Health, Information, and the American Way!

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Good morning everyone!  I am very excited to be heading to Washington, DC to attend the AHIMA Team Talks and Hill day events!

Why?

Well, first there is the fact that I’ve always been a little bit of an “advocate” at heart. From the ecology club I started in the 7th grade (sigh – only 4 people joined including me), to the letters I used to write on behalf of multiple causes, to the daughter I raised who once failed a history test because she refused to give the desired answers to questions about Christopher Columbus (because he was a usurper of the indigenous people) and who only a couple of weeks ago kindly rearranged books in Barnes and Noble because books written by and about Frederick Douglass were only shelved under “Cultural Studies” and not under American History where  they belonged, I am appreciative of being allowed to be a part of the democratic process that is the United States of America. After all, we’re only here because of a little effort conducted by a band of “advocates” known as The American Revolution, right?

Second, it is important. Health care in our country is in bad shape and health information and technology can play a big part in helping to improve care and to decrease costs.

What is advocacy? According to Princeton University’s WordNet, (2011) advocacy is the, “active support of an idea or cause etc.; especially the act of pleading or arguing for something.”

Yep, that sounds about right.

But what does that have to do with health information?

I’ve referred to HIM previously as the “keeper of the keys” for quality health information, and AHIMA is the keystone of HIM. According to the paper About the American Health Information Management Association (AHIMA) made available on the AHIMA Communities of Practice Hill Day community, “AHIMA members believe you achieve quality health through quality information” (2011).

Yep, that sounds about right too.

But with so much change happening in the HIM realm including health care reform and its associated Meaningful Use requirements, advances in technology, the coming conversion from ICD-9 to ICD-10, it is easy to lose sight of what “quality information” really means, and what we, as a profession, must do to preserve and maintain it.

AHIMA, as an organization 60,000 people strong, has a big voice in advocating for health information. AHIMA organizes its Hill Day as a means to provide members with opportunities to meet to discuss relevant topics, and then to talk about these topics with our elected officials. In short, AHIMA provides us with a wonderful opportunity for advocacy.

On Tuesday during our meetings with our representatives in the 112th Congress, AHIMA members will focus on the following (AHIMA, 2011):

  • The HIM profession and the AHIMA association – who are we and what do we do? Our strategic focus on key points such as the adoption and implementation of the EHR, health information exchange, guidelines for interoperability including attention to standard terminologies and classification systems, privacy and security of health information, ICD-10, and more.
  • Support for the “Health Information Professions Advancement Act” which will address the need for the HIM profession and shortages of knowledgeable, trained professionals.
  • Protection for HIT and HIM initiatives established as part of ARRA-HITECH including Meaningful Use.
  • A solution for the patient identity challenges encountered as HIT evolves.

I will be blogging and tweeting from DC – so stay tuned as Lynn goes to Washington!

You can find more detailed information about AHIMA’s Hill Day on the AHIMA website.

Of note, AHDI/CDIA has its Advocacy Summit scheduled in DC for May 3-4.

See you on The Hill!!

Lynn

Director of Health Information Services

M*Modal

References:

Asmonga, D. (2011) About the American Health Information Management Association (AHIMA). Retrieved March 26, 2011 from http://cop.ahima.org/Community/Topics/tabid/66/ctl/Detail/mid/409/community/63/topic/43217/Default.aspx

Princeton University WordNet. (2011). http://wordnetweb.princeton.edu/perl/webwn?s=advocacy

“Improved Patient Care through Quality Health Information”

I usually keep my blog agnostic of M*Modal, and try to make it of interest to anyone in the health information space, regardless of the technology they use. But since the HIMSS conference about a month ago, the resulting follow-up conversations and news from the HIT world made it more apparent to me why I came to work for M*Modal – and why we’re all in this business in the first place. So I thought I’d stray from my own rules a bit.  The blogger’s prerogative.   I also hope to use this as a jumping-off point to an ongoing discussion – what is quality health information?

At HIMSS this year, there was, as you would expect, a tremendous amount of talk about meaningful use, health information exchange, adoption, you name it. The exhibit hall was full of vendors whose products will solve all of a health care provider’s problems. There were “transformative” solutions everywhere you looked.  Since HITECH ARRA announced its meaningful use requirements, HIT has exploded with new products, new technologies, and a scramble to help the provider (or perhaps capitalize on the need to?) achieve compliance.

But as I talked with people who came to the M*Modal booth asking, “what is different about M*Modal”, it forced me to think about that myself. Why is M*Modal different?

My two cents:

  • We aren’t a “vendor”.  Yes, we sell technology. But with our technology comes our people – a partnership. The service we provide can’t be separated from our technology.
  • We aren’t about the revenue cycle. We’re about health care. Yes – documentation plays a big part in revenue cycle management and our technology certainly helps with that – but “Improve your revenue cycle!” isn’t our mission.
  • Our founders have been using the terms “health information universe” and “meaningful clinical document” for years – as evidenced in a slide from an early presentation that is still relevant today. A universe of meaningful clinical documentation has been what M*Modal is about since its inception.
  • We spend hours talking about how to improve the documentation experience for caregivers, and how to use information to build a more collaborative experience for the patient care team and the HIM. We talk to physicians, to HIM professionals, to technology vendors, to transcription service providers, to continuously improve not just their experience using our technology, but their ability to make use of health information in general.
  • Yes, our M*Modal team includes scientists and engineers, but it also includes health information professionals from MTs to transcription managers to coders to CDI specialists to RNs to those of us who have been in the business so long that we’ve done pretty much everything there is to do in HIM.
  • We honestly believe that health information can have an impact on the care of the patient – and on wellness itself. As our CTO Detlef Koll put it in his response to the PCAST report, ‘truly meaningful use of health information has the potential to transform health care.”

Do we have our challenges? Of course – we’re growing fast and we’re crazy busy.  But from the interns who frequent our offices, to our scientists, to our customer service personnel, to the people who keep our data center running, to our administrative and HR staff, to our marketing and business development teams, we’re all part of a team who works every day towards a vision of improved patient care through quality health information.  And at the end of a day, no matter how long, that is really all that matters.

Over the coming weeks, we’ll be talking more about “quality health information” and what that means to business, to health care providers, and most importantly, to the patient.

I look forward to hearing from you about what “quality health information” means from your perspective.

All my best as always,

Lynn

PS:  This post also appears at Excellence in Health Information.

Help for a Senior HIM Student’s Capstone Project…

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Kaitlyn Crowther is a senior in the University of Pittsburgh’s HIM program. She has been working with us at M*Modal for a while now – and does a great job!

Kaitlyn guest-blogged for us back in January for our HIM Student Corner in Excellence in Health Information.

Does anyone know a doctor who would be willing to help her complete her project by completing a very short, easy survey about electronic medical records?  It’s only 13 easy questions and would help an HIM student get some great results for her project!

The survey is located here.

Many thanks!

Lynn

Effective Communications – the Webinar

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Today we have so many options for communication available to us that provide opportunities that we’ve never seen before. We can expand our workforce, our business relationships, our education, and our communities without thought of geographic boundaries and physical location. Webinars are one method of communicating with remote audiences and of providing education which give us the ability to reach out to and communicate with people from all over the world.

But a colleague of mine from M*Modal, Transcription Services Manager Paula Pasquinelli, and I were talking about the challenges of this particular medium. We talked about how presentations and material that go over great for an in-person audience sometimes fall flat for a webinar audience.

Why is that? Well, let’s face it – when people attend a webinar you probably don’t have their full attention. When sitting in an audience or classroom, we likely wouldn’t be rude enough to pull out a book, watch television, or work while listening to the presenter (though I personally would like to have smart phones checked at the door). A remote audience feels no need worry about manners and courtesy – if they don’t pay attention, who knows? They won’t bother anyone, so who cares?

So I was thinking about some tips for webinar presenters and attendees – and we’d love to hear your tips too!

For attendees:

  1. Pay attention. Treat the webinar as you would an in-person lecture or meeting. Did you pay to attend the webinar? Then think about the dollars you’re throwing away if you multi-task while the webinar is under way. Even if you didn’t pay for the webinar, you have invested a certain amount of time.  Don’t waste that time and risk missing out on useful information by multi-tasking during the session.
  2. Participate. Sometimes it is difficult to stay focused. Help yourself and the presenter by using the tools at hand to provide feedback. Does the webinar medium allow you to “clap” or “smile” electronically?
  3. Communicate. Ask questions and provide comment when asked. Some webinar tools allow attendees to “raise a hand” or to present questions via chat. Have a question? Ask! This will help you to stay focused, will help other attendees because likely someone else has the same question, and will help the presenter to know someone is listening.
  4. Take notes. You’re attending that webinar for some reason – get the most out of it by taking notes and retaining information.
  5. Clear your environment. You wouldn’t play music, talk on the phone, watch television, converse with coworkers during a physical presentation would you? Don’t do it during a webinar either. Try to find a quiet place where you can listen without interruption.

For presenters:

  1. Keep it lively! There is a reason to use a webinar versus print media to present information. If you are simply going to read your content – save everyone the time and write a paper instead.
  2. Engage and include your listeners. Ask questions. Ask opinions. Don’t forget there are people on the other side of that webinar!
  3. Learn to use your tools. Do you have interactive features such as chat, “hand-raising”, “clapping”, available? Take a few minutes to review those features with your audience. Have them practice using them. Remind them to use them during your session. Use those tools to wake up your audience by asking things like, “are you still there? Claps your hands if you’re listening!”
  4. Learn to use tools such as highlighting, underlining, drawing on your presentation to draw attention to important items and to help keep listeners engaged.
  5. Watch for questions and comments. Keep an eye open for raised-hands, questions or comments offered by chat. If you don’t have those types of tools available, stop occasionally and ask if there are questions or comments and allow people time to participate.
  6. In a remote session, I personally don’t like to hold questions til the end since I think an interactive session is much more interesting for the listener. But you must consider the size of your audience. A group of 10 – 20 people works well for a more interactive session. But taking questions during the session for larger groups can eat up too much of your limited time.
  7. BE INTERESTING! Try to use humor, engage your audience, give “pop quizzes”, toss out questions and select someone to respond. Back when I used to do training, I used to give out “virtual chocolate” for correct answers to questions.
  8. If you are conducting a remote training, intersperse exercises and activities with talking. Create exercises, puzzles, a few true/false or multiple choice survey questions. Some webinar tools allow you to ask questions and collect responses online.
  9. Make your presentations colorful. Use graphics instead of lots of text.

10.  Provide the opportunity to ask questions or give comments after the webinar. Give an email address for those who are uncomfortable asking questions during your session.

11.  Ask for comments and suggestions to improve the experience. If you have the tools, provide a survey at the end. Read the comments and suggestions and use them to improve your next webinar.

Does anyone else have tips and suggestions for participating in or giving webinars? Post them here!

Also posted on Excellence in Health Information

All the best,

Lynn

M*Modal

New MT Survey Available Now! Let Your Voice be Heard.

Historical Profession

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Good morning everyone:  This is posted on behalf of Gary David, PhD, project leader of  the Bentley University MT Research Team.  This is a great opportunity to provide accurate data about your profession.  Please pass along to MTs everywhere.

2011 Medical Transcription Survey

In an attempt to gauge the continuing changes to the medical transcription industry and the MTs who work in it, The Bentley University MT Research Team is conducting a new professional survey of MT work. (The 2011 MT Survey https://bentley.qualtrics.com/SE/?SID=SV_3DhIq9ANhs1sz7m or go to http://www.medicaltranscriptionsurvey.com ).

The previous MT survey (to which 3800 MTs responded) provided tremendous insight into the state of the profession, the skills, talents and dedication of those working in it, and the challenges the profession faces (the final survey report can be found here: http://ehealthrecords.wordpress.com/publications/).

Any MT working in the profession is invited to complete the survey. It is anonymous and confidential, and will help us to continuously evolve our understanding of those whose work is important to the healthcare industry.

Sincerely

Gary C. David, PhD (Project Leader)

50 is the New – 50

Old woman pouring tea, unknown artist, 19th ce...

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Well today is the day. I turn the big 5-0. And you know what? Nothing happened. I don’t look any different than I did yesterday.  I don’t feel any different than I did last month, or last year. I feel as though I SHOULD care about turning 50 – but I kind of don’t. In fact – despite my jokes about my advancing age, I welcome turning 50.

I have to admit it feels a little bit freaky. My mother died when she was 51. Her mother died at 56. That’s cutting things a bit too close to home. But I’m blessed in that I seem to have taken after my father’s more long-lived side of the family. I don’t have the illnesses that plagued my mother and her mother and for that I am so thankful.

Another odd thing is realizing that many of my colleagues and coworkers are younger than my children. Now THAT is weird. These folks are writing equations on white boards that I can’t even begin to comprehend, and I want to ask them if they have their cell phones and AAA cards with them.

But as I was telling my boss yesterday, Mark Ivie, COO of M*Modal, age for me has meant credibility. Being 5’2”, female, and – ahem – prone to getting excited about things, I’ve been called “spitfire” in my life more times than I can count. I’m pretty sure no man presenting a passionate argument has ever had to hear, “you’re a real little fire-cracker, aren’t you.”  So I suppose I’m hoping that a few wrinkles will stop the head-patting.

But most of all, I’ve come to appreciate the value of the knowledge that only age and its accompanying experience can bring. I’m taking classes these days and have come to understand that I learn more in one morning spent with colleagues and friends who are even more “experienced” than I – than I do in a whole semester’s worth of classes. And they don’t charge nearly as much per credit.

And as long as I am on the subject of classes – here’s to all the women of “experience” who are back in school! How wonderful is it that there are so many of us? And how fun is it to be reminded that your younger classmates, despite brains and energy and how good they look in jeans, can’t hold a candle to the more “experienced” students when it comes to class discussions?

One thing that does bother me about turning 50 is that I am behind on my “goals.” It might surprise some of you to learn that I’m just a little bit hard on me when it comes to expectations I’ve set for myself. I’ll cut anyone in the world some slack – except me. But you know what? Nothing has exploded. Nothing disappeared. Nothing fell off.  Absolutely nothing changed because I didn’t achieve a certain milestone “by the time I turn 50.”

So lesson learned. If I didn’t hit some goal by age 50 – so what? I’ll hit it by the end of the second 50 years – and just imagine how smart I’ll be by then.  🙂

All the best as always,

Lynn

Managing MTs and other HIM Workers – The Risks and Benefits of Using Independent Contractors

This posting also appears on Excellence in Health Information – but I thought it an important enough message to post here as well…

This week, we are pleased to have Linda Yaniszewski as our guest writer. Linda is President and CEO of ExecuScribe, Inc., founded in 1989 with corporate offices in Rochester, NY and Charlotte, NC.  ExecuScribe has a completely USA based workforce of 160 transcriptionists.  Linda is a board member of the Clinical Documentation Industry Association and a founding member of the newly formed Bayscribe American Transcription Network.

Under Linda’s leadership, ExecuScribe has seen continuous growth and was recognized for its growth by inclusion on the prestigious Inc 500 – the 500 fastest growing privately held companies in America – in both 2003 and 2004.  Linda has also been recognized for her leadership and community efforts as an Athena nominee, Rochester’s Small Businessperson of the Year, and a finalist for the Ernst & Young Entrepreneur of the Year.

Linda has seen firsthand the evolving role of the medical language specialist and its value to patient care and their new role in the world of electronic health records.

Thank you so much to Linda for contributing an experience that could be so helpful to so many…please allow me to introduce Linda Yaniszewski.

I had my ah-ha moment in the spring of 1989.  Having been a medical malpractice defense paralegal for ten years, I saw that there was a need in our community for administrative help.  I left my job and hung my shingle on a 200 square foot office in downtown Rochester, New York in April of that year.  While we began by offering all kinds of services – word processing, database management, resumes – it did not take long to identify that the need in our community was in medical transcription.  We were given a small opportunity in a large medical center in Rochester.  Our performance on that small opportunity led to our being awarded the contract to service the entire 1100 bed medical center, as well as all of its outpatient clinics.

As part of my due diligence I found that the standard hiring methodology for most MTSOs was independent contractors.  We decided to build our recruiting model around the use of ICs.  Adhering to published IC rules, we were careful to explain the various benefits and limitations to the independent transcriptionists we employed:

  • ExecuScribe did not control their time (they could work for other companies).
  • There was no required work schedule (flexible time schedules were permitted).
  • ExecuScribe provided no training or continuing education.
  • There was no direct deposit of paychecks. IC submitted invoices and ExecuScribe paid them directly.

In addition, the limitations to the IC and cost-saving benefits to ExecuScribe were clear:

  • No FICA would be paid.
  • No health insurance would be paid.
  • No paid time off (PTO) was available.
  • No 401K programs were offered, or funds matching provided.
  • No unemployment taxes were paid.

Categorizing our MTs as ICs was working well for ExecuScribe until the State of New York Unemployment Commission requested a full audit of my company, contractors and practices. I had been aware that the a Task Force had been created to address the incorrect classification by employers of individuals, up to 10% of workers in New York State were identified as having been misclassified. ExecuScribe’s team of ICs were some of them.  The audit changed our IC strategy forever and served as fair warning for many well-intentioned MTSOs.

ExecuScribe produced all the contractor files that auditors requested, including all demographic information for our ICs. The company, not to compromise patient care, kept quality assurance (QA) results for each IC. To our surprise the demographic information was considered a legal “employee file”. Furthermore, the QA information was looked at as employee training. Before the company knew it, ICs were declared employees by New York State.

Although when utilizing an IC model, MTSOs achieve major savings in taxes, benefits and insurance, ExecuScribe learned the hard way that the benefits did not outweigh the risks. Initially, we were required to pay back FICA, unemployment taxes, penalties and interest. And as if the state audits weren’t enough, there was also a risk of the federal government getting involved. If the federal government audited my company and also reclassified ICs as employees, it would have cost ExecuScribe more than a million dollars in penalties and fines.  While most entrepreneurs pride themselves on being risk takers, this was a risk I was not willing to take. It was time to make a change.

We decided that the only solution was to transition to an employee model. We announced our intentions and successfully converted ICs to employees within 90 days; an impressive feat as 95% of the ICs became employees. The tradeoff for ICs was that ExecuScribe would pay them a lower line rate for transcription, but give them complete benefits, a policy the company still continues today. In addition, we required minimum production commitments and set hours were assigned and enforced.  We could now track and measure each transcriptionist’s QA and hold them accountable for meeting our QA standards. We could now use their retrospective QA reviews as a coaching and mentoring tool to help them improve their skills.

As with most changes, the first and most important step was communication.  We informed ICs of the need to transition them to employees, and why. ICs were provided with frequently asked questions, company documents, webinars and face-to-face meetings. It was explained that the decrease in line rates would be more than offset by the benefits they would receive as ExecuScribe employees. In fact, the benefits worked as a recruiting tool and minimized turnover.

The few transcriptionists who remained ICs were also educated as to the New York state requirements for an IC:

  • Form an independent corporation.
  • Have multiple clients.
  • Advertise in some media (e.g. telephone book).
  • Carry workers compensation insurance.

Federally, there is an IRS 20 Factor test on employment status that further defines whether an individual is an employee under the common law rules. MTSOs should check to ensure they are compliant and be aware of the risks in their organization.

Following the conversion ExecuScribe experienced surprising results. Productivity went up, way up. Transcriptionists had assigned work to do and designated hours to perform their work. We were able to deploy three shifts, giving us 24/7 coverage and significantly improving turnaround times. In the past, my management team was required to manage 40 ICs doing the work of 20 employees. Because full time employees are easier to coordinate, the same managers could now manage 50 to 75 full time employees.  While we had anticipated a drop in profits, that did not occur.

Results were communicated back to the entire team:

  • Morale improved.
  • There was a new sense of company loyalty.
  • MTs began “fighting” for work.
  • Company profits increased.
  • Everyone was able to do more with less.

While using only ICs may be tempting from a cost-savings perspective, MTSOs need to be aware of the risks.  If ICs are given any training, receiving any benefits, are being assigned specific work hours, or are getting paid via paychecks, they will be considered employees. MTSOs need to be aware, analyze their risks and prepare.

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