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

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…



Help for a Senior HIM Student’s Capstone Project…

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Kaitlyn Crowther is a senior in the University of Pittsburgh’s HIM program. She has been working with us at M*Modal for a while now – and does a great job!

Kaitlyn guest-blogged for us back in January for our HIM Student Corner in Excellence in Health Information.

Does anyone know a doctor who would be willing to help her complete her project by completing a very short, easy survey about electronic medical records?  It’s only 13 easy questions and would help an HIM student get some great results for her project!

The survey is located here.

Many thanks!


HIM Student Guest Blogger

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Hello everyone:  What does an HIM student and first-time HIMSS conference attendee think of the whole HIMSS experience?

Our HIM student blogger this week is Dan Engel from the University of Pittsburgh.

Dan was born and raised in Kingston (Wilkes-Barre), PA. He graduated from the University of Pittsburgh in 2009 where he completed a BS in Biological Sciences and and minored in chemistry. He is currently working on his MS in Health Information Management, Health Information Systems concentration, RHIA option, and he will graduate in April 2011.  Dan hopes to pursue a career with an HIT vendor after graduation.

Dan attended the HIMSS conference this year as a (very helpful!) part of the M*Modal team.  Here are his impressions of his first trip to HIMSS.

I had the privilege of attending the HIMSS 2011 trade show in Orlando, FL last week. Reputed as one of the largest health IT conventions in the world, it was an exciting, but overwhelming; interesting, but exhausting experience. While it was a trip to Orlando, where the weather was warm and sunny, compared to a cold and snowy Pittsburgh, let me assure you that it was all business with no play or sightseeing (even though Universal Studios and Disney World were between the hotels and convention center). This post won’t fill you in on all the great stuff you missed at the show, but will relay the experience of being at an exhibit of this type and magnitude for the first time….

See the rest of Dan’s post at Excellence in Health Information
Til Next Time,

This week’s HIM Student Corner

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This week, our HIM student corner features Kaitlyn Crowther.  Kaitlyn is a senior in Pitt’s Health Information Management program and is from Allentown, Pennsylvania.  She currently works as a student abstractor in the vascular surgery department at UPMC Shadyside an also works as a tour guide at the University of Pittsburgh.  Kaitlyn hopes to have a long career in HIM and looks forward to the changing landscape of health information.  Kaitlyn is currently doing an internship with M*Modal and it has been our great pleasure to have her!

Visit Excellence in Health Information to see what Kaitlyn has to say..

Have a lovely weekend!



Important Advice – “Think Outside the EHR”

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This week on our Excellence in Health Information blog, we are honored to host Valerie Watzlaf as our guest blogger. Valerie J. M. Watzlaf, Ph.D., FAHIMA, RHIA is an Associate Professor within the Department of Health Information Management in the School of Health and Rehabilitation Sciences at the University of Pittsburgh. She is very active in professional and scientific societies having served on the Data Quality Task Force of the American Health Information Management Association (AHIMA), the Chairperson of the Coding, Policy, and Strategy Committee of AHIMA, the Research Committee of AHIMA, the Council on Accreditation of AHIMA and currently serving as a Board member of AHIMA.

Dr. Watzlaf asks HIM professionals and students to “think outside the EHR” to the true integrity and usefulness of health information in support of patient health.  She asks them to question, ” is it best to document to get it done and meet regulations or to provide documentation integrity, quality and perfection?”

Please join us in this important discussion  – HIM Professionals of the Future:  “Think Outside the EHR.”

All my best as always,


HIM Student Corner!

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Hello everyone: I am pleased and excited to present our first HIM student posting! This also appears on Excellence in Health Information. Please allow me to introduce Mark Domm. Mark is a Health Information Management student in his senior year at the University of Pittsburgh. He is from Pittsburgh and hopes to pursue quality management and eventually consulting when he graduates. Thank you to Mark and to the University of Pittsburgh HIM department for letting us borrow him.

Here is what he has to say…

I’ll go ahead and speak for all of us students. Way back when our collective educational journeys began, the most any of us could envision at the mention of “Health Information Management” was musty medical records, drab thumb accessories utilized for flipping through drab medical records, and all of this occurring in, you guessed it, a drab medical records setting. Leading others in this environment (if you can call giving others instructions on where to file what leading) was as good as it was going to get (if you can call that good).

Many of us found ourselves in Health Information Management. And “found ourselves” is the most accurate way to put it. We didn’t seek this area out for the most part. Circumstances seemed to dictate this chosen career path more than desire, and most of our beginning clinical experiences (i.e. smack dab in outdated medical records departments) and classes (the history of coding followed by… well coding) cemented this thinking. The Anatomy and Physiology didn’t exactly dissuade us to think about things differently either.

I would venture to say that for most of us what we envision when presented with the term “Health Information Management” has changed dramatically, and that is putting it lightly. In fact all of my ideas about it are upside-down. After all of the subsequent classes and experiences and speakers I can’t help but view Health Information Management with wide eyes.

Now I am speaking boldly here, and I believe that I need to back up my change of heart and big words with some hard evidence. At one hospital the medical records department is being torn down because it is going completely electronic; where before there were files and people hunched over files there are now construction workers constructing. Consultants have been relating stories of flying everywhere on someone else’s dime. We have been presented with the reality that everything (and I mean everything) is going to be completely and utterly overhauled in the healthcare world (i.e. ICD-9 to 10). Technology that is in some cases ancient (that might be an exaggeration) such as telemedicine is the basis for new and revolutionary technology. Even the rooms that healthcare is taking place in is becoming smart (for example the case of the room that is literally called the Smart Room).

Frankly the last couple months have been a whirlwind of examples of Health Information Management Workers of all walks of life involved in a dizzying number of healthcare settings, the least of which is the traditional medical records department. And some of the stories related to us by HIM workers have ranged from touching (working with very troubled kids) to exciting (training in different parts of the country) to alarming (hole punchers flung in anger and defaced property).

Although I can’t pinpoint the precise moment, somewhere in there the subtle grimace I would display at the mention of my major changed. More and more I’m realizing that the future in HIM really is a bright one.

-Mark Domm

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