Thursday, September 20, 2007

Good Pill Hunting

When Blue Shield recently announced plans to raise my health insurance premiums by 71%, I had no choice but to switch to another health plan. As much as I may have liked my primary physician, I wasn’t willing to pay an extra $3,000 a year just for the privilege of seeing his face. As soon as I had been enrolled in my new health plan (one of California’s largest and most popular HMOs), I received some very impressive brochures in the mail detailing what Kaiser Permanente does to protect my privacy. A lot of effort went into producing these brochures. The artwork was outstanding. I’m sure the text had been carefully vetted by Kaiser’s attorneys. And yet, when I arrived at its facilities for my orientation session, I couldn’t help but chuckle. New Kaiser members entering the conference room were being asked to sign in using a form that requested their names, phone numbers, and medical record numbers.

It didn’t take long for my curmudgeonly streak to find its voice. Requesting a private moment with the women who were in charge of the orientation session, I asked if they were aware that they were in direct violation of the new HIPAA regulations (anyone in that room could have picked up the clipboard and walked off with nearly a hundred names and medical records numbers). They were genuinely startled when I suggested that they report this breach of security to risk management.

My niece, who is now training employees at another HMO ran into a similar level of healthcare-related naivete. Her boss, who doesn’t understand why trainees can’t just listen in on real-time calls from HMO members, had to be reminded that such electronic eavesdropping would be a definite violation of the new HIPAA rules aimed at protecting the privacy of the HMO’s patients.

So let’s all ask the obvious question: If the HIPAA regulations go into effect in a forest and nobody hears, are they still valid?

I raise this issue because, as the medical transcription industry continues to expand overseas, the question of context becomes more and more important to the act and art of transcription. One of our occupational hazards is that the right word in the wrong context can cause a critical error in medical documentation. If a transcriptionist doesn’t even know where or how to look something up, then clarity of context is at stake.

Why have shows like “Murder, She Wrote,” “Law and Order,” “Diagnosis: Murder,” and “CSI” been so popular with audiences? It’s not just because people like to solve puzzles. It’s because they want meaning to accompany the facts that are put before them. They want to understand how the pieces of a puzzle fall together -- how one fact relates to another -- so that they can take that knowledge and apply it to new challenges.

As some readers may know, I come from a family of teachers and librarians. Our family sport was not baseball, football, or tennis. It was called “Go look it up.” As a result, websites like (where one can search for cheap airfares) are more fun for me than a video game. Why? Because I have to put some of my own imagination and forethought into creating new and interesting permutations. I can change my gaming experience at will – if I know where my mind wants to go. It’s not enough to know that the information is out there. Figuring out a way to put it to use is a way to stretch and tone your mind’s muscles.

As the folks at Cunard Line used to say,“Getting there is half the fun!”

The wealth of information on the Internet is a godsend to medical transcriptionists who can now do a great deal of their research online while attempting to clarify a physician’s dictation. Sometimes MTs must think way outside of the box – even if it involves using a wild card search to identify a drug that is being mispronounced. Many of us struggle with the challenge of “It’s not what he’s saying -- it’s what he could be saying – that matters.”

"Librarians are not just good at Internet searching because we understand how to play word games,” writes Marylaine Block. “We're good because we know where we need to go and the quickest routes for getting there; we are equipped not just with compasses but with mental maps of the information landscape.”

Alas, such research skills and semantic derring-do are not what one hears being valued these days in the medical transcription industry. Cost per line, TAT, and offshoring are at the top of the list. Quality assurance rates pretty high. The new HIPAA regulations get a lot of attention. But being able to figure out what a doctor meant to say?

Easier said than done.

As one cruises around the various medical transcription newsgroups, message boards, and mail lists, one frequently encounters requests for help from newbies (as well as from veteran transcriptionists) who are struggling to decipher a doctor’s garbled speech or identify a new or foreign drug. Thus, it was quite heartening to encounter a post from an aspiring MT who described her ongoing efforts to devour word lists, read through archived files, and study sample reports. When new terms were posted, she would read them, copy them, and paste them into a document on her hard drive.

This woman, interestingly enough, insisted that the most valuable thing she had learned from the online medical transcription community was how to do her research. She would go through all of her books in search of answers. If her effort yielded no solutions, she would then search for an answer on the Internet. If she still came up empty handed, she would go back to the original post which had sparked her investigation to see if someone else had already answered the question. In doing so, her aim was not to find the answer itself, but to understand how and where the correct answer could be found.

Her conclusion? “Any newbie should know that thousands of dollars of reference materials are useless if you don't know how to reference, cross reference, and reference some more! Anyone that does not realize this wants to be an MT for a job, not a career.”

The ability to conduct research by using a variety of sources is an invaluable strategic weapon in a medical transcriptionist’s arsenal of databases and books of mass instruction. While it’s great to have all kinds of data at your disposal, if you don’t use it wisely, you can get into trouble. Sometimes the answers one receives are not the answers one hoped to find (one of this year’s greatest research-related tragedies was the discovery of how much data had been tampered with or “sexed up” in order to sell the war in Iraq).

Trying to see through our own intellectual prejudices can be painful. Accepting only the facts we want to believe without questioning other possibilities is counterproductive. That’s why the emphasis on speedy turnaround time can so easily jeopardize the integrity of transcribed reports. Thanks to high speed Internet connections and a new crop of powerful search engines, the answers to many of our questions can be found with startling rapidity. And yet, if the pressure to deliver reports according to increasingly narrow deadlines prevents medical transcriptionists from researching an arcane piece of medical terminology -- or the name of a particular medication -- the patient can suffer what is known in the legal field as “great bodily harm.”

Who says irony is dead?

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