Medical transcription: Smart Delivery system for EMR adoption

ARRA (American Recovery and Reinvestment Act) or Economic Stimulus bill was introduced in February 2009, aimed at spurring economic growth across multiple industries through Government spending. Out of this $ 19 billion was aimed at the healthcare Industry by way of incentives for meaningful adoption and implementation of EHR (Electronic Health Record) also known as EMR (Electronic Medical Record).

What is EMR/EHR?

Given below are the definitions of EMR and EHR

EMR: Is the electronic record of health related information on an individual that is created, gathered, managed and consulted by licensed clinicians and staff from a single organization involved in the individual’s health and care.

EHR: is the aggregate electronic health related information on an individual that is created and gathered cumulatively across more than one health care organization and is managed and consulted by licensed clinicians and staff involved in the individual’s health and care

Implementation of EMR/EHR has several benefits apart from that of the financial stimulus offered. These benefits include customizable templates according to doctor requirements, consistent & accurate data, easy retrieval and data input by pointing and clicking.

Having said that one needs to look at the down side of Direct Data Entry by doctors into the EMR/EHR system:

· Lack the convenience of free form of dictation that allowed the doctors flexibility of time while allowing them to avail the benefits of comprehensively capturing data.

· More time spent on data entry rather than on patient care that could lead to loss of productivity of doctors causing them to treat lesser number of patients.

· Lack of eye contact while entering data with patients could lead to dilution of the “Bedside Manner” which forms an integral part of the personal care that patients expect.

· Only tech-savvy doctors can adapt to this method.

· Patient information would be in identical formats without the inclusion of personalized data that is an important part of healthcare.

· Affect the bottom line of the healthcare facility in a negative way due to loss of productivity.

Having seen the benefits and the downside of EMR/EHR adoption one can see that the adoption of EMR/EHR through direct data entry by doctors can have a learning curve and lead to a loss of productivity. This may seriously hinder the transition and delay the adoption process. To solve this one needs to look at the possibility of adopting EMR/EHR while still retaining the traditional medical transcription method for creating records.

This could help overcome issues like loss of productivity leading to erosion of bottom line, personal care for patients etc. One needs to look for a medical transcription service provider that has the capabilities to import patient information to the EMR system while at the same time able to maintain accuracy, turnaround time and offer reasonable rates.

TransDyne has a smart delivery system, which has features like User defined folder paths to enable easy imports to EMR systems. The Smart Delivery system is the suggested mode of document delivery where pre-defined file saving would help import documents to EMR systems.

Not only that TransDyne offers quality Medical Transcription at reasonable prices, done by expert Medical Transcriptionists with a very quick turnaround time executed through secure HIPAA compliant channels, with very high levels of accuracy and all this with technology that is advanced but easy to use!

Medical transcription: What is meant by HIPAA compliant systems?

HIPAA(Health Insurance Portability and Accountability Act) protects the health insurance coverage of workers when they lose employment or change their employers. HIPAA also covers the privacy of identifiable health information (PHI- Personal Health Information) regardless of the format in which it exists, including electronic, written or verbal.

HIPAA applies to:

· Health care providers
· Health plans
· Health care clearinghouses
· Any such third parties that perform services involving PHI or exchange electronic data on behalf of the healthcare facility.

Under the last category HIPAA applies to medical transcription service providers, as they are involved in providing a service that involves the electronic transmission of PHI.

HIPAA and outsourced medical transcription

As already stated HIPAA applies to medical transcription because medical transcription is the process of creating records of the patient-healthcare professional encounter. And the process of outsourcing medical transcription to a medical transcription service provider would involve:

· Uploading audio files (narration of patient-healthcare professional encounter) to the server
· Transmission of audio files
· Downloading the audio files
· Transcribing the audio files
· Transmission of the finished transcripts
· Downloading the finished transcripts by the healthcare facility.

Considering the procedure involved security of data is applicable at all stages:

1. When Data is at rest: This would be safety of data when it is stored prior to transmission to the medical transcription service provider and when the finished transcripts are stored before transmitting back to the healthcare facility.

2. When Data is in motion: This would include safety of data during uploading audio files, transmission of audio files, downloading audio files and transmission of finished transcripts

3. When Data is in use: This would involve safety of data when the audio files are being transcribed.

4. When Data is disposed: This would involve safely disposing of defunct files in such a way to ensure that they are completely destroyed and cannot be accessed by unauthorized entities.

How does TransDyne ensure HIPAA compliance while providing medical transcription services?

· Use of the right systems and software: The use of 128-bit data encryption, multi-tiered application architecture, design level security safeguards, firewall protected networks, sterilized e-mail servers, denial of access procedures and multi-modal alerts safeguards data when it is at rest and when data is in motion.

· Use of processes: Use of processes like company owned & managed facilities, not engaging any sub-contractors, employing manned security at the entry/exit points, round-the-clock video surveillance and the lack of removable storage media protect the data in use. The other measures taken for ensuring security of data in use are limiting the access to the application by User ID and an encrypted password. Access to files is limited based on the user’s role. Once a user is logged in, if no activity is performed for certain time, the user is automatically logged out of the system. This ensures that there is complete security of data when it in use.

· Educating people: Educating people on the importance and procedures for HIPAA compliance gives them a professional outlook. Having them give a commitment in writing further ensure HIPAA compliancy. This protects the data in all stages.

TransDyne believes in maintaining security standards that not only meet HIPAA standards, but also exceed them. Not only HIPAA compliance of outsourced medical transcription services, TransDyne also ensures accuracy of above 99%, guaranteed turnaround time of 24 hours with an option of 4-12 hour turnaround time for STAT reports at a very reasonable price!

Outsourcing medical transcription: The right solution for healthcare facilities to cope with expansion plans

In today’s world change is the one thing, which is constant. Change has never been more relevant than when it comes to healthcare. A healthcare facility has to cope up with the latest developments in healthcare, all the while stretching their budgets to the limit. The latest equipment, the latest techniques, adding on new specialties to the existing practice, all this can put a strain on limited resources.

As the scope of operations of a healthcare facility keep expanding their back office requirements like medical transcription and medical billing needs also expand accordingly. As this happens the first reaction of the healthcare facility is to add on more staff to cope up with increasing medical transcription needs or alternately outsource the overflow of transcription requirements to independent contractors or to a medical transcription service provider or a combination of all three.

This move provides a solution albeit temporarily. But as time passes there could be serious discrepancies in terms of the following:

· Quality of reports: The accuracy level or the quality of the finished transcripts depends totally on the quality of people working on it. Use of varied sources to cope with medical transcription needs can dilute the quality control. This could have an impact on the quality of healthcare.

· Turnaround time: Having varied turnaround time would mean that all the data needed to make an informed decision would not be available to the healthcare professional at the right time, which can affect the timeliness of the care imparted.

· Cost per line of transcription: Having transcription done by various sources would mean that the cost per line of transcription would increase.

· Systems/media used for transcription: The technology used for transcribing would be diverse given the different sources, all these would mean additional costs for integration with the healthcare facility systems.

· Serious issues with HIPAA compliancy: HIPAA compliancy would be difficult to monitor given the numerous entities involved in the process.

· Delays in processing for the accounts receivable cycle: Medical transcription is the first stage of the accounts receivable cycle; delay in medical transcription would mean delays in the rest of the reimbursement process.

· Time spent coordinating various sources of medical transcription increases: Report distribution and signing of finished transcripts would be delayed due to the various sources of medical transcription work.

· Manpower dealing with medical transcription providers would increase: The healthcare facility would have to appoint extra people to coordinate the varied sources of transcription to ensure a smooth workflow.

All these factors can have a serious impact on both the quality of healthcare and the bottom-line of the healthcare facility.

What is the most economical and efficient solution to cope with expanding needs of a healthcare facility?

Outsourcing medical transcription needs to TransDyne would provide a one-stop solution for all the medical transcription needs of a healthcare facility no matter what their expansion plans.

How does TransDyne provide a one-stop solution to the medical transcription needs of a healthcare facility?

TransDyne provides superior solutions for medical transcription needs by having:

· Right people: TransDyne has a large team of well-trained medical transcriptionists in place. TransDyne believes that training should be slanted in such a way as to provide maximum expertise in minimum time. That is why medical transcriptionists in TransDyne have been trained in one or two areas of specialty making them domain experts. This means that the team at TransDyne can cope with the varying volumes of transcription without affecting the accuracy or the turnaround time.

· Right process: TransDyne has the right processes in place that ensure not only quality and turnaround time but also HIPAA compliancy. All the transcription work is executed in-house and not through sub contractors, this ensures better control over quality and safety of information. Quality of final transcripts is ensured through a four level check involving medical transcriptionist, proofreader, unit-in-charge and the quality assurance team.

· Right technology: TransDyne uses the latest technology to ensure:

1. Easy upload, by allowing the healthcare professionals to retain familiar and flexible modes of dictation
2. Safety during transmission through the use of encryption, firewalls and password protected access.
3. Easy download of file to enable distribution of finished transcripts.
4. A system which ensures ease of tracking dictations, finished transcripts and archiving facilities that can be customized to the healthcare facility’s needs

By having the right people, right processes and right technology in place TransDyne offers.

Medical transcription: What are the methods of quality assessment?

Quality is an important criterion in any decision making process. Assessing quality becomes even more important when it comes to availing service as critical as medical transcription. Medical transcription is the process of converting audio records of a patient- healthcare professional encounter into a text format.

This accuracy/quality of medical transcription critical as this forms the basis of:

· Permanent patient history
· Present and future treatment plan and basis for monitoring progress of the patient
· Referrals/tests/procedure
· Statutory requirements
· Evidence in case of disputes/litigation
· Accounts receivable processing

It is important that records that play such an essential role be of the highest accuracy/quality possible. While making the decision to outsource medical transcription needs it is vital to ensure that the medical transcription service provider has HPI guidelines in place for assessment of quality.

What are HPI guidelines?

The concept of Quality Assessment (QA) began in 1990 when a format was developed by Judy Hinickle to assess quality of transcription. This was followed by presentations made to thousands of transcription supervisors and educators around the country by Health Professional Institute (HPI), American Association for Medical Transcription (AAMT), American Health Information Management Association (AHIMA), and Medical Transcription Industry Association (MTIA).

Health Professions Institute then adapted and promoted this for its standard-setting SUM program for medical transcription. This QA method is the basis of most programs and is of most thorough and effective nature, embracing true Continuous Quality Improvement concepts.

TransDyne executes medical transcription using quality guidelines by HPI

What do HPI guidelines consist of?

HPI guidelines consist of quality check parameters and computing system for quality satisfaction and highest accuracy levels. HPI guidelines are categorized as follows:

Error 1. Medical Word misuse-Point 1.00
This is considered one of the most serious errors as it can affect every aspect of treatment administered to the patient. Even billing information is affected by this error. Guesswork or making up of words when dictation is not understood is also included in this error category.

Error 2. Omission- Point 1.00
This is also considered an equally serious type of error as it reflects on the ability and professionalism of the medical transcriptionist.

Error 3. Medical word misspelling- Point 0.75
This is the incorrect spelling of medical terminology.

Error 4. English word misspelling or Misuse -Point 0.75
This includes misspelling of English words nouns, verbs, qualifying adverbs etc, which could have a serious consequence.

Error 5. Inappropriate blanks- Point 0.75
These refer to blanks that are left unfilled, and those, which could be filled up by extensive research by the medical transcriptionist.

Error 6. Grammar errors- Point 0.5
Grammar errors include incorrect use of medical abbreviations, misuse of words, misuse of parts of speech, misuse of subject-verb, singular/plural misuse, etc.

Error 7. Punctuation errors- Point 0.5
Include errors with regard to punctuation like coma, colon, semi colon etc that change the meaning of the sentence if misused.

Error 8. Typographical errors- Point 0.25
Minor grammar, punctuation or capitalization errors.

Error 9. Formatting errors- Point 0.25
This error refers to the prevailing departmental/physician guidelines for placement of certain information within the document. E.g. Headers, Footers, templates as defined by the client.

Having these quality guidelines in place ensures that everybody in the TransDyne team is guided by the same principles. TransDyne offers Quality Transcription with accuracy of 99% or above. TransDyne ensures quality by adopting a four level quality check of Medical Transcriptionist, language proofreader, unit in charge and finally by the quality assurance team which tries to minimize errors before returning the finished reports.

Quality medical transcription at low costs

There is a saying that goes something like this “You get what you pay for”. It implies that one can get quality products/services only if the price is high. But this is not the case with medical transcription; it is possible to get great quality at very low rates. Sounds counterintuitive but it is true.

These are times when healthcare facilities are tightening their belts as much as possible, it makes business sense to keep the organizational structure lean and avail of outsourcing services for non-core activities.

Medical transcription plays an important role in the delivery of quality healthcare. To this end it is important to source a medical transcription service provider, which can deliver both quality and reasonable prices.

What is quality of medical transcription?

Quality/ accuracy in medical transcription refers to the accuracy of the final transcript viz. a viz. the audio file.

How to evaluate methods used for ensuring quality?

· Careful selection of medical transcriptionists: Since medical transcription is a manpower-based process, the quality of medical transcriptionists has a direct impact on the accuracy of reports. It is important to focus on a company that selects its employees through a stringent screening process.

· Training methods used: Training plays an important role in preparing the medical transcriptionists to produce transcripts of the highest accuracy. A company, which focuses on training their medical transcriptionist in one or two specialties of medicine rather than generic training, would be preferable. This would ensure that the quality of transcripts produced would be high from the very beginning.

· Quality control process: Check the method used by the service provider to provide accurate transcripts. An intense process involving checks at every level would ensure that errors are minimized.

· In house medical transcription: To ensure that quality transcripts are delivered, it is vital to ensure that the service provider executes the work in-house not through vendors. This would ensure that the service provider has total control over the quality control process.

What is low cost?

Low cost of transcription means that the cost per line of transcription should be lower than the current cost. Cost per line should be defined clearly with no additional or hidden costs

How can low cost be ensured?

· Fair billing method: The billing method used by the service provider can have a direct impact on the cost per line. The definition of cost should be verifiable, definable, measurable, consistent, fair and honest.

· Economies of scale: The service provider being specialist in medical transcription can pass on the benefits of economies of scale, which the healthcare facility may not have doing the medical transcription in-house.

· Use of technology: The use of advanced technology by the service provider can cut down logistics cost making it possible for them to deliver excellent service at low costs.

TransDyne is a medical transcription service provider, which believes in ensuring quality by recruiting the best talent through rigorous screening, training them to be domain specialists, applying a four level quality check process and executing all the medical transcription work in-house.

TransDyne ensures low cost per line of transcription using a fair and easy method of billing, passing on the benefits of economies of scale to the customers and uses technology that makes the medical transcription process easy and cost effective.

Medical transcription: Strategies for outsourcing

What is the strategy to be adopted for outsourcing medical transcription?

1. Identify healthcare process: This will show the healthcare facility the flow of work and identify processes that can be outsourced and those, which are to be retained in-house.

The typical workflow for healthcare would be as follows:

· Appointment by patient to visit doctor/emergency visit
· Filling up of demo forms
· Doctor visit
· Dictation of notes
· Medical transcription
· Medical coding
· Medical billing
· Insurance claims processing
· Re-imbursement
· Follow up of payment over and above insurance re-imbursement.

This flow clearly shows that the first four tasks cannot be outsourced but other tasks like medical transcription can be outsourced.

2. Assess the feasibility of outsourcing medical transcription

a. Can medical transcription be executed outside the healthcare facility premises?
With the advent of Internet, it is possible for medical transcription to be executed outside the physical premises of the healthcare facility.

b. Are there any security implications to outsourcing medical transcription?
Security of confidential patient health information has to be ensured. Care has to be taken to make sure that the medical transcription service provider is HIPAA complaint and covered under a business associate agreement.

c. Can medical transcription be tailor made to match the requirements of the healthcare facility?
The needs of different healthcare facilities is different, care has to be taken to source a medical transcription service provider who can cater to different volumes, formats and specialties and according to the turnaround time specified.

d. Can the medical transcription service provider’s performance be monitored?
The performance of a medical transcription service provider can be monitored in terms of accuracy and turnaround time.

3. Sourcing medical transcription service provider
a. Cost: This is perhaps one of the most criteria for outsourcing, Care has to be taken that the cost per line of transcription parameters are understood completely before comparing quotes.

b. Turnaround time: Turnaround time is an important factor that affects both the healthcare and profitability aspect of the healthcare facility.

c. Availability of talent pool: To make sure that a service provider can provide continuous and consistent service it is important to evaluate the talent pool available to the service provider.

d. Risks: This refers both to the risk of poor quality as well as security of information. To mitigate this,  assurances of quality level and the security measures taken by the service provider need to be evaluated

4. What is the value proposition of outsourcing medical transcription?
a. Speed: Outsourcing medical transcription ensures the speedy creation of medical records under all circumstances.

b. Profit increase: Outsourcing medical transcription brings down the cost per line of transcription and improves the bottom line. It also helps increase profits by shortening the receivables cycle.

c. Increased process efficiency: Outsourcing medical transcription increases the efficiency of the healthcare process by making information available to the healthcare professionals on time.

d. Improved Management focus: Outsourcing medical transcription improves the management focus by freeing up valuable resources like real estate, supervisory staff, capital investment etc.

Outsourcing to TransDyne can provide all the strategic advantages to the healthcare facility. TransDyne is a professionally managed medical transcription service provider that offers quality Medical Transcription at reasonable prices, done by expert Medical Transcriptionists with a very quick turnaround time executed through secure HIPAA compliant channels, with very high levels of accuracy and all this with technology that is advanced but easy to use!

Medical transcription:A necessity or luxury?

To assess whether medical transcription is a necessity or luxury one needs to look at the history of medical transcription and the role it plays in the provision of quality care and the profitability of a healthcare facility.

· Evolution of medical transcription: Medical transcription is process of creating records of patient-healthcare professional encounter. Creation of records of the patient encounter has been around for a long time. Over time medical transcription has evolved from its’ early stages due to the advance of technology and the Internet. The various stages of evolution that medical transcription has gone through are as follows:

Ø Hand written notes
Ø Dictation-shorthand-typing on the manual typewriter
Ø Dictation- recording on tapes- transcribing on manual/electronic typewriter.
Ø Uploading dictation on the computer system, downloading, transcribing and uploading finished files and then transmission back to the healthcare professional through the use of Internet.

· Role of medical transcription: Medical transcription has always played a behind the scene role in the form of an essential support to the process of healthcare. Medical transcription plays an important role in the following:

Ø Recording the patient-healthcare professional encounter
Ø Referrals/ tests
Ø Statutory requirement
Ø Insurance re-imbursement
Ø Evidence in case of litigation
Ø As part of patient medical history.

One can see that medical transcription plays an important role in the core business of a healthcare facility and its’ profitability. It would be considered a necessary service rather than a luxury.

How can this necessary function of medical transcription be made economical and efficient?

Medical transcription can be made economical and efficient by outsourcing to a professionally managed company, which needs to be evaluated on the following:

· Quality/accuracy: Quality of the transcribed document refers to the percentage of accuracy in the transcribed document viz. a viz. the audio files. Accuracy level assured by the medical transcription service provider should be as close to 100% as possible.

· Turnaround time: Turnaround time refers to the period between uploading the audio file to the time when the finished record is made available to the healthcare professional. A turnaround time of 24 hours with quicker turnaround time options for STAT reports would be considered reasonable.

· Data security: Security of confidential patient data is an important consideration. This becomes even more critical when the data is transmitted back and forth. Any prospective medical transcription service provider needs to be critically evaluated in terms of the measures taken by them to ensure security of data.

· Price: Cost savings per line of transcription is perhaps one of most important considerations for outsourcing medical transcription needs. The pricing provided by the medical transcription service provider needs to be reasonable and the terms of pricing should be easy to understand.

· Volume flexibility: It is not possible to predict the volume of patient inflow. Therefore it is not possible to predict the volume of medical transcription work required. A medical transcription service provider needs to be evaluated on the basis of their ability to cope up with varying volumes and factors like weekend and holiday transcription requirements.

· Right use of technology: Technology plays an important part in the medical transcription process. It can make the process simpler, quicker and safer by providing easy methods of capturing dictation, uploading files, downloading completed records and even for archiving of patient records. Tracing the information required can be made easier through the use of technology. The medical transcription service provider should be evaluated on the use of technology in the medical transcription process.

· Billing methods: The billing method used by the medical transcription service provider can have a direct impact on the profitability of the healthcare facility. The billing method needs to explained at the beginning of the process. The billing method should be evaluated to ensure that it is, verifiable, definable, measurable, consistent and fair & honest.

· Success stories: Success stories or testimonials of satisfied customers can give the added comfort to the decision making process.

TransDyne offers medical transcription with an accuracy of above 99%

TransDyne assures a turnaround time of 24 hours with an option of 4-12 hours for STAT reports.

TransDyne ensures security of data by securing technology, processes and people.

TransDyne offers a reasonable and fair price by charging 10 cents per line, which is calculated by using the character line pricing method.

TransDyne maintains a large, well-trained team of medical transcriptionists, which enables them to cope with varying volumes

TransDyne offers medical transcription services by using the latest technology that is advanced and easy to use.

TransDyne uses the character line billing method that is verifiable, definable, measurable, consistent and fair & honest

TransDyne has the testimonials of their success stories available for viewing on their website.