An HIT Moment with … Jeffrey Levitt

An HIT Moment with ... is a quick interview with someone we find interesting. Jeffrey Levitt is chairman and CEO of Precyse Solutions.

What are the key issues involved in moving traditional HIM departments to paperless and EHR-based operations?

Without a doubt, physician adoption. Physicians want to focus on delivering quality care and avoid spending time adapting to a new system or altering their workflow.

There are many issues involved in the transformation to a paperless EHR environment. However, we often receive questions about how to manage the changes that people will have to go through. They must re-think their workflows, processes, and tools that have changed as a result of the investment in the EHR. Many have a hard time giving up things that they understand to embrace change and something new — knowing these new paperless systems may potentially result in job losses in a difficult employment environment.

Coupled with change management tasks are training and conversion issues required under the new systems and workflows. For example, to move to a new dictation and transcription platform or automated coding platform, transcriptionists, editors, and coders must receive additional training and education. At the same time, the basic core HIM functions and processes must continue, otherwise the revenue cycle will be disturbed and billing and collections will be delayed. An efficient and streamlined conversion strategy, reinforced with proven implementation methodologies, is required to minimize disruption while existing HIM employees are learning a new set of systems and procedures.

How can speech recognition be used to turn provider dictation into electronic documentation within the EHR?

Acquisition of data directly from clinicians remains one of the largest obstacles for EHR adoption and information sharing among facilities. This is caused in part by the difficulty of capturing data in a structured format. Many physicians are reluctant to document patient encounters in a structured format directly into EHR systems because they believe it will require more time, more hindrance to their established and desired workflow.

Recently, new technology has emerged with potential to bridge the gap between dictation and structured data entry. Solutions have moved from speech recognition to speech understanding, a more suited concept for the EHR decade, which allows physicians to continue documenting clinical information efficiently via natural language, which is analyzed and processed into a structured narrative in real time. A structured narrative fuses unstructured text; gross document structures like sections, fields, paragraphs, lists; and individual concepts, their modifiers and relationships — all of which are encoded using standard medical terminologies and nomenclatures.

Precyse is pleased to incorporate the M*Modal Speech Understanding technologies in our transcription platform. Utilizing the business logic in our workflow platform and M*Modal’s continuous learning process, speech profiles are established with a new physician’s first dictation, and drafts rapidly improve with continued use. Today, over 80% of our total physician dictations are seamlessly converted into useable drafts, significantly improving transcriptionists’ productivity and providing faster document turnaround. The benefits in accelerating the document generation improves communications between caregivers, can expedite the admissions and discharge processes, and accelerates the billing process to reduce DNFB, to say nothing of the increase in physician satisfaction and adoption.

What coding and documentation issues are currently challenging for HIM departments?

Almost every hospital we encounter has a shortage of qualified coders. Without the ability to code and process charts on a timely and accurate basis, the revenue cycle is disturbed while billing and collections are delayed. At the same time, medical coding is getting more complex because of new medical technologies coming online, changes to the rules of coding and coding specificity as required by MS-DRGs.

Other problems coders encounter are incomplete charts, or documents that do not contain appropriate detail. Because, to a physician, the primary purpose of clinical documentation is continuity of patient care, charts and records are often not prepared from the perspective required for properly coding provided services. With these complexities, the resulting lack of accurate and complete documentation presented to coders can result in the use of nonspecific and general codes. This impacts data integrity and reimbursement and presents potential compliance issues and recovery audit risk.

To mitigate these risks, coders have turned to time-consuming querying to clarify documentation. According to one of our clients, some of their facilities have seen up to 50% of charts submitted to coders result in needing a query back to the physician, further delaying the billing process.

Remedying this problem, many providers have looked to outside help. Experienced coders can be brought in on a contract basis, or even work in a remote setting to ease the burdens on in-house staff. Providers can also contract for coding auditors and educators, and clinical documentation specialists to work directly with physicians to help them understand the difference between clinical documentation and reimbursement documentation.

What tips would you offer for coding audit and compliance?

We urge our clients to invest in training for their coders, and are glad to assist them with the coding education function. We make a vast majority of our internal continuing education materials available to our clients, as well as our de-identified charts for coding practice and education. In those hospitals where we have responsibility for the coding function ourselves, we conduct regular mock audits in addition to our own efforts to identify improvement areas that need to be strengthened in our processes and training. We also build continuous improvement plans into our standard methods of operation. Finally, our Compliance, Privacy and Security Officers spend a lot of time in new colleague orientation and our internal compliance program ensures that we maintain and enhance our own focus on compliance.

How do you see the roles and responsibilities of the hospital HIM department changing over the next five years?

Because more hospitals will be purchasing and deploying more sophisticated EHR systems over the next few years under HITECH, many of the clerical functions will be reviewed and rethought around absence of the assembled paper chart and the introduction of the electronic record. In multi-hospital systems with size, scale and resources, these groups will begin to use the experiences they’ve gained from the regionalization and centralization of their business offices to do the same with their medical records and HIM departments. While there must always be some on-site HIM professionals to handle interdepartmental communications and address physician and patient requests for records, many of the professionals who had formerly been part of the more labor-intensive, paper-based environment at the site of care will find that their jobs have been physically moved to more centralized offices, or to their homes.

Likewise, some of these functions will have been re-engineered for greater efficiency and productivity. We also anticipate the creation of new HIM job categories for many of these workers as we begin to understand how to better extract data from the EHR systems to provide more automated reporting that will be required in our new environment. So, it wouldn’t be surprising to see whole new categories of HIM workers beginning to assist in the preparation of decision support tools, pay-for-performance and other quality reporting information, or aggregate patient information for other uses in the health care system.

It will be a very exciting decade for health care information technology and management, one that will resemble nothing of the past decade. We can thank advancing technologies and mastering new workflows for this anticipated transformation.