makes a person sick

makes a person sick [2006-05-10]
so tired of the selling out of america

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

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.

Stand firm! [2008-04-08]
I agree. I actually knew someone who typed some work with no spaces after a new client complained about the cost and said something about being ripped off because of paying for spaces. The gal that did this was actually a past president of AAMT, years ago I might add. She took it on the chin, took the next few tapes home, and returned a few reports with no spaces, no line spacing, etc. The office manager flipped her lid and went nutso on her. Hmmm, my friend said, I don't do anything I don't get paid for. End of story, end of a headache account. I still smile when I think of that story. That would be like a surgeon saying, Oh, I don't get paid for the stapling your wound shut, so I had the nurse use the masking tape. Single spacing after a period makes me crazy too. Do the math. It just to rip us off a bit. Think about how many spaces are saved over thousands and thousands of transcribed lines with single spacing after periods, and know if you are doing that you are undermining the profession and everyone in it. Quit being stupid. If your employer disagrees, tell him/her to have at it themselves.

You're so right, SusieQ [2008-04-08]
I have a huge, huge problem with our professional organization. Errr, ummm, where is the word transcription in AHDI. We've had the plug pulled on us by the ole gals who've been holding the reins for years. It's like a good ole girl association. Most of them have worked for global services, hauled in the big bucks for helping get those services off the ground, and have done it all with no second thoughts. It makes me sick. Our compensation hasn't increased at all. In fact, it has decreased steadily for the past decade. I do, wholeheartedly, wish we could unionize somehow. We should be paid hourly at a sizable rate like other skilled trades. I hate to say it, but our profession is made up of nearly 100% women. We need to be confident, stand up for ourselves, and not let this get any further out of hand.

Job openings [2008-02-08]
Can anyone please send me emails on services who have been willing to supply the MT with up to date, state of the art, platforms to work on. I am so sick and tired of starting jobs with services only to find out you have to copy and paste your work from A to B, because of crappy platforms, or if you don't copy and paste, the platforms are so prehistoric, you could type faster on a selectric. I want to work, have 35 years exp in all field. I have invested major money into up to date computers, software, hardware, etc so I can perform my job for the service to the best of my ability - what comanpies have done the same for us? I am looking again - someday I might find that one service who is looking out for us, as well as their pocketbooks. I don't expect to make millions, I dont' mid ESL doctors, or doing OPS or even working weekends, all I ask is respect for our profession and provide us with quality tools to perform out jobs. ANY INFORMATION WOULD BE GREATLY APPRECIATED - I hope this posts, I have put many posts on this board, but they are never published ?

MTs and uniting [2008-02-05]
You will never be able to get all MTs to unite. It will never happen because everybody is so wishywashy about it. Afraid to lose their jobs maybe? What jobs? All US MTs are losing their jobs every day, little by little. Line counts are shrinking with no explanation. How about MT management, do they know? You know they aren't opening their mouth. They don't wanna lose their cushy jobs and will kissbutt when it comes to company officials who know nothing about transcription but think they do.Howlong will their jobs be around? Any company official cando a schedule, take sick calls,be the shoulder for an MT to cry on, and make customer service calls. Its a no-brainer. Management definitely is not standing up for MTs, lets see what happens when their turn comes.

Supply and demand [2006-07-31]
That is only going to supply the industry with cheaper labor! If the demand is that high for MTs then it would seem we would be paid more since there do not seem to be enough of us, right? Then here comes AAMT to the rescue with the latest of their nutty ideas - training people to do our jobs for even less! Seems to me that would flood the labor pool with new MTs (I use the term loosely here) and drive down our wages. I am so glad I gave up my membership and CMT years ago when I saw the direction they were going. I still have friends who are AAMT members who, IMHO, appear to be brainwashed. One person told me recently that the USA does not have enough people interested in becoming an MT and that is why AAMT is recruiting overseas and it will not impact our jobs at all. Argh!

yeah, noticed that too, speak nniiicccceeee and dddiiissttinncctt for a machine, huh? [2006-07-06]
Makes my blood boil!!!

$50,000 indeed [2006-06-03]
Ugh! I am so sick and tired of seeing those bloated salary projections. I was an MT for 15 years and the most I ever made was $31,000 - and that job was hourly. The most I ever made on production was $23,000. Makes me sick.

Real nice to know [2006-03-29]
that the doctor has so much more respect for a machine than he does the human ears that have to make a living listening and typing the reports day after day! This is what the doctor said... “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.”

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

The Top 10 Reasons to Become a Medical Transcriptionist [2006-01-19]
January 17th 2006Work From Home You've seen the commercials: medical transcriptionists are in high demand. Should you consider this field? Below are the top ten best reasons to become a medical transcriptionist. If these characteristics are something you're looking for in a job, then medical transcription may be for you. To get started, try “Working at Home the American Way in Medical Transcription” by Debra Jan Hebert, an experienced (http://medtrans4u.com) medical transcriptionist. 10. Quick entryMany lucrative professions require extensive training and advanced degrees. Other jobs in the medical field can take eight or more years of grueling, expensive schooling to begin. In medical transcription, you can begin your work in a year or less, avoiding huge debts and student loans. Some employers require no training, especially not if you already have good English skills and some experience in a medical field. 9. Contribute to societyAs a medical transcriptionist, you can contribute to society in many ways. In addition to the economic contributions you'll make to the overall economy, experienced medical transcriptionists become well-versed enough to catch errors or even act as patient advocates. Medical transcriptionists can see inconsistencies and correct them as well. By quickly returning transcripts to hospitals, private practices and individual doctors, medical transcriptionists can ensure fast patient care in the medical system. 8. Work from homeWhile the Bureau of Labor Statistics reports that 70% of medical transcriptionists still work in hospitals or physicians' offices, medical transcription is becoming increasingly popular as a work-from-home profession. The convenience of a home office appeals to some people on its own virtues, while parents may value the opportunity to stay close to their young children and still support the family full time. No matter what the reason, if you're looking to work from home, you should seriously consider medical transcription. 7. Excellent payWhile compensation methods may vary, almost all medical transcriptionists enjoy excellent pay, even in entry-level positions. According to (http://medtrans4u.com) DJS Enterprises, you can earn as much as $50,000 to $80,000 a year as a medical transcriptionist. If your pay is production-based, as you gain more experience and dexterity in medical transcription your salary will steadily increase. If you're looking for a job that can really support your family working from home, medical transcription may be for you. 6. Job securityThe US Bureau of Labor Statistics reports that the job outlook for medical transcriptionists is definitely positive. The medical transcription field is expected to grow at a faster than average rate through the year 2014. This indicates that medical transcriptionists will have plenty of opportunities to find steady work, even if they work at home on a freelance basis for at least another 8 years. 5. Job satisfactionWhile job satisfaction may vary from job to job and person to person, if you enjoy being able to visibly track the progress you've made in a day, medical transcription can bring you a high level of job satisfaction. As your completed medical reports pile up, you'll be able to see how much you've accomplished. 4. Set your own hoursMost of the medical industry operates 24 hours a day. Many hospital and at-home medical transcriptionists are able to set their own hours at any time to accommodate their families or other commitments. No matter when you're able to work, there's a medical record waiting to be transcribed. In medical transcription, you can work when it's most convenient for you. 3. Comfortable work environmentWhether they work in a hospital, a private office or from home, medical transcriptionists enjoy a comfortable work environment. Noise levels are low, safety risks are minimal and strenuous labor is negligible. In medical transcription, you'll enjoy a comfortable office and dedicated work station to transcribe. And what could be more comfortable than working in your own home? 2. Transferable skillsMedical transcriptionists acquire many transferable skills that they can use in other jobs if ever they want to leave the industry. In addition to a basis in the medical field, transcriptionists learn skills that could apply as a court reporter or an administrative assistant. Transcriptionists also develop their English skills, which can be useful in all types of positions that involve writing and editing. Whether medical transcription is a step on your path or your dream job, the skills you learn can improve your overall career outlook. 1. Rewarding workWhy do people become doctors? The vast majority of the people who endure 8 or more years of schooling and incur substantial debts and student loans to become doctors do so because they love to help people and to cure them of their illnesses. Every member of the medical field helps in this endeavor. What could be more rewarding than to contribute to the speedy treatment of people who desperately need your help? If these ten things sound like characteristics you're looking for in a job, look into medical transcription. You can learn more about medical transcription from books, the Bureau of Labor Statistics and other materials online.

Registration Open for Nation's First University Course [2005-10-25]
Registration Open for Nation's First University Course on Medical Transcription Voice Recognition Editing; Pair of Richmond, VA Community Colleges Partner With OAK Horizons Cymed For Online Class 10/24/2005 5:18:00 PM EST The Community College Workforce Alliance (CCWA) in Richmond VA, opened enrollment today for a medical transcription training course aimed at graduating students who are prepared to edit preliminary medical reports generated through voice recognition. CCWA is a partnership between J. Sargeant Reynolds and John Tyler Community Colleges and serves the workforce needs of the Greater Richmond area. This first of its kind university-based course was developed with the support of OAK Horizons, an online content developer of Transcriptionist training courses and CyMed, the nation's third largest employer of domestic transcriptionists. We're excited about launching the Medical Transcription/Voice Recognition Editing program, stated Matt Meyer, Dean of CCWA Workforce Training. Our mission is to serve the workforce and economic development needs of the region through educational programs that prepare students for positions that offer solid long term employment prospects. Since CyMed has already agreed to hire each graduating student for the first three years of the program, we are able to offer tremendous security for any student who is anxious about choosing an educational track that leads towards a long term employable career path. This partnership makes a lot of sense for CyMed, CCWA and the MT community on a number of levels, commented Robert Lynch, CyMed's President and CEO. Although we certainly expect the current method of transcription to be around for a long time, this course will help extend the range of employment opportunities available to program graduates. CCWA and OAK Horizons have developed an excellent program and we are looking forward to hiring graduates with the expanded voice recognition editing skill set.

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

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.

INDIA - Why medical transcription is such a major draw [2005-08-20]
The medical transcription business is drawing people from other sectors. That’s because the income can be quite substantial. Transcriptionists are paid anywhere between 60 paise to Rs 2.0 per line. At a minimum of 6 hours and transcribing 800 lines per day, transcriptionists can make around Rs 1,200 a day. Working 26 days a month, they earn more than Rs 30,000 (USD 450 - 500)a month. They send their reports to an Editor for proof-reading who are paid upwards of Rs 40,000 per month. As a result, hundreds of professionals are quitting their regular jobs to assist US doctors in transcribing their conversation with patients. X-ray, pathology, surgery and discharge reports of US patients are also being transcribed out of India. To be a transcriptionist, an aspirant has to acquire skills in medical terminology. The next step is the editor. Level three is a quality analyst (QA) who has to work out of the office of the MT firm. It’s a daily ritual for thousands of homemakers across India. After sending husbands to work and kids to school, they download voice files and start transcribing medical illnesses of patients in the US. Slowly, medical transcription from home is becoming a phenomenon, particularly in tier-II cities where the BPO boom hasn’t yet caught on and educated women are still not being encouraged to venture out of home. “Almost half of our 600 home employees are women. Working from home allows them to spend more time with family,” said Mr Rajiv Shetye, VP, Spryance, a Boston-based medical transcription firm which now has 1,200 employees in India. According to estimates, India has about 100 medical transcription companies and the big ones include Accusis, Spryance, Stheris and Heartland. About 10,000 people work in the $120 million-strong industry. Still, there is a lot of untapped potential. The US market for market transcription is about $12 bn per annum, which is more than double the BPO exports of India. More than 700 million hospital events need to be recorded every year. According to Nasscom, about 1.6 lakh such transcriptionists will be needed in India by 2008. Earnings depend on how much time a person is able to devote. Billing is based on the number of lines transcribed. HARSIMRAN SINGH

Losing medical integrity [2005-08-05]
Losing medical integrity By Pius KamauDenver Post Columnist Not too long ago, all my local transcriptionist had to do was call me when she couldn't understand something in my medical dictation. Now, I no longer know who transcribes reports of my surgical procedures and physical exams or where they are. I only know that most hospital transcriptions have been outsourced. At times, the resulting inaccuracies are incredible or enormously amusing. Transcription is only one of many medical fields facing outsourcing, which is rapidly making inroads into American health care. The stability of medicine is being chipped away to satisfy America's Wal-Mart belief that cheaper is better. While the public prefers not to know how fundamental changes in health-care delivery may be adversely affecting it, real harm to patients has resulted from outsourcing. Recently a lab that processed specimens from across the nation was found to have misinterpreted Pap smear results. In some cases, a pathologist hadn't actually read some slides. Such labs aren't chosen because they do a better job than local pathologists. Simply put, they're cheaper. Cost-cutting is the new mantra, and shoring up profits the prevailing credo in a world where the quick fix trumps the long-term, universal good. The net result has been to throw many competent lab techs out of work. Valuable, highly qualified people have forever been lost to the medical world. My former medical transcriptionists were used to my accent, and offered occasional advice on how Americans pronounce certain words. They were replaced by others who find American speech heavily accented and sometimes indecipherable. Hospitals are not factories; they don't manufacture screwdrivers or light bulbs. Hospitals are small communities, where sundry departments and personnel form a mosaic that fulfills the essential function of the institution: to heal the sick. It's a cohesion that has slowly been dismantled to squeeze out more profits for investors and HMO moguls. The practice of medicine is unique in that each person in the system plays a vital role. Frequently, we discuss puzzling radiologic images, weird pathological presentations, and brainstorm difficult surgical cases in corridors and lunchrooms. Unfortunately, there's now a move to outsource imaging technology as well as other forms of testing and therapeutic modalities. Without casting aspersions, I believe many of us wouldn't like to discover that our scans are read in Beijing, Bombay or Manila. Hospital staff collegiality has suffered irrevocable damage. X-ray, lab technicians and other medical colleagues have been let go or moved away because their expertise was deemed useless. Change is inevitable. But it should always be geared toward making patient care better and safer, not jeopardized by profit- taking. It's conceivable that future insurance policies will offer several options: Pay more if you want care in local facilities or pay nothing if your treatment is provided in Mexico, South America or Africa. If you could save a few dollars, would you do the latter? Looking at this as well as other aspects of our failing system, it's easy to see that the businessmen we have entrusted our health care to will do anything they can to shortchange the public, as long as we let them. The question is: What will it take before we all say enough? I want my transcriptionist down in my medical records office. I don't want to talk to a radiologist in Bombay or Nairobi about a patient in Denver. I want a pathologist I can interact with on a regular basis. Surely you don't want your surgeon to be located in Guadalajara? Pius Kamau of Aurora is a thoracic and general surgeon. He was born and raised in Kenya and immigrated to the U.S. in 1971. His column appears on alternate Wednesdays.

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 .