Friday, July 31, 2009

The ROI on Speech Technology enabled EHR's


For a long time, big healthcare IT vendors have sold their EHR's citing that it reduces or eliminates transcription costs. What they don't tell you however, is the real cost of using their template-based documentation tool.

A study conducted by the AC group of 573 charts reported that entering data into the EHR took on an average 9 times longer than using dictation.

For a medium volume practice that would mean over $320 saved per day per physician using Speech-to-Text technology versus using Template based charting tool.

For a physician whose hourly wage is closer to $200 per hour, the true ROI is the time saved getting data inside EHR systems.

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Accelerating TRUE Adoption of EHR using Speech Technologies


According to a report published by AC Group (www.acgroup.org), there is a 73 percent failure rate of EMRs due to usability frustrations, noting that when clinicians lose the ability to dictate narrative notes and are forced to directly key data into an EMR, it takes significantly longer to document patient encounters.

In our previous blog posts we discussed the emergence of Speech To Data Technologies which extract Discrete Data Elements which are used to drive EHR's. Today, we would like to demonstrate how physicians can document encounters by using speech.

In the example below clinician enters vitals into the EHR using speech

When a clinician dictates:
"PE...vitals...one ninety eight...eight five and irregular...fifteen...one thirty one ninety eight"

This is what is sent to the EHR:
PHYSICAL EXAMINATION: VITAL SIGNS: Weight 198, pulse 85 and irregular, respiration 15, blood pressure is 131/98

This data can then be graphed inside Mrecord's Speech Driven EHR platform.

Speech-to-Text technology is accelerating the true adoption of EHR systems, allowing physicians to use the fastest, most convenient method of getting data inside an EHR.

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Thursday, July 30, 2009

How's Healthcare Working For You?

President Obama was in Raleigh yesterday and spoke about the current US Healthcare crisis. One of his comments that struck a cord with me was,
We have a system today that works well for the insurance industry, but it doesn't always work well for you!

You think. I'm glad that someone at the top is really being vocal on the issue.

Many health insurance companies today are for-profit. Don't get me wrong, I have no issues with companies making profits. My issue is how they do it.

When managed care come into play 25+ years ago, the main idea was to make healthcare more affordable. Great idea that got away from us. This helped the patient with lower out of pocket expenses. "See the doctor for only $10 a visit!" WOW! That's great. "No more huge deductibles!" Even better news. "Lower monthly premiums!" Will the good news ever stop! The only one getting hurt here was the doctor.

  1. His fees were cut - on the promise that joining the plan would bring more patients and the network would have a limited number of providers.
  2. More red tape and paperwork...all those tests now need to be pre-approved, referrals need to be obtained and if you didn't belong to all the plans (with all the different rules & requirements) you had angry patients that demanded you "join the network."
  3. More staff to handle all the phone calls, administrative work and learn all the nuances of each plan. More money spent for non-revenue generating work.
Jump ahead to today. We are paying more money for each doctors visit. Copays have increased, deductibles are back and, as an added bonus, we now have deal with co-insurances.

Doctors' patient load has increased, the patients are sicker because they only seek care when they can't get better on their own, their costs for doing business has increased, administrative costs have increased but, their reimbursements have decreased!

What? The doctors are making less, but we are paying more....so where is all the extra money going?

The answer is in the quote.

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Mrecord Speech-To-Text Platform gets a big upgrade

Over the past few months we have been hard at work, adding some big new features to our Speech-to-Text platform and we are almost ready to take the veil of it. This will be our single biggest upgrade till date. Here are some of the features that are planned as part of this release

Multiple levels of routing preferences
This was a big request from our MTSO customers. They wanted the ability to add DS to a provider pool but wanted to set multiple levels of preferences eg. Most Preferred, Preferred, Allowed, & Blocked. We listened and it is available now. Here is how it works

DS Brenda --> Most Preferred --> Dr. Joe
DS Cindi --> Preferred --> Dr. Joe
DS Jannie --> Allowed --> Dr. Joe
DS Sarah --> Blocked --> Dr. Joe

So if Brenda is logged in, she gets first dibs at it. Cindi would get Dr. Joe only if she is logged in and doesn't have something that is she most preferred DS for. Jannie on the other hand can only get Dr. Joe's work if neither Brenda nor Cindi are online (and dont have anything of higher preference available). Finally, Sarah would not be able to get any files for Dr. Joe at all.

Forecasting Report
Managing a MTSO work queue without forecasting reporting is a tasking assignment. Our newest forecasting report takes the guess work out of managing your work queue. It lets you know how many DS are logged in and based on their individual targets what your backlog would be. This allows managers to identify over-flow work and bring in additional teams to help.

Pay-for-Performance
Our new Pay-for-Performance module is going to be single largest driver of quality & tat improvement for your organization. Managers can set quality & productivity goals and set rewards (or penalties) against them. Poor performers are weeded out, high performers are rewarded & the ones in the middle are motivated to improve. Your clients will be very happy (read loyal) and your bottom-line is secure.



Pre-Typed Text Reporting
Perhaps the one feature with the single largest (and immediate) bottom-line impact is the new Pre-Typed Text Reporting module. Managers can now surgical separate "actual work" from "pre-typed text" and move their DS to a fair-pay mechanism. Expect large scale savings and very large positive impact on your bottom-line, allowing you to finally compete with the big-boys.

Auto-matching Document Specialist with Speakers/Authors
For a large MTSO (or even a medium-sized one) matching Authors with DS can be a very time-consuming task. With our new match.com style matching, you can easily, quickly & accurately pair your DS with Authors. Set as many matching criteria as you like and precisely build auto-assignment queues. You will wonder how you ever lived without this feature.


Global & Personal Dictionaries
We now offer Global & Personal Dictionaries. You now central host your global dictionary & auto-text words and your DS automatically sync with every time on log in. You can push new drugs, medical words by simply adding it to your Global dictionary. Likewise, DS can create their own personal dictionary and it is synced up with their online accounts. If they switch computers, their personal dictionary is automatically available on their new PC.



Global & Personal Auto-Text & Auto-Correct (auto-expander) Word Lists
Similar to dictionaries, Managers & DS can use global & personal auto-text & auto-correct word lists. They are auto-synced every time on login with the DS's PC.



Powerful Importing Tool
Here is another nifty new tool that we added to our platform, the ability to import lists directly into the system regardless of the source of the lists. As you can see in the screenshot along side, you can import appointment schedules & referring doctors lists exported from practically any HIS server out there.



Besides the above, there have been hundreds of small tweaks & bug fixes, with dramatic gains in performance & speed throughout the system. More information on release dates to follow soon or contact your sales representative or call us at 919 374 2484 extension sales.

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Tuesday, July 21, 2009

Creating Software that Polarizes Users

Years when Mrecord started as a company our focus was to build some great software that worked for its customers. Ever since our first product we have stuck to the same fundamentals and our users rewarded us with loyalty and fan following. Today we would like to share them with our readers
  • Make it really fast & accurate: Faster is better than slower and we understand that our customers time is too valuable to have them wait for our apps.
  • Make it easy to use without manuals: We know users don't like intrusive technology that is complex to learn & use. We keep our interface really easy & intuitive and we do that by using them ourselves every day.
  • Invent, Innovate, never duplicate: Since our inception we have kept our customers needs at the core of all our ideas. We have learnt from their experiences and have been bold enough to rethink the way we did things. Today more than ever we are driven by the spirit of innovation.
  • Deliver it through the cloud: We think buying & installing software is so 1900's (frankly we think its a rip off). Which is why all our software is delivered via the web. We embrace the everywhere, anywhere, everytime motto and build our products to do the same. We don't sell our software, you simply subscribe to use it. And if you find someone better you can take your data with you (we will help you do it).
  • Embrace Open Standards & Open Access: For too long now the healthcare industry has been held hostage by proprietary & closed source systems that locked their data away. We vow to change that forever. All Mrecord platforms are open standards with APIs so that you can extend functionality with your own custom apps & access and use your data anyway you like. That is our promise and that will never change.
  • Pursue Customers who buy into you, not the ones you love to have: We build software technology for customers who use & love our products, provide us with feedback and suggestions and are emotionally invested in our success. We tend not to build for that elusive sale we could have, we rather stay focused on what our current customers needs are. This has worked for Apple & Porsche, we believe it works for us.
  • Obsess Over Customers: This one we picked up from Jeff Bezos of Amazon.com. We obsess over our customers needs & requests. We keep our competitors in our peripheral vision but our customer is the focus of our obsession.
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A Decadent Waste

Until not too far back in the past organizations spent huge amount of money on providing email services to their users. This is generally how it stacked up
a) Buy Expensive Hardware to become Mail Servers & more equipment to provide redundancy & failover
b) Buy Expensive Mail Server Software (typically your Microsoft Exchange Server)
c) Then buy Microsoft Outlook license for every user
d) Hire Expensive IT staff to install, manage & run the above
e) Buy, Install & Manage Firewall Hardware to protect the servers, network & data
g) Buy, Install & Manage Spam Filtering Software h) Buy, Install & Manage Backup Solution
i) Setup Expensive Server Rooms to put all this equipment in
h) Lease Expensive Internet Connections from local ISP's
k) Buy, Install & Manage Expensive Software to push emails to mobile devices
l) and the list keeps on going...

To us this adds up to a decadent waste of resources & effort.

Today, you can setup (yes, you) email services for your entire organization for practically nothing without having to buy, install, manage anything (or anyone) in under 60 seconds. Yes, its called SaaS - Software As A Service. It is pertinent to note that almost all SaaS solutions are delivered via the web using a web browser.

Healthcare, though a late adopter of technology, can leap frog all of the above by simply moving to SaaS based healthcare IT. Plus, one of the major upside of SaaS for healthcare is that since it is delivered via the web it is available anywhere, anytime via any internet connected computer (mac, pc, linux or the much talked about chrome) or mobile device.

SaaS is largely built on open standards, & have embraced open access like traditional software never will. SaaS healthcare should be on the checklist on every healthcare manager looking to use the substantial push by the adminstration to adopt IT technology.
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What does OPEN mean to you?

Lately, we have been hearing from people tha they are confused by what OPEN means in the world of technology. So here is a little explanation of what OPEN really is.

  • open source: a program whose source code is made available for use or modification as users or other developers see fit. If an EHR goes open source, then the creators share it with others who then copy the original code and UI design, improve it, put their improvements back into the pool and share some more. Eventually, most open source EHR's projects turn into commercial open source product as the project matures.
  • open standards: relying on rules that are widely used, consensus based, published and maintained by recognized industry standards organizations. These organizations decide the standards that you should follow (even if you didn't have enough say on it) so that everyone drives on the same side of the road. HTML, Bluetooth, and hundreds of other technologies are possible today because of open standards.
  • open access: developers of open access programs publish APIs (application programming interfaces) that make it easy for you to get to the data on your platform. Mrecord's EHR, Google maps, Twitter are all great examples.
  • open infrastructure: Amazon's cloud is an example of this. Amazon builds the pipes and allow people to rent them to build their own systems on. No servers to buy or run.
  • open architecture: A system (hardware or software) where people can learn how it works and then build things to plug in to extend it. The IBM PC had an open architecture, which meant that people could build sound cards or other devices to plug in (without asking IBM's permission).
So now you have it, all that OPEN means today. When you evaluate your next technology provider be sure to ask -- "How OPEN are you?"

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Friday, July 17, 2009

Is "Discrete Reportable Data Elements" The New CPOE?


CPOE (Computerized Physician Order Entry) is what drives traditional EHR systems wherein Clinicians work in front of the computer and using a keyboard enter data into a computer. There have been wide spread reports of push-back from physicians of this approach. Instead clinicians have liked the portability of dictation devices & the ability to narrate their patient encounters. But traditional transcription has its own drawbacks. Critical Data Elements were trapped in these rich documents but there were limited ways to extract and extrapolate them.

Enter "Discrete Reportable Data Elements"

Mrecord's cutting edge Speech-to-Text technology now allows clinicians to use dictation to capture their encounters and transform it into RICH DATA -- data that can drive EHR without having to use traditional CPOE.

What we are seeing now is the paradigm shift from using traditional keyboard based data entry to perhaps the most natural of human communications. Today you can use speech to give commands to your car, speed dial your phones and do web searches. Isnt it about time our clinicians are offered the same technology to drive their EHR instead of strapping them to a keyboard.


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Thursday, July 16, 2009

Meaningful Use Gets Initial OK and what it means to Speech-To-Text providers

The federal HIT Policy Committee has approved revised recommendations of a workgroup for an initial definition of "meaningful use" of electronic health records systems.

For the new recommendations, the work group revised objectives for EHRs to meet by certain deadlines. The revised 2011 criteria calls for qualified health care providers to:
  • Allow patients to access their health records in a timely manner;
  • Develop capabilities to exchange health information where possible;
  • Implement at least one clinical decision support rule for a specialty or clinical priority;
  • Provide patients with electronic copies of discharge instructions and procedures;
  • Submit insurance claims electronically; and
  • Verify insurance eligibility electronically when possible.
  • The group also called for health care providers to allow all patients to access personal health records by 2013, two years earlier than under the initial recommendations.
  • However, what is particularly important to Speech-to-Text providers is the section about CPOE.
    Computerized Physician Order Entry
    The work group also clarified criteria related to computerized physician order entry systems. The new recommendations call for health care providers to use CPOE systems for 10% of all orders of any type. However, the work group did not offer guidance on whether the 10% requirement would apply to each individual order type or all orders in total.
    Speech-to-Text providers should take serious note of this. This mandates that physicians have to manually enter orders into their EHR and force physicians to switch from using speech to narrate the order.

    Speech-to-Text providers should look to accelerate their Discrete Data Reporting capabilities if they are to help their customers meet this criteria of meaningful use. Mrecord has pioneered the technology behind TRUE Speech-to-Data and continues to build leadership in the space. Mrecord Speech-Driven EHR embraces the concept of taking "orders" via speech instead of cumbersome CPOE.

    Isnt it time they reinvent CPOE?

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    Friday, July 10, 2009

    Narrating Your Notes -- Dos and Don'ts

    In listening to more and more narrated notes, I have discovered that there are so many factors that can impair your scribe from being able to do a good job. So I thought that I would write about the Dos and Don’ts of narrating your notes.

    Doctors' poor handwriting is a well-recognized source of medical errors, but their sometimes sloppy speech habits are a less well-known contributor. A study based on a sample of 220 dictated medical records totaling 9,726 lines of transcription found 27% of the 96 more-serious flaws were attributed to the speaker, typically a physician, and not the scribe. Twenty of 38 critical flaws (53%) and six of 58 major flaws (10%) were traced to the speaker.
    Critical flaws include patient misidentification, medical word misuse and omitted dictation. Major flaws include misspellings and inappropriate blanks. Minor flaws include punctuation, grammar and formatting errors. [1]
    • Do speak clearly into the recorder or the phone. Hold the recorder or the phone about 3-4 inches from your mouth. If it is too close, the sound is not good at all and if it is too far way, then you may not be heard.
    • Do not eat, chew gum or drink while you are dictating. Sometimes these noises can be louder than you may think and the noise is amplified when you are wearing headphones typing a report.
    • Do spell out unusual places or names. This includes new medications, other Doctors names, patient names, etc.
    • Do not use punctuation. The medical transcription is trained in utilizing correct punctuation, grammar and spelling
    • Do dictate in a quiet place. Too much noise in the background is distracting and can cause blanks in a dictation.
    • Do your dictations when you're supposed to do them, and keep records of which ones you've done. It shows where to start looking for things if a dictation goes missing. Also, don't wait for six months to tell the MTs or nurse about mistakes.
    • It takes longer than 10 minutes to type a 30-minute dictation. It can take around two hours to type a 30-minute dictation. It takes longer for less experienced MTs or highly technical material. Giving the MTs 10 minutes to type a 30-minute dictation will get you disliked.
    • Only label dictations as stat if they really are stat. A transfer for cardiac surgery is stat; the provider wanting to go on vacation is not stat.
    [1] Medlaw.com


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    Mom Always Said to Share, but Is This Too Far?

    How often were you reminded to share when you were younger? Toys, games, snacks, drinks - we all remember this. However, I recently read an article where sharing has taken to a whole new level. Shared medical appointments or SMA's.

    According to an article in the AARP bulletin, there is a group of cardiologists in Massachusetts providing this new type of health care service. Further research on the web located many practices throughout the country that offer this type of appointment as well. Up to 15 patients can schedule a 90 minute appointment with the physician. Questions are addressed with the entire group and the physician can interact privately with individuals if and when needed. Ok, so when was the last time you spent 90 minutes with your physician? Exactly! Patients receive face to face health care in a group setting, which enables them to learn from each other and gain a greater understanding of their own medical conditions. During SMAs, patients benefit from listening to each other's questions while experiencing the support of a group environment. Patients can easily identify with each other because they are all dealing with the same issues.

    SMAs may sound like a new-age idea, but in fact the approach integrates tried-and-true methods. Patients learn from and are inspired by others in the group.

    SMA's are not for all conditions or every circumstance, but there are definitely benefits to this type of open group discussion. With the decline in primary care physicians and the aging population, this just might be a trend for the future.

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    The Importance Of Measurability of Collaboration

    As management consultant Peter Drucker once said: “If you can’t measure it, you can’t manage it.”

    There is a lot of talk surrounding "Meaningful Use" and in our blogs we have raised different view points regarding it. We feel it is time to introduce another dimension to the discussion -- Measurability.

    We feel that Measurability of Health Metrics are the key to achieving "Meaningful Use" and to fulfill the National Goals of Improving quality, safety and efficiency, Engaging patients in their care, Increasing coordination of care, Improving the health status of the population & Ensuring privacy and security.

    However, there is no current measurability requirements for collaboration in the current committee draft recommendations. Most EHR's implement "messaging" as a way to collaborate within the clinical setting. Ironically, tasks are easily lost, buried under an avalanche of messages with zero to little visibility. To achieve the national goals defined by the committee it is important to introduce metrics & measurability in the key area of clinical collaboration.

    Efficient & Measurable collaboration will be the largest component to drive continuity of care and is the key to reduce long term cost of healthcare in the nation. Yet there is no leadership in this key area of healthcare process improvement.

    At Mrecord our approach has been about clinical collaboration which is measurable & visible. Our collaborative EHR ensures that tasks assigned to different groups or individuals are tracked, & their outcomes are measurable. As a physician you have the peace of mind that your instructions have been followed through. As an administrator you can easily identify bottlenecks and inefficiencies in the system thereby reducing costs.

    Isnt it time collaboration within a medical office became measurable?


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    Thursday, July 02, 2009

    The Road from Medical transcription to Speech-To-Text - How The Times Have Changed

    It used to be that the doctor would see the patient and then dictate the visit into a recorder. The tape would then go to the transcriptionist sitting in an office. They would place the tape into a player and would type out the report. The report would then be placed in the doctor’s “in box.”

    Times have changed. With today’s technology, the doctor can dictate anywhere, in the car, on the beach, late at night when they can not sleep. With our Speech-to-Text platform, the doctor dictates the report on the digital recorder, turns the computer on, plugs the recorder into the USB cable and the reports are automatically uploaded to Mrecord servers. The reports are automatically voice recognized, reviewed and audited and then uploaded back to the provider within 24 hours. The doctor (or whoever they may designate) can review the reports, make any necessary changes, lock the report and the doctor’s e-signature will append to the report. If you utilize an electronic medical record (EMR), we also have the capability to import the dictation into your EMR. Give us a call for a 2 week trial.



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    More Access to CCHIT!

    Have you heard the news? CCHIT is reviewing additional certification options for EMR's! If you've looked at the current CCHIT certification requirements - it's a daunting task. Fifty-three pages of daunting, to be exact. After working in and managing practices in the past, I welcome most of their requirements. It's all the technical, behind the scenes, stuff you never see that I don't get. Not to worry, I have the best technical staff anyone could ever want. They have been pounding out countless hours to meet these 53 pages of challenge. However, not all EMR's are created or developed equal and CCHIT is reviewing certification options for these groups.

    One type of EMR group concentrates their efforts on the charting, prescribing and tasking portions. These EMR's integrate with other PM products allowing physicians to keep their current PM system. CCHIT is now looking at certification that would be specific to this type of carved out product.

    Another EMR type is practice specific - Practices that are in the process of developing their own EMR that will meet their specific needs. These groups will also have the opportunity to receive certification for their creation. Why is this important? If certified, these practices will now become eligible for stimulus funds available through the American Reinvestment & Recovery Act/HITECH Act.

    Here's an excerpt from CCHIT on June 8, 2009 that highlights the recommendations from the certification committee:
    • A rigorous certification for comprehensive EHR systems that significantly exceed minimum Federal standards requirements. This certification (EHR-C) would be targeted to the needs of providers who want maximal assurance of EHR capabilities and compliance

    • A new, modular certification program for electronic prescribing, personal health records, registries, and other technologies. Focusing on basic compliance with Federal standards and security, the EHR-M program would be offered at lower cost, and could accommodate a wide variety of specialties, settings, and technologies. It would appeal to providers who prefer to combine technologies from multiple certified sources.

    • A simplified, low cost site-level certification. This program would enable providers who self-develop or assemble EHRs from non certified sources to also qualify for the ARRA incentives.

    There are many options in the types of EMR's available. By offering certifications to a variety of EMR products, CCHIT is opening the door for more practices to take advantage of available funds. This then allows the important quick sharing of patient information - especially when it may be needed the most.