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

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!



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,

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.

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!


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 ( 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,


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

AHDI West – Petition to Legislators for Transcription in Meaningful Use

Hello:  Take a look at Jay’s latest post on AHDI Lounge.  He draws attention to ADHI West’s online petition to consider transcription as a valued part of Meaningful Use….

AHDI-West Online Petition Advocates For Inclusion  Of  MT  In Meaningful Use Criteria

The Western Region of the Association for Healthcare Documentation Integrity (AHDI-West) has created an online petition directed at federal legislators:

We petition your continued support in these urgent times by communicating with the Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health IT, seeking acknowledgment in regulations that the dictation-transcription process and structured narrative reports are recognized as vital elements of electronic health records (EHR), are included in the definition of “meaningful use”, and recognized as essential for ensuring patient safety.

The petition can be electronically signed online.

Jay Vance, CMT
AHDI Lounge Administrator/Moderator

Thanks AHDI West for taking such an important step! And thanks as always to Jay for bringing it to our attention.


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