MEDICAL TRANSCRIPTION OUTSOURCING TO INDIA?

Being judgmental about a thing you know is one thing, but being naïve about one possibility is what annoys me the most.

A sweet little conversation between two men in the elevator today when one of them was considering outsourcing his medical transcriptions to India.

“Indian companies are known for being frauds man, I believe every field there makes no sense since they are driven with schemes. Medical transcriptions!! how can you even think about outsourcing it from an Indian company, they probably don’t even know what that means”

Let me tell you, especially to all those who think on such lines, you are only being naïve. I have had my medical bills outsourced to an Indian company called Acroseas and let me tell you that this transaction was anything but a fraud.

Acroseas works with healthcare providers and medical groups to provide innovative medical Transcriptions. They combine their industry experience and professionalism with advanced medical billing software to provide their clients with timely services.

They leverage advanced technology to provide more efficient, timely and accurate precision driven medical outsourcing services. Their professionalism is very impressive and they do not impose over their clients this so called ‘we know it all’ attitude like our doctors here.

Their medical transcription services are at extremely cost-effective rates.

So yeah, people out there, do not listen to those who give you such probabilities and theories. Experience is the best teacher.

Top 10 Open Source Medical Billing and Electronic Medical Records Applications

For those loyal readers of this blog, you’ll know that open source software and in particular open source EMR software has been a much discussed topic. I guess people love it when you talk about a free EMR. I must admit that I’m always intrigued by open source (free) software and open source EMR software is no different.

I recently came across a list of the top 100 Open Source Software Tools for Medical Professionals.

You know I’m a sucker for a list and I especially like EMR lists, so here’s their top 10 open source EMR software:
1. FreeMED
2. OpenEMR
3. OpenEMR Current
4. OpenEMR Virtual Appliance
5. FreeB
6. SmartCare
7. XChart
8. OpenMRS
9. Open Dental Software
10. ClearHealth

Quite an interesting list to choose from. Now if I could just get the data on number of installs for these applications. When I mean installs I mean doctors who actually use these open source EMR systems every day in their practice. Anyone want to let us know where we can find that data? Or any open source EMR packages want to fill us in on their progress?

I’ll update the post if I find anything or get that information in the comments.

Interesting. I wonder why none of these are CCHIT certified?

Free EMR by Medicare?

I’ve been working with John Deutsch of EMR Experts, Inc. and I invited him to be a guest blogger on my blog. Here’s an article John sent me about the Free Vista EMR offered by the government. While I think the news about Vista being free came out about 2.5 years ago, the information about adopting it is still VERY relevant. Probably because the EMR adoption level is so low.

Enjoy John’s take on the government’s “Free EMR.”

Is anything ever free these days? Maybe so.

Instigated by the incredibly slow adoption of Electronic Medical Records (EMR) by doctors across the nation, Medicare is announcing it will begin offering doctors free electronic medical record software solutions.

Both upfront and ongoing costs have been critical factors in the lagging EMR adoption rate. Medicare hopes that by providing doctors with a free or very low-cost system, doctors will readily adopt EMR putting healthcare providers in America on a common system, thereby, providing Medicare and the general public with obvious, health, reporting and billing benefits.

The proposed system is VistA, (Veterans Health Information Systems and Technology Architecture) the widely popular system built by the Veterans Administration.

The adoption of VistA has resulted in the VA achieving a pharmacy prescription accuracy rate of 99.997%. Due to the implementation of VistA, the VA also outperforms most public sector hospitals on a variety of criteria.
The VistA system is public domain software, available through the Freedom of Information Act directly from the VA website or through a network of distributors.

Installed in over 1300 inpatient and outpatient facilities, the system is well-established and quite successful by EMR standards.

But can a system designed for a large organization like the VA also work for a solo practitioner family practice office?

A doctor in a New York Time article writes:

“It is one thing to use a system that someone else installed and someone else maintains. It is another to get a set of disks in the mail and do it yourself.”

Those who have tried to install VistA on their own would agree.

“Giving out a version of VistA is a great idea,” said Dr. David Kibbe, director of the Center for Health Information Technology at the American Academy of Family Physicians, a group that has been working on the project. “But at the beginning, there was a lot of wishful thinking. They said, ‘We’ll just release it.’ I said, ‘Where’s the fairy dust?’ ”

The problems with the healthcare sector and its slow adoption of electronic medical records are much deeper than some would like to admit, and viable solutions have been hard to come by.

The healthcare system is extremely fragmented, with thousands upon thousands of practices all practicing differently, using different billing systems, with different levels of computer proficiency, and different workflows.

Building a one-size-fits-all system has failed in the past and will likely continue to fail. The fact that over 300 different vendors currently develop and market EMR software attests to the need for customization.

The need for pre- and post-sale customization is a reality in every practice since every practice operates differently. Even practicing physicians within the exact same specialty do things differently and run their practices differently.

A key challenge for systems with large installation bases is often that the system becomes rigid simply due to the vendor trying to please too many different practices. Customization gets repeatedly delayed or shelved altogether.

Another concern is that when medical records are stored on servers that Medicare can access and control as they please practices may be hesitant to use the system regardless of the benefits to the practices and their patients.

While Medicare’s plan is to offer the software for free, one must ask what free is. Currently, free is software but not training, installation, and ongoing support.

Even if Medicare did make it 100% free, a free EMR is not free if it fails. The costs involved with a failed implementation can far outweigh the costs of purchasing an EMR at market price due to productivity losses, and hardware and implementation costs.

Maybe Medicare could focus more of their resources in the development and promotion of better standards for integrating already proven EMR systems and integrating EMR systems with electronic personal health records, managed by the patient

Why not offer patients a free electronic health record which can easily interface to all the major EMR vendors in the market? Wouldn’t a record they control, that can communicate with all their health providers, and be accessed by any other provider in the event of an emergency be more beneficial?

After all, isn’t the patient’s best interest the goal of healthcare in the 21st century?

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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.