Computers in Healthcare

Insights from HIMSS – Meaningful Use | Innovation | ICD-10

On the final day of the HIMSS12 conference in Las Vegas, NV I had an opportunity to interview Thom Kuhn, Sr. Systems Architect, ACP. This is a summary of our discussion regarding his personal observations of the conference.

AB: Thom, did you attend any sessions at HIMSS that stand out as particularly important with respect to physicians in small ambulatory practices?

TK: Janet Corrigan, president and CEO of the National Quality Forum (NQF) gave an insightful presentation on the state of quality measurement. There is general consensus of a cycle that progresses from evidence to guidelines to decision support. It is this cycle that drives development of the documentation for quality improvement. Quality Improvement and EHRs are closely inter-linked with data being necessary for decision support. One cannot manage any of the emerging value-based payment systems without lots of data. In this more complex system, there is a concern that small practices may not have the resources to survive without being part of an integrated health delivery network.

AB: What were your insights regarding Meaningful Use?

TK: There has been disappointment with the lack of interoperability and the ‘fuzziness’ around standards in stage 1. We recognized that the early requirements were weak. The key objectives for Stage 2 are to enhance information exchange and interoperability in a real world setting using individual standards. With ICD-10 potentially on hold and a few key standards such as SNOMED-CT for problems, there is a great opportunity for the use of clinical terminologies that can be mapped to reporting on the back end.

AB: Are there any highlights for specialists in Stage 2 Meaningful Use?

TK: Yes, one of the enhancements in Stage 2 is the ability to do registry-based reporting. This is a way for specialties to get around the problem of measures. For example,  if you are a cardiologist, you will already be using a registry in order to follow your patients. Stage 2 Meaningful Use allows for a reporting function from the registry vs. using standalone reporting tools. This is a much more seamless process.

AB: What is being done to foster innovation in the EHR market?

TK: Because of the Meaningful Use funding, the typical supply-demand equation does not work. Some vendors have more demand than they can manage. EHR vendors also do not know their customers as well as they should. Smaller EHR vendors, where traditionally innovation takes place, are strapped as a result of the need to support existing customers, add new customers and manage implementations. What is becoming apparent is that a company may need to be a certain size in order to to innovate and establish a footprint in the market. As a result, it remains difficult for small vendors to support innovation.

AB: Were there any additional announcements at HIMSS that readers should be aware of?

TK: The postponement of ICD-10 created a major buzz when announced at the HIMSS conference. However, many large organizations have committed budget and resources over the past twelve months and are going to continue with their plans to implement ICD-10. HIPAA 5010 compliance was supposed to be easy in advance of ICD-10, however has been a nightmare for practices that have not been getting paid. Some practices are down more than $100,000 without any cash flow. They did everything right. They were told that 5010 was going to work and it has not worked in many settings. Unfortunately in healthcare, it is extremely difficult to have a soft launch. As a result, what happens is that practices function as the beta testers. What is needed is a longer certification period and more effective testing. This is a lesson that needs to be applied to ICD-10 deployment.

This post is the personal opinion of the author and does not necessarily reflect the official policy or position of the American College of Physicians (ACP). ACP does not endorse a specific EHR brand or product and ACP makes no representations, warranties, or assurances as to the accuracy or completeness of the information provided herein.

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