EMR Systems and Provider Databases

October 29th, 2015 by folioblog | Permalink

As EMR implementation continues, there is increasing awareness of the lack of accuracy and utility of the Provider Databases that underlie new systems.  This reflects the heightened emphasis on accuracy required by HIPAA regulations in communicating patient PHI, but also the lack of resources available to provide quality external Provider information.

Typically the new EMR system allows either self or batch enrollment of the client’s internal and/or credentialed provider file. …Continue Reading »

Interoperability and Accountability

April 17th, 2015 by folioblog | Permalink

Recently ONC released its Interoperability Roadmap as a framework for the transmission of clinical electronic health records consistent with the goals of the HITECH Act. The ‘Roadmap’ has been criticized as actually delaying Interoperability because of an emphasis on theoretical concepts rather than realistic implementation steps. And Interoperability is widely viewed as failing.

Defenders of the Roadmap say it is ‘not my problem’. Rather it is the problem of the industry and, to some, that reflects the industry’s ‘inability’ to overcome its competitive profit model and cooperate with other vendors in developing interoperable linkages.

Competition aside (not limited to vendors) this may not be the major problem with Interoperability. Interoperability assumes the knowledge of accurate electronic endpoints for the effective transmission of clinical information. Since these endpoints do not exist, the IHE (Integrating the Healthcare Enterprise) has developed specifications for ‘Provider Information Sources’ for Directories that are to contain the endpoints. The theoretical construct assumes literally thousands of these sources collaborating in a seamless fashion. This vision explicitly ignores both (1) the complexity of the multiple relationships between providers and organizations and (2) the underlying and fundamental rate of change in both demographics and these relationships. Rather than seamless communications there is the alternative view of misdirected clinical information to expired organizations or providers, to the wrong organizations or providers, or simply residing virtually without delivery. And who would be accountable?

‘New’ Hospital EMRs –Implications for Provider Databases

November 5th, 2014 by folioblog | Permalink

A recent report by the Klas Research organization revealed that the two major hospital EMR vendors, Epic and Cerner, took a combined 60% market share of all new hospital EMR systems purchases in 2013. And Epic has passed Meditech in overall number of hospital EMR systems installed, topping over 1,000 hospitals.

Installation of a new hospital EMR involves a series of complicated steps depending on the interfaces or connections of the EMR system to other hospital systems and what capabilities are packaged within the EMR. One of the factors that is often overlooked in successful implementation is the porting of legacy provider databases and the ongoing maintenance of provider databases in the new system. No matter what enhanced capabilities are included in the EMR, if it rests on a foundation of outdated legacy databases and outdated data maintenance processes, its effectiveness will be diminished. These databases are the key not only for accurate billing and record keeping, but more importantly in communicating the ‘coordination of care’ required in and out of the hospital network.

Affordable Care Act (ACA), Nurse Practitioners, and Provider Databases

April 21st, 2014 by folioblog | Permalink

The Affordable Care Act (ACA) has had an uneven beginning but appears to be gaining traction in expanding health insurance to uninsured Americans. The ACA will have an impact on Provider Databases as a result of increases in referrals and changes in referral patterns with new insurance networks.

One other ACA impact on Provider Databases results from the restrained growth in new physicians in the U.S. coupled with the increased retirement of the existing ‘boomer’ generation of physicians.

The demand/supply imbalance coupled with the desire to ameliorate the rise in healthcare costs will undoubtedly lead to greater use of ‘non physicians’ performing primary care services …Continue Reading »

Provider Databases: A National Problem

March 24th, 2014 by folioblog | Permalink

Much of the improvement in health care and efficiency rests on the foundation of accurate and up-to-date Provider information for efficient and error free billing, medical records and transcription…and even more importantly on long term patient ‘Continuity of Care’.

The emphasis on accurate Provider information has exposed weaknesses: a 2013 OIG report* found that 48% of Medicaid’s NPPES provider databases contain errors; California was forced to remove its Physician Directories from its state run Health Information Exchange (HIE) because of inaccuracies; and recently the ONC sponsored HIE Provider Directory Workgroup disbanded without any serious, feasible recommendations for implementation. …Continue Reading »

OBAMACARE and Legacy Provider Databases

January 6th, 2014 by folioblog | Permalink

The implementation of Obamacare and the resulting increase in newly insured Americas will have important implications for legacy referring provider databases in healthcare organizations as they attempt to provide coordination of care.

This is a result of two factors: First, the newly insured population will, in most cases, have received some form of healthcare… …Continue Reading »

New Guidance and Penalties for Healthcare Transactions with ‘Excludeds’

July 23rd, 2013 by folioblog | Permalink

In May, 2013 the Office of Inspector General (OIG) of Health and Human Services (HHS) issued new guidance on the penalties associated with the payment of claims made to ‘Excluded individuals or entities’ for any Federal Health program (primarily Medicare and Medicaid). The authority to impose civil fines and deny payment for claims resides in various Federal statutes including most recently the Affordable Care Act of 2010. An Excluded person or entity is defined as one who has engaged in fraud or abuse related to Federal Health programs and the penalties may include a $10,000 fine for each claimed item or service and may also be subject to an assessment of up to 3X the amount claimed.

Guidance on what constitutes liability, falls not only on the Excluded person or entity BUT ALSO TO A NON-EXCLUDED PERSON, PROVIDED the NON-EXCLUDED PERSON KNEW or ‘SHOULD HAVE KNOWN’ they were dealing with an ‘Excluded’ person.

As examples: …Continue Reading »

Inaccuracies in Medicare and Medicaid Provider Data Highlighted

June 28th, 2013 by folioblog | Permalink

A May 2013 Office of Inspector General for the Department of Health and Human Services report* analyzed the Provider data files of Medicare and found a very high error rate.

To quote portions of the Executive Summary:

“Medicare provider data in NPPES (National Plan and Provider Enumeration System) and PECOS (Provider Enrollment, Chain and Ownership System) were often inaccurate. In NPPES, provider data were inaccurate in 48% of records…. in PECOS, provider data were inaccurate in 58% of records…Addresses, which are essential for contacting providers and identifying trends in fraud, waste, and abuse, were the source of most inaccuracies and inconsistencies. Finally, CMA did not verify most provider information in NPPES and PECOS….…Continue Reading »

Electronic Medical Record Successful Usage –Fact or Figment?

June 5th, 2013 by folioblog | Permalink

Recently Health and Human Services announced that it had exceeded its target of Electronic Medical Record (EMR) implementation by paying more that 50% of ‘Eligible Professionals’ almost $6 billion in incentive payments (with more to come)based on their ‘Meaningful Use’ of EMR systems. All of this effort is an outgrowth of the requirements in the American Recovery and Reinvestment Act of 2009 (ARRA), the so-called Stimulus Bill.

Indeed this can be seen as a milestone in the overarching effort to migrate the healthcare industry to EMRs but more importantly introduce interoperability between healthcare parties for EMR transmissions via Health Information Exchanges (HIEs).

Moreover the industry, which is the beneficiary of the incentive payments, has by and large endorsed the program.

But, is this an unqualified success? There do appear to be several considerations that might temper this ‘success’. …Continue Reading »

Domestic and International Medical School Education for Physicians in Massachusetts – A Perspective

April 11th, 2013 by folioblog | Permalink

Source: FolioMed Provider Data Management Statistical Data

One of the issues facing the new changes in healthcare is the ability of Physicians to respond to the increase in uninsured patients who would be eligible for insured and routine medical services.  By one count if there are roughly 300,000+ actively practicing Primary Care Physicians (PCP)* in the country and 30 million newly insured, that implies a net gain of 100 patients per PCP.  Using an average multiple of 4 visits a year, there could be up to 400 additional patient visits per PCP.  And, assuming a 20 patient day, approximately one additional month of patient care per year per PCP.

Numbers can be disputed but whatever the result there will no doubt be an increase in the demand for PCP services.  One of the solutions to solving this capacity ‘problem’ would be to allow less than fully licensed Physicians, such as Physician Assistants and Nurse Practitioners, to screen and treat patients and assume some of the traditional functions normally reserved for Physicians.  Another solution would be to increase the available ‘supply’ of Physicians by either increasing the number of US medical schools (a very long term approach) or encouraging the entry of more Physicians educated in foreign medical schools. …Continue Reading »


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