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Canopy A WebBased Case Management Solution for your Health System.

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Canopy A WebBased Case Management Solution for your Health System. – PowerPoint PPT presentation

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Title: Canopy A WebBased Case Management Solution for your Health System.


1
DIA Meeting
Emerging Standards for Health Information
Unexpected Opportunities and Challenges from the
HIPAA Health Reform Acts
David C. Kibbe, MD
Director, Health Information Technology American
Academy of Family Physicians President,
NCHICA Chapel Hill, NC david.kibbe_at_canopysystems.
com
September 17, 2002
2
David C. Kibbe, MD Disclosure
  • Director of Health Information TechnologyAmerican
    Academy of Family Physicians
  • President-elect, North Carolina Healthcare
    Information and Communications Alliance, NCHICA
    www.nchica.org
  • Chairman and Founder of Canopy Systems, Inc.,
    whose ASP model Web-based softwareCanopyis
    used to support community-wide case management,
    utilization management, and disease management
    programs at hospitals and integrated delivery
    systems nationwide
  • Email dkibbe_at_aafp.org

3
Presentation Topics
  • HIPAA As Health Care Reform by Stealth
  • Complementary Standards-Setting Activities
  • HIPAA 2, HIPAA 3, etc.
  • The Office-Based Physician and Standards
  • Next generation of office IT will be standards
    based
  • OpenEMR and the Family Physician
  • Questions

4
Example Information Flows in Book Buying
5
Information Flows in Healthcare
6
HIPAA The Most Important Health Care
Legislation Since the Passage of Medicare
  • Health Insurance Portability Accountability Act
    of 1996 PL 104-191
  • Administrative Simplification Statute
  • Transactions Codes
  • Privacy
  • National Identifiers
  • Security
  • Delays and Guidances
  • Civil Monetary Criminal Penalties
  • Applies to all providers who bill electronically,
    or whose agents do so on their behalf

7
Health Policy Reform Failures 2001
  • Patients Bill of Rights
  • Medicare prescription drug benefits
  • Mental health parity expansion
  • FDA commissioner appointment delay (along with a
    number of other key health department leadership
    vacancies in the federal government)
  • Economic stimulus package after 9/11, failed due
    to a health care policy reform impasse between
    Republicans and Democrats in Congress

8
Health Policy Successes in 2001
  • HIPAA Transactions and Privacy Final Rules
  • Regulatory relief, e.g. less paperwork
  • Bioterrorism appropriations
  • Small for nurse training and education

9
HIPAA Minor Provisions Assume Major Proportions
and Impact
  • Major Provisions
  • Eliminate job-lock for patients with pre-existing
    conditions
  • Guarantee access to health plan coverage
  • Make health insurance portable
  • Establish MSAs
  • Minor Provisions
  • Promote long term health insurance
  • Create health data standards for administrative
    transactions and privacy of electronically
    transmitted health data
  • Address Medicare fraud and abuse at OIG level

10
HIPAA Comprehensive Standards for Health
Information
11
Who Must Comply?
  • Health Plans
  • Clearinghouses
  • All providers (physicians, hospitals, nursing
    homes, etc.) that transmit any health information
    in electronic form for which there is a HIPAA
    standard, e.g. claims
  • Electronic covers transmission over any
    computer network, but also magnetic tape, CD,
    disk
  • I.e. virtually all medical practices

12
When Do We Have to Comply?
13
What HIPAA-EDI standard transactions will affect
doctors?
  • Health claims or encounter information transfer
    x12-837
  • Eligibility status in a health plan x12-270/271
  • Enrollment and disenroll actions in a health plan
    x12-834.
  • Referral certification and authorization x12-278.
  • Health claim status x12-276/277.
  • Health care payment and remittance advice
    x12-835.
  • Health plan premium payments x12-820.
  • First report of injury (proposed).
  • Health claims attachments (proposed) x12-275.

14
An X12-837 Transaction
HL7201                                       
                              NM1852BAPTIST
HEALTH CARE24590657322                     
             N31000 W. MORENO
STREET                                           
            N4PENSACOLAFL325010000           
                                          
HL87220                                     
                               SBRP18R1936041
0MMA                                        
             SBRS18Med SuppCI         
                            NM1IL1CRUTCHFIELD
TOMMYRMI466484181A                          
         N31301 CUSTER RDAPT
202-222                                          
        N4PLANOTX750757491                   
                                      
DMGD819360410M                               
                               NM1PR2MEDICARE
PI00090                                     
        NM1PR2State Farm InsPI123456789 
                          CLM004809091347B1427
14A1YAYYN                       
       DTP096TM9900                          
                                     
DTP434RD820011215-20011215                   
                               DTP435DT0000000
09900                                            
            CL10101                          
                                          
REFEA000480909                                
                               HIBK71946      
                                                  
            HIBF71596BF8360BF8442BF73309
BF7823                                  
HIBH18D820000401BHA2D820000401BHB2D82
0011203BHA1D820360410BHB1
HIBEA2214.9BE7623                     
                               HIBG09BGC5   
                                                  
            NM1711SAITERJOSEPHXXD53184 
                                   SBRS18MED
SUPP11                                      
                       SBRP18R19360410MMA
         CASCOA21049.99                     
                                        
CASPR2214.9                                  
          AMTB61427                           
                    AMTT31427                 
                              AMTN1162.11     
                                       
AMTPG1427                                     
          AMTB11427                           
                    DMGD819360410M           
                              OIYY        
                                       
MIA137701                                   
          MOA0.23                              
                    NM1IL1CRUTCHFIELDTOMMYR
MIHC2597224343            N31301 CUSTER
RDAPT 202-222                            
N4PLANOTX750757491                           
          NM1PR2STATE FARM INSURANCEPINO
NE                    NM1PR1MEDICAREPI00
090   LX1                                     
                 SV20610HC73721LT1427UN1 
                           DTP472D820011215  
                                    
SVD00090006101                             
          CASPR2214.9                        
                    SVD00090006101         
                            CASCO451049.99   
                                     
15
MDs in Each Stage of Grieving (over loss of
control over health care information)
HIPAA-Meter for Physicians
  • Denial and isolation
  • Anger
  • Bargaining
  • Depression
  • Acceptance
  • 70
  • 15
  • 5
  • 5
  • 5

16
Many HIPAA Presentations Imply that Rules Were
Devised to Punish Physicians
  • And miss the point that the Primary Objectives of
    HIPAAs Administrative Simplification Provisions
    are
  • To improve the efficiency of health care delivery
    by standardizing the electronic data interchange
    (EDI) of certain administrative and financial
    transactions between provider and payers, and by
    specifying the medical and administrative code
    sets that should be used with the standard
    transactions.
  • To protect the privacy of health care information
    by setting standards for privacy and security of
    individually identifiable information.

17
Beyond HIPAA
  • NCVHS
  • National Health Information Infrastructure
  • Health-E US
  • Institute of Medicine
  • Leapfrog
  • National Quality Forum
  • CMS Quality Improvement Organizations (formerly
    PROs)
  • Markle Foundations Connecting for Health
  • CDC and bioterrorism defense information network

Standards
18
Key Insights from Connecting for Health
  • The time is right for accelerating clinical
    data standards adoptiontechnical capabilities
    exist and interests are aligning (e.g. CHI,
    AHA, IOM, Leapfrog)
  • There are several operable or nearly operable
    standards
  • Everyone needs data
  • Consumers and providers to improve health and
    health care
  • Payers to drive improvements in quality and
    effectiveness of care
  • Public health to identify and respond to health
    threats
  • Health services researchers to develop strategies
    that improve outcomes
  • There is extensive overlap in the data needed by
    all of these stakeholders (e.g. there is a
    community of interest)

19
Key Insights from Connecting for Health
  • Surveys indicate that the lack of
    interoperability serves as a key barrier to
    adoption of computerized patient records within
    the practicing clinician environment
  • Many providers are ready to move to adoption of
    clinical data standards, but state of readiness
    varies across the health care system
  • Standards adoption is an important enabler for
    adoption of computerized patient records.

20
CMS QIO
Devices
CDC
JCAHO
Symptoms
Laboratory Clinical Observations
Encounters Diagnoses Procedures
FDA ADE
Providers
Survey/Satisfaction
CMS payment
  • Other data categories
  • Still Images
  • Motion Images
  • Physiologic signals

Charges
NCQA
Illustrative, not factual
21
Illustrative, not factual
22
A New Opportunity
  • Bring together the emerging momentum for
    standardization with state-of-the-art Web and
    Internet technologies to create a national health
    information infrastructure

23
A New Opportunity contd
  • using public domain and open source software to
    create multi-purpose electronic health records
    that link
  • Lab results
  • Pharmacy data
  • Demographic information
  • Insurance information
  • Encounter data
  • Radiology
  • Patient functional status
  • Lab orders
  • Adverse effects
  • Diagnoses
  • Procedures
  • Discharge summaries

24
Priority Data Types
  • Patient-provider encounter information
  • Specialty/location
  • Date
  • Provider
  • Visit level codes (CPT4)
  • Diagnoses
  • Procedures

25
Second Level Priority Data Types
  • Radiology
  • Patient functional status
  • Lab orders
  • Adverse effects
  • Diagnoses
  • Procedures
  • Discharge summaries

26
Presentation References
  • On the AAFP Web site, www.aafp.org/hipaa

27
Presentation References
  • The AMA Field Guide to HIPAA Implementation
  • Kibbe, Hubbard, and Root co-authors
  • Covers Transactions, Privacy, andSecurity Rules
  • Exercises, worksheets, sampledocuments
  • Available from AMA Press
  • NCHICA Web Site
  • www.nchica.org
  • Collaborative HIPAA work products
  • EarlyView Tools for Privacy and Securitygap
    analysis
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