Towards a smooth Electronic Health Records system implementation

August 15, 2008 – 5:16 pm

Laying the foundations for an EHR system implementation at your Medical Practice – The sum of parts approach

Electronic health records (EHRs) are regarded as the technology through which the quality of healthcare could be improved. In due course it is very likely that Electronic health records (EHRs) will become the primary means of clinical documentation for medical practices, thus positively influencing the efficiencies of the organization at the provider and practice levels. However, not all organizations are prepared for the scope and scale of a full EHR implementation.

Let us try to chart out a way that could lay the foundation required for a smooth electronic health records implementation at an individual practice or enterprise; a step by step process that will make the transition easier and dull the impact that the challenges of workflow changes and capital expenditure will throw up, without the required preparation.
Creating and storing your data in a way compatible with EHRs using a scalable system that reduces physician workflow changes and minimizes capital expenditures is the first step on your way to a smooth transition. For example, taking steps like saving transcribed reports in an EHR-friendly way or implementing an electronic central database for viewing of data will prepare the Medical Practice for the inevitable EHR system while also allowing the Practice to meet their current needs better.
This incremental, ’sum of parts is greater than the whole’ approach to an EHR implementation could make all the difference!

Preparing for the EHR system while improving efficiencies immediately could lead you to a variety of strategies under various workflow heads. Let us look at an example that uses three main workflow heads as focal points on the way to a cumulative approach to EHR implementation:

1. Transcription
For Medical Practices that currently use transcription for clinical documentation, we’d recommend specific, easy-to-use formatting of transcribed reports which could be downloaded into the EHR when the practice is ready to make the move. The two levels to this strategy that should be addressed by your foundation system are:

- Simple formatting that allows for basic identification of both patient and provider. The formatting involves placing markers within the transcription that will allow the EHR system to identify the patient and download, say the progress note into the appropriate chart when the EHR is implemented. For practices that already store their transcription electronically in a well-defined format, it is possible to automate the process of the insertion of these markers.
- Making changes that will allow for more information to enter a patient’s chart. It involves the insertion of additional markers or dot codes within the body of the transcribed text that will allow the EHR system to extract specific information such as allergies, problems, medications, diagnoses and lab information, and place them into the appropriate sections of the chart. This step of your strategy will involve some changes for your physician (in terms of their dictation method) and her transcriptionists. As a Practice Manager this might involve a co-ordinated training effort to make sure this step lands right.
Storing transcription in an EHR-friendly way allows a Medical Practice to establish the basis of a complete electronic health record with only minor alterations in workflow, albeit with a cumulative effect. When the EHR system is ready to go live, the stored information can be accessed by the EHR, and the practice can transition much faster with a significant amount of medical data already in place.
Building efficiencies on the Transcription focal point minimizes capital expenditure as a Medical Practice begins building its EHR.

2. Medication Management & Prescription Writing
The next step of our cumulative strategy is a partial implementation of the EHR system, focussed on a specific, commonly performed activity.
Prescription writing and Medication Management is a great focal point to work around on a partial implementation. The benefits will include:

- Legibility of prescription will stop being a bottleneck to efficiencies
- Inter-drug and drug-allergy checking before prescriptions
- Automatic updation of the medication lists
- Drugs can be automatically renewed from the medication list
- Routine information, including correct spelling, instructions, dosage and administration route are all accurately recorded on the prescription using Templates

Using a cumulative approach, the Medical Practice would only implement the prescription module, thus staggering capital expenditure. Additionally, the workflow changes at the provider and practice levels are limited to the task of electronic prescription writing.

3. Repository or Centralized Electronic Database
Physicians, nurses, billing clerks and a variety of other people within a Medical Practice require access to a patient information. Information stored on paper charts is a bottleneck that takes time and effort to ease, thus affecting the efficiencies of the Medical Practice. An EHR system can eliminate the problem of on-demand patient information by providing immediate and simultaneous access to patient information while keeping that information secure through authorizations.
Practices currently using transcription can push Transcribed reports into a “view only” version of the EHR system, meaning that providers and other authorized personnel primarily use the EHR as a central database of data. The implementation would involve establishing a local network with authorized database access to the EHR, serving those who require access to patient data.
The benefit is efficiencies.
Online access to transcribed data from any EHR-enabled computer, will result in higher efficiency thanks to on-demand patient information. This benefit also extends to offsite use, as providers can be enabled to login and view required data. Because of the ability of the EHR system to extract data from the transcribed reports and charts, this partial implementation will not only provide a means to view historical patient data but will also build problem,allergy and medication lists and other chart categories from the information in the cental database or Repository.

As with the partial implementation of Medical Management and Prescription writing, the capital expenditure for software, services, and hardware is staggered and thus lower, since it represents an cumulative rather than a full mplementation.

This cumulative approach is ideal for Medical Practices that are not prepared to take a plunge into a full transition to EHR for reasons of capital, organizational readiness or the immediate needs of the organization. While not an alternative to a full EHR implementation, this sum of parts approach is a way for your Medical Practice to take immediate action on the way to a full scale EHR implementation.

Announcement : Gift Free Medical Transcription Services

April 4, 2008 – 12:23 pm

We are happy to announce an i-Script initiative that allows i-Script clients to gift One Week of Free Medical Transcription services to their friends, colleagues and professional contacts. On signing up with us your friends can use our service absolutely free for a week. If they are satisfied with our services and choose to stay with us for a duration of 60 days or more, you stand to receive a check for $ 75, as an i-Script referer.
You can navigate to the Gift Card form by clicking on the ‘Refer a Friend’ button on our home page or clicking on the link below.

Refer a Friend

Please feel free to send as many gift cards as you wish to your friends! Happy gifting!

Thoughts on the future of Health Information and Patient records

April 4, 2008 – 12:17 pm

Over the last decade, the evolution towards the electronic patient record shows that, over time, documentation habits change either through regulations and standards or through user/client preferences. This is a slow but sure process, that we see in action today, even with all the challenges that face standardization and implementation of regulations.

Until a decade back, there were few regulations and standards that MTs and their employers had to meet. However, Patient and Practitioner concerns over privacy and data security in our age of Information Technology soon led to the Health Insurance Portability and Accountability Act (HIPAA).
Several observers felt that HIPAA would not have an effect on the medical transcription industry, due to the sheer magnitude of adherence to process and focus on data security and integrity that is required for the implementation of HIPAA industry-wide. Some Transcription Service Providers were concerned a few years back that the majority of the transcription industry would not be able to meet several specific HIPAA requirements: policies and procedures, access controls and audits of access to patient information.
All this is has slowly changed with employers beginning to demand HIPAA compliance and in many instances changing employees, vendors and contractors when they don’t get it.

The demands to enhance patient safety and increase efficiency while reducing costs for users, will ensure that it becomes mandatory for service providers and healthcare practices to migrate to a HIPAA compliant environment.

The buck doesn’t stop there though. The evolution and change will continue. The best people in the business will identify, promote and grow new technologies in health information management in order to build their business through creating value for their clients. Some have adopted technologies such as application service provider (ASP) services or have developed web applications in-house, to move away from less convenient methods like FTP to provide access and archiving of Medical Documents to their clients. We are happy to note here that i-Script has provided its own Document Delivery web application, Scriptase© to its clients for some years now, free of cost.

Newer delivery/sharing methods and technologies that focus on Health Information Management will soon come into play. (Watch out for i-Script’s own Health Information Management initiative, Scriptase Exchange©, in the coming months)

That isn’t all; maybe the future will bring medical coding embedded within documentation, thus saving cost. Its going to be fun!

We will continue to explore and report trends in Health Information and Patient records connected to MT analyzing associated client benefits. Watch this space.

Welcome to the i-Script Corporate Blog

March 7, 2008 – 12:03 pm

A new year, a new website, a new blog; and a higher commitment to provide best-of-business solutions in Medical Transcription! We officially welcome everyone to the i-Script corporate blog.

We will cover topics ranging from latest technologies and industry trends, to unique i-Script business practices that we hope you’ll find interesting and possibly useful for your business. Some of the broad issues that will be covered include Medical Transcription process, HIPAA, Electronic Medical Records and news items of relevance to you as a Medical Service Provider.

The i-Script blog will serve as a forum to discuss industry news and trends as well as i-Script services, products and news, in an effort to generate conversations on hot topics and issues affecting the world of Medical Transcription and Healthcare.

Please come back from time to time to see what is happening here and leave a comment to let us know what you think!