San Diego MT Discovers Missing Link

In 1962, when Who’s Afraid of Virginia Woolf? premiered on Broadway, playwright Edward Albee used new dramatic techniques to bore a hole into the American psyche. Unlike classic Greek dramatists who favored the use of a “deus ex machina” -- or mystery writers who thrived on revealing hidden pieces of evidence – Albee shattered the illusions of an alcoholic couple trapped in a miserable marriage by allowing one partner to call the other’s bluff with devastating accuracy. As an evening of drunken debauchery and dysfunctional party games (Humiliate the Host, Get the Guests, Hump the Hostess, Bringing Up Baby) wound down, Albee’s shrewd and shrewish Martha sighed “Truth or illusion, George. Doesn’t it matter to you...... at all?”

A pertinent question, indeed! In April, the Medical Transcription Industry Alliance held its annual conference in Seattle, a city that had recently been rocked by a sizable earthquake. Over at Seattle’s Pacific Science Center, “Titanic: The Artifact Exhibit” invited visitors to touch a wall of ice upon which a series of hand prints had been fashioned. The bone-chilling sensation made it shockingly clear that, instead of drowning, most of the 1,509 people who perished in history’s greatest maritime disaster succumbed to hypothermia after being exposed to the icy waters of the North Atlantic. As the MTIA conference got underway, an unsettling theme started to emerge through a pattern of acutely painful reality checks. Like Albee’s searing drama, the conference forced participants to confront some appalling truths and/or prepare to dump a bunch of tired illusions that have haunted the transcription industry.

• After 18 years as the driving force behind the American Association for Medical Transcription, news of Executive Director/CEO Claudia Tessier’s sudden resignation provoked emotional outbursts ranging from deep concern about AAMT’s future to ecstatic war whoops (a former AAMT President was seen clicking her heels in the air to express her delight). However, finding someone who can replace Tessier and breathe new life into AAMT will be a daunting task. What will the future bring for AAMT? Truth or illusion?

• News spread quickly that, as a result of acquiring an ASP company named Speech Machines, industry giant Medquist had gained access to competitors’ client information which had been resting on the Speech Machines servers. As Medquist tries to redefine itself as a technology company, many MTIA members wonder how soon that company’s definition of “free market competition” will start to resemble Microsoft’s monopolistic arrogance. Will MTIA’s Board of Directors take action with regard to the predatory practices of the industry’s largest medical transcription service? Truth or illusion?

• In yet another demonstration of the supposed wonders of speech recognition technology, a representative from Dictaphone/Lernout & Hauspie went through the text she had dictated three times without catching a simple grammatical error. When asked why she had not fixed this error, she stated that she had seen it and should have corrected it, but was in a rush to finish her presentation. Truth or illusion? MTs don’t have that luxury. For a real eye-opener on the continued woes of Lernout & Hauspie and the future of speech recognition, read about Lernout & Hauspie's Continued Woes.

• Joe Weber’s article entitled “Speech Recognition: Is It Ready for Docs?” raised an important question: Can users of speech recognition safely rely upon statistical analysis of performance if SR fails to understand context? Editing SR-generated documents can easily cause a lazy eye syndrome among editors which leads to easy distraction and diminished concentration. If mistakes such as the one missed in the above-mentioned demonstration keep getting missed, will more serious mistakes metastasize throughout a patient’s medical record? Truth or illusion? If such mistakes are not caught in the process of editing SR-generated documents, could patients be harmed – or die -- from the use of speech recognition technology?

• After more than three decades of the women’s rights movement, and AAMT’s never-ending struggle to gain professional respect for medical transcriptionists, there are still female MTSOs who refer to their transcriptionists as “my girls.” Truth or illusion? Are service owners (instead of doctors) the real reason why MTs can’t get no respect?

A particularly hot topic was whether companies should look toward combining coding and transcription services as a way to broaden profits (the assumption being that medical transcriptionists already know enough to do coding). Truth or illusion? Unlike medical transcriptionists, coders have to pass a variety of exams and continuing education courses in order to maintain their licenses. Medical transcriptionists might not wish to embark on another learning curve with no guarantee of being financially rewarded for their efforts. There might also be strong resistance from the folks in AHIMA and other parts of the coding industry.

In one of the keynote sessions, William Young (President of Market Trends, Inc.) explained how the market assessment commissioned by MTIA to determine the size and scope of the medical transcription industry had tried to evaluate the different types of medical transcription services and the relationships they held with their clients. Estimating that the current market ranges up to $25 billion -- with an estimated 30% increase in volume predicted over the next two years -- Young tried to demonstrate how questions of satisfaction with regard to accuracy, quality, responsiveness, turnaround time, and cost often determine whether a national, local, or independent MTSO will offer the best match of services for a particular client. Young’s presentation left MTIA’s membership struggling to decide whether, once again, they were dealing with truth or illusion.

• In examining overall satisfaction with outsourced transcription, the sample size of Young’s market analysis found the impact of offshore transcription firms too small to allow for any future projections. Truth or illusion? Nearly 10% of MTIA’s membership now consists of offshore firms aggressively marketing their services to American hospitals and MTSOs while seeking positions on MTIA’s Board of Directors.

• If the rate at which companies represented on MTIA’s Board of Directors keep disappearing into Medquist’s hungry maw continues unabated, MTIA’s board will have a tough struggle to stay true to the organization’s rank-and-file membership. Truth or illusion? Now that Medquist has swallowed most of MTIA’s large members, small to medium-sized companies may have trouble finding the time and/or funds to participate at the board level. MTIA may soon face an identity crisis.

• Despite exhortations that the medical transcription industry must catch up to other industries which have quickly and easily surpassed us in embracing new technology, MTIA’s conference demonstrated with truly appalling visuals that an industry which stresses accuracy in healthcare documentation is doing a very poor job of proofreading its own materials. MTIA’s conference binder was filled with numerous mistakes and outdated information about its membership. Slide presentations and placards outside the conference rooms contained typos which should have been caught. Do we practice what we preach? Truth or illusion?

• An article by MTIA Board member Joe Weber which appeared in the conference binder included the statement “We wanna get the draft text as accurate as possible, so that minimal editing is required.” Truth or illusion? Any MT who submitted that text in a report would probably be fired. That kind of grammar causes MTSOs to lose credibility and lose accounts.

• Outgoing MTIA President Steve Dunkle’s presentation on the opportunities technology might bring us in the future resembled the Pentagon’s approach to spending billions on an unproven missile shield program. Is this the future MTSOs should embrace? Most of the people in the room represented small to medium-sized MTSOs that would be bankrupted by attempting even one small portion of Dunkle’s Star Wars vision. Truth or illusion? When push came to shove, Dunkle confessed that only one or two big hospital chains were thinking about this approach and that his presentation was mostly hypothetical.

In what may well have been her farewell appearance before the MTIA membership, Claudia Tessier (speaking with an adrenaline-induced fervor bordering on a Florentine frenzy) outlined the work being done by ASTM’s transcription committee and the relationships spawned with other organizations that impact the future of healthcare information management. The most eagerly awaited session, however, was Kathy Rockel’s superb and concise presentation about the new HIPAA regulations that had just gone into effect a week prior to the MTIA conference. Discussing the political process which brought HIPAA to its current state and HIPAA’s specific impact on the transcription industry, Rockel outlined key issues confronting MTSOs:

• Criteria for determining HIPAA compliance include low development and implementation costs relative to the benefits of using the HIPAA standard.

• The question of whether an MTSO is considered a business partner or a clearing house might have a huge impact in determining the size of penalties for failure to comply with the HIPAA regulations.

• The issue of claims attachments and how they are dealt with under the HIPAA rules and regulations will have a major impact in focusing attention on transcription’s role in profitability and reimbursement. Within two years there may be no more handwritten notes in patients’ charts with the possible exception of nursing entries and vital signs.

• In order for MTSOs to protect themselves and their transcriptionists from having patients knocking on their doors and insisting on their right to make changes in their medical records, revised contracts must stress that the MTSO and/or transcriptionist does not hold the final record.

• The financial impact of HIPAA compliance for MTSOs is expected to be 1-3 times the costs of preparing for Y2K. Most transcription services will find themselves needing to draft written policies and making changes in some operational procedures. One of the most pressing issues involves developing policies and practices for those who work at home.

• Compliance with the new HIPAA regulations will be enforced by the Office of Civil Rights. Truth or illusion? Since the Bush Administration has yet to allocate any extra funding to this office, the actual enforcement of the HIPAA regulations may result in nothing more than a photo opportunity for political purposes.

• A bill has subsequently been introduced to say that no rules are final until all of the final rules have been published except for the individual identifier rule or until 2004 (whichever is sooner). Truth or illusion? “It will be interesting to watch Congress respond to the cries from business about the cost of HIPAA and see where this one goes,” says Rockel. To stay abreast of further developments, she advises subscribing to a mailing list that can be found at HIPAA listserv.

A panel designed to demonstrate how educating MTs can increase the bottom line for hospitals and service owners was aided tremendously by the hard data provided by Elaine Olson of Stat Enterprises, Inc. This may have been the first time that anyone has actually tracked productivity in a work environment based on the impact of continuing education of MTs. Using her experience consulting with a regional hospital, Olson described the transformation of an in-house transcription team from a group of lethargic, unmotivated, underachieving MTs with a bad attitude to people who had more respect for themselves, were taking more interest in their work, and whose productivity had jumped as much as 80%! While the results of her presentation were inspiring, the question still remains: How long will the learning curve take to accomplish such results?

The answer was found in a small booth in the exhibit area where I came across a product that justified my trip to Seattle. In the process of touring vendor exhibits, one becomes a little numb to the strutting and hype coming from sales teams that make great promises but don’t always deliver the goods. When you come across the real thing, the blunt truth behind the product is so daring and refreshing that you sit up and pay close attention.

I don’t usually flip out over new software, but I think that Chad Francisco, the creator of Keymaster, should be given an industry award for the most innovative and thoughtful use of technology to help medical transcriptionists. I would urge everyone reading this article to visit the Keymasters website and order his demo CD. After viewing the intelligently designed and coherently scripted multimedia presentations on the demo CD, you will understand why Keymaster – a product designed by an MT who has an acute appreciation for how an MT works – truly represents this industry’s “missing link.”

Keymaster goes far beyond most word expanders. Its owner did a spectacular job of putting together the pieces of an MT’s work process puzzle and understanding the big picture. A Windows-based word expander that will work with any Windows application (it does not need to be linked to your word processor in order to function), Keymaster combines the use of established shorthand techniques for building short forms with a database of more than 450,000 transcription words and phrases which it calls the MEDb or MED Brain. Owners of MEDb receive daily electronic updates containing new drug names and other emerging medical terminology which can be added into the database with several keystrokes. Drugs appear with standard dosages; definitions are accessible from your keyboard.

Whereas traditional publishers of medical transcription reference materials have dragged their feet and been reluctant to publish their word list books in electronic format, Keymaster incorporates the vocabulary and definitions into a huge database that matches your keystrokes. Its suite of products shows people how to systematically create and use short forms so that they can earn as they learn.

I can’t speak highly enough of this product. But what excites me even more is what it can do for this industry.

• If incorporated into the curricula of medical transcription courses, Keymaster can probably do a faster job of training more people to become medical transcriptionists so that they are able to enter the workplace ready to perform at decent levels of productivity.

• Medical transcriptionists who are individual contractors will find this product boosting their productivity while saving them time researching new drugs and medical terms on the Internet.

• MTSOs and Transcription Departments that train their employees on this software will be able to process larger volumes of work with greater accuracy. If their employees have an incentive program, they will earn more money. Happier, more loyal employees build better team morale. Get it? Got it? Good!

• Quality assurance people will find their work at lot easier to perform; clients may also get greater accuracy in their documentation.

• As more and more productive MTs enter the American labor market, there will be less need to send transcription offshore.

In short, Keymaster offers a cost-effective, easily affordable, win/win solution for many of the problems facing America’s medical transcription community. In terms of earning a return on your investment, I would suggest budgeting for this product before anyone budgets for the cost of an AAMT membership. Why? Because embracing Keymaster’s technology will give MTSOs and medical transcriptionists the tools with which to quickly generate sufficient revenue to pay for AAMT memberships.

Truth or illusion? Don’t take my word for it. Check out this product yourself.