5E-HITECH, EMR, Client-Server, Clouds, SaaS, ASP, CHISP 2...

1

HITECH, EMR, C/S, Clouds, SaaS, ASP, CHISP

…WHAT?

American Society of Health Informatics Managers™

Presenter: Stephanie L. Cecchini, CPC, CEMC, CHISP 1

Objectives

• Introduce “Health IT”

• Learn the roles and responsibilities of Health IT staff in physicianLearn the roles and responsibilities of Health IT staff in physician practices

• Find out what Computer Science Skills can turn clinical staff into Health IT Professionals

• Learn the Basic Language of Health IT

• Discover how Experts select an Electronic Health Record

• Gain knowledge of Health IT Rules, Regulations, and Standards

ASHIM.ORG 1.877.263.1261

Gain knowledge of Health IT Rules, Regulations, and Standards (psssst….your auditors know them!)

2

2

INTRODUCTION

3

Exploding Growth in Health IT

• 11 % growth rate in 2009‐‐outpacing all other segments of the $1 trillion global health care marketg

• 450,000 providers operate with paper charts

• $19 Billion in EHR incentives to EP

• 5 Year deadlines and penalties

• Shortfall of 50,000+ qualified Health IT workers

ASHIM.ORG 1.877.263.1261

4

3

What Does $19 Billion Dollars look like?

ASHIM.ORG 1.877.263.1261

5

JOB ROLES IN HEALTH IT

6

4

Job Titles

• Common Positions:

– Clinical and medical informatics leaders

– Technical and IT security positions

– Directors, managers/supervisors, and team leads

– Project management professionals

– Application and implementation specialists

– EMRs analysts, data analysts, web designers, EMR architects, interface experts

– Sales, marketing and business development

ASHIM.ORG 1.877.263.1261

7

Specialized Job Roles

• Clinical/Practitioner Consultants

• Practice Workflow and Redesign SpecialistPractice Workflow and Redesign Specialist

• Implementation Managers and Support Specialist

• Trainers

• IT and Support Staff

• Sales, Marketing, and Operations Management

ASHIM.ORG 1.877.263.1261

8

5

Job Titles• Entry level:

– Application Analysts

– Help Desk Specialists, and more.

• Previous clinical experience (i.e. CPC, CCS, and RN)

– Clinical Software Trainers

– EHR Implementation Specialists

– Practice Management and Consulting

– Practice Work Flow Analysts, and more.

• Previous IT experience:

– Application Development

– Network Engineers

ASHIM.ORG 1.877.263.1261

– Programmers

– Database Professionals

– Systems Administrators, and more.

9

Identifying Positions

• Indeed.com

– FloridaFlorida

– California

– Ohio

– Texas

• Search Terms:

– EMR IMPLEMENTATION OR SUPPORT

“H lth IT”

ASHIM.ORG 1.877.263.1261

– “Health IT”

10

6

Technical Skills

• Computer Science Skills Needed by Clinical Staff

– Operating EMRs and Program Languages

– Data securityData security

– Data queries

• Clinical knowledge Needed by IT Staff

– Medical Terminology and Anatomy

– Workflow

– Regulatory

• Industry specific knowledge Needed in Sales and Exec Management

ASHIM.ORG 1.877.263.1261

– IT and Health Care Models in EMR

– Workflow

– Regulatory

11

COMPUTER SCIENCE CONCEPTS

12

7

Recognize Popular Operating Systems & Uses

• Windows

• Mac OS

• UNIXUNIX

• Linux

– Common applications for server operating systems:

• File and printer sharing

• Application services (including databases)

• Website services

E il d i

ASHIM.ORG 1.877.263.1261

• E‐mail, groupware and messaging

• Terminal services

• Caching

13

Health IT Programming Terms to Understand

• Markup: information added to (web) content, usually through the use of Tags.

• Tag: A Tag is an element used to denote Markup.g g p

• HTML (Hypertext Markup Language): HTML defined presentation for content.

• <B> Makes this content bold </B>

• XML (eXtensible Markup Language): User defined structured information and data

• <pqri‐measure‐number>NQF 0435</pqri‐measure‐number>

ASHIM.ORG 1.877.263.1261

pq /pq

• JavaScript: a program script that can get data

14

8

Basic Concepts in Data Security

• Internet security

– Firewalls and proxy servers

• Authentication

– A two‐factor (T‐FA) or (2FA) authentication system uses two factors—for example, an ATM card with a PIN.

• Wireless Networks

– Wireless Personal Area Networks (WPANs) (i.e. Bluetooth)

– Wireless Local Network (WLAN) is based on IEEE (Institute of Electrical

ASHIM.ORG 1.877.263.1261

Wireless Local Network (WLAN) is based on IEEE (Institute of Electrical and Electronic Engineers) 802.11 standards and interconnects a larger area (i.e. a building).

– Wi‐Fi Protected Access (WPA and WPA2) is a security protocol that certifies a secure wireless computer network.

15

Basic Concepts in Data Security

• Cryptography

– Encryption: PPK

– Hashing: A “hash” is a number that uniquely identities text in aHashing: A hash is a number that uniquely identities text in a message.

• Two different messages will not produce the same hash results.

– Digital signatures: Combines the public key encrypted message, with a hash and a private key, that can only be opened by the public key

ASHIM.ORG 1.877.263.1261

– Public Key Infrastructure: storing, managing and maintaining the public and private keys

16

9

Public and Private Keys

ASHIM.ORG 1.877.263.1261

17

Secure Data with PPK

ASHIM.ORG 1.877.263.1261

18

10

Integrity & Digital Signature

ASHIM.ORG 1.877.263.1261

19

Perform Data Queries to Report Information

• SQL (Structured Query Language) is a standard language with the ANSI (American National Standards Institute) for accessing databases.

• SQL statements are written to “fetch” information from tables that are• SQL statements are written to “fetch” information from tables that are located in a relational data base.

• SQL understands a set of rules that are communicated with keywords, punctuation, spaces, mathematical operators, and characters that have meaning when used inside of query statements.

– SELECT

– FROM

ASHIM.ORG 1.877.263.1261

– WHERE

– GROUP BY

– ORDER BY

20

11

RDBMS

• RDBMS (Relational Database Management Systems) are software programs used to maintain data records and indices in tables.

• RDBMS software rules are similar, but vary by program

ASHIM.ORG 1.877.263.1261

– MS SQL Server, IBM DB2, Oracle, MySQL, Microsoft Access, etc.

21

SQL Commands

• SELECT tells SQL what column/s to go to get the data and how much detail you are asking for from that column.

• FROM tells SQL what table/s to go to find the data.

SELECT pt id pt name FROM Patients

ASHIM.ORG 1.877.263.1261

– SELECT pt_id, pt_name FROM Patients

• WHERE tells SQL the special conditions you want applied to the data. It is like giving a more detailed map to SQL in order to limit data to the exact data you want.

• SELECT pt_id FROM Patients WHERE pt_id = ‘10000000001’

22

12

More SQL Commands

• GROUP BY is used when an aggregate function is used and more than one column is selected. It tells SQL how you want to group the data .

– AVG() ‐ Returns the average value

– COUNT() ‐ Returns the number of rows

– FIRST() ‐ Returns the first value

– LAST() ‐ Returns the last value

– MAX() ‐ Returns the largest value

MIN() Returns the smallest value

ASHIM.ORG 1.877.263.1261

– MIN() ‐ Returns the smallest value

– SUM() ‐ Returns the sum

• ORDER BY tells SQL how to sort the data results.

23

Example SQL Query

ASHIM.ORG 1.877.263.1261

24

13

THE BASIC LANGUAGE OF HEALTH IT

25

Health ITStakeholders

ASHIM.ORG 1.877.263.1261

26

14

ARRA and HITECH

• The Health Information Technology for Economic and Clinical Health Act, or HITECH Act, is a part of the Recovery Act

• An incentive payment program to encourage eligible professionals and hospitals to use electronic health records (EHR).

• EPs = OVER 10% outpatient

― Physicians, Dentists, Podiatrists, Optometrists, Chiropractors

• Non EP= UNDER 10% outpatient

ASHIM.ORG 1.877.263.1261

p

― ED physicians, anesthesiologists, and pathologists

27

HITECH Medicaid Payments• Apply and register with CMS (needs NPI)• Up to $64K• Does not require MU to be demonstrated before payments begin• Payments begin when state is ready to administer the program• Payments begin when state is ready to administer the program. • 30% Medicaid Pts (or 20% for Pediatricians) • No penalty for non‐participation in HITECH

HITECH Caps 85% Max Incentive

$25,000 in Year 1 $21,250$63,750

$10,000 in Years 2‐6 $8,500

ASHIM.ORG 1.877.263.1261

28

For Pediatricians under 30% Medicaid Patients

$16,667 in Year 1 $14,167$42,500

$6,667 in Years 2‐6 $5,667

15

HITECH Medicare Payments• Apply and register with CMS (needs NPI)

• Up to $44K

• Requires 90 days MU before payments begin

C d t 75% f MFS ll bl l f• Capped at 75% of MFS allowable or lesser of…

ASHIM.ORG 1.877.263.1261

• Penalties as follows….

29

HITECH Medicare Reductions

• For most office‐based physicians who do not adopt EHR technology by 2015, Medicare payments will be reduced by:y p y y

From YearReduction in Medicare

Payments

2015 1%

2016 2%

ASHIM.ORG 1.877.263.1261

2017+ 3%

30

16

Dates for 2011 Medicare Adopters

• January

– Registration for the Medicare Incentive begins.

• AprilApril

– 90% Attestation for the Medicare Incentive begins.

• May

– EHR Incentive Payments expected to begin.

• October

– Last day for to begin 90‐day reporting period for CY 2011

ASHIM.ORG 1.877.263.1261

y g y p g p

• February 29, 2012

– Last day to register and attest to receive $ for (CY) 2011.

31

Meaningful Use

• To qualify for incentive payments an EP must become a “meaningful users” of technology

– “Don’t make perfect the enemy of good”

• Stage 1: Implement base EHR technology

• Stage 2: Expand HIE health information exchange.

• Stage 3: Pt‐centered HIE that improves population health.

First Payment YearPayment Year

2011 2012 2013 2014 2015

2011 Stage 1 Stage 1 Stage 2 Stage 2 Stage 3

ASHIM.ORG 1.877.263.1261

32

0 Stage Stage Stage Stage Stage 3

2012 Stage 1 Stage 1 Stage 2 Stage 3

2013 Stage 1 Stage 2 Stage 3

2014 Stage 1 Stage 3

2015 Stage 3

17

MU Stage 1

• EP must meet objectives from 4 categories

– Category 1: “Core” objectives (15)

– Category 2: “Menu‐set” objectives (5 of 10)

– Category 3: “Core” Clinical Quality Measures (3 of 6)

– Category 4: “ Menu Set” Clinical Quality Measures (3 of 38)

ASHIM.ORG 1.877.263.1261

33

MU 1 ‐ Cat 1: Core Objectives1. Tested ability to exchange data with other EMRs

2. 50% of visits record basic Pt demographic information

3. 80% of visits document a current Pt problem list

4. 80% of visits document current medication lists

f d ll5. 80% of visits document allergies

6. 50% of visits document vital signs (ht and wt for children)

7. 50% of visits document smoking status

8. At least one EHR clinical decision support rule and alert

9. 100% Drug‐drug, drug‐allergy, drug‐formulary checks

10. 40% e‐Rx (retail pharmacy)

11. 30% CPOE (for medication orders)

12. 50% of visits provide the Pt a clinical summary (w/in 3 days)

13 0% f i i id h h ( /i 3 d )

ASHIM.ORG 1.877.263.1261

13. 50% of visits provide the Pt a chart copy (w/in 3 days)

14. Ability to report on meaningful use CMS quality measures

15. Keep Pt data private & secure ‐ HIPAA risk analysis with action plan

34

18

MU 1 ‐ Cat 2: Menu‐Set Objectives (5 of 10)

1. Tested ability to transmit immunization information to registries

2. Tested ability to send data to public health agencies

3 10% of visits provide Pts with education resources3. 10% of visits provide Pts with education resources

4. 10% of visits provide Pts with lab results within 4 days of report

5. 50% of new visits include Rx Reconciliation – current to best‐choice

6. Implement a drug formulary accuracy check

7. 50% of outbound Pt referrals provide a summary of care record

8. 40% of Pt visits incorporate lab test results into the EHR

9. Ability to generate reports of Pts with a specific defined condition

ASHIM.ORG 1.877.263.1261

9. Ability to generate reports of Pts with a specific defined condition

10. Follow‐up reminders to 20% of Pts (Internet or phone)

35

MU 1‐ Cat 3: Clinical Quality Measures (3 of 6)

• Required “Core” Clinical Quality Measures:

1. NQF 0013: Hypertension: Blood Pressure Measurement

2. NQF 0028: Preventive Care and Screening Measure Pair: a.) Tobacco Use Assessment; b.) Tobacco Cessation Intervention

3. NQF 0421: PQRI 128 Adult Weight Screening and Follow‐up

If the Denominator (all patients that meet the defined properties) is Zero…

• Alternate “Core” Quality Measures:

1 NQF 0024: Weight Assessment and Counseling for Children and

ASHIM.ORG 1.877.263.1261

1. NQF 0024: Weight Assessment and Counseling for Children and Adolescents

2. NQF 0041: PQRI 110 Preventive Care and Screening: Influenza Immunization for Pts ≥ 50 Years Old

3. NQF 0038: Childhood Immunization Status

36

19

MU 1‐ Cat 4: Clinical Quality Measures (3 of 38)

1. NQF 0031/PQRI 112 ‐ Breast Cancer Screening.

2. NQF 0027/PQRI 115 ‐ Smoking and Tobacco Use Cessation

3. NQF 0055/PQRI 117 ‐ Adult Weight Screening Follow‐Up

20. NQF 0067/PQRI 6 ‐ Coronary Artery Disease (CAD)

21. NQF 0083/PQRI 8 Heart Failure (HF)


23. NQF 0084/PQRI 200 ‐ Heart Failure (HF)

24 NQF 0068/PQRI 204 I h i V l Di (IVD)4. NQF 0004 – Initiation Alcohol Drug Dependence Tx

5. NQF 0018 ‐ Controlling High Blood Pressure

6. NQF 0075 ‐ Ischemic Vascular Disease (IVD)

7. NQF 0105/PQRI 9 ‐ Anti‐depressant medication manage

8. NQF 0036 ‐ Use of Appropriate Medications for Asthma

9. NQF 0002/PQRI 66 ‐ Testing for Children with Pharyngitis

10. NQF 0043/PQRI 111 ‐ Pneumonia Vac Status Older Adults

11. NQF 0047/PQRI 53 ‐ Asthma Pharmacologic Therapy

12. NQF 0001/PQRI 64 ‐ Asthma Assessment

13. NQF 0034/PQRI 113 Colorectal Cancer Screening

14 NQF 0012 ‐ Prenatal Care

24. NQF 0068/PQRI 204 ‐ Ischemic Vascular Disease (IVD)

25. NQF 0059/PQRI 1 ‐ Diabetes





30. NQF 0073/PQRI 201 ‐ Ischemic Vascular Disease (IVD)

31. NQF 0575 ‐ Diabetes

32. NQF 0086/PQRI 12 ‐ Primary Open Angle Glaucoma

33. NQF 0088/PQRI 18 ‐ Diabetic Retinopathy

34. NQF 0089/PQRI 19 ‐ Diabetic Retinopathy 14. NQF 0012 Prenatal Care

15. NQF 0014 ‐ Prenatal Care: Anti‐D Immune Globulin

16. NQF 0032 ‐ Cervical Cancer Screening

17. NQF 0033 ‐ Chlamydia Screening for Women.

18. NQF 0081/PQRI 5 ‐ Heart Failure (HF)


/ p y

35. NQF 0387/PQRI 71 ‐ Oncology Breast Cancer

36. NQF 0385/PQRI 72 ‐ Oncology Colon Cancer

37. NQF 0389/PQRI 102 ‐ Prostate Cancer

38. NQF 0052 ‐ Low Back Pain

37

Accrediting Bodies ‐ EHR

• EHR technology must be certified to be eligible for HITECH

– Temporary Certification Program: The EHR has been– Temporary Certification Program: The EHR has been certified by an ONC‐Authorized Testing and Certification Body (ONC‐ATCB, or ATCB).

– Permanent Certification Program The National Institute of Standards and Technology (NIST) through its National Voluntary Laboratory Accreditation Program (NVLAP) will be responsible for accrediting organizations to test health

ASHIM.ORG 1.877.263.1261

be responsible for accrediting organizations to test health information technology (particularly EHR technology) under the permanent certification program.

38

20

Health Information Exchange (HIE)

• HIE is the process of moving or sharing HIPAA protected health information (PHI) among organizations

• Exchange of clinical and, potentially, administrative datag p y

• Exchange of the continuity of care document (CCD)

• ePrescribing

• Medication history and reconciliation

• Delivery of lab results

• Management of a master patient index

• Record locator services

ASHIM.ORG 1.877.263.1261

• Electronic eligibility and claims transactions

• Computerized Physician Order Entry (CPOE)

• Provider portal

39

Health Information Exchange

ASHIM.ORG 1.877.263.1261

40

21

Basic Concept of an HIE

• Patient Index EMPI

Pt: ID # EMR

Stephanie L. Jones 1014 Leg1

S. Jones Z1245 Pharmacy

Steph Jones 123789 Leg1

Stephanie Jones 448899 Provider

ASHIM.ORG 1.877.263.1261

S.L. Jones 147010 Laboratory

41

CDS

• Clinical Decision Support (CDS) tools provide health care providers with Pt specific information to help prevent errors and improve healthcare efficiency at the time and location of the medical ydecision‐making. It is a real‐time reference that combines comparative, Pt specific information (such as the Pt’s signs and symptoms, allergies, and lab results) with general knowledge:

Diseases

Diagnoses

Medications

Treatments

ASHIM.ORG 1.877.263.1261

Treatments

Drug Formularies (coverage limitations)

Medical/Clinical Guidelines

Payer Requirements

42

22

e‐Rx

• E‐prescribing electronically transmits a new prescription or renewal authorization to a pharmacy. p y

• It can be accomplished as part of an EMR/EHR EMR or via an application service provider (ASP).

• According to the 2009 National Progress Report on e‐Prescribing, released by Surescripts—70 percent of physicians who do e‐prescribe do so through their EHR.

ASHIM.ORG 1.877.263.1261

43

CPOE• The EMR transmits the order to the appropriate place, department, or

individuals so it can be carried out.

– Medications

– Laboratory tests and Radiology and imaging tests

l d b k– Blood banks

– Therapies (e.g., physical, occupational, respiratory, rehabilitation)

– Consultations with specialists

– Surgical preparation and Recovery room protocols

– Discharges and Pt transfers and more

• This can reduce errors related to the interpretation of handwritten orders

• It provides an opportunity for real‐time clinical decision support such as d d l i di i i d li h

ASHIM.ORG 1.877.263.1261

dosage and alternative medication suggestions, duplicate therapy warnings, and drug‐drug, drug‐disease, drug‐lab value, and drug‐allergy interaction checking.

44

23

DICOM Standards and PACS EMRs

• Electronic Picture Archiving and Communication EMRs (PACS) store and receive diagnostic images in a

• PACS uses files and messages from a data dictionary called ( l d d )DICOM (Digital Imaging and Communications in Medicine)

ASHIM.ORG 1.877.263.1261

45This description is meant for purposes of illustration only.

RFID in Health Care

• Radio Frequency Identification (RFID) technology uses radio waves for the remote exchange of data between an RFID reader and a RFID tag, which is attached to a specific objectattached to a specific object.

– Blood banking: tagging of blood transfusions from donor to patient with active tags to provide alerts if blood has not been properly refrigerated.

– Medication administration: tagging of unit‐of‐use drugs for proper administration to reduce errors and to improve safety.

– Medication authentication and restocking: tracking of drug origin and expiration date so that the system can alert the caregiver in case an

ASHIM.ORG 1.877.263.1261

item is counterfeit, has expired or needs to be refilled.

– Patient tracking: RFID wristbands and physician laptop readers to automatically identify the patient name, blood type, allergies and medications.

46

24

Wireless Concepts in Health Care

• Mobile health (mHealth), also termed “wireless healthcare”

– Examples:Examples:

• Remote use of tablets,

• PDAs,

• Smartphones, and

• SMS texting

ASHIM.ORG 1.877.263.1261

47

EXPERT EMR SELECTION

48

25

Cloudy with a chance of …SAAS

• Runs on the Internet

• Storage, processing, security and bandwidth are run by vendorStorage, processing, security and bandwidth are run by vendor

• Usually cheaper

• Access can be easier‐‐‐and can also be an issue

• Speed can be an issue

• Requires ownership of data language in the contract

ASHIM.ORG 1.877.263.1261

49

Cost ‐ what’s a general idea?

ASHIM.ORG 1.877.263.1261

50

26

And, then what?

ASHIM.ORG 1.877.263.1261

51

Savings – What’s a general idea?

• Chart, Fax, Paper and Ink: $5 per Pt x 2496 = $12,480

• Pharmacy Calls: $.50 per Pt x 2496 = $1,248

• A/R: 3% on Collections: $364,800 A/R x .03 = $10,944

ASHIM.ORG 1.877.263.1261

• Storage/Destruction: $40 x 12 months = $480

Per Year $25,152

52

27

Example ROIC/S EMR ANALYSIS 2011 (90 days) 2012 2013 2014 2015 2016 TOTAL

TOTAL SAVINGS $ 6,288 $ 25,152 $ 25,152 $ 25,152 $ 25,152 $ 25,152 $ 132,048

IT COST $ 19,100 $ 8,700 $ 8,700 $ 8,700 $ 8,700 $ 8,700 $ 62,600

EMR VENDOR COST $ 52,500 $ 7,500 $ 7,500 $ 7,500 $ 7,500 $ 7,500 $ 90,000

CLOUD EMR ANALYSIS 2011 (90 days) 2012 2013 2014 2015 2016 TOTAL

TOTAL SAVINGS $ 6,288 $ 25,152 $ 25,152 $ 25,152 $ 25,152 $ 25,152 $ 132,048

IT COST $ 17,300 $ 11,900 $ 11,900 $ 11,900 $ 11,900 $ 11,900 $ 76,800

TOTAL COST $ 71,600 $ 16,200 $ 16,200 $ 16,200 $ 16,200 $ 16,200 $ 152,600

HITECH Medicare Payment $ 18,000 $ 12,000 $ 8,000 $ 4,000 $ 2,000 $ - $ 44,000

NET COST $ 53,600 $ 4,200 $ 8,200 $ 12,200 $ 14,200 $ 16,200 $ 108,600

RETURN (BEFORE INTEREST & TAX) $ (47,312) $ 20,952 $ 16,952 $ 12,952 $ 10,952 $ 8,952 $ 23,448

ASHIM.ORG 1.877.263.1261

53

EMR VENDOR COST $ 13,000 $ 8,000 $ 8,000 $ 8,000 $ 8,000 $ 8,000 $ 53,000

TOTAL COST $ 30,300 $ 19,900 $ 19,900 $ 19,900 $ 19,900 $ 19,900 $ 129,800

HITECH Medicare Payment $ 18,000 $ 12,000 $ 8,000 $ 4,000 $ 2,000 $ - $ 44,000

NET COST $ 12,300 $ 7,900 $ 11,900 $ 15,900 $ 17,900 $ 19,900 $ 85,800

RETURN (BEFORE INTEREST & TAX) $ (6,012) $ 17,252 $ 13,252 $ 9,252 $ 7,252 $ 5,252 $ 46,248

What questions should the Privider ask?

• When do I want to do this?• Have I looked at my choices and narrowed it to 3‐5 vendors?• How will it interface with my practice management software? • What is the structure of the license, and length of agreement? • What guarantees are offered for HITECH incentive payments? • What are the professional references of the EMR company?• What templates can be customized or dictated?• What is the total price; what’s included (and what’s not)?• What ad‐hoc reports can I run?• What training and ongoing support is provided? • Will I maintain complete data ownership?

ASHIM.ORG 1.877.263.1261

• Will I maintain complete data ownership?• What is the typical implementation period?• Have I negotiated the best price?• Can someone in my office “talk the talk”?

54

28

What about Productivity?

• Work flow preparation and planning

• Assume a 30‐50% reduction in visits for a “period of time”

Plan to extend hours– Plan to extend hours

• Reassignment of staff duties

ASHIM.ORG 1.877.263.1261

55

INTEROPERABILITY AND STANDARDS

56

29

Interoperability and Standards

• Structured Data

– Concept/names (Hypertension, High Blood Pressure)

– Name/concepts: I’m “cold,” I have a “cold,” or “COLD” (Chronic Obstructive Lung Disease)

• There are hundreds of “vocabularies” (i.e., terminologies or nomenclatures)

– SNOMED CT, CPT, ICD‐9, LOINC, RXNorm, etc.

– EHR vendors historically used proprietary

ASHIM.ORG 1.877.263.1261

y p p yvocabularies

• Final Standards Rule 45 CFR Part 170

57

Vocabulary Standards

• Problem List

– ICD‐9‐CM, Vols. 1‐2 or SNOMED CT® July 2009

• Procedures• Procedures

– ICD‐9, Vol. 3, CPT®, HCPCS Level II

• Laboratory Test Results

– Logical Observation Identifiers Names & Codes (LOINC®) version 2.27

• Medications

– Any source vocabulary that is included in RxNorm

• Immunizations

ASHIM.ORG 1.877.263.1261

Immunizations

– HL7 Standard Code Set CVX ‐ Vaccines Administered, July 30, 2009

• Race and Ethnicity

– OMB Standards Statistical Policy Directive No. 15, October 30, 1997

58

30

Content Standards

• Pt Summary Record

– HL7 Clinical Document Architecture Release 2 (CDA)– HL7 Clinical Document Architecture, Release 2 (CDA) Continuity of Care Document (CCD)

– ASTM E2369 Standard Specification for Continuity of Care Record

• Electronic Prescribing

– NCPDP SCRIPT Standard, Implementation Guide, Version 8

ASHIM.ORG 1.877.263.1261

– NCPDP SCRIPT Standard, Implementation Guide, Version 10.6

59

Content Standards (cont.)

• Electronic Submission of Lab Results to Public Agencies

– HL7 2.5.1

• Electronic Submission to Public Health Agencies• Electronic Submission to Public Health Agencies

– HL7 2.3.1

– HL7 2.5.1

• Electronic Submission to Immunization Registries

– HL7 2.3.1

– HL7 2.5.1

ASHIM.ORG 1.877.263.1261

• Quality Reporting

– The CMS Physician Quality Reporting Initiative (PQRI) 2009 Registry XML Specification

60

31

Privacy Standards

• Encryption and Decryption of ePHI

– Any encryption algorithm identified by the National Institute ofAny encryption algorithm identified by the National Institute of Standards and Technology (NIST) as an approved security function in Annex A of the Federal Information Processing Standards (FIPS) Publication 140‐2

• Verification Information not Altered in Transit

– A hashing algorithm with a security strength equal to or greater than SHA‐1 (Secure Hash Algorithm (SHA‐1) as specified by the

ASHIM.ORG 1.877.263.1261

National Institute of Standards and Technology (NIST) in FIPS PUB 180‐3 (October, 2008)) must be used to verify that electronic health information has not been altered

61

ICD‐9‐CM, Vols. 1‐2

• International Classification of Diseases, Ninth Revision, Clinical Modifications Volumes 1 and 2 are diagnosis codes. ICD‐9‐CM is gmade up of alphanumeric codes that represent diseases, conditions, or circumstances that has or could cause a person’s illness, injury, or death. Volume 3 contains procedure codes.

ASHIM.ORG 1.877.263.1261

ICD-9-CM ExampleICD-9-CM = 410.90 Acute myocardial infarction 410, Unspecified site 9, unspecified episode of care 0


32

SNOMED CT® July 2009

• SNOMED Clinical Terms® (SNOMED CT®) International Release –July 2009 are codes used for research and for sharing of information y gabout the Pt’s diagnosis and treatment. An update of the codes is done every six months. At its simplest, it contains three primary “core” tables: Concepts, Descriptions, and Relationships.

SNOMED CT Example:conceptId=22298006descriptionId=751689013|type=FullySpecifiedName|name=Myocardial infarctiondescriptionId=37436014|type=Preferred|name=Myocardial infarctiond i ti Id 37442013|t S | C di i f ti

ASHIM.ORG 1.877.263.1261

descriptionId=37442013|type=Synonym|name=Cardiac infarctiondescriptionId=37443015|type=Synonym|name=Heart attackdescriptionId=37441018|type=Synonym|name=Infarction of heartrelationshipId=184430024|relationship=Is a concept2=Disorder of myocardium (57809008)relationshipId=2689547022|relationship=Is a concept2=Structural disorder of heart (128599005)


CPT®

• Current Procedural Terminology (CPT®) procedure codes, published by the American Medical Association (AMA), represent procedures y ( ) p pperformed and billed by physicians.

• The format for CPT® codes is five characters. CPT® also may have modifiers up to two digits. For example: xxxxx‐xx.

ASHIM.ORG 1.877.263.1261


33

HCPCS Level II

• Healthcare Common Procedure Coding EMR (HCPCS) Level II codes are used to identify medications, medical supplies, and some y ppmedical procedures.

• The format for HCPCS Level II codes is up to five characters. For example: xxxxx.

ASHIM.ORG 1.877.263.1261


Logical Observation Identifiers Names and Codes (LOINC®)

• LOINC are open source codes used to identify laboratory clinical observations and results. LOINC is updated every six months p y(LOINC 2.27 was released July 7, 2009). LOINC is available as a Microsoft Access (.mdb) database file and a tab‐delimited text file (.txt).

ASHIM.ORG 1.877.263.1261

LOINC Example:CODE<component/analyte>:<kind of property>:<time aspect>:<EMR type>:<scale>:<method>5193-8 <Hepatitis B virus surface Ab>:< ACnc >:< Pt> :< Ser >:< Qn >:< EIA >


34

RXNorm

• RxNorm provides unique identifiers for clinical drugs from 11 source vocabularies (including SNOMED CT, FDA, VA, First DataBank Inc., etc ) It is a set of relational tables that organize data by conceptsetc.). It is a set of relational tables that organize data by concepts. Drugs that are identical in name, ingredients, strengths, and dose forms are grouped together with the same unique code

ASHIM.ORG 1.877.263.1261

392151 AMOXICILLIN 200 MG ORAL TABLET392151 Amoxicillin 200 MG Oral Tablet392151 Amoxicillin trihydrate 200 mg tablet392151 Amoxicillin trihydrate 200 mg tablet (product)

EXAMPLE: RxCUI = 392151


Health Level Seven (HL7)

• Health Level Seven (HL7) is an XML‐based language, which provides a uniform format for the transmission of health‐related information. It provides a “messaging standard,” which is a set of rules that enable clinical applications to exchange data. These messages are in a human‐readable format but require some interpretation.

ASHIM.ORG 1.877.263.1261

HL7 Message Example:MSH|^~\&|AccMgr|1|||20090112154645||ADTÂ03|59912415|P|2.3||| EVN|A03|20090112154642||||| PID|1||10006579^^^1^MRN^1||SMITH^DONALD^D||19241010|M||1|111^SMITH ST^^FOWL^CA^999990000^^M|1|8885551212|8885551212|1|2||40007716^^ÂccMgr^VN^1|123121234|||||||||||NO PV1|1|I|IN1^214^1^1^^^S|3||IN1^214^1|37^JONES^WALT^^^^^ÂccMgr^^^^CI|||01||||1|||37^JONES^WALT^^^^^ÂccMgr^^^^CI|2|40007716^^ÂccMgr^VN|4|||||||||


35

HL7 Standard Code Set CVX

• The Center for Disease Control and Prevention’s (CDC’s) National Center of Immunization and Respiratory Diseases (NCIRD) maintains p y ( )the HL7 external code set CVX. The codes in HL7 Version 2.3 table 0292, represent the initial content of the external CVX code, which was added by the CDC in order to remain current with new vaccines. The code set consists of two‐ to three‐digit code, short description, and full vaccine name.

ASHIM.ORG 1.877.263.1261

69

ASTM Specification for Continuity of Care Record (CCR)

• ASTM E2369 is an XML based language, which provides a uniform format for the transmission of health‐related information.

– It references the following content: • Information Source ‐ Required• Person Information ‐ Required• Language Spoken ‐ Required if known• Support ‐ Required if known• Advance Directive ‐ Optional • Allergy / Drug Sensitivity ‐ Optional • Comment ‐ Optional • Condition/Problem ‐ Optional • Encounter ‐ Optional • Health care Provider ‐ Optional • Immunization ‐ Optional • Payers ‐ Optional

ASHIM.ORG 1.877.263.1261

y p• Medication Prescription and Non‐Prescription ‐ Optional • Plan of Care ‐ Optional • Pregnancy ‐ Optional • Procedure ‐ Optional • Vital Sign ‐ Optional • Results ‐ Optional

70

36

Physician Quality and Reporting Initiative (PQRI)

• PQRI, first created as a Medicare quality reporting program. PQRI is reported in a CMS‐approved XML format. The 179 PQRI measures p ppwere developed by various organizations. The denominator (total number of Pts in the measured population) defines the condition or aspect of care.

– Example: PQRI 112 Breast Cancer Screening. Description: Percentage of women 40‐69 years of age who had a mammogram to screen for breast cancer.

ASHIM.ORG 1.877.263.1261

71

Visit our Booth #105

• Use code:

LongBeachRocks

To receive a special chance to win prizes and special discounts on ASHIM educational materials, references,

and merchandise

ASHIM.ORG 1.877.263.1261

72

37

Questions?

Stephanie Cecchini, CPC, CEMC, CHISPAmerican Society of Health Informatics Managersy g

Toll Free: 877‐263‐1261Fax: 801‐236‐2258

http://ashim.org/

ASHIM ON FACEBOOK: http://www.facebook.com/ashimorg

ASHIM ON TWITTER: http://twitter.com/ASHIMORG

ASHIM.ORG 1.877.263.1261

p

ASHIM ON LINKED IN http://www.linkedin.com/groups?gid=2185050

73

About the Speaker

Stephanie L. Cecchini, CPC, CEMC, CHISP is SVP at the American Society of Health Informatics Managers, Inc. where she continues a longtime commitment to best serve the needs of the Health IT community and physicians who are using and adopting health IT. Stephanie is an

ti l l h lth lt t ith i ifi t d b d b l t h lthexecutive level healthcare consultant with significant and broad ambulatory healthcare business experience including: ROI decision support for EHR adoption or alternate planning, payer matrix strategies and negotiations, billing and collections with Medicare, Medicaid and all lines of commercial payer business, revenue cycle and cash flow management, work‐flow analysis, change management, physician record granularity training (Evaluation & Management and 1CD‐10), and development of “train the trainer” education models.

She brings to her position more than fifteen years’ involvement in health care regulations compliance including: overpayment recovery demand response, STARK compliance, OIG risk assessment with audit and plan (CPT, HCPCS, and ICD‐9 coding and billing), HIPAA privacy,

ASHIM.ORG 1.877.263.1261

assessment with audit and plan (CPT, HCPCS, and ICD 9 coding and billing), HIPAA privacy, security, and transactions, and now the recent HITECH stimulus eligibility and meaningful use compliance.

.

74

5E-HITECH, EMR, Client-Server, Clouds, SaaS, ASP, CHISP 2...

Documents

Transcript of 5E-HITECH, EMR, Client-Server, Clouds, SaaS, ASP, CHISP 2...