PLEXUS

Where Health Information Experts Come Together

SEPTEMBER/OCTOBER 2015 VOLUME 11, ISSUE 5

Shifting Regulatory Landscape

>>>

CLINICAL
MEDICINE
page 22
Hematology/Oncology
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Integrity Conference

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 >>> Editor’s Message

A Salute to Our Unsung Regulatory Heroes

OR’S MESSAGE
Kristin M. Wall, CHDS, AHDI-F

he App Savvy User

A
mong household chores and doing taxes, I’d rank
spending time learning and reviewing policies,
rules, and regulations as one of my least favorite
e, all I wanted was to fit in. But I
things to do. The words monotonous and uninteresting
d that we’re all searching to fit in
e... we all come
feel liketooutsiders
mind. In andfact, I’m pretty sure that one of two
do things things
and feelhappen
things that during
are those activities: I fall into a men-
tal coma orand
e and unconventional I begin
dorky.daydreaming about all the things I’d
all dorks! rather
My name be isdoing.
Sydney
Despite Imy
, my dad’s a plumber, lack of enthusiasm, these things need to
collect
books, andbeI’mdone because the resulting consequences of either not
secretly terrified
oon animals. I’m completed
being a dork!” (a dirty house and going to jail, respec-
ney White tively)
[2008 movie
are evenstarring helping businesses and its personnel understand the legal-
less appealing. As far as completing taxes
da Bynes] ese of the oftentimes complicated-sounding standards and
is concerned, my wonderful husband, thankfully, takes on
the bulk ofIsn’t thatit?task. rules and decipher which ones apply.
ology is wonderful!
Thankfully, also, there are those in the world who do I distinctly remember compliance consultant Brenda
pose the feeling behind that
enjoy setting
ment could vary depending standards, Hurley, CMT, AHDI-F, once saying that she prefers to
staying up-to-date on relevant
hether or notlaws,thedesigning
particularor updating internal company policies, complete the tasks on her to-do list she likes the least
ology youand are leading
using is working first. She gets those pesky items out of the way first so
audits of procedures. It’s their thing, their
niche. ToIt’all
rly and efficiently. that she can go on to the more fun aspects of her job and
the compliance officers and experts in policy
s inevitable
our computer gets a virus,
regulations enjoy her day. This is a great mindset to adopt.
your thank you for the role you play in
out there,
ams or Internet connection tech programs and apps I’ve used Whetherposition
resources; you’re statements
a businessandowner, independent
low, the screen freezes up, or this past year for work: Moodle, contractor, or employee, you
best practices and standards must stay updated on the
guide-
other wacky technology glitch Webassessor, Dropbox, SendSpace, lines; and
rules AHDI help desk; pertaining
regulations member, com- to healthcare documenta-
“Do it with pleasure. We don’t
your day. But overall, I think QuizFaber, nearly all the Microsoft pany, and credentialed professionals
tion and patient records. But knowing isn’t enough; you
ology is amazing and fun and suite, Personify, SysAid, Adobe, directories; special interest alliances,
must implement and follow these rules and regulations
always get to do what we want to
lain cool! It’s odd to think how SpeedType, FileZilla, Windows Live AHDI Lounge blog, and other net-
also—or be prepared for the consequences.
ent the world would be today Messenger. On a personal note, I’ve working avenues; and many others—
do, but there are things we have to
omputers never been invented. been using a slew of apps on my In this issue of Plexus, Nick
all available at www.ahdionline.org.
decipher
Mahurin will help us
what does an “app-savvy” user iPad: iTunes, Pinterest, OneNote, In this issue you will read about a Use, and we’ll also
the latest about Meaningful
do. Once you have to do something,
ike? It used to be that people RecipeBook, iBooks, Maps, Flipboard, learn
number some safetygreat
of other techniques
websites,about
tech- data security in the
were really into technology games, and others. I even have apps cloud from
nologies, andAsaf Cidon.Have
resources. In clinical
a greatmedicine, Lilian Carr
find the pleasure in doing it. Since
considered “geeks” or “dorks.” to check for movies at Fandango or has provided
resource us with
you want an us
to tell interesting
about? article about thera-
the years, computers, tablets, Redbox, or to do online banking and peutic
Email me exchange. Enjoy! PP
at kwall@ahdionline.org.
plasma
you have to dopayit bills.
phones, and other devices anyway,
Many apps you mightvia
are available
become more prominent and multiple devices—and synchroniz-
as well enjoy it,able
ible, and society has shifted
reotype of geeks and dorks.
right? Do devices—which
across those it with
makes taking care of work or per-
pleasure.”
the first adopters and efficient
sonal business quick and convenient.
of technology are the cool kids. I would be remiss if I didn’t KristinM.M. Wall, CMT, AHDI-F
Kristin Wall

one I know is very cool!

– Matthew
’s the case, then pretty muchmention
resources you may have forgotten
ere is a brief recap of some of
elpful, useful, or just plain cool
VOLUME 11 • ISSUE 5
McConaughey
some of the great member
Editor-in-Chief, Senior Programs
Editor-in-Chief,
Coordinator, AHDI
Senior Programs Coordinator, AHDI
about: Matrix and Plexus article
archives; online CECs; component
SEPTEMBER/OCTOBER 2015 1

me 8 • Issue 6 NoVember 2012 1

>>> Contents SEPTEMBER/OCTOBER 2015 • Vol. 11, ISSUE 5

FEATURES CLINICAL MEDICINE

MEANINGFUL USE: AND THE WINNER IS...
by Nick Mahurin 12 22 Therapeutic Plasma Exchange
by Lily Carr, CHDS, RHIT, RN
MEDICOLEGAL Clinical MEDICINE

USING THE CLOUD SECURELY FOR

HEALTHCARE DOCUMENTATION
by Asaf Cidon
16 26 Let’s Talk Terms
by Beverly Sofko, CMT
Clinical MEDICINE

>>>
TECHNOLOGY AND THE WORKPLACE
28 CMT/CHDS Challenge Quiz

20
GETTING BACK TO BASICS by Cyndi Sandusky, CHDS
by Michelle LaBrosse, PMP Clinical MEDICINE
0.5 PROFESSIONAL DEVELOPMENT

22
>>>

DEPARTMENTS/COLUMNS
16 1 Editor’s Message by Kristin M. Wall, CHDS, AHDI-F
4 President’s Message by Jay Vance, CMT, CHP, AHDI-F
6 Tech Talk by Curt Hupe
0.5 TECHNOLOGY AND THE WORKPLACE

8 Pathways by Lea M. Sims, CHDS, AHDI-F

PROFESSIONAL DEVELOPMENT

10 Newly Credentialed
11 Around the Country
29 Exercise Your Brain by Donna Blessing, CMT
0.5 Clinical MEDICINE

31 Professional Practice Desk

32 Corporate Perspectives
34 AHDI News and Who’s Who
36 Funny Bone by Richard Lederer, PhD

2 SEPTEMBER/OCTOBER 2015 WWW.AHDIONLINE.ORG

 The Fine Print
 his symbol identifies creditworthy items preapproved by AHDI. To earn CE credit,
T
CMTs/CHDSs should submit a brief (300-word) summary of a preapproved article.
Article summaries preapproved by AHDI can be written and submitted at the end of
your recertification cycle every 3 years. Do not submit them upon completion. Alternately, AHDI members
may log in at www.ahdionline.org to see if an online quiz is available. Permission to reproduce copies of
articles for educational use may be obtained from the editor at kwall@ahdionline.org.

CMTs/CHDSs may opt to take the online quiz in lieu of an article summary for any article where this
symbol is also indicated. You can find these CE quizzes at the AHDI website under
Member Center > My Benefits > Online CECs. Members must first log into the AHDI
website to access these quizzes.

SEPTEMBER/OCTOBER 2015
november
Vol. 11, No. 5 2012 THE FINE PRINT
Vol. 8, No. 6 The statements and opinions contained in the articles of Plexus are solely those of the
individual authorsThis
andsymbol
contributors andcreditworthy
identifies not Open Road
itemsGraphic Design
preapproved Services.
by AHDI. To earn
Editor-in-Chief
editor-in-Chief The Publisher disclaims responsibility
CE credit, CMTs shouldfor any injury
submit a brief to persons orsummary
(300-word) propertyofresulting
a preap-
Kristin Wall, CHDS, AHDI-F
Kristin Wall, CMT, AHDI-F from any ideas orproved
products referred
article. tosummaries
Article in the articles or advertisements.
preapproved by AHDI can be written and
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kwall@ahdionline.org submitted at the end of your recertification cycle every 3 years. Do not submit them upon
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completion. FOR
Alternately, PUBLICATION:
AHDI AHDI
members may log welcomes industry contributions,
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online
Associate Editors
AssoCiAte editors submissions for publication
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for review and consideration
of articles byuse
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editor.
be
JenniferBlessing,
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CMT CMT, CPC, CGSC Any individual
obtained from the oreditor
groupatinterested in submitting an article or column content should
kwall@ahdionline.org.
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is published bi-monthly by the
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1. Articles must Manual ofinStyle,
be submitted 10th format
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and instance where
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Association for Healthcare
4230 Kiernan Ave., Suite 130
Documentation Integrity
AMA style conflicts with The Book of Style
exceptions will be made depending on content).for Medical Transcription, 3rd edition,
Modesto, CA 95356-9322
4230 Kiernan Ave., Suite 120 the AMA standard is used to comply with industry publishing standards, because
2. Articles should include full name and contact information for each author/contributor as
Modesto, CA 95356-9322 those outlined in The Book of Style for Medical Transcription, 3rd edition, are specific
CUstom PUbLishinG well as a brief bio (2–3 lines) for each author/contributor.
to documentation in a transcription setting and not to formal publication.
serviCes Provided by 3. Consider including a 15- to 20-question multiple-choice quiz with your article to
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Speaks BC in the industry, Plexus has been
4230 Kiernan Ave., Suite 130 edited to comply with the style and standards as outlined by the American Medical Association
Modesto, CA 95356-9322 (AMA) Manual of Style, 10th ed. In any instance where the application of AMA style conflicts
All contents ©2012 Association for with The Book of Style for Medical Transcription, 3rd edition, the AMA standard is used to com-
VOLUME 11 • ISSUE
Healthcare 5
Documentation Integrity ply with industry publishing standards, because those SEPTEMBER/OCTOBER
outlined in The Book of Style2015 3
for Medical
Transcription, 3rd edition, are specific to documentation in a transcription setting and not to
formal publication.
 >>> President’s Message

Survival is Not an Option

Jay Vance, CMT, CHP, AHDI-F

I
t is with a great sense of anticipation
and enthusiasm mixed with humility
and trepidation that I write this, my first
article for PLEXUS as AHDI President.
The past year has been an opportunity for
me to “learn the ropes” from my predeces-
sor, Susan Dooley, a colleague and friend
who has done a great job of helping to
move our association forward in the midst
of challenging times. It has been an honor
to serve as President-Elect during Susan’s
tenure as President. Now that the gavel
has been passed, I’m more cognizant than
ever of the possibilities and potential
roadblocks our organization faces in the
coming year. It is my intent, beginning
with this article, to set the tone for my time time, wisps of hope are wafting in the wind. The pendu-
as AHDI President as one of realistic optimism, a determi- lum is slowly starting to swing back in our direction, and
nation to face the challenges before us with the conviction this is the moment for us to stand up and make our
that we can make a difference in our profession. If I did presence felt among other healthcare stakeholders.
not believe that, I would not be serving in this position. What are these glimpses of hope I speak of, you may
I have no intention of being a “caretaker” whose best-case well ask. What is taking place in the broader health-
scenario is to keep our association functioning on life sup- care delivery arena which should encourage us to press
port for one more year. Simply surviving is not an option! forward with renewed vigor? I could cite a number of
Of course, brave words mean little in the real world; specific examples, but in a nutshell, there is a growing
what our members expect and deserve is action and tan- awareness among healthcare providers that the technology
gible results. The members of the AHDI National Leader- that was supposed to have made healthcare documenta-
ship Board are deeply committed to pursuing initiatives tion specialists superfluous has, on the contrary, shone
that will have a measurably positive impact on the morale a light on the importance of our role as guardians of the
and welfare of AHDI members and healthcare documen- American public’s medical records. Technology such as
tation specialists in general. It would be easy to focus on automated speech recognition (ASR) and electronic medi-
all the challenges we face and the setbacks our profession cal records (EMRs) have by no stretch of the imagination
has experienced, throw up our hands and say, “What’s eliminated the need for skilled healthcare documentation
the use?” Well, that’s not going to happen on my watch. specialists, and key stakeholders are slowly awakening to
There are no such things as insurmountable odds—just this reality. As the hype surrounding EMRs subsides and
problems which haven’t been solved yet. Now is not the reality sinks in, more and more clinicians are rising up in
time for us to give up, because for the first time in a long protest against the dehumanizing effect this technology is
4 SEPTEMBER/OCTOBER 2015 WWW.AHDIONLINE.ORG
having on the practice of medicine.
Healthcare administrators are forced
to quantify the cost of deteriorating
morale and lost productivity, and the
cost is proving to be high indeed.
One seminal event took place over
the summer, which I believe merits
particular mention as we look for
signs that the tide is starting to turn
in our favor. In July the American
Medical Association (AMA) held
a town hall to give its members an
opportunity to tell their stories about
interactions with health information
technology such as EMRs. A seem-
ingly endless parade of practitioners
told one horror story after another
about how technology has severely
impaired their ability to practice
good medicine. One physician in
particular, Dr. Kay Kirkpatrick, an
orthopedic surgeon with a very large
clinic in Atlanta, made the follow-
ing statement: “We chose not to do
structured notes in our practice ...
The templates are difficult when you
build them from scratch and they
didn’t know the first thing about
orthopedics or surgery or special-
ties, so we pay the $21,000 per year
per doctor for transcription because
our notes are readable, and they still
relate to the care of the patient.”
How great is that?!
Of course, I realize this is just one
anecdote, and we must not extrapo-
late too much from stories like these.
But the important thing for us to
acknowledge is that these kinds of
stories are more and more common,
and as a result, now is the time for
us to seize the moment. A window of
opportunity has opened—maybe just
a crack, but that’s all we need to col-
lectively shout, “We’re still here!”
Over the coming months you’ll be
hearing more about the specific
initiatives AHDI will be engaging
in as we press forward. In some
instances we will be continuing
and expanding existing endeavors
which show promise, and we’ll also
be trying some new things and new
ways of doing things in order to take
advantage of the opportunities before
us. But rest assured, it’s going to be
an exciting ride, and I hope you’ll
come along! P
Jay Vance, AHDI President 2015-
2016, was elected as an at-large
member to the AHDI National
Leadership Board in 2014. He is a
15-year veteran of the healthcare
documentation and health informa-
tion technology fields.

The Book You

Reach for Most
The Book of Style
for Medical Transcription,
3rd edition.
Chapter 1: Types,
Formats, and TATs

For coated:
Blue: 534
Green: 382

For uncoated:
Blue: 547
Green: 380

This widely acclaimed industry standards manual has long been the trusted resource
for data capture and documentation standards in healthcare. The 3rd edition
delivers a streamlined and strategically reorganized flow of critical
data, enhanced explanation of standards and practical application, The BOS 3rd edition is
robust examples taken from clinical medicine settings, trend available for purchase
notes that identify the impact of technology on the state online at www.ahdionline.org.
of the industry, and new chapters on security/privacy,
standardized templates and nomenclatures, the
3rd edition price:
$50 members, $70 nonmembers.
electronic health record, and speech recognition
editing.

VOLUME 11 • ISSUE 5 SEPTEMBER/OCTOBER 2015 5

 >>> Tech Talk
Your Tech Questions
Answered
Curt Hupe
R egarding the adoption of Windows 10, compatibility
with one’s employer’s platform is the biggest
consideration. If that’s not an issue, what is your
recommendation?
While Windows 10 is supposed to fix many of the flaws
in Windows 8, the user agreement with this new operat-
ing system gives Microsoft even greater control over our
data than with prior versions. I was particularly aghast
at the so-called optimization scheme that involves
“shared computing,” which means the bandwidth I pay
for is redistributed by Windows to other users for certain
processes. I still can’t believe this.
I generally wait 3 or 4 months before making any oper-
ating system change in order to allow time for the major
bugs to come to light and get fixed, but even though I’m
6 SEPTEMBER/OCTOBER 2015
TECHNOLOGY AND
0.5 THE WORKPLACE
anxious to dump Windows 8, I’m pretty queasy about
moving to Windows 10. What are your thoughts?
I completely understand your hesitation on upgrad-
ing your operating system. If your Windows goes down,
you’re down for the count. Always be prepared to have
something fail. If you have no problems, then you’ll be
ahead of the game! There have been several problems
reported when users tried to upgrade.
Regarding the user agreement for Windows 10, I
viewed the latest end-user license agreement I could find
on Microsoft’s website at http://www.microsoft.com/en-
us/Useterms/OEM/Windows/10/UseTerms_OEM_Win-
dows_10_English.htm. I didn’t see any reference to an
optimization scheme or shared computing. This could
have been in a pre-release of Windows 10. Unless you’re
working from a laptop, I don’t see how the operating
WWW.AHDIONLINE.ORG
system would be able to share your Internet connection.
However, I have heard rumors of some ISPs stating they
want to share consumer’s bandwidth by creating public
hotspots off of private routers. I’m not certain if this has
actually been put in place. An easy way to make sure
you’re the only one on your Internet is to make sure you
change the default password on your router, and make
sure it’s set up with WPA security or better.
Your plan of waiting 3 or 4 months before upgrading
is a good one. Though, to take that a step further, before
any upgrade, make sure your hardware and software (es-
pecially unique software such as transcription platforms
or other specialty software) is compatible. If you have
the option to test, be sure to do that too.
In the event that Windows 10 is a dud for you,
Microsoft does allow you to go back to your previous OS
within the first 30 days. Be sure you have a good backup
and/or set up restore points.
The operating system is the core of your structure and
if you have software or hardware that hasn’t been tested
to be 100% compatible, you’re putting your ability to
work at risk.
I don’t yet have a full opinion on Windows 10. I’ve
heard lots of positive feedback from colleagues and
industry experts. I understand that Microsoft has imple-
mented many new options to ease the frustrations many
Windows 8 users had.
free of viruses and hackers.
1. Keep your computer updated. This includes
Windows, web browsers, anti-virus, and other
software.
2. Have a secure password. You’re just asking for
trouble if you use passwords that are too basic or
easy, such as 1234. Be sure to note your password in
a secure place.
3. Secure your wireless network. Your wireless
network should have at least WPA security or better
with a strong password. Change the password often.
4. Keep the security software enabled. I often see users
disable the security or firewall software for testing,
then they forget to re-enable it.
5. Be cautious about others using your computer.
Remember, your computer is your vehicle to work—
if your computer crashes, so can your paychecks.
Remember the best way to keep your computer safe
is to be vigilant; don’t open suspicious emails, don’t be
click happy, and be responsible on the websites you visit.
Just being aware of your online and email presence and
where you click goes a long way. P
Curt Hupe is director of operations for ChartNet Tech-
nologies. Curt has over 15 years in the IT industry and 5
years in the medical transcription IT field. He welcomes
your feedback at Curt@ChartNetTech.com.

H ow would I know if someone has access to my

computer through Homegroup, online, or email?
Being slow is a known indicator, but I wish there was a
program or some way it would be known if an outside
source is hacking in. I have Norton Security Suite but
heard they cannot handle all the hackers coming in
every day.

You’re correct in your statement that computer slow-

downs can be an indicator of something not being right,
though just remember, it doesn’t necessarily mean that
you’ve been hacked. You’re also on the right track by
having a security suite product. Users can only access
your computer through your home group if they are on
your network, and they can only get on your network
through your wireless router. Most hackers don’t really
want access to your computer, what they do want is for
you to download a file, or click on a link, or visit a site
that will install malware that will do the dirty deeds
for them.
Here are a few easy ways to help keep your computer

VOLUME 11 • ISSUE 5 SEPTEMBER/OCTOBER 2015 7

 >>> Pathways
Focus
W
hen
I was a kid, I
dreaded bringing home a
bad grade. My parents were zealous
about my academic progress, and
like most parents of their generation,
zeroed right in on any area of poor
performance or underperformance
with the mindset to correct and
improve. My greatest struggles were
always in mathematics (I am so not a
numbers person), and it took several
patient tutors to get me over some
difficult algebra and calculus speed
8 SEPTEMBER/OCTOBER 2015
on Your Strengths
Lea M. Sims, CHDS, AHDI-F
bumps along
my academic
highway. Good
grades were
the expectation,
and while those
grades were usu-
ally acknowledged
and sometimes
celebrated, very
little attention was
directed at widen-
ing my access to and
engagement with sub-
jects in which I clearly
excelled.
My parents followed
the same ideology that
has shaped a great deal of
historical thinking around
personal development—i.e.,
improve your weaknesses.
The goal of that traditional
thinking is that it’s better to be
a well-rounded person with ba-
sic proficiency in all areas than
it is to truly excel in one or two
key areas. The challenge with that
approach is we spend so much time
trying to shore up skills and abilities
that are not ever going to become
differentiating strengths for us that
our true strengths lie dormant and/or
greatly underdeveloped.
All people have a unique combi-
nation of talents, knowledge, and
skills—strengths—that they use in
their daily lives to do their work,
1 CEC
3 QUIZ
PROFESSIONAL
DEVELOPMENT
achieve their goals, and interact with
others. Clifton StrengthsFinder as-
sessment provides materials, tools,
and in-depth reports to help you
better understand and benefit from
your unique strengths. According to
StrengthsFinder 2.0:
“At its fundamentally
flawed core, the aim of
almost any learning pro-
gram is to help us become
who we are not. If you don’t
have natural talent with
numbers, you’re still forced
to spend time in that area
to attain a degree. If you’re
not very empathetic, you get
sent to a course designed
to infuse empathy into your
personality. From the
cradle to the cubicle, we
devote more time to our
shortcomings than to our
strengths.”
Our very best contributions to
life, community, and commerce
will always lie in the untapped and
underdeveloped domain of our in-
nate strengths. We lean into and
migrate toward those strengths quite
WWW.AHDIONLINE.ORG
naturally—which is why they are ably on American Idol or The Voice)
strengths—but we often find our- the difference between a talented
selves in systems and structures that singer with extensive training and a Talent – A natural way of thinking,
prohibit their exploration, develop- truly gifted vocalist who has had no feeling or behaving
ment and deployment. We spend an training whatsoever. No amount of
inordinate amount of time in high
school and college mired in subjects
training can give you an innate abil-
ity. Those come from the beautiful
X
and concepts that will have little use expression of our genetics. Investment – time spent practicing,
or applicability in our future daily “While it may be possible, with a developing your skills, learning, and
lives. And we find ourselves in jobs considerable amount of work, to add building your knowledge base
that pigeonhole us in tasks and proj- talent where little exists, our research
ects that don’t come close to tapping suggests that this may not be the best
our best talents and abilities.
According to a Gallup survey of
use of your time. Instead, we’ve dis-
covered that the most successful people
=
more than 10 million people globally, start with a dominant talent—and then Strength – the ability to consistently
only a third of respondents indicated add skills, knowledge, and practice to provide a near-perfect performance
that they were in jobs that afforded the mix. When they do this, the raw
them the opportunity to do what they talent actually serves as a multiplier,”
do best every day. The remainder are says Tom Rath, author of Wellbeing
not able to focus on their strengths. The and Strengths Finder 2.0. P
inability to spend a significant por-
tion of the working day in the zone of An innate ability or natural talent on its own can only carry you so far. Even the most
competency doing work that represents naturally gifted singer will need coaching and the benefit of being able to read music,
someone’s best skills and capabilities understand timing and musicality, and the discipline of practice and rehearsal.
leads to emotional disengagement from
work and ultimately to deep dissatis- In next month’s column, we’ll take a deep dive into Strengths Finder 2.0 and identify all
faction, some of which is strongly tied 34 strength domains, how they group together, and what they mean. If you are inter-
to anxiety and depression. ested in taking the assessment, you can purchase an activation code at:
In 2001, a team of Gallup scientists
led by Dr. Donald O. Clifton devel- http://strengthstest.com/strengths-tests/strengthsfinder-20-access-code.html
oped and released an assessment tool
based on a 40-year study of human
strengths, wherein they identified 34
talent themes, or strength domains,
evident in varying degrees across the
human spectrum regardless of race,
gender, or environment. This assess-
ment, Strengths Finder, is designed
to identify how all 34 of these
strength domains naturally present
and exert themselves, from strongest
to weakest, based on a person’s in-
nate responses.
What is a strength? Most of us
would probably identify a strength as
something we’re good at, and this is
resoundingly true. But what makes
us good at it? Genetics? Education?
Practice? The answer is all of the
above. A strength must begin and Lea Sims is Senior Healthcare Marketing Strategist for Verizon Enterprise
grow from an innate talent or gift. Solutions, where she has been since 2011. She is the former director of
Without a natural talent, training and professional practices for AHDI and author of the Book of Style for
practice will only take you so far. Medical Transcription, 3rd ed. She lives in Green Cove Springs, Florida, with
Every one of us has witnessed (prob- her husband and three children.
VOLUME 11 • ISSUE 5 SEPTEMBER/OCTOBER 2015 9
 >>> Newly Credentialed

Certified! CMTs Bridged to CHDSs!

AHDI congratulates and welcomes
the following healthcare documen-
tation specialists who achieved
Order online CHDS status between 7/1/2015 and
www.ahdionline.org 8/31/2015. Certified Healthcare Docu-
mentation Specialists have proven
their level-2 transcription knowledge,
skills, and applied interpretive judg-
ment in all domains represented on
the CHDS Exam Blue Print through
AHDI’s rigorous credentialing exam.
AHDI congratulates the following
CMTs who achieved CHDS status
between 7/1/2015 and 8/31/2015.
CMTs who earned their CHDS
have proven their level-2 transcrip-
tion knowledge, skills, and applied
interpretive judgment in the expanded
healthcare documentation content
found on the current exams but not
covered under any previous CMT
blue print.

Karen Aureli, CHDS

Jama Bowers, CHDS Catherine Adams, CHDS
Gayathri J, CHDS
Terri Kelsey, CHDS Jean Hill, CHDS
Rajkumar Mohammed, CHDS
Carolyn Panko, CHDS Therese Kissel, CHDS
Kathy Petty, CHDS
Lori Mongrella, CHDS

The must-have Ready to Practice! Bobbie Perkins, CHDS

guide for MTSOs AHDI congratulates and welcomes Tammy Ricken, CHDS
and independent the following healthcare documen-
Nicole Schneibel, CHDS
tation specialists who achieved
contractors! RHDS status between 7/1/2015 and
8/31/2015. Registered Healthcare Susan Walters, CHDS
Documentation Specialists have
eBook Pricing: proven their ability to reach for excel-
lence by successfully completing rig-
$15 Eligible AHDI orous testing of all level-1 knowledge
Members domains represented on the RHDS
Exam Blue Print.
$20 List Price
Trisha King, RHDS
CECs: 3 ML Tammie Lucas, RHDS
June Myers, RHDS
Mary Patterson, RHDS
Order online Hannah Peterson, RHDS
Becky Skudlarek, RHDS
www.ahdionline.org Susan Sue Ling, RHDS

10 SEPTEMBER/OCTOBER 2015 WWW.AHDIONLINE.ORG

>>> Around the Country
DISTRICT 1
United States: WA, OR, CA, ID, NV, UT, AZ, HI, AK
Canadian Provinces: BC, YT

DISTRICT 2
United States: MT, WY, CO, NM, ND, SD, NE, KS
Canadian Provinces: AB, SK, MB, NT, NU

DISTRICT 3
United States: MN, WI, MI, IL, IN, OH, KY, IA
Canadian Provinces: ON

DISTRICT 4
United States: WV, VA, DC, MD, DE, NJ, PA, CT, RI, NY,
MA, NH, VT, ME
Canadian Provinces: QC, NB, NS, PE, NL

DISTRICT 5
United States: MO, AR, OK, TX, LA

DISTRICT 6
United States: AL, MS, TN, NC, SC, GA, FL, PR

Check the Online Event Calendar frequently

for events and updates not listed here.

DISTRICT 1 DISTRICT 3 DISTRICT 6

AHDI-West Great Lakes Regional AHDI-Florida
October 15 October 23-24 November 19
November 19 Annual Symposium “Let’s Get En- Q4 Board Meeting
December 17 gaged” Online Webinar
BOG Meetings Embassy Suites 6:30 – 8:00 PM
5 p.m. Pacific Dublin, Ohio Janis Smith: janniem611@gmail.com
events@ahdi-west.org Preapproved CECs: 6.5 www.ahdi-fl.org
www.ahdi-west.org bnaill3596@sbcglobal.net
www.greatlakesregionahdi.org Space Coast Chapter
DISTRICT 2/3 December 5
Mighty Rivers Regional (MMR) West Michigan Chapter Holiday Meeting
October 2-3 November 7 9:00 – 11:30 a.m.
Annual Symposium “Joining Forces to Fall Educational Meeting Palm Bay Hospital
Succeed” Preapproved CECs: 3 Palm Bay, FL
Hilton Lisle Lori.Bierling@SpectrumHealth.org pat_bowen@msn.com
Lisle, Illinois (near Chicago) https://wmcahdi.org http://www.ahdi-fl.org
Preapproved CECs: 9
www.mrrahdi.com

COMPONENT EVENTS
Do you know of an educational seminar, study group, webinar, or other event of interest to members not listed here? Get the word out about your component’s
event by submitting your event information at www.ahdionline.org / Get Connected / Events / Event Calendar. Your information will appear in AHDI’s Online Event
Calendar as well as in Plexus magazine, and it’s free!

VOLUME 11 • ISSUE 5 SEPTEMBER/OCTOBER 2015 11

Meaningful Use: 1 CEC
3 QUIZ
And the Winner is... MEDICOLEGAL

Nick Mahurin

G
overnment regulations. They protect the public
from unfair, unwise and sometimes unsafe practic-
es by imposing rules of conduct. Sometimes they
serve to level the playing field; sometimes they change
the field itself. Rule changes are often proposed by the
special interests they affect, so it should be no surprise
there are winners and losers.
Health information has been around for as long as
healthcare itself, but until recently, records had been casual or deliberate misuse of records. Compliance with
paper-based, isolated to care venues and difficult to repli- HIPAA was a burden, but it wasn’t disruptive. Care
cate or misuse. That changed with computer files, faxing delivery and documentation continued as before, just
and Internet connections. The meteoric growth of data much more carefully. Disclosure of information moved
and the capacity to share it in this recent Information Age from the subjective discretion of each person in the chain
has led to greater availability of information and concern of care to declared permission by patients themselves.
about its misuse. Thus, HIPAA came along in 1996 as an That was a modest price to pay for protecting everyone’s
introductory effort by regulators to protect citizens from privacy. So far, we’re all winners.

12 SEPTEMBER/OCTOBER 2015 WWW.AHDIONLINE.ORG

 In this same era, Electronic Medical Record (EMR)
programs emerged from the shadows with some momen-
tum. EMRs would always be an issue for transcription.
They rely on databases to store discrete values of infor-
mation. (See sidebar for a primer on structured data.)
This contrasts with records systems that store the kind of
documents that transcription typically produces. In other
words, EMRs were not designed to consume documents.
They could import documents, but that was a secondary
feature that didn’t maximize documentation potential.
EMRs were designed for data entry and retrieval.
If any singular event caused a decline in transcription,
it was the financial crisis of 2008. More accurately, it was
the response to that crisis. In that year, it seemed as if
EMRs would eventually become pervasive in a timeline
of about 20 years. And, there would be plenty of time for
our industry to adapt. But when the government passed
the huge stimulus package in 2009, one component was
the Health Information Technology for Economic and
Clinical Health (HITECH) Act that incentivized health-
care providers to adopt EMRs.
In this moment, the regulations of the era became a
threat to the very existence of medical transcription. The
status quo of the time was dictation. How did they intend
for physicians to make the change? Did they intend for
MTs to lose their jobs? (This was, of course, an economic
stimulus package intended to save and create jobs.) The
law and subsequent rules put forward were silent on those
topics. While they had good intentions and would accom-
plish some useful outcomes, they left the stepping stones
too far apart. We began losing as a multi-year fuse had
been lit with an implication that transcription was incom-
patible with new regulations.
The HITECH Act introduced the concept of Meaning-
ful Use (MU). The Act recognized that it would be silly
to simply pay healthcare providers to purchase EMR
programs without also ensuring they would use them in a
meaningful way. The Act also realized that Congress was
not the right body to determine what would be
meaningful. The Department of Health and Human
Services (HHS) was tasked with creating necessary
regulations and defining what would constitute MU.
As an industry threatened, we anxiously awaited these
definitions, how they would prescribe implementation
of EMRs and what our role would be. When Meaningful
Use Stage 1 was finally announced by HHS, it left many
questions critical to our industry completely unanswered.
The leading EMR vendors were emboldened. After all,
VOLUME 11 • ISSUE 5
a law had been passed that all but required providers to
purchase their products. They were in the driver’s seat.
We were definitely losing.
Most EMR vendors were opposed to transcription
and wanted to see it end in favor of providers self-
documenting for two primary reasons. First was the
value of structured data vs. narrative. While we know
the inherent value of narrative notes, EMR products are
designed to leverage the value of structured data. When
discrete measures or findings are integrated into natural
language, it takes human interaction to find and interpret
them1. Imagine, for example, a provider pondering how
a patient’s blood pressure has trended over a long period
of time. If she has typical narrative reports that contain
those readings, she must look at each, find the informa-
tion and note it. If an EMR stores blood pressure values
discretely, it can easily present, and perhaps even chart,
that information on demand.
The second reason was financial. Enterprise software
vendors almost always market their products based on a
return on investment (ROI). They show prospective
customers how much money they will save or make
based on the implementation of their solution. Even
before the windfall launched by the HITECH Act, EMR
vendors found transcription to be a convenient source of
budgeted funds to pay for their products. If a hospital was
already spending a million dollars per year on transcrip-
tion, they could argue that their product would eliminate
the need for that service or department. With the strike
of a pencil, there was a million dollars available to invest
in the EMR product without increasing the hospital’s
expense budget.
Prior to the economic crisis of ‘08 and the subsequent
passage of the HITECH Act, transcription industry lead-
ers foresaw the EMR adoption trend and took proactive
action.
AHDI partnered with AHIMA and many transcrip-
tion technology firms to incubate an ambitious project
called CDA4CDT. The idea was to build a bridge from
conventional transcription to the type of deliverable file
format that EMRs could consume. MS Word documents
that worked so effectively for narrative wouldn’t meet the
need. Clinical Document Architecture (CDA) was a little
used standard included in Health Level 7 (HL7), circa
2002. It had promise, but required much more granular
definition for various types of encounters before it was
ready for prime time. CDT in that project name stood for
Common Document Types. The idea was to flesh out a
SEPTEMBER/OCTOBER 2015 13
CDA definition for each of the common document types
we transcribe. These documents would contain both
human- and machine-readable data. When marketing
minds became involved, the project gave up the nerdy
name for a more aspirational one that had meaning to
providers and the public. While we wanted to save our
industry’s role in the documentation of encounters, there
was an even broader topic. In the EMR and without docu-
mentation assistance, providers were often steered to rigid
checkboxes and drop-down boxes. That was a departure
from decades of so-called narrative documentation that
captured rich context that told the patient’s unique story.
The group rallied around the critical importance of
flexible narrative, and the Health Story Project (HSP)
was born.
HSP worked for years providing countless hours of
volunteer time and significant private financial contribu-
tions in the form of member dues to develop CDA imple-
mentation guides (standards) that defined precisely what
would be in a History & Physical, for example, and seven
other report types. All eight were balloted through HL7 to
yield industry standards containing precise definitions for
the most common document types. MU came along just
a couple of years into the effort bringing a decisive shift
away from dictation and transcription despite physician
objections. In HHS’s oversight to morph dictation and
transcription, winners and losers had been identified.
We were losers. Providers were losers. EMR vendors
now took charge of health information.
14 SEPTEMBER/OCTOBER 2015
Naturally, after the Stage 1 disappointment, members
of the Health Story Project and broader allies, including
AHDI, stepped up lobbying and advocacy in efforts to
persuade regulators of the value of narrative. After years
of such activities, as regulators were working through
the process to define requirements for the second stage of
MU, there was a breakthrough. HHS wanted to empha-
size interoperability (sharing of records among provider
EMR systems) in Stage 2. That meant they must identify
a standard to allow one provider to send records to anoth-
er provider even when they used different EMR products.
Conventional interfacing was expensive and limited. It
wouldn’t serve this need. The standards used didn’t honor
all of the newly defined MU rules for discrete data. In an
effort to show HHS the value of narrative, our advocacy
highlighted our progress with CDA, because we knew
they would only be persuaded if there was a practical
solution to include it in the EMR. It turned out that CDA
implementation might be able to provide the interoper-
ability vessel regulators sought.
At that point, eight common document types had been
completed. When regulators asked which type the Project
intended to prepare next, those developing the standards
responded they planned to circle back to consolidate all
the CDA types into one common implementation guide
before proceeding with further types. The process had
improved over the course of years, and developers wanted
to harmonize all of them, honoring the newest best prac-
tices. This consolidation project led to what became
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 send records to a specialist when mak-
ing a referral, and the specialist will be
able to send records back upon provid-
ing service.
Finally, the outlook for transcription
was improving. This was the shift in the
playing field back in our favor the in-
dustry had needed for so long. But how
long would we have to wait? MU2 was
originally scheduled to take place in
calendar year 2014. In December of
2013, HHS announced they would
provide 24 months rather than 12. That
delay meant that as of this printing,
healthcare organizations are still de-
ploying MU2 certified versions of their
EMR systems. The transcription indus-
Y ou don’t have to be a computer programmer to appreciate the difference
between structured data and narrative data. Imagine having all your
contacts in a MS Word document. You could browse the document to find
try anxiously awaits an opportunity to
contribute to EMR documentation via
information, but you wouldn’t expect to be able to tell Word to dial a phone C-CDA interoperability.
number or to map an address the way a contact manager can. Storing data There are challenges for those of us
in discrete fields allows a program to understand and treat data for what it is. in the trenches making early attempts at
A zip code is different from a city. On the other hand, when presented with C-CDA interoperability, and there will
only a few data fields when filling out a form, we have experienced discomfort be more political jockeying. But today
with the constraint. the same regulatory process that nearly
To visualize how C-CDA can present a human readable document similar destroyed our industry is set up to sup-
to MS Word but keep invisible computer codes in the background for only an port our rebound. It won’t return to 2009
EMR to process, reflect back to your WordPerfect days. Remember Reveal levels, as not all documentation needs
Codes? Those codes didn’t appear on your screen or on paper (unless to be dictated, but there is a very good
exposed), but they were in the file behind the document canvas ready to tell chance that transcription, perhaps in a
the computer what to do. In that context, most HDSs have been comfortable modernized form, will experience
with hidden codes for decades. a renaissance.
Winners can include patients with
rich, highly usable health records utiliz-
ing the best of both structured and nar-
rative content, as well as providers who regain their voice
known as Consolidated CDA (C-CDA). HHS actually
and get appropriate assistance. Maybe even we in the
sponsored the project. For the first time, we weren’t
transcription industry can look forward to greater
relying on private dues. Government was contributing.
appreciation. P
That was a win.
During the Meaningful Use Stage 2 (MU2) public
Reference
comment period, EMR vendors pushed back on a C-CDA
1. Natural Language Processing (NLP) is an area of
requirement, but it was ultimately included in the final
information technology that seeks to break down those
rule. This is even bigger than it may seem. Not only does
differences between natural language and discrete data,
C-CDA represent an opportunity for transcription to play
but it is an immature science that was not ready to
a role in the EMR era, it promises to improve health
reliably and completely bridge the divide.
records for all patients by preserving a place for narrative
to co-exist with EMR structured data. And, for the first
time ever, all EMR products (certified for MU2) will be
required to support sending and receiving records in a Nick Mahurin is the CEO of InfraWare and Co-chair of
common format. A primary care physician will be able to the HIMSS Health Story Project.
VOLUME 11 • ISSUE 5 SEPTEMBER/OCTOBER 2015 15
 1 CEC
3 QUIZ
TECHNOLOGY AND
THE WORKPLACE

Using the Cloud Securely for

Healthcare Documentation
Asaf Cidon

F
ew better understand the com-
plexities of data-related care
coordination than healthcare
documentation professionals.
After all, they’re contend-
ing with the pressures
of needing accurate
data—not to men-
tion the changes
brought by
technology—on
a daily basis. And as
healthcare reform brings
massive shifts to the indus-
try, decision-making relies more
than ever on sound and secure data,
especially as regulatory compliance burdens increase.
As a result, productivity tools and technology that
makes data accessible from anywhere would seem to
offer an ideal solution. Such tools make sensitive patient
data seamlessly accessible, which can be a godsend,
but with them also come increased risks. Namely, this
dynamic leads to PHI proliferating across a litany of
devices, and those, as we have seen time and again, are
prime targets for data breaches. Sensitive files are con-
stantly synced to mobile devices, making them particular-
ly vulnerable because they are so easily misplaced. And
once a phone or tablet is lost, so is the PHI that’s stored
on it. Consider, for example, that nearly 60 breaches, each
affecting more than 500 individuals, involved the loss or
theft of mobile devices so far in 2015,
according to the Department of Health
and Human Services.
The Health Insurance Portabil-
ity and Accountability Act
(HIPAA) makes it clear that
safeguarding patient data is
essential, but as more
and more records
become electronic,
more must be done to
accomplish that. On one
hand, the accessibility
of ePHI improves the quality,
efficiency, and convenience of care;
yet controlling access to and protecting data
requires more precision than simply locking files in a
cabinet and shredding them later. For example, HIPAA’s
access control requirements must include passwords,
encryption, audit trails, and deliberation about which
employees truly need access to given files in order to
deliver effective care.
It’s all enough to make medical transcriptionists—and
their healthcare clients—wary of embracing such tech-
nologies, foregoing the cloud entirely in favor of legacy
network systems. But that’s a mistake, too, since those
outdated systems are a veritable playground for hackers.
However, the good news is that it is possible to miti-
gate security risks associated with using the cloud which,
in fact, can become a boon to your workflow, enhancing

16 SEPTEMBER/OCTOBER 2015 WWW.AHDIONLINE.ORG

the delivery of documentation and making it possible to
accomplish more than ever before. And maintaining
confidence in the security of your PHI in the cloud
simply sweetens the deal.
Why is it important to have access to information
whenever and wherever you need it? In an era when
many transcriptionists work remotely, it’s essential
to make it possible for workers to access information
in a secure, efficient way—especially as margins get
squeezed with looming regulatory changes. And speak-
ing of margins, the cloud is often a more cost-effective
alternative to on-premise networks, VPN connections,
and SFTP exchanges, particularly when one considers
the fact that more and more people in healthcare and
otherwise are turning to cloud-based solutions to simplify
their workflow. If your transcriptionists (or even, for
that matter, your GPs) are using solutions like Dropbox,
Google Drive, and Microsoft OneDrive in their personal
lives, you can bet they’re going to try to incorporate it
into work as well—whether you want them to or not.
A transcriptionist might think she’s doing a good thing
by installing Dropbox on her work computer, and stor-
ing and syncing patient files to it so she can work from
home. But if Dropbox suffers a breach or she loses her
phone, not only will it cause a nightmare for the company
and the healthcare system, it compromises the patients’
privacy and violates HIPAA.
Still, employees will continue trying to use the cloud at
work, simply because it’s useful and efficient. The smart
thing to do is to stay one step ahead of these impulses.
Doing that requires sanctioning cloud solutions. It might
seem like a risky prospect, but enables you to take all the
necessary safeguards to make sure your employees—and
your patients—know their confidential information lies
securely in your hands.
With all that in mind, here’s what you need to know to
make the most out of the cloud—and ensure the utmost in
security.
Don’t fear the cloud. It’s easy to think that the
familiar—for example, a server that sits on-site at your
facility—is better and more secure than new technolo-
gies like the cloud. But all too often, this belief is
predicated on mistaken beliefs about the integrity of
hardware, backups, a bulletproof network, and secure
remote access. It seems scary for confidential data to
reside in what may seem like the ether of the cloud,
but the fact is that software as a service (SaaS) net-
VOLUME 11 • ISSUE 5
works are often more secure than their legacy alterna-
tives. That’s because cloud providers have consider-
ably more resources at their disposal to secure their
environments, employ some of the best security minds,
and perform routine penetration and other tests of their
solutions. What’s more, the efficiencies you’ll gain
will surely set you apart from other transcription busi-
nesses—as will your sophistication in taking security
into your own hands.
Encrypt seamlessly. Chances are you don’t need to
encrypt everything that your business touches; for
example, those cheat sheets on medical codes likely
don’t need extra security protection. But because your
team is handling everything from voice recordings
that contain sensitive patient health information to the
transcripts themselves, it’s important to implement
security protocols seamlessly, so users don’t have to
give a second thought to how to do their work in an
efficient, secure manner. If the encryption solution you
select disrupts workflows, or hinders the best parts of
the cloud, then you can bet that people will find work-
arounds, which are sure to be unsecure.
Collaborate—the right way. Consider, for example,
the client who dictates into a handheld digital
recorder and then sends the files to your firm. Sensible,
secure options for exchanging these recordings are
few and far between: For decades, the dominant way
to exchange recordings and transcriptions involved a
secure file transfer protocol (SFTP) server. But from
an efficiency and security standpoint, the SFTP and its
lack of reliability just doesn’t cut it anymore. Email,
too, is usually not encrypted and therefore inappropri-
ate in light of HIPAA regulations. Not to mention the
fact that email frequently can’t handle large file sizes.
If the client uploaded to a cloud-based platform,
this could be significantly streamlined: Each morning,
clients might upload files to their designated shared
folder, and you, in turn, could drag the raw files to re-
distribute to your transcriptionists. To keep those files
secure, it’s important that they be encrypted before
they ever reach the cloud, so they’ll remain protected
no matter who is handling them. For example, some
providers will permit you to create a special upload
portal that will do just that for you, enabling collabora-
tors and clients to securely upload documents, auto-
SEPTEMBER/OCTOBER 2015 17
 matically encrypt them,
and launch them directly
into your secured cloud
folder without any setup
or inconvenience on
their part.
Guard against employee
mistakes. It’s increasingly
transcriptionists’ expectation
to be able to work from
anywhere, so savvy documentation professionals
will know to accommodate the demands of a mobile
workforce. Permitting the use of personal devices can
be key—and it can also make sound financial sense
for any small business. But while it enables you to cut
down on fixed costs, it also often means relinquishing
some control over how work is managed and how data
stays protected. But it doesn’t have to.
It’s possible to enable people to use their personal
devices on your terms, though, by employing file-level
encryption with the data itself. Essentially, this means
that the data will remain encrypted anywhere it resides,
whether that’s on a cloud storage business’s servers,
synced to a mobile device, or in transit between the two.
Don’t forget the dirty truth about sync. When a
cloud provider purports to enable HIPAA compliance,
users might expect that the compliance is retained
when using standard features. But that’s the thing with
file synchronization and why it’s so important to read
the fine print when it comes to cloud storage, sharing,
and sync solutions. Often, the solutions that tout com-
pliance recommend that users disable file sync—which
typically supplies a powerful productivity advantage.
Most users don’t know the encryption and compliance
are compromised at that point, and syncing can pose a
huge risk where PHI is involved. In fact, syncing
18 SEPTEMBER/OCTOBER 2015
PHI across devices essentially breaks the encryption
protection and duplicates thousands of non-encrypted
files. Subsequent theft or loss of these synced devic-
es—which now contain unencrypted data—can cause a
massive HIPAA breach.
File-level encryption, however, provides the cloud’s
silver lining, because it retains encryption—and subse-
quently, compliance—no matter how often or to what
device files are synced. Because the encryption occurs
before the file reaches the cloud, it will always remain
encrypted, appearing as an indecipherable jumble to
any unauthorized user or malicious actor who may
inadvertently find himself in possession of the files.
It seems as if we hear about a new healthcare data
breach every day, and we can’t continue to work that way.
Taking steps to secure data and making it convenient and
simple to maintain the security is the key to removing this
threat to our patients and our businesses. Planning and
maintenance of systems to secure the data in all the ways
we use it cannot be delayed any longer. P
Asaf Cidon is CEO and co-founder of Sookasa, a cloud
security and encryption company that enables safe adop-
tion of popular cloud services such as Dropbox to store
sensitive information.
WWW.AHDIONLINE.ORG
 Psst. Pass it On...
Membership is POWER!
Let your colleagues in on the secret of all the
great benefits you get as an AHDI member!

The POWER to CONNECT with

• like-minded professionals.
• leaders in the healthcare industry.
• fellow advocates who care about the
quality of healthcare documentation.

The POWER to SAVE on

• continuing education.
• credentialing exams and prep guides.
• AHDI products and webinars.

The POWER to EXCEL with

• the widest network of healthcare
CONVENTION documentation professionals.
AND EXPO
Where Health Information experts Come Together

• the most innovative, hot-topic

July 2011 VOluME 7, ISSuE 4
educational opportunities.
100 toFacts
Boost your Knowledge
• publications and discussions that address
the important industry topics and trends.

clinical mEdicinE page 30

Medical/Surgical Tools & Equipment

Find out more at www.ahdionline.org.

EmployErs GuidE page 44

Getting
Michelle LaBrosse, PMP
W
hen there’s a lot going on, we often push the
fundamentals aside and forget the basic skills that
have been part of our success. Project manage-
ment has been a central part of my own success from the
beginning of my career. So, when I’m faced with new
challenges or when I’m wondering why a project isn’t
going as well as I’d like, I remember this abbreviation:
IPEMC.
As the quarter ends, you’re probably getting ready to
begin some new work or home projects. So this is a great
time to get back to the basics with IPEMC.
I.P.E.M.C.
At any point in time, both people
I and organizations have more projects
than they have resources to do them.
During initiation, we have to priori-
is for tize the projects we will pursue, who
Initiate. will sponsor the projects, and who
will staff them.
20 SEPTEMBER/OCTOBER 2015
0.5 CEC
PROFESSIONAL
DEVELOPMENT
Once you decide to pursue a project,
P the project manager and the project
team develop the plans to create the
final deliverables. This is your road
is for map you’re going to be living with
Plan. until the project is done. Give it the
care and feeding it deserves.
E
This is where the project team does
the work to create the final deliver-
ables of the project. It is the largest
part of most projects, and it goes far
is for
Execute. better if adequate time was taken to
properly plan the work of the project.
M This phase is the truth factor. It is
where you are monitoring the prog-
ress of the project and seeing what
is for Monitor is getting done and what isn’t. Make
& Control. sure to account for any changes,
WWW.AHDIONLINE.ORG
and make mid-course corrections to keep the project on
schedule and in budget. If monitoring isn’t truthful, it
isn’t helping anyone.
During this phase, the final deliver-
C able is accepted by the customer
of the project, and the project team
documents what they learned that can
is for be of value on their next project.
Close. Whether the project was a huge
success or a flop, a lot was learned
either way. Make sure you take the time to capture the
glory and the agony.
Another place to look is at your organization. Do you
have a project management office (PMO)? Is it function-
ing well? If you don’t, maybe you need to explore build-
ing one for your organization. A supportive infrastructure
can go a long way to ensuring project success.
Some of the smartest and most effective people and or-
ganizations I know have a “back to basics” default button.
VOLUME 11 • ISSUE 5
If your projects aren’t going well, sometimes that’s where
you need to look – both for yourself and your organiza-
tion. P
Michelle LaBrosse, PMP, is an entrepreneurial power-
house with a penchant for making success easy, fun,
and fast. She is the founder of Cheetah Learning (www.
cheetahlearning.com), the author of the Cheetah Success
Series, and a prolific blogger whose mission is to bring
Project Management to the masses. She is a graduate of
the Harvard Business School’s Owner/President Man-
agement (OPM) program and holds engineering degrees
from Syracuse University and the University of Dayton.
SEPTEMBER/OCTOBER 2015 21
 Hematology/Oncology
CLINICAL MEDICINE
1 CEC
3 QUIZ
CLINICAL
MEDICINE

Therapeutic
Plasma Exchange
Lily Carr, CHDS, RHIT, RN lytes such as sodium and potassium. Plasma contains
albumin, clotting factors (including fibrinogen), and

I
n humans, plasma is the liquid portion of blood
wherein red and white blood cells are suspended.
It makes up a little over half (55%) of blood
volume and is itself 92% water. It helps maintain
homeostasis, the acid/base balance, and serves as a
transport medium, facilitating exchange of electro-
globulins (such as antibodies).
Definition and History. Therapeutic plasma ex-
change, or TPE, is the removal of a large volume of
plasma (around 1 to 1.5x circulating plasma volume
exchanged) and replacing it with fluid via re-infusion
to take the place of the removed plasma.
As early as 1914, plasmapheresis was performed

22 SEPTEMBER/OCTOBER 2015 WWW.AHDIONLINE.ORG

in animal studies. By 1940, Edwin Cohn, a biologi-
cal chemistry professor, developed a fractionation
method to separate plasma into its components and
products. During World War II, plasma exchange
was used in traumatic injuries, replacing coagulation
factors while maintaining volume status. In 1959, the
first TPE procedure to treat a disease was performed
by Dr Michael Rubinstein on a patient with TTP.
Since that time, the procedure has been refined and
expanded, and TPE can be used in a variety of clini-
cal situations, from the critically ill in an ICU bed to
the outpatient setting.
McCleod (38S) states “In most instances the
therapeutic goal is depletion of a harmful plasma
constituent, most often a harmful antibody.” Sub-
stances removed can include toxins, autoantibodies,
plasma proteins, immune complexes, and inflamma-
tory mediators.
TPE Procedure
Plasma can be separated by a centrifuge or mem-
brane (as in hemodialysis). Most clinical trials have
been done with centrifuged plasma. In the centrifuge
method, blood is removed, an anticoagulant added
(usually citrate), then the blood is centrifuged, plas-
ma and its undesired components removed, and the
blood returned with plasma substitute, usually albu-
min, or the treated/replacement or donor plasma. The
membrane method filters the plasma based on size of
the particle rather than specific gravity. Membrane
separation is less efficient, as rates are 30% plasma
extraction versus 80% for the centrifuge method.
Plasma Replacements
There are a variety of plasma replacement alterna-
tives during the TPE reinfusion process. Ideally, the
TPE replacement would be the patient’s own plasma,
filtered of harmful components, and re-infused (sec-
ondary plasma processing using filtration or chemi-
cal or immunoadsorption columns). However, this
is usually not possible. Most commonly it is either a
plasma derivative or donated human plasma.
Plasma replacements:
• Human serum albumin (4-5% human serum albu-
min - or HSE - maintains plasma volume, pre-
venting hypotension and edema). It is used most
often, as it is readily available and has low risk of
adverse effects.
• Fresh Frozen Plasma or FFP is another option:
It contains the clotting factors and antibodies that
HSE may lack; however, there is a greater risk of
allergic reaction and it takes longer to prepare.
• Cryoprecipitate-reduced or cryo-poor plasma has
factors VIII, XIII, and fibrinogen and von
Willebrand Factor (VWF) greatly reduced (it is
used for treatment of TTP).
• Cryoprecipitate is made from the cold-insoluble
proteins of thawed FFP and has concentrated
factors VIII, XIII, VWF, fibrinogen, and fibro-
nectin. It is used in cases of coagulopathy/hemor-
rhage due to lack of fibrinogen or factor XIII and
also in bleeding due to uremia. It is second-line
therapy for hemophilia/VWD.
• Pathogen-reduced plasma products. Intercept

Targets for TPE:

Substance Disease/Condition

Autoantibodies TTP, ITP, myasthenia gravis, Guillain-Barre, Goodpasture

syndrome, Wegener granulomatosis, anti-GBM glomerulonephritis

Probable autoantibodies CIDP, multiple sclerosis

Antigen/antibody complexes Hepatitis C vasculitis, SLE

Alloantibodies Transplant sensitization/rejection, transfusion reactions

Paraproteins Waldenstrom macroglobulinemia, myeloma cast nephropathy

Non-Ig proteins FSGS

Endogenous toxins Hypercholesterolemia, liver failure, SIRS

Exogenous poisons Mushrooms, drugs

VOLUME 11 • ISSUE 5 SEPTEMBER/OCTOBER 2015 23

 currently is the only FDA-approved plasma
Hematology/Oncology
CLINICAL MEDICINE
product in the US. Plasma is treated with amoto-
salen plus ultraviolet A light resulting in remov-
al of many viruses, including HIV, hepatitis B
and C viruses, and West Nile virus.
Some Specific Conditions and Diseases Treated by
Therapeutic Plasma Exchange
Hematologic/Vascular
These include thrombotic microangiopathies.
Among these is thrombotic thrombocytopenic pur-
pura (TTP), and TPE is a first-line therapy. In TTP,
plasma exchange removes the larger von Willebrand
factor (VWF) and removes the ADAMTS-13 inhibi-
tors (ADAMTS-13 deficiency is an underlying
pathology in TTP). Another indication is atypi-
cal hemolytic uremic syndrome (HUS) in patients
with sepsis and multiorgan failure. These patients
can go into disseminated intravascular coagulation
(DIC), and TPE is thought to remove tissue factor
and plasminogen activator inhibitors-type-1 and
antithrombin III and then replace depleted protein C
and coagulation factors. Another indication is drug-
associated thrombotic microangiopathy, specifically
with clopidogrel (Plavix) and ticlodipine (Ticlid).
These drugs produced a similar pathophysiological
response as in TTP, and thus TPE works in a similar
fashion in these cases.
Blood disorders such as Waldenstrom macroglob-
ulinemia (high IgM levels) or cryoglobulinemia can
be treated with TPE to immediately lower levels. It
will not, however, treat the underlying disease.
TPE may be recommended for systemic lupus ery-
thematosus (SLE) where there is pulmonary hemor-
rhage or cerebritis. TPE can remove the autoanti-
bodies and immune complexes.
Hepatic
TPE can be used to treat Wilson disease with
hemolysis and fulminant hepatic failure. In this
situation, plasma-free copper causes destruction
of red cells, release of plasma-free hemoglobin,
and eventually causing multiorgan failure (MOF).
Plasma-free copper and plasma-free hemoglobin are
removed via TPE. Acute fulminant liver failure is
another indication, wherein the liver cannot synthe-
size some of the major coagulation proteases, result-
ing in severe coagulopathy; TPE can remove toxins
and the re-infused product can contain coagulation
factors.
Transplantation
Incompatible ABO solid organ transplantation is
24 SEPTEMBER/OCTOBER 2015
yet another use for TPE. A recipient’s autoantibod-
ies, which could trigger a rejection response, can be
removed through TPE (such as IgG and IgM). Close
monitoring of antibody titers is done throughout the
post-transplant timeframe.
Renal
Diseases targeted include anti-glomerular base-
ment membrane disease (Goodpasture syndrome),
rapidly progressive glomerulonephritis (RPGN),
and Wegener granulomatosis. The removal of im-
mune complexes and deposits can be accomplished
with TPE, but its use in renal disease can be depen-
dent on if the patient is on dialysis and how acute
the situation is—usually those critically ill and
showing signs of pulmonary hemorrhage are poten-
tial TPE candidates.
Neurologic
Acute inflammatory demyelinating polyneuropa-
thy (Guillain-Barre syndrome), chronic inflamma-
tory demyelinating polyradiculoneuropathy (CIDP),
multiple sclerosis (MS), myasthenia gravis, and
pediatric autoimmune neuropsychiatric disorders
associated with streptococcal infections and Syden-
ham chorea (PANDAS). In these situations, TPE is
thought to again remove auto-antibodies reacting
with the myelin in Guillain-Barre/CIDP, the neurons
in the basal ganglia in PANDAS, and the acetylcho-
line receptor in myasthenia gravis.
To help determine if TPE would be beneficial in
certain diseases/disorders, the American Society
for Apheresis (ASFA) has established categories
and guidelines for professionals. Categories range
from I to IV: I is first-line therapy, II is second-line
therapy, III optimum role of apheresis therapy is not
established, IV apheresis is harmful or not effective.
Recommendation grades are numbered and lettered:
1 is strongest, 2 is weakest, while A, B, and C repre-
sent high, moderate, and low-quality evidence avail-
able to support treatment (http://asheducationbook.
hematologylibrary.org/content/2012/1/7.full.pdf) .
Benefits and Risks
Benefits:
• It is a targeted therapy, it goes after specific
toxins or autoantibodies, and it has a less
systemic effect than a medication or more
invasive treatment.
• Less disruption than whole blood transfusion on
the delicate fluid balance in the body, especially
in a critically ill patient.
• Immediate removal of toxic or target substances.
WWW.AHDIONLINE.ORG
Drawbacks:
• It can have adverse effects, including allergic
reactions. The most common side effects are
paresthesias (relates to transient hypocalcemia
from use of citrate to prevent clotting, which in
turn binds to calcium, causing the paresthesias)
and urticaria.
• Other risks include those associated with vascular
access, including infection and dislodging of the
catheter.
• It usually requires several TPE procedures to
effectively lower or remove offending antibodies,
factors, or other agents, as these are also found in
interstitial fluids, and after a TPE procedure move
into the intravascular spaces, necessitating addi-
tional TPEs for their removal. Each TPE treatment
takes about 1-3 hours.
Implications for Healthcare Documentarians
CPT codes include:
• 36514 Therapeutic apheresis; for plasma pheresis
• 36515 Therapeutic apheresis; with extracorpo-
real immunoadsorption and plasma reinfusion
• 36516 Therapeutic apheresis; with extracorpo-
real selective adsorption or selective filtration
and plasma reinfusion [extracorporeal immuno-
adsorption (ECI) or Prosorba column] (Aetna).
The ICD-10-PCS code is 6A550Z3 Pheresis of
Plasma, Single. It is also important to have the
correct and relevant ICD-10-CM diagnosis codes to
support the CPT code.
In the CMS Medical National Coverage Deter-
mination Manual, plasma exchange is covered for
conditions such as acquired myasthenia gravis,
plasma exchange as a last resort treatment of TTP
and life-threatening rheumatoid vasculitis, treat-
ment of Goodpasture syndrome, and for treatment of
glomerulonephritis associated with AGBM antibod-
ies and advancing renal failure or pulmonary hemor-
rhage (Section 110.14).
For healthcare documentation specialists, the rec-
ord should support the disease process or condition
requiring the TPE, including laboratory, pathologi-
cal, and clinical examination findings. It is impera-
tive that documentation specialists be familiar with
the underlying conditions and diseases requiring TPE
to ensure accurate and complete records for billing
and, most importantly, continuity of care purposes. P
Lillian Carr has worked for BJC/Missouri Baptist
Medical Center as a remote transcriptionist for 12
years after working as a nurse for over 15 years.
VOLUME 11 • ISSUE 5
She is a recent graduate of the Saint Louis Univer-
sity RN to BSN program (summer 2015). She enjoys
volunteering and gardening. She is passionate about
health care, from documentation to access to care,
and currently is studying Parish Nursing in a volun-
teer capacity for rural areas.
References
AABB, aka American Association of Blood Banks
(n.d.). Highlights of Transfusion Medicine History.
Retrieved from http://www.aabb.org/tm/Pages/high-
lights.aspx
Aetna (2015). Plasmapheresis/Plasma Exchange/
Therapeutic Apheresis. Retrieved from http://www.
aetna.com/cpb/medical/data/200_299/0285.html
American Red Cross (2015). About Blood Plasma
http://www.redcrossblood.org/learn-about-blood/
blood-components/plasma
Benjamin, R. and Swinton McLaughlin, L. (2012).
Plasma components: properties, differences, and
uses. Transfusion (52) 9S-19S.
Choi, Tom (2015). Plasmapheresis and vasculitis
affecting the kidney. Kidneycentric. Paper 9. Re-
trieved from http://digitalcommons.wustl.edu/kid-
neycentric_all/9
Centers for Medicare & Medicaid Services (March
2013 revision). Chapter 1, Part 2 (Sections 90-
160.26) Coverage Determinations. Medicare Nation-
al Coverage Determinations Manual. Retrieved from
http://www.cms.gov/Regulations-and-Guidance/
Guidance/Manuals/downloads/ncd103c1_part2.pdf
Gambro (n.d.). Therapeutic Plasma Ex-
change (TPE) and the Prismaflex System.
Retrieved from http://www.gambro.com/
PageFiles/7966/306100326_1%20PrismaflexTPE-
Folder-FINAL.pdf?epslanguage=en
McCleod, B. (2012) Plasma and plasma deriva-
tives in therapeutic plasmapheresis. Transfusion (52)
38S-44S.
Nguyen, T. C., Kiss, J. E., Goldman, J. R., &
Carcillo, J. A. (2012). The Role of Plasmapheresis in
Critical Illness. Critical Care Clinics, 28(3), 453–
468. doi:10.1016/j.ccc.2012.04.009.
Ward, D. (2011). Conventional Apheresis Thera-
pies: A Review. Journal of Clinical Apheresis (26)
230-238.
Williams, M. and Balogun, R. (2014) Principles
of Separation: Indications and therapeutic Targets
for Plasma Exchange. Clinical Journal American
Society of Nephrology (9), 181-189
Winters, Jeffrey (2012). Plasma exchange: con-
cepts, mechanisms, and an overview of the American
Society for Apheresis guidelines. Hematology 2012.
7-12
R 2015 29 SEPTEMBER/OCTOBER 2015 25
 CLINICAL MEDICINE
Let’s Talk Terms
Beverly Sofko, CMT
TERM DEFINITION
factor Xa inhibitors
Savaysa™ (edoxaban) tablets
corneal stroma
therapeutic hypothermia
(induced hypothermia)
Bellafill® (dermal filler)
low-dose-rate (LDR)
brachytherapy from implants situated within or close to the tumor
vitamin K antagonists (VKAs)
26 SEPTEMBER/OCTOBER 2015
1 CEC
3 QUIZ
CLINICAL
MEDICINE
MANUFACTURER
Anticoagulants that stop the activity of clotting factor
Xa and help prevent blood clots from emerging or be-
coming worse. These inhibitors are normally used as
prophylaxis in those individuals who are undergoing
knee and hip replacement surgeries where blood clots
can develop and bring about pulmonary embolism and
deep venous thrombosis.
Brand name of the generic form edoxaban, a factor Manufactured by Daiichi Sankyo
Xa inhibitor for lessening the risk of systemic Co., LTD., Tokyo, Japan. Distribut-
embolism and stroke in those with nonvalvular atrial ed by Daiichi Sankyo, Inc., Parsip-
fibrillation. Tablets available as 15 mg, 30 mg and pany, NJ.
60 mg.
Situated in front of Descemet membrane and behind
Bowman layer, the thickest layer of the cornea. It
gives one’s cornea its strength and represents nearly
90% of the total corneal thickness.
Also called induced hypothermia, a noninvasive
treatment method to help avoid lasting brain injury
in those individuals who are resuscitated following
sudden cardiac arrest. It works by a machine pump-
ing cooled water by way of polymer wraps that are
positioned on the patient’s torso and legs.
Brand name of the generic form dermal filler, an Made by Suneva Medical, Inc., San
injected gel that helps to correct smile lines and Diego, CA.
moderate-to-severe facial acne scars on the cheek in
patients who are over 21.
Known as LDR (brachytherapy), a kind of internal
radiation therapy that sends small dosages of radiation
in one’s body. Small, empty catheters are briefly
introduced directly into the tumor. A sequence of
radioactive pellets are introduced into each catheter.
Computer guidance regulates how far the pellet goes
into the catheter to accurately target the position of the
tumor and how long the pellet remains in the catheter
to discharge its radiation dosage. This type of brachy-
therapy can give an exact treatment over a few hours.
Known as VKAs, a class of materials that lessen
blood clotting by lowering the action of vitamin K.
They are utilized as anticoagulant medicines to help
stop thrombosis.
WWW.AHDIONLINE.ORG
TERM DEFINITION MANUFACTURER
3-dimensional (3D) conformal Known as 3D conformal radiation, a radiation therapy
radiation method that shapes radiation beams to the contour of
one’s tumor. Utilizing this technology, a tumor can
be viewed in three dimensions with the assistance of
image guidance. Radiation beams can then be distrib-
uted from various routes to the tumor based on these
images. This method has been mainly integrated into
intensity-modulated radiation therapy.

Brand name of the generic forms carbidopa and
Rytary™ (carbidopa and levodopa)
levodopa, for treating Parkinson disease. Available in
extended-release capsules
extended-release capsules of carbidopa and levodopa
23.75 mg/95 mg, 36.25 mg/145 mg, 48.75 mg/195 mg
and 61.25 mg/245 mg.
Manufactured for Impax Pharma-
ceuticals, a division of Impax
Laboratories, Inc., Hayward, CA,
by Impax Laboratories, Inc.,
Jhunan, Taiwan.

hallucinogen persisting perception Known as HPPD, a neuropsychological disorder that

disorder (HPPD) can take place after ingesting hallucinogenic drugs.
It materializes as any of a broad variety of visual
contortions, which may escalate and drop in intensity,
or might remain continual. It normally decreases over
time. In numerous incidents, it dissipates entirely.
Medically, not much is known about the disorder and
there is no fixed cure.
Cosentyx™ (secukinumab) Brand name of the generic form secukinumab, a hu- Manufactured by Novartis Pharma-
injection man interleukin-17A antagonist for treating moderate- ceuticals Corporation, East
to-severe plaque psoriasis in adult individuals who Hanover, New Jersey.
are candidates for phototherapy or systemic therapy.
The injection is available as 150 mg/mL solution in
a single-use pen or prefilled syringe, in addition to
150 mg lyophilized powder in a single-use vial for
reconstitution.

Dexcom® G4 Platinum Continuous Known as Dexcom® G4 Platinum CGM System, a Designed by Dexcom, Inc., San
Glucose Monitoring System (Dex- glucose monitoring instrument for identifying trends Diego, CA.
com® G4 Platinum CGM System) and tracking patterns in those individuals 18 years of
age and older who are afflicted with diabetes.

Phoxillum™
(renal replacement solution)
Prestalia® (amlodipine besylate
and perindopril arginine) tablets
Brand name of the generic form renal replacement Manufactured by Gambro Renal
solution, a replacement solution used for managing Products, Inc., Daytona Beach, FL.
electrolytes in continuous renal replacement therapy.
Dosage is individualized based on the individual’s
fluid, electrolyte, clinical condition and acid-base and
glucose balance.
Brand name of the generic forms amlodipine besylate Distributed by Symplmed Pharma-
and perindopril arginine, a calcium channel blocker ceuticals.
and long-acting ACE inhibitor combination for treat-
ing hypertension. Tablets available as 3.5 mg/2.5 mg,
7 mg/5 mg or 14 mg/10 mg.

VOLUME 11 • ISSUE 5 SEPTEMBER/OCTOBER 2015 27

 1 CEC
CLINICAL MEDICINE
3 QUIZ
CMT/CHDS Challenge Quiz CLINICAL
Cyndi Sandusky, CHDS MEDICINE

1. Which of the following is a disease 8. Which type of cancer is the Clark stag- 15. Which of the following terms de-
that causes vascular occlusion, typically ing system used to describe? scribes minute veins of the heart wall
of the arteries in the neck and brain? A. Thyroid cancer that drain directly into the heart cham-
A. Moyamoya disease B. Angiosarcoma bers?
B. Turner syndrome C. Ovarian cancer A. Venae cavae
C. Kawasaki disease D. Melanoma B. Thebesian vessels
D. Horner syndrome C. Azygos veins
9. Which of the following is not a symp- D. Dodd perforators
2. Which is not a symptom of tom of sickle cell disease?
Ehlers-Danlos syndrome? A. Swelling of the hands and feet 16. Which of the following is a primary
A. Flexibility of fingers B. Increased hemoglobin levels bone cancer that typically manifests dur-
B. Chronic pain C. Joint pains ing adolescence?
C. Premature coronary artery disease D. Splenomegaly A. Wilms tumor
D. Easy bruising B. Ewing sarcoma
10. Which is a common chemotherapy C. Neuroblastoma
3. Which of the following is believed to regimen used to treat non-Hodgkin D. Rhabdomyosarcoma
be useful in treating damaged skin? lymphoma?
A. Gingko biloba A. R-CHOP 17. Which of the following describes a
B. Red yeast rice B. 5-FU thickening and tightening of the skin of
C. Flaxseed oil C. VCAP the fingers or toes?
D. Balsam of Peru D. AC A. Heberden nodes
B. Bouchard nodes
4. What type of surgery may be per- 11. Which of the following instruments is C. Dupuytren contractures
formed via a transsphenoidal approach? not used in eye surgery? D. Sclerodactyly
A. Nasolacrimal duct surgery A. Cystotome
B. Pituitary surgery B. De Wecker scissors 18. A person who tells lies on a regular
C. Glenohumeral joint surgery C. Malyugin ring basis with no particular goal could be
D. Rhinoplasty D. Westcott scissors said to have which of the following?
A. Organic delusional syndrome
5. Which of the following signs indicates 12. Which of the following procedures is B. Pseudologia fantastica
a condition of hypocalcemia? commonly used to treat portal hyperten- C. Tourette syndrome
A. Courvoisier sign sion? D. Aphasia
B. Kernig sign A. TVT procedure
C. Chvostek sign B. Hartmann procedure 19. Which of the following describes a
D. Murphy sign C. TIPS procedure potentially life-threatening skin condition
D. Maze procedure of the floor of the mouth?
6. Which of the following is not an HIV/ A. Hand-foot-mouth disease
AIDS medication? 13. Which of the following is not used in B. Periodontitis
A. Ritonavir treatment of benign paroxysmal posi- C. Ludwig angina
B. Raltegravir tional vertigo? D. Parotiditis
C. Acyclovir A. Epley maneuver
D. Viramune B. Semont maneuver 20. Which of the following is not a term
C. Brandt-Daroff exercises used to describe an infection by the
7. Which can be used to determine the D. Valsalva maneuver Epstein-Barr virus?
presence of pyloric stenosis? A. Kissing disease
A. Succussion splash 14. Which of the following describes a B. Mononucleosis
B. Gastric empyting study pseudo colonic obstruction often occur- C. Herpesvirus 4
C. McBurney sign ring after major surgeries? D. Sleeping sickness
D. Courvoisier sign A. Ogilvie syndrome
B. Churg-Strauss syndrome
C. Meckel syndrome
D. Fitz-Hugh and Curtis syndrome
28 SEPTEMBER/OCTOBER 2015 WWW.AHDIONLINE.ORG
 >>> Exercise Your Brain 0.5 CEC
CLINICAL
MEDICINE
Donna Blessing, CMT

&
AMPERSAND ANAGRAM
Two words are combined and their letters arranged in alphabetical order. These combined words can always be
connected with the word “and” and are standard phrases heard in the course of performing medical transcription.
Hints are provided in the right-hand column.

Clue

1. beefiiknrssst _ _ _ _ _ & _ _ _ _ _ _ _ _ Given when describing a procedure

2. ceeiiilnrsstttuuvy _ _ _ _ _ _ _ & _ _ _ _ _ _ _ _ _ _ _ lab test to help determine which

antibiotic to use

3. aaeelmnnpsssst _ _ _ _ _ _ _ _ _ _ & _ _ _ _ part of a SOAP note

4. aaaeioprsstv _ _ _ & _ _ _ _ _ _ _ _ _ a lab test performed due to GI

discomfort

5. aacdegiiiinnnors _ _ _ _ _ _ _ _ & _ _ _ _ _ _ _ _ a common procedure performed on

infected wounds

6. adddeeepppprr _ _ _ _ _ _ _ & _ _ _ _ _ _ common saying in start of op note

7. ceoprssty _ _ _ _ & _ _ _ _ _ done before a blood transfusion

8. aaacdeegiilnorttttu _ _ _ _ _ _ _ _ _ _ & common procedure performed on

_ _ _ _ _ _ _ _ _ women

9. abceeghhiilmmnooortt _ _ _ _ _ _ _ _ _ _ & common blood test, especially

_ _ _ _ _ _ _ _ _ _ when being admitted to the hospital

10. achhiiloprsstyy _ _ _ _ _ _ _ & _ _ _ _ _ _ _ _ the report type dictated when

admitting patient into hospital

11. aabgkms _ _ _ & _ _ _ _ a type of ventilation

12. aaaacccehiilmmnooprrttu _ _ _ _ _ _ _ _ _ _ _ _ _ & common phrase to describe head

_ _ _ _ _ _ _ _ _ _ exam
Answers on page 34

VOLUME 11 • ISSUE 5 SEPTEMBER/OCTOBER 2015 29

 CLINICAL MEDICINE
CMT/CHDS Challenge Quiz
Answers:
1. A – Moyamoya syndrome is a pro-
gressive disorder that affects the blood
vessels in the brain (cerebrovascular). It
is characterized by the narrowing (ste-
nosis) and/or closing (occlusion) of the
carotid artery inside the skull, the major
artery that delivers blood to the brain.
At the same time, tiny blood vessels
at the base of the brain open up in an
apparent attempt to supply blood to the
brain, distal to the blockage. These tiny
vessels are the “moyamoya” vessels for
which the disease was named.
2. C – The symptoms that one experi-
ences with EDS are mostly due to the
lack of collagen or issues with collagen
production which can cause joints to
become extremely flexible with excess
collagen or painful with decreased
collagen. Being easily bruised is often
a symptom as well, and is caused by
narrow blood vessels.
3. D – Balsam of Peru comes from the
resin of the bark of the balsam tree. It
smells like vanilla and is an antisep-
tic. Balsam of Peru is found in many
body care products such as shampoo,
conditioner, and lotion. Some alterna-
tive medicine practitioners suggest it as
a short-term remedy for the healing of
minor wounds.
4. B – A transsphenoidal approach is a
commonly used surgical approach for
removal of pituitary region masses, with
many advantages over open craniotomy.
 
5. C – The Chvostek sign is a clinical
sign of existing nerve hyperexcitability
seen in hypocalcemia. It refers to an
abnormal reaction to the stimulation of
the facial nerve.
6. C – Acyclovir is an antiviral drug
typically used to treat herpes infections.
7. A – Succussion splash. To examine
for this sign, gently shake the abdomen
by holding either side of the pelvis. A
30 SEPTEMBER/OCTOBER 2015
positive test occurs when a splashing
noise is heard, either with the naked ear
or with the aid of a stethoscope. The test
is not valid if the patient has eaten or
drunk fluid within the last three hours.
8. D – Melanoma. The Clark level, in
association with the Breslow depth,
is used to indicate the amount of
melanoma invasion into the skin, from
superficial epidermis all the way down
to subcutaneous fat.
9. B – Patients with sickle cell disease
generally have decreasing hemoglobin
levels. The red blood cells take on the
C-shape of a sickle and tend to die
early, which causes a constant shortage
of red blood cells, or anemia.
10. A – R-CHOP is a combination
chemotherapy treatment consisting of
rituximab, cyclophosphamide, hydrox-
yldaunorubicin (doxorubicin), Oncovin
(vincristine), and prednisone. It has
been approved as a first-line treatment
for diffuse large B-cell non-Hodgkin
lymphoma since 2006 and has been
used in the treatment of multiple other
B-cell non-Hodgkin lymphoma sub-
types.
11. A – A cystotome is used in bladder
surgery, whereas a cystitome is used in
eye surgery.
12. C – The TIPS (or transjugular intra-
hepatic portosystemic stent) procedure
creates an artificial channel within the
liver between the inflow portal vein and
outflow hepatic vein and is used to treat
portal hypertension, esophageal varices,
and the buildup of ascites.
13. D – The Valsalva maneuver is done
by exhaling with force against a closed
airway. It is often used to clear pressure
in the ears, but can also be used to help
break a supraventricular tachycardia.
14. A – Ogilvie syndrome, also known
as acute megacolon, occurs when there
is massive dilation of the colon without
the presence of a mechanical obstruc-
tion. It can be seen after major surgeries
such as CABG or joint replacements
and is felt to develop because of abnor-
mal intestinal motility.
15. B – The Thebesian venous network
is considered an alternative pathway
of venous drainage of the myocar-
dium, typically seen in the atria. It is
composed of small valveless venous
channels.
16. B – Ewing sarcoma can occur
any time during childhood and young
adulthood, but it usually develops dur-
ing puberty when bones are growing
rapidly. The tumors typically develop in
the long bones of the arms and legs and
are often metastatic to other bones and
the lungs.
17. D – A classic symptom of scleroder-
ma, sclerodactyly starts with puffiness
or edema of the fingers or toes that can
progress to thickening and tightening of
the skin which causes the fingers to curl
inwards into a clawed position.
18. B – Pseudologia fantastica, also
known as pathological lying or mytho-
mania, is a syndrome in which a person
tells extensive and fantastical lies as a
habit. These lies are always within the
realm of possibility and the sufferer
may even believe the lies they tell.
19. C – Ludwig angina is a potentially
life-threatening cellulitis of the floor of
the mouth, often occurring with dental
infections such as abscesses, which can
cause obstruction of the airways if left
untreated.
20. D – The Epstein-Barr virus, or her-
pesvirus 4, is one of the most common
viruses found in humans. It is transmit-
ted by oral transfer of saliva or genital
secretions (kissing disease or mono-
nucleosis), but typically causes few or
no symptoms. It is estimated that 90%
of adults in the US have been exposed
to EBV.
WWW.AHDIONLINE.ORG
 >>> Professional Practice Desk
Tackling the complexities of professional practice in healthcare documentation one issue, trend,
and challenge at a time…
Q: Is it ever alright to transcribe “Bilateral tympa-
nostomy.”
A: Most docs don’t dictate the correct plural term
“bilateral tympanostomies” when referring to tube
placement in both ears. They may even assume that by
including “bilateral” it is pluralized, and generally it is
assumed by the reader that tube placement in both ears
is what is intended when “bilateral tympanostomy” is dic-
tated and/or read in the record.
Essentially, “bilateral tympanostomy” would be the
equivalent of saying “tube placement in both eardrum,”
whereas “bilateral tympanostomies” is equivalent to say-
ing “tube placement in both eardrums.”
Q: I have noticed that some providers will dictate
things like “We will proceed with further imag-
ing and make recommendations based on the findings,”
or “We gave the patient an injection into his right knee.”
I have heard that the “We” should be changed to an “I”
in such cases. I was wondering, though, if there is a “best
practices” recommendation for this.
A: Unless the facility or client for which you work
has policies and procedures or otherwise provides
specific instructions for changing “we” to “I” for such
statements, it is recommend to transcribe as dictated. It
cannot and should not be assumed about whom the pro-
vider is referring or if he/she really means himself/herself
alone. Providers have a team of people (nurses, PAs, lab
techs, etc.) they work with who provide assistance and
care also (giving shots, drawing labs, taking vital signs,
dressing wounds, scheduling PT or diagnostic studies,
etc.). The provider could be talking in the collective
about one or more team members. Additionally, patients
are more apt to participate in their own care and may be
given a choice in their treatment options, so he/she could
be referring to the patient as part of a “we” statement. In
transcription, we cannot afford to guess or assume what a
provider means in such an instance.
Have a professional practice question?
Submit your inquiry to the AHDI Professional Programs Department for research and response: professionalpractices@ahdionline.org.
VOLUME 11 • ISSUE 5
Q: I am wondering what your take on 7.3.4 pages
155 and 156 AHDI BOS is. In our facility if a
department such as orthopedics or obstetrics gynecology
is mentioned in the report we have been using lower case.
A: I always tell people that the easiest way to re-
member when to capitalize names of specialties
is to insert the name of a person in place of the word. If
you can replace it with a person’s name, then it should be
capitalized. If you replace it with a person’s name and the
sentence doesn’t make sense, it’s being used in a generic
way and should be lowercase.
Examples:
The patient was seen by Orthopedics last week and will
be scheduled for surgery Tuesday.
The patient was seen by Dr. Black last week and will be
scheduled for surgery Tuesday. (This works so Orthope-
dics should be capitalized.)
He was referred to Cardiology for cardiac workup.
He was referred to Joe Smith for cardiac workup. (This
works so Cardiology should be capitalized.)
Likewise, most often when the word “the” precedes the
specialty or department name, it’s being used as a com-
mon term, not a proper noun. Only capitalize such terms
when referring to the complete/official name.
Examples:
Mary was seen in the obstetrics clinic just yesterday for
followup.
The orthopedics department will be open at 9:00 a.m.
The patient arrived to the emergency department at 3:23
a.m. and was pronounced deceased at 4:02 a.m.
Her son will follow up at St. John’s Orthopedic Clinic
next week.
The patient arrived to Baptist South Emergency Depart-
ment at 3:23 a.m. and was pronounced deceased at
4:02 a.m.
SEPTEMBER/OCTOBER 2015 31
 >>> Corporate Perspectives
Getting to Know
AHDI’s Corporate & Educational Members
1. Let’s start by learning more about
Terra Nova and what your organiza-
tion does.
Terra Nova is an independently
owned documentation solutions
provider, with offices in Canada
and the United States. Operating
since 2001, our healthcare division
services hospitals and physician
practices to improve the capture,
transcription, and timely delivery
of a complete patient record. Our
expertise in technology and the
experience of our team ensures
99.7% accuracy and 100% on-time
delivery. We are very proud of that
accomplishment.
2. What are Terra Nova’s guiding
principles?
Our entire team is guided by our
commitment to excellence; excel-
lence in reputation and excellence
in service to our clients and the
32 SEPTEMBER/OCTOBER 2015
FEATURED COMPANY:
Terra Nova
patients they serve. Every member
of our team understands the impor-
tance of an accurate patient story.
We value the relationships we’ve
built with our clients who trust and
rely on us to deliver exceptional
service in all aspects of the services
we deliver.
3. Terra Nova has locations in
Canada and the United States. From
your perspective, what are some
similarities and differences in the
healthcare documentation industry
between the two countries?
The obvious difference is that the
US has a privatized model of care,
while the Canadian model is public
medicine. The US market has been
outsourcing services for several
decades. The Canadian industry
is slowly moving in that direc-
tion. Historically, most work was
completed by an in-house staff.
The reservation to outsource is
usually based on a previous nega-
tive experience, when the process
was handled poorly. It is more cost
effective to outsource transcription
and a decision to outsource should
be based on credible vendor perfor-
mance, integrity, and the value of
that service to an organization.
4. In light of the changing land-
scape in health IT and HIM please
share with us some of Terra Nova’s
recent initiatives to adapt to this new
environment in regard to services/
products offered and continuing
education for the workforce?
Terra Nova continually evolves
to meet the demands of our ever-
changing industry. We are, and must
be, committed to continuing educa-
tion and training. We encourage
professional credentialing, with a
reimbursement program to support
our team members in their profes-
sional growth and development.
WWW.AHDIONLINE.ORG
5. From your standpoint, do you
think the document creation work-
force will grow, shrink, or remain
about the same and why?
I think that our industry has
evolved more in the last ten years
than in the previous thirty years.
It was necessary to create efficien-
cies with new technologies. While
hospitals are required to do more
with less money, the concept of
technology being the epitome of
creating the patient story is unreal-
istic. We are able to create de-
tailed patient information records.
Physicians are less engaged with
patients. I believe that we must find
a balance between using technol-
ogy and retaining the physician’s
relationship with the patient, creat-
ing a narrative to have a complete
health story. We must have skilled,
comprehensive medical language
specialists for this to be successful.
While the profession has changed,
I believe that we will see growth in
the future.
6. What accomplishments are you
most proud of with Terra Nova?
I am very proud to have grown an
independent company with integ-
rity, a mutual respect within our
entire team of professionals, and
with a commitment to excellence in
everything we do in our service to
clients and, ultimately, the patients
they serve. I am very proud of who
we are.
7. In closing, is there anything else
you would like to share with our
readers?
This industry is continuously
changing, yet the entire Terra Nova
team does not waiver in our com-
mitment to delivering our service to
clients with excellence, for the bet-
terment of healthcare delivery. P
Maria French is the president and
CEO of Terra Nova Transcrip-
tion, established in 2001, leading
an accomplished team in providing
clinical documentation services for
hospitals and healthcare facilities
throughout Canada and the United
States. A respected leader in the
medical documentation industry,
she has also served in various board
capacities with Junior Achievement,
YM-YWCA Enterprise Centre, and
Habitat for Humanity. She is a Paul
Harris Fellow of Rotary Interna-
tional and has served for more than
twenty-five years as a Rotarian.

Association for Healthcare Documentation Integrity STATEMENTS OF ACTIVITY

August 2015 YEARS ENDED DECEMBER 31, 2014 AND 2013

Dec 31, 2014 Dec 31, 2013

The following are compiled statements of financial position of the REVENUES:
Association for Healthcare Documentation Integrity, a nonprofit mutual Membership Dues 296,453.44 373,886.82
benefit corporation, as of December 31, 2014, and the related statements Professional Practices 147,946.31 158,695.47
of activities for the year then ended. Meetings and Events 109,126.50 159,172.97
Advertising and Publications 18,728.94 17,829.60
Management is responsible for the preparation and fair presentation of Certification 67,062.53 109,409.47
the financial statements in accordance with accounting principles generally Royalties 9,727.72 18,119.89
accepted in the United States of America and for designing, implementing, Shipping and Handling Income 11,120.01 13,555.54
and maintaining internal control relevant to the preparation and fair Interest Income 0.00 0.00
presentation of the financial statements. Other Products and Services 32,355.69 45,378.18
Discounts -3,982.00 -8,657.50
TOTAL REVENUES 688,539.14 887,390.44

These reports and information are for AHDI member use only. Dec 31, 2014 Dec 31, 2013
EXPENSES:
STATEMENTS OF FINANCIAL POSITION Personnel salaries and benefits 301,289.94 461,076.15
DECEMBER 31, 2014 AND 2013 Professional and contracted services 58,841.63 62,334.36
Dec 31, 2014 Dec 31, 2013 Meetings and events 75,295.87 93,936.67
ASSETS Facilities 38,528.56 45,203.49
Cash and Equivalents 46,032.61 20,126.79 Cost of goods sold and used 19,565.76 16,359.80
Accounts Receivable 12,327.69 27,150.18 Postage and shipping 20,804.30 26,513.72
Inventories 14,849.98 24,081.40 Printing and reproduction 4,105.68 6,211.64
Prepaid Expenses 4,137.88 6,719.55 Merchant fees and service charges 27,731.75 32,047.16
Property and Equipment 5,927.48 50,407.36 Accounting 2,500.00 9,755.63
TOTAL ASSETS 83,275.64 128,485.28 Depreciation 46,116.00 76,011.39
Telecommunications 8,584.35 13,416.14
LIABILITIES & EQUITY General insurance 12,391.40 18,299.73
Accounts Payable 250,298.3 305,199.3 Legal 50.25 1,792.45
Accrued Liabilities 16,799.93 19,321.25 Supplies 3,168.29 3,957.84
Deferred Revenue 165,335.57 207,524.12 Operating expenses 21,344.22 41,607.46
Long Term Liabilities - lease/line of credit 205,285.86 210,262.87 Dues and subscriptions 550.00 550.00
TOTAL LIABILITIES 637,719.70 742,307.50 Advertising 288.12 203.77
Cancellation of debt -11,995.14 -7,023.11
EQUITY Miscellaneous 0.00 0.00
Retained Earnings - Prior -613,822.22 -598,958.37 TOTAL EXPENSES 629,160.98 902,254.29
Net Income - Current Year 59,378.16 -14,863.85
TOTAL EQUITY -554,444.06 -613,822.22 TOTAL PROFIT/LOSS Dec 31, 2014 Dec 31, 2013
TOTAL LIABILITIES & EQUITY 83,275.64 128,485.28 INCREASE/DECREASE IN MEMBERS' EQUITY 59,378.16 -14,863.85

VOLUME 11 • ISSUE 5 SEPTEMBER/OCTOBER 2015 33

 >>> AHDI News & Who’s Who

Finding Your Membership Benefits on AHDI’s Website

O nce you are logged into the AHDI website, you’ll have immediate access to your membership benefits.
Under “Get Involved” click on “Access Your Benefits,” which is your gateway to your benefits. You’ll find
links to the Plexus file library, online CEC quizzes, online learning library, and much more.

While you’re online en-

joying your benefits, please
invite your colleagues to
join AHDI! It’s quick and
easy with the new tool. Click
“Refer a Friend” in the “My
Profile” box to get started.

Advertise Your Events

Answer Key to Anagrams Combined
by “and” Puzzle C omponents, don’t forget to post your upcoming events, study
groups, etc., to the AHDI Events Calendar (http://www.
ahdionline.org/events/event_list.asp). Events to be included in the
1. risks and benefits November/December 2015 issue of Plexus need to be posted by
2. culture and sensitivity November 6, 2015.
3. assessment and plan To submit an event, email details for the text below to kwall@
4. ova and parasites ahdionline.org.
5. incision and drainage
6. prepped and draped District No.:
7. type and cross Component Name:
Event Name:
8. dilatation and curettage
Date(s) of Event:
9. hemoglobin and hematocrit Time of Event:
10. history and physical Website:
11. bag and mask Contact Name:
12. normocephalic and atraumatic Contact Email:
Preapproved CECs:

34 SEPTEMBER/OCTOBER 2015 WWW.AHDIONLINE.ORG

>>> AHDI News & Who’s Who

AHDI’s New Website is Live Upcoming Continuing Education Webinars

I n case you missed our email earlier this month,

AHDI’s new redesigned website is live! Beyond a
new look, the website has improved navigation and
R ead more details about these webinars and more
at http://www.ahdionline.org/events/event_list.asp.
To narrow your search, click the dropdown menu
expanded functionality such as: and select either “AHDI Webinars” or “Component
Events.”
• District Connections—your AHDI member
community in your geographic area. October 8
• Membership cards. Compensation Best Practices Toolkit
• Improved search capabilities. Sherry Doggett; Joyce Smith; Patricia King; Carole
• Search & Connect box on every page to easily Gilbert, RHIT, CHTS-IM; Cheryl Klopcic, RN,
find the most popular areas. BSN, CMT, RHIT
• Refer a friend to join AHDI. 1 p.m. PDT/4 p.m. EDT
CE Credit: 1 PD
Please visit www.ahdionline.org to update your
profile and change your temporary password. After October 14
logging in, visit “Manage Profile” and “Edit Bio” to Pre-Employment Exams – What Educators Need
provide your updates. Your login information was to Know
emailed on September 7 or you may click “Forgot Mary Schmidt
Your Password?” in the Sign In box to have a link 12 p.m. PT/3 p.m. ET
emailed to you to reset your password. CE Credit: 1 PD
If you need assistance, we’re available with only
a click of your mouse with our new contact form or October 20, 2015
you can call us toll free at (800) 982-2182 (direct: GVSU Scribe Academy—Insight into the Role of
209-527-9620). the Scribe
We look forward to your visit to the new website Jean Nagelkerk, PhD, FNP, and Ryan Cook, MBA
and please make sure to complete the survey to pro- 11 a.m. PT/2 p.m. ET
vide us with your feedback. You’ll find a link to the CE Credit: 1 PD
survey on the homepage.
October 28
The Benefits of Membership (FREE)
AHDI Board Appoints Fox-Acosta as Susan Dooley, MHA, CMT, AHDI-F
District 1 Director 1 p.m. PT/4 p.m. ET
CE Credit: N/A

T he National Leadership Board appointed Karen

Fox-Acosta, CHDS, AHDI-F, to fulfill the remain-
der of the term (2015-2016) for the District 1 Director
November 9
Beyond Transcription—Blazing New Trails
position recently vacated by Lisa Woodley, RHIT, Melissa Harper, Kathy Vome, Angela Griggs, Sheila
CHDS, CHTS-PW. Woodley has recently resigned for Guston, Lucy Koch, Lori Pospiech, and Janine
personal reasons. Woodhull
11 a.m. PT/2 p.m. ET
CE Credit: 1 PD

VOLUME 11 • ISSUE 5 SEPTEMBER/OCTOBER 2015 35

2015 AHDI Integrity Award Winners Announced
Lifetime Achievement
The award goes to… Bonnie Monico, CHDS, AHDI-F, Omaha, NE
Distinguished Service Award
The award goes to… Nick Mahurin, Terre Haute, IN
Advocate of the Year
The award goes to…Brenda Wynn, CMT, AHDI-F, Williamston, NC
Educator of the Year
The award goes to… Susan Whatley, CHDS, AHDI-F, Winter
Haven, FL
Employer of the Year
The award goes to… Phelps County Regional Medical Center,
Rolla, MO
Other nominees for this award include: Opti-Script, Inc. of
Kemersville, NC
Innovation Through Technology
The award goes to… M*Modal
Membership Impact Award
The award goes to… AHDI-West Regional, Sandy Shumaker, CMT,
AHDI-F, President
Member of the Year Award
The award goes to… Stephanie Kinney, RHIT, CMT, AHDI-F,
Wyoming, MI—Component affiliation: Great Lakes Region and
West Michigan Chapter
Other nominees for this award include:
Sandy Shumaker, CMT, AHDI-F of Glendora, CA
Rising Star Award
The award goes to… Piyush Sharma, of Mississauga, ON,
attending CanScribe Career College
Other nominees for this award include:
Alicia Sharon Marge, Linden, PA, Everett Community College
Ashley Powell, East Wenatchee, WA, Everett Community College
Clara Newcomb, Flora Vista, NM, Everett Community College
Crystal Carmichael, Los Lunas, NM, Everett Community College
Danielle Sealock, of Luray, VA, Everett Community College
Delana Mason, of Morrilton, AR, Everett Community College
Jasmine Sandberg, of Benton City, WA, Everett Community
College
Karen Botelho, of Fall River, MA, Everett Community College
Leslie Dodge, of Caro, MI, Everett Community College
Lisa Reyes, of Kennewick, WA, Everett Community College
Loanne Bannister, of Crescent, B.C., CanScribe Career College
Magdalene Harless, of Paris, AR, Everett Community College
Mary Lopez De Morales, of Grand Forks, B.C., CanScribe Career
College
Melissa Brown, of Louisville, KY, Everett Community College
SEPTEMBER/OCTOBER 2015
In honor of educator Marilyn Craddock, the Rising Star
award serves to recognize an outstanding industry
student for a contemplative and informed response to
the Association’s annual essay contest.
This year AHDI’s essay topic was “Embracing Future
Technology.”
Winning essay by Piyush Sharma:
The vast and complex world of technology is often met with
trepidation. Simplicity however, is complexity resolved. By
comprehending and adapting technological tools into health
care environments, we continue to enhance the quality of
health-care across all mediums. Whether it is physician-
patient communication, health care delivery or medical
research; the quality of health care has improved in cohesion
with the incorporation of technology. Undoubtedly,
technology holds a key contributory role to the field of
medicine.
Specifically, the niche of medical transcription has shown an
increase in efficiency through utilizing innovative technology.
These advancements have allowed for progressively shorter
turn over times, ultimately leading to more efficient
completion and dispersion of electronic medical records. All
while respecting the confidentiality of EMR’s and protecting
patient security; a notion that is so integral to our work.
As transcriptionists, we have an eagerness to adapt and
incorporate any readily available technological tools. This not
only assists us in our ability to produce efficient, accurate and
precise results; it also makes way for new developments and
protocols to be established.
Since its existence, medical transcription is heavily
intertwined with technology. From historical typewriters to
more recently, speech recognition; transcription has
flourished through use of technology. In recognition of this
trend, the federal government has opted to spend up to $29
billion in incentives to encourage hospitals to digitize health
care records.
In recognizing the importance of technology to medical
transcription, perhaps we are reinstating that the most vast
and complex structure that exists today is indeed the human
brain. As medical transcriptionists, by embracing technology
we strive to further globally enhance health care and delivery.
WWW.AHDIONLINE.ORG
 >>> Funny Bone
The Name is the Game
Richard Lederer, PhD
T he fastest man in the world is Usain Bolt. Louis Jean
and Auguste Marie Lumiere created the first movies
that told stories. In French, Lumiere means “light.”
Names such as Bolt and Lumiere that are especially
suited to the profession or a characteristic of their owners
are called aptronyms. Believe it or not, Daniel Druff is
a barber, C. Sharpe Minor a church organist, and James
Bugg an exterminator. Some aptronymic personages are
famous:
• champion tennis player Margaret Court;
• football star Jim Kiick;
• baseball stars Early Wynn, Herb Score, Johnny
Bench, and Cecil and Prince Fielder;
• golf stars Gary Player and Tiger Woods
(woods are golf clubs);
• astronaut Sally Ryde;
• presidential spokesperson Larry Speakes;
• Romantic poet William Wordsworth;
• World Series of Poker champions Jamie Gold
and Chris Moneymaker;
• American judge Learned Hand;
• manufacturer of toilets Thomas Crapper;
• and (joke alert!) spouse snipper Lorena Bobbitt
(Get it? “Bob it”).
While we’re on the topic of spot-on appropriate sur-
names, you know, of course, that it wasn’t that long ago
that Steve Jobs, Johnny Cash, and Bob Hope were alive.
But now we have no Jobs, no Cash, and no Hope.
Here’s a cute game that employs aptronymic first
names: These days, we often attend conferences, parties
and other gatherings where we are asked to wear name
tags that say, “Hello, I’m _____.”
AMAZING WORDS
* Amazing Words is author Richard Lederer’s
career-capping anthology of bedazzling, beguiling,
and bewitching words. Richard will sign each book
and personally inscribe, if so requested.
36 SEPTEMBER/OCTOBER 2015
The object of our game is to match a real first name
with a real profession to spark a punny connection, as in
“My name is Homer, and I’m a ballplayer,” “My name is
Jimmy, and I’m a safecracker,” and “My name is Mary,
and I’m a justice of the peace.”
Even more spectacular are serial puns on names and pro-
fessions. Hello, our names are:
• Alexis, Carmen, Chevy, Jack, Mercedes, Otto,
Phillip, and Rusty, and we work on cars.
• Annette, Bob, Brooke, Eddie, Gil, and Tad, and
we’re fishermen.
• Beech, Sandy, Shelly, and Wade, and we’re
lifeguards.
• Bill, Buck, and Penny, and we work at the
mint.
• Bud, Daisy, Holly, Iris, Lily, Pansy, Petunia,
Rose, and Violet, and we sell flowers.
• Case, Courtney, Sue, and Will, and we’re
lawyers.
• Charity, Chastity, Faith, Grace, Hope, Mercy,
and Neal, and we’re ministers.
Richard Lederer is the author of more than 44 books about lan-
guage, history, and humor, including his best-selling Anguished
English series and eight newly released books. He has been
profiled in magazines as diverse as The New Yorker, People,
and the National Enquirer, and frequently appears on radio as
a commentator on language. Dr. Lederer’s syndicated column,
Looking at Language, appears in newspapers and magazines
throughout the United States. He has been named International
Punster of the Year and Toastmasters International’s Golden
Gavel Winner. He is the 2010 recipient of AHDI’s Lifetime
Achievement Award.
www.verbivore.com
richardhlederer@gmail.com
9974 Scripps Ranch Blvd.
#201
San Diego, CA 92131
WWW.AHDIONLINE.ORG
Why Get
CERTIFIED?
Registered and Certified Healthcare Documentation Specialist

1 earns you RESPECT

& Recognition
as a member of the healthcare team

2 HIPAA
demonstrates you’re trained and certified in

compliance

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4 new roles EHR prepares you for

in the

5 ON YOU
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Get ready to put RHDS or CHDS after YOUR name.

www.ahdionline.org