CDIA Annual Conference – See you there!

Collage of Charlotte, North Carolina.

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Hello from the CDIA conference in Charlotte! I only got in late last evening, but have already seen some friendly faces in the lobby (hey Tony!) and I look forward to catching up with everyone.

Yesterday I attended AHIMA’s Computer Assisted Coding (CAC) Summit in Baltimore. It was a terrific day – jam packed with speakers ranging from HIT companies to health care providers to HIM experts.

One thing was clear.  Amid the talk about CAC technology selection, implementation, training, return on investment, and metrics, the common denominator was this – computer assisted coding can’t work if the documentation it processes isn’t accurate, comprehensive, and complete.  Another interesting thing – the speakers who produce the technology, some of the earliest providers of CAC, made frequent references to electronic versions of dictated documents as sources of the high-value documentation required to drive this very-important technology.

So the timing is perfect to attend the Clinical Documentation Industry Association’s (CDIA) 2011 annual conference in Charlotte, North Carolina (hey, there are green leaves down here!).  Topics for discussion will cover everything from meaningful use, to marketing, to transcription’s role in health care reform. It will be a wonderful conference!  CDIA (formerly MTIA) always does a great job staging their annual conference – so if you are in the area, be sure to attend!

However, as we cover the buzzword topics of the day, I hope CDIA makes time for the nuts and bolts of what transcription vendors need to know in order to stay viable into this future where so much depends on the documentation that we help to produce.  I hope it helps its members, especially those trying to run small-to-midsize companies during a difficult economy and a time of great upheaval resulting from EHR implementations and the provider’s need to cut costs, to be aware of the foundational tools which will help them.  Yes, it is terribly important for the medical transcription industry to be informed of health care reform and the changes in the technological and political climates that will affect them. I agree that they must become complete clinical documentation companies and not just “medical transcription” providers.  I applaud the CDIA name change which reflects our evolution from “typing services” to clinical documentation experts. I honestly believe we are clinical documentation at its most valuable. But it is even more important that we revisit the basics of quality, cost-effective management, resource allocation, training and education – the kinds of things that we talk about on this blog all the time – if we are to stay whole during this turbulent – but very exciting – time.  There is great opportunity for us, but we will have to play it smart every step of the way to become, and stay, successful.

As the health care and HIM worlds buzz with talk of advanced technologies such as CAC, health care reform and meaningful use, ICD-10 conversions, and other big changes coming our way, more than ever we see that high-quality narrative documentation is high-value documentation. “Value” is the operative word here as we realize that the narrative documentation that we play a big part in producing is integral to the success of all of these efforts.

So come to the CDIA conference – and come visit me in the M*Modal booth!

See you there,

Lynn

Important Step for Narrative Documentation – Must-Attend Webinar!

Hello everyone: Please see below for an invitation to attend a webinar that explains how to participate in the HL7 ballot cycle for the HL7/IHE Health Story Consolidation Project implementation guide.

For those who are not familiar, the HL7/IHEHealth Story Consolidation Project is an important and very exciting initiative. It brings together efforts from the Health Story, which created HL7 CDA implementation guides and content standards for the electronic exchange of information contained in the most commonly used clinical document types, with IHE and HITSP implementation guides. This is exciting news since the two efforts sometimes duplicated each other, and there were some disconnects and discrepancies created along the way, but both initiatives made important progress towards the goal of accessible, interoperable, and useful health information.

With the consolidation of these two projects, these disconnects and duplications will be eliminated. The previously released Health Story guides will be republished in a single source along with updated versions of the Continuity of Care Document (CCD), and all will be updated for compliance with Meaningful Use and also to meet the requirements of HITSP C32/C83.

This is a very exciting effort which, if widely adopted, could resolve so many of the challenges presented by capturing, exchanging, and using clinical data electronically in a way that is also meaningful and understandable by human caregivers and the patient. With so much conversation underway about the adoption of a useful standard for the exchange and use of truly meaningful health information, this seems a huge step towards the solution we have all been waiting for.

If you are passionate about meaningful health information and also about having this information made available in a safe, secure manner in the electronic environments which we all agree are necessary to cut health care expenditures and improve patient care, then please attend this important session.

All the best,

Lynn – M*Modal

Dear Members and Friends of the Health Story Project

You are invited to participate in an education session to encourage participation in the current HL7 ballot cycle for the HL7/IHE Health Story Consolidation Project implementation guide. Please register using the link below, and forward as you wish to colleagues who may have an interest.

Webinar: HL7/IHE Health Story Consolidation Project: How to Participate in the HL7 Ballot

When: Wednesday, April 13, 4-5 PM eastern

Register for Webinar: https://www2.gotomeeting.com/register/810108362

The HL7 International data standards organization will soon open a ballot for an important package of standards for health information exchange. The Health Story Project is hosting a webinar to show those unfamiliar with the process how to participate in the ballot.

The HL7/IHE Health Story Consolidation Project has harmonized exchange standards for eight common types of clinical documents along with the HL7 Continuity of Care Document (CCD) standard and the HITSP C32 requirements for Meaningful Use into one single implementation package. ONC’s Office of Standards and Interoperability (S&I) is hosting the effort within its S&I Framework and is facilitating the project. Within HL7, the project is sponsored by the Structured Documents Work Group.

Development of the original eight implementation guides for History & Physical, Discharge Summary, Operative Note, Consult Note, Progress Note, Procedure Note, Unstructured Documents and Diagnostic Imaging Reports was supported by the Health Story Project through an associate charter agreement with HL7. The project has harmonized these with complementary IHE Profiles and will result in a series of corresponding change proposals to IHE and updates to templates required for Meaningful Use.

The HL7 Ballot is open to all. This webinar will review all administrative, documentary and technical steps needed to cast your ballot and to participate in the ballot reconciliation process.

Holistic Health Information

A system with high adaptive capacity exerts co...

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Hello everyone: As springtime finally settles on us (we had a warm day yesterday here in Pennsylvania), I notice the yearly onslaught of neighborhood walkers and runners all out getting some air and some exercise – with the goal, no doubt, of improving their health. Many of these people are taking a holistic view of health, knowing that health must come from an all-around approach and not from any one source.

And of course, being me, thoughts of health lead to thoughts of health care which of course lead to thoughts of health information – specifically – of holistic health information.

No, I’m not going to tell you where to find information about aromatherapy or acupuncture – but I would like to talk about the need for a real discussion about the whole of health information – about the usefulness of health information in the care of the patient and all of its related parts.

What do I mean by that?

According to Wordnetweb.princeton.edu, the word holism means:

“the theory that the parts of any whole cannot exist and cannot be understood except in their relation to the whole; “holism holds that the whole is greater than the sum of its parts”; “holistic theory has been applied to ecology and language and mental states”1

If you ask me, this definition applies perfectly to health information and in fact M*Modal’s CEO (and in the spirit of full disclosure, my boss), Michael Finke, has for years now referred to the “health information ecosystem” in his discussions.

Why bring that up now?

I’ve had occasion over the past couple of weeks to talk with people from several organizations, all concerned with the state of health information for a variety of reasons. And again it strikes me that our conversations about health information tend to become as silo-ed and disconnected as the health information systems we lament. We talk about the pieces that affect us personally, losing our view of the whole.

While that is natural and understandable, it is time that we begin to talk about health information as a “whole that is greater than the sum of its parts.” Its parts might be HIT, transcription, the EMR, coding and billing, privacy and security, or whatever – but at the end of the day, ‘the parts of any whole cannot exist and cannot be understood except in their relation to the whole.’

Think about that.

  • Discrete data points have no meaning without surrounding context
  • Coding can’t be accurate if the documentation is not
  • Transcription is meaningless if it doesn’t make it into the patient record
  • The EMR is worthless if it doesn’t give a whole picture of the health of the patient
  • HIT has no value if systems and technologies don’t talk to each other
  • Privacy and security doesn’t protect anyone if information can’t shared between caregivers and the patient
  • Core measures and other quality reporting will not result in better patient health if the information used to drive the reporting isn’t complete and accurate
  • The list could go on and on…

These are all parts of the one holistic ecosystem of health information. Can we “fix” any of these separate parts if we don’t consider their relationship to the whole? No, not in a way that’s meaningful. How do we know if a particular topic is part of the ecosystem? Easy – can you trace it back to improved care of the patient?

So does effective coding for billing go back to care of the patient? Yes – healthcare ain’t free and it is necessary to know that payers are being billed and providers compensated appropriately. Does the ability to share information collaboratively amongst members of the patient care team connect back to the care of the patient? Of course. That’s a no-brainer. Do customized section headings on a printed document connect back to care of the patient? Nope. Does forcing the doctor to use documentation methods that cause him to spend more time documenting and less time focusing on the patient connect back to improved care of the patient? Well, not in my opinion though others might disagree.

Within the transcription audience in particular, I’ve recently been struck by the disconnectedness between groups when I’ve talked about AHDI and CDIA (formerly MTIA) coming together to work on certain projects collaboratively. I hear comments about this being for transcriptionists and that being for inhouse transcription and something else being for transcription service providers and something else again being a problem caused by this group of service providers or by that particular company.

My fear? That if we don’t realize that we all need to be of one mind in understanding the role of transcription in the creation of quality health information, regardless of who is producing it and where it is produced, that the arguments will be moot in a few years…

There are certain truths about the use of medical transcription in the production of quality health information that are real regardless of whether or not the work is transcribed by an inhouse MT or a service MT, by an MT in India or an MT in Bismarck, North Dakota, by an MT working in a small physician practice, or an MT working for a huge global transcription service provider. Some of these are:

1. The documentation produced must be of high quality. It doesn’t matter if the work is produced in Oklahoma, in India, or on Mars. Without quality – the rest of the arguments for transcription fall apart.
2. The method of producing the work must be cost effective and efficient for the group performing the work – no matter who it is.
3. The work must be cost-efficient for the end user, whether it is a healthcare provider customer of an MTSO or the physicians in a practice with an on-site MT.
4. The work must provide value to the provider beyond being a typed document. If it’s only value is that it looks pretty on a printed page – then the work will disappear faster than you can say “customized formatting requirements.”
5. The process must be efficient for doctors from dictation to editing and review to sign-off.
6. The work must be completed quickly enough to be useful for patient care and HIM purposes.
7. We must understand the world of electronic records and the realities of how we can be a part of that world.
8. We must – and this is a biggie – produce the evidence that shows that transcription is a valuable part of health information. If we sound as though we are trying to preserve our businesses rather than trying to preserve health information that has value to the provider, then we lose credibility.

Is anyone interested in all of the various health documentation related groups coming together to promote, educate, and communicate about the things we must know now to remain a viable part of the health information ecosystem? If so, tell them about it. With AHDI/CDIA Advocacy Day coming soon, we must come together as one voice in support of the preservation of holistic health information.

Of note, CDIA’s national conference is coming up this week. Conferences are often a venue where the organization asks its constituents to listen to its leaders and speakers. But there is no better time to ask them to listen to you.

AHDI
CDIA (formerly MTIA)

All the best,
Lynn
M*Modal

1 Retrieved April 11, 2011 from http://wordnetweb.princeton.edu/perl/webwn?s=holism

Lynn Goes to Washington – with AHIMA!

The trip to Washington, DC, as part of AHIMA’s Hill Day was everything I thought it would be and more. It was busier than I expected! Somehow I expected a lot of wait time with meetings scheduled here and there, and time for “tweeting” in between – but instead we had our running shoes on heading from meetings on one side of Capitol Hill to meetings scheduled on the other side, only to be running back in the opposite direction again 30 minutes later.  Hats off to AHIMA for what must surely be the extreme sport equivalent of appointment scheduling!

For those who are not familiar with AHIMA’s Hill Day, there were 175 AHIMA members on Capitol Hill that day, all of us divided into our component state associations (CSAs). AHIMA schedules Hill Day attendees to meet with their own elected officials so that officials actually talk with their constituents – the voters who put them in office – and who can take them out again. After all, that is the power of our process, right? AHIMA participants then attend meetings with senators with their CSA groups and with their House representatives in groups or alone depending on their districts. In my case I was the only AHIMA representative from District 4 in Pennsylvania, so I attended the meeting in Congressman Altmire’s office alone while the other PA attendees headed to their meetings. Then we met up again later on. What a schedule!

There were six of us there from Pennsylvania. Three were experienced Hill Day attendees – Valerie Watzlaf from the University of Pittsburgh, Denise Dunyak from Siemens Health, and our group leader, seven-time Hill Day veteran Wannetta Edwards from Precyse Solutions. Newbie attendees in our group besides me (from M*Modal) were Laura Rizzo from Lancaster General Health and Stephanie Donovan from Pierce College. Our group had a perfect mix of experienced and first-time Hill Day attendees – and our group’s members came from a diverse mix of backgrounds representing health care providers, HIM service solutions, HIT companies, and education.

Our group from Pennsylvania did not, unfortunately, get to meet with the senators or representatives themselves but instead met with staffers whose positions ranged from legislative assistants to legislative correspondents to health policy advisors to health correspondents. These are the gatekeepers to the elected officials – catch their attention, and you have a good chance of getting the attention of the senator or representative. Bore them – and you’re done. But no pressure, right?

This was a particularly challenging time for AHIMA to make its case. With one week left in the countdown to government shutdown if an agreement on the federal budget isn’t reached and debates underway over the U.S. presence in Libya, AND health care conversations happening this same week about accountable care and other concerns, our health information issues were not likely to be foremost in discussions on Capitol Hill.  Add to that the House repeal of health care reform after last fall’s elections and continued threats to that legislation as well as big budget concerns, and we had a big task in front of us.

But AHIMA had an important case to make, and did a great job of summarizing Hill Day issues both for us as attendees – knowing that we might have to make our case in less than 15 minutes –  sometimes less than 5 minutes – and in the information packets we left behind.

Here are the major issues that we brought to the attention of Capitol Hill:

  • The HIM profession and AHIMA. Who are we? What do we do? Why should legislators listen to us? What impact do we have on health care and on issues important to legislators? AHIMA, an organization 61,000 members strong, has a big role to play in the successful implementation of the EHR and health information exchange, the adoption and successful use if ICD-10, and most importantly, continued use of health information as tool for communication and collaboration between care givers.
  • The Health Information Professions Advancement Act. What is the skillset and the knowledge required of HIM personnel given the changes to our industry in recent years, and in years to come? How do educational requirements for the HIM professional change to support those requirements? How do we preserve and protect funding established for the education of HIM and HIT professionals?
  • Protection for ARRA – HITECH and meaningful use initiatives. With the budget under scrutiny, AHIMA wants to ensure that progress that has been made towards the adoption and effective use of the electronic medical record doesn’t go away. We can’t go backwards!
  • Support for a study by the GAO for a solution to the challenges presented by patient identity. The use of electronic health records, or the sharing of meaningful health information in any medium, requires that we know who the patient is without risk to the patient’s privacy or the security of the patient’s personal information.  AHIMA wishes to gain governmental support for a study into how to identify patients without risk to the patient’s privacy.

All of these issues are of tremendous importance in health care today if we are to ensure that health information and technology achieves its potential to decrease costs, improve quality of care for individual patients, and to improve overall health for the population of the United States. Who better than HIM professionals, the “keepers of the keys” to safe, accurate, useful health information, to support and promote this cause?

And who better than to help to ensure quality, comprehensive health information than those who have been providing it for many years – medical transcription professionals?

Those of us who are involved in medical transcription must remember that transcription is indeed a valuable part of HIM and should support AHIMA in its efforts to preserve quality health information.

Even better – AHDI and CDIA have their own Advocacy Summit coming up in May.  This is your opportunity to tell your representatives in government about your contribution to health care – and what you’d like them to do to help to preserve that role in helping to decrease the cost and improve the quality of health care by enabling the availability of high-quality, comprehensive, and complete health information.

We will talk in more detail in coming weeks about these and other concerns and what we can do to preserve excellence in health information.

More to come…

Lynn

M*Modal

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