We spend a lot of time serving hospitals, and the times are changing. Hospitals today are doing critical work in the most real-time setting there is – the doors never close; patients never stop arriving. Many of them are embracing ground breaking, forward thinking work under tremendous pressure to adapt to a rapidly changing landscape. No rest for the weary!
The clarion call to deliver a more personalized, flexible and empowered health care experience to a highly invested customer base (remember, patients are customers after all) is one heard across the country. While the topic of health care is landing square in the eye of the storm these days, we thought it would be interesting to showcase a few herculean efforts hospitals are making to forge the new frontier.
In a two-part post, we’ll introduce a few heroic hospitals doing some heavy lifting, breaking ground from which other hospitals can draw inspiration:
The Mayo Clinic’s Center for Individualized Medicine is working toward leveraging the power of gene sequencing, which looks to patients’ genomic blueprints to determine aspects of their health. In a piece for US News and World Report, the center’s director, Gianrico Farrugia, said the primary value should be the needs of the patients, and, “We can’t live up to it unless we turn to genomics.” Perhaps in the not too distant future, patients will be able to tote their genome mapping on their iPads.
This sizzling hot new delivery mode enables clinicians to interface with patients via video conferencing to assess, diagnose and monitor health issues remotely. Telemedicine most often benefits patients and families in rural communities by broadening access to distant specialists; plus, hospitals can bring in readily accessible staff to meet unexpected demands, such as in the ER. Mercy Health was an early pioneer in telehealth, beginning in 2006, equipping its ICU with telemedicine capabilities. Since then, Mercy has reduced mortality rates to 20 percent below the expected level, and reduced hospitals stays’ durations by 30 percent, according to the US News & World Report.
Physicians in Executive Leadership
The entrenched hierarchies that divided a hospital’s clinical and administrative staff are dissipating. After all, who has a deeper understanding the real needs of patients than doctors on the front lines? Today an increase in physician hospital executives who work in tandem with hospital administration to develop policy and make critical decisions regarding patient care is a model garnering more interest. According to Becker’s Hospital Review, now there are more than 60 joint MD-MBA degree programs, compared to only a smattering in the 1990s, for example.
Becker’s cited San Diego-based Scripps Health as one example of a system that broadened physicians’ role in decision-making. When the Physician Leadership Cabinet was created, the group included chiefs of staff and CEOs from each hospital campus, along with the VP of nursing. The cabinet strengthens collaboration between Scripps administrators and physicians as they develop strategies to improve quality and efficiency while reducing costs and clinical variation. Win win!
We applaud the continuous efforts of progressive minded hospitals to innovate toward improved patient care, reduced waste and costs, and a more flexible, empowered patient experience. As always, we stand ready to empower physicians with an integrated approach to capturing the physician’s narrative with accuracy and speed. After all, it all begins with a patient’s story. More on that in part 2!
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Since the highly publicized launch at the top of October, the newly minted Healthcare.gov’s website – the aggregate for people to compare and purchase health care coverage from the exchanges – failed to deliver, no doubt. Folks eager (or grudgingly resigned) to explore their options reported endless wait times, difficulties just logging on and/or hassles creating a new account. The buck stops at his desk, and at a press conference this week the president admitted as much. “There’s no sugarcoating it: The website has been too slow and people have had trouble navigating it,” he said. Yes; that about sums it up!
If the president was looking to sell the benefits of the Affordable Care Act, the initial roll-out didn’t help his cause. The topic is already radioactive, and it’s going to take time and a continued communications effort to explain the advantages for 85% of Americans who do have coverage, and to showcase those it is intended to help. Still, regardless of where you stand on the contentious legislation process and subsequent efforts for repeal, beginning March 31st, 2014, the mandate for healthcare insurance takes effect.
Now, the Obama administration’s technical team sits squarely on the hot seat as they try to rescue the beleaguered site and calm the storm of public dissent. Talk about an unintended consequence – there’s something for everyone to agree on here. Those who support, and reject the ACA can each lay claim to frustration – the website’s crashing debut was something to which everyone’s pointing a finger. So what went wrong, and how is it going to get fixed?
Most reporting seems to focus on three key areas: 1. Lack of appropriate or timely key testing before the launch, 2. A rush to roll-out on October 1st, and 3. Changes in key decisions just weeks prior to launch. The finger pointing is certain to continue – with HHS Secretary Sebelius scheduled to testify before Congress to offer a collective mea culpa – while a newly ordained team of IT experts joins forces with the current team and toils away, no doubt, to clean up the mess.
Yes – the White House has called in the big guns. A renewed effort is underway – a “tech surge,” to help rescue the glitches in the code and repair the public’s confidence. NPR’s Elisa Hu wrote, “The Obama administration says this surge is made up of engineers from inside and outside government, but beyond saying Presidential Innovations Fellows are involved, officials haven’t specified who’s making up those teams and what exactly they’re doing to fix the systemic issues with the site.” (Come to think of it, I’m not sure I’d want to be identified as a member of the S.O.S. team – they’re going to get little sleep over the next few months as it is.)
As the drama unfolds, the president was quick to reinforce that, “This law is more than a website. The policy is already helping people with a pre-existing condition – its helping students stay on their parents policies longer. The law isn’t broken, just the website.”
You know, you just never appreciate coders under something goes wrong. We’re hoping the new A-Team delivers – until then, we’re watching!
Despite the clarion call for the healthcare field to migrate toward digitizing the patient record, where seamless interoperability allows the safe, accurate and expedient exchange of patient data between health care providers, the lofty vision hasn’t exactly become reality. So far, the number of doctors who have successfully adopted a fully functional EHR system is still lower than expected, and paper records still rule. (Wasn’t technology supposed to nix paper altogether? Hasn’t done it so far!)
So the goal of increasing access to data, preserving security, decreasing duplication and improving patient satisfaction is still more than a stone’s throw away. While many EHR vendors routinely cite, “reduced medical transcription costs” as a key selling point, the role of clinical documentation specialists hasn’t gone away – in fact, it’s only broadened.
According to a white paper released by AHDI (Association for Healthcare Documentation Integrity) and CDIA (Consumer Data Entry Industry Association), dictation and traditional transcription still remain the preferred method of data input for doctors. Many still find the EHR templates cumbersome, time-consuming – and an unwelcome distraction from patients. A panacea, they are not! Still, the demand to adapt is relentless.
So instead of nixing MT’s altogether, now more than ever, qualified, expert editors are needed to ensure data is interpreted and transcribed with integrity and precision – plus, many doctors will still choose the traditional route, or need help in making the transition. So in the crawl toward achieving the benefits of meaningful use, how can MT’s bridge the gap?
In Medical Transcription: Proven Accelerator of EHR Adoption, AHDI and CDIA outline a compelling case for the collaboration of the medical transcription industry in achieving the promises of the EHR by engaging in the following:
- Use Existing and Proven Technology Platforms to Facilitate the Transition to Electronic Records. Many Transcription companies (such as iData!) already use platforms that can integrate with EHR systems. Collaboration between the two can expedite their adoption.
- Develop and Support Quality and Security Standards Leading to Greater Document. The medical transcription industry has made a push toward consistent, complete, and accurate documentation so critical to patient safety and coordination of care via standardization. The efforts will go a long way in delivering a shareable, accessible, secure, accurate and up-to-date patient record, reducing redundancy, saving costs and improving communication between clinicians and facilities.
- Continue to Create a 21st Century Workforce to Enable EHR Deployment. In the age of the knowledge worker, the clinical documentation industry can promote the education and certification to help entry level MT’s transfer skills and knowledge necessary to deploy new systems, ensure document compliance and assist in the transition from a paper system to a fully functional electronic system.
The role of the MT will continue to evolve in to a more value-added role during this time of critical transition. “The skills of a transcriptionist – to listen and be detailed and research-oriented, with a familiarity of medical terminology and disease process – are still in critical need in HIM departments during this time of healthcare transformation,” said AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA. “The transcriptionists that can demonstrate agility by moving into a new position can carve out a valuable niche for themselves.”
Not only can the MT revolutionize his or her own skills, in the process, they make significant contributions toward bringing facilitating the best of both worlds. So competition between medical transcription and the EHR is out – and collaboration is in.
We always remember that the people we serve are patients, who are served by doctors, who often work in bustling hospitals and relentless emergency rooms. What was your last experience in the ER like? Efficient, or agonizing? We’re betting you remember exactly how long it was before you were seen, particularly if your emergency didn’t include spurting blood or broken bones. It’s never fun.
According to the CDC, between 2003 and 2009, wait times in hospital emergency departments increased by 25%, or from 46.5 minutes to 58.1 minutes on average. No one likes to wait, and languishing in the ER, holding onto a throbbing arm or a wailing toddler tops of the list. A possible solution? Telemedicine. Yes, George Jetson, the future is here. One medical school on the cutting edge is forging the new frontier.
Citing an epidemic of overcrowding for more than 2 decades, The UC San Diego School of Medicine recently launched a pilot program to explore the merits of connecting doctors to patients from remote locations when the ER gets overwhelmed. How? You guessed it – by empowering technology to become more humanizing. The doctor will see you NOW – albeit via computer monitor.
According to UC San Diego, “The study is the first of its kind in California to use cameras to bring on-call doctors who are outside of the hospital to the patient in need.” Aside from decreasing patient wait times and improving patient care, the project may help alleviate the staffing issues associated with matching adequate resources to erratic ER cycles.
Dubbed the Emergency Department Initiative to Rapidly Accommodate in Times of Emergency (EDTITRATE), consenting patients are prioritized accordingly and linked to an offsite (but immediately available) physician via high fidelity sound and video, or telemedicine station. An ER nurse facilitates the process. High fidelity sound and video enables the telemedicine physician to examine a patient’s eyes, nose, throat and skin, listening to the heart and lung sounds through the module. Lab and imaging tests may be ordered, reviewed and documented as well. Finally, the attending physician onsite reassesses the patient to confirm findings and actions, and can take time to address patient concerns and questions.
Funded by a $50K grant by the University of California Health Quality Improvement grant, the goal is to expand the project’s reach to the ED in La Jolla. If successful, hospitals across the nation may adopt a similar model.
What are your thoughts? Is this one more step toward improving patient care and satisfaction, particularly with the market opening to so many more people? Or, does telemedicine create one more barrier to the connection between doctor and patient? Time will tell. Till then, we’re keeping the pulse on the response.
We don’t think so. We might be biased, as a regional clinical documentation company. As you may know, the clinical documentation industry has endured a serious overhaul. We’ve stood witness to crushing buy-outs and massive consolidations over the past decade.
Back then, more than a dozen large companies occupied the marketplace for medical transcription, with hundreds more small and mid-sized companies serving local and regional markets. A scant four years ago, Medquist, Spherus, CBay, M*Modal, Nuance, and Transcend soaked up the lion’s share of the clinical documentation services market. Today – just M*Modal and Nuance remain standing, with smaller and mid-sized companies either swallowed up, scrambling to survive, or carefully adapting to new technologies.
We fall under the latter – a mid-sized firm continuing to build long-standing relationships, offering a robust system that integrates with more than 400 EHRs, and a demonstrating a relentless commitment to service. It’s why the little guy still rocks.
What Consolidation Means for Healthcare Providers
What does the distilling of so many companies into just a couple mammoths mean for providers? On one level, consolidation makes sense. If the holy grail of clinical documentation is nation-wide interoperability, so that medical records are accessible across varied providers during the course of a patient’s lifetime, then consolidation would seem to empower that process. After all, which is easier to integrate: one or two different systems, or hundreds in competition with one another?
On the other hand, an industry dominated by a handful of big players does not necessarily serve the cause of interoperability. In fact, large companies which are engaged in a cutthroat, all-out war for market share, particularly in an industry undergoing rapid change, will be torn between competing business strategies. The first strategy entails attempting to become a one-stop shop for all needs, thereby excluding other systems from working with your particular system. The other promotes a more open architecture, where your system integrates well with others, thereby promoting adaptability, albeit at the expense of winning all aspects of a client’s business.
The lesson for medical practices and hospitals on a budget (or really any healthcare provider) is that taking an incremental approach to improving clinical documentation may be a better strategy than wiping your previous processes from the slate and trying to start fresh. In order to do that, it may be wise to steer clear from industry giants engaged in a competitive struggle for market share, and instead toward a mid-sized vendor which can integrate with existing systems. Flexibility and adaptability are king.
In fact, many mid-sized clinical documentation vendors ensure that their solutions can integrate with any system out there. This may reflect a commitment to open standards, or it could just be out of competitive necessity. Since they can’t achieve “one-stop-shop” status, these companies have made it part of their business model to integrate. iData fits squarely into this category.
Small Companies, Big Wins
But there are added benefits to working with smaller vendors. First, when something goes wrong, you don’t necessarily get shuffled through the beaurocracy of a larger organization. Truth is, each client doesn’t matter to them as much as to smaller companies, who literally depend on every single client for their livelihood. Around here, if something goes wrong, you can often get transferred straight to the CEO (that’s me) with your issues.
Next, smaller companies are typically more agile and innovative than more entrenched organizations. We’re continuously working harder to create new and better solutions, products and services to keep our clients satisfied; otherwise, we perish. We stay hungry – and we stay on the line with our customers. Win win!
So being the biggest doesn’t mean being the best. After all, small is mighty.
Medical transcriptionists have tough, complex jobs. Their task requires attention to detail, thorough knowledge of medical terminology, expert communication skills, editing prowess, a visceral commitment to accuracy and an ability to change to adapting trends – such as learning to integrate with EHR systems. Not to mention patience; if you think doctors’ handwriting is sometimes impossible to decipher, think about translating their verbal dictation!
The nature of the MTs’ assignment often places them squarely under the gun to produce, and fast. Plus – the work is often solitary in nature. It’s not for everyone, but very gratifying for just the right person.
So our question up for debate is this: Do credentials matter? Some clinical documentation companies require employees to earn their CMT (Certified Medical Transcriptionist) designation, selling this is a lynchpin of their services.
But if you’re choosing between two software engineers, and one demonstrates proven skills, experience and knowledge, while the other has certification, but no experience, which one would get your vote?
Aye, that’s the rub. There is an argument for obtaining certification in medical transcription, we agree, and at iData we offer tuition reimbursement for employees who seek to seek the CMT designation. There are two types of voluntary certification – The Registered Medical Transcriptionist (RMT) and the Certified Medical Transcriptionist (CMT). You can read up about each designation’s content and objectives here.
According to industry advocates ADHI (American Healthcare Documentation Professionals Group), which administers the test, the CMT exam is “designed to assess competency in medical transcription by determining if a candidate has the core knowledge and skills needed to practice medical transcription effectively in a multispecialty acute-care facility, where variable specialties, document types, and difficulty of dictation necessitate an advanced level of clinical knowledge and interpretive ability.”
What are the advantages of certification? Certainly achieving certification measures competency. While experience and tenure often counts for “street cred,” the CMT proves knowledge. Only experienced MT’s are encouraged to participate in the CMT designation. Since the caliber of our MT’s, and the quality work they produce is our lifeblood, we too affirm the need for proven expertise. We offer training and certification to our employees, but it’s not a requirement here. Why?
Because it takes more than knowledge to make a stellar MT. We’re certain some people can achieve CMT status and go on to great success. Still, others may not have what it takes to go the long haul. Some MT’s get burnt out, frustrated, or desire a more team-environment in which to work – an escape from the often solitary confines of the job. So we’ve tried other methods, too, including personality assessments, to flag ideal candidates.
Bottom line? (Pun intended.) We believe in certification, but it isn’t a guarantee that person will be propelled to the front of the line for promotions. What’s your take?
It’s how Wal-Mart discovered people buy more Pop-Tarts before a big storm. It’s how researchers in Canada discovered when vital signs are unusually stable there is a correlation to a serious fever 24-hours later. It’s how air traveler’s can determine which flights are likely to arrive on time. What is it? Big data. And it’s potential for tracking and predicting the future is, well, big!
According to his piece in the Wall Street Journal titled, “Why ‘Big Data’ is a Big Deal,” L. Gordon Crovitz argues that the next frontier to conquer lies in harnessing the inexhaustible amount of data we now search, share, transfer and store. We can all see that information gets captured everywhere, from our transactions at Target to our flu symptoms into the electronic health record. (EHR) So what is Big Data, exactly?
In Crovitz’ WSJ piece, he introduces the newly minted book, Big Data: A Revolution That Will Transform How We Live, Work, and Think, written by Oxford scholar Viktor Mayer-Schonberger, and Kenneth Cukier, data editor at The Economist. The book he says, “should spur policy makers to rethink how to protect privacy while enabling more access to data.” Eye; there’s the rub – especially where health care is concerned.
“Big data differs from traditional information in mind-bending ways. For one thing, the authors write, ‘society will need to shed some of its obsession for causality in exchange for simple correlations: not knowing why but only what. This overturns centuries of established practices and challenges our most basic understanding of how to make decisions and comprehend reality,’” writes Crovitz.
Just exactly what is Big Data? It’s the popular vernacular to describe the exponential growth, availability and use of information, both structured and unstructured. Analyzing large data has typically been used primarily in target marketing, but will become a key basis of competition, spurring productivity, growth, innovation, and consumer surplus.
What interested us most about this piece was Crovitz’ pronouncement that the health care sector has much to gain by using big data – to improve health care, and to capture critical information to predict, track and treat a range of medical care issues.
“Using big data to improve health care is one of the biggest opportunities, but current laws make it hard to mine even data aggregated from many patients. If we had electronic records of Americans going back generations, we’d know ore about genetic propensities, correlations among symptoms, and how to individualize treatments,” Crovitz writes.
The authors of the book Crovitz touts argue that the risk of compromising privacy ought to be balanced against the potential of making health related information available to researchers. What are your thoughts?
At iData, our robust systems capture an inordinate amount of patient data every day. To what end could that data be utilized? If clinicians were to extract critical data from patient records to analyze trends and make predictions – both from a business perspective and a wellness and public safety perspective – what potential could the results yield?
So while our transcriptionists are busy keying in data to interface with patient records, we’re exploring the added value delivered by data that can be combined, tracked and interpreted along with other sources of data. We’re ready for the new frontier – what about you?
In our industry, turn-around-time, or TAT, is everything – well, part and parcel with accuracy and quality. Each one is critical component – we have to deliver it all. Every medical transcription company claims their service is the speediest. But how do they prove it?
And if they’re not measuring up – do they put their money where their mouth is? They should. We do.
24: More than just a T.V. Show
First – yes; you should expect a medical transcription provider to deliver – but also, to prove they’re doing it. It’s critical, because patient records provide necessary information from which the clinician’s work flows – for analyzing history, making diagnosis, making references to specialists and protecting against litigation. Never underestimate the power of the patient record!
So of course, the speed with which data is extracted, recorded and returned is paramount, and turn-around-time to our industry is akin to arrival and departure times in the airline industry. It’s the basis by which our success is measured. The “gold standard?” Ideally, most reports should be returned in 12 – 18 hours, others, from the emergency room for example, should arrive back within 1 – 6 hours.
At iData, we guarantee our turn-around-time, or our clients don’t pay. We think it doesn’t get any more committed than that!
Drilling down: Questions to ask your Clinical Documentation Provider
There are plenty of choices in finding a clinical documentation provider – no argument there. Of course we think you should choose our locally owned small business because we invest so intimately in our customers. Regardless of your choice, it should be an informed one, so we recommend asking the following questions when searching for a new provider:
- What is your average turn-around-time in delivering reports? A provider should have no trouble giving you a solid answer on this and should provide exacting data to show a history.
- What quality controls are in place? Speed is critical, but it cannot be sacrificed at the expense of quality. A slip of the key, a misinterpreted medication dosage can cause serious damage. (Around here our systems ensure each report passes through no less than 3 quality controls. But that’s just us!)
- What kind of technology platform supports their infrastructure? It’s essential that a medical transcription provider use the most cutting edge technology that allows for mobile usage, cloud-based storage and EHR interface. We have to adapt even before our clients do so we can move at the speed of light when the time arrives.
- How do they measure turn-around-time? Each provider should offer their customers reports measuring their turn-around-time. It should be easy to analyze their performance based on delivery after initial data is provided and customers run their own real-time reports.
Like we said – our guarantee at iData is to deliver reports on time, every time – or our customers don’t pay. We’re pretty incentivized to get them turned around on time, every time. Just what the doctor ordered.