September 4 , 2007

Meet Our Advisors Q & A
For The Record
Vol. 19 No. 18 P. 24

Distinguished. Honored. Leaders in their field. Those are a few of the attributes of For The Record’s new advisory board. For years, this collection of talent has helped reshape the healthcare industry by tackling tough issues and spearheading the charge for change when necessary.

Despite these accolades, what may be most impressive is the group’s ability to educate colleagues and newcomers. All five members share an affinity and a talent for teaching. It’s primarily for that reason we believe they can help guide this magazine to become an even better source for HIM professionals who want to learn and stay on top of the industry’s latest developments.

As a matter of introduction, we posed a few questions—some serious, others not so much—to each advisor to ascertain their thoughts on what’s going on in healthcare.
Advisor Bios

Toni Cade, MBA, RHIA, CCS, FAHIMA, an associate professor in the HIM department at the University of Louisiana at Lafayette, holds a bachelor’s degree in medical record science and a master’s degree in business administration. She coauthored the Professional Review Guide for the RHIA, RHIT, CCA, CCS, and CCS-P examinations and wrote an instructor’s resource manual to accompany Medical Language.

As a consultant, Cade has extensive experience conducting seminars and workshops in coding and reimbursement to participants in various healthcare settings throughout the United States. Most recently, she has worked with attorneys involved in medical malpractice cases.

A former nominee for the AHIMA’s Champion Award and Educator’s Award, she has served the Louisiana HIMA in many capacities, including as president, and was awarded the Distinguished Member Award in 2003. She also received the Outstanding Volunteer Award for her efforts as coding roundtable coordinator in 2003-2004.

Gail I. Smith, MA, RHIA, CCS-P, is the director and associate professor of an HIM online progression program at the University of Cincinnati (UC). She has been an HIM professional and educator for more than 30 years. Prior to joining UC, she was the program chair of an HIT program and director of HIM in a multihospital facility.

Smith has served as a coding consultant for many years and authored Basic CPT/HCPCS Coding for the AHIMA. She is an active member of the AHIMA and previously served as a member of the board of directors. Smith received a bachelor’s degree from Ohio State University and a master’s degree in education from The College of Mount Saint Joseph in Cincinnati.

Scott Faulkner, CEO of InterFix, has more than 27 years of experience in the HIM industry. He served in several senior sales and development positions at Lanier Worldwide, VDI Technologies, Dictaphone Corporation, and Speech Machines. Faulkner is a past president of the Medical Transcription Industry Association. He is also an active board participant for the American Association for Medical Transcription (AAMT), now the Association for Healthcare Documentation Integrity (AHDI), and an author who contributes to multiple industry publications.

Michelle L. Dougherty, RHIA, CHP, is a manager of practice leadership for the AHIMA. In her role, Dougherty provides professional expertise to AHIMA members, outside organizations, and industry initiatives on health information practice issues, electronic health records, and information exchange initiatives. Dougherty also serves as coordinator and project manager for a number of task forces, including e-HIM, Long-Term Care, and the Legal Health Record, and represents the AHIMA and the HIM profession at Health Level Seven and on the EHR (electronic health record) technical committee. Dougherty is a frequent speaker and an award-winning author.

Robert S. Gold, MD, has more than 40 years of experience as a physician, medical director, and consultant. Gold is nationally known for his educational presentations regarding the clinical orientation of coding for the AHIMA and HCPro audioconferences. He is CEO and cofounder of DCBA, Inc., a consulting company that provides physician-to-physician educational programs in documentation improvement along with coder education in the diagnoses and procedures to which they assign codes. Gold also writes educational articles for physicians and coders and works with professional colleges and national organizations to enhance the value of ICD data.

1. If there was one thing you could fix in the U.S. healthcare system with a snap of your fingers, what would it be?

Toni Cade: I really wish that all Americans would have health insurance coverage.

Gail I. Smith: First item that came to mind was to cut the bureaucracy and start focusing on the patient and quality of care.

Scott Faulkner: Completely interoperable electronic patient records.

Michelle L. Dougherty: High insurance premiums, rising deductibles, and the increase in noncovered services.

Robert S. Gold: Personal medical savings accounts. As weird as it seems, as different as it is, it’s a pretty darned good idea. Makes everyone responsible for self and family.

2. A national health information network by 2014: Doable or better make that 2024?

TC: Better make that 2024. I don’t consider myself to be a pessimist, but I am a realist.

GIS: Hate to sound like a pessimist, but make it 2024.

SF: Depends on the definition of “doable.”

MLD: Can we split the difference? I think we’ll have made significant progress by 2014, but we won’t have achieved the full vision by then.

RSG: I’ll take a chip in my forearm, but the data had better be accurate.

3. How important is a presidential candidate’s healthcare policy when it comes time to cast your vote?

TC: It is very important. I believe it is important to make an informed choice; for me, that means knowing the position each candidate takes on the issues that are important to me. Healthcare policy is very important to a lot of people.

GIS: Very important; I am looking for a viable plan—not the same old talk, talk, talk.

SF: Highly important. I want the government to move further away from the delivery of healthcare and stick to what it does best, which is, um, er ... is this a trick question?

MLD: It is just one of a number of issues that I consider but definitely in the top five.

RSG: I don’t care. The insurance companies will do what they want to do, regardless.

4. Who’s the most fascinating person in healthcare?

TC: Monroe Dunaway Anderson. Anderson was not a physician. He was not even employed in the healthcare industry. He was a wealthy, friendly, humble, and kind businessman who was instrumental in the building of the M. D. Anderson Cancer Center in Houston.

GIS: Tackling this question from a HIM perspective, Michael Leavitt, Health and Human Services secretary, is a logical choice. Carolyn Clancy, MD, at the Agency for Healthcare Research and Quality is getting a lot of attention, but personally speaking, I believe Linda Kloss, MA, RHIA, CAE, CEO and executive vice president of the AHIMA, is a true leader in the healthcare arena and meets the definition of fascinating.

SF: A newborn baby.

MLD: I can’t narrow it down to one. There are a number of people who are doing great work and have an important vision for healthcare.

RSG: Still is C. Everett Koop, MD, to me. Maybe because he and I used to do bilateral inguinal hernia repairs together in four minutes skin to skin at the Children’s Hospital of Philadelphia and then run to the lounge for a cigarette, write orders, dictate the op note, and then run back and double team another bilateral hernia. Then he had his MI (myocardial infarction), and the cigarettes were doomed.

5. What has been HIPAA’s effect on the healthcare industry?

TC: I believe the intent of HIPAA was based upon a reasonable premise. But I have seen situations where interpretations have been exaggerated.

GIS: For the healthcare providers, it led to more paperwork, accounting for disclosures, seeking answers to the state vs. federal issues, etc. Recent news articles have highlighted the fact that HIPAA is still misunderstood and, in some cases, taken too far. On a positive note, HIPAA has brought national standards for confidentiality to the forefront.

SF: The unintended consequences include a generally false portrayal to the public that their records are really, really secure, along with an incredible bloating of largely unnecessary administrative costs.

MLD: You mean besides signing forms stating that you’ve received the Notice of Privacy Practices when one was never offered (my personal pet peeve)? I think HIPAA has put privacy and security in the forefront. In all of my years in healthcare, the issues weren’t an apparent part of national policy discussions and consumer interest. HIPAA, along with the vision for an interoperable healthcare system, has kept privacy, confidentiality, and security in the forefront.

RSG: Caused a lot of hullabaloo, caused a lot of fear and suspicion, caused a lot of jobs to be created, caused a lot of lawsuits and fines, and didn’t really change privacy at all. Some of us are more aware of it, but it hasn’t stopped talking.

6. Pick one: House or Grey’s Anatomy

TC: House.

GIS: Grey’s Anatomy.

SF: I don’t watch either.

MLD: Definitely Grey’s.

RSG: House is a jerk—just like real docs. Grey’s is a real soap opera nowadays and doesn’t deserve a following. It used to. Too bad.

7. Do you maintain a personal health record (PHR)?

TC: I do not have a personal health record … yet. I guess the reason I do not have a PHR is that I am relatively healthy, meaning that I take no medications, have no illnesses, and have never been in the hospital (other than to deliver my children). When this begins to change, there will be a more immediate need to document and store vital health and medical information.

GIS: Yes, I do, but it needs attention.

SF: Yes, although it is almost impossible to do so given the current state of technologies actually deployed in my provider setting, which do not easily allow for file exportation.

MLD: Yes. I think all HIM professionals should maintain a PHR to understand what it is like to be on the receiving end of release of information processes. Although I didn’t start my PHR with that motivation, it has been interesting and challenging deciding what to maintain and obtaining records.

RSG: Not since the Navy in 1986.

8. What is your opinion of retail health clinics?

TC: These retail health clinics are appearing in supermarkets and drugstores. They are usually staffed by nurse practitioners. There are obvious advantages to retail health clinics. They are conveniently located and offer lower costs. Most hospital emergency rooms are unable to keep up with the volume of patients. These retail health clinics are not regulated, and I am concerned about patient quality and safety. With strict guidelines in place and proper oversight, this new trend could serve a subpopulation of less-ill consumers.

GIS: Interesting concept and controversial—will leave the opinions to the clinicians.

SF: I believe in a free market, and as more healthcare options are made available to consumers, more efficient delivery models will emerge.

MLD: I am a little intrigued but have a wait-and-see attitude. They are meeting a consumer demand/need in the industry. Time will tell if they will be a long-term solution.

RSG: A doc in the box is a good, community way to provide access to healthcare and take pressure off of emergency rooms. However, they should be manned by folks who know what they’re doing and are not dropouts from other venues of practice. Having a nurse as a screener is a common practice in hospitals, having a PA (physician’s assistant) or nurse practitioner is also common before it is determined that you have to see the “doc.” And, with good protocols, I feel this is a valuable resource to the community. But I would encourage them not to use folks fresh out of training who have no experience with real medicine in life and can make serious omission errors because “they’ve never seen it before.”

9. Does your family physician have paper records or electronic? If he or she is paper-based, have you ever suggested converting to an electronic medical record (EMR)? If so, what kind of response did you receive?

TC: My family physician, like many other physicians, has a combination of paper-based and electronic records. They are in the process of converting to an EMR.

GIS: Proud to say yes. He uses a computer tablet and documents while we chat (still makes eye contact). On my first visit, I presented him with copies of my personal health record, and he was impressed.

SF: I wouldn’t go to a physician that uses paper-based records.

MLD: The physician who I see the most is the pediatrician for my children. The practice doesn’t have an electronic health record, and I have been brainstorming an approach to bring up the issue.

RSG: They are electronic. Problem is that their code sets are wrong for a cardiologist—and that’s a shame.