CBay to purchase Spheris

spheris [2007-01-30]
Anyone know the deal with Spheris lately, heard they were bought out by Healthscribe and are going to be outsourcing most. Need to know is I should stay or start looking AGAIN....Have two teenagers at home that need to be fed and we all know the way they eat.

Spheris took over Healthscribe (nm) [2007-01-30]
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CBay to purchase Spheris? [2006-10-11]
Is it true due to Spheris' increasing debt the last two quarters,in part due to a difficult platform, has made them a target for CBay? Will Spheris become a wholly-owned Indian subsidiary at some point? The cost savings to this financially distressed company could be too good to pass up.

Spheris Completes Acquisition of Vianeta Communications [2006-05-11]
FRANKLIN, Tenn., May 8 /PRNewswire-FirstCall/ -- Spheris, a leadingglobal provider of medical transcription technology and services, todayannounced the completion of its acquisition of Vianeta Communications, aleading developer and supplier of enterprise-wide clinical documentationtechnology for hospitals, health systems and group practices. The acquisition further expands Spheris' ability to deploy technologyand service solutions for healthcare providers of any size and complexity.Virtually all healthcare specialties, including radiology, will be able tobenefit from Spheris' enhanced clinical documentation technology andservice options. Customers are telling us they want an integrated technology andservice solution that is flexible enough to be combined and deployedeffectively across their health information management and radiology ITsystems, said Steven E. Simpson, Spheris president and chief executiveofficer. The acquisition of Vianeta significantly expands Spheris'technological capabilities, including speech recognition and XML datatagging for use with electronic health records, and thereby enhances ourability to meet the evolving and unique needs of all healthcareorganizations. Bringing Spheris and Vianeta together combines what we believe to bethe most advanced technology in the medical transcription industry with themost powerful global network of medical transcriptionists, said Vianetachief executive officer Ralph Aceves. By joining forces, we believe we'vecreated the best possible solution for addressing the growing expectationsof our customers to improve quality, productivity and turnaround time. Working together as a combined entity, Spheris and Vianeta are alreadyin discussions with several major healthcare institutions about theexpanded capabilities made possible by the acquisition. The favorableresponses already given by our existing customers and potential newcustomers have confirmed the value proposition we created by joining thetwo organizations, said Simpson. In addition to continuing to service and enhance the Vianeta solutionscurrently deployed in the marketplace, Spheris will integrate the twoorganizations over the next several months and anticipates the announcementof new product offerings in the near future. Financial terms of theparties' agreement were not disclosed.

CBay Awarded Multi-Year Contract [2006-01-19]
ANNAPOLIS, Md., Jan. 18 /PRNewswire/ -- CBay Systems announced today thatit was awarded a contract by Premier Inc. to provide integrated dictationcapture, transcription and web-based document management solutions to itsmember healthcare facilities. Under the terms of the agreement, CBay is theapproved provider to Premier's alliance of approximately 1,500 hospitals andhealthcare systems across the United States. A leading provider of healthcare technology and business processoutsourcing (BPO) services, CBay addresses various issues in the healthcaresector, primarily focusing on transcription process improvement andreceivables management. By leveraging HIPAA-compliant Internet technologiesand highly credentialed global resources, CBay delivers measurableefficiencies and savings to hundreds of hospitals, clinics and physiciangroups. A selection committee at Premier evaluated numerous medical transcriptionservice organizations from across the country and determined that CBay'ssolutions were the right choice for its members. CBay is very excited about this opportunity to provide medicaltranscription services to Premier's member hospitals, said Michael Kimball,CBay's senior vice president of sales and marketing. We offer the ideal blendof service, experience, technology, and value to ensure that Premier's membersreceive timely and accurate medical documentation to help them provide thebest patient care.

Spheris to Acquire Vianeta Communications [2005-12-21]
Integrating Vianeta's open and scalable XML-based software into Spheris'existing medical transcription technology will also accelerate a host of otherinitiatives Spheris is currently executing and further developing for both itstechnology and service capabilities. Speaking on behalf of the entire Vianeta team, we are pleased to bejoining such an industry force, said Vianeta Chief Executive Officer RalphAceves. We are looking forward to becoming part of the Spheris mission tolead the medical documentation industry through superior services and best-in-class technology. Following completion of the transaction, Spheris will continue to serviceand enhance the Vianeta solutions currently deployed in the marketplace. The transaction, which is subject to customary closing conditions, isexpected to close in the first quarter of 2006. Financial terms of theparties' agreement were not disclosed.

cbay "expansion" [2005-11-14]
If anyone is interested, two of the three companies that I personally worked for that were sold to Cbay, have now disappeared. The buildings are empty,the employees are gone. That's how they expanded in Michigan. They continue to include these two companies in their list of acquisitions, but the transcriptionist's who worked for these two acquisitions are out of work, so the work must be going to India as it is certainly no longer here in Michigan anymore. Thanks Cbay!

spheris [2005-11-10]
What a crock of garbage. Why wouldn't you send business to India? The probably make less than we do, which isn't saying much. Spheris has the worst reputation in the industry and treat their MTs like garbage. The company revenues are 200 million? Sure isn't going to the MTs in the US.

Spheris [2005-10-23]
I have a friend who is just dying to work at home. I do, but only local dictation. What can I tell her about Spheris? Are they reliable, is there enough work. you know, all the stuff one should know before committing? I don't see much of anything positive on this compay but I could be wrong myself. Are there any companies out there that ARE good? For her she says benefits are not an issue which is something I can't visualize, but that's her position.

Spheris India looking at expanding in tier-II cities [2005-10-20]
BANGALORE: US-based medical transcription company Spheris, which recently acquired HealthScribe, is looking to expand in a tier-II cities in India, preferably in the South by 2006. Spheris India (formerly HealthScribe), based in Bangalore, recently opened an additional 300-seat center in Coimbatore this month. The company has over 2000 employees in India at present, and plans to ramp up the headcount to 3000, next year. “We feel that large cities are very competitive while smaller cities have a lot more candidates who are serious in taking up medical transcription as a full-fledged career,” said Suresh Nair, CEO and MD, Spheris India. Elaborating this aspect, he said that unlike BPOs or call centers, which require good spoken English skills, medical transcription is more knowledge-oriented and needs good grammatical skills. Commenting on the merger with Spheris- the second biggest medical transcription company globally, he said that the move had made HealthScribe a truly global company with access to bigger funds and support for growth. The company has already added 15 new accounts from the Spheris' stable. Nair said that next year, he plans to start a technology development team that would build solutions based on their delivery platform and sell them commercially. Nair also revealed that by end of 2006, Spheris India would look at new areas like medical coding and billing. Spheris' revenues globally are in the region of $200 million. He expects Spheris India to grow at 60% this year. “The medical transcription industry has made a comeback in India and US customers are sending more and more work to us,” he said.

CBay Systems Makes Deloitte’s List of 500 Fastest Growing [2005-10-20]
CBay Systems Makes Deloitte’s List of 500 Fastest Growing Technology Companies in North America Maryland Fast 50 Rapid Growth Recognized for the Second Year in a Row CBay Systems, a leading provider of healthcare business process outsourcing (BPO) services and the largest provider of Indian transcription technology and services to the US healthcare market today announced that it was again named to the Deloitte Technology Fast 500. The ranking measures the 500 fastest growing technology companies in North America, based on percentage revenue growth over the past five years, during which CBay Systems grew 779 percent. CBay addresses various issues in the healthcare space, primarily focusing on medical transcription. The company’s HIPAA-compliant solutions leverage Internet technologies to provide integrated dictation capture, transcription and web-based document management services to hospitals, clinics and doctors. Making the Deloitte Technology Fast 500 for the second year in a row is commendable in today’s highly competitive technology industry, said Tony Kern, deputy national managing principal of Deloitte’s Technology, Media Telecommunications industry practice. “Achieving sustained revenue growth of 779 percent over five years is a tremendous achievement. We congratulate CBay Systems on being one of the 500 fastest growing technology companies in North America. Inclusion on the nation-wide Fast 500 list follows CBay’s recent acknowledgement as a member of the Deloitte Technology Fast 50 in Maryland. This list highlights the 50 fastest growing technology companies in the state of Maryland for 2005. CBay’s Chairman CEO, Raman Kumar said, “It is an honor for CBay to be recognized for the second year in a row, but we are especially proud of these awards, as they communicate our explosive growth and ever-increasing customer base, providing concrete evidence of our superior product and commitment to customer service.” He also added, “We have 41 centers in our network in India, employing over 5000 people and the number is increasing every month, to cater to our expanding customer base in the US.” Fast 500 Selection and Qualifications The Fast 500 list is compiled from Deloitte’s 15 regional North American Fast 50 lists, nominations submitted directly to the Fast 500, and public company database research. Entrants must be headquartered in North America and must be a “technology company,” defined as a company that owns proprietary technology that contributes to a significant portion of the company's operating revenues; or devotes a significant proportion of revenues to the research and development of technology. Using other companies' technology in a unique way does not qualify. About CBay CBay Systems is a leading provider of healthcare technology and business process outsourcing (BPO) services and the largest global provider of transcription services to the healthcare industry. CBay’s more than 5,000 highly trained medical language specialists and customer service professionals spread out in 41 production centers situated across 10 states in India serve 650+ health systems, hospitals, clinics and physician practices 24 hours a day, 365 days a year, using HIPAA compliant web-based technologies with a commitment to the highest standards of quality, service and value. CBay is headquartered in Annapolis, Maryland with the Indian corporate office in Mumbai. For more information, visit www.cbaysystems.com. About Deloitte Deloitte refers to one or more of Deloitte Touche Tohmatsu, a Swiss Verein, its member firms and their respective subsidiaries and affiliates. In the US, services are provided by the subsidiaries of Deloitte Touche USA LLP (Deloitte Touche LLP, Deloitte Consulting LLP, Deloitte Financial Advisory Services LLP, Deloitte Tax LLP and their subsidiaries), and not by Deloitte Touche USA LLP

Spheris Hiring more workers in India [2005-10-11]
Spheris says it is hiring more workers in India Media Release Oct. 6, 2005 An American company that transcribes doctors notes said Wednesday it is setting up a transcription center in the southern Indian city of Coimbatore, making it the latest U.S. company to expand outside India's traditional outsourcing hubs. Spheris Inc. of Franklin, Tennessee, has already hired 300 people for its new center in Coimbatore, in India's southern Tamil Nadu state, and plans to add another 700 workers in the next year, the company's president and chief executive, Steven E. Simpson, told reporters. Workers at the Coimbatore office transcribe taped dictation of U.S. doctors'' diagnosis and advice for patients, saving the physicians time and allowing them to treat more people. Spheris already employs 2,000 people doing the same work in the southern city of Bangalore _ one of the hubs of India's outsourcing business _ but decided to expand to Coimbatore because of the city's large untapped pool of skilled workers, he said. The city has a strong foundation in education and is inexpensive, he said of Coimbatore, a city of one million people 360 kilometers (224 miles) south of Bangalore. Western firms have sought to cut costs by farming out software development, engineering design and routine office work to India. But the influx of Western firms has led to labor shortages and rising wages in larger cities that have become centers for the outsourcing business, such as Bangalore and Hyderabad. In contrast, wages in smaller cities have not risen nearly as fast and are now about 30 percent lower than in traditional outsourcing hubs. Among the companies that have chosen to set up operations lesser-known Indian cities are Honeywell International Inc., which has an office in the southern city of Madurai, and IBM Corp., which has built a facility in the western city of Calcutta.

Spheris Helps Employees Displaced by Katrina [2005-10-01]
NASHVILLE, TN–Spheris, a global provider of medical transcription services and technology, is reaching out to help its more than 100 employees who were affected by Hurricane Katrina. Spheris employs more than 5,000 professional MTs, most of whom work from their homes, and had more than 170 employees located in the devastated gulf states of Louisiana, Mississippi and Alabama. “It took some time, but I am happy to say we have been able to locate all of our employees,” said Spheris CEO and President Steven E. Simpson. “Through the efforts of our employee relations specialists, we were able to determine that all of our colleagues escaped serious physical harm. Nevertheless, 21 Spheris employees have potentially lost their homes and all their possessions; 15 are in their homes, but are not able to work because of lost utilities; and several employees have relocated and been able to resume work.” According to Simpson, Spheris is currently assisting with additional relocation efforts of other employees unable to return to their homes. On Tuesday, Aug. 30, as the world began realizing the devastation facing millions of Americans, Spheris established a Spheris Employee Relief Effort as a means to provide corporate-sponsored assistance to Spheris employees who experienced a significant hardship directly caused by Hurricane Katrina. Spheris started the fund with the initial contribution and vowed to match a large percentage of Spheris employee contributions. In the days that followed, Spheris saw overwhelming generosity from its employees wanting to help, and in response set up an automated process for Spheris employees to donate their unused Paid Time Off (PTO) and cash contributions through payroll deduction on the Spheris corporate intranet. In addition to using the company intranet, Spheris is sending regular e-mail updates to all its employees and an e-mail address (Naturaldisasterloop@spheris.com) has been established to enhance the company’s ability to communicate and respond to its employees’ needs. To date, Spheris employees have personally donated more than $77,000 in cash and $112,000 in donated hours of PTO for their colleagues in need. And, those donations are already helping numerous Spheris employees. Peggy Stolf, who lives in St. Bernard Parish outside of New Orleans, is a Spheris MT supervisor who is receiving assistance from her employer. “Words cannot express the gratitude my family has for Spheris,” said Stolf. “Through this entire disaster, Spheris became my family's rock that we could cling to, to help us through.” The Stolf family lost its house, all of its possessions and its beloved dog to the devastating flood waters and is now living with family in Augusta, GA. While it would be easy to focus on what she lost, Stolf chooses to focus on what she gained. “Though we did lose a lot, we did gain a renewed faith in humanity and compassion,” said Stolf. “And, I cannot even find the right words to express the kindness and care that Spheris has shown toward me and my family.”

Evergreen+Spheris=India [2005-09-07]
I'm sure everyone noticed in sm's submitted article about India's opportunities for housewives in medical transcription, that one of their work sources is Spheris. Another submit states that Evergreen Hospital is outsourcing to Spheris ---- does Evergreen know their medical records are going to India? Doubt it!!!! PS. The article about India said Stheris -- it's an error -- wonder how many of these errors show up in transcribed reports. Hmmmm

Spheris storms up health care [2005-08-15]
Spheris purchase of Avicis/HealthScribe helped push the company into the top 30 of the nation's health care technology businesses, while Passport Health Communications cracked the top 100. The 12th annual Healthcare Informatics 100 placed Spheris, a medical transcription firm, as the 28th largest health care IT firm with $152.7 million in revenue last year. Officials at the Franklin-based company, which last year bought industry rival Avicis/HealthScribe for $75 million, expect revenue this year to top $200 million. That deal helped push revenue last year up 41 percent, the seventh largest increase in the health care IT market. Further down the list, Healthcare Management Systems slipped from 60th to 66th place last year despite revenue rising slightly to $34.5 million last year. In addition, Passport joined the top 100 list at No. 92 as revenue increased from $13.1 million to $19.2 million in 2004. The Franklin company provides health care insurance eligibility and benefits information online for hospitals and physicians. Earlier this year Passport bought software developer Healthworks Alliance Inc., which allows health care providers to identify and eliminate denied insurance claims and write-offs. In all, the 100 companies represented $24 billion in IT products and services, according to the June report.

VBC obscures line counting [2007-06-25]
VBC is an invention by Medquist to further obscure the line counting mess they created. MedQuist and Spheris dominated the committees that recommended this awful concept.

spheris [2007-01-30]
Anyone know the deal with Spheris lately, heard they were bought out by Healthscribe and are going to be outsourcing most. Need to know is I should stay or start looking AGAIN....Have two teenagers at home that need to be fed and we all know the way they eat.

CBay to purchase Spheris? [2006-10-11]
Is it true due to Spheris' increasing debt the last two quarters,in part due to a difficult platform, has made them a target for CBay? Will Spheris become a wholly-owned Indian subsidiary at some point? The cost savings to this financially distressed company could be too good to pass up.

DocQment(TM) Ovation - MedQuist Launches Next-Generation [2006-07-07]
MOUNT LAUREL, N.J., June 29 /PRNewswire-FirstCall/ -- Today's healthcare providers face what appear to be several conflicting challenges in the area of dictation. Pressures to decrease costs and improve productivity must be weighed against the need to demonstrate compliance and increase physician choice and satisfaction. To help its customers meet these challenges, Medquist Inc. (Pink Sheets: MEDQ) has introduced DocQment(TM) Ovation, a Web-based, enterprise digital voice capture and transport solution. Studies by the Healthcare Information and Management Systems Society (http://www.himss.org/) have shown that when considering the purchase of a new dictation system, providers value HIPAA compliance most highly, followed by Web-based, centralized administration and automatic document routing. Because Ovation is Web-based, it offers easy-to-use tools to manage documents, users and workflow from any computer with Internet access, creating numerous opportunities for productivity improvement. Physicians can select from a variety of options for capturing their dictation, including telephones, PDAs, and desktop computer-based dictation devices. DocQment Ovation is our newest technology innovation developed in direct response to industry feedback and providers' interest in replacing previous- generation dictation systems, says Scott Bennett, MedQuist senior vice president of Sales and Marketing. An integral component of our growing technology portfolio, Ovation helps to provide an end-to-end solution from dictation to billing, including front-end and back-end speech recognition. Document Ovation was specifically engineered to be compatible with MedQuist's previous-generation dictation stations, thus facilitating the retention and recruitment of transcriptionists, and making it easy for providers to upgrade with little or no physician retraining required. Deployed at the customer's location, Ovation provides an enterprise view that allows transcription supervisors to easily manage users, documents and voice files from a single dashboard instead of using multiple systems. Ovation's sophisticated configuration options enable administrators to easily track work and share resources in order to get the right document to the right Transcriptionist at the right time. According to Emmy Weber, MedQuist vice president of Product Management, Breakthrough capabilities engineered into DocQment Ovation, like the ability to define the date that begins the aging process for documents (including admit date and date of discharge), give users better information at the point of dictation to improve workflow, accuracy and report routing. With MedQuist's help, we configured DocQment Ovation around the way we do business, says Wanda Newton, HIM director at Maury Regional Healthcare System, a three-hospital system located in Tennessee. With Ovation, we are now managing our hospitals and departments more efficiently. We saw a 34 percent increase in productivity in the first two months of use of Ovation, a positive trend that we expect will continue. Ovation is available for immediate installation. For more information, contact a local MedQuist representative or dial 1-877-489-1500 for sales assistance. MedQuist, a member of the Philips Group of Companies, is a leading provider of clinical documentation workflow solutions in support of the electronic health record. MedQuist provides electronic medical transcription, health information and document management products and services, including digital dictation, speech recognition, Web-based transcription, electronic signature, medical coding, mobile dictation devices, and outsourcing services.

CBaySystems Introduces CBayFlo VoiceDirect [2006-07-07]
ANNAPOLIS, Md., July 6 /PRNewswire/ -- CBaySystems Services, Inc., one of the industry's fastest-growing providers of medical transcription solutions, today announced the general availability of CBayFlo VoiceDirect -- its own automated digital dictation and voice capture system. Using CBayFlo VoiceDirect, everyone involved in the medical transcription process -- physicians, HIMs, and transcriptionists -- is able to take advantage of greater speed, quality and security, from capture, to review, to transcription, to approval, to records management and archiving. At its core, CBayFlo VoiceDirect enables physicians to dictate into any digital recording device -- a PDA, tablet PC, desktop or phone -- and have it securely captured for transcription. Highly accurate, and featuring natural language processing, it eliminates the time and cost of manually transcribing recorded dictation. With the introduction of CBayFlo VoiceDirect, hospitals who are dependent on expensive, proprietary dictation systems from Dictaphone, DVI, and Lanier can enjoy new freedom and flexibility. CBayFlo VoiceDirect incorporates the same features and quality at a significantly lower price. At the same time, it is built on an open technology platform that allows it to interface with legacy Dictaphone, DVI, Lanier and home-grown systems. This allows a smooth migration path (with zero training) as well as easy integration with other HIM systems. By developing our own technology, we're able to seamlessly integrate the power of voice into every component of our CBayFlo platform, said Christopher Foley, President of CBaySystems Services. Our commitment to RD means we're no longer reliant on a third party system, and can deliver more of the benefits from this powerful technology -- and significant savings -- directly to our customers. Some of the specific benefits of CBayFlo VoiceDirect include: * High security and voice quality -- resulting in better quality records, and easier workflow * Compliance with the latest HIPAA regulations and technologies * Customized/advanced reporting capabilities, through a secure web portal: making it easy for HIMs to review and manage the entire workflow process Part of a Comprehensive CBayFlo Technology Suite CBayFlo VoiceDirect is just one of the components of the CBayFlo System -- a fully-integrated technology platform that manages medical transcription records at every stage of their lifecycle, from dictation and scheduling, through transcription, editing, web-based management, and long-term archiving. Unlike other systems that force hospitals into a fixed process, CBayFlo is flexible and customizable to work the way you want to work. All processes and workflows can be configured to your exact business and information/reporting requirements. Specific components of this powerful technology platform include: * CBayFlo DocView: advanced document viewing/editing/reporting * CBayFlo VoiceRecord: software for PDAs and digital recorders that allows voice to be uploaded to the web, and offloaded to a dictation server for transcription * CBayFlo eDemographics: an HL7 interface engine to exchange data with other HIM and patient records * CBayFlo Enterprise Document Manager: hospitals can manage and track the transcription process through a web-based portal -- CBayFlo DocuTrack: real-time updates of the status of each record and file -- CBayFlo DocView: document view/edit -- CBayFlo E-signature: document e-sign -- CBayFlo DocXchange: an HL7 compatible interface engine As an ASP application (no additional hardware or software is required for the hospital to purchase), CBayFlo is extremely secure and reliable, with multiple levels of redundancy incorporated into its standard architecture. The CBayFlo platform represents an important component of the WorldClass Advantage we deliver to our customers every day, noted Foley. By providing advanced technology, hospitals and physician practices can significantly reduce costs and save time -- allowing them to devote more resources to improving patient care.

Spheris Completes Acquisition of Vianeta Communications [2006-05-11]
FRANKLIN, Tenn., May 8 /PRNewswire-FirstCall/ -- Spheris, a leadingglobal provider of medical transcription technology and services, todayannounced the completion of its acquisition of Vianeta Communications, aleading developer and supplier of enterprise-wide clinical documentationtechnology for hospitals, health systems and group practices. The acquisition further expands Spheris' ability to deploy technologyand service solutions for healthcare providers of any size and complexity.Virtually all healthcare specialties, including radiology, will be able tobenefit from Spheris' enhanced clinical documentation technology andservice options. Customers are telling us they want an integrated technology andservice solution that is flexible enough to be combined and deployedeffectively across their health information management and radiology ITsystems, said Steven E. Simpson, Spheris president and chief executiveofficer. The acquisition of Vianeta significantly expands Spheris'technological capabilities, including speech recognition and XML datatagging for use with electronic health records, and thereby enhances ourability to meet the evolving and unique needs of all healthcareorganizations. Bringing Spheris and Vianeta together combines what we believe to bethe most advanced technology in the medical transcription industry with themost powerful global network of medical transcriptionists, said Vianetachief executive officer Ralph Aceves. By joining forces, we believe we'vecreated the best possible solution for addressing the growing expectationsof our customers to improve quality, productivity and turnaround time. Working together as a combined entity, Spheris and Vianeta are alreadyin discussions with several major healthcare institutions about theexpanded capabilities made possible by the acquisition. The favorableresponses already given by our existing customers and potential newcustomers have confirmed the value proposition we created by joining thetwo organizations, said Simpson. In addition to continuing to service and enhance the Vianeta solutionscurrently deployed in the marketplace, Spheris will integrate the twoorganizations over the next several months and anticipates the announcementof new product offerings in the near future. Financial terms of theparties' agreement were not disclosed.

CBay Awarded Multi-Year Contract [2006-01-19]
ANNAPOLIS, Md., Jan. 18 /PRNewswire/ -- CBay Systems announced today thatit was awarded a contract by Premier Inc. to provide integrated dictationcapture, transcription and web-based document management solutions to itsmember healthcare facilities. Under the terms of the agreement, CBay is theapproved provider to Premier's alliance of approximately 1,500 hospitals andhealthcare systems across the United States. A leading provider of healthcare technology and business processoutsourcing (BPO) services, CBay addresses various issues in the healthcaresector, primarily focusing on transcription process improvement andreceivables management. By leveraging HIPAA-compliant Internet technologiesand highly credentialed global resources, CBay delivers measurableefficiencies and savings to hundreds of hospitals, clinics and physiciangroups. A selection committee at Premier evaluated numerous medical transcriptionservice organizations from across the country and determined that CBay'ssolutions were the right choice for its members. CBay is very excited about this opportunity to provide medicaltranscription services to Premier's member hospitals, said Michael Kimball,CBay's senior vice president of sales and marketing. We offer the ideal blendof service, experience, technology, and value to ensure that Premier's membersreceive timely and accurate medical documentation to help them provide thebest patient care.

Spheris to Acquire Vianeta Communications [2005-12-21]
Integrating Vianeta's open and scalable XML-based software into Spheris'existing medical transcription technology will also accelerate a host of otherinitiatives Spheris is currently executing and further developing for both itstechnology and service capabilities. Speaking on behalf of the entire Vianeta team, we are pleased to bejoining such an industry force, said Vianeta Chief Executive Officer RalphAceves. We are looking forward to becoming part of the Spheris mission tolead the medical documentation industry through superior services and best-in-class technology. Following completion of the transaction, Spheris will continue to serviceand enhance the Vianeta solutions currently deployed in the marketplace. The transaction, which is subject to customary closing conditions, isexpected to close in the first quarter of 2006. Financial terms of theparties' agreement were not disclosed.

Foreign speaking docs [2005-12-01]
They keep the FSDs HERE for us to struggle with and send the easier stuff to India where the MTs who don't speak English are given an 8 week crash course in English diction, typing and computer processing. Those of us who have worked our entire adult lives in this profession are left to keep the FSDs from getting their backends sued for malpractice. I'm proud of my profession and resent being demeaned and cheated out of what I've spent a lifetime perfecting by seeing it given away by a money hungry, two-faced oursourcing country that swears on a stack of Bibles that we do not now and never will outsource outside the United States. Way to go Spheris.

cbay "expansion" [2005-11-14]
If anyone is interested, two of the three companies that I personally worked for that were sold to Cbay, have now disappeared. The buildings are empty,the employees are gone. That's how they expanded in Michigan. They continue to include these two companies in their list of acquisitions, but the transcriptionist's who worked for these two acquisitions are out of work, so the work must be going to India as it is certainly no longer here in Michigan anymore. Thanks Cbay!

spheris [2005-11-10]
What a crock of garbage. Why wouldn't you send business to India? The probably make less than we do, which isn't saying much. Spheris has the worst reputation in the industry and treat their MTs like garbage. The company revenues are 200 million? Sure isn't going to the MTs in the US.

Spheris [2005-10-23]
I have a friend who is just dying to work at home. I do, but only local dictation. What can I tell her about Spheris? Are they reliable, is there enough work. you know, all the stuff one should know before committing? I don't see much of anything positive on this compay but I could be wrong myself. Are there any companies out there that ARE good? For her she says benefits are not an issue which is something I can't visualize, but that's her position.

Spheris India looking at expanding in tier-II cities [2005-10-20]
BANGALORE: US-based medical transcription company Spheris, which recently acquired HealthScribe, is looking to expand in a tier-II cities in India, preferably in the South by 2006. Spheris India (formerly HealthScribe), based in Bangalore, recently opened an additional 300-seat center in Coimbatore this month. The company has over 2000 employees in India at present, and plans to ramp up the headcount to 3000, next year. “We feel that large cities are very competitive while smaller cities have a lot more candidates who are serious in taking up medical transcription as a full-fledged career,” said Suresh Nair, CEO and MD, Spheris India. Elaborating this aspect, he said that unlike BPOs or call centers, which require good spoken English skills, medical transcription is more knowledge-oriented and needs good grammatical skills. Commenting on the merger with Spheris- the second biggest medical transcription company globally, he said that the move had made HealthScribe a truly global company with access to bigger funds and support for growth. The company has already added 15 new accounts from the Spheris' stable. Nair said that next year, he plans to start a technology development team that would build solutions based on their delivery platform and sell them commercially. Nair also revealed that by end of 2006, Spheris India would look at new areas like medical coding and billing. Spheris' revenues globally are in the region of $200 million. He expects Spheris India to grow at 60% this year. “The medical transcription industry has made a comeback in India and US customers are sending more and more work to us,” he said.

CBay Systems Makes Deloitte’s List of 500 Fastest Growing [2005-10-20]
CBay Systems Makes Deloitte’s List of 500 Fastest Growing Technology Companies in North America Maryland Fast 50 Rapid Growth Recognized for the Second Year in a Row CBay Systems, a leading provider of healthcare business process outsourcing (BPO) services and the largest provider of Indian transcription technology and services to the US healthcare market today announced that it was again named to the Deloitte Technology Fast 500. The ranking measures the 500 fastest growing technology companies in North America, based on percentage revenue growth over the past five years, during which CBay Systems grew 779 percent. CBay addresses various issues in the healthcare space, primarily focusing on medical transcription. The company’s HIPAA-compliant solutions leverage Internet technologies to provide integrated dictation capture, transcription and web-based document management services to hospitals, clinics and doctors. Making the Deloitte Technology Fast 500 for the second year in a row is commendable in today’s highly competitive technology industry, said Tony Kern, deputy national managing principal of Deloitte’s Technology, Media Telecommunications industry practice. “Achieving sustained revenue growth of 779 percent over five years is a tremendous achievement. We congratulate CBay Systems on being one of the 500 fastest growing technology companies in North America. Inclusion on the nation-wide Fast 500 list follows CBay’s recent acknowledgement as a member of the Deloitte Technology Fast 50 in Maryland. This list highlights the 50 fastest growing technology companies in the state of Maryland for 2005. CBay’s Chairman CEO, Raman Kumar said, “It is an honor for CBay to be recognized for the second year in a row, but we are especially proud of these awards, as they communicate our explosive growth and ever-increasing customer base, providing concrete evidence of our superior product and commitment to customer service.” He also added, “We have 41 centers in our network in India, employing over 5000 people and the number is increasing every month, to cater to our expanding customer base in the US.” Fast 500 Selection and Qualifications The Fast 500 list is compiled from Deloitte’s 15 regional North American Fast 50 lists, nominations submitted directly to the Fast 500, and public company database research. Entrants must be headquartered in North America and must be a “technology company,” defined as a company that owns proprietary technology that contributes to a significant portion of the company's operating revenues; or devotes a significant proportion of revenues to the research and development of technology. Using other companies' technology in a unique way does not qualify. About CBay CBay Systems is a leading provider of healthcare technology and business process outsourcing (BPO) services and the largest global provider of transcription services to the healthcare industry. CBay’s more than 5,000 highly trained medical language specialists and customer service professionals spread out in 41 production centers situated across 10 states in India serve 650+ health systems, hospitals, clinics and physician practices 24 hours a day, 365 days a year, using HIPAA compliant web-based technologies with a commitment to the highest standards of quality, service and value. CBay is headquartered in Annapolis, Maryland with the Indian corporate office in Mumbai. For more information, visit www.cbaysystems.com. About Deloitte Deloitte refers to one or more of Deloitte Touche Tohmatsu, a Swiss Verein, its member firms and their respective subsidiaries and affiliates. In the US, services are provided by the subsidiaries of Deloitte Touche USA LLP (Deloitte Touche LLP, Deloitte Consulting LLP, Deloitte Financial Advisory Services LLP, Deloitte Tax LLP and their subsidiaries), and not by Deloitte Touche USA LLP

Spheris Hiring more workers in India [2005-10-11]
Spheris says it is hiring more workers in India Media Release Oct. 6, 2005 An American company that transcribes doctors notes said Wednesday it is setting up a transcription center in the southern Indian city of Coimbatore, making it the latest U.S. company to expand outside India's traditional outsourcing hubs. Spheris Inc. of Franklin, Tennessee, has already hired 300 people for its new center in Coimbatore, in India's southern Tamil Nadu state, and plans to add another 700 workers in the next year, the company's president and chief executive, Steven E. Simpson, told reporters. Workers at the Coimbatore office transcribe taped dictation of U.S. doctors'' diagnosis and advice for patients, saving the physicians time and allowing them to treat more people. Spheris already employs 2,000 people doing the same work in the southern city of Bangalore _ one of the hubs of India's outsourcing business _ but decided to expand to Coimbatore because of the city's large untapped pool of skilled workers, he said. The city has a strong foundation in education and is inexpensive, he said of Coimbatore, a city of one million people 360 kilometers (224 miles) south of Bangalore. Western firms have sought to cut costs by farming out software development, engineering design and routine office work to India. But the influx of Western firms has led to labor shortages and rising wages in larger cities that have become centers for the outsourcing business, such as Bangalore and Hyderabad. In contrast, wages in smaller cities have not risen nearly as fast and are now about 30 percent lower than in traditional outsourcing hubs. Among the companies that have chosen to set up operations lesser-known Indian cities are Honeywell International Inc., which has an office in the southern city of Madurai, and IBM Corp., which has built a facility in the western city of Calcutta.

Spheris Helps Employees Displaced by Katrina [2005-10-01]
NASHVILLE, TN–Spheris, a global provider of medical transcription services and technology, is reaching out to help its more than 100 employees who were affected by Hurricane Katrina. Spheris employs more than 5,000 professional MTs, most of whom work from their homes, and had more than 170 employees located in the devastated gulf states of Louisiana, Mississippi and Alabama. “It took some time, but I am happy to say we have been able to locate all of our employees,” said Spheris CEO and President Steven E. Simpson. “Through the efforts of our employee relations specialists, we were able to determine that all of our colleagues escaped serious physical harm. Nevertheless, 21 Spheris employees have potentially lost their homes and all their possessions; 15 are in their homes, but are not able to work because of lost utilities; and several employees have relocated and been able to resume work.” According to Simpson, Spheris is currently assisting with additional relocation efforts of other employees unable to return to their homes. On Tuesday, Aug. 30, as the world began realizing the devastation facing millions of Americans, Spheris established a Spheris Employee Relief Effort as a means to provide corporate-sponsored assistance to Spheris employees who experienced a significant hardship directly caused by Hurricane Katrina. Spheris started the fund with the initial contribution and vowed to match a large percentage of Spheris employee contributions. In the days that followed, Spheris saw overwhelming generosity from its employees wanting to help, and in response set up an automated process for Spheris employees to donate their unused Paid Time Off (PTO) and cash contributions through payroll deduction on the Spheris corporate intranet. In addition to using the company intranet, Spheris is sending regular e-mail updates to all its employees and an e-mail address (Naturaldisasterloop@spheris.com) has been established to enhance the company’s ability to communicate and respond to its employees’ needs. To date, Spheris employees have personally donated more than $77,000 in cash and $112,000 in donated hours of PTO for their colleagues in need. And, those donations are already helping numerous Spheris employees. Peggy Stolf, who lives in St. Bernard Parish outside of New Orleans, is a Spheris MT supervisor who is receiving assistance from her employer. “Words cannot express the gratitude my family has for Spheris,” said Stolf. “Through this entire disaster, Spheris became my family's rock that we could cling to, to help us through.” The Stolf family lost its house, all of its possessions and its beloved dog to the devastating flood waters and is now living with family in Augusta, GA. While it would be easy to focus on what she lost, Stolf chooses to focus on what she gained. “Though we did lose a lot, we did gain a renewed faith in humanity and compassion,” said Stolf. “And, I cannot even find the right words to express the kindness and care that Spheris has shown toward me and my family.”

look who wrote the article - an Indian. SM [2005-09-09]
You should send the hospital administrator an anonymous letter and let them know that their records are being sent to India. Spheris just got in trouble for not informing a hospital in California that they were sending the records overseas.

Evergreen+Spheris=India [2005-09-07]
I'm sure everyone noticed in sm's submitted article about India's opportunities for housewives in medical transcription, that one of their work sources is Spheris. Another submit states that Evergreen Hospital is outsourcing to Spheris ---- does Evergreen know their medical records are going to India? Doubt it!!!! PS. The article about India said Stheris -- it's an error -- wonder how many of these errors show up in transcribed reports. Hmmmm

Transcend and MDI Founder Announce Stock Option Agreement [2005-08-19]
ATLANTA -- Aug. 18, 2005 -- Transcend SERVICES, INC. (Nasdaq SmallCap: TRCR) today announced that a co-founder of Medical Dictation Inc. (MDI), Sue McGrogan, has agreed to invest $200,000 in Transcend as of August 15, 2005 through the purchase of 71,942 shares of common stock. This purchase is part of an overall option agreement that provides four options to purchase $200,000 each that could result in $800,000 of total investment over the next two years. Half of the investment will be in cash and the other half in the forgiveness of a note due to Sue McGrogan from her sale of MDI to Transcend. These purchases will be made at a price of 110% of the average market price for the ten trading days prior to said purchase. The remaining three options are exercisable on the six- month anniversary dates of the execution of the option agreement and cannot be carried forward once the option date has passed. MDI is a transcription company that has been in operation since 1988 in Brooksville, Florida founded by Sue McGrogan and her mother Liz McGrogan. The McGrogans first entered the industry in 1972 as owner-operators of a medical transcription company in New Jersey. MDI recently became a wholly owned subsidiary of Transcend. Both Liz and Sue McGrogan have played an important role in Transcend since the acquisition of MDI by Transcend on January 31, 2005. Liz currently serves as interim general manager at MDI, which has grown from $6.4 million in revenue in 2004 to a current annualized level of over $8 million. Sue is a Business Unit Manager at Transcend, managing a significant portion of Transcend's field operations. Alex Munoz, Transcend's EVP of Operations stated, Having worked closely with Liz and Sue during the integration of our two companies, their level of increased commitment is exciting as we continue to make changes within the company. Liz McGrogan agreed, commenting, We are both very excited about the future of Transcend and MDI, and the potential growth through new business and acquisitions. Sue added, The decision to invest money into Transcend is indicative of our confidence in Transcend and its future.

Seventeen employees will lose their jobs [2005-08-17]
2005-08-16by Lori VaroshJournal Reporter KIRKLAND -- Seventeen employees of Evergreen Hospital Medical Center in Kirkland will lose their jobs, most by Aug. 31, victims of a trend toward outsourcing the work of medical transcriptionists. Spheris, a Franklin, Tenn.-based contract medical transcription company, will begin today to take over the work of typing doctors' dictation into Eastside patients' records, hospital spokeswoman Amy Gepner confirmed Monday. The practice is increasingly common among area hospitals. It provides benefits in expertise and cost savings, supporters say. But critics warn that, without careful safeguards, the practice can put patients at risk. Outsourcing has become the area standard, said Caitlin Hillary, spokeswoman for Overlake Hospital Medical Center in Bellevue, which outsourced its transcriptionists in 1999. Such companies have the expertise and the employee base to handle the peaks and valleys of patient loads, she said. Overlake had been having trouble recruiting transcriptionists before it outsourced those jobs, and the solution has worked well, Hillary said. Job quality is `inferior' But others find outsourcing generally ``is inferior to having long-term, loyal staff,'' said Diane Clark, supervisor of transcription services for the UW Medical Center, which outsources about half of its transcription work. Because they offer lower pay, transcription companies attract people with less experience, Clark said. Those workers have no particular loyalty to the medical center, and no personal investment in the work. And, because they often work on a per-line basis, ``the faster they type, the more money they make,'' which can result in mistakes, Clark said. Nor do physicians always review the transcriptions as they should, she added. If the doctors' notes are not transcribed accurately, ``it could result in patient care issues,'' Clark said. Outsourcing can work if the companies routinely sample the work for accuracy and have a second pair of eyes proof-reading the transcription. Spheris was chosen because of its quality, said Evergreen's Gepner. Physicians at the Kirkland hospital read and sign off on all transcriptions before they go into a patient's medical record, she said. In an April memo to physicians obtained by the Journal, however, medical staff warned that problems are possible during a transition period to the new system. ``There will be a period of time in which the new dictation service will need to adapt to the phraseology and individual traits of our Evergreen physicians; during that time there will be more blanks and errors, so please pay close attention to your dictation for accuracy,'' the memo said. The taxpayer-supported hospital expects to save $400,000 a year over its current costs for transcription services, including salaries and benefits, Gepner said. But the move is also being made because existing transcriptionists cannot keep up with the workload without a $500,000 to $750,000 investment in equipment as well as personnel. ``It doesn't make business sense to be significantly increasing the cost,'' Gepner said. The hospital's administration proposed outsourcing and the hospital district's commissioners approved because it was ``best for patient safety,'' Gepner said. ``What we need to do is get (the information) as fast as we can in the patient record,'' she said. Spheris already is capable of working with the new patient records system Evergreen added two years ago, she said. The contract with Spheris also requires that no work be sent out of the country and that all 17 Evergreen transcriptionists be offered jobs, Gepner said. ``Three have chosen to go with Spheris,'' she said. The company has taken out ads in local newspapers seeking more transcriptionists. Some employees complain, however, that the contractor is simply not offering a living wage. Spheris offered 7.5 cents per line, said one transcriptionist, who asked for anonymity for fear that a ``measly'' severance package would be withdrawn. An average Spheris worker would make less than two-thirds that of an Evergreen employee, according to the figures the Transcriptionist provided. Evergreen transcriptionists earn $13.50 to $19.62 per hour, plus a 7-cent per line bonus for more than 938 lines a day. At a consistent day's work of 1,200 lines, the midrange Evergreen employee would earn $150 a day, compared to $90 for the Spheris worker. ``I have to pay a mortgage, pay bills,'' the transcriptionist said. ``I can't live on that kind of wage. ... I'd just be giving my expertise away.'' In a letter to the hospital district's Board of Commissioners in June, transcriptionists complained that they learned by e-mail that their jobs would vanish and that the severance package offered is ``insulting.'' Evergreen didn't want to provide as long a period of extended health care for laid-off workers as the standard set by Overlake and Group Health hospitals, explained Carter Wright, spokesman for SEIU, the health-care workers union. ``Evergreen is not only getting rid of jobs, they're trying to do it on the cheap,'' Wright said. ``There's concern about cutting down errors in hospitals and streamlining medical records,'' he said, ``but it's really important to make sure the information is accurate. Accuracy can literally be a matter of life and death.'' In the June letter, transcriptionists urged commissioners ``to look at the human cost of your actions. We are not only employees of this hospital, we are members of this community, a community that you have sworn to represent.'' The hospital that touts its role as the biggest employer in Kirkland is sending Kirkland jobs elsewhere and dumping employees into the pool of 600,000 state residents without health insurance, a transcriptionist complained. Outsourcing is best for patient safety, Gepner said. ``We're putting patient safety concerns over public relations concerns.'' Lori Varosh can be reached at lori.varosh@kingcountyjournal.com or 425-453-4234.

Spheris storms up health care [2005-08-15]
Spheris purchase of Avicis/HealthScribe helped push the company into the top 30 of the nation's health care technology businesses, while Passport Health Communications cracked the top 100. The 12th annual Healthcare Informatics 100 placed Spheris, a medical transcription firm, as the 28th largest health care IT firm with $152.7 million in revenue last year. Officials at the Franklin-based company, which last year bought industry rival Avicis/HealthScribe for $75 million, expect revenue this year to top $200 million. That deal helped push revenue last year up 41 percent, the seventh largest increase in the health care IT market. Further down the list, Healthcare Management Systems slipped from 60th to 66th place last year despite revenue rising slightly to $34.5 million last year. In addition, Passport joined the top 100 list at No. 92 as revenue increased from $13.1 million to $19.2 million in 2004. The Franklin company provides health care insurance eligibility and benefits information online for hospitals and physicians. Earlier this year Passport bought software developer Healthworks Alliance Inc., which allows health care providers to identify and eliminate denied insurance claims and write-offs. In all, the 100 companies represented $24 billion in IT products and services, according to the June report.

MedQuist Announces Key Findings of Independent Review [2005-08-05]
MedQuist Announces Key Findings of Independent Review of Client Billing MT. LAUREL, N.J., July 30 /PRNewswire-FirstCall/ -- MedQuist Inc. (MEDQ.PK), a leading provider of electronic medical transcription, health information and document management services, today announced the key findings of an independent review of the company's billing methods. The findings were presented to the company's Board of Directors, which initiated a broad program of changes and reforms to the company's business practices. The Board of Directors also took disciplinary action against certain company employees. The Board of Directors announced today changes in its senior management. Howard S. Hoffmann, an experienced and accomplished interim manager, has been appointed as MedQuist's interim CEO with a clear mission to implement the changes and reforms to the company's business practices, including its billing practices, and to bring the company current in its SEC filings. Steve Rusckowski, who had temporarily assumed the CEO position in December 2003 in addition to his Board position and led the company through the difficult period of the independent review, will continue as a member of the MedQuist Board. The Board also announced that it has accepted the resignations of its Chief Financial Officer, Brian Kearns, and its Chief Legal Officer, John Suender. This was an extremely thorough and comprehensive review that has clearly identified areas in which we must make changes and improvements, said Scott Weisenhoff, the lead Director on the review. Added Howard S. Hoffmann, who is also a principal and partner at Nightingale Associates, LLC, of Stamford, CT.: Our priority mission now is to work with our customers to clarify and, where appropriate, rectify any problems, make the needed changes and reforms internally, and become current in our SEC filings. The changes we are making address a pressing industry challenge and our goal is to ensure that billing methods are reliable, accurate, measurable and verifiable to customers using transcription services. We hope that our actions will encourage other medical transcription companies to address the challenge presented by AAMT line-based billing methods. Review Findings The review, conducted for the Board of Directors by Debevoise Plimpton LLP and PricewaterhouseCoopers LLP, identified a number of issues regarding the company's billing practices. The review found that with respect to its contracts that called for billing based on the AAMT line, the company used ratios and formulas to determine the number of AAMT transcription lines for which clients were billed rather than counting the number of relevant characters to determine a billable line as provided for in the contracts. With respect to these contracts, the company's use of ratios and formulas as a surrogate for counting was generally not disclosed to the clients. In addition, a company employee explained inaccurately to KPMG LLP (KPMG), the company's outside auditors, the computation of AAMT lines on one of the company's major transcription platforms. The use of ratios and formulas caused some clients to be billed more and some to be billed less than if the counting method provided for in the contracts had been used. In addition, the ratios and formulas for certain client accounts were changed by the company, generally without disclosure to clients, in order to affect profit margins. Due to the ambiguities inherent in the AAMT line definition and the limited extent of the information available to the company for earlier periods, the company is unable at this time to determine with any reasonable certainty the aggregate amount of overbilling. The AAMT line definition was originally developed in the early 1990s by three major medical transcription industry groups, including The American Association for Medical Transcription (AAMT). They defined a line as 65 characters and also defined the term character to include such things as macros and function keys. However, these definitions turned out to be inherently ambiguous and difficult to apply in practice. AAMT itself withdrew its endorsement of these units of measure in 1998. However, many buyers of transcription services have continued to purchase transcription services and issue requests-for-proposals that ask for quotes in AAMT line units. The review concluded that the rationale for using the ratios and formulas was to adopt a consistent and commercially reasonable billing method, given the lack of common standards in the industry and the ambiguities inherent in the AAMT definition. The review found no evidence that the amounts MedQuist billed clients, in general, were commercially unfair or inconsistent with what competitors would have charged. Moreover, MedQuist has been able to attract and retain clients in a competitive market. The next step for the company is to assess the financial impact on customers and on MedQuist. When the financial assessment has been finished and KPMG has completed its consideration of the review findings, and pending any additional work KPMG may believe appropriate to do as a result of the findings, MedQuist anticipates that KPMG will then be able to complete its audit of the company's 2003 financial statements and its review of MedQuist's interim quarterly results. Until KPMG's audit and review have been completed, MedQuist will be unable to finalize its financial statements and file its Form 10-K for the year ended December 31, 2003 and its Form 10-Q for the quarter ended March 31, 2004. The company also will likely not be able to file its Form 10-Q for the quarter ended June 30, 2004 in a timely manner. Because the company has not yet completed its financial assessment and the results have not been reviewed by KPMG, MedQuist is unable at this time to estimate with any reasonable certainty the effect that the review of its billing practices may have on its reported revenues, results of operations and financial position. MedQuist has also been informed by the staff of the Securities and Exchange Commission that the SEC has opened a formal investigation of the company. The company will continue its efforts to cooperate with the SEC, as it has since it voluntarily advised the SEC of the company's review of its billing methods. Business Practice Reforms and Management Changes The Board of Directors has outlined a broad program of business practice changes and reforms that will be instituted beginning immediately. Highlights include: * Enhance a mandatory and formal ethics training program that was recently instituted. * Accelerate an existing program that is migrating clients from several disparate legacy billing platforms to the company's new platform, DocQment Enterprise Platform, or DEP. The company intends to utilize only consistent, client-verifiable billing units of measure. Additionally, the company will meet with clients currently billed on the basis of an AAMT line definition to determine an alternate and verifiable unit of measure acceptable to the client pending their agreement to convert to the new platform. MedQuist has succeeded in converting approximately 35% of its transcription revenue to DEP. * Develop definitive and clear protocols for count methodology and billing, institute periodic internal audits and new reporting mechanisms to make sure all billing systems are in accordance with client contracts. * Reform the contract review and administration process to clarify any ambiguous terms with respect to units of billing, and develop a centralized contracts administration database to track compliance with client contracts. * Expand the customer feedback system to allow entry, by any employee, of customer comments and complaints. * Assign a Chief Compliance Officer to develop, maintain and enforce compliance with all company policies and procedures. The Board also took disciplinary action against five MedQuist employees. Said Gregory Sebasky, MedQuist's President: We believe that we have done what is necessary and appropriate in light of the results of the review. We will continue to build a strong and motivated organization and continue MedQuist's commitment to a high standard of ethics and customer satisfaction. Statements in this press release that are not historical facts are forward-looking statements within the meaning of the securities laws and regulations. These include statements regarding becoming current in SEC filings, solidifying relationships with our customers and any other expectations or anticipated events. These forward-looking statements involve a number of risks and uncertainties that could cause actual results to differ materially.

Electronic Health Records: Just around the Corner? Or over the Cliff? [2005-08-02]
We recently implemented a full-featured electronic health record in our independent, 4-internist, community-based practice of general internal medicine. We encountered various challenges, some unexpected, in moving from paper to computer. This article describes the effects that use of electronic health records has had on our finances, work flow, and office environment. Its financial impact is not clearly positive; work flows were substantially disrupted; and the quality of the office environment initially deteriorated greatly for staff, physicians, and patients. That said, none of us would go back to paper health records, and all of us find that the technology helps us to better meet patient expectations, expedites many tedious work processes (such as prescription writing and creation of chart notes), and creates new ways in which we can improve the health of our patients. Five broad issues must be addressed to promote successful implementation of electronic health records in a small office: financing; interoperability, standardization, and connectivity of clinical information systems; help with redesign of work flow; technical support and training; and help with change management. We hope that sharing our experience can better prepare others who plan to implement electronic health records and inform policymakers on the strategies needed for success in the small practice environment. Policymakers and physician leaders are counting on electronic health records to improve quality of health care and revitalize practice , and a recent report forecasts that widespread use of electronic health records will save the health care system $77.8 billion annually—5% of total health care expenditures in the United States. It is difficult to get an accurate figure for use of electronic health records by primary care physicians, but estimates range from 5% to 13%. Seventy-eight percent of physicians in the United States practice in groups of 8 or fewer; therefore, understanding and overcoming the obstacles faced by small practices will be essential to successful use of electronic health records. Although the experience of small physician practices that implemented electronic health records has been usefully described, more work is needed. Our independent, community-based, 4-internist primary care medical practice went live with an electronic health record system on 14 July 2004. We report on our experience. Our medical practice, Greenhouse Internists, has operated in Philadelphia since 1989. We serve an economically and ethnically diverse urban and suburban population. We derive approximately 60% of our revenue from capitated managed care and participate in Medicaid (through 2 Medicaid health maintenance organizations) and Medicare (fee-for-service and capitated managed care). We handle more than 16 000 patients encounters yearly, and our focus is comprehensive ambulatory care. We have 1 registered nurse who handles clinical and administrative contact with insurers, forms, telephone triage, and routine prescription refills; a front desk staff that handles reception, referrals, and telephone calls; and medical assistants who handle chief symptoms, vital signs, phlebotomy, and electrocardiography. We have no mid-level practitioners. Before we instituted electronic health records, we used computers for scheduling and billing only. When our malpractice carrier stopped offering occurrence coverage and we had to accept claims made coverage, we used the 2-year savings window to invest in an electronic health records system. Our motivation was complex: We hoped it would automate frustrating repetitive processes (such as prescription refills) and minimize some of the ways in which we routinely failed to meet patient expectations (such as one of us not knowing what another had said the previous day to a patient on the telephone). We hoped that the system might pay for itself, but we were not at all confident that it would. We made a leap of faith that pay for performance was coming and that this investment would eventually position us for greater success. Like many of our colleagues, we believed that we would have to implement an electronic health record system sooner or later, and the one-time cash surplus made it possible for us to do so sooner. One of us had experience in managed care and population health and was hoping to use those insights at the practice level. We chose our system on the basis of recommendations of colleagues and because it was offered by a large national company. We hoped that the latter attribute would make it more likely that we could count on long-term support. We did not interview multiple vendors because we believed that all full-featured products would have unanticipated advantages and disadvantages. To support our electronic health records system, we needed to change the practice management system that was in place for scheduling and billing. To minimize the impact on physician–patient interaction, we opted for an encrypted wireless network with Tablet personal computers (Hewlett Packard, Palo Alto, California), which we purchased from a different vendor. None of the physicians was especially computer-literate. The total quoted cost of our system, including hardware, software, training, and 1 year of support, was approximately $140 000, which is within the range that other investigators have reported on a cost-per-physician basis. Staff and Physician Training Training meant different things to different team members. None of the physicians had previously used a Tablet PC with a Windows XP operating system (Microsoft Corp., Redmond, Washington), and we needed training on the device as well as on the new system. Some staff members had never used a mouse (our previous practice management system was not Windows-based). The medical assistants, who had previously made notes by hand, were now asked to use wireless-equipped laptops with mouse pads or track-ball pointers. For the system itself, 2 types of training were given. Super users were taught how to set up and administer the record (and therefore were enabled to make some structural changes to the system). Regular users were trained in basic system operation but were not given administrative training and privileges to make changes to the system. Super users were charged with customizing the system for our particular practice environment and developing work flows, which were clearly defined and documented steps to guide everyone on how to use the new system to accomplish the work of the office. After 2 rounds of planning meetings and 2 days of on-site training, we went live, meaning that we committed to using our electronic health record to document clinical care from that time forward. Training requires organizational redundancy or reserve; in a busy physician practice, neither is present. Our business manager incurred an injury that kept her out of work for 1 month before we went live; during that month, much of our focus became covering her core functions (payroll, billing, scheduling, and staff management) rather than training. For the first 3 days of live operation, we reduced our appointment schedule by 50%; thereafter, we attempted to maintain our schedule at two thirds for 2 weeks, but ongoing demand for appointments made this impossible. Hardware and Performance We had put in place a complex computer network that none of us knew how to support, maintain, or operate. Shortly after we implemented the practice management system, we experienced a virus attack that crashed our system. After the virus was removed, we experienced several lengthy losses of both telephone and data service. Identifying the cause of each of these system failures was a diagnostic problem well beyond our skills, with several possible corporate culprits. Before we went live, we had had a limited, inexpensive relationship with a small local computer support company; because we were paying annual support fees to both hardware and software vendors, we thought we would not need these local services after implementation. We were wrong. In fact, our relationship with the local company expanded rapidly in time, importance, and cost after implementation. Because we now rely on our system for core clinical functions (prescriptions, telephone calls, and accessing records), small technical malfunctions create major operational problems. Our expanded relationship with the local computer company now costs an unbudgeted $2000 per month, and the response time of our technical support is often inadequate. Redesign of Office Work Flow A well-run primary care office is a complex interdependent operation with well-defined work flows. General principles that guide the design of work flows in our office include simplicity and accessibility for patients, safety, comprehensive documentation, and delegation. We operate under the assumption that the physician is the most skilled, and most expensive, person in the office and should only do what no one other than a physician could do. Our entire office meets monthly for 1 hour, and weekly meetings of staff teams are held to adjust work flows as conditions or demands change. Responding to a request for a prescription refill, for example, requires 3 or 4 people performing interrelated but distinct tasks to deliver it safely, reliably, and promptly; we average 30 to 40 such requests daily. The collective integrated operation of our office thus represents 15 years of weekly and monthly staff meetings that constructed our functional systems piece by piece over time. On 14 July 2004, we had to redesign every office system we had in place. Our commitment that going live would mean that documentation of clinical care on or after that date would be created and found in the electronic health record seemed simple, but clinical care included not only office visits but telephone calls, prescription refills, handling of laboratory results, and other functions. Each of these tasks had a work flow, and all work flows had to be redesigned more or less simultaneously. A clear go-live date was desirable because, as a matter of patient safety, we needed to know where to look for information, and the longer we ran parallel paper and electronic systems, the harder that would be. The process of radically redesigning 15 years of accumulated work flow in a short interval was extremely stressful. The system we chose is designed for flexible application in a variety of settings, ranging from large integrated delivery systems to smaller practices. Although the vendor urged us to think through and document the new work flows in advance, we found ourselves making innumerable decisions about how we would use the system before we really understood how it worked, and our vendor did not know enough about how our office worked to help us. We were forced rapidly to adjust our work flows during implementation, which seemed akin to redesigning an airplane in flight. Decreased Competence and Increased Effort Going live rendered everyone in the office incompetent to do their core jobs. The front desk had to use new on-screen forms to record telephone messages; pairing electronic messages with paper charts required the file clerks to follow a new work flow; physicians had to find telephone messages on their computer desktop rather than neatly piled in a physical telephone message bin. The medical assistants had to record vital signs and chief symptoms in the computer and had to learn how to record results of a tuberculosis skin test, visual acuity test, or urinalysis. Everyone in the office simultaneously experienced pervasive anxiety and unhappiness. Waiting time for patients dramatically increased. In short, people were miserable at work. We began to have weekly full staff meetings and weekly physician meetings, all of which were more acrimonious than they had ever been. Variations in clinical style and work flow among the physicians—which had seemed acceptable if unnoticed before—now became a subject of group scrutiny. What did we have to change, and what could we hang on to? What did the physicians have to do the same way, and where could we tolerate difference? All these issues had to be renegotiated at a time of enormous stress on the practice. We observed that a culture of blame set in: Things were not going well, and it had to be someone's fault. Several staff members complained that the work environment was less collegial, and they often felt criticized, as one put it, by everyone. They did not associate these feelings with the electronic health record and, at least initially, neither did we. Coincident with our shared frustration came a dramatic increase in workload, especially for the physicians. Even when we had reached the point where we could competently use the new system, every patient represented a new patient to the electronic health record, and the old paper chart had to be abstracted and data moved into the electronic chart. Some aspects of chart abstraction could perhaps have been delegated (for example, entering medication lists or immunization histories), but we worried that our staff—who have only limited clinical training—might make mistakes, and decisions about what data to abstract require the clinical judgment of a physician. At first, the system shut down daily at midnight for backup and maintenance; backup was later moved to 2:00 a.m. to accommodate 2 of the doctors who were trying to work from home in the evening. The stress level in our office remained high for about 3 months, by which time we had seen most of our complex patients and entered their long medication and problem lists into the system. We had now begun to realize some of the benefits of computerization, including computer-generated prescriptions, faster access to specialist correspondence, real-time access to charts anywhere in the office, the ability to message or route information and tasks electronically in the office, and the ability for the same chart to appear on multiple desktops. Within 4 to 6 months, waiting time had improved and staff were more excited and confident. Patient Acceptance Patients have been impressed and pleased to see their prescriptions appearing on wireless-enabled printers sitting unconnected to our Tablets. They have also enthusiastically benefited from occasional use of the Internet or such tools as the National Cholesterol Education Program Risk Calculator during their visit. Some patients, however, found the increased waiting time during the early phase of implementation unacceptable, and many left our practice because of it. At a time when everyone in the office was stressed, our customer service skills were not at their best. Several patients have asked a version of a question posed by a supportive, long-established patient: Doctor, do you find you are spending more time interacting with the computer than with your patients? For a while, the answer was clearly yes. Financial Impact Our total annual budget for technology support before implementation was approximately $10 000, which comprised maintenance and support of our previous practice management system and limited network. Our postimplementation annual budget will be $40 000, which includes annual support payments to hardware and software vendors and our local computer support vendor. We will have $24 000 in annual carrying costs for the financing of our system purchase over the next 5 years. The clearest savings we have seen was from the elimination of $45 000 in annual transcription costs. Although the file clerks no longer do filing, they now scan and name correspondence (see the following description), and we have been able to eliminate only 1 staff position for an additional annual savings of $20 000. We expect savings on chart supplies to be offset by increased costs of toner and printer maintenance, technical support, and replacement of equipment. At best, we see the expense side as a wash. On the revenue side, we accrue no additional revenue from any current payer for having an electronic health record. We had already maxed out on most quality incentives for which we were eligible when we were using well-organized paper charts and office systems. The electronic health record may enable us to see more patients in the same time or offload physician work more reliably and safely because the system provides clear, timely, legible documentation to support expanded clinical team activities, but this reallocation will require substantial staff retraining. Within 1 year of implementation, we expect to free up our current file room space and perhaps make it clinically productive and revenue-generating. As an offset to these potential gains, it is possible (although unlikely) that physicians will be less productive because the electronic health record generates more work for them. For example, whereas the physicians used to dictate notes, they must now type them. Physicians must also participate more in filing. Our electronic system offers us 24 document types (for example, consultation or laboratory report), and each document must be assigned a type and given a name. Because accurate labeling and data entry are essential both to take advantage of the information retrieval capability of the system and to find anything once it is filed, the physicians must oversee and modify the categorization and manual input of key data elements. As a result, we often feel like data input drones. No wonder one of us described the new work flow as a physician speed-up. Computerization in a world without established standards that link medical data systems is inefficient. When we have a working interface, as we do with our main outside clinical laboratory (which handles about 80% of our laboratory testing volume), the reports come named, and the individual laboratory results automatically populate flow sheets and letters to patients. Results can be efficiently retrieved and graphed, and trends can be analyzed. Unfortunately, most of the information we receive (such as radiology reports, consultations, and procedure reports) does not come to us in a format that the system can recognize electronically. Our colleagues in integrated delivery systems and the Veterans Administration do not face this problem because most of their clinical data are generated within their system and the interfaces already exist. National standards on the interoperability of medical data systems would be a big step forward for small practices. For now, we may switch referral patterns to hospitals and specialists who will give us information in a form that flows most easily into our system. Lessons Learned It is naive to assume that small practices will move to electronic health records without a variety of supports, one of which is certainly financing. None of the many beneficiaries of our investment—patients, insurance companies, our specialist colleagues, health plans, our liability carrier—have directly shared in the cost of implementing an electronic health record system. Enhanced reimbursement models will be needed for wider adoption. This could be achieved through performance incentives tied to implementation of such systems in capitated contracts or through a common procedural terminology code for data transfer to reflect the one-time increased effort and cost of moving data from paper to electronic format. A recent report estimates incentives of $12 000 to $24 000 per full-time physician per year would be needed to make the business case for immediate adoption of electronic health records, with those incentives transferring to performance-based incentives over time. Any of these incentive models would work for us and make adoption easier in other small practices. Although some predict that vendors will shift their focus to the small practice market, it is difficult to see how vendors will support implementation of an electronic health record in the small practice setting while keeping prices affordable. Small practices need much more training and support from vendors than do large groups. The support provided by our large national vendor presupposed the existence of dedicated information technology staff and an administrative layer that could plan work flow and train staff. Neither of these infrastructures are present in a small office, and both are critical to success. In addition, small practices need structured assistance to develop their capacity to manage organizational change. Models of shared local training and support must be developed if small offices are to be successful in implementation. Perhaps the most important asset we could have used to ease the pain of implementation was more clinical capacity. A decline in productivity after implementation of an electronic health record seems inevitable, and if a practice is already straining to meet patient demand, an absence of reserve magnifies the stress of implementation. For us, the financial stress of acquiring the electronic health record precluded simultaneous addition of a new mid-level practitioner or physician, which argues even more strongly for the need for financial support. Patients want and expect their physician, especially their primary care physician, to have a comprehensive grasp of what is going on with them medically and to be able to respond to such questions as, How much weight have I lost? or What was my cholesterol level last time? Clearly, aggregating comprehensive clinical information at the point of care is a basic function of excellent primary care. Why is it that every academic health center and hospital acquires state-of-the-art cardiac imaging tools promptly, but primary care offices and residency training programs are still using paper records? Given their experience with other customer service operations, such as retail, banking, or travel, patients assume a level of information technology infrastructure that most of us in health care simply do not have. Unsupported by technologies now taken for granted almost everywhere else, we in health care regularly fail to meet basic patient expectations. A major factor that prompted us to adopt an electronic health record was the hope, now at least partially fulfilled, that it would improve our ability to meet patient expectations and improve our job satisfaction. Despite the difficulties and expense of implementing the electronic health record, none of us would go back to paper. We find ourselves able to be better physicians: We communicate more quickly and clearly with patients on the telephone and by letter, transmit important clinical information (albeit on paper produced automatically by our system) more efficiently to specialists, and spend less time paging through charts to find out what the previous cholesterol values (for example) had been. Practicing with a computer in hand allows us to access current health information for ourselves and our patients without having to leave the room or interrupt the flow of a patient encounter. We have already caught a glimpse of population health possibilities when, on the same day as the withdrawal of valdecoxib from the market, we were able to identify and send letters about the withdrawal to the 16 patients in our practice who were taking the drug. We expect soon to produce a list of patients with diabetes so that we can audit their care and see how well we meet our care standards. We also plan to use our electronic health record to provide each of these patients with an individualized report on services for which they appear to be overdue. If the United States is to realize the benefits of information technology in health care, substantial investments will be needed to shepherd small offices through what is an arduous process. We believe that many practices will examine the current environment and defer a decision to adopt an electronic health record, and given our experience, it would be hard to disagree with them. All the hoped-for benefits to the overall delivery system and to patients will only accrue if small offices, which are the access points to health care for most patients in the United States, successfully adopt information technology. We believe that new models are urgently needed to deliver both financial and administrative support to those who would accept the challenge. Author and Article Information From Greenhouse Internists, P.C., Philadelphia, Pennsylvania. Acknowledgments: The authors thank their office staff for their courage, flexibility, and support throughout this project. Without their willingness to try something new, implementation of the electronic health record would not have been successful. They also thank business manager Debbie Preite for her leadership and willingness to learn more about computers than she ever thought she could, or wanted. Finally, they thank Cheryl Norvell for manuscript assistance and Steve Downs, Holly Humphrey, and David Reuben for their encouragement and review of an earlier draft of the manuscript. Potential Financial Conflicts of Interest: None disclosed. Requests for Single Reprints: Richard J. Baron, MD, Greenhouse Internists, P.C., 345 East Mt. Airy Avenue, Philadelphia, PA 19119; e-mail, rbaron@greenhouseinternists.com .