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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

Can Healthcare Do Security Successfully?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

ACOs: A sustainable business model for HIEs?

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

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

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

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

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

 

 

Developing and Implementing System-Wide Policies

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

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

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

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

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

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

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

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

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

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

Earl Reber is executive director, eProtex.

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

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

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

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

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

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

Efficiencies Converge with EHRs, Practice Management

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

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

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

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

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

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

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

Running the numbers

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

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

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

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

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

Seeking domino effect

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

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

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

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

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

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

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

Next steps

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

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

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

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

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

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

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

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

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

Unused functionality

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

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

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

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

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

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

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

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

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

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

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

Revenue opportunities

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How Far Does Meaningful Use Go?

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

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

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

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

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

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

Building an HIE with minimal IT or know-how

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

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

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

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

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

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

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

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

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

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

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

Obstetrics-Gynecology Transcription

Obstetrics and Gynecology Transcription services

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

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

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

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

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

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

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

The Generals of General Transcription

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

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

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

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

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

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

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

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

Natural Language Processing Underutilized in Radiology Despite Advanced Capabilities

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

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

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

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

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

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

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

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

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

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

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

Natural language processing underused in radiology

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

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

• To flag patient records to support outcomes research;


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


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

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

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


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


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

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

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

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