Building an HIE with minimal IT or know-how

The Western Washington Rural Health Care Collaborative (WWRHCC) has a formidable challenge. The nonprofit health network comprising 10 critical access hospitals (CAHs) serves some 288,000 residents who for the most part are elderly and uninsured, underinsured, or are Medicare/Medicaid beneficiaries.

Access to specialists such as orthopedic doctors or cardiologists is difficult for a population living in an isolated and underfunded region, said Andrea Perkins-Peppers, HIM/IT director for Forks Community Hospital. “Being a collaborative, that is something that we’ve been able to provide more easily and with less travel,” she said.

In 2007, WWRHCC received a $1.4 million FLEX CAH Health IT grant, which required the health network to enable connectivity between three of its CAHs and each of their respective rural health clinics to share pharmacy information. The health network was looking for a vendor that could deliver an interface to essentially create one system out of the three disparate systems at the hospitals. WWRHCC was also focused on only having one system for the pharmacists to learn.

After an RFP was released, WWRHCC held a one-day vendor fair and oversaw demonstrations by 10 vendors. Perkins-Peppers said that the selection of Orion Health was based on the vendor’s "impressive" portal, its clear understanding of what the health network wanted and its honesty in what was possible and what was not.

Orion Health built the platform at the first hospital and trained the IT staff there. The IT staff was then tasked with bringing that knowledge to the other hospitals that desired inclusion in the project. "That was the ideal," she said. Once the three hospitals were chosen, however, one hospital dropped out and another took its place. Five IT staff members from two hospitals that were not involved in the implementation were tapped to help, but eventually couldn't commit their time. "The biggest challenge was the staff time," Perkins-Peppers said. With the high turnover of IT staff and time limitations, the health network relied on Orion Health to provide those resources.

The FLEX CAH Health IT grant also allowed WWRHCC to share information for trauma patients with a large tertiary hospital, which the health network has successfully done with Seattle-based Harborview Medical Center. Now physicians at Harborview's emergency department can access information for trauma patients that are en route to their facility. WWRHCC can scan handwritten notes and send them electronically to the ED physicians.

The connectivity is still in the early stages. While at first encountering physician resistance, buy-in was achieved when physicians were able to sign in and get the information they needed all in one place, she said. When the telepharmacy project began, pharmacists were brought to the table early on for their input. "At the close of the [pharmacy] project, we found that we had a health information exchange," she said. "We came at it backwards." Perkins-Peppers said if WWRHCC were to do the project over again, the health network would have approached the physicians in the beginning, announced that they were building an HIE and then gotten physician acceptance by engaging them in the process at the start. Regardless, she said, "I also believe we can get physician buy-in now by meeting with those groups and showing them what we have."

WWRHCC will be engaged in a public outreach and education program within the next two months, as well as continue to get physicians and staff trained at new facilities, including its other tertiary partners, Seattle-based Swedish Medical Center and Port Angeles-based Olympic Medical Center. The idea is to expand the HIE so more patient information can be shared.

The health network secured another grant to enhance its HIE platform and deliver more functionalities to help eligible hospitals, health systems and physicians potentially meet meaningful use criteria, Perkins-Peppers said.

There's a significant lesson to be learned from WWRHCC's experience in building the telepharmacy project and HIE, she said. "It's important for people to realize that just because they're small and they don't have a whole lot of resources they can do a big project like this; we did it with very little IT resources and very little knowledge, just a lot of hard work and will power," Perkins-Peppers said. "It can be a really beneficial thing for the public."

This article was originally posted at http://ping.fm/1NRFu

Efficiencies Converge with EHRs, Practice Management

As providers adopt electronic health records systems, they gradually become more adept with the technology as they flip the switch on advanced features and become conversant with the capabilities and quirks of the software.

Each advance, however small, leads to more efficiencies. Before getting an EHR at Hillside Medical Office in Wichita, Kan., phone messages for nurses were written on paper. Now they're put directly in the EHR while the operator is talking to the patient. There are no more lost messages from a patient who never got a response.

"We know who took the message, when they took it, what the message was and who they sent it to," says Dave Gordon, practice administrator. "The person who answers the phone calls up the patient name and puts in the message, tasks it to a nurse and the message is instantly in the patient's chart and pops up on the nurse's screen. That creates efficiency throughout the whole building. It's not a lost transaction."

But it gets even better when an EHR is interfaced to a practice management system, Gordon says. A Hillside coder working in the practice management system-which is on the same platform from Pulse Systems Inc. as the electronic record-can click on a patient chart in the EHR and look at the actual physician notes to determine if the encounter was appropriately coded.

Billing staff in the PM system's accounts receivables module can click over to any needed clinical information in the EHR. Front desk staff or clinicians answering patient phone calls can click over to the patient chart during the call and answer questions rather than hunt down the paper chart.

Transcription costs have gone down, as have costs for managing paper charts, "not to mention the frustration when that chart could not be found or was being used by another person," Gordon says.

"Granted, we have more expenses associated with computers, but I haven't determined the exact dollar offset. But that's unimportant-there's no way we would go back to the paper format," he adds.

Running the numbers

Physician I.T. consultant Steven Lazarus, however, has run the number for clients, and the math adds up.

One, a money-losing, 15-physician cardiology group practice that adopted an integrated EHR/PM system, created efficiencies that paid for the new system in just one year, says the founder of Denver-based Boundary Information Group.

"Practices that figure this out will make a lot of money and have happy patients who won't want to go anywhere else," says Lazarus, ticking off the clinical and financial windfalls for combining EHR and practice management efficiencies: better data capture that reduces lost charges; improved coding; automated patient reminders; and proper follow-up treatment of chronic patients, among other benefits, can help a practice's revenue grow.

But it doesn't necessarily happen overnight. Eighteen months after going live on an EHR from gloStream Inc., Troy, Mich., Julie Hopkins, practice manager at BayView OB/GYN in Petoskey, Mich., noted such efficiencies, but only now is indentifying the financial impact.

The practice has a large Medicaid population and has had its reimbursements cut in that business segment, but while overall revenue is down, net income is up. "While I can't pinpoint all the efficiencies, we're running more efficiently with fewer errors, and the result is better performance all around," Hopkins says.

Seeking domino effect

Practices that become adept at using EHRs, however, sometimes face problems with "throughput" to their practice management systems. To get the full benefits of an EHR/PM integration requires clinicians and administrative staff to upgrade their practice management skills.

Steven Seligman, M.D., co-founder of Omega OB-GYN in Arlington, Texas, notes that clinicians rarely go near a practice management system. But as a clinician and administrator, he's finding previously untapped but useful PM functions now that his EHR is up and running.

For example, he can be in the EHR while talking to a patient on the phone, and toggle to the practice management system to check the patient's next appointment and remind them about it during the call.

He also runs PM reports showing monthly collections and staff productivity, and can access a physician's schedule for the next day and if necessary add a patient to the schedule.

Gail Burdine, administrator at Omega OB-GYN, is using the EHR/PM integration to cut several steps out of the billing process. Omega uses a combined, single database system from Greenway Medical Technologies, which takes an electronic superbill created in the EHR to generate a claim in the PM after billing staff review.

Six months after getting the combined system in 2004, billings and collections were up 16 percent, she adds. Seven years later, the practice is run by four billing FTEs and one collections staffer. Prior to the EHR, Omega had up to five FTEs managing records, work now done by a single employee. And two physicians have been added without an increase in billing staff.

"Reimbursements for what we do are trickling downward. If that's how it's going to be, then we need better ways to get the claims downstream. These are all little things, but they add up to better efficiency."

Next steps

At BayView OB/GYN, the implementation of an electronic record has given staff the confidence to dig deeper into the practice management system.

After the practice's first EHR went live, the provider replaced its practice management system because the vendor was not cooperative in integrating it with the electronic records system.

During the intervening 10 months before a new PM was in place, staff got comfortable with the EHR.

When the new practice management system was in place, the staff got "braver" with the software, Hopkins says: front desk employees, for example, started looking deeper into billing and insurance information and resolving issues, instead of shoveling all patient billing questions to the billing staff.

 "They were less reluctant, they were ready to go in it," Hopkins adds.

The new practice management system also started drawing interest from an unexpected source-clinicians. Some nurses and physicians are occasionally accessing the PM system from the EHR during the course of the day.

Nurses, for example, will check demographics and pharmacy orders rather than ask registration to do it. "All physicians send electronic prescriptions; they need to in order to meet meaningful use requirements, but they actually love it," Hopkins says. "Some of them even send their own referral letters and corresponding paperwork."

But even years into a market push for integrated EHR/PM systems and a focus on cross-pollinating the systems to gain efficiencies, there's still plenty of room for technological and process improvements.

Wunna Mine, CIO at three-site Camarena Health in Madera, Calif., says there are practice management functions that are medically useful to clinicians, but haven't garnered much attention because caregivers don't make a habit of using the practice management system.

Unused functionality

Camarena Health uses an EHR from MED3000 interfaced with a practice management system from HealthPort. With the PM, a clinician can run a report on the last time diabetic patients were seen, but the system doesn't prompt a user to generate such a report, so the functionality goes largely unused.

In addition, even after four years since the EHR came in, providers still check off charges on a paper superbill.

The process could be automated, but physicians still are not entirely confident the EHR can and will generate the appropriate codes, Mine says.

While Mine hasn't seen a spike in the use of the practice management system, Camarena Health is piling up efficiencies. The EHR makes it easy to know if patients are up-to-date with treatments by running reports when a patient comes in, and prompting the treating physician to check on gaps of care.

Data validation also is much better since the EHR arrived, he notes.

For instance, when the practice first started running outcomes reports on patients with diabetes or asthma, it found it wasn't capturing data on race and other demographic information in the practice management system, which it has since added.

So once again, it comes full circle. While implementing an EHR doesn't always lead to more efficient use of a practice management system, it does create an opportunity for improvement.

Before adopting an integrated EHR/PM from Allscripts, billing staff at Physicians Medical Center in Las Vegas had to do some running around when insurers wanted physician notes to support submitted claims.

Now, "instead of going down stairs, finding the notes and copying them, they just print the notes from the EHR and send them to the insurance company," says Sharron Grodzinsky, CEO.

That's just one example of efficiencies seen in the billing department, she notes.

In the three years since the software went in, the department has lost two staff members to attrition and didn't replace them. Coding has improved with use of the EHR's code-checking capabilities, Grodzinsky says.

Revenue opportunities

Physicians now routinely code one level higher, which translates into nearly 10 percent more revenue for the practice, according to her estimates.

Other EHR functions are translating to more revenue. Patients who like automated checks for drug formulary compliance or gaps in care, or getting their patient care summaries, are referring others to the practice, she adds.

Archer Physical Therapy and Pilates Institute Inc. in Aventura, Fla., opened in October 2008 with an EHR from WebPT in Phoenix.

It wasn't until March 2011 that the three-therapist firm got a practice management system from Kareo Inc., Irvine, Calif. Kerry Siman-Tov, a therapist and the owner, isn't sure if she's using the PM to its full capability, but says it serves all the practice's administrative needs.

But she knew she couldn't get by any longer using QuickBooks for accounting, a claims submission application for Medicare, a clearinghouse for major commercial insurers, and paper claims for some other payers.

"I do all the finances so if I get bogged down in that I can't treat patients." What she's learned, however, is that documentation comes from the EHR, and documentation is the bedrock of billing. "Without the EHR I'm lost, I can't manage the practice efficiently without it." Before the EHR, for example, the practice had to hire staff to manage patient notes, which is now done by the caregivers themselves.

"What I've learned about using an EHR is that it saves a tremendous amount of the therapists' time in documentation, provides for accurate HIPAA and Medicare compliant documentation, and instantly populates the claim into the Kareo system upon completion in WebPT," Siman-Tov adds.

"This eliminates the need for redundant data entry and eliminates the need for additional personnel to transcribe dictated notes, proofread them and file into paper charts, which then need to be stored."

The EHR saves time and resources and improves the efficiency of health record management in our facility. It also allows us to fax our documentation to the referring physicians with an internal fax feature."

But even providers who have made a concerted effort to maximize EHR and PM efficiency still grapple with a learning curve.

Having implemented its PM and messaging system in May 2010 and its EHR in November 2010, Dave Gordon, the practice administrator at Hillside Medical Office, believes some of the practice's seven physicians are less efficient than they were when they were dictating notes.

On the other hand, while the docs aren't going home any earlier, they no longer need to cart charts home to complete since they're able to access the system from anywhere they have the Internet, Gordon says.

Comprehensive use of EHRs may or may not bring better use of the practice management system, but integration between the two applications magnifies the efficiencies made possible by EHRs.

BayView OB/GYN, which implemented its EHR in March 2010 but went nearly a year without integration between the EHR and PM systems because of a tiff with its old PM vendor, was forced to do dual data entry during that time, recalls Julie Hopkins, the practice manager.

So it was a relief when the gloStream PM went live in January. Now, aside from billing charges, clinicians and support staff can access any other part of the PM from the EHR, such as schedules, insurance information, account balances and coding.

They no longer have to use two systems to check on past or current appointments, or no-shows, and registration staff save time by shooting out test orders from the EHR.

Nurses can even schedule appointments from the EHR if working late and support staff has gone home, and front-line staff can access prescriptions and orders when patients call.

"There's a lot of administrative questions they can answer themselves," Hopkins says.

When the EHR went live, she feared one of the biggest hurdles to acceptance would be elimination of the paper superbill.

The whole flow of the practice ran off the patient checking in and printing off a superbill that followed them through the office.

But the EHR was going to generate and house the superbill, and "my staff could not fathom life without those paper bills," Hop kins recalls.

"Then, one day they had them and the next day they didn't. I honestly thought that would have been the biggest transition, but it went off without a hitch."

And the electronic superbill delivers efficiencies the practice never even considered.

It tracks the patient-when the patient has checked in, received certain treatments and incurred certain charges-but also enables staff to look at the bill and know where the patient is, such as the waiting room, getting an ultrasound or in exam room 11.

"We're not going around hunting for patients," Hopkins says.

How Far Does Meaningful Use Go?

Attempting to snag incentives for meaningful use of electronic health records opens physicians' eyes to capabilities within EHRs they never knew existed. But meaningful use can open the eyes of staff members and administrators as well. Having had 11 of its 14 physicians successfully attest for meaningful use of electronic health records in May and June, Sharron Grodzinsky, CEO at Physicians Medical Center in Las Vegas, credits the initiative with helping her learn how to generate reports for measuring quality indicators.

Meeting the patient education meaningful use measure also reminded her of a library of body images in the EHR that can be drawn on, enabling clinicians to better explain certain conditions or procedures, such as blockage in the heart.

Kansas City Dermatology in Overland Park, Kan., expected its physicians to attest to meaningful use in September 2011, and just following the path to meaningful use made everyone a better EHR user, says Shirley Sherwood, office manager.

Because of meaningful use criteria to have a problem list for patients and conduct drug-allergy checks, the practice revamped how it tracks allergies. For instance, if a patient is allergic to latex, an alert will pop up on the screen when the patient's chart is accessed. "So it's there from the get-go," Sherwood says. "You can't go past the alert until you click on it."

The newest twist on using the software is embedding patient educational materials into the records system to click and print on demand during a visit, says Karen Eggers, practice administrator.

This article was originally posted at http://ping.fm/2o8JX

The Generals of General Transcription

When you are thinking about stepping foot into transcription, it is always a good idea to know what you're getting into before you even try. First and foremost, you need to ensure that you are ready for a fast paced environment that takes little to no hostages. In fact, you have to be on your toes at all times, especially with your writing, if you want to keep up with even the most mundane forms of transcription.

General transcribers will work on just about anything. From radio, broadcasting, documentaries, to any other form of media or legal items that require a general transcription professional. But, what is it you can expect as a general transcription professional? Well, first and foremost you will want to know what transcription really is.

Transcription, or general transcription is, a business, which helps to convert the spoken word to a written, or electronic text file. You can be asked to either work live or from a pre-recorded sitting. While yes, live can be far more difficult than a pre-recorded audio or video tape, it is always good for you to be well versed in either of these forms of general transcription in the instance that you get hired on for a live or recorded transcription job.

In the field of general transcribing you can work for a transcription service company or work freelance. Either of these are legitimate forms of transcribing, however, with a companies backing, you may very well begin to land some of the more lucrative general transcribing jobs.

A couple of the requirements of general transcription, as with any other kind of transcribing out there, are that you have a fairly quick typing speed. Many of these companies will ask that you type two hundred words per minute or more. This is simply because if you're transcribing live, you have to be able to keep up with what people are saying with little difficulty. You may even be asked to submit to a speed-typing test, which will rate how many words per minute you type, as well as your accuracy.

The accuracy portion of these tests will help to assess whether or not you're capable of spelling and grammar. While people won't always speak correctly per the language they speak, you are going to be asked to type out each and every word as though the person is speaking. For this reason, the proper use of punctuation is an absolute must. Nothing is worse than a transcription that is flat and lacks the emotion that the people used while speaking the words you are transcribing.

Just like any other field that you may be interested in working in, general transcribing requires that you know your job and know it well. Without this pre-knowledge of the field, you will be swimming up stream with no hope in sight. Of course, on the job training will also help you to overcome any shortcomings that you may have with your general transcription career or gig.

This article was originally posted at http://ping.fm/kcLig

Obstetrics-Gynecology Transcription

Obstetrics and Gynecology Transcription services

Obstetrics and Gynecology are two medical specialties that have seen tremendous growth and change over the years. These two specialties are often merged as a single specialty and are called in different abbreviated terms such as OB/GYN, OBG, O&G, etc. Though obstetrics and gynecology are often mentioned as a single medical specialty, obstetrics deals with pregnant care whereas gynecology is an umbrella term that encompasses any disease or disorder in the female reproductive system.

But what is common in both the fields is that it deals with both physical as well as emotional issues for a patient and any tiny error in the patient record can lead to major misunderstandings. As both obstetrics and gynecology deal with subjects that a layperson has little or no knowledge of, the onus is on the physician to produce accurate medical records that are unambiguous and structured.

To streamline the smooth documentation workflow of an Obstetrics and Gynecology Clinics are turning to professional medical transcription providers. And to cut costs most of the major obstetrics and gynecology clinics and hospitals outsource their medical transcription and documentation work to developing countries like India. In house transcribers can be very expensive and due to the increase in newer and advanced medical treatments such in-vitro fertilization, the test tube method and several more, the volume of the workload of a gynac or obstetrician has increased manifold. This leads to missed deadlines, high operational costs and delayed patient care.

Which is why off shore destinations like India are the undisputed choice of physicians and hospitals. The online transcription module followed by most medical transcription companies, seamlessly integrates with almost all the EMR, EHR available in the market. The rates of all these Obstetrics and Gynecology transcription services are also very cheap. They charge a reasonable 10 ¢ to document a single line of 65 characters. This low price amount helps in enhancing the revenue cycle of a clinic. The in-house on the other hand charge an expensive amount of, $35 to $38 to document the same line and leads to piling up of overheads.

Hence the hospitals, clinics soliciting the service of the OB - Gyn transcription providers get cost-effective accurate Obstetrics - Gynecology medical transcription service within a turnaround time of 12 hours. Moreover they are given the STAT options of 2/4/6/8hrs.

To assess their accuracy and quality standards almost the major companies provide a 7 day free trial. With so many reasons favouring outsourcing medical transcription services it is no wonder that it is the fastest growing field in the whole world.

This article was originally posted at http://ping.fm/Sl7ka

Natural language processing underused in radiology

Natural language processing (NLP) has multiple applications to radiology but is underused in the field, according to a recent article in the Journal of the American College of Radiology. However, the earlier technology on which NLP is based--voice recognition software--still has yet to be accepted by many radiologists, a Diagnostic Imaging survey found.

According to the JACR study, NLP currently has three main applications in radiology:

• To flag patient records to support outcomes research;


• To pinpoint specific data points, such as individual imaging findings, for analysis and quality improvements;


• To help radiologists improve their documentation by creating reports that highlight key points.

George Hripcsak, a biomedical informatics professor at Columbia University, told Diagnostic Imaging that NLP could have these additional benefits:

• It can be used to search patient databases for similar findings, which helps residents practice their diagnostic skills;


• Some types of NLP can help care teams identify instances where suspicious findings have been overlooked;


• It can convert radiology reports into language that's easier for laypeople to understand.

However, the physician survey found that only half of radiologists liked their speech recognition software. Thirty percent were unhappy with it, and the rest apparently didn't respond or had no opinion.

NLP software is considered the next generation of voice recognition programs. If it is no more accurate in "understanding" text than voice recognition is in recognizing speech, however, physician trust will be a barrier to acceptance.

This article was originally posted at http://ping.fm/FFn8V

Natural Language Processing Underutilized in Radiology Despite Advanced Capabilities

Natural language processing, considered the next generation of voice recognition software, makes it easier for you to summarize, find, and retrieve data from radiology reports. But a recent study shows many of you still aren’t using it.

Nearly 50 years ago, speech recognition software debuted on the healthcare scene, and providers used it to record radiology report findings. Technology improvements have taken the software to the next level with natural language processing (NLP), and it now plays a significant role in quality improvement efforts, said Ronilda Lacson, MD, a radiology research associate at Brigham & Women’s Hospital. NLP takes the voice-created narratives and makes them structured and searchable.

“NLP makes sure physicians report findings appropriately,” Lacson said. “They can record information in such a concise form so that when patient histories are pulled for review they’re like a thin cut of focused data.”

In a study published in the September Journal of the American College of Radiology, Lacson and her colleagues identified three main uses for NLP. The software can pull records that meet specific criteria to support effective outcomes research. Various versions also let you pinpoint specific data points, such as individual imaging findings, for analysis and quality improvements. However, the most valuable, long-term NLP use, Lacson said, is the brief reports it can create to highlight key content and critical findings. Other radiologists can study these summaries to improve their future documentation.

Lacson said the technology is underused, but her study didn’t include utilization rates in the imaging industry. According to Lacson’s research, there are roadblocks to efficiently implementing NLP, and a recent non-scientific poll of Diagnostic Imaging readers found that, as an industry, these difficulties have you divided on whether you use or like it. Based on 145 responses, roughly 50 percent of you are pleased with voice recognition software. However, nearly 30 percent of you dislike it.

These barriers come from a lack of information, said George Hripcsak, MD, a biomedical informatics professor at Columbia University. For much of his career, Hripcsak has studied how to use NLP to support clinical research and patient safety efforts, and he said there are many challenges to widespread implementation.

“Many radiologists just don’t know what programs are out there or what they can do with them,” he said. “Not only that, but the radiology market is also small. It likely doesn’t attract a lot of attention from companies looking to sell NLP systems.”

In addition, Lacson pointed to the steep learning curve associated with NLP technology and the lack of standards in place for measuring the usefulness of the software as hurdles to overcome.
Even with all these obstacles, Hripcsak said NLP offers many opportunities to enhance medical education, as well as patient safety. You can use NLP to search patient databases for groups of records that share specific findings, he said. This teaching tactic exposes your residents to many cases with similar characteristics and gives them the opportunity to practice their diagnostic skills.

Some NLP versions can help providers work as a team to catch instances where suspicious findings have been overlooked. In these cases, NLP sends up a red flag if there hasn’t been any follow up on anything troubling that was identified in an imaging test and noted in a patient’s record.

In the age of healthcare portals that give patients immediate access to their medical records, NLP can be a translation tool for people who don’t have medical training, Hripcsak said.
“Many people have fairly low health literacy,” he said. “And, it’s important they understand what a radiologist says about their MRI or CT scan. NLP can put a radiologist’s report into easy-to-understand lay language.”

This article was originally posted at  http://ping.fm/Ipy4Z

Health 2.0 speaker says 'find a way to build a business model'

“Health 2.0 has the promise to change the healthcare industry,” the conference’s opening keynote speaker Mark Smith, president of the California HealthCare Foundation, told the audience on Monday.

Smith also asserted that health reform is necessary for innovation and vital to the success of Health 2.0 entrepreneurs’ business model because the current system is set up to pay for volume.

[See also: 11 health IT startups go for the money.]

Launched in 2007, Health 2.0 stages an annual conference focused on innovation and on tools aimed at helping consumers manage their health and connect to care providers.

California HealthCare Foundation (CHCF), a nonprofit grant-making philanthropic organization, has set up an innovation fund so companies can “innovate, spread and change the world,” Smith said. The fund was created, he said, because “I’m tired of seeing successful pilots die on the vine.”

Despite the success of a grant-funded pilot, academic entrepreneurs often move onto the next grant opportunity, according to Smith. CHCF hopes its efforts will help entrepreneurs “try to find a way to build a business model.”

[Q&A: Todd Park on the bridge between HHS' Health Data Initiative and meaningful use.]

The good news is that technology is maturing and policy to support these initiatives is evolving, Smith said. The bad news is that technology is not the obstacle. Rather, guild rules, payment rules and culture are the obstacles. The other bad news is that the industry is running out of time, he said. Despite widespread bipartisan agreement that the system is broken and needs to be fixed, the cost of healthcare is continuing to escalate and the fiscal future of the country relying on healthcare reform.

Smith offered areas of opportunities for innovators:

• Solutions should address cost, but they shouldn’t merely shift cost. Until reimbursement reform eliminates the “perverse incentives” for payment, entrepreneurs need to understand which stakeholder’s money is being saved.


• Entrepreneurs should innovate in a way that makes the healthcare system more convenient for patients. They need to understand, however, that the value proposition of patients may “represent a threat to the existing order,” Smith said. He cited Kaiser Permanente’s shift of educating and marketing its electronic health record system from the providers to the patients because the EHRs delivered value for patients.


• Solutions that enable rapid learning for providers addresses the under-learning problem that currently exists because there is so much data being generated that is taking providers too long to consume. Being able to turn massive data into information and then learning “is a big priority,” Smith said.


• Finally, the enrollment of the uninsured – numbered around 35 million – beginning in 2014 creates huge challenges for payers. Solutions will be called on to address when and how the newly ensured will want to sign up.

“Health 2.0 is on the verge of taking off,” Smith said, because of the mature technology. Affordability, accessibility and improved quality and outcomes will drive Health 2.0 solutions, he concluded.

10 Hilarious Medical Transcription Errors

Medical transcription is a very important process when it comes to the business of saving lives. Those are the seemingly indecipherable notes on your patient sheet that your doctor will look over to help decide which medicines and treatments you will need to become a functioning human being again. Unfortunately, a lot of these notes are written in haste and words can be misspelled, forgotten, or switched around.

You might be shocked to hear that doctors goof up on those notes, especially when receiving wrong doses or entirely wrong medicines can do much more harm than good. While medical transcription errors are best avoided, not all of them spell doom for a patient. In fact, a lot of them are hilarious. Here are some of the best medical transcription errors that have found themselves leaked onto the Internet.

Transcription Error: The patient was breathing heavily with no signs of respiration

Hmm. This sounds like the kind of case that only House M.D. could solve, with a mixture of snark and common sense. I guess the twist ending would be chest spasms without lung compression. Or House would just call whoever wrote this note an idiot.

Transcription Error: The baby was delivered, the cord clamped and cut and handed to the pediatrician, who breathed and cried immediately

Doctors spend years and years in school, learning how to do doctor things. After these years and years of school, they have to go through years of on the job training. This is quite understandable, as anybody with a decent chance of being elbow deep in somebody’s intestines should know what they are doing. The downside of this is doctors don’t learn sentence structure. Or this was just the world’s most emotional M.D.

Transcription Error: Exam of genitalia reveals that he is circus sized

This is the type of note that we all wished our doctors would write for us. Forget those cheesy pick-up lines. Whenever you are at the bar you would just pull out this official documentation from your doctor, show it to the woman of your choice, and have the night of your life. This is of course assuming that the note is accurate, which this example certainly wasn’t. It was just the best accidental compliment of that patient’s life.

Transcription Error: Bleeding started in the rectal area and continued all the way to Los Angeles

That sounds terrifying. The specific level of terror depends on the distance between the patient’s rectum and Los Angeles, but it is arguable that the phrase “bleeding started in the rectal area” is terrifying enough on its own.

Transcription Error: She is numb from her toes down

Alright ladies, if these are the problems that you are seeing the doctor for then you have officially lost all rights to make fun of guys about refusing to see doctors. We at least wait until that numbness reaches our ankles. Tough guys will wait until it hits the knees. Or else the doctor forgot to address the serious matter of toes growing out of a woman’s forehead.

Transcription Error: Social history reveals this 1 year old patient does not smoke or drink and is presently unemployed

On second thought, this might not be an error. The news is always talking about how fast kids are growing up these days, what with all the hormones put in our cheeseburgers and all. Maybe doctors are actually concerned about alcoholic chain smoking infants. Maybe this medical transcription is proof that we will finally see a baby born with a glorious mustache.

Transcription Error: Patient called and left word that he had expired last week

This patient wins the award for most courteous zombie of all time. Of course the doctor probably meant that the patient’s health insurance or something had expired, but a polite zombie apocalypse is a far more interesting theory.

Transcription Error: On the second day the knee was better, and on the third day it disappeared completely

Everybody has memories of falling down and scraping their knee when they were little. You would sit there and cry over what was a horrific injury in your mind, but actually barely qualified as a boo boo. It was at this time a supposedly funny uncle or dad would joke that they had to amputate. After all, if you don’t have the knee it won’t hurt anymore. This is what happens when somebody gives that funny uncle/dad a medical license.

Transcription Error: Discharge status: Alive but without permission

It is not unheard of for doctors to get a God complex since their jobs are literally life and death. It is a little weird to see one so blatant about his need to control everything. Most doctors would be glad to see a patient breathing, let alone healthy enough to leave the hospital. It sounds like this doctor wants to track down this patient and take away his clean bill of health with his bare hands.

Transcription Error: The patient is tearful and crying constantly. She also appears to be depressed

Sherlock Holmes is not only the world’s greatest detective, but also the world’s greatest physician. His bedside manner leaves a little to be desired, though.

This article was originally posted at  http://ping.fm/7BBrs

Diabetes care improves with EHRs

Care for patients with diabetes improved appreciably when their physicians use electronic health records (EHRs) extensively, according to a recent study.

Physicians who participated in the Massachusetts eHealth Collaborative from 2006 to 2008 significantly increased their ability to generate and use registries for laboratory results and medication usage. The more actively physicians used their EHRs, the more they used registries, particularly for care of patients with diabetes.

Researchers looked at the use of registries in the years immediately before and after the Massachusetts eHealth Collaborative program installed free EHRs for participating physicians. In 2005, 44% of physicians could generate a laboratory results registry; by 2009, 78% could.

 

In the same period, the percentage of physicians who could generate a medication registry increased from 33% to 83%. The ability to generate a diagnostic registry remained stable at just under 90% for practices of all sizes.

 

The use of registries "is considered a measure of physicians' engagement with [EHR] systems and a proxy for high-quality healthcare," according to the researchers. Registries are lists of patients with specific health risks, diagnoses, laboratory results, or medications that enable physicians to assess their own quality measures. The ability to generate registries is one measure of meaningful use of EHRs used by the Centers for Medicare and Medicaid Services.

In another study looking at the role of technology in managing diabetes, use of a mobile application was found to reduce A_1C levels in patients with type 2 diabetes by nearly 2% over a 1-year period.

Participants received cell phones preloaded with diabetes management software and were asked to enter their blood glucose levels when they tested. The app analyzed the reading, sending a text message coaching the patient on ways to quickly moderate their blood sugar levels if they were too high or low.

The study involved 26 primary care practices with 163 patients. At the end of the year, patients who used the mobile app with provider decision support had a mean drop in glycated hemoglobin of 1.9%. Patients in a control group experienced a decline
of 0.7%.

This article was originally posted at  http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Diabetes-care-improves-with-EHRs/ArticleStandard/Article/detail/739113?contextCategoryId=44687

4 tips to boost hospital efficiency

Implementing new technology can be tedious, and the work doesn't stop once go-live occurs. Constant changes are needed to keep IT systems up to speed and better improve their performance.

But luckily not every update requires hours to complete. Edna Boone, senior director, mobile initiatives at HIMSS, gives us four quick and simple IT tweaks to improve hospital efficiency.

[Q&A: How meaningful use is clashing with ICD-10.]

1. Embrace best practices. Boone suggests considering tried and true best practices – such as total quality management, business process reengineering and Lean and Six Sigma – and applying those concepts to your IT department. By employing Lean Sigma Six concepts, for example, an organization can streamline IT functions and increase customer satisfaction through proven techniques.

2. Involve your users. "Engage key stakeholders and end users of your system and process in your workflow and efficiency analysis," said Boone. The additional opinions could open your eyes to improvements. "Implementing small, incremental changes while working on large-scale plans can have big results as well," she added.

[See also: The top 3 takeaways from National Health IT Week.]

3. Look for additional resources. Consider an automated workflow modeling application, Boone said. In addition, look to the Process Management and Workflow section of the HIMSS Management Engineering and Process Improvement Toolkit. The section contains tools and tips regarding ways to simplify processes, implement Six Sigma to determine risk management and improve IT implementation and operations.

4. Consider the customer's perspective. Boone recommends taking on the role of the customer and completing a walk-through of your processes to identify both barriers and opportunities. "Start by calling for an appointment," she said. "Then try to find the department in the hospital. What is the environment like? Is the staff friendly and welcoming?" Next, take a look at your admission process. "Is it quick, complicated, too invasive, lots of paperwork, or easy to maneuver?" Boone said. "And finally, what are the procedures? How did the staff interact with the client?"

This article was originally posted at  http://ping.fm/fEcOI

Top 5 green health IT trends

If properly executed, green IT can mean healthcare organizations see fewer bills, contribute lower levels of carbon emissions, and enjoy an easier transition into mandated practices. But it has to be done right. Noble and potentially cost-efficient, but embracing the "go green" trend isn't simple.

Jerry Buchanan, account director Healthcare Technology and Services at eMids Technologies, shares five powerful green IT practices for healthcare.

1. EMR: Paper trails have met their match with the creation of one of the most popular green IT practices: the electronic medical record. "Anyone can remember going to the doctor and seeing a huge file filled with paper,” said Buchanan.

[Q&A: Between the lines of NEJM's EHR report, 'trust trumps tech' authors say.]

An analysis conducted by Kaiser Permanente, published in the May 2011 issue of Health Affairs (subscription required), estimated that EMRs have the potential to reduce carbon dioxide emissions by as much as 1.7 million tons across the United States. The same study, which looked to 8.7 million users of Kaiser Permanente HealthConnect, showed that using an EMR avoided the use of 1,044 tons of paper for medical charts annually. It all resulted in a positive net effect on the environment.

2. Telemedicine: Although telemedicine has existed for more than 20 years, its benefits are just now coming to light, especially in rural communities. "People don't have to drive all over for specialist referrals and things of that nature,” noted Buchanan. In addition to cutting down on gas emissions, telemedicine has been shown to better manage chronic diseases; improve the care of elderly, homebound, and physically challenges patients; and improve community and population health.

3. Server Virtualization: Server virtualization continues to be one of the most common ways organizations are going green. By virtualizing servers in their data centers, organizations are reducing the number of physical servers used. In turn, this cuts physical hardware costs and the data center's carbon footprint. A report by The 451 Group titled “Eco-Efficient IT” found that each server eliminated through virtualization can reduce power consumption in a data center by up to 400 watts, which is the equivalent of about $380 per year, per server.

[See also: GAO pushes for better federal green IT efforts.]

4. Desktop Virtualization: Desktop virtualization doesn’t just lower energy costs – it can also increase productivity and decrease capital expenses on PC hardware. The technology promises thin-client computing by centralizing management of all user desktop environments on a single platform. In 2009, Forrester Research published a report comparing thin clients to desktops and found thin clients consume between five and 60 watts per device, compared to the 150 to 350 watts used by a desktop PC.

5. Virtual Collaboration: Web conferencing, instant messaging and other software all come into play when promoting virtual collaboration. By partaking in virtual employee meetings and other collaborative efforts, travel and other expenses are cut dramatically. Employing virtual collaboration increases efficiency and enables employees to access information and applications anywhere at any time. Additionally, using this technology can increase productivity and teamwork.

What is your organization doing to go green?  Leave your comments below.

This article was originally posted at http://ping.fm/oixsi

Dictating From Anywhere ? Violation of HIPAA Privacy Rule?

Digital voice recorders, mobile phone aps, or even speech recognition may violate the HIPPA Privacy Rule when physicians go mobile with dictation.

Health organizations are required to protect patient privacy under the guidelines set forth by the Health Insurance Portability and Accountability Act (HIPAA). Medical transcription services utilize secure servers and encrypt files to protect against privacy breaches, but doctors can easily violate the HIPAA Privacy Rule, create poor audio quality dictations and cause transcription errors when dictating from “anywhere.”

Protecting Patient Privacy and HIPAA Compliance

Physicians who transmit patient data electronically must comply with the HIPAA privacy rule to protect patient privacy. The Office of Civil Rights Privacy Rule describes “protected health information” (PHI) as being “individually identifiable information” that is transmitted by any media between the physician and his business associates within or outside the HIPAA-covered entity.

Therefore, if a physician is dictating a clinic note in the hallway outside the exam room and that information can be readily overheard by other patients, the doctor is not HIPAA compliant. If the physician uses a digital voice recorder without password protection or encryption and the recorder is left unsecured, this would also be a HIPAA violation. Doctors should take steps to ensure HIPAA compliance when dictating.

Digital Voice Recorders and Poor Quality Audio

Portable devices such as digital voice recorders and mobile phones, when used in public places, pick up background noise that obscures the dictator’s voice. Even simple movement of the recorder can cause static; and a doctor dictating in a car might as well be dictating in a wind tunnel if he has the window down or AC going. Dictating on the move increases the chances of background noise, changes in volume, and other interruptions that compromise sound quality. These same distractions are likely to result in poor dictation habits and incomplete dictations.

Dictation Errors Become Transcription Errors

While dictating on the move can seem convenient to the busy physician, it is not the best way to improve accuracy and rarely results in organized and concise medical documents. When on the move, physicians are not likely to have ready access to necessary patient information which leads to misinformation and/or incomplete dictations. Rushing from one location to the next with recorder in hand, breathlessly dictating amid heels clicking and doors squeaking, is a poor dictation habit.

Dictation practices that follow a routine will save time, not those that are crammed in between other activities. Not only does dictation multi-tasking lead to transcription errors, it also leads to the possibility of recording personal conversations and even restroom visits when distracted physicians accidentally leave their recorders on.

Mobile Dictation for Emergencies Only

Modern technologies provide physicians many options for dictating, but dictating on the go should be reserved for emergencies only. Stat dictations that need to be done immediately for the welfare of the patient are often called in to a service and are not done with the daily dictations.

For everyday dictating, it is much more efficient to establish a routine. This will save time, protect patient privacy, and result in quality medical documents done right the first time. Very few physicians are trained in the art of dictation, but it is a valuable skill for the busy physician to master.

http://ping.fm/XAy7t

Day-Long HIPAA Boot Camp Targets HIM Professionals

The 2011 annual convention of the American Health Information Management Association, Oct. 1-6 in Salt Lake City, features a series of in-depth post conference educational sessions on the 6th, including an eight-hour HIPAA Privacy and Security Boot Camp.

The camp is designed for health information management directors, other professionals with little or no privacy experience who is taking on a new role as a privacy officer or would like to, and existing privacy officers who want a better understanding of regulations and issues.

"I'm not going to assume they know too much," says Kelly McLendon, the presenter and founder of HIXperts, a Titusville, Fla.-based consultancy. "I'm not going to leave anyone behind, but at the same time will go beyond the basics."

McLendon will cover the tools of HIPAA privacy compliance, such as policy templates, spreadsheets and other forms for specific functions, such as cataloging records systems with protected health information. He'll cover expected requirements in a final omnibus HIPAA rule expected this year covering the privacy, security, breach notification and enforcement rules, and also cover privacy regulations from the HHS Substance Abuse and Mental Health Services Administration.

"This is a very deep view of HIPAA for HIM and privacy professionals, but we will start from the basics and make sure everyone understands from the ground up," McLendon says. More information on educational session 7004, "HIPAA Privacy and Security Boot Camp," which starts at 9:00 a.m., is available at ahima.org.

This article was originally posted at  http://ping.fm/J7wro

HIPAA at 15: HITECH Tightens Health Care Data Privacy Laws

Fifteen years after Congress enacted the HIPAA data privacy laws, health care IT is adapting to guidelines made more stringent by the 2009 HITECH Act.

With 2011 marking the 15th anniversary of the Health Insurance Portability and Accountability Act, health care providers and IT companies continue to evaluate how to keep electronic health data secure.

On Aug. 21, 1996, President Clinton signed into law a set of rules detailing who can access personal health information. Under HIPAA, health information may not be disclosed without a patient's consent unless disclosure is necessary to administer benefits, payment or health care.

Under HIPAA, providers must regularly disclose privacy practices to patients, and parties must also disclose information to the Department of Health and Human Services if they're under investigation.

"It does give patients rights to their records and the rights to know who's seen their records, and that's important," John Moore, an analyst at Chilmark Research, told eWEEK. The law doesn't tell hospitals what to do with the data, however, Moore added.

HIPAA has also influenced the passage of the Obama administration's 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which made penalties for data breaches more severe. Data breaches can now cost companies up to $250,000, Moore noted.

The 2009 HITECH Act widened the scope of privacy protection under HIPAA following criticism that the privacy laws had not been rigorously enforced, according to Amit Trivedi, health care program manager for ICSA Labs, a division of Verizon. ICSA tests electronic health records (EHRs) to see if they satisfy federal mandates on meaningful use.

Under HITECH, "business associates," or third parties such as a billing company or cloud provider, now must follow the HIPAA privacy laws by protecting patient information and reporting data breaches, Mike Gleason, director of information services at Scottsdale Healthcare, in Scottsdale, Ariz., told eWEEK.

"That wasn't as clearly spelled out in the initial HIPAA law but was in HITECH provisions," Gleason said.

Concerns about HIPAA rules have resulted in some companies avoiding the health care IT space altogether, according to Moore.

"You need to jump through hoops to make sure a solution is HIPAA-compliant," Moore said. "So some companies say we're just not going to go there, particularly now that they've strengthened HIPAA rules and [implemented] big penalties for those that have violated HIPAA."

Meanwhile, HIPAA privacy laws have led to opportunities for vendors such as Proofpoint, a software as a service (SaaS) company that provides email archiving to large enterprises.

In an email, Proofpoint's service can spot identifiers, such as Social Security numbers or the name of a disease, that could be in violation of HIPAA laws, Rami Habal, director of product marketing at Proofpoint, told eWEEK.

"We spend a lot of time in R&D defining what HIPAA compliance is," he said.

For health care, HIPAA has served as an example for other industries to follow as far as data privacy, Habal suggested.

"It's sort of an important thing to recognize that HIPAA is almost at the forefront as far as best practice in ensuring privacy in business communication, and you have more and more organizations abiding by it," he said.

In addition, providing access to health care data in the cloud has made HIPAA compliance easier, Habal said. "You can have a more secure HIPAA compliance infrastructure in the cloud than what you get on premise," Habal said.

To keep data secure, Scottsdale Healthcare, in Arizona, uses Proofpoint's email archiving service, Microsoft Vergence (formerly Sentillion) single-sign-on technology, Barracuda Web-filtering and Entrust RSA token IDs to authenticate remote access.

In addition, the hospital system conducts annual threat assessments and tests to ensure that the network remains secure and to guard against unauthorized access, Scottsdale Healthcare's Gleason said.

"Security is a layer that needs to be there, it needs to be stringent, and it needs to be adhered to, but it cannot be an obstacle in providing information," he explained.

HIPAA laws have brought a greater awareness for health care providers that data security is important, Gleason said. The privacy laws have impacted the agenda of Scottsdale compliance committee meetings and have made hospital employees more careful as far as how they communicate with one another and have led to increased auditing of who's viewing data records.

"I think there's much more awareness, not only in our employee population but also our patient population," Gleason said. Awareness of HIPAA laws means "you can't just kibitz with your co-worker," he added.

This article was originally posted at  http://ping.fm/YA9K8

 

Data Security in Healthcare Industry Shows Strength Through Cloud Computing

Since the advent of the Health Information Portability and Accountability Act of 1996 and the more recent Health Information Technology for Economic and Clinical Health Act of 2009, healthcare providers have worked to create effective and creative solutions to oblige new regulatory compliance requirements. The proliferation of electronic medical records systems gives hope to security and compliance success.

Fierce Markets recently published an article explaining how cloud computing-based EMR systems may have advantages over traditional, in-house storage practices and technology. According to the source, healthcare providers have increasingly turned to the cloud-based solutions to keep up with policies such as HIPAA compliance and encryption regulations, and many have seen success.

Some studies show EMR and emails are often less likely to be encrypted when handled entirely internally compared to the rate at which private EMR systems providers execute this practice, the website reports. To ensure a successful partnership with EMR and email security solutions providers, healthcare officials need to carefully analyze each prospective vendor, the source adds.

According to the American Medical Association, HIPAA compliance violations can cost helathcare providers up to $1.5 million in penalties annually, while the maximum penalty per occurrence is $50,000.

This article was originally posted at  http://ping.fm/Nrh8m

Students can avail the benefits of our quality based and low cost transcription services

It is almost a difficult task for the university students to transcribe their lectures especially when they have minimum time to devote on additional burden of their studies. Mediscribes inc., through its unique service features offers a team of professionals that provide top priority lecture notes transcription. Innumerable educational institutes, universities and schools have utilized the services of our company that is identified as unique and the most distinct site from other sites in the competitive market.

Our expert’s helps to support the students transcribe their notes irrespective of their degrees, since we have people who are employed from varied fields and sectors to service our clients at the level best. The entire task of converting digital audio recording to analog recording is handled in the most accurate and precise manner by our expert transcription team.

One of our best features is that we never tend to outsource the service of our Academic Transcription to the low income and wage countries as most of our competitors do in the competitive market. Our service helps to make our students achieve their targets and goals much easily by providing them quality lecture notes.

We also undertake to transcribe the most expensive source materials like professional, university, lecture and educational transcriptions at the affordable rates. However, our lower rate never tends to affect the kind of quality service that is provided to our clients.

Our experts can convert audio into textual form and compile all the research documents in to the customized formats as desired by our clients. We have a team of qualified transcribers that strictly adhere to the deadlines and thus ensure to submit all their transcribed projects in time.

Students can submit their audio and video files and presentations made in PowerPoint or other softwares. We also offer the interview transcription services in order to meet urgent or immediate requirements of our clients as our team is well trained to undertake the these kind of urgent requirements on day to day basis.

Transcribing documents involve a lengthy procedure to first transcribe the documents and then carry on the entire proof reading process over the transcribed documents. With our quality team of experts, we are able to handle any number of transcriptions in a day, while ensuring timely and accurate submission of the lecture notes.

About Mediscribes

Mediscribes, Inc. is one of the fastest growing transcription & document management systems providers in United States, based in Metro Louisville. Mediscribes is an ISO 9000-2001 certified company, rendering cost-effective consolidated transcription solutions to major hospitals, clinics, and other healthcare facilities in United States. Mediscribes is the most value-providing organization in the market today with a strong presence in America and offshore locations. The firm specializes in providing highly accurate transcription adhering to ADHI guidelines in unbeatable turnaround time with robust & proven document management system as its vantage point to its esteemed clientele.

Mediscribes provides end-to-end transcription solutions as its primary offering. For our customers, we focus on dictation systems, both ASP as well as enterprise level solutions, with the help of our most valued asset ezVoiceIntelligence (ezVI), providing specialty-specific qualitative transcription along with a “whole nine yards” document management system. Mediscribes specializes in EMR data integration as well. Our data dispatch department is highly proficient in integrating transcribed reports into any type of EMR. Healthcare facilities that do not have EMR get the option to use our web-based file monitoring interface called eTranscribe for global access to their data. eTranscribe has special features of E-signing, E-faxing, auto-printing, and user-friendly document search criteria.

For additional information, please visit http://ping.fm/20MYy http://ping.fm/OETSR

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The 5 traits of a usable EMR

There are several factors inhibiting EMR adoption, but the concept of usability is often at the root, and rightfully so. Although effective training and implementation methods affect user adoption rates as well, poor usability has a strong impact on productivity, error rate, and user satisfaction.

And usability should be considered more than just user satisfaction, according to Rosemarie Nelson, principal of the MGMA Consulting Group. The concept is far more complex, and to Nelson, it’s synonymous with workflow integration. “Too much attention is given to the number of clicks and screens, when what should be considered is how and when information is presented,” she said.

Dr. Steve Waldren, MD, Director of the American Academy of Family Physicians’ Center for Health IT, explained that when it comes to understanding usability, it’s essential to consider utility as well. “Usability is subjective in many ways,” he said. “It has to do with the functionality of the system. Utility is making sure the system does the things you need it to do.”

[Q&A: Between the lines of NEJM's EHR report, 'trust trumps tech' authors say.]

So what determines if an EMR is useable? Better yet, how can prospective users ensure a system won’t result in headaches over lost productivity? According to Nelson, the first step is to recognize no system is perfect.

“The problem for most providers is they, nor their vendor implementation team, look for that commonsense template: the one that fits a majority of patient visits, not the ‘perfect’ template that allows visits for all patients to be documented. There is just too much variation to expect 100 percent.”

With that in mind, here are five additional elements to consider when it comes to EMR usability.

1. Supportiveness: According to both Waldren and Nelson, the system should support workflow. “It’s not about a single user,” said Waldren. “It’s about an entire practice.” Waldren suggests presenting vendors with three clinical scenarios: the most common instances at a practice, the most challenging instances at a practice, and the most number of interactions among staff. That way, it’s evident how the system supports specific workflow. “I suggest doing two sets of the scenarios,” he said. “One that you present the vendor ahead of time, and the second during the demo. Then you can see the system’s flexibility to take care of each scenario.”

2. Flexibility: Nelson considers flexibility to be key, not just within the system, but also with those using it. “Usability is all about integrating a tool into a provider’s day,” she said. To illustrate, she suggests considering the evolution of the phone. “We started with one phone, then we add extensions,” she said. “Then, we came up with portable phones because our work is mobile. We found that we needed phones to follow us, not us having to go to the phone.” Since usability can become complicated, she said, the way a provider uses the tool might evolve as he/she becomes comfortable with improvements in workflow and operational efficiencies. Therefore, it’s essential to change how he/she interacts with the device and the software.

Continued on next page.

3. Ease of Learning/ Naturalness: Is the system burdensome and clunky? To be sure it isn’t, Nelson suggests providers take a close look at how they interact with their nurses when using the EMR in the demo. This goes for both patient encounters in the office and on the telephone, as well as incoming documentation, like test results and correspondence. “If it appears cumbersome or redundant, [physicians won’t] achieve the intended benefits because [they] just won’t use those features,” she said. “The best way to observe and understand the dance between nurse and provider is by taking a trip to see the EMR in operation at a practice.” Both the nurse and the provider should visit the site, said Nelson, to fully experience the change they’ll have to adapt to in their own office setting.

4. Effectiveness: Although an EMR’s effectiveness to streamline workflow is obvious when considering its usability, Waldren said providers should also consider the changes taking place in healthcare. “The current is based on volume: patients, procedures, etc.,” he said. “Patients aren’t connected. The future is value-based and consumer directed. Clinical data will be used to measure quality.” With that in mind, Waldren says it’s essential to find a system that will effectively straddle both worlds.

5. Efficiency: To Nelson, an EMR should save time, and even the smallest aspects of a system could mean wasted hours. However, some EMRs do a good job of allowing a nurse and a provider to easily work on the same computer station with fast log-out/log-in.
“This keeps the active patient online to allow for the concurrent work of the provider and nurse. Even something as simple as keeping the electronic chart ‘open’ on the desktop can be a boon to workflow; a nurse or provider is often in one patient’s chart when a phone call interrupts their work, and they need to open another chart. But, of course, they don’t want to lose the one they are working on.”

One thing is for certain when it comes to EMRs and their usability: it’s an evolution that’s essentially controlled by the user. “EMR usability must evolve similarly in that as we try to use it within our day, we can see where improvements can be made,” said Nelson.

This article was originally posted at http://ping.fm/JJNpF

Medical Transcription: Advantages of Outsourcing it From a Service Provider

When it concerns transcribing the medical records of a healthcare facility, there are several options in front to them. They could opt to go in for a transcription department or contract Independent contractors, or engage the services of an expert medical transcription company. Sometimes healthcare providers decide to have a mixture of all three.

However, outsourcing medical transcription needs on a total basis to a medical transcription company has a lot of benefits. Once the expertise of the service provider has been verified in terms of correctness, turnaround time, HIPAA compliance, technology and the pliability of services, there are many advantages to outsourcing the work

Given here are some of the benefits of outsourcing medical transcription:

Reducing time: By outsourcing, the administrative staff of the hospital as well the healthcare professionals can structure their limited time better to concentrate on the main business; that of providing healthcare.

Conserving resources: Outsourcing transcription liberates resources like technology, office space, working capital, management personnel etc. These resources can then be utilized for maximum benefit.

Savings on overhead: Having transcription in-house would require infrastructure like space, computers, power etc, which would have to be used to perform medical transcription. By outsourcing, outlay on this infrastructure could be saved.

Decreased efforts: A lot of inputs are needed from teams at every level, when transcription needs are executed in-house or through the use of independent contractors. Activities like hiring and training require a lot of effort. Outsourcing ensures that these efforts are used more productively.

Decreased strain on internal resources: Due to raising costs, declining percentage of payments, and constrained budgets, it has become increasingly challenging to manage internal resources. Outsourcing transcription lessens the burden on internal resources.

Leveraging from the knowledge of the provider: Outsourcing has the advantage of the hospital gaining from the skills of the service provider. The know-how and expertise of the service provider add to the other advantages of outsourcing.

High level of service: As more and more resources of the healthcare facility are liberated, the focus on delivering quality services would get better, thereby enhancing the quality of service.

Flexibility of choice: One of the major advantages of outsourcing medical transcription is the adjustability of services provided. The responsibility of having to arrange medical transcription services for varying influxes of patients, holiday transcription and weekend transcription needs is on the service provider.

Enhance shareholder value: With the decrease of expenses, gains are maximized thus enhancing shareholder value.

Streamlined and improved operations: With one of the vital contributors in the healthcare process being taken care of, the administration of the clinic is free to focus on other areas. This helps streamline and enhance operations.

Staying competitive: The ability to reduce expenses without affecting the quality and prompt delivery of patient records gives a competitive advantage to the healthcare facility.

Enhancement and expansion of services: With enormous cost cutting benefits and improvement in efficiency by outsourcing, the healthcare facility's improvement and future plans become a reality.

Increase in cash flow: Medical transcription is the primary stage of the receivables cycle. Outsourcing ensures that the turnaround time is quicker, thus quickening the receivables cycle. This in turn improves the cash flow.

Apart from all the above long-term benefits, outsourcing transcription needs to a professional transcription company has benefits like quality services at fair prices, done by expert transcriptionists with a very prompt turnaround time executed through secure HIPAA and HITECH compliant channels, with very superior levels of accuracy and all this with technology that is advanced but simple in usage!

This article was originally posted at  http://ping.fm/jO3DV

Government task force aims to expand health IT to rural areas

The Departments of Health and Human Services and Agriculture have signed a memorandum of understanding linking rural hospitals and clinicians to capital loan programs to help them purchase software and hardware needed to implement health IT.

On Aug. 16, the White House publicly announced the Administration's commitment to this agreement.

[See Obama's new rural jobs initiative includes health IT.]

HHS'  Rural Health Information Technology Task Force, has been working with the Department of Agriculture (USDA) to ensure that rural healthcare providers can use USDA's Rural Development grants and loans to support the acquisition of health IT.

The Office of the National Coordinator for Health Information Technology and the Health Resources and Services Administration make up the task force.

Two key USDA Rural Development programs that can help expand health IT infrastructure in rural America include the:

• Community Facilities Program, which provides direct and guaranteed loans as well as grants for community facilities projects in rural areas. This program may help offset the costs of electronic health records implementation for rural health care providers.


• Distance Learning and Telemedicine Grant Program, which may provide grants to help bring telemedicine services to rural communities.

This article was originally posted at http://ping.fm/L4e7k

White House sponsored meetings connect health providers, innovators

The White House's Startup America Initiative is sponsoring a series of meetings between local healthcare providers and health IT innovators who are close to the proof-of-concept stage in developing their ideas. The Office of the Chief Technology Officer of the U.S. and the Office of the National Coordinator for Health IT (ONC) are co-presenting the sessions.

The first such meeting was held in May in Philadelphia, where 10 innovators met with 10 area healthcare organizations. Similar events are planned for San Francisco later this month, Indianapolis in October and New England, also in October.

Writing on ONC's Health IT Buzz blog, Wil Yu, special assistant, innovations, for ONC's office of the chief scientist, offered these potential benefits for the meetings between tech visionaries and providers:

• Healthcare organizations that participate can identify potential future developers that they wish to collaborate with from a host of candidates in a single day, substantially lowering their search costs.


• Innovators can find potential partners by presenting to a dozen organizations at once--saving precious time and accelerating their development timelines.

The sick cost of medical paperwork

The science of speech recognition

EHR / EMR Certification and its Impact on Your Medical Practice

How do I know whether the EMR and EHR products I am considering are truly certified by the US government as Certified Health IT products? And, if I am not confident of receiving incentive payments for my practice, why should I care whether they are certified? Isn’t it most important to have a system that digitizes my information well and makes it easily retrievable for diagnostics, information, and billing purposes?

As most medical providers understand by now, the purchase of and /or implementation of EMR and EHR software is becoming a necessity. Not everyone is convinced of immediate efficacy of EMR and EHR systems in each of their individual practices, but it is the way the medical industry is headed. So for most of us, this means biting the medical software bullet and choosing an EMR / EHR system sometime very soon making sure that it will work with the specs of your practice or medical group.

Certified EMR and EHR systems, and submitting proof of their meaningful use, can bring financial incentives and payments for medical practices. Conversely, by 2016, lack of implementation, may result in penalties for practices.

How do you know which Software Products are certified Health IT Products, and qualify for incentive payments?

The US Government maintains a Certified Health IT Product list at: http://ping.fm/MrygU.

According to the site, “The Certified HIT Product List (CHPL) provides the authoritative, comprehensive listing of Complete EHRs and EHR Modules that have been tested and certified under the Temporary Certification Program maintained by the Office of the National Coordinator for Health IT (ONC). Each Complete EHR and EHR Module listed below has been certified by an ONC-Authorized Testing and Certification Body (ONC-ATCB) and reported to ONC. Only the product versions that are included on the CHPL are certified under the ONC Temporary Certification Program.”

It should be noted that different modules of different packages can be certified independently. One should not assume that a brand name of X means that every module of product X is EMR certified. Excellent medical software reviews by companies such as CTS, Inc. online from reputable companies to review different modules of EMR packages.

Using the online listing of the Certified Health IT Product list, which is maintained by HHS should offer an authoritative listing of products. Even if you are not particularly excited by the financial incentives because you do not believe they will bring you great return, or if you feel that because of your patient base you would not qualify for many incentive payments (very few Medicare or Medicaid patients, for instance) there are other reasons you might want to buy a Certified Health IT product:

1. Because companies that want to compete for this large audience of buyers are eager to sell the quality of their product, they are often more aggressive about good training and problem rectification. They are eager not to have complaints lodged against them, or to receive bad reviews for their products.


2. Because EHR certified systems are eager to be able to upload their material to CMS, they are eager to have good reporting capabilities and interactive modules that communicate information with each other and with of EHR systems easily.


3. Because standards and rules for certification are still in flux, certified packages and their various modules need to be responsive to changes in rules and in the law. So if your practice buys into an EMR / EHR that is certified, you are likely buying into a product that will stay current and be reviewed and regularly updated.

Legal Transcription services playing a crucial role in enhancing the growth and success of legal business

Legal Transcription is today considered as a most crucial process in every legal business and practice, provided it is carried out with accuracy, speed and in appropriate time too. Legal Transcription is directly related to an effective business workflow management. Many successful legal professionals today are unable to spare their valuable and sufficient time for Tran scripting their documents and legal records. Thus, they have the best option to hire the services of legal professionals and substantially reduce their workload and backlog burden.

Outsourcing all the legal work of transcription to the experts can help lawyers not only in increasing their overall office efficiency, business workflow but work productivity too. The services of legal transcription are today available in abundance for almost every court proceeding, trials, judgments, reports, briefs and interrogations. Usually these services consist of a quality team of expert transcribers.

The transcribers are either trained or are highly qualified and experienced in handling the extensive legal work of transcription with much ease and comfort. Many successful transcription services install the software of state of the art technology for transcribing the legal documents and records. These records are then proofread and send to the editing department for further development of professional and customized cataloged files.

Benefits of companies offering services of a Legal Transcription:

• They offer you accurate transcriptions of your legal documents and records.


• They help you to manage and control your transcription with much ease and comfort.


• They ensure the confidentiality and security of all your legal documents.


• They help in reduces your responsibility of managing and controlling your documents.


• They help you with customized format of transcriptions to suit all your professional requirements.


• They assure the best services of their expert proofreaders, legal professionals and editors.

The overall cost of these services depends entirely upon the requirements of their legal professional clients. However, the beneficial factors of hiring legal transcription services help many legal professional to waive off the overall additional cost of transcription services.

Many legal transcription companies offer their services at the most affordable rates to lawyers, legal firms, courts and attorneys. Documents like testimonials, motions, briefs, court transcripts, tape recordings, summons, meeting minutes are Tran-scripted in a short span of time by the team of expert legal transcribers. Hiring the services of legal transcriptions enables legal professionals to focus their task on more productive trainings programs as offered to their employees. This helps in directly reducing the cost of business operations and increasing the productivity of their legal business.

About Mediscribes

Mediscribes, Inc. is one of the fastest growing transcription & document management systems providers in United States, based in Metro Louisville. Mediscribes is an ISO 9000-2001 certified company, rendering cost-effective consolidated transcription solutions to major hospitals, clinics, and other healthcare facilities in United States. Mediscribes is the most value-providing organization in the market today with a strong presence in America and offshore locations. The firm specializes in providing highly accurate transcription adhering to ADHI guidelines in unbeatable turnaround time with robust & proven document management system as its vantage point to its esteemed clientele.

Mediscribes provides end-to-end transcription solutions as its primary offering. For our customers, we focus on dictation systems, both ASP as well as enterprise level solutions, with the help of our most valued asset ezVoiceIntelligence (ezVI), providing specialty-specific qualitative transcription along with a “whole nine yards” document management system. Mediscribes specializes in EMR data integration as well. Our data dispatch department is highly proficient in integrating transcribed reports into any type of EMR, to include GEMMS, NextGen, Allscripts, Med-Infomatix, etc. Healthcare facilities that do not have EMR get the option to use our web-based file monitoring interface called eTranscribe for global access to their data. eTranscribe has special features of E-signing, E-faxing, auto-printing, and user-friendly document search criteria.

For additional information, please visit http://ping.fm/rVMAx http://ping.fm/O8tuf

How to Find a Legal Transcription Company

Legal transcribers undertake oral dictations from the law professionals and transcribe it into the written electronic or printed forms. These documents include projects on Depositions Transcription, Trial Proceedings, Discussion of legal matters, training sessions and much more. Many legal professionals like lawyers, public prosecutors, attorneys, court and legal departments benefit by utilizing the services of legal transcribers. However, what is more important is to choose a right transcription company that can accurately transcribe all the legal documents including briefs, reports, tapes, arbitrations in the need of time and with accuracy.

It is a far tedious process for the legal professionals to manage their large legal database and information on daily basis. Hiring the services of legal transcribers enables the professionals to reduce their workload and simultaneously concentrate on other core areas of their legal concern. Many legal transcription firms offer a team of legal professionals that have expertise knowledge in the areas of legal research methodology and terminologies. They ensure to provide their best quality work and transcription services to the legal professionals and those too at the most affordable rates.

Legal Transcription Company helps to reduce the backlog of legal files. This directly ensures reducing workload too. They also help in enhancing the productivity and efficiency by doing accurate segregation of legal documents. All the oral legal records are converted into written electronic formats. This helps the law professionals to reduce the overall cost of hiring manpower, filing documents or either choosing the latest resources and technologies to handle the task of transcription independently.

Many quality based transcription companies provide 24x 7 hours customer help to their clients along with the quality that is assured by the team of their editors, proofreaders and legal writers. There are also specialized companies that offer the services of transcribing confidential jury instructions, trials, tape recordings, witness oral records, by adopting the latest browser softwares technologies to ensure complete confidentiality while transferring transcribed documents to their clients.

It is very essential to know whether the proposed transcription company is well-equipped to offer accurate transcription. You must reconsider choosing a company that possesses qualified transcribers having adequate legal terminology knowledge and expertise. You can also choose to select the company that provide quality services of transferring transcribed documents of courte proceedings and judgment reports by utilizing advances online browsers to ensure complete confidentiality to their clients.

You must take care to choose the service providers that assure to meet your customized deadlines too. One of the best ways to select a right company that offer the services of legal transcript is to do a good research online and acquire referrals from the professional who are already utilizing the expertise services of transcription service providers.

About Mediscribes

Mediscribes, Inc. is one of the fastest growing transcription & document management systems providers in United States, based in Metro Louisville. Mediscribes is an ISO 9000-2001 certified company, rendering cost-effective consolidated transcription solutions to major hospitals, clinics, and other healthcare facilities in United States. Mediscribes is the most value-providing organization in the market today with a strong presence in America and offshore locations. The firm specializes in providing highly accurate transcription adhering to ADHI guidelines in unbeatable turnaround time with robust & proven document management system as its vantage point to its esteemed clientele.

Mediscribes provides end-to-end transcription solutions as its primary offering. For our customers, we focus on dictation systems, both ASP as well as enterprise level solutions, with the help of our most valued asset ezVoiceIntelligence (ezVI), providing specialty-specific qualitative transcription along with a “whole nine yards” document management system. Mediscribes specializes in EMR data integration as well. Our data dispatch department is highly proficient in integrating transcribed reports into any type of EMR, to include GEMMS, NextGen, Allscripts, Med-Infomatix, etc. Healthcare facilities that do not have EMR get the option to use our web-based file monitoring interface called eTranscribe for global access to their data. eTranscribe has special features of E-signing, E-faxing, auto-printing, and user-friendly document search criteria.

For additional information, please visit http://ping.fm/9LiaQ http://ping.fm/6JBgB

Optimize Your Legal Practice by Outsourcing Legal Transcription Work

To organize legal documents takes away your time and is a tedious job for legal professionals. Companies providing legal transcription services make these procedures of preparing documents easier, ensuring perfect and simplified documentation for your legal practice.
Well organized services.

Being busy with your legal practice, it might be difficult to systematically manage the pile of legal documents. Companies providing outsourcing transcription services have made your work much easier, reducing your responsibilities of documentation. Well organized services provided

by these firms make it possible for you to get your routine documentation work done in time.

Taking help of legal transcription services you will get your documentation done by professionals. Using outsourcing transcription services helps you save time for the focused area of your business. Similarly, you can also get help of audio transcription services who can convert

dictated information of courtroom sessions into doc files improving your office efficiency.

Legal transcription services could be given only in trusted hands as the nature of information of the content is bound to be sensitive and confidential. Because of its professional nature law firms find outsourcing transcription services extremely suitable.

Outsourcing transcription services reduce your workload ensuring an error-free production of superior quality of legal documents:

• Saves time and endeavor


• Cuts down on operating costs


• Reduces the volume of paperwork


• Prevents backlog of records


• Increases your efficiency and productivity


• Helps to focus on key business issues


• Prepares documents in your desired electronic file formats

Legal transcription service providers use updated technology and software to provide superior quality of legal documents. A skilled panel of legal experts, plus transcribers, proof readers, and editors transcribe the dictation accurately in a timely manner.

Legal transcription services carry wide experience transcribing general correspondence, legal letters, public hearings, briefs, licensing appeals, deposition statements, etc. How will you identify apt legal transcription services for you? An ideal outsourcing transcription services will have following features:

Saves time and endeavor
Cuts down on operating costs
Reduces the volume of paperwork
Prevents backlog of records
Increases your efficiency and productivity
Helps to focus on key business issues
Prepares documents in your desired electronic file formats

This article was originally posted at http://ping.fm/9AqtD