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Centralizing HIM Operations: An Enterprise Approach

Posted on August 15, 2018 I Written By

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

Technological advances, policy changes and organizational restructures are continuously bringing trends to the healthcare industry, specifically impacting healthcare facilities. Centralization of operations is one of those trends. Driven by a value-based model, the centralization of health information management (HIM) aims to streamline operations, standardize processes, reduce costs and improve quality of care and patient satisfaction.

Oftentimes, HIM departments operate with disparate processes due to legacy standard processes and acquisitions of new entities and are unable to efficiently integrate and access information when it is derived from multiple sources. This causes inconsistencies in processes and procedures, as well as incompleteness of information and unavoidable redundancies. Furthermore, decentralization can result in risks such as ineffective information management, inaccurate coding and breaches.

Silos of information hinder standardization, and as a result create compartmentalized pockets of information from sources, slowing down communication and making change more difficult. However, through the use of electronic HIM technology, secure information can be shared and processed across various departments and facilities at a quicker pace than ever before. Taking these efficiencies one step further, instead of siloes of information, many organizations are moving to a centralized model that can reduce operational costs by streamlining organizational performance, establishing consistent processes through standardization and eliminating redundancies.

Patient health information must be linked across the healthcare continuum to provide the best quality of care. Additionally, sources of information must be linked to electronic health records (EHRs) to support centralization and enhance patient care. To connect silos and reduce risks, healthcare facilities must centralize HIM operations to create standardization and improve coordination across the continuum of care.

Benefits of Centralization

Healthcare facilities can greatly benefit from incorporating the centralization of HIM operations into their long-term organizational plans. In fact, the benefits are greater than any hurdles encountered during the transition. Benefits include:

  1. Improves operational efficiency: Moving from a fragmented system to a model that streamlines operations improves efficiency and decreases administrative and operational costs.
  2. Eliminates redundancies and reduces errors: Helps to standardize processes, procedures and forms across a healthcare system to ensure they are the same throughout facilities.
  3. Improves financial performance: Restructuring improves productivity and efficiency as resources are centrally located, which positively impacts the bottom line.
  4. Fosters collaboration: Eliminates silos of communication that cause a stagger in the flow of information – improving communications and optimizing patient outcomes.
  5. Increases accessibility: Provides the benefit of system-wide accessibility to patient information for release purposes, such as billing and coding.
  6. Optimizes workflow: Allows opportunities to reexamine workflows for optimal efficiencies across the HIM continuum, bringing business value.

Driving Transition Towards Centralization

When an organization transitions to centralized HIM operations, it’s important that the journey be completed with the right preparation and execution. HIM professionals must establish processes that foster opportunities for consolidation and standardization that then result in reduced cost, mitigation of risk and overall improved patient care.

Prior to implementing a centralized model, HIM professionals must take certain steps into consideration:

  • Acquire an executive sponsorship to provide direction, support, budget and resolution to potential problems that may arise during the transition.
  • Establish a multidisciplinary steering committee to address centralization and your organization’s information policy, aligning resources with strategy.
  • Identify challenges, gaps, risks and opportunities while working with collaborators to achieve goals for improvements.
  • Define and establish standards, processes and procedures.

Centralization: The Decision is Yours

It is important for HIM professionals to be proactive when determining his or her organization’s vulnerabilities and address them immediately, as breaking down barriers that add risk ultimately drives down costs and improves efficiencies.

Additionally, everyone in an organization may not support the transition. However, executive sponsorship and collaboration between staff, departments and facilities is essential. To gain consensus, HIM professionals must understand the culture of the departments involved and how to leverage their individual technological capabilities.

The work of healthcare professionals is being reshaped by the centralization of HIM operations. If you’re looking to succeed during this ambiguity of change, transforming HIM to a centralized model throughout an enterprise provides healthcare facilities with a competitive advantage, as the integration of emerging technology continues to become a crucial step towards efficient, successful operations.

About Ciox
Ciox is a health technology company working to solve the clinical data illiquidity challenge by providing transparency across the healthcare ecosystem and helping clients manage disparate medical records and is a proud sponsor of Healthcare Scene. When stakeholders do not have timely access to the complete clinical picture of patients, critical decisions about patient care, medical outcomes research, disease prevention, reimbursement, and payments are sub-optimized. Ciox’s scale, expertise, expansive provider network and industry leading technology platform make it the most reliable clinical data company in the US. Through its standards based technology platform, HealthSource, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability.  Learn more about Ciox’s technology and solutions by visiting www.ciox.com

Experts Tell All: How Leaders Ensure Successful Healthcare ERP Adoption

Posted on August 9, 2018 I Written By

The following is a guest blog post by Sallie Parkhurst, Carol Mortimer, Michelle Sanders, and Heather Haugen PhD from Atos Digital Health Solutions.

According to Gartner, approximately 75% of Enterprise Resource Planning (ERP) implementations fail despite the significant opportunity for process management improvement in key business areas including human resources, payroll, supply chain management, and finance.  We gathered critical feedback from experts who have lived through hundreds of implementations across a broad spectrum of industries. Their advice was insightful!

Our discussion focused on three distinct areas where leaders should focus in order to avoid some of the common missteps of large complex implementations. That is, leaders must clearly define their strategic approach to these key business functions beyond the selection of ERP tools. This work spans the system selection and implementation phases of an ERP project. Engaging the appropriate internal experts early in the process ensures effective governance, reality in the “current state” and data accuracy.  This effort is required for the entire life cycle of an ERP.  Finally, leaders need to consider the resources, time and leadership required to continue successful adoption after implementation; this is often left until after implementation and creates significant financial surprises and resource constraints.

Clearly Defined Strategy:

  • Leadership and Communication: Most ERP systems have an impressive array of functions and options to make processes more efficient and effective. How those systems are used in your organization must be defined, communicated, and governed throughout the entire process.  The leadership team is ultimately responsible for this effort, but must consider how to best communicate and engage the entire organization to achieve the goals.  The change management effort is quite extensive and is a key predictor of success!
  • Functionality: The functionality you need should be driven based on your business needs. While this seems obvious, many organizations buy a suite of products that includes more advanced functionality than they need, functionality they can’t take advantage of because of other system constraints, or functionality that requires data from other systems they don’t have. Set the parameters for demos and consider defining the scenarios to get an accurate picture of system capabilities for your specific needs.
  • Interfaces: ERP systems can interface with many different systems ranging from clinical systems to warehouse applications. This is a great opportunity to ensure better overall integration of business processes, but don’t underestimate the work required. Ask about the cost of interfaces, maintenance required, potential impact from upgrades, and any limitations of your current systems and data specifications for accurate and efficient electronic transmission. Also, be sure to ask about any third party vendor software required during discussions involving interfaces.

Engagement of Experts:

  • Knowledge Experts: Most organizations don’t engage their internal experts early enough in the project. Involving your subject matter experts during system selection can be tricky, but it pays big dividends in the end. These experts know the current systems or manual processes, but they also know the workarounds and issues that need to be addressed. Ensure that these people are also involved in defining data tables and other “area specific” customization.
  • Document Current State: This is cumbersome work, but organizations that take the time to define their current workflows gain more efficiency and cost savings from their new ERP systems. When this step is skipped, implementations stressors (time and resources) force the new system to mimic old system processes or manual processes that degrade the overall value of the new system.
  • Competencies and Development: Your new ERP system will probably stretch your team’s competencies, and will often require additional team training. This is a great opportunity to offer growth opportunities in your organization.  It may also require hiring for specific skill sets.
  • Priorities: The toughest question a leader faces when implementing a new system is “What are we going to stop doing to ensure the success of this effort?” Give your team time to focus on and perform high quality work.

Long-Term Commitment

  • Resource commitments: Any large system capable of making dramatic improvements in efficiency and accuracy of business processes will always require an investment of time and resources after implementation. Organizations almost always underestimate the long-term investment associated with maintenance, upgrades, training, and optimization. However, organizations that commit even a few hours per week in a disciplined manner find it easy to maintain and even improve on the value they expect from their ERP.
  • Beyond implementation – achieving adoption: The difference between simply installing a system and achieving business value lies in the long-term commitment by an organization’s leaders to optimize the use of the system.

ERP tools offer a significant opportunity to better manage critical business functions, but adoption of those systems requires:

  1. A clearly defined strategy for the key ERP business functions you plan to implement;
  2. Engagement of your internal experts early and often; and
  3. Commitment of resources and funds to realize the value of your investment.

About the Authors: 

  • Sallie Parkhurst is Senior Project Manager and an expert in Finance for ERP implementations for Digital Health Solutions Consulting, Atos.
  • Carol Mortimer is Senior Consultant and an expert in Supply Chain Management for ERP implementations for Digital Health Solutions Consulting, Atos.
  • Michelle Sanders is Senior Project Manager and an expert in HR and Payroll for ERP implementations for Digital Health Solutions Consulting, Atos.
  • Heather Haugen is the Chief Science Officer for Atos Digital Health Solutions.
  • Inbal Vuletich serves as the editor for Atos Digital Health Solution publications.

What Clients Value about Atos’ ERP Solutions and Services:

  • Expertise across all ERP business functions
  • Depth of knowledge of the ERP systems and how they function in various environments
  • The combination of industry expertise and system expertise
  • Ability to solve problems and understand clients’ challenges
  • How our team cares about their problems and challenges like they are our own

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.

HCCs: An Operational Perspective – HIM Scene

Posted on August 8, 2018 I Written By

The following is a guest blog post by Cathy Brownfield, MSHI, RHIA, CCS, Chief Operating Officer, TrustHCS.

Hierarchical Condition Categories (HCCs) were mandated by the Centers for Medicare and Medicaid Services (CMS) in 1997. In 2003 HCCs were selected as a risk adjustment model to be used to determine reimbursement for Medicare Advantage Plans.  They describe chronic condition diagnoses for patients and are determined from other codes assigned during physician encounters—including ICD-10 codes, CPT codes and medication codes.

The HCC framework is progressively being applied to numerous healthcare reimbursement reform initiatives. As the shift from volume to value advances, so does the importance of accurate HCC coding. This month’s blog explains the correlation between HCC coding and value- based reimbursement.

Two HCC models prevail

There are two HCC models in use by the federal government: CMS-HCC and HHS-HCC. Both models employ a risk adjustment score to predict future healthcare costs for plan enrollees. They operate within a hierarchical structure in which the more complex diagnoses absorb and incorporate less complex, chronic conditions.

The CMS-HCC model addresses a predominantly elderly population (65 years and over) and includes more than 9,000 ICD-10 codes that map to 79 HCC codes; these numbers do change and will increase slightly in FY 2019.

The Department of Health and Human Services (HSS) maintains the HHS-HCC model, which addresses commercial payer populations and covers all ages. This system incorporates CPT and medication codes and is currently comprised of 128 HCC codes.

Relationship to risk adjusted payment programs

The following are some of the risk adjusted payment programs currently using HCCs to determine reimbursement:

  • MA – Medicare Advantage Plan
  • MSSP – Medicare Shared Savings Program (ACO)
  • CPC+ – Comprehensive Primary Care Plus (Medical Home Model)
  • Commercial – Mainly the ACA

Each of the models primarily use ICD-10 codes taken from claims data to identify individuals with serious or chronic illnesses and assign a risk factor score to each enrollee based upon a combination of the individual’s health conditions and demographic details. Each HCC has a risk factor, an individual can have multiple HCC’s and those factors add up to their overall risk adjustment factor.

According to the CMS website, “risk adjustment allows CMS to pay plans for the risk of the beneficiaries they enroll, instead of an average amount for Medicare beneficiaries. By risk adjusting plan payments, CMS is able to make appropriate and accurate payments for enrollees with differences in expected costs. Risk adjustment is used to adjust bidding and payment based on the health status and demographic characteristics of an enrollee. Risk scores measure individual beneficiaries’ relative risk and risk scores are used to adjust payments for each beneficiary’s expected expenditures. By risk adjusting plan bids, CMS is able to use standardized bids as base payments to plans.”

How to operationalize accurate HCC coding

The risk-adjustment data for these programs is based on active diagnoses. In order to ensure the information is accurate, providers must conduct face-to-face encounters with their patients and all pertinent diagnoses must be documented in the medical record on an annual basis. Accurate documentation and coding is paramount to proper reimbursement under risk adjusted programs that use HCCs.  Beyond accurate HCC coding, it is important for HIM professionals to be aware of CMS reporting and data collection methodologies when operationalizing HCCs.

Reporting considerations to know

In 2012, CMS began transitioning the Medicare Advantage Organizations (MAOs) data collection method from its original format to an Encounter Data Payment System (EDS). The data collected under the EDS is unfiltered and more detailed than EDS’s predecessor, Risk Adjustment Payment System (RAPS). While CMS has gone back and forth on which algorithm to use, a blend of 85 percent RAPS and 15 percent EDS scores is currently in place for 2018.

Data is submitted directly to CMS where filtering logic is applied to extract the valid diagnosis codes from the data. The codes are then used in the risk score calculation process. With this process, MAOs must verify the completeness and accuracy of the data submitted to CMS to ensure that all appropriate diagnosis codes have been accepted for risk adjustment by CMS.

The RAPS/EDS blend will return to a 75/25 split in 2019. Additionally, CMS is proposing to calculate the EDS risk scores amended with RAPS inpatient diagnoses. Other 2019 changes are listed below.

2019 CMS-HCC Model Changes

  • Behavioral Health Conditions
    • HCC 55 Drug/Alcohol Dependence: Add opioid (and other substances) overdose ICD-10 diagnosis codes to HCC 55
    • Add HCC 56 Drug Abuse, Uncomplicated, Excluding Cannabis, includes opioid dependence diagnoses (among other narcotics)
  • Mental Health and Substance Abuse Disorders
    • Add HCC 59 Reactive and Unspecified Psychosis
    • Add HCC 60 Personality Disorders
  • Add HCC 138, Chronic Kidney Disease Stage 3 (Moderate Only)

Role of HIM and where to learn more about HCCs

In the new frontier of value-based payment, HIM is the purveyor of accurate coding and HCC assignment for organizations and providers. Savvy HIM leaders ensure they have the most up-to-date information by monitoring the following websites and information sources:

About Cathy Brownfield
Cathy Brownfield is the Chief Operating Officer of TrustHCS. She holds over 17 years of operations, auditing and coding experience. Prior to TrustHCS, Cathy served as the Operations Director for HealthPort’s Coding Operations division overseeing scheduling, billing, and quality assurance efforts.

Cathy holds her Master of Science in Health Informatics from Arkansas Tech University. She received her Bachelor of Science in Health Information Management from the same university. Cathy is a Registered Health Information Administrator and a Certified Coding Specialist. As a member of the American Health Information Management Association she volunteers on the Coding Community Council and also the PPE work group.

Healthcare AI Adoption Curve – Where Is Your Hospital At?

Posted on July 30, 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.


The above image is the best one I’ve seen when it comes to the adoption and integration of AI into healthcare. Of course, this same chart has been used to describe the integration of technology into healthcare in general. The reason this chart is so relevant is that very few healthcare organizations have reached the point where they are an IT enabled business with IT embedded in business with hybrid, cross-functional roles. If this is true for technology in general, AI is still way out there.

In fact, the one complaint I have about this chart is that it’s missing a bubble that should say “What’s AI?” Ok, that’s a little bit of an exaggeration, but not much for many healthcare organizations. They’d more appropriately ask “How can I use AI in healthcare?” but it’s about the same point. Most aren’t there yet, but they’re going to have to get there. AI is coming and in a big way.

The good news is that most of the AI a healthcare organization will use will be embedded in the IT systems they purchase. This is why it’s so important that healthcare organizations have good vendor partners. Healthcare organizations aren’t going to enable this AI future. They’re going to partner with vendors who bring the AI to bear for them. When David Chou shared the image above, he asked the right question “What is your role as the CIO for the adoption of AI?” How many of you know the answer to that question?

If you’re not sure the answer, check out this other image and tweet that David Chou shared about using AI for automation:

I agree 100% with David Chou that if you want to start thinking about how to utilize AI, then start with repetitive tasks which can and should be automated. Take the mundane out of your healthcare providers lives. That will create some early AI wins that will help you to be able to build an AI driven culture in your organization.

Using Video Cameras in Healthcare to Improve Care

Posted on July 27, 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.

I must admit that I didn’t know exactly what I was getting into when I scheduled this video interview with Paul Baratta, Business Development Manager for healthcare at Axis Communications. However, I was intrigued by the idea that they were using thermal cameras in healthcare to detect various healthcare incidents.

The great news is that Paul Baratta really opened my eyes to a lot of possibilities for how various cameras (standard and thermal) can help a hospital work more effectively. Along with talking about the thermal cameras they’ve implemented in hospitals, we also talk about other ways that cameras can help an organization run smoother and more efficiently. Think about a video camera monitoring an IV bag. That’s cool tech. We also talk about the privacy issues related to cameras and the privacy benefits of using thermal cameras. Plus, I ask Paul about the cost and ROI of cameras and whether they’re reasonable for every size healthcare organization or not.

Needless to say, after this interview, I’m even more confident that video cameras are going to be an important part of the wired room in healthcare. To see what I mean, check out my interview with Paul Baratta from Axis Communications.

Let me know what you think of the use of video cameras in healthcare. Do you disagree with any of the comments I or Paul shared? Do you see other applications where video cameras could make a difference in healthcare organizations? Share your thoughts and ideas in the comments or on Twitter with @HealthcareScene.

If you enjoyed this video interview, be sure to Subscribe to the Healthcare Scene channel on YouTube and view the playlist of all our video interviews.

Switch From Epic To Cerner Comes With Patient Safety Questions

Posted on July 25, 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.

Here’s a story in which no health system hopes to take a lead role — the tale of a Cerner installation that didn’t go well and the blowback the system faced afterward.

On October 1 of last year, Phoenix, Az.-based Banner Health switched its Tucson hospitals from Epic to a Cerner system, a move which reportedly cost the health system $45 million.

No doubt, the hospitals’ staff and physicians were trained up and prepared for a few bumps in the road, particularly given that the rest of its peers had already gone to the process. The Phoenix-based not-for-profit, which owns, leases or manages 28 acute-care hospitals in six states, had already put the Cerner system in place elsewhere, apparently without experiencing any major problems.

But this time it wasn’t so lucky, according to an article in the Arizona Daily Star. According to the news item, there were “numerous” reports of medical errors filed with the Arizona Department of Health Services after Tucson-area hospitals in the Banner chain were cut over to Cerner.

The complaints included claims that errors were creating patient safety and patient harm risks, according to one filing. “Many of the staff are in tears and frustrated because of the lack of support and empathy [for] the consequences [to] patient care,” one stated.

Not only did the conversion lead to patient safety accusations, it also seems to have lowered physician productivity and shrunk revenue as doctors learned to use the Cerner interface. While predictable, this has to have added insult to injury.

Meanwhile, according to the paper, the state seems to come down on the side of the complainants. While hospital leaders denied there were any incidents resulting in a negative outcome for patients, “the hospital’s occurrence log for October 2017 showed numerous incidents of medical errors reported to be a result of the conversion,” state investigators reportedly concluded.

While the state didn’t fine Banner or issue a citation, it did substantiate two allegations about the conversion, the Star reported. The allegations were related to computer/printer glitches impacting patient care and an inability to reliably deliver medications and order tests as part of care for critically ill patients.

The article says that Banner responded by pointing out that it has made more than 100 improvements to the Cerner system, resulting in better workflows and greater information access for physicians and staff. But the damage to its reputation seems to have been done.

No, perhaps Banner didn’t do anything particularly wrong when it installed the Cerner platform. However, if its leaders did, in fact, lie to the state about problems it actually had, it was not a smart move. On the other hand, one of the biggest problems you can have during an EHR implementation is users who don’t want to cooperate and make it a success. It’s not hard to see users who were happy with Epic dragging their feet as they shifted to Cerner. Either way, this is an important lesson as hospitals continue to consolidate and they consider switching the EHR of the acquired hospitals.

Remote Release of Information: The Next Step in Secure and Compliant Exchange of Patient Health Information

Posted on July 18, 2018 I Written By

The following is a guest blog post by Patty Sheridan, MBA, RHIA, FAHIMA; SVP, Life Sciences at Ciox & Tarun Kabaria; Executive VP, Provider Operations at Ciox.

Across the industry, there is an influx of health information management (HIM) departments and medical groups moving their HIM operations from hospital main campuses and individual physician practices to centralized, offsite locations to gain efficiencies and make better use of valuable square footage in their facilities. For many organizations, this move began decades ago with the implementation of remote coding and/or the need to free up space for patient care.

These ‘virtual HIM” departments can be located at a separate facility, home-based office or remote vendor locations, and result from the continued adoption of electronic health records (EHR) and pressure to manage costs, offering HIM directors and practice administrators the opportunity to reorganize and form more efficient spaces and processes. Outsourcing functions, such as release of information (ROI), allows HIM staff to focus on other priorities of data governance while maximizing available space.

From a financial perspective, costs associated with regulations, staffing, printing, mailing and square footage are increasing; and in some instances, volumes of requests are increasing due to health plans, lawsuits and the portability of healthcare. Furthermore, allowable fees for releasing medical records are decreasing in some states. As a result of these rising financial pressures, healthcare providers are finding it more difficult to make ROI a profit center in their organizations.

HIM departments are experiencing additional pressures from rising health plan request volumes, requiring flexible operational solutions in order to meet the increasing demand. In a typical year, the volume of health plan requests tends to increase to the order of 20-30 percent, and this year those numbers are expected to triple. With such an influx of requests, moving to a virtual model allows for the onsite staff to be augmented with the remote team, fulfilling these large volume requests without impacting the core ROI and patient requests.

Another prevalent challenge is timeliness. With the advent of rebranding the Meaningful Use program to focus on promoting interoperability and the increase in various governmental and payor audits, timeliness of response to requests for medical records is critical and penalties for non-compliance are steep. As such, healthcare providers are reaching the point of diminishing returns in regards to managing the ROI function on their own, and in some cases, will not be able to meet the time deadlines imposed upon them to gain incentives, avoid penalties and takebacks.

These new industry influences create the need for even faster, more efficient, error-free fulfillment of medical record requests and pave the way for a new approach designed to help your organization meet this demand: Remote ROI.

The Remote ROI Process

The ROI process is a time-consuming administrative challenge for HIM professionals, requiring compliance expertise, secure and efficient technology, and a trained and knowledgeable staff. The Remote ROI process starts at your healthcare facility when requests for release of health information are received. From there, your chosen third party vendor, such as Ciox, receives the request from the hospital or practice via a mutually agreed upon, secure mechanism. Securely connected and able to access the hospital or practice EHR, an offsite ROI Specialist then reviews the requests for proper authorizations, identifies and captures the records to be released, and transmits the medical records from your facility’s EHR in an encrypted electronic format to the third party vendor’s ROI centralized processing center. The release is delivered to the requestor through an automatic print and mail process or electronically via a secured delivery method. Ciox’s process is computer-assisted using artificial intelligence and natural language processing thereby reducing turnaround time, improving patient satisfaction and ROI outcomes.

When creating your Remote ROI process, follow these three fundamental steps to ensure its success:

1. Determine the method of access to the Request Letter/Authorization received by the hospital or physician practice.

There are several mechanisms by which requests and authorizations are securely made available to Remote ROI Specialists for ROI processing. The most common methods include:

  • Requests/Authorizations are scanned into the EHR – Staff at the facility scans the requests/authorizations into the EHR. The Remote ROI Specialist accesses the EHR to view the information and begin the process.
  • Requests/Authorizations are faxed – Staff at the facility faxes the requests/authorizations to a fax-in queue provided by the third party vendor. The Remote ROI Specialist accesses the fax-in queue to view the information.
  • Requests/Authorizations are scanned and placed in a shared folder – Staff at your facility scans the requests/authorizations into a shared folder accessible by the Remote ROI Specialist at the third party vendor’s secure Remote ROI Processing Center.
  • Requests/Authorizations are automatically received via health data exchange or health information exchange.

2. Establish connectivity to the EHR to validate the authorization, review the medical records and process the request.

An acceptable baseline for securing the connection to your EHR system(s) must be established for Remote ROI. The appropriate connectivity scenario depends on the underlying technologies at your facility. When understanding which technologies are at your disposal and establishing connectivity, remember that security is key in this part of the process. Keep that in mind when selecting a third party vendor, as it’s paramount to select a company that makes the security of the exchange of protected health information a top priority. Furthermore, it’s of critical importance to select a vendor that has earned certified status for information security by the Health Information Trust (HITRUST) Alliance. The HITRUST CSF Certified Status ensures that key healthcare regulations and requirements for protecting and securing sensitive private healthcare information are met.

3. Ensure compliance standards to track when and who accessed protected health information.

As an added security effort, it’s crucial to follow compliance standards that allow insight as to who accessed patient health information and when it was accessed. To ensure maximum security, computers located at the third party’s Remote ROI processing facility should be secured utilizing encryption, anti-virus protection and web filters.

Passwords should be provided by the facility for access to their specific EHR and stored in an electronic password vault. The password vault should be linked to the third party’s directory that is only accessible by the ROI Specialist using their directory account. Third parties should provide complete audit trail capabilities to track personnel accessing the EHR and processing medical record requests from your applications.

By moving some or all of the onsite ROI functions to a Remote operation, you can streamline the ROI workflow, reclaim square footage for other purposes and have additional capacity available for request volume fluctuation. As an added benefit, the immediate access to requests and authorizations speeds turnaround times on processing requests, which is particularly important when considering tight timelines for meeting Meaningful Use and audit-related releases.

If you’re looking to make HIM operations more efficient and cost effective, Remote ROI can open the doors to achieving those goals.

About Ciox
Ciox is a health technology company working to solve the clinical data illiquidity challenge by providing transparency across the healthcare ecosystem and helping clients manage disparate medical records and a proud sponsor of Healthcare Scene. When stakeholders do not have timely access to the complete clinical picture of patients, critical decisions about patient care, medical outcomes research, disease prevention, reimbursement, and payments are sub-optimized. Ciox’s scale, expertise, expansive provider network and industry leading technology platform make it the most reliable clinical data company in the US. Through its standards based technology platform, HealthSource, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability.  Learn more about Ciox’s technology and solutions by visiting www.ciox.com

Connecting the Data: Three Steps to Meet Digital Transformation Goals

Posted on July 16, 2018 I Written By

The following is a guest blog post by Gary Palgon, VP Healthcare and Life Sciences Solutions at Liaison Technologies.

A white paper published by the World Economic Forum in 2016 begins with the statement, “Few industries have the potential to be changed so profoundly by digital technology as healthcare, but the challenges facing innovators – from regulatory barriers to difficulties in digitalizing patient data – should not be underestimated.”

That was two years ago, and many of the same challenges still exist as the digital transformation of healthcare continues.

In a recent HIMSS focus group sponsored by Liaison, participants identified their major digital transformation and interoperability goals for the near future as:

  • EMR rollout and integration
  • Population health monitoring and analytics
  • Remote clinical encounters
  • Mobile clinical applications

These goals are not surprising. Although EMRs have been in place in many healthcare organizations for years, the growth of health systems as they add physicians, clinics, hospitals and diagnostic centers represents a growing need to integrate disparate systems. The continual increase in the number of mobile applications and medical devices that can be used to gather information to feed into EMR systems further exacerbates the challenge.

What is surprising is the low percentage of health systems that believe that they are very or somewhat well-prepared to handle these challenges – only 35 percent of the HIMSS/Liaison focus group members identified themselves as well-prepared.

“Chaos” was a word used by focus group participants to describe what happens in a health system when numerous players, overlapping projects, lack of a single coordinator and a tendency to find niche solutions that focus on one need rather than overall organizational needs drive digital transformation projects.

It’s easy to understand the frustration. Too few IT resources and too many needs in the pipeline lead to multiple groups of people working on projects that overlap in goals – sometimes duplicating each other’s efforts – and tax limited staff, budget and infrastructure resources. It was also interesting to see that focus group participants noted that new technologies and changing regulatory requirements keep derailing efforts over multi-year projects.

Throughout all the challenges identified by healthcare organizations, the issue of data integrity is paramount. The addition of new technologies, including mobile and AI-driven analytics, and new sources of information, increases the need to ensure that data is in a format that is accessible to all users and all applications. Otherwise, the full benefits of digital transformation will not be realized.

The lack of universal standards to enable interoperability are being addressed, but until those standards are available, healthcare organizations must evaluate other ways to integrate and harmonize data to make it available to the myriad of users and applications that can benefit from insights provided by the information. Unlocking access to previously unseen data takes resources that many health organizations have in short supply. And the truth is, we’ll never have the perfect standards as they will always continue to change, so there’s no reason to wait.

Infrastructure, however, was not the number one resource identified in the HIMSS focus group as lacking in participants’ interoperability journey. In fact, only 15 percent saw infrastructure as the missing piece, while 30 percent identified IT staffing resources and 45 percent identified the right level of expertise as the most critical needs for their organization.

As all industries focus on digital transformation, competition for expert staff to handle interoperability challenges makes it difficult for healthcare organizations to attract the talent needed. For this reason, 45 percent of healthcare organizations outsource IT data integration and management to address staffing challenges.

Health systems are also evaluating the use of managed services strategies. A managed services solution takes over the day-to-day integration and data management with the right expertise and the manpower to take on complex work and fluctuating project levels. That way in-house staff resources can focus on the innovation and efficiencies that support patient care and operations, while the operating budget covers data management fees – leaving capital dollars available for critical patient care needs.

Removing day-to-day integration responsibilities from in-house staff also provides time to look strategically at the organization’s overall interoperability needs – coordinating efforts in a holistic manner. The ability to implement solutions for current needs with an eye toward future needs future-proofs an organization’s digital investment and helps avoid the “app-trap” – a reliance on narrowly focused applications with bounded data that cannot be accessed by disparate users.

There is no one answer to healthcare’s digital transformation questions, but taking the following three steps can move an organization closer to the goal of meaningful interoperability:

  • Don’t wait for interoperability standards to be developed – find a data integration and management platform that will integrate and harmonize data from disparate sources to make the information available to all users the way they need it and when they needed.
  • Turn to a data management and integration partner who can provide the expertise required to remain up-to-date on all interoperability, security and regulatory compliance requirements and other mandatory capabilities.
  • Approach digital transformation holistically with a coordinated strategy that considers each new application or capability as data gathered for the benefit of the entire organization rather than siloed for use by a narrowly-focused group of users.

The digital transformation of healthcare and the interoperability challenges that must be overcome are not minor issues, nor are they insurmountable. It is only through the sharing of ideas, information about new technologies and best practices that healthcare organizations can maximize the insights provided by data shared across the enterprise.

About Gary Palgon
Gary Palgon is vice president of healthcare and life sciences solutions at Liaison Technologies, a proud sponsor of Healthcare Scene. In this role, Gary leverages more than two decades of product management, sales, and marketing experience to develop and expand Liaison’s data-inspired solutions for the healthcare and life sciences verticals. Gary’s unique blend of expertise bridges the gap between the technical and business aspects of healthcare, data security, and electronic commerce. As a respected thought leader in the healthcare IT industry, Gary has had numerous articles published, is a frequent speaker at conferences, and often serves as a knowledgeable resource for analysts and journalists. Gary holds a Bachelor of Science degree in Computer and Information Sciences from the University of Florida.

Rate Of Healthcare Ransomware Attacks Falls In First Half of 2018

Posted on July 12, 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.

Most research I’ve read lately suggests that the rate of healthcare cyberattacks is at an all-time high, and that ransomware is leading the parade.

But is that really true? Maybe not. A new security report has concluded that the rate of ransomware attacks on healthcare organizations actually fell during the first half of this year, and what’s more, that such attacks trended lower during the same period.

The study, which comes from security firm CryptoniteNXT, notes that cybercriminals target healthcare because they can fetch great prices for the data by reselling it on the dark web. Also, given the complexity of healthcare networks and the high number of vulnerabilities in those networks, thieves see providers as a fat and easy target.

However, when it comes to ransomware, the landscape may be changing. CryptoniteNXT found that the number of ransomware attacks impacting over 500 patient records dropped from 19 major data breaches in the first half of 2017 to 8 major breaches in the first half of 2018. That’s an impressive 57% decrease.

The biggest reported records IT/hacker-driven breach hit LifeBridge Health, affecting 538,127 individuals. Other organizations targeted included academic medical centers, medical practices, ambulatory surgical centers, health plans and government agencies.

Meanwhile, the rate of ransomware attacks as a percentage of IT/hacking events has fallen substantially, from 30.16% during the first half of 2017 to 13.6% during the first half of this year.

On the other hand, the volume of patients affected has climbed. Roughly 1.9 million patient records were breached in the first half of this year, compared with 1.7 million records the first half of 2017 and 1.8 million records the second half of that year, it concludes.

Also, the report notes that ransomware attackers are far from done with the industry. The authors say that ransomware will still pose a “formidable threat” to healthcare organizations and that new variants such as AI-based malware will pose a major threat to healthcare organizations for the next couple of years.

To fend off hacking attacks, CryptoniteNXT recommends adopting new best practices such as moving target cyber defense and network micro-segmentation, which can address the inherent weakness of TCP/IP networks.

Approaches For Improving Your HCAHPS Score

Posted on June 27, 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.

Improving your HCAHPS scores gets easier if you make smart use of your existing technology infrastructure. To make that work, however, you have to know which areas have the greatest impact on the score.

According to healthcare communications vendor Spok, hospitals can boost their scores by focusing on five particularly important areas which loom large in patient satisfaction. Of course, I’m sure these approaches solve problems addressed by Spok solutions, but I thought they were worth reviewing anyway. These five areas include:

  • Speed up response to the call button
    Relying on the call button itself doesn’t get the job done. If calls go to a central nursing station, it takes several steps to eventually get back to the patient, it’s possible to drop the ball. Instead, hospitals can send requests directly from the call button to the correct caregiver’s mobile device. This works whether providers use s a Wi-Fi phone, smartphone, pager, voice badge or tablet.
  • Lower the noise volume
    Hospitals are aware that noise is an issue, and try everything from taking the squeak out of meal cart wheels to posting signs reminding all to keep the conversations quiet. However, this will only go so far. Spok recommends hospitals take the additional step of integrating the monitoring of equipment alarms with staff assignments systems, and as above, routing nurse call notifications to the appropriate patient care providers mobile device. Fewer overhead notifications means less noise.
  • Address patient pain faster
    To help patients with the pain as quickly as possible, give staff access to your full directory, which allows nurses to quickly locate provider contact information and reach them with requests for pain medication orders. In addition, roll out a secure texting solution which allows nurses to share detailed patient health information safely.
  • Make information sharing simpler
    Look at gaps in getting information to patients and providers, and streamline your communications process. For example, Spok notes, if communication between team members is efficient, the time between a test order and the arrival of the phlebotomist can get shorter, or the time it takes the patient transport team to bring them to the imaging department for a scan can be reduced. One way to do this is to have your technology trigger automatic message to the appropriate party when an order is placed. Also, use the same to approach to automatically notify providers when test results are available.
  • Speed up discharge
    There are many understandable reasons why the patient discharge process can drag out, but patients don’t care what issues hospitals are addressing in the background. One way to speed things up is to set up your EMR to send a message the entire care team’s mobile devices. This makes it easier for providers to coordinate discharge approval and patient instructions. The faster the discharge process, the happier patients usually are.

Of course, addressing the patient care workflow goes well beyond the type of technology hospitals use for coordination and messaging. Getting this part of the process right is a good thing, though.