Verisma

April 18, 2024

By January 2026, all certified electronic health record (EHR) users must comply and exchange information per the Trusted Exchange Framework Common Agreement (TEFCA). My colleague, Roberta Baranda, past president of the California Health Information Association (CHIA) and health information management (HIM) director at Valley Children’s Hospital spoke about TEFCA several years ago. I looked it up and thought, another government regulation to enforce what we’ve all been needing, wanting and working towards for many years, interoperability. If all of us are on the same page about interoperability, why is it so difficult to achieve?

An unprecedented amount of data is being collected across a diversity of sectors, which, if harnessed, could transform public health decision-making. Yet significant challenges stand in the way of such a vision, including the need to establish standards of data sharing and interoperability, the need for innovation in both methodological approaches and workforce models, and the need for data stewardship and governance models to ensure the protection and integrity of the public health data system. (Martin, et. al., 2022)

Why’s the Government Weighing in on Interoperability? Better Patient Outcomes

All healthcare professionals agree there’s a need for a viable, reliable method, and framework for health information to be exchanged. Most everything we do in health information ultimately results in trusted info being exchanged. When we analyze charts, the purpose is to ensure completeness of the record so the recipient will have the patient’s full story. When we code a record, the data are captured for research recipients and the payers to receive information pertaining to cost of care. Document imaging specialists ensure paper records are incorporated into the electronic version of the chart to provide continuity of care. Of course, clinicians feverishly document care of the patient knowing information will result in better outcomes or prevention of further illness.

Federal efforts may address some impediments to electronic health information exchange. Specifically, the Trusted Exchange Framework and Common Agreement being implemented by the Office of the National Coordinator for Health Information Technology (ONC)—which aims to describe a common set of nonbinding principles to help facilitate exchange among health information networks—may mitigate costs providers face by providing a simpler approach to connecting with other providers. However, stakeholders noted that participation in this effort is voluntary and does not address issues like information technology staffing shortages and gaps in broadband access that pose particular challenges to electronic exchange for small and rural providers. (Gordon, 2023)

Health Information Access Challenges

The government mandate speaks to the importance of access to health information. The vision of our national organization, American Health Information Management Association (AHIMA) is “A world where trusted information transforms health and healthcare by connecting people, systems, and ideas.” Can TEFCA be the conduit for us to get there? The National Institutes of Health (NIH) addresses implications and solutions for interoperability challenges, including a copious amount of health data with outdated workforce models, and numerous resource constraints.

Data science and technology companies continue to be on the cutting edge of information exchange. As such, the data science and technology sector has the expertise to help mitigate and solve challenges within legacy data systems… departments working within a resource-constrained environment and a workforce whose expertise is focused on health, rather than technology. In addition, to increase accuracy and efficiency, there is a need to develop processes for timely data sharing that require minimal human effort. (Martin et. al, 2022)

TEFCA Guidance Resources: ONC and AHIMA

During the February Verisma Academy webinar, Elisabeth Myers, Deputy Director, Office of Policy, ONC, presented an on-demand course with solid, actionable information that’s really worth checking out: Exploring HTI-1, TEFCA and AI in Healthcare – Where Are We in 2024?

Separately, AHIMA provided a two-page guideline on what TEFCA means for provider organizations, underlining the idea that when orgs exchange information through Qualified Health Information Networks (QHINs), “there’s increased focus on how to expand use cases and make a broader impact.” In terms of adaptability, “TEFCA will be able to grow and adapt as needed to ensure it serves user needs,” including “a three-year roadmap for the TEFCA to begin utilizing the Fast Healthcare Interoperability Resource (FHIR).”

Will TEFCA Help Solve Interoperability Challenges?

At the very least, TEFCA has us discussing this important topic and moving in a unified direction as an industry. Providers who struggle with resources to stay on top of what these regulations mean, or how to operationalize them, can lean on external partners who’ve expertise in this space – ultimately benefiting everyone.

I’m proud to work for a company fostering interoperability with technology-rich tools mitigating human error. We help provider partners manage the deluge of incoming records, care coordination processes, and sharing information — with privacy and security at the forefront. We’re also passionate about becoming your trusted partner.

References:

www.ahima.org; What Does the TEFCA Mean for Your Organization?
https://ahima.org/media/zw3hx0c3/tefca_summary_fin.pdf

Martin LT, Nelson C, Yeung D, Acosta JD, Qureshi N, Blagg T, Chandra A (2022) The issues of interoperability and data connectedness for public health. Big Data 10:S1, 19–24, DOI: 10.1089/big.2022.0207.

Gordon, L. (2023) Electronic Health Information Exchange: Use Has Increased, but Is Lower for Small and Rural Providers. GAO-23-105540; Published: Apr 21, 2023.
https://www.gao.gov/products/gao-23-105540.

March 21, 2024

In recent years, artificial intelligence’s (AI) use in healthcare has grown into a realm of profound innovation, promising to revolutionize the very landscape of medical practice and patient care. From performing labor intensive repetitive tasks, enhancing diagnostic accuracy, treatment efficacy, and operational efficiency, AI stands as a beacon of hope to address some of the most pressing challenges facing the healthcare industry.

ONC

The Office of the National Coordinator for Health Information Technology (ONC) actively promotes the adoption and responsible use of AI in healthcare. During the February Verisma Academy webinar, Elisabeth Myers, Deputy Director, Office of Policy, ONC, presented their current guidance regarding the use of AI in clinical decision support.

Challenges

Myers also outlined numerous challenges surrounding the use of AI in healthcare such as perpetuating information asymmetries that may lead to healthcare inequalities. AI can also magnify ethical, legal and social concerns during data collection and use, leading to ineffective or even unsafe recommendations.

Guidelines and Initiatives

Given this, the ONC developed guidelines to facilitate the responsible and ethical use of AI in healthcare, including considerations for data privacy, security, and equity. A few of their key initiatives are:

• Interoperability Standards facilitating the seamless exchange of healthcare data, crucial for AI applications to access and analyze data from various sources
• Ethical Guidelines ensuring AI is used responsibly — protecting patient privacy and promoting equitable healthcare delivery
• Data Governance Frameworks addressing data quality, security, and privacy issues

Impact

As a result, the ONC issued a final rule regarding Decision Support Intervention (DSI) which revises existing Clinical Decision Support (CDS) criterion, streamlining and simplifying requirements for all Health IT Modules. In addition, it establishes new maintenance of certification requirements to continuously review and update DSI-related information. Myers describes the policy impact of DSI Certification Criterion as follows:

• Improving transparency
• Enhancing trustworthiness
• Fostering an information ecosystem
• Advancing health equity by design

The final rule preamble describes each characteristic and associated approaches that can be taken to assess and mitigate risks. Myers provided participants with a link to ONC’s website for more information on their AI initiatives and fact sheets regarding DSI’s final rule.

Education and Training

The ONC also has initiatives to educate and train providers and organizations about the potential benefits and challenges of AI in healthcare. In addition, ONC works closely with other federal agencies, such as the Food and Drug Administration, to develop regulatory frameworks for AI-based medical devices and software applications.

AI is growing rapidly and the ONC is staying on top of it by developing standards and rules for the safe and effective use of AI in healthcare. Interested in learning more? Access Verisma Academy’s on-demand course: Exploring HTI-1, TEFCA and AI in Healthcare – Where are we in 2024?

January 2, 2023

Privacy gets (more) complicated

We’ve said it before – the US is overdue for a national conversation on privacy. 2023 only increased the stakes with the increased adoption of AI, stark state-level differences on social policies, and the prevalence of cybersecurity threats.  Navigating these conflicts – in the absence of a national privacy framework – will be increasingly time-consuming and high-stakes for privacy and compliance professionals.

Patients will be the primary focus

Healthcare consumerism and patient-centered care have been hot topics in 2023 and will remain so in 2024. One area that hasn’t received as much attention is the emphasis on individual patient factors – for example, what constitutes a burden for some patients when requesting records is not for others.  Information blocking exceptions specifically prioritize individual factors in the preventing harm and content/manner exceptions. It will no longer be enough to have a black-and-white procedure manual; instead, organizations may want to consider a “playbook” of factors to be considered.

Expect regulatory activity, especially in early 2024

The last Congress will be one of the least productive in memory – and there weren’t high hopes given the ideological polarization and thin margins in both chambers. Expect to see regulatory agencies attempt to step in through rulemaking.  Early 2024 will likely see the most activity – agencies will want to publish or enact any rules prior to 60 days before a potential change in administrations.

and as always …

Executing on fundamentals is key

This one goes across all areas – we can’t stop emphasizing fundamentals while we handle increasing complexities. It’s the little things that get you in the end. Keep on top of cybersecurity by emphasizing employee cyberhygiene, patient privacy and safety by verifying patients with two identifiers, and patient access by improving request processes and adding new delivery options.

By Barbara Carr, RHIA

In today’s ever-evolving healthcare landscape, navigating the challenges posed by increasing payer audits and denials demands a proactive and expertly crafted approach to claims accuracy and compliance. To effectively tackle these challenges, healthcare organizations must adopt an integrated solution that tracks the entire audit process from initial request receipt to denial and appeal resolution. This comprehensive and systematic approach is vital for mitigating the financial risks associated with payer audits and ensuring sustained success.

Herea are some top reasons you should focus on optimizing your payer audit management process:

Enhanced Efficiency and Organization: The integration of all audit-related information and documents into a centralized system streamlines the entire audit process. This eliminates manual tracking, reduces administrative burdens, and safeguards against missing critical deadlines.

Timely Response to Audits: By diligently tracking audits from the moment of request, Release of Information Specialists (ROIS) can promptly respond to audit inquiries, reducing the likelihood of delayed or incomplete responses that may lead to denials. An integrated system also provides valuable data on the status of audits, ensuring that deadlines are met.

Improved Visibility and Transparency: Payer audits involve multiple steps and stakeholders. A comprehensive system offers real-time visibility into the audit status, empowering coding teams, clinical documentation teams, compliance officers, and management to stay informed about audit progress, denials, and appeals.

Identification of Patterns and Trends: With an effective audit management process, organizations can identify patterns and trends in coding audits and denials. Analyzing this data enables a proactive approach to address root causes and prevent future denials, ultimately leading to improved financial outcomes.

Compliance and Regulatory Adherence: Adherence to coding and billing regulations is critical for healthcare organizations. Your audit tracking solution should be built to ensure systematic compliance with these requirements.

Effective Appeals Management: Tracking audits through the denial and appeal process is essential for efficient appeals management. With proper audit management technology, an audit team can identify common reasons for denials and develop targeted strategies to overturn them.

Data-Driven Decision Making: Comprehensive reporting capabilities (beyond spreadsheets) enables an audit team to gather data on audit outcomes, denials, and appeal success rates. Armed with this critical data, financial teams can make informed decisions regarding coding practices, training needs, and resource allocation.

Proactive Risk Mitigation: Vigilant monitoring of audits and denials allows organizations to proactively address potential compliance risks and coding errors. This approach reduces the financial impact of denials and minimizes the risk of audits leading to legal or regulatory issues.

A comprehensive approach to payer audit management supported by advanced technology is essential for healthcare organizations to achieve sustained success in an increasingly complex healthcare landscape. By focusing on optimizing this process, organizations can stay ahead of payer audits and denials, safeguard financial stability, and maintain a commitment to delivering high-quality patient care.

By Connie Renda, MA, RHIA, CHDA

Challenges in HI Staffing

Understaffing

Understaffing is a perennial issue that plagues healthcare information management. The demand for skilled professionals often surpasses the available talent pool. A report from the Society for Human Resource Management (SHRM) notes that finding suitable candidates and retaining employees will be paramount for organizations in 2023. However, this search for top talent often collides with budget constraints, creating significant challenges, especially in an era marked by concerns over inflation. Many organizations find themselves handcuffed by hiring freezes or grappling with staff shortages due to employees on FMLA leave, compounding the problem further. The critical HIM duties cannot be deferred and require a dependable workforce, which isn’t always readily accessible when needed.

Skill Gaps

In the ever-evolving healthcare landscape, skill gaps are another major headache for healthcare information leaders. As Forbes aptly points out, the industry is grappling with substantial talent shortages as skill sets struggle to keep pace with rapidly advancing technology. This disconnect between the demands of modern healthcare and the available skill sets places additional pressure on organizations striving to maintain efficiency and compliance in their operations.

Fluctuating Workloads

Fluctuating workloads compound the woes of healthcare information leaders. The volume of work can oscillate dramatically, leading to unexpected spikes in demand that strain an already stretched workforce. Coping with these variations efficiently while maintaining a high standard of service becomes an ongoing challenge.

What Can We Do?

Develop a Flexible Workforce Strategy

Maintaining staff agility is one way to ensure operational continuity and peace of mind. My colleagues had many great ideas to achieve this from cross training to assigning multiple job roles. More experienced staff (or outsourced partners) are motivated by new learning experiences and can help address staff shortages, workload surges, and unique projects. In fact, this is such an effective strategy that Verisma launched a team dedicated for this purpose called Verisma bench.  

Consider Efficiency Gains Through Outsourcing

In addition to ROI, many other administrative HIM tasks can frustrate staff who could be spending more time working at the top of their license. Outside partners can alleviate these burdens and improve efficiency, while eliminating the headaches of hiring and training. Verisma, for instance, can manage tasks like prior authorizations, purge projects, inbound document management, and referral management. so staff can focus on what matters most – patient care. 

Leverage Technology-Enabled Strategic Partnerships

Strategic partnerships are more than supplemental staff. They’re relationships built on experience, consistency, time, and effort. Better yet, technology-enabled service companies do more than complete tasks – they build for the future. Working with a trusted company like Verisma to help with staffing challenges makes sense and allows you to share the burden of finding a qualified, reliable team to address talent shortages.