OUTSURCING MEDICAL TRANSCRIPTION

There are two things we Humans should accept in life, one being unnervingly optimistic even in highly impossible situations and second and most annoying of all, believing any type of testimonials and accepting it to be true without any second thought.

I say this basis my personal experience, because today I am actually annoyed at our immaturity towards decision making. No this is not on account of any type of loss which I have suffered, but it is on account of all the losses WE as humans are suffering from.

One brilliant example would be outsourcing medical transcription. Accept it, they cost you a fortune in terms of time. Health professionals who’ve invested their man hours on medical transcription know how and what it costs (in terms of opportunity cost).

And when other countries offer to provide the same services at a cheaper rate we develop perceptions about them being unreliable and poor in quality.

India for one has been blamed to have outsourced really poor quality of medical aid. That would have happened once and people have generalized the whole country for it. This is indeed very disappointing. I myself have outsourced medical transcription to an Indian company called Acroseas Global Solutions, I didn’t find any such problem with my report. In fact, the transcriptions were accurate and impeccable.

We need to think from our heads and not from others’.

HHS Says Certified EHR Available in Fall 2010

Well, it always seems to happen when I go out of town on vacation that HHS finally decides to go to work and make some announcements. The final rule for the Temporary EHR certification rule is out and will be published to the Federal Register on June 24th. It’s non-final format is available at the Federal Register’s Public Inspection Desk. Does anyone else kind of squirm when they read about this final rule for a temporary EHR certification. Final and temporary just don’t sound right together, but that’s what we have.

The Healthcare IT Guy attended an HHS ONC press conference and added a nice little summary of what was said:

*As of today if you’re interested in being a certification body you must request the HHS Certifying Body application in writing
*On July 1 ONC will start accepting applications
*By the “end of the summer” (HHS’s words) there will be one or more certifying bodies open for business (accepting products)
*By “this fall” (again, their words) there will be fully HHS certified products available

One important clarification was made by ONC — there is no grandfathering in CCHIT or previously certified products. Everybody is going to be re certified using the new NIST rules. This means that if you have even 2011 CCHIT certification now it won’t mean anything, you have to go through the process again. CCHIT is offering their “ARRA Interim Certification” but beware — the rules say that you have to follow the NIST plans, not what CCHIT developed. So, if you have the ARRA Interim Certification you may not have pay again but you still will be required to change your software to meet the HHS/NIST test plans and requirements.

Nothing that’s all that newsworthy, except it’s nice to finally have a little bit more solid timeline for when there will be some ARRA EHR certification bodies.

I think that Shahid’s analysis of the now meaningless 2011 CCHIT certification is spot on as well. Although, I’m sure we’ll still see quite a few EMR vendors using the marketing power of the CCHIT certification on unsuspecting clinics who don’t know the difference.

Yes, it does also mean that clinics will have to wait until Fall of 2010 (or later) before they’ll really know if an EHR will be a certified EHR or not. Of course, I’ll be very surprised if less than 98% of EMR vendors don’t become ARRA certified.

ARRA Q&A: Are imaging costs recoupable under the HITECH act?

I got the following question from Brandon about the need to have a domain controlled network in order to comply with HIPAA.

I am currently trying to implement an EMR system in a small practice. I am trying to convince the parties involved that it is necessary to transition to a domain controlled network for security reasons even though this type of network is not required for our EMR system or its server. My understanding of HIPAA is that simply having a firewall does not qualify as a “secured network”. Am I right on this?

Brandon,
You are correct that just having a firewall does not likely qualify as a “secured network.” However, that doesn’t necessarily mean that you need to have a domain controlled network to meet the HIPAA security standards. You could still manually apply the domain security policies on to individual computers and achieve the same level of security.

Of course, the key word in that statement is the word “manually.” If you have less than 10 computers, then this probably isn’t a huge deal and can be done manually. Once you pass 10 computers (or somewhere in that range) you probably want to consider using active directory to manage the security policies on your computers. It’s much easier to apply policies on a large number of computers using active directory. Plus, you can know that the policy was applied consistently across your network.

You also shouldn’t ignore the other benefits of a domain controlled network. I’ve written previously about the benefits of things like shared drives as a nice companion to an EMR. Active Directory makes adding these shared drives trivial. It’s also a nice benefit to have a universal login that’s managed by the domain and can work on every computer in the office.

Plus, if your EMR runs on SQL Server and you buy a nice but inexpensive server with Windows Small Business Server, then you already have the software for active directory. So, it’s really an easy decision to use it. I’ve implemented it at a site with 5 computers and it’s been a great thing to have even if it’s a bit of overkill.

EMR on Twitter

I imagine that many of my readers use Twitter to find EMR information. Twitter is an interesting beast. It takes a little getting used to, but can be used in a whole number of ways. However, what people don’t realize is that you don’t have to be on Twitter and have a Twitter account to enjoy many of the benefits of Twitter.

I especially like Twitter during conferences. For example, during the HIMSS 2010 conference I would just search for the tag HIMSS2010 and found all sorts of interesting information about what was happening at HIMSS. Here’s a simple search for people talking about EMR on Twitter.

I think one of the main uses of Twitter is a way to share some of my favorite EMR links. I use this EHR and HIT twitter account to do that for some of my favorite bloggers. It’s also fun to see people’s reactions to the various items I post on that account. I guess people like what I’ve done since that account has 4232 followers of it.

At the end of the day, Twitter for me is a way for me to connect with lots of interesting people. Tomorrow, I’m going to lunch with a local CPA and blogger that I met on Twitter. It’s timely, since I’ve been looking around for a CPA. So, we’ll share lunch, I’ll teach him about blogging and we’ll see if his CPA services are a good fit for my needs.

Beyond that I’ve connected with so many people on Twitter. I’ve gotten free tickets to shows in Las Vegas. I’ve gotten free graphic design work. I’ve seen some of the latest breaking news before CNN and the likes are broadcasting it. I’ve found side work on Twitter. Plus, I’ve gotten hundreds of questions answered by my smart twitter friends.

Obviously, I’m a pretty big fan of Twitter. In fact, many of you likely found this blog through Twitter. I love Twitter because it can be used in so many ways. How do you use Twitter?

Also, if you want to connect to my personal twitter account (which also does quite a bit of EMR related content), I’m @techguy.

EMR Stimulus Q&A: Government Incentives for EMR Adoption Outside of Medicare and Medicaid

Time again for everyone’s favorite topic (or so it seems), EHR stimulus questions and answers. Today’s EMR stimulus question comes from Jamie who asked the following question on a previous post:

Does anyone know whether or not the government is implementing some kind of incentive benefit for non-Medicare/Medicaid users? Or are these practices totally out of luck?

The short answer (at least for now) is not really. The ARRA EHR stimulus money is provided through Medicare and Medicaid programs as “bonuses” for those who show “meaningful use” of a “certified EHR.”

With that said, there are some grants available for special situations. For example, they have a beacon communities program which are given to organizations that will supposedly take EHR software to the next level and be examples for their communities of what can be done with IT and EMR software.

I’ve heard there’s other grants that people can apply for also, but I’m not sure all of the details. I also hear that there might be some EMR stimulus money available in the latest healthcare reform bill. For example, I read somewhere recently that the healthcare reform bill includes some stimulus money for long term care which has basically been left out of stimulus money as well.

Clinics interested in EMR software should also be able to get some help from the RECs and HITRCs. At least their stated mission is to assist doctors to adopt and meaningfully use EMR software. I think the jury’s still out on how helpful these RECs will actually be. It’s a nice idea, but could go horribly wrong if not done right.

I won’t go into all the details here, but not qualifying for the EMR stimulus money might just be the best thing that’s happened to your practice. That means you won’t be distracted and you don’t need to wait. You can hone in on the other EMR benefits and start reaping those benefits without all the bureaucracy.

Offsite Backup Services for an EMR

I’ve been seeing a number of new offsite backup services for EMR software. They are becoming quite sophisticated and are an option that I think many doctors offices should consider. I know that in one doctors office I setup a USB hard drive which they could take home with them in order to have some semblance of an off site backup.

This is far from perfect and even harder to secure the right way. Not something that most doctors offices will want to take on alone. However, the real problem with this type of “off site” backup is that they too often forget to take the backup offsite. They don’t verify that the backup was done. I’m sure there’s more, but you get the picture.

Seems like many of these off site backup services provide a really great service that solves a lot of these problems. Not all of them (like verifying that the backup can be restored), but they are becoming quite sophisticated.

I’m interested to hear other people’s experiences with these type of offsite backup services. What do you like? What do you dislike? What do you wish they’d do?

I have a feeling these type of really useful services won’t be in rich supply on the HIMSS vendor floor, but I’ll be keeping my eyes out for useful and practical services like this at HIMSS. If you’re a vendor of a service like this that will be at HIMSS, let me know so we can meet. Same goes for any ambulatory EMR vendors. I’d love to meet with you at HIMSS too.

Large EMR Vendor Bias Towards EMR Stimulus

One thing I’m starting to notice is that it seems that ALL of the large EMR vendors are strong proponents of the EMR stimulus. All but a couple of the comments I’ve found from large EMR vendors laud praise upon the HITECH act. Listening to the information they’re putting out, you’d think that this was a fantastic stimulus package that will just be too good to pass up.

Now, I’m not saying that what these EMR vendors are saying is a lie (although some of the things they’ve said are). What I am saying is take a look at what motivation an EMR vendor has to do anything but prop up the EMR stimulus package. As far as I can see, there’s little benefit to their EMR business to talk poorly about the EMR stimulus. EMR vendors want people to think that the EMR stimulus is simple, effective and incredibly well done. If this were the case, many doctors should and would be all over it and EMR vendors would see increased sales. If EMR vendors were to describe it as complicated, ineffective and poorly defined, then that means fewer sales for those EMR vendors.

My point here isn’t to argue whether the EMR stimulus is good or not. It’s just to highlight that EMR vendors are (and probably should be) biased in their opinions of the EMR stimulus package.

Interestingly, a few smaller EMR vendors have made the opposite case. They’ve come out that the EMR stimulus is an atrocity, does little to improve doctors’ productivity and often hurts productivity.

The battle lines have been drawn. Just make sure you’re not a casualty of biased information.