Welcome to the Lounge!

The AHDI Lounge is an exchange blog for dialogue and discussion around trends, drivers, and challenges facing the healthcare documentation profession and a place for AHDI members to address these issues. It's just a spot for busy MTs, editors, educators, students, managers, and service owners to chat about the profession. So grab a latte and join us!

About AHDI

AHDI (Association for Healthcare Documentation Integrity) is the world's largest professional society representing the healthcare documentation sector. Our purpose is to set standards for education and practice in the field of health data capture that ensure the highest level of accuracy, privacy, and security for the US healthcare system.

TRSI To Train Medical Scribes

Posted on Tuesday, November 30, 2010 comments (116)
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A press release today announces that TRS Institute, in collaboration with ScribeAmerica, will be offering an online training course for medical scribes:

TRSI CEO Peter Reilly says, "We are thrilled to partner with ScribeAmerica - the leader in medical scribe management and education. The new training represents a first. Until now, medical scribe training was limited in scope and available only in instructor-led environments." He adds that the cutting-edge course will open highly rewarding professional opportunities in the emerging healthcare documentation arena to program graduates.

The new Medical Scribe online training program will launch in January, 2011. As part of its ongoing commitment to make job training programs as widely accessible as possible to allied health professionals, TRSI will offer a time-limited partial scholarship for students who enroll between now and the first class, on Monday, January 10, 2011.

Jay Vance, CMT
AHDI Lounge Administrator/Moderator

The Doctor-Patient-Laptop Relationship

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From the CT Mirror comes a very thought-provoking article exploring how electronic medical records (EMRs) are changing the doctor-patient relationship dynamic:

Even if the shift from paper to computers does not change a doctor's behavior, typing in a computer can seem more disruptive than taking notes on paper, said Makoul, who has studied the effects of electronic medical records on doctor-patient interactions.

A comparison of doctors using paper charts and those who had recently begun using electronic records found that there was little difference in the amount they looked at or wrote in the chart, Makoul said.

"But it's extremely, unbelievably different what it looks and feels like," he said.

In my mind this is yet more evidence that most EMRs in their current form do not enhance the effective practice of medicine. On the contrary, they're cumbersome for the physician and disruptive for the patient. In the quest to save money, the personal interaction between doctor and patient--what little of it was left--is being further destroyed.

It would be interesting to see what would happen if enough patients flat out told their doctors, "I'm not coming to see you until you get rid of that stupid computer!"

Jay Vance, CMT
AHDI Lounge Administrator/Moderator

Maybe Medical Scribes Aren't Such A Bargain After All

Posted on Monday, November 29, 2010 comments (4)
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Very interesting article from the KevinMD.com blog regarding the use of medical scribes in physician practices. We initially covered this story in an earlier blog post. The follow-up article by Douglas Perednia, MD exposes some of the flaws in the rationale behind using scribes, with particular criticism aimed at the irrationality of forcing doctors to use electronic medical record systems that are so poorly designed and cumbersome as to make hiring a scribe seem like a good idea!

Well worth taking a few moments to read.

Jay Vance, CMT
AHDI Lounge Administrator/Moderator

Nuance Consolidates Medical Transcription Services & Technology Offerings

Posted on Thursday, November 18, 2010 comments (3)
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According to a press release today, Nuance is consolidating its medical transcription services and technology offerings into a unified entity called Nuance Transcription Services. From the press release:

Nuance Transcription Services combines Nuance's proprietary eScription speech recognition platform, which has achieved a Best in KLAS award in speech recognition for six years in a row, with the Company's highly experienced, global medical transcription and editing services team. Nuance Transcription Services also draws upon strengths and resources from two recently acquired leaders in medical transcription outsourcing, Outsourcing Solutions Inc. (OSi) and Encompass Medical Transcription Inc., which received the highest overall score among transcription service providers in the KLAS 2010 mid-term performance review.

Nuance has accumulated a number of transcription-related technology and services companies since 2005 when ScanSoft--owners of the Dragon speech recognition product--acquired and merged with Nuance. Here are a few key acquisitions:

* 2006 - Dictaphone Corporation
* 2007 - Focus Infomatics, Inc.
* 2008 - eScription, Inc.
* 2008 - Philips Speech Recognition Systems
* 2009 - IBM Speech Technology patents
* 2010 - MacSpeech
* 2010 - Outsourcing Solutions, Inc. (OSi)
* 2010 - Encompass Medical Transcription, Inc.

Clearly, Nuance's (ultimately unsuccessful) bid for the assets of Spheris was in keeping with its recent history of acquiring competitors in both the medical transcription services and speech recognition technology fields. At this point it would appear that M*Modal is the only "brand name" speech recognition technology vendor that isn't owned by Nuance, although I hear rumors about other SRT projects in the works that nobody wants to talk about.

Can't imagine why that would be...!

Jay Vance, CMT
AHDI Lounge Administrator/Moderator

The Computer Will See You Now

Posted on Tuesday, November 16, 2010 comments (9)
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Great post over at Robin Daigh's MD-IT blog describing a patient's perspective of a visit to an EHR-equipped physician:

Almost the entire time during the exam and discussion, my daughter’s doctor was typing on the computer about her symptoms and treatment, making mistakes in his typing, and repeatedly going back to edit what he had just typed. I felt like the entire visit he was distracted because he was concentrating so hard on composing and typing the chart note.

I was taken aback by the amount of time he spent on the computer. Our visit was about 15 minutes long, of which he spent about 30% of the time paying attention to my daughter, and 70% paying attention to the computer. I didn't feel we had his whole attention during any part of our visit.

I was also thinking that I could have typed what he just did in less than half the time he spent doing the same task and produced a more comprehensive note. I think that he could have dictated the note in less than half the time as well, since he probably only typed about five sentences.

Jay Vance, CMT
AHDI Lounge Administrator/Moderator

New Medical Transcription Credentialing Program On Track For 2011

Posted on Friday, November 12, 2010 comments (6)
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AHDI President-Elect Ava Marie George provides an update on the new credentialing program in an article in ADVANCE for Health Information Professionals.

AHDI is currently in the beta testing phase and had 207 candidates sign up to sit for the exam. All candidates are expected to complete the beta exam by the end of November. AHDI is hoping to notify all beta test takers by the end of December. The go-live launch for the new RMT, CMT and combined CQE exams is anticipated by the middle to end of January 2011 pending unforeseen technical difficulties.

Jay Vance, CMT
AHDI Lounge Administrator/Moderator

Medical Transcription Is Green!

Posted on Tuesday, November 9, 2010 No Comments
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NOTE: The following is an email conversation posted here with the permission of the author, Debbie Bright-Chunn:

Today I received a phone survey by the Louisiana State University Public Policy Research Lab asking about whether my business had "green jobs." After a lengthy questionnaire about using solar panels, conserving gas usage, cleaning up the coastline, etc., I informed them that our business and our ICs did indeed have green jobs. At the end of the survey, the person conducting it informed me that we did not fit into the character of "green jobs" since we were not conserving energy and helping the environment. I then told her that I was on a national board that went to Washington, DC each year to promote our green jobs and that no one there had ever disputed the fact that we were in that category. Then I was connected to a man named Bill Randazzo who politely asked more questions and said he really appreciated the work we do. He said that something about their questionnaire must be wrong because in his eyes, what we did offer was truly "green." Please see his note below. Thought this was quite interesting....maybe some people really are listening to us!

Hello,

My name is Bill and I spoke to you briefly on the phone. I have spoken to the official who ordered this survey and he agrees that there is one gaping hole in our survey that was uncorrected. In a situation like yours, the jobs themselves do not fit the definition of "green", but the operational practices are the very definition of green. We have now added new questions to accomodate green practices.

Thank you so much for helping us identify this glaring omission!

Bill Randazzo
LSU Public Policy Research Lab

Debbie Bright-Chunn, RHIT, CMT, AHDI-F
HIM Director, Bastrop Rehabilitation Hospital
CEO, Bright Consulting, LLC
2009-2012 AHDI Board Member
AHIMA-Approved ICD-10-CM/PCS Trainer

Survey Says: Healthcare Data Security Inadequate & Not A Priority

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From the hard-to-believe department today comes an article from HealthDataManagement.com about a troubling survey regarding healthcare data security. According to the article, a recent survey by research firm Ponemon Institute reveals not only that a significant number of surveyed organizations cannot properly secure patient data, but that data security in those organizations is not perceived to be a priority.

Admittedly the sample size is small, consisting of interviews with 211 senior managers at 65 hospitals, delivery systems and physician practices. Nevertheless, the results are alarming:

* Protecting patient information is not a top priority at 70 percent of responding hospitals. Two-thirds of organizations have less than two staff dedicated to data protection management.

* The patient billing and medical records departments are the most susceptible to data loss or theft.

* Seventy-one percent of respondents do not believe HIPAA regulations have significantly changed practices for managing patient records.

* The Ponemon Institute extrapolates the findings of the survey to indicate a significant number of data breaches go undetected and therefore unreported.

The full report, "Benchmark Study on Patient Privacy and Data Security," is free and available here.

Jay Vance, CMT
AHDI Lounge Administrator/Moderator

President Obama: Offshoring Fears Outdated, Unwarranted

Posted on Monday, November 8, 2010 comments (19)
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From networkworld.com/IDG News Service comes an article portraying U.S. President Barrack Obama as less protectionist than some of his earlier remarks seemed to indicate. According to the article, the president told business executives in Mumbai, India that the perception that Indian call centers and back office operations cost U.S. jobs is an old stereotype that ignores today’s reality that two-way trade between the U.S. and India is helping create jobs and raise the standard of living in both countries. Earlier this year, while proposing reforms to the U.S. tax system, the president had alarmed offshore outsourcing services providers by criticizing U.S. tax codes "that says you should pay lower taxes if you create a job in Bangalore, India, than if you create one in Buffalo, New York."

Of course, a discussion of the macroeconomic ramifications of offshore outsourcing is an altogether different conversation than, for instance, how HIPAA/HITECH can be enforced in foreign countries. The former, in my opinion, is unlikely to yield anything new in the way of obstacles to offshoring, but the latter is still very much up in the air.

Jay Vance, CMT
AHDI Lounge Administrator/Moderator

AHDI-West Online Petition Advocates For Inclusion Of MT In Meaningful Use Criteria

Posted on Thursday, November 4, 2010 comments (2)
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The Western Region of the Association for Healthcare Documentation Integrity (AHDI-West) has created an online petition directed at federal legislators:

We petition your continued support in these urgent times by communicating with the Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health IT, seeking acknowledgment in regulations that the dictation-transcription process and structured narrative reports are recognized as vital elements of electronic health records (EHR), are included in the definition of “meaningful use”, and recognized as essential for ensuring patient safety.

The petition can be electronically signed online.

Jay Vance, CMT
AHDI Lounge Administrator/Moderator

Medical Transcription Compliance Under HITECH

Posted on Wednesday, November 3, 2010 comments (8)
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From the Journal of AHIMA comes an article well worth reading regarding the changes medical transcription service providers are facing under the HITECH portion of the stimulus bill passed last year.

When President Obama signed the American Recovery and Reinvestment Act (ARRA) in February 2009, the HIPAA rules for privacy and security of protected health information (PHI) became more accountable, enforceable, and subject to litigation. A healthcare provider’s responsibility for controlling protected health information (PHI) was greatly expanded—as were the penalties for failing to do so.

The changes have direct impact on the decisions a provider makes on medical transcription: where services will be performed, who will be performing them, and how the agreements will be written. There are new concerns to contemplate, new criteria to weigh, and new items to add to checklists.

The authors address the compliance challenges surrounding offshore outsourcing, and also provide a useful list of questions HIM directors should be asking prospective MT service providers.

Jay Vance, CMT
AHDI Lounge Administrator/Moderator

Are Medical Transcriptionists The "Gatekeepers Of Grammar"?

Posted on Tuesday, November 2, 2010 comments (20)
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Very thought-provoking blog post by Chad Sines at omniscribeonline.com regarding medical transcriptionists' attention to/obsession with grammar:

Why do we as MTs feel that we are the gatekeepers of grammar? Isn’t that a faulty view of our role?

We are fighting a battle that no physician/facility really cares about. In practice we have allowed so many style variations in templates that our QA spends the majority of their time checking style instead of critical patient information.

Now I am not saying that grammar/style is irrelevant, but I am saying it MUST not be how we define ourselves. It should be secondary except in cases where it honestly affects patient safety.

Feel free to weigh in with your thoughts.

Jay Vance, CMT
AHDI Lounge Administrator/Moderator

CBay Systems Prepares For IPO

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From TheFactoringBlog.com comes some interesting tidbits of information about CBay Systems (majority owner of MedQuist and recent acquirer of the assets of the late Spheris) as it prepares for an initial public offering:
  • CBaySystems processed (on an annualized run rate basis) more than 2.9 billion lines on its platform.
  • CBaySystems has more than 14,000 MTs and MEs.
  • More than 60% of the 2.9 billion lines CBaySystems processed used ASR technology.
  • Nearly 40% of the 2.9 billion lines CBaySystems produced were done offshore.
  • CBaySystems serves more than 2400 hospitals, clinics and physician practices throughout the U.S., including 40% of hospitals with more than 500 licensed beds.
CBay's S-1 form quotes some market research from a firm called ValueNotes:
  • ValueNotes estimated that the market for outsourced medical transcription services was $5.4 billion in 2009.
  • Outsourced medical transcription is expected to grow 8.2% per year over the next five years to $8.0 billion in 2014.
  • In addition, ValueNotes estimates that the outsourced medical transcription market was 33% of the overall MT market in 2009, and it projects a growth in the market to 38% in 2014.
Out of all that information, what I find the most interesting is the assertion by the market research firm that in 2009 only 33% of medical transcription was being outsourced, meaning two-thirds of transcription was still being done in-house at hospitals, clinics and physician practices. I would have thought the outsourced percentage was higher than that.

Jay Vance, CMT
AHDI Lounge Administrator/Moderator

MedQuist To Implement New AHDI/AHIMA QA Best Practices

Posted on Monday, November 1, 2010 No Comments
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In an article published in ADVANCE for Health Information Professionals online magazine, DeeAnn Logan and Michael Clark note that MedQuist is in the process of providing "education and implementation of the AHDI/AHIMA QA Best Practices across their entire customer base." The article points out that adherence to quality standards is essential in order to provide accurate structured data for import into electronic health record (EHR) systems. "If the documentation is not of the highest quality," the authors state, "any expectation of structuring or analytics goes out the window."

I think this is significant for a couple of reasons. First of all, if a transcription service provider with the footprint of MedQuist does in fact manage to convince its entire client base to implement the new QA standards, that would be a huge step toward the creation of truly industry-wide standards. Secondly, it's crucial that all of us in the industry consistently remind the healthcare community, as Logan and Clark do here, that even the most advanced NLP technology can't extract meaningful data unless the underlying patient encounter record is accurate. I believe NLP holds great promise for our industry as a way for us to add significant value to the information we process. But we must keep banging the drum for the inclusion of skilled medical language specialists in the healthcare documentation process. Neither speech recognition technology nor point-and-click EHR systems can provide the level of quality necessary to ensure the American people that their medical records are truly accurate and trustworthy.

Jay Vance, CMT
AHDI Lounge Administrator/Moderator
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