Notes

Outline

Barriers to EDI Implementation:  The Case of Small Vision Care Providers Christopher J. Feahr, OD Vision Data Standards Council http://VisionDataStandard.org

Low Provider Awareness of HIPAA TCS Rules No information coming from professional associations… nowhere to ask questions. Payors have their hands full… not worrying about provider compliance. PMS vendors waiting to see what the payors do… vendors are not talking to SDOs or attending standards meetings.

Serious Transaction and Code Set “Gaps” SDOs were not made aware of TCS problems in Vision… payors never told them. Product nomenclature/coding standards… requires manufacturer and lab input. Manufacturers and labs want to stay as far from HIPAA as possible… viewed as government intrusion and attempt to control industry.

DSMO Cannot Recommend a Solution Without… Broad industry representation of the problems. Clear statement of unsupported business requirements. List of unsupported data elements for each transaction.

Create Provider-Oriented Standards Organization to… Advocate for provider business needs within DSMO organizations. Represent provider requirements to manufacturers, labs, and PMS vendors. Create, maintain, distribute industry transaction standards and code sets. Educate providers.

“Production Arm” for SDO may be required to… Deliver implementation guides in “machine readable” format. Create standard specification for IG rules engine. Meet tight delivery schedules imposed by HHS rule changes. Coordinate external code set updates.

Benefits to Small Providers True Administrative Simplification Payor relationships: more than just claims Real-time eligibility data… captured in PMS Auto-post payments from ERA to Accounts Receivable Provider-to-provider communication Lab orders and results captured in PMS Referrals, consultations, reports to other doctors Rx orders from PMS… directly to pharmacy This is only the beginning!!

Next Steps… Create a permanent organization to manage provider IT requirements. Work with domain experts and PMS vendors within each medical specialty. Work with DSMO organizations to represent requirements for all provider domains. Active outreach to providers and their suppliers and business associates.