California Electronic Discovery Act

The California Electronic Discovery Act became effective on June 29, 2009. This important new legislation is California's first attempt to deal specifically and comprehensively with the issues presented by the discovery of e-mails, word processing document files, digital images, internet access records, and numerous other types of "electronically stored evidence" (ESI) in California state court litigation. It substantially re-vamps the California treatment of the discovery of ESI, often referred to as "e-discovery." Due to the importance of this topic, every California attorney needs to be aware of electronic discovery issues and how they will be handled in California. E-discovery is a rapidly expanding area and those California attorneys who have not yet encountered e-discovery issues in the course of their practices may reasonably expect to do so in the foreseeable future. At present, E-discovery is probably the hottest single issue in litigation

USA's Greatest Speed Skater Takes His Medical Practice to the Cutting Edge

Thirty years ago, Eric Heiden became the first athlete to win five gold medals at a single Olympic Winter Games, setting world and Olympic records and sweeping all five individual speed skating events. It's a feat no other skater has ever accomplished. He dominated the sport, set 15 world records, and after retiring, successfully competed as a cyclist, winning a U.S. championship and racing in the 1986 Tour de France.

Today, Doctor Eric Heiden is achieving a different kind of success – as an orthopaedic surgeon following in his father's footsteps and fulfilling a lifelong dream to practice medicine. It's a passion he pursues with the same drive and dedication he displayed as a world-class athlete. And just as he did while training to race, he embraces new ideas to make Heiden Orthopaedics, his Park City, Utah, practice, the best that it can be.

"There is a fine line between being successful and not being successful,” said Heiden. "Whether it's in sports or medicine or some other profession, you always need to do that little bit extra, try that little bit harder. You have to keep an open mind, watch what's going on in other industries, and then be willing to incorporate new ideas and new technologies that will allow you to do what you do even better.”

Dr. Heiden recently put that philosophy into practice at his own clinic. He is in the process of implementing a revolutionary records management software system that will take Heiden Orthopaedics to the cutting edge of information technology.

"We are on the cusp of major technological changes in the medical field with regard to patient medical charts,” he explains, "but a lot of private practices have not yet made the transition. I've been practicing medicine for 14 years, and when I was at University of California-Davis, we were just starting to put together electronic medical records. I've been watching the software capabilities expand for about eight years now. I've looked at a lot of different packages and Records Studio® was the one for us.”

Still at the forefront, utilizing high-tech to improve performanceJust as athletes benefit from high-tech gear, clothing and equipment that enables them to be faster, better, stronger, Heiden says Records Studio utilizes superior technology to help optimize the performance of all departments of his medical practice, not just patient care.

"You are always looking for ways to maximize your dollars, minimize your expenses, and better serve your patients,” he explained, "and this software does all three – plus, we were able to implement it with minimal disruption to the practice.”

A content management system that manages all physical and electronic files, Records Studio adapts to any existing records structure and works across an entire enterprise, including all of its business units and departments around the world. It allows users to create, route, store, search and retrieve data from all corporate systems and databases, including records, files, documents and e-mail.

Customizable and cost effective"One of the best things about the software,” said Heiden, "is its flexibility and ease of implementation. The platform is adaptable to individual practices and even to individual preferences within a practice. For example, my wife Karen, who is also a physician at Heiden Orthopaedics, is a hand surgeon. I'm in sports medicine. The things we want to know about a patient will be different. She's going to want more specialized hand information. I'm going to want to know about knees and shoulders. With Records Studio, we're each able to determine what we want our records to look like.

"Plus,” he added, "I'll be able to access those records from anywhere in the world, so if I'm traveling with a sports team in Europe and I need information about somebody's medical history, I have immediate access to that electronic record.”

Heiden sees potential for drastically reducing IT costs when the system is fully operational. "One immediate cost savings,” he says, "will be transcription costs. Automatic transcription will save the practice thousands of dollars each year. Generating physical charts, entering paper, storing and filing the charts – all that takes time and costs money,” continued Heiden.

A healthy choice for patients, tooGathering relevant patient information is challenging in our current health care system, says Heiden, and electronic records will provide a much more efficient and accurate way to acquire, sort, share and use information as needed, saving time and money for patients as well as doctors, and improving the quality of care. Too much information is lost, mistranslated or duplicated, all of which adds to our country's increasing health care costs.
"The health care industry is being encouraged to develop electronic medical records,” said Heiden. "There is, in fact, a government stimulus program to help with the cost of implementation. The hope is that by having an electronic medical record, correct information can be easily and securely disseminated within the medical field. Now, with paper charts, it's very difficult to gather pertinent patient information, especially if that patient has seen a number of different providers.”

The bottom line, says Heiden, is that utilizing Records Studio will allow him more time to do his real job – practicing medicine – and helping other athletes reach their goals and achieve their dreams.

Global Market for Medical Transcription Services to Exceed $48.43 billion by 2015

Global Market for Medical Transcription Services to Exceed $48.43 billion by 2015

Global market for medical transcription services is projected to exceed $48.43 billion by 2015. Growth in the industry is primarily triggered by efforts to prune down healthcare costs. Health maintenance organizations, healthcare providers, and hospitals, primarily in developed countries, are increasingly turning towards the maintenance of digital records of patient encounter, which is contributing for rapid proliferation of medical transcription services.
Medical Transcription Services are experiencing high demand due to several reasons, including insurance purposes, and detailed documentation of medical records. Though emerging technologies such as EMR systems, and speech recognition technology are threatening MT services, the industry will continue its growth, stimulated largely by federal regulations to document patient medical records.

The United States is the largest market worldwide for medical transcription services followed by the UK, Australia and Canada, as stated by the new market research report on medical transcription services. The increasing complexity of the healthcare sector, coupled with heightened demand for reliable healthcare documentation for insurance claims, have been the two major factors driving the US medical transcription industry. MT Outsourcing emerged as a best option for conventional hospitals to gain competitive edge over managed care organizations, and to fortify market standing by offering quality patient care. India is presently an undisputed leader in terms of number of offshoring contracts, followed by Philippines.

Key players profiled in the report include Acusis India, Audio Dicta Transcription Services, C-Bay Systems Holding Ltd., CBay Systems (India) Pvt Ltd., MedQuist Inc., Care Technologies India Private Ltd., Etransmed Medical Transcription, FocusMT India Pvt. Ltd., Global eBusiness Outsource, Inc., iMedX Information Services Pvt. Ltd, IQ West Outsource Technologies Corp., Scribe, Inc., Spheris Inc., TransDyne, Transmedic Outsourcing Philippines, Inc., Webmedx, Inc., and World Tech U.S.A. Inc among others.

Happy Birthday, HITECH!

Happy Birthday, HITECH!
Yes, readers of the HIM world, it was 1 year ago today that President Obama took that fateful pen to paper and signed the American Recovery and Reinvestment Act (ARRA), paving the way for electronic health records (EHRs) and all the perks and headaches associated with them.
The push for EHRs is part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, a component of ARRA with the specific goal of using a combination of technology and training to improve health care while reducing costs. Things like regional extension centers and EHR incentive payments (which you've hopefully heard all about by now), fall under the legislation, as does funding for educational programs so there's a work force available to coordinate such projects.
So far, the stimulus seems to be working. In a recent survey, nearly 50 percent of patient respondents said their doctor used digital records during their last visit. Of those 14.3 percent said their doctor had installed the electronic system within the past 6 months.
It's a great start, but there's still the problem of making sure those records can connect. Last week--perhaps in honor of HITECH's approaching milestone--the Secretaries of the Department of Health and Human Services (HHS) and the Department of Labor announced the availability of nearly $1 billion in stimulus grants to help states promote EHR adoption and build health information exchange (HIE). Among the recipients, California snagged more than $100 million to fund its efforts, while Massachusetts earned $26 million and Vermont and Tennessee secured $12 million each.
The anniversary is a celebratory moment, but it also marks a deadline for some organizations. Starting today, business associates (BAs), including medical transcription service organizations (MTSOs), must comply with the HIPAA Security Rule. Once reserved for covered entities, the extensive requirements for encryption and protection of personal health information were expanded to BAs under HITECH. MTSOs and other affected companies had a year to get in line, but now HHS is ready to drop the hammer.
What does it mean for those in the MT biz? You'll have to wait until our March issue to find out (we're checking in with industry experts to see who's prepared for HITECH). From the looks of it, BAs better hope compliance audits aren't high on the HHS agenda.

Spheris boss details company's woes

Affidavit: Company faces Indian tax hit, 'cannot endure a prolonged stay in chapter 11'

An affidavit filed in conjunction with Spheris' bankruptcy filing today sheds some light on what's been happening behind the scenes at the troubled medical transcription company, which has found potential buyers.
In the filing, Robert Butler, who has been working with Spheris since November, details "the Debtors' liquidity difficulties" and "eroding financial performance" that led it to skip an interest payment and a likely violation of some covenants of its senior credit agreement.
Accordingly, the company hired investment banking firm Jefferies & Co. to pursue the sale of its assets. Jefferies pitched more than 45 potential buyers, but the joint deal bid of CBay Inc. and MedQuist was judged to be the best offer.
Other interesting tidbits from the affidavit include:
"Competitors have been casting doubts on the company's viability" to its largest clients, who are likely to jump ship should Spheris' restructuring take a while.
Spheris employs about 4,200 medical transcriptionists worldwide, with its Indian operations providing about 35 percent of its services to customers.
The company is expecting a $2 million bill from India's tax authorities soon that, if not "satisfied immediately," could result in the Indian government shuttering its operations there."If Spheris India were to cease operating for even a couple of days, the result would be disastrous" to the company as a whole, Butler said. His team is seeking the court's permission to pay the taxes from its U.S. bank accounts.
Spheris "cannot endure a prolonged stay in chapter 11" without "significant risk" to its survival and its proposed debtor-in-possession lenders are unwilling to back a drawn-out process.
The company's four executives have employment agreements, with each earning an average annual salary of $210,000 excluding bonuses and other incentive compensation.
Its two-week payroll bill comes to $2.7 million.
As of Jan. 31, the company had about $75.6 million in pre-petition loans outstanding, including interest. Its senior credit agreement dates to July 2007.
It owes another $133.6 million on the bonds it issued in 2004. Those bonds (Ticker: SPYS.GB) fell to $17 from $48 this afternoon and now yield more than 110 percent. They were issued in the spring of 2006 with an interest rate of 11 percent.
As of Dec. 31, the company estimates it had $115 million in federal tax net operating loss carryforwards, a "valuable" asset that could be used to offset future profits. As of June 30 of last year, that number was $104 million.

PeaceHealth to lay off 38 medical transcriptionists in Whatcom region

BELLINGHAM - PeaceHealth will lay off 38 medical transcriptionists in its Whatcom region and shift the work to two U.S. companies - a move that will occur in two waves beginning Feb. 18.
The employees, who provide transcription services for St. Joseph Hospital and PeaceHealth Medical Group in Bellingham, were told Wednesday, Jan. 20.
"When I opened the meeting, I just wanted to thank them," said Dale Zender, PeaceHealth's regional chief financial officer and the vice president of finance.

"It's a really tough time. We have to acknowledge all the years of service that so many of them provided," Zender added.
About half of the local positions will be cut next month as the medical group's transcriptions are outsourced first. Those workers' last day on the job will be Feb. 17.
The services provided for the hospital will be cut starting early next year, PeaceHealth representatives said.
When completed, the cut is expected to save PeaceHealth about $500,000 annually.
PeaceHealth representatives said outsourcing the work to companies that specialize in medical transcription is more efficient, is in line with what the organization has done in its other operations in Oregon, Washington state and Alaska, and is part of a system-wide standardization.
Superior Global Solutions, out of Plano, Texas, and Transcend Services Inc., based in Atlanta, Ga., will handle the new transcription work.
PeaceHealth representatives said they have specified that the new transcription be kept on U.S. soil even though it's more expensive to do so, rather than sending it offshore to foreign work centers.
About 8 percent of the Whatcom region's medical transcription services are being done in Sri Lanka, but PeaceHealth stressed that the new work will remain domestic.
Medical transcriptionists edit and create final reports based on the dictation of doctors and other health care providers. The original dictation is turned into a draft via speech-recognition software, with results that are correct about 90 percent of the time.
Transcriptionists then look at the draft, listen to the dictation and fix anything that's incorrect.
Laid-off workers can choose a severance package, which will provide a minimum of four weeks' pay and three months' benefits, more if they have worked for PeaceHealth longer.
They also could continue working at PeaceHealth for up to six months in what is called the Project Pool, at their current rate of pay and benefits, as they look for a job elsewhere in PeaceHealth.
Affected employees also can apply for work with Superior and Transcend, which could allow them to work locally.
A work fair will be held at the Main Campus for that purpose, though PeaceHealth said the companies don't have a contractual obligation to hire the laid-off employees.
"I think that they would hire as many as they could," said Peter Krautwald, PeaceHealth's regional director of Health Information Management. "They're (affected workers) familiar with a lot of the physicians already."

Axolotl Corp. Successfully Completes Interoperability Testing at Annual Integrating the Healthcare Enterprise (IHE) Connectathon

SAN JOSE, Calif. Axolotl Corp., the nationwide leader in health information exchange (HIE) solutions and services, today announced that it successfully passed testing at the Integrating the Healthcare Enterprise (IHE) North American Connectathon event in Chicago.
The annual IHE Connectathon promotes the adoption of IHE standards-based interoperability systems in commercially available healthcare IT systems. The Connectathon serves as an industry-wide testing event where participants can test their implementations with those of other vendors.
During the Connectathon, systems exchange information with complementary systems from multiple vendors, performing all of the transactions required for the roles they have selected, called IHE Actors, in support of defined clinical use cases, called IHE Profiles. Axolotl successfully demonstrated interoperability with 20 other healthcare IT vendors. These IHE profiles represent the foundation of Axolotl's interoperability services.
For more than a decade, Axolotl’s advanced interoperability services have enabled physicians, hospitals, payers, labs, imaging centers — entire communities to securely communicate, collaborate and share clinical information, greatly improving the timeliness and safety of patient care. By bringing together information from all of the disparate systems of these diverse stakeholders, Axolotl seamlessly provides unprecedented clinical information exchange for its users.
Axolotl completed Connectathon testing for the following IHE actors in one or more IHE integration profiles.
XDS.b Document Registry (Cross-Enterprise Clinical Documents Share profile);
XDS.b Document Repository (Cross-Enterprise Clinical Documents Share profile);
PIXv3 Patient Identity Cross-reference Manager (Patient Identifier Cross-Reference HL7 V3 profile);
PDQv3 Patient Demographics Supplier (Patient Demographic Query HL7 V3 profile).
“Axolotl is committed to interoperability solutions that are based on industry standards. Our longstanding involvement with IHE and other standards bodies gives Axolotl industry-leading competencies in developing the standards-based solutions that help solve our customers' interoperability challenges,” said Glenn Keet, President of Axolotl. “We are thrilled to once again have completed and demonstrated our best of class solutions at the Connectathon.”
Additionally, Axolotl’s advanced interoperability services will be demonstrated at the Interoperability Showcase at the Annual Healthcare Information and Management Systems Society (HIMSS) Conference & Exhibition, March 1–4 in Atlanta.
About Axolotl Corp
Founded in 1995, Axolotl Corp. is North America’s leading provider of browser-based products and services for secure health information exchange and management. Its award-winning Elysium® Exchange suite of solutions enables health care providers to instantly share information, reduce costs, and improve quality and efficiency.
Elysium helps thousands of health care entities—including hospitals, health systems, regional health information organizations (RHIOs/HIEs), clinics, laboratories, radiology centers and physician practices—to securely exchange clinical information for more than 25 million patients. Elysium’s community-wide Master Patient Index, EdgeServer(s), Interoperability Hub (I-Hub), Community Virtual Health Record (VHR), and certified ambulatory EMR with integrated e-Prescribing are all provided as a software service (SaaS). Axolotl-employed U.S.-based transcriptionists, combined with an integrated NLP engine, provide high-quality medical transcription services for acute and ambulatory care environments connected to Elysium HIEs.
Axolotl is based in San Jose and best known for introducing Clinical Messaging®, now at the heart of all health information exchange. For more information about Axolotl, see www.axolotl.com.