Retained Surgical Items – Root Causes and Prevention Measures

05-September-2019 Rajeev Rajagopal Medical Transcription

Retained surgical items are a major concern for infection prevention and surgical services departments. In hospital settings, incidents of unintended retention of foreign objects occur in operating rooms, labor and delivery areas, ambulatory surgery centers, and other areas where invasive procedures are performed. Good evidence-based processes for preventing retained objects are as crucial as the quality operation notes that medical transcription companies provide.

Retained Surgical Items - Root Causes and Prevention Measures

Magnitude of the Problem

Retained surgical items were ranked eighth on the ECRI Institute’s 2016 Top 10 Patient Safety Concerns list. The Joint Commission received 772 voluntary reports of retained surgical items from 2005-12, while other research found that 4,500 to 6,000 surgical item cases occur annually in the U.S. (Becker’s Hospital Review). According to the Association of periOperative Registered Nurses (AORN), the most common inadvertently retained items are:

Soft goods, such as sponges and towels

Small miscellaneous items, including unretrieved device components or fragments (such as broken parts of instruments), stapler components, parts of laparoscopic trocars, guidewires, catheters, and pieces of drains

Needles and other sharp implements

Instruments, most commonly malleable retractors

Risks to the patient depend on what the item is, where it is in the patient and how long it has been there. Complications result when the retained item leads to infection or causes damage to surrounding tissue. Surgical cotton gauze sponges are the most harmful retained surgical item because additional surgery is usually required for removal (Becker’s Hospital Review).

In addition to posing a serious health threat for patients, unintentionally retained surgical items can cause financial and reputational damage for organizations. In February 2019, The Sacramento Bee reported that the California Department of Public Health announced that regulators were fining Redding’s Mercy Medical Center after a patient died due to chest inflammation caused by a medical sponge left behind during surgery.

Root Causes of Unintended Surgical Items

The main reasons for unintended surgical items are:

lack of policies and procedures
unreliable practices such as inconsistency when counting sponges
noncompliance with existing policies and procedures
failures in communication with surgeons
nurses not communicating relevant patient information
problems with hierarchy and intimidation
inadequate or incomplete education of staff

According to a 2017 study about 88 percent of retained surgical item cases happened during a procedure in which sponge and instrument counts were declared “correct,” which suggests human error.

Risks for unintended retained items include: patients with high body mass index, an emergency procedure, and unexpected intraoperative development. Other risk factors include more than one surgical procedure, multiple surgical teams, and multiple staff turnovers during the procedure.

Prevention Measures

Experts recommend several measures to prevent retained surgical items. The recommendations of the AORN Guideline for Prevention of Retained Surgical Items are as follows:

A consistent multidisciplinary approach that includes standardized, transparent, verifiable and reliable prevention measures
Accounting for instruments, surgical soft goods, sharps and other miscellaneous items opened onto the sterile field during all procedures in which these items are used
Taking measures to prevent device fragments
Taking standardized measures for reconciling count discrepancies during the closing count and before the end of surgery. If there is a discrepancy in a count, the surgical team should take actions to find the missing item
Evaluation of adjunct technologies for use as a supplement to manual counting procedures
Readily available documentation to reflect activities related to prevention of RSIs
Development of policies and procedures for the prevention of RSIs, with periodical review and revision as necessary
Participation of perioperative personnel in quality assurance and performance improvement activities

The Joint Commission recommends that a counting procedure should be performed audibly and visibly by two persons engaged in the process. The surgical team should verbally acknowledge verification of the count. The count should be performed before the procedure begins, in order to establish a baseline count; before the closure of a cavity within a cavity; before wound closure begins; at skin closure or end of procedure; and at the time of permanent relief of either the scrub person or the circulating registered nurse.

A July 2019 article in Outpatient Surgery (XX, No. 7) titled “Technology to Prevent Retained Items” provides several examples of sponge-detection technology that can protect against retained items. These include:

Matrix label or barcoding – using each sponge’s unique identifying number, this program tracks sponges counted in and out.
Radio frequency detection device – all the sponges for a case come with a small tag that can align with a radio frequency device. The detection wand can detect the tagged sponges if they are left in a patient or put in the trash.
Combined approach – In this system, each sponge features its own unique RFID transmitter that can be detected by a wand device and scanned into and out of a program on a touch-screen table. It can identify the exact location, type and number of sponges in the surgical site.

As counting is prone to error, standardized counting practices are obviously the best way to make certain that all surgical items are accounted for and recorded. New technology can go a long way in preventing counting errors and ensuring that nothing is left behind.

A crucial aspect of documentation for surgical procedures, quality operation notes are essential for patient safety, post-operative care, remuneration and defense in litigation. Partnering with an experienced medical transcription services company can help providers ensure proficient, legible operation notes.

Burnout Common in Large Radiology Practices, finds Survey

02-September-2019 Julie Clements Radiology Transcription

Burnout is a serious concern among healthcare professionals, impacting clinician efficiency and patient safety. Radiology is one of the specialties with a high incidence of provider burnout. The 2018 Medscape National Physician burnout and Depression report ranked radiology the seventh highest specialty for burnout, higher than in 2017 and 2016. Many radiology practices rely on radiology transcription services to manage their EHR documentation workload. A new survey has found a high incidence of burnout among radiology practice leaders.

Burnout Common in Large Radiology Practices, finds Survey

The survey was conducted by researchers from the University MD Anderson Cancer Center’s Department of Radiology in Houston and published by the Journal of the American College of Radiology. The team reported that more than 50% of radiology practice leaders consider burnout a “very significant problem”. Overall, 71% reported stress due to workplace factors. Other important findings:

22% of respondents reported that burnout was a “significant” problem.
Burnout did not vary by geographical region but varied by practice size.
37% of respondents who led a practice of five or fewer radiologists cited burnout as a serious problem compared to 71% among practices with 50 radiologists or more.
36% said stress from personal or social factors affected radiologist employee wellness “very significantly”. These factors were statistically significant by region, practice size and practice type.
Both personal and social factors varied by geographical region, practice size, and practice type
Only 19% of practice leader respondents said they had mechanisms to deal with burnout; 21% reported they had “very effective mechanisms” to address the problem.

The team concluded that “radiologist burnout as perceived by practice leaders continues to be a significant profession issue”.

An article in Diagnostic Imaging discussed various strategies that radiologists and organizations can implement to combat burnout.

What radiologists can do:

Radiologists need to renew their faith in their profession and think about why they chose the field and why it is so important. Radiology services have a deep impact on people’s health.
Thinking positive is crucial. Practising positive psychology includes understanding that failures are just transient and focusing on plus points including long and short-term achievements.

What organizations can do:

Change the work environment culture so that radiologists with more time for exercise as well as rest.
Change assessment structure – Experts recommend moving away from Relative Value Units (RVU) productivity as sole assessment of physician effectiveness. According to them, radiologists would benefit through compensation structuredon just on productivity but also elements such as participation in hospital committees, respect from referring clinicians, and teaching activities.
Reduce administrative tasks – Bureaucratic tasks can be extremely challenging for radiologists. Frequent work breaks, opening reading rooms, and ensuring ergonomic workstations can help relieve physician stress and also strengthen team relationships. Organizations also need good leaders who can communicate well and solve problems.
Enhance independence and control – The ACH HR Commission identified lack of control or autonomy as one of the key reasons for burnout among radiologists. In fact, larger groups result in less independence and more focus on measures of productivity. Giving physicians more control or autonomy can boost their morale.
Focus on radiology burnout in national physician meetings. Sharing best practices and research and demonstrate their significance on a national level. Experts also recommend developing curricula to teach wellness principles.

The need to demonstrate value under the pay for performance model has also put radiology practices under a lot of pressure to showcase their contribution to medicine. However, experts say that it is difficult for radiologists to define and demonstrate value. An article in Radiology Business cites a Stanford radiologist as saying that defining value in diagnostic radiology is challenging for many reasons, especially because most radiologists focus their efforts on diagnosis and treatment decisions usually made by other providers.

“The higher rate of practice-level mechanisms to assess burnout in larger practices may reflect higher awareness of this issue among practice leadership; there continues to be a need for practice-level strategies to mitigate it”, wrote the Houston researchers.

Addressing burnout among radiologists is critical to improve provider efficiency and patient care. The ACR has developed the Radiology Wellness Being Program to provide a diverse range of resources for practice leaders and their radiologists across all practice types” (www.canhealth.com). Medical transcription companies help radiology practices manage electronic health records, which is important for documenting and communicating results, and following up on reports.

Study: Many Patients Do Not Have Advance Directives Before Surgery

29-August-2019 MTS TEAM Healthcare News

Electronic health records have the potential to make health care more precise and preventive, and support retrieval of patient information to support clinical decision making. Medical transcription services ease the data entry burden on providers, allowing them to spend more time with their patients rather than in front of the computer. Such documentation support is especially useful for surgeons who need to take time to discuss treatment choices with patients, and after the decision is made, specifics of the procedure, as well as its risk, expected recovery, and care. Advance care planning (ACP) is an important communication topic between patients, their family, and their health care providers.

Advance care planning (ACP) helps patients prepare for current and future decisions about their medical treatment and place of care. The patient’s preferences about end-of-life care are expressed in an advance care directive – a legal document that comes into force if the patient is incapacitated or unable to speak for him/herself.

ACP involves making decisions about emergency treatments in the event of a life threatening illness, injury, or surgical complications. It is also recognized as a valuable tool for everyone, regardless of age or current health status. Decisions that come up during emergency treatment usually relate to cardiopulmonary resuscitation (CPR), ventilator use, dialysis, tube feeding, medically administered hydration, and comfort care.

However, even as ACP is widely accepted as a way to maintain patient self- determination, facilitate medical decision making, and promote better care at the end of life, a new study found that many patients do not have advance care directives in their medical records.

The study, published in the Journal of Internal Medicine, examined at EMRs of 400 patients who underwent preoperative evaluation. The researchers reported that about 71% of patients seen in preoperative testing clinics before surgery do not have an advance directive (AD) in place. In the event of surgical complications, this can result in patients’ families having to take difficult decisions about the kind of care their loved one receives. Importantly, ADs better align the care people receive in a crisis with their wishes and desires.

Healio summarized the findings of the researchers at the Regenstrief Institute, Indiana University Health and Indiana University School of Medicine as follows:

only 30% of patients in their study had some form of AD documentation that spelled out the kind of emergency medical care they wanted
only 16% had had ADs that were scanned into the EMR where a clinician could access it
Of those with AD scanned into the EMR, only 11.8% had a surrogate decision maker and 11.5% had a living will
People age 65 and older and patients with congestive heart failure were significantly more likely to have an AD scanned in their EMR

One of the researchers said that the study findings suggest that there is significant scope for improvement in advanced care planning in the clinical setting.

“When an AD is not available in cases of emergency, it creates a complex situation for the care providers and surrogate decision makers. Emotions are often high, and family members may have difficulty navigating those emotions to make the best decision for their loved ones,” she said.

The American Medical Association (AMA) recommends that physicians routinely engage their patients in ACP and provides the following directives on the matter:

Encourage all patients to consider their values and perspectives on quality of life and document their goals for care if they faced a life-threatening illness or injury, including preferences for specific medical interventions.
Patients need to identify a person who could make decisions on their behalf if their illness rendered them unable to do so, and make their views known to the designated person, and their family members and close friends.
Physicians should be prepared to answer patients’ questions about ACP and refer them to additional resources for reference, if required.
Patients should be educated about how ADs can help guide treatment decisions in collaboration with patients themselves when they have decision-making capacity, or with surrogates when they do not. The patient’s surrogate should be included in the discussion whenever possible.
Notes from ACP discussions, including the patient values and preferences for treatment in an emergency, should be incorporated into the EMR. The patient should be advised to give a copy of the advance directive document or written designation of proxy to the surrogate and others so that it will be available when needed.
As the patient’s goals, preferences, and choice of decision maker can change over time, physicians should periodically review these matters with the patient (and surrogate, whenever possible). The EMR should be updated with the changes.

Effective interactions between surgeons and patients require time. Medical transcription outsourcing can help providers focus on addressing patients’ concerns and expectations, clarify any misunderstandings they may have about specific medical conditions or interventions, and help them plan for care at the end of life.

Patient Matching Problem Continues to Dog Healthcare Industry

26-August-2019 Rajeev Rajagopal Medical Transcription

The transition from paper charts to electronic health records (EHRs) has dramatically changed the way patient care is provided. EHRs help clinicians document treatment decisions, order medications and review laboratory results. Medical transcription companies have evolved along with the technology, helping physicians improve notes and complete patient records correctly and in a timely manner. However, while digital health records offer many benefits, interoperability depends on their capability to accurately match patient information.

Patient Matching Problem Healthcare Industry

Patient matching means knowing with certainty that information in the medical record belongs to the correct person. Patient matching challenges occur when:

the physician cannot access a patient’s medical record
the record contains another patient’s data, or
the record contains incomplete or inaccurate information

Despite the advancements that have been made, recent reports indicate that the patient matching problem is continuing to dog the healthcare industry.

Patient matching errors can have dire consequences for patient safety. When a physician cannot access a patient’s medical record, the record contains another patient’s data, or the record contains incomplete or inaccurate information, the physician cannot provide the correct treatment. ECRI’s Patient Safety Organization says 181 healthcare organizations voluntarily reported 7,613 wrong-patient events over a 30-month period in 2013 to 2015. Lack of data integrity also leads to denied claims and wasted time, and affects patient satisfaction.

Matching patients with their records correctly has become more challenging as patients now have an increasing number of ways to enter health systems’ networks, according to an article in the Wall Street Journal. The reasons for duplicated or inappropriately merged records include:

Typos
Data entry errors when entering patient information initially
Common and similarly spelled names
Missing information
Not updating data such as names, addresses and other identifying information
Workarounds
Different EHR systems record patients’ addresses in different ways. For inctance, one system may use “Street” in addresses, while others may use “St.

According to a report from Pew Charitable Trusts, as many as one out of five patients may not be matched to all the right records held at their provider.

A 2016 Ponemon Institute survey of more than 500 respondents showed that 86 percent had experienced or known about a medical error that occurred because of patient misidentification. The survey identified the following reasons for patient matching errors:

Source: www.healthitanalytics.com

In the above-mentioned survey, up to 84% of respondents said that staff had to spend about one hour to correct a patient identification error.

In January 2018, the U.S. Government Accountability Office (GAO) reported that efforts to accurately match patient records will continue to challenge providers, payers and others, with no one-size-fits-all approach to ensuring that information in different health records refers to the same patient (www.healthcaredive.com). Interoperability – linking electronic patient medical records across institutions and time – cannot succeed unless an individual’s charts held in the different places can be matched.

The GAO report discussed the various approaches that stakeholders used to identify and verify records refer to the same patient. Some used manual matching which involves manually verifying records to see if they refer to the same patient. Others reported using digital tools and software to verify data in EHRs. Based on demographic data elements, such as a patient’s name, address, Social Security number (SSN), and birth date, algorithms identify the likelihood that a given record matches a given individual.

However, stakeholders pointed out that not every system uses the same number or type of variables, and all providers do not have a sufficiently high level of data integrity to provide these algorithms with the information they need to ensure accurate results every time. Further, the GAO report stated that stakeholders said that it is difficult to determine the accuracy of the health IT tools used to match patients’ medical records automatically.

Nevertheless, both the GAO and Pew studies concluded that “no one solution currently exists to achieve highly reliable matches for all patients across all EHR systems” (www.healthcaredive.com). Solutions put forward to securely match patient records include: clarifying government funding restrictions for unique patient identifiers, reaching a consensus on standardized demographics, using apps to share identity information, verifying a patient’s phone number with the provider, and exploring the use of biometrics.

Many hospitals are already turning to biometrics to overcome a growing patient-identification problem, according to a recent WSJ article. Biometrics includes such as fingerprinting, facial recognition and iris scan. Northwell Health, based in New Hyde Park, N.Y., introduced a biometric system using iris scanning and facial recognition technology last September. The Harris Health System, which serves Houston and other areas, initiated palm-vein scanning in 2011 to identify patients. This system has nearly 2500 patients named “Maria Garcia”, and 230 of those people also share the same birth date.

As providers explore measures to ensure accurately match information in the medical record to the right patient, outsourcing medical transcription to an experienced service provider can ensure quality clinical documentation. Error-free medical records are necessary to support accurate, efficient and meaningful exchange of clinical data or interoperability.

Reading Visit Notes Improves Medication Adherence, Suggests New Survey

22-August-2019 Julie Clements Medical Transcription

Physicians and nurses enter medications in visit notes, often with the help of EMR-integrated medical transcription services. However, getting patients to adhere to their medication prescriptions is a major concern for healthcare providers. Studies show that poor medication adherence causes preventable deaths and costs the U.S. economybillions of dollars annually. The good news is that a new study found that online access to visit notes can promote medication adherence. Published by leaders from OpenNotes, the study covered 20,000 patients at three early OpenNotes facilities – Beth Israel Deaconess Medical Center (BIDMC), the University of Washington Medicine (UW), and Geisinger Health System.

Reading Visit Notes improves Medication Adherence

Medication adherence is necessary to properly manage symptoms, reduce adverse reactions, and improve quality of life. Nonadherence can lead to adverse outcomes especially in patients who have various comorbilities and take multiple medications. It can increase risk of ED visits, and hospitalizations, and death.

A research review published in Annals of Internal Medicine estimated poor medication adherence costs the U.S. health care system between $100 billion and $289 billion annually. Lack of adherence was responsible for approximately 125,000 deaths each year, as well as at least 10 percent of hospitalizations that occur every year.According to the review, studies consistently show that “20 percent to 30 percent of medication prescriptions are never filled, and that about 50 percent of medications for chronic disease are not taken as prescribed.” The researchers found that individuals who take prescription drugs generally only take about 50 percent of the prescribed doses.

Experts say a lack of medication adherence also can explain why some prescription drugs appear to work better in studies than they do among the general population, and why patients experience relapses or die when they have been prescribed medication that should control their conditions, New York Times’ “Well” reports. Simply put, former Surgeon General Everett Koop said, “Drugs don’t work in patients who don’t take them.”

Experts suggest that medication adherence can be improved via mobile medication management, pharmacist interventions, predictive analysis and integrated data systems, and lowering the costs of drugs.

Patient compliance refers to the extent to which a patient correctly follows medical advice. The new OpenNotes survey suggests that patients who read their visit notes are more likely to understand prescription advice and follow it. Summarizing the findings the study, Patient Engagement HIT reports that access to clinician notes helped

64 percent of patient respondents better understand why their clinician prescribed a certain medication,
Another 62 percent feel more in control of their medications
57 percent of respondents find answers to questions they had about their medications, saving them a call to their doctors
61 percent of respondents feel more comfortable taking their medications

While 14 percent of patients at BIDMC and Geisinger reported that access to visit notesimproved their ability to adhere to medication plans, at UW, thirty-three percent of patients reported medication adherence improvements. Patients who did not speak English or who have lower literacy scores were found to have more noticeable improvements.

Catherine DesRoches, DrPH, executive director of OpenNotes describes sharing clinical notes with patients as a “relatively low-cost, low-touch intervention.” (patientengagementhit.com).

However, the study’s co-author recognizes that this kind of transparent communication is not easy as it is a departure from convention. Physicians considering note-sharing for the first time would tend to worry aboutpotential effects on their workflow and about making their patients nervous. But he points out that experience shows that patients approve it and it holds great promise for medication adherence. In addition, transparency is mandated by federal law and policy and providers need to utilize the opportunity to share health care information to promote clinical management and health improvement.

Giving patients the ability to access their notes can boost medication adherence. For this to work, physicians need to maintain accurate medication records, and according to Mag Mutual, this can be a challenge. Medication reconciliation, the process recommended for providers to maintain the most complete and accurate list possible of a patient’s current medications, can be compromised by several factors such aspatients’ lack of knowledge of their medications,physician and nurse workflows, frequent changes in patients’ medications, use of undocumented over-the-counter medicines,and lack of integration of patient health records across the continuum of care.

A collaborative approach to medication management requires both patient and provider interventions. Among other things, accurate and timely charting is crucial. Outsourcing medical transcription can help with this by allowing physicians maintain precise, concise and clear visit notes with a medication list that includes continued medications, modified medications, new medications and discontinued medications.

How to Keep the Healthcare Environment Clean and Healthy

19-August-2019 MTS TEAM Medical Transcription

The healthcare environment is highly sensitive. You cannot afford any kind of contamination that could compromise patient safety. The physical cleanliness of the healthcare environment is as significant as the “clean” medical data provided by a medical transcription service, when it comes to ensuring optimum patient care, safety and satisfaction.

how to keep the healthcare environment clean and healthy 1

Patient care and patient satisfaction are clinical responsibilities that hospitals and other healthcare facilities have to fulfil. During a patient’s stay, the environmental and non-clinical aspects are what make the patient experience good or bad. Factors such as the hospital’s physical environment and the team that maintains it also play a critical and often under-appreciated role. Any type of medical facility where you provide care to patients requires a high level of performance, cleanliness and safety. Those receiving treatment or just visiting a hospital or other such healthcare environment are vulnerable to infection, which makes effective cleaning processes indispensable in corridors, waiting rooms, reception area and the wards. There is no doubt that a hygienic and warm environment is aesthetically important as well because it will help generate a feeling of wellbeing and trust in the patients and those who accompany them.

Unfortunately, almost a hundred thousand people die every year in the U.S from hospital acquired infectious diseases, according to CDC (Centers for Disease Control and Prevention) statistics. This points to the failures of traditional cleaning systems. Here are some hospital cleaning best practices advocated by North American public health officials and Kaviac Cleaning Systems, a provider of complete cleaning systems.

Focus on the most touched surfaces: These surfaces include doorknobs, phones, bed rails and remote controls in patients’ rooms. Dangerous bacteria are most likely to exist on these high-touch areas.
Start with clean areas and go on to the dirtier ones: Often cleaning staff start from the dirtiest places such as the rest room and then proceed to the cleaner parts of the facility. This is to be avoided because you could more easily spread disease-causing agents from a bathroom or kitchen where mops and rags are used. In hospitals, cleaning should start from the rooms of the healthiest patients and then go on to the rest rooms and the wards with the sickest patients.
Use gloves properly: If gloves are used improperly, bacteria will spread dangerously. Ideally, different gloves should be assigned for patient rooms, household tasks, and jobs involving heavily soiled items. Gloves should always be changed between patients. Never wear them in hallways, and change them when moving from a residential area to a shared restroom space. Cleaning staff must wash their hands after removing gloves.
Avoid cross contamination: Mops and rags could spread contamination and must be disposed of carefully. Now, revolutionary techniques of spraying, vacuuming, and disposing of contaminants are available that will ensure that bacteria never leaves the room.
Control air pollution: Bacteria must be kept out of the air stream. To ensure this, cleaning staff must roll dirty bedclothes away from their bodies before placing them in linen bins. Trash bags should be tied carefully without releasing the excess air in the bag.
Minimize chemical content: It is best to choose cleaning solutions with less chemical content. This will ensure that abrasive chemicals do not irritate patients’ nasal passages or harm the skin of cleaning staff.
Dispose of contaminated materials safely: It is important to ensure that when contaminated materials such as soiled linens, contaminated biological materials from clinics, and dirty cleaning fluids are removed, there is no chance for contamination.

Ideally, the healthcare facility should have a regular program of infection control education and training for their staff. In addition, they should make sure that the infection control practices and standards are being met through a program of regular checks.

To ensure a safe and efficient healthcare environment, here are some steps administrators can take:

Safety: Safety is very important in a healthcare set up. There are various measures that help you promote safety. For example, the staff should be provided with comfortable attire and shoes so that they can work for longer hours without any discomfort. The shoes should provide protection from slips and falls, and from sharp objects. Make sure that the exam rooms and waiting rooms do not have sharp edges or objects that could harm patients and you should also have a clear and open space for walking freely between rooms.
Good programs: Ensure that all your papers are kept organized and you have access to the medical records of your patients at your disposal, this is very important. Advanced technology like ERP software allows you to provide information faster and also helps your employees work more efficiently.
Separate areas for patients: Often when you enter a medical facility, multiple patients occupy the same space. This is a dangerous practice that can produce undesirable results. A good way to avoid the spread of a virus or airborne disease is to keep sick patients separate from those who have just come for a regular check up or for a follow-up visit.
Qualified and experienced staff: To ensure efficient patient care, it is important to have skilled doctors and nurses. Due to the high demand for doctors and nurses, there are chances of higher turnover rates. One way to reduce the turnover rate in your practice is to keep your employees happy by offering good salary, proper treatment of personnel on the job and benefits that extend beyond what they would find elsewhere. However, make sure to employ skilled and experienced nurses and doctors for optimal results.

Healthcare units have various activities like providing quality care, documentation of medical records, monitoring patients, and so on. Reliable support is available in the form of outsourced services from reputable organizations. A medical transcription company providing EMR-integrated medical transcription services would be a good partner when it comes to healthcare documentation requirements. Similarly, cleaning services are also provided by dedicated agencies that use the best cleaning products and systems to help hospitals and other healthcare facilities maintain a clean and healthy environment.

Five Major Challenges Facing Healthcare Administrators

16-August-2019 Rajeev Rajagopal Medical Transcription

Healthcare administrators face unique challenges when it comes to the management of hospital departments, staff, finance, and health information. Regulatory changes, technological advancements, disease management, phenomenal increase in data, goals of value-based care, cyber security issues, and the protection of patient records have made health care a complex system. Just as medical transcription services have evolved to keep pace with the latest developments such as electronic health records (EHRs), healthcare administrators need to adapt to deal with the dynamic healthcare scenario to succeed in their tasks. Let’s take a look at the current issues in healthcare management.

Challenges Facing Healthcare Administrators

Transition from fee for service to value based healthcare: The Medicare Access and CHIP Reauthorization Act (MACRA) was passed in 2015 and completely changed the reimbursement landscape with a phased transition to value-based billing systems. With value based care, improving patient outcomes and efficiency in the provision of care could be the most important goal for healthcare administrators in the coming years. Value-based payment models require physicians to deliver the best outcomes while paying attention to resource utilization with the goal of minimizing healthcare costs. To effectively implement a value-based model, healthcare executives need to share actionable insights with physicians, especially on the cost of care. This will help physicians manage resources appropriately and make better patient care decisions. Hospital systems will need to engage patients in their health, harness the power of their data, connect stakeholders at all levels, and integrate the goals of value-based care in the daily workflow. They need to come up with effective strategies to deliver lower-cost care.
Improving patient outcomes using technology: Experts say while the healthcare costs in the U.S. are much higher than in other countries, patient outcomes have actually dropped. Health informatics is taking over every aspect of the industry. To improve patient outcomes, healthcare administrators will need to ensure that EHRs and other technologies are effectively implemented within the healthcare organization (Becker’s Hospital Review). In fact, electronic patient records allow hospitals and physicians to share information seamlessly. They must keep up with advances in medicine, technology and government regulations and policy changes to ensure quality medical care and improve operational efficiency.
Expanding access to care: Healthcare systems need to ensure that patients can easily and affordably access the care they need to achieve optimal health outcomes. Lack of access to care will lead to delays in treatment, which can exacerbate medical conditions and cost of care for both the patient and the health system. Industry professionals must work to understand the challenges patients face when seeking care and devise innovative strategies to resolve these issues. Healthcare administrators need to consider how services can be made available to patients, especially those living in rural areas. Telehealth, mobile health technology, and online scheduling are options that can promote treatment access in ways that are convenient for the patient.
Cyber security – confidentiality/privacy issues: With digital transformation initiatives, healthcare cyber security has become a major concern for hospitals and their management. In April 2019, providers, health insurers and their business associates reported 44 data breaches to the federal government. According to medical device manufacturer Abbott and the Chertoff Group, about 75 percent of providers and 62 percent of administrators feel underprepared to face cybersecurity risks, due to staffing, training, and awareness (healthitsecurity.com). The HIPAA Security Rule requires covered entities to evaluate data security controls by conducting a risk assessment, and implementing a risk management Outsourcing medical transcription to a HIPAA-compliant transcription company, for instance, can ensure that patient health information is well-protected. Engagement across all stakeholders in the healthcare ecosystem is critical to ensure cyber security.
Shortage of healthcare professionals: America’s aging population is expected to double in the next 20 years and 75 percent of Americans over 65 live with multiple chronic health conditions. These statistics are really alarming given the fact that the nation is facing a shortage of healthcare professionals. The Association of American Medical Colleges predicts a shortage of up to 120,000 physicians by 2030. The Bureau of Labor Statistics estimates a need for 649,100 replacement nurses by 2024. Becker’s Hospital Review notes that hospital administrators must have a plan in place to address staffing challenges and compete for the best employees – registered nurses, licensed practice and licensed vocational nurses, nursing aides, orderlies and attendants, and physicians and surgeons. They must develop strategies and policies to recruit, hire and retain qualified healthcare professionals.

Electronic health records are one of the top tools that can help healthcare administrators and physicians provide timely, quality care. EHRs enhance care coordination by allowing patient information to be shared among multiple health care providers and organizations. But administrators need to deal with the financial and staffing financial burdens of purchasing EHR software and hiring the specialized staff necessary to implement and maintain it. Fortunately, HIPAA medical transcription services are available to take care of EHR data entry work which cuts into physician time with patients.

Study: Physician Stress and Patient Safety Concerns linked to EMR Usability Issues

08-August-2019 MTS TEAM Medical Transcription

This year, the health care industry marks the 10th anniversary of the Health Information Technology for Economic and Clinical Health (HITECH) Act, which set the adoption of electronic medical record (EMR) systems as a critical national goal. Medical transcription services have kept pace with the widespread implementation of EMRs, helping physicians maintain accurate and organize documentation in patient records. However, a new study points out that EMR usability issues are contributing to patient safety concerns and also fuelling physician burnout (www.reliasmedia.com). The researchers recommend greater transparency to address EMR-related flaws.

Patient Safety Concerns linked to EMR Usability Issues

ER physicians have always expressed concerns about how EMR data entry interrupts patient interactions. The study findings support these arguments.

Researchers at MedStar Health’s National Center for Human Factors in Healthcare (NCHFH) in Washington, DC studied the use of two popular EMR systems at four separate emergency department (ED) sites. At each site, about 10 to 15 emergency medicine physicians carried out six standard clinical tasks on their own systems. The researchers recorded the number of clicks required and the amount of time needed to complete each task. The study found that results varied widely across the four sites:

Wide variation in the number of clicks and time required to complete a standard clinical task
Significant differences in the time taken to perform a task
High error rate (associated with the task) across the sites
Huge variability across the systems of the two EMR vendors

The study revealed patient safety issues with popular certified EMR products in different sites.

Error rates ranged between 16-36% in X-rays of the left elbow, wrist, and forearm. The lead researcher observed that the reason for this error could be that physicians could be ordering an X-ray on the wrong side or of the wrong body part, or because they issued an incomplete order that only called for an X-ray on two of the three body parts.
Error rates ranged from 16% to as high as 50% across the four sites when physicians entered a prednisone taper medication order.

The researchers highlight the importance of customization and configuration of EMR systems from the provider’s side in order to reduce such variability.

In September 2018, a report from the AMA, Pew Charitable Trusts and Medstar Health, Ways to Improve Electronic Health Record Safety identified the problems with EHR usability, implementation and testing (www.ama-assn.org). The study was based on an analysis of 557 reports provided by clinicians. The researchers identified seven EHR safety and usability challenges physicians should watch out for:

Data entry: Clinicians may find it difficult to perform EHR data entry along with treating patients. In one instance, the researchers found that the clinician selected the wrong frequency for a drug to be administered because the clinician was not aware that the order in which the options were organized in the EHR had changed.
Alerts: In some systems, EHR alerts are absent, incorrect or ambiguous. For example, in one case, though the patient’s gelatin allergy was listed in the EHR, the clinician was not alerted about it while prescribing a medicine.
Interoperability: Lack of proper interoperability within the EHR system’s components or with other systems may hinder communication of information. For instance, interoperability problems prevented clinicians from accessing a patient’s lab records maintained in another part of the hospital.
EHR displays: Confusing, cluttered or inaccurate visual displays often made it difficult for clinicians to interpret medication/prescription information.
Difficulty in accessing information: Clinically relevant information, such as results of diagnostic tests, may be unavailable because it is inaccessible or stored in the wrong location in the EHR.
System automation and defaults:The EHR automates to information that is unexpected, unpredictable or not clear to the clinician.
Workflow support: Discrepancy between the EHR and the end user’s intent can affect workflow. In one case, the physician entered an order for diagnostic tests and instructions in a special field, unaware that the lab staff could not view this information. As a result, the tests were not conducted.

According to researchers, health care providers and EHR developers should use safety-based, rigorous test case scenarios to identify and correct problems and help avoid such patient safety issues. Studies show EMR usability is a major contributor to physician burnout, which is harmful to both physicians and their patients. At the same time, suboptimal EHR design also impacts patient safety.

Experts are calling for stakeholders to take measures to address EHR usability challenges. Outsourcing medical transcription is also a practical option when it comes to managing burdensome EHR documentation tasks and reducing physician stress.

Reports Highlight Need to Bridge Care Gap in Behavioral Health

05-August-2019 MTS TEAM Psychiatry Transcription

Behavioral and mental health disorders are a leading cause of illness and disability worldwide. Poor mental health can negatively impact physical health, and vice versa. It also affects family and relationships, social interactions, school and work, etc. Behavioral and mental health practices collect more comprehensive data as a result of screening tools and from ongoing treatment. Mental health transcription services are available to help them streamline documentation, increase efficiency, and meet their unique data reporting requirements.

Over 44 million American adults have a mental health condition, according to Mental Health America. However, untreated behavioral health conditions are a major concern in the US. Recent reports highlight the urgent need to bridge the care gap in behavioral health.

Bridge Care Gap in Behavioral Health

Mental and Behavioral Health – Staggering Stats

Nearly half of all Americans with mental illness are not getting treatment, according to Mental Illness Policy Org. The National Institute of Mental Health estimated that during a one-year study period, 51 percent of adults in the U.S. with bipolar disorder and 40 percent with schizophrenia were untreated. Only 43 percent of people with mental illness received treatment in 2016.

A 2017 survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) revealed that of the estimated 56.9 million US adults with a behavioral health condition, 7 out of 10 (or 39.7 million adults) are not receiving treatment for it (www.fiercehealthcare.com). According to the report, as much as 92% of adults with substance use conditions do not receive treatment. The rates of non treatment for those with serious mental illness and other mental illnesses are 33% and 65%, respectively.

A recent study commissioned by the Michigan Health Endowment Fund (MHEF) found that nearly 38 percent of people with a mental illness (670,000 residents) and 80 percent (more than 500,000 people) with substance use disorder were not getting treatment in Michigan (www.bridgemi.com). The news report cites the executive director of the Michigan chapter of the National Alliance on Mental Illness as saying that they considered this an epidemic in mental illness in Michigan.

Mental health disorders are widely prevalent among children. According to a University of Michigan study published in JAMA Pediatrics, about one in seven children have at least one treatable mental health disorder, including depression, anxiety or ADHD. However, the researchers found that half of them did not receive the required treatment from a mental health professional in 2016.

Barriers to Behavioral Health Care

There are many reasons why people with symptoms of behavioral health conditions may not actively seek or receive diagnosis and treatment for their disorders. A 2018 report from virtual behavioral health care provider Able To, Inc. found “cost” and “stigma” to be the most important barriers to mental health care. The key barriers listed in the report are as follows:

Costs of treatment are high (inability to pay)
Stigma or society’s attitude toward mental health
Fear of being labeled
Unsure if condition is serious enough to need treatment
Stigma of thinking something is wrong with me
Fear of having to take medication
No time to seek help, go to counseling, etc.
Unsure if health insurance will cover therapy
Fear of discussing personal problems with physician/therapist
Most treatments are not very effective

Similar to medical conditions, early intervention is crucial to achieving success in treating mental and behavioral health conditions. Primary care providers are often the first point of contact for children with psychiatric disorders. Therefore, primary care providers need to collaborate more effectively with mental health professionals and families to bridge care gap in behavioral health.

Measures to Bridge Mental Health Gap for Patients

As there is a strong link between mental and physical health, patient monitoring by both primary care providers and mental health professionals is crucial to ensure that both behavioral and physical problems are addressed. Here are expert views on the matter, including recommendations provided in a recent article published by Psychiatry Advisor:

Simplifying state-regulated health care facility requirements, especially for co-located primary care and behavioral health settings
Promoting bidirectional workforce education
Encouraging a collaborative team-based approach to care – screening patients, implementing first-line treatments, and having consultation and referral options to psychiatrists in primary care offices. Blending physical and mental health care within a single facility increases care collaboration and also decreases patient stigma
Expand financing and reimbursement options for integrated care
Improving mental health literacy and helping patients make informed decisions about healthier lifestyle behaviors, including addressing tobacco use and excess weight.
Improving mental health coverage
Ensuring qualified providers are available by training more psychiatrists and providing physician assistants (PAs) with specialized training in mental health.
Using telehealth to overcome lack of access to mental health treatment – providers can use secure communication pathways to engage with patients wherever they are located and deliver mental health care.

Integrating mental health care in primary care settings will provide mutual access to electronic health record systems. Medical transcription outsourcing can help physicians manage their EHR-related documentation tasks and streamline reporting requirements.

PAC- RIS Integration – Top Considerations and Benefits

01-August-2019 Rajeev Rajagopal Radiology Transcription

Radiology reports allow referring physicians to decide patient management and provide appropriate and timely care. Voice recognition (VR) is widely used by radiologists to create radiology study reports. Nevertheless, many radiologists still rely on radiology transcription services to proofread and correct VR generated reports. The reason for this is the high rate of transcription errors in associated with VR diagnostic radiology reports (www.radiologykey.com). The performance of a radiology department is measured in terms of its capability to deliver error-free reports rapidly.

PAC-RIS Integration

The availability of patient data is key aspect in information-based decision-making by physicians. Interoperability of various healthcare systems is necessary to make patient data available for effective decision-making. Radiology images and reports are key elements of a patient’s medical history. All care providers need to have easy access to radiology information to diagnose illnesses and assess treatment outcomes.

The integration of Picture Archiving and Communication Systems (PACS) with electronic medical records (EMRs) provides clinicians with easy access to radiology information. It can also help reduce costs by minimizing duplicative scans and redundant image and report distribution. PAC-EMR integration also saves radiologists time, improves workflow, and helps them access clinical data in the EMR more often, according to a study published in the Journal of Digital Imaging in 2018 (www.radiologybusiness.com).

The research team gathered EHR access data on 37 users covering a period from 180 days before the PAC integration to 240 days after. Following PACS integration it was found that:

EHR access time reduced to 6 seconds from 52 seconds (which amounts to an average of more than a working day (8.26 h) per radiologist per year)
Radiologist-initiated EMR access increased from more than 36 percent before integration to more than 44 percent after integration
EMR use increased over time following integration

The authors concluded that, much more than being “a matter of convenience”, the interface between EMR and PACS truly improves patient care and helps specialists demonstrate their value.

“There is substantial aggregate time savings provided by integration,” the authors wrote. “More importantly, these time savings organically drive changes in radiologist practice projected to change diagnosis in 1 out of every 200 cases read. We believe that in light of these results, PACS-EMR patient context integration should be considered an essential component of every PACS environment.”

How can PACS-EMR be achieved? According to an article in Imaging Technology, successful integration depends on the following considerations:

Plan for best-of-breed solution architecture – For integration to be effective, the architectural design would need to account for multivendor, multisystem integration. The departmental PACS and information systems, such as RIS, cardiovascular information systems (CVIS) should interface with the EHR in the hospital as well as outpatient clinics and referring practice.
Minimize downtime – In effective integration, there would be minimal impact on workflow and care delivery. For instance, workflow in the emergency department (ED) is time critical and cardiology departments have highly specific needs. PACS-EMR integration should cause minimal disruption to these processes.
Optimize the patient experience: Effective integration would allow various stakeholders involved in the patient’s care to make quick and informed decisions. This is essential to optimize patient care and enable cost-effective healthcare delivery. It will also streamline information and save radiologists’ time by preventing repeat order verification, duplicate screening forms, and redundant insurance validation.
Leverage current standards compliance: Interfacing based on DICOM (digital imaging and communications) and HL7 standards will allow quick sharing of information across the care continuum. It will facilitate quick integration of various systems and allows information to be shared without the need for costly and time-consuming integration project.
Hosting of PACS: Organizations considering PACS options must first identify how their system will be used and where it will be hosted. PACS can be hosted in-house, at a remote hosting facility, or in the cloud (as Software as a Service). Organizations must choose the vendor that can meet their needs. The Internet is the best system for health data exchange. Internet-connected medical devices and systems are necessary elements of an ideal data exchange. Integration via the Internet can combine information from numerous systems and provide data as an element of a portal, a mobile application, or as part of any system.

Error-free and timely medical and radiology reports are crucial for successfully PACS-EMR integration. With the improvements in speech recognition systems, many groups are moving this mode. One of the main benefits of voice recognition is that clinicians can use structured templates to send finalized reports to the referring physician in quick turnaround time. According to a new study by Reaction Data (www.healthcareitnews.com), today 85 percent of radiologists use a speech recognition system to record their reports while 15 percent continue use the traditional dictation method and send it to a radiology transcription service provider. The study also found that of the 15 percent of provider organizations that have not yet adopted speech recognition and 41 percent said they have no plans to ever adopt the technology. This shows that medical transcription outsourcing is still relevant to ensure accurate patient data for effective decision-making.