March 18, 2014

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Texas Children’s Hospital has established a new, first-of-its-kind Pediatric Surgery Physician Assistant Fellowship program. The inaugural class of four physician assistants – Lesley Davies, Jackie Guarino, Caitlin Justus and Cassie Mueller – officially started their fellowship on January 20.

The fellowship is a 12-month didactic and clinical program designed to extensively train physician assistants to become leaders in all areas of pediatric surgery.

The fellows’ two-week orientation period has featured training sessions, discussions about patient satisfaction, quality outcomes, research and child abuse awareness and special meetings with Mark A. Wallace, president and CEO, Charles D. Fraser, surgeon-in-chief, and the surgical faculty, among others.

On February 3, the fellows started their month-long rotations through each of the full spectrum of pediatric surgical subspecialties including: cardiovascular surgery, neurosurgery, orthopedics, general surgery, urology, otolaryngology, plastic and craniofacial surgery, as well as trauma services. After completing nine rotations, the fellows will have the opportunity to select the one area they want to focus on and will receive two additional months of training in that field.

In addition, the fellows will complete one month of research and participate in multiple community outreach projects, including career fairs at schools, wellness fairs and community service programs, such as Habitat for Humanity.

Leading the program is Dr. Larry Hollier, chief of plastic surgery at Texas Children’s Hospital and medical director of the fellowship program, Ryan Krasnosky, program director, and Brenda J. Davis, fellowship coordinator.

Lesley Warriner Davies, MPAS, PA-C:
Lesley is excited to be team leader of the first class of Pediatric Surgery Physician Assistant Fellowship program. She received her B.F.A in Ballet Pedagogy from the University of Oklahoma in 2006 and danced professionally in Dallas and Austin. She then obtained her Master’s degree in Physician Assistant Studies from the University of Texas Medical Branch at Galveston in 2013. Lesley is from the Houston area and currently lives in Dickinson with her husband where they enjoy cycling and spending time with family and friends. She is a member of the Texas Academy of Physician Assistants and the American Academy of Physician Assistants.

Jackie Guarino, MPAS, PA-C:
Jackie is a fourth generation Houstonian and a 2009 Summa Cum Laude graduate of the University of Houston. She completed her B.S. in Allied Health in three years and obtained her Master’s degree in Physician Assistant Studies from Baylor College of Medicine (BCM) in 2013. During her clinical years at BCM, Jackie rotated through Texas Children’s Hospital in General Surgery and GI/Liver service and is excited to be back as a member of the first class of the Pediatric Surgery Physician Assistant Fellowship program. Jackie currently resides in Houston and enjoys spending time with her large family and friends and her chocolate and yellow lab dogs, cooking, Crossfit and volunteering.

Caitlin Justus, MPAS, PA-C:
Caitlin graduated from Texas A&M University at College Station in 2011 with a B.S. in Allied Health, graduating cum laude. She received her Master’s degree in Physician Assistant Studies from the University of Texas Medical Branch at Galveston in 2013. She is a member of the American Academy of Physician Assistants and the Texas Academy of Physician Assistants. Caitlin currently resides in West Houston with her husband and enjoys activities with her church, exercising, reading and serving others. She is a proud member of the first class of the Pediatric Surgery Physician Assistant Fellowship program and looks forward to an exciting year ahead.

Cassandra Mueller, MPAS, PA-C:
Cassie is originally from Andover, Minnesota, and received her B.A. in physiology from the University of Minnesota in 2010. Cassie graduated from the Interservice Physician Assistant Program of Fort Sam Houston in 2013 (the U.S. Military’s Physician Assistant Program). She continues to serve in the Minnesota National Guard as a physician assistant and enjoys running marathons. She is excited about the opportunity to be in the first Pediatric Surgery Physician Assistant Fellowship program and looks forward to becoming a Texan.

March 11, 2014

ICD10a

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 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

February 18, 2014

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On February 7, West Campus was awarded the top honor at the Houston West Chamber of Commerce’s 16th Annual Economic Development Summit and Star Awards. Michelle Riley-Brown, president of West Campus, accepted the 2014 Pillar Award which recognizes a business or organization that consistently and tirelessly supports the business community, exemplifies the determined spirit of the Houston West Chamber and promotes a superior quality of life in our community.

“I was truly honored and humbled to receive the highest award on behalf of Texas Children’s Hospital West Campus,” said Riley-Brown. “We have grown tremendously since we opened our doors three years ago, and we look forward to continuing to treat children and families in the West Houston community.”

The Pillar Award is voted on by the Star Award Events Committee. West Campus also served as a sponsor of the event.

Watch a video about West Campus.

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Dr. Daniel Penny, chief of Cardiology and section head and professor of Pediatrics-Cardiology at Baylor College of Medicine, will present the 12th Annual William J. Rashkind Memorial Lecture in Pediatric Cardiology at Cardiology 2014, the 17th Annual Update on Pediatric and Congenital Cardiovascular Disease. The conference, hosted by the Children’s Hospital of Philadelphia, will take place in Lake Buena Vista, Florida February 19 through 23.

“I am honored to be delivering the keynote address at this year’s Cardiology conference,” says Penny. “This is a great opportunity to showcase the cutting edge techniques and thought leadership we practice at Texas Children’s Heart Center.”

Cardiology 2014 is a comprehensive post-graduate course for pediatric cardiologists, neonatologists, surgeons, nurses, intensivists, anesthesiologists, sonographers, perfusionists and all those involved in the care of neonates, children and young adults with cardiovascular disease. This year’s theme is “Innovations: What We Know. What We Need to Learn. Where We Need to Be.” Penny’s speech, The Quest for the Ultimate Team, will discuss the importance of assembling a comprehensive team of specialists and experts to deliver the best possible care to pediatric cardiology patients.

In addition to the keynote address, Penny also will serve as a panelist during a discussion about the management of aortic valve disease and represent Team Houston during a quiz bowl which will test his knowledge against experts in the field from around the United States. Other Texas Children’s Heart Center experts who will be giving presentations or attending the conference include:

  • Dr. Carrie Altman, medical director of Pediatric Cardiology at Texas Children’s and associate professor of Pediatrics at Baylor.
  • Dr. Paul Checchia, medical director of the Cardiovascular Intensive Care Unit at Texas Children’s and professor of Critical Care Medicine at Baylor, will present: Maximizing Success in the Coming Age of Values-driven Healthcare: Turning Things Upside Down to Get Them Right Side Up and will also represent Team Houston during the quiz bowl.
  • Dr. Silvana Lawrence, medical director, community and program development at Texas Children’s and associate professor of Pediatrics-Cardiology at Baylor.
  • Dr. Keila Lopez, pediatric cardiologist at Texas Children’s and assistant professor of Pediatrics at Baylor.
  • Dr. Kristen Sexson Tejtel, pediatric cardiologist, Center for Preventive Cardiology at Texas Children’s and assistant professor of Pediatrics-Cardiology at Baylor.

Visit the conference’s website for more information on Cardiology 2014.

A new eight-bed Pediatric Intensive Care Unit at West Campus is now open. The unit will allow the hospital to accommodate patients with higher acuity and meet the needs of the community. The PICU will be staffed 24/7 with experience, board-certified critical care physicians, PICU nurses and support staff.

“We want to provide a higher level of care here at West Campus after seeing the needs of the community,” said Shannon McCord, director of West Campus Patient Care Services. “This allows even more patients to receive their care closer to home.”

West Campus is now able to care for patients with conditions including but not limited to:

  • Asthma
  • Diabetes
  • Meningitis
  • Respiratory failure
  • Seizures
  • Shock

And neonates (<30 days) diagnosed with:

  • ALTE
  • Bronchiolitis
  • Hyperbilirubinemia
  • Suspected sepsis

Patients in need of care that is outside of the scope of care for West Campus will still be transported to Main, but this new expansion will impact the ability of the West Campus facility to do more surgical procedures and admit more patients from the Emergency Center who before were triaged to Main Campus.

The results are in! The units below will receive a special prize for having the highest number of surveys completed but it’s not too late to join these teams. The survey deadline has been extended to Friday to make sure everyone has a chance to participate and let us know how we’re doing in patient and family centeredness.

Congrats to these units who had the highest survey participation so far:

Main: Emergency Center and Cancer Center Clinic
West: Emergency Center and PM&R
Pavilion: Outpatient Obstetrics

Patients and families are the lifeblood of our organization. We want to hear your thoughts on how well we provide family centeredness in our patient care areas across the system.

To better understand best practices related to family centered care we have partnered with Institute for Patient and Family Centered Care (IPFCC), an organization dedicated to “advancing the understanding and practice of patient- and family-centered care in all settings where individuals and families receive health care.”

Below is a survey developed by the IPFCC, designed to help us better understand where we excel and still have growth related to family centered care system-wide. Please take 5 minutes to fill out this survey, providing your personal thoughts about family centered care in your patient care area. Families are an important piece of the nursing strategic plan, and your feedback will help ensure that any improvement effort we commence aligns with our needs.

https://www.surveymonkey.com/s/TRQVJ2L

Our goal is to have EVERYONE and ANYONE that works or provides care on any patient care unit to fill out this survey (inpatient, outpatient, EC, Pediatrics, Health Centers etc.) This is an anonymous survey and is asking for your personal opinion! Please complete by Friday, February 21.