Just meant messages come and even more quickly

Just meant messages come and even more quickly [2008-04-09]
x

Meant to say two-DAY strike! [2007-11-20]
Gotta scare them a little. They only way they will value MTs are when they're not around.

can't find message I left. either [2008-05-20]
If one leaves a comment that is not 'approved' or 'welcome', it gets quickly deleted or one gets a 'warning'! Today I posted two really nice comments and I cannot find them!

Yeah, right!!! [2008-04-08]
Any MT who edits any voice recognition files should be stoned. If they want to take out the human element, leave it out. The whole voice recognition thing will disappear in a heartbeat. One in a thousand doctors might, might be able to pull it off without help from a medical transcriptionist/editor. Actually, I doubt that. I teach medical transcription, and one of first instructions to students is, Never, never, never spell a word or drug as dictated by the MD, and never pay attention to their instructions with regard to punctuation. It isn't a matter of trying to nip voice recognition, it's a matter of not jumping through the hoops or nooses meant to eventually hang us. If they're using VR, just tell them to have a happy life and be on your way. Helping them out is like give terrorists a map and directions. C'mon people. Use the gray matter.

Don't fear VR --- ignore it!! [2008-04-08]
Any MT who edits any voice recognition files should be stoned. If greedy MDswant to take out the human element, let's eave it out. The whole voice recognition thing will disappear in a heartbeat. One in a thousand doctors might, might be able to pull it off without help from a medical Transcriptionist with professional judgment and a working brain.Actually, I doubt that one in a thousand would be able to rely on their own perfection. I teach medical transcription, and one of my first instructions to students is, Never, never, never spell a word or drug as dictated by the MD, and never pay attention to their instructions with regard to punctuation. It isn't a matter of trying to nip voice recognition in the bud, it's a matter of not jumping through the hoops or nooses meant to eventually hang us. If they're using VR, just tell them to have a happy life and be on your way. Helping them out is like give terrorists a map and directions. C'mon people. Use the gray matter.

New MT's [2007-02-23]
I really messed up the last sentence to my follow-up to SM. I meant I loved the challenge and the opportunity to learn something new. Gerri

Neurologist saves $12,000 per year on medical transcription [2006-02-22]
Recognition vs. Transcription W. Palm Beach, FL neurologist saves $12,000 per year on medical transcription using state-of-the-art voice recognition software [ClickPress, Tue Feb 21 2006] Dr. H. Steven Block, M.D. uses Dragon NaturallySpeaking Medical Edition, voice recognition software for medical professionals, to eliminate a very real business problem--medical transcription costs-- which six years ago, began topping the $1,000-a-month mark. Today, a doctor can easily spend three times that amount. Very open about his high regard for the Dragon Medical VR product, Dr. Block had much to say about its place in his solo practice: “I purchased Dragon Medical from Eric Fishman’s company, Nuance, which is actually located in the same building as my practice, on the floor above me. Neurology is all about ‘nuance’, no pun intended. But ‘nuance’ is really the best word to describe the health effects of a neurological problem. It has been a major focus of my practice.” “Very subtle neurological changes can have devastating health consequences. You have to be able to communicate those subtleties in order for a medical record to have any meaning.” “I see some really sick patients. Using an on-the-spot note generation product like Dragon, instead of a transcription service, let’s me get back to the referring physician with a fast note, usually within 10 minutes of seeing the patient. That kind of speed in delivering a medical exam note with ‘nuance’ can mean a great deal to everyone involved. You see, I can’t type. I never learned how to type. My kids who grew up instant-messaging can type faster than I can speak. They don’t need Dragon. But for me, Dragon is a wonderful tool.” Dr. Block, 49, is no stranger to high technology tools: “There are only so many hours in the day,” he laughed, driving down the road, talking via wireless cell phone headset, “and I’m very detail-oriented. I couldn’t be without Dragon, quite frankly.” One word I did not hear from Dr. Block is the word “downtime”. It doesn’t seem to exist in his vocabulary. Having traveled the long and winding upgrade path for both Dragon and laptop hardware, Dr. Block has watched and participated in the evolution of the product for six years. “Like a surfer looking for the perfect wave,” he joked. The improvement he’s seen in the most recent version of Dragon Medical—combined with a high-RAM laptop with at least 512MB—has boosted performance to an almost unbelievable 99.5% real time voice recognition accuracy level, according to his observations. His advice to new users: “If you haven’t tried Dragon Medical in the last four years,” he said, “try it again, the way it is now, with the new speech engine. It uses mathematical models to analyze word groups. There is a learning curve, but the training is not that bad, consisting of you reading a 15 minute script into a microphone, then a little touch-up here and there.” “Try a few charts each day, and sit down where it’s quiet, where you can relax and concentrate on your speaking habits. Tech support is great; they’ll help you, and be sure to read the help file “How to Speak to a Computer”—and the manual. Especially for often repeated phrases, the voice-actuated “macros” are great, a real time-saver. It’s well-worth the time you invest in learning how to use this tool.” What are the pitfalls? “Mumbling,” says Dr. Block, “that’s the main problem. Doctors are used to dictating in a low, monotone mumble, as fast as they can. A person might be able to handle it by going back and listening to the recording again and again. But for voice recognition, doctors need to speak in a normal, conversational tone of voice, just like we are doing right now. Speak normally, and Dragon has no problem, it works very well. It’s really quite simple.” He stated that using a handheld Sony digital voice recorder with removable memory stick allows him to dictate anywhere, anytime, then later, “feed” the sound file to Dragon, achieving about 98% voice recognition accuracy. (Please note: If you are considering making a recording for later voice recognition by Dragon, be sure and use 16-bit resolution .avi format, or Dragon won’t even try to “digest” it. It won’t bother with a recording of poor quality, because the end result would be useless.) Although he is considering it, Dr. Block has not yet adopted a commercial EMR(Electronic Medical Records) software system for his medical records, mainly because of concerns about interoperability standards. (Coming soon to an EMR near you.) However, by using Dragon Medical as his “front-end” for the creation of detailed paper medical records, email reports, and digital-FAX messages, Dr. Block not only uses computers, but has also created a highly personal and expressive way to “chart” a patient, unmatched in detail, depth, and the “human touch” by out-of-the-box EMR software. Would EMR software developers do well to discuss with this doctor any design plans for a voice-controlled, voice-recognition-based EMR program? I think so. Will a “hands-free” EMR workstation which responds to voice commands--as does the entire Dragon program--ever be used to help maintain a “sterile field” in the medical environment of the future? It certainly worked well on the Starship Enterprise, didn’t it?

HERE's more of what he thought 10/05...sm [2006-02-21]
TAMT NEWS Texas Association for Medical Transcription ____________________________________________________________________ A recognized component of AAMT October 2005 SPECIAL MESSAGE FROM PETER PREZIOSI, PhD, CAE I would challenge this group to think of new and expanded roles for transcriptionists in the electronic health environment. Let’s not think of transcription as it is today but as a role that is at the nexus of health information and information technology. Transcriptionists should be reattached from the physician dictator and deployed to the entire electronic health record, ensuring that data captured, documentation, and report generation is accurate, complete, and appropriately placed throughout the record. Emerging roles for the Transcriptionist include database administrator, data abstraction, data coding, etc. Once both the profession and the industry embrace this concept, we must quickly put together the educational infrastructure and partner with the technology vendor community to build the software to support this vision, creating an emerging role in the workplace. This new role in the EHR expands the value of transcription, gets transcription away from production and being considered a commodity, and makes us true team players in quality patient documentation. Think of the individuals we could attract to the profession if this were the scope of practice! This is a long-term vision that requires us to begin now to reposition both the profession and the industry. Let’s not wait for the crisis to worsen. Peter Preziosi, PhD, CAE Executive Director American Association for Medical Transcription 100 Sycamore Avenue Modesto, CA 95354 (209) 341-2445 (209) 527-9632 fax peter@aamt.org www.aamt.org/ca/texas/newsletter.doc

The Top 10 Reasons to Become a Medical Transcriptionist [2006-01-19]
January 17th 2006Work From Home You've seen the commercials: medical transcriptionists are in high demand. Should you consider this field? Below are the top ten best reasons to become a medical transcriptionist. If these characteristics are something you're looking for in a job, then medical transcription may be for you. To get started, try “Working at Home the American Way in Medical Transcription” by Debra Jan Hebert, an experienced (http://medtrans4u.com) medical transcriptionist. 10. Quick entryMany lucrative professions require extensive training and advanced degrees. Other jobs in the medical field can take eight or more years of grueling, expensive schooling to begin. In medical transcription, you can begin your work in a year or less, avoiding huge debts and student loans. Some employers require no training, especially not if you already have good English skills and some experience in a medical field. 9. Contribute to societyAs a medical transcriptionist, you can contribute to society in many ways. In addition to the economic contributions you'll make to the overall economy, experienced medical transcriptionists become well-versed enough to catch errors or even act as patient advocates. Medical transcriptionists can see inconsistencies and correct them as well. By quickly returning transcripts to hospitals, private practices and individual doctors, medical transcriptionists can ensure fast patient care in the medical system. 8. Work from homeWhile the Bureau of Labor Statistics reports that 70% of medical transcriptionists still work in hospitals or physicians' offices, medical transcription is becoming increasingly popular as a work-from-home profession. The convenience of a home office appeals to some people on its own virtues, while parents may value the opportunity to stay close to their young children and still support the family full time. No matter what the reason, if you're looking to work from home, you should seriously consider medical transcription. 7. Excellent payWhile compensation methods may vary, almost all medical transcriptionists enjoy excellent pay, even in entry-level positions. According to (http://medtrans4u.com) DJS Enterprises, you can earn as much as $50,000 to $80,000 a year as a medical transcriptionist. If your pay is production-based, as you gain more experience and dexterity in medical transcription your salary will steadily increase. If you're looking for a job that can really support your family working from home, medical transcription may be for you. 6. Job securityThe US Bureau of Labor Statistics reports that the job outlook for medical transcriptionists is definitely positive. The medical transcription field is expected to grow at a faster than average rate through the year 2014. This indicates that medical transcriptionists will have plenty of opportunities to find steady work, even if they work at home on a freelance basis for at least another 8 years. 5. Job satisfactionWhile job satisfaction may vary from job to job and person to person, if you enjoy being able to visibly track the progress you've made in a day, medical transcription can bring you a high level of job satisfaction. As your completed medical reports pile up, you'll be able to see how much you've accomplished. 4. Set your own hoursMost of the medical industry operates 24 hours a day. Many hospital and at-home medical transcriptionists are able to set their own hours at any time to accommodate their families or other commitments. No matter when you're able to work, there's a medical record waiting to be transcribed. In medical transcription, you can work when it's most convenient for you. 3. Comfortable work environmentWhether they work in a hospital, a private office or from home, medical transcriptionists enjoy a comfortable work environment. Noise levels are low, safety risks are minimal and strenuous labor is negligible. In medical transcription, you'll enjoy a comfortable office and dedicated work station to transcribe. And what could be more comfortable than working in your own home? 2. Transferable skillsMedical transcriptionists acquire many transferable skills that they can use in other jobs if ever they want to leave the industry. In addition to a basis in the medical field, transcriptionists learn skills that could apply as a court reporter or an administrative assistant. Transcriptionists also develop their English skills, which can be useful in all types of positions that involve writing and editing. Whether medical transcription is a step on your path or your dream job, the skills you learn can improve your overall career outlook. 1. Rewarding workWhy do people become doctors? The vast majority of the people who endure 8 or more years of schooling and incur substantial debts and student loans to become doctors do so because they love to help people and to cure them of their illnesses. Every member of the medical field helps in this endeavor. What could be more rewarding than to contribute to the speedy treatment of people who desperately need your help? If these ten things sound like characteristics you're looking for in a job, look into medical transcription. You can learn more about medical transcription from books, the Bureau of Labor Statistics and other materials online.

MedQuist Shortens Radiology Report [2005-11-23]
MedQuist Shortens Radiology Report Turnaround TimeTuesday November 22, 2:01 pm ET MOUNT LAUREL, N.J., Nov. 22 /PRNewswire-FirstCall/ -- Northeast Regional Medical Center, located in Kirksville, Missouri, recently purchased and completed their implementation of MedQuist's (Pink Sheets: MEDQ - News) SpeechQ for Radiology(TM) system. Licensed for 109 beds, the staff at Northeast Regional takes great pride in providing the highest quality care for the residents of northeastern Missouri, right in their own backyard. Ron Leazer, the hospital's chief financial officer, is always looking for new processes and technology that allow the hospital to better meet the needs of its patients, medical staff and caregivers. Northeast Regional's radiologists now use SpeechQ for Radiology's front-end speech recognition capability to dictate, edit and authenticate (electronically sign) a report in one session. Flexible workflow choices also allow review and correction by medical editors. Editing the recognized text automatically updates each physician's speech recognition profile, improving speech recognition accuracy. Our radiologists can now dictate a case, immediately review it and then electronically sign the report in a single step which significantly reduces our radiology reporting turnaround time, says Leazer. Our referring physicians and the hospital caregivers now receive a finalized report within minutes after the exam has been reviewed and interpreted by the radiologist, instead of the hours -- or even a day later -- that was the case before SpeechQ for Radiology. And we have been able to redirect our transcriptionists to other departments, to provide better service to other staff members. Northeast Regional Medical Center radiologist, P.M. Williams, D.O. states, The system was very easy to learn and use. After only 30 minutes of training, which included the voice enrollment process, I was comfortably using the system. In addition, the referring physicians are pleased with how quickly they receive my final reports with SpeechQ for Radiology as I have all my reports complete when I leave the hospital at the end of the day.

TRANSCEND: appointment of Lance Cornell as Chief Financial Officer [2005-11-02]
TRANSCEND SERVICES, INC. today announced the appointment of Lance Cornell as Chief Financial Officer. Mr. Cornell replaces Mr. Mark D. Meersman, who has decided to return to the position of partner-in-charge of inProcess Consulting, a management consulting firm that he left six months ago to join Transcend. Mr. Cornell is a Certified Public Accountant with over 18 years of experience in accounting, finance and financial management, including controller and chief financial officer positions with publicly traded companies. Prior to joining Transcend, Mr. Cornell was Chief Financial Officer for nearly five years at Facility Resources, Inc., a private consulting firm specializing in facility-related project management, systems implementation and outsourcing for large corporations. Prior to that experience, Mr. Cornell served in chief financial officer and controller positions in two separate publicly traded companies in the healthcare information systems industry. Mr. Cornell received a B.S. degree in Finance with highest honors from the University of Colorado. Larry Gerdes, the Company's President and Chief Executive Officer, commented on the announcement: We welcome Lance's financial executive experience to our executive management team and thank Mark for his many and varied contributions to our Company. Mark has assisted the company in the automation and analysis of financial data that will prove helpful as we focus on improving our overall profitability. Lance not only understands the challenges facing the Company, but also sees the opportunities for the Company to grow and prosper in the $6 billion market for medical transcription services in the United States. We are particularly excited about his experience in planning and financing growth strategies, including acquisitions. Mr. Cornell commented: I am excited about the potential effects that the Company's BeyondTXT speech recognition functionality and its strategic acquisition initiative should have upon the Company's financial performance. I look forward to helping the Company achieve its growth and profitability objectives. About Transcend Services, Inc. Transcend believes that accurate, reliable and timely transcription creates the foundation for the patient medical record. To this end, the Company has created Internet-based, speech recognition-enabled voice-to-text systems that allow its skilled medical language specialists to securely and quickly produce the highest quality medical documents. The Company's wide range of transcription services encompass everything needed to securely receive, transcribe, edit, format and distribute electronic copies of physician-dictated medical documents, from overflow projects to complete transcription outsourcing. For more information, visit http://www.transcendservices.com.

HL7 Launches eHealth Effort for Katrina Relief [2005-09-30]
The Health Level Seven, Inc. (HL7) community is supporting the development of portable, interoperable electronic health records for the hundreds of thousands of people whose lives have been disrupted by Katrina. Many HL7 members are already involved, improving access to vital healthcare information and HL7 has formed a task force to support and guide further efforts. Last week, HL7 issued a call to members to participate and is forging relationships with other industry groups to solve the immediate and long-term problems of disaster relief and preparedness. The HL7 community represents the most concentrated group of interoperability expertise anywhere. We are rising to the challenge of rebuilding the medical records of the displaced population and doing so in a way that can become a model for the future of the country, says Mark Shafarman, HL7 Chair. We stand ready to work with anyone and everyone implementing standards-based applications. Our Reference Information Model for healthcare, our community of experts and our standards and specifications for interoperability can guide this process. The Healthcare Information and Management Systems Society (HIMSS) Electronic Health Record Vendors' Association (EHRVA) is already working with the Office of the National Coordinator for Health Information Technology (ONCHIT) towards constructing and integrating an electronic health record (EHR) infrastructure within the areas of the gulf coast affected by Hurricane Katrina. HL7 Standards Making a Difference HL7 standards are already making an impact on the ground in the wake of Katrina providing access to records of childhood immunization records. The American Immunization Registry Association (AIRA) (www.immregistries.org) -- an HL7 member organization -- reports that nine registries are now using HL7 messages to query the Louisiana Immunization Network for Kids Statewide (LINKS), resulting in retrieval of 4,250 records as of Tuesday, September 27. Immunization registries querying LINKS are: Arizona, Houston, Idaho, Indiana, Maryland, Ohio, Washington, West Virginia, and Wyoming. The importance of HL7 standards was never more evident than during Katrina, said Julie A. Boom, M.D., Medical Director, Houston-Harris County Immunization Registry and Director of the Immunization Project at Texas Children's Hospital, and AIRA member. Literally overnight, the Houston-Harris County Immunization Registry was able to be connected to the 'LINKS' Louisiana statewide immunization registry with the assistance of Scientific Technology Corporation. Because each registry was fully HL7 compliant, this link was able to be made quickly and easily. Retrieving these records from LINKS has saved the public health community thousands of dollars for the cost of re- immunizing these children and it saves the children of Louisiana from the discomfort of additional immunizations. This experience truly highlights the importance of following national standards and should encourage other immunization registries to fully support HL7 standards as soon as possible. More solutions are in the works: * Oracle Corporation, an HL7 benefactor, had been working in close cooperation with the Louisiana Department of Health and Hospital to create a regional solution for health information sharing before the hurricane struck and is now accelerating those efforts. * HL7 member organization OZ Systems, which provides information technology for the State of Texas' Early Hearing Detection and Intervention Program (TEHDI), is exploring ways to use HL7 messaging standards to transfer hearing screening results data for Louisiana newborn evacuees who had to have their screenings done in Texas. This data needs to be sent back to respective birthing facilities in Louisiana or the Louisiana Department of Health as needed for CDC reports, or to assure that an infant receives care if necessary. * Intel Corporation is coordinating the donation of 1,500 laptop personal computers to the American Red Cross for distribution to shelters in support of Katrina disaster relief efforts. In addition, Intel will donate 150 wireless Internet access points. * Additional support for the Gulf region has been pledged by HL7 members including the Los Angeles County Department of Health Services, Information Systems Branch; Medquist Corporation; Microsoft Corporation and TeleVital. HL7 and its more than 2,220 individual and corporate U.S. members have information technology expertise in all segments of the healthcare industry, and real-world experience in developing an infrastructure that is standards based and allows interoperable records to be distributed over multiple sites using multiple local applications. In addition, HL7's more than 500 corporate members include not only EHR vendors, but infrastructure and integration vendors together with suppliers of standards-compliant dictation and transcription. HL7 Response and Recovery Taskforce The HL7 Response and Recovery Taskforce has been meeting daily, speaking with government officials, technologists and planners. The Task Force will coordinate education and outreach to the HL7 community including vendors and providers, HL7 International Affiliates as well as other standards development organizations, and U.S. national bodies such as the Office of the National Coordinator for Health Information Technology (ONCHIT), the Department of Defense (DoD), the Veterans Health Administration (VHA), and the Centers for Disease Control and Prevention (CDC). The Taskforce will design, coordinate and organize implementation projects focusing on the creation of a healthcare information infrastructure to help address the personal and public health information crisis created by Katrina. HL7 members wishing to be involved in this effort should respond via katrina@HL7.org and sign onto the Katrina support listserv available on the HL7 web site (www.HL7.org). Participation by EHRVA In the aftermath of Katrina, the EHRVA has been actively engaged with the Office of the National Coordinator for Health Information Technology (ONCHIT) and other healthcare stakeholders to support the potentially nomadic evacuee population in the goal of making medical record information available wherever they receive care. * The EHRVA is on task of suggesting immediate means to meet emergency patient information needs and laying the groundwork for rebuilding a patient information management infrastructure. During this process, the EHRVA is dedicating workgroup and executive committee time to plan a practical framework. * EHRVA contribution to Katrina Relief leverages the organization's partnership with IHE and an ongoing commitment to devise viable interoperability models. * EHRVA is in dialogue with ONCHIT and channeling updates and requests to members to support roll-out of response plans now and in the near future. EHRVA has joined with HL7 in this call to members to participate and pool resources for interoperable electronic health records. The two organizations are ideal partners in this effort, since two of their core goals are based on making progress in the areas of standards and interoperability. EHRVA is comprised of 35 member companies that serve the vast majority of healthcare providers in the nation with Healthcare Information Technology (HIT) solutions, which complements and overlaps with HL7's membership. Since Hurricane Katrina we've been humbled by the dedication of our clients in hospitals and physician practices as they have brought EHR technology into the heart of the crisis. We are taking our cues from providers who are working from the conviction that a stronger HIT foundation will better prepare us for any eventuality such as these recent storms, said Charlene Underwood, EHRVA chairperson and Director, Government and Industry Relations for Siemens Medical Solutions. Collaborative Efforts toward a Regional Recovery The HL7 community has the largest single pool of expertise on healthcare information systems and how to connect them for effective collection and delivery of healthcare information. Its members are active in efforts with state and local and national agencies, including the Department of Health and Human Services and the Centers for Disease Control and Prevention. In addition to EHRVA, HL7 is offering to collaborate with all organizations providing solutions for the affected area. About EHRVA HIMSS EHRVA (http://www.himssehrva.org) is a trade association of Electronic Health Record (EHR) vendors who have joined together to lead the HIT industry in the accelerated adoption of electronic health records in hospital and ambulatory care settings in the US. The association provides a forum for the EHR vendor community to speak with a unified voice relative to standards development, the EHR certification process, interoperability, performance and quality measures, and other EHR issues as they become subject to increasing government, insurance and provider driven initiatives and requests. Membership is open to HIMSS corporate members with legally formed companies designing, developing and marketing their own commercially available EHRs with installations in the USA. The association, comprised of 35 member companies, is a partner of the Healthcare Information and Management Systems Society (HIMSS) and operates as an organizational unit within HIMSS. About HL7 Founded in 1987, Health Level Seven, Inc. (http://www.HL7.org/) is a not- for-profit, ANSI-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery, and evaluation of health services. HL7's more than 2,000 members represent approximately 500 corporate members, including 90 percent of the largest information systems vendors serving healthcare. HL7's endeavors are sponsored, in part, by the support of its benefactors: Accenture; Centers for Disease Control and Prevention (CDC); Duke Clinical Research Institute (DCRI); Eclipsys Corporation; Eli Lilly Company; the Food and Drug Administration; GE Healthcare Information Technologies; Guidant Corporation; IBM; IDX Systems Corporation; Intel Corporation, Digital Health; InterSystems Corporation; Kaiser Permanente; McKesson Provider Technologies; Microsoft Corporation; Misys Healthcare Systems; NHS Connecting for Health; NICTIZ National ICT Institute for Healthcare in The Netherlands; Oracle Corporation; Partners HealthCare System, Inc.; Pfizer, Inc.; Philips Medical Systems; Quest Diagnostics Inc.; Science Applications International Corporation; Siemens Medical Solutions Health Services; Solucient, LLC; the U.S. Department of Defense; Military Health System; the U.S. Department of Veterans Affairs; and Wyeth Pharmaceuticals.

Dr. Pius Kamau [2005-09-26]
I posted above and stated I was a tranacriptionist, wow! I sure know how to make an impression haha! I meant I am a transcriptionist. (It was late) Thanks!

Dictaphone Expands ichart Speech-Certified [2005-09-09]
Dictaphone Expands ichart Speech-Certified Transcription Network; Responds to Increasing Demand with Certification Program and Call for Additional Transcription Partners American Association for Medical Transcription (AAMT) Annual Convention and ExpoHONOLULU--(BUSINESS WIRE)--Sept. 6, 2005--Today at the American Association for Medical Transcription (AAMT) Annual Convention and Expo, Dictaphone announced the creation of the healthcare industry's first Speech-Certified Transcription Network in response to the substantial growing demand for its ichart(R) Managed Services solutions. ichart Managed Services combines Dictaphone's industry-leading speech recognition technology with transcription services performed by Dictaphone's Speech-Certified Transcription Network, which has been trained to edit on the company's speech recognition platform. This combination of labor and technology delivers lower-cost, high-quality medical transcription with rapid turnaround. All Dictaphone transcription service partners are required to pass its rigorous certification program to ensure even higher levels of service excellence and proficiency in speech recognition editing. ichart Managed Services is quickly proving what we suspected when we introduced the product less then one year ago: that using speech recognition to drive down the enormous costs and improve the quality of transcription is the future of medical documentation outsourcing, said Don Fallati, senior vice president of marketing for Dictaphone. The overwhelming response we've had from the market is driving us to create the first Speech-Certified Transcription Network, offering our clients the most talented and best-equipped group of 'speech recognition-enabled' transcription service providers. Speech-Certified Transcription Providers are thoroughly trained, evaluated and benchmarked against specific industry-standard quality, speed and customer service metrics. Those that meet the strict criteria will receive certification and will be reevaluated quarterly to ensure continued adherence. Tamara Brown, president and CEO of Encompass Medical Transcription, Inc., a member of Dictaphone's Speech-Certified Transcription Network, said, ichart has allowed us to increase the volume of work Encompass can do with our existing staff and enabled us to train new medical transcriptionists to generate high-quality reports at a higher level of productivity. Headquartered in Wisconsin, Encompass is a U.S. medical transcription company that employs only U.S.-based medical transcriptionists. We welcome and encourage other medical transcription companies to join the Speech-Certified Transcription Network, Fallati said. The interest we've seen from potential partners wanting to participate in the program has been significant and reflects the broad momentum in our industry for acquiring the skills associated with speech recognition. About Dictaphone's ichart Managed Services Dictaphone's ichart Managed Services offering aims to meet the needs of organizations currently relying heavily on outsourced transcription but who are attracted to the savings that can be generated by speech recognition. The program blends Dictaphone technology with transcription services performed by Dictaphone's Speech Certified Transcription Network who have been trained to edit on the company's speech recognition platform. Customers receive a blended line rate covering work that is transcribed traditionally as well as documents edited from speech recognition. Frequently, significant savings can be achieved by healthcare organizations over current line charges. About Dictaphone Healthcare Solutions Group Dictaphone is the world's largest supplier of dictation, transcription and speech recognition systems and services that simplify and enhance the production and management of paperless electronic patient information. Through the integration of speech recognition and natural language processing within existing health information management workflow, Dictaphone systems are helping healthcare organizations save money and improve patient care by increasing the speed, accuracy and usability of their medical documentation. For more information, please visit www.dictaphone.com or call 1-888-350-4836.

ZyDoc Extends Clinical Data Center For Pharmaceutical Research [2005-08-10]
ZyDoc, an award-winning technology leader in e-Transcription and Automated Medical Documentation Solutions, announced that it will be offering a customizable suite of clinical data solutions, MedDocTM designed to fulfill the needs of the pharmaceutical industry. The solutions will be used for clinical and marketing research, FDA studies, and post-approval drug monitoring. Currently, these systems are used by physicians for transcription and extended value of EMR (electronic medical records) and PAC systems by allowing the doctors to expedite data capture into the systems with dictation. Hauppauge, New York (PRWEB) August 10, 2005 -- ZyDoc, an award-winning technology leader in e-Transcription and Automated Medical Documentation Solutions, announced that it will be offering a customizable suite of clinical data solutions, MedDocTM designed to fulfill the needs of the pharmaceutical industry. The solutions will be used for clinical and marketing research, FDA studies, and post-approval drug monitoring. Currently, these systems are used by physicians for transcription and extended value of EMR (electronic medical records) and PAC systems by allowing the doctors to expedite data capture into the systems with dictation.James Maisel, M.D., Chairman of ZyDoc explains, ZyDoc is delighted to offer our distinctive technology to the pharmaceutical industry. The companies innovative solutions allow a pharmaceutical company to effortlessly initiate an FDA study with web-based training with documentation, distribution of protocols, consents, and updates to an unlimited numbers of physicians from a centralized point. This remarkable solution is also well suited for physicians and eliminates their travel requirements for education and training. ZyDoc serves as the third-party administrator for the clinical studies, handling HIPAA requirements, and Business Associates Agreements with physicians and patients.ZyDoc has over 10 years of experience in working with physicians who want to document their medical encounters quickly and efficiently. ZyDoc offers low risk, high productivity solutions focused on dictation for data capture involving no change in work habits, infrastructure cost, outlays or extensive training. The company converts the dictations into web-based forms and enters the information into a relational database allowing searches on any data combinations. This provides an effective means for post approval monitoring of drug use and complications. The web-based TrackDoc system offers substantial advantages to physicians and investigator over traditional alternatives and can be implemented in days. These solutions are suitable for 100% of physicians and require no IT experience or internal support. ZyDoc solutions seem like a transcription service on the front end to the physicians and have all the advantages of traditional formal clinical investigational studies. All data is easily shared with other providers or investigators and will ultimately result in larger studies, implemented faster with lower costs.According to Steve Koski, CEO and president of ZyDoc, The ZyDoc technology platform offers a number of advantages to pharmaceutical companies over traditional FDA studies in terms of the ease of implementation, operations, total costs, quality, speed of care, and disaster recovery. The solutions require no software or IT personnel, and are compatible with all PCs and operating systems with Internet browser capability. There is no training involved or complicated software to customize or learn. Doctors can start dictating data immediately after enrollment using 800 toll free dialup or digital handheld recorder. Documents are always available on the Internet with HIPAA secure connections, and can be reviewed and signed remotely. The documents can also be automatically downloaded and printed to a PC, electronically signed, faxed, or shared with authorized caregivers over the Internet. Data can also be stripped of PHI (personal health information) and caregivers for HIPAA and ethical requirements. The ZyDoc carrier class data center has proven reliable without failure over the past year and was operational even during the Northeast blackout of 2003.AvailabilityZyDoc is offering MedDoc immediately to pharmaceutical companies. Current ZyDoc transcription clients are interested in enrolling in clinical investigations in all specialties. Investigators can contact the ZyDoc data center at 631-273-6125. Doctors can start data collection immediately with the TelDoc 800 service or use low-cost digital handheld recorders. ZyDoc provides multimedia demonstrations, training, and support via the Internet at http://ZyDoc.webex.com. For more information on ZyDoc Clinical Data Solutions, visit www.ZyDoc.com. About ZyDoc.com Corporation.ZyDoc is a transcription service and software development company providing e-Transcription, automated electronic health record (EHR), documentation, and infrastructure ASP legacy-replacement solutions. Physicians, transcriptionists, and other healthcare professionals use these services to produce, organize, and distribute multi-specialty patient electronic medical records (EMR) sees in Community Health Information Networks (CHIN). ZyDoc solves the PC literacy, data entry bottleneck, implementation, and cost issues that plague other clinical documentation and transcription companies. The company uses transparent embedded technology that leverages front and back-end speech recognition, workflow enhancements, and the Internet. ZyDoc is a development partner with SUNY Computer Sciences at Stony Brook, Microsoft Solutions Partner, ScanSoft Platinum Dealer, and an IBM Speech Premier Business Partner. In 2004, ZyDoc was ranked third nationally in medical transcription by The Medical Records Institute. ZyDoc has won other awards and was named The Healthcare Tablet Application of 2003.Press contacts:James M. Maisel, M.D.Chairman, ZyDoc.com1455 Veterans Memorial HighwayHauppauge, NY 11749www.ZyDoc.comjmaisel@zydoc.com 631-273-1963SOURCE: ZyDoc

Telecommuting grows in health care industry [2005-08-06]
August 5, 2005When Rebecca Bryant, a coding specialist for Scottsdale Healthcare, was scheduled for knee replacement surgery last December she asked her employer if she could telecommute during her recovery. She figured it would be temporary until she had regained her ability to walk. But working from her Chandler home inputting codes used for billing, research and other purposes proved so successful that she and her employer decided to make it permanent. It is so convenient. I’m saving gas, I’m helping prevent pollution, I’m really doing my thing and getting to enjoy my home, she said. The company, which operates two hospitals in Scottsdale, has been so happy with the experiment they have expanded it to let five of their coders work from home, and they plan to have 14 coders on line from home full time by September, according to Jan Elezian, coding manager for the health care company. It is hard to find good coders in the Valley, she said. We looked at retention (of employees) as a really big factor in our decision. In addition to making employees happier, it also has improved their productivity by up to 20 percent, Elezian said. They don’t have the office distractions. The expansion of teleworking to include coders comes in addition to about 40 Scottsdale Healthcare transcriptionists, who have typed doctors’ verbal dictation and instructions for patients for many years from their homes. Health care companies are among a group of businesses that are finding good uses for telecommuting — having employees work from home instead of driving to the office. The concept, also known as telework, can work in industries such as health care, finance and others where some employees spend much of their time inputting data into computers. One of the business advantages is that it reduces costs by cutting back the amount of office space needed for the staff. According to a study sponsored by Valley Metro, the transit company that promotes alternatives to the onedriver-per-car transportation, the percentage of Valley employers with more than 50 employees that offer telecommuting as an option increased from 20 percent in 2001 to 28 percent last year. Part of the reason for the increase is the development of virtual private networks, which are allowing remote computer users to gain secure access to the central computer system. Cox Communications is providing a managed virtual private network to Scottsdale Healthcare in which Cox manages the router through which Scottsdale Healthcare’s data traffic is channeled as well as technical and support services, eliminating the need for the health care provider to operate the system with its own personnel. Many companies have virtual private networks, but more companies are migrating to managed VPN, said Darryl Drenon, Cox Arizona director of business services. We become your IT department. In addition to facilitating work from home, VPNs allow employees to directly access the office computer from hotels on the road or from branch offices, he said. Another health care company that uses telecommuting is the Mayo Clinic, which allows 118 medical transcriptionists and two quality assurance officers to work from their homes full time. Several other quality and management staffers work from home part time. The program started about a decade ago when seven transcriptionists were allowed to telecommute only two days a week, said Nancy Buss, manager of the medical transcription department. As our staff grew, we realized that in order to recruit and retain transcriptionists, we would have to offer telecommuting as an option, she said. Many companies that offer transcription services offer telecommuting from anywhere in the United States, and the Mayo Clinic had to at least offer telecommuting locally to keep staff, she said. She said the clinic is considering expansion of the program to allow employees to telecommute from further afield such as from second homes in northern Arizona. The only major disadvantage is the work-at-home employees don’t get the social connections that come with working with others in an office, she said. But they usually get over that quickly. Transcriptionists are independent workers, she said. They like their own space and control over their work environment. Telecommuting doesn’t work for all job categories such as people who deal directly with customers. Bank One has found that it works best for those who are involved in analysis, telephone and computer work, said spokeswoman Mary Jane Rogers. It depends on the job and how to best serve the customers, she said. Thousands of our employees have direct contact with customers. Mesa also has found teleworking is better for some jobs than for other, said Kevin Wallace, transportation planning administrator, who oversees the city’s telework program. For some folks it worked, and for others it didn’t, he said. For some people we thought it would work, but they had meetings and other things that required them to physically be here. He added the monitoring of employee work is important to make sure the work is getting done from home.

Electronic Health Records: Just around the Corner? Or over the Cliff? [2005-08-02]
We recently implemented a full-featured electronic health record in our independent, 4-internist, community-based practice of general internal medicine. We encountered various challenges, some unexpected, in moving from paper to computer. This article describes the effects that use of electronic health records has had on our finances, work flow, and office environment. Its financial impact is not clearly positive; work flows were substantially disrupted; and the quality of the office environment initially deteriorated greatly for staff, physicians, and patients. That said, none of us would go back to paper health records, and all of us find that the technology helps us to better meet patient expectations, expedites many tedious work processes (such as prescription writing and creation of chart notes), and creates new ways in which we can improve the health of our patients. Five broad issues must be addressed to promote successful implementation of electronic health records in a small office: financing; interoperability, standardization, and connectivity of clinical information systems; help with redesign of work flow; technical support and training; and help with change management. We hope that sharing our experience can better prepare others who plan to implement electronic health records and inform policymakers on the strategies needed for success in the small practice environment. Policymakers and physician leaders are counting on electronic health records to improve quality of health care and revitalize practice , 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. 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%. 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. Although the experience of small physician practices that implemented electronic health records has been usefully described, more work is needed. Our independent, community-based, 4-internist primary care medical practice went live with an electronic health record system on 14 July 2004. We report on our experience. Our medical practice, Greenhouse Internists, has operated in Philadelphia since 1989. We serve an economically and ethnically diverse urban and suburban population. We derive approximately 60% of our revenue from capitated managed care and participate in Medicaid (through 2 Medicaid health maintenance organizations) and Medicare (fee-for-service and capitated managed care). We handle more than 16 000 patients encounters yearly, and our focus is comprehensive ambulatory care. We have 1 registered nurse who handles clinical and administrative contact with insurers, forms, telephone triage, and routine prescription refills; a front desk staff that handles reception, referrals, and telephone calls; and medical assistants who handle chief symptoms, vital signs, phlebotomy, and electrocardiography. We have no mid-level practitioners. Before we instituted electronic health records, we used computers for scheduling and billing only. When our malpractice carrier stopped offering occurrence coverage and we had to accept claims made coverage, we used the 2-year savings window to invest in an electronic health records system. Our motivation was complex: We hoped it would automate frustrating repetitive processes (such as prescription refills) and minimize some of the ways in which we routinely failed to meet patient expectations (such as one of us not knowing what another had said the previous day to a patient on the telephone). We hoped that the system might pay for itself, but we were not at all confident that it would. We made a leap of faith that pay for performance was coming and that this investment would eventually position us for greater success. Like many of our colleagues, we believed that we would have to implement an electronic health record system sooner or later, and the one-time cash surplus made it possible for us to do so sooner. One of us had experience in managed care and population health and was hoping to use those insights at the practice level. We chose our system on the basis of recommendations of colleagues and because it was offered by a large national company. We hoped that the latter attribute would make it more likely that we could count on long-term support. We did not interview multiple vendors because we believed that all full-featured products would have unanticipated advantages and disadvantages. To support our electronic health records system, we needed to change the practice management system that was in place for scheduling and billing. To minimize the impact on physician–patient interaction, we opted for an encrypted wireless network with Tablet personal computers (Hewlett Packard, Palo Alto, California), which we purchased from a different vendor. None of the physicians was especially computer-literate. The total quoted cost of our system, including hardware, software, training, and 1 year of support, was approximately $140 000, which is within the range that other investigators have reported on a cost-per-physician basis. Staff and Physician Training Training meant different things to different team members. None of the physicians had previously used a Tablet PC with a Windows XP operating system (Microsoft Corp., Redmond, Washington), and we needed training on the device as well as on the new system. Some staff members had never used a mouse (our previous practice management system was not Windows-based). The medical assistants, who had previously made notes by hand, were now asked to use wireless-equipped laptops with mouse pads or track-ball pointers. For the system itself, 2 types of training were given. Super users were taught how to set up and administer the record (and therefore were enabled to make some structural changes to the system). Regular users were trained in basic system operation but were not given administrative training and privileges to make changes to the system. Super users were charged with customizing the system for our particular practice environment and developing work flows, which were clearly defined and documented steps to guide everyone on how to use the new system to accomplish the work of the office. After 2 rounds of planning meetings and 2 days of on-site training, we went live, meaning that we committed to using our electronic health record to document clinical care from that time forward. Training requires organizational redundancy or reserve; in a busy physician practice, neither is present. Our business manager incurred an injury that kept her out of work for 1 month before we went live; during that month, much of our focus became covering her core functions (payroll, billing, scheduling, and staff management) rather than training. For the first 3 days of live operation, we reduced our appointment schedule by 50%; thereafter, we attempted to maintain our schedule at two thirds for 2 weeks, but ongoing demand for appointments made this impossible. Hardware and Performance We had put in place a complex computer network that none of us knew how to support, maintain, or operate. Shortly after we implemented the practice management system, we experienced a virus attack that crashed our system. After the virus was removed, we experienced several lengthy losses of both telephone and data service. Identifying the cause of each of these system failures was a diagnostic problem well beyond our skills, with several possible corporate culprits. Before we went live, we had had a limited, inexpensive relationship with a small local computer support company; because we were paying annual support fees to both hardware and software vendors, we thought we would not need these local services after implementation. We were wrong. In fact, our relationship with the local company expanded rapidly in time, importance, and cost after implementation. Because we now rely on our system for core clinical functions (prescriptions, telephone calls, and accessing records), small technical malfunctions create major operational problems. Our expanded relationship with the local computer company now costs an unbudgeted $2000 per month, and the response time of our technical support is often inadequate. Redesign of Office Work Flow A well-run primary care office is a complex interdependent operation with well-defined work flows. General principles that guide the design of work flows in our office include simplicity and accessibility for patients, safety, comprehensive documentation, and delegation. We operate under the assumption that the physician is the most skilled, and most expensive, person in the office and should only do what no one other than a physician could do. Our entire office meets monthly for 1 hour, and weekly meetings of staff teams are held to adjust work flows as conditions or demands change. Responding to a request for a prescription refill, for example, requires 3 or 4 people performing interrelated but distinct tasks to deliver it safely, reliably, and promptly; we average 30 to 40 such requests daily. The collective integrated operation of our office thus represents 15 years of weekly and monthly staff meetings that constructed our functional systems piece by piece over time. On 14 July 2004, we had to redesign every office system we had in place. Our commitment that going live would mean that documentation of clinical care on or after that date would be created and found in the electronic health record seemed simple, but clinical care included not only office visits but telephone calls, prescription refills, handling of laboratory results, and other functions. Each of these tasks had a work flow, and all work flows had to be redesigned more or less simultaneously. A clear go-live date was desirable because, as a matter of patient safety, we needed to know where to look for information, and the longer we ran parallel paper and electronic systems, the harder that would be. The process of radically redesigning 15 years of accumulated work flow in a short interval was extremely stressful. The system we chose is designed for flexible application in a variety of settings, ranging from large integrated delivery systems to smaller practices. Although the vendor urged us to think through and document the new work flows in advance, we found ourselves making innumerable decisions about how we would use the system before we really understood how it worked, and our vendor did not know enough about how our office worked to help us. We were forced rapidly to adjust our work flows during implementation, which seemed akin to redesigning an airplane in flight. Decreased Competence and Increased Effort Going live rendered everyone in the office incompetent to do their core jobs. The front desk had to use new on-screen forms to record telephone messages; pairing electronic messages with paper charts required the file clerks to follow a new work flow; physicians had to find telephone messages on their computer desktop rather than neatly piled in a physical telephone message bin. The medical assistants had to record vital signs and chief symptoms in the computer and had to learn how to record results of a tuberculosis skin test, visual acuity test, or urinalysis. Everyone in the office simultaneously experienced pervasive anxiety and unhappiness. Waiting time for patients dramatically increased. In short, people were miserable at work. We began to have weekly full staff meetings and weekly physician meetings, all of which were more acrimonious than they had ever been. Variations in clinical style and work flow among the physicians—which had seemed acceptable if unnoticed before—now became a subject of group scrutiny. What did we have to change, and what could we hang on to? What did the physicians have to do the same way, and where could we tolerate difference? All these issues had to be renegotiated at a time of enormous stress on the practice. We observed that a culture of blame set in: Things were not going well, and it had to be someone's fault. Several staff members complained that the work environment was less collegial, and they often felt criticized, as one put it, by everyone. They did not associate these feelings with the electronic health record and, at least initially, neither did we. Coincident with our shared frustration came a dramatic increase in workload, especially for the physicians. Even when we had reached the point where we could competently use the new system, every patient represented a new patient to the electronic health record, and the old paper chart had to be abstracted and data moved into the electronic chart. Some aspects of chart abstraction could perhaps have been delegated (for example, entering medication lists or immunization histories), but we worried that our staff—who have only limited clinical training—might make mistakes, and decisions about what data to abstract require the clinical judgment of a physician. At first, the system shut down daily at midnight for backup and maintenance; backup was later moved to 2:00 a.m. to accommodate 2 of the doctors who were trying to work from home in the evening. The stress level in our office remained high for about 3 months, by which time we had seen most of our complex patients and entered their long medication and problem lists into the system. We had now begun to realize some of the benefits of computerization, including computer-generated prescriptions, faster access to specialist correspondence, real-time access to charts anywhere in the office, the ability to message or route information and tasks electronically in the office, and the ability for the same chart to appear on multiple desktops. Within 4 to 6 months, waiting time had improved and staff were more excited and confident. Patient Acceptance Patients have been impressed and pleased to see their prescriptions appearing on wireless-enabled printers sitting unconnected to our Tablets. They have also enthusiastically benefited from occasional use of the Internet or such tools as the National Cholesterol Education Program Risk Calculator during their visit. Some patients, however, found the increased waiting time during the early phase of implementation unacceptable, and many left our practice because of it. At a time when everyone in the office was stressed, our customer service skills were not at their best. Several patients have asked a version of a question posed by a supportive, long-established patient: Doctor, do you find you are spending more time interacting with the computer than with your patients? For a while, the answer was clearly yes. Financial Impact Our total annual budget for technology support before implementation was approximately $10 000, which comprised maintenance and support of our previous practice management system and limited network. Our postimplementation annual budget will be $40 000, which includes annual support payments to hardware and software vendors and our local computer support vendor. We will have $24 000 in annual carrying costs for the financing of our system purchase over the next 5 years. The clearest savings we have seen was from the elimination of $45 000 in annual transcription costs. Although the file clerks no longer do filing, they now scan and name correspondence (see the following description), and we have been able to eliminate only 1 staff position for an additional annual savings of $20 000. We expect savings on chart supplies to be offset by increased costs of toner and printer maintenance, technical support, and replacement of equipment. At best, we see the expense side as a wash. On the revenue side, we accrue no additional revenue from any current payer for having an electronic health record. We had already maxed out on most quality incentives for which we were eligible when we were using well-organized paper charts and office systems. The electronic health record may enable us to see more patients in the same time or offload physician work more reliably and safely because the system provides clear, timely, legible documentation to support expanded clinical team activities, but this reallocation will require substantial staff retraining. Within 1 year of implementation, we expect to free up our current file room space and perhaps make it clinically productive and revenue-generating. As an offset to these potential gains, it is possible (although unlikely) that physicians will be less productive because the electronic health record generates more work for them. For example, whereas the physicians used to dictate notes, they must now type them. Physicians must also participate more in filing. Our electronic system offers us 24 document types (for example, consultation or laboratory report), and each document must be assigned a type and given a name. Because accurate labeling and data entry are essential both to take advantage of the information retrieval capability of the system and to find anything once it is filed, the physicians must oversee and modify the categorization and manual input of key data elements. As a result, we often feel like data input drones. No wonder one of us described the new work flow as a physician speed-up. Computerization in a world without established standards that link medical data systems is inefficient. When we have a working interface, as we do with our main outside clinical laboratory (which handles about 80% of our laboratory testing volume), the reports come named, and the individual laboratory results automatically populate flow sheets and letters to patients. Results can be efficiently retrieved and graphed, and trends can be analyzed. Unfortunately, most of the information we receive (such as radiology reports, consultations, and procedure reports) does not come to us in a format that the system can recognize electronically. Our colleagues in integrated delivery systems and the Veterans Administration do not face this problem because most of their clinical data are generated within their system and the interfaces already exist. National standards on the interoperability of medical data systems would be a big step forward for small practices. For now, we may switch referral patterns to hospitals and specialists who will give us information in a form that flows most easily into our system. Lessons Learned 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. Any of these incentive models would work for us and make adoption easier in other small practices. 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. Perhaps the most important asset we could have used to ease the pain of implementation was more clinical capacity. A decline in productivity after implementation of an electronic health record seems inevitable, and if a practice is already straining to meet patient demand, an absence of reserve magnifies the stress of implementation. For us, the financial stress of acquiring the electronic health record precluded simultaneous addition of a new mid-level practitioner or physician, which argues even more strongly for the need for financial support. 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. Author and Article Information From Greenhouse Internists, P.C., Philadelphia, Pennsylvania. Acknowledgments: The authors thank their office staff for their courage, flexibility, and support throughout this project. Without their willingness to try something new, implementation of the electronic health record would not have been successful. They also thank business manager Debbie Preite for her leadership and willingness to learn more about computers than she ever thought she could, or wanted. Finally, they thank Cheryl Norvell for manuscript assistance and Steve Downs, Holly Humphrey, and David Reuben for their encouragement and review of an earlier draft of the manuscript. Potential Financial Conflicts of Interest: None disclosed. Requests for Single Reprints: Richard J. Baron, MD, Greenhouse Internists, P.C., 345 East Mt. Airy Avenue, Philadelphia, PA 19119; e-mail, rbaron@greenhouseinternists.com .