29 Aug 2013

Top 10 Reasons Why You Should Make The Switch To Digital From Cassettes

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Still using audio tapes to dictate? 

Thinking about switching to a digital recorder or call-in system?

Top 10 reasons why you should make the switch:

  1. Tapes easily become lost or misplaced, resulting in wasted time and productivity. When a digital audio file is sent for transcription, a copy can be sent and a copy kept for a period of time (for redundancy purposes).
  2. Tapes wear out and recording quality degrades over time, resulting in wasted time and additional costs. Digital audio files do not contain any actual moving parts and cannot be “eaten” by a recorder.
  3. Tapes are normally recorded with multiple reports on them, which means the transcriptionist receives these jobs all at once. The moment a digital audio file has been dictated, it can be sent–thus the MT receives the dictation more quickly and turnaround time improves.  Stat dictation can be transcribed immediately.
  4. It is only possible to record onto tapes using “overwrite” mode. This means that if you need to add additional audio to a file, you have to append the additional audio. With most digital systems, it is possible to insert audio mid-file, which means if you need to add an extra paragraph, you can.
  5. Tapes are physical, meaning that a tape recorded in Timbuktu cannot be transcribed in Topeka within the same hour. Digital audio files are not geographically constrained. A digital file recorded in Timbuktu can therefore be transcribed in Topeka or any other location within the hour, thus improving turnaround and providing the opportunity to reduce office space and cut expenses via out-sourcing. Read more
29 Aug 2013

States scramble to get healthcare law’s insurance marketplaces up and running

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Washington Post article by Sarah Kliff and Sandhya Somashekhar, August 24, 2013

With a key deadline approaching, state officials across the country are scrambling to get the Affordable Care Act’s complex computer systems up and running, reviewing contingency plans and, in some places, preparing for delays.

Oct. 1 is the scheduled launch date for the health-care law’s insurance marketplaces — online sites where uninsured people will be able to shop for coverage, sometimes using a government subsidy to purchase a plan. An estimated 7 million people are expected to use these portals to purchase health coverage in 2014.

The task is unprecedented in its complexity, requiring state and federal data systems to transmit reams of information between one another. Some officials in charge of setting up the systems say that the tight deadlines have forced them to take shortcuts when it comes to testing and that some of the bells and whistles will not be ready.

“There’s a certain level of panic about how much needs to be accomplished but a general sense that the bare minimum to get the system functional will be done,” said Matt Salo, executive director of the National Association of Medicaid Directors. “It will by no means be as smooth and as seamless as people expected.”

Oregon announced this month that it will delay consumers’ direct access to its marketplace, opening the Web site only to brokers and consumer-assistance agents in order to shield consumers from opening-day glitches.

“Even though we’re testing now, once you actually have the system up, you don’t know what the bugs will be,” said Amy Fauver, spokeswoman for Cover Oregon, the state agency implementing the law there.
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22 Aug 2013

FDA Issues Guidelines On Wireless Medical Devices

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From article on InformationWeek by Ken Terry – August 19, 2013

The Food and Drug Administration (FDA) has released final guidelines on the design, testing and use of radio-frequency (RF) wireless medical devices. Although it doesn’t promulgate legally enforceable responsibilities, the document is intended to guide both device manufacturers and healthcare providers toward the safe and secure use of wireless medical devices. Covered are devices “that are implanted, worn on the body or other external wireless medical devices intended for use in hospitals, homes, clinics, clinical laboratories, and blood establishments.”

The FDA document has no relation to the impending guidance from the agency about how it will regulate apps that turn smartphones and tablets into medical devices. In fact, the draft guidance on RF wireless devices was issued in 2007, before smartphones and tablets became a factor in the industry. The FDA is focusing on the safety aspects of medical devices in hospitals, homes and other fixed-care settings.

For example, the guidance states, “Because there are risks associated with RF wireless systems, we recommend that you carefully consider which device functions should be made wireless and which device functions should employ wired connectivity.” Among the issues that could compromise transmissions from wireless devices and potentially endanger patient safety, the FDA guidance says, are:

– Poorly used wireless networks.

– Lost, corrupted, or time-delayed transmissions.

— Degradations in wireless transmissions that might be caused by competing wireless signals or electromagnetic interference.

– Lack or compromise of wireless security.

– Potential misuse of wireless devices because of lack of or inadequate instructions for use.

The document cautions that although a cellular phone network might be adequate for voice communication, “it might not be sufficient for certain medical functions. Connections lost without warning, failure to establish connections, or degradation of service can have serious consequences, especially when the medical device relies heavily on the wireless connection. Such situations can compromise the wireless transmission of high-priority medical device alarms, time-sensitive continuous physiological waveform data, and real-time control of therapeutic medical devices (such as wireless foot switches).”

The FDA document also addresses the security of wireless signals and data from medical devices. Wireless transmissions should be encrypted to safeguard not only the data but also hospital information systems, it says. Among the areas of vulnerability, it warns, are Bluetooth communications between devices and wireless networks.

The guidelines don’t discuss the issue of hackers trying to take control of implanted devices such as pacemakers and defibrillators. Fears of that kind of cybercrime –which, so far, have proved baseless — were sparked by a letter that the Information Security and Privacy Advisory Board, which advises the National Institute of Standards and Technology (NIST), sent to government agencies last year. The board suggested that FDA take this kind of threat into account in its regulation of monitoring devices.

The FDA statement also makes several “recommendations for pre-market submissions for devices that incorporate RF wireless technology.” The agency suggests how manufacturers should describe wireless devices in submissions to the FDA and directs them to provide information about any “risks and potential performance issues” associated with a device’s wireless functions. In addition, the FDA wants device makers to describe the testing of their products for the range of risks described in the guidance.

The FDA notes that the Federal Communications Commission (FCC) also regulates wireless technology, so jumping through the FDA’s hoops might not be sufficient to obtain approval for wireless medical devices.

Last September, for example, the FCC released its final rule for medical body-area networks (MBANs), which include wearable monitors that send data to wireless hubs in hospitals. The FCC allocated certain portions of the radio frequency band to MBANs, one for indoor and another for outdoor use.

15 Aug 2013

Simple solutions can help fill gaps in health care

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Story by Dan Gunderson, Minnesota Public Radio August 8, 2013

FERGUS FALLS, Minn. — Martha Hitzeman is legally blind, and at 87, needs medication for pain and to prevent strokes.

But sometimes she forgets to take her pills.

“She was starting to miss doses, sometimes maybe four or five doses in 10 days,” said her daughter, Marie Fuchs. “So I knew she wasn’t getting the medication she needed.”

Fuchs, who manages her mother’s medication, enrolled Hitzeman last August in MedSmart, a pilot project run by PioneerCare a long-term-care facility in Fergus Falls.

Her mother now has a small device on her kitchen table that holds two weeks’ worth of medication. The automated dispenser beeps twice a day — and keeps beeping until Hitzeman tips it over and the pills are dispensed.

“When I hear it ringing, I do what I need to do and take my time getting out here ’cause it will ring till I get here,” Hitzeman said. “It’s really a wonderful convenience.”

By ensuring that elderly people take medications, the simple device could allow them to stay healthy and out of the hospital or nursing home. After a year, it has proved so successful that other communities plan to start using the program.

MedSmart was created in response to a state Minnesota Department of Human Services request for ideas that could help elderly patients stay at home. It is funded in part by a $117,000 DHS matching grant.

The device is connected to a phone line, and if it isn’t tipped over within an hour, Marie Fuchs will receive an automated text message.

“I was able to take a week’s vacation last fall and not worry about her taking her meds every day,” Fuchs said. “It gives her the independence and gives me the peace of mind that she’s getting what she needs.”

The MedSmart program costs patients $39 a month. Data collected during the project found the device reduced medication errors for most participants.

In Fergus Falls, there are 73 people using the MedSmart program, 40 of whom are monitored each day. On a recent week, 39 took their medication as directed 100 percent of the time.

The device won’t help everyone. For some, it won’t provide the level of help they need. However, the project is filling a need in the community, said Todd Johnson, a pharmacist at Lake Region Healthcare in Fergus Falls.

“I know there’s a case or two where family members have said, ‘you pretty much allowed my family member to maintain independent living, when they weren’t able to do that before,’ ” he said. “Non compliance, especially with chronic disease medications, or just not taking them properly or running out of them is a major cause of re-admissions, clinic visits.”

There are a number of devices on the market that dispense medication, but what makes the Fergus Falls project unique is that it’s not just about technology, said Karen Wulfekuhle, director of home and community services for PioneerCare. It provides a local team of health professionals who decide on the best solution for individual patients, she said.

Wulfekuhle is trying to convince insurance providers to pay for the medication reminder. She said it’s not unusual for insurance to pay hundreds of dollars a month for drugs a patient needs.

“The argument is, how valuable is that medication if they’re not taking it? A $39 a month charge for a machine that helps support their health – [it] makes sense to cover that expense if in turn it’s going to keep them out of the hospital,” she said.

Since 2003, DHS officials have awarded 400 grants to organizations that help fix health care gaps for the elderly according, Jean Woods, director of the department’s aging and adult services division.

The grants cover a variety of community based projects. An earlier grant helped establish an electronic monitoring program for seniors in Fergus Falls. Another grant trained Somali volunteers in the Twin Cities to check on elders and perform basic home chores. In Aitkin County, a grant funds a volunteer program to add safety equipment to the homes of senior citizens to reduce falls.

“Minnesota has been very intent and very purposeful about wanting to make sure people, wherever they live in the state, can stay home and be served through home and community-based services,” Wood said.

DHS officials awarded $2.3 million in grants during the 2012 fiscal year. The funding is appropriated each year by the legislature. The department tracks grant projects for five years. More than 90 percent become self sustaining, Wood said.

08 Aug 2013

Physician Payments Sunshine Act Goes Into Effect Without Initial Concerns

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From Kaiser Health News article by Kelsey Miller – August 5th, 2013

The Physician Payments Sunshine Act, an Affordable Care Act provision requiring doctors and medical companies to disclose their financial relationships, went into effect Aug. 1. Physicians say they are now working to find a balance between necessary transparency and what some perceive to be burdensome filing.

“We want to spend our time seeing patients, not doing paperwork,” said Dr. Jason Mitchell the director of the Center for Health IT at the American Academy for Family Physicians.

The Sunshine Act requires drug companies and medical device makers to report payments, gifts and investments to Centers for Medicare and Medicaid Services. Though the act is now in effect, a complete set of records are not due until March 2014 and will not be made public until September 2014.

Consumer advocates and other stakeholders favor openness when it comes to the large amounts of money medical and pharmaceutical companies spend to influence a doctor’s choices, according to a Pew Health Center statement from 2012. Holding both parties accountable with a clear reporting system would allow consumers to spot potential bias.

Mitchell, who is also a practicing family physician in Missouri, does not anticipate many immediate changes for doctors – aside from fewer lunches with pharmaceutical representatives.

He predicts that because of the increased attention placed on these small meetings that make up a majority of the reportable interactions, doctors will likely shy away from them – which could be problematic. If doctors minimize their working relationships with pharmaceutical and medical representatives, their knowledge could be “less of a resource,” Mitchell said. It’s important for doctors to keep up with drug and product information in other ways, he added.

In an effort to simplify the reporting of these payments, a number of iPad and iPhone Apps have been developed. Doctors and industry professionals can enter data by hand or scan documents which are filed into easy lists and spreadsheets.

The Centers for Medicare and Medicaid Services created different Apps designed specifically for doctors and others for medical companies, both of which have to remain accountable for these transactions.

Though it’s up to the companies to do the reporting, doctors are encouraged to keep their information up to date and to follow up on what transactions are being reported.

“There’s no reason to believe it will be erroneously reported,” Mitchell said. “We don’t have anything to hide. We certainly are very conscious of conflicts of interest.”

“Transparency is a good thing,” Mitchell said. “But we certainly don’t want an increased burden.”

01 Aug 2013

Walgreens must pay woman $1.44 million over HIPAA violation

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From July 26, 2013 Indianapolis News article

A Marion County Indiana jury Friday awarded a woman $1.44 million after finding Walgreens and a pharmacist violated her privacy when the pharmacist looked up and shared the woman’s prescription history.

The lawsuit filed in Marion Superior Court spun out of a tangled relationship between the pharmacist, her husband and the man’s ex-girlfriend.

The verdict and seven-figure award came at the conclusion of a four-day jury trial.

The lawsuit alleged Audra Peterson, a pharmacist at the Walgreens store at 6269 W. 38th St., improperly reviewed the prescription history of Abigail Hinchy, Crown Point, and divulged that confidential information.

“As a provider of pharmaceutical service, defendant Walgreens Co. owes a non-delegable duty to its customers to protect their privacy and confidentiality of its customers’ pharmaceutical information and prescription histories,” Hinchy claimed in the lawsuit.

Walgreens was negligent in training and supervising Peterson, the suit said, while Peterson breached her statutory and common law duties of confidentiality and privacy to Hinchy.

The six-member jury found for Hinchy, ruling the pharmacist and Walgreens violated privacy rules when Peterson looked up records on Hinchy, her husband’s ex-girlfriend, according to attorney Neal F. Eggeson, who represented Hinchy.

He said testimony indicated Peterson then shared that information with her husband, Davion Peterson, who has a child with Hinchy.

“We take seriously our responsibility to safeguard the privacy of medical records in our possession,” the company said in an emailed statement late Friday. “The pharmacist in this case admitted she was aware of our strict privacy policy and knew she was violating it. She was appropriately disciplined for her action.

“We believe it is a misapplication of the law to hold an employer liable for the actions of one employee who knowingly violates company policy. We intend to appeal the ruling.”

25 Jul 2013

ICD-10 Transition Should be Major Focus Now

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From July 22, 2013 Article on HealthLeaders Media

Hoping for a deadline extension, many physician practices are behind. Instead they should be highly focused on the transition from ICD-9 to ICD-10 code sets, says one expert.

With so many challenges and changes coming at physician practices, it can be hard to know where to focus attention. Healthcare reform is reshaping the way healthcare is provided and paid for it, and one of the most fundamental changes involves coding.

Physician practices should be highly focused on the transition from ICD-9 to ICD-10 code sets, says Peggy Stilley, CPC, CPMA, CPC-I, COBGC, ACS-OB, director of audit services with the AAPC in Salt Lake City. Stilley also is part of the AAPC’s ICD-10 Curriculum Training Team, which assists physician practices in switching from the current set of 14,000 codes to over 69,000 codes.

In August 2012, HHS released a final rule that officially delayed the ICD-10 compliance date until October 1, 2014, but CMS more recently warned that physicians should not count on any more delays. That means now is the time to get in gear for the transition, Stilley says.

“I’ve seen it all over the board at this point. Some are right on target with where they should be, and we have some practices that have just begun putting their teams together, assessing their policies and procedures to see where the effect of ICD-10 may be for them,” Stilley says.

“You have to start there because there are so many systems in use even by the smaller practices, and all of those systems have to talk to each other with the new ICD-10 codes. When you get to implementation, how will you ensure that all these systems are talking to one another the way they are supposed to?”

That integration of disparate systems is proving to be one of the biggest challenges for physician practices, Stilley says.
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18 Jul 2013

Massive Open Online Healthcare (MOOH)

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A tongue-in-cheek Article from the Atlantic dated July 10, 2013

Simply eliminate the human element, and costs will plummet toward zero.

Hark, a new age dawns in healthcare! No longer must we tolerate long waiting times for a doctor appointment or service in the hospital emergency room. No more will we suffer inequities in access to healthcare. Relentlessly climbing healthcare costs will become a thing of the past. Herald instead a brave new world, in which cutting-edge information technology will solve once and for all the core problems that have plagued US healthcare for decades.

Just as the MOOC (Massive Open Online Course) has revolutionized education at all levels, so the MOOH (Massive Open Online Healthcare) is about to revolutionize the nation’s healthcare system, putting out of work most of the businesspeople, politicians, and pundits who have for so long profited from its afflictions. At last, we stand on the threshold of not just “the next big thing” in medicine, but the final and biggest thing of all.

The MOOC was born in 2008, when prophets of the new information technology finally realized that the real purpose of pedagogical accessories such as teachers and classrooms is educational content delivery. The MOOH is emerging just five years later, as healthcare leaders finally realize that the real purpose of physicians and hospitals is merely to deliver medical content. To achieve massive increases in efficiency, we simply need to get rid of most teachers and physicians.

Consider the following analogy. In the old days, people contracted infectious diseases such as measles or smallpox, which often left their victims permanently scarred or even dead. Then onto the scene burst vaccination, from the Latin for cow, because the first vaccination was derived from cowpox. Suddenly, people no longer contracted such diseases. The MOOH does the same thing — transforming medical care from a highly labor-intensive, expensive process into an efficient type of inoculation.
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16 Jul 2013

60% of Docs Wouldn’t Recommend Their Profession as a Career

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Article from HealthLeaders Media posted July 11, 2013

The administrative burden of being a physician continues to fuel discontent among doctors. More than a third report having a negative outlook for the profession, and the majority would not recommend it as a career choice.

Nearly 60% of physicians wouldn’t recommend the profession to young people, a survey shows.

The various sources of the doctors’ discontent include decreased autonomy, lower reimbursements, administrative and regulatory hassles, corporate medicine, litigation fears, and longer work hours, much of which has meant that they’re spending too much time away from patients.

urgent care center

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Source: Health Leaders Media

Looking ahead, 36% of the 3,456 physicians who responded to a survey conducted this spring by Atlanta-based physician staffers Jackson & Coker reported a negative outlook for the profession, while 16% were favorable and 48% cautious.

“What we have begun to find is that pretty much across the board the physicians are becoming a little disenchanted with the business of medicine,” says Edward McEachern, vice president of marketing Jackson & Coker.

“Not the practice of medicine, but the business of medicine, because of this overwhelming administrative burden that is very difficult for them to work through and still practice good patient care medicine. It’s to the point where we ask ‘would you be willing to recommend the medical career as a position to the younger generation’ and for the first time we’ve really begun seeing them not recommend it.”
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11 Jul 2013

10-Point ONC Safety Plan Seeks to Improve EHR Use

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Article from HealthLeaders Media posted July 9, 2013

New federal guidelines aim for electronic health record systems to be used in a way that improves care and patient safety, and to ensure that system designs don’t make certain types of errors more likely to happen.

Providers will make fewer medical errors that can harm patients—at least in theory—after implementation of a federal health IT safety plan unveiled this month. The plan recommends prohibitions of so-called vendor contract gag clauses and says demonstration of electronic health record systems’ safety features should be a prerequisite for certification.

The 10-point plan, issued by the Office of National Coordinator for Health IT, seeks to resolve problems highlighted in the Institute of Medicine’s November, 2011 report, Health IT and Patient Safety: Building Safer Systems for Better Care, by allowing electronic health record system users to report on problems using the Common Formats protocol, under development by the Agency for Healthcare Research and Quality.

“Health information technology enables substantial improvements in health care quality and safety, compared to paper records,” the ONC said in a fact sheet accompanying release of the plan. “Yet health IT can only fulfill its enormous potential if risks associated with its use are identified, if there is a coordinated effort to mitigate those risks, and if it is used to make care safer.”

The 50-page report’s two main purposes are to use electronic health records in a way that improves care and patient safety, and to make sure electronic health record and computerized physician order entry system designs don’t make certain types of mistakes more likely to happen.
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