plexus sept oct 2013

PLEXUSWhere Health Information Experts Come Together

SEPTEMBER/OCTOBER 2013 VOLUME 9, ISSUE 5PLEXUS

ClInICal mEdICInE page 28Neurodegeneration

Does Risky Behavior Equal Risky Business?

Risk Management Risk ManagementDoes Risky Behavior Equal Risky Business?

Take a Seat. Get to Work.This companion workbook is designed to work in tandem with The Book of Style for Medical Transcription, 3rd edition. The Workbook contains practical application exercises to assist students, postgraduates, and working MTs with orientation to standards and preparation for AHDI credentialing exams. Multiple-choice questions, proofreading exercises, and transcription practice via interactive audio CD included. Get your copy today!

Get your copy from the Online Store at www.ahdionline.org!

Book of StyleThe

THIRD EDITION

Published by the Association for Healthcare Documentation Integrity

(formerly AAMT)

Practical Application & Assessment

Lea M. Sims, CMT, AHDI-F

THE BOOK OF STYLE Workbook

$50 U.S.

April 15, 2012, marked the one-hundred-year anniversa-ry of the Titanic sinking on

her maiden voyage. For 75 years the Titanic was lost under the sea, even-tually to be discovered off the coast of Newfoundland in 1985. Decades (and countless movies, documenta-ries, and books) later, there is still a strong fascination worldwide with the story of the “practically unsink-able” luxury liner that hit an iceberg and sank to an ocean-floor grave two miles below the surface.

According to History,1 a number of theories have been speculated upon as to the “fatal flaws” and errors that led to the ship’s demise along with the lives of over 1500 passengers. While the impact from the iceberg, tearing a 300-foot gash in the side of the ship, is suspected to have been the primary cause of the ship sinking, other poten-tial causes or contributing factors included a design flaw in the ship’s watertight bulkheads, the ship’s steel plates being too brittle for the freez-ing waters, and an onboard coal fire.

As was dramatically demonstrated in James Cameron’s 1997 film, Titanic, it was most notably the far-from-adequate number of lifeboats and disorganized evacuation process that added to the Titanic’s tragic ending. Had the regulations for the required number of lifeboats been more stringent, had each lifeboat

been filled to the maximum capac-ity of 65 occupants (instead of being sent off with half that many or less), and had the crew been given—and followed—proper emergency evacuation training and procedures, the number of lives saved may have been double or greater than the 705 who survived.

There is a lot to be learned from epic tragedies such as the sinking of the Titanic in 1912, the Challenger space shuttle disaster in 1986, and the bombing of the Twin Towers and Pentagon and hijacking of United Flight 93 in 2001—as well as from everyday experiences like texting and driving or unsafe food handling, both of which could have disastrous results for the “doer” as well as those around him or her if laws are not followed and common sense is not embraced and exercised. It’s a trickle-down effect of action and reaction, of cause and effect.

An evaluation of policies and procedures needs to be done. Chang-es need to be made and documented. Employee/contractor training needs to take place. Agreements need to be discussed and signed. Regular followup, continuing education, and reinforcement of the rules need to happen. And an understanding of the reasons why all of these things are important is critical.

Ask yourself: Are you willing to risk damages—and potential

lives—of “titanic” proportions? Being healthcare documentation specialists isn’t just about how well you can document patients’ medi-cal data. Knowing how to minimize risk, complying with privacy and security safeguards, and implement-ing best practices are all ways to help mitigate risk to the patients whose records you transcribe and edit as well as to yourself and/or the company for which you work. Be diligent and proactive in learning about or coming up with prevention tactics and solutions, because even unintended consequences can result from complacency, carelessness, and blatant disregard of rules and regula-tions. There is no excuse.

In this issue, you’ll read about The Juno Case—an important “wake-up call” for the transcription sector, as well as quality in health information documentation. As well, you’ll learn the latest in neurodegeneration in multiple sclerosis from Jane Warren. Enjoy! P

eDITOR’S MeSSage

Risk Mitigation—Enhancing Opportunities While Reducing Threats

1Volume 8 • Issue 6 NoVember 2012

“Before, all I wanted was to fit in. But I learned that we’re all searching to fit in and we... we all feel like outsiders and we all do things and feel things that are bizarre and unconventional and dorky. We’re all dorks! My name is Sydney White, my dad’s a plumber, I collect comic books, and I’m secretly terrified of balloon animals. I’m a dork!” – Sydney White [2008 movie starring Amanda Bynes]

Technology is wonderful! Isn’t it? I suppose the feeling behind that statement could vary depending on whether or not the particular technology you are using is working properly and efficiently. It’s inevitable that your computer gets a virus, your programs or Internet connection runs slow, the screen freezes up, or some other wacky technology glitch ruins your day. But overall, I think technology is amazing and fun and just plain cool! It’s odd to think how different the world would be today had computers never been invented.

So what does an “app-savvy” user look like? It used to be that people who were really into technology were considered “geeks” or “dorks.” Over the years, computers, tablets, smart phones, and other devices have become more prominent and accessible, and society has shifted its stereotype of geeks and dorks. Now the first adopters and efficient users of technology are the cool kids. If that’s the case, then pretty much everyone I know is very cool!

Here is a brief recap of some of the helpful, useful, or just plain cool

tech programs and apps I’ve used this past year for work: Moodle, Webassessor, Dropbox, SendSpace, QuizFaber, nearly all the Microsoft suite, Personify, SysAid, Adobe, SpeedType, FileZilla, Windows Live Messenger. On a personal note, I’ve been using a slew of apps on my iPad: iTunes, Pinterest, OneNote, RecipeBook, iBooks, Maps, Flipboard, games, and others. I even have apps to check for movies at Fandango or Redbox, or to do online banking and pay bills. Many apps are available via multiple devices—and synchroniz-able across those devices—which makes taking care of work or per-sonal business quick and convenient.

I would be remiss if I didn’t mention some of the great member resources you may have forgotten about: Matrix and Plexus article archives; online CECs; component

resources; position statements and best practices and standards guide-lines; AHDI help desk; member, com-pany, and credentialed professionals directories; special interest alliances, AHDI Lounge blog, and other net-working avenues; and many others—all available at www.ahdionline.org.

In this issue you will read about a number of other great websites, tech-nologies, and resources. Have a great resource you want to tell us about? Email me at [email protected]. P

Kristin M. Wall, CMT, AHDI-FEditor-in-Chief, Senior Programs Coordinator, AHDI

EDITOR’S MESSAGE

The App Savvy User

Kristin M. Wall, CMT, aHDI-Feditor-in-Chief, Senior programs Coordinator, aHDI

VOLUME 9 • ISSUE 5 SEPTEMBER/OCTOBER 2013 1

Take a Seat. Get to Work.This companion workbook is designed to work in tandem with The Book of Style for Medical Transcription, 3rd edition. The Workbook contains practical application exercises to assist students, postgraduates, and working MTs with orientation to standards and preparation for AHDI credentialing exams. Multiple-choice questions, proofreading exercises, and transcription practice via interactive audio CD included. Get your copy today!

Get your copy from the Online Store at www.ahdionline.org!

Book of StyleThe

THIRD EDITION

Published by the Association for Healthcare Documentation Integrity

(formerly AAMT)

Practical Application & Assessment

Lea M. Sims, CMT, AHDI-F

THE BOOK OF STYLE Workbook

$50 U.S.

Reference: History. A&E Television Networks, LLC. <http://www.his-tory.com/topics/titanic>

FeaTUReS

CONTeNTSSEPTEMBER/OCTOBER 2013 VOL. 9, ISSUE 5

1 editor’s Message Kristin M. Wall, CMT, AHDI-F

4 president’s Message Jill Devrick

6 Tech Talk Curt Hupe

8 Newly Credentialed

9 Connections

22 In the Limelight

24 Life Unsedentary Rachel Quatkemeyer, CMT

27 exercise Your Brain

35 professional practice Desk

36 News and Who’s Who

39 around the Country

40 Funny Bone Richard Lederer, PhD

28 Neurodegeneration in Multiple Sclerosis Jane Warren, ELS

31 Let’s Talk Terms Beverly Sofko, CMT

33 CMT Challenge Quiz Brett McCutcheon, CMT, AHDI-F

CLInICaL MEdICInE

COLUMnS & dEPaRTMEnTS

10THe JUNO CaSe: a SeNTINeL eVeNT FOR THe TRaNSCRIpTION SeCTORLea M. Sims, CMT, AHDI-F

14IT ReaLLY DOeS MaTTeRDebra Jones

18HeaLTH INFORMaTION DOCUMeNTaTION: WHO OWNS THe QUaLITY OF THe INFORMaTION?Karen L. Fox-Acosta, CMT, AHDI-F

TeCHNOLOgY aND THe WORKpLaCe

CLINICaL MeDICINe

CLINICaL MeDICINe

CLINICaL MeDICINe

2 SEPTEMBER/OCTOBER 2013 WWW.aHdIOnLInE.ORG

MeDICOLegaL

MeDICOLegaL

SepTeMBeR/OCTOBeR 2013Vol. 9, No. 5

editor-in-ChiefKristin Wall, CMT, [email protected]

associate editorsBrenda Wynn, CMT, aHDI-FJennifer Della’Zanna, CMT, CpC, CgSCRuthanne Darr, CMT, aHDI-F

DeSIgNOpen Road graphic Design ServicesTerri a. Heuser-Woltersart [email protected]

aDVeRTISINgDavid HallSales [email protected]

Plexus (ISSN: 1938-453x)is published bi-monthly by the association for Healthcare Documentation Integrity4230 Kiernan ave., Suite 170 Modesto, Ca 95356-9322

Copyright NoticePlexus is published six times a year by the association for Healthcare Documentation Integrity, 4230 Kiernan ave., Suite 170 Modesto, Ca 95356-9322 all contents ©2013 association for Healthcare Documentation Integrity

This symbol identifies creditworthy items preapproved by aHDI. To earn Ce credit, CMTs should submit a brief (300-word) summary of a preapproved article. article summaries preapproved by aHDI can be written and submitted at the end of your

recertification cycle every 3 years. Do not submit them upon completion. alternately, aHDI members may log in at www.ahdionline.org to see if an online quiz is available. permission to reproduce copies of articles for educational use may be obtained from the editor at [email protected].

CMTs may opt to take the online quiz in lieu of an article summary for any article where this symbol is also indicated. You can find these Ce quizzes at the aHDI website under Member Center > My Benefits > Online CeCs. Members must first log into the aHDI website to access these quizzes.

The Fine print

The statements and opinions contained in the articles of Plexus are solely those of the individual authors and contributors and not Open Road Graphic Design Services. The Publisher disclaims responsibility for any injury to persons or property resulting from any ideas or products referred to in the articles or advertisements.

TO SUBMIT CONTeNT FOR pUBLICaTION: AHDI welcomes industry contributions, and all submissions for publication are welcome for review and consideration by the editor. Any individual or group interested in submitting an article or column content should follow the guidelines below for submission:

1. Articles must be submitted in MS Word format and should not exceed 1500 words (some exceptions will be made depending on content).

2. Articles should include full name and contact information for each author/contrib-utor as well as a brief bio (2–3 lines) for each author/contributor.

3. Consider including a 15- to 20-question multiple-choice quiz with your article to facilitate online continuing education (CE) access for credentialed MTs.

4. Articles must be submitted with a signed Author Agreement. An Author Agreement for Plexus can be requested from the senior programs coordinator and editor at [email protected].

5. Articles should be emailed to [email protected]. Author Agreements should be signed and faxed to 209-527-9633 or scanned

and emailed to [email protected].

NOTe TO ReaDeRS: In keeping with other publications in the industry, Plexus has been edited to comply with the style and standards as outlined by the American Medical Association (AMA) Manual of Style, 10th ed. In any instance where the application of AMA style conflicts with The Book of Style for Medical Transcription, 3rd edition, the AMA standard is used to comply with industry publishing standards, because those outlined in The Book of Style for Medical Transcription, 3rd edition, are specific to documentation in a transcription setting and not to formal publication.

3Volume 8 • Issue 6 NoVember 2012

november 2012Vol. 8, No. 6

editor-in-ChiefKristin Wall, CMT, [email protected]

AssoCiAte editorsJennifer Della’Zanna, CMT, CPC, CGSCDebra Hahn, RMTBrenda Wynn, CMT

desiGnNetwork Design GroupJen Smith, Art [email protected]

Alicia Miller, Graphic Designer

AdvertisinGMeredith Schwartz, Account Executive Network Media Partners, Inc.410-584-1952

[email protected]

Aisha France, Advertising Coordinator

Plexus (ISSN: 1938-453x)is published bi-monthly by the Association for Healthcare Documentation Integrity4230 Kiernan Ave., Suite 130

Modesto, CA 95356-9322

CUstom PUbLishinG serviCes Provided by Network Media Partners, Inc. and Network Design Group, The Creative

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CoPyriGht notiCePlexus is published six times a year by the Association for Healthcare Documentation Integrity, 4230 Kiernan Ave., Suite 130 Modesto, CA 95356-9322 All contents ©2012 Association for Healthcare Documentation Integrity

This symbol identifies creditworthy items preapproved by AHDI. To earn CE credit, CMTs should submit a brief (300-word) summary of a preap-proved article. Article summaries preapproved by AHDI can be written and

submitted at the end of your recertification cycle every 3 years. Do not submit them upon completion. Alternately, AHDI members may log in at www.ahdionline.org to see if an online quiz is available. Permission to reproduce copies of articles for educational use may be obtained from the editor at [email protected].

CMTs may opt to take the online quiz in lieu of an article summary for any article where this symbol is also indicated. You can find these CE quizzes at the AHDI website under Member Center > My Benefits > Online CECs.

Members must first log into the AHDI website to access these quizzes.

THE FINE PRINT

The statements and opinions contained in the articles of Plexus are solely those of the individ-ual authors and contributors and not Network Media Partners, Inc. The Publisher disclaims responsibility for any injury to persons or property resulting from any ideas or products referred to in the articles or advertisements.

TO SUBMIT CONTENT FOR PUBLICATION: AHDI welcomes industry contributions, and all submissions for publication are welcome for review and consideration by the editor. Any individual or group interested in submitting an article or column content should follow the guidelines below for submission:

1. Articles must be submitted in MS Word format and should not exceed 1500 words (some exceptions will be made depending on content).

2. Articles should include full name and contact information for each author/contributor as well as a brief bio (2–3 lines) for each author/contributor.

3. Consider including a 15- to 20-question multiple-choice quiz with your article to facilitate online continuing education (CE) access for credentialed MTs.

4. Articles must be submitted with a signed Author Agreement. An Author Agreement for both Plexus and Matrix can be requested from the senior communications coordinator at [email protected].

5. Articles should be emailed to [email protected].

6. Author Agreements should be signed and faxed to 209-527-9633 or scanned and emailed to [email protected].

NOTE TO REAdERS: In keeping with other publications in the industry, Plexus has been edited to comply with the style and standards as outlined by the American Medical Association (AMA) Manual of Style, 10th ed. In any instance where the application of AMA style conflicts with The Book of Style for Medical Transcription, 3rd edition, the AMA standard is used to com-ply with industry publishing standards, because those outlined in The Book of Style for Medical Transcription, 3rd edition, are specific to documentation in a transcription setting and not to formal publication.



pReSIDeNT’S MeSSage

Jill Devrick

Have you ever had one of those moments when you stop and look around won-

dering, “How in the world did I get here?” It reminds me of a quote from the classic ‘80s movie Ferris Bueller’s Day Off: “Life moves pretty fast. If you don’t stop and look around once in a while, you could miss it.” I don’t know about you, but for me, the “it” I might miss is the “why” behind what I do. The many obligations of my life keep me constantly in motion. But every once in a while, I need to take inventory of my roles and responsibilities and ask myself not just how I got here, but “What’s the point?”

This is a question I’m sure many healthcare documentation special-ists frequently ask themselves. With all of the changes due to regulations and technology in the healthcare industry, our workforce has endured several years of instability and uncertainty. AHDI has been weather-ing the storm, too, and feeling the effects. I bring this up because I think that many of us feel like we struggle along in our own little life-boats, paddling upstream or around in circles, just trying to stay afloat, but not making any real progress. However, one of the most valuable aspects of being part of an associa-tion like AHDI is that we are all in

the same boat and can not only stay afloat, but also set a course for a destina-tion where our skills and expertise will protect patient safety and support organizational integ-rity through high quality healthcare documentation.

Over the next year, I will work with the AHDI National Leadership Board, as well as with regional and local chapters, to navigate the chal-lenges we face towards a destination where our versatility, vitality, and voice demonstrate our true value to the healthcare industry. The evolu-tion of the medical transcriptionist to healthcare documentation specialist reminds me of the evolution of the telephone to the smart phone. The essence and purpose of the telephone is the same today as it was when it was invented, but the packaging, features, and benefits have been enhanced over time.

I believe that MTs have always been like smart phones that add value to the healthcare documenta-tion workflow far beyond converting the dictation to text. The arrival of meaningful use, EHR technology, speech recognition, and the transi-tion to ICD-10 has created many opportunities to share our expertise and fulfill our mission to protect the integrity of patients’ health informa-tion. We want to be known as the champions of documentation excel-lence in the healthcare industry, but

we can’t wait around to be asked. We have to make our move yesterday, and if not

yesterday, right now.If you are reading this and think-

ing, “Good, I’m glad someone is getting out there and doing some-thing,” then I’m sorry to inform you that you are not off the hook. Every AHDI member can—must—con-tribute to our success. Being part of an association is about sharing the responsibility, as well as sharing the benefits. Here are some ideas for how you can contribute to our mission and vision.

Workforce Development: Cultivating our Versatility• Promote continuing education, even for the uncredentialed and those looking elsewhere. Invite a colleague to attend a webinar, read a blog, or attend a training event.• Look for opportunities in your organization to ask questions, learn, and be challenged. Find out what you can do to assist with ICD-10 or EHR preparations, patient advocacy, etc. • If you have a problem, suggest a solution. Your perspective may shed light where other ideas have come up short.• Inform AHDI about what we can do to bolster your professional development. We want to provide relevant educational opportunities

Meaningful Momentum


that will help you grow.• If you are a pioneer in a new role, share your experience with others. The lessons you learn in EHR support roles, patient advocacy, clinical documentation improvement, and so on can help others try new paths, too.

Credentialing: Demonstrating our Value• Obtain or maintain your certification. Nothing demonstrates your value as a healthcare knowledge worker better than proving and maintaining your mastery of our body of knowledge.• Transition to the CHDS or RHDS. The bridge course is affordable and provides 10 CEUs. Go for it!• Promote the value of credentialing and the body of knowledge you mastered with employers, physicians, uncredentialed HDSs, and others. • Encourage using the CHDS or RHDS as a requirement for new hires, promotions, or transitions to emerging documentation roles.

advocacy and alliance Building: asserting our Voice• Gather data and demonstrate the positive return on investment (ROI) that you provide as an HDS, and if you are a manager, build a strong ROI case for your department or company. Toot your own horn.• Communicate real-life examples of how you and your profession

make a difference in person and on social media. How many critical errors have you corrected or flagged? What have you done to improve productivity for yourself or the physicians you support?• Partner with physicians and other HIM professionals to develop practical solutions. Many organizations need our assistance, but don’t realize we are the ones to ask for help. Share the success of these partnerships.• Promote the “Your Record Speaks” campaign and how HDSs contribute to patient safety.• Create “elevator speeches” for HDSs and AHDI. Be ready to evangelize about the importance of documentation integrity whenever the opportunity presents itself.

Community: Strengthening our Vitality• Encourage the downtrodden not to stay stuck. Many of our col- leagues need our support to find the right path and move forward. Build some mentoring relation- ships and nurture them. • Promote the value of AHDI membership. Many in our workforce don’t understand how an association works and why it is so important to our industry. Our membership is what gives us strength and vitality.• Advise AHDI about the specific tools, training, and events that you want and offer your detailed ideas.

Better yet, volunteer to take action – all hands on deck!• Join an alliance, study group, local chapter, etc. You will benefit from the collaboration, and the group will benefit from your contributions, even if you are a newbie.• Speak out as a positive voice on social media. Shed light in the comments section and link to blogs, articles, organizations, and events that demonstrate forward motion in addressing our challenges.

My list may seem like a lot to ask, but the verbs we use on our journey will determine how happy we are with the destination. Don’t be con-tent to let others who don’t under-stand our role define it – or elimi-nate it – without understanding the versatility, value, voice, and vitality that our workforce brings to the healthcare documentation process. I look forward to hearing your stories and celebrating our victories – both big and small – over the next year. P

Jill devrick is a proud 3M telecom-muting software geek who has worked with hundreds of healthcare documentation organizations since 1995. She earned her BA and MPA degrees from West Virginia University. Jill is President of AHDI’s National Leadership Board and serves on the executive commit-tee of the Health Story Project.

“Isn’t it funny how day by day nothing changes but when you look back everything is different…” – C. S. Lewis


TeCH TaLK

In IT, “cloud” is one of the most overused buzzwords in the industry. There are companies

everywhere trying to sell cloud applications, cloud storage, cloud services, cloud monitoring, cloud everything! But what exactly is this cloud? You probably think you have a good idea, but it’s likely not the same idea as your neighbor has—even though you both probably have a good deal of data stored there. Wikipedia even states that cloud computing is a jargon term without a commonly accepted non-ambiguous scientific or technical definition.

In the simplest terms, the cloud is a group of computer servers, sometimes several thousand servers, located at one or many datacenters, which offer remote users (like you) space to store their digital stuff. Some of the most recognized cloud products are email, websites, and social media. If you can access any of your information from a computer other than your desktop or laptop, that can be considered utilizing the cloud. Facebook, anybody?

A cloud service that has taken off in recent years is cloud storage. Many of you have probably heard of this or even use cloud storage. Cloud storage provides users a way of ac-cessing personal files from just about any device that has an

Internet connection. For example, if you saved your vacation pictures in the cloud you could view them while at a friend’s house; just log into your cloud account and look at your pic-tures. Working on a report for your boss, and forgot the latest revisions on your home computer? That wouldn’t be a problem if you saved the files in the cloud. Most cloud providers even have a mobile app to provide interoperability on cell phones and tablets. No more worrying about copying important files to a USB drive to haul around with you.

Some popular consumer cloud storage applications are Dropbox, Google Drive, and SkyDrive. These specific providers all provide

solutions for Windows, Android and iOS devices. They are also argu-ably the three most popular names in cloud storage, though, to be sure, there are hundreds of other services as well. So with all these choices, how do you choose a provider? Should you even be using cloud storage? What about security?

Consumer cloud storage applica-tions typically work by installing the application on a PC. This application creates a special folder on that com-puter. Anything saved in that folder is automatically copied to the cloud. Then, any PC which also has that application installed under the same account will synchronize the folder across all PCs the user designated as belonging to that network. Files

Clearing up the CloudCurt Hupe

TECHNOLOGY AND THE WORKPLACE

1 CEC

3 QUIZ


saved in this folder are also acces-sible from tablets, phones, or the provider’s website.

First, I’ll state that I think every-one should use cloud storage for their personal files. Especially since all of the providers mentioned in this article provide some amount of free storage. It’s free; why not take advantage of it?

Note that I mentioned “personal” files. If you’re considering cloud storage for business reasons, which might involve storing protected health information (PHI), special care should be taken. Of course, PHI always needs to be secure, even if storing that information on your local PC. When using the cloud, the provider must be HIPAA compliant or certified. If you’re not already us-ing cloud storage I’ll provide some brief insight into these most popular services.

Dropbox has been around since 2007 and, according to their website, has over 175 million users. Dropbox has a user interface easy for even novice users to learn. You can share files with other users by just sending them a link. Dropbox even integrates with Facebook. Although Drop-box offers the least amount of free storage, starting at 2GB, you can potentially earn up to 18GB extra by referring new users. Dropbox

does not currently hold any HIPAA certifications, so using Dropbox for storing PHI of any kind could cause a HIPAA violation.

Google Drive takes cloud storage one step further by integrating with its popular Google Docs, a suite of office applications that include simultaneous editing of documents and spreadsheets. Google Drive offers free storage of up to 15GB in the cloud, though that can be misleading because this total stor-age is spread across Google Drive, Gmail, and Google+ Photos. Google drive also does not hold any HIPAA certifications.

Microsoft’s SkyDrive integrates well with the Microsoft Office Suite, Windows 8, and Facebook. Similar to Google Drive, users can edit office documents saved on SkyDrive within the web browser using Office Web Apps. SkyDrive offers 7GB of free storage. Microsoft states that data stored on their systems are HIPAA compliant; however, remember it’s not just how the data is stored. Users must be careful when using any cloud storage, as the point of the service is to make it easy to share information, and you don’t want to share PHI. It’s never a good idea to store PHI on your local com-puter unless absolutely necessary. Although HIPAA requires the use of

passwords, it doesn’t specifically re-quire them to be “strong” passwords. The same holds true for encryption; although it’s not required for stored data, it’s certainly a good idea. If you do store PHI locally, a combina-tion of strong passwords, encryption tools, and physical security will miti-gate any potential HIPAA violation.

The best features of using these services is that you can easily share documents with others, and it provides some peace of mind that files are safe in the event of a computer crash. Apart from sharing and backup, cloud storage systems also provide a great way to collabo-rate with coworkers on communal projects.

Each of these companies has their own nuances that make them unique, and different users certainly will have their favorites. If you’re look-ing for the most space, Google Drive is your best bet. Although Dropbox has the least free storage available, its large user base and easy-to-use software and mobile apps make it a popular choice. P

Curt Hupe is director of operations for ChartNet Technologies. Curt has over 15 years in the IT industry and 5 years in the medical transcription IT field. He welcomes your feedback at [email protected].

Free

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6

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NeWLY CReDeNTIaLeD

Stella ebinger, RMTYoung Harris, ga

amanda parks, RMTgreenville, MS

Laurie patenaude, RMTFort Mill, SC

Rita Scanlan, RMTNew Castle, IN

Jerri Shook, RMTOrland, Ca

Ready to Practice!

Diana Boyd, CMTCorning, Ca

annette Hager, CMTNew Market, MD

Jeannette pemberton, CMTSt. Louis, MO

Jayaraj F V, CMTBangalore, Karnataka

ajay patil, CMTJaysingpur, Maharashtra

S D Sudhirrram, CMTTamil Nadu, Chennai

aHDI congratulates and welcomes the following healthcare documentation specialists who achieved RMT status between 7/1/13 and 8/31/13. Registered Medical Transcriptionists have proven their ability to reach for excellence by successfully completing rigorous testing of all level-1 knowledge domains represented on the RMT exam Blue print.

aHDI congratulates and welcomes the following healthcare documentation specialists who achieved CMT status between 7/1/13 and 8/31/13. Certified Medical Transcriptionists have proven their level-2 transcription knowledge, skills, and applied interpretive judgment in all domains represented on the CMT exam Blue print through aHDI’s rigorous credentialing exam.


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The AHDI Marketplace offers something for every occasion. Visit the AHDI Marketplace to browse the merchandise created just for you, including designs for: healthcare documentation professionals, RMTs and CMTs, ACE attendees, and advocacy campaigns. Come back frequently to find out what’s new! Wear it, drink it, live it—Professional Pride!

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http://www.emdat.com


Tanya guenther, CMT, aHDI-F

How is it that a student and advocacy can go together? Easily when you are a

healthcare documentation specialist (HDS) student! Merriam-Webster’s Collegiate Dictionary, 11th Edition, gives the following definition of advocate: One that pleads the cause of another, one that defends or main-tains a cause or proposal, one that supports or promotes the interests of another. Well, we can support and promote the interests of our profession for sure!

As HDS students and new gradu-ates, we are all advocates for our profession. We are educating our friends and family about healthcare documentation and its importance. As we know, there are many people who think of transcription in terms of the process of “typing” a document. By further explaining healthcare documentation to our family and friends, we are able to increase public knowledge about the important role we play in the health-care system. This is advocacy! You are probably already an advocate for our profession without realizing it!

What are some of the other ways you, a student or postgraduate, can be an advocate for our profession? Get involved with your local or state/regional component of AHDI. This is a great place to network with other professionals and work collec-tively as a group toward increasing awareness of our profession.

Student and postgrad members are also eligible to serve as officers in a local component. As a student or postgraduate, you can also work to form a new chapter in your area! Students and postgraduates can also serve on local, state/regional, and national committees—these are all great ways you can get involved.

As advocates for our profes-sion, we are also advocates for the healthcare system. Many people are completely unaware of the job we do and how it may impact the quality of their health care. We have the ability to inform the public of what we do and why it is important, not only to us but to them as well. We can work together to promote and advance our profession, to increase awareness of the important role we play, and to educate the public about obtaining

and reviewing their healthcare records (www.yourrecordspeaks.com).

As students and postgrads, we need to jump in and learn everything we can about our profession. By do-ing so we are gaining the knowledge and confidence to be advocates for our profession. So go out there, get involved, and advocate! P

This article has been modified from the original article published in Plexus, May 2007, Vol. 3, Issue 3.

Tanya Guenther resides in the Cariboo region of British Coumbia, Canada, and has been working in the HDS in-dustry since 2005. She has served on a number of committees through AHDI in the past and currently is a member of the AHDI Approval Committee for Certificate Programs (ACCP).

CONNeCTIONS

Advocacy: You Don’t Have to Wait for Graduation


The Juno Case: a Sentinel event for the Transcription Sector

On December 13, 2012, a jury returned the largest civil wrongful death judgment ever recorded in Baldwin County, Alabama. The case involved

the death of Sharon Juno, who was administered a lethal dose of Levemir insulin, an outcome that originated with a transcription error. The jury awarded a stunning $140 million to the patient’s family, a verdict that was vacated by the court shortly thereafter.

Thomas Hospital of Fairhope, Alabama, along with its transcription outsource partner Precyse Solutions and India-based Medusind Solutions and Sam Tech, Inc., entered into confidential settlements with the victim’s family just prior to the reading of the verdict.

Regardless of the vacated verdict, the message from the jury was clear. A documentation error, perpetuated by questionable hospital policies and a series of even more questionable clinical decisions, resulted in the inarguable death of a patient. The fact that a transcrip-

tion company was even named in a wrongful death suit should make the industry sit up and pay attention. The issue of “liability” is now resoundingly on the table, and everyone connected to the health information manage-ment process would do well to consider the implications. Who is ultimately responsible for the accuracy of clinical information? This verdict challenges the long-held assumption that the physician is the legally responsible authority for the information in a patient’s record. In this case, neither the patient’s physician nor the nurse who administered the Levemir dosage (ten times what the patient should have received) was

Lea M. Sims, CMT, aHDI-F

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held accountable for this outcome. In addition to the question of liability, the healthcare

documentation industry needs to be mindful of the critical role that quality assurance played in this case. The plaintiff’s attorney was successful in convincing this jury that poor quality measures and negligent quality assurance practices contributed to the error in this patient’s record and that if Thomas Hospital had entrusted its documentation to a more qualified, certified healthcare documentation team, this error likely would not have occurred and this patient would not have died as a result of it. In reality, the plaintiff’s argument was fraught with misinterpretation and assumption, both around the quality practices and “standards” of the industry as well as what was reasonably within the scope of control of either the hospital or its transcription partners. Layered upon that rather dense landscape was also the issue of offshore outsourcing, and the presump-tion that “cheap” services offshore had compromised the quality of this patient’s documentation clearly had an impact on this verdict.

How did something that started out with a speech recognition error end in the wrong clinical decision and the death of a patient? AHDI has long warned the HIM sector that such an outcome was not only a possibility but a probability. Our “worst case scenario” involved an error made either by an SRT engine or an MT/editor (or both) that somehow went uncorrected through the quality assurance process, unnoticed and uncorrected by the physician, and unquestioned by a subsequent healthcare provider at the point of additional care. The case of Sharon Juno was the case we’ve been holding our breath for.

The Case TimelineSharon Juno was treated in the spring of 2008 at

Thomas Hospital in Fairhope, Alabama. Despite the recommendation from her physician (Dr. A) that she go to a step-down rehabilitation facility, the patient opted at the end of her stay to be discharged to her home. The patient was sent home with discharge instructions and a copy of her hand-written medication administration record (MAR). The original MAR was then bundled with her admission and treatment records to be scanned into the EMR in the HIM department. Dr. A dictated Ms. Juno’s discharge summary, and the audio was deliv-ered to Precyse Solutions. Thomas Hospital contracted Precyse Solutions for documentation services and opted

to participate in the Precyse offshore transcription pro-gram. This meant that the audio dictated by Dr. A was transmitted to the offshore partners where it was first put through a speech recognition system and then delivered, along with the SRT draft, to a series of MT editors and QA personnel who were responsible for editing the draft and finalizing it for delivery back to Thomas Hospital. In the case of Sharon Juno, the SRT engine captured the first draft, erroneously capturing “80 units” rather than “8 units” for the Levemir dosage. Four additional sets of ears, including both the QA1 and QA2 editors, saw the reference to “80 units” in the draft and heard the dosage as it was suggested by the SRT engine. None of them heard it differently or had any reason to question what they heard. The discharge summary was finalized and transmitted to Thomas Hospital, where it was pending signature by Dr. A at the time of this incident.

In the meantime, Sharon Juno spent her first night after discharge at home alone and sustained a fall in the middle of the night. Though she was uninjured, the incident forced her to reconsider spending time in the



rehabilitation facility. She called her son the morning after her first night home and told him she wanted to go to Mercy Medical for rehabilitation. Her son transported her to Mercy Medical but neglected to bring any of her discharge paperwork or her medications. Upon admis-sion, Mercy Medical contacted Thomas Hospital seeking a copy of Ms. Juno’s MAR. Because it was hospital policy that once bundled, a patient’s records could not be unbundled for any reason until they had been scanned into the EMR, the personnel at Thomas Hospital contacted Dr. A, who told them to refer to the patient’s discharge summary where her discharge medications should also be listed, per his dictation. The nurse transferred the medications by hand from the discharge summary (which had not been read, reviewed, or signed by Dr. A) to a new MAR and sent it to Mercy Medical.

Sadly, the lack of critical thinking in the chain of custody for this patient’s health information did not end there. The treating nurse at Mercy Medical administered 80 units of Levemir to this frail, chronically ill patient without questioning the dosage. The patient lapsed into a coma, never regained consciousness, and died eight days later.

The argumentsThe victim’s family filed suit against all parties

involved in the outcome – i.e., both hospitals, all three

transcription companies, the patient’s physician, and the nurse who administered the medication to the patient. All parties, the Complaint asserted, were guilty of clinical negligence and of violating the standards of care that should have prevented this patient’s death. Per the Com-plaint, the nurse was negligent in applying the standard of care for administration of this patient’s medications. Dr. A should have requested a review of the discharge summary before ever suggesting it be used in lieu of the MAR. The hospital should not have permitted an un-signed, unverified report to serve as an active physician order. The hospital should not have restricted unbundling of the MAR. And the hospital should not have tried to save money by allowing its records to be transcribed by allegedly “unskilled” offshore labor, especially without strict oversight and monitoring of quality. Again per the Complaint, Precyse should have engaged in more rigorous monitoring and oversight of its offshore partner, should have been using certified transcriptionist/editors, and should have been following AHDI’s Quality Assurance “standards.”

The Defense attorneys had their work cut out for them. Clearly a patient had died due to clinical negligence. The “series of unfortunate events” that resulted in this outcome were contributed to by every named party in the Complaint. Each defendant brought unique legal representation and a bevy of subject matter experts, and each one claimed no fault in the patient’s death. The nurse claimed she was only following the doctor’s orders. The doctor claimed he could not be responsible for an error in a discharge summary he had not seen or signed and that the hospital had behaved unethically when it refused to unbundle the original MAR and created an unverified secondary MAR. The transcription companies claimed they had no legal liability for patient care outcomes and that the Joint Commission holds the physician responsible for authenticating a document before it is used for clinical decision-making. And the hospital pointed to every other named party in the Com-plaint, blaming the nurse for administration, the doctor for negligence over his record, and the transcription companies for negligence in ensuring quality and accura-cy. The buck was passed…and passed…and passed again.

The ImplicationsThe jury returned with an inarguably biased verdict,

holding only the hospital and the transcription compa-

nies responsible for this outcome. In re-ality, all parties were partially to blame, but the two people most historically ac-countable for care outcomes (the physi-cian and the nurse) went largely unscru-tinized by the plaintiff and unmentioned in the verdict. How is that possible? The scapegoat of an offshore transcription program undoubtedly clouded the facts of the case, making it easy for a jury to ignore the responsibilities of the clinical team and cast blame on a foreign source of error.

But the most compelling question for this industry is this: Should the medical transcription companies have even been named in the case? Should a documentation service be held liable for medical malpractice? The jury certainly believed that the error originated in documenta-tion, and thus, a significant portion of the blame rested there. A great deal of time was spent in deposition and in the courtroom examining AHDI’s quality guidelines to determine whether the transcription companies were engaging in rigorous quality assurance practices. AHDI’s reference to a “critical error” as one that can impact patient safety reinforced the plaintiff’s argument that transcriptionists should not be making documentation errors that have the potential to “kill” the patient. Neither the plaintiff’s attorney nor the jury were interested in en-tertaining the argument that no matter how rigorous your QA practices are, error in the record is not only likely but inevitable. And for that reason, the transcription industry could not possibly shoulder the burden of care decisions made on the basis of an unsigned record.

What should the response of AHDI and the clinical documentation industry be to this case? How does this outcome impact HIM departments and outsourcing deci-sions? The downstream impact of this case is unclear, though certainly there is now a precedent in place for more malpractice and wrongful death cases of this na-ture. AHDI and the industry should consider the follow-ing suggestions for leveraging this case on behalf of the industry:1. Issue a public response. The case provides AHDI with a golden opportunity to issue a public statement/ release in response to the case around liability and the importance of quality standards and credentialing.2. Advance the argument for credentialing. Given the reality that the hospital HIM department bore the

brunt of this vacated verdict (and presumably the brunt of the settlement), the case affords AHDI with an unprecedented opportunity to advance the argument for transcription credentials with AHIMA. 3. Clearly define liability. The industry needs a clear statement and supportive documentation that define liability for the HIM documentation space. AHDI should work with AHIMA to shape a position statement and guidelines for defining legal liability.4. Engage the Joint Commission. Where acute care facilities are concerned, the Joint Commission is the governing authority on policy and practice. AHDI and AHIMA should work closely to engage the Joint Commission around the facts and outcome of this case so that the JC can reinforce its position on physician authentication to its accredited hospital base.5. Review and amend QA Best Practices language. AHDI should revisit its current QA guidelines to strengthen liability language around physician authentication and better clarify the role of retrospective review and scoring as a training measure. The association should likewise consider clarifying its explanation of critical errors in a way that cannot be used to assign liability to transcription in a court of law.

At the end of the day, this was a tragedy of decision-making, but it can serve as a touchstone for this industry moving forward to right-size and strengthen our positions and practices. P

lea Sims is the former Director of Professional Practices for AHDI, author of The Book of Style for Medical Transcription 3rd edition, and current Chair of the AHDI’s Credentialing Commission for Healthcare Documentation (CCHD). Sims was a key witness for the Defense in the Sharon Juno case, testifying on the stand in Baldwin County around transcription standards, best practices, and prevailing policies.


Debra Jones

I’ve been a medical transcriptionist/editor/medical language specialist since 1994. Anyone who has been around in this business through these tremendous

changes has probably done the same thing—add one title after another to the job description. When I started, I worked in-house at a small rural Oregon hospital. I knew the physicians because we’d greet each other passing in the hall. Sometimes we’d sit at the same table for lunch in the cafeteria. Every report was transcribed, although we did use normals for the physicians already back then. I started out with ER reports and discharge summaries, and my supervisor worked closely with me as I pro-gressed to consultations and operative reports.

I have been an at-home healthcare documentation specialist since 1997. The hospitals I transcribe for are rarely in my state. I have never met any of the physicians

whose voices I hear on digital recordings. I have never even personally met my supervisor. Editing makes up 90% of my work volume.

Do I understand the need for greater efficiencies in today’s healthcare delivery system? Of course. Anyone not living under a rock these days knows that there are more people on our planet who need medical care and that governments and businesses alike do not have unlimited funds with which to finance this care.

I have belonged to AHDI for a number of years. I first joined when it was still AAMT. I have read all the articles about how what we do is so important, now more than ever. I have read how important it is for us to know what is in our personal medical record. I have read these articles and others and warned family members for years not to go to the ER alone, and to try to have a family member with them when they are really sick in the hospital.


It ReallyDoes Matter


With all that experience, I still felt that my job wasn’t very important. Line rates are less than they were 18 years ago when I started. I have no personal relation-ship with the physicians whose voices I hear on digital recordings. I have to correct ridiculous errors generated by speech engines. I lost the “spark” that motivated me when I first entered the field.

I have always had what my family dubs a “sensitive” stomach. Neither my mother nor I can remember the times she took me to see our family doctor as a kid. Sometimes symptoms would become quiescent; other times, they were quite bothersome.

Two and a half years ago, my nurse practitioner and I agreed it was time to have someone take a “look-see” to find out what was going on in my gastrointestinal system, and I underwent both an EGD and a colonoscopy. The colonoscopy was unremarkable. The pathologist reported that random biopsies demonstrated increased duodenal intraepithelial lymphocytes in the absence of villous atrophy that could be suggestive of early celiac disease. The EGD showed a small hiatal hernia. Noth-ing spectacular on either study. I was referred back to my nurse practitioner with the advice to take an H2 blocker and, if that was ineffective, to try a proton pump inhibitor.

I talked with my nurse practitioner. I took ranitidine daily and tried to watch my diet. That seemed to work for about a year and a half. About a year ago, I began having what I came to call “attacks.” I had increased abdominal pain and bouts of vomiting that could last for hours. I stayed in contact with my nurse practitioner, and we discussed possible diagnoses. The next step was diagnostic imaging. My NP was ready to proceed, but tried to hold off due to costs and my busy life.

During a couple of these attacks we tried to get some lab work done while it was happening to point us in a direction. Unfortunately, I live in a rural area, 50 min-utes away from her office. She either had a full day of patients scheduled or I would convince myself that it was because of too much stress, not exercising enough, or some other justification. Perhaps having been an MT all these years and transcribing reports for patients diagnosed with “functional abdominal complaints” after spending thousands of dollars on tests unconsciously

influenced me as well. One Saturday night in May, I had the worst “attack”

I had ever experienced. I laid on the floor, as I could find no position of comfort in bed. It was severe enough to scare me. The next morning, I got up and went to the ER.

My husband wanted to come along that morning. I persuaded him it wasn’t necessary. Waits in the ER can be long. I worked in a healthcare-related field. Certainly I could speak for myself and express myself clearly.

Unfortunately, the hospital did not have an ultrasound tech available that Sunday morning, one of the main reasons I finally decided to go to the ER while symp-toms were acute. The diagnoses were gastritis and acute pancreatitis. I was discharged home with Zofran, Protonix, and hydrocodone.

Even though I asked for copies of my labs several times, I was told that my NP would need to request them. I was in her office two days later, at 8:30 a.m. Incredibly, my lipase had been 7100, amylase 1649, AST 621, and ALT 447. That was shocking enough, but reading the report the ER physician had written of my ER visit topped that by a mile.

I told him I had not had more than 1-2 drinks in the past 3 weeks, but that was reported as, “recently she tells me that she stopped drinking alcohol.” I had attempted to say I was not a regular, heavy user of alcohol. I thought I said, several years ago I drank 1-2 drinks a night, 4-5 nights a week. That turned into, “she said she drinks one to two alcoholic drinks per night at least seven days a week and sometimes four to five alcoholic drinks per night.”

While I innocently sat in the ER, calls were made to other area ERs to check on my record of visits there. Even though I had not been to another area ER in years (I have had a total of three ER visits my entire life), my record reflects that “they have somebody with the same name but slightly different birth date and different PO box number. The patient did present to [that hospital] in March for a similar episode.” Indeed, I had not. Maybe the tip-off should have been the slightly different birth date and different PO box number.

All I can say is, thank God for my NP who has known


me for 20 years and knew the record was not accu-rate. After my visit with her that day, I went home and contacted the hospital to start the process of “Request to Amend Protected Health Information.” In all, I delin-eated four errors in the physician’s History of Present Illness, one error in my Past Medical History, one error in my Physical Examination, and two errors in the Emer-gency Department Course.

The ER physician did not even get the description and location of my abdominal pain right. Throughout all of this, I had never had pain in my right upper quadrant that would be typical for a gallbladder. My NP documented that I was clearly jaundiced with scleral icterus when I went to see her. The ER physician noted twice that my sclerae and pupils were anicteric. It is clear he used templates for my physical examination which did not correlate with the true findings.

Lab results two days after my ER visit returned show-ing an AST of 82, ALT of 236, amylase of 97, and lipase of 67. Hepatitis panel was normal. By the time I returned again to my NP for follow-up, all values had returned to normal. AST was 18, ALT 27, amylase 50, and lipase 49. Not bad for someone accused of being a chronic habitual alcoholic.

Next stop for me was imaging. Right upper quadrant ultrasound showed “numerous shad-owing gallstones

largely filling the gallbladder but noted to be mobile with changes in position. There is some associated sludge.” CT scan report stated, “The gallbladder contains layer-ing dependent material consistent with a combination of gallstones and sludge.” Liver was unremarkable, i.e., no evidence of fatty liver as can sometimes be seen with alcoholic cirrhosis or liver disease.

Throughout this process, I continued to share results of my follow-up examinations, lab results, and imaging with the hospital where I had been seen in the ER. Con-fident that I confirmed everything I had indicated as an error in the ER report through subsequent reports from my nurse practitioner and diagnostic studies, I felt sure the ER physician would agree that errors had been made in my report—errors potentially damaging to me should I ever have to change insurance carriers.

I ultimately underwent a laparoscopic cholecystec-


tomy at a different hospital two weeks after being seen in the ER. The surgeon was clear in his report that I had “developed acute pancreatitis with appropriate elevation of enzymes and liver function studies that seemed to be related to the passage of common duct stones.”

In the operation, a “myriad of adhesions were taken down, and the duodenum was stuck to the undersurface of the gallbladder. There was some bleeding, and there was a lot of bared parenchyma of the liver.” I ended up with a J-P drain in my stomach and a three-day stay in the hospital because of continued nausea, vomiting, and slow return of bowel function. The drain was removed on the fourth day. The actual postoperative diagnosis was “acute and chronic cholecystitis with cholelithiasis, probably passed choledocholithiasis, and pancreatitis by enzymes.”

The pathology report confirmed “chronic active calcu-lous cholecystitis, cholesterolosis, and adenomyomatous hyperplasia.” It also states that “several of the small stones are found blocking the cystic duct.”

At this point, I shared the operative report with the ER physician, and I felt certain that the requested changes would be made to my ER report, deleting the errone-ous reference to excessive alcohol use on my part. The source of my elevated amylase, lipase, and liver function tests was clear.

Funny thing about physicians in this day and age of medicine malpractice—they do not like to come close to admitting anything that sounds like a mistake.

In the amendment, regarding the issue of alcohol use, he stated, “I feel that this is the one area where, perhaps, she does have a point. I did not mean to imply that she was an alcoholic, but I did feel that this may be exacer-bating her, either gastritis or pancreatitis.” I don’t know what else stating that I drank 7 nights a week or 4-5 drinks a night would imply. He stated again, “I did not mean to imply that she was an alcoholic, but I do recall that she told me she had been drinking more alcohol than usual, sometimes 4-5 alcoholic drinks per night, was, I think, in reference to a distant past, and a reference to the most she has ever drank in her life.” (Verbatim.)

I have spoken to an attorney regarding this matter. It means that much to me that my medical history is recorded correctly. Lawsuits, of course, are founded on a claim being made for financial damages. I can prove no

financial damage at this point unless or until some day when I am denied medical coverage or put into a high-cost, high-risk insurance pool because of being cast as a chronic alcoholic.

To summarize, here is what I hope you get out of this:1. What we do as MTs matters. It is vitally important that patients everywhere have an accurate, concise history of their medical care. That is probably the biggest gift I have received from this whole experience. The “spark” has come back. I am again proud to say I am a medical transcriptionist. I have learned firsthand the havoc that can be caused in patients’ lives when incorrect information is put in their record. 2. As I have been telling family members for years, if you can help it, don’t go to the emergency room alone. If you are admitted and are quite sick or have undergone surgery, arrange to have family or a friend sit with you. 3. Make sure you keep a personal folder—whether that be paper or electronic—of your medical history. I am lucky in that I have been seeing the same nurse practitioner for almost 20 years. She knows and trusts me, and I have ready access to 20 years of my medical history through her files, which is unusual in this day and age. People move, physicians retire, medical offices close, and it becomes difficult if not impossible to track down old records. If something ever does come of this ER report, I will have a 20-year track record of seeing the same healthcare provider with no indication of exams or lab results to indicate I was an alcoholic or heavy alcohol user. 4. Make sure the physician hears what you say. If you have any doubt, ask them to reiterate. Repeat what you said. It’s important that they get it right. Getting it wrong can have bad consequences for you— financially and emotionally. P

deb Jones has been a healthcare documentation special-ist for almost 20 years, witnessing lots of changes in the field over that time, with more yet to come. Whatever hat you wear wherever you work, she hopes that sharing her personal experience will remind you that what we do is important and something we can take pride in doing.


As healthcare documentation specialists (HDSs), we envision ourselves as team

players, working in concert with patients, clinicians, and health information management (HIM) and health information technology (HIT) professionals as partners; sometimes referred to as the silent partners in health care, often thought of as patient advocates.

Some would argue our core transcription responsibility in its purest form means

“only” to make a full written or typewritten copy of dictated material, never to deviate from the author’s word, edit, place blanks or flag, and always to give the clinician the final say. Others might emphasize our true skills lie in production, grammar, punctuation, style, and looking up referring doctor names and addresses. Then there is the debate over verbatim transcription versus appropriate editing. Traditional dictation/transcription practice and editing comes with an inherent amount of subjectivity; hence AHDI’s emphasis on credentialing, life-long learning, approved education programs, standards and best practices in education, editing, auditing, researching, and ensuring quality content and patient health records with integrity.

Did the HDS hear that right? Even if the documenta-tion professional heard it correctly, is that really what the clinician/author meant to say? That phrase “meant to say” is extremely potent. It wields the power of how our skills reflect much more than purely replicators of

dictated words. The phrase also implies a world where dictation/transcription is the sole source of patient care encounter data capture, a world we know no longer holds true. Documentation of the patient experience by a clinician has taken on myriad forms. We have dictation to speech recognition, sometimes with clinician editing or not, sometimes with back-end speech editing by an HDS professional, and oftentimes without any further quality assurance or clinical documentation improvement review. We have the electronic health record in its variety of presentations, vast or inadequate drop downs, options to copy/paste, insert normal templates and macros, auto sign and auto populate, often lacking any form of quality control. The future of speech recognition projects the promise of speech intelligence—an auto-fill option where a clinician’s typical phrases could be placed within the record at the touch of a button with a computer algorithm suggesting what the author meant to say.

I believe there is overwhelming evidence that the responsibilities reflected in our knowledge, skills, jobs responsibilities, and career paths are so much more than purely transcribing exactly what clinicians say, particularly because we now have so many forms of documentation capture; hence the name change of the association, the professional title change to healthcare documentation specialist (HDS), and the evolution of our credentials to Registered Healthcare Documentation

Health Information Documentation: Who Owns the Quality

of the Information?Karen L. Fox-acosta, CMT, aHDI-F

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Specialist (RHDS) and Certified Healthcare Documentation Specialist (CHDS). What remains to be seen is the rel-evance of that evolution in today’s healthcare marketplace and competitive business models. Can we really be seen as more than just typists or medical secretaries, and are we, as individuals and as a collective industry, ready to step up and bear the weight of a title that reflects so much more than being the messenger but instead an inspiring member of the patient safety and risk management team focused on elimi-nating sentinel events in patients’ lives that could occur due to medical record errors or health information that lacks the nuances and uniqueness of that individual patient’s story?

Patients, clinicians/authors, healthcare documentation specialists/medical transcription service organizations (MTSOs), clinician authentication, and healthcare enterpris-es/facilities/medical offices hold the qualitative responsibil-ity to create, document, and provide a patient care record with integrity; one that withstands the test of being useful for real-time clinical decision-making, one that provides safety for patients and mitigates risks, as well as rendering a record that is supportive of reimbursement requirements. These areas lend themselves to further scrutiny as we look further into who owns the integrity of patients’ health information.

The patient owns quality and integrity of information during the patient encounter as information passes from patient to clinician/author.

Patient Care Encounter—The Patient

POTEnTIal RISKS• Mistakes due to inadequate, erroneous, incomplete or copious patient-generated information• Omission of critical information due to length and/or complexity of care encounter• propagation of researched symptoms or patient self-diagnosis • errors and omissions due to compromised clinician attention (divided between patient and eMR/eHR)

aHdI adVOCaCY EFFORTS, PROdUCTS, SERVICES, mEmBERSHIP BEnEFITS• public education on the value of a well-constructed personal health record (pHR & Your Record Speaks website and public awareness campaign)• promotion of the dictation/transcription process as the fastest, most economical means of building a robust record and preserving physician attention on frontline care

Responsibility for information integrity then shifts to the clinician/author who compiles relevant data to generate the care record.

Clinician Capture—The author

POTEnTIal RISKS• errors and omissions due to poor clinician retention of care encounter details • Mistakes in data entry (eMR/eHR) • Inaccuracies in dictation (wrong words or values, transposed terms, nonpertinent info, etc.)• errors resulting from poor dictation quality (speed, clarity, background noise, disorganized speech, challenges of english as a second language, etc.)• Technology-enabled errors (self-created terms, copy/ paste from past reports, erroneous templates, haste in using pick lists, wrong selection by accident or intentional by ease of access, coding expectations and, MU2 and MU3, aCO-reporting requirements)

aHdI adVOCaCY EFFORTS, PROdUCTS, SERVICES, mEmBERSHIP BEnEFITS• promotion of standards of practice via aHDI’s Dictation Best practices tool kit to connect quality clinician input to quality documentation output• promotion of HDS as qualified peer to support quality- focused migration to the eMR/eHR and provide risk management and quality assurance analysis of eHR-captured clinical data

In traditional dictation/transcription, speech editing, EHRs with partial narrative option, and quality assur-ance review, the weight then transfers to healthcare documentation specialists and healthcare documenta-tion business owners who partner with the clinician/author to ensure accurate data capture. In other forms of data capture (clinician front-end speech, point-click EHRs, once-and-done documentation, EHR scribes), the burden of accuracy and completeness typically bypasses a quality/integrity review touch-point in the workflow process and moves directly to authentication.

Healthcare documentation Specialists and Business Owners

POTEnTIal RISKS• Mistakes in documentation due to inadequate transcription/ editing skills• errors in speech recognition due to absence of, poor, or inadequate back-end speech editing• errors and omissions perpetuated in the record due to failure to flag for review• pressures of turnaround time that force production over quality

http://www.ahdionline.org/ProfessionalPractices/ToolKits/PHRFacilitatorToolKit/tabid/442/Default.aspx

http://yourrecordspeaks.org/

http://ahdionline.blogspot.com/2013/08/your-record-speaks-walking-public.html

http://www.ahdionline.org/ProfessionalPractices/ToolKits/DictationBestPractices/tabid/270/Default.aspx

http://www.ahdionline.org/Portals/0/downloads/MTs_as_EHR_Facilitators_Flyer.pdf

• Variance in standards and business best practices • Inaccuracies due to unfamiliar dictation/authors, first-in/ first-out pressures; multiple accounts, specialties or work types; multiple and conflicting client profiles• errors perpetuated via inadequate training, lack resources, or access to tools like author samples • Failure of proper knowledge or use of research tools and techniques

aHdI adVOCaCY EFFORTS, PROdUCTS, SERVICES, mEmBERSHIP BEnEFITS• promotion of a defined scope of practice and professional standards using The Book of Style for Medical Transcription• establishment of credentialing as standard of practice to ensure appropriate skillset for access to clinical records • Compliance with privacy & security standards like BOS, HIpaa education, Compliance Best practices Manual• Cultivation of standards and best practices for clinical documentation training programs—aCCp education approval program• Open access to verbatim transcription position paper• promotion of standards of practice in quality assurance through use of Healthcare Documentation Quality assessment and Management Best practices• Recognition of relevant value of HDS through circulation of equitable compensation position paper• advancement of standards of practice through widespread use of BenchMark KB• establishment of best practices through utilization of Turnaround Time (TaT) guidelines

The ultimate accountability then passes back to the clinician/author for the review and authentication process. Healthcare enterprises via coding, HIM, HIT and other entities in the work flow continuum have touch-points that shoulder some of the burden of health information with integrity through policy creation and implementation of procedures that focus on the quality, accuracy, and completeness of health information that is unique to each patient prior to authentication; however, most often, healthcare facilities assume once “signed by the clinician” everything is as it should be.

Clinician authentication— The Healthcare Enterprise/Facility

POTEnTIal RISKS• errors in final documentation due to inadequate clinician review• errors perpetuated due to lack of clinician review (flagged items left blank or uncorrected, auto-signature, “Dictated but not read” indicators, etc.)• Insufficient policies/procedures or enforcement of p&ps by healthcare enterprises regarding authentication, author review, and/or automated signature best practices• Insufficient p&ps, standards, or compliance with quality assurance best practices • Inadequate error data collection propagating lack of knowledge of scope of problem• Inadequate protocols to verify accurate and complete patient health information• errors exponentially replicated in the interoperable eHR and health information exchanges• emphasis of health information capture primarily for revenue generation or cost savings versus clinical decision making and building content-rich patient health stories to provide better patient care• pervasive culture in healthcare delivery that keeps patients in the dark about their own health records• Inadequate knowledge and oversight by regulatory bodies to ensure accuracy, completeness, and health information that is unique to each patient

aHdI adVOCaCY EFFORTS, PROdUCTS, SERVICES, mEmBERSHIP BEnEFITS• public education around the importance of an accurate health record and consumer engagement in health record review—Your Record Speaks and Walking pSa - a Medical Record Can Mean Life or Death• advocacy and alliance building with the Joint Commission, Health and Human Services (HHS), Office of National Coordinator (ONC), american Health Information Management association (aHIMa), Health Information and Management Systems Society (HIMSS), american Medical association (aMa) to address error rates in the health


http://www.ahdionline.org/ProfessionalPractices/BestPracticesandStandardGuidelines/BookofStyleforMedicalTranscription/tabid/282/Default.aspx

http://www.ahdionline.org/Certification/tabid/524/Default.aspx

http://www.ahdionline.org/ProfessionalPractices/BestPracticesandStandardGuidelines/ComplianceBestPracticesManual/tabid/443/Default.aspx

http://www.ahdionline.org/Careers/NewMTTraining/AboutEducationProgramApproval/tabid/210/Default.aspx

http://www.ahdionline.org/AdvocacyPublicPolicy/WhereWeStand/AHDIPositionStatements/AHDIStatementonVerbatimTranscription/tabid/165/Default.aspx

http://www.ahdionline.org/LinkClick.aspx?fileticket=f3sQg96ixiQ%3d&tabid=601

http://www.ahdionline.org/AdvocacyPublicPolicy/WhereWeStand/AHDIPositionStatements/RolesandValueofHealthcareDocumentationSpecia/tabid/690/Default.aspx

http://www.ahdionline.org/BenchmarkKBOnline/tabid/283/Default.aspx

http://www.ahdionline.org/ProfessionalPractices/BestPracticesandStandardGuidelines/TranscriptionTurnaroundTime/tabid/273/Default.aspx

http://ahdionline.blogspot.com/2013/08/your-record-speaks-walking-public.html

http://www.ahdionline.org/AdvocacyPublicPolicy/Advocacy/tabid/175/Default.aspx


record and quality pre-documentation and post- documentation review• Improving the accuracy of Narrative patient Notes - 2009 error abstract • Four-pillar strategic plan to include goal to collect data of medical/health record errors regardless of capture method• Creation and access to aHDI’s eHR Toolkit

Each of the complex core pillars explored have their own attendant risks. AHDI has worked diligently to ad-dress the potential risks and deliver solutions to the in-dustry, workforce, AHDI members, healthcare providers and consumers through advocacy tools or standards of practice to diminish patient safety concerns and provide effective risk management.

Ultimately, we all bear a collective accountability to the question of who preserves the quality of patient health information. Our industry and HDS profession-als play a significant role in obtaining the best possible outcome along the work flow path, yet the clinician car-

ries the definitive liability as the author of patient health records, and it is patients who could pay the ultimate price for records that are incomplete, inaccurate, or contain misinformation. We aim to see a resurgence of our relationship with clinicians/authors as critical team members of the workflow process, and also recognition within the entire healthcare system, as we demonstrate how our skills protect the integrity of patient records, culminating in the primary goal of improving popula-tion health and lowering risks. P

This article was written by Karen L Fox-Acosta, CMT, AHDI-F, based on a patient safety project devel-oped in conjunction with Lea Sims, CMT, AHDI-F.

Karen l. Fox-acosta is AHDI Immediate Past President 2013-2014, and has been a member of AHDI for over 10 years. She works as a quality assurance manager for Shumaker Transcription Services and has been in the healthcare documentation industry for 16 years.

This widely acclaimed industry standards manual has long been the trusted resource for data capture and documentation standards in healthcare. The 3rd edition delivers a streamlined and strategically reorganized flow of critical data, enhanced explanation of standards and practical application, robust examples taken from clinical medicine settings, trend

notes that identify the impact of technology on the state of the industry, and new chapters on security/privacy,

standardized templates and nomenclatures, the electronic health record, and speech recognition

editing.

The BOS 3rd edition is available for purchase

online at www.ahdionline.org.

3rd edition price: $50 members, $70 nonmembers.

The Book You Reach for MostThe Book of Style for Medical Transcription, 3rd edition.

Chapter 1: Types, Formats, and TATs

For coated:

Blue: 534Green: 382

For uncoated:

Blue: 547Green: 380

http://www.ahdionline.org/Portals/0/downloads/Dictation Error Report Abstract.pdf

http://www.ahdionline.org/GetConnected/Leadership/NationalLeadershipBoard/tabid/634/Default.aspx


My Career Path–From MT to Ninja.Wait, What?Sheryl Williams, CMT, aHDI-F

This column is dedicated to providing examples of healthcare documentation specialists who are actively seeking and embracing new and/or expanding roles.

IN THe LIMeLIgHT

Kat King’s career path start-ed in medical records in “pre-electronic” 1974 and

subsequently included many years as a medical transcriptionist and a business owner. She acquired and utilized various skill sets along the way, including a comprehensive knowledge of medical terminology, pharmacology, labs tests, procedures and critical thinking skills. She has an interest in technological advanc-es, the ability to “play well with oth-ers,” and access to a vast amount of information and experiences through being an engaged member of AHDI. Little did she know that these skills and experiences would eventually serve her well in her new role as an “electronic medical record Ninja.”

Circumstances presented them-selves a few years ago necessitat-ing a detour in Kat’s career course. Having been intrigued by electronic medical records and realizing the inevitability of universal adoption of these systems, Kat decided to embark on an educational and occupational journey to, as she puts

it, “embrace the Dark Side.” As Kat had no prior college

credits, she needed to start from scratch from an educational standpoint. Following three years of juggling school and work, she attained associate degrees in general studies and healthcare informatics from Rogue Community College near her home in southern Oregon. She is now pursuing a bachelor’s degree from the Oregon Technology (OIT).

Meanwhile, Dr. Kathleen Myers, an emergency physician, recognized the need for medical scribes and founded Scribes STAT, based in Portland, Oregon. The business later expanded into offering support for EMR implementations. A new position, called EMR Tutor, was created. Scribes STAT began working with local colleges to recruit employees for these new and expanding roles. EMR tutors are contracted to work on-site at facilities during the first several weeks of an EMR imple-mentation. Kat was hired by Scribes STAT to help provide “at the elbow” support for providers, nurses, and support staff learning to navigate a new EMR. The tutors work directly with facility staff, called “Super Users,” certified platform trainers, as

well as IT analysts from both Epic and Paragon/McKesson. The tutors provide feedback with regard to po-tential privacy concerns, especially the usage of workstations on wheels (WOW) units in public areas. They


help to identify and trouble-shoot implementation glitches, and offer optimization of physician order sets, macros and templates.

Since being employed by the com-pany, Kat has had many memorable experiences. The term “Ninja” has been applied as a term of endear-ment referring to the fact these EMR tutors, who wear black scrubs, seem-ingly appear out of nowhere to help solve whatever problem arises. EMR tutors help determine whether an issue relates to system design, system implementation, or user education. They are able to un-derstand the “big picture” and the significant down-stream impacts of process changes. Following the designed workflow within an EMR is paramount to successful data cap-ture, retrieval and continuity of care.

Scribes STAT provides EMR sup-port at all levels of the healthcare process; but the EMR should never get in the way of providers and clini-cal staff from providing care. One example was when Kat and another tutor were urgently paged to the op-erating room because a patient being prepped for surgery suddenly devel-oped a catastrophic gastric bleed. The anesthesiologist was not accus-tomed to using the system to order blood products, which is a complex process. Before entering the OR, they needed to follow strict scrub-in protocols. It was quickly determined, due to the emergent nature of the situation, to temporarily bypass the

system and utilize a manual process. All the necessary documentation could be done once the patient was stabilized.

Recently Kat was covering the obstetrical/NICU floors, during which time several sets of multiple births occurred. Something as seem-ingly simple as naming conventions for newborn babies can create huge system data problems if not followed consistently.

Kat has been complimented on her calming demeanor when approach-ing problems. Through her efforts she has been welcomed as a valued member of the healthcare team. She points out this role takes you out of your comfort zone, behind a com-puter screen, and into the real-time “live action” of the hospital or ambulatory setting.

Kat states medical transcription-ists are perfectly positioned to enter this new career field and are being recognized as an untapped resource. However, she cautioned that pursu-ing additional education is critical. The combination of an appropriate degree, technological knowledge, healthcare documentation expertise, and soft skills will enable an MT to successfully navigate this transition. She added that many colleges and online schools now offer excellent programs in healthcare informatics. The role of an EMR tutor is just the tip of the iceberg of evolving and expanding roles within the health-care informatics arena, and could be

a viable option for many MTs. Some of you may recall a late

1980s phenomenon known as the “Teenage Mutant Ninja Turtles.” These turtles remained isolated from society except when their services were required to battle crime, evil, aliens, etc. Each of the four was named for a Renaissance artist. Somehow it seems especially fitting that Kat King has come full circle and has been reborn as an “electron-ic medical record Ninja.” P

Sheryl Williams has been employed in healthcare documentation since the Reagan administration. She cur-rently works for Command Health. Sheryl is serving on the AHDI Na-tional Leadership Board as District 3 Director. She lives on a small farm near beautiful Red Wing, Minnesota.

Many healthcare documentation specialists are speculating about what the future holds for them; others are taking steps to ensure their place in the evolving workforce.

We would like to hear from you on this topic! The focus of this column will be to highlight healthcare documentation specialists who are utilizing and/or enhancing their skills by performing in unique, nontradi-tional, and expanding roles.

please forward a brief summary of the person or position you would like us to know about, as well as your contact information, to Sheryl Williams CMT, aHDI-F, at [email protected].


As healthcare documentation specialists, we are often on the clinical side of medicine,

transcribing or editing the physician point of view: the medical terms, treatments, and recommendations. Often, we don’t experience the patient’s point of view. For this article of Life UnSedentary, I did just that. I interviewed three gracious women who offered intimate details on their personal battles with weight loss and their experiences with Roux-en-Y gastric bypass surgery as a tool to help overcome obesity.

Roux-en-Y gastric bypass (RYGB) is a type of weight loss surgery that reduces the size of your stomach to about the size of an egg by stapling off a section of it, which reduces the amount of food you can consume at meals. The surgeon attaches this pouch directly to the small intestine, bypassing most of the rest of the stomach and upper part of the small intestine. The procedure reduces the amount of calories and fat your body absorbs from the foods you eat, resulting in additional weight loss. RYGB can be done laparoscopically or as an open procedure.

Ava Marie George, MBA, CMT, AHDI-F, who underwent RYGB in early June 2010, was motivated

to gain control of her weight by both her children and her health. “I wanted to live to see my children graduate from high school and college, for them to marry and have children. The potential for me to not see any grandchildren was a huge motivation. Secondary was my health. I had uncontrolled high blood pressure and adult-onset diabetes.”

Doctors generally recommend surgery only if you are severely obese—at least 100 pounds over-weight for men and 80 pounds for women. Karin Lucas, CMT, underwent an open RYGB in December 2002, and stated that

before surgery, “I could not get out of bed without help...it was embar-rassing to say the least.” Karin made the decision to undergo surgery at the age of 35. “I had type 2 diabetes, sleep apnea, high blood pressure, and I could not even walk around the block to get exercise and enjoy my two children.”

In addition, surgeons usually don’t recommend RYGB unless you haven’t been able to lose a large amount of weight and keep it off through diet, exercise, and changes in lifestyle, as was the case for patient Lori Follett, who underwent the procedure in late December

The Patient’s POV: An Intimate Look at Weight-Loss SurgeryRachel Quatkemeyer, CMT

LIFe UNSeDeNTaRY

2012. When asked what her deciding factor for surgery was, Lori states, “I have struggled with my weight for as long as I can remember. Over the years I just kept getting bigger and bigger. I have tried every diet you can possibly think of. I have lost weight like a pro, but I always gained it back and then some. I was finally to a point where I didn’t want to be involved in my life socially and knew I needed to change because I was missing too much. I wasn’t successful on my own and needed the tool that surgery would provide for me.”

While recovery from RYGB is about six weeks, Lori was “back to my old self” within two weeks, while Karin was bartending at her parents’ bar within one week of being released from the hospital. Ava states, “I had three C-sections before. This surgery was way easier than those surgeries.” Precautions were taken with Karin’s open RYGB procedure. “I was in the hospital for four days right after surgery, and I had to remain in Spokane, WA, where I’d had my surgery, for a whole month before I could go to my actual home 20 miles away, just in case there were any issues.” With a laparoscopic procedure, Lori was in the hospital about 24 hours.

Ava, Karin, and Lori together have lost enough weight to equal the size of a 9-foot tall adult ostrich, a weight loss of about 350 pounds collectively (losing over 100 pounds

individually) through Roux-en-Y gastric bypass surgery, and all of them state they would absolutely do it again, despite any complications they suffered. While Ava experi-enced no immediate postoperative complications, she later had exten-sive problems with malabsorption, which caused uncontrolled tachy-cardia, which in turn caused mini strokes. “I am fully recovered and on a strict regimen of vitamin and mineral supplements as well as three types of iron to keep my hemoglo-bin and hematocrit up. I also avoid greens to keep my potassium down.” Ava states that despite her more severe complications, the most difficult part of her experience was the diet. “I just could not eat. I could not taste food at all. I ate just to be

sure that I did not lose weight too fast. It took about two years for my taste to come back. I was on 100% liquids for about three months. I gradually moved up to solids, but it took about six months for me to be comfortable with food.” In spite of all that, Ava states, “I absolutely would still go through it again.”

In the face of being fed through a feeding tube for the first couple of weeks after surgery and undergoing four additional surgeries to release recurrent abdominal adhesions, Karin states she, too, would undergo weight loss surgery again. Like all RYGB patients, Karin underwent major changes in diet post surgery. For six weeks baby food was on her menu. “You should have seen the looks I received when I would bring


my baby food to the bar to eat at lunch when I worked...it was price-less!” Karin also states the biggest surprise was the amount of energy she experienced right after surgery. “It seemed like I could take on the world and didn’t need to sleep to rejuvenate at all. It was the most amazing thing, especially after years and years of being too large to even think about exercising without practi-cally giving myself a heart attack.”

All three women have had to change their eating habits and adhere to strict diets after surgery. Karin warns, “Be committed to changing your lifestyle for the rest of your life; there’s no going back,” and also states surgical candidates should be prepared to say goodbye to carbonated beverages, alcohol, cigarettes, and sugary foods. “To this day, I cannot have anything carbonated, as it makes me bloat up, and sugar is a huge no-no. I have to limit my sugars to 5 grams or less per serving—so you can tell, it’s a little bland.” Lori also limits her sugar intake and states that if she splurges on sugary treats, she will get very sick for several hours with nausea, vomiting, sweating, stomach cramping, and dizziness. For comparison, most flavored yogurts have around 20 grams of sugar per container, and these ladies are consuming no more than 5 grams of sugar per serving.

In addition to changing dietary habits, new habits have to be formed with regard to regular exercise to keep the weight off. Ava walks everywhere and is joining a health club, having recently moved to the health-oriented city of Loyola, IL. Lori works out at a gym four to five times a week for one and a half to two hours, focusing on cardio and strength training. In addition to changing exercise habits, Lori states that candidates should be prepared to dedicate themselves to a “massive amount of vitamin supplementation for the rest of your life.”

As you can see, gastric bypass is a BIG commitment, and Lori stresses that undergoing surgery is by no means a “quick fix” or “magic cure” for weight loss. This is not the easy way out. It involves possible complications and major lifestyle changes. Ava, Karin, and Lori have undergone tremendous life-changing transformations through Roux-en-Y gastric bypass surgery, and they encourage all surgical candidates considering the procedure to thoroughly research their options before making such a huge commitment. Health insurance may cover the procedure, but specific requirements may need to be met prior to coverage.

Thank you Ava, Karin, and Lori, for your contribu-tions to this article. I wish you immense health and happiness on your continued journeys!

As always, consult with your physician regarding weight loss, or consult a surgeon in your area to decide if surgery might be the right weight-loss tool for you. P

Rachel Quatkemeyer has been in the transcription industry for 10 years. She lives with her husband and two sons in Ravenna, Ohio. She can be contacted at [email protected].


LIFe UNSeDeNTaRY

eXeRCISe YOUR BRaIN

Answers on page 37

Brand-Generic Equivalents Word Search Instructions: Ten common brand name drugs are listed below. On the line provided, write the name of the generic drug for each brand name drug listed, then find and circle all 20 drug names in the puzzle below.

1. Xanax = _______________ 6. Synthroid = _______________2. Diflucan = _______________ 7. Zovirax = _______________3. prozac = _______________ 8. Flexeril = _______________4. prilosec = _______________ 9. Lopressor = _______________5. Zocor = _______________ 10. Neurontin = _______________



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Jane Warren, eLS

In 1978, Louise, a petite 38-year-old receptionist, felt so weak and hazy one day that she collapsed in her bedroom. She couldn’t move her left side and was

unable to hold a conversation. She continued to have occasional, unpredictable bouts of weakness, but she never sought medical attention. Louise didn’t have another one of these spells until 1998, three years after she married her second husband, Sebastian, a profes-sional ballroom instructor. It struck when she and her husband were dropping a relative off at the airport. Afterward, while in the car, she suddenly “felt funny” and “out of it.” Since the feeling went away quickly, she didn’t say anything to her husband.

They then stopped at a local restaurant. When Louise got out on the passenger side of the car, her legs started to give way, and the left side of her body felt as if it had just shut down. She managed to make it into the restaurant, but she collapsed once inside. She didn’t lose consciousness but felt foggy. Louise was able to get up with Sebastian’s help, and he drove her to the local emergency room. The emergency room staff thought she had a stroke because of the weakness on her left side. She couldn’t even hold a pen to write, and to add insult to injury, she was left-handed. In triage her blood pressure was extremely high. She underwent a battery of tests throughout the night, and her blood pressure was monitored and stabilized. She also underwent magnetic resonance imaging of the brain, which revealed multiple sclerosis.

What is multiple Sclerosis?Multiple sclerosis (MS) is a chronic disease of the

central nervous system (CNS) in which myelin, the fatty, protective substance that serves as an insulator for axons,

or nerve fibers, is attacked by our own body. The CNS includes the brain, spinal cord, and optic nerves.1 Like a teething puppy chewing on an electrical wire, MS eats away at the myelin, resulting in demyelination of these axons. Its onset is unpredictable because symptoms can either be gradual or sudden. They can appear at an instant but may not reappear until months, even years, later. These symptoms include weakness in one or more limbs, usually on one side of the body, visual problems such as double vision or visual loss, lack of muscle coordination, and an unsteady gait. In the later stages of MS, most people experience bladder dysfunction, extreme fatigue, and heat sensitivity. Symptoms occur because myelinated tracts in the CNS are disrupted; however, the peripheral nervous system is untouched.2

It has long been established that MS is primarily an autoimmune disorder. However, in recent years, research suggests that neurodegenerative mechanisms may also be involved, especially in the early course of the disease.3

How do these mechanisms strip the nerve fibers of their protective myelin? Before we discuss this salient point, let’s examine the four different courses of MS.4

disease Courses• Relapsing-remitting MS: This form of MS is the most common. An estimated 85% of people start with this disease course. The person may experience an acute attack or flare-up and then recover completely from the attack. Sometimes the recovery may be prolonged, but function usually returns to near baseline after the attack.• Primary-progressive MS: In this stage, neurological disability is more progressive, with almost no plateaus

CLINICALMEDICINE

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or remissions in between attacks. Neurological function steadily worsens. Approximately 10% of people experience this disease course. By the time a diagnosis is made, the patient will have already experienced neurological symptoms and much disability. • Secondary-progressive MS: This form occurs in roughly 65% of individuals who start with relapsing- remitting MS.5 People entering this phase have neurological decline. Disability is progressive, even between acute attacks, and patients have a harder time recovering after an attack. They also have fewer attacks. Time between onset of MS and transition from relapsing-remitting to secondary-progressive MS is approximately 19 years.• Progressive-relapsing MS: This form is the least common, occurring in 5% of the population. People with this form have progressive disability from the time of diagnosis but also experience clear acute exacerbations.

Pathogenesis of mS A well-established opinion of MS pathogenesis stems

from an animal model called the experimental autoim-mune encephalomyelitis model. Experts believed that T-lymphocytes in the immune system wreak havoc in the CNS by targeting the myelin. According to Vyshkina and Kalman, these T cells seep through the blood-brain barrier, proliferate, and attack oligodendrocytes (brain cells that support the axons) and myelin.6

However, in the 1990s, the scientific community identified a neurodegenerative process in MS indepen-dent of an adaptive immune response.7 This process occurs after an inflammatory response and demyelin-ation. T cells, B cells, plasma cells, and groups of cells that actively defend the CNS against foreign invaders partake in this inflammatory response. Thus, we now believe that neurodegeneration in MS involves a com-plex chain of events in which the myelin is no longer protected; axonal loss ensues; metabolism is disrupted; and, most importantly, mitochondrial function falters.6 These changes take place in different parts of the brain and spinal cord, targeting both gray and white matter.

Lassmann and van Horssen 8 describe the neurodegen-erative changes in MS according to disease stage:• During the early stages of MS, when most patients experience relapses and remissions, plaques or lesions form in the white matter. These plaques stem from inflammatory demyelination.• In patients with primary or secondary progressive MS, more degenerative changes are seen in the brain, such as demyelination in the cerebral and cerebellar cortex and degenerative changes in both white and gray matter. Also, patients with severe disease demonstrate atrophy in the brain and spinal cord, along with tissue loss and dilatation of the ventricles (cavities in the brain that contain cerebrospinal fluid).• The severity of inflammation in the CNS declines with patient age and duration of disease.• In patients with secondary-progressive MS, dense inflammatory cells are seen in the meninges, which may promote active demyelination and damage the cerebral cortex. This notion warrants additional studies.• Ironically, inflammation in the CNS may decrease in the very late stages of the disease in which the disease process “burns out.” Axonal injury also decreases. Iron accumulates in the brain during this burnt-out phase.

Possible neuroprotection and RemyelinationSome experts agree that loss of axons, not the extent

of the demyelination, results in neurological disability and maintain that neurodegeneration in MS still has yet to be fully understood. However, looking at MS as a neurodegenerative disease as well as an autoimmune disease could yield more effective treatments in the future. Such treatments could curb inflammation and provide neuroprotection and repair of damaged nerves.

Current TreatmentAfter Louise was diagnosed in 1998, her doctor

wanted to start treatment right away, but she refused for three years. During that time, she struggled with constant weakness and had difficulty keeping up with her beloved ballroom dancing. Finally, her doctor encour-aged her to take interferon, a drug that jump-starts the immune system and slows the progression of MS, which


she’s been taking faith-fully ever since. Once a week, like clockwork, Sebastian administers the drug to his now 73-year-old wife via an intramus-cular injection to her hip. She endures debilitating flu-like side effects for 18 to 24 hours after the injection and can only ballroom dance for a few minutes at a time because of constant fatigue. But she’s thankful for the interferon because she can still get around…and live. P

References1. National Multiple Sclerosis Society. What is Multiple Sclerosis? http://www.nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/what-is-ms/index.aspx 2. “The neurobiology of multiple sclerosis: genes, inflammation, and neurodegeneration,” Hauser SL, Oksenberg JR. Neuron 52, 61–76, October 5, 2006 (Ad-dress: Department of Neurology, School of Medicine, University of California at San Francisco, San Francisco, CA, USA) http://ac.els-cdn.com/S0896627306007161/1-s2.0-S0896627306007161-main.pdf?_tid=cb74c42c-031e-11e3-8d9c-00000aab0f6c&acdnat=1376291835_c5e56f2b505526708ec2f3363a23ec56.3. “Neurodegeneration in multiple sclerosis: novel treat-ment strategies,” Luessi F, Siffrin V, Zipp F. Neurother 12(9), 1061–1077 2012 (Address: Focus Program Trans-lational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), Department of Neurology, University Medical Center Mainz, Johannes Gutenberg University Mainz, Langenbeckstr 1, 55131 Mainz, Germany) http://www.expert-reviews.com/doi/pdf/10.1586/ern.12.594. National Multiple Sclerosis Society. Four Disease Courses of MS. http://www.nationalmssociety.org/about-

multiple-sclerosis/what-we-know-about-ms/what-is-ms/four-disease-courses-of-ms/index.aspx5. Wikipedia The Free Encyclopedia. Multiple Sclerosis. http://en.wikipedia.org/wiki/Multiple_sclerosis6. “Autoantibodies and neurodegeneration in mul-tiple sclerosis,” Vyshkina T, Kalman B. Lab Invest 2008;88(8):796-807. (Address: Veterans Administration Medical Center and Department of Neurology, SUNY Upstate Medical University, 800 Irving Avenue, Re-search (151), Syracuse, NY, USA) http://www.med-scape.com/viewarticle/580276 7. “Multiple sclerosis as a neurodegenerative disease: pathology, mechanisms and therapeutic implications,” Stadelmann C. Curr Opin Neurol 2011 Jun;24(3):224-9 (Address: Institute of Neuropathology, University Medi-cal Centre, Gottingen, Germany) http://www.ncbi.nlm.nih.gov/pubmed/214550668. “The molecular basis of neurodegeneration in mul-tiple sclerosis,” Lassmann H, van Horssen J. FEBS Lett. 2011 Dec 1;585(23):3715-23 (Address: Center for Brain Research, Medical University of Vienna, Spitalgasse 4, A-1090 Wien, Austria) http://www.sciencedirect.com/science/article/pii/S001457931100593X

Jane Warren, a former medical transcriptionist, is a freelance medical writer and a certified editor in the life sciences. She has been in medical communications since 1989 and has had her own business as a freelancer for eight years.

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CLINICaL MeDICINe

LeT’S TaLK TeRMSBeverly Sofko, CMT

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TeRM DeFINITION MaNUFaCTUReRKhedezla® (desvenlafaxine) extended-release tablets

amitiza® (lubiprostone) capsules

Recoveryaid back posture training device

aqualipo® (lunch-break lipo)

Gilotrif™ (afatinib) tablets

Ferkel™ thigh holder

Simponi® (golimumab) injection

astagraf Xl™ (tacrolimus) extended-release capsules

Brand name of the generic form desvenlafaxine, a serotonin and norepinephrine reuptake inhibitor (SNRI) for treating major depressive disorder. Avail-able as 50 mg and 100 mg extended-release tablets.

Brand name of the generic form lubiprostone, a prescription chloride channel activator for treating chronic idiopathic constipation in adults, irritable bowel syndrome with constipation in women 18 years or older, and opioid-induced constipation in adults with chronic, non-cancer pain. Available in 8 mcg and 24 mcg capsules.

Part of a line of postural training attire designed to help rehabilitate and stop back pain. The RecoveryAid works with the body’s own natural abilities to address and rectify body mechanics.

Referred to as lunch-break lipo, due to the minimal amount of time used to perform the procedure, a type of liposuction that uses a water jet fat removal method that helps to remove fat cells from the patient’s body. The procedure requires no anesthesia and claims to tighten skin with reduced bruising and swelling.

Brand name of the generic form afatinib, a kinase inhibitor for the treatment of metastatic nonsmall-cell lung cancer (NSCLC). Available in 20 mg, 30 mg and 40 mg tablets.

A holder that helps secure one’s thigh and provides counteraction during ankle arthroscopy surgery.

Brand name of the generic form golimumab, a prescription injection for treating moderately-to-severe active rheumatoid arthritis, active psoriatic arthritis, active ankylosing spondylitis and moderate-to-severe ulcerative colitis. Available as 50 mg given by injection.

Brand name of the generic form tacrolimus, a calci-neurin-inhibitor immunosuppressant for the prophy-laxis of organ rejection in patients receiving a kidney transplant with mycophenolate mofetil (MMF) and corticosteroids. Available in 0.5 mg, 1 mg, and 5 mg extended-release capsules.

Manufactured for Osmotica Phar-maceutical Corp., Wilmington, NC, by AAIPharma, Wilmington, NC. Distributed by Par Pharmaceutical Companies, Inc., Spring Valley, NY.

Marketed by Sucampo Pharma Americas, LLC, Bethesda, MD, and Takeda Pharmaceuticals America, Inc., Deerfield, IL.

Designed by Kelly Collier and Gary Chimes, PhD, MD, of ActivAided Orthotics, Pittsburgh, PA.

Distributed by Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT.

Designed by Smith & Nephew.

Manufactured by Janssen Biotech, Inc., Horsham, PA.

Manufactured by Astellas Ireland Co., Limited, Killorglin, County Kerry, Ireland. Marketed by Astellas Pharma US, Inc., Northbrook, IL.


CLINICaL MeDICINe

LeT’S TaLK TeRMS

TeRM DeFINITION MaNUFaCTUReRBloxiverz™ (neostigmine methylsulfate)

Vibativ® (telavancin) for injection

Breo™ Ellipta™ (fluticasone furoate and vilanterol inhalation powder)

latuda® (lurasidone hydrochloride) tablets

Zubsolv® (buprenorphine and naloxone) sublingual tablets

actemra® (tocilizumab)

oligoarthritis (oligoarticular juvenile idiopathic arthritis)

Brand name of the generic form neostigmine methylsulfate, an intravenous drug used for the reversal of the effects of nondepolarizing neuromuscular blocking agents after surgery. Available in 0.5 mg/mL and 1 mg/mL strengths.

Brand name of the generic form lipoglycopeptide, for treating adult individuals with complicated skin and skin structure infections brought on by gram-positive pathogens, including MRSA. Available in 250 mg or 750 mg single-use vials.

Brand name of the generic form fluticasone furoate and vilanterol inhalation powder, a prescription once-daily maintenance treatment that works by lessening inflammation in the lungs and helping the muscles surrounding the airways of the lungs remain relaxed to expand airflow and cut down exacerbations in those individuals with chronic obstructive pulmonary disease.

Brand name of the generic form lurasidone hydrochlo-ride, an atypical antipsychotic for the treatment of schizophrenia and bipolar depression. Available in 20 mg, 40 mg, 60 mg, 80 mg, and 120 mg tablets.

Brand name of the generic forms buprenorphine and naloxone, a partial opioid agonist for the maintenance treatment of opioid dependence. Available as 1.4 mg buprenorphine with 0.36 mg naloxone or 5.7 mg bu-prenorphine with 1.4 mg naloxone sublingual tablets.

Brand name of the generic form tocilizumab, a prescription injection for treating severely active rheumatoid arthritis in adult individuals, active systemic juvenile idiopathic arthritis and active polyarticular juvenile idiopathic arthritis in patients 2 years and older. Available in single-use vials of 80 mg per 4 mL, 200 mg per 10 mL, and 400 mg per 20 mL.

One of the seven types of juvenile idiopathic arthri-tis, this is an autoimmune disorder where the child’s immune system invades healthy cells and tissues. It is characterized only by joint inflammation and the de-velopment of arthritis in four or less joints in the first six months of the ailment. If the arthritis is limited to four or less joints after the first six months, then the ailment is labeled as persistent oligoarthritis. If more than four joints are affected after six months, this ailment is labeled as extended oligoarthritis. These ailments first show up before the age of 16.

Designed by Flamel Technologies who is headquartered in France and has operations in St. Louis, Missouri.

Manufactured and marketed by Theravance, Inc., South San Francisco, CA.

Developed by GlaxoSmithKline, NC, in concert with Theravance, San Francisco, CA.

Manufactured for Sunovion Pharmaceuticals, Inc., Marlborough, MA.

Manufactured for Orexo US, Inc., by AAIPharma.

Manufactured by Genentech, Inc., a member of the Roche Group, South San Francisco, CA.


CLINICaL MeDICINe

CMT CHaLLeNge QUIZ

Brett McCutcheon, CMT, aHDI-FCLINICAL MEDICINE

1 CEC

3 QUIZ

1. all of the following medications are comprised of two or more individual medications, except:A. Bactrim.B. Zetia.C. Unasyn.D. Vytorin.

2. The vaccine for this disease is derived from the vaccinia virus.A. polioB. tetanusC. measlesD. smallpox

3. a slit lamp is used in what specialty?A. otolaryngologyB. radiologyC. obstetricsD. ophthalmology 4. Epinephrine is also known as:A. serotonin.B. adrenaline.C. dopamine.D. histamine.

5. Bony swellings typical of osteoar-thritis are called ________.A. Heberden nodesB. ganglion cystsC. de Quervain syndromeD. Dupuytren disease

6. a thoracentesis would be performed for what condition?A. pleural effusionB. pneumoniaC. bronchitisD. emphysema

7. This vessel carries oxygenated blood from the lungs to the heart.A. inferior vena cavaB. pulmonary arteryC. superior vena cavaD. pulmonary vein

8. The adrenal glands are associated with which organ?A. liver.B. pancreas.C. brain.D. kidney.

9. Broca’s area can be found in the:A. brain.B. stomach.C. heart.D. liver.

10. Thrombocytopenia is a relative decrease in the number of:A. red blood cells.B. platelets.C. white blood cells.D. antibodies.

11. Which of the following is considered a neurologic disorder?A. multiple sclerosisB. muscular dystrophyC. Raynaud diseaseD. acrocyanosis

12. all of the following drugs are used to treat human immunodeficiency virus infection except:A. efavirenzB. tenofovirC. lamivudineD. acyclovir

13. The white surface of the eye is known as the:A. conjunctiva.B. retina.C. sclera.D. iris.

14. Which of the following is a bacterial disease?A. chicken poxB. acquired immunodeficiency syn-dromeC. Lyme diseaseD. infectious mononucleosis

15. Which of the following muscles can be found in the leg?A. platysmaB. supraspinatusC. vastus lateralisD. lateral rectus

16. all of the following are considered liver function tests except:A. creatinineB. alkaline phosphataseC. bilirubinD. albumin

17. Which of the following is a neurologic disorder characterized by lack of voluntary coordination of muscle movements?A. dysarthriaB. ataxiaC. peripheral neuropathyD. agnosia

18. The following drugs are common-ly used to treat schizophrenia except:A. haloperidol.B. risperidone.C. clozapine.D. fluoxetine.

19. Which of the following is associated with decreased levels of dopamine in the brain?A. epilepsyB. cerebral palsyC. schizophreniaD. Parkinson disease

20. This vein is located between the elbow and shoulder.A. basilicB. brachialC. ulnarD. subclavian

34 SEPTEMBER/OCTOBER 2013

anSWERS

1. answer: B. Zetia. Zetia (ezetimibe) is a cholesterol absorption inhibi-tor that can be found along with simvastatin in the combination drug Vytorin.

2. answer: d. Smallpox. The vaccinia virus causes the more mild disease cowpox, which confers immunity to smallpox.

3. answer: d. Ophthalmology. A slit lamp is used to examine the struc-tures of the eye.

4. answer: B. Adrenaline. This is a hormone and neurotransmitter pro-duced mainly in the adrenal glands.

5. answer: a. Heberden nodes. These are hard, bony growths formed in the distal interphalangeal joints.

6. answer: a. Pleural effusion. A pleural effusion is a buildup of fluid in the pleural space, which surrounds the lungs.

7. answer: d. Pulmonary vein. While vessels that carry oxygen-rich blood are typically arteries, the pulmonary vein is so named because the flow of blood in the vessel is toward the heart.

8. answer: d. Kidney. The adrenal glands (also known as the suprare-nal glands) sit atop the kidneys and are mainly responsible for releasing stress hormones such as adrenaline.

9. answer: a. Brain. Broca’s area is the region of the brain chiefly responsible for speech.

10. answer: B. Platelets. Platelets, or thrombocytes, are important in blood clot formation.

11. answer: a. Multiple sclerosis. This is an inflammatory disease in which the myelin sheaths, or insulating layers, of nerve cells are damaged.

12. answer: d. Acyclovir. Acyclovir is a nucleoside analogue and is effective in the treatment of herpes.

13. answer: C. Sclera. The sclera (or “white part of the eye”) is the protective outer layer of the eye.

14. answer: C. Lyme disease. Lyme disease is caused by certain species of bacteria in the genus Borrelia and is transmitted primarily by the deer tick.

15. answer: C. Vastus lateralis. This muscle is on the lateral aspect of the thigh and is the largest part of the quadriceps femoris muscle group.

16. answer: a. Creatinine. Creatinine is cleared from the body by the kidneys and is considered a kidney function test.

17. answer: B. Ataxia. This is commonly assessed during physical examination using the finger-to-nose test.

18. answer: d. Fluoxetine. Fluoxetine (Prozac) is a commonly prescribed antidepressant.

19. answer: d. Parkinson disease. Levodopa, which is a precursor of dopamine, is the most commonly prescribed medication to treat this disease.

20. answer: B. Brachial. The brachial vein begins at the point where the radial and ulnar veins meet, and then becomes the axillary vein near the shoulder when it meets the basilic vein.

RESOURCEShttp://www.nlm.nih.gov, 2013.http://www.webmd.com, 2013.

Brett mcCutcheon currently works as a speech recognition editing mentor. He studied microbiology at The Ohio State University and has served on the AHDI Credentialing Development Team, Ethics Committee, and Board of Directors. He lives in Denver, Colorado.

CLINICaL MeDICINe

CMT CHaLLeNge QUIZ


pROFeSSIONaL pRaCTICe DeSK

Q:Does the BOS list the proper style for transcrib-ing Bi-RADS categories and diagnoses? If not,

do you know a reference book that does—a trusted refer-ence book?

A: The ACR (American College of Radiology) has a BI-RADS FAQs document that is helpful. BI-

RADS is a registered trademark, so it is in all capitals with the hyphen after BI. The 10th Edition AMA Manual of Style confirms this style.

BI-RADS is not found in the BOS3e, but we’ve noted it for consideration of inclusion in the next edition.

This ACR page http://www.acr.org/Quality-Safety/Resources also references HI-RADS (head injury) and LI-RADS (liver imaging) as other Reporting and Data Systems, so the hyphen inclusion makes a lot of sense.

Q: Need to enlist your expertise to confirm SCMV as synchronized controlled mechanical ventila-

tion, one of the ventilation modes found on some models of anesthesia ventilators.

The most I can find on the term SCMV is from the live medical site below, but I am not sure it is a reliable site (http://livemedical.net/scmv-synchronized-controlled-mechanical-ventilation/), which states that SCMV is a ventilation volume-controlled mode sometimes called:

SIPPV (synchronized intermittent positive pressure ventilation)A/C (assist-control ventilation)VCV (volume-controlled ventilation)

A: SCMV: Mechanical ventilators utilize several separate systems for lung ventilation referred to

as “modes,” which are actual settings on the ventila-tion machine. These modes are in three main categories: volume, pressure, or spontaneous control. The term SCMV (synchronized controlled mechanical ventilation) refers to the mandatory volume-controlled ventilation working in sync with patient spontaneous breathing and is designed for prolonged ventilation (for example, in patients who are in a deep coma). It is also used in

anesthesia along with application of a neuromuscular blocking agent (for example, on ventilated ICU patients with severe reversible respiratory failure) to enhance ventilator-patient synchrony.

Here are additional resources: http://lungventilator.com/EnglishVersion/CMV_AD.htm:http://www.technomedical.ru/en/equipment/168/4582/http://en.wikipedia.org/wiki/Mechanical_ventilationhttp://www.criticalcareshock.org

Q: I am seeing more and more EMRs containing phrasing like this: “This note was dictated with

dragon-speak technology. There may be typographical errors secondary to the transcription technology.” I am thinking the use of these statements is not quite right, bordering on dangerous. Can anyone tell me to whom I could address the question of this meeting com-pliance and documentation rules and regs?

A: In this case, the HIM director should be alerted to this phrase being inserted. The HIM director

should then check with the hospital attorney for an opin-ion as to the potential risk of including such a statement announcing that there could be careless errors included in their report (and seemingly not worried enough about such errors to actually fix them). Hopefully the hospital attorney will be able to offer excellent rationale for this phrase to be removed from all future reports.

Q: Dictated: “The patient was given 4 nitroglycer-ins.” I was taught, and I know it has appeared in

literature from AHDI on more than one occasion, that we do not make the drug itself plural, but we cannot seem to locate anything in the BOS regarding this. We should tran-scribe “4 nitroglycerin.” What are your thoughts on this?

A: You are correct; the plural reference wouldn’t be placed on the medication name but rather on the

types or forms (pills, tablets, injections, etc.) in which the medication is given.

So, it would be correct to remove the “s” from “nitro-glycerins” to state: The patient was given 4 nitroglycerin.

Tackling the complexities of professional practice in healthcare documentation one issue, trend, and challenge at a time…

HaVE a PROFESSIOnal PRaCTICE QUESTIOn? Submit your inquiry to the aHDI professional programs Department for research and response: [email protected].


aHDI NeWS & WHO’S WHO

2013 aHdI Integrity award Winners announced

Congratulations to the following individuals and organizations who were the recipients of an AHDI

Integrity Award this year. Winners were announced at our Awards presentation during our 35th Annual Con-vention & Expo in Lake Buena Vista, Florida.

lifetime achievement The award goes to… Susan M. Pierce, RHIT, CHPS, CMT, AHDI-F (awarded posthumously)

distinguished Service award The award goes to… Kathryn Martin, AHDI-F

Educator of the Year The award goes to… Diane M. Gilmore, CMT, AHDI-F Other nominees for this award include: Michelle Marino, CMT

Employer of the Year The award goes to… Shumaker Transcription Service Other nominees for this award include: Amphion Medical Solutions, LLC

Excellence in Credentialing The award goes to… Tracey Walter, RMT Other nominees for this award include: Marcia Gordon, CMT

Innovation Through Technology The award goes to… New England Medical Transcription Other nominees for this award include: EMDAT, Inc.

membership Impact award The award goes to… Mid-Michigan Chapter Other nominees for this award include: AHDI-West Regional

Hall of Fame—member of the Year award The award goes to… Sandra Shumaker, CMT, AHDI-F (component affiliation: AHDI-West)

Rising Star award The award goes to… Katrina Watkins (attending Medline School of Medical Transcription)Other nominees for this award include: Colleen Barnes (attending CanScribe Career College)

In honor of educator Marilyn Craddock, the Rising Star award serves to recognize an outstanding industry student for a contemplative and informed response to the Association’s annual essay contest.

This year AHDI’s essay topic is Why Get Involved? Students are the next generation of healthcare docu-mentation specialists. Students were asked to write a 200-word responsive essay outlining their understand-ing and insights as to why it is important for them to get involved. Katrina Watkin’s winning essay is below:

“Why Get Involved?”For every action, there is an equal and opposite reac-

tion. Technology will forever advance in our industry leaving us to think about how these changes impact us as well as the patient and physician in both a positive and negative way.

Adjusting to change can be an exciting experience, or a challenging one; however, it is often necessary either way. It is crucial in our industry to continue adapting to ever-growing and inevitable changes to provide the highest level of service to both patient and physicians. Our long-standing commitment is based on providing the highest standards of excellence in each and every job. We have a responsibility to manage industry stan-dards as a team; we must get involved.

I personally choose to embrace innovation as an exciting experience. By learning to excel in advancing technologies, I will ensure that the quality of work I proudly provide is sustained, which is pivotal to accurate and timely patient records.

As said famously by Maria Robinison, “Nobody can go back and start a new beginning, but anyone can start today and make a new ending.”

I choose to start today and make a new ending.



High Reliability and Quality at the Joint Commission

The 21st Annual Liaison Network Forum convened August 14 at The Joint Commission’s headquarters

in Oakbrook Terrace, IL. AHDI CEO Linda G. Brady, CAE, represented AHDI and our community of health-care documentation specialists and industry partners. Throughout the event, important issues to our commu-nity were brought to The Joint Commissions attention and heard by other healthcare associations in attendance. We made important headway in advocating for quality and integrity in healthcare documentation and raising awareness among a group of influential stakeholders. Read more.

aCE 2013 Session Recordings available

AHDI’s 35th Annual Convention & Exposition fea-tured three days of continuing education sessions

taught by leading experts in clinical medicine, industry and technology trends, healthcare documentation, and workforce development. Now you can purchase the ses-sion recordings to download and watch at your conve-nience on your computer or mobile device. ACE 2013 session are the perfect opportunity to catch up on what you missed and earn those much needed CECs.• See a list of available sessions• Get complete information, packages, and pricing

1. alprazolam 2. fluconazole 3. fluoxetine 4. omeprazole 5. simvastatin 6. levothyroxine 7. acyclovir 8. cyclobenzaprine 9. metoprolol10. gabapentin

Brand-Generic Equivalents Word Search answer Key

http://www.ahdilounge.org/index.php/2013/08/high-reliability-and-quality-at-the-joint-commission-liaison-network-forum/

http://www.ahdionline.org/GetConnected/Events/AnnualConventionExpo/ACE2013AvailableRecordings/tabid/731/Default.aspx

http://www.ahdionline.org/GetConnected/ACE2013SessionRecordings/tabid/730/Default.aspx



launch of RHdS Recredentialing Course

Registration is open for the Registered Healthcare Documentation Specialist (RHDS) Recredentialing

Course. Enrollment is open each month from the 1st to the 25th for the course starting the 1st of the next month. Learn more and register.

RMTs who earned their credential before the release of the current exam blue prints will transition automati-

cally to the RHDS designation through a revised recre-dentialing course. RMTs may take the recredentialing course at any time during your cycle to bridge over to an RHDS. Alternatively, you may wait until the end of your current cycle and earn your RHDS when you recertify. Successful completion of that updated recredentialing course will earn the RMT their new RHDS designation and their new 3-year cycle will begin. Read more.

AHDI’s member relations team has assembled a list of the top 10 free resources available on our

website. Click the links below to access what you need anytime!

1. Qa Best practices (.pdf) – Provides a blueprint for the application of a leading-edge quality program that is compatible with paper-based medical records, hybrid EHR record systems, as well as fully implemented electronic health record systems. It applies the Plan, Do, Check, Act (PDCA) method of continuous quality improvement. The free Qa Best practices Tool Kit provides a set of explanatory and operational tools that are intended to be adapted by users to their own needs.2. Solutions for Success in the eHR Workforce (.pdf) – Download this quick reference flyer to help market your medical transcription knowledge and skills for new roles in the EHR. 3. CeC Quizzes – Earn continuing education credit by reading and responding to content in AHDI publications. More than 200 credit-worthy articles, columns, and quizzes are available! (Available to Individual Professional members; login required)4. Credentialing Candidate guide (.pdf) – This “go to” resource includes everything you need to know about earning your RMT or CMT (soon to be rebranded to RHDS and CHDS), including the entire blueprints for both exams.5. plexus archives – The complete library of Plexus from 2005 to present is available for download.

As a bonus, the archive of Matrix continues to be available with issues from 2007 to 2011. (Open to AHDI eligible members; login required)6. Membership Directory – Quickly look up and connect to fellow AHDI members to build your professional network. You can also look up current organizational members with our Corporate/educational Membership Directory. (AHDI members only; login required)7. Social Media “How To” Webinar Recordings – Originally developed for AHDI’s social media volunteers, these webinar recordings are helpful to anyone interested in learning the “ins” and “outs” of social networking.8. Online Buyer’s guide – Available 24/7, the Buyer’s Guide is a quick reference tool you can use to find technology vendors, consultants, and other service providers. 9. Let’s Talk about – In this series of open letters and Town Hall forums, AHDI’s Board focused on advancing the dialogue on critical issues facing our profession today. 10. alliances – AHDI members are invited to join any of our virtual special interest group alliances. Discussions are held via email listservs to exchange information, networking, and address the common needs and interests of the group. If you’re looking to connect with people in your local area, check out the list of aHDI components organized across the U.S. (AHDI members only)

Top 10 Free Resources from aHdI

http://www.ahdionline.org/Certification/RebrandingtheAHDICredentialingExams/tabid/724/Default.aspx

http://www.ahdionline.org/EducationTraining/CredentialsDesignations/RegisteredMedicalTranscriptionistRMT/RMTRecredentialingCourse/tabid/400/Default.aspx

http://www.ahdionline.org/Portals/0/downloads/QA_Best_Practices.pdf

http://www.ahdionline.org/ProfessionalPractices/ToolKits/QABestPracticesToolKit/tabid/600/Default.aspx

http://www.ahdionline.org/portals/0/downloads/SolutionsForSuccess.pdf

http://www.ahdionline.org/MemberCenter/MyBenefits/OnlineCECs/tabid/216/Default.aspx

http://www.ahdionline.org/LinkClick.aspx?fileticket=EF%2ffWGQ3FCk%3d&tabid=533

http://www.ahdionline.org/ProfessionalPractices/Publications/Plexus/PlexusDownloads/tabid/341/Default.aspx

http://www.ahdionline.org/ProfessionalPractices/Publications/Matrix/HealthDataMatrixDownloads/tabid/340/Default.aspx

http://www.ahdionline.org/MemberCenter/MyBenefits/Directories/MemberDirectory/tabid/455/Default.aspx

http://www.ahdionline.org/GetConnected/AHDICompanyMemberDirectory/tabid/661/Default.aspx

http://www.ahdionline.org/GetConnected/Leadership/ComponentManagementCenter/LeadershipToolbox/SocialMediaSpecialistResources/tabid/607/Default.aspx

http://www.ahdionline.org/VendorPartnerPrograms/OnlineBuyersGuide/tabid/239/Default.aspx

http://www.ahdionline.org/AdvocacyPublicPolicy/WhereWeStand/LetsTalkAbout/tabid/551/Default.aspx

http://www.ahdionline.org/GetConnected/SpecialInterestAlliances/tabid/256/Default.aspx

http://www.ahdionline.org/GetConnected/FindMTsNearYou/tabid/549/Default.aspx


dISTRICT 1United States: Wa, OR, Ca, ID, NV, UT, aZ, HI, aK, pRCanadian provinces: BC, YT

dISTRICT 2United States: MT, WY, CO, NM, ND, SD, Ne, KSCanadian provinces: aB, SK, MB, NT, NU

dISTRICT 3United States: MN, WI, MI, IL, IN, OH, KYCanadian provinces: ON

dISTRICT 4United States: WV, Va, DC, MD, De, NJ, pa, CT, RI, NY, Ma, NH, VT, MeCanadian provinces: QC, NB, NS, pe, NL

dISTRICT 5United States: Ia, MD, aR, OK, TX, La

dISTRICT 6United States: aL, MS, TN, NC, SC, ga, FL

COmPOnEnT EVEnTS

Do you know of an educational seminar, study group, webinar, or other event of interest to members not listed here? get the word out about your component’s event by submitting your event information at www.ahdionline.org / get Connected / events / event Calendar. Your informa-tion will appear in aHDI’s Online event Calendar as well as in Plexus magazine, and it’s free! Check the Online event Calendar frequently for events and CeC approval updates not listed here.

dISTRICT 1

dISTRICT 2mountain States Region October 12November 9December 14Monthly Board [email protected] www.ahdi-msr.org

dISTRICT 3mighty Rivers aHdIOctober 3-5annual MeetingKahler grand HotelRochester, [email protected]/

dISTRICT 4aHdI-nEmaNovember 1-34th annual ConferenceHoliday Inn Conf. Ctr.Breinigsville, [email protected]/

dISTRICT 5

dISTRICT 6aHdI Southeast RegionalOctober 4-6Fifth annual RetreatLarge Homegatlinburg, [email protected]

Space Coast ChapterDecember 7annual Holiday Meetingpalm Bay Hospital auditoriumpalm Bay, FL9 a.m. to 12 [email protected]/scc-index.htm

aROUND THe COUNTRY

NOTE: Approved CECs at time of publication deadline as listed.


FUNNY BONe

aMaZINg WORDS*

RICHaRD LeDeReR, pHD

Long ago in prerevolutionary France there lived one Etienne de Silhouette, a controller-general for Louis XV. Because of his fanatical zeal for raising taxes

and slashing expenses and pensions, he enraged royalty and citizens alike, who ran him out of office within eight months.

At about the same time that Silhouette was sacked for his infuriating parsimony, the method of making cutouts of profile portraits by throwing the shadow of the subject on the screen captured the fancy of the Paris public. Because the process was cheap and one that cut back to absolute essentials, the man and the method became associated. Ever since, we have called shadow profiles silhouettes, with a lowercase s.

Thousands of common words in our language are born from proper names. These words lose their reference to specific persons and become generic terms in our dictionaries; when they do, they usually shed their capital letters. Such additions to our vocabulary help our language to remain alive and growing, muscular and energetic.

The Greeks had a word for people who live on in our everyday conversations—eponymos, from which we derive the word eponym, meaning “after or upon a name.” Stories of the origins of words made from people or places, real or imaginary, are among the richest and most entertaining about our language.

Here is a quiz in which you are asked to identify ten common words and the names of the immortal Americans from whom they descend.

1. Samuel Augustus _______, a San Antonio rancher, acquired vast tracts of land and dabbled in cattle raising. When he neglected to brand the calves born into his herd, his neighbors began calling the unmarked offspring by his name. Today this word has come to designate any nonconformist.

2. _______, the name of a courageous Apache warrior chief, became a battle cry for World War II paratroopers.

3. Amelia Jenks _______ was an American feminist who helped to publicize the once fashionable puffy la-

dies drawers that seemed to bloom like linen flowers.

4. A century before Elvis Presley, the handsome face of Civil War general Ambrose E. _______ was adorned by luxuriant side-whiskers sweeping down from his ears to his clean-shaven chin.

5. A colorful plant characterized by scarlet leaves is especially popular at Christmastime. This Christmas flower takes its name from Joel R. _______, our first ambassador to Mexico, who introduced the plant to the United States from its native land.

6. In 1812, in an effort to sustain his party’s power, Mas-sachusetts governor Elbridge _______ divided the state into electoral districts with more regard to politics than to geographical reality. It happened that one of the Governor’s manipulated districts resembled a salamander. To a drawing of the district a waggish cartoonist added a head, wings, and claws; the name of the creature was lent immediately to the shaping of electoral entities for political gain. 7. Sylvester _______, an American dietary reformer, donated to our language the name of a cracker made of ground whole wheat flour. answers1. maverick-Maverick 2. geronimo!-Geronimo 3. bloom-ers-Bloomer 4. sideburns-Burnside 5. poinsettia-Poinsett 6. gerrymander-Gerry 7. graham cracker-Graham

Richard lederer is the author of more than 43 books about language, history, and humor, including his best-selling Anguished English series and eight newly released books.He has been profiled in magazines as diverse as The New Yorker, People, and the National Enquirer, and frequently appears on radio as a commentator on language. Dr. Lederer’s syndicated column, Looking at Language, appears in newspapers and magazines throughout the United States. He has been named International Punster of the Year and Toastmasters International’s Golden Gavel Winner.

* Amazing Words is author Richard Lederer’s career-capping anthology of bedazzling, beguiling, and bewitching words. Richard will sign each book and personally inscribe, if so requested.

aMaZInG WORdS

Immortal Mortalsplease explore my Web site at http://www.verbivore.comemail: [email protected] Scripps Ranch Blvd., #201 San Diego, Ca 92131

Association for Healthcare Documentation Integrity STATEMENTS OF ACTIVITYMay 6, 2013 YEARS ENDED DECEMBER 31, 2012 AND 2011

Dec 31, 2012(Restated)

Dec 31, 2011The following are compiled statements of financial position of the REVENUES:

Association for Healthcare Documentation Integrity, a nonprofit mutual Membership Dues 466,962.41 545,712.78

benefit corporation, as of December 31, 2012, and the related statements Professional Practices 236,574.96 429,603.97

of activities for the year then ended. Meetings and Events 143,540.84 228,997.57

Advertising and Publications 23,852.86 88,817.66

Management is responsible for the preparation and fair presentation of Certification 115,838.28 142,335.24

the financial statements in accordance with accounting principles generally CDIA Operational Fee 26,700.00 138,000.00

accepted in the United States of America and for designing, implementing, Royalties 40,016.63 50,026.11

and maintaining internal control relevant to the preparation and fair Shipping and Handling Income 21,401.46 31,235.98

presentation of the financial statements. Interest Income 16.84 48.47Other Products and Services 36,873.36 14,562.36Settlement Income 0.00 2,643.75Discounts -7,542.00 -10,434.31

These reports and information are for AHDI member use only. TOTAL REVENUES 1,104,235.64 1,661,549.58

STATEMENTS OF FINANCIAL POSITION EXPENSES:DECEMBER 31, 2012 AND 2011 Personnel salaries and benefits 651,834.21 902,300.75

Dec 31, 2012(Restated)

Dec 31, 2011 Professional and contracted services 111,312.84 185,363.48ASSETS Meetings and events 70,474.89 236,678.10

Cash and Equivalents 66,814.11 27,788.00 Facilities 77,601.23 112,981.78Accounts Receivable 18,367.81 96,606.49 Cost of goods sold and used 38,020.90 54,630.61Inventories 32,209.08 43,257.49 Postage and shipping 38,307.44 52,849.57Prepaid Expenses 23,237.86 81,328.46 Printing and reproduction 10,654.97 7,578.32Property and Equipment 124,795.75 211,052.01 Merchant fees and service charges 26,005.16 30,333.77

TOTAL ASSETS 265,424.61 460,032.45 Accounting 21,705.30 34,930.88Depreciation 86,908.00 92,550.00

LIABILITIES & EQUITY Telecommunications 19,207.17 30,740.00Accounts Payable 447,787.2 495,365.7 General insurance 11,297.78 12,156.63Accrued Liabilities 27,473.45 33,948.18 Legal 17,384.45 4,691.05Due to CDIA 0.00 12,454.84 Supplies 3,997.79 5,286.61Deferred Revenue 259,648.51 306,333.20 Operating expenses 39,797.80 37,337.40Long Term Liabilities - lease/line of credit 129,473.82 122,440.30 Dues and subscriptions 1,214.78 1,246.82

TOTAL LIABILITIES 864,382.98 970,542.18 Advertising 324.39 1,272.19Cancellation of debt -33,569.90 -10,350.91

EQUITY Miscellaneous 114.30 -646.61Retained Earnings - Prior -510,600.51 -380,128.87 TOTAL EXPENSES 1,192,593.50 1,791,930.44Net Income - Current Year -88,357.86 -130,380.86

TOTAL EQUITY -598,958.37 -510,509.73 TOTAL PROFIT/LOSSTOTAL LIABILITIES & EQUITY 265,424.61 460,032.45 INCREASE/DECREASE IN MEMBERS' EQUITY -88,357.86 -130,380.86

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