Challenges in Obtaining Complete Medical Record Data

By Lesley Brown, SVP of Product Management at Halfpenny Technologies

As previously discussed the potential benefits to health plans of compiling a complete picture of their member’s health status are abundant.  The more data and information you have about your members, the better help and guidance you can give them to ensure they receive the most appropriate and best care without redundant replication of services.  And without unnecessary cost!

Being able to obtain a comprehensive medical record for a member from a physician’s practice is one avenue that health plans can take to enrich their member’s health records.  Yet, technical and business challenges aside, being able to gather a comprehensive or full medical record from an EMR can be difficult.  Experience has demonstrated that all too often much of the key clinical information about a patient is missing from the “structured” components of Electronic Health Records.  And this occurs even when data is retrieved using “industry” standard formats such as the HL-7 C-CDA template and document structure.  This missing clinical data ranges from lab result interpretations, medication detail around frequency and dosing, allergy information to physician signatures.  An additional challenge is the inability to distinguish and interpret between actual missing data in a record from “null” data elements such as “no information documented” or “no known information”.  This absent information can be very challenging to find and retrieve from within an EHR system.  Experience has shown that reliance on “industry standards” such as the C-CDA templates isn’t sufficient.  Add in the fact that many different EMR’s are in use today by physician groups and hospitals, and these medical record systems are built in a proprietary way, making the challenge of finding that missing or incorrect information different between EMR systems and hence physician practices.  As a result of these challenges, healthcare providers who would like to gather clinical data in order to compile a more complete picture of their member’s health are faced with a project that is time consuming, extremely expensive, frustrating and can often result in disappointment and incomplete personal health information.

Looking to obtain a complete medical record on your members?  Halfpenny Technologies has been in the clinical data exchange business for more than 15 years and over that time have built reusable interfaces that connect to 90%+ of the top EHR vendors and LIS/HIS systems.  Halfpenny Technologies comprehensive clinical data exchange platform uses a multi-faceted methodology to obtain clinical record data.  We do not rely solely on the use of the C-CDA standard.  Halfpenny Technologies completes a quality assessment at each data retrieval stage identifying how full or complete a medical record is and highlighting missing sections or data elements.  We can then work with our customers to identify ways to ensure that clinical data is being acquired and stored correctly.  Halfpenny Technologies’ vendor agnostic approach allows the receipt of any EHR medical record data format and in return health plans can receive clinical data in the layout of their choice. Our continued investment in innovative solutions has uniquely positioned the company as a national provider of clinical data exchange solutions to the health care industry.

 

Ivy Creek Healthcare to Expand Physician Outreach Program

Clinical Data Exchange Solutions provided by Halfpenny Technologies solutions to assist in expansion

BLUE BELL, Pa.–(BUSINESS WIRE)–Ivy Creek Healthcare announced today an expansion of their hospital physician outreach capabilities through clinical data exchange solutions provided by Halfpenny Technologies Inc. (“HTI”). The HTI platform will facilitate the exchange of clinical laboratory orders and results to physicians, clinics and long-term care facilities that refer to the Ivy Creek three hospital system.

“Our team is looking forward to helping Ivy Creek expand into their surrounding communities through their clinical outreach initiatives with our clinical data exchange and business intelligence solutions,” Tim Kowalski, President & CEO said. “We have worked with over 95% of the EMR companies so we are uniquely positioned to assist in providing Ivy Creek’s patients with reliable, proven interoperability solutions that we deliver as a fully managed services delivery model. Our latest V7 release of our Web-based Clinical Orders and Results Portal will also be rolled out to assist their clients with a secure, easy to navigate system to create clean requisitions and to view results online.”
Read more here

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Ready for #HIMSS16?

The 2016 HIMSS Conference is almost a month away! Scroll through our infographic and find some useful information on the conference before you leave for Las Vegas.

HIMSSinfographic

We are so excited for HIMSS and to showcase how we can solve your interoperability challenges.

Like what you see? Make sure you subscribe to our blog and follow us on social media for more updates!

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By Emily Pollock, Marketing Specialist at Halfpenny Technologies

Supporting Shared Savings Models, Care Coordination & the Actionable Exchange of Lab Data with LOINC®

lab_test_tubesOften, when I make a presentation to healthcare executives and lab people, I’m struck by the level of unfamiliarity regarding the Logical Observation Identifier Names and Codes (LOINC®). It is not that all are unfamiliar with it; lab directors and some managers and medical technologists are familiar but, overall, most are not. This is a telling fact about the state of our preparedness for data sharing, coordinated care, and advanced analytics. As a further example, a group of senators recently sent a letter to the Centers for Medicare and Medicaid Services (CMS) requesting a re-evaluation and “reboot” of the Meaningful Use (MU) program citing, among other things, concerns regarding the program’s ability to achieve meaningful interoperability. LOINC® is part of the solution.

LOINC®: The Cornerstone for Interoperability

The cornerstone of interoperability is the use of standardized data structure and coding schemes. Since clinical laboratory data comprise the bulk of an individual’s medical record and are essential for healthcare decision making, one would expect it to be prominently featured in all interoperability discussions. In the realm of clinical laboratory data exchange, specifically for lab results, two standards come to mind immediately:

  1. The Laboratory Reporting Initiative (LRI) as a structure standard, andLOINC-maooing_CTA
  2. LOINC® as a coding standard.

While both are mentioned in MU regulations and the accompanying Office of National Coordinator (ONC) standards documents, they are not widely recognized as critical for interoperability progress – but they are!

The History of LOINC®

The Logical Observation Identifier Names and Codes (LOINC®) system was created in 1994 at the Regenstrief Institute, associated with Indiana University. Initially focused on laboratory observations (all laboratory categories and Veterinary Medicine), it has also expanded to include other clinical observations made on patients.

  • LOINC® has been endorsed by the American Clinical Laboratory Association (ACLA) and the College of American Pathologists (CAP).
  • It has been adopted for test reporting by large commercial labs such as Quest, LabCorp, Mayo Medical Laboratories, and MDS Labs; large HMOs including Kaiser Permanente and Aetna; governmental organizations including the CDC, DOD, VA, and NLM.
  • Internationally, LOINC® has been adopted as a national standard in many countries, including the United States, and has been translated into many languages.

Interoperability has two cornerstones:

  1. standardized structure
  2. standardized content.

LOINC® was created to solve the problem of laboratory data interoperability by promoting standardized content. To date, most labs use proprietary order and results codes. In the past, when results were manually transported or faxed, standardization was not an issue. However, in our emerging electronic healthcare setting without content standardization there is no interoperability. LOINC® mapping can help.LOINC_mapping

Facts about LOINC®:

  1. LOINC® is the “new” standard for lab results and lab orders
  2. It is critical for Meaningful Use
  3. It can me key to the success of independent and hospital labs
  4. LOINC® is large and complex – Test dictionary builds and LOINC® mapping are specialty skills that require lab and LIS expertise as well as LOINC® expertise.

The prudent approach by hospital and independent labs is to be proactive and prepare while there is still time. That is why my colleague, Halfpenny Technologies Clinical Data Specialist Jane A. Burke BSMT (ASCP) and I have co-written a white paper positioning LOINC® with respect to care coordination, meaningful interoperability, the exchange of actionable data, and supporting shared savings models. We hope that this white paper entitled, Supporting Shared Savings Models, Care Coordination and the Actionable Exchange of Lab Data with LOINC®, provides the foundation for LOINC® knowledge and offers you the important questions you need to ask regarding LOINC® mapping and test dictionary creation for your organization.

Find a LOINC® Mapping Expert

For those that conclude that they do not have the skill set and/or the infrastructure to support LOINC®, alternatives do exist and should be examined. Most LIS vendors do not offer such services to support their software systems and most labs are left to fend for themselves. However, some third-party vendors offer services for the initial dictionary build, LOINC® mapping, ongoing maintenance, as well as, middleware solutions that can bridge the gap in current capabilities of existing LISs.

Being able to positively answer the above questions or, at least, have a roadmap to achieve them within the first year of the start of MU stage 2 (2014), will prepare the lab for the realities of providing clinical services to physicians in the era of accountable care.

For more information, on LOINC® Mapping and Test Dictionary builds, please contact Halfpenny Technologies at 855-277-9100 or visit us online at http://www.halfpenny.com.

Gai Elhanan, M.D., M.A.

Chief Medical Information Officer

*LOINC is a registered United States trademark of Regenstrief Institute, Inc.

Access to actionable lab data is essential for the success of care management for Health Plans & ACOs

Lab_data_health_plansHealth insurance and Accountable Care Organizations (ACOs) are faced with constant challenges due to a rapidly evolving health care landscape fueled by change from compliance initiatives, health reform and an unstable economic environment.  To tackle these challenges, health plans and ACOs need to develop go-to-market strategies and analytics solutions that define the organization’s future position and answer critical questions surrounding growth, profitability and sustainability. The ultimate success of these organizations will be determined by its ability to:

  • Predict shifts in their customer-base
  • Manage the cost of care
  • Collaborate more effectively with providers
  • Increase NCQA and HEDIS quality scores and Medicare Five-Star rating

Access to actionable lab data plays a significant role in the success.

Health plans utilize care management programs that typically implement a variety of interventions tailored to needs of specific groups of affected individuals.  A model that identifies those individuals who have high risk of complications has the greatest potential to impact outcomes and lower healthcare cost. Complete and real time lab results can help health plans model individuals who have high risk of complications, greatest potential to impact outcomes, and lower healthcare cost.

It is necessary for health plans to access to lab results to help them better determine the effectiveness of care management programs.   Some of the challenges and opportunities regarding lab data include:

  • Health Plans and ACOs typically experience difficulty receiving clinical data from labs.
  • Clinical data can have a significant impact on a health plan’s Medicare Five Star Rating, NCQA and HEDIS quality scores.
  • Health plans and ACOs seek laboratory data to reduce instances of drug contraindications, generate clinical alerts, and populate personal health records.
  • Lab results can demonstrate the efficacy of care management programs.
  • Ability to provide clinical data can be an important factor for a lab to achieve in-network status with a health plan or ACO.
  • Health Plans and ACOs share in a unique position to help a lab understand leakage (testing performed by out-of-network lab).

Health plans and ACOs need a true interoperability solution for lab and clinical data which can better enable their organizations to manage and lead in the coordination of individual care, support shared savings models, and deliver measurable and actionable outcomes that help health plans drive down the cost of care and ultimately improve population health.

Brian Muck is the SVP of Sales & Marketing for Halfpenny Technologies

Interested in more?

Hospitals/Labs Outsourcing EHR Integration is an Emotional Hurdle, Not Financial

Healthcare is the largest industry in our economy, yet it is the last to migrate into the “digital or electronic” age. Healthcare has been last to the party largely because of the incredible amount of fragmentation within the industry. Additionally, the best of breed attitude regarding testing, diagnosis and treatment has resulted in the development of unique systems, equipment and protocols that were never designed to feed into a single or “connected” database.

Many factors are helping to fuel this change, but certainly the biggest factor is the federal government incentives for physicians to implement EHRs in their practices. Over 500 unique EHR vendors are participating in the biggest land grab that the industry has ever seen! While integrating one laboratory information system to one EHR may not present significant challenges, integrating 40 to 50 different laboratory and registration systems to over 500 different EHRs could tax any IT department. To add to the chaos, the hospitals and labs cannot predict or control the demand they will have from a quantity standpoint or from which EHRs.

Most businesses will evaluate their core competencies and decide which functions should be outsourced as opposed to keeping in house. For example, a law firm will probably outsource their printing, but keep their firms legal work in house. Healthcare facilities have been slow to subcontract anything due to the implications and potential effect it might have on patient care. As every piece of medical equipment now provides a digital record, how will facilities react? Should healthcare facilities farm out some of their information technology demands or should they staff up to meet the current peak demands they are experiencing?

Here are some reasons to outsource EHR connectivity:

  • Reduced cost from direct labor as well as general and administrative expenses
  • Move staff to more critical/unique tasks, providing flexibility
  • Allows for erratic demand; do not have to staff for peaks
  • Reduce start/completion time for projects

Outsourcing EHR connectivity is a lower cost alternative than keeping the function in house. Hundreds of facilities across the country have conducted an ROI analysis and determined that subcontracting is the more cost effective path to take. While the argument can be made that if current staff is under-utilized, performing this function in house would not add any incremental cost, few if any healthcare facilities find themselves in this position. Additionally, efficiencies exist when utilizing a team that has a successful track record to complete EHR connectivity projects because that is what they do “all day, every day!”

With all the demands that IT departments have to integrate equipment or systems within the four walls of the facility, by outsourcing EHR connectivity, options exist to be more responsive to those demands. Typically most facilities will put EHR connectivity at the bottom of the priority list, which can have a significant negative impact to growing/maintaining an outreach program.

As external physician groups sift through the 500 EMR vendors to find the right one, they generally do so without consulting their lab providers as to which one they chose or the timing for implementation. Most lab providers find out only when the EHR has been installed and they receive a call from the practice saying, “connect us.” Staffing for the peak is not cost effective and alternatively making the client wait until time is available usually results in a lost business opportunity.

It is very difficult, if not impossible, for an in-house staff to compete with a third-party provider regarding project completion. Constantly being pulled away for “higher priority” projects that will always be more interesting to the internal team can mean that the completion of EHR projects could drag on for several months, when in fact could be completed in a few weeks.

Why then is subcontracting such a huge hurdle for many organizations? Although there are very good reasons to subcontract, many administrations appear to want to internalize EHR connectivity for non-financial reasons that in some cases maybe emotional or “fear based” in nature. Because healthcare facilities are not traditional outsourced, they usually dismiss the notion without giving it a fair evaluation. IT departments, in particular do not want to give up the opportunity to increase their influence and or increase staff, and initially resist outsourcing.

Many in house staffs will embrace the idea of expanding their influence outside the walls of their facility and the challenges that new EHR connectivity projects can offer. What happens next is that they become embroiled in the “perfect storm” of ambulatory physician practices, the myriad of EHR vendors with their various capabilities, and their own clinical or business development staff. IT staffs quickly become disinterested in the repetitive nature of the process to electronically connect their clients, as well as meeting the objectives of all the different stakeholders. IT departments are usually not geared to be able to successfully meet all the challenges that these groups can present. Deadlines are missed, existing or potential clients are lost, and confidence in the internal staff to get things done suffers.

While outsourcing may not be the perfect answer for all, it clearly should be given greater consideration to meet the incredible demands that healthcare facilities will face over the next five years. At a minimum, it could be utilized as a backup strategy to augment internal staff and allow the facility to concentrate on its core competency of delivering the best in patient care. As their trust with the third-party provider grows, and emotion is taken out of the equation, it just might become a critical part of your “connected” strategy.

 

What is the Right Connectivity Strategy for My Outreach Program

and how about them U of A Wildcats; I think they have a real chance this year in the NCAA!

Let’s review the environment. In many areas of the country, the penetration rate of physician of EHR/EMRs will drive from a lowly 20% to nearly 80%. This adoption rate is fundamental to the changes necessary to drive more effective and efficient healthcare. But let’s also be honest, too; it is also driven by funding from good old Uncle Sam. These physicians and physician groups will also want to comply with meaningful use criteria to qualify for stimulus funding to underwrite their costs of entering the new electronic medical record and health record era.

Meaningful use criteria, as many already know, in stage one, two and three begin and then accelerate sophisticated use of these systems. Early stages mandate the storage of discrete data like lab which comprises nearly 80 to 90% of the potential data within an EMR. Let also not be modest; laboratory diagnostic data represents probably the largest data source for diagnostic efforts of physicians. No bias here! Later stages mandate Order Entry so drug-to-dug, drug-to-disease interactions can be checked, and – drum roll, please – laboratory ordering which eliminates errors, reduces manual data entry, (there is a solid ROI behind clean orders and getting paid, but that’s another blog) and promoting quality and efficiency across the spectrum of care.

It only makes sense. Reality check number one; there are at least 375 different EMRs out there that we know about. We are learning about new ones on the pace of a couple per month. It is the Wild West, and it sort of feels like a there is a stampede coming over the hill doesn’t it?

If you are one of the 75% of hospitals laboratories in America with an outreach program or are a reference lab, you could be facing this stamped and that’s actually not the worse part. The worst part is they are all DOCTORS!!!!! (By the way, I hope our Chief Medical Information Officer does not read this blog, but I couldn’t help throwing that analogy in. You should see him when he is mad; he turns all sort of funny shades of red and purple! Anyway…) So, you are facing the stampede and wondering what’s the right strategy. Okay, let’s start with the options.

Option 1. My IT department controls an Interface Engine. Why can’t I just connect my orders and results to it, and let them connect to all the different EMR’s? Sounds simple, right?

Here are a couple questions to ask yourself.  Does your IT department have a lot of extra time on their hands? Have they already completed the ICD9 to ICD10 and 4010 to 5010 conversions? Are they prepared to handle the stampede? Can they deal with 375 different EMR systems? Are they good with doctors?

Option 2. I could use the physician access system/portal vendor I am currently doing business with! Sounds good, doesn’t it? If you are using one of them, they probably already have some connections out there. You have used them for quite some time. You like them or maybe not.

Okay, here are a couple questions to ask yourself. Are they prepared to handle the stampede? Can they scale to the demand you have and all of their other customer’s needs, too? Is EMR connectivity a sideline or are they really in this business with both feet? How is there service now? What might it be like when things get really crazy?

Option 3. Use the local HIE. This one usually comes from corporate. “We don’t want you wasting time building interfaces to EMR’s, because we have that covered with this here strategic relationship with the state’s HIE!”

Okay, you have got my pattern figured out. Here are some questions to ask yourself. Who is faster at building interfaces to my clients’ EMR, the HIE or my competitor? Can you afford to wait? Does the HIE initiative take care of the special requirements and workflow of lab order and result processing? How are the specimens going to be received? Will I be able to get paid with the information they are sending? How will MRN, Event, Episode or Account Numbers be associated with the order when transmitted to the LIS? Will the physician be presented with ask-at-order-entry-questions? Will an ABN get printed, signed and will the transaction contain an indicator of same? Is the HIE technology biased in any way that might prevent it from interfacing really well to all my customers EMRs?

(Note to reader: some HIE technology vendors are also EMR vendors and may not play nice with other EMRs or heavily influenced by your competitor. You get the picture. Their goals may not coincide with your goals to protect and grow your business.  At the worst case, you might want your own strategy in place or at least a backup!)

Option 4. Find a vendor who does this for a living: just this.

Big Finish – I hope you find the rather weak attempts at humor and analogy not too distracting. There is merit within each option and other’s I haven’t mentioned, but I pick on each pretty hard for a purpose. There is a are large demand for connectivity now and we expect it to grow.  Your strategy and options deserve careful consideration and potentially a multifaceted approach. If you already have a strategy, great, what’s your back up plan? If you don’t have a strategy, it’s probably time to start the process.  I welcome any and all comments, thoughts, concerns as long as they are positive and constructive, for the rest I’d like to introduce you to our CMIO; he’d love to hear from you!!!!!

(Note to reader: Our CMIO, Dr. Gai, is actually an incredibly smart, nice, and visionary individual. His face doesn’t turn red when he gets mad either. I’ve never actually seen him mad, and I enjoy his company. I just made all this up to see if he would read my blog!)