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EHR Benefit – Eliminate Staff

Posted on April 30, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s time for the next installment in my series of posts looking at the long list of EHR benefits.

Eliminate Staff
The idea of eliminating staff is a really hard one to talk about. Often the staff in a medical office becomes a family and so it’s really hard to think about losing a staff member in order to pay for the EMR. In fact, it’s incredibly common for staff in a clinic to fear an EMR implementation because they’re afraid that their job is in jeopardy.

From my experience, it’s incredibly rare for any existing staff to lose their job during an EMR implementation.

There are two main reasons why it’s unlikely that someone will lose their job because of an EMR implementation. The first is that most healthcare organizations have a natural employee attrition. When this happens the organization can just choose to not replace the departing employee. This is one way to save money on staff without having to actually fire any employees.

The second reason that people don’t lose their job to the EMR is that those people get reassigned to new jobs. For some people this can be nearly as bad as losing a job, but for many it’s basically a shift in job responsibilities. This shift can often be welcome since the EMR implementation can free them up to do work that they always wanted to do and never were able to do before.

The areas of healthcare that I’ve seen most affected by an EMR implementation is medical records, transcription, billing, and the front desk. We’ve already written previously about transcription and EMR. The front desk and billing can be affected, but generally stays close to the same from what I’ve seen. A lot of this depends a lot on what type of staffing you had before the EMR. I have seen some organizations implement an EMR and save money on front desk and billing staff.

Medical records (or HIM if you prefer) is usually the most impacted. Certainly they still have an important place in the office for things like release of records and other records management functions. They also have to continue to deal with the legacy paper charts. However, their days of finding, organizing and filing charts are over when an EMR is put in place. In some cases the chart organizing and finding gets replaced with things like scanning into the EMR. In other cases, there isn’t as many medical records staff needed.

Many who are reading this post are probably balking at the idea of eliminating staff being a benefit of an EMR implementation. They’d no doubt point to the EHR backlash that we see from many doctors who complain that an EMR makes them much slower and takes up too much time. This is an important item to consider when evaluating the benefits of an EMR in your organization. It’s not much of a benefit to save other staff cost if the doctor spends twice as much time per patient.

However, on the other side of the coin is those doctors who swear by the efficiency their EMR provides them. I’ll never forget this older OB/GYN I met who told me he would NEVER use an EMR. Two years later that same OB/GYN was proclaiming his love of EMR. He described how he wouldn’t be able to see nearly as many patients as he did each day without the EMR. He acknowledged the slow down that occurred when they first implemented the EMR, but once they adapted to the EMR workflow they were able to see most patients.

No doubt Eliminating Staff can be a mixed EMR benefit basket depending on your unique situation. Although, this is true with almost every EMR benefit we’ll cover in this series. This can be a tremendous benefit of EMR or it can also be an expense as you find you need to hire more staff.

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Need Point of Care EMR Documentation to Meet Future EMR Documentation Requirements

Posted on April 12, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As part of my ongoing writing about what people are starting to call the EHR Backlash, I started to think about the shifting tides of EMR documentation. One of the strongest parts of the EHR backlash from doctors surrounds the convoluted documentation that an EMR creates. There is no end to the doctors who are tired of getting a stack of EMR documentation where 2 lines in the middle mean anything to them.

Related to this is the physician backlash to “having to do SOOOO many clicks.” (emphasis theirs) I still love the analogy of EHR clicks compared to playing a piano, but unfortunately EHR vendors haven’t done a good job solving the two things described in that article: fast predictable response and training.

With so many doctors dissatisfied with all the clicking, I predict we’re going to see a shift of documentation requirements that are going to need a full keyboard as many doctors do away with the point and click craziness that makes up many doctors lives. Sure, transcription and voice recognition can play a role for many doctors and scribes or similar documentation methods will have their place, but I don’t see them taking over the documentation. The next generation of doctors type quickly and won’t have any problem typing their notes just like I don’t have any issue typing this blog post.

As I think about the need for the keyboard, it makes me think about the various point of care computing options out there. I really don’t see a virtual keyboard on a tablet ever becoming a regular typing instrument. At CES I saw a projected keyboard screen that was pretty cool, but still had a lot of development to go. This makes sense why the COWs that I saw demoed at HIMSS are so popular and likely will be for a long time to come.

Even if you subscribe to the scribe or other data input method, I still think most of that documentation is going to need to be available at the point of care. I’ve seen first hand the difference of having a full keyboard documentation tool in the room with you versus charting in some other location. There’s just so much efficiency lost when you’re not able to document in the EMR at the point of care.

I expect that as EMR documentation options change, the need to have EMR documentation at the point of care is going to become even more important.

EHR Benefit – Transcription Costs Savings

Posted on January 18, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s time for the next installment in my series of posts looking at the long list of EHR benefits.

Transcription Costs Savings
When I first writing about EMR (yes, it was only called EMR at the time), this was probably the biggest reason that doctors gave for implementing an EMR in their office. Doctors looked at their transcription costs and saw EMR as a great way to replace those transcription costs. Or at least the doctors could use the transcription cost savings to pay for the EMR.

This has proven true for many doctors and no doubt was the financial mechanism that many practices used to go electronic. In fact, I always wondered if the transcription world was on a final death march thanks to EMR. My view of transcription has greatly evolved over the years. In fact, I think we’re seeing a resurgence of transcription in healthcare.

The reason for the renewed interest in transcription is because a large number of providers that start using EHR are tired and overwhelmed by the “number of clicks” that are required by an EHR. When a doctor reaches this point, there immediate reaction is “EMR is so much slower than transcription” or the related “I miss my transcription.”

I always found EMRs that facilitated transcription a little odd, but considering the above trend they might be well positioned to capitalize on those doctors who want to use transcription with their EHR. Plus, the transcription industry is shifting as well. They’re moving quickly away from just being simple transcriptionists to embracing coding and other ways to assist in the clinical documentation process. Considering the complexity of ICD-10, this might be an interesting opportunity.

What does seem clear is that doctors will be more and more interested in ways to streamline the EMR documentation process. I won’t be surprised if many doctors choose transcription as a way to accomplish this goal. Although, I’m not sure this will be the case with new doctors. Transcription has its own learning curve and I don’t see many new doctors who don’t have transcription experience going that direction.

In the end, it’s hard to really say whether transcription cost savings is an EHR benefit. In many cases it could be. Certainly the shrinking transcription industry would agree that many doctors are saving money on their transcription costs. Although, it depends on the clinic and whether they cut out their transcription when they implement their EHR. While we might see some return to transcription, I expect that long term the transcription industry will need to evolve or die as most next generation doctors won’t even consider the idea of transcription.

Dragon Medical Enabled EHR – Chart Talk

Posted on July 12, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently was asked by Deanna from Mighty Oak to check out a demo of their Chart Talk EHR software (previously called DC talk). It’s always a challenge for me since there are only so many hours in a day to be demoing the more than 300 EHR companies out there. So, instead of doing a full demo, I asked Deanna to highlight a feature of Chart Talk that set them apart from other EHR software companies.

She told me that Chart Talk’s killer feature was its integration with Dragon Naturally Speaking’s voice recognition software. I was very familiar with DNS and other voice recognition software, so I was interested to see if they really could create a deep integration of Dragon Medical over the other EHR software I’d seen that integrated it as well.

I have to admit that I was pretty impressed by the demo. It was really quite amazing the number of things that you could do with your voice in the Chart Talk EHR software. Certainly standard transcription like documentation worked out well in Chart Talk. However, the impressive part was how you could navigate the EHR with your voice. Here’s a demo video that does a decent job illustrating it:

What made the documentation even more interesting (and is partially shown in the above video) is the use of various DNS macros and the even more powerful built in macros for pulling in vital signs, past history, etc. Plus, I like the idea that when you have any issues with Dragon Medical, you don’t get someone at your EHR company who doesn’t really know much about Dragon. Since Chart Talk’s completely focused on Dragon integration, you know they know how to support it properly.

I of course only saw a partial demo of the Chart Talk software. So, I’m only commenting on the Dragon Medical integration in this post. It would take a much longer and more in depth evaluation to know about the other features and challenges to the software.

Plus, there’s no doubt that voice recognition isn’t for everyone. They tell me that some people do the charting with their voice right in front of the patient. That feels awkward to me, but I guess it works for some people. Then, there’s the people who don’t want to go through the learning curve of voice recognition. However, I’d guess that Chart Talk could make a case for being some of the best at teaching people to overcome that learning curve since every one of their users uses it.

I also know that Chart Talk originally started as DC talk. So, anyone considering Chart Talk should likely take a good look at how well the software fits with their specialty. I know the people at Mighty Oak have been making a big effort to work for any specialty. However, like every EHR software out there, they just work better for some specialties better than others.

It’s also worth noting that Chart Talk is a client server EHR. I guess the web browser isn’t quite ready for the processing power that’s required to have a nice voice enabled user experience.

Needless to say I was impressed by the voice recognition integration and how pretty much every command can be performed using your voice. I’d be interested to know of other EHR companies that are striving for that type of deep integration. I’m not just talking about being able to basically dictate into a text field. I’m talking about actual navigating the EMR with your voice.

Doctors’ Training vs. Transcriptionists’ Training

Posted on April 12, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This will be a bit simplified, but I think you’ll get the idea. If you consider a doctor’s training. Doctors are trained in an incredible volume of information and then how to use that information along with a lot of other variables to be able to evaluate patients conditions, provide care and at the end of the day solve problems.

On the other hand, transcriptionists are trained to do repetitive tasks very well with high accuracy. Certainly they have to have some skills with the medical terminology. Also, many have moved beyond transcription into helping with the clinical documentation and ensuring that it’s documented properly.

None of this should be news to anyone. Now for the big finish…

Which training is more suited for someone doing a million clicks on an EMR?

Is it any wonder that scribes and other creative models for documenting a patient visit in an EMR are becoming an important part of the discussion? Watch for many more creative models using people to come out in the next year.

Medical Transcription Becomes Clinical Documentation

Posted on February 21, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Neil already broke the news a few weeks ago that the MTIA (Medical Transcription Industry Association) changed its name to the CDIA (Clinical Documentation Industry Association). I was able to attend the press event that they held to officially announce the change.

I’m sure that many might not think this is such a big deal. Ok, the name change isn’t that big of a deal. However, I’d say that this part of the movement that I’ve been talking about for quite a while. Basically the survival of transcription for the forseeable future.

I don’t think I talked to any transcription companies at the event that weren’t working on some sort of EMR tied to transcription strategy (MD-IT, FutureNet, and MxSecure to just name a few). In many cases they’re doing their very own EMR offering.

I do think that the small transcription provider is likely in trouble. However, I won’t be surprised if transcription companies become successful EMR companies.

There’s still quite a few question marks with this strategy. For example, how well can a transcription company that’s use to working with people transition to making software?

The good thing is that these transcription companies already have relationships with a lot of doctors who want an EMR that somehow still uses transcription. I talked with one transcription company that offers an EMR and they had an interesting way of using transcription and voice recognition to transition them to EMR while helping them to learn to get use to doing the voice recognition. Very interesting approach.

Maybe transcription isn’t the long term solution. However, I wouldn’t count out the transcription companies just yet.

EMRandHIPAA.com’s HIMSS11 coverage is sponsored by Practice Fusion, provider of the free, web-based Electronic Medical Records (EMR) system used by over 70,000 healthcare providers in the US.

Voice Recognition Set to Grow in Healthcare

Posted on February 17, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In a recent Healthcare IT News article, they wrote about a KLAS research study that found that the speech recognition market is ready to grow. Here’s a small portion of the article:

Providers report a demonstrable return on their speech recognition dollars, according to a new report from KLAS. Participants of the study indicated benefits of speech recognition such as staff reductions, improved report turnaround times and increased physician satisfaction.

“The speech recognition market is ripe for healthy growth,” said Ben Brown, author of the report. “Currently, less than one in four hospitals use the technology, however, in light of meaningful use and the benefits providers point out in this study, we expect it will assume a more prominent place in the role of clinical documentation.”

It seems like a bit of journalistic spin to say that speech recognition provides a “demonstrable return.” My personal experience tells me that users either love or hate speech recognition. The article does aptly state that it requires some up front investment to learn voice recognition and access the long term benefits that voice recognition provides.

The other obvious part of the report is that Dragon still dominates the voice recognition landscape. I recently also got an email from Eric Fishman of EMR Consultant, EHR Scope, EHR TV, etc fame (and also an advertiser on this site) about a new voice recognition, dictation and transcription software they’re distributing called Frisbee.

They have a bunch of videos showing Frisbee transcription software in action on EHR TV. I found the one called Frisbee, Dragon Medical and EMR Workflow pretty interesting.

I could see this type of software providing the platform for the future of the transcriptionist. Neil Versel recently posted the news that the Medical Transcription Industry Association (MTIA) will be changing their name to the Clinical Documentation Industry Association. No doubt transcription companies are looking at ways to survive. One of those ways will be for the transcriptionist to go beyond just transcribing to assisting with the clinical documentation (including the complicated ICD-10). Seems like Frisbee’s voice recognition into the EMR with the Frisbee routing capabilities for doctors approval and sign off could be an interesting workflow.

I’m not quite as bullish on voice recognition as the report linked above, but there’s no doubt that voice recognition will continue to play a role in healthcare. Especially as it continues to improve its recognition ability and becomes integrated with mobile devices.

New Online Market Place for EMR Transcription Services

Posted on November 17, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Having this blog has given me the opportunity to talk with a number of different transcription companies over the years. I think one thing has become pretty clear. The face of transcription is certainly changing quickly, but the need for transcription is still going to be there for a long while to come. Although, it won’t be the same process of transcription as we know today. Transcription and EMR will start to come together more and more.

Many of us (including myself) were quick to use transcription cost savings as a way to justify the purchase of an EMR. What I think we’ve seen over the 5 or so years I’ve been writing about EMR is that transcription can still be a fantastic compliment to an EMR system. EMR cost justification will often have to come from some of the other EMR benefits.

With that as background, I was quite interested in a company called myMonolog that I met at the Mobile Health Expo. They’re creating an online marketplace for finding and utilizing a transcription service. I’ll admit that I’m not an expert in transcription, but I like the idea that you have a marketplace of transcription providers to choose from and you can see the ratings and reviews from other people who have used that transcription service. I also like that they have an app for Smart Phones to be able to record, send and view the transcriptions.

I’d still like to see them do some deep integrations between their system and EMR vendors, but I think it’s an interesting idea to create a marketplace for transcription services. Plus, if you choose to change transcription service providers, you can still use the same interface with a new provider. Or if your transcription company gets behind, you can just hire another transcription provider to catch you up.

myMonolog has offered Physicians, Nurses or administrators that read this site a 1 week free trial of transcription services if you use the promotion code: “emrandhipaa” when registering. If you need transcription services, try it out and let me know what you think of the service.

“I use EMR and so I am MY OWN transcriptionist.” – Doc at AAFP

Posted on September 30, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’m currently in Denver attending the AAFP conference. So far I’m really glad that I’ve come to the conference. It’s really fantastic to be surrounded by providers. It’s a stark contrast to HIMSS where you’re mostly surrounded by industry insiders and not that many providers. The practical questions the doctors ask are fascinating.

Of course, the comments they make are also fascinating. The title of this post is a comment one lady made in the David Kibbe session on Meaningful Use:
“I use EMR and so I am MY OWN transcriptionist.”

The problem with this comment is that it just doesn’t have to be true. It could be true depending on which EMR software you selected and how you implemented the EMR. However, that’s a choice you make when you choose and implement an EMR without any transcription.

I’ve actually seen a number of EMR vendors that have some really nice and deep integration between their software and transcription companies. There are even transcription companies that are building their own EMR software which obviously leverages the power of transcription.

Plus, many doctors happily use voice recognition like Dragon Naturally Speaking to still do what essentially amounts to transcription with their EMR.

Add in developments around natural language processing and the idea of preserving the narrative that is so valuable and interesting while capturing the granular data elements is a really interesting area of EMR development.

Of course, one of the problems with this idea is that many people like to use the savings on transcription costs as a way to justify the cost of purchasing and implementing an EMR. Obviously, you’ll need to look for other EMR benefits if you choose to continue transcription.

Just to round out the conversation, there are a wide variety of EMR vendors which each have their own unique style of documentation. Part of the problem is that many people don’t look much past the big “Jabba the Hutt” EMR vendors which are these ugly click interfaces that spit out a huge chunk of text that nobody wants to see. There’s plenty of EMR vendor options out there. Keep looking if you don’t like an EMR vendor’s documentation method.

Transcriptionists Becoming Medical Documentation Specialists

Posted on May 26, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

There’s lots of really interesting transformations happening in the transcription industry (as I’ve written about before). One of those that I haven’t seen many people talking about is the transition of Transcriptionists becoming Medical Documentation Specialists.

It kind of makes sense that transcriptionists could assist doctors in doing all the granular medical documentation. Certainly the doctor will still be the center of the documentation and they’ll be the source of all the documentation. However, I can quickly see the transcriptionists job continuing to move away from the straight transcribing of voice to text and more and more into the medical documentation arena. This trend had been happening for a while, but I can really see this accelerating as transcriptionists try to find their way in an EMR world.