Free Hospital EMR and EHR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to Hospital EMR and EHR for FREE!

Fundamentals of Securing Reimbursement for Healthcare Technology

Posted on November 28, 2018 I Written By

The following is a guest blog post by Keith J. Saunders, Esq., Founder & CEO of FHAS.

The utilization of technology to enhance and improve the patient experience is among today’s leading topics in healthcare. Recent technological developments have permitted improved access to healthcare, high quality care delivered in the most cost effective manner possible, and patient data to be acquired and leveraged to furnish more effective services. Whether through an Apple watch, telemedicine to rural or underserved areas, electronic medical record systems, clinical informatics, or delivery of care through robotic technology, there are many amazing opportunities to improve and enhance the patient experience.

One area which is frequently overlooked for enhancement of the patient experience is the integration of these modalities into the reimbursement system. No matter how innovative and effective the technology may be, at the end of the day the services or items in question need to be paid for by the patient’s insurance coverage.

Whether you are involved in product design or make purchasing decisions, one crucial element you should take into account in the design and deployment of new technology is how to pay for it. The following reimbursement decision algorithm can help to expedite that decision.

1. Is this a covered item or service?

The answer to this initial question can be found in the scope of coverage issued by the respective third party payors, both government and private. If you are seeking to have an item paid for by the Medicare program, your first stop should be the Medicare Benefit Policy Manual. If you are seeking to have an item paid for by the Medicaid program, consult the guidelines of the respective Medicaid program offered by the state in which the beneficiary resides. A general listing of essential benefits required to be offered under the Medicaid program may be found at the CMS Medicaid/CHIP homepage.

Similarly, commercial insurers publish their own benefit policies on their corporate websites which set forth what services and products are covered by their various products. After you have determined that an item is a covered service, the next step is to ascertain under what circumstances it will be afforded coverage by the payor, and to what degree.

2. Under what circumstances will a payor cover an item?

The answer to this question is typically found within the coverage and payment guidelines issued by third-party payors. The good news is that these policies are usually quite detailed and subjective. The bad news is that you may have to conduct extensive research to determine how they are applied. A good place to start for the Medicare program is at the National Coverage Determinations manual (NCD). The NCD will provide a general scope of coverage for a device or service, but to find more comprehensive guidance regarding coverage, you should go to the websites of the Medicare Administrative Contractors (MACs). The MAC websites will furnish detailed guidance regarding coverage and payment guidelines for specific items and services covered under the Medicare program.

The process for Medicaid is similar in that each state program maintains coverage criteria either directly or through the entities selected for delivery of benefits, such as Medicaid managed care plans.

Commercial insurers, such a Blue Cross Blue Shield, likewise maintain their coverage and payment guidelines online for review, which set forth the scope and conditions for reimbursement for services or items.

3. What documentation or information do I need to capture to ensure coverage of an item or service?

The answers to this question can also be found in the coverage and payment guidelines referenced above. Typically the coverage and payment guidelines specify the type of information required by a payor to make a payment determination. This is a critical component of the payment determination process and represents perhaps the area of greatest peril for the deployment of new technology.

If you are deploying new technologies or procedures, I would strongly recommend that you familiarize yourself with the payment rules for the third party payors you are seeking to bill for your service. The greatest technology in the world is of little value if payment is impaired due to the failure to tailor your technology to the coverage and payment guidelines. Similarly, if you are seeking to purchase a new technology or service as a healthcare provider, you must likewise consider how you will pay for the device or service.

The enhanced patient experience which we are all seeking through improved quality and efficiency can only be attained if reimbursement is on our radar. By doing so, we can ensure that our constituencies receive the benefit of innovative technology while maintaining financial peace of mind.

If you don’t have that peace of mind and the above steps seem too overwhelming, you can also reach out to a trusted claims review partner with expertise in reimbursement, like FHAS. Not getting paid because you’re using innovative technology is almost always an avoidable outcome.

About FHAS
FHAS, a URAC accredited IRO and ISO 9001 certified company, is one of the largest independent providers of “healthcare as a service” (HAAS) for government and commercial clients with a particular focus on adjudication services and medical claims’ review services. In 1996, FHAS began furnishing Medicare Fair Hearing Services to Durable Medical Equipment (DME) Administrative contractors located throughout the United States. Since that time, FHAS has expanded its scope of appeals services to include complex medical reviews for the following: Medicare Parts A, B, PDRC Appeals, and DME Appeals, internal and external health plan appeals, and the entire Pennsylvania Medicaid fair hearing process. FHAS utilizes a network of board certified physicians, legal professionals, and other healthcare professionals with diverse specialties, who have the expertise to render decisions for external review requests. In addition to professional services, FHAS provides enterprise-grade software solutions to healthcare and insurance industries. Their newest product Cogno-Solve is a comprehensive, RPA software platform that automates claims and appeals decision-making functions.

From Fragmented to Coordinated: The Big Data Challenge

Posted on November 27, 2018 I Written By

The following is a guest blog post by Patty Sheridan, MBA, RHIA, FAHIMA; SVP, Life Sciences at Ciox.

When healthcare organizations have access to as much data as possible, that translates into improved coordination and quality of care, reduced costs for patients, payers and providers, and more efficient medical care. Yet, there is a void in the healthcare data landscape when it comes to securing the right information to make the right decision at the right time. It is becoming increasingly critical to ensure that providers understand data and are able to properly utilize it. Technologies are emerging today that can help deliver a full picture of a patient’s health data, which can lead to more consistent care and the development of improved therapies by helping providers derive better insights from clinical data.

Across the country, patient data resides across multiple systems, and in a variety of structured and unstructured formats. The lack of interoperability makes it difficult for organizations to have access to the data they need to run programs that are critical to patient care. Often, various departments within an organization seek the same information and request it separately and repeatedly, leading to a fragmented picture of a patient’s health status.

Managing Complexity, Inside and Out

While analytics tools work well within select facilities and research communities, these vast data sets and the useful information within them are very complex, especially when combined with data sets from outside organizations. The current state of data illiquidity even makes it challenging to seamlessly share and use data within an organization.

For example, in the life sciences arena, disease staging is often the foundation needed to identify a sample of patients and to link to other relevant data which is then abstracted and mined for real world use; yet clinical and patient reported data is rarely documented in a consistent manner in EHRs. Not only do providers often equivocate and contradict their own documentation, but EHR conventions also promote errors in the documentation of diagnostic findings. Much of the documentation can be found in unstructured EHR notes that require a combination of abstraction and clinician review to determine the data’s relevance.

Improved Interoperability, Improved Outcomes

Problems with EHR interoperability continue to obstruct care coordination, health data exchange and clinical efficiency. EHRs are designed and developed to support patient care delivery but, in today’s world of value-based care, the current state of EHR interoperability is insufficient at best.

Consider the difficulty in collecting a broad medical data set. The three largest EHRs combined still corner less than one-third of the market, and there are hundreds of active EHR vendors across the healthcare landscape, each bringing its own unique approach to the information transfer equation. Because many hospitals use more than one EHR, tracking down records for a single patient at a single hospital often requires connecting to multiple systems. To collect a broader population data set would require ubiquitous connection to all of the hundreds of EHR vendors across the country.

The quality integration of health data systems is essential for patients with chronic conditions, for example. Patients with more serious illnesses often require engagement with several specialists, which means it is particularly important that the findings and data from each specialist are succinctly and properly communicated to fellow doctors and care providers.

Leveraging Technology

As the industry matures in its use of data, emerging technologies are beginning to break down information road blocks. Retrieving, digitizing and delivering medical records is a complex endeavor, and technology must be layered within all operations to streamline data acquisition and make executable data available at scale, securing population-level data more quickly and affordably.

When planning to take advantage of new advanced technologies, seek a vendor partner that provides a mix of traditional and emerging technologies, including robotic process automation (RPA), computer vision, natural language processing (NLP) and machine learning. All of these technologies serve vital functions:

  • RPA can be used to streamline manually intensive and repetitive systematic tasks, increasing the speed and quality at which clinical and administrative data are retrieved from the various end-point EHRs and specialty systems.
  • NLP and neural networks can analyze the large volume of images and text received to extract, organize and provide context to coded content, dealing with ambiguous data and packaging the information in an agreed-upon standard.
  • With machine learning, an augmented workforce can be equipped to increase the quality of records digitization and the continuous learning across the ecosystem, where every touchpoint is a learning opportunity.

Smarter, faster and more qualitative systems of information exchange will soon be the catalysts that lead paradigm-shifting improvements in the U.S. care ecosystem, such as:

  • Arming doctors with relevant information about patients
  • Increasing claims accuracy and accelerating providers’ payments
  • Empowering universities and research organizations with timely, accurate and clinically relevant data sets
  • Correlating epidemics with the preparedness of field teams
  • Alerting pharmacists with counter-interaction warnings

Ultimately, improving information exchange will enable healthcare industry professionals to elevate patient safety and quality, reduce medical and coding errors tenfold and enhance operational efficiencies by providing the relevant data needed to quickly define treatment.

Achieving this paradigm shift depends almost entirely on taking the necessary steps to adopt these emerging technologies and drive a systematic redesign of many of our operations and systems. Only then will we access the insights necessary to truly impact the quality of care across the healthcare landscape.

About Ciox
Ciox, a health technology company and proud sponsor of Healthcare Scene, is dedicated to significantly improving U.S. health outcomes by transforming clinical data into actionable insights. Combined with an unmatched network offering ubiquitous access to healthcare data, Ciox’s expertise, relationships, technology and scale allow for the extraction of insights from structured and unstructured clinical data to create value for healthcare stakeholders. Through its HealthSource technology platform, which includes solutions for data acquisition, release of information, clinical coding, data abstraction, and analytics, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability. Ciox improves data management and sharing by modernizing workflows and increasing the accuracy and flow of information, while providing transparency across the healthcare ecosystem and helping clients manage disparate medical records. Learn more at www.ciox.com.

The Leadership Demands of Value Based Care

Posted on November 8, 2018 I Written By

The following is a guest blog post by Mary Sirois and Heather Haugen PhD from Atos Digital Health Solutions.

The topics of Population Health and Value Based Care continue to swirl through nearly every healthcare conversation.  Leaders across the healthcare provider and payer industries are looking for strategies to reduce costs and improve quality in hopes of improving the bottom line and increasing the viability of the organization within the community; and every vendor has a solution. We recently formed an expert panel to study and better understand the current state of work being done across healthcare provider organizations.  We explored the topics of leadership strategy and commitment, data aggregation, data analytics, and consumer engagement.  Our conversations reinforced the importance of developing a research-based approach to help healthcare leaders navigate the breadth and depth of this critical initiative: value based care.  Our findings continue to drive our work in defining solutions that meet healthcare leaders’ needs to better serve their organizational missions as care providers and employers in their communities.

The expert panelists included Zach Goodling, Director, Population Health and Care Coordination at Multicare; Randy Osteen, VP Applications, Information Management at CHRISTUS Health; and Ruth Krystopolski, SVP of Population Health at Atrium Health.

The panel discussion gave attendees the opportunity to:

  1. Understand experiences and lessons learned from industry population health and informatics leaders in preparing for value-based care opportunities to improve care quality and reduce costs in their communities
  2. Learn about approaches to data aggregation and analytics to support population health’s strategic and operational priorities
  3. Gain an understanding of various care models deployed by different organizations to manage high risk populations
  4. Appreciate the organizational culture and leadership challenges faced within each of the value-based care journeys of three different dynamic organizations

The discussion began by recognizing that the current state of healthcare is isolated and disconnected; it has interoperability challenges, misaligned incentives for employers, payers, providers, and community services; it tends to focus on sickness for an uninformed and confused user population; and it places accountability on providers that often results in duplication or even scarcity of services.

The opportunity here is tremendous!  We can find ways to:

  • Enhance the ability to improve care quality and consumer (patient, member, employee) quality of life and reduce the cost of care.
  • Come together in consumer-centric manner, using interoperable, technology-enabled, data-driven, innovative business models that cross stakeholder boundaries and focus on quality of life across the continuum of care and services, acknowledging shared risk and creating a more accountable consumer population.

Key messages from the group were enlightening and reflected the progression of the entire healthcare industry.

We heard from all three panelists about the arduous work required to make even small amounts of progress. “We have been on a five-year journey to create capabilities in population health management, managing plans to assist members, identify care gaps, and develop care plans.”  The topic of data arose throughout our interviews.  The panel discussed various concerns around data aggregation. “The biggest hurdle is aggregating data from non-affiliated places and various systems.”  “Data is vital to supporting a broad view of each patient; without it, it is very difficult.” And they cautioned organizations about relying on too much data. “When it comes to analytics, being more actionable is better than gathering more data.”

Many leaders find the array of solutions and systems available to healthcare organizations overwhelming. Our experts provided some insight on platform strategy. “Must identify consistent, reliable, scalable solutions.  It is difficult when you have too many solutions/platforms. If you can get users onto the same system, even if it is not the best of class, using the same governance model and tools creates important consistency and scale.”

The panelists had some ideas about other success factors beyond the tool set.  “Social determinants are often the biggest impact when managing a population. We joke that we are all social workers. We are putting these resources in place and able to monitor 400-450 patients with some of the highest risk patient populations.” They encouraged a paradigm shift for those setting strategy for value based care. “I am often impressed by the level of expertise in healthcare, but surprised by the lack of awareness about the macro environment.  We need to ensure we help our people understand the “why” behind the need for change. The organizational work pales in comparison to the cultural changes required to make progress.” Several panelists also reinforced the long-term focus required for value based care programs to succeed. “This is an iterative process that will evolve over time, not a program with a beginning and end.”

Key Themes from Panelists

  1. A clearly defined leadership strategy and commitment are imperative.
  2. Most organizations are still in the early stages of defining their value based care processes. They are working to improve their understanding of consumer engagement and activities that potentially influence consumers. They are exploring new ways of leveraging technologies to engage consumers and provide new models of care.
  3. The lack of interoperability makes data aggregation difficult and the application of meaningful analytics even more challenging.

A Value Based Care Model

Understanding these key themes provides healthcare leaders with a better understanding of where to focus their efforts, but they still need a model to navigate the various domains of value based care.  The model below includes five areas of consideration for healthcare leaders to use as they continue to define their value based care efforts.

  1. Leadership Strategy & Commitment: Define, refine, and commit to a strategy that allows the organization to realize the benefits of value based care. Leadership engagement is imperative and has the power to accelerate or limit the amount of progress in every domain.
  2. Data Aggregation: Compilation of disparate clinical, financial, social, supply chain, administrative, public, and consumer data is vital for supporting clinical and business decisions.
  3. Data Analytics and Business Intelligence: The ability to utilize aggregated data to make informed clinical and business decisions that improve quality, reduce costs, and offer value to consumers
  4. Models of Care: Leveraging digital technology as appropriate, selection of a care delivery model based on collaboration and communication among all health care providers, payers, consumers, and community resources that contribute to individual consumers’ health and well-being
  5. Consumer Engagement: Connection and engagement between external stakeholders (consumers) and organizations (company or brand) through various channels of correspondence. This connection can be a reaction, interaction, effect, or overall customer experience that takes place online and offline.

Maturity and Organizational Evaluation

An example of the progression in organizational competency within each dimension is shown below, focusing on the most important dimension: Leadership Strategy and Commitment.

Value based care domains establish a critical foundation for assessing progress.  Organizations can then begin to evaluate their maturity within each domain. Atos is developing an innovative algorithm to rank organizational maturity within each domain, as seen in the following chart:

This type of insight helps healthcare leaders to think more strategically about where they invest and how they prioritize the many competing initiatives that impact value based care. This strategic view often results in new operating models and elucidates new ideas, innovative approaches, and ultimately better outcomes for consumers, both inside and outside of the healthcare system.

Atos believes that the digital transformation in healthcare is facing three shockwaves:

  1. Shockwave 1: Requires leaders to rationalize and streamline existing systems, notably through real-time clinical delivery and an EHR, in addition to the integration of financial, revenue cycle, and clinical data to fully understand care quality and costs that impact overall revenue and the organization’s financial viability
  2. Shockwave 2: Interconnect and increase collaboration between all ecosystem players, notably through collaboration and digital solutions. Deeply analyze and optimize treatments with new big data and cognitive technologies for population health (achieve early detection of epidemics, discover new risk factors, uncover new treatments, etc.). This is also at the heart of the research in which Atos is participating.
  3. Shockwave 3: Leverage the latest advances in artificial intelligence, machine learning, and genomics analysis. Leverage high performance computing solutions to enable precision medicine. This is probably the most striking advance on the healthcare horizon.

It will be no small feat for organizations to navigate these shockwaves, respond to ongoing payment reform, and address a changing consumer population; it will require discipline and focus. A complete, thoughtful approach will enable healthcare organizations to move from systems of reactive, disconnected care to a global health system that supports individuals throughout their lives.

About the Authors:

  • Mary Sirois is the Vice President of Integrated Solutions Delivery, focused on population health and value-based care services and technology delivery across all of Atos’ solutions. In addition, Ms. Sirois is a member of the Atos Scientific Community.
  • Heather Haugen is the Chief Science Officer for Digital Health Solutions for Atos.
  • Inbal Vuletich serves as the editor for Atos Digital Health Solution publications.

About Atos Digital Health Solutions
Atos Digital Health Solutions helps healthcare organizations clarify business objectives while pursuing safer, more effective healthcare that manages costs and engagement across the care continuum. Our leadership team, consultants, and certified project and program managers bring years of practical and operational hospital experience to each engagement. Together, we’ll work closely with you to deliver meaningful outcomes that support your organization’s goals. Our team works shoulder-to-shoulder with your staff, sharing what we know openly. The knowledge transfer throughout the process improves skills and expertise among your team as well as ours. We support a full spectrum of products and services across the healthcare enterprise including Population Health, Value-Based Care, Security and Enterprise Business Strategy Advisory Services, Revenue Cycle Expertise, Adoption and Simulation Programs, ERP and Workforce Management, Go-Live Solutions, EHR Application Expertise, as well as Legacy and Technical Expertise. Atos is a proud sponsor of Healthcare Scene.

Five Guiding Principles for Leveraging the Healthcare Contact Center

Posted on November 2, 2018 I Written By

The following is a guest blog post by Mike Wisz, Director, Analytics – Healthcare, Advisory Services, and Melissa Baker, Business Analyst, Healthcare, Advisory Services, at Burwood Group.

Consumer experience is more critical than ever for healthcare organizations. Today, the financial performance of health systems increasingly depends on converting consumers into patients and retaining patients within network—patients who now have expanding options for urgent, primary, and elective care. A contact center is a critical component of an inviting “digital front door” for consumers—which is why forward-looking healthcare organizations are envisioning how to transform call centers into patient engagement centers.

As part of an enterprise approach to patient access and experience, each organization will chart its own path in building out contact center capabilities. Healthcare CEOs increasingly recognize that consumers want to interact with their healthcare services as they do with companies in other industries, such as retail or hospitality.

The following are five guiding principles for developing a consumer-grade contact center experience.

First do no harm.

A poorly performing call center can result in frustrated patients or guests whose experience prompts them to look elsewhere for services. So first, deal with current problems, even if they are not easily discoverable. Using all available data sources, assess call handle times, customer effort required, and call routing accuracy against established targets or external benchmarks. If service levels are not acceptable, these problems must be resolved.

Make it easy for patients to connect.

Health systems should make it very easy for customers to access services using their preferred channel of communication. This access should be aligned from the customer’s perspective across touchpoints such as consumer-facing websites, patient portals and self-scheduling applications, and mobile applications offered to patients.

Remember: Productive agents create happy customers.

Consolidating contact center operations should result in more efficiency. Improving efficiency while offering additional services across more medical groups requires automation. Domain-specific knowledge support including scripts and protocols, empowers agents to rapidly resolve service requests. Skills-based routing gives managers the ability to staff flexibly while ensuring target service level performance. Desktop integrations with scheduling, billing, and clinical systems inform agents of highlighted information to reduce contact handle times and increase first-contact resolution rates.

Focus on outcomes. Measure and monitor.

Identify the business outcomes that are most important to determining success. These will likely focus on customer experience, agent productivity, and overall operational effectiveness. Many KPIs and metrics can be measured, but pick a few that will highlight performance against your most important outcomes. Ensure reports are available that provide visibility into key metrics and that reporting is timely enough to be actionable.

Align to enterprise vision and objectives.

It is not always clear in healthcare organizations who owns the “consumer experience.” Leaders from groups representing marketing, population health, clinical quality, and revenue cycle management should align and work together to ensure the contact center serves as a vital component of the organization’s comprehensive approach to patient experience.

In this new environment driven by consumerism, competition for patients will only continue to escalate. Successful health systems will learn to better leverage their contact centers as a way to attract and retain patients and optimize physician utilization, and to tackle a complex set of new challenges.

About Burwood Group
Burwood Group, Inc. is an IT consulting and integration firm. We help forward-thinking leaders design, use, and manage technology to transform their business and improve outcomes. Our services in consulting, technology, and operations are rooted in business alignment and technical expertise in cloud, automation, security, and collaboration. Burwood Group was founded in Chicago, IL and is celebrating over 20 years in business. Today, Burwood includes 250 employees and seven U.S. offices including a 24×7 Operations Center in San Diego, CA. Whether you are developing strategy, deploying technology, or creating an operational model, Burwood is a dedicated partner. To learn more, visit www.burwood.com.

The Wisdom of Yogi Berra in Medical Benefit Appeals

Posted on October 31, 2018 I Written By

The following is a guest blog post by Keith J. Saunders, Esq., Founder & CEO of FHAS.

“This hearing will now come to order.  For the record, today’s date is…and the following parties are present…”

I have repeated this sentence thousands of times over the past twenty three years while serving as a hearing officer for the Federal Medicare program and as an Administrative Law Judge (ALJ) for the Commonwealth of Pennsylvania Medicaid program.  Serving as an adjudicating official for medical benefit appeals can provide one with a unique perspective on human nature and the shortcomings of the medical appeals process. 

In this post, I would like to share three takeaways from my experience in order to assist you in being a successful participant in the appeals process, whether you participate from the side of the payor or appellant.

Know the medical facts.

My first piece of advice is inspired by a quote from the great New York Yankees baseball player and manager Yogi Berra: “You can observe a lot just by watching”.  Most participants in medical benefit appeals fail to perform the requisite watching.

If you are going to successfully defend or pursue your appeal, you must know the medical facts of the case. This might seem obvious, however you would be shocked to learn how many times a claim denial is appealed and it is very apparent that the parties don’t know or understand the condition of the patient, underlying the facts of their case. For medical provider appellants who are part of large health systems, the need to survey all records within your system pertaining to the subject of the appeal is critical.

For third party payers it is likewise critical to ensure that you possess a complete understanding of the condition of the patient.  I once presided over a hearing where the health insurer was challenging the necessity for the patient to have a wheelchair.  They indicated that the medical information submitted with the claims failed to indicate that the patient could not walk.   If they had performed a survey of the medical records contained within the file they would have ascertained that the patient was a bilateral AKA. For those of you who do not frequently traverse through medical records, this acronym stands for bilateral above the knee amputee; this patient had no legs.

Understand why the claim was denied.

Turning again to Yogi Berra for my second piece of advice: “You’ve got to be very careful if you don’t know where you are going because you might not get there.” In order to be an effective advocate for your position, you must thoroughly understand why a claim for reimbursement has been denied by the third party payor.  One of the most frequent bases advanced for denials in both the Medicare and Medicaid programs is the blanket catchall basis of, “a lack of medical necessity”.  This basis is utilized to deny submitted claims which lack a valid physician’s signature on the order, claims which fail to meet specific medical necessity criteria, or even claims that were not submitted in a timely manner.

As an appellant, you must possess a thorough understanding regarding what has transpired from the reimbursement standpoint, end of story.  If you are an appellant, please read the basis for the claim denial being put forth by the third party payer. To take my Yogi quote further, it is impossible for you as an advocate to get where you want to go, that is, get paid, if you do not know why the claim has been denied. When you as an appellant receive a denial notice, whether it is an explanation of benefits or a remittance advice, review the basis for denial.  If it indicates that critical medical necessity evidence is missing, review your records to find it.

Arguments that the medical policy is foolish or that the payor doesn’t understand what the patient needs may make you feel better for having given the adjudicator a piece of your mind, but are ultimately ineffective. I once had an appellant argue to me that requiring a physician’s order was a foolish requirement for an orthotic device.  When I asked the gentleman making that arguments how a payor was to ascertain if an item was medically necessary, he indicated that they should just ask him, the vendor.  Needless to say that was not an effective argument.

If you have received a blanket denial, such as a lack of medical necessity, please reach out to the third party payor to ascertain what exactly is missing or unclear.  Once you have determined what the problem is, you are then in a position to solve it.

Know the coverage and payment guidelines.

My final recommendation is that you acquire an in-depth knowledge of the coverage and payment guidelines or medical policies which govern the items or services for which you are seeking payment.  As a hearing officer or ALJ, I would find myself frequently asking appellants or payor representatives to furnish the basis within the policies for the denial of items.  More often than not on both sides of a case, neither party could articulate why an item should or should not have been paid.

I suppose in those situations they turned to another quote from Yogi: “If you ask me a question I don’t know, I’m not going to answer it.” Today there is no reason for any party to be unaware or unknowledgeable regarding medical policies or coverage and payment guidelines. All commercial health insurers and government programs, such as Medicare and Medicaid, publish their policies online.  Knowledge of the rules is one of the cornerstones to being a strong advocate for your position. From the provider standpoint, it is one of the critical components needed in order to have an item covered by a payor.

My advice may seem rather basic, but years of experience have shown me that it is a failure to address the fundamentals which causes most claims to be denied. In summary: 1. Know your patient and the medical records surrounding a claim; 2. Know the facts surrounding why reimbursement has been denied; 3. Know the rules which govern payment criteria for your claim.

If you pay attention to the foregoing you will be a much stronger advocate for your position and will likewise achieve and maintain a higher success rate in your appeals. In medical benefit appeals, as in baseball, “It ain’t over until it’s over.”

About Keith J. Saunders, Esq.
Keith J. Saunders, Esq. is the Founder & CEO of FHAS, a leading provider of medical review analytics and support services to government and commercial sectors. Weaving together over 30 years of experience working on behalf of health plans, providers, and government agencies, Mr. Saunders furnishes his clients with valued-based solutions that minimize administrative waste, maximize return on investment, and yield holistic results for all stakeholders. A former General Counsel to Blue Cross Blue Shield Plans, Mr. Saunders was an Air Force Judge Advocate proudly serving in Operation Desert Shield/Desert Storm. Mr. Saunders attained his Juris Doctorate from Duquesne University and is a long-time member of the American Health Lawyers Association (AHLA).

About FHAS
FHAS, a URAC accredited IRO and ISO 9001 certified company, is one of the largest independent providers of “healthcare as a service” (HAAS) for government and commercial clients with a particular focus on adjudication services and medical claims’ review services. In 1996, FHAS began furnishing Medicare Fair Hearing Services to Durable Medical Equipment (DME) Administrative contractors located throughout the United States. Since that time, FHAS has expanded its scope of appeals services to include complex medical reviews for the following: Medicare Parts A, B, PDRC Appeals, and DME Appeals, internal and external health plan appeals, and the entire Pennsylvania Medicaid fair hearing process. FHAS utilizes a network of board certified physicians, legal professionals, and other healthcare professionals with diverse specialties, who have the expertise to render decisions for external review requests. In addition to professional services, FHAS provides enterprise-grade software solutions to healthcare and insurance industries. Their newest product Cogno-Solve is a comprehensive, RPA software platform that automates claims and appeals decision-making functions.

Taming the Healthcare Compliance and Data Security Monster: How Well Are We Doing?

Posted on October 18, 2018 I Written By

The following is a guest blog post by Lance Pilkington, Vice President of Global Compliance at Liaison Technologies.

Do data breach nightmares keep you up at night?

For 229 healthcare organizations, the nightmare became a reality in 2018. As of late August, more than 6.1 million individuals were affected by 229 healthcare-related breaches, according to the Department of Health and Human Services’ HIPAA Breach Reporting Tool website – commonly call the HIPAA “wall of shame.”

Although security and privacy requirements for healthcare data have been in place for many years, the reality is that many healthcare organizations are still at risk for non-compliance with regulations and for breaches.

In fact, only 65 percent of 112 hospitals and hospital groups recently surveyed by Aberdeen, an industry analyst firm, reported compliance with 11 common regulations and frameworks for data security. According to the healthcare-specific brief – Enterprise Data in 2018: The State of Privacy and Security Compliance in Healthcare – protected health information has the highest percentage of compliance, with 85 percent of participants reporting full compliance, and the lowest compliance rates were reported for ISO 27001 and the General Data Protection Regulation at 63 percent and 48 percent respectively.

An index developed by Aberdeen to measure the maturity of an organization’s compliance efforts shows that although the healthcare organizations surveyed were mature in their data management efforts, they were far less developed in their compliance efforts when they stored and protected data, syndicated data between two applications, ingested data into a central repository or integrated data from multiple, disparate sources.

The immaturity of compliance efforts has real-world consequences for healthcare entities. Four out of five (81 percent) study participants reported at least one data privacy and non-compliance issue in the past year, and two out of three (66 percent) reported at least one data breach in the past year.

It isn’t surprising to find that healthcare organizations struggle with data security. The complexity and number of types of data and data-related processes in healthcare is daunting. In addition to PHI, hospitals and their affiliates handle financial transactions, personally identifiable information, employee records, and confidential or intellectual property records. Adding to the challenge of protecting this information is the ever-increasing use of mobile devices in clinical and business areas of the healthcare organization.

In addition to the complexities of data management and integration, there are budgetary considerations. As healthcare organizations face increasing financial challenges, investment in new technology and the IT personnel to manage it can be formidable. However, healthcare participants in the Aberdeen study reported a median of 37 percent of the overall IT budget dedicated to investment in compliance activities. Study participants from life sciences and other industries included in Aberdeen’s total study reported lower budget commitments to compliance.

This raises the question: If healthcare organizations are investing in compliance activities, why do we still see significant data breaches, fines for non-compliance and difficulty reaching full compliance?

While there are practical steps that every privacy and security officer should take to ensure the organization is compliant with HIPAA, there are also technology options that enhance a healthcare entity’s ability to better manage data integration from multiple sources and address compliance requirements.

An upcoming webinar, The State of Privacy and Security Compliance for Enterprise Data: “Why Are We Doing This Ourselves?” discusses the Aberdeen survey results and presents advice on how healthcare IT leaders can evaluate their compliance-readiness and identify potential solutions can provide some thought-provoking guidance.

One of the solutions is the use of third-party providers who can provide the data integration and management needs of the healthcare organization to ensure compliance with data security requirements. This strategy can also address a myriad of challenges faced by hospitals. Not only can the expertise and specialty knowledge of the third-party take a burden off in-house IT staff but choosing a managed services strategy that eliminates the need for a significant upfront investment enables moving the expense from the IT capital budget to the operating budget with predictable recurring costs.

Freeing capital dollars to invest in other digital transformation strategies and enabling IT staff to focus on mission-critical activities in the healthcare organization are benefits of exploring outsource opportunities with the right partner.

More importantly, moving toward a higher level of compliance with data security requirements will improve the likelihood of a good night’s sleep!

About Lance Pilkington
Lance Pilkington is the Vice President of Global Compliance at Liaison Technologies, a position he has held since joining the company in September 2012. Lance is responsible for establishing and leading strategic initiatives under Liaison’s Trust program to ensure the company is consistently delivering on its compliance commitments. Liaison Technologies is a proud sponsor of Healthcare Scene.

Insights, Intelligence and Inspiration found at #AHIMACon18 – HIM Scene

Posted on October 15, 2018 I Written By

The following is a guest blog post by Beth Friedman, BSHA, RHIT.

Last month’s HIM Scene predicted important HIM insights would be gained at the 90th AHIMA Annual Convention. And this prediction certainly came true! Thousands of HIM professionals discussed changes to E&M coding, physician documentation and information security during the organization’s Miami event. HIM’s expanding role in healthcare analytics was also recognized. Half of AHIMA’s “hot topics” presentations covered data collection, analytics, sharing, structure and governance.

For example, HIM’s role in IT project management was the focus of an information-packed session led by Angela Rose, MHA, RHIA, CHPS, FAHIMA, Vice President, Implementation Services at MRO. She emphasized how enterprise-wide IT projects benefit from HIM’s knowledge of the patient’s health record, encounter data, how information is processed and where information flows. In today’s rapid IT environment, there is a myriad of new opportunities for HIM—the annual AHIMA convention casts light on them all.

Amid all the futurecasting, AHIMA attendees also received valuable insights and fundamental best-practice advice for the profession’s stalwart tasks: enterprise master person index (EMPI), clinical coding and release of information (ROI). Here are few of the highlights.

Merger Mania Brings Duplicate Data Challenges

Every healthcare merger includes strategic discussions, planning and investments focused on health IT. System consolidation can’t be avoided—and it shouldn’t be. Economies of scale are a fundamental element of merger success. However, merging multiple systems into one means merging multiple master person indexes (MPIs).

Letha Stewart, MA, RHIA, Director of Customer Relations, QuadraMed states, “It’s not uncommon to see duplicate medical record rates jump from an industry average of 8-12 percent to over 50 percent during IT system mergers due to the high volume of overlapping records that result when trying to merge records from multiple systems or domains”. As entities come together, a single, clean EMPI is fundamental for patient care, safety, billing and revenue. This is where HIM skills and know-how are essential.

Instead of leaving HIM to perform the onerous task of duplicate data cleanup after a merger and IT system consolidation, Stewart suggests a more proactive approach. Here are four quick takeaways from our meeting:

  • Identify duplicate data issues during the planning process before new systems are implemented or merged.
  • Use a probabilistic duplicate detection algorithm to find a higher number of valid duplicates and lower number of false positives.
  • Clean up each system’s MPI before IT system consolidation occurs and as implementations proceed. Be sure to allocate sufficient time for this process prior to the conversion.
  • Maintain ongoing duplicate data detection against the new enterprise patient population to prevent future issues.

Maintaining a clean MPI has always been a core HIM function—even back to the days of patient index cards and rotating metal bins. Technology in combination with merger mania has certainly upped the ante and elevated HIM’s role.

Release of Information Panel Raises Red Flags for Bad Attorney Behavior

Another traditional HIM function with nascent issues is ROI. A standing-room-only panel session raised eyebrows and concern for AHIMA attendees regarding a pervasive issue for most HIM departments: patient-directed requests.

Rita Bowen, MA, RHIA, CHPS, CHPC, SSGB, VP Privacy, Compliance and HIM Privacy, MRO, moderated the panel that included other ROI and disclosure management experts. Bowen, a healthcare privacy savant, asked how many attendees receive patient-directed requests that are actually initiated by an attorney’s office. Dozens of hands went up and the discourse began. Here’s the issue.

To avoid paying providers’ fees for record retrieval and copies, attorneys are requesting medical records for legal matters under the guise of a patient-directed request. During the session, four recommended strategies emerged:

  • Inform your state legislators of this bad attorney behavior
  • Discuss the issue with HIM peers in your area
  • Hold meetings with your OCR representative to determine the best course of action
  • Question and verify suspicious patient-directed requests to clarify and confirm the consent

Finally, no AHIMA convention would be complete without significant attention to clinical coding!

Coding Accuracy Takes Center Stage

One of the AHIMA convention’s annual traditions includes announcement of Central Learning’s annual national coding contest results. Eileen Tkacik, Vice President, Information Technology at Pena4, sponsor of the 3rd annual nationwide coding contest to measure coding accuracy, reported that inpatient coding accuracy fell slightly in 2018 compared with the 2017 results. “Average accuracy scores for inpatient ICD-10 coding hovered at 57.5 percent while outpatient coding accuracy experienced a slight bump from 41 percent in 2017 to 42.5 percent in 2018,” according to Tkacik.

While some were concerned about the results, others expected a decline as payers become more aggressive with coding denials and impose greater restrictions on coders’ ability to determine clinical justification. This is especially true for chronic conditions—another hot coding topic among AHIMA attendees.

Nena Scott, MSEd, RHIA, CCS, CCS-P, CCDS, Director of Coding Quality and Professional Development at TrustHCS, emphasized the need for accurate hierarchical condition category (HCC) code assignment for proper risk adjustment factor (RAF) scoring under value-based reimbursement. Everything physicians capture—and everything that can be coded—goes into the patient’s dashboard to impact the HCCs, which are now an important piece of the healthcare reimbursement puzzle.

Finally, Catrena Smith, CCS, CCS-P, CPCO, CPC, CIC, CPC-I, CRC, CHTS-PW, Coding Manager at KIWI-TEK, presented an informative session on the new coder’s roadmap to accuracy and compliance. She reiterated the need for compliance with coding guidelines and shared examples of whistleblower cases. In addition, Smith provided valuable pointers for newly employed clinical coders to consider:

  • Understand the important role that coders play in compliance
  • Know the fraud and abuse laws
  • Implement checks and balances to compare payer-driven code requirements to best-practice coding guidelines
  • Review the components of an effective compliance plan
  • Do not participate in fraudulent activities because coders and billers can be held civilly and/or criminally liable

Inspiration Found at the Beach and on the Dance Floor

Beyond the convention center, the educational sessions and the exhibit hall, I made time at this year’s AHIMA convention to enjoy the beach. Two power walks and a few meditation moments were the icing on my #AHIMACon18 cake this year. I intentionally found time to enjoy the warm sunshine and moonlit evening festivities including MRO’s signature event and AHIMA’s blanca party. Dressed in white, AHIMA attendees kicked up their heels to celebrate 90 years of convention fun—and think about AHIMA 2019 to be held September 14–19 in Chicago, Illinois. We’ll see you there!

About Beth Friedman
Beth Friedman is the founder and CEO of Agency Ten22, a healthcare IT marketing and public relations firm and proud sponsor of the Healthcare IT Marketing and PR Community. She started her career as a medical record coder and has been attending the AHIMA conference for over 20 years. Beth can be reached at beth@ten22pr.com.

Healthcare Leaders: Feeling a Bit Discombobulated?

Posted on October 11, 2018 I Written By

The following is a guest blog post by Heather Haugen PhD and Inbal Vuletich from Atos Digital Health Solutions.

After passing through the security checkpoint at Milwaukee International Airport (MKE), a frazzled traveler is greeted by a low-hanging placard.  It reads: Recombobulation Area.  Clearly someone on the MKE management team with a sense of humor was acknowledging the fact that many travelers become a bit discombobulated as they proceed through security and that many probably need an area where they can get their collective psyche back in order.

The idea of a Recombobulation Area seemed especially appropriate as we returned from a healthcare conference on Lake Geneva where a wide spectrum of thought leaders presented and discussed their experiences from the past decade.  The group’s shared conclusion was that no one could have prepared for or predicted the level of change experienced in the healthcare environment over the past decade.

The changes we discussed encompass every aspect of how care is delivered, from EHRs to ERPs. Healthcare leaders navigate clinical, financial, and compliance hurdles daily – often all tangled together. Clinicians face new technologies, new workflows, new regulations and standards (that often conflict), new reimbursement requirements, new governance models, and something new… coming soon.  How can we expect better care in such a tumultuous environment?

During this time of dramatic change, it is important to identify a way to measure progress (or lack thereof) so that we can stay focused on our goals and desired outcomes.  One of the best mechanisms for assessing the impact of our work in healthcare is the use of data.  A simple research plan such as the one below can be used to assess the impact of changes – and could possibly even elucidate new ideas.

  • Research question: An overarching question to define the effort
    • For example:
      1. How effective are EHR alerts in preventing medication errors?
  • Specific aims: Specific objectives that address the overarching question
    • For example:
      1. To characterize the differences in medication errors before and after EHR implementation
      2. To understand the factors that increase alert fatigue
  • Methodology: How to address each specific goal. This step often requires some collaboration with a statistician or someone with research experience.
    • Define the sample population
    • Define the data elements to collect
    • Determine appropriate timeframes
    • Data analysis plan
  • Results: The presentation of the analyzed data
  • Conclusions: Discussion of the results and their meaning. What are the actionable steps for the organization?

Healthcare has evolved significantly to embrace new advancements in technology, but the challenges we continue to face need to be assessed objectively.  Thus far, our research has focused on the factors that influence adoption of new technology.  It has been fascinating and the outcomes caused us to consider new ideas and better approaches. Our EHR research published in Beyond Implementation remains relevant and valuable to healthcare leaders.  We are committed to helping healthcare organizations shift from the tumultuous set of ongoing changes to a research-based approach to ensure ongoing process improvement and discipline for technology adoption.  Our colleagues’ experiences, the rich research and data that exist today, and the stories of successes and challenges in healthcare organizations provide us with a critical Recombobulation Area. We must take the time to pause and learn from objective data and research methodologies to ensure that all this change focuses on improving patient care.

About the Authors:
Heather Haugen is the Chief Science Officer for Digital Health Solutions for Atos. She is also the author of Beyond Implementation: A Prescription for the Adoption of Healthcare Technology.

Inbal Vuletich serves as the editor for Atos Digital Health Solution publications.

About Atos Digital Health Solutions
Atos Digital Health Solutions helps healthcare organizations clarify business objectives while pursuing safer, more effective healthcare that manages costs and engagement across the care continuum. Our leadership team, consultants, and certified project and program managers bring years of practical and operational hospital experience to each engagement. Together, we’ll work closely with you to deliver meaningful outcomes that support your organization’s goals. Our team works shoulder-to-shoulder with your staff, sharing what we know openly. The knowledge transfer throughout the process improves skills and expertise among your team as well as ours. We support a full spectrum of products and services across the healthcare enterprise including Population Health, Value-Based Care, Security and Enterprise Business Strategy Advisory Services, Revenue Cycle Expertise, Adoption and Simulation Programs, ERP and Workforce Management, Go-Live Solutions, EHR Application Expertise, as well as Legacy and Technical Expertise. Atos is a proud sponsor of Healthcare Scene.

Bridging the Communication Gap Between Health Plans and Providers

Posted on October 3, 2018 I Written By

The following is a guest blog post by Tarun Kabaria; Executive VP, Provider Operations at Ciox.

Effective communication and trust are the essential keys to any relationship, and the plan-provider relationship is no different. A shift towards value-based coordinated accountable care has urged health plans and providers to collaborate to improve population health and patient experience while lowering costs. Most plan-provider communication revolves around rate negotiations.

An open, honest relationship with transparent communication and cooperation is needed to bridge the communication gap and create mutually beneficial partnerships. Sharing data, creating health plan-provider networks, utilizing audits and providing access to new technologies are all methods health plans and providers could use to help promote collaboration and bridge communication.

Data Sharing Across the Care Continuum

To foster collaboration, data sharing should be implemented and incentives should be aligned across the care continuum so that both parties are motivated to improve outcomes and lower costs. Data sharing is one of the key benefits of bridging the communication gap between health plans and providers.

Health plans hold the bulk of useful data and, when that data is combined with the providers’ clinical expertise, the likely result is better patient outcomes. Sharing data gives providers access to claims information that also provides with them a patient’s entire medical history. This information is useful in helping educate patients about their health risks and to boost transparency in plan-provider communication.

Health plans and providers keep a vast amount of patient information. Health plans have historical claims data while providers have clinical data. Both parties use their data for checks and balances and to mutually determine the best treatment and most appropriate care for patients. Lack of collaboration, usually due to interoperability challenges, means both data types aren’t shared. A key aspect to achieving collaboration and alignment is trust. Sometimes parties are lacking in trust when it comes to the use of their data; however, advancements in technology and use of the blockchain to create transparency are helping to change the tides.

Health plans and providers must have upfront discussions on what information will be shared, and each party must share data that is useful to the other. For health plans, this means understanding how reimbursement is determined, the factors that influence the payments they receive and how they are reimbursed based on clinical outcomes rather than interventions delivered. In turn, providers must clearly communicate the clinical outcomes health plans are or are not achieving. Ultimately, all measures should include preventative care, lower per capita cost and improve population health as well as patient experience and satisfaction. They should also improve how data is managed and transitioned. Providers that implement a strategic quality management approach to deliver high-quality, valued-based care can achieve better clinical outcomes.

Health Plan-provider Networks

Plan-provider communication networks are needed to efficiently and effectively harness data from both parties and enable rapid innovation and the sharing of real-time data for immediate response. Health plan-provider networks utilize care management, electronic health records (EHRs), and analytics to seek to resolve communication and collaboration challenges between health plans and providers. In keeping with HIPAA regulations, communication between health plans and providers must be customized to include only information that is relevant to specific attributed patient populations, physicians, reimbursement and care delivery models. The goal of plan-provider networks is to present both parties with transparent, high-quality data to improve trust and increase health plan-provider engagement to improve communication and, ultimately, population health.

Using Audits to Bridge Communication

The rise of audit requests has posed a problem in the plan-provider relationship. Both health plans and providers must work toward greater compliance, and auditing medical records is a crucial step in the process.

Providers struggle with numerous types of information requests from various third-party health plans, governmental agencies and national health plans, which often have different deadlines and vernaculars. As a result, health plans are forced to repeatedly call health information management (HIM) and audit departments when claims data inaccurately identifies place of service, provider or other patient information. An upsurge in audit requests from commercial and other health plans threatens to exacerbate these problems.

The audit process can change the plan-provider relationship from adversarial to advantageous by improving communication. Bridging communication gaps and language barriers through clearer record requests would take the burden off providers and alleviate plan problems. Technology will also play a critical role in making this entire process as automated as possible.

Chart requests that come from commercial health plan audits represent just five percent of all requests that providers receive. Hospitals also receive high volumes of medical record requests from other hospitals, physicians, attorneys, patients and more. The problem is that commercial plans often assume they are the only requestor. Education is required on both sides of the audit equation to improve processes and reduce plan-provider friction.

For providers, all data from each request and submission should be entered in a centralized audit management software application for the organization. This helps providers track audit activity by health plan and type of audit, maintain a record of all documents sent, better manage requests, and stay abreast of audit trends.

Patient access, clinical coders, billers and collectors perform unique functions and speak different languages across the hospital revenue cycle. Similarly, commercial health plans have multiple departments and terminology involved in audit processing. In many cases, inter-departmental communication and language barriers are the main obstacles to overcome.  However, technology is playing a growing role in creating greater transparency within the healthcare ecosystem—by acquiring, digitizing and giving shape to both structured and unstructured records.

Time Will Tell

Bridging the communication gap will not happen overnight. It will take time and effort from all parties involved; however, these methods are a good starting point.

As the digital era has taken hold, our attentions are turning to a better utilization of the vast data flowing through both providers and health plans. This will translate into a better understanding of patient outcomes, improved revenue cycles and more insightful growth strategies for all parties.

About Ciox
Ciox, a health technology company and proud sponsor of Healthcare Scene, is dedicated to significantly improving U.S. health outcomes by transforming clinical data into actionable insights. Combined with an unmatched network offering ubiquitous access to healthcare data, Ciox’s expertise, relationships, technology and scale allow for the extraction of insights from structured and unstructured clinical data to create value for healthcare stakeholders. Through its HealthSource technology platform, which includes solutions for data acquisition, release of information, clinical coding, data abstraction, and analytics, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability. Ciox improves data management and sharing by modernizing workflows and increasing the accuracy and flow of information, while providing transparency across the healthcare ecosystem and helping clients manage disparate medical records. Learn more at www.ciox.com.

Informed Consent: Let Go of the Status Quo

Posted on October 1, 2018 I Written By

The following is a guest blog post by Shahid Shah.

We’ve all heard it before: “healthcare is slow to adopt new technologies.” In fact, we’ve heard it so many times that we just accept it as gospel and don’t give it much thought.

It’s not true though.

For example, I remember when the iPhone was first released, it was easily adopted by doctors because it gave them something they craved: increased freedom by having access to information on the go.

What’s probably true is that “healthcare institutions are slow to adopt new technologies that impact status quo.

Why is that?

Because the perceived cost of maintaining the status quo is smaller than the cost of the innovation (e.g. product or solution), even if that innovation is free.

When the cost of not doing something new is low, nothing will change: and bad leadership is often able to keep the cost of maintaining status quo very low. Poor leaders add hurdles, like requiring unknowable ROI analyses, for introducing innovation but don’t penalize maintenance of status quo. This means that it’s easier to not introduce anything new – because the cost of not innovating is low but the cost of innovating is high.

Let’s take a look at digital patient consent as an example of an innovation – obtaining patient consent to perform a healthcare service is something that no hospital can do without. Called “informed consent”, this is a document that patients are required to sign before any procedure or health service is delivered. You’d think that because this form is the initial and primary document before almost any other workflow is started, that it would be the first to be digitized and turned into an electronic document.

Unfortunately, it’s 2018 and informed consent documents remain on paper. Thus:

  • JAMA reports that two-thirds of procedures have missing consent forms
  • JAMA reports that missing consent forms cause 10% of procedures to be delayed, costing hospitals over $500k per year
  • Joint Commission reports over 500 organizations annually experience compliance issues because of missing consent forms. There’s almost a 1 in 4 chance that your own organization has this compliance problem.
  • A recent JAMA Surgery paper estimated that two thirds of malpractice cases cited lack of informed consent, which increases liability risk
  • Superfluous paperwork directly contributes to clinician burnout
  • Patients often don’t understand their procedures or aren’t properly educated about the service they’re about to use

Today, many healthcare institutions go without automation of consent documents – which I’m calling the status quo. Even though this document is essential, and its non-digital status quo creates many financial, clinician, and compliance burdens, it’s not high in the list of priorities for digitization or automation.

As I enter my third decade as a health IT architect, after having built dozens of solutions in the space that are used by thousands of people, I still find it difficult to explain why even something as simple as an informed consent isn’t prioritized for automation.

It’s not because solutions aren’t out there – for example, FormFast’s eConsent is a universally applicable, easy to deploy, and easy to use software package with a fairly rapid return on investment. With eConsent software, clinicians aren’t interrupted in their workflows, patients are more satisfied, compliance becomes almost guaranteed, and procedures aren’t delayed because of lost paperwork.

A senior network engineer at East Alabama Medical Center recently wrote “the comparison of creating a form in the EHR vs. an eForms platform? There is no comparison. We are saving thousands of dollars by using eForms technology and the form creation is simple.”

Why do you think even something essential like patient consent forms remain on paper? Drop us a line below and let us know why the status quo is so powerful and what’s keeping your organization from adopting electronic forms solutions.

Note: FormFast is a proud sponsor of Healthcare Scene.