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Serving Over 20,000 US Medical Transcriptionists

ASPs - How the Internet is changing EMR

Posted By: Karunakar on 2008-09-02
In Reply to:

Healthcare, along with construction, education and retail are ranked as being the slowest adopters of IT. With more pressure than ever from government, insurers and patients, why is healthcare still so far behind?

As health care becomes more integrated, electronic medical records (EMRs) have become an integral part of any practice.

In its simplest form, the concept of EMR is electronic storage and instant availability of clinical information to authorized users at the point of care. Increased efficiency is one of the foremost benefits. Because of increasing technological advances, we are seeing the delivery and implementation model of EMR changing with the times.

Practitioners today have an option to choose either EMR on "Client-Server" or an ASP platform.

Traditionally, EMRs had been deployed directly in the clinic on a Client-Server platform using a main computer (a "server") located in the clinic. The data is then accessed using a "client" i.e. another computer connected directly to the server through the local area network (LAN).

However, with the increased demand for cost-effective EMR solutions, and advances in Web based technology, many vendors are now offering EMR on ASP platform.

The Application Service Provider ("ASP") model is a way of providing EMR to medical practices that takes advantage of the Internet. An ASP replaces the on-site server at a physician’s office with a server installed and managed at a central data center. Physicians and practice staff can access the software applications remotely via PCs connected through the Internet. It is an effective EMR solution for Solo and Medium Medical Practices.

The increase in demand and interest in the ASP model is attributed to the various advantages it offers over the traditional Client-Server model:

Low cost of ownership: The foremost advantage to the practice is the reduction of hardware, software and maintenance costs. Software installation, maintenance, upgrades, back-up etc. are carried at the vendors end. The clinic does not require hiring of specialized IT staff to manage the day to day activities related to EMR. The user has to pay a fixed or transaction-based fee, mostly on monthly basis which also reduces the cost.

Easier accessibility of data at multiple locations: The ASP based solution allows the physician to access patient data at multiple locations via PCs connected to the Internet. This is very useful for clinics having multiple locations: the physician does not have to stick to a particular PC or location to access patient data.

Easier Upgrades & maintenance: The EMR vendor can centrally update the existing software at his end rather than going to each site for upgrades. This results in fast and effortless upgrade without interfering with the day-to-day operations of the clinic. Upgrades to a Client-Server platform could also require upgrading the existing hardware. This adds to the cost further. With an ASP model, the EMR vendor upgrades the hardware as needed at his end rather than requiring the physician to purchase additional hardware.

Greater Flexibility: ASP platform is far more flexible than Client-Server systems. Most Client-Server EMRs require the practice to buy the application outright rather than choosing a step-by-step implementation. Once the clinic has chosen a Client Server platform, it is difficult to switch to a different vendor because the cost incurred during the initial implementation for hardware and software is high. As ASP based EMR platforms have enjoyed an increase in demand, vendors offering these solutions have to address certain issues in order to increase the acceptance of ASP based EMRs over Client-Server solutions:

Security & Privacy of Medical Records: Since all the medical data is transmitted over the Internet, patient privacy issues are vital. In fact, ASP systems can be more secure than most Client-Server systems. HIPAA Complaint ASP systems are professionally managed data centers with high level data security systems in place. Data moves through a secured and encrypted pathway across the internet with standards such as SSL-128 in use. Firewalls installed at both ends stop unauthorized access to the network. In addition, Digital Certificates and PINs are some of the other measures being implemented by vendors.

Ownership of Medical Data: Because the patient data is stored at a site outside of the clinic, prospective ASP clients often ask the question ‘Who owns the Data?’ In most cases Service Level Agreements or other legal agreements are formulated and put in place to ensure that the ASP users can retrieve their data upon the termination of services, if they chose to do so.
Availability of Internet Connection: Since ASP platform is web based, it requires a stable and fast Internet connection at the clients end. The physician might not be able to use the solution if the connectivity is slow or interrupted. Most vendors recommend T-1 or DSL lines, both readily available in most locations, to ensure seamless flow of information and uninterrupted workflow.

In summary, ASPs offer an effective alternative to traditional Client-Server applications with the promise of lower cost of ownership, greater flexibility, easier implementation and maintenance. Physicians have come to realize that ASPs have grown up, and more practices will begin to migrate to the ASP model in the future as the concept gains increased acceptance.



LINK/URL: EMR Software for clinical practices in US


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Other related messages found in our database

Internet based transcription - need advice on how to go internet
Can anyone offer any help/advice on how go about becoming internet based from a call in system, or how to keep the call in system for the docs and put transcriptionists on the internet?  Not sure where to start to get information on how to go about doing this. Any help will be appreciated.  Thanks.
If you want to work on the internet from home, take an internet course
But only from Andrews School or M-TEC. Many companies will waive the 2-years' experience requirement and will test and hire you if you go to either of those schools. Do NOT bother with At Home Professions, Penn Foster, US Career Institute, or ESPECIALLY Trans-Am, which is also known as Trans-SCAM and is a total ripoff. You will have a VERY difficult time getting hired without experience unless you choose Andrews School or M-TEC. Yes, they cost more, but that's because they are excellent training programs, not "correspondence courses."
How do they think that changing their name....sm
would matter diddly squat in the industry?  If their rationale for considering it is because no one knows who they are then changing the name isn't going to change that.  Seems silly that members and supports would be asked to pay for the costs of changing instead of focusing on marketing.
CHANGING COURSE

Well, after the reading and research I have done, I think I agree with one writer that stated that at the rate things are going now in the transcription world that in 5 years 80% of us will be out of jobs!!  Either through technology and/or offshoring!!


So, instead of waiting for another axe to fall on me...I have been chopped up enough by the MTSOs...... I am hoping to decorating cakes for a living!!!


I am waiting to hear back from a local bakery where I just interviewed. 


I have taken all the Wilton cake decorating courses and have done quite a few birthday, wedding, and mother's day cakes in the past...I definitely am not Duff or anyone at Charm City Cakes, but it is something I truly enjoy doing and it was my "therapy" that got me through a divorce about 10 years ago. 


So, I will be working 8 hours a day only, get immediate feed back, paid hourly and not production, and hopefully will be able to transition into this job permanently....


So, I hope and pray that I am wrong about the future of this profession for which I have worked so long and hard....but the stress now is almost unbearable and ain't worth it no more!!!        


Changing Course
That is a great idea. You might work into doing some on the side and go into business for weddings, etc. I had a friend who did that and make good money. She was in great demand too. If you get a business of your own, you would make a lot more and could probably do a lot of it sitting.
Probably not...just changing
I work on a VR account, and trust me, there will always need to be people behind it checking what the computer types.  There are just certain things that need an actual brain to decipher that a computer just cannot pick up. 
Oh, I am not changing what I said
because again, have not seen it ever used with lung.
Oncology because of the always changing...sm
meds. And I have to admit, though I have done ortho a lot in the past and know it well, I just don't like it.
Anyone know anything about changing sim on cell?
Can you remove sim card on Sprint phone and put in a T-mobile?  Please help if you can for I am a "technically challenged MT."
We are changing the company.
Watch and see.  And all your rage and CAPS can't change that.  The lawsuits, the SEC, the shareholders, the clients.  We are all changing the company. 
Changing Careers
I absolutely LOVE medical transcription work. It is the best kind of work for me. I have always, up until five years ago, made plenty of money to support my family (I am a single 45 year old mom).

However, I have become very scared. So, I have 80% decided that I have to go back to school and start over. It makes me sick, but I can't watch my pay decrease every year like this.

I really, really, really want to continue MT work, but it just doesn't feel secure for me anymore.

AND - changing careers at my age is also scary, but I have a friend who did it at 50-something years old, so I guess I can, too.
Who's changing the subject?
and so am I.

Try to keep up.
This is changing the subject a bit, but.....

What about birds?  If people had a bird that they had in a cage, and not let FLY for exercise, is that a bad pet-owner?  Most bird owners that I know of, have birds in a cage and they let their birds poo in a cage on the paper in the bottom of the cage. 


What about cats?  Cats are domesticated animals just like dogs and some people NEVER let their cats go outside.  They let their cats do their business in a litter box. 


I just don't see any difference in this and using the potty pads, and like I said, I have used potty pads with previous dogs I have had.  They do not smell if you pick up the dirty pad right away, which I do when at all possible.  It's the dog hiking his leg on the furniture which is NOT acceptable to me and I agree--it stinks and I have a terrible problem going on with this---I try to clean it up as soon as I can, but he is definitely ruining my floors and thus why I was asking for advice on the hiking of the leg. We need new floors (carpet) in our house anyway and we are planning on replacing them soon but I need to get the dog re-trained somehow before we get the new flooring or else I'll still be in the same boat I'm in now.  I've just got to figure out how to retrain him back to the potty pads.  Wish me luck!


Have a nice day!


Jen, seriously, the face of MT is changing. sm
Get that degree.  Trust me on this.  Yes, it's nice sitting home in jammies with the kids.  I did it a lot of years, but I made way more money then than now.  Things are changing drastically and fast in this field.  Get the degree.
You are changing your position.
I breed Yorkies and was in the pet care business for over 30 years.  Of course, you love your pets and they have a place in your family but you do not let a dog growl at you, as you stated.  One of your original posts you said if a dog growled or bit, oh well, dogs have bad days, too.  That gives a very different impression than the one you are trying to make now.
changing the subject a bit . . .

Does anyone know of a really good hair product for the "frizzies" ?


With summer coming, I'm dreading my hair curling and frizzing with the heat and humidity, have tried a lot of products without success.  Any tried and true methods? thank you  in advance ! 


So what are they changing it to? The Anal
.
Not sure if changing jobs will help...

There are very few places now that have no ESL doctors.  When I changed jobs last November I thought I would lose my mind because there are so many ESLs on the accounts, but honestly after getting the same ones over and over, they should get easier.  I actually miss the days when I was just starting out getting 5 cpl typing nothing but ER reports.  Yeah, it got boring sometimes, but I was bringing in more money then than I am now making 8.5 cpl.  Ah, the good ole days!


Changing jobs ....
I'm wanting to buy my first house this spring.  Ive been working at home for the same national for the past 3 years.  I have been an MT FT for 9 years.  Does switching jobs really affect your credit poorly?  I think I could be making a lot more money, if I changed companies, but Im afraid it will hurt me being at a new job and trying to buy a house.  I have also heard that as long as you are in the same line of work, it won't matter...Any insight on this?
changing jobs

If you are an IC, it would not matter as you do not have to say "who" you work for - just prove your income.


and the QA people wonder why we ever get anything right. It is always changing.
nm
Changing careers

I have been an MT my entire life.   I had no formal training - just had a knack for it and always had a job doing transcription.  I was sought out many times. However back about 1993 I started hearing rumors about voice recognition. I at that time decided to go to school and get a nursing degree as I wanted to stay in healthcare. I obtained my LPN- RN - then BSN in 1999.   Took me awhile but I did it.  Since that time I have done some coding, worked as a nurse and been promoted to transcription supervisor in 2000.  I also teach transcription at our local college.  Since I have such a broad range of experiences in all the things you are looking at I would suggest nursing - you are going to get the most valuable education in that field - with many opportunities.   If you don't like it you would have the bulk of your education and could easily slip int to coding or transcription.  Just my opinion.


changing email

Hi Moderator:


Can you please direct me how to enter my new email addy?  Either on line and send it to me at my new one? or what? Thanks so much


 


The MT's are now the editors. Everyone changing to SR. SM
They are calling MTs "editors" for doing SR. They are also hiring like crazy, since they predict many new "editors" will quit because of cut in pay.
changing careers

It seems a lot of people are feeling the same crunch.  I have been an MT for 10 years  I too used to have a excellent hourly plus incentive with great bennies in-house jobs which was outsourced to an Indian Company. I worked from home and make ok. Now it's hard to even find a decent line count with benefits at all. I am working as an IC at 9 cpl and no bennies. As a single Mother I simply cannot do this anymore.  There companies who offer employee status and bennies but the line rates are so low or they want you to work 2nd or 3rd shift and with my family situation this is not possible.


I too am making a career change plans.  It seems that nursing is all the rage with the high paying jobs and plenty of them. But as a former nursing student years ago before MT I know it's not for me.  Too high pressure and the bullying in nursing school is unbelievable as is the 2 year committment to school full time.


I decided to try Assocaites degree Accounting/CIS. I hope to enter as a clerk or bookkeeper and work towards the Bachelors degree once working as a clerk.  In the meantime I have been brushing up on Powerpoint, Excel, etc and applying for secretarial and admn assistant jobs. 


 I had considered medical billing but I am somewhat soured on the healthcare system and outsourcing.  I figured Accounting is much broader and can work for more than one industry, but have seen accounting positions in healthcare systems too. 


I wondered if people would share what fields they were considering.


For new MTs... the field IS dying between VR contsantly improving and outsourcing/offshoring our jobs are dwindling as are the pay and benefits.  If you are a married-stay-at-home type of Mom with luxury of a second income and your husband's benefits MT might still be ok for a little extra money on the side.  But for anyone trying to support either themselves or their family on MT -- forget it.   Its a good part-time Mom job these days and that is about it. 


Sad.  There are many excellent and quality MTs who have a ton of knowledge.  I wondered how they intended to transfer skills to another profression.  The writing is on the wall.  I hope to be out in 2-1/2 years tops. 


 


 


 


The field is changing, Just Me, and SM
those whose incomes are dropping drastically are either unable or unwilling to change with it. The unables have my sincere sympathy; but in any case, don't make the mistake of basing your decisiosn on those who are on the way out. If your talents suit the work you'll end up doing over time, whatever that turns out to be (you won't be doing straight transcribing, though), you'll make a decent middle-class wage appropriate to a skilled clerical worker. Which is what we are. If the changes lead you to advance your secondary education and move to a higher skill level, well, hopefully you'll make even more. Best wishes.
changing careers
After almost 30 years of MT work under my belt, I'm ready to throw in the towel and hit the pavement. I'm already out there interviewing. Even if I make only what I make as an MT, if it's a job that I like, then it'll be worth it. Wish me luck!
I don't think it is dying, I think it is changing sm
There will always be a need for a hand typed medical narrative. Having said that, how much need is anyone's guess. FOR NOW, many companies are moving towards at least some VR. I have watched my company ramp it up and now ramp it down again. Why? The quality isn't there and part of that is the MEs who are doing them.

Being an ME usually only appeals to someone who can't actually type the report with any speed and accuracy (not a real MT in my book) or an MT who can longer tolerate the wear and tear on her hands (a real MT). The pay is less, which might not be a problem IF the software didn't require so darn much editing! Either the software needs to be a LOT better or we need to be paid more, if they want to the best quality, so that real MTs are doing the ME thang.

What I see happening, even now, is that companies who will hire a traditional, old-fashioned typing MT want the very best they can get at the best price they can get her. It is and will be increasingly a buyers market for our services. It will edge out any MT who is marginal...in speed, in accuracy, in attitude, in work ethic. That is to say, those of us who can stay glued to our desks and produce 99.5% or better accuracy AND do it with speed, will still be around for quite a while yet. The tolerance that some companies for not showing up on time, not getting your minimums, not producing very good work, is decreasing. I see this as a trend.

Less work? Not for some of us. No work, as in we don't need the chaff of this industry? You bet, and it is happening already.

The truly top-notch MT will always be needed. Do you have any idea how very few of us there are? I have not talked to a company who has more than 1 or 2 of us that they consider the cream of their crop. If you want to stay, look at what you need to improve, be it work ethic, speed, accuracy or scope of knowledge. If you don't, you'll be in one of the first groups out of this business.
Changing jobs
If you are working now, I would recommend you keep that job.

I don't know what you mean by taking classes, but if you have not completed a coding program and learned enough in it to pass an AHIMA or AAPC certification exam *right now,* it is unlikely that an employer will hire you for coding.

Taking a job in medical records might help you break the ice at that facility, but taking a job in other areas isn't likely to help much. Any possible benefit from taking a housekeeping is so small and so unpredictable that it isn't worth losing the job you now have.

This counselor sounds as though she doesn't have a good grasp on the requirements of the coding industry.

Your best bet is to set up a study plan and work toward passing a certification exam in coding, then look for a job.
Changing settings

You can change the settings.   With your mouse on the main desk top screen, right click and go downto properties.  Go over to the settings tab and this will give you options for changing the font size.   You can change it in that setting by changing the pixel settings, or you can click on the Advanced button and change your DPI setting (or both).


Hope that helps.


If they are changing the rules...then all
you can do is keep your emails to prove that you are just doing what they previously told you to do. If you keep deleting, then you don't have a leg to stand on

As far as the ridiculous corrections like a instead of an, that may be ridiculous, but one way is correct and one isn't. I am a QA and my reports get reviewed by the client. If I let one of the ridiculous corrections go through, then you better believe that they point it out. I mean I agree that they aren't the really important errors, but if the client cares, I care. If the client is going to jump on me for it, then I have to correct the MT. So, don't look at as the QA nit picking you...she is just doing what the client wants.

On the other front, save your emails or you don't have a leg to stand on.
It's not going downhill but it is changing
The job is evolving into an Editor process and there is a higher-than-ever ratio of difficult dictators.

The line rates are not something you can count on moving upward but they never have been. Where money is usually made is in production with incentives and bonuses.


Changing to a new expander

Cathy,


You may want to read through Sharon Allred's experience switching from PRD to Instant Text - click on link below. Instant Text  can be set up the way you want it, and you can skip learning all the advanced features if you don't want to use them.


Instant Text  can import your pp2 file with a few clicks so you can use your PRD list as before with some restrictions concerning entries starting with numbers and entries containing symbols.


Like ShortHand Instant Text is a Windows software.


Marianne
Textware Solutions
800-355-5251 


Try changing the extension to .vox
nm
Line count changing
I have noticed lately that mine line count has been dropping on a daily basis.  I finally started checking my own lines as opposed to the company line counter and I have realized that I am NO LONGER getting paid for my spaces, without telling me.  I have half a mind to start typinglikethisbecauseifyoudonotpayforthemyoudonotgetthem!!!!!  Is it me?
why would the resolution change without someone changing it?
nm
I hate changing it either way - wish they would leave it alone
nm
My PT recommended changing the height sm
and the position of the chair a few times a day, getting up and walking around q hour, etc. Sitting for prolonged periods as we do causes us to "freeze" and get into trouble with aches and pains. It really does help to move around a bit.


The industry is changing and as it stands

now I would not recommend this field to anyone, but I am not worried about not having a job, at least not in the next 5 years.  I am good at what I do and can do any work type, can do ESLs with little problem, have done QA, so I feel like there will always be a job as long as I want it.  The pay may never get any better though. 


There aren't that many jobs available, but there are so many people looking for work that a lot of companies don't feel like they need to pay to advertise.   Check with employment agencies or temporary agencies.  I worked for  temporary agency years ago and got offered full-time positions with every place I worked.


Not sure what your career of choice is in, but you can get just about any degree on-line, or at least do all the basic courses. 


Not sure of your financial situation, but if still paying for technical school, going part-time probably won't work for you so you could go to school or get in some type of internship for whatever you wanted to do.   


You can sit back and wait for someone to knock on your door and offer you your dream job, but you'll most likely die waiting, or you can get your goal and work towards it.  If you aren't willing to do that, then you are stuck where you are. 


Thinking of changing jobs again...

any companies to avoid like the plague?   


The field is changing in a lot of different ways

this is one of them.  I agree that the doctor is responsible and that it is not my job to make him sound educated. Years ago, it might have been different.  There also was better pay and respect.  Now it is all about TAT and price reduction.  There has to be a balance. 


If one of my regular docs messed up, sure, I'll fix it.  With this type of dictator...nope.  Respect for the patient?  It has to include the doctor too.  If it involves vital information then I'll indicate in the note that the information needs to be verified.  Maybe HE is in the wrong field...not me.


 


Changing burial sites...(sm)
Anybody know anything about changing a loved one's burial site after the fact?  We lost my mom a few years back and buried her in the "wrong" cemetery (we were all heartbroken and didn't have the strength to argue with her dad, who bought the plot for himself many years ago and decided HE didn't want it, but didn't want the money he spent on it to go to waste--she always deferred to him and our immediate family did not want to make waves--now we see that this was the wrong thing to do).  Anyway, she is buried in an ugly and dangerous part of town.  The cemetery that my immediate family had originally chosen (me, my dad, and siblings) is close to my dad's house, beautiful, and peaceful--and where my dad wants to be buried, as well, and we want to move mom there.  Any ideas?  I don't even know where to start with this.
I am probably going to be changing from dialup to DSL - just exactly what do I need - new modem? nm
nm
changing background colors
1. Click on Start | Control Panel | Display | Appearance | Advanced
2. Cick in the White box that says "Windows Text"
3. Under Item you'll have Window and under Color 1 you'll have you're bright white.
4. Click on the down arrow and either pick one of the colors you see or click on Other.
5. Click on the white box (lower right) and on the far right a bar will appear that goes from bright white to black. Click down the bar a little bit at a time until you get the color you like. You'll see the colors change in the COLOR box. When you have the color you like, click "Add to Custom Colors" and then click OK. Click OK twice more.

You have now changed the display on your screen alone. Whoever you send the file to will see it according to their settings.
Rules about changing reports

Does anyone know the rules about changing reports after they've been signed? Is it ok? Do you have to keep a copy of the original? Do we just add an addendum?


I can't find anything in my BOS.


Thanks in advance.


burnout/changing companies
Hi everyone - I post here frequently but I need to remain anonymous for this one; hope you understand.

I'm looking for thoughts from MTs about whether switching to a different company alleviated burnout. I am trying to figure out if it's MT itself, or just the service I work for, that is causing my severe burnout.

I'm on the verge of hauling myself to a doctor for antidepressants (paying out of pocket, of course... no psych insurance coverage as an IC!) and my line counts have dropped drastically. I have bilateral CTS to boot. I'm struggling pretty badly with all the "classic" burnout signs.

Thanks all!
My company in changing some things

I need to get some input on some changes and see what you all think about this. Previously I was making 10 cents per line. No benefits at all.  No paid holidays.


Here is the new offer:


Essentially full time - certain taxes will be withheld; eligible for 6 paid holidays and five vacation days (accrued monthly) each year.  Adjusted line rate would be .0866.


or


part-time employee - essentially an independent contractor; employer portion of FICA is being withheld. Adjusted line rate would be .0924.


What's your opinion?  Is this being fair or am I being ripped off?? I am so lost when it comes to having to deal with the taxes, etc, that I am not sure about this at all.  All I see right now, is less money on the paycheck and... any change makes me a bundle of nerves!!  Any advice or suggestions??


Need to ask QA or the client about removing/changing
s
You can try cleaning the heads or changing out the
ink cartridge, especially if you have one of the trial or low capacity ink cartridges.

Go to your Start Menu, Control Panel, Printers and Faxes, right click on Dell Printer 720, Properties, General, Printing Preferences, Options pulldown menu in the top right hand corner of that screen. Then you go to Troubleshooting and you can check your ink cartridge levels. Cleaning is under the little ink drop menu tab on the left hand side under maintenance tool.
Thinking about changing worktypes

I think I'm in the minority here, but I'd much rather do long reports than quick short ones.  Right now I'm doing prog notes/fups/etc but I also get a few psych notes here and there.  I'd much rather do 4-5 30min psych notes than 50 2-min clinic notes a day but I found out that that clinic is leaving so I won't be getting those any longer.  Should I just my manager that I want the longer reports and hope she'll find me something else?  Or just keep my mouth shut and keep chugging along?


Thinking about changing to FT IC position (sm)

Could someone give me some info on what I need to do to protect myself tax wise as an IC?  I used to work in the past for MQ PT and a local hospital PT.  I just had extra state and federal taken out there to help compensate.  Now I am thinking of changing to this company as an IC FT and know I will need to do quarterly estimates.  I assume I can talk to my tax person and they will give me an idea of what amount I need to submit each quarter. 


Is there anything else that might be different I should know about? 



TIA