Health Information Management

Evaluate transcription and consider your options in light of recent technological advances

JustCoding News: Inpatient, July 21, 2010

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If you’ve been outsourcing your transcription but think there might be a better way to meet your needs in-house, you may want to take another look at some other options. You may have more than you realize.

Reconsider speech recognition

If she had to do it again, Cheryl Doudican, RHIA, executive director of HIM services at Mercy Health Systems of Oklahoma in Oklahoma City says she’d implement speech recognition “in a New York minute.”

Granted, speech recognition is a significant investment both financially and in terms of other resources such as time, Doudican notes. “When I first began obtaining quotes for back-end speech recognition, I was under the assumption that it was one of those things where you flip a switch and it just happens. But it isn’t like that,” she says. “It’s a completely different culture for the transcriptionists, a completely different way of doing things, and it takes time to change the culture.”

But the move eventually paid off for Mercy Health Systems. “We saw tremendous savings,” Doudican says. Before adopting the technology, Mercy’s Oklahoma City facility averaged a cost per line of 18–20 cents. After implementing back-end speech recognition, Mercy’s costs dropped as low as 11 cents per line. In addition, it eliminated outsourcing costs for almost four years.

“Before implementing speech recognition, we had approximately 16 transcriptionists and always ran a backlog that was handled by an outsourcing company, with the highest month’s cost being $60,000,” she explains. But the hospital was able to eventually eliminate outsourcing entirely and edit everything internally.

“Granted, the recognized cost savings took time; it most definitely wasn’t seen overnight,” Doudican says. To eliminate outsourcing, the hospital initially had to train traditional transcriptionists to become editors and add editors to the staff. But a year and half to two years down the road, Doudican saw major gains in cost savings.

Most, if not all, speech recognition product vendors will provide a written return on investment (ROI), which includes projected timelines on when you should begin seeing the benefits of speech recognition, says Doudican.

“And we actually exceeded the goals set for us and our ROI,” she adds. “But it is something you have to advocate for with your CFO and finance people.”

Mercy Health Center in Oklahoma City also deployed front-end speech recognition for its radiology physicians, which gave them the option to self-correct their dictation or route their dictation to an editor.

In terms of training your transcriptionists for the transition, you have some decisions to make. For one, you’ll have to decide how to pay transcriptionists who will take on the role of editors vs. standard transcriptionists.

Doudican opted to pay everyone the same amount per line. Otherwise, she wasn’t sure she’d be able to find traditional transcriptionists who wanted to make the change to being an editor. In addition, Mercy Health Center decided to take care of its traditional transcriptionists who wanted to be cross-trained as editors by maintaining their average line count pay during their training period, which was normally one month. This was not only good employee relations, but it also served as an incentive for them to adopt this new technology without losing income while learning, Doudican says.

Your transcriptionists may be nervous that speech recognition will replace them altogether. This is a common misperception; in actuality, there couldn’t be anything further from the truth, Doudican says.

“Chances are quite good that you will always have the need for traditional transcriptionists as well as editors because there are some dictators which do not quality for speech recognition,” she says.

Doudican estimates that 90% of her dictators actually qualified for speech recognition.

But to make speech recognition happen, HIM directors must be open to changing traditional transcription and willing to push for the change. The director needs to be the one who brings a sound ROI to the CFO, for example. “It really depends on the HIM director to be a visionary. They need to be able to think outside the box and the routine,” Doudican says.

Transcribe directly into your EMR

Another option for providers with electronic records is to have transcriptionists document directly into their patients’ records. Presbyterian Health Systems in Albuquerque, NM, is on a two-year rollout program to introduce this method to all of its ambulatory clinics, which use Epic as their ambulatory health record.

They’ve had very few problems during the rollout. “Clinic work is simpler than the complex care in a hospital situation. It is more ongoing basic healthcare,” says Sharlene Dolman, RHIA, CPHIT, consultant at MPA Consulting and interim transcription manager at Presbyterian Health Systems. “So clinical transcriptionists, if they are secure in their knowledge base and feel comfortable with their physician dictators, the physician dictation probably isn’t going to be a problem.”

And not much changes for the ambulatory physicians. They continue to dictate into Presbyterian Health Systems’ dictating system, just like the other physicians. The only change is that the transcriptionists type directly into the patient’s record in Epic, and then the physician goes into the record to sign it.

Nancy Espinosa, supervisor of medical transcription at Presbyterian Health Systems, is a big fan of the program for many reasons. For example, transcriptionists don’t have to link reports, which she says saves a lot of legwork. In addition, transcribing directly into the record reduces error because transcriptionists don’t need to match the correct physician and the correct patient. They don’t have to find demographics because the information is going directly into the patient record. And while the transcriptionists type, they see the rest of the patient’s record.

“So if there is a medication that you can’t understand, you can actually see that medication in the record,” Espinosa explains. “You have information that you didn’t have before at your fingertips.”

The only real drawback Espinosa and her staff have encountered with this program has to do with quality assurance. “Once [we transcribe into] the record, we don’t have access to it anymore,” Espinosa says. If there are blanks in the record, for example, the physician is responsible for filling them in.
HIM counts on the physicians to alert them to any problems with the record, says Dolman.

Editor’s note: This article was originally published in the August issue of Medical Records Briefing. E-mail your questions to Senior Managing Editor Andrea Kraynak, CPC, at

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