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Google to test pilot storing patient health records.... [2008-02-21]
I read this article on the Fox News page this morning. A worthwhile read for all interested -
http://www.foxnews.com/story/0,2933,331613,00.html
Electronic Health Records [2007-12-25]
I think it is just another Bush/corporate medical conspiracy to make transcriptionists do more for less, since hospitals and physicians seem to expect even quicker turnaround time with the advent of electronic records. MTs will soon be working for minium wage if something isn't done. Coding may not be safe, either.
Very interesting [2007-07-21]
article. We are just in the beginning phase of going electronic at my place of employment. I think it is a pain in the butt, especially when we have those in authority who have no idea what they are doing. We have records stored everywhere currently. We have some as hard copy in charts, some in a program called Ecet, and others just floating around. It is totally chaotic.
Electronic Health Records on MSNBC--interesting article [2007-07-20]
Ifound this pretty interesting. Thought I would share with all of you. If you have already seen the article, sorry for the duplication.
Electronic health records don FONT-FAMILY: Arial>Electronic health records -- touted by policymakers as a way to improve the quality of health care -- failed to boost care delivered in routine doctor visits, U.S. researchers said on Monday.
http://www.msnbc.msn.com/id/19684970/from/ET/
Interesting, indeed, do you think that is why she left MQ? [2007-07-15]
It says she worked for them until recently. Also says she is very active as an advocate for veterans and more recently in fighting the cause against US companies that outsource American jobs to foreign countries. Hmmmm
I'd never read this article from May, [2007-07-06]
but had just heard about it. There are some very important details given about this company.
Transcend Services records Q1 profit [2006-04-20]
The Atlanta-based medical transcription technology company (NASDAQ: TRCR) had net income of $150,000 on $8 million in revenue, compared with net income of $12,000 on $5.3 million in revenue in the first quarter of 2005. Earnings were 2 cents a share, compared with break-even earnings in the first quarter of 2005.
The nearly $3 million increase in revenue is attributable to the acquisition of Medical Dictation Inc. in January 2005.
We are pleased to return to profitability after a difficult year in 2005, said Larry Gerdes, president and CEO. I am encouraged by both the improvement in our gross profit as a percentage of revenue and the results of our expense control initiatives. To grow our revenue 51 percent with only a 4 percent increase in other operating expenses shows that we can leverage our relatively fixed overhead costs as we grow.
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.
Court records sent abroad [2005-08-25]
Trial and hearing tapes were farmed out to Hong Kong for transcription, in violation of rule
Marion County judicial officials are investigating what appears to be an unprecedented security breach in which workers in Hong Kong prepared hearing and trial transcripts in a yet-to-be-determined number of cases.
The outsourcing of what is supposed to be an in-house court function has alarmed Indianapolis judges because these records often contain sensitive information and are critical for appellate judges to understand what transpired in courtrooms months or years before.
Local officials have informed the Indiana Supreme Court of the breach, and the court, which enforces rules on the handling of court records, is awaiting information from Marion County.
This is prompting a thorough investigation, said Marion Superior Court Judge Jane Magnus-Stinson, a member of the court's three-person executive committee. We're talking about the record that goes up on appeal. If it's wrong, that's big stuff.
She said no judge is believed to have authorized a court employee or court employees to send official trial tapes offshore.
A spokesman for the Virginia-based National Association of Court Reporters said he was unaware of any U.S. court sending transcription work overseas and that the group has tried to determine whether it's going on.
The best-quality transcript is prepared by someone who was present at the proceeding, said Marshall Jorpeland, the national group's communications director. The best-educated English speaker in Hong Kong isn't going to know street slang unless they've moved there from here.
Other concerns include Social Security numbers appearing in transcripts, as well as the names and addresses of crime victims or their family members and sensitive information about employment or income, Jorpeland said.
Marion County's judicial leaders are trying to figure out how much work was sent overseas in violation of a local court requirement that transcriptions be done in-house by county employees to protect against privacy violations -- including identity theft -- and to ensure accuracy.
At least one court reporter has acknowledged some work on major felony cases was sent to a private firm, said Mark Renner, the Marion Superior Court administrator.
Renner declined to release the name of the court reporter or the judge for whom the reporter works. The employee has not been reprimanded but could face disciplinary action, including a possible dismissal.
Renner said the breach occurred after an experienced court reporter hired an Indianapolis transcription firm, Baynes Shirey, which does business as ClearPoint Legal, to prepare transcripts. That work was then outsourced to Scriptero, a Hong Kong company that has more than 50 clients from all over the world that demand at least 4,000 transcripts a year, according to court officials and the company's Web site.
Neither company responded Tuesday to requests for comment.
No one is accusing either firm of wrongdoing. Renner said he intends to send a letter today to Baynes Shirey asking for a complete list of proceedings the firm has transcribed for Marion County's court system.
On its Internet site, Scriptero says it is often hired to transcribe depositions, which usually are closely reviewed for accuracy by participants, and that it uses only native-language transcriptionists. The Hong Kong firm boasts a 99.75 percent accuracy rate, but that's been of little consolation to local officials.
This assignment of transcripts to anyone other than another Superior Court reporter shall cease immediately unless the Judge of your Court gives you express permission to so assign the responsibility of transcription to some outside entity, Renner wrote in an e-mail sent Friday to court officials.
Renner said a Porter County judge notified Marion County officials of the breach last week after hearing about it from a member of the Indiana Shorthand Reporters Association
An e-mail that was ultimately received by the Judge in Porter County from the company in Hong Kong confirmed that they had in fact been doing work from Marion County, including full transcripts from jury trials, Renner told court officials.
Tina DeBone, president of the Indiana reporters association, said she blew the whistle to court officials but did not name any of the firms involved. She said no Porter County judges were involved.
DeBone said she heard about the violation from a court reporter in Arizona who had been approached by the Hong Kong company. DeBone, a victim of identity theft, said she was worried about sensitive information falling into the hands of terrorists who might use it to enter the United States.
Farming out transcription work is in complete violation of the reporter's contract that each reporter signed, Renner said in his e-mail. These contracts, signed with Marion Superior Court, do not provide for hiring private companies to do transcription work.
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.
Telecommuting grows in health care industry [2005-08-06]
August 5, 2005When Rebecca Bryant, a coding specialist for Scottsdale Healthcare, was scheduled for knee replacement surgery last December she asked her employer if she could telecommute during her recovery. She figured it would be temporary until she had regained her ability to walk.
But working from her Chandler home inputting codes used for billing, research and other purposes proved so successful that she and her employer decided to make it permanent.
It is so convenient. I’m saving gas, I’m helping prevent pollution, I’m really doing my thing and getting to enjoy my home, she said.
The company, which operates two hospitals in Scottsdale, has been so happy with the experiment they have expanded it to let five of their coders work from home, and they plan to have 14 coders on line from home full time by September, according to Jan Elezian, coding manager for the health care company.
It is hard to find good coders in the Valley, she said. We looked at retention (of employees) as a really big factor in our decision.
In addition to making employees happier, it also has improved their productivity by up to 20 percent, Elezian said. They don’t have the office distractions.
The expansion of teleworking to include coders comes in addition to about 40 Scottsdale Healthcare transcriptionists, who have typed doctors’ verbal dictation and instructions for patients for many years from their homes.
Health care companies are among a group of businesses that are finding good uses for telecommuting — having employees work from home instead of driving to the office. The concept, also known as telework, can work in industries such as health care, finance and others where some employees spend much of their time inputting data into computers.
One of the business advantages is that it reduces costs by cutting back the amount of office space needed for the staff.
According to a study sponsored by Valley Metro, the transit company that promotes alternatives to the onedriver-per-car transportation, the percentage of Valley employers with more than 50 employees that offer telecommuting as an option increased from 20 percent in 2001 to 28 percent last year.
Part of the reason for the increase is the development of virtual private networks, which are allowing remote computer users to gain secure access to the central computer system.
Cox Communications is providing a managed virtual private network to Scottsdale Healthcare in which Cox manages the router through which Scottsdale Healthcare’s data traffic is channeled as well as technical and support services, eliminating the need for the health care provider to operate the system with its own personnel.
Many companies have virtual private networks, but more companies are migrating to managed VPN, said Darryl Drenon, Cox Arizona director of business services. We become your IT department.
In addition to facilitating work from home, VPNs allow employees to directly access the office computer from hotels on the road or from branch offices, he said.
Another health care company that uses telecommuting is the Mayo Clinic, which allows 118 medical transcriptionists and two quality assurance officers to work from their homes full time. Several other quality and management staffers work from home part time.
The program started about a decade ago when seven transcriptionists were allowed to telecommute only two days a week, said Nancy Buss, manager of the medical transcription department.
As our staff grew, we realized that in order to recruit and retain transcriptionists, we would have to offer telecommuting as an option, she said.
Many companies that offer transcription services offer telecommuting from anywhere in the United States, and the Mayo Clinic had to at least offer telecommuting locally to keep staff, she said.
She said the clinic is considering expansion of the program to allow employees to telecommute from further afield such as from second homes in northern Arizona.
The only major disadvantage is the work-at-home employees don’t get the social connections that come with working with others in an office, she said. But they usually get over that quickly.
Transcriptionists are independent workers, she said. They like their own space and control over their work environment.
Telecommuting doesn’t work for all job categories such as people who deal directly with customers. Bank One has found that it works best for those who are involved in analysis, telephone and computer work, said spokeswoman Mary Jane Rogers.
It depends on the job and how to best serve the customers, she said. Thousands of our employees have direct contact with customers.
Mesa also has found teleworking is better for some jobs than for other, said Kevin Wallace, transportation planning administrator, who oversees the city’s telework program.
For some folks it worked, and for others it didn’t, he said. For some people we thought it would work, but they had meetings and other things that required them to physically be here.
He added the monitoring of employee work is important to make sure the work is getting done from home.
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
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Health Care Associations Judge CyMed as Nation's Top [2005-08-02]
Health Care Associations Judge CyMed as Nation's Top Transcription Service Provider; Representatives from AHIMA, MGMA and AAMT select CyMed for MTIA Beacon Award RICHMOND, Va.--(BUSINESS WIRE)--Aug. 1, 2005--CyMed, Inc. was honored today with the first ever Beacon Award for service excellence and billing clarity by the Medical Transcription Industry Alliance (MTIA). The award was established by the MTIA Billing Methods Principles (BMP) committee to recognize the industry's top outsourced service provider who demonstrates application of the BMP pricing ideals of verifiability, definability, measurability, consistency and integrity. MTIA, which serves the interests of more than 1,000 national competitors, recruited senior executives from the American Health Information Management Association (AHIMA), the Medical Group Management Association (MGMA), and the American Association of Medical Transcriptionists (AAMT) to judge the competition between the market's top vendors.
CyMed's case study and references made the difference, noted Scott Faulkner, MTIA's BMP committee chair and ex-officio member of the judging panel. MTIA is proud to represent an alliance that includes many strong and ethical transcription service providers, but in the end, it's how well you satisfy the interests of the customers that really matters. CyMed came out on top of this year's competition simply because their clients convinced the judges that they earned it.
Although we have received numerous recognitions for our technology and business growth, being selected as the winners of the first Beacon Award is special because many of the evaluation criterions were based on actual client experiences, commented Robert Lynch, CyMed's President and CEO. Since AHIMA, MGMA and AAMT represent our clients and employees respectively; we feel their recognition of us as MTIA's top transcription service provider brings credibility to our Six Sigma approach and confirms our market leadership with respect to customer satisfaction.
About CyMed
CyMed provides economical outsourced medical transcription and records management services through proprietary processes based on Six Sigma quality management principles and applied industry leading technology. Health care providers rely on the company to cost-effectively convert recorded free-form medical dictation into electronically formatted patient records. Headquartered in Richmond, VA, CyMed is a portfolio company of Hagerty Peterson Company, LLC (www.HagertyPeterson.com). For more information on CyMed, visit www.cymedinc.com, email info@cymedinc.com, or call 800-456-8951.
Management? [2008-10-29]
I've been in this a good long while too and hear what you are saying about organizing. Many of us believe there has to be a better way.
Oneparadox in the MT-landthat has always puzzled me in the 10 or so places I worked: Why does any promotion from within a company result in less pay? I am a highly efficient producer of quality, so I have often been targeted for management, proofing, QA type positions, only to need to turn them down when I learn it involves at least a$5/hr pay CUT! I suppose the plus side is not having the pressure of production, but does this mean all the slowest, least efficient producers are in the lead positions? This is one of many things that does not make sense in the MT industry.
How can we sell the value of what we do? What magic PR would work? The bottom line is companies and hospitals need to cut corners, but if we could somehow convince them the corners they are cutting could be patient lives based on documentation errors, that would be key. We all have a stake in the nationwide shortage of MTs currently pegged at 40,000 and HIM supervisors pegged at 10,000.
Yet under current conditions of wages literally staying the same for the past decade despite credentialing, continuing education, and high quality, I think it will take a huge top-down or bottom up approach toenforce nationwide standards that really include MTs at the table.
Part of the problem is way bigger than us--the fragmented nature of healthcare in the US in general, and health documentation specifically. Can you imagine if every hospital, clinic and MT company had the same QA standards? Used the same IT network?Literally every place I have worked has a different system for QA, a different software platform, a different judge of what is adequate.
I am considering education inHIM because I want to: 1)Earn more and collaborate with others to solve problems, 2) Use my years of experience as an MT to benefit other MTs, 3) Not throw the baby out with the bathwater by neglecting years of education and proficiency in order to become a waitress and earn more in tips than I can transcribing my fingers to the bone!
There has to be some value in our collectiveexperience, and I have tried to support AHDI but with the down-spiraling economy, I cannot afford to renew my membership this year and will be paying off my state AHDI convention costs on my credit card for the next year. There has to be a better way!!
BINGO ! [2008-10-27]
You hit the nail on the head! Gutless.
There aremany socially adept, mentally healthyat-home workingMTs who choose towork fromhome forgood reasons; avoiding daycare costs, caring for an elderly parent in the home, disabled and working from homeismore desireable for them, etc.
But a great many at-home MTsI have dealt workfrom homedue toof lack ofhealthy mental self-image, and because theylack good psychologicalhealthas well as thesocial skills that would allow them to interact on a daily basis with an outside group. This type of person suffers from very low self-esteem, self-image issues (often obese), may not play well with others, and consider being bullied over the phone to be the lesser of two evils. In these cases, working alone from home makes their lives a lot less stressful.
Unfortunately for the rest of us, whether at home or in the workplace, this type of person is easily manipulated, belittled, often abused by family members and coworkers, incapable of defending themselves, and scared to death to demand that their right to be treated civilly be honored. They are the first tocave in to intimidation, and when grilled for answers they give way like Jello.They are too frightened to step up and do the right thing, for themselves or others, and they silently refuse to face the confrontation thatcould resultfrom demanding the legal rights of their profession.
The general attitude of this type of personis don't rock the boat and I won't get yelled at, go with the flow to avoid confrontation, and this attitude is fostered bythemany managers that lead by fear and intimidation.
Unfortunately, unless a large group of confident, independent, strong and intelligent young women are recruited into this industry immediately, there will be no union, MTs will continue to cower from management like scared mice, wages will continue tolower (although corporate salaries do not), and as these frightened creatures die off, this industrywill die with them, and because of them.
Go ahead and flame me; I'm fireproof.
IC Taxes [2008-07-28]
Make sure you either get with a good accountant or get a really good tax program (we use TurboTax every year) because as an IC, taxes don't get taken out of your check, but you get to take deductions for everything that you use for your business. If you own your house, you can deduct the square footage of your office space from your mortgage, you can deduct part of your electricity bill, cell phone, internet, any equipment you have to buy, milage if you have to travel for work - the list can go on and on. Just make sure to keep receipts and good records - I got audited my first year as an IC. I passed with flying colors because everything was legit and I had a receipt to back it up. Hope this helps you and good luck!!! =)
If I might add a word or two [2008-07-22]
Make sure you fully understand the rules of being an IC. The number one rule is: The element of control. An IC has it. A service cannot tell you the hours and/or days you have to work, the pay rate, or anything else of that nature. The rules that apply to the service (which is an IC faction) also apply to you.
Here's a web site with the rules: http://www.irs.gov/businesses/small/article/0,,id=99921,00.html
Working as an IC sm [2008-07-20]
I likeworking as an IC more than working as a full time employee....I just do not make good employee material due to my health. Although I really, really need health insurance, I just cannot deal with shift work but I will have to at this point and time in my life. I did just accept a job as an employee, tho, because I am getting older and I have to think about taxes, Medicare, etc.....So, I am praying that it will work out.......as I am determined to MAKE it work.
You can make more money as an IC because taxes aren't taken out, BUT........you do have to put aside monies for paying taxes, etc...and with what most MTSOs are paying these days, the cost of living, the awful state of the economy, it is pretty hard to do that.
Also, MOST companies even dictate a schedule to you anyway, even as an IC, which is wrong on so many levels, and I think we as MTs all know this.
Time to introduce a bill [2008-06-27]
This is great news but from my experience, the bottom line is all most companies care about. The company I worked for never paid for enough quality control hours-usually only one hour per day and outsourced it's MT work. Records came back with incorrect names, gender, diagnoses, procedures and labs because the outsourced Transcriptionist could not flag the work for the dictating doctor (boss said doctors were too busy to deal with it) and/or entered anything just to get the chart to clear medical records. They only dealt with issues when lawsuits arose and my guess would be that since most cases are arbitrated, the doctors were the winners yet again. All this is to say, even if the suits know they will get better quality, they do not care because they are only concerned with lining their pockets.
It is not just MT jobs that suffer because of outsourcing. Will you (or anyone else for that matter)be denied work or insurance in the U.S. because an overseas transcriptionist entered erroneous information in your medical record? U.S. citizens would probably be outraged to discover this is happening to their private information despite HIPPA. I believe it is time to get tough and form a coalition to introduce a bill to end outsourcing of medical transcription. Time to take a stand and fight back.
You're right but ... [2008-04-11]
Yes, absolutely, the suits and middle managers have no clue at all, nada, zip, zilch about medical transcription. However, many doctors actually invest in offshore MT companies .... according to Wall Street Journal. It was, oh, maybe 10 years ago that there was a caption or article about medical transcription being where the money is, as in investments, etc. You're right. Typically the MDs don't know and don't care who transcribes their dictation. Most do care, however, about quality at least to some degree. I'm just glad someone came up with a study as to cost effectiveness for whatever reason. It's like they're thrown us a crumb. Hope we get the whole cookie soon.
This is a skilled trade [2008-04-08]
You know, an apprenticeship is just what we need. Really. I also think we should be paid hourly, and that hourly rate would increase significantly after a year or two of on-the-job training wherever you work. At the very, very least we should get paid as much as coders; and everyone knows they haul it in compared to medical transcriptionists. By the way, the coders rely on what we transcribe. Interesting.
can't find message i left [2008-04-01]
left a quick message for an article I just read and I have no idea where it is. All I can find our these chatty things.??????
Google to test pilot storing patient health records.... [2008-02-21]
I read this article on the Fox News page this morning. A worthwhile read for all interested -
http://www.foxnews.com/story/0,2933,331613,00.html
Electronic Health Records [2007-12-25]
I think it is just another Bush/corporate medical conspiracy to make transcriptionists do more for less, since hospitals and physicians seem to expect even quicker turnaround time with the advent of electronic records. MTs will soon be working for minium wage if something isn't done. Coding may not be safe, either.
your link didn't work - here's the link [2007-11-23]
there was an ET and an apostrophe at the end of your link - would've worked with or without the ET but not the apostrophe *grins*
http://www.msnbc.msn.com/id/19684970
Very interesting [2007-07-21]
article. We are just in the beginning phase of going electronic at my place of employment. I think it is a pain in the butt, especially when we have those in authority who have no idea what they are doing. We have records stored everywhere currently. We have some as hard copy in charts, some in a program called Ecet, and others just floating around. It is totally chaotic.
Electronic Health Records on MSNBC--interesting article [2007-07-20]
Ifound this pretty interesting. Thought I would share with all of you. If you have already seen the article, sorry for the duplication.
Electronic health records don FONT-FAMILY: Arial>Electronic health records -- touted by policymakers as a way to improve the quality of health care -- failed to boost care delivered in routine doctor visits, U.S. researchers said on Monday.
http://www.msnbc.msn.com/id/19684970/from/ET/
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.
MedQuist Announces Unaudited Financial Results, 6 Million in Operating Loss [2006-05-11]
MT. LAUREL, N.J.--(BUSINESS WIRE)--May 11, 2006--MedQuist Inc. (Pink Sheets: MEDQ.PK) announced today certain preliminary, partial and unaudited financial results, and provided updated information regarding previously-announced litigation and governmental investigations and proceedings. Once the Company completes the financial assessment and review of its billing practices disclosed in the Company's previous filings with the SEC, KPMG LLP, the Company's independent registered public accounting firm, will complete the audit the Company's financial statements. The Company is continuing the process of working toward becoming current in its periodic reports pursuant to the Securities Exchange Act of 1934. The Company's review of its current and prior period unaudited financial statements, as well as KPMG LLP's audits for those periods, may identify adjustments or reclassifications which may be reflected in the periods to which they relate. At this time, the Company cannot estimate the total costs of (i) the billing review, (ii) defense of the class action matters, (iii) the SEC investigation, and (iv) compliance with the Department of Justice investigation, all of which have been previously disclosed in either the Company's filings with the SEC or the Company's press releases. Accordingly, the only costs related to the defense of these matters that have been included in the results below are actual costs incurred through March 31, 2006 by the Company. Because the completion of the billing review and resolution of the litigation and governmental investigatory matters are pending, the Company is not certain whether any changes to the accounting treatment of any component of its consolidated financial statements will be required and, if any changes are necessary, whether any such changes would have a material impact on its current or prior period consolidated financial statements. Accordingly, the financial information set forth below is preliminary, unaudited, and subject to change based on the completion of the financial assessment and review of the Company's billing practices, resolution of the class action matters and governmental investigations and proceedings, and the completion of the review and/or audit of its financial statements, as appropriate.
The financial information and related narrative discussion set forth below is derived from the Company's internal books and records. The Company cautions investors not to place undue reliance on the financial information presented below. As a result of the developments described above and in the Company's previous SEC filings, the Company's financial statements have not been audited or reviewed by KPMG LLP, its independent registered public accounting firm. The financial information contained in this press release also has not been audited or reviewed by an independent registered public accounting firm. Such information is not a substitute for the information required to be reported in the Company's Forms 10-K and Forms 10-Q that have not yet been filed. There can be no assurance that the results of the billing review, and resolution of the litigation and governmental investigatory matters will not have a material adverse effect on the Company's revenue, results of operations and financial condition.
Legal Proceedings
Investigations and Proceedings Commenced by the SEC and the Department of Justice
As previously announced, the Securities and Exchange Commission (the SEC) is currently conducting a formal investigation of the Company. The Company will continue to fully cooperate with the SEC.
As previously announced, the Company received an administrative HIPAA subpoena for documents from the United States Attorney's Office for the District of Massachusetts on December 17, 2004. The subpoena sought information primarily about the Company's provision of medical transcription services to governmental and non-governmental customers. The information was requested in connection with a government investigation into whether Medquist and others violated federal laws in connection with the provision of medical transcription services. MedQuist continues to cooperate fully with the Department of Justice.
Shareholder Securities Litigation
As previously announced, a shareholder putative class action lawsuit was filed against the Company in the United States District Court District of New Jersey on November 8, 2004. The action, entitled William Steiner v. MedQuist, Inc., et al., Case No. 1:04-cv-05487-FLW (the Shareholder Putative Action), was filed against the Company and certain former Company officials, purportedly on behalf of an alleged class of all persons who purchased MedQuist common stock during the period from April 23, 2002 through November 2, 2004, inclusive (the Class Period). The complaint specifically alleged that defendants violated federal securities laws by purportedly issuing a series of false and misleading statements to the market throughout the Class Period, which statements allegedly had the effect of artificially inflating the market price of the Company's securities. The complaint asserts claims under Section 10(b) and 20(a) of the Securities Exchange Act of 1934 and Rule 10b-5, thereunder. Named as defendants, in addition to the Company, were its former president and chief executive officer and its former executive vice president and chief financial officer.
On August 16, 2005, a First Amended Complaint in the Shareholder Putative Class Action was filed against the Company in the United States District Court District of New Jersey. The First Amended Complaint named additional defendants, including certain current and former directors, certain former Company officers, the Company's former and current external auditors and Koninklijke Philips Electronics N.V. (Philips). Like the original complaint, the First Amended Complaint asserted claims under Sections 10b and 20(a) of the Securities and Exchange Act of 1934 (the Act) and Rule 10b5 of the Act. The Class Period of the original complaint was expanded 20 months and now includes the period from March 29, 2000 through June 14, 2004. Pursuant to an October 17, 2005 consent order approved by the Court, Lead Plaintiff Greater Pennsylvania Pension Fund filed a Second Amended Complaint on November 15, 2005. The Second Amended Complaint dropped Philips as a defendant, but alleges the same claims and the same purported class period as the First Amended Complaint. Plaintiffs seek unspecified damages. Pursuant to the provisions of the Private Securities Litigation Reform Act, discovery in the action is stayed pending the filing and resolution of the defendants' motions to dismiss, which were filed on January 17, 2006, and will be fully briefed by May 26, 2006. The Court has not set a hearing date on the motions. The Company believes that the claims asserted in the Second Amended Complaint are without merit, and is vigorously defending the action.
Customer Litigation
As previously announced, a putative class action was filed in the United States District Court Central District of California. The action, entitled South Broward Hospital District, dba Memorial Regional Hospital, et al. v. MedQuist, Inc. et al., Case No. CV-04-7520-TJH-VBKx, was filed on September 9, 2004 against the Company and certain present and former Company officials, purportedly on behalf of an alleged class of non-Federal governmental hospitals and medical centers that the complaint claims were wrongfully and fraudulently overcharged for transcription services by defendants based primarily on the Company's use of the AAMT line billing unit of measure discussed below. The complaint charges fraud, violation of the California Business and Professions Code, unjust enrichment, conversion, negligent supervision and violation of the Racketeer Influenced and Corrupt Organizations Act. Plaintiffs seek damages in an unspecified amount, plus costs and interest, an injunction against alleged continuing illegal activities, an accounting, punitive damages and attorneys' fees. Named as defendants, in addition to the Company, were a senior vice president, its former executive vice president of marketing and new business development, its former executive vice president and chief legal officer, and its former executive vice president and chief financial officer.
On December 20, 2004, the Company and individual defendants filed motions to dismiss for lack of personal jurisdiction and improper venue, or in the alternative, to transfer the putative action to the United States District Court District of New Jersey. On February 2, 2005, plaintiffs filed a Second Amended Complaint both adding and deleting named plaintiffs in an attempt to keep the putative action in the United States District Court Central District of California. On March 30, 2005, the United States District Court Central District of California issued an order transferring the putative action to the United States District Court District of New Jersey.
On August 1, 2005, the Company and the individual defendants filed their respective Answers denying the material allegations contained in the Second Amended Complaint. On August 31, 2005, the Company and individual defendants filed motions to dismiss the Second Amended Complaint for failure to state a claim and a motion to dismiss in favor of arbitration, or in the alternative, to stay pending arbitration. On December 12, 2005, the plaintiffs filed an Amendment to the Second Amended Complaint. On December 13, 2005, the Court issued an order requiring plaintiffs to file a Third Amended Complaint.
Plaintiffs filed the Third Amended Complaint on January 4, 2006. The Third Amended Complaint expands the claims made beyond issues arising from contracts based on AAMT line billing and beyond customers billed based on an AAMT line, alleging that the Company engaged in a scheme to inflate customers' invoices without regard to the terms of individual contracts and even in the absence of any written contract. The Third Amended Complaint also limits plaintiffs' claim for fraud in the inducement of the agreement to arbitrate to the three named plaintiffs whose contracts contain an arbitration provision and a subclass of similarly situated customers. On January 20, 2006 the Company and individual defendants filed motions to dismiss the Third Amended Complaint for failure to state a claim and a motion to compel arbitration of all claims by the arbitration subclass and to stay the case in its entirety pending arbitration. On March 8, 2006 the Court held a hearing on these motions, and took the matter under submission. The Court has not yet ruled on the motions. The Company believes that the claims asserted have no merit and intends to vigorously defend the putative action.
Medical Transcriptionist Litigation
Hoffmann Putative Class Action
As previously announced, a putative class action lawsuit was filed against the Company in the United States District Court Northern District of Georgia. The action, entitled Brigitte Hoffmann, et al. v. MedQuist, Inc., et al., Case No. 1:04-CV-3452, was filed with the Court on November 29, 2004 against the Company and certain current and former Company officials, purportedly on behalf of an alleged class of current and former employees and statutory workers of MedQuist, who are or were compensated on a per line basis for medical transcription services (the Class Members) from January 1, 1998 to the time of the filing of the complaint (the Class Period). The complaint specifically alleged that defendants systematically and wrongfully underpaid the Class Members during the Class Period. The complaint asserted the following causes of action: fraud, breach of contract, demand for accounting, quantum meruit, unjust enrichment, conversion, negligence, negligent supervision, and Racketeer Influenced and Corrupt Organizations Act violations. Plaintiffs sought unspecified compensatory damages, punitive damages, disgorgement and restitution. On December 1, 2005, the Hoffmann matter was transferred to the United States District Court District of New Jersey. As discussed immediately below under the heading Myers Putative Class Action, the Company believes that the claims presently asserted have no merit and intends to vigorously defend the putative action.
Myers Putative Class Action
As previously announced, a putative class action entitled, Myers, et al. v. MedQuist Inc. and MedQuist Transcriptions, Ltd., Case No. 05CV 4608 (JBS), was filed against the Company on September 22, 2005 in the United States District Court District of New Jersey. The action was brought on behalf of a putative class of MedQuist's employee and independent contractor transcriptionists who claim that they contracted with the Company to be paid per AAMT line, but were allegedly underpaid due to intentional miscounting of the number of characters and lines transcribed. The named plaintiffs asserted claims for breach of contract, unjust enrichment, and request an accounting.
The allegations contained in the Myers case are substantially similar to those contained in the Hoffmann putative class action and the two actions have now been consolidated. A consolidated amended complaint was filed on January 31, 2006. The named plaintiffs assert claims for breach of contract, breach of the covenant of good faith and fair dealing, unjust enrichment and demand an accounting. On March 7, 2006 the Company filed a motion to dismiss all claims in the consolidated amended complaint. The motion has now been fully briefed. The Court has not set a hearing date on the motion. The Company believes that the claims asserted in the consolidated actions have no merit and intends to vigorously defend the suit.
Derivative Litigation
On October 4, 2005, the Company announced the dismissal with prejudice of a shareholder derivative action filed in United States District Court District of New Jersey. The suit, Rhoda Kanter (Plaintiff) v. Hans M. Barella et al. (Defendants), was filed on November 12, 2004 against Philips and ten current and former members of MedQuist's Board of Directors. MedQuist was named as a nominal defendant.
In a ruling dated September 21, 2005, the Court found Plaintiff's allegations that MedQuist's Board members breached their fiduciary duties to the Company to be insufficient. The Plaintiff had alleged that for a period from 2001 through 2004, the Defendants violated their fiduciary duties by permitting artificial inflation of billing figures; failing to adequately ensure accurate and lawful billing practices; and failing to accurately report the Company's true financial condition in its published financial statements. To the contrary, the Court concluded: Far from alleging facts supporting a substantial likelihood of liability, Plaintiff here has painted a picture of a board of directors that acted responsively given the circumstances . . . . On October 3, 2005, plaintiffs filed a motion for reconsideration of the Court's order dismissing the action with prejudice. On November 16, 2005, the Court denied Plaintiffs' motion for reconsideration. On December 13, 2005, Plaintiffs filed a Notice of Appeal with the United States Court of Appeals for the Third Circuit.
On March 21, 2006, Plaintiff filed her opening brief on appeal. On April 20, 2006, MedQuist and the other defendants filed their opposition briefs. The appeal will be fully briefed by May 4, 2006. The Court of Appeals has not set a hearing date for the appeal.
Customer Accommodations
As previously disclosed, the primary allegations in a number of the litigation matters relate to how the Company interpreted the AAMT line billing unit of measure. The AAMT line billing unit of measure was developed in 1993 through a collaboration among several industry organizations with the intent of providing standardization in industry billing practices. However, due to inherent ambiguities in the definition of this unit of measure not fully anticipated at the time of its introduction, AAMT line-based billing was applied inconsistently throughout the medical transcription industry and eventually renounced by the groups initially responsible for its development. Despite these issues, a number of companies in the industry have continued to use AAMT line-based billing, and some customers still request proposals and contracts based on the AAMT line.
Like many medical transcription service providers, MedQuist once used the AAMT line unit of measure to calculate invoices for many of its medical transcription clients. It has been widely recognized and well documented throughout the industry, however, that the AAMT definition of a line is inherently ambiguous and subject to a wide variety of interpretations. In fact, no single set of AAMT characters was ever defined for this unit of measure. Accordingly, MedQuist began the process in 2004 of transitioning its AAMT line-based customers off the AAMT line unit of measure and, in April 2005, the Company completely eliminated the use of the AAMT line for billing and called on other industry transcription providers to follow its lead.
Due to these AAMT line unit of measure ambiguities, and the disparity in its interpretation, health care providers have raised concerns regarding charges for transcription services by their respective transcription providers, including the Company. In response to those concerns, and to foster ongoing business relationships with its customers, the Company has approached certain customers and offered to resolve any issues related to their prior AAMT line and other billing related issues.
As previously disclosed, the Company's Board of Directors has authorized Company management to make accommodation offers, up to an aggregate amount of $65.0 million, to certain customers to resolve any concerns over AAMT and other billing related issues. As of March 31, 2006, (i) the Company has entered into agreements with certain customers who have accepted accommodation offers to resolve concerns over AAMT and other billing related issues, and paid or credited an aggregate amount of $31.3 million as an accommodation to those customers and (ii) additional accommodation offers have been made by the Company to certain other customers in the aggregate amount of $11.9 million. From April 1, 2006 through the date of this release, the Company has entered into agreements with additional customers and paid or credited an aggregate amount of $2.9 million and has extended accommodation offers to additional customers in the aggregate amount of $1.1 million. Company management currently intends to make additional accommodation offers in the future, consistent with the Board's authorization described above, although the timing and amount of such offers have not yet been determined and the Company's plans may change in the future. The accommodation offers do not represent an estimate of potential liability, if any, in any of the previously disclosed litigation or investigatory matters pending against the Company.
The Company is unable to predict how many customers, if any, will accept the outstanding accommodation offers on the terms proposed by the Company, nor is the Company able to predict the timing of the acceptance (or rejection) of any of these outstanding accommodation offers. Until such offers are accepted, the Company may withdraw or modify the terms of the accommodation offers at any time. In addition, the Company is unable to predict how many of the future offers, if made, will be accepted on the terms proposed by the Company. The Company believes that its existing cash resources and cash flows from operations are sufficient to fund all of the customer accommodation offers it may make.
By accepting the Company's accommodation offers, the customer must agree, among other things, to release the Company from any and all claims and liability regarding prior AAMT and other billing related issues. The accommodation offers made to date, and those offers which may be made in the future, are not an admission of liability by the Company of any wrongdoing or an admission or acknowledgement that its billing practices with respect to such customers were or are incorrect. MedQuist Inc. -- Preliminary and Unaudited Financial Information
(in millions)
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Three months ended
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March 31, 2006 March 31, 2005
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Revenues $ 97 $ 108
Operating loss $ (8) $ (2)
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As of As of
March 31, 2006 December 31, 2005
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Cash $ 164 $ 178
Debt $ - $ -
Three Months Ended March 31, 2006
Revenues:
Preliminary, unaudited results indicate that the Company's revenues decreased $11 million to $97 million for the three months ended March 31, 2006 from approximately $108 million for the comparable 2005 period. This decline in revenues is largely due to decreases in transcription outsourcing services and product sales of $9 million or 10%, and $2 million or 27%, respectively. The decline in transcription outsourcing revenues is largely due to a decrease in the volume of lines transcribed primarily related to clients for whom we no longer provide transcription services. Additionally, pricing pressures continued on the base transcription business during the first quarter 2006, but revenues were impacted far less by pricing pressures than in the comparable 2005 period. Management expects that pricing pressures will continue for the foreseeable future but that the introduction of several new sales initiatives and improved customer service programs should cause transcription volume to stabilize or improve throughout the duration of 2006.
Operating Loss:
Preliminary, unaudited results indicate that our operating loss increased $6 million to a loss of approximately $8 million for the three months ended March 31, 2006 from an operating loss of $2 million for the comparable 2005 period. The operating loss of $8 million was primarily attributable to $9 million of costs associated with the following: (1) costs related to the ongoing billing review including (i) legal fees incurred in connection with governmental investigations and proceedings and defense of the class action matters and (ii) non-legal professional fees; and (2) increased expenses related to prior years' accounting reviews and audit. Operating loss was also impacted by the $11 million decline in revenues over the same period.
Balance Sheet Highlights:
As of March 31, 2006, the Company had $164 million in cash and cash equivalents and no debt. The $14 million decrease in cash as of March 31, 2006 compared with December 31, 2005 was primarily attributable to accommodation payments ($10 million) and capital expenditures ($4 million). There were no issuances of capital stock or other securities for the three months ended March 31, 2006.
The Company expects to incur significant costs and expenses in the future relating to the ongoing billing review, defense of the class action matters and governmental investigations and proceedings, and accommodation agreements. These costs and expenses include (i) legal fees relating to the SEC and Department of Justice investigations and proceedings, (ii) legal fees relating to defense and resolution of the litigation matters described above, (iii) customer accommodation payments and credits, and (iv) non-legal professional fees. The timing and level of these costs and expenses is, in many cases, not within the Company's control. While the Company is unable to predict the timing and level of these costs and expenses, the Company currently believes that it has sufficient resources, including cash on hand and cash flow from operations to fund these costs and expenses. However, there cannot be any assurance that unanticipated changes in the level of these costs will not exceed the Company's available cash resources, nor can there be any assurance that sufficient financing from external sources will be available to the Company on acceptable terms, if at all. In the event that the Company's cash requirements exceed its available cash resources, or if the timing of such costs and expenses requires the Company to divert cash resources away from operations, the Company may not be able to execute its operating plan, which could have a material adverse effect on the Company's business and results of operations.
Other Developments
Restructuring:
As previously disclosed, in conjunction with the Company's movement to a single national service and support organization, a restructuring plan was developed in 2005 to consolidate approximately forty-eight (48) operating facilities and centralize certain components of the business in order to improve operating efficiencies. The Company is expecting to incur total restructuring costs of up to $8.5 million associated with this plan through the end of the fourth quarter of 2006. The Company incurred $1 million of restructuring costs for the three months ended March 31, 2006. This restructuring is expected to generate annualized savings of approximately $18.5 million. The Company realized approximately $1.9 million in savings during the three months ended March 31, 2006. Specifically, the Company has shifted resources to a single national service delivery and support organization for all of the Company's services and products and is in the process of eliminating local service centers.
The plan does not contemplate reductions of, and the Company has no current intentions to reduce, its medical transcription workforce. Rather, the Company will continue in its efforts to hire additional qualified transcriptionists. Further, although the Company is consolidating its local service centers as described above, customer-facing teams, led by account managers, will continue to coordinate customer support on the local level. The customer-facing teams will continue to work with and be supported by the Company's centrally managed customer service organization.
Offshore Outsourcing to India by US and EU [2006-05-10]
Posted May 1, 2006, this article analyzes the legal and cross-cultural issues that affect data Privacy Regulation in business. It examines India's lack of law enforcement and scores it workforce regarding the potentiality of selling confidential information and India's lack of faith of its ability to enforce any laws it has declined to adopt to protect personal information.
A long but must read for those concerned about offshoring.
Scribe Healthcare Technologies Exceeds 6,000 Users [2006-04-20]
Scribe Healthcare Technologies, a leading healthcare technology company based in the Chicago area, today announced growth has exceeded 6,000 users. Scribe platform users include physicians, clinicians, administrative personnel, and transcriptionists.
Lake Forest, IL (PRWEB) April 20, 2006 -- Scribe Healthcare Technologies, a leading healthcare technology company based in the Chicago area, today announced growth has exceeded 6,000 users. Scribe platform users include physicians, clinicians, administrative personnel, and transcriptionists.
“Until recently our growth has been primarily organic, selling to hospitals and profit driven medical practices. In 2005 we started targeting Medical Transcription Service Organizations (MTSOs) using our technology to run their businesses. Now with the launch of a joint venture “in2scribe”, we hope to become the foremost industry resource for MTSOs.” says Vice President of Sales Marketing, John Weiss. “As a result our growth rate continues to ramp.”
Scribe technologies are modular and Web-based, leveraging the Internet and standard Microsoft applications. Scribe offers a variety of technologies that help MTSO manage their business, recruit and train transcriptionists.
About Scribe Healthcare Technologies, Inc.Scribe Healthcare Technologies is a privately-held healthcare technology company based in the Chicago area. The company has developed a proprietary web-based platform that complements and extends the value for patient registration, Practice/Hospital Management and EMR Solutions. Scribe’s platform includes complete solutions for dictation, transcription, document management, EMR-Lite, Web portal, online prescriptions and reporting with data analytics.
Scribe serves more than 6,000 users. Business partners and resellers include consulting firms, transcription companies, and business process outsourcers. Additional information is available at www.scribe.com.
About in2scribeIn April 2005, the owners of Scribe Healthcare Technologies, EFD Transcription Services, and PENATCLE Electronic Records and Systems fulfilled their dream to create a network that would pull together resources to help to improve the efficiency, productivity, and profitability of the highly fragmented, mid-sized medical transcription firms.
Utilizing the talents and experience of our members, a common technology infrastructure, and a central management point, in2scribe offers a menu of services to our members including new profit centers, benefit plans, level-loading of your work load, and more. More information is available at www.in2scribe.com.
Dismaying, dismal [2006-03-28]
I have recently completed the course and an externship and do not have my first MT job yet. I did very well in both classes and externship and was told by the program's administrator that I would make an very good MT. A local clinic may have a job for me doing clerical work, but they are laying off 75% of their transcriptionists because they have recently made the switch to electronic medical records, and there are very limited openings for beginners, overall. I have just started paying off an educational loan while still unemployed, and I am beginning to see opportunities for what I have struggled for just drift away, while I am being conceptualized into coder or some other job description byour industry'sleadership.
Medical Transcription Recognized as an Apprenticeable Occupation [2006-03-14]
CHICAGO--(BUSINESS WIRE)--March 10, 2006--Graduates of selected medical transcription training programs will now have access to registered apprenticeship programs, as the U.S. Department of Labor (DOL) has now declared medical transcription to be an apprenticeable profession - the first step in establishing a national apprenticeship program. The Office of Apprenticeship Training, Employer and Labor Services approved the application for apprenticeability determination submitted by the Medical Transcription Industry Association (MTIA) along with the American Association for Medical Transcription (AAMT).
Having a recognized apprenticeable occupation will provide a pipeline of medical transcription professionals entering into a workforce facing a serious labor and skills shortage. stated Keith Flannery, Vice President, MTIA. Workforce development under the standards established by this apprenticeship program will aid in facilitating the transition between student and an employable, productive, and qualified medical transcriptionist.
Given the challenge the industry faces in recruiting qualified candidates to meet the ever-increasing demand for real-time, quality healthcare data, a registered apprenticeship program couldn't be developed and launched at a more critical time, stated Peter Preziosi, PhD, CAE, AAMT Executive Director. Workforce development is essential to ensuring that documentation experts are in place to assist the industry in transitioning to an electronic health record and to preserving the quality and integrity of the health record in that future.
The Registered Apprenticeship Program, sponsored by the Medical Transcription Industry Association (MTIA), will offer structured on-the-job learning and related technical instruction for qualified medical transcriptionists entering the profession. The two associations, along with the Office of Apprenticeship Training, Employer and Labor Services, are finalizing program details.
Medical Transcription is a crucial process in the provision of quality healthcare in our country. This is a hallmark program for the industry, said Sean Carroll, President, MTIA.
Experience & proficiency requirements [2006-03-01]
What are the experience and proficiency industry requirements for U.S. MTs?
Per this article (http://www.fortherecordmag.com/archives/ftr_071805p26.shtml), Competition from overseas sources is also emerging in large part due to the lack of minimum wage laws in those countries. Low entry-level wages and lack of adequate compensation for skilled, experienced MTs have discouraged many individuals from selecting medical transcription as a viable career option at a time when the MT workforce is aging. Compounding the problem is the fact that many new MT graduates are not able to find employment because they are unable to meet experience and productivity requirements for U.S. MTs as mandated by the industry.
A real eye-opener to say the least. Wholesale giveaway of good quality American workers.
Neurologist saves $12,000 per year on medical transcription [2006-02-22]
Recognition vs. Transcription
W. Palm Beach, FL neurologist saves $12,000 per year on medical transcription using state-of-the-art voice recognition software
[ClickPress, Tue Feb 21 2006] Dr. H. Steven Block, M.D. uses Dragon NaturallySpeaking Medical Edition, voice recognition software for medical professionals, to eliminate a very real business problem--medical transcription costs-- which six years ago, began topping the $1,000-a-month mark. Today, a doctor can easily spend three times that amount.
Very open about his high regard for the Dragon Medical VR product, Dr. Block had much to say about its place in his solo practice: “I purchased Dragon Medical from Eric Fishman’s company, Nuance, which is actually located in the same building as my practice, on the floor above me. Neurology is all about ‘nuance’, no pun intended. But ‘nuance’ is really the best word to describe the health effects of a neurological problem. It has been a major focus of my practice.”
“Very subtle neurological changes can have devastating health consequences. You have to be able to communicate those subtleties in order for a medical record to have any meaning.”
“I see some really sick patients. Using an on-the-spot note generation product like Dragon, instead of a transcription service, let’s me get back to the referring physician with a fast note, usually within 10 minutes of seeing the patient. That kind of speed in delivering a medical exam note with ‘nuance’ can mean a great deal to everyone involved. You see, I can’t type. I never learned how to type. My kids who grew up instant-messaging can type faster than I can speak. They don’t need Dragon. But for me, Dragon is a wonderful tool.”
Dr. Block, 49, is no stranger to high technology tools:
“There are only so many hours in the day,” he laughed, driving down the road, talking via wireless cell phone headset, “and I’m very detail-oriented. I couldn’t be without Dragon, quite frankly.” One word I did not hear from Dr. Block is the word “downtime”. It doesn’t seem to exist in his vocabulary.
Having traveled the long and winding upgrade path for both Dragon and laptop hardware, Dr. Block has watched and participated in the evolution of the product for six years. “Like a surfer looking for the perfect wave,” he joked. The improvement he’s seen in the most recent version of Dragon Medical—combined with a high-RAM laptop with at least 512MB—has boosted performance to an almost unbelievable 99.5% real time voice recognition accuracy level, according to his observations.
His advice to new users: “If you haven’t tried Dragon Medical in the last four years,” he said, “try it again, the way it is now, with the new speech engine. It uses mathematical models to analyze word groups. There is a learning curve, but the training is not that bad, consisting of you reading a 15 minute script into a microphone, then a little touch-up here and there.”
“Try a few charts each day, and sit down where it’s quiet, where you can relax and concentrate on your speaking habits. Tech support is great; they’ll help you, and be sure to read the help file “How to Speak to a Computer”—and the manual. Especially for often repeated phrases, the voice-actuated “macros” are great, a real time-saver. It’s well-worth the time you invest in learning how to use this tool.”
What are the pitfalls? “Mumbling,” says Dr. Block, “that’s the main problem. Doctors are used to dictating in a low, monotone mumble, as fast as they can. A person might be able to handle it by going back and listening to the recording again and again. But for voice recognition, doctors need to speak in a normal, conversational tone of voice, just like we are doing right now. Speak normally, and Dragon has no problem, it works very well. It’s really quite simple.”
He stated that using a handheld Sony digital voice recorder with removable memory stick allows him to dictate anywhere, anytime, then later, “feed” the sound file to Dragon, achieving about 98% voice recognition accuracy. (Please note: If you are considering making a recording for later voice recognition by Dragon, be sure and use 16-bit resolution .avi format, or Dragon won’t even try to “digest” it. It won’t bother with a recording of poor quality, because the end result would be useless.)
Although he is considering it, Dr. Block has not yet adopted a commercial EMR(Electronic Medical Records) software system for his medical records, mainly because of concerns about interoperability standards. (Coming soon to an EMR near you.)
However, by using Dragon Medical as his “front-end” for the creation of detailed paper medical records, email reports, and digital-FAX messages, Dr. Block not only uses computers, but has also created a highly personal and expressive way to “chart” a patient, unmatched in detail, depth, and the “human touch” by out-of-the-box EMR software.
Would EMR software developers do well to discuss with this doctor any design plans for a voice-controlled, voice-recognition-based EMR program? I think so. Will a “hands-free” EMR workstation which responds to voice commands--as does the entire Dragon program--ever be used to help maintain a “sterile field” in the medical environment of the future? It certainly worked well on the Starship Enterprise, didn’t it?
HERE's more of what he thought 10/05...sm [2006-02-21]
TAMT NEWS
Texas Association for Medical Transcription
____________________________________________________________________
A recognized component of AAMT October 2005
SPECIAL MESSAGE FROM PETER PREZIOSI, PhD, CAE
I would challenge this group to think of new and expanded roles for transcriptionists in the electronic health environment. Let’s not think of transcription as it is today but as a role that is at the nexus of health information and information technology.
Transcriptionists should be reattached from the physician dictator and deployed to the entire electronic health record, ensuring that data captured, documentation, and report generation is accurate, complete, and appropriately placed throughout the record. Emerging roles for the Transcriptionist include database administrator, data abstraction, data coding, etc. Once both the profession and the industry embrace this concept, we must quickly put together the educational infrastructure and partner with the technology vendor community to build the software to support this vision, creating an emerging role in the workplace. This new role in the EHR expands the value of transcription, gets transcription away from production and being considered a commodity, and makes us true team players in quality patient documentation. Think of the individuals we could attract to the profession if this were the scope of practice!
This is a long-term vision that requires us to begin now to reposition both the profession and the industry. Let’s not wait for the crisis to worsen.
Peter Preziosi, PhD, CAE
Executive Director
American Association for Medical Transcription
100 Sycamore Avenue
Modesto, CA 95354
(209) 341-2445
(209) 527-9632 fax
peter@aamt.org
www.aamt.org/ca/texas/newsletter.doc
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