Welter Healthcare Partners
Jennifer
Could your new electronic medical record system be missing vital information the old paper-based system captured?nnEven the most seasoned technology champion has to stop and ask that question, if for no other reason than the new medical record looks very different than the old one. To put it in classroom terms, today’s EMR is often multiple-choice, not essay.nnBut almost as long as there have been doctors, the preferred way for them to communicate has been through a narrative—a story.nnEMRs may introduce gaps in that narrative, says Philip Resnik, professor of linguistics in the Institute for Advanced Computer Studies at the University of Maryland.nnSince 1999, Resnik’s been studying the limitations of entering clinical information into discrete fields and checkboxes in an EMR. At the recent South by Southwest conference, Resnik described the dilemma clinicians face: to embrace the EMR with all its limitations, or to push ahead for new technologies such as natural language processing that rarely see clinical use today.nnResnik illustrates the problem with a sample narrative of a woman complaining of shortness of breath. In a slide he highlights snippets that are easily entered into EMRs, such as symptoms and actions taken. But he also underscores much text that helps tell the story of the patient’s encounter in the ER but doesn’t readily map to fields in an EMR.nnn”The doctors in the ER were trying to figure out whether the shortness of breath in this woman was due exclusively to her failing heart, or was there a problem with pneumonia,” Resnik says. “People who have pneumonia do not respond promptly to [BiPAP] treatment. But she responded promptly. This gave them information.”nnResnik bets that few point-and-click EMRs have a check box or slider control for how quickly a patient responded to a treatment.nnText fields in EMRs can capture this information, but in a busy exam room, with doctors trying to point, click, and enter EMR data during the exam, while also trying to maintain eye contact with the patient, how much time will be left for text entry?nnThe dilemma compounds when you realize that any data entered in text fields will resist analysis. Database analysis works best with discrete numbers. So even if we get doctors to enter the portions of their narrative that don’t fit in discrete data fields, we’ve lost the ability to really analyze that data.nnAs an experiment, Resnik and some other researchers took 20 cardiology dictations and went through them manually, highlighting the info that could be placed in discrete fields, without having to type into a text box.nn”Then we took two cardiology experts and said, ‘Let’s pretend this clinical record is somebody a doctor across the country referred to you as a case,'” Resnik says. Researchers had highlighted info that couldn’t be placed in the discrete fields, and they asked the cardiologists to rate how severe a gap in the record the highlighted information was.nnnIn half the records, there was at least one thing the two doctors independently concluded should have been in the patient’s record.nnThe researchers did another experiment where they assumed that the EMR, which happened to be in use in British Columbia, could capture more of the narrative with some extra engineering.nnThe cardiologists still found a severe problem in one out of four records, Resnik says.nnAnother issue with EMRs is the advance of medical science. In the early 1990s, a higher-resolution CT scanner was introduced. Radiologists started discovering semi-opaque nodules in the lungs which indicated a much higher probability of lung cancer. But older medical records simply offered the choice of “opaque” or “transparent” and had no way of expressing the newer notion of “semi-opaque.”nnSuch examples must abound in medicine as it advances. How valuable will today’s EMRs be in tomorrow’s realities?nnThe traditional clinical narrative also has another set of nuances not present in the typical modern EMR. Narratives may say that something is “suggestive of” a particular condition without that condition actually being present. Patients may deny the presence of a particular condition, such as chest pain, but the EMR may not allow for such a denial to be a structured part of the record. In another example, doctors may agree that a particular pilot-as-patient should not be recertified to fly without undergoing a particular procedure.nnn”I have a feeling ‘Don’t recertify patient to fly without this procedure’ is not a check box that is easy to put into this medical record,” Resnik says.nnSymptoms also change over time, and EMRs may not be nearly as good as a narrative when expressing this.nnOn top of all these concerns, a generation of older clinicians who are used to simply narrating their records creates a recipe for a mass exodus of personnel on top of growing doctor shortages.nnResnik worries that with the current stampede to meaningful use, all these considerations are being ignored.nnAs somewhat of a salvation, work continues on natural language processing. Resnik, who consults in this field, notes that machines are making strikes in learning to read, parse, and code narratives, partly because of the recent move to “big data” and advances in machine learning such as IBM’s Watson project.nnIn other fields, including marketing and advertising, big data—the sophisticated analysis of very large data sets—is a big deal. Healthcare tech seems to be late to the game. Too many of today’s EMR solutions seem to be based on the old-style client/server technology of the 1990s.nnIn Resnik’s opinion, doctors shouldn’t be checking boxes while they’re trying to do a narrative. He says there are ways to “engineer the ergonomics” of the system. He, and I, think it’s time we do.
ICD-10 is Coming…. Don’t Be Left in the Dark!
Physician practices and hospitals may need up to 2 years to plan for and successfully implement ICD-10. With the implementation date set for October 1, 2014 (and multiple sources saying there will be no more delays!) it is important to start your education and training now! ICD-10 will bring monumental changes to all healthcare providers and facilities – failure to prepare will result in a significant decrease in revenues, cash flow and productivity!nn Welter Healthcare Partners ICD-10 training is facilitated by an AHIMA ICD-10-CM/PCS certified trainer with over 6 years of experience of ICD-10 training and education – for physicians and hospitals! Our ICD-10 training is comprehensive and fully customizable to meet your specific needs.nnFor more information about ICD-10 training for your practice or facility click here, or call us today at 303.534.0388 or 877.825.8272!
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This interactive and hands-on ICD-10 training is designed to prepare coders for the AAPC and AHIMA ICD-10 proficiency examinations. Participants will gain the tools they need to appropriately select ICD-10-CM and ICD-10-PCS codes. These training sessions will be coder centric, and the content will be designed for those staff who will be responsible for applying (or verifying) these codes to documentation. Throughout the academy, participants will be given an assortment of scenarios to code to obtain the proficiency they need for coding in ICD-10. Participants only needing ICD-10-CM training (physician and outpatient coding) should register for the first day of the academy only (Day 1). Participants needing ICD-10-PCS training (hospital/inpatient coding) will need to register for the entire 3-day academy.n
Overview of ICD-10 Academy Agenda:
n(lunch, snacks and drinks will be provided each day) [twocol_one]ICD-10-CM (Day 1) AHIMA-approved ICD-10-CM/PCS trainers will educate coding staff regarding ICD-10-CM with a focus on:n
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- Convention changes and additions
- Concept changes and additions
- Chapter specific guideline changes and additions
- Live coding workshop
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n**This training has the approval of 8.0 CEU’s from the American Health Information Management Association (AHIMA) (AAPC members can submit these CEU’s to AAPC for credit) [/twocol_one] [twocol_one_last]ICD-10-PCS (Days 2 and 3) AHIMA-approved ICD-10-CM/PCS trainers will educate coding staff regarding ICD-10-PCS with a focus on:n
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- The structure of ICD-10-PCS text and codes
- The definition and application of each root operation
- The method by which an ICD-10-PCS code is selected
- Live coding workshops
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n **This training has the approval of 16.0 CEU’s from the American Health Information Management Association (AHIMA) (AAPC members can submit these CEU’s to AAPC for credit)nnClick here for detailed training agenda nn[toggle title_open=”Required Academy Materials:” title_closed=”Required Academy Materials:” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]AHIMA ICD-10-CM Coder Training Manual and/or AHIMA ICD-10-PCS Coder Training Manual – Upon registration participants Training Manuals (CM only, or CM/PCS for 3 day training) will be ordered on their behalf – cost is $75.00 per training manual (discounted from $100.00 per manual) and will be added to the registration fee.nnContexo ICD-10-CM (Draft) and/or ICD-10-PCS (Draft) – Upon registration participants coding manuals (CM only, or CM/PCS for 3 day training) will be ordered on their behalf – cost is $90.00 per ICD-10 book and will be added to the ration fee. ($180.00 for both CM and PCS books for the 3 day training) (Discounted from $110.00 per book)nn**Book Pick-Up: In order for pre-requisites to be completed prior to the actual course date, participants will be required to pick up their books from 8am – 5pm, at Welter Healthcare Partners headquarters at 6870 W. 52nd Avenue, Suite 102, Arvada, CO 80002 on:n
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- Friday, February 28, 2014 – for the March Coder Academy
- Friday, May 30, 2014 – for the June Coder Academy
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nIf you need to make alternative arrangements to pick up your books, please contact Jennifer at 303.534.0388.[/toggle]nn[toggle title_open=”Academy Pre-Requisites:” title_closed=”Academy Pre-Requisites:” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”][twocol_one]ICD-10-CM Only (day 1):nICD-10-CM Coder Training Manual: Pages 2-82; Reading and accompanying section review questions[/twocol_one] [twocol_one_last]ICD-10-CM-PCS (3 day academy):nICD-10-CM Coder Training Manual: Pages 2-82; Reading and accompanying section review questions and ICD-10-PCS Coder Training Manual: Pages 2-83; Reading and accompanying section review questions[/twocol_one_last][divider_flat][/toggle]nn[toggle title_open=”Academy Dates and Locations:” title_closed=”Academy Dates and Locations:” hide=”no” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”][threecol_one]Englewood, COnREGISTRATION DEADLINE MARCH 4thnMarch 12-14, 2014n8:00am – 5:00pmn(On 3/13/14 training will be held from 9:00am – 6:00pm)nSwedish Medical Center – Pine B & C Conference Roomn501 E. Hampden AvenuenEnglewood, CO 80113[/threecol_one] [threecol_one]Thornton, COnREGISTRATION DEADLINE May 30thnJune 11-13, 2014n8:00am – 5:00pmnSpine Education & Research Instituten9005 Grant Street, Suite 100nThornton, CO 80229[/threecol_one] [threecol_one_last]ONLINE (web-based) Coder AcademynREGISTRATION DEADLINE June 20thnJuly 8-10 2014n8:00am – 5:00pmnRegistered Participants will have webinar training details emailed to them 72 hours prior to the training.nnParticipant Training Books will be shipped 2 weeks before training. Please provide the address of where books should be shipped on the registration form.[/threecol_one_last][divider_flat] [/toggle]n
Academy Registration Fee:
nICD-10-CM Only (Day 1) – $275.00 per participant (plus $165.00 for the training manual and the ICD-10-CM book)nnICD-10-CM-PCS (3 Day Academy) – $800.00 per participant (plus $330.00 for the training manuals and the ICD-10-CM/PCS Books)n
Registration Discounts:
nPractices registering 3+ participants will receive $50.00 off each registration.n
Seating is limited, register now to guarantee your spot today!
nClick here for registration formn
Course Instructors:
nToni Woods, CPC and Whitney Horton, CPC, CCCnMs. Woods and Ms. Horton are AHIMA-Approved ICD-10-CM/PCS Trainers. They are educators and trainers in the areas of ICD-10, physician documentation, Medicare coding and documentation guidelines, ambulatory medicine coding, hospital, and other facility coding and documentation. They work with physician practices of all specialties and are experts in analyzing chart documentation and in reengineering practices to enhance their reimbursement systems and processes, and overall increase revenue and profitability. Their goal is to empower physicians and health care professionals and staff to understand the language of the coding and billing world, and to give them the tools they need for successful reporting and reimbursement of their services. Ms. Woods and Ms. Horton are enthusiastic about the future of ICD-10 and are on the forefront of providing ICD-10-CM/PCS education and implementation processes.