Epic and axiUm

One of the lesser known aspects of the Affordable Care Act, yet one that is absolutely necessary to meet the “Affordable” aspect of the Act, is the Electronic Health Record or EHR.  After a Congressional delay of more than a year, it is slated to become mandatory for all claims transactions in mid-October.

Will it happen?  I have my doubts, and they stem from more than fifteen years history with the issue.

The key to the EHR and to any electronic data interchange (EDI) is the general acceptance of standards.  In the healthcare industry the standard format is set as ASNA ASC X12 by a committee that includes all interested stakeholders in the process.  Reporting of data uses standard sets for health procedures (CPT for medical and CDT for dental), diagnostic grouping for why procedures might be performed (soon to be ICD-10 for medical and dental and SNODENT for dental).  Although there are now accepted standards for reporting authorization, claims, and payment electronically, there is no standard software at the operational level.

A huge number of the dental schools, including the University of Tennessee, which I recently toured, use a system called axiUm, a Practice Management software that has capability to measure the quality of outcomes and assist in defining the effectiveness of treatment choices.  However, most of the schools do not use this capability and graduating students have no compatible Practice Management software to use at the dental practice level.

Similarly, there are ongoing measures to standardize medical data interchange.  My daughter-in-law is in training to be a certified Epic trainer, a choice she rightly feels will allow her to capitalize on opportunities as the HER rolls out.  Epic has the advantage of having developed a system for use by patients as well as physicians and claims staff. 

When I was the National Dental Director for WellPoint, the Blue Cross of California branch attempted to reduce medical accidents by offering any physician in California, BCC contracted of not, a free computer tied to a server that would allow review of any and all prescriptions a patient might be on.  We had only about a 35% acceptance rate.

Current literature indicates similar lack of embracement of the HER by physicians today, some of whom feel it is intrusion in to their practice and others, that it is just one more time-consuming step that detracts from patient care.  From a patient standpoint, my first-hand experience in attempting to retrieve my blood studies electronically has run into compatibility problems from my email service and privacy issues from the intermediary between my physician and myself.

I was taken aback at a recent medical presentation in Sacramento where I was told that Epic and axiUm were unable to communicate between themselves; this, in spite of the fact that the X12 claim record will include both medical and dental codes.  I was told that the federal government intentionally chose not to endorse a standard as it would be considered federal endorsement of a private company.

I find this hard to support when I see how the Centers of Medicare and Medic aid Services contract across the public sector; contracting with physicians, hospitals and medical device companies, setting goals and incentives for efficiencies, and demanding common use of codes, diagnoses and results.

I am hopeful that eventually reason will prevail and there will be better interchange of information and standardization.  If so, the ultimate winner will be the patient and healthcare costs will be based on improvement rather than on fee-for-service.

For many of us, time catches up with us, forcing us to retract, support, or at the least rethink a position we have put into print.  In my next post I will share my recent experience in such a case: in my case, my position on data security.  I think you will find it interesting and perhaps enlightening.