I see every day the barriers of the electronic health record (EHR) that face the health care community. Tablets are fancy gadgets but I am so concerned that the text is so small and so hard to read. Errors are made. Implementation is slow going and a daunted task. The conversion of the workflow and the training are so critical and yet it is easily misunderstood to how important it is. Proper training is needed and yet we rely on salespeople to guide the process, a train the trainer approach. The colleges of today and our educational system is failing us since there is not enough grants to offset offering new and upcoming programs for technicians to be trained on the electronic health record. Our backs are against the wall, so many of my friends have lost jobs since the government is regulating everything and the physicians are not coming on board like they anticipated. Let’s face it the real reason for the loss of jobs is the grant money ended. We are all waiting on the next funded project. Yes, the electronic health record is here to stay but the barriers are bigger now than ever.
I just can’t believe we are so close to changing to a new coding system with so many providers not getting their claims out the door and paid. I can only imagine the mess it is going to be unless your health care organization or office is starting to plan now for ICD-10. As an educator/consultant I really do not see that many small practices even concerned about ICD-10 yet. Are you conducting an office assessment of your internal needs? Do you know what training is required before you can submit a clean claim? What is your staff going to do to get the training they need? Are you going to send them to a webinar, full day conference or back to school to the formal classroom. What is your approach?
Wow, it doesn’t seem that long ago that I was learning all about Diagnostic Related Groups (DRG’s) and now it is time to learn a new way of coding. I am so glad that I have a pre-nursing background and that I continue to teach and work with allied health students today. It keeps me young. I try to always keep one hand in full grip of the basics of medicine and one hand always ready to reach for the new concepts that come along. We really needed to be life long learners if we are going to really understand and embrace ICD-10.
I hope that the new coders that are just coming into the career field do not have to go through what I went through to learn coding and to transition to DRG’s. I know now that I was hired because of all my pre-nursing education and my on the job training in respiratory therapy. I can still remember when they offered me the job as a coder. I was so excited to be offered a job in the medical field that was full time days. The administrator told me upon hiring me that they did not have a medical records director in place. After working for about two weeks, they sent me to a workshop in another city to learn everything I needed to know about coding and DRG’s. I really relied upon my medical background to grasp everything that I needed to know. I kept all kinds of medical books, surgical books, dictionaries open in front of me as I coded the diagnosis and the procedures. If there was something I didn’t understand I would try to ask a question of the physician on the case. The physicians came to the medical records department on a regular basis to complete their records. It was acceptable for coders and physicians to discuss cases in the dictating room. I can still remember the other people in the department and how they related to me as a new person and in my new role. They were like, Oh she is the one that works with and talks to the doctors, ooooh. Most of my coworkers acted like they were all scared to even say hello to the physicians when they came into the department. I became very comfortable with working with physicians early on in my career. Before I knew it I was asked to join them in their committee meetings and take notes
Finally the day came when I was introduced to my new boss. She was young and pretty and single.
She was fresh out of college. After working with my new boss after about three months and DRG’s was coming closer to being fully implemented in our state, I can remember asking her a question about a particular case that I was working on. I was having a challenging time trying to really grasp the concepts of all the DRG’s and how to map them. I approached my director with a question. She tried to explain it the best she could. I still did not get how she arrived at her choice. I sat the record to the side and thought I would try again tomorrow. I approached her again the next day and she explained to me again what the DRG should be. I asked her why that particular DRG and she got very upset with me.. I got upset when she changed her tone of voice and she ended up saying to me, do I need to draw you a picture? I was so hurt by that comment. I shouted back to her, “I guess you do and left her office”. I finally assigned the DRG that she suggested and submitted the claim but I realized that I had a lot of work to do to really understand the concepts behind how to select the best code and the best DRG’s.
In reflection, I think about how hard it was to learn and apply new concepts and I think about how hard it is going to be for some of these hospitals when they need to train their staff on coding for ICD-10 and really start implementing the system. I think about the coders themselves and the countless hours of sleep they are going to lose when they try to implement this new mandate. Are hospitals going to hire a pretty little thing, right out of college and think that she can do the job of implementation by herself? Are administrators and Health Information Managers (HIM) going to send people to a one day workshop and think they can learn it all there? What about productivity rates? Are hospitals going to only hire people with years of experience? There is definitely going to be a learning curve? Who is going to pay the price?
I am now on board with a network whereby I can communicate with my physicians and access my medical information. The portal is called My Mercy. I am finding the website easy to navigate and very informative. My physician answers his emails timely and answers me thoroughly when I have a question. I would like for this network to consider a few up grades to their system. I would like to access my diagnosis and treatment. I think that would be helpful. I cannot remember the date of when I was in for a sore throat last and what he prescribed that worked so for me to have that information would be helpful. I have a few more suggesstions but this is one that sticks out the most. I know they do not realize that I have alot of experience in this sort of thing (Selecting and Implementing EHR’s) Other than that good job. I would rate them a B-
Just this week the Office of the National Coordinator for Health Information Technology (ONC) announced their selection of the final two regional extension centers (RECs). This brings the total count to 62 and completes a national network of RECs. The last two RECs will provide support for providers in Orange County California and the state of New Hampshire.
RECs are funded by the Economic Stimulus Bill of 2009, or more specifically, the HITECH Act. This program has received funds of $677 million so far. Their mission is to help 100,000 providers become “meaningful users” of electronic health records in 24 months. Each individual REC is required to help at least 1,000 providers achieve “meaningful use” status. Will RECs deliver on their mission?
Their poll also ties in with a blog post titled, “5 Reasons RECs are RECkless.” One of their main concerns with RECs is the short timeline. RECs funded in February of this year have just 17 months to reach their goal; the others funded in April have 19 more months. So, if their goal is to help 1,000 providers in this short time frame, they will need to work with 50 to 60 providers a month. Do they really have enough time and reosurces to support this demand? Where are they going to find enough staff?
To participate in their poll and read more from their article, visit: http://www.softwareadvice.com/articles/medical/five-reasons-we-think-recs-are-reckless-1092310/
Here is the latest. Did you hear that Medicare and the Veterans Administration this fall will enhance their Web sites by adding a “Blue Button”? What does that mean? The blue button will enable beneficiaries to download their claims and medical information held by Medicare and the VA. I personally want this concept to go one step further. I want to see and to have access to everything in my medical record. If we, the American population can have access to online banking and we can review banking account information online then why can’t we review our medical information online?
If you are not keeping up with and tracking your own health information then you are in the dark. I am advocating that we all take action now and start to compile, track and store our own health information. Our health information is scattered and the average American has over 5.5 medical records. We need to take care of our health care information. We need to know what is inside our medical records. We have the right to make an amendment. We have the right for a copy of it. We have rights. Let’s use them. To learn more follow my blog.
No one really likes the word, audit. Most people have a negative connotation or impression associated to the word, audit or auditor. In the health care field, an audit is a review, check or inspection of your hospital or practice. An auditor is a professional that can audit several aspects of a facility. They can inspect anything from your physical building, your processes on how your company does business to how they spend their money. This sounds scary, doesn’t it? It doesn’t have to be. 2010 is named the year of the audit. Why is that? There are many factors that come into play with the answer. One of the main factors for this being the year of the audit is the health care transparency issue. Americans want to know where their health care dollars are being spent. Most everyone has read by now that health care fraud and abuse is on the rise. If you want some solid answers, the thought is conduct and audit.
Most auditors are trained professional and they have written criteria or standards to go by. Most generally, auditors can not walk into your facility and ask to review something without your knowledge of what it is that they want to look at. You must know or someone at your facility must know what the standard is in which they are reviewing you on. There needs to be a policy in place on how your company works with auditors and the auditing process. It is up to each facility or practice to make sure that they keep up with the criteria or the standards that govern their business. The standards are usually made available by the company that is reviewing your site or they are available on government websites.
The reason that I have chosen to write this article is that I am an independent Health Information Management (HIM) consultant and I am seeing a rise in the number of nursing personnel that are entering into this type of work. There are many types of nurse auditors out in the field today. Nurse auditing is on the rise. The Nurse auditor that I am most familiar with and that I would like to share with you about is an individual who reviews clinical information for a company, usually an insurance company. They review and interpret clinical information and make sure that it matches criteria provided by the company they work for. They spend many hours inside of an office with their noses peered inside the medical record. Sometime they bring along a laptop and enter data into it for their company. They are usually meticulous to detail. They are usually independent contractors meaning that they work on a contract or project basis. They are usually self-employed and self managed. They usually do not have any health benefits but their pay is usually higher than what a regular facility will pay you for your time. As an auditor, you have a flexible schedule whereby you can choose the days and times you want to work. This person usually is requested to travel, it can be local and sometime more extensive than that. For the most part, the auditor must have a reliable car, car insurance along with a cell phone. Most auditors will have their own computer; sometimes the company will supply them. Each contract is different.
Have you thought about this as a career field for yourself? Do you know of someone that would like to work in the filed? Does this sound exciting? Are you self motivated? Do you like to work independently? Do you have solid computer skills? Read on for some additional information before you make a decision.
Here is some reason why this type of work may not be for you. If you need a steady income this type of work might not work for you. Most companies work on a project basis and they do not guarantee hours or an income. If you are not able to follow-instructions verbally and need to have someone show you with a hand on approach, this might not be the type of work that you are suitable for.
I am not advertizing for any job or position, this article is meant for educational purposes only. The field is truly exciting. I have worked along side many LPN and RN’s. If you are a new nurse entering the field or a seasoned nurse needing a break, I hope that you will consider the possibilities or nurse auditing.<a href="http://positiveresourceconsulting.com
Even though I am a health care consultant concerned with health information management and the transition to the Electronic Health Record. I am also a consumer of health care. I was born with a cleft palate. I have since found out that I probably have a condition called Sticklers syndrome. Once this diagnosis was tossed around and landed in my medical record it has caused some concern with obtaining life insurance at a reasonable rate. Now as of today, I have one physician that has uses this term repeatedly and none of my other physicians that I go to even know what it is. This is very frustrating for me especially since I have a career in health information technology. I checked with some of the agencies out there that capture rare disease information and they report that there are 4 cases in the United States that have Sticklers syndrome. I know this is not accurate because since my diagnosis of this condition my own daughter of 23 has been diagnosed with it. I have already myself found numerous cases with the Stickler foundation where I reviewed some of their cases. What a discrepancy with our reporting system? We have some real issues with how things are recorded and reported in the US and so I am excited to see that this issue might finally be addressed and corrected with utilizing an Electronic Health Record EHR) and thus by reporting to patient registries for quality improvement, public reporting, etc.
The second category of engaging patients and families is long overdue. I think if I have read correctly that the committee is wanting to:
• Provide patients with an electronic copy of or electronic access to clinical information per patient preference
• Provide access to patient specific educational resources
• Provide clinical summaries for patients for each encounter
I think that education is the key here. The American Health Information Management Association (AHIMA) has taken an active role in trying to educate consumers and empower them to take more responsibility for their health care information. More needs to be done in this area. Here again I go back to my own personal experience. I have to track my health information so that I can ensure that I receive good quality care. I believe everyone should have access to their personal health information at all times. I really feel that each physician should give the patient a summary of his/her condition after each encounter. This doesn’t have to be in paper format. It could be sent to a flash drive and every patient would have one with their personal health information on it. Of course training would need to be done on how to use a flash drive. (Believe me there are a lot of people who do not even know about them or how they work) The flash drives today are becoming more sophisticated and technically secure. A person can purchase one with password protections, or biometrics. I feel very secure using a flash drive to carry my information to and from my doctor’s appointments. As a consultant, I am also very involved with training the health care providers about the importance of sharing information with their patients. I am also involved with training different health support groups on how to approach their providers when they need information. Training is the key here.
I hope this gave some insight to my thoughts on the term meaningful use. When you look at the term meaningful use one really has to ask themselves who is the end user. Who is the consumer of this information? To me the answer is -we all are.
To find out more on how I am involved please go to my website. http://www.healthcaretracker.org