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TRAINED EDITOR [2008-07-03]
Hi,
I have been reading a post about Transcriptionist editing and where do to go to betrained as aneditor? Is it something you learn on your own or what? Any advice would be appreciated.
Thanks,
Barb
technology moves on... [2008-08-03]
Anyone entering this field now needs to learn to be tech savvy or they are going to starve. I learned the theory part, but my school did not require us to use word expanders, so I am already behind right out of the gate. I also would be a better Editor if I learned the shortcuts instead of relying on the mouse. I am working on it, but it does not come naturally to me. These tools are the only way to survive in this business and VR is one of the biggest tools to the MTSOs and it is here to stay!
editing [2008-07-13]
As far as I know, it is just like learning new software which is usually what you have to do with any new job. Of course, you have to be trained as an MT just like witha regular transcription job, not sure if that is what you were asking? But like I said, it is just like learning new software, not a big deal.
VR is here to stay [2008-07-03]
I think it serves any professional to keep up with any technology affecting their chosen profession. A medical Transcriptionist who refuses to learn editing of voice recognition files will end up being left behind. Having said that, if you're thinking about transcription work, then choose a school who isn't afraid of current technology and includes it in their curriculum.
I love voice recognition. Working with it on a high-end technical level has made me understand that there isn't now, nor probably ever will be, a substitution for the human element. TRAINED EDITORs will ALWAYS have job security. Because any speech rec system is only as good as the people behind the scenes writing the software. It's not an unlimited technology, and it simply cannot interpret certain things. I love reading some of the gobbledegook it spits out, and snicker while I edit it.
Please stop being afraid of technology. Learn it, embrace it, get good at it, and secure your own future.
TRAINED EDITOR [2008-07-03]
Hi,
I have been reading a post about Transcriptionist editing and where do to go to betrained as aneditor? Is it something you learn on your own or what? Any advice would be appreciated.
Thanks,
Barb
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.
CBay Systems Makes Deloitte’s List of 500 Fastest Growing [2005-10-20]
CBay Systems Makes Deloitte’s List of 500 Fastest Growing Technology Companies in North America Maryland Fast 50 Rapid Growth Recognized for the Second Year in a Row
CBay Systems, a leading provider of healthcare business process outsourcing (BPO) services and the largest provider of Indian transcription technology and services to the US healthcare market today announced that it was again named to the Deloitte Technology Fast 500. The ranking measures the 500 fastest growing technology companies in North America, based on percentage revenue growth over the past five years, during which CBay Systems grew 779 percent.
CBay addresses various issues in the healthcare space, primarily focusing on medical transcription. The company’s HIPAA-compliant solutions leverage Internet technologies to provide integrated dictation capture, transcription and web-based document management services to hospitals, clinics and doctors.
Making the Deloitte Technology Fast 500 for the second year in a row is commendable in today’s highly competitive technology industry, said Tony Kern, deputy national managing principal of Deloitte’s Technology, Media Telecommunications industry practice. “Achieving sustained revenue growth of 779 percent over five years is a tremendous achievement. We congratulate CBay Systems on being one of the 500 fastest growing technology companies in North America.
Inclusion on the nation-wide Fast 500 list follows CBay’s recent acknowledgement as a member of the Deloitte Technology Fast 50 in Maryland. This list highlights the 50 fastest growing technology companies in the state of Maryland for 2005.
CBay’s Chairman CEO, Raman Kumar said, “It is an honor for CBay to be recognized for the second year in a row, but we are especially proud of these awards, as they communicate our explosive growth and ever-increasing customer base, providing concrete evidence of our superior product and commitment to customer service.” He also added, “We have 41 centers in our network in India, employing over 5000 people and the number is increasing every month, to cater to our expanding customer base in the US.”
Fast 500 Selection and Qualifications
The Fast 500 list is compiled from Deloitte’s 15 regional North American Fast 50 lists, nominations submitted directly to the Fast 500, and public company database research. Entrants must be headquartered in North America and must be a “technology company,” defined as a company that owns proprietary technology that contributes to a significant portion of the company's operating revenues; or devotes a significant proportion of revenues to the research and development of technology. Using other companies' technology in a unique way does not qualify.
About CBay
CBay Systems is a leading provider of healthcare technology and business process outsourcing (BPO) services and the largest global provider of transcription services to the healthcare industry. CBay’s more than 5,000 highly trained medical language specialists and customer service professionals spread out in 41 production centers situated across 10 states in India serve 650+ health systems, hospitals, clinics and physician practices 24 hours a day, 365 days a year, using HIPAA compliant web-based technologies with a commitment to the highest standards of quality, service and value. CBay is headquartered in Annapolis, Maryland with the Indian corporate office in Mumbai. For more information, visit www.cbaysystems.com.
About Deloitte
Deloitte refers to one or more of Deloitte Touche Tohmatsu, a Swiss Verein, its member firms and their respective subsidiaries and affiliates. In the US, services are provided by the subsidiaries of Deloitte Touche USA LLP (Deloitte Touche LLP, Deloitte Consulting LLP, Deloitte Financial Advisory Services LLP, Deloitte Tax LLP and their subsidiaries), and not by Deloitte Touche USA LLP
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.
INDIA - Why medical transcription is such a major draw [2005-08-20]
The medical transcription business is drawing people from other sectors. That’s because the income can be quite substantial. Transcriptionists are paid anywhere between 60 paise to Rs 2.0 per line. At a minimum of 6 hours and transcribing 800 lines per day, transcriptionists can make around Rs 1,200 a day. Working 26 days a month, they earn more than Rs 30,000 (USD 450 - 500)a month. They send their reports to an Editor for proof-reading who are paid upwards of Rs 40,000 per month.
As a result, hundreds of professionals are quitting their regular jobs to assist US doctors in transcribing their conversation with patients. X-ray, pathology, surgery and discharge reports of US patients are also being transcribed out of India.
To be a transcriptionist, an aspirant has to acquire skills in medical terminology. The next step is the editor. Level three is a quality analyst (QA) who has to work out of the office of the MT firm.
It’s a daily ritual for thousands of homemakers across India. After sending husbands to work and kids to school, they download voice files and start transcribing medical illnesses of patients in the US.
Slowly, medical transcription from home is becoming a phenomenon, particularly in tier-II cities where the BPO boom hasn’t yet caught on and educated women are still not being encouraged to venture out of home.
“Almost half of our 600 home employees are women. Working from home allows them to spend more time with family,” said Mr Rajiv Shetye, VP, Spryance, a Boston-based medical transcription firm which now has 1,200 employees in India.
According to estimates, India has about 100 medical transcription companies and the big ones include Accusis, Spryance, Stheris and Heartland. About 10,000 people work in the $120 million-strong industry.
Still, there is a lot of untapped potential. The US market for market transcription is about $12 bn per annum, which is more than double the BPO exports of India. More than 700 million hospital events need to be recorded every year. According to Nasscom, about 1.6 lakh such transcriptionists will be needed in India by 2008. Earnings depend on how much time a person is able to devote. Billing is based on the number of lines transcribed.
HARSIMRAN SINGH
Dictaphone Announces Significant Growth in Its iChart [2005-08-09]
Dictaphone Announces Significant Growth in Its iChart(R) Managed Services Program; Responds to Increasing Demand for Low-cost, High-accuracy Transcription, Leveraging Speech Recognition and Dedicated Network of Service Partners Aug. 8, 2005--Dictaphone announced today that its iChart(R) Managed Services program experienced substantial growth in the first half of 2005. iChart Managed Services uses an ASP model to combine the power of Dictaphone's industry-leading speech recognition technology with a proven network of outsourced transcription service providers to deliver low-cost, high-accuracy transcription with rapid turn-around.
The second quarter brought several milestones for the iChart ASP business:
-- Overall number of lines invoiced per month surpassed 30 million
-- Monthly invoiced line volume for outsourced services doubled from the end of 2004
-- Number of billable sites for iChart topped 300
-- Several significant new contracts were secured during the first half including Adventist Health System, Sarasota Memorial Hospital, and Guthrie Clinic.
Other major iChart Managed Services customers include Allina Medical Clinics, Lifemark, and Massachusetts General Hospital.
iChart Managed Services is seeing tremendous demand from a market that has been searching for new ways to lower transcription costs without compromising on accuracy, said Don Fallati, senior VP of marketing for Dictaphone. The success of the program is also a testament to the power of our underlying technology. Whether customers choose to use our software themselves or outsource the report editing process to our network of service partners, they still get the ROI that our speech recognition platform ensures.
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 labor provided by several major transcription service companies who have been trained to edit on the company's speech recognition platform. Customers receive a 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, ranked 31st in Healthcare Informatics ranking of top 100 companies by healthcare revenue, currently deploys dictation, transcription and speech recognition systems in some of the world's premier healthcare organizations. Its solutions automate and integrate critical elements in the creation and management of health information, helping healthcare organizations improve productivity and the quality of patient care. Dictaphone's flagship Enterprise Express(R) dictation, transcription and report management system is an integral part of the creation and flow of patient information in a substantial number of U.S. hospitals. It is estimated that it currently supports several hundred thousand physicians who use Dictaphone systems to generate an estimated two million reports a day. Dictaphone is also actively deploying its EXSpeech(R) and PowerScribe(R) speech recognition solutions, designed to dramatically reduce transcription costs and speed report turnaround. Dictaphone has also introduced the iChart(R) family of Internet subscription-based applications services provider (ASP) solutions that offer dictation, transcription, and speech recognition access, as well as the ability to integrate existing systems with new coding, natural language and data mining technologies, which can significantly reduce the costs of managing patient information. For sales and product information, visit Dictaphone at www.dictaphone.com or call 1-888-350-4836.
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
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Philips SpeechMagic™ wins “Most Innovative Speech Recognition [2005-08-02]
Philips SpeechMagic™ wins “Most Innovative Speech Recognition Solution” Award
Vienna, Austria – Royal Philips Electronics (AEX: PHI, NYSE: PHG) announced today that it has won the industry-leading “Most innovative speech recognition solution” award from Speech Technology Magazine. Philips received the award jointly with Dolbey and Borgess Medical Center for increasing medical transcription productivity by more than 30% at the medical center in Kalamazoo, Michigan. This resulted in cost savings of $ 212,000 for outsourced medical transcription within the first year of operation.At Borgess, SpeechMagic is integrated into the Fusion Text® medical reporting application, and is currently used by 129 physicians in a back-end recognition process. The increased output of the transcription team has cut report turnaround-time from between 24-96 hours to 4-72 hours, which ensures that no treatment is interrupted due to missing medical data. “Borgess Medical Center, Dolbey and Philips have shown that the time is right for industrial-grade speech recognition in the medical area. They achieved clear economical benefits as well as improvements in patient care. Their commitment to use speech recognition technology for the benefit of both, patients and physicians has convinced us that they deserve this award,” says John Kelly, Editor-in-chief, Speech Technology Magazine.Bjoern Aune, Sales Director North America at Philips Speech Recognition Systems comments: “This award is yet another proof that solutions which are powered by SpeechMagic lead to clearly measurable results. Borgess Medical Center joins a Spanish and a UK hospital group, which have recently been awarded for their improvements in efficiency and patient care, strengthening SpeechMagic’s leading position in the medical speech recognition market.”About Royal Philips ElectronicsRoyal Philips Electronics of the Netherlands (NYSE: PHG, AEX: PHI) is one of the world's biggest electronics companies and Europe's largest, with sales of EUR 30.3 billion in 2004. With activities in the three interlocking domains of healthcare, lifestyle and technology and 159,709 employees in more than 60 countries, it has market leadership positions in medical diagnostic imaging and patient monitoring, color television sets, electric shavers, lighting and silicon system solutions. News from Philips is located at www.philips.com
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