As we head into 2020, I reached out to a number of people in Health Information Management (HIM) and Health Information Technology (HIT) to hear their thoughts on these hot topics: Social Determinants of Health (SDoH), Privacy and Security of Health Information, Medical Coding Standards, and Patient Matching.
Turns out that SDoH was a particularly hot topic, so tomorrow we’ll share the responses we received in regards to SDoH. Today, we’ll share what a number of experts saw coming down the pipe on the other 3 topics. I think you’ll enjoy these insights and perspectives heading into 2020.
Rita Bowen, VP, Privacy, Compliance and HIM Policy at MRO
The hottest topic for 2020 will be the Information Blocking Rule. There will be some areas of that rule and HIPAA that may appear in conflict – which will further drive the discussion and need for an update to HIPAA. I have predicted for sometime now that the US needs something more in line with GDPR, such as what California institutes 1/2020 “CCPA”.
As the Information Blocking Rule encourages the flow of information for patient enhanced management of their own healthcare through the use of health information – we will be seeing increased patient directed flow of their health information to APIs and other support management tools. Flow of information for quality improvement/population health will be seen via QHINs
Gerry Blass, President & CEO at ComplyAssistant
Third Party Vendor Security Risk Management (TPVSRM), aka “Business Associate”, programs will become a routine “Trust but Verify” process due to the potential threats, vulnerabilities and actual incidents caused by BAs resulting in unauthorized access to PHI, PCI, PII and even business confidential data. It isn’t enough to have a Business Associate Agreement (BAA) in place to satisfy the legal aspects of the business relationship. Organizations must also verify that controls are in place to protect confidential data.
The many aspects of what is necessary to include in a strong TPVSRM program to demonstrate compliance, due diligence and risk management will be a hot topic for 2020 and beyond.
Bill Wagner, CHPS, CPCO, Chief Operating Officer at KIWI-TEK
Consumer use of health apps is expected to continue to rise and with the announcement of Google’s Project Nightingale, the privacy and security of this information and how it is used will continue to be a hot topic.
Looking forward, there are three emerging trends that challenge the privacy and security of PHI:
First is the development of cloud based storage and sharing of PHI. While this practice is covered under HIPAA, it increases the vulnerability and exposure of that information. Next is the development of mHealth technologies that enable online access to PHI through applications, smartphones, personal sensors, and tablets. If the hosting organization is not a covered entity or business associate, they are not subject to HIPAA privacy and security standards. A third trend in the collection of health information is social media. Social networking and patient websites related to health are increasingly prevalent. These websites are used to discuss treatment options and to provide patient support.
Most individuals have a limited understanding of when data about their health is protected. Even the developers of technology and social media platforms may not have a clear understanding of where HIPAA oversight begins and ends.
Lauren Riplinger, JD, American Health Information Management Association (AHIMA) Vice President, Policy and Government Affairs
Pay attention to the release of the final information blocking rule by the ONC. The rule represents a fundamental, cultural shift in which sharing of health data is permissible under HIPAA to one in which the data must be shared in order to avoid civil penalties or other disincentives under the law. Education and training for all staff will be needed for this operational shift in how we share and exchange health information.
Julie Pursley Dooling, MSHI, RHIA, CHDA, FAHIMA, American Health Information Management Association (AHIMA) Director, HIM Practice Excellence
Patient identification and matching will continue to be a hot topic due to its core relation with overall data integrity and patient safety. In December 2019, the inclusion of report language by Congress directed the ONC to report (within one year) on the effectiveness of current patient matching methods and recommended actions that increase the likelihood of accuracy. HIM professionals should continue to identify best practices and solutions in their respective organizations that will correctly identify patients and effectively manage the duplicate record error rate in the master patient index.
Daniel Cidon, CTO at NextGate
In 2020, organizations will need to look outside their EHRs for managing patient identity. Because EHR systems were never designed for multi-vendor environments—and lack the sophisticated algorithms for linking data outside the organization—they can no longer withstand today’s increasingly complex IT environment.
While EMPI tools remain an industry best practice for managing patient identities, several innovations are expected to mature in 2020 including location intelligence, third-party data and blockchain. An EMPI approach—backed by one or more of these complimentary technologies—will be a powerful advantage in extending match rates over the next decade. Location intelligence, for example, ensures address information is consistently formatted using data from the U.S Postal Service, thereby averting errors at the point of capture. Integrating blockchain into the future of patient identity management can offer enhanced control for patients and more confidence for providers while lessening certain privacy and security risks. Blockchain also has potential in providing a transparent and trustworthy architecture for patient matching and verification.
As healthcare becomes consumer-driven, it is equally critical to consider use of other identification mechanisms to ensure that patient demographic information is accurate and up-to-date. Use of personal smartphones, for example, to streamline registration and allow patients to play an active role in managing and updating their data, can help to improve patient matching efforts at key stages where data errors often occur; during enrollment and at registration.
Momentum for a national patient matching strategy which began in 2019 will continue to build in 2020. While the ban for a national patient identifier was ultimately left intact, the ruling by the House represented a significant turning point at the federal level. Further, as evidenced by separate requests for information, government officials are actively seeking ways to work with the private sector to evaluate and advance patient matching approaches in the coming year.
Jon Melling, Partner at Pivot Point Consulting
This initiative [national patient identifier] by the House of Representatives is long overdue. As the U.S. healthcare industry wrestles with how to deliver value and more collaborative coordinated care, it is essential to find ways to more accurately identify patients. The risks of poor patient matching include duplicate records, duplicate testing, poor productivity as well as threats to patient safety and the ability to provide multi-disciplinary coordinated care.
The quality, operational and financial benefits of patient matching have always been clear. CMS (and by inclusion, the ONC) is rightly focused on promoting interoperability and removing opportunities for information blocking. The industry now needs to find the best way to implement patient matching in a way that these risks can be mitigated and strategic initiatives can best be supported and enabled.
Of course problems with patient matching affect all aspects of care and healthcare organizations including providers, payers, patients and systems vendors. All will have an important say in how patient matching will be facilitated and delivered. This initiative is another first step in resolving a perennial problem. Hopefully the industry will move expeditiously in identifying viable options.
Sue Bowman, MJ, RHIA, CCS, FAHIMA, American Health Information Management Association (AHIMA) Senior Director, Coding Policy and Compliance, Policy and Government Affairs
ICD-11 was adopted by the World Health Assembly in May 2019 and goes into effect on January 1, 2022, which means that is the earliest any country can implement ICD-11. Many countries will not be ready to transition to ICD-11 until later. The World Health Organization (WHO) believes migration to ICD-11 will be less expensive than the transition to ICD-10 due to automation and the development of new tools, such as coding, browsing, translation, and mapping tools.
It is unknown when the US will adopt ICD-11. The National Committee on Vital and Health Statistics (NCVHS) subcommittee on standards held an ICD-11 expert roundtable in August of this year. The purpose of this meeting was to produce a set of questions to help guide the Department of Health and Human Services in developing research that will facilitate a smooth transition process and inform the decision regarding the ICD-11 implementation date in the US. One research activity that will need to be undertaken prior to a decision regarding US adoption is an evaluation of ICD-11 to determine if a US clinical modification will need to be developed. In a November 25 letter to the Secretary of Health and Human Services (HHS), the NCVHS recommended that HHS conduct research to evaluate the impact of different approaches to the transition and implementation of ICD-11 in the US for mortality and morbidity classification. The NCVHS also recommended that HHS provide timely leadership on strategic outreach and communications to the US healthcare industry about the transition to ICD-11.