Confluence

OCT. 17,2013

Quirk Healthcare Solutions White Paper

Confluence Connecting the Dots

Understanding the Impact of ICD-10

INSIGHTS

About Quirk Healthcare Solutions Our team has worked with clients in industries ranging from one-physician clinics to nationwide organizations. Our staff includes physicians, nurses, MHAs, and MBAs to provide a multi-faceted view to all challenges. We’ve distilled what works, and we can provide an invaluable perspective. Everyone on our team brings real-world experience to the table.

We are doers, not theorists. This wealth of knowledge offers us a unique perspective into the strategies that work and those that don’t; we want to share the most effective ones with you.

PAGE 2 Confluence - Connecting the Dots

Contents In Brief

3

ICD History: Regulatory Foundation & Governance

3

Relationship of HIPAA 5010 to ICD-10

4

ICD-10 Facts

4

Planning for ICD-10

5

Making the Transition

5

Suggested Action Items

7

Further Information

7

A GOOD START During the past 50 years, immunizations have led to

Since the 1990s, IIS have been used as

the elimination (or near-elimination) of several

population-based electronic registries, serving as

vaccine-preventable diseases, substantially reducing

databases of individual immunization records.

deaths, disabilities, and illnesses. Vaccines have proven to be one of the most successful and

In non-emergency situations, IIS have the potential

cost-effective public health tools for preventing death

to enhance immunization programs. In disasters, IIS

and disease. They are among the most important

can be of critical importance. In the aftermath of

achievements of the 20th century.

Hurricane Katrina, IIS enabled the recovery of almost 19,000 immunization records of children who had

There is strong evidence of a correlation between

been forced to evacuate the New Orleans area. This

Immunization Information Systems (IIS) and an

translated to a cost savings estimated at more than

increase in vaccination rates, leading to a reduction of

$3 million in vaccine plus administration fees.

vaccine-preventable diseases.

Cumulative number of LINKS immunization records searched and found in the months after Hurricane Katrina (Sept. 2005 to Sept. 2006).

60000 Records Found

Records

50000

Searches

40000 30000 20000 10000 0

Sep 2005

Oct

Nov

Dec

Jan

Boom J A et al. Pediatrics 2007; 119:1213-1217

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep 2006

PAGE 4 As the utilization of IIS and Electronic Health Record (EHR) systems matures, there is greater opportunity for interoperability between the two entities. In large part, this opportunity is driven by the goal of the American Recovery and Reinvestment Act (ARRA) to increase the Meaningful Use (MU) of EHRs among medical providers. To receive EHR-MU incentives, Eligible Providers (EPs) and facilities must meet various operational and public health criteria established jointly by the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC).

The immunization-specific objective for MU Stage 1 is to test and establish a connection from the EHR system to the IIS in the EP’s jurisdiction. For MU Stage 2, EPs must demonstrate ongoing successful submission of electronic immunization data from a certified EHR system to IIS using Health Level 7 (HL7) standard protocol version 2.3.1 or 2.5.1.

At points of care, providers use IIS to:

A USEFUL TOOL

• Determine vaccination status and appropriate vaccines.

• Create and manage interventions.

• Manage vaccine inventory.

• Generate vaccine records.

• Analyze individual and population data.

• Support clinical decisions.

At the population level, IIS provide: Electronic submission of data to IIS can significantly improve the accuracy and timeliness of immunization records. Fully scalable and interoperable IIS serve both points of care as well as population-level reporting and analytics.

• Aggregate data on vaccinations for program management and surveillance.

• Steering of public health immunization initiatives.

• Public health decision support.

Confluence - Connecting the Dots

A Shifting Landscape

Planning for ICD-10 A Shifting Landscape There are currently 56 IIS nationwide, including Puerto Rico. The states of California, New York, Pennsylvania, and Texas have multiple registries, while Connecticut and New Hampshire have none.

Physician requirements for submission of data to registries include: •

Mandatory submission in 27 states, known as the “push” method.

•

Voluntary (strongly encouraged) submission in 35 states.

•

Electronic requests from state registries as part of future MU requirements,

known as the “pull” method.

Pharmacy requirements include: •

Direct submission of data to state registries.

•

Direct submission of data to primary care physicians.

Nine states (Alaska, Arizona, Arkansas, Hawaii, Michigan, New Jersey, New Mexico, North Carolina, and Chicago) have laws that specify penalties for immunization providers who do not submit data to IIS. This underscores the value of IIS in connecting to EHR systems, providers, vaccine-administering pharmacies, and state registries through the HL7 standard protocol.

The Challenges Because IIS have traditionally existed as information silos within their respective geopolitical domains, recordkeeping and reporting requirements have evolved separately. This poses an ongoing challenge to successful immunization programs. For example: •

There is currently no national immunization network that provides connectivity for providers and pharmacies.

•

There is no bidirectional connectivity available to/from most state registries.

•

Each change in law requires a change in technical HL7 requirements.

Although Meaningful Use Stage 2 was intended to standardize the formats for data submission, many state registries are introducing additional requirements and nuances that make a standard interface challenging. In addition, some states are now requiring that primary care physicians be notified when immunizations are provided at specialty clinics, hospitals, urgent care facilities, and hospitals. This is a formidable task for providers who must report to a single registry. When reporting to multiple registries, the requirement becomes almost impossible.

There are currently 56 IIS nationwide, including Puerto Rico. The states of California, New York, Pennsylvania, and Texas have multiple registries, while Connecticut and New Hampshire have none.

Physician requirements for submission of data to registries include: • Mandatory submission in 27 states, known as the “push” method.

• Voluntary (strongly encouraged) submission in 35 states.

• Electronic requests from state registries as part of future MU requirements, known as the “pull” method.

Pharmacy requirements include: • Direct submission of data to state registries.

• Direct submission of data to primary care physicians.

Nine states (Alaska, Arizona, Arkansas, Hawaii, Michigan, New Jersey, New Mexico, North Carolina, and Chicago) have laws that specify penalties for immunization providers who do not submit data to IIS. This underscores the value of IIS in connecting to EHR systems, providers, vaccine-administering pharmacies, and state registries through the HL7 standard protocol.

Confluence is packaged with many additional services, such as:

• The ability to serve as a data repository for national immunization records.

•

Connectivity to payers, drug manufacturers, education facilities, correctional

facilities, the CDC, and others.

Now in its proof-of-concept stage, Confluence offers access to patient immunization history for any provider who administers an immunization. Confluence is MU2-certified and comes with a maintenance-free, dedicated support desk. The product is currently available in the following states:

PAGE 6 Confluence - Connecting the Dots

The Solution

Suggested Action Items • Assemble an internal team • Identify current software vendors and needs • Establish a timeline • Inventory systems and workflows • Determine the need for assistance from an outside vendor or consultant • Evaluate staff training needs • Execute an implementation plan • Document a contingency plan for a failed go-live As with all things, communication is key to success. Make sure your staff is aware and involved in the upcoming transition, and familiar with any contingency plan as well. Most importantly, make sure your personnel are well-trained and know who to contact with any questions or concerns.

Further Information A wealth of ICD-10 information is available online. Below are a couple of links to get started.

• To sign up for CMS email updates, go to: https://public.govdelivery.com/accounts/USCMS/subscriber/new?topic_id=USCMS_608 • To learn more about ICD-10 from CMS, go to: https://www.cms.gov/icd10/

For more information on how Quirk Healthcare Solutions can help automate your practice and bring you into compliance with the ICD-10 changeover, contact us at 855.WE.QUIRK or info@quirkhealthcare.com

www.quirkhealthcare.com

2MILLION

$

in Meaningful Use payments

five star rating

Quirk offers a full range of services for our clients Quirk Healthcare Solutions offers a range of services to prepare clients to successfully transition to ICD-10. Our services include: This includes: • Core Team Training • Provider Documentation Training • Document Customization • Template Customization • Internal testing to ensure proper functioning of software, including identification and resolution of any internal systems issues caused by creating or receiving transactions with ICD-10 codes • External testing to ensure transmission and receipt of ICD-10 transactions

For more information on how Quirk Healthcare Solutions can help your practice contact us at 855.WE.QUIRK or info@quirkhealthcare.com

www.quirkhealthcare.com

4 100

MONTHS

PROVIDERS LIVE

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Medicare Advantage is one of the most lucrative business lines for insurance companies and providers

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• Medicare Advantage Providers

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• IPAs and MSOs • Primary Care Physicians

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• Specialists

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Graphs and Charts

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Medicare Advantage is one of the most lucrative business lines for insurance companies and providers

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eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat.

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LOREM IPSUM DOLER SIT AMET

Image Placeholder

Medicare Advantage is one of the most lucrative business lines for insurance companies and providers

Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat.

Consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua.

Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur: • Insurance Companies • Medicare Advantage Providers • IPAs and MSOs • Primary Care Physicians • Specialists

Lorem ipsum dolor sit amet LOREM IPSUM DOLER SIT AMET Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.

LOREM IPSUM DOLER SIT AMET Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat.

• Insurance Companies • Medicare Advantage Providers • IPAs and MSOs • Primary Care Physicians • Specialists

Image Placeholder

Medicare Advantage is one of the most lucrative business lines for insurance companies and providers