MT India Digest - http://groups.yahoo.com/group/MTID

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MT India Digest
Moderated Discussion List
"Effective MT Forum"
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Published by:
MT India www.MTIndia.org

Moderated by:
Amit Chatterjee, SM amit@...

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Aug 31, 2002 Digest #086
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.....IN THIS DIGEST.....

=============NEW===============

-=HIPAA =-

~Pramod Karankar
"impact of HIPAA on our buisnesses"

~Navdeep Gupta
"confidentiality is the area where we Indians are lacking"

-=EMR=-

~Keith Stafford, MD
"why more physicians are not getting into EMR"

===========CONTINUING============

-=Dual employment=-

~Joshua
"employers who are against dual employment prefer an
master-servant relationship with their employees"

===========BILLBOARD==============

-=Danielsoft=-

~Sangeeta Mundhra

=============NEW===============

From: Pramod Karankar <pramodk_2001@...>
Subject: HIPAA

Hi all:

Can you all please share with me the details of the
HIPAA act. I will be greatful if any of you could send
me in detail about the same or where I can have access
to the same.

Best regards,

Pramod Karankar
Comment? mailto:MTID@yahoogroups.com

++++ new post - same topic ++++

From: Navdeep Gupta <jt_imt@...>
Subject: Confidentiality

Hello friends,

I want to discuss MT confidentiality with you all
because this is the area where we Indians are lacking
most. Anyone who can suggest any new methodology to
keep confidentiality is welcome.

Thanks
Navdeep Gupta
Comment? mailto:MTID@yahoogroups.com

[MODERATOR COMMENT]

The following is an effective checklist for HIPAA:
http://www.ahima.org/journal/pb/01.06.1.html

Also see these links:
http://www.mtindia.org/article/default.cfm
http://cms.hhs.gov/hipaa/
http://www.hipaacomply.com/
http://www.hipaadvisory.com/
www.cpri-host.org
http://www.hipaa.org/
http://www.hipaa-iq.com/

We are in the process of putting up an FAQ regarding HIPAA -
questions and suggestions are welcome. AAMT and MTIA have both come
out with guides on this - do network and use the same.

I totally disagree with Navdeep's observation - "confidentiality -
this is the area where we Indians are lacking." Navdeep, I am not
aware which organization you represent and what policies are
followed there, but your observation is not based on hard facts. Do
you have an inkling about prevailing systems in the US? Most Indian
companies have a better security protocol compared to those in the
US for the simple reason that they came into existence at a time
HIPAA was "in the air"! They didn't have legacy systems which
required to be overhauled, and being an offshore service provider
you tend to take greater cognizance of security/confidentiality
requirements if you want to stay in business.

I am not stating that Indian MTSOs are HIPAA compliant today, but
then neither are HMOs in the US. Here is an example:

*** VA Toughens Security After PC Disposal Blunders ***

Federal Computer Week reports the Department of Veterans Affairs
(VA) is tightening its policy on the disposal of old computers
following disclosures that 139 computers containing sensitive
personal information about veterans, including their medical
records, were given away. Although the VA has had security rules
since 1997 on purging sensitive data before disposing of old
computers, the policy was breached by the Indianapolis VA Medical
Center. The facility failed to erase personal information before
giving away the computers to educational institutions, the state of
Indiana or private individuals. A local TV news team's
investigation found patient records on the used computers bought
for $10 each at a thrift store.

Read more: http://www.hipaadvisory.com/news/index.cfm#0826fcw

Contrary to what many reflect on this and other forums, there are a
significant percentage of MTSOs in India who have staked all their
money as well as credibility in this business - and some more! If
Indians were lacking in confidentiality, you wouldn't have seen the
software giants or all the BPOs rushing into India!

Best,

Amit C.
Comment? mailto:MTID@yahoogroups.com

++++ new post - different topic ++++

From: Keith Stafford, MD <drwks@...>
Subject: Why the vast majority of physicians have failed to find
value in EMR.

EMR vendors do not understand how things work in the medical world.
When they start claiming JCAHO and HIPAA are beneficial entities, t

hey clearly have no idea of what they are speaking. I do not think
physicians are opposed to something new. Laparoscopic surgery was
widely adopted quite rapidly. PDAs are being used quite routinely.
We use new drugs probably too easily. There is more to the
problem.

Rather than demanding the government legislate physicians into
buying their product, computer companies need to look at why more
physicians are not getting into EMR and the reasons are not the
ones they think. These are my thoughts on the subject:

1) Cost: This is a major obstacle. Many have accused physicians
who have not purchased EMR's of being cheap and greedy. This view
totally disregards the realities of modern medical practice. All
of us, including those of us with "paperless offices" have seen our
incomes shrink significantly in the last couple years. This trend
is not going to get better anytime soon. Very few physicians,
especially primary care physicians are making the kind of money the
computer people think they are making. It is certainly
understandable why someone whose income is declining under current
circumstances would not want to commit themselves to thousands of
dollars per month of increased spending. All of these Return on
Investment predictions produced by the computer companies are way
off. They all assume one will lay off employees after one
computerizes, but it did not happen in my office and I doubt it
happens in other offices either. The employees just end up doing
something different. Instead of filing charts, they are scanning
documents into the computer. My office manager now spends a
significant amount of her time trouble shooting various computer
problems, instead of doing assorted paper office activities. The
ROI predictions also do not take into account the cost of
continually updating ones computer system. Microsoft changes their
operating system at least every other year. Computers and servers
have to be replaced on average every three to four years. It has
been advocated that one use an ASP to decrease costs, but one still
has to develop a network within the office, which is extremely
expensive. These costs are all in addition to the thousands being
spent on the EMR software itself, which also requires never ending
support costs. Paper charts have a cost associated with them, but
they are fixed and finite. One can hardly make this claim with a
computer network. Even though I am paperless and cannot imagine
going back to paper, I know given my current financial situation I
would be unable to purchase an EMR if I had to do it today. It is
wrong to take the position that cost is not a legitimate
obstruction to physicians going paperless.

As part of the cost issue, the EMR industry has to start allowing
physicians to actually use their software before purchasing it.
The standard sales technique is for the sales person to demonstrate
and then walk out the door, without the physicians ever getting to
"play" with the software. I think the EMR industry is afraid to
allow physicians to do this. It is a legitimate fear of physicians
to spend all of this money and then when the system arrives they
find out it does not do what they thought it could.

2) Technical Difficulties: To read all of the articles one would
think that all there is to becoming paperless is spend a lot of
money, have the computers and software installed and that is it.
After the installation everything runs smoothly with no problems at
all. My experience has been quite different. On an almost daily
and certainly weekly basis we have some computer problem or
another. The complexity of these only increases as we get newer
computers and more software.

These problems are annoyances to us computer geeks (the majority of
physicians who have taken the leap), but to the non-computer geek
these problems will stop the offices in their tracks. Paper charts
may be at times hard to read and sometimes hard to find, but they
are physically accessible. This is not true when computer systems
go down and this happens quite routinely. Until the computer world
can come up with ways to make computers and the networks function
without constant technical snafus the transition to EMR, especially
among small practices, will be very limited. Most practices now
have computerized practice management systems and I believe
physicians experiences with these systems make them very wary of
putting their entire operation on a computer. One can still provide
patient care if the billing system goes down, but it is very hard
to take care of patients when the EMR goes down.

3) Functionality: Each software package has assorted functions
built into it. All of them however, are basically means of
producing a SOAP note. That is something which physicians do each
day with their pen and paper in a much faster time than computers
can generate. One can argue that the computer generated SOAP note
is far more detailed than the note physicians write on their own.
This is certainly true, but most physicians know these details are
all fluff, required to meet coding requirements and to try and keep
the attorneys happy when you are sued. They are not essential to
the quality care of patients. It is hard to spend lots of your own
money on something that is not essential to what you do.

I believe for EMR software to be widely accepted it needs to do
more than produce multi-page progress notes. This functionality
should include the following:

E/M coding. Most systems now have this, but again I have found
them of very limited use. The only way they work is to generate
your note entirely from data items. I think this is a lousy way to
generate a note (I free hand type the HPI) so the E/M coding does
not work for me. It is also a constant reminder to me that our
medical system is totally messed up. When we need a computer
program to tell us how to bill for an office visit there is
something seriously wrong. Do we need computers to take better
care of patients or just to make this crazy system we have created
work? Computers need to help us take better care of patients to be
worth buying.

Drug Interactions are often sited as a benefit of the EMR. I
cannot speak for all software packages, but I have found in my EMR
the allergy and drug interaction function totally worthless. It
lights up for almost every drug I prescribe. Therefore, I ignore
it. If I want to find out about drug interactions I use my
Epocrates. Epocrates is actually quite good, but it is not part of
my EMR. It is also extremely annoying to have a new drug come on
the market, but not be able to document it using the EMR since it
takes several months for it to show up in the EMR database.

Health Maintenance and other protocol driven medical practices has
great potential for computers, but it must be difficult to program
as I know of very few software programs which have this capability.
This should be a standard part of every EMR.

The ability to create knowledge databases need to be a part of
every EMR, but to the best of my knowledge it is not a part of any
EMR. For example, the moment new recommendations for cholesterol
management come out, one should be able to put an easily accessible
memo in the EMR that can then be easily referenced. Even better
would be when the patient's lab result electronically returns with
a cholesterol of 240 that memo along with the patient's other risk
factors are automatically sent to the physician for action. Now
that is how computers can help us take better care of patients, but
we are a long ways from that happening.

Communication functionality also needs to be enhanced. It has to
allow communication among the primary office staff, with the easy
attachment of that communication to the patient's chart. The
patient's entire chart has to be easily printed to printer or fax
or e-mail. It should allow the receipt and routing of faxes, since
the rest of the world is not yet paperless. The EMR needs to be
tightly integrated with the internet. It has to allow e-mail
communication with physicians and patients, again with the ability
to easily capture this communication. If one puts a patient's
e-mail address in the demographic portion of the chart, that
address should then be able to be pulled in Outlook, or some other
e-mail software package, without having to be retyped. Of
course, all of the HIPAA silliness now has to be integrated for
another increase in the cost. Fully functioning word processing
integrated with all of the chart elements should be part of the EMR
as well.

4) Time: Those advocating EMRs claim they are major time savers.
They may save a little time once implemented, but no one talks
about the huge amount of time required to implement them. Time is
something few physicians have in excess. It takes tons of time to
research all of the software packages and various network
requirements. Then once purchased it takes a huge amount of time
to input all of the data required. One has to design templates (the
ones which come with the systems are rarely useable), set up
protocols, enter the data for the hundreds of drugs one uses. This
all takes a huge amount of time and requires ongoing maintenance to
keep it current.

I am sure there are other impediments to EMRs, but these are the
main ones which come to my mind.

Keith Stafford, MD
Flemington, NJ
Comment? mailto:MTID@yahoogroups.com

===========CONTINUING============

From: joshuapeter harry <joshuapeterharry@...>
Subject: Dual employment

Dear Amit,

I recently went through your news letter asking for
Moderators/Editors/Educators, which I wrongly assumed was an work
at home position and in the very next news letter you clarified
that it was not an dual employment and you sound rather apologetic
being misunderstood by all.

From the content of your letter I understand there are many people
who are dead against dual employment. I just cannot understand
what is wrong in dual employment. Even though we work for US
clients I think our mindset is typically Indian. I personally feel
that employers who are against dual employment prefers an
master-servant relationship with their employees, never
acknowledging their employees sincerity, dedication and service but
always wants them to be faithful as a servant. It is true, a
servant cannot serve two masters, but he can be faithful with two
friends.

Best regards,

Joshua (Editor)
Comment? mailto:MTID@yahoogroups.com

===============BILLBOARD==================

From: Sangeeta Mundhra <sangmun@...>
Subject: Seeking information about an MT unit Danielsoft

Hello,

I am seeking info. about the MT company Danielsoft based in
Rourkela, Orissa. They had registered me as an HMT Trainee with
them and were supposed to send me trial work. This company was
supposedly off work for a short duration, but was supposed to have
resumed work from 5th July. Since then, I have sent numerous
e-mails to them, but have not received any reply to date.

I had mailed to you earlier inquiring about the credibility of this
company, when I was told that they were a franchisee of Iridium,
which was a HealthScribe business partner - hence above board. If
possible, could you kindly help me to find out whether the company
has resumed work and is still in operation or not.

Thanking you in anticipation,

Sangeeta
Comment? mailto:MTID@yahoogroups.com
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