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Less Than Half of Healthcare Users Trust Critical Organizational Data

Posted on November 29, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

If you’re a healthcare CIO, you must hope that your users trust and feel they can leverage data to do their jobs better. However, some of your colleagues don’t seem to be so sure. A new study has concluded that less than half of users in responding healthcare organizations have a high degree of trust in their clinical, operational or financial data.

The study, which was conducted by Dimensional Insight, surveyed 85 chief information officers and other senior health IT leaders. It asked these leaders how they rated trust in the data leveraged by their various user communities, the percentage of user population they felt was self-service oriented and making data-driven decisions, and whether they planned to increase or decrease their investments in data trust and self-service analytics.

When rating the level of data trust on a 10-point scale, just 40% of respondents rated their trust in financial data at eight or above, followed by 40% of clinical data users and 36% of operational data users.

Perhaps, then, it follows that healthcare organizations responding to the survey had low levels of self-service data use. Clinical data users had a particularly low rate of self-service use, while financial users seemed fairly likely to be accessing and using data independently.

Given these low levels of trust and self-service data usage, it’s not surprising to find out that 76% of respondents said they plan to invest in increasing their investment in improving clinical data trust, 77% their investments in improving operational data trust and 70%  their investment in financial data trust.

Also, 78% said they plan to increase their spending on self-service analytics for clinical data and 73% expect to spend more on self-service analytics for operational data. Meanwhile, while 68% plan to increase spending on financial self-service analytics, 2% actually planned to decrease the spending in this area, suggesting that this category is perhaps a bit healthier.

In summing up, the report included recommendations on creating more trust in organizational data from George Dealy, Dimensional Insight’s vice president of healthcare applications. Dealy’s suggestions include making sure that subject matter experts help to design systems providing information critical to their decision-making process, especially when it comes to clinicians. He also points out that health IT leaders could benefit from keeping key users aware of what data exists and making it easy for them to access it.

Unfortunately, there are still far too many data silos protected by jealous guardians in one department or another. While subject matter experts can design the ideal data sharing platform for their needs, there’s still a lot of control issues to address before everyone gets what they need. In other words, increasing trust is well and good, but the real task is seeing to it that the data is rich and robust when users get it.

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.

Will Remote Medical Coders Ever Return to the Hospital? – HIM Scene

Posted on November 14, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This week on the Journal of AHIMA blog, Elena Miller, Director of Coding Audit and Education at a healthcare system, posted this really fascinating question:

Will Coders Ever Return to the Office?

Elena does a good job of explaining how quickly remote work has become part of the medical coder’s life and the benefits it provides. However, she looks at large companies like IBM that are eschewing remote work and bringing their employees back to the office. It’s fair to wonder if the same thing will happen with medical coders who are requested to work from the hospital as opposed to their home.

I’d suggest that this is extremely unlikely to happen. First, I think it’s a mistake for IBM to bring everyone back to the office. Second, the reasons that IBM wants to bring everyone back to the office don’t apply to medical coders as much as it does IBM employees.

While IBM made a big splash with their announcement of bringing everyone back to their office, I think they’re going to regret this decision. They’re going to lose some of their best people who want to work remotely and that’s going to leave them in a bad place. Finding and keeping high quality people is the hardest thing to do at any company. The problem is that the most skilled people in your workforce can find a job anywhere at any time and your competitors are still offering remote work. It’s such a bad idea to lose all of these quality people by getting rid of remote work across the board.

I’m sure IBM needed to change the culture of the company where many remote workers weren’t being efficient in their work. That needs to be addressed, but banishing remote work across the board has all sorts of bad consequences. Don’t be surprised if IBM has made a bunch of exceptions for their highest performing people and if they go back on such a broad policy. A hospital or health system that does this will find the same problem and most can’t afford to lose their best medical coders who can certainly find remote coding work elsewhere if needed.

All of this said, the bigger issue is that remote coding work is quite different than most of the IBM jobs. Most IBM jobs benefit from collaboration and they’re hard to track as far as results. This is why they benefit from being in the same office with their colleagues with whom they need to collaborate and that can hold them accountable.

While medical coders certainly run into challenging cases where they benefit from collaboration, for the most part, medical coding is an individual sport. Plus, there are good ways to track coders productivity, accuracy, etc so you can hold them accountable for their work regardless of whether they’re at home or in the office. This is why I think it’s pretty unlikely that medical coders will return to the office.

Sure, there may be some edge cases where certain healthcare leaders who bring all their coders back as a way to send a message to staff. I think that’s what happened in the IBM case. However, much like I think will happen with IBM, those leaders will backtrack to remote coding soon enough. No doubt there will also be some edge cases where it makes sense to bring a specific coder back on site for training or other remediation for poor performance. Some medical coders may even request to be on site based on their own needs. However, if you can’t trust them to code remotely, my feeling is that you probably shouldn’t trust them to code at all.

Elena does make a great point in her article about remote coders not having the same opportunities to advance in their organization. Being present definitely matters if you are aspiring into leadership positions. What’s not clear to me is how many remote coders really aspire to leadership positions. Those that do seem to be doing remote coding on the side to supplement their income as they rise through the HIM leadership ranks. Maybe I’m wrong and there are a lot of remote medical coders that aspire to leadership in their organizations.

Let us know what you think in the comments and on social media @HealthcareScene. Will remote medical coders return to the office? Will remote coding hurt HIM professionals’ leadership opportunities?

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.

Hospitals Taking Next-Gen EHR Development Seriously

Posted on October 22, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Physicians have never been terribly happy with EHRs, most of which have done little to meet the lofty clinical goals set forth by healthcare leaders. Despite the fact that EHRs have been a fact of life in medicine for nearly a decade, health IT leaders don’t seem to have figured out how to build a significantly better one — or even what “better” means.

While there has been the occasional project leveraging big data from EHRs to improve care processes, little has been done that makes it simple for physicians to benefit from these insights on a day-to-day basis. Not only that, while EHRs may have become more usable over time, they still don’t present patient data in an intuitive manner.

However, hospital leaders have may be developing a more-focused idea of how a next-gen EHR should work, at least if recent efforts by Stanford Medicine and Penn Medicine are any indication.

For example, Stanford has developed a next-gen EHR model which it argues could be rolled out within the next 10 years. The idea behind the model would be that clinicians and other healthcare professions would simply take care of patients, with information flowing automatically to all relevant parties, including payers, hospitals, physicians and patients. Its vision seems far less superficial than much of the EHR innovation happy talk we’ve seen in the past.

For example, in this model, an automated physician’s assistant would “listen” to interactions between doctors and patients and analyze what was said. The assistant would then record all relevant information in the physical exam section of the chart, sorting it based on what was said in the room and what verbal cues clinicians provided.

Another initiative comes from Penn Medicine, where leaders are working to transform EHRs into more streamlined, interactive tools which make clinical work easier and drive best outcomes. Again, while many hospitals and health centers have talked a good game on this front, Penn seems to be particularly serious about making EHRs valuable. “We are approaching this endeavor as if it were building a new clinical facility, laboratory or training program,” said University of Pennsylvania Health System CEO Ralph Muller in a prepared statement.

Penn hasn’t gone into many specifics as to what its next-gen EHR would look like, but in its recent statement, it provided a few hints. These included the suggestion that they should allow doctors to “subscribe” to patients’ clinical information to get real-time updates when action is required, something along the lines of what social media networks already do with feeds and notifications.

Of course, there’s a huge gap between visions and practical EHR limitations. And there’s obviously a lot of ways in which the same general goals can be met. For example, another way to talk about the same issues comes from HIT superstar Dr. John Halamka, chief information officer of the Beth Israel Deaconess Medical Center and CIO and dean for technology at Harvard Medical School.

In a blog post looking at the shift to EHR 2.0, Halamka argues for the development of a new Care Management Medical Record which enrolls patients in protocols based on conditions then ensures that they get recommended services. He also argues that EHRs should be seen as flexible platforms upon which entrepreneurs can create add-on functionality, something like apps that rest on top of mobile operating systems.

My gut feeling is that all told, we are seeing from real progress here, and that particularly given the emergence of more mature AI tools, a more-flexible EHR demanding far less physician involvement will come together. However, it’s worth noting that the Stanford researchers are looking at a 10-year timeline.  To me, it seems unlikely that things will move along any faster than that.

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.

AI Project Set To Offer Hospital $20 Million In Savings Over Three Years

Posted on October 4, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

While they have great potential, healthcare AI technologies are still at the exploration stage in most healthcare organizations. However, here and there AI is already making a concrete difference for hospitals, and the following is one example.

According to an article in Internet Health Management, one community hospital located in St. Augustine, Florida expects to save $20 million dollars over the next the three years thanks to its AI investments.

Not long ago, 335-bed Flagler Hospital kicked off a $75,000 pilot project dedicated to improving the treatment of pneumonia, sepsis and other high mortality conditions, building on AI tools from vendor Ayasdi Inc.

Michael Sanders, a physician who serves as chief medical informatics officer for the hospital, told the publication that the idea was to “let the data guide us.” “Our ability to rapidly construct clinical pathways based on our own data and measure adherence by our staff to those standards provides us with the opportunity to deliver better care at a lower cost to our patients,” Sanders told IHM.

The pilot, which took place over just nine weeks, reviewed records dating back five years. Flagler’s IT team used Ayasdi’s tools to analyze data held in the hospital’s Allscripts EHR, including patient records, billing, and administrative data. Analysts looked at data on patterns of care, lengths of stay and patient outcomes, including the types of medications docs and for prescribing and when doctors were ordering CT scans.

After analyzing the data, Sanders and his colleagues used the AI tools to build guidelines into the Allscripts EHR, which Sanders hoped would make it easy for physicians to use them.

The project generated some impressive results. For example, the publication reported, pathways for pneumonia treatment resulted in $1,336 in administrative savings for a typical hospital stay and cut down lengths of stay by two days. All told, the new approach cut administrative costs for pneumonia treatment by $800,000.

Now, Flagler plans to create pathways to improve care for sepsis, substance abuse, heart attacks, and other heart conditions, gastrointestinal disorders and chronic conditions such as diabetes.

Given the success of the project, the hospital expects to expand the scope of its future efforts. At the outset of the project, Sanders had expected to use AI tools to take on 12 conditions, but given the initial success with rolling out AI-based pathways, Sanders now plans to take on one condition each month, with an eye on meeting a goal of generating $20 million in savings over the new few years, he told IHM.

Flagler is not the first, nor will it be the last, hospital to streamline care using AI. For another example, check out the efforts underway at Montefiore Health, which seems to be transforming its entire data infrastructure to support AI-based analytics efforts.

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.

Montefiore Health Makes Big AI Play

Posted on September 24, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

I’ve been doing a lot of research on healthcare AI applications lately. Not surprisingly, while people find the abstract issues involved to be intriguing, most would prefer to hear news of real-life projects, so I’ve been on the lookout for good examples.

One interesting case study, which appeared recently in Health IT Analytics, comes from Montefiore Health System, which has been building up its AI capabilities. Over the past three years, it has created an AI framework leveraging a data lake, infrastructure upgrades and predictive analytics algorithms. The AI is focused on addressing expensive, dangerous health issues, HIA reports.

“We have created a system that harvests every piece of data that we can possibly find, from our own EMRs and devices to patient-generated data to socio-economic data from the community,” said Parsa Mirhaji, MD, PhD, director of the Center for Health Data Innovations at Montefiore and the Albert Einstein College of Medicine, who spoke with the publication.

Back in 2015, Mirhaji kicked off a project bringing semantic data lake technology to his organization. The first pilot using the technology was designed to find patients at risk of death or intubation within 48 hours. Now, clinicians can also see red flags for admitted patients with increased risk of mortality 3 to 5 days in advance.

In 2017, the health system also rolled out advanced sepsis detection tools and a respiratory failure detection algorithm called APPROVE, which identifies patients at a raised risk of prolonged ventilation up to 48 hours before onset, HIA reported.

The net result of these efforts was dubbed PALM, the Patient-centered Analytical  Learning Machine. PALM “represents a very new way of interacting with data in healthcare,” Miraji told HIA.

What makes PALM special is that it speeds up the process of collecting, curating, cleaning and accessing metadata which must be conducted before the data can be used to train AI models. In most cases, the process of collecting data for AI use is largely manual, but PALM automates this process, Miraji told the publication.

This is because the data lake and its graph repositories can find relationships between individual data elements on an on-the-fly basis. This automation lets Montefiore cut way down on labor needed to get these results. Miraji noted that ordinarily, it would take a team of data analysts, database administrators and designers to achieve this result.

PALM also benefits from a souped-up hardware architecture, which Montefiore created with help from Intel and other technology partners. The improved architecture includes the capacity for more system memory and processing power.

The final step in optimizing the PALM system was to integrate it into the health system’s clinical workflow. This seems to have been the hardest step. “I will say right away that I don’t think we have completely solved the problem of integrating analytics seamlessly into the workflow,” Miraji admitted to HIA.