the continuing relevance of medical transcription in health …...2011/05/17 · the continuing...

The Continuing Relevance of MedicalTranscription in Health Care

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Lynn [email protected]

Management for the Modern MTSOhttp://mmodal2.wordpress.com

Excellence in Health Informationhttp://community.advanceweb.com

/blogs/hi_18/default.aspx

Company Confidential

[email protected]




Agenda The state of medical transcription and speech

recognition today The new best practices for adoption and use Measuring success - Using the right metrics at the right time for

the right purpose A comparison of a 2006 AHIMA presentation given by this

speaker with what her message is today.

Dictation as the Key to Adoption and Acceleration Narrative documentation in an electronic world.


The state of medical transcription and speechrecognition today The new best practices for adoption and use Measuring success - Using the right metrics at the right time for

the right purpose A comparison of a 2006 AHIMA presentation given by this

speaker with what her message is today.

Dictation as the Key to Adoption and Acceleration Narrative documentation in an electronic world.

Lynn Kosegi

Relevance in Today’s HIM WorldMedical transcription1. Is part of HIM2. Supports Meaningful Use, ICD-10

conversion, NLP and CAC3. Must provide documentation that is

valuable and useful; not cheap4. Must focus on quality of content5. Can support options and flexibility6. Can be cost-effective without sacrificing

MT payCompany Confidential

Medical transcription1. Is part of HIM2. Supports Meaningful Use, ICD-10

conversion, NLP and CAC3. Must provide documentation that is

valuable and useful; not cheap4. Must focus on quality of content5. Can support options and flexibility6. Can be cost-effective without sacrificing

MT pay4

What I’ve Learned…2006… Carefully Select

physicians Carefully Select MTs Low to mid producers No high producers

“As Dictated” Physicians must

change habits

Now… Bring ‘em on – let the

technology select thephysician All MTs – Editing IS

transcription Requirements per

meaningfuldocumentation


2006… Carefully Select

physicians Carefully Select MTs Low to mid producers No high producers

“As Dictated” Physicians must

change habits

Now… Bring ‘em on – let the

technology select thephysician All MTs – Editing IS

transcription Requirements per

meaningfuldocumentation

Transcription is part of HIM…

6

Opposing needs

Enterprise need for structured andencoded data Physician’s need for a fast and easy way

to capture information Care givers’ need for context,

communication, and collaboration


Enterprise need for structured andencoded data Physician’s need for a fast and easy way

to capture information Care givers’ need for context,

communication, and collaboration

Lynn Kosegi

Company ConfidentialLynn Kosegi8

Transcription and the HIMRe-connect with your HIM roots! What are the documents used for? Are they used for coding? If not, why? What works? What’s missing? “What can I do to make this document

more useful?”


Re-connect with your HIM roots! What are the documents used for? Are they used for coding? If not, why? What works? What’s missing? “What can I do to make this document

more useful?”

9

ICD-10

More specificity Extensive training Decreased productivity – 50% Learning curve Hybrid phase

Loss of “super bills” Loss of staff – attrition


More specificity Extensive training Decreased productivity – 50% Learning curve Hybrid phase

Loss of “super bills” Loss of staff – attrition

Speaker Name

GEMsGeneral Equivalence Mappings No direct mappings From SNOMED to ICD-9 Many to one relationship

ICD-9 to SNOMED – Not semantically equal; One to many

From SNOMED to ICD-10 More granular but still not one-to-one

Specificity requirements


General Equivalence Mappings No direct mappings From SNOMED to ICD-9 Many to one relationship

ICD-9 to SNOMED – Not semantically equal; One to many

From SNOMED to ICD-10 More granular but still not one-to-one

Specificity requirements

Lynn Kosegi

Company Confidential12

AHIMA. "Putting the ICD-10-CM/PCS GEMs into Practice." Journal ofAHIMA 81, no.3 (March 2010): 46-52.

Retain the Narrative

Availability of context and concepts Application of rules for coding Retain use of encoders Retain and improve familiar workflow Increase ease of use Decrease learning curve Increase adoption


Availability of context and concepts Application of rules for coding Retain use of encoders Retain and improve familiar workflow Increase ease of use Decrease learning curve Increase adoption

Lynn Kosegi

Increased information demands

14

Industry Stressors

Increased demand for information ICD-10 Meaningful Use Core measures, PQRS

More difficult methods of informationcapture Direct data entry Front-end speech recognition


Increased demand for information ICD-10 Meaningful Use Core measures, PQRS

More difficult methods of informationcapture Direct data entry Front-end speech recognition

Lynn Kosegi

Information Demands

ICD-10: Specificity ~5 times the number of codes From 2011 CAC summit: One ICD-9 code with >7,500 ICD-10 mappings!

Impact on direct-data entry


ICD-10: Specificity ~5 times the number of codes From 2011 CAC summit: One ICD-9 code with >7,500 ICD-10 mappings!

Impact on direct-data entry

Lynn Kosegi

Information Demands Meaningful Use Problem list “Problems” versus billable diagnoses Medications

Quality Core measures PQRS – CMS integration into Meaningful Use

reporting

Clinical Decision Support Patient-facing summary


Meaningful Use Problem list “Problems” versus billable diagnoses Medications

Quality Core measures PQRS – CMS integration into Meaningful Use

reporting

Clinical Decision Support Patient-facing summary

Lynn Kosegi

Road to Adoption

Speech recognition plus MT editing• Efficiencies and cost savings• Cost avoidance• Comprehensive and complete

documentation• High adoption by physicians• Flexibility and options


Speech recognition plus MT editing• Efficiencies and cost savings• Cost avoidance• Comprehensive and complete

documentation• High adoption by physicians• Flexibility and options

Discrete Data is not enough…

Limited to specific vocabularies - uses Many “standards” – link ICD-9, ICD-10 CPT LOINC RxNorm Radlex SNOMED Accepted standard for interoperability


Limited to specific vocabularies - uses Many “standards” – link ICD-9, ICD-10 CPT LOINC RxNorm Radlex SNOMED Accepted standard for interoperability

Company ConfidentialSpeaker Name

The Health Story Perfect foundation for CAC, quality

reporting, clinical decision support HL7/IHE Health Story Consolidation Health Level 7 Integrating the Healthcare Enterprise CDA4CDT HITSP C32/83 CCD Meaningful Use http://www.healthstory.com/pdf/HealthStoryC

onsolidation.pdfCompany Confidential

Perfect foundation for CAC, qualityreporting, clinical decision support HL7/IHE Health Story Consolidation Health Level 7 Integrating the Healthcare Enterprise CDA4CDT HITSP C32/83 CCD Meaningful Use http://www.healthstory.com/pdf/HealthStoryC

onsolidation.pdfLynn Kosegi

CCDContinuity of Care Document Combines ASTM CCR and HL7 CDA XML-based, CDA Specifies encoding and structure for

exchange of patient summary Mandatory narrative – Human interpretation

Encoded data elements


Continuity of Care Document Combines ASTM CCR and HL7 CDA XML-based, CDA Specifies encoding and structure for

exchange of patient summary Mandatory narrative – Human interpretation

Encoded data elements

23

Narrative DocumentationEnables… Ease of human understanding Quality and compliance Usefulness Enterprise-wide efficiency

……across the continuum of care


Enables… Ease of human understanding Quality and compliance Usefulness Enterprise-wide efficiency

……across the continuum of care

Lynn Kosegi

Meaningful Use

The promise…

The EHR will – Improve patient care Reduce costs Improve population health

How?


The promise…

The EHR will – Improve patient care Reduce costs Improve population health

How?

Speaker Name

Reality Difficult to get information into the EHR More difficult to get it to the PHR Text is of no use Adoption of physician self entry is low Systems designed for the clinician at

point-of-care are not useful for HIM LOTS of paper


Difficult to get information into the EHR More difficult to get it to the PHR Text is of no use Adoption of physician self entry is low Systems designed for the clinician at

point-of-care are not useful for HIM LOTS of paper

Speaker Name

Quality of Content

28

Most importantly..

It’s not just about productivity

It’s about high-quality, comprehensivedocumentation to support increasingdemands for information….produced in away that happens to be cost-effective


It’s not just about productivity

It’s about high-quality, comprehensivedocumentation to support increasingdemands for information….produced in away that happens to be cost-effective

Lynn Kosegi

From a Physician at RSNA..after reviewing draft text produced by

M*Modal’s front-end speech using an un-trained profile…

“this is better quality than I’m getting from<unnamed MTSO> MTs…”

If you are not delivering quality, none ofthe other arguments matter.


..after reviewing draft text produced byM*Modal’s front-end speech using an un-trained profile…

“this is better quality than I’m getting from<unnamed MTSO> MTs…”

If you are not delivering quality, none ofthe other arguments matter.

30

Options and flexibility

32

Key to Adoption

Ease of use for physician Flexibility Options

Comprehensive information Timely Accurate Useful


Ease of use for physician Flexibility Options

Comprehensive information Timely Accurate Useful

Lynn Kosegi

Dictation and Transcription..

In a new light… The Road to Meaningful Use Ideal capture method for physicians Human understandable information Options, flexibility, and scale Actionable information


In a new light… The Road to Meaningful Use Ideal capture method for physicians Human understandable information Options, flexibility, and scale Actionable information

Lynn Kosegi

Cost-effectiveness

35

Beyond Speech Rec…Old Way ICs and home-based

workers Flexible scheduling Over staffing Avon-lady MTs Pay by productivity

New Way Employees Assigned schedules Appropriate staffing Career-minded MTs Pay for committed

time and quality


Old Way ICs and home-based

workers Flexible scheduling Over staffing Avon-lady MTs Pay by productivity

New Way Employees Assigned schedules Appropriate staffing Career-minded MTs Pay for committed

time and quality

Changing Face of DocumentationMedical Transcription is competing with:• Front-end speech recognition• EHR – Direct entry• Front-end speech rec• Templating• Direct data entry

Hospitals are looking for the most cost-effective solution…


Medical Transcription is competing with:• Front-end speech recognition• EHR – Direct entry• Front-end speech rec• Templating• Direct data entry

Hospitals are looking for the most cost-effective solution…

Lynn Kosegi

The Career-Minded MT Professionalism Remote workers Scheduling Productivity based pay The Independent Contractor The “hobby MT” I’m not budging

Compensation Training and education Credentialing


Professionalism Remote workers Scheduling Productivity based pay The Independent Contractor The “hobby MT” I’m not budging

Compensation Training and education Credentialing

39

Lessons from the SummitSpeech Recognition Eliminate MTs Decrease MT pay Use lesser-skilled,

lower paid MTs “As dictated” It’s all about the $$$

CAC CAC for “mundane”

coding Elevate lower-skilled

coders Retain highly-skilled

coders It’s all about useful

Documentation


Speech Recognition Eliminate MTs Decrease MT pay Use lesser-skilled,

lower paid MTs “As dictated” It’s all about the $$$

CAC CAC for “mundane”

coding Elevate lower-skilled

coders Retain highly-skilled

coders It’s all about useful

Documentation

Lynn Kosegi

The Myth of the “% Gained”

Company ConfidentialLynn Kosegi

Workforce Management

WorkforceManagement

Output –not “%Gain”

Editing –Typing

distribution

HeadcountImpact

Output – not “% Gain”

Editing – Typing distribution

75% rule

Use productive typists

FTE/PTE work assignment

Total efficiency –

Headcount impact

Gap analysis

Assign editing to highproducers


WorkforceManagement

FTE/PTEwork

assignment

GapAnalysis

Output – not “% Gain”

Editing – Typing distribution

75% rule

Use productive typists

FTE/PTE work assignment

Total efficiency –

Headcount impact

Gap analysis

Assign editing to highproducers

Performance Management

EffectiveTraining

WeeklyMentoring

FinalDocumentQuality

• Monitor final quality

• Effective training

• Ongoing Mentoring

• Basic editing skills

• Can your MTEs quickly –

• Create sections/subsections

• Create numbered lists

• Replace incorrect text

• Insert text


Performance

Management

WeeklyMentoring

Most-CommonEdits

KeyboardShortcuts

FinalDocumentQuality

• Monitor final quality

• Effective training

• Ongoing Mentoring

• Basic editing skills

• Can your MTEs quickly –

• Create sections/subsections

• Create numbered lists

• Replace incorrect text

• Insert text

Cost of the IC Linda Yaniszewski from ExecuScribeAfter changing from IC to employees –

“Results were communicated back to the entire team:• Morale improved.• There was a new sense of company loyalty.• MTs began “fighting” for work.• Company profits increased.• Everyone was able to do more with less”

http://bit.ly/e7YiQICompany Confidential

Linda Yaniszewski from ExecuScribeAfter changing from IC to employees –

“Results were communicated back to the entire team:• Morale improved.• There was a new sense of company loyalty.• MTs began “fighting” for work.• Company profits increased.• Everyone was able to do more with less”

http://bit.ly/e7YiQI45

Hospital versus Service MTs

Employee versus IC FT versus PT Enforced schedule vs “Oprah Effect” Training vs “throw it over the fence” Management vs 100 MTs/supervisor Optimization vs invisibility Doctors forced to accept change vs

invisible to doctors


Employee versus IC FT versus PT Enforced schedule vs “Oprah Effect” Training vs “throw it over the fence” Management vs 100 MTs/supervisor Optimization vs invisibility Doctors forced to accept change vs

invisible to doctors

Commoditization“I’ll do the same thing cheaper” vs“I’ll add value to your documentation”

Given a choice, would you pay more toone electric company than to another? Who cares about the electric company as

long as the lights are on? You all know which companies(y) will

survive if you all become the electriccompany.


“I’ll do the same thing cheaper” vs“I’ll add value to your documentation”

Given a choice, would you pay more toone electric company than to another? Who cares about the electric company as

long as the lights are on? You all know which companies(y) will

survive if you all become the electriccompany.

47

Service Level Options Lowest Cost Line Optimal Cost Reduction

Meaningful Clinical Document Useful clinical documentation EMR readiness Useful documentation

Premium Service Retention of demanding difficult customer Customization Keeping speech invisible


Lowest Cost Line Optimal Cost Reduction

Meaningful Clinical Document Useful clinical documentation EMR readiness Useful documentation

Premium Service Retention of demanding difficult customer Customization Keeping speech invisible

48 M*Modal Proprietary and Confidential

Speech Technology and PricingWarning! Beware of demands for customization at

the price of a low-cost line Don’t provide a Cadillac for the price of a

bicycle

Educate customers about what they arepaying for Would they rather pay for – Physician specific preference Meaningful Clinical Documents


Warning! Beware of demands for customization at

the price of a low-cost line Don’t provide a Cadillac for the price of a

bicycle

Educate customers about what they arepaying for Would they rather pay for – Physician specific preference Meaningful Clinical Documents

49

Appropriate Pricing

Know what your customer wants Know what you want to sell Price accordingly Pay MTs accordingly

Every other industry in the worldunderstands this concept!


Know what your customer wants Know what you want to sell Price accordingly Pay MTs accordingly

Every other industry in the worldunderstands this concept!

50

Would you charge the same for a Jetta asyou would for this?


Quest for Semantic Interoperability


Discrete Data Elements

Discrete data points are not enough Narrative documentation provides – Ease of use for physicians Cost efficiency for facility Comprehensive information for HIM Expressiveness required for communication Encoded data for reporting


Discrete data points are not enough Narrative documentation provides – Ease of use for physicians Cost efficiency for facility Comprehensive information for HIM Expressiveness required for communication Encoded data for reporting

Lynn Kosegi

From Detlef Koll, CTO and VP of Research andDevelopment, M*Modal

“We already have semantic interoperability inhealth information today. Narrative notes arethe one form of documentation that can beunderstood by every human in the patientcare team, including the patient himself…”


From Detlef Koll, CTO and VP of Research andDevelopment, M*Modal

“We already have semantic interoperability inhealth information today. Narrative notes arethe one form of documentation that can beunderstood by every human in the patientcare team, including the patient himself…”

54

Questions?

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