Professional Development for Healthcare Professions Blog

Head in the Sand- The Value of an Informed Professional

Posted by Chad Sines on Fri, May 31, 2013 @ 07:00 AM

head in sandIt is hard to not have conversations about politics these days. No matter which side you support, chances are you are passionate in that belief and ready to fight when someone challenges you. During a discussion with a friend, they made a dramatic statement. “If people really learned the facts regarding where politicians stand and why they hold those beliefs instead of just taking other’s word for it, the political landscape would be a very different place.” A truer statement could not be made and it is applicable in so many aspects of our lives.

This topic is sort of a continuation of the previous blog entry that asked if we were our own worst enemies. The focus of that entry was that MTs do now stay informed while the purpose of this is to state that allied health professionals form immovable opinions based on what someone else tells them instead of their own personal research and experience.

In speaking with a few students recently, I heard them discussing how horrific speech recognition was and that it was the bane of the MT world; however, when questioned all admitted having no personal experience using the technology but instead had heard others proclaim the statement which meant it must be true. Ironically a few months ago I heard a similar conversation from experienced MTs who also admitted never using it and purposefully avoiding it at all costs.

I was part of a conversation with coders who felt that ICD-10 was the end-all, be-all wonderful thing for healthcare but none had ever stopped to think of the costs, who would pay for it, and how the industry would increase the workforce by 150% to 200% to cover the need. Not a single one had read any academic research (read non-vendor propoganda but peer-reviewed research) that showed that in Canada the permanent need became 1.5 to 2 coders to handle the load that used to take a single coder because of all the additional specificity...and the research was clear that the need did not decrease. So imagine now the cost of coding increase by 150% to 200%..can we sustain that at a time we are screaming for cost cutting?

Many are also jumping on the bandwagon of the EHR being a detriment to patient care because they feel it will decrease patient access time and increase costs. While this may be true, the further into the conversation you get, the more of the real reason you hear. MTs are afraid of where they will fit into the EHR because someone mentioned that fewer traditional MTs would be needed. Coders are also leary because they are now beginning to fear the same thing. Again reading the academic research is inconsistent. I am currently doing my doctoral dissertation on the EHR and it is amazing how much we have heard promised that is so far not holding true.

The logic is intriguing as it takes a while for people to get to the point where they admit their true reasons for their dislike or like of certain technology. Even more intriguing is that they allow others to make a statement that is then taken as fact without challenge. This often leads to the ostrich head-in-the-sand thinking. If you avoid it, it will go away or the more hardcore stance of “if we declare it as detrimental to healthcare, it will go away.”

I just cannot accept this line of thinking as logical. Even if there are some truths in the scenarios, ultimately this approach will lead to personal failure as the professional is left on the sidelines as they find they are no longer qualified to participate in the changing healthcare documentation arena. A much better approach would be for the professional to invest their time in personally learning about these new technologies and determining how, or if, they can fit in. We must keep current with technology and expose the good and the bad and ensure that we continue to have a place in the future. We must be an informed medical professional.

Do you feel you are an informed professional?

Accepting Instructive Feedback

Posted by Chad Sines on Tue, May 28, 2013 @ 07:00 AM

Med-Line School of Medical TranscriptionMany view QA or their instructor as almost an adversary. An assignment is submitted, critiqued and returned with criticism, feedback, and some grading that has an effect on the professional's future. This naturally puts a student/professional into a self-defense posture where the first reaction is to protect one’s self instead of being open to criticism. This posture, albeit natural, will limit your learning, frustrate your instructor, and hamper the mentoring process sometimes to the point where the student avoids the interaction at all costs, even to their own detriment. This is very evident when reading forums where professionals are complaining about QA who are "idiots" or students who think their instructor is out to get them.

For the student, using your instructor is an absolute must especially if a grade is lower than expected. The goal should be to learn from your mistakes. Often times when a poor grade is received, the student goes into a self-protecting mode where they look for any loophole or justification in an attempt to show they did not do as bad as the grade shows.

Your goal is to look to see why you are WRONG instead of trying to find a loophole to say you might be right. Assignments are designed around what is expected in the industry. Below are some Dos and Don’ts that will help you through the process.

Some Dos
  • Do accept that outside of a rare grading error, you were wrong. You might not know why you were wrong, but chances are more than strong that you were. 
  • Do email your instructor for input any time you are confused as to why something was incorrect if the issue is simple and can be handled via an email dialog. Schedule a phone conversation if an issue seems complex and is better handled over the phone. Often a short five minute call can fix an issue that would have required many back and forth emails.
  • Do schedule a call with your instructor any time you fail an assignment to go over your mistakes. No exceptions. Often you can learn more from your failures than your successes.
  • Do accept that any feedback is not personal and is designed to better you. The goal for all involved is to better you.
  • Do incorporate all feedback. Your instructor hates to see you repeating the same error over and over as it shows that you are not learning from your mistakes. Make a list as you are speaking to the instructor. With each report you do, go over that list before sending it in until you are absolutely certain that you no longer make that error.
Some Don’ts
  • Do not expect your instructor to come to you when you are having issues. It is your responsibility to reach out when you have questions, concerns, or need additional help. Your instructor cannot help you if you do not ask.
  • Do not assume that since you did poorly that the program or instructor is somehow flawed or that there was a serious grading error. Assume there is additional information that you are not incorporating into your work that will be identified after your scheduled meeting.
  • Do not delay or refuse to meet with your instructor. This can damage the mentoring relationship as well as develop undesired habits. Bad habits are hard to break. If you can identify and correct your issues early, you will have a much easier time going forward. It is your obligation to reach out whenever you are confused.
  • Do not send your assignments to other students, family, or other outside sources to help you see why you could have been right. First, on the job you would be violating the HITECH Act and could face termination as well as civil and criminal ramifications. Second, your instructor is the only resource who can tell you what your mistake was and how to fix it, or if they happened to make a mistake, they are the only one who can fix it. Those outside the industry are especially unsuited to critique your work as they have no understanding of the required formatting, expected grammar, and medical terminology. Third, it is the instructor’s job to mentor you through your mistakes so that you do not continue making them. They would rather help you stop the error now than continue to have to mark it over and over again.
  • Do not focus on the minor issues at the expense of the critical ones. Learning how to place commas or that you need to capitalize a brand name is good but not nearly as important as having the correct diagnosis, medical term, or lab value. Prilosec and prilosec are both understandable despite the capitalization error. Lipoma and lymphoma are not easily understandable without more research.
I hope this all comes across in the way it was intended and that you immediately begin to incorporate this. For many of us, accepting criticism and our faults is an ongoing process. Accepting positive criticism and then acting on it makes everyone’s life easier and will help you achieve your goals much quicker than doing it on your own.

Topics: Professional Development

Our Own Worst Enemy- The Dangers of Reactionism

Posted by Chad Sines on Fri, May 24, 2013 @ 07:00 AM

InformedSome recent conversations with MTs and coders have me questioning whether we are often their worst enemy. Right now I know that there are some sharpening their claws for the strike, but hear me out. Traditionally our profession is more reactive than proactive. I think that is an undeniable fact. Although we loudly voice what we do not like about the current state of the profession or where it is trending, we seem to shy away from the more successful proactive approach…or we begin to get involved, hit a speed bump, run back to safety and say “I tried and nothing changed.”

MTs are used to being the behind-the-scenes person who “types what we hear” (we hate the term but I think our actions, or inaction, speak louder that words) and dare not question the physician or offer ideas on improving dictation practices even though it could lead to reduced errors and increase patient safety. Coders are seeing changes pushed onto them as well even though physicians are ill-prepared to provide them the information they need to implement new changes.

We let vendors develop systems that we use on a daily basis without insisting on being part of the development and complain heavily after the fact about how it could be better. I recall a few years ago during a meeting where a vendor showed his nifty EHR that was in development. It was nice. It had a place for all medications, allergies, past medical history, etc. When asked if there was a shortcut key that would import that information into the record as the MT was typing, there was a look on his face where he realized that he should have thought about that. He mentioned that maybe he should have MTs give him ideas…wonder if any volunteered after the meeting. Obviously the EHR field has evolved immensely since then, but the main point is still relevant.

Over time I think we have allowed ourselves to be marginalized to a point where we have no voice. Even worse than not having a voice is that many have no idea what they should be voicing their opinions about. The age-old ostrich head in the sand. A discussion with some “seasoned” professionals recently led me to realize that even those in a position to know what is important to them, often simply do not read much, or any, of the information being sent to them.

Healthcare and healthcare documentation is changing at an exponential rate. We are seeing a push to the EHR with promises of cost savings and increased patient contact time despite after-the-fact corrections, the healthcare law that congress recently put into action changes the face of medicine to a degree that is unknown at this point, privacy concerns over the inability of many countries to ensure privacy is pushing work back onshore, MTs are being asked to know more for a lower rate of pay, we know we will need close to double the coders to handle ICD-10 even though there is currently a shortage….the list could go on and on.

I have heard professionals state that AHDI, CDIA (MTIA) - now gone, AHIMA, etc, are not saying or doing the right things; however, what are the complaining individuals doing to shape the future of this profession other than complain on a blog or forum? Interestingly each of these groups are run by people just like you and me who decided to be a part of shaping their association based on what they feel is best for the future. Being a part of the change is much harder than the Monday night quarterback approach that we see so often.

I do think each professional owes it to themselves to, at the very least, know the issues. That is what a professional does. We would not see a doctor, lawyer, banker, etc as a professional if they did not keep up with trends in their profession yet that is standard practice for many in this one. Although membership in a professional association is a great way to gain access to the information, there are endless other opportunities to find the information.

So here is the basic test on whether you are informed or not. Can you answer these three basic questions with confidence?

1) What is “meaningful use” and why is this term currently very important?
2) Why is the topic of the “narrative report” such a hot topic in healthcare documentation?
3) How does the recent HITECH Act affect you as an MT?
4) What is ICD-10 and why do some see it as critical while others see it as being a bad idea?
5) How is the Affordable Care Act affecting healthcare? 

These topics have been mentioned frequently and loudly in professional emails, webinars, and meetings as well as discussed in various healthcare documentation publications. AHDI, AHIMA, MGMA, AMA, and other professional associations have shared the information as well. We should all be an informed professonal and in turn be the ones educating others. Every non-student should know these topics by heart now. If not, there is a problem.

So where do you stand? Are you going to react to what someone else decides is right for your future and hope for the best or be proactive and shape that future the best way you can?

Topics: Industry Issues

Professionalism and Your Email Address

Posted by Chad Sines on Tue, May 21, 2013 @ 07:00 AM

Professional DevelopmentTechnology and as important, professionalism when dealing with technology remains the most frequent weaknesses in allied health.

Today’s topic is a combination of both professional development and technology. It is a critical issue that is often overlooked and sadly many healthcare specialists do not realize how it may be affecting their opportunities.

It used to be that you walked into an office, looked someone right in the eye, shook their hand and presented yourself. Working in a virtual environment means there is little face-to-face contact. Your instructors, networking contacts, recruiters, and eventually employers only know you by what you show them. One of the first things you say about yourself is through your email address. Sexy_mt@, mtmammawannabe@... is just not professional. It makes an initial statement that you most likely do not want. Not only does it mean that someone seeing your email address has no way to recall who you are (you want them to see your email and think of your name instantly), but it also comes across as unprofessional. In speaking to many recruiters over the years, one of the most recurrent themes is that unprofessional emails result in shredded resumes. Scary to think just how many MTs might have trouble finding a job simply because of an email address.

So here are some non-negotiables when it comes to your professional email address:
  • Avoid references to your hobbies, politics, religion, children, marital status, etc. While these are things to be very proud of, they should be used for personal communication only and not professional/educational communication.
  • Your email needs to have your name in it and be clear, i.e. firstname.lastname@, lastname.firstname@, firstnamelastname@, etc. 

So go ahead and get started on the right foot. If you cannot create a new email with your Internet host, visit gmail.com and click Create New Account. Go ahead, do it now, and begin using your new professional email for all your professional correspondence. Reply in the comments below when you have made your new email and started using it.

Topics: Professional Development

Style Over Substance - Making Ourselves Irrelevant

Posted by Chad Sines on Fri, May 17, 2013 @ 07:00 AM

GrammarI was reading a blog entry comparing large MTSOs to Wal-Mart. The author made some interesting points that inspired the reader to think; however, she had a few grammatical errors. What struck me as off was that the comments seemed to suggest that since this MT made “glaring” errors, the substance of the article was not worthy of reading. The author apparently was to be shamed and discarded as seemingly irrelevant simply because of “mute” versus “moot” and other simple oopsies. While reading the comments I was almost yelling “WHO CARES??? Get off your pedestal and listen to the message!!”

This left me scratching my head and wondering if MTs have lost touch with who they are and what their role is. Why do we as MTs feel that we are the gatekeepers of grammar? Isn’t that a faulty view of our role? I was taught that our main focus is on patient safety. We transcribe dictated material and alert the physician when we notice a potential safety issue.

A prime example occurred at a meeting I attended a few years ago where an auditor gave a presentation on what she did. She showed us a transcription and asked us to find the errors. We saw “tylenol” instead of “Tylenol” and declared it proudly. We saw “you’re” instead of “you are.” We even found some subject-verb agreement errors. The auditor kept track until we declared ourselves finished.  We were so proud. A group of 20ish MTs had ripped that document to pieces and proved our relevance in healthcare documentation…or did we… After ensuring we were finished the auditor thanked us for proving her point that we have forgotten what our role is truly about. None of us noticed that there were four separate doses of morphine in the record as active prescriptions scheduled at different times which constituted a very lethal dose had they been administered. (a result of the physician increasing the strength but failing to DC the previous dose) Oops. Result- Pretty words, dead patient.

So why did a group of about twenty people with 20+ years experience for many including several instructors miss something that should have been glaring like a neon sign?

I think the reason is that we have moved away from patient safety and into the world of grammar keepers. We are fighting a battle that no physician/facility really cares about. In every example above, patient safety was never a concern; however, the one issue that was a severe risk was completely missed. In practice we have allowed so many style variations in templates that our QA spends the majority of their time checking style instead of critical patient information.

With the push towards the mandatory EHR, the role of the MT is changing overnight. The grammar keepers are being pushed aside for those who can bring value to the table. It is a very different way of approaching healthcare documentation. It requires one to look at the substance and disregard what is meaningless to all but other grammar keepers.

Now I am not saying that grammar/style is irrelevant, but I am saying it MUST not be how we define ourselves. It should be secondary except in cases where it honestly affects patient safety…And no..Safety is not affected just because we feel we want to throw our hands in the air. "I told the patient to go their" is understandable despite being grammatically correct and do not even get me started on "your, you're" or the use of commas.

I think we need to get back to substance over style. We have to refocus and get back on task. What is said must be more important than how it is said. In a blog, the writer’s interesting points could be missed leading to a lack of enlightenment for the reader which only stifles knowledge. In the case of a patient record, it could end up harming the patient. Unless we can wrap our mind around our true purpose, we are going to have little success showing outsiders why we are relevant.

Topics: Industry Issues

The Art of Followership- Part IV

Posted by Chad Sines on Tue, May 14, 2013 @ 07:00 AM

followerYes People
We have all seen the yes people. These are the ones who agree with whatever the leader says. They have no critical thinking skills or at least choose not to use them.

This group is severely frustrating for true leaders. True leaders need followers who will challenge their message. They want a follower to alert them when their plan may be flawed. This is another all too common follower type in this industry. Poor leaders assume that these followers are good because they do not challenge the message. Too often we chastise, embarrass, and attempt to shut down those who disagree with the message lending many to resort to just nodding the head.

Survivors
The survivor is a center of the road follower. They tend to feel that it is better safe than sorry. They have become proficient survivors of change by not bucking the system. This is the typical MT and coder in my opinion. They have seen changes come and go that often leave them at a significant disadvantage, but they feel their options are limited. They are reactive and ultimately fade out as they become obsolete.

Ironically, many MTSOs are in the same boat. Faced with challenges to lower costs they utilize questionable practices such as offshoring to countries with no privacy laws and questionable quality all in an effort to drive the cost of business down.

Effective Followers
Effective followers are dependent, critical thinkers who are active in the process. They are proactive and demand real, purposeful change. They see themselves just as valuable to the organization as the leaders. They are less concerned about being liked than doing the right thing. They seek to bring about positive change. They are not afraid to stand up and let leaders know that their message is wrong. They are often viewed as trouble makers by those in authority because they refuse to comply with a direction they cannot support.

This industry is in dire need of Effective Followers. We should all strive towards this category, not yielding to pressure when we feel the message is wrong. Our industry is struggling to be relevant in an age where speech recognition and the EHR seek to make us obsolete. Without effective leaders to demand a new course for the industry, we have little change for success.

So what type of follower are you?

Topics: Professional Development

Shed or Dead--Are You Shedding or Deading?

Posted by Chad Sines on Fri, May 10, 2013 @ 07:00 AM

Med-Line School of Medical TranscriptionToday I recalled one of the most interesting talks at ACE a few years ago from Kathy Dempsey. She likened us to lizards that frequently must shed their skin in order to live. If the lizard does not shed its skin, it dies… So how capable are we in shedding the old in order to make room for the new? 75% of all change efforts fail. Those are some scary statistics. Those goals to lose weight and exercise come to mind; however, it applies to all aspects of our personal and business life. Kinda scary when you think about all the wasted opportunities.

The analogy is true, especially in this industry. Healthcare documentation is changing at warp speed. We went from computers to speech recognition to natural language processing and here comes this EHR “thing” that is being defined as it is being implemented. Some are panicking but many are seeing this as an opportunity to define a new future for this industry.

In this industry, we are often very complacent when it comes to new technology and change in general. It is amazing to me how often I see people regurgitating information from other sources without understanding it and/or without questioning the information's validity, where it came from, and what the motives might have been. We have to shed this superficial learning and instead embrace an in-depth learning experience.

We as healthcare documentation experts or in training to be experts must keep our minds open to the new changes. Change will happen with or without us. Change does not care if we use it or it leaves us behind. For those Med-Line students who are reading this, you are definitely fortunate to be with a school that is keeping current with technology and health information management. You will learn the tools necessary to succeed. Those who stay abreast of technology and learn to use it as a resource to position themselves in this new and exciting era are going to see some pretty cool and exciting things happen in this industry and in a relatively short amount of time.

So how good are you at shedding the old and embracing the new?

Topics: Professional Development

Going When the Going Gets Tough

Posted by Chad Sines on Thu, May 09, 2013 @ 07:00 AM

Med-Line School of Medical TranscriptionGoing to school while also juggling work, family, home and the many challenges life throws at us each day could challenge the time management skills of Stephen Covey himself. At times, you might feel ready to throw in the towel and give up on school all together. It is in these moments that you must remember the value of investing in yourself. Giving up on school and turning your back on your education will be a decision you regret for years and years to come.

Take the long view
The chaos of life always threatens to derail us from our goals because the urgency of today can obscure your long term goals. When the hot water heater breaks, your kids get sick and you have deadlines looming at work, it's hard to remember exactly why you're also adding the pressure of school. Taking the long view of things and reminding yourself that school is a temporary state can help you get through the day to day. You will not always attend school and when you're done, you will look back on your most difficult days as your greatest learning moments.

Envision success
When the pressures feel like they have risen to an unsustainable level, it helps to have a vision of success to look at as a reminder of why you're making sacrifices today. Success experts recommend creating a vision board with images of what success looks like for you in the future. These board's serve as a constant visual reminder of exactly what you're working for. When the daily grind threatens to pull you under, these images can keep you focused on the long term.

Take care of yourself
Keeping your eyes on the prize and reminding yourself of your long term goals can help you manage the stress of attending school while attending to your life. Some days, though, you will simply need to slow down and take care of yourself. You work hard and deserve that bubble bath, a play date with your kids, a great movie or whatever activity renews your spirit. Taking this time to enjoy life today will give you new energy to work for your goals tomorrow.

Going to school is tough. You're asked to sacrifice time and energy you don't have for future goals. But, at the end, you will look back on this time with a sense of accomplishment and pride for what you achieved.

Topics: Professional Development