All Is Not Well in the HIT Space

 

Several upcoming deadlines are on the horizon that will impact operations of providers, hospitals, and intermediaries.

HHS has a fairly cavalier attitude about the changes mandated by Obamacare. Some of these issues are very serious and not to be taken lightly. For providers the impact will be major in terms of operations, ability to bill correctly and the liklihood for substantial expenses to convert ICD Coding from ICD-9 to ICD-10.

HHS and the ACA have set arbitrary and unrealistic deadlines for these changes.  Inexplicably Farzad Mostashari, who thus far has done an exemplary job planning, educating and implementing the changes cast upon us by the Affordable Care Act.   Farzad Mostashari, MD, is the National Coordinator for Health Information Technology. In this role, he oversees the Office of the National Coordinator for Health Information Technology (ONC), a division of the United States Department of Health and Human Services. He joined ONC in July 2009 and was appointed national coordinator in April 2011.

Farzad Mostashari, MD, the national coordinator for healthcare IT, asserted today there would be no extension of the deadline for switching from the ICD-9 medical coding system to ICD-10. The deadline for conversion would remain Oct. 1, 2014. 

Converting from the old ICD-9 diagnostic coding to ICD-10 is much more complex than adding or changing a few codes. The ICD codes are deeply embedded in provider actions and insurance company process. Most providers will be unable to accept ICD 10 codes as of the original deadline of October 2013, so the original deadline was pushed back 12 months until October 2014.

However even at that date most providers and/or insurers will have to use a dual system of legacy ICD 9 and ICD 10.

The consulting firm Deloitte’s White Paper elaborates in detail about the process of the conversion, the expense, and complex inter-relationship of HIT systems, including Electronic Medical Records, and coding. Switching to ICD 10 involves much more than adding codes (the increase is about 7,000 in ICD 9 to over 40,000 codes.

The lofty goal is worthwhile and obtainable. The process is well explained and oulined in this chart.

Mostashari is on the ‘firing line’ from both side s of the table for other issues as well.

Today in the third of three hearings held by subcommittees of the House Energy and Commerce Committee, Farzad Mostashari, National Coordinator for Health Information Technology reassured a congressional panel that health IT interoperability will take some dramatic leaps forward within the next two years.

Michael Burgess, MD (R-TX) vice-chairman of the House Subcommittee on Oversight and Investigation, questioned the sluggishness of interoperability.

“We do hear about this a lot,” Burgess said. “Even anecdotally, hospital systems in the same city, that have the same operating system aren’t talking to each other.”

“You’re the head, why don’t you fix that?,” he asked Mostshari. “Why don’t you just make that happen?” Was this a rhetorical question ?

This statement reveals the lack of understanding by congress how our health system operates and the complexity and workings of daily operations by hospitals and providers.  This type of political grandstanding serves no productive purpose, especially when all the principals  had mulitple reform deadlines given to them in an arbitrary fashion by HHS.

It also points out the misguided perception that throwing money at  issues is not the entire solution and also that ‘haste makes waste’  It appears that Congress learns slowly.

 

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Not having an Electronic Health Record

From:  The Glass Hospital

 

The 92 year old lady with a hip fracture, a not uncommon story.  What will happen?  Here’s one scenario.

 

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This frequent occurrence played out as such:

Orthopedic Dialogue

Six months ago I posted a story about a demented 94 year old patient who’d fractured her hip. She’d lost more than thirty pounds in the preceding months and had already had a collarbone fracture from a previous fall.

The course of action in this case resulted in a breach of ethical conduct, bad feelings in the department, and the opening for a medical malpractice incident. Fortunately only the first two occurred.

All of the above could have been avoided had there been an electronic health record.

After the outcome, the chairman of the department had this to say, which says it all,

At the end of our chat, the chairman handed me copies of pages from the patient’s chart.

“Is that your note?” he asked me. I nodded.

 

“I can’t read a word of it,” he told me.

The day is coming when this will no longer occur.

Electronic health records, health informaton exchanges, a national and/or regional health information network and interoperability will break the glass barriers between health information ‘silos’.

 

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BIG DATA META-DATA DATA-ANALYTICS DATA SCIENCE

 

Health care and health care informatics have an annual ‘buzz-word’. Physicians in clinical practice are bombarded with may medical terms which are fairly well mastered during the course of a career. Their has been many advances in science, biology, medicine and healthcare.

During the pre-clinical years students and physicians use some statitical means to measure probabilities, media, means, averages, standard deviations to determine risks and benefits of treatments. Statistics were taught as a separate free standing course, however unless one was going to be a researcher it was rarely used in every day practice.

In the current environment it has become vital to understand what informaticists learn and teach. Future practice patterns and evidence based medicine will be based on these studies.

In the past clinical situations have been measured fairly subjectively. Now with electronic data storage the data is much more objective, measured and quantified to be recorded.  Whether what we are measuring and recording are accurate is another story.  However it is the best we have for now.

The tools we use now are far more advanced and capable of storing almost an infinite numbe of data points.  Complex algorithms can be derived for calculating multi-factoral variables and to extract hidden relationships in a blizzard of seemingly unintelligible data.

Physicians and patients are just beginning to benefit from these new tools.  The evolution of ‘preferred practice patterns’, the cochrane studies, present more objective evidence based studies for clinicians. Meta-studies aggregate multiple related studies to build a greater and/or more diverse cohort.

Medical students and trainees are learning these techniques during their formal education.  However the current generation of clinicians have been left behind, as the current knowledge base explodes in size and in  methodology.

The growth is fueled by connectivity and also studies done in the late 20th century indicating the exponential growth of information and the technology to run it.

Reversal of HHS policy has Positive Outcome

 

DIGITAL HEALTH SPACE INTERRUPTS IT’S SERIES ON ACO’S TO BRING YOU THIS HEARTENING STORY

Dying child was on life support when new lungs became available

Ten-year-old Sarah Murnaghan, who has cystic fibrosis, is receiving a lung transplant, at this moment.

The previous policy regarding the prohibition of children less than 12 years old with cystic fibrosis  receiving an adult lung transplant was reversed several weeks ago by the Dept of HHS in response to a public outcry  regarding the policy.  The policy was the result of obsolete statistics regarding survival statistics of children with the fatal genetic disease, cystic fibrosis which affect the lungs.  Previously adult lungs were also avoided due to size discrepancy between adult lungs and those of children.  The availability of adult lungs is much greater than children.

HHS Secretary Sibelius approves recommendations for lung transplant in child.

 

The criteria for lung transplantation in children with cystic fibrosis has been expanded .

 

 

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