Transcribe Medical Transcription Service

Medical Language Specialists“MT Knowledge Workers”

A Vital Part of Today’s Healthcare System

Presentation ByLaura Holbert, CMT, Owner

OUR MISSION STATEMENT

To promote the integrity of healthcare

documentation through development

of an educated, prepared workforcein clinical documentation

The different methods of preparing a patient record and the different types of approaches to accomplish this.

The cost of creating patient records depending upon the chosen method, i.e., physician creation, in-office transcription, subcontracting transcription, and outsourcing to US. vs. off-shore service.

The advantages of using a transcription service and comparison covering office costs, physician’s time, quality, etc.

What TranScribe Medical Transcription Service offers including pricing, turnaround, quality, confidentiality,and specialty services.

Methods

Costs

Advantages/

Comparison

Services

The Following Presentation Will Include:

Which method do you use?

Is it really the most cost-effective method for your business?

Is there another solution to cost savings?

Will it benefit you in the future as well?

There are Different Methods Physicians Use

To Create A Patient Record

METHODS OF DOCUMENTATION

Front-end/Back-end speech recognition (voice technology)

Structured data entry (keyboard, touch screen, mouse) EMR system – reports created

by physician

Dictation (preferred choice by 80% of doctors) using sound files, tapes, phone system

Handwriting notes was the beginning of patient

recording--although still used today, it is not as popular

HANDWRITING A PATIENT RECORD

According to Medical Documentation Guidelines, if a chart note was not documented, the service was not done.

That's also true if the chart is illegible and a CMS (Centers for Medicare and Medicaid Services) auditor can't read it.

Since a physician's notations in the medical record are an important part of treatment, illegible notes create a serious problem for all healthcare providers who need the information for follow-up care.

DICTATING A PATIENT RECORD

The physician dictates the medical information into a recording device. The medical transcriptionist listens to the dictation and transcribes it onto a computerized file which is then sent to the healthcare provider.

Dictation remains the most intuitive and least time-consuming means of data entry. Physicians can dictate anytime, anywhere using a PDA, digital dictation machine or telephone at their convenience.

Provides expressive power to describe patient's condition and other health-related events.

Dictating patient records provides for more efficient use of doctor's time.

STRUCTURED DATA ENTRY -- EMRElectronic Medical Records (EMR) is a software in which all of the patient’s medical records can be stored. The most important part of every EMR is the process of entering the data. EMR is basically a collection of complete patient data which is made available to the physician which helps in providing a complete, correct, and timely view of patient’s information.

EMR has transformed the industry of healthcare recently. Most of the healthcare professionals were of the opinion that the technology of EMR would take the place of Medical Transcription completely. Nonetheless, the healthcare industry almost immediately understood the fact that medical transcription has more advantages than EMR and majority of the healthcare professionals prefer dictating notes instead of documenting the data through Electronic Medical Records.

Some EMRs are strictly point-and-click, template-driven systems that make no allowance for dictation and transcription, while other EMRs are DRT enabled, allowing physicians to use traditional dictation as a means of populating the EMR.

There are several disadvantages of using the EMR method of patient’s recordkeeping.

EMR requires additional time and certainly more attention for a medical doctor to search from huge amounts

of data and generate progress notes using specific templates. Templates must be customized as per the physician's requirement. Customization can be inflexible and costly, well accepted by only tech-savvy doctors.

The approach of direct data entry by the physician has generally failed because busy providers reject it altogether. Output from these templates is too identical and it loses individuality for each patient. It is difficult for a provider to capture complete patient encounters on a computer in front of a patient.

All these above-stated reasons show that EMR is a remarkable technology; however it cannot replace the traditional method of medical transcription. It takes more time, and definitely more concentration, for a physician to navigate through large data set and create progress notes using point-and-click templates.

Although an average transcribed report costs $2 to $4, it can reduce the doctor's time spent on data entry. And, considering the value of doctor's time, transcription is not a costly proposition. By not having a medical transcriptionist it is costing, on average, nine times the amount when a physician types his/her own reports.

FRONT-END/BACK-END SPEECH RECOGNITIONThere are two types of Speech Recognition Technology (SRT) systems. Front-end speech recognition (FESR) is where the speaker dictates into the PC and the voice is converted to text concurrently and the speaker himself corrects the errors made by the software; doctors have been reluctant to adapt to this system due to time constraints in their busy schedule.

With back-end speech recognition (BESR), or delayed SRT, commonly in use now with large hospitals and clinics, the speaker has dictated, then an editor (such as an MT) listens to the voice file, edit for errors and proofreads the draft.

When comparing FESR with BESR it was found that enterprise healthcare organizations experienced significant success with BESR by routing work translated through a speech recognition engine to an MT for later correction. This method supported clinicians’ ability to narratively dictate without changing their habits and therefore has been widely accepted as an effective documentation method. Typically 80% of clinicians were adaptable to BESR with no change in dictation habits, and higher for certain specialties like radiology.

The trouble with FESR that many clinicians find objectionable is the need to interact with the process to make real-time corrections, thereby causing a change in dictation habits and slowing the clinician down.

Although there is an upside (real-time documentation means immediate completion for the chart) in most situations that value is diminished by the extra time it takes the clinician to complete the record, the associated costs of that clinician’s time, and the fact that turnaround time (TAT) via a back-end process is usually adequate.

A lot of homework is needed to train the equipment before it can be used. Even well-trained equipment needs human intervention like

editing, proofreading and formatting. SRT cannot correct improper grammar, incorrect punctuation, incomplete dictation etc. Then there are many homonyms involved where the human brain processes and uses the appropriate words, while voice recognition softwares need to prove their credibility in this regard. Background noise too reduces the recognition accuracy.

Even though many EMR and SRT technology providers have taken aim at medical transcriptionists (MTs) as being a costly and obsolescent part of healthcare documentation, the limits of EMR and speech recognition technology (SRT) are being significantly complemented by the work of MTs in cases where solution providers and savvy healthcare organizations have recognized the value of the relationship between technology and MT “knowledge workers.”

WHICHEVER METHOD A PHYSICIAN CHOOSES . .

Transcription provides for more efficient use of doctor's time.

Physicians can dictate anytime, anywhere using a PDA, dictation machine or telephone at their convenience

Medical Transcription has long been the standard for documenting patient encounters. It is more convenient for a provider as compared to handwritten notes or electronic data entry. There are many advantages of transcription in comparison to point-and-click charting.

Providers need not change the way they practice just to accommodate an EMR. EMR can interact with transcription service so that transcriptions can be attached directly into the patient electronic medical record, if such a facility is provided by the EMR vendor.

Provides physician with expressive power to describe patient condition and other health-related events.

Corresponds to the physician's usual method of working. Dictation remains the most intuitive and least time-consuming means of data entry.

Medical Transcriptionists Will Continue To BeAn Integral Function of Medicine

Advantages

In our experience and, that of many EMR vendors, dictation is the preferred choice by 80% of doctors.

ELIMINATING TRANSCRIPTION

CAN HURT BOTTOM LINE

Why?

Physician’s Time Cost Convenie

nce

WHAT IS THE MOST COST EFFICIENT WAY TO PRODUCE A PATIENT

RECORD?Dictation is the most efficient way

to document patient care

Take the example of a typical outpatient visit to an internist. It takes about one minute to dictate a note for an established patient and about $4.30 in direct and indirect costs (See Figure).

By contrast, many EMRs use structured data entry as the primary method for entering clinical notes, in which physicians point and click their way through drop-down menus. The time required is, at best, equal to that of a transcribed note, and physicians often report it takes 8 to 10 minutes to complete a note using structured data entry, meaning the indirect cost to physicians is anywhere from $13.50 to $27.

Indeed, physicians may “save” $1.60 in outsourced transcription expense but at the cost of their valuable time. Physicians report working an extra 1 to 2 hours or seeing 2 to 3 fewer patients per day using direct data entry. In reality, work has just shifted from a lower cost resource to a practice’s most valuable resource, its physician. In our experience, this loss of productivity with structured data entry is the single biggest barrier to physician EMR adoption. By contrast, physicians are delighted to learn they can continue to dictate and let the transcription service deliver the clinical note to their EMR.

DISCRETE REPORTABLE TRANSCRIPTION

(DRT)Even with EMR and Voice Recognition technology, there is still a need for human intelligence.

Specifically, a practice that needs to remain productive and not lose patient visits due to productivity shortfalls will continue with dictation/transcription.

Discrete Reportable Transcription -- DRT is the answer many are looking for by combining the efficiencies and quality gains of medical transcription with the value of discrete data.

The need for quality transcriptionists with good knowledge of domain will only increase in the future.

Benefits of Continued Use of a Transcriptionist

Physicians should be focused on their patients, not their keyboards. DRT allows physicians to dictate their patient visits, leaving more time to improve their patient's health.

Dictation remains the most intuitive and least time-consuming means of data entry.

A study by the AC Group finds that traditional EHR data entry takes nine times longer than narrative dictation/transcription. Users come to a crossroad where they need to weigh the balance between the cost of transcription and the loss of productivity.

Though many EMR and Speech Recognition technology providers have taken aim at medical transcriptionists (MTs) as being a costly and obsolescent part of healthcare documentation. the limits of EMR and speech recognition technology (SRT) are being significantly complemented by the work of MTs in cases where solution providers and savvy healthcare organizations have recognized the value of the relationship between technology and MT “knowledge workers.”

WHICHEVER METHOD YOU CHOOSE . . .

Whether you hand write notes, point and click with an EMR system, dictate using sound files, tapes or a phone system, or some type of voice recognition technology – it has been proven that medical transcription is still the most cost-effective way to produce a patient encounter.

EMR has revolutionized the healthcare industry in recent times. Many experts felt that EMR & Voice Recognition would totally replace Medical Transcription -- however; the industry soon realized that transcription has certain advantages over point-and-click charting and many physicians preferred to dictate notes rather than document the data at the point of care themselves.

Dictation using sound files, tapes, phone system

EMR System, point-&-clickVoice Recognition (FERS or BERS)Medical Transcription is proven most cost

effective

Hand-Written Patient Records

So Now You Have Decided To Use A Medical Transcription Service . . .

Which Is Best For Your Business?

In-Office Medical Transcription (employee)

Outsourcing to U.S. Transcription Service (subcontractor)

Outsourcing to Off-Shore Transcription Service (subcontractor)

Wages Overtime Expenses Towards Benefits Payroll Taxes Workman's Comp Expense Sick/Vacation Time Coverage Expense Employee Training/Retraining Expense Software

Dictation/Transcription Equipment Maintenance Expense

Dictation/Transcription Equipment Capital Expense

IT/Technical Support Management Expense Office Supplies Extra Office Space

IN-OFFICE MEDICAL TRANSCRIPTION (EMPLOYEE)

The following chart will show the annual cost for an In-Office Medical Transcriptionist

Hiring a transcriptionist as a full-time employee adds to your direct labor costs in terms of salaries, payroll benefits and payroll taxes,

increasing the total cost of running your organization.

Expenses Include:

NOTE: (*Hourly wages for CALIFORNIA STATE based on statistics as provided

by US Dept of Labor)

A per-line cost to have an In-Office Transcriptionist would equal $0.25 per line.Our rates range between $0.09 -- $0.13 per line. As you can see, it is more costly for in-office transcription.

OUTSOURCING TO U.S. TRANSCRIPTION SERVICE (SUBCONTRACTOR)

Outsourcing transcription outweighs the cost of in-office transcription. When you outsource your medical transcription requirements, you no longer have to own or maintain a dictation system, a typing platform or worry about upgrading your equipment. Your capital expenses on maintenance with the average maintenance agreement can cost upwards of 10% of equipment costs, annually.

Eliminates transcriptionist employment taxes and benefits

Avoid hiring, training and management expenses for transcription

Equipment costs such as transcription machine, software, computer, desk, etc.

Cuts out sick time, vacation and family leave costs

Access to best technology with zero capital investment

Make use of office space otherwise reserved for transcription

Focus on patient care vs. administrative duties

Pay for only the services you use and nothing more

Priv

acy

Physicians must weigh all the factors when choosing an MT provider because there is more to their decision than cost alone. Some of the unintended consequences can put patient privacy at risk, the very things the HIPAA was intended to avoid. Laws that affect the patient privacy of medical records are difficult to enforce overseas.

Cost

Even though the cost for overseas services is appealing, “reports transcribed by overseas medical transcription services usually require editing for accuracy by domestic medical transcriptionists before they meet U.S. quality standards, therefore requiring additional costs.” (http://www.bls.gov/oco/ocos271.htm#outlook)

Lang

uage

Bar

rier

Many foreign MTs who can speak English are not familiar with American expressions and/or the slang doctors often use, and can be unfamiliar with American names and places. An MT editor, certainly, is then responsible for all work transcribed from these countries and under these conditions.

OUTSOURCING TO AN OFFSHORE TRANSCRIPTION SERVICE

WHAT OUR SERVICE OFFERS IS . . .QUALITY

TranScribe Medical Transcription Service is a small U.S. business working with seasoned medical transcriptionists who are very conscientious about the aspects of documenting patient encounters, providing consistent quality, and meeting delivery times. They are highly trained, hand picked, then specifically trained to each individual account. We tailor our services to meet your individual needs. Our MTs rely on their thorough knowledge of anatomy, pharmacology and physiology to edit documents as they type. They listen for dictation errors such as invalid lab values, drug usage or left/right discrepancies, and flag errors for correction prior to the transcription becoming a permanent part of the patient record. Through this process, we produce documents that are extremely accurate and reflect the professionalism of your practice.

Confidentiality is a very important part of our business. All medical transcriptionists are required to sign a HIPPA Confidentiality Agreement with strict adherence.

We are a transcription service with a professional attitude and a very dedicated, hard-working team of qualified transcriptionists. We DO NOT outsource any work off-shore -- ALL work is performed in the United States.

Work is proofread by a certified QA manager. We use customized dictation and workflow options and full

integration with practice management and EMR systems.

Methods of Dictation/Transcription

Pick-Up/Delivery Capability: Pick-up/delivery of tapes is available to local clients. Otherwise they can be sent

overnight mail at our cost. Reports can then be returned electronically or a hard copy can be delivered, again locally or overnight mail. As well, these patient records are ready to implement into an existing EMR system ready for your electronic signature.

Telephone Dictation Service: If you choose this method, you establish a four-digit PIN for security purposes.

We provide a phone number, keypad instructions, and 24/7 access to our medical transcription system.

Digital Hand-Held Recorder: A digital hand held recorder is a pocket-size mobile dictation device that stores

voice digitally. You can carry the recorder anywhere and dictate at any time. When you are ready, you can upload the digital audio files to our medical transcription system using our secure FTP website. The obvious advantage to hand-held recorders is portability and they can record many hours at a time. We recommend the Olympus Digital Records. At the end of the day you transfer encrypted files from your recorder to your computer and send them through FTP to our secure server. We will guide you through the process.

WHAT OUR SERVICE OFFERS IS . . . CONVENIENCE

WHAT OUR SERVICE OFFERS IS . . .A COMPLETE SERVICE

Templates -- We offer our templates to suit the physician’s dictation or will use your templates, whichever is preferred.

Quick Turnaround -- We give a quick turnaround. A 24 to 48-hour turnaround from the time dictation is made available unless otherwise specified, then a quicker turnaround is available.

Guaranteed Accuracy -- You will receive guaranteed accuracy, corrections at no cost, and a personalized service to your office.

Free reprints, if needed. Daily Patient Logs -- A daily patient log is created and delivered with patient

records to ensure accountability. Fully HIPAA-Compliant secure web interface providing audio file upload, tracking,

and transcribed file download capabilities. Confidentiality -- Providing full confidentiality of all office/patient material. Availability -- We are available for questions via phone, instant message, or e-mail. Encryption/Secure FTP -- Documents are sent in encrypted files from our secure FTP

Server or in encrypted e-mail attachments in Microsoft Word, Word Perfect or Adobe PDF format. Transcribed reports are delivered right to your computer (PC) ready for print and/or integration into your current or future EMR.

Storage -- All transcribed documents are archived indefinitely. Specialty -- Our medical transcription services cover most branches of medicine

including cardiology, neurology, dermatology, gastroenterology, orthopedics, geriatrics, pain management, physical therapy, pediatrics, immunology, radiology, endocrinology, ophthalmology, chiropractic, obstetrics, family practice, electrophysiology, otolaryngology, urology, psychiatry, humanistic counseling, workers comp, and more.

WHAT OUR SERVICE OFFERS IS . . . AFFORDABILITY

Prices will vary from $0.09 cents to $0.13 cents per line.

Lines are based on a 65-character count line.

Our pricing tools are based on such factors as volume, turnaround time, types of dictation chosen, specialty requirements and document management flow system requirements.

Reports can be implemented into an existing EHR system saving cost of printing.

You will receive personalized service to your office.

Transcribe MedicalTranscription Service

Quality Is Very Important, It Leaves An Impression On Your Business

If you are interested in using our services, or if you are using a service currently and maybe just are not quite satisfied, try our services for a week at no cost to you. Some of our clients who have previously used an outsourcing off-shore service in the past tried our services and are very pleased.

A referral list supplied upon request.

We would be more than happy to furnish sample reports if you so desire.

If you have any questions regarding any of the services we provide, please feel free to call. We hope to hear from you soon. You will not be disappointed.

Call us at (951) 696-7379 or e-mail to transcribe@verizon.net or visit our website at

www.transcribemed.com

FOR FURTHER INFORMATION: http://www.healthstory.com http://www.mtia.com http://www.cchit.org http://www.adhi.com http://www.ahdionline.org