The industry's move toward health information exchange across disparate entities presents a number of challenges for financial and administrative information systems, says Henry Chao, chief technology officer at the Centers for Medicare and Medicaid Services.
He gave examples of such challenges during the Financial Systems Symposium at the HIMSS 2010 Conference & Exhibition in Atlanta. A physician may order a radiological exam, read and interpret the images and receive reimbursement. But what happens when an authorized provider elsewhere access the images via an HIE and reads them, "and does that person get reimbursed?" Chao asked.
Another example: Organizations will have to tweak their financial systems to account for meaningful use incentive payments. The organizations will have to show what they got paid, what they did with the payments, and how the payments are recorded in the general ledger.
Organizations also will be challenged to help others appropriately use their data accessed from an HIE, Chao noted. When getting data from elsewhere, the receiving organization has to care about who owns the data, and treat and use that data as a guarded asset. But CMS and other organizations need to publish information on how to use their data, and what types of other data are available to merge with that initial data set, to get more value, he said.
The bottom line is that enterprise integration will be necessary, even in financial systems, as HIEs will send that data to places previously not envisioned, Chao cautioned. That will affect CMS as much as any other organization. "Now, we're part of a supply chain. We have to teach people how to use our claims data and it's not an easy thing."
Chao acknowledged comments from the audience on how much data exchange and appropriate use would be aided by national patient and health plan identifiers. These were mandated in 1996 and still have not been established. Congress later prohibited the spending of federal funds to establish a patient identifier, but at the same time continues to press CMS to stop using Social Security numbers as identifiers. "We certainly want to do it, but we need some legislative approval and appropriations," Chao said.
Vexing issues that haven't yet been figured out have hampered development of a health plan identifier, Chao said. For example, insurers are regulated at the state level and those operating in multiple states may offer different versions of the same core health plan state-by-state, making establish of an identifier difficult. The absence of a push from Congress with appropriate funding also has slowed the health plan identifier. "We get funds to start a program but not to continue over the long term."
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