As HIPAA Compliance Looms, Related Tech Products Proliferate

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Federal privacy regulations designed to give patients guaranteed access to their medical records and more control over how their protected health information is used and disclosed are due to go into effect in April of next year.

The privacy provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), apply to health information created or maintained by health care providers who engage in certain electronic transactions, health plans and health care clearinghouses, according to the Department of Health and Human Services.

A number of software makers have developed products that aim to make health care providers HIPAA compliant.

One of those products is Mercators Healthcare Integration Package Version 2.1, by Mercator Software, Wilton, Conn.

Senior Vice President David Raye of Mercator says the product “allows organizations to share data among different types of systems.”

Mercator does this by modifying a companys disparate back-end systems all to be HIPAA compliant, Raye says.

When this is done, an employee putting a claim through the system can retrieve information from numerous back-end systems, all of which will automatically be HIPAA compliant, Raye explains.

Mercator “brings a common language to all the back-end systems,” he notes.

Steve Mariconda, director of Mercators Solutions Unit, says the initial process is to deploy the standards-based part of the software into the clients computer systems environment.

“Without having our product, this would have to be done manually,” Mariconda notes.

Employees who use the tool neednt be skilled programmers, he adds. The system employs a graphic tool in a prepackaged format, meaning an employee simply “drops and drags” information he or she needs to use to the HIPAA-compliant system.

“Once everything is deployed, it runs itself,” Mariconda says. “It watches for transactions and when something comes in, its processed automatically.”

Mercator “saves a tremendous amount of time and money,” he says, because of “the efficiency and flexibility it creates in the business logic.

“There are a lot fewer exceptions or transactions put in a pend state,” he continues. Things flow through better, theres more efficiency and you can process claims faster.”

Mercator runs on all versions of Windows, as well as Windows NT and Unix, and it supports the IBM mainframe, the company says.

Raye estimates it takes between 12 and 18 months to assess, implement, test and get the product up and running.

A range for the cost of the HIPAA deployment is from $250,000 to $1 million, depending on the size, nature and complexity of the organization, Mercator officials say.

“The core system itself is less, depending on how many licenses youre buying and the extent of services you may be buying,” Raye says. The average sales price of a Mercator license is from $250,000 to $300,000.

Mercator is resident software, meaning it sits on a computers hard drive, and is not obtained through an application service provider (ASP).

Another product that seeks to fill the HIPAA requirement need is HIPAA Rx, sold by WorkSmart MD, Daytona Beach, Fla.

Jayson Meyer, who works in business development at WorkSmart, says the product is a do-it-yourself kit for small- to medium-size health care providers. It tutors users about HIPAA, identifies HIPAAs impact within the providers organization and puts the providers requirements in place, he explains.

“It provides a formal gap analysis of exposures, as well as solution options and associated costs,” Meyer says. “It also provides a strategic plan that will direct the budgetary process and implementation activities and prioritization of required tasks ranked by criticality of completion.”

HIPAA Rx is designed for any medical office, Meyer says. Specifically, those who use it include doctors, dentists, chiropractors, mental health practitioners, some hospitals and assisted living facilities.

The product aims to help clients standardize the way health information is sent electronically, in order to conform to HIPAA requirements, Meyer says.

“HIPAA creates one national standard all insurance companies have to accept, HIPAA Rx helps put the systems in place in the right format,” Meyer says.

It does that by being a “consultant in a box,” he claims.

“Most of it is operational in nature,” says Meyer. “It has to do with policies and procedures and behavioral things. It takes them through a step-by-step compliance plan. Theres a demo, a piece of software that walks them through phases.

“It helps them develop policy and procedure and things you have to do under HIPAA,” he continues. “It does organizational training and helps offices meet privacy and security controls.”

The product does this in part by limiting, according to HIPAA guidelines, the ways doctors can use or disclose patient information outside of treatment. For example, the HIPAA guidelines affect how much patient information can be given to a lawyer for the purpose of a lawsuit involving that patient, Meyer says.

“Before the doctor uses patient information for other than payment or treatment, there is a procedure that HIPAA Rx helps them do,” he explains.

“A very easy-to-use interface helps them identify the things they need to change to become HIPAA-compliant,” he notes. “Then there is a training video that trains staff [and] helps them meet HIPAA requirements.”

Training on the product in an office of about 10 employees takes about three months, if the office has an individual dedicated to the project, he says.

The product includes the software and training videotape and a questionnaire administered over a network.

System requirements include Windows 95 or above, 64 or more megabytes (MB) of RAM and a CD-ROM drive.

The package costs $699. It can be modified without altering the price, Meyer says.

Lytec Medical 2001 is another product available that seeks to help medical offices be HIPAA-compliant.

MediSoft, Gilbert, Ariz., a division of NDC Health, Atlanta, is the vendor.

System requirements include a server with 64MB of RAM, an 8 gigabyte (GB) hard drive, a Pentium processor, a CD-ROM drive, a tape backup, a modem for electronic billing, and Windows 95/98/ME/NT/2000/XP, according to the Lytec Web site.

Features of Lytec Medical 2001 include inventory tracking to produce reports designed to inform a user of inventory sold and/or to be reordered.

“Automatic pop-up reminder messages alert you to reorder inventory at the appropriate time,” according to the Web site.

Lytec also offers the ability to display or print more than 12 new reports, including reports for monthly/yearly summary, sales tax, refunds, pending claims, inventory sales and reordering, and more, according to the Web site.

Lytecs medical billing software is designed for medical offices, dentists and medical billing services, the company says.

Integrated within the product is electronic claims software to transmit claims through a clearinghouse, according to the site.

Lytec sells “Interactive Software Training” which includes an interactive instructor meant to guide a user through the Lytec Medical software.

A public relations person working for the company says that the latest version of the software is Lytec Medical XE, which was released in early August.

Pathfinder Benefits, a product sold by Integrail Solutions, Latham, N.Y., is “a comprehensive decision support solution for addressing care and cost challenges facing payers and providers,” says Michael Rosenblum, chief operating officer.

“Pathfinder merges and transforms medical and pharmacy data to furnish analysts and executives with critical information needed to better manage health care resources,” he explains.

Pathfinder is deployed through an ASP and is built to comply with HIPAA regulatory requirements, the company says.

Integrails Pathfinder and Pathfinder PRO applications are designed for various types of end users, including pure analysts, mid-level business users, and the executive or occasional user, Rosenblum says.

Pathfinder “merges and transforms medical claims and pharmacy claims data through a combination of industry standard methodologies and Integrails proprietary business rules,” he notes.

“This enables clients to perform both retrospective analysis to review results of clinical practice patterns within the context of a populations illness burden, and prospective analysis to allow clients to identify high-risk patients for disease management, and to help determine more accurate payment rates,” he continues.

Pathfinder aims to help users discover which providers are most efficient, which treatments are most effective, and how pharmacotherapy impacts clinical outcomes, says the company.

The product includes a library of Quick Click reports that provide actionable information with a few clicks of the mouse, and eight structured analysis paths that contain more than 50 standard reports, says Intergrail. These paths are meant to guide a client through the types of analyses that Rosenblum says will help them achieve the results they are looking for.

The analysis paths are point-and-click, requiring no extensive technical skills on the part of the user, he adds. Clients can quickly switch among analysis paths when they discover patterns in data that interest them.

“There is also an ad hoc analytic and reporting component to the Pathfinder PRO application that gives the end-user direct access to the data mart to query and analyze data–all without having to be a programmer,” Rosenblum says.

Pathfinder is deployed in an ASP model. The client requires only access to the Internet or direct connectivity to Integrail and a PC. There are no requirements for the client concerning application servers or database servers, as these are provided and maintained by Integrail, he says.

HIPAA-compliant connectivity can be achieved through the Internet, dedicated line, or dialup.

Implementation time is dependent on the existing format of a clients data, as well as the number of members and number of medical and pharmacy claims data feeds that need to be transformed, Rosenblum says.

Integrail meets with each client to understand the data to be able to better assess the complexity and therefore, the length of the implementation cycle, he says. Once the final data extract is received by Integrail, the implementation process takes approximately four to eight weeks to complete.

Integrail provides complete training sessions for all Pathfinder users, typically scheduled toward the end of the implementation process, Rosenblum says.

These training sessions can be performed using actual data from the installation or a training database. The training is generally broken up into two distinct areas. The first portion of the training will focus on the underlying population-based case-mix/risk adjustment methodology and the episode-based illness classification system. The second portion of the training will focus on software use, he says.

Integrail guides the user through the various levels of the software and helps them develop profiling strategies using the functionality in the application, Rosenblum says. Integrail uses case presentations to help reinforce the analysis available through the various analytical paths in the software.

Complete guides and supplements to the methodology and application training are provided to each named user of the software, Rosenblum notes. These materials are also available online, within the software, and through the clients Extranet application portal.

Updates to the manuals are completed with each update to the methodology or application version, he adds.

The company declined to quantify cost of the product, noting that it varies and is determined by the package bought and client characteristics, such as the number of data feeds and the membership size.


Reproduced from National Underwriter Life & Health/Financial Services Edition, November 4, 2002. Copyright 2002 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.