The October 2009 cover article examines the provisions in the American Recovery and Reinvestment Act that offer exceptional opportunities for HIM programs, individuals, and the profession as a whole. Other features report on how diversity in the HIM workforce can help reduce healthcare disparirities and how integral senior-level professional practice experiences are for HIM students.

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The Department of Health and Human Services announced awards totaling $27.8 million to health center networks and large multi-site health centers to implement health IT.

The funds are part of the $2 billion allotted to HHS’s Health Resources and Services Administration (HRSA) under the American Recovery and Reinvestment Act to expand healthcare services to low-income and uninsured individuals.

The $27.8 million will be used to expand and upgrade health IT systems, including electronic health records, and are related to other ARRA efforts to promote the adoption and use of health IT throughout healthcare.

Eighteen grants totaling more than $22.6 million will support EHR implementations. Grants totaling more than $2.6 million will help four grantees implement other health IT-related projects, including creation of health information exchange networks. Another five grants totaling more than $2.5 million will help health centers use existing EHRs to improve patient health outcomes.

HRSA-supported health centers treated 17 million patients in 2008, 40 percent of whom have no health insurance, according to HHS.

A list of grant recipients is available through the above link. More on ARRA provisions for community health centers is available through the HHS.gov/Recovery site.

For healthcare providers seeking to participate in the federal government’s “meaningful use” incentive program, the barrier of entry may be lowering.

David Hunt, MD, chief medical officer at the Office of the National Coordinator for Health IT, indicated that criteria in the program’s first phase will focus on getting providers to purchase and begin using electronic health record systems. Hunt spoke at Health Data Management’s Health IT Stimulus Summit in Boston yesterday.

“You have to be able to send data, and [the Centers for Medicare and Medicaid Services] has to be able to receive it,” Hunt said, quoted in Health Data Management. “The big thing for 2011 is that you actually acquire this equipment and start using it.”

Hunt did not comment directly on what this meant for the criteria proposed by the Health IT Policy Committee this past summer. He noted that officials are collecting a “‘tremendous amount’ of information from many sources.”

The “meaningful use” program will provide Medicare or Medicaid bonuses to hospitals and physicians that become “meaningful” users of EHRs. Payments begin in 2011, leading many in the industry to question how ambitious the initial set of criteria can afford to be, given the low use of EHRs currently.

The program, specified in the HITECH section of the American Recovery and Reinvestment Act, leaves the details up to the Department of Health and Human Services. The Office of the National Coordinator, part of HHS, has been facilitating the process.

A proposed rule on the program is expected in December. The notice will include 60 days for public comment.

Medicare expects its fee-for-service systems will be tested and fully operational on the X12 5010 standard by January 1, 2011. That’s bad news for health plans that may have been hoping the big payer would run late and create an industry-wide delay.

The upgrade to the HIPAA transaction 5010 standard was announced in tandem with the January 2009 final rule mandating the upgrade to ICD-10-CM and -PCS. The 5010 standard is necessary to support ICD-10.

According to a timeline published in the final rule, by the end of 2010 covered entities should have completed internal testing and can send and receive compliant transactions (”level 1″ testing). In January 2011 they begin testing with trading partners and move into production (level 2). The compliance date for all covered entities is January 2012, one year in advance of the ICD-10 deadline.

Read more in the current issue of AHIMA ICD-TEN newsletter.

In the September print issue, Lou Ann Schraffenberger, MBA, RHIA, CCS, CCS-P, FAHIMA, reviewed the ICD-9-CM diagnosis code changes for FY 2010. She offers an extended version of the article “New ICD-9-CM Diagnosis Codes for FY 2010” in the AHIMA Body of Knowledge. She also highlights ICD-9-CM procedure code changes in a special, Web-only article.

Revisions to both code sets go into effect October 1. The 2009 addenda with all the changes to the ICD-9-CM tabular and alphabetic index (volumes 1 and 2) are located on the National Center for Health Statistics Web site. The 2009 addenda with all changes to the ICD-9-CM procedure tabular and alphabetic index (volume 3) are located on the Centers for Medicare and Medicaid Services Web site.

Strike when the ink is wet. 

That is the motto of the clinical documentation improvement specialists (CDSs) at Shands Hospital, based in Jacksonville, FL. They routinely “shadow” physicians as part of their clinical documentation improvement program (CDIP), seeking clarification in real-time and making recommendations for how physicians can fine-tune documentation to enable more accurate coding.

CDIPs are popular in healthcare facilities looking to capture better documentation. Physicians know the documentation they need for treatment and continuity of care, but CDSs are anticipating additional detail that will later produce more complete and accurate coding. A more thorough description can enhance reimbursement and more correctly reflect the facility’s quality of care indicators.

Officials at Shands and other facilities using this technique say they get more out of their CDIPs when documentation specialists are present with physicians in real-time, not querying later via e-mail or paper forms left in the chart. But some challenges, like time management and physician buy-in, also come with the successes. (more…)

“No” is a common word heard by PPE coordinators.

Getting busy HIM professionals to host an HIM student for a professional practice experience can be a challenge. As important as the internships are in giving students real-world experience, PPE coordinators say it takes a mix of professionalism, emotion, and incentives to place students in today’s hectic work world.

Securing sites has become increasingly harder as more HIM departments face major health IT installations and reduced staffing, says Kathy Cliggett, MA, RHIA, an assistant professor and PPE coordinator at Gwynedd-Mercy College in Pennsylvania. HIM directors often feel stretched too thin to host a student, she says.

Other HIM professionals may be hesitant because they don’t know enough about the programs and responsibilities, says Stephanie Donovan, MBA, RHIA, assistant professor of HIM at Gwynedd-Mercy. “I think communicating realistic expectations to our clinical sites is one of the key components of them accepting students,” she says. (more…)

The September 2009 issue focuses on clinical documentation improvement (CDI) and how MS-DRGs and RACs are giving organizations the motivation to start CDI programs. Other features examine ICD-10 training in England and the value of professional practice experiences for HIM students. (more…)

A Wisconsin woman who was fired in September 2008 for accessing her estranged son’s medical records was reinstated last month after an arbitrator deemed the punishment excessive.

After learning her son sought care at the hospital, the woman, a health unit coordinator at St. Francis Hospital for 30 years, accessed his records eight times in one year in hopes of learning his current address or when he was next scheduled for an appointment. The mother acknowledged that her actions were inappropriate, but said she accessed her son’s records to find out whether he was okay after one of his friends was murdered in 2007.

The woman was unable to contact her son because his medical records listed her residence as his home address and listed no appointments. However, after someone saw her son enter a residence, the woman sent him a birthday card to that address. The son, who is in his mid-20s, then filed a complaint with the hospital alleging she must have gotten the address through his confidential medical records, which prompted the investigation and her firing. (more…)

Yesterday HHS published its breach notification rule for HIPAA covered entities. Today the Federal Trade Commission’s rule appeared in print, making it official also. The FTC rule applies to entities not covered by HIPAA, primarily vendors of personal health records. The rule is effective September 24, 2009. Full compliance is required by February 22, 2010.

FTC’s rule requires vendors of personal health records and related entities to notify consumers when the security of their individually identifiable health information has been breached. Both the FTC and the HHS rules were required by provisions in the American Recovery and Reinvestment Act, signed into law this past February.

As with the HHS rule, entities must notify affected individuals without unreasonable delay and no later than 60 calendar days after discovery of the breach. Neither HHS nor FTC amended the timeline specified in the ARRA provision.

The rule specifies that notifications should be written in plain language and include, to the extent possible, a brief description of what happened, the types of information involved, steps individuals should take to protect themselves, and a brief description of what the entity is doing to investigate and mitigate the breach. The notification must provide consumers with contact information that includes a tollfree number, e-mail address, and Web site or postal address. (more…)