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October 25, 2010

Difference Makers
By Maura Keller
For The Record
Vol. 22 No. 19 P. 8

For The Record presents its first annual spotlight on 10 outstanding HIM professionals, each of whom are doing their part to push the profession forward.

When you think of the best HIM professionals, what attributes come to mind? Knowledge? Certainly. The ability to adapt seamlessly? Definitely. Care and consideration for the people they serve? Absolutely.

In honor of National Health Information and Technology Week (November 7 to 13), we asked readers to nominate exceptional individuals who exhibit the above traits and more. Many strong candidates emerged (a hearty thank you to all those who participated), making it difficult to narrow it down to a select 10. Spotlighted below are those individuals who are helping reshape the HIM profession in a time of enormous change.

Sue Ann Porzel, RHIT
Director of the Health Information and Records Department at Oak Forest Hospital of Cook County
Entering into the HIM field was the start of a second career for Sue Ann Porzel. “After my children began school, I knew I wanted to work in the medical field but not have a hands-on role with patients,” she says. “I researched different careers and chose HIM because I could incorporate my business background. I then chose to attend Moraine Valley [Community College] since it has the highest passing rate of the RHIT exam in the country.”

Today, Porzel, director of the health information and records department at Oak Forest Hospital outside Chicago, is responsible for 30 employees, including those in cancer registry, clerical, coding, release of information, and transcription. Besides managing the department, she participates in the development and implementation of policies, procedures, and standards regarding health information and monitors changes in legislation and accreditation standards that affect HIM.

“After accepting my current job, I was most interested in the challenge of bringing manual processes into the electronic era,” Porzel says. “I wanted the department to earn the respect it deserves and educate others on health information management. I also want to continue to improve the working interdepartmental relationships in the hospital.”

During her tenure at Oak Forest, Porzel has restructured the department’s work processes, decreased the hospital’s delinquency rate, and lowered the turnaround time for coding charts. She also has been instrumental in implementing coding audits and ambulatory specialty clinic encounter forms.

“I enjoy the variety that this position entails—everything from working with risk management to quality assurance to the billing office,” Porzel says. “No day is ever the same. The most rewarding aspect of this position is working collaboratively with other departments to improve patient care.”

Due to the tough economy and budget cuts, Porzel has been challenged to maintain productivity standards with less staff.

“As our organization is consolidating, I would like to be able to contribute my knowledge and experience of health information management as we go forward,” she says. “I hope to continue to be an asset to my organization as we move ahead in this exciting time of multihospital system integration, along with the implementation of the electronic record.”

Terri Krevey, RHIA, MHA
Director of HIM at Mercy Health Partners
Terri Krevey graduated from Ithaca College in New York with a bachelor’s degree in medical record administration. ”I started out in college as a physical education major and decided I wanted to change my major during my junior year. My college advisor placed me in the medical record program because my courses ‘fit.’ I guess it was lucky for me—I loved it,” Krevey says.

After getting her feet wet at Hurley Medical Center in Flint, Mich., she moved to Pennsylvania to work at Berwick Hospital, during which time she went back to school to obtain a master’s degree in health administration at the University of Scranton.

Today, Krevey’s responsibilities include coding, transcription, filing, correspondence, chart assembly, and analysis for Mercy Scranton and Mercy Tyler.

“I’m responsible for the budget, planning, hiring, discipline—all that goes with a management position,” Krevey says. ”Since we are part of a larger health system [Catholic Health Partners out of Cincinnati], I have opportunities that most other HIM directors may not have. I have counterparts in other states to talk to. We meet on a somewhat regular basis; the peer exchange is great.”

Krevey most enjoys the variety of work offered by her position. From performing basic clerical functions to administrative duties within the office, she likes to restructure and find different ways to perform daily tasks. Implementing new technology and subsequently redesigning workflow also stir her passion. ”I like to be involved in technology changes and growth,” she says. “The most rewarding events are when a physician calls me to say what a great job one of my employees had done or when a patient that we have assisted sends a letter to administration saying how our HIM department staff went out of their way to assist them or when you make a visitor smile.”

The ongoing changes in the HIM industry keep Krevey on her toes. “You would think after 20-plus years in the field, things would be easier, but the world of HIM is forever changing. The changes seem to be coming fast and furious.”

While it is a challenge to stay on top of things, Krevey wouldn’t have it any other way. “I would love to be in an electronic world,” she says. “While I know there is an end in sight with dates coming up in the next couple years for implementation, I just would love to have the technology now. All I want for Christmas is an EHR.”

Juana Colon, RHIA
Corporate Director of HIM at Orlando Health
On her way toward earning a bachelor’s degree in Spanish literature and Puerto Rican studies at Fordham University in New York, Juana Colon also earned a minor in business with the intent of working at the United Nations. However, those plans took a turn when, as a junior, she became intrigued with a career in healthcare while working part time in a hospital setting. Upon graduation, she was given the opportunity to work full time in cancer registry at Montefiore Medical Canter in the Bronx. The rest, as they say, is history.

As the corporate director of HIM at Orlando Health in central Florida, she is responsible for the daily operations of 255 full-time employees across six facilities as well as the Shared Services that comprise medical transcription, corporate coding, practice management, and the cancer service line.

“The responsibilities that I enjoy the most are working through our technological changes, ensuring that the legal health record represents the care that was rendered to our patients,” Colon says. “Working with the technology aspects and changes is very exciting in this ever-changing environment of health information management.”

It is Colon’s desire to provide Orlando Health’s patients and physicians with the best services that HIM can provide, offering them the most accurate and complete medical information as well as utilizing technology to enhance the delivery of care.

“The most exciting portion of my role is the collaboration with the entire medical staff as well as the administrative team that must occur to deliver the best care to our patients,” she says. “What I find rewarding is the ever-challenging world of distribution of medical information and the use of technology that forces HIM professionals to look to others in a collaborative approach to deliver the care necessitated to our patients.”

In her role, Colon hopes to attract the best HIM professionals as they face the complexities of advanced technology as well as strive to meet the federal requirements for health information exchange and disease management.

“Our profession will allow us to continue to collaborate with the clinical informatics, finance, and education areas to enhance the documentation that our patients are in desperate need of,” she says. “The educational component for the future of our profession is critical. These challenges allow us to provide the data needed to care for our patients in the future.”

Cathy Egan, CCS
Manager of Clinical Documentation Improvement and Inpatient Coding at Bayshore Community Hospital
As the manager of clinical documentation improvement and inpatient coding at Bayshore Community Hospital in Holmdel, N.J., Cathy Egan is part cheerleader, part team builder, part educator, part salesman, part politician, and part coding and documentation compliance expert. She tackles all these roles in an effort to promote proper documentation practices and accurate coding.

“Many HIM professionals will relate to my comparisons, as many of us spend our days wearing many hats, creating innovative solutions to promote and achieve best-practice goals,” Egan says.

Ten years ago, Egan felt a great need to improve vague physician diagnostic terminologies in the medical record.

“I found that many physicians were unaware that they were not describing the acuity or severity of their patients’ illnesses to the degree of coding specificity that aligned with treatment and hospital utilization expended,” she says.

Along with a physician advisor, Egan developed the COR (Compliance, Outcomes, and Reimbursement) team, educating medical staff and her organization on how precise diagnostic terminologies convert into ICD-9-CM coded language and how it all worked within the diagnosis-related group system.

“Soon we had a team of dedicated, skilled professionals promoting clinical documentation excellence,” she says.

Egan, who recently completed her degree in health information technology and will be sitting for the RHIT exam this fall, has taught ICD-9-CM at the local community college for the past 10 years, offering students a semester of clinical practice experience.

“I enjoy coming to work every day knowing that I will be working with highly skilled professionals sharing devotion to the same values within our program’s mission statement,” she says. “We all work together to achieve a common goal and have worked hard to put processes in place to measure our collective and individual performances. We strive to sustain our program goals and continue to improve our performance. We have built successful positive relationships within the medical staff and many other clinical areas. Today there is an improved understanding of the importance of good documentation practices within our organization.”

As an HIM leader, Egan values the skills and attributes of each of her team members. “Each has unique qualities and skills that complement one another, allowing for the development of a dynamic team,” she says. “I try to be a good leader and a mentor focused on building individual skills and confidence to perform well. I want to ensure that my staff has all the tools to do the job efficiently and effectively. I want them to know that I understand the complexity of their jobs, and I acknowledge and applaud their passion to perform good work. In the end, it’s about ensuring that each individual feels good about what they do every day and that they feel they have positively contributed as a viable member of the healthcare team.”

Kathy Cameron, RHIT
Director of Enterprise HIM Services at WellStar Health System
Purely by chance, Kathy Cameron entered the HIM profession more than 30 years ago as a file clerk in a hospital medical records department. At the time, she had two years of college-level liberal studies and no formal schooling related to HIM.

“I was exposed to and moved into other HIM positions that included patient index, release of information, chart abstracting, and completion,” she says. “I was fortunate to have been taken under the wing of the department manager, who encouraged me to further my education.”

After many years as a business owner and working in a vendor environment, Cameron returned to HIM on the healthcare provider side of the fence.

“I wanted to feel closer to patient care and the impact that HIM has on quality and efficiency,” she says. “I am very excited about the impact technology and the electronic health record can bring to support patient care and quality outcomes. As an HIM professional, it is important that my organization, clinicians, and patients have health information that is accurate, complete, easily accessible, timely, and actionable at the point of care.”

As enterprise HIM director for WellStar Health System, a multihospital integrated delivery network in Marietta, Ga., Cameron oversees system strategy for data integrity in the EHR, monitors the enterprise master patient index and its source systems, ensures compliance with Joint Commission and regulatory guidelines, helps establish legal health record policy, and tracks transcription service delivery.

“I most enjoy working with the multidisciplines of patient care with a common goal of driving quality care,” Cameron says. “It has allowed me to see and understand the dynamics and end-user requirements, whether they be information technology, physicians, or frontline nursing. The most rewarding aspect of my job is being able to come to the table with HIM-oriented recommendations and solutions that bring significant and recognizable value to these end users.”

One of the greatest challenges facing Cameron is her ability to stay on top of all the changes happening in the HIM sphere. “From the legalities of electronic health information to privacy regulations to implementing new systems in order to achieve meaningful use, I strive to be a resource of current, accurate information and an advocate of best practice,” she says. “Having been in the profession for over 30 years, I have never seen more opportunity for HIM professionals than what we see today.”

Gwendolen Thomas, RHIT, CPC
Chief of HIM Services for the Phoenix Veterans Administration
For Gwendolen Thomas, there isn’t one task that stands out within her role as chief of HIM services at the Phoenix Veterans Administration. Rather, she delights in nearly every aspect while gaining pleasure from helping others.

“The most rewarding part of the day is helping a patient, family member, attorney in receiving information they requested. Helping a patient find his or her way to an appointment, directing calls to the person that could help the needs of the client, helping to push a patient struggling in a wheelchair in getting from one destination to another, but most of all sitting down and talking to a patient and listening to the stories they have to tell,” Thomas says. “This is what I enjoy the most—knowing that I contributed a part of me every day that can help make someone’s life a little easier.”

Thomas began her career as a care worker for physically and mentally handicapped children. After receiving degrees as a medical secretary and surgical technologist, she earned her associate’s degree and proceeded to obtain her RHIT certification.

“In 2004, I was interviewed and hired on at St. Cloud, Minn., VA Medical Center as a HIMS [health information management services] intern, and I received extensive training in becoming a supervisor within my field,” she says. “When hired as a HIMS intern, you are taught by experts within your field about finance, privacy, FOIA [the Freedom of Information Act], VA directives, and much more. I did extensive traveling during my first year and a half observing how other VAs were run and attended conferences around the United States.”

Three years later, after a stint as the assistant chief of HIMS at the W. G. “Bill” Hefner VA Medical Center in Salisbury, N.C., Thomas became the medical care cost recovery revenue coordinator at the Phoenix VA. From there, she was promoted to her current position.

“I oversee the HIMS department, which consists of the file room, scanning, release of information, coding, records management, transcription contract, and ward administration,” says Thomas, who also finds time to contribute to the VISN (Veterans Integrated Service Network) 18 Compliance and Integrity committee, the VISN 18 Ethics committee, and the Medical Records committee, among others.

“I just completed a project where the file room on the first floor was completely closed and now the area will be utilized for patient care services,” she says. “Because the VA has had an electronic records system for many years, the scanning department is kept busy by scanning in materials that are received from outside facilities to our CPRS [computerized patient record system] so that providers can keep abreast of not only what patients are seen for in the VA but also of what occurs when patients are seen by an outside provider from the private sector.”

Keeping on top of an industry in flux and finding enough hours in the day to get the job done present challenges. “In the healthcare field, technology changes daily,” Thomas says. “What you had today is gone tomorrow. This isn’t always bad but good because people are living longer compared to five, 10, 15 years ago. What I strive to attain is giving some of my old knowledge to future HIMS people but also learning something new from them. Change is good.”

Lori Tilley, RHIA
Director of HIM and Privacy Officer at SkyRidge Medical Center
In college, Lori Tilley knew she wanted to pursue a career in healthcare but not one that involved direct patient care. As a result, she pursued a degree in health information administration from the Medical University of South Carolina and followed that accomplishment with earning her RHIA certification.

At SkyRidge Medical Center, a 220-bed facility located in Cleveland, Tenn., Tilley oversees the daily operations of the HIM department. She also serves in two other key roles: chairperson of the forms committee and privacy officer.

One of Tilley’s first challenges was working at a facility in the middle of a merger that involved combining the services of two HIM departments. “I was looking forward to working along with a talented group of healthcare professionals,” she says. “My goal is that as a team we can provide a complete medical record that captures the treatment provided to a patient at our facility.”

What does Tilley find most rewarding in her position? “When I receive a letter or phone call recognizing one of our HIM associates for his or her outstanding customer service,” she says. “This shows that HIM professionals have an impact on the patient’s experience with the facility. SkyRidge Medical is accredited by The Joint Commission, and I am also rewarded by the fact that the HIM department contributes to that accreditation.”

Like many HIM departments these days, Tilley’s is faced with the prospect of preparing hospital staff and physicians for the conversion to an EMR system. “I hope to attain the support of both the staff and healthcare providers during the transition process when records will be viewed electronically and we move away from paper-based record storage,” she says.

“Lori is perhaps one of the most positive people I have ever dealt with as a HIM business owner,” says John King, chief operating officer at EvriChart. “She is constantly seeking new ways to improve efficiencies in her department and is very receptive to new methods for getting this done with respect to medical records and managing her PHI [protected health information] in general. More importantly is the respect and care she shows to her staff and to my staff as a leader. … She is very inquisitive and empowers others to assume responsibility. Her expectations are very high and she has a way of making everyone want to be better at what they do.”

Thom Cartwright, LVN, RHIT, CCS
HIM Consultant for Kforce Healthcare
Thom Cartwright began his HIM career in 1975 as a medical record specialist in the U.S. Army. Upon discharge, he attended nursing school. “I worked in the emergency department for approximately 10 years before starting the RHIT (formerly ART) program in the hopes of entering the utilization management field,” he says.

For several years, Cartwright worked as a director of utilization management/case management during the time when utilization management was beginning to evolve into case management.

“I always thought that something in my career was lacking, and that’s when I discovered the world of HIM and coding,” he says. “So I brushed up on my coding and sat for the CCS exam. Coding and clinical documentation improvement have always been my passion, so I was thrilled to begin a new chapter in my career.”

For the past 15 years, Cartwright has been involved in both coding consulting and coding management. He finds fulfillment in the management aspect because it gives him a chance to help people grow into their careers. “I feel a real pleasure in helping people with their careers and have always thought of myself as a sort of ‘career counselor,’” he notes.

One thing Cartwright looks forward to in the coming months is the implementation of ICD-10. “This is something that we have all needed for a long time,” he says. “So many other departments and agencies rely heavily on accurate and specific data and to me that has been the shortfall of ICD-9. I can remember as a director of case management being in need of detailed reports but could not get them due to lack of specificity. The implementation of ICD-10 is exciting.”

During his tenure at Kforce Healthcare, Cartwright has enjoyed the variety of job assignments, traveling, and meeting new people. “I have been very fortunate to have had the help of good people in my career beginnings,” he says. “Now I feel it’s my turn to reciprocate.”

Elizabeth Stewart, RHIA, CCS, CRCA
Vice President and Managing Partner of The Stewart Group, LLD
For Elizabeth Stewart, juggling multiple roles within the HIM field comes naturally—especially for someone who loves what she does.

Currently, Stewart is vice president and managing partner at The Stewart Group LLC, a private consulting firm specializing in HIM, patient access and financial services, compliance, and transcription management for hospitals, physicians, and clinics, among others. She is also the executive director of the South Carolina Health Information Management Association, managing nearly every aspect of the 1,200-member organization’s activities. Last but not least, she finds time to serve as clinical coordinator and adjunct faculty in the HIM program at Midlands Technical College. In other words, she’s entrenched in the industry.

“Each role found me, to be honest,” Stewart says. “In all three cases, the jobs started out as something else, evolving into more complex assignments with broader responsibility. Ultimately, it’s both an inner need for challenge, a strong drive from an early age to work in healthcare because you can help others, and the experience of spending good quality time in numerous management and leadership roles that makes me interested in taking on responsibilities in our field.”

It’s all part of an overall plan to help others. “That’s really the goal,” she says. “Can I help someone find a better way with a little guidance, some encouragement, setting a good example of doing the right thing even when that’s not always the easiest thing? If not, then I haven’t made them happy in the end. Did I use all of the resources available to me to get that person to what they needed? That’s my responsibility—returning in service what I have been fortunate enough to learn so that someone else can learn.”

The challenges and diversity of each role constantly push Stewart to think, transform, and manage. “I can teach but am constantly being taught, both from the professional and personal perspectives,” she says. “I love all the different intertwining parts of HIM and related entities. Working in various roles as I do now, I can switch off from being a manager to a legislative advocate to an educator and then use each of those roles in concert. It keeps me more current and relevant to the different perspectives in our field when I can touch them all.”

Evelyn Santos, CCS
Compliance Specialist at Duke University Health System
Learning her position from the ground up, Evelyn Santos, compliance specialist for the ancillary service at Duke University Health System, understands what it takes to embrace a role and turn it into a career.

After receiving her degree in communication arts from Oklahoma Baptist University, Santos began working at a local hospital as a medical records clerk, learning the basics of the department during her tenure. Since that time, she also worked as an inpatient/outpatient coder in New Jersey before assuming her position at Duke.

“After 10 years of being a coder, I accepted this position as compliance specialist and helped spearhead a new program on coding ancillary services for the hospital,” Santos says. Her role involves training new hires, managing the ancillary coders’ workflow, and being one of the go-to people for questions related to verifying hospital charges and coding. She also maintains constant communication with the different cost centers in the Duke system, addressing issues such as charge and documentation referrals, audits, and coordination of in-services.

“Problem solving and the different challenges my role entails was appealing to me since this was something the HIM department here has not done before,” Santos says. “The work that we provide as a group, even though we are not involved directly with patient care, is in a way patient care by getting the bills out correctly, compliantly, and in a timely manner.”

Santos equates her role to being in school, where it’s possible to learn something new every day.

“That keeps me on my toes—aside from working with such wonderful professionals in the HIM field,” she says. “The most rewarding part is when you try to do and make things right the first time, then this gets reflected in the overall efficiency of the system and customers are happy.”

Since she’s involved extensively in the coding process, HIM functions related to billing offer Santos a unique challenge. “Sure we code and verify the charges and go through the edits to make sure it is clean when it goes out the door, but there is a whole different world in billing since different insurance [companies] have their own rules,” she says.

As the HIM profession continues to grow in stature, Santos sees a bright and busy future. “Medicare rules change often and the Obama administration is now implementing healthcare reform, which means we need to have more education and understanding about these changes,” she says. “With ICD-10 being implemented in 2013, there is plenty of room to grow and migrate to different areas of the profession—the sky’s the limit.”

— Maura Keller is a Minneapolis-based writer and editor.