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

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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.

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There are always people who stand out. Who go the extra mile even without being asked. Who stay late to comfort a patient family. Who have a passion for the mission and give their all to ever part of their job. Texas Children’s is full of these employees. That’s what makes us such a special place to work and the best place to receive care.

West Campus leadership is looking for those people amongst us. They’re developing a plan to recognize and honor those individuals who excel in exhibiting the characteristics outlined in the Texas Children’s Hospital Guiding Principles, demonstrate excellent customer service attributes, and deliver the finest possible work to our patients and their families.

As West Campus continues to grow, it is very important to recognize employees who work diligently each day to provide that WOW! customer service experience, treats everyone they meet with courtesy and respect, and always exhibits trustworthiness in all aspects of their job.

This new award will be named “Best of the West” and will be presented quarterly to a deserving West Campus employee, contractor or provider.

Read the criteria and fill out the nomination form now!

You may fill out the electronic form online and submit it, or you may place paper nominations in one of five (5) ballot boxes located around the campus. Ballot boxes are located in the Human Resources suite, within the third-floor Chapel lobby area, outside the entrance to DOTS Kitchen, within the Main Lobby, and in the second-floor corridor nearest the Emergency Center entry area.

Recipients of the “Best of the West” award will receive:

1. Use of specialized parking spot for the quarter
2. A paver stone with their name inscribed on it installed on the West Campus grounds
3. Their picture and biography on the monitor mounted outside of the Conference Center leading to DOTS Kitchen, and
4. Coupons for a free meal at DOTS Kitchen and a free drink from The Coffee Spot.

This is an opportunity to recognize the dedication of the entire team that is making Texas Children’s Hospital West Campus the very “Best of the West!”

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An article in the March 3 edition of Time magazine titled “Young Kids, Old Bodies,” raises the issue of obese children aging too quickly, and the dramatic health decline some are seeing as a result.

Dr. Siripoom McKay, a professor of pediatric endocrinology at Texas Children’s, and Dr. Sanjiv Harpavat, a pediatric gastroenterologist at Texas Children’s, were both quoted in the article, after noting the many health issues plaguing (and aging) this generation’s obese children.

“I am thinking that we will have people in their 30s, 40s and 50s who should be at their most productive,” said McKay, “who will be on dialysis or have had several heart attacks.”

Researchers are starting to see signs of accelerated cellular aging at the molecular level in obese children. The extra pounds on children can affect the body in multiple ways, including early signs of puberty, high cholesterol, diabetes, hypertension, fatty liver and cirrhosis.

In order to combat the problems, many doctors are prescribing medications that were originally only intended for adults (typically over the age of 40). Unfortunately, these drugs can present side effects in children such as stomach pains, muscle weakness and fatigue. But without the medication, some children may face worse alternatives such as heart attacks or liver transplants.

Hoping to stop (or at least slow down) one obese patient’s liver decline, Dr. Harpavat has plans to put the boy on a drug trial that’s testing whether cystamine can improve the symptoms of fatty liver. If it works, the patient may be saved from an early downward spiral in his health.

Top gastroenterologists, endocrinologists and other specialists at Texas Children’s are constantly researching improved ways to treat symptoms of child obesity and fight the signs of premature aging in this generation’s obese boys and girls. But for now, beyond medications, lifestyle strategies like a healthier diet and more exercise are still among the best ways to improve health in obese children.

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When my husband Matt and I found out we were pregnant with our daughter Finnley, we both knew we wanted to use a midwife instead of an OB. A midwife is different than an OB in the sense that they usually have a more natural/holistic approach to care. While they are trained to deliver babies, they usually care for women with a normal, non high risk pregnancy. For example, instead of going to drugs to help progress labor, they are more likely to suggest things like walking, using a yoga ball, and changing position. An OB may start with Pitocin, or have a more technical approach to care. Midwives are just as capable to assess a pregnant woman, diagnose problems, and remedy them as needed, but will transfer care to an OB if the patient becomes high risk. We chose a midwife because I knew that I wanted to have a natural delivery without any medications and I wanted our baby to come when she wanted to, without anything speeding her along. My husband and I believed that with a midwife, the birth that we wanted was more likely to happen.

After doing tons of research we decided to use the midwife group from the Women’s Specialists of Houston. Luckily for us, they are housed here at the Pavilion! The group consists of six Certified Nurse Midwives, meaning they are Advanced Practice Nurses that are certified by the American Midwifery Certification Board. Not only has the group been around since 1994, they work in collaboration with the physicians in the practice, just in case you need a higher level of care. The midwives are on-call 24/7, just like the doctors, and do all prenatal visits themselves (they also provide well-woman, family planning and post-partum care).

One of my favorite things about the midwife group was that at each visit you see a different midwife. This was especially important to me and my husband because there was no way to know who would be on-call when we went into labor. I couldn’t fathom getting to the hospital and finding out the doctor on-call was someone I had never met. Because of this practice, I knew each midwife personally, formed a relationship with and trusted each one. I knew that whoever was on-call would be someone that had been a part of my care from the very beginning and I trusted my life and most importantly, my child’s life in their hands.

There are a few questions I get asked all the time by people that aren’t familiar, or even know you have a choice, when using a midwife.

  • Don’t all midwives do home births?

No, some midwives work in hospitals and birthing centers, there are some that only do home births though, if that’s what you’re interested in!

  • What if you had to have a C-Section?

Thankfully I didn’t, but if there was an emergency that could only be handled by an OB, there is always an on-call physician present in the Pavilion in the event a problem arises that isn’t under the scope of practice of the midwife.

  • Does having a midwife mean you can’t get any pain medication?

No! I chose to go the drug-free route and was so proud of myself for having a pain medication free childbirth. But, having a midwife doesn’t mean you have to do that. You can still get an epidural, or the pain medication of choice. Having a midwife doesn’t prevent you from having the birth you have planned. They are there to help, support and give you what you need on one of the most exciting days of your life!

If you are considering using a midwife in the future, I would suggest sitting down with your partner and discussing what sort of childbirth you imagine and ask yourself some questions. Do you want to attempt a drug free birth? Do you imagine yourself trying alternative methods for pain management such as being in the bath or shower, massage, aromatherapy oils and changing position? Do you want to have some freedom in your labor by having the option of moving around? Or, would not having an OB cause you anxiety? Feeling comfortable and confident in your decision is extremely important, so take your time, do your research and follow your gut!

Using the Midwife Group at the Women’s Specialists of Houston was one of the best decisions I made during my pregnancy (besides having a Doula, but that is another story for another time).

Now that Matt and I are expecting baby Curie #2 (SURPRISE!), I am so excited to be using the midwives again. I know we will get the time and care that we need to grow and thrive. I am so thankful for what they do every day and thankful that Texas Children’s Pavilion for Women gives those like me the opportunity to have the pregnancy and birth that we want, even if it is a little unconventional.

Read Bump Watch next week to see one mother’s experience through a videotaped midwife delivery.

The Virani family is donating $2 million to Texas Children’s Cancer Center to establish and support research efforts at the Faris D. Virani Ewing’s Sarcoma Research Center, located on the 10th floor of Texas Children’s Hospital’s Feigin Center. The gift honors their 8 year old son Faris Virani’s battle with Ewing’s sarcoma, a rare disease in which cancer cells are found in the bone or soft tissue. Diagnosed in January 2013, Faris is still in treatment but does not have any active disease.

The research efforts will aim to develop better diagnostic and therapeutic approaches and for a cure to become a reality for children with Ewing’s sarcoma. At a ceremony celebrating the new center, Faris presented pediatric oncologist, Dr. Jason Yustein, with a piggy bank containing the first gift towards the new research center.

Ewing’s sarcoma is the second most common bone tumor in childhood and one of the most prevalent pediatric tumors. Over the past 30-40 years because of the lack of understanding of the biology of Ewing’s sarcoma, only marginal advancements have been made in the care and management of patients with this disease. In order to develop better diagnostic and therapeutic approaches and a cure for Ewing’s sarcoma, more research need to be conducted so that efforts can be focused on improving treatment approaches.

Unfortunately, many patients with Ewing’s sarcoma experience metastatic disease that spreads to multiple sites in their body and a significant portion of patients that do respond to therapy eventually relapse. In the last 15 years, only one new chemotherapeutic agent has been introduced to the treatment regimen for patients with this disease and currently treatments are extremely intensive and may have both short and long term effects that can negatively impact lifestyle and quality of life for these patients.

February 25, 2014

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Finding herself awake in the middle of the night, Jenni Stearman, a NICU nurse at Texas Children’s Newborn Center, began scrolling through posts on Facebook before stopping at one that struck a chord in her heart.

It was a touching update from a NICU parent expressing appreciation for everything the NICU nurses do, and it inspired Stearman to return the compliment by conveying her appreciation and empathy for NICU parents.

“I guess I was just a little bit emotional and I read the post and it was just really inspiring. It was too late to call anyone and talk about my feelings, so I typed,” said Stearman.

Although she was home, off-duty, and had a lot going on in her personal life with an upcoming move, wedding and honeymoon, Stearman took some time to reflect on the rewarding experience of getting to know so many loving families in the NICU at Texas Children’s. In her late-night Facebook post, Stearman recounted the journey and struggle of a NICU parent.

“You are in a situation that you didn’t plan on being in and everything that you did plan is now unobtainable. You feel completely out of control of the situation around you. You are dependent on others to do what you so dearly long to be able to do for your own child. Everything that you would normally do to comfort and care for your baby has been taken away from you. I’m here to tell you, I understand your pain and I appreciate you,” she wrote.

She continued by sympathizing with them and expressing gratitude for all that they do to make her job and life even better.

“You trust me with your most valued possession. You learn to trust my instincts and I yours. We become a team with one common goal in mind and that is to get your child home with you as quickly as possible and as healthy as possible. Thank you for that trust. You become my “friends” while we spend 36hrs/week together. After months of this, we have shared more conversation than I have with some of closest friends. We have shared times of pain and times of joy. We have cried together and we have shared laughter. In some cases we share bonds that will extend far beyond the NICU. Thank you for being my friend.”

And finally, she thanked them for staying in touch and giving her hope during tough times.

“The NICU can be a depressing place (as you know). Your updates help us keep faith that all we do is for a very good reason,” she wrote.

Stearman tagged some of the NICU parents she knew in the post, and by morning, many people had forwarded it on and reached out to tell her how much it meant. The post gained so much momentum that the Huffington Post decided to publish it as an op-ed health piece on their national site, highlighting how much our NICU nurses care about the patients and families at Texas Children’s. The post has generated thousands of social media “likes” and shares.

“I wrote it for the NICU moms so I was happy to hear they were sharing it,” said Stearman. I’m really, really happy that people loved it and felt inspired by it.”