My name is Susan O’Brien and I am the EDI Product Manager for Physician Computer Network. Physician Computer Network is an information technology vendor for office-based physicians of all types. We are the vendor for and represent approximately 20,000 installations supporting over 100,000 physicians, which translates into an estimated 25% of the office-based physicians in the United States. We provide computer solutions for both the financial and billing aspects of physician’s office and well as clinical information systems.
On behalf of Physician Computer Network I would like to thank you for allowing us to participate in the hearings on health care claims attachments. Once a standard has been decided upon, we as a vendor will be tasked with the engineering, development, installation, training and support necessary to fulfill the electronic computer requirements being set forth. As the vendors are responsible for a significant portion of the responsibility surrounding this claims attachment standardization initiative, we appreciate the opportunity to express our concerns.
Speaking to the question posed regarding the positive impacts of the inclusion of X12 and HL7 messaging in one standard, we believe that any standard adopted which facilitates the sharing of data would be positive. This would be true of virtually any format. The negative impact as a software vendor would be the re-engineering and development necessary to capture the data by a specific mandated date.
The primary reason for the anticipated difficulty in fulfilling the electronic needs of our customers would be because the integration of clinical information across departments in the office-based physician arena is extremely uncommon. Less than 1% of our entire customer base is actually doing this now. It is common for physician’s offices to have computers to handle the financial aspects of their business alone. Not only do they not share this information across departments, but it is not currently common for physician’s offices to capture clinical information electronically at all.
There are various software programs on the market to address the clinical aspect of the business. We are currently continuing to develop and have installed at numerous sites a clinical based electronic medical record system named Health Point. Physician Computer Network is heavily involved in this joint venture with Glaxo Welcomme to provide electronic medical record technology. The development of the Health Point product has made us truly aware of the challenges involved in computerizing clinical information. This technology is still undergoing metamorphosis, and is not readily available for all specialties. The clinical based technology at this point in time could be considered cost-prohibitive to the smaller size practices.
However, it could be stated that within the available clinical systems arena, it is common functionality for the clinical software to provide to the financial practice management system information for billing purposes, such as procedure codes, diagnosis codes, provider, place of service, etc. Theoretically the same could be accomplished for submission of a health care claim attachment format.
The implementation of an initiative such as this is an enormous undertaking. Assuming a standard has been decided upon, we as vendors must engineer the capturing of the data, whether it be through a full-blown electronic medical record system such as Health Point, or perhaps a more theoretically simple method. We know it is not being formally captured electronically now, except for the few offices which have invested in the electronic medical records systems.
If we, for example of adopting a seemingly simpler method, were to provide for text capture of surgical notes or progress reports generated on a PC using Microsoft Word or some other industry standard text based software program, providers will still have to purchase some type of incremental technology. Amazingly enough, we have found within a certain faction of our customer base, consisting primarily of small offices or rural areas, that the use of a PC is not common. They typically use older technology purchased some 5-10 years ago not conducive to meeting current industry standards.
For instance, we often use third party PC software such as Procomm Plus to facilitate the communications piece of a claim transmission or to provide access to a payer’s bulletin board system. As we struggle to keep up with mandates such as NSF 3.01 and CLIA number submission, we implement the use of this PC software with our programs. As recently as last week I was speaking with a representative from Blue Cross and Blue Shield of Nebraska. She was explaining to me the demographics surrounding the physicians they service and specifically how they do not have PCs and their reluctance to pursue incremental technology siting the costs associated with this type of movement as being the primary reason.
Once the product and technology is sold to the provider, we must provide for the installation, training, and ongoing support to the office personnel in the field. The process of installing the capability alone can be analyzed as follows: Of our 20,000 physician’s offices, approximately 50% bill electronically. A simple straightforward installation could be estimated at requiring 2 man hours to complete. For 10,000 offices at 2 hours each, it would take approximately 20,000 man hours or 500 weeks. One man could complete approximately 80 installs per month or 960 per year. Implementing an initiative such as this, would necessitate our organization to hire and devote at least 10 ½ people full time for an entire year to this project. This alone would cost as much as a half-million to one million dollars.
Obviously, billing initiatives can have potentially devastating effects on vendor organizations. The development and implementation alone will be very expensive. As a vendor we will seek funding from our customers, the providers. As recently as December, 1997 implementing a simple change to facilitate the CLIA number mandate for Medicare lab claims brought our organization to its knees just by virtue of the sheer number of sites impacted and an aggressive drop dead date for claim denial imposed.
In closing, the more swiftly we can obtain a format decision the better. It is imperative that the providers and health care organizations are made fully aware of the specifics surrounding this initiative. It is also extremely important that an incremental approach with a timeline appropriate to the task be addressed.