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June/July 2019

Washington Scene: AHIMA Goes to Capitol Hill
By Lesley Kadlec, MA, RHIA, CHDA
For The Record
Vol. 31 No. 6 P. 26

HIM professionals from across the country recently brought their many years of skills and expertise to Capitol Hill during AHIMA’s 2019 Advocacy Summit in Washington, D.C.

The Advocacy Summit is an opportunity for AHIMA members to advocate for the interests of HIM professionals. The summit helps build recognition for the value of the HIM profession and offers members an opportunity to make legislative contacts on Capitol Hill. This year, 180 attendees completed a total of 197 visits to congressional leaders during the summit.

Summit attendees heard presentations from AHIMA’s leadership as well as several government speakers, including Andrew Gettinger, MD, chief clinical officer for the Office of the National Coordinator for Health Information Technology (ONC); Timothy Noonan, JD, acting deputy director of health information privacy at the Office for Civil Rights (OCR); and Donna Pickett, RHIA, MPH, chief of classifications and public health data standards head at the Collaborating Center for the World Health Organization.

EHR Challenges
In his presentation, Gettinger cited two challenges related to EHRs that his office is addressing: administrative burden for clinicians and a lack of interoperability and access created by information blocking.

In November 2018, Health and Human Services released a draft report, “Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs.” Led by the ONC in collaboration with the Centers for Medicare & Medicaid Services, the report was required by Congress under the 21st Century Cures Act.

When the comment period closed in January 2019, Gettinger noted that there were more than 200 comments submitted, including AHIMA’s continued support of Section 4001 of the 21st Century Cures Act to reduce regulatory or administrative burdens relating to the use of EHRs. The final report is scheduled to be completed this summer.

In addition to accepting comments, the ONC also held a variety of listening sessions, town halls, and webinars on the proposed rule.

According to Gettinger, the principal burdens reported in the comments included documentation issues related to billing, prior authorization, and quality measurement, as well as poor clinician experience with HIT, clinicians spending too much time on EHRs instead of patient care, and prescription drug monitoring programs that are not readily integrated into EHRs.

In February 2019, the ONC published a notice of proposed rulemaking, “21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program.” The proposed rule addresses, among other things, the subject of information blocking.

The intent of the information blocking rule is for electronic health information to move effortlessly throughout the health care ecosystem, ensuring that clinicians have access to electronic health information when and where they need it. The comment period for the information blocking proposed rule closed on May 3.

Three Key Issues for the OCR
Noonan pointed out three key issues upon which the OCR is focusing: risk management, risk analysis, and enabling individual access to health information. These topics are outlined in a report issued by the OCR’s HIPAA audit program.

The OCR has been conducting audits of HIPAA-covered entities and their business associates over the last several years to better understand what health care organizations are doing well and to identify areas for improvement. Audits showed organizations performed best in delivering timely breach notifications, posting their notices of privacy practices (NPPs), and providing patients with the required NPPs.

Noonan said the OCR plans to share the lessons learned from its audits as well as provide additional guidance and technical assistance later this year.

Noonan also provided an overview of the types of complaints and investigations the OCR’s enforcement program has completed. He stated that the health information privacy division receives about 25,000 complaints every year, and 350 breach reports were investigated in 2018.

The challenges regarding breaches are constantly in flux. According to OCR data, 41% of breaches thus far in 2019 were e-mail related, such as successful phishing attempts. Laptops continue to be a concern as well. Hacking was identified as the most common type of breach in the first two months of 2019.

In addition, Noonan discussed several high-profile examples of OCR enforcement actions that resulted in significant fines for HIPAA violations. In one example, three settlements were reached in response to the filming of an ABC television documentary series that did not obtain the necessary authorizations from patients in the featured hospital.

ICD-11-MMS Revisions
During a session at the summit, Pickett shared how the ICD-11-MMS (ICD-11 for Mortality and Morbidity Statistics) revision reflects a major redesign of the ICD-10 classification system. It was designed to be more IT friendly and to assist in better data collection on morbidity.

Two new features in ICD-11 are extension codes, previously referred to as adjunct codes, and cluster codes. These codes are used to describe laterality, acuity, and other aspects of diseases and health conditions. When breaking a diagnostic statement into component parts, it is necessary to have a way to link them in the coded record. “Clustering” is the feature that enables this type of linking functionality.

These features offer great potential for improving the data available in ICD-11.

The earliest date ICD-11 could be available for use in the United States for mortality data collection is 2023. However, before that can occur, HIT systems need to be updated significantly and comprehensive staff and coder education must be completed. Additionally, some countries will likely need to adopt modifications to ICD-11. The World Health Organization has proposed licensing restrictions that would limit modifications, but the specifics have not yet been released.

HIM Priorities Shared With Congress
Day two of the summit culminated in attendee appointments with their elected officials. As in prior years at the Advocacy Summit, attendees had the opportunity to educate members of Congress on a critical set of issues impacting the HIM profession. Attendees focused on four HIM priorities during their meetings; issue briefs were developed to assist attendees in their discussions on the following topics:

• aligning HIPAA’s individual right of access with HIT certification functionality;

• extending the HIPAA individual right of access to noncovered entities;

• encouraging note sharing with patients in real time; and

• addressing patient matching challenges by omitting the recurring ban on the adoption of a unique patient identifier in the fiscal year 2020 appropriations legislation to empower Health and Human Services to work with industry to advance a nationwide patient matching strategy.

Advocacy is not a one-time event but rather an ongoing exercise to ensure HIM voices are heard. AHIMA’s advocacy and public policy team continuously monitor, respond to, and participate in policy and HIM industry initiatives seeking to further shape and guide issues of importance to the profession.

Anyone interested in HIM advocacy can register for a replay of AHIMA’s “Virtual” Advocacy Summit to learn more about how they can get involved and hear even more ways to have their voices heard.

In addition, AHIMA’s “Advocacy Action Center” is available for HIM professionals to assist them in contacting their congressional offices to advocate on a variety of important issues.

The Virtual Advocacy Summit replay is available at https://my.ahima.org/store/product?id=65736.

AHIMA’s Advocacy Action Center is accessible at http://cqrcengage.com/ahima/home.

— Lesley Kadlec, MA, RHIA, CHDA, is director of policy and state advocacy engagement at AHIMA.