Emerging Technology: What Are You Afraid Of?”

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What Are You Afraid Of?
When new technology hits the market, HIM departments can turn into scary places. Here's how those in the trenches overcame their fears and embraced the technology.

By Lynn Jusinski

Stressfuland evendownright scary, implementing a new technology that affects HIM personnel is a huge step. Will it work right? Will the staff embrace the new workflow practices? Will the employees know that this won't put them out of a job?

With Halloween a little over a month away, ADVANCE took a look at some of the ways that HIM professionals overcame their fears and found out that technology may not be that scary after all. Their tales won't have you cowering under the covers, but they'll show you how even when faced with a few fears about a new technology on the market, you can get through it—and even see vast improvements in your department along the way.

Demons, Dracula and Document Management

At Tift Regional Medical Center in Tifton, GA, the business office and HIM department sought out a document imaging and electronic medical record (EMR) piece to add to their existing systems. First, the business office would implement the new technology, McKesson's Horizon Business Folder™, and then a few months later, HIM would come on board with the Horizon Patient Folder™ from McKesson. At least, those were the plans.

When the business office began having to make some big decisions concerning the electronic document management system (EDMS), it became apparent that the HIM department would be losing a say in the process, unless the implementation was escalated for the HIM department. The HIM director, Kathy Alberson, jumped aboard, months in advance of when the department was slated for implementation of Horizon Patient Folder. "It brought high anxiety to our HIM department and others because they had to escalate the decisions and the workflow that they needed to move to an electronic environment," said Guy McAllister, chief information officer (CIO).

The HIM director looked to where she knew she could get support through the rough patches�she spoke to colleagues at the American Health Information Management Association, and she looked at other HIM departments that had already gone through the EDMS implementation process. Teams were formed to address policy and other issues that came up before and during implementation, and soon, worries about how the workflow in HIM would go were put to rest. "Today, we're live and we wouldn't go back," McAllister said.

Horizon Patient Folder included an electronic signature piece, and with the new systems in place, printing is out of the question at Tift. The HIM director is adamant about not printing, and makes sure no one does because the results can be scary. For example, a physician printed out a copy of a record and wrote notes on it's a no-no at Tift, because every notation becomes part of the record, and a handwritten addition would get lost in the system and could compromise patient care.

Following the implementations, Tift saw vast improvements in workflow and all the employees in the 23 person HIM department are happy with the new technology. "This is a wave that HIM professionals have been watching get closer and closer, the electronic world, and I think for many of them, they were glad to see it," McAllister said.

Cobwebs, Creatures and CAC

For years, coders have heard the scary tale of computers taking over their jobs—but they've yet to see that come to fruition. Now that computer-assisted coding (CAC) technology is on the market, a new fear exists—will this actually work? Sandra Leonard, coding manager, MedQuist, admitted she was skeptical. She began using an older technology that did all the coding by computer. The only humans involved were Leonard and a few other coders who went to talk to the doctors if a code was assigned incorrectly. Leonard admits that she was amazed by the old system, with the computer doing pretty much everything—but that system definitely wasn't perfect.

Later, Leonard and her team of coders began using CodeRunner™ technology from MedQuist. The technology can be used for remote coding solutions, as well, which meant Leonard got to go home to work, something that didn't scare her at all...most of the time. "It definitely takes self-discipline. From a coder standpoint, because it's flexible and you're hourly, you work your 40 hours and you spread the hours out how you want," Leonard commented. "As a manager, my biggest challenge is not to be on the computer so much. It's sitting in my home, so it's easy to put in 10, 12, 15 hours a day."

The technology codes the whole chart when natural language processing (NLP) is used. When NLP isn't an option, documents can be scanned or faxed into the system. While Leonard said she was fascinated when the technology first came around and she realized how well it works, she's not worried that it will put her out of a job. "When it came up with the right stuff, it was like, wow," Leonard said. "But as an experienced coder you see different things the computer missed and you realize there is still job security and I'm fine."

She added that when someone new comes on to the team, they're always hesitant at first because the technology is something new and somewhat scary. "Then within a day or two, they love it because it's allowing them to open up their lives a little bit more," Leonard said.

Spiders, Spectres and Speech Recognition

Coders are not alone in hearing for years that their jobs would be claimed by computers. MTs heard the same rumors, only about speech recognition technology, rather than CAC. "I have been in the business for 30 years, and it seems like we've been talking about speech recognition the entire time," joked Carol Weisher, MBA, RHIA, director of medical information and transcription at Advanced Healthcare, Milwaukee, WI.

Speech recognition technology lurked right around the corner for a while, but it's finally gotten widespread use over the last few years. Weisher actually looked forward to speech recognition, but she definitely needed some convincing that her fears about how it would work were unfounded. "You'd go and listen to these presentations and you'd listen to these demos, and the doctors had to speak very unnaturally to get it to recognize," Weisher added.

Faced with a tremendous backlog and MTs who were working hours upon hours of overtime, Weisher began looking at speech recognition technology. After selecting Dictaphone's EXSpeech product, she had to deal with new fears—those of her staff. Was she trying to replace them? Would they be out of a job soon? Weisher dealt with the questions and let the staff members know that she was just trying to make their lives easier. She admitted to them that the clinic system was trying to save money, but assured them that the technology wouldn't replace them. "We told them, 'we're doing this so you can also get your lives back,'" Weisher explained.

Now, about two-thirds of her MTs are trained on the system, and they seem to be enjoying the change. "When we talk to them about it, they don't want to go back to regular typing," Weisher said.

Georgette Wilson, RHIA, manager of health information services at Brigham and Women's Hospital in Boston had a bit of a different experience with speech recognition. She outsources all of her transcription and chose eScription's speech recognition technology EditScript. At the same time as the new technology was being implemented, Wilson was also switching transcription vendors. Although it seemed like it could turn into a scary experience, Wilson said the whole process went smoothly, and her department is reaping the benefits.

Face Your Fears

Wilson summed up her experience of adding new technology to her HIM department. "I liken it to buying a new car. You have the old car, which works pretty well and is still running. Then you go out and buy a new, shiny car, and you realize all the fancy bells and whistles you've been missing all that time," she said.

No matter what worries you have about implementing technology in your HIM department, remember that fears can be overcome. Most of the time, technology can lead to vast improvements in efficiency and productivity. If you're feeling overwhelmed by an upcoming implementation, talk to someone who's been through the process already. If you're having concerns about how the technology will work, speak to the vendor and get your questions answered. And if you're worried about how your staff will react, just remember to keep an open line of communication and an open mind. In the end, you'll see you have nothing to be afraid of.

Lynn Jusinski is an assistant editor with ADVANCE.

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