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When evaluating a Pediatric E.H.R. system, evaluating the connections and technology is challenging even for a technology savvy individual. One indicator of a system, the skills of individuals at an E.H.R. company or the dedication to solving a technology issue is the connections to other companies. Electronic prescriptions (ERx) are sent through a network/hub developed by the three large Pharmacy Benefits Managers (PBMs) known as Surescripts/Rx Hub. Surescripts allows E-prescription companies to link up directly to their network as well as E.H.R. system vendors. There are two primary levels of certification for Surescripts. The first provides the capability to send prescriptions, refill prescriptions and receive refill requests from the Pharmacy. The second level of certification provides all the formulary files for almost every plan in the country as well as the medication history of a patient. Some E.H.R. vendors choose to connect through an e-prescribing company (e.g. Dr. First) for one or both of these major components.

The second level of certification requires large files to be moved and managed. A small vendor might not have the technology capability and/or the financial resources to complete both level of certifications. A good question to ask a contact at the E.H.R. Company that you are evaluating is if they have direct connections for Surescripts? If not, ask why and explore other facets of the system – has the vendor been denied to link to a Health Information Exchange for lack of technology capabilities? If so, ask why?

If there appears to be a gap in the technology, consider exploring the credentials of the technology team – are they led by a CIO with experience in technology as well as a degree in Computer Science or Engineering?

Each encounter at a Physician’s office generates numerous Diagnosis and CPT codes. A practice needs to appropriate manage their billing and collections for the practice to be effective and efficient. If a physician has 20-30 patient visits a day, the physician might generate 100-200 CPT codes (or more) each day. Each of these CPT codes needs the appropriate DX codes to optimize payment with each insurance company. Even with the ‘right’ diagnosis codes, Insurance companies change their ‘scrubbers’ and ‘rules’ to accepting claims. For instance, one of the regional carriers changed their scrubbers in Mid March 2010 to deny multiple adm codes 90466 unless the code utilized “Units” on the first 90466. The biller needs to follow-up on the claim, resubmit, if denied, investigate the reason further. In the 90466 example, we learned that neither the local insurance representative or our clearing house group were aware of the change (the carriers do not inform billing teams of the changes in their practices and how to be appropriately paid).

How does your billing team monitor this issue? Do they take the time and extra effort to resubmit the claims? Are there other billers that do not have day to day responsibility for the account that perform an audit 1x per month? What are some benchmarks to monitor how well the practice is doing with the billing and collections?

On the last question, there are standards/guidelines established by the Medical Group Management Association (MGMA). The benchmarks in MGMA are fairly non-biased and provide data for a practice administrator or physician partner to monitor the billing performance. Three benchmarks include % of collections to contract amount, # of Accounts Receivable (AR) days, distribution of sick-code office visits, and % of total revenue spent on billing and collections. The ideal is to move the practice to be collecting above the MGMA benchmark goal, maintain the number of AR days to less than 35, a ‘reasonable’ distribution of visit types, as well as a cost of billing that is within the national rate for the specialty. If your practice is meeting/exceeding all these benchmarks – great job…congratulate your billing team and look for further areas to optimize the revenue cycle. If your practice is below is more than one of these areas, drill down and identify what is the ‘root’ problem and work each week to improve.

Health and Human Services named three certification bodies within the same thirty day period: The Drummond Group, CCHIT and InfoGard. These organizations all test on the same requirements to verify that an Electronic Health Record (E.H.R.) system or an E.H.R. module meets the guidelines established by the Office of the National Coordinator (ONC). E.H.R. certifications started in September 2010 and will continue into 2011. A certification is good for 2011/2012.

For E.H.R. systems that focused in a single specialty (e.g. Pediatrics), these systems still need to meet the standards for all the criteria. Further information can be found in the final rule created by ONC. A vendor needs to work with an ONC approved certification body to confirm the terms and conditions of certification including the time-line that is agreeable to both parties. There are hundreds of Vendors starting the certification process now that the criteria is confirmed as well as the first three certification bodies have been named. Interesting that some of the large E.H.R. companies paid about 2x the cost of certification a year ago to one of the current certification bodies (CCHIT) anticipating that they would have certification first and this would be a competitive advantage. From the providers perspective, there is no difference to them if the E.H.R. is certified in October 2010 or March 2011.

No. In order to meet regulatory requirements implementing the HITECH Act, including the definition of “Certified EHR Technology,” EHR technology (Complete EHRs and/or EHR Modules) must be tested and certified by an ONC-ATCB. Any other certifications issued by an organization that is not an ONC-ATCB at the time of issuance will be invalid for purposes of meeting the definition of Certified EHR Technology and cannot be used to qualify for incentive payments under the Medicare and Medicaid EHR Incentive

Programs. Unless reissued in accordance with the requirements of the temporary certification program, certifications previously issued by an online casino organization that has subsequently become an ONC-ATCB will also be invalid for purposes of satisfying the definition of “Certified EHR Technology,” because such certifications were issued prior to the organization achieving ONC-ATCB status.

Certification by an ONC-ATCB means that EHR technology meets the specific standards, implementation specifications, and certification criteria established for the temporary certification program. (HHS issued an interim final rule outlining specific standards and certification criteria on December 30, 2009, and a final rule is expected to be issued in the near future.)

EHR technology must be tested and certified by an organization authorized by ONC as an ONC-ATCB, using currently adopted standards and certification criteria. Once ONC has authorized testing and certification organizations as ONC-ATCBs, the follow actions are appropriate:

Developers of EHR technology who wish to have their EHR technology tested and certified

Health care providers who are eligible under the Medicare and Medicaid EHR Incentive

Federal Health IT Strategic Plan was published in June 2008. As part of the 2009 HITECH

The Office of the National Coordinator for Health Information Technology (ONC) has a vision for interoperable health IT all over the nation. This work requires that ONC supports the creation of a learning health system that is patient-centered and uses information to improve health and health care of individuals and the population continuously. ONC started to obtain input for a detailed roadmap outlining goals, principles, objectives, strategies, and tactics for this effort. This roadmap will pave the road to ONC’s vision and help the health system be accountable.

The original Act, included in the American Recovery and Reinvestment Act, must update the 2008 Strategic Plan.

The updated Federal Health IT Strategic Plan will tell about objectives, milestones, and metrics related to health information exchange and associated privacy and security protections, electronic health record utilization, and will point out the needs of underserved populations to reduce health disparities. It will basically address the time period of 2011 through 2015 but it also will lay the groundwork for continued innovation and progress past 2015.

The strategic planning process will depend upon your insights and experience. We would like the process to be highly participatory, with bold involvement across the health care sector, and opportunities for public input and discussion. To this end, the HIT Policy Committee’s Strategic Plan Workgroup is tasked with developing for the Policy Committee the Health IT Strategic Framework to give notice to the strategic planning process and providing a vehicle for public and private input.

The Framework will have recommendations for the Committee for updates to the Federal Health IT

Strategic Plan. The present draft Framework organizes key strategies into four themes: meaningful use of health IT; policy and technical infrastructure; privacy and security; and learning health systems. For each theme there are goals, principles, objectives, and strategies. Ultimately, the Federal Health IT Strategic Plan will go two steps further by planning specific tactics and measures per theme.