2011 Nevada Health Care Forum, Oct 11th

It'll be a full and an interesting day, no doubt. I attended last year, and wrote about it in my October 13th, 2010 blog update (scroll down).

My CEO Marc Bennett (pdf) will be on the HIE panel. I've known Marc since 1993. He just exudes comprehensive knowledge.

This year I'll take my good camera. Stay tuned, more to come...
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JUST IN

ONC, Health 2.0 launch popHealth app challenge
October 10, 2011 | Mary Mosquera

The Office of the National Coordinator for Health IT and the Health 2.0 entrepreneurial organization have opened a contest for developers to innovate with the popHealth tool beyond its reporting functions so healthcare providers can learn more about their patient populations and improve their care.

popHealth is an open source reference implementation software service that can automate the calculation and reporting of the ambulatory care clinical quality measures in stage one of meaningful use. Its data gathering and calculation capabilities make it easier for providers to discern trends in patient populations...
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ICD-10 And Meaningful Use Dominate AHIMA 2011
October 11, 2011, Ken Congdon, editor in chief, Healthcare Technology Online

Last week marked the 83rd annual American Health Information Management Association (AHIMA) convention. This year's event was held in Salt Lake City, and attendance seemed a bit lighter this year than in years' past — perhaps the result of fiscal cautiousness given our struggling economy. However, one contingent of the AHIMA membership community was at the conference in full force — coders. This attendance, no doubt, was heavily influenced by the upcoming transition from ICD-9 to ICD-10 code sets scheduled to take place in October 2013. ICD-10 will increase the sheer number of codes by nearly five times — from 14,000 to almost 70,000 — and changes the format of codes overall. For example, an ICD-9 code could only be up to five characters in length, where an ICD-10 code can be up to 7 characters long. These changes require upgrades to coding software and supporting backend systems, as well as significant change management on the part of the coding community. As expected, a number of ICD-10 solutions and services were on display in the AHIMA 2011 Exhibit Hall geared toward helping healthcare facilities meet these new coding requirements...

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THIS IS A GROANER

Law firm loses hard drive with patient records
Attorneys represent St. Joseph cardiologist sued for malpractice
By Tricia Bishop, The Baltimore Sun
8:31 p.m. EDT, October 10, 2011

A Baltimore law firm lost a portable hard drive containing information about its cases, including medical records for 161 stent patients suing cardiologist Dr. Mark G. Midei, a firm client, for alleged malpractice at St. Joseph Medical Center in Towson.

The drive was lost Aug. 4 by an employee of Baxter, Baker, Sidle, Conn & Jones who was traveling on the Baltimore light rail, according to a letter obtained by The Baltimore Sun that was sent to one of the stent patients last week — two months after the drive went missing.

The storage device held a complete back-up copy of the firm's data, including medical records related to the stent malpractice claims, along with patient names, addresses, dates of birth, social security numbers and insurance information...

...But it's unclear if the law firm would be covered by the medical record privacy law, the Health Insurance Portability and Accountability Act, commonly known as HIPAA. The incident may have exposed a loophole, said Marc Rotenberg, executive director of the Electronic Privacy Information Center in Washington and an adjunct professor at Georgetown University Law Center.

HIPAA regulates the protection of patient information by "covered entities" — providers of health care or health plans and data management companies. But malpractice attorneys aren't expressly mentioned.

"Under HIPAA, covered entities have an affirmative obligation to encrypt" data, Rotenberg said, adding that it "may be the case that a law firm is not a covered entity." He called the lost drive a "serious issue, particularly considering the sensitivity of medical information" and said that situation could pose a "problem for the firm, because people might say they were being negligent."...
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More to come later. I'm off to the Nevada Health Care Forum.

POST-FORUM NOTES


Above: The calm before the storm. I got there early. Below, the crowd filled in. Nice turnout.

Above, my CEO, Marc Bennett, on the HIT/HIE panel.

Below, presentation of the day. The Mayo Clinic. Dr. Swensen: "Half of what we spend every year nationally on health care is recoverable waste."


Throw it down, Sir! You are not alone.

Indeed.

ThedaCare by any other name. Regarding which I've been harping for quite some time.

Above, also from the Mayo Clinic presentation. Something to do with IQ. I'm not kidding (more to follow on that slide, lol). I hope we can get copies of his presentation deck.

Below, a lunch break presentation from the Green Valley High School Choir. Very, very nice.


Met a lot of cool people today.

More to come. Tired tonight. Both me and my new shelter rescue puppy.

Carlos. Woof.
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ACOs?

There was much discussion at the Forum regarding the potential viability of "Accountable Care Organizations" (and a lot of hedging; justifiably so). Apropos of the subject, from AmedNews:

ACOs face steep funding shortfall, learning curve
A survey says there's "still a lot of confusion" about accountable care organizations and a lack of resources dedicated to them.
By VICTORIA STAGG ELLIOTT, amednews staff. Posted Oct. 11, 2011.

A majority of hospitals, medical centers and physician groups are developing accountable care organizations, but few have dedicated the resources necessary to build one successfully.

An understanding of how this part of health system reform works is sometimes lacking, according to the Accountable Care Organization Readiness Study released Sept. 21 by the management consulting firm Beacon Partners in Weymouth, Mass.

The Patient Protection and Affordable Care Act states that accountable care organizations for Medicare beneficiaries will launch on Jan. 1, 2012. On March 31, the Centers for Medicare & Medicaid Services issued a proposed rule on ACOs. A final rule is under development.

Beacon queried about 200 executives at hospitals, academic medical centers, ambulatory clinics and physician practices during the summer. About 92% were in the planning stages of an ACO, and 30% said they had an operational ACO.

Although significant work is required to create an ACO, the survey found that few health systems were devoting sufficient resources to establish one. CMS has estimated that an ACO will take $1.8 million to launch and run. The American Hospital Assn., however, has data indicating that $11.6 million to $26.1 million is needed to operate an ACO...
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There was also a lot of Forum discussion on the likely outcomes and impacts of the current SCOTUS challenges to the PPACA ("Obamacare"). No one, however, noted that ACOs are legislatively established by the PPACA -- Section 3022, to be precise.


I also find it noteworthy that ACO activity is to commence this coming January 1st, yet we still have no operationally governing CFR Final Rule.

Moreover, should the law be struck down in toto, the ACO piece goes down with the ship, I would think.

BobbyG's 15 second Photoshop musing.

OK, BELOW, WHAT WILL BE THE UPSHOT OF THIS NEWS?

Health information technology: Incentives may not always serve intended purpose

Survey suggests some awards are going to doctors who have been using electronic health records for years
By Josh Israel and Kimberly Leonard

About half of the first batch of federal dollars meant to encourage doctors and hospitals to switch to electronic records went to providers who were converts to the technology long before the stimulus program was announced, an iWatch News analysis suggests.

The analysis could raise questions about whether the government will be able to meet its goal of widespread adoption of health information technology. While these early numbers are hardly conclusive, they suggest that a large swath of payments intended to be an incentive for new adoption of electronic health records are merely rewarding health providers for minor adjustments to systems they have had in place for years...
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Well, yeah, the "low hanging fruits," 'eh?

THIS IS PAINFULLY FUNNY

I recently receive a letter from another specialist I had occasion to consult. It was an excellent evaluation, clearly dictated, and in a style not yet of the computer-generated boilerplate type that is becoming commonplace now that the electronic medical record is taking hold...

Click the image for the link.
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NICE HIE BLOG FIND


Very smartly presented, clean, well-organized, and easy to navigate. Great resource. I put them in my blogroll. Click the banner to check it out.

GREAT NEW HIE ARTICLE


Excerpt from the full AHIMA Journal article (original link here):

Legal Considerations in Joining an HIE
By Chris Dimick
…
State Law versus HIPAA
Another legal HIE issue comes when state law is more strict than HIPAA when it comes to exchanging and releasing medical records. This especially comes into play with state laws centered on protecting specially protected records like substance abuse and HIV/AIDS data.

Typically the trained HIM professional is responsible for dissecting a record request by a neighboring state and reconciling the two state laws. But when requests come from unfamiliar states, HIM professionals need to carefully consider the two states’ laws and decide what is legal to send through the HIE. EHR systems complicate matters as currently most cannot truly segregate all parts of a person’s record that fall into a certain protective category. An HIM professional can pull complete protected records, but usually hints to things like mental health and disease are viewable in other sections of the record, like medication history. HIV treatment records could be blocked, but an HIV drug cocktail on the medication list might get sent unnoticed.

“When I transmit the medication history for a patient, I probably have not weeded out those medications that are only related to the individual’s treatment for their mental health illness,” Egan says. “That is the sort of crossover that folks really have to sit down and figure out how they are going to do that.” There are two current solutions to this legal risk. An organization can over-block records, excluding everything with a diagnosis code related to the specially protected information. Or an organization can stretch their patient consent document to cover multiple years and include consent for exchanging specially protected information in an HIE. “That is harder on the lawyer side because you are really stretching the knowing consent into ‘I agree that you can release this for anything that might come up in the next couple of years,’” Egan says. “That is a little bit of a harder case.”

Intellectual Property Rights
Sometimes more than just a patient’s record gets exchanged during health information exchange, like intellectual property. Business processes, database details, facility-developed patient data, and software details can all be revealed when an organization exchanges data through an HIE…

Malpractice
The use of an HIE, or lack thereof, could lead to lawsuits in the future. While no cases have been filed yet, Egan and Orth see the potential for malpractice lawsuits being filed if a provider had access to vital information through an HIE but failed to review the information.

In the past record transfers have not been immediate enough to constitute a lawsuit stemming from a provider not accessing an exchanged record. But as HIEs improve their processes and speed up their delivery, malpractice suits could appear. Facili- ties would need to modify their practice procedures to ensure staff has checked whether there is further relevant information about each patient by way of an HIE... [pp 62-64]

I am sort of the Office Crank on the topic of "obtaining consent" (see prior posts). Nice to see this.
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A SHOUT-OUT TO ONE OF MY COLLEAGUES

Fern Percheski, our resident Sensei of All Things Grant Related, is one of the authors (Chapter 9) comprising this book just released and now available on Amazon.


Click the book cover image. Fern and I go back to my first stint with HealthInsight in the early 1990's. She is the best.

Oxford University Press, 'eh?