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.          

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.

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!