Finding the right medical transcription school may be the most important decision you will make in your career. This may seem like a bold statement - especially since, at first glance all medical transcription schools look pretty much the same. But nothing could be further from the truth. There are really only a few medical transcription schools that are truly competency-based. That is, schools that prepare you to get a job upon graduation.

DIPLOMA MILLS

Oh, don’t worry, there are plenty of “diploma mills” out there. The problem is that in this business, a diploma is not what matters. The only thing that matters is whether you can perform the work. And the only way to learn to do the work is to enroll in a top-flight medical transcription school. Taking shortcuts on a fast track to a diploma is a total waste of time and money. Too many people find this out the hard way — and it is a very costly mistake, indeed.

MYTH OF NO OPPORTUNITY

Unfortunately, most people who make that mistake become completely discouraged and disillusioned and just give up, assuming that there is no real opportunity for a career in medical transcription. When the reality is that there are hundreds of unfilled medical transcription job vacancies every day of the year. Right now the medical transcription industry is literally begging for new talent. But medical transcription companies need people that can produce, not people that require a lot of handholding and mentoring.

CONVENIENCE

One aspect you will want to consider in finding the right MTS for you is convenience. Some vocational and community colleges offer MT programs. The obvious challenge there is travel time and arranging your schedule to fit theirs. One great benefit for going the home-study route is that you can study whenever YOUR schedule allows. For many stay-at-home moms, this is a very, very big advantage.

iLIANT Corporation (”iLIANT”), a leading provider of software, business outsourcing, and consulting services for physician practices, and CBay Systems, Ltd. (”CBay”), a leading provider of healthcare business process outsourcing (BPO) services, announce a strategic alliance to provide medical transcription services.

Effective immediately, CBay will manage and assume operational responsibility of iLIANT’s North Carolina based transcription clients. A separate Services Agreement will allow iLIANT to extend CBay transcription technology and services to its physician clients on an ongoing basis. CBay provides transcription and information management services to physician groups, hospitals, integrated health care facility networks, and medical clinics.

iLIANT’s transcription clients will benefit from the innovative technology and medical transcription process tools offered by CBay. CBay’s HIPAA-compliant solutions leverage leading Internet technologies and highly credentialed transcriptionists to provide easier, more secure, accurate and cost-effective medical transcription. The iLIANT relationship will benefit CBay by immediately increasing its customer base as well as opening a new sales channel through which the company can offer its medical transcription services.

iLIANT provides comprehensive business support services aimed at leveraging technology in ways that simplify the physicians’ practice. The alliance with CBay allows iLIANT to remain focused on its core competencies of providing industry leading IT and business services. “We have experienced tremendous success in building strong alliances with leading vendors, like CBay, as a means to provide quality solutions to meet our clients’ needs now and into the future,” said Jay Langford, Director of Business Development for iLIANT. “The strategic alliance with CBay allows our clients to benefit from cutting-edge technology while continuing to receive the outstanding quality and service that they are accustomed to receiving.”

Founded in 1998, CBay has shown remarkable growth through product revenue and acquisition activity. “The iLIANT agreement is a significant validation of our strategy to lead in the healthcare transcription outsourcing market through solutions that combine best practices and leading technology,” said CBay Chairman and Chief Executive Office, V. Raman Kumar.

Rationale: Increasing evidence supports a key role for the transcription factor nuclear factor (NF)-?B in the host response to pneumococcal infection. Control of NF-?B activity is achieved through interactions with the I?B family of inhibitors, encoded by the genes NFKBIA, NFKBIB, and NFKBIE. Rare NFKBIA mutations cause immunodeficiency with severe bacterial infection, raising the possibility that common I?B gene polymorphisms confer susceptibility to common bacterial disease.

Objectives: To determine whether polymorphisms in NFKBIA, NFKBIB, and NFKBIE associate with susceptibility to invasive pneumococcal disease (IPD) and thoracic empyema.

Methods: We studied the frequencies of 62 single-nucleotide polymorphisms (SNPs) across NFKBIA, NFKBIB, and NFKBIE in individuals with IPD and control subjects (n = 1,060). Significantly associated SNPs were then studied in a group of individuals with thoracic empyema and a second control group (n = 632).

Measurements and Main Results: Two SNPs in the NFKBIA promoter region were associated with protection from IPD in both the initial study group and the pneumococcal empyema subgroup. Significant protection from IPD was observed for carriage of mutant alleles at these two loci on combining the groups (SNP rs3138053: Mantel-Haenszel 2 × 2 ?^sup 2^ = 13.030, p = 0.0003; odds ratio [OR], 0.60; 95% confidence interval [CI], 0.45-0.79; rs2233406: Mantel-Haenszel 2 × 2 ?^sup 2^ = 18.927, p = 0.00001; OR, 0.55; 95% CI, 0.42-0.72). An NFKBIE SNP associated with susceptibility to IPD but not pneumococcal empyema. None of the NFKBIB SNPs associated with IPD susceptibility.

Conclusions: NFKBIA polymorphisms associate with susceptibility to IPD. Genetic variation in an inhibitor of NF-B therefore not only causes a very rare immunodeficiency state but may also influence the development of common infectious disease.

Infection with Streptococcus pneumoniae remains a significant global problem, accounting for the deaths of more than 1 million children younger than 5 years worldwide (1). Invasive pneumococcal disease (IPD) is defined by the isolation of S. pneumoniae from a normally sterile site, such as blood (septicemia), cerebrospinal fluid (meningitis), or pleural fluid (thoracic empyema). The incidence rate of IPD ranges from 10 to 100 per 100,000 persons per year, and despite advances in medical treatments, the mortality rate of IPD in adults remains at least 10 to 20% (1). Colonization of the nasopharynx by the pneumococcus is widespread, yet only a minority of individuals develop invasive disease (2). An important, and often neglected, factor that influences the development of infectious diseases such as IPD is the host’s genetic profile (3).

The ubiquitous transcription factor nuclear factor (NF)-?B is central to a diverse array of cellular processes, including host innate and adaptive immune responses (4, 5). Activation of NF-B occurs after stimulation of a variety of immune receptors, including Toll-like receptors (TLRs) and members of the interleukin (IL)-1 and tumor necrosis factor receptor superfamilies. The signaling pathway downstream of the TLR and IL-1 family of receptors is complex and incompletely understood; key mediators include the cytoplasmic adaptor molecules MyD88 and Mal/TIRAP, which activate TRAF6 via IL-1 receptorassociated kinases (IRAK1 and IRAK4) (6, 7). In unstimulated cells,NF-?Btranscription factors are prevented frombindingDNA due to their association with the inhibitors of NF-?B (I?B) protein family; phosphorylation of the I?B inhibitors by the I?B kinase complex leads ultimately to their degradation and the release of NF-?B, which is then capable of inducing gene transcription (5, 8). The best-studied members of the I?B family are I?B-?, I?B-?, and I?B-?, encoded by the genes NFKBIA (Chr14q13.2), NFKBIB (Chr19q13.2), and NFKBIE (Chr6p21.1), respectively (5). The recent identification of functional homologs of NF-?B and I?B in the horseshoe crab suggests that these components originatedmore than 500 million years ago and further underlines the key role of this pathway in host defense (9).

Although polymorphisms within genes encoding the activating TLRs have been associated with a number of disease states (10), the role of genetic variation within downstream components of the NF-?B pathway in disease development remains largely unexplored. Exceptions are the associations described between variants in NFKBIA with Crohn’s disease, trachoma, and sarcoidosis (11-13), and the recent association of a functional polymorphism in IRAK1 with outcomes from sepsis (14).

There is increasing evidence to support a critical role for the NF-?B pathway in the host immune response to pneumococcal infection. Many of the immune receptors capable of activating NF-?B are stimulated during pneumococcal infection, and, in particular, TLR2 recognizes components of gram-positive bacteria such as S. pneumoniae (15-17) and TLR4 recognizes the pneumococcal toxin pneumolysin (18). Activation of NF-B by pneumococci has been clearly demonstrated both in vitro and in animal models (19-22), and targeted genetic disruption of the NF-B p50 subunit in mice has been shown to increase susceptibility to overwhelming pneumococcal infection (23). Recently, two patients have been described with mutations in the NFKBIA gene leading to impaired NF-B activation and a primary immunodeficiency syndrome characterized by recurrent severe bacterial infections in association with the skin condition anhidrotic ectodermal dysplasia (24, 25). On the basis of these findings, we hypothesized that common polymorphisms in the I?B genes may be associated with susceptibility to the phenotype of IPD regularly encountered in clinical practice. To investigate this further, we studied the frequencies of polymorphisms in the three major I?B genes NFKBIA, NFKBIB, and NFKBIE in groups of individuals with IPD and thoracic empyema, as well as two control groups.

Growing a medical practice is never an easy task, and implementing the right growth plan can be perplexing even to the most seasoned professional. When the service area begins to change, particularly when it begins to grow, many practices are forced into facing growth–whether they are ready for it or not. The ability to implement the right technology and the right strategic plan under these circumstances can be the difference in growing along with the market or missing a tremendous opportunity.

PROBLEM

North Fulton Family Medicine is a full-service family medicine practice serving the North Atlanta region with two locations in Alpharetta and Cummings, GA.

In 1997, we recognized that our service area was in the middle of a population boom with new highways beginning to spill out of Atlanta, feeding commercial and residential development. This presented an incredible opportunity for growth of the practice if we planned wisely and made significant preparations. We determined that we could accommodate this growth by adding a satellite office with enough additional space to serve new patients and maximize same day encounters when the numbers increased.

However, the decision to expand would necessitate staff, and an increase of our staff-to-provider ratio of 4.8:1. With four physicians and 21,000 patients, we preferred not to increase our staff-to-provider ratio. We also did not want to support the increased administrative burden of managing new patient charts, while running the risk of increased volume creating inconsistent communication and difficulties in sharing information between multiple sites. Our annual transcription costs were already more than $100,000, and we didn’t want a planned expansion to drive a disproportionate increase in overhead.

Our desire to grow the practice without increasing costs, and to add technological advancement to the practice, compelled us to begin a search for electronic medical record (EMR) technology.

After a seven month search and multiple site visits, we selected the A4 Health Systems’ HealthMatics[R] electronic medical record system. Our reasoning was based on the system’s logical design-flow that guides caregivers from one step to the next throughout each encounter, intranet e-mail capability that would allow us to connect our new Cumming office, the integrated scanning module and the ability to customize the system to our needs.

In December 1998, our practice went live with the Healthmatics EMR. The process involved significant on-and off-site work to establish required clinical customizations, link the practice sites, and train key users and the entire employee population. Local training consisted of setting up a classroom, dividing the staff into sections and split sessions for hands-on time. Each member received approximately eight hours of training from A4’s instructors.

The implementation itself was easy, due to physician support. Initially it took two to three patient visits to get the electronic chart fully populated with patient information. We were immediately able to treat 15 scheduled patients per provider each day, as well as 70 to 75 walk-ins.

Some employees did not survive the transition and left as a result of the system’s introduction. Others supported the vision and quickly learned the system. For example, Thomas Bat, M.D., the practice director, was a proponent of the paperless office, but was only marginally computer literate when the implementation began. Through his own dedicated efforts to learn the EMR, he is now completely proficient with it.

On October 17, 2006, the West Virginia Department of Health and Human Resources (WVDHHR) was notified of an outbreak of acute gastroenteritis, characterized by vomiting and diarrhea, among attendees at a family reunion. The outbreak initially was reported by a group of attendees to their local health department in Garrett County, Maryland. The same day, the information was relayed to the Grant County Health Department in West Virginia and subsequently to WVDHHR. The reunion was held on October 14 at a private residence in Grant County, West Virginia, and the 53 identified attendees included residents from Florida, Maryland, New York, Pennsylvania, Virginia, and West Virginia. This report describes a collaborative, multijurisdictional epidemiologic investigation using a cohort study and laboratory analyses to determine the source of infection and appropriate control measures. The results indicated that a combination of person-to-person and foodborne transmission of two strains of norovirus, likely introduced by persons from two different states and subsequently at least two food items, was the probable cause of these illnesses, highlighting the challenge of investigating and controlling norovirus outbreaks. During periods of peak norovirus activity, public health officials should emphasize the importance of appropriate handwashing and the exclusion of ill persons from social gatherings.

In collaboration with state and local health departments, interviews were conducted with 11 reunion attendees to help generate hypotheses and develop a list of attendees and foods served. A questionnaire was then developed to conduct a cohort study involving all reunion attendees. Questions addressed illness onset, symptoms, attendance at prereunion gatherings, consumption of specific food items, contact with ill persons, and onset of symptoms among nonattendees. Questionnaires were administered by telephone and in person by state and local health department staff members from West Virginia and Maryland in coordination with health departments from the other attendee jurisdictions in Florida, New York, Pennsylvania, and Virginia.

An attendee case was defined as two or more episodes of nonbloody diarrhea (i.e., two or more loose stools in a 24-hour period) or vomiting within a single 24-hour period on or after October 7, 2006, in a person who attended the reunion. A nonattendee case was defined as acute illness characterized by vomiting or diarrhea with onset after 12 a.m. on October 18 in persons who did not attend the reunion but who had direct contact (i.e., within 3 feet) with attendees after the reunion.

The list of reunion attendees included 53 persons, of whom 48 (91%) were interviewed. Of those interviewed, 28 (58%) had illness that met the attendee case definition. In addition, four cases were identified among nonattendees, all of whom were household contacts of attendees. Symptoms reported by the 28 ill attendees included diarrhea (96%), vomiting (75%), abdominal cramps (71%), nausea (61%), headache (54%), chills (36%), body aches (32%), fever (not specified) (21%), and fatigue or malaise (18%). Nineteen (68%) of the 28 ill attendees were female, and six (21%) were aged [less than or equal to] 10 years. Six (21%) of the patients sought medical care. For the 25 patients who reported both date of illness onset and date of recovery, the median duration of illness was 54 hours (range: 6-135 hours). Twenty-one of the 28 attendee cases occurred during October 14-16 (Figure).

[FIGURE OMITTED]

The 1-day reunion began at 11 a.m. on October 14. Persons with illness onset after 8 p.m. on October 14 through 12 a.m. on October 18 were included in the cohort study, as were persons who attended but did not become ill (Figure). Persons with illness onset either before the reunion or after 12 a.m. on October 18 were excluded. Incubation periods were calculated by subtracting the date and time of the first possible exposure from the date and time of illness onset. The first possible exposure was defined as either the time the person arrived at the reunion or the time the person arrived at a prereunion gathering where previously ill persons were present. Nine of the 48 interviewed attendees were excluded from the cohort study because they did not meet the defined illness-onset criteria. Three had illness onset >72 hours after the reunion. Six attendees had illness onset either before the reunion or within 6 hours after the reunion began and might have introduced the illness into the reunion; four of these six were immediate family members from New York who had traveled to the reunion together, including a child who was ill with vomiting and diarrhea during the reunion, and the other two were West Virginia residents who had no contact with each other or the family from New York immediately before the reunion.

Of the 39 attendees included in the cohort study, 19 met the case definition and illness-onset criteria, and 20 did not become ill. The median incubation period for the 19 cases was 36 hours (range: 20-61 hours). Of 31 food items served at the reunion (Table 1), two items were identified as significant risk factors for developing illness (p<0.05, by two-tailed Mantel-Haenszel chi-square test) and were eaten by the majority of ill persons: scalloped potatoes (relative risk [RR] = 2.8, 95% confidence interval [CI] = 1.1-6.9) and chicken (RR = 2.2, CI = 1.0-4.8). Both food items were eaten at the reunion by persons who were ill before the reunion, which might have provided an opportunity for these persons to contaminate the food at the event. The chicken was purchased at a store by the family from New York, whose four members had been ill before the reunion, which provided another opportunity for the food to be contaminated. The scalloped potatoes were brought by persons from West Virginia who were not ill before the reunion. Consumption of the chocolate cheese ball also was statistically associated with illness (p = 0.04), but the item was only eaten by seven persons. In addition, six of the seven attendees who ate the chocolate cheese ball also ate both the chicken and scalloped potatoes; all seven ate the chicken. Self-reported direct contact with ill persons at the reunion, including with the symptomatic child, also was a significant risk factor for developing illness (RR = 2.3, CI = 1.0-5.1). Attendance at prereunion gatherings at either home A or home B was not associated with illness. Reunion attendees were provided information on appropriate hand hygiene and the potential for viral shedding and secondary transmission up to 2 weeks after symptoms resolved.

Synergy Software Development Inc. (Pink Sheets:SGYS), is proud to issue a letter of intent for the acquisition of Medical Transcription Services Inc., a leading provider of medical transcription services in the southeastern United States.

“The acquisition of Medical Transcription Services will augment `Evolution,’ our current healthcare offering, with the quality of their product and by incorporating their existing client base of hospitals and healthcare providers with our own,” commented Dr. Todd Hanson, CEO of Synergy Software.

“I believe this merger is in alignment with Medical Transcription Services’ goals and business mission. Our product will be able to enhance Synergy’s `Evolution’ and will improve the quality of medical care to our ongoing and future healthcare customers,” says Philip Scanlon, CEO of Medical Transcription Services.

Medical Transcription Services is designed to save medical professionals time, improve the quality of patient care, and reduce the risk of medical professional liability claims.

Synergy Software Development Inc. (SGYS), located in Boca Raton, FL, is defined as a secure applications software development business specializing in the healthcare industry. Synergy’s advanced clinical information technology was developed specifically for use by hospitals, physician groups, private practitioners and other healthcare providers.

Synergy Software Development Inc. has revolutionized the way in which patient information is made available in the healthcare industry. With Synergy’s “Evolution” product, healthcare providers are able to maintain a continuous level of high-quality care and information, with the additional benefit of reducing unnecessary expenditures. All of the Synergy applications adhere to HIPPA guidelines.

Safe Harbor

The foregoing contains “forward-looking statements” which are based on management’s beliefs as well as on a number of assumptions concerning future events and information currently available to management. Readers are cautioned not to put undue reliance on such forward-looking statements, which are not a guarantee of performance and are subject to a number of uncertainties and other factors, many of which are outside Synergy Software Development control that could cause actual results to differ materially from such statements. For more detailed description of the factors that could cause such a difference, please see SGYS filings with the Securities and Exchange Commission. SGYS disclaims any intentions or obligation to update or revise any forward-looking statements, whether as a result of new information, future events or otherwise. The information is presented solely to provide additional information to further understand the results of SGYS.

EATONTOWN, N.J. — Premier Product EMscribe VFx to Automatically Fill Out Medical Forms Based on Unique Approach and Combination of Speech Recognition and IVR Technology

Artificial Medical Intelligence (AMI) today announced its formal launch into the US market with the introduction of its EMscribe VFx Interactive Voice Response IVR) form filling solution.

AMI is a physician-led provider of medical software and services that help automate the production of medical documentation.
The company’s first product to market is EMscribe VFx, a form filling solution that automatically fills out medical forms over the telephone. The product employs a unique approach that combines AMI’s patent pending speech recognition technology with touch-tone telephone. This unique approach and combination of technologies provide the highest degree of reliability, user success and experience when filling out a form.

In addition, EMscribe VFx’s speech recognition capability leverages the most comprehensive and sophisticated grammar structure on the market. This makes the product extremely reliable for capturing complex information like email addresses, which are notoriously difficult to capture over the telephone.

According to Elliott Familant, AMI’s chief technology officer, “With EMscribe VFx, medical facilities can significantly reduce overhead time and money spent on filling out and processing forms. The methods and technologies that we offer are an exceedingly reliable way to capture complex information. Even email addresses can be captured, which are frequently needed in forms, but cannot be encapsulated today by any other commercial IVR application on the market.”
Pricing and Availability

EMscribe VFx is available immediately, with pricing appropriate for a wide range of clinical situations, ranging from small physician practices to an entire hospital system and will depend on the degree of customization required by the customer. Interested parties can call (866) 415-6112 or email: info@artificialmed.com.

Preview of Automatic Coding Offering

The company will be announcing its second product offering, EMscribe DX, on Feb. 14, 2005 at the upcoming HIMSS conference in Dallas. EMscribe DX is a coding solution that automatically scans documents containing medical phrases and matches them to appropriate ICD9 diagnostic codes.

About AMI

Founded in 2002, Artificial Medical Intelligence (www.artificialmed.com) is a physician-led provider of medical software and services that help automate the production of medical documentation and infrastructure. Its solutions are targeted to hospital healthcare facilities and physician practices that are looking to automate process management and improve the accuracy and efficiency of processing medical documents. AMI can also help customers achieve the goal of creating a complete electronic medical record. The company differentiates its offerings based on its physician-centered approach to product design and testing, patent pending speech recognition and artificial intelligence technologies. AMI also provides professional IT consulting services for healthcare IT Infrastructure and support.

PEABODY, Mass. — Leading PC Dictation Solution Enables Radiology Department to Save $300,000 a Year and Reduce Document Turnaround Time by 80%

ScanSoft, Inc. (Nasdaq: SSFT), the global leader of speech and imaging solutions, today announced that Penn State Milton S. Hershey Medical Center has selected ScanSoft Dragon NaturallySpeaking(R), the leading speech recognition solution for medical professionals, to automate transcription within its Department of Radiology. Leveraging expertise from ScanSoft value-added reseller LANtek, Hershey Medical Center was able to reduce medical report turnaround times by 80%, improve overall patient care and virtually eliminate the costs of manual transcription.
Using ScanSoft Dragon NaturallySpeaking, the medical center’s radiology department can now create reports in real-time simply by dictating into their PCs. Prior to deploying Dragon NaturallySpeaking, the institution employed the services of eight full- and part-time transcriptionists, who took approximately 72 hours to turn around completed medical reports. After several unsuccessful attempts at installing other voice recognition systems on their own, the hospital turned to LANtek to design a deployment of Dragon NaturallySpeaking that would work in conjunction with an existing document workflow solution. Within the first four months, the deployment had paid for itself and had reduced report turnaround time to less than 14 hours - an improvement of more than 80%. In addition, the installation resulted in significant cost savings of nearly $300,000 annually, and the hospital was able to reposition the transcriptionists to more value-added positions within the organization.

“Speech recognition software is truly the future of healthcare technology applications - the benefits of the software are clearly tangible, and the cost and time savings are tremendous,” said Timothy Yanchuck, Penn State Milton S. Hershey Medical Center. “Within a week of our ‘go live’ date, it became clear that our use of Dragon NaturallySpeaking would be successful, as the departmental faculty saw the resultant benefit to patient care. We are quite pleased with the level of accuracy and ease of use of ScanSoft’s product as well as the training and other services provided by LANtek.”

ScanSoft’s Dragon NaturallySpeaking 7 technology portfolio gives healthcare providers, technology suppliers and system integrators the ability to quickly and easily add speech recognition functionality to commercial and in-house PC- and Web-based Healthcare Information Systems (HIS) and Electronic Medical Records (EMR) applications. Through the speed and accuracy of Dragon NaturallySpeaking, healthcare organizations world wide have saved thousands of dollars per doctor each year in reduced or eliminated manual transcription costs.

LANtek is a ScanSoft Premier Partner that has been working with Dragon NaturallySpeaking for five years. LANtek’s services include customized deployment of Dragon NaturallySpeaking with EMR software, practice management software, and electronic medical document imaging software.

“The Hershey Medical Center had tried a number of other voice recognition solutions prior to Dragon NaturallySpeaking,” said Brady Bunner, an account executive at LANtek. “None of the other alternatives provided the level of functionality and ease-of-use Dragon NaturallySpeaking offered. We were able to design compatibility between Dragon NaturallySpeaking and Hershey Medical Center’s IDX Radiology Information System that lowered costs for the hospital, that was accepted by physicians, and that improved patient care.”

“The healthcare field stands to gain a great deal from the proliferation of speech technologies, and the time and cost savings are real, as proven by implementations such as Hershey Medical Center,” said John Shagoury, President, ScanSoft Productivity Applications. “From full-scale hospital implementations to making individual practitioners more productive, ScanSoft speech technology can improve existing processes and compliance and can increase focus on the most important thing - patient care.”

SOMERSET, N.J. — Medical Transcription Billing, Corp. announces a new plan to offer medical transcription services at only 4 cents per line to all physicians who use MTBC’s 4% Medical Billing services.

MTBC’s new 4-for-4 plan is designed for physicians who are interested in a comprehensive billing solution as well as a secure and reliable transcription service. MTBC’s 4 cents transcription services will include all of the features currently offered at the 8 cents per line fee, but at half the cost. The 4-for-4 plan includes a toll-free number and a secure Personal Identification Number (PIN) for the physician to dictate the work. The transcription work is completed and emailed back to the physician within 24 hours.
“MTBC’s 4-for-4 plan offers physicians a complete practice management solution,” explains MTBC’s President, David Rosenblum. “The 4-for-4 plan includes comprehensive billing and patient management features which will help the physician spend more time with patients and less time with paperwork.”

MTBC’s 4% medical billing services are comprehensive, including patient scheduling, immediate on-line eligibility verification, electronic claim submissions, follow-up and appeals, electronic remittance advice (ERA) and electronic funds transfer (EFT), as well as patient billing. In addition to 24/7 Internet access to information on scheduling, patients and billing, MTBC also provides customized superbills and other office forms, practice analysis and financial reporting to its medical billing clients. Proprietary software tracks each claim through the entire billing process - from the moment a patient is scheduled, until payment is received - reducing the cost of overlooked claims.

In an attempt to control medical malpractice cost, many states are passing laws that limit the amount awarded for pain and suffering. These limits have made it more difficult for low-income victims of malpractice to file a lawsuit, according to a Wall Street Journal article (8 Oct. 2004). The trial costs, which include hiring expert witnesses, usually run about $100,000. Because damages due to pain and suffering are capped, claims must be based on lost income or ongoing medical costs. Claimants who do not suffer significant economic damages–ie, retired persons, homemakers, and children–have a difficult time finding lawyers to represent them. While such legislation may reduce suits and awards, it does not reduce medical error.
Insurance companies are working to prevent malpractice suits by educating practitioners about ways to reduce errors. MGIS Property and Casualty Insurance Service, Inc. released a brochure (January 2005) that explains the liability risks caused by unclear communication and by improperly delegating tasks to others. When delegating patient care to a colleague, both doctors should agree that no patient will receive a medication refill without being questioned by the on-call physician about symptoms, the steps the patient has taken to relieve the problem, and when the patient last saw the attending physician. For their own protection as well as that of their colleagues, on-call physicians should not prescribe potent anti-depressants or pain-killers without examining the patient.
The brochure also points out how practitioners inadvertently delegate decisions to non-professionals that can lead to further injury, missed diagnoses, or inappropriate treatment. For example, a doctor may prescribe ‘light duty only’ and ‘limited work schedule’; but without specific instructions that refer to the person’s regular activities, such as ‘lift no more than 20 pounds,’ the patient, an employer, or a parent or teacher is left to define the more general prescription. The brochure emphasizes that physicians must know enough about a patient’s regular routine to “specify in plain language the restrictions needed to prevent the patient from sustaining an injury or exacerbating a previously treated problem.” Patients who receive care that may require follow-up if infection or complications arise also need specific, clear, non-technical written instructions about how to identify a problem and ask for help. Telling clients to return if they have any problems “forces patients to decide what they think the doctor thinks is a ‘problem.’” Liability insurers may have samples of written instructions for common situations, such as identifying the presence of an infection, that doctors can use in their practice. Insurers’ loss prevention department may also be willing to check a physician’s in-house instructions for clarity.

Another potentially risky situation involves relaying the results of diagnostic tests. Telling patients that the physician’s office will not contact them unless a test is positive is a dangerous practice. It is too easy for test results to get mislaid or forgotten. An office aide can mail negative results to patients or speak with them directly by phone. Aides should not leave results on an answering machine because of privacy concerns, unless the client has given permission. Physicians, themselves, should tell patients of significant positive results so that patients have the opportunity to ask any questions about their condition and future treatment that they may need.

Doctors must remember that they have the final responsibility for making sure that patients understand any ‘informed consent’ form that they sign. A signed form obtained by an aide is not enough. Doctors also have final authority for the accuracy of any transcriptions of their dictation. Signing off on the transcription without reading it risks the possibility of not catching errors that may lead to injury. “The wide latitude juries and the law give physicians for human error,” the brochure explains, “rarely is extended in situations in which physicians plead that they were too busy to ensure the accuracy of their operative, X-ray or consultation reports.”

While accurate communication and safe delegations can go a long way toward minimizing errors, another Wall Street Journal article (18 May 2004) indicates that sincere, properly-worded apologies can lessen the likelihood of lawsuits when mistakes are made. Recognizing that people are less likely to sue when a doctor has maintained open and honest communication, some medical institutions and liability insurance companies are encouraging doctors to admit their mistakes and apologize. While doctors must be careful not to express too much responsibility before all the facts are known, they certainly can honestly convey what they do know and express regret. As Northwest Physicians Mutual Insurance Co. (Salem, Oregon) tells clients who attend its seminar on disclosing errors and apologizing: “Apology is psychologically expected when wrong has been done.”