Major challenges looming for health IT leaders

Mostashari

Health information technology leaders have a lot on their plates today and more to come—implementing systems to match the federal IT incentive payment program upgrades, satisfying auditors roaming the land, meeting privacy constraints and preparing for the switch to a huge set of updated diagnostic and procedural codes.

At the College of Healthcare Management Executives' 2013 Fall CIO Forum in Scottsdale, Ariz., last week, these looming challenges were center stage, with probably none larger than the impending, nationwide shift to the International Classification of Diseases 10th Revision of diagnostic and procedural codes.

The one-year countdown began Oct. 1 for the federally mandated upgrade to the ICD-10 codes, many times more numerous and complex than the ICD-9 codes they will replace. It has been deemed a heavier lift for healthcare IT than the Y2K preparations.

The compliance deadline for ICD-10 is Oct. 1, 2014. Meeting it industrywide will require installation of thousands of new or upgraded systems as well millions of hours of training for coders and clinicians. Several surveys show the healthcare industry is behind schedule on ICD-10.

“What I hope doesn't occur is just-in-time training, because this is of a complexity that the front-line physicians and other clinicians are going to need ample time in training,” said CHIME President and CEO Russell Branzell, who welcomed a record 750 attendees to the 21st annual meeting of the organization.

A related challenge is how hospitals with substantial numbers of community physicians on their medical staffs will ensure that they, too, are adequately trained, since failing to meeting the ICD-10 mandate will hit the affiliated doctors and the hospitals on their bottom lines, said Al Smith, CIO at Capella Healthcare, Franklin, Tenn.

“Our employed physicians, we have a pretty good plan,” Smith said. “We can roll that out and control that. But what do we do with the affiliated (physicians), who will affect not only their revenue but our revenue?” The challenge he said, is “trying to come up with something that complies with (the Stark self-referral law) so we don't get in trouble, but still offers them something of value.”

In September, HHS' Office of the National Coordinator of Information Technology launched a national review of best practices for matching patients to their medical records—a key concern for patient privacy, safety and provider efficiency. Work on the report has been caught in the partial federal government shutdown. But when it is released, “if it makes sense to us, we can anoint it and champion it,” said Jeff Smith, CHIME's public policy director, who contributed to one of two conference sessions on patient matching.

Biometric devices, such as fingerprint and palm scanners, are making some inroads as patient identifiers, said Bill Spooner, senior vice president and CIO at Sharp HealthCare, San Diego, and a panelist at a second session on the issue. Sharp is using a palm scanner, Spooner said. But “that only works when the patient is there,” he said. “When they're not there and you need to send the record over to another provider, you can't send them the patient's hand.”

Spooner would like to see local communities doing more experimenting, with providers collaborating around the adoption of a common local patient identifier, since most healthcare interactions occur with patients living in the same region as the provider. Patient identification and authentication could be a service provided by local health information exchanges, many of which are struggling to find revenues, he said.

Government audits of the federal electronic health records incentive payment program began in fall 2012. The auditors have been checking into how the more than $16 billion has been spent. The audit programs themselves have had some birthing pains.

“A lot of whiplash,” audit survivor Pamela McNutt said about initial encounters with the fed contractors doing the audit. With the CMS over their shoulder providing advice, audit contractor Figliozzi and Co. followed up its initial record demand with two more for additional information, McNutt told CHIME conferees.

“When we got our summons, our notice, we thought we were going to be well prepared,” but, “one minute we had to provide this information and the next minute we didn't,” said McNutt, senior vice president and CIO Methodist Health System, Dallas.

Next came auditors for Texas, who required a massive data dump to ensure all was well with the Medicaid portion of the EHR incentive program. “Finally, nine months after we started this process, we received notice that they had confirmed we'd met our charity care (requirement),” McNutt said. Methodist passed its Medicare and Medicaid incentive payment program audits, she said, but they weren't finished.

HHS' office of inspector general called, saying they were going to audit the Medicare program's auditors. Methodist made it through all three with clean bills of health, said McNutt, who advised her peers to keep detailed records, particularly documenting the implementation dates of any new, certified EHR system used in the incentive payment program.

Dr. Farzad Mostashari was both a keynote speaker and a panelist at the CHIME meeting. Mostashari stepped down on Oct. 5 as head of the ONC. He did his best to quell speculation that there would be any delays in the schedule for moving the program up to Stage 2, which launched for some hospitals on Oct. 1, and will for qualifying physicians and other “eligible professionals” Jan. 1.

“There is no legal way to change the (Stage 2) final rule without a pretty elaborate process that takes nine to 12 months,” he said. Instead, Mostashari said, CHIME and others pressing for relief from penalties for noncompliance might look to “sub-regulatory guidances.”

“There is the ability in the rule for hardship exemption,” Mostashari said. “You wouldn't get the payment, but you wouldn't get the penalty. That's where I would advise CHIME to look.” Mostashari's replacement, interim director Dr. Jacob Reider, who was scheduled to speak, was a CHIME no-show because of the federal shutdown.

Without doubt the most surprising event of the conference was the performance by outgoing CHIME board chairman George Hickman, whose brief day-two plenary session appearance singing—beautifully—“Who Am I?,” a solo from the musical Les Miserables, astonished many CHIME members. Hickman, CIO at Albany (N.Y.) Medical Center, said he studied voice as a youth and sings occasionally in churches, but had kept that part of his life separate from his health IT career.

Follow Joseph Conn on Twitter: @MHJConn