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.

Deprescribing to Improve Patient Safety and Quality of Care

27-February-2020 Julie Clements Medical Transcription

Medications are an essential component of care. Medical transcription outsourcing helps providers maintain clear and concise documentation of the medication process in patient records. Complete, accurate medication documentation is essential for proper clinical decision-making and to prevent adverse events. However, while physicians are taught to prescribe medications, they receive no clear guidance on “deprescribing” unnecessary medications. Deprescribing is defined as “adjusting medications down to the minimum effective dosage or stopping them when a patient’s health status changes in a way that medication burden or potential for harm outweighs the benefit of the medication” (www.aafp.com). Physicians understand deprescribing but guidelines typically include recommendations for initiating medications, but not stopping them. As a result, polypharmacy – the concurrent use of multiple medications by a patient – is high and increasing across the country. Many recent studies stress the need for reducing inappropriate polypharmacy to improve patient safety and quality of care. Polypharmacy – An Increasing Medical Burden Older people and those with multiple chronic diseases are at a higher risk of polypharmacy and potentially inappropriate medications. A paper published in Science Direct lists the factors that increase the risk of polypharmacy as:

Increasing age
Increased intake of over-the-counter medications in addition to prescription medications
Use of supplements or herbal options
Multiple hospitalizations or emergency room visits
Treatment by multiple providers

Multiple medications pose a cost burden for the patient as well as the nation at large. It puts patients at increased risk for adverse drug-to-drug interactions, falls, hospitalizations, psychological distress, malnutrition, nursing home placement, pneumonia, and death. Report: 5 Medications that can be Deprescribed Physicians put a patient on a medication to see whether it will help with certain symptoms, but then the medication may be never stopped. According to a recent article in MD Linx, there are five common medications that physicians should consider describing: proton pump indicators (PPIs), statins, antibiotics, antimuscarinic medications for overactive bladder, and benzodiazepines. The article cites the findings of various studies to support the case for deprescribing these drugs.

PPIs: Purchased over the counter, PPIs are widely prescribed and often used for much longer than the 2 weeks for which they are needed. Though they are generally considered safe, PPIs are associated with serious adverse events such as cardiovascular disease (CVD), pneumonia, osteoporotic fractures, Clostridioides difficile infections, acute kidney injury, chronic kidney disease, dementia, upper gastrointestinal cancer, and death.
Statins: Statins are one of the most commonly prescribed drugs for lowering cholesterol levels in blood and reducing risk of heart disease. However, recent research shows that some patients only achieved very small reductions in risk of CVD by taking statins. The researchers suggest that physicians should weigh the potential risks and benefits of taking statins daily before prescribing the medication.
Antibiotics: According to the CDC, at least 30% of the estimated 154 million antibiotic prescriptions written each year in US outpatient settings are unnecessary. Antibiotics aim to fight infections, but overuse and misuse of antibiotics have led to the development of antibiotic-resistant pathogens. Risks of over prescribing also include increased disease severity and length, health complications, increased healthcare costs, re-hospitalization, and medical treatment for health problems that could have resolved on their own.
Antimuscarinic medications for overactive bladder (OAB): Antimuscarinic agents are widely used to treat urinary dysfunction in patients with OAB but come with many adverse effects, including cognitive impairments and death. Moreover, a study published in The Pharmaceutical Journal found that a major reason for patients not restarting treatment was that they experienced no difference in symptoms on or off treatment.
Benzodiazepines: According to a recently published study, 30.6 million adults (12.6 percent) use benzodiazepine. Of this 12.6 percent, 10.4 was prescribed and 2.2 percent was misuse. Overall, misuse accounted for 17.2 percent of use. The MD Linx article points out that 5.3 million Americans take benzodiazepines in a way not prescribed by their physicians and that benzodiazepine-related deaths increased from 135 in 1999 to 11,500 in 2017.

Reducing Inappropriate Polypharmacy The focus of deprescribing is to reduce or stop medications that no longer benefit the patient. This should be done when a patient’s health status changes in a way that the medications’ potential for harm is greater than the benefit the medication offers. A January 2019 AAFP article outlined ways to start deprescibing for a patient:

Identify the medications that are potentially harmful to the patient
Determine if the medication can be reduced or stopped
Initiate conversations with the patient to help them understand the benefits of stopping the inappropriate medication/s
Routinely check if the medication is responsible for causing falls, or other adverse events
Setting up alerts for legacy prescribing in the prescription system to prevent legacy drugs from being continued beyond their intended duration
Plan drug tapering and withdrawal
Monitor and support the patient in case of adverse withdrawal events

The goals of deprescribing should be prevent disease from getting worse or causing withdrawal effects, reduce medication burden, better control chronic conditions and improve quality of life. As physicians focus on the development of interventions to reduce inappropriate polypharmacy, medical transcription companies can help with their EHR-related documentation tasks. Proper documentation of medication management in patient progress notes is an essential step towards improving patient safety.

Technologies and Techniques to Improve Operating Room Safety

24-February-2020 Rajeev Rajagopal Medical Transcription Outsourcing

Patient safety in the operating room (OR) has improved significantly over the years. However, while EHR surgical workflow modules and medical transcription services have improved preoperative patient management and postoperative patient management, the challenge of providing safe surgical cares till remains. Reports say that most adverse events in OR are preventable and caused by communication failures and human errors such as lack of focus. Today, there are a wide range of technologies and techniques to help surgical teams improve patient safety in the OR.

Here are some innovative developments in OR safety:

Black box technology: In January, Northwell Health began implementing black box technology in its operating rooms. The functions of the OR Black Box are similar to the black boxes or flight data recorders in airplanes. Developed by Toronto-based surgeon TeodorGrantcharov, the technology captures information during surgeries. This high-tech system to improve safety features cameras and microphones to record the video and audio of the operative procedure as well as physiological data from the patient and the anesthesia monitor. The system then coordinates and reconstructs the data to facilitate review and improve care. Using algorithms, it can detect potential issues and alert a surgeon. Dr. Mark Jarrett, senior vice president and chief quality officer at Northwell Health, believes the OR Black Boxes enables surgical teams to learn, minimize risk and improve care. “It is a proactive approach to improving safety and replicating favorable practices”, says Dr. Jarrett (www. libn.com).
OR simulation lab: Since 1999, Newark Beth Israel Medical Center in the RWJBarnabas Health network has offered a training program for its employed nurses as well as recent graduates to develop OR-specific skills. This year, Modern Healthcare reported that the system took the program a step further by setting up a simulation lab in an unused OR with mannequins and other equipment. This allows nurses to practice skills tasks multiple times till they can do it accurately and confidently in a risk-free environment. The program trains nurses on preparing the patient for surgery and handling and using surgical instruments. It’s all about improving patient safety, experience and comfort.
A recent article in Outpatient Surgery (February 2020, Vol XXI, No. 2) discussed several products and technologies designed to protect patients from preventable harm:
Non-invasive monitoring platforms: Pulse oximetry and capnography monitorsare extremely valuable for monitoring basic vital signs. While pulse oximetry monitoring measures the degree of hypoxemia in arterial blood, capnography is a method to estimate the partial pressure of carbon dioxide in the arterial blood. Both are literally life-saving platforms.
Videolaryngoscopy: A standard laryngoscope blade is a easy to use, safe and effective airway management option, but poses problems for complex patients with numerous comorbidities. Challenges may arise due to limits in neck flexibility, narrow jaw opening, enlarged tongue, poor tissue mobility, or cervical problems. Videolaryngoscopy reduces the risk of intubation failure and other complications in patients with a difficult airway.
Stabilizing pads: When placing patients in basic supine and lateral positions, surgeons can use positioning pads to prevent risk of pressure injuries and nerve damage. Stabilizing pads can be used to prevent patients from slipping on the surgical table. In addition to appropriate positioning, pressure points should be well-padded.
Endoscope maintenance: Endoscopes are difficult to clean and disinfect. Adenosine triphosphate (ATP) testing and borescopes can help keep endoscopes safe and sterile. ATP testing can detect presence of biological matter and bacteria growth in an endoscope’s lumens. Borescopes can detect impurities inside the endoscope’s channels that can jeopardize patient safety. Proper scope care also includes drying after proper disinfection. Today, integrated forced-air drying platforms have revolutionized the scope drying process.
Medication identification measures: A medication error is any preventable event that may cause or lead to wrong medication use or patient harm while the medication is in the control of a health care professional or patient. Several factors contribute to preventable medication errors in the OR. High-tech barcoding systems and automated medication dispensing cabinets are effective medication safety solutions, but their use is limited to hospitals and large surgery centers. Medication labeling can help staff indentify and administer the correct medication.
Preventing retained surgical items: Studies have found that 4,500 to 6,000 surgical item cases occur annually in the U.S. Detection technology is the best way to make certain that all surgical items are accounted for and recorded. Options to prevent retained surgical items include fixing radiofrequency tags on sponges and towels and abdominal wanding to detect barcoded sponges.

According to a World Health Organization study that analyzed the challenges of increasing complexity in medical technology, the main reasons for adverse events related to new technologies are lack of proper training and longer learning curves. So operating room safety can be improved only through assessment, improved training and coordination of the surgical team, open communication, and a willingness to adapt and adopt new skills and processes.

Operating room safety also depends on effective documentation of patient care. As surgeons focus on patient safety and care delivery, medical transcription outsourcing can help ensure quality documentation before and after operations.

How Artificial Intelligence is adding Value to Radiology

20-February-2020 MTS TEAM Radiology Transcription

As a US based medical transcription company that provides HIPAA compliant radiology transcription services, we closely track developments in diagnostic imaging and related areas. Recent reports indicate that artificial intelligence (AI) and machine learning (ML) are creating inroads into these fields, offering radiologists many opportunities to increase workflow efficiency and productivity, improve patient care, and reduce costs. Let’s take a look at the benefits of AI applications in radiology.

Improved Diagnosis

AI promises improved diagnosis. Diagnostic tools can be trained using cutting-edge technology to read radiologic scans and tissue samples. Radiologists can take advantage of AI and ML to find abnormalities in patient scan images that could help lead physicians to arrive at the right diagnosis. In a study published in Radiology in 2018, AI was able to detect Alzheimer’s disease in brain scans six years prior to diagnosis with 98% accuracy. As advanced tools automate repetitive tasks and help radiologists prioritize cases or secondary reads according to tumor detection, they can provide patients with a more accurate diagnosis (www.itnonline.com).

Current FDA approved algorithms allow identifying suspicious pulmonary nodules, reducing CT dose, identifying intracranial haemorrhage, spinal fractures, pulmonary embolism, pneumothorax, and rib fracture. An article in Radiology Business noted how experts developed a way to use AI to overcome diagnostic challenges in pediatric elbow abnormailities by automating the elbow radiograph analysis. It’s not easy to diagnose elbow injuries in children using X-rays due to the unique features of the developing skeletal system. Also, fracture patterns in children’s elbows vary significantly depending on the child’s age and certain developmental factors. The researchers solved these problems by developing an AI elbow application model that could process multiple views of the pediatric elbow, and recognize patterns in an image and classify if something is present or not.

The BBC recently reported on a study which found that AI outperformed doctors in diagnosing breast cancer. The AI model developed by an international team was as good as the current NHS double-reading system of two doctors. An expert noted that AI promises to make breast cancer screening more accurate and efficient, reducing waiting time and worrying for patients, and providing better outcomes. However, the report points out that while AI would eliminate with the need for dual reading of mammograms by two doctors, easing pressure on their workload, it would not replace the radiologist. At least one radiologist would be in charge of diagnosis.

Continuous Learning

AI can also support continuous training of radiologists and other healthcare professionals (www.itnonline.com).AI and ML can create feedback loops – the process through which inputs of a system are plugged back. When radiologists are notified of a pathology or surgical result, this will allow radiologists to easily access previous cases with similar outcomes/diagnosis, helping them learn more and improve future processes.

Cybersecurity

Radiology practices are as vulnerable to cybersecurity threats as medical practices. The complex radiology environment comprises various systems where protected health information (PHI) is transmitted and stored. This includes RIS, PACS, imaging equipment, mobile devices, e-mails and other messaging systems, cloud storage, patient portals, and revenue cycle management systems. Moreover, many processes are managed by business associates such as medical transcription companies, medical billing and coding companies, etc. The increasing use of these systems and processes has increased risk of security breach. Radiology practices need to take steps to protect patient records and reduce the likelihood of a breach. The Imaging Technology News article recommends that radiologists should implement an effective AI security solution that includes protecting all AI-powered systems, leveraging AI to improve cybersecurity, and using AI to predict attacks.

Reimbursement

With declining reimbursement rates for image reviews, radiologists are under increasing pressure to read and interpret more images to meet their productivity goals and stay in business (www.healthanalytics.com). At the same time, the increasing amount of data that radiologists have to interpret is also leading to burnout and taking attention away from patients. The need to read images quickly can also affect accuracy of results. Misdiagnoses can be harmful and costly to patients’ health as well as to radiology business.Advanced algorithms can identify abnormal results more accurately and quickly compared to radiologists, easing their burden and overcoming reimbursement related challenges.

AI products are set to take on more complicated and complex problems in the radiology scenario. To succeed with AL and ML, radiologists need to be educated on the benefits of using AI, as well as how to use the tools correctly. Importantly, providers must also be able to identify when AI errs, says Mitchell Schnall, MD, chair of the radiology department at the Perelman School of Medicine at the University of Pennsylvania (diagnosticimaging.com).

Radiologists educate themselves on AI and practice using the tools at the the ACR AI-Lab created by the American College of Radiology’s (ACR) Data Science Institute. This tool allows radiologists to access learning videos and cases as well as to design their own to test how the technologies work.

Even with advances in technology, radiology practices will continue to need reliable transcription services to produce reports as quickly and efficiently as possible. This will allow the requesting physician to read and act upon radiology reports in a timely manner for proper patient management.

Global Medical Transcription Market to Reach USD 16.64B by 2024

17-February-2020 Julie Clements Medical Transcription

Global Medical Transcription Market to Reach USD 16.64B by 2024

This is an update to the blog “Medical Transcription Service Market to Witness Growth Through 2019”.

According to an earlier market research report from Technavio, the global medical transcription market is expected to grow by USD 16.64 billion during 2020-2024, at a CAGR of over 5%. One of the major factors that will have a positive impact on the growth of the market is the rising need for automation of medical transcripts in the healthcare sector. Increasing healthcare data is the major factor that leads to process automation. Medical transcription service that is automated will help to overcome all challenges associated with time and efficiency. Many manufacturers are also introducing automated transcription with technologies such as speech recognition systems. This helps in integrating medical data by various information systems of hospitals and compiling patient information at a single place, which is nationally accessible.

Technavio’s most recent market research analysis has found that the medical transcription industry is projected to expand at a compound annual growth rate (CAGR) of 6.04% from 2022 to 2027. It is anticipated that the market will grow by USD 24,676.02 million.

The market is segmented on the basis of geography (APAC, Europe, MEA, North America, and South America) and end-user (hospitals and physician groups and clinics). Based on end-user, the growth rate of the medical transcription market by the hospitals segment is expected to be faster compared with the physicians’ groups and clinics segment.

Key Catalysts for the Growth of Medical Transcription services

Key factors that are contributing to the market growth by the hospitals segment include:

Improvements made in the existing hospital IT systems to maintain patient records efficiently
Rise in stringent government regulations that ensure data privacy and security in the hospital IT systems
Expansion in the adoption of cloud-based systems for MT and automated speech recognition software
The need for automated transcription in healthcare facilities to improve patient care, accessibility, accuracy, and time efficiency.

Important Market Trends for Medical Transcription

One major development that will affect the expansion of the global medical transcription industry is the development of speech recognition technologies. Medical report transcription can be automated with speech recognition software. Without requiring human input, the software translates audio files to text. It is simple to integrate software-automated text data into information systems and share information with medical specialists for additional therapy. The global market for medical transcription is thus anticipated to expand during the forecast period due to the inclusion of voice recognition technologies.

Geographically, North America is one of the largest markets and the region will provide major growth opportunities to vendors over the forecast period. Almost 41% of the overall market’s growth will originate from North America during the forecast period. Key factors that are contributing to the growth of the market in this region are investments in advanced IT infrastructure and innovation. The key areas for investments in healthcare IT are big data analytics and cloud-based tools. Also, adoption of automated cloud-based voice recognition systems and structured medical cloud storage has increased. The US and Canada are the key markets for medical transcription in the region. However, the market growth rate in these regions will be slower than that of APAC during the forecast period.

As per another recent report by Technavio, hospitals saw a steady rise in market share in 2017, reaching USD 30,413.25 million, and by 2021, the market share was still rising. The goal of the government’s stricter laws is to guarantee system security and privacy for data. Furthermore, further expenditures in IT and healthcare will spur advancements in cloud-based computing and automatic speech recognition. Over the course of the forecast period, these factors are anticipated to propel the medical transcription market at a steady pace. In addition, the study offers a synopsis of the historical and projected market shares, their respective categories, and the factors driving growth between 2017 and 2027.

Key Players

Major medical transcription companies discussed in the report include

Acusis LLC
Excel Transcriptions Inc.
Global Medical Transcription LLC
iMedX Inc.
Lingual Consultancy Services Pvt. Ltd.
MModal IP LLC
MTBC Inc.
nThrive Inc.
Nuance Communications Inc. and
World Wide Dictation Service of New York Inc.

Competition among key players is prompting them to introduce several innovative and advanced technologies. Though the fast-growing market will offer vast business opportunities to the vendors, concerns about medical data privacy will challenge their growth. The report recommends market vendors including U.S. based medical transcription companies to focus more on growth prospects in the fast-growing segments, while maintaining their positions in the slow-growing segments to make the most of the opportunities.

Do you want to know about the significance of medical transcription in a hospital?

Read our blog post, 5 Ways in Which Medical Transcription Is Important in a Hospital Setting.

Find out how our advanced medical transcription services can enhance efficiency and accuracy in your practice.

Importance of a Comprehensive HIPAA Risk Analysis

13-February-2020 Rajeev Rajagopal HIPAA Compliance

The U.S. Department of Health and Human Services Office for Civil Rights (OCR) recently announced new enforcement actions and settlements for violations of Health Insurance Portability and Accountability Act (HIPAA) rules. These actions provide several key takeaways for healthcare providers, other covered entities, and their business associates such as medical transcription companies. OCR’s announcement came following a healthcare provider’s failure to report a breach of protected health information (PHI) and continued noncompliance with the HIPAA Rules, including failures to conduct thorough, enterprise-wide HIPAA security risk analyses and implement HIPAA Security Rule policies and procedures. Covered entities that don’t conduct a comprehensive HIPAA risk analysis are at risk for penalties for HIPAA violations.

The HIPAA Security Rule defines a risk analysis as an “accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of electronic protected health information held by the covered entity or business associate.”
HSS recommends that, based on the likelihood and impact of potential risks to e-PHI, covered entities should implement appropriate security measure to address those risk areas. The security measures and the reason for adopting those measures should also be documented.

According to OCR’s guidance, a HIPAA risk analysis should include the following nine elements (www.healthitsecurity.com):

Wide scope of analysis: Organizations should assess the potential risks and vulnerabilities to the confidentiality, availability, and integrity of all ePHI it creates, receives, maintains, or transmits in any form and/or location. Even email, spreadsheets, Word documents, and PowerPoints should be examined for ePHI, noted a legal expert in the Health IT Security article.
Collect and examine data: Data should be collected to identify where the ePHI is stored, received, and maintained. Data collection can be done by reviewing past and/or existing projects, performing interviews, reviewing documentation, etc.
Recognize and document potential threats to ePHI: anticipated threats to ePHI and vulnerabilities that can lead to disclosure of ePHI should be identified and documented.
Security measures: Current security measures used to protect ePHI should be evaluated to ensure that they are configured and used properly. It should be checked whether security measures mandated by the Security Rule are in place.
Determine the probability of threat occurrence: Organizations should consider the likelihood of possible risks to ePHI and document all threat and vulnerability situations along with likelihood estimates that may affect the confidentiality, availability, and integrity of ePHI.
Assess the potential impact of threat occurrence: The extent of the potential impact resulting from a threat triggering or exploiting a specific vulnerability that can compromise the integrity of ePHI should be assessed and documented.
Determine the level of risk: All threat and vulnerability combinations identified during the risk analysis should be assigned risk levels. Corrective actions to be performed to mitigate each risk level should also be documented.
Finalize documentation: Good risk analysis documentation is crucial to the risks management process.
Make risk analysis a continuous process: Risk analysis should be periodically reviewed to see if updates are needed. The Security Rule does not specify frequency of performance and this will differ among covered entities.

HIPAA Compliance: Medical Transcription Outsourcing Alert

In 2018, KrebsonSecurity reported on an ePHI breach in a Kansas-based company that provides medical transcription services for hospitals, clinics and private physicians. The breach, purportedly due to a “ransomware infestation”, resulted in leaking of sensitive patient medical records for thousands of physicians, according to the report. Issues reported include exposure of the password-protected portal physicians use to upload audio-recorded notes about their patients for transcription as well as unauthorized access to the numerous online tools intended for use by the employees of the medical transcription company. The site was taken down and rebuilt following this ransomware attack.

In 2015, we reported on predictions about rising incidence of healthcare data breaches. The ever-increasing number of access points to PHI and other sensitive data through electronic medical records (EMRs) and the growing popularity of wearable technology have contributed to making healthcare data a vulnerable target for cyber criminals.

These breaches should serve as a reminder for organizations to closely monitor outsourcing medical transcription services and other functions that involve transferring and maintaining data online. Here are some of the important considerations when choosing a healthcare outsourcing company:

Ensure that the company is HIPAA compliant
Has a non-disclosure agreement drawn up with the employees
Ensures that your data is securely stored
Employs strong encryption

A reliable HIPAA compliant medical transcription company will be alert to updates in HIPAA compliance and enforcement actions. Such companies undertake periodic risk assessments to protect against breaches and ensure secure handling of sensitive patient data.

Strategies to Reduce Communication Barriers and Improve Patient Handoffs

10-February-2020 MTS TEAM Medical Transcription

Strategies to Reduce Communication Barriers
Keeping accurate, up-to-date patient records is a professional requirement and crucial to deliver excellent and safe patient care. U.S. based medical transcription companies play a key role in helping physicians across all specialties maintain accurate healthcare documentation. Up-to-date information about patient care, treatment, condition, and any recent or probable changes is necessary to prevent communication gaps during patient hand-offs. However, according to The Joint Commission (TJC), 80% of medical errors occur due to communication gaps, often within a handoff.

TJC defines a patient handoff as a “contemporaneous, interactive process of passing patient-specific information from one caregiver to another for the purpose of ensuring the continuity and safety of patient care.”

There are different types of handoffs:

Physician-to-physician
Shift-to-shift
One unit to another
Nursing unit to diagnostic area
Patient discharge and transfer between facilities
Between special settings, such as the emergency department and the general medical ward, between the operating room and the ICU, etc

The American College of Emergency Physicians considers the patient handover “the most dangerous point in a patient’s ED journey (www.ems1.com). Care transitions are risky as they give rise to opportunities to make mistakes, mostly due to communication gaps and lapses. According to a 2015 Report from The Risk Management Foundation of the Harvard Medical Institutions Inc., communication failures in U.S. hospitals and medical practices were major factors in 30% of its malpractice claims, with malpractice costs amounting to $1.7 billion in over five years. Enhancing communication during transitions of care can improve patient safety, reduce malpractice risk, and decrease healthcare costs.

Four Ways to Improve Patient Hand-off Communication

Combination of verbal and written components: Hand-off communication can take place face-to-face, by phone, or via the medical record. Direct interaction between providers or face-to-face exchange of information is the preferred form of verbal communication as it involves discussion between the parties involved. The electronic report is a handoff tool within the electronic medical record (EMR) that staff can use to review information in an electronic format during the handoff process. Medical transcription outsourcing can help givers of information ensure robust information on the patient in the EMR. Digitized records allow clinicians who receive the information to recognize and review trends and identify important issues that needed to be acted upon. According to the American College of Obstetricians and Gynecologists, the most effective handoff of patient information includes both verbal and written components.
Standardization: The TJC strongly recommends standardizing the hand-off process by implementing a suitable strategy. Two common hand-off transition interventions are:
- SBAR (situation, background, assessment and recommendation), and
- I-PASS (illness severity, patient summary, action list for the next team, situation awareness and contingency plans, and synthesis and “read-back” of the information)
Organizations can adopt either of these strategies, as long as the information provided is structured and thorough.

Risk management: Identify situations in which handoffs occur in the course of patient care so as to spot risk points and identify critical opportunities for improvement. Based on this, a formal policy and procedure can be established for patient handoffs, including written and oral communication to support standardization (using SBAR or I-PASS). This will allow the development a specific strategy for handling hand-off communication data on a regular basis.
Education: The entire healthcare team should work on assessing and enhancing communication skills.
- All team members – physicians, nurses, and others – should be provided with effective tools to ensure seamless communication exchanges.
- Staff should be trained in the patient handoff policy and step-by-step protocol
- Both individuals and teams should learn and hone the skills needed to handle routine and rare events as well as on-call situations. Essential skills include performing time-outs, speaking up, attentive listening, how to give and receive orders, and documenting accurately.
- Training together will ensure all members involved in the hand-off process develop teamwork communication skills
- Conducting periodic audits can ascertain whether staff is adhering to the designated procedure
- Retraining staff regularly and especially after a handoff error, and developing methods to minimize irregularities and correct errors

Timely, accurate, consistent and complete documentation is a critical component of effective communication in patient handoffs. Whether written or electronic, information related to transfer of patient care should the following key elements: pertinent demographic information, a brief history and the results of a physical examination, an active problem list, medications and allergies, pending test results, ongoing or anticipated therapy, key patient values and preferences, and any other critical information, which should be documented in the patient’s medical record if not already present (www.acog.org). Outsourced medical transcription services are a practical option to ensure accurate and up-to-date information regarding patient care.

Team work is essential to prevent communication failure. As the American Academy of Pediatrics points out in a recent article, “Fumbled handoffs do not have to happen. Clinicians working together to improve two-way communication is a game changer in patient care”.

Coronavirus Outbreak – U.S. Hospitals Must be Prepared

03-February-2020 Rajeev Rajagopal Diseases and Conditions

It is time U.S. hospitals prepared for another emerging infectious disease – Coronavirus infection, after Zika and Ebola.

With the recent Coronavirus outbreak, first identified in Wuhan, Hubei Province, China, U.S. hospitals are getting prepared to screen and treat patients with this deadly viral infection. The Centers for Disease Control and Prevention (CDC) along with the World Health Organization (WHO) is closely monitoring this outbreak. According to WHO, the main symptoms of this infection are fever and lesions in both lungs. Some patients have reported difficulty breathing too.

Advisory Board says that as of now, Officials in China have reported 132 deaths and 5,974 confirmed cases of this virus. Coronaviruses are a large family of viruses that cause a range of illnesses including the common cold and more severe diseases such as MERS (Middle East Respiratory Syndrome) and SARS (Severe Acute Respiratory Syndrome). Coronaviruses are transmitted between animals and people. The first case of novel coronavirus in the U.S. was reported on January 22 in Washington State.

There is no vaccine or specific treatment available for 2019-nCoV (2019 novel coronavirus). The CDC clinical criteria for a 2019-nCoV patient under investigation (PUI) have been developed based on what is known about MERS-CoV and SARS-CoV and are subject to change as additional information becomes available.

2019-nCoV Spreads to the U.S

Now, five cases of the virus have been confirmed in the United States, including people in Arizona, California, Illinois and Washington. All of them had travelled to Wuhan, China, where the outbreak began. However, CDC is monitoring 110 people across 26 states for possible infection and expect to see more cases in the U.S.

The CDC recently announced that it has deployed more than 100 staffers in 3 US airports to screen for the emerging coronavirus from China.

What U.S. Hospitals Should Do

In an advisory, the American Hospital Association (AHA) has advised its members to follow CDC’s interim guidance, when evaluating patients with fever and acute respiratory illness. Based on this Interim Guidance on Outbreak of 2019 Novel Coronavirus (2019-nCoV), patients in the United States who meet the following criteria should be evaluated as patient under investigation (PUI):

Fever and symptoms of lower respiratory illness (last 14 days before symptom onset)
History of travel from Wuhan City, China
Close contact with a person who is under investigation for 2019-nCOV while that person was ill, or
Close contact with an ill laboratory-confirmed 2019-nCoV patient

As a part of emergency preparedness for infectious disease, it is crucial that hospitals make changes in their EHR systems. They can also incorporate coronavirus-specific questions into their EHR systems. For instance, Massachusetts General Hospital has a travel navigator alert in its EHR that documents areas of concern for certain infectious diseases. There will be questions on travel to certain areas. If patients answer “yes,” it would trigger the automated alert for specific testing and care precautions. Providers should also inform their medical transcription companies to make such changes in their EHR system for better medical records management.

Health care providers should –

Obtain a detailed travel history for patients being evaluated with fever and acute respiratory illness
Evaluate patients and discuss their case with public health departments, if their clinical presentation is vague
Provide isolated treatments for patients at risk of having the virus
Notify about any PUI to both infection control personnel at the healthcare facility and local or state health department
Advise everyone in their locality to avoid unnecessary travel to Wuhan, China
Recommend patients who traveled to China in the past 14 days and have fever, cough, or difficulty breathing, to seek medical care right away and to avoid contact with others
Make PUIs wear a surgical mask as soon as they are identified
Assess suspected patients in a private room with the door closed, ideally an airborne infection isolation room

Providers and staff caring for PUIs should wear gloves, gowns, masks, eye protection, and respiratory protection. To increase the probability of detecting 2019-nCoV infection, CDC recommends collecting and testing multiple clinical specimens from different sites, including all three specimen types-lower respiratory, upper respiratory, and serum specimens. Currently, diagnostic testing for 2019-nCoV can be conducted only at CDC. Providers must also stay updated by accessing AHA’s webpage for hospitals about the outbreak.

Top Strategies for Reducing Patient No-Shows

30-January-2020 MTS TEAM Medical Transcription Outsourcing

Efficient and timely medical transcription services allow physicians to focus on care and ensure precise patient scheduling, among other things. However, missed appointments or patient no-shows are a major concern in primary care settings and across different medical specialties in the U.S. A patient no-show is defined as a scheduled appointment that the patient neither uses nor cancels. A study published in Laryngoscope in March 2018 reported an overall no-show rate of 20% for 22,759 scheduled clinic visits at a single academic Otolaryngology department. Other studies have found that the rates of no-shows in primary care setting in the U.S. ranged from 5% to 55%, according to research published in the Journal of Family Medicine and Disease Prevention in 2018.

Consequences of missed appointments

When patients don’t show up for their appointments, it creates administrative and financial problems for practices. Physicians lose their valuable time. The whole practice is put behind schedule and staff is left struggling to adjust the rest of the day. An appointment that is not canceled on time prevents the practice from reassigning the slot to another patient. One study found that an unused time slot cost individual physicians an average of $200 (www.forbes.com). Medbridge Transport reported that a practice with multiple physicians can have 14,000 unfilled time slots each year, and that patient no-shows cost the healthcare industry $150 billion annually.

Missed appointments are also detrimental to patients’ health. Missing appointments interrupts continuity of care, monitoring of medication efficacy, and timely delivery of preventive services and screenings. When a patient with an acute illness does not show up, the condition could get worse and progress to chronic with complications.

Why do patients miss appointments?

The common reasons why patients don’t show up are as follows:

Costs: High costs of care can be a deterrent to keeping medical appointments. In 2012, up to 49 million adult patients skipped recommended care for financial reasons (www.qminder.com).
Transportation issues: According to a Medbridge Transport whitepaper, about 3.6 million U.S. patients missed their appointments because of transportation problems. Transportation was found to be the reason why patients missed an appointment 67 percent of the time. For older adults, transportation issues rank third among the barriers to accessing health services.
Long wait times
Forgetting the appointment
Being called to work unexpectedly
Not being able to reach the practice to leave a voicemail or cancel
Poor medical literacy – patients are unaware that keeping appointments is important for their health
Lack of understanding of the appointment scheduling system
language barriers
emotions – fear and anxiety about procedures and bad news

Strategies for reducing no-shows

The Medbridge Transport study reported that medical practices that proactively work towards minimizing no-shows can reduce no-shows by up to 70 percent. Here are seven strategies to address the problem of missed healthcare appointments:

Assign a dedicated staff member to manage scheduling: Rather than have several staff members involved in patient appointment scheduling, practices should have a single person to manage this. This will ensure better management of the physician’s time.
Set up an effective reminder system: Many practices have automated patient reminder e-mails and/or text messages. Sending reminders at the right time is important to get a response. Best practice is to send the first reminder three weeks before the appointment, the second reminder three days before the appointment, and the final reminder three hours before the appointment, according to one study (www.medicaleconomics.com). Practices can also consider directly contacting patients who consistently miss appointments.
Reduce wait times – Physicians need to spend as much time as necessary with a patient to provide a diagnosis and develop a treatment plan. However, long wait times can cause frustration and lead patients to miss appointments. Implementing solutions in the waiting room can enhance physicians’ ability to retain, attract and satisfy patients. Reducing wait times will make it more likely they will return for follow-up appointments.
Educate patients: Physicians and staff should educate patients on the importance of keeping appointments as well as timely canceling and rescheduling of office visits. A Medical Economics article explains that the Elmont Teaching Health Center in New York succeeded in tackling no-shows by providing patients with the necessary guidance in reminder phone calls one day before the appointment, in multi-lingual signage at the clinic, in face-to-face conversations during appointments, and in phone calls following a missed appointment.
Prioritize accessibility: One reason for no-shows is because patients cannot reach anyone at the practice or couldn’t leave a voicemail to cancel. This shows the importance of prioritizing accessibility. Practices can implement strategies that will ensure that staff members answer all incoming calls. The entire front-desk should be encouraged to answer the phone, whether it’s their responsibility or not. Patients should be always able speak to a person and not be directed to voicemail.
Track the data to predict and prevent no-shows: Predicting and preventing missed appointments can potentially improve access to care. Analyzing data in the scheduling system can help providers identify patients that are likely to become a no-show or cancellation. This will allow them to plan accordingly and take corrective actions to mitigate the impact of the no-show/cancellation.
Build a meaningful relationship with patients: In many cases, patients don’t show up because they can’t due to a transportation problem. Help with transportation or home visits can help such patients. Staff can call up and check on patients who have had surgery to know if their healing and recovery process is progressing as planned. Patients who feel better may assume that they don’t need to keep their follow-up appointment. When patients feel meaningfully connected to their healthcare teams, they will be induced to come back.

When implemented together, the above strategies can produce real results. By supporting physicians in their documentation tasks, medical transcription companies help them focus on improving patient care and outcomes and preventing missed appointments.

Advantages of Interface between the Laboratory Information System and the Electronic Health Record

27-January-2020 Julie Clements EHR Transcription

Pathology comprises many laboratory functions related to disease diagnosis, treatment, and prevention. The goal of pathology is to provide accurate diagnosis so that the treating physician can develop an optimal treatment plan. Pathology transcription services play a key role in helping hospital labs, reference labs, and public health labs ensure that information transmitted to the patient’s electronic health record (EHR) is accurate, complete, and delivered in a functional format.

EHRs have transformed the way clinicians interact with laboratory information, including test order entry and result review. With widespread adoption of EHRs, pathologists and laboratories face many challenges. Understanding the implications of EHR for pathology labs and overcoming these challenges is crucial to succeed in the era of expanding EHR usage, according to a 2015 report that discussed the role of the pathologist in the EHR environment.

The Health Information Technology for Economic and Clinical Health (HITECH) Act established an EHR incentive program under which physicians and hospitals could qualify to receive incentive payments if they adopt and demonstrate “meaningful use” of a certified EHR, that is, use of the EHR to improve the quality, safety, and efficiency of patient care. In the inpatient setting, stage 1 of meaningful use calls for structured laboratory result display in the EHR for more than 40% of laboratory results. Stage 2 of meaningful use requires the following:

Incorporating more than 55% of yes/no or numerical lab results into the EHR as structured data
Use of computerized provider order entry for at least 30% of laboratory orders
Electronic transmission of reportable disease diagnoses to public health agencies using Health Level 7 International (HL7) standards
Use of the Logical Observation Identifier Names and Codes vocabulary standard for test code names
For hospitals: sending structured electronic lab results to ambulatory ordering providers for more than 20% of electronic laboratory orders received

Implementation of an Interfaced Electronic Health Record and Laboratory Information System (LIS) is needed to achieve the first 2 goals of stage 2. Meaningful Use Stage 3 calls for clinical lab managers and pathologists to take steps to promote EHR use for care coordination, hassle-free transitions of care, and improve interoperability and seamless healthcare data transfer.

A study published in Arch Pathol Lab Med, March 2017 reported that interfacing the EHR with LIS improve lab workflow and offer many clinical benefits such as decreased TAT, fewer stat specimens and preanalytic errors, and a more effective electronic add-on ordering process.

This is how the LIS-EHR integration process works: After determining the test(s) that the patient needs, the referring clinician generates the order in their EHR, and sends it to the LIS of the selected lab. The lab gets the information about the patient and the needed test(s). After completing the tests, the lab sends the results from the LIS back to the referrer’s EHR (Medical Laboratory Observer, Oct 2018). However, besides interoperability between the lab and the referrer, successful lab-EHR integration depends on many factors:

The test results should be automatically uploaded in the patient’s laboratory results section in his or her profile in the referrer’s EHR.
The results should be presented in a format that can be easily understood by the clinician as well as the patient. There should be educational information about each lab value that was analyzed.
The EHR should be able to monitor submitted orders for which results have not been received; likewise, the lab should be able to track test orders back to the clinician.
The EHR should alert the referrer when the LIS delivers ordered test results.
Ideally, the EHR should issue red flags if parameters are out of normal range.

When clinicians have direct access to lab results in their EHR, it translates to reduced risk of preanalytic errors, improved patient safety, increased efficiency, and improved quality of care.

Quality documentation is critical for the success of EHR-LIS integration. Medical transcription outsourcing can help clinicians meet their EHR-related documentation requirements. Labs can rely on medical transcription companies specialized in pathology transcription to ensure accurate and timely pathology transcripts, including physician notes, diagnostic reports, pathology consultation notes, specimen description, pathological observations and comments, and more.

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