EMR, Transcription, Specialty EMR, EHR, Electronic Health Record, Medical billing

Smartlogic Highlights Content Intelligence Over Enterprise Semantics

2012-02-09T01:39:00.005-08:00

Smartlogic recently released a new version of its Semaphore software, which took home the 2011 European Frost & Sullivan Technology Innovation Award. Version 3.3 adds new semantically-rich features, but the company itself has been shifting its strategy to talk about its solution less as the enterprise semantic platform and more as a content intelligence platform for identifying, classifying, extracting, analyzing and utilizing hard-to-find information from among unstructured assets in existing information management systems like Microsoft SharePoint.

Why? According to marketing VP Maya Natarajan, it’s an in to better customer access. “Whenever you think of the word semantic, there’s such a small percentage of the population that understands what it is,” she says. “But amazingly the uptake for content intelligence is so great. People immediately understand that so much quicker” — that is, she says, that content intelligence describes all the business reasons and benefits for deploying an enterprise semantic platform.

Another way to make the virtues of content intelligence even more obvious: Smartlogic is planning to introduce prebuilt starter taxonomies to kickstart the process in some vertical sectors. Meanwhile, Version 3.3 has brought to its customers features that still proclaim its semantic heritage, including a semantic visualization tool.

“This is a massive step for us,” she says. “It’s taken the product to another level.” With the tool, users can click on a topic to visually see all its associated topics rather than wade through a table. For instance, the screen below shows all the associations for NASA astronaut Buzz Aldren, and from there users can visually explore relationships to those topics, as well.

Associated with the semantic visualization tool is an ontology review tool, says Natarajan. As an example, a subject matter expert may know that Apollo 11 is related to Apollo 13, but that information hasn’t yet made its way into the enterprise’s ontology. “You can actually add those things in independently,” she says. “It lets you provide feeedback to the taxonomy or ontology that is created so the organization can label its information assets very, very clearly.”

These days, most of Smartlogic’s customer base are invested in Microsoft’s SharePoint content management system. FAST Search Server 2010 for Sharepoint is an option beyond SharePoint’s native search for creating metadata directly from content, but Semaphore further enhances things by improving the metadata quality as well as accurately and consistently applying metadata and classification to the search engine capability, Natarajan says. “We also provide an ontology-driven solution so we use a taxonomy to really, really improve search or improve findability,” she says.

The company last year sponsored independent research by MindMetre that it said indicates that, while Microsoft SharePoint is emerging as the industry standard for content management, the most effective SharePoint-based solutions tend to combine the platform’s powerful capabilities with specialist applications that can improve the end-user experience and fill gaps in functionality. According to that study, “ SharePoint is not and never will be an application that companies can simply take out of the box and plug in for a complete solution.”

Semaphore has yet to incorporate into the platform capabilities it acquired with its acquisition of SchemaLogic last fall. Says Natarajan, “There are some interesting aspects to the SchemaLogic product that we are in the process of integrating. That has not yet happened, but it will be happening.” She declined to provide further details at this point.

Read Full Article Here

Toward Intelligent Health IT (iHIT) Systems: Getting Out of the Box

2012-02-09T01:39:00.003-08:00

In this post, I describe a new type of application that I refer to as iHIT. iHIT stands for Intelligent Health IT.

The Architecture of Traditional Health IT systems

Traditional software architectures for health IT systems typically include the following:

Dependency Injection (DI)

Object Relational Mapping (ORM)

An architectural pattern for the presentation layer such as the Model View Controller (MVC) pattern

HTML5, CSS3, and a JavaScript library like JQuery

Other architectural patterns including GoF Design Patterns, SOLID Principles, and Domain Driven Design (DDD)

Structured Query Language (SQL)

Enterprise Integration Patterns (EIPs) implemented through an Enterprise Service Bus (ESB) using HL7 messages as the "Published Language"

REST or SOAP-based web services.

An entire generation of developers has been trained in these techniques. They represent proven best practices accumulated over several decades of object-oriented design and relational data management. Although pervasive in today's clinical systems, these applications lack basic intelligent features such as the ability to capture and execute expert knowledge, make inferences, or make predictions about the future based on the analysis of historical data. In some cases, they actually look like glorified data entry systems.

With the availability and explosion of medical knowledge and real world observational EHR data, these intelligent features will become important in assisting clinicians in the medical decision making process at the point of care by reducing their cognitive load.

Intelligent Health IT (iHIT) Systems

iHIT systems process huge quantities of both structured and unstructured data to provide clinicians with specific recommendations. iHIT systems play an important role in translating Comparative Effectiveness Research (CER) findings into clinical practice. Comparative effectiveness Research (CER), an emerging trend in Evidence Based Medicine (EBM), has been defined by the Federal Coordinating Council for CER as "the conduct and synthesis of research comparing the benefits and harms of different interventions and strategies to prevent, diagnose, treat and monitor health conditions in 'real world' settings." For example, based on the clinical profile of a patient, CER can help determine the best treatment option for breast cancer among the various options available such as: chemotherapy, radiation therapy, and surgery (Masectomy and Lumpectomy).

The following are examples of key characteristics displayed by iHIT systems:

The ability to analyze patient data as well as very large historical observational data sets in order to make probability-based predictions about the future and recommend specific actions that can yield the best clinical outcomes given the clinical profile of a patient.

The ability to capture and execute expert knowledge such as the medical knowledge contained in Clinical Practice Guidelines (CPGs). This includes the ability to mediate between different CPGs to arrive at a specific recommendation by merging and reconciling the medical knowledge in multiple CPGs as is the case with patients with comorbidities.

The ability to perform automated reasoning by inferring new implicit clinical facts from existing explicit facts and by exploiting semantic relationships between concepts and entities.

The ability to retrieve knowledge from unstructured data sources such as the biomedical research literature from sources like PubMed in order to answer clinical questions sometimes posed in natural language.

The ability to learn over time (and hence become smarter) as the amount of processed data continues its exponential growth.

Very fast response time to queries over very large data sets.

Sounds like Artificial Intelligence? I believe we are indeed witnessing the resurgence of artificial intelligence (AI) and even the ideas of the Semantic Web in the healthcare industry. As healthcare costs and quality become national priorities for many countries around the world, the boundaries of computing will continue to be pushed further. Actually, some of the underlying principles of intelligent systems (such as probability theory) were originally developed decades and even centuries ago in the field of biomedical research. Williams Osler (1849-1919) famously said:�

Medicine is a science of uncertainty and an art of probability.

Technologically advanced and competitive industries like financial services (e.g., credit eligibility and fraud detection), online retail (e.g., recommendation engine), and logistics (e.g., delivery route optimization) have adopted some of these technologies. Health IT developers now need to embrace them as well. This will require thinking out of the box.

The Ingredients of iHIT Systems

iHIT systems represent not one, but the integration of many different technologies. Statistical Analysis and Machine Learning algorithms play an important role in iHIT systems. Examples include:

Logistic Regression models

Decision Trees

Association Rules

Bayesian Network

Neural Networks

Random Forests

Time Series for temporal reasoning

k-means Clustering�

Support Vector Machines (SVM)

Probabilistic Graphical Models (PGMs) based on methods such as Bayesian networks and Markov Networks for making clinical decisions under uncertainty.

These algorithms can be used not only for making therapeutic predictions (e.g., the future hospitalization risk of a patient with Asthma), but also for dividing a population into subgroups based on the clinical profile of patients in order to achieve the best treatment outcomes.�

Clinical Practice Guidelines (CPGs) are usually-based on Systematic Reviews (SRs) of Randomized Controlled Trials (RCTs) which are essentially scientific experiments. According to a report titled "Clinical Practice Guidelines (CPGs) We Can Trust" which was published last year by the Institute Of Medicine (IoM):

However, even when studies are considered to have high internal validity, they may not be generalizable to or valid for the patient population of guideline relevance. Randomized trials commonly have an under representation of important subgroups, including those with comorbidities, older persons, racial and ethnic minorities, and low-income, less educated, or low-literacy patients. Many RCTs and observational studies fail to include such "typical patients" in their samples; even when they do, there may not be sufficient numbers of such patients to assess them separately or the subgroups may not be properly analyzed for differences in outcomes.

Predictive analytics using statistical analysis and machine learning algorithms on the other hand operates on large real world observational data and can therefore provide feedback on the effectiveness of the actual use of different therapeutic interventions. Although very costly, RCTs are still considered the strongest form of evidence in EBM. Despite their inherent methodical challenges (lack of randomization leading to bias and confounding), observational studies are increasingly recognized as complementary to RCTs and an important tool in clinical decision making and health policy. iHIT systems play an important role in translating Comparative Effectiveness Research (CER) findings into clinical practice in the form of clinical decision support (CDS) interventions at the point of care.

iHIT systems also use business rules engines to capture and execute expert knowledge such as the medical knowledge contained in Clinical Practice Guidelines (CPGs) and Care Pathways. Examples include rules engines based on forward chaining inference, also known as production rule systems. These rules engines can be combined with Complex Event Processing (CEP) and Business Process Management (BPM) for intelligent decision making.

iHIT systems support ontologies such as those represented by the web ontology language (OWL) providing reasoning capabilities as well as the ability to navigate semantic relationships between concepts and entities.

More advanced iHIT systems have Natural Language Processing (NLP) and Automatic Speech Recognition (ASR) capabilities in order to answer clinical questions posed in natural language. They rely on Information Retrieval techniques like probabilistic methods for scoring the relevance of a document given a query and the application of supervised machine learning classification methods such as decision trees, Naive Bayes, K-Nearest Neighbors (kNN), and Support Vector Machines (SVM).

In some cases, the responsibilities of an iHIT system are performed by Intelligent Agents which are autonomous entities capable of observing the clinical environment and acting upon those observations.

For scalability and performance, iHIT systems often sit on NoSQL databases and run on massively parallel computing platforms like Apache Hadoop while leveraging the elasticity of the cloud.

Integrating these technologies is the main challenge posed by iHIT systems. An example is the integration between statistical and machine learning models, business rules, ontologies, and more traditional forms of computing such as object-oriented programming. Various solutions to these challenges have been proposed and implemented.

Human-Centered Design

Finally, iHIT systems fully embrace a human-centered design approach. They provide a seamless integration between automated decision logic and clinical workflows. They provide the clinician with detailed explanations of the rationale behind the actions they recommend. In addition, they use techniques like Visual Analytics to enhance human cognitive abilities in order to facilitate analytical reasoning over very large data sets.

Natural language processing could eventually change medicine

2012-02-09T01:39:00.001-08:00

In a recent post on his Disease Management Care�Blog,�Jaan Sidorov, a physician with a keen eye for trends, speculated that natural language processing (NLP) might be used to pick up missing diagnoses from free text and perhaps even predict problems before physicians spot them. He cited a�Mayo Clinic study�that found that the use of an NLP program to scan free text in encounter records was nearly as accurate as lab tests in showing whether patients had the flu.

This is not a new idea. The University of Utah School of Medicine has been conducting�studies�of NLP for nearly a decade. But NLP is starting to become more capable, as shown by its growing use in computer-assisted coding. A�VA study found�that the use of NLP with free text identified post-operative complications more accurately than claims data did.

Meanwhile,�Nuance Communications�is working with the University of Pittsburgh Medical Center to apply NLP to electronic health records documentation, using IBM's Watson technology. The hope is that NLP will eventually be able to parse medical terms in free text to speed up data entry. Also, the researchers would like to be able to apply analytics to the data and generate "smart alerts" that can help providers improve patient care.

While the Mayo study focused on using NLP in biosurveillance to spot disease outbreaks early, Sidorov was intrigued by the possibility of employing such a system to detect diseases that physicians had not yet diagnosed. In addition, he noted, NLP-based analytics might be able to identify risk factors and "prospectively identify those persons at greatest risk for future complications, such as an avoidable hospitalization."

More immediately, he noted, NLP could be used to pick up diagnoses that have not been entered in problem lists--a continuing issue with EHRs. NLP is not the only way to do this; a recent study showed that a�decision support tool�could infer probable diagnoses from medication, lab and billing data. But only the NLP method can extract such data from free text.

Structured data in EHRs continues to be suboptimal for a number of reasons, including EHR design, lack of lab interfaces, and physician resistance to inputting data into point and click templates. Someday, when NLP can be reliably used to turn dictation into discrete data, physicians will be able to use EHRs more effectively, and it will be easier to measure their performance. Until then, however, the issues with EHR documentation are unlikely to disappear.

The idea of using NLP for predictive modeling and alerts, meanwhile, will continue to gain traction as researchers discover new ways to apply the growing power and speed of computers to medicine. Of course, computerized insights will never replace the intuition and knowledge of a skilled, experienced physician. But it would be nice if he or she had that extra edge. -Ken

Online legal transcription services benefit corporate legal departments

2012-02-09T01:36:00.003-08:00

Online Legal Transcription Service benefit corporate legal departments. When you run a business non-core processes can often get in the way and take up valuable time. These responsibilities are now extensively outsourced by most large organizations and small and medium-sized companies too.

Legal compliance is important for any business

A major responsibility that businesses cannot avoid is legal compliance. Many issues arise from non-compliance. It is not easy to keep tabs on Federal and State regulations. At the same time, potential lawsuits from employees or customers are always a threat. So most corporate concerns maintain a legal department. Just as data and its transcription are needed for the smooth running of your business, your legal department would require this service too.

Legal transcription service online – fast and efficient

Online legal transcription is a quick and effective way to get your legal data transcribed quickly and accurately. The best option is to outsource your requirements to specialized legal transcription company.

Partnering with a reliable transcription company ensures a great deal of efficiency.

Your manpower and resources are left intact and can be devoted to core processes.

You also would not have to invest in the infrastructure, software and hardware to perform transcription.

Legal transcription services from reliable companies are available at cost-effective rates.

Convenience of online transcription service

The online transcription service is a very convenient form of data transcription where files can be dictated by clients through a digital dictation machine. He data can be transferred through secure FTP (File Transfer Protocol) software set up by the legal transcription company, which also provides the system requirements and software. The transcribed documents can be easily tracked through a document flow management.

Encryption-secured browser-based file transfer is also offered. An experienced company can provide customized or 24-hour turnaround times, though file size and audio quality are important considerations here.

Get your data transcribed on time

While prices vary based on the nature of the file transcribed, online legal transcription by a reliable company is accurate and prompt. Deadlines are never missed and a whole lot of systems are put in place for ensuring security throughout the process. One of the major reasons for the efficiency of the online legal transcription process is the team of trained and experienced transcriptionists, and legal and technical professionals that the legal transcription company employs.

So as you see, online legal transcription services benefit corporate legal departments by ensuring efficient documentation and freeing their valuable time and resources for core business tasks.

Read more here.

'Meaningful use' readiness drops among hospital CIOs

2012-02-09T01:36:00.001-08:00

Hospital CIOs are rapidly losing confidence in their organization's ability to qualify early for federal subsidies for "meaningful use" of EMRs, according to an updated survey from the College of Healthcare Information Management Executives.

In a November survey, results of which were released last week, just 15 percent of the 191 CHIME members queried said they expected to qualify for the Medicare and Medicaid bonus payments in the first half of federal fiscal year 2011, which began Oct. 1. That is down nearly half from the 28 percent who expressed confidence in their ability to meet the standards early in a similar survey conducted in August.

"One potential reason for the drop in confidence may be due to the fact that CIOs are getting a clear view of the horizon, as many of their questions are being answered by federal agencies," Chuck Christian, director of information systems and CIO at Good Samaritan Hospital in Vincennes, Ind., says in a CHIME press release. "Many of the clarifications are adding to the complexity of the task at hand."

While just 10 percent of CIOs don't believe their organizations will achieve meaningful use until Stage 2 of the program--fiscal years 2013-14, the same as in the August poll--concerns even among the most confident respondents have shifted. While more named EMR certification as their top concern three months earlier, this time a plurality of 29 percent view CPOE as the most problematic area of meaningful use. Some 22 percent said capturing and/or submitting quality data was their No. 1 concern, while 13 percent were most worried about vendor readiness.

More than six in 10 respondents expect to have some difficulty with CPOE requirements, particularly when it comes to convincing clinicians to enter enough orders electronically for the entire hospital to qualify for federal stimulus money.

"To really engage physicians, one must provide evidence that clearly shows the advantages of CPOE," explains David Muntz, senior VP and CIO of Baylor Health Care System in Dallas. "Our experience has shown that once a physician begins using the technology, they will influence others. It is imperative that physician workflows are improved by the introduction of not only CPOE, but clinical documentation, and all other aspects of EHRs."

Bizscribes - Your One Stop Shop for Transcription Services

2012-02-02T04:32:00.001-08:00

Transcription may have started small but with the exponential growth of the industries, the transcription services also started expanding and growing. The arena of transcription services has undergone drastic changes and at the current time, there is a huge demand of good Business Transcription Services. Every industry is thriving on information and therefore the need for good transcription services has increased like never before. Bizscribes understand the importance information for its customers and therefore it has taken up the task of information feeding. It excels in providing the clients with different transcription services and thus renders valuable information to them.

Bizscribes is the one stop shop for Transcription Service because it serves its customers with a wide range of business transcription needs. Starting from board meetings, conferences and speeches to one-on-one interviews, the company supplies its customers with all sorts of transcribing solutions. Apart from providing solutions for business transcription needs, the company also specializes in providing transcription services in other areas like media transcription, legal transcription, academic and medical transcription.

Other strengthening factors of Bizscribes’ services which have contributed toward its high esteem are time and money. Transcription is not at all an easy task and the main reason behind it is the time factor. It is so because the turnaround time of Business Transcription is very short and hence it is important that the company must keep its resources well planned. Bizscribes makes sure that it is ready to encounter with all sorts of transcription challenge and deliver the results within the desired turnaround time of the customers. It makes sure that the clients do not have to compromise in the service levels and the results are delivered with utmost accuracy.

This one stop shop for transcription needs also provides dictation services and it has a wide range of dictation services which range from standard telephone to PC-based software to digital voice recorders. Now it even provides dictation solutions for Smartphone’s like iPhone and Blackberry. This customer-focused company has built its reputation for providing high-quality, comprehensive and cost-effective transcription services.

About Bizscribes Inc.

Bizscribes Transcription Service is a leading provider of quality and accurate business transcription services at affordable prices. Your transcription needs could include meetings, conferences, speeches, one-on-one interviews, board meetings, etc. Get accurate transcription within the timeframe that best suits your business transcription needs. We also transcribe board meetings and calls to analysts for quarterly and annual performance.

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

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Rob Byer
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2012: The Year of the Semantic Web

2012-01-28T05:16:00.005-08:00

In 1996, Tim Berners-Lee, director of the World Wide Web Consortium (W3C), defined modern Semantic Web technology with this vision:

If the interaction between person and hypertext could be so intuitive that the machine-readable information space gave an accurate representation of the state of people's thoughts, interactions, and work patterns, then machine analysis could become a very powerful management tool, seeing patterns in our work and facilitating our working together through the typical problems which beset the management of large organizations.

Fifteen years later, the Semantic Web is used in a variety of fields from art museums informatics to breast cancer research. Although the global implementation of the Semantic Web vision may be years from becoming a reality, many sophisticated IT departments are increasingly adopting semantic standards and migrating to semantic technology-based products to achieve the same benefits in their enterprise that the Semantic Web delivers to the Web. This technological trend will continue to penetrate industries as diverse as finance, medical devices, telecommunications, life sciences, and the intelligence community. In fact, I believe that 2012 will be the year of the Semantic Web.

Here are three use cases from 2011 that illustrate the growing impact of semantic technology in commerce and culture today, and why society is migrating toward a data-driven world.

1. Telecommunications -- The Siri Use Case

Even if you don't know anyone whose Christmas list included an iPhone 4S, it's still true that Apple sold 35 million iPhones in the first quarter, ending December. And it's estimated that Apple will sell 125 million more in 2012. That's a lot of people talking to themselves, I mean, their voice assistant Siri. She's the virtual servant or concierge who can help you arrange a place to eat or stay, activities to do, provide you with directions (hopefully better than those dictated by my GPS). All you do is speak, click, or type, and your little helper collects information from a slew of websites, assisting you in your decision-making process. It can even secure a restaurant reservation for you, or an airplane ticket. All of this is why Siri and a few other features use TWICE as much data as the last iPhone model. The iPhone 4S even uses more data than the iPad.

Co-founder, CTO, and VP Design of Siri, Tom Gruber, is a pioneer in the world of the Semantic Web. A forerunner in using the Web to collect and share information, he is credited with defining "ontology" in a technical sense for computer science -- the first one to call "ontologies" a technology for enabling knowledge sharing. Gruber established the DARPA Knowledge Sharing Library and was among the founding innovative thinkers who laid the groundwork for what we now call the Semantic Web.

2. Enterprises -- The Best Buy Use Case

In December of 2009, Jay Myers, the Lead Development Engineer at Best Buy, published a strategic formula for business data and semantics. It consisted of three circles, the first two added together to produce the third: Externally facing linked open data + Internal linked data = Insights. He explains:

The external data sphere represents human and machine readable data that you'd want everyone to access. One of the primary vehicles gaining popularity on the web is RDFa, a way of utilizing richly annotated HTML to deliver data to machines while retaining the rich visual web human users have become accustomed to... The great thing about "front-end" semantic markup techniques is with a little additional knowledge and tools, it allows countless numbers of HTML devs to create a very rich web of data by simply adding data annotations to their HTML, essentially making the entire web an open and queryable database or API for us to extract knowledge from.

Was the strategy successful? According to an interview of Jay by Doc Sheldon of SearchNewsCentral.com ("RDFa: The Inside Story From Best Buy"), I would say yes. The Best Buy Lead Development Engineer said this:

Within just a couple of months, we began to see an increase in our organic search results. Before long, it had increased by 30 percent over historical rates. We also saw an increase in our click-through rate. Yahoo did a study a while back and found that people that had rich snippets on the results pages were seeing around a 15 percent increase in CTR, which has proven to be the case for us. And of course, it makes our web site "smarter" and more open to machines, which ultimately benefits customers.

3. Museum Informatics -- The Annapolis Historic Foundation Use Case

Finally, consider the recent collaboration between a museum collection in Annapolis, Marylandand my technology firm, Orbis Technologies, Inc. The bulk of our business concentrates on delivering semantic applications to the Department of Defense and commercial clients with near-Internet data challenges. However, we were also able to use our technological capabilities to enhance the world of art exhibits. In a display that ran for seven months, we worked with the Annapolis Historic Foundation to showcase the work of a variety of craftsmen in Annapolis between the years 1700 and 1810, with special focus on portrait artists, silversmiths, and cabinetmakers.

Orbis essentially created an interactive knowledge application for the exhibit that facilitated cross-referencing of information on an artist or image. For example, by clicking on the name of silversmith William Faris, or cabinetmaker John Shaw, a person is able to access all other kinds of information related to the craftsman. As in millions of other use cases, semantic technology was used to create connections between different kinds of data available on points of interest -- in this instance, artisans and objects.

What Semantic Technology Can Do

These broad project applications of semantic technology share common components, of course. Successful implementations often have well understood process workflows that support the generation of a defined product. The unique, domain/industry vocabularies are often required for structured, semi-structured, and unstructured data. These project characteristics, combined with the correct products, can create successful semantic technology-driven projects that demonstrate the value and subsequent return on investment.
In other words, in the best of situations -- where optimal project characteristics are in place -- semantic technology can address common infrastructure problems associated with massive database integration efforts and data overload (i.e., too much data and not enough actionable information or real knowledge). The core semantic technology standards (e.g. RDF) provide machine-readable formats for explicitly describing relationships in a format that models human cognition, thereby creating information that facilitates the human decision process.

The Semantic Web allows us to invest our brain power on responsibilities and tasks that require alert human cognition -- and gives the tedious line checking and data grabbing to a machine who doesn't talk back, get grumpy or demand coffee.

That's why 2012 will be the year of the Semantic Web.

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

Give Me a Sign: What Do Things Mean on the Semantic Web?

2012-01-28T05:16:00.003-08:00

Coca-Cola, Toucans and Charles Sanders Peirce

The crowning achievement of the semantc Web is the simple use of URIs to identify data. Further, if the URI identifier can resolve to a representation of that data, it now becomes an integral part of the HTTP access protocol of the Web while providing a unique identifier for the data. These innovations provide the basis for distributed data at global scale, all accessible via Web devices such as browsers and smartphones that are now a ubiquitous part of our daily lives.

Yet, despite these profound and simple innovations, the semantic Web’s designers and early practitioners and advocates have been mired in a muddled, metaphysical argument of at least a decade over what these URIs mean, what they reference, and what their actual true identity is. These muddles about naming and identity, it might be argued, are due to computer scientists and programmers trying to grapple with issues more properly the domain of philosophers and linguists. But that would be unfair. For philosophers and linguists themselves have for centuries also grappled with these same conundrums [1].

As I argue in this piece, part of the muddle results from attempting to do too much with URIs while another part results from not doing enough. I am also not trying to directly enter the fray of current standards deliberations. (Despite a decade of controversy, I optimistically believe that the messy process of argument and consensus building will work itself out [2].) What I am trying to do in this piece, however, is to look to one of America’s pre-eminent philosophers and logicians, Charles Sanders Peirce (pronounced “purse”), to inform how these controversies of naming, identity and meaning may be dissected and resolved.

‘Identity Crisis’, httpRange-14, and Issue 57

The Web began as a way to hyperlink between documents, generally Web pages expressed in the HTML markup language. These initial links were called URLs (uniform resource locators), and each pointed to various kinds of electronic resources (documents) that could be accessed and retrieved on the Web. These resources could be documents written in HTML or other encodings (PDFs, other electronic formats), images, streaming media like audio or videos, and the like [3].
All was well and good until the idea of the semantic Web, which postulated that information about the real world — concepts, people and things — could also be referenced and made available for reasoning and discussion on the Web. With this idea, the scope of the Web was massively expanded from electronic resources that could be downloaded and accessed via the Web to now include virtually any topic of human discourse. The rub, of course, was that ideas such as abstract concepts or people or things could not be “dereferenced” nor downloaded from the Web.

One of the first things that needed to change was to define a broader concept of a URI “identifier” above the more limited concept of a URL “locator”, since many of these new things that could be referenced on the Web went beyond electronic resources that could be accessed and viewed [3]. But, since what the referent of the URI now actually might be became uncertain — was it a concept or a Web page that could be viewed or something else? — a number of commentators began to note this uncertainty as the “identity crisis” of the Web [4]. The topic took on much fervor and metaphysical argument, such that by 2003, Sandro Hawke, a staffer of the standards-setting W3C (World Wide Web Consortium), was able to say, “This is an old issue, and people are tired of it” [5].

Yet, for many of the reasons described more fully below, the issue refused to go away. The Technical Architecture Group (TAG) of the W3C took up the issue, under a rubric that came to be known as httpRange-14 [6]. The issue was first raised in March 2002 by Tim Berners-Lee, accepted for TAG deliberations in February 2003, with then a resolution offered in June 2005 [7]. (Refer to the original resolution and other information [6] to understand the nuances of this resolution, since particular commentary on that approach is not the focus of this article.) Suffice it to say here, however, that this resolution posited an entirely new distinction of Web content into “information resources” and “non-information resources”, and also recommended the use of the HTTP 303 redirect code for when agents requesting a URI should be directed to concepts versus viewable documents.

This “resolution” has been anything but. Not only can no one clearly distinguish these de novo classes of “information resources” [19], but the whole approach felt arbitrary and kludgy.

Meanwhile, the confusions caused by the “identity crisis” and httpRange-14 continued to perpetuate themselves. In 2006, a major workshop on “Identity, Reference and the Web” (IRW 2006) was held in conjunction with the Web’s major WWW2006 conference in Edinburgh, Scotland, on May 23, 2006 [8]. The various presentations and its summary (by Harry Halpin) are very useful to understand these issues. What was starting to jell at this time was the understanding that the basis of identity and meaning on the Web posed new questions, and ones that philosophers, logicians and linguists needed to be consulted to help inform.

The fiat of the TAG’s 2005 resolution has failed to take hold. Over the ensuing years, various eruptions have occurred on mailing lists and within the TAG itself (now expressed as Issue 57) to revisit these questions and bring the steps moving forward into some coherent new understanding. Though linked data has been premised on best-practice implementation of these resolutions [9], and has been a qualified success, many (myself included) would claim that the extra steps and inefficiencies required from the TAG’s httpRange-14 guidance have been hindrances, not facilitators, of the uptake of linked data (or the semantic Web).

Today, despite the efforts of some to claim the issue closed, it is not. Issue 57 and the periodic bursts from notable semantic Web advocates such as Ian Davis [10], Pat Hayes and Harry Halpin [11], Ed Summers [12], Xiaoshu Wang [13], David Booth [14] and TAG members themselves, such as Larry Masinter [15] and Jonathan Rees [16], point to continued irresolution and discontent within the advocate community. Issue 57 currently remains open. Meanwhile, I think, all of us interested in such matters can express concern that linked data, the semantic Web and interoperable structured data have seen less uptake than any of us had hoped or wanted over the past decade. As I have stated elsewhere, unclear semantics and muddled guidelines help to undercut potential use.

As each of the eruptions over these identity issues has occurred, the competing camps have often been characterized as “talking past one another”; that is, not communicating in such a way as to help resolve to consensus. While it is hardly my position to do so, I try to encapsulate below the various positions and prejudices as I see them in this decades-long debate. I also try to share my own learning that may help inform some common ground. Forgive me if I overly simplify these vexing issues by returning to what I see as some first principles . . . .

What’s in a Name?

One legacy of the initial document Web is the perception that Web addresses have meaning. We have all heard of the multi-million dollar purchasing of domains [17] and the adjudication that may occur when domains are hijacked from their known brands or trademark owners. This legacy has tended to imbue URIs with a perceived value. It is not by accident, I believe, that many within the semantic Web and linked data communities still refer to “minting” URIs. Some believe that ownership and control over URIs may be equivalent to grabbing up valuable real estate. It is also the case that many believe the “name” given to a URI acts to name the referent to which it refers.

This perception is partially true, partially false, but moreover incomplete in all cases. We can illustrate these points with the global icon, “Coca-Cola”.

As for the naming aspects, let’s dissect what we mean when we use the label “Coca-Cola” (in a URI or otherwise). Perhaps the first thing that comes to mind is “Coca-Cola,” the beverage (which has a description on Wikipedia, among other references). Because of its ubiquity, we may also recognize the image of the Coca-Cola bottle to the left as a symbol for this same beverage. (Though, in the hilarious movie, The Gods, They Must be Crazy, Kalahari Bushmen, who had no prior experience of Coca-Cola, took the bottle to be magical with evil powers [18].) Yet even as reference to the beverage, the naming aspects are a bit cloudy since we could also use the fully qualified synonyms of “Coke”, “Coca-cola” (small C), “Classic Coke” and the hundreds of language variants worldwide.

On the other hand, the label “Coca-Cola” could just as easily conjure The Coca-Cola Company itself. Indeed, the company web site is the location pointed to by the URI of http://www.thecoca-colacompany.com/. But, even that URI, which points to the home Web page of the company, does not do justice to conveying an understanding or description of the company. For that, additional URIs may need to be invoked, such as the description at Wikipedia, the company’s own company description page, plus perhaps the company’s similar heritage page.

Of course, even these links and references only begin to scratch the surface of what the company Coca-Cola actually is: headquarters, manufacturing facilities, 140,000 employees, shareholders, management, legal entities, patents and Coke recipe, and the like. Whether in human languages or URIs, in any attempt to signify something via symbols or words (themselves another form of symbol), we risk ambiguity and incompleteness.

URI shorteners also undercut the idea that a URI necessarily “names” something. Using the service bitly, we can shorten the link to the Wikipedia description of the Coke beverage to http://bit.ly/xnbA6 and we can shorten the link to The Coca-Cola Company Web site to http://bit.ly/9ojUpL. I think we can fairly say that neither of these shortened links “name” their referents. The most we can say about a URI is that it points to something. With the vagaries of meaning in human languages, we might also say that URIs refer to something, denote something or identify (but not in the sense of completely define) something.

From this discussion, we can assert with respect to the use of URIs as “names” that:

In all cases, URIs are pointers to a particular referent

In some cases, URIs do act to “name” some things

Yet, even when used as “names,” there can be ambiguity as to what exactly the referent is that is denoted by the name

Resolving what such “names” mean is a matter of context and reference to further information or links, and

Because URIs may act as “names”, it is appropriate to consider social conventions and contracts (e.g., trademarks, brands, legal status) in adjudicating who can own the URI.

In summary, I think we can say that URIs may act as names, but not in all or most cases, and when used as such are often ambiguous. Absolutely associating URIs as names is way too heavy a burden, and incorrect in most cases.

What is a Resource?

The “name” discussion above masks that in some cases we are talking about a readable Web document or image (such as the Wikipedia description of the Coke beverage or its image) versus the “actual” thing in the real world (the Coke beverage itself or even the company). This distinction is what led to the so-called “identity crisis”, for which Ian Davis has used a toucan as his illustrative thing [10].
As I note in the conclusion, I like Davis’ approach to the identity conundrum insofar as Web architecture and linked data guidance are concerned. But here my purpose is more subtle: I want to tease apart still further the apparent distinction between an electronic description of something on the Web and the “actual” something. Like Davis, let’s use the toucan.

In our strawman case, we too use a description of the toucan (on Wikipedia) to represent our “information resource” (the accessible, downloadable electronic document). We contrast to that a URI that we mean to convey the actual physical bird (a “non-information resource” in the jumbled jargon of httpRange-14), which we will designate via the URI of http://example.com/toucan.

Despite the tortured (and newly conjured) distinction between “information resource” and “non-information resource”, the first blush reaction is that, sure, there is a difference between an electronic representation that can be accessed and viewed on the Web and its true, “actual” thing. Of course people can not actually be rendered and downloaded on the Web, but their bios and descriptions and portrait images may. While in the abstract such distinctions appear true and obvious, in the specifics that get presented to experts, there is surprising disagreement as to what is actually an “information resource” v. a “non-information resource” [19]. Moreover, as we inspect the real toucan further, even that distinction is quite ambiguous.

When we inspect what might be a definitive description of “toucan” on Wikipedia, we see that the term more broadly represents the family of Ramphastidae, which contains five genera and forty different species. The picture we are showing to the right is but of one of those forty species, that of the keel-billed toucan (Ramphastos sulfuratus). Viewing the images of the full list of toucan species shows just how divergent these various “physical birds” are from one another. Across all species, average sizes vary by more than a factor of three with great variation in bill sizes, coloration and range. Further, if I assert that the picture to the right is actually that of my pet keel-billed toucan, Pretty Bird, then we can also understand that this representation is for a specific individual bird, and not the physical keel-billed toucan species as a whole.

The point of this diversion is not a lecture on toucans, but an affirmation that distinctions between “resources” occur at multiple levels and dimensions. Just as there is no self-evident criteria as to what constitutes an “information resource”, there is also not a self-evident and fully defining set of criteria as to what is the physical “toucan” bird. The meaning of what we call a “toucan” bird is not embodied in its label or even its name, but in the context and accompanying referential information that place the given referent into a context that can be communicated and understood. A URI points to (“refers to”) something that causes us to conjure up an understanding of that thing, be it a general description of a toucan, a picture of a toucan, an understanding of a species of toucan, or a specific toucan bird. Our understanding or interpretation results from the context and surrounding information accompanying the reference.

In other words, a “resource” may be anything, which is just the way the W3C has defined it. There is not a single dimension which, magically, like “information” and “non-information,” can cleanly and definitely place a referent into some state of absolute understanding. To assert that such magic distinctions exist is a flaw of Cartesian logic, which can only be reconciled by looking to more defensible bases in logic [20].

Peirce and the Logic of Signs

The logic behind these distinctions and nuances leads us to Charles Sanders Peirce (1839 – 1914). Peirce (pronounced “purse”) was an American logician, philosopher and polymath of the first rank. Along with Frege, he is acknowledged as the father of predicate calculus and the notation system that formed the basis of first-order logic. His symbology and approach arguably provide the logical basis for description logics and other aspects underlying the semantic Web building blocks of the RDF data model and, eventually, the OWL language. Peirce is the acknowledged founder of pragmatism, the philosophy of linking practice and theory in a process akin to the scientific method. He was also the first formulator of existential graphs, an essential basis to the whole field now known as model theory. Though often overlooked in the 20th century, Peirce has lately been enjoying a renaissance with his voluminous writings still being deciphered and published.

The core of Peirce’s world view is based in semiotics, the study and logic of signs. In his seminal writing on this, “What is in a Sign?” [21], he wrote that “every intellectual operation involves a triad of symbols” and “all reasoning is an interpretation of signs of some kind”. Peirce had a predilection for expressing his ideas in “threes” throughout his writings.

Semiotics is often split into three branches: 1) syntactics – relations among signs in formal structures; 2) semantics – relations between signs and the things to which they refer; and 3) pragmatics – relations between signs and the effects they have on the people or agents who use them.

Peirce’s logic of signs in fact is a taxonomy of sign relations, in which signs get reified and expanded via still further signs, ultimately leading to communication, understanding and an approximation of “canonical” truth. Peirce saw the scientific method as itself an example of this process.

A given sign is a representation amongst the triad of the sign itself (which Peirce called a representamen, the actual signifying item that stands in a well-defined kind of relation to the two other things), its object and its interpretant. The object is the actual thing itself. The interpretant is how the agent or the perceiver of the sign understands and interprets the sign. Depending on the context and use, a sign (or representamen) may be either an icon (a likeness), an indicator or index (a pointer or physical linkage to the object) or a symbol (understood convention that represents the object, such as a word or other meaningful signifier).

An interpretant in its barest form is a sign’s meaning, implication, or ramification. For a sign to be effective, it must represent an object in such a way that it is understood and used again. This makes the assignment and use of signs a community process of understanding and acceptance [20], as well as a truth-verifying exercise of testing and confirming accepted associations.

John Sowa has done much to help make some of Peirce’s obscure language and terminology more accessible to lay readers [22]. He has expressed Peirce’s basic triad of sign relations as follows, based around the Yojo animist cat figure used by the character Queequeg in Herman Melville’s Moby-Dick:

In this figure, object and symbol are the same as the Peirce triad; concept is the interpretant in this case. The use of the word ‘Yojo’ conjures the concept of cat.

This basic triad representation has been used in many contexts, with various replacements or terms at the nodes. Its basic form is known as the Meaning Triangle, as was popularized by Ogden and Richards in 1923 [23].

The key aspect of signs for Peirce, though, is the ongoing process of interpretation and reference to further signs, a process he called semiosis. A sign of an object leads to interpretants, which, as signs, then lead to further interpretants. In the Sowa example below, we show how meaning triangles can be linked to one another, in this case by abstracting that the triangles themselves are concepts of representation; we can abstract the ideas of both concept and symbol:

We can apply this same cascade of interpretation to the idea of the sign (or representamen), which in this case shows that a name can be related to a word symbol, which in itself is a combination of characters in a string called ‘Yojo’:

According to Sowa [22]:

“What is revolutionary about Peirce’s logic is the explicit recognition of multiple universes of discourse, contexts for enclosing statements about them, and metalanguage for talking about the contexts, how they relate to one another, and how they relate to the world and all its events, states, and inhabitants.

“The advantage of Peircean semiotics is that it firmly situates language and logic within the broader study of signs of all types. The highly disciplined patterns of mathematics and logic, important as they may be for science, lie on a continuum with the looser patterns of everyday speech and with the perceptual and motor patterns, which are organized on geometrical principles that are very different from the syntactic patterns of language or logic.”

Catherine Legg [20] notes that the semiotic process is really one of community involvement and consensus. Each understanding of a sign and each subsequent interpretation helps come to a consensus of what a sign means. It is a way of building a shared understanding that aids communication and effective interpretation. In Peirce’s own writings, the process of interpretation can lead to validation and an eventual “canonical” or normative interpretation. The scientific method itself is an extreme form of the semiotic process, leading ultimately to what might be called accepted “truths”.

Peircean Semiotics of URIs

So, how do Peircean semiotics help inform us about the role and use of URIs? Does this logic help provide guidance on the “identity crisis”?

The Peircean taxonomy of signs has three levels with three possible sign roles at each level, leading to a possible 27 combinations of sign representations. However, because not all sign roles are applicable at all levels, Peirce actually postulated only ten distinct sign representations.

Common to all roles, the URI “sign” is best seen as an index: the URI is a pointer to a representation of some form, be it electronic or otherwise. This representation bears a relation to the actual thing that this referent represents, as is true for all triadic sign relationships. However, in some contexts, again in keeping with additional signs interpreting signs in other roles, the URI “sign” may also play the role of a symbolic “name” or even as a signal that the resource can be downloaded or accessed in electronic form. In other words, by virtue of the conventions that we choose to assign to our signs, we can supply additional information that augments our understanding of what the URI is, what it means, and how it is accessed.

Of course, in these regards, a URI is no different than any other sign in the Peircean world view: it must reside in a triadic relationship to its actual object and an interpretation of that object, with further understanding only coming about by the addition of further signs and interpretations.

In shortened form, this means that a URI, acting alone, can at most play the role of a pointer between an object and its referent. A URI alone, without further signs (information), can not inform us well about names or even what type of resource may be at hand. For these interpretations to be reliable, more information must be layered on, either by accepted convention of the current signs or the addition of still further signs and their interpretations. Since the attempts to deal with the nature of a URI resource by fiat as stipulated by httpRange-14 neither meet the standards of consensus nor empirical validity, the attempt can not by definition become “canonical”. This does not mean that httpRange-14 and its recommended practices can not help in providing more information and aiding interpretation for what the nature of a resource may be. But it does mean that httpRange-14 acting alone is insufficient to resolve ambiguity.

Moreover, what we see in the general nature of Peirce’s logic of signs is the usefulness of adding more “triads” of representation as the process to increase understanding through further interpretation. Kind of sounds like adding on more RDF triples, does it not?

Global is Neither Indiscriminate Nor Unambiguous

Names, references, identity and meaning are not absolutes. They are not philosophically, and they are not in human language. To expect machine communications to hold to different standards and laws than human communications is naive. To effect machine communications our challenge is not to devise new rules, but to observe and apply the best rules and practices that human communications instruct.

There has been an unstated hope at the heart of the semantic Web enterprise that simply expressing statements in the right way (syntax) and in the right form (RDF) is sufficient to facilitate machine communications. But this hope, too, is naive and silly. Just as we do not accept all human utterances as truth, neither will we accept all machine transmissions as reliable. Some of the information will be posted in error; some will be wrong or ill-fitting to our world view; some will be malicious or intended to deceive. Spam and occasionally lousy search results on the Web tell us that Web documents are subject to these sources of unsuitability, why is not the same true of data?

Thus, global data access via the semantic Web is not — and can never be — indiscriminate nor unambiguous. We need to understand and come to trust sources and provenance; we need interpretation and context to decide appropriateness and validity; and we need testing and validation to ensure messages as received are indeed correct. Humans need to do these things in their normal courses of interaction and communication; our machine systems will need to do the same.

These confirmations and decisions as to whether the information we receive is actionable or not will come about via still more information. Some of this information may come about via shared conventions. But most will come about because we choose to provide more context and interpretation for the core messages we hope to communicate.

A Go-Forward Approach

Nearly five years ago Hayes and Halpin put forth a proposal to add ex:refersTo and ex:describedBy to the standard RDF vocabulary as a way for authors to provide context and explanation for what constituted a specific RDF resource [11]. In various ways, many of the other individuals cited in this article have come to similar conclusions. The simple redirect suggestions of both Ian Davis [10] and Ed Summers [12] appear particularly helpful.

Over time, we will likely need further representations about resources regarding such things as source, provenance, context and other interpretations that would help remove ambiguities as to how the information provided by that resource should be consumed or used. These additional interpretations can mechanically be provided via referenced ontologies or embedded RDFa (or similar). These additional interpretations can also be aided by judicious, limited additions of new predicates to basic language specifications for RDF (such as the Hayes and Halpin suggestions).

In the end, of course, any frameworks that achieve consensus and become widely adopted will be simple to use, easy to understand, and straightforward to deploy. The beauty of best practices in predicates and annotations is that failures to provide are easy to test. Parties that wish to have their data consumed have incentive to provide sufficient information so as to enable interpretation.

There is absolutely no reason that these additions can not co-exist with the current httpRange-14 approach. By adding a few other options and making clear the optional use of httpRange-14, we would be very Peirce-like in our go-forward approach: We are being both pragmatic while we add more means to improve our interpretations for what a Web resource is and is meant to be.

[1] Throughout intellectual history, a number of prominent philosophers and logicians have attempted to describe naming, identity and reference of objects and entities. Here are a few that you may likely encounter in various discussions of these topics in reference to the semantic Web; many are noted philosophers of language:

Aristotle (384 BC – 322 BC) – founder of formal logic; formulator and proponent of categorization; believed in the innate “universals” of various things in the natural world

Rudolf Carnap (1891 – 1970) - proposed a logical syntax that provided a system of concepts, a language, to enable logical analysis via exactly formula; a basis for natural language processing;rejected the idea and use of metaphysics

René Descartes (1596 – 1650) – posited a boundary between mind and the world; the meaning of a sign is the intension of its producer, and is private and incorrigible

Friedrich Ludwig Gottlob Frege (1848 – 1925) – one of the formulators of first-order logic, though syntax not adopted; advocated shared senses, which can be objective and sharable

Kurt Gödel (1906 – 1978) – his two incompleteness theorems are some of the most important logic contributions of all time; they establish inherent limitations of all but the most trivial axiomatic systems capable of doing arithmetic, as well as for computer programs

David Hume (1711 – 1776) – embraced natural empiricism, but kept the Descartes concept of an “idea”

Immanuel Kant (1724 – 1804) – one of the major philosophers in history, argued that experience is purely subjective without first being processed by pure reason; a major influence on Peirce

Saul Kripke (1940 – ) – proposed the causal theory of reference and what proper names mean via a “baptism” by the namer

Gottfried Wilhelm Leibniz (1646 – 1716) – the classic definition of identity is Leibniz’s Law, which states that if two objects have all of their properties in common, they are identical and so only one object

Richard Montague (1930 – 1971) – wrote much on logic and set theory; student of Tarski; pioneered a logical approach to natural language semantics; associated with model theory, model-theoretic semantics

Charles Sanders Peirce (1839 – 1914) – see main text

Willard Van Orman Quine (1908 – 2000) – noted analytical philosopher, advocated the “radical indeterminancy of translation” (can never really know)

Bertrand Russell (1872 – 1970) – proposed the direct theory of reference and what it means to “ground in references”; adopted many Peirce arguments without attribution

Ferdinand de Saussure (1857 – 1913) – also proposed an alternative view to Peirce of semiotics, one grounded in sociology and linguistics

John Rogers Searle (1932 – ) – argues that consciousness is a real physical process in the brain and is subjective; has argued against strong AI (artificial intelligence)

Alfred Tarski (1901 – 1983) – analytic philosopher focused on definitions of models and truth; great admirer of Peirce; associated with model theory, model-theoretic semantics

Ludwig Josef Johann Wittgenstein (1889 – 1951) – he disavowed his earlier work, arguing that philosophy needed to be grounded in ordinary language, recognzing that the meaning of words is dependent on context, usage, and grammar.

Also, Umberto Eco has been a noted proponent and popularizer of semiotics.

[2] As any practitioner ultimately notes, standards development is a messy, lengthy and trying process. Not all individuals can handle the messiness and polemics involved. Personally, I prefer to try to write cogent articles on specific issues of interest, and then leave it to others to slug it out in the back rooms of standards making. Where the process works well, standards get created that are accepted and adopted. Where the process does not work well, the standards are not embraced as exhibited by real-world use.

[3] Tim Berners-Lee, 2007. What Do HTTP URIs Identify?

This article does not discuss the other sub-category of URIs, URNs (for names). URNs may refer to any standard naming scheme (such as ISBNs for books) and has no direct bearing on any network access protocol, as do URLs and URIs when they are referenceable. Further, URNs are little used in practice.

[4] Kendall Clark was one of the first to question “resource” and other identity ambiguities, noting the tautology between URI and resource as “anything that has identity.” See Kendall Clark, 2002. “Identity Crisis,” in XML.com, Sept 11 2002; see http://www.xml.com/pub/a/2002/09/11/deviant.html. From the topic map community, one notable contribution was from Steve Pepper and Sylvia Schwab, 2003. “Curing the Web’s Identity Crisis,” found at : http://www.ontopia.net/topicmaps/materials/identitycrisis.html.

[5] Sandro Hawke, 2003. Disambiguating RDF Identifiers. W3C, January 2003. See http://www.w3.org/2002/12/rdf-identifiers/.

[6] The issue was framed as what is the proper “range” for HTTP referrals and was also the 14th major TAG issue recorded, hence the name. See further the httpRange-14 Webography .

[7] See W3C, “httpRange-14: What is the range of the HTTP dereference function?”; see http://www.w3.org/2001/tag/issues.html#httpRange-14.

[8] See http://www.ibiblio.org/hhalpin/irw2006/.

[9] Leo Sauermann and Richard Cyganiak, eds., 2008. Cool URIs for the Semantic Web, W3C Interest Group Note, December 3, 2008. See http://www.w3.org/TR/cooluris/.

[10] Ian Davis, 2010. Is 303 Really Necessary? Blog post, November 2010, accessed 20 January 2012. (See http://blog.iandavis.com/2010/11/04/is-303-really-necessary/.) A considerable thread resulted from this post; see http://markmail.org/thread/mkoc5kxll6bbjbxk.

[11] See first Harry Halpin, 2006. “Identity, Reference and Meaning on the Web,” presented at WWW 2006, May 23, 2006. See http://www.ibiblio.org/hhalpin/irw2006/hhalpin.pdf. This was then followed up with greater elaboration by Patrick J. Hayes and Harry Halpin, 2007. “In Defense of Amibiguity,” http://www.ibiblio.org/hhalpin/homepage/publications/indefenseofambiguity.html.

[12] Ed Summers, 2010. Linking Things and Common Sense, blog post of July 7, 2010. See http://inkdroid.org/journal/2010/07/07/linking-things-and-common-sense/.

[13] Xiaoshu Wang, 2007. URI Identity and Web Architecture Revisited, Word document posted on posterous.com, November 2007. (Former Web documents have been removed.)

[14] David Booth, 2006. “URIs and the Myth of Resource Identity,” see http://dbooth.org/2006/identity/.

[15] See Larry Masinter, 2012. “The ‘tdb’ and ‘duri’ URI Schemes, Based on Dated URIs,” 10th version, IETF Network Working Group Internet-Draft,January 12, 2012. See http://tools.ietf.org/html/draft-masinter-dated-uri-10.

[16] Jonathan Rees has been the scribe and author for many of the background documents related to Issue 57. A recent mailing list entry provides pointers to four relevant documents in this entire discussion. See Jonathan A Rees, 2012.

MIT Research: The Advantage Of Ambiguity In Language

2012-01-28T05:16:00.001-08:00

Most think that language evolved as a way for people to exchange information, however, linguists and other communication students have long reasoned over why language evolved. Famous linguists, amongst them MIT's Noam Chomsky, have debated that language is actually badly designed for communication and state that it is only a byproduct of a system that may have evolved for other reasons, maybe for structuring our own private thoughts.

As proof for their theory, these linguists highlight the fact that language is ambiguous. They claim that in a scheme, which is optimized for passing information between a speaker and a listener each word would only have one meaning to avoid any risk of confusion or misunderstanding. In a study published in the journal Cognition a team of MIT cognitive scientists has now upturned the linguists hypothesis with a new theory, which argues that ambiguity makes language in fact more efficient as it permits the reuse of short, efficient sounds that listeners can easily distinguish depending on the context.   

Senior author of the study Ted Gibson, an MIT professor of cognitive science says:

"Various people have said that ambiguity is a problem for communication. But once we understand that context disambiguates, then ambiguity is not a problem - it's something you can take advantage of, because you can reuse easy [words] in different contexts over and over again."

The word "Mean" for instance is a rather ironic example of ambiguity, as it can obviously stand for indicating and signifying something, yet it can also refer to an intention or purpose, for instance as in "I meant to go to the store". It could be another word for something or someone offensive or nasty, as well as referring to the 'mathematical average', and just by adding an 's' at the end of the word makes the definition even more versatile, for example, "a means to an end" refers to an instrument or method, or financial management, as in "to live within one's means".

Given all these different definitions, literally no one who masters the English language gets confused when hearing the word "mean." The reason is that the different senses of the word occur in very different contexts, which enables listeners to interpret its meaning almost automatically.

The researchers believe that the simplest words for language processing systems most probably exist because of this disambiguating power of context, which may restrain the ambiguity of languages to reuse words.

Based on previous studies and on observations they suggest that words with fewer syllables, high frequency and the simplest pronunciations should have the most meanings.  

To examine their theory, the researchers conducted corpus studies in Dutch, English and German. A corpus study is the study of language based on "real life" language examples that are stored in corpora (or corpuses), i.e. computerized databases created for linguistic research.

Their theory that shorter words that occurred more frequently and conformed to the language's typical sound patterns tend to be ambiguous was confirmed, when they compared certain properties of words to their numbers of meanings. They observed that the trends were statistically important in all three languages.

In order to comprehend why ambiguity makes a language more instead of less efficient, one has to examine the competing desires of a speaker and listener. Whereas a speaker wants to put across as much as possible to a listener with as few words as possible, the listener aims to gain a complete and specific understanding of what the speaker is trying to convey. However, as the researchers have already pointed out, it is "cognitively cheaper" if the listener concludes certain things from the context of the conversation, rather than the speaker having to spend more time on longer and more elaborate descriptions.

The result is a system that leans toward ambiguity by reusing the "easiest" words. Piantadosi states that once the context is taken into account, it becomes clear that "ambiguity is actually something you would want in the communication system."  

Implications for computer science  

According to the researchers, the statistical nature of their paper demonstrates a trend in the field of linguistics that is starting to depend more heavily on information theory and quantitative methods.   

Gibson states that, "The influence of computer science in linguistics right now is very high," and adds that natural language processing (NLP) is a major objective of those who operate at the intersection of the two fields.   

Piantadosi highlights that ambiguity in natural language presents enormous challenges for NLP developers, saying:

Ambiguity is only good for us [as humans] because we have these really sophisticated cognitive mechanisms for disambiguating. It's really difficult to work out the details of what those are, or even some sort of approximation that you could get a computer to use."

However, as Gibson pointed out, this problem has long been known by computer scientists and even though the new study offers a better theoretical and evolutionary explanation as to why ambiguity exists, the fact that, "Basically, if you have any human language in your input or output, you are stuck with needing context to disambiguate," still exists he says.  

Written by Petra Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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

Collaborative Intelligence & the EHR

2012-01-25T05:56:00.001-08:00

A provider's essential critical knowledge is often so obscured that the EHR becomes more of an obstacle than a useful source of clinical information.

The meaningful use-compliant electronic health record (EHR) has quickly become very adept at capturing and sharing standardized, structured clinical content that can be communicated, stored, and to some extent consumed by other systems. Unfortunately, this strength is also the EHR's greatest limitation. Amid the structured templates and required fields of the EHR, the essential critical knowledge a provider needs to know is often so obscured that the EHR becomes more of an obstacle or annoyance than a truly useful source of clinical information.

No Place for Clinician's Thought-Process?
The critical clinical insights that providers most need from an EHR are simply not available to allow for informed decision-making. The required fields may all be populated, but the patient's story remains frustratingly incomplete.

The reason for this is simple: by its very nature, the EHR paradigm of capturing clinical information by way of mouse-and-keyboard input into structured forms limits the expressiveness of content. Because there is no place for non-standard information or for the clinician's thought process in reaching certain diagnoses in the templates, we not only miss out on the details of a patient's clinical history, but also on the critical information that reflects the way doctors think.

Documentation of the rationale for conclusions, relevant temporal and sequential facts, causal information, etc. is either lost or obscured beyond efficient retrieval. Some EHRs have incorporated options to allow providers to capture unstructured narrative information, but the resulting text usually has limited utility since it remains unstructured data buried inside various notes fields.

This dilemma is significant. It will take more than incremental feature improvements to realize the promise of the EHR: to support everything from disease management to clinical decision support to major operational efficiencies. To deliver on the expectations for eHealth, we need the EHR not only to capture and effectively use structured data, but also to capture the full patient story and support clinical collaboration based on that story.

What is needed is collaborative intelligence, a solution that enables and supplements the kind of complete and focused clinical picture physicians convey via face-to-face collaboration. Providing such intelligence requires an understanding of clinical workflows, and an ecosystem of people, process and technology to provide the clinical insights that permit clinicians to zoom in on the most critical information quickly and effectively.

All of the pieces required for such collaborative intelligence are in place today: Recognition and understanding of spoken content, semantic web coding and analysis to drive actions and learning algorithms that continuously improve the performance of automated systems based on human feedback. Four key technologies provide the backbone:

Speech Understanding: Speech is the most natural way for humans to convey complex information, and it is the preferred mode of clinical documentation for most physicians today. Speech-based documentation is fast and interferes with the provider-patient interaction least. Converting speech into structured clinical notes using computers reduces costs and time lag associated with human transcription.

The availability of next-generation speech understanding technology now provides significantly higher accuracies across medical disciplines and documentation types than what has previously been available through speech recognition systems. Integration with various clinical systems further optimizes the efficiency of the technology.

Natural Language Understanding (NLU): Sophisticated technology to "read" and understand unstructured clinical narrative is a critical ingredient for collaborative intelligence. We can now produce meaningful structured information from narrative content, merging the benefits of dictation and structured documentation.

Irrespective of whether clinical narrative is captured through dictation or directly in textual form, the synergistic combination of speech and natural language processing (NLP) technologies now yields highly accurate, context-aware clinical content that is codified to standardized medical ontologies such as SNOMED-CT. This in turn drives actionable information and together with structured EHR data enables clinical decision support and improves the quality of care.

Semantic Clinical Reasoning: Once meaningfully structured narrative information is available, it must be made accessible in workflow-friendly, flexible modes. Newly available tools allow physicians to gain access and insights into clinical data that were impossible to get a few years ago. Also, these tools make physicians more productive because they are capable of abstracting and summarizing the relevant clinical information for each provider. They can reason across millions of documents or drill down on the relevant information about one patient in a given context.

Information mined from narrative content can be combined with structured data from EHRs to obtain holistic insights into the patient's story. From retrospective analyses to real-time feedback for physicians at the time of documentation that enables more timely clinical documentation improvement (CDI) to the ability to share clinical insights among caregivers in a collaborative system, the fruits of this reasoning are game-changing.

Machine Learning: To realize the full scope of its benefits, a collaborative intelligence system must be both highly scalable and responsive to the incessant changes in medical knowledge. The only way to achieve these objectives is through "machine learning" - intelligent systems that improve their predictions as they process more information.

Many NLP systems lack a robust capability to do this or rely on hand-crafted rules for knowledge updates, an inherently non-scalable approach. Learning from human feedback is crucial as it provides a constant opportunity to adapt to the changing environment as well as to improve the results and insights gained from collaborative intelligence.

Taken together and combined in the right manner, these technologies and workflows offer the best path to fulfill the goals of eHealth. The EHR remains an essential tool for advancing the quality and efficiency of care, but all stakeholders in healthcare have to remember that it is far from a panacea. To reach the goals of complete, accurate and seamlessly interoperable clinical information, we need to take into account that the most complete, accurate and interoperable way of communicating clinical information is via the spoken word. It also happens to be the most efficient way of capturing such information.

Juergen Fritsch is the chief scientist of MedQuist. He was previously chief scientist and co-founder of M*Modal, and before that, he was one of the founders of Interactive Services (ISI), where he served as principal research scientist

This article was originally posted at http://health-information.advanceweb.com/Features/Articles/Collaborative-Intelligence-the-EHR.aspx

Collaborative Intelligence & the EHR

2012-01-25T05:55:00.001-08:00

A provider's essential critical knowledge is often so obscured that the EHR becomes more of an obstacle than a useful source of clinical information.

The meaningful use-compliant electronic health record (EHR) has quickly become very adept at capturing and sharing standardized, structured clinical content that can be communicated, stored, and to some extent consumed by other systems. Unfortunately, this strength is also the EHR's greatest limitation. Amid the structured templates and required fields of the EHR, the essential critical knowledge a provider needs to know is often so obscured that the EHR becomes more of an obstacle or annoyance than a truly useful source of clinical information.

No Place for Clinician's Thought-Process?
The critical clinical insights that providers most need from an EHR are simply not available to allow for informed decision-making. The required fields may all be populated, but the patient's story remains frustratingly incomplete.

The reason for this is simple: by its very nature, the EHR paradigm of capturing clinical information by way of mouse-and-keyboard input into structured forms limits the expressiveness of content. Because there is no place for non-standard information or for the clinician's thought process in reaching certain diagnoses in the templates, we not only miss out on the details of a patient's clinical history, but also on the critical information that reflects the way doctors think.

Documentation of the rationale for conclusions, relevant temporal and sequential facts, causal information, etc. is either lost or obscured beyond efficient retrieval. Some EHRs have incorporated options to allow providers to capture unstructured narrative information, but the resulting text usually has limited utility since it remains unstructured data buried inside various notes fields.

This dilemma is significant. It will take more than incremental feature improvements to realize the promise of the EHR: to support everything from disease management to clinical decision support to major operational efficiencies. To deliver on the expectations for eHealth, we need the EHR not only to capture and effectively use structured data, but also to capture the full patient story and support clinical collaboration based on that story.

What is needed is collaborative intelligence, a solution that enables and supplements the kind of complete and focused clinical picture physicians convey via face-to-face collaboration. Providing such intelligence requires an understanding of clinical workflows, and an ecosystem of people, process and technology to provide the clinical insights that permit clinicians to zoom in on the most critical information quickly and effectively.

All of the pieces required for such collaborative intelligence are in place today: Recognition and understanding of spoken content, semantic coding and analysis to drive actions and learning algorithms that continuously improve the performance of automated systems based on human feedback. Four key technologies provide the backbone:

Speech Understanding: Speech is the most natural way for humans to convey complex information, and it is the preferred mode of clinical documentation for most physicians today. Speech-based documentation is fast and interferes with the provider-patient interaction least. Converting speech into structured clinical notes using computers reduces costs and time lag associated with human transcription.

The availability of next-generation speech understanding technology now provides significantly higher accuracies across medical disciplines and documentation types than what has previously been available through speech recognition systems. Integration with various clinical systems further optimizes the efficiency of the technology.

Natural Language Understanding (NLU): Sophisticated technology to "read" and understand unstructured clinical narrative is a critical ingredient for collaborative intelligence. We can now produce meaningful structured information from narrative content, merging the benefits of dictation and structured documentation.

Irrespective of whether clinical narrative is captured through dictation or directly in textual form, the synergistic combination of speech and natural language processing (NLP) technologies now yields highly accurate, context-aware clinical content that is codified to standardized medical ontologies such as SNOMED-CT. This in turn drives actionable information and together with structured EHR data enables clinical decision support and improves the quality of care.

10 health IT wishes for 2012

2012-01-24T00:50:00.003-08:00

It’s easy to make predictions about health IT for the year to come, but what if someone asked what your IT wishes were for 2012? What would you like to see happen most in the health IT space?

We asked Wendy Whittington, MD, a practicing pediatrician and chief medical officer of Anthelio Healthcare Solutions, to list her top 10 IT wishes for 2012. From interoperability to telehealth, Whittington outlined what she, and most of her peers, would hope to see come true during the upcoming year.

1. A greater emphasis placed on the federal health IT strategic plan.According to Whittington, healthcare professionals and government officials alike should be paying closer attention to federal health IT strategic plan, and she suggests a revision of sorts could be helpful. “I would like to see that become a working document that we’re constantly referring to,” she said. “One of our biggest problems is a document comes out and it’s good, but what’s happening in healthcare is changing – a document needs to constantly be tweaked.”

2. The emergence of more affordable solutions for healthcare systems and hospitals to attain meaningful use. Many hospitals and systems have been scrambling to find a fast solution to an EHR, said Whittington, to gain access to those meaningful use dollars. “But what ends up happening is they think to get there, [they need to] buy the biggest and the best,” she said. “The total cost of ownership far exceeds the return they’ll get back. I’d like to see a lot of the lesser-known providers of EHRs getting more attention.” Whittington also added alternatives to EHRs, like open source, could be just as successful for a 100-bed hospital, for example. “I’d put the money into optimizing the less-expensive option,” she said.

3. Real interoperability and not just “lip service” interoperability of our health IT systems. Whittington referenced vendors who promise true interoperability, yet, months after implementing the technology, hospitals are still left with communication issues. “[Hospitals] will ask, 'Will this communicate with doctors in the outpatient clinic?’ and the answer is ‘yes,’” she said. “But years after hearing that answer, you still have the same problem. So interoperability is important, but there’s no progress and, in fact, no financial incentives for vendors to play nice.” And financial incentives, in theory, wouldn’t end with vendors and interoperability – Whittington suggests the same goes for communication among hospitals. “Both technology and health communication,” she said. “Less financial disincentive to communicate and more real interoperability.”

4. A better health IT “roadmap.” Ultimately, Whittington would like to see a healthcare system that’s, “patient-centered, evidence-based, efficient, equitable and prevention oriented,” she said. The health IT strategic plan, she said, has vision but isn’t a “cookbook.” “In medicine, we resist cookbooks,” she said. “It’s taken a long time for physicians to assess protocols and evidence-based medicine order sets, so it’s in our nature to not be told how to do things.” However, with everyone left to his or her own devices, it’s easy for chaos to ensue, so Whittington suggests a more standardized way of implementing required technology.

5. The optimization of EHRs. Installing them is just the beginning, said Whittington. “We end up doing what we need to do to get by … slap in that EHR and meet those standards, when really, there’s so much more work that needs to be done.” She said not to forget to optimize your EHR, and when it comes to doing so in hospitals, she suggests doing away with commonly held “silos” and working holistically. “[We need to] work more holistically to optimize clinical documentation and ICD-10, and optimize EHRs around those same principles,” she said. “Work as one big team rather than little, individual ones.”

6. Less whining about going to ICD-10 and smarter planning about how to get there. Whittington said her point with this wish is simple. “It’s like,'Come on guys, we’ve known for a long time that we’re the last country in the world [to transition to ICD-10] and we need to go there,'” she said. “For a while ... the argument from the AMA was, 'We’re too busy and we have a lot of other things going on,’ and I agree; there is a lot of change. But we’ve known about this for years.” There’s going to be change in how care is delivered for many years to come, she continued, and waiting for things to calm down would take even longer. “Just suck it up,” she said. “That’s what I tell my kids.”

7. More innovation across all of healthcare but mainly health IT. EHRs in hospitals just aren’t innovative enough, said Whittington. “There’s a lot of money being dumped in and all these systems being put in, but doctors are still complaining that it slows them down and is cumbersome,” she said. According to her, there needs to be more innovation around ways to get information into the EHR from the beginning. “We’re starting to see a little glimmer of hope with transcription work and being able to put info into an EHR, but we haven’t begun to realize of the benefit [of EHRs] because we still struggle to get information in and out,” she said.

8. A shift to patient-centered care and population health. “The way we have our health delivery system set up, with hospitals being the center of the universe and EHRs being the information repository, we aren’t necessarily making populations more healthy,” said Whittington. She referenced once again the strategic plan, which calls for more attention paid to shifting the center of care out of the hospitals. “As we build out HIT infrastructure, we need to think about where patients need to go to find the right care at the right place at the right time to keep populations healthy.”

9. Value out of big data in healthcare. Professionals are constantly “throwing data” into their EHRs, but, said Whittington, we haven’t even begun to realize the value we can get out of it. “You can even tie in ICD-10 and a lot of other principles into this as we get better at capturing granular data in patients,” she said. “ICD-10 helps with that: apples to apples coding, more specifically. We should get better at comparative effectiveness research and knowing what’s going on.”

10. The expansion of telehealth principles into the wellness space. “The way we deliver healthcare today is inefficient, and it’s not going to take us into the future if we ever intend to be cost effective and affect the health of more people,” said Whittington. She recognized the positive ways telehealth is being used in rural communities, but she said she would like to see it being used more to keep populations healthy. “So if a patient wakes up and checks [his/her] glucose levels, the results are beamed to a case management center,” she said. “And if you take that one step further, all of the people who walk into the ER for their strep throats. It’s about using the principles of telehealth to keep those folks where they belong.”

Follow Michelle McNickle on Twitter, @Michelle_writes

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

11 healthcare data trends in 2012

2012-01-24T00:50:00.001-08:00

Mobile devices, data breaches and patient privacy rights were some of the most talked-about topics in health IT in 2011, and according to expert opinions complied by ID Experts, 2012 won’t be any different.

In fact, experts continue to predict an upswing in mobile and social media usage, response plans, and even reputation fallout. Eleven industry experts outlined healthcare data trends to look for in 2012.

1. Mobile devices could mean trouble. Healthcare organizations won’t be immune to data breach risks caused by the increased use of mobile devices in the work place, said Larry Ponemon, chairman and founder of the Ponemon Institute. A recent study confirms that 81 percent of healthcare providers use mobile devices to collect, store, and/or transmit some form of personal health information (PHI). But, 49 percent of those admit they’re not taking steps to secure their devices.

2. Class-action litigation firestorms are looming. Class-action lawsuits will be on the rise in 2012, predicts Kirk Nahra, partner, Wiley Rein LLP. This will most likely be due to patients suing healthcare organizations for failing to protect their PHI. This past year was filled with several similar suits for organizations, some of which involved business associates and breached patient data. And despite the outcomes, one affect is certain: significant risk and cost for companies affected by the suits.

3. Social media risks will grow. Chris Apgar, CEO and president at Apgar & Associates, predicts that, as more physicians and healthcare organizations move to social media, its misuse will increase the exposure of PHI. A recentexample includes a healthcare worker posting sensitive information about a patient on his Facebook. According to ID Experts, healthcare organizations often don’t develop a social media use plan, leaving a gray area of sorts for employees exposing PHI through personal social networking pages.

4. Cloud computing is not a panacea. Moreover, the technology is outpacing security and creating unprecedented liability risks, said James C Pyles, principal, Powers Pyles Sutter & Verville. According to Pyles, with fewer resources, cloud computing is an attractive option for healthcare providers, especially with the rise of HIEs. But, with privacy and legal issues coming to light, ID Experts said a “covered entity” will need to enter into a “carefully written business associate agreement with a cloud-computing vendor before disclosing protected health information.”

5. Reliance on business associates could result in new risks. Larry Walker, president of the Walker Company, believes economic realties will force healthcare providers to continue to outsource many of their functions. This includes billing to third parties or business associates, even though business associates are considered the “weak link in the chain” when it comes to privacy and security.

6. Organizations could see reputation fallout. Rick Kam, president and co-founder of ID Experts, said identity theft and medical identity theft resulting from data breach exposure are causing patients financial and emotional harm. This often results in patients switching to other providers. According to the Ponemon study, the average lifetime value of one patient is more than $113,000.

7. Mobile will be big in the industry. Christina Theilst, consultant and blogger, reiterated how the use of tablets, smartphones, and tablet applications in healthcare continues to grow. In fact, nearly one-third of providers use mobile devices to access EMRs or EHRs, according to a CompTIA study. And with the onslaught of this mobile technology, providers will need to balance usability, preferences security, and more all while adopting written terms of use with employees and contractors, said ID Experts.

8. Emphasis on “willful neglect” will lead to increased enforcements of HIPAA. Adam Greene, partner, Davis, Wright, Tremaine, said the focus over the next year will be on the 150 HITECH Act audits and publication of the final rules implementing modifications to the HIPAA regulations. But the biggest changes, he said, may be at the OCR investigation level. Expect OCR to pursue enforcement against noncompliance due to “willful neglect,” resulting in a sharp increase in financial settlements and fines.

9. Privacy and security training to become an annual requirement. Peter Cizik, co-founder and CEO at BridgeFront, said healthcare organizations have gotten better at putting procedures in place, but staff still isn’t following them. And since the majority of breaches happen due to human error, targeted training and awareness programs will become common in the upcoming year.

10. An increase in fraudsters means an increase in fraud risk education.Jonnie Massey, supervisor at the Special Investigations Unit, Oregon Dental Service Companies, said pressure, opportunity, and rationalization are all dangerous elements that can lead to committing a healthcare-related crime. And during hard economic times, these crimes are more prevalent. Educating those at risk may deter some from stepping over the line, or help those at risk to prevent themselves from being a victim.

11. Healthcare organizations will turn to cyber liability insurance. As organizations continue to implement their EHRs, said Christine Marciano, president of Cyber Data Risk Managers, they will consider options to protect themselves and their patients. A breach can be both costly and damaging to the organization’s reputation. And with the increased vulnerabilities, as part of a data breach response plan, organizations will increasingly turn to a cyber security/data breach insurance policy.

Follow Michelle McNickle on Twitter, @Michelle_writes

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

Save money by outsourcing legal transcription jobs

2012-01-17T06:08:00.007-08:00

Outsourcing legal documentation tasks has proved to be a cost-effective option for law firms. Rather than transcribing the various legal documents in-house, they stand to gain a lot when they entrust the work to reliable service providers. With in-house legal transcription, a law firm has to spending considerable time and resources on transcribing legal dictation. Legal transcription outsourcing services helps legal practitioners and law firms to get the work done in quick time, as well as save the money that would be required to carry out the documentation work within their practices.

By hiring the Legal Transcription Service offered by professional legal transcription companies, you can eliminate your transcription headaches. You don't have to worry about transcribing briefs, depositions, notes, letters, motions, statements, client tapes, pleadings, court tapes, summons, interviews, court transcripts and jury instructions. Legal transcription outsourcing services considerably reduce the work load of legal professionals and allow them to save valuable time which could be spent on other important areas of the business.

Equipped with a team of qualified and experienced transcriptionists, proofreaders, legal experts and editors, transcription outsourcing service providers use advanced technology, dictation equipment and software to provide quality legal transcripts in minimum turnaround time. Cost-effective transcription solutions are available for client letters, memorandums, wire tap, general correspondence, reports, interrogations, trials, judgments, briefs, minutes of seminars and conferences and so on.

How it can help you save money

Outsourcing legal documentation jobs to an experienced legal transcription company ensure an assortment of benefits in terms of money, time and effort. The major advantage is that you can reduce the number of people who work for you. Thus, you can save money spent on

Salaries

Employee benefits such as payroll taxes, health insurance, medical office space, paid vacation time, workers' compensation insurance, and more

Ongoing training

Human resources for recruiting and handling turnover

Management and administration

Setting up office space and utilities

Technical support: When you outsource you need not have to maintain additional personnel for technical support. The transcription companies provide you with continuous technical assistance.

Major Benefits of Legal Transcription Outsourcing

As the legal transcription firms hire professionals to do the work, you have experts working for you without paying any thing for their services. Also, they help you to free up your resources and personnel to work on core business activities. These transcription firms offer services at low rates and provide accurate customized transcripts. They usually have a turnaround time of 24 hours, preventing any kind of backlog. Well-planned legal transcription services ensure the following additional benefits:

Error-free and timely updated legal documents

Reduce bulk paper work in your practice

Minimize backlogs of legal files

Easy retrieval of files at any time

Maintain legal documents in user-friendly file formats

Outsourcing solutions are available for busy lawyers, paralegals, attorneys and other legal professionals. Legal transcription outsourcing services save their valuable time and money, and allow them to focus on their core business and improve their bottom line.

http://ping.fm/BTPx9

SemTechBiz Conference ? Call for Presentations Open until January 16

2012-01-17T06:08:00.005-08:00

SemTechBiz is returning to San Francisco on June 3-7, and once again we plan to make it the biggest and most comprehensive educational conference on the business of semantic technologies. And that’s exactly where we are asking you to contribute please – by sharing the practical experience you have gained in your own semantic projects.

We’re looking for case studies big and small – whether you’re building the semantic infrastructure of the future, like the DoD Enterprise Web, or you’ve done semantic annotation on a local business web site, like Plush Beauty Bar. They’re all relevant, because the curiosity of the audience is so rich and diverse.

The�Call for Presentations�ends on January 16, 2012, so get your abstract together ASAP. All the information you need, and the links to submit your presentation proposal, are�HERE.

Conference registration is also open. Register by February 17 and save with substantial early bird discounts.

If you have any questions, feel free to email me at Tony@SemanticWeb.com

Thanks,

Tony Shaw

A Brief History of Classification

2012-01-17T06:08:00.003-08:00

Girginakku at Glencairn. These clay tablets were used for many purposes, including cataloging.

The earliest known means of classifying an object and keeping it in order are girginakku. These are ancient Mesopotamian clay tablets that were attached to scrolls and tablets and used to identify the contents. Examples of approximately 5300 years in age can be found in the British Museum.

Girginakku at Glencairn. These clay tablets were used for many purposes, including cataloging.

The famous Library of Alexandria in Egypt housed one of the earliest forms of library catalog in the third century BCE. The library reportedly housed more than 120,000 scrolls which were stored in bins categorized by subject. Each of these bins was labeled, and the labels were indexed in Pinakes. The taxonomy of subjects was devised by Callimachus, the second recorded librarian at Alexandria. He created a system with 11 main categories: six genres and 5 kinds of prose (6 categories for non-fiction, 5 for fiction.) These were rhetoric, law, history, medicine, mathematics, natural science, epic, tragedy, comedy, lyric poetry and miscellaneous. The influences of this system are still seen today in such systems as the Dewey Decimal Classification system.

Beginning in the 8th century CE, the Islamic library at Baghdad, The House Of Wisdom, began collecting books in earnest. The knowledge of papermaking had been acquired from Chinese prisoners and books proliferated. This is akin to the explosion of digital information we see today. These books were organized into genres, categories and sub-categories to make them easier to manage until the library was destroyed by a Mongol invastion in the mid 13th century.

The Leiden University Library, The Netherlands, created the first printed institutional library catalog shorty after it opened in the late 16th Century. The book was titled Nomenclator, and was a list of all authors whose books - in manuscript or print - were available in the library. The Library continued on the leading edge until the 20th century: it was among the first to use cards for its catalog and in 1969 began work on an automated system which was bought by OCLC in 2000. OCLC maintains WorldCat, the Worldwide Catalog, a machine system for libraries large and small, private and public, worldwide.

In 1735 Carolus Linnaeus published his Systema Naturæ, more commonly known as the Linnaean or Animal Kingdom taxonomy. Most of us are familiar with this system from grade school biology - there are three kingdoms (animals, plants, minerals) which are divided into classes, orders, genus and species. This is purely hierarchical in nature, and while it is capable of greater things, is used as an information placement tool mostly by non-biologists - akin to navigation taxonomies today. When you speak to people about taxonomy, this is often what they think of, and it is very useful to have some examples of similarity and differentiation at the ready to explain how your own taxonomy relates.

Three hundred years later Melvil Dewey created the Dewey Decimal system, which organizes artifacts by subject into 10 main categories. This system took hold quickly in the public and school libraries in the United States. The Library of Congress created their first dictionary catalog a couple of decades later in 1898, the Library of Congress Subject Headings. This is the basis for cataloging and classifying all of the works that are in or are sent to the Library of Record in the USA. These catalog entries are the basis for a fee-based service which generates income for the LoC. It charges other libraries for copies of their catalog cards so that the subscribing library doesn’t have to do the cataloging work themselves.

In the middle of the 20th Century an Indian mathematician and scholar by the name of Ranganathan created Colon Classification, a system still in use in Indian Libraries today. He posited that everything could be organized under 5 key facets, combined appropriately for the resource: Personality, Matter, Energy, Space, and Time. Each of these facets has a controlled value entered which is obtained from a taxonomy or thesaurus. The delimiters between the facets is a colon, and they are always entered in the PMEST order. This type of faceted taxonomy is a more practical solution for cataloging items in a digital world. Rather than having to have a list of 10k items, one can have 4 lists of 10 items, which is much easier to manage. This is NOT a rule - it is an example. Each application has its own business requirements.

Taxonomies in the enterprise reach back further than one thinks, but became known to researchers in 1858 when the NY Times began its index to the newspaper. It became such a valuable tool that publishers began indexing books and periodicals and publishing such - H.W.Wilson is a great publisher of indexes. The Reader’s Guide to Periodical Literature is one that most school students are introduced to. Database providers and large academic/scholarly/professional publishers added this capability early on as well. Proquest/Gale/Cengage, Dialog, Factiva, Reuters, IEEE, ACM all have indexes. Large government organizations also have indexes organized by subject taxonomies or thesauri: NASA, DTIC, NIH, BLS, CIA, NAICS, SEC.

Taxonomies for the enterprise and the web as we know them today began as experiments in search improvements in the 1990s. Yahoo’s first release and Open Directory were clearly a librarian-like effort to organize the then small web. Those categorization structures were re-created within the realm of Natural Language Processing - math with letters. Pattern matching is the basis for much of what occurs in these systems for rules based categorization. In simplest terms, a rule which tags a piece of content with a term from the taxonomy is an if-then statement.

Efforts are underway to transform semantic systems into more than just known item or NLP derived labeling to systems capable of contextual understanding. Ontologies are the means by which much of this effort will be accomplished in the short term. An ontology is more advanced than a taxonomy as it an contain self-defined relationships beyond that of parent-child. It can also be used to infer data and reason over information. The World Wide Web Consortium is one of the key leaders in efforts for standards in this space, as a semantic space is what Tim Berners-Lee had in mind for the web from the beginning.

This article was originally posted at http://ping.fm/N9Nzq

Future Enterprise - The Future of The Internet

2012-01-17T06:08:00.001-08:00

David Hunter Tow – Director of the Future Planet Research Centre, forecasts that within the next decade the Internet and Web may be at risk of splitting into a number of separate entities- fragmenting under technological, national, business and social pressures.

In its place may emerge a network of networks – continuously morphing- linking and fragmenting, with no central dominant domain backbone; instead a disconnected, random structure of networks with information channeled through uncoordinated switching stations and content hubs, controlled by a range of geopolitical, social and enterprise interests.

For authoritarian states such as China, North Korea, Iran and Syria as well as criminal cartels, this will facilitate the expansion of their operations, allowing them to circumvent exposure of illegal activities in much the same way as the current Darknet network.

Darknet- the alternate network of virtual channels that currently operates beneath the backbone of the Internet has long been a place for clandestine operations, by both criminal and state networks. It is also used as a tool by cyber authorities to provide evidence of DDoS, port scanning, worms and other malware; also allowing dissidents from repressive regimes to remain in touch with the outside world, providing protection to whistle blowers and hosting pirated movie and music sites- out of reach of traditional search engines.

Autocratic governments are also maintaining increasingly tight censorship over politically sensitive sites via controlled points of entry to their cyber fiefdoms, even to the extent of distorting current and historical events. Both China and Iran now have plans to establish their own Internet infrastructure to further strengthen the control and censorship of their populations and no doubt other authoritarian states will follow. But this power won’t be limited to dictator-run states. The increasing threat of Internet censorship via the proposed SOPA- Stop Online piracy Action legislation in the US, confirms the threat facing online freedom even within democratic nations and has already motivated opposition by major Web companies concerned about the arbitrary blocking of any site considered deemed to be infringing copyright laws.

At the same time white hat hacker groups plan to launch their own communication satellites linked to a grid of tracking stations in order to avoid such Government surveillance and interference, as discussed at the recent Chaos Communication Congress in Berlin

But Apple, Facebook, Google, Amazon as well as Cable and Internet TV companies have already begun to fragment the web to support their own Walled Garden strategies of quarantining and manipulating membership data, applications, entertainment, search results and identities. Facebook membership data cannot be transferred to other social sites. Adobe’s Flash software as well as a number of developer applications were banned by Apple, which means the iPhone browser cannot display a large portion of the Internet. Likewise Amazon’s Kindle will only display books on sale or for rent by the company. Google Plus fails to adequately attribute search results to original sources and multiple Ids are banned.
Such social sites have become closed silos, similar in many respects to those of authoritarian sites such as China.

The more this type of restricted, proprietary architecture gains traction on the Web the more it will become fragmented and the easier it will be for criminal groups to exploit, placing the open and egalitarian charter of the future Internet at risk.

But there are compelling reasons why such closed silo strategies, introduced by Governments or Web companies are likely to eventually collapse.

As outlined in previous blogs, physics ordains that information flows cannot be constrained and will eventually spread by pathways of least resistance, driven by consumer demand, competitive pressure and technological advances. In addition, biological ecosystems with limited genetic variation are the most vulnerable to extinction. Companies within the cyber ecosphere are equally vulnerable- more susceptible to competition and rapid changes in their technological and social environments if open access to innovative ideas and information flows is restricted.

The emergence of the Semantic Web is also a catalyst for greater openness, facilitating the interpretation, linking and application of knowledge stored in millions of discrete databases across the Web. This is a vital advance in fostering greater transparency, flexibility and autonomy within the Cybersphere.

But the battle for web control and Internet supremacy is only just beginning, not only between the US and China but also involving all other nations in the newly emerging multi-polar world. The US still maintains the controlling votes in ICAAN - the Domain management company, despite many attempts to democratise its management.

But now the US will be forced to flex up and stop playing the role of alpha male in an increasingly equal and diverse information world.
By its obsession with maintaining technology dominance of critical assets such as the Web, particularly in a time of global warming, with an urgent need to effectively manage global resources for all populations, the US is ironically accelerating the rise of alternate Internets and Webs.

China is charging ahead with alternate communication networks, as in most areas of new technology. After all its search engine - Baidu, already has 500 million users - almost as many as Google worldwide. Baidu works hand in glove with the Central Communist Party and is the ultimate arbiter of reality for its users, committed to working within the Government's paranoid censorship parameters constrained by a massive firewall of 50,000 Internet police. But with 200 million bloggers producing trillions of words a day as well as subscribers to RenRen and Seina Weibo- the equivalent of Facebook and Twitter, it’s becoming an increasingly tough call- even for a totalitarian government.

So now the momentum is building for a multi-Internet infrastructure as governments of all colours attempt to impose their will and dominate the evolution of the pre-eminent artefact of our civilisation, which may hold the key to the planet’s survival.
In the short term China cannot replicate the mega optic fibre cable, satellite and server networks of the present Internet, but it can deploy a mesh of alternate channels linking its own network assets to other friendly systems, for example in Africa, South America, Iran and Russia; at the same time constructing a topology complete with their own domain servers. In addition, it will develop its own knowledge hubs while leveraging the existing core public assets such as the priceless science, engineering, social and economic databases of the current Web.

The new US Net Neutrality rules recently introduced to prevent balkanisation are already under heavy fire, with broadband providers prevented from engaging in anti-competitive behaviour by blocking content or slowing access to sites and applications, as Comcast attempted to do in 2007 with the BitTorrent "peer-to-peer" protocol.
But as the pressure to bypass the new rules to allow a multi-speed Internet has increased, so too have the tensions been building between the major Social Web, Broadband and Cloud providers- Google, Apple, Facebook, Cisco, Verizon, Amazon, VMware etc. Cloud vendors have been erecting a new set of proprietary firewalls, with VMware the exception, adopting an open architecture to encourage developers to leverage and extend its technology.

The more such closed architecture with differing operational and security standards gain traction however, the higher the risk that the CloudSphere will eventually become fragmented, less productive and more vulnerable to hacking.

Meanwhile, despite its financial problems, the EU plans to spend billions on boosting broadband speeds to increase productivity and competitiveness. The European Commission will spend 9 billion euros to rollout super-fast broadband infrastructure and services across the European Union to help create a single market for digital public services by 2020 for half its population including- e-health, intelligent energy and cyber security applications, assisting utility companies, construction cooperatives, public authorities and rural users.

New Internet Architecture options are also on the horizon, with a number of innovations in train, forecast to improve the Web’s flexibility while avoiding fragmentation. But these could be put in jeopardy by the US’s intransigence over ceding control.

For example the National Science Foundation has established the Future Internet Architecture program- Nebula, to better secure Internet- Id verification, data safety, mobile access and cloud computing. Google is also setting up a new Web architecture to improve search effectiveness.

At a recent Internet Conference run by the European Paradiso Group, a number of advanced options were discussed including- Internet routing algorithms with quantum options to provide more efficient and secure routing paths; flexible spectrum allocation; a smart Internet environment enabled by networked sensors; a content and context aware Web combined with self-organising and self-adaptive capabilities to provide more autonomy and optimisation.

In addition, the proposed Named Data Networking (NDN) architecture shifts the communication emphasis from today's focus on resource addresses, servers, and hosts, to one oriented to content and context. By identifying data objects instead of just locations, NDN transforms data into the primary Internet focus. While the current Internet secures the channel or path between two communication points, adding data encryption as an extra, NDN will implicitly secure content security and trust.

These and other advances will result in the emergence of Internet Mark 3.0, following its early incarnation as a simple packet data transfer system and then transforming into a pervasive information search powerhouse over the last decade

But Internet 3.0 will only emerge if fragmentation of its infrastructure and the ensuing chaos is avoided

Internet Mark 3.0 will offer- complex multidimensional and ultra-efficient processing and the dissemination of realtime, multi-services and decision-making based on content and context– not just physical objects.
Such capability will drive societal transformation at hyper speed catalysing - urbanisation, mobility, vastly improved health and education services and all forms of virtual reality, as well as the beginning of a truly symbiotic web-human partnership in complex decision-making.

The Future of the Web has been discussed in a number of previous blogs by the author.

In summary-

By 2015 Web 2.0- The Social Web- will have developed into a complex multimedia interweaving of ideas, knowledge and social commentary, connecting over three billion people on the planet.

By 2025, Web 3.0- The Semantic Web- will have made many important contributions to new knowledge through network science, logical inference artificial intelligence. It will be powered by a seamless, computational mesh, enveloping and connecting human and artificial life and will encompass all facets of our social and business lives- always on and available to manage every need.

By 2035, Web 4.0- the Intelligent Web- will be ubiquitous- able to interact with the repository of all available knowledge of human civilisation- past and present, digitally coded and archived for automatic retrieval and analysis. Human intelligence will have co-joined with advanced forms of artificial intelligence, creating a higher or meta-level of knowledge processing. This will be essential for supporting the complex decision-making and problem solving capacity required for civilisation's future survival and progress.

Also by 2035 the last of the enterprise walled gardens will break down and leak like stone walls surrounding an ancient town. Techniques and technologies across the spectrum of knowledge will continue to spread, expand and link in new ways as they always have, bypassing temporary impediments, because that is the physical reality of information and knowledge.

The future Internet will inevitably follow these laws- becoming more open and flexible, using common protocols as enterprises and consumers demand greater flexibility. As an increasing number of data providers begin to implement Tim Bernier Lee’s Linked Data principles, it will transform into the creation of an open global Infosphere containing billions of links and coordinated by the World Wide Web Consortium.

This will offer a blueprint for connecting information from different sources into a single global data repository, with the Global Commons and Public Domain models playing an increasingly important democratic role.

Most importantly the Web will be equally available to and controlled by all nations, under the auspices of a specially constituted UN body, devolving forever away from US control.

But this can only happen if the underlying structural integrity of the Internet and Web is preserved. If managed as a global cooperative project it will result in enormous benefits for the whole of humanity. But if the Future Internet splits and fragments along geopolitical and competitive lines, as its current evolution suggests, then much of its potential benefit for our civilisation and planet will dissipate.

The future of this pre-eminent human-engineered living organism of the 21st century is now in the balance..

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

Festive Season brings 10% off on all Car Rental Services

2012-01-10T08:55:00.000-08:00

For all those packing your bags for vacation, car rental services will come handy as you go about exploring your destination. Hiring a car very much in advance should make your holiday cozier and you can avail discounts. The good news is NWT International is offers good discount of 10% to celebrate this festive season of Christmas!

India is one country that draws a huge number of tourists. The cultural diversity and other historical legends are a good pull. Plus, when the peak season has set in tourists would have already decided their respective destinations. Over a period of time, the condition of roads in India has been improved significantly. No matter what their destination is, tourists can hit upon a quality car rental service company. They can hire affordable as well as luxury vehicles and also the cars that cater to the need of travel in India. By hiring a car travelers can set their own pace to their and eventually save time and money as compared to what the public transport delivers.

For the most royal and luxurious travels you can even hire a Limo and frame the exotic experience in your memory forever. As a matter of fact, most travelers now want style, which is way beyond the ambit of service. Hiring a BMW, Mercedes and even a Limo is no uncommon these days. Shamil Vora, CEO of NWT Limo said, “Currently, the market trend clearly explains for the customers’ desire for style apart from quality. So, companies are renting out premium luxury cars for greater revenue and lure high end customers”. The luxury car segment is booming at the rate of almost 28% whilst the entire car rental industry is between 12% to 14%.

Since you’re travel will always be outside your own city, hire the airport transportation too to get to the airport conveniently as and when required. Rather than hiring a radio taxi, contact NWT International, a company that can provide you best quality airport transportation service. There are a lot of problems with hiring a taxi. It can lead to inordinate delays, possible break down, etc. The transportation will very much be available in all tourism based cities; however you should do some homework. It is better to book that in advance and also do some research about their service.

Ahead of your holiday you can also choose from a variety of tour packages like history tourism, adventure tourism, spiritual tourism & beach tourism. For adventure lovers, diversity is extraordinary – from the heli-skiing in the soaring Himalayas to the white water rafting on the Ganges, Indus as well as Teesta. For spiritualists, visiting the shrines is like discovering the heartbeat of the nation. Arguably, tourism is one of the indispensible parts of India’s economy.

To avail the most affordable and quality holiday packages, car rental including Limo services and airport transportation you got to turn to us. NWT International is one of the market leaders. Our organization strives not to comprise on quality at all and yet provide the most affordable services, which consumers always yearn for.
Get in touch on info@nwtlimoint.com and await the Seasons Best Discount offer!

About eToursTravels

etourstravels is the leading tour operator in Ahmedabad India, providing personalized tour packages. Founded in 2009, it assists guests from all over the world by offering them highly unparalleled services to materialize their acation dreams in a hassle free way. It also offers pre-designed tour packages, Accommodation bookings, Bus/Train/Air ticket bookings, Vehicle rentals, guided tours and Airport pick-up/drop-off services.

For more information, call +91 - 98246 84545 or visit http://www.etourstravels.com.

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Be Sure That Know ? So Why A Medical Transcription Career Is Really A Prudent Decision Money-wise

2012-01-10T03:34:00.001-08:00

The healthcare approach draws inputs by various sources for instance pharmaceuticals, laboratory services in addition to information from individual records etc. Quality and competitive pricing will also be positive factors which in turn enable healthcare clients to possess their transcription work outsourced to these kind of firms. Developing good patterns requires practice which may seem tedious in the beginning, but will in due course save time. Many countries in foreign lands have outsourced their own work to states like India, which has a considerable English speaking human population. Choosing a program that may be self-paced can turn out to be tricky, because it means you can complete it every time that works for yourself.

Medical transcription will be most outsourced job inside the healthcare industry and will get the aim for reducing both time period and cost factors active in the daily documenting connected with patient details. Hence, when it relates to giving lectures, seminars, etc medical transcription provides quite a lot of help to these folks. MT requires correct spelling however terms and ideas, occasionally correcting healthcare vocabulary or transcript issues. If you work place is good as opposed to your performance gets increases and you also give better results than with the disturbed environment. Such an EMR might be both efficient and cost efficient.

Outsourcing medical transcription considerably minimizes the workload of your healthcare experts and enables those to concentrate on the core treatment pursuits. Most people get deeply into this career thinking they can simply work without having experience and make thousands phone. Turnaround time commitments are followed using the appropriate team, right processes plus the right technology. This also maintain a pool of additional benefit from eliminating indirect cost which would have been sustained by executing using this method in-house. The person who performs this system is a transcriptionist. These inputs are invaluable from litigation where the physician has to rationalise the diagnosis as well as the treatment provided. This has showed numerous job business opportunities and has proved to be extremely useful to many people. An easy plus convenient option on the market to healthcare facilities regarding medical transcription might be that of outsourcing their would need to a professionally managed supplier who will provide customized solutions to manage their transcription requires.

Different modes involving document delivery such as automatic printing, faxing, delivery to particular folders, access of transcripts for you to multiple users and so on. If you are receiving paid by this line, that price may possibly be a little pretty much depending on what number of reports you can easily produce. Most health records have a doctor’s verbal description on the patient’s condition that may not be narrowed down on the predefined categories of your point and push system available thru many electronic wellbeing records. It is actually a life-long investment that really needs transcribers to consistently study reference fabrics, technology, and medical language. For new employees, professional training is it being given to gain higher accuracy levels demanded by industry. Keeping a day to day schedule of events will help you manage your period. This is really important for ensuring you do have accurate plus reliable medical records delivered when they’re due. Medical practitioners not to mention their staff utilizing busy schedules have short while to allot meant for researching medical transcribing service companies. These reports are then delivered back to the health care professional. However, in order to be certified, you need for you to earn continuing knowledge credits every a couple of years.

This article was originally posted at http://ping.fm/fiCu5

Medical Transcription: A Versatile Tool for Hospitals beyond Managing Costs

2012-01-06T05:29:00.001-08:00

In a recession hit market as USA, even the medical industry, which is closely connected to the critical aspect of human life, is not less affected. Therefore, it is not strange to see clinics and hospitals in US resorting to cost cutting measures and going in for affordable outsourced services. Medical Transcription, the prerequisite for medical documentation in modern times, has received obvious significance as an outsourced service in recent years, with affordability being considered one major aspect., and looking to the increased demand of medical transcription operators and services in US alone, this will continue to be in focus, for variety of reasons including cost-effectiveness.

As a major attribute associated to medical transcription, comes the convenience to document the sequence of events carried out between a doctor and his patient. This facilitates documenting the most crucial details involved in any case in the form of a soft copy, post medical transcription of a given audio record. This way, hospitals get all the details such as patient’s health profile, medication and consultation provided by concerned physician, along with every minute point so as to carry out his treatment, by way of medical transcription. Needless to emphasize, if hospitals don’t take help of medical transcription services, they must be doing it through in-house resources. In other words, hospitals or clinics save considerable amount of time, resources and cost by hiring a medical transcription service provider.

When cost is a concern, you can never think of spending lavishly & medical transcription is no exception in that respect. The present online buzz has simplified things for better, as medical transcription services can be as well availed overseas. Sitting in US, a hospital management can employ a medical transcription agency in India or elsewhere and still ensure up-to-date documentation of its medical records. When medical transcription within the country is not coming reasonably, hospitals prefer the overseas way & grab good deals with a medical transcription agencies located abroad.

A handy modus operandi is another feature coming with medical transcription. When hospitals lead the medical transcription way, they indirectly simplify the job of their support staff & back office workers who might be less acquainted with intricate medical terminology. A good medical transcription agency will usually ensure that it produces medical documents that are multipurpose & easy to understand at every interface. So the objective to generate a simplified version of the most complex lingo spelled out by medical practitioners gets met through this document generated by medical transcription provider.

In a country like USA, essentiality of medical transcription cannot be less stressed also because documenting patient details & health records is mandatory for hospitals. Furthermore, healthcare facility centres are operated in high-tech environment and therefore, professional functioning of these centres can be ensured only with the expertise coming with medical transcription specialists. Ideally, such medical transcription service providers use high degree of security channels such as HITECH or HIPAA Compliance and ensure a secure & authentic edge to medical documentation.

Affordability is definitely one aspect when zeroing down on a medical transcription agency within the US or abroad, but given the assorted advantages coming along with medical transcription services, hospitals can look forward to a really sophisticated work environments in their purview.

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/T2lex

Why Business Transcription Essential for Business Communication

2011-12-30T03:08:00.003-08:00

Do you record your business conversations?

If not, here is why it is all important that you have an audio recording of your business communications. Thanks to the opening up of global trade regulations and the influx of outsourcing, more and more businesses have a presence across the globe. And most business deals, pacts and partnerships are more often than not conducted and agreed on a transatlantic phone call or a video call.

A recording of your conversation is not an added advantage but mandatory to avoid disputes and lawsuits later on.

Why is a recording essential?

A recording of your business communication is essential as it is not humanely possible to remember every word you uttered during a business call! A recording of all your electronic business communication serve as a legal proof and can also prevent you from shelling out time and dollars, trying to remember or debating over, trivial issues.

It doesn’t take an expert to figure out that, most brilliant ideas and suggestions, made at the conference room hardly make their way to employee’s desks! An audio or video recording can be a smart way of making sure that, that interesting idea gets implemented rather than remaining a vague memory few weeks later.

Confounded about the ethicality of the issue?!

“I usually record all my sales meetings, board meets, presentations, conference calls and when I listen to the recordings later, I feel like an eavesdropper or a seedy secret agent” says Mr. David who runs an advertisement firm. But the fact of the matter is that recording conversations has become a necessary evil in the business set up. If it makes you feel queasy, know that arguing about a conversation you had is certainly not a very pleasant or ethical option either.

Wondering if it’s legal in the first place

It certainly is, but the regulations and laws change from place to place, and recording telephonic business conversations comes with a whole baggage of legal ramifications. There are some states that require the consent of all people involved in a conversation like California, Washington, Nevada, and in some states like Alabama, New York the consent of one person involved in a telephonic conversation is enough.

It can get a little confusing (not to mention scary) if you make a business call from New York to your vendor in California. Legal expert’s advice to get the express consent of all parties involved in the telephone call if you don’t want to risk being on the wrong side of federal wiretapping laws.

Business Transcription Outsourcing - Accurate Business Transcripts

2011-12-30T03:08:00.001-08:00

Organizations with in-house business transcription services might often find it expensive to maintain office staff for the purpose. Transcribing business proceedings involves a lot of time and effort. A professional business transcription company can help in this regard, by providing quality business transcription services to help organizations organize their transcription processes.

Business transcription services are available for clients from various industries such as financial, retail, advertising, automotive, packaging, healthcare, technology, media, education, medical, transport, and more.

Major Benefits of Outsourcing

Listed here are some of the benefits of outsourcing business transcription services to business transcription companies.

Experienced and well-trained team proficient in business communication is at your service

Quick turnaround time

Save money as well as valuable time

Reduce infrastructure investment

Stringent quality assurance processes

Accurate and efficient services

Time zone differential gives customers access to 24/7x365 workdays

Free trial offer

Capability to work on a number of file formats

Transcription Services for Diverse Business Processes

Business transcription outsourcing services include transcriptions of meetings, conferences, seminars, boardroom discussions, interviews, annual general meetings, shareholder board meetings, focus groups, teleconferences, computer desktop dictations, lectures, speeches, press releases, mobile dictations, employee surveys, insurance claims, forecast meetings, business meeting recap, training session and group discussion.

What you have to do is simply send the audio and video files to your business transcription serviceprovider.Thecontent for business transcription is received from any source including standard/micro cassettes, DAT, VHS, audio files, (.wav, .vox, .dss, and .mp3) and the Internet.

Business transcription outsourcingcompanies will convert the audio visual content into ready-to-publish transcripts in the format of your choice. To ensure the accuracy of business transcripts, the completed transcripts are re-verified, proofread and reviewed. Once the process is complete, the transcripts are sent to the customer via email or FTP or in any other manner preferred by the customer. Foolproof security and confidentiality of the data is ensured through stringent security measures.

To make sure that you get accurate business transcripts, business transcription companies are equipped with an excellent team of transcriptionists, proofreaders, quality analysts, and editors. Their expertise and state-of-the-art technology helps to deliver professional business transcription services. Their command over English language and business terms, their comprehension skills, time management skills and capacity to listen to every word ensures clients quality business transcripts.

Getting accurate business transcripts has become easy now. Today there are many professional business transcription companies that provide consistent, accurate business transcription services on time, and at competitive pricing.

This article was originally posted at http://ping.fm/dj639

What is Clinical Data Mining?

2011-12-08T05:50:00.001-08:00

Clinical Data-Mining (CDM) involves the conceptualization, extraction, analysis, and interpretation of available clinical data for practice knowledge-building, clinical decision-making and practitioner reflection.

Clinical data can be obtained from various sources like Medical Transcript Files and Electronic Medical Records (EMR). We can create a new Clinical database which accumulates large quantities of information about patients and their medical conditions using these two sources. Relationships and patterns within this data could provide new medical knowledge.

Importance of Clinical Data Mining:

In Year 2010 more than 30 million people were treated for life threatening diseases. Cancer and Heart Disease are few of them. Identification of early signs of cancer and heart disease is possible and can save thousands of lives. Analyzing a database of thousands of patients which can provide valuable information about the probable causes, nature of progression, etc., can help in developing systems that could identify disease at the earliest signs of occurrence leading to timely treatment and preventive techniques.

Every year, new guidelines come out regarding the usage and the dose of different drugs. Sometimes guidelines show some drugs taken in combination can produce adverse effects. The latest example of the same is :

June 8 2011, the FDA came out with new guidelines for the use of simvastatin, particularly noting specific combinations of medications that are now defined as "contraindicated" with simvastatin at any dose.

Using this knowledge database we can find the patients taking those contradicting drugs.

Approach of Clinical Data Mining:

The process of Data Mining is divided into four phases: i) Data Collection ii) Pre-Processing iii) Data Parsing iv) Application of Knowledge

Data Collection: Clinical Data of any patient is stored in two Different formats. i) Medical Transcript File (contains 25 to 30% of information) ii) EMR (contains 75-80% of information).In this phase, each patient information of transcript file and EMR is mapped.

Pre-Processing: To get accurate output from the parser, the input document needs to be in Clinical Document Architecture (CDA). So in pre-processing phase given input document is converted into CDA format.

Data Parsing: Pre-Processed Data is parsed into a single structured format. Here negation, Snomed Codes, Rx-Norm Codes, ICD-9 Codes, Body Measurements, Drug Dosages, Smoking Status and Allergies are detected.

Application of Knowledge: Using this knowledge we can create a new Database, and querying the database can be useful in medical research and in improvement of patient healthcare. For-example we can query:
1. What is LDL laboratory level? Is it below 100? Do they also have MI (history of heart attack)? If so is LDL less than 70.
2. If EF < 40%, needs 2D Echo and 3D Echo
If EF still remains < 40%, needs EP Level 4

If EF < 35%, needs AICD

About ezDI

The Company is one of the leaders in business intelligence and healthcare analytics that aim at improving the quality of services in healthcare and reducing costs. The company offers integrated solutions with a single data feed, and increases the industry’s speed, accuracy, flexibility and value overtime.

For additional information, please visit http://www.ezdi.us .

Importance of Transcriptions Services in Businesses

2011-12-03T05:23:00.001-08:00

Transcription is nothing but a process of transcribing, which involves the transforming of data from one format to another. The process of data transformation can involve transcribing audio into text format, hard copies into digital format, from video files into text format.

In businesses, transcribing process plays a very important role. It helps entrepreneurs to have a documented text format of various video files and audio files of the company. And, in the video data transformation, it also allows people to hear its audio version perfectly and convert into a written format in consistent manner. The organizations into businesses can outsource their transcription work to the companies with experienced and highly trained professionals called data transcriptions.

Transcription Services are available in a variety of formats. In order to come up with a perfect and error-free copy from the files, the service provider makes the use of customized and optimized software that helps the professionals in carrying out the work successfully. Here, the professionals are required to listen closely to the audio transcripts or review the hard copies carefully and type out the data simultaneously. The entire process of transcribing is carried out with an aim to convert spoken language source into a written or printed form.

With increasing globalization, Medical Transcription Companies from offshore countries offer very seamless and cost competitive transcription services. Apart from it, the transcription company also gifts several benefits to the organization seeking transcribing service.

First, its benefit is clearly palpable through its cost saving process. Outsourcing data transcribing services certainly helps in reducing the overhead costs of the company. At the same time, it also decreases the costs associated with payroll and benefits expenses significantly.

Two, it allows the company to achieve growth in skills and expertise. If a company outsources its transcription works to the offshore service provider, it certainly receives superior practices, skills, jobs and technology that are employed in the work processes. It also provides an access to ownership workflow systems, process re-engineering skills, and productive staffing and delivery models, combined with state-of-the-art technology delivered by experts.

Lastly, transcription services allow the organizations to focus more on its core business goals and objectives. It also enables companies to avoid capital expenditures to a greater extent. With an idea of outsourcing the transcription work, the company does not need to recruit more in-house professionals for transcribing and this relives them from the responsibility of maintaining training a dedicated staff for that purpose. While with the outsourcing of transcribing work, the accountability and control costs are transferred to the service provider.

So, go for the services that help in saving money along with effort, thereby giving you growth in the business.

Read more: http://ping.fm/yISN8

Training, EMR tracking can slash risk of radiation overdoses

2011-11-29T03:20:00.003-08:00

Knowing how many diagnostic images a patient has had over a lifetime can help physicians and patients weigh risks and benefits before using more radiation imaging, says Boston emergency physician Adam C. Levine, MD. [Photo by Ted Grudzinski / AMA]

The American Medical Association House of Delegates adopted new policies aimed at preventing deadly radiation overdoses and curbing the cumulative lifetime impact of radiation from diagnostic tests such as computed tomography.

Delegates at the November Interim Meeting voted to support education and standards for the medical personnel, usually nonphysicians, who use ionizing and nonionizing radiation to ensure that they know how to avoid over-radiating patients. The AMA also will support raising awareness among patients about medical radiation exposure.

The AMA will encourage the development and use of electronic medical record systems that track the number of imaging procedures a patient has received in inpatient and outpatient settings.

"The American Medical Association has been working toward solutions for reducing medical radiation exposure, and new policy adopted by the AMA promotes the safe use of medical imaging devices and supports proper training for the medical personnel who use them," said AMA Immediate Past President Cecil B. Wilson, MD.

"The AMA encourages the continued development and use of standardized medical record systems to help physicians track the number of imaging procedures a patient has received to help mitigate the potential dangers associated with cumulative radiation exposure," he said.

More than 60 million CT scans are ordered each year.

Knowing such information can help physicians and patients more meaningfully consider the risk-benefit ratio before proceeding with a medical imaging study involving radiation, said Adam C. Levine, MD, a Boston emergency physician and an alternate delegate for the American College of Emergency Physicians.

"The emergency department where I work recently added this exact feature to our EMR, which allows me to click one button and see the total number of abdominal or chest or head CTs that any given patient I am seeing has had," said Dr. Levine, who spoke on behalf of the college as well as the Young Physicians Section in reference committee testimony. "One patient I was working up recently for renal colic had already had 39 prior abdominal CTs, and another sickle cell patient in whom I suspected [pulmonary embolism] had no less than 55 chest CTs. Simply having this knowledge allowed me to adjust my diagnostic plan for both these patients to protect them from further ionizing radiation while still leaving the clinical management plan entirely between me and my patient."

More than 60 million CTs are ordered each year, and between 30% and 40% are clinically inappropriate, said research cited by the AMA's Physician Consortium for Performance Improvement. This year, the consortium adopted performance measures to help physicians reduce both CT radiation doses and unnecessary testing.

Delegates also directed the AMA to support campaigns initiated by the American College of Radiology and others. One is Image Wisely, which focuses on reducing radiation doses and eliminating unneeded testing in adult patients. Another is called Image Gently, which targets improvements for pediatric patients.

This article was originally posted at http://www.ama-assn.org/amednews/2011/11/28/prsf1128.htm

Greening your technology: A high-tech way to save the planet

2011-11-29T03:20:00.001-08:00

Illustration by Jon Krause after Henri Rousseau

Since he was a teenager, Daniel Wolk, MD, a family physician in the suburbs of Philadelphia, has had a passion for protecting the environment. Now that he is physician, he sees energy conservation as a key component to patient care.

"My driving philosophy is that my patients will be most healthy when they have a healthy environment to live in. So I feel as a physician I have a role in helping to make that happen," he said.

Dr. Wolk has implemented behind-the-scenes initiatives aimed at cutting the amount of waste at his practice. This includes reducing wasted energy by adopting certain habits with technology use. His practice unplugs chargers when the devices aren't in use and sets computers to go to sleep after a period of inactivity, shutting them down completely at night. His practice uses recycled computer equipment. He has found that each step is small when measured alone, but that they add up to more significant results environmentally and financially.

Christina Vernon, an architect who leads the Office for a Healthy Environment at the Cleveland Clinic, said most people think of construction as the only opportunity to "go green." But green initiatives have as much to do with the way a practice operates as they do the materials used to construct the building that houses the practice. A large component is the technology used to run the practice.

"Practices will become environmentally friendly the moment they implement an [electronic medical record] system," said Barry Haitoff, CEO of Medical Management Corp. of America. Going electronic will significantly reduce the tons of paper typically used by most physician practices, he said.

But practices can take it a step further and look at the energy consumed by the technology it adopts. So it's not just about going electronic, but also about choosing the right computer equipment and the most eco-responsible vendors, training office staff on best practices, and knowing what to do with electronic equipment when it's ready to be discarded.

Decisions that have low impact on the environment also affect the bottom line, experts say.

Dr. Wolk sees another difference in addition to the energy he saves by running a "green" practice -- the hundreds of dollars shaved off his utility bills each month. His advice to physicians starting green initiatives: "Look at what's called the triple bottom line. That means not only the profit and costs of how you're setting up your practice as a business, but also looking at the environmental costs and the benefits of the choices you're making and also how they're interacting with your monetary bottom line," he said.

"Power savings will ultimately lead to money savings."

Buying green
Whether a physician office has a full-blown EMR or a practice management system, it's likely that the office has at least one computer in its inventory. When purchasing computers, the easiest thing to do is to look for the Energy Star label.

Energy Star is a joint program of the U.S. Environmental Protection Agency and the U.S. Dept. of Energy focused on energy conservation. It evaluates products for energy efficiency, and those with low emissions are given an Energy Star label. The Energy Star is the most widely recognized label in the U.S. Other countries use their own labeling systems.

Although most mainstream technology companies have taken steps to control energy consumption to earn the Energy Star label, medical device vendors are behind in that area.

There is no Energy Star equivalent for the medical device industry, but that doesn't mean it has to remain that way. Asking the right questions during the procurement process will help physicians understand the environmental impact of new technology. It also will put pressure on vendors to know the impact and take steps to reduce it, Vernon said.

Neil Rosen, an architect and a member of the U.S. Green Building Council, said during the procurement process practices can require potential vendors of, say, imaging equipment, to prove they are in the top 25% of the most energy-efficient. He said this type of pressure has forced many manufacturers to examine their energy consumption. Many were surprised to learn how much energy they use and started looking for ways to lower it.

Rosen, who is also senior project manager in facilities at North Shore LIJ Health System in New York, said manufacturers are finding ways to cool equipment without using water, a method long used by many imaging devices.

"There's a lot of great questions that we can be asking as buyers, as purchasers of stuff that will put pressure on the industry to have the answers," Vernon said.

Employee engagement
Vernon said the "biggest missed opportunity" when it comes to green initiatives is engaging the work force. One way to achieve this is with education, she said.

"Individuals in our community and our work force, they get it at home," Vernon said. "They don't walk out the front door leaving all the lights on, the television on, the radio blaring. They understand basic energy conservation practices at home, and we are encouraging them to bring those practices with them to work."

Rosen said a little carrot, as opposed to the stick, goes a long way. Recognition for doing good is something employees respond to, he said. "You have to get them to want to do it, not force them to do it."

Dr. Wolk said most of his practice's green activity is done passively. But he has been known to leave a comical note here and there if he notices lights have been left on after hours.

Rosen said performance-based bonuses can include the practice's carbon footprint, which is easy to track and monitor over time, starting with the utility bills. If the energy consumption is less, the bills will go down.

Practice Greenhealth, a member organization for health care facilities dedicated to an environmentally friendly practice, offers online tools to reduce, manage and measure a facility's carbon footprint. Some tools are free, and others are restricted to members.

There are changes that can be made in the background to help reduce waste.

Computers can be programmed to go to sleep if inactive for more than a few minutes. Shutting computers down completely will save more energy, but if employees routinely walk away and return shortly thereafter, the time it takes to power up each time would be a frustration point most employees won't appreciate, Rosen said. Powering the machines down at night would be more efficient, he said.

There also are power strips equipped with motion detectors that will put devices to sleep when no movement is detected and wake up when someone enters the room.

Office printers present opportunities for conservation, said Meagan Bozeman, who works in Xerox's solid ink sustainability and consumables strategy area. Paper waste can be cut in half by printing on both sides of a sheet of paper.

Bozeman said paper waste has the biggest impact on the environment. To put it into perspective, she quoted EPA figures showing that it takes almost 17 watt hours to produce a single sheet of paper (recycled paper uses 12 watts). A medium-sized copier, which is typical for use in a doctor's office, that produces about 50 copies per hour, uses 17 watts of energy per hour -- the same as producing one sheet of paper.

The type of printer and the ink can make a difference. Laser printers use less energy than ink jet printers. And combination fax, copy and printing machines can reduce energy consumption by 50%, Bozeman said.

Ink cartridges also are a source of waste that can be reduced by behavior modifications. Bozeman said solid ink sticks produce 90% less waste than liquid ink cartridges and cost less to produce, package and deliver.

Life cycle of technology
When purchasing new technology, practices need to talk to vendors about the total cost of ownership, which includes a plan for what happens to the product once its life cycle has expired.

Dr. Wolk said his decision to recycle all his old technology not only helps reduce waste but also helps consumers down the chain save money by purchasing refurbished equipment instead of new. He has saved money by buying refurbished equipment.

Vernon said practices should ask vendors about the life cycle of equipment, both IT as well as medical devices. Questions to ask include how much toxic heavy metal is in the device and how it is recycled when it exceeds its lifespan. The vendor should know how much it will cost to have someone haul away the equipment, how it is recycled, and whether the vendor has product stewardship in place, in which case the vendor would take it back.

The EPA has a list of resources on its website to find a place to donate, recycle or dispose of technology safely.

Dr. Wolk admits that many initiatives have small impacts on their own. But if those little changes are multiplied by millions of people, they could be substantial, he said.

This article was originally posted at http://www.ama-assn.org/amednews/2011/06/06/bisa0606.htm

Legal Transcription Outsourcing: Benefits for Law Firms

2011-11-25T04:12:00.007-08:00

Legal Transcription outsourcing offers innumerable benefits for law firms by reducing their burden and ensuring more streamlining of their functioning. Not only law firms, but independent legal professionals including attorneys, lawyers, and paralegals also benefited; they can experience greater efficiency and success with their cases because the nitty-gritty details of their task are taken care of well. These details may appear small, but they can have mighty consequences if not taken care of well. Inappropriate wording, left out recordings, procedures not carried out properly – any of these could create problems.

Why Legal Transcription Services Are Important

Recording various kinds of data is not enough, they need to be transcribed accurately and stored effectively for further use. This is where law firms spend much of their manpower and resources. Reliable legal transcription companies can record, transcribe and store data securely and also ensure a smooth flow of data through an efficient FTP (File Transfer Protocol).

Expertise of Legal Transcription Companies

Legal transcription outsourcing is carried out by companies hiring trained legal transcriptionists, law experts and technical personnel to effectively transcribe various comprehensive legal data. This data could include court proceedings, rulings, hearings, client letters, memorandums, court transcripts, briefs, legal pleadings, subpoenas, interrogations, client tapes, and court tapes. Legal transcription companies can also handle live transcription of proceedings and communication such as conference calls and telephone communication.

File Dictation Options

A legal transcription company normally provides two methods of dictation – digital dictation and the toll-free number. Clients can choose the mode that suits them best.

Digital Dictation

Digital dictation involves the use of dictation machines. The law firm representative or legal professional dictates the details into a digital recorder provided by the transcription firm. The dictated details are automatically downloaded to a local computer from which the details reach the firm's secure server. The files are transferred securely as part of the legal transcription service with the help of encryption technology.

Toll-free Telephonic Dictation

In the toll-free number method the files are dictated through telephone. The information dictated directly reaches the secure server of the transcription firm. In both cases the transcriptionists access the server to download the data to be transcribed.

File Transfer Protocol

The FTP is the connection between the law firm's computer and the transcription company's secure server and this facilitates smooth transfer of files to and fro.

With legal transcription outsourcing there are innumerable benefits for law firms and legal professionals. The legal transcription service will do its part in facilitating greater efficiency for the law firms.

http://ping.fm/KwWrA

Legal Transcription Company - Get Efficient and Timely Services

2011-11-25T04:12:00.005-08:00

A Legal Transcription Company helps you get efficient and timely services in transcribing legal files. Legal responsibilities are something all businesses have to deal with. Often they put a significant strain on resources and consume the time and effort of your employees. Legal transcription outsourcing will be ideal for businesses as it is cost-effective and flexible.

Legal Transcription Outsourcing Makes Businesses Perform Better

Legal responsibilities are often quite elaborate and resource consuming. There are various Federal and State regulations organizations must satisfy. Failure to comply invites legal penalties and litigation. Sometimes there are lawsuits to deal with while at other times there are other legal issues that hamper the progress of an organization. Legal transcription outsourcing is one of the methods businesses can employ to ensure expert handling of the legal responsibilities so that they can fully focus on the core aspects of running the business – factors directly affecting productivity and earnings.

Legal Responsibilities in Good Hands

With providers of legal transcription services taking care of the legal chores and paperwork, your business or law firm can ensure expert handling of these responsibilities while also streamlining costs and functioning. You wouldn't have to maintain a workforce for legal transcription and administration alone. This will help you save precious resources which in turn will ensure lesser operating costs that contribute to more sustainability. Selecting a reliable and experienced legal transcription company can make the vital difference.

Businesses can count on legal transcription services to record and securely transcribe their legal documents, correspondences, conference calls, court transcripts, rulings and other media. The legal transcription company deals with all fields of law including corporate, criminal, intellectual property, family, real estate, employment, and more.

Benefits of Legal Transcription Services

The characteristics of legal transcription service provided by a reliable company usually include:

99% accuracy with good audio

Multiple-level quality checks

Document flow management system

Digital recorders and toll free numbers for dictation

Browser based transfer of files along with FTP or email systems

EMR interface, transcription server interface

Availability of full work flow modules

Local representative in most areas

Round-the-clock customer service

Cost-effectiveness and Flexibility

Legal transcription services are cost-effective, in line with specific client needs, and are flexible enough to provide transcription for:

Court proceedings

Wire tap

Legal letters

Law office recordings

Regular recordings

Trial

Verbatim

General correspondence

Legal pleadings

Reports and briefs

Court transcripts

Client letters

With a reliable legal transcription company you get efficient and timely services that are adaptable to your unique requirements and lead to greater cost-effectiveness.

http://www.articlesbase.com/outsourcing-articles/legal-transcription-company-get-efficient-and-timely-services-5423707.html

There?s an App for That: Health Plans See Limitless Potential in Mobile Smart Devices

2011-11-25T04:12:00.003-08:00

For health insurers, the soaring popularity of mobile smartphones and tablet devices has created a new platform to connect with members, physicians and brokers. But while the technology offers almost limitless potential, health insurers are in the early stages of understanding how to tap it.

More than 82 million people in the U.S. own a smartphone, according to second-quarter data released Aug. 30 by comScore, Inc., which tracks digital-based trends. Google’s Android phone has 42% of the market, and Apple’s iPhone has 27%.

Karl Ulfers, vice president of consumer solutions at OptumHealth, a subsidiary of UnitedHealth Group, predicts mobile devices will become a “critical channel” for health plans to interact with members. Within the next two years, they “will become the most important engagement tool we have.”

David Passavant, director of health engagement design at UPMC Health Plan in western Pennsylvania, agrees and says, “the single most powerful attribute of the mobile platform is that people always have it with them.” Michele Stankowski, director of application development at Health Net, Inc., says mobile smart devices could replace desktop computers within the next decade, and says it will be critical for health plans to “stay ahead of the curve technologically.”

‘We’re Smarter Now’

There are important parallels between the growth of mobile smart devices and the early days of the Internet, and Passavant says health plans need to learn from mistakes made then. While early dial-up connections limited what could be done with websites, it took at least a decade for websites to mature and be useful on a wide scale. The biggest problem was that health insurers, along with many other industries, didn’t understand the potential of the online universe. Too much emphasis was placed on getting a website up and running rather than developing a site that would be useful to users. “The mistake…was failing to understand people’s needs and motivations. We’re smarter now. We have a deeper understanding of how to use technology to connect with people, be it elegant interfaces, personalization, humor or gaming,” he explains. “By understanding human- centered design,…you can build technology that optimizes the user experience, not just the amount or type of information displayed.”

At the very least, Passavant says every health plan should allow members to use mobile devices to (1) access a personal health record (PHR) or view claims information, (2) locate network providers and pharmacies using the device’s internal global positioning system, and (3) access a virtual identification card. UPMC Health Plan, he says, is gearing up to launch an app in the first quarter of 2012 that will incorporate those features. From there, he says, the company will examine how mobile devices can be used to engage members. “The plans that innovate and win in this space will borrow the best ideas from other industries — such as travel, banking, retail and gaming — and engage members in ways that web sites never could.”

Two months ago, Health Net released a mobile app aimed at its broker community and internal sales team. When meeting with clients, they traditionally have relied on a paper “plan wheel” that allowed them to show various plan design configurations and prices. But along with being expensive to produce, that tool became outdated as soon as new benefit designs were launched, Stankowski says. “Sometimes, almost as soon as they got distributed, they were out of date.” The mobile version of the plan wheel is easy to update and can be used to create a sales presentation through an iPad. And it gives the salesperson or broker the ability to create a library of plans that sell most often, she says. Another app, to be deployed in 2012, will give brokers a dashboard view of their book of business. It will mimic the functionality now available on the company’s website.

Insurers Have Growing App-etite

When it comes to diagnosing, treating and monitoring patients, the potential of smart devices is almost limitless. Special blood pressure cuffs and scales, for example, can be plugged directly into a smart device and the data can be sent to a physician.

Health care is one of the key growth areas for smartphones because the devices offer the ability to communicate more effectively with patients, exchange data, push out alerts and help ensure that eligibility and other information is accurate and current, says Thomas Harpointner, CEO of digital marketing firm AIS Media, Inc. There are now about 6,000 mobile medical applications.

According to Harpointner, smartphone adoption among physicians has outpaced that of the general U.S. adult population. And a whopping 95% of physicians use their smartphones to download medical data. Moreover, the devices could allow physicians to conduct e-health visits.

OptumHealth’s CareTracker app, for example, offers cloud-based health IT systems that physicians can use to access patient medical records and manage schedules. It also has billing and other administrative functions.

The popularity of social media sites could be combined with apps to promote health. OptumHealth’s OptumizeMe app, which has been available to members and non-members for the past year, gives users the ability to compete with friends and colleagues in health-focused challenges. And participants can earn electronic “reward badges” for reaching their goals. The app has been promoted in fitness magazines and has had thousands of downloads, says Ulfers. Users, he says, seem to like the social component of the app that allows them to share results with friends and invite people to join. “We found they weren’t just using apps for themselves, they were communicating socially…and building out social circles.” Optum is planning to launch a 2.0 version of the app early next year that will let members interact with peers and a health coach via the application. The coach, for example, will be able to recommend challenges or nutrition programs and then track the results.

More Apps Are Targeting Health

Here’s a rundown of some health plans that are using, and intend to use, smart devices to connect with members:

Humana Inc.: The MyHumana Mobile app lets members access their ID cards, search and compare drug prices, locate providers and pharmacies, and track claims and health account balances. The company also has a fitness app (HumanaFit) that lets members track their workouts, monitor their heart rate and share results with friends through social networks. For 2012, Humana’s innovation arm will be testing health management features that might be useful to members who have a chronic condition, says Julie Kling, mobile executive business lead. The first version will likely be aimed at diabetes because that condition requires frequent monitoring, she explains. An app, for example, might let a member monitor blood sugar, blood pressure or pulse rate and then transmit that information to a physician or care manager. “We are pushing the limit.”

Highmark Inc.: The Pennsylvania Blues plan operator launched its health and wellness Health@Hand iPhone app in 2010. Along with using the device’s internal GPS to locate providers and pharmacies, the feature helps members search for information about illnesses, symptoms and medical conditions. A health and wellness section of the app offers coaching tips and information about health and wellness programs available to Highmark members. Early next year, the company will launch a mobile version of its member websites, says spokesperson Kristin Ash.

Cigna Corp.: It’s been a year since the health plan operator launched Cigna Mobile, which lets members use mobile devices (in Spanish and English) to locate network providers, facilities and pharmacies. It also lets customers review covered drugs, search for generic equivalents and compare prices. While the company doesn’t have any mobile apps yet, it does provide a mobile environment that can be accessed by smart devices, says spokesperson Joe Mondy. Users also can track claims, annual deductibles and health account balances.

Health Net: The California-based health plan operator launched Health Net Mobile about a year ago. The most popular feature lets members access their identification card and eligibility information, which can be photocopied at the doctor’s office, says Stankowski. “People will forget to bring their insurance card, but they never run out of the house without their smartphone,” she says. While a prototype is being developed that will allow the image to be digitally scanned, few doctors’ offices are now equipped with scanners. Late last month, Health Net’s Federal Services division launched a mobile app for active duty and retired military members covered by its TRICARE business. That app, which allows members to search for providers and access answers to frequently asked questions, was developed shortly after the Dept. of Defense renewed its contract with Health Net. The health plan operator also is looking into integrating a member’s personal health record into Health Net Mobile through its partnership with WebMD.

CDPHP:The health plan operator’s Find-A-Doc Mobile app, which was launched in March, has had more than 21,636 downloads and hits to the mobile Web version. It lets members look up detailed data about network providers and supplies driving directions. To boost adoption, CDPHP has promoted it into member communications, on its website, and in print media with a QR code that leads to the Web jump page. It also has been advertised on digital billboards, according to the company. Future upgrades will allow members to view, fax, or email their insurance ID card to a provider’s office.

What HIE needs to mature: Regional critical mass

2011-11-25T04:12:00.001-08:00

In the course of meeting Stage 1 Meaningful Use criteria, Beaufort Memorial Hospital in Beaufort, S.C., will have the basic infrastructure in place for health information exchange, which by design will enable meeting the more complex HIE requirements expected for Stages 2 and 3.

To have patient data available and shareable makes a lot of sense - and a lot of patients would agree with that, said Ed Ricks, vice president of information systems and CIO of the 197-bed hospital. "A lot of clinicians absolutely believe that the more good information they have - it has to be information they rely on and trust - when they're trying to make clinical decisions the better decisions they can make," he said. But for now, Ricks said, he’s still looking for a business case for HIE.

Ricks is not alone. Many in the industry expect studies to come out in the coming years that quantify both clinical and business value. The Wisconsin HIE and Vanderbilt University Medical Center are two notable examples in 2011. But the HIE market is not mature and what's required to reach that point in the journey is a critical mass of participating healthcare providers in the region and volumes upon volumes of data.

There are other issues that Beaufort Memorial Hospital must contend with, which are not unique to the hospital. It is just starting implementation with the South Carolina Health Information Exchange, despite the fact that getting participation from other hospitals in the state has been difficult. Beaufort Memorial Hospital is 20 miles from the Georgia border, with two large hospitals south of it in Georgia, which are part of the local healthcare market Beaufort belongs to, geographically speaking. "More likely our patients migrate to those hospitals than in-state hospitals," he said, pointing out one of the challenges of statewide HIEs. As a retirement and vacation destination for snowbirds, who live part of the year up north, Ricks notes that it's more meaningful to communicate and exchange patient information with physicians in those northern communities, as well. That said, Ricks points out that the two Georgia hospitals aren't participating in HIE efforts.

The federal funding for statewide HIEs is covering expenses for SCHIE for approximately 24 months, enough time for stakeholders to assess the value of HIE for the community, according to Ricks. "What's valuable in our community is that we can integrate all of our physician offices and hospital data together. Then that population of people - 95 percent of their care is in the community - wherever they present, someone has the full picture," he said. "That's the grand scheme." In addition, Ricks said, "We hope it will help us meet Stage 3. That's why we've got the structure going for us, that's why we're participating."

Beaufort Memorial Hospital is anticipating what's coming down the pike by building a better discrete data structure, which will enable the hospital to be more nimble and interface and integrate the data more quickly, Ricks said. "There's clearly going to be more quality measure reporting, which has to be done with discrete data from the EMR," he explained. "So we're just trying to structure all of our documentation to be less narrative - more discrete data - so we'll be able to capture it as we need." Building the infrastructure to store and manage more data and to have the ability to extract the data more rapidly will also allow the hospital to participate more easily and quickly when standards are finalized.

With respect to standards, Ricks believes the industry actually needs more government. "I think we need to be told exactly what we need to do, what data elements are critical and how everyone can transmit the same things in the same format," he said. It will likely take five or so years to get to that point, according to Ricks. "The early adopters are going to be doing things that are a waste of effort at some point, but we still want to participate," he said. To date, Beaufort has built the interface that extracts data and is testing the transmission of the continuity of care document format, which is a Stage 1 requirement.

In the process of capturing data as completely as it can, the hospital is mindful of ensuring that physicians' workflow is not impeded. "Engaging the physician is critical," Ricks emphasized. "One of the goals is to make sure that a full implementation of your EMR is not just an IT project, it's actually a business project, and everyone in the organization understands that they have a role in both building and using the system."

A national health information network is up to seven years away, Ricks predicts. "People are thinking in that way and getting on the right path," he said. "Part of that is impetus from the Meaningful Use money and part of it was that organizations were already trying to work towards doing the right thing for their patient population."

This article was originally posted at http://ping.fm/qObk5

Medical transcription India giving boost to the allied health profession

2011-11-20T23:44:00.003-08:00

For physicians and health care centres, here is some good news. In the recent years, medical transcription India has witnessed a significant growth giving a big boost to the allied health profession, legal, insurance and others including the revenue. The transcription services which moved to the online platform a few decades ago is helping professionals to work dedicatedly. Many estimates peg the business to be worth more than thousands of crores and are going to be huge.

Demand for medical and legal transcription services has also taken a leap in the few years. And with the growth, the medical transcription India has made its space successfully in the world as a quality data transcription services provider. The dictated recording are transcribed by a team of experts that comprises of medical transcriptionist, editors and proofreaders whose responsibilities are to ensure error free work and deliver it at prompt.

The experts undergo rigorous training hours so that they can transcribe clinic notes, audio and video recordings into text formats without losing the significance of the content. For quality work, many medical transcription India companies take the assistance of sophisticated software to deliver excellent work.

In varied professions, records have to be maintained as a lot many things are dependent on these records or data. In certain cases, detailed medical records become the base for processing insurance claims.

Across the nation, numerous medical transcription India companies have mushroomed that are catering the demands of the world with great professionalism. Most of the firms hold their own in house training sessions to train their employees. They also hold English-speaking classes for their employees so that they understand their clients’ requirements and interact in a better way.

Confidentiality always remains the top priority of transcription services firm. To make certain, they use FTP while delivering their work.

Because of affordable rates and quality work, medical transcription India has remain successful to imprint the impression of professionalism in the global market that convinces them to outsource to India. There is also the impression that certified medical transcription companies helped the nation to multiply its revenue.

However, all medical transcription India companies retain their value but if you are trying to conclude your search for a professional data medical transcription services then browse the web and you can easily find many data transcription services firm. Always remember, ask for some sample work so that you can judge the professionalism and quality of work the firm provides.

So, medical transcription India reduces your efforts and helps health professionals work dedicatedly.

Financial incentive programs for electronic health records

2011-11-20T23:44:00.001-08:00

While Medicare and Medicaid EHR programs offer incentives for eligible providers who adopt EHRs, only the Medicare program imposes a penalty on providers who delay the adoption of EHRs.

Physicians report having a great interest in obtaining federal funds for adopting electronic health record (EHR) technology, but two of the biggest barriers to their adopting EHRs are a lack of information about how to receive federal incentive funds and concerns about the initial cost of adopting EHRs, according to a recent study.¹

Daniel Gottlieb, JD

In the past year, much of the focus has been on how healthcare reform under the Patient Protection and Affordable Care Act (PPACA) will affect physicians and other providers, but the Medicare and Medicaid incentive programs for adopting EHR technology were established a year before passage of the PPACA under the Health Information Technology for Economic and Clinical Health (HITECH) Act.

The HITECH Act, which was part of the federal stimulus legislation enacted in February 2009, authorized approximately $27 billion in incentives to providers, hospitals, and critical access hospitals (CAHs) to adopt EHRs. At the time, President Obama told Congress that EHRs could save the healthcare system $80 billion annually.

Eligible physicians and other providers can receive up to $44,000 by participating in the Medicare EHR Incentive Program and up to $63,750 by participating in the Medicaid EHR Incentive Program. Hospitals can receive base payments of up to $2 million plus additional amounts, depending on several factors.²

The aforementioned study focused entirely on Florida physicians who participate in Medicaid. As noted in the study, Florida is an important state for assessing physician attitudes toward EHR incentives because Florida has more licensed physicians than any other state, as well as large numbers of both Medicare and Medicaid beneficiaries.

THEORY VERSUS PRACTICE OF EHR USE

While increasing the efficiency and improving—or at least not hurting—quality is the stated goal of EHR technology as well as many other health reform initiatives, whether those goals can be achieved using EHR technology remains an open question, particularly when healthcare professionals may be reluctant to adopt the technology. Accordingly, the Florida study sought to identify possible obstacles to adopting EHRs, despite the financial incentives being offered.

Of the physicians in the Florida study who said they are not planning to seek the financial incentives available to them, 42% said that one significant barrier to their adopting EHRs was that the physicians needed "more information about the incentive program." Sixty-nine percent of the physicians said that they were deterred by the "costs involved" in implementing EHRs, and 42% said that they were deterred by not knowing which EHR system to purchase.

Many early adopters of EHR technology have used healthcare attorneys and other consultants familiar with details of the EHR incentive programs to simplify the process of determining eligibility and to provide assistance with navigating other requirements. Providers who prefer a more hands-on approach can find applicable information about eligibility and details about timelines and requirements that must be met on government Web sites.

Certain physicians, such as those who furnish 90% or more of their covered professional services in an inpatient or hospital emergency department, are not eligible for either the Medicare or Medicaid program.

INCENTIVE SPECIFICS

For the Medicaid EHR Incentive Program, it is essential to note that not all states are ready to participate. Therefore, although registration for the Medicare Incentive Program was open nationally as of January 1, 2011, registration is not uniform.

Information on when registration is available in each state participating in the Medicaid EHR Program is posted on the Centers for Medicare and Medicaid Services (CMS) Web site under Medicaid State Information, including a list of launch dates, Web sites, and email addresses by state.³Approximately 30 states currently have registration open for their Medicaid incentive programs.

For Florida providers, registration for the Medicaid incentive program was scheduled to open in September, and eligibility requirements and other details are available on the Agency for Healthcare Administration (AHCA) Web site.⁴ CMS also maintains a list of state Web sites and email addresses for each state.⁵

For the Medicare incentive program, many details can be found on the Web site of the Office of the National Coordinator for Health Information Technology (ONC),⁶ as well as the CMS Web site,⁷ which contains summarized information, as well as details of regulation and guidance issued to date, including the final rule previously published in the Federal Register.⁸

CMS has a publication listing frequently asked questions, and many providers have found it a helpful distillation of the rules for the incentive programs. For an overview of the applicable timelines for implementing and receiving incentive payments, CMS has a user-friendly "milestone" chart that provides a broad overview of significant dates in both EHR incentive programs.⁹ In addition, CMS has published a list of CMS regional offices and other external contacts.

The ONC and the National Institutes of Health have posted a video online with summary information about the EHR programs.¹¹ The ONC Web site has a Certified HIT Products List (CHPL),¹² and a list of organizations that have been selected as ONC-authorized testing and certification bodies.¹³

Although both the Medicare and Medicaid EHR programs offer incentives for eligible providers who adopt EHRs, only the Medicare program penalizes providers who delay in adopting EHRs. Under the Medicare incentive program, professionals must adopt EHRs (and meet the applicable requirements) by 2012 to receive the maximum incentive payments.

Beginning in 2015, Medicare-eligible professionals, hospitals, and CAHs that do not successfully demonstrate "meaningful use"¹⁴ of EHR technology will have a payment adjustment in their Medicare reimbursement (although eligible professionals may be exempted in the case of "significant hardship.)¹⁵

As an alternative, the Medicaid EHR Incentive Program offers providers the opportunity to receive incentive payments for early adoption, but without a downward payment adjustment to reimbursements for providers who have not adopted EHRs.

As with any government program, navigating the specific rules and related criteria for achieving "meaningful use" can be off-putting to busy practitioners. It appears, however, that the push to encourage EHR use is here to stay. Eligible professionals who have not already adopted EHRs should begin the process quickly to take advantage of the financial incentives.

REFERENCES AND ENDNOTES

1. Menachemi N, Yeager VA, Bilello L, et al. Florida physicians seeing Medicaid patients show broad interest in federal incentives for adopting electronic health records. Health Aff;30:1461-70.

2. Centers for Medicare and Medicaid Services. EHR Incentive Program for Medicare hospitals. https://www.cms.gov/MLNProducts/downloads/EHR_TipSheet_Medicare_Hosp.pdf. Published November 2010. Accessed October 2011.

3. Centers for Medicare and Medicaid Services. Medicaid state information.http://www.cms.gov/EHRIncentivePrograms/40_MedicaidStateInfo.asp. Revised October 2, 2011. Accessed October 2011.

4. Florida Agency for Health Care Administration. Hospital grace period.http://ahca.myflorida.com/medicaid/ehr. Accessed October 2011.

5. Centers for Medicare and Medicaid Services. EHR Incentive Program state contacts.http://www.cms.gov/apps/files/statecontacts.pdf. Revised September 28, 2011. Accessed October 2011.

6. The Office of the National Coordinator for Health Information Technology.http://healthit.hhs.gov/. Revised February 18, 2011. Accessed October 2011.

7. Centers for Medicare and Medicaid Services. Overview: EHR Incentive Programs.http://www.cms.gov/EHRIncentivePrograms/01_Overview.asp. Revised September 30, 2011. Accessed October 2011.

8. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Medicare and Medicaid programs; EHR Incentive Program; Health record incentive program, final rule. To be codified at 42 CFR §412, 413, 422, et. al. Fed Regist. 2010; 75(44, pt 2): 44314-44588. http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf.

9. Centers for Medicare and Medicaid Services. EHR Incentive Program Milestone Timelines.http://www.cms.gov/EHRIncentivePrograms/Downloads/EHRIncentProgtimeline508V1.pdf. Accessed October 2011.

10. Centers for Medicare and Medicaid Services. List of CMS regional office contacts.https://www.cms.gov/EHRIncentivePrograms/Downloads/Regional_Point_Of_Contacts_10-12-10.pdf. Accessed October 2011.

11. National Institutes of Health. Medicine Dish: CMS EHR Incentive Program.http://www.videocast.nih.gov/Summary.asp?File=16077. Published August 18, 2010. Accessed October 2011.

12. Department of Health and Human Services. Certified health IT product list. http://onc-chpl.force.com/ehrcert. Revised December 23, 2010. Accessed October 2011.

13. Department of Health and Human Services. ONC-authorized testing and certification bodies. http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=3120. Revised December 28, 2010. Accessed October 2011.

14. Centers for Medicare and Medicaid Services. Meaningful use overview.https://www.cms.gov/EHRIncentivePrograms/30_Meaningful_Use.asp. Revised September 20, 2011. Accessed October 2011.

15. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Incentive Payments to EPs. To be codified at 42 CFR §495.102(d)(3). Fed Regist. 2010; 75(44). [Note: Eligible professionals may be granted an exception, on a case-by-case basis, from the downward adjustment if the Department of Health and Human Services (HHS) determines that the reduced Medicare reimbursement would pose a "significant hardship." This exemption may be extended by HHS on an annual basis for up to 5 years.]

Important Steps

Five key things providers, hospitals, and critical access hospitals should do in adopting electronic health records (EHRs) and participating in the incentive programs:

Confirm your eligibility
Each of the Medicaid and/or Medicare EHR incentive programs has rules pertaining to eligibility and qualifications once EHR technology is adopted, and these rules must be met to receive incentive payments.

Register
Register for the program(s) and begin the process soon to maximize incentive dollars.

Consider obtaining legal advice
Consider having a healthcare lawyer familiar with the applicable EHR incentive issues as well as software licensing matters review information technology (IT) vendors' contracts before entering into them. Such agreements can contain pitfalls and unnecessary risks for providers.

Choose certified EHR technology wisely
Perform due diligence regarding an IT vendor's performance in delivering EHR technology that will work for your particular needs. Simply because an IT application is listed on the Certified HIT Products List does not mean that it will fit your situation. Providers should ask IT vendors about both successes and challenges that may have occurred when the vendor has implemented EHR technology for similarly situated providers.

Understand "meaningful use"
To qualify for incentive payments, it is not enough merely to adopt certified EHR technology. Providers must attest to "meaningful use" of the EHR technology, which, simply put, means that providers need to show they're using EHR technology in ways that can be measured significantly in quality and in quantity. Accordingly, providers should assess their needs and confirm that once they adopt EHR technology, they can put it to meaningful use in the context of their particular clinical needs.

4 PHI tips for HIEs

2011-11-09T05:45:00.001-08:00

One of the biggest current obstacles to health information exchanges (HIEs) is the rather thorny matter of consent to data sharing.

Patients are not the only wary ones, either. Providers often see patient protected health information (PHI) as a competitive advantage, and something they are reluctant to share with other hospitals or physician practices. Opt-in or opt-out, how can HIEs convince patients and providers to consent to data sharing?

At least one health-centric IT consultancy maintains that is not actually the best question to be asking.

“Whether an opt-in or opt-out model is chosen … the adoption of HIE is less about which model is right for its participants and more about which model will best serve its population,” according to a white paper released by Perficient on Tuesday.

Aiming to help HIEs better understand how to share PHI, Perficient suggests four tactics in the white paper. Those are:

1. Review state laws and regulations. Health information exchanges need to consider state rules from the outset, as no national standard solution exists for establishing an HIE. And those rules vary from state to state.

2. Establish Trust. Whether you permit patients to opt in or opt out, ther issue is “how much information should be shared within the exchange and with whom it is shared,” Perficient officials wrote.

3. Add Value. The HIE “comes at a great cost” to all participants, so it’s necessary to “ensure up front that the expectations and needs of those involved are documented and incorporated into the development of the HIE,” Perficient advised.

4. Privacy and Confidentiality Issues. Patient consent is viewed as perhaps the trickiest issue of them all. Indeed, “patients have consistently listed privacy and confidentiality issues as their top concern with HIE,” the white paper noted, explaining that the personal information itself, as well as the reason for exchanging PHI, can potentially sway patients one way or the other.

Whether or not a particular HIE will survive and thrive “is wholeheartedly dependent upon how providers work with patients to build trust and buy in, and the ability of the HIE to add value to participating organizations, patients and the community,” Perficient concluded in the report, titled "Reap the rewards of HIE with patient, organization, and community opt-in and opt-out."

Coalition defines EHR to HIE data sharing standards

2011-11-09T05:44:00.001-08:00

A band of U.S. states and technology vendors came together to create technical specifications that enable EHRs to feed into HIEs.

The specifications, agreed upon Tuesday, “leverage existing HL7 standards, technical frameworks from IHE International, and HIE implementations,” the group explained in a prepared statement.

Two use cases concern “the detailed data and metadata specification for a compliant Continuity of Care Document,” the working group noted, explaining that the first, Statewide Send and Receive Patient Record Exchange, enables health records to be encrypted, then sent over the Internet, whereas the second use case, Statewide Patient Data Inquiry Service, is what allows clinicians to query an HIE for patient data. These specs, the working group added, sync with Beacon Community guidelines for purposes of reporting to ONC.

“I am encouraged by and excited about this type of collaboration, which has the potential to advance real-world pilots, implementation and feedback on standards for health information exchange,” said Doug Fridsma, MD and PhD, director of the Office of Standards & Interoperability at the Office of the National Coordinator of Health Information Technology (ONC). “The results of this kind of initiative can help us advance health IT nationwide."

Indeed, what started within the New York eHealth Collaborative (NYeC) soon grew to include California, Colorado, Maryland, Massachusetts, New Jersey, New York, and Oregon because, as NYeC executive director David Whitlinger added, “we soon realized that many other states were facing the same interoperability challenges and many of the EHR and HIE vendors were also looking for clarity from the marketplace to define their product roadmaps.”

In addition to the seven states, the EHR/HIE Interoperability Workgroup includes eight EHR vendors: Allscripts, eClinicalWorks, e-MDs, Greenway Medical Technologies, McKesson Physician Practice Solutions, NextGen Healthcare, Sage Healthcare Division, and Siemens Healthcare, as well as three HIE services vendors participating, those being Axolotl, InterSystems, and Medicity.

This article was originally posted at http://ping.fm/Z8BrX

Legal Transcription Services ? Benefits for Legal Professionals

2011-11-07T04:48:00.005-08:00

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Healthcare Data Mining, Structured Data and Natural Language Processing

2011-11-07T04:48:00.003-08:00

Medicine and healthcare have been one of the most researched and studied branches of Science for centuries. There are records of use of medicines as early as 500 B.C. Research and development over millions of years has led to the establishment of the current structured healthcare system. Documentation of patient records is an integral component of healthcare and mandatory in many countries which rely on insurance-based healthcare systems.

Early forms of healthcare documentation involved physicians keeping hand-written records of patient visits and filing this information for future reference. Managing records of thousands of patients in paper became impossible, not to mention that paper-based records were vulnerable to loss in natural calamities.

This led to the birth of electronic healthcare data capture and documentation. Patient records were then managed in the form of electronic documents and systems like EMRs, EHRs, and other forms of electronic healthcare data management systems provided secure patient information and easily available to the physicians whenever required.

Hospitals and healthcare practices across the US spend thousands of dollars every year in documenting and managing patient care details to meet statutory requirements of the healthcare industry. Most of this data is recorded and stored in EMRs and EHRs and used generally for insurance purposes or for reference.

An innovative and visionary line of thought is the use of concrete data and evidence to support medical decisions. This is called EBM or evidence-based medicine. Evidence of this is available from as early as 1854 when John Snow (considered the father of epidemiology) used maps with bar graphs to discover the source of a cholera outbreak and trace it to the water supply system in London. He counted the number of deaths and plotted the victims’ addresses on a map and saw that all the deaths occurred around a common water body. This was one of the earliest applications of data mining.

The modern EMR of a hospital or healthcare facility is a rich treasure-house of information of thousands of patients with a wide facet of illnesses, containing thousands of medicines, history etc. Each and every bit of information stored in this system could be a part of a pattern of events which if studied could give valuable insights into the pattern of diseases and the techniques of treatment and if researched lead to predictions about disease outbreaks.

The question however is how do we tap into this vast pool of data and extract the information we need!!!

This could be available either by:

Manually searching through thousands of documents.

Creating an electronic tool to search for data and analyze patterns.

Manual searching of such huge volumes of data is not a practical solution. An electronic tool to do that would have to be an intelligent system which should know exactly what to search for, where to search it, and how to present it in the most useful way. Different physicians have different styles of dictation and formats of reports, the search tool will have to separate out the required information and present the most valuable information.

For example:

Heart disease is one of the most common causes of death in the United States.

Identification of early signs of heart disease can save thousands of lives. Analyzing a database of thousands of patients with heart disease can give valuable information about the probable causes, nature of progression, etc., of heart disease and help in developing systems that could identify heart disease at the earliest signs of occurrence leading to timely treatment and preventive techniques can save many lives.

Natural Language Processing or NLP is a field of computer science and linguistics concerned with the interactions between computers and human (natural) languages. It began as a branch of artificial intelligence. In theory, natural language processing is a very attractive method of human–computer interaction. Natural language understanding is sometimes referred to as an AI-complete problem because it seems to require extensive knowledge about the outside world and the ability to manipulate it.

Combining NLP and data mining provides the solution to tap into the huge resource of health-care data and provide tangible solutions to queries and problems.

EZDI is a clinical Natural Language Processing Engine that identifies and converts relevant text into codes and numbers using patented technology.

EZDI combines data mining and NLP to extract clinical information from an EMR, or any healthcare documentation system, and provides structured information on diseases, findings, procedures, microorganisms, pharmaceuticals, etc., arranged systematically with computer processable collection of medical terminology SNOMED-CT (Systematized Nomenclature of Medicine – Clinical Terms).

Key Areas of Application Include:

Improving the Quality of Patient Care

Identifying high-risk patient groups with combinations of symptoms and/or risks.

Identifying the need for prophylactic measures to prevent outbreak of disease.

Improve patient care through efficient prescribing of drugs by identifying duplication or over-prescribing of drugs, and also identifying potential drug interactions in contraindicated drugs

Search for statistical data regarding patient-disease patterns, classifying them based on age, gender, geographical locations, food groups, etc., by identifying common factors among patients with similar diseases.

Identifying the need for diagnostic tests in specific patients, leading to effective dispensing of health care measures.

Ensure Compliance of Health Care Documentation

EZDI’s search engine makes auditing and reporting of “medical records compliance” an automated process.

Revenue Generation and Saving

Lowering the cost and effort involved in clinical Research and Development through automated chart review.

Identifying the need for specific diagnostic tests in specific patients, leading to effective dispensing of health care measures and eliminating unnecessary tests.

EZDI is the perfect tool for evidence-based medicine and treatment and is the future of healthcare in general. With accuracy up to 98% and immediate availability of query results, EZDI is the future of clinical data analytics this product will ensure more effective and efficient healthcare delivery.

About ezDI

The Company is one of the leaders in business intelligence and healthcare analytics that aim at improving the quality of services in health care and reducing costs. The company offers integrated solutions with a single data feed, and increases the industry’s speed, accuracy, flexibility and value overtime.

For additional information, please visit http://www.ezdi.us .

5 roadblocks to meaningful use Stage 2

2011-11-07T04:48:00.001-08:00

Summer of 2012 will be an interesting time in healthcare, as Stage 2 requirements of meaningful use will finally come to light. In the meantime, doubts remain regarding the successful adoption of Stage 2 – and whether it’s even possible.

As of now, certain roadblocks exist, and as long as they’re present, Stage 2 success is up in the air. That’s why we asked Guillermo Moreno, vice president of Experis Healthcare, to break down some of the issues he sees with MU Stage 2 and what can be done to address them.

1. Completing Stage 1. Moreno said the completion of Stage 1 is easier said than done. “The challenge [is togetting everyone to complete Stage 1 in a holistic manner enough that when we go to Stage 2, we’re looking at some type of uniformity,” he said. “To me, that’s the primer to all of it -- getting enough of a sizeable mass of the industry to complete Stage 1 and move to Stage 2." Luckily, according to a recently published HIMSS report focusing on meaningful use progress, research has shown a 16 percent increase within seven months of hospitals meeting Stage 1 of meaningful use. The report indicated that, “more eligible hospitals are likely to succeed in meeting the criteria for this first stage of meaningful use, an important step as healthcare providers strive to become meaningful users of health information technology.”

2. Having a clear timeline and guidelines. “In context, if you look at where we started this whole discussion around meaningful use and trying to push the industry and physicians to automate, it’s been a series of relaxations around what was intended to be in the mandate itself,” said Moreno. And just this past July, we saw another relaxation through the delay of Stage 2 until 2013 to 2014, giving way to more criticism surrounding the timing of meaningful use. According to the article published this past July, the Health IT Policy Committee was still, “scrambling to pull together a rough draft of recommendations to guide the Office of the National Coordinator for Health Information Technology (ONC) and CMS on what to include for Stage 2.”

3. Obtaining quality data. Moreno said another major challenge is both measuring and obtaining quality data. “That's a challenge because there’s so much fragmentation in the industry around the data itself and the quality of data,” he said. “What we’re doing, at least generically in Stage 1 and 2, isn’t necessarily going to get us to the point where we, as an industry, can say we’re collecting the right data for the right purpose.”

4. Focusing on additional projects. According to Moreno, the industry is overwhelmed between mandates and meaningful use. “All the things organizations have on their plate, like EMR roadmaps, CPOE, and more, it’s like we’re just piling on the list,” he said. Although it’s tempting to become distracted, Moreno suggests a “continued religion” around abidance and/or completion of the different stages. “That’s important,” he said. “It’s a good thing we should focus on. You don’t want to let go of the hammer we put in place, so to speak.”

5. Receiving feedback and recognition. Support and clarity surrounding advancements in the industry is key, said Moreno. “A lot of these organizations are measuring or attempting to measure, but really, data concerning how many net organizations have completed [Stage 1] and have gotten benefits would be good,” he said. “And then, recognizing and supporting those who have actually taken on the thought leadership of doing things as demonstrating sites, or as leaders in the industry as well.”

Follow Michelle McNickle on Twitter @Michelle_writes

The 6 hidden costs of EHRs

2011-11-01T05:07:00.001-07:00

If you haven’t spent much time analyzing the costs of EHRs, this part of the process may be an eye opener. Why should one consider the hidden costs of EHRs?

EHR costs are much more than just the initial purchase, implementation and maintenance fees. If a budget misses the hidden costs, an implementation could fail, degrade over time and worst-case scenario – bankrupt an organization.

To help sort out these expenses, several broad cost categories should be considered: Initial, Repeat, Future and Special Project costs.

Cost Area	Initial	Repeat	Future	Special Projects
EHR licenses	X		X
EHR maintenance and support fees	X	X
Hardware (servers, computers, mobile devices, printers, cameras, etc)	X	X	X
Data center or hosted costs	X	X	X
Internet Bandwidth	X	X	X
IT Staffing	X	X
EHR staffing (management, trainers, implementers, support, etc.)	X	X
EHR staff facilities	X	X
Reduction of patient schedules during go lives	X		X
Staffing the “bubble”	X		X
Supplies, cell phone & mileage reimbursement	X	X
Data migration and system conversions	X		X
Interfaces	X		X
Reporting	X	X	X
Customizations	X	X	X	X
Specialty requirements	X		X	X
Third Party Software (e.g. Dragon, education materials, code sets)	X	X	X	X
New modules or technologies (e.g. kiosks, Dragon, patient portals, encrypted email for e-health visits, digital pens, mobile applications)			X	X
Policies and procedures	X	X
Regulatory compliance	X	X

So which of these are the hidden costs? Many total-cost-of-ownership (TCO) computations do not include the following costs. Often, as a result, the C-Suite is blindsided a year or so later when these costs appear.

Hardware: It is a no-brainer to include the cost of upgrades and new hardware for the TCO. Rarely does the TCO exceed three to five years. In that time frame, almost all hardware needs to be replaced, including the servers, a multi-million dollar initiative in organizations of 200 or more.

Reporting: EHR vendors will often tell you they have great reporting. But it is rarely enough. Almost always, the provider purchases a third-party reporting system. Even if the existing reporting system is capable, rarely is the staffing included for developing the reports.

Customization: Although the mantra in the industry has shifted from “customize first and learn how to use second,” a lot of customization still happens. Most people consider the upfront costs of customizing – developer time and any tools required.

What is not figured into the costs is regression testing at the time of upgrades and bug fixes. Too often, a rollout occurs and your customizations are broken, and sometimes, even the fields you have used no longer exist. Customization isn’t a part-time job; it requires a close relationship with your vendor throughout the life of the EHR.

Specialties: Somespecialty templates turn out to be insufficient for the physicians who request unplanned customizations or require a new product all together. Oncology and ophthalmology templates partially use inventory, and most EHR systems are not capable of this. The oncology flow sheets are more complicated than most EHR templates allow for, so workflow becomes cumbersome. Thus, these and other sub-specialties may require this type of added cost.

Support: No one ever completely explains how much support will cost. The EHR environment becomes vital for physicians, nurses and clerical staff. If any one component – and there are a lot – goes down you, have to be ready for those costs incurred. And you have to have systems in place to mitigate down-time.

Regulatory Compliance: The cost of meeting regulatory guidelines goes up each year. Committees, consultants, policies and procedures and more have to be considered into the costs of maintaining an EHR.

Keep in mind that other costs exist as well, depending on product and type of rollout. It is unlikely a total-cost-of-ownership analysis will capture all costs, but using the list above will help capture the vast majority.

This article was originally posted at http://ping.fm/4utiA

Six Sigma for Medical Transcription

2011-10-29T03:15:00.001-07:00

Six sigma for medical transcription

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Primary care physicians, meet your regional extension centers

2011-10-25T03:09:00.001-07:00

Regional extension centers can help you select and implement an electronic health record system and attest to meaningful use.

There are 62 RECs spread across the country.

Implementing an electronic health record (EHR) system in your primary care practice is no small task. You must consider hundreds of individual elements about the system itself, plus the cost, the hit to your practice's productivity during installation, and, of course, compliance with federal regulations.

Regional extension centers Z(RECs, pronounced R-E-Cs) are a free, or nearly free, tool designed to assist you with the process, and with attesting to meaningful use, so that you can receive your share of the incentive funds and begin to exchange health information with the greater healthcare community in your area. In fact, 62 RECs are spread throughout the country.

THE REC MISSION

In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act established the Health Information Technology Extension Program. Its mission, according to Sec. 3012 of the HITECH Act, is "to assist healthcare providers to adopt, implement, and effectively use certified EHR technology that allows for the electronic exchange and use of health information."

The Office of the National Coordinator for Health Information Technology (ONC) of the U.S. Department of Health and Human Services (HHS) further defined the REC programs:

"The RECs will support and serve healthcare providers to help them quickly become adept and meaningful users of [EHRs]. RECs are designed to make sure that primary care clinicians get the help they need to use EHRs. RECs will:
■ "provide training and support services to assist doctors and other providers in adopting EHRs,
■ "offer information and guidance to help with EHR implementation, [and]
■ "give technical assistance as needed.
■ "The goal of the program is to provide outreach and support services to at least 100,000 priority primary care providers within 2 years."

Practices with only a few physicians—and limited budgets—now have access to free, or nearly free, assistance from health information technology (HIT) experts who will help you choose the most suitable EHR for your practice, guide you through its implementation, and then assist you as you attest to meaningful use with the government. But not all RECs are alike. And this fact has led to some challenges for both physicians and vendors.

ONE EHR VENDOR'S UNIQUE JOURNEY

Jonathan Bertman, MD, FAAFP

In an effort to streamline their own operations and provide what they believed were the best options for the physicians they serve, some RECs created "preferred vendor lists" that were populated mostly with larger EHR vendors. The reasoning behind this strategy seems to be that these RECs were trying to be forward-thinking by raising the bar on which EHRs they recommended to their constituency. In following this path, they expected the EHRs they selected to include functionality that is not required by the ONC for attesting to meaningful use.By itself, that's not necessarily a bad thing. The RECs, however, unintentionally excluded EHRs that they later learned were a better fit for the smaller primary care practices the RECs were created to help in the first place.

For example, one EHR that's popular with physicians because of its functionality and lower cost is Amazing Charts. Built from scratch by a Rhode Island family physician, Amazing Charts has won awards for its design. Even so, the company struggled to get its EHR onto the RECs' preferred vendor lists due to its lack of certain modules and components even though the inclusion of these functions, such as a SaaS (software as a service) component, is not required to achieve level one meaningful use.

"There's a huge learning curve the RECs have gone through," says Jonathan Bertman, MD, FAAFP. Bertman founded Amazing Charts in 2001 after constructing an EHR in 1999 and spending 2 years perfecting it through trial, error, and feedback from other physicians. Today, Amazing Charts is used in more than 3,700 practices nationwide.

"When the ONC first announced the REC project, like every other EHR vendor, we realized we needed to be listed by these RECs if we were to compete. We contacted the RECs and received their request for proposals [RFP]," he says.

"Every single REC had a different RFP, but they all asked essentially the same questions," he adds. "Are you certified? How do you do this? How do you do that? While filling them all out, we realized they weren't based on any sort of science. It was just a very onerous process that I think smaller EHR companies couldn't do because of resources."

From that process, many RECs ruled out Amazing Charts immediately because it didn't have a built-in SaaS model. Bertman soon discovered that all of these RECs had in place different processes, and very few of them were truly vendor agnostic, as they were mandated to be. He felt it wasn't fair that his tax dollars were being used to promote his competitors' EHRs.

"I assumed that this wasn't the ONC's intention, so I sent letters to the RECs that had refused us," Bertman says. "I asked them who made these decisions and how the decisions were made. The comments we got back were vague. No one wanted to be pinned down. So we decided not to fight every single REC."

Instead, Amazing Charts went directly to the ONC to discuss its experiences. The company scheduled a meeting with David Blumenthal, MD, then national coordinator for HIT in HHS.

"But on the morning of the meeting, he cancelled, and we ended up sitting with other people," Bertman says. The group made five recommendations that day:
■ RECs with a preferred vendor list should be required to disclose everyone who's on the board making decisions.
■ Vendor selection committees should be made up of a majority of physicians from small practices or staff from small practices.
■ A universal application process should be created so that EHR companies can apply just once, not 62 different times.
■ The RECs' studies on usability should be disclosed.
■ The ONC should enforce REC vendor neutrality. An REC should not have a preferred list. Having a preferred list means the government is recommending certain products over others, which is unfair.

"Their response to our recommendations was to say that the process could not be changed," Bertman says. "Nothing really happened after we approached the ONC.

"But now, we're listed with many RECs. And it was the physicians that made the difference," he says. "They got all the marketing hype, and they didn't buy any of it. They weren't signing up in the numbers the RECs needed, [and] they weren't agreeing to working with the preferred vendors, and at that point the RECs began coming back to us. The RECs first said 'no thanks' and rejected us and then came back looking for a way to include us."

Amazing Charts is now on most RECs' lists, and Bertman says the company is working to get on the others.

"My sense is that the RECs needed to go through that process," he says. "They're composed mostly of IT people and quality assurance people from health insurers. They thought they understood usability and what doctors needed, but they didn't, and doctors pushed back."

Therefore, the RECs changed their approach, because their funding depends on them hitting their targets.

COLLABORATION SEEN AS KEY TO SUCCESS

Scott Irwin

"Working with the RECs has been an ongoing educational process from a vendor standpoint, and one that is really starting to benefit both our clients and the EHR vendor community," says Scott Irwin, director of state engagement and REC support for NextGen Healthcare.

"The RECs were originally put on short timeframes to begin working with physicians and EHR vendors toward meaningful use," he says. "This initial push created several very quick—and sometimes rushed—vendor selection processes."

For instance, according to Irwin, many RECs had to start their vendor selection even before ONC-ATCB (authorized testing and certification body) certification of EHRs was open for the vendors. In addition, the RECs quickly had to assess the physician landscape in the geographic areas they cover to determine:

■ how many physicians already had EHR systems,
■ what services they would need,
■ which EHR vendors had an existing footprint in which areas, and
■ what obstacles physicians might face when purchasing EHR systems.

This challenge, along with an effort by some RECs to be vendor-neutral, created some initial hurdles to overcome for both the RECs and the EHR vendors, Irwin says, adding that the experience had the benefit of demonstrating to vendors that effectively helping physicians attest to meaningful use would require collaboration between all parties.

"How the relationships were established varied from state to state," Irwin says. "But out of 62 RECs, today we are now collaborating closely with 57 of them to get providers to meaningful use."

According to Irwin, now that RECs and EHR vendors are collaborating, the industry is beginning to see success stories. Through the Meaningful Use Vanguard (MUV) program, many states have highlighted physicians who have attested to meaningful use already with the help of a local REC and a vendor.

"One of our clients, Peter Muir, [MD] of Springfield Center for Family Medicine in Ohio, was honored by the ONC this summer for his success in achieving meaningful use and for helping others through MUV," Irwin says. "Another client, Complete Family Medicine, will be recognized [in October] as the first practice to reach meaningful use in Missouri."

Most of these early milestones were achieved with physicians and practices that had purchased an EHR system before REC involvement, Irwin says. "However, with these successes starting to mount up, the RECs now can provide more value to the physicians who need help purchasing, implementing, going live, and then attesting to meaningful use."

For RECs to continue beyond the initial government funding, Irwin says, they need to bring together—for the benefit of both physicians and EHR vendors—all the critical initiatives in their areas. This effort would include:
■ health information exchange (HIE),
■ medical homes,
■ accountable care compliance, and
■ any payer-driven programs that incentivize providers for quality.

"Physicians who perceive value from their RECs during the meaningful use attestation process will continue to seek help while they navigate all the upcoming changes in healthcare IT," Irwin says.

RECs have gotten the message. Their purpose is to help physicians, not force unwanted technology on them. They're listening to what doctors are saying. Consequently, they're succeeding like never before.

"Now, RECs are going to their constituents and asking, 'What is it that you really need?' as opposed to the technologist on the board saying, 'What you docs need is an EHR that has the ability to send out an order and has practice management and has a SaaS version and has XYZ,' " Bertman says. "That was just them guessing what was needed. When they finally asked, the docs said, 'We just need something that lets us document—without costing too much—and gets us home in time for dinner.' Once the RECs started asking, things began to work out."

ONE REC'S PERSPECTIVE

Some RECs do not do all of their own implementation work. Instead, they contract it out to EHR implementation organizations, such as the Massachusetts eHealth Collaborative (MAeHC).

Micky Tripathi

MAeHC is not the REC in Massachusetts. The REC in that state is the Massachusetts eHealth Institute (MeHI). MAeHC is, however, the REC in New Hampshire, as well as being a contractor to the MeHI. MAeHC also contracts with the New York eHealth Collaborative, doing EHR implementation work for 400 to 500 physicians, as well as to the Rhode Island Quality Institute.

It's not unusual for different RECs to use different operational models. Some RECs provide their own staffs and complete all their own implementation work, whereas others contract much of their implementation work out to other implementation organizations.

"As these RECs receive the federal grant money, they define their programs and sign contracts with implementation organizations, such as the MAeHC, who actually provides the services to the physicians," says Micky Tripathi, president and chief executive officer of MAeHC and the MAeHC Professional Services Corp.

In those states, physicians can select who will implement their EHRs from a list of implementation organizations that their REC already has vetted.

"From the physician's perspective, it's a group of organizations that have already been certified, the price has been negotiated, and they know that the quality will be there because it's already been pre-negotiated for them," Tripathi says.

This situation enables the physicians to make choices based on their own experiences and in their own interests—a hallmark of the ONC's REC program.

"The MAeHC has a longer history in this than most RECs because we were founded in 2004. The origins of the REC program in some ways stem from the lessons learned from our organization and the primary care information project," says Tripathi.

MAeHC also is a nonprofit organization and part of the Massachusetts Medical Society, so it is closely tied with the physicians there.

"We have pretty deep physician roots, and as a nonprofit, a lot of the physicians who work with us like the idea that we're very close to the medical society, so they can trust that we only have the interest of the mission that we subscribe to," Tripathi says.

RECs receive core funding from the federal government that goes to creating the organization. On top of that they receive "direct-assistance funding" that amounts to $5,000 per physician signed to a contract. Unlike the core funding, which is paid up front, the direct-assistance is paid out incrementally according to the REC's performance benchmarks for each physician.

LIST OF REC SERVICES

"We go in, and if they don't already have an EHR in mind, we help them with the vendor selection process," Tripathi says. "We don't choose the vendor for them, but we work with them to think through the differences among the vendors to find the best option for them. Some of the RECs have a fixed list of vendors that the physicians are supposed to choose from, but we don't get involved in that. Again, each REC is different.

"Then, we do a preliminary assessment of the practice's readiness from a technical, business, organizational, staff, and change management perspective," Tripathi says. "Our experience has been that it's really the people issues more than the technical issues that you'll have to deal with. Then we go through their workflow and look at the gap between where they are and where they need to be. We identify their needs. Hardware, software, different skill sets, staff training, staff changes, workflow re-orientation from paper to electronics.

"Then we help them through the actual implementation of the system, supplement the training they'll get from the vendor, and make sure they have a smooth go-live."

At that point, the MAeHC passes the practice over to the vendor. "We make sure they have a smooth transition to the vendor's support organization," Tripathi says.

SELECTING THE BEST EHRS FOR THEIR PHYSICIANS

Unlike some RECs, the MAeHC New Hampshire REC does not compile a preferred-vendor list.

"We found that, in the market, that was a barrier more than anything else," Tripathi says. "We certainly fell prey to this, too, thinking that these preferred-vendor relationships would provide value. What we ended up seeing, though, as a number of RECs went through that process, is that they got into these bare-knuckle negotiations with the EHR vendors for what appeared to be not much more favorable pricing terms. It also ended up closing out some vendors, which sent the message 'you're not invited here.' The 'marriage' ended up starting out on rocky footing because we're arguing with the vendors before there are even any sales.

"We decided that this wasn't the right way to start. We'll work with any vendor in the state of New Hampshire. We really just want this to be a win-win for everyone," Tripathi says.

Because many EHRs were excluded from the preferred-vendor lists for lacking the functionality that is not actually required to attest to meaningful use, the question has been raised as to why RECs went in this direction in the first place.

"It's a fair question," Tripathi says. "I think that in almost every case, it was very well-intentioned. The RECs were thinking that this was the way of the future, and that they needed to build a scalable business model that would serve the physician better. But then you end up with the unintended consequence of closing out some vendors when you really didn't mean to do that. I don't think it was done with malicious intent.

"We've been in the market long enough to know that you can't predict what the market will do, and you can't dictate what the market will be, so you have to follow where it wants to go and try to get it aligned with the meaningful use goals," Tripathi says. "The vendors are our partners. In the long run, the RECs are just a tiny little blip on the screen. The RECs will eventually go away, and the EHR vendors will be the ones who carry this forward."

ONE SIZE DOES NOT FIT ALL

Working with RECs will differ from one region to the next. Some RECs, following an ONC requirement that RECs provide or match 10% of the federal funds, require physicians to make a payment up front to collect those funds, usually less than $1,000.

Some RECs choose not to collect that 10%, opting instead to provide all of their services for free—from initial contact through assisting the practice with attestation to meaningful use—and documenting all of their out-of-pocket expenses over and above those reimbursed by the federal funds, to show the ONC that they provided value equal to the 10% as goods and services.

Other RECs use a different business model. The Rhode Island REC, for example, offers its practices a portion of the $2,500 in federal funding it receives following a practice's successful attestation of meaningful use if the practice completes the EHR implementation with the REC.

In some states, physicians can contract directly with an REC's subcontracted implementation organization. In Rhode Island for example, physicians can negotiate the final cost of implementation services directly with the MAeHC.

Why the difference among RECs? The ONC requires RECs to present a sustainable business model that would show revenue in years three and four. The RECs that charge do so because, for them, it's the only way to fulfill the requirement.

"The REC program model varies by market. In New Hampshire, we believe that physicians should not have to pay for this," Tripathi says. "It's supposed to be a subsidy program that gets them up and running on an EHR, and the minute you start charging them, you've created a barrier. So, on principle, we feel they shouldn't have to pay. But from a market perspective, it also introduces a barrier to adoption that we don't want to introduce," Tripathi adds.

If the process sounds complicated it is. The process is intended, however, to enable both physicians and RECs to make sound decisions based on their local knowledge rather than having them conform to standards and procedures arbitrarily set by the federal government.

CHALLENGES TO RECS

The biggest challenge to the REC process thus far is getting the word out to physicians that the RECs even exist. Even though RECs work hard at outreach in their areas, many practices are so overwhelmed that mail from an REC ends up in the reception desk's circular file before physicians get to see it.

It's too important of an opportunity to let go undiscovered, however. If you have worked with an REC, inform your fellow physicians so they, too, can consider whether to involve an REC in their EHR selection and implementation decisions.

"There's just so many things going on for physicians," Tripathi says. "I think they get really confused with the meaningful use incentive payments versus the REC. It's incredibly complicated. Even those of us who spend all of our working hours thinking about it get confused. I can't imagine how physicians are supposed to sort through all of this stuff and not kill people as they're practicing medicine."

Tongue-in-cheek as that may be, Tripathi makes an important point. The reason RECs exist is to help physicians get through the EHR selection and implementation process with their sanity intact.

IMPORTANT POINTS TO REMEMBER WHEN DEALING WITH RECS

RECs are here for you, the primary care physician. Their mandate is to help you achieve meaningful use with the best EHR for your particular practice. But not all RECs are alike, and although if you use an REC you must use the one in your region, you do not have to use the EHR it is recommending.

If you prefer, you can do your own research and determine which EHR is best suited to your practice and provides the required functionality to attest to meaningful use. You can and should rely on EHR vendors to help you ascertain this information. And then you can go to your REC and say, "This is the EHR I want to use." The REC is required to help you in the same way as if you had chosen an EHR from its list.

Physicians exert enormous power in the EHR industry through their purchasing decisions. Consumer demand drives this industry. You call all the shots with the RECs, so you can concentrate on the important business of implementing the best EHR for your practice and then attesting to meaningful use, which is all the RECs really want for you anyway, and entirely how they get paid.

This article was originally posted at http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=745416&sk=&date=&pageID=6

Can Healthcare Do Security Successfully?

2011-10-21T06:40:00.005-07:00

I'm going to answer this question with what I believe to be the correct answer: Yes, the healthcare industry is capable of doing security successfully. I base that belief not only on my experience over the last 20 plus years, but also because of the many examples of organizations that are getting it right, and the many industry leaders who have proven that security can be implemented successfully. So why do I pose the question? Because many organizations are still lagging in the area of healthcare security. Perhaps the better question is, why do some organizations get it right and others struggle? There are several reasons for that, but what might be more interesting is to look at a couple of critical factors that have contributed to successful healthcare security programs.

Leadership
Leadership sets the tone for a successful security program. The most effective security programs have often been overseen by a business leader who makes patient privacy and data security a priority, and an experienced security professional that knows how to translate those priorities into practical action. Each executive is directly involved and ensures the information security program is realized through the provisioning of resources needed. They view patient privacy and data security as a responsibility, not just a cost center or necessary regulatory evil. In most organizations where there is struggle -- or failure -- it is usually traced back to a lack of focus at the top and/or insufficient resources to get the job done correctly. Survey after survey for the past few years has documented the shortcoming.

Objectivity
In addition to strong executive leadership that makes privacy and security a priority, another benchmark of successful programs is an appreciation for -- and openness to --objectivity in measuring performance. One of the first tenants of data security is to never allow the same person who built or manages a system to also test or audit that system. Separation of duties, third party assessments and consulting with outside experts have always been important keys to successful data security programs. Information security is an extremely dynamic subject area in which expertise should be maintained. This is particularly true when talking about strategic design and assessing risk.

Smart organizations seek external input when developing a security strategy, designing an enterprise security controls architecture or selecting the right technologies to enable their strategy. First, consultants come at the problem with the experience of having seen many environments. Second, they have already worked with many of the solutions/approaches in operation and tend to stay current in the technology. Third, there should be objectivity in the process; it is also important to consider the value of lessons learned elsewhere. The successful organization takes advantage of both knowledge and experience and reaps the benefits in cost avoidance, implementation successes and enhanced adoption.

The successful organization also takes advantage of objective measurement in assessing risk, both initially in determining which controls are needed, and on the back end by assessing effectiveness. One of the most informative tools employed in security management is the risk analysis. If done right, it will produce the roadmap needed for building, remediating or validating the security program. If done regularly, it will produce a honed awareness of where risk is enabled and support a better understanding of what security measures are most effective. Risk management is continuous. Risk analysis should be conducted at least annually in most environments, or when significant change occurs in the organization or information enterprise. Every regulated industry is required to conduct risk analysis -- healthcare is no exception. The HIPAA Security Rule calls for conducting a risk analysis, as does HITECH in both its Breach Notification Rule for determining harm and its Meaningful Use Rule attestation requirements for receiving incentive funds.

My Answer
Can health care do security successfully? Absolutely, and many organizations are. But, unfortunately many are not. The two success factors that relate to the culture of an organization: leadership and objectivity. Establishing a culture that views security as a core business responsibility and embraces objectivity in measuring effectiveness enables an organization to learn and improve more rapidly. Using external third parties for conducting risk analysis is a security best practice and it allows organizations to avoid costly lessons learned.

Mac McMillan is CEO of CynergisTek Inc. and chair of the HIMSS Privacy & Security Policy Task Force.

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

The HIT of ACOs, part 2: Beyond health information exchange

2011-10-21T06:40:00.003-07:00

[caption id="" align="alignleft" width="194" caption="John Loonsk, MD, FACMI, is chief medical officer for CGI Federal. From 2006-2009, he was director of interoperability and standards in the Office of the National Coordinator for Health Information Technology."][/caption]

Will accountable care organizations follow the lead of HIEs in analyzing data across participating providers, or surpass them?

In this series, we are examining ways health IT can best support the goals of Accountable Care Organizations (ACOs) for health reform.

In our first article we focused on how clinical care and administrative data, as well as software tools, can be arrayed to support quality and efficiency analytics and reporting for an ACO. Data analytic technology usually operates retrospectively on non-transactional data that can be accumulated from diverse systems. As such, while not easy it is perhaps the easiest part of architecting an ACO technical infrastructure. There are analytic challenges in accumulating, normalizing, linking and processing the "iceberg" of both data visible in measures and the greater quantities of less-visible, supportive data needed for analytics and reporting.

Cross-organizational analysis
There are also many political issues related to bringing together multi-organizational, constituent data, but the business risk being imposed on ACOs and the opportunity that comes from bringing in claims data from multiple payers should help pressure for pan-ACO cooperation in this area. There are also clear reasons for being able to analyze data across multiple ACO constituent organizations. Some very useful quality measures, for example, relate to readmission factors and other elements of multi-organizational care. It is not clear that reporting or analysis from individual EHRs will ever be able to easily access these measures without some sort of intermediate organization whether that is the ACO or not.

The challenges of improving, rather than just reporting on, quality and efficiency, however, are even more daunting. Quality and efficiency "management" rather than just "measurement" places a heavier reliance on ACO-wide sharing of transactional clinical and cost data and on workflow processes rather than just retrospective analysis and reporting. Some of the kinds of quality and efficiency management that ACOs will seek can certainly come from taking analytic learnings and manually applying them though programs and policies that induce changes in care. But in many respects manual application misses what many think can provide the greatest gains from using EHRs and electronic technology.

Many believe that bringing clinical record data and derived knowledge together electronically in the clinical workflow offers the best opportunities to make substantive impacts on quality and efficiency. Some of these activities fall under the broad and somewhat ill-defined title of "clinical decision support" (CDS) and medical error reduction, but some are also more mundane information sharing patterns that relate to where and how clinical record data can be accessed – by people and by systems – and what an EHR is for the broad community of an ACO.

Here is a concrete way of helping to visualize these issues and capabilities. Some communities now have what amounts to a single, shared EHR for all of their community and hospital providers. They are not just sharing a single brand of EHR that is implemented several times in different organizations. They actually have a single instance of an EHR where patient record data are seamlessly accessible in both community and hospital settings. At times, they are getting to this state by having all of the providers owned by the same care organization. At other times, they are getting there because the hospital(s) purchased a particular product and is aggressively providing EHR services to community physicians from the same data repository. In these environments, at the most basic level, the ACO organizational boundaries match the single instance EHR organizational boundaries. Said another way – there is a single, "community EHR" where community and inpatient providers can retrieve store, retrieve and manage patient records that include entries from multiple providers.

Such a community EHR offers great opportunities for information sharing – both viewing and electronic processing – with minimal interoperability needs. As such, it readily provides some functions that can be used to help manage quality and efficiency of care. It provides an infrastructure that supports many medical home concepts without having to work though all of the politics and workflow incentives for insuring that the right primary care provider has all of the information that is needed. It eases transition of care issues. Medication reconciliation when a patient moves into an inpatient setting can be done one time for each involved organization instead of each time a patient moves in and out of inpatient care. Patient record sharing is made technically simple because instead of having to achieve machine processable, semantic interoperability between multiple EHRs, authorization to query the record from the shared store is all that is necessary. Processes can be setup to automatically determine if a newly planned test has already been done. And the growing category of "managed" vs. "transactional" medical record data (summary record, problem list, medication list, allergy list, care plan) is much easier to share and support for all participants in a patient's care. A shared instance of some of these managed clinical record data eases processable information reconciliation between organizations, minimizes duplication of the work of managing these data, and provides a common platform for the trigger data that are the jumping off point for leveraging automated CDS and other quality and efficiency processes though electronic query and processing.

Most developing ACOs will not have a community-wide EHR and will, instead, have numerous different EHRs. These organizations will then need to try to emulate some of these information sharing capabilities and functions by combining the EHRs with private health information exchanges (HIEs).

Without stronger standards, however, it remains to be seen whether the private HIE products will be able to sufficiently overcome the interoperability challenges and provide similar functionality. If not, the difference between these models may become not only an indicator of ACO success, but an important component in the viability of independent community providers in an increasingly electronic clinical care world.

Communitywide HIE a 'foundational element' in health system's ACO strategy

2011-10-21T06:40:00.001-07:00

Eastern Connecticut Health Network (ECHN), a not-for-profit healthcare system, has contracted with MobileMD, a Yardley, Pa.-based vendor, to help it build a communitywide health information exchange.

The HIE not only will provide connectivity among ECHN's two hospitals and five ambulatory-care sites, but also will reach out to non-ECHN providers, including competing healthcare systems in the Manchester, Conn., area. The HIE will be available to community physicians, as well as a skilled nursing facility, a rehabilitation center and a home health agency.

ECHN said the HIE will be a foundational element in its accountable care organization strategy.

"ECHN looks forward to working with MobileMD as the means to establish closer communications with community providers," Charles Covin, ECHN's vice president for information services, said in a statement. "The MobileMD product suite will permit all members of the provider community to better communicate and share pertinent information in a secure manner."

MobileMD offers a cloud-based HIE for clinical and administrative data exchange among all providers caring for patients within a community. The company claims that it can connect EHRs from any vendor.

An interesting sidelight: ECHN recently renewed its network provider contract with Aetna, yet chose not to use Aetna's Medicity subsidiary as its HIE vendor.

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

ACOs: A sustainable business model for HIEs?

2011-10-18T04:06:00.005-07:00

Few regional and state health information exchanges have found a sustainable business model. John Tempesco, chief marketing officer at ICA, a Nashville-based HIE vendor, recently told attendees at a Massachusetts conference that accountable care organizations (ACO) might provide the solution.

Speaking at a meeting of the Massachusetts Health Data Consortium, Tempesco said that the key to HIE success will be "patient centered HIE technology" that enables true communication at critical hand offs, collaboration across the continuum of care and analytics to determine best practices to reduce costs while improving quality. These also are the goals that ACOs will have to achieve.

Noting that the industry is moving toward a quality-driven model that depends on care coordination, Tempesco said, "The missing link to care coordination through automation has been a combination of both data portability and patient centric approaches to exchanging information in the healthcare sector. HIE provides the portability of patient records and the ability to put the patient at the center of the healthcare process."

What Tempesco didn't mention is that private HIEs within healthcare systems are growing much faster than public HIEs funded by state and federal grants. These private exchanges have forced the closure of some regional or community HIEs because of lack of support from the healthcare providers that have their own HIEs. Some observers expect that hospital-based ACOs will use private HIEs to exchange data across care settings.

Interestingly, ICA, which uses technology developed at Vanderbilt University Medical Center, serves both private and public HIEs. Among its clients are Vanguard Health System in Massachusetts, the Kansas Health Information Network, MidSouth eHealth Alliance, and Middle Tennessee eHealth Connect.

Developing and Implementing System-Wide Policies

2011-10-18T04:06:00.003-07:00

This is the fourth article in a five-part series designed to spur you toward privacy and security policies that will help your organization achieve HIPAA compliance. So far, we've covered risk assessment, Trojans andcoordinating information across departments. In this article, we discuss the important step of crafting and implementing policies system wide.

When discussing policies related to HIPAA compliance, they must be system wide, not department specific. Just as we discussed collaboration among decision-makers in our last article, policy development and implementation must also be a joint effort across many hospital departments. Physical therapy is different than radiology, which is different than cardiology, which is different than obstetrics, and so on.

Take, for example, the hospital lab. Only those conducting the tests are in the clinical lab. In the radiology department, however, there is a steady stream of patients in and out of the diagnostic area. In the lab, there is virtually no chance of a patient seeing another patient's private information. In radiology, it's a different story. So what might work as a privacy policy for lab may not work for radiology.

Together with other hospital departments, write a blanket, hospital-wide policy that meets everyone's needs, but note - you can include exceptions. Consider exceptions an extra level of protection for your hospital with regard to HIPAA compliance. For example, you may write a policy that states, "All computer screens with patient information displayed will not be viewable by the general public." In the lab, this works just fine. But what about in radiology? Who is the general public? Does it include a patient that came into the diagnostic area for a specific test, or a patient who happens to walk past the room? To address these concerns, you may write an exception that would specify that the patient not be brought into the room until their unique information is up on the screen, or perhaps you may add a "screen block" that would make the computer screen not viewable from the patient's vantage point.

Or consider this example: Let's say your hospital policy states that every user must log into a computer or medical device with a unique user name and password. But you have an older-model X-ray machine that only allows two different user names and passwords. You can write an exception stating that the device is known not to comply with the hospital policy and will be maintained in a secure area, used only by the radiologist assigned that day - and never left unattended in public areas.

When crafting hospital security and privacy policies, it's important to consider "addressable" vs. "required" specifications, meaning those requiring appropriate assessment and safeguards, and mandatory implementations as stated in the HIPAA Security Rule, respectively. Addressable, however, does not mean "ignorable." It means it must be evaluated for application in your hospital and may be determined not to be necessary to reduce your risk. You have probably heard a lot about encryption lately, and some think it's the silver bullet to preventing breaches. Encryption is an addressable standard, meaning each hospital should address its applicability to them, taking into account factors like size, possibility of a breach and value of risk associated with a breach. Then decide whether it should be addressed by your hospital.

A note on encryption: It will not necessarily reduce your risk of a privacy breach, neither will it protect you from HIPAA violations. Encryption is broken with a password. And where do many people keep their passwords? On a post-it note, taped to their computer screen! So if you leave your laptop in the car one evening after work and it's stolen with the password taped to the screen, that's a clear breach.

You may also have heard of different levels of encryption: 256-bit vs. 128-bit vs. 64-bit (the higher the number, the harder it is to break the code). Some hospitals write 256-bit encryption into their privacy policies when the HIPAA statutes may require far less. In other words, don't impose impossibly strict self-regulation when your privacy policies are adequate at a lower level. If there is a privacy breach, HIPAA officials may judge your institution based on your own policies if they're stricter than federal regulations require.

Finally, remember this: The only thing worse than having no policy is having a policy you don't follow.

In our final article in this series, we'll cover purchasing IT and medical equipment as it relates to being HIPAA Compliant.

Earl Reber is executive director, eProtex.

ACOs: A sustainable business model for HIEs? http://ping.fm/1mfEY

2011-10-18T04:06:00.001-07:00

Little question, one of many issues that make authorized language hardest to understand is its unusual words and terms. Some authorized phrases equivalent to-decide, court, interrogation etc. are comparatively well-known, the place as others are full mystery to non-professionals. Some legal writings tend to include very lengthy sentences, typically tons of of phrases in length. This makes the transcription job harder. Below are some tips and hints of the authorized terms encountered in legal transcription and easy methods to transcribe a doc successfully.

Some troublesome legal phrases and terms. Without figuring out these, transcribing authorized documents can be virtually impossible.

1. Arbitration-A way of different dispute decision during which the disputing events agrees to abide by the decision of an arbitrator.
2. Assignment-The switch of legal rights, from one person to another.
3. Chapter-This is a course of governed by the federal regulation to assist individuals, once they can’t or is not going to pay their bills.
4. Bifurcation-Splitting a trial into two parts: a legal responsibility phase and a penalty phase.
5. Certiorari- It refers to the order of a court so that it may possibly assessment the decision and proceedings in the lower court.
6. Deed-A written legal document that describes a chunk of property and outlines its boundaries.
7. Defamation-The publication of the assertion that injures a person’s reputation.
8. Deposition-It is a process in which a witness testifies underneath oath, earlier than trial.
9. Escrow-The deed of a property will likely be in escrow( in pending), till the completion of the real estate transaction.
10. Foreclosures-When a borrower can’t repay a loan and the lender seeks to promote the property.
11. Immunity-Exemption from a legal obligation or penalty.
12. Implied warranty-A assure imposed by legislation in a sale.
13. Intestate-To die with out a will.
14. Plaintiff-The one who initiates a lawsuit.
15. Pro se-A person who represents himself in courtroom alone without the assistance of the lawyer.
16. Quash-To nullify or declare invalid.
17. Slander-Defamatory oral statements and gestures
18. Subpoena-An order compelling an individual to appear in court docket or produce documents.
19.Suvoir Dire-Means communicate the truth.

Tips to turn out to be a superb authorized transcriptionist
Under are certain guidelines you need to maintain in your thoughts to develop into a very good authorized transcriptionist.
1. Take heed to a legal phrase or group of significant phrases fastidiously again and again before transcribe, till you aren’t sure.
2. Understand each legal testimony appropriately and use them appropriately.
3. Analyse what’s being dictated, hear dictator’s voice, and comply with it as a guide.
4. A 1-hour tape will take not less than 3 to four hours, relying on your speed. Maintain a very good speed throughout, in an effort to finish it in time.
5. Overview document for a second time and improve it by studying rules.
6. Use information discovered within the appendix, prefix, suffix sections of authorized reference texts, each time necessary.
7. Edit the ultimate copy, which needs to be free of spelling, punctuation, grammar or any other errors.
8. Proofread the transcript with 100% accuracy.

Legal transcription includes the conversion of audio recordsdata into typed transcripts. Modern-day legal transcription technology has gone digital and is highly effective.

Efficiencies Converge with EHRs, Practice Management

2011-10-13T06:08:00.003-07:00

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

Building an HIE with minimal IT or know-how

2011-10-13T06:08:00.001-07:00

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

Obstetrics-Gynecology Transcription

2011-10-05T03:14:00.003-07:00

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

The Generals of General Transcription

2011-10-05T03:14:00.001-07:00

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

Natural Language Processing Underutilized in Radiology Despite Advanced Capabilities

2011-10-04T06:08:00.003-07:00

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

Natural language processing underused in radiology

2011-10-04T06:08:00.001-07:00

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

10 Hilarious Medical Transcription Errors

2011-09-28T03:06:00.003-07:00

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

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

2011-09-28T03:06:00.001-07:00

“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.

Diabetes care improves with EHRs

2011-09-20T06:06:00.001-07:00

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

2011-09-17T03:09:00.001-07:00

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

2011-09-17T03:08:00.001-07:00

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