March 11, 2014


The Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital (BIPAI) recently announced its partnership with Chevron and the global health nonprofit AmeriCares by accepting a grant to address the gap in health care resources in Romania.

AmeriCares has been providing lifesaving anti-retroviral medications, anti-infectives and nutritional supplements to families receiving care at BIPAI’s Romanian NGO affiliate, the Baylor College of Medicine Black Sea Foundation, since 2004. Now, Chevron Romania has made a multi-year commitment to increase the availability of medications and medical supplies at selected public and private hospitals in Romania through AmeriCares and the Baylor College of Medicine Black Sea Foundation.

According to Michael Mizwa, chief operating officer of BIPAI, the partnership will provide support for our global health initiatives, specifically for care, treatment and capacity building in Romania. Funds will be allotted to help bolster our inventory of medical and pharmaceutical supplies to specific hospitals and clinics serving disenfranchised populations in Romania.

Since being founded in 1996 by Dr. Mark W. Kline, BIPAI has grown into a network of state-of-the-art clinical centers in Romania and across southern and East Africa. BIPAI-affiliated organizations provide care and treatment to more than 180,000 HIV-infected children and their family members, which is believed to be more than any other program in the world. BIPAI is now part of Texas Children’s overall global health initiative, which includes the largest collection of pediatricians and pediatric specialists in the world.

With the new Chevron partnership, BIPAI and AmeriCares will expand the donation of medication and medical supplies to a network of qualified health care institutions across Romania, by increasing BIPAI-Romania’s capacity to manage larger quantities of donations on behalf of its own clinical center as well as additional health care institutions with identified resource needs throughout Romania.

“Our partnership with Chevron will take our humanitarian partnership to a higher level of expanded outreach across Romania,” said Tammy Allen, director of AmeriCares programs in Asia and Eurasia.

To date, AmeriCares has supported BIPAI-Romania’s health care programs with gift-in-kind donations valued at $41 million.


When the American Medical Association (AMA) petitioned the government on February 12 to delay the start of ICD-10 many wondered what would happen. What will happen at Texas Children’s is pretty clear – the conversion to ICD-10 will go live October 1.

“Here at Texas Children’s, we started working on this process more than a year ago,” said Myra Davis, senior vice president of Information Services. “We’re making the necessary changes to our systems, as well as implementing an education program for providers and coding staff that will make the transition as smooth as possible.”

On October 1, Texas Children’s and health care organizations nationwide will transition to ICD-10, the coding system used to report and code diagnoses, injuries, impairments and other health problems and their manifestations. It will replace ICD-9, the current coding system used at Texas Children’s.

Everyone has acknowledged that implementing a new coding system won’t be easy. In fact, the AMA estimates that even small physician practices can expect to spend between $57,000 and $226,000 to get ready for the change. But everyone agrees that the result will be better data for providers, patients and researchers.

While the AMA continues to seek a repeal of ICD-10, it nonetheless remains a federal mandate and physicians are urged to prepare for the October 1, 2014 compliance deadline.

On February 27, the head of the Centers for Medicare and Medicaid Services (CMS) said that nothing has changed with the ICD-10 deadline. Marilyn Tavenners spoke to a group of IT professionals at a national conference when she made that announcement.

“There are no more delays, and the system will go live on October 1,” Tavenner said. “We’ve delayed this several times, and it’s time to move on.”

A quick timeline

In 2008, the U.S. government agreed that America should join with other nations in implementing ICD-10. They originally set October 1, 2013, as the deadline, but that was extended to 2014. The new codes will impact the hospital’s electronic medical record (EMR) and affect codes for both diagnoses and procedures. All told, the number of diagnosis codes will increase from 14,000 to 69,000, while the number of procedure codes will grow from 14,000 to 71,000.

The last time the U.S. changed its national coding system was in 1979. That’s when hospitals and providers moved from ICD-8 to ICD-9. People who favor the next move to ICD-10 point out that when ICD-9 first was implemented, people still could smoke in hospitals.

“Medicine has evolved so much, it only makes sense to update our systems,” Davis said. “Think of how many new treatments have been developed in the last 25 years. The old code set wasn’t designed to capture those innovations, while the new code set better describes what’s happening in medicine today.”

In the end, Texas Children’s is committed to meeting the October 1 deadline to implement ICD-10, no matter what the chatter is in the industry.

For more information
ICD-10 Fact Sheet
ICD-10 Industry Updates
ICD-10 Myths and Facts


March 12 is Registered Dietitians Day, a day established by the Academy of Nutrition and Dietetics to increase the awareness of the registered dietitian as the most valuable and credible source of scientifically based food and nutrition information and to recognize them for their commitment to helping people enjoy healthy lives. Texas Children’s salutes its many dietitians and diet technicians as they impact the lives of patients throughout its system. The dietitians are clinicians, administrators, educators and researchers providing services in the hospitals, clinics, research facilities and community centers. They also are helping to promote the reputation and expertise of Texas Children’s with exciting accomplishments in the field of nutrition.

Here are a few of the highlights from 2013:

  • Kristi King, senior clinical dietitian, was named media spokesperson for the Academy of Nutrition and Dietetics and was interviewed for many local and national media.
  • The Academy’s of Nutrition and Dietetics Food and Nutrition Conference and Expo was hosted for the first time in Houston. Texas Children’s dietitians were the host of two Pre-FNCE events that spotlighted Texas Children’s Simulation Center and Pavilion for Women. The Texas Children’s Eating Disorders program and its clinical nutrition staff members also were key speakers at another FNCE event along with seven poster presentations and one conference presentation. Texas Children’s had an impactful presence in the home town national conference.
  • The 10th edition of the Pediatric Nutrition Reference Guide, which is internationally renown, was published. This year marked the first electronic version of the book as it became an ebook available through Amazon.

Texas Children’s acknowledges the many contributions of its nutrition team and the impact they have on the many programs and medical services at Texas Children’s.


By Titi Otunla, Certified Nurse Midwife

Becoming a midwife was part calling and part admiration for the midwives I witnessed growing up in England. I knew I wanted to assist women with health decisions and especially be involved in one of life’s most transformative experiences – childbirth.

The midwifery philosophy acknowledges pregnancy and birth as normal physiological events in a woman’s life. When a woman chooses our practice and comes to the hospital for the birth, she will have a midwife with her throughout labor. Midwifery guidance and support ensures that labor and the birth progress is undisturbed. Midwives believe in being with women, assisting them to have the birth they desire. We teach and strongly encourage women to practice the mind-body connection, which helps prepare them for a satisfying birth.

At Texas Children’s Pavilion for Women, our team of six Certified Nurse Midwives practices with The Women’s Specialists of Houston. Our patients choose to birth with a midwife and have comfort in knowing that if their pregnancy becomes high-risk they can be referred to physicians within the group. The hospital has an intimate and soothing environment but in the event emergency care is needed, women are assured that they are in a state-of-the-art facility with world-class expertise readily available.

About Titi Otunla: Titi a Certified Nurse Midwife with the Women’s Specialists of Houston at Texas Women’s Pavilion for Women. She’s been a midwife for 27 years and believes that a positive birth experience is important for all women.


Texas Children’s Advance Practice Providers hosted their first International Conference recently. It was a huge success with more than 130 attendees from across the world. The conference started with two days of pre-conference seminars focusing on pharmacology, skills labs and palliative care. The main conference included attendees and speakers from across the nation to equip advance practice providers with acute and subspecialty care knowledge, as well as to connect with experts for collaboration.

The mission of the Texas Children’s Hospital Advanced Practice Provider Conference (TCHAPP) was to empower advanced practice registered nurses (APRNs) and physician assistants (PAs) through state of the art education, training, innovation, collaboration and professional development. The conference curriculum was diverse and allowed attendees to tailor their learning experience to their own unique practice needs.

March 4, 2014

3514icd10640Most people receiving care probably assume their medical records include details like whether their condition is acute or chronic, how their illness is progressing or, at a minimum, which side of the body an injury may have occurred.

Believe it or not, there has not been a standard way to document basic information like this in patients’ medical records across the U.S. The new coding system – ICD-10 – will change that.

On October 1, Texas Children’s and healthcare organizations nationwide will transition to ICD-10, the coding system used to report and code diagnoses, injuries, impairments and other health problems and their manifestations. It will replace ICD-9, the current coding system used at Texas Children’s.

Why make the change?

In 2009 the U.S. Dept. of Health and Human Services formally adopted ICD-10 as America’s new national coding system and set October 1, 2014 as the deadline for facilities and providers to implement the new system.

ICD-10 is important because a patient’s record is a legal document. It notes exactly what care a patient has received, when they received it, why they received it and treatment plans going forward.

Before, a record could show that a patient had uncontrolled diabetes but had no additional documentation. Now, with the increased specificity of ICD-10, the record will show whether the diabetes was caused by an underlying medical condition or whether it was triggered by an external factor, like medication or chemicals. The new codes specifically ask for the type, any complications and the manifestations of a certain diagnosis.

“It’s all about improving the documentation of the care a patient receives,” said Texas Children’s Chief Safety Officer Dr. Joan Shook. “It’s critical because it can improve the quality of care. It ensures our compliance with CMS (the office responsible for Medicare and Medicaid) regulations, and it affects the hospital’s revenue.”

Know the two parts of ICD-10

There are two types of ICD-10 coding: ICD-10-CM, which means “clinical modification” and refers to diagnosis coding. The other is ICD-10-PCS, which stands for procedure coding system and refers to coding for inpatient hospital procedures. Both will be implemented at Texas Children’s on October 1.

How Texas Children’s physicians are preparing

Because ICD-10 will change the hospital’s Epic system, which is our electronic medical record (EMR), members of the hospital’s Epic support team have been meeting with physicians since November to determine the best way to refine it. Physicians will participate in “clinical documentation assessments” to determine what tools need to be refined or added to Epic to make it ICD-10-ready.

The hospital has partnered with Baylor College of Medicine to provide e-learning videos for the doctors about ICD-10. Each specialist will take three to four e-learning courses this summer, along with an e-learning course on Epic.

Throughout the process, a team of ICD-10 physician champions will serve as liaisons to the medical staff. Each specialty also has its own Epic physician liaison should they have any questions or comments.

How others at Texas Children’s are preparing

The coding staff is attending “boot camps” to learn the ins and outs of the new system.

Additionally, the hospital has been educating providers’ offices through the Texas Children’s Health Plan newsletter since last year.

How the rest of us can prepare

Even if you do not work in a role where you have to document or understand documentation codes, you should understand, in general, what’s happening and how it may impact your own medical record documentation. The best thing you can do in the months ahead is learn as much as you can about ICD-10. Below are links to a quick fact sheet and helpful sites with basic information.

For more information

ICD-10 Fact Sheet
ICD-10 Industry Updates
ICD-10 Myths and Facts


Since 2008 more than 500 Texas Children’s Hospital patients with cancer and other life-limiting disorders have been photographed by Flashes of Hope. The non-profit organization hopes to change the way children with cancer see themselves and it’s doing just that here at Texas Children’s. Now those photographs will be displayed for hundreds of people who visit this year’s Fotofest at The Health Museum.

“We want to document this time together as a family,” said co-founder of the Houston chapter, Amy Spelman.

Professional photographers come to the hospital for the photo shoots and capture smiles to preserve the courage, beauty and dignity of the difficult time in each family’s life. The photographs take focus off of the sickness and bring light to the strength and beauty of a child filled with hope. It’s a chance for the kids to see themselves through a different lens.

In 2001 the parents of a child with cancer started the organization which has now grown to 55 cities across the country including Houston. The photographs are given completely free to the families. The mission, “Flashes of Hope raises funds to accelerate a cure for children’s cancer while honoring the unique life and memories of every child fighting cancer.”

The Fotofest reception on Thursday, March 6, is free and open to everyone. It’s a chance for families and caregivers of patients to come see the photographs. Spelman said there have been instances when the family of a deceased child comes to honor their memory as they view the photos on display.

“I hope they get to see something in their child’s face that maybe they’ve never seen before,” said Spelman.

Perhaps a rare smile captured in a photograph which had been hiding during treatments; a moment in time that will stay with the families and caregivers forever through photos.

The photos will remain on display at The Health Museum until Tuesday, May 6.