Monday, September 24, 2007

The Shifting Sands of Industry

The travel industry is currently focusing attention on the spate of new 4000-room hotels opening along the famed Las Vegas Strip: Bellagio, Mandalay Bay, Monte Carlo, Venetian, New York, New York, etc. But as one approaches America’s fastest-growing city from the air, the amount of new residential construction dotting the landscape is simply mind boggling. Only in Las Vegas could productions such as Cirque du Soleil'sMystere” and “O” have theaters built to meet each show’s astounding specifications. Only in Las Vegas can a person look out from his hotel room window and see the Eiffel Tower, the Statue of Liberty, erupting volcanos, and battling pirate ships. If you can fake it there, you can fake it anywhere......... unless, of course, you’ve come to Las Vegas on business.

For the average MT, long hours spent sitting in front of a monitor while struggling to convert the garbled speech of dictating physicians into coherent medical documents often leads to a growing sense of isolation. The stark decor of today’s office cubicle makes it hard to believe that medical transcription -- which, for many years, was relegated to hospital basements -- has evolved into a billion-dollar industry in which emerging technologies and global economics weigh heavily on the bottom line. If one had taken to heart Deep Throat’s infamous tip to “Follow the money,” the path would recently have led MTs to Las Vegas, where the Medical Transcription IndustryAlliance (MTIA) celebrated its 10th anniversary at Caesar’s Palace in late April.

While the American Association for Medical Transcription aims to educate and boost the self esteem of individual medical transcriptionists, MTIA is squarely focused on the commerce of the medical transcription industry. With satellite technology and the Internet creating all kinds of possibilities for international trade, the 1999 conference focused attention on a wide variety of business and technology issues without ever losing sight of the fact that money makes the world go round. As usual, workshops were offered to educate medical transcription service owners (MTSOs) on how to manage a business more effectively through the intelligent use of financial reports, how to understand the value of one’s business and how to sell one’s business.

Like OPERA America and several other professional service organizations, MTIA grew out of a most informal and tentative gathering. At the invitation of Sally Pitman, a group of medical transcription service owners met in San Francisco ten years ago to try to find common ground where they could discuss issues facing their industry, solutions to problems facing their businesses, and start to network with each other. Wondering where such actions might lead, some of the people at that first meeting were extremely nervous about letting their guard down.

For several years MTIA remained an ad-hoc organization with administrative duties handled by Pitman through her company, the Health Professions Institute. But as MTIA’s ranks continued to grow, the organization achieved critical mass and incorporated as a nonprofit. Through the dedicated efforts of a committed Board of Directors and two hard-working Executive Directors (Catherine S. Baxter followed by Molly Malone), MTIA now stands as a valuable professional service organization that is rapidly maturing while coping with a quickly-shifting power base within the industry. Membership is at record levels (as was attendance at the annual conference).

This year’s conference theme -- “Classic Questions, Better Answers” -- reflected a solid menu of workshops and discussion groups dealing with such relevant issues as standards of quality assurance, business management, marketing tips and human resources. During the opening session, as Sally Pitman described the history of MTIA’s growth to attendees, it was curious to note that her presentation -- essentially an oral history of an industry -- had never really been preserved in print. Even Executive Director MollyMalone (who had been involved in the organization since MTIA’s birth) expressed her shock at hearing the story told in its entirety for the very first time.

Pamela K. Wear, former President of AHIMA, did a superb job of outlining better ways to communicate with HIM Directors for marketing purposes as well as to improve day-to-day operations. One of the most moving, honest, and truthful presentations was Ellen Drake’s tips on how to effectively work with offsite transcriptionists to improve scheduling, communication, retention, and quality assurance.

Workshops ranged in style from panel discussions to solo presentations; from informal chat rooms to lavish networking receptions, lunches and dinners sponsored by such loyal MTIA vendors as Dictaphone Corporation, Digital Voice, Inc., Lanier Worldwide, Inc., Crescendo Systems Corp., and StatEnterprises, Inc. But with technology driving change, the really hot issues centered around voice recognition, Y2K, and the use of the Internet to transfer sound files to remote transcriptionists. Not only did the government of Barbados have a booth in the vendor’s showroom, about 20 Indian and Pakistani entrepreneurs attended MTIA’s conference. Their enthusiasm and interest was palpable.

More than ever before, the MTIA conference offered an opportunity for MTSOs to interact with vendors and learn about emerging technologies. At this year’s conference many vendors delivered strong presentations which were carefully tailored to the needs of the medical transcription industry. Microsoft’s representatives laid out a pretty impressive game plan of how they are attempting to use networking software to improve data flow, linkages and communications within healthcare facilities. But to my mind, the best technical presentation came from Ken Kloss of BCB Voice Systems, Inc., who smoothly and clearly articulated the process by which voice files can be moved over the Internet.

Voice recognition technology received quite a bit of attention, with the general consensus being that MTs shouldn’t run out and quit their day jobs. I found it particularly interesting to note the differences between presenters who had taken the time to learn and understand how a transcriptionist works with language as opposed to those who were so totally infatuated with their technology that they were blind to some dangerous flaws.

A grandly humorous and energetic speaker – who also does seasonal work as Santa Claus -- came from Communication Skills For Government and Business. David Hirt knew his audience and how to play up to them. Masterfully recreating Victor Borge’s classic routine about phonetic punctuation (which is available from Sony Masterworks on CD# MDK48482), he had the audience eating out of his hand and laughing at the challenges which confront anyone trying to understand the structure of the English language. By contrast, the presentation from Lernout & Hauspie did a remarkable job of talking down to the audience while attempting to gloss over voice recognition’s critical inadequacies.

One serious cause for concern was the suggestion that voice recognition should be able to handle so much of a transcriptionist’s work (and achieve accuracy rates of 90% or more) that a transcriptionist would only need to quickly scan a document to spot any mistakes. Questions were raised about:

  • The fact that a transcriptionist still has to listen to the entire sound file in order to proofread the work performed by voice recognition (Where’s the savings in time?)

  • On-screen editing can easily fall prey to “lazy eye syndrome,” which often fails to catch important errors (Where’s the savings in accuracy?)

  • Many transcriptionists are instinctively editing out material as they transcribe; with voice recognition it would take more work to delete unnecessary verbage and reformat a report -- thus causing people to actually work harder to be less productive (Where’s the savings in keyboarding?).

  • With an emphasis placed on using MTs as editors and proofreaders – and perhaps devaluing their compensation because they were no longer performing traditional transcription – what would prevent hospitals and other employers from assuming that entry level clerks are capable of proofreading transcribed medical documents?

There were occasional bittersweet moments of human folly. One service owner shared the sad tale of learning about the MT who, for two solid years, had arbitrarily been leaving out entire sentences that she didn’t agree with or couldn’t understand. One person (who is not a service owner) expressed her sincere, if somewhat misguided hope that more employers have chaplains available on staff for their MTs. Several of MTIA’s board members stressed that people should not believe everything they read on Internet message boards devoted to medical transcription.

Weak points in some presentations were highlighted with glaring brilliance as some people relied a little too heavily on their technology. There’s nothing quite as impressive as a slick Powerpoint presentation that has too many typos in it (especially if the audience consists of seasoned medical transcriptionists) or the product demo that fails to work in front of an audience that is keenly interested in using a new cost-saving technology.

While Star Wars fans eagerly awaited the release of The Phantom Menace, conference attendees couldn’thelp wondering about “the phantom transcription service.” In recent years, one publicly-traded company (MedQuist) has acquired most of the 900-pound gorillas in the medical transcription industry (Transcriptions Ltd, The MRC Group, Secrephone, Digital Dictation Inc., and Lanier’s Medical Transcription division). MTIA boardmember John A. Donohoe, Jr. chose not to attend the conference because he was busily preparing MedQuist’s secondary stock offering. But as one streetwise attendee wryly noted, “Look at the size of the businesses that are here and then ask yourself why he would participate? There’s nothing left for him to buy!”

The fallout from the recent mergers and acquisitions accomplished by MedQuist and Rodeer will have a fascinating effect on reshaping MTIA as a grass-roots service organization. Although today MedQuist employs more than 6,000 MTs across the nation, it now has only one vote in the organization. So does Rodeer. What this does is force MTIA to concentrate on servicing the bulk of its membership – medium to small-sized transcription firms – while tackling some political consciousness-raising tasks and acting as an information provider to media and other outside forces which seek data on an industry of increasing importance to health carein America.

One thing’s for sure. The volume of work has grown so huge that there is apparently more dictation than anyone can handle. To make matters worse, there is a severe shortage of qualified medical transcriptionists. With too much work on one side of the equation and too few people to handle it on the other, the obvious question to ask is: How have rates managed to stay so low? And whether sending work offshore will continue to keep rates down instead of letting the market push them up – where they need to go -- if MTSOs are to remain competitive and meet the rising costs of technology and labor.

Two new board members were elected at the conference’s final session, MTIA’s annual business meeting. DeLaine Russell (Vice-President of Healthscribe,Inc. in Sterling, Virginia) expressed a strong desire to help MTIA take a more pro-active role in lobbying Congress. And Joseph “Jay” Cannon (Senior Vice-President of Operations for Network Health Services in Brentwood, Tennessee) stressed his passion for the medical transcription industry as one of the strengths he would bring to MTIA’s Board ofDirectors.

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