Infectious Disease Specialist Shortage: a Looming Crisis

02-May-2019 MTS TEAM Medical Transcription

We must hurry. Superbugs are coming for us. We need experts who know how to treat them – Matt McCarthy, MD, in an open-ed for the New York Times.

Experienced medical transcription companies know just how important it is to ensure accurate and timely narratives of physician dictation that feed into electronic health records (EHRs). Error-free provider information and clinical records promote continuity of care. However, some medical specialties face more specific challenges. A recent New York Times report highlights the urgent need to tackle the shortage of infectious disease specialists in the US. According to the author, Matt McCarthy, an infectious-disease physician at Weill Cornell, with the rise in drug-resistant infections, the growing shortage of infectious disease specialists “could not be happening at a worse time”.

Infectious Disease Specialist Shortage: a Looming Crisis

Infectious diseases are a major global health threat. In the US, endemic diseases such as chronic hepatitis, HIV, and other sexually transmitted infections affect millions of people. Foodborne infections pose an additional threat. According to the US Centers for Disease Control and Prevention (CDC) two million Americans develop antibiotic resistance infections each year, which cause up to 23,000 deaths. Although there has been considerable progress in the reduction of vaccine-preventable diseases, drug-resistant superbugs are spreading. The CDC lists C. difficile or C. diff, Carbapenem-resistant Enterobacteriaceae (CRE) and N. gonorrhoeae as three “urgent” antimicrobial resistant threats. The CDC recently reported that Candida auris, an emerging fungus infection, is on the rise worldwide, and that the number of confirmed cases and in the U.S is 587. The shortage of infectious disease specialists makes these threats even more frightening.

Dr. McCarthy points out that, like nephrology, infectious diseases too do not fill all of its training spots every year in the National Resident Matching Program. The number of programs filling all of their adult-infectious-disease training positions fell by more than 40 percent between 2009 and 2017.

Why is there a deficit of infectious disease doctors? According to Dr. McCarthy, the reason is lack of proper compensation. While infectious disease specialists handle some of the most complex patient cases in healthcare, they are among the lowest paid due to Medicare’s reimbursement process. Medicare and Medicaid use relative value units (RVUs) as the basis for reimbursement to physicians. Many private health insurance carriers also use RVUs as their reimbursement basis. Each RVU is assigned based on the complexity of the services as by a defined CPT code, and each has 3 components:

Physician work RVUs are related to the time spent in providing a service or performing a procedure, the overall difficulty involved, and the cognitive and technical skills needed
Practice expense RVUs represent non-physician clinical staff time, medical supplies, and equipment used to maintain and operate the medical facility where the patient encounter occurs
Professional liability RVUs account for the cost of malpractice insurance

Of the three RVU components, physician work RVUs have proved to be the most contentious and difficult to accurately quantify. While the RVU formula prioritizes invasive procedures over intellectual expertise, the problem is that infectious-disease specialists provide expert consultation rather than procedures, and they don’t get reimbursed much for that, says Dr. McCarthy.

He explains how diagnosing a case of fungal pneumonia took hours with reviews of X-rays and imaging studies, discussions with the radiologist and primary care physician, and microbiological study. Most of this work was unpaid. Today, new threats require sophisticated diagnostic techniques that need a lot of expertise. While the Food and Drug Administration has approved new powerful antibiotics to confront the rising threat of superbugs, infectious-disease specialists are often the only health care providers who know how to use them, says Dr. McCarthy. Unless the insurance system has a better way to measure the value of diagnoses and treatments, physicians in cognitive specialties will not get the compensation they deserve.

A recent article in Contagion Live highlighted the problem of burnout among infectious disease specialists. According to the report, the causes of burnout among infectious disease physicians include focus on documentation, billing, RUVs, administrative tasks, and lack of support staff, concerns which also affect other physicians in other fields. However, infectious disease specialists face many unique challenges, according to Kwan Kew Lai, MD, DMD (www.contagionlive.com).

“Infectious disease is also the only field where illnesses are emerging [that] did not exist before, such as extensively drug-resistant organisms or new influenza viruses due to genetic re-assortment. Infectious diseases are also re-emerging due to political factors, civil wars, lack of access to vaccines, anti-vax movements, climate change, globalization, etc.”, she noted.

Dr. Lai also says that new treatments for various diseases may affect patients’ immune system, predisposing them to various infectious diseases. Further, as life span increases thanks to bone marrow or solid organ transplants, infectious disease specialists need to work to prevent and treat patients’ infectious complications.

Outsourcing medical transcription is a viable strategy to overcome the challenges associated with EHR documentation. The industry needs to work towards addressing the other concerns faced by infectious disease specialists so that the nation has experts who can treat deadly superbug infections.

Strategies to Retain Nurses in the Workplace

29-April-2019 Julie Clements Healthcare News

Nurses make up the largest proportion of healthcare workers in the US. Nurses are involved in almost all aspects of care, including monitoring and assessing patients, bedside and medication management, assistance with surgeries, data collection/reporting, etc. In fact, a large proportion of the recordings that medical transcription companies transcribe consist of nurse dictation.

Strategies to Retain Nurses in the Workplace

However, recent reports indicate that the nation is projected to experience a shortage of Registered Nurses (RNs) due to factors such as the aging Baby Boomer generation and the growing need for health care services (www.aacnnursing.org).According to US Bureau of Labor Statistics (2018) projections, 1.1 million additional nurses are needed to avoid a further shortage.

The RN Work Project, a 10-year national longitudinal study of new nurses started in 2006, found that more than 18% of new nurses quit their first job within a year and more than 26% leave it within two years. Healthcare organizations need to take measures to retain their nurses. The first step in this direction is to look into the reasons why nurses decide to stay or decide to leave their job. Here are the findings of the 2018 Press Ganey Nursing Special Report on this matter:

Nurses across all age groups and experience levels cited dissatisfaction with the work environment as the key factor driving them to quit.
For nurses who had been practicing less than two years, praise, recognition, nurse manager support, certification, and joy in work were the key predictors of intent to stay.
For RNs practicing for more than 20 years, intent to stay was driven by leadership, influence over their schedule, and quality of care.
Nurses in adult step down and med/surgical units with sick patients and less staffing than a critical care unit, were more likely to say they were going to leave within one to three years.

As one expert notes, to prevent nurse attrition, organizations need to understand the varying motivators of job satisfaction across the nursing life cycle (www.healthleadersmedia.com). The following strategies can help organizations retain nurses in the workplace:

Improve the work environment: It’s hardly surprising that organizations with a negative reputation see an outflow of nursing staff. According to the Health Leaders Media report, one hospital struggled with nurse recruitment and retention due to its punitive environment leading to a lack of respect toward nurses by physicians and administrators, and from nurse to nurse. The hospital also acquired a negative reputation because of its poor quality outcomes and a restrictive policy of recruiting only experienced nurses. The situation improved significantly when the hospital took steps to improve the work environment.
Overhaul the recruitment process: The healthleadersmedia.com report describes how the hospital reversed its policy of hiring only experienced nurses and focused simply on recruiting graduates. The CNO met each candidate personally and spoke about the hospital’s vision for the future.
Flexible scheduling: Flexible work options can serve as organizational recruitment/retention strategies. While needing significant work, nurses want to balance their many work-life responsibilities. With flexible work schedules for nurses, hospitals can manage their round-the-clock patient care needs. Flexible work options are a win-win situation for health care organizations and nurses.
Efficient role assignment: Hospitals will benefit if they deploy older nurses as mentors for new nurses. Experienced nurses can guide younger nurses and help them discharge their duties efficiently. The organization will benefit as the protégé’s confidence grows and the mentor contributes to the retention of a new nurse.
Fostering career development and recognition: Implementing measures to promote both career development and recognition are important to keep both experienced and fresh RNs. Nurses need professional support to stay abreast of technological advancements and innovations and get to the top of the game. Career ladders rooted in accomplishment vs. tenure can help organizations retain RNs.
Promoting a healthy work environment: Creating a healthy work environment allows nurses to provide high standard, compassionate patient care while promoting professional fulfillment and self-care to prevent burnout. Measures to improve working conditions and ease workload include adding more elevators and ceiling lifts, and investing in quality medical transcription services.

Organizations should also offer compensation and benefit packages to retain seasoned nursing staff. Older nurses should be adequately compensated for their role and experience. Additional incentives for retention include rewarding high performers, offering paid training opportunities, and providing more opportunities for internal advancement.

Dictation Tips for Healthcare Practices – Get Great Transcripts

22-April-2019 MTS TEAM Medical Transcription

Accurate clinical documentation is critical to health care quality and safety. The quality and accuracy of medical transcripts are also crucial, because treatment decisions are based on the information in the chart.Error-free transcripts can be achieved only with clear medical dictation. With poor dictation and recording, even a professional medical transcription company will find it difficult to transcribe the records and thus fail to meet the turnaround time. Documentation errors that have an effect on clinically relevant data may pose risks to patient safety.
Dictation Tips for Healthcare Practices
Poor dictation habits can severely affect

the quality of patient care
timely reimbursement
medical transcription provider’s turnaround time

Often physicians may not pay due attention regarding the format they use, patient information, accents, background noise, and speech patterns. Such a poorly dictated report requires more attention and time from transcribers as well as multiple levels of review.

Best dictation practices to follow

While recording an audio file that needs to be transcribed, you must keep in mind these best practices.

Choose a calm and quiet environment

Doctors are often interrupted in their consultation room and background noise can be overwhelming.For transcriptionists, it may be challenging to deliver error-free transcripts especially when the dictation contains incomprehensible accents, mumbling, rapid speech and disturbing noises, which prevent them from meeting the expected accuracy level.You can even consider dictating in an outdoor location, while avoiding noisy areas such as that with traffic noises or windy areas which can compromise the audio quality. Hospitals should understand that high-quality dictation is for their own good too. Recording in incorrect formats can also impact the timely return of reports.
You should avoid speaking with your team members during the recording and also avoid other noises such as the ringing of mobile phones. In case of any distraction, make sure to pause the recording on your device.

Watch the dictation speed and volume

Often, physicians may be busy with their schedules and rush through the dictation process, resulting in reduced clarity.Dictating at an even pace helps the transcriptionist hear every tone of a vowel or consonant in a word.Volume issues are also a concern. If the volume of the recorded file is low or if the physician whispers, transcriptionists will be stuck. They can’t get what they can’t hear.Dictators have to speak loudly and clearly.
If you are new to the recording equipment, try test dictations and send the final copy. Send only encrypted audio files for transmission to your transcription provider.

Data organization matters

Another factor that leads to poor dictation is the lack of organization. If a medical case is reported unorganized and if they are interrupted, there are chances for doctors to leave out key points.For instance, if the dictator is explaining a surgical procedure and failed to mention closing the incision, transcribers too will not report this, leading to further consequences. Physicians should organize the data before dictating, by identifying details of referring physician information – address and/or fax number, the patient’s demographic details as well as how to send the report (mail or fax) and to whom. Start each dictation with your name.

Provide clear details

Make sure to include the patient’s full name, proper mailing address; file numbers; reference numbers; patient record number; and subject matter. Also, give clear instructions such as a starting a new paragraph as well as indicating punctuations, open or closed quotes and parenthesis.
Use abbreviations, only if their expanded form is reported at least once in the recording. Never abbreviate names of medications. Dosage instructions should also be dictated consistently to avoid any errors in transcript.

Plan a clear dictation process

With a clear dictation system and best practices prepared, doctors joining the facility can just go through and follow them to ensure quality dictations.The hospital’s transcription department or the medical transcription company the hospital has partnered with needs to maintain a log that records documentation problems, which would enable them to track any physician issues.Transcription providers can also rank their physicians in terms of correction effort, which provides another level of measuring their success as dictators.Physicians can ask for feedback on their dictations from the transcriptionist, which would help them improve.

Hire skilled transcriptionists

While poor dictation makes quality healthcare documentation a difficult job, practices must make sure that their transcriptionists have sound knowledge of basic to advanced medical terminology related to diverse areas including anatomy and physiology, disease process, and laboratory values and procedures.While dictating too hard medical terminologies, it is better for physicians to just spell out the word.It is recommended to consider medical transcription services provided by an experienced company, as an established firm will meet better accuracy level.
Many practices are now relying on speech recognition tools to transcribe their recordings, which help to improve EHR clinical documentation accuracy and boost patient safety. Even if such software can convert your words into text, quality checks need to be done to ensure accuracy. A study published in JAMA Network Open that analyzed how accurate dictated clinical documents created by speech recognition software are, has observed an error rate of more than 7% in speech recognition – generated clinical documents, which demonstrates the importance of manual editing and review.

Key Causes of Medical Diagnostic Errors

18-April-2019 Julie Clements Medical Transcription

key-causes-of-diagnostic -errors

Diagnostic errors have emerged as a pressing public health problem. Studies report that thousands of patients die or are permanently disabled every year due to diagnostic errors. While outsourcing medical transcription helps physicians focus better on their patients during appointments, errors in diagnosis can occur due to various reasons. According to a new analysis of national data from John Hopkins Medicine, diagnostic errors result in nearly 800,000 Americans dying or facing permanent disability annually across all clinical settings, including hospitals and clinics.

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Diagnostic errors often arise from a mix of clinician biases and systemic issues in healthcare, according to the Agency for Healthcare Research and Quality (AHRQ). Missed or delayed diagnoses, especially for conditions like cancer, are a major reason for malpractice claims. Research into these errors is frequently based on closed malpractice cases in primary care, pediatrics, emergency medicine, and surgery. Poor teamwork and communication among clinicians are common factors for diagnostic mistakes in emergency and surgical settings. Lack of reliable systems for managing outpatient care-like handling urgent patient calls or ensuring test result follow-ups—further raise the risk of diagnostic errors.

Let’s take a look at the common causes of diagnostic errors and effective strategies for prevention.

Why Diagnostic Errors Occur

There are different types of diagnostic errors that can occur due to various reasons. Different types of diagnostic errors include:

Misdiagnosis or incorrect diagnosis
Missed diagnosis – completely failing to identify a present condition
Delayed diagnosis – diagnosing a condition too late)
Failure to recognize a related condition
Missed complications – failing to recognize complications arising from a diagnosed condition
Communication errors – poor communication between healthcare providers or between the provider and patient

Many factors can cause diagnostic errors:

Flaws in clinical reasoning: Diagnostic biases or inaccurate beliefs affect decision-making. Physicians often rely on heuristics (“rules of thumb”) to reach a provisional diagnosis, especially when the patient has common symptoms. Cognitive biases include:
- Availability heuristic – Diagnosis of current patient biased by experience with past cases or referring to what comes to mind most easily
- Anchoring heuristic – Sticking with a diagnosis. For instance, when a patient does not respond to treatment, this type of bias would lead the physician to order a stronger dose or a different formulation of a previously prescribed medication instead of considering another diagnosis
- Framing – Assembling elements that support a diagnosis
- Blind obedience – Relying on another physician’s opinions, where an agreement is reached based on an authoritative source (such as laboratory and imaging test results) without adequate examination.
- Omission bias – Placing excessive emphasis on avoiding the adverse effects of a therapy, which leads to under-utilization of a beneficial treatment.
Communication problems: Communication breakdowns are the most common causes of medical errors. Whether verbal or written, these issues can arise in a medical practice or a healthcare system and can occur between a physician, nurse, healthcare team member, or patient. Poor communication can result in diagnostic errors.
Errors related to testing: Diagnostic errors in the testing process can be classified as preanalytic, analytic, and postanalytic. Preanalytic errors refer to problems with test selection, ordering, and specimen collection. Analytic errors refer to problems performing a clinical laboratory test. Postanalytic errors include problems with interpreting tests, reporting. and use of test results to make a diagnosis.

Lack of reliable systems for common outpatient clinical situations: The AHRQ points out that lack of proper mechanisms for triaging acutely ill patients by telephone and following up on test results, also increases the chances of diagnostic error. Errors leading to misdiagnosis included inadequate documentation, faulty triage, and lack of protocols for handling telephone calls.
Time constraints: Limited time with patients during appointments can result in rushed assessments and potential oversights. When physicians have only limited time to assess patients, it can lead to rushed decisions and potentially overlooking crucial information, increasing the likelihood of misdiagnoses or delayed diagnoses. This is often due to high patient volumes within a limited timeframe, leading to hurried evaluations and missed critical details. Medical transcription services can help to a certain extent by allowing physicians to focus on the patient rather than on entering information into the EHR.
Overconfidence: Overconfidence is a risky trait in medicine, particularly in fields like emergency medicine, where patient outcomes depend on accurate and timely decisions. A study published in February 2024 (Adv Med Educ Pract) that looked into the possibility of a relationship between overconfidence, time-on-task, and medical errors, noted that overconfidence occurs when physicians overestimate their abilities, believing they perform better than they actually do. This can lead to diagnoses based more on personal opinion than on sufficient patient data. Instead of relying on relevant and reasonable information, overconfident individuals tend to trust their instincts.
“The VIP Syndrome”: Researchers also highlight the VIP Syndrome as a reason for diagnostic errors. The VIP Syndrome is when the physician is intimidated or is unwilling to recommend things which may be unpleasant for their patient. This may lead them to prioritize special treatment or expedite care, potentially leading to diagnostic errors by rushing through assessments, overlooking crucial details, or ordering unnecessary tests, all in an attempt to please the patient. This can potentially cause misdiagnoses and compromise the quality of care.

Preventing Diagnostic Errors

Measures to prevent diagnostic errors include Improve clinician training, evaluate physician workloads and develop more accurate diagnostic tools and techniques. According to research published in JAMA Internal Medicine in January 2024, this could include using AI to evaluate patients, select the most appropriate tests and reduce delays. However, the study cautions that care must be taken to ensure the models are performing correctly without introducing errors or widening health disparities.

“In the end, helping physicians become better diagnosticians means coaching and training physicians, and helping physicians clearly explain diagnoses to patients,” says the paper’s first author, Andrew Auerbach, MD, MPH. “I suspect AI will help with many tasks, but we still have work to improve communication between patients and healthcare team members to fully advance the field,” he notes (source: UCSF).

Outsourcing Medical Transcription Can Help

Partnering with a medical transcription company is a viable strategy to deal with EHR-related documentation concerns and prevent missed diagnosis due to reduced time that physicians have with their patients at the appointment. Professional transcriptionists can ensure clear and accurate documentation, which can play a crucial role in minimizing diagnostic errors by providing a comprehensive record of a patient’s medical history, symptoms, examination findings, and test results. This allows healthcare providers to make informed decisions based on complete information, thus reducing the risk of misinterpretations or overlooking vital details that could lead to incorrect diagnoses.

Outsource your medical transcription and focus on what matters most-patient care.

How Technology is Making a Difference in the Emergency Department

11-April-2019 Rajeev Rajagopal Medical Transcription

Technology now impacts every aspect of our lives. In the medical field, technological innovations have transformed healthcare delivery. Innovative software and other advancements allow medical transcription service providers to work with physicians to turn their clinical dictations into notes for integration into electronic health records (EHRs). Recent reports draw attention to the role of technology in the emergency department (ED). IT implementation in the ED is making a difference by boosting operational efficiency, reducing costs, and improving patient outcomes and staff retention. technology-making-difference-emergency-department

Telemedicine: Telemedicine is a great example of medical technology. In the ED, telemedicine is decreasing improper admissions and readmissions, saving costs and promoting efficient resource allocation (www.healthtechmagazines.com). One of the main concerns in EDs is high patient volume, which strains resources. With video technology, the ability to share and review images, and to interact with the patient, telemedicine can reduce ED response times greatly and improve access to specialty care. Providers can use the technology to make risk-based decisions about patients’ care. ED visits for individuals with behavioral health issues are rising and patients may have to wait for hours for an evaluation. Telepsychiatry programs can reduce behavioral health load in the ED and deliver quality, cost-effective, timely mental health services.
Artificial Intelligence: A 2018 UC Irvine (UCI) health report described how artificial intelligence tools speed emergency care at the UCI Medical Center. The center has implemented an innovative app that takes just about 20 seconds to analyze a CT scan for cerebral hemorrhages. This task can take more than an hour in a busy ED. Another AI tool at the center assesses magnetic resonance imaging (MRI) results to grade genetic mutations in deadly brain tumors that cannot be examined safely via surgical biopsy as they are too deep. The technology can also predict a tumor’s growth and recommend countermeasures. According to the UCI center’s scientists, technology can even learn to interpret all sorts of medical images and data.
Communication tools: Technology continues to improve communication in the ED. While EHRs have helped streamline health management and communication in emergency situations, a 2016 Business Journal report discussed several technologies that have reduced the stress associated with ED visits and made them more patient-friendly. Technology helps patients make the important decision on where to go in an emergency. They learn about estimated ER wait times on hospital websites or digital freeway billboards. ER staff can be notified of the patient’s symptoms via a web or mobile emergency room notification app, including expected arrival time. This will help ED staff better prepare for treatment. Patients can also use the app to fill out a registration form online or expedite the process at a registration kiosk. Some systems let patients scan their health care card, whereby information about them will be instantly downloaded from a health information exchange.

Once patients are in the virtual line, they can sign up to track their wait time via text messages. Text updates from the hospital team will also keep the patient’s loved ones informed about treatment progress. After they return home following the treatment, patients can continue to manage their health online. They can access their electronic medical record (EMR), find a physician, make appointments, and get answers to health care questions.

Smartphones and tablets for ECG review: Physicians can review ECGs on tablets and smartphones (www.dicardiology.com). Cardiologists can get immediate access to ECGs wherever they are and immediately evaluate chest pain patients for potential ST-elevation myocardial infarction (STEMI). By enabling earlier activation of the cath lab, especially during off-hours, this technology can help reduce door-to-balloon times. It can also simplify and speed collaboration in hospitals, allowing the ED or ICU staff to get a cardiologist’s opinion on abnormal ECGs. Physicians can also review regular ECG exams in between procedures or at their convenience.
Electrocardiogram-transmitting technology: Paramedics and physicians in Roseville, Calif., are using state-of-the-art electrocardiogram-transmitting technology to get things move faster in the ED (ww.gov.tech). This wireless technology can cut about 20 minutes off of the time it takes from when a patient enters a hospital until doctors provide life-saving intervention. It allows paramedics to send 12-lead electrocardiogram (ECG) results, or data from 12 angles of the heart’s electrical system, to a specially designated hospital where emergency room doctors and cardiologists can assess the patient’s heart condition before arrival. This is improving patient outcomes and patient lives.

Patients who arrive in the ED may be unresponsive or unable to supply the requisite details. While medical transcription outsourcing can ensure quality EHR documentation, interoperable EHRs are necessary for ER physicians to create a complete picture of the patient’s health history and develop the emergency care plan. However, true EHR interoperability is far from fruition. Industry stakeholders need to work towards EHR interoperability to improve quality of healthcare processes in general and in the ED in particular.

How Primary Care Physicians Are Significant in the US Healthcare System

08-April-2019 MTS TEAM Medical Transcription Company

As a medical transcription company, we know that accurate patient data is crucial for providing optimal patient care. When a patient falls sick, he/she first goes to a primary care physician. Primary care physicians are the logical basis of an effective healthcare system that assures high quality care, good patient satisfaction and efficient use of resources. Moreover, primary care physicians also have the right patient data that can be shared among multiple providers that may be treating the patient. A strong physician-patient relationship is essential to ensure better healthcare and patient satisfaction. Proper communication and trust helps to build good rapport between the patient and the doctor and it also helps the patients recover quickly.
pcps-are-significant in-us-healthcare-system
According to a study published in JAMA Internal Medicine, receipt of primary care is linked to high value care and better patient experience. According to David M. Levine, MD, MPH, Brigham and Women’s Hospital, Harvard Medical School, Boston, and colleagues, receipt of primary care is associated with more high-value care, and better respondent access and experience.

There are many countries that organize their healthcare system around primary care. The value of primary care is still a debated topic in the US Healthcare sector. The study mentioned above was conducted to know whether receipt of primary care affected the quality and experience of outpatient care in the United States. The researchers gathered data from adults aged 18 years or older. They compared 49,286 adults who received primary care to 21,133 who were without primary care during the study period 2012 to 2014. They compared the performance in 39 clinical quality measures and seven patient experience measures. The outcomes were aggregated into high- and low-value quality composites, an overall patient experience rating, and experience composites.

From the study they found that for each year the frequency with which healthcare was used by adults with primary care was similar to that of adults without primary care. The mean number of the groups were, emergency department visits (0.2 for both; P = .17), outpatient visits (6.7 vs. 5.9; P = .11), and inpatient encounters (0.1 for both; P = .92). Patients with primary care received significantly more high value care in 4 or 5 composites than those without primary care did. This included high-value cancer screening, recommended diagnostic and preventive testing, high-value counseling, and among those with diabetes, high-value diabetes care. There was no significant difference in the proportion with and the proportion without primary care who received high value medical treatment such as statins for dyslipidemia.

With these findings, the healthcare system leaders and policymakers are looking for new ways to improve value in primary care. Allan H. Goroll, MD, Massachusetts General Hospital, Harvard Medical School, Boston suggested that underfunding primary care is the major reason for the poor performance by the US Healthcare system. The findings by Levine and colleagues show the valuable contribution of primary care in the US healthcare system; they recommend that additional investments and practice reform can help use primary care to its full potential.

Goroll suggests some ways to use primary care:

Changing the primary care payment model: The current payment model is retrospective fee for service structure which is undervalued. This should be changed to a risk adjusted, comprehensive prospective structure with enough resources to provide primary care.
Diversion of funds: 3 percent net investment in US healthcare spending to primary care could maintain a high-performing primary care system. This diversion of funds should be attainable by making small reduction in wasteful spending.
Relying on outcome measures rather than process measures, and providing more interdisciplinary training to improve physicians’ understanding of how the multidisciplinary, team-based model improves healthcare and workflow.

Primary care is important for patients as it provides a place to which patients can bring a wide range of health problems for appropriate attention. It also facilitates an ongoing relationship between patients and clinicians and fosters participation by patients in decision making about their health and their own care. A good doctor-patient relationship is vital to good health. Accurate medical documentation is also imperative. Today, most healthcare organizations hire medical transcription services to ensure reliable medical records. They offer customized services at affordable rates and also help physicians and other healthcare professionals focus more on providing quality patient care and service. The valuable time saved via outsourcing medical documentation also helps in building a strong doctor-patient relationship.

Could Virtual Care be the Future of Healthcare Services?

04-April-2019 Julie Clements Healthcare News

Virtual care or telehealth service is rapidly gaining popularity in the healthcare industry, which allows patients to seek medical advice and receive prescriptions through flexible channels from a medical practitioner without leaving the comforts of their home. The evolution of virtual doctor significantly helps in quick access to medical care, improves chronic diseases management, and ensures cost-effectiveness. E-visits help parents of children and older patients avoid traveling to the hospital, and save both time and money. virtual-care-future-of-healthcare-services Virtual visits are very useful for urgent care; these can truly provide an initial medical assessment of any injury or any temporary problems such as acne, tick bites, sinus, seasonal allergies, eye irritation, and strains and sprains that are clearly not life-threatening. With increase in the use of telemedicine and virtual visits, there will also be a consequential increase in the trend of outsourcing medical transcription for telemedicine.

Studies show that majority of patients and clinicians perceive no loss of communication when using virtual visits or e-visits as compared to traditional office visits. Only one-quarter of the consults typically result in a referral to the emergency department. A specialist or primary care doctor can direct the patient to the right facility through telemedicine. This helps in resolving urgent cases like wound lacerations, respiratory infections etc, even when the office is closed. Virtual visits are considered convenient and affordable, and also help in providing an effective diagnosis regardless of the specialists’ location. However, these cannot completely replace the existing healthcare continuum as yet because most of the e-visits are done for primary care or follow-up services of chronic conditions. Dermatology e-visits are also done by sending a close-up photo of the area. If the e-visits are providing high-quality care, more patients will demand it.

There are some legal challenges that physicians face when using telemedicine. In a 24/7 virtual clinic, majority of consults are done by videoconferencing to treat dozens of common issues. In order to capture the information for electronic medical records, physicians need to make sure if their systems are secure and HIPAA-compliant. Before instituting a telemedicine service, physicians should check with their liability insurers. Insurance claims for treatment of minor illnesses which were done through e-visits will be reimbursed. All private health plans, Department of Veterans Affairs, Medicaid, and Medicare now cover some e-visits. More health centers and hospitals are launching virtual health centers because the costs of virtual visits are less than in-person visits. However, according to health economists, e-visits could add costs rather than limit them if doctors and patients schedule e-visits unnecessarily.

The virtual care impact has made patient care more reliable than ever before and has simplified the consultation process. Doctors and consult experts from around the world can analyze detailed patient history and research conditions, even in the absence of any sophisticated medical facilities. There is no doubt patients also value the quality time they get with the doctor without having to travel all the way to the provider’s location. Researches show a large majority of patients rating virtual visits at 9 or 10 on a 10-point scale. This suggests that not seeing a doctor face-to-face may not after all, significantly impact the quality of care. For patients who live in remote locations and those who don’t have to visit a physician frequently, telemedicine and virtual visits could be really beneficial. Virtual visits are not appropriate for all patients in all situations, that is true. However, clinicians agree that virtual visits are better than office visits when it comes to scheduling of patient appointments and improving efficiency.

Medical transcription services for telemedicine, which would reduce the documentation burden on physicians, could also gain increasing popularity in the coming years if telemedicine/virtual care is adopted more widely across the healthcare spectrum.

Warm & Welcoming Physicians Can Help Improve Patient Health Outcomes

01-April-2019 Rajeev Rajagopal Medical Transcription

Finding different ways to improve the relationship physicians have with their patients is essential to create an entirely new environment for patients and staff. If a patient feels more valued and engaged, then he or she can bond better with their care providers, and quickly recover from their illness. A good patient-doctor relationship is essential for providing better patient care and to build up the relationship, doctors need quality time free from documentation hassles. A reliable provider of medical transcription services can take care of the medical documentation, allowing physicians to spend more quality time with the patients and focus on their individual requirements. Doctors must be good listeners too if they are to provide personalized care for their patient community.

physicians can help improve patient health outcomes

According to a study by researchers from Stanford University, doctors who are warm, welcoming and reassuring can actually improve health outcomes. Small things that doctors say and do to connect with patients can make a huge difference. A recent study was conducted at Stanford in this regard that included 76 participants. The participants received a skin prick test, a common procedure used in assessing allergies, and the pricks made their skin itchy and red. The doctor examined the allergy reaction. For one group, the doctor did not interact much whereas for the other group the doctor shared some words of encouragement. The group that was given assurance by their doctor reported that their reactions were less itchy. The doctors did not in fact give any medication to the participants. This shows that a doctor’s words might be more powerful than we normally realize.

Another study was also conducted to know whether the same words from a doctor influence patients differently depending on how warm or competent the doctor seemed. Again a group of participants were given a prick test. One group met a physician who was warm and competent, called patients by name, smiled, chatted and maintained eye contact with the patients. The other group met a physician who sat glued to the computer, did not introduce herself and asked random questions related to the allergy prick. For both groups, the physicians gave the same cream, a hand lotion, to reduce the allergic reaction and itching. The study revealed that the first group that went to the welcoming and warm physician experienced reduced itching and the other group who went to the less friendly physician had no effect even after applying the cream.

The study shows that the words and attitude of the physician who projected desirable qualities, warmth and competence, had a positive effect on the patients. In other words, doctors who take an effort to connect with the patients can ensure successful treatment. With advanced technologies such as AI (artificial intelligence) and ML (machine learning) being introduced in the medical field, you don’t need to go to the doctor and meet them personally for minor treatments. However, we should not underestimate the value of personally interacting with the doctor. Physicians should listen to their patients and treat them well and at every stage they should explain about the treatment, medications, tests etc., and keep patients informed about the possible consequences. Sometimes physicians find it difficult to build a good rapport with the patient during short visits but it does not take too long to obtain information about the patients. The time spent to develop a closer relationship with the patient is time well-spent because it will ensure positive outcomes in terms of improved health outcome for the patient and improved patient satisfaction for the physician.

With the introduction of the EHR, doctors are forced to spend most of their time on medical documentation and related jobs. Busy physicians can hand over the medical documentation process to a competent medical transcription outsourcing company and enjoy the advantages such outsourcing brings.

What Makes the Emergency Room Vital for All Hospitals

28-March-2019 MTS TEAM Medical Transcription Company

An emergency room or ER is a medical treatment facility for critically ill patients when they have had some type of accident or emergency. The severity of their condition and the treatment is determined through a process called triage, which is immediately done by triage nurses and physicians in ER. Since the ER was commonly used for emergency medicine services, hospitals developed the department of emergency medicine. Gradually the emergency medicine service was recognized as a medical specialty for patients who present without prior appointment for treatment for any acute illnesses or injuries. The emergency rooms are the entry points to their medical care. The ER service also records patients’ clinical data/ER reports for which outsourced services from medical transcription companies are often utilized.

emergency room hospitals

Components of EMS System

The emergency medical service includes information system management, medical direction and evaluation, governmental legislation and regulation, integration of health services, and prevention awareness.

Critical Conditions Are Handled in the Emergency Rooms

ER physicians treat conditions such as physical trauma, mental illness, asthma and COPD, myocardial infarction, cardiac arrest, and heart attack, among others. Emergency care has a significant role to play in healthcare delivery and almost half of all hospital-associated medical care is provided in emergency departments, as surveys and studies confirm. This large volume of medical care provided in emergency rooms could be due to reasons such as the quick access to healthcare, and patients’ trust in the comprehensive care delivered by emergency departments. Another reason for overcrowding in ERs may be lack of insurance coverage. Patients are allowed to visit the ED even if they don’t have insurance coverage. ERs are open round the clock and accept patients regardless of insurance coverage and regardless of the payer.

The emergency room is a place connecting all providers and organizations involved in the care of the patient. In fact, the ED provides support to primary care practices by performing complex diagnostic assays and also by handling overflow as well as after-hours and weekend demand for care. When patients are treated in an ED, it is a great support for office-based physicians, especially patients with complex and potentially serious conditions.

Emergency Room Vital Procedures

A medical screening exam is conducted in the following manner.

An emergency room physician examines you and asks questions.
Diagnostic tests are prescribed if necessary. These include electrocardiogram (ECG), CT scans, x-rays, blood work, etc.
Consultations are also coordinated with other specialists.

Demand for Hospital Emergency Departments

The importance of the emergency room is felt in many rural areas where shortage of doctors often causes these departments to function erratically. The lack of doctors, and closure of emergency rooms along with an ever-growing patient registry could be a serious problem. Overcrowding is another concern in emergency rooms.

Emergency departments could be overcrowded because of an inability to treat all patients in an adequate manner, if there is lack of emergency room physicians or nurses. Usually, they will do their best to provide you with privacy and the best quality of care. Crowding also occurs when the emergency patients are held in the emergency department until inpatient beds are available.

In some areas, access is blocked to emergency departments because of overcrowding. However, RAND researchers reviewing such incidents point out that if patients are given timely access to primary care and less expensive forms of care, it could reduce the number of non-urgent visits to emergency departments. The operations of emergency departments must be integrated into both inpatient and outpatient care systems. For this, more use of interconnected health information technology, better coordination of care and case management, and more collaborative approaches to medical practice are necessary. When these steps are taken patients would be given better access to non-emergent care, and you can minimize duplicative testing, and avoid unnecessary hospital admissions.

Medical transcription outsourcing companies assisting ER physicians would endorse the view that emergency rooms are vital for all hospitals. The ER offers hope and a positive outlook for patients and their families. There are so many reasons why emergency rooms are important not only to patients and their families but also to physicians and hospital systems. Appropriate measures must be taken to avoid ER overcrowding and physician burnout.

Study: Overlapping Surgery Safe for Most Patients, but Not High-risk Groups

21-March-2019 Rajeev Rajagopal Medical Transcription Outsourcing

General surgeons diagnose and treat surgical conditions affecting various areas of the body – the breast, lung, abdomen, thyroid, arm, legs, colon, rectal, skin, and more. Operative reports describe the indication, procedure, and any complications of the procedure and must be completed immediately after any operative procedure. Most surgeons prefer to outsource medical transcription to ensure timely documentation of dictated operative reports, which is crucial to manage the patient throughout the postoperative period. Such support can prove extremely valuable for surgeons performing overlapping surgery – scheduling procedures in more than one operating room at a time. However, a new study published in the Journal of the American Medical Association suggests that surgeons should be cautious about overlapping surgeries for high-risk patients as it may pose higher death rates and complications for this group.

The Case for Overlapping Care

In overlapping surgery, the main surgeon will move from one operating room to another performing the critical parts of one surgical procedure, while his or her team of trainee surgeons or physician assistants completes another patient’s surgery. For instance, the assisting team will close up an incision (a non-critical portion of an operation) on one patient as the senior surgeon begins surgery on another patient. Massachusetts General Hospital provides several reasons for using overlapping care:

Useful in emergencies – when many people are injured who need immediate surgery, overlapping surgery allows them to be treated by the hospital’s most skilled surgeons and their teams.
Cuts time waiting – Overlapping cuts the time patients may need to wait to have their non-emergency surgery as well as the time surgical teams must wait between cases.
Improves access – Overlapping allows patients greater and more prompt access to certain surgical specialties.
Ensures availability of important services – Overlapping enables more surgeries to be scheduled during the daytime hours when important areas such as pathology, laboratories and radiology are fully operational.
Promotes optimal use of resources – Managing operating rooms effectively helps the surgical team care for patients more efficiently.
Facilitates education of newer surgeons – Teams of less experienced surgeons gain significant knowledge from the attending surgeon has extensive training and experience.

Overlapping Surgery vs Concurrent Surgery

The American College of Surgeons (ACS) distinguishes between overlapping surgery and concurrent (simultaneous) surgery, and advises against concurrent surgery. According to the ACS,

Overlapping surgery is when critical portions of cases do not coincide, that is key elements of the first operation are finished, freeing up the primary attending surgeon to start an operation in another room while others finish the first operation.
In concurrent surgeries “the critical or key components of the procedures for which the primary attending surgeon is responsible are occurring all or in part at the same time.”

ACS guidelines state: “A primary attending surgeon’s involvement in concurrent or simultaneous surgeries on two different patients in two different rooms is not appropriate.”

Overlapping Surgery not safe for all Groups of Patients

The new study found that overlapping surgery is safe for most patients, but not for all. The researchers looked into the safety of overlapping surgery in about 66,000 patients at one of eight institutions included in the Multicenter Perioperative Outcomes Group registry. The surgeries performed included joint replacement, coronary artery bypass graft surgery, spine surgery, and craniotomy. A given surgeon’s overlapping operations for each of these types of surgeries were compared to non-overlapping operations he or she performed. The study found that:

For most overlapping surgeries, there was no increase in deaths or overall complications (major and minor surgical complications combined) compared to surgeries that did not overlap.
Major complications such as stroke and heart attack were slightly higher for overlapping surgeries.
In high-risk patients (those with a high risk of dying or developing post-operative complications based on their age and pre-existing health conditions), surgical overlapping resulted in slightly higher death rates.
In both overlapping surgeries involving coronary artery bypass grafting and those involving high-risk patients, mall errors in surgical care could have harmful effects.

“Overall, the study findings suggest that overlapping surgery is likely to be a safe practice for most patients, but the exploratory analyses do suggest potential areas for concern and further investigation”, the researchers concluded.

Need to Keep Patients informed

A 2017 U.S. study found that most people don’t know that surgeons are sometimes involved in multiple operations happening at the same time. Most of the participants felt that patients should be told before surgery exactly which components of their operation might done by a senior surgeon or by a trainee, or resident, surgeon or an assistant. The researchers said that surgeons should discuss overlapping surgery with patients beforehand and obtain their consent if this is part of their practice. ACS guidelines state:

“As part of the preoperative discussion, patients should be informed of the different types of qualified medical providers that will participate in their surgery… and their respective role explained. If an urgent or emergent situation arises that require the surgeon to leave the operating room unexpectedly, the patient should be subsequently informed.”

Regardless of whether surgeons provide overlapping surgeries or not, outsourcing medical transcription can ensure accurate and timely operative reports. An experienced medical transcription company in the USA would have professional transcriptionists who are knowledgeable about the diseases and operative techniques relating to general surgery and its subspecialties. They can provide error-free EHR-integrated surgical reports, helping providers focus on their core tasks by freeing up their time.

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Study: Overlapping Surgery Safe for Most Patients, but Not High-risk Groups

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