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:

health analytics

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

how to keep the healthcare environment clean and healthy 1

Maintaining healthcare environment cleanliness is vital for ensuring patient safety and promoting overall wellbeing. A hygienic healthcare setting prevents the spread of infections and also enhances patient trust and satisfaction. Just as high quality medical transcription services ensure clean, error-free medical data, maintaining a physically clean healthcare environment is crucial to prevent infections and deliver optimal patient care. Both aspects, data cleanliness and physical hygiene, work hand in hand to create a safe and efficient healthcare ecosystem that meets established healthcare cleaning standards.

The Importance of Healthcare Environment Cleanliness

The healthcare environment is inherently sensitive. Any form of contamination, whether physical or microbial, can put patients and staff at risk. The Centers for Disease Control and Prevention (CDC) estimates that nearly 100,000 people in the U.S. die each year due to hospital-acquired infections (HAIs). This alarming statistic underscores the critical importance of maintaining rigorous cleaning protocols and following hospital hygiene best practices in every corner of a healthcare facility — from waiting rooms to intensive care units.

A clean and organized environment contributes significantly to patient satisfaction. The comfort, confidence, and peace of mind that come from entering a spotless hospital or clinic cannot be underestimated. Cleanliness reflects the professionalism and dedication of the healthcare organization toward patient care.

Healthcare Environment

Best Practices for Healthcare Hygiene

To ensure consistent and effective healthcare environment cleanliness, hospitals and clinics should adhere to established cleaning standards and procedures. Here are some essential practices:

  1. Focus on High-Touch Surfaces

    Surfaces such as doorknobs, bed rails, telephones, and remote controls are hotspots for harmful bacteria. Cleaning these high-touch points frequently with approved disinfectants can significantly reduce the risk of cross-contamination.

  2. Clean from Cleaner to Dirtier Areas

    One common mistake in cleaning procedures is starting with the dirtiest areas, like restrooms, before cleaning patient rooms. This practice can spread contaminants. Instead, cleaning staff should begin with the rooms of healthier patients and progress toward areas with higher contamination risks.

  3. Proper Use of Gloves

    Improper glove use is a frequent source of bacterial transmission. Different gloves should be designated for different cleaning tasks. Gloves must be changed between patient rooms, and cleaning staff should always wash their hands after removing them.

  4. Prevent Cross-Contamination

    Mops, cloths, and other cleaning tools can harbor and spread bacteria if not handled properly. Modern cleaning technologies, such as spray-vacuum systems and touch-free disinfection devices, help minimize contamination and ensure thorough cleaning while strengthening overall cross-contamination control measures.

  5. Air Quality Management

    Airborne bacteria and particles can compromise the cleanliness of healthcare spaces. To prevent this, cleaning staff should carefully handle linens and waste materials, ensuring trash bags are sealed without releasing contaminated air. Adequate ventilation and regular air filter maintenance also play a vital role here.

  6. Choose Gentle Cleaning Agents

    Cleaning solutions should be effective yet non-irritating. Harsh chemicals can harm patients with respiratory sensitivities or skin conditions. Opt for eco-friendly or hospital-grade disinfectants that maintain hygiene without introducing toxic residues.

  7. Safe Disposal of Contaminated Materials

    Proper disposal of soiled linens, biological materials, and cleaning fluids is essential. Waste management protocols must be followed to prevent recontamination and ensure compliance with healthcare regulations.

Daily Cleaning Checklist for Healthcare Settings

Here are the key areas administrators should focus on to ensure a safe and efficient healthcare environment:

  • Safety: Safety is critical in a healthcare set up. There are various measures to promote employee and patient safety. For example, 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. Have a clear and open space for walking freely between rooms.
  • Records management: Ensure that all your files are well organized and that you have easy access to the medical records of your patients. Advanced technology like ERP software allows you to provide information faster and also helps your employees work more efficiently.
  • Separate areas for patients: When entering a medical facility, multiple patients are often seen occupying the same space, which is a dangerous practice. 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 a 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.

AI-Integrated Medical Transcription and Its Role in a Clean Healthcare Environment

Cleanliness isn’t just about physical hygiene, it extends to data integrity and workflow management. AI-integrated medical transcription services play a pivotal role in maintaining an organized, paper-free healthcare environment. By converting physician dictations into accurate digital records, these services reduce the need for physical paperwork and storage, minimizing clutter and contamination risks associated with printed documents.

Moreover, AI-driven transcription solutions can automatically integrate data into Electronic Medical Records (EMR) systems, ensuring instant access and easy retrieval of patient information. This streamlined process eliminates manual errors, enhances administrative efficiency, and supports a cleaner, more sustainable workplace.

When combined with reliable cleaning practices, AI medical transcription contributes to a holistic form of healthcare cleanliness, where both the environment and the data are pristine and secure.

Maintaining healthcare environment cleanliness requires a comprehensive strategy that combines human diligence, modern technology, and digital accuracy. From disinfecting high-touch surfaces to adopting AI-integrated medical transcription services, every detail contributes to a safer and more efficient healthcare system. Clean surroundings inspire trust, reduce infection risks, and promote patient wellbeing — the ultimate goal of every healthcare organization.

Ensure error-free patient records with our expert medical transcription services.

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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.

How Open Notes can help in Mental Health Therapy

29-July-2019 Julie Clements Psychiatry Transcription

Each year, about 1 in 5 adults in the U.S. (46.6 million) experiences mental illness, according to the National Alliance on Mental Illness (NAMI). Mental health transcription services help therapists to maintain electronic medical records to accurately reflect their patients’ clinical condition. Good record-keeping is crucial in psychiatry practices to promote better communication and care as well as continuity, consistency, and efficiency.

With national OpenNotes initiative that works to give patients easy access to their health care visit notes, providers need to ensure that EMRs contain accurate lists of medications, symptoms, health problems, etc. A new survey conducted as part of a study published in the Journal of Medical Internet Research found that patients had a positive experience with reading their notes in their EMR.

How Open Notes can help in Mental Health Therapy

Challenges facing Mental Health Treatment

 Despite increased public awareness about mental health issues and the need for open communication to manage the condition, many people delay treatment. A report in Psychology Today reported on the challenges facing mental health treatment:

  • People find it difficult to accept they may have a mental illness and worry about the potential stigma associated with seeking mental health treatment.
  • Many people who need mental health services cannot access suitable treatment.
  • For those who get treatment, the type and quality of the therapy can vary quite widely. Studies show that the type of treatment would depend on many factors, such as individual choices and preferences, organizational values and resources, systems/policy level factors, etc.
  • There is lack of consensus about the type of mental treatment that a particular patient should receive.

 OpenNotes can transform Health Care, say Studies

 After the patient visit, the therapist or mental health provider summarizes the information from the visit in a note that becomes part of the patient’s medical record. The note usually contains a diagnosis, information patients share with the clinician, medication updates, the medical assessment, a treatment plan or next steps, and other pertinent information from the visit.Many practitioners rely on a psychiatry transcription service providerto ensure accurate and timely documentation.

Reporting on the recent survey, the American Medical Association (AMA) points out that shared notes are especially useful for involving patients in their own care and building trust among “vulnerable patients with a lower sense of control”. The study survey, which was conducted in 2017, included responses from 23,710 patients or their caregivers from Beth Israel Deaconess Medical Center (BIDMC), the University of Washington Medicine system and the Geisinger system.

  • About two-thirds of patients said they benefited from reading their notes
  • Only 3.3% said they were confused by their notes
  • Only 4.8% said reading their notes made them more worried

Therapists who implement the OpenNotes program share visit notes with patients, either online using secure patient portals, or on paper. The key benefits of shared notes include:

  • Improved communication
  • Improved safety
  • Reminds patients of their health plan
  • Patients can follow up on recommended procedures, tests or appointments, which can improve adherence
  • Better patient-doctor relationships
  • Helps patients be better prepared for physician-office visits – patients can review steps taken, any changes or new problems they have, and prepare questions to ask their therapist at the appointment

A 2013 study noted that by writing notes useful to both patients and themselves and then inviting patients to read these notes, clinicians can help patients address their mental health issues more actively and reduce the stigma they experience (www.opennotes.org). Patients tend to feel empowered when they realize their own abilities in reading notes, talking about them with their clinician, and putting them to constructive use.

 Access to Visit Notes – Privacy Concerns

 There are several things that physicians need to keep in mind while giving patient access to clinical notes. One key concern is privacy, according to the recently published study. The authors noted that almost 11.5% of clinicians and patients said they were “very concerned” about privacy, and less than half reported actively addressing the shared notes during visits. The AMA STEPS Forward™ module recommends the following measures to address this concern:

  • Having a process in place for patients to privately and securely grant access to their records and visit notes to another person of their choosing
  • Let patients know they may have the chance to decide which notes can be viewed
  • Tell patients that they can withdraw viewing privileges from a proxy or caregiver at any time

The module also notes that clinicians can “hide” certain notes from patients and discuss them in person later.

While patients have the right to access to their record, mental health providers must still satisfy documentation standards and professional requirements. Experienced US based medical transcription companies are well equipped to help them with this.

Study: EHRs may not reflect Accurate Ophthalmic Medication Information

25-July-2019 MTS TEAM Healthcare News

Many ophthalmologists rely on outsourced ophthalmology transcription services to ensure accurate and timely patient records. Electronic health records (EHRs) offer many benefits for ophthalmology practices and have evolved significantly to improve documentation, coding, billing, and security of patient data. However, a new study published in JAMA Ophthalmology found that medication lists created by EHRs may not capture up-to-date and accurate information on ophthalmic medications. The researchers found mismatches between the transcribed progress notes and the structured EHR-based medication list. The study noted that these findings can compromise patient safety and care.

Study: EHRsmay not reflect Accurate Ophthalmic Medication Information

 Benefits of Electronic Patient Records in Ophthalmology

With an aging population and increase in chronic conditions, the demand for ophthalmology and optometry services is growing. Supported by medical transcription companies, ophthalmologists leverage EHRs to document patient encounters and simplify collaboration between patient’s coordinated care team. Once patient information is entered in the system, the data becomes available for various uses,including billing and audit purposes. Other benefits:

  • Diagnostic tests and reports from ophthalmic photography, angiography, visual fields, OCT and measurements for cataract surgery can be stored and displayed in the patient’s electronic medical record (EMR).
  • Inclusion of these test results in the patient’s EMR allows the practitioner to interpret and see these results from anywhere, anytime.
  • All the latest ICD and CPT codes are integrated in the system, so that clinicians can capture, submit and track charges electronically. This improves medical billing efficiency.
  • EHRs can increase compliance with mandated documentation standards.
  • Secure digital records allow patients to view and monitor their care, set-up their appointments, and get prompt answers to their questions.

While EHRs offer all these advantages, researchers found that they may not reflect the most accurate and up-to-dateophthalmic medication information. This raises concerns about patient safety and continuity of care since many patients use EHR-generated printed medication lists to keep track of their prescribed medications between clinic visits.

Study highlights Discrepancies in EHR Medication Lists

The team examined medication-related information contained in the EHRs of 53 patients at the University of Michigan Kellogg Eye Center. The patients had been treated for microbial keratitis, or corneal infection between July 2015 and August 2018. The researchers compared the following types of documentation:

  • The structured medication list in the EHR server
  • Medications written into the clinical progress notes and transcribed by the study team

The study found that:

  • Of the 247 medications identified, 32.1% differed between the progress notes and the formal EHR-based medication list.
  • About one-third of patients had at least 1 medication mismatch reported in their EHR.

These findings are especially relevant for corneal infection because the drugs and treatments change rapidly for this condition, with some medications requiring compounding.

Medication Mismatch increases Risk of Avoidable Medication Errors

In a typical office visit, the physician provides verbal medication instructions to the patient. At the same time, the clinician or a scribe transcribes the discussion into the unstructured or “free text” section of the patient’s EHR. The printed after-visit summary given to the patient will include an EHR-generated medication list.

However, in practice, data about medications (and other information) is captured in multiple formats in multiple locations. Mismatches between the clinician’s notes and the EHR medication list can result in avoidable medication errors for patients who rely on the automatically generated lists.

The study listed the reasons for medication discrepancy (www.beckershospitalreview.com) as:

  • Medications not prescribed through the EHR ordering system (43.9 percent)
  • Outside medications not recorded in the internal EHR medication list (40.4 percent), and
  • Medications that were prescribed through the EHR ordering system and in the formal list but not described in the clinical note (15.8 percent)

Cornea specialist Maria Woodward, M.S., M.D., assistant professor of ophthalmology and the study’s lead author noted that this level of inconsistency is a red flag.

“Patients who rely on the after-visit summary may be at risk for avoidable medication errors that may affect their healing or experience medication toxicity”, says Woodward.

 The Solution

The researchers’ suggestions to improve accuracy of medication information for patients are as follows:

  • The post-visit summary should include instructions on how the medications should be used.
  • To ensure that error-free medication lists, physicians need to double-document. The same information must be entered in two separate places – the clinician’s note and the formal medication list.
  • Developing software solutions to ease the burden of EHR clinical documentation and make it easier to reconcile medication names and dosage.

In a busy clinical setting, physicians focus on communicating directly with the patient, clarifying the treatment plan, addressing patient concerns and answering their questions. In this scenario, medical transcription outsourcing is a good strategy to ensure comprehensive, accurate note-taking.

Impact of Nonverbal and Verbal Communication in Clinician-Patient Interactions

22-July-2019 Rajeev Rajagopal Medical Transcription

Listening skills are important in the medical field. Speed and accuracy are key attributes when it comes to medical transcription services. To understand the physician’s dictated notes and create timely, error-free medical records, medical transcriptionists need to have strong listening skills. Likewise, nonverbal communication has a significant impact on the clinician-patient encounter and has been attracting increasing attention in recent times.

Impact of Nonverbal and Verbal Communication in Clinician-Patient Interactions

The benefits of effective nonverbal and verbal physician-patient communication include:

  • Builds a restorative physician-patient relationship
  • Enhances patient autonomy
  • Promotes patient-centered care
  • Encourages patients to share vital information required for an accurate diagnosis of their condition
  • Gives physicians a better understanding of patients’ needs, which can potentially lead to better symptom reduction
  • Improves patient understanding and adherence to treatment plans
  • Reduces physicians’ work-related stress and burnout
  • Has positive effects on health care costs by reducing diagnostic tests, referrals, and length of hospital stay

Studies have found that nonverbal communication accounts for about 80% of essential communication between individuals. HealthLeaders recently reported on a doctoral study which provided evidence that nurses can improve the patient experience by honing their listening skills. Listening impacts the quality of the interactions between healthcare staff and patients, and this influences patients’ emotional functioning, quality of life, adherence to treatment, and ability to recall information. The author points out that active listening can influence HCAHPS scores and patient care compliance, and positively influence a healthcare organization’s financial wellbeing.

The study participants comprised 23 patients from 15 different health systems in Southern California after they were discharged from their inpatient stay. The researcher’s aim was to understand patients’ perspectives on:

  • nurse behaviors which indicate if listening has or hasn’t occurred
  • how their experience with nurses who listened or did not listen affected them during hospitalization and after discharge

Positive listening behaviors: Patients regarded the following as positive listening behaviors:

  • Making a connection: The study found that certain verbal nurse behaviors made patients feel that a connection had been made. These verbal cues include asking questions and personalizing care, encouraging the patient to share information, directly addressing the patient, and talking to the patient before performing a care task. Making eye contact, body language (especially sitting), and catering to individual patient care preferences were nonverbal behaviors that supported making the connection.
  • Reassuring the patient: Patients reported verbal behaviors that put them at ease as: narrating care, anticipating questions, providing reassurance, including family in discussions, and not complaining about job tasks. Nonverbal behaviors that reassured them included follow-through, empathy, not rushing to get out of the room, and therapeutic touch.
  • Ensuring safe and effective care: Patients felt they received quality care when nurses displayed positive verbal behavior such as answering their questions, repeating back what the patient said, passed along information, and asked if interventions worked. Positive nonverbal behaviors that patients considered as improving their safety included nurses assisting when needed, noticing patients’ body language, believing what the patient says, taking notes, taking direction from the patient, and taking nothing for granted.

Detrimental listening behaviors: Patients identified certain nurse verbal and nonverbal behaviors as making them feel they were not being listened to:

  • Arrogance – Negative verbal behaviors include arrogant actions and words, while nonverbal arrogant behaviors include not believing the patient and dismissing patient concerns.
  • Misuse of power – This includes discounting or making light of patient concerns, arguing with the patient, rejection of patient input, and not clarifying orders.
  • Incivility/Insensitivity – This includes fabricating excuses, a gruff tone or attitude, and stopping patients from talking. Patients saw lack of eye contact, eye rolling, acting put out, and focusing elsewhere as negative nonverbal behaviors.

While active listening in the healthcare setting is increasing in significance, it is more complex than it sounds. Nurses need to develop soft skills which will enhance teamwork and collaboration and lead to improved patient outcomes. The SAGE & THYME model can serve as a guide for listening and responding to patients’ concerns (www.nursingtimes.net). Recommendations include:

  • Listening fully without interrupting
  • Holding back with any advice until approaching the end of the conversation
  • Asking the patient what support they have
  • Asking patients what they think would help

A study published in BMC Med Educ in 2018 identified eye contact, posture, tone of voice, head nods, gesture, and postural position as the important non-verbal signs by a physician which influence a patient’s disclosure of history details in a consultation. Since verbal and non-verbal aspects of communication have an important impact on the physician-patient-encounter, the study recommends that undergraduate medical students receive explicit training on verbal and non-verbal aspects of communication.

Researchers have found that physicians spend more time working on their EHR than in face-to-face time with patients during clinic visit. EHR data entry has led to loss of eye contact, reducing the frequency of questions about psychosocial aspects in a patient’s medical history, a reduced response to emotional aspects provided by the patients, and to a reduced disclosure of history details by the patients (BMC Med Educ).

Reliable medical transcription outsourcing companies providing EHR-integrated documentation solutions can minimize such issues and improve physician-patient verbal and non-verbal communication during the office visit.

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