Health Information – what exactly IS the problem?

Do we know what problem we are trying to solve with all of our discussions about health information, IT, and meaningful use?

Depending on which group you are following, the problem might be:

  • Lack of training and change management upon implementation of an EMR
  • Lack of workflows that work for the clinician as they perform patient care
  • Interference with the physician – patient relationship, and the time it takes the physician to document patient encounters
  • Systems that do not make use of the information available in narrative documentation
  • Lack of discrete data
  • Systems that do not communicate with each other
  • Cost
  • Increased information requirements for coding driven by ICD-10-CM, POA indicators, and other changes that require the HIM to have MORE information when template-driven EMRs mean physicians sometimes provide less information
  • Lack of information available to the patient for his/her own care
  • And on and on and on….

If no one agrees on what the problem is, how do we create a solution?

The problem isn’t lack of documentation. We have handwritten notes, and history and physical reports, and operative reports, and consultation reports, and letters to referring physicians, and ED reports, and discharge summaries, and lab reports, and x-ray reports, and social service notes, and physical therapy notes, and dietary notes, and medication orders, and nursing notes, information in the HIS, the RIS, the PACS, the document management system, the inpatient EMR, the physician practice portal, the primary care provider’s written notes, the consultants notes, the anesthetists notes, the surgeon’s notes….

Good gravy –  we’ve got documentation coming out our ears!

BUT – none of it is connected!

EMR implementations and “meaningful use” sound like beautiful things…but if this EMR doesn’t talk to that EMR, and that EMR doesn’t talk to the HIS, and some documents are updated and printed from the transcription system because the EMR can’t format a letter, so the changes to that letter never get to the EMR, and the inpatient system doesn’t talk to the outpatient system, and none of the systems from one facility talk to the systems at another facility – have we really solved the problem?  Where is the source of truth for patient’s health information?

See that is the key I think…

We used to think in terms of paper documents. Written or dictated and transcribed; printed or uploaded through an HL7 interface, we thought in terms of documents. In many cases we still do.

Now “discrete data” is the buzzword of the day. To hear many people speak, “discrete data” is supposed to be the solution to all of our problems.

But just as documents are disconnected, so are discrete data points. When we have discrete data, we still don’t have INFORMATION.

Look up the terms “data” and “information” and every source will tell you that data in and of itself is NOT information.  Data doesn’t become information until it has been processed in a way that applies context and meaning. Knowing the patient’s temperature tells you nothing about the patient’s general health. Knowing that the patient’s blood pressure is normal doesn’t tell you the patient is healthy.

Some of us think the answer is to use NLP to extract discrete data from narrative reports and then keep the remaining narrative somewhere else in the EMR….

Let’s think about this.

We need the information from the narrative because the disconnected data points have no meaning without context. And the physician can dictate that narrative relatively conveniently. But the narrative isn’t available in the EMR – so we can’t get TO the narrative. And if the narrative IS in the EMR, we can’t get to the information IN the narrative. So we ask the physician to enter the information into the discrete fields of the EMR himself. But the EMR doesn’t provide the means for him to do this easily. So let’s let the physician continue to dictate. But now we’ve got that narrative report, and we can’t get TO the information in the narrative. Oh wait, sure we can. We’ll use NLP to pull discrete data FROM the narrative to put it IN the EMR, and now the information IS available…but oh wait, we just decided that discrete data is NOT information, but we DO have information in the narrative report, but we can’t get TO the information IN the narrative report, and we can’t share the information in the narrative report, so we’ll apply NLP to get discrete data FROM the narrative, which we can then put IN the EMR…


The solution to the healthcare information problem (if only we could agree on what the problem actually is) seems to be…

… to provide useful information in a way that does not interfere with the doctor – patient relationship, and which is readily available to all the consumers of health information.

With so much information available in so many different systems…how does any user of health information wade through it all?  If users can’t find the information that is “meaningful” to them…is any of it “useful”?

We need technology to ENHANCE the workflow of the humans who use it. We need it to capture truly meaningful and useful information.  Not collections of documents and not collections of data points, but actionable, accessible information. And then we need the tools that allow us to make use of that information.

What does the MTSO do in the meantime?

  • Understand what problem you are trying to solve, and commit. Are you trying to solve the physician’s problem?  The HIM’s problem? The CFO’s problem?
  • Create a strategy and a roadmap to address that problem – a strategy that is complete and end-to-end.
  • Create alliances and partnerships that support your goals. Why partner with a company that is driving away your business and driving your prices down by turning you into a nameless, faceless commodity?
  • Research your options for technologies that support your strategy.
  • Don’t get sidetracked. Have a checklist at the ready. Understand the need for a Chief Strategy Officer (maybe you) whose job it is to keep your company from straying.  Does every process or change you plan to implement support your strategy?  For example:
    • If your strategy is to provide ease of use for the physician, don’t get sidetracked into processes or technologies that reduce costs for the healthcare provider, but which force physicians to adopt practices that interfere with their work.
    • If your strategy is to support standards and meaningful use, don’t get fooled into adopting methods that reduce costs, but which do not support meaningful documentation.
    • If your strategy is to reduce costs for the healthcare provider, don’t get pulled into supporting service levels that increase your costs.
    • If your strategy is to improve the usefulness of information for HIM purposes, don’t be tempted to adopt requirements that will allow you to deliver the rock-bottom price, but which will do nothing to ensure that the HIM has better information available to them.

Til next time,


What does the Medical Transcription Industry Sell?

Are you selling what your healthcare provider customers want?

Do your customers know what they want?

The average MTSO does not differentiate between the service levels it offers its customers, except perhaps to price differently for tighter TATs and sometimes for the methods used to produce the documentation.

But how many MTSOs consider actual documentation service levels beyond TAT and quality when selling, implementing, and servicing a customer?

How many bill differently for differing levels of documentation service?

Even more interesting – how many MTSOs pay the MT  differently based on these same levels?

What do I mean by documentation service levels?

When it comes to clinical documentation, a healthcare provider (even if they don’t realize it) is usually looking for one of the following – or something somewhere in between:

  1. The lowest-cost line
  2. Meaningful documentation and EMR readiness
  3. Premium level service  – customization according to individual preference

The following will help you to determine the healthcare provider’s goals, and how to accommodate them in a way that makes financial sense.


Requirements and Specifications

There are providers out there, despite all the fuss about the EMR and meaningful use, who are –  let’s face it – only interested in how low that price can go. In fact, cost reduction is often the driver behind a provider who adopts a technology hoping to reduce or eliminate transcription. The dollar is all they are worried about.

To achieve the lowest-cost line, the focus for the use of speech recognition in the production of transcription needs to be on producing draft text that requires –

  • The fewest edits possible
  • At the lowest implementation cost

For the lowest-cost line, rules to handle content should be “as dictated”  or “verbatim” whenever possible. MTs should not deviate from verbatim transcription/editing unless what the doctor said is actually incorrect. They should not over-edit. The hospital should be told that in order to achieve the highest productivity and lowest cost line, they need to accept true verbatim transcription (unless of course what the physician says is actually incorrect).

What this means is that changes that might be made to the draft text for other service level types shouldn’t be made – if you are selling (and being paid for) the low cost line, you’ve got to deliver the low cost line! This means the onus for the content of the document is placed on the physician – not on the MT as it often is.

At a high level, this means the provider gets the sections and subsections they dictate, in the order dictated. They get numbered lists when explicitly dictated. They get abbreviations and acronyms as dictated. If they dictate clipped sentences, they get clipped sentences. They get document formats that are easy and cheap to implement, and which do not interfere with speech recognition.

Yes – many requirements of this type can be automated in some systems.

But remember – selling the lowest cost line does NOT mean focusing ONLY on decreasing the MT cost per line! It also means decreasing implementation and other support costs.

Selling the lowest cost line while maintaining high implementation and support costs means your MT payroll is taking the entire hit for the low cost line – and come on everyone, how low do you think MT pay can go if you still expect to deliver quality?

When offering a low-cost line, it is not cost effective to require the MT to lose productivity by performing manual formatting tasks.  It is not cost effective to pay implementations staff to create custom templates.


This type of implementation when done effectively will result in the fewest edits, highest MT editing productivity, and lowest implementation costs.


An MTSO providing the lowest cost line option to a hospital MUST require that hospitals comply with the requirements agreed upon during contract negotiations.

Sometimes a hospital agrees to requirements to get the lowest price, but after go live will request customization based on physician preference. “Can you please make this exception just for Dr. Smith? Just for Dr. Jones? Just for Dr. Miller?”

And before you know it – you’ve got a custom implementation for which you’re being paid a rock-bottom price!

The MTSO who gives into these requests while providing the service at the lowest price will find itself providing a high-cost product at a losing price. Implementation cost will increase, MT productivity will decrease, and the MTSO will lose.

And before we go on to the next service level – please folks – don’t let anyone tell you that “verbatim” transcription is the same thing as application of standards.  The only time “verbatim” means “standards” is if the physicians all, always, dictate according to standards. Which of course (ahem) they all will, right?

“Verbatim” transcription is often the furthest thing from useful standards there is…


This option is the one most encouraged by me  – and by my employer M*Modal.

The goal here is to create standards that increase the usefulness of documentation. Emphasis is on the value of the clinical information within the document, rather than on the individual document itself.

  • Physicians and clinicians know what content to expect in every document improving ease of use for patient care – EVEN if they are not the author of the report.
  • Coding and other HIM activities are easier because variation in clinical vocabulary is normalized.
  • Coding and other HIM activities are efficient because content requirements are designed to ensure that the clinical event is appropriately documented.
  • There is less re-work in the HIM department and less need for additional physician querying to collect information needed for coding and billing.
  • Compliance with the above and with JCAHO and other requirements can be reported on and enforced.
  • There is less risk of physician or MT error when deviation from standards is not allowed.
  • Documents are more useful in an electronic environment because they can be more readily structured and encoded for EMR consumption. An EMR cannot make use of data that it does not understand.

Content requirements should be based on industry standards, such as that provided by the Health Story Project (CDA4CDT).

In general, requirements should be designed for usefulness and value; not based on individual preference, and should be consistent across every work type.  Emphasis should be on effective and useful display of content; not on aesthetics. Use of hanging indentations, complicated tables, graphics, use of special characters, formats that differ from work type to work type, physician to physician, or from one section of a document to another, should be weighed against the usability of the information.


MTs for these accounts may take a slight productivity hit since they will on occasion need to make changes to the draft text that they would not have to make for an “as dictated” account.   Implementation costs for this service offering are low, but MT compensation plans should be mindful that MTs may not be as productive on these accounts as they are on true “as-dictated” accounts. Physicians do not often dictate according to standards even when willing to accept them.

In general, when considering requirements for clinical documentation, the question “does this requirement make the document more valuable for patient care, for HIM or other healthcare constituent purposes, and for use in the EMR” should be asked.  If the answer is no – don’t do it.


There are times when it may be necessary to cater to individual physician or departmental preference, even if the preference is of no particular value.  Though this is never the optimal method of creating useful documentation, it may be necessary from time to time in order to satisfy that very demanding customer.

NOTE: Be aware that your competitors are continually presenting your customers with low cost options, which the provider may accept even if that option requires them to give up customized requirements.


Style Specifications

  • Section and subsections per preference – regardless of what the physician dictates.
  • Selections for style according to preference – again, often regardless of what is dictated.
  • For productivity purposes, “as dictated” MAY apply – but only if physicians actually accept verbatim transcription.  Many times, “as dictated” hospitals actually require a great deal of manipulation that contradicts the “as dictated” requirement. Examples:
    • MTs are asked to put medications and procedures in numbered lists even if physicians clearly dictate in full sentences.
    • MTs are asked to create section or subsection titles that are not dictated.
    • MTs are told “if Dr. Smith dictates xyx, type abc”.
    • When setting up the requirements for speech recognition, be sure the customer really wants “as dictated” before selecting “as dictated” options.
    • Format requirements are based on individual preference. Meeting these types of requirements usually decreases MT productivity, since MTs will be expected to comply regardless of what is dictated.  Or if the requirements can be automated, they will increase implementations costs because of the more time-consuming set up.


MTSOs providing this level of service must be aware:

  • This level of service almost always contradicts meaningful, useful documentation since compliance cannot be enforced and is not reportable –
    • You can’t enforce compliance if there is nothing to be compliant with.
    • Customization is expensive to set up and to maintain.
    • MTs who edit documents requiring a great deal of customization will not be as productive as MTs who work on accounts who want the lowest cost line, or who have standard requirements.
    • Expectations for productivity and compensation should be adjusted appropriately.

In summary – keep this in mind as you sell, implement, and produce work for your healthcare provider customers.  To retain the healthcare provider customer in today’s competitive and changing market, you must get your hooks into them.  You’ve must become a necessity  – irreplaceable.

Create hooks:

  • Competing on price rather than on more useful documentation increases the risk of replacement by the next vendor to offer the same service at a lower price.
  • Providing more useful documentation allows you to get “hooks” into the facility, making replacement by another MTSO or a technology more difficult.
  • Get your hooks in everywhere you can – through technology offerings,  USEFUL service levels, expertise, and knowledge of how the provider uses the documentation.
  • Competing on traditional differentiators such as price, “quality”, and TAT increases the risk of lost business.

Always remember:

You are not differentiating yourself by offering customization and individual user preference at a low price!

If I had a dollar for every MTSO who has told me that their willingness to provide custom requirements is their “differentiator”  I’d be…well, I’d have a whole bunch of dollars.   🙂

Guess what folks – if everyone offers the same “differentiator” – it ain’t a differentiator.

Even if this strategy helps you win the healthcare provider customer  – will it help you retain them?

When the next MTSO offers them the same TAT , quality, and custom requirements at a lower price….

Or when a technology vendor tells your customer that they can eliminate transcription costs entirely….

What reason does the provider have to stay with you?

Til next time,


Healthcare IT – Let’s Stop Preaching to the Choir…

Hi everyone: for those of you who are on LinkedIn, and who are part of the HIMSS LinkedIn group (if you aren’t, join it)…here is a great opportunity to insert yourselves into a discussion that is really ridiculous.

The entire discussion is generated primarily by IT folks, project managers, implementation consultants, and the like. Just like many of the other healthcare IT blogs out there.

While we all blog and discuss amongst our own – they are out there blogging amongst there own. Hm. Pretty much a waste of time for all concerned, don’t you agree?

Here is one chance, amongst MANY, for those of us who are passionate about high-quality, useful, cost effective, and truly meaningful clinical documentation to make our voices heard amongst those who are deciding how technology should be implemented – even though they know nothing about the people at the core of the technology – the physicians and their patients.

We all – including me – need to leave our safe domains where we’ll be patted on the backs by our fellows who agree with us – and start talking amongst the folks who do NOT agree with us. Because maybe they DO agree with us – and they just don’t it. 🙂

I know it’s intimidating – I’m the first to be intimidated by someone with technical knowledge that I just don’t have, “gosh, I sound like an idiot because I don’t know about fractal mathematics..” But they don’t know what WE know either. Those of us on the human side of things have got to stop belittling ourselves and letting the technologies take the credit for what WE make work. We have a lot to bring to these discussions!

Let’s get out into the masses folks…are we ready?

Top Ten Reasons why EMR/EHR Implementations are Failing.


I just gotta say….Social Media

Can I just tell you all that I am LOVING social media?  I have to admit that our communications manager (Lindsey – many of you have met her at the trade shows) dragged me kicking and screaming. I had a twitter account and Facebook page long before I actually did anything with them.  🙂 I just didn’t see the point – and who has TIME!!???

But she kept after me (bless her heart because I can be umm…just a tad stubborn) and I started my blog about 2 months or so ago, and started tweeting just a few weeks ago.

And guess what – I’m hooked!

The first thing I noticed was how EASY it was for me to find people who had common interests and by following them, to find links to an incredible wealth of information. I have LEARNED so much in the last few weeks!  Sure, the information was always there and available to me – but I didn’t have the tools to filter it and to find what was useful to me.

Even so, I pretty quickly said to myself, “my gosh – I’m already so tired of hearing myself talk – how am I going to keep this up?”

But then something wonderful started to happen.


People started emailing me, facebook messaging me, connecting with me on LinkedIn and Plaxo, finding me on twitter, thanking me, agreeing with me, disagreeing with me, arguing with me – DISCUSSING with me.

I realized, “my gosh – this industry is still full of passionate, involved, motivated people!”

The healthcare documentation industry WASN’T gone at all!  And it ISN’T dying!

Yes friends, the “faithful” are still there! We just didn’t have the means to gather – to communicate – to take advantage of strength in numbers.

We didn’t have the foundation upon which to build a movement. Every crusade needs its meeting ground, right? Its home base?

Because I do believe that healthcare documentation and our efforts to keep it useful, to keep the substance of the old ways while introducing the capabilities of the new, is a crusade.  And nothing less than an all out, no holds barred campaign will keep it going and will allow us to reach our vision…..which, as far as I can see it, is to enable:

Truly meaningful, high quality, comprehensive clinical information that is convenient for the doctor to provide, is accessible to those who need it, is cost effective and efficient, and which – most importantly – contributes to the ability of the doctor to care for the patient.

Social media gives us that home base. Our campaign headquarters.

Reach out!  How? If you don’t use twitter, Facebook, or other social media tools yet, use the links to the right to take you to the places that will help you get started.

If you HAVE accounts already, use them. You’ll be amazed.

Let’s use social media – to learn, to teach, to discuss – to spread the word about our crusade.


Are we telling the real [Health] Story?

Are we missing the boat when we talk about structured data, meaningful use and the Health Story Project?

The Health Story Project is an initiative founded originally by Alschuler Associates, LLC, M*Modal, AHIMA, AHDI, MTIA, and supported now by many other members of the healthcare community. Its purpose is to translate clinical information provided through dictation and narrative reports into a language that can be accepted by, shared between, and used in electronic health records.

The Health Story (formerly CDA4CDT) does this in two ways:

  1. By creating and promoting a standard for the exchange of structured data through HL7 CDA (Clinical Document Architecture).  Adoption of this HL7 data standard supports interoperability – the ability to access and share the valuable information that was previously locked deep inside the narrative. It also supports meaningful use guidelines by providing the ability for healthcare providers to structure data provided in a narrative report such that it can be understood by an EMR.
  2. Creating the content standards for the most common document types – so far for consultation reports, history and physical reports, operative notes, procedure notes, discharge summaries, and DICOM.

We are all abuzz these days about item number 1 – everyone wants to talk about meaningful use and the EMR/EHR.

The Health Story Project solves the problem of getting information out of the narrative and into the EMR, doesn’t it?

Well, not quite….regardless of how the CDA document is created, through Speech Understanding or by the application of a more traditional NLP followed by human validation, there is still a big gap that we aren’t talking about.

Let’s say we’ve got this beautifully structured report – all ready to go. Now what? How does it get into the EMR? Osmosis? Telekinesis? Vulcan mind meld?

How many EMRs are accepting the Health Story standards?  How many healthcare providers know about the Health Story?

I work for M*Modal.  We’ve been creating CDA documents as our native format through our Conversational Documentation Services (CDS) since day 1. For documents that are typed from scratch, or created with the help of our Speech Understanding process, we’ve been there, done that, have the T-shirt. It’s not a big deal for us – everyone who knows us, knows we used the term “Meaningful Clinical Document” to describe documents created in our native CDA format long before the term “meaningful use” was coined.

And do you know what happens? Many (not all!) of our partners strip all the structure OUT of the document – and deliver straight text back to their healthcare provider customers.  GASP! You mean they HAVE structured documents, already in CDA format, and they are WASTING them?

Well sure they are. Why? The easy answer is because the healthcare provider customer has no way to consume the CDA. The EMR doesn’t accept it.

But I think there is another answer to this question. Many of our partners aren’t using the Health Story standards to drive content because we are by and large in this industry still providing content based on preference, not on usefulness.

Here is my take.  We are MISSING a big part of what the Health Story project is about.  Sure, it is about creating the HL7 CDA data standard for exchange of structured clinical data, blah, blah, blah.

But look up above at item number 2!  We forget that a big part of the Health Story discussion is deciding what CONTENT is useful, and should be a part of, the common document types.

Healthcare providers NEED to see a chief complaint in an H&P. They need to see allergies, medications, and past medical history. They should have a hospital course section in a discharge summary in order for it to be useful.

The content, the information, is what is important about that document! That is the core truth that we forget during all this talk about structured data.

But do your healthcare provider customers KNOW about this? Do they know that you can help them to define standards for useful content requirements for their work types?

Even if the EMR is not accepting the Health Story HL7 CDA data standard, the sheer availability of the standard content is in and of itself of tremendous value.

So why are we scrambling around trying desperately to accommodate requests for hanging indents and worrying about widowed and orphaned lines on a printed page when we know these things don’t matter for healthcare and that paper is going away?

Why are hospitals succumbing to the traditional speech rec vendor mantra “you get what you say – type what you hear” in pursuit of the cheapest line, when standards for meaningful documentation are more cost effective for the facility in the long run?

We should be telling the healthcare providers that we can help them achieve the CONTENT they need to provide high quality patient care, to support coding and billing and revenue cycle management, to add value to analytics and abstraction – to support the entire spectrum of healthcare’s use of documentation.

If your healthcare provider customers knew you had the ability to provide these content standards for meaningful, truly useful documentation WITHOUT forcing their doctors to adopt a process they DON’T want – don’t you think they’d put pressure on the EMR vendors to accept the Health Story’s HL7 data standard?

But if they don’t understand the value of what you can do for them – why would they care about anything beyond the cheapest line they can find?

We all agree that the narrative is important. We all know doctors don’t like having to enter their own data into a structured template in an EMR. We’ve all seen the torn-up hundred dollar bill. Old news folks.

If we want this initiative to work, we must do a better job of promoting the Health Story Project to the healthcare provider.

The content of the documentation – the valuable information provided – THAT is the REAL Health Story.

Let’s start telling it.


ACE 2010 Presentation – Keeping Transcription Relevant into the Future


Hi everyone:  Here is a link to my ACE 2010 presentation for those of you who requested.

It was wonderful seeing you all there – terrific discussions!


Medical Transcription into the Future….

I loved ACE this year! I thought we engaged in some of the most interesting and thought provoking conversation in years.

But I’m confused.

There was a lot of GREAT discussion about keeping transcription relevant in the changing world of clinical documentation – because clearly it IS still relevant. No one debates anymore that everyone from doctors to coders miss the narrative when it isn’t included in the EMR.

And I was excited to hear discussion about what additional skills and knowledge the MTSO and MTs will need going into the future. I LOVED it! I haven’t heard such lively discussion at AHDI in a long time!

But here is where confusion sets in.

There was talk about putting our existing skills and knowledge about document management systems and coding, particularly ICD-10 coding, to use. Hmm. What knowledge? Many MTs and MTSOs lost the connection to coding and complete document management long ago when MTs left the hospital. Not all of them – but very few MTSOs or MTs are exposed to coding or to document management beyond dictation capture and document delivery these days.

Document management goes far beyond the piece transcription is involved in, and includes documents not handled by transcription at all.

And when it comes to ICD-10, well this is a topic that has fulltime, lifelong coders and HIM directors shaking in their boots.

Let’s clarify two points that some of us in the transcription world don’t quite get.

  • Doctor’s don’t dictate codes. I heard comments about how all an MT has to do is capture codes dictated by the doctor and there you go, coding is done. With the possible exception of the clinic and practice worlds where E/M coding is used, or maybe radiology, when have you heard a doctor dictating codes?
  • You cannot code an inpatient encounter from one document. Even if MTs had access to all of the dictated and transcribed reports for an encounter, coders use the entire record, from the ED notes to the progress notes to nursing notes – many of which might be handwritten or entered directly into the EMR by the doctor or a nurse.

Can we assist with the coding process? We sure can! Can we code from the transcribed document? No.

Another point of confusion for me, mixed in the message about the MT’s changing role in the future of transcription, was a lot of advice about getting bachelors or even masters degrees, getting RHIT or RHIA certification, PMP certification, and collecting any number of EMR/EHR certifications. Then there were suggestions about becoming project managers, EMR product specialists, EMR trainers and implementation consultants, marketing specialists, and more.

Even the suggested future roles for MTs included preferences for RHIT or RHIA certification and even “masters’ degrees preferred.”

Folks, there is a difference between exploring the relevance of transcription into the future and the future role of the MT as the MT exists today, and listing jobs that will be available outside of transcription.

I’m not saying that MTs don’t have the ability to become any of these things. Of course they do! If they want to begin their careers and educations all over again, they can become high school biology teachers or real estate appraisers too.

But there is a difference between developing the role of the MT and replacing it.

And let’s be realistic about our current knowledge base and skill set. As a group, we do NOT know about ICD-10. We do NOT know about hospital document management systems. We do NOT know about RAC reviews and hospital revenue cycle management. How can we realistically figure out what we need to learn if we don’t take a realistic view of what we don’t know?

What is our goal here? To keep transcription relevant and to contribute to the value and usefulness of clinical documentation? Or to act as a job placement program for displaced workers?

For me, I say we’re not done yet! We have tremendous value! We may have difficulty understanding and articulating exactly what that value is, but it’s there.

What can MTSOs do? Something we can, and MUST do right now is to become true documentation experts. We must partner with our healthcare provider customers to create truly useful, meaningful, documentation NOW. Not when we get this or that certification, and not when (and if) our customers finally decide to adopt Health Story standards.

Some first steps:

1. Learn about your customers and how they are using the documentation you deliver to them.

2. Are they using it for coding? If not, why?

3. What parts of the documentation do they find useful?

4. What pieces are missing?

5. What can you do to help them complete the missing pieces?

6. Do your customers know about the Health Story project? Do they know that the Health Story is not just about standardizing the electronic format of the most common document types for upload into the EMR, and that it also defines content requirements which can be used today, right now, even if their EMRs aren’t accepting HL7 CDA yet?

7. Do YOU know about the Health Story project?

Most importantly –

Stop marketing yourselves as a commodity that can be replaced as soon as someone cheaper comes along offering the same service at a lower price!

If your healthcare provider partners rely on you to help them with compliance, coding, other revenue cycle tasks, and more – you will not easily be replaced.

Somehow our industry’s entire value proposition became that we will accommodate every individual user preference for document content and form there is. I have had countless MTSOs tell me that this is their market differentiator. If that is true – then stick a fork in us folks. We’re done.

But I for one am not ready to roll over yet….

Til next time,

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