Category Archives: EMR

Paying the high price for ICD-10 compliance when using EMR systems in US hospitals

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Lucky for us in Malaysia, our hospitals with EMR systems with technology already incorporating the ICD-10 code set, are not up against paying the high price of implementing ICD-10 unlike in the US where hospitals using EMR/EHR systems are gearing up for the October 2013 ICD-10 dateline (which is likely to be delayed again to October 2014).

One example of an US hospital system that encompasses 14 hospitals, is the North Shore Long Island Jewish Health System, N.Y. They estimate the price tag will be about US$50 million (about RM158 million) including project management, I.T. remediation(some 90 applications), training and other areas.

Sutter Health which runs 24 hospitals across northern California, is another example which provided an even higher price tag–well over $100 million (about RM316 million), including $60 million (about RM190 million) for technology remediation (some 146 applications will need to be remediated) and $25 million (about RM79 million) for a computer-assisted coding program

Both these organizations are said to well ahead of the rest of the industry in their ICD-10 planning in the US. However, they are being cautious and concerned with  long-term financial impact on their revenue when converting past billing claims to ICD-10 and also estimating where documentation would need to be enhanced to support the more granular codes in ICD-10.

In the US, ICD-9 codes have been used mainly for billing, historically. It seems every clinical encounter that gets billed to an insurance payor includes diagnosis designations, encoded as ICD-9 codes.

Thus, I can understand the profound impact of paying the high price of implementing ICD-10 in the US when changing the fundamental method of encoding diagnoses to a whole new system .

The rationale for making such a change (given the disruption that will occur) is that the ICD-10 code set is more detailed and extensible, allowing for more than 155,000 different codes, and permits the tracking of many new diagnoses and procedures (a significant expansion on the 17,000 codes available in ICD-9).

As we know ICD-10 was developed by the WHO and released in 1992, soon after the ICD-10 system was adopted relatively swiftly in most of the world including in Malaysia.

Abridged, from the article The High Price of ICD-10 by Gary Baldwin, June 26, 2012, Health Data Management reporting  from the HFMA conference June 24-27 2012 in Las Vegas, where panelists shared the above estimates.

With additional references from:
practicefusion.com/, Website
ehrscope.com, Blog
pdmanesthesia.com/, Blog for the image in this post

The Five Rights of Data Administration!

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If you read the post Documentation of medication administration in medical records, I am sure you did not miss reading about how clinicians and nurses use the “Five Rights of Medication Administration” to ensure proper patient care.

If you work in an EMR environment, then the following infographic, entitled “The Five Rights of Data Administration,” created by Symantec to help Health IT staff and users like you, Health Information Management(HIM) / Medical Records (MR) practitioners answer important questions about the use, access, and availability of critical patient data. This infographic outlines specific best practices to ensure that patient information is kept secure regardless of where it is. The infograhic also helps you and Health IT staff in organizations like the hospital you work in better understand the administration of patient data

I believe HIM/MR practitioners working in an EMR setting need to adopt similar but modified best practices for ensuring proper security and privacy for patient data based on the specific best practices outlined in this infograhic.

Note: Click on the infograhic above to view a larger image in a new tab of your current window.

From this infograhic, you need to cultivate the following specific best practices with coordination, guidance and help from IT staff of your hospital.

  1. Right Time – data in EMRs should be available to authorised personnel in your department whenever they need it and must be backed up and secure
  2. Right Route – users like clinicians who need access to EMR data regardless of where they and the device they’re using, must have ready access to updated data your are responsible for at your end
  3. Right Person – ensure only the right people have access to certain information though access verification in your department
  4. Right Data – prevent unauthorised tempering or accidental corruption of data with only users entitled or authorised to have access to data in your department and minimising or banning Bring Your Own Device (BYOD) mobile devices
  5. Right Use – ensure only the “minimum necessary” information is provided to external sources who request data that can be extracted from your end of the EMR system, thus assuring confidentiality

Just like medication administration is taken very seriously with the utmost accuracy and attention to detail as they can mean the difference between life and death, the proper administration of patient data should also be taken very seriously as it too can prevent misdiagnoses or mistreatment without accuracy and attention to detail.

EMR Adoption Model

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I first knew about a standard for tracking adoption of electronic medical records(EMR) applications within hospitals and health systems while reading from a recent news article of an IT blog about how Advocate South Suburban Hospital, a Hazel Crest hospital in Illinois, USA was awarded a Stage 6 status based on this model. This prompted me to find out more about this model.

The EMR Adoption Model(EMRAM) is a methodology and algorithms to automatically score by evaluating the progress in a hospital’s IT-enabled clinical transformation status using EMRs.

EMRAM was developed in 2005 by HIMSS Analytics which is a wholly owned, not-for-profit subsidiary of the Healthcare Information and Management Systems Society (HIMSS) using the HIMSS Analytics® Database originally derived from the Dorenfest IHDS+ Database™ in July, 2004.

Founded 51 years ago, HIMSS and its related organisations are headquartered in Chicago with additional offices in the United States and in Europe. Nearer home, HIMSS Analytics launched its Asian operations from their HIMSS Asia Pacific office located in Singapore. As on 14 June 2011, four Singapore hospitals have been awarded the Stage 6 EMRAM Award. No update is available for Malaysian hospitals from this link.

This HIMSS Analytics Database exclusive to HIMSS Analytics, is a comprehensive collection of data from thousands of institutions. It is a most comprehensive source for highly accurate healthcare provider IT market intelligence. The gathered data is used to create a realistic portrait of the health IT landscape – how hospitals are making the transition to paperless and what types of vendors and products they are using to get there.

Using this resourceful and authoritative database on EMR adoption trends, hospitals can track and review their progress in the levels of  their EMR capabilities ranging from limited ancillary department systems through a paperless EMR environment.

Hospitals need to complete eight stages using the EMRAM,

i.e Stage 0 when a hospital has not installed all of the three key ancillary department systems (laboratory, pharmacy, and radiology) through Stage 7. The intent is to reach Stage 7, which represents an advanced electronic patient record environment, where paper charts are not used at all to deliver patient care.

For more information, visit www.himss.org and www.himssanalytics.org (each link opens in a new tab of your current window).