[Histonet] RE: CMS Postpones Deadline for Physician Signatures

Wed Dec 22 10:40:05 CST 2010

I completely agree that both electronic and paper requisitions will require strict processes to ensure that either the hand written or electronic signature is secure and correct. Even after CMS "educates" us, their process and direction will probably be vague and will require all our best efforts.

MERRY CHRISTMAs and have a WONDERFUL NEW YEAR!!!   

William DeSalvo, B.S., HTL(ASCP)

Subject: Re: CMS Postpones Deadline for Physician Signatures
Date: Wed, 22 Dec 2010 09:09:32 -0700
From: JEllin <@t> yumaregional.org
To: wdesalvo.cac <@t> hotmail.com; trathborne <@t> somerset-healthcare.com; jweems <@t> sjha.org; histonet <@t> lists.utsouthwestern.edu

Yes we received the update.  But there is still questions about difference from electronic ordering CPOE vs review and verify correct entry before proccessing by a clinician.  Even though it states that this does not address electronic orders. We feel that this can be a problem for the future.  

Sent via DROID one Verizon Wireless

-----Original message-----

From: WILLIAM DESALVO <wdesalvo.cac <@t> hotmail.com>
To: trathborne <@t> somerset-healthcare.com, Jesus Ellin <jellin <@t> yumaregional.org>, jweems <@t> sjha.org, histonet <histonet <@t> lists.utsouthwestern.edu>
Sent: Wed, Dec 22, 2010 15:44:34 GMT+00:00
Subject: CMS Postpones Deadline for Physician Signatures

I have just received notice that the CMS requirement for Physician Signature Deadline of Jan 1, 2011 has been postponed.

http://www.cms.gov/ClinicalLabFeeSched/

CMS has decided that in the first quarter of 2011 they will be developing educational and outreach materials to help educate all of us that are affected by the policy change. Looks like we have a little more time to figure this new process out.  

William DeSalvo, B.S., HTL(ASCP)

> From: wdesalvo.cac <@t> hotmail.com
> To: trathborne <@t> somerset-healthcare.com; jellin <@t> yumaregional.org; jweems <@t> sjha.org; histonet <@t> lists.utsouthwestern.edu
> Date: Fri, 17 Dec 2010 12:38:12 -0700
> Subject: RE: [Histonet] Physician Signatures
> CC: 
> 
> 
> They sign into the case prior to surgery, they have Physician Assistant (PA) assigned to the case, a nurse is assigned to the case and they then enter additional information into the system after they complete surgery. It meets requirements. In Pathology, many of your Frozen Section specimens arrive in the lab on verbal orders or nursing applying a signature and we have processed for years. I believe the key point that you have to wrap your head around is that the electronic orders by the surgeon are complete before there is any delivery of results, the signed and preliminary or final report by the pathologist and that meets regulatory requirements. I have more concern on the clinical side. Orders can be entered, tests performed and results delivered more easily than in Pathology. 
> 
> William DeSalvo, B.S., HTL(ASCP)
> 
> 
> 
> 
> 
> > Subject: RE: [Histonet] Physician Signatures
> > Date: Fri, 17 Dec 2010 14:06:04 -0500
> > From: trathborne <@t> somerset-healthcare.com
> > To: wdesalvo.cac <@t> hotmail.com; jellin <@t> yumaregional.org; jweems <@t> sjha.org; histonet <@t> lists.utsouthwestern.edu
> > 
> > So how do the surgeons electronically order a test? Do they order it before the procedure? What if they discover something and need to add an additional specimen? Our orders are electronically entered in the OR during the procedure. The surgeon is scrubbed and performing the procedure while the circulating nurse places the order.
> > 
> > -----Original Message-----
> > From: histonet-bounces <@t> lists.utsouthwestern.edu
> > [mailto:histonet-bounces <@t> lists.utsouthwestern.edu]On Behalf Of WILLIAM
> > DESALVO
> > Sent: Friday, December 17, 2010 1:56 PM
> > To: Jesus Ellin; jweems <@t> sjha.org; histonet
> > Subject: RE: [Histonet] Physician Signatures
> > 
> > 
> > 
> > I previously did not go into to deep detail about security and compliance, but in our system all computer portals are password protected, orders are signed with electronic signature of the ordering person and when a hard copy paper form is printed, the ordering physician's electronic signature is applied. It is the same type of process and signature that is used by the pathologist to electronically sign off all pathology reports. I absolutely agree that you must control access to ordering and maintain integrity in the system. As you work through your process to develop a more electronic system, you will have the opportunity to build in and require proper controls. With those controls implemented, you can then become confident that the electronic process can and will meet your regulatory requirements. 
> > 
> > William DeSalvo, B.S., HTL(ASCP)
> > 
> > 
> > 
> > 
> > 
> > > Subject: RE: [Histonet] Physician Signatures
> > > Date: Fri, 17 Dec 2010 10:46:15 -0700
> > > From: JEllin <@t> yumaregional.org
> > > To: JWeems <@t> sjha.org; wdesalvo.cac <@t> hotmail.com; histonet <@t> lists.utsouthwestern.edu
> > > 
> > > This is true about electronic ordering but there is a provision on what
> > > is acceptable for electronic order, just ordering in a system and
> > > spitting out requisitions does not comply, There needs to be password
> > > verification and review of this information by the clinician before it
> > > is ordered and sent to the laboratory performing the service when the
> > > requisition is created. They go on to say that orders and requisitions
> > > are different aspects and should not be confused. IF the orders are just
> > > received through an electronic interface then there is a difference.
> > > But if the specimen is received using any paper form then this needs to
> > > be signed by the clinician either electronically or manually.
> > > 
> > > We are looking at this really closely, with using paper requisitions,
> > > even orders from the OR for frozens, molecular studies, interoperative
> > > work, all needs to be signed by the surgeon. Can you imagine the impact
> > > that this is going to cause. 
> > > 
> > > Our current solutions is to have maybe standing orders in place and move
> > > and look at process within the Main OR's, outpatient OR and clients.
> > > Once again a huge problem,, but Bill is right this will lead to more and
> > > more paperless enviroments.
> > > 
> > > 
> > > Jesus Ellin
> > > Yuma Regional Medical Center 
> > > 
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