Medical Transcription and Meaningful Use
Last week’s post mentioned the new standards that were released on “meaningful use.” I believe it is one of the most significant things to impact the industry of medical transcription that we’ve seen in a long time. What does all of this really mean?
The use of electronic health records (EHRs) is increasing in the United States. It is said that EHRs will improve patient care, assisting with the caregiver’s decision making and thereby impacting patient outcomes. While thousands of physicians have implemented this in their practice, the transition certainly hasn’t been an easy one.
The HITECH Act, passed last year, provides an incentive to the healthcare industry for moving to an electronic health record. The federal government will now make incentive payments available to support the adoption and use of an EHR. This totals up to $27 billion over 10 years, and can mean as much as $44,000 (through Medicare) and $63,750 (through Medicaid) per clinician.
These incentives are not available, however, for simply adopting an electronic health record. The providers must prove “meaningful use.” The industry has awaited the standards that define how this will be measured, and these were released last week. You can view the Department of Health and Human Services press conference here. Take a listen and then come back for discussion on how this impacts our industry.
In order to prove meaningful use, physicians must follow the standards announced at the press conference. Here’s a chart to help you see what some of this looks like.
On first glance, one might think this is not something that will impact us. Doesn’t almost every physician record things like vital signs and medications? Read it again. The most impactful words for the medical transcription industry are “as structured data.” Structure data is information that is broken down into discrete, searchable data elements. As Jay Vance reported in a recent AHDI Lounge blog, a tsunami is about to hit us.
How do we take what medical transcriptionists traditionally do and create structured data? Medical transcriptionists are already working with technology to provide editing of documents processed by a speech recognition engine. How might this fit in what we do? Or does it indeed mean the end of free form dictation and transcription in healthcare? Are you still breathing?
In the healthcare blogs that I have been reading, some physicians are standing up strongly for not losing their ability to have free form text in the healthcare record. Their claim, as would ours be, is that a point and click system, or a system that is only data elements, does not tell the entire patient’s story. Other physicians have commented that the required items on this list are not things they collect. How many times have you actually had your height and weight and vital signs taken at your ophthalmologist’s office? Those physicians are saying they won’t even qualify for the incentives.
So, what does our future hold? The data elements must be identified and tagged. The “point and click” systems will do this automatically. The information could also be analyzed and tagged, either by a computer or by a human. Natural language processing is a way for data tags to be inserted into documents. As I understand from the limited research I’ve done so far, it can be done on the front end, as in the systems we are seeing now, or as “back end” tagging. I don’t pretend to understand the technology enough to really say how it works or what might work for us. What I can see is that the move to any kind of front end structured data entry for the healthcare record would not be a good thing for our industry.
What I DO know is this. It’s way past time for us to be addressing this. It is critical that medical transcriptionists stand together and be sure that the medical community understands the value we bring. In addition, we are all patients. Do you want your healthcare record to only tell a part of the story, and that be whatever part is available in a point and click system?
In his blog Voice of the Doctor, Nick van Terheyden has a really interesting article about NLP in medicine. Be sure to take the time to watch the video he has on this blog post. I found it fascinating to watch a computer play Jeopardy. As he says, even with the errors that were made, it’s still pretty impressive stuff.
I expect meaningful use to be a hot topic at next week’s AHDI meeting. I would hope to see our association focus on this important topic more than it focuses on how the structure of our organization might look. If we don’t get our hands around this one, there will be no need for a new structure. I will be posting blog updates from the AHDI meeting next week as I learn more.
What about you? Have you been impacted in your work setting by the electronic health record? Do you have physicians who are using it? What do you think our future might look like? I look forward to having some real discussion on this one!
Related posts:
- Medical Transcription and Meaningful Use
- Meaningful Use from a Patient’s Perspective
- Medical Transcription and the EHR: Doing it the Right Way
- Medical Transcription: Let’s Tell Our Stories!
- Medical Transcription: Time To Make a Difference
Tagged with: HITECH Act • meaningful use in medical transcription • medical transcription technology
Filed under: Challenges in Medical Transcription • HITECH Act
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A MAJOR part of why my position was no longer needed at the hospital where I used to work was because the ER went to a system of “circling things” and hand-writing some things (I thought legibility was one of the main reasons FOR going to dictated and transcribed notes) that were then run through a machine down in Medical Records that turned them into an electronic document that went into the patient chart. The ER notes had previously been about 70-80% of my transcription. THEN, for patients who were private pay or private insurance, a “mobile surgical center” was opened. Patients who were Medicare/Medicaid still had to have their surgeries performed at the hospital, and those reports were still transcribed by us at the hospital; but the bulk of the operative reports were now typed by transcriptionists at the surgical center. That further reduced the jobs to be typed in our department another 10-15% or so. At that time, there were 5 full-time and 1 “occasional” employee in the Transcription Department. Radiology also transcribed their own reports, so we didn’t have those either. Needless to say, I haven’t been back to the hospital to see how many of the other girls are no longer in transcription. (Because they are part of the union, if they are no longer needed for transcription, they fall into a seniority “within the union” and can kick someone else with less seniority out of their jobs to have a job at the hospital themselves. There was a lady who came into our department more about 7 months after I had been there, but she started at the HOSPITAL 1 month before I did, so when they made cuts by seniority, I was the one who was let go due to lack of work. I can see this “electronic medical record” thing going crazy within the industry and many “in-house” staff being let go. Along with that will mean that the dictation that we get coming into our homes over the internet (or by other means, if you get transcription via cassette or some other way) is going to drop to an all-time low because those patients’ records will also be point and click or draw a circle or fill in a form and then get turned into an electronic record. I’ve SEEN those pages, and the parts that doctors have to actually write on lines (that have horribly small spacing) are every bit as illegible to read as the prescriptions that they write out! It will be a disaster, but if it happens to us in a major way, I know that I won’t be able to hold out not having an income until the industry realizes that it made a mistake and needs their legible reports again!
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Kathy Reply:
July 27th, 2010 at 9:08 am
Sherry, thanks for sharing that experience. I think things are going to change, the challenge is that we don’t know how yet. What if MTs could tag documents just like they edit SRT? Quite some time ago, I was involved with a standards organization where they were talking about how to add data tags to transcribed reports. At the time, it seemed quite doable and I think this could be the same. What will have to be seen is who creates the system that eventually gets used and then people will have to have training on it. Structured data will do a lot in health care to be able to aggregate data and improve care. Ever feel like we are on a roller coaster?
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I look forward to reading your blog updates from the AHDI convention, Kathy. I do hope you find the time to do that. It is greatly appreciated by those who are unable to attend.
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I recently completed one of those “black out the box” patient health documents at an orthopedic clinic. Many of my answers needed further explanation, for which space there is none. In a medical record, even small comments that the doctor adds to the report clarifies a point that if left unsaid leaves the document incomplete. (When I was filling it out, I kept saying to myself, “yes, I have been treated for that but . . .” or yes, I take this but for . . . not for . . .” Very frustrating.) I believe wholeheartedly that coordination of medical records is essential, but the manner in which it is being instituted is extremely lacking. It is depersonalization. How can you depersonalize your medical information?!?
My biggest question is: With the Medical Transcription business being a HUGE industry, what do these million dollar companies say about the future of their businesses? Have “the powers that be” addressed the fact that change in this manner will put untold numbers of people out of work, and that an entire industry will suffer?
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Kathy Reply:
July 27th, 2010 at 2:44 pm
Cindy, I think that’s the part that’s missing. The narrative is what tells the patient’s story! I have one meeting set up for next week with one of the technology vendors to talk about how this all fits and what it could mean to MTs. I hope the associations (both AHDI and MTIA) will put some focus into really getting attention on this one. I imagine that will be a hot topic next week at the AHDI meeting.
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