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Dear Miriam,
Are we talking "backbone" or "legacy"? I
realize that these are not mutually exclusive concepts, but I suspect that the
reason EDI is still running on much of the big iron in gorilla
land is that they built it over a decade ago. It's not
because it is an efficient way to connect with their smaller partners.
Among these same large enterprises, how much NEW DEVELOPMENT ...that
is not being undertaken solely to avoid legal problems with HIPAA...
is focused on EDI?
Over in provider land, there is no legacy-anything
for B2B communication, and we have NOT implemented any significant
amount EDI, even in the face of a federal mandate. Big Business can
no longer afford to have a take-it-or-leave it attitude toward its Small
Business trading partners because EVERYONE in the industry (including the
patient) pays for the small provider's inefficiency.
I'm not saying we should forbid the use of EDI, but
let's not mandate its use where it is clearly not economically feasible... and
will actually increase operating costs for hundreds of thousands of
small providers. Let's try very hard not
to mandate ANY particular standard. All we NEED to mandate
is a Fair standards development process that considers the requirements of ALL
stakeholders.
Common Sense will then drive us all toward the most
efficient system... if we can simply keep the process
within a consensus-driven SDO.
Regards,
-Chris
----- Original Message -----
Sent: Monday, June 02, 2003 12:46
PM
Subject: RE: Transition paper
Dr.
Feahr, Peter et al,
With
all due respect, my 2 cents.
EDI
is still the backbone of most of the sexy e-commerce that is running other
industries -- manufacturing, retail, etc. Even those that are
implementing cool XML and web stuff still have an EDI backbone under the
covers.
Healthcare needs the backbone that has proven successful in other
industries and that is why I don't think HIPAA is barking up the wrong
tree. To try and create consensus in a non-X12 standard -- after it took
a decade to get it for X12 -- would simply have us asking the same questions a
decade from now about what is wrong with that standard.
Best Regards,
Miriam J. Paramore (Co-Founder and President of HAWK)
President
& CEO
PCI: e-commerce for healthcare
9001 Shelbyville Road
iTRC
Building
Louisville, KY 40222
502-429-8555
www.hipaasurvival.com
===========================================
This email contains
confidential information intended only for the named addressee(s). Any use,
distribution, copying or disclosure by any other person is strictly
prohibited.
(Please forgive the cross-posting to "business
issues", but I think it belongs there too)
Dear Peter,
Thank you again for this thoughtful and
evenly balanced statement of the problem and proposed solutions. I
would offer a few comments, however, on your new 6.18 section that
answer's Rachel's question "Is legal relief of any type just treating
symptoms and not the illness?"
First, we need to keep in mind that we have 2
problems to solve: the deadline and the original cost/inefficiency problem
that TCS was intended to mitigate. I agree that the deadline problem
is tricky... but it's also completely artificial. Give me a few hours
with the Federal register and a pail of White-Out and I can make that
problem disappear! The administration can stick to its guns and derail
the healthcare industry right before an election year... or it can
maintain the status quo while we ALL (providers included) take a deep breath
and a second look at the ORIGINAL problems TCS was intended to
fix. In my view, this is a no-brainer for President
Bush's Administration.
"Managed Legal Relief" is by far the most
detailed and intelligent proposal I have seen for averting the Certain
Disaster of obeying the law and/or the Tragedy of entirely calling
off our noble effort to remove cost/error from healthcare.
At the same time, however, we MUST address the
questions that Rachel and I and many others are raising about the wisdom of
using EDI as the standard in an industry as important and as fragmented
as healthcare. There are only two positions that I can imagine us
adopting with respect to the present Rule and EDI:
1. EDI is a good and workable concept for our
industry... today... and people just need to get more serious about
implementation. OR
2. EDI is physically incapable of
removing net cost or improving net efficiency in healthcare...
that both it and the regulatory process that is presently driving
it are, in fact, ADDING cost/complexity to an industry already
overburdened with its core mission of delivering care.
Does anyone in healthcare anticipate true
ROI from the existing Transaction Rule... even for the billions we have
already invested in EDI? What about ROI for EDI-development dollars
spent over the next couple years? These questions must be
answered WHILE we struggle with the self-inflicted problem of the
deadline. Until a few weeks ago, it was considered "in very bad taste"
to openly criticize the federal government's plan or suggest it will not
accomplish its stated objective. If I'm really the only guy in the
country who thinks EDI is barking up the wrong tree and that pouring
additional development dollars into it would be a BAD idea in Q4
of 2003... then I guess I'll have to shut up and go back to being
an eye doctor. If you think I'm on the right track, however... but
simply believe we'd never be able to execute such a dramatic course
change in such a short time... then I ask you to remember two
concepts: TRAIN WRECK and ELECTION YEAR. There is plenty of
motivation here for a dramatic course change!
I think it would be very helpful to step WAY
back from HIPAA for a moment and ask ourselves, "What is the most sensible
course of action for ALL industry stakeholders and for our Patients...
from this moment forward?"
Best regards,
-Chris
----- Original Message -----
Sent: Sunday, June 01, 2003 8:04
PM
Subject: Re: Transition paper
I would like to thank those who have sent
comments. Three so far have been to the listserv; so I would like to
answer those in the listserv format.
A. To David Frenkel, who
asked if I had tested the conclusions of the paper in Washington (see
below).
David, thanks for your comments. I always find
your emails must reading. My expectation is that the concept of
administrating the implementation using status information linked to legal
relief may not be intuitively attractive to HHS. I thought it needed
to be said anyway. Although it is a small amount of work now, it
stands the better chance of controlling the delay such that we would not
face it anew, say, a year from now. I would hope the give it close
examination. Saying that, I have very high regard for HHS and CMS
administration and will contentedly go along with the outcome.
The paper also has other value, including:
-
description of the risk we are facing
- description of the
causes of the risk, c.f. 6.7
- discussion of, as WEDI
asked, what it means to be compliant; c.f 1.3, 5.1.2, 5.1.4, 6.1, and
6.2
- description of the criteria for waiver of penalty;
c.f. 2.3-2.6.
B. To Susan Hollabaugh, who asked, since we are
proposing to gather information anyway, why not get the underlying or
internal status information that in most cases is driving the pace of
implementation. Thanks, Susan, for bringing up a great point.
I have added a new paragraph 6.17 to the paper should it ever go out with
another new version. The paragraph is reprinted
below.
C. To Rachel Forster who complimented me by including
a reference to the paper along with the WEDI and AHA letters and with
Kepa's 3rd essay on market forces. Rachel, I agree heartily with the
potential for new technology but am not so sure about its relevance to
today's problem. I have added a new paragraph, 6.18, quoted
below, on this and some related subjects.
Again, thanks you all for
even reading the paper. It is an entertaining
subject.
Peter
Peter Barry
Peter T Barry
Company
Independent Consulting Health Care and Information
Systems
Ozaukee Bank Building
1425 West Mequon Road
Mequon
Wisconsin 53092
(414) 732 5000 (national
cell)
[EMAIL PROTECTED]
-------------------------------------------------------------------------------------------
New
paragraphs added to the paper:
6.17 Why just gather the status
between trading partners?
This paper only proposes to gather the status
between trading partners. It does not propose to gather information
on internal projects of a covered entity even though internal information
might be highly indicative of eventual progress. But internal
information might be unnecessarily intrusive, more subjective, and
gathering it would definitely burden the industry. Instead, this
paper proposes to index only the more objectively defined status on EDI
exchange. It is simpler, oriented to results rather than project
steps, and does not burden the industry.
6.18 Is legal relief of
any type just treating symptoms and not the illness?
One line of
discussion is that this paper, the WEDI letter, AFEHCT and AHA testimony,
Drs. Braithwaite's and Fusile's report, and Dr. Zubeldia's essay on market
forces represent Band-Aids, that they do not address the underlying
problem. The underlying problem is variously suggested to be (1)
that government fiat is unworkable, (2) it places undue or inequitable
demand on smaller entities, (3) it ignores the financial plight of
providers, (4) it is high distraction from a Medicare/Medicaid funding
crisis, and (5) it is too complex, cumbersome, and costly to
implement. It is frequently suggested that EDI technology is old and
problems would be much less if more modern technology were used
instead.
I view all these points as interesting topics for
discussion. They are more than philosophic discourse, but they do
not address the present problem of October 16th; so they completely miss
the point. Since there is no way the industry can meet the deadline,
the government has only two possible actions: (1) abandon the
effort, or (2) give relief from the deadline. Abandonment is
defeatist, ignores the excellent gains and potential good that will come
of the present effort, and would cause its own heavy costs and
dislocation. It is also politically infeasible. So the only
viable course is to provide legal relief. The central thesis of this
paper is that the relief should be linked with status information to
enable effective administration.
Peter
Peter Barry
Peter
T Barry Company
Independent Consulting Health Care and Information
Systems
Ozaukee Bank Building
1425 West Mequon Road
Mequon
Wisconsin 53092
(414) 732 5000 (national
cell)
[EMAIL PROTECTED]
---------------------------------------------------------------
Peter,
Have
you tested the political waters in Washington with your conclusions?
There seems to be bigger distractions in Congress in regards to Medicare
drug benefits and diminishing Medicare reimbursements. On top of all
this next year is a presidential election. It is already well known
that most hospitals in the US are already having financial problems and
there appears to be little effort to alleviate this regardless of the
HIPAA issues.
Regards,
David Frenkel
Business
Development
GEFEG USA
Global Leader in Ecommerce
Tools
www.gefeg.com
612-237-1966
-----------------
Forwarded
Message:
Subj: RE: Transition Paper
Date: 5/30/2003 9:16:27 PM
Central Daylight Time
From: [EMAIL PROTECTED]
To:
[EMAIL PROTECTED]
Sent from the Internet
(Details)
Peter,
I found your paper full of great ideas
and I am circulating it within my own organization. I do have one
concern regarding the gathering of status information.
I work for a
provider organization and we do use a clearinghouse but our clearinghouse
only knows what our status is with them. However, there are many steps
that lead up to the point of even submitting claims to our clearinghouse
to test.
1)status of our PMS HIPAA upgrade,
2) our competence
level with the IGs
3)status of our payer surveys and the collection
and review of Companion Guides
4)data gathering related to the
requirements laid out in the companion guides
5) completion of a gap
analysis and all the other countless things I have forgotten to mention.
If our CH uploads information regarding our HIPAA status with them
to the Data Gathering Website, it would not be a true reflection of where
we (the provider) are in the implementation efforts. If we are trying to
determine how ready the industry is then it seems to me we need to know
this type of information as well.
For example, we have done a Work
Flow Inventory, a Gap Analysis, modified many of our Patient Registration
Forms to collect new date, developed a comprehensive training program to
train staff to collect the new data, developed materials to explain to
patients why we are asking all these new questions, begun testing with a
third party organization (prior to sending to our CH), etc...
We
are in a very different place than many of the other providers that submit
to the same CH that we use, but the CH does not record or store this type
of detail.
If we are going to take the time to gather industry wide
detail on where we are, don't we need to know this type of information?
Would the Clearinghouses be expected to gather this type of information
about their providers?
Susan
-----Original
Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED]
Sent: Thursday, May 29, 2003 1:44
PM
To: WEDI SNIP Transactions Workgroup List
Subject: Transiion
Paper
Attached is an updated copy of the Transition paper I presented
at the WEDI conference last week. This builds on WEDI positions, but
it does not in any way represent anyone's opinion by my own, errors and
all. If it is useful to you, you may freely distribute it.
Besides its recommendations, it may offer helpful description of
the transition problem and business strategies to deal with it. It
also addresses the contest between technical perfection and general
conduct of business, the latter prevailing to my
thinking.
Peter
Peter Barry
Peter T Barry
Company
Independent Consulting Health Care and Information
Systems
Ozaukee Bank Building
1425 West Mequon Road
Mequon
Wisconsin 53092
(414) 732 5000 (national
cell)
[EMAIL PROTECTED]
---
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The WEDI SNIP listserv
to which you are subscribed is not moderated. The discussions on this
listserv therefore represent the views of the individual participants, and
do not necessarily represent the views of the WEDI Board of Directors nor
WEDI SNIP. If you wish to receive an official opinion, post your question to
the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These
listservs should not be used for commercial marketing purposes or discussion
of specific vendor products and services. They also are not intended to be
used as a forum for personal disagreements or unprofessional communication
at any time.
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The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time.
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