Government of Guam and Guam HIE Visit ApeniMED World Headquarters

ApeniMED and members of the Government of Guam and the Guam HIE are attending the November ONC Meetings in Washington, D.C. this week. See below for photos of the Territory of Guam’s visit to ApeniMED’s headquarters on November 14, 2011.

Ed Cruz, CIO of Guam and John Fraser, CEO of ApeniMED

(L to R) Seonho Kim, ApeniMED; Chris Smith, ApeniMED; Ed Cruz, CIO of Guam; John Faser, ApeniMED; Vince Quichocho, Guam Memorial Hospital; Brian San Nicolas, Healthcare Advisor to the Governor of Guam; and Ian Morris, ApeniMED

Ed Cruz, CIO of Guam, in Washington, D.C.

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Say Hello to Dr. AI

-by John Fraser, CEO of ApeniMED

Have you ever wondered how computers will read, understand and make recommendations about your clinical information?  Do you wonder how these systems will be able to combine information from multiple, disparate clinical sources to draw conclusions?  Well the smart guys have been working hard, and they believe the answer is a combination of two things; standardized clinical information in machine-understandable formats, coupled with the latest artificial intelligence (AI) software technologies.  I’ll call this convergence, Dr. AI.

How will it work?

Technically, Dr. AI will consist of software including semantic and inference engines that are able to read, understand, and make inferences about multiple pieces of clinical information on a patient potentially scattered across multiple healthcare organizations.  For example, Dr. AI will be able to understand and flag negative drug interactions when a provider is entering a prescription for a patient, even if they have received prescriptions from multiple providers.  Dr. AI could also nightly review patient medical records in a clinic and recommend many different things:  treatments that should have occurred (reminders), possible negative drug interactions (warnings), tests that are missing or need additional follow up, and public health advice on new threats or treatments that will be understood from continuous reading of public health and CDC information sources.

The great news is that all of this is based on non-proprietary, open standards.  In addition, as newer rules and better software are developed, the entire system will become smarter, without have to re-code information or upgrade software.

But to allow Dr. AI to read all the new clinical information flowing into everyone’s new EMRs, the information will need to be reformatted into simple English-like sentences using a new, standardized of vocabularies.  Standardizing these vocabularies is well underway with such projects as the Unified Medical Language System (UMLS) being developed by the U.S. National Library of Medicine.

Once this this done, Dr. AI will assist providers to help watch over your health and well-being, by always being there watching, analyzing and recommending the best and latest treatments based on all available information regardless of the data’s location.   This will drive better outcomes, less expensive healthcare, and faster translation of clinical research into direct patient care.  Say hello to “Dr. AI !”.

 

 

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The ACO Final Rule: What Should I Know?

-Michael Dillon, ApeniMED

On October 20th, 2011, the Centers for Medicare and Medicaid Services (CMS) published the final version of its regulations for Accountable Care Organizations (ACOs).  Since then, one of the most prevalent questions in healthcare has been “So, now that the final ACO rule is out, what should I know?”  This article provides three central outcomes of the final rule for everyone to know.

ACOs Can be Many Things, There Are Several Different ACO Programs:
Healthcare providers often bashfully say, “I’m not really sure, exactly, what an ACO is.”  ACOs, as a concept, should be considered a model for reforming the delivery and payment of services in healthcare.  ACOs, as individual entities, are groups of healthcare providers voluntarily coordinating care and tracking associated quality metrics.  As a result, those providers can be accountable for the quality of health enjoyed by the population they serve.  With that definition in mind, it’s not hard to see why ACOs can be many different types of organizations.  In fact, there are several Medicare programs available for ACOs, meaning that ACOs can be different types of organizations participating in different government programs.

Providers Can Participate Without Risking Monetary Loss:
In the proposed ACO rule, all providers that participated in an ACO program would share in the benefits or the losses.  The final rule includes a “one-sided model” where the organizations may share in the ACO savings without risking any losses.  Allowing provider groups to share in the benefits of ACO programs while shielding them from any risks may seem unfair, but the rule does include a time limit.  An ACO may only register for the one-sided track during their first registration period.  Then, if an ACO continues to participate, it must join a program where it shares in both losses and benefits.

Providers Can Only Join One ACO:
The federal government received a huge amount of feedback on the proposed ACO rule and much of that feedback resulted in changes to the final rule.  One common piece of feedback was to allow providers to join more than one ACO.  However, the final rule has upheld the proposed rule allowing physicians, hospitals or other providers to participate in only one ACO.

The final ACO rule is long, over 700 pages long, and as such, it covers a wide breadth of topics.  Other important topics omitted from this article include the specific quality measures required for participation, the specific different ACO “tracks” or programs and so on.  More information on the ACO program and the final rule is available from the Centers for Medicare and Medicaid Services.

 

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CMS Audit Services Now Live

-Jaimie Farel, ApeniMED

The new CMS electronic submission of documentation in response to MAC, RAC, CERT, and PERM Audits is now live. Last month, we introduced the Electronic Submission of Medical Documentation (esMD) project, an initiative by the Centers for Medicare and Medicaid Services (CMS) to streamline the claims auditing process to CMS via the Nationwide Health Information Network (NHIN).  This month, we discuss how esMD and CMS will make audit processes faster and more efficient for providers and hospital organizations.

With the Centers for Medicare and Medicaid Services (CMS) processing over 4.8 million claims each day, providers and hospital organizations may be faced with an audit to help CMS recover over $70 billion in improper payments made each year. This number is generated from Payment Error Rate Measurement (PERM) and Comprehensive Error Rate Testing (CERT) organizations. PERM and CERT organizations measure the improper payment rate by sampling claims submitted against medical evidence within the claim and help identify where improper payments are being made.

CMS uses Medicare Administrative Contractors (MACs) to make payments on behalf of Medicare and Recovery Audit Contractors (RACs) to recover improper payments through an auditing process. Today, providers have 45 days to respond to an audit request on a particular claim. Audits can be historical (from several years ago), meaning providers must maintain accurate records. This may also have negative implications on a provider’s cash flow if a provider must pay back money already spent from several years ago. esMD helps address these issues by allowing providers to respond to audits electronically, leading to a faster resolution on an audit.

Providers dealing with a significant number of audits may find additional cost and administrative savings moving from paper-based to electronic processes. Hospitals can spend tens of thousands of dollars on postage, handling, and supplies in response to paper-based audits.

It is expected that esMD will eventually cover the full spectrum of all CMS transaction types to streamline the auditing and recovery process for providers, leading to increased efficiencies, increased savings, and faster resolution of audits.

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What is VLER?

-Michael Dillon, ApeniMED

The Virtual Lifetime Electronic Record initiative, or VLER, is a joint initiative by the Department of Veterans Affairs (VA) and the Department of Defense (DoD) to provide better access to healthcare records for our armed services and veterans.  The VLER initiative was launched in 2009 after President Obama gave the following direction to the VA and DoD:

“work together to define and build a seamless system of integration with a simple goal: When a member of the Armed Forces separates from the military, he or she will no longer have to walk paperwork from a DoD duty station to a local VA health center; their electronic records will transition along with them and remain with them forever.”

Although the President laid out a simple goal, executing on the IT capabilities necessary to accomplish that goal has proved to be anything but simple.

VLER is not a piece of software or a single product, but rather an initiative to drive interoperable records – the ability for electronic healthcare records to work with disparate systems.  As such, the VLER initiative does not create a literal single record.  Instead, VLER provides the ability to share records between facilities, providing the same complete information that would be available through a single, comprehensive record.

The VLER initiative includes a number of projects across the country from a small array of software vendors.  VLER provides interoperability to the variety of facilities where veterans and service members receive care, including military facilities, VA facilities and private healthcare facilities.  VLER uses NHIN Exchange as a core component to connect HIEs and communities with the VLER initiative, again showing the power and promise of NHIN, the Nationwide Health Information Network.

Today, more than 10 communities have gone live with VLER pilots. VLER is providing our armed service members with a cohesive record of their healthcare across a range of facilities, making the goal set out by our President a reality.

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The Electronic Submission of Medical Documentation (esMD) Project

-Rob Flessner, MBA, ApeniMED

In September 2011, the Centers for Medicare and Medicaid Services (CMS) unveiled a pilot project, Electronic Submission of Medical Documentation (esMD), under which providers will be able to reply to CMS Review Contractors’ requests for medical documentation through secure, electronic responses employing Nationwide Health Information Network (NHIN) standards.

CMS receives approximately 4.8 million claims per day, and the CMS Office of Financial Management estimates that improper payments totaling more than $35.4 billion dollars in Medicare and more than $22.5 billion in Medicaid are made each year.  CMS has stated that most improper payments can only be detected by a human comparing a claim to supporting medical documentation, which is currently submitted to CMS in paper format.

The esMD pilot project gives providers an additional option for responding to requests for medical documentation: electronic transmission through a CMS gateway to the review contractor that requested it.

Benefits of the esMD pilot for HIEs, HIE members and stakeholders include faster resolution of Recovery Audit Program audits as a result of submission of supporting medical documentation in an electronic workflow for HIE members (Medicare providers) who have or are implementing an EHR and/or electronic billing system, an administrative transaction use-case for HIEs and HIE stakeholders that encourages participation with the HIE while solving business processes and paper workflow, among many more.

Learn more about the esMD Project and how you can participate – White Paper: NHIN and Electronic Submission of Medical Documentation (esMD) to CMS.

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Accountable Care Organizations: Where are they now?

-Jaimie Farel, ApeniMED

As we discussed last month, an Accountable Care Organization (ACO) is “an organization of healthcare providers that agree to be accountable for the quality, cost and overall care of Medicare beneficiaries who are enrolled in a traditional fee for service program,” (Centers for Medicare and Medicaid Services). This month, we’ll discuss the current state of ACOs and the impact they will have on the future of healthcare.

The Centers for Medicare and Medicaid Services (CMS) released a set of proposed regulations for ACOs in March 2011, opening a comment period for providers and hospital organizations to express questions and concerns. Feedback is currently under review by CMS with the final regulations expected to be released at any time now. The initiative is planned to take off in January 2012.

In the meantime, hospitals, providers, and healthcare organizations across the nation are not waiting for regulations to finalize. Several organizations are developing plans to form ACOs, with some groups having already implemented their version of an ACO. Looking ahead, ACOs should have a need to connect with Health Information Exchanges (HIEs), whether regional, state, private HIEs or specially designed for ACOs, for the interoperable exchange of patient health data and metrics.   This interoperability between ACOs and HIEs can further increase the coordination of care and lower costs in the healthcare ecosystem.

The goal of an ACO to improve the integration of care among providers, and enhanced cooperation among beneficiaries, providers, healthcare organizations and stakeholders will give beneficiaries and patients a higher quality of care they deserve. The ACO blueprint, with final regulations still undetermined, holds potential to end an era of fragmented care and emphasize the importance of more coordinated and efficient patient care.

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ApeniMED Connects HIE-Bridge to Department of Veterans Affairs in VLER Health Pilot Program

ApeniMED Connects HIE-Bridge to Department of Veterans Affairs in VLER Health Pilot Program

MINNEAPOLIS – October 11, 2011 – ApeniMED, a leader in healthcare connectivity, today announced the successful go-live of a Virtual Lifetime Electronic Record (VLER) Health pilot project, using the Nationwide Health Information Network (NHIN). This project connects the Community Health Information Collaborative’s HIE-Bridge™ HIE and the U.S. Department of Veterans Affairs (VA) for exchange of veteran health data via the ApeniMED NHIN Platform.

VLER Health is a multi-faceted business and technology initiative that includes a portfolio of health, benefits, personnel, and administrative information sharing capabilities. The VLER Health program enables the interoperable exchange of select health data between the Department of Veterans Affairs (VA) and non-governmental agencies. In this pilot, the Minneapolis VA Health Care System (MVAHCS), which operates the Twin Ports Community-Based Outpatient Clinic in Superior, WI, is partnering with Essentia Health, a HIE-Bridge participant headquartered in Duluth, MN.

Approximately 6,000 veterans receiving care from the Twin Ports clinic and Essentia Health are eligible to participate in the VLER Health program. Electronically sharing health information reduces the need for veterans and families to carry records between public and private providers and allows providers to make more informed decisions at the point of care.

“We are proud to work with the Community Health Information Collaborative, Essentia Health, and the VA on this important project,” said John Fraser, ApeniMED CEO and newly appointed member of the Minnesota e-Health Advisory Committee. “ApeniMED technology overcomes challenges paper records present and will improve care for our veterans and their families.”

This effort compliments the MVAHCS’s desire to provide quality healthcare to their veterans. “We are committed to offering new technologies that enhance our abilities to provide the veterans in Minnesota and Western Wisconsin with high quality healthcare and services,” said MVAHCS Director Steve Kleinglass.

ApeniMED was the VA’s first partner to be both compliant with the Office of the National Coordinator for Health IT (ONC), a division of the Department of Health and Human Services (HHS), and experienced connecting with multiple federal agencies, allowing the pilot to move into production quickly.

About ApeniMED
ApeniMED, known for its industry-leading HIE platform and NHIN expertise, was founded in 2007 by experts in healthcare technology and specializes in health information exchange and federal agency connectivity using the Nationwide Health Information Network (NHIN).

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CONTACT

 

Jaimie Farel, ApeniMED
612-435-7612
www.apenimed.com

 

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ApeniMED CEO John Fraser to Help Advance Healthcare Connectivity in Minnesota

MINNEAPOLIS – October 3, 2011 – ApeniMED, a leader in Health Information Exchange (HIE) and Nationwide Health Information Network (NHIN) connectivity, announced today that CEO John Fraser has been appointed by the Minnesota Commissioner of Health to the Minnesota e-Health Advisory Committee.  The Minnesota e-Health Initiative is “a private/public collaboration to accelerate the adoption and use of health information technology as a powerful tool to improve healthcare quality, increase patient safety, reduce healthcare costs and improve public health.”

As a member of the Minnesota e-Health Advisory Committee, Fraser will help develop policies, coordinate national Health Information Technology (HIT) activities, and advise on special projects and activities over his two-year term as the Health Information Technology Vendor Representative.

The Committee is composed of outstanding members of Minnesota’s healthcare community and acts in an advisory role to the Minnesota Commissioner of Health. The committee meets quarterly, with additional meetings and conference calls as necessary.

Fraser was selected on account of his nationally-recognized expertise in healthcare connectivity and information security, PKI, and the Internet.  Fraser is involved in several other standards groups.  In 2009, Fraser founded and co-chairs the Kantara Initiative’s Healthcare Identity Assurance Workgroup (HIAWG). This international workgroup is developing the standards and technologies to plug patients into the emerging Nationwide Health Information Network (NHIN).  He is also a member of Healthcare Information and Management Systems Society (HIMSS), Integrating the Healthcare Enterprise (IHE), and HL7.

About John Fraser
Fraser is the founder and CEO of ApeniMED (formerly MEDNET), based in Minneapolis, MN. ApeniMED is an industry-leader in health information exchange and federal agency connectivity using the Nationwide Health Information Network. Fraser co-founded and was former CEO and Board Chair of VisionShare Inc., a company delivering secure Medicare billing services to over 10,000 hospitals and clinics in the United States. VisionShare was renamed Ability Networks in early 2011.  John has also served on a number of community and non-profit Boards.  He is a graduate of the University of Minnesota.

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CONTACT

Jaimie Farel, ApeniMED
Marketing Communications Specialist
510 First Avenue North, Suite 650
Minneapolis, MN 55403
612-435-7612
www.apenimed.com

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ApeniMED Staff Interviewed on Guam Radio Station

ApeniMED’s Chris Smith, Seonho Kim, Ian Morris, Hielix’s Dale Emerson, and Ed Cruz, the CIO of the Territory of Guam and State HIT Coordinator were featured on Guam talk radio channel K57 “The Big Show” as a panel of experts on the progress and impact of health information technology on the island. ApeniMED, along with partner Hielix, were selected to implement the Territory of Guam Health Information Exchange (HIE), including installation and integration of the ApeniMED HIE Platform on and with providers, payers, and the stakeholders on Guam.

See photos from the interview below.

Seonho Kim, ApeniMED (left) and Chris Smith, ApeniMED (right)

Ed Cruz, Guam CIO and State HIT Coordinator (left), Seonho Kim, ApeniMED (right)

Dale Emerson, Hielix (left), Ed Cruz, Guam CIO and State HIT Coordinator (right)

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