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BANGALORE -- After seeing patients at the Arizona Medical Clinic in Sun City West, dermatologist Anthony Santos describes their cases on a hand-held digital recorder.


Mahesh Barat, Special to the Post-Gazette Parimala Jaggesh is an architect turned home worker in Bangalore. Each day, she receives audio files from doctors in the United States and types transcripts of their case notes for the Pittsburgh-based firm of Acusis Inc. Click photo for larger image.

Before going home, he plugs the recorder into one of the hospital's computers. From there, his audio files are encrypted, compressed, shipped via the Internet through Pittsburgh and sent on to this bustling Indian city 9,100 miles away from Phoenix.

A few hours later, Santos' words end up in the laptop computer of Parimala Jaggesh, an at-home worker for Pittsburgh-based Acusis Inc., who will type a transcript of his dictation.

Santos and Jaggesh have never spoken to each other, so he has no idea that his voice is her favorite among the doctors whose dictation she transcribes.

When the Acusis staffers in Bangalore call Jaggesh to ask her to do extra transcribing, they only need mention they have a digital recording from the clear-voiced Santos.

"They know how to get work done from me," she says with a laugh. "They say it is Anthony Santos. Then I cannot say no."

Jaggesh is one of about 350 home transcriptionists Acusis employs in Bangalore and other Indian cities. The company, founded by native Pittsburgher David Iwinski Jr., has a lofty goal: to become the dominant player in the medical transcription business in the United States, using its cyber-partnership with educated, English-speaking workers in India.

Bangalore wakes up as night falls in the United States, so while American doctors sleep, Jaggesh and her colleagues transcribe their dictation.

Jaggesh, an architect turned home worker, hits the shortcut keys on her Compaq laptop to insert familiar phrases and consults online reference files when she is stumped by an unusual medical or pharmaceutical term.

Her finished work is downloaded to the Bangalore offices of Acusis. Editors there compare every line of her transcription to the original recording, make corrections if necessary, and grade her daily performance.

Santos' transcripts are sent back to the Arizona Medical Clinic within 12 to 24 hours after the doctor plugs his recorder into a PC. They can be returned even faster, under two hours, for an extra fee.

Faster, more accurate

Even though the work is taking place halfway around the world, the result is speedier and more accurate than that done by a smaller local service, which used to take five to seven days to return transcripts, said Terry Daly, the clinic's chief information officer.

Medical transcription has a huge potential market of perhaps $12 billion to $15 billion a year. The current transcription companies are fragmented, ranging from small mom-and-pop operations to the industry leader, New Jersey-based Medquist Inc., which employs 10,000 transcriptionists to serve 3,000 health-care providers.

Acusis, just 3 years old, considers itself mid-size. The privately-held firm employs about 650 people here and abroad, 460 of whom are in India. The company serves about 40 hospitals and clinics across the country, including Children's Hospital of Pittsburgh.

Iwinski's hopes for becoming an industry leader rest on proprietary software written by 50 company programmers in India to manage the nearly instantaneous flow of words from hospitals in the United States to home transcriptionists in India and back again.

But it also relies on the cost advantages of Indian employees. The Acusis pay system for transcriptionists, based on volume and accuracy, ranges from 1 to 2 Indian rupees per line.

Jaggesh may do 1,000 lines a day. At the average pay rate, that would earn her roughly $27 a day, or $135 for a five-day week -- good wages in India, where the average annual income is about $500.

At the Acusis headquarters in Bangalore, each space has a name.

A training area is called Gurukul, meaning "abode of the teacher" in Sanskrit. A visitor's room is named Athithi, or guest. Quality control is dubbed, in English, the Potter's Wheel; software development, the Cutting Edge; and startups, the Test Tube.

"It's very challenging work," Naveen Janarbhan, a quality control specialist, said as he compared a transcriptionist's work to an original recording of a doctor reciting medical jargon at a fast clip, describing a patient who is a heavy smoker and has a family history of cancer.

A mechanical engineer by training, Janarbhan carefully went over the transcript, taking extra care when it came to the medications the physician had prescribed for the patient.

'Concentration is the key'

"We have to be careful. Our eyes should be here. Our ears should be here. Our mind should be here," Janarbhan said. "Concentration is the key."

He found a few mistakes in the transcription he was editing, all minor and none involving medication or diagnosis. Nevertheless, he called the home Transcriptionist to ask her to be more careful.

The system grades each transcriptionist and the results are available to everyone in the company. That peer pressure, according to Iwinski, is "a strong motivator" to do well.

The job isn't that easy. Sometimes, doctors are munching an apple or eating lunch while they talk, making them difficult to hear. A nurse interjects to ask about a patient's medication. Papers rumple in the background. The topics can be technical, the jargon heavy.

Occasionally, Jaggesh is distracted by music playing in the background of a doctor's recording, the noisy atmosphere of a hospital or extraneous chatting of passersby.

But she takes most of it in stride.

"It's fun. It's very challenging," said Jaggesh, who likes working in her three-story apartment, which she shares with two sons, two dogs and husband Navarasa Nayaka Jaggesh, a well-known comedy actor in Indian films whose screen name is simply Jaggesh.

Parimala Jaggesh works around her family's schedule, taking her laptop with her as she moves from floor to floor, and occasionally typing in a serene rooftop garden overlooking the city. At other times, she works in a top-floor room that contains a figurine of the elephant god Ganesh, thought to bring good fortune.

She keeps track of her daily reports, and if her accuracy dips below 96 percent, she studies the file so she doesn't repeat the same mistake. Sometimes she has a bad day, and she gets called by the office.

"We do appreciate the feedback. You get a call that you have dropped down in accuracy on one file. Then it's a challenge," she said. "I take it that if my editors find the fault, I should have been able to do it."

She enjoys the small personal things that sometimes show through in a doctor's dictation -- a laugh made over a mistake or a spouse in the background trying to hurry things along.

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