The Classroom vs Practice in Health Information

A medical record folder being pulled from the ...

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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

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