Doctors are not Clerks

Sometimes in IT, you see glaring problems that seem so simple.  And then you look a little closer.  That's where I was when a nurse friend of mine was telling me about how the doctor she worked for had broken 3 keyboards, gave up his vow not to cuss, and was missing his beloved Kentucky basketball games.  The reason why?  "10 years of school, 14 years of practice, and now I'm a clerk".
Electronic Medical Records - Gotta get there
Don't get me wrong. I am a very pro-EMR guy. I am an evangelist for electronic medical records and networking information together, personal health records and all the rest. The cost savings are real, and the impact of connecting all of these "islands of information" on patient care can make a real difference.
I've read some articles lately where isolated issues of mistakes and security have been problematic. Two things will always be true in computers, Garbage in - Garbage Out. And the computer only does what it's told to do. In other words, the issue isn't the digital record, it's the implementation that messed thing up.
With that background, I guess I look at EMRs the same way. If you look at the statistics about EMR adoption, EMR that have been disposed of, and EMR impact on physician productivity - the numbers are staggering. And embarrassingly poor.
But why are the results so bad?
I'm not going to get into all of the issues, but one that just seems so straightforward to me. Yes there are exceptions, but for the most part, EMR vendors have justified their price by selling the elimination of transcription costs. Then they rip the tape recorder out of their hands and give them a keyboard. Sure, there are pull downs and decision trees, with point and click, and tablets. But for the most part, the EMR has taken mobility away, and turned the most expensive person in a practice and turned them into a clerk. By the way, that very expensive clerk is also probably the least efficient computer user in the office.
So let's trash all the EMRs and stick with paper, right? Of course not.
Voice Recognition -Part of the Solution:
Yes, VR has had some fits and starts too.  And when I use my voice dial on my cell phone and say "Call Mike Davis", it comes back with "Calling Pizza Hut".  Grrrr
But like anything, the allure of a gazillion consumers drive VR companies to solve that market.  One that shows up int healthcare is Dragon. A great software package which does a terific job of turning voice into text, right there on your screen.  But here we go again - the doctor is now editing his/her own jobs.  Again the doctor is a clerk.  Further, there are lots of support issues anytime you load consumer grade, machine-based software, into an enterprise environment.
More importantly, how does the document really fit into the workflow of clinical documentation?  How is it returned?  Networked?  Shared?
Do EMRs have Voice Recognition?  Sometimes.  But usually they suffer from being poorly implemented and it's obvious that they're bolted on, and not really part of the normal, natural design of the product.
So, what's the answer?  Embrace Integrated Dictation

Ultimately, EMRs/EHRs and the rest will solve this issue with some emerging technologies that allow for voice recognition with "chunking", and tagging data. But there are answers today.  One of my clients, VocalEZ, clearly understands the issues, because their founder grew up in this very specific space, and set out to design the solution with the individual practitioner at the base.  By integrating into whatever systems (PM, EMR, paper) are in place, VocalEZ can leverage all of the scheduling, referring, and demographic information in the systems, and slide right into the existing doctor work-flow. And by utilizing a Speechmike, which looks and acts suspiciously like a digital recorder, or a mobile device, the doctor can dictate just like always.  While they go see the next patient, the job is processed by some very robust VR software (up to 99% accurate). and ready for a staff member or contracted resource to edit, and it's automatically returned to the designated task basket, file server..Net result - Doctor is a Doctor, and the transcriptionists become editors that can be more than twice as productive, thus cutting costs and time dramatically. So, if you don't have an EMR, and are holding off because of all the reform uncertainty, this is your bridge.  If you have an EMR, but are struggling with adoption, this is your driver.
When I learned about VocalEZ, I felt like the guy at Chrysler who said "why don't we put a sliding door on the driver's side of the vans too?"





 

Offshore Medical Transcription - Still Worth the Risk?

For the past year I have been working on a project with a partner in the UK for the NHS. Throughtout the process, I've done extensive research on the competitive landscape, and found myself looking way beyond the simple cost equation that many think of with MT, which they view as a commodity.

Let's deal with reality:

The need for clinical documentation is not going away.  Even the EMR companies are conceding that transcription is still a critical piece of the equation.  I'll save my rant on Voice Recognition as the enabler for EMR for another day.   For now, let's just assume that there is alot of work to be done, and not enough medical transcriptionists in the US or UK to do the work in a traditional model.  Add rising demand to shrinking resource, and you get rising costs - or...opportunity for a new player to change the rules.  Like other aspects of IT, outsourcing, offshoring, outasking, whatever you want to call it has created enormous investment and development in countries like India, the Philippines, and several others.

It is what it is:

Right, wrong, or indifferent, we are all now accustomed to working thru endless telephone system mazes and extended hold times, only to be connected to someone we cannot understand.   The companies who have sent there service and call centers overseas have done it for a reason - to drive down costs and be more competitive in the marketplace.

The same has happened with MT.  And for a handful of years, alot of companies grew dramatically with this model and were able to leverage technology and a less expensive labor component to grow their business.  And customers, looking for savings, made the jump.

Changing World:

But now, those same companies that utilize offshore labor are feeling the bite of the changing global marketplace.  MT is not returning the margin it once was, and those invested overseas are looking at ways to leverage those English speaking workers into a higher margin business, such as Call Centers.  Make no mistake, this in not to bash the offshore workers.  But the shrinking margins have led to more competition from other applications, making a tight labor market even tighter.  The result is a higher costs, slower turnaround time, lower quality, and frustrated customers.

Today's Reality:

I could go on discussing costs vs production sacrifices,  but I'll let you look at the financials of the large MTSOs out there to reach your own conclusion.  I won't get in to broken English, natural disasters or the political and business dynamics of working in these countries.  To me - one issue trumps them all.

As we all drive toward EMR, EHR, PHR, and all the other TLAs (three letter acronyms) of the community health networks, the overriding concern must be security and privacy.  In the US we have HIPAA, and Europe has it's own Data Protection legislation.  And yet we hear again, even this week about medical records being for sale in India.  Or the story about an MT in Pakistan threatening to post a California hospital's record online because payment was not received through a long line of subcontractors. How can a hospital administrator really afford to take that risk?  Is there really regulation that includes verification, Chain of Custody, and real enforcement? 

Bottomline:

I would contend that a health care provider has a sacred obligation to protect its medical records.  This is not talking someone through how to solve a PC problem.  Obviously, the industry is paying attention.  Stronger HIPAA regulations are on the way, and MTSOs are all taking different directions in trying to deal with the shifting sands.

My take - the ones who utilize a comprehensive Voice Recognition process, (read - not just a tool or Dragon), to drive productivity in their primarily US-based workforce, will win the day. 

Wondering if a Blog has an ROI

So here I go again, writing a blog.  I've played with this idea before.  I've done a few, and then I get too busy and stop.  I wonder the same thing about Twitter.  For the past several months I've done a variety of activities to determine whether there is any real value to spending time I don't have to do this very thing,
Well, I'm doing it, so I guess I see enough value to keep dabbling.  And over the past months I have come to learn that there are many great uses and absolute directed revenue that is derived from social networking.  Having said that, I believe that 90% of the tweets and blogs do not have a Return on Investment.  And that's OK,  As long as you take a realistic view of the outcome.
To be fair, I am not a social networking guru.  I don't have a huge marketing staff researching latest trends and tools and strategies.  But I am also not a guy who is addicted to Facebook or Twitter, nor do I think anyone cares what I ate for lunch.
I have however found real value as I've dabbled in this arena.  Specifically here:
1.  Research - What a great way to get realtime, current, feedback from folks on just about any subject.  What a great educational resource to watch how Microsoft has launched 7, or Google Voice, or you name it.  And then the point-counterpoint conversations that arise from real users,  Yes, I know they are not all who they pretend to be.
2.  Relationships - How else would I ever get to have a direct conversation or exchange with some of the most influential and visionary folks around the world.  It so helps from being in the cocoon of a large corporation and prevents group think.
3.  Global Thinking - I'm an IT guy.  I'm a healthcare guy. Solutions I look at have so much play around the world that it helps me think globally.  It's shocking how similar some of the challenges are in underdeveloped countries to the US.  A doctor in Iraq for example is an island of information. Is that any less true in the rural US?  When you show up in the ER, does the doctor know anything about you?
4.  Hearing the message - Sometimes I hear myself say something or see what I write - and it just helps me cristalize my message.
I will be exploring many issues in coming posts and commit to sharing with you my learnings along the way.