THIRD NATIONAL MEDICAL BANKING INSTITUTE

February 24-25, 2005

Nashville, TN

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Joseph Nichols, MD, Director of Healthcare Solutions

Edifecs

Redmond, VA

Title:  Transaction-based Business Intelligence - Leveraging HIPAA to Gain Value from Transaction Data

Session Focus/Summary:

Precious resources have been diverted to achieve "compliance", but the return on investment has been elusive.  For many in the healthcare industry the concept of "Administrative Simplification" has become an oxymoron.  There is little doubt that we need to create a more interoperable environment in healthcare; an environment that provides not only greater efficiency, but also assures that information is consistently defined and easily available across enterprises.  This presentation will explore the challenges that we are facing in sharing information to support critical business functions and appropriate patient care.  It will identify new opportunities to acquire "actionable information" that has become available due to the HIPAA legislation.  The advantages of using Transaction-based Business Intelligence through the use of standard transactions will be reviewed.

Learning Objectives:

1. Understand the issues with extracting information about healthcare events from processing-focused legacy systems.

2. Define the concept of event centric vs. processing centric view of healthcare data.

3. Evaluate the role of the HIPAA transactions as a potential source of business intelligence data.

4. Review potential applications of a transaction-based data repository.

5. Examine the advantages of a transaction-based approach to data extraction as compared to legacy system queries.

Biography:

Dr. Joseph Nichols is currently Director of Healthcare Solutions for Edifecs.  Prior to coming to Edifecs, Joe served as the Chief Medical Information Officer for Paladin Data Systems and also provided independent consulting for a number of payor and provider clients related to healthcare claims data.  Dr. Nichols was previously President and founder of CHIS (Community Health Information Services, now Adaptis).   While at CHIS, he was responsible for all systems development and operations for a company that processed and distributed over $200 million in premiums a year.  Prior to his five years at CHIS, Joe was Vice President for Managed Care with LYNX Medical Systems.  Prior to his position at LYNX, he was in active practice as a board certified orthopedic surgeon for 15 years.

Dr. Nichols holds a clinical assistant professor appointment with the University of Washington and teaches a course for the Health Information Administration program.  He was a contributing author to a university textbook on electronic medical records.  He has been active in state and national professional associations, Washington Health Policy Board, the Washington State Department of Health, the University of Washington, the Foundation for Health Care Quality, and many other organizations involved in issues related health information policy.  He has a number of national and regional publications related to issues around health policy, quality improvement, and health information systems.

Dr. Nichols has extensive knowledge of HIPAA Privacy, Security and Transactions and Code sets.  He has authored an educational CD focused on physician practices on behalf of the State Medical Association.  He has been a consultant and presenter for the Washington State Medical Association, CHITA (Community Health Information Technology Alliance) and CMS, and has presented more than 20 times around the State of Washington over the past 2 years on HIPAA Privacy, Security and Transactions requirements.