March 25, 2019 – Inpatient psychiatric facilities are spending a significant proportion of their average revenue on compliance with basic conditions of participation for Medicare, according to a new report from the National Association of Behavioral Healthcare (NABH). Inpatient treatment centers spend a total of $1.7 billion each year on Medicare compliance, which equates to 4.8 percent of the average facility’s annual revenue, including all revenue from services covered by commercial insurance. The high cost of participation, as well as inconsistent application of regulations in the real-world environment, make it challenging for psychiatric facilities to stay compliant with Medicare. The administrative burdens associated with participation may even prompt some providers to stop accepting Medicare all together, making access to behavioral healthcare even more challenging for the nation’s aging population. “Inpatient psychiatric facilities operate under a heavy burden of federal regulatory requirements,” explains NABH.
Three major categories of requirements that pose the most problems for facilities, the organization said. A list of regulations known as “B-tag” requirements are among the most problematic, asserted the report. B-tag regulations include detailed protocols for patient evaluations, medical records, and staffing levels. However, many requirements have not been updated in decades, resulting in outdated and confusing workflows for providers and administrators. “As enforced today, the B-tags produce frequent citations and impose large costs on providers, mostly through low-value documentation requirements,” said NABH. “Among our respondents, almost 80 percent of freestanding psychiatric hospitals report at least one B-tag citation in their most recent three compliance surveys.” The association estimates that B-tag compliance costs inpatient psychiatric facilities $622 million annually, largely due to on-the-ground interpretation of these rules by Medicare surveyors.
Surveyors may demand specific approaches to meeting compliance guidelines without assessing whether an existing strategy still meets the federal program requirements, the report explained. This produces an environment in which success is more or less arbitrary, and providers may spend millions of dollars revamping an adequate program simply to meet the criteria of an individual assessor. Psychiatric facilities are also taking issue with Medicare’s requirement to address ligature risks, or physical structures within the facility that could be used for self-strangulation. “Psychiatric providers care deeply about keeping patients safe, which includes protecting patients from self-harm or suicidal behaviors,” said the brief. “As CMS has recognized, however, providers cannot feasibly create ‘ligature-free’ environments that are completely devoid of potential ligature attachment points.” “Nonetheless, some surveyors demand major changes to psychiatric facilities’ infrastructure or staffing to address perceived issues that carry only minimal risk for patients in that setting.” Sixty percent of NABH members responding to a survey about the issue have received a citation for ligature risk within the last two years, the report notes. Facilities spend an average of $15,600 per bed to address these issues, again to meet the individual assessments of surveyors who may contradict one another.
NABH urges Medicare to institute a more standardized approach to assessing facilities for ligature risks and offer more guidance on areas that present the highest risks. These steps would reduce the likelihood of high spending on lower-value modifications. Lastly, the organization is seeking revisions to enforcement of the Emergency Medical Treatment and Labor Act (EMTALA), which is intended to ensure that anyone presenting to a hospital’s emergency department will be screened and stabilized regardless of their ability to pay for services. While NABH supports the law and its mission to ensure access to care for all individuals, the law’s impact on the inpatient psychiatric environment is not the same as in acute care. “EMTALA permits each provider to determine which clinicians are designated as ‘qualified medical persons’ (QMPs) who may screen patients for emergency medical conditions,” details the report. “Some regulators, however, are using EMTALA to raise the baseline licensure requirements for QMPs in inpatient psychiatric facilities. This approach upends decades of accepted clinical practice, and fails to account for widespread shortages of clinicians with psychiatric expertise.” The law is also putting pressure on some inpatient facilities to admit involuntarily committed patients, regardless of that facility’s ability to manage the risks those patients may present to themselves or others. “EMTALA should not be used to address the shortage of facilities that treat involuntarily committed patients,” NABM asserts. “Federal regulators should respect state procedures for involuntary commitment, including state arrangements for facility designation and patient transfer.” The ability for inpatient psychiatric facilities to meet Medicare compliance requirements can have major effects on the commercial insurance industry, as well. These facilities tend to operate under extreme financial constraints, and the more they spend on Medicare compliance, the more they will need to charge commercial payers to compensate. The Centers for Medicare and Medicaid Services has made significant efforts to reduce administrative burdens for acute care and physician providers, but has not yet addressed similar pain points in the behavioral health ecosystem. “These concerns lie at the heart of CMS’ ‘Patients Over Paperwork’ initiative,” the report points out, referencing Administrator Seema Verma’s signature effort to slash redundant, costly requirements for providers. “CMS should take this opportunity to modernize its guidance and standardize its survey practices. The proposals outlined here would cost CMS little to implement, and would lift a heavy burden from psychiatric facilities and their staff without affecting—and perhaps even improving— care quality and access for patients with severe behavioral healthcare needs.” Reforming the application of B-tag regulations, which are fundamentally more than half a century old, could significantly reduce unnecessary spending and increase financial security for inpatient psychiatric treatment centers, as would improving the process of assessing facilities for compliance with ligature risk rules and EMTALA protocols. “Adopting less burdensome requirements would benefit the healthcare system overall by reducing unnecessary costs, and by bringing greater stability and predictability for providers as they navigate the regulatory environment,” stresses the NABH. “In addition, patients may directly benefit from reduced regulatory burden as clinicians are able to shift more of their attention—and facilities are able to shift more of their resources—away from compliance for compliance’s sake and toward initiatives that meaningfully contribute to safe, high-quality care.”
According to TeamLease World of Work Report, an average of 2.35 hours is spent accessing social media at work every day and 13 per cent of the total productivity is lost owing to the social media indulgence alone.
The unrestricted usage of social media is having a negative impact on workplace productivity, as employees spend more than 32 per cent of their time on social media every day for personal work, says a study.
According to TeamLease World of Work Report, an average of 2.35 hours is spent accessing social media at work every day and 13 per cent of the total productivity is lost owing to the social media indulgence alone.
“Indulgence in social media and the resultant slacking is a testimony of pastimes getting more interesting than work.
Hence rather than blindly instituting rules, organisations should get to the root cause of the misuse and devise policies that make work more challenging and the work culture more aspirational,” Kunal Sen, Senior Vice President, TeamLease Services said.
As per the study, apart from loss of productivity, the extensive usage of social media by employees has also resulted in an increase in loss of confidential information, defamation, misinformation and employee solicitation.
According to the report, Facebook is the most visited social media platform. Out of the 62 per cent employees who accessed social media during working hours, nearly 83 per cent of them spend significant time browsing Facebook.
The report noted that the use of social media at workplace and resultant slackening has become very rampant. Some employers have policies in place, and some are leveraging social media to their benefit, but most are clueless about how the menace could be handled, it said.
The ‘Social Media at Workplace’ is the third in TeamLease survey series and was administered on HR managers across sectors. Read more.
Doctors are being driven daffy by electronic health records, or EHRs.
Updated: January 16, 2019 – 12:13 PM
Sally Pipes, for the Inquirer
That’s the takeaway from a recent report in the Journal of the American Medical Informatics Association. Seven in 10 Rhode Island doctors surveyed who used electronic health records said that the technology stressed them out. Those who reported health information technology-related stress were anywhere from 1.9 to 2.8 times as likely to burn out. In Pennsylvania, 45 percent of physicians report feeling burned out, according to a separate survey from Medscape.
They can thank the federal government for these professional headaches. A decade ago, the Obama administration pushed doctors to adopt electronic records in hopes they’d speed up the provision of care and improve health outcomes. Ten years on, these mandates have delivered much the opposite.
The federal mandate that doctors adopt electronic health records was included as part of the American Recovery and Investment Act — more colloquially known as the 2009 stimulus package.
The feds yielded a variety of carrots and sticks. Doctors that demonstrated meaningful use of the technology were awarded part of $17 billion in incentives. Doctors who didn’t risked having their payments from Medicare and Medicaid slashed.
President Obama boasted that the program would “cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests.” The idea was that a mass upgrade of the nation’s health IT would facilitate the sharing of information among physicians and hospitals — and ultimately lead to more accurate diagnoses and more effective and efficient treatment.
The information technology revolution had transformed so many other parts of the American economy. Why couldn’t it do the same for health care?
The government’s carrots and sticks worked. From 2009 to 2015, the share of hospitals using a basic electronic health records system increased from 12 percent to 84 percent.
They may have adopted electronic records. But that doesn’t mean the technology works — or that it’s improving patient care.
The programs on the market are often clunky, time-consuming, and insensitive to the complexities of modern medicine. Physicians, who already face suffocating administrative burdens, are logging ever-increasing amounts of data that have little clinical relevance. Time with patients is disrupted by an endless flood of alerts and messages.
Two-thirds of doctors say electronic records degrade their patient interactions, according to a survey from the Physicians Foundation. More than half of physicians report that the records reduce efficiency; more than a third say they diminish the quality of care.
Screen time has replaced face time. Only one-fourth of the average doctor’s day is spent face-to-face with patients. Half is devoted to electronic health records and other administrative tasks, according to a study published in the Annals of Internal Medicine.
Our country can ill afford to have physicians spending three-quarters of their time on things besides patient care. Our population will require more and more care as it ages. That’s among the reasons the Association of American Medical Colleges projects that the United States will be short as many as 120,000 doctors by 2030.
The shortage could grow even worse if doctors react to the burdens federal pressures have foisted upon them by leaving the profession. The Physicians Foundation found that roughly eight in 10 doctors had reported feelings of burnout. Nearly half of doctors are looking to change career paths.
Rolling back the federal electronic health records mandate won’t stop doctors and hospitals from incorporating health information technology into their practices and facilities. Instead, it will allow them — not the government — to decide how to balance patient care and technology use. In theory, clinicians will use technology to improve their ability to deliver high-quality patient care — rather than using technology simply to satisfy the government.
Doctors choose their profession because they want to heal people, not fill out paperwork. It’s time for the government to get out of the way and let physicians actually practice medicine.
Sally C. Pipes is president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is “The False Promise of Single-Payer Health Care” (Encounter 2018). @sallypipes.
Posted: January 16, 2019 – 12:13 PM
Sally Pipes, for the Inquirer
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing, Medical Transcription, Scribe Services, and AzaleaHealth EHR. We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information. We have education programs in Medical Scribe Specialists. #MedicalTranscription #AzaleaHealthEHR #RevenueCycleManagement #MDSofKansas #MedicalBillingService #MedicalScribes
– Further transparency in EHR testing and development is imperative to improving EHR usability and reducing patient harm associated with EHR use, according to AMA and Medstar.
The organizations offered recommendations for three information blocking regulations that may improve EHR usability and safety in a recent JAMA Networkperspective.
“A major impediment to addressing usability and safety issues has been the inability of clinicians, researchers, and developers to communicate openly and share specific usability and safety challenges associated with EHR technology,” wrote AMA and Medstar.
“Although medical device companies are required to share usability and safety issues, some EHR vendors have resisted sharing this information — even information related to events that have resulted in substantial harm,” the duo continued.
EHR contracts often include clauses preventing healthcare organizations from sharing certain information about EHR systems, such as gag clauses that require authorization from the vendor to share screenshots, videos, and other information about purchased products.
These clauses may prevent the transparency necessary to allow researchers studying EHR usability and safety issues to gain an accurate and complete view of how products work.
“Even though it is important to recognize the need to protect intellectual property — the issue vendors generally raise when discussing gag clauses — the inability to share critical usability and safety information can affect product improvement and patient safety initiatives,” the organizations maintained.
Lack of transparency restricts independent review of EHR products by outside entities and can negatively affect a healthcare organization’s ability to make a truly informed EHR purchasing decision.
Additionally, the inability of third parties to fully assess a purchased EHR product may give EHR vendors less incentive to improve usability.
Provisions of the 21st Century Cures Act require state that EHR vendors who seek ONC Health IT Certification cannot prohibit or restrict the communication of information related to EHR usability.
“Although this is a major step forward, the specific details of what constitutes prohibition and restriction of usability information has not been defined, and it is unclear what actions by an EHR vendor may be included under this provision,” noted the team.
First, the organizations suggested ONC ensure EHR vendors provide information to support usability and safety research and testing by enabling researchers to access test environments and rigorous test cases.
“Without EHR environments that support testing, effective studies of usability and safety threats with appropriate experimental designs are not possible,” the organizations stated. “Policies should require basic EHR functionality for usability and safety testing, such as the ability to enter test cases into the EHR system, and require reasonable access to EHR testing environments.”
Second, AMA and Medstar urged ONC to consider policies that prohibit EHR vendors from blocking their clients from participating in EHR usability and safety testing.
“Health care organizations are often completely reliant on their EHR for delivering clinical care and on their EHR vendor for technical support, upgrades, and numerous other aspects of the technology,” wrote the organizations.
This power dynamic may prevent healthcare organizations from participating in EHR usability and safety testing or contributing information about specific usability and safety challenges out of concern for their relationship with their vendor.
“Policies should prohibit adverse actions that may be taken by EHR vendors to dissuade health care organizations and clinicians from participating in usability and safety research or acting in good faith to report usability and safety issues,” stated AMA and MedStar.
Finally, the organizations suggested ONC develop policies that require EHR vendors to allow healthcare organizations to share information related to EHR usability and safety problems in a timely manner so users can compare usability challenges across products from different vendors.
“Overall, the inability to address the issues of usability represents a market failure,” AMA and Medstar wrote.
By including policies in information blocking regulations that promote transparency surrounding EHR usability and safety, federal entities can help healthcare organizations make better-informed purchasing decisions for improved clinician satisfaction and patient safety.
Healthcare IT News
Pew Charitable Trusts says not enough attention is being paid to electronic health record usability from a safety point of view. And given that federal certification requirements don’t address two key safety factors, it’s offering EHR developers and provider organizations a toolset to help boost patient protections. READ MORE
HealthITSecurity
Only 7 percent of executives surveyed by Reaction Data believe that healthcare IT security technology will have a significant disruptive impact on healthcare. Twenty-nine percent said that telemedicine will be the biggest disruptor, 20 percent said AI, 15 percent said interoperability, 13 percent said data analytics, 11 percent said mobile data, 3 percent said cloud, and surprisingly only 2 percent said blockchain would be the biggest disruptor. READ MORE
Health Data Management
For many organizations, vulnerable web applications may be their weakest link when it comes to an effective data security strategy. About three-quarters (73 percent) of successful perimeter breaches in 2017 were achieved using vulnerable Web applications, according to Kaspersky Lab’s analysis of penetration tests it conducted on corporate networks that year. READ MORE
EHR Intelligence
The Physician Self-Referral Law, commonly known as the Stark Law, places unnecessary administrative burdens on providers while hindering care coordination and health data exchange, according to a letter from HIMSS to CMS Administrator Seema Verma. In response to the federal agency’s June request for information (RFI), HIMSS advised CMS to change Stark Law regulations to ensure they do not prohibit or interfere with health data exchange and care coordination.In its letter, HIMSS emphasized that alternative payment models (APMs) require a flexible regulatory framework to succeed. READ MORE
Health Data Management
The healthcare IT industry faces a host of challenges today, including silos within hospitals that restrict information sharing, integrating artificial intelligence into clinical practice, to solving the opioid crisis. While distributed ledger technologies such as blockchain won’t mitigate all of them, this technology can resolve a number of significant pain points associated with routine business processes. READ MORE
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing, Medical Transcription, Scribe Services, and AzaleaHealth EHR. We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information. We have education programs in Medical Scribe Specialists. #MedicalTranscription #AzaleaHealthEHR #RevenueCycleManagement #MDSofKansas #MedicalBillingService #MedicalScribes
As a medical scribe, prospective students can learn how doctors build trust and interact with patients.(Gary John Norman/ Getty Images)
If you’re considering a career in medicine, working as a medical scribe is a best bet for familiarizing yourself with patient care. A medical scribe works directly with physicians, primarily focused on charting patient encounters in the electronic medical record. What’s more, scribe positions can be full or part time, making it a viable job choice for a student.
If this sounds appealing, consider the following 10 reasons why prospective medical school students should consider becoming a medical scribe.
1. You will shadow physicians. Most admissions committees expect students to have had shadowing experiences before they apply to medical school. One of the greatest benefits of shadowing is that the experience will help you see how physicians handle being busy and stressed.
2. You will learn a great deal about medicine. As a scribe, you will start to listen for the signs and symptoms that help a physician come to a diagnosis or a differential diagnosis list. Over time, you will be able to anticipate what some of these diagnoses may be.
3. You will make money while you learn and shadow. Learning is inherent in this job, so think of it as a free education. You also won’t have to beg a physician to let you tag along on patient visits; you will actually be part of the health care team.
4. You will learn a lot about teamwork. You’ll be able to observe the respect given to team members and watch them intuitively help one another.Many medical students have no idea what the roles of interdisciplinary providers are until they get to their third year. You will be better prepared to understand the role of a physician assistant or a nurse practitioner because you have seen them in action.
5. You will learn medical language. Over time, you will learn how to spell and pronounce the words, and what they mean. The more familiar you are with the terminology, the less you’ll have to rely on rote memorization after you enter medical school. Humans more easily remember things through experience than simply by reading a text.
6. You will watch, hear and see how trust is developed. I think this is different than basic shadowing where the focus is on the physician. What I am talking about here is the dance between the patient and physician that generates caring and trust. For example, you might hear how the physician works to clearly understand what a patient said or you might see the doctor comfort a patient by touching the patient’s hand.
7. You will learn about the medical record. You will learn why the patient’s chief complaint is different from the history of present illness. You will understand the importance of the social history and mental status exam. The order will be more meaningful, and you will practice it so often that you could do it in your sleep.
8. You will learn about templates, checklists and smart phrases. All of these tools are to help physicians become more efficient, but clearly the tools aren’t enough because they hired you to help.
9. You’ll probably increase your typing speed and efficiency. Not only are these skills beneficial to you, but they’re important in terms of maintaining patient flow and reducing patient wait time.
10. You will get to listen to patients. This, in my opinion, is the most important reason. You will get to hear their story, their pain and their fears. You will learn to be in the moment and block out distractions, which is what all patients hope their doctors will do.
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing, Medical Transcription, Scribe Services, and AzaleaHealth EHR. We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information. We have education programs in Medical Scribe Specialists. #MedicalTranscription #AzaleaHealthEHR #RevenueCycleManagement #MDSofKansas #MedicalBillingService #MedicalScribes
When Hancock Health was hobbled by ransomware, it wasn’t for the usual reasons. No one had clicked a suspicious link in a phishing email. It had its system fully backed up and recoverable.
The attack came from an outside vendor. Hackers stole credentials from one of Hancock Health’s hardware providers, then targeted the hospital’s backup site.
They delivered the ransomware via the connection between the backup site and the hospital’s main site server farm, compromising the backups, the connection and the hospital’s records.
After consulting with their cyber-security partner, Hancock Health paid the attackers about $55,000 in bitcoin, which was cheaper than fixing its system on its own, and it still took over three days for everything to return to normal.
Looking at the series of events, three major takeaways immediately jump out from Hancock Health’s ransomware attack and recovery.
By taking the following steps, a healthcare organization could avoid a similar fate.
Keep backups separate through segmentation
Maintaining backups is of course key to defeating ransomware. If an organization is able to quarantine the infected machines, they can simply wipe them and reimage them from backups without having to pay a cent in bitcoin.
The trick, of course, is keeping backups clean. In a flat network like the one at Hancock Health, everything’s accessible at the same level. Hackers with access to the backups were able to get access to the main data center. Had the backups been segmented, the criminals still would have disrupted the hospital’s operations, but the recovery could have been quicker and easier.
By putting up firewalls with strict filtering between different network segments, an organization can quarantine an attack from backups. With properly segmented networks, it can just close off the infected segment and reimage the infected machines.
Manage vendors with an eye toward security
No matter how much ransomware training is provided to employees, and no matter how many internal processes are in place, one vulnerable vendor can still leave an organization’s systems open.
Was that Hancock Health vendor categorized as a critical service provider? How much due diligence was conducted when reviewing its security posture? Was there a plan to break the kill chain in case the vendor was compromised?
A supply chain affects an organization in many ways, and one of the most commonly overlooked aspects of any relationship is cybersecurity. Now more than ever, organizations need to thoroughly vet partners that have sensitive access to their systems and keep close tabs on who has credentials.
Another caveat is that an organization’s systems don’t even have to be affected. When vendors shut down from a ransomware attack, an organization can still lose essential services. Allscripts had several applications knocked offline after ransomware gripped two of its data centers, affecting a variety of healthcare providers.
While the company hustled to get back online, customers had to make do without the infected applications. Always think through a contingency plan for when a critical partner is at the receiving end of an attack.
Expand cybersecurity partnerships
While vendors can cause attacks, they can also prevent them.
The Hancock Health attack confirms the need for pre-arranged partnerships with industry experts to assist during crisis situations. A hospital only has so much resident cybersecurity expertise. After all, its mission is delivering quality care that improves patient outcomes, not thwarting ransomware.
By striking up a relationship with a specialized cybersecurity firm, Hancock Health got quick access to threat mitigation and disaster response services.
Finding such a firm before an attack occurs can allow you to test procedures and resiliency regularly. By conducting mock data breach exercises, an organization can identify and address any gaps before they’re exploited.
In addition to uncovering potential vulnerabilities, like lack of segmentation, an outside firm can limit the damage after an attack and ultimately get an organization up and running faster.
The longer it takes to fully recover from an incident, the costlier it can become, and in healthcare especially, any delay can cost lives.
While many ransomware attacks are the result of phishing emails and unsuspecting employees, it’s not the only way hackers can paralyze your systems. Any outside vendor that has access can unwittingly become the source of malware.
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing, Medical Transcription, Scribe Services, and AzaleaHealth EHR. We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information. We have education programs in Medical Scribe Specialists. #MedicalTranscription #AzaleaHealthEHR #RevenueCycleManagement #MDSofKansas #MedicalBillingService #MedicalScribes
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing, Medical Transcription, Scribe Services, and AzaleaHealth EHR. We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information. We have education programs in Medical Scribe Specialists. #MedicalTranscription #AzaleaHealthEHR #RevenueCycleManagement #MDSofKansas #MedicalBillingService #MedicalScribes
With copy and paste rampant, UW Health chief medical information officer Shannon Dean says toolkits and vendors can help, but physicians need to take responsibility for proper clinical documentation.
Overuse of copy and paste in electronic health records is a problem. Sure, it’s convenient. And it’s entirely understandable why it’s a common shortcut used by scores of physicians. But it often results in note bloat – unwieldy patient records overflowing with repetitive documentation – that can potentially lead to serious safety risks.
“Copying or importing text increases the risk of including outdated, inaccurate, or unnecessary information, which can undermine the utility of notes and lead to a clinical error,” wrote researchers in a 2017 study in Journal of the American Medical Association.
The practice of copy and paste has to be reigned in, and one chief medical information officer, writing for the Agency for Healthcare Research and Quality, says that has to start with the physicians themselves.
Shannon Dean, MD, CMIO at University of Wisconsin School of Medicine and Public Health, penned a column this month for AHRQ’s Perspectives on Patient Safety. She began with an example of what can happen when notation gets lazy.
She cites the case of a 78-year-old man who, “with an alleged history of ‘PE’ (interpreted by the clinicians as pulmonary embolism) received an unnecessary CT scan to rule out a suspected ‘recurrence’ of pulmonary embolus.
“As it happens, years earlier, the abbreviation ‘PE’ had been used in the electronic note to indicate that the patient had had a physical examination, not a pulmonary embolism!” said Dean. “In a vivid example of copy and paste, once the diagnosis of pulmonary embolism was mistakenly given to the patient, it lived on in the EHR.”
Beyond the risks to patient safety, that also points to the unnecessary costs that can pile up when unwitting clinicians order tests that are based on erroneous and repetitive data.
Nonetheless, said Dean, too many clinicians still copy and paste as a habit: “Perhaps we are complacent about copy and paste because we remain unconvinced that there is a correlation between its use and patient safety.”
In her article, she surveys more than a dozen studies on the subject, and finds that published research into adverse outcomes isn’t as voluminous as one might expect, even if it’s understood, intuitively, that the practice isn’t ideal.
So “it is clear that much work remains to be done,” said Dean. She points to toolkits like the one put together by AHIMA, and the fact that Epic has rolled out functionality that can “identify the source of every character within a note, whether it is newly typed, imported from another source, or copied and pasted.”
Still, “I am aware of very few organizations that are actively using these tools to educate and mentor clinicians in a systematic way to improve documentation quality,” she said.
While more academic research would be welcome on the correlation between copy and paste and patient safety, she said, it’s fairly widely accepted that it’s a shortcut that should only be used sparingly and in specific instances.
Healthcare organizations need to start making use of resources such as AHIMA’s toolkits, Epic’s auditing features and innovations like natural language processing technology to help physicians do better with their EHR documentation.
She also points to the OpenNotes initiative, which continues to gain momentum, as another big opportunity: Giving patients the ability to read their own doctor’s clinical notes allows them to “hold us accountable for quality documentation.”
But at the end of the day, “physicians need to reestablish ownership of the accuracy of clinical documentation,” said Dean. “We must stop blaming the EHR for our carelessness and start educating ourselves about how to use documentation efficiency tools, including copy and paste, more responsibly.”
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing, Medical Transcription, Scribe Services, and AzaleaHealth EHR. We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information. We have education programs in Medical Scribe Specialists. #MedicalTranscription #AzaleaHealthEHR #RevenueCycleManagement #MDSofKansas #MedicalBillingService #MedicalScribes
Most healthcare providers, patients, and industry stakeholders agree EHR technology has the potential to yield marked improvements in population health management, predictive medicine, and clinical decision-making. However, EHR use also introduces new risks to patient safety. A study released in October of 2017 found EHR use has been listed as a contributing factor to patient injury at an increased rate over the past decade. Poorly-designed EHR systems combined with human error have resulted in patient safety problems in an increasing number of malpractice claims from 2007-2016. Here are a few steps providers and IT developers can take to deter this rising trend.
Online medical diagnosis and treatment
Limit use of copy-paste functionality
Shortcuts built into EHR systems have been embraced by provideders as a way to reduce the amount of time spent at their monitors. However, one shortcut could potentially pose a threat to patient safety.
Researchers in a 2017 JAMA study found providers may be increasing the risk of patient harm by entering repetitive or inaccurate EHR clinical data into physician notes using copy-paste functionalities.
Ultimately, researchers found resident physicians used copy-paste to enter more than half of all data into physician EHR notes. The prevalence of copied information in physician notes increases the likelihood of repetitive, nonspecific, and irrelevant data existing in EHRs.
“Copying or importing text increases the risk of including outdated, inaccurate, or unnecessary information, which can undermine the utility of notes and lead to a clinical error,” researchers stated.
Researchers recommended healthcare organizations and health IT developers consider ways to limit the amount of copied information in physician EHR notes by inhibiting certain information from being saved.
“This finding could spur EHR design that makes copied and imported information readily visible to clinicians as they are writing a note but, ultimately, does not store that information in the note,” researchers stated.
The National Institute of Standards and Technology (NIST) also cautioned providers against relying too heavily on the copy-paste functionality for clinical documentation.
Along with the ECRI Institute and U.S Army Medical Research and Material Command’s (MRMC) Telemedicine and Advanced Technology Research Center (TATRC), NIST offered recommendations for reducing copy-paste-related errors.
Specifically, researchers recommended implementing EHR designs that enhance the visibility of information being selected for copy and paste to prevent users from inadvertently copying certain unrelated or unwanted areas of information.
Additionally, authors recommended locking certain areas or sources of information to prevent copying altogether. For example, organizations could disable the copy-paste function when providers are entering data into a blood bank information system to prevent errors related to blood transfusions.
Limiting or restricting over-use of the copy-paste functionality during clinical documentation can help to reduce patient safety threats stemming from irrelevant or redundant information.
IMPLEMENT A SIMPLE, UNCLUTTERED EHR INTERFACE
Simple EHR interfaces are best, according to a recent report from Pew Charitable Trusts.
Convoluted or overly-complex EHR designs can confuse providers and negatively impact clinical productivity. Poorly-designed EHR interfaces can also inhibit providers’ ability to quickly find information.
Furthermore, EHR interfaces that lack key information altogether can cause clinicians to search for data in multiple places, which may slow down patient care delivery.
“Important design principles include knowing what users need for a simple interface, removing complexity, using simple and clear terminology, emphasizing key elements, and using color effectively to draw users to important areas,” advised the authors.
By extension, healthcare organizations should also refrain from excessive EHR customization.
“These customizations — which may be requested by a health care facility or staff — may not have undergone rigorous testing by the care team or the product developer to detect potential safety concerns,” the research team wrote.
Keeping EHR design simple improves EHR usability and enables providers to view information in as clear, concise, and straightforward a manner as possible. Ensuring EHR data is clear and accessible can help to reduce the chances of clinical errors and EHR-related safety risks.
IMPROVE PHYSICIAN EDUCATION SURROUNDING EHR USE
EHR system design can play a hand in heightening the risk of patient safety problems, but human error is more commonly the culprit.
Reducing safety risks related to human error require improved physician education about EHR technology and use. At the 2017 ONC Annual Meeting, a panel led by ONC Chief Medical Officer (CMO) Andy Gettinger discussed the importance of understanding how EHR software works.
In an effort to increase provider understanding of EHR technology, ONC is working to develop a “Usability Change Package” focused on building a tool provider organizations can use to gain a base level of knowledge about usability.
The resource will provide informational materials to EHR users in a variety of settings to help them assess and improve the usability of their systems.
“Now with ONC and this change package work, we’re seeing much more attention around implementation and what is happening there,” stated Raj Ratwani, National Center for Human Factors in Healthcare Senior Research Scientist and Scientific Director.
Educating providers about the affect implementation decisions can have on the overall usability of their EHR systems can help to avoid costly, long-term software problems.
ENCOURAGE HEALTH IT DEVELOPERS TO IMPROVE HEALTH IT STANDARDIZATION
While healthcare organizations bear responsibility for EHR use-related errors, health IT developers and certification bodies can also help to reduce liability risks.
“We became aware of the potential liability risks related to the use of EHRs shortly after their introduction, and we anticipated that EHRs would become a contributing factor to medical professional liability claims,” wrote authors in a 2017 report from the Doctors Company.
Researchers suggested most EHR-related problems could be attributed to a lack of widespread standardization among health IT developers early on after EHR adoption became common.
“Many EHR-related problems could have been avoided if the federal government had developed vendor standards for EHR use and interoperability and required beta testing in the healthcare environment to ensure usability and safety before the HITECH Act mandated its widespread adoption in 2009,”they wrote.
Improving standardization and usability testing could help to reduce or avoid EHR-related patient safety risks. Additionally, researchers suggested health IT developers take provider concerns and other feedback into account when designing EHR technology in the future.
“Physicians and other healthcare workers played a minimal role in the initial design of the EHR, and their concerns have been largely ignored,” stated researchers.
Improved communication between health IT developers and providers could serve as a way to reduce provider frustrations with EHR use and limit patient safety risks through more streamlined, standardized system design.
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing, Medical Transcription, Scribe Services, and AzaleaHealth EHR. We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information. We have education programs in Medical Scribe Specialists. #MedicalTranscription #AzaleaHealthEHR #RevenueCycleManagement #MDSofKansas #MedicalBillingService #MedicalScribes
More than 90% of hospitals and 80% of physicians’ offices now have electronic health records (EHRs) – and while the digitization of medicine has improved patient safety, it also has a dark side. Today The Doctors Company, the nation’s largest physician owned medical malpractice insurer, published a new study showing that EHR-related malpractice suits are on the rise.
The study reveals that claims in which EHRs are a factor grew from just 2 from 2007 through 2010 to 161 from 2011 through December 2016. Typically, the EHR is a contributing factor in a claim, rather than the primary cause, according to David B. Troxel, MD, study author and medical director at The Doctors Company.
It’s the second study of its kind by The Doctors Company, which recognized early on that despite the potential of EHRs to advance the practice of good medicine and patient safety, there would be unanticipated consequences from this rapidly adopted new technology. The latest research compares 66 claims made from July 2014 through December 2016with the results of the first study of 97 claims from 2007 through June 2014.
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing, Medical Transcription, Scribe Services, and AzaleaHealth EHR. We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information. We have education programs in Medical Scribe Specialists. #MedicalTranscription #AzaleaHealthEHR #RevenueCycleManagement #MDSofKansas #MedicalBillingService #MedicalScribes
A new survey from SelectHub, a technology selection management company, examined the thoughts of medical professionals and patients regarding electronic health records.
The team interviewed 1,007 Americans who have access to EHRs, as well as 107 healthcare professionals, including nurses, physician assistants, administrators, technicians and medical laboratory scientists. In an email, Chris Lewis, a creative partner of SelectHub, said the survey results were not limited to users of a certain EHR vendor or system.
Apparently, healthcare workers and patients both have a fairly positive sentiment of EHRs — at least according to the survey.
Among healthcare professionals, 53.5 percent said they had a positive outlook on EHRs, and 33.7 percent indicated they had a very positive stance. Approximately 10.9 percent had a neutral opinion, 2 percent expressed a negative opinion and 0 percent had a very negative outlook.
These results are surprising, given that electronic health records are often considered something healthcare workers love to hate.
Despite these favorable viewpoints, EHRs don’t seem to be cutting down on the amount of time professionals spend on health records. Among those who switched to using an EHR system, the average number of hours per week spent on health record work only decreased from 19.7 hours to 18.6 hours.
Additionally, 81 percent of professionals said EHRs have increased general workplace productivity.
The SelectHub survey included a wide range of healthcare participants, such as administrators, medical laboratory scientists and office receptionists. But it is interesting to note that a study out of the University of Wisconsin and the American Medical Association found that at least among primary care physicians, EHRs are time-consuming and only complicate matters. According to that study, EHR-related tasks take up nearly half of the average PCP’s workday.
Among patients included in the SelectHub survey, 60.4 percent expressed a generally positive opinion of EHRs, and 19.7 percent had a very positive opinion. Additionally, 16.6 percent had a neutral stance, 3 percent had a negative opinion and 0.3 percent indicated a very negative opinion.
“Perhaps the most surprising aspect of our research though was the reasoning behind patients’ support of EHR technologies,” Lewis said via email.
Seventy-six percent of patients said they believe their doctor’s use of an EHR has either a positive or very positive impact on the healthcare they receive.
“Furthermore, those who received thorough instructions on EHR use and access reported accessing their records more than twice as frequently, suggesting a potential need for more information resources for patients,” Lewis added.
Photo: Mutlu Kurtbas, Getty Images
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing, Medical Transcription, Scribe Services, and AzaleaHealth EHR. We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information. We have education programs in Medical Scribe Specialists. #MedicalTranscription #AzaleaHealthEHR #RevenueCycleManagement #MDSofKansas #MedicalBillingService #MedicalScribes
ORANGE, Calif., August 24, 2017. The American College of Medical Scribe Specialists (ACMSS) applauds the passage last Friday of a bipartisan bill in the U.S. House of Representatives to create a pilot study in Veteran’s Administration hospitals to determine whether using Medical Scribes to assist physicians will help shorten the VA’s notoriously long wait times and ease other patient service problems. ACMSS only asks that the Senate modify the language in the bill to ensure the VA employs only Certified Medical Scribe Specialists.
The purpose of The Veterans Affairs Medical Scribe Pilot Act of 2017 (HR 1848), introduced by Rep. Phil Roe, M.D. (R-Tenn.), is to create a two-year medical scribe pilot program under which VA will increase the use of medical scribes at ten VA medical centers, employing 30 scribes in all. It is hoped that the use of medical scribes in the program will reduce the amount of time physicians spend on daily documentation so that they may increase the number of patients physicians can see and the amount of time physicians are spending with each patient. Every 180 days during the two-year program the VA will be required to report to Congress the programs effect’s on provider satisfaction, provider productivity, patient satisfaction, average wait time and the number of patients seen per day.
After the bill’s passage, Roe, who is Chairman of the House Committee on Veterans’ Affairs and a physician, released a statement on the purpose of the legislation. “Since the VA waitlist scandal broke three years ago, I’ve examined several ways to improve patient care for veterans, and one that came up repeatedly in discussions was cutting down on the time physicians spend entering data,” Roe said. “Many private-sector physicians report the use of medical scribes has a positive and meaningful impact on their ability to see patients. Scribes can help input patient data and allow physicians to focus on patient care and use their time more efficiently. That’s why I introduced legislation to start a pilot program to examine whether or not the use of medical scribes would have similar positive effects in the VA.”
ACMSS agrees with all of the elements contained in the Act, but is sending a letter to the Senate Committee on Veterans Affairs, asking for one change before the bill goes to the Senate for a vote. “If this legislation is approved in the Senate and the program goes forward, employing Medical Scribes to assist physicians at the VA will undoubtedly improve efficiencies and have the positive effect the bill proponents desire, and more,” said ACMSS Executive Director Kristin Hagen. “However, in approving the language, ACMSS urges the Senate to insist that only Certified Medical Scribe Specialists be used in the program. Medical scribes provide real-time documentation and increase practice efficiencies in a great number of areas outside of clinical documentation, but they must be certified.”
ACMSS is an independent certifying organization and works in compliance with the Centers for Medicare and Medicaid Services (CMS) to meet national goals and initiatives of Meaningful Use of Certified Electronic Health Record Technology (CEHRT), and Medicare Access and CHIP Reauthorization Act (MACRA) and its Merit-Based Payment Incentive System (MIPS). Certified Medical Scribe Specialists also meet the “qualified people” standard in CEHRT and assist with the design and infrastructure to support ongoing transformative care and change.
The ACMSS certification program meets current and proposed CMS certification requirements toward use of EHRs through its Medical Scribe Certification & Aptitude Test (MSCAT). In addition to the overall certification exam, ACMSS provides specialty certifications in vascular medicine, dermatology, oncology, primary care, internal medicine, emergency medicine and general patient care, enabling access to all across the specialties.
“Employing Certified Medical Scribe Specialists is the best way that care providers get can ensure they get back the time and attention they need to join the evolution of the outpatient healthcare industry into a patient-centered system that focuses on integrative medicine, prevention, disease reversal and wellness,” Hagen said.
Please contact ACMSS directly at info@theacmss.org, visit our website at theacmss.org, or phone 800-987-3692 if you have any questions regarding the ACMSS program and/or materials.
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing, Medical Transcription, Scribe Services, and AzaleaHealth EHR. We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information. We have education programs in Medical Scribe Specialists. #MedicalTranscription #AzaleaHealthEHR #RevenueCycleManagement #MDSofKansas #MedicalBillingService #MedicalScribes
As many as 80 percent of all medical claims submitted to insurance carriers contain mistakes estimated at $68 billion (1). Approximately 55 percent of evaluation and management (E/M) claims are incorrectly coded resulting in $6.7 billion in improper Medicare payments.(2) Providers looking to avoid lost revenue and serious consequences are raising the training standards of its administrative staff seeking out those who have completed specialized training and certification offered by Practice Management Institute (PMI).
Watchdog agencies, enforcement, and penalties are on the rise, creating a high-risk environment for physicians. Tighter screening measures adopted by the Affordable Healthcare Act have resulted in 17,000 providers losing their license to bill Medicare (3). Doctors have ultimate responsibility for all claims billed under their unique provider number, and a physician’s signature on any claim is held as verification of the accuracy and legitimacy of each claim (4).
Increased scrutiny has prompted doctors and healthcare facilities to require their employees to become certified. From an enforcement perspective, staff who knowingly submit fraudulent claims for payment can be held liable (5).
David Womack, President and CEO of PMI, says, “It’s critically important that providers have well trained staff. The physician needs to have confidence that their personnel are running the business correctly so they can focus on quality patient care.”
Physicians dedicate their careers to quality patient care; most have had little exposure to the increasingly complex world of medical claims management. They rely on their billing and administrative staff to stay on top of the guidelines set forth by Medicare and third parties. PMI helps providers adopt higher training standards with specialized courses and certification exams that address these high-risk areas of practice administration.
Womack says, “Taking steps to successfully train and certify staff in these areas means physicians are more likely to submit accurate claims and receive correct payments for their services, and ensure that practice liability is minimized.”
About Practice Management Institute (PMI):
For more than 30 years, Practice Management Institute, also known as PMI, has helped physicians, hospital systems, medical societies, and educational institutions provide comprehensive education and training to medical office staff nationwide. By offering a variety of educational programs and professional certifications, PMI helps to build competency, compliancy, and effectiveness that assures the continued success of their clients.
Since PMI’s formation in 1983, more than 20,000 individuals have earned certification in one more areas of expertise. PMI is recognized by both the Centers for Medicare and Medicaid Services and the Department of Labor for training in: medical coding, third-party billing, office management, and compliance. PMI training helps ease the burden of running a successful medical practice through thorough education and up-to-date training for non-clinical staff, allowing physicians to focus on patient care to improve the experience of the patient. For more information, visit http://www.pmiMD.com.
About David Womack:
David Womack, President and CEO, has been instrumental in PMI’s continued success since 1991. He has helped PMI transition into a cutting-edge leader in medical office staff education and training while developing key relationships with healthcare organizations, hospitals, colleges, and medical societies across the country. His commitment to excellence has helped PMI become an industry leader recognized by both governmental organizations and healthcare systems across the country.
Sources:
1. “Incorrect Medical Coding Corrupts the Core Data Used by Health Care Facilities, Has Negative Consequences Throughout Health Care Industry.” Integrated Healthcare Executive. N.p., n.d. Web. 05 May 2017.
2. “55% of E/M Claims Incorrectly Coded – What’s Your EMR Software Doing to Help?” HealthFusion, June 24, 2014.
3. The $272 Billion Swindle.” The Economist. The Economist Newspaper, 31 May 2014. Web. 05 May 2017.
4. College, From The. “Who Is Liable for Coding Mistakes?” The Rheumatologist. N.p., 01 Oct. 2010. Web. 05 May 2017.
5. U.S. Department of Justice Memo, “Individual Accountability for Corporate Wrongdoing” aka, the Sally Yates Memo, September 9, 2015.
As we get ready for National MT week, let’s take a look at the importance [still] of the Medical Transcriptionist in today’s healthcare industry:
A skilled workforce produces quality documentation. Healthcare documentation specialists (HDSs) and medical transcriptionists (MTs) ease the documentation burden from physicians.
HDSs and MTs consistently achieve documentation accuracy rates higher than 99%,¹ and by harnessing this workforce’s expertise, clinicians’ time, coding, and revenue are optimized and the data governance strategy is strengthened.
The narrative allows physicians the opportunity to add the qualitative information that provides context to the patient’s medical history and care. HDSs and MTs understand the complex story-telling of patient care and are experts in document standards and data capture.
Your healthcare documentation team are highly skilled, analytical quality assurance specialists who provide risk management support in capturing healthcare encounters and making sure they are documented in a way that promotes clinical clarity and coordinated care.
HDSs and MTs need to be positioned to ensure accurate documentation of care encounters and to identify gaps, errors, and inconsistencies in the record that may compromise care or compliance goals.
HDSs’ and MTs’ body of knowledge is vast and includes pharmacology, human disease processes, anatomy and physiology, HIPAA, privacy and security, and diverse technologies used to capture health data.
Certify to healthcare delivery that HDSs and MTs have the training and expertise to be valued among the allied health and HIM delivery teams by earning and maintaining your professional certification.
#NMTW #PrecisionMatters
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing, Medical Transcription, Scribe Services, and AzaleaHealth EHR. We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information. We have education programs in Medical Scribe Specialists. #MedicalTranscription #AzaleaHealthEHR #RevenueCycleManagement #MDSofKansas #MedicalBillingService #MedicalScribes
That’s the takeaway from a recent report in the Journal of the American Medical Informatics Association. Seven in 10 Rhode Island doctors surveyed who used electronic health records said that the technology stressed them out. Those who reported health information technology-related stress were anywhere from 1.9 to 2.8 times as likely to burn out. In Pennsylvania, 45 percent of physicians report feeling burned out, according to a separate survey from Medscape.
They can thank the federal government for these professional headaches. A decade ago, the Obama administration pushed doctors to adopt electronic records in hopes they’d speed up the provision of care and improve health outcomes. Ten years on, these mandates have delivered much the opposite.
By Kate Monica
10 Reasons to Consider Becoming a Medical Scribe Ahead of Med School