Download the Fact Sheet PDF

FOR IMMEDIATE RELEASE Media contact:
October, 2010 Kevin W. Irland
703-886-1117
kevin.w.irland@verizon.com

Verizon Expands Medical Data Exchange to Include Broader Range of Patient Health Data

Expanded Focus Allows More Physicians, Health Care Providers to Digitally Share X-Rays, Lab Results to Accelerate Use of Electronic Medical Records

October 14, 2010

BASKING RIDGE, N.J. – In its continuing efforts to help the health care industry accelerate the use of electronic medical records, Verizon is expanding its Medical Data Exchange platform to allow more types of digital patient health data to be shared.

Previously, the Verizon Medical Data Exchange facilitated transcriptionist-to-physician and physician-to-physician sharing of dictated notes – itself a significant step in the adoption of electronic medical records. The expanded offering now enables a wider range of health care providers – from large health systems to rural hospitals to small physician practices – to securely and privately share additional digital records such as X-rays and lab results.

To help enable this transition, Verizon is introducing new IT consulting services that are well-suited to meet the needs of providers that can now use the Medical Data Exchange. These professional services will help members of the exchange quickly leverage the nationally available platform as more providers increasingly embrace electronic medical records.

“The Verizon Medical Data Exchange is a first-of-its-kind platform and another important step in realizing the promise of a truly digitized health care system in the U.S.,” said Peter Tippett, vice president – technology and innovation, Verizon Business. “The expanded capabilities of our data exchange will help accelerate the shift from paper-based to electronic-based medical records, and in the process help speed patient diagnoses and drive productivity and cost efficiency throughout the U.S. health care system.”

Verizon continues to sign on new members to the expanded exchange, including Alert Notification, a personalized emergency notification and health records provider; Amaji, a provider of digital clinical documentation services; NLP International Corporation, a provider of natural language processing software; Tolven Inc., a provider of open-source health informatics software solutions; and ZyDoc Medical Transcription, a provider of medical knowledge-management solutions. These members join the founding members of the group, which include Verizon; ICSA Labs, an independent division of Verizon Business; the Medical Transcription Industry Association; and medical transcription companies MD-IT, MedQuist, MxSecure,Sten-Tel and Webmedx.

In addition, the Medical Transcription Service Consortium, which was created to support the operation of the exchange, has been renamed to reflect the consortium’s expanded mission and focus. The new name for the group is the Medical Data Exchange Consortium. ICSA Labs continues to play a key role in managing the consortium and its activities as a neutral third party.

“Verizon is delivering on the initial promise of moving the focus of its Medical Data Exchange beyond transcriptions to encompass the entire health care ecosystem,” said Amy DeCarlo, principal analyst – security and data center services, Current Analysis. “Opening up the platform to other forms of medical records will encourage the sharing of digital information in a secure manner.”

Verizon Medical Data Exchange Brings the U.S. Closer to Broad EMR Adoption
Beginning in 2011, the U.S. federal government will offer health care providers financial incentives to spur the widespread adoption of electronic health records. As part of the American Recovery and Reinvestment Act of 2009, a total of $27 billion will be invested over the next decade, representing the first substantial commitment of federal funding to boost adoption of electronic health records across the U.S. health care system.

Launched in March, the Verizon Medical Data Exchange is a pivotal step toward the sharing of electronic medical records in the U.S. Available nationally, the exchange is designed to meet meaningful-use requirements established under the 2009 Health Information Technology for Economic and Clinical Health Act. These requirements are a set of interoperability standards, implementation specifications and certification programs intended to certify electronic health record technology to enable clinicians to better coordinate patient care and reduce administrative costs.

“The Verizon Medical Data Exchange enables us to help our clients demonstrate meaningful use in several critical ways,” said Robin Daigh, vice president, marketing and business development, MD-IT. “Meaningful use requires that hospitals and eligible physicians securely and electronically share health information. With minimal investment and a mandatory security audit, the exchange helps meet these requirements with the added benefit of maintaining existing provider work flows.”

Verizon Connected Healthcare Solutions
Verizon Connected Healthcare Solutions offers a comprehensive portfolio of managed, IT and consulting services for the health care industry that help transform patient care delivery, enhance access to care and better manage costs. Visit thewebsite for more information.

About Verizon Business
Verizon Business, a unit of Verizon Communications (NYSE, NASDAQ: VZ), is a global leader in communications and IT solutions. We combine professional expertise with one of the world’s most connected IP networks to deliver award-winning communications, IT, information security and network solutions. We securely connect today’s extended enterprises of widespread and mobile customers, partners, suppliers and employees – enabling them to increase productivity and efficiency and help preserve the environment. Many of the world’s largest businesses and governments – including 96 percent of the Fortune 1000 and thousands of government agencies and educational institutions – rely on our professional and managed services and network technologies to accelerate their business. Find out more at www.verizonbusiness.com.

VERIZON’S ONLINE NEWS CENTER: Verizon news releases, executive speeches and biographies, media contacts, high-quality video and images, and other information are available at Verizon’s News Center on the World Wide Web atwww.verizon.com/news. To receive news releases by e-mail, visit the News Center and register for customized automatic delivery of Verizon news releases.

The HITECH Act, part of the Ameri- can Reinvestment and Recovery Act (ARRA), offers $44,000 incentives for clinicians who adopt an Elec- tronic Medical Records (EMR) system. The qualifier is that clinicians must demonstrate “Meaningful Use” of their system. Definitions of Meaningful Use are currently being shaped by the Office of the National Coordinator of Health Information Technology (ONCHIT) and the Department of Health and Human Services (HHS).

In a poll of leading EMR vendors1 about what they feel will emerge in the Mean- ingful Use definitions, ePrescribing, interoperability and quality reporting were recurring themes. According to Evan Steele, CEO of SRSsoft, “We define Meaningful Use from the physicians’ perspective. Meaningful Use of an EMR is achieved when that EMR successfully enables a physician to accomplish his or her goals for quality of care, cost-effec- tiveness, and outcomes measurement— and it is more likely to be achieved by technology that does not compromise productivity or practice style.”

Steele asks, “How can physicians become meaningful users of systems that have been shown to reduce their productivity?” This is a key question that HHS and ONCHIT should be addressing in the Meaningful Use definitions. Without “practical use,” there can be no Meaningful Use.

Just last year, a New England Journal of Medicine survey2 indicated that only 4 percent of clinicians have a fully functional EMR (with order-entry and clini- cal-decision support capabilities), and only 13 percent have a basic system. A report published by AC Group,3 a well-known health IT consulting firm, shows a 73 percent failure rate of EMRs due to usability frustrations, noting that when clinicians lose the ability to dictate narrative notes and are forced to directly key dataintoanEMR,ittakessignificantly longer to document patient encounters. The result is either a reduction in the number of patients seen or longer hours spent keeping up with documentation.

Narrative dictation has been the documentation method of choice of clinicians for decades because of its proven efficiency. It is the fastest, most accurate way to capture a patient’s comprehensive health story. In 2007, the Joint Commission reported a non-compliance factor of 26 percent among hospitals for standard IM.6.10: The hospital has a complete and accurate medical record for patients assessed, cared for, treated or served.4 If we make clinicians’ jobs more difficult when it comes to documenting medical records, in which direction do we think this statistic will move?

Where Medical Transcription Fits

Narrative dictation has a partner—the Medical Transcriptionist (MT ). The MT constituency, supported by two associations—the Medical Transcription Indus- try Association (MTIA) and the Asso- ciation for Healthcare Documentation Integrity (AHDI)—converged on Capitol Hill in early June to address members of Congress and the Senate about the state of the industry. Few people outside of healthcare even know that the medical transcription industry exists. Fewer people, even in healthcare, have a real understanding or appreciation for the role medical transcription plays in patient safety and risk management.

Against the backdrop of a national, interoperable Electronic Health Record (EHR) system, it’s little surprise that health information technology (HIT) constituents would view medical transcription labor as an expendable cost of healthcare. In fact, it is the mantra of many EMR vendors: “You can replace your transcription with our technology.” Not only is this untrue, but transcription offers other benefits:

• Clinicians benefit by being more efficient
• Patients benefit by having more complete and accurate patient records
• The more than 300,000 MT constituents benefit by maintaining the craft they call their livelihood
• HIT constituents benefit because tran- scription is an EHR/EMR adoption enabler

Speech Recognition

EMR technology is a valuable tool, but if one critical lesson has been learned through deployment of speech-recognition technology (SRT), it’s that technology is, in fact, just a tool—not a replacement for human intelligence.

For definition purposes: “Frontend” SRT is a realtime speech-to-text translation process whereby the clinician corrects the document while dictating; “Backend” SRT is a delayed speech-to-text translation process whereby the clinician dictates and the audio is subse- quently translated for correction by an MT. The main difference between the two methods is whether the clinician interacts with the computer to generate documentation or just dictates, leaving the documentation to medical language specialists—MTs.

For decades SRT aimed to replace the transcription labor market with technology. Eventually SRT market leaders recognized the role and value of MTs in advancing SRT solutions: MTs support the efficient clinical practices of familiar narrative dictation; they bring human intelligence and expertise needed to correctmedicalerrors,whethercreated by the clinician or by SRT. In the end, SRT benefited from the work of MTs, increas- ing market adoption and advancing the role of MTs.

The lessons learned by SRT vendors are slowly being embraced by EMR vendors. If clinicians continue to reject technology that does not support improved efficiency and economic impact, the market will right itself through consumer pressure, and hybrid solutions involving MTs will emerge just as they have with SRT.

As HIT legislation is being written and HHS and ONCHIT define Meaningful Use, MTIA and AHDI are using these lessons learned about the importance of narrative dictation and the significant role transcription should play as an acceler- ator for EHR adoption5 and member of the HIT community. Ultimately, Meaningful Use flows from practical use, and for the majority of clinicians, practical use flows from narrative dictation.

As Steele notes, “Everyone wants the EMR incentives, but the realities of a fast- paced, busy medical practice will cause physicians to abandon the EMR systems just as they have been doing en masse without the incentives. The incentives will only accelerate the demise of traditional point-and-click EMR systems as physicians with less IT proficiency and a lower level of IT support attempt to use the very same systems that have failed among the deep-pocketed, more technically savvy early adopters.”

Not Just Transcription–Discrete Reportable Transcription (DRT)
Since transcription involves the craft of memorializing the spoken word into the written word, it is often confused with clerical work and not perceived to be part of health information technology. Medical transcription in its most useful form actually involves a number of critical HIT components:

• Discrete Data encoded with XML and formatted for CDA or CCD standards to aid interoperability
• Natural Language Processing (NLP) to extract specific data elements that enable automation for Decision Support, E&M Coding, PQRI (Quality Measures) Report- ing and any process that calls for data mining
• Backend Speech Recognition to improve productivity and help control costs

These are the technologies of the medical transcription industry, readily provided by Medical Transcription Service Organizations (MTSOs) directly or through third-party partners, and

bearing significant value when coupled with the service of transcription knowl- edge workers (MTs). When delivered as DRT, medical transcription is, in fact, very much part of HIT and a key enabler of EHR adoption and “practical use.”

Natural Language Processing (NLP) and Discrete Data
Natural Language Processing converts human language into representations that enable computer programs to inter- pret for data manipulation. Once free-form text is in this discrete form, it can be mined for valuable information that feeds virtually any and all healthcare process systems, including EMRs, enabling automation for coding, reporting and so forth.

Consider the logic of how information flows from the human mind to meaningful data in the most natural way:

1. Knowledge and information is originated by the human mind, beginning with an idea or concept.
2. Since talking is the fastest, easiest and most comprehensive method of knowledge and information transfer from the human mind, narrative dictation most effectively expresses those ideas or concepts.
3. Transcription provides conversion of that analog information from audio to readable (essentially “digitized”) text.
4. During the conversion, human intelligence is applied (by MTs) for interpretive integrity and contextual accuracy that technology alone cannot validate. (With the aid of speech recognition that conversion of voice to text can aid the transcrip- tion process with some efficiencies.)
5. Once memorialized (digitized), the information is subject to manipulation by software (such as NLP) that can break that information down into meaningful discrete data elements, encoded with data exchange language (such as XML) to make the information completely interoperable.

Could it be any easier for clinicians to get from concepts to Meaningful Use? Discrete Reportable Transcription strikes the right balance between technology, human intelligence, practicality/usabili- ty, economic pressure and interoperabil- ity. Despite the EMR mantra to eliminate transcription, it turns out that transcrip- tion is one of the EMR’s greatest assets to adoption.

Impact on Quality of Patient Cares When it comes to billing, improper coding can lead to penalties.Who would, therefore, entrust coding to technology alone? Although NLP offers coding automation, no one would send out a bill without proper validation from a qualified coder. NLP can do for coders what SRT does for medical transcription- ists, but in the end, human intelligence is necessary to ensure integrity.

Coding occurs after medical services are provided. The worst thing that can happen when coding and billing are wrong is a financial consequence. Docu- mentation, on the other hand, happens after and before patient care. The worst thing that can happen when documen- tation is wrong is a consequence that could be deadly. (Incidentally, documentation feeds coding, so it could also lead to billing errors.)

MTs must be skilled knowledge workers— technologically savvy medical language specialists—with vast medical vocabularies and interpretive skills to recognize and correct medical errors that mitigate risk and help protect patient safety.

Quality Case Studies

Numerous studies have been conduct- ed to assess quality of data capture via direct data entry, as well as via narrative dictation.

Case # 1: A study by the U.S. Department of Veterans Affairs about Direct Data Entry6 revealed that the average number of significant errors per patient via direct data entry is 7.8. The study also reports direct data entry to be the “least favorite method” of health information data capture by clinicians, prone to a new class of errors not found through traditional methods of documentation, such as copying and pasting, forwarding old data without updating it, and indicating contradictory findings.

Case # 2: In a follow-up study by the V.A. in 2007 addressing“critical”issues in an electronic documentation system,7 the researchers found that “although all clinicians use copy and paste tools, they also complain that it is a dangerous prac- tice.” Other key findings:

• Lack of Confidence: The research indi- cated a significant trust problem, noting that many providers had become skep- tics about the veracity of the electronic chart. Copied text would not properly reflect changes in patient status. Problem lists would be brought into the note as a whole object instead of discrete data and were often not up-to-date and accurate. Medication lists were noted as the most severe and dangerous problems, often not accurately representing what the patient was intended to be taking.

  In response, the researchers urge EHR designers to develop software that high- lights the presence of copy-and-paste text, alerting users to be careful.

• Information Overload: Pharmacists particularly complained of the extensive amount of time required to determine why a patient was on a specific medica- tion. Nursing notes often had extensive templating, with up to 90 percent of the notes having empty or default values.

  Many physicians reported avoiding nurs- ing notes in order to save time, assuming that if there was a problem, the allied health professional would call.

  In response, the researchers recommend that “use of templates should be minimized as much as possible as they take up a lot of space for very little true information.” They encourage EHR designers to develop software for creating and inserting more fine-grained coded objects, so notes can still be created rapidly, but be more like normal documenting.

• Decision-Making: Most providers reported the difficulty of extracting meaningful data from a large number of notes and confusing text. Since many clinical condi- tions require tracking or trending, individual providers had to resort to paper lists they would keep. In addition, because the objects being pulled into the notes were simply pasted in either chronological or alphabetical order without regard to their relevance to the problem at hand, readers had difficulty discerning the full thoughts and intent of other providers.

  In response, the researchers recommend support of narrative dictation capture with DRT: “The insertion of large amounts of data automatically into narratives circum- vents some of the cognitive processing that providers would otherwise undertake when constructing a note. Automatically inserted data is left in raw format for several reasons including time costs to edit and verify the information.The inserting provider may not even read it. The task of the system designer is to ensure that insertable coded data is both part of workflow as well as supportive of cognitive processing.”

Case #3: In a study conducted by the Medical Transcription Industry Asso- ciation regarding narrative dictation accuracy,8 it too revealed errors during creation—in this case while dictating— with an average of 0.3 errors per dictation. Critical errors accounted for 32 percent and major errors for 68 percent of all dictation errors. The most common criti- cal errors were reporting on the wrong patient, providing a wrong drug name or dosage, and dictating contradictory information such as “left side/right side” or inconsistent medical findings. The most common major errors were use of made-up words or acronyms, followed by gender or age mismatch. With the aid of a Speech Recognition translation engine, the error rate actually increased to 1.3 errors per dictation.

Three associations, AHIMA, AHDI (formerly AAMT ) and MTIA, have estab- lished quality scoring metrics and stan- dards with an expected documentation accuracy rating of 98 percent or above. Direct data entry, narrative dictation and speech recognition all significantly fail to meet that benchmark, averaging 85 percent accuracy overall. By contrast, MTs are held to a 98 percent accuracy standard.

Workforce Development, Credentialing and Offshoring
As the baby boomer population ages and patient visits increase, the need for quali- fied MTs is actually increasing. During the visit to Capitol Hill, medical transcription industry leaders discussed industry initia- tives to develop labor for this important sector further, as well as formalizing stan- dards and certification, since this job truly can be a matter of life and death.

AHDI and MTIA have worked with the U.S. Department of Defense (DOD) and Department of Labor (DOL) in creating an initiative called Mission Medical Tran- scription: The Career that Moves with You.9 This career outreach program targets military spouses interested in a portable career within the expanding health IT arena. Since Mission Medical Transcription was launched in 2007, more than 800 military spouses have enrolled in AHDI-approved schools.

Offshoring transcription is another chal- lenge that should require stiffer regula- tion, both because of privacy concerns and workforce qualifications. A signifi- cant percentage of transcription is done offshore because the industry has failed to develop a stronger U.S. workforce to keep up with demands, and because too many consumers of transcription place so much weight on cost-savings when considering healthcare documentation solutions. This is truly a slippery slope and needs to be better regulated to ensure that patient safety comes first.

Economic Impact and Getting the Stimulus Money Economically, does it make more sense for a clinician earning $200 per hour to spend time generating documentation, or an MT who earns a modest $20 per hour—and which of those two profes- sionals produces the best quality result?

As “Goliath” HIT vendors influence the definitions of Meaningful Use and legis- lation is written to drive the nation to a national, interoperable EHR, the little known MT sector will flex its “David” muscle with two principal objectives:

1. Influence HHS and ONCHIT to include “practical use” as a prerequisite to Meaningful Use and take the time to understand the dynamics and impact of documentation, both from a usability perspective and a patient safety perspective. Further, to communicate that narra- tive dictation and transcription are not only a quality assurance necessity, but very much a part of HIT and interoperability when understood in the context of DRT.
2. MTIA has forged an EMR Work Group to define interoperability standards between MTSOs and EMR vendors. Unlike EMR vendors, who take aim at transcrip- tion as an unnecessary cost of documentation, MTSOs are not interested in competing with EMR vendors. The goal is to cooperate and complement—to drive

a successful national Electronic Healthcare System initiative without pillaging the assets clinicians and others depend on to ensure integrity, safety, practical use and Meaningful Use. In the end EMR vendors that work with MTSOs will come out on top.

This article was originally published in the June 2009 issue of Healthcare Ledger.

_____________________________________
For additional information on DRT, view the video at http://www.mtia.com/downloads/MarkAndersonVideo.wmv
_____________________________________

References

1. EMR Vendors on HITECH – Part Three of a Series http://www.histalkpractice. com/2009/03/19/emr-vendors-on-hitech-part-three-of-a-series/

2. The New England Journal of Medicine – a National Survey of Physicians http://content.nejm.org/cgi/content/abstract/NEJMsa0802005v1

3. Mark R. Anderson, FHIMSS, CPHIMS, CEO, AC Group – DRT-enabled EHRs http://www.acgroup.org

5. Critical Issues in an Electronic Documentation System. http://www.pubmedcentral. nih.gov/articlerender.fcgi?artid=2655797

6. MTIA/AHDI Industry White Paper: Medical Transcription – Proven Accelerator of EHR Adoption http://www.mtia.com/Downloads/White_ Paper-Medical_Transcription-Proven_Accelerator_of_EHR_Adoption.pdf

7 Direct Text Entry in Electronic Progress Notes – An Evaluation of Input Errors http://square.umin.ac.jp/DMIESemi/ y2003/20040216/03010061.pdf

8. Improving the Accuracy of Narrative Patient Notes (Daigh, et al.), “The Role of Documentation Specialists in Supporting Physician Use of EMRs” http://www.mtia.com/downloads/DictationErrorReportAbstract.pdf

9. Mission Medical Transcription: The Career that Moves with You.
http://www.defenselink.mil/News/newsarticle.aspx?id=32890

Today, the transcription industry faces challenges both in maintaining the stability of its value proposition to the healthcare community and in expanding.  As with the Roman Empire, a
good highway is critical, not to move physical goods and services, but to move the value product of 21st century healthcare data.

We often hear in healthcare news about the NHIN (National Health Information Network) as well as HIE’s (Health Information Exchanges). These kinds of initiatives point to the value that everyone in the healthcare community recognizes in being able to effectively exchange, share and move healthcare information.  In the forthcoming standards for “Meaningful Use” as set by the federal government, interoperability is the critical cornerstone to those standards.

How does information get moved today?  From the perspective of the transcription service organization that produces some of the 1.2 billion patient notes on an annual basis, it is currently done with difficulty.  With an infinite variety of systems and architectures, getting data out of one system and organization and into another requires an army of dedicated developers, engineers, and associated resources.  Standards vary from facility to facility, location to location.  Considering that 25% of those notes are shared with other providers, the task to efficiently and securely exchange this information is formidable.  What is needed is a highway, an effective efficient method of transport that addresses these business concerns.

In early 2009, Verizon Business began to take a close look at healthcare and asked how they could best utilize their resources as one of the biggest infrastructure providers and managers to bring efficiency to healthcare.  Out of this examination, came the formation of a private, secure, network-based platform designed to meet all NHIN requirements.

Verizon engaged the leading transcription companies in the U.S. in an effort to bring the best solution providers to this exchange.  A consortium was formed which included ICSA Labs, MTIA, StenTel, MedQuist, MD-IT, Webmedx, and  MXSecure as original founding members of the exchange with a singular unified purpose to simplify the exchange of healthcare data.  MDex (Medical Data Exchange) encompasses authentication, security, delivery, and messaging standards using available technology and standards.

MDex will initially allow transcription service organizations to seamlessly send data from one facility to the other while protecting the business relationship, maintaining security, and improving delivery methods, especially when compared to email and fax.

Like the roads of the Roman Empire, MDex will allow effective transport of critical data throughout the healthcare domain.  The aggressive implementation and solution goals set by Verizon and the consortium of transcription service providers will ensure that platform providers will have first access to this system.  In the near future, access to MDex will become available to other health care organizations including EMR/EHR companies, pharmaceutical, labs, and others.

StenTel is proud of our participation in this project with Verizon.  We strongly believe that this exchange will help to not only maintain the stability of the MTSO value proposition but will help it to grow and expand.  StenTel is working hard to integrate the MDex into its existing platform, continuing to develop the value that our customers expect, require and must have.

MedPlus’ Care360 solution has been implemented and used by 150,000 practitioners within North America for Labs and EPrescription services. MedPlus recently added the EHR functionality to their Care360 solution to expand its footprint within the ambulatory market. The addition of StenTel’s EntriPoint and related dictation functionality and services, further enhances the Care360 product as it allows practitioners to continue their day-to-day practices while leveraging the value of a fully integrated EHR solution.

• Notice to patients alerting them to breaches “without unreasonable delay,” but no later than
• 60 days after discovery of the breach
• Notice to Covered Entities (CEs) by Business Associates (BAs) when BAs discover a breach
• Notice to the secretary of HHS and prominent media outlets about breaches involving more than 500 patient records
• Notice to next of kin about breaches involving patients who are deceased
• Notices to include what happened, the details of the unsecured PHI that was breached, steps to help mitigate harm to the patient, and the CE’s response
• Annual notice to the secretary of HHS 60 days before the end of the calendar year about unsecured PHI breaches involving fewer than 500 patient records

The breach notification requirements for CEs went into effect on September 23, 2009 and on February 17, 2010 for Business Associates.  As such, revised HIPAA Business Associate Agreements (BAAs) must be executed between CEs and BAAs. Other basic recommendations of ensuring compliance are to:

• Pay Attention to the HIPAA Security Rules: Many organizations attempt to comply with HIPAA Privacy Rules but ignore HIPAA Security Rules. HIPAA Security Rules contain 20 separate “standards” that an entity must address. The standards deal with technical and procedural controls, such as workstation security, facility access control and contingency planning.
• Create a WISP and Document HIPAA Policies and Procedures: Policies and procedures to address HIPAA requirements must be written and communicated to employees, and more importantly must accurately reflect your actual practices. Developing a WISP (Written Information Security Policy) is a must.
• Perform a HIPAA Security Assessment: A required but often overlooked step to HIPAA compliance is to perform (and document) a security assessment.  §164.308 of HIPAA requires an entity to “conduct an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of electronic protected health information held by the…entity.”
• Train Employees and Implement Sanctions for Violations: Employees must be trained on HIPAA in general, and on your organization’s specific policies and procedures. HIPAA also requires an organization to apply sanctions to employees who violate HIPAA or your policies.  §164.530(e) of HIPAA states that “…an entity must have and apply appropriate sanctions against members of its workforce who fail to comply with the privacy policies and procedures of the …entity or the requirements of (HIPAA)”.

In the financial, legal, and healthcare business sectors, security continues to drive and account for significant portions of existing operational and IT budgets.  According to Forrester Research in their “State of Enterprise IT Security 2008-2009”, when asked, “How important to your IT security organization will security be in the next 12 months?” the respondents rated data security as #1, application security, #2, and alignment of IT security with business practices at #5, respectively, as their primary concerns.

In the U.S. alone, there are at least 8 federal laws and statutes related to
security that apply across all business sectors including retail, healthcare,
financial, pharmaceutical, and public and private sector interests. In
addition to federal steps, individual states are enacting security and privacy legislation that is even more prescriptive. Massachusetts regulation 201 CMR 17, which became effective March 1, 2010, is the most restrictive in the nation, mandating the protection of PII
(Publicly Identifiable Information) through encryption and security measures that every business in the state must meet.

Any security expert will tell you that effective security is made up of multiple, overlapping, redundant layers.  This applies, not just on a technical level but also from a business practices
and human resources perspective.
We take the same approach to security as well.

What is StenTel doing to meet these challenges and ensure that both internally, as an organization, we are secure, and that our partners and customers can have peace of mind knowing they are
working with an organization that takes security seriously?

From a technical point of view, StenTel safeguards its infrastructure and communication by employing the most effective security strategies.  Our data center is a SAS 70 Type II certified data center.  We fully utilize the expertise from Cisco Systems in developing a network infrastructure that passively and actively monitors and responds to security threats.  Our business communication is fully protected by the world-class encryption capabilities of the Zix Corp. e–mail encryption solution set.  Even data used by StenTel and stored in “the cloud” is fully encrypted and protected, utilizing the best in breed solutions from Mezeo.

Additionally, the best technology is useless unless business practices align with IT security.  To accomplish this, an organization can’t simply say that they are aligned, they have to demonstrate it.  StenTel is proud to have achieved SysTrust certification as audited by a 3rd party firm in October 2009. SysTrust certification in the areas of confidentiality, security, and availability means that the methods and approaches that StenTel uses in performing business
operations, meet internationally recognized “best practices”.  The evaluation framework that these principles from SysTrust are based upon help ensure that StenTel maintains a proactive alignment of security to business in a prospective manner.

Lastly, and most importantly, the human element must be addressed from
a security perspective.  This means that we have to take the time to help our employees and contractors appreciate the critical nature of security—how to be ‘security-conscious’ and function in their job roles in a secure manner.  Every StenTel employee spends time on an annual basis attending HIPAA and
Security & Privacy training to ensure that they are aware and value the role that their actions play in keeping security paramount to the success of our business and those of our partners and customers.

From the lessons that we have learned, we bring intrinsic value to you as a customer, client and partner.  Additionally, we have leveraged our expertise and technology to provide solutions to businesses that want to adopt a strong security posture.

To learn more about our security services and products, please visit
www.stencrypt.com.

So what does all of this mean for you?  While security and responses to security threats will continue to evolve and mature, StenTel is committed to going beyond technology alone to a secure way of doing business.

With HITECH, ARRA, Meaningful Use, Interoperability, security, privacy, business intelligence, analytics and profitability staring down every business and organization, what is one to do?

Tackling all of these things (and more) individually is impossible enough, but the challenge is made more difficult when IT and business fail to engage one another. To meet these needs and those that are yet unknown, it is critical that businesses align their  IT with their business objectives, so  the two are in sync.  Only then can IT truly support the business and only then can the business meet its IT objectives.

Much of what is driving the great debates taking place in the private and healthcare sectors is related to the ability to manage on one hand the need for openness to information exchange, and on the other to protect what must be private.

What is StenTel doing
to align IT and business
needs together?

We are taking a multi-pronged parallel approach. First, we are looking carefully at our existing platform to see how it can and will evolve to meet both existing and future needs. For example, as we develop our Apollo project, we do so at a pace that allows us to pause long enough to address how this suite of products will best conform to the new security requirements of HIPAA 2.0 and the HITECH Act. Additionally, our desire to integrate the Verizon Medical Data Exchange into our platform to provide secure information exchange across the healthcare domain has helped us to set the appropriate development priorities.

Additionally, if we learned no other lesson from our SysTrust certification, it was that the proper framework for a business process lies in allowing enough time for proper execution.  So what does this mean?  That StenTel will work at releasing better quality, better designed products and services, but will do so at a pace that allows them to be mature, stable, and effective immediately upon their release.  In the past, the more frantic pace of updates, application changes, etc., challenged the overriding priority to do the right thing for the customer.  After all, faster is not necessarily better.

Our overarching goal is to provide, not just the Information Technology, but the Business Technology that our customers and our organizations require.  This means working hard on the appropriate resources to make them work better for your business, rather than just giving platforms and applications a facelift.

So we are working behind the scenes in what are, at the moment, not very visible ways to deliver a more efficient, secure, scalable workflow platform for not only transcription, but for healthcare data services.  Consider it the site work that will be a requirement to build the foundations of what is to come in the future of healthcare IT.

Since then the medical transcription industry has faced the threat of obsolescence by speech recognition and more recently by point-and-click electronic medical records (EMR) technologies.  Through it all, two prevailing themes have kept the medical transcription industry and its U.S. workforce of over 400,000 in tact:

Technology alone is not smart enough to ensure the level of accuracy and documentation integrity offered by human intelligence that trained medical transcriptionists bring.

Busy physicians cannot justify the time spent or the cost to document records through self-edit speech recognition or self-entry EMR technology means, when medical transcriptionists can do the job for a fraction of the cost.

Many technology providers have suggested for years that transcription can and will go away.  Most practitioners today recognize this to be impractical and do not wish to give up the practice of narrative dictation.  StenTel’s response is to embrace the threat, reinvent ourselves, and deliver services and products that drive new value.  (It takes a medical transcription, and technology provider to recognize the problems and offer practical solutions.)

In 2010, StenTel prefers to no longer think of itself as a medical transcription and technologies provider, but rather a health information management
solutions provider.  Our goal is to help our clients leverage clinical documentation services and technologies to meet the emerging challenges of health data management .

How do we do this?

At the core of this is a powerful tool called natural language processing (NLP). NLP takes ordinary text documents and codifies them for data extraction.  A document presented with standard markup language, such as XML, HL7, CDA or CCD hold much greater potential than just a text document.  When documents can be structured and mined, it means the information, broken into discrete data elements, can be imported into EMRs and/or used to support analytics and reporting for applications such as core measures, PQRI, coding, decision support, and a number of reporting requirements for achieving “Meaningful Use”.

Narrative dictation is the easiest, fastest and most complete method for clinicians to express themselves when originating information capture.  That’s why it is so important and valuable to them.  Unlike solutions that aim to take that practice away from clinicians in its purest most effective form, StenTel offers the means to advance it.  Yes, we use backend speech recognition as a tool that is transparent to the dictator to enhance transcriptionist productivity and reduce consumer costs. Regardless of the solutions we develop or the tools we use, we always protect clinicians’ most valuable asset – freeform narrative dictation – and apply technology to then bring out the most value that information can generate.

StenTel offers a broad range of health information management products and services.