Promoting Disability Inclusion in Medical Practices

31-December-2018 MTS TEAM Medical Transcription

Patients have specific expectations when it comes to their office visit and one is that their provider listens to them and demonstrates understanding, according to a PwC Health Research Institute survey. However, working with electronic health records (EHRs) leaves physicians little time to interact with patients. Outsourcing medical transcription helps to a great extent by allowing providers to spend less time on clinical documentation and focus on face-to-face interaction with their patients. But patients with mobility impairments face certain unique problems when visiting a physician’s office. The concerns are that medical practices are not accessible to patients with disabilities or not properly equipped to deal with them. Disability inclusion means that the needs and engagement of people with disabilities are taken into account so that each person has the same opportunity to live, work, learn, and play to the best of their abilities and desires.

More than 20 percent of Americans or about 57 million people live with a disability, according to a 2017 New York Times report. This includes 8 percent of children and 10 percent of nonelderly adults. With the increasing incidence of diabetes, arthritis, and other chronic conditions and increased life expectancies for people with congenital conditions, the number of Americans with disabilities in all age groups is likely to rise.

Since the passage of the ADA, significant advances have been made in facilities for people with disabilities. Citing a study, a 2017 New York Times reported that patients with disabilities don’t always get the same treatments for the same medical conditions. Researchers called more than 250 specialty practices to schedule an appointment for a fictional patient they presented as partly paralyzed and unable to self-transfer from a wheelchair to the exam table. The researchers reported that more than 20 percent of the offices did not give an appointment on the grounds that their building was wheelchair inaccessible, they did not have height-adjustable exam tables, or their staff lacked training to move the patient. Even practices that agreed to schedule the appointment said they did not have the necessary gear to move the patient, and may need to omit parts of the physical exam.

As the Agency for Healthcare Research and Quality (AHRQ) notes, many people with mobility problems have a ‘thinner margin of health’. For instance, they usually have higher rates of unaddressed cardiovascular risk factors like obesity, smoking and hypertension. As a result, people with mobility impairments require a more complex array or services than people without such issues. However, in reality, this patient segment faces many barriers when visiting family physicians:

Physical barriers in medical offices, such as lack of ramps, weight scales, grab bars, height-adjustable examination and imaging tables, inadequate space within the practice to maneuver a wheelchair or to transfer to an examination table
Lack of transportation
Less likelihood of receiving routine medical care, including cancer screening, flu vaccines and vision and dental exams.
Noninclusive health or wellness programs designed for people without disabilities
Inaccurate or inadequate knowledge or stigmatizing attitudes of clinicians about disabling conditions
Inadequate training for clinicians and staff
Competing priorities in the health care system
Communication barriers, such as failure to cater to deaf patients who require sign-language interpreters

The effects of these barriers vary depending on the type of disability type, according to a study published in The New England Journal of Medicine. For instance, stigma is generally more of a problem for people with mental health or intellectual disabilities, whereas inaccessible equipment can prevent a person with a significant mobility disability from getting even basic services such as being weighed.

Cost and space are major limitations for small practices. While the price of a height-adjustable table can be as high as $6000, a wheelchair scale can cost $3400 and a ceiling lift and sling, $1800 dollars. In small practices, exam rooms do not enough space to house larger tables and chairs for family members and also have enough room to maneuver a mobility device.

The Centers for Disease Prevention and Control (CDC) reiterates the importance of disability-inclusive healthcare that applies to both communication and physical access. The CDC’s recommends that physicians can ensure inclusive healthcare in the following ways:

Know how to effectively communicate with patients who have a range of disabilities, including those with hearing, speech, or vision problems, or intellectual disability
Make accessible medical equipment available for people with disabilities, such as scales, examination tables, or chairs
Spend more time with patients who may need such facilities during examinations
Take time to meet the patient’s specific health care needs
Give people with disabilities the information needed to live a long and healthy life, even if they don’t ask for it
Listen and respond to the patient’s health concerns
Communicate clearly and directly with the patient

According to the New York Times report, doctors with disabilities are making a difference when it comes to disability inclusion. The reason is that people with disabilities would feel more comfortable with concerns similar to theirs.

Good medical documentation is critical to good care and promotes patients’ and physicians’ best interests. Spending more time with patients can take away from time needed for documentation tasks. Medical transcription services can address this concern by ensuring reliable, accurate and timely patient records essential for quality care.

Mental Health a Cause for Concern during the Holiday Season

27-December-2018 Julie Clements Psychiatry Transcription

It’s sad but true – mental health is a cause for concern during the holidays. The festive time of year can be a lot of fun, but it can be stressful for people from many walks of life. In fact, the demand for mental health care services and mental health transcription services tends to increase during the holiday season.

A survey by the American Psychological Association (APA) found that almost half of all women (44 percent) and a third of men (31 percent) reported an increase in stress around the holidays. According to the National Alliance on Mental Illness (NAMI), people already living with a mental health condition should take extra care of their overall wellness and health during the holiday season. NAMI board member and psychiatry specialist with Suburban Psychiatric Associates Dr. Michael Hallet (letstalkstigma.org) notes that an estimated 60 percent of patients who already have a mental health diagnosis may have exacerbated symptoms during this time. Many factors are responsible for triggering the holiday blues or seasonal affective disorder (SAD):

The decrease in sunlight during fall and winter affects the body’s biological clock and leads to feelings of depression.
From the pressure of shopping for gifts, cooking, fixing up the house, throwing parties and traveling, increased demands during the Christmas and New Year season can lead to unrealistic expectations and trigger the holiday blues.
Memories of a loved one who has passed, a recent heartbreak, or conflicts in the family can surface at family gatherings, and make these painful occasions. Distance from family make the holiday blues worse for some people.
Overindulging or binge eating and drinking can cause heartburn and fatigue, as well as weight gain. Consuming alcohol in excess can cause depression and even aggressive behavior.
Out-of-control holiday spending or spending obligations often lead people into a downward spiral.

There are many things people can do to minimize the blues. The first is to manage expectations. Things may not always go perfectly but there will be many good moments to savor. We should be realistic about what we can afford and avoid the pressure to overspend. The key is to plan ahead, prioritize, and budget.

If you find you have too many invitations to social events, pace yourself and set boundaries. Avoid social activities, chores and events when you need to. On the other hand, people who are feeling isolated can reach out to friends or volunteer at local charities or community events. This is a great way to stay connected, while enhancing personal satisfaction and happiness. Other tips to cope with holiday stress:

Follow normal routines as far as possible.
Eat and drink in moderation and avoid alcohol if you are depressed.
Spend time on what relaxes you – listening to music, dancing, or reading
Stay physically active – exercise regularly, even if it means just taking a small walk.
Get sufficient sleep.

Holiday blues are typically a temporary phenomenon, but the condition can become a cause for serious concern if it crosses over into clinical depression and impairs daily functioning. That’s when you need to seek professional help.

Medical doctors, including family medicine physicians and internists and well as nurse psychotherapists treat holiday depression. The condition can be diagnosed through a simple history and physical exam. Lab tests or other tests may be recommended to rule out any medical conditions that may be causing symptoms. A full history of your symptoms can help determine if your condition is a mild case of the holiday blues or a chronic depressive disorder.

Treatment for seasonal affective disorder usually comprises a combination of self-help, counseling, and antidepressant medications (fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa). Phototherapy can effectively treat people suffering from SAD (WebMd). The treatment involves about a half hour a day of exposure to artificial sunlight. It can be used either alone or in combination with antidepressant medicines and psychotherapy. Focused treatment can help reduce the symptoms.

Documenting assessments, progress notes, treatment plans, etc., is a time-consuming and challenging task for any healthcare provider. A www.ehrinpractice.com report notes that behavioral and mental health practices use clinical data differently from other specialties or general medical practices. Behavioral and mental health specialists require electronic health records (EHRs) with special features as they collect more intensive data resulting from screening tools and from ongoing treatment. Further, these specialists mainly depend on effective care coordination across clinical settings and patient engagement to achieve positive clinical outcomes. They are also subject to more data privacy laws that extend beyond HIPAA’s requirements. As physicians focus on patient care, contracting with an experienced medical transcription service company can ensure accurate and timely EHR documentation that meets industry regulations.

Patients discharged around the Holidays face higher Risk of Readmission, says Study

24-December-2018 Rajeev Rajagopal Healthcare News

It can be very depressing to spend your holidays in hospital, but a new study says that this could be safer than being discharged.

Hospital discharge refers to the point at which inpatient care comes to an end and when continuing care is transferred to other settings. Outsourcing medical transcription helps healthcare providers provide timely and accurate discharge summaries that reflect all confirmed diagnoses and all care administered during a patient’s hospital stay. Delays in the discharge are depressing for patients and costly for hospitals, leading to backlog in new admissions from the Emergency Departments (ED), outpatient clinics, and transfers from the Intensive Care Units (ICU). However, researchers say that discharging patients around the holidays might not be good for them. Published on Dec. 10 in the BMJ, the new study reports that hospital discharge during the holidays is linked to more readmissions, and even death.

Electronic health records (EHRs) have improved the efficiency and speed of patient discharge. According to a study from Case Western Reserve University, in hospitals meeting the federal government’s measure of “meaningful use” of electronic health records, patients are discharged nearly four hours earlier-about a 3 percent reduction of the average five-day hospital stay. Even such small improvements can produce significant savings when adopted in a large health-care system, according to the study author.

However, discharging patients quicker so that they can be home for the holidays can prove detrimental for them. Researchers from the Institute for Clinical Evaluative Sciences in Toronto found that sending patients home during the holidays might not be a good idea. They studied 2002-2016 data on more than 217,000 adults and children who were discharged from hospitals in Ontario during the Christmas break as well as 454,000 people discharged in late November and January. The study showed that:

For every 100,000 patients discharged during the holidays, there were 26 more deaths, 188 more rehospitalizations, 483 more visits to emergency departments and 2,999 fewer follow-up appointments
Patients discharged during the holidays had a comparatively higher risk of death or readmission to the hospital within the next 7, 14 and 30 days.
The risk of death or readmission was greatest – 16 percent higher – within the first seven days
Patients discharged during the holidays were 39 percent less likely than those sent home at other times to have a follow-up appointment within seven days.

The researchers said that part of the problem may be reduced access to care, difficulty in booking appointments, and holiday-related staffing shortages, or because the patients themselves wanted to wait until the holidays were over. The team stressed that providers need to take these aspects into consideration and focus on discharge planning and coordination of care during the holiday season.

Hospital discharge is a complicated and challenging process for healthcare providers, patients and caregivers. Good practice in discharge planning is the basis of successfully shifting an individual from a hospital environment to their home or other environment. Studies have found that timely, safe and transitions from hospital can significantly improve patient outcomes. Effective discharge planning decreases the chances of readmission, support recovery, ensure proper medication prescription and adherence, and adequately prepare caregivers to take over the care of the patient. Timely and efficient discharge requires:

Effective communication with individuals and across settings
Determining the most appropriate setting for ongoing care
Efficient systems and processes to support discharge and care transfer
Clear discharge management plans
Early identification of discharge or transfer date

Additionally, a paper published by www.uptodate.com recommends that in order for the patient to be considered safe and ready for discharge to home or to a non-acute environment, the a provider should pay attention to several factors beyond the medical determinants. These factors include:

Patient cognitive status
Patient activity level and functional status
The nature of the patient’s current home and suitability for the patient’s conditions
Availability of family or companion support
Ability to obtain medications and services
Availability of transportation from hospital to home and for follow-up visits
Availability of services in the community to assist the patient with ongoing care

In a journal news release, the Institute for Clinical Evaluative Sciences researchers noted that factors such as excessive eating and drinking, higher levels of stress, and lack of sleep are common during the holidays and could affect the health of recently discharged patients. A wsau.com article cites Dr. Lauren Lapointe-Shaw, a general internist at Toronto General Hospital as saying that patients can improve their chances of a better outcome after discharge by being knowledgeable about self-care and any medication changes that need to be made, and communicating with their provider if anything goes wrong.

A study from the Yale University School of Medicine showed that patient outcomes could be improved after a hospital stay if a detailed discharge summary is created and delivered quickly to the patients’ physicians. Medical transcription companies play a key role in helping hospitals complete patient discharge related documentation in a timely manner.

New Year Goals and Resolution Ideas for Physicians

20-December-2018 MTS TEAM Medical Transcription

With the New Year approaching, physicians, like everybody else, would do well to consider making New Year resolutions to improve practice efficiency and spend more time with patients, and most important, reduce stress. Outsourcing medical transcription can help with all of this. Here are some more good New Year Resolution ideas for physicians that can have a positive impact on their lives and the wellbeing of their patients.

Utilize technology effectively: There is a wealth of new technologies in clinical practice and managing a practice’s IT needs is critical to its effective operation and the ability to provide better patient care. One of the major issues that physicians continue to face is managing their EHR system. EHRs require too much time for data entry, make data mining difficult, and reduce physician-patient visit time. While EHR-integrated medical transcription services are available to help make documentation quicker and easier, physicians across all medical specialties can push to improve EHR functionality so that the focus back on the patient and the provider can document the encounter quickly and completely.
Improve care provision and delivery: Easier and faster patient care and follow up is another thing that most physicians have on their New Year wish list. Smarter appointment scheduling can promote delivery of better care within the limited window of time allocated. One strategy is to allocate more time for patients with chronic or complicated conditions. Installing quality online appointment scheduling software can reduce patient wait time and improve the patient experience, and ultimately, patient retention.

Telehealth is a technological tool that physicians can take advantage of to improve the way they provide care. The bonus is that, for the first time in 2019, Medicare will pay doctors for new communication technology-based services such as virtual check-ins with their patients, virtual consultations between physicians, evaluation of remote pre-recorded images and video and an expanded list of telehealth services.

Enhance patient communications: Communicating effectively with patients is key to improving the patient experience and building good physician-patient relationships. Physicians Practice offers the following tips to improve communication with patients: ask open-ended questions at the consult to better understand their problem and symptoms; pay attention to non-verbal cues to see if patients understand instructions; use simple nonmedical language so that patients can follow; use the teach-back method to educate patients with low literacy; implement patient satisfaction surveys to assess the effectiveness of patient communication with physicians and staff, and ensure empathic communication with the patient and family in an adverse situation.

Improving patient communications also involves ensuring that office functions like insurance verification are streamlined so that staff can inform patients of their financial responsibilities and engage them at the outset. The goal should be to make every patient contact-phone, email, or visit-quick and flawless, with respect for their time.

Create and implement effective patient education programs: In this era of value-based care, physician practices need to aim to provide effective patient education in all aspects of their care. Patients should be educated on what they are expected to do, along with a clear explanation on priorities. This will empower and engage patients in managing their own care, and help them communicate effectively more effectively with their physician when there is a problem. Educational programs and material should be simple, clear and to the point.
Address stress and burnout: According to the American Academy of Family Physicians (AAFP), nearly two-thirds of family physicians report at least one element of burnout, and the trend is moving in the wrong direction. Administrative burden, excessive EHR complexity and lack of interoperability, inadequate payment, and maintenance of certification hassles are the key factors responsible for driving physician stress and burnout. In fact, physician wellness was a focal point for the Academy in 2018.

Building stress resiliency should be an important goal for physicians in 2019. Strategies to accomplish this include, getting sufficient sleep, making time for exercise, maintaining a healthy diet, building a positive mindset, learning how to cope with difficult situations and planning ahead. Keeping these wellness resolutions is also critical. In a 2017 Reader’s Digest article that listed the New Year resolutions of top physicians, Adam Splaver, MD, said,

“As a busy cardiologist, it is easy to get swept away in the vortex of chaos that comes with the occupation. In order for me not to lose my sense of self, my purpose, and reestablish zen, I am adding a practice of mindfulness to my routine. I meditate daily and incorporate a breathing practice into my work. I have felt more grounded, at ease, and fully present in the moment as a result.”

Also Read: 2020 New Year Resolution Ideas for Doctors

As we enter 2019, healthcare providers face many challenges like leveraging data to manage health and drive decisions, controlling costs and improving care quality, harnessing digital technology, and much more. Influencers and stakeholders, including medical transcription companies, need to work with physicians to intensify the efforts to meet the goals of improving care while promoting clinician wellbeing and practice efficiency.

How Physicians Can Reduce Documentation Burden and Optimize Health Information

17-December-2018 Julie Clements Medical Transcription

The innovative system of blending EHR and medical transcription service has helped medical professionals to achieve a higher level of quality in their work. Electronic Health Record or EHR is a systemized collection of patients’ healthrecords that are stored in electronic format. The EHR enhances the ability to exchange health data electronically and ensure high quality service and safe care for patients. EHR documentation includes complete details of the patient which includes name, data, demographics, allergies, medical history, medication, lab test reports, medical bills etc. These health records can be shared through a connected network across various health care settings so that providers can access the data from anywhere and give their expert opinion. The EHR market is expected to grow drastically by 2023. In many countries financial incentives are given for the implementation of EHR. The global electronic health record was valued at $23,592 million in 2016 and is expected to reach $33, 294 million by 2023.

Even though the EHR system provides various advantages, physicians are forced to sit in front of the computer rather than spend time with the patients.

The Centre for Medicare and Medicaid Services are aiming at reducing the burden of paperwork on physicians. Obtaining patient history and completing the documentation on a patient is very important from the point of view of patient care and good clinicians achieve that. Documentation should not be a burden because it is an integral part of patient care. However, documenting and re-documenting is a waste of time. Physicians should ensure that they are not wasting their valuable time by obtaining worthless information that may not be relevant to the care plan. One way to eliminate obtaining valueless information is to stop mandating arbitrary family history and random review of systems.

Here are some suggestions that Dr. Erica E Remer, a qualified and experienced Emergency Medicine physician with over 25 years of experience proposes whereby physicians can obtain valuable information, avoid useless information, and reduce the burden of medical documentation on healthcare providers.

1. History is important it must be obtained by ancillary personnel and reviewed and validated by the provider. Stop copy and paste of previous documentation in prior notes.
  - Family history and pertinent past medical or surgical history should be obtained.
  - Social history of patients which may include tobacco or alcohol use should be collected as it may be relevant.
  - The physical examination should be appropriate for the chief complaints or chronic condition or potential diagnoses.
  - Medical decision making should clearly show what the provider was considering and thinking, the plan to evaluate the problems, and what the investigative studies demonstrated.
  - Review of systems should be obtained and there should not be any numerical value of system so that patient cannot understand the seriousness of the illness.
  - All diagnoses should be addressed.
2. Medical necessity mustbe met for everyone.
3. Submission of bill for payment should be on the basis of:
  - Complexity of medical decision making like acute problems or multiple problems or high risk patients
  - Time: complex history acquisition, review of various diagnostics studies, complex counselling, spending extra time talking to patients in case of unnecessary antibiotic or suicide and should be compensated, consultation and discussion with other healthcare providers.

Healthcare providers should be paid for the amount of work they have done. While documentation is important, giving proper patient care is more crucial. Healthcare units can minimize the burden of medical documentation by hiring a reliable medical transcription company that can ensure complete accuracy in the medical records. With good medical records and reliable health information healthcare centres can make better clinical decisions and also provide improved health care.

Non-alcoholic Fatty Liver Disease a Major Contributor to Increasing US Healthcare Costs

13-December-2018 Rajeev Rajagopal Diseases and Conditions

Healthcare costs are phenomenal in the United States. It is estimated that the nation spent 17.8% of its GDP on healthcare in 2016. In comparison, the average spending of 11 high-income countries – Canada, Germany, the U.K., Australia, Sweden, Japan, France, Switzerland, the Netherlands, Denmark and the U.S – was only 11.5%, according to a new report published in the Journal of the American Medical Association. The U.S. spent $9,403 per capita, which is almost double what the others spent. There are many reasons for this excessive spending in the United States – medicines are more expensive, doctors are paid more, diagnostic tests and hospital services cost more, and considerable money is spent on planning, regulating, and managing medical services at the administrative level. Medical transcription costs are also considerable in hospitals, and many hospitals are looking to reduce in-house transcription costs by adopting medical transcription outsourcing that is more affordable. Among other major factors contributing to increased healthcare costs are certain chronic diseases that Americans suffer from such as cardiovascular diseases, smoking and alcohol related health issues, diabetes, Alzheimer’s disease, cancer, obesity, arthritis, asthma and stroke. Liver disease is looming as another major healthcare threat now in the United States.

According to the American Liver Foundation, around 100 million individuals in the United States suffer from non-alcoholic fatty liver disease (NAFLD) and it costs the U.S. healthcare system around $32 billion annually. It is the most common form of chronic liver disease now, and the prevalence of this disease reflects the increasing trend of obesity in America. The extra fat build-up in the liver cells in this case is not due to alcohol. There is a real need for readily available treatments for this health condition, which could save money as well as valuable human lives.

Researchers at Intermountain Healthcare’s Intermountain Medical Center in Salt Lake City examined medical records from 2005 to 2015 and identified 4,569 patients diagnosed with NAFLD. A control group of 12, 486 patients with no diagnosis of the disease was identified for comparison purposes. With the help of data from SelectHealth, the insurance section of Intermountain Healthcare, the researchers analyzed the healthcare costs per patient and the overall costs per year in both groups. The calculations indicated an economic burden of $32 billion annually for the United States.

The costs of the disease comprised of:

Emergency room visits
Inpatient hospitalization and outpatient appointments
Mortality
New medication or changes to existing medication
Organ transplantation
Medical procedures or new diagnoses

This research is the first ever estimate on actual healthcare utilization associated with non-alcoholic fatty liver disease in the US.

Obesity or gaining fat is one of the main reasons for non alcoholic fatty liver. The liver stores fat in its cells and as the amount of fat increases the disease advances to non-alcoholic steatohepatitis and it is marked by liver inflammation and scarring that may cause irreversible damage. If the disease is ignored, then it leads to liver failure. People who are overweight, have diabetes, or have family members with liver diseases must be screened for non-alcoholic fatty liver disease.

This is an era of rising healthcare costs and diseases that were uncommon and unrecognized a decade before, have now become major epidemics that will further drive costs in the years to come. The study highlighted the fact that if treatments do become available, there could be potential reduction in healthcare costs. The researchers have validated a predictive risk score that uses basic lab values and a patient’s medical history to predict which patients are at a higher risk of developing liver damage due to NAFLD. They intend to use this prediction tool to understand the problem at a population level by intervening with nutritional and therapeutic options that may include clinical trials, before the patient reaches end stage liver disease. Community initiatives can also play a significant role in increasing awareness about NAFLD and motivating people to adopt a healthy and active lifestyle that can prevent obesity and its related complications.

When it comes to treatment and care for liver disease accurate medical records are crucial. Care providers must have easy and anytime access to patients’ medical records and this can be ensured by medical transcription companies that provide value-added medical transcription. Research reports show that hospitals plan to deploy more medical transcription tools or utilize outsourced medical transcription from a good medical transcription firm to control transcription costs.

Hospitals Are Planning to Use More Medical Transcription Tools, Says Study

10-December-2018 MTS TEAM Medical Transcription

Software dealers are adding more modern features to legacy tools and hospitals are increasingly embarking on digital transformation initiatives that involve automation, outsourcing and advanced reporting techniques. In fact, more and more hospitals are considering implementing medical transcription technologies or using medical transcription services. According to recent research reports, hospitals are planning to deploy more medical transcription tools from companies including Acusis, Nuance, MModal, iMedX, Precyse, Scribe Healthcare, Superior Global Solutions, Transcend Services and TransTech Medical Solution among others. In their report released last month, Technavio, a leading market research company, reveals that hospitals worldwide will spend more than 72 billion by 2020, representing 6 percent compound annual growth rate. Voice recognition technologies are a big driver of hospital plans. Another market research company, Radiant Insights, says that the key factors driving hospitals to adopt transcription tools are their reliability, portability and cost-effectiveness.

Radiant Insights also forecasts that the increasing adoption of automatic transcribing technologies is expected to replace various analog devices in the near future. Other factors responsible for the growth of the market are the rise in the value of skilled professionals and an increase in medical transcription outsourcing. Moreover, increase in the number of transcribers coupled with many years of training to learn various methodologies and terminologies are expected to boost the overall market demand in near future.

As more hospitals are focusing on outsourcing medical transcription to third-parties, this is likely to double the number of third-party service providers. The medical transcription (MT) industry is considered to be one of the most vibrant segments in the healthcare management sector, as it is affected by changing technological transformation.

Many initiatives undertaken by local governments including rising adoption of the electrical health record systems in both developed and developing economies are expected to fuel market growth in the coming years. The increasing popularity of automation in the healthcare sector in order to provide superior, safer and quality service to patients is positively influencing the current model of medical transcription industry.

Medical transcription is the process by which doctors and healthcare professionals process health records which are then converted into readable text format from voice and text report. This data is used mainly by Health Information Technology organizations and electronic health record (EHR) initiatives. Instant transcription is provided for storage and transfer of the voice recorded data to the medical transcription department. The recent technological revolution in the healthcare sector has led to growing adoption of electric consoles, word processors and several smart devices. The medical transcription devices available now have in-built speech recognition and memory storage systems. Generally, medical transcription is performed by healthcare professionals or in-house transcriptionists.

The medical transcription industry is categorized into regional market segments such as North America, Europe, Asia-Pacific, Latin America and Africa. North America has shown major growth in recent years due to the rise in the adoption of the latest technologies in medical sciences and the existence of a well-established healthcare infrastructure. The end users of medical transcription services include hospitals, physician practices, clinical laboratories, academic medical centers and others.

Beware of Dangerous Transcription Errors in Medical Records

06-December-2018 Julie Clements Medical Transcription

Accurate clinical documentation is critical to health care quality and safety. As an experienced medical transcription company in the U.S., we understand the importance of accuracy when transcribing medical records. Error-free transcripts ensure the right treatment and help avoid legal consequences. Patients, mainly older adults, have to be very careful about what’s in their medical record.

According to reports from the Office of the National Coordinator for Health Information Technology, 8 in 10 individuals who have viewed their medical record online considered the information useful, and it is estimated that nearly 1 in 10 people who access records online end up requesting that they be corrected for a variety of reasons. The report also finds that 27% individuals were unaware or didn’t believe that they had a right to an electronic copy of their medical record.

Kaiser Health News recently discussed the impact of medical record errors in patient care. Based on the live examples given, diverse errors you can expect in your medical records include:

Your medical records may come with pages and pages of notes that referred to a different person with the same name, but different medical conditions that were much more complicated and numerous than yours
An incorrect diagnosis, scan or lab result may have been inserted into your record, raising the possibility of inappropriate medical evaluation or treatment
Medical conditions you don’t have. For instance, a patient’s record contained “renal cell carcinoma” (kidney cancer), instead of “basal cell carcinoma” (skin cancer) – an illness mentioned while describing his medical history.
Records indicate the patient has an underactive thyroid when in fact he/she has an overactive thyroid.
Certain things may be omitted such as lab results, allergies and medications; and family history may not be conveyed accurately
Demographic information such as patient’s name, address, phone number or personal contacts may also be incorrect, making it difficult to reach them in case of an emergency or causing a bill to be sent to the wrong location.

Under HIPAA guidelines, if an error is discovered in the medical record, patients have the right to ask for a correction. It is recommended to check with your doctor or hospital if they have a form (either a paper or electronic version) to submit a suggested change. Errors such as a wrong phone number can be corrected by drawing a thin line and marking the suggested change in the margins or making an electronic note. At the same time, complicated errors such as incorrect description of symptoms or a diagnosis may require a brief statement explaining what material in the record is wrong, and why and how it should be altered. In most states, physicians and hospitals are required to respond in writing within 60 days, with the possibility of a 30-day extension. Patients also have the option to file a complaint with the government office that oversees HIPAA or a state agency that licenses physicians.

It is also noted that rejections can be warranted when facts or medical judgments are in question. For instance, if the patient needs to eliminate a diagnosis from the record, as she won’t be eligible for an insurance coverage, it wouldn’t be an acceptable reason for making a change.

Errors can also occur in transcripts created by speech recognition software. A July 2018 study published in JAMA found that among 217 clinical notes randomly selected from 2 healthcare organizations, the error rate was 7.4% in the version generated by speech recognition software, 0.4% after transcriptionist review, and 0.3% in the final version signed by physicians. This study notes that 7 in 100 words in unedited clinical documents created with SR technology involve errors and 1 in 250 words contains clinically significant errors. Observed error rate in speech recognition-generated clinical documents also demonstrates the importance of accurate medical transcription services, manual editing and review. Online access to medical records serves as a key tool to help individuals and caregivers understand their health and manage their health care needs. While accessing medical records, patients must make sure to look for possible mistakes in their personal details (name, address, health insurance plan provider, social security number), health information (doctor’s appointment notes, medical history, symptoms, diagnoses, medicines), and their medical bills.

Aligning Radiology Metrics with the Goals of Value-based Care

03-December-2018 Rajeev Rajagopal Radiology Transcription

Correct and timely imaging reports are critical to make the right treatment decision and radiology transcription services play a key role in helping radiologists convert dictated reports into intelligent and accurate documents. The shift to value-based care brings new challenges for radiologists, but also provides new opportunities for them to contribute to better patient outcomes.

The basis of the value-based healthcare approach is paying healthcare providers based on the patient’s health outcome and not on basis of volume of services delivered. How is value in healthcare defined? According to the authors of a book titled Redefining Health Care, value is “the health outcomes achieved per dollar spent.” They state that “improving value requires either improving one or more outcomes without raising costs or lowering costs without compromising outcomes, or both.”

So radiologists need to demonstrate improved value by aligning radiology metrics with the goals of value-based care. However, this is a challenging task. On the one hand, technological advances have transformed the role of radiology imaging tools from static to dynamic. Medical imaging plays a critical role in disease management as it can help diagnose numerous conditions and is used in almost every branch of medicine. However, as a www.hospitalhealthcare.com report points out, the specialty of radiology faces several unique problems such as increased workload, shortage of imaging specialists, and limited time available for interpreting and communicating the imaging exams with patients and referring clinicians. This poses challenges for radiologists to improve operational efficiency, performance and quality, and achieve the goals of value based care. Here are some expert suggestions for improving radiology outcomes without increasing costs:

Reduce duplication of imaging studies: Additional imaging tests should be recommended by radiologists only when such additional testing is truly necessary. However, a study published in the Journal of the American Medical Association reported that there is a high incidence of repeat imaging – CT scans, ultrasound scans, and chest X-rays – in emergency departments (EDs). The researchers said the drivers of unnecessary diagnostic imaging include incentives offered to non-radiologist physician offices to install advance imaging equipment and order abundant imaging tests to generate revenues, self-referrals by patients themselves after hearing about the latest in MR or CT scans, and duplication of tests when a patient switches physicians. Going by the appropriateness criteria published by the American College of Radiology can ensure that imaging is ordered and performed only when warranted.
More effective diagnostic imaging testing for quick, accurate clinical diagnoses: Providing the right image with the right interpretation at the right time is necessary for prompt, accurate diagnosis. However, in a September 2015 report, the Institute of Medicine said that each year, 5 percent of outpatients experience a diagnostic error, and up to 17 percent of adverse events experienced by hospitalized patients each year are caused by diagnostic errors. Leading healthcare company Mckesson says maximize diagnostic imaging in value-based care, radiology departments need to:
- Allow real-time accessibility: Enable images from imaging systems to be accessible to clinicians real-time on a variety of devices in a variety of settings.
- Maximize efficiencies: Assess imaging workflows to identify opportunities to reduce testing and turnaround time.
Establish broad-based health information exchange (HIE): Experts recommend that establishing broad-based health information exchange (HIE) can lead to substantial health care savings by reducing duplicate ED ultrasounds, chest X-rays and CT scans. Clinical data from patients’ electronic medical records, which physicians have access to, should be integrated into workflow of the diagnostic imaging department. This will promote safe and effective diagnostic imaging. Radiologists, technicians and other department staff should have access to all the following patient information:
- History and physical
- ED notes
- Pathology reports
- Surgical history
- Discharge notes
- Laboratory results
- Allergies
- Medications
Medical transcription outsourcing ensures the accuracy of such information which is critical for interpreting images correctly and making accurate diagnoses. Having imaging-relevant patient information from EHRs integrated into the diagnostic workflow also promotes operational efficiency, saves, times and helps avoid unnecessary follow-ups or repeat tests.
Provide high quality, accurate reports: Providing radiologists with two-way access to the EHR can reduce the risk of mistakes, according Carestream. Supplementing radiology reports with multimedia will boost efficiency while adding value to conventional reporting, according to a study published in the Journal of the American College of Radiology. Experts say that multi-media radiology reports with text and images, tables, graphs, and relevant hyperlinks specific images and bookmarks will help the referring physician get a quick understanding of the study, easing collaboration with the radiologist.
Improve communication: Radiology business recently reported on a new study published in Radiology which stressed the importance of good communication between the referring physician and the radiologist. The authors wrote that it is no longer acceptable to use imprecise terms such as ‘interval’, ‘short-term’, ‘non-urgent’ or ‘routine’. They noted that radiologists’ recommendations should follow national guidelines and other accepted practice standards. Attaching disclaimers excusing typographic and grammatical errors was not acceptable, they wrote. Communicating directly with the physician via telephone can also help avoid errors in care.
Reduce the complexity of information technology (IT) tasks: Managing their IT tasks is a challenging task for radiology practices. A recent Radiology Business article says that the complexity of IT tasks can be reduced by bringing together the right systems, software, infrastructure, and team. The report describes how Central Illinois Radiological Associates (CIRA), one of the Midwest’s largest private diagnostic and interventional radiology groups, minimized IT complexity by creating an enterprise worklist. Radiologists can now view all their studies within their specific subspecialty throughout all hospitals and systems they read for, in proper priority. Interfaced systems simplified data and reporting, improved physician workflow, and eliminated manual IT tasks, offering benefits for patients, physicians and the practice at large.

As radiology practices strive to create value, achieve affordable care, and promote better outcomes and patient and physician satisfaction, radiology transcription companies will provide all the support they need to create correct, intelligent, and timely imaging reports to ensure the right treatment decisions.

New Research: Infectious Diseases have a Seasonal Element

29-November-2018 MTS TEAM Infectious Diseases Transcription

Every year, infectious diseases take a heavy toll on health and healthcare resources in the U.S. The most common infectious diseases in the U.S. are influenza, viral hepatitis, measles, mumps and Rubella, pneumonia, STD, AIDS and HIV, and whooping cough. According to the CDC, the number of visits to physician offices for infectious and parasitic diseases stood at 16.8 million in 2015. Many physicians rely on medical transcription services to manage their documentation tasks as they focus on managing their patients. Our medical transcription company sees a rise in demand for infectious diseases transcription services in November-December, commonly called the flu season.

A new study from the Columbia University Mailman School of Public Health suggests that infectious diseases have a seasonal element. The researchers say that although flu can circulate throughout the year, flu viruses are spread most commonly in fall and winter. The study was based on data of 69 infectious diseases, including neglected tropical diseases, collected from the WHO, the US Centers for Disease Control and Prevention (CDC), and the European Centre for Disease Prevention and Control. The main findings of the study published in the journal PLOS Pathogen are as follows:

There are periodic surges in disease incidence correlated with seasons or other annual conditions, though the reasons for this seasonality are not entirely clear.
While outbreaks of influenza in winter and chickenpox in the spring are common, each acute infectious disease has its own “seasonal window of occurrence”.
Seasonality of acute infectious disease can vary among geographic locations and differ from other diseases within the region.
In addition to acute infectious diseases, the incidence of chronic infectious diseases such as hepatitis B virus and HIV/AIDS is higher during certain times of the year.
Many infectious diseases can have a common seasonal driver while differing greatly in many aspects of their biology.

The researchers examined four drivers of seasonal outbreaks: environmental factors, host behavior, host phenology, and exogenous biotic factors.

Environmental factors: Breeding of mosquitoes is influenced by temperature and rainfall, and seasonal weather may affect human immune response through the availability of food or exposure to very cold conditions.
Host behavior: Infectious diseases are spread through some kind of contact such as direct, through the air, and in droplets. Both human behavior and the behavior of pathogens have a seasonal element. The report notes that measles spikes when “susceptible hosts are gathered together”, that is, when school is in cessation. Host behavior also influences transmission. The New York State Department of Health reported an increase in measles cases in October 2018. In Brooklyn, six children were infected by a child who visited Israel, which has experienced an outbreak this year. Similarly, moving to locality with confined areas and inadequate infrastructure also increases the risks of contracting infectious diseases.
Phenology: Circadian rhythms and innate metronomes also impact human immune systems with cells counts fluctuating throughout the day.
Exogenous biotic factors: Many diseases are associated with interactions that occur within the “ecological community of hosts, reservoirs, and vectors,” according to the new study. For instance, the complex relationships between antibiotics and the human gut microbiome causes pathogenic bacteria like Clostridia to grow faster, and reduce bacteria that restrain those more harmful agents.

Previous studies have also drawn attention to the link between influenza outbreaks and climate. A 2016 study in the Proceedings of the National Academy of Sciences of the United States of America examined the correlation between absolute humidity, temperature, and flu outbreaks. The researchers reported that the amount of water vapor in the air drives influenza across latitudes. In colder temperatures, high humidity reduces influenza incidence, while in higher temperatures, high humidity increases influenza incidence.

Researchers call for specific public health initiatives during cold, dry, temperate winters to prevent flu transmission. People can reduce their risk of infectious diseases by taking precautions such as: frequent and thorough hand washing, particularly after coughing or sneezing; cough or sneezing into a tissue instead of hands; not touching the nose, mouth or eyes, the entry points for the influenza virus; not sharing food, cups, bottles, and other materials, and consulting a doctor/staying at home if feeling ill.

Physicians need to urge patients to get the flu vaccine by educating them about its benefits. A recent WKBW report cites Dr. William Schaffner, an infectious disease specialist at the Vanderbilt University School of Medicine as saying, “The vaccine is not perfect, none of us believe it is, but it’s the best thing we have for preventing influenza, and even if it doesn’t prevent the illness completely, and this is very important, it tends to make the illness milder.”

Each year, flu activity varies with different strains spreading across the nation. From May 20 to Oct. 13, 2018, around 197,300 respiratory specimens were tested for influenza by U.S. clinical laboratories. Up to 1.4 percent of the specimens were positive, including about 65 percent positive for influenza A viruses and about 35 percent positive for influenza B viruses. Timely and accurate documentation is essential to ensure appropriate care. Busy physicians can ensure this by partnering with an experienced medical transcription company for infectious disease transcription.