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News and Trends

October 1, 1998
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Oasis Is Here. Are You Ready?

OCTOBER: THE LEAVES ARE CHANGING COLORS, football season’s here, and, ready or not, it’s time for all Medicare-participating home healthcare agencies to start collecting OASIS-B (Outcome and Assessment Information Set) data.

Many agencies are prepared to submit the HCFA-required health and functional status assessments with their home healthcare software that is already equipped with OASIS extraction capabilities. Some are even capable of collecting the information electronically at the point of care with handheld devices.

But not the majority, says Steve Lund, executive director of the Minnesota HomeCare Association. "Most of our agencies are too small to be technically compliant."

Reiterating the concern of a small agency in southern Minnesota with 70 clients, 15 of which are not eligible for Medicare, Lund says the agency still doesn’t know what it’s going to do about OASIS. "It doesn’t make sense for them to spend money on that kind of stuff." A small agency operating on narrow margins often has a hard time budgeting for the equipment required to collect data, he says.

So what are agencies that are lagging behind going to do? For starters, HCFA, the government department that administers Medicare, is providing free software called HAVEN (home assessment validation and entry) for entering and transmitting OASIS data. Nurses will continue to make rounds with pencil and paper to collect outcomes information and an assistant will enter the data manually on a PC.

Alternatively, those agencies that have made an investment in scanning technology can skip the data entry step. "But I’d be surprised if half the agencies have the capability to do this," Lund says. The third option is to collect OASIS data at the point of care.

Home healthcare consultant Tom Williams estimates that as many as 15 percent to 20 percent of home caregivers are using computers at the point of care. But for a typical home care agency with 30,000 to 35,000 visits and only 1,500 OASIS assessment per year, "checking a box on a piece of paper can often be more efficient," Williams says. "From a financial standpoint, it doesn’t always make sense to automate clinicians at the point of care."

Regardless of the preparedness, home health agencies are required to start sending assessment data electronically to their states’ survey agency on a monthly basis, beginning Jan. 1, 1999. The state agency--in most cases the Department of Health--will compile the data and send it to HCFA.

Lund agrees that HCFA’s premise with OASIS is good, and even the government’s pressure on agencies to become automated has proven benefits in reducing costs and serving the patient with quality care. But it’s not just OASIS that home healthcare agencies are dealing with now, Lund says. Reimbursement rates have been cut by 15 percent. They are also facing the interim payment system, surety bond issue (currently on hold) and JCAHO’s ORYX performance measurement requirements. "We have three or four elements hitting at the same time, any one of which would be enough to cause commotion in an industry like home care," Lund says.

But many feel that the industry has had plenty of time to prepare for OASIS. "The industry’s been talking about it for awhile now," Williams says. "HCFA turned up the heat with respect to electronic claims submission a few years ago which forced agencies to consider automation."

The real winners in this situation are vendors with clinical data capture tools, he says, with virtually every clinical system vendor building the OASIS data set into its software.

--Jeffrey Elliott

Editor’s Note: For more information on home healthcare information systems, including vendors that offer OASIS-compliant software, please see our coverage beginning on page 75.

Effort to Secure Standards

A NEW CONSORTIUM IS CALLING FOR STANDARDS development organizations, vendors, providers, security advocates and government agencies to promote healthcare IT security standards.

The group, comprised of the Healthcare Open Systems and Trials (HOST) organization, National Information Assurance Program (NIAP) and ARCA Systems is trying to fill the gap between healthcare data security policy and standards development. "Policymakers have no standard to implement," argues HOST executive director Lewis Lorton.

According to Lorton, the project needs comprehensive industry support--first to define what data elements need to be protected; and second, to determine how to apply a standard to healthcare applications.

NIAP--a partnership between the government’s National Institute of Standards and Technology and National Security Agency--asked HOST to facilitate the effort. Stealing a page from the International Organization of Standardization (ISO), those involved will create healthcare "protection profiles" that outline the requirements needed to protect health information and assign the standards that ensure product compliance.

The model used in developing protection profiles is based on common criteria for information technology security evaluation. This methodology was developed by the United States, Canada, the United Kingdom, France, Germany and the Netherlands in the early 1990s for advancing ISO security standards. The common criteria approach defines the enviroment of information that must be protected.