Medical Transcription and the EHR

medical-transcriptionAs a result of the Affordable Care Act, healthcare providers were offered incentives by the US Government to move towards an electronic health record (EHR) which gives physicians, hospitals and other providers the ability to improve and coordinate care across the healthcare ecosystem.

The US Dept. of Health and Human Services announced that as of the end of April, more than half of physician practices and other eligible providers have received Medicare or Medicaid incentive payments for adopting or meaningfully using EHR’s.  80% of the eligible Hospitals have also benefited from these incentive programs which are critical to advancing patient care.

For many of those physician offices and hospital facilities that have not taken advantage of the government incentives, cost is the primary concern.  To implement an EHR system whether in a physician’s office or a hospital environment is an expensive and complex process that requires money, time and personnel. Other concerns for some of the non-adopters are an increase in security risks for digital files and access to confidential information are among the reasons why they continue to use paper health records. However, it’s actually paper records that leave your practice in serious danger of a security infringement.  Security advantages EHRs hold over paper records include encryption, internal control, and data backup.   So how does this affect the need for medical transcription services?

EHR vendors have always felt that the healthcare facilities could eliminate transcription and pay for the electronic record from the monies that were allotted to transcription.  This seemed to be a pretty good idea until after the implementation of the EHR.  Providers quickly realized that meaningful conversations cannot be captured with a drop down box.  The time spent navigating the EHR was inefficient, coupled with concerns about the quality of the documentation, fear of inaccurate documentation and over-billing allowed administrators and physicians to understand that there is still a need for transcription technology and services.

A skilled medical transcriptionist or editor can be the economical choice when faced with passing laborious tasks on to the most costly person in the documentation workflow—the physician—and can assist as the backup to authenticate data intended for utilization by the EHR.

Medical transcription services aid in the collection of the clinical narrative, which is the clinical documentation in the physician’s own words. The clinical narrative is a first-person view of the patient’s encounter.  It is contextual, which is near impossible to reproduce with most EHR documentation options.  Medical transcription provides the smooth and significant documentation option that many physicians want in an EHR.

Medical transcription service companies provide highly compliant documentation tools for physicians and administrators.  It allows the physician to dictate using a cell phone, hand-held digital recorder, a computer microphone, or using a traditional telephone (landline or VoIP).   Since dictation is a faster and easier clinical documentation option, it also reduces the time physicians spend documenting in the EHR.  Medical transcription can also make the patient’s record in the EHR more complete.  If medical records are more comprehensive, than the quality of care and patient safety can be improved, while the probability of negative medical effects can be reduced.

The use of dictation and medical transcription with an EHR can be the perfect example of clinical documentation for many physicians.  It can lead to a more complete patient record, which is something all are aspiring for.

Here at Fast Chart, we are committed to only hiring domestically located Medical Transcriptionists that meet our rigorous standards and training. This is why Fast Chart has an accuracy rate > than 98.5%.

Fast Chart prides itself on providing innovative, accurate and affordable clinical documentation solutions to meet each client’s unique needs. Feel free to contact us or call our office toll free at 1-800-334-6606 with any questions.

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