In a couple of recent articles that are not connected, there is an underlying connection. One, in "For the Record" discusses The Hazards of Note Bloat and the unintended consequences of having a lot of information that doesn't truly say much about the complexity of the patient's condition, not to mention that it is "difficult to view, notes lengthen and errors accumulate." But wait, aren't EHRs supposed to reduce errors? The article goes on to explain how narrative (dictation/transcription) notes have been reduced, but not completely eliminated. It also discusses speech recognition and its implementation this month.
The next article talks about the value of outsourcing as a cost-savings process to reduce costs and how this is happening in a big way in Canada. This model has been shown again and again to be cost effective and many hospitals across the US have already embraced this practice to help reduce costs.
In yet another article, 3 major healthcare groups were identified as having caught the financial flu and are not doing particularly well at this time.
In reviewing the 3 unrelated articles, it became apparent that there may be a myopic view of how to balance reducing costs with optimal EHR utilization. Consider this. EHRs are here to stay. We need them and the value they bring to healthcare overall. What we don't need is documentation that doesn't improve the quality of the patient encounter. We need streamlined, content-rich, not bloated notes that drone on endlessly with what the previous note stated. We need to optimally enable physicians so they have the time to see a growing patient population, not spend endless hours doing their own data entry. We also must get the level of detailed specificity now that will be needed as the ICD-10 date edges ever closer. Healthcare organizations must be fiscally healthy enough to provide care and continue to be viable as baby boomers get to Medicare age. So yes, they do absolutely need to cut costs in the right places but keep those that enhance their revenue capabilities.
Here's the conundrum in summary. If healthcare organizations and hospitals focus only on reducing costs at the expense of eliminating medical transcription/editing, they are using a tunnel vision approach that will reduce costs but will simultaneously fail to optimize reimbursement. Complete, detailed documention renders optimal coding, which leads to appropriate and optimal reimbursement. If this process becomes muddy through "note bloat" or abbreviated input from extremely busy clinicians, the revenue cycle process may breakdown and the endless cycle of trying to reduce costs and not optimize documentation will continue.
Stop the broken cycle of cost-cutting measures as the only option. It's time to see the bigger opportunity and realize the value gained in the outsourced model of quality dictation/transcription and speech editing process to capture all the details needed for ICD-10 today. This can get healthcare organizations over the financial flu and on the road to recovery. By adopting a practice of excellent documentation practices, these 3 unrelated items can become related in a way for long-term success with the EHR and improve patient outcomes as one of the most important goals.
A new day and a new adventure begins. In working with MTSOs for a number of years, and with the requirements of HITECH making the headlines, I have decided to start something new and provide a number of services and solutions for business associates and covered entities in efficiently achieving compliance in the area of privacy and security. Privacy Officer Services officially begins today.
This new business is designed to support business associates and covered entities in the development of their customized policies and procedures for privacy and security, to assist with completing their required security risk analysis and a number of other services like employee training, education, monthly updates, quarterly updates for the business website, and weekly updates in news in and around privacy and security as well as technical developments. There are many more and there is a unique solution for every healthcare organization.
My goal is to help these business associates achieve the HITECH requirements in a cost-effective manner so that their current staff can continue on with the business at hand in delivering on-time services and provide the customer experience their clients expect.
By outsourcing their privacy officer reponsibilities to me, they will gain efficiencies in a number of ways like having a knowledgeable resource available every day without having to add to their employee count. Having someone who can attend meetings, and present to potential and existing clients on their privacy solutions can be a huge advantage in the world where we see and hear about costly security breaches nearly every day.
It's a new world filled with legal requirements and challenges for business associates and covered entities - this is a way to check a very important responsibility off the "must-do" list and put this into the hands of someone they know and can trust to provide the right solution today.
While EHRs are going in rapidly across the country, it's important to remember that the demand for value in reducing costs, improving patient safety and providing access to more Americans still leads the charge when it comes to why we move to electronic systems in health care. One of the best ways to enhance the value in EHR systems data mining and research is to keep a robust, detailed record of each individual patient who has a unique history unlike any other. Medical transcription/editing captures details provided by clinicians that are crisp and precise filled with data and information that can get us to the goal of improved patient outcomes through the application of secondary healthcare data. There are a number of reporting agencies that are making results available to anyone who is interested in taking a look. Organizations like the Leapfrog Group, Health Grades, Bridges to Excellence along with a score of others, provide information on various diseases and outcomes. Some secondary data use reporting is required such as core measures reporting. And when I say required, I mean that there is a 2% penalty in market-basket outcomes if you choose not to report. It is probably reasonable to anticipate that the number of hospitals reporting outcomes and the agencies to which they report will also increase. This is why it is a key fundamental and logical approach that the use of dictation and medical transcription or medical editing with speech recognition tools will be the best way to capture these necessary details and be able to produce content-rich results when reporting outcomes to continuously improve care. Nine of 10 Healthcare executives agree in a survey conducted by Pricewaterhouse Coopers (PWC) that secondary use of health information will significantly improve the quality of care and that those benefits will improve in the future. A clear two/thirds anticipate a huge increase within the coming two years. (1) Consider the AMIA findings of the gains that can be made from the expansion of knowledge about diseases, treatments and make strides in public health along with advances in privacy and security. (2) There is much to be gained as we move into this era of using secondary data to advance healthcare and this can best be achieved if we continue to capture the details provided by clinicians through the dictation and interpretation process. The outcomes, however, will only be as good as the content from which the information comes - that's why dictated/transcribed reports are a gold mine of information. To in any way short-cut details will severely limit the wide-range of benefits.
Just for fun!!!! Who needs a break from the news? I know I do. Some of the headlines are just way too depressing and all the talk about repealing health care reform just makes me tired. So here's a little diversion that I hope will bring you a smile. These lyrics should be sung to the melody, Friends in Low Places - so get your Garth on folks and sing along! Friends In Home Office PlacesI stay home and work, not because of the perksIt's the job that I chose from the startThe money's not great, barely puts food on the plateBut in healthcare I'm doing my partYou think that it's grand, what I do with my handsBut it comes with superior skillsI know I belong, you can tell from this songWhile I keep trying to juggle my billsCause I've got friends in home office placesWhere the internet sings and they keyboard racesTo the goal of the day, and I'll be okayOh I'm not hooked on financial statusThink I'll slip on down to my Facebook pagesOh I've got friends in home office placesThings happen so fast, my IM's a blastAnd now I have new SRTBefore you can say, social media's the wayI've got to Tweet my trip to DC!Today's EHRIs demanding so farTo keep up with ObamacareDocs need us today, to help them relayThat important O2 sat on room airI've got friends in home office placesWhere the internet sings and the keyboard racesTo the goal of the day, and I'll be okayOh I'm not hooked on financial statusThink I'll slip on down to my Facebook pagesOh I've got friends in home office places
In a couple of recent articles that are not connected, there is an underlying connection. One, in "For the Record" discusses The Hazards of Note Bloat and the unintended consequences of having a lot of information that doesn't truly say much about the complexity of the patient's condition, not to mention that it is "difficult to view, notes lengthen and errors accumulate." But wait, aren't EHRs supposed to reduce errors? The article goes on to explain how narrative (dictation/transcription) notes have been reduced, but not completely eliminated. It also discusses speech recognition and its implementation this month. 
