Archive for Medical Transcription Outsourcing

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.

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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.

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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.

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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.”

Reyes added, “The challenge now is for our local stakeholders—the private sector and the government—to ensure that the right components are in place when the investors begin pouring in.”(BCM)

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Transcription Technology Watch

This is the first in a series of quarterly articles that will focus on technologies relevant to medical transcription. Hopefully, maybe even those MTs who are techno-phobic will find some of the topics enlightening, stimulating and/or of value in making career decisions. But maybe not. To challenge that hope, I’ve started off with everyone’s favorite technology: speech recognition. If you want to really stimulate a transcriptionist, just say “speech recognition.” Or, better yet, assert that “speech recognition will forever change the process of converting physicians’ thoughts and utterances into text.” Then run for cover.

Every transcriptionist out there has heard some form of that assertion. Their reactions range from dismissal to fear to anger. So what’s the truth? What does the future hold? Well, at some point in the future, there will be no medical transcription. Physicians will dictate into a PC or portable device; their speech will be converted to text; and the dictator will make any necessary corrections to finalize the report. No transcription expense. No transcription delay. But that future is at least 3 years off. Just kidding. It’s way more than that. However, there is a future closer than that, related to speech recognition, which has some major implications for this industry.

Doctors hate doing anything that they believe is below their stature or slows down their ability to generate revenue. So we will not see “front-end” recognition-where they correct their own mistakes as described above-in most environments for many years. But there’s a new game in town. It’s called “back-end” speech recognition. Physicians don’t change a thing in their dictation behavior. They continue babbling into telephones or some other dictation device just like they always have. But their voice files are now run through a server-based recognition engine, a draft is produced, and a medical editor corrects the errors both in recognition and dictation.

This technology is truly beginning to get some traction. Physicians love innovation, but they hate change. So this suits them just fine. In fact, they typically don’t even know it’s going on. The goal of back-end speech recognition is to at least double the productivity of transcriptionists. And to do it for about a penny a line. Most implementations are not quite there yet. Speech recognition talk has always been ahead of speech recognition technology. Nonetheless the handwriting is on the wall. This technology will begin to transform transcription in the coming years. So it seems wise for MTs to learn more about it and perhaps even to embrace it.if they like what they learn.

Currently, it is prohibitively expensive for an independent transcriptionist or small transcription company to purchase a recognition server. However, there are a number of ASPs popping up, which charge by the line to produce a draft. I could tell you a lot more groovy stuff about this rather exciting technology, but I’m just about out of my allotted space. So tune in next quarter for the second Watch article, which will explain more about how it works and what it means for medical transcriptionists. Unless, of course, I feel like writing about something else.

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