News

The Senate’s recent decision to repeal the ban on funding for the development of a unique patient identifier (UPI) marks a potential watershed moment in the development of what previously has been a hot third rail for privacy concerns.

This controversial possibility of developing a UPI provides a new opportunity to link a patient’s health records throughout the health ecosystem, but also highlights the inherent challenges of such a project.

Accelerated adoption of digital health and health information technology (health IT) is well into the process of transforming access to and delivery of healthcare in the U.S. and across the globe – and their power has been on full display throughout the unprecedented global COVID-19 pandemic. From telehealth and information exchange to artificial intelligence and machine learning, optimizing the reach and utilization of health IT has brought safe, quality care to previously underserved areas while creating new opportunities that promise to make a lasting impact on patients and providers alike.

While advancements have been made, interoperability and comprehensive standards to support health information exchange are works in progress, and uncertainty over compliance with new and evolving regulatory mandates – such as those governing handling of patient data in the 21st Century Cures Act – persists. The good news is that collaborations between health IT developers, provider and payer organizations, industry associations and state and federal agencies continue to evolve and improve.

Wellesley, MA — October 28, 2021 –– Bundling errors continue to wreak havoc on hospital bottom lines in 2021, causing 34% of inpatient charge denials with an average value of $5,300 each. That’s according to an auditing and revenue integrity report analyzing more than $100 billion worth of denials and $2.5 billion in audited claims released today by Hayes, makers of MDaudit, the industry’s leading integrated auditing, billing compliance and revenue integrity platform for the nation’s premier healthcare organizations.

“Healthcare Auditing and Revenue Integrity: 2021 Benchmarking and Trends Report” shares the findings of Hayes’ review of professional and hospital claims audited in MDaudit Enterprise during the first 10 months of 2021. Internal auditors identified a significant number of concerns in the claims they reviewed, with approximately 33% of the audits resulting in “disagree” findings. The concerns centered primarily around disagreements between procedure codes and diagnoses.

Compliance has gotten a bad rap in healthcare. Traditionally viewed as a necessary cost center, this department is too often viewed as the police force of a health system.

A lot is missing from this simplistic view of the processes that ensure hospitals and health systems aren’t hit with avoidable penalties when the auditors come knocking. Within a rapidly evolving regulatory framework that includes more than a year of fluctuating COVID and telehealth guidance (among other changes), compliance in essence becomes the safeguard to a healthy, sustainable bottom line.

HISTalk»

As actors work to comply with the Cures Act Final Rule, it’s become clear that greater consensus is needed regarding the interpretation of the definition of electronic health information (EHI) and the designated record set (DRS). As many readers know, the Cures Act Final Rule includes interoperability requirements related to information blocking and health IT certification. Both rely on the definition of EHI, which is grounded in the definition of the DRS, as defined by HIPAA.

I’m proud my organization AHIMA has been able to collaborate with the American Medical Informatics Association (AMIA) and the Electronic Health Record Association (EHRA) on a taskforce to examine the relationship between specific aspects of the Cures Act Final Rule and the definitions of DRS and EHI.

As actors work to comply with the Cures Act Final Rule, it’s become clear that greater consensus is needed regarding the interpretation of the definition of electronic health information (EHI) and the designated record set (DRS). As many readers know, the Cures Act Final Rule includes interoperability requirements related to information blocking and health IT certification. Both rely on the definition of EHI, which is grounded in the definition of the DRS, as defined by HIPAA.

I’m proud my organization AHIMA has been able to collaborate with the American Medical Informatics Association (AMIA) and the Electronic Health Record Association (EHRA) on a taskforce to examine the relationship between specific aspects of the Cures Act Final Rule and the definitions of DRS and EHI.

The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement.

In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System.

As a part of this series, I had the pleasure to interview Brad Bostic, CEO of hc1.

Brad founded hc1 to bring the benefits of precision health to all patients after witnessing his mother lose her battle with cancer while being treated like a number. He created hc1 with a bold vision to bring the power of precise diagnostic and treatment insights into the care delivery process, believing that transforming lab data into personalized healthcare insights would empower healthcare organizations to ensure patients get optimal diagnostic lab tests and personalized prescriptions for the best possible outcomes. Today, hc1 is the bioinformatics leader in precision testing and prescribing and its hc1 Precision Health Cloud™ is live across more than 20,000 lab and health system locations.

Due to critical shortages of healthcare personnel and ICU beds, several states have declared “crisis standards of care,” including Alaska. As if they don’t need one more thing to worry about, a new virus has been detected in the state. Dubbed “Alaskapox” by the media, the virus was found in two additional patients who sought treatment at a Fairbanks urgent care clinic. The symptoms include skin sores, fever, joint pains, and swollen lymph nodes. Both patients recovered within a few weeks, but it’s worrisome as these cases are similar to an initial case in 2015 and another one five years later. The virus has been identified as one from the same family as smallpox and cowpox. Epidemiologic investigation linked the virus to outdoor cats who may have picked it up from cows or other mammals, including voles. Just goes to show that public health was important before COVID-19 and will continue to be important in the future. Let’s hope governmental entities show up with their pocketbooks to fund the kinds of investigations needed to tackle emerging illnesses.

A new report from AHIMA, AMIA, and EHRA asks for consensus on the definitions of “electronic health information” and “designated record set” to better help organizations operationalize the requirements found in the 21st Century Cures Act. The organizations had formed a task force last year in preparation for key compliance deadlines. The task force will be asking stakeholders for feedback on the report and will continue to refine their work as the 2022 deadlines for compliance to the information blocking portions of the Act approach. The health information export portion of the Act kicks in at the end of 2023.

ONC must standardize the definition of electronic health information (EHI) for the successful operationalization of the 21st Century Cures Act final rule’s interoperability goals, according to a report from three major health IT organizations.

The American Health Information Management Association (AHIMA), the American Medical Informatics Association (AMIA), and the HIMSS Electronic Health Record Association (EHRA) formed a task force to create the Defining EHI and the Designated Record Set in an Electronic World report.

EHR Intelligence»

Three major healthcare informatics organizations this week published a new study designed to help guide the conversation around how electronic health information should be managed and put to use by healthcare providers and technology developers.

WHY IT MATTERS
The American Health Information Management Association, the American Medical Informatics Association and the HIMSS Electronic Health Record Association on Monday put out a report, Defining EHI and the Designated Record Set in an Electronic World (PDF), which focuses on  issues around operationalization of the definitions of electronic health information and designated record set.

The definition of "electronic health information" will need to be standardized to ensure compliance with HHS' Cures Act Final Rule, according to a recent report by The American Health Information Management Association, the American Medical Informatics Association and the Electronic Health Record Association.

The American Health Information Management Association (AHIMA) (@AHIMAResources), the American Medical Informatics Association (AMIA) (@AMIAinformatics), and the Electronic Health Record Association (EHRA) (@EHRAssociation) announced the release of a preliminary report that examines key issues related to the operationalization of the definitions of electronic health information(EHI) and designated record set (DRS).

How these definitions will be operationalized by clinicians and developers are critical to successful compliance with the Cures Act Final Rule. The Cures Act Final Rule includes interoperability requirements related to information blocking and health IT certification, both of which rely on the definition of EHI, which is grounded in the definition of the designated record set as defined by HIPAA.

CENTENNIAL, Colo. – September 20, 2021 – Harris Healthcare’s Data Integrity Solution Business Unit – which includes patient data integrity powerhouses Just Associates, Inc., and QuadraMed® Corporation – have entered a strategic partnership with RightPatient® to integrate biometric patient identification into its existing suite of master patient index (MPI) management solutions. Doing so provides important protections against front-end contamination of the MPI and EMPI and helps eliminate the patient misidentification and safety issues created by “dirty” patient identification data. This is especially important now as spikes in remote patient registrations due to COVID-19 have led to a sharp increase in duplicate patient records.

Wellesley, MA — September 20, 2021 — Hayes, makers of the industry’s leading integrated auditing, billing compliance and revenue integrity platform for the nation’s premier healthcare organizations, announced today that Vasilios Nassiopoulos, CPC, CCO, will present Leveraging Denial Trends to Identify Risks and Prevent Audits at the AHIMA21 Virtual Conference. The presentation, which explores the catalyst behind rising claims denials and how healthcare organizations can reverse the trend, takes place on Sept. 22 at 11:45 a.m. ET.

The uncertainty and risk created by pandemic-related disruptions in care have health plans in uncharted water when it comes to relying on claims data and utilization patterns to inform their risk models. But while these disruptions weakened the reliability of traditional risk models, they also created opportunities to deepen and enrich member data by leveraging consumer and other data related to social determinants of health (SDoH)that can deliver significant performance and accuracy benefits.

Expanding data sources and enhancing analytics capabilities allows health plans to develop the capacity for more precise, holistic member engagement while improving the most impactful health outcomes in individuals and populations. Doing so will help lift Star Ratings, improve care compliance, close gaps, enhance member satisfaction, reduce costs and drive profitability gains.

HIT Consultant»