Monday, June 3, 2013

Challenges of ICD-10 compliance

Abstract As compared to the former ICD-9-CM, ICD-10-CM is much more advantageous and eases effectiveness and efficiency through which work can be executed at the health care centers. The new system is much more specific and easily manages clinical information as regards to amulatory and managed counters. It is also through this structure that a larger expansion as far as code numbers are concerned can be attained. The classification is much more diverse as compared to that of diseases and injuries, to cater for the inclusion of risk factors frequently witnessed in a primary health care setting. Even though the list of benefits in regards to the implementation of the system is inexhaustible, the major challenges underlying the implementation of the system can also not be ignored. These are like: high costs, need for training and many more. In this essay therefore, the writer is going to analyze the challenges that accrue to a health care organization as far as compliance is concerned in regards to implementation of the system, amidst the many benefits it entails. The report is also going to have a discussion section where the challenges are going to be analyzed and selected solutions to some of the challenges. Introduction There has recently been a lot of movement towards the use of cloud software’s especially in the health care sectors. However, it is essential that every health care service analyses the pros and cons of the tools before embarking on their use so as to get the best model for service. (Anderson pp.1).Some of the cloud systems for consideration are the ICD-9 AND 10, the SAAS system and the EHR systems. In this report however, the underlying focus is going to be on the ICD-10 system. Term definition Cloud computing Cloud computing is a model designed to share a large pool of computing resource for example networks, services and servers. The interaction should be flexible and convenient provision with minimal release of management effort or the intended service interaction (Armbrust, pp.46). The evolving trend in technology has brought about great development in the discipline. Cloud computing infrastructure as a service in the business environment is available for the general public (Armbrust,pp.46). It exists at the disposal of the providers hence the need for the consumers to decide how they can benefit with its operations. If the customer can have a wide range of services to be fulfilled the cloud infrastructure can also be restructured. The multipurpose cloud computing systems can remain distinct but bound together by standardized technology enhancing resource portability. This will enhance the services of the customers, organization, public or community is achieved. ICD-10 ICD -10-CM is an abbreviation that stands for “the international classification of diseases, 10th revision, clinical modification”. This is a classification that is comprised of more than 69,000 codes of diagnosis which are very essential for the analysis and assessment of clinical as well as enterprise intelligence so as to improve the delivery of health care as well as reduce on the various costs that are incurred in the sector. Discussion The diseases and epidemics that are happening in the United States as the moment necessitate that the systems at use by the health care are updated to better suit the delivery demands. The limited use of technological processes in the reporting framework, for both current diseases and codes that are procedural in nature have been the main limitations to the growth of the sector in terms of delivery offered, quality of services and procedures for reimbursement. Although the work related to the conversion of organizations from ICD-9 TO ICD -10 may appear impossible, it is essential to understand that the size of the practice involved and type of facility are directly related to the complexities that may be accrued during the implementation phase. Deduced from the above diagrammatic summary of the likely challenges’ to the system, the key areas of consideration are the financial impacts of the system and whether they are sustainable, the work force of the health care sector in regards to practical usage of the system, the readiness of the vendors involved in the implementation and management of the system, the payments top be made to the providers and lastly, the issue regarding waste, fraud and abuse of the ICD-10 System. Challenges of compliance Financial risk and sustainability Experts have estimated that the use of the system will result to an initial decrease in the overall revenues and cash flow that are attained by the health care providers following its implementation. The rates are said to increase from the current 100 percent of denial to about 200 percent following the implementation and a simultaneous increase in the amounts of accounts receivable from 20 percent to 40 percent firm (Hing and Burt,Pp. 120-126). The error of claims is also anticipated to increase from the current 6 percent to a rate of about 10 percent as compared to the current 1cd-9 system. It has been noted that in order to continue receiving the same revenue cycle, firms must ensure that they budget for cash flow impacts that may potentially affect their operations following compliance, prepare for updates in terms of it soft wares ,measures of conversion and testing among others. The major challenges following this is that there may be a limitation in the assessment activities of the current physicians patterns of documentation in regard to the determination of the final financial implication of the transition firm (Hing and Burt,Pp. 120-126). Fraud and waste One of the challenges that health care providers are constantly faced with is the payment of claims that is not proper. This is one of the challenges that accrue to a firm by engaging a vendor and provider in the management of their systems, just as is the case with the ICD-10 System. Some of the challenges that firms are going to face with the system in ensuring that they are appropriately billed for their services are: to review the current software and ensure that the billing system is coherent with the new ICD -10 system (Jodock, PP 12-16). This will involve the training of the staff on the application of the new codes and ensuring that the records of the firm are detailed as required to the 1cd-10 system. This will also necessitate the firm to consistently carry out audit through use of an outside firm which is very costly. Authentication and security The authentication issue or rather the issue of information security is major issue in cloud computing, particularly with the use of public, community and hybrid cloud computing models. In the case of the health care sector, the challenge of security, in regards to the ICD-10 is still a major issue. This is a major issue for many organizations because they tend to choose these models as opposed to private cloud computing because of the cost. Organizations have come to rely on data a great deal for all their operations. There are various security issues or concerns with cloud computing. The security issues have been divided into two major groups: security issues that are faced by the service providers and security issues faced by the users. The extensive utilisation of virtualization in the implementation of cloud infrastructure causes unique security issues for clients and tenants especially in regards to the patient privacy concerns since the information is stored in a facility that is off-site. (Avresky, Pp136). Vendor management in terms of scalability In most cases’ the issue with cloud computing as far as the ICD-10-CM software is concerned, are issues that deal with scalability firm (Hing and Burt,Pp. 120-126). Most of the service providers claim to be in a position to effectively handle the needs of their clients through the provision of the efficient services despite the size of the health care firms. In this case therefore, there have been various concerns depending on whether the system can be able to effectively offer value for the businesses when the numbers of users in need of the services are many (Buyya et al, pp 29).This is especially due to the fact that the codes required are more and complex as compared to the initial system software Maximum support Similarly, the use of the ICD-10 system of computing requires the support of the employees of the firm, without which the use of cloud computing is bound to fail. The employees are the end engine that drives the system as their input is most needed for the various data that is needed by the system (Olariu and Abuelela, pp.7). It requires a great deal of support of the employees to move from the present system of human resource management to the system based on the cloud. The movement from the current system of the firm will also be difficult due to the fact that the system may sometimes impose different application architecture to the one that was previously being used by the health care firm. This will especially be witnessed in the areas of access to the HR data where previously there were different rights of access to the various users. The costs of conversion from the previous system to the cloud computing one may outweigh the costs. Service disruption There is a higher magnitude that transition to the ICD 10 will have a greatly impact on the services of the practicing fiord and thereby resulting to disruption and the consequent frustration of the members of staff. This is due to the fact that the system involves the consideration of an appropriate stakeholder staffing in order to ensure that engagement and attrition are better attained by the firm (Hing and Burt,Pp. 120-126) . This will also require further training of the staff in order to help mitigate the medical and safety risks that may come along with the implementation of the system. Any down time that will be experienced in the health care firm will represent lost opportunity since the managers will not be able to carry out the various human resource management functions which they are mandated to do (Thomas,pp. 214).On the other hand, disruptions lead to damages in the reputation of the firm or the department, especially if they are not able to carry out their functions in time. Disruptions which may rise due to insufficient or inadequate service level agreements (SLAs) with the providers of the cloud, in mos,t cases they are inadequate or non-existent, thus the human resource department have very little assurances of the up time of the cloud services. Effectiveness and efficiency The health care firms that consider using the system for their functions will be greatly concerned about the quality, availability, and the performance of their connection to the Internet. Ojala and Tyrvainen (pp. 40) noted that problems arise when the activities of the firm which were previously done offline are moved online, thereby exceeding the bandwidth’s ability to carry out its functions. Due to this, there will be a need to increase the bandwidth of the firm to continue to support the increased work requirements, otherwise, the access to the HR data will be serious constrained leading to little acceptance of the cloud technology by the firm. Millan and Bromage (pp, 149) also recognized the problems of latency, which refers to the time taken to deliver a packet of data from one location to another, especially in cases where the data is needed urgently. Due to the unpredictable and varied latency over the Internet, many organizations are receiving concerns about the ease with which they will carry out their HRM functions. Some organizations have resorted to carrying out some of their critical HRM functions in-house due to the delays that are encountered in the cloud system (Molen and Brace, pp.133). Virtualization Virtualization changes the relationship between the operating system and the underlying hardware, be it storage, computing, or even networking. This is because of the introduction of another layer- virtualization - which itself must be correctly configured, managed as well as secured. Some of the security issues in this case included the possibility of compromising the virtualization software, or “hypervisor”.Data through a network can be viewed, stolen or compromised. Customer data being transmitted through a network can be hijacked and accessed or stolen especially in case where the service provider does not have adequate security measures. For any health care organization, there are various security complications that are added to the current network technology by deciding to go the cloud computing way. Some of the security issues that can face an organization by using remote service providers for its computing services include: eavesdropping, packet sniffing, Spam over Internet Telephony (SPIT), Denial of Service (DOS), or generally tampering with the network affecting the organization’s operations (Askhojet al, pp175). User access Secondly, there is risk associated with user access control. The migration of the company data to the cloud significantly dilutes the power of the firm to control the access (Chang et al, pp139). The employees of the firms can access the information on the cloud thus in some instances, they may engage in activities that put the organization to be susceptible to potential vulnerabilities. There are higher risks for sensitive data. It is therefore through this issue that the health care providers have little control over disaster recovery issues and protocols that involve the continuity of the business due to the protocols placed on the data by the vendor of the SAAS system. Data pooling Thirdly, data pooling is another risk as it increases the possibility for attack. The attackers are highly motivated by the sheer volume of information that is hosted together in the cloud. The shared storage inside the cloud has in the past experienced high levels of attacks (Shor pp. 18.). However, the providers have been able to deal with the risk through the use of technologies such as Hypervisor; virtual containers and the use of compartmentalization techniques for instance encryption. Lack of control In the use of cloud computing, the organisations do not have much control over the infrastructure that provides these services, as mostly they are provided by service providers. This is especially the case with public, community and hybrid cloud. The health care organisation receives computing as services without having to understand the underlying infrastructure that provides the services. This lack of control comes as a major disadvantage for the contracting organisations. For example, in case the cloud system fails or goes down, the organisation remains helpless since they do not have the visibility of the infrastructure and the entire system is basically out of their control. This lack of control can cost the organization a lot, especially where the services are depended on for the productivity of the organization (Shor,pp.18).The organization is left to rely on the service providers to rectify the problem without a proper knowledge of the period of time it might take for this to happen. Outages are real, they have happened in the traditional ways of providing computing services and they happen today in cloud computing, and there is no guarantee that they will not happen in the future of computing. It is also more disappointing when the organization or the consumer is not in control as is the case with cloud computing. Issues arising from cloud technology usage There have been concerns with regards to the privacy especially since the cloud service providers can access the data stored and communication between the firm and the users. The privacy issues also arise in terms of the jurisdiction where the data is stored. The other privacy concern is the access, deletion or even the alteration of the data which may be deliberate or accidental. The privacy concerns have been dealt with through focus on encryption and other security considerations at the application level (Molenand Brace, pp.131). Secondly, there are concerns with regards to compliance especially with the regulations for instance SOX and HIPAA in the US. The firms will face higher costs at reduced benefits if they are to comply (Miller, pp.234). Thirdly, there are concerns with regards to the legal considerations. The revolution that is characterized by the increased adoption of the cloud computing technology will present an array of legal concerns for instance security concerns, the sharing of data resources that are proprietary as opposed to open source and the infringement on the trademarks (Millan and Bromage, pp. 148). Finally, there are issues of abuse. The different users so not have the same intentions as some may have ulterior motives for instance by subscribing to and using the cloud as launch pad for attack on the other users of the services (Millan and Bromage, pp. 148) Solutions to the problems To address the issue of authentication or security, the providers of cloud computing must come up with adequate controls to offer the same or greater security level that it would be the case for organisations if they were not using cloud solutions. Security measures such as data encryption, access control and security – both physical access to the servers as well as user logins, privacy, control, legal issues, and compliance with regulations have in the past been beneficial to organizations. However, the changes that have taken place in the recent past (the move to cloud computing) have required that these security measures are re-evaluated and more effective measures implemented. There is need for the provider of the services on the cloud to put in place strict security measures and policies, necessitating additional trust in the clients. Use of grade security systems that employ special-purpose security hardware has also been suggested to help with the issue of authentication a far as the use of cloud computing is concerned. Standards for utilizing Trusted Computing techniques in desktop computers and laptop, networking, and storage should also be adopted. This will ensure that security is maintained in the use of computing services provided on the cloud (Halpert, pp 121). To address the issue of lack of control, health care providers should seek to use private clouds as much as possible. A private computing cloud refers to a stack of network, server and storage media provided to a particular company for the purpose of computing. When a well managed private cloud computing is used, the applications become customized to the needs of the particular company. The resources in this case can be configured and reconfigured according to the needs of the company. The ability to customize the resources in private cloud computing has proven valuable to companies in terms of maintaining control. This is because with a conventional dedicated server stack that is either managed internally or by a third party service provider, the company gets to choose the server, networking, as well as storage needs, buy them and use the particular configuration (Furht and Escalante,pp 4-17).Additionally, the practice is able to access applications without the issue of congestion as is the case where services are offered to various clients like in the other three kinds of computing. This allows the practice the flexibility of using the services at its own convenience. Another benefit of private cloud computing is that the company enjoys a high level of security for its information. In private cloud model, the company is likely to save very little in terms of cost, but there is assurance of control and data security and privacy as data stays within the firewalls of the practicing firm.An organization that decides on going for an outsourced high impact cloud model, then it can decide to use private cloud controlled and managed by an outside service provider. In this case, service providers provide dedicated settings separate from their public cloud models both physically as well as logically (Gozzi,pp.67) Conclusion The use of cloud computing technology greatly enhances the efficiency of the operations of the firms and businesses that adopt it thus enhancing cost reduction. There are three main models of launching the cloud computing in the organizations. The models include IaaS, PaaS and SaaS with the latter being the most advanced. 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