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Danielle Lydon/CEO of Framework MI, Inc.

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Presentation on theme: "Danielle Lydon/CEO of Framework MI, Inc."— Presentation transcript:

1 Danielle Lydon/CEO of Framework MI, Inc.
Based out of Cincinnati Ohio. Over 25 years in healthcare, across the entire spectrum of healthcare.

2 “No Man is an Island” (or Hospital, Physician, Pharmacy, Trading Partner)

3 History of Data Exchange
History of data exchange in the healthcare Paper/Snail Mail Fax, with shiny wax rolls of paper and (early data exchange through flat files, NSF, and other means of sharing data between trading partners.

4 History of Data Exchange Continued
Modems for sending print images or electronic copies – unstructured data

5 History of Data Exchange - Continued
Healthcare starts to get serious about exchanging data in the 90’s (Driver healthcare costs) 1991, the Workgroup for Electronic Data Interchange (WEDI) ..paving the way for 1996 Health Insurance Portability and Accountability Act (HIPAA) – mandates a requirement for one format vs. over 400!) ASC X12 is instrumental in having language included in HIPAA, ensuring ASC X12's role in bringing health care administration one step closer to uniformity across the industry The Health Insurance Portability & Accountability Act (HIPAA) transaction regulation is published adopting nine X12 transactions for the health care industry. ASC X12 signs MOU with the Department of Health & Human Services (HHS), Standards Development Organizations (SDOs) & Data Content Committees (DCCs) to manage the EDI standards adopted under HIPAA January President Bush launched an initiative to make electronic health records available to most Americans within the next 10 years. April 21, 2005, HIPAA's security provisions went into effect for all covered entities except for small health plans HIPAA X Transactions Enchantements

6 History of Data Exchange - Continued
CMS defined its role as providing: “support for development of Electronic Health Records February The HITECH act is signed into law. Beginning in fiscal year 2012 March President Obama signed the Patient Protection & Affordable Care Act. Provisions in the Act strengthened the HITECH Act, and gave us “Meaningful Use” by Physicians and hospitals need to prove that they have met 25 different functional objectives with their use of an EHR product to be considered “meaningful users”. These objectives include computerized physician order entry (CPOE), the use of clinical decision alerts, incorporation of lab results into their EHR as discrete data, ePrescribing and electronic information distribution to patients. Penalties include cuts to Medicare payments for those not implementing EHR. June 2012.  The Supreme Court upholds the Affordable Care Act (ACA) by a vote of 5-4.  Many items in the ACA warrant the rapid transition to electronic medical records for skilled providers:  1) hospitals will increasingly align with like-minded, data-driven partners who can prove successful outcomes like readmission prevention; 2) Corporate Compliance programs that will now be required for nursing homes to drive continuous improvement and prove it with data; 3) Accountable Care and it's incentives for participants who have electronic medical records.  Summary:  market forces more than ever before are driving the rapid transition to EMR in post-acute care.

7 Where are we today? Where are we headed?
E H R Patient Portals, for patient/doctor/pharmacy Patient Provider to Payor Portals between Providers/Pharmacies Web Portals for sharing various data between trading partners.

8 Data, Revenue Cycle, Aggregation Income Generation

9 Importance of Collaboration
Why is collaboration important in the healthcare market? Importance: Outcomes Strategy Communications Trending Branding, Marketing, Sales “Daddy of them all” – Financial.

10 Today’s Vision - Connecting our Islands

11 Yesterday Tomorrow Today Complex Claims Management Case
Transactional (Authorizations, Eligibility, EDI) Denials (Remediation, Tracking, Resolution, Vendor Management) Audits (All Audits, including RAC, Payor, Internal) Reporting Support, Customization, Consulting Authorizations Drug Spend Clinical Outcomes (HEPC, HIV, ETC.) Supply Chain Yesterday Today Tomorrow

12 Good Places to Begin Ease of sharing information
Reduction in Costs associated with trading partner communication Areas that benefit from Score Cards, Dashboards Patient communications Other

13 Discussion on various portals:
Internal/External Score Cards/Performance Metric (Departments, Payors, Subcontracted Vendors, ER Staffed Services, Outcomes, etc. RAC and other audits Medication Adherence Collections, Denials, Authorizations, Funding Hospital to Physician, Physician to Vendors, Hospital/Pharmacies

14 HIPAA Considerations HIPAA considerations, and other security measures
HIPAA Data – Yes or NO De identifying patient level data Encryption, security, certificates Who has access? Onboarding new Portal users Policies and Procedures

15 How to Start Work Group to determine how would your organization benefit Include departments, stack holders, marketing, and IT Mock up simple web portal Etc. Start small, dream big.

16 “I work in healthcare, then I go home at night to the 21st century.”
David Levin, Cleveland Clinic Chief Medical Information Officer, shared his perspective on the need to reform healthcare and to balance healthcare technology with improving the quality of patient-physician interactions. He emphasized the need for medical devices and health IT to fit into hospital workflows. “I don’t want tech to be sexy, I want it to be seamless.”

17 Barriers, Mind over Matter
“Big data is like teen sex. Everybody is talking about it, everyone thinks everyone else is doing it, so everyone claims they are doing it.” Dan Ariely, a professor and director of the Center for Advanced Hindsight at Duke University.

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