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September 2008 — Vol. 3, No. 9

In This Issue

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The Digital Office is a monthly online newsletter published by the Healthcare Information and Management Systems Society (HIMSS).
Copyright© 2008 by the Healthcare Information and Management Systems Society.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission. Contact HIMSS Publications at 230 E. Ohio St., Suite 500, Chicago, IL 60611; 312-915-9237; jlofstrom@himss.org
HIMSS Healthcare Information Systems Initiative
Patricia Wise, RN, MSN, MA
Colonel, USA Ret'd
Vice President, Healthcare Information Systems, HIMSS
For more information on the HIMSS ambulatory initiative, contact Mary P. Griskewicz, MS, FHIMSS, Senior Director, Ambulatory Information Systems, HIMSS, mgriskewicz@himss.org or 203-421-8317
For information on The Digital Office
Joyce Lofstrom, MS, APR
Senior Manager, Corporate Communications, HIMSS
jlofstrom@himss.org/312.915.9237


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From the editor...

This edition of the Digital Office looks at the patient…what patients want in healthcare, how they find the type of care and information needed, and who can provide that quality care for patients in our ever-evolving world of healthcare.

You’ll find answers to those questions in the articles that follow, a selection of shorter stories on activities at HIMSS and throughout the industry.

Physicians and office managers should review the DOQ-IT (Doctor’s Office Quality Information Technology) University Partnership article to learn more about this partnership between the federal government and other healthcare organizations throughout the country to provide an ongoing eLearning opportunity. This isn’t a new resource – it was introduced in 2007 – but it is one that is consistently updated with new and relevant information. Courses include Care Management, for patients with chronic disease, or an EHR Adoption course that can help guide you through the implementation of the electronic medical record.

In this election year, improving patient care and answering the consumer call for equitable healthcare and health insurance is on everyone’s mind. U.S. Rep. John D. Dingall (D-MI) presents his perspective in 2009 Will Bring New Opportunities for Health Reform. This article first appeared in the HIMSS enewsletter, the Pulse on Public Policy.

You will find lots of opportunities to be part of HIMSS’ efforts to move forward the adoption of health IT in the News Briefs section of the newsletter. Be sure to take a minute to review.

And finally, learn how an ambulatory clinic at Rosalind Franklin University Health System in North Chicago, Ill. overhauled its ambulatory claims operation – and improved its bottom line – with new technology in our Already There…Implemented Health IT column.

We are always interested in your feedback on and ideas for the Digital Office. Send your comments to jlofstrom@himss.org at any time.

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DOQ-IT University Partnership

Readers of the Digital Office may know about the DOQ-IT University, an interactive, Web-based tool designed to help guide solo and small-to-medium sized physician practices in the adoption and implementation of electronic health records (EHRs) and care management practices. But this information is worth repeating here to provide readers with a reminder that can help streamline and improve the transition from paper to digital patient records.

Care Management Tools
DOQ-IT University

DOQ-IT University, launched by the Centers for Medicare & Medicaid Services (CMS) in 2007, is a free, nationally available elearning system. DOQ-IT University is updated frequently with new content reflective of the current health care environment. Each DOQ-IT University course is organized to guide the user through a series of modules that include tools to use to manage the practice, links to evidence-based guidelines, and patient resources. Visit DOQ-IT University.

Focus on Care Management

The Care Management course of DOQ-IT University offers methods for working with patients with chronic illness -- as well as suggestions for workflow redesign in the physician office, use of health information technology (HIT), and a broader utilization of staff skills and interests -- to help the primary care practice work more efficiently and effectively.

Care management content includes:

Features include:

Focus on the Electronic Health Record

Implementing an electronic health record is a significant project that can bring great benefit to a practice and help improve care management.

DOQ-IT University’s course in EHR Adoption guides you through:

  1. Assessing the readiness of your practice for an EHR
  2. Preparing your practice for a successful EHR implementation
  3. Selecting a vendor that best meets your practice needs
  4. Redesigning core office workflow processes using EHR technology
  5. Evaluating EHR implementation and optimizing office workflows

For more information on DOQ-IT University, contact LuAnn Kimker, manager care management of Masspro at LKimker@maqio.sdps.org.

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2009 Will Bring New Opportunities for Health Reform

Rep. John D. Dingell (D-MI)  

In many ways, our health care system is the best in the world. Yet too many Americans do not have access to quality care, and many who have access still face financial ruin due to inadequate coverage. It’s nothing short of a disgrace that here, in the world’s wealthiest country, 47 million people are without health coverage. Nearly nine million of them are children. Most adults without health insurance are working full-time, but have jobs that do not provide insurance.

Unfortunately, for nearly eight years our President has done little to help the growing pool of uninsured and underinsured Americans. And this Administration has fought nearly every effort to improve or extend coverage for our youngest, oldest, poorest and most vulnerable.

In 1993, the last time our country launched a serious reform effort, health care spending was 14 percent of our GDP. Today it’s nearly 17 percent.  Annual insurance premiums for a family of four now average more than $12,000. Half of all bankruptcies in our country are the result of medical expenses.

Our current health care system isn’t just morally indefensible, it's also economically untenable. Some of our largest corporations simply can’t compete with foreign companies based in countries with universal health care.

It’s been sixty years since President Truman issued the first call for a national health care plan. In 1942, my father, John Dingell, Sr., tried to answer Truman’s call by introducing the National Health Insurance Act in the House of Representatives. And I have carried on Pop’s work, opening each Congressional session by introducing a bill to provide every American with health insurance.

Though we have not moved forward as far or as quickly as I would have liked, we have made significant progress, chiefly by creating programs such as Medicare, Medicaid and SCHIP. These programs have allowed millions of Americans to enjoy better health and feel more financially secure.

In 2009, we must build on these efforts. Next year, there will be new opportunities for reform. Not only because we will have a new Administration, but also because support for comprehensive reform has become widespread, and a diverse group of business and health industry leaders are now calling for change.

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HIMSS to Sponsor Electronic Prescribing Solutions Showcase

Mark your calendar for HIMSS Electronic Prescribing Solutions Showcase on Oct. 6-7 at the Sheraton Boston Hotel & Towers in Boston, Mass. New federal legislation establishes mandatory electronic prescribing for the Medicare Part D prescription drug program set to begin in January 2009 with a 2 percent increase in reimbursement for providers that employ electronic prescription software.  Be one of the first to view the latest technology solutions available for you to participate in this new federal reimbursement program at this exclusive HIMSS-sponsored E-Prescribing Solutions Showcase.  For more information, please contact Jonathan French, Project Manager, at 703-562-8822, and for exclusive sponsorship opportunities, please contact Kelly Laidler, Senior Director of Sales, at 312-915-9285.

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Tracking the Progress of Health IT

See the response from Mark Leavitt, director, Certification Commission for Health Information Technology, on just how far implementation of the electronic medical record has come.  This is his entry on the blog of the Health Affairs journal, published in August 2008. As stated on the Health Affairs Web site, in the publication’s the lead article, the Markle Foundation’s Carol Diamond and New York University’s Clay Shirky argue that, if we are to unlock the potential of information technology (IT), we need to expand beyond narrowly focused standard setting. Health Affairs also published two Perspectives on this article, plus Dr. Leavitt’s.

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News Briefs

HIMSS Task Force Details Worldwide EHR Implementation Trends
In a new report, a HIMSS task force describes four common factors that affect electronic health record implementation worldwide, Healthcare IT News reports.

The HIMSS Global Enterprise Task Force reviewed EHR implementations at health care IT centers in 15 countries in North America, Europe, Asia Pacific and the Middle East.

The report, "Electronic Health Records: A Global Perspective," evaluated the EHR projects based on security, quality, financial resources and implementation barriers.

The task force concluded that the four common factors affecting EHR projects are:

The report also details each country's EHR status, a review of achievements, encountered barriers and recommendations (Means, Healthcare IT News, 9/9).

Do Adults With Certain Health Conditions Search for Health Information Online?
Fifty-six percent of U.S. adults diagnosed with depression or anxiety have researched a health topic online in the past year, according to a new survey by Forrester Research. Also in the top five health conditions researched online were allergies, asthma, cancer and diabetes.  Go to the Data Points section of iHealth Beat to find out more.  This survey was published on Sept. 11, 2008. Registration may be required.

New Volunteer Opportunity
Participate in HIMSS Workgroup Focused on Healthcare Transformation and HIT

With healthcare spending in the United States totaling more than $2 trillion a year and 47 million people in the United States lacking health insurance, healthcare reform will be a top priority for the next President and the new Congress. As healthcare IT stands as a proven tool for improving the efficiency and effectiveness of healthcare, HIMSS is in a key position to provide federal policy makers with concrete recommendations (including funding recommendations) in early 2009 about the critical role of healthcare IT in efforts to transform healthcare.  We must be ready for this unique opportunity and we need volunteers to make sure our recommendations reflect the industry.

All interested members are encouraged to sign-up for our new “Healthcare Transformation through Healthcare IT Workgroup” which will focus on making policy and funding recommendations to our next President and new U.S. Congress. Co-chairs for this Workgroup will be Maggie Lohnes, RN (Chair, HIMSS Advocacy & Public Policy Steering Committee) and Harry Greenspun, MD (Chair, HIMSS Government Relations Roundtable). The Workgroup will convene from September – December 2008, enabling the development and dissemination of a final report by February 2009. Meeting dates will include: Sept. 24, Oct. 8 and 22, Nov. 12 and 19, and Dec. 3 and 17. All meetings will take place via conference call from 9:30 - 10:30 a.m. EDT on these designated dates. Members will be asked to participate in dissemination and outreach efforts for the Workgroup’s final report in February – March 2009.

Please contact K. Meredith Taylor, HIMSS, director, congressional affairs, if you have questions or would like to participate in this Workgroup.  Provide Meredith with your name, title, employer, e-mail address, telephone, and mailing address.

NQF Endorses National Consensus Standards for HIT
To improve quality and efficiency and reduce errors and unnecessary treatments across the healthcare system, the National Quality Forum (NQF) has endorsed nine new national voluntary consensus standards for HIT in the areas of electronic prescribing, electronic health record interoperability, care management, quality registries, and the medical home.  These HIT structural measures are intended to help providers assess the efficiency and standardization of current HIT systems and identify areas where additional HIT tools can be used.

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White Paper Web Links

Real Time Adjudication of Healthcare Claims White Paper is a work product of the HIMSS Financial Systems Financial Transactions Toolkit Task Force. This white paper provides a current review of RTA activity in the industry for both hospitals and physician practices. 

Re-engineering the Revenue Cycle for the Emerging Medical Consumer White Paper
Revenue cycle processes and workflows are receiving unprecedented attention as our industry faces new demands on financial management and emerging drivers impacting revenue cycle management. This white paper addresses revenue cycle management around the patient encounter life cycle and how HIT can be leveraged to support providers in dealing with current trends, market forces and future developments. This paper was developed by the 2007-2008 HIMSS Financial Systems Revenue Cycle Management Task Force. 

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CCHIT Update

CCHIT Announces Newly Certified 08 EHR Products
The Certification Commission for Healthcare Information Technology (CCHIT®) announced on Sept. 30 that 10 electronic health record (EHR) products for office-based physicians are the first certified under the new CCHIT Certified® 08 criteria.

Now in its third year, the certification program’s criteria and testing have been significantly updated to provide physicians with more assurance that certified products will meet their needs for functionality, interoperability and security. The Commission added 19 criteria to the 200 required in 2007. The new criteria focused on the ability to exchange patient information with other systems. This year optional ambulatory EHR certification was also available for Child Health and Cardiovascular Medicine.

Read the complete news release on the CCHIT Web site.

Resources for physicians
The Physician’s Guide to CCHIT Certification has been updated to help physicians and practices understand the value of the latest 08 ambulatory EHR criteria. It is designed to explain the benefits of certification and what physicians need to consider when they are choosing EHRs. The updated guide is available at www.cchit.org and www.ehrdecisions.com. In addition, CCHIT is producing the first in a series of audio reports about certification, offering a database of incentive programs available to assist with EHR adoption, and providing other relevant information to help doctors make informed decisions about EHRs. The reports will be available for download beginning Sept. 30 at www.ehrdecisions.com.
           
Applications for 08 certification; launch of 09 HIE certification program
Applications will reopen for 08 certification of ambulatory EHRs with options for additional certification in Child Health and Cardiovascular Medicine on Oct. 1, and will be accepted on a continuous basis through March 31, 2009.

Also on Oct. 1, a certification program for health information exchanges (HIEs) will open for the first time. Recognizing that some HIEs are in an early stage of funding and business development, and wishing to lower the barriers to certification for these entities, the Commission has received a limited amount of funding from the Office of the National Coordinator, Health Information Technology, U.S. Department of Health and Human Services, to support certification fee reduction grants for nonprofit, operational HIEs with limited annual revenues. Information about this new 09 HIE program, including the criteria and test scripts, the HIE Certification Handbook and the applicant agreement, is available at http://cchit.org/certify/hie.

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Already There…Implemented Health IT
Working Smarter as e-Eligibility Works Harder

By Terry Kinzer
Manager of Patient Financial Services, Contracting, and Credentialing
Rosalind Franklin University Health System, North Chicago, Ill.

Improving your business operations requires changes to your business through process improvement and essential tools. In our case, RelayHealth's ENHAC fully integrated real-time eligibility service enabled our change yielding dramatic results—a 72 percent revenue increase in co-pays alone—that completely overhauled ambulatory claims operations and our bottom line.

Here’s our story: Rosalind Franklin University Health System is located 35 miles north of Chicago in a town called North Chicago. Our internal billing office supports three clinics serving 18 doctors and practice administrators: Scholl Foot & Ankle Center, the Behavioral Health Center and the Reproductive Medicine Center. 

Everyone working within a medical practice has unwillingly experienced outstanding claims languishing in accounts receivable days to months. In 2006, Rosalind deployed its new EHNAC-accredited clearinghouse claims processing system to resolve this challenge and optimize revenue. It was clear from the start that the seamless PPM/EMR integration of real-time eligibility made possible through AdvancedMD medical billing software was critical in automating the insurance verification process with payers. What we did not anticipate was the high level of success of error-free “clean” claims generating accurate data within hours, along with the accelerated cash flow in less than six months.

The staff now processes, in batch format, 100 to 300 claims per day including eligibility verification, capturing instant information to project revenue from commercial insurers and government programs, like Medicaid, prior to the patient’s appointment.  Because the new ambulatory claims operation is increasing reimbursement faster and more efficiently, we know and collect the patient’s co-pay the day of their visit versus waiting for the data from an EOB.  We also receive patient benefits data allowing us to work with the patient on non-covered services and project what the patient may owe.  This seamless sharing of data has changed our business methodology entirely. 

Additionally, the normalized payer reporting of claims acceptance or rejection is delivered much quicker and in an easy-to-read and workable format. Previously, all reports were examined one by one. Now error reports are parsed to a special file for easy consolidation. We can more quickly identify the errors and now have the tools we need to make decisions regarding how to best resolve errors.

Having our cash flow on track begets other business process changes. My four employees have re-engineered the way we conduct business, allowing them to work smarter while commanding our two vendor partners to work harder--maximizing our rate of payment and reducing the time we realize actual revenue.

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