Healthcare Interoperability

UPDATE: In case you missed our discussion, you can watch the video recording below:

Healthcare Interoperability-blog

One of the hottest topics in all of healthcare is the concept of healthcare interoperability. I remember when Farzad Mostashari said that he would use every lever he had at his disposal to make healthcare interoperability happen. Karen DeSalvo and Andy Slavitt have carried on that tradition and really wants to make interoperability of health data a reality in healthcare. However, it’s certainly not without it’s challenges.

With this challenge in mind, on Monday, February 22, 2016 at Noon ET (9 AM PT), I’ll be sitting down with two of the biggest healthcare intoperability nerds I know (I say that with a ton of affection since I love nerds) to talk about the topic. Here’s a little more info on the healthcare interoperability panel we’ll be having:

You can join our live conversation with Mario and Richard and even add your own comments to the discussion or ask them questions. All you need to do to watch live is visit this blog post on Monday, February 22, 2016 at Noon ET (9 AM PT) and watch the video embed at the bottom of the post or you can subscribe to the blab directly. We’ll be doing a more formal interview for the first 30 minutes and then open up the Blab to others who want to add to the conversation or ask us questions. The conversation will be recorded as well and available on this post after the interview.

In this discussion we’ll dive into the always popular FHIR standard and its potential to achieve “scalable interoperability” in health care. We’ll talk about FHIR’s weaknesses and challenges. Then, we’ll dive into health care interoperability testing and the recently announced AEGIS Touchstone Test platform and how it differs from other interoperability testing that’s being done today. We’ll talk about who’s paying for interoperability testing and where this is all headed in the future.

If you’d like to see the archives of Healthcare Scene’s past interviews, you can find and subscribe to all of Healthcare Scene’s interviews on YouTube.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

1 Comment

  • I can’t speak to the legal system isesus (if you’re referring to medical malpractice risk avoidance), but I CAN speak to the insurance industry part of your post since E/M coding, auditing and physician education is my thing . I probably taught one of the first classes in E/M coding when the codes first came out in January 1992 and to this day, the majority of the consulting and education work I do surrounds understanding the appropriate use from a clinical perspective these codes. As a result, I can say with a high degree of confidence that if the physician does just 2 simple things, 95% of the time they’ll have absolutely no problems having sufficient documentation to support the appropriate level of E/M service:(1) Practice good medicine(2) Be diligent about documenting what you did during the encounter. If it’s important enough to ask the question or to examine, it’s import to write down the response/finding, regardless of whether it’s a positive or a negative finding/response.There are a handful of codes where the appropriate level of service requires that the physician SOMETIMES do/ask what may not be clinically intuitive for the patient’s presentation. But for those instances, what the doctor needs to remember to do above/beyond what’s clinically intuitive is something that I literally could write for you on the back of a business card. Yes, with a couple of exceptions those are the HIGHEST level of service you could report for that category of code (the exceptions to that in the office setting are level 4 new patient visits and level 5 consults). But for the vast majority of physicians (all specialties) if you look at the acuity and/or clinical complexity of their entire panel of patients, the instances where that highest level of service SHOULD be reported (based on how cognitively difficult the encounter was) is a relatively low portion of all of the physician’s office E/M services.Or let me put it this way I haven’t seen a work up of a problem(s) yet that was truly deserving of being reported as a 99214 service where the physician didn’t AUTOMATICALLY *need* to ask ROS questions in 2 or more systems, or didn’t need to do a detailed physical exam of the affected (and related) body areas/organ systems ( need to here being defined as needed if the doctor was practicing good medicine). No the biggest problem with there being a mismatch between the level of service reported and the volume of documentation in the record are the kinds of problems I’ve listed below.(1) It was a lengthy encounter and one that would have qualified for billing the higher level of service, but the PHYSICIAN FAILED TO DOCUMENT THAT THEY WERE USING THE TIME RULE to select the level of service. Where more than 50% of the face-to-face time is spent in counseling and coordination of care, time should be used to determine the level of service. The physician must document that they spent X minutes of a Y minute face to face encounter discussing .. then include a sufficient SUMMARY of the discussion to justify the amount of time claimed (in other words, would another physician of your specialty have agreed that a discussion of those isesus would have typically taken the amount of time claimed in the record). (2) The level of service selected was clinically appropriate given the cognitive difficult of the assessment, but the physician failed to document the negative exam findings and/or negative ROS responses obtained during the assessment. Had that work been documented, the level of service selected would have been supported by the volume of documentation too. (that where the not documented, not done mantra comes from).(3) When you look at the problem severity description for the E/M level selected, the problem(s) the physician was evaluating were more appropriately represented by the problem severity descriptor for a lower level of service. In other words, irrespective of the volume of documentation, the physician simply overvalued the encounter. So yes, we can talk about those things that aren’t clinically intuitive that you need to get into the record for your MORE COMPLICATED new patient and consult visits. And we can talk about whether (and how often) when 99215 is the right level of service, you’ve got to remember to document things that aren’t clinically intuitive in order to support the 99215. But for the rest of the encounters, I think you’ll find that if you haven’t made one of the 3 mistakes I described above, if you are diligent about documenting only what you actually did (and needed to do) during your assessment of the patient, the right level of service for that visit will be supported.And the best thing about that is that you’ll see that there’s absolutely no clinically superfluous information in those progress notes to essentially sterilize or confuse the clinical picture of what was actually going on with the patient’s health at the time of your assessment.No, the problem comes when you think that documentation drives the level of service. It doesn’t. The Medicare program published that rule way back in 2001 [Pub 100-4, Chapter 12, Section 30.6.1 (A)]. The AMA reminded us of the role of the contributory component the nature of the presenting problem(s) (problem severity) to assist physicians in their selection of an E/M service back in a CPT Assistant article from August 2006. If you can set aside your current perceptions about E/M codes and the documentation requirements and go back to the code definitions themselves looking at the problem severity descriptors ALONG with the requirements for the key components of that code I think you’ll see what I’m talking about. If you understand how the type of workup you need to do (from a clinical perspective) equates to which level of service, you’ll see that the AMA and CMS actually did a pretty good job describing what you need to do clinically along the continuum of cognitive difficulty from the fairly simply presentations to the most complex. Again, if they made me emperor, that’s not to say I wouldn’t change a few things! But the system, as it’s designed right now, usually doesn’t require you to document anything more than you found it medically necessary to do in order to support the level of service that’s consistent with the cognitive work you did. The few instances where extra documentation may be needed (and extra work actually performed), it’s limited to those encounters where the cognitive work you did was represented by a code that requires a complete history and/or a complete exam and what you needed to do clinically was a couple of elements short of that.EHR’s are perpetuating the myth that documentation drives the level of service. In the long run, IMHO, we do our patients (and our physician colleagues) a disservice by buying into the hype.

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