Economic Stimulus Package

Wednesday, January 28, 2009 — LATEST NEWS

Senate Panels OK Stimulus Bill; Health IT Revisions Made Yesterday, the Senate Appropriations and Finance committees approved portions of the economic stimulus package that include funds for health care. Prior to approval, the Senate Appropriations Committee made several revisions to the $5 billion health IT portion of the stimulus package. Meanwhile, the Senate Judiciary Committee heard testimony on health IT privacy. CongressDaily et al.

Obama Calls for All Americans To Have EHRs Within Five Years

Friday, January 9, 2009 - In a speech pushing his economic stimulus plan on Thursday, President-elect Barack Obama called for all U.S. residents to have electronic health records within five years, Health Data Management
reports.

Obama said, "To improve the quality of our health care while lowering its costs, we will make the immediate investments necessary to ensure that within five years, all of America's medical records are computerized." He added, "This will cut waste, eliminate red tape and reduce the need to repeat expensive medical tests. But it won't just save billions of dollars and thousands of jobs, it will save lives by reducing the deadly but preventable medical errors that pervade our health care system."

During his presidential campaign, Obama said he would allocate $50 billion over five years to support the adoption of standards-based health IT systems and a national health information network (Goedert, Health Data Management, 1/8).

The First Thanksgiving

In 1621, the Plymouth colonists and Wampanoag Indians shared an autumn harvest feast which is acknowledged today as one of the first Thanksgiving celebrations in the colonies. This harvest meal has become a symbol of cooperation and interaction between English colonists and Native Americans. Although this feast is considered by many to the very first Thanksgiving celebration, it was actually in keeping with a long tradition of celebrating the harvest and giving thanks for a successful bounty of crops. Native American groups throughout the Americas, including the Pueblo, Cherokee, Creek and many others organized harvest festivals, ceremonial dances, and other celebrations of thanks for centuries before the arrival of Europeans in North America.

Historians have also recorded other ceremonies of thanks among European settlers in North America, including British colonists in Berkeley Plantation, Virginia. At this site near the Charles River in December of 1619, a group of British settlers led by Captain John Woodlief knelt in prayer and pledged "Thanksgiving" to God for their healthy arrival after a long voyage across the Atlantic. This event has been acknowledged by some scholars and writers as the official first Thanksgiving among European settlers on record. Whether at Plymouth, Berkeley Plantation, or throughout the Americas, celebrations of thanks have held great meaning and importance over time. The legacy of thanks, and particularly of the feast, have survived the centuries as people throughout the United States gather family, friends, and enormous amounts of food for their yearly Thanksgiving meal.

What Was Actually on the Menu?
What foods topped the table at the first harvest feast? Historians aren't completely certain about the full bounty, but it's safe to say the pilgrims weren't gobbling up pumpkin pie or playing with their mashed potatoes. Following is a list of the foods that were available to the colonists at the time of the 1621 feast. However, the only two items that historians know for sure were on the menu are venison and wild fowl, which are mentioned in primary sources. The most detailed description of the "First Thanksgiving" comes from Edward Winslow from A Journal of the Pilgrims at Plymouth, in 1621:
"Our harvest being gotten in, our governor sent four men on fowling, that so we might after a special manner rejoice together after we had gathered the fruit of our labors. They four in one day killed as much fowl as, with a little help beside, served the company almost a week. At which time, among other recreations, we exercised our arms, many of the Indians coming amongst us, and among the rest their greatest king Massasoit, with some ninety men, whom for three days we entertained and feasted, and they went out and killed five deer, which they brought to the plantation and bestowed upon our governor, and upon the captain, and others. And although it be not always so plentiful as it was at this time with us, yet by the goodness of God, we are so far from want that we often wish you partakers of our plenty."

(Did you know that lobster, seal and swans were on the Pilgrims' menu? Learn more...)

Seventeenth Century Table Manners:
The pilgrims didn't use forks; they ate with spoons, knives, and their fingers. They wiped their hands on large cloth napkins which they also used to pick up hot morsels of food. Salt would have been on the table at the harvest feast, and people would have sprinkled it on their food. Pepper, however, was something that they used for cooking but wasn't available on the table.

In the seventeenth century, a person's social standing determined what he or she ate. The best food was placed next to the most important people. People didn't tend to sample everything that was on the table (as we do today), they just ate what was closest to them.

Serving in the seventeenth century was very different from serving today. People weren't served their meals individually. Foods were served onto the table and then people took the food from the table and ate it. All the servers had to do was move the food from the place where it was cooked onto the table.

Pilgrims didn't eat in courses as we do today. All of the different types of foods were placed on the table at the same time and people ate in any order they chose. Sometimes there were two courses, but each of them would contain both meat dishes, puddings, and sweets.

More Meat, Less Vegetables
Our modern Thanksgiving repast is centered around the turkey, but that certainly wasn't the case at the pilgrims's feasts. Their meals included many different meats. Vegetable dishes, one of the main components of our modern celebration, didn't really play a large part in the feast mentality of the seventeenth century. Depending on the time of year, many vegetables weren't available to the colonists.
The pilgrims probably didn't have pies or anything sweet at the harvest feast. They had brought some sugar with them on the Mayflower but by the time of the feast, the supply had dwindled. Also, they didn't have an oven so pies and cakes and breads were not possible at all. The food that was eaten at the harvest feast would have seemed fatty by 1990's standards, but it was probably more healthy for the pilgrims than it would be for people today. The colonists were more active and needed more protein. Heart attack was the least of their worries. They were more concerned about the plague and pox.

Surprisingly Spicy Cooking
People tend to think of English food at bland, but, in fact, the pilgrims used many spices, including cinnamon, ginger, nutmeg, pepper, and dried fruit, in sauces for meats. In the seventeenth century, cooks did not use proportions or talk about teaspoons and tablespoons. Instead, they just improvised. The best way to cook things in the seventeenth century was to roast them. Among the pilgrims, someone was assigned to sit for hours at a time and turn the spit to make sure the meat was evenly done.

Since the pilgrims and Wampanoag Indians had no refrigeration in the seventeenth century, they tended to dry a lot of their foods to preserve them. They dried Indian corn, hams, fish, and herbs.

Dinner for Breakfast: Pilgrim Meals:
The biggest meal of the day for the colonists was eaten at noon and it was called noonmeat or dinner. The housewives would spend part of their morning cooking that meal. Supper was a smaller meal that they had at the end of the day. Breakfast tended to be leftovers from the previous day's noonmeat.
In a pilgrim household, the adults sat down to eat and the children and servants waited on them. The foods that the colonists and Wampanoag Indians ate were very similar, but their eating patterns were different. While the colonists had set eating patterns—breakfast, dinner, and supper—the Wampanoags tended to eat when they were hungry and to have pots cooking throughout the day.

Source: Kathleen Curtin, Food Historian at Plimoth PlantationAll Photos Courtesy of Plimouth Plantation, Inc., Plymouth, Mass. USA. ca.

Historic Change
Brenda J. Hurley, CMT, AHDI-F
Florida Delegate

This is the morning after our national election and with the results now confirmed, no matter your political affiliation, we have all clearly witnessed historic change for our country. Whether your candidate won or lost, we all now must join together to contribute to the much-needed work that must be done for the success of our country.

I cannot help but consider how much historic change we have already witnessed within our own profession. For me, I have been in medical transcription for nearly 40 years, I have seen us go from the windowless basements in hospitals with only 1 or 2 old references and using equipment (typewriters) that was often handed down from other departments. Our job titles changed as well from the girls in the typing pool, typists, medical secretaries, transcribers, to medical transcriptionists. Few people knew who we were within the institutions where we worked and fewer knew that we even existed as reports just miraculously appeared on patient charts as if done by the stroke of magic.

Today, through change, things are different as we often work from our home offices using computers with Windows, we have enormous references available to us including the Internet, and our titles are continuing to evolve as some of our roles also evolve from medical transcriptionists to editors, to trainers, to educators, to consultants, to speech recognition editors, to documentation specialists, to perhaps even some yet determined as our profession continues to evolve and change.

With nearly 4 decades of tremendous change in our profession, there are still some things that have not changed all that much – dictators dictate, we analyze and interpret the dictation to transform it from speech to text, whether on paper or electronically, whether the complete report or only portions of the report, whether through a platform for report creation or through a web portal directly inputting within an electronic health record, we have adapted and continue to change as our role in healthcare documentation evolves.

Our association that represents this noble profession has also evolved to reflect these changes. We are no longer singularly defined as medical transcriptionists as some of us now work in areas that reflect the evolving roles within medical transcription but rather our single focus remains the integrity of the healthcare documentation – created through traditional transcription or through the use of other technologies (i.e., speech recognition, electronic templates, etc.).

Our association has not abandoned medical transcriptionists, it is leading us to prepare for the change that is coming (and where it has already arrived) as the technology that impacts us continues to evolve. Our roots in traditional medical transcription are essential to our ability to transition our skills to making this change, and the association is doing all it can (with limited resources) to give us educational opportunities to prepare us with new skills for new roles in healthcare documentation.

I truly understand the frustration that many medical transcriptionists feel about the profession. Just as so many things have changed over the last 40 years for our profession, some things have not changed nearly enough. We have been undervalued far too long for the importance of our role and contribution we make to quality healthcare documentation. We have not controlled the domain of medical transcription and report creation through the dictation process as others continue to set cumbersome rules or make decisions that negatively impact the ability for us to do our work efficiently and effectively. We continue to be squeezed economically to do more for less as our national healthcare costs escalate and the emphasis on patient safety diminishes.

So how do you propose we make change? Some have suggested that they will leave their careers to go to other jobs. Some have stayed on but have chosen instead to be bitter and complain to anyone willing to listen about the injustices they are subjected to in this field of medical transcription. In the words of Dr. Phil, “How is that working for you?” Leaving a profession that you love, staying bitter and angry only to complain to anyone or everyone who tries to make a change – does that really work for you, does that really work for the greater good of our profession? Those are questions only you can answer.

Have we not seen in this recent historic election that people can and indeed do have the ability to evoke change! There has never been a better time to join together to speak out in a collective voice that change is needed. That collective voice is through the Association for Healthcare Documentation Integrity (AHDI), the organization that advocates for all of us! Just imagine the change we could impact if our membership was 30,000 or more, instead of 7,000. Our association represents our interests in standards-development organizations, with our legislators, the U.S. Department of Labor, through alliances with our organizations (i.e. AHIMA, MTIA, HCCA, etc.), and in numerous other places – giving us a mechanism and a voice for change in the evolving world of healthcare documentation.

Ask yourself, if AHDI wasn’t there for us, who would be? If AHDI was not representing us within these entities, who would be?

If you think that your single membership does not matter – it does. Just as individuals contributed to change in this historic election through their financial contributions, through their volunteering to work for change and by coming together they were rewarded with success.

I cannot guarantee you that with your membership it will make all of our plans and goals successful, but without you and your contribution to our association, I can guarantee that it will be more difficult to achieve our success.

During this historic election we have witnessed that when people come together they can make change; clearly that message is the same for all of us who have shared in the career of medical transcription, it is time to come together to make change.

Join AHDI, join your local chapter, if you live in an area that has no local component association then join the Online Association. Join me and other committed volunteers by getting involved, if only for an hour a month or more, we need all contributions, as collectively we can make history!