Mobile technology applications have changed information sharing and allowed health-care providers to use patient data in ways that were unimaginable fifteen years ago. Dr. Colin Banas, chief medical information officer at Virginia Commonwealth University (VCU) Medical Center, has been on the ground floor of the technological transformation in health care for the past ten years.
HEALTH CARE’S DIGITAL DEMANDS
Banas explains the challenges of complying with ICD-10.
The ICD-9 is a code doctors and insurance companies have used for years to record disease states—specifically when creating charges for billing purposes. A government mandate to move to ICD-10, a much more complex and detailed system, is forcing physicians and hospitals to make major changes in how they record patient data.
ICD-10 requires a new, longer code that includes letters and decimals.
Prior ICD-9 codes were three to five characters in length with a total of 13,000 codes. New ICD-10 codes are three to seven characters in length with a total close to 70,000. In response to that increase, developers are implementing a computer-assisted coding software that reads doctors’ notes digitally using natural-language processing to produce the correct code for verification.
Physicians will have to include new details when creating a record.
Training software will walk doctors through a decision pathway to choose the most accurate code.
Doctors need to be trained on an entirely new system.
At the core of a successful transition, Banas is ensuring doctors document properly. “We can’t get the right code without the right documentation,” he says of a training plan to improve doctors’ medical recording.
As CMIO, his responsibilities include providing communication systems, mobile applications, diagnostic tools, patient portals, and electronic medical records (EMR)—everything touching the patient and clinician experience as it relates to technology. “Early on, the role felt more like lead physician representative for the EMR, but as technology becomes more important, the position is ever expanding,” Banas says.
As a practicing physician, Banas spends 25 percent of his time working with resident physicians, students, and patients at VCU. His role as a hospitalist—a doctor who specializes in hospital care—gives him insight into the challenges physicians face when dealing with new technology and also into the areas where innovation has the greatest potential to improve patient outcomes. “It’s an important part of my identity to practice internal medicine,” he says. “I can also help fellow providers adopt new applications because I’m a user, too.”
Banas’s journey to become a CMIO followed his affinity for technological solutions. After completing his residency, Banas earned a master’s degree in health administration that led him to a role as director of care coordination, where he worked closely with the chief medical officer. “When my mentor was deciding to build up the office of clinical transformation, he saw I had passion for technology and technical aptitude,” Banas says. “So I was tapped to be one of the first physician informaticists for the medical center.”
During his tenure, Banas has spearheaded a number of initiatives that have improved patient outcomes, including an easily accessible safety dashboard that coalesces a patient’s data during a hospital stay in one place. Everything from the patient’s dietary restrictions to their overdue medications is available in a quick snapshot. The application uses intuitive icons, allowing a provider to pull up an entire unit and see the group’s data filtered in a graph. The dashboard has been especially helpful in preventing sepsis, a dangerous condition commonly caused by bacterial infections in hospitalized patients.
Another major project is an early warning system application that allows doctors to see key attributes of illness for a given group of patients in one screen. Patients’ vitals are tracked in real time and an algorithm then calculates a score from one to fifteen. When the number surpasses a certain threshold, doctors are notified that the patient is approaching a danger zone. “We try to see their absolute score and see how they’re trending,” Banas says. Since implementation of the system, the hospital has seen a 30 percent reduction in code blues—the code designating a patient needing immediate assistance—out of the ICU.
Banas has also overseen the use of mobile technology to help doctors communicate more effectively. VCU physicians now have a mirror of core EMRs available on their mobile devices. They can also use an app on their mobile device to follow up with lab results or notes.
As technology improves, the next big leap in data sharing is to offer interoperability. That means that a patient’s accumulated data would be available to them at any time, and information could flow freely, but securely, between caregivers. “There are a lot of safety and cost-saving outcomes that could be achieved by being able to communicate effectively to the next caregiver so there aren’t any repeated, unnecessary tests,” Banas says. “Maybe by 2020, we’ll have nailed it, or at least taken a big bite out of the interoperability concept. We’re close to the tipping point and gaining momentum fast.”