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
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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
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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
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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
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
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
ATLANTA, GA – (November 18, 2015) – Azalea Health’s solution, Azalea EHR 2.1, is one of a select few EHRs to achieve certification on all 64 CMS clinical quality measures (CQMs). Eligible providers are required to report on CQMs to demonstrate meaningful use and receive an incentive payment under the Meaningful Use Stage 2 rule. The provider can select and report on nine from the list of 64 approved CQMs for the electronic health record (EHR) incentive programs.
“Our healthcare system is evolving rapidly towards quality and outcomes-based payments so it’s imperative for Azalea to ensure we offer the most innovative, flexible and functional EHR as well as quality reporting platform for physicians and other care providers,” said Baha Zeidan, CEO of Azalea Health. “The three main pillars of our company are innovation, partnership and leadership and this CQM certification embodies those pillars as we navigate our customers successfully through the future of healthcare.”
The Azalea 2.1 EHR includes fully integrated electronic health records, practice management, interoperability services, patient portal, personal health records, telehealth, and the AzaleaM mobile platform integrated with Apple® HealthKit, as well as revenue cycle performance services.
Azalea Health helps reduce the complexity of operating a medical practice, enabling physicians to spend more time with their patients. Azalea’s cloud-based solution is simple to implement and easy to use, streamlining administrative workflow while maximizing a practice’s resources and revenue cycle.
This Complete EHR is 2014 Edition compliant and has been certified by an ONC-ACB in accordance with the applicable certification criteria adopted by the Secretary of the U.S. Department of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments.
Azalea Health is a leading provider of fully integrated, technology-enabled healthcare solutions and managed services for practices of all sizes and most specialties. Azalea’s comprehensive portfolio includes integrated electronic health records, practice management, electronic prescribing, interoperability services, personal health records, patient portal, telehealth, AzaleaM mobile platform integrated with Apple® HealthKit, as well as revenue cycle performance services. The Azalea platform also provides tools and resources to help customers meet their Meaningful Use and ICD-10 requirements as well as strategies to navigate accountable care and alternative payment models. To learn more, please visitwww.AzaleaHealth.com, call (877) 777-7686 or connect via social media on Facebook, Twitter and LinkedIn.
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing and RCM, Medical Transcription, Pre-Certs with 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
The ICD-10 Compliance date is looming and it is imperative that healthcare providers be prepared to make the transition. It affects everything from claims processing, physicians’ workflow, and patients’ access to care. Many organizations may be rallying employees and resources in order to make the switch from the ICD-9 to the ICD-10 coding for medical diagnoses and inpatient hospital procedures before the implementation date of October 1, 2015.
To make matters worse, the transition is not easy, but a major undertaking with nearly 19 times as many procedure codes and almost five times as many diagnosis codes in the ICD-10 than in the ICD-9. While the ICD-10 switch is definitely necessary, as the outdated and clinically inaccurate ICD-9 has not been updated since its installation, in 1979, the ICD-10 stands to enhance the quality of healthcare, improve data for epidemiological research, as well as enable physicians to make better clinical decisions. However, this is dependent on the ability for the healthcare industry to make a smooth and accurate transition to the new International Classification of Diseases, according to Richard Milam, president and CEO of EnableSoft
In order for healthcare providers to successfully meet the ICD-10 deadline, Milam suggest five best practices to ensure an expedient, smooth ICD-10 transition:
Richard Milam, president and CEO of EnableSoft
1. Employ Robotic Process Automation That Does the Work for You
“You” is meant to imply the entire organization because that is how many resources it will take to have the ICD-10 switch completed by the deadline if Robotic Process Automation is not used to update and add the multiple new codes into EMR, NDC, medical billing, and claims processing data systems. Certain softwares may have to upgraded or replaced to support the 68,000 diagnoses codes and nearly 87,000 procedure codes; however, through a series of human-directed scripts, Robotic Process Automation technologies will populate the specific fields in the data systems with the ICD-10 data required. The already costly transition to the new ICD-10 can be mitigated by not having to outsource or hire new employees to enter the new codes manually. Furthermore, the data transition can take place over the course of a few days, not a few months, ensuring healthcare providers will be ready to transition to using the new ICD-10 codes.
2. Test Your Software
Not only should you confirm with your clearinghouses, billing service, and payers that they will be upgraded and compliant with the ICD-10, but when they will be ready for testing to occur. Robust end-to-end testing must occur with your software in order to ensure claims are being accepted properly and processed by insurance contractors, Medicaid, Medicare, and other payment processes are operational. Test internally to ensure transactions can be generated and sent with the ICD-10 codes and test externally to ensure the transactions are successfully received by payment providers and that the payment can be processed correctly. After October 1, any ICD-9 codes used in transactions will not be accepted for services and will be rejected for payment. Failure to test your software properly can result in disruptions in patients’ receiving the treatment they need and receipt of due payments.
3. Educate or It All Falls Down
The updated, enhanced medical coding that is to enhance and improve patient diagnoses, performed procedures, treatment, and billing will not prove capable of these abilities without humans to employ its codes, terminology, and procedures appropriately and correctly. You must educate your staff about the changes to the ICD-10 and perform practices and routines in order to prepare for the change. Have each of your staff participate in educational seminars in order to become informed of the changes and how that will affect their position, the procedures patients are to undergo based on the new diagnosis codes, as well as the improved treatments that patients are to have performed. Assist and inform staff by identifying the 50-100 most commonly used ICD-9-CM diagnosis codes based on specialties and determine the equivalent ICD-10-CM codes, and have this information accessible before and after the implementation of the ICD-10. Having your staff prepared and knowledgeable about the ICD-10 will reduce delays in patient care and procedures, which is the reason for the ICD-10—to deliver improved diagnosis and advanced medical treatments that will enhance patients’ quality of care.
4. Implement an Effective Communication Method and Coordinate Conflict Resolution
While making the data transition and update to the new and diverse medical coding that is in the ICD-10, it is imminent that there may be delays in processes, confusion over coding and form completion, as well as workflow changes. Make sure your employees know who they can contact or call on if they are unsure of what code to report, how to complete a form, or other transitory questions that may arise following the implementation of the ICD-10. Identify leads and supervisors for each workflow and specialty area that will be available for their staff requests and questions, and make sure those individuals are highly educated on the ICD-10 and have the authority to execute a resolution. Additionally, determine how transactions handled just prior to the compliance date will be handled in order to ensure payment processing will occur—and more importantly—patients are covered financially and receive the best treatment. Identify critical areas or procedures that may be challenging to transition to using the ICD-10 and have practical resolutions for those practices ready to be executed if, and when, needed.
5. Obtain the correct medical documentation and update your forms to support the ICD-10.
Patient intake forms, EMR forms, insurance forms, and superbills must be updated to support the ICD-10 codes. In order to have patient medical records completed correctly and treatments performed effectively, in addition to have payments process, healthcare providers, clearinghouses, and payers must update their forms to reflect the codes in the ICD-10. Physician forms must be updated with the new medical terminology and diagnoses and procedural codes, along with superbills. Identify categories of uncommon services and diagnoses and determine units, time, and cost for each category in order for physicians to be able to report in the EMR and on superbills. Determine and have readily available a list of common or most frequently used abbreviations to ensure they are utilized correctly and correspondently with the ICD-10 terminology and codes. Lastly, and this goes without saying, obtain the updated and correct documentation that will stand as educational and reference material in regards to the ICD-10. The American Medical Association publishes the ICD-10 codebook and other supplementary documentation on topics such as anatomy and physiology, mappings, and coding workbooks. Make sure to have these ICD-10 Bibles available, and in all areas, for staff and physicians to reference when needed or desired.
The healthcare industry is about to embark on an intense change in treatment, reporting, and payment processes as the ICD-10 Compliance date approaches. While the ICD-10 is definitely necessary to reflect advances in medicine and detailed diagnoses, the change is extremely disruptive for healthcare providers. By employing efficient technologies and engaging effective strategies, healthcare providers can execute the ICD-10 transition quickly and accurately by the compliance date. READ MORE
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing and RCM, Medical Transcription, Pre-Certs with 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
Doctors beware: The EHR debacle may get much worse American Thinker
More and more people are having the disturbing experience of seeing their doctors spend more time pecking at a computer keyboard than examining them. The doctors are entering data into their patients’ electronic health records in compliance with federal rules introduced a few years ago. EHRs drive doctors crazy. Their own experience tells them that electronic recordkeeping interferes with care, by taking time away from patients.
Patients press the ‘record’ button, making doctors squirm Washington Post
According to author Christie Aschwanden: My dad had a health scare recently, and at a doctor’s appointment to receive some important test results, my mom wanted to record audio of the visit on her smartphone. “If he had gotten some terrible diagnosis, I wanted to be able to share that discussion with you and your sister,” Mom told me later. But when she asked if it was okay to record, the doctor replied, “No. I don’t want you to do that.”
Senator blasts EHR program Healthcare IT News
Until physicians have EHRs that can talk with one another, the Precision Medicine Initiative introduced by President Barack Obama could be in jeopardy, Sen. Lamar Alexander said. “We’ve got to get these records to a place where the systems can talk to one another — that’s called interoperability — and also where more doctors, particularly the smaller physicians’ offices, want to adopt these systems, can afford the cost and can be confident that their investment will be of value,” Alexander said.
Healthcare Finance News
Text of a bill by Rep. Ted Poe to delay the switch to ICD-10 diagnostic coding surfaced recently, in which it requests further study on the disruption on healthcare providers could face resulting from the replacement of ICD-9. The three-page bill, H.R. 2126, was proposed on April 30 but the text was not posted for over a week. The bill would prohibit the Secretary of Health and Human Services from replacing ICD-9 with ICD-10 on Oct. 1, as is scheduled.
Almost 90 percent of healthcare providers hacked in last 2 years Slash Gear
Cyber attackers have increasingly turned their attention to healthcare providers, of which nearly 90-percent were hacked over the course of the last two years. The growing number of cyber attacks against the healthcare industry is said to cost $6 billion annually, marking a trend where hackers shift focus from financial institutions and retailers to those with medical records. All in all, these attacks are said to have doubled in the United States over the last half decade.
CMS promotes ICD-10 readiness with more end-to-end testing RevCycle Intelligence
There are 142 days left until the International Classification of Diseases — ICD-10 — compliance. What’s next? More Medicare end-to-end testing efforts, says The Centers for Medicare & Medicaid Services. CMS has announced via email announcement a final opportunity for a sampling of volunteers to conduct ICD-10 end-to-end testing. From July 20 through July 24, 2015, the sample group will conduct testing with Medicare Administrative Contractors and the Common Electronic Data Interchange contractor.
Could high-tech health record solutions lead to less expensive healthcare? Government Technology
Imagine if you never had to fill out another patient information form at a doctor’s office again. That’s the promise of a new portable patient health record service developed by Boca Raton-based InfoPeHR. For $35, patients can buy a credit card-sized USB drive that can hold their records — including high-resolution medical images — for a lifetime, said InfoPeHR owner Bernard Brigonnet.
Misuse of EHR systems and medical errors EHR Intelligence
Does EHR technology reduce the likelihood of medical errors throughout the healthcare continuum? The input from medical professionals answering this question is mixed. There are certain mistakes that were tied directly back to the misuse of EHR or e-prescribing systems. As previously reported, one pharmacist had ordered acetaminophen for the wrong patient because they had two records open at the same time.
EHR alerts increase HPV vaccine rates 10 times over Health IT Analytics
EHR alerts that help providers remember to start or complete the HPV vaccine for pediatric patients have significantly increased the rate of protection against cervical cancer. Patients between the ages of 9 and 18 were three times more likely to start the vaccine series and 10 times more likely to finish the entire course when EHR alerts were available to their primary care providers, found a study published this month in the Journal of the American Board of Family Medicine.
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing and RCM, Medical Transcription, Pre-Certs with 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
Retail giants Walmart and Target, and likely others, will continue their steady march into the healthcare setting, sensing an opportunity to leverage their customers with a mix of technology that could be a boon to the digital health space.
Speaking at Health 2.0’s WinterTech conference in San Francisco, officials with both companies said the move toward providing a deeper level of services, including some level of chronic disease management, could apply to both their employees and consumers, as part of a wider effort to contain healthcare costs and to guide consumers to healthier lifestyles.
“It is indeed a customer-facing retail clinic. However, it is also an on-site clinic for our employees,” said Ben Wanaker, who leads the Walmart Care Clinic business. “All of our employees have health needs, all are on high-deductible health plans and Walmart, like everyone else, is struggling with healthcare costs.”
Both Target, which made headlines recently with its collaboration with Kaiser Permanente in Southern California, and Walmart will be exploring technological tools to enhance efforts, which could range from partnerships and acquisitions on technologies like mobile coaching apps to telemedicine efforts.
“We’re working on our digital telehealth strategy,” Wanamaker said, though he did not provide a time line or further details.
Eric Brotten, VP of consumer health and referral solutions for Optum, likewise said retail clinics will continue to evolve, and that Optum, a division of insurance giant UnitedHealthcare, will be on the lookout for technologies to bolster its offerings. From a payer standpoint, the idea makes a lot of sense, he said.
“The real goal of that is to provide care in a way that ultimately drives outcomes in a different care setting,” he said, noting that Optum runs about 20 retail clinics in Texas, Kansas and Nevada.
For Target, much of the expansion will come in the way of collaborations, with the Kaiser effort cited as an example that could be extended into other regions, according to Michael Laquere, senior buyer for pharmacy at Target.
“We very much take a partnership approach,” he said, adding it and other retailers have an opportunity to reach potentially millions of consumers. He also demonstrated Target’s new pharmacy prescription app, suggesting medication adherence could be assisted through retail health.
“This is a big step and a big investment,” he said. The app can help with dosage alerts, refills and take pictures to assist with transferring prescriptions. Target partnered with Mscrips on the app.
“We’re building this platform, so we’re looking at things like coaching tools, ways to connect with telemedicine, connecting with pharmacies in a more virtual way,” he said when asked what Target’s next moves into the digital health space might include. In addition, scheduling functionality for appointments is of interest.
“We’re really interested in technologies and applications that can help us deliver evidence-based primary care,” Wanamaker said of Walmart’s goals. “Whether that’s (electronic medical record) applications or applications that live in a provider or patient’s pocket. We care about the quality in our care but we also need to be very efficient.”
From a data standpoint, retailers could be sitting on potentially riveting customer information, particularity as it relates to buying pattens, a la Amazon, and health outcomes. If successfully harnessed, seeing what kind of food a customer with a health condition is buying could lead to suggestions that might improve health, or mitigate a chronic condition like Type 2 diabetes.
Yet the potential is not yet realized because of potential privacy issues and regulations, although the opportunity is there.
“It’s a huge opportunity, but it’s something that we have to be very careful about,” Laquere of Target said. “The key is being really transparent and really clear about how we’re using the data and that it actually adds value.”
Wanamaker of Walmart agreed, within the regulatory constraints
“We think we have a tremendous opportunity that can help consumers make better decisions.”
While the retail sector sees opportunity in healthcare, Wanamaker said it’s unreasonable to suggest Walmart or Target would be the be-all, end-all for healthcare. But, he said, it could be a strong starting point for many people who struggle to access the healthcare system initially.
“We would never make the claim that we will be the beginning and the end of your healthcare needs,” he said. “However, not everyone gets to the beginning, and we want to be the beginning.
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing and RCM, Medical Transcription, 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 and Healthcare Documentation Specialists. #medicaltranscription #azaleahealthEHR #revenuecyclemanagement
Recent research reveals new trends among EHR buying. Take a look at the data on top EHR buyer trends of 2014 provided by Softwareadvice.com. #EHRtrends2014
Key findings when analyzing 385 interactions with EHR buyers reveal their primary reasons for evaluating new software, and their most desired features and applications, include:
Mobile support topped the list of desired capabilities, with 40% of the buyers requesting this feature, followed by e-prescribing (24%) and lab integration (20%)
85% of buyers overwhelmingly prefer a web-based over an on-premise system
The majority of buyers (89%) aren seeking an integrated system, that includes applications such as billing or scheduling
AzaleaHealth is certainly at the cutting edge in addressing buyers’ needs. Azalea Health enhances the workflow of your practice, giving you the power to connect the medical side with the financial side. It is a true cloud-based solution so you don’t have to worry about maintaining servers and software. We take care of it. The fully integrated solution enables physician and specialty practices to afford a sophisticated technology that meets all their practice management needs at a fraction of the complexity and cost. #azaleahealthEHR
Azalea Health’s integrated EHR and billing solution has the flexibility to accommodate multiple specialties of any size practice. The company provides Electronic Health Records (EHR), Practice Management (PM), Revenue Cycle Management Services (RCM), mhealth app, and a Patient Health Records Portal.
Recently the company announced its merger with EHR provider, simplifyMD. The merged company, with their combined skills and products, will be able to offer expanded services and product options, as well as the tools and resources to help customers with meeting their Meaningful Use and ICD-10 requirements. The company will continue to be dedicated to simplifying the life of physicians and administrators byproviding a complete solution that is easy to implement and use. #azaleahealthmerger
Implications for EHR Vendors Mobile support topped the list of requested EHR features, with nearly 40 percent of buyers in our sample requesting support for tablets and/or smartphones. With practices increasingly integrating mobile devices into their charting workflows, mobile support will be a key determinant in EHR purchasing decisions for buyers in 2014. Products that offer mobile applications will be well positioned to win business this year.
Vendors should also highlight their products’ meaningful use-mandated elements; e-prescribing and lab integration ranked highly on the list of requested features, thanks in no small part to their inclusion in MU requirement criteria.
Additionally, integrated suites are the future of EHRs. Nearly 90 percent of buyers explicitly requested to evaluate a system that integrates EHR with other applications (such as billing and scheduling). With nearly a quarter of the buyers replacing existing EHR solutions doing so because of a lack of integration, it seems the days of the standalone EHR are numbered.
Implications for EHR Buyers
Most of the buyers in our sample wanted to implement their new EHR software within three months. However, the climbing percentage of buyers replacing existing systems due to dissatisfaction suggests buyers would be well served by dedicating as much time as needed to the evaluation process.
Researcher Commentary
“We’re seeing significant demand for mobile solutions that allow users to access the EHR on tablets, or even on smartphones while on-the-go. Mobile devices are increasingly being integrated into practices’ workflows, and buyers need solutions that facilitate the efficiency those mobile devices can offer.”
“The percentage of buyers replacing existing implementations continues to rise. With so many buyers beginning their research with rapid-fire implementation timelines, I expect that proportion to continue growing. My advice to buyers is this: don’t impose a hard deadline on your evaluation process. Find a system that truly addresses your needs before making a purchase, rather than adopting a system and attempting to make it suit your purposes once in place.”
Methodology
Software Advice regularly speaks on the phone with medical practices seeking new EHR software. For this analysis, we randomly selected 385 of our phone interactions from Q1 2014 to analyze. Buyers were asked about their reasons for evaluating systems, the most critical features required and deployment preferences, among other criteria.
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing and RCM, Medical Transcription, 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 and Healthcare Documentation Specialists. #medicaltranscription #azaleahealthEHR #revenuecyclemanagement
Electronic health records ripe for theft POLITICO
America’s medical records systems are flirting with disaster, say the experts who monitor crime in cyberspace. A hack that exposes the medical and financial records of hundreds of thousands of patients is coming, they say — it’s only a matter of when. As health data become increasingly digital and the use of electronic health records booms, thieves see patient records in a vulnerable healthcare system as attractive bait, according to experts interviewed by POLITICO. On the black market, a full identity profile contained in a single record can bring as much as $500.
“I think the health data stewards are probably a little behind in the race. The criminal elements are incredibly sophisticated.” READ MORE
Let Azalea Health put your mind at ease. Azalea is the hub and heart of your practice, giving you the power to connect the medical side with the financial side. It is a true cloud-based solution so you don’t have to worry about maintaining servers and software. We take care of it. The fully integrated Azalea Health solution enables physician and specialty practices to afford a sophisticated technology that meets all their practice management needs at a fraction of the complexity and cost.
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Transcription, Revenue Cycle Management, AzaleaHealth EHR, and REAL-TIME solutions with Medical Scribes. 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 and Healthcare Documentation Specialists.
Transcription provides the clear, cost-effective solution to the on-going crisis in healthcare documentation.
JOHNSON CITY, TN – EHRs continue to adversely affect the doctor-patient relationship, according to a new article published in Medscape. The article (requires free membership with Medscape, click here), titled “Doctors are Talking: EHRs Destroy the Patient Encounter”, describes in detail the toll EHRs are taking on both physicians and patients.
The article cites three main physician gripes:
1. EHRs have made the patient encounter “far more annoying and complex than it ever was before.”
2. EHRs “make (physicians) feel like data entry clerks, with a computer telling them how to practice medicine.”
3. EHRs “erode the doctor-patient relationship by creating a barrier between the two.”
Scribes – A Good, But Not Best, Solution
The article continues with a discussion of the pros and cons of using an in-office Scribe. While some physicians favored the use of Scribes, others vehemently opposed it. As one physician commented, “We have to hire a person to deal with the already expensive EHR. At the end of the day, we are still worse off than before we had the EHR forced on us.”
Another physician added, “So adding another $25,000/year employee on top of the $80,000 for the EHR is the ‘happy’ solution?” a doctor asked. “I am not the government with unlimited money.”
MTSOs Are Offsite Scribes
In contrast to the more expensive approach of onsite scribes is the model of the offsite transcription vendor, which is a superior option for three key reasons:
1. Deep history and familiarity with the doctors’ and their clinical documentation preferences and style.
2. Strong expertise in medical language terminology and usage.
3. Significantly lower expense than onsite scribes, with no lost time for holidays or sick days.
EHR Vendors: Barrier or Facilitator?
Despite the clear advantages of offsite transcription, it cannot be implemented without the cooperation of EHR vendors, which are the gatekeepers for the implementation of the all-important interface for importing transcribed notes — or sections of notes — into the EHR’s patient record. In many cases, interfaces remain expensive, non-standardized, and difficult to implement — all of which act as a deterrent to implementation.
“The high barriers to entry for getting an interface in place limits the options many physicians have regarding the clinical documentation workflow,” said Mark Christensen, CEO of WebChartMD. “We’re asking EHR companies to join us in making it possible for physicians to choose the documentation modality best suited to them and their practice of patient care. If physicians prefer some modality other than dictation, that’s their choice. But if their preference is dictation and transcription, we’re asking EHR companies to remove the financial and technological barriers that restrict a physician’s ability to make that choice.”
For more information, or to dialogue further on this topic, contact Mark Christensen directly at mark@webchartmd.com or 1-423-343-5702.
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Transcription, Revenue Cycle Management, AzaleaHealth EHR, and REAL-TIME solutions with Medical Scribes. 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 and Healthcare Documentation Specialists.
This is a great article that speaks to the errors that can occur with Speech Recognition and EHR if proper editing and care are not taken for review. The end of the article even speaks to the growing demand for Medical Scribes, so be sure to read the complete article. You won’t be sorry!
It isn’t often that a doctor is mistaken about how many feet his patient has.
An intern recently presented a newly admitted patient on morning rounds, reporting that the patient was “status post BKA (below the knee amputation).” “How do you know?” the attending physician inquired. “It has been noted on each of the patient’s prior three discharge notes,” replied the intern, looking up from his computer screen. “Okay,” responded the attending physician. “Let’s go see the patient.”
When the team arrived in the patient’s room, they made a surprising discovery. The patient had two feet and ten toes. Where did the history of BKA come from? It turned out that four hospitalizations ago, the voice recognition dictation system had misunderstood DKA (diabetic ketoacidosis) as BKA, and none of the physicians who reviewed the chart had detected the error. It had now become a permanent part of the electronic medical record — as if written in stone.
Fortunately, this error could be easily corrected. But the intern’s mistake highlights a growing problem with government-mandated electronic medical records. Doctors are spending more time in front of computer screens and less time with actual patients. This affects how doctors interact with patients. Inevitably, errors creep into their patients’ charts. Prudent patients should be aware of this trend and take steps to ensure the accuracy of their medical records.
The HITECH (Health Information Technology for Economic and Clinical Health) Act of 2009 essentially mandates that physicians and hospitals adopt electronic records by 2014, or face penalties in the form of reduced Medicare/Medicaid payments.
At first glance, adopting electronic medical records (EMRs) would seem a no-brainer for doctors and hospitals. After all, electronic records are the norm for many successful businesses, assisting with sales, inventory, and billing. In theory, electronic medical records should allow doctors to work more efficiently. But in practice, many doctors are finding that EMRs hinder their ability to practice good medicine.
A recent study from Northwestern University found that, “physicians with [EMRs] in their exam rooms spend one-third of their time looking at computer screens, compared with physicians who use paper charts who only spent about 9% of their time looking at them.” According to Enid Montague, PhD, first author of the study, “When doctors spend that much time looking at the computer, it can be difficult for patients to get their attention… It’s likely that the ability to listen, problem-solve and think creatively is not optimal when physicians’ eyes are glued to the screen.”
New York Times health writer Dr. Pauline Chen similarly described that young doctors in training are so busy filling out obligatory electronic forms, they spend only 8 minutes per patient each day. As a result, they cut corners:
When finally in a room with patients, they try to [rush through interviews] by limiting or eliminating altogether gestures like sitting down to talk, posing open-ended questions, encouraging family discussions or even fully introducing themselves.
As Dr. Chen noted, the bad habits they learn in training will carry over to when they become independent practitioners.
(Some doctors are coping with this problem by hiring “scribes” — additional clerical people to enter data into the computer, while the physician converses with the patient. But this requires physicians or hospitals to hire additional personnel. As the New York Times noted, “In most industries, automation leads to increased efficiency, even employee layoffs. In health care, it seems, the computer has created the need for an extra human in the exam room.” The “solution” of scribes doesn’t eliminate the inefficiency caused by electronic medical records — it merely shifts the problem elsewhere.)
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Transcription, Revenue Cycle Management, AzaleaHealth EHR, and REAL-TIME solutions with Medical Scribes. 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 and Healthcare Documentation Specialists.
MDS understands that document specificity is critical for ICD-10. You do not want to see an interruption with your payors.
AAPC released recent study results showing clinical documentation of more than 20,000 physicians with only 63% of current documentation adequate to support the ICD-10 requirements. Predictions show one of the largest problems following the October 1, 2014 implementation date for ICD-10 will be documentation insufficient to support the specificity requirements.
If you think ICD-10 is all about new codes, you are dead wrong. ICD-10 is really about “documentation” ─ we clinicians have learned from day one that, “If it’s not documented, it wasn’t done.” This situation is even truer in the ICD-10 world, where the coder must build the ICD-10 code based on the presenting story of that patient’s visit from admissions to discharge. With all the new code options, you never know what code will be built.
Case in point: The ED physician sees and diagnoses the patient with head and chest contusions and a fractured femur caused by a motor vehicle accident (MVA). The hospital admits the patient. The nurse, who documents the patient history assessment, discovers the patient hit the vehicle in front of her on a busy residential street. The therapist teaching the patient how to crutch walk discovers new information that the patient was driving home after a fight with her in-laws and was texting when the accident occurred. The entire story is now documented fully and ready for coding to add to the claim’s reimbursement.
A “MVA”, “on a residential street,” “texting while driving” and “fighting with in-laws” are all now capable of being coded. Even though 50 percent of the new ICD-10 codes are based on laterality, there are so many new codes that can be used. Documentation matters. Specificity matters.
Real-time documentation is especially important. Care managers will need to know the documentation is present and when the patient status changes from “Observation” to “Inpatient”. They can no longer wait for the end of the shift for clinicians to document. Medical necessity must be present; if not, queries sent to physicians will likely increase. Clinical documentation improvement (CDI) specialists will have to forward clarifications to physicians if information in the clinician’s note does not correspond with what the physician documented. The volume of queries overall is expected to increase substantially. If documentation is not entered in real time, the longer that information remains on the coder’s desk, the longer the time to attain revenue and reimbursement.
Users of electronic medical record systems also need to be able to document laterality as well as perform in-depth documentation for specificity. For example, a coder will need to receive a thorough description of the wound to understand where the insertion of the IV on the body occurred, the reason for the IV order and the medication administered. To be able to describe the location of injury (i.e., is it located left or right side or upper or lower part of the body?), distal or proximal, medial or lateral, and much more will be even more critical for ICD-10 coding.
Physicians working in medical practices or clinics are expected to experience difficulty adjusting to the new ICD-10 code sets. They will be responsible for providing hospitals with information in ICD-10 form to aid their peers. Clinic orders, such as lab and radiology, will need ICD-10 diagnosis so the hospitals can process these orders appropriately. If the coordination of this level of communication doesn’t improve, patient care and treatment can be affected and denials will surely increase.
So are you really ready for ICD-10? Apparently it’s not just a coding project.
Diane Taylor, RN-BC, Delivery Manager, CTG Health Solutions, is a healthcare professional with 30-plus years’ experience with a focus on clinical transformation and change management.
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Transcription, Revenue Cycle Management, AzaleaHealth EHR, and REAL-TIME solutions. 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.
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.
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