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Every year when WEDI holds its national conference in Baltimore, I attend for two reasons: 1) It’s a quick drive from Philadelphia, and 2) I always gain a fresh perspective on the current priorities in healthcare information technology, particularly for the federal government.
What I learned this year is that there is a serious effort to move things along for “interoperability” of healthcare systems. One initiative involves the certification of electronic health records in the ambulatory setting, a component of which is e-prescribing. This is being done through the Certification Commission for Healthcare Information Technology (CCHIT). EHR vendors must be able to demonstrate the functionality and interoperability of their systems, according to specific CCHIT criteria. This is not a casual effort. The demonstration takes a full day and there is a $28,000 charge.
There is also focus now on turning the X12N 837 into a real-time adjudication transaction. What’s behind this are consumer-driven health plans and higher deductibles, as consumers carry more of the financial load for their health insurance. We are likely to see a trimmed-down 837 that will be used for real-time adjudication. It’s just a matter of all the players agreeing on what should be included. With the higher deductibles, physicians are at greater financial risk. Real-time adjudication can reduce bad debt, since physicians will know what to collect at the time of the visit.
Consumer-driven health plans have also gotten the attention of the banking sector. Companies like JPMorgan, a presenter at the conference, see opportunity here. The prediction is that close to 75% of employers will offer a health savings account within the next two years. Use of debit and credit cards at the point of service, with credit extensions to patients, are part of the equation. The attraction for the banks is the $1.3 trillion payment flow, according to JPMorgan.
Then there is the question of which standard is the appropriate one for use in health information exchange and electronic health records, to name two areas. The lead organization here is the Health Information Standards Technology Panel (HISTP), which is sponsored by the American National Standards Institute (ANSI). ANSI is the accrediting body of standards development organizations. (As an aside, it’s not ANSI X12 but ASC X12. The ASC stands for accredited standards committee. I get tired of hearing X12 referred to as ANSI X12.)
And then there is the NPI. This new provider identifier is causing a lot of grief, which doesn’t come as a surprise to me. What I find interesting is that quite a few third-party plans require pharmacies to have an NPI, but have given physicians some slack. What I also find interesting is the number of third-party plans that are still not set up to handle the NPI, particularly since HHS published the final rule back in January 2004.
WEDI continues to play a pivotal role in bringing trading partners in healthcare together. But pharmacy isn’t at the table. This needs to change. You can check out this organization by going to www.wedi.org. CT
Bill Lockwood is the publisher of ComputerTalk.
He can be reached at email@example.com.