Implementing Telemedicine during this COVID-19 Crisis and Preparing for a Changed World

06-April-2020 MTS TEAM Medical Transcription

Telemedicine during this COVID-19 Crisis

The COVID-19 pandemic poses a formidable threat to public health. Physician practices are facing unique challenges in delivering care safely to non-urgent patients. Now, more than ever, physicians need unstinted support to provide patient care. One of the major steps towards this is the promotion of telemedicine during the COVID-19 nationwide public health emergency. The Centers for Medicare and Medicaid Services (CMS) as well as commercial health insurance companies now reimburse healthcare providers for a broad array of telehealth and telemedicine services delivered during the COVID-19 crisis. Physician practices can rely on US based medical transcription services to document these virtual consultations in electronic health records (EHRs).

Telemedicine has been around for a long time and is known for its ability to streamline workflows and reduce costs. However, adoption of technology for virtual patient consultations progressed at a slow pace due to barriers such as cost, state licensure, and lack of good reimbursement. All of that has changed in recent times and especially with the coronavirus pandemic.

Starting January 1st, Medicare established new payment codes for services provided via virtual check-ins, e-consults, and remote evaluation of patient images. Now, with the novel coronavirus pandemic, telemedicine is surging, thanks to the federal government’s actions to support virtual consults. The administration declared Medicare and Medicaid would reimburse virtual visits at the same rates as for in-office appointments, thereby overcoming a major cost barrier for telemedicine adoption by smaller physician practices. The government has also temporarily eased regulations to allow the use of mobile devices for virtual visits. While only a few insurance companies had covered virtual visits in the past, many are now on board with paying for such appointments. According to analysts at Forrester Research, virtual health-care interactions are on pace to top 1 billion by year’s end (www.cnbc.com).

Telehealth is proving a major advantage in this public health emergency, and there is no reason why it cannot do much more for the regular delivery of health care in normal circumstances. We strongly believe that telemedicine is here to stay. As many healthcare facilities are not yet equipped to provide telemedicine, we rounded up guidelines from the American Medical Association (AMA) and industry experts to expedite its implementation.

Prepare to launch telemedicine services

Organize a team to adopt and launch telemedicine services quickly.
Make sure your malpractice insurance policy covers telemedicine care.
Understand the policy and payment rules for various telemedicine services.
The AMA recommends reaching out to the payer with the highest percentage of the facility’s patient population to discuss telehealth coverage.

Choose the software

Check whether your EHR platform has a telehealth functionality. If not, contact your state medical association/society for guidance to choose a telehealth vendor. Leverage the resources provided by the American Telehealth Association.
Contact various vendors and schedule product demos. Things to consider when choosing the product include customer support, training on the software use, ability of the telemedicine platform to integrate with the practice EHR, etc. Professional computer and technical support are essential for the program to run well.
Consider your budget – whether you would need software on a short-term or long-term basis.
Check out how vendor services are priced. The majority of telemedicine systems are cloud-based and bill on a monthly basis.
Choose HIPAA compliant telemedicine software based on your practice’s needs. Useful features to look for include secure videoconferencing, appointment scheduling and virtual waiting room, and e-prescribing. Specialty practices may have specific requirements (www.softwareadvice.com).
Ensure that the technology is equipped with camera quality, sound, etc. to support the type of exam. Experts point out that the better the technology is, the better the experience is for the patient, and the volume of services that can be provided (www.healthcareitnews.com).

Train staff

Train staff to use the telemedicine tools. This can be a challenge on the shortened timeline, especially if the organization did not have virtual health services in place. Reliable vendors offer training modules to help users deploy the software.
Have procedures in place to determine if/when a telehealth visit is appropriate and train clinicians, care team members and schedulers.

Patient outreach and care

Notify patients that telemedicine consults may replace physical office visits and when virtual visits will be available. This can be done via your website, patient portals and other patient-facing communications.
Decide when telehealth visits will be available on the schedule. Revise scheduling processes to accommodate telehealth.
Ensure that your staff can support hands-on patient outreach. For successful patient triage develop questions that patients can either answer electronically or over the phone when scheduling.
Make sure you get advanced consent from patients for telemedicine interactions. There are platforms that can support this electronically.
Educate patients on how to access telehealth visits on your practice’s software to maintain workflow and avoid disruptions to care.

Providing telemedicine services

Set up a quiet space in your office to provide telemedicine services. Acoustics within a building are important. “Concrete or tiled rooms create echoes where it can be challenging to hear and talk to a patient. This is easily remedied with some accommodations for acoustics such as soundboards on the walls”, advises an expert (www.healthcareitnews.com)
Make sure you have a secure broadband internet connection. The video quality and amount and speed of data transfer will depend on the amount and speed of the internet connection.
Document the start and stop times of the call.

Implementing telemedicine will ensure that patients are not exposed to infections unnecessarily, and also protect clinicians from unnecessary exposures. Telemedicine can also ensure that low-acuity patients (both those with infections and those with routine chronic illness follow-up needs do not excessively burden health care systems. Patients are also showing a preference for providers who offer telemedicine. “From a recent survey we conducted of U.S. patients, we found that 84% are more likely to select a provider that offers telemedicine over one that doesn’t, so it’s clear this technology is something patients want,” says Lisa Hedges, Software Advice (www.healthcareitnews.com).

As physicians and patients prepare for a changed world where virtual care is the norm, medical transcription service providers can ensure proper documentation of telemedicine visits EHRs in the same way as in-person visits. Such complete and accurate documentation is crucial not only for continuity of care, but also consistent procedures for ordering testing, medications, etc. and support billing for telehealth visits, cautions the AMA.

Using Telemedicine for Patient Care during the COVID-19 Pandemic

02-April-2020 Julie Clements Medical Transcription

Using Telemedicine during the COVID-19 Crisis

As healthcare providers in the U.S. brave the challenges of caring for people affected by the COVID-19 pandemic, medical transcription outsourcing companies continue to support them with timely and accurate documentation solutions. When the rapid escalation of COVID-19 cases called for a concerted policy response, the federal government announced an expansion of telehealth benefits to help stop the spread of the pandemic. With telemedicine, vulnerable patients receive virtual care without having to visit a healthcare center or physician office.

Telemedicine and telehealth have been around in the U.S. since the 1950s. Over the years, advancements in technologies have made digital health a widely deployed strategy, allowing patients to touch base with their physicians 24×7 for their acute needs. The COVID-19 pandemic has put the spotlight on telemedicine as an effective way to connect patients, physicians and health systems. Remote screening, diagnosis and treatment through telecommunications technology such as remote monitoring devices and video conferences are allowing physicians to screen and treat a greater number of patients in their home. Let’s take a look at how virtual healthcare is being used during the coronavirus crisis:

Reduces spread of the disease: Telemedicine allows patients with COVID-19 symptoms to stay at home. Quarantined patients can communicate with their physicians via virtual platforms. By avoiding the need for physical office visits, telemedicine reduces the spread of the virus to the community as well to medical staff.
Limits high-risk non-COVID patients’ exposure to the virus: By deploying telehealth programs, people who have other ailments and chronic conditions can schedule telemedicine consultations with their physician from home, without having to visit a medical facility. This reduces their risk of contracting the virus.
Reduces providers’ exposure to the virus and other infectious diseases: Using telemedicine to triage patients with acute conditions limits healthcare staff’s exposure to the virus. Tele-triage and seeing patients remotely eliminates minimizes risk of transmission of the virus to physicians and other healthcare workers.
Saves healthcare resources: The telemedicine approach to COVID-19 can take pressure off already resource-strained health systems and save money. A Stat News article points out: “As virus continues to spread while we are unprepared to determine whether every person with a cough or fever has contracted the disease and what level of care the person needs”. This can lead to unnecessary use of the emergency room (ER). With telemedicine in place, low and medium-risk individuals can touch base with their physician via secure messaging, phone, or video call. The physician will recommend the proper course of action based on information about the patient’s symptoms and concerns. By keeping patients unlikely to have COVID-19 out of the ER, telemedicine can keep costs down, save healthcare resources, and prevent overcrowding.

Telehealth Options

There are various forms of telemedicine and telehealth. The options put forward by the American Telemedicine Association (ATA) are:

Remote access to medical services: This brings health care services to distant locations such as rural areas, extending the reach of physicians and health facilities. As a COVID emergency measure, the home has been designated as an originating site effective March 6, 2020.
Live video conferencing and real-time interactive consultation: This involves the use of video for medical consultations with a patient or a specialist assisting the physician in diagnosis.
“Store and forward”: Diagnostic images, vital signs and/or video clips along with patient data are stored and transmitted, allowing review and diagnosis by the healthcare professional.
Remote patient monitoring: These services include monitoring blood glucose or heart ECG.
Mobile health: The Internet and wireless devices can be used to get specialized health information. This option also facilitates online discussion groups for peer-to-peer support.

Telehealth and telemedicine help to keep “people safe and out of hospitals and doctors’ offices, map the virus and triage individuals needing medical care,” said Ann Mond Johnson, CEO of ATA, in a statement (www.foxnews.com).

The Centers for Disease Control and Prevention (CDC) and commercial insurance companies have expanded telehealth coverage to curb the novel coronavirus outbreak. New CMS guidelines require Medicaid and commercial plans to ensure that providers are reimbursed for telehealth services at the same rate as in-person services, remove restrictions on using the home as an originating site, and cover various forms of telehealth such as video, phone, and secure messaging.

As telemedicine services are rendered, outsourcing medical transcription can help providers ensure accurate and complete documentation of digital healthcare visits in electronic health records.

AMA releases Playbook to Promote Patient Access to Electronic Medical Records

30-March-2020 Rajeev Rajagopal Medical Transcription

AMA releases Playbook to Promote Patient Access to EMR

Electronic health records (EHRs) improve care quality and coordination, promote accurate diagnoses, and save time and money. HIPAA compliant medical transcription companies securely integrate with EHRs to help physicians manage their electronic documentation tasks. Digital records ease communication with patients and allow physicians to share data with other providers and track continuing care. One of the most significant benefits of EHRs is that they provide physicians and patients with shared access to health information and foster patient participation in their care. However, it is found that misconceptions about HIPAA often restrict patient access to their own medical records. The American Medical Association (AMA) has now come out with a playbook to address this problem.

Patients have the right to access their own medical information. Per HIPAA, patients can make a request to view and obtain a copy of their health records, get copies of their records in paper or electronic format, and have records sent to another entity for treatment, billing, or operations purposes. HIPAA allows patients access only to health data that is included in a “designated record set,” defined as: “medical records; billing and payment records; insurance information; clinical laboratory test results (including genomic information generated by a clinical laboratory); wellness and disease management program files; and clinical case notes”.

HIPAA mandates that hospitals, medical clinics, physician practices, pharmacies and health insurers have meet patient record requests within 30 days (a one-time 30-day extension may be granted).

However studies have revealed that there are several barriers that prevent patients from getting their medical records, according to a 2018 Kaiser Health News report. A study by researchers at Yale University covering 83 leading hospitals found that only 53 percent of hospitals’ forms indicated patients could get their complete records. Likewise, GetMyHealthData campaign to extend access to digital health information found that the problems with note sharing could be more widespread in practices, with consumers reporting poorly informed or unhelpful staff, high fees, long waits and frustrating bureaucratic processes, among other barriers.

The U.S. Department of Health and Human Services (HHS) explains that providing patients easy access to their health information empowers them to be more in control of decisions regarding their health and well-being. When patients can access their own health record, they can:

better monitor chronic conditions
make more informed decisions about their health
adhere to treatment plans
find and fix errors in their health records
track progress in wellness or disease management programs
directly contribute their information to research

However, myths around HIPAA Right of Access have prevented some providers from sharing health information with patients who request it. There are misconceptions about complex legal requirements surrounding patient electronic access to medical information. These myths cause a lot of confusion among patients, third parties, and medical practices focused on delivering good patient care.

The AMA’s online Patient Records Electronic Access Playbook seeks to dispel these myths. The Playbook educates physicians about:

the need to provide patients with access to their medical records
the legal requirements related to medical record access and the sharing of records with patients

The AMA’s new resource on patient access to electronic records provides reliable information on a several topics such as:

Amounts and types of information
Forms and formats for sharing records
Patient requests and Involvement of third parties
Timing for record request fulfillment
Denial of record request access
Permissible charges
Confidentiality of substance use disorder records

The playbook also provides guidance to help medical practices understand EHR capabilities and meet patient record requests efficiently while complying with federal and state laws. It recommends that healthcare providers learn how patient records can be shared with other healthcare providers, how to enter data into patient portals, and how to send patient records to USB drives or CDs. Physicians should also encourage patients to take an active interest in their healthcare, get a copy of their health records, and check these for errors.

“As technology plays an increasingly important role in collecting and exchanging health data, the AMA believes that providing patients with improved information access and better information privacy are not mutually exclusive goals,” said AMA Board Chair Jesse Ehrenfeld, MD, MPH in a press release announcing the release of the playbook. “The new playbook is an important example of the AMA’s commitment to ensuring patients can easily access their personal health information that has been entrusted to physicians.”

EHR-integrated HIPAA compliant medical transcription services can help physicians ensure secure, up to date and accurate clinical notes. In fact, outsourcing medical transcription to a reliable service provider is the first step in efficient patient note sharing.

Coronavirus Preparedness Strategies for Medical Practices

26-March-2020 MTS TEAM Medical Transcription

As COVID-19 cases continue to grow, governments across the world are implementing stringent regulations to contain the outbreak. Healthcare professionals are on the front line in the war against the novel coronavirus. With the number of infections in the U.S. surging to over 33,000 at the time of this writing, medical practices need to be well prepared to deal with the virus outbreak. Our medical transcription company has compiled a list of readiness measures recommended by experts:

Educate staff about the novel coronavirus: Staff needs to be educated about COVID-19 and the protocols to contain it. According to the American Academy of Family Physicians (AAFP), instructions for staff should cover facility policies and practices to minimize risk of exposure to the respiratory pathogen that causes COVID-19, preventing transmission of infectious agents, and COVID-19 evaluation. Staff should also be educated on advising patients about changes in office procedures such as calling prior to the office visit if the patient has any respiratory infection symptoms and developing family management plans in case of their exposure to COVID-19.
Have a plan to identify patients with COVID-19 symptoms: To identify patients infected with the virus, practices need to develop standard questions that their staff can ask when patients call the practice, says Debra A. Cooper, R.N., a senior risk management specialist with medical liability insurer Coverys (wwwfiercehealthcare.com). This should include questions about travel to a country where the virus infection exists, whether they have had contact with a person who has tested positive for coronavirus or is suspected of having the virus, and if they have been caring for a person with the infection. Patients should be asked about their respiratory symptoms and those with a risk of coronavirus infection should be sent to a designated local testing facility. If patients have questions about the virus, physicians can direct them to the CDC website which provides accurate information on COVID-19 and advice about travel, social distancing, how much to go in public, etc. Several states have expanded telehealth options to reduce the number of persons who visit their physician in person, which will help slow the spread of disease.
Establish a COVID-19 office management and healthcare worker safety plan: The AAFP recommends that practices have an office management plan that covers patient flow, triage, treatment and design. Physicians need to take measures to ensure that staff and other patients are shielded from infected persons. This includes ensuring meticulous hand hygiene and cleaning, limiting patient visits to clinics and hospitals only if necessary; shifting consultations to virtual channels (such as phone and video); and adhering to standard droplet precautions (surgical mask, gloves, and gown) with respiratory patients. Staff and caregivers must be provided with alcohol-based hand sanitizer, approved respirators, Personal Protective Equipment (PPE), surgical masks, gloves, and gowns. Setting up a negative pressure room can prevent the spread of germs in the facility (www.fiercehealthcare.com).
Follow infection control best practices: In addition to use of PPE, staff should be educated about proper infection control procedures, including hand washing. The AAFP says that routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in health care settings, including those patient-care areas in which aerosol generating procedures are performed. High-touch areas should be frequently cleaned using products using cleaning supplies approved for SARS-CoV-2. Practices can refer to CDC’s recommendations for environmental cleaning and disinfection, along with the EPA’s list of approved products.
Collaborate with local hospitals and stay informed: Practices should establish communication with other health care professionals in their community and local hospitals. They should notify their local or state public health department if they have a high-risk patient. Practices also need to identify sources of materials and supplies required for care during the pandemic, and order appropriate items. Physicians should stay informed and track the ever-evolving coronavirus pandemic by visiting their state and local department of health’s website.

The coronavirus (COVID-19) outbreak presents unique and significant challenges for the entire healthcare system. Physician practices need to ensure staff safety while trying to deliver appropriate patient care. Medical transcription outsourcing can help meet their documentation needs.

Are EHRs Equipped to Deal with COVID-19?

23-March-2020 Julie Clements EHR Transcription

Electronic health records (EHRs) are a reliable source of data for disease symptoms, laboratory results, and treatments, and medical transcription services play a role in ensuring this. However, experts are now mulling over the capabilities of electronic health records (EHRs) to deal with infectious diseases like the current pandemic.

In a recent Stat news report, two researchers from Duke University noted that COVID-19 will be “the ultimate stress test” for EHR systems, with challenges such as evolving workflows, data demands and cyber threats. EHR usability can be improved by planning around these flaws, say Drs Erich Huang, MD, and Eric Perakslis.

Improve EHR functionality and usability: EHRs are designed to track and bill procedures, rather than provide optimal patient care, say the researchers. An electronic medical record (EMR) has many tabs: the face sheet, history, problems, medications, allergies, visits, notes, lab studies and demographics. Patient data is not available in one place – the provider can get a clear picture of the patient only after clicking on each tab, which usually takes a long time. This is likely to become even burdensome with the influx of COVID-19 patients. Difficulties in assembling a cohesive narrative of the patient’s data can conceal the patient’s susceptibilities and risks for the coronavirus infection. The experts offer the following suggestions to improve EHR functionality and usability:
- Providing a patient-centric construct that allows clinicians to trace back the patient’s signs, symptoms, and diagnostic tests.
EHR optimization to deal with COVID-19: The experts recommend that increased resources and rapid updating of EHR systems to deal with this new infectious disease. EHR updates must accommodate new symptoms, comorbidities, risk factors, and the relevance of geographic location of COVID-19. Updates the system is crucial to improve clinical productivity and efficiency, improve patient care and reduce clinician burnout. EHR vendor Epic Systems has responded to this requirement with a COVID-19 update for its software. However, EHR are complex and updates are costly, resource consuming and slow, the researchers explained.
Use specialized mobile apps to support new or evolving EHR systems: This will help streamline patient evaluation, triage, interoperability and other essential functions that EHR workflows cannot handle.
Improve EHR interoperability capabilities: COVID-19 is also testing EHR interoperability capabilities. During a natural disaster or disease outbreak, it is crucial to be track patients using EHRs. But today’s EHRs are unlikely to have the capabilities to track hundreds to thousands of patients and ensure a proper response to COVID-19. The doctors made the following suggestions to improve information exchange during the COVID-19 pandemic:
- Deploying the application programming interface (API) provision in the ONC interoperability rule
- Ensuring IT staff is up to date with a hierarchy of technology, data, and business priorities
- Ensuring oversight and diligence on all computer IT procedures
- Increasing cybersecurity awareness, preparedness and activities to avoid the possibility of a ransomware outage during an epidemic.
The researchers also recommend adding scribes to enhance clinician efficiency as well as deploying analytic staff for COVID-19 reporting. Medical transcription companies specialized in infectious disease documentation can also help with this.
According to another study published in the Annals of Internal Medicine implementing travel history into the EHR can help put infectious symptoms in context for clinicians (www.ehrintelligence.com).

Infectious diseases such as Severe Acute Respiratory Syndrome (SARS) in 2002 and 2003, Middle East Respiratory Syndrome (MERS) in 2012 and 2013 were associated with very specific travel. COVID-19 is also similar. Implementing travel history could prompt warning signs and even protective measures to limit the spread of the disease, say the authors – Trish Perl, MD, chief of infectious diseases and geographic medicine at UT Southwestern Medical Center, and Connie Savor Price, MD, of the University of Colorado School of Medicine.

The suggestions are as follows:
- Implementing travel history as a vital sign, along with temperature, heart rate, respiratory rate, and blood pressure, travel history
- This detailed patient data can encourage further testing, and also help implement protective measures for individuals who come into contact with the patient
- EHRs can also integrate with travel history to customize immediate diagnosis for returning travelers
“We have the infrastructure to do this easily with the electronic medical record, we just need to implement it in a way to make it useful to the care teams. Once the infrastructure is built, we’ll also need to communicate what is called ‘situational awareness’ to ensure that providers know what geographic areas have infections so that they can act accordingly”, said Perl in a news release.

EHR data is very useful for infectious disease surveillance and has been successfully used to track the incidence of Lyme disease, detect newly diagnosed HIV infections, and assess time-based trends in sexually transmitted disease testing as a study published in Curr Infect Dis Rep. in 2019 noted. With the emergence of the novel coronavirus disease, it is imperative that EHR data use in public health surveillance activities continues to increase. Among other things, updating EHR systems to face the new threat is the need of the hour.

Common Prescription Errors and How to Prevent Them

19-March-2020 Rajeev Rajagopal Medical Transcription

Prescription Errors and How to Prevent Them

To err is human. However, when it comes to medications, errors in prescribing, transcription and administration can prove very costly by compromising patient safety and increasing healthcare expenditure. Outsourcing medical transcription to an expert can ensure accurate entry of orders into the EHR. But medication errors can occur in various other areas of the medication-use system, such as when prescribing drugs, when preparing or dispensing drugs, or when the drug is administered or taken by a patient.

The National Coordinating Council for Medication Error Reporting and Prevention defines a medication error as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer.”

According to an article published on www.mdlinx.com in February, 2020, the risks of adverse drug events are high in the U.S. as there are more than 10,000 prescription drugs on the market and about one-third of all American adults take five or more medications daily. What’s worrying is that most prescription errors are preventable.

Types of Medication Errors

Common prescribing errors, medicines and situations that can cause severe harm to patients and even death and include:

Use of the wrong medication, strength or dose – Incorrect medication, dosage strength or dosage form may be given to the patient. Wrong strength or dose can occur due to incorrect use of decimals while writing the dose of a drug. For e.g., confusion can occur and lead to incorrect medication administration in the following case: the medication order reads Administer M Sulphate 2g IV now and every 6 hours. Confusion can arise as to whether M Sulphate refers to magnesium sulfate (MgSO₄) or Morhine sulfate (MSO₄).
Mistakes due to same-sounding or look-alike drugs – Misreading medication names that look similar or sound similar is a common error. Unintended interchange of drugs can occur when medicines are prescribed verbally. For example, the FDA reported several instances of confusion between two drugs with similarity in names: Farxiga (dapagliflozin), a drug that lowers blood glucose levels in type 2 diabetes, and Fetzima (levomilnacipran), an antidepressant (www.mdlinx.com).
Administration of medications by the wrong route – Such errors include intravenous administration of enteral formulas, giving oral medications intravenously, mix-up of epidural and intravenous lines, and using intravenous medications orally.
Miscalculations when administering drugs intravenously – Intravenous medications are especially risky due to their greater complexity. Studies have shown that intravenous medication errors in the U.S. have a significantly higher rate of associated deaths than other medication errors. A 2015 study published in the British Medical Journal (BMJ) found that a large proportion of IV administration errors occur because of knowledge and/or skill deficiencies, and that these errors reduce in the first few years of clinical experience.
Errors in ordering and transcription – Common ordering errors include omission, orders that are incomplete and lack clarity, wrong drug, wrong time, wrong dose, wrong dosage form, patient allergy errors, and wrong patient. Transcribing errors occur when mistakes are made while manually transcribing orders into written records and those that are electronically transcribed into the EHR. Causes of transcription errors include incomplete or illegible prescriber orders, incomplete or illegible nurse handwriting, use of error-prone abbreviations, improper defaults in the EHR, and lack of familiarity with drug names, doses, or frequencies (www.ashp.org).
Omitted or delayed prescriptions for medicines – Delays and omissions in medication administration have been identified as being a major patient safety issue. Delayed medication refers to medication prescription or administration more than two hours after the time the dose is due. This can vary based on the condition being treated. An omitted dose can refer to failure to prescribe a drug in a timely manner or not administering a dose before the next dose is due. For once only doses, omitted dose refers to failure to administer dose within 2 hours of the time it is due. Omitted or delayed prescriptions can prolong patient recovery times and lengthen admission.

Best Practices to Avoid Medication Errors

The U.S. Food and Drug Administration (FDA) receives more than 100,000 U.S. reports each year associated with a suspected medication error. Following certain good practices can help minimize the risk of avoidable medication errors.

Clarity in dose instructions – To prevent confusion, doses should explicitly and routinely be prescribed.
Review medicine procedures – This can help identify critical medicines where timeliness and continuity of administration is important. Electronic prescribing and dispensing systems should be configured to support identification of critical medications.
Proper communication – Prescribers should communicate to other healthcare professionals, the patient and caregivers about an urgent prescription that requires dispensing and administration.
Understand drug interactions – Pharmacists and healthcare professionals need to recognize and be aware about the drug interactions can cause significant patient harm
Explaining potential interactions to patients – Adverse interactions can also arise due to patient error. Patient should be educated about therapeutic requirements, which can help prevent injury or poor outcomes.
Ensure medicines reconciliation – Effective medicines reconciliation is crucial when patients are admitted and discharged from hospital

Organizations should develop and implement specific strategies to address medication errors and prevent patient harm. Areas to focus include high-risk populations, high-risk processes, high-alert medications, and easily confused drug names medication (www.ashp.org). Transcription errors can be prevented by outsourcing EHR-related documentation task to a reliable medical transcription company. Established service providers have trained and experienced medical transcriptionists who can maximize the use of computerized prescriber order entry and ensure medication safety.

Telehealth a Viable Option to Combat COVID-19, especially for Seniors

16-March-2020 MTS TEAM Healthcare News

Telehealth a Viable Option to Combat COVID-19

U.S. coronavirus cases have reached 1000 at the time of this writing (March 11), leading authorities to limit public interaction and urge students to take classes online. Infectious disease specialists are staying prepared and vigilant to manage people with suspected exposure, while researchers are working round-the-clock to find drugs or vaccines to treat or prevent COVID-19. As the battle against the spread of the outbreak intensifies, some EHR vendors have updated their software to screen and support patients with 2019-nCoV. US based medical transcription companies are ensuring that frontline clinicians tackling COVID-19 get the efficient documentation support they require.

The healthcare industry is looking to telehealth to fight the spread of COVID-19. On February 25, Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC), recommended telehealth as a feasible option to triage and treat low-risk patients to reduce risks of transmission. However, Messonnier urged Congress to ensure that telehealth is a viable option for all seniors, since the fatality rate for older patients is significantly higher (www.modernhealthcare.com). First week of March, Congress passed a coronavirus response bill that will allow Medicare reimbursement for telehealth services to treat older adults at home.

COVD-19 poses serious risks for seniors, including death. A study of patients in Wuhan, where this infectious disease originated revealed that elderly patients are more likely to develop acute respiratory distress syndrome (ARDS), which causes severe breathing problems. The researchers also reported that patients who get ARDS are likely to be older and usually have other illnesses like diabetes, heart disease, and kidney disease (www.forbes.com). In fact, the CDC’s March 3 update recommended that individuals age 65 or older think about the actions they can take to reduce their exposure. Older adults do not have the immune tolerance that younger people have. Restricting face-to-face contact or social distancing has been recommended to prevent COVID-19 spread in communities.

Modern Healthcare lists many ways how telehealthis a practical option to help prevent the spread of coronavirus, and especially help seniors:

24X7 access to care: With telehealth, patients can access care quickly round the clock, without having to make a trip to the doctor’s office. Though there is no specific medication for the coronavirus, clinicians can use telehealth to provide patients with advice on self-care and also keep them under observation at home.
Ensures patients stay at home: By keeping patients at home, telehealth visits minimize community exposure. Patients who identified as at risk can avoid contact with other patients in waiting rooms and also the physicians who treat them. Video visits even allow providers to work safely from home.
Helps reserve in-person care for high-need patients: Telehealth will allow healthcare providers to focus on triaging and screening exponentially more patients with telehealth vs. an in-person visit. This will enable them to identify the critical cases that require attention in brick-and-mortar settings.
Allows patients to access infectious disease specialists: With telehealth, patients, especially those in rural areas, can get the specialized care they need from infectious disease experts across the country.

The coronavirus response bill that Congress passed authorizes about $500 million to allow for Medicare providers to administer telehealth services. In addition to providers, payers and vendors are also using telehealth to expand access to care (mhealthintelligence.com). Blue Cross Blue Shield Association (BCBSA) BCBS will expand access to telehealth and nurse-provider hotlines. Spectrum Health has announced free virtual screenings for individuals in Michigan who are experiencing possible COVID-19 symptoms, which will help determine those who need further evaluation Bright. md’s free COVID-19 evaluation and screening tool is available to all hospitals in the US. The tool will enable patients to access to advice from home, 24 hours a day, so that they can stay quarantined. If it finds that the patient has COVID-19, the software will direct the individual to care. Older people and those with severe chronic medical conditions have been advised to stay home as much as possible. Leading EHR vendor Epic says that their software is equipped with various tools to help treat and prevent the spread of COVID-19. Epic EHRs facilitate electronic visits, MyChart messages or video visit functions that allow patients to virtually connect with clinicians without going to the hospital and potentially infecting others.

As healthcare industry puts in its best efforts to combat COVID-19 with the support of the federal government, infectious disease medical transcription service providers will remain committed to providing accurate and timely support for proper management of medical records.

Optimize EHR Use with Medical Transcription Services and Improve Patient Safety

12-March-2020 Julie Clements EHR Transcription

Medical Transcription Still Relevant in the EHR Era

The introduction of Electronic Health Records (EHR) created the common belief that medical transcription will be wiped out from the medical industry very soon. However, medical transcription exists and continues to grow as members of the medical community are likely to use dictation and transcription in the future as well. Many providers outsource the transcription tasks to medical transcription companies to ensure accuracy and completeness of the documentation.

In spite of the many benefits the EHR system promises, one of its major disadvantages is that physicians have to spend more hours on computers to create patient records themselves, and spend less hours with the patients. As a result, doctors quickly become frustrated and experience burnout. This could affect the quality of patient care, reduce face-to-face consultation time, and lead to poor performance of the physicians.

A practical solution is the use of medical transcription. Even in this EHR era, medical transcription plays an important role in the medical industry. Several industry experts are of the opinion that nearly 50% to 80% of EHR implementation is a failure. Even though many believed that the integration of EHRs into the health care system will completely digitize the processes and put an end to transcription, the reality is that transcription services are still in considerable demand. Let us look at some statistics.

According to the Bureau of Labor Statistics, in 2016 there were approximately 57,400 medical transcriptionists or health care documentation specialists in the United States. The reports also show a 3% decline from 2016 through 2026. But healthcare providers will continue to hire medical transcription solutions as a part of revenue cycle management and also to document medical records effectively.

Cost reduction considerations: According to a recent report by Becker’s Health IT & CIO, in Buffalo, New York–based Catholic Health is investing more than $100 million in a project to implement Epic EHR. The project is targeted to take around 18 months. So, if healthcare units purchase these expensive projects there will be a rising need to curb expense and they will associate with reliable medical transcription vendors for lower line rate and tighter turnaround times.

To facilitate accurate documentation: To make the medical documentation process easier, the EHR system uses cookie-cutter templates, drop-down lists, and check boxes. The reality is that healthcare providers are expected to spend considerable time learning the integrated features of an EMR which may include any or all of the previously mentioned templates, drop-down lists, and seemingly endless screens of check boxes, as well as learn how to properly dictate. All these documentation tasks must be done at the time of the consultation and it leads to poor patient – doctor communication, lower quality patient care and poor performance by the physicians. This is a frustrating task for healthcare professionals. Reports have emerged in which physicians express a diminished enthusiasm for their profession, noting that administrative tasks were less about patient relationships and more about coding, billing, reimbursement, and compliance.

The Medscape Annual Survey 2017 indicated that 51% of physicians had frequent or constant feelings of burnout, the Medscape’s National Physicians Burnout & Depression Report 2018 showed 56% of the physicians saying documentation burdens contribute to burnout, and 24% blamed increased computerization of EHR work. So this shows that EHR affects the productivity of the physicians.

Speech Recognition and Medical Transcription

90% of hospitals plan to expand their use of speech recognition technology. Speech recognition works in two ways for documentation – back-end speech recognition and front-end speech recognition. In back-end speech recognition, the physician dictates, the audio is converted to text, and a trained medical transcriptionist edits the resulting document whereas in front-end speech recognition the dictator dictates directly into free-text fields and edits the transcription with no intervention necessary by the medical transcriptionist.

A report published in JAMA Network Open named “Analysis of Errors in Dictated Clinical Documents Assisted by Speech Recognition Software and Professional Transcriptionists,” found that the error rate reached 7.4 percent when documentation was generated by speech recognition software. The study included 217 documents dictated by 144 different physicians during the period Jan 1 2016 to Dec 31, at healthcare organizations that used Dragon Medical 360 | eScription by Nuance. Around 121 physicians’ specialities were known and there was a total of 35 specialities- 37.2% surgeons, 24.8% internists, and 38% other specialties. There was more than 7 percent error rate in documents that went through speech recognition software. A minor error in medical documentation poses significant risk to the safety of the patient and it also affects reimbursements. Dictators with different accents or dialects and those who mumble or dictate quickly will likely produce a report that requires thorough editing. According to a study “Error Rates in Physician Dictation: Quality Assurance and Medical Record Production,” published in the International Journal of Health Care Quality Assurance, the physician-as-editor model does not always take the time to edit and proofread their dictation.

So, from all the above aspects we can understand that medical transcription is still relevant in the healthcare industry. Speech recognition can be unreliable and requires supervision and intervention; it will not eliminate the need for skilled medical transcriptionists and health care documentation specialists.

In order to obtain error-free medical records, a blended approach of medical transcription and EHR system is the ideal option. Physicians can easily dictate their notes and then send them to skilled medical transcriptionists who transcribe the audio into accurate transcripts which are later integrated into the physicians’ EHRs. A reliable provider of US based medical transcription services uses HL- 7 interface to provide EHR-integrated medical transcription to healthcare providers.

Important Benefits of a Digital Pathology Environment

05-March-2020 Rajeev Rajagopal Pathology Transcription

The implementation of digitized medical record systems or electronic health records (EHRs) across the US has put patient information at the physician’s fingertips. US based medical transcription services play a key role in ensuring precise and timely EHR documentation. Even as it poses security concerns, digital health tools and services have become an integral part of people’s lives. One of the fields that has benefited from digitization in recent times is pathology.

According to the Digital Pathology Association, digital pathology incorporates “the acquisition, management, sharing and interpretation of pathology information – including slides and data – in a digital environment”.

In traditional microscopy, pathologists view glass slides under the microscope to provide a diagnosis. Glass slides or specimens need to be physically delivered to the pathology lab, which can delay diagnosis and patient care. Digital pathology on the other hand, provides pathology information in a digital environment. Glass microscope slides are scanned to create high-resolution digital images that can be viewed on a computer screen or mobile device.

The FDA authorized digital pathology for primary diagnosis in the U.S. in 2017. Factors driving the digitization of pathology include the increase in teleconsultations, measures to enhance lab efficiency, and use of digital pathology in disease diagnosis as a result of integration of digital pathology with digital tools, barcoding, specimen tracking, and digital dictation (www.globenewswire.com). Let’s see how digital pathology is improving the safety, quality, and efficiency of disease diagnoses in pathology laboratories.

- Improved workflow: Digital files can be used multiple times for diagnostics, sharing, and instructive purposes. Pathologists can save time spent on viewing and analyzing hundreds of specimen slides under a microscope. With digital images of tissues, pathologists can share digital images of tissues with healthcare providers in different locations – with just a click of the mouse.
- Improved and faster diagnosis: In conventional pathology, slides had to be shipped to other specialists, which could lead to delays, higher costs, and also increased risk of material damage or breakage. With digital pathology, second opinions can be obtained faster, and patients and clinicians no longer have to wait a long time for the diagnosis.
- Lowers costs: Sharing tissue slides digitally will help critical health information to be made available to patients and healthcare professionals not only faster but also at lower cost. It could also allow high throughput for volume pathology.

Other benefits of digital pathology as listed by Medical Sectra include:

- - Minimizes risk of missing data: Digital files can be easily stored and archived. Each image is automatically linked to the correct report via a unique number. Slides can no longer be lost and missing images can be marked
  - Improves pathologists’ efficiency: Digital work lists improve the pathologists’ efficiency by allowing them to easily keep track of their work. They can view tissue sections completed, those that need to be reviewed, which should be prioritized, and other details. Further, digitization increases flexibility by allowing pathologists to work from anywhere at any time.
  - Enhances analytical capabilities: In microscopic slide examination only a particular section of the tissue can be seen even at the lowest magnification. Digitization allows the entire slide to be viewed and analyzed on the monitor as well as zooming in to examine various areas. Further, several staining can be compared side by side. When viewed alongside with radiology images, digital pathology files can improve diagnostics.
  - Allows archiving: Digital pathology files can be easily stored and viewed at any time.

The digital pathology market is growing. Reports indicate that the increasing incidence of chronic conditions will drive the need to adopt digital pathology. As pathology laboratories seek to improve diagnostics via digitization, pathology transcription services can help ensure accurate documentation for laboratory reports.

AI is Transforming Transcription, but Human Intervention May Be Needed

02-March-2020 MTS TEAM Medical Transcription

New AI Technology Transforming Medical Transcription
Technological advancements in the healthcare industry have enabled physicians and other healthcare providers to better diagnose and treat their patients well. The healthcare industry has undergone various technological advancements over the past few years like EHR implementation, voice recognition technology etc that have enhanced the workflow in every healthcare unit. Along with other advanced technology, EHR-integrated medical transcription service also plays a crucial role in improving the overall patient care. With advanced technology, transcription, transport, workflow, delivery and safe storage of medical records can be carried out without any hindrance and it also facilitates continuous work stream.

The latest advancement in the field of healthcare is that Nuance Communications, Inc. (NUAN) has announced that its Dragon® Medical One cloud-based platform is now available in France, Belgium, and the Netherlands. It is integrated within the electronic health record (EHR), Dragon Medical One enables French – and Dutch-speaking physicians to capture a patient’s complete story at the point of care. This minimizes administrative workloads and enables better medical record documentation with extra care and quality.

This system is already used in the US, UK, Canada and Australia and Dragon Medical is trusted by more than 500,000 clinicians worldwide and it helps to minimize the burden of documentation. It also ensures up to 45 percent faster and capture up to 20 percent more relevant data using personalized tools on wide range of devices. Clinicians simply open the application, choose the section they need and start speaking to update their EHR. According to Dr. Paul Altmann, Consultant Nephrologist and Chief Clinical Information Officer, Oxford University Hospitals NHS Foundation Trust in the United Kingdom, with the implementation of Dragon Medical One, there is a dramatic change in clinic letter turnaround time, delivering efficiencies in the process, as well as improving overall patient experience. Nuance has helped accelerate the adoption of their electronic health record. Robert Dahdah, Executive Vice President and Chief Revenue Officer, Nuance said “No matter their location, physicians face the same pressures of administrative workloads, and have the same needs for tools that help them focus on providing the best possible care to their patients.”

The Need for Human Intervention

AI-assisted technology does improve efficiency and saves time and money. But to ensure utmost accuracy there is the need for human touch. While artificial intelligence is able to do most of the heavy lifting in transcription work, the technology is not yet faultless. Therefore, we need human transcribers to ensure accurate transcripts, with professional transcriptionists acting more as editors now.

Similarly, it is not possible for the AI algorithms to work exclusively without human touch in areas like data collection, data annotations and validation to build an ideal system.

Data collection: Having a consistent, diverse source of data points is especially important for algorithms that need to be changing constantly. For example, voice recognition tools that need to recognize new slang or industry terms. After data collection it needs to be transformed into something a computer can understand and it requires human assistance.
Data annotation: Unorganized data is not useful for AI. So, professionals can annotate semantically, categorize text and content, extract entity information and bound images and video. The organized data can be fed to the algorithm.
Data validation: No algorithm is complete without testing. Test users for AI need to be as similar as possible to the targeted users of a “complete” algorithm to make sure the system will understand their inputs. So, we need skilled industry professionals who can help annotate date to test drive AI output.

Advanced technology along with the support of a reliable medical transcription company that offers EHR-integrated medical transcription helps to streamline clinical documentation without compromising on quality patient care.