NHS England attempts (another) digital overhaul with £230m investment in IT

Derek du Preez | On April 4, 2014

The UK’s Health Secretary, Jeremy Hunt, made a rather bold statement last year. He declared that by 2018 he wants the National Health Service (NHS) transformed into a paperless organisation supported by new digital technologies – which if successful, could save taxpayers a whopping £4.4 billion a year. This gives an organisation that is now over 65 years old and which is sprawled across the country just four years to overhaul legacy systems and hop on the digital bandwagon.

A key milestone in this paperless agenda was revealed this week – NHS England pushed out a strategy document that outlines how it plans to invest £230 million in ‘high quality’ IT systems for General Practices. Something it hopes will go a long way to achieving Hunt’s vision. But, before we get too excited about this, let’s just remind ourselves that the government’s last attempt to overhaul IT in the NHS was a complete and utter disaster. Not only did it waste billions of pounds with suppliers, which frankly have failed to deliver bugger all, but UK taxpayer is still set to dish out hundreds of millions of pounds despite the project having being ‘canned’.

Not only this, but more recently the NHS has faced a backlash over controversial plans to extract, store and sell on ‘unidentifiable’ patient data from GP systems – a subject that Stuart has been following closely for a while now. Needless to say, health IT in the UK has a chequered past and the government has a lot riding on getting it right this time round.

Aim: Bettering the patient experience

The plan, or the ‘operating model’ as NHS England puts it, states that the money is going to be used to improve the quality of GP care by enhancing patients’ experience of services, support and encourage greater integration of care and provide efficiency benefits for practices by reducing paperwork, freeing up more time for the patients. All good in theory.

How to make a healthcare data sharing controversy worseYou’ve got to hand it to the UK government. If there was one way to make its plans to build a hugely…Feb 26 2014diginomica.com

The general idea is that the £230 million GP funding for IT will be distributed to Clinical Commissioning Groups based on patient population size (CCGs are groups of Practices that work together to plan and design local services across England). NHS England claims that this will ensure “equity across all parts of England based on a core IT service offer”. Alongside this, there will be a range of ‘add-on IT services’ which can be tailored and implemented to fit with local service improvement strategies – but more on that later.

Beverly Bryant, director of strategic systems and technology at NHS England said:

“Digital systems are the foundation upon which to build a modern, efficient and responsive health service. Enabling information to flow between care providers and between providers and patients will help achieve a safe, convenient and personalised health service for all.”

It is hoped that the investment will create online transactions for patients that include booking appointments, ordering repeat prescriptions and accessing individual health records online. It also supports the aim of implementing integrated digital care records across the NHS – the main stumbling block with previous projects – which should give health professionals access to patient information they need, without patients having to provide the same details to multiple agencies.

A push for localisation? 

One of the most interesting points to be taken from this announcement was highlighted by Tracey Grainger, programme head of Primary Care IT at NHS England. She said:

“These arrangements will continue to give general practice providers a choice of high quality clinical IT systems that are tailored to local requirements while enabling the flexibility and innovation we recognise the service needs. This is underpinned by an on-going commitment from NHS England to continue to support and encourage the development of a world class IT infrastructure across health and care.”

The salient point here being one of localisation. The strategy plan outlines that the IT investment will be split into ‘core’ IT services, which includes things like infrastructure, disaster recovery, service desk, training support, and ‘add-on GP IT services’ – which are discretionary and to be aligned with local CCG strategies. For me, this is the smartest thing I have heard so far.

One of the biggest mistakes from the previous National Programme for IT (the multi-billion pound disaster) was that the government tried to implement a monolithic, standardised system from the top down, with complete disregard for local requirements. Although all Practices and health services fundamentally provide similar care, they are also bound to have different business processes, capabilities and needs – as is the same with any other sector.

In fact, former NHS chief executive Sir David Nicholson said exactly this to a group of MPs last year when questioned on whether he thought it was possible procure a national IT project for health. His exact words were:

“The idea of ruthless standardisation has proved illusionary…the idea of managing change of that nature, from the top, centrally, simply is not possible.”

Verdict

1. Although I’m wary of being too optimistic – given that this is an IT health project in the UK – there are some things I like about this. Distributing money based on population size makes sense. Giving the money to CCGs to spend based on local requirements makes sense. Splitting the services into core and add-on makes sense.
2. However, I do think that the Health Secretary’s 2018 target for a paperless NHS is unrealistic. This is an organisation that is incredibly unique and incredibly complex. Not to say that good work can’t be done in the next four years, but let’s not rush it and let’s learn from mistakes of the past. The last thing we need is another few hundred million pounds of taxpayer money down the drain.

http://diginomica.com/2014/04/04/nhs-england-attempts-another-digital-overhaul-230m-investment/

HHS Releases HIPAA Compliance Assessment Tool

By Katie Wike, contributing writer

New HHS tool helps providers assess security risks to HIPAA compliance

According to HealthIT.gov, “ONC, in collaboration with the HHS Office for Civil Rights (OCR) and the HHS Office of the General Counsel (OGC), developed a downloadable Security Risk Assessment Tool (SRA Tool) to help guide” providers through the HIPAA-required assessment.

The Security Risk Assessment (SRA) Tool is meant to help providers in small to medium offices conduct risk assessments and, a HIPAA regulations require providers to regularly examine the way protected health information is handled, this new tool is a valuable asset to those looking for a way to meet the requirement.

“By conducting these risk assessments, healthcare providers can uncover potential weaknesses in their security policies, processes and systems. Risk assessments also help providers address vulnerabilities, potentially preventing health data breaches or other adverse security events. A vigorous risk assessment process supports improved security of patient health data,” wrote HHS in a press release.

"Protecting patients' protected health information is important to all healthcare providers and the new tool we are releasing today will help them assess the security of their organizations," said Karen DeSalvo, M.D., national coordinator for health information technology. "The SRA tool and its additional resources have been designed to help healthcare providers conduct a risk assessment to support better security for patient health data."

"We are pleased to have collaborated with the ONC on this project," said Susan McAndrew, deputy director of OCR's Division of Health Information Privacy. "We believe this tool will greatly assist providers in performing a risk assessment to meet their obligations under the HIPAA Security Rule."

http://www.healthitoutcomes.com/doc/hhs-releases-hipaa-compliance-assessment-tool-0001

Humana’s latest digital health pilot will test remote patient monitoring for Type 2 diabetes

Over the last nine months, Humana (NYSE:HUM) has undertaken a series of pilot projects aimed at testing the potential of remote patient monitoring in reducing hospital readmissions, improving health outcomes and cut costs.

Its latest program, called Activities in Daily Living, will utilize an engagement platform from Pharos Innovations to help its Medicare Advantage members better manage their Type 2 diabetes at home.

Humana said that select members in Illinois, Wisconsin, Michigan and Texas who have diabetes and take insulin or another diabetes medication will use Pharos’ Tel-Assurance platform to self-report health information like blood sugar levels, symptoms, diet and medication adherence daily. They can use a cellphone, telephone or internet to report the information, which will be reviewed by Tel-Assurance nurses. The nurses who will reach out to the member if any of the data indicates complications or cause for concern.

“We’re expecting to reduce unnecessary inpatient admissions and to improve self-care management,” a Humana rep said in an email.

This is the fourth remote monitoring pilot Humana has launched recently. It partnered with home health monitoring Valued Relationships Inc. and Healthsense on two separate pilots aimed at using sensors and medical alert systems to reduce serious long-term effects of falls and emergencies, and cut unnecessary emergency room visits. The insurer is also working with AMC Health on a pilot program using remote monitoring to improve congestive heart failure outcomes.As health insurers adapt to consumer-driven health and accountable care models, they’re making moves to do a better job of proactively engaging members in their health.

The diabetes pilot will run for six months and include 500 members.

Read more: http://medcitynews.com/2014/04/humanas-latest-digital-health-pilot-will-test-remote-patient-monitoring-type-2-diabetes/#ixzz2xugY0AEI

Burnt Out Primary Care Docs Are Voting With Their Feet

This KHN story was produced in collaboration with 

Janis Finer, 57, a popular primary care physician in Tulsa, Okla., gave up her busy practice two years ago to care full time for hospitalized patients. The lure? Regular shifts, every other week off and a 10 percent increase in pay.

Illustration by Doug Chayka

Lawrence Gassner, a Phoenix internist, was seeing four patients an hour. Then he pared back his practice to those who agreed to pay a premium for unhurried visits and round the clock access to him.  "I always felt rushed," said the 56-year-old. "I always felt I was cutting my patients off."

Tim Devitt, a family physician in rural Wisconsin, took calls on nights and weekends, delivered babies and visited his patients in the hospital. The stress took a toll, though: He retired six years ago, at 62.

Physician stress has always been a fact of life.  But anecdotal reports and studies suggest a significant increase in the level of discontent-especially among primary care doctors who serve at the frontlines of medicine and play a critical role in coordinating patient care.

Just as millions of Americans are obtaining insurance coverage through the federal health law, doctors like Finer, Gassner and Devitt are voting with their feet. Tired of working longer and harder because of discounted insurance payments and frustrated by stagnating pay and increasing oversight, many are going to work for large groups or hospitals, curtailing their practices and in some cases, abandoning primary care or retiring early.

"I was thinking of leaving medicine; I didn't think I could maintain the pace," Gassner said about why he switched to a concierge-style practice with the help of consultant MDVIP.  "I went to bed many nights lying awake, worrying that I missed something."

The timing couldn't be worse. "The lack of an adequate primary care infrastructure in the U.S. is a huge obstacle to creating a high-performing health care system," said David Blumenthal, president of The Commonwealth Fund, a health care research foundation.

A 2012 Urban Institute study of 500 primary-care doctors found that 30 percent of those aged 35 to 49 planned to leave their practices within five years. The rate jumped to 52 percent for those over 50.

Stressed doctors, meanwhile, often mean anxious, dissatisfied patients. Many consumers report feeling shortchanged after waiting weeks or even months for an appointment, only to get a quick once-over and be told there isn't time to address all their complaints in one visit.

"Your actual one-on-one with the doctor is getting to be less and less," said Christine Miserandino, 36, of Valley Stream, N.Y., who sees many doctors to manage her lupus.

Unhappy Doctors, Unhappy Patients

There are no hard national data on physician burnout. But nearly half of more than 7,200 doctors responding to a survey published in 2012 by the Mayo Clinic reported at least one symptom of burnout that indicated a loss of enthusiasm about medicine or cynicism about it. That's up from 10 years ago, when one quarter of doctors reported burnout symptoms in another survey.

A RAND study for the American Medical Association last year found that nearly half of surveyed physicians called their jobs "extremely stressful" and more than one-quarter said they were either "burning out," experiencing burnout symptoms "that won't go away," or "completely burned out" and wondering if they "can go on."  Nonetheless, many described themselves as satisfied with their profession.

But should the happiness of physicians - a fairly privileged lot - be of concern to their patients? Experts answer with a resounding 'yes,' saying that unhappy doctors can make for unhappy patients.

Indeed, one of the drivers of physician dissatisfaction is their sense they are shortchanging patients: that they are too rushed, don't have enough time to listen and aren't always providing good care.

"Being a doctor is a bit like being a parent, where they say you're only as happy as your least happy child," said Martin Kanovsky, 61, an internist in Chevy Chase, Md., who reduced the number of patients he is seeing from 1,200 to 400 last December when he switched to an MDVIP concierge practice. "At the end of the day, if you have one patient who's unhappy, you're unhappy."

Research shows that patients of satisfied doctors are more likely to show up for their appointments and adhere to treatment for diabetes and high blood pressure. Another survey found dissatisfied physicians reporting more difficulty than other doctors in caring for patients.

And in another study, burned-out surgeons were more likely to report having made a major medical error, in the past three months. 

"What drives physician satisfaction is also what patients and payers want - delivering good care. And we're less and less able to do that," said Christine Sinsky, an internist in Dubuque, Iowa, who is working with the AMA to try to improve physician satisfaction. "You spend less time listening to patients, getting to know them, and thinking more deeply about their care." 

'I Knew I Had To Be Able To Sleep At Night'

That was the situation that confronted Janis Finer, who loved - but ultimately left -primary care to work with hospital patients.

Like many physicians, she did not want to be bothered with the business of medicine -dealing with insurers, hiring staff and making bank deposits -and sold her practice to a hospital.

But hospital administrators dictated the pace, telling her she needed to see 22 to 28 patients a day.  "At one point, we were scheduled to see patients every 11 minutes," Finer said.

She was supposed to suggest they schedule another visit if they had more than one or two medical complaints. But Finer worried they wouldn't come back.

"I knew I had to be able to sleep at night," she said. "I was trained to dot every 'i,' and cross every 't' and leave no stone unturned."

If a patient had anemia, for example, she could simply prescribe iron, but she wanted to find out what was causing it. 

But she found she was unable to do such things while seeing so many patients.

At the same time, her income lagged far behind that of her peers in specialties, a pay disparity that irked her more over time. Salaries of primary care physicians were around $220,000 in 2012, according to the 2013 Medical Group Management Association's compensation survey, while specialists were averaging close to $400,000, with cardiologists and orthopedic surgeons earning over half a million dollars.

Efforts to boost compensation for primary care doctors have been largely unsuccessful. Specialists' pay is based largely on procedures, but primary care doctors are usually paid per visit, and not reimbursed for managing their patients' care outside of visits, which can consume a lot of their time.

Richard J. Baron, president of the American Board of Internal Medicine, set out to document how much time a doctor spends managing care and discovered that on a typical day, he or she handles 18.5 phone calls; reads 16.8 e-mails; processes a dozen prescription refills (not counting those written during a visit); interprets 19.5 lab reports; reviews 11 imaging reports; and reads and follows up on 13.9 reports from specialists.

"This is not just busy work -- this is about meeting the patients' needs," Baron said.  "But … it doesn't generate revenue."

'I Used To Be A Doctor; Now I'm A Clerk'

Perhaps the single greatest source of frustration for many physicians is a tool that was supposed to make their lives easier: electronic medical records.

Many do not merely dislike electronic health records - they despise them. "We were surprised by the intensity of their reports," said Mark Friedberg, a physician and co-author of last year's RAND study.

In 2009, President Obama committed billions of dollars to help defray providers' costs of going digital. The goal was to boost coordination of care and to reduce errors and rampant duplication. Most primary care doctors got financial help from the federal government and also face potential penalties beginning next year if they don't use the new systems.

But many physicians say that instead of speeding things up, digital records have slowed them down. They say the designs often frustrate patients and providers -with the doctor's face often turned to the computer screen while the patient is talking.

Digital records often contain numerous, repetitive information fields but leave little room for the kind of personal, nuanced observation that was captured in an old-fashioned doctor's note. And restrictions on who is allowed to input the data have shifted many administrative tasks from medical assistants and nurses to physicians.

Using electronic medical records is often more time-consuming for primary-care physicians than for specialists, because they are often taking more comprehensive medical histories, tracking more tests and lab results and filling in more fields.

"Many physicians said to us, 'I used to be a doctor, now I'm a clerk,'" said Dr. Jay Crosson, a pediatrician and vice president of professional satisfaction for the AMA.

Worsening Shortage Forecast

Meanwhile, the promise of electronic health care records to reduce errors and duplication and facilitate communication has so far gone largely unfulfilled, as far as many doctors are concerned.

John Schumann, a primary care doctor who teaches at the University of Oklahoma's School of Community Medicine in Tulsa, sees patients at three different hospitals, with three different record systems. "They're all different and none of them talk to each other," he said. "That's the kind of thing that drives doctors' nuts."

To ease the burden, some physicians have started using scribes - laptop-carrying assistants who follow them in and out of the exam room.

Scribing is one of several proposals to provide greater support to physicians by giving more responsibility to nurses, health coaches and health educators. But adding personnel involves additional costs, which worries physicians trying to limit their overhead.

The trend line, meanwhile, is troubling. The Association of American Medical Colleges estimates the United States will be short 45,000 primary-care doctors in 2020, when 268,000 are projected to be practicing. That compares to a shortfall of 9,000 in 2010, with 254,800 practicing.

Even a recent uptick in medical students who are electing primary care is not enough to avert the projected shortage. Meanwhile, experienced doctors are joining large groups or becoming hospital employees, which some argue reduces clinical autonomy and discretion -such as deciding how much time to spend with patients -and which may potentially drive up health-care costs because hospitals may tack on additional fees to their bills.

"They want a place to shelter from the storm," Blumenthal said.

http://www.kaiserhealthnews.org/Stories/2014/April/01/doctor-burnout.aspx

Gaming technology saves millions for Spanish healthcare

Technology in health isn’t just about investment, it’s about massive savings

In Spain’s Basque Country patients with chronic diseases including asthma, diabetes and arthritis are turning on their Xbox games consoles with their doctors’ approval. They are using a system called Teki which has been developed for the Basque health authorities by IT consultants Accenture.

Teki takes advantage of the Kinect system on Xbox which has a video camera that tracks a gamer’s movement so they can interact with games without a joystick or controller. The off-the-shelf technology means that patients can be monitored in their homes but also interact with health professionals without constant visits to a clinic or hospital.

Teki is part of a larger move towards using the phone and internet for interacting with the health system. During the first year of the project, Accenture estimates there was a €50 million saving through reducing the number of visits to hospitals. Some 18 per cent of primary care interactions in the Basque Country now happen online or over the phone.

Irishman Sean Shine is Accenture’s senior managing director for health and public service, and has been involved in major healthcare technology projects around the world in recent years including Teki.

He says “connected health” – where medical records are stored electronically and then linked up so that trends in the overall system can be spotted – is key to getting the most out of technology in the health system. Accenture is involved in connected health projects in Australia, Norway, Singapore and the US but Shine says they are not the sole preserve of wealthy countries with well-funded health systems.

“Brazil is beginning to look at connected health and beginning to look at a public-private partnership where they may get the private sector to invest to build some of that infrastructure and provide it back to them on an ongoing basis,” says Shine. “They don’t have the funding to provide for everything up-front but they want to see if they can do it almost on a month-by-month basis.”

In the UK, Accenture delivered a project for Cambridge University Hospital to address acute bed shortage which saved £5.7 million (€6.9 million) annually. One hospital in the group also managed to reduce the average length of stay by five days.

Despite the cost savings, some might be uncomfortable with the notion of a management consultant deciding how long you need to recuperate after a major procedure. “Obviously in order to do that you need to have the right skills because you can’t just have a generic consultant coming in and saying what if we moved this or changed this around. Having the mix of the clinical skills and the typical consulting and engineering type capabilities and bringing those together is essential.”

Shine also points out that Accenture has hired the necessary skills so it can help its clients make clinical decisions. “I’m still amazed when I meet some of the doctors we have on our payroll. They are lifetime physicians, they’ve been around but they’ve moved from being active clinicians into the consulting space.”

The use of technology in the Irish health system has a decidedly mixed history not least because of under-investment. In most European countries, 2-3 per cent of the healthcare budget has been invested in IT, in Ireland it’s been less than 1 per cent. As a result, Shine believes difficult decisions need to be made about investing at a time when costs are under severe pressure.

“There is a recognition [in the health system] that many of these things need to be done. I think we’ve seen a renewed focus on recognising that investments in the IT and administrative infrastructure are needed. And that the benefits of doing that are as significant, perhaps even more so, than some of the clinical things that are being done.

“You say you are putting in a new financial system and everyone falls asleep but actually you need that as a base.”

http://www.irishtimes.com/life-and-style/health-family/gaming-technology-saves-millions-for-spanish-healthcare-1.1744945

Cole Memorial offers telemedicine for pediatric emergencies

Photo courtesy of Cole Memorial

Cole telemedicine

From left, Cole Memorial Hospital maternity department employee Ashley Cowburn, RN, along with pediatrician Dr. Marlene Wust-Smith, examine Sophia Cizek, 4, with her father, Scott, and Steve Weidner, RN, in the hospital’s emergency department pediatric telemedicine examination room.

COUDERSPORT — Cole Memorial Hospital in Coudersport has launched pediatric telemedicine in the emergency department and maternity unit, thanks to the Optimizing Utilization and Rural Emergency Access for Children (OUTREACH) program through the University of Pittsburgh Medical Center.

Hospital officials said when a child requires emergency health care, pediatricians and emergency medicine providers at Cole Memorial will be able to consult with clinical specialists at Children’s Hospital of UPMC via the new state-of-the-art telemedicine technology.

“The telemedicine unit is portable so it can be used in the emergency department or in the newborn nursery at the hospital, allowing our providers to collaborate with pediatric specialists in Pittsburgh,” said Ann Slotta, RN, director of maternal/child and inpatient behavioral health services at Cole Memorial.

Telemedicine offers two-way audio/video conferencing applications to provide high-level clinical consultations between a Cole Memorial provider and a specialist at a distance.

Cole Memorial director of emergency services Shannon Work, RN, said 18 percent of the patients that visit the hospital’s emergency department are age 18 and under. 

Hospital officials said so far, the benefits of Cole Memorial’s pediatric emergency telemedicine service include patients and their family travel less to receive specialized care; the need for hospital admissions may be reduced; when higher-level care or a special procedure is required, transfers may be made immediately; expert care is available 24/7; and provides patients, their family members, hospital providers and staff with an increase in satisfaction with the outcomes.

“The first pediatric tele-emergency patient visit ... allowed our patient to be evaluated by an emergency room provider at the Children’s Hospital of Pittsburgh, who agreed with me that he was stable for discharge to his own home,” said Dr. Marlene Wust-Smith, a pediatrician. “Our patient was relieved to not have to travel four and a half hours to Pittsburgh, and I was reassured that his presenting complaint did not require further work-up.” 

In addition, the following tele-medicine services are available at Cole Memorial with expert clinical partners such as: Rheumatology with the Geisinger Health System in Danville and cardiology and neurology with UPMC Hamot Heart and Vascular Institute in Erie. 

For more information, visit the website www.colememorial.org.

http://www.bradfordera.com/news/article_b7eb4d68-b921-11e3-8d27-0019bb2963f4.html

AAPC Alert - Keep Calm and Code On

The United States Senate just passed HR 4302, the Protecting Access to Medicare Act. If signed into law by President Obama, then this bill will delay ICD-10 and shift required implementation from October 1, 2014 to as early as October 1, 2015. The act also extends the “doc fix” for Medicare’s Sustainable Growth Rate (SGR) payments for a year.

The bill was rapidly introduced to the House of Representatives on Thursday, March 27th, for vote. After a voice vote passage, it moved to the Senate for today’s vote. Primary arguments cited for delaying the ICD-10 implementation included lack of readiness surrounding clinical documentation, vendor solutions, and systems testing.

We encourage you to keep calm and code on. 

If you are ready for implementation, then we know this delay may be difficult; we will support you with both access extensions and refresher courses. If you need another year, then this change offers an opportunity to increase your readiness through proactive education, practice, and testing. The postponement allows improvement of anatomical knowledge, review and adjustment of documentation quality and clinician education, and adjustment of coding and billing procedures.

AAPC remains committed to serving you with the highest quality training and support to help you adapt to the ever-changing healthcare environment.

www.aapc.com

ICD-10: Translation 101

Never let it be said that the implementation of ICD-10 has not been exciting.

ICD-10 is still a critical project that will continue to require our full attention. One of the areas of implementation that seems to create the most anxiety is translation. So let’s talk about it.

You’ve probably heard about the concept a hundred times and in several ways, such as mapping, crosswalking, translating, converting, etc. But what does it really mean? And what is the best verb to describe it? I offer, for your consideration, a breakdown of the verbs that are associated with the act of identifying the ICD-10 counterpart for a given ICD-9 code, or vice versa:

• Mapping – Using a starting point (ICD-9 code) and plotting an end point (ICD-10 code).

• Crosswalking – Identifying a code that is the equivalent of a starting code (ICD-9 or ICD-10).

• Converting – Changing policies, processes, and systems from current ICD-9 logic to ICD-10 logic, including the codes themselves.

• Translating – Using all methods available (including mapping, crosswalking, and converting, along with review of business requirements, clinical equivalence and appropriateness, and standard coding methodologies and guidelines) to identify the equivalent code or codes in ICD-10.

Many people use these terms interchangeably, but I am here to offer a little perspective, having done all of the above with my own two hands. These are not the same actions, but each can be a step in a much larger process that we all must embark upon if we are to implement ICD-10. 

We can’t use just one technique and call it a day. Case in point: we have all heard of the general equivalence mappings, or GEMs, that were developed by the Centers for Medicare & Medicaid Services (CMS) and 3M and released for free to the public for use in the transition to ICD-10. These mappings are also the standard “crosswalk” as required by the Patient Protection and Affordable Care Act. But these mappings, of which only a small percentage could be considered an actual “crosswalk,” are only a starting point in a much larger process. Look at this statement found in the GEMs User’s Guide:

“There is no simple ‘crosswalk from I-9 to I-10’ in the GEM files. A mapping that forces a simple correspondence — each I-9 code mapped only once — from the smaller, less detailed I-9 to the larger, more detailed I-10 defeats the purpose of upgrading to I-10. It obscures the differences between the two code sets and eliminates any possibility of benefiting from the improvement in data quality that I-10 offers. Instead of a simple crosswalk, the GEM files attempt to organize those differences in a meaningful way, by linking a code to all valid alternatives in the other code set from which choices can be made depending on the use to which the code is put.”

A simple solution is not always the best solution, and the translation process is anything but simple. In fact, it is a dynamic process that can change between business areas based on the use of codes or code data. Not everyone uses the codes in a standard way. If we’re completely honest, not everyone applies the codes according to the official coding guidelines. What we code is wholly determined by our understanding of the codes and how to apply them. The same is true for how codes are used within a payor system and how claims processing and adjudication rules are coupled with codes in the systems. Therefore, a standard “crosswalk” is not a solution based in reality in today’s healthcare environment.

But we shouldn’t feel defeated or start looking at ICD-10 implementation as some sort of insurmountable obstacle. Instead, let’s set aside our frustrations, breathe, and take a moment to assess what needs to be done to translate our ICD-9 world into the language of ICD-10. Here are some tips to get you started:

1. Assess and prioritize what requires modification. Because the implementation clock is ticking, don’t waste your precious time on efforts that can wait until after the implementation date has come and gone. Focus on what absolutely needs to get done in time for testing and ahead of implementation.
2. Take stock of your internal coding expertise. Leverage the human resources you have to help in any translation efforts you may have going on, regardless of whether they are expert coders or know “just enough to be dangerous.” Get started and assess where your gaps in knowledge are.
3. Identify your clinical resources. Clinical knowledge may be all you need to address any gaps that can’t be filled by your coding expertise. Sometimes it’s only a small piece of the puzzle that will yield the solution.
4. Take advantage of free resources – GEMs and ICD-10 manuals are available free of charge through CMS (www.cms.gov/Medicare/Coding/ICD10) along with the new Road to 10 provider portal (www.roadto10.org). Start by familiarizing yourself with the ICD-10 code set using the manual, and then you can begin any translation by looking up your ICD-9 codes in the GEMs. Use the manuals, which provide coding guidelines, to identify any codes that the GEMs do not identify. Remember, the GEMs are only an approximation.
5. Align your translations with your business requirements. Translation does not end with the identification of the appropriate ICD-10 codes. Review your translations in the context of your business requirements. Some ICD-10 codes may not be applicable, and there may be additional gaps that will need to be addressed.
6. Create a review and approval process. Employ more than one set of eyes to review the translations, ensuring that all solutions are as complete and accurate as possible. Formalize the approval process by identifying the owner of the process, and make sure he or she is responsible for approving any translation solution along with when the approval was given.
7. Archive your translation solutions. Who knows what will be needed in terms of documentation, post-implementation, so make sure you have all solutions and their related information archived and available for future reference.

Don’t sweat the small stuff. And don’t bite off more than can be chewed properly before October 1, 2015. But do get started sooner rather than later!

About the Author

Mandy Willis is a Certified Coding Specialist and AHIMA Approved ICD-10 Trainer with 15 years of experience in the healthcare industry. She has worked in the small physician practice environment, commercial payer and Medicare and Medicaid. Currently, her focus is on assisting all sectors of the healthcare industry in making the transition to ICD-10.

Contact the Author

willis.m@ghc.org

http://icd10monitor.com/enews/item/1162-icd-10-translation-101

Expert panel recommends functional status quality measures for skilled nursing facilities

Expert panel recommends functional status quality measures for skilled nursing facilities

An expert panel convened by federal regulators has offered recommendations for functional status quality measures in skilled nursing facilities. Released Friday was a summary of the experts' advice to create a functional status quality measure in SNFs, as well as inpatient rehabilitation facilities and long-term care hospitals.

The panel also announced that it had decided against recommending that items from Section G of the Minimum Data Set be used to determine a restorative goal. 

The Centers for Medicare & Medicaid Services contracted with nonprofit research organization RTI International to convene the experts, including rehabilitation clinicians, administrators and researchers.

The discussion centered on the use of items from the Continuity Assessment Record and Evaluation (CARE) set, which was developed as part of a demonstration project to standardize assessments across different post-acute settings. Specifically for SNFs, the experts examined four outcome measures: the change in self-care and change in mobility scores for medical rehabilitation patients, and the discharge self-care and discharge mobility scores for these patients.

Most CARE mobility and self-care items already are assessed in SNF settings, as well as in IRFs, the experts noted. However, “challenging mobility activities” such as car transfers are not routinely assessed in these settings. Assessing these abilities is important for residents who are returning home or to a community-based setting, they concluded.

The panel also addressed risk adjustment. Individuals who have an incomplete stay — including those who die or are unexpectedly transferred to a hospital — should not be included in calculating the quality measure, they recommended. Neither should those who have maximum scores on the self-care and mobility items at admission, since they have no room for improvement. Gender and Medicaid status should be excluded, but age, history of falls and prior functional status would be appropriate risk-adjustment factors, the panel determined.

Not all self-care and mobility items would be applicable in each post-acute setting, the panelists noted. For example, they discussed dropping the “wash upper body” item for SNFs, because most residents bathe in a tub or shower.

Click here to access the complete CMS document.

http://www.mcknights.com/expert-panel-recommends-functional-status-quality-measures-for-skilled-nursing-facilities/article/340307/

Hospital medicine doctors are key to improving patient satisfaction

SUNEEL DHAND, MD | PHYSICIAN | MARCH 31, 2014

Improving patient satisfaction and enhancing the hospital experience is all the buzz today in health care. Every hospital executive across the country is talking about it, and coming to terms with how their organization’s reimbursements will be directly tied to their performance in this area.

A decade ago, none of us had ever heard of HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores, the core metric by which health care facilities are now being evaluated. And while improving patient satisfaction scores is a complex issue that requires a multifaceted approach from all levels of the organization, one thing is certain: As the most visible frontline clinicians during any medical patient’s hospitalization, hospital medicine doctors are key to driving this improvement. They are the face of the hospitalization, act as the main point of contact for the patient, and are the doctors who will be most involved in their care. The old model of the hospitalist being present “to just round” on patients in place of their regular PCP is long outdated. It’s therefore crucial to recognize their role in improving the hospital experience. Here are some everyday ways hospitalists can do this:

• Making clear to the patient from the beginning the role of the hospitalist, their relationship with the patient’s PCP, and how they will be in charge of the patient’s complete care as part of a collaborative care team. This helps to reassure an often anxious elderly patient and their family.
• Regular use of aids such as explanatory introductory cards, pamphlets and business cards. Leave them on the table in the room so that family members can also see them and know the doctor who’s in charge of the care.
• Making a clear plan for the patient every day. Utilize whiteboards in the patient’s room and keep them updated.
• Developing more optimal patient rounds, including multidisciplinary rounding models to ensure that all members of the health care team are on the same page.
• Setting aside dedicated time for extended patient and family meetings each day, usually in the afternoons.
• Making clear that you are regularly communicating with the specialists who are also involved in the patient’s care.
• Developing and maintaining good communication skills, always displaying empathy and compassion.

Statistics show that two of the most frequently cited patient complaints are a lack of time with their doctors and health care staff exhibiting poor communication skills. On a practical level, in order to maximize time with patients, hospitalists obviously need a manageable daily patient census. Formal communication skills training is often well received by physicians, especially if feedback is given in a friendly and collegial atmosphere. It’s traditionally been an area that the health care profession hasn’t got into, and older physicians in particular are much less likely to have ever received any formal training or skills advice.

Worried about pushback if you bring up the concept? Most physicians actually enjoy thinking about the topic, and are very keen to improve their skills. Ultimately, it’s all about making the patient feel comfortable, at ease, and listened to. Some proven communication techniques that physicians should utilize include making eye contact, sitting down, and asking open-ended questions. These are very basic, but often forgotten about during a typical hectic day. They can all be taught, improved upon, and coached.

Specialists also need to step up to the mark. They need to be encouraged to maximally collaborate with the hospital doctor and to make the patient feel like all their care is being coordinated. The other touches that go into improving a hospital stay, such as regular nursing checks, being clear on wait times, and following up post-discharge with a personal (non-automated!) message from a nurse or administrator, should all be added to the mix.

Let’s remember that this isn’t simply about saying that you’ve “improved patient satisfaction” and raising survey scores for the sake of reimbursements. Patient satisfaction is really about understanding what the patient is experiencing and the emotional roller coaster that goes with being sick. HCAHPS scores, while by no means the perfect survey, may be the jolt the medical profession needs to strive for what it should have been doing all along: providing patients with a high level of customer service at a low point in their lives.

Hospital medicine doctors are best placed to engage the patient from the beginning, and by focusing on the hospitalist group to lead the way, organizations can soar to new heights.

Suneel Dhand is an internal medicine physician and author of Thomas Jefferson: Lessons from a Secret Buddha and High Percentage Wellness Steps: Natural, Proven, Everyday Steps to Improve Your Health & Well-being.  He blogs at his self-titled site, Suneel Dhand.

http://www.kevinmd.com/blog/2014/03/hospital-medicine-doctors-key-improving-patient-satisfaction.html

Mountain Summit Physical Fitness Challenge: mHealth Games

We are getting ready to watch the highly anticipated men's freestyle mountain climb.

This is the "iron man" of the Olympics, what you have all been waiting for.

Natalie, I hate to interrupt but I have just received breaking news in tonight's games, it appears the two favorites:

Johnny Three-Scoops and Earl Strong-Fit will not only be fighting for their individual victories tonight, but the fate of their entire teams may lie in the outcome of this single event.

With only 3 events to go, and this being the only event in which their respective teams have a real contender, this could decide the gold Dr. D. If I am correct, TEAM UNFIT and TEAM HEALTH are tied 9 to 9 in the medal count!

ALL EYES WILL BE ON THESE TWO TONIGHT!

YOU, can help TEAM HEALTH reach the top first by correctly answering the questions!

ARE YOU UP FOR THE CHALLENGE?

Click the picture above to launch the game or visit us at www.mhealthgames to play!