Ensuring Patient ID Online

Although patient identification has long been an issue within the hospital community, a new push in the conversion to electronic health records (EHRs) has added new challenges and solutions. Some organizations, like the Department of Defense (DoD) are already verifying the identity of their patients and other authorized users of their online system, MyHealtheVet. The DoD, however, has the luxury of a Veterans Administration database that includes all military personnel that would be accessing the system.

What health systems without pre-existing user databases should do is still up in the air. Privacy and security experts have not yet decided which methods of ensuring patient identity online are most effective and easiest to use. No matter the conclusion, however, most agree that it will still be necessary to verify patient credentials like a driver’s license, passport, or biometric identifier before allowing that patient to access their records online. 

Some states are implementing programs allowing access to partial records. Indiana’s State Department of Health, for example, has an online vaccination portal which allows parents to verify their children and view online immunization records. A parent must be registered by their child’s healthcare provider, and all access requests are monitored by a separate system.

Other businesses, such as identity card company Gemalto, are suggesting the use of SmartCards for patients. These cards, similar to the federal government’s Common Access or “CAC” cards, will contain a chip with biometric information about the user.

A federal policy committee has provided three guidelines that should be followed when thinking about enabling online access. The access should require a username and password at the minimum, with the option for additional security if the user chooses. The protection should not be so difficult that it discourages patients from participating, and providers should look to the Office of the National Coordinator for Health Information Technology (ONC) for guidance on identification methods. While this guidance has not yet been provided, a team within the National Institute of Standards and Technology has directed the agency to work with the ONC in setting up best practices.

You may find the original article from the Government Health IT website here. 

Hospitals Get Creative to Limit Medicare Readmissions

Since October, Medicare has been calculating the number of Medicare patients readmitted to hospitals within 30 days of their discharge. This data is kept for the new Value Based Purchasing Program, a part of health care reform (HCR) that penalizes hospitals with high rates of readmission by withholding a part of their reimbursement money.

The program has begun to change the payment structure of Medicaid away from government payments to hospitals per procedure, and towards payments for the overall wellness of the patients. These changes are a welcomed change by many patients, and even by some health care professionals who believe that this is the way hospitals will be paid in the future.

As a result, some hospitals have been employing new techniques to ensure that patients are able to care for themselves at home. According to an article in the Waco (TX) Tribune, some hospitals in Texas will have a nurse call the patient at home to follow up on their recovery and ask if there is anything the patient needs. Others will automatically schedule a follow up appointment with the patient’s doctor. Still others may send health care professionals to the patient’s home to ensure a smooth transition.

Many hospitals employ a discharge questionnaire that asks questions such as “will there be a friend or family member to assist you at home,” “Are you able to get to the pharmacy,” and “do you understand any changes in medication?” While these questionnaires have been in place for a while in many hospitals, some have tweaked the questions in an effort to prevent readmissions.

The program, combined with the resulting changes in hospital procedure, mark a significant change in hospital culture. This change will be important over time, as penalties for readmissions only escalate in the coming years. 

CDC Predicts a Bad Flu Season

The Centers for Disease Control and Prevention (CDC) warned the public earlier this month to be prepared for a bad year of the flu. The CDC found that this year’s flu season got underway in late November, the earliest start since 2003. The CDC also warns that the strain being seen this year tends to be more severe than in the past.

Normally, a spike in flu like symptoms is not expected until late December, but the CDC reported that the season kicked off the week of November 24^th. During that week, about 2.2% of doctor visits were for flu-like symptoms.

The flu is expected to be especially bad in the south, where five states are seeing outbreaks. These states include Tennessee, Mississippi, Alabama, Louisiana, and Texas. Meanwhile, Georgia and Missouri are reporting moderate levels of this year’s strain.

The best tool against infection is still vaccination. The vaccine that is available this year is well equipped to handle the flu, according to the CDC, and officials there believe the vaccine will be effective. So far, 123 million doses of the vaccine have been distributed, and 112 million of those have been administered.

This year, unlike past years, there is not expected to be any shortage of vaccines, so everyone should be able to get a vaccine if they want one. The CDC especially recommends vaccinating vulnerable groups including children, pregnant women, and healthcare workers.

You can view the Denver Post article here, and the CDC report here. 

OIG Report finds that More Oversight is Needed in EHR Incentive Program

More oversight is needed for the new Medicare Electronic Health Record (EHR) program, according to a report from the Health and Human Services’ (HHS) Office of the Inspector General (OIG).

The program started in 2011 under Center for Medicare and Medicaid (CMS) studies and disbursed about $1.7 billion in its first year. CMS estimates that they will pay a total of $6.6 billion in incentive payments throughout the life of the program, which goes through 2016. More information on the program can be found here.

The report found that, while cursory checks were done to ensure eligibility in the program, the program mostly operates by applicants self-reporting. The model can work, but there was not enough verification done to ensure that the self-reported data was correct. The report stated that CMS “does not verify that… percentage-based measures [reported] reflect the actual number of patients for a given measure, or that professionals and hospitals possess certified EHR technology.”

Specifically, CMS has not yet done any post-payment audits, and they do not have a system in place to assess a potential recipient before a payment is made. Part of the issue may be the limited information that is included in reports that are collected by the Office of the National Coordinator for Health Information Technology (ONC) and shared with CMS.

As a result, the OIG report suggested that CMS set up a pre-payment verification system, where they obtain supporting documentation from applicants, and that they provide guidance and specific examples of what would represent acceptable supporting documents from applicants.

The CMS Acting Administrator Marilyn Tavenner responded to the report, saying that pre-payment audits were not necessary. She contends that these audits would only slow down the process and delay incentive payments, but she agreed with the need for CMS to provide more guidance on documentation.

The report also suggested that ONC improve their reporting and certification programs for EHR technology so they can verify information that CMS is getting from applicants.

You can find the full OIG report here, and the Modern Healthcare article on the report here. 

More States Opt for Federal Health Exchanges than Expected

An important state health insurance exchange (HIX) deadline has come and gone, and it seems that more states will be opting for the federal option than experts originally thought.

In line with implementation of the exchanges under the Affordable Care Act, states had three options to choose between. There was the state-based exchange, in which a state would run its own HIX, the federal-exchange which ceded control of the HIX to the federal government, and a partnership option where the state and federal governments work together.

The Department of Health and Human Services (HHS) set a deadline of December 14^th for states to report their decision.  States that opted to run their own exchanges were also required to submit blueprints of the HIX plans for approval. This deadline was moved from November at the request of the Republican Governors Association. NAHAM News previously reported the shift on November 16^th (States Given More Time to Work on Health Exchanges).

The deadline has come and gone, with 18 states and the District of Columbia opting for their own exchanges. An additional 7 states have indicated that they will partner with the federal government, and the remaining 25 states default to the federal exchange. These partnership numbers may change slightly, however, because states that are not running their own exchanges have until by February 15, 2013 to partner with HHS.

State run exchanges will be put in place by California, Colorado, Connecticut, District of Columbia, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, Mississippi, Nevada, New Mexico, New York, Oregon, Rhode Island, Utah, Vermont, and Washington.

Partnership exchanges will be put in place by Arkansas, Delaware, Illinois, Iowa, Michigan, North Carolina, and West Virginia.

These numbers are interesting for a number of reasons. First of all, many of the states that defaulted to the federal system have Republican governors who emphasize the importance of the state government. Some of those governors have supported their decision to default to the federal option by calling a state HIX, “state run in name only.”

Secondly, most experts expected the number of states that opted for the federal option to be much lower.  Mostly, only small states were supposed to default to the federal system. While states can switch to their own health exchanges in future years, the logistics of the first year are going to be a challenge for HHS.

See the Kaiser Family Foundation map of States decisions here. This article was written with research from and NPR article, and a Healthcare IT News article. 

Joint Commission Releases 2013 Survey

The Joint Commission has released its 2013 Survey Activity Guide for Health Care Organizations.

You may find it here, and it is also posted on NAHAM’s Joint Commission Toolkit, available to NAHAM members online.

The Joint Commission’s 2013 Survey Activity Guide (released December 18, 2012) has replaced the 2012 guide. The guide provides detailed information to help an organization prepare for an accreditation on-site survey. Included is a description of each activity that takes place during an accreditation on-site survey including logistical needs, session objectives, suggested participants and an overview of the session.

Also available online to NAHAM members is an archived webinar that introduces the toolkit and discusses Joint Commission surveys, the toolkit, Tracer Methodology, and other special considerations for your next Joint Commission Survey.  The webinar is presented by Michael Sciarabba, CHAM, Director of Patient Access Services, Advocate Illinois Masonic Medical Center and the chair of the NAHAM Policy Development/Government Relations Committee and Brenda Sauer, RN, MA CHAM, Director, New York Presbyterian Hospital and NAHAM’s current Vice President.

EHRs May turn Small Errors into Big Ones

A new review of electronic health records (EHRs) by the Pennsylvania Patient Safety Authority found that mistakes made in EHRs can be farther reaching than errors using traditional paper records.

The study examined over 3,000 incidents over the course of 8 years that stemmed from EHR errors. In about 80% of the cases, the results were errors with medication, and many of the rest involved incorrect or unnecessary lab tests. In the medication errors, about half of the patients were prescribed the wrong medication, and another quarter were under medicated.

So why are mistakes traveling farther? Electronic systems are becoming increasingly networked to things like the hospital pharmacy or other health information exchanges. This means that an error that may have previously been caught before it was replicated may now cascade to other systems before being caught. The scale and amplification of mistakes has increased.

The article, published here, also points out that in the short run, more mistakes are being made. One cause of this could be the lack of training that users of the systems have received. Federal programs that incentivize the implementation of electronic systems, and deadlines that came with the 2009 stimulus funds may have caused a quick rollout of systems to staff members who did not yet know how to use them. Additionally, some facilities may be using EHRs in addition to paper records, producing incomplete information entered into the system.

In some systems, information that is typed into the wrong box is not recognized. In others, system glitches can cause issues, like random medication orders appearing in some patients records.

Most experts believe, however, that these are temporary setbacks. As time progresses, EHR systems will become smarter, and staffs will become accustomed to using them. Long term, most still agree that EHRs serve as an investment that will yield future gains.