Sunday, September 23, 2007

The Long And The Short Of It

Anyone who has worked in a kitchen understands the value of preparing certain foods so that, when it’s time for them to be added into the cooking process, precious time isn’t wasted. When cooking with a wok, it is especially important to have your vegetables chopped, meat sliced and seasonings pre-measured so they can be tossed into the mix in rapid succession in order to effect a successful stir fry.

Multiply that process by thousands of meals and it should be evident why so many restaurants depend upon food processors to slice mushrooms and peppers, chop onions and garlic, pre-bake mini-loaves of bread and prepare a wealth of other foods to be used during the course of an evening’s service. Sauces and salads are often prepared in advance. Some dishes (like scalloped potatoes) are preheated so that, once the restaurant fills with customers, the kitchen can function as smoothly as an assembly line.

The prep work done in advance of a meal’s food service usually takes place behind the scenes, invisible to the consumer whose primary concerns are presentation, ambience, taste, and smell. Any customer who is rude --or stupid enough -- to suggest that he should get a reduced price because his carrots were julienned with a food processor earlier in the day (instead of being cut as soon as he placed his order) deserves to be booted out the door and told never to return.

Nevertheless, the medical transcription industry is often confronted with clients who think they should not have to pay for words that have been placed into a dictated report through a transcriptionist’s intelligent use of macros and/or word expanders. Such clients routinely balk at the idea of paying for spaces between words -- or the extra keystrokes required to create a blank line between two paragraphs. These penny-pinching cretins want every benefit of the industrial, technological, and informational revolutions without having to pay for it.

Guess what? They’re wrong!

As we all know, you get what you pay for. And if you’re not willing to pay for the prep work that goes into producing an acceptable product, then you shouldn’t be entitled to a product you can’t or won’t pay for. So let’s just cut the crap and talk about what a word expander does, how a word expander can be used intelligently to boost any typist’s productivity, and how medical transcriptionists can improve their work product by relying on the versatility of a good word expander.

Think back to the days when Clark Kent, Lois Lane, and Jimmy Olsen were working at the Daily Planet. Back then, secretaries had to learn something known as“shorthand.” Whether they were schooled in the Gregg or Pitman technique, shorthand allowed them to use a series of codified signs to take down someone’s spoken words and later type them up in the original text. Shorthand used specific symbols as linguistic algorithms. It was a process similar to compressing an electronic file into a *.ZIP file and then unzipping the compressed file back to its original size and format.

Court stenographers – later known as certified shorthand reporters– used Stenotype machines to convert speech to text through the use of typed “short forms” which could be read back to the court (or dictated to a transcriptionist) by the CSR in the original sequence of spoken words. As computers entered the court reporting industry, CSRs were able to use their Stenotype machines to type short forms onto a cassette tape. This tape could then be played back into a computer to speed up the transcription process. While this greatly reduced turnaround time on court documents (thus eliminating a major profit center for transcriptionists), the system of using short forms that convert to long forms has remained intact and developed popular new applications.

The basic principles for creating medical terminology short forms are very similar to shorthand (one takes the prefixes and suffixes used most often in medical terminology and develops ways to codify them so that one can expand certain terms using a minimum of keystrokes). A word root like “ampu” can be expanded to “amputated,” “amputating,” “amputation,” or“amputates” by typing “ampud,”“ampug,” “ampuj,”or “ampus.” Similarly, suffixes like “ology,” “otomy, and “ectomy” can be systematically added onto a word root by adding a single letter to the short form.

It didn’t take long for one egomaniacal soul to insist that her list of nearly 40,000 short forms should be memorized and used by everyone else. Her puritanical rigidity only helped to clarify the strengths of any word expander’s customizable features for users who have different needs. The sad truth is that many of this woman’s short forms were of absolutely no use to me. And when she suggested that I devote an hour each day for the next year to memorizing her short forms, she was not very happy with what I suggested she might do.

Not all medical transcriptionists handle the same type of work. Some MTs have clients who specialize in only one or two areas of medicine. Some do operative reports, others do Workers’ Compensation Evaluations. And some MTs are rather ornery critters who have a real problem with authority figures.

But for those MTs with even the slightest amount of imagination, a word expander can relieve the boredom of listening to a rambling physician by transforming transcription into a word game. It is much easier to type three letters (EGD) and have them expand with clinical precision to “esophagogastroduodenoscopy.” With minimal effort COPD expands to “chronic obstructive pulmonary disease” and ERCP expands to “endoscopic retrograde cholangiopancreatography.” While all this is happening, the MT is adjusting to a new work rhythm or “beat” which is quicker, more entertaining, and makes the shift go by faster.

The use of a word expander offers many critical advantages. Popular programs like Shorthand For Windows are highly customizable. One can create multiple word lists for different accounts. The extensive and creative use of short forms leads to fewer typos, transpositions, and other mechanical errors that might slow down a word processor’s spell checker. Last, but not least, solid and steady use of a word expander increases one’s productivity by as much as 30%.

Some MTs have clients with distinctly personal challenges that can be conquered through the intelligent use of a word expander. Take, for instance, the case of the stuttering Chinese physician. The easiest way for me to help him address each consultation letter (without making me want to punch a hole in my office wall) was to assign a short form for each address he used on a regular basis. Thus, whenever CC8 was dictated, my word expander would substitute the following address block:

Collin Leong, M.D.
929 Clay Street, Suite 301
San Francisco, California 94108

A neurologist who liked to affix a boilerplate paragraph at the end of many reports was asked to request that the transcriptionist use the “JG1" short form in order to insert the following text:

“The patient was informed that the headache studies involve treatment of headache per the consent form. The patient is aware that MRI scans or other diagnostic studies will not be performed as part of this headache study plan, except as indicated in the consent form. The patient is also aware that we can give the patient 90-94% assurance by virtue of the history and examination that there is no intracranial abnormality. The patient is aware that MRI scanning would be necessary to obtain 98- 99% assurance that there is no intracranial problem, and that any intracranial abnormality would be unrelated to a longstanding headache problem.”

How does a word expander affect billing? MTs paid by the keystroke will instantly complain that they are being cheated out of money. Clients who are billed by the line will instantly complain that they are being gouged for extra lines. And MTSOs who bill their clients by the minute of recorded dictation time often kick themselves because they fear they are losing countless dollars by allowing certain clients to use short forms.

These people are all missing the point.

Short forms are used to make the work process easier to perform. If productivity increases by 30%, you still earn more money. If the frustration level decreases by 30%, you go home happier at the end of your shift. And in case anyone forgot, if the client’s work process becomes easier, he is more inclined to pay you on time and refer business to you.

For many medical transcriptionists, knowing how to make effective use of a word expander program is reallya question of determining what short cuts an MT can get “into her fingers” as she continues through the work day. As one gets accustomed to a particular physician’s speech patterns, it makes perfect sense to create a short form named ASNOY which will expand to “Abdomen was soft, nontender, no organomegaly.” Short forms become particularly helpful for certain standard phrases like“year old Caucasian woman” (YOCW), “year old Hispanic male” (YOHM), “year old Vietnamese female” (YOVF),“year old Japanese gentleman” (YOJG), etc.

Naming short forms requires an extra bit of creativity when confronted by multiple terms that can be abbreviated with the same short form. In such situations, adding a number to a two-letter short form is often easier than trying to remember numerous permutations of the letters contained in the long form. For example, “US1" can stand for“United States,”“US2" can stand for "ultrasound” and “US3" can stand for“ultrasensitive.”

One very quickly learns to avoid using standard English language words as short forms. All it takes is having a proofreader shove a report under your nose that says “At that point, she began to shortness of breath violently, crying that no one understood her problems” to get the message. Here’s one of my favorite mistakes: “The patient was the passenger in the front seat of a carcinoma.”

Mea culpa! Mea culpa! Mea maxima culpa!

Similar precautions should be taken with proper names. Would anyone like to guess what short form was used to type: “Patient name: Abdominal Examination Jones”?

Sometimes, in switching word lists from one account to another (or substituting for another transcriptionist) the slightest variance in short forms can produce hilarious results. Most MTs would routinely use BM as a short form for “bowel movement.” You do not want to be the unfortunate soul whose report goes into the chart and states: “The patient complains that she has not had a black male in three days.”

Regardless of which word expander program is chosen, once they have gotten the feel of short forms into their fingers, few medical transcriptionists are willing to work without a word expander. The laughter over medical bloopers fades as one continues to edit and refine a list of short forms. For medical transcriptionists and production typists, the creative use of a word expander program is a strategic form of preventive medicine which should be considered an ergonomic defense against repetitive stress injuries.

From a risk management standpoint, the price of making word expanders available to employees is a no-brainer. Any employer who fails to understand that purchasing and installing a word expander program is infinitely more cost effective than having a qualified medical examiner (QME) rate an employee as a qualified injured worker is a damned fool!

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