Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!
As an Internal Medicine physician working in a small digital office, I am frequently called upon to share data with other healthcare providers and patients. In 2005, a colleague introduced me to the Continuity of Care Record (CCR) standard.
I was impressed with the interoperability of the CCR standard that would allow me to exchange healthcare data electronically with my peers, some of whom are working with an electronic medical record and others whose records remain paper-based.
Since the fall of 2006, I have been exchanging healthcare data primarily for referrals of complex patients. Data exchange based on the CCR is richer than the traditional paper medical record that most primary care physicians fax to their consulting providers.
For example, one of the beauties of the CCR is that complex medical terms are presented in a codified manner, such as ICD-9 codes for problems, NDC codes for medications, and LOINC codes for laboratory tests. In addition, the CCR generator I use to pull the data from my database allows me to be selective and choose the relevant information that is needed to solve a particular medical problem; thereby improving the efficiency of the receiving providers.
The PDF Healthcare Best Practices Guide and Implementation Guide, which were released in 2007, supplied me with the tools to attach diagnostic images and text documents to the summary document. Most tests and procedures are in either image or text format, and by including these in the information exchange, I am able to help reduce healthcare costs.
In addition, the positive feedback I received from my peers who received PDF Healthcare files in place of traditional medical records gave me the confidence to recently begin exporting PDF Healthcare files to my patients for the purpose of populating an untethered personal health record (PHR). I believe that a patient-directed PHR that has been pre-populated with authoritative data from a primary care physicians’ electronic medical record is the quintessential, longitudinal health record that our national leaders believe to be the Holy Grail that can solve the ills of a broken healthcare delivery system.
In closing, my implementation of the CCR in the PDF Healthcare format has helped me to improve the quality of care I deliver to my patients and at the same time reduce the cost of caring for them. The CCR standard used with the PDF Healthcare Best Practices and Implementation Guides allows for the interoperable, electronic sharing of relevant, codified healthcare information at the point of care for specialty referral and into a robust longitudinal health record of interested patients.
Stasia Kahn, MD is an internist with Fox Prairie Medical group of St. Charles, IL.
By Scott Bayou
Perhaps I am missing a piece of the puzzle, but I really don’t understand clearing-houses like Emdeon and others.
We have X12 transactions that are supposed to level the paying field, yet most hospitals that I speak with are still sending their payment data through a clearinghouse and receiving the remittances back from the clearinghouse.
On the way back is where the real confusion comes into play for me. I know from companies like HDX that there is a per-transaction fee associated with the creation of the transaction. This per-transaction fee is variable (based on your ability to negotiate?) and varies from 15-40 cents per transaction.
Why? What benefit is being purchased? Each hospital has the right to obtain their 835 remittance, and there are various products on the market that allow for conversion to fixed text formats. Buy once and create postings to your HIS while avoiding per-transaction fees.
What am I missing?
Reporting? Most people I speak with get a limited set of reports from their vendor, and have to pay more if they want to customize reports or add new.
Archival? These transactions are not that big and can be held in most hospital’s Imaging or Document Management applications.
Relationship with vendor? Perhaps, many Siemens customers are given options to purchase HDX – or are they a partner? Not sure of the real relationship, but someone is making a ton of money out of something that should be transparent.
Management of variances? Perhaps, this is a problem that shouldn’t be, but always seems to exist in the X12 transaction processing world.
Managing the minute differences that are expected by various payers? This might be it! Lack of governance in the payer market begs the need for clearinghouses?
Maybe, but I would love to hear what others think about this.