Concerns around Meaningful Use Implementation

If one were to dig down and understand the real intent of implementing EHR and meet Meaningful Use criteria, it would be nothing but to achieve improved outcomes, better efficiencies and lesser healthcare costs. The healthcare delivery mechanism is expected to become much better as a result of this. However, somehow the focus seems to be revolving more around evaluating healthcare setups to determine their incentive payment eligibility, based on Meaningful Usage, rather than understanding the core issues which stand in the way of its implementation. In its current state, it is becoming more and more difficult for hospitals with limited resources to attain MU eligibility. The ones who fall into this category include smaller critical access hospitals and community health centers which generally treat patients with lower income and are more often than not uninsured. Although they seem to be using EHRs which are in some shape, it is in attaining MU certification where they seem to be falling short - primarily due to lack of availability of resources to invest, low patient volume and difficulty recruiting qualified IT personnel .On the contrary, the bigger hospitals with deeper pockets and superior resource access seem to be having a better ratio of eligibility.

The matter is likely to get worse when eventually hospitals start getting penalized after a few years. It will result in job losses of physicians and hospitalists employed by the smaller setups. This will ultimately lead to the whole purpose of implementing MU EHRs going for a toss. At the current rate of progress, it will be the patients who will suffer at the end of the day. This consequence was not preempted before the roll out started and hence some short-terms solutions are being suggested in order to handle the situation. For e.g. extending the last date for stage 2 implementation is one such option. The other one being mooted is that of the extending help to the struggling medical setups to expedite the process of full implementation of EHRs. Without concrete steps it would not be possible for the government to reach the stage it envisages to i.e. that of sharing patient data across providers and have clinical information following patients wherever they receive care.

One of the major stumbling blocks while attempting to qualify for the incentive program is that of meeting the requirement for computerized provider order entry. This issue seems to be more pronounced in the cases of hospitals which have failed to qualify for the incentive. It is not just the technical gaps but also the cultural and organizational ones which contribute to it. For the setups which achieved MU, the concerns hovered more on the technical front; related more towards providing patients secure and easy access to their data , identifying the factors that contribute towards the calculation of the quality measures and generating the data for the same. In a broad sense though, all this has cast a shadow on the pace at which Health IT adoption was expected to pick up and given its detractors an opportunity to hit back. Meaningful stage 2 adoption seems to be bane of many such groups. One such feels that there is not enough time available to validate the e- measures and so just implementing the software in practices will not necessarily mean that the objectives will be met automatically. Also, not every measure is of equal importance or value to every practice. For the physicians which have successfully completed stage 1, vendor readiness is posing a problem .Without the appropriate software updates and required support, Physicians will be unable to meet the Stage 2 requirements and get penalized without apparently any mistake from their end.

The general consensus is thus on extending the date for Stage 2 implementation by a year to avoid outstripping the capacities of vendors and physicians and risking complete derailment of the overall Health IT adoption process. This will allow the some exemplary practices to successfully implement Stage 2 requirements by 2014 and share their experiences and learning with vendors and providers for faster and efficient adoption at a broad scale subsequently. Healthcare software development teams can help you build projects within allocated budgets and time schedules.

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Is ICD-10 Implementation on Track?

Is ICD-10 more difficult to use compared to ICD-9? Well, first and foremost there is no choice available; all stakeholders covered under HIPAA, e.g. Patients, Providers, Laboratories etc., are required to start using ICD-10 codes if they are to stand a chance of getting reimbursed for their claim after October 2014. Worker’s Compensation and Auto Liability claims are the only exceptions to the rule. The only similarity between these 2 approaches is the process of looking up for codes. The differences otherwise start right from the format. While ICD-9 codes uses are generally numeric with 3 to 5 digits, the ICD-10 codes are alphanumeric with 3 to 7 characters. Most important difference lies in the fact that ICD-10 will require additional documentation to be which in order to provide more information for the codes chosen. External circumstances and the location of injury or accidents need to be captured. Thus from a current number of 13000, when ICD-10 gets implemented the number of codes will go up to 68000.

All this is being done with the intention of capturing the exact details of the cause of ailments of patients. The higher the precision of diagnosis, the better the chances of administering the best possible treatment. Thus, rolling out an ICD-10 is not to be looked upon as an update to the ICD-9 code set. The lack of specificity in the former is what might have triggered of the need for the later but its implementation is a comprehensive process. A coder for example cannot necessarily handle the job in isolation unless all the relevant information is available in detail. In any case, the best person to program manage the roll-out of ICD-10 coding standards in a healthcare setup has to be either of the three - the physician, the practice administrator/office manager, or the billing manager. The concerned person has to have the confidence of all the staff and the required level of authority to ensure a smooth transition. Each of the stages - assessing, budgeting, planning, communicating, training, implementing, and monitoring requires good astute leadership to drive the implementation. Although there are mapping tools now available, they do not necessarily provide a definitive code for a situation because a one-to-one mapping is not always possible.

Surprisingly, inspite of its binding nature, the implementation of ICD-10 has not been at the pace at which it is expected to be. Practices have expressed their concerns, with the top three being:

• The high cost of implementation
• Need for changes in clinical documentation
• Loss of productivity

Some other concerns expressed include the difficulty of documenting patient encounter and the difficulty in choosing the right diagnosis code. One of the surveys conducted indicated that cost for a 10-physician healthcare setup to overhaul its practice management system and electronic health record software was approximately going to be more than $201,000. This can act as a huge deterrent, given the high amount of investment needed, for setups of similar or larger sizes. A few providers though are hopeful that their respective vendors for PMS and EHR would handle the cost of upgrading since they will not be left without a choice.

However, the starting point of all this – co-ordination among the stakeholders has unfortunately not at the level at which it is expected to be. ICD-10 implementation is not just changes to be made to software; it will require a lot of healthcare software testing and training on the part of providers. Unless enough time and effort goes into the last 2 areas , providers might have to deal with a shock when they take a look at their cash flow post Oct 2014.

One of the reasons why the implementation could be a tough one of achieve is because it is being planned simultaneously scheduled with the Stage 2 Meaningful Use of EHR and state Health insurances exchanges. Besides the financial angle, the sheer amount of time and energy that all such parallel implementation will require from all concerned people in healthcare setups is going to affect their ability to meet their primary responsibilities – that of providing good care to their patients. But inspite of all the uncertainties, physicians do not have a choice but to see that they themselves are aware of the coding fundamentals and are actively driving their teams towards a planned implementation. If not, a rude shock seems inevitable.

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