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

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

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

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.

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

Health, Information, and the American Way!

US Congress on Capitol Hill, Washington DC

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Good morning everyone!  I am very excited to be heading to Washington, DC to attend the AHIMA Team Talks and Hill day events!

Why?

Well, first there is the fact that I’ve always been a little bit of an “advocate” at heart. From the ecology club I started in the 7th grade (sigh – only 4 people joined including me), to the letters I used to write on behalf of multiple causes, to the daughter I raised who once failed a history test because she refused to give the desired answers to questions about Christopher Columbus (because he was a usurper of the indigenous people) and who only a couple of weeks ago kindly rearranged books in Barnes and Noble because books written by and about Frederick Douglass were only shelved under “Cultural Studies” and not under American History where  they belonged, I am appreciative of being allowed to be a part of the democratic process that is the United States of America. After all, we’re only here because of a little effort conducted by a band of “advocates” known as The American Revolution, right?

Second, it is important. Health care in our country is in bad shape and health information and technology can play a big part in helping to improve care and to decrease costs.

What is advocacy? According to Princeton University’s WordNet, (2011) advocacy is the, “active support of an idea or cause etc.; especially the act of pleading or arguing for something.”

Yep, that sounds about right.

But what does that have to do with health information?

I’ve referred to HIM previously as the “keeper of the keys” for quality health information, and AHIMA is the keystone of HIM. According to the paper About the American Health Information Management Association (AHIMA) made available on the AHIMA Communities of Practice Hill Day community, “AHIMA members believe you achieve quality health through quality information” (2011).

Yep, that sounds about right too.

But with so much change happening in the HIM realm including health care reform and its associated Meaningful Use requirements, advances in technology, the coming conversion from ICD-9 to ICD-10, it is easy to lose sight of what “quality information” really means, and what we, as a profession, must do to preserve and maintain it.

AHIMA, as an organization 60,000 people strong, has a big voice in advocating for health information. AHIMA organizes its Hill Day as a means to provide members with opportunities to meet to discuss relevant topics, and then to talk about these topics with our elected officials. In short, AHIMA provides us with a wonderful opportunity for advocacy.

On Tuesday during our meetings with our representatives in the 112th Congress, AHIMA members will focus on the following (AHIMA, 2011):

  • The HIM profession and the AHIMA association – who are we and what do we do? Our strategic focus on key points such as the adoption and implementation of the EHR, health information exchange, guidelines for interoperability including attention to standard terminologies and classification systems, privacy and security of health information, ICD-10, and more.
  • Support for the “Health Information Professions Advancement Act” which will address the need for the HIM profession and shortages of knowledgeable, trained professionals.
  • Protection for HIT and HIM initiatives established as part of ARRA-HITECH including Meaningful Use.
  • A solution for the patient identity challenges encountered as HIT evolves.

I will be blogging and tweeting from DC – so stay tuned as Lynn goes to Washington!

You can find more detailed information about AHIMA’s Hill Day on the AHIMA website.

Of note, AHDI/CDIA has its Advocacy Summit scheduled in DC for May 3-4.

See you on The Hill!!

Lynn

Director of Health Information Services

M*Modal

References:

Asmonga, D. (2011) About the American Health Information Management Association (AHIMA). Retrieved March 26, 2011 from http://cop.ahima.org/Community/Topics/tabid/66/ctl/Detail/mid/409/community/63/topic/43217/Default.aspx

Princeton University WordNet. (2011). http://wordnetweb.princeton.edu/perl/webwn?s=advocacy

“Improved Patient Care through Quality Health Information”

I usually keep my blog agnostic of M*Modal, and try to make it of interest to anyone in the health information space, regardless of the technology they use. But since the HIMSS conference about a month ago, the resulting follow-up conversations and news from the HIT world made it more apparent to me why I came to work for M*Modal – and why we’re all in this business in the first place. So I thought I’d stray from my own rules a bit.  The blogger’s prerogative.   I also hope to use this as a jumping-off point to an ongoing discussion – what is quality health information?

At HIMSS this year, there was, as you would expect, a tremendous amount of talk about meaningful use, health information exchange, adoption, you name it. The exhibit hall was full of vendors whose products will solve all of a health care provider’s problems. There were “transformative” solutions everywhere you looked.  Since HITECH ARRA announced its meaningful use requirements, HIT has exploded with new products, new technologies, and a scramble to help the provider (or perhaps capitalize on the need to?) achieve compliance.

But as I talked with people who came to the M*Modal booth asking, “what is different about M*Modal”, it forced me to think about that myself. Why is M*Modal different?

My two cents:

  • We aren’t a “vendor”.  Yes, we sell technology. But with our technology comes our people – a partnership. The service we provide can’t be separated from our technology.
  • We aren’t about the revenue cycle. We’re about health care. Yes – documentation plays a big part in revenue cycle management and our technology certainly helps with that – but “Improve your revenue cycle!” isn’t our mission.
  • Our founders have been using the terms “health information universe” and “meaningful clinical document” for years – as evidenced in a slide from an early presentation that is still relevant today. A universe of meaningful clinical documentation has been what M*Modal is about since its inception.
  • We spend hours talking about how to improve the documentation experience for caregivers, and how to use information to build a more collaborative experience for the patient care team and the HIM. We talk to physicians, to HIM professionals, to technology vendors, to transcription service providers, to continuously improve not just their experience using our technology, but their ability to make use of health information in general.
  • Yes, our M*Modal team includes scientists and engineers, but it also includes health information professionals from MTs to transcription managers to coders to CDI specialists to RNs to those of us who have been in the business so long that we’ve done pretty much everything there is to do in HIM.
  • We honestly believe that health information can have an impact on the care of the patient – and on wellness itself. As our CTO Detlef Koll put it in his response to the PCAST report, ‘truly meaningful use of health information has the potential to transform health care.”

Do we have our challenges? Of course – we’re growing fast and we’re crazy busy.  But from the interns who frequent our offices, to our scientists, to our customer service personnel, to the people who keep our data center running, to our administrative and HR staff, to our marketing and business development teams, we’re all part of a team who works every day towards a vision of improved patient care through quality health information.  And at the end of a day, no matter how long, that is really all that matters.

Over the coming weeks, we’ll be talking more about “quality health information” and what that means to business, to health care providers, and most importantly, to the patient.

I look forward to hearing from you about what “quality health information” means from your perspective.

All my best as always,

Lynn

PS:  This post also appears at Excellence in Health Information.

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