Holistic Health Information

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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.

CDIA (formerly MTIA)

All the best,

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

2 Responses

  1. Great article Lynn, and I could not agree more with the need for quality documentation. I’m so glad you put that as number one. I do believe this is critical to patient safety and accurate health information, which is why I am so passionate about developing software tools for the transcription community.

    I will be at CDIA and will be bringing your article up with people I talk to there. Will you be there? I hope so.

    Best regards,

    • Yep! I’ll see you there!

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