Since she started at Summit Health in 1993, Michele Zeigler has witnessed significant change, and learned that the only way to navigate a journey as complex as electronic transformation is to follow a roadmap. In this interview, Zeigler talks about the long-term IT strategic plan her organization recently formulated, which includes new data and IT governance, and how her team is leveraging lean processes to improve not only the selection but also the utilization of new technologies. She also talks about the importance of leadership buy-in, hitting restart on ICD-10, the Summit Health app store she hopes will increase patient engagement, and why volunteering is more than just a hobby.
- ICD-10 governance
- Hitting the restart button — “There are a lot of unknowns.”
- 600-record audit with Nuance
- Comparing historical data in ICD-9 & ICD-10 – “It’s going to be challenging.”
- Summit’s app store
- Patient engagement tools
- Volunteering with United Way
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For the things that are known and the things that we can do something about, I think we’ve given it a very good try to minimize any risk, but there are a lot of unknowns.
What we were able to do is look at the documentation and take it through an ICD-10 lens. Instead of just telling the orthopedic surgeon you’ve got to learn these seven things, it was ‘you have to learn these seven things,’ and ‘here are the things you would need.’
Sometimes one code in ICD-9 extrapolates to two pages of codes in the ICD-10 world. Think about your statistical reporting. I know people are just thinking to go live and get paid, but you’ve got a lot of data and historical data that you need to be able to think about reporting.
I think that’s exciting. It’s a little bit of a different area that we’re going into, but being that we’re in a rural area, mobile connectivity is sometimes a challenge.
Gamble: In terms of some of the priorities on your plate, where do you stand with ICD-10? Was it something where you had to change your strategy on the fly?
Zeigler: Actually for ICD-10, we started that about three years ago. We have an excellent team leader and an executive sponsor group, but the team leader has about five subcommittees. One is data and reporting, one is our physician practices, one is documentation and the ancillary departments, and then there’s the sub-committee for HIM — the coding and documentation processes. That group, the whole group, has done a very good job.
What we decided to do with the delay in the date is to take either a six or a nine-month hiatus, so we’re going to kick off February 1. We’re going to get everybody back together and we’ll start ramping up our regular meetings. We’ve done almost all of our system upgrades and we did some testing with CMS for the systems that we could test. For the things that are known and the things that we can do something about, I think we’ve given it a very good try to minimize any risk, but there are a lot of unknowns.
Plus, we have some payers and I think it’s our state workers comp and auto that has decided that they’re going to stay on ICD-9. That makes it even more complex for us, because we’re going to be living in two worlds. Now, our coders have been doing dual coding for probably the last year or year and a half. We were a beta site for Nuance for their computer-assisted coding — we’ve done that both on the inpatient and the outpatient side. We contracted with Elsevier for a lot of ICD-10 education, and we were able to leverage that for all different disciplines of staff. They had good education that was tailored to like physicians, and not just global. It was also surgeons, orthopedics, etc.
What we did for our physicians is an audit of about 600 records, and Nuance helped with this. What we were able to do is look at the documentation and take it through an ICD-10 lens. Instead of just telling the orthopedic surgeon you’ve got to learn these seven things, it was ‘you have to learn these seven things,’ and ‘Dr. Smith, when we looked a couple of your op reports, here are the things you would need.’ We customized the education to the physicians as much as we could.
We also have a clinical documentation improvement process. By knowing some of those documentation improvements, it’s going to help us as we review that documentation after October 1. We also did vacation blackout weeks, and that included key members of senior leadership as well. We are just going to kick in our plans as we had them before, but adjust them to the new timeline.
Gamble: I’m thinking that through the audit of 600 records, you turned up some pretty interesting results.
Zeigler: We did, and there were some common themes because there’s certain things with ICD-10. It taught us as well a lot of the areas to focus on. It allowed us to work with some of the surgeons on some standards. We use a lot of templates here. We’re 100 percent live with electronic progress notes at both facilities. That was something that the medical staff mandated. As we found things that were pretty across the board, we would put it in their standard progress note or do something similar to that to help them with that documentation process.
Gamble: I’m still a little bit blown away by what you said about having to deal with the ICD-10 and 9 codes. I don’t know how common that is but that’s got to be really a difficult one.
Zeigler: Well, initially, we did not have just one subgroup on our ICD-10 but it was, how are you going to do reports? If you do certain ICD-9 reporting, all those years that you reported on this is not going to correlate because sometimes one code in ICD-9 extrapolates to about 25 or 30, or sometimes two pages of codes in the ICD-10 world. Think about your statistical reporting. I know people are just thinking to go live and get paid, but you’ve got a lot of data and historical data that you need to be able to think about reporting. We’ve tried to figure out crosswalks, tried to figure out as much as we can about how we can begin to think about comparing historical data that was collected in terms of ICD-9 against ICD-10 data. It’s going to be challenging. I don’t think anybody has the perfect solution to that.
Gamble: No, not that I’ve heard. Okay, so we’ve talked about quite a lot. Are there any other priorities on your plate, which sounds funny to say because clearly there’s so much already?
Zeigler: We’re working on a couple of things. One that’s been fun but also challenging is that we’re in a rural area where we have about 170-180,000 people in our county, but a lot of the county is mountainous and has spotty cell phone coverage. It makes mobile challenging at times. So we’re working with a vendor called MobileSmith and we’re creating some apps. We’re going to have a Summit app store, and it’s nice. It’s going to allow us to do some things so that you can find a physician. You have map directions right on your smartphone to get from where you are now to that physician’s office, or find out where is the nearest urgent care center.
We’re also working on a pill minder app. Many times people come in to the ED and they say, ‘I take a blue pill but I don’t know what it’s for.’ This app allows you to take a picture of the pill or take a picture of the prescription bottle. If you had that or even if your kids could set that up for you, it could help. I have an elderly parent that I don’t even have the ability to know what her medications are. Sometimes I get asked to share that and I don’t know. But if I had an app that helped me with this or I could help my mom set it up, that would be neat.
What are some things that we are developing to do a reach-out and to help people with that patient engagement? We don’t always give them very good tools to manage that. We have a paper form that you can download that you can keep a list of your meds, but this provides a tool. If you had a child that was on different medications, you could create a profile, because sometimes you don’t remember all these things off the top of your head. I think that’s exciting. It’s a little bit of a different area that we’re going into, but being that we’re in a rural area, mobile connectivity is sometimes a challenge.
Gamble: Doing things like setting up those apps, what we’re seeing is that these things can certainly make a difference in terms of medication adherence and even having patients show up at appointments. If you have the directions and everything on your phone, it just makes it easier for people to get the care they need.
Gamble: That’s very cool. The last thing I wanted to ask you about was getting outside of the office. I saw on LinkedIn that you’ve done a lot of volunteer work, and I just wanted to talk about why that’s important to you and just how it’s benefited you being part of United Way among other organizations.
Zeigler: I feel strongly that most of us are pretty fortunate, and giving back to your community is important. I got involved with the United Way. We ask at least one of our members of senior management to be on their board so that we’re not only aware but supportive of any local community needs. And I stayed on. They asked me to be the vice president and then I was the president for a couple of years and was able to do some really neat things and get to know different organizations in the community and to make a difference in your own backyard.
I think those of us that work in health care, we care about people. That just allowed me to extend it more and to hopefully make a difference in some different ways. I always would share with people sometimes when you give a donation to American Cancer Society or something like that, not that isn’t important enough and not that they don’t need it and do a good job with those funds, but when you give to the United Way, you could be helping your neighbor. You could be helping the girl in the checkout. You could be helping a family that had a fire, because part of the donations go to the local Red Cross and they’re all spent locally.
It was a very humbling and rewarding opportunity for the six years that I spent there. I made a lot of good friendships in the community and I still stay in touch with many of those folks, and it led to other civic organizations that I do some things with. It’s been good.
Gamble: And just getting that different perspective and a broader perspective.
Gamble: Do you still find some time for the horse-riding?
Zeigler: I try to. I haven’t done as much riding the last year or so as I’d like to, but I still very much enjoy the horses and my three dogs and my barn cats. We seem to get more and more barn cats. I think my neighbors drop them off every once in a while. It’s okay.
Gamble: They’re multiplying quickly.
Gamble: It’s just so important to have any activity that you’re disconnected.
Zeigler: Yes. It’s very peaceful where I live and I have the horses right there, so I see them a couple of times a day. It’s very relaxing. I find it relaxing.
Gamble: Alright, I know that you have so much going on, so I really appreciate you taking all the time to speak with us. It’s been really interesting hearing about everything you guys are doing.
Zeigler: Thank you. You have a Happy New Year.
Gamble: Thank you, you too, and I hope to catch up with you again down the road.
Zeigler: Okay, it’s a deal.
Gamble: All right. Thank you, Michele.