Twin studies commissioned by Health and Human Services (HHS) and conducted by AHIMA contractors suggest that while computer-assisted coding can help thwart fraud, it can also increase the potential for wrongdoing.

“One of the things that was the most surprising to me is that EHRs [electronic health records] can increase exposure to fraud,” said national health information technology coordinator David J. Brailer, MD, PhD, whose office authorized the work.

“One of the lesser-known frauds in healthcare is identity theft in the name of healthcare,” Brailer explained at the San Diego conference.

The AHIMA research cites an estimate by the National Health Care Anti-fraud Association that fraud accounted for at least 3% of healthcare spending, or $51 billion, in 2003, but also mentions that fraud-related losses could run as high as 10%, or $170 billion.
But automated coding software and other fraud-fighting applications could produce a net savings of $15.5 billion per year if properly integrated into a system of interoperable EHRs, the studies show.

Additionally, the research serves to define best practices for fraud prevention and detection for policymakers and healthcare organizations to consider while building a national health information network (NHIN). At the top of the list of 10 principles for preventing healthcare fraud is the declaration, “The Nationwide Healthcare Information Network (NHIN) policies, procedures, and standards must proactively prevent, detest, and reduce healthcare fraud rather than be neutral to it.”

Another suggestion is that well-designed technology can actively prevent fraud instead of merely spotting problems after they happen.

AHIMA CEO Linda Kloss called the work a “road map” for improving care quality with EHRs. “It is our hope that this report will put the problem of fraud under a brighter spotlight,” Kloss said.

Brailer said there is “no easy, pat answer” just yet for making the recommendations part of the national EHR strategy, because his office needs time to examine the report. He said he expects to know more after the HHS awards contracts for four consortia of large health providers and information technology (IT) organizations to developing NHIN prototypes, which was supposed to happen by early November.

The coordinator also took the opportunity to rally health information managers and technology specialists behind the idea of interoperability. “You’re the infantry that will make this happen,” Brailer said during a keynote address. “The use of the electronic health record is inevitable. No force can stop it.”

Brailer found a lot of kindred spirits among the gathering of nearly 6,000 people, including Mark Frisse, MD, director of regional informatics programs at the Vanderbilt Center for Better Health.

Frisse highlighted the dogged efforts of the health IT community to get KatrinaHealth.org, a data-sharing portal for health professionals treating those displaced by Hurricane Katrina, up and running one week after the storm ravaged the Gulf Coast in late August. “What KatrinaHealth.org showed us is not just should we do it, but that we can do it,” Frisse said.

“Katrina has made policymakers aware that healthcare is a national security issue,” added Scott Wallace, president and CEO of the National Alliance for Health Information Technology, a diverse coalition of health IT advocates.

Wallace noted that HHS Secretary Mike Leavitt had been meeting with public health officials in Asian countries about how to prepare for a possible outbreak of avian flu. “It may well be that Mike Leavitt doesn’t want to be Mike Brown,” Wallace said, referring to the former Federal Emergency Management Agency director who resigned in the face of heavy criticism over his handling of Katrina response efforts.

Frisse and Wallace were among an expert panel whose members largely agreed that money will start flowing into provider- and patient-centric health information networks once the many divergent interests are able to overcome hurdles to open but secure communication of healthcare data. Newly installed AHIMA president Jill Callahan Dennis, an author and HIM consultant from Parker, Colo., echoed this sentiment by declaring that she will focus on the communication and availability of information, two key drivers of patient safety.

A number of speakers mentioned the urgency of defining the “legal health record,” which is the one, definitive set of health information on a single patient, whether the record is on paper or in electronic form. Others stressed modernizing outmoded, inefficient workflow processes in hospitals and medical practices.

“We can’t just electrify paper. We absolutely have to do the redesign,” said Christine Bechtel, director of government affairs for the American Health Quality Association. Bechtel spoke about the role of Medicare quality improvement organizations in helping physician practices adopt health IT and about the Centers for Medicare & Medicaid-sponsored Doctors’ Office Quality-Information Technology project.

Quality improvement organizations can provide free “consulting” services to medical practices and help them hone in on what they seek in a vendor, Bechtel said, despite the fact that the organizations cannot recommend specific vendors or provide financial assistance or technical support.