National Medical Transcription Week

In 1985, then President Ronald Reagan gave a proclamation that the week of May 20 through May 26 would be set aside as National Medical Transcription Week. The following is an excerpt from that proclamation:

"A century ago, physicians knew many of the patients from birth, knew all their ailments, and provided all their medical care. Today, with medical specialization and greater mobility among people, many skilled physicians may treat the average American during a lifetime. Using transcribed medical records, each physician can easily and quickly review a patient's medical history even if the physician has never seen the patient before. Because of the work done by trained medical transcriptionists, patients can be assured that the history of their medical care is portrayed accurately and legibly. Medical transcriptionists have therefore become a vital link between the physician and the patient.

It is appropriate for our Nation to recognize the contributions of medical transcriptionists. We should encourage hospitals, allied health education programs, and community colleges to provide appropriate courses of instruction recognizing the high standards that must be met by medical transcriptionists and the vital function they perform."For more about medical transcription visit this link Medical transcription services

Medical transcription: Establishing a process for continuous quality improvement

The importance of documenting the patient encounter is manifold as it helps in many aspects that contribute to the smooth running of healthcare facilities, besides being a statutory necessity. As healthcare services are critical it is important that the process of documenting the patient- healthcare professional encounter be subject to certain norms. The patient – healthcare professional encounter can be documented by various means, one of the most preferred being medical transcription; a process which converts dictation to text.

As medical transcription has an important supporting role to play in the process of healthcare, a best practices guide titled “Healthcare Documentation Quality Assessment and Management Best Practices” has been jointly created by AHDI, MTIA and AHIMA. One of the highlights of this manual is alignment with the Plan-Do-Check-Act cycle.

Each stage of the process is vital to ensure that the process of healthcare is documented keeping in mind that maintaining the highest standards of quality is a continuous process. The goal of this quality assessment program is to ensure that healthcare documentation is clear, consistent, accurate, complete and timely.

Act: Continuous quality improvement

As quality is a key word in the medical transcription process, the process of improving quality should be proactive rather than reactive. That is the quality improvement program should aim at preventing errors from occurring rather than correct errors after they occur. To this end the key steps in a quality improvement program should be:

·                                 Review

·                                 Revise

·                                 Communicate

·                                 Monitor 

The quality improvement program for medical transcription services should focus on all aspects of medical transcription including: 

Dictation devices: The quality of audio is a major contributor to the quality of medical transcription. It is important to address this issue by studying in detail all types of dictation devices to determine which one produces optimum output. It is also important to have a clear idea of the working of the device so as to avoid audio problems like clipped words, garbled words etc

Author education: As the healthcare professional is the originator of the transcript by providing a narration of the patient encounter, it is important to educate the author on dictation best practices.  These could include:

1.                               Choosing the right dictation device

2.                               Knowing the equipment

3.                               Importance of choosing a noise free environment for dictation

4.                               Practice of specifying type of report etc at the beginning of dictation

5.                               Using the right pace of dictation

It is also important to establish a forum for feedback that flows both ways between the healthcare professional and medical transcriptionists

Medical transcriptionists: The responsibility of transcribing the dictation into transcripts rests for the most part on the medical transcriptionist. It is important to provide medical transcriptionists with the means to produce quality medical transcription. These could include:

1.                               Provide training

2.                               Provide resources

3.                               Provide feedback

4.                               Use feedback as learning opportunities

5.                               Distribute samples for difficult authors

6.                               Provide formats/ templates/ macros/ normal

7.                               Assign mentors for new medical transcriptionists

8.                               Provide incentives for quality

Account specific: This would address the issues specific to particular accounts making it easy for medical transcriptionists to produce quality. These could include:

1.                               Easy to use account specification sheets

2.                               Constantly update the information on account specification sheets

3.                               Maintain up to date lists of healthcare professionals etc specific to the account

Medical transcription outsourcing: Leads to flexibility

In today’s situation healthcare facilities have to maintain a delicate balance between providing quality healthcare and still maintaining profits. The demands made on the limited resources available to a healthcare facility are numerous. In such a situation it is important for healthcare facilities to have maximum flexibility so that they can adapt themselves quickly to the changing demands placed on them. Outsourcing medical transcription can help healthcare facilities remain flexible!

How does outsourcing medical transcription help the healthcare facilities remain flexible?

Though medical transcription is an important contributor to the healthcare process it is not part of the core competencies of the healthcare facilities. The key to maintaining flexibility is to concentrate on the core competencies and outsource all the other activities.

Outsourcing medical transcription helps the healthcare facility remain flexible by the following means: 

o                              By offering a price structure based on fee for services rendered: Outsourced medical transcription service providers normally quote prices that are based on the services used by the healthcare facilities, that is based on variables like number of lines, number of reports, number of pages etc., instead of a flat rate. This ensures that healthcare facilities incur expenses limited to the usage of services.

o                              By helping transform fixed costs to variable costs: By outsourcing medical transcription the healthcare facility can convert the fixed cost incurred for in-house transcription to variable costs. Fixed costs like real estate, salaries etc can be avoided.

o                              Enabling increased flexibility in resource management: Outsourcing medical transcription frees up several valuable resources. The healthcare facility is then in a position to utilize these resources for other purposes.

o                              Helping reduce response time to outside changes: In a changing atmosphere it is important for healthcare facilities to be able to respond to changes in a speedy manner. Outsourcing medical transcription ensures that valuable resources are free for the healthcare facilities to use while responding to outside changes.

o                              Increase focus on core activities: Outsourcing medical transcription ensures that the healthcare facilities can focus on their core activity of providing quality care rather than on other associated activities like medical transcription.

o                              Freeing up key employees: Outsourcing medical transcription not only benefits the healthcare professionals but also key employees of the healthcare facility like the support staff, the management staff and the information technology staff to focus on the core business of the healthcare facility.

o                              Increasing speed: Outsourcing medical transcription ensures that the patient medical records are available to the healthcare professionals and support staff on time. This ensures that the speed of service is also more efficient.

o                              By helping avoid bottlenecks to quicker reimbursements: Outsourcing medical transcription not only reduces direct and indirect costs but also removes bottlenecks that hinder the cash flow. Medical transcription is the first step in the receivables cycle; timely medical transcription ensures that the process of reimbursement can start on time.

However the process of outsourcing medical transcription needs to be approached with caution. Apart from evaluating the medical transcription service provider on the basis of criteria like accuracy, turnaround time and technology used, healthcare facilities need to evaluate the medical transcription service provider on the following additional points: 

1.                             Billing methodology

2.                             Ability to deliver quality by checking on training methods and levels of quality checks used.

3.                             HIPAA/HITECH compliance

4.                             Experience of the medical transcription service provider by checking on references

5.                             Actual capability of the medical transcription service provider by availing a free trial

6.                             Availability of open channels of communication.

Once the medical transcription service provider has been evaluated on all these criteria the healthcare facility can enjoy

immaculate services, which lets them enjoy the benefit of being flexible in an ever-changing competitive environment.

The Medical Transcription Team

In any average sized medical transcription unit one will come across a team of people executing the project. The common hierarchies of people who form the medical transcription team include,

• The Transcriptionist
• Quality Editors (QA)
• Project Administrators

The medical transcriptionist is the front liner, working at the very first stage of making of the transcript. What does the medical transcriptionist do? Well it is his job to listen to the audio tapes and the physician's dictations, type them up, make a transcript and check out its contents. No wonder one of the most preferred skill a transcriptionist should have is the active listening skill besides the knowledge to understand all the technical details that is being talked about. All major flaws, if any, have to be identified at this stage itself. The quality of a professional medical transcriptionist is graded based on the on the quantity/quality of transcript produced by him.

The work is now passed on by the transcriptionist to the next level that consists of quality editors. What do the quality editors do? Well as the name suggests, the quality editors have to edit the medical transcript, which means, looking out for finer errors (such as spelling mistakes, incorrect words and proper formatting). The QA has to make sure that the transcript is ready for release to the client via the Project leaders/administrator.

Medical transcription outsourcing: Supporting information management

Information has become the key to success for most businesses today. Healthcare is no different; the process depends on correct and timely information to be able to provide vital services.  In fact the healthcare process starts with collection of data from patients, which includes both demographical, and health related inputs. This data needs to be processed to be converted into usable information for various purposes like clinical decision-making, receivable management and risk management.

Medical transcription is one of the methods that help convert the data collected by healthcare professionals and other support staff into information in a textual format. Due to the way medical transcription functions intuitively to support healthcare professionals and healthcare facilities, it has been found to be one of the most preferred methods of documenting the care process. As medical transcription is a specialized process requiring the right team, the right technology and the right process to meet the required standards, outsourcing transcription to a professional medical transcription company has been found to be a viable option.

Outsourcing medical transcription is not only a viable option in economic terms as it results in cost savings but also aids in information management. Given below are some of the information management areas that outsourcing transcription services aid in:

Data collection: The process of medical transcription starts with the collection of data from the patients. Outsourced medical transcription service providers aid in this by allowing healthcare professionals and other support staff to retain dictation as a means of collecting data and further help them by allowing them to use dictation devices of their choice.

Processing the data into usable information: This data is transmitted for transcription by expert medical transcriptionists using multiple quality checks to ensure maximum accuracy. Medical transcription companies use  well-trained teams and stringent quality processes to ensure quality.

Improving quality of information: Medical transcription companies also help in improving the quality of information to acceptable levels when healthcare professionals use speech recognition software as means of recording their findings on the patient encounter by providing editing and proofreading services.

Information distribution:  Once the patient medical records are transcribed with maximum accuracy and within the promised turnaround time, this information is transmitted to the healthcare facility using HIPAA and HITECH compliant channels to ensure security. Transcripts are delivered in the manner specified by the healthcare professional for maximum convenience with options like electronic signature, delivery to specific folders, remote printing & faxing, delivery to multiple healthcare professionals etc. for maximum convenience.

Information management: Medical transcription service providers help in managing information by archiving these records on a periodical basis and enabling search of older transcripts using various criteria. Transcription providers also aid in adoption of EMR/ EHR using HL7 interface.

Outsourcing medical transcription to a professional and technologically savvy medical transcription company can help healthcare facilities in various aspects of information management.

Medical transcription outsourcing: Providing vital support

Healthcare is an important contributor to modern life; saving lives and improving the quality of life. With the increasing demand for healthcare services, the renewed emphasis of proper documentation of the care process and the move towards a wired healthcare system, pressures on the healthcare sector have increased.  There has been a lot of debate about doing away with the time-tested methods of documenting the care process and a move towards documentation at the point of care by the healthcare professional himself/ herself.

Though this method has certain merits, the wastage in terms of decreased healthcare professional productivity and diluted focus on the patients & the process of care makes this method impractical and unattractive. Medical transcription services have been helping healthcare facilities and healthcare professionals in documenting the care process for a long time. Over time transcription services have evolved into specialty services that have customized themselves around the work life of healthcare professionals and the healthcare facility operations. Apart from the convenience and increased productivity due to medical transcription services, outsourcing medical transcription has provided healthcare facilities and healthcare professionals with numerous advantages using a combination of the right teams, the right technology and the right process.

Among the most significant benefits of outsourcing medical transcription the ones given below stand out as the most significant:

Clear: Outsourcing medical transcription helps produce clear and unambiguous patient medical records. Not only this, the process of medical transcription is very simple and clear making it very easy to use. The process of medical transcription starts with dictation of notes regarding the patient encounter. Dictation is one of the most preferred methods for healthcare professionals as it offers them convenience, flexibility and the option to record the narrative portion of the patient encounter. Having the narrative portion as part of the patient medical record enables better diagnosis.

Consistent: Outsourcing medical transcription produces consistent results. Healthcare professionals have the benefit of specialty trained medical transcriptionists expertly transcribing their dictation to ensure that the information in the records is consistent. Using trained teams and stringent quality processes, medical transcription service providers ensure consistent, accurate and prompt documentation

Complete: Documenting the care process using the services of a professional medical transcription company ensures that the documentation is complete including the distinctive points of the patient encounter. This ensures that the complete information is available for various purposes like billing, coding, as evidence in case of litigation and for future encounters

Cost: One of the most significant benefits of outsourcing medical transcription is that of reducing the cost of transcription. Apart from this outsourcing medical transcription also ensuring that there is no wastage of resources, contributing to increasing the productivity of healthcare professionals and accelerating the reimbursement process.

Outsourcing medical transcription to the right medical transcription company provides numerous and long term benefits to healthcare facilities. Moreover medical transcription companies also help in the adoption of EMR/EHR using HL7 interface, while still enabling dictation- transcription as a means of documenting the care process.

Medical transcription outsourcing: Points to be considered during outsourcing

Outsourcing medical transcription is a prudent business decision and helps the healthcare facility focus totally on their core business while providing the right support. However the outsourcing decision is not one to be taken lightly and needs a thorough analysis of what the healthcare facility hopes to gain from the outsourcing decision. To make sure that everybody in the healthcare facility is comfortable with the outsourcing decision it is important for the healthcare facility to ask itself some questions:

a)     Is medical transcription part of the core business of the healthcare facility?

Medical transcription is not part of the core business of a healthcare facility though it does play an important role in the operational and commercial aspects of a healthcare facility. Medical transcription is a specialized skill requiring a combination of the right team, the right technology and process to be able to meet the criteria of being accurate, timely, secure and cost effective.

b)    How much is medical transcription costing currently?

Having medical transcription in-house could be costing the healthcare facility more than what they originally would have estimated. While calculating cost of in-house medical transcription factors like these should be taken into consideration:

o                              Overheads

o                              Allocation of management & administration staff for managing medical transcription in house

o                              Wastage of resources during slack times

o                              Overtime pay during excess inflow of work

o                              Extra pay for weekend and holiday transcription

c)     What are the other resources being used for in house medical transcription?

In-house medical transcription could also involve usage of resources like secretaries, Information Technology staff, capital equipment etc. for medical transcription.

d)     What are the accuracy levels and turnaround time of transcripts?

In-house medical transcription could result in varied levels of accuracy due to the varying volumes of transcription. The accuracy levels could be high when volumes are low and low when volumes are high.  The turnaround time could also similarly vary depending on the volume of transcription. The turnaround time being shorter during slack periods and vice versa during periods with high volumes

e)     Is it important to retain medical transcription in-house?

There are certain factors like concerns for security of the data that could be a hurdle to the outsourcing decision. Choosing a service provider with measures in place to secure people, processes and technology can eliminate security concerns and remove any hurdles to the outsourcing process.

f)       What are the alternate options available?

Healthcare facilities have the option of outsourcing their overflow transcription needs to a combination of independent contractors or medical transcription service providers. This could however result in the healthcare facility having to put in more efforts to coordinate medical transcription from various resources. The easy fix to ensure that transcripts are created in a timely, accurate, secure and cost effective manner is to outsource medical transcription on a turnkey basis to a professional medical transcription service provider

g)     What is the cost of outsourcing medical transcription?

Outsourcing medical transcription ensures that the cost of transcription is restricted to the cost per line of transcription. Initially the healthcare facility may have to have a minimum outlay towards finalizing the service provider and adapting to the technology used by the service provider.

h)    What are pitfalls of outsourcing medical transcription?

The common pitfalls while outsourcing a function as vital as medical transcription is the fear of poor quality and security concerns. Another major concern is that the price quoted by the service provider may have hidden costs. Both these concerns can be overcome by choosing a service provider who has the right team in place to meet quality concerns,  has adequate measures in place to ensure total security and uses a billing method that is measurable, verifiable, definable, consistent and fair& honest.

i)       What is the value addition in outsourcing medical transcription?

Outsourcing medical transcription provides the healthcare facility with many value added services like technology that offers multiple benefits like different modes of document delivery, archives making it easy to trace transcripts in different stages, specialty medical transcription etc.

j)       What about the transition to outsourced medical transcription services?

Transition from in-house transcription to outsourced services can be eased when the medical transcription service provider has open channels for customer service. This would enable the service provider to solve minor issues as and when they crop up.

k)     What about existing investments in EMR?

Existing investments is EMR/EHR can be protected if the medical transcription service provider has the capability for HL7 interface enabling data to be transmitted to the EMR/EHR system.

l)       What are the options available to capture dictation?

This is a main concern for time starved healthcare professionals, this concern can be overcome by choosing a service provider who allows the healthcare professionals to retain their familiar modes for capturing dictation.

The process of outsourcing medical transcription can become easier by choosing a medical transcription service provider who alleviates these fears/doubts that may rise during the outsourcing process.