2011 in review

I wasn’t as active on my blog as I should have been this year, but this is kind of fun anyway.  The WordPress.com stats helper monkeys prepared a 2011 annual report for this blog.

Here’s an excerpt:

The concert hall at the Syndey Opera House holds 2,700 people. This blog was viewed about 12,000 times in 2011. If it were a concert at Sydney Opera House, it would take about 4 sold-out performances for that many people to see it.

Click here to see the complete report.

Thanksgiving 2011

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Thanksgiving – 2011

Hello everyone: I know I have been remiss in my blogging duties – primarily because of many of the things that I am so thankful for this year! There just aren’t enough hours in a day or days in a week to fit it all in.

My list of “what I am thankful for” this year is very similar to last year’s list, with a couple of notable exceptions.

Here is what I continue to be thankful for, and what I am newly thankful for, in 2011.

1. As always – my children. So ok, not so much “children” anymore, but all of you parents out there understand what I mean. I continue to be amazed at their bravery in following their own paths – Erin in her pursuit of an education that will support her desire to champion human rights and Patrick in his studies that allow him to understand and express the human condition so beautifully, while their less-than-brave mother followed a more practical and safer path. I am continually grateful that they allow me to live my dreams vicariously through them. I am also once again grateful that I can sit here writing while my daughter cooks in the kitchen on this Thanksgiving! The smells coming from the kitchen are delightful…

2. Honbun – as always my rock and the guy who makes it possible for me to do whatever it is that I seem to spend so much time doing. Because despite how many balls I manage to keep up in the air at work, I cannot manage to remember that my car needs gas. I am completely aware of how spoiled – and lucky – I am in having a partner like him. I am thankful for him every day of my life.

3. M*Modal. What can I say? I am amazed every day at the vision of Michael Finke and the rest of the team at M*Modal and after more than four years I still can’t believe I am lucky enough to work with them. This year I am also grateful for the opportunity MedQuist gives us in furthering our mission to serve health care.

4. My healthcare provider customers. I pinch myself every time I get to talk to people like those at Mayo Clinic, Geisinger Health System, and MD Anderson Cancer Center. These places and others like them are what health care aspires to be – and we at M*Modal aspire to serve.

5. University of Pittsburgh Health Information Management and Health Information Systems programs. What do they put in the water over there at Pitt that produces such knowledgeable HIM and HIS professionals? Under the leadership of Valerie Watzlaf, Patricia Anania-Firouzan, and the other staff members, this program is doing something right. Looking for talented HIM professionals? Looking for a terrific education in an important field? Look no further than Pitt.

6. Last – but in no way least! My new Health Information Services team at M*Modal. Dan Engel, Kaitlyn Crowther, and Nathan Gibbon (you’ve “met” them all previously on my blog). Related to item #5 on my list (all three are from Pitt), but also bringing their own unique attributes to the brand new team at M*Modal dedicated to learning about how M*Modal can better serve health care, these folks are such a pleasure to work with. I am having more fun working with these passionate and talented people than I’ve had in 30 years in the business. You’ll be hearing more from them as time goes by – and they leave me in the dust…

Wishing everyone a wonderful Thanksgiving…

Lynn Kosegi

M*Modal

The Classroom vs Practice in Health Information

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As M*Modal heads out to Salt Lake City today to attend the 2011 AHIMA Convention and Exhibit, I thought it particularly appropriate to kick off the week with a guest posting from a relatively new member of the M*Modal team and graduate from the University of Pittsburgh’s HIM program, Nathan Gibbon. Today’s HIM students spend a great deal of time learning about the benefits of electronic health information and it is interesting to hear about their experiences in the real world after they graduate.

Nathan Gibbon graduated from the University of Pittsburgh’s HIM program in the spring of 2011, after which he was hired as a healthcare implementation business analyst by M*Modal. Before graduation, Nathan did his six-week clinical at M*Modal working on the identification of information for core measures reporting in documentation. Nathan’s senior project, “Using Natural Language Processing to Improve Reporting of Core Measures for Pneumonia,” completed with fellow Pitt student Dino Mascio also at M*Modal, won first prize at Pitt’s 2011 SHRS Student Advisory Board Poster Competition. So, please welcome guest blogger, Nathan Gibbon.

I attended an excellent Health Information Management program at the University of Pittsburgh. I was taught well, and I enjoyed my time there. In my classes we learned about the Electronic Health Record (EHR) and Electronic Medical Record (EMR), and how they have and will revolutionize the healthcare industry. I learned how the electronic systems will provide ongoing documentation of patient information that doctors will be able to access from all over the world.

Fast forward two years later…I am now working for a company which seamlessly integrates its speech recognition and natural language technologies into healthcare documentation workflows, and which helps to increase adoption and usability of electronic health records. The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act (ARRA) of 2009, was signed into law on February 17, 2009, to promote the adoption and meaningful use of health information technology. These acts saw a plethora of electronic health record systems spring up, along with hospitals spending big money to have the systems implemented.

The textbooks provided for my classes went over workflows, systems analysis, waterfall diagrams, Microsoft Access databases etc….all to help an electronic record system be created, implemented, and used effectively. One of the best experiences the program gave me was the Clinical Experience class. We had four individual clinical experience sessions, one per semester. In this class, the students were sent to a hospital, somewhat of our choosing (I picked one close to my house), and were placed in the Health Information Management Department or Medical Records Department. Not everyone’s facility was the same, but for the majority of us, we had similar experiences. I was shocked to see that this hospital was able to run on such little staff, rushing around a basement floor with paper records. Some records were stored on moveable shelves (that I played with frequently when bored), others were stored on random carts, and others were left on the floor of a dark room. The hospital I was assigned to failed to comply with some standards for housing medical records set by the Joint Commission, (formerly JCAHO). Several of my classmates spoke of their clinical sites in the same manner. The facilities simply did not have the room to house all the medical records – not to mention that paper records deteriorate over a long period of time. From that experience I saw the desperate need for the electronic health record in healthcare. All the space, time, and resources wasted on the paper records could be simplified if they were made into electronic format. I was onboard.

For my final clinical experience, CE4, I requested to be placed at a local health information technology company, Multimodal Technologies (M*Modal). The company provides an on-demand Software as a Service (SaaS) business model (in “the cloud”) and their solutions are all based on a standard for information exchange, HL7 CDA. When I first began my Clinical Experience 4, I thought this company was a competitor of the major EHRs in the healthcare world. However, after a talk with the Chief Technology Officer (CTO), Detlef Koll, I learned otherwise. M*Modal can help to increase adoption of the EHRs which might otherwise be cumbersome for healthcare providers to use. Some hospitals implemented major brands of EHR systems which I was surprised to learn do not communicate with other systems because they do not use a standard format for data exchange. This means there is zero interoperability, something we learned from our textbooks that electronic health records would provide.

In conclusion, the way health information management and electronic health records are described in textbooks does not exactly play out in real world scenarios. The information I learned in school was very helpful, and the benefits of EHRs are real, however, the healthcare environment won’t see those benefits when systems cannot readily communicate with adjacent systems. In conjunction with systems being able to communicate and being able to transfer data, systems should be built specific to what the users really need. This will prove to be a long and difficult process. Software vendors will have to spend many hours studying physicians and healthcare providers in order to understand exactly how they are interacting with the system. But until that work is done, systems will continue to be cumbersome for those that interact with them.

Nathan Gibbon
Healthcare Implementation Business Analyst
M*Modal

AHIMA, Health Information, and Value-Based Health Care

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Hello everyone: It is almost that time again! The days are getting cooler, and Fall is in the air. We know what that means, right? It is almost time for the AHIMA National Convention and Exhibition! This year the convention is in beautiful Salt Lake City, Utah and I can’t wait! This will be a particularly interesting conference with so much going on in the world of health information. Health care providers are deep into conversions to electronic health records at the same time that are gearing up for the conversion from ICD-9 to ICD-10 coding. New technologies such as natural language technologies and computer assisted coding are being discussed. Perhaps most interestingly, the HIM profession is making plans on how to support new models for healthcare delivery including accountable care and the patient-centered medical home, because regardless of what happens on The Hill in DC, the move to value-based healthcare must happen.

Those of us in the transcription industry must pay particular attention to the changes occurring in HIM. As discussions about computer assisted coding and ICD-10 occur, it becomes more apparent than ever that complete, comprehensive narrative clinical documentation is a must-have and a no brainer. Despite talks of how transcription will be eliminated by the EHR, we still have a huge role to play in the delivery of care to patients.

Follow this link to my posting on Excellence in Health Information to hear a bit more. And I hope I see you all in Salt Lake City!

Til next time,
Lynn
M*Modal

Speech Recognition – Throw Away Everything You Thought You Knew – from AHDI ACE 2011

Hello everyone: I apologize for taking so long to get these slides uploaded! I’ve been crazy busy traveling, and then playing catch up after traveling. I’m looking forward to writing more about ACE 2011 (very exciting this year!) as soon as I get a few moments, but I wanted to get these out to you now.

AHDI_ACE_20110821

And for anyone who wants more information about some of the things mentioned in my slides, here are some links to previous articles:

Speech Recognition – general

Is Speech Recognition the answer to all your problems?

Speech Rec is here to stay…

MT Compensation and Management

MT Compensation

The Demise of the Career MT

What Factors Contribute to MT Career-Mindedness?

Optimization of speech recognition Technology Results

When Metrics Mean Nothing – The Myth of the “Percent Gain”

What does the Medical Transcription Industry Sell?

Narrative Documentation, Standards

Are we Telling the Real Health Story?

A Vision for Truly Meaningful Health Information

The Documentation and Coding Adjustment (DCA): A CDI Specialist’s Perspective

This week on Excellence in Health Information, I am pleased to present Donna Wright, MSN, RN, CCDS, currently a medical coding data analyst at M*Modal, formerly a Clinical Documentation Improvement Specialist for a health system here in Pittsburgh. Donna has a 28-year-long nursing career and has worked in a variety of fields including critical care, OR, clinical research, and supervisory/management in long term care. She is a graduate of Lehigh University, St. Luke’s School of Nursing, with a BSN from Slippery Rock University and MSN in Informatics from Walden University.  Donna is married to a structural engineer and has two grown children.

Donna brings up some interesting points in her post about clinical documentation improvement and the stance CMS has taken with respect to changes in reimbursement levels resulting from documentation improvement.  I visited a provider two weeks ago who told me, “we are only asking to be paid for what we are actually doing – no more and no less.” What does everyone think? Do you have a story to tell about CDI in your organization?

See what Donna has to say here…

Health Information – the Exciting Road Ahead!

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Hello everyone:

I have been privileged over the past couple of weeks to visit some of the most prestigious health care providers in the country and to hear their thoughts about the state of health information today.  I can tell you that we in the health information field are in for some exciting times ahead!  Whether we work for HIT or HIM companies or for health care providers, the changes occurring in health care mean that our roles in serving health care are changing too.  So there could be no better time to pick up our conversations again on Excellence in Health Information.

See the rest here…Health Information – the Exciting Road Ahead!

Til next time!
Lynn
M*Modal

Change Ahead for M*Modal and MedQuist

Today’s world is full of change.  In the world of health care, with new discoveries, new treatments, and new technologies found seemingly every day, change may be the only constant.

And so it is with businesses that support health care, where change can lead to the need for migration to new service and product offerings and to corresponding changes in business models.  Consolidations of businesses in the health information service and technology domains often occur as companies seek to increase revenues, take advantage of synergies, or as in the case I’m going to talk about here, to merge two companies with different but complementary talents as part of a growth strategy.

Most of you have probably heard that my employer M*Modal is about to be affected by such a change.  On Monday, July 11,  a merger between M*Modal, a leader in speech recognition and natural language understanding technologies, and MedQuist, a leading provider of medical transcription services and documentation workflow technology, was announced.  It was also announced that Vern Davenport, former CEO of Misys Healthcare and long-time HIT industry leader, will become the CEO of the combined company.

This announcement came as a surprise to many who know us as the small but quickly growing company whose senior executives are the very guys you came to know as industry innovators.  It may not have been a surprise to some, however, who in view of market activity in recent years wondered at M*Modal’s ability to compete against significantly larger companies.

And though we at M*Modal have rather enjoyed being David in a David-and-Goliath-like competitive environment, our leaders understood that now is the time when acceleration of our efforts is needed for our customers.

MedQuist too has been observing changes in the industry and sees value in combining their world-class services with the industry-leading technology that will allow them to offer their customers the best of both worlds – innovative technology offered by people who understand the world in which it will be implemented and used.

What does this mean to M*Modal customers and to its partner relationships?  It means only good things.  To the partners who rely on M*Modal technology to provide services to their customers, it means robust strength.  To the partners who incorporate M*Modal solutions into their technology offerings, it means partnership with a company with greater market presence.  To our health care provider customers, it means greater flexibility and options.  And since M*Modal understands that our customers need us to act fast in response to health care’s changing needs, then perhaps most importantly, this merger means that M*Modal will have the ability to bring solutions to health care faster.

Many of you have been kind enough to ask what this means to me personally.  To be honest, I was surprised at the announcement, and was admittedly concerned.  I mean, anyone who knows me knows that I believe in M*Modal and its vision with my whole heart.  But… after a visit from our future leader, Vern Davenport, my concerns have changed to excitement, hope, and even eagerness.

In speaking with the M*Modal team, he made it clear that this is not a case of one company absorbing another.  To the contrary, he explained that we are two companies joining forces to support health care providers as they continue to adopt electronic health records and as they embark on the transformation to value-based care.   He told us that his role as the CEO of the newly formed company will not be a job for him – it will be a mission.  He said he is here for one reason – to make an impact on health care. Well, for me that was the statement that clinched it.  I’m in.

In short, this new relationship will ensure that M*Modal can continue on its path towards creating a collaborative ecosystem for health information that supports the health care provider and which contributes to health care itself.  We have always strived to serve those who serve the patient – and now we’ll have the ability to do so with even greater impact.

For the immediate future, the two companies will continue to operate separately as all the i’s are dotted and t’s are crossed.  But stay tuned for more!  I’ll be sure to keep you updated…

In the meantime, like me, rest assured that we are not the Starship Enterprise and the Borg (you know, “you will be assimilated. Resistance is futile.”)  Like Jean Luc Picard, current M*Modal CEO Michael Finke and the other M*Modal leaders will continue to lead us as we “boldly go where no one has gone before” into the exciting times ahead.  (CBS Entertainment, 2010)

For more details, here is a link to the formal announcement  http://www.medquist.com/Home/tabid/36/Default.aspx

All my best as always,

Lynn

Still M*Modal

Disclaimer:  All nerdy Star Trek references are mine – not to be blamed on anyone else at MedQuist or M*Modal.

CBS Entertainment. (2010).  Star Trek^TM. Retrieved July 14, 2011 from http://www.startrek.com/.

Response to Questions…

Hello everyone:  Over the past couple of months I’ve been privileged to present at several conferences and to do a couple of webinars. Since then some questions about these presentations have been sent my way (thank you!).

I thought it might be helpful to provide some links to some past articles that might be of interest to anyone who has questions about some of the presentations.

Thanks so much for proving once again how dedicated the people in the health information industry are to providing and producing high-value health information!

As always, questions and comments are most welcome!

Lynn,

M*Modal

Speech Recognition – general

Is Speech Recognition the answer to all your problems?

Speech Rec is here to stay…

MT Compensation and Management

MT Compensation

The Demise of the Career MT

ACE 2010 Presentation – Keeping Transcription Relevant into the Future

What Factors Contribute to MT Career-Mindedness?

Slides from NEMA AHDI Presentation…

Optimization of speech recognition Technology Results

When Metrics Mean Nothing – The Myth of the “Percent Gain”

What does the Medical Transcription Industry Sell?

Narrative Documentation, Standards

Are we Telling the Real Health Story?

A Vision for Truly Meaningful Health Information

Speech Recognition as the Accelerator of Meaningful Clinical Documentation

Hello everyone: Over the last couple of weeks I had the opportunity to attend several conferences. One was the national conference of the Case Management Society of America (CMSA) (more about this visit later) which was held in San Antonio, Texas, (home of the Alamo). Then I had the privilege of presenting to two state HIMA conferences; New Jersey (NJHIMA) in Atlantic City, and then back to Texas (TxHIMA) for their state conference in Dallas.

As always, I really enjoyed meeting with state HIMA members. It is so satisfying to know that wherever you are in the country, HIM professionals have the same passion for safe, high-quality, useful health information. It is also interesting to see that everyone seems to be facing the same challenges with respect to adoption and use of electronic health records. Everywhere I go, I hear the same stories about point-and-click, template-driven EHR systems that are time-intensive and cumbersome for the physician, that don’t provide the necessary information for the HIM, and which cause concerns for the health care enterprise because of costs and questionable ROI.

Needless to say, there is always interest in discussing narrative documentation including how to produce it cost-effectively and efficiently, and how it can be used to generate the discrete data needed for the interoperable exchange of information, to provide data for reporting and analysis, to drive clinical decision support and other automated care protocols, and in general, to realize the benefits that we all expect as we make use of electronic health information.

Some of you have seen these before, but just in case, here are my slides:  NarrativeDocumentation_HIMA_20110629.

In a nutshell:

1. Today’s changing health care environment is setting higher standards for documentation while seemingly making it more difficult for physicians to document patient care. The need for documentation to support Meaningful Use, to drive the communications and reporting necessary for Accountable Care and the Patient-Centered Medical home, to enable the conversion to ICD-10 from ICD-9, and to support the reporting required to monitor quality and outcomes is increasing. It is more apparent than ever that comprehensive, complete, and accurate health information is integral to the functioning of any health care facility. And yet newer methods of documenting patient care are often inefficient and time consuming for the physician and are not intuitive for other consumers of health information.
2. Dictation is still a viable, economical, and effective means of capturing clinical information.
3. In order to be cost- and time-effective, options for clinical documentation must be made available based on the type of encounter being documented and the needs of the user. For some encounters, templated, structured forms are likely sufficient. For others, physicians may do very well with speech recognition and self-editing. For more complex encounters, physician dictation supported by skilled medical transcription might still be the best way to go. The point is – health care providers must have flexibility and options for capturing the complete, comprehensive level of information required to support patient care, coding for billing and reimbursement, research and population health reporting, and all of the other uses for health information.
4. Speech recognition and other technologies, when combined with efficient management practices, can be a cost-effective way to produce high-quality narrative documentation.
5. We cannot continue to look to the best practices that many services and providers have historically followed when implementing speech recognition. In the past the goal might have been to “create cheap documentation fast” – now the goal for clinical documentation MUST be, “create useful documentation efficiently.’
6. Quality is key. We are all hearing a great deal about natural language processing, computer assisted coding, and other technologies that will help us to process and make use of our health information – but if the documentation at the foundation of these technologies is poor – the technology can’t do its job.
7. Efficient management practices are another key component. The percentage of productivity gained does not necessarily reflect the increase in output! Again, technology is no replacement for effective management practices.
8. It is not, as many believe, necessary to eliminate narrative documentation in order to have semantically interoperable electronic information. The Health Story, HL7, IHE Consolidation project is making great strides towards the creation of interoperable standards for the exchange and use of health information which will allow us to have the structured and encoded clinical data that we need to support automated processes, while at the same time retaining the human-readable narrative information that is required for communication and understanding. I personally have always been a big believer in having my cake… and eating it too. 

If you have any questions about the slides or the presentation please let me know. I’d love to hear your thoughts and experiences!

Till next time,
Lynn
M*Modal