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About Bizscribes Inc.

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

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

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

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

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

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

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

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

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

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

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

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

                          

In his State of the Union speech, President Barack Obama made just one explicit mention of the 2010 health law. Here is a transcript of the few parts of his speech that mentioned health care issues:

Innovation also demands basic research. Today, the discoveries taking place in our federally-financed labs and universities could lead to new treatments that kill cancer cells but leave healthy ones untouched. …

I will not go back to the days when health insurance companies had unchecked power to cancel your policy, deny your coverage, or charge women differently than men. …

Official White House photo by Pete Souza

Do we want to keep these tax cuts for the wealthiest Americans? Or do we want to keep our investments in everything else – like education and medical research; a strong military and care for our veterans? Because if we’re serious about paying down our debt, we can’t do both.

The American people know what the right choice is. So do I. As I told the Speaker this summer, I’m prepared to make more reforms that rein in the long term costs of Medicare and Medicaid, and strengthen Social Security, so long as those programs remain a guarantee of security for seniors. …

I recognize that people watching tonight have differing views about taxes and debt; energy and health care. But no matter what party they belong to, I bet most Americans are thinking the same thing right about now: Nothing will get done this year, or next year, or maybe even the year after that, because Washington is broken. …

I’m a Democrat. But I believe what Republican Abraham Lincoln believed: That government should do for people only what they cannot do better by themselves, and no more. That’s … That’s why we’re getting rid of regulations that don’t work. That’s why our health care law relies on a reformed private market, not a government program. …

Above all, our freedom endures because of the men and women in uniform who defend it. As they come home, we must serve them as well as they served us. That includes giving them the care and benefits they have earned – which is why we’ve increased annual VA spending every year I’ve been president.

————————————————————–

Indiana Gov. Mitch Daniels delivered the Republican response. Here are excerpts of his remarks:

[We] must unite to save the safety net. Medicare and Social Security have served us well, and that must continue. But after half and three quarters of a century respectively, it’s not surprising that they need some repairs. We can preserve them unchanged and untouched for those now in or near retirement, but we must fashion a new, affordable safety net so future Americans are protected, too.

Decades ago, for instance, we could afford to send millionaires pension checks and pay medical bills for even the wealthiest among us. Now, we can’t, so the dollars we have should be devoted to those who need them most.

The mortal enemies of Social Security and Medicare are those who, in contempt of the plain arithmetic, continue to mislead Americans that we should change nothing. Listening to them much longer will mean that these proud programs implode, and take the American economy with them. …

It’s not fair and it’s not true for the President to attack Republicans in Congress as obstacles on these questions. They and they alone have passed bills to reduce borrowing, reform entitlements, and encourage new job creation, only to be shot down time and time again by the President and his Democratic Senate allies.

This year, it falls to Republicans to level with our fellow citizens about this reality: if we fail to act to grow the private sector and save the safety net, nothing else will matter much. …

In word and deed, the President and his allies tell us that we just cannot handle ourselves in this complex, perilous world without their benevolent protection. Left to ourselves, we might pick the wrong health insurance, the wrong mortgage, the wrong school for our kids; why, unless they stop us, we might pick the wrong light bulb!

                          

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

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

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

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

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

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

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

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

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

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

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

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

Follow Michelle McNickle on Twitter, @Michelle_writes

This article was originally posted at http://www.healthcareitnews.com/news/11-healthcare-data-trends-2012?page=0,1

                          

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

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

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

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

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

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

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

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

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

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

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

Follow Michelle McNickle on Twitter, @Michelle_writes

This article was originally posted at http://www.healthcareitnews.com/news/10-health-it-wishes-2012?page=0,1

                          

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Physician engagement with patients through personal health records may be more of a challenge than getting patients to use the system, says G. Daniel Martich, MD, FACP, chief medical information officer and vice president for physician services at UPMC.

Because of the particular software design of the e-visit portion of the PHR at UPMC, it can be used only by generalists such as primary care internists and family care practitioners. Of the 69 UPMC practices and 350 physicians in that category, 27 of the practices have opted in completely. Individual physicians also can opt in, and in the other 42 practices at least one doctor has agreed to respond to participate in HealthTrak and respond to the e-visit portion of the PHR.

Among physicians who are reluctant to participate in UPMC’s PHR system, Martich says the most common reason was that they feared the direct connection to the patient would be a time burden.

“They worried that the patient would write tomes, as opposed to a quick phone conversation. They thought it would be so onerous, looking at attachments of articles the patient clipped from Reader’s Digest and they’d never get through their day,” he says. “That, by and large, is myth. In fact, we’re finding that patients are much more succinct if they have to type it in rather than talking to you on the phone.”

Holly Miller, MD, MBA, FHIMSS, chief medical officer with Fishkill, NY–based Med-Allies and a HIMSS director, seconds that conclusion. She participated in a time study at the Cleveland Clinic that showed physicians actually saved time by allowing lab results to be released to the PHR rather than calling the patient.

Physicians also can be protective of patient data, with good intentions, Martich says. They don’t like the idea of lab results, for instance, being shared directly with the patient without the doctor being able to explain what they mean. The results in the PHR must be accompanied by an explanation of what the results mean, possibly with a link to a more detailed discussion, Miller says.

“They’re worried that the patient is going to get horrific news without the doctor first being able to review it, refine it, and present it in the best way,” Martich says. “That concern is understandable, but it really has not been a problem.”

Reliability of the information in the PHR is key, Miller says. Early experiences with PHR models have shown that physicians will not trust any model that depends on the patient entering data. It is far too easy to enter incorrect or incomplete data, she says, and that is why the tethered model is the key to success with a PHR. Physician adoption also depends on the PHR being integrated in such a way that it is automatically generated through the EMR, she says.

“It is unrealistic to expect a provider to go outside of their work flow and log in to a disparate system,” Miller says.

                          

News story about ePrescribing featuring Allscripts client, Dr. Suneel Parikh from Queens Long Island Medical Group.

Practice Fusion’s free e-prescribing feature connects you to over 50000 pharmacies across the US. Learn how to order new medications and refills using past medication history or by searching through our NDC based medication library. practicefusion.com learn.practicefusion.com http practicefusion.com
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