Health Information – the Exciting Road Ahead!

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Hello everyone:

I have been privileged over the past couple of weeks to visit some of the most prestigious health care providers in the country and to hear their thoughts about the state of health information today.  I can tell you that we in the health information field are in for some exciting times ahead!  Whether we work for HIT or HIM companies or for health care providers, the changes occurring in health care mean that our roles in serving health care are changing too.  So there could be no better time to pick up our conversations again on Excellence in Health Information.

See the rest here…Health Information – the Exciting Road Ahead!

Til next time!
Lynn
M*Modal

Speech Recognition as the Accelerator of Meaningful Clinical Documentation

Hello everyone: Over the last couple of weeks I had the opportunity to attend several conferences. One was the national conference of the Case Management Society of America (CMSA) (more about this visit later) which was held in San Antonio, Texas, (home of the Alamo). Then I had the privilege of presenting to two state HIMA conferences; New Jersey (NJHIMA) in Atlantic City, and then back to Texas (TxHIMA) for their state conference in Dallas.

As always, I really enjoyed meeting with state HIMA members. It is so satisfying to know that wherever you are in the country, HIM professionals have the same passion for safe, high-quality, useful health information. It is also interesting to see that everyone seems to be facing the same challenges with respect to adoption and use of electronic health records. Everywhere I go, I hear the same stories about point-and-click, template-driven EHR systems that are time-intensive and cumbersome for the physician, that don’t provide the necessary information for the HIM, and which cause concerns for the health care enterprise because of costs and questionable ROI.

Needless to say, there is always interest in discussing narrative documentation including how to produce it cost-effectively and efficiently, and how it can be used to generate the discrete data needed for the interoperable exchange of information, to provide data for reporting and analysis, to drive clinical decision support and other automated care protocols, and in general, to realize the benefits that we all expect as we make use of electronic health information.

Some of you have seen these before, but just in case, here are my slides:  NarrativeDocumentation_HIMA_20110629.

In a nutshell:

1. Today’s changing health care environment is setting higher standards for documentation while seemingly making it more difficult for physicians to document patient care. The need for documentation to support Meaningful Use, to drive the communications and reporting necessary for Accountable Care and the Patient-Centered Medical home, to enable the conversion to ICD-10 from ICD-9, and to support the reporting required to monitor quality and outcomes is increasing. It is more apparent than ever that comprehensive, complete, and accurate health information is integral to the functioning of any health care facility. And yet newer methods of documenting patient care are often inefficient and time consuming for the physician and are not intuitive for other consumers of health information.
2. Dictation is still a viable, economical, and effective means of capturing clinical information.
3. In order to be cost- and time-effective, options for clinical documentation must be made available based on the type of encounter being documented and the needs of the user. For some encounters, templated, structured forms are likely sufficient. For others, physicians may do very well with speech recognition and self-editing. For more complex encounters, physician dictation supported by skilled medical transcription might still be the best way to go. The point is – health care providers must have flexibility and options for capturing the complete, comprehensive level of information required to support patient care, coding for billing and reimbursement, research and population health reporting, and all of the other uses for health information.
4. Speech recognition and other technologies, when combined with efficient management practices, can be a cost-effective way to produce high-quality narrative documentation.
5. We cannot continue to look to the best practices that many services and providers have historically followed when implementing speech recognition. In the past the goal might have been to “create cheap documentation fast” – now the goal for clinical documentation MUST be, “create useful documentation efficiently.’
6. Quality is key. We are all hearing a great deal about natural language processing, computer assisted coding, and other technologies that will help us to process and make use of our health information – but if the documentation at the foundation of these technologies is poor – the technology can’t do its job.
7. Efficient management practices are another key component. The percentage of productivity gained does not necessarily reflect the increase in output! Again, technology is no replacement for effective management practices.
8. It is not, as many believe, necessary to eliminate narrative documentation in order to have semantically interoperable electronic information. The Health Story, HL7, IHE Consolidation project is making great strides towards the creation of interoperable standards for the exchange and use of health information which will allow us to have the structured and encoded clinical data that we need to support automated processes, while at the same time retaining the human-readable narrative information that is required for communication and understanding. I personally have always been a big believer in having my cake… and eating it too. 

If you have any questions about the slides or the presentation please let me know. I’d love to hear your thoughts and experiences!

Till next time,
Lynn
M*Modal

The Year in Review – Management for the Modern MTSO

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Hello everyone: I’ve had a couple of questions come to me recently and thought I’d provide an easy guide to some of the topics we covered since the blog went live this past summer.

By far the topic that generated the most interest was MT compensation – and we will for sure talk more about this – stay tuned! The most popular article was MT Compensation followed by When Metrics Mean Nothing – The Myth of the “Percent Gain”.

Here is a brief index of topics and links to articles from 2010.  Many of the articles fit into multiple categories, so feel free to browse.

I hope this is helpful and I look forward to lots of great discussion in 2011.

All the best,
Lynn

The Future of Medical Transcription

Is Medical Transcription Still Relevant?

The Sheep, the Wolves and NLP. A Cautionary Tale.

Medical Transcription into the Future….

ACE 2010 Presentation – Keeping Transcription Relevant into the Future

Are we telling the real [Health] Story?

Health Information – what exactly IS the problem?

HIM – Out of the Basement and into the Forefront

ICD-10 and Health Information Technology

Speech Recognition – general

Is Speech Recognition the answer to all your problems?

Speech Rec is here to stay…

MT Compensation and Management

MT Compensation

The Demise of the Career MT

ACE 2010 Presentation – Keeping Transcription Relevant into the Future

What Factors Contribute to MT Career-Mindedness?

Slides from NEMA AHDI Presentation…

MTSO Value – Relevance

Medical Transcription into the Future….

Are we telling the real [Health] Story?

What does the Medical Transcription Industry Sell?

Will we see you at AHIMA?

Optimization of speech recognition Technology Results

When Metrics Mean Nothing – The Myth of the “Percent Gain”

What does the Medical Transcription Industry Sell?

Health Information and Healthcare – Education and News

Health Information – what exactly IS the problem?

Lynn goes to the Doctor

A New Concept in Healthcare?

Will we see you at AHIMA?

HIM – Out of the Basement and into the Forefront

Help for a Front-end Speech Recognition Nightmare

ICD-10 and Health Information Technology

Clinical Documentation – Friend or Foe

Health Information Management Students Today

Lynn’s HIM Back-to-School Update

The New Year Already? What’s Coming Up?

Exciting Times for Health Information

AHDI – M*Modal Transcription Series – beginning in January!

Let’s Get Tweetin’!!

Back to School Time for Medical Transcription!

Exciting Times for Health Information

Happy New Year 1910!

Image by Puzzler4879 A Blessed New Year To All via Flickr

Here we are again at the end of another year. Some say the perception of the years speeding by faster and faster is just an attribute of getting older. But I prefer to think that the last year flew by because it was busy and exciting! The year was full of activity, for M*Modal which continues to grow by leaps and bounds, and for me personally.

This was the year I got myself back to school, the year I made lots of new friends and worked with lots of old ones with a similar passion for health information at AHDI and AHIMA and with our M*Modal customers. It was the year I took on new projects such as working with the interns from University of Pittsburgh’s HIM program, and it was also the year I learned about social media! As I look back I can hardly believe that I only entered the world of social media this past summer. Social media has been such a tremendous communication tool and source of information and education for me that I can’t imagine doing without it now.

But most of all, this was a year during which conversations about health care changed in an incredibly exciting way.

Yesterday I was talking with my boss, Michael Finke, CEO and spiritual leader (though he does not admit to that) of this no-longer-little movement we call M*Modal, when he said this might be the most exciting time for healthcare and for health information that has been seen in decades. I agree.

Why? Because the conversation is changing. Conversation about healthcare is changing its focus from being about “improving healthcare” to being about “improving patient health.” A few years ago, that kind of statement would have been seen as idealistic and unrealistic, but now I read about it every day.

This last year has been full of talk about the Accountable Care Organization (ACO) and the Patient Centered Medical Home (PCMH), established under the Patient Protection and Affordable Care Act to transform care of the patient to a collaborative team effort – a team that includes the patient – to manage chronic illness, to prevent complications and avoid hospitalizations and procedures when possible, and to improve overall health.

Physicians and healthcare organizations are making use of social media to promote and educate the public about health matters. Influential physician bloggers such as Kevin Pho, MD (KevinMD.com) continually provide much needed information about health and about changes in healthcare. Mayo Clinic reaches thousands through its Center for Social Media, with greater than 100,000 followers on Twitter and the largest medical provider channel on Youtube.

Vaunted health systems such as Mayo Clinic, Geisinger Health System, and Kaiser Permanente are leading the way, showing the rest of the world how healthcare can be centered around the patient and not around reimbursement.

Kaiser’s incredible book Connected for Health: Using Electronic Health Records to Transform Care Delivery (Liang, 2010) talks about placing the patient at the center of care, “home as the hub” (Liang, 2010, p. 15), and how their efforts to improve health information contribute to patient health.

Mayo Clinic explains its history and how it continues to act on the vision of the Mayo brothers years after they are gone in another of my favorite reads, Management Lessons from Mayo Clinic: Inside One of the Worlds Most Admired Service Organizations (Berry, Seltman. 2008).

And Geisinger Health System sees results by piloting  innovative new payment models for patients – package prices for total care before, during, and after certain procedures rather than pricing for each individual event that occurs during a patient stay – including treatment for any complications that might occur.

Systems like Mayo and Geisinger prove that physicians and researchers, passionate about the health of their patients, will flock to a system that revolves around health of the patient even if they are paid as employees and not for the numbers of patients they see or the number of procedures they perform. I think that model for healthcare must be an incredible relief to physicians who have long been feeling the pinch of lower reimbursement and higher costs at the expense of the health of their patients.

And what must exist at the core of all of these efforts in order for them to succeed? Health information. Without complete, accurate, timely, and accessible health information, collaborative care of the patient can’t happen. In fact, as we read every day, health information can no longer be separated from the topic of patient health.

So despite the results of the last election and the talk about healthcare reform being rolled back, the train is a-rolling. There is no stopping it now.

What do I say to the nay-sayers in Washington who are determined to repeal healthcare reform because of party politics? At the risk of sounding incredibly naïve – and maybe just a little bit silly (when has that ever stopped me before) – I’m going to re-visit the words of Bob Dylan when he said…

Come senators, congressmen
Please heed the call
Don’t stand in the doorway
Don’t block up the hall….

….For the times they are a-changin’. (Dylan, 1963)

In the new year ahead, in our world of health information, let’s not be left behind. Let’s join the conversation and think about how we can contribute to better patient health.

I can’t wait to see what we can do together in 2011!

All the best to you and yours for the New Year,
Lynn

References:

Liang, L. L. (2010). Connected for health: Using electronic health records to transform care delivery. San Francisco, CA: Jossey-Bass.

Dylan, B. (1963).  “The Times They are A-Changin’.” Lyrics. Copyright by Warner Bros. Inc.; renewed 1991, 1992 by Special Rider Music.  Retrieved December 30, 2010 from http://www.bobdylan.com/#/songs/the-times-they-are-a-changin

Lynn’s HIM Back-to-School Update

US medical groups' adoption of EHR (2005)

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Given the changes facing us in this field, graduates from modern HIM programs will be valuable additions to our HIM and HIT teams. I hope so – because (since I never finished the program I started many years ago for various reasons) I’m officially taking classes again now. And how FUN it is to take classes that are immediately relevant to what I do on the job every day. How often do we get to say that about classes we might take towards a particular degree program? I can tell you that I don’t use 85% of what I learned in my project management classes. And much of what I learned during the time when I thought I’d grow up to be an English teacher? Well, as much as I love him, let’s just say I’ve never been called upon to quote Yeats in my life.

I can tell you this for sure – I thought some of my coursework was going to be easy because I took the same or similar classes a long time ago. Well guess what – this is not your father’s HIM program. 🙂 I was originally annoyed that so many of my old classes had to be repeated. Now I am glad!

I honestly feel as though the majority of coursework I’ll be doing in my HIM program will be absolutely useful to me. My only concern is whether or not I can keep up with the – ahem – somewhat younger students. But I plan to give my two children – also college students – some competition for the best grades on the refrigerator in the Kosegi kitchen.

I’ll be interested to see how HIM education keeps pace with the changes coming to healthcare and particularly to health information. Everyone now is concerned about teaching ICD-10 instead of ICD-9. That’s a given. What will HIM personnel need to know about Meaningful Use? About measuring quality outcomes?

And of course we all know that for a number of years HIM will be living in a hybrid world consisting of both paper and electronic records and facilities that have reached varying stages of Meaningful Use compliance. We will also need to handle information that has been coded using ICD-9 along with information that has been coded using ICD-10. After all, even if we do effectively flip the switch and convert from ICD-9 to ICD-10 in one day, there is no magic “easy button” that will retroactively re-code the information that was coded yesterday.

I mentioned previously that something that concerns me a bit is that the HIM students I’ve talked to over the past few months don’t want to go to work for hospitals or other healthcare providers. They want to work for technology companies. The reason for this seems to be that the technology world is forward thinking and exciting whereas the HIM departments that they’re exposed to during their clinicals are backwards, resistant to change. The students I speak with see a lot of paper on these clinicals and a lot of backwards appearing processes. What I say however is that the reason these departments are engaging in seemingly backwards ways of doing things may not be that the users are resistant to new ways of thinking. It may be that the technology available to them doesn’t serve their needs. If they are printing information from the EMR and matching it with other paper documentation to make a complete record – isn’t it possible that this is because the EMR isn’t providing the workflow that meets the needs of both clinicians and the HIM personnel?

So what can we do to counter the impression that HIM in the provider realm is boring and backward thinking while technology is exciting and progressive? Here are a couple of things that might help:

  • Don’t be an obstacle to change! Yes, speak up about change that doesn’t make sense – but don’t object to change just for the sake of objecting. Show those who are new to the field that we bring something special to the table – an understanding of the real needs of users of health information – in addition to our ability to learn and implement new ways.
  • Think about health information from a holistic perspective. We talked before about how all of the various stakeholders in the HIM process focus on their own unique challenges. Transcription providers, coders, billers, HIM correspondence personnel (for whom ROI means release of information), hospital finance personnel (for whom ROI means return on investment), auditors, CDI specialists, technology vendors, and of course clinicians – we all separate the larger topic of health information into the pieces that directly affect us. Let’s look at the discussions taking place in groups outside our own to get a better idea of what “quality” health information really means.
  • Educate ourselves. There is a wealth of information out there that will help those who live in the reality of the HIM today to prepare for tomorrow.

Here are a few excellent sources of information to get you started:

AHIMA Body of Knowledge: If you aren’t a member of AHIMA, join. They have a wealth of information available covering a wide variety of topics including a Meaningful Use Vocabulary Toolkit made available in late October.

• CMS –in particular, their Quality of Care Center

CCHIT’s EHR blog

Disruptive Women in Health – they often have links to great information.

Kaiser Health News

Maybe we “old schoolers” can show the folks who are new to the field that we too can be forward thinkers…

Til next time,
Lynn

A New Concept in Healthcare?

Hello everyone:  I’ve been reading about the accountable care organization (ACO) with great interest, in particular a blog hosted by The Commonwealth Fund (www.commonwealthfund.org).

The ACO is a concept that encourages groups of physicians to work together as teams to promote better health outcomes and decreased costs.

This idea is exciting. Instead of paying for expensive clinical tests which may or may not be beneficial to a patient’s care, or for expensive treatment AFTER a patient has become severely ill, these organizations are paid to keep patients healthy. Not only is this obviously good for the patient, but it is also an opportunity to decrease healthcare costs by decreasing the need for  expensive diagnostic tests, treatment, and surgeries after a patient has developed a condition or complication that could possibly have been prevented.

There are several potential options for payment models discussed by Karen David of The Commonwealth Fund in her blog posting Coherent and Transparent Health Care Payment: Sending the Right Signals in the Marketplace. These include the global fee option, where organizations are paid one fixed fee for all care for a health condition, and bundled acute case rates, where certain procedures are paid for by one rate that covers surgeon’s fees, anesthesiologist’s fees, the hospital bill…and even for after care should complications arise after the surgery! Sound too good to be true? According to Karen Davis in this same post, Geisinger Health System in Pennsylvania already offers a global fee for several procedures performed there. Ms. Davis in her post states that she is proud to serve on the board of directors for Geisinger, and well she should be!  This is truly an exciting, and seemingly a common sense, approach to healthcare finance.

As with any major reforms of this size and scope, the ACO will need to overcome numerous challenges and obstacles if it is to be successfully adopted – but I will continue to watch with great interest!

For more interesting reading, go to www.commonwealthfund.org. There is a LinkedIn group (subgroup of Healthcare Executives Network) at http://linkd.in/dxFOli.  Go To LinkedIn Groups directory and search for Accountable Care Organizations to request membership to the group.

What do you think?

-Lynn

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