2018 - New Year and New Opportunities

If we have learned anything from previous years and the severity of the attacks from cybercriminal activities, it is that the resourcefulness of attacks on PHI have been unprecedented. For the year ahead, we have every reason to believe this will continue and it really is up to us to set a new standard in preparing our organizations for the onslaught.

Start with employee education:  This can be achieved in many forms. Don't limit yourself to expecting employees to read long policy and procedure manuals. As well, it is unrealistic to think that once a year canned training or worse, just training upon orientation is enough for the workforce to be armed with what they need to know to safeguard your patients' health information. Education should be creative and provided as often as possible. See a news story about a breach? Use that opportunity to share best practices in how to avoid that happening to you. Want to see how alert your teams are against phishing? Send a bogus email and see how many of them click on the link (to nowhere, since you are managing this), and how many actually report it as they should to appropriate held desk staff. Live interactive educational sessions with "real world" examples of breaches and their consequences will always be most powerful.

Next step, ask employees to share their stories:  One thing that I find extremely valuable is to ask your employees to share their personal experiences with HIPAA. Friends and family who have had experiences with no access to record copies, or a provider encounter where the information was not accurate will be eye-opening to those hearing the stories. Another good one is asking your people if they've had any issues with identity theft or medical identity theft. These are impactful because they are actual events that can help those around them understand the risks of a breach of PHI or hacking attacks are not always going to be just the "other guy." This is happening all around us.

The bottom line is that there is just no substitute for focus on the efforts that are being made to get to PHI and how we must all be on guard all the time.        

Delays in Breach Notification = OCR Fines

The first OCR fine for 2017 was issued to Presence Health for delay in notifying 836 patients of a breach experienced in 2013. Presence Health met the requirement of notifying HHS of the breach within 60 days after the end of the calendar year in which the breach is discovered (notification took place January 31, 2014).  

There have been many articles written about the need to investigate a potential breach, and establish what happened, how it happened and do a thorough job in getting as complete as possible, the names of all individual affected by the breach so that notification can take place. What you don't want to do is forget the breach notification rule that states that for a breach of any size, patients must be notified "without unreasonable delay, but in no case longer than 60 days." Certainly, there are a few exceptions like law enforcement delay and other rare situations, but the rule is clear.

The fine is significant enough, but remember that along with the OCR fine, generally comes a corrective action plan (CAP). In this particular case, there was a requirement to revise existing policies and procedures related to the Breach Notification rule. Training materials would also need to be updated and provided to appropriate workforce members with documentation of the date the training was provided. Evidence of compliance with the CAP is always required.

A couple of key takeaways include noting that the OCR will investigate all breaches and that it generally takes a good bit of time for the OCR to make their determination based on information requested and provided. The fine, if infractions are identified will follow and the CAP will take resources and an investment on the facility's part. Breaches and their impact are significant and the financial costs associated with them run deep.  

Read the full article here   

  

CYBERCRIME UPDATE

The rise of cybercriminal activity in healthcare is cause to review current security protocols and practices.Since 2017 is well underway, this may be the right time to modify HIPAA policies and procedures, check those business associate agreements, formalize a breach response plan and carefully review update your security risk analyses. 

It didn't take very long for the bad guys to figure out where the valuable ePHI resides and they've made quick work to targeting health plans and healthcare organizations across America. In 2015 alone through 57 large breach events, over 112 patients' data was compromised.

At the present time, based on end of year 2016 data from the OCR wall of shame, nearly 75% of the total number of patients impacted are a result of hacking activities. The number of patients affected by hacking healthcare organizations alone is about 128 million!  

Because insider threats remain the best gateway for cybercrime activities, healthcare organizations should take the time to update their HIPAA education arsenal. One of the best defenses is an informed workforce. Periodic reminders with real-life events as examples serve as an excellent way to keep the workforce informed that what they do, makes a difference. Another effective solution is to provide examples of how emails that look authentic can simply be an invitation and gateway to the intruders.  Help your workforce be your best first-line defense!   


https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf

The Future of HIPAA Compliance Audits

HIPAA Compliance audits are scheduled to resume later this year with an anticipated 1,200 to be conducted between 2014 and 2015.  The word is that 800 covered entities will be audited and 400 will be completed for business associates.  The interesting twist is that covered entities will be asked to provide names of their business associates and it is anticipated that the selection may come from this submission. 

The initial round of audits was referred to as "friendly" audits, conducted by KPMG, a contractor for the OCR.  This round will be manned by OCR staffers who, as we speak, are being trained for this mission.  Important for all interested parties to keep in mind that the funding for this project will come from fines assessed based on organizations who have failed to prepare properly for HIPAA compliance. 

Since over 25 million dollars in penalties have been assessed thus far due to "willful neglect," meaning disregard for attempting to comply with the requirements of the final rule, it can be reasonably expected that OCR auditors will be swift to levy fines for those who have failed to take steps to prepare. 

We've been given ample time to prepare.  After all the HITECH Act of 2009 laid the foundation for business associate compliance and the Final Rule was published in January 2013.  So for all the procrastinators out there, the clock is ticking at a heightened pace and you cannot delay any longer.  Get the facts, scale up or down to the size of your organization and just get it done!    

HIPAA - BUSINESS ASSOCIATES AND COMPLIANCE - NOT READY FOR PRIME TIME

At the AHIMA convention October 26-30, 2013, much of my time was spent on HIPAA privacy and security.  No surprises there, right?  It has become pretty clear by now, that this is a major focus area for me.  After 2 full days in the privacy and security institute, which was fantastic, by the way, and another 3 days making the rounds in the privacy and security education tracks, there were a couple of observations that were a bit concerning. 

UNDERSTANDING HIPAA COMPLIANCE REQUIREMENTS:  By now, HHS has made it abundantly clear what is required to both covered entities and business associates.  If you have followed HIPAA breach news at all in enforcement efforts, you know that fines are being assessed. What's more, the OCR promises to audit business associates from this point forward now that they are included under HIPAA Omnibus.  We have seen varying degrees of preparedness by business associates ranging from statements about their platform compliance to those who say, "Well, we have never experienced a breach," to those who think their business associate agreement is all that is needed. Really - are you sure about that?  If there are no policies in place or education for your staff to understand incident reporting requirements, how do you really know if you've ever had a breach?       

MANY BUSINESS ASSOCIATES ARE NOT PREPARED: With the HITECH act of 2009, we knew about the extensions of HIPAA to business associates and should have been fully prepared since or before that time. We have had access to the HIPAA audit protocol since the summer of 2012. This is an absolute roadmap to a solid compliance strategy. It is not difficult to understand exactly what is needed for compliance, yet many business associates continue to fall short. Here is a case to consider that should give you considerable pause: If a business associate hires an employee and provides that individual with a desktop computer or laptop to do their work, and the employee a year later, suddenly disappears without a trace from the workforce with said computer that likely contains PHI (it happens all the time, folks), is that a breach? Does that business associate know how to reasonably account for the potential PHI on that system? Without policies and procedures, a breach notification response team, and reporting processes through the required 4-step risk assessment, will the covered entity even be notified?      

COVERED ENTITIES ARE UNCLEAR ON DUE DILIGENCE:  There is an expectation of due diligence steps to be undertaken by covered entities in ensuring their business associate partners have taken appropriate steps towards compliance. This is one of the single most important steps healthcare organizations and individual providers should be taking to protect their patients' PHI. The new guidance from AHIMA clearly mentions the value and importance of this key step in the process. Yet, still today, this is not happening on nearly a wide enough scale. 

KEY TASKS TO DO (yesterday) NOW: 

Business Associates - 
1. Do not delay in preparing to comply with all regulations under HIPAA
2. Get your policies and procedures documented (privacy, security, breach notification)
3. Train ALL workforce members and document that training has taken place.  Hold them accountable for what they have learned. 
4. Update your BAAs - this is particularly important for those who hire independent contractors.
5. Conduct your comprehensive security risk analysis.  Yes you do have to do one, regardless of the size of your organization and it must be documented. 

Covered Entities/Providers -
1. Make a list of ALL business associates.
2. Make sure that they have signed your updated business associate agreement - even if it is not due yet, proactively get these completed.
3. Ensure that you know where the work you are outsourcing is being performed. 
4. Ask for evidence-based proof of compliance (excerpts from policies, copy of BAA, risk analysis, etc.).
5. Ask for the name of your business associates' privacy officer - get their name and contact information and establish open dialogue about their compliance efforts today! 
 
Compliance does not have to be expensive or burdensome, but it is required. Failure to comply with HIPAA can lead to an automatic willful neglect penalty. With over 12 million patients impacted by business associate breaches since 2009, there is clearly much room for improvement in practices along with baseline requirements of the law. If you want more information on how we can help, contact us here.

Production Pay and Revenue Cycle Management

AHDI has published a position paper that was released at the annual convention in Indianapolis earlier this month.  In this paper, the association presents the current state of healthcare documentation and why it is essential to consider a more flexible compensation model that takes into account the many other duties of the professional medical transcriptionist. 

In a recent article published in For The Record, Sherry Doggett, President of AHDI states "There are many things that medical transcriptionists perform in many scenarios in the work envionment that really are not conducive to production pay."  Additionally, healthcare documentation specialists (MTs) are often asked to move from one computer to another, a different transcription platform or system, work back and forth between straight transcription and speech recognition, work multiple accounts and different doctors through a single shift.  All of these transitions are counter productive.  

Take into consideration different account specifics that vary within a single account to accommodate different physicians' style and add the numerous queries and flags MTs notate throughout the day, the corrections they must make to errors during dictation.  These things take time - uncompensated time and you have the makings of upheaval that may erode the future of this important sector.  When allied health professionals consider their work to be of decreasing value and say they work in a "sweatshop for minimum wage," it is beyond time to pay attention to the type of comments seen here.  

Year after year, healthcare documentation specialists have been asked to do more for less while the commoditization of this profession has been squeezed from every angle.  It is considered a cost center when there has been a failure to recognize the value of this knowledge-based field.  Consider coding.  How can coders code without the documentation that tells the unique patient's story and is the basis for coding?  How is it we will be able to move successfully into ICD-10-CM/PCS without better and more specific documentation?  

It is interesting to observe the conflicting opinions about whether or not front-end speech is better for quality patient care.  On the topic of front-end speech, Jeffrey Linder, MD believes that "physicians are more likely to see and respond to alerts if they are using an EHR."  While the AJR published a study that revealed a 23% error rate in front-end speech compared to 4% in dictation/transcription reports.      

In all the efforts to employ technology to improve healthcare, the technology advances absolutely have their place and merit in moving us away from paper.  That said, providers are faced with more demands, larger case loads and in truth they need choices that suit their preferences that will lead to efficiencies.  Forcing any one solution on multiple providers will be met with resistance and will not accomplish the goals of patient safety and better outcomes.  Rather, in a current article, Nick vanTerheyden, MD states "The most appropriate means of documentation is the one that is most effective and productive to a physician's workflow.  It will take a combination to deliver the highest clinican satisfaction."    

When all is said and done, it seems that in order to get more information, meet the needs for the clinical documentation improvement required for ICD-10-CM/PCS, and achieve meaningful use goals, healthcare organizations that intentionally keep dictation and transcription as well as other options will come out on top.  Looking at creative compensation methods for the professionals behind the scenes that help produce these quality documents from which coding and billing take place must move higher in priority in order to keep them engaged.  Many have left the profession already due to poor compensation and we cannot afford to lose any more at a time when the language of medicine is a premium concern.  We must value these hard-working professionals and look at other areas for controlling costs in the revenue cycle.     

Smart Moves for Smarter EHRs

In a couple of recent articles that are not connected, there is an underlying connection.  One, in "For the Record" discusses The Hazards of Note Bloat and the unintended consequences of having a lot of information that doesn't truly say much about the complexity of the patient's condition, not to mention that it is "difficult to view, notes lengthen and errors accumulate."  But wait, aren't EHRs supposed to reduce errors?  The article goes on to explain how narrative (dictation/transcription) notes have been reduced, but not completely eliminated.  It also discusses speech recognition and its implementation this month. 

The next article talks about the value of outsourcing as a cost-savings process to reduce costs and how this is happening in a big way in Canada.  This model has been shown again and again to be cost effective and many hospitals across the US have already embraced this practice to help reduce costs.

In yet another article, 3 major healthcare groups were identified as having caught the financial flu and are not doing particularly well at this time. 

In reviewing the 3 unrelated articles, it became apparent that there may be a myopic view of how to balance reducing costs with optimal EHR utilization.  Consider this.  EHRs are here to stay.  We need them and the value they bring to healthcare overall.  What we don't need is documentation that doesn't improve the quality of the patient encounter.  We need streamlined, content-rich, not bloated notes that drone on endlessly with what the previous note stated.  We need to optimally enable physicians so they have the time to see a growing patient population, not spend endless hours doing their own data entry.  We also must get the level of detailed specificity now that will be needed as the ICD-10 date edges ever closer.  Healthcare organizations must be fiscally healthy enough to provide care and continue to be viable as baby boomers get to Medicare age.  So yes, they do absolutely need to cut costs in the right places but keep those that enhance their revenue capabilities. 

Here's the conundrum in summary.  If healthcare organizations and hospitals focus only on reducing costs at the expense of eliminating medical transcription/editing, they are using a tunnel vision approach that will reduce costs but will simultaneously fail to optimize reimbursement.  Complete, detailed documention renders optimal coding, which leads to appropriate and optimal reimbursement.  If this process becomes muddy through "note bloat" or abbreviated input from extremely busy clinicians, the revenue cycle process may breakdown and the endless cycle of trying to reduce costs and not optimize documentation will continue. 

Stop the broken cycle of cost-cutting measures as the only option.  It's time to see the bigger opportunity and realize the value gained in the outsourced model of quality dictation/transcription and speech editing process to capture all the details needed for ICD-10 today.  This can get healthcare organizations over the financial flu and on the road to recovery. By adopting a practice of excellent documentation practices, these 3 unrelated items can become related in a way for long-term success with the EHR and improve patient outcomes as one of the most important goals.          

Privacy Officer Services

A new day and a new adventure begins. In working with MTSOs for a number of years, and with the requirements of HITECH making the headlines, I have decided to start something new and provide a number of services and solutions for business associates and covered entities in efficiently achieving compliance in the area of privacy and security. Privacy Officer Services officially begins today.

This new business is designed to support business associates and covered entities in the development of their customized policies and procedures for privacy and security, to assist with completing their required security risk analysis and a number of other services like employee training, education, monthly updates, quarterly updates for the business website, and weekly updates in news in and around privacy and security as well as technical developments. There are many more and there is a unique solution for every healthcare organization.

My goal is to help these business associates achieve the HITECH requirements in a cost-effective manner so that their current staff can continue on with the business at hand in delivering on-time services and provide the customer experience their clients expect.

By outsourcing their privacy officer reponsibilities to me, they will gain efficiencies in a number of ways like having a knowledgeable resource available every day without having to add to their employee count. Having someone who can attend meetings, and present to potential and existing clients on their privacy solutions can be a huge advantage in the world where we see and hear about costly security breaches nearly every day.

It's a new world filled with legal requirements and challenges for business associates and covered entities - this is a way to check a very important responsibility off the "must-do" list and put this into the hands of someone they know and can trust to provide the right solution today.

Medical Transcription - The Gold Mine

While EHRs are going in rapidly across the country, it's important to remember that the demand for value in reducing costs, improving patient safety and providing access to more Americans still leads the charge when it comes to why we move to electronic systems in health care. One of the best ways to enhance the value in EHR systems data mining and research is to keep a robust, detailed record of each individual patient who has a unique history unlike any other. Medical transcription/editing captures details provided by clinicians that are crisp and precise filled with data and information that can get us to the goal of improved patient outcomes through the application of secondary healthcare data. There are a number of reporting agencies that are making results available to anyone who is interested in taking a look. Organizations like the Leapfrog Group, Health Grades, Bridges to Excellence along with a score of others, provide information on various diseases and outcomes. Some secondary data use reporting is required such as core measures reporting. And when I say required, I mean that there is a 2% penalty in market-basket outcomes if you choose not to report. It is probably reasonable to anticipate that the number of hospitals reporting outcomes and the agencies to which they report will also increase. This is why it is a key fundamental and logical approach that the use of dictation and medical transcription or medical editing with speech recognition tools will be the best way to capture these necessary details and be able to produce content-rich results when reporting outcomes to continuously improve care. Nine of 10 Healthcare executives agree in a survey conducted by Pricewaterhouse Coopers (PWC) that secondary use of health information will significantly improve the quality of care and that those benefits will improve in the future. A clear two/thirds anticipate a huge increase within the coming two years. (1) Consider the AMIA findings of the gains that can be made from the expansion of knowledge about diseases, treatments and make strides in public health along with advances in privacy and security. (2) There is much to be gained as we move into this era of using secondary data to advance healthcare and this can best be achieved if we continue to capture the details provided by clinicians through the dictation and interpretation process. The outcomes, however, will only be as good as the content from which the information comes - that's why dictated/transcribed reports are a gold mine of information. To in any way short-cut details will severely limit the wide-range of benefits.

Medical Transcription - In Home Offices

Just for fun!!!! Who needs a break from the news? I know I do. Some of the headlines are just way too depressing and all the talk about repealing health care reform just makes me tired. So here's a little diversion that I hope will bring you a smile. These lyrics should be sung to the melody, Friends in Low Places - so get your Garth on folks and sing along!

Friends In Home Office Places

I stay home and work, not because of the perks
It's the job that I chose from the start
The money's not great, barely puts food on the plate
But in healthcare I'm doing my part

You think that it's grand, what I do with my hands
But it comes with superior skills
I know I belong, you can tell from this song
While I keep trying to juggle my bills

Cause I've got friends in home office places
Where the internet sings and they keyboard races
To the goal of the day, and I'll be okay
Oh I'm not hooked on financial status
Think I'll slip on down to my Facebook pages
Oh I've got friends in home office places

Things happen so fast, my IM's a blast
And now I have new SRT
Before you can say, social media's the way
I've got to Tweet my trip to DC!

Today's EHR
Is demanding so far
To keep up with Obamacare
Docs need us today, to help them relay
That important O2 sat on room air

I've got friends in home office places
Where the internet sings and the keyboard races
To the goal of the day, and I'll be okay
Oh I'm not hooked on financial status
Think I'll slip on down to my Facebook pages
Oh I've got friends in home office places

Challenges in 2011

As we start a brand new year, it is going to be particularly important to take notice of all that is happening in healthcare documentation. The sense of urgency for hospitals and providers to adopt EHR technology is on the rise and shows no signs of slowing down, despite the challenges, expenses and the myriad of complexities also known as meaningful use.

So what is an MT to do? Do we just go through our normal day and hope that our job is not the one eliminated? Or should we look at credentials, education and find new roles that we can do? Personally, I think it is a mistake if we don't get active in taking a long, hard look at this head-on instead of hoping that we can ride the wave to the shore.

We have heard for years that medical transcription and coding are similar (from the standpoint of clinical knowledge) and yet they remain, for the most part, very separate processes. It seems prudent to revisit these 2 tasks and see how we might bring them closer together in an effort to gain efficiencies and speed up the billing process. Having worked as both a coder and a transcriptionist, I know the skill sets are very similar. We must know and understand the language of medicine, A&P, pharmacology, disease process and so much more.

Even aside from the obvious coding option, there are others that come to mind. For those who aren't necessarily resigned by geographics or other requirements to working at home, becoming a scribe may be an option. There are probably individuals working as scribes who will tell you it isn't the same job and I completely acknowledge that it's not the same, however, it still comes back to all the medical knowledge and then training to perform the tasks that the physician needs for entry into the EHR. It can be learned, and you clearly have a huge head start.

Then what about analytics, quality reporting and a host of other tasks that we can learn? There are many options, and AHDI is exploring these with several current initiatives, but there is one step first. We need to understand that much of what will take place when the nation's healthcare goes electronic hasn't quite yet been fully determined. The roles are still being discovered. So the potential is there -- and it won't come without additional training, possible college preparation and credentials. This is just simply a call to keep eyes and possibilities wide open.

What can you do today? Start learning all you can about these new systems and keep your networks strong. Be informed and don't be afraid to consider going back to school. At a time when I thought I wouldn't need to go back to school, I find myself today enrolled at the University of Cincinnati in their BS HIM program to convert my RHIT to RHIA. Funny thing is that I looked into this program back in 2006 and decided not to do it, because I didn't think I needed to. Of course the enrollment advisor reminded me that had I done it then, I would already have gradutated. I guess the moral of this story is never say never - you might be surprised by the necessities in an evolving career!

EHR Process: Speak Your Preference

EHRs and meaningful use (MU) are getting so much publicity. There is the carrot (financial incentive) and stick (reduced reimbursement) approach to get them in place by 2014 with the promise of reducing costs, improving patient outcomes and patient safety. Through all of this publicity, seems we haven't heard enough from the chief care giver - the physician.

Many of the EHRs that have been approved by CCHIT don't include a dictation/transcription option. CCHIT may not ultimately be the approval body. Interestingly enough, MU definitions haven't been finalized. So there are goals to meet that haven't been fully defined and timelines that associations like the AMA and AHA along with a host of other national groups that have spoken clearly about how the all or nothing MU criteria plan is ill-advised. They agree that the timeline is not realistic.

We probably all can agree that EHR implementation without meaningful use doesn't get us to the goals promised. And we understand that it is a given to migrate away from paper records. However, the rush to get it done seems to put physicians and a practical improved approach to healthcare delivery in the system that we have, in the backseat.

Let's look at this from an objective perspective. Now we have healthcare reform. That's great news for so many who don't have healthcare today. It means that an additional 32 million (estimated) Americans will have access to healthcare who previously did not or did if their conditions became critical enough for them to present to the ER. What will healthcare reform do to physician case loads? To hospital census? Let us not forget that we have an aging population with baby-boomers approaching retirement. Do we have enough physicians for all this increased volume?

Now let's look at how many EHR systems approach healthcare documentation. They are designed for the physician to become the data entry clerk - and in truth, many are operating this way today. VA's VISTA system, Kaiser Permanente, and there are a host of EHRs designed for ambulatory settings and physician office practice that utilize the same approach.

Here's a thought. Do you see the president of a bank entering deposits and counting out cash at his bank? No, so why would we ask our most highly educated member of the healthcare delivery team to become a data entry clerk?

Currently 1.2 billion patient reports are created by expert medical transcriptionists who have trained and many have become credentialed in their field. Narrative dictation captures the unique circumstances of each individual patient. No two patients are alike in their history and even presenting symptoms. And to leave out important details of the patient's additional illnesses can most certainly impact hospital and physician revenue. So why would we A. slow physicians down entering the detail and B. risk lower reimbursements?

The purpose of this blog post is just simply this. Consider: The physicians who are mostly going to be time and resource-impacted by EHR implementation need to speak out in favor of the ability to continue to document patient encounters in the most efficient and complete way. Physicians' voices must be heard in this evolution to electronic records. What EHR systems must do is provide an avenue for physician choice in documentation practices.

If physicians want to self-enter - then that should be an option. However, for those physicians with a patient case-mix that is complex and those with multiple medical problems, their option to continue to dictate will mean the difference in their ability to increase the demand on their time as patient loads increase.

Physicians - please speak up - be sure that you have options in how you document patient encounters. You are the CEO of the healthcare delivery team and the process needs to provide better patient safety and ensure that your time is optimized while ensuring appropriate reimbursements for all you do.

Happy Holidays!

The holidays are here. Can you believe it? It's time to consider what you are thankful for, to enjoy some quality time with family and friends and to cherish what is meaningful in your life. It is also time to plan for the year ahead and think about what you want to achieve. Not so much like the New Year's resolutions we make with good intentions because they don't always last, but think more long-term and make plans to get there with a list that has dates and interval checks along the way.

Been putting off finishing that college degree? Get on track to complete it. Been thinking about your first or a new credential? Begin to study and prepare so that you can celebrate when you successfully get that achieved! Thought about running for a leadership office? Maybe this is the year to throw your hat in the ring. Whatever it is, make a serious to-do list that has something special in it - something that allows you to check it off the list, but you end up way better off once it is done! This is a way to get energized!

This year, I am incredibly thankful for the amazing friendship and support from MTs everywhere as I have traveled across the US serving as president of AHDI. I am so inspired by all those who have attended meetings and participated on committees and work groups to provide a strong future for us in this profession. There is so much to do, and the way everyone is pulling together to get us there, I have every confidence we will prevail.

So this holiday when you are contemplating your future, ask yourself, have I reached my full potential? Is there more I could do? Should do? If _______ happens, what will I do next? Prepare for the unexpected, continually improve yourself, plan for success, and decide to be great! How will you make 2010 your best year yet?

The EHR in Prime Time

Did you happen to catch CBS Sunday Morning yesterday, 9/13/09? Well if you didn't here's a link but the lead story was the EHR and all its benefits. David Blumenthal, MD, National Coordinator, spoke and others who are leading the charge. The move to the EHR is part of President Obama's healthcare reform initiative, Title XIII of ARRA that was signed into law in February. And we need to get this done.

There is little doubt that the improvements that a fully integrated and nationally linked healthcare system can bring to us as a country. Improved outcomes, less waste, faster information available when every minute counts - all of these are crystal clear, valid and important to achieve. My only concern is that we don't want to fail to capture the critical details of the patient's unique set of circumstances at the risk of getting it done faster.

There have been plenty of articles written about some of the shortcomings of new systems as well as the merits of others. This is a decision that cannot be lightly made nor should it be made hastily without all the considerations a decision of that magnitude should receive.

I am confident that these decisions will be well-made and that meaningful use will help ensure that these goals are optimally met. We do need to utilize enabling technologies like Health Story project to preserve the details of every patient's story and include this through technological solutions so that no critical issues are overlooked or left out. Physicians have so many pressures on their time with increasing patient loads. Allowing them to continue to document in this manner will help them continue to focus on the work they do best - and that is diagnose and treat their patients. You can have transcribed reports that are fullyl minable in an EHR.

Check out the story on CBS Sunday Morning and tell me what you think.

ACE Summary!

Gaylord Opryland, Nashville, TN – Music City USA was the scene for the 31st annual AHDI Annual Convention and Expo. And what an event it was. We kicked the event off with a Wednesday night welcome reception and everyone showed up in their jeans and boots to learn a few line dances from 3 very talented instructors. Later (once we had a few steps figured out), we were entertained by Les Richardson and County Line. What an awesome event and everyone was there!

Thursday morning we heard from our opening keynote, Donna Hartley who shared her incredible story with the message being that you can be more than a survivor, you can really thrive even in tough situations. She shared 9 tips you can do to get the most out of your career and your life.

At 10:00 AM the exhibit hall opened and our exhibitors were there with new offerings and great solutions for our members. Next followed the afternoon educational sessions with 3 tracks, medical, industry and MT practice. There were so many wonderful sessions to attend that it was really difficult to choose. What I did was buy the CD so I wouldn’t miss a thing.

Thursday afternoon was the continuation of the QA Summit (first launched in Louisville, KY at the MTIA meeting) and the summit leaders spent time in lively discussion on blanks and how best to address that segment of what is often a dissatisfaction indicator. Our next steps are clear and we will continue on towards a white paper on quality for our industry standard.

Friday morning early Nick van Terheyden, MD spoke on the Health Story Project (www.healthstory.com). This is the solution that uses CDA language to deliver narrative text in a format that is searchable data in the EHR. This is one of the single most important developments for our sector and every one in our profession should know about and begin to talk about how this will get implemented at every MTSO and every hospital across the nation. This is what builds the bridge from dictation and allows physicians to continue to be efficient (dictate, their preferred method of documentation by over 80%) and still allow the information to be formatted for EHR systems.

Next, we had the opportunity to hear from Bruce Mast, our Thursday morning keynote on the evolution of our role. That was a powerful, eye-opening session that proposed many possibilities based on the knowledge of our professionals – not the method of how we do it.

Then on Saturday morning, we were incredibly fortunate to have Jonathan Perlin, MD, PhD speak to us about what’s happening in healthcare and the opportunities that will abound with healthcare reform. His background and experience with both the VA and currently as the Chief Medical Officer for HCA puts him in a key position to share his insight with our members. He has also been named one of the top 10 physicians in America.

Then with an afternoon filled with outstanding educational sessions, it was time to wrap it all up with our first ever, Integrity Awards Red Carpet event and after party. The paparazzi was there snapping photos of our members who were dressed to the nines and everyone looked fabulous! The awards were presented then everyone moved over to the Gaylord’s Fuse nightclub for music, food and beverages. There was more dancing and fun for all there and as the main part of the conference concluded, we all agreed that this was one of the best events ever. The Gaylord facility was filled with greenery, waterfalls and blooms from all over the world. And speaking of the “world” their waterway complete with boat rides shares water from 17 countries worldwide.

For those who just didn’t get enough of the conference, Sunday morning the Managers and Supervisors special interest group conducted their annual event (8:00 – 11:30 AM) with great attendance and content-rich topics about how they are working and evolving in this new generation of EHR systems with SRT technologies and it was an excellent event with panel discussions and idea sharing.

When it was time to leave, I anticipated a feeling a sadness that it was over, but surprisingly, most of what I was thinking was how great the event was and how much more there is to look forward to. Our sector is evolving and as we prepare for this future, gaining knowledge and being involved in these changes at this level is something I treasure. For those who could not attend, I encourage you to get as much information as you can. If you aren’t a member, consider joining your professional association because there’s never been a more important time to be connected. The next few years are going to be amazing and we all need to be involved in securing our place as the knowledge worker for the future. Our roles will evolve, and the more visibility we have, the more opportunities we’ll have to stake our claim and say, “Yes I can do that – I have the expertise.”

Nashville, Here I Come!

As the song goes..."Well my bags are packed and I'm ready to go"... And I couldn't be more excited about annual conference this year. ACE at the beautiful Gaylord Opryland is going to be one of the most amazing conventions we have ever had. We are doing so many new things this year. AHDI is always looking for more ways to share the latest information with attendees and this year there are many events with a new flair.

We are for the first time, doing a simulcast of a panel discussion with our closing keynote, Bruce Mast, Linda Yanisiewski, MTIA president, Peter Preziosi, CEO of AHDI and MTIA and me. One of the reasons we thought this was important is because we understand that times are tough and not everyone can travel to a convention. But we thought it would be innovative to take some of the convention to you.

This year our initiatives have been clear from January 1, 2009! We must produce an SRT curriculum and it is ready. We must update the QA standards for our industry - that collaborative work is well underway to be complete this year and we are having a face-to-face meeting in Nashville to continue to advance the work. We must continue to be visible in Capitol Hill. This work continues not only at our summit, but meetings have continued all year long and we have retained a lobbying firm, Dewey Square Group to ensure our voices are heard. We must develop our future roles that will evolve with the EHR and that work is well underway. We need to draft an open letter to all MTs to unite for the purpose of a louder, stronger voice in showing tremendous value we bring to healthcare and that has been drafted. And we must do all of these things and more for every person working in this sector and help support them in getting credentialed because it is high-time for us to join the rest of the healthcare field in doing that and having better tools/resources such as the Interfix Knowledge Base (KB).

We know that these are challenging times. We also know that if we sit quietly on the sidelines, that change will take place without our input or consideration. As the saying goes, out of sight, out of mind and it does happen when we are silent and invisible regardless of our many contributions. We can let change happen to us, or we can actively participate in ensuring that healthcare reform includes healthcare documentation professionals.

So as many of us gather in Nashville, (making this our first ever green conference in keeping with that socially responsible initiative) for those of you who can't make it this year, I wanted to be sure you know that AHDI is working for all of you who are working at home, in offices and in hospitals and clinics and we will continue to work on your behalf to secure a great future.

Hope: Where to Find it

We have talked about change - now let's shift the focus to another word that we must keep close at hand and that's "hope." In difficult times when the economy is down, it's hard to remain hopeful when the headlines are less than encouraging. But if you have your health, a job, and a place to live, you are ahead of about 1/3 of the world's population. We've heard growing up that it is so important to be thankful for all we have, but often it is easier to see what we don't have and what would be nice to have and we lose focus on all that is right with our lives, our jobs and our future.

The other day, I signed up online for a 401K plan with my employer. It was a great process and the 401K plan itself is a great one with a well-known company with many offerings. But I was less than excited to see the return rate of the investment choices. All but 2 were in negative numbers (and had been for longer than 2 years) and the 2 that weren't were less than 2 points each. Pretty discouraging and I nearly considered not signing up. But then I got to thinking that this big economic situation we are in won't solve itself. It is going to take each of us to do a few things to help us turn this thing around. We have to keep on moving forward every single day. So where do we find hope?

Suggestion #1. Watch President Obama on Wednesday night, 7/1 during his live Town Hall meeting. Better yet, submit a question and get involved. I agree that we can't fix the economy without fixing healthcare at the same time - it is too great an issue and this is something that not only affects everyone, it costs everyone. Let's get it solved.

Suggestion #2. I read somewhere recently that we have to give up all hope of creating a better yesterday. Yesterday is gone, but there is still time today to be the best you can be, make a difference for someone else, contribute where you can, and take a first step of many to have a hopeful, realistic tomorrow. Tell someone you appreciate them and ask your boss how you can help your company be more successful. You may be surprised at the response.

Suggestion #3. No matter your current situation, challenge yourself to create a positive outlook for tomorrow. Rather than seeing things as hopeless, envision that this is a difficult situation and then set out to make tomorrow better than the day before. Ask yourself what should I do next to get back on track.

We cannot undo the past and we also should not worry about the future. The past is gone, the future is not here yet, but our opportunity today is large and alive. Healthcare reform will happen. We have had the opportunity to speak to the decision-makers about meaningful use and we have continued to speak up and our voices are being heard.

What if we all decided that the most important thing we could do is work together as a profession and help healthcare decision-makers realize how valuable our contributions are? What if we help make the point that healthcare reform can take place better with us meaning that EHR systems are in use, nationwide with narrative text? What if we decided that the issues we sometimes take issue with in this profession are really not big issues at all? What if we all finally realized that as healthcare evolves, we need to be right in step with it and engage in the process? That's meaningful use of all of our time. That would spell a very hopeful future!

Changes in Healthcare, Changes in Medical Transcription

Let’s talk about change for a minute, shall we? Change is something that happens in every aspect of our lives – we get older (dang it!), our kids do, we move and relocate, we get new cars, we utilize better technologies, we have way more than 3 or 4 channels on TV, we don’t have to wash dishes by hand, we have energy efficient appliances that do more, cost less to use and in general improve our efficiency.

All change is not bad – but change is a fact of life. Let’s face it, many of us used to transcribe on typewriters with carbon paper or at the very least white out. We have seen various renditions of voice capture hardware. Long distance used to cost hundreds and hundreds of dollars on even modest plans. Now most everyone gets unlimited long distance for about $25 or perhaps even VOIP for a flat rate.

This industry has witnessed many changes and evolutions. We must embrace change – many of us should be change-agents by now because of the many changes we have witnessed, been through or otherwise led changes.

Most of you know what kind of crisis healthcare is in. And you also know that we have a President who vows to fix healthcare so everyone can have access. The debate is long and volatile about how to exactly get it done the best way, however, we know that the “status quo is not an option on the table,” as stated by Barack Obama. We have already been impacted in many ways by healthcare reform.

The drive to push costs down is being driven by a huge number of reasons. MS-DRG changes, ICD-10 upcoming, RAC audits nation-wide, POA (present on admission) to name a few and with 54% of the nation’s hospitals operating in the red and 80% of those with 500+ beds in the red, our healthcare system must change and is changing - now. That means we must evolve with this change.

I know many people like their present routines and don’t want to change, but the EHR is shrinking our market share. That’s simply the truth. Those with the best skills, the most differentiators and the willingness to change and evolve as our sector does will never worry about a job.

Did you know that people who are optimistic about change, even life-altering change live longer than those who are not? These people have the secret recipe of not only making lemonade with the lemons that come their way, they are also constantly seeking out enough lemons to make lemon meringue pie! Be creative and keep a smile close at hand.

We are not witnessing an end-game strategy, it is an evolving shift - and as Darwin said, “it’s not the strongest or the largest of the species that survives, but the one most adaptable to change.” So please everyone know what’s going on in our profession, be the best you can be – make yourselves indispensible to your employer! Be flexible and know what the drivers are in what’s taking place here and let’s move forward together and succeed!

Happy Memorial Day Weekend!

MT Relevance in Healthcare's Future

There is a lively discussion taking place here not just on the topic of mandatory credentialing but also the facts around MT relevance and our place in healthcare documentation's future. There are a number of great issues being presented and the burning questions seem to be larger than life.

Read this and more below:

For the purposes of history, very few professions willingly seek regulation and credentialing. AAMT/AHDI has always known we would have our work cut out for us by going down this road. But history has also shown that professions that are unwilling to self-regulate will either be (a) forced into regulation by the government or (b) forced out of relevance by technology and automation. Any unregulated, noncredentialed profession that can’t demonstrate a significant value-add is bound for marginalization. And unless you’re completely isolated from what’s going on in our industry right now, that is exactly what’s happening to our profession

Here is a final excerpt from that final post made by Lea Sims regarding what our choices are when faced with the reality of what is happening and why we need to engage this entire sector. We must face the facts of the transformation that is taking place - thought provoking:

...So…it’s really up to every MT, not to AHDI. How long can you count on your behind-the-scenes, no-credential, no-accountability, low-visibility role to sustain you in healthcare? Most experts say that within the next 5 to 10 years, a great deal of what you are doing will be automated (if you don’t believe that, you should be attending HIMSS) and all healthcare might need an MT for is to capture some complex narrative at the acute care level. All “normals” will give way to automation. All “templates” will give way to automation.

What value will you demonstrate to healthcare of the future? What cost-saving solution can you demonstrate? What ability to protect the patient can you market? What assistance with clinical decision-making can you offer? Instead of arguing with me here about what you are NOT, how much time are you spending thinking about what you ARE? You can say “no” to “risk management” as a value-add role, but what are you willing to say “yes” to? That’s all healthcare is going to listen to, folks.

When it comes to the art of this profession, at the end of the day, is our role to simply document what is dictated or is there an element of critical thinking involved? I have to say that some of the many MTs I know make sound decisions and corrections every day, many times a day - because they have the skill to do so. There is compelling information here that we all need to consider as those who would suggest that our role is clerical and therefore potentially just an expense that systems and technology can replace or do we choose to validate our skills and evolve them to the next wave in healthcare reform?

The issues around AHDI and what we do in support of MTs is substantial. That too, has evolved. Yes it is true that AAMT was different in earlier years, but as all things must, we had to change our mission and direction because frankly our members needed more. In order to provide membership with relevant and meaningful offerings, we too had to evolve with healthcare. Membership in AHDI is substantive and provides value in many forms. Through the Knowledge Base (KB), advocacy, credentialing, continuing education, leadership development, standards of practice, networking and more.

Will end this here but would ask that our members start speaking up and share what you think. And don't just tell us - tell those who are hearing misinformation. What is AHDI doing that we need to do more of? What aren't we doing that we should? And what do you think about some of the comments that have been made on this post? Do you agree or disagree? What further points need to made. We are listening - and your thoughts matter.

The Perfect Day

Everyone has a vision of the perfect day. Sunshine blue skies at the beach. Fresh powder on the slopes for spring skiing. A quiet afternoon with a favorite book. A day at the spa for pampering and indulgence. The list goes on and everyone has their own vision of what that day might look like. For me, the perfect day would be the one where the following takes place:

Morning: Healthcare documentation professionals everywhere have joined forces and now more than 200,000 have found common ground and been heard clearly above the noise and chatter of healthcare reform. They have united and have secured their future as professionals who have for years contributed tremendous value to patient care. This profession was long thought of as adding cost, but it has come to light that this documentation sector adds exceptional value to accuracy and completeness in a patient's medical reports. It is what we do, and yet so few people know it or appreciate our knowledge. They say "we type what is dictated." Anyone who has ever done this job knows it is so much more than that. Until we as a profession can put aside the pointing fingers at problems, placing blame, quit focusing exclusively on pay first, measure our contributions and begin to demonstrate the value add, we cannot experience that perfect day. Are you ready for that perfect day? I say it is long overdue. No matter how tough we think we have it, we don't have to look very far to see those in much worse circumstances. We have time to recast our future, but we cannot do it alone. Let's work together towards that perfect day.

Afternoon: The next part of my perfect day would be the evening news stating that scientists around the world have confirmed that we have finally slowed and turned back the clock on global warming. The news report would go on saying....Evidence now shows that so many people continue to do little things to make a big difference and there is now solid proof that the polar ice is once again gaining mass and polar bears are making a strong recovery. Fewer species are facing extinction and our timeline for climate change has dramatically improved. And with alternative energy sources and creative technologies, there is an excellent chance we can turn this around completely. Now that would be a perfect end to a most excellent day!

This week, we will celebrate Earth Day on 4/22 and National Arbor Day on 4/24. As we think about the things we can do to improve our world, let us also think about how we sustain our professional world and move it forward for a better career and one that brings not only job satisfaction at the end of each day but the promise for even better days ahead where we embrace new technologies and put our expertise to work. Now wouldn't that really be a perfect day? Be part of the solution - take action - talk to your employer today about the tremendous value you provide every day!