Hoping for a deadline extension, many physician practices are behind. Instead they should be highly focused on the transition from ICD-9 to ICD-10 code sets, says one expert.
With so many challenges and changes coming at physician practices, it can be hard to know where to focus attention. Healthcare reform is reshaping the way healthcare is provided and paid for it, and one of the most fundamental changes involves coding.
Physician practices should be highly focused on the transition from ICD-9 to ICD-10 code sets, says Peggy Stilley, CPC, CPMA, CPC-I, COBGC, ACS-OB, director of audit services with the AAPC in Salt Lake City. Stilley also is part of the AAPC’s ICD-10 Curriculum Training Team, which assists physician practices in switching from the current set of 14,000 codes to over 69,000 codes.
In August 2012, HHS released a final rule that officially delayed the ICD-10 compliance date until October 1, 2014, but CMS more recently warned that physicians should not count on any more delays. That means now is the time to get in gear for the transition, Stilley says.
“I’ve seen it all over the board at this point. Some are right on target with where they should be, and we have some practices that have just begun putting their teams together, assessing their policies and procedures to see where the effect of ICD-10 may be for them,” Stilley says.
“You have to start there because there are so many systems in use even by the smaller practices, and all of those systems have to talk to each other with the new ICD-10 codes. When you get to implementation, how will you ensure that all these systems are talking to one another the way they are supposed to?”
That integration of disparate systems is proving to be one of the biggest challenges for physician practices, Stilley says.
A tongue-in-cheek Article from the Atlantic dated July 10, 2013
Simply eliminate the human element, and costs will plummet toward zero.
Hark, a new age dawns in healthcare! No longer must we tolerate long waiting times for a doctor appointment or service in the hospital emergency room. No more will we suffer inequities in access to healthcare. Relentlessly climbing healthcare costs will become a thing of the past. Herald instead a brave new world, in which cutting-edge information technology will solve once and for all the core problems that have plagued US healthcare for decades.
Just as the MOOC (Massive Open Online Course) has revolutionized education at all levels, so the MOOH (Massive Open Online Healthcare) is about to revolutionize the nation’s healthcare system, putting out of work most of the businesspeople, politicians, and pundits who have for so long profited from its afflictions. At last, we stand on the threshold of not just “the next big thing” in medicine, but the final and biggest thing of all.
The MOOC was born in 2008, when prophets of the new information technology finally realized that the real purpose of pedagogical accessories such as teachers and classrooms is educational content delivery. The MOOH is emerging just five years later, as healthcare leaders finally realize that the real purpose of physicians and hospitals is merely to deliver medical content. To achieve massive increases in efficiency, we simply need to get rid of most teachers and physicians.
Consider the following analogy. In the old days, people contracted infectious diseases such as measles or smallpox, which often left their victims permanently scarred or even dead. Then onto the scene burst vaccination, from the Latin for cow, because the first vaccination was derived from cowpox. Suddenly, people no longer contracted such diseases. The MOOH does the same thing — transforming medical care from a highly labor-intensive, expensive process into an efficient type of inoculation.
Article from HealthLeaders Media posted July 11, 2013
The administrative burden of being a physician continues to fuel discontent among doctors. More than a third report having a negative outlook for the profession, and the majority would not recommend it as a career choice.
Nearly 60% of physicians wouldn’t recommend the profession to young people, a survey shows.
The various sources of the doctors’ discontent include decreased autonomy, lower reimbursements, administrative and regulatory hassles, corporate medicine, litigation fears, and longer work hours, much of which has meant that they’re spending too much time away from patients.
Looking ahead, 36% of the 3,456 physicians who responded to a survey conducted this spring by Atlanta-based physician staffers Jackson & Coker reported a negative outlook for the profession, while 16% were favorable and 48% cautious.
“What we have begun to find is that pretty much across the board the physicians are becoming a little disenchanted with the business of medicine,” says Edward McEachern, vice president of marketing Jackson & Coker.
“Not the practice of medicine, but the business of medicine, because of this overwhelming administrative burden that is very difficult for them to work through and still practice good patient care medicine. It’s to the point where we ask ‘would you be willing to recommend the medical career as a position to the younger generation’ and for the first time we’ve really begun seeing them not recommend it.”
Article from HealthLeaders Media posted July 9, 2013
New federal guidelines aim for electronic health record systems to be used in a way that improves care and patient safety, and to ensure that system designs don’t make certain types of errors more likely to happen.
Providers will make fewer medical errors that can harm patients—at least in theory—after implementation of a federal health IT safety plan unveiled this month. The plan recommends prohibitions of so-called vendor contract gag clauses and says demonstration of electronic health record systems’ safety features should be a prerequisite for certification.
The 10-point plan, issued by the Office of National Coordinator for Health IT, seeks to resolve problems highlighted in the Institute of Medicine’s November, 2011 report, Health IT and Patient Safety: Building Safer Systems for Better Care, by allowing electronic health record system users to report on problems using the Common Formats protocol, under development by the Agency for Healthcare Research and Quality.
“Health information technology enables substantial improvements in health care quality and safety, compared to paper records,” the ONC said in a fact sheet accompanying release of the plan. “Yet health IT can only fulfill its enormous potential if risks associated with its use are identified, if there is a coordinated effort to mitigate those risks, and if it is used to make care safer.”
The 50-page report’s two main purposes are to use electronic health records in a way that improves care and patient safety, and to make sure electronic health record and computerized physician order entry system designs don’t make certain types of mistakes more likely to happen.
Errors in patient care, attributed to electronic health record systems used in emergency departments, are “incredibly common,” says a researcher. But vendor contracts prevent physicians from speaking publicly about problems with the systems.
Patients are being subjected to treatment mistakes and harm because of design problems in electronic health record systems now being rolled out in the nation’s emergency rooms. But emergency department doctors are powerless to correct these flaws because of gag clauses that prohibit them from publicizing the issues.
Those are among several key findings in a report released Monday by 15 members of an American College of Emergency Physicians [PDF] panel who say hospital administrators have rushed to buy systems from major EHR vendors to get incentive payments without considering the ED.
When inpatient systems are introduced to different emergency room processes, emergency physicians’ input is not sought in advance, leading to major functional problems impeding good care.
Asked if emergency room electronic health record errors cause frequent errors in patient care and even harm, Jesse Pines, MD, Office for Clinical Practice Innovation director at George Washington University and the report’s senior author, replied:
From article posted on InformationWeek June 17, 2013
The average patient can’t fathom why the sharing of electronic medical records is so hard. But those inside healthcare aren’t thrilled either with the state of electronic record interoperability, as several smart discussions at this week’s Digital Healthcare Conference in Madison, Wis., showed.
“If we’re this far into this implementation across the country, and we still have this level of discordance, shame on us,” said Dr. Frank Byrne, president of Wisconsin’s St. Mary’s Hospital. “How did we get here and how do we get out? Because we’ve created barriers.
Epic CEO and founder Judy Faulkner highlighted some of the obstacles to data sharing, from patients wanting to control such sharing, to difficulty training clinicians, to the many technical challenges. While data-definition standards in theory should make sharing easier, “the standards are only describing a very, very small subset of the data that’s really there,” Faulkner said.
Here are a few of the broad questions about interoperability discussed at the DHC 2013 event, with input drawn from several speakers and sessions. What’s missing? Share your thoughts in the comments below.
Q: Shouldn’t data standards allow easier sharing across vendor systems?
From June 10, 2013 article on InformationWeek web site.
While some companies still lag behind, EHR vendors are moving rapidly to enable their mobile products with speech recognition, either directly or through third-party interface vendors.
In the first category is Cerner, which just last month integrated Nuance Communications’ speech recognition product with its ambulatory mobile EHR for iPads, according to Jon Dreyer, director of mobile solutions marketing for Nuance. In an interview with InformationWeek Healthcare, Dreyer added that in January, Epic embedded Nuance in its latest mobile EHRs for the iPhone and iPad.
Allscripts, which voice-enabled its Sunrise inpatient mobile EHR some time ago, doesn’t yet have speech in its Wand ambulatory EHR. But an Allscripts spokesperson told InformationWeek Healthcare that Wand will be integrated with the MModal and Apple Siri voice recognition applications later this summer.
Other major companies are also using third-party vendors to provide an iPad-native front end that includes speech recognition to their EHRs. For example, Dreyer said, Nuance is integrated with Iconx, which makes a mobile interface for NextGen, and with MedMaster Mobility, which does the same for Greenway.
Small independent vendors have also built speech-enabled mobile EHRs for certain specialty areas, such as emergency departments, urgent care centers, and dermatology. For example, Nuance is embedded in Sparrow EDIS, Montrue Technologies’ ED-specific iPad application, and Touch Medix’s Lightning Charts, also designed for the ED. Modernizing Medicine and EZDerm have devised mobile EHRs specifically for dermatologists.
Fewer than 1 in 10 doctors used electronic records last year to U.S. standards, according to a survey that shows the challenge facing a multibillion-dollar effort to digitize the health system for improved patient care.
Only 9.8 percent of 1,820 primary-care and specialty doctors said they had electronic systems that met U.S. rules for “meaningful use,” a list of tasks such as tracking referrals or filling prescriptions online. Less than half all those surveyed, or 44 percent, had any system in place, according to the report published by the journal Annals of Internal Medicine.
The Obama administration has spent about $15 billion since 2009 to help doctors and hospitals adopt electronic health records, fueling growth for vendors such as McKesson Corp. (MCK) and Cerner Corp. (CERN) In March, the administration said it was considering new regulations, amid complaints that the systems are hard to use and don’t share information easily.
The survey “ should be of concern to policy makers,” said the authors, led by Catherine M. DesRoches of Mathematica Policy Research Inc. in Cambridge, Massachusetts. “Significant progress needs to be made before such systems are believed to be usable by most physicians.”
The researchers surveyed the physicians from late 2011 through early last year. A third or less had an electronic system for tracking referrals, generating reports on quality of care, sending patients reminders for preventive or follow-up meetings or generating lists of those who had missed appointments or were overdue for care.
From article in >InformationWeek, May 28, 2013
A new study argues that some doctors make only minimal use of electronic health records (EHRs) not because they’re Luddites, but because their style of practice “absorbs” clinical uncertainty rather than trying to minimize it through the use of IT. If this is true, the widespread adoption of EHRs may not change how some doctors diagnose and treat patients.
The study, which was published in the Journal of the American Medical Informatics Association (JAMIA), used interviews and direct observations of 28 physicians in a Texas multispecialty group to explore the reasons why some doctors used the practice’s EHR more than others did. The researchers showed that the physicians’ perceptions of uncertainty in caring for their patients were correlated with how they used the EHR.
For the uninitiated, uncertainty is a universal attribute of medical practice, not a sign of an incompetent clinician. Good evidence supports less than half of what doctors do, and there are many clinical situations in which they don’t know what they’re confronting or, even if they do, what they should do about it.
Based on their observations and interviews, the researchers divided the Texas doctors into three categories: reductionists, who believed that the more structured data they recorded in the EHR, the less uncertainty they had and the better the care they were providing; absorbers of uncertainty, who spent more time conversing with patients and less time documenting information; and hybrids, who exhibited characteristics of both reductionists and absorbers.
“The distinguishing factor in categorizing physicians as uncertainty reducers was their overarching focus on information as the key driver of uncertainty management,” the study said. Lead author Holly J. Lanham, assistant professor of medicine/hospital medicine at the University of Texas Health Science Center San Antonio<, told InformationWeek Healthcare that this was partly because these doctors thought that their documentation would help other providers caring for the same patient.
This article appears in HealthLeaders Media, May 16, 2013
Music at loud decibels can contribute to miscues among surgeons and nurses in the operating room, raising the risk of medical error, researchers say.
Operating rooms are noisy places. There’s mechanical noise from whirring drills, beeping and humming from vital sign monitors, and whooshing sounds from fans and suction devices. Those sounds are largely unavoidable.
But then there’s human noise, from conversations, doors opening and closing, the clanging of team members handling instruments and equipment, and, of course, the sound of whatever songs the team wants to hear.
Now, a study is suggesting that all that noise could contribute to miscommunication that leads to errors or issues in patient safety, says Matthew Bush, MD, and colleagues from the University of Kentucky, Lexington.
Their project, described in an article this week in the Journal of the American College of Surgeons, exposed 15 volunteering surgeons to varying levels of noise from conversations, machinery and other operating room sounds. They found that the louder the noise, the less the surgeons were able to discern sentences accurately. When the doctors were asked to complete tasks simultaneously, their ability to hear accurately declined even further.
The music—Beatles tunes played at 74.2 decibels—was louder than normal conversational sound of about 60 db. But, Bush says, it was loud enough that “you’d have to raise your voice to be heard over this environment.”
Factor in that auditory ranges for operating room staff may be diminished by age or damage from occupational or environmental exposure, and the risk for miscommunication increases.