Success Story continued:

In “a small window of time,” Dr. Virgo realized, the practice would have to restructure to meet meaningful use criteria, while also meeting the challenge of the new ICD-10 coding requirements. Dauntingly, Dr. Virgo also heard rumors of practices that had acquired systems that failed to meet federal requirements.  Was it possible to acquire expensive equipment and systems, make extensive changes, and still not have it right? 

In ZaneNet Connect, she found assistance, with “wonderful attention to detail, with reminders and bullet points” that moved the project forward. Dr. Virgo also found the MSO “realistic” in helping her budget for unanticipated expense for new computers and wiring and in finding financing help appropriate for a smaller office.

 In 2011, ZaneNet arrived in early April to do workflow and IT assessments and by mid April had reported to Dr. Virgo on its results and recommendations.  Upgrades would be necessary both for the existing eClinicalWorks system and for the internet service, for increased speed and better pricing. The office infrastructure would be improved and expanded.

 Upgrades and technical changes moved forward at a steady pace. The office upgraded its eClinicalWorks EHR to a meaningful-use-qualified version and added e-prescribing to its routines. Dr. Virgo reports that she was pleased by the staff training provided for the upgrade, a crucial need. 

A big issue was coordination, Dr. Virgo recalled, as records were moved to remote hosting.  Here ZaneNet stepped in to time the steps needed and schedule the work, and all went well. The IT staff reconfigured the wireless router and VPN to better serve the office, including a remote desktop that allows secure home access. The office moved to a faster internet service, changing all phones to a single internet-based (VoIP) system, and acquired new computers and network equipment.

In August, ZaneNet conducted a gap analysis, to determine whether systems, processes and workflows met the Meaningful Use criteria. In September, Dr. Virgo signed off on IT implementation. An updated MU gap analysis in early October verified the changes.

“Going Live” on the upgraded system, Dr. Virgo’s practice achieved Milestone 2 on November 11, 2011. She is presently working toward connecting to the HIE.

 Dr. Virgo is delighted with her practice’s new workflow, which has moved to a new level of performance incorporating e-prescribing and improved handling of insurance and referrals. “Every step streamlines the work and saves time,” she says, pleased with her new efficiency.

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 “Tip of the Month” The Patient Portal continued:

The patient portal can be employed as a valuable tool in meeting a number of core and menu objectives required to achieve Stage 1 Meaningful Use and, later, Stage 2. In a previous issue, we explored core objective 12, which requires that more than 50% of all patients seen by the provider are provided an electronic copy of their health record within three business days upon request. A patient portal can be used to meet this objective.

The portal is useful and sometimes essential to meeting other meaningful use objectives from both the core and menu categories. Core objective 13 requires that clinical summaries be provided within 3 business days to 50% of all patients seen. Patient visit summaries can be sent directly to the patient portal after the patient encounter, where they are immediately available as required. This process also allows additional savings on printing costs foregone.

Menu objective 4 requires that patient reminders be sent to 20% of all unique patients 65 years or older and 5 years or younger. The patient portal can send reminders electronically, a savings in time and resources.

Menu objective 5 mandates that more than 10% of all unique patients seen by the provider are provided timely electronic access to their updated health information within four business days of the encounter. This objective can be met only through the use of a patient portal.

Finally, we have menu objective 6, requiring patient-specific education be supplied to 10% of all unique patients. Educational materials can be printed out from the EHR or be sent to the patient directly through the patient portal. By using the portal, the provider can forward relevant educational information to the patient before the patient leaves the examination room.

Of the Stage 1 meaningful use core and menu objectives, these five can best be accomplished by using a patient portal. A medical practice can greatly benefit from integrating a patient portal with its EHR and exploring its many uses. 

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Maryland Health IT News continued:

“When President Obama signed the Affordable Care Act two years ago today, Governor O’Malley and I began moving forward immediately to implement reform in order to maximize its benefits for Maryland families, seniors and small businesses,” said Lt. Governor Brown. “Many benefits are already in place, and many more will become available through Maryland’s Health Benefit Exchange. With HealthReform.Maryland.gov, we can provide clear information to help Marylanders learn what health reform means for them and how they can take advantage of it. The site is another important tool in our ongoing efforts to reduce costs, expand access, and improve the quality of health care for all Marylanders.”

“Thanks to health care reform, quality and affordable care is becoming a reality for families across Maryland,” U.S. Senator Barbara Mikulski said. “I’m so proud of what we accomplished. We saved and strengthened Medicare and closed the prescription drug donut hole. With new consumer protections, families can choose which primary care doctor is right for them, and which pediatrician is right for their children. Young adults are now covered on their parents insurance until they’re 26. We ended the punitive practices of insurance companies so you can’t be denied access to care due to a preexisting condition. And because of health care reform, being a woman is no longer a preexisting condition.”

“Thanks to health care reform, all Marylanders will have access to affordable, quality health insurance,” said U.S. Senator Ben Cardin.  “Our focus now must be on ensuring that Marylanders have the information they need about what benefits are available to them so they can make informed choices about their coverage.  This website is a great resource because it will provide important information to individuals and businesses so they can make decisions about their health care needs.”

Additional sections of the site include “What is Health Care Reform,” which provides basic background information about the Affordable Care Act as well as a timeline for when changes take effect, and “Maryland Moving Forward,” which provides updates on the State’s work to implement the ACA and details about the Health Care Reform Coordinating Council. Marylanders can also stay up-to-date on health care reform by signing up for email updates or following the Office of Health Care Reform on Twitter (@MDHealthReform).

“HealthReform.Maryland.gov is designed to be a straightforward, easy to use resource that explains what health care reform means for Marylanders,” said Carolyn Quattrocki, Executive Director of the Governor’s Office of Health Care Reform. “Visitors can also get updates on our progress and see how Marylanders are benefiting today, including 51,868 young adults in Maryland who have gained coverage by staying on their parents’ health insurance plan and 52,243 Maryland seniors in the Medicare Part D ‘donut hole’ who are receiving automatic discounts on their prescriptions.”

"This website is a great source of information on health reform in Maryland," said Dr. Joshua M. Sharfstein, Secretary of the Maryland Department of Health and Mental Hygiene. "If you have questions, the website will have answers."

“This new website will be of great help to consumers seeking to understand their health care options. It is another example of the great job which the O'Malley-Brown Administration is doing to fully implement the two year old Affordable Care Act here in Maryland,” said Vincent DeMarco, President, Maryland Health Care For All! Coalition.

Maryland is recognized as a national leader in ACA implementation. The State has taken significant steps to establish Maryland’s Health Benefit Exchange, a one-stop competitive marketplace that will make qualified health plans available to qualified employers and individuals, including those with pre-existing medical conditions. HealthReform.Maryland.gov will keep Marylanders posted on the progress of the Health Benefit Exchange, which under the ACA must become operational in fall, 2013 for coverage beginning January 1, 2014. 

During this year’s session of the Maryland General Assembly, Lt. Governor Brown is championing the Health Benefit Exchange Act of 2012 (SB 238/HB 443) to continue implementation of the Exchange.  Earlier this week, the bill was approved by the House Health and Government Operations Committee and the Senate Finance Committee.

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The HIPAA Privacy Security Audit continued:

Program Objectives: As a part of OCR’s health information privacy and security compliance program, the audit program will assess mechanisms for compliance, identify best practices and discover risks and vulnerabilities that may not previously have come to light through complaint investigations and compliance reviews. OCR will share the best practices and guidance on meeting compliance challenges via its website and other outreach efforts.

Who Will Be Audited? Every covered entity and business associate is eligible for an audit. OCR will audit as wide a range of types and sizes of covered entities as possible; covered individual and organizational providers of health services, health plans of all sizes and functions, and health care clearinghouses may all be considered for an audit. Covered entities are expected to provide the auditors their full cooperation and support.

How Will the Audit Program Work? Entities will be informed by OCR of their selection and asked to provide documentation of their privacy and security compliance efforts. In this pilot phase, every audit will include a site visit and result in an audit report. During site visits, auditors will interview key personnel and observe processes and operations to help determine compliance.

Following the site visit, auditors will develop and share with the entity a draft report; audit reports generally describe how the audit was conducted, what the findings were and what actions the covered entity is taking in response. The covered entity will have the opportunity to discuss its concerns and describe corrective actions it has implemented. The final audit report submitted to OCR will incorporate what steps the entity has taken to resolve compliance issues and describe any best practices of the entity. For more information about the OCR role, visit 

http://www.hhs.gov/ocr/privacy/hipaa/understanding/srsummary/index.html.

The accompanying figure suggests the time frame for the audit process, starting with the time of initial notification that as audit will be performed.

As covered entities under HIPAA, primary care practices utilizing electronic health records are subject to these audits.  Clearly, preparation is important. Maintaining full documentation of your practice procedures will greatly simplify the audit process by making it easier to supply the required information.

  As part of its IT Managed Services, ZNC offers a HIPAA Compliance Package that includes HIPAA IT assessment, IT configuration, security policies and procedures, and one-time employee training.

 Steps in preparing for an audit, taken from the February 2012  AHIMSA Advantage online newsletter:

 Create a Risk Assessment program.

1. Update your privacy and security policies and procedures.
2. Practice what you preach. Auditors will want to see how well staff understands HIPAA requirements and how their work habits consistently support protection of PHI.
3. Conduct a mock survey. [See National Institute of Standards and Technology Special Publication 800-52 on security compliance recommendations.]
4. Step up training efforts. Auditors will want to see coursework, documentation, sign-up sheets, and documents in personnel folders.
5. Look at your business associate agreements.

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