The Future of Clinical Documentation Industry

I was forwarded an email today from my ASP which is written by a company that helps MTSOs purchase and buy other MTSOs describing the industry and explaining reasons as to the changes happening. I read this and loved it, wanted to share.

I could NOT find the link to the blog post but will copy it here directly from the email I was forwarded:

The Changing Landscape in Clinical Documentation

In my last note I talked about the evolution of the clinical documentation business and why I thought it would survive. This past month two very significant events occurred further changing the landscape in the industry: (i) the closing of the Clinical Documentation Industry Association (MTIA) and (ii) the announced merger of Transcend Services with Nuance Communications. Does this change my mind?

Not really.

From a nostalgic perspective, these changes are a little melancholy. I attended my first MTIA conference in 1996 or so. It always seemed like a right of membership to complain about the annual dues versus the perceived benefits of MTIA. But it’s sad to see it gone and we’ll miss the annual meeting. With regard to Transcend, it has been a significant player in the medical transcription industry for over 15 years. Their management team did such a tremendous job of growing the business that Nuance just offered to purchase them for $29.50 per share ($300 million). Alas, in several months the Transcend name will also be gone.

From a business perspective, you have to wonder if these events forecast a bleak future for the industry. Are there now too few potential members with enough money to support an industry association? Is the number two player in the industry selling out before it’s too late?

Addressing the latter first, Nuance put their money where their mouth is by investing $300 million in the industry to buy Transcend. The name Transcend might go away, but the relationships with its clients and the vast majority of its employees (especially the MT’s) will remain intact. I know that the management team at Transcend is very smart, but I am also certain that the management team at Nuance is neither naïve nor stupid. They believe in the industry and that’s a good thing. Transcend acted in a manner they believed to be in the best interests of their shareholders, clients and employees. So did Nuance.

The closing of MTIA related in part to the consolidation in the industry. But, truth be told, most MTSO’s have not sold out. However, we just went through an unprecedented downturn in the economy and everyone had to find areas to cut back on expenses. On top of that the industry is undergoing rapid technological change and pricing declines affecting everyone in the business. In the end, paying dues to an industry association probably just wasn’t high on the list of many. MTIA did a great job for many years and we should thank all of the board members and the MTIA leadership for their efforts.

Change is a double edged sword. Kodak filed for bankruptcy, but FUJI Film is more successful than ever. Clinical documentation is not going away – it is changing. You have to be willing to invest the time, energy and money necessary to change with it. If you don’t want to do that, you owe it to yourself, your clients and your employees to consider taking the route that Transcend did. If you ever want to explore that or talk about what we are seeing, please give me a call.

John Suender, President
Suender M&A Advisors, LLC

I then went on to browse their site (and sign up for email alerts) and came across this article. The typos bother me, but the information that lies within is priceless.

Some Thoughts About the Future of the Clinical Documentation Industry

There are so many interesting, exciting (and sometimes downright frightening) things going on in our industry. We need to "go with the flow," reinvent ourselves if somethings not working, and the key to that IS knowledge.

Medical Transcription Tools

Tools of the Trade

So, I'm working today (from home of course), and my son also being home for spring break comes in to the room to let me know that his App Redeem will be depositing money in my PayPal account.  Great!  Next out of his mouth, he says, "Hey mom, there is a cool App that may help you with your work."

I'm intrigued because he's a smart kid and very into technology (MIT is his goal).

He clicks on his iPhone 4S (yes, he has the better phone - I have an Android) and I am in my glory.  The App is called iTriage.  There are drugs names (generic & brand name) and (the best part for me) medication side effects.  I can't tell you how many times I'm transcribing for Dr. McEaty who's listing side effects while eating lunch (hence the name) and I can't for the life of me make out what he's saying.  I used this today and already scored some blanks.  There's a physician look-up, a symptom checker, procedures and blood test descriptions (although no normal ranges).

This is amazing....All in this info in the palm of your hand FOR FREE!

A screenshot from their blog:

You can install it right on your phone via Google Play.

Now, of course if you're a hypochondriac, this is not a good thing, but for transcriptionists, this is a diamond in the rough!

Shameless plug to follow -- 

If you're in need of quality clinical documentation or know someone who does, please visit us at Just My Type Transcription

EMR Implementation and Protecting Patients

EMR implementation is happening everywhere we turn. This is a definite step in the right direction but there are problems with this (this is not a productivity post).  Next up is voice recognition, speech understanding technology, SR, VR, whatever you're calling it. Hospitals, clinics, physicians are saving big money (are they?) by the changes happening, but who is thinking about the quality of the patient record in all of this?

This is my business....Transcribing patient reports and being a patient myself, this is hot topic. All the pointing and clicking leaves little to not only the patient's narrative but also the doctor's voice. Then, there are the doctors' speech who could never, in their lifetime, be recognized and plopped into a patient's record without editing of some sort (or a complete re-type).  

One lesson that has stuck with me from a mentor of mine is when transcribing, we should not be messing with the doctor's voice.  Yes, we edit (according to client preference of course) and fix glaring grammatical errors, but a good transcriptionist will NOT mess with the doctor's voice. He speaks how he speaks, and we need to respect that.

To answer my earlier question -- there are some driving forces in our business who are interested in fighting for clinical documentation quality assurance. Kathy Nicholls put together a study that is so incredibly interesting I wish more folks would take notice.  See her blog post about it at Identifying Errors, Protecting Patients Report.  There are the all-to-common R/L discrepancies, medication dosage errors (mostly on account of SRT), lab values, etc., but check out these numbers:

In looking at the types of errors, here’s what we see:

• Dictated left/right inconsistencies: 1.92% of total
• Discrepancies/inconsistencies: 7.93% of total
• Lab value errors: 2.64% of total
• Medication Error in dosage: 2.88% of total
• Medication Error in name of drug: 3.13% of total
• Patient Demographics/
• Incorrect Information: 11.78% of total
• SRT Errors 69.71% of total

Now, with these percentages one must look at the larger scale of this, and Kathy said it best in her comment on the blog:

.....those percentages seem small, until you extrapolate it to the bigger picture. The reports from the CDC show a total of 34.4 million inpatient admissions per year, 109.9 million outpatient visits per year, and 123.8 million ER visits per year. If you assume (loosely) that each inpatient visit generates 3 reports of some kind (I’m thinking history and physical, procedure note of some kind, and a discharge summary) and each of the other types each has one report, that equals 336.9 million reports per year. Now that 1% becomes 3.37 million with errors, 2% 6.74 million, and 3% 10.1 million. It puts a new light on that for sure. And you’re also right, no one wants that 1% to be their family member or their personal record.

I think the point is that we have to find ways to share this information with the RIGHT people. It’s not about saying we don’t want the technology as it does bring some good things. It IS about calling for initiatives that put a quality check in place for information that goes into the EHR before it harms a patient.

Here's a sampling of the errors found:

• Penicillin listed as an allergy and then prescribed as a discharge medication.
• Metoprolol 500 mg
• “SPECT myocardial infarction” instead of “SPECT myocardial perfusion.”

Errors from SRT

• “Informed consent was obtained” became “informed consent for suicide was obtained.”
• Glyburide became Namenda. These two aren’t even close in sound, and so the patient with diabetes ends up getting treatment for Alzheimer’s.
• Tramadol became Trileptal. Clearly a medication for epilepsy isn’t going to help this patient’s rheumatoid arthritis very much.

This is very troubling and I hope those in the clinical documentation field (including EMR vendors) will not take this lightly. Do we risk harming patients just to save facilities money?  And, to that end, how much are they truly saving when you add in malpractice, EMR implementation productivity loss, and all the other "consequences" that come along with it?  

There are transcription companies (us, for one) who offer an alternative which is a perfect solution in my opinion. If the EMR allows structured data, a doctor can dictate the visit, which we all know is the quickest way to document the encounter, and our software plugs the dictation into the appropriate areas of the EMR. We  are checking and double checking patient record QUALITY!  Without quality checks (by folks who actually know what to look for) of some sort the facilities, offices, clinics WILL lose patients one way or the other.

If you're a patient, REQUEST your record, find out about WHAT QUALITY CHECKS are in place in handling YOUR record -- it's YOUR right.

Have you or a loved one had an issue with your medical record AND how it was handled?  I would love to hear from you!   

If you're interested in our services, please contact us through our website Just My Type Transcription or at info (at) justmytypetranscription(dot) com.