FALL 2009 VOLUME 14, ISSUE 4 ANESTHESIA BUSINESS CONSULTANTS The database of an anesthesia billing system should contain invaluable data with regard to all that takes place in a hospital’s operating rooms and delivery suites. Because there is a charge created for each and every anesthetic, the level of detail captured by an anesthesia department should rival that of the hospital information system itself. While the file layouts of many anesthesia billing systems are defined by the information necessary to generate a claim, we are starting to see the emergence of a new generation of software that seeks to capture not only what will be necessary to get paid for anesthesia but also data that will allow the anesthesia practice not only to manage itself more effectively, but to provide the hospital administration productivity and performance indicators and metrics that underscore the potential role of anesthesia in more effective operating room management. ABC offers The Communiqué in electronic format Anesthesia Business Consultants, LLC (ABC) is happy to announce that The Communiqué will be available through a state-of-the-art electronic format as well as the regular printed version. The Communiqué continues to feature articles focusing on the latest hot topics for anesthesiologists, nurse anesthetists, pain management specialists and anesthesia practice administrators. We look forward to providing you with many more years of compliance, coding and practice management news through The Communiqué and our Monday e-mail alerts. Please log on to ABC’s web site at www.anesthesiallc.com and click the link to view the electronic version of The Communiqué online. To be put on the automated email notification list please send your email address to [email protected]. ➤ INSIDE THIS ISSUE: OPERATING ROOM UTILIZATION DATA MANAGEMENT 1 THE ANESTHESIA RECORD POWERED BY SHAREABLE I NK ® : A DIALOGUE WITH THE I NVENTOR 3 I S YOUR CONCURRENCY SOFTWARE COMPLIANT? 7 THE STATE OF AIMS ADOPTION 12 THE TIPPING POINT FOR ANESTHESIA I NFORMATION MANAGEMENT SYSTEMS 14 THE COST-CUTTING APPROACH TO HEALTHCARE REFORM 18 13 STEPS TO A DISASTROUS ANESTHESIA I NFORMATION SYSTEM I MPLEMENTATION 20 ANESTHESIOLOGY PRACTICE WEB SITES 22 HITECH IN A HIGH TECH ERA 25 EVENT CALENDAR 28 Continued on page 4 O PERATING R OOM U TILIZATION D ATA MANAGEMENT Jody Locke, CPC ABC Vice President for Practice Management
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Anesthesia Business Consultants: Communique fall09
Communiqué features articles focusing on the latest hot topics for anesthesiologists, nurse anesthetists, pain management specialists and anesthesia practice administrators.
Communique is created by Anesthesia Business Consultants (ABC), the largest physician billing and practice management company specializing exclusively in the practice of anesthesia and pain management.
ABC serves several thousand anesthesiologists and CRNAs nationwide with anesthesia billing software solutions.
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Transcript
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The database of an anesthesia billing system should contain invaluable data with regard to all that takes place in a hospital’s operating rooms and delivery suites. Because there is a charge created for each and every anesthetic, the level of detail captured by an anesthesia department should rival that of the hospital information system itself. While the file layouts of many anesthesia billing systems are defined by the information necessary to generate a claim, we are starting to see the emergence of a new generation of software that seeks to capture not only what will be necessary to get paid for anesthesia but also data that will allow the anesthesia practice not only to manage itself more effectively, but to provide the hospital administration
productivity and performance indicators and metrics that underscore the potential role of anesthesia in more effective operating room management.
ABC offers The Communiqué in electronic formatAnesthesia Business Consultants, LLC (ABC) is happy to announce that The Communiqué will be available through a state-of-the-art electronic format as well as the regular printed version. The Communiqué continues to feature articles focusing on the latest hot topics for anesthesiologists, nurse anesthetists, pain management specialists and anesthesia practice administrators. We look forward to providing you with many more years of compliance, coding and practice management news through The Communiqué and our Monday e-mail alerts. Please log on to ABC’s web site at www.anesthesiallc.com and click the link to view the electronic version of The Communiqué online. To be put on the automated email notification list please send your email address to [email protected].
➤ INSIDE THIS ISSUE:
Operating rOOm UtilizatiOn Data management . . . . . . . . . . . 1the anesthesia recOrD
the pace picks Up in the DevelOpment Of health infOrmatiOn technOlOgy One theme common to all the different proposals for healthcare reform in this season of intense advocacy is the need to increase both the capabilities and the installed bases of health information technology. David Blumenthal, MD, MPP, National Coordinator for Health Information Technology in the Department of Health & Human Services recently noted that:
It would be hard for any health professional today to escape the conclusion that the an-tiquated, paper-dominated system we now have in place isn’t working well for patients, creates added costs and inefficiencies, and isn’t sustainable. As we look at our na-tion’s annual health care expenditures of approximately $2.5 trillion, there are many ways our current system fails both patients and providers. It is clear that change is necessary.
The need for change from our “antiquat-ed, paper-dominated systems” to powerful and flexible information technology has been clear for quite some time. We generate and depend on a massive amount of informa-tion, to which we add more data every day. Managing all the information that we record and using it to its maximum capabilities are major challenges for anesthesiologists and other professionals. ABC invested in powerful custom-built anesthesia practice management software, F1RSTAnesthesia™, several years ago. This system goes far beyond claims and revenue cycle management, of course. Jody Locke illustrates the use of data on the time and units billed and the actual collections per anesthetizing location, by hour, to analyze utilization and identify opportunities for increases in productivity in his article “Operating Room Utilization Data Management.” While Jody’s graphs and charts come from F1RSTAnesthesia™, which he helped to shape, he acknowledges that “there is no one best way to capture and present operating room utilization data.” To look at some of the ways in which other developers and organizations manage
data, we invited several such developers to describe their systems in this issue of the Communiqué. The digital pen-and-paper method of completing an anesthesia record marketed under the name Shareable Ink Anesthesia Record™ represents brand-new technology about which we are very excit-ed – so much so that we have entered into an exclusive agreement with the company that developed the system under which, for a certain time, we will be the sole anesthesia billing company to sell the digital pen under the F1RSTAnesthesia™ Record. Several third party systems represented in this issue are already quite familiar to most anesthesiologists. Readers will immediately recognize the name Docusys®. Teecie Covad, VP for Product Management at Docusys, Inc. has written a comprehensive descrip-tion of the features and benefits of a true AIMS in “The Tipping Point for Anesthesia Information Management Systems.” Picis® Anesthesia Manager is another system used by many anesthesiologists every day. It has a large installed base in hospitals across the country. Dr. Carlos Nunez, Chief Physician Executive for Picis®, gives an excellent his-torical overview of the changing industry needs and adaptations, and the Picis® so-lution, including a synopsis of the federal Stimulus Package that will reward hospitals for demonstrating the �meaningful use� of in-formation technology starting in 2011. The nearly $20 billion in Stimulus funds to promote the adoption of elec-tronic health records was one aspect of the American Recovery and Reinvestment Act of 2009 (“ARRA”). Another part of ARRA significantly alters and supplements HIPAA privacy and security provisions. Abby Pendleton, Esq. and Jessica Gustafson, Esq. review the HITECH (Health Information Technology for Economic and Clinical Health Acts) provisions of ARRA per-taining to patients’ privacy rights, breach notification, and the consequences of breach-ing private information. ASA has created a new organization, the Anesthesia Quality Institute (AQI),
to develop a national data registry for anesthesia. To achieve similar goals of collecting data from multiple operating rooms to support benchmarking and quality improvement initiatives, SouthEast Anesthesiology Consultants of Charlotte, NC, launched its own Quantum Clinical Navigation System™ in the 1990s and reports that Quantum is now installed in 25 hospitals. John Kunysz, Quantum’s chief operating officer, describes the system and its value in his article “The Cost-Cutting Approach to Healthcare Reform.” Joe Laden, a name very familiar to participants in the MGMA-Anesthesia Administration Assembly (AAA) and other members of the anesthesiology community, has synthesized everything he learned from studying and comparing multiple exam-ples in his write-up entitled “Anesthesiology Practice Web Sites.” His checklists and brief descriptions will be invaluable to readers contemplating creating or expanding their own websites. Having read of the amazing capabili-ties of anesthesia information management systems in the first half of this issue, do not miss the wonderful warning “13 Steps to a Disastrous Anesthesia Information System Implementation” by AAA officer and VIP Phil Mesisca. The changes that have taken place in anesthesia practice since I founded ABC thirty years ago are staggering — and the constants are equally amazing. We are all privileged to work in an area that asks us to learn new technologies and new practices, or at the very least, new approaches, all the time. As with every quarterly issue of the Communiqué, I am most grateful for the willingness of experts like those noted above to share their knowledge with us.
With best wishes,
Tony MiraPresident and CEO
ABC is very proud to be the exclusive sponsor of a major new event at the Annual Meeting of the American Society of Anesthesiologists: A Celebration of Advocacy, the opening session of the 2010 meeting which will be held in at the Morial Convention Center in New Orleans, Louisiana from October 17th through October 21st.
Despite the potential of an anesthesia practice database to enhance operating room efficiency this aspect of practice management is in its infancy. The most common use of productivity data con-tinues to be the evaluation of potential stipend requirements. Anesthesia prac-tice managers are coming to understand the correlation between operating room utilization and the need for financial support. The financial analysis seeks to assess whether the revenue potential of each location covers the cost of provid-ing the care. Having a reliable handle on the profitability of each location covered has been proven to be a consistently ef-fective means of both justifying stipend requests and encouraging administrators to reconsider adjusting coverage require-ments. The key, of course, is the ability to produce and present the data and calcu-lations in a manner that is both clear and compelling. Forward-looking practices also use similar types of productivity metrics to evaluate each line of business on a regu-lar basis. Such forms of analysis provide an important means of assessing the rea-sonableness of continued coverage. The
result of such service-line specific review may result in requests for additional financial support or they may inspire cre-ative thinking about alternative ways of providing coverage more cost effectively. A classic example involves a practice that had believed it was important to tie up every surgery center in town to keep out the competition; once the group assessed its actual yield per location day, however, it quickly realized that a number of the coverage contracts were significantly im-pacting the compensation of the average shareholder. A careful assessment of the data led to the elimination of some of the less productive contracts and a much more realistic book of business. Rare is the anesthesia practice that is not challenged by the economics of coverage and reimbursement. The con-ventional approach to the enhancement of practice profitability tends to focus on revenue enhancement, either through more aggressive contracting or accounts
receivable management. The fact is that such efforts have limited ability to re-solve significant profitability shortfalls. Typically, the only real solution involves matching staffing to revenue, which may involve adjusting coverage. It is one thing to work on ways on increasing the size of the revenue pie, but if the pie is divided too many ways then none of the slices will support the income expectations of the providers. The use of productivity data and metrics to assess the profitability of cov-erage is leading to a view that an even better strategy would be to use the same kinds of information more pro-actively to actually help hospitals and surgi-cen-ters manage rooms more effectively on a prospective basis. This is opening doors of opportunity for anesthesia practices to be seen more as problem-solvers in the tricky business of operating room man-agement. Some practices have been so successful in their education of hospital
Continued from page 1
Table 1: An example of Operating Room Production Metrics by Room
administration that key stakeholders have come to rely on the anesthesia metrics and scorecards as the most reliable means of measuring operating room efficiency. Key to all of these strategies is the ability to produce normalized produc-tivity metrics by anesthetizing location. The value of being able to drill down to the specific anesthetizing location is be-coming increasingly clear. To this end developers of billing software are making the necessary modifications to file layouts. Having the capability to capture such data and actually being able to gener-ate reliable reports on demand, however, are two quite different issues. Not only must forms be designed to encourage the practitioner to indicate where the case was performed, but there must be a clear logic and structure to the labeling. Minor inconsistencies in provider labeling can greatly impact the quality of the informa-tion reported. Operating Room #1 must be reported and entered the same way for every case or the performance indicators will not make sense. It does not matter what the labeling convention is, so long as it is consistent. Once this is accomplished the results can be invaluable. ABC’s F1RSTAnesthesia allows for perfor-mance data to be tracked in a variety of ways. Standard performance metrics are
a very useful starting point. It is espe-cially useful to be able to track average case production, units billed, hours of anesthesia time and actual collections by operating room. Even more useful is the ability to look at these same metrics by shift or time of day. Perhaps the best mechanism for monitoring utilization is the ability to plot activity by hour of day. Four typical examples of utilization data are included in the tables accompanying this article. These represent actual report data for two ABC clients.
Table 1 presents key performance metrics in summary for calendar 2008. This table allows for the assessment of comparative productivity among locations as compared to standard bench-marks. Most practices try to achieve an average productivity of 50 ASA units per location day, which should be sufficient to cover the cost of coverage given a rea-sonable payor mix. Ideally, each location should generate at least 7 hours of bill-able anesthesia time. This is considered a sustainable level of production. Table 2 compares activity by shift for the same locations. Here the view is his-torical. Conventional wisdom holds that in an 8 hour shift there should be 6 hours of billable anesthesia time. It is also true that 75-80% of the revenue per anes-thetizing location should be generated during the day shift. Table 3 shows the number of loca-tions in use by hour of the day. Here production data is aggregated and aver-aged for eight months. Most observers are interested in the point at which the level of activity starts to drop off. This
th e cO m m U n i q U é fa l l 2009 pag e 5
Continued on page 6
Table 2: An example of a typical shift utilization assessment
Table 3: An example of a typical Utilization graph
type of graph also allows for the compar-ison of activity by day of week. The last chart, Table 4, presents pro-ductivity metrics for day shift versus overall productivity over time and allows for the identification of downward trends or seasonal variations in productivity. This type of analysis is especially useful for the assessment of staffing needs and will sometimes be incorporated into a staffing budget. Anesthesiologists intuitively recog-nize the value of timely and accurate data in the management of their activities. There is no question that the use of high tech digital monitors has greatly enhanced the quality of care provided in the oper-ating room. There is no reason to believe the same concept will not prove equal-ly as valuable in the management of the operating rooms themselves. Anesthesia providers just need to get over the precon-ceived notion that they are captive to the system. There is no question that the pos-session of such data and the ability to use it effectively in the education of the hos-pital administration represents a new role for many practices. The case for a more
active role for anesthesia in the manage-ment of operating rooms is being made daily across the country. It will not be a wholesale transformation of the specialty but a gradual evolution from quiet ob-server to active participant. As in so many things, the best advice is to identify oppor-tunities to demonstrate small examples of process improvement and build on suc-cesses one by one.
It is easy to look at these types of charts and graphs and to say, that is in-teresting but it would not be too useful in my hospital. Such an attitude, however, will inevitably be a self-fulfilling propo-sition. There is a reason why so many of the largest anesthesia practices are in-vesting in technology and data capture devices to be able to reliably measure and monitor patterns of operating utilization. They have long since learned that having the tools to manage manpower and staff-ing more effectively is the key to their cost-competitiveness and survival. This may not be the kind of technological ap-plication that captures the imagination with its sophistication or innovation but it is clearly one that ensures profitability. While there is no one best way to capture and present operating room uti-lization data there are clearly systems that are more user-friendly and flexible than others. ABC is especially proud of its F1RSTAnesthesia software and the various ways clients have been able to use its data to manage their practices more effectively and to provide unexpected value added service to their hospitals.
th e cO m m U n i q U é sp r i n g 2009 pag e 6
Continued from page 5
Table 4: An example of utilization trends over time
Operating rOOm UtilizatiOn Data management
th e cO m m U n i q U é fa l l 2009 pag e 7
Anesthesia groups that practice in a “care team” setting use concurrency software to calculate the maximum number of cases that an anesthesiologist is medically directing at any given time. This software ultimately assigns concurrency modifiers to each claim being billed, thus influencing the expected allowable that an insurance company will pay. The biggest flaw with such concurrency programs is their inability to properly handle intra-operative handoffs, or relief. For example, Anesthesiologist A begins medically directing a case at 2:00pm. Anesthesiologist B takes over the case at 3:00pm and the case ends at 3:30pm. Unless your concurrency software has the ability to input multiple anesthesiologists with multiple start/stop times on the same case, the software is
not giving you accurate data. From a billing standpoint, relief cases are billed under one anesthesiologist’s name with the total case time. This anesthesiologist’s name billed is typically the physician with the greatest amount of time in the case. However, from a compliance perspective, each physician’s start/stop times need to be analyzed for concurrency in order to properly select the correct medical direction or medical supervision modifier. In the example given above, Anesthesiologist A may have a maximum concurrency ratio of three CRNA rooms from 2:00-2:59pm. Anesthesiologist B may have a maximum concurrency ratio of five rooms from 3:00-3:30. If the concurrency analysis is run only on Anesthesiologist A from 2:00-3:30pm,
the concurrency modifier assigned will be incorrect, which will result in a potential overpayment from the payer, as shown in Figure 1. In conclusion, intra-operative handoffs should be well documented on the anesthesia record and concurrency should be run on each anesthesiologist’s individual times in order to properly calculate the modifier assigned on the claim form. Since Medicare medical direction (1-4 concurrent CRNA rooms) pays 50% of the allowable to anesthesiologist, while medical supervision (5+ rooms) pays a maximum of only 4 units to the anesthesiologist, it is crucial that your concurrency reports be able to substantiate the modifier billed on each case.
As part of our desire to keep both clients and readers up to date, the Communiqué has been printing compliance information since its inception. In the Compliance Corner, we will now formally keep you abreast of the various compliance issues and/or pick out a topic that would be of interest to most of our readers.
is yOUr cOncUrrency sOftware cOmpliant?
Hal Nelson, CPCABC Director of Compliance and Client Services
Figure 1. Is This Case Medically Directed (QK) or Supervised (AD)?2:00pm 3:30pm
Anesthesiologist A Anesthesiologist B
1:3 1:5
th e cO m m U n i q U é fa l l 2009 pag e 8
the anesthesia recOrDTM pOwereD by shareable ink®:
a DialOgUe with the inventOr Continued from page 3
things with it. This is a key capability of
the Shareable Ink Anesthesia Record.
We can “slice and dice” the data and
push it out to various stakeholders of the
anesthesia record. For example, informa-
tion required for billing can be sent to the
billing company without the delay and
cost associated with scanning or mail-
ing. Because our system conducts rule
checking and can immediately notify the
provider about errors, we can eliminate
sending the chart back to the provider for
rework that would normally add weeks to
the A/R cycle.
We can also send information about
narcotics used during the case to the
pharmacy. Sometimes, we take the data
from many forms and build “dashboards,”
web pages that give a view into data ag-
gregated from many cases. Institutions
can use these dashboards to monitor
SCIP measures such as antibiotic admin-
istration time and patient temperature on
PACU arrival.
As another example, my group has
always recorded anesthesia ready time in
addition to surgery start time. This way,
we can measure how efficiently the OR is
running. If the hospital asks us to provide
an extra anesthesiologist to staff a room,
we may be able demonstrate that anoth-
er room is not necessary by bringing at-
tention to this OR “downtime.” If there
is sufficient downtime, the resource issue
can be addressed by scheduling existing
rooms more efficiently.
Unfortunately, my group never had
an easy mechanism for collecting and
analyzing the data. The exercise would
have been too tedious to retrospectively
enter that data from all the paper charts.
But now, using the Shareable Ink system,
the data is available electronically and
anyone with a spreadsheet can analyze it.
The system can even attach time stamps
to checkboxes, signatures, or any other
data collected from the form. This allows
groups using the Shareable Ink Anesthesia
Record to do detailed data analysis with
regard to CRNA supervision.
Question: How does the technology
by Shareable Ink compare to scanning?
First, information is immediate and
actionable with the Anesthesia Record.
Scanning is not as timely because the pro-
cess requires someone – usually not the
anesthesiologist – to physically obtain
the record, put it in a work queue, and
then scan it. Scanned information is also
less actionable. For example, if some-
one scans a record with no anesthesia
end time or no signature, and then, sub-
mits it for payment, days or weeks would
pass before the anesthesiologist is notified
about the missing information.
Second, all you get is a “picture” of
the record with scanning. You don’t really
obtain any discrete data. You can’t easily
answer questions like, “what percentage of
my patients are ASA 4E?” or “how many
central lines did I put in last year?” from an
archive of scanned records.
Question: What made you come
up with the Shareable Ink Anesthesia
Record?
I’ve always been fascinated with tech-
nology. That’s probably why I chose anes-
thesia as a specialty. I took a break from
clinical medicine before residency to
manage the healthcare market for a divi-
sion within Apple Computer. I remember
giving a talk in 1993 in which I predicted
that someday all doctors would be car-
rying PDAs. Since medical school, I’ve
known that healthcare providers were
mobile professionals with their own spe-
cific computing needs.
The digital pen is the ultimate ex-
tension of mobile computing. Finally,
we have a technology that fits our work-
flow. Previously, in order to use an EHR,
we had to modify our workflow to fit de-
cades-old technology. With the Shareable
Ink technology, we just do our jobs as we
have for years. Only now, we seamlessly
capture our information digitally in the
background.
Question: How did you start
Shareable Ink?
During residency, in the middle
of the “dotcom” boom, I took a sab-
batical to join a start-up company called
PatientKeeper. PatientKeeper was one
of the first companies to allow clinicians
to use PDAs and smartphones in their
th e cO m m U n i q U é fa l l 2009 pag e 9
workflow. The company has grown tre-
mendously over the years, and now, they
have signed contracts with about 12% of
US hospitals.
I reached out to my friend Steve
Hau, the founder of PatientKeeper, and
was able to convince him to become the
CEO and a co-founder of Shareable Ink.
Steve has a proven track record of build-
ing new companies in healthcare IT and
making customers successful. He quick-
ly assembled a terrific team of industry
veterans.
Question: Who is using the
Shareable Ink Anesthesia Record?
Anesthesiologists from coast to
coast are using our system, and we are
also working with physicians in other
specialties, in both the inpatient and
outpatient settings. Our anesthesiologist
clients aren’t limited to any particular lo-
cation or sub-specialty. We can take any
existing anesthesia record and make it
work with our system.
Question: What are the benefits
of using the Shareable Ink Anesthesia
Record?
There are numerous benefits that
accrue to both the individual anesthe-
siologists as well as to the institutions at
which they practice. The main benefit
to the providers is that they get almost
all of the advantages of having an EHR
– but without the hassles associated with
changing workflow.
With our system, there is virtually
no learning curve or training involved;
everyone already knows how to fill out
an anesthesia record with a pen. Because
of immediate rule checks, anesthesiolo-
gists know that they are filling out their
records completely and won’t be asked
weeks later to recall, for a particular case,
what time they transferred care in the
PACU. Taken together, this positively
impacts job satisfaction and the bottom
line.
The benefit to the institution is that
they get access to data that they have
always wanted but never had before —
and without having to scan or key enter
the records. Also, there is essentially no
burden on the IT staff. No Shareable Ink
software is installed on site. All the infor-
mation from the pen is encrypted and
transmitted to our servers where all the
computing is done. Administration and
providers can optionally access the data
using a standard web browser and the
data is always owned by the client.
Question: What benefits does it
bring to the anesthesia provider?
The benefits are multiple. From an
administrative and workflow perspec-
tive, the Shareable Ink Anesthesia Record
eliminates lost records, cuts down on
the number of records that need to be
reworked and decreases days in A/R.
Providers no longer have to fill out bill-
ing tickets and carry around anesthe-
sia records until they reach some critical
mass that reminds them to do their bill-
ing and send in their paperwork.
From a clinical perspective, it en-
courages more complete and accurate
charting since it can notify us if we’ve
submitted a record with a required el-
ement missing, such as an unsigned
Continued on page 10
th e cO m m U n i q U é fa l l 2009 pag e 10
CRNA compliance statement or missing
signature.
From a practice management stand-
point, the Shareable Ink Anesthesia
Record allows you to capture all sorts of
new data that was never easily available
before. One of the first things my group
implemented was recording our position
on the call schedule on our records. With
the Shareable Ink system, it’s easy to col-
lect all this data so we can actually ana-
lyze how much a particular position on
the call schedule works over time. This
will allow us to staff more efficiently.
Finally, from a financial perspec-
tive, we now have all the data we need in
order to qualify for pay by performance
or to report a new PQRI measure. If a
new performance measure is initiated, we
don’t have to do a lot of computer and
data entry work, we just have to intro-
duce a new field on a form.
Question: How does Shareable
Ink technology compare to current
Anesthesia Information Management
Systems (AIMS)?
Anesthesia Information Management
Systems have been commercially avail-
able for over a decade yet they have been
installed in less than five percent of the
marketplace. I believe this lack of adop-
tion is due to two primary factors: cost
and difficulty of use.
The Shareable Ink Anesthesia Record
costs only a fraction of the amount an
AIMS costs, and we can capture all of
the salient data that the institutions that
pay for these AIMS want. The Shareable
Ink Anesthesia Record is also incredibly
easy to use. Training is minimal and the
workflow of the user doesn’t change.
In addition, AIMS require provid-
ers to use a keyboard, mouse, or other
data entry device, and thus modify the
way they work in order to accommodate
data entry. I think this is the main reason
that there has not been more widespread
adoption of these systems. The approach
that we’ve taken with Shareable Ink
allows providers to practice the way they
do now, input data in a way that is natu-
ral and familiar, and still get the benefits
of an electronic system.
Question: How does the cost com-
pare to AIMS?
Current AIMS systems require new
computer hardware to be installed in
every operating room, sometimes even
requiring the replacement of anesthesia
machines! The Shareable Ink Anesthesia
Record not only costs a fraction of the
cost of an AIMS in implementation, it
also saves the institution ongoing costs
related to training and support. Our phy-
sicians report that they require about
half an hour of training. CRNA users,
who don’t need to take advantage of the
alerting or reporting functions, report
that their training took just five minutes!
On the support side, we’re not asking
the providers to do anything new other
than place the pen in a cradle. There’s not
much that can go wrong so ongoing sup-
port costs are miniscule.
Question: What about automated
vitals signs capture?
the anesthesia recOrDTM pOwereD by shareable ink®:
a DialOgUe with the inventOr Continued from page 9
th e cO m m U n i q U é fa l l 2009 pag e 11
We don’t automatically capture
vitals signs, and I believe that that is one
of our strengths. Using the Shareable Ink
Anesthesia Record, providers are still en-
gaged with the case and record the vital
signs every five minutes. This means that
every five minutes the vitals have to go
from our eyes, through our brains, and
then be written on the anesthesia record.
It’s been suggested that while using
an AIMS, providers have a tendency
to let the record go on “autopilot,” and
they can actually be less vigilant to the
vital signs. I know some controversy sur-
rounds this.
What we know for a fact is that cases
have been litigated where the automat-
ed anesthesia record failed to record the
vital signs for extended periods. Also,
many providers are concerned about
AIMS systems capturing spurious data,
such as recording an abnormally high
pulse because the cautery is in use. They
fear that these data might increase their
liability and lead to increased documen-
tation burdens to edit the readings. The
Shareable Ink approach still allows for
the human filtering of inaccurate vital
signs so that the record reflects what ac-
tually happened during the case.
Question: What are the challenges of
implementing the technology?
The main challenge is in educating
the institution. Hospitals are often re-
luctant to start new IT projects because
of their history of being over budget
and behind schedule. Normally, once
we show the parties involved how little
training is involved and how minimally
disruptive it is to their workflow, things
go very fast.
The only requirement to deploy
the system is that the location have an
Internet connection. As I mentioned,
we don’t install any software on site.
All we leave behind is a docking cradle
for the pen and a driver to allow that
cradle to communicate with our servers.
Computing is done securely and remote-
ly by Shareable Ink’s servers.
Another challenge is interfacing to
the wide range of hospital IT and OR in-
formation systems that exist. Fortunately,
the interface work isn’t required to get
started. And the team at Shareable Ink
has a deep knowledge and significant ex-
perience at this task.
Question: How does the Shareable
Ink Anesthesia Record work with OR in-
formation systems?
We can interface into the OR
information system. Often, the
anesthesiologist keeps the most
accurate and up to date record. This
is especially true if the circulating
nurse is expected to enter data into an
OR system while performing clinical
duties. By extracting data from the
anesthesia record, powered by Shareable
Ink and uploading it into the existing
OR information system, Shareable Ink
relieves physicians and nurses from the
mundane, distracting and expensive
task of data entry. The Shareable Ink
Anesthesia Record is very complementary
to traditional information systems
because it draws on their strengths
of storing, retrieving, and displaying
data. Data entry is a limiting factor on
all existing systems, and now, we’ve
made that process a part of the existing
workflow nearly effortless.
Question: Why did you choose ABC
to be your partner?
I’ve been an ABC customer from
within two busy anesthesia practices.
Every few years, we re-evaluate the mar-
ketplace and consider changing billing
vendors and every time, we return to
ABC for our business.
We chose ABC to be Shareable Ink’s
reseller in the anesthesia marketplace
because of their market share, focus on
the anesthesia market, their expertise in
anesthesia billing and practice manage-
ment, and their willingness to embrace
new technologies.
Reference: Vigoda, M.M., Lubarsky, D.A.
Failure to Recognize Loss of Incoming Data
in an Anesthesia Record-Keeping System
May Have Increased Medical Liability. Anesth
Analg 2006;102:1798-1802
th e cO m m U n i q U é fa l l 2009 pag e 12
Although still far from achieving
mainstream adoption, anesthesia infor-
mation management systems (AIMS)
have made significant strides in market
penetration over the last five years.
Commercially viable AIMS solutions
have been available for more than two
decades, but it is only recently that the
notion of implementing an automated
anesthesia record has become widespread
within the practice of anesthesiology.
Perhaps the federal government’s push
to increase the adoption of electron-
ic health records (EHRs) as a part of
the recently passed “stimulus package”
will lead to near universal acceptance of
AIMS, but there are other forces at work
that have moved AIMS from being an
interesting experiment to a vital tool for
the management of anesthesia patient
information.
First and foremost, the leading
AIMS solutions have matured in ways
that reflect not only the progress of tech-
nology, but also the realities of modern
clinical practice. Even the most basic
systems can recreate the paper anesthe-
sia record; capturing data from moni-
tors and anesthesia machines, as well as
input from the user to document things
such as medications, fluids and clinical
notes. However, more advanced systems
such as Picis® Anesthesia Manager have
moved beyond simple record keeping,
and now offer decision support tools and
remote access that extend the usefulness
of the electronic record. There have also
been advances in configurability, usabil-
ity and stability that have made AIMS
easier to implement and more transpar-
ent to the workflow of the average user.
Probably the most significant technologi-
cal advance that has directly increased
adoption of AIMS has been the integra-
tion and interoperability of these systems
with the information infrastructure of
the hospital.
The most successful AIMS solu-
tions are those that allow the electronic
anesthesia record to operate seamlessly
with the other information systems in-
stalled in the hospital. The interopera-
bility begins in the operating room and
extends as far as the outpatient areas.
In fact, the event that led to the larg-
est market expansion of AIMS was the
availability of the first commercially
viable suite of perioperative automation
solutions, Picis CareSuite, in 2003. By
combining a traditional operating room
management system (ORMS) with the
clinical solutions for preoperative evalu-
ation, anesthesia automation, and recov-
ery room (PACU) documentation, AIMS
adoption in the United States jumped in
one single year from a handful of sys-
tems to almost 100. Vendors offering
stand-alone systems began to suffer and
in some cases disappear, while the tradi-
tional hospital information system (HIS)
vendors attempted to enter the market.
While interoperability of AIMS
solutions was a welcome development
for the IT management of the hospital,
it was the gains in usability that began to
turn the tide with anesthesia providers
in terms of user acceptance. For
example, the availability of patient data
from outside the perioperative period,
the state Of aims aDOptiOn Carlos M. Nunez, M.D.
Chief Physician Executive, Picis®Wakefield, MA
th e cO m m U n i q U é fa l l 2009 pag e 13
such as allergies, medications, lab and
other test results, has helped drive the
acceptance of anesthesia automation
and streamline workflow. One of the
most important immediate benefits is
the ability to quickly access a patient’s
previous anesthesia management details
without sifting through paper charts.
This is especially useful for patients who
have difficult airways or other notable
pathology that could affect the delivery
of anesthesia. The ability to copy forward
portions of the patient’s previous pre-
anesthesia evaluation(s) also saves a great
deal of time and eliminates redundancy.
As a result, the pre-anesthesia
evaluation and immediate preoperative
preparation of the patient became less
of a paper chase and improvements in
the reliability of data captured from
medical devices helped make anesthesia
providers more comfortable with the
automation of clinical record keeping.
Advanced user interface design and
flexible configuration options pushed
the acceptance of AIMS even further.
The evidence is clear in the marketplace:
those AIMS solutions that offer
comprehensive interoperability beyond
the four walls of the OR and integrate
well into the unique workflow of
anesthesia have established themselves as
the leaders.
The final inherent trait of AIMS
that provides tremendous incentives to
hospitals is the ability to use their col-
lected data to facilitate both clinical and
administrative functions. The growing
use of decision support is an excellent ex-
ample of how vast amounts of data col-
lected across the perioperative period can
be available to the end users of AIMS, at
the point of care. AIMS-based decision
support systems enable users to create
their own rules, providing clinicians with
timely notifications based on patient
data that can help the clinician guide the
course of care. Imagine the AIMS screen
displaying a colored icon or sending a
text message to an anesthesiologist when
a patient with a history of Malignant
Hyperthermia has a recorded body tem-
perature that is rising. The collection
of data at the point of care also makes
remote access to the anesthesia record
possible, so that clinicians have access
to patient information from any OR or
PACU bed, anywhere they happen to be.
Then, after the episode of care is com-
plete, all of that data is available to gen-
erate billing (professional fees, supplies,
pharmacy, etc.) as well as research and
quality reporting. The ability to generate
reports with AIMS data, as required by
the Surgical Care Improvement Project
(SCIP), is vital in today’s healthcare en-
vironment. The information that is doc-
umented in an AIMS, such as time from
antibiotic dose to incision, appropriate
sterile technique, use of beta-blockers,
insulin use and glucose levels, and the use
of intraoperative warming devices, can
also be used to justify improved contract
rates for insurers that are willing to com-
pensate for proof of improved quality of
care.
The American Recovery and
Reinvestment Act of 2009 (ARRA)
included nearly $20 billion to stimulate
the adoption of electronic health
records. Beginning in 2011, the federal
government will reward hospitals with
incentive payments for demonstrating
the “meaningful use” of information
technology. After 2015, the incentive
payments go away; they replaced with
financial penalties for those hospitals
that do not meet the government’s
goals. A large part of the meaningful
use criteria center around the established
and growing requirements for quality
reporting as mandated by the Centers
for Medicare and Medicaid Services
(CMS). The perioperative care areas
of the hospital are where a great deal
of the data that CMS requires for its
quality measures reporting program
are collected, such as SCIP. ARRA may
provide the final push necessary to arrive
at near universal adoption of AIMS in
the coming years. For more information
on getting to meaningful use in high
acuity areas of the hospital, such as the
perioperative suite, Picis invites you
to visit http://www.picis.com/Picis-
Advocacy and download our position
papers.
Carlos Nunez, MD, is
Picis’s Chief Physician
Executive. He can be
reached at Carlosnunez
@picis.com
th e cO m m U n i q U é fa l l 2009 pag e 14
Although Anesthesia Record Keepers
have been available for nearly 30 years,
it has only been in the last decade that
broadly featured Anesthesia Information
Management Systems (AIMS) have been
available. In this comparison, I have de-
fined an Anesthesia Record Keeper as an
electronic system that produces a paper
printout of a legible, complete anesthesia
record at the end of a case; my definition
of an AIMS gets closer to the ideal – an
electronic anesthesia medical record that
maintains integrated communication
with other hospital and provider systems
throughout the perioperative period
(such as clinical information systems
used by nurses, clinical data repositories
used by hospitals and professional fee
billing systems in place for the group).
As AIMS mature to the stature of
information systems, they are gaining
acceptance. Yet, market penetration for
this product is still, by nearly all esti-
mates, less than 10%. Ultimately, one of
the most limiting factors of widespread
adoption has been the requirement to
win over two groups to purchase and
implement an AIMS: facility administra-
tors who typically provide the budget,
and physicians, who need to use the tech-
nology. A confluence of factors aimed
at both potential buyers, however, is
moving the AIMS industry to the tipping
point of widespread adoption.
feDeral initiatives
First, a national emphasis on health
IT through the federal economic stimu-
lus package, although not directed to spe-
cialty systems such as AIMS, will likely
leave such specialty groups as lone users
of paper records in an electronic envi-
ronment – a situation that will hasten
conversion. A secondary push toward
health IT has been proposed through the
national health care reform proposal re-
cently introduced by Senator Baucus and
others, encouraging health providers to
use IT to coordinate care, curb Medicare
abuse and fraud, improve care quality
and reduce duplicate tests.
Second, in the national debate sur-
rounding healthcare reform, reduc-
ing costs through the elimination of
Medicare abuse and fraud is a primary
focus when discussions turn to paying
for such proposals. Those discussions
generally lead to scrutiny of health pro-
viders who bill for their services and the
RAC (Recovery Audit Contractor) pro-
gram is the latest permutation of that
the tipping pOint fOr anesthesia infOrmatiOn
management systems Teecie Cozad
Vice President, Product Management, DocuSys, Inc.Atlanta, GA
th e cO m m U n i q U é fa l l 2009 pag e 15
examination. As advised by Pendleton
and Gustafson in ABC’s Summer 2009
Communiqué (“What Anesthesiologists
and Pain Management Physicians Need
to Know About the RAC Program”),
improved demonstration of medi-
cal compliance and documentation of
start and end times, invasive lines, post-
operative pain services, medical neces-
sity for monitored anesthesia care cases
and chronic pain management are wise.
The case completeness checks provided
by a robust AIMS such as DocuSys® will
perform real time concurrency checks
and prevent a provider from closing a
case until all billing requirements are
complete.
safety anD QUality – hanD in hanD
The continued emphasis on patient
safety and quality embodied by CMS’s
Physician Quality Reporting Initiative
(PQRI) will also drive AIMS adoption.
The more anesthesiology quality mea-
sures are adopted by payers, the more
technology will play a role in prompting
the clinician to document their evalu-
ations and actions and to report their
performance effectively. While relatively
small bonuses are held out to stimulate
participation in these measurement pro-
grams now, the general consensus is that
physician payments will go the route of
hospital payments where bonuses for re-
porting became bonuses for performance
before becoming reductions in payments
for non-reporting. A good AIMS should
have a decision support engine that
allows the anesthesiology group to design
prompts to achieve 100% compliance
with both performance and reporting
on quality measures. It should assist the
anesthesiologist by selectively prompting
at the appropriate time for an appropri-
ate subset of patients to avoid message
fatigue.
Wrong site surgery is another in-
stance where one can imagine the an-
esthesia provider with a widening
downside potential. Although surgeons
and anesthesiologists are still getting paid
when “never” events such as this occur,
Bierstein suggested in the Winter 2009
issue of the Communiqué (Health Care
Quality and Measuring Performance),
…“it is not hard to imagine…[a system
that allocates] a pro rata share of respon-
sibility for perioperative injury.”1 An
AIMS can offer checklists to the user that
assist in documenting anesthesiology’s
part in the important “Time Out” for
confirmation of patient demographics
and surgical site.
Other safety measures that can be
enhanced with an AIMS include verifica-
tion and reporting of adverse medication
reactions. Utilizing an AIMS that incor-
porates a drug information database can
Continued on page 16
1 A recent Medicare MLN Matters article (MM6405) indicates that Medicare no longer covers any hospital or other services provided in connection with a wrong site/wrong patient/wrong procedure episode, stating spe-cifically that “All providers in the operating room when the error occurs, who could bill individually for their services, are not eligible for payment..”
th e cO m m U n i q U é fa l l 2009 pag e 16
standardize allergy and home medica-
tion documentation, eliminate dupli-
cate documentation through inbound
integration of codified allergy and drug
information from nursing information
systems and can enable selective decision
support at the point of care around al-
lergy alerting and potential drug-to-drug
interactions.
Capturing postoperative complica-
tions is a required and necessary part of
the provision of anesthesia. A feature-
rich AIMS of today should allow the pro-
vider to document any events that are
noted during or after the case and track
them for Quality Improvement purposes.
Some AIMS, such as DocuSys, permit the
separation of Quality Improvement doc-
umentation from the generally available
Anesthesia Record. Additionally, there
are active projects aimed at building
multi-institutional clinical anesthesia da-
tabases for benchmarking and outcomes
research to which groups may wish to
contribute. These databases are built on
the output of various AIMS. Enterprise-
level reporting databases may contain the
clinical data repositories of related infor-
mation systems as well as AIMS data.
An important benefit of technolo-
gy highlighted by the advent of Personal
Health Records (PHRs) is a concept that
the Cleveland Clinic and others imple-
mented a decade ago – that of having
the patient participate in their preopera-
tive care by completing a computerized
health questionnaire. An AIMS that can
incorporate a triage methodology for
presurgical testing and pre-anesthesia
evaluation based on the patient’s health
history can provide extensive patient
safety benefits by communicating the
patient’s surgical risk to the entire medi-
cal team for optimization well in advance
of the day of surgery. Using technology
in this way permits the primary care pro-
vider, surgeon, anesthesiologist, preop-
erative nurse and the patient to work in
concert to improve care and eliminate
duplicate testing – additional goals of na-
tional health care reform proposals.
an aims at the pOint Of care
Adoption of an AIMS is dependent
on two buyers and both have to be con-
vinced of the value of an AIMS for a pur-
chase decision to be made. Let’s start
with the problems that an AIMS can
solve for the provider at the point of care.
First, after years of development and
feedback from the anesthesiology market,
it is understood by AIMS manufactur-
ers that systems have to be easy to learn
and easy to use. No one in the fast paced
arena of anesthesia delivery has time to
grapple with a user interface that is not
intuitive. Some systems require less han-
dling than others to thoroughly docu-
ment a case, but a primary requirement
of any successful AIMS implementation
is that the anesthesia providers must be
able to focus on the patient and not on
the tasks of using a computer or docu-
menting physiologic data. Some sys-
tems, like DocuSys, have minimized the
work involved in supply and drug utili-
zation by accepting bar code scanning to
replace drop down lists, and by sending
utilization data to materials management
and pharmacy systems automatically so
that anesthesia providers do not have to
manage charge forms.
Second, the fear on the part of anes-
thesia providers that erroneous vital signs
will be entered into the record has largely
receded as more and more clinicians have
gained the understanding that a legible,
complete record is far easier to defend in
the tipping pOint fOr anesthesia infOrmatiOn management systems
Continued from page 15
th e cO m m U n i q U é fa l l 2009 pag e 17
court than an incomplete hand-written
record. Most providers utilizing AIMS
now enter a quick note to explain aber-
rant physiologic data recordings.
The federal Drug Enforcement
Agency (DEA) has made additional func-
tionality of some AIMS, like DocuSys, a
real benefit. With requirements for anes-
thesia providers to document narcotic use
and wasting, the AIMS that can provide
complete electronic narcotic reconciliation
can save significant time for anesthesia
providers as well as hospital pharmacists,
both of whom are in short supply. Many
hospitals have implemented dedicated
medication dispensing carts in each oper-
ating room because of the difficulties en-
countered and the resources consumed in
reconciling anesthetic narcotic usage. A
comprehensive AIMS should eliminate
the duplicate documentation required to
dispense the medication from the cart and
document its administration in the record
by communicating bi-directionally with
the cart and with pharmacy.
Other efficiencies can be brought
to the point of care by a well designed
AIMS. Access to previous medical re-
cords in a manual world can be slow and
inefficient. Immediate access to AIMS
records means that the anesthesiolo-
gist can quickly review a patient’s previ-
ous airway management techniques in
preop to assist in planning. A strong
AIMS should automatically post com-
plications during a case to the patient’s
future PreAnesthesia Evaluation record
to extend safety to upcoming visits and
maintain links to images of the airway, if
available.
For those anesthesiologists who serve
as managers of the OR, an AIMS system
can help to streamline traffic through
the OR with the use of patient and pro-
vider tracking systems. Most AIMS utilize
the work station monitor and/or plasma
screens to provide boards that document
a patient’s progress through the perioper-
ative process. The best AIMS also provide
tools that allow the anesthesia manager
to assign anesthesia providers to add on
cases without phone calls and pages. The
OR/Anesthesia utilization reports avail-
able in an AIMS can permit anesthesia
managers to gather data for underuti-
lized FTEs that can successfully result in
needed stipends or produce the proof
sources for additional manpower when
there is high utilization.
Those with departmental responsi-
bilities to support professional fee billing
and physician compensation recognize
manual systems as inherent sources of
errors and omissions. A primary benefit
of an AIMS is the elimination of missing
charge sheets and the automatic trans-
mission of billing data – either in image
or data formats – at the close of each
case. A good AIMS will provide reports
to verify that all cases made it to the bill-
ing destination, reporting on closed,
opened but not completed, and cancelled
cases. Those who have successfully im-
plemented AIMS with billing support
have seen their “Days to Bill Drop” de-
crease by 10 or more days.
the bOttOm line is still the bOttOm line
Finally, returning to the second buyer
for an AIMS, it is the hospital or facility
executive who makes the final purchasing
decision. For the anesthesia group who
desires to implement an AIMS, the group
needs to operate at a strategic level to ac-
complish their wish. Hospitals lose mil-
lions of dollars every year because many
co-existing diseases are not adequately
documented. No other physician group
is better positioned to provide the docu-
mentation that can result in accurate
identification of co-morbidities for surgi-
cal patients than anesthesiologists. Using
an AIMS that can separate the healthy
from sick patients; start a PreAnesthesia
Evaluation with a patient’s personal
health record, and bring in preopera-
tive nursing documentation to validate
it, allows the anesthesiologist to spend
a couple of minutes on identifying co-
morbidities on a subset of surgical pa-
tients. This strategic use of an anesthesia
resource can significantly improve the fi-
nancial status of the hospital. More ac-
curately capturing charges on all items
used for a particular patient and provid-
ing information that allows the hospital
to more accurately track inventories of
drugs and supplies provides even more
ammunition in convincing hospital ex-
ecutives that an Anesthesia Information
Management System is an investment
that cannot wait.
Teecie Cozad is Vice
President, Product
Management at
DocuSys, Inc.
in Atlanta, GA.
Questions may be
sent to tcozad@
docusys.net; readers
may also find further information at
www.docusys.net.
th e cO m m U n i q U é sp r i n g 2008 pag e 18th e cO m m U n i q U é fa l l 2009 pag e 18
You cannot open a newspaper or turn on the television today without hearing about healthcare reform and healthcare quality. The driving force behind healthcare reform is that it is currently 18.4% of our gross domestic product. Despite the amount of money being spent on healthcare, hospitals and practices alike are concerned with what may happen to already diminishing mar-gins and therefore are looking to decrease costs. Quantum Clinical Navigation System™ has been quietly working in the background for more than twelve years providing proof of quality and help-ing hospitals, physicians and practices decrease costs and implement pay for performance models. By capturing 50 perioperative in-dicators Quantum CNS can measure numerous types of outcomes:
1. Efficiency measures such as case delays and cancelations;
2. Practitioner performance, includ-ing measuring complications or incidents and answering the fol-lowing two questions:
a. Which doctor is not per-forming according to best practices or industry guide-lines for evidence based medicine?
b. How can we mentor the doctor to become a better practitioner?
3. Critical quality indicators that assist in meeting JCAHO stan-dards, SCIP initiatives and PFP
initiatives. Quantum CNS also produces reports that allow clients to measure the CQI data by loca-tion, physician and comparative benchmarks. Numerous best prac-tices have been instituted based on CQI results;
4. Patient satisfaction through patient satisfaction surveys administered after surgery or once the patient has returned home, and
5. CQI data captured throughout the continuum of care: patient check in, holding room, operating room, post-op, hospital floor, home, and reported back to the physician, surgeon and hospital.
Southeast Anesthesiology Consultants, the founding company of Quantum CNS, has been using the system since its creation. “We wanted to be able to mea-sure, analyze and continuously improve our processes and performance,” said Dr. Richard Gilbert, President and CEO of Southeast Anesthesiology Consultants and Quantum CNS. Quantum is designed to flow natu-rally with the patient care models already in use throughout physician groups and hospitals. Unlike expensive healthcare IT systems which force clinicians to bear the burden of cumbersome interfaces and extra steps, Quantum CNS provides a very high “return on clinician time” in
the cOst-cUtting apprOach tO healthcare refOrm
John M. KunyszFACHE, Chief Operating Officer, Quantum Clinical Navigation System™
Charlotte, NC
th e cO m m U n i q U é fa l l 2009 pag e 19
addition to the standard “return on in-vestment” model. One example of the way Quantum CNS’s real time report-ing helped Southeast Anesthesiology Consultants occurred in their Obstetrics Anesthesiology division. One of SAC’s physicians always received patient sat-isfaction scores of 98% or better. A few months ago, for no particular reason, this physician’s score began to drop
dramatically. In less than two weeks he went from patient satisfaction scores of 99% to scores below 70%. Because of the real time reporting that this physician’s hospital chief received, SAC was able to quickly intervene, discuss the results with the physician and see immediate improvement with the scores rebound-ing to 99% in a matter of days. “It was remarkable,” commented John Kunysz, COO of Quantum CNS, “This particular
physician’s scores dropped dramati-cally and then rebounded in less than 24 hours due to the data Quantum pro-vides on a real time basis.” Actions like this have kept SAC’s overall patient satis-faction 98% or better for over five years. This kind of real time reporting and im-mediate focused intervention is not pos-sible with most traditional QA programs using retrospective chart review. Another way that Quantum CNS’s reporting data is invaluable for physi-cians and hospitals is that it can aid in payer negotiations. Instead of having to rely on payer data, SAC can proudly showcase their own data, prove that they are able to beat all national benchmarks and ultimately use it as a tool to negotiate better reimbursement rates. Finally, Quantum Clinical Navigation System aids in cost re-duction. If you were to achieve the level of benchmarks that Southeast Anesthesiology Consultants can achieve with antibiotic administration, lower-ing of myocardial infarction and stroke incidences nationwide the United States would save more than $5 bil-lion in healthcare expenses each year. (See “Proper Antibiotic Administration Savings”, inset) These cost savings would allow hospitals and practices to begin implementing expensive technol-ogy, such as EMR systems, and could lessen the burden of healthcare reform on an already weak economy.
prOper antibiOtic aDministratiOn savingsThe national incidence of surgical site infection is 3-5% of all patients. Incidents of SSI cost approximately $3,000 for an additional 7-9 hospital days per patient. Appropriate administration of antibiotics decreases SSI 40-80%. The current benchmark for appropriate antibiotic administration is 50-75% of the time. If SAC administers antibiotics 90% of the time appropriately they will save $6.48 million dollars a year on 100,000 patients. Being able to increase the percentage of time that proper antibiotic administration occurs would result in a multi-million dollar savings nationwide.*Cost & Benchmark source: Barnard, Bonnie MPH, CIC “Fighting Surgical Site Infections”
Number of patients undergoing anesthesia annually: SAC- 95,205 patients/year US approx. 40 million patients/year.
Average cost to traditional health insurer for first 90 days after heart attack per patient $ 38,501** Total cost SAC patients $ 731,519 Total cost National Benchmark $ 7,892,705 Estimated savings to health plans/patients resulting from SAC reduced events = $7,163,236Estimated national savings if benchmark reduced to SAC benchmark levels = $2.618 Billion
*Benchmark Source: Chung, Dorothy and Stevens, Robert, “Evidence-based Practice of Anesthesiology,” page 379.
** Cost Source: NBER Working Paper No. 6514, nber.org/digest/Oct 98, National Bureau of Economic Research.
Number of patients undergoing anesthesia annually: SAC-95,205 patients per year, US approximately 40 million patients per year. Cost at discharge for inpatient care per patient $ 9,882** Total cost SAC patients $ 187,758 Total cost National Benchmark $ 4,703,832 Estimated savings to health plans/patients resulting from SAC reduced events = $4,516,074 Estimated national savings if benchmark reduced to SAC benchmark levels = $1.897 Billion
*National benchmark is <1%, so .5% is used for calculation. *Benchmark Source: Fleisher, Lee; ”Evidence-Based Practice of Anesthesiology, page 163.**Cost Source: Neurology, Vol 46, Issue 3, 854-860, 1996, American Academy of Neurology, “Inpatient costs of specific cerebrovascular events at five academic medical centers”
John M. Kunysz, FACHE, is a licensed
CPA formerly with
P r i c e w a t e r h o u s e
Coopers and KPMG.
He received his MBA
from the University
of California, Los
Angeles, and Bachelor of Science degree
from San Diego State University. For ad-
ditional information regarding Quantum
Clinical Navigation System visit www.
quantumcns.com or call 1.800.354.3568.
th e cO m m U n i q U é fa l l 2009 pag e 20
13 steps tO a DisastrOUs anesthesia infOrmatiOn system
implementatiOnPhil Mesisca, MBA, CMPE
University of Pennsylvania Health System, Philadelphia, PA
Implementing an Anesthesia Information System (AIS) is a major un-dertaking for an anesthesia practice. The question is less about “should we” and more about “when or how should we” as it is inevitable that most practices will even-tually make the move. This article will review the steps to be avoided for a suc-cessful AIS implementation. 1. pUrchase vapOrware. Ignore any discussion with a vendor
that includes “… not now, but we will be able to handle that in our next ver-sion …”.
2. assUme the ais will fix all yOUr OperatiOnal prOblems.
In the words of Bill Gates “The first rule of any technology used in a busi-ness is that automation applied to an efficient operation will magnify the ef-ficiency. The second is that automation applied to an inefficient operation will magnify the inefficiency.” If you have someone constantly tracking down missing anesthesia records now, you’ll probably have someone tracking down incomplete or open electronic anesthesia records later.
3. UnDer-estimate the time anD resOUrces neeDeD fOr implementatiOn.
Most large capital investment projects come in late and over-budget. There will be significantly more issues than you will anticipate and make sure you
prepare for the time devoted to the one out of every 5 clinicians who will offer significant resistance.i
4. Only cOnsiDer the cOsts anD resOUrces neeDeD tO implement.
You can’t prepare for every future problem so prepare for your response to a problem. Think about on-going issues and future needs such as tech-nical support, upgrades, training, record security, interfaces, on-going fees, data mining, expansion licenses, backup processes, etc. There is an enormous amount of work in prepar-ing for the implementation, but many practices don’t properly plan for the continued resources and time needed for the months/years after the go-live date.
5. let the aDministrative team take cOmplete respOnsibility fOr implementatiOn.
Key physicians and CRNAs must be
involved for a successful implemen-tation. These individuals must also be given the needed time to properly plan and implement – and remember “implement” is beyond the day the system goes live.
6. if the hOspital is fUnDing the ais, make sUre yOU allOw it tO Dictate what system yOU will implement even if yOU knOw that it will nOt meet yOUr neeDs.
You certainly need to be reasonable, but implementing a system that isn’t going to do the job properly will be a lose/lose for both your group and the hospital.
7. mODify the ais tO accOmmODate hOw yOU DO things tODay in yOUr practice.
The more willing a practice is to be flexible and modify work processes to take advantage of the technology, the higher the probability that the poten-tial benefits will be realized.
8. ignOre the research that DOcUments the enOrmOUs DifficUlty fOr peOple tO change anD JUst assUme that everyOne will embrace this new technOlOgy.
Consider a recent study that showed that despite the real possibility of death if patients did not change their lifestyle, fewer than 15% of heart
th e cO m m U n i q U é fa l l 2009 pag e 21
attack survivors were following their doctor’s advice to adhere to a healthy diet just one year after their heart attack.ii Even if things go perfectly, few people embrace change.
9. DOn’t fill the Open clerical pOsitiOn in yOUr practice since yOU are abOUt tO implement yOUr new ais anD yOU’ll sUrely have mUch less neeD fOr these pOsitiOns Once yOU gO live.
Before, during and for months after implementation you will have more need than ever for administrative support. This is also a critical time to have stability in key positions. President Abraham Lincoln believed that his nomination as the Republican candidate for his second term had not come because he was the best man, but rather because the party had con-cluded that it would be best to “not swap horses while crossing the river” since they were in the middle of the war. Good advice to remember.
10. set Unrealistic expectatiOns. No system will meet all your needs
and wants. Forget about your wants. Prioritize your needs.
11. be an eternal Optimist anD
avOiD cOnflict. It is imperative to confront the issues,
debate them, fix them, and move on. Consider the Stockdale Paradox as noted by famed author Jim Collins in his landmark book Good to Great. It’s named after Admiral James Stockdale, who survived 7 years as a POW during the Vietnam War. You can listen to a brief audio on this on Collins’s web site (http://www.jimcol-lins.com/media_topics/brutal-facts.html#audio=59), but the key quote from the book is “You must never con-fuse faith that you will prevail in the
end – which you can never afford to lose – with the discipline to confront the most brutal facts of your current reality, whatever they might be.”iii
12. wOrry that this will be baD fOr billing cOmpliance, malpractice claims, Or patient care.
Billing compliance documentation will be much better as long as your ac-tions are compliant. Non-compliant actions will be duly noted in the elec-tronic system (e.g. If you note at 11:00 that you were present for induction but induction actually occurs at 11:42 you will have a problem). So if you do the right thing the documentation proving that will be better than ever.
A survey published in Anesthesia & Analgesia showed that departments using an AIS for anesthesia record keeping believed that these systems were useful for managing malpractice risk and did not increase malpractice exposure.iv
A study at the University of Michigan showed that the use of electron-ic reminders improved procedure documentation compliance and pro-fessional fee reimbursement.v Another study at Massachusetts General Hospital showed that real-time checking of electronic records for doc-umentation errors and automatically text messaging clinicians greatly im-proved the quality of documentation.vi
13. UnDerestimate the valUe Of an ais.
An MGMA survey across all medical practices reflected that after the first 6 to 24 months, the benefits of electron-ic health record adoption generally increasingly exceed the cost, and most practices eventually wonder how they ever conducted business without an
electronic record. vii Although anes-thesia is certainly very different from other specialties, similar results can be expected.
So the good news is that eventually you will have better documentation for billing compliance. Eventually charge cap-ture will be more accurate. Eventually the billing cycle will be faster. Eventually mal-practice risk will be reduced. Eventually patient care will be better. Eventually you’ll be telling stories to the residents and SRNAs about life before the AIS imple-mentation and how paper was used. They will stare at you in disbelief.
i MGMA Information Exchange – Electronic Health Records, November 2006.ii University of Massachusetts Medical School (2008, February 1). Patients Diagnosed with Coronary Heart Disease Continue Poor Diets, Study Shows. ScienceDaily. Retrieved August 28, 2009, from http://www.sciencedaily.comiii Collins, Jim. Good to Great: Why Some Companies Make the Leap…and Others Don’t. Harper Business; Edition 1, October 16, 2001.iv Feldman JM. Do Anesthesia Information Systems Increase Malpractice Exposure? Results of Survey. Anesthesia & Analgesia. 2004; 99: 840-843.v Kheterpal S, Gupta R, Blum JM, Tremper KK, O’Reilly M, Kazanjian PE. Electronic reminders im-prove procedure documentation compliance and professional fee reimbursement. Anesthesia & Analgesia. 2007 March; 104(3):592-7.vi Sandberg WS, Sandberg EH, Seim AR, Anupama S, Ehrenfeld JM, Spring SF, Walsh JL. Real-time checking of electronic anesthesia records for documentation errors and automatically text messaging clinicians improves quality of documentation. Anesthesia & Analgesia. 2008 January; 106(1): 192-201.vii MGMA Electronic Health Records: Perspective from the Adopters, October 2007.
Virtually all large anesthesiology practices have a corporate website. Some are quite detailed and complex. Fewer medium and small practices maintain a web presence. Should every practice consider creating a practice website or upgrading its current site? After examining a number of anesthesia practice websites, one can see that most have common elements and purposes. Before considering website design, the practice should seriously consider the purpose of the website and its intended effects. The reasons given by anesthesia practices for expending the time and money needed to produce an effective website are to implement one or more of the following:
1. Establish a “web presence”2. Recruit anesthesia personnel via
the website3. Provide patient information4. Assist in the patient billing process5. Schedule anesthesiologists via
surgeon preference6. Internal uses such as maintaining
call schedules, document retrieval and communications.
7. Marketing to patients, surgeons and facilities seeking anesthesia coverage.
web presence
Currently, almost every business has a website, so anesthesiology practices may believe that they too should have one. However, many surgical anesthesiology practices with exclusive hospital contracts do not experience competitive pressure and have not yet
seen the need for a web presence. Pain management practices are more market-driven and usually maintain a web site that can help promote their services to patients and referring physicians. Although a web presence alone may not be the motivating factor to establish a website, practices should consider the fact that most businesses are found these days via internet searches. A simple but well designed website may be an alternative to a costly listing in the business pages of the local telephone book.
recrUiting Some anesthesia practices state that their website is mainly for recruiting purposes. This is especially true of practices that employ CRNAs and experience difficulty with hiring and turnover. A properly designed
and maintained web site can appear at the top of search results that are run by physicians or CRNAs seeking employment in your area. Some practices post jobs and allow resumes to be submitted through their website. If your local competitors are doing this and you are not, you are at a disadvantage. With proper search engine placement and a long term strategy for recruitment, the anesthesia website can reduce or eliminate the need for outside recruiters as well as for recruiting and advertising fees.
patient meDical infOrmatiOn Many practices place extensive patient education information on their web site. This information may be generic such as the description of the types of anesthesia and anesthesia complications. Specific information
anesthesiOlOgy practice web sitesJoe Laden
Anesthesia Associates of Louisville, PSC Louisville, KY
th e cO m m U n i q U é fa l l 2009 pag e 23
such as the anesthesia group’s preoperative testing requirements can be available on the website. The ASA has patient information on its website that can be linked to.
patient billing
In addition to billing and collection policies and procedures, some practices have links to the practice’s billing company. It may also be possible to provide a mechanism for patients to view and pay their bills on the practice web site with credit cards and PayPal.
anesthesia anD sUrgery scheDUling
In some areas of the country, anesthesiologists compete within hospitals and are scheduled by surgeon preference. A web presence and scheduling system are vital to these practices.
marketing Beyond a simple “web presence”, some anesthesiology groups market their
skills and experience to the community and to prospective facilities in need of anesthesiology services. To do this the website could describe the group’s accomplishments and special services it delivers to the facilities at which it operates. If the group is involved in community activities and charities, these can be promoted on the web site. Practices with office-based pain management divisions usually describe these services on the website and provide contact, location and hours of operation information.
internal Use Some practices maintain a website only for internal use and some include a private section with password access on their public website. Internal uses include: call and vacation schedules, posting of clinical and business documents and internal communications. Practices that use a commercial web-based scheduling system can post a link to their system here.
hOsting anD cOst
A website can be hosted on your corporate network or via a web hosting service. Hosting should not cost more than a few hundred dollars per year. The cost of designing and implementing a web site can range from zero for a simple web page hand-coded by someone in the practice to tens of thousands of dollars for the elaborate web site of a large anesthesiology practice.
website placement If you want prospective employees and local patients to find your website by searching using Google, Bing, Yahoo and other search engines, you need to take some steps to assure that your site will be retrieved high in the search engine results lists. This is called Search Engine Optimization and the techniques to do this will be known by your website designer.
implementing yOUr website
An anesthesiology practice will most likely use a professional website design company to product a website or upgrade its current website. However, before the website design work is done, the practice manager and one or more physicians should examine the websites of many local and national anesthesiology practices to obtain ideas about the website elements the practice would like to emulate. Having a good idea as to the layout and features of one’s website before the implementation process starts can save the practice time and money and make it much more likely to produce an effective result.
cOntinUing relevance
After the anesthesiology website is implemented, it should be updated frequently with current information
Continued on page 24
th e cO m m U n i q U é fa l l 2009 pag e 24
about the practice. If you scan the web looking for anesthesia group web sites,
you will find ones that look like they have not been updated in years. Someone in your practice should be designated to keep the website up-to-date. One way to make your website look current is to include frequently updated news items or a patient information blog on the front page.
anesthesiOlOgy practice web sitesContinued from page 23
Website Main sections
Information about the Practice History Mission Statement Group makeup Message from group leader(s) Services Provided: (e.g.: Surgical
Anesthesia, Ambulatory Anesthesia, Chronic Pain, Acute Pain, OB
Anesthesia, Neuroanesthesia, Cardiac Anesthesia, Critical Care
Anesthesia) Special Services Quality Assurance Program Practice Divisions (OR, OB, Pain, Critical
Care, Office Based) Facilities Covered Description and pictures of facilities
Links to facilities Location/Directions/Maps Self-promotion & differentiation from
competing groups Information about group in video format
Providers (MD, CRNA, AA) Names of providers Provider biographies/qualifications Provider photographs Links to articles and accomplishments of
group members
Patient Information Medical Information Description of types of anesthesia OB anesthesia considerations
Recruiting CRNA opportunities MD opportunities Administrative positions Ability to email or upload resume City, state and community information Links to area attractions, real estate and
schools
Administration/Billing Billing Information Insurance accepted Billing policies and procedures Link to billing company Online Payments: Credit Card/PayPal Support staff names and contact Information Private access sections
MD/CRNA Call Schedules Vacation SchedulesLink to scheduling softwareInternal Communication / Private EmailLink to group’s intranetAccess to Company Documents Policies and Procedures Medical Information Links to anesthesiology clinical sitesAccess to patient billing information Access to Quality Management/Assurance
System
ASA’s LifelinetoModernMedicine.comThe American Society of Anesthesiologists
Joe Laden has served as the Business Manager for Anest-hesia Associates of Louisville, PSC since 1981. He has written many articles about anesthesia business topics and has made presentations at MGMA, ASA and other business conferences. To contact Joe with any questions or comments about infor-mation in article: [email protected]. More lists of academic and private practice websites can be found at http://
sites.google.com/site/joeladen/Home
Private Practice http://www.valleyanesth.com/http://www.amg-group.com/http://www.gasdocs.com/http://www.wacmdpa.com/http://www.northeasternanesthesia.com/ http://www.anesthesiapmc.com/ http://seanesthesiology.com Pediatrichttp://www.napdocs.com/
Some examples of Good Anesthesia Practice Websites:
th e cO m m U n i q U é fa l l 2009 pag e 25
The Health Information Technology for Economic and Clinical Health Act (“HITECH Act”), included as part of the American Recovery and Reinvestment Act of 2009 (“ARRA”), significantly alters and supplements provisions of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) protecting the privacy and security of individuals’ protected health information (“PHI”). Subtitle D of HITECH—pertaining to patients’ privacy rights, breach notification, and consequences of breaching private information—significantly expands the HIPAA privacy and security provisions. This article will summarize some key aspects of the privacy and security portions of the HITECH Act.
liabilities Of cOvereD entities anD bUsiness assOciates
In one of the most significant expansions of HIPAA effectuated by the HITECH Act, the HITECH Act expanded certain requirements, which previously only governed covered entities,1 to also govern business associates of covered entities.2 Specifically, Section 13401 of the HITECH Act directly applied the administrative, physical and technical safeguard requirements of the HIPAA Security Rule to business associates, and mandated that business associates maintain policies, procedures and documentation of security practices. In addition, pursuant to Section 13404 of the HITECH Act, the privacy requirements
addressed by the HITECH Act (and summarized in this article) are made applicable not only to covered entities, but also to their business associates.
Whereas HIPAA specifically governed covered entities, and thus made only covered entities liable for HIPAA violations, both covered entities and business associates are liable for HIPAA violations based on the HIPAA amendments in the HITECH Act. Prior to HITECH, it was the covered entity’s responsibility to ensure the business associate complied with HIPAA standards. If a business associate committed a HIPAA violation, the consequence was termination of the contract if the business associate remained non-compliant. Now, if a business associate is non-compliant, then that business entity is subject to consequences directly from the HHS, including criminal and civil liabilities.
reQUireD nOtificatiOn fOr infOrmatiOn breaches
Effective September 23, 2009, both covered entities and their business
associates will be liable for breaches of a patient’s unsecured protected health information.3 The HITECH Act requires a covered entity or its business associate to notify an individual of a breach of that individual’s unsecured protected health information within 60 days of discovering the breach. When a breach involves individual consumers, depending on the number of individuals who are involved, an individual notification or media notification will be utilized. Notification must also be made to the Department of HHS immediately if the breach involves 500 or more individuals. If the breach involves less than 500 individuals, the provider can maintain such information on a log, which must be provided annually to HHS.
Guidance from HHS Surrounding Breach Notification
On April 29, 2009, HHS published additional guidance regarding the HITECH Act’s requirements regarding the breach notification requirements for unsecured protected health information.4 Note that the breach notification requirements apply only to unsecured protected health information, which is defined as protected health information that is not unusable, unreadable or indecipherable to unauthorized individuals.
The additional guidance was mandated by Section 1302 (h) (2)
1 A covered entity is defined as “(1) [a] health plan. (2)A health care clearinghouse. (3) A health care provider who transmits any health information in electronic form in connection with a transaction covered by this subchapter.”
2 A business associate is “a person or organization, other than a member of a covered entity’s workforce, that performs certain functions or activities on behalf of, or provides certain services to, a covered entity that involve the use or disclosure of individually identifiable health information. Business associate functions or activities on behalf of a covered entity include claims processing, data analysis, utilization review and billing.” http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html
3 Unsecured protected health information is defined as “protected health information that is not secured through the use of a technology or methodology specified by the Secretary….” HITECH § 13402(h)(1)(A).
Continued on page 26
hitech in a high tech eraAbby Pendleton, Esq.
Jessica L. Gustafson, Esq.i
The Health Law Partners, P.C.Southfield, MI
th e cO m m U n i q U é fa l l 2009 pag e 26
of the HITECH Act, which required HHS to issue guidance “specifying the technologies and methodologies that render protected health information unusable, unreadable, or indecipherable to unauthorized individuals ….” Although compliance with this guidance is not mandatory, HHS emphasized that following the guidance will serve as a safe harbor, resulting in “covered entities and business associates not being required to provide the notification otherwise required by section 13402 in the event of a breach.”
On August 24, 2009, HHS published an Interim Final Rule,5 which clarifies guidance specifying technologies and methodologies that render PHI unusable, unreadable or indecipherable to unauthorized individuals, and further outlines new regulations governing covered entities’ and business associates’ responsibilities under the HITECH Act to provide notification to affected individuals and to HHS following the discovery of a breach of unsecured PHI. The new regulations will be codified at 45 C.F.R. § 164.400 et seq.
the stakes are raiseD – increaseD enfOrcement
As noted above, the HITECH Act contains provisions so that penalties that apply to covered entities for violations of HIPAA also apply to business associates. Further, the HITECH Act revises and expands current penalty provisions for violations of health privacy and security regulations. The HITECH Act contains new provisions related to noncompliance due to “willful neglect” and requires the government to formally investigate any complaint of a violation if a preliminary investigation of the facts indicates a possible violation due to willful neglect. The HITECH Act also replaces the
current penalty of $100 per violation with a new tiered-penalty system.
Of particular importance, the HITECH Act also includes a provision authorizing enforcement by State Attorney General Offices if the attorney general of a State has reason to believe that an interest of one or more residents of that State has been or is threatened or adversely affected. In such cases, the Attorney General can bring a civil action on behalf of the state residents to enjoin any continuing violation or to obtain damages on behalf of the residents. The court may also award costs and reasonable attorney fees to the State. 6
reQUireD accOUnting Of DisclOsUres invOlving electrOnic health recOrDs
As many providers are aware, under HIPAA, covered entities are not required to provide individuals with an accounting of disclosures of their protected health information if the disclosure is related to treatment, payment, or the health care operations of the covered entity. Per the HITECH Act, providers who use or maintain electronic health records will be required to account for disclosures related to treatment, payment, or the health care operations of the covered entity. In such cases, the accounting period is limited to three (3) years prior to the date on which the accounting is requested. The effective date for this new requirement is dependent upon whether the provider acquired an electronic health records as of January 1, 2009 or after January 1, 2009. For users of electronic records
4 74 Fed. Reg. 19006 (April 17, 2009), available at http://edocket.access.gpo.gov/2009/pdf/E9-9512.pdf
5 74 Fed. Reg. 42740 (August 24, 2009), available at http://frwebgate6.access.gpo.gov/cgi-bin/PDFgate.cgi?WAISdocID=282472267445+0+2+0&WAISaction=retrieve
6 Section 13410 of the HITECH Act.
hitech in a high tech eraContinued from page 25
th e cO m m U n i q U é fa l l 2009 pag e 27
as of January 1, 2009, the HITECH Act applies to disclosures made on and after January 1, 2014. For users acquiring electronic health records after January 1, 2009, the HITECH Act applies to disclosures made on and after the later of January 1, 2011 or the date the entities acquires the electronic health record. 7
the minimUm necessary rUle
With regard to non-treatment situations, HIPAA requires providers to only use the minimum amount of PHI necessary to accomplish permitted tasks. Section 13405 of the HITECH Act clarifies that a covered entity will be seen as having complied with this “minimum necessary” standard if it limits the disclosed PHI to the “limited data set.” The limited data set excludes identifying information such as names, addresses, telephone numbers, social security numbers, etc. However, if the limited data set is not sufficient, the minimum necessary standard applies. By August 2010, HHS will issue guidance surrounding the definition of minimum necessary. Until this guidance is issued, the Act requires “in the case of the disclosure of protected health information, the covered entity or business associate disclosing such information shall determine what constitutes the minimum necessary to accomplish the intended purpose of such disclosure.”
prOhibitiOns On sale Of electrOnic health recOrDs Or phi
Unless one of six (6) specified exceptions apply, the HITECH Act prohibits a covered entity or business associate from directly or indirectly receiving remuneration in exchange for any protected health information, unless the entity obtained a valid HIPAA authorization that specifies whether the
protected health information can be further exchanged for remuneration. The exceptions to the general prohibition include the following:
• The purpose of the exchange is for public health activities;
• The purpose is for research and the price charged reflects the costs of preparation and transmittal of the data for such purpose;
• The purpose is for treatment, subject to additional protections promulgated by regulation;
• The purpose is in connection with the business operations of the entity;
• The purpose of the exchange is for remuneration that is provided by a covered entity to a business associate for activities involving the exchange of protected health information that the business associate undertakes on behalf of and at the specific request of the covered entity pursuant to a business associate agreement;
• The purpose of the exchange is to provide an individual with a copy of his or her own protected health information.
HHS is authorized to develop additional exceptions. Notably, the effective date for this provision is six (6) months after the date of the promulgation of final regulations (HHS is responsible for promulgating regulations no later than 18 months after the enactment date of the Act).8
access tO infOrmatiOn in electrOnic fOrmat
The HITECH Act states that where a covered entity uses or maintains an electronic health record with respect to protected health information, the
individual shall have a right to obtain from the covered entity a copy of such information in an electronic format.9
cOnclUsiOn
The HITECH Act significantly alters and supplements provisions of HIPAA protecting the privacy and security of individual’s PHI. Providers and their business associates are well advised to familiarize themselves with such requirements in order to remain in compliance with the expanded health information privacy and security requirements.
i The authors would like to thank Neda Mirafzali, a 3L law student at Michigan State University Law School and a law clerk currently working with The Health Law Partners, P.C., for her contributions to and assistance with this article.
7 Section 13405 (c) of the HITECH Act.8 Section 13405 (d) of the HITECH Act.9 Section 13405 (e) of the HITECH Act.
Abby Pendleton and Jessica L. Gustafson are partners with the health care law firm of The Health Law Partners, P.C. The firm represents hospitals, physicians, and other health care providers and suppliers with respect to their health care legal needs. Pendleton and Gustafson co-lead the firm’s Recovery Audit Contractor (“RAC”) and Medicare practice group, and specialize in a number of areas, including: RAC, Medicare, Medicaid and other payor audit appeals, healthcare regulatory matters, compliance matters, reimbursement and contracting matters, transactional and corporate matters, and licensing, staff privilege and payor de-participation matters. Pendleton and Gustafson also regularly assist attorneys with their health care legal needs. They can be reached at (248) 996-8510 or apendleton@thehlp.