7 Considerations for Successfully Outsourcing Medical TranscriptionBy Adele Field | ZyDoc
If your facility is evaluating either switching to a new medical transcription service organization (aka “MTSO”), or outsourcing to augment in-house transcription operations, here are 7 critical areas to consider.
- Cost and efficiency
Salaries and employee benefits for in-house transcriptionists are obvious factors that may tip the balance in favor of outsourcing. Volume fluctuations also affect costs, as well as efficiency. A spike can produce a backlog that delays transcription turnaround and claims submission. A lull means downtime during which compensation must still be paid. A transcription service that offers 24/7 availability, and most do, can accept any amount of dictation at any time and return the transcription according to schedule. You pay only for the work performed.
Takeaway: An MTSO should have scalable staffing capability to accommodate extra volume without a hiccup in either quality or turnaround.
Costs for medical transcription are usually per line or per visible black character (VBC), because these methods are easy to calculate and verify. Extra fees for rush turnaround (“stat”) will likely apply. It is less typical, but possible, to find services that charge per minute of dictation, per hour of work, or per page. A quick Google search will immediately give you many options, but do some homework before selecting the lowest price. A low-ball rate may not be worth the headache of having to make constant corrections to work done by poorly trained, inexperienced typists. Responsive customer service is another differentiator.
Takeaway: Evaluate quality as well as price. Ask about the qualifications of the transcriptionists who will be assigned to your account, and dictate a report as a test of skill, pricing, and customer service.
- The technology, and technology requirements, have changed
Everyone realizes that use of paper documentation is decreasing and will likely vanish in time. Even standalone word-processed documents are becoming obsolete, because they do not work well in EHRs. Cassette recordings are a thing of the past, and CDs and DVDs are inefficient because they must be hand-carried or shipped. It is now common for transcription services to use a cloud-based, HIPAA-compliant platform to accept dictation, route and track jobs, and return encrypted transcription files that can be reviewed, electronically signed if desired, printed, and attached to the EHR. User search capabilities and custom reporting are other commonly available features. A limited number of MTSOs with high-tech capabilities can insert transcribed text directly into the EHR. Recently, natural language processing (NLP) has emerged as a technology for extracting structured data from dictation, thus enabling automated population of discrete EHR fields, computer-assisted coding and billing support, clinical documentation improvement, research, analytics, and structured reporting.
Takeaway: Transcription services are now mostly web-based, rather than hard-media dependent. State-of-the-art MTSOs can offer EHR population and structured data services in addition to transcription.
- Equipment and investment
A wide range of dictation devices gives users the freedom to dictate from any location using an existing phone, smartphone or tablet. Most transcription services will also accept files uploaded from USB handheld recorders, but the data must be encrypted. Transcribed files will be returned in RTF or Word-compatible format, and will be printable to a standalone or network printer.
Takeaway: Existing equipment and software may be sufficient for dictating and printing, requiring little or minimal investment, but any device and workflow for transmitting dictated PHI must support strong encryption for security and HIPAA compliance. A dedicated smartphone app may require a one-time purchase or fee-based license, or be included with your account at no cost, depending on terms of service. Enterprise-level network dictation systems are custom installations that are beyond the scope of this discussion.
Web-based transcription services that use FTP for file transmission put your data at risk because FTP servers are vulnerable. A secure transcription platform should prevent contractors from exporting audios, PHI metadata and transcribed documents out of the platform. To be fully secure, there should no “off-site” storage of patient health information (“PHI”). From the original dictation recordings to the completed transcribed documents, all processes should be performed on protected servers within a secure data center. The documents themselves in every phase of their life cycle must be stored in encrypted fashion in the database in the data center.
Takeaway: Ask about security protocols in place before you hire a web-based transcription service. Do they use FTP? Do they use a certified, secure data center? Remember that your data is at risk if transcriptionists can download and share your audio files. For more information about transcription security, see zydoc.com/security. For more information about transcription security, see http://www.zydoc.com/security/.
- How it works
- To initiate service, the MTSO will gather data from you for any options you need such as headers, templates, letterhead, and electronic signature.
- You will need to provide lists of system users and their level of authorization if applicable (“administrator,” “dictating author,” etc.); lists of referral physicians if any; patient demographics; and any special instructions.
- You can expect to sign a Business Associate Agreement (BAA) to ensure confidentiality. You will need to authorize a credit card or other payment form.
- You will be assigned dial-in or log-in credentials with an ID and password, and will be provided with instructions and training to use the system features you have chosen.
- The MTSO will provide a list of prompts if applicable for such functions as Record, Start, Pause, Overwrite, Stop, Flag as Stat, and Send.
- After you complete your dictation by ending your call or uploading your file via encrypted transmission, your report will be transcribed and returned, again with HIPAA-compliant encryption, into a folder on your PC desktop or network, and/or inserted into your EHR.
- You will have the opportunity to review, approve, and optionally e-sign, or return the document for correction.
- You may also have the option to have your report faxed or mailed to a referring physician, or inserted into your EHR, depending on services offered by the MTSO.
Takeaway: In most cases after providing some initial information, you can be set up very quickly, if not immediately, to send dictation to a transcription service. Ramp-up for a medical group with multiple providers may take longer.
- On-shore or offshore
After the U.S., India and the Philippines account for the largest market share of the medical transcription business. An ongoing relationship with a U.S.-based company is the most reliable choice for high-quality accurate transcription and responsive customer service. The quality of documentation is in the details. Does the transcribed report make sense? Were medical terms AND standard English phrasing understood and typed correctly? Are there errors that change meaning due to mis-typed or omitted words? If you outsource directly to a foreign company, you may lower your costs by a few pennies per line, but you will need to dedicate more time to vigilant and constant review of the work, and probably make more corrections. Security can also be a concern.
Takeaway: Building a relationship with an established U.S.-based transcription service will provide the highest accuracy with fewest corrections over the long term. You will be able to communicate any concerns easily. The main benefit of choosing an offshore company is lower cost. Tradeoffs with offshoring may be issues of quality control, security, and communication that could actually cost you more in the long run.
- Bumps in the road
Speech is arguably the most natural way to communicate, so most clinicians find dictating clinical documentation easy and efficient. In an NIH-supported research study by ZyDoc, clinical dictation was shown to be an average of 2.5 times faster than typing. Although speaking is a more natural modality, good speech habits when dictating may need to be learned. Sub-par transcription accuracy might stem from audio that is hard to hear or from dictation characterized by a heavy accent, although competent transcriptionists take professional pride in their ability to understand and transcribe difficult dictation. As a transcriptionist gains familiarity with your dictation style, these types of problems should disappear. In a multi-provider facility, network security might present an issue, but technologically advanced MTSOs are experienced in handling these challenges and working with in-house HIM staff to find effective solutions.
Takeaway: Using a transcription service is generally a smooth experience to begin with, and improves over time as the transcriptionists become familiar with your account.
- Getting the best performance from your MTSO
The most important factor in getting high-quality, accurate transcription is by dictating clearly, but it is not the only factor. For a list of ways to optimize your transcription results, see our blogpost, 21 Tips for Getting Accurate Transcription.
Takeaway: Getting good transcription is a two-way street. Careful dictation is critical.
“Roadmap for Outsourcing Transcription” Copyright ZyDoc 2017
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