Meaningful Use Update &
Tips and Tricks for a
Successful EHR
Implementation
Mike Spencer
GBS Corp
Thursday, January 26, 2012
Housekeeping
Thursday, January 26, 2012
Housekeeping
 Next Event
Thursday, January 26, 2012
Housekeeping
 Next Event
 Marketing Stuff
Thursday, January 26, 2012
Housekeeping
 Next Event
 Marketing Stuff
 Surveys
Thursday, January 26, 2012
Housekeeping
 Next Event
 Marketing Stuff
 Surveys
 Miscellaneous
Thursday, January 26, 2012
Meaningful Use Update &
Tips and Tricks for a
Successful EHR
Implementation
Mike Spencer
GBS Corp
Thursday, January 26, 2012
Meaningful Use Update
Thursday, January 26, 2012
Medicare / Medicaid Incentive Payment Schedule
Thursday, January 26, 2012
Incentive Program Statistics
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CMS has Dispersed $2 Billion Plus in Incentive
Payments
155,000 Eligible Providers have Registered
3:1 Medicare vs. Medicare Program
Slightly more than 21,000 have attested
 One in Seven
 Stampeed to Attest by 10/1/2012
21,000 Attested – 444 Were Unsuccessful
28% of Physicians Have Registered – 5% Short of CMS
Acceptance Rate of 33%
Stage 2 Delayed Until 2014
Final Release of Stage 2 Specifications in June 2012
Thursday, January 26, 2012
Incentive Program Timelines
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October 1, 2011 – Last day to begin 90 day reporting
period for CY 2011
February 29, 2012 – Last day for EPs to register and
attest to receive an incentive payment for CY 2011
Missouri and Illinois Medicaid Programs are open
2015 – Medicare payment adjustments begin for EPs
and eligible hospitals that are not meaningful users
of EHR technology
2016 – Last year to receive a Medicare EHR incentive
payment; Last year to initiate participation in
Medicaid EHR Incentive Program
2021 Last year to receive Medicaid EHR incentive
payment
Thursday, January 26, 2012
Incentive Program Web Sites
CMS Web Sites
• http://www/cms.gov/EHRIncentivePrograms
• http://healthit.hhs.gov
State Incentive Program Web Sites
•
Missouri
• http://www.dss.mo.gov.mhd.ehr
•
Illinois
• http://hfs/illinois.gov.ehr
Check State Status at:
• http://www/cms.gov/apps/files/medicaid-HITsites
Thursday, January 26, 2012
EHR Adoption
Thursday, January 26, 2012
EHR Adoption – Are Practices Really Using Their EHR?
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•
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Total of 237,562 Physicians
• 40.4% Have Adopted EHR
• 30.8 % Solo Practitioner
• 75.5% 26+ Providers
HIMSS Leadership Survey
• 2010 – 22% Reported EHR as Fully Functional
• 2011 – 27% Reported EHR as Fully Functional
• 42% Solely Focused on Reaching Meaningful Use
Center for Disease Control – Office Based
Providers
• 2009 – 6.9% EHR Fully Functional
• 2010 – 10.1% EHR Fully Functional
Thursday, January 26, 2012
EHR Adoption – Why Practices Struggle?
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Physician Challenges
• Technology Can Be Complex
• Intelligent Work Flow is Lacking
• Too Many Mouse Clicks
• Patient Interaction
Practice Challenges
• Poor Planning
• No Project Management
• Staff Struggles With Change Management
• No Governance Process in Place
• Poor and Inadequate Training
Thursday, January 26, 2012
Success or Failure – The Choice is Yours!
•
•
Rewards of a Successful EHR Implementation
• E & M Coding Optimization
• Reduced Expenses
• Increased Revenue
• Improved Staff Efficiency
• Improved Outcomes and Compliance
• Improved Patient Satisfaction
Results of a Poor EHR Implementation
• Reduced Productivity
• Reduced Revenue
• EHR Budget Overruns
• Extended Timelines
• Physician and Staff Frustration
• Patient Dissatisfaction
Thursday, January 26, 2012
Tips & Tricks for a Successful EHR
Implementation
Thursday, January 26, 2012
Tips & Tricks for a Successful EHR
Implementation
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•
Plan, Plan, Plan!!
• Designed a True Project Plan
• The EHR is not a Magic Bullet
• Don’t Duplicate Your Current Work Flow
• Change and Improve Work Flow
• Look for New Efficiencies
• One Size Does Not Fit All
It’s All About the Training
• Don’t Skimp on Training – EHR is Not
Plug-n-Play
• Be Sure and Include Your Nurses
Thursday, January 26, 2012
Tips & Tricks for a Successful EHR
Implementation
•
Implementation Considerations
• Don’t Force Providers To Do the Same Thing
• Balance Individualization with Standardization
• Start With Top 10 Diagnosis Codes – Build
Protocols
• Introduce New Features Every Few Weeks
• Constantly Evaluate Users
• 30 – 60 – 90 Day Review
• Observe and Identify Short Cuts
• Reduce Mouse Clicks
• Chart Abstraction/Chart Scanning
• Have Your Patients Help with Data Entry
• Patient Portal
• Kiosk
• Smart Pen Technologies
Thursday, January 26, 2012
Tips & Tricks for a Successful EHR
Implementation
•
Prepare Your Staff
• Everyone Must Participate in Training
• Champion Physician
• Buddy System
• Assume High Stress Levels for Several
Months
• Be Prepared for the Long Haul
• Role Adjustments
• Assist Providers
• Training Tools
• Web Based Tutorials
• Test Patients / Practice Database
Thursday, January 26, 2012
The Future of EHR
Thursday, January 26, 2012
EHR Is Here to Stay!
Do You Want to Be Part of the Future of Healthcare?
• Adoption is Patient Driven
• The Patient is Your Co-Pilot
• Patients Will Demand Interaction
• Patient Centered Medical Home (PCMH)
• Accountable Care Organizations (ACO)
• Health Information Exchanges (HIE)
•
Don’t Stop with Meaningful Use – Make the Most of
Your EHR
• Outcomes
• Health Maintenance
• Patient Reminders (Revenue!)
• Research Revenue
• Evaluate * Adjust * Optimize
Thursday, January 26, 2012
Five Stages of Major Society Changes
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Stage
Stage
Stage
EHR
Stage
Stage
Thursday, January 26, 2012
1 – Idea is Dismissed as a Pipe Dream
2 – Change is Delayed
3 – Disruption by Early Adapters of
4 – Domino Effect
5 - Dominance
Mike Spencer
Regional Sales Consultant
(314) 517-5054
mikesp@gbscorp.com
Thursday, January 26, 2012
5010 Update
Jackie Griffin
Gateway EDI
Thursday, January 26, 2012
TODAY’S OBJECTIVE
PROVIDE CLEARINGHOUSE PERSPECTIVE
OF THE TRANSITION
DISCUSS THE TOP THREE REJECTIONS
EDUCATE YOU WITH 5010 TIPS TO GET
YOU THROUGH THE TRANSITION
Thursday, January 26, 2012
WHO IS GATEWAY EDI?
WHY WE ARE DIFFERENT?
INDUSTRY LEADER
Thursday, January 26, 2012
• Providers trust
Gateway EDI to
maximize revenue,
increase cash flow
and catch claims
issues before they
impact a practice.
5010 TRANSITION
WHERE ARE WE AT?
• 80% of claim volume as of
01/18/12
• All Medicare Part A & B
• Delay in acknowledgement reports
• No issues with remittance advice
Thursday, January 26, 2012
5010 TRANSITION
WHERE WE ARE AT? (CONT.)
• Eligibility (270-271)
4010 information on 5010
responses
5010 information on 4010
responses
Payer/Trading Partner/
Vendor readiness
Thursday, January 26, 2012
TRANSITION ISSUES
ACKNOWLEDGEMENT REPORTS
File
Acknowledgements
999
• Batches of claims rejected
• Unclear reasons for the rejection
• Manual work
• Added time to resolving issues
Claim
Acknowledgements
277CA
• Denying lines of service
• Not claim denials
• Vary by payer
Thursday, January 26, 2012
TRANSITION ISSUES
FILE DELAYS
Payers not processing format sent
• Switched to 5010 with no notice
• Did not switch to 5010 on scheduled
date with no notice
Thursday, January 26, 2012
TOP REJECTIONS
BILLING PROVIDER
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Must be a provider of health care services
Must be a physical address
Requires a 9 digit zip code
PO Box must be sent as Pay To address
Thursday, January 26, 2012
TOP REJECTIONS
PROVIDER IDENTIFIERS
• Payer specific identifiers have been
moved or removed.
• Limited to Tax ID, Social Security Number,
State License Number and Provider UPIN
Number.
Thursday, January 26, 2012
TOP REJECTIONS
INJECTABLE DRUGS
• NDC code missing or not valid
• Drug quantity
• Unit of measurement
Thursday, January 26, 2012
IMPACTS FOR PROVIDERS
IMPACT TO CASH FLOW
Delay in
receiving
payment
No payment
being received
Increase in
paper claims
Thursday, January 26, 2012
HOW TO REDUCE IMPACT
SUGGESTIONS EDUCATE YOURSELF ON DATA
REPORTING REQUIREMENTS
TALK WITH YOUR CURRENT
PRACTICE MANAGEMENT
VENDOR
MONITOR REJECTIONS AND
REMITTANCE CLOSELY
NETWORK WITH COLLEAGUES
AND INDUSTRY LEADERS
Thursday, January 26, 2012
JACKIE GRIFFIN
CLIENT SERVICES DIRECTOR
WWW.GATEWAYEDI.COM/5010
For more 5010 tips visit Jackie’s blog:
http://blog.himss.org/2011/12/06/its-here-icd-10-playbook-v2/#more-2056
Thursday, January 26, 2012
Technology & Common
HIPAA Risks
Eric W. Humes
Keystone IT Consulting
Thursday, January 26, 2012
What is HIPAA?
(just in case you didn’t know)
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•
•
The Health Insurance Portability and
Accountability Act (HIPAA) was passed by
Congress in 1996 to set a national
standard for electronic transfers of
health data.
At the same time, Congress saw the need
to address growing public concern about
privacy and security of personal health
data.
The task of writing these rules eventually
fell to the U.S. Department of Health and
Human Services (HHS).
Thursday, January 26, 2012
What is HIPAA?
(just in case you didn’t know)
• February 20th, 2003 HHS publishes
the HIPAA Security Rule.
• April 14th, 2003 HHS issued the
HIPAA Privacy Rule.
Thursday, January 26, 2012
PHI vs. ePHI
• Two considerations to keep in mind:
– HIPAA Privacy Rule – General guidelines
relative to Protected Health Information (PHI)
– HIPAA Security Rule – Specifically regarding
electronic PHI (ePHI)
Thursday, January 26, 2012
Little Known Fact #1
• PHI must be protected in ANY form!
– Many people think that HIPAA only applies to
PHI in electronic form. While it is true that the
Security Rule applies only to electronic PHI, this
is covered within the Privacy Rule, which covers
PHI in *ALL* forms.
• Examples of other forms
– Hard copy information
• Charts, insurance forms, lab results, etc…
– Electronic Forms
• Emails, Blogs, Tweets, EPM/EMR Software, Check-in
Kiosks, unprotected monitors, etc…
– Spoken Word
Thursday, January 26, 2012
Little Known Fact #2
• Business Associates (BAs) of Covered
Entities (CEs) must comply with the terms
of HIPAA as outlined within their BA
agreement.
– Most BAs think they do not need to follow any
of, or even know about, HIPAA if they,
themselves, are not healthcare providers,
healthcare payers/insurers, or healthcare
clearinghouses.
Thursday, January 26, 2012
CE’s & BA’s Must Comply
• Covered Entities: (CE’s)
– Health Plans
– Healthcare Clearinghouses
– Any healthcare provider or employee thereof
• Business Associates: (BA’s)
– Anyone who provides legal; actuarial;
accounting; consulting; data aggregation;
management; administrative; accreditation; or
financial services to a Covered Entity.
 Must sign a HIPAA Business Associates
Agreement
Thursday, January 26, 2012
HIPAA Violations
• 2 Types of HIPAA Violations
– Negligent
– Purposeful
 Read LHE article on Technology and Common
HIPAA Risks
http://www.leagueofhealthcareexperts.com/
news/hipaa_risk_0112.html
Thursday, January 26, 2012
Examples of Negligent
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Improper disposal of old computers and backup tapes
Inadequate physical protection of computers or network
containing ePHI
Leaving detailed PHI in a voicemail message
Sending unencrypted ePHI in an email
Blogging/Facebooking/Tweeting about a patient
situation – even if anonymously doing so
Careless handling of user names and passwords
Inadequate network firewall
Exposing EMR systems to malicious code (malware)
when connecting to the Internet
Failure to maintain Business Associate Agreements with
vendors
Allowing patients or visitors to be near unattended and
unlocked computers
Thursday, January 26, 2012
Examples of Purposeful
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Accessing or using ePHI without having a legitimate
need to do so
Allowing another employee to utilize any systems via
your password
Disclosure of PHI to an unauthorized individual
Sale of PHI to any source
Accessing ePHI on a website or cloud-based EMR that is
not secured*
Connecting unapproved devices to the network
Failure to encrypt ePHI before transporting (physically or
electronically)
Misuse of confidential patient information for personal
use
Deliberately compromising EMR security measures
Thursday, January 26, 2012
* See slide on Cloud Computing
Times a’ Changing!
• How does today’s technology change
the way WE should think about HIPAA?
– Social Networking
– Cloud Computing
– Mobility
• What about our patients?
– Patient communication
– Patient portals
• Clinical workflows
– HIPAA risks associated with this?
Thursday, January 26, 2012
Social Networking
• Social Networking
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Facebook
LinkedIn
Twitter
Blogs
• Excellent ways to share information,
but remember:
– Never post anonymously about a patient
– Remember the ‘elevator’ code of conduct with
online
 Google “Dr. Flea”
Thursday, January 26, 2012
Patient Identifiers
• The 18 Health Information Identifiers:
1. Names
2. Geographic location
3. Dates
4. Telephone numbers
5. Fax numbers
6. Electronic mail addresses
7. Social security numbers
8. Medical record numbers
9. Health plan beneficiary numbers
10.Account numbers
11.Certificate/license numbers
12.Vehicle identifiers
13.Device identifiers
14.Web Universal Resource Locator (URL)
15.Internet protocol (IP) address number
16.Biometric identifiers (including finger or voice prints)
17.Full face photographic images and any comparable images
18.Any other unique identifying number, characteristic, or code
Thursday, January 26, 2012
Cloud Computing
• Cloud Computing has two definitions:
– The popular definition
– The true definition
• Current Forecast: “partly cloudy” where
HIPAA is concerned!
– Many who say that its inevitable…
– Many who say No Way!
– Currently no regulations that specifically
govern this area of technology
• Are Cloud-Based Service Providers
Business Associates?
– Online backup services
– Web-based EPM/EMR Hosting Companies
Thursday, January 26, 2012
Mobility
• Mobile Technology
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–
–
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Smart Phones
iPads
Tablets
Laptops
• Can be lost, stolen, compromised
• Password protect all devices
– 2 Factor Authentication
• Enable “Remote Wipe” services
• Encrypt any local ePHI
– Or better yet, keep ay ePHI on remote secured
servers and access remotely through an
encrypted VPN tunnel
Thursday, January 26, 2012
Patient Communication
• Patient Portals
– Real-time access to patient records on-line
– Growing in popularity since Meaningful Use
– The specific Meaningful Use measures that a
patient portal can help to meet are:
• Timely electronic access to changes in health
information
• Electronic copies of their health record
• Clinical summaries after each office visit
• Patient-specific education resources
– Bottom line: Must Be Secure!
• Email
– Never email ePHI unless data is encrypted and
password protected.
Thursday, January 26, 2012
Clinical Workflow
•
HIPAA Risks associated with this:
– Patient left alone in a room with an unlocked computer
• Ctl+Alt+Del then Enter to lock a windows computer
• Some EMR’s have a hot key or button that will
automatically lock computer
– ePHI left exposed on a monitor screen
• Common in Check-in/Check-out areas and nurse
stations
• Cover all public area monitors with Privacy Filters which
only allow a limited viewing angle
 Walk the path of the patient. What can they see,
hear, read, access... ?
Thursday, January 26, 2012
Final Thoughts
• Simply put, HIPAA restricts the sharing of PHI.
• PHI should be shared with as few individuals
as needed to ensure patient care.
• In this age of technology, it’s the sharing that
is becoming easier and easier, thus making it
harder and harder to be HIPAA compliant.
Thursday, January 26, 2012
Questions?
Thursday, January 26, 2012
Thank you for attending
Healthcare Stimulus 101
January 2012
Let us know how we’re doing!
The LHE strives to make our seminars educational in
nature, knowledge-based and encompass current
subject matter. We appreciate your feedback as we strive
to continue to bring these quality topics and important
issues to you. Thanks in advance!
http://www.leagueofhealthcareexperts.com/survey
Thursday, January 26, 2012