This month's Newsletter topic addresses Electronic Health Records. I encourage everyone to read further. Yes, there may be information that Health Care Professionals already know. Yes, Medical Transcriptionists can provide a solution. But this government incentivized rush to EHR is important to every individual, as it could impact the future cost of your health care.
An Electronic Health Record (EHR) is an electronic version of a patient's medical history, that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that persons care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports The EHR automates access to information and has the potential to streamline the clinician's workflow. Each individual entry is known as an Electronic Medical Record (EMR).
EHRs are the next step in the continued progress of healthcare that can strengthen the relationship between patients and clinicians. The data, and the timeliness and availability of it, will enable providers to make better decisions and provide better care.
For example, the EHR can improve patient care by:
- Reducing the incidence of medical error by improving the accuracy and clarity of medical records.
- Making the health information available to all appropriate sources, reducing duplication of tests, reducing delays in treatment, and patients well informed to make better decisions.
- Reducing medical error by improving the accuracy and clarity of medical records.
All of that seems to make sense, doesn't it? The government has set aside $20 billion for incentives to health care providers in the 2009 Recovery Act, better known as the stimulus bill. These incentives are set to go out in the form of $22,000 Medicaid payments within the next six months to health care providers who deploy and meaningfully use certified electronic health records systems in their offices or hospitals.
Prior to this bill, just 17% of physicians' offices and 12% of hospitals had implemented some kind of electronic health records system. According to the Office of the National Coordinator for Health Information Technology, 74% of hospitals have responded to surveys saying they are planning on investing in health information systems.
The problem with the current system is this: Paper trails get lost, incorrect prescriptions get written and doctors' time is wasted listening to patients explaining their medical histories. The government's solution is to make this process digital and connected. If a doctor's notes are entered into an electronic record, they can be accessed by another medical professional across the city, state or country. This reduces the possibility of human error and doctors can diagnose problems faster and spend time seeing more patients. That is good for all of us.
Of course that solution has its own set of problems. The cost of implementation is certainly a large factor but collaboration methods, usability and training are also an issue. There are 472 EHR vendors offering certified "Complete EHR's". This government mandated change in the medical community is good for the digitized health records business, but even as these systems become easier for doctors to use, there can be clerical issues for doctors entering historical data on every patient. The implementation barriers need to be overcome and the over-abundance of vendors competing in this marketplace dominated by a small number of major players could create problems down the road.
Several market factors come into play, including Doctor's dissatisfaction with their choice of EHR systems - likely selected in haste to meet the government incentive timetables. There may be disenchantment with EHR incentives as the financial rewards decrease while regulations intensify. It seems that just like the "dot.com" bubble, the "EHR" bubble (nurtured by government incentives) will not last.
The US healthcare system initiative to develop a national electronic health record (EHR) infrastructure by 2014 aims to share and exchange health information and support personal health records for all Americans successfully. In a recently published Speech Recognition Adoption White Paper written by the Medical Transcription Industry Association (MTIA) and the Association for Healthcare Documentation Integrity (AHDI), a great deal of emphasis was placed on the role medical transcriptionists must continue to play in driving a successful national EHR. Many EMR and Speech Recognition Technology (SRT) providers have taken aim at medical transcriptionists (MTs) as being costly and an obsolescent part of healthcare documentation. However, the limits of EMR and SRT are significantly complemented by the work of medical transcriptionists in cases where solution providers and savvy healthcare organizations have recognized the value of the relationship between technology and MT "knowledge workers". COMMON SENSE AND HUMAN THOUGHT CAN NEVER BE REPLACED BY A MACHINE.
We can compare front end speech recognition (FESR) with backend speech recognition (BESR). FESR is the process where speech-to-text translation occurs real-time with the creation of a narrative dictation, typically for concurrent correction by the dictator. BESR is the process where the speech-to-text translation occurs subsequent to the creation of a narrative dictation, typically for later correction by a third party (such as an MT).
When comparing FESR with BESR, it was found healthcare organizations experienced significant success with BESR by routing work translated through a speech recognition engine to an MT for later correction. This method supported clinicians' ability to dictate without changing their habits. Other facts supporting BESR:
- Medical CFO's realize the cost savings and support BESR.
- 80% of clinicians were adaptable to BESR with no change in dictation habits.
- With MT's typically producing 1.5 to 2 times the volume over that of conventional transcription, BESR is an effective option for ACCURATELY documenting health records.
FESR has also made strides in the past decade. FESR now improves with repetition and can "learn" from completed and corrected documents. Many clinicians find FESR objectionable as there is the need to interact with the process to make real-time corrections which causes a change in dictation habits and slows the clinician down. Real time dictation documentation means immediate completion for the chart, but in most situations, that value is diminished by the extra time it takes the clinician to complete the record and the associated costs of that clinician's time.
Next time you visit your primary care physician and have your medical record manually documented into an EMR by your physician while seeing you, ask how much he/she likes the process. If you are a clinician, then you understand. While EMR technologies can be impressive, the process is not well-embraced when it distracts from the intimacy of the patient encounter or slows the process down to the point where fewer patients can be seen.
Clinician behavior is unlikely to change if there is continued time and efficiency pressures driving the healthcare industry. If EMR continues to challenge clinicians, then the role of a medical transcriptionist will be extremely relevant in helping meet the current adoption challenges. MT's are poised to evolve into clinical data, data quality and decision support specialists.
Physicians may "save" money in outsourced transcription expense, but is it at the cost of their valuable time? Physicians are compellingly being sold on the fact that "You can do it yourself!!!". The question is, "AT WHAT PRICE?" Studies have shown that a physician making an 'average salary' is losing upwards of $75,000/year spending their time doing clerical work. Recapture your productivity! Medical Transcription is relevant to documentation because it is the companion of narrative dictation with this key advantage - documentation of complete and accurate records. Medical Transcription services a significant percentage of the health care industry and enables scalable deployment across enterprise healthcare feeding those systems with unstructured and/or structured data health records.
This will lead to improved decision support and adoption of EMR usability - both are vital to the future of healthcare interoperability and the national EHR initiative. Moving forward, organizations that are focused on providing integrated solutions that leverage both technology and service offerings will ultimately lead to improved patient care.
Improved patient care is good for all of us. Think about this mandate affecting the healthcare industry the next time you see your primary care physician and ask questions about the procedures in place at his medical practice. The more informed a patient can be, and the more communication with the physician, the more likely that he or she will choose a system carefully so as not to adversely affect the quality of patient care.
Thanks so much for being a part of the Transcription Plus, LLC community.
Transcription Plus, LLC