1. Outsourcing and HIM Issues, Pros & Cons Don Asmonga Director, Government Relations April 16, 2004

2. Who Am I? Donald D. Asmonga, MBA Director, Government Relations With AHIMA since February 7, 1994 Capitol Hill Veteran Policy & Government Relations Team: –Dan Rode, VP of Policy of Government Relations –Sue Prophet, Director of Coding Policy & Compliance –Jean Schlichting, Senior P&GR Coordinator

3. Who Is AHIMA? Founded in 1928 Health Information Management (HIM) Professionals 47,000+ members nationwide 52 Component State Associations 8 credentials (CCA, CCS, CCS-P, CHP, CHS, CHPS, RHIT, RHIA) Directors, managers, privacy officers, coders, educators and more… eHIM Over 230 HIM & HIT programs nationwide WWW.AHIMA.ORG

4. Outsourcing What is it? Functions performed by personnel or staff not in the employ of the service provider Examples: Medical transcription Coding & clinical evaluation Claims processing Editing Adjudication Call centers Data storage Other data processing tasks

5. Outsourcing Background Information: Nearly half of all transcription is outsourced to specialized vendors. From 1998-2003: IT software and services spending grew from $2.5 billion to $10 billion (ITAA, ES, the Impact of Offshore IT Software and Services Outsourcing on the U.S. economy and the IT Industry, March 2004) $20 billion market for US medical transcription--$40 million to India. (.2%) 30% of Medical Transcription Industry Alliance (MTIA) members have international operations. (www.mtia.com)www.mtia.com Dept. of Labor projects that 97,000 new health information technicians will be needed by 2010.

6. Outsourcing Background Problems: University of California at San Francisco Hospital –Sub-sub-sub contractor in Pakistan threatened to post confidential files on web unless paid. (was paid) Only one incident in millions of patients in California Heartland Information Services –Extortion attempt by employees in Bangalore, India. Reveal confidential information unless provided cash payment. (caught, arrested & awaiting trial)

7. Outsourcing (Con) Primary Concerns: Privacy –Overseas access to US protected health information. Entities beyond the reach of HIPAA Economics –Loss of US jobs and businesses Technology –Ease of transfer of information

8. Outsourcing (Pro) Why Outsourcing is Necessary: Not enough qualified transcriptionists. Demand has increased dramatically. –More information required –Electronic health records Demand for quicker turnaround times. From 48 hours in years past to 4-6 hours, or shorter. Why? –Improve patient care/reduce medical errors –Tightening of standards of accreditors and regulators –Desire to deter malpractice litigation

9. Outsourcing (Pro) Prompt payment and pressure from payers –More detailed documentation –More transcribed documentation: ER reports, clinic notes, daily progress notes, physician office records, etc… Cost Reduction –Cheaper rates per line

10. Outsourcing Outlying Issues: Privacy –How do we reach those not covered by HIPAA? Workforce –Workforce development & training needs to be addressed to meet current and future demands –Any law that restricts outsourcing MUST make provisions for workforce training Time –Turnaround time: speed of processing

11. Outsourcing Outlying Issues: Information and Communication Technology (ICT) –New technologies enhance security: technology, strong policies, training and monitoring –Adoption of ICT to increase quality, safety, and cost effectiveness. Examples Electronic health records Voice recognition technology Artificial Intelligence engines to scan text documents and assign billing codes Direct entry of data by clinicians via templates –Technology will change professions eHIM

12. Outsourcing Outlying Issues: –Questions? How fast can we have these technologies? How fast can the industry facilitate an assimilate these technologies? Adoption of ICD-10 will assist and enhance ICT. Foreign markets don’t want to lose business –Addressing problems

13. Outsourcing Helpful Tips: All parties adhere to confidentiality, privacy and security laws Establish and abide by clearly defined protocols for handling, processing, storing, and transferring information. Also call for audits and audit trails of information Follow recognized best practices and accepted standards

14. Helpful tips: Require fair and equitable training and reimbursement of qualified labor hired to perform the outsourced tasks Overseas outplacement training should address language and cultural barriers Contracts should call for an immediate disclosure of any violation or legal or contractual obligations along with immediate corrective measures All for a termination clause to be invoked if protocols are breached

15. Questions? Don.Asmonga@ahima.org www.ahima.org Don.Asmonga@ahima.org