Health Information – the Exciting Road Ahead!

Dr. Schreiber of San Augustine giving a typhoi...

Image via Wikipedia

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!

Change Ahead for M*Modal and MedQuist

Today’s world is full of change.  In the world of health care, with new discoveries, new treatments, and new technologies found seemingly every day, change may be the only constant.

And so it is with businesses that support health care, where change can lead to the need for migration to new service and product offerings and to corresponding changes in business models.  Consolidations of businesses in the health information service and technology domains often occur as companies seek to increase revenues, take advantage of synergies, or as in the case I’m going to talk about here, to merge two companies with different but complementary talents as part of a growth strategy.

Most of you have probably heard that my employer M*Modal is about to be affected by such a change.  On Monday, July 11,  a merger between M*Modal, a leader in speech recognition and natural language understanding technologies, and MedQuist, a leading provider of medical transcription services and documentation workflow technology, was announced.  It was also announced that Vern Davenport, former CEO of Misys Healthcare and long-time HIT industry leader, will become the CEO of the combined company.

This announcement came as a surprise to many who know us as the small but quickly growing company whose senior executives are the very guys you came to know as industry innovators.  It may not have been a surprise to some, however, who in view of market activity in recent years wondered at M*Modal’s ability to compete against significantly larger companies.

And though we at M*Modal have rather enjoyed being David in a David-and-Goliath-like competitive environment, our leaders understood that now is the time when acceleration of our efforts is needed for our customers.

MedQuist too has been observing changes in the industry and sees value in combining their world-class services with the industry-leading technology that will allow them to offer their customers the best of both worlds – innovative technology offered by people who understand the world in which it will be implemented and used.

What does this mean to M*Modal customers and to its partner relationships?  It means only good things.  To the partners who rely on M*Modal technology to provide services to their customers, it means robust strength.  To the partners who incorporate M*Modal solutions into their technology offerings, it means partnership with a company with greater market presence.  To our health care provider customers, it means greater flexibility and options.  And since M*Modal understands that our customers need us to act fast in response to health care’s changing needs, then perhaps most importantly, this merger means that M*Modal will have the ability to bring solutions to health care faster.

Many of you have been kind enough to ask what this means to me personally.  To be honest, I was surprised at the announcement, and was admittedly concerned.  I mean, anyone who knows me knows that I believe in M*Modal and its vision with my whole heart.  But… after a visit from our future leader, Vern Davenport, my concerns have changed to excitement, hope, and even eagerness.

In speaking with the M*Modal team, he made it clear that this is not a case of one company absorbing another.  To the contrary, he explained that we are two companies joining forces to support health care providers as they continue to adopt electronic health records and as they embark on the transformation to value-based care.   He told us that his role as the CEO of the newly formed company will not be a job for him – it will be a mission.  He said he is here for one reason – to make an impact on health care. Well, for me that was the statement that clinched it.  I’m in.

In short, this new relationship will ensure that M*Modal can continue on its path towards creating a collaborative ecosystem for health information that supports the health care provider and which contributes to health care itself.  We have always strived to serve those who serve the patient – and now we’ll have the ability to do so with even greater impact.

For the immediate future, the two companies will continue to operate separately as all the i’s are dotted and t’s are crossed.  But stay tuned for more!  I’ll be sure to keep you updated…

In the meantime, like me, rest assured that we are not the Starship Enterprise and the Borg (you know, “you will be assimilated. Resistance is futile.”)  Like Jean Luc Picard, current M*Modal CEO Michael Finke and the other M*Modal leaders will continue to lead us as we “boldly go where no one has gone before” into the exciting times ahead.  (CBS Entertainment, 2010)

For more details, here is a link to the formal announcement

All my best as always,


Still M*Modal

Disclaimer:  All nerdy Star Trek references are mine – not to be blamed on anyone else at MedQuist or M*Modal.

CBS Entertainment. (2010).  Star TrekTM. Retrieved July 14, 2011 from

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,

Preaching to the Choir at AHDI Florida

Sunrise at Fort Lauderdale Beach

Image via Wikipedia

I must have been a very good girl lately, because here I am again visiting AHDI Florida whose annual meeting is, of course, right on the beautiful beach in Fort Lauderdale.  Pennsylvania has been a bit on the chilly and rainy side, so this feels pretty wonderful!

But my favorite thing about being here is the people of AHDI Florida. It must be all this sunshine, because they are so full of energy!  Their meeting this year is called, “The Winds of Change” and from my previous experiences with this group, they get that change is coming their way – and rather than bemoaning the fact – they are embracing it and making it their own.  In fact, they “get it” so well that in a way I feel like I’m cheating speaking here….I am, in effect, preaching to the choir.  🙂  But since I know the members of this group will take what they hear and will spread the gospel of dictation and transcription as enablers of electronic health information, then I can enjoy the Florida sunshine without guilt.

My presentation is titled Speech Recognition – Throw Away Everything you Thought you Knew.  In this presentation I will ask listeners to throw away a lot of common assumptions about speech recognition and transcription – including a few things I might have told them a few years ago before I joined M*Modal after some experiences with a different vendor.

Because you see – we did it wrong.  The message about speech recognition and transcription has always been about saving money, and that unfortunately has often meant decreasing MT line rates rather than looking at the many other ways the technology can be used to decrease costs. And now look where we are. We are in an era where comprehensive information is a must-have for quality and outcomes reporting, as a driver of automated clinical decision support systems, as a source of data for population health reporting, and as a foundation for technologies such as natural language processing and computer assisted coding.  But instead of promoting the fact that transcription is an excellent source of high-quality, comprehensive information which can adhere to all the content requirements a provider needs to drive other aspect of HIM and health care, we have been focused on productivity.

Many in the industry (not all!) have been focused on providing cheap documentation; not high-value documentation. They’ve been focused on print formats, not content requirements.  And worst of all, they’ve been driving down the value of our skilled medical transcriptionists causing them to leave the industry.  I actually had a service provider tell me during my trip to DC for the Advocacy Summit that hospitals aren’t reluctant to use offshore transcription anymore, not because they realized that the quality could be just as good, but because the types of errors that would have caused the cancellation of a contract ten years ago don’t even get mentioned today. In other words, it is about “cheap”; not about quality.  Folks, I’m here to tell you, the day a provider stops complaining about poor quality is the day they are telling you that you are extraneous, your documentation is not being used for anything important, and you are not long for this world.

As you all know – I don’t care if the transcription is done in the U.S., or in India, or on Mars. I don’t care if it’s being produced through traditional typing, backend speech, or telekinesis. Poor quality documentation is USELESS for all of the purposes that documentation must be used for today – from computer assisted coding to PQRS (formerly PQRI) reporting, to the use of the documentation as a communications tool for members of a patient care team in an ACO or patient-centered medical home, to the reconciliation of problem lists and creation of patient-facing summaries that is required as part of Meaningful Use, and more.  The quality MUST be there – or transcription won’t be.

Unfortunately many speech recognition vendors, and I’m sorry to say, even many transcription service organizations, continue to promote the wrong message – the message of “cheap” documentation, not valuable documentation.  Let me ask you this – if the health care provider is only giving up printed paper documents of inconsistent quality that are not being used for any purpose other than to check-off requirements on a chart completion list, when someone comes along and says, “hey, the docs can do direct-data entry into the EHR so we don’t need transcription anymore,” is the provider going to use, “but we get the transcription so cheap…” as a reason to convince the decision makers that transcription should be kept as a means of documentation?  Not hardly…

Let’s forget everything we thought we knew about speech recognition and transcription and look at it in a new light.  Let’s remember that dictation and transcription can be the accelerator of high-value electronic health information, not something that electronic information can replace.

So – all you folks out there in the choir – can I get an Amen?

All my best as always,

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:

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.

“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,


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

AHDI Florida Technology Workshop

Florida AHDI

In Florida? Join us at the AHDI Florida Technology Workshop as M*Modal and AHDI continue the Management for the Modern MTSO series.

From 9:30 to 11:30 we’ll be discussing Innovative Transcription…

Folks, the more doctors I talk to, the more I’m convinced – without my natural bias for transcription – that transcription is integral to the creation of comprehensive health information.

But can we  compete? Can we stay relevant? How do we add the value that providers will be willing to pay for?

Let’s talk!  See you in Orlando!


%d bloggers like this: