Realizing the potential for HME

Tuesday, September 24, 2013

Electronic signatures have the potential to save our industry a great deal of time and money but there are barriers to their use. How can we overcome these obstacles and start using their transformative power?

I have spent a great deal of time thinking about electronic signatures in my business and, more broadly, in the medical devices industry. Understanding the definition of an electronic signature and the HIPAA implications, as well as how it can be effectively deployed for my company, has been critical to developing a plan to use this technology. I discovered that the largest barrier to the adoption of electronic signatures is our thinking about it.

Forty-seven states have adopted the Uniform Electronic Transactions Act (“UETA”), which is designed to promote the recognition of electronic signatures. (Illinois, New York and Washington state have not adopted the UETA, though these states do have other laws that recognize electronic signatures.) In looking for rules for my business, I focused on Pennsylvania, which has adopted broader regulations.

An electronic signature is defined as “an electronic sound, symbol or process attached to or logically associated with a record, and executed or adopted by a person with the intent to sign the record.” For example, a signature can be a typed name, a click-through dialog box combined with other identification processes, biometric measurements, digitized pictures of handwritten signatures, or an encrypted authentication system.

With respect to electronic signatures, HIPAA requires five implementation features: access control (the system allows access to only those persons or software programs that have been granted access rights); audit controls (a company must determine reasonable and appropriate audit controls for information systems that contain or use electronic protected health information); message integrity (the data arrives unaltered); user authentication (verification of the identity of the sender and the recipient); and transmission security (guarding against unauthorized access while the information is being transferred over an electronic network).

There are more details to all of this, but the law is very clear: We can use electronic signatures in our business if we follow the rules. So why don’t we?  

The primary barriers to using electronic signatures in our industry are related to physician adoption of this technology and the costs associated with electronic signature platforms. Let’s look at these two separately and see if we can’t move the thinking here.

Physicians must sign documents on every order. There is no way around that. They must coordinate the care, and their signatures and notes are critical to the funding of the devices we sell. We are not going to get them to broadly adopt our electronic platforms, especially with so many different groups of folks looking for them to sign their documents. 

The driver here is the physician practice software. When an interface for the physicians to accept and sign electronic documents is developed, we (as an industry) will be able to connect to them directly. While there may be some pockets in medical group-owned DME and O&P entities where platforms are shared, this outbound-to-companies electronic relationship will be driven by the software providers that the physicians employ.

While every order needs that physician signature, it is only one of many signatures needed to provide sufficient clinical, internal sales, end user and other compliance data. We have needs for signatures in all of these arenas and also have to collect and retain those documents in a manner that is compliant and will stand up in an audit.

The second barrier relates to cost. Electronic signatures that are collected in a compliant manner are expensive. Adobe and other companies have platforms that are good, but they do not integrate with medical device industry billing software packages and they are expensive fee-for-signature models. Large companies cannot absorb those costs, especially when the outside signature platforms do not introduce sufficient efficiencies that would be found in an enterprise platform that was integrated with the company’s billing software. The cost of these solutions is a barrier unless significant efficiencies to a company’s workflow process are realized. 

So what is a small company like mine to do? I have met with many organizations that struggle with the documentation collection portion of our business model that understand a broad-based electronic signature platform is needed. Given the cost barriers and lack of good options, I decided to write software to manage this problem for my business.

 The challenge was to create a solution that integrated with my billing software (Brightree), collected all of my documents in a compliant manner and employed a variety of collection vehicles, including electronic signatures. It had to be designed for our industry with workflows that would match what we are doing every day.  

I knew it could be done because I have developed different software solutions for issues we have had in the past that really helped my company be efficient. This time, we developed a documentation management system that automatically creates documents from our Brightree billing data via their application processing interface (API). This solution transforms the workflow process I employ and offers us terrific efficiencies in our business model.

Our industry as a whole is behind with electronic signatures. My senior staff was in support of using them even without the physicians. We felt that the doctors may take a while to open up their platforms, but there is a great deal we can do to make ourselves ready using the tools we have.

Here are some good questions to ponder: What processes would operate differently if you collected 50% of your documents electronically with signatures? How would you realize efficiencies? Could our care model benefit from these methods and ideas? How quickly can you move to a “paperless” office? What would you do with all of those stackers?

Electronic documents, charts, signatures and other types of technology are heading our way and it is a good thing. Be ready for it and find a way to make your transformation to this new reality a competitive advantage for your company.

Jim Noland, SMS/ATP, CRTS, is the founder of Presque Isle Medical Technologies and Conduit Technology, the parent company of the web-based documentation tool LMN Builder and the forthcoming cloud-based clinical documentation tool Conduit Office. Reach him at