HIPAA and EMR Synergies

Transcription

1 HIPAA and EMR Synergies Margret Amatayakul, RHIA, FHIMSS Margret\A Consulting, LLC The Sixth National HIPAA Summit Washington, DC Margret\A Consulting, LLC

2 Fifth Annual HIPAA Summit Agenda Realizing the purpose of HIPAA Administrative Simplification HIPAA requirement to make recommendations for uniform data standards for patient medical record information National Health Information Infrastructure and other Initiatives EMR/CPR/EHR/PHR Are their differences? Technical Implications of HIPAA Privacy, Security, Transactions Contributions to CPR 2 November 1, 2002

3 HIPAA and EMR Synergies Realizing the purpose of HIPAA Administrative Simplification Margret\A Consulting, LLC

4 Administrative Simplification Promote efficiencies and effectiveness Through use of information systems Through adoption of standards Transactions and Code Sets Privacy and Security 4 Patient Medical Record 4 Information Just short of requiring electronic medical record 4

5 Electronic Focus of HIPAA Transactions and Code Sets promote electronic financial and administrative transactions Privacy is best accomplished with electronic support RBAC for minimum necessary use 5 Flags for managing restrictions 5 Security is only for electronic PHI (Except for the mini security rule in privacy requiring safeguards for all PHI) 5

6 HIPAA and EMR Synergies HIPAA requirement to make recommendations for uniform data standards for patient medical record information Margret\A Consulting, LLC

7 Legislative Directive Section 263 of HIPAA... requires the National Committee on Vital and Health Statistics (NCVHS) to... "study the issues related to the adoption of uniform data standards for patient medical record information and the electronic exchange of such information and 7 report to the Secretary of HHS by 7 August 21, 2000 on recommendations and legislative proposals for such standards. 7

8 Premise Capture clinically specific data Once at the point of care, and Derive information therefrom for Every other legitimate use 8... reflects the belief that significant 8 quality & cost benefits can be achieved in health care if clinically specific data are captured once at the point of care and that all other legitimate data needs are derived from those data 8

9 Interoperability A-s-t-h-m-a Basic Interoperability #S-Dx-#E Functional Interoperability 9 9 #S-Dx-SNOMED- Asthma-#E Semantic Interoperability 9

10 Interoperability Standards Radiology Laboratories Patient Hospital Pharmacy Knowledge bases Physiological monitors Medical devices HL7 & DICOM HL7 HL7 ASTM & HL7 IEEE HL7 & ASTM PMRI PMRI 10 IEEE Bedside computer HL7 HL7 & ASTM HL7 10 Registration/ Admissions Billing ASC X12N & NCPDP Clinical content Orders & results Payers NCPDP & ASC X12N Pharmacy Benefits Mgrs NCPDP & X12N Community Pharmacies (Adapted from Electronic Health Records: Changing the Vision, Eds. GF Murphy, MA Hanken, and KA Waters. Philadelphia: W. B. Saunders Company, 1999) 10

11 Comparability Terminology Vocabulary Set of highly granular, specialized terms Classification Organization of related terms 11 Code 11 representation of term 11

12 Comparability Standards Other Codes Health Language Center UMDNS (ECRI)* DEEDS UPN (HIBCC)/UPC (UCC) Diagnoses & Procedure Codes Alternative Link* CDT-2* CPT-4* HCPCS* ICD-9-CM/ICD-9-V3* ICD-10-CM* ICD-10-PCS ICIDH-2 * Fully or partially included in the UMLS Metathesaurus as of March 1, 2000 Message Specific Codes 12 DICOM NCPDP IEEE HL7* X12N Convergence SNOMED CT Clinically Specific Codes DSM* 12 Gabrieli LOINC* MEDCIN MedDRA SNOMED V3* NHS Clinical Terms* Nursing Codes HHCC* NANDA* NIC* NMMDS NOC* OMAHA* PCDS* PNDS 12

13 Data Quality (American Health Information Management Association. Practice Brief Data Quality Management Model. Chicago: AHIMA, June 1998) 13

14 HIPAA and EMR Synergies National Health Information Infrastructure and other Initiatives Margret\A Consulting, LLC

15 Since the 1991 IOM Report: G-CPR Project National Health Information Infrastructure Connecting for Health Internet Usage Patient Safety

16 HIPAA and EMR Synergies EMR/CPR/EHR/PHR Are their differences? Margret\A Consulting, LLC

17 Electronic Medical Record A medical record (as today) that has been digitized Document imaging system Documentation system For the provider

18 Electronic Health Record A European EMR? Health conveys a broader meaning Includes personal health Still seems to be provider focused

19 Computer-based Patient Record A bad word anymore? Focused on patient Intended to focus less on provider only Does this mean not for health care? Will this go the way of POMR? Was goal too much, too early? 19

20 Personal Health Record Recent concept to bridge the gap between the patient s (person s) record and that held by provider Will the provider read/use/care? What does this do for the person? So why can t we have one record? 20 Is this what NHII will do? 20 20

21 HIPAA and EMR Synergies Technical Implications of HIPAA Privacy, Security, Transactions Contributions to CPR Margret\A Consulting, LLC

22 Even More than the Flags Interfaces between systems not previously interfaced That s a good thing! Uses and disclosures permitted for treatment, payment, and operations (i.e., no consent or authorization) 22 Contributes to sharing information a 22 goal of NHII! 22

23 Data Standards Transactions are a start Claims attachments will merge interoperability and data issues Vocabularies beginning to be reconciled Will ultimately contribute to meaningful 23 data 23 Isn t that needed for patient safety? 23

24 Planning your Project Consider implications of HIPAA Look long range to future HIPAA requirements: Prioritize based on first claims attachments Gain support for other purposes: Patient safety isn t just about CPOE CPOE EMR/EHR/CPR/PHR 24 Transactions work flow 24 issues Scanning for outsourced coding should be leveraged for other work flow issues 24

25 Margret Amatayakul Margret\A Consulting, LLC Schaumburg, IL Tel Margret\A Consulting, LLC