Health Information Management

How to outsource transcription overflow

HIM-HIPAA Insider, January 9, 2007

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Transcription timeliness and quality encourage physicians to dictate more. The transcribed document allows physicians to communicate efficiently with referring and other treating physicians. It also supports the coding efforts of their office staffs. Transcription also benefits a healthcare organization's coding staff, other healthcare staff (e.g.,nurses, therapists, etc.), and quality and risk-management personnel.

However, this important function finds itself plagued by the same condition as coding-a shortage of qualified personnel. Even with many institutions performing transcription remotely, the shortage continues. Moreover, the demand for dictated documents is increasing.

If internal staff cannot handle the volume of work, it may be necessary to outsource some or all of your transcription.

When to outsource
When you decide whether to outsource your transcription, there are several items to consider:

  • Why do we require outsourcing? Why are we contemplating it?
      - Lack of qualified staff? Increase in volume? Need for new equipment and lack of capital funds? Need for the space currently occupied by transcription?
  • Have we eliminated all the nontranscription duties we can from the currently employed transcriptionists?
  • Will we be able to retain some staff to perform quality review of the transcribed work returned?
  • Do we have technology available in house to establish an interface with the outside firm or must we manually cut and paste their work into our system? Will their work be segregated from any organizational report repositories?
      - Labor? Benefits? Supplies? Equipment? Equipment maintenance? Space?
      - How much does it cost to transcribe a minute of dictation in house versus outside? Can it be done less expensively without compromising quality? Can it be done less expensively and improve quality/timeliness?

Review the following advice while you assess whether to outsource:


  • Speak with some of your physicians to see which transcription firms they use. The firms will likely be local, smaller medical-transcription firms. The advantage is they will be familiar with some of your physicians, having already transcribed some office work. The disadvantage: They may not have the technology to connect with your dictation system.
  • If you select a regional or national firm, do not sign a long-term contract. If you have not finished your assessment of the situation, a long-term contract with a rate agreed upon during a time of desperation may be a career-limiting action.
  • Send out the most recent work that does not have top priority such as discharge summaries or outpatient visit reports dictated yesterday and today. Have some of your transcriptionists work the oldest work and the others work today's priority work. By segregating the work this way, you will not fall further behind.
  • Do not hesitate to use more than one transcription firm. This benefits you because the two transcription firms know you might be outsourcing work on a long-term basis and are comparing them to other firms.

Editor's note: The above article was adapted from the book More With Less: Best Practices for HIM Directors, written by Rose T. Dunn, RHIA, CPA, FACHE, FHFMA. For more information or to order, call 877/727-1728 or go to

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