Electronic Health Records (EHR) Management and Challenges in Long Term Care Industry

The four most critical challenges faced by the Long Term Care industry today.

Shortage of Nursing Staff : One of the major challenges in the nursing homes today is shortage of adequate nursing staff. This has a direct impact on the service provided by the nursing staff as the residents have to wait for assistance from the nurses. In other words, the residents’ activities of daily living (ADLs) like bathing, dressing, eating, medication etc…are at times not being done in a timely manner. Hence it is very important for the nursing homes today to have adequate nursing staff.

Complex Regulations : Proper documentation and management of medical records is the most integral part and is a mandatory requirement for any Long Term Care facility. Nursing staff has been efficient in adhering to these requirements. But this is not the case in all Long Term Care Facilities. Errors may occur in cases where documentation is done manually. This increases the risk of regulatory citations and this can be avoided with a proper Electronic Health Records system in place. It would be any added advantage if your EHR software has both financial and clinical systems integrated under one system to take care of both financial and clinical functions in one platform.

Rising Operational Costs : Rise in operational cost directly impacts the cost of treatment given to the resident. Long Term Care facilities must have effective systems in place to controls costs. One option is to outsource their financial and clinical documentation part as this is a time consuming activity. This not only reduces the cost as there is no need to have additional staff assigned to perform these activities but also allows the LTC staff to focus on their core activity of providing quality health care to the residents.

EHR Management : It is very important to have a right EHR system in place. A lot of Long Term Care Facilities end up acquiring a system which is generic and not a customized platform. In this case LTC facilities are paying for software which has some of the functions which they might never use or which does not have some of the functions and are doing it manually. Hence it is very important to identify a right vendor who can provide you a customized and cost effective solution for your EHR software.

Any comments are welcome.

For further questions on effective EHR management call 408-856-6651 or e-mail chiragb@promantra.net

Ideas and Growth Opportunities in LPO Segment

U.S alone accounts for a large share of the $250 billion global legal market. Out of this huge chunk, it is generally estimated that 3 to 4 billion can easily be outsourced. Except for the courtroom representation and agreement, all other legal activities can be outsourced. Hence it need not be mentioned that the potential of this industry is immense. The percentage of the distribution of lawyers in U.S is also equally interesting. According to U.S Info, 73% of the lawyers in U.S are employed in private practice and 10% are working in the legal department of the corporate world and these two are the major segments addressable for outsourcing.

For example, in India few of the LPO companies have started doing what the BPO or KPO were doing, prioritize their area of operation and target their prospective clients. The primary reason for this being the limitation of the availability of skilled manpower. The scenario is similar to the one faced by the BPO industry after its rapid growth: lack of skill workforce. A report by NASSCOM said, the number of law graduates from different Law Schools in India is around 15000 every year. Out of this number, hardly 1000 students enter LPO every year. This may be because the industry is still in its nascent stage. Language also acts as a constraint in some cases as the attorneys working for LPO should have a sound knowledge on English.

Although this number is sure to grow in future, it might not be enough. It is thus important for the LPO industry to decide from the very beginning on which area of operation it wants to focus. An effort to tap all possible fields will make its resource thin thereby increasing its vulnerability to the competitors. In a survey in U.S, 24% of CEOs showed their concern over the ever mounting litigation cost. So companies will be keen in identifying areas where they can outsource their legal work and bring down their litigation cost. Considered this perspective, the corporate sector is the prime target for LPO. Corporate industry is one of the many industries that are conducive to the concept of outsourcing.

One thing that the LPO needs to adapt directly from KPO and BPO is a regular maintenance of on-site resources. Since the industry is at its nascent stage, it is important that it gets regular nurture and care from offshore as well as on-site entities. Any LPO player genuinely interested in expanding its business should have 20% of its resource on-site. This can be a combination of local law school hiring or a combination of H1-B1-L1 visas. Whatever may the approach be, a successful LPO needs to maintain an on-site resource that will directly interact with the clients and a strong team offshore that will work for the client. Only a successful combination of these two can ensure the prosperity of a Legal Process Outsourcing unit.

Evolving Legal Service Ecosystem: The Growth of LPO

After decades of stasis, the legal industry in the United States and other traditional common law system countries is in the midst of an evolution. The entire ecosystem of legal service- its market, agencies and partners are all going through a significant change. As buyers of legal service, the relation of the client with his attorney is under pressure because of the rising legal cost that the client has to bear. In a circumstance like this, the client demands greater value for every dollar that he spent, thus providing a perfect ecosystem for the growth of legal process outsourcing within the country and to other service provider countries like India, China and Philippines.

It is only a handful of traditional law firms that have been able to adapt and adjust with this situation resulting in increased share of profit per equity partner. For most others, it is a new era of competition, both with other law firms and the new players that have entered the market in response to the corporate buyers. In an environment, like this, the Senior Law Firm Partners and General Counsels (GC) in Corporate America face a big challenge. Their budgets are showing little or no growth as corporations and Law Firms take the cost line management very strictly. In the meantime, the rates of the Law Firms are rising on an annual average rate of 5 to 6 per cent. (LawMarketing, Nov 18 2007). A recent report by RSG Consulting showed that the key areas of concern among the clients are: rising fees of the attorneys and the heavy price of buying legal advice.

Keeping the client's demand in view, the Law Partners and General Counsels no longer turn to in-house hires or traditional firms for works like document review or contract administration. When the clients want cost efficiency without compromising for the quality of their work and prefer to outsource their work to offshore entities. India is particularly a favorite spot serving their purpose, as the lawyers are trained in common law system, speak English, deliver quality work product and are cost effective as compared to their U.S counterparts. This shift has also resulted in a move away from the traditional system of pricing on a time-spent basis to product pricing on a per-unit-basis. It also results in a change from dollar- per-hour to dollars-per-contract.

There is a paradigm shift in the traditional manner of segmenting legal work by these Law Partners and Corporate. The ongoing process of distributing high end and low end work to a cost effective and efficient provider available in low cost countries like India has certainly strengthened the ecosystem. A client may pay a full rate to the firm but the question is, is he happy paying $300 per hour to a first-year associate, when he can get that same quality of work in paying just a fraction of it. For example, in a M&A case, this unbundling of the law pyramid will make GCs move to new-model firms to manage the process and brief the key documents (in place of senior associates) and offshore entities to do the diligence review (in place of junior associates and paralegals). At each level, the cost efficiency will be significant.

These changes brought in by the Law Firms and Corporate for running their legal process as cost effectively as the rest of the processes in their business has in fact strengthened the entire ecosystem, including changes in overall industry outlook towards strategizing budgeting and execution of legal work. As the Corporate become more sophisticated, the law firms are forced to change their approach and the new entrants, both for the high-end (new model firms) and low end (outsourcing), stand strong in this changed ecosystem for legal service, thus giving more impetus to the growth of Legal Process Outsourcing.