Why Business Transcription Essential for Business Communication

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

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?

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:

1. 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.



2. 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

1. 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.


2. 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.


3. 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.


4. 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

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

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

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

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

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

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

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

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

• 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.


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

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.³ Approximately 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

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

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

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Healthcare Data Mining, Structured Data and Natural Language Processing

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:

1. Manually searching through thousands of documents.


2. 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

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

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

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Primary care physicians, meet your regional extension centers

• 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