Ebola — Cloud IT and ICD-10 Can Help

Healthcare IT News ran a story regarding Texas Health Resources, Ebola, and the failure to link CDC listed symptoms for Ebola with the proper clinical workflow, and to record those symptoms along with the patient travel history from Africa in the Epic Systems E.H.R.

The question is not whether people or technology is to blame.  The question is, now that the event occurred, how can we respond rapidly and how to prevent this from happening again?

Flexible and agile systems and processes (E.H.R. workflow, training) are required. Disease management protocols should be built into the workflow to capture the right clinical concepts. Hopefully, Texas Health Resources will be re-tooling their E.H.R. and people process immediately.

As we move from these quick reactions for this single event to avoid a crisis epidemic, we can think about better data.   The transition from ICD-9 to ICD-10, will move the U.S. health system from a number of codes describing hemorrhagic fever symptoms–which might mean Ebola–to one specific code for Ebola.  ICD-10 provides a specific code for Ebola virus, A98.4.  Biosurveillance is enabled by better, more accurate data, to quickly track and catalogue diseases and readily share information.   Clinicians don’t have to be ICD-10 coders, but they do have to accurately describe and capture the complete condition of the patient using the right clinical concepts to enable better data to work.  But that is what clinicians were trained to do in nursing school, and medical school.

Then, we need to ensure that this information is entered – completely – into the EHR via agile workflows and that it can rapidly shared – in real time – not just as a retrospective report in 12 months with CDC or CMS for an Accountable Care Organization.   Some commenters on the Healthcare IT article said they thought paper charts were better, and that if only we didn’t have an E.H.R. we would not have gotten into this mess.  Those who pine away for a return to paper must be forgetting that paper is harder to share. We need rapid consumption of shared knowledge across the U.S. healthcare system.  Paper doesn’t support that.  But does Epic support ubiquitous sharing?  That is, can you get this data if you you aren’t running Epic?  How long and how much money will it take to re-engineer the Epic system and process to ensure that the question …have you recently traveled to Africa?… is included when the patient presents with the CDC listed symptoms for Ebola the next time?  What if the patient were being admitted and diagnosed during an encounter where the healthcare provider is using Epic E.H.R. in Tennessee? Could the health care provider and Epic customer in Tennessee immediately benefit from the modifications that were made to the Epic system in Texas?  Sharing across the continuum of care, by setting, system, geography, and health organization is the future.  It is mission critical in emergency responses to stemming a potential epidemic.

The answer seems to be to share more of this information in the cloud and present it easily to clinicians, health workers, the CDC, and the public, in abstract depersonalized form using mobile health, not in on-premise software systems in one health organization in Texas.

Michael F. Arrigo

Michael Arrigo, an expert witness, and healthcare executive, brings four decades of experience in the software, financial services, and healthcare industries. In 2000, Mr. Arrigo founded No World Borders, a healthcare data, regulations, and economics firm with clients in the pharmaceutical, medical device, hospital, surgical center, physician group, diagnostic imaging, genetic testing, health I.T., and health insurance markets. His expertise spans the federal health programs Medicare and Medicaid and private insurance. He advises Medicare Advantage Organizations that provide health insurance under Part C of the Medicare Act. Mr. Arrigo serves as an expert witness regarding medical coding and billing, fraud damages, and electronic health record software for the U.S. Department of Justice. He has valued well over $1 billion in medical billings in personal injury liens, malpractice, and insurance fraud cases. The U.S. Court of Appeals considered Mr. Arrigo's opinion regarding loss amounts, vacating, and remanding sentencing in a fraud case. Mr. Arrigo provides expertise in the Medicare Secondary Payer Act, Medicare LCDs, anti-trust litigation, medical intellectual property and trade secrets, HIPAA privacy, health care electronic claim data Standards, physician compensation, Anti-Kickback Statute, Stark law, the Affordable Care Act, False Claims Act, and the ARRA HITECH Act. Arrigo advises investors on merger and acquisition (M&A) diligence in the healthcare industry on transactions cumulatively valued at over $1 billion. Mr. Arrigo spent over ten years in Silicon Valley software firms in roles from Product Manager to CEO. He was product manager for a leading-edge database technology joint venture that became commercialized as Microsoft SQL Server, Vice President of Marketing for a software company when it grew from under $2 million in revenue to a $50 million acquisition by a company now merged into Cincom Systems, hired by private equity investors to serve as Vice President of Marketing for a secure email software company until its acquisition and multi $million investor exit by a company now merged into Axway Software S.A. (Euronext: AXW.PA), and CEO of one of the first cloud-based billing software companies, licensing its technology to Citrix Systems (NASDAQ: CTXS). Later, before entering the healthcare industry, he joined Fortune 500 company Fidelity National Financial (NYSE: FNF) as a Vice President, overseeing eCommerce solutions for the mortgage banking industry. While serving as a Vice President at Fortune 500 company First American Financial (NYSE: FAF), he oversaw eCommerce and regulatory compliance technology initiatives for the top ten mortgage banks and led the Sarbanes Oxley Act Section 302 internal controls I.T. audit for the company, supporting Section 404 of the Sarbanes Oxley Act. Mr. Arrigo earned his Bachelor of Science in Business Administration from the University of Southern California. Before that, he studied computer science, statistics, and economics at the University of California, Irvine. His post-graduate studies include biomedical ethics at Harvard Medical School, biomedical informatics at Stanford Medical School, blockchain and crypto-economics at the Massachusetts Institute of Technology, and training as a Certified Professional Medical Auditor (CPMA). Mr. Arrigo is qualified to serve as a director due to his experience in healthcare data, regulations, and economics, his leadership roles in software and financial services public companies, and his healthcare M&A diligence and public company regulatory experience. Mr. Arrigo is quoted in The Wall Street Journal, Fortune Magazine, Kaiser Health News, Consumer Affairs, National Public Radio (NPR), NBC News Houston, USA Today / Milwaukee Journal Sentinel, Medical Economics, Capitol ForumThe Daily Beast, the Lund Report, Inside Higher Ed, New England Psychologist, and other press and media outlets. He authored a peer-reviewed article regarding clinical documentation quality to support accurate medical coding, billing, and good patient care, published by Healthcare Financial Management Association (HFMA) and published in Healthcare I.T. News. Mr. Arrigo serves as a member of the board of directors of a publicly traded company in the healthcare and data analytics industry, where his duties include: member, audit committee; chair, compensation committee; member, special committee.

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