Medical Transcription as Proven Accelerator of EHR Adoption

The transcription sector took a solution-focused message to Capitol Hill June 3-4 in response to President Obama’s provisions and mandate for EHR adoption under the recent HITECH Act. With this administration’s push to have both a definition and criteria for “meaningful use” determined by July of this year, the Medical Transcription Industry Association (MTIA) and the Association for Healthcare Documentation Integrity (AHDI) believe there is a critically narrow window of opportunity for this sector to ensure that such criteria includes provisions for the evolving role of transcription in hybrid capture, where complex narrative is preserved and quality outcomes, not just fiscal savings, drive adoption and integration. The HIT vendor community is positioning itself around key decision-makers in the Department of Health and Human Services (HHS), in whose hands the determination of “meaningful use” now resides. Inarguably, the primary interest of those vendors is in securing widespread EHR adoption through HITECH provisions, and our message to legislators was that HHS needs others at the decision-making table whose interest is geared more toward how these technologies will be deployed and not whether they will be deployed.

Defining “meaningful use” is not the role of HIT but rather of clinicians and experts in health care documentation who can speak to the document workflow process and the complexities of capturing health stories in a way that informs clinical decision-making and promotes coordination of care. If the “meaningful use” definition is shaped only by the vendor community, there is great risk for EHR deployment to fall short of health care’s goals for capturing and consuming health information. All stakeholders, most importantly the patient, lose under such an imprudent integration approach.

More than 120 legislative appointments were held during the 2-day summit through collaborative dialogue from both MTIA business owners and AHDI health care documentation workers who met together with Senate and House members to share the importance of our quality-focused sector in accurately capturing patient health stories. We visited with legislators from 26 states and delivered letters from AHDI members to their respective legislators for 28 states. Each person had an opportunity to share the key talking points and messages prepared for the event, as well as to engage in dialogue with legislators and their aides about the role transcription can and does play in accurate capture. Likewise, we stressed the need to preserve complex narrative in the EHR so that the important nuances of a patient’s story are captured outside of restrictive point-and-click templates. Consideration must be given, as well, to the impact on clinicians who are inefficiently deployed to capture health care encounters rather than engaging in provision of care. And we talked about the value of a knowledge worker positioned in partnership with physicians to ensure the accurate, secure capture and repurposing of health information.

MTIA and AHDI will be engaging the services of a lobbying firm to push this message to the right people on the HELP committee (Health, Education, Labor and Pensions) as well as those in HHS who will ultimately be responsible for the “meaningful use” definition. In addition, through our lobbying firm, we will continue to drive this message and our recommendations to David Blumenthal, the National Coordinator for Health IT, so that the role of transcription is not left out of EHR integration standards, recommendations and regulations. Both medical transcription service organizations (MTSOs) and MTs will have an opportunity to contribute to and participate in this advocacy effort.

MTIAPI and MTIA Forged Medical Transcription Accord

The Medical Transcription Industry Association of the Philippines, Inc. (MTIAPI) has forged an agreement with the US-based Medical Transcription Industry Association (MTIA) to protect the interest of the industry.

MTIAPI president Myla Rose Mundo-Reyes, who attended the Building a Viable and Sustainable Relationship with Offshore MT Service Organizations by the Medical Transcription Industry Association (MTIA) conference held recently in Long Beach, California reported.

“I was actually glad that the participants’ concerns on quality, data privacy, public holidays and government support in policy making were openly raised because I was given the opportunity to inform them that the Philippines is addressing exactly the same issues that really matter to our clients,” Reyes said.

Reyes reported that MTIAPI and MTIA agreed to forge a partnership to protect the interests of the industry and its players. Some of the highlighted areas of cooperation were policy enforcement on data privacy protection, intellectual property rights protection of their MT curricula, certification of MT workers and training facility accreditation, a company verification process, and some business matching activities for MTIA’s US Medical Transcription Service

Organizations (MTSO) members looking for offshore partners.

Colin Christie, CEO of MXSecure and MTIAPI director who joined the meeting viewed the meeting as a great step towards future cooperation.

“The well-attended panel discussion has torn down barriers to the Philippines’ emergence as the outsourcing and offshoring destination of choice and presented the country as having viable solutions for US MT companies looking for a virtual extension office so as to expand their businesses.

Reyes, who is also the managing director of Total Transcription Solutions, Inc., explained that the panel discussion corrected some of the participants’ negative perceptions about offshoring and informed them of where to go, who to talk to, and what to consider if they want to explore outsourcing to other countries.

“I was actually glad that the participants’ concerns on quality, data privacy, public holidays and government support in policy making were openly raised because I was given the opportunity to inform them that the Philippines is addressing exactly the same issues that really matter to our clients,” she added.

Another MTIAPI delegate and marketing manager of IQ West, Sammy Pe, said that as a result of the panel discussion, he was able to get a number of leads at the convention.

MTIAPI director and Transkripsyo chief executive officer Michael Chua said, “It was a very good mission. I believe the delegation presented the Philippine value proposition very well. We are looking forward to having more US companies taking a second look at the Philippines for their outsourced transcription needs.”

Medical transcription companies bracing up for newer challenges

The Medical Transcription industry, recently rechristened as the Clinical Documentation industry, is gearing up to counter the challenges posed by technology and outsourcing. In order to reinvent itself, the industry has resolved to move beyond conventional medical transcription services to encompass every touch point in the clinical documentation continuum, according to the newly-formed Clinical Documentation Industry Association.

Hitherto, a medical transcription company’s sole job was to convert voice files into text format, edit them, and send them back for the physician’s review. But CDIA is now looking at a broader role for medical transcription companies. It now wants transcription services to include not just transcribing and editing but also producing meticulously documented clinical reports which could also be used for coding and billing to ultimately make a practice’s workflow faster and more efficient.

The industry which is already facing an existential threat from medical transcription outsourcing firms in developing countries is also seeing some competition from sophisticated transcription software.

A case in point is the front-end and back-end speech recognition (SR) transcription software. While the front-end SR software captures physician voice files directly into the computer and converts them to electronic text format, the back-end SR software additionally sends the transcribed files to a professional transcriptionist for correction and editing. The latter is more popular among physicians as it is screened both by a transcriptionist and physician, and makes the reports more reliable and error-proof.

But technological advances and the threat from outsourcing notwithstanding, the role of medical transcription companies continues to remain important. With more and more patients to tend to each day, providers have little time for medical transcription functions even with the aid of software. So they would continue to use the services of medical transcription companies who in turn would have to raise the bar and add more value to their services.

Ultimately the future of medical transcription industry will depend on its willingness and ability to modify transcription services in line with the changing physician requirements and technological advances.

Medical Transcription

Medical transcription, also known as MT, is an allied health profession, which deals in the process of transcription, or converting voice-recorded reports as dictated by physicians and/or other healthcare professionals into text format.

Traditional medical transcription is a form of document creation that the medical industry considers outdated, but necessary as a means of providing the necessary documentation needed to satisfy regulatory and insurance provider requirements. The practice of modern medicine dictates that the physicians spend more time serving patient needs than creating documents in order to make financial ends meet. More modern methods of document creation are being implemented through the technology of computers and the internet. Voice Recognition (VR) is one of these new-age technologies. With the power to write up to 200 words per minute with 99% accuracy Voice Recognition has freed physicians from the shackles of traditional transcription services.

Medical transcription is still the primary mechanism for a physician to clearly communicate with other healthcare providers who access the patient record; to advise them on the state of the patient’s health and past/current treatment; to assure continuity of care. More recently, following Federal and State Disability Act changes, a written report (IME) became a requirement for documentation of a medical bill or an application for Workers’ Compensation (or continuation thereof) insurance benefits based on requirements of Federal and State agencies.

The medical transcription industry will continue to undergo metamorphosis based on many contributing factors like advancement in technology, practice workflow, regulations etc. The evolution toward the electronic patient record demonstrates that, over time, documentation habits will change either through standards and regulations or through personal preferences. Until recently, there were few standards and regulations that MTs and their employers had to meet. First, we had the Health Insurance Portability and Accountability Act (HIPAA). It wasn’t long ago “experts” stated that HIPAA would not have any effect on the medical transcription industry. Either in a state of denial or ignorance of the law, many transcriptionists and companies have continued on their existing course of providing medical transcription. Many providers are concerned that the majority of the transcription industry will not be able to meet several specific requirements: namely, access controls, policies and procedures, and audits of access to the patient information. Without the knowledge or resources to comply, many in the industry are claiming to comply and signing their Business Associates Agreements without taking the security measures required. Many are uninformed, and some are choosing to remain so, believing that the world of transcription cannot possibly be expected to make these adaptations. The fact is that the employers will demand HIPAA compliance and will change employees and contractors when they don’t get it. There will also be demands to enhance patient safety, increase efficiency, and reduce costs. It is mandatory for service providers and healthcare practices to migrate to a HIPAA compliant environment.

Why Medical Transcription Services are in High Demand

Medical transcription services are in high demand in a variety of healthcare settings. These services are in high demand mainly because:

• They help speedy processing of patient insurance claims
• They ensure accurate and detailed medical records which are of great importance in any healthcare setting
• They can efficiently handle the growing volume of medical reports in hospitals, clinics, primary healthcare centers, acute care centers
• They ensure that clients receive properly formatted, edited and reviewed documents

Most companies in the medical transcription field offer HIPAA (Health Insurance Portability and Accountability Act) compliant transcription services. Reliable transcription services are available for operative reports, diagnostic imaging studies, laboratory summaries, x-ray reports, physical examination reports, patient histories, ER reports, clinic notes, referral letters, progress notes, psychiatric evaluations, physical examination reports, pathology reports and death summaries.

Convenient Dictation Options and Flexible File Formats

Leading transcription companies offer affordable and convenient dictation options – toll free number, digital recorders or computer based dictations. The voice-recorded files can be in any format including WMV, MPG, AVI, MOV, ASF, ASX, RM, SWF, DIC or extended audio formats such as WMA and MP.

Qualified Professionals to Handle the Rising Transcription Demands

To handle transcription services in various specialties–including pediatrics, gastroenterology, internal medicine, radiology, orthopedics, cardiology, chiropractic and podiatry–at 99% accuracy, these service providers have a team of skilled and experienced medical transcriptionists, quality analysts and proofreaders. They utilize the best combination of tools and techniques to output transcribed files in various formats (such as JPG, GIF, XML, PageMaker, XML, PDF, HTML, TIFF, FrameMaker, QuarkXpress, Word and Excel) through FTP or browser based 256 bit AES encryption protocol.

If you need medical transcription service for generating accurate transcripts, it is important to get the support of a dependable service provider.

Benefits of Outsource Medical Transcription Services

Medical Transcription is the process of understanding and transcribing the transcript made by healthcare professionals, such as doctors, treatment procedures, prognoses, diagnoses etc. It is the wide procedure of transcribing voice-recorded reports done by doctors and healthcare professionals into text formats for various uses.

Today there are extensive medical transcription services are available that cover all kind of the specialties in medicine. As the health care industry grows up, one finds that the number of companies is specialized in providing medical transcription services. Medical transcription is growing day by day. These services are provided to a wide range of practices and organizations that can include healthcare facilities, hospitals, laboratories, clinics, individual doctors and physicians’ groups.

Electronic storing of medical records is preferred by contemporary medical organization because of the giant number of patient information being accumulate. It crafts it very easy to integrate all details including the medicine, diseases details and other diagnostic information. Maintaining of this type of records is primarily to facilitate the patient’s healthcare. Also to use it as a general use data bank while still maintaining privacy of patient data.

Medical transcription services are offered exclusively for all the different medical specialists. Nowadays we have experienced medical transcriptionists who do specializations in transcription of different branches of medicine.

Medical Transcription Services includes:

• Radiology Transcription
• Cardiology Transcription
• Gynecology Transcription
• Dental Transcription
• Psychology Transcription
• Neurology Transcription
• Dermatology Transcription
• Orthopedic Transcription
• Academic Transcription

Medical transcription is one of the most widely outsourced works in the healthcare industry. Medical transcription services can consistently give you the combined unique experience of 99% accuracy, data security and absolute privacy for your records and documents. The concentrated training provided at these outsourcing companies guarantees quality and speed. To guarantee maximum accuracy in medical transcription, all these medical transcription services have experienced editors and proofreaders. Another foremost benefit of outsourcing these medical transcription works is that backup copies of patient data. These are forever available at the servers of these outsourcing companies and so it is easier to search and access patient records. Medical Transcription outsourcing is one of the most important industries in the outsourcing range.

Association readies for EHR advocacy summit

The proven ability for medical transcription to facilitate accurate, cost-effective EHR adoption will be the key message brought by the members of the Association for Healthcare Documentation Integrity (AHDI) and the Medical Transcription Industry Association (MTIA) to federal legislators on Capitol Hill when the associations convene in Washington, DC, for their annual Advocacy Summit. With the HITECH Act, the Obama Administration’s high priority on nationwide EHR adoption has opened an opportunity for the transcription sector to educate the current Administration and Congress about the need for contemplative, prudent migration to the EHR – one that preserves the role of complex narrative and engages human intelligence in ensuring the accurate, secure capture of patient healthcare encounters.

The Advocacy Summit, being held June 3-4, 2009, in Washington, DC, will focus on the need for standards and regulations in EHR technology integration/adoption, the role of transcription in safeguarding protected health information (PHI), and the need for workforce development funding in healthcare documentation to ensure a knowledgeable, prepared next gen workforce that is capable of functioning in the quality assurance role the EHR will demand.

“Healthcare can ill afford a knee-jerk reaction to the EHR requirements of the HITECH Act,” states Peter Preziosi, PhD, CAE, AHDI/MTIA chief executive officer. “Successful EHR adoption and meaningful interoperability hinge on healthcare’s ability to set standards that promote efficient, cost-effective, quality-driven data capture solutions. The transcription sector is uniquely positioned to offer healthcare delivery the means to make that happen, and that’s what we’ll be sharing with this new Administration and the new Congress.”

The associations will take to the Hill their Transcription: Proven Accelerator to EHR Adoption whitepaper, which includes compelling statistics that demonstrate (a) the loss of income to physicians who integrate EMR/EHR technologies ineffectively, (b) the critical role of transcription technology solutions in facilitating better EHR adoption, (c) the value of solutions that create “rich, interrelated narratives” rather than cookie-cutter records, and (d) the irreplaceable role of a knowledge worker in data integrity management.

Verbatim Transcription

A run-on sentence. A misspelled drug. A superfluous comma. Heck, maybe even a split infinitive. Dictation errors can irk word-wary MTs, but should they be forced to overlook such grammatical offenses? Thus begins the debate over verbatim transcription, a contractual item that makes MTs withhold all judgment — medical, grammatical or otherwise — and simply type what the dictator says. The controversial practice pits risk management against quality assurance (QA), but MTs’ reputations and patient care are what’s on the line.

While traditional transcription lets MTs correct punctuation, misspellings and dictation errors at their discretion, verbatim transcription requires MTs to transcribe notes exactly as dictated. The practice is usually based on the client’s preferences; if a doctor doesn’t want his words altered, the MT is expected to transcribe word-for-word. There are arguments for and against the no-edits approach, but most MTs aren’t thrilled about it.

The running joke is, “If you want verbatim transcription, I will put in every ‘uh,’ ‘ah,’ ‘oh’ and ‘um’ that you have dictated,” said Barb Marques, CMT, AHDI-F, president-elect of the Association for Healthcare Documentation Integrity (AHDI).

In reality, it’s no laughing matter.

Risky Business

Doctors can make mistakes, so risk managers champion verbatim transcription as a way to keep MTs from taking the fall, according to Donna Brosmer, CMT, AHDI-F, NREMT-B, quality officer, Spheris. If the document ends up in court, an MT can claim no culpability because the doctor requested the dictation be transcribed word for word. If the MT changed any words, he or she might be held accountable for the error – a mark hospitals and medical transcription service organizations (MTSOs) don’t want on their hands.

But many say verbatim transcription neglects the value a skilled MT can bring to the table. With knowledge of diseases, diagnoses, treatments and medical terminology — not to mention, a knack for grammar and punctuation — MTs can serve as the first line of defense against errors, according to Brosmer. “You have a group of very intelligent people creating these reports, transcribing these reports,” she said.

For example, a good MT would know the difference between Xanax and Zantac and could correct the mix-up if a doctor misspoke, Brosmer said. MTs are also trained to notice when a doctor switches between left and right.

“If he said ‘right foot’ five times in the report and he gets down to the bottom and says ‘left,’ 99.9 percent [of the time], he really does mean the right foot,” Marques said.

Errors like that are becoming more common as good dictators become few and far between. With doctors able to dictate from their Blackberrys and iPhones, MTs are struggling to hear over the background sound of gyms, pools and oncoming traffic, Brosmer said.

Physicians are also getting more lax. Marques said today’s rising doctors do not speak in complete sentences, making it harder to understand the report. While a skilled MT would have the confidence to edit and make corrections without delaying the report, with verbatim transcription, the MT would have to query the physician or flag errors in hopes he would re-examine his work.

Making matters worse, many doctors don’t review their transcribed reports, according Lesli McGill, director of U.S. operations, SPi Healthcare. McGill hails from the “old school” of transcription, where she learned to edit as she transcribed. She recalled the “rubber stamp” method physicians used to approve reports — simply passing it on without so much as a glance. In today’s electronic environment, that stamp has been replaced with a click of approval, making it even easier to overlook flagged items.

Employee Pride

What the controversy boils down to is quality. MTs pride themselves on delivering a timely and accurate record, so they loathe initialing a document that isn’t up to par — especially if that document is hauled into court. “[MTs] want people to understand they did the best job they could with that document,” McGill said. “It reflects badly on them if it’s a verbatim account and you’ve got a bad dictator.”

The squabble isn’t likely to end soon, the experts said. The topic was among discussions at the Medical Transcription Industry Association (MTIA) Convention last April, and it’s expected to be on MTs’ minds at the AHDI conference later this month. In health care, quality isn’t something to take lightly; a mistake that slips through the cracks could mean the difference between life and death. MTs are supposed to be the first defense against errors, but amid the skirmish of lawsuits and legal liability, some fear verbatim transcription will push patient care to the wayside.

Medical Transcription: Proven Accelerator of EHR Adoption

The recently enacted Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009 represents an important first step towards achieving the vision of a nationwide, fully interoperable electronic health record (EHR) system. However, the gap between that vision and current reality remains wide. Many healthcare providers still use paper records. Other providers have tried to implement EHR systems, but unfortunately, many such projects have failed. “Industry experts agree that failure rates of electronic medical record (EMR) implementations range from 50 to 80 percent.” Clearly, the challenges of EHR adoption and implementation remain great.

EHRs promise to lower costs resulting from inefficiency and inappropriate and/or redundant care while improving the coordination of care and exchange of information among healthcare enterprises. However, despite these promises and efforts to date, adoption rates among physicians still remain relatively low, with costs cited as a major deterrent. Other adoption concerns include complex organizational and system work flow issues and the increased documentation burdens on the part of physicians when they are asked to use direct text entry. Several studies have shown that practice productivity can decrease by at least 10 percent for several months following EHR implementation. In some non-oncology studies, the average drop in revenue from that loss of productivity was approximately $7,500 per physician.”

Outsourcing Medical Transcription Can Help Reduce Costs

Need to organize physicians’ handwritten notes and prescriptions into electronic documents without spending a fortune? A medical transcription service is what you need.

What is the need for medical transcription service?

All medical institutions require computerization of medical notes for clean and compact record-keeping, insurance claims processing, quick reference, conferencing and various other reasons. Hospitals and clinics have long been hiring full time transcriptionists to do the same. But this is an expensive option and not the ideal solution if you have varying volume of transcription needs. Alternatively, you can give transcription duties to other clerical staff or use voice recognition software. But these solutions can be quite inaccurate, putting the health of your patients at stake. Your clerical staff may not be well trained for medical transcription and accuracy of voice recognition usually is too low to be useful. A medical transcription service gives you the best combination of expense, quality and accuracy.

How does medical transcription work?

• Physicians dictate their notes into a recording device, usually a toll-free phone line or handheld digital recorder. Most medical transcription services support both these methods. Some services also accept recorded cassettes. Mp3 is the preferred sound format when using digital recorders, though other formats can also be used.
• The recorded information is then sent to the medical transcription service provider. Information security during transfer is critical. Your patients’ personal information must not be leaked out at any cost. Digital recordings are submitted via the Internet. This can be done using a secure web site and file transfer protocol (FTP) using custom software from the provider, or even through encrypted email. In case of a toll-free line, the information is directly recorded on the provider’s servers.
• The recorded notes are then transcribed and returned to the hospital or clinic. Information is usually returned as word files, though other formats like pdf can also be specified. Delivery methods include secure web sites, FTP, custom software, encrypted email and in some cases fax.

More comprehensive medical transcription services are also available. They offer an online system that stores both the audio files and transcripts, organizes them by date, doctor, or patient, and keeps track of progress as they’re being transcribed. These services are more expensive but offer substantial management benefits.

Important Considerations

Accuracy: The returned work must have accuracy close to 100 per cent. Select a medical transcription service that employs experienced and skilled medical transcriptionists and quality assurance professionals who review the transcriptions before delivering them to you. Your doctors should review and evaluate each transcript on delivery to prevent any damage to your patients’ health and well-being.

Turnaround Time: It refers to the maximum time within which medical transcripts will be delivered to you after submitting the audio recordings. Most medical transcription services offer a turnaround time of 24 to 48 hours. Most also include a STAT service that allows you to specify a turnaround time of one-, two- or four-hours at an additional cost. Different types of notes can have different turnaround times.

Security: Medical transcription services are subject to HIPAA rules about patient confidentiality. The industry standard for internet security is 128-bit SSL security. Physical security at the provider location is also important. Careful employee screening and tracking is essential. Audit trails can assist in tracking employees. An audit trail keeps track of each individual who accesses a given set of notes and the modifications they make.

Sound Quality: Good quality of sound recording is essential for performance. Digital handheld recorders provide better sound, though they carry an additional hardware cost. Some medical transcription services charge lower prices if you provide them with better quality recordings.

Location of service: Many medical transcription services use both domestic and international transcriptionists. There is generally no difference in quality and accuracy between the domestic and outsourced services. Having transcription teams all around the world enables the service providers to meet deadlines. You will most like pay more for service if you insist on using medical transcriptionists located in a developed country like the US.

How much will you have to pay?

You are charged per line of text. The industry standard is 65 characters in a single line including spaces. Some medical transcription companies however, include lesser number of characters in a single line. Price usually ranges from $.05 to $.20 per line.

Most medical transcription service providers offer free trial runs. Carefully assess the provider’s ability to meet deadlines, the accuracy of transcripts, and ease of interaction with his customer service representatives during the trial run. Many providers assign a dedicated team of transcriptionists for long term contracts and also offer lower prices. Carefully evaluate your requirements, and compare medical transcription services before making a decision.