Category: EMR and EHR

RIHIMA kicks off 2020 with lively discussions of HIM ‘hot topics’

On By Lisa A. EramoIn AHIMA, Audits, Data analytics, EMR and EHR, HIM management, Uncategorized

By Lisa A. Eramo, MA

Presenters touched on a variety of hot topics at the most recent RIHIMA meeting: Data mining, patient matching, and evaluation and management (E/M) coding. Approximately 40 people attended the event held in Warwick, Rhode Island on January 17, 2020.

Data management skills a ‘must’ for HIM

Lolita M. Jones, MSHS, RHIA, CCS, healthcare data mining consultant at iquerydata.com encouraged attendees to gain data management skills so they can continue to add value in an increasingly artificial intelligence-driven healthcare environment. In the not-so-distant future, Jones said HIM professionals will be charged with auditing large data sets, identifying patterns, and recommending physician education. They’ll no longer manually assign codes and perform audits with limited sample sizes. Those with data management skills will be able to weather the storms of change and prevail, she added.

HIM professionals with data management skills, for example, can convert official coding guidelines into database queries to identify potential coding problems proactively—before payers and Recovery Audit Contractors do, said Jones. Why is it critical for HIM to write these queries? They possess the subject matter expertise to identify all of the diagnosis and procedure codes that apply to each query, said Jones. They can also help decision makers draw accurate conclusions and glean actionable insights from the data, she added.

How does one obtain data management knowledge without obtaining a master’s degree? Grassroots education at local and regional AHIMA meetings, said Jones. HIM professionals can also attend data management-related tracks at the annual AHIMA conference or take a variety of courses online.

Patient matching is more critical today than ever before

Letha E. Steward, MA, RHIA, director of customer relations at Quadramed gave an informative presentation on patient matching in the context of mergers, acquisitions, and health information exchange. A duplicate record doesn’t just affect one hospital—it affects many providers in real-time, said Steward. “As soon as you create a duplicate, the patient’s medical record is fragmented,” she added.

When hospitals and physician practice merge onto a single EHR platform, they must have a process in place to identify and resolve duplicates, said Steward. She encouraged organizations to use referential data because it’s updated as life events occur, and it can enhance automated matching. She also encouraged attendees to think about using cell phone numbers as unique identifiers because they don’t change often.

E/M documentation problems persist

Oby Egbunike, CPC, COC, CPC-I, CCS-P, director of professional coding at Lahey Health Care System, Burlington, MA spoke about the importance of the chief complaint—a detail that’s often omitted from E/M documentation. “This is the driver for whatever else the physician is going to do,” she said.

When documenting the exam, Egbunike said physicians should consider this question: Is the exam for the purpose of diagnosing and treating the patient or for coding? For example, a full organ system exam isn’t necessary for an ear infection, she added.

 

Can HIM and technology be friends?

On By Lisa A. EramoIn AHIMA, Data analytics, EMR and EHR, Health information technology, HIM advocacy, information governance, Release of information, Uncategorized

Let’s face it. Technology changes every industry. This is especially true in HIM as it continues to revolutionize the way in which providers release health information, document in the medical record, assign codes, and more. How can HIM professionals keep up, and what must they do to stay current? These are two of the many questions that arose during the recent RIHIMA meeting on February 9 in Warwick. Approximately 50 people attended the event.

The future of HIM

Now that the hurdle of ICD-10 implementation has passed, AHIMA has set its sights on data analytics and information governance, both of which require a new level of training at the master’s or doctorate levels, said Donna Corbani, CCS. Corbani attended the 2017 AHIMA House of Delegates meeting in October and reported on several AHIMA initiatives. “We have to embrace technology to be relevant,” she added. “Automation is coming.”

Specific EHR certifications are helpful, said Corbani. “You’re golden when you have this and a background in HIM,” she added.

HIM must convey to executives that no technology is 100% accurate and that coders must validate coded data, said Corbani. One attendee voiced concerns about computer-assisted coding, stating that HIM must educate senior leaders about its limitations and flaws. Another attendee said HIM needs to be at the table as EMRs are developed and implemented because they can shed light on the flaws inherent in many products, preventing executives from having false hope that the technology will be a panacea.

HIM and IT also need to work together to develop best practices for EHR use and maintenance. Requiring users to ‘open a help ticket’ isn’t efficient in a rapidly-changing patient care environment, said one attendee.

Managing health information for transgender patients

Angela Carr, partner at Barton Gilman, LLP, provided an informative session on how healthcare providers can manage electronic health information most effectively for transgender patients by developing a policy for release of information, name changes, and more.

“The more we learn and talk about it, the better we’re going to be at providing care. The ultimate goal is to provide better care for this population,” said Carr. HIM can help by developing a policy to address the following:

*Data capture — Help providers explain to patients why they collect information about gender identity and preferred pronouns (e.g., for continuity of care, preventive care, etc.).

*HIPAA authorizations — Explain how and why providers may share information about gender identity and sexual orientation when it relates to treatment. This requires an explanation of uses and disclosures for treatment, payment, and healthcare operations, said Carr. Patient education must happen long before records are completed. This would help avoid conflict when sensitive information in the discharge summary is auto-faxed to the patient’s primary care physician, she added.

*Names/name changes —  Explain how the provider handles patient name and any subsequent name changes. For example, the medical record includes the individual’s legal name as it appears on their insurance card, but the provider uses an ‘aka’ when communicating directly with the patient.

Carr suggested conducting focus groups with transgender patients to see what they want and need. “The best way to learn is to talk to the people you’re trying to protect,” she said. “Be honest, and have a dialogue with people.” She also directed attendees to the World Professional Association for Transgender Health.

Reducing cancer in Rhode Island

David Rousseau, chair of the Partnership to Reduce Cancer in Rhode Island, talked about the importance of data in cancer research. Approximately 6,700 people in Rhode Island are diagnosed with cancer annually, and approximately 43,000 residents are living with cancer already.

Rousseau’s team is at the forefront of prevention. His team examined more than 500 people at various skin cancer screening events throughout 2017, helping individuals who couldn’t get a timely appointment with a dermatologist. This year, Rousseau said the partnership will be looking more closely at the large number of individuals who have insurance but don’t undergo preventive colonoscopies. Approximately 650 Rhode Islanders are diagnosed with colon and rectal cancers annually.

What’s at the heart of this research? Coded data.

 

 

 

What HIM can expect in 2018 and beyond

On By Lisa A. EramoIn AHIMA, Audits, EMR and EHR, HIM management, HIPAA, ICD-10, medical coding, Revenue integrity, Uncategorized

The list of topics covered at the recent RIHIMA meeting truly ran the gamut: Medicare payment reform, Office for Civil Rights (OCR) enforcements, the 21st Century Cures Act, FY 2018 ICD-10-CM coding changes, and more. The meeting, which drew approximately 50 people, was held in Warwick on October 20. The theme? Looking ahead to 2018 and beyond.

Health IT updates

Jennifer L. Cox of Cox and Osowiecki, LLC kicked off the morning with an update on health IT, the future of which she said is unclear in light of unprecedented budget cuts to infrastructure. What can HIM professionals expect during the next year and beyond? Cox told attendees to keep their eyes open for the 21st Century Cures Act, which she said is one of the most significant regulations that will affect the HIM profession. The legislation, which was enacted in December 2016, includes a section on health IT interoperability that requires data sharing and prohibits data blocking. A first set of draft rules is due by March 2018.

“This is going to be bigger than HIPAA and Meaningful Use–it will be the biggest thing in our careers that will shift how we use health information,” said Cox.

Cox also touched on the federal government’s efforts to remove Social Security Numbers (SSN) from Medicare cards by 2019. Although this may reduce identity theft, she said it creates an inability for HIM professionals to verify patient identity using this unique identifier. HIM may eventually need to create consistent verification standards in lieu of having access to the SSN, she added. They may also need to retrospectively sanitize records to remove the SSN. Cox encouraged attendees to make a list of all the ways in which they currently rely on the SSN so they can work collaboratively with the legal/compliance department to develop a strategy for how they’ll handle these scenarios once the SSN is no longer available.

Cox also warned of increasing OCR activity, stating that high-dollar settlements have increased over the last year and a half. She encouraged attendees to monitor the OCR’s running list of resolution agreements because she said it’s often a roadmap for potential vulnerabilities. “Learn from your colleagues’ misfortune,” she said. “This is what [the OCR] cares about, and what they care about, we should care about.”

Risk assessments should be a top priority, she said, adding that many independent physician practices are failing Meaningful Use audits because they didn’t conduct an assessment during the year of attestation. Also remember to fix any problems discovered during the assessment, she added.

Staff education is equally as important, said Cox. For example, employees should notify their IT department when a computer is particularly slow, as this could signal an impending cyber attack. “These are very sophisticated attacks,” she added. “It takes minutes–not hours–to infect the entire system.”

FY 2018 coding updates

Mary Beth York, senior associate at Barry Libman, Inc. discussed several important ICD-10-CM coding changes that took effect October 1, 2017. She encouraged attendees to review the FY 2018 ICD-10-CM coding guidelines as well as the 2018 Addendum. When coders rely entirely on the encoder–and don’t review all of the additions, deletions, and revisions–they aren’t as aware of these oftentimes subtle changes, she said.

Third-party release of information

Amy Derlink and Laureen Rimmer, both of MRA Health Information Services, gave an informative presentation on ROI best practices.

Derlink encouraged attendees to create a third-party audit record review policy that addresses these and other questions: Will you ask to see the business associate agreement between the health plan and third-party auditor before releasing information? Will you allow the third-party auditor onsite? What access will you provide to the third-party auditor? Will it include remote access? How will you comply with HIPAA’s minimum necessary requirements? “We need to protect privacy,” she said. “That’s our number one obligation.”

Don’t let auditors bypass HIPAA to access protected health information, said Derlink. Quality audits (e.g., HEDIS) are not included in uses and disclosures for treatment, payment, and operations, she added.

Rimmer said HIM must leverage technology and tap into data analytics to identify compliance risk and prepare for audits. “Understand your data, and know what’s going on so you can be proactive with your own internal audits,” she said. “As you see themes, you need to drill down.”

Embracing leadership qualities

Karen A. Benz of Benz Strategic Group gave an interesting presentation on leading vs. managing. “Management is doing. Leadership is being,” she said. “As a leader, you set the culture and tone of your department.” She described managers as productivity-oriented implementers, and she identified leaders as open-minded agents of transformational change. Managers ask people to follow, but when you’re a leader, people will follow naturally, she explained.

She challenged attendees to embrace leadership qualities and not succumb to negativity. Doing so improves employee retention and satisfaction. And when employees are happy, they’re often willing to go the extra mile for patients as well.

 

 

 

 

Inspiration, innovation key themes at the 2016 annual AHIMA convention

On By Lisa A. EramoIn AHIMA, Apprenticeship, EMR and EHR, information governance, Patient advocacy, Patient communication, Patient engagement, Patient portals

20161018_211108“Inspire big thinking to launch our future” was the theme of the 88th annual AHIMA convention held October 16-19 in Baltimore, MD. And wow, did it inspire. I imagine that most HIM professionals walked away from the event feeling incredibly energized about the role they’ll play in this new era of big data and patient engagement.

In my opinion, the most powerful presentation was that of Dr. Bennet Omalu, the first doctor to diagnose chronic brain damage in NFL athletes. He also inspired the movie “Concussion” starring Will Smith. Dr. Omalu received frequent applause as he shared his personal journey–one in which he overcame insurmountable odds in war-torn Nigeria to not only attend medical school at the age of 15 but also to ultimately make a discovery that revolutionized neuroscience and sports medicine/safety. I had goosebumps just listening to him. As I watched and listened in awe, I was reminded that with hard work, passion, and a little luck, anything is possible. This is an important lesson for everyone, including HIM professionals working tirelessly to improve compliance and data integrity within their organizations.

Retired American astronaut and U.S. Navy Captain Mark Kelly continued the theme of inspiration as he spoke about his career flying 39 combat missions over Iraq and Kuwait during the first Gulf War. He also described in vivid detail what it felt like to blast off in a rocket when he served as the commander of space shuttle “Endeavor” on its final flight. His talk then turned personal as he spoke about the day his wife, former congresswoman Gabrielle Giffords, was severely wounded after being shot in the head at near point-blank range. Giffords joined him on stage at the conclusion of the talk and received a standing ovation.

Many of the sessions throughout the duration of the conference focused on thinking ‘outside the box’ of traditional HIM roles.

For example, ONC Chief Medical Information Officer Andrew Gettinger, MD, encouraged HIM professionals to help their organizations integrate patient-generated data into the EHR–especially as medical care continues to move outside of a hospital’s four walls. He said HIM is also well-suited to help organizations “harvest digital dividends” from EHRs–that is, use the technology (and big data) to solve operational challenges and problems.

During a panel discussion about the future of healthcare, AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA, encouraged attendees to imagine the HIM jobs of the future–and take steps now to prepare. Is higher education warranted? A specialty credential? She said to embrace industry changes–not simply react to them.

Panelists identified these healthcare trends that will continue to shape HIM in the years to come:

  • Push for transparency around healthcare costs
  • Integration of patient-generated data for a 360 degree holistic view of one’s health
  • Increased interoperability to meet patients’ demands and coordinate care more effectively
  • Best practices to educate patients about their health information
  • Best-of-breed strategic partnerships
  • Availability of clinical information at the point of care

Others spoke about new and emerging roles in HIM, including data scientist and healthcare data quality manager. Michelle Basco, RHIA, of Children’s Medical Center spoke about her own journey to become a personal health record coordinator. HIM professionals are uniquely qualified to engage and educate patients. “They need to learn, and they need us by the side,” she said.

Various speakers also talked about the importance of developing an HIM workforce to meet the job demands of the future. Apprenticeship programs are critical, said Bill Rudman, PhD, RHIA, executive director of the AHIMA Foundation. “We’re evolving so quickly with technology. On-the-job experience is so necessary,” he added.

Marci Wilhelm, of MedPartners, said apprentices with whom she’s worked achieved a 95% coding accuracy rate in only 90 days. Debra Boppre, MSM, RHIA, CCS, CCS-P, FAHIMA, of Trinity Health recounted a similar experience with apprentices who helped address coding backlogs at their facility.

Boppre encouraged other HIM professionals consider serving as mentors. “You owe it to these HIM professionals,” she said. “Invest the time, and you will see the return on investment over and over again.”

Information governance was also a hot topic. During a panel discussion, panelist Sally Beahan, RHIA, MHA, director of HIM at UW Medicine said to start small by identifying the ways in which HIM is already striving to enhance data integrity. Others shared their journeys toward information governance and encouraged HIM professionals to champion the effort within their organizations.

Did you attend the AHIMA convention? If so, what did you take away from it? What inspired you the most?

 

 

 

Why HIM professionals hold the keys to patient satisfaction

On By Lisa A. EramoIn AHIMA, Communication, EMR and EHR, Freelance writing, Healthcare writing, HIM management, ICD-10, Patient advocacy, Patient engagement, Patient portals, Patient satisfaction, Uncategorized

I started writing about medical coding and health information back in 2005. When I stop and think about how many changes HIM professionals have been through during that decade, it’s mind-boggling! First it was MS-DRGs and the dawn of clinical documentation improvement, then the Affordable Care Act and the push for electronic health records, then ICD-10, and now a transition to value-based payments.

As medical records have evolved, HIM professionals’ skills have evolved as well. With their intimate knowledge of data — particularly how data is created, modified, stored, and shared — they bring such value to the table. The sky is the limit when HIM and IT collaborate effectively. Add a hospital executive to the mix, and you’ve got a powerful trio of intelligent minds that can propel process improvement forward. What an exciting thought!

Unfortunately, it’s sometimes difficult to find common ground. And it’s easy to lose valuable ideas in translation. The good news is that everyone seems to speak the language of ‘patient satisfaction.’ Organizations nationwide  continue to focus on the patient experience — especially in light of the important role that both of these plays in CMS’ latest hospital quality star ratings.

This is an opportunity for HIM. Take it.

Meet with a C-suite executive and explain how HIM can engage patients. Here are a few examples:

  1. Portal navigation. Who is most qualified to convey the value of portals and educate patients how to use them? HIM.
  2. Health coverage education. Who is most knowledgeable of complex insurance policies (including copayments, deductibles, coinsurance, etc.) and can thus help patients understand these concepts? HIM.
  3. Digital forms. Who can help digitize forms, integrate EHR data into those forms, reduce duplication, and create opportunities for e-signatures on mobile devices? HIM.
  4. Advocacy for privacy and security. Who can help patients understand their rights to obtain copies of their own medical records? HIM.
  5. Protection against medical identity theft. Who can implement policies and procedures to thwart identity theft and protect patient information? HIM.
  6. EHR best practices. Who can help physicians integrate the EHR into the exam room so it doesn’t disrupt communication? HIM.

In what other ways do you, as an HIM professional, strive to improve the patient experience daily?