Computer Software Update

The Challenges of Electronic Documentation

Since the passage of HIPAA legislation in 1996, major health care providers have sought ways to efficiently manage expanded patient privacy rights and requirements, while increasing electronic data exchanges. The changes brought about by HIPAA, including the implementation of many new policies and procedures, have led to a series of paradigm shifts in the health care industry that have notably increased the compliance burden on health care providers.

Similarly, the passage of Sarbanes-Oxley in 2002 — in the wake of Enron-type corporate accounting scandals — added another layer of critical organizational concerns to the mix by way of heightened corporate governance regulations. One key health care related issue set in motion by Sarbanes-Oxley revolves around data management and compliance brought about by the growth of the Internet and the expanded reliance on electronic documents and communications.

 Many savvy health care executives, who are well aware of HIPAA requirements, are just beginning to address the growing issues surrounding data integrity for their businesses. Ensuring that the documents you create, store, send and receive electronically are what they should be, is becoming a critical business process need.

Today, with most documents being generated and exchanged via e-mail, online and other electronic methods, it is easy for people to make subtle changes to a document — either maliciously or accidentally — that pass through undetected by the human eye or automated controls currently in place. These minor changes often cause major headaches for an organization with regards to record-keeping, compliance with Medicare and Medicaid policies and procedures, claims processing by payer companies, and even in protecting patients' privacy rights. The inability to easily identify where a document's integrity begins and ends also raises questions about individuals' identity protection.

Virtually all electronic communication, fax, e-mails and mailed hard copies are subject to tampering. Sometimes these changes are obvious, other times they are not. Regardless, unintended changes, errors or omissions can cause significant problems in operations or compliance when the integrity of these documents comes into question.

The integrity challenge is particularly complex in the health care industry, which is lagging in the definition of true standards for electronic communication. In addition to the heavy regulatory environment, which leads to a substantial paper-handling burden, the way information is shared also varies from constituent to constituent within the industry. For example, while home medical equipment (HME) suppliers are rapidly moving to Web-based and other electronic solutions, the majority of physicians today prefer to send documents such as prescriptions, physician orders or Certificates of Medical Necessity (CMNs) via fax. Physicians are less comfortable, at present, with electronic alternatives. On the other hand, HMEs and pharmacies have moved quickly toward electronic communications, although paper continues to play a dominant role as e-prescribing slowly makes progress.

Verifying the authenticity of all of the required documentation in the industry can be daunting. Verifying in a way that is cost-effective and non-intrusive to established business processes is an even more formidable task. In today's environment, however, executives have little choice other than to explore automated, electronic ways of overcoming the challenge. They must remain compliant, grow revenue, retain existing customers and stay competitive at the same time. The question is, how?

A Solution for Today and Tomorrow

Technology solutions do exist in the market today to facilitate all types of communication and to authenticate document integrity. HME providers can select an electronic workflow solution for online processing of CMNs and physician orders. Look for solutions that are industry-approved, regulation-compliant and can integrate digital signatures and physician credentialing features, while providing tamper-detection through content authentication technology.

Additional features such as a robust forms engine, attachment-handling capabilities, document tracking and linking, batch processing, and more, enable online-to-fax and fax-to-online communications for HMEs to physicians, payers or others — and back.

These types of solutions incorporate robust time-stamping technology, and certain solutions offer the capability to apply the United States Postal Service Electronic Postmark for trusted third-party verification of document integrity. The benefits of using technology solutions to authenticate document integrity include: reduce total processing time, improve staff productivity, shorten payment cycles, simplify forms processing, centralize and archive documents digitally, and streamline compliance. These solutions also ensure that documents and their contents are protected and provide irrefutable evidence of the who, what and when for each transaction or document processed.

HME companies such as American HomePatient, Brentwood, Tenn.,and Advanced Homecare, Greensboro, N.C., are utilizing Authentidate's CareCert and CareFax to support their reimbursement processes to implement physicians' preferred modes of working, whether fax or electronic. These companies recognize that a successful electronic solutions approach must not only deploy strong, industry-standards-based technology and HIPAA compliance, but also adapt to the multiple modes of operation of the constituents they deal with, in order to accelerate their own move to efficiency. Only then can they attempt to stay ahead of the reimbursement challenges posed by increasing regulatory compliance requirements and caps by payers such as Medicare.

As time progresses and physician adoption of electronic solutions gains momentum, more fax and paper flow will be substituted with electronic processes, leading to further reductions in the HME's cost base. However, being able to electronically handle both fax and electronic documents allows companies to mitigate the risks associated with slower adoption of electronic solutions by their constituencies.

Moving forward, health care executives must begin to recognize the challenges posed by growing cost pressures in the face of stricter corporate oversight and fiduciary requirements. New ways must be sought to overcome these challenges head on. Technology solutions do exist today to help medical providers update, enhance and automate their key business processes, while also allowing their constituents — particularly doctors — to do business within their own comfort zones.

This article originally appeared in the July 2006 issue of Mobility Management.

About the Author

Daniel J. Wallace, M.D., is a rheumatologist, a best-selling author and a medical scholar in the fields of osteoarthritis, fibromyalgia, arthritis and lupus research. Dr. Wallace is a Clinical Professor of Medicine at UCLA with a practice based at Cedars-Sinai Medical Center. He is board certified in both internal medicine and rheumatology. He is involved in the care of 2,000 lupus patients, the largest practice of its kind in the United States. The Wallace Rheumatic Disease Research Center runs more than 20 clinical trials for patients with rheumatoid arthritis, lupus, ankylosing spondylitis, psoriatic arthritis and fibromyalgia.

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