Global Medical Transcription Software Market Analysis 2019-26

18-November-2019 MTS TEAM Medical Transcription Company

With the increasing number of hospital visits and physician consultations, it is crucial for physicians to allocate more time for patient interaction than on documentation. Medical transcription service companies are of great support for practices to get clear transcripts of their recordings in short time. Many physicians are also using medical transcription software to transcribe their dictations.

This software dramatically reduces the clinical documentation time and allows physicians to focus more on patient care. Also, remote access to dictation platforms are allowing physicians to dictate from anywhere and anytime, resulting in higher adoption of transcription software.

The global medical transcription software market size that was valued at USD 1.17 Billion in 2018, is now expected to reach USD 3.84 Billion by 2026, exhibiting a CAGR of 16.5% during the forecast period 2019-2026.

Recent technological advancements in medical transcription software are favoring the market growth. Factors such as reduced costs and easy-to-use nature of the software have led to high adoption of the product across the world. The advancements made in cloud services and their incorporation in medical transcription software has had a massive influence on the growth of the market in a positive way.

Key factors that are likely to boost the growth of this medical transcription software market are

Usability
Convenience of operations
Operational benefits and enhanced flexibility
Government regulations and acts
Growing importance of clinical documentation in healthcare

This global market is classified on the basis of deployment, end-user facility, type, end user, and region.

Based on deployment, the market is divided in to cloud/web-based and installed/ on premises. End-user facilities include hospitals, diagnostic centers and clinics. On the basis of type, the market is divided in to voice capture and voice recognition. End-users of this market include Radiologists, Surgeons, Clinicians and others. By region, the market is segmented in to North America, Europe, Asia Pacific and Rest of World. Factors that drive this market growth in North America include growing need of clinical documentation, emphasis on maintaining patient information in structured formats, regulations imposed by government authorities, increasing infrastructure facilities and higher investments on clinical documentation. In market value, Asia Pacific is expected to witness the highest growth owing to rising awareness about clinical documentation.

Key market players discussed in the report are Nuance Communications, Inc., M*Modal IP LLC (3M), Dolbey, Acusis LLC, Voicebrook, Inc., Speech Processing Solutions GmbH (Philips Dictation), Xelex Digital LLC (WebChartMD), nThrive, Inc., Scribe Technology Solutions and ZyDoc Medical Transcription. Nuance Communications, Inc. was the leading player in 2018, and the company is reinforcing its strategic position in this global market, owing to hold on unique technology, wide range of product offering, robust distribution network, superior quality and post-sale support.

While this software provides diverse benefits, experienced transcriptionists can provide accurate transcripts. EHR-integrated medical transcription services help physicians achieve the quality transcripts they are looking for.

Doctors On-call – A Great Option for Assisted Living Facilities

14-November-2019 Julie Clements Medical Transcription Company

Timely and effective medical attention is indispensable for patients with disabilities, especially those living in assisted living facilities. In many of these facilities there are no on-site or on-call doctors, and when an emergency occurs patients have to be taken to the emergency room. This is a major concern for residents of such facilities and their loved ones. Ready availability of a doctor is a great comfort for patients, especially the elderly who are weak and vulnerable. Even in a regular physician practice, patients are happy and comfortable when the doctor listens to their concerns with patience. This also helps in building trust among patients and improving the patient-doctor relationship. To save time, most physicians utilize medical transcription services that ensure timely medical documentation. With reliable support services, doctors can become better listeners and provide personalized care for their patients.

A convenient and effective healthcare system that can provide medical assistance exclusively to elderly patients at any time is vital to ensure quick recovery from illnesses and a comfortable life. Assisted living is one such set up that is similar to nursing homes but their primary focus is to help residents carry out their daily activities. Moving to an assisted living facility or a nursing home is not easy. But some people choose to move because they live alone and would be happier spending time with others every day. Some need more care than they can get at home.

An assisted living facility accommodates seniors who no longer wish to stay at home and cannot live independently at home. It is a facility that is suitable for people who need assistance in a skilled and intermediate care facility. Initially assisted living was started to serve fairly healthy retirees, offering meals, social activities and freedom from home maintenance and housekeeping. Today, there are many such facilities with 800,000 people. Now most residents are over age 85, according to government data. About two-thirds need help with bathing, half with dressing, and 20 percent with eating.

Like any other American elders, even they have a long list of prescribed drugs and 80 percent of them need help in taking the medicine. Many of these places have become the primary residential setting for people with dementia. Studies show that almost 70 percent of residents have some level of cognitive impairment and the patients find it difficult to coordinate medical appointment, tests, travel to offices and labs. Many experts in the field say more attention should be given to medical and mental healthcare in assisted living.

Lindsay Schwartz, an executive at the National Center for Assisted Living said that assisted living has expanded its role in providing medical care over the years by including nursing staff and partnering with other healthcare staffs. However, most of these facility operators may not be entirely willing to provide medical care on-site. This is because their marketing strategies are built on looking and feeling different from the typical nursing home facilities. Their main objection is to “medicalizing” their communities.

Dr. Alan Kronhaus, an internist and Dr. Taavoni started a practice called Doctors Making Housecalls in 2002. This setup is an example of how assisted living offers medical care. The practice dispatches 120 clinicians, 60 doctors, nurse-practitioners, physician assistants and social workers that provide service to 400 assisted living facilities in North Carolina. They spend ample time with the patients, and look after each person in detail. In a 2017 study, it was found that the practice could reduce emergency room transfers by two third.

In Manhattan, The Lott Assisted Living Residence depends on a single geriatrician, Dr. Alec Pruchnicki, to provide medical care for most of its 127 or so residents. When residents fall sick, they or their family members contact the doctor who provides the required treatment. A nearby hospital, Mount Sinai Hospital also employs Dr. Pruchnicki and provides emergency services when required. Spending a lot of time in emergency rooms and hospitals can be difficult for patients. Though they receive the treatment needed, they get exposed to infections and may contract diseases.

Typically, stays in assisted living facilities are short and most residents move on to nursing homes after around 27 months on average.

Family members are worried when the residents arrive unaccompanied at emergency rooms from assisted living facilities and are not able to give clear details about their problems. So, a solution to this problem could be seeking the assistance of more healthcare providers to the assisted living facility instead of calling 911 and taking them to the emergency room. However, adding doctors to assisted living could lead to higher facility charges.

The new system is advantageous because it can improve the quality of life for homebound patients and caregivers and reduce healthcare costs by allowing people to stay in a safe place and avoid unnecessary emergency expenses, hospitalization etc. With enough on-call doctors at assisted living facilities, better care could be provided for elders and people with disabilities.

Six Strategies to Build Better Rapport with Patients

11-November-2019 Rajeev Rajagopal Medical Transcription Company

The importance of building patient rapport can hardly be stressed enough in an age of electronic health records (EHRs). While the EHR has improved quality of care and patient safety through improved management, it takes up a portion of the physician’s time at the encounter and has been found to decrease attention given to the patient. While medical transcription companies help resolve this concern with EHR-integrated documentation support, physician and nurses need to focus on building rapport with patients. This is crucial to promote good communication and a positive clinician-patient experience which can improve care.

The physician-patient relationship is the crux of all medicine. The American Medical Association Code of Medical Ethics states that a physician-patient relationship is a clinical encounter, a moral activity and a relationship “based on trust, which gives rise to physicians’ ethical responsibility to place patients’ welfare above the physician’s own self-interest or obligations to others, to use sound medical judgment on patients’ behalf, and to advocate for their patients’ welfare.”

A recent Kitsap Sun article recalled the Norman Rockwell painting of a doctor holding a stethoscope to the chest of a little girl’s doll as the ideal example of a provider’s effort to gain the trust and confidence of his patient. Published in a 1929 edition of the Saturday Evening Post, the picture illustrates the importance of rapport-building in the patient-physician interaction.

Good manners and earnest communication to understand the patient’s feelings are the first steps to building good rapport with patients. Here are six ways to build a positive physician-patient relationship:

Start building rapport at the introduction: Physicians and their team need to begin building rapport with patients the moment they introduce themselves, notes an article in Practice Dermatology. Patients should be asked how they preferred to be addressed – whether their formal name or a shortened version should be used. The preference should be used consistently. Using the patient’s preferred name during all encounters will establish feelings of familiarity and comfort, and build rapport.
Treat patients with respect and dignity: Physicians and nurses need to remember that patients are people with families, friends, jobs, experiences and futures. Patients are in a vulnerable position when they are in the physician’s office or exam room. Providers need to do everything they can to preserve the patient’s respect and dignity. This means paying attention to what they are saying and protecting their privacy and modesty. By adopting the right attitude and manner, physicians can show that they are genuinely interested and concerned and ready to help. Building rapport is essential to build trust.
Express empathy: Empathy is defined as the ability to understand and share the feelings of another. Clinicians need to show their patients that they understand their situation and feelings, and care about them. In the medical field, there are two types of empathy – cognitive and affective (patientengagementhit.com). Cognitive empathy is the physician’s ability to recognize a patient’s emotions, reflect those emotions back to the patient, and consider the emotions when making care decisions. Affective empathy is when providers themselves genuinely feel the emotions the patient feels. According to researchers from the University of Chicago, physician empathy requires both cognitive and affective empathy. While showing empathy and building rapport, physicians should not allow let patients’ issues or attitude to affect them emotionally.
Maintain eye contact: Maintaining eye contact fosters a sense of compassion, connection and caring. With the computer in the examination room, there is the danger that the physician may focus on EHR data entry rather than on the patient. Medical transcription services help physicians with their charting and put individual attention and personable eye-contact back in the equation.
Minimize distractions and practice active listening: Physicians need to avoid all distractions during care. Text messages and app notifications can prove major distractions. Physicians need to put their beeper and smartphone on silent mode and turn off app notifications. At the same time, they need to practice active listening to share a patient’s thoughts and feelings. Active listening means the physician needs to listen to what the patient is saying, repeat what was heard to the patient, and check with the patient whether their understanding of what was said is correct. This is a reliable rapport building strategy. It’s important to limit the number of time questions are asked or interrupt patients when they are presenting their chief complaints.
Engage the patient in developing the care plan: Open communication is the basis of building patient rapport. It’s important for patients to understand as much as possible about their own health and participate in their care. Educating patients will make them feel empowered and enhance the relationship with the healthcare provider. Clinicians should ensure that patients understand instructions and fill in knowledge gaps, which is crucial for successful care.

Building patient rapport is so important that practices are seeking outside support to bridge any gaps between patients and practitioners. Many are hiring patient rapport managers. As a recent Physicians Practice article explains, patient rapport managers are members of the practice team with healthcare experience who provide extra attention to patients on the physician’s behalf. Patient rapport managers follow up with patients after an invasive procedure, a sudden illness, a trauma or an emotional event. They improve patients’ feelings of intimidation, calm fears and uncertainties, and answer common questions. Medical transcription outsourcing is another type of support service that physicians can rely on. An experienced medical transcription company will handle clinical documentation tasks efficiently so that physicians and nurses can focus on their patients and establish a strong rapport with them.

Study finds Mismatches between EHR Documentation and Actual Clinical Encounters

07-November-2019 MTS TEAM Medical Transcription Outsourcing

EHR Documentation

Electronic health records (EHRs) improve the physician’s ability to diagnose patients’ problems sooner and reduce or even prevent medical errors, improving treatment outcomes. Many providers rely on medical transcription outsourcing to document voice recordings into EHRs.

EHRs can improve diagnostics and support better patient outcomes only if the provider has access to complete and accurate health information. However, EHR Intelligence recently reported on a study that found significant problems with physician EHR use. The researchers noted discrepancies between EHR documentation and what actually happened at clinical encounters. The study was based on an observation of nine resident emergency physicians over 180 patient encounters in two academic medical centers between 2016 and 2018. The key points of the research which was published in September in JAMA Network Open are as follows:

The researchers shadowed the physicians for 20 encounters (10 encounters per physician per test site) to obtain real-time data and reviewed associated EHR data.
Five types of data were collected: descriptive data about encounters and participants; review of systems (ROS) observation data (audiotape); observed physical examination (PE) activities, documented concurrently on standardized forms; ROS documentation in the EHR; and PE documentation in the EHR.
The participant physicians’ real-time performance was compared with clinical documentation.
Comparison of two error-prone sections of the EHR — documentation of review of systems (ROS) and physical examination — with happened during an encounter matched only 38 and 53 percent of the time, respectively.
There was little difference in results between the two test sites.

Concluding that there were inconsistencies between the physicians’ EHR documentation and the actual ROS and PE reports, the researchers wrote,

“This study demonstrated inconsistencies between resident physician documentation and observed behavior. Furthermore, the relevance analysis, in which the reason for visit was cross-tabulated against the percentage of unsubstantiated physical examination by body system, demonstrated that unsubstantiated documentation is more common when it may be less clinically relevant.”

According to the researchers, their results raise the possibility that some documentation may not accurately represent physician actions. They recommended that further studies should be undertaken in other clinical settings to discover if this occurrence is widespread.

The researchers also speculated on the reasons for the variance between EHR documentation and actual ROS and PE reports.

Rapid replacement of paper records with electronic: One reason could be rapid adoption of EHR in an industry that has traditionally used paper records. When a healthcare facility moves patient data from paper records to the EHR, quality checks are necessary at each step to ensure accuracy and integrity of the data. However, the study points out that there are been investigation into the accuracy of physician documentation.
Burdensome payer documentation requirements: Another reason for the mismatch between EHR documentation and clinical encounters could be burdensome reporting requirements. Payers are found to provide financial incentives to generate lengthy documentation, but these reporting requirements may not be feasible for EHR users due to their heavy workflows.

In the 2020 physician fee schedule released in July, the Centers for Medicare and Medicaid Services (CMS) focuses on reducing the administrative burden on physicians, including work involving electronic health records (EHRs). In fact, the American Hospital Association (AHA) made the following recommendation to CMS on the matter: “Remove requirements that result in providers repeating one another’s documentation and instead develop documentation and/or payment requirements that enable providers to produce a single, synthesized, dynamic patient narrative, such as by allowing a primary care or admitting physician to enter a patient’s history and requiring subsequent providers to review and confirm the accuracy of the history and add only the information that may expand on or change the patient story.”

Many studies have also looked into physician stress and burnout associated with EHR use. Physicians are not trained in data entry, and this can be all the more challenging in the office setting where they need to focus on arriving at a correct diagnosis and providing quality treatment. One study found that for every hour physicians spent in direct contact with patients, 2 more hours are spent on electronic health record (EHR) and desk work (Annals of Internal Medicine, September 6, 2016).

Using scribes or medical transcription services can reduce the EHR-related administrative burden associated with EHR use, improve levels of physician satisfaction, and allow for better focus on patients. While medical transcription companies are not onsite, their clinical documentation support is very valuable for all specialties. They are well-equipped to provide ensure timely and accurate clinical documentation with feeds to EHRs. With HIPAA-compliant medical transcription service providers, physicians do not have to worry about the confidentiality of PHI (Protected Health Information).

Key Challenges That Health Administrators Face [infographic]

04-November-2019 Julie Clements Infographics

Management of hospital departments, staff, finance, and health information is a hectic task for health administrators. Just as medical transcription services have evolved to keep pace with the latest developments, healthcare administrators need to adapt with the dynamic healthcare scenario to succeed.

Read the infographic below

Key Challenges That Health Administrators Face

HIPAA Compliance – Emerging Trends and Updates

31-October-2019 Rajeev Rajagopal HIPAA Compliance

Healthcare data breaches expose demographic or financial information, putting patients at risk of fraud or identity theft. Third party vendors are a frequent cause of a patient data breach. That’s why it’s important for healthcare entities to choose a HIPAA-compliant medical transcription company for their EHR-related documentation requirements. At the recently held “Safeguarding Health Information: Building Assurance Through HIPAA Security” conference focused on the Health Insurance Portability and Accountability (HIPAA) regulatory framework, the federal Office for Civil Rights (OCR) highlighted the increasing number of breaches related to hacking/IT incidents.

Patient Privacy Breaches on the Rise

The latest Protenus Breach Barometer reveals that patient privacy breaches may be on the rise, with hacking causing the majority of security incidents in 2019. Other causes identified by the study include phishing attacks, malware or ransomware, extortion of ransomware, and data theft. Key findings in the report:

Up to 31.6 million patient records were breached in the first half of 2019 , double 2018’s total of 15 million.
There is at least one health data breach per day
There was a total of 285 incidents from January to June 2019
Hacking accounted for 60% of the total number of breaches during the first half of 2019, with 168 hacking incidents involving 27.8 million records
Hospital insiders were responsible for more than 3 million patient record breaches during the reported timeframe (in 60 incidents)
45 percent of Business Associate (BA) breaches were caused by an outside hacker
The largest single largest breach in the first half of 2019 was the hacking of over 20 million patient records that involved a third-party billing collections firm

“Hacking continues to threaten healthcare organizations, with a distressing number of patient records breached in the first half of the year,” researchers wrote. “Breaches of patient privacy continue to loom throughout the healthcare industry and seem to be on the rise in the first half of 2019.”

HIPAA Enforcement Initiatives a Top Priority in 2020

At the 11th annual HIPAA conference, OCR highlighted top HIPAA enforcement initiatives. Moving into 2020, organizations handling health data need to take steps to adhere to standards to ensure protected health information (PHI) is secure and should be aware of

Shifting OCR enforcement priorities
Regulators’ continued attention to key HIPAA compliance activities
The changing threat landscape for health data, and
New guidance and frameworks for health data not regulated by HIPAA

The conference emphasized OCR’s focus on the following:

Ensuring patients and their families have access to important information
Action to enforce HIPAA Right of Access
Importance of responding in a timely and appropriate manner to breaches and complaints
Importance of compliance cornerstones – OCR stressed “risk analysis at the front end” as a major point of enforcement
Increasing incidence of phishing attacks and network attacks, and also insider attacks
New tools and guidance on privacy and security best practices

HIPAA 2020 Requirements for Healthcare Entities

Organizations in the healthcare industry need to implement “reasonably appropriate” protections to protect and secure patient’s PHI. This will minimize the risk of experiencing a healthcare data breach. The Compliance Group lists the HIPAA requirements for 2020 as follows:

Technical: This refers to implementing cybersecurity measures such as encryption or firewalls to protect PHI on electronic devices.
Physical: The security of an organization’s physical site should be maintained with measures such as video cameras, alarms, and keypad locks with unique access codes for each employee.
Administrative: All employees must be trained on the specific policies and procedures that apply to the organization’s business processes.

Organizations need to conduct self-audits of their privacy and security practices to ensure that they meet HIPAA 2020 standards.

HIPAA and Third Party Vendors

Healthcare organizations need to ensure that the third parties they partner with (business associates, partners, and subcontractors) should also meet HIPAA regulations. For example, a medical transcription company that handles EHR-related documentation is required to comply with HIPAA regulations and safeguard the patient information it stores, creates, transmits, or maintains in compliance. Healthcare providers are responsible for the privacy and security of their patients’ information at all times. That’s why it’s essential to partner only with a HIPAA complaint third party vendor.

Before outsourcing medical transcription or any other office task, practices need to evaluate whether the company is HIPPA-compliant. Having a checklist that covers the technical, physical, and administrative facets of HIPAA compliance can help physicians choose the right medical transcription service provider. Vendor evaluation should cover the following points:

Vendor’s HIPAA risk assessment, security policies and procedures
Protocols in place for responding to a breach/emergency
Written contracts on how client data will be handled – who within the company will have access to the data and how is that controlled
Whether there is a provision for regular data backups of stored data in standard format
How frequently activity logs are audited
Whether they are carrying out regular HIPAA risk assessments
Encryption of sensitive data both at rest and in transit
Workstation policy

The vendor should be required to sign a Business Associate Agreement to the effect that the vendor will abide by security laws and all pertinent conditions as mandated by HIPAA. It should be clarified in the written contract that the vendor does not have ownership of any personal data, but has a limited license for use of the data outlined in the written contract. A liquidated damages clause should be created that clearly states the vendor should fairly compensate the Provider if any stored data is lost, destroyed, or breached (ITPAC Consulting). Have an expert on HIPAA expert review these conditions and confirm that they are sufficient for maximum security.

High-Quality EHR Documentation Crucial to Fight the Opioid Crisis

28-October-2019 Julie Clements EHR Transcription

According to recent estimates from the National Institute of Drug Abuse, more than 130 people in the U.S. die after overdosing on opioids. In 2017, opioid abuse was declared a public emergency by the Department of Health and Human Services (HSS). Medical transcription outsourcing companies help physicians to document opioid abuse in electronic health records (EHRs), which is necessary for continuity of care as well as for purposes of research and education. Proper clinical documentation can go a long way in ensuring quality treatment for opioid addiction and improving patient outcomes.

Characteristics of Reliable EHR Documentation

In response to HHS declaring the opioid epidemic a public health emergency in 2017, the American Health Information Management Association (AHIMA) put forward guidelines to help clinicians ensure reliable documentation of how patient use or abuse opioids. AHIMA lists the seven characteristics of optimal EHR charting as: clear, consistent, complete, reliable, precise, legible, and timely. According to the group, using these characteristics can help clinicians provide high-quality documentation, which is crucial for care and also for tracking the specifics of opioid use. AHIMA’s Opioid Addiction Documentation Tip Sheet demonstrates what clinical documentation for potential opioid abusers would look like if it was or was not based on these characteristics.

Clear: Clear documentation means that when symptoms are recorded, a clear, supporting diagnosis should also be documented on the chart. The documentation should be as informative as possible and leave no room for uncertainty. For example, if a patient is admitted with lethargy and is addicted to heroin, not documenting the addiction would lead to lack of clarity in documentation.
Consistent: Consistency means there should be nothing conflicting in the documentation. Small details matter. AHIMA provides the following example of inconsistency in documentation: “39-year-old male patient was admitted for opioid use. This is the second admission for opioid abuse in the last two weeks for her.” The questions that arise are: whether the patient was male or female and if the admission was for opioid use or opioid abuse.
Complete: An example of an incomplete medical record would be when abnormal findings are documented without an associated condition. Investigations such as a positive drug screen should be documented as evidence of opioid abuse. A medical record would be also considered incomplete if all entries are not authenticated by the clinician’s signature and date.
Reliable: To meet the reliability criterion, there should be a diagnosis in record that correlates with the opioid addiction therapy. The example in the AHIMA documentation tip sheet is that of a patient who is methadone dependent and is admitted for systolic CHF exacerbation. If the clinician documents that methadone therapy should be continued – without indicating the opioid dependence – the documentation would lack clarity and be considered unreliable. It is an instance of treatment provided without the documented condition.
Precise: The data in a medical record should be precise with as many details as possible about the patient’s condition, treatment, and patient-provider interaction. Data integrity is extremely important as it is used to identify and track patients as they move from one level of care to another (AHIMA). Not documenting the specific drug that is being misused is an example of imprecise documentation.
Legible: Illegibility in the medical record can lead to high error rates in documentation, improper treatment, poor continuity of patient care, dispensing of wrong medications, and coding audits. Documentation must be legible and easy to decipher.
Timely: AHIMA gives the following example of poor quality documentation at the time of care being delivered:
- H&P Documentation: 55-year-old male admitted with right torus fracture of the distal right tibia after falling off of his front porch. Day 3 of admission: Right torus fracture of the distal tibia is healing. Will be admitted to rehab for drug dependency and mental health issues.

AHIMA points out that the above documentation is poor because it does not indicate:

the patient’s drug dependency and mental health issues present on admission
the drug that the patient is dependent on
the mental health issue the patient has

When it comes to treating opioid dependency, optimal EHR documentation that tells the patient’s story completely and accurately can promote continuity of care and patient safety as well as improve research and education.

To deal with this challenging public health crisis, the HHS is focusing its efforts on five major priorities:

improving access to treatment and recovery services
promoting use of overdose-reversing drugs
strengthening understanding of the epidemic through better public health surveillance
providing support for cutting-edge research on pain and addiction
advancing better practices for pain management

As physicians support HSS in its goals, they can rely on an experienced US based, HIPAA complaint medical transcription company to ensure the accuracy and quality of EHR documentation and avoid errors that can undermine patient care.

Current and Evolving Trends in Dermatology

24-October-2019 MTS TEAM Medical Transcription

The field of dermatology is evolving rapidly with new technologies and treatments. Experts in visual analysis, dermatologists treat a range of skin problems on a daily basis, from psoriasis to skin cancer. The practice of dermatology requires physicians to focus on communicating effectively with patients. Outsourcing medical transcription takes care of their EHR-documentation tasks. In addition to enhancing quality of care and reducing medical errors, a reliable dermatology medical transcription service provider helps physicians to get the most out of the EHR with the least interruption to care.

The top trends impacting dermatology in recent times are the transition to a multidisciplinary approach, new technologies and treatments, and the implications of electronic medical records (EMRs) in dermatology.

Multidisciplinary Approach to improve Dermatology Treatment

Recent reports list several trends that are impacting the dermatology landscape in the U.S. and dermatologists need to adapt their practices to these changes. Summing up the results of a 2017 American Academy of Dermatology’s Burden of Skin Disease study, Health Affairs reported that:

Skin disease is more common than all cardiovascular diseases and diabetes
In 2013, nearly 50 percent of Americans over age 65 had a skin disease
Serious skin diseases caused 22,953 deaths in 2013
In 2013, skin disease cost the U.S. health care system about $75 billion in medical, preventative, and drug costs
Lost productivity due to skin diseases totaled $11 billion for patients and their caregivers in 2013
The number of Americans with skin disease is expected to increase as the population ages
The demand for dermatologists far exceeds supply and is growing

As there are numerous associations between skin diseases and other conditions, treating dermatological conditions now requires a multidisciplinary approach. Dermatologists need to collaborate with other specialists to deliver high quality care. The Health Affairs article cites the example of a patient with eczema who may have difficulty sleeping due to their itchiness. To effectively address this problem, dermatologists would need to work with allergists, neurologists, and sleep specialists.

New Technologies and Treatments

Another important trend is the introduction of new technologies. A recent Dermatology Times article discussed an array of new technologies and treatments that physicians can leverage to enhance services and daily workflow. One of the areas where technology will have the greatest impact is improving care for skin cancer, particularly melanoma. These include:

Confocal microscopy which provides high-resolution microscopy lesion images at the beside
Photo-acoustic tomography (PAT) – 3-D technology that shows a lesion’s depth, aiding prognosis or staging
Raman spectroscopy (RS): identifies chemical and biological compounds in the outermost skin layers

New therapeutics include JAK inhibitors for treating vitiligo, alopecia areata, and psoriasis, and gene and stem cell therapy.

Dermatology Times notes that the future may see physician assistants and nurse practitioners providing more dermatology care. However, experts caution that dermatologists should closely supervise physician extenders.

EMR Systems in Dermatology

MDEdge recommends that dermatologists need to choose an EMR system that is dermatology-compatible. This will make it easier for them to document information such as multiple lesions in different anatomic sites or identify multiple biopsy sites.

Practices need specialty-specific EMR software that will able to receive and integrate laboratory values, dermatopathology and radiology results and consultation notes from other physicians. Such integration can minimize duplicate services, increase patient satisfaction, and meet Meaningful Use (MU) criteria. According to the report, until such an integrated system is developed, dermatology practices should consider adopting an EMR system that is compatible with hospitals, other specialists’ offices, and diagnostic centers in the vicinity, which will maximize interoperability at the local level.

Patient-centered Communication with Documentation Support

In dermatology and other medical fields, EMRs offer the opportunity for care delivery integration, but they have decreased physician job satisfaction and increased physician burnout. Studies found that physicians spend up to 2 hours on EMR-related tasks for every 1 patient-care hour (www.ama-assn.org).

A study published in JAMA Dermatology in 2017 found that using scribes resulted in significant documentation time savings and reduction of physician burnout. Trained scribes shadowed the dermatologists using dedicated laptops, and documented patient-physician interactions and recorded orders, medications, and diagnoses for the physician to approve.

The study, which was conducted by dermatologists at Boston’s Brigham and Women’s Hospital, noted that with scribe support, dermatologists were willing to see additional patients, signaling improved physician efficiency, better patient access, and boost in clinical revenue.The research letter authors also reported that “scribes were well received by patients, with few refusals and unchanged overall patient satisfaction scores.”

The research letter authors also reported that “scribes were well received by patients, with few refusals and unchanged overall patient satisfaction scores.”

The authors also acknowledged that, in addition to scribe services, the EHR documentation support provided by a medical transcription service company is valuable in situations other than face-to face care.

“Other solutions combating physician documentation burdens, such as real-time dictation software or conventional transcription services, have been employed particularly successfully in diagnostic specialties, such as pathology and radiology, which have limited point-of-care patient interaction,” they wrote.

Admissions to the ICU – Important Concerns and Considerations

21-October-2019 Rajeev Rajagopal Medical Transcription Company

Physicians managing intensive care units (ICUs) provide focused, high quality care to critically ill patients. Medical transcription companies help with their documentation needs, allowing physicians to provide patients with the treatment, constant monitoring and frequent nursing care they need. However, long stays in the ICU are costly and arduous for patients and their families, affecting society at large. According to a new study, many admissions to the intensive care unit may be preventable, which can improve care and reduce health care costs (www.sciencedaily.com).

Many Admissions to the ICU are Preventable

The study, which was published online in the Annals of the American Thoracic Society, analyzed more than 16 million ICU admissions of patients in Medicare Fee-for-Service, a Medicare Advantage plan, and a large private national insurance plan over the period 2006-15.

The team identified two patient groups whose care could have been handled better outside the ICU:

Patients with an “ambulatory care sensitive condition” – patients with a chronic or medical condition such as high blood pressure, urinary tract infection or uncontrolled diabetes. Timely outpatient care for these conditions could prevent these patients from being hospitalized.
Patients a “life-limiting malignancy” or cancer who are likely to die within a year and for whom palliative care would be appropriate.

The researchers also noted that ICU admissions may be preventable for serious illnesses such as chronic lung disease, heart failure and neurodegenerative disorders.

The findings of the study are as follows:

16.7 percent of the nearly 100 million hospital admissions during the study period included an ICU admission.
Between one in six and one in seven ICU admissions might have been avoided.
During the 10-year study period, ICU hospitalizations for ambulatory care sensitive conditions were found to have been slowly decreasing, while the percentage of patients in the ICU with a life-limiting malignancy had been increasing.
There was an almost eight-fold difference among states in the rates of ICU admissions
The number of ICU beds available appeared to be the factor determining the rate of ICU admissions in different geographic areas among these two patient groups

According to the authors, a substantial portion of ICU admissions in the U.S. may be prevented. They suggest that investing in outpatient, preventive, and palliative services should be viewed as “an important complementary, if not alternative, strategy to increasing the critical care workforce in seeking to provide the best care for the nation’s sickest patients”.

Decisions regarding Admission to the ICU

The medical conditions that lead to ICU admission include critical illnesses heart attack, stroke, poisoning, pneumonia, surgical complications, and major trauma from road traffic accidents and burns, etc. However, experts note that decisions regarding admission to the ICU are usually made despite uncertain information, time constraints, and without the patient being able to participate in discussions. According to a new study published in The Hospitalist in February 2019, several factors influence decisions to admit patients to the ICU such as:

The hospital or ED protocols
How comfortable hospitalists are handling sicker patients
Number of beds available
Who makes the final decision

The researchers noted that patients who are on a life support system do require admission to the ICU, but apart from that, it is impossible to predict the true need for intensive care. Further, they also point out that mortality risk may not be the best way to determine which patients will benefit the most from ICU admission. Considering only mortality risk may miss patients who might have a lower risk of dying, but still could benefit greatly from going to the ICU.

When is Intensive Care Appropriate?

Intensive care is appropriate for patients requiring support of two or more organ systems, and patients with chronic organ system impairments who also require support for an acute reversible failure of another organ. Experts say that the factors that must influence the decision for admission to intensive care are:

Diagnosis and prognosis
Severity of illness
Age
Coexisting disease
Recent cardiopulmonary arrest
Availability of suitable treatment
Response to treatment to date
Anticipated quality of life
The patient’s wishes

ICU care involves a multidisciplinary approach. Patients are provided with around-the-clock intensive monitoring and treatment. The primary goal in ICU is to decrease length of stay, so as to improve care quality and reduce cost.

The ICU is an expensive resource. However, as the article in The Hospitalist points out, ICU clinicians and experts continue to seek ways to ensure high quality and high value ICU care, from assessing patient outcomes to reducing ICU beds to developing new levels of care. As physicians seek answers to these complex issues, they can outsource medical transcription to ensure accurate and timely ICU documentation that reflects patient severity.

Disclaimer – The content in this blog that is provided by Managed Outsource Solutions (MOS) is only for informational purposes and should not be seen as professional medical advice. MOS is only passing on information that is already published and does not accept any responsibility for any loss which may occur due to reliance on information contained in this blog.

Strategies to Reduce Risks of Surgical Site Infections

17-October-2019 MTS TEAM Medical Transcription Outsourcing

With new payment models, strong clinical documentation improvement (CDI) has become very significant and many surgical specialties outsource medical transcription to improve documentation in surgical operation notes. However, ensuring good documentation is just one of the many challenges that surgeons face on a daily basis. They need to perform procedures carefully and competently, assess and deal with intraoperative challenges, and most important, take measures to ensure patient safety and prevent surgical site infections (SSI).

Infection control and prevention is a major safety issue in hospitals across the United States. Most health care associated infections (HCAI) are surgical site infections. According to a 2019 CDC report, SSI has a mortality rate of 3%, and is the most costly HAI type with nearly 1 million additional inpatient-days annually and an estimated annual cost of $3.3 billion.

A surgical site infection develops in the part of the body on which the operation was performed. Surgical site infections may be caused by endogenous factors such as bacteria on the patient’s skin, or exogenous factors such as staff, the environment, or materials used for surgery.

Factors that increase patients’ risk for SSIs include:

Diabetes, nicotine use, steroid use, obesity, malnutrition
Prolonged preoperative stay and perioperative transfusion
Perioperative antibiotic prophylaxis
Wrong use of antibiotics prior to surgery
Not treating infection at remote site prior to surgery
Shaving the site vs. clipping
Long duration of surgery
Improper skin preparation
Improper surgical team hand preparation
Ventilation and sterilization problems in the operating room
Surgical attire and drapes
Asepsis
Surgical technique: hemostasis, sterile field, foreign bodies

Best practices for preventing SSIs relate to intravenous and oral antibiotics, using skin prep agents, controlling patients’ glucose levels, and maintaining optimal temperature. Standard SSI prevention measures are listed below:

Appropriate hand hygiene and operating room attire
Patient bathing/showering with soap or antiseptic agent prior to surgery
Choosing the appropriate antiseptic for a specific surgical procedure based on current clinical guidelines, including an alternative agent in case of patient sensitivity, appropriate dose, timing of administration, method of application, and suggestions for its discontinuation
Measures should be taken for every patient to prevent inadvertent hypothermia
Implementing a glucose control protocol for all surgical patients – monitor for hyperglycemia pre-operatively, intra-operatively, and post-operatively
Educate patients and families about appropriate personal hair removal practices
Identify Patients who carry Staphylococcus aureus (SA) and decolonize preoperatively
Keep patients warm during and after surgery

A recent article in Outpatient Surgery (XX, No. 9, September 2019) makes several recommendations for preventing SSIs based on measures implemented at the Saint Francis Health System hospital campus and at their surgery center.

According to the article, pretreating instruments at point of use can reduce SSI risk and also make the task of reprocessing techs easier. The report notes that the Joint Commission expects surgical instruments to at least be kept moist until terminal cleaning if the instructions for use (IFUs) of specific instruments recommend this.

Another recommendation is to conduct audits of the decontamination area to check if OR staff is complying with pretreatment protocols. After indentifying the gaps, staff should be educated on the right way of doing things. Pretreatment teams can be set up in the operating room.

All personnel such as surgeons, nurses and other clinical staff should be involved in SSI prevention. Different people in different departments should be encouraged to speak out about problems they perceive from their own perspective. This can help in developing a solution that works for all.

Today, technology is revolutionizing the infection control and prevention process. Recent innovations include: pulsed UV disinfection, air sterilizer for washrooms and other critical areas, maceration for human waste disposal, fogging machine to destroy bacteria and viruses, alcohol-free hand sanitizers, footwear sanitizing station, and disposable gowns.

Researchers are now using electronic health record (EHR) data for automated detection of post-op surgical site infections. Medical transcription companies play a key role in this context by providing surgical practices with complete operative and procedure reports immediately after surgery.