Health Trends


"Medical Transcription , Electronic Medical Records, Central Depository of Patient Recors - the dynamics and scope of electronic information capture are tremendousÖ "

While most of this section has dealt with how you can start using computers in your current medical practice, this section will familiarize you with some of the advances that are taking place in the field of medical informatics and how they are changing healthcare management.


Medical Transcription 

Medical Transcription is one of the fastest growing professions in the US today. Medical transcription as a career in India also has suddenly shot into the limelight. While many talk about it, few really seem to know what it entails, how they can use this service and what its benefits are. 

            This is what itís all about. Medical Transcription is the typing of reports from dictation recorded by a doctor or health professional pertaining to medical information. Typically doctors in USA dictate the case histories of their patients into audio-tapes. The medical Transcriptionist (MT) in India hears the tapes and keys the data into a computer. The data files are then sent back to the US to maintain, records, and for follow up. While at a glance this may look like a typistís or data entry operatorís job it involves more than that. The MT has to be a responsible person who understands medical terminology and can correctly transcribe the data, as human lives may depend on it. Presently most of the transcription work comes for USA, though it is sure to spread to other countries soon, including India. 

            Outsourcing transcription can be more cost effective than using in-house secretarial staff and or temporary workers to transcribe dictation. Also, answering phones, doubling as a receptionist and doing a variety of chores ruins their concentration, thus causing delays and increasing the errors in their work. The standard 3 to 1 ratio of transcription service help speed up turnaround time on dictated documents while never having to worry about someone being on vacation. Being sick, or quitting and leaving you in the lurch. A good transcription service can even help you work effectively with the computers you have in your office to process the transcribed reports which will be delivered to you electronically. So, with all these benefits almost all hospitals in the US have chosen to outsource transcription. 

            Transcription has become a necessity in most US hospitals, because of managed care and the need to have all data in digital format. In India, the scenario is different we are still struck in the paper age, but it wonít be long before hospitals and practitioners wake up to the benefits of going digital. So, if you or your hospital is interested in using the services of medical transcriptionists, there are many companies in India. You could check out, or to find more information. As mentioned earlier, this is a very new field with tremendous growth opportunities to be a supplement to medical practice.


Computer-Based Patient Records (CBPR) or Electronic Medical Reports (EMR) 

The thought of transferring years of paper patient records into an electronic format is overwhelming for most physicians. Many of the daily inadequacies of the paper chart continue to be overlooked because the alternative consequences seem steeper. Purchasing an electronic medical record (EMR) for the office is a huge undertaking. But, the advantages of switching to an EMR cannot be overstated. Labs that are not filed, or progress notes that havenít been completed or filed makes paper patient charts incomplete. And even an innocent water spill can ruin vital information on paper-based charts. Determining whether an EMR makes sense in a medical office is a function not only of finance, but also of the quality of services provided. The clinical and administrative staff will  save time by automating repetitive tasks, reduce malpractice by maintaining upto Ėdate, secure and complete patient information for determining a course of treatment, and improve patient education and compliance.

            With EMR, all elements of the patientís record exist in a computer file. In most contemporary software packages, different elements of the chart are accessible through graphic user interface methods that allow the user to move easily from one part of the record to another. In addition to having the ability to enter text, the user may navigate through the record by pointing to icons on the screen to generate progress notes and flow sheets, complete insurance forms, prescribe medications, or perform countless other clinical and administrative tasks.  

            An extension of EMR is the decision support system, which assists  physicians in medical decision Ė making. Diagnostic decision support systems integrate clinical findings (e.g., signs, symptoms and test results) with disease profile to produce probability-based pairings of findings and diseases, while therapeutic decision support permits the physician to generate a patient-specific disease-specific treatment plan, including medication prescription, patient education, and diet therapy. 

            Most hospitals in the US and other advance nations have adopted CBPR. This is not to say that it is the panacea for all problems. The hospitalís computerized clinical care systems have also resulted in many horror stories, such as employers getting information about an employee and then denying employment or job advancement, or misuse by insurance companies. Because no federal law exists in the US on access to CBPRís (except in the case of military hospitals and Medicare patients), the field is potentially open to abuse. However, the Computer-Based Patient Record Institute and new federal legislation are tackling these and other issues. 

            The future holds much promise for computerized medical records. When built-in reminders and knowledge database links are included in these systems, evidence-based medicine will be more uniformly practiced, resulting in better patient care. Although a few hospitals in India do maintain EMR, we are a far way off from. It is about time that informed physicians and healthcare decision-makers saw the promise of CBPRís and took steps to change the healthcare system.

Central Depository of Patient Records

One of the things that has evoked sharp interest in the United States and some of the more developed nations is the need for a central depository of medical records. A central depository is nothing more than a central database through which an authorized physician could access and review appropriate portions of a patientís medical records. Information from multiple distributed databases is then displayed to the physician as if from a single source. 

            For decades, the patientís medical records has been hand-written on paper and stored in folders on shelves in each healthcare facility the patient visited. As a patient travels from office to office, his or her history becomes fragmented such that no single health care provider has A complete picture of it. With the technology available today, electronic storage and retrieval of patient information could significantly improve access to the patientís information that is currently distributed in many healthcare facilities and offices, located across the country and around the world. This be a powerful tool in a number of ways: The Physician would get a more complete view of the patient, the trending of information would be easy, comparison to national databases on diseases and symptoms would aid in disease recognition and treatment, and access to all the appropriate test results would eliminate the cost of duplicate testing.  

            With these benefits in mind, in 1965, the federal government proposed building the National Data Center, a vast database that would be a central depository of cradle-to-grave electronic records for every citizen. The center was never built, in part because of concerns about privacy. Ownership of the information with the patient, physician and the repository needed to be considered. There were issues about confidentiality of patient information and security of access to the correct patient information. Dealing with technology and inter-state legalities were other issues. Besides, it could not be decided as to how much information should be stored for  how long so that the system is cost-effective and has fast access. One of the biggest concerns was abuse of information. 

            Though the cost, technology, access and other issues for such a major project still remain unsolved, many federal agencies and institution have built their own databases, each with their own databases, each with their own guidelines and policies. Many states are beginning to design and implement data collection form healthcare organizations to support analysis, comparative reporting, and decision making. Multi-facility organization and universities have also already begun to create these distributed networks of clinical patient data. 

            A solution to some of these issues is now being sought, as plans for a virtual repository are under way. There are several advantage to the fact that data in the virtual repository are not stored in one place. The cost storage is spread across all the organizations. The fears of information being misused by another caregiver who could browse this single, large repository are gone. In addition, there is no redundancy of the information having to be stored in two or more places. The data are protected because they do not  reside in one place. This concept will work on both global and regional levels, but it also can be used in individual institutions. For a community  hospital, it makes good business sense. The hospital does not need to buy and build a very expensive repository when all the information already exists within the existing computer systems. Whether the Internet finally makes this project a reality still remains to be seen.

Copyright © 2002 Dr. Subrahmanyam Karuturi