Keeping Your Clinical Documentation Safe: A Business Continuity Checklist for 2021

Keeping Your Clinical Documentation Safe: A Business Continuity Checklist for 2021

The ONC concurs. As stated in their February 2020 final report, “In practice, EHR systems and the way clinicians interact with them to complete documentation tasks often add to administrative burden.”

In Healthcare IT Today’s recent article on automating EHR documentation, the use of ambient clinical voice is recommended as one solution to the EHR clinical documentation conundrum. But, today its impact is limited, expensive and only specialty-focused. Until ambient clinical voice is widely available, what else can be done to simplify clinical documentation processes, procedures, and workflows? The answer lies in wider use of data and performance analytics to inform a variety of documentation options based on care setting, specialty and physician preference.

AUTHOR

DeliverHealth

DeliverHealth Web Admin

Keeping Your Clinical Documentation Safe, Secure and Accessible: a Business Continuity Checklist For The New Now

The company quickly remediated the situation by offering customers temporary access to its other clinical documentation technologies. But the disruption for end users, including physicians, was massive.

Since then there have been numerous direct ransomware and malware attacks on hospitals and health systems. Attacks perpetuate disruption, hinder access to clinical documentation, and increase risk to care.  

Business continuity strategies to combat these attacks, though advanced compared to past practice, remain an ever-evolving commitment. And with every step forward, bad actors and cybersecurity threats keep pace. For example, hacking incidents in healthcare rose by 42 percent in 2020 and the total number of patient records breached by hacking has surged according to a recent survey by Protenus, a Baltimore-based healthcare analytics company. 

Lyndon B. Johnson once said, “No experience is a bad experience unless you gain nothing from it.” Since the event, Nuance’s clinical documentation services business line, has invested heavily and worked tirelessly to ensure the safety and resilience of its systems—and the satisfaction of physician users.  On March 1, 2021, DeliverHealth was created as the spin out of Nuance’s HIM business. DeliverHealth carries forward the mission to ensure safe, secure and accessible clinical documentation, and continues to build upon it through education, support and industry guidance. Our guiding principles include: 

  • Develop business associate (BA) business continuity and disaster recovery processes, procedures, and protocols to ensure system and service resilience.
  • Implement protective technology to manage whatever comes your way including adopting multi-tenant system cloud computing, Azure-hosted security (or equal accountability), redundancy, active-active failover, and regular third-party access monitoring and failover drills on production systems.

Now is the time to check your dictation, transcription, scribing, EHR, and other clinical documentation systems before the next cyberattack threatens your health system’s PHI.

Protecting your clinical documentation systems is not a once-and-done action. It’s an ongoing marathon against cyberattacks for your BAs and internal IT teams.

As such, every clinical documentation solution should deliver the following modernized capabilities to ensure resilience to maintain your business continuity.

Modernizing Your Clinical Documentation Systems 

During the Office of the National Coordinator (ONC) annual meeting in March 2021, the need for data modernization was cited as the best path forward to meet U.S. health challenges. Clinical documentation systems are no exception to this important initiative.

Modernized clinical documentation systems include built-in technology protections to detect hacks, provide active-active failover capabilities, and eliminate business continuity risks. Testing mechanisms and “fire drill” disaster recovery plans with trusted BAs are incorporated into service agreements. Your internal IT team runs business continuity drills all the time—and so should your vendor partners. Demonstrating resilience is a two way street.

While some upfront work is required of hospital IT departments, it is in their best interests to modernize clinical documentation systems.  These system vendors should do the heavy lifting when it comes to training, conversion, privacy, security, redundancy leading to resilience, and failover testing. New capabilities are baked into modern systems to reduce long-term cost, time, and resource demands. They serve as best-practice hallmarks for business continuity and disaster recovery.

Six-Point Checklist for Clinical Documentation Safety: Inspect What You Expect

When considering a modernized clinical documentation partner, there are six specific checklist items to evaluate. These six criteria work together to protect data against disruption and ensure consistent access to your systems.

  1. Cloud computing: Cloud-based computing is the first step to ensure high availability, redundancy, and resilience of your clinical documentation systems and data. With a cloud solution, the vendor is responsible for the clinical documentation platform—not your overburdened IT team. Systems are managed in real time and all data is encrypted using current standards. Facilities are SOC 2, SOC 3, and HIPAA compliant, and offer tier 3+ security (armed guards and bioscan for entry).
  2. Azure-hosted security center: Azure is Microsoft’s cloud computing service division. While many vendors use Azure, it is important to make sure your clinical documentation partner optimizes the platform’s full potential. And while Azure isn’t the only approach, vendors should at least meet its level and standard. For example, all systems should be monitored continuously with real-time dashboard watching. Any security gaps or irregular traffic can be flagged, and mitigation advice provided. Samples of Azure reports are available here: https://status.azure.com/en-us/status/history/.
  3. Redundancy through multiple data centers: Clinical documentation must be available to physicians 24/7/365. Interruptions are not acceptable. Uptime is essential to patient care, physician satisfaction, and downstream revenue cycle processes. Data centers located in multiple geographic regions protect uptime and replicate data to ensure full redundancy and business continuity.
  4. In an inevitable event, the focus on redundancy shifts to system and data recovery through recovery time objective (RTO) and recovery point objective (RPO) commitments from the BA. Ask your vendors about RTO and RPO performance. RTO is the time needed to recover core tenets of a disaster recovery strategy. RPO describes data loss and helps to inform the development of a backup strategy. For clinical documentation systems, RTO and RPO should be measured in minutes, not hours.
  5. Active-active failover: Failover is the foundation to business continuity. Active-active failover is paramount to acceptable RTO and RPO. Technically, active-active is a high availability (HA) clustering configuration whereby at least two nodes actively run the same system or application simultaneously. This serves to support more effective load balancing to improve throughput and response times. Best practice is to perform failover tests in production regularly. Your partners should be able to perform these tests at any time upon your request, or at the time you review all BA business continuity plans.
  6. Redeployment: Compromised systems must be redeployed quickly. This includes servers, cloud native resources, and networks in minutes, not hours. Infrastructure as code and infrastructure release pipelines are critical to this.

Staying Safe, Secure, and Accessible Means Staying Ahead

Threats against your clinical documentation systems are ever present. If something disrupts these systems, your vendor must have proper resilience to recover. And you have an obligation to ensure your BAs can deliver this level of resilience. Patient data, system uptime, physician satisfaction, and revenue cycle are all at stake.

Keeping your clinical documentation safe means your organization stays on the path to proper reimbursement and uninterrupted patient care. For more information, download DeliverHealth’s latest infographic on clinical documentation resilience here.

Resiliency and Business Continuity – 6 Questions to Ask

Clinical documentation is mission critical to revenue cycle, patient care and physician efficiency. Third-party partners that manage your clinical documentation must be reliable—even when hacks, upgrades and other disruptions occur.

Transcription, speech, EHRs, scribes, and other clinical documentation platforms are important allies to achieve these goals. However, they must be resilient. Downtime isn’t an option. Patient care, physician productivity, revenue cycle operations, and patient privacy is at stake.

Can Performance Analytics Impact the EHR Clinical Documentation Conundrum?

EHRs have been implemented for nearly two decades in healthcare and many usability issues still remain. Of these, one of the top issues reported by physician users in virtually every EHR usability study is clinical documentation.

The ONC concurs. As stated in their February 2020 final report, “In practice, EHR systems and the way clinicians interact with them to complete documentation tasks often add to administrative burden.”

In Healthcare IT Today’s recent article on automating EHR documentation, the use of ambient clinical voice is recommended as one solution to the EHR clinical documentation conundrum. But, today its impact is limited, expensive and only specialty-focused. Until ambient clinical voice is widely available, what else can be done to simplify clinical documentation processes, procedures, and workflows? The answer lies in wider use of data and performance analytics to inform a variety of documentation options based on care setting, specialty and physician preference.

AUTHOR

Michael Clark

Chief Executive Officer

Celebrating Women’s History Month

Joanne Hunter
Vice President, Customer Success | DeliverHealth

In her role as VP of Customer Success, Joanne is responsible for all aspects of the customer experience at DeliverHealth.

Q: Tell me about your background.

A: Well, I have spent the better part of my career in clinical documentation—with the exception of a short stint in the lighting industry, working with the builder’s association as opposed to AHIMA! I’ve been with Nuance since 2011 when the company I worked for was acquired by them. So, my experience includes more than a little bit of knowledge of the industry and the company, but our new journey as DeliverHealth is exciting.

Q: Have you always been in healthcare? What drew you to the industry?

A: Most of my career has been focused on HIM. But that’s not how it all began. My mother was the Director of Nursing at a small 52-bed hospital, so I grew up in and around healthcare. I worked in the hospital as a teenager and had aspirations of medical school. But there was a different plan for me. I’ve played the piano since I was six years old, which means nothing to my career path except that my dexterity from playing helped my ability to type. And type FAST. So, during college, I worked in the HIM department, and the rest is history. I discovered my aptitude for transcription, and because it was all based on output numbers, I was highly efficient and productive. So productive, in fact, that it prompted the decision to start my own business.

I struck out on my own but soon had employees working out of my house. My little medical transcription enterprise took off. The business flourished, at one point making the Inc. 500 fastest growing companies list, and nine years later I sold it to MedQuist. After working as an SVP at MedQuist for nine years, I took a new path and, for a brief period, went to work in the lighting industry. Healthcare once again beckoned with an opportunity as an SVP for Webmedx, which I jumped on. In 2011, the company was sold to Nuance and that’s where I’ve been ever since. Though it has been a journey with twists and turns, I ultimately adjusted and pivoted when needed. Throughout my career, I’ve followed my talents in a space where I have the most value to share.

Q: What advice would you give to young women who want to go into a healthcare field?

A: Always remember that there are lots of avenues in healthcare. And as life happens, realize that your skills can transfer to those other areas. Healthcare will always be here. The opportunities are endless. Be creative, explore your options and always be intentional in doing your job.

Q: Has the industry changed for women over the course of your career?

A: I’ve definitely seen an uptick in the number of women in leadership positions, though there continues to be room for women to equalize. I would love to see more women in the vendor space in healthcare, and as a former small business owner, I know there are opportunities that women could capitalize on!

Q: Who/what has been the biggest influence on your career?

A: I have had a variety of role models over the years—my mother, for one, was definitely an inspiration. But I think that the biggest influence on my career was having someone tell me that while I was good enough and capable enough for a management position, I was not getting the job. That had a profound impact on me. Knowing that I was worthy and capable, but not being given the opportunity, motivated me to prove that I could do it, on my own. That negative experience has kept me determined over the years.

Q: Working in HIM/clinical documentation, what are your thoughts about the impact women have had on the industry? How does that influence you?

A: Women play such a critical role in all aspects of healthcare that it is hard to not recognize and take great pride in that fact. I have loved every step of my journey, with all its successes, failures, ups, and downs. However, I also know that all of my achievements have not been because I’m a woman, but because I worked at it—because I could. I was smart enough, savvy enough, confident enough. And that’s my message for everyone. Strive to do great things not just because…but because WE CAN.

Lori Adams Ticknor
Owner and CEO, QMEDET | Partner organization to DeliverHealth

QMEDET Solutions dramatically reduces medical documentation costs by providing scalable technology solutions that streamline workflows, increase production, and improve quality of care.

Q: Tell me about your background.

A: I have been in the clinical documentation industry for 23 years. After studying biology and English in college, I landed in medical transcription as a way to use both skill sets. After working in a hospital for a few years, I transitioned to working from home and then started my own company. 

Q: Have you always been in healthcare? What drew you to the industry? 

A: Aside from high school jobs and a summer spent working in my grandad’s store, I have always been in healthcare. I love the challenge of a constantly changing field. Transcribing a report can be like solving a puzzle, and you either learn something new or use something you have already learned in each case.  Making sure that the patient record is accurate is of utmost importance.

Q: What advice would you give to young women who want to go into a healthcare field?

A: I would tell them to go for it! Healthcare is a great field to be in for challenging work and job security. There will always be a need for individuals who enjoy learning and helping others at the same time. 

Q: Has the industry changed for women over the course of your career?

A: I believe it has! I think the ability to work remotely has helped many women manage their careers and family life at the same time.

Q: Who/what has been the biggest influence on your career?

A: That is hard to narrow down to one person. Growing up, I watched both of my grandads and my dad run their own companies. I guess that part is in my blood. But maybe the biggest influence on my career came from a negative experience that occurred when I started working from home as a contractor for someone else. That motivated me to found my own company that became known for treating contractors well, while maintaining the mission of document accuracy and integrity for our clients.

Q: Working in HIM/clinical documentation, what are your thoughts about the impact women have had on the industry? How does that influence you?

A: I definitely think women have had a huge impact on the industry. So many of us started out as independents, lugging tapes back and forth from offices. Others started as “secretaries,” responsible not only for the medical documentation, but also for anything else that needed to be done in the office—including getting coffee! The industry has seen so many technological changes, but in spite of all the changes, there is still a need for a skilled human on the final end of that document to ensure accuracy before it hits the medical record. As women, we have navigated those changes throughout the years. We’ve banded together in online groups, formed ethical companies that value contractors, and worked to always put the patient first—all the while balancing our family and community responsibilities, expanding our education, and preparing ourselves for future changes. It is easy to keep pushing forward when you get to work with so many dedicated women.

Jodie Hilliker
Director, Activation & Training | DeliverHealth

In her role at DeliverHealth, Jodie works in EHR performance activation and adoption, responsible for all aspects of activation and training for clients.

Q: Tell me about your background.

A: I have multiple degrees in medical fields—respiratory therapist, flight paramedic, and sleep therapist—and ended up managing a department in a hospital where I trained incoming paramedics. At the urging of my supervisor at the time who recognized that one of my strengths was teaching, I became an affiliate faculty at a small college near my home in northeastern Pennsylvania. For a few years I taught courses in paramedic training, respiratory therapy, and other topics until I was approached about becoming an Epic trainer. I struck out down that path, earning multiple Epic certifications and eventually becoming an implementation director. Along the way I met Doug Herr and David Carr. The three of us have worked together for many years and now are all at DeliverHealth!

Q: Have you always been in healthcare? What drew you to the industry?

A: I have always been in healthcare in some fashion. Always wanted to be in healthcare, for as long as I can remember. As a kid, my goal was to go to medical school. Grades allowed, but medical school is expensive, so I chose a path that got me into medicine in a different capacity. And I’ve loved every minute of it. There wasn’t a specific draw for me. It was definitely just a part of me. I am a caretaker. Every part of me is filled up by helping my clients avoid struggle. The more I can help them, the happier I am.

Q: What advice would you give to young women who want to go into a healthcare field?

A: Without a doubt I would tell them, you’ve got to love it. You can’t go into it for money or schedule. It’s a profession that you have to feel a fire for or else you’re not going to be happy. Find the part of healthcare you’re passionate about and go into that field.

Q: Has the industry changed for women over the course of your career?

A: Absolutely. There are so many more opportunities for women than there used to be. Fifty years ago the idea of a nurse practitioner didn’t even exist! 

Q: Who/what has been the biggest influence on your career?

A: Without a doubt, my parents. Without them I wouldn’t be where I am today. They always encouraged me to achieve at the highest level, supported me through any ups and downs, and would have sacrificed their happiness to help me reach my goals. Because of their support I had the confidence to follow my passion and always be doing something I loved to do.

Q: Working in EHR implementations, what are your thoughts about the impact women have had on the industry? How does that influence you?

A: It’s hard not to think about how far women have come, with so much opportunity to still advance! Every day I see IT teams that used to be all men and today it’s a real mix of men and women. And I work with so many great women who are now sitting at the boardroom table as CFOs, CIOs. That’s inspiring!