Urgent message: Sending your dictation to India or the Philippines may save you money, but do you really want a transcriptionist whose first language isn’t English?

Author: Mary Goehring
Author Credit: Mary Goehring is CEO of Transcription Plus, LLC (www.transcriptionplus.net) in Bristol, Connecticut. She can be reached at (860) 583-2818 or [email protected]

No one will disagree that errors cost money–in any business. Medical errors account for more deaths in America than breast cancer, AIDS, or car accidents annually. In a report issued by US Pharmacopeia, transcription errors are the fifth-most-common cause (15%) of medication improprieties—with patients over 65 being twice as likely to be harmed. (1) A study by the independent healthcare ratings company HealthGrades places reported preventable deaths due to healthcare personnel mistakes at 195,000 per year. (2)

It may seem ironic that the FDA implies that it may be dangerous to import drugs from Canada, while the healthcare industry endorses processing of radiology tests and medical records in countries where English is not the primary language, such as India and the Philippines. This substandard wage outsourcing may yield up-front financial gain but is extremely controversial with regard to patient care issues, not to mention complete indifference to national allegiance. The question is: Do the benefits outweigh the potential for inaccuracy? How can you minimize the risk of malpractice or other legal proceedings? Most importantly, what is the ultimate benefit to the patient?

The unfortunate truth is that bottom-line concerns affect quality patient care. The transcription outsourcing market is estimated to have been $8.4 billion in 2010. (3)The wages their employees earn fall far below industry standards, as does the quality of their work, resulting in poor to mediocre end results. Outsourcing of transcription services to overseas concerns is popular and trendy these days, primarily because of cost savings, but there is an associated cost with those front-end savings. It’s true that the Health Insurance Portability and Accountability Act (HIPAA) doesn’t prevent outsourcing offshore, but the countries benefiting from it are not bound by U.S. laws and, in the event of a security breach, it would be difficult to hold medical transcription firms in these countries accountable. Confidentiality and secure data transfer also are considerations in choosing a transcriptionist. Medical Identity theft consists of stealing information that allows treatment and even costly surgeries to be falsely submitted to insurance companies, as well as exposing personal information. That bottom line is extremely costly. Protection of personal information is critically important; it takes considerable effort to keep personal information private.

Know Your Options
Transcription is an important part of the day-to-day operations in the medical community. What viable transcription options are available? Which avenue provides the best checks-and-balances system to help avoid errors and protect confidentiality and security? Let’s take a look.

EHRs and In-House Transcription
Medical transcription is one of the components of sophisticated electronic health record (EHR) systems sold by software vendors. (For a rundown of some of the EHR systems available, see http://www.softwareadvice.com/medical/electronic-medical-record-software-comparison/) These systems may be well suited in settings such as hospitals and large healthcare facilities. An independent study by Superior Consultant Company, however, indicated that for smaller practices, a vendor solution is cheaper and the EHR software may not integrate well with simple software applications or documentation requirements. (Superior Consultant Company is a nationwide integrated management and information technology consulting firm serving every segment of the healthcare delivery system and a division of Xerox – ACS Healthcare Systems.) The costs of in-house transcription can be minimized if transcriptionists are hired on a temporary project basis. Many companies feel an in-house solution provides them total control over productivity standards.

Large USA-based Transcription Companies
These companies have impressive marketing budgets and large staffs. They offer generally adequate quality and rapid turn-around. Transcriptionist compensation is based on line-production quantity, not quality; they are rewarded for volume not accuracy. These companies may have high turnover, yet can provide a cost-effective option because of their size and volume. Additional information on what to look for in a large transcription company is available from GMR Transcription at http://www.gmrtranscription.com.
Single Contracted Transcriptionists

Individual transcriptionists can offer somewhat lower prices because they have no overhead. Many are good; some lack credibility. Contracting an individual transcriptionist means you may not have 24/7 coverage or access to that person. On the other hand, working with an individual provides the opportunity for that person to get used to your style, accent, and context.

Small Transcription Companies
Quality-minded, small transcription companies often can provide an effective solution. A reputable company can provide expeditious processing with personal service dedicated to individual client requirements. Credible companies offer a common-sense approach, as well as 24/7 on-call support structured to fit your exact requirements and formats. However, a small transcription company may not have a large number of available transcriptionists to immediately cover a significant-sized unexpected project and may not provide in-house training.

Interview for a Good Fit
When you consider to whom you want to entrust your professional and/or personal vital records, there is one absolute feature that must not be compromised: Accuracy. Transcriptionists should be English-language specialists, with English as their first language and be able to properly and accurately transcribe the English language from the spoken word. To help you choose the right company for your needs, here are some key questions to ask:

  • Are all your offices based in the United States? Remember, you want to minimize the risk for medical identity theft and confidentiality breach by securing a company bound by U.S. laws.
  • Is there an accuracy guarantee? If so, what is it? Keep in mind that a guarantee of 99% accuracy = 10 mistakes in a 1,000 word document; a guarantee of 97% accuracy = 30 mistakes in that same document.
  • Do you have the ability to process tapes and digital voice transfer with encrypted files?
  • Do you offer simple, secure electronic data transfer? Digital audio files can be easily uploaded to your computer from a recorder (or called in to a 1-800 number) and, with the touch of a button, quickly transferred to a secure web server. The web server should also act as a secure storage area for completed transcripts.
  • Is speech recognition offered? This method can be practical, fast, and cost effective because it automates a significant portion of the documentation process.
  • Is the staff certified, proficient, and accomplished with 24/7 “on-call” support?
  • Are transcriptionists assigned consistently and is auxiliary coverage available? Will you be assigned the same transcriptionist each time you use the company’s services? Is there a plan for back-up coverage and cross-training?
  • Is your secure file transport protocol (SFTP) server for client file transfer located in the United States? Again, protection of personal information is critically important and a U.S.-based server is bound by HIPAA guidelines.
  • Do you offer toll-free dictation lines and unlimited online storage? Depending on your business, you may be required by law to retain documentation for an extended period of time.
  • Do you have the technical knowledge and ability to directly access our in-house electronic health record (EHR) system? For example, a VPN client is necessary to establish encrypted tunnels for highly secure remote connectivity.
  • Does the company meet/exceed the HIPAA guidelines and standards for protecting patient information?
  • Is the company a member of the Better Business Bureau or State Chamber of Commerce? If they are, you may be able to check for ratings and reviews.
  • Is the firm a member of the Association for Healthcare Documentation Integrity (AHDI) (http://www.ahdionline.org)? (AHDI produces a directory of credentialed professionals and maintains a list of approved medical transcription educational programs.) If so, they may be more informed about changes in technology and lawful requirements.
  • How many years of proven experience does your transcription company have?
  • Are services billed on a per page, per line, per black character, or per hour basis? In other words, are the transcriptionists compensated for speed or given an opportunity to be accurate?

The best type of relationship between an urgent care practice and its transcription service is one that is predictable, consistently delivers a quality product, is flexible, and lasts over the long term. Requiring that your transcription service checks out well by asking the questions outlined in this article will go a long way toward ensuring a beneficial relationship that caters to your specific needs, protects your privacy, and delivers the high-quality documentation that professionally represents your urgent care practice to the world.

  1. United States Pharmacopeia. http://www.usp.org
  2. HealthGrades. http://www.healthgrades.com
  3. The Healthcare Information and Management Systems Society. http://www.himss.org
What To Look for in a Medical Transcriptionist
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