MaHIMA Connect

Official Newsletter of MaHIMA

April 2010 (archived)

In this issue:

1. Editor's Note
   
2. President's Message
   
3. 2010-11 Election Results & Call for Volunteers
4. MaHIMA Finance Report - Semiannual Review
   
5. AHIMA House of Delegates:  Environmental Scan House Team
   
6. MaHIMA is going to the Hill
   
7. Legal Briefs: Bad Records = Bad Verdict: Lessons from a Medical Malpractice Case
8. Technology Forum:  Paving the Way to Interoperability:  A Long Road from the 70's to Today
9. MaHIMA 2010 Strategic Planning
10. AHIMA's New CoP is Here! 
11. MyPHR Activities and Events
12. Heading Towards ICD-10
13. MaHIMA Winter Meeting Recap
14. Education Notes - Fisher College
15. Education Notes - Labourè College
16. Education Notes - Bristol Community College
17. Congratulations to Our Newly Credentialed
18. Remembering MaHIMA Members, Friends & Family
19. Preview:  New England State HIMA 13th Annual Conference

                              back to previous issue

Editor's Note Editor

Clare Carvel, M.Ed., RHIA, CCS

Happy spring!

This weekend, I was greeted by these crocuses in my front yard ... the first of the spring flowers. April is a wonderful time of year when we are inclined to visit our gardens, wash windows, pack away sweaters, fleece and perhaps old ways of thinking and doing things ... it's a time for GROWTH!

As we enter the age of electronic health records, ICD-10 and other changes and challenges in the profession, we need to grow our knowledge base and look at our work flows with an open mind and willingness to change how we get things done. This is a very exciting time for HIM. Federal funds have been allocated for implementation of electronic records and a viable health care infrastructure and we are on the brink of ICD-10 implementation, a coding system with big improvements and dramatic differences from the system we are accustomed to using. It is a great time to learn and be willing to try new work methods whenever possible. If you have not read "Who Moved My Cheese" by Spencer Johnson, M.D., by all means, do! It is a short read and well worth the time. Just like in the book, those who meet change with a willingness to embrace it usually gain recognition as successful workers and leaders; they're the folks who get a great deal done with available resources and few complaints. Success, especially in a profession that has a changing landscape and is in dire need of qualified people, can often be determined by your willingness to learn, grow and change.

To help you identify whether you need a crash course on current topics, take a look at some of the terms being spotlighted in the health care industry:

• ARRA
• HITECH Act
• MU
• 5010

Thanks to the many people who have authored articles and summaries, you can learn something about these and other timely topics by reading this issue of Connect!

At a recent Strategic Planning Session, Elyse DiSciullo, MaHIMA President-Elect, identified "Growing MaHIMA" as a primary goal for 2010-2011. Many excellent ideas came from that group which will require individual and collaborative effort from members to turn them into action. As we enjoy the spring season, let's learn more about issues and opportunities pertinent to our profession, put that knowledge into practice and join together to help grow MaHIMA.

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President's Spring Message

  Jackie Raymond, RHIA

 

 

Back to the Future

The number of major HIM issues hitting the national spotlight emphasize the need for educational programs in Health Information Management in Massachusetts. I have been fortunate to work with some pretty amazing health information professionals within the Massachusetts Health Information Management Association. The MaHIMA board members truly care about the future of health information professionals and work very hard to improve communications, education and legislative affairs through the new website, with fabulous program material, member advocacy and interpretation of major legislation.

Looking back on my 2008 MaHIMA President-Elect ballot statement,  I hoped to strengthen the ability to communicate with MaHIMA members, share my thoughts and ideas in managing health information, and increase networking. Forming the MaHIMA Director/Manager HIM Forum (currently at 77 members) succeeded in strengthening communication through networking, knowledge exchange and comparing best practices. We meet quarterly and alternate sites and topics for discussion. The more we can get to know other MaHIMA members and exchange information and compliance strategies, we all benefit. Our next meeting topic is electronic health records (EHR's). We begin with some AHIMA resources (briefings, white papers), share entity policies/practices, and bounce new ideas off each other. For example, how will each entity comply with the newest HITECH rule effective February 17, 2010 and provide electronic copies of medical records to a patient upon request? I look forward to additional MaHIMA members joining the Director/Manager HIM Forum and will continue to organize future meetings and topics.

Thanks to everyone who supported me and showed me the way within MaHIMA. It was a very rewarding and educational experience both personally and professionally. I encourage you all to take the leap and volunteer for the Massachusetts Health Information Management Association. You know much more than you think you do and have much to offer.

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2010-11 Election Results
 & Call for Volunteers

Elyse DiSciullo, RHIA, President-Elect

2010-11 Election Results

I am pleased to announce the results of the MaHIMA 2010 Campaign for President-elect and Director of Communications. We had an excellent group of candidates interested in representing MaHIMA and offering their expertise in a variety of areas. Nineteen percent of MaHIMA eligible voters cast their vote during the campaign period. The results are as follows:

President-elect: 
Mary Radley, RHIA

Director of Communications:
Jeanne Fernandes, RHIA

Our new officers will be sworn in at the MaHIMA Annual Business Meeting on May 3, 2010 at the Radisson Hotel, Manchester, NH.
Thank you for taking the time to cast your vote. If you are interested in joining a MaHIMA Committee and/or assisting our newly elected officers please read on.

Call for Volunteers for 2010-11

Getting involved in your professional organization provides benefits to you and your profession . . . . what an exciting time for our expertise!  Let's grow the organization together.

For you:                                                         For the profession:

Recognition as a leader who has commitment to the profession	Advancing changes in rules, standards, and regulation
Networking with peers in the profession	Guiding valuable products and services for member continuing  education
Join a committee which interests you	New ideas
Possible speaking opportunities	Enhancing public awareness and image of the field
Participate in an educational meeting through introducing a speaker  or assisting with registration	More member involvement Opportunity to meet speakers and network
Writing an article for MaHIMA Connect for name recognition and to   showcase your accomplishments	Learning how others influence the profession
Innovative ideas to utilize in the work setting	Recruiting new professionals
Access to bright, imaginative people who will keep enthusiasm high	Image building for the profession
Opportunities to enhance technology skills	Understanding new technologies
Making a difference	Spreading the word

MaHIMA needs you and your skills to help make it a better organization for all of us. I encourage you to review the  list of committees and contact the chairs listed. Remember this is YOUR organization!  Follow the link below to our website and sign up now!!!!!  Thank you for your support of the association!

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MaHIMA Finance Report - Semiannual Review
(July-December 2009)

Linda Hyde, Chair, Finance Committee

The FY 2010 budget was presented at the Fall Meeting with projected income and expenses of $104,854.  As of the end of December, MaHIMA has $84,680 in assets with 81% ($68,616) in the Merrill Lynch account for reserves.  This represents approximately 9 months of expenses which is in keeping with AHIMA recommendations.

MaHIMA's first six months of financial data shows an income of $41,672 and expenses of $52,525.  14% of our income was from AHIMA rebates but this is much lower than what we normally see by the end of December which accounts for the income being $10,000 less than expenses.  Due to a changeover to a new membership database, AHIMA was delayed in sending out rebate checks.  We will see the additional income reflected in our third quarter reports.  57% of our remaining income came from the four educational programs for this period.  All of this programs-generated revenue is on target with our budget, with the exception of the Fall Meeting.  Revenue was lower than budgeted due to decreased attendance but this was offset by vendor sponsorships.  22% of the income in this period was from our portion of the profit share from the New England HIMA Annual Conference.  Expenses are primarily for the educational programs, AHIMA Summer Leadership/Team Talks, and delegate expenses for attending the AHIMA House of Delegates.  Administrative Director fees and office expenses are in line with the budgeted amounts for the first six months of the year.

The Finance Committee will be performing a semi-annual review of actual to budget figures to determine if any re-forecasting for the remaining six months of the year is needed.

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AHIMA House of Delegates Environmental Scan House Team

Karen Griffin, Director, Legislative Affairs & Advocacy

Engaging in the CSA Environmental Scan - You can make a difference ....

AHIMA collaborates with the Environmental Scan House Team to conduct annual environmental scans with each Component State Associations (CSA) along with the House of Delegates (HOD) to identify and prioritize trends in the industry that will assist AHIMA and CSA's with future strategic planning. Such issues impacting these trends may include the day-to-day operations of the health information management (HIM) profession, workforce challenges, EHR developments, ICD-10, reimbursement changes, new HITECH regulations...to name just a few. The initial environmental scanning process was originally implemented in 2005 and was intended to be a means of collecting pertinent information across all CSA's. Today this responsibility resides with the Environmental Scan House Team, of which I am a member. The Environmental Scan House Team is charged with providing input with the preparation of the survey, processing the results, and communicating the findings to the various stakeholders, including the HOD Teams, AHIMA Board of Directors, CSA leaders, and AHIMA staff.

I am pleased to inform you that Massachusetts will be reaching out to the entire membership for your collective insight and feedback via an electronic survey. This is our opportunity as members to influence the direction of AHIMA, as well as our CSA, with the planning, development, and budgeting strategies moving forward. This process will help to better position the profession both locally and nationally.

Did you know that from the inception of the environmental scanning process in 2005, the participation level has increased greater than 50%, with 2009 reflecting 98% of CSA participation? This is encouraging for the Association and highlights the importance of member feedback.

So exactly how will this work? You can expect to receive an electronic survey in April 2010 from the MaHIMA Communications Committee. I would ask that you take a moment to review the contents of the survey and then complete it in a timely fashion. The survey will include six (6) short sections; Customer, Economic, Technological, Social, Political and Geographical Environments; and you will be asked to prioritize your selections. CSA's will be responsible for collecting the results, submitting the findings to AHIMA, and then the Environmental Scan House Team will review the results and share the information with various stakeholders.

Next step? Watch for the upcoming electronic survey from MaHIMA and please make time to respond so that your valued input is part of the future strategic planning of the HIM profession.

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MaHIMA is Going to the Hill

 Karen Griffin, Director, Legislative Affairs & Advocacy

Mark your calendar for our upcoming Beacon Hill Day at the State House in Boston on Thursday, May 20, 2010.  The month of May is a beautiful time of year to visit historical Boston and our annual Beacon Hill Day is a wonderful opportunity to network with fellow HIM professions, learn about important legislative issues, and participate in group visits to legislative offices. 

The topics for this year's event include an update on Health Care Reform, an update on the Massachusetts Registry of Vital Records & Statistics Bill, and how to research, sponsor and write a bill.  Registration information will be available by April 6th and posted to our Calendar page.

Hope you can join us for Hill Day to learn more about how you can influence the legislative decision-making process in Massachusetts, and earn CEU's at the same time.

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Legal Briefs:  Bad Records = Bad Verdict: 
Lessons from a Medical Malpractice Case

Colin J. Zick, Esq., Folley Hoag LLP

 

According to Massachusetts Lawyers Weekly¹, the largest medical malpractice verdict in Massachusetts in 2009 was a $15 million award against Children's Hospital. While the facts of that case are interesting, and I will discuss them below in greater detail, the verdict is particularly noteworthy because it reflects on health information and record keeping practices. In particular, the lawyer for the plaintiff described his strategy as follows: "I did not try this as a malpractice case. I tried this as an obstruction of justice case, that was the only way." The obstruction in his words was that the hospital "screwed with major parts of the record especially the ICU note."

Jason Fox was born in Pennsylvania with a heart defect and underwent many surgeries in his home state before doctors there referred him to Children's Hospital in Boston. Jason's father said his son was a playful little boy before the surgery in Boston, but that things went very wrong at Children's during the cardiac catheterization, and later in the intensive care unit. Jason was discharged three weeks after the surgery with what his father describes as massive, permanent brain injuries. Jason died in 2004 because, according to his family's lawyers, physicians at Children's Hospital had damaged his brain during his surgical procedure and hastened his death by injecting him with too much contrast media and giving him too much anesthesia.

Despite this tragic outcome resulting in Jason's death, four different Boston law firms refused to take the case. Jason's father finally sought out his cousin, a lawyer in California, to take the case. That cousin, James E. Fox, devised a unique but not an unheard of strategy: he focused on several instances in which Jason's medical records appeared inconsistent or appeared to have been edited after the fact. This same strategy was used several years ago, in Keene v. Brigham and Women's Hospital, a case which went all the way to the Massachusetts Supreme Judicial Court. In Keene, a Superior Court Judge had tried to impose liability by default and waive the hospital's charitable immunity because of the missing records. The Supreme Judicial Court overturned that decision on appeal, however.

So what does the case of Jason Fox mean for health information management professionals? It should remind us that, more than ever, it is important to focus on the quality and integrity of the patient record. More than ever, your audit trails will come under review and therefore it is important for providers and other users of medical record to be educated about how amendments can be made, and how they should be made to prevent incorrect impressions from being drawn later on².

____________________________________
¹www.masslawyersweekly.com/pdfs/LargestVS_2009.pdf  (Jaunary 18, 2010)

²Fox, et al. v. Boston Scientific Corporation, Children's Hospital and Mallinkordt, Suffolk Superior Court (Nov. 2009).

 

Colin J. Zick is a member of Foley Hoag LLP's Health Care and Litigation practice groups. He advises clients on a variety of matters, including HIPAA, patient confidentiality, patient care, fraud and abuse, OIG advisory opinions, compliance programs, reimbursement, and other health care related issues.  Atty. Zick has served as a Committee Chair on the Boston Bar Association HIPAA Task Force, has participated in a variety of health care educational programs and is an advisor and frequent speaker for MaHIMA.  Atty. Zick invites you to visit the Foley Hoag LLP's website blog, "Privacy, Security and the Law" at http://www.securityprivacyandthelaw.com/ for timely and informative discussion on cases impacting the HIM Profession and health care in general. 

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Technology Forum:  Paving the Way to Interoperability:  A Long Road from the '70s to Today

 Pat Rioux, RHIA, eClinicalWorks

Jerry Sierra, a nurse with over 10 years of healthcare IT experience, reported his frustration to HISTalk about transferring medical records for a 2009 move from Wisconsin to Ohio. A self-described cynic, he expected a negative experience from the outset but it is worse than you might expect.

He filled out a request for his son's electronic medical record to be sent from a Wisconsin hospital to the new pediatrician in Ohio and waited a few weeks before he called to schedule an appointment. They had no idea what he was talking about so they sent him a new form which he got in the mail a few weeks later. He filled out the Ohio form and sent it along to the Wisconsin hospital HIM department. A few weeks later, the hospital sent a letter stating that they needed the request completed on their own form. So he copied the information onto the hospital form and sent it off. He checked a few weeks later and was told that it was mailed to the Ohio medical practice.

When he brought his son for the appointment at the new pediatrician's office in Ohio, he brought along his tattered copy of the EMR report ‘just in case'. You guessed it! No records had been received so the office had to scan the tattered copy and put it into the new EMR for his son.

What is so bad about this story of delays and frustration is that the Wisconsin hospital and Ohio pediatrician office use the same exact vendor's EMR! As Sierra said in his posting...."there you have it - a shining example of real-world interoperability!"

So, what is different in 2010? At the recent HIMSS Conference in Atlanta, Dr. John Halamka, chair of the Health IT Standards Panel, known as ‘HITSP', summarized the history and progress of health IT standards, noting that it has been a ‘long road.' He knows that we will pave the way to interoperability and change the outcome of stories such as Jerry Sierra's to one of efficient and immediate transfer of electronic medical records.

Halamka, who also serves as co-chair of the government's Health IT Standards Committee and CIO of Harvard Medical School, has worked on promoting standards for the last five years and thinks that they should be harmonized and commissioned, based on clearly articulated priorities. He notes that from 1970 until the mid-90s, we were in the ‘formation' phase and from 1996 to 2009, we experienced the ‘coordination' phase.

From now to 2015, he predicts that we will experience:

• The end of the comment period on health IT standards
• New request for proposals, such as the creation of a new harmonization organization
• A new framework for harmonization, conformance testing, specifications writing and tools, and
• The evaluation of the Nationwide Health Information Network, NHIN.

Reaching the goals will involve a lot of work by the major players:

• Federal and state government participants such as the Health IT Standards Committee with its broad range of stakeholders (providers, consumers, vendors, health plans, federal agencies, etc.
• Health Information Exchanges (HIE) and Regional Health Information Organizations (RHIOs)
• Certification Commission on Healthcare Information Technology (CCHIT)
• CCR/CCD (Continuity of Care) developers including the American Association of Family Practitioners along with other physician organizations, such as AMA, ACOG, AOA, ACOFP, MGMA, etc.
• HL7 (Health Level 7) standards protocol backed by ANSI with templates, standard vocabulary, etc.

Citations:
Ackerman, Kate. "HIMSS '10: Big Story Is EHR Certification Plan." iHealthBeat, (March 03, 2010)
http://histalk2.com/2010/01/04/readers-write-10510/
http://www.ihealthbeat.org/features/2010/himss-10-ehr-certification-announcement-highlight-of-day-two.aspx

 

Pat Rioux, RHIA, is employed by Westboro-based eClinicalWorks, a market leader in ambulatory electronic medical record solutions.  Their CCHIT-certified EMR and practice management system is in use by more than 30,000 providers in all 50 states.  Its Patient Portal allows patients and doctors to communicate easily, safely and securely over the Internet, and eClinicalWorks Electronic Health eXchange (eEHX) is the fabric behind clinical integration systems becoming community-wide projects. 

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MaHIMA 2010 Strategic Planning

Susan Marre, RHIA, Past-President & Chair, Planning Committee and Susan Pepple, Director, Communications

Elyse DiSciullo, MaHIMA President-elect, has identified "Growing MaHIMA" as her primary goal for the 2010-2011 association year. During a strategic planning session on Friday, March 12, twenty current and future MaHIMA leaders assembled to discuss what is meant by growth and how we would achieve it.

Through a facilitated discussion, we defined growth as increased membership, increased volunteerism and leadership, increased use and application of technology, and increased awareness. This article will briefly present the highlights of our plans for each of these areas.

Membership: Encourage individuals to join the association

1. Existing members to personally invite peers to join and participate in MaHIMA
2. Outreach to area HIT schools and programs
3. HIM professionals within vendors and service providers

Volunteerism and Leadership: Encourage MaHIMA members to volunteer for committees and other activities and to seek leadership roles in the association

1. Mentor potential volunteers/leaders
2. Approach potential volunteers/leaders with small, focused opportunities to participate
3. Potential volunteers/leaders include:

A. Non-traditional MaHIMA members, e.g., students, entry level HIM professionals, and retirees
B. Related professionals, e.g. IT, patient accounts, quality, legal, etc.
C. HIM professionals working in alternative health care settings, e.g. doctor's offices, SNFs, LTACs, insurance, vendor and service providers, etc.

Technology: Increase our use of technology to benefit our members

1. Use webinars and webconferencing to deliver targeted and specific education content at a lower cost to a greater number of people.
2. Create and host social media and teleconferencing to link people with people, and people with resources.

Awareness: Develop an overall plan and strategy for increasing awareness of MaHIMA and our activities

1. Investigate working with an outside firm that specializes in marketing for non-profit associations
2. Create a multi-year marketing team within MaHIMA
3. Targets for awareness building include:

A. Political or governmental bodies and agencies
B. Within our facilities or employers
C. Allied Associations
D. Press/Public

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AHIMA's New CoP is Here!

Gail Wood, RHIA, Massachusetts CoP Facilitator

 

Have you logged in yet?

Here is a link to the new users guide to help you get started:  http://www.ahima.org/pdf_files/UserGuide022510.pdf

Why the change? Simply, the technology of the original CoP was old and just could not continue to be used. It was also an opportunity to introduce new functionality more compatible with other networking sites.

Though it looks different, many parts of the Cop are still there including:

• e-mail
• discussion threads (now called comments)
• links
• resources
• member search
• content search (enhanced)
• community search and join
• chat
• profile - enhanced
• document collaboration
• notifications (they need to be reset and are not currently working)

New Features:

• What's New - top 100 items new in all your communities
• What's Popular - top 100 most popular items in all public communities
• rating ranking bookmarking
• workspace (Wiki)
• topic concept - all content together in one area
• my contributions
• sharing contributions & bookmarks
• topic wizard for adding content - automatically approved
• RSS feeds

Remember, the CoP is still a work in progress. Additional enhancements to come include:

The ability to cross-post topics to different communities
Chat
Polls

So log in, see what it's all about and become a member of the CoP Feedback Community to get help and make comments.

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MyPHR Activities and Events

Marianne Garfi, RHIA, CCS-P, MyPHR Community Advocate

 

We started 2010 with two successful MyPHR events!

The first event involved training, with four people participating in the MyPHR "Train the Presenter" module. The attendees are now prepared to take the MyPHR presentation on the road.  Please share my public CONGRATULATIONS announcement to:

• Oby Egbunike
• Denise Haddad
• Kevin Nelson

For the second event, Sue Marre, RHIA gave the MyPHR presentation to the HIT program students at Bristol Community College in Fall River.
It was a great opportunity for the 24 students to participate in the MyPHR presentation, and to share the information they received as patients and future HIM professionals.

And a reminder....there are many Massachusetts presenters in this campaign, and we want to give this Show!

Please suggest the topic for your peer groups, volunteer organizations and support network.  Everyone needs a Personal Health Record, and our show gives you the tools to make that happen!

To coordinate a date, please contact Marianne Garfi, RHIA, CCS-P at Garfi.marianne@dol.gov. We look forward to our next Show!

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Heading Towards ICD-10

Linda Hyde, RHIA

 

As the deadline for implementing ICD-10-CM/PCS grows closer, MaHIMA is adding a regular feature column to our newsletter to give readers highlights of what is happening, resources that can help with planning, and implementation recommendations.

The AHIMA web site and CoP are the best resources currently available for information on ICD-10. The ICD-10 web page http://www.ahima.org/icd10/index.html contains the latest information on ICD-10 training and planning seminars. You can also sign up for a free monthly electronic ICD-10 Newsletter containing articles on coding tips, training strategies, FAQs and much more. From the ICD-10 web page you can select ‘Preparing for ICD-10' where you can access additional resources including a ‘Role-Based Model for ICD-10 Implementation'. Organized by type of organization and then by major job function, this guide is organized by year and contains To Do items outlining the major tasks you should be doing in that year and then what corresponding resources are available to help you with those tasks. This guide can serve as an excellent checklist for all of the preparation, both organizational and personal, that will be needed to ensure a successful implementation of ICD-10. For example, data managers in 2010 should be learning the fundamentals of ICD-10-CM/PCS, mappings between ICD-9-CM and ICD-10-CM/PCS and starting a dialog with their IT staff and vendors for early planning. These role based guides are currently available for Healthcare Provider Organizations, Academic Institutions and Health Plans.

MaHIMA has started its preparations for ICD-10 with the recently released ICD-10-CM/PCS e-Survey results and our ICD-10 Summit held on March 31st. In addition, AHIMA is holding its "AHIMA Academy for ICD-10: Building Expert Trainers in Diagnosis and Procedure Coding" in Boston from June 17 to 19, 2010. Look for a recap of what was learned from the ICD-10 Summit in the July issue of Connect, along with our next steps in offering support and services to members as we head towards October, 2013.

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MaHIMA Winter Meeting Recap

The Winter Meeting was held on January 29, 2010 at the Marlboro Holiday Inn.  For those unable to attend, below are summaries of selected presentations.  Special thanks to the presenters for sharing their summary in this issue of Connect.

Thanks also to Denise Duhamel, RHIA for her photography at the Winter Meeting.  Click here to view pictures from the session.

Speaker Summaries:

Evaluating Quality Using EHR's - Plans, Progress and Next Steps
Planning for ICD-10/PCS:  Practical Considerations for Transition
Panel Discussion:  Best Practices in Clinical Documentation Improvement

Evaluating Quality Using EHR's - Plans, Progress and Next Steps

Linda A. Hyde RHIA

This presentation focused on how Electronic Health Records (EHR's) can be used to capture and report data for quality measurement and performance improvement. The last several years have seen an increase in the number and types of quality measures that are required for public reporting and/or payment for healthcare facilities as well as physicians. These measures currently rely on the use of billing data and/or manual abstraction for data collection. The HITECH (Health Information Technology for Economic and Clinical Health) act under ARRA (American Recovery and Reinvestment Act) contains provisions for healthcare providers to receive incentive payments to accelerate the adoption of electronic health records (EHRs). These incentive payments are based on providers being able to demonstrate that their EHR meets specific criteria, referred to as ‘meaningful use', indicating that they are using the EHR as part of their patient care processes.

CMS issued their proposed rule on January 13, 2010 defining their Meaningful Use criteria and the process by which healthcare providers can request incentive payments. One aspect of the Meaningful Use proposed rule covers the use of EHR's to collect and report clinical quality measures. CMS listed a number of proposed measures for both eligible professionals and eligible hospitals to be selected for demonstrating Meaningful Use and have request feedback on the number and types of measures to be included in each of the stages of EHR implementation. One have major concern with the initial list of proposed measures is the limited number, especially for eligible professionals that have already undergone any review and re-tooling for total electronic data capture.

Responses to the proposed rule are due by March 13. Over the next several months it will be important to understand the capabilities that will be needed by EHR's to collect and report on quality measure data and be prepared to determine your organizations readiness for meeting the meaningful use criteria.

Note: for more information, use this link to the AHIMA ARRA web page, where you will find up-to-date information about ARRA, HITECH and the proposed "meaningful use" rule, along with AHIMA responses.
http://www.ahima.org/arra/

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Planning for ICD-10/PCS: Practical Considerations for Transition

Luisa DiIeso, RHIA, CCS

The following project management categories associated with the transition from ICD-9-CM to ICD-10/PCS were presented:

Training Assessments:

• Collective staff assessments are required in order to formulate group training plans and schedules.
• Casemix distribution and the composition of the current coding staff (inpatient vs. outpatient) should be carefully considered to ensure adequate staffing, recruitment, and retention plans prior to and during transition.
• Current coding flow process and procedures should be assessed for efficiency and streamlined as needed.
• Coders need to individually assess their interest, commitment, and current skill sets. Strengthening of key foundations such as code classification/ structure and Anatomy and Physiology are required to promote a smooth transition to I-10/PCS.
• AHIMA recommendations for training are projected: 16 Hours for I-10-CM; 24 Hours I-10-PCS; 10 Hours Practice Application: Total of 50 hours per AHIMA - 1/10/10.

Practice Considerations/Highlights of Categories of Changes:

• Injuries, Poisonings, Other: 7th Character extensions exist for some specific data elements such as Gustilo classification for certain open fractures, Glasgow coma scale code assignments - point of component recording, encounter episode extensions for injuries, poisonings, other (A= initial, D=subsequent, S=sequelae). Underdosing of medications is reported in ICD-10 in addition to poisonings, adverse effects.
  Practice Considerations: Forms Re-Design: ED, Cast Room, Orthopedic Clinics; Service Specific Communication and Data Requirements: Orthopedic, ED, Radiology Services.
• Pregnancy, OB, Postpartum: Time Frame Changes for Abortions/Fetal Deaths from 22 to 20 weeks; Early/Late Vomiting in Pregnancy from 22 to 20 weeks. Episode of care has been eliminated in ICD-10 and replaced by trimester at the time of encounter: 1st, 2nd, or 3rd. Seventh (7th ) character extensions exist to specifically identify the fetus affected by a specific condition (i.e., malpresentation.)
  Practice Considerations: Prenatal forms revision and OB service documentation updates as well as comparative data analysis and reporting variations.

ICD-10-PCS/Overview:

• Seven Character Alphanumeric Code Structure Example: 0BNN0ZZ Note: Letters O, I are not used.
• For the example above (0BNN0ZZ) Character 1 = Section; Character 2=Body System; Character 3=Root Operation ; Character 4 = Body Part; Character 5 = Approach; Character 6=Device; Character 7=Qualifier 
• Root Operations: There are a total of 31 Root Operations that have specific definitions, some of which are very different than the current ICD-9-CM definitions.
  Practice Considerations: Casemix cross-section of practice applications in order to reinforce exposure and memorization of root operations and ease transition to I-10-PCS.

Resources:
www.ahima.org
www.cms.hhs.gov/ICD10/

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Panel Discussion:  Best Practices in Clinical Documentation Improvement

Susan Raviv, RHIA, Session Moderator

At the MaHIMA Winter Meeting on January 29, 2010, a Panel Discussion on Best Practices in Clinical Documentation Improvement (CDI) was presented as the afternoon General Session. Susan Raviv, MBA, RHIA, Director of HIM at the North Shore Medical Center, was the Panel Coordinator and introduced the topic of CDI as the leading the way to assist hospitals in obtaining more accurate and complete documentation at the time of admission and during the patient's stay. Susan further explained that the role of a Clinical Documentation Specialist (CDS) is to review the patient chart for specific documentation and seek clarification when documentation is absent or ambiguous. A CDI program facilitates communication among the Medical Staff, Clinical Documentation Specialists, DRG validators, and coders to provide documentation that accurately reflects severity of illness (SOI) and risk of mortality (ROM).

Four Clinical Documentation Specialists from different hospitals presented their experience and expanded on various processes used for at their respective facilities.

Kristine O'Day, MBA, BSN, RN, is the Clinical Documentation Specialist at the North Shore Medical Center. Kristine explained how their CDI program brings value to the hospital as seen through improvements in the hospital profile, physician profile and casemix index. As one of the Clinical Documentation Specialists, she utilizes her clinical nursing knowledge, along with expertise in MS-DRGs, MCCs and CCs, as she reviews documentation of Medicare and Blue Cross cases.

Adrienne Gmeiner, RN, CCS, Clinical Documentation Specialist at Lawrence General Hospital, noted that after reviewing patient documentation, she notes when clarification or additional information is needed on paper forms, by e-mail, or verbally. Once received, the physician documents his/her response directly into the medical record. Data is tracked for the number of reviews, date and type of query, physician queried, physician response, working DRG, query DRG, coded DRG and final billed DRG. Collaboration at Lawrence General occurs through ongoing communication, newsletters, Hospitalists' and Residents' orientation, and Nursing education.

At Emerson Hospital, Patricia Spry, RN, Clinical Documentation Specialist, is pleased with ongoing success of the CDI program, attributing much of it to support from the Chief Medical Officer (CMO) and physician champion. The CDS, CMO and MD Advisor meet weekly to discuss issues with the Medical Staff, including outstanding/unanswered queries, and to provide clinical support for developing educational material. The CDI program was responsible for a 3 million dollar gain in revenues within the first year of operation. The casemix rose from 1.19 in October 2007 to 1.44 in October 2008.

Kelley Sears, RN, Clinical Documentation Specialist at Caritas Christi Good Samaritan Medical Center told how in November 2007, a CDI Program was initiated at all six hospitals in the Caritas Christi system. A tracking tool called CDI Monitor generates physician profiles, volume of queries, MD response rate and financial impact of each physician. Strong support from senior leadership for improvement of physician responses exists. The VP champion at each facility acts as problem solver and facilitator. There is a strong working relationship between CDS and the Coding Department.

In summary, collaboration is required among the Clinical Documentation Specialist(s), physicians, Medical Staff leadership and DRG Validators and coders to make a Clinical Documentation Improvement Program successful. Software and other resources are available to support the program, different hospitals have varying methods but all have a common groundwork for the process. Clinical Documentation Specialists are key to effective implementation of a CDI Program, and a successful program can lead to a substantial positive impact on hospital reimbursement.

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Education Notes: Fisher College 
HIM Education Accreditation

 

Patricia Parkes, RHIA, Program Director, HIT & Medical Coding

 

 

 

You are all well-versed with healthcare accreditation - Joint Commission, CARF, AOA, ACS, AAAHC, to name a few. However, many prospective students (and even some HIM professionals) are not fully aware of the HIM education accreditation standards.

CAHIIM (Commission on Accreditation for Healthcare Informatics and Information Management Education) is an independent accrediting organization whose mission is to serve the public interest by establishing and enforcing quality Accreditation Standards for Health Informatics (HI) and Health Information Management (HIM) educational programs (www.cahiim.org). Many schools will state that they follow AHIMA standards or that they are AHIMA approved or accredited. They may follow AHIMA standards, but AHIMA does not approve HIT and HIM programs. It is CAHIIM that accredits these programs. It is always best to instruct prospective students to check the Program Directory on the CAHIIM website to be certain if a college is CAHIIM accredited or in candidacy status.

Due to the mandated development and implementation of the electronic health record, it is estimated that we will need an additional 51,000 qualified health I.T. workers in the U.S. over the next five years. The American Recovery and Reinvestment Act (ARRA) funding has given many higher education institutions and trade schools the means to develop Health Information Technology and Health Information Management programs. In order for graduates of these programs to be eligible to take the RHIT and RHIA certification exams, the program that they graduate from must be CAHIIM accredited.

You can reach Patricia Parkes at pparkes@fisher.edu or by calling 508-699-6200.  Website:  www.fisher.edu

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Education Notes: Labourè College

Nancy A. Entwistle, MPA, RHIT, CCS, ACE, Chairperson & Assistant Professor, Coding & HIT

We are working on preparations for ICD-10 training ... watch for more information to come!

You can reach Nancy Entwistle at Nancy_Entwistle@laboure.edu or by calling 617-296-8300 ext 4063.   Website:  www.laboure.edu

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Education Notes: Bristol Community College
                    New Interim Director Announced

 

Joy Rose, MSA, RHIA, CCS, Interim Director, HIT & Medical Coding Certificate Program

 

 

 

 

Greetings from Bristol Community College Health Information Technology Program

Bristol Community College (BCC) is pleased to announce the appointment of an Interim Program Director, Joy P. Rose, MSA, RHIA, CCS, to the Health Information Technology Program.

The spring semester is the final semester for many of our HIT students as well as our coding certificate students. The graduating HIT seniors are looking forward to their final Professional Practice Experience (PPE) at sites throughout Southcoast Massachusetts and Rhode Island.

BCC thanks MaHIMA and all hospital and practice sites for supporting the Health Information Technology A.S. and Medical Coding Certificate Programs.

BCC will continue to provide the most current courses to support the rapid changes in our industry, allowing our students to be on the cutting edge for employment. Please feel free to contact me at any time joy.rose@bristolcc.edu or (508) 678-2811 ext 2329.  Website:  www.bristolcc.edu

Next month we will have some more information. Thank you!!

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Congratulations to our Newly Credentialed

The following MaHIMA members earned an AHIMA credential in the first quarter of 2010:

Jeanne Fernandes, RHIA
Gerard Pugsley, CCA
Philip Tentindo, RHIT

MaHIMA grants Certification Scholarships to any member of MaHIMA who has taken and passed one of the AHIMA sponsored certification programs.Information on the MaHIMA Certification Scholarship is available at www.mahima.org/member_certification_scholarship/. 

The following newly credentialed members have been awarded a Certification Scholarship from MaHIMA this past quarter:
Margaret Kornegay, CCA
Christopher Rushbrooke, CCS
Kelly Sousa, CCA

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Remembering MaHIMA Members, Friends & Family

Our condolences to the following:

• Family of member Mary Lemoine, RHIT, who passed away in January.  Mary was the Director of Medical Records at McLean's Hospital in Belmont.
  
  
• Judy Simansky, RHIA on the passing of her mother, Ethel Simansky, in March.  Judy is the Director of Health Information Management at Lowell General Hospital. Contributions may be made in Ethel's memory to the Solomon Schechter Day School of Greater Boston, Hebrew Senior Life or the Beth Israel Deaconess Medical Center.
  
  
• Paul Arvantides, RHIA, President of Medical Coding Services, Inc. (MCS) (Corporate Partner of MaHIMA), on the passing of his mother, Pat Arvantides, founder of MCS.  For those wishing to honor her memory, please make a contribution in her name to the Susan G. Komen Foundation.
  

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Preview: New England HIMA 13th Annual Conference

There is still plenty of time to register for our upcoming annual conference. This year's meeting takes place on May 2-4 at the Radisson Hotel in Manchester, NH and features 3 days of educational sessions and a 2 day trade show. Up to 18 ceu's are available to HIM professionals on topics such as ICD-10, HITECH, Joint Commission Update, Management Development, AHIMA Update with outgoing CEO Linda Kloss & Incoming CEO Alan Dowling, Coding Clinic Forum, OASIS Data Collection, Critical Access Hospital topics, Transcription Benchmarking, and Technology topics. 

Keep abreast of the HITECH legislation with our update from the Washington Office of HIT Adoption.

Seeking a coding credential?  We have a one or two day prep session for a CCS Exam candidate, and a one day option for a CCS-P Exam candidate.

Need some Project Management skills?  A full day program is being offered on Sunday, May 2, or you can sit in on an introductory session on Monday afternoon.

Need to fire up your life and/or your speaking?  Our keynote, Donna Hartley, through her story telling, will share strategies to enrich your attitude, enhance customer service, improve communication, and welcome change.  This is a must see!

Looking for New Technology to assist in your HIM practice?  Our Tuesday morning Technology Breakfast sessions have lots to offer and our Exhibitors are generously supporting us in our two-day trade show in the Radisson Hotel Armory.

Register through April 23rd HERE.

Details:

6 New England State HIMA Annual Convention
Sun-Tues, May 2-4, 2010
Radisson Hotel - The Center of New Hampshire, Manchester, NH
Click here for a full agenda and registration.

Check our Education Calendar at www.mahima.org for registration and up to date information on all our events.

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Connect Editor in Chief

Clare Carvel , MEd, RHIA, CCS
clarecarvel@comcast.net

Connect Staff Editor

Sherry Palo, RHIA, CCS
palo@tiac.net

Connect Technical Editor

Karen O'Donnell, RHIA
karen@mahima.org

Photographer

dduha987@comcast.net

 

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