Thursday, April 8, 2010

Open Government Plan increases transparency for CMS and provides valuable data sets for Business Intelligence analysts

Recently I was invited to contribute to a great healthcare IT community web site. SearchHealthIT part of the TechTarget group contains several useful resources. I am looking forward to continuing to write about healthcare informatics and regulatory changes that are affecting each and everyone of us who are in the healthcare market.

My latest post: Click here

Wednesday, March 24, 2010

Summary of the H.R. 3590 and the impact on physicians

Today I reviewed a great summary of the H.R. 3590 bill that was signed into law on 3-23-2010. This was a pdf published by the North Carolina Medical Scociety.

It is clear that there will be many changes that practices will start seeing. Some are relating to the potiential increase in Medicare/Medicaid patients (estimated at 16 million new Medicaid receipients), also some of the new penalties associated with not participating in the PQRI initiative. It is estimated that a 1.5% to 2% penalty will be imposed begining in 2015 for non PQRI participants . So, if EHR is in your plans, and you the practice does see a high volume of Medicare/Medicaid then this maybe a good time to contact the vendor to seek assistance for PQRI.

I also saw how there will be some bonus payments (10% Medicare bonus) for primary care and general surgeons practicing in shortage areas 2011-2015.

Thursday, March 18, 2010

New release on a powerful open source PACS/RIS clearcanvas 2.0

For all the open source fans, a new version if the clearcanvas RIS/PACS 2.0 has been released. clearcanvas is a great suite of imaging solution. This application has many of the functionality and features of some of the market’s top PACS/RIS application providers. The difference is this is “FREE” (more details on licensing available here: )

I have installed this solution and I was very surprised how quickly it can be deployed. What were more impressive were the advanced capabilities it enables you to perform just by using their SDK. This solution was built on an extensible application framework.

This solution can be provide immense value for some of the healthcare organizations looking to implement a small PACS system to manage their imaging (Ultrasounds) without all the high costs associated with some of the packages offered in the market. An OB/GYN practice or Imaging center can eliminate all the costs associated with Photo-paper, expensive color ink, and the need to file by hand these images in the chart, just by simply rolling out this type of solution and offering the physicians access to high quality images through the clearcanvas client. For radiology, this open source package offers a great range of features:

• Image storage, retrieval and archival
• Image viewing and or streaming
• Modality work list
• HL7 capabilities
• Workflow engine
• IHE-modeled Scheduled Workflow
• Paperless protocoling
• Preliminary Diagnosis workflow
• Resident-Supervisor workflow
• Customizable technologist documentation
• Multi-facility, multi-HIS Master Patient Index

So if you are a big open source advocate, and want to reduce (eliminate) direct licensing costs, this may just be the PACS/RIS solution you need. But note that as with many open source solutions, having the appropriate skills to support and troubleshoot is critical. While you may purchase support through clearcanvas, it is important to fully evaluate your need, current hardware and how you plan on having the application supported.
Check out their web site

Wednesday, March 10, 2010

Real-Time Claim Adjudication a "new" way to look at collecting your money

In a time where we are reminded daily that much of the current technologies (EHR, HIE, EDI, and others) will reduce medical error, improve patient care, we tend to overlook the prolific results that other technologies have to offer to health organizations. The market offers that great solutions that billing departments across the nation would appreciate how it can reduce claim denials, put money in the bank much quicker and overall improve the practices bottom line.

Real-time claim adjudication (RTCA) is a solution that enable medical organizations to bill for services before the patient leaves the practice. This allows for the organization to submit a claim with the procedures performed and get a response displaying the allowable charges and patients remainder responsibility based on the contractual agreement.

This has been around for some payers in some states. Humana, some Blue Cross Blue Shied of some states (BCBS of NC has started the development but has not officially released any target dates). Some PMS vendors have been able to successfully enable practices to take advantage of this functionality. AthenaHealth was one of those vendors, with their RTA (Real time Adjudication) services, it makes for a very attractive model for any practice looking to lower the denial rate on their claims.

Using Real Time adjudication is a no brainer when one begins to realize how much time is spent on claim filing, refiling and working the denials. It is known that insurance eligibility verification does resolve some of the claim denial issues, however, much of the billing departments pains lies in dealing with payers who may deny some procedures and not others within the same claim, and then the battle to explain to the patient why they are now responsible for the balance.

According to some recent MGMA statistics published in we can see some of the costs associated with claim denials:

57,168,299 Number of claims per year that must be resubmitted due to payer denial due to incorrect patient demographics from non-electronic registration

857,524,484 Minutes per year to resubmit claims denied due to payer denial due to incorrect patient demographics from non-electronic registration

14,292,075 Hours per year to resubmit claims denied due to payer denial due to incorrect patient demographics from non‐electronic registration

289,762,993 Dollars saved per year by not having to resubmit claims denied due to payer denial due to incorrect patient demographics from non-electronic registration

While in the perfect world RTCA would work so well with an EHR, especially when the provider can submit the encounter electronically right after the visit, it is important to note that even if a physician write the data or circles the procedures and diagnosis on the paper charge sheet, the checkout individual may have the ability (depending on the Practice Management System) to perform the RTCA task and benefit from this wonderful technology.

Thursday, March 4, 2010

High level review of new proposed certification process

With the recent publication of the Proposed Establishement of Certification Progreams for Health Information Technology, it has been the most anticipated item since the meaningful use proposed requirements. As many have anticipated, CCHIT is in fact on top of the list of the most likely to become the certification body or the (ONC-ACB) ONC Authorized Certification Body.

While most or possibly all the proposed rule focuses on what are the requirements on the certification body, testing and accreditation. The HIT recemendations very much in line with the CCHIT and that also includes the costs of the actual certification which still range from 30,000 to 50,000 dollars for complete EHR/EMR or 5,000 to 30,000 dollars for modules.

The document outlines some estimates on what products will be tested, including statistics on Commercial/Open Source EHR products, Commercial/Open Source EHR Modules and Self-Developed Complete EHRs modules. The total count of products tested is about 181.

The document also outlines that there will be addiotional certifications that the ONC will potentially use for other technologies. The reference was made to the Personal Health Records (PHR) as well as Health Information Exchange (HIE).

Wednesday, March 3, 2010

The much anticipated Proposal for certification or Certified EHR

While many are still talking to the EHR vendors at the exhibit halls at the HIMSS 2010, The Office of the National Coordinator for Health IT (ONC) released yesterday the notice of proposed rulemaking (NPRM) for the two certification programs. This proposed program has two proposals in it. One that will be temporary and the other would be permanent.

The proposed program outlines the following:

The first proposal would create a temporary certification program that would be issue temporary certifications through the authorized testing and certification bodies (ONC-ATCB) to test and certify complete EHRs/or EHR Modules. During this first proposal the ONC would assume most of the responsibilities during the temporary certification program. This means that no other organization (private ones) would serve as an accreditation body.

The second proposal would create a permanent certification program that would replace the first temporary proposal. This would also mean that the ONC is intended in allowing approved private sector accreditor to fulfill the responsibility of the accreditation body.

The National Institute of Standards and Technology has been working with the ONC to develop the test method and infrastructure that will be used by many of the testing laboratories in the testing stage for both proposed certification programs. This entity (NVLAP) would include specific calibration and or test standards related methods and protocols that would satisfy the needs and requirements of an “Certified EHR”.

The details of what would be the methodology used in the certification test is defined as “The same basic methodology used in third-party conformance assessment”.

More details to come once I can get through the 184 pages of the proposal.

News Media Party at the Georgia Aquarium HIMSS 2010

Another highlight of my day was the exciting news Media meet up. Organized by John Lynn creator of the (Great healthcare informatics resources). During this meeting, I was fortunate to meet up and discuss with several individuals the current challenges our healthcare faces as well as some of the exciting changes going on. John and I got do talk about healthcare technology, ARRA and some of the challenges we all face in this field. John who is very passionate about the healthcare field shared with me some of his thoughts on the current ARRA and impact it has on healthcare practices.
Jean DerCurahian who is a news writer for TechTarget was also attending, and had the opportunity to exchange some thoughts. We in the healthcare bloggerspere have a lot in common. Sharing our thoughts, opinions and experiences hopefully can bring value to others.