Tuesday, July 20, 2010

Automating Faxes - Turn-Around Documents

Recently a prospect presented the following scenario:

High number of facilities
Fax is the current communication method between facilities and the lab
Faxes are handled by humans at both the facilities and at the lab
How can we improve our process?

The techniques described below can be put into practice in low volume situations as well.

While the ideal would be to eliminate faxes entirely with, for example, a web site or an email-technique, or, ideally, direct application integration, these techniques all require a change on the part of the faciltiy; something that is often too hard to accomplish.

So, what can you do with faxes to improve the process through reducing labor effort and reducing errors?

Phase 1 (Fax Server)
Implement a fax server at the lab.  A fax server can send and receive faxes without a human handling the paper.

At the lab, the fax server can be configured to receive fax as electronic files based upon the number that originated the fax.  As an example, Facility A faxes from fax number A.  When the fax is received at the lab by the fax server, the fax server detects that the fax originated at fax number A and therefor places the fax file into a directory accessed by the clerk that works on faxes from facility A.  alternatively, the fax server can be configured to email the fax file to the clerk.   Variations on this theme include uploading the fax file into a workflow system that automates the routing of the fax.

At the lab, the fax server can be configured to send faxes to facilities, such as Facility A.  An easy way to do this is through a "fax printer" accessible from the Windows Print environment at each desktop.  This makes it trivial to "print" the lab results directly from the lab application and have the results, with a header page, fax out to Facility A.

Phase 2 (Workflow)
Implement case processing at the lab.  Case Processing quickly automates manual steps in a process.  As an example, the inbound fax might contain an order for a single patient to perform multiple tests or it might contain multiple patients for the same test or a combination.  Case Processing automates presenting to a human the fax and enabling that person to quickly key the correct test orders.  It then can queue up the individual test into multiple testers queues in an appropriate priority order.  When the tests are completed, the results can be matched to each of the orders, the orders assembled into a single fax, and the fax sent out to the correct facility.

Phase 3 (OCR)
Implement Optical Character Recognition at the lab to reduce the manual data entry from Phase 1 above.  In particular, OCR can detect a facility identifier, the individual patient medical record numbers (MRN), and, if the fax form has been configured effectively, it could detect which tests to perform.  In this way, the bulk of the work performed by a human in Phase 1 can be reduced.  It can't be eliminated, because OCR always has errors that need to validated, but it can significantly reduce the human effort required.

Additional techniques to improve the above include:

1. use "comb" style hand-print constraints:

Open comb fields (i.e. no line on top)
o Cells must have a U shape (otherwise they might be recognized as an "L"
o Tick marks in between characters must be of the same height but use a high mark to separate words or sections (SSN or date are good examples)

2. provide "turn-around" documents whenever possible
Turn-around documents are those that originate at the lab, sent to the facility, are adjusted by the facility, and returned.  Examples might include a "orders approval" form that lists every lab to be performed for every patient.  The key benefit of turn-around documents is that the lab has complete control of the placement of content on the form, as well as the ability to uniquely identify each page - this enables the OCR product to know what the form is exactly and then do the recognition of the text based on known locations for the content.  Besides, the facility people will have to do less work.

Friday, July 2, 2010

ONC's Temporary Certification Program (provider-focus)

Today ONC conducted another teleconference to inform providers that have built their own solutions how they will be affected by the Certification Program.

Carol Bean, Director of Certification
Steve Pozniak, Director of Federal Policy

http://healthit.hhs.gov/portal/server.pt has a listserv to inform us.

Both Carol and Steve said basically the same as yesterday.  See my previous post.

Each ATCB must provide testing for onsite (at the ATCB's facility) and remote for both development and deployment sites.   The deployment site is typically the Providers facility.

Adding functionality to your existing solution that has been certified does not require that you re-certify.

Questions & Answers

  1. What is an EHR Module?
    • It's anything that meets at least 1 certification requirement. For example, a Problem List could be an EHR Module (thought it's unlikely).  another example might be a List module (Problem, Medication, Treatment, etc) that too could be an EHR Module.  
  2. We use both a complete EHR and self-developed software.  Will we need to certify the self-developed software too?
    • If you have a hybrid then you'll have to test and certify the self-developed software.
  3. Does previous CCHIT certification flow-on?  Grandfather clause....
    • No.
  4. What is the process for getting certified?
    • That depends upon the ATCB.
  5. what if you've got 3 certified complete EHRs and you're using parts of each at different facilities.  Is it sufficient that the 3 EHRs have been certified?
    • A clear answer wasn't provided, in my view.
  6. Would self-attestation suffice?
    • You'll have to check with CMS - incentive payment question.
  7. What testing methods are required?
    • Testing methods approved by ONC.
  8. What if you're running previous version of certified EHRs or highly customized solutions, what certifications are required?
    • Get your system certified.
  9. What kind of cost are we looking at?
    • 14 applications were sent out - it would be great if all of them achieved accreditation. 
  10. Assuming the legacy environment and I get it certified, how long does the certification last?
    • Let's say you get tested at Stage 1 (10 measures) and then we set Stage 2 (13 measures), you'll then need to re-certify.

Thursday, July 1, 2010

ONC's Temporary Certification Program

Today, ONC hosted a telephone conference to update Health IT Developers and Vendors of EHR technology on the Temporary Certification Program.  


The speakers were:
Carol Beam, Director of Certification and Testing, ONC
Steve Posnack, Director of Policy, ONC

The rules serve two purposes:

  1. Established the process for the National Coordinator to select ONC's Authorized Testing and Certification Body (ATCB)
  2. Set some of the parameters around the testing itself.

This rule paves the way for vendors to get their products tested and certified.

Some of the parameters around testing include:
Section 170.420 - the Principals of Proper Conduct
ATCBs must support testing of both developed and deployed solutions
170.445 & 450
ATCBs must also support testing of both complete EHRs and EHR modules.

The following were questions posed by the audience.

  1. What is a new version? (ie does a bug release constitute a new version)
    • If an EHR developers defines it as a new release, then they will require a new certificate.
  2. How does a customer claim certification? (ie do they have to provide some sort of proof of sale / license)
    • The Certified Health IT Product list will be managed by ONC and that website will be the source of truth.  For Meaningful Use reporting, a unique identifier will be assigned to each bundle of products that in combination achieve Meaningful Use requirements.
  3. What if a solution is offered both bundled and un-bundled?
    • There will be unique identifiers for each (bundled and un-bundled).  ONC will not be testing whether they are actually being used - that's a function of the audit (CMS).
  4. What bodies will provide oversight of both the ATCB and the developers?
    • in the temporary program, ONC will provide oversight of ATCB (adhere to the Principals of Proper Conduct)
    • in the permanent program, vendors will be subject to a post-market surveillance program
  5. What will the certification cost?
    • CCHIT had presented potential pricing ranges - we generally used those as our estimates.  We're hoping that the competitive environment that we hope we've created will reduce those costs.
  6. Will there be a "seal" of certification?
    • We require that the ATCBs tell the developers to convey to prospective purchasers and customers:  product name, date of certification, certification number, etc.  We don't specify a particular image.
  7. What about Clinical Quality Measures?
    • When a product is ready to be certified, the measures will have to have been published....  Stay tuned.
  8. What about additional software that may be required?
    • The additional software will have to be identified and listed.