The Classroom vs Practice in Health Information

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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

AHIMA, Health Information, and Value-Based Health Care

Salt Lake City, Utah, USA in January 2009.

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Hello everyone: It is almost that time again! The days are getting cooler, and Fall is in the air. We know what that means, right? It is almost time for the AHIMA National Convention and Exhibition! This year the convention is in beautiful Salt Lake City, Utah and I can’t wait! This will be a particularly interesting conference with so much going on in the world of health information. Health care providers are deep into conversions to electronic health records at the same time that are gearing up for the conversion from ICD-9 to ICD-10 coding. New technologies such as natural language technologies and computer assisted coding are being discussed. Perhaps most interestingly, the HIM profession is making plans on how to support new models for healthcare delivery including accountable care and the patient-centered medical home, because regardless of what happens on The Hill in DC, the move to value-based healthcare must happen.

Those of us in the transcription industry must pay particular attention to the changes occurring in HIM. As discussions about computer assisted coding and ICD-10 occur, it becomes more apparent than ever that complete, comprehensive narrative clinical documentation is a must-have and a no brainer. Despite talks of how transcription will be eliminated by the EHR, we still have a huge role to play in the delivery of care to patients.

Follow this link to my posting on Excellence in Health Information to hear a bit more. And I hope I see you all in Salt Lake City!

Til next time,
Lynn
M*Modal

Speech Recognition – Throw Away Everything You Thought You Knew – from AHDI ACE 2011

Hello everyone: I apologize for taking so long to get these slides uploaded! I’ve been crazy busy traveling, and then playing catch up after traveling. I’m looking forward to writing more about ACE 2011 (very exciting this year!) as soon as I get a few moments, but I wanted to get these out to you now.

AHDI_ACE_20110821

And for anyone who wants more information about some of the things mentioned in my slides, here are some links to previous articles:

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

What Factors Contribute to MT Career-Mindedness?

Optimization of speech recognition Technology Results

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

What does the Medical Transcription Industry Sell?

Narrative Documentation, Standards

Are we Telling the Real Health Story?

A Vision for Truly Meaningful Health Information

The Documentation and Coding Adjustment (DCA): A CDI Specialist’s Perspective

This week on Excellence in Health Information, I am pleased to present Donna Wright, MSN, RN, CCDS, currently a medical coding data analyst at M*Modal, formerly a Clinical Documentation Improvement Specialist for a health system here in Pittsburgh. Donna has a 28-year-long nursing career and has worked in a variety of fields including critical care, OR, clinical research, and supervisory/management in long term care. She is a graduate of Lehigh University, St. Luke’s School of Nursing, with a BSN from Slippery Rock University and MSN in Informatics from Walden University.  Donna is married to a structural engineer and has two grown children.

Donna brings up some interesting points in her post about clinical documentation improvement and the stance CMS has taken with respect to changes in reimbursement levels resulting from documentation improvement.  I visited a provider two weeks ago who told me, “we are only asking to be paid for what we are actually doing – no more and no less.” What does everyone think? Do you have a story to tell about CDI in your organization?

See what Donna has to say here

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

Response to Questions…

Hello everyone:  Over the past couple of months I’ve been privileged to present at several conferences and to do a couple of webinars. Since then some questions about these presentations have been sent my way (thank you!).

I thought it might be helpful to provide some links to some past articles that might be of interest to anyone who has questions about some of the presentations.

Thanks so much for proving once again how dedicated the people in the health information industry are to providing and producing high-value health information!

As always, questions and comments are most welcome!

Lynn,

M*Modal

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…

Optimization of speech recognition Technology Results

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

What does the Medical Transcription Industry Sell?

Narrative Documentation, Standards

Are we Telling the Real Health Story?

A Vision for Truly Meaningful Health Information

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

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