Monthly Archives: January 2015

HL7 Proposes New Interoperability Standards for Health IT

Sharing is caring.  We’ve all heard this phrase, right?  Well, this also applies to healthcare data, too.  The past decades where healthcare has become more and more digitized means that there’s more and more electronic data being housed.  As interoperability becomes increasingly inevitable, there are some real growing pains that we all have encountered while trying to share this information to others, even those within the same institution.  Because vendors, governmental agencies (even those within the federal government), private and public institutions were all speaking their own (data) language, trying to exchange information was a bit of a headache, to say the least.  HL7 has recognized this and have proposed an interoperability standard known as FHIR, or Fast Health Interoperability Resources. What would it look like?  Here’s an excerpt from this govhealthit.com article:

“FHIR is attractive primarily because it is based on a truly modern web services approach (and one used by companies such as Yahoo, Facebook and Google). This approach makes it easier for systems to exchange very specific, well-defined pieces of information, rather than entire documents.Today in HIT, the common standard is one based on what is known as C-CDA, or Consolidated Clinical Document Architecture. And unfortunately, C-CDA is designed to transfer entire documents, rather than a single piece of data or a simple list.

This means that today, when a physician requests just one piece of information about a patient, the system often needs to transfer multiple documents to fulfill the request. This process can often be inefficient, because a physician may have to search through many pages of information to find just one piece of needed data.

FHIR, on the other hand, makes it simple for anyone to receive only, and specifically, the piece of information requested. FHIR also allows access to smaller or “granular” data elements that are not included in some clinical documents.”

Is this going to revolutionize healthcare data like HIPAA did back in the early 2000s?

EHRs: Once Implemented, You Can’t Just Forget It

All too often in mid-size to smaller organizations (across any industry, really), time and effort is not really dedicated to optimizing a technology once implemented unless it’s an emergency.  That seems to also be the case for EHRs.  For most providers especially smaller physician groups that used a paper-based system, this has been especially hard.  However, larger providers such as hospital groups are experiencing similar pains.  (Remember the first U.S. Ebola case a few months ago partially being blamed on the Epic clinical workflow?  At the time of implementation, I’m sure Ebola was not on the mind of the vendor nor of the client).  Here is an article that talks about this further w/researchers exploring this at Scott and White Health System.

CMS is Serious about Hospital Acquired Conditions and is Punishing Where it Hurts-the Pocketbook

One uses of Medicare claims data is to assess and monitor different quality issues including HACs (Hospital Acquired Conditions). These are events deemed as preventable and avoidable by the hospital including bed sores, infections from catheters, and other infections that are typically recognized as being avoidable.  CMS has cracked down by cutting Medicare payments to the tune of $373 million to 721 hospitals that are deemed at having the worse rates of patient infections and injuries.  These include hospitals that I was shocked to hear were included:  Brigham and Womens, The Cleveland Clinic, and Geisinger.

In determining the HAC penalties, Medicare judged hospitals on three measures: the frequency of central-line bloodstream infections caused by tubes used to pump fluids or medicine into veins, infections from tubes placed in bladders to remove urine, and rates of eight kinds of serious complications that occurred in hospitals, including collapsed lungs, surgical cuts, tears and reopened wounds and broken hips. Medicare tallied that and gave each hospital a score on a 10-point scale. Those in the top quarter — with a total score above 7 — were penalized, states the article.

This puts more pressure on hospitals to not only ensure their employees are following universally accepted infection control protocol such as frequent hand washing and computerized physician orders instead of being hand-written (and therefore subject to interpretation errors) but to also ensure clinical documentation and thereby claims billing accurately reflects the patient’s medical condition severity.  One way to do this?  You guessed it—-implement ICD-10.