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I've noticed a lot of practitioners use PhraseExpander or some other shortcut writing tool to write their patient notes - I'm curious to know how they get aroun

I've noticed a lot of practitioners use PhraseExpander or some other shortcut writing tool to write their patient notes - I'm curious to know how they get around the HIPAA certifications, especially since they are a dedicated key logger on top of any OS. Do you have any insight in this arena? I wonder if it is because they are not 'the record,' but instead are 'tools to create' the record that is eventually uploaded and stored in another platform? Might be a tangential question, thanks for the patience

duffpkg 6y ago
There is a lot of controversy in this area. Medicare rules are pretty clear that to the extent tools like that are used systematically to enhance bill-ability they are prohibited. Malpractice litigation is having a field day with computerized systems which is why so many states are being pressure to institute caps. Pretty much everyone tries to use templating tools to increase bill-ability to some extent. Healthcare is rife with conflicting goals. The underlying problem is that we need an economical way for doctors to have more time to spend in the room with patients but no one, patients included, wants to pay for that. I really hope "concierge" medicine, a lot of that now happening on the lower priced end not only for "luxury patients", continues to take off. You pay some cash out of pocket but get care that is dramatically better and more preventative.
- anonymouse008 6y ago
  Woa -- do you have a link to the regulation (chapter, but looking at Medicare fully now) to things that are designed to "systematically to enhance bill-ability"? So you're saying if you use a templating tool to be more efficient and save time, it's explicitly not allowed AND you're opening up either yourself or the technology tool to malpractice litigation?! Goodness!
  - duffpkg 6y ago
    Malpractice is a totally separate thing from Medicare Fraud. With respect to malpractice, having automated or semi-automated encounter notes with huge systematic similarity looks absolutely terrible if something goes wrong. Don't take my word for it, consult your attorneys. With respect to Medicare fraud see the False Claims act and its interpretation in the enforcement actions against many parties beginning in 2016. Keywords would be like "not medically necessary" and "upcoding". I believe the monster enforcement action just this week against GHC also involves that.
    - anonymouse008 6y ago
      Goodness -- thank you very much for this potent thread. Good wishes to all your works!
    - manapause 6y ago
      Let us not forget “stand in your shoes” Stark provisions which made many a brother-in-law who owned a DME company very sad. Hospices dropping off cookies with their contact information is kosher. Incentivizing a medical office to hit 100 nebulizer-orders, or cpap referrals -> federal prison.
- nradov 6y ago
  Concierge medicine won't solve anything at scale. We have a shortage of physicians, especially in primary care, and it's only getting worse as the population ages. What we really need is just more doctors. The federal government should remove the bottleneck by boosting funding for residency program slots.
manapause 6y ago
My experiences in healthcare/EMR were focused on Medicare part B (home health); physicians, NPs, and PAs that made house calls. This is a great question; being thrust into hippa compliance from 2000 - 2012 was the easy part, and can perhaps be summed up as “ fax machines behind a door, paper charts and/or laptops/tablets locked in trunks*, all-in Blackberry enterprise services, Exhange over ssl xml-rpc endpoints, and ensuring EMR portal uptime was so much of the fun parts. The hard part: training home health medical groups how to VPN - and how to never mix work tech and personal tech.” I am unaware of hippa changes since the blackberry-era, and while I can’t imagine specific apps being named in amendments to the law, I can say without a doubt that hippa at the time meant having total control over all technical Devices used by your clinicians, prepping all laptops and equipment to use encrypted storage, ssl-encrypted email, VPNs, etc was always made easier by focusing on training, troubleshooting, and being able to mitigate the raw chaos monkey power of a doctor with a gadget. With the passage of the HITECH act, being able to facilitate the automated logging of a doctor’s conversation with a patient’s family or caregiver towards the CPO (care plan oversight) and making the fulfillment of PQRI initiatives automatic... “so easy a doctor could do it”... meant (at the time) a very hefty pay raise for part-B collections. TLDR: hippa was easy, training doctors to change their ways is hard. producing the tech that makes their lives easier means assuaging them of their worries that they are maximizing Medicare collections. It is fun to imagine these days that transcription, location, and barcode technology has “made it” to the point we dreamed about ~10 years ago.

duffpkg 6y ago

There is a lot of controversy in this area. Medicare rules are pretty clear that to the extent tools like that are used systematically to enhance bill-ability they are prohibited. Malpractice litigation is having a field day with computerized systems which is why so many states are being pressure to institute caps. Pretty much everyone tries to use templating tools to increase bill-ability to some extent. Healthcare is rife with conflicting goals. The underlying problem is that we need an economical way for doctors to have more time to spend in the room with patients but no one, patients included, wants to pay for that. I really hope "concierge" medicine, a lot of that now happening on the lower priced end not only for "luxury patients", continues to take off. You pay some cash out of pocket but get care that is dramatically better and more preventative.

anonymouse008 6y ago
Woa -- do you have a link to the regulation (chapter, but looking at Medicare fully now) to things that are designed to "systematically to enhance bill-ability"? So you're saying if you use a templating tool to be more efficient and save time, it's explicitly not allowed AND you're opening up either yourself or the technology tool to malpractice litigation?! Goodness!
- duffpkg 6y ago
  Malpractice is a totally separate thing from Medicare Fraud. With respect to malpractice, having automated or semi-automated encounter notes with huge systematic similarity looks absolutely terrible if something goes wrong. Don't take my word for it, consult your attorneys. With respect to Medicare fraud see the False Claims act and its interpretation in the enforcement actions against many parties beginning in 2016. Keywords would be like "not medically necessary" and "upcoding". I believe the monster enforcement action just this week against GHC also involves that.
  - anonymouse008 6y ago
    Goodness -- thank you very much for this potent thread. Good wishes to all your works!
  - manapause 6y ago
    Let us not forget “stand in your shoes” Stark provisions which made many a brother-in-law who owned a DME company very sad. Hospices dropping off cookies with their contact information is kosher. Incentivizing a medical office to hit 100 nebulizer-orders, or cpap referrals -> federal prison.
nradov 6y ago
Concierge medicine won't solve anything at scale. We have a shortage of physicians, especially in primary care, and it's only getting worse as the population ages. What we really need is just more doctors. The federal government should remove the bottleneck by boosting funding for residency program slots.

manapause 6y ago

My experiences in healthcare/EMR were focused on Medicare part B (home health); physicians, NPs, and PAs that made house calls. This is a great question; being thrust into hippa compliance from 2000 - 2012 was the easy part, and can perhaps be summed up as “ fax machines behind a door, paper charts and/or laptops/tablets locked in trunks*, all-in Blackberry enterprise services, Exhange over ssl xml-rpc endpoints, and ensuring EMR portal uptime was so much of the fun parts. The hard part: training home health medical groups how to VPN - and how to never mix work tech and personal tech.” I am unaware of hippa changes since the blackberry-era, and while I can’t imagine specific apps being named in amendments to the law, I can say without a doubt that hippa at the time meant having total control over all technical Devices used by your clinicians, prepping all laptops and equipment to use encrypted storage, ssl-encrypted email, VPNs, etc was always made easier by focusing on training, troubleshooting, and being able to mitigate the raw chaos monkey power of a doctor with a gadget. With the passage of the HITECH act, being able to facilitate the automated logging of a doctor’s conversation with a patient’s family or caregiver towards the CPO (care plan oversight) and making the fulfillment of PQRI initiatives automatic... “so easy a doctor could do it”... meant (at the time) a very hefty pay raise for part-B collections. TLDR: hippa was easy, training doctors to change their ways is hard. producing the tech that makes their lives easier means assuaging them of their worries that they are maximizing Medicare collections. It is fun to imagine these days that transcription, location, and barcode technology has “made it” to the point we dreamed about ~10 years ago.