If you’re associated with a physician practice, you’ve probably been the target of at least one EMR/EHR vendor’s sales pitch in the past few months. And the pitch is a good one: EMR/EHR implementations can make practices more efficient, provide better patient outcomes and best yet, make you eligible for a portion of the federal incentives tied to EMR/EHR implementation.
But before you charge off on an EMR/EHR implementation, consider how the the system will impact the content and quality of your clinical documentation. Most EMR/EHR’s rely on clinicians to manually input the majority of the patient information. The clinician sits at a terminal, usually in front of the patient, and types in only the most basic of information on the encounter in an effort to move as quickly as possible to the next patient.
While this may work for some practices in certain environments, many physicians feel that this inability to thoroughly document their diagnosis and treatment plans in detail is a serious drawback of the EMR model. As noted in a recent study of physicians done by Nuance Healthcare Solutions, over 74% of physicians surveyed felt that the “cookie cutter templates” used by most EMR’s in documenting patient encounters are a serious challenge to realizing the full potential of the EMR.
So how best to thoroughly document the patient encounter? In the same study, physicians cited the ability to speak the patient narrative directly into the EMR as being one of the top 5 most important features of the EMR. And this makes sense; most physicians are used to dictating and in fact, prefer dictation to any other form of documentation.
So how to bridge the gap between the template based efficiency of the EMR and the physician’s desire to more thoroughly document the patient encounter by dictating a narrative portion of the report? What is required is a seamless method of allowing the physician to dictate the narrative section of the report without having to pick up the phone, type in a text box or login to a separate system.
Landmark’s Integrated Dictation Solutions allow clinicians to dictate directly from the PC while accessing the EHR using a handheld speech microphone. There is no need to log into a different system or enter any patient or demographic information. The resulting dictation is sent electronically to our servers where it is run through our speech recognition engine. Physicians can choose to edit the speech recognized document themselves or have Landmark provide the editing. The narrative appears in the templated document and is ready for signature.
Best of all, there is no hardware or user licenses to buy. You purchase only what you need, when you need it.
The Wall Street Journal ran an interesting story the other day that caught my eye. “Caterpiller Joins “Onshoring” Trend” (Kris Maher and Bob Tita, Wall Street Journal, 3/12/2010) pointed out that Caterpillar, the Fortune 500 manufacturer of heavy equipment, was planning on bringing significant portions of its heavy equipment manufacturing back to the US from overseas.
The article indicated that while this trend was small, a growing number of manufacturers were bringing work back to the US, citing a weak dollar which makes it costlier to do work overseas. According to the authors, companies were seeing growing disadvantages in offshore production, “including shipping costs, complicated logistics, quality issues, political unrest and theft of intellectual property.”
Now, don’t get me wrong, this movement is not a tidal wave, its more a trickle right now. But the reasoning behind it makes sense and is applicable in a lot of ways to the US transcription industry. Two of the issues cited above, quality and theft of intellectual property, are directly applicable to transcription. For years, hospitals and practices have put up with poor quality in the name of cheap transcription. As the standard of living rose in India and the Philippines, their costs have risen commensurately. Add to that the fact that the dollar has deteriorated in value and the overseas cost advantage is just not that overwhelming anymore.
The second issue related to transcription, theft of intellectual property, is analogous to the theft of protected health information (PHI). Countries such as China and India have little regard for US and European notions of intellectual property protection. And while companies can put as many safeguards and controls around our personal information as they want when they send it overseas, we all know that no one is going to stop a really determined thief; if they want our information, they’re going to get it. Put these two ideas together and I think we can see why respected companies such as Caterpillar are worried enough about protecting their multi-billion dollar investments in research and development that they are bringing work back onshore.
It’s my opinion that the onshoring trend will continue to advance for at least the next few years as the US economy continues to be slow keeping the dollar weak. The good news is that with the growing use of speech recognition and editing technology, the US based transcription industry should be well prepared to handle the increased work load without driving up labor costs.
You have made the decision that it is time to look for a new transcription vendor. There are a number of reasons that you might be unhappy with your present vendor such as poor document quality, slow turnaround times, outdated technology, or perhaps you are just shopping to see if what you are currently being offered is competitive in today’s marketplace. Regardless of the reason, here are 5 Quick Tips on what to look for in finding the right transcription service for your organization.
1) Take Advantage of Free Trials-All transcription companies are going to claim that their technology, quality, turnaround times and customer service are second to none. You can only really verify if these claims are true by “test driving” their service. While you should always check references provided by the company, the best way to really get a sense of what your experience will be with a particular company is to have them type some of your dictation for a couple of days. It is a little more work up front but in the end, you will have a great idea of what it’s going to be like working with your chosen company.
2) Ask About Their Transcription Process- Will you be assigned a dedicated transcriptionist(s) or will your work will be pooled with work from other clients. Will your work be sent overseas or done here in the US? Will the work be speech recognized? Pooling of work, overseas transcription and speech editing are all means that companies use to keep costs down. With conscientious review and editing, document quality is usually not an issue. However, quality problems are more likely to crop up with these approaches if there is not a sound QA process in place.
3) Check Out Their Technology- Make sure to get a demonstration of their dictation and document management software. Describe how your office works and understand how their technology will impact your processes. The dictation system should be flexible enough to mirror your current system to minimize the changes for your physicians. The document management system should be internet based so you can access it anywhere, be HIPAA compliant, and easy to use. Find out how long documents are stored in the system and are accessible by staff.
4) Read Their Contract- Many companies will try to lock you in to using their services by putting clauses in their contracts that restrict your ability to leave, even if the level of service has deteriorated significantly. Three year contracts, 90-180 day cancellation clauses, exclusive arrangements and minimum volume commitments are all ways that transcription companies will try to lock you in to using their services. You should stay with a company because they offer great service at a reasonable price, not because you’re locked in to a contract. Read the contract thoroughly and keep an eye out for clauses that can result in problems for you down the road.
5) Don’t Pay Extra Fees- Many companies will try and charge for things like interface development, licenses for using their software, long distance fees for utilizing their dictation system, fees for STAT reports, training and other “extra’s” that are part of their cost of doing business. Some companies charge $5,000 or more for developing an interface to your systems. If a company wants your business, they should be willing to cover these costs.
Follow these tips and you will be well on your way to finding a top notch transcription partner.