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Aug 06, 2005

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Electronic Health Records: Just around the Corner? Or over the
Cliff?

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Dear Friends,

Here are some interesting excerpts, from an article by Drs. Baron,
Fabens, Schiffman, and Wolf in the Annals of Internal Medicine
published by the American College of Physicians. The clearest
savings the authors found, was from the elimination of $45000 in
annual transcription costs :o)

< Policymakers and physician leaders are counting on electronic
health records to improve quality of health care and revitalize
practice (1-4), and a recent report forecasts that widespread use
of electronic health records will save the health care system $77.8
billion annually-5% of total health care expenditures in the United
States (5). It is difficult to get an accurate figure for use of
electronic health records by primary care physicians, but estimates
range from 5% to 13% (6, 7). Seventy-eight percent of physicians in
the United States practice in groups of 8 or fewer; therefore,
understanding and overcoming the obstacles faced by small practices
will be essential to successful use of electronic health records. >

<It is naive to assume that small practices will move to electronic
health records without a variety of supports, one of which is
certainly financing. None of the many beneficiaries of our
investment-patients, insurance companies, our specialist
colleagues, health plans, our liability carrier-have directly
shared in the cost of implementing an electronic health record
system. Enhanced reimbursement models will be needed for wider
adoption. This could be achieved through performance incentives
tied to implementation of such systems in capitated contracts or
through a common procedural terminology code for "data transfer" to
reflect the one-time increased effort and cost of moving data from
paper to electronic format. A recent report estimates incentives of
$12 000 to $24 000 per full-time physician per year would be needed
to make the business case for immediate adoption of electronic
health records, with those incentives transferring to
performance-based incentives over time. .

Although some predict that vendors will shift their focus to the
small practice market, it is difficult to see how vendors will
support implementation of an electronic health record in the small
practice setting while keeping prices affordable. Small practices
need much more training and support from vendors than do large
groups. The support provided by our large national vendor
presupposed the existence of dedicated information technology staff
and an administrative layer that could plan work flow and train
staff. Neither of these infrastructures are present in a small
office, and both are critical to success. In addition, small
practices need structured assistance to develop their capacity to
manage organizational change. Models of shared local training and
support must be developed if small offices are to be successful in
implementation.

Patients want and expect their physician, especially their primary
care physician, to have a comprehensive grasp of what is going on
with them medically and to be able to respond to such questions as,
"How much weight have I lost?" or "What was my cholesterol level
last time?" Clearly, aggregating comprehensive clinical information
at the point of care is a basic function of excellent primary care.
Why is it that every academic health center and hospital acquires
state-of-the-art cardiac imaging tools promptly, but primary care
offices and residency training programs are still using paper
records? Given their experience with other "customer service"
operations, such as retail, banking, or travel, patients assume a
level of information technology infrastructure that most of us in
health care simply do not have. Unsupported by technologies now
taken for granted almost everywhere else, we in health care
regularly fail to meet basic patient expectations.

A major factor that prompted us to adopt an electronic health
record was the hope, now at least partially fulfilled, that it
would improve our ability to meet patient expectations and improve
our job satisfaction. Despite the difficulties and expense of
implementing the electronic health record, none of us would go back
to paper. We find ourselves able to be better physicians: We
communicate more quickly and clearly with patients on the telephone
and by letter, transmit important clinical information (albeit on
paper produced automatically by our system) more efficiently to
specialists, and spend less time paging through charts to find out
what the previous cholesterol values (for example) had been.
Practicing with a computer in hand allows us to access current
health information for ourselves and our patients without having to
leave the room or interrupt the flow of a patient encounter. We
have already caught a glimpse of population health possibilities
when, on the same day as the withdrawal of valdecoxib from the
market, we were able to identify and send letters about the
withdrawal to the 16 patients in our practice who were taking the
drug. We expect soon to produce a list of patients with diabetes so
that we can audit their care and see how well we meet our care
standards. We also plan to use our electronic health record to
provide each of these patients with an individualized report on
services for which they appear to be overdue.

If the United States is to realize the benefits of information
technology in health care, substantial investments will be needed
to shepherd small offices through what is an arduous process. We
believe that many practices will examine the current environment
and defer a decision to adopt an electronic health record, and
given our experience, it would be hard to disagree with them. All
the hoped-for benefits to the overall delivery system and to
patients will only accrue if small offices, which are the access
points to health care for most patients in the United States,
successfully adopt information technology. We believe that new
models are urgently needed to deliver both financial and
administrative support to those who would accept the challenge. >

To read the entire article, go to:
http://www.annals.org/cgi/content/full/143/3/222

Ciao!

Maj (Dr) Amit Chatterjee, SM
Strategist / Founder ~ mailto:amit@...
MT India ~ www.mtindia.org
"The Community of MT Professionals"

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NEWS AND VIEWS :
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1) Acusis Recognized for Excellence in Billing and Pricing
Methodologies

Pittsburgh based Acusis®, a leading provider of medical
transcription services to hospitals, clinics and physician
practices was recognized for outstanding excellence after placing
as a runner-up for the 2005 MTIA Billing Method Principles (BMP)
Beacon Award. The Medical Transcription Industry Alliance (MTIA)
along with other industry affiliates evaluated outsourced medical
transcription service organizations and selected finalists based
upon those that employed the following billing and pricing
principles: verifiability, definability, measurability,
consistency, and integrity.

Leading healthcare associations from the American Association of
Medical Transcription (AAMT), American Healthcare Information
Management Association (AHIMA), Modern Healthcare magazine and
Medical Group Management Association (MGMA) were chosen to assess
semi-finalists from leading medical transcription service
organizations in the industry. Evaluation of 24 applicants resulted
in six selected as semi-finalists based on their ability to
demonstrate clarity in pricing methodologies and billing practices
and support this transparency with actual client experiences.
"Receiving recognition for first place was CyMed, Inc. who was very
closely followed by Acusis. By placing high, our panel of judges
can attest that Acusis maintains a high standard of integrity in
the relationship with their clients," assessed Scott Faulkner, MTIA
Board Member and BMP Beacon Award committee chair.

"We are constantly seeking ways to improve the service we offer to
our customers. We've recently added new billing features, pricing
options as well as participated in an independent audit to verify
to our customers that we maintain the highest integrity when it
comes to customer billing," commented David Iwinski Jr., chief
executive officer of Acusis. In August, 2005, AcuSuite®, Acusis'
web-based software application has been enhanced with a new
feature, AcuBilling, available for use this fall. AcuBilling
provides customers with the means to access billing information
electronically at their convenience.

http://biz.yahoo.com/bw/050804/45903.html?.v=1

2) Losing medical integrity?

Not too long ago, all my local transcriptionist had to do was call
me when she couldn't understand something in my medical dictation.
Now, I no longer know who transcribes reports of my surgical
procedures and physical exams or where they are. I only know that
most hospital transcriptions have been outsourced. At times, the
resulting inaccuracies are incredible or enormously amusing.

Transcription is only one of many medical fields facing
outsourcing, which is rapidly making inroads into American health
care. The stability of medicine is being chipped away to satisfy
America's Wal-Mart belief that cheaper is better.

While the public prefers not to know how fundamental changes in
health-care delivery may be adversely affecting it, real harm to
patients has resulted from outsourcing. Valuable, highly qualified
people have forever been lost to the medical world. My former
medical transcriptionists were used to my accent, and offered
occasional advice on how Americans pronounce certain words. They
were replaced by others who find American speech heavily accented
and sometimes indecipherable.

Looking at this as well as other aspects of our failing system,
it's easy to see that the businessmen we have entrusted our health
care to will do anything they can to shortchange the public, as
long as we let them. The question is: What will it take before we
all say "enough"?

I want my transcriptionist down in my medical records office. I
don't want to talk to a radiologist in Bombay or Nairobi about a
patient in Denver. I want a pathologist I can interact with on a
regular basis. Surely you don't want your surgeon to be located in
Guadalajara?

http://www.denverpost.com/opinion/ci_2911669

3) Are we typists?

More recently, two MTs I know applied for jobs at large hospitals.
Each transcriptionist had about 15 years of acute care experience.
After they filled out the application form, the very next step in
the process was a type-from-copy test, in which a paragraph was
propped up next to the monitor on a document holder. They were
asked to type it, and timed for speed. Neither of the paragraphs
had anything to do with medicine. Neither of the MTs did very well
on the typing test.

Both of these transcriptionists had worked on a production basis
for transcription services. One of these MTs produced 1,600 lines
per 8-hour day on a regular basis, the other came in at about 1,400
lines per day (lpd). But it turns out they weren't really great
"typists."

MTs are not "typists." And asking an MT to take a speed-typing test
is as irrelevant as it would have been to test Shakespeare to see
how fast he could write!

http://health-information.advanceweb.com/common/Editorial/Editorial.aspx?CC=5720\
5

4) STPI-IT Park to be inaugurated at Coimbatore - HealthScribe
books 40,000 sq.ft

Communications Minister Dayanidhi Maran is today scheduled to
inaugurate an IT park at the Kumaraguru College of Technology at
Coimbatore, the first one promoted by Software Technology Parks of
India (STPI) in the campus of an educational institution.

Software major Cognizant Technology Solutions has already taken
about 40,000 sq.ft of space, while medical transcription leader,
Healthscribe India, has booked as much area area in the one lakh
sq.ft IT park, Selvakumar, Joint Correspondent of the college, told
reporters here on Friday.

Cognizant, which also starts its full time operations tomorrow, has
plans to have 400 professionals in the first year of operations,
Selvakumar said, adding that Healthscribe would be employing about
700 persons for its services in medical transcription and clinical
documentation.

STPI has entered into an agreement with the college for
establishing the park in the campus for enabling IT companies to
set-up operations in Coimbatore, emerging as major IT destination.

http://www.hindu.com/thehindu/holnus/006200508060350.htm

5) India Needs More Focus on Medical Transcription

Medical transcription is a booming offshore outsourcing industry.
Last year the IDC reported that US spending on medical
transcription totaled approximately $2.3 billion in 2004, and is
still estimated to reach $4.2 billion in 2008.

Countries like the Philippines and Luxembourg have been enjoying a
great deal of this boom, but as with many industries, medical
transcription may expect to enjoy the largest profit base in India.
But will lack of performance guidelines make this specific industry
India's outsourcing weakness?

It is essential that Indian healthcare outsourcing service
providers should get appropriate instructions from their principal
client as to what specific practices they have to comply with in
order to meet the federal privacy standards stipulated by HIPAA.

Whenever an Indian vendor provides medical transcription service to
an American hospital or clinic, it needs to inherently protect the
confidential patient information and the data it receives for the
purposes of back-office processing.

Last year there was an international report that many Indian
outsourcing outfits actually observe the HIPAA and other related
regulations. But this applies to BPOs and offshore consultancy in
general; when it comes to medical outsourcing, specifically, it
appears stricter vigilance is required.

http://www.offshoring-digest.com/index.php?p=161
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All original content of this newsletter is © Copyright 1998-2005
Mediweb Infotech Pvt. Ltd. All cited articles are copyright of
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Thank you for your interest in MT India!

The MTIndia Team
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