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.

Outsourcing Medical Transcription Services – Save Money

Outsourcing medical transcription services reduces the workload and can help save money.

From the business point of view, outsourcing medical transcription services is believed to be very cost-effective. There are numerous medical facilities in the US which have recognized the benefits offered by the outsourcing companies and are pleased with their functioning.

Medical transcription is stressful and time consuming. The major disadvantage of employing in-house staff to carry out the transcription work is that it is not economical as the expenditure incurred (employee benefits, salary) is huge. Moreover, it proves impractical in the long run. Doctors, however, find it difficult to manage transcription work and treat patients. Excess work invariably results in stress and this could adversely affect the treatment of patients.

Outsourcing of medical transcription is therefore the most sought after service as it reduces the workload and substantially decreases client expenditure. Outsourcing of work can be either onshore or offshore. The cost of labor in countries like India, Philippines, and China is far less than that in developed countries like the US, UK and Canada.

Professional MT companies employ experienced transcriptionists who are trained in the field. The companies work round the clock and this makes the processing of work faster. The use of the latest technology and software also helps in speedy completion of the work. The work is constantly assessed and regular quality checks are conducted by proofreaders and analysts. This ensures that accuracy and standard of work is consistently maintained.

Outsourcing medical transcription services can help save money anywhere from 40% to 60%. A flexible and client-centric company handles all the aspects of transcription and provides unsolicited customer and technical support. Doctors find sufficient time to attend to their patients and focus on giving adequate treatment which they rightly deserve.

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.

The Importance Of Transcription In The EHR Age

In preparation for the AHIMA (American Health Information Management Association) Conference next week, my publisher and I have been speaking with several transcription services companies that will be exhibiting at the show. Since Healthcare Technology Online is a new media outlet, these conversations typically begin with us describing the focus and purpose of our website and weekly email newsletters. In more than one instance, a representative from a transcription company questioned our interest in their services. “We’re not a technology company,” they’d say. “I don’t see how our content and offerings would be of interest to your audience.”

This response floored me. While it’s true that most transcription companies offer outsourcing services as opposed to hardware or software technologies, these companies still play a vital role in healthcare IT — particularly as more healthcare facilities migrate to an EHR (electronic health record).

Transcription: The EHR On-Ramp

Some proponents of EHR suggest that template-driven electronic documentation capture is the best approach to realize the benefits of EHRs. However, this approach often forces the process and behavioral changes that have been primary barriers to EHR adoption. Furthermore, relying on a physician to key information into an EHR or select data from a series of drop-down menus while with a patient can lead to human error, inaccuracy, and incomplete information.

Using a “migratory” approach to EHR can help you avoid these potential pitfalls. With this approach, physicians can continue to interact with patients the way they always have and continue to leverage their existing dictation and transcription processes. However, getting voice data into a transcribed format that can be seamlessly integrated with or digested by the healthcare facility’s chosen EHR platform becomes a required capability of the transcription services company. In response to these growing EHR integration needs, most transcription services companies leverage the latest NLP (natural language processing), XML (extensible markup language), and HL7 (health level seven)-compliant technologies. These tools can create templates for data entry that automatically populate an EHR. In other words, data is tagged according to the report’s format and the NLP’s output and uploaded directly into the EHR in the appropriate place. It then becomes simple for the transcriptionist to perform a quality check of the data to ensure it matches physician instructions and the requirements of the EHR. In this way, the transcription provider truly serves as a healthcare facility’s on-ramp to an EHR.

Key Transcription Provider Criteria

Ensuring that the transcription service company you select can deliver data that can easily be fed into your EHR is just one step of the process. Other areas to consider when selecting a transcription services company include:

• guaranteed compliance with HIPAA (The Health Information Accountability & Portability Act) when it comes to handling the protected health information of your patients
• storage in a mission-critical data center that provides 99.99% uptime and security
• a guaranteed transcription accuracy rate of 99%
• multiple levels of quality assurance
• transfer of files through FTP (file transfer protocol) or browser-based secure 256 bit AES (advanced encryption standard) encrypted file transfer protocol
• 24/7 technical support

Again, while not a “technology” in and of itself, medical transcription is a vital part of adopting EHRs and other healthcare information management processes. Transcription companies will provide the industry with the guidance and support necessary to accelerate EHR adoption and help us to embrace the electronic age of clinical documentation.