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Serving Over 20,000 US Medical Transcriptionists


Posted By: Anony on 2009-01-25
In Reply to:

December 8, 2008

A New Day Rising
By Selena Chavis
For The Record
Vol. 20 No. 25 P. 10

Medical transcription, long the mainstay for healthcare documentation among providers, is forging into unknown territory as the industry redefines its role in the framework of EMRs. 

Like many facets of the healthcare industry, the transcription field is evolving around the electronic movement. Many questions have been raised about how medical transcription will be integrated into electronic medical records (EMRs) as the industry looks toward the future. While there are varying opinions about what the future holds, most experts agree that, at some point, the role of the medical Transcriptionist will be redefined.

“I think the case is it will morph … and potentially be replaced … or evolve in a way that is different from what it is today,” says Claudia Tessier, RHIA, vice president of the Medical Records Institute. “I and others have the perspective that it will be encroached on unless it adapts and morphs.”

With the promise that EMRs bring to scaling healthcare costs and improving quality of care, Tessier points out that many in the healthcare industry see an opportunity to eliminate the practice of dictation and transcription in its current form. Gone would be the days of feverish typing from handheld dictation devices; the new era would have clinicians input their own documentation directly into patient records via the convenience of cell phones, pull-down menus, and point-and-click and free-text keyboard entry methods.

Add to those efficiencies the promise that many believe speech recognition technology holds, and Tessier says two questions about medical transcription emerge: When will direct data entry options have a significant impact on medical transcription, and what is medical transcription’s role in the transition to EMRs and computer-guided care?

But are potential changes to the process well thought out? Susan Lucci, RHIT, CMT, AHDI-F, director of transcription operations with TRS Transcription and president-elect of the Association for Healthcare Documentation Integrity (ADHI), believes that healthcare documentation is too complex to ever fully integrate into a point-and-click system.

“I think we’ll see a dramatic shift in the kind of work we receive—more severe, less physician office,” she says, pointing out that, in some situations, documentation requires a narrative from the physician. “I think that we can all agree that no two patients are the same. The drawback would be if we ever took it [narrative dictation] out entirely.”

Then, there’s the fact that some areas of the country are lagging behind in the electronic movement. Miriam Wilmoth, CMT, AHDI-F, a member of the ADHI’s electronic health record team and president of the Tennessee Association for Medical Transcription, notes that many providers in her region are still using paper records. “We still have that dichotomy in Memphis,” she says. “Some of the trends that are hot in other areas of the country take a while to trickle down here.”

Going forward, Tessier believes the key to success is providing choice and flexibility with multiple options available, including traditional transcription, computer entry, and speech recognition. “There are all of these options. What’s important is that clinicians be given these options,” she says.

Adapting the Process
No one can fully predict the long-term effect of the electronic movement on the transcription industry or how the role of transcription will evolve over time, but many contend that it will not see its demise anytime in the near future.

“The reality is that the transcription industry is so big that the impact of EMRs and HIT are longer term,” Tessier says, adding that many in the field may become complacent under that belief. “To a great extent, there continues to be a belief that because it is still big, it will continue to be big.”

Currently, the Medical Records Institute estimates that 90% of information capture is dictation and transcription compared with less than 3% front-end speech recognition and about 6% direct physician input by keyboard, stylus, touch screen, and other methods. Alongside those numbers, the AHDI estimates that global medical transcription expenditures are between $12 billion and $20 billion annually, with the largest share of that occurring in the United States.

Tessier points to industry frustrations over the high cost of medical transcription alongside a demand that currently outweighs the supply of medical transcriptionists. Add to that concerns about turnaround time and quality, and many are seeking ways to improve the process.

Change is coming, Tessier says, suggesting that “it’s not an ‘either/or.’ It’s more an ‘and … and … and.’ It’s not being replaced by EMRs—it’s being integrated.” It also means that adjustments are coming, and professionals need to adapt their skill sets. “Everyone would be a lot more comfortable if they knew change means X, Y, Z,” she adds.

Take speech recognition technology, for instance. When it was first introduced, Tessier points out that many in the industry predicted the demise of transcription. Now, 20 years later, the industry is bigger than ever, but at the same time, speech recognition has come a long way and is expected to continue on that track.

Lucci believes there are many opportunities to create efficiencies. “There is a clear evolution to much more speech recognition editing,” she notes. “We’re seeing increases in requests from our clients to use speech recognition.”

Improvements in speech recognition technologies have been steadily expanding the capabilities of computers to understand voice commands, and the benefits achieved through increased productivity cannot be denied. Statistics reveal increases in productivity that equate to upward of 50%.

Wilmoth points to a Memphis hospital where speech recognition technology was implemented in the radiology department. Radiology transcriptionists were given notice that the organization was unsure of the technology’s long-term impact.

However, the end result was that 17 radiology transcriptionists were no longer needed. “The technology worked fine. They [the hospital] only have enough traditional transcription to keep one [transcriptionist] busy,” says Wilmoth, who adds that she envisions voice recognition being a tool that is specialty specific. “I don’t think it will take off as quickly with HIM transcription.”

Raising the bar for efficiencies within an EMR will be the integration of speech recognition with the Clinical Documentation Architecture for Common Document Types, a system for interoperable healthcare reports that conform to standards for information exchange. The standardization and adoption of these electronic documents are expected to enlarge and improve the flow of data, including narrative documentation, into the EMR.

In this case, transcription’s role morphs into an editing function, opening up the need for an expanded skill set from medical transcriptionists, suggests Wilmoth, where listening skills must be adapted, and more critical thinking approaches must be used.

Alongside efficiencies created with speech recognition, many are looking to direct entry from clinicians as an answer to transcription costs associated with traditional dictation, but Lucci says it is unrealistic to expect that dictation will be completely replaced for the long term, especially in the hospital setting. Pointing to statistics that suggest narrative dictation is faster than narrative computer entry, she says that in the acute care setting, few physicians can perform all their required tasks and then have the additional burden of the time required in a computer-entry model.

“I think hospital dictation will not change a whole lot for a while yet,” she says.

Lucci also doesn’t believe that it will make sense to convert certain types of critical patient information to a point-and-click method. “One thing for sure is the history of present illness,” she says. “That is uniquely the situation that caused the patient to present in the first place. It requires narrative input.”

The Readiness Factor
Wilmoth concedes that most EMRs currently have dictation and transcription integration ability where documents are either uploaded into the system or copied and pasted into the record. With that capability in mind, how ready and willing are physicians and clinicians to take on the task of direct entry?

Clearly, statistics reveal that traditional medical transcription is still the choice of many physicians, although trends with younger, more computer-savvy physicians suggest that the tide will continue to turn toward more direct computer-entry models. Wilmoth says the concept of choices should be paramount going forward, and physicians should be kept in mind, especially in the hospital setting where technological choices that are not embraced by clinicians and physicians can often equate to higher costs due to a lack of use or incorrect use.

Wilmoth mentions a comment she recently overheard from a radiologist who was opposed to changing dictation practices to computer entry, who said, “I did not go through 12 years of school to be a secretary.”

“It’s not an elitist attitude. Their skills lie elsewhere,” Wilmoth says. “Taking the dictation option out is certainly going to frustrate some and potentially affect patient care.”

Computer-entry models will likely be embraced more in the physician office setting, Lucci says, where the need to create efficiencies and reduce overhead is becoming more urgent. Statistics from the Medical Records Institute suggest that transcription costs per physician range from several thousand dollars to more than $25,000 annually, making technologies such as speech recognition and point-of-care documentation more attractive.

Alongside resistance to change from some physicians is the question of how a transcription workforce already diminishing in numbers will adapt to its role being redefined. Acknowledging that as more EMRs enter the physician office setting, the need for transcriptionists will continue to decrease, Wilmoth says many transcriptionists are not prepared to “morph” into the editing roles that will be required to complement speech recognition technology.

“It’s a different skill set,” she says. “I think there are some that can transition into editors … some will ride it out and retire … and some will refuse to embrace technology and will go do something else.”

Then, there’s the compensation issue. Presently under notable debate is how to create a fair and equitable system to pay medical transcriptionists for “editing” work, especially in the training phase when production levels dip. Alongside that scenario is the fact that they “will have to edit twice as much as transcribed to make as much money,” according to Wilmoth.

Is Accuracy a Factor?
Consider the following differences between dictated instructions and what medical transcriptionists were able to catch and clarify as potential errors in physician-entered documents. According to Lucci, the following variances were just a few of nearly 150 errors one transcriptionist found in just two months’ time:

1. Dictated: Will resume Altace and metoprolol, but will hold if the systolic blood pressure is less than 10 or the diastolic is less than 60.
   Typed: Will resume Altace and metoprolol, but will hold if the systolic blood pressure is less than 100 or diastolic is less than 60.

2. Dictated: Zosyn 3.375 mg q eight hours IV X 7 days.
   Typed: Zosyn 3.375 grams q eight hours IV X 7 days.

“Physicians have entrusted transcriptionists to do their documentation for well over 30 years,” Lucci says, pointing to the fact that, in many ways, physicians have limited their own ability to document accurately because it has not been their day-to-day practice. “Is accuracy an issue? If you look at clinician-entered information as compared to dictated and transcribed reports, I think you would be surprised to see that the quality isn’t as good. A well-trained [medical transcriptionist] will catch errors in dictation and speech recognition.”

Issues associated with accuracy may be compounded in that physicians may not have the time to be as thorough as they need to be if left to enter their own documentation directly into an EMR.

“Not only is accuracy an issue, but completeness is a bigger issue to telling the patient story,” Lucci says.

Wilmoth tells the story of a patient whose visit to a physician amounted to no more than a series of questions and answers. She notes that the physician pointed and clicked his way through the exam on the computer without ever “laying a hand” on the patient and then proceeded to bill for a complete exam.

“The questions then become, was he attempting to overbill, or did he not understand the documentation system?” she asks. “The other scenario is that they may underdocument to save time.”

It appears certain that traditional dictation and transcription practices are evolving. As they do, the EMR’s impact is by most accounts a change for the better in healthcare documentation. What is perhaps not completely certain is how exactly that transition will take place, to what extent, and when it will happen.

— Selena Chavis is a Florida-based freelance journalist whose writing appears regularly in various trade and consumer publications covering everything from corporate and managerial topics to healthcare and travel.

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The Laws of Medical Transcription


1.  When a doctor carefully and distinctly spells out the name of a patient, drug, body part or referring doctor, it will be spelled WRONG. 


2.  If a doctor calls from the O.R., incoherent with rage because a note he/she dictated is not done and the patient in question is anesthetized on the table, that note will have been dictated on the Dictaphone that is sitting inside the doctor’s pocket. 


3.  A dictation that is stat, urgent and absolutely vital to the patient’s care will be dictated into a Dictaphone with dead batteries.


4.  When dictating an involved neurosurgical op report involving rarely used instruments and multiple complications, the doctor will be sitting next to either a beeping ventilator in a crowded ICU or a screaming infant. 


5.  The speed at which an ESL doctor dictates is increased in direct proportion to the thickness of his/her accent: i.e., ESL = mc2 = total incomprehensibility.


6.  A doctor who is a crystal clear, concise and organized dictator whom you love to transcribe for, within 15 days from the moment you begin working on his/her account will decide to accept a job at another hospital. 


7.  The above mentioned crystal clear, concise and organized dictator will be replaced by the only doctor in the Western Hemisphere who has both a lisp AND a stutter. 


8.  A doctor with a sexy, deep voice that turns your knees to Jell-O and your skin to goose-flesh will have a stomach the consistency of Jell-O and a face that resembles a goose. 

medical transcription info
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What I am wondering is quite honestly how to go about finding a good job of this nature. As well as what online course would be best to take for this?

Also please be honest with me and tell me if it's worth it to take the course. I'm not looking for a lot of money but something is better than nothing and want to keep busy.
medical transcription bloopers

    118 Medical Transcription Bloopers.

  1. The patient comes in for a lesion on the penis which has been present on and off for 2 years and seems to be getting smaller.
  2. Patient comes in complaining of hoarseness. The patient apparently lives with his wife and does a fair amount of talking.
  3. The left side of his cranium is missing.
  4. He does have well-known hemorrhoids.
  5. Reflexes in the upper extremities are normal and symmetrical. Lower extremities show an absent right ankle compared to the left.
  6. I also gave her a back book to start doing exercises in.
  7. He does have a fairly high stress job and appears in the clinic with his lap-top computer today.
  8. The patient wishes to establish with a neurologist with the diagnosis of Parkinson's disease.
  9. She is on SEPTRA right now for a sinus infection which she was given over the phone.
  10. She has not been taking the medications that were prescribed. She notes that smoking marijuana currently helps most of her symptoms.
  11. The patient reports that since she had a colonoscopy, she has noticed some problems with her short term memory.
  12. 28 year old male comes in requesting a work release for his foot.
  13. She reports some hearing loss, with difficulty hearing her husband.
  14. She has a long history of asthma; usually she has found that this is exacerbated by being around moles.
  15. During our exam, this man was shaking: basically he was shaking his right leg when I was watching, and he was not shaking his right leg when I was not watching. According to the EMT who brought him back in to the room, when he went outside to get the man he looked completely normal, walked in unaided with no problem, sat down in the room and began shaking and having what he calls "spasms and seizure-like activity." He has good deep tendon reflexes on the left side, which he did not shake until at the end of the exam: I think he may have forgotten which side was supposed to shake and which side wasn't.
  16. Her next complaint is abdominal pain that she notices only when the wind blows on her abdomen.
  17. He describes the ear pain as being in the ear.
  19. This is her first period since vaginal delivery of a three month old baby.
  20. The patient fell while rollerblading on his left hand.
  21. Fracture to the proximal phalanx of the right fourth toe on the right fifth foot.
  22. Multiple strains and sprains secondary to motor vehicle accident of the neck, shoulders and low back.
  23. The patient cannot touch her shoulder blade with her right shoulder.
  24. The patient was taken to the microscopic room.
  25. The pain starts right after he eats meals located around his belly-button.
  26. The patient presents for follow-up of thoracic back strain, which occurred 03/16/96 while twisting in the dishroom.
  27. Patient comes in to Urgent Care feeling concerned because at work he feels slightly confused and disoriented. At work he usually carries on 3-4 conversations at a time, and now he only is able to carry on one conversation at a time.
  28. Admits to being hypochondriacal about things recently and in fact she has had to stop watching the TV show "E.R." because she gets every symptom that she sees.
  29. Her husband had received the "husband of the year" award two years ago, but has since moved out and is living with a church secretary.
  30. The patient was standing in the kitchen, leaning against the sink, waiting for coffee to perk (drip) and a throw rug slipped out from under him and his foot hit the wall.
  31. ...has a cousin who developed curly hair after having a child.
  32. They will be following up with Dr. Knackstedt in July of this year just to check on his ears.
  33. 15 year old boy was accidentally hit with 5 BB gun shots while he was jumping on a trampoline.
  34. (Re a 5-year-old Urgent Care patient:) Active young man who is very conversant with respect to dinosaurs.
  35. The patient has a brother and sister who are normal.
  36. She will now be living with father and strep-mother...
  37. Mother comes in for consultation re beast-feeding her infant.
  38. She has actually not felt well since her daughter was born three years ago.
  39. About 8 a.m. this morning was the last time she had an inhalation.
  40. She reports that, since the auto accident, the pain in her low back is much improved.
  41. She has had two flares of the previous sinus tract I identified. She states it is related to having sexual intercourse, and since stopping that she has had no further problems.
  42. She fell and hit her left forearm against a rock which remains painful and swollen today.
  43. He sustained injuries to his forehead and face when he fell from his glasses.
  44. I recommended to mother that she get an over-the-counter ear removal preparation.
  45. 48-year-old male with left index finger laceration which occurred 45 minutes before he presented to the Urgent Care department on a piece of glass.
  46. She gets headaches with her migraines.
  47. I recommended MIACALCIN, 1 puff in each nose on a daily basis.
  48. ...and has two cousins identical to her father...
  49. He also has external hemorrhoids, which he says he likes to keep to himself.
  50. ...he is seen today with his daughter Judy; but I guess not with his boy Elroy.
  51. Healthy-appearing child with upset mom.
  52. She also complains of pain in her right ankle. She says she is not sexually active.
  53. The patient complains of low back pain. She is able to move all of her legs.
  54. The patient reports a fatal reaction to IODINE in the past.
  55. The patient wonders if she can fly as far as her ears.
  56. She was also given an in-the-ear hearing aid whose patient was a husband of ours.
  57. She was the diver of a car going approximately 25 MPH...
  58. The patient was given Dr. Davis' car and instructions were given to him to follow up with Dr. Davis within the next week.
  59. FAMILY HISTORY: Significant for a half-brother of unknown origin. Past medical history is significant for a basal cell carcinoma on her head which was removed recently.
  60. After a suicide attempt, the patient was given a choice of admission to the Johnson Unit or vacation with her sister.
  61. He has been monitoring his blood pressure. Does not drink. Does not use much soap.
  62. She will lie down, feel a bit better, cook her husband's breast, then her own breakfast, eat, still feel tired and no energy until after lunch.
  63. She is 15 years old. Chronic runny nose for 20 years.
  64. Stepped on a TETANUS SHOT.
  65. He has some concern about chewing on vacuum tubes when he was an electronic repairman as a child.
  66. Eat before the meal.
  67. He did develop perianal skin irritation with some skin rash extending out onto his bucket.
  68. She has had 3 pregnancies, 1 liver birth and 2 spontaneous abortions.
  69. I plan to see her in two weeks and reassess her injured parts.
  70. She apparently has had a cold for several weeks, but just started to turn green the last couple of days.
  71. Husband is somewhat negative and difficult to live with. She is not interested in a trial of medication for this.
  72. She did suffer loss of consciousness and was told by a chest x-ray that she had a lung contusion.
  73. The patient has not been using METROGEL because it was too drying and her face peeled off in chunks.
  74. She has had surgery when her husband was in the Navy for hemorrhoids during a pregnancy.
  75. She does admit to bruxism with what few teeth she has.
  76. She smokes one glass of alcohol per week.
  77. . . . concentrated on chest, abdomen and all four lower extremities.
  78. He was evaluated in the Emergency Room where he broke some ribs.
  79. The patient has complaints of problems maintaining an erection for over a year.
  80. Despite both standing and lying down, I was unable to demonstrate a hernia.
  81. The patient had a trial of PROZAC on which he became violet.
  82. Examination of the remaining hand is within normal limits.
  83. The wound is doing fine, without complaints.
  84. She is not clear on why she has seen me in the past, but states that whatever I treated her for had cleared up with whatever treatment I had given her.
  85. Exam demonstrates a chile who is modestly febrile.
  86. Basically what happened is she hit her right knee against her chin, biting her tongue causing her neck to be thrust to the left. Now she has pain in her left arm.
  87. He is employed as electrician but does not really remember any specific incidence which could have precipitated his hemorrhoidal problems.
  88. The patient has chest pain if she lies on her left side for over a year.
  89. On the second day the knee was better and on the third day it had completely disappeared.
  90. The patient has been depressed ever since she began seeing me in 1983.
  91. The patient has left his white blood cells at another hospital.
  92. She slipped on the ice and apparently her legs went in separate directions in early December.
  93. The patient left the hospital feeling much better except for her original complaint.
  94. Because of her complaints we gave her an endoscopy so she could look into the problems she is having.
  95. The patient complains of post-coital spitting.
  96. She now wears a 42, cup size 8 bra. She may ultimately be a candidate for reduction.
  97. She was the belted driver in the back seat.
  98. He does want the TV louder than his wife.
  99. The patient was found to have an extremely small facial nerve for the size of his body.
  100. This is a 48-year-old white female black lady.
  101. 19-year-old vehicle involved in a female accident.
  102. When not inebriated, we have always found David to be a delightful and cooperative person.
  103. Elderly male, seeking physician with hearing deficit.
  104. Otherwise, I have recommended rechecking in a few weeks just to make sure that the ear is completely gone.
  105. She has breast-fed the baby with frequent loose stools.
  106. She was the driver of a car that was seatbelted and turning left . . .
  107. She did have a female sister who committed suicide.
  108. Apparently the next day she developed this rash on her hands, and the feet had gone away.
  109. Would like for mom to contact me in about a week to seven days if it is not a lot better.
  110. "It should be noted that from now on ________ will be weighed with gown and panties only.
  111. At work yesterday, she was lifting a 5-gallon bucket of pain.
  112. Last time he ate was about 8 hours ago when he had a bowel of cereal.
  113. She was seen at Sacred Heart emergency room last night for an episode of profound weakness and lightheartedness.
  114. She is under some increasing stress in her household due to the presence of three teenagers.
  115. His appetite, as far as his parents are concerned, is probably normal in terms of volume, but he is the worst eater of the mother's children.
  116. A 78 year old woman told her PCP "I just KNOW I have BEGONIA".
  117. This man says that he thinks he has a sinus infection. Recently, he laughed with his mouth full of lasagna and got some of it up his nose.
  118. This man was seen by me a month and a half ago and got over it.
    Forwarded from Frieda Norris.

Global Medical Transcription
I checked out quite a few schools when I was looking. At the time the range was from around $700 for tapes to around $5000 or more for one of the more well-known schools. GMT was $2500. I had read on one of the boards that doing the tapes unsupervised, without anyone to explain things or ask questions of, was not a good idea. I thought that made sense.

I wanted a school that would train online and train in the use of FTP, etc. All the work was done via FTP at GMT.

I wanted a school that had some kind of placement program. GMT did, & I got hired by Medquist a couple of days after I graduated. I stayed there for about 9 months, then moved on & have been working ever since. I think the course was 6 months. It was not self-paced; you had to keep up. I was at my computer for at least 8 hours a day.

I liked GMT just fine. My instructor was great, there was some virtual classmate comaraderie, they encouraged us to use a word Expander right away, provided us with software & books. Everyone was nice & helpful, including the people working in accounting & registration, among other contacts.

I did check out a local community college that had an MT program. They had a prerequisite course that was not available until Fall (this was in April or so). You could not take any other classes until you had taken this one, & you could not take any other classes concurrently. I remember estimating that it would have taken me more than 3 years to get through the program. The JC was cheaper, but not when I took 3 years of living expenses into account. I decided to go the shorter, full-time, more expensive route because I wanted to be working sooner.

I liked GMT & am glad I went through their program. But they were hard to find, didn't advertise much, & now I think they went out of business. I just tried their web address & the link was dead. It's not because it was a bad school. It's just that no one knew about them.

Medical transcription is like learning a sm
foreign language. It takes years and years to become fluent and able to transcribe whatever comes through your queue. Also required are excellent spelling, grammar and punctuation skills as well as computer skills.

Nowadays, the majority of dictators have thick foreign accents which make it difficult for even the most experienced MTs. It has become a situation of translate and transcribe!! You really need to know your stuff.

That's the medical transcription industry
Which is probably why, when someone with 15+ years of experience applies with these companies, they get a big song-and-dance about being 'not quite what they were looking for'. That is, if they even hear back from them at all.

Non-medical transcription rate.
Does anyone charge an hourly rate to do non-medical transcription? If so, could you please tell me how much? I just got a job offer to do non-medical transcription, but she wants me to give her an hourly rate. Any info would be appreciated. Thank you.
Anyone have ADHD/ADD and do medical transcription?
If so, how do you keep focused?  I have a really hard time with this.  Are you being treated?  If so, what has worked or not worked for you?  TIA
FYI - this is a medical transcription board,
Yer preachin' to the wrong congregation.
medical transcription service owner. nm
Medical Transcription Service Owner :D
When you do not know, you should ask and you are not an idiot! :)
iTran medical transcription suite??

Does anyone type in this program for a company called DRC, Digital Records Corporation.  If so, can you tell me some about it, and possibly give me a web site so I can check it out to see what it is like?


MTSO stands for Medical Transcription
Service Owner and that is what Nationals are so, no, there is no difference. Not a dumb question at all!
Indian Association for Medical Transcription?
I hear you. It is to bizarre to see that the only way AAMT can continue to exist is because of their financial support from the Indians - HELL-O - last I checked wasn't it American Association for Medical Transcription? Ok, let's see, maybe if I transcribe work for France I can get certified there even though I live here, no I think the Australia sound better, oh wait... I like Thailand, maybe I can .....
Medical Dictation Transcription Company
Is anyone familiar with the transcription company Medical Dictation or know anything about them?