Twenty Years of Transcription

Aug. 10, 2015 / By Jill Devrick

Twenty years ago, I began my journey in healthcare documentation technology. I’ve been traveling up and down memory lane for the past few days, thinking about how the healthcare industry has changed, and healthcare documentation tools and processes along with it.

Back in the mid-90s, healthcare documentation was almost entirely created for paper, whether it be handwritten notes and forms or transcribed documentation. Many of the hospital medical transcription departments I visited at that time were transitioning from typewriters and fancier word processing units to networked workstations running our DOS-based ChartScript application. I remember transcriptionists being concerned because a computer-based transcription system could measure productivity more consistently and precisely than the manual methods employed with typewriters and word processors.

In that era, medical transcriptionists were usually employed by a healthcare organization and paid by the hour with benefits. The implementation of computer-based systems enabled productivity monitoring to ensure that each transcriptionist was meeting performance expectations, and sometimes they were paid an incentive bonus for productivity that exceeded expectations. Because transcription departments were in-house, the transcriptionists knew the physicians and the physicians knew them, so they were a part of the healthcare team. Organizations had a high level of control over who they hired to transcribe and edit healthcare documentation, and they were able to determine from individual skill sets, talents and preferences who would be best to fill various roles, whether it be staking out an area of specialization, conducting quality reviews of completed documentation, providing training on documentation best practices or taking on technical and troubleshooting roles related to documentation systems and workflow. At the time I thought medical transcription was a great career option for someone who had a lot of healthcare knowledge and wanted to support physicians and patients without taking on a clinical role herself.

But over the years, the medical transcription career path has become challenging to navigate. As technology continued to advance, healthcare organizations began to target medical transcription as an area to cut costs. Some organizations moved from hourly pay to production-based pay, and others gradually outsourced the transcription function until eventually the department was eliminated. Also during that time, back-end speech recognition technology came along, touted (but not necessarily proven) to increase productivity so significantly that transcriptionists could be paid less per line but still make the same amount of money per pay period. And then EHRs were brought into healthcare organizations with the assumption that medical transcription services could be eliminated because physicians could easily enter their own documentation using front-end speech recognition, templates, and typing.

Okay, I have a confession to make- I love technology and think it can be a wonderful tool for progress in healthcare organizations if it is well-thought and carefully implemented, but today I am putting my hat on as an advocate for the many medical transcriptionists (now known as healthcare documentation specialists) who have been through so much change over the past 20 years, and not necessarily for the better. Many of the myths associated with the new technologies I described above did not turn out to be true. For example, to tell a stellar traditional transcriptionist who types 100+ words a minute that she has a productivity problem when speech recognition does not yield a significant percentage increase is ridiculous. And yes, physicians now have tools to enter their own documentation, but at what cost, and who is supporting them in ensuring quality so they can focus on patient care?

Recently, AHDI convened a task force of transcription managers from healthcare organizations and medical transcription service organizations (MTSOs) to talk about compensation best practices for healthcare documentation specialists in today’s healthcare environment. They have created a “Compensation Best Practices Toolkit” that explains the implications of the various technological changes in health care on documentation practices and how that should translate to compensation practices.

From my own observations, I think one of the biggest misconceptions is that medical transcription is a data-entry production-based job, but in truth it requires extensive knowledge of medical language, disease processes, clinical procedures and much more. As knowledge workers, healthcare documentation specialists need the flexibility to do research, have conversations, troubleshoot issues and provide whatever support necessary to assists physicians in creating accurate, complete and timely documentation. Yes, they should have productivity standards, but productivity should never trump quality, especially when patient lives are at stake. Healthcare documentation specialists are a critical part of the documentation team, even if traditional transcription is being reduced in favor of newer documentation capture methods and support/QA roles.

Jill Devrick, product solutions advisor with 3M Health Information Systems, is Immediate Past President of the Association for Healthcare Documentation Integrity (AHDI).

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