12. http://www.aishealth.com/

Happy New Year. Over the holidays I read the article in the December 22, 2009 Healthcare Finance Newsweek which according to PricewaterhouseCoopers’ Health Institute published a report called “Squeezing every penny out of healthcare costs.”

The primary emphasis in 2010 will be on reducing costs in the healthcare industry. What bothers me is that back in the mid 80’s hospitals were focused on management engineering studies in which the primary focus here was to analyze operational functions, processes and procedures to reduce costs. Then as we moved into the early 90’s the focus was on cost containment within the healthcare industry whereby hospitals now were supposed to review again all operational functions, processes and procedures to again reduce costs. As we moved into the late 90’s and early 2000 hospitals now were focused on revenue enhancement. I suppose if you can’t reduce costs you must increase revenue. Now here we are at the end of 2009 and the number one focus in 2010 will be on reducing costs, well I guess what bothers me is if the healthcare industry couldn’t get it right the first two times why does someone such as PWC or any one else think hospitals will be any more successful in 2010.

Bruce Jacobs CPA
Director, Financial Management Services
http://www.inteck-inc.com/fms.htm

The implementation process can be a long painful period when facing the implementation of the entire system. Effectively installing the MEDITECH system or even an application is critical to ensure that an organization’s capital resources are being invested effectively to help satisfy their goals and objectives.

So, what are the benefits of installing the entire system at once compared to installing individual add-ons later?

“Big Bang” – Complete System Install

Everything is installed at once. Frequently, the momentum will decrease or gets lost after a partial go live. It is common for the same core team staff to be used for multiple modules. These same people have put in many hours to build and support new systems and it is hard to start another module implementation directly following a major “go live” or system activation.

Funding may be reallocated to other projects outside of the MEDITECH implementations. Due to unforeseen critical issues outside of MEDITECH, the capital dollars for a second phase may either be drastically decreased or allocated for another project.

The training for the staff will need to be redone or refreshed IF the phased in modules are integrated with the current modules already LIVE. This decreases end user satisfaction and capital dollars.

The “Phased-In” approach may affect all financial areas due to the fact there may be major changes within the billing, admitting and scheduling processes and procedures.

The daily support model will need to be adjusted and possibly re-engineered for the IT Help Desk along with departmental “super-users” in regards to staff system issue support.

“Phased In” – Application Add-ons

With individual add-ons, it is sometimes less stressful on the staff due to the fact that not all systems in all areas are installed at once.

Capital money or budget can be submitted for a longer period of time. Meaning, facilities can budget for different modules being installed over a longer timeframe.

Having a partner (such as a consulting firm) with you to produce positive and valuable end results can enable you to effectively install your MEDITECH applications.

Regardless if you choose to use the big bang or phased in approach, the key to your success is understanding your facility’s needs and goals. Use the assistance available, within your own facility as well as external resources, to minimize the install time as well as any issues that may arise. The final product will be a well-utilized system that fosters patient safety and employee satisfaction.
–Mary Helen Thome, Director, Meditech Services Division

I struggled for a week trying to come up with a topic for this week. Driving home last night from a Cub Scout meeting it came to me… a Top 10 to get us into 2010! Now, what stories in healthcare IT? Surely ARRA and HITECH. And defining and refining “meaningful use.” What about the conviction of former McKesson CEO Charles McCall? And then I realized I couldn’t come up with 10. And then another holiday miracle!

HealthcareIT NewsWeek did it for me! An email arrived in the wee hours with a top 10! But alas, not mine. Most would be, but I need to rearrange. So here is my spin – and in the tradition of David Letterman, in reverse order.

10. Leapfrog names 45 best hospitals in country for 2009 – sure it’s nice to be on this list, but did it really deserve to be number one?

9. Premier picks 23 top performing hospitals – Again, a good list to be on, but just because Healthcare IT was used as a criteria doesn’t merit a top spot on any list.

8. ‘Most Wired Hospitals’ for 2009 named – Another good list. One of my favorites. But how can a list be the among the top stories. How these organizations got there is the real story!

7. Healthcare IT can ‘bail out’ hospital budgets – Duh! Is this really news to any of us in the industry? Haven’t we all been preaching the value of IT goes well beyond pushing out a patient statement or transmitting an insurance claim?

6. “Meaningful use” no mystery, experts contend – Really? ONC has recommendations (see next item). But it’s a shell. More details are coming, but there’s room for interpretation and lots of questions on how the entire process will work. When this article came out on May 11, 2009 Scooby Doo and the Mystery Machine couldn’t have come close to discovering the secret of meaningful use.

5. ONC policy committee approves recommendations on meaningful use – Now we’ve got something! OK, we’ve got a clue. Two months after we were told it isn’t a mystery!

4. Healthcare IT stimulus funding: Show me where to put the money – This is a huge question! How could it have rated so low on the original list?

3. War on talent about to begin in healthcare IT – This has to rank higher simply because one of the main goals of ARRA was to stimulate the economy. Jobs help do that, therefore doesn’t this help prove ARRA is working. OK, maybe only somewhat.

2. Survey: Secondary use of electronic health data will improve care, cut costs – The controversy that this survey has generated is reason enough for me. There was even a survey that said healthcare IT doesn’t do either one.

And MY number one story for 2010…

Obama: EHRs for Americans by 2014 –At number six on the original list this is way underrated! Where would the other stories have come from without this grandiose idea from our President?

So there you have it… I admit, I stole the list. But my rankings are my opinion. Top 10 lists are like armpits… you can fill in the rest. And for what it’s worth, I would have placed the McCall conviction in the middle and bumped the Premier list out. The end of the McCall saga was followed closely by industry pundits more noteworthy they myself. How it got left off is beyond me. Do you have a top 10? Share it here!

By the way, I’ll be on vacation next week, so don’t expect to see words of wisdom from me on December 23, 2009. Happy Holidays to everyone.

Jeff Kerber
General Consulting
http://www.inteck-inc.com/arraservices.html