With HIPAA rules not yet finalized, healthcare industry stakeholders across the country are already employing technology to unclog the paperwork logjam long vilified as the bane of medical practice.
"There's a lot of good work going on," says James Schuping, executive vice president of Workgroup for Electronic Data Interchange. WEDI is a coalition of providers, payers, vendors, clearinghouses, government entities, standards organizations and consumer representatives advising HHS Secretary Donna Shalala in the selection of national electronic healthcare standards. "You've got (stakeholders) in all geographic communities that are trying to move toward administrative simplification, some more aggressively than others."
But for many docs, it's still a paper world.
"The one segment that has the farthest to go is the provider community," Schuping says. "I just think it hasn't been real to them. A fairly significant number of practitioners are not computerized. Many of them are still maintaining manila file folders."
Those who have taken the plunge say they have swapped hours on hold and unwieldy charts for computer networks capable of transmitting data in a keystroke.
Jeff O'Connor, M.D., a family physician in Spokane, Wash., taps a keyboard to electronically chart, order labs and access information ranging from patient eligibility and benefits to appointment times and staff scheduling. "Ninety percent of what we need is right on the computer. From my end, it's simpler."
He says his solo practice is saving more than $15,000 annually through automation, due to jettisoning at least a half-time position and not hiring additional staff despite an increased patient load. "I know for a fact I've been able to keep my overhead down. We'd have a lot more people around here, chasing charts."
O'Connor and some 4,350 other physicians in Washington, Oregon, Nevada and Idaho use an intranet devised by PointShare, a Bellevue, Wash., information technology company, to communicate with health plans.
PointShare's Virtual Private Network is online but protected from the Internet by a fire wall for security purposes, says Chief Medical Officer Dennis Schmuland, M.D. Only those with authorization can access the intranet, but those within the network can exit to roam the Web at large.
Schmuland, who practiced family medicine for 13 years, says the average U.S. physician accepts 16 managed care contracts. Administrative functions have historically bogged down under the disparate requirements imposed by each payer.
"Everyone was on the phone, on hold or standing at the fax machine. Doctors were not able to take care of patients and take care of all this administrative stuff."
That burden is lightened when a medical office uses PointShare's intranet to transmit data common to all associated health plans, Schmuland says. And care is enhanced when physicians receive results and reports electronically, often the next day.
A one-page referral form created by the company and adopted by six health plans streamlines and tightens the handoff to specialists. After seeing a patient, the consulting physician electronically attaches a report to the form. "This enables fewer patients to fall through the cracks," Schmuland says.
Primary doctors pay a basic fee of $50 per month for PointShare's eligibility verification, referral automation and intranet e-mail, Schmuland says, and reap an average savings of about $4,000 each year. In communities with sufficient numbers of specialists in the system, that amount triples to $12,000.
While stakeholders in such other states as California, Massachusetts, Michigan, Minnesota and Virginia also are moving toward administrative simplification, many point to the Utah Health Information Network as a forerunner.
UHIN, a not-for-profit association of providers, health plans, state government and business, has enabled providers to funnel standardized claims to insurers via modem through a private data switch since 1995. About 95 percent of physicians and all Utah hospitals send information electronically through the switch, says executive director Bart Killian.
Utah's healthcare industry has collaboratively created a spate of standards--such as codes used for anesthesiology--for the state, Killian says. After a 30-day public comment period, such standards become rule. "We have not had one single complaint to the insurance commissioner by a provider regarding these standards. Not one. That says, as an industry, we've come together to solve the problem," Killian says.
For an annual $50 fee for solo practitioners, plus 3 cents per optional explanation of benefits, UHIN's switch conveys acceptable data to the appropriate health plan, spitting back problem submissions to the sender for correction. But it never opens a file. "(It's) a very simple way to deal with privacy, but very effective," Killian says.
Jeanne Martin, business manager of Southeastern Utah Radiology in rural Carbon County, estimates filing claims through UHIN has spared her four-person billing office from hiring another employee at $9.25 per hour.
Martin says turnaround times are down more than 60 percent. Often claims are processed in less than a week. "It's amazing what electronic billing does for an office," she says.
Pierre Pincetl, M.D., an internist and the chief information officer for University of Utah Hospitals & Clinics, says his 900-physician organization already has saved more than the $10,000 per year UHIN costs.
Pincetl says UHIN is evolving, with pharmacies slated to sign on soon. That will enable each provider to electronically check a patient's benefits, search for drug interactions, relay a prescription and receive a confirmation note when it has been filled.
The network also plans to have a VPN up and running by year's end, Pincetl says.
Constructing an intranet capable of ensuring privacy is the primary challenge common to all such endeavors. "That's going to take some work for anybody."
Another barrier is a noisy marketplace littered with unintegrated systems not appropriately tailored to medicine, O'Connor says.
"The systems that have come out over time have not been oriented toward the user," O'Connor says. "It needs to be pretty intuitive from the beginning, or it isn't going to fly for most people. It's got to look and feel and be like what they're doing already. Too many programs I looked at expected me to change the way I do things."
While O'Connor is pleased with his current system, the fact remains there is still no single, fully-integrated, nationally standardized electronic format.
Federal Regulatory Director Kathleen Fyffe, of the Health Insurance Association of America and the WEDI board, says hundreds of competing technology companies offering a host of incompatible formats are vying for position.
"It's been a very fragmented situation," says Fyffe. "It has not evolved over time toward a national standard in the marketplace. That's why the federal government had to step in. HIPAA mandated it because the market did not move on its own."
The healthcare industry has embraced computer technology in the clinical arena, such as labs and MRIs, she says. "But when it comes to the transaction-based systems that have to do with the business transaction, it's lagged."
Fyffe says the ultimate goal of national uniformity and automation on the business side of medicine is reduced cost, improved quality and increased efficiency.
While the federal government is behind schedule in issuing the seven HIPAA regulations related to administrative simplification, Fyffe says four of those are expected to require compliance by the end of 2002 and the three remaining by 2003.
Holt Anderson, executive director of the North Carolina Healthcare Information and Communications Alliance, says there's a financial disincentive and economic risk for vendors to develop and customers to purchase a uniform electronic format before the rules are finalized. "They certainly want to avoid expenditures that could result in a noncompliant product rendered useless by final rule."
With an eye on the two-year window between rule and required compliance, NCHICA--a not-for-profit partnership with more than 150 members ranging from professional associations and societies to hospitals and technology corporations--is working in concert to implement administrative simplification in the Carolinas, Anderson says.
While strides are being made toward compliance across the country, Schuping says, much work remains, particularly with providers slow to gain momentum.
"It's here. It's going to happen. It's going to be mandatory. They need to get ready for it."
Larry Watkins sounds the alarm in meetings across the country as director of HIPAA strategies for Per-Se Technologies of Atlanta, a publicly traded company providing electronic services and products to 85% of the nation's hospitals and 33,000 physicians.
"We're working in all 50 states to coordinate HIPAA implementation," says Watkins, board member of WEDI and its strategic national implementation process co-chair.
"The awareness level is so low. Many providers see it as a vendor problem, a technology issue. They don't realize that the administrative requirements for security can only be handled by the physician's office. There isn't any way around it."
Linda Boone Hunt is a Prescott, Ariz.-based investigative reporter and feature writer.