Is Medical Transcription Still Relevant?

I found my favorite business article on, titled Dee Hock on Management .

A direct quote from Dee Hock:

“Substance is enduring, form is ephemeral. Failure to distinguish clearly between the two is ruinous. Success follows those adept at preserving the substance of the past by clothing it in the forms of the future. Preserve substance; modify form; know the difference. The closest thing to a law of nature in business is that form has an affinity for expense, while substance has an affinity for income.”1

What does this have to do with medical transcription?

It struck me as I read this article for about the hundredth time that this statement has special relevance to clinical information.

In all the debates about healthcare these days – about health insurance and costs and the EMR and meaningful use criteria – we all but forget what healthcare is all about, and what it is about our segment of the healthcare industry that is important.

Healthcare is about the interaction between doctors and patients. Everything that is done in healthcare revolves around the central fact that healthcare is purely and simply about doctors caring for patients.

We have a tiny piece of this of this interaction because we are involved in the creation of the documentation which helps to facilitate it. So in the broad spectrum of what we do – what is the “substance” and what is “form”?

We take information provided by the doctor and help to turn it into useful documentation.

But do we create the information? No. The doctor does. The doctor decides which information is relevant to the care of the patient.

Clinical information has endured from the time doctors began writing down what they observed about the patient, what they did to treat the patient, and how the patient responded. This information is the “substance” in this equation.

How we capture, communicate, store, and disseminate that information. Ah, now THAT changes all the time. That is the “form” in this equation.

Which of these documentation solutions preserves the substance of the information while “clothing it in the forms of the future?”1

EMR and templating systems –
• Often change the information by steering doctors through a series of text boxes and drop-down menus rather than allowing them to enter information according to intuition and knowledge. They may even change the examination process to fit the template.
• Doctors may limit the amount of information captured because of how much time it takes to do it.
• But the information is available for use in the EMR.

So yes, the EMR puts the information into the form of the future, but no, I don’t think we can say it preserves the substance.

Front-end speech recognition –
• Doctors may limit the information provided not wanting to take the time to correctly dictate (“typing with their tongues”) and then edit a long document.
• Behavior modification comes into play again as doctors change what they speak to words they know will be recognized. If the system gets a word wrong often enough, doctors will find a way not to say it.
• The speech recognition might be a type that can be used to point, click, and dictate directly into the fields of an EMR, achieving the goal of having the information available in the EMR.

So yes, front-end speech recognition may help to put the information into the form of the future – but the doctor falls prey to the same problems – limiting and changing the information he provides according to the structure of the EMR, and he might actually change the substance of the information to make the speech recognition work better.

Dictation and back-end speech recognition with editing by skilled medical transcriptionists –
• With the right speech recognition system and implementation, doctors can provide information the same way they have for years, without change.
• Doctors may provide whatever information they find useful, without being limited by the technology.
• Doctors’ time is not negatively affected since skilled MT editors will take care of turning the draft text into a useful document.
• Acceptance of standards such as those proposed by the Health Story ( allow the information to be captured, shared, and used in an electronic environment – putting the information into the form of the future.

So let’s see – which of these methods preserves the substance, which is the valuable information provided by the doctor, while “clothing it in the form of the future?”1

I only see one – how about you?

Hey, let’s look at another piece of this quote –

“The closest thing to a law of nature in business is that form has an affinity for expense, while substance has an affinity for income.”1

Since the combination of transcription and technology IS preserving substance while modifying form, and our technology-only “eliminate-your-transcription-costs” competition is preserving form while modifying substance, isn’t THAT fun! But that is a topic for another day….

1 – Waldrop, M. Mitchell. (October 31, 1996). “Dee Hock on management.” Fast Company. Retrieved from , December 18, 2007

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