Keeping an Eye on Healthcare Documentation

Why Aren't Records Digital Yet?

2009-07-19T19:46:00.001-07:00

An excellent article on the challenges of a fully-implemented national electronic record system. And it doesn't matter if this particular author is speaking about records in Canada. The challenges are the same here in the States.

Will Electronic Records Save Healthcare?

2009-07-06T17:22:00.000-07:00

This fictional case study spotlights potential problems with electronic health records. While the error in this particular "study" is not a true failure of the EHR, per se, it does point to complications that arise when multiple systems are not fully integrated or intraoperable. As so often happens when technology is deployed as a solution, it fixes one problem but creates new ones.

Another interesting article, written by a physician with 30 years of experience, wonders if the debate around the rising cost of healthcare is focused on the wrong things. The author, Dr. Tom Shragg, states, "It is not that the current debate tries to address too many problems and attempts to kill too many birds with one stone. Rather, it is that the debate is aimed at the wrong birds – the focus is on the wrong issues."

Dr. Shragg complains that charting through an electronic medical record takes him away from time with his patients. He also believes, "These computer records may improve accounting, but not health care."

But his larger concerns center around the focus on reducing pay for specialists and the concept of moving to a single-payer national health insurance plan. "When a patient needs surgery for colon cancer or breast cancer, when she gets pneumonia or has a heart attack, will paying less to the specialist for treatment improve health care? I may wish there were fewer fires, but reducing the number of firefighters won't make it so. We could do more, perhaps, to prevent fires (and illness), but when prevention fails, we still need people trained and ready to respond."

"Finally, creating a national health insurance to cover everyone will probably increase costs, not decrease them, just as feeding the world's hungry three full meals a day would not reduce our grocery bill. Personally, I think instituting universal health care is the humane thing to do, but let's be honest: Somebody will have to pay for it."

This debate is far from over.

Does the title "Medical Transcription" fit anymore?

2009-06-19T12:41:00.000-07:00

AHDI, the premier professional association representing the practitioners in the healthcare documentation industry, is conducting a survey of current practitioners. You are invited to participate in this survey to determine a possible updated work/career title that more effectively encompasses the evolving scope and practice of the present and future healthcare documentation professional. Make your opinion known at: http://www.surveygizmo.com/s/147016/career-title-survey

Please share this link with anyone you know working in the field.

From The Headlines: Hospital CEO Guilty of Bribery

2008-10-06T08:58:00.000-07:00

This just landed in my inbox:

Breaking News

Robert Urciuoli, former president and chief executive officer of 146-bed Roger Williams Medical Center in Providence, R.I., was again found guilty of conspiring to bribe a state senator to use his public office to press the hospital’s interests. Frances Driscoll, the hospital’s former senior vice president, was acquitted of a charge related to the scheme. Their previous convictions on the same charges were overturned on appeal last year. Read more soon at modernhealthcare.com.

I can't help but think that the healthcare system is so broken that hospital executives can't compete without cheating. Something has to give.

From the Headlines: AMA Issues Report Card on Insurers - and Costs are Going Up

2008-06-17T05:03:00.000-07:00

Perhaps spurred by the recent trend of insurance companies rating physicians on a variety of performance measures, the docs are getting even. The American Medical Association released their first report card on insurers. They reviewed Medicare and seven national commercial health insurers, focusing primarily on the accuracy and timeliness of payments. They based their findings on a random sampling of 3 million claims.

Medicare came out on top - with 98% of the services billed being paid. UnitedHealthcare had the lowest rating, with only 62% being paid at the contracted rate.

The article claims that 14% of a physician's total revenue is spent trying to get paid. You can read the full story here.

In another report, a "study by PriceWaterhouseCoopers predicts that medical costs will increase 9.9 percent in 2008 and an additional 9.6 percent in 2009." More than 500 employers and health plans were surveyed for this report.

Dr. David Chin, leader of the Health Research Institute at PriceWaterhouseCoopers said, "Health care providers, insurers and employers will have to monitor medical costs carefully if we are to avoid a resurgence of the double-digit annual increases seen in the past." You can read this story here.

Passing off the increases to employers and/or the insured will not be a sustainable solution, in my humble opinion. With the current state of the economy - record high gas prices and the cost of groceries climbing - hard-working Americans and business owners (particularly small businesses) will not be able to shoulder the burden.

From The Headlines: NY Medicaid To Stop Paying For 'Never Events'

2008-06-06T10:40:00.000-07:00

Last September I blogged about Medicare's decision to suspend payments for hospital-caused second surgeries (see my 9/4/07 post) that will start this October. At that time I predicted that within a year private insurance companies would follow suit.

Today, the New York state Medicaid program has announced that it will no longer cover avoidable hospital errors that result in procedures or surgeries. You can read the article in its entirety here.

There are four months left until the new Medicare policy goes into affect. Still plenty of time for other states and private insurers to hop on board.

From the Headlines: Hospital Cited in Transfusion Error

2008-05-26T12:46:00.000-07:00

A patient died in the ER after receiving a transfusion of the wrong blood type. "'Eight units of Type A blood were prepared for [a different] patient but only six were used,' the report said. The report by the Agency for Healthcare Administration reveals that there was "no documentation of what was done with the additional two units of blood."

It would seem to me that this is a significant piece of information that was inadvertantly left off of the documentation. Surely there is a procedure for dealing with this situation that was not followed properly.

To read the article in its entirety, visit http://www.local6.com/news/16365609/detail.html

An Example of Senseless Spending in Healthcare - True Story

2008-04-08T11:57:00.000-07:00

A friend of mine recently went in to the hospital to have a pacemaker implanted. Her surgeon wanted her to have an electrophysiology study done prior to the procedure, to rule out any additional problems. Since both procedures require a night's stay in the hospital it made good sense to do them on the same day. An efficient use of healthcare resources - not to mention my friend's time. You know what they say about best laid plans...

My friend arrived at the hospital bright and early on the day of her scheduled procedures. She was prepped with an IV, had her groin shaved for the electrophysiology study, and was ready to be wheeled away when someone realized that the technician who performs those studies was not working that day. A simple mistake? A costly error. My friend had her pacemaker implanted and spent the night in the hospital as planned. She then had to return two days later to have the electrophysiology study done - which required another night's stay in the hospital. Not only did this prolong her recovery, but will undoubtedly cost her (and her insurance company) a horrendous amount of money. I can't help but think about the recent policy made by Medicare regarding avoidable secondary procedures... (see my previous post on this topic)

I share this story because it is no secret that healthcare spending is completely out of control, and we often see medical transcription being cut from the budget because it provides the illusion of saving money. Taking a knowledge worker out of the documentation process is not cost effective. Avoiding mistakes like the one my friend encountered would be a great first step.

What Good is Bad Data?

2008-01-11T21:53:00.000-08:00

I recently read an article about a hospital system in Pennsylvania spending a horrendous amount of money on a software platform that they hope will provide interoperability of the information from a variety of systems and sources into accessible, consistent data. The article suggests that the software will also help alleviate confusion among physicians who use similar medical terms and will help physicians differentiate between generic and brand name drugs. It all sounds great.

My concern is the integrity of the data to begin with. There is a lot of money being invested in technology meant to make health information more accessible and user-friendly - but hardly anyone is talking about the quality of the data or how to protect it. I would argue that the output is only as good as the input. You can't prepare a gourmet meal using expired ingredients - and you shouldn't make medical decisions on information that hasn't been verified.

From the Headlines: Medical Records Affect More than Your Health

2007-10-24T19:54:00.000-07:00

Did you know that you could be denied life insurance or long term care insurance because of an error in your medical record? Financial planner Carolyn McClanahan, who is also a doctor, warns "I don't think consumers know how often errors occur in medical records and how those records can impact them."

McClanahan says even if you aren't denied coverage, you could end up paying higher premiums because of errors or unclear information in your medical record. For example, if a doctor dictates that you suffer from anxiety but fails to state that it is situational anxiety, this lack of detailed information may result in higher premiums.

To read the article in its entirety, visit http://cbs4.com/topstories/local_story_296221310.html.

It's so important to request a copy of your medical records and check them for accuracy and completeness. It can be a matter of additional and unnecessary cost - but it can also be a matter of life and death.

From the Headlines: Importance of Recertifying Physicians

2007-10-01T21:21:00.000-07:00

An article printed September 20, 2007, in Modern Healthcare brings up the need for physicians to participate in Maintenance of Certification, citing "As medical science advances almost daily, lifetime certification no longer suffices to assure quality of care."

http://modernhealthcare.com/apps/pbcs.dll/article?AID=/20070920/FREE/309210007/0/mostreadmonth

You might wonder what Maintenance of Certification is exactly. "It is a voluntary process, above and beyond licensure, designed to ensure that practicing physicians stay current in their specialties... (it) requires that physicians demonstrate—on an ongoing basis—the knowledge and skills that are needed to deliver excellent care."

The article goes on to explain that many of the country's largest insurance companies are embracing Maintenance of Certification, in part by offering higher plan reimbursements to physicians who opt to participate.

With the complexity of medicine today, this makes nothing but good sense to me. I would want to know that my physician was actively pursuing continuing education and doing everything possible to remain completely up-to-date regarding his/her specialty.

From a documentation standpoint, it is equally as important that other members of the healthcare team make a commitment to lifelong learning. Certified medical transcriptionists (CMT), for example, are required to submit proof of 30 continuing education credits every 3 years in order to maintain their credential. Credits must be spread out over 4 core and 2 complementary areas so that a CMT does not become "lopsided" in their education. With so much emphasis on the privacy and security issues surrounding medical documentation, a minimum of one-fifth of the required credits must be in the medicolegal arena. Another one-fifth must be directed to technology advancements in the industry and other issues directly affecting the workplace. The other core areas are clinical medicine and medical transcription tools.

Without continuing education, transcriptionists and other practitioners cannot exercise sound critical thinking as they perform their jobs. Anyone with the ability to affect patient care should not only be credentialed - but should be commited to ongoing learning.

From the Headlines: Chip Implants Linked to Tumors

2007-09-11T21:50:00.000-07:00

In 2005, the US Food and Drug Administration approved implanting microchips into humans to enable physicians to access the medical records of those patients. Sound a little sci-fi? The technology was touted as innovative and potentially life saving, and approximately 2000 humans worldwide have already been implanted with these chips.

Microchips have been implanted in animals for decades, in part as a means for tagging domestic pets for simple identification in the event they run away from home. But studies are starting to surface showing a connection between these implanted microchips and malignant tumors. So far these tumors are reportedly only showing up in animals, but you can't help but think about those 2000 human guinea pigs who are already implanted.

Regardless of the recent publicity around this issue, the FDA is standing by their approval of this technology. VeriChip Corp., the company that owns the current patent, estimates there are approximately 45 million potential chip-bearers in America alone.

Will the benefits of instantly available medical histories over-ride the potential health implications of these implanted microchips? Only time will tell.

From the Headlines: Concerns about IT's Effect on Patient Care

2007-09-05T21:01:00.000-07:00

At a recent meeting of the American Nurses Association, nurses stated that increased IT has added to their workload and cut down their time with patients. They expressed frustration over the fact that they often have to enter information into more than one system - for example, an electronic medical record and a prescription ordering system. While they feel a more integrated system might be better, one nurse still said, "Even with technology everywhere, patient care is still the main thing in nursing."

(To read the article in it's entirety, visit http://www.ihealthbeat.org/articles/2007/9/4/Nurses-Raise-Concerns-About-Health-ITs-Effect-on-Patient-Care.aspx)

While I recognize the need to streamline processes in an effort to lower costs, it has never made sense to me to require a nurse (or, heaven forbid, a physician!) to take on the additional responsibility of documenting the patient care encounter. These health professionals have been trained in patient care. This is their area of expertise. Accurate documentation requires a completely different set of skills.

Case in point: I recently visited my family practice doctor for my annual exam. The clinic I go to has installed docking stations in all of the exam rooms and the physicians and nurses now carry around laptop computers so that they can document their patients' encounters directly into their electronic medical record system using a series of drop down menus and text fields. When the nurse asked me to name my list of medications so she could type them into my record she stopped on "ranitidine, " asking me if I knew how to spell it. Of course I do! Not only am I an observant healthcare consumer, but I also happen to be trained in medical terminology and healthcare documentation (specifically, medical transcription). I carefully spelled it out for her, and under her breath she mumbled, "Hmm. I've never heard of that one." Perhaps if I had called it by it's brand name - Zantac - rather than the generic form, she would have recognized it.

The point is, this very capable healthcare professional went to school to learn nursing skills - how to take blood pressure and do wound care and assess patient needs. While the training of a medical transcriptionist may be similar in some respects to nursing (terminology, anatomy and physiology, study of disease processes, etc.), at one point the two professions branch off in entirely different directions. Just as you shouldn't expect a medical transcriptionist to accurately assess a patient's blood pressure, you should not expect a nurse to know the intricacies of accurate healthcare documentation.

I think the nurse quoted in the article above said it well - "...patient care is still the main thing in nursing." Though if the current trend continues, they can add documentation skills to their palette of skills.

If healthcare facilities really want to cut costs by adding extra responsibilities to already overworked staff, why not try having physicians clean the toilets and empty the trash cans at night? Surely they can save money by canceling their janitorial service. At least no one's life depends upon them doing a good job at that.

From the Headlines: Medicare Won't Pay for Mistakes

2007-09-04T21:12:00.000-07:00

Starting October 1, 2008, Medicare will no longer reimburse hospitals for preventable errors that could be avoided if hospitals followed proven preventive procedures or common-sense precautions. If a surgeon leaves a sponge inside the patient during a routine surgery, Medicare won't pay for the secondary procedure to retrieve the sponge. Furthermore, the hospitals will be prohibited from billing patients or insurers for these charges. The hospitals must absorb the expenses.

The Centers for Disease Control and Prevention estimates that 270 people a day - or 99,000 patients every year - die from infections they acquired after they entered the hospital. The Agency for Health Care Research and Quality has found that about 32,000 patients are injured annually in hospitals, often from preventable medication errors - when patients are given too much or too little medication or the wrong drug entirely.

Let's face it, accidents happen. Humans are, by nature, error prone. But in an environment of escalating costs for healthcare, something has to give. Someone has to be held accountable.

This bold move by Medicare is sure to raise debates both pro and con. If I were a gambler, I'd bet my next paycheck that within a year of the new Medicare rule taking effect private insurance companies will institute similar rules.