The Tools of the Trade

When we started our first medical transcription business in 1980, Transcription Specialists, our tools consisted of IBM Selectric typewriters, Dictaphone transcribers and lots of carbon paper. That was as high tech as it got. The carbon paper was used to make copies for us to use to figure out the “line count” when it came time to bill the clients and pay the typists. Twice a month out came a big box of yellow carbons and then begin the job of “figuring” the line count. It was rather haphazard to say the least.

Every day we made the rounds of hospitals and medical offices picking up their tapes and bringing them to our office. Our typists would come to our office every morning to pick up their daily supply of tapes. Later that evening they would return with their typed documents.

By 1986, while operating Medical Dictation Service, we were using a couple Lanier dedicated word processors. They were about the size of small refrigerators. But they did a very good job. We were rather “modern.” Of course there was no “networking” of computers or any Internet searches. In fact, there was no Internet.

At about this time we added a Xerox copy machine and did away with our carbon paper. Now the Lanier word processors were big, but these copy machines were about the size of a compact Mercedes. And talk about expensive leases; they made carbon paper a very fond memory indeed. But, we were truly high tech now! However, we were still figuring line count using the copies we made of the typed document. And we were still making the rounds every day to pick up tapes and deliver typed documents.

By 1994, when we founded Digital Transcription Inc, we were ready to take a true step into high tech technology. No more copy machines, Dictaphones or even Lanier word processors.

True word processing on the desk-top computer was a reality and digital files were here to stay. From this point on, we would no longer pick up tapes and deliver typed documents. We installed a digital dictation call-in system in our office. To use our medical transcription service, one had to dictate using a telephone instead of into a dictation machine. When the dictation was complete, we had the files in hand immediately. Instead of waiting for typists to come to our office to pick up tapes, we put the dictated digital files in the typist’s individual mail box on our FTP computer for immediate downloading. When the work was done the typists uploaded the Word document right back to that FTP computer. We in turn moved the completed files to the client’s mail box on the FTP computer for electronic downloading to the doctor’s office where they printed out the final product.

And since the transcription was in a digital file, a new and utterly accurate method of counting the typed document became available, line counting software.

One of the advantages this system gave us was our ability to hire typists all over the US instead of being limited to a short drive time to our office. In addition, it also allowed us to service clients all over the US as well. The client no longer had to be within a reasonable drive time to our office.

So our favorite tools now are 1) the desk top computer with powerful word processing software–MS Word. 2) The digital dictation system, 2) our FTP server and 3) our line count software

So tell me, what tools have you found to be your favorites in the field of medical transcription?

Digital Transcription Inc

Ralph & Carol Bass

ralphebass@digitran.net

caroljbass@digitran.net

864-292-8487

www.digitran.net

http://medicaltranscriptionproblems.com/

Electronic Medical Records is not something that will be in our future someday, it is very much present now. It’s all around us. Is it a good idea? To the home-based medical transcription industry, that is like asking horse and buggy makers what they think of that new gadget the automobile. You’re not likely to get a helpful answer. But emotion aside, for the physician there are several things need to be considered.

1) How imperative is it to experiment with these new technologies right now? Let’s face it; they will get better and cheaper over time. Not a few medical practices have put small fortunes into EMR’s only to get rid of them later. They simply were not happy with the results.

2) Are you satisfied with traditional methods right now? Generally this means you dictate into a phone or a digital recorder and forget about it. That’s not bad. Many physicians are very happy with this method.

3) How valuable is your time? For instance, getting Voice Recognition programs to work can be like wrestling with a pig, you just get dirty and the pig loves it! (Now that didn’t make perfect sense but I’ve been looking for some place to use that illustration which I think is really cool.) But you get this idea; it can be frustrating and even incite the spilling forth of bad language.

4) Point and Click database software gives you limited options with canned paragraphs that aren’t always helpfully descriptive.

5) The cost of traditional medical transcription is an economic bargain. In 1982 we started our first medical transcription business; we charged 10 cents a line. Now, 28 years later, we charge 10.75 cents a line. How does that rate of inflation compare with the other products, services and salaries that you pay for today? It is truly a deal!

6) And remember this: MS Word documents are Electronic Medical Records. They can be imported into most any EMR program you are currently using.

7) Then there is the editing role of the medical transcriptionists. This is especially useful for those doing ERM’s which often fail at this point.

Now, having said all this, what is the future of medical transcription? Will EMR’s replace it? Or will EMS’s open a new arena of cooperation between the physician and traditional medical transcription? One other point of importance is compliance. Is the US government requiring physicians to provide an electronic product that will make it easier to move the record between various medical offices?

Here is an important question for the medical transcription companies: what has been your experience in recent years? Do you keep clients that have moved to EMR’s, or are they “letting you go”? Has your work increased in recent months, or is it decreasing in the face of this type of competition?

Our own experience is that our clients that have adopted EMR’s eventually stop using our service. We have not been successful in convincing them to use us in some type of auxiliary role. They tell us that they are saving money with this new technology over our low rate.

So, we are worried; are you?

Digital Transcription Inc

Ralph & Carol Bass

ralphebass@digitran.net

caroljbass@digitran.net

864-292-8487

www.medicaltranscriptionproblems.com

The weak link between the transcription firm and the physician / medical records supervisor can be the office staff. It can also be the strongest link; it just depends on the quality of that staff.

Here is the bad news, many (I’m not sure it’s not most) of the people we are hiring in America today have one or more of these issues: indolent (read lazy), obtuse (read stupid) or dishonest (read crooked). These people cost companies large amounts of money through theft, loss of customer satisfaction and the need to hire additional staff to do what a smaller staff could in fact do. Let’s consider how these problems and the people that embody them affect our businesses and economy.

1) Indolent: Let’s face it, some people simply don’t like to work. They have jobs because they must earn some kind of income. But they don’t want to do one thing more than what they must in order to actually do that job. You run into these people at retail stores as well as various offices. Their response to criticism of their work ethic is: “ they are not paying me enough to do …(fill in the blank).” The idea of doing above and beyond the call of duty in order to demonstrate to their employer just how valuable they are never crosses their mind.

I can remember talking to a young lady that worked for us; someone I thought was intelligent and capable, about the possibility of moving into management. After expressing my appreciation on how she had preformed so far and suggesting she that it appeared she had a bright future in business, I then went to explain that I would like to consider her for management. That I would give her the opportunity to demonstrate her full capabilities and if she performed as well as I expected she would, she would be brought into management. I then sat back and waited for her response. That response? “How much raise do I get? If I don’t get a good raise, I’m not doing one thing more that I’m doing right now!” It will be no surprise to the reader I’m sure to find out that we decided to look elsewhere in our search for management material.

In addition, we have experienced much frustration when trying to solve a simple problem in a client’s office by a secretary who simply responds “that’s not my job” to any instructions you might be providing to resolve a simply difficulty.

2) Obtuse: Many secretaries do not actually know how to do anything well. Now you are going to think that in this next story I’m kidding you, but I’m not—here goes. I was working with a secretary over the phone trying to help here call up and read the medical transcription on her computer. Now, often the first step to take in dealing with computer problems is simply to reboot and try again. So I tried that, in fact I tried it several times because I simply could not understand why the “picture” I expected on the screen was not showing up. Remember, I was on the phone; the secretary was working on the computer. Then it dawned on me; she was turning off and on the monitor, not the computer. She didn’t know the difference! (I’m not kidding.)

Many feel their lack of knowledge on a given topic is their boss’s fault; it is somehow the companies responsibility to train them; that they themselves have no responsibility to invest in their own lives through increased education or training.

3) Crooked: I know that job place theft is a problem you are probably well aware of, but how would that show up in the medical transcription field? Well one way that we have experienced it is with secretaries that want their “friends” to get the medical transcription account. This is generally not in the interest of the physician, simply in their interest.

But even more disturbing is how they go about pulling this off. They will find fault with everything you can imagine, the great majority of which is false or simply nitpicking and then go to their boss and complain about how that medical transcription company is doing a lousy job. By the way, I know a medical transcriptionists who can do this far better than what we are getting here.

The result is a loss of quality service to the physician as well as a form of theft to that medical practice.

Digital Transcription Inc

Ralph & Carol Bass

ralphebass@digitran.net

caroljbass@digitran.net

864-292-8487

www.digitran.net

Few subjects are more relevant in the medical transcription world than this one. Many physicians and medical records specialists are concerned about this topic. What is the issue and what are their concerns? The issue is offshore outsourcing and the concerns are these:

1) There are difficulties in simply understanding those that live in other countries because of language and dialect differences, hence the title of this paper.
2) Even if they do speak English, American colloquial and idiomatic speech is not apart of their culture, as a result they will have no idea how to handle it.
3) There is often geographic and regional information needed to do acceptable transcription that is not a part of that culture either.
4) What about the security of the dictation itself? If it is being zipped around the world, who has access to it?
5) And my all time favorite; “Isn’t this un-American?”

How should the physician or medical records specialist view or deal with these issues? Let’s go over them again one at a time:

1) There are difficulties in simply understanding those that live in other countries because of language and dialect differences.

Almost certainly the end client will not communicate directly with the offshore typists so, understanding verbal speech will not be an issue for them. It will, however, be a big issue for the medical transcription service. If the service can’t communicate well with the off shore provider, then how is it possible to obtain quality transcription? Well, in fact, under this scenario quality transcription will not take place. However, many local and overseas companies do communicate well with each other. If quality communication is not possible, however, off shore associates should not be pursued. And in fact, there are some offshore business people that cannot communicate with Americans, no matter how they try.

2) American colloquial and idiomatic speech is not a part of their culture; as a result they will have no idea how to handle it.

In essence, it is the job of the American firm to make sure colloquial and idiomatic speech is correctly understood and typed. This boils down to having the off shore client’s work carefully reviewed until it is obvious they are “getting it.” In time much of this can be learned by the off shore typist. In addition, it is important to have the offshore client (or local typists for that matter), double slash (//) the work at points of confusion. With the “find” option, the proofer can zip to the points in question, edit as needed and move on quickly.

3) There is often geographic and regional information needed to do acceptable transcription that is not a part of that culture either.

Again, if the same typist is used by the client firm for your work every day, geographic and regional information will be learned. But again, the local medical transcription service is ultimately responsible for making sure this is addressed.

4) What about the security of the dictation itself?

Security, this is a hard one. Most client firms assume they have a trustworthy relationship with their offshore partners—and they may. But there are no guarantees. There are good security programs that can and must be used to move the files through the Internet. This is a given. Any firm that sends medical records “in the open” is both breaking the law and is downright foolish.

5) “Isn’t this un-American?”

One can appreciate the desire to “buy American” and thereby protect American jobs. Economically, however, this is actually flawed logic. The standard of living of any country that buys from others what these countries can produce cheaper is thereby improved by the transaction. In other words, the economy of the US is much improved by buying bananas from other countries than in incurring the additional cost of growing them in the US instead. True, there would be many new US jobs associated with this banana business, but the cost to the consumer would be so great as to actually lower the standard of living of the US as a whole. This applies to all products, medical transcription included. However, notwithstanding the economic soundness of this statement, many simply don’t believe it. So, it is the perception that must be lived with and dealt with—not the facts.

Like most firms, we export some of our work to an offshore staff and thereby take responsibility to deal with each of these problems.

However, the “buy American” issue takes a little special handling. Let’s face it “everybody is doing it” is pretty much a fact. The only difference is that we actually tell our clients this if they ask. A firm of any size that says they don’t use offshore typists would cause me to question their veracity. A lie is a poor foundation for a trusting relationship. We address this issue this way: if asked we respond that we do send some work offshore but if they prefer to have their work done here by Americans only, we will honor their request and make sure it is done only in the US.

Digital Transcription Inc
Ralph & Carol Bass
ralphebass@digitran.net
caroljbass@digitran.net
864-292-8487
www.digitran.net

by Ralph and Carol Bass

Do you ever get letters from transcription services guaranteeing 99% accuracy in their transcription work; that’s impressive, don’t you think? That last sentence with spaces was 144 characters. When you accept “99% accuracy” you are saying I will accept 1.44 errors for every sentence of that length; again, that is every sentence in the whole document! Did you know that? Would you be happy with that? I would not.

Don’t get me wrong, errors are inevitable, no matter who does the work. And we certainly don’t want to be unreasonable and nitpicking, but still you want to keep errors at a minimum. In fact, we want to do a whole lot better than 99%. How do you we, or you, do that?

Now whether you are a medical transcription service producing the work or a medical practice receiving the work, here are a few ideas that might help:

• 1) Give the typist samples of the doctor’s work—lots of them. Many questions can be resolved by just studying a few good examples. In fact, this must be the single best method for minimizing errors in medical transcription—study that doctor’s past work. All this assumes that the person doing it in months past was a good and accurate medical transcriptionist. If the examples are of poor quality, they will be of limited help.
• 2) And as a follow up to point 1 above, make sure your typists are actually studying the samples, carefully. You don’t want to go to all the trouble of obtaining these examples just to be blown off by a typist that thinks their time is too valuable to reference example like this.
• 3) And as a second follow up to the above points, insist that each typist keeps an updated example notebook for every physician they do work for. Little steps like this will generate quality work which is what we all strive for.
• 4) When you (the medical practice or the transcription service) see errors, even if they are not a big enough problem to send the work back for a retype, do this: make a copy and mark boldly the errors and fax it back to the service or the typist. These illustrations will go a long way to eliminate even these small errors next time. And don’t forget, these notes should go in the typist’s notebook mentioned above.
• 5) And remember this, if the problems are big enough that a retype is justified, then don’t fail to ask that the work be done over—at no cost to you. But remember this, if you are unreasonably picky, you may lose a great medical transcriptionist. So, be reasonable.
• 6) If you have taken these steps but still say, “I’ve tried all this; the work is still bad, now what?” Simple, get another typist if you are a medical transcription service or another service provider if you are a medical practice. If they won’t work with you to improve the quality of their work, why work with them? Obviously they are simply not able to do quality work, or they do not care to make the effort.

Quality transcription is out there. You should make the effort to insure your medical transcription office produces it or your medical practice receives it.

Now, what additional ideas do you have to insure quality medical transcription?

Digital Transcription Inc
Ralph & Carol Bass
ralphebass@digitran.net
caroljbass@digitran.net
864-292-8487
www.digitran.net

by Ralph and Carol Bass

“We just love our transcription service but they have a very hard time hearing our files; why is that?” This was the question of one medical office.

You would be surprised how often this problem comes up, or perhaps you wouldn’t be. Here are a few reasons for poor dictation quality—which results in poor transcription quality:

1) Many will handle papers and charts while dictating. The mixture of the voice and the papers diminishes the quality of the dictation considerably. And you can rest assured that the offending paper noise occurs just at a critical point!

2) Some will eat while dictating. You don’t believe it? Believe it; lunch is a favorite time for some when it comes to dictation. It is hard to understand how some can be so inconsiderate, but the fact is—they are.

3) Sleeping while dictation? I know you think I’m nuts, but we have a client who falls asleep while dictating—and she is a sleep disorder specialist!

4) Using the rest room while dictating (this is where I got the title to the paper). Truly few things can be more disgusting than this—and few things demonstrate the lack of consideration and common decency as well.

5) Using a cell phone to dictate on; cell phones often, even generally, do not have the quality to do proper dictation.

6) The lazy jaw syndrome (they simply won’t open their mouth). What can you say about this problem? It sounds like mush.

7) Dictating as fast as you can. Time is money and it is important to get as much done in as short a time as possible. Of all the problems associated with dictating, this may be the number one offender. If you don’t enunciate, very often you cannot be understood.

Dictating in a noisy room is a major problem. People talking in the background, phones ringing and office equipment running create terrible problems for the person trying to hear and type the dictation.

And guess what? The transcription suffers from these bad habits. Do you want to guess who gets the blame when that happens? Yep, the person doing the transcription is always the culprit.

Is there any way to make this problem go away? It’s tough. But consider these possibilities:

1) The best place to start is simply to ask that a certain practice be addressed. After all, “you have not because you ask not”. Many physicians are very nice people and if you drew this problem to their attention, they would address it.

2) But what about those that aren’t so nice? And there are a few that fit this category as well.

a. Start with the director of medical records or office manager. Very often this person will be able to go to bat for you.

b. Consider making a copy of the dictation and returning it with the transcription. Ask for help; explain you desperately want to provide quality transcription but that is all but impossible if the dictation quality is poor. Ask them to listen to the dictation and “advise” you.

c. And last, just how bad do you need this client? Sometimes the only option is to fire them. This is not what we are here for. This we simply do not ever want to do. But, there are times….

Do you have other ideas? Share them with us.

Digital Transcription Inc

Ralph & Carol Bass

ralphebass@digitran.net

caroljbass@digitran.net

864-292-8487

www.digitran.net

by Ralph and Carol Bass

Here is the question: are you looking for temporary help or a permanent medical transcription supplier? The answer is; Yes.

Say again? As it is often packaged, you have only two choices: 1) obtain temporary help to get you out of a transcription jam, or 2) obtain a permanent supplier to do all your work. But are these the only options? How about a better one, a middle ground? Permanently keep temporary help. Why?

Advantages: Like a good Boy Scout or Girl Scout, with temporary help permanently on call, you are prepared for the inevitable. Here are some things that are truly inevitable:

1) Your typists will get sick, and they won’t give you a two-week notice when it happens. But you won’t care if you have planned ahead.

2) They will have babies. How long are you prepared to wait till they can get back to work? Generally in a short day or two and you already have problems.

3) They will go on vacation. Even if you know the vacation is coming up, it won’t help much; your work will get behind. But, with a built-in temporary staff, when they do, you won’t even notice.

4) Your equipment will crash and you will need time to fix it. But when you plan ahead, your work will not suffer.

5) Does your typing staff know they can be replaced so easily? You know, when you think about it, that’s not so bad!

6) And don’t forget, company obligated SS payments, the company portion of the State and Federal Withholding, Medicare payments, paid sick days, paid vacations, equipment costs and space allocation are no longer your problem when you outsource.

Disadvantages: There are disadvantages. For instance, when work is skimpy in your office, the overflow service will still be looking for something to do even though you could cover it easily in-house. Also, when things go south and you have to send a glut of dictation out for transcription, the work may be turned a bit slower. After all, they aren’t used to that much work every day.

Conclusion:

As is so often the case in life, the middle ground is the place likely to serve you best. Keep yourself in a position to do the unexpected overflow of dictation, quickly and without pain. Keep a service “on staff.” Give them a small amount of work daily with the understanding that they will be there for you when problems develop. And keep this point in mind, when they are needed to step up to the plate, they won’t be wondering where the plate is. They will already know how you like things done: formatting, vocabulary usage, delivery of work. Everything will be in place to serve you smoothly.

But remember this, if you are a stranger to them, the likelihood that they will feel obligated to get your donkey out of the ditch will be small indeed. And even if they did care—“Now how do you want this formatted again?” You get the idea? It’s painful to develop a working relationship from scratch—especially in a work glut.

And this one extra point, when you need temporary help don’t say to the service “we only need help until our girl gets back from vacation (or having a baby). Often you will hear “we don’t do temp work.” Why would they say that? Because it takes a great deal of time and effort to learn how you like your work done, how you want documents formatted, what vocabulary you tend to use and how develop that interaction with your office. And just when it’s beginning to get figured out—“we won’t be using your service any longer.” With that in mind, why would they do temp work?

So make a deal with them; we have a temporary need but we plan on using your service permanently for all types of overflow. With that type of long term benefit, you will find many services willing to go the extra mile now—knowing that effort will have long term advantage later.

Does maintaining a temporary service permanently make sense to you?

Digital Transcription Inc

Ralph & Carol Bass

ralphebass@digitran.net

caroljbass@digitran.net

864-292-8487

www.digitran.net

Is Company Size Important?

The Small vs. Large Medical Transcription Service

by Ralph and Carol Bass

“I’m sorry but my baby’s sick; I won’t be able to do your work today.” or “We’re going to the beach Monday, so I won’t be working next week.” or “Oh, didn’t I tell you I was pregnant?” or “Bob and I have broken up; I’m moving back to Montana to be with mom.” These are but a few of the dreaded words for the client who went for the “low price” but ended up getting a low blow instead. Can it happen to you? You bet, if your medical transcription service is simply too small to deal with issues like this from their own staff.

But, both the small and the large medical transcription service each have their pluses and minuses. There is a trade off of cost and benefits. Consider these differences:

The Large Service with 50-200 Typists

There Are Pluses—

1) There is adequate staff to cover the personal problems of their typists. You aren’t left in a bind if one of their staff gets sick, pregnant or moves out of town.

2) There is an abundance of stand-by equipment if needed. A break down of a computer will not impede their production.

3) If you are a techy, they have the bells and whistles. These don’t often add much to the service, but they do dazzle with their foot work.

There Are Minuses—

1) “Now what clinic did you say you were?” Personal knowledge and attention are often missing; you’re just a number.

2) “I’m sorry; we don’t do it that way.” Lack of flexibility to your preferences is common. Their not like Burger King, they don’t do it your way.

3) They can be more expensive; they have plenty of clients, they don’t need bargain basement clients.

4) The system learning curve can be daunting.

The Small Service with 1-3 Typists

There Are Pluses—

1) You can talk to the person who does your work personally. You could become friends. Actually, the gal that used to transcribe in your office might have gone home and become your “service.”

2) Your typist has an intimate knowledge of your preferences and style and can be very accommodating.

3) Sometimes their rates are more competitive.

There Are Minuses—

1) Their personal problems become your transcription problems.

2) Their equipment problems become your transcription problems.

3) Their system is mostly low tech. Their kids just might be playing online games on the computer where your records are stored (Yikes!).

The Mid Size Service with 4-19 Typists

What is the solution? Well perhaps the mid sized service is in a position to provide the desirable balance. They are big enough to insulate you from the personal problems of staff typists and small enough to provide personal service, to know you by name, to learn your vocabulary and style and to provide some nice service such as FTP, 800 numbers and telephone dictation.

And when that patient shows up unexpectedly and you want a report sent again, fast because you don’t have time to hunt it down on your system—well, the small service is picking the kids up from school when you call, the large service will resend at a price and the mid size service says, sure, we can do that, we will fax that to you immediately.

In terms of your own experience, what size medical transcription service provides the best service?

Ralph & Carol Bass

Digital Transcription Inc

ralphebass@digitran.net

caroljbass@digitran.net

www.digitran.net

864-292-8487