WHITEPAPER HOW MUCH COMPLIANCE DOES YOUR EHR UNDERSTAND?
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1 WHITEPAPER HOW MUCH COMPLIANCE DOES YOUR EHR UNDERSTAND? 1
2 INTRODUCTION Process regulations and compliance have been the major gauges brought in by regulatory authorities in U.S. to ensure that hospitals not only adopt electronic process for their day to day operations but also ensure that they use it meaningfully to help their patients get improved and enhanced care. Compliance is not limited to just the health records or the clinical features but is an aspect encompassing all parts of the healthcare applications. HIPAA (Health Insurance Portability and Accountability Act) compliance is mandatory and certifications like CCHIT (Certification Commission for Healthcare Information Technology) or others are required to exhibit compliance levels of the EHR applications. Meaningful Use Objectives: Eligible professionals and Eligible Hospitals should be able to demonstrate how meaningfully they are using their EHR systems. The financial incentives serve as the carrot to motivate hospitals to adopt EHR sooner and effectively. The larger intent of Meaningful usage of EHR applications is to bring in an overall change in the interactions between the patient and the providers, and the software sub systems. The compliance standards enforced should validate the health IT subsystems that serve as interface channels for communicating the data across various stakeholders involved in the entire health care management cycle. The standards laid out for meaningful use increase in stages over time. This would give time for the health care professionals to imbibe the essence of going electronic in the true spirit of creating a healthier community and also give the professional users, time to efficiently and effectively use these electronic systems. Usage is measured by a set of numerator, denominator and exclusion criteria that would help arrive at the scores for meaningfulness of the software usage. The core and the functional measures are arrived at from the electronic system and these transcend the entire cycle right from recording: Patient registration Recording demographics Problem Lists Vitals Smoking status Allergies 2
3 The various EHR compliance criteria are depicted in the diagram below: CHALLENGES IN EHR COMPLIANCE US Healthcare industry is trying to cope up with the new regulations that have been brought in as a result of ARRA and HITECH act. As a result of which there needs to be significant investment in modernization of their current systems and moving to newer EHRs. Most EHR vendors are racing against time to ensure that they meet the MU - Stage 2 timelines. Interoperability and Data Exchanges have elevated EHR systems from simple, selfcontained applications to broader systems that can become universal with international codification standards and nomenclatures. The canvas is deeper covering not only the clinical data but aiding in educating the patients and involving them through collaboration portals that cuts across new age technologies like Mobility, Cloud and Big Data. THE BIG DRIVERS IN EHR COMPLIANCE Healthcare payment models play a vital role in driving EHR compliance as new models require facilities and providers to move into value metrics. Payment structures are changing with patient centered care. EHR Vendors need to gear up to compete for the Stage2 and Stage 3 MU implementations in terms of their engineering and marketing resources. According to the Practice Profitability Index released in May 2013 by CareCloud and QuantiaMD, more than 40% of physicians say they will be implementing new EHR systems in Half of the physicians surveyed want to 3
4 improve operational performance in billings and collection, while 31% want to improve their technology overall. o Payer side compliance to submit accurate claims With EHR usage, fraud and unnecessary cost should be prevented. Healthcare professionals need to ensure that accurate claims and all documents supporting the service are submitted. This should ensure that Medicare programs are utilized accurately. Coding-Diagnosis Coding Clinical Modification (ICD-9) and (ICD- 10) which will replace the ICD-9-CM to report diagnoses on October 1, Procedure Coding Using Healthcare Common Procedure Coding System (HCPCS) CPT - 4 code procedures on all claims to describe medical procedures and professional services are requirements to comply with the CMS (Centre for Medicare and Medicaid services) guidelines. According to Taxpayers against Fraud ( TAF ), the federal government receives over $16 for every $1 it spends investigating and prosecuting civil healthcare fraud. The above compliance will help bring down the fraudulent cases which have risen by about 7.7% more during the last 5 years. Miscellaneous Regulations State Specific Reports: There are more regulations that healthcare applications should comply with in the form of State Reports. There are mandatory state specific reports that should be submitted o CONCLUSION for the patient data as a part of the CMS guidelines. There are state specific formats and this data helps in creating a healthier community with focus on specific healthcare issues. Wage Reports: The electronic data for the staff wages (quarterly wage reporting or monthly wage reporting), Electronic Unemployment Reports that are related to the wages of the staff working in the facility. Regulations are holistic and cut across the various applications used in the healthcare business process. Though many are aware of HIPAA and the MU clinical regulations there is indeed a compliance check across the various business features of healthcare applications. HOW CAN CALSOFT LABS HELP YOU Calsoft Labs has the expertise of building collaborative, scalable, future proof and fully integrated health informatics solutions thus enabling the productivity of the clinical, financial and support functions of different healthcare stakeholders viz., Providers, Payers, Technology Vendors and Pharma/Life Sciences. Our healthcare practice comprising certified professionals, technology and domain experts understand the nuances of various healthcare regulations and have built solution accelerators and frameworks to speed up compliance projects for our customers. Our mature project execution methodologies and processes make the software flexible to make the changes that would meet the continuous rules listed for the regulatory and compliance needs of the healthcare industry. 4
5 REFERENCES MLN/MLNProducts/Downloads/837P-CMS-1500.pdf 1-spent-fighting-healthcare-fraud/ ABOUT US ALTEN Calsoft Labs is the Enterprise IT and Product Engineering services brand of ALTEN group( specialized in enabling global enterprises with agile application and product engineering capabilities leveraging SMAC(Social, Mobility, Analytics and Cloud), thus transforming their business, from development of innovative strategy and solutions and delivering sustainable results. ALTEN Calsoft Labs is a wholly owned subsidiary of ALTEN group (Euronext: ATE). Set up in 1988, ALTEN is a European leader in Engineering and Technology Consulting (ETC) with 17,000 employees in over 20 countries worldwide. For more information: Follow us on Facebook: Follow us on Twitter: Copyright 2014 Information presented here is proprietary to ALTEN Calsoft Labs. Release of this information (in part or full) to third parties is strictly prohibited without prior written permission from ALTEN Calsoft Labs. 5
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