Ebola highlights ICD-9 problems

How fortunate are we here in the United States that the Ebola virus has not taken hold? Whether it be due to the response of our healthcare system or blind luck, likely some of both, we have avoided what could have been the next AIDS-level catastrophe.

NEMT CEO Linda Sullivan

West Africa continues to struggle but according to the World Health Organization, there appears to be a downward trend of reported new cases.

Where the United States did fall short, however, is in our continued use of ICD-9. While politicians and others have made fun of the specific nature of ICD-10, that very specificity is what would enable the vitally necessary tracking of this or any other new disease or condition.

As the only industrialized country in the world still using ICD-9, we see that the Ebola virus has pointed up how important it is that the deadline of October 1, 2015 for U.S. implementation of ICD-10 be adhered to.

The days of ICD-10 being used as a political football need to come to an end.

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Headphones: A forgotten tool for compliance

NEMT is very lucky to have a wonderful internal newsletter. I use this newsletter as part of my HIPAA compliance for education. We do a formal education with each team member and then we supplement with relevant HIPAA-related educational articles. I just turned in my latest article, which was about HIPAA and headsets.

NEMT President Linda Allard

We are a transcription company, and headsets are very important to us. Obviously a medical transcriptionist needs to use a headset to listen to dictation as well as to keep that dictation private. Home-based transcriptionists have to be especially careful that no one else in their home is able to hear what is being transcribed. Use of a headset ensures the level of privacy necessary.

Thinking about how a home-based transcriptionist handles voice privacy made me wonder how hospitals handle things they need to hear on their computers. Are they setting up special areas or using headsets when they listen to a document to code or bill? Do those needing to listen for patient care have an area where they can listen to a dictation in privacy? Most dictation is digital these days, so you can listen to it on your computer. Are you making sure that your facility is protecting this voice data? Protecting audible PHI is just as important as protecting paper PHI. If someone is listening to a document on their speakers, are others that don’t need that level of PHI able to hear it?

MTs are accustomed to the use of headsets, but I do hear from people that a headset is inconvenient or that you can’t hear well from them. Headsets are so much better now than they were when I started transcribing. It’s funny – there are stores in airports devoted to selling headsets so you can listen to your music when you travel. Some of them are very expensive, and many people think nothing about buying these expensive headsets for music and entertainment. For someone who needs to listen to PHI , a headset is a tool that you need to really think about. The good news is that you don’t need one of those really expensive ones that come from the airport store. There are medical equipment providers who focus on headsets, and they come in all shapes and sizes as well as price ranges.

If you are using your speakers, you are definitely not getting the best sound quality. You are also opening yourself up to not being HIPAA compliant. If anyone else is near when a doctor says any patient identifying information, you are now out of compliance. Are you making sure that your home-based employees are being careful as well? With the holidays coming, soon there will be family visiting. Will they be working while company is visiting? If so, using speakers could be a problem if those family members can hear what has been dictated.

Take a few minutes and check your environments where PHI is being listened to on a computer. Make sure it is compliant, and don’t forget to check your home-based team members.

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Where’s my computer?

While this information will prove to be more useful for Windows 8 users, it is also relevant to those using Windows 7.

Andrew Clarke

There are times when you need to access files directly on your computer.  Windows XP called it My Computer, but Windows 7 and Windows 8 just call it Computer.

In Windows 7, you can access Computer from the start menu, but Windows 8 no longer has a start menu.  The answer is to place a shortcut on your desktop.  Here’s how it’s done.

  • Right-click in an empty spot on your desktop, and click Personalize.

  • Click Change Desktop Icons.

  • Click Computer so that there is a check mark in the box in front of it, and click OK.

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Ebola — Better to keep your mouth shut and be thought a fool …

In case you missed it, there’s been a disturbing development in the ongoing U.S. Ebola saga. This time, it’s not the spread of the disease, it’s the spread of misinformation.

Tara Courtland

Communications Director Tara Courtland

Ebola patient Thomas Eric Duncan was initially evaluated, misdiagnosed and released by Dallas Presbyterian Hospital and after the story hit, the National Institute of Allergy and Infectious Diseases blamed the nursing staff. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said publicly that the nursing staff “dropped the ball,” having known about Duncan’s travel from Ebola-stricken Africa, but not putting it into his chart.

Now it turns out, it was in his chart — his Electronic Health Record included all of that information, but the doctor didn’t see it.

That was the first mistake that the feds made, but it wasn’t the last. No sooner had Fauci corrected that mistatement, then another official, Tom Frieden of the Centers for Disease Control and Prevention, said it was nurses’ own fault they contracted the disease while caring for Duncan.

“There was a breach in protocol and that breach in protocol resulted in this infection,” Frieden said. “When you have potentially soiled or contaminated gloves or masks or other things, to remove those without any risk of any contaminated material touching you is critically important and not easy to do right.”

The next day, of course, Frieden took it back after reports began surfacing that the nursing staff was ordered to treat Duncan for two days without hazmat suits and that’s more likely how the disease was transmitted.

Then there was the travel. Nurse Amber Vinson, who’d cared for Duncan, was diagnosed with Ebola just after returning from Ohio on a passenger plan.

Frieden called her out again, saying “She was in a group of individuals known to have exposure to Ebola. She should not have traveled on a commercial airline.”

That’s strike three for the feds after it turns out that Vinson had been in regular contact with the CDC, which Frieden runs, and had been given permission to take the plane.

In times of crisis, we need to be able to count on our leaders to provide accurate information to keep us safe — and calm. Three major mistakes in a row not only erodes our confidence, it also slanders the front-line responders who are now literally risking their lives to care for the sick.

Our national healthcare agencies may do well to remember the old adage: “Better to keep your mouth shut and be thought a fool than to open it and remove all doubt.”

NPR first reported this story at http://www.npr.org/2014/10/24/358574357/was-cdc-too-quick-to-blame-dallas-nurses-in-care-of-ebola-patient.

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Getting connected — by federal mandate?

Will it take yet another government mandate for connectivity between hospitals to occur?

An interesting article in the “New York Times” entitled “Doctors find barriers to sharing digital medical records” succinctly describes the problem that still persists in the evolution of patient documentation

NEMT CEO Linda Sullivan

Going back to 2008 when the HITECH Act was passed, one of the primary goals was easy yet secure accessibility of our medical records regardless of where we were geographically.

According to the article, only 14% of physicians are able to exchange patient data outside of their own systems. While this lack of connectivity is common between nearly all systems, Epic was sighted as a prime culprit, no doubt because of the huge number of installations they have implemented.

Epic’s business model is sustainable long-term because not only are they paid handsomely for implementing their systems, they charge ongoing fees for many things, including transmittal of patient documentation to another system. That’s a great profit center, which costs them nothing once the software is in place.

I am certain connectivity between systems will occur. The question is: What will it take to make it happen, and when?

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