Don’t be a Typing Service! Be a Knowledge Source.

Greetings from Austin! Now lets get started!  In keeping with our previous discussions, lets talk about the basics of what we need to do if we are going to stay relevant into the future.

Take a deep breath…

Transcription isn’t going away today.  According to a recent article in on, it is estimated that 66% of critical access hospitals and 56% of rural hospitals don’t even expect to demonstrate meaningful use by 2015.

“Sixty-six percent of critical access hospitals and 56 percent of rural hospitals did not expect to demonstrate meaningful use by 2015, according to the report: “Few hospitals have installed the comprehensive EHR systems envisioned in the ARRA.”

Not that we don’t have to be prepared for meaningful use – we do! But we need to prepare from the bottom up.  We don’t have a lot of time to do this – but we do have some time, and this is a must – not an option.

MTSOs must IMPROVE and PROVE the value of what they provide NOW.

Think about this –

If your healthcare provider customers are not convinced of the value of dictation and transcription now, such that they KNOW you cannot be replaced by physician direct-data entry or by front-end speech, how will you convince them that you have the skill and the knowledge to help them with meaningful use?

Back to the basics…

What is clinical documentation?

  • Is it documents that get lost, misfiled, faxed all over creation, used only to cross a doctor off a deficiency list?
  • Is it valuable clinical information that is used enterprise-wide for multiple purposes by many users?
  • If the documentation is not being used – do you know why?

Here is a problem:

  • Many hospitals aren’t coding from transcribed reports anymore. The reality is that if they aren’t using your reports to drive revenue cycles, it is going to be difficult to convince them of the value of those reports.
  • Do you know if your provider is using your transcribed reports for coding? For CDI?
  • Does your company have the HIM knowledge required to help deliver reports that contain the information needed for coding and other HIM purposes?

Many of us in the transcription world now have never worked in a hospital medical records or HIM department. Because of this, transcription has in many cases become segregated from the HIM process. We no longer talk with coders, with abstractors, with the correspondence department, with CDI specialists, about how our documentation is used.

So what what must be do to prove our value beyond the delivery of typed documents?  Do we know?

  • Do MTs and MTSOs have the knowledge and skill required to validate and reconcile clinical data presented in narrative reports? Does anyone know what these skill requirements are?
  • Do healthcare providers BELIEVE that MTSOs have knowledge of clinical information that goes beyond transcribing a document?

If not – why? Well, in my opinion we helped to shoot ourselves in the foot…

  • MTSOs for years have won customers by   –
    • Promising content requirements based on departmental or personal preference rather than on usability.
    • Offering custom print formats instead of documents that are structured for ease of use and efficiency.
  • By defining “quality” as adherence to individual preference and print formats. Focusing on perceived quality – not quality of content.
  • By contributing to the commoditization of their own industry by working on platforms that downplay the value of the SERVICE provided, convincing hospitals that MTSOs are  interchangeable entities to be bargained for at the lowest price.
  • How does any hospital have confidence that an MTSO has the knowledge required to validate clinical content if they think all MTSOs are the same and can be disposed of as soon as a cheaper one comes along?

Consider this.  Coders aren’t treated as disposable and interchangeable  – why  is it that coders are respected and MTs are not despite a very similar knowledge base?

And before anyone sneers at that last statement – what has happened to transcription over the years that the perception now is that MTs do NOT have a knowledge base similar to coders?  It wasn’t always this way! Let’s stop it now!

Don’t be a typing service!  Action Items:

  1. Understand the difference between “documents” and “information”.
  2. Talk to your customers. The customer that you never hear from is often not the “happy” customer. Often this is the customer who is already on the way out.
  3. Become the clinical documentation expert – the consultant who provides advice on the best way to capture and share useful clinical information.
  4. If your organization does not have an understanding of purposes for documentation besides the obvious  one (patient care) including coding, abstraction and registries, billing and revenue cycle tasks, clinical documentation improvement, etc., add this knowledge to your company.

Hire someone with HIM experience, or take the time to learn the basics beyond transcription. If your company already has an HIM component, use your HIM expertise to drive your transcription service, and vice versa. Don’t put these two functions in separate silos. Don’t use your HIM expertise for sales – but not for production.

  • Partner with your healthcare provider customers.
  • Make your reporting a necessary part of the clinical documentation workflow of a hospital or clinic.
  • How are they using the documentation you provide?
  • If they are not using it for coding, why? Find a way to make the reports you provide more useful for coding purposes.

    Coders don’t LIKE to code from the EMR!  Despite the inefficiencies of paper, they miss the “patient story” encompassed by that paper chart.  The EMR is a collection of facts.

    The old type paper chart contained the entire plot from exposition to crisis to climax to resolution. Use this to your advantage. How do you contribute to the story?

    • Create a documentation discovery process through which you provide expertise and guidance on how to improve your customers’ documentation.
    • What does your customer LIKE about their existing transcribed reports?
    • What don’t they like? What is missing?
    • What can you do about that?
    • What are people in your customer’s HIM department doing to compensate for what is lacking in the transcribed reports? What can you do to decrease this problem?

      It is widely agreed that lack of physician satisfaction is a large reason for the low adoption of electronic records. But eventually someone will force the new technology on them – regardless of whether or not they like it.

      It is up to us to prove that transcription is valuable beyond the problem of physician adoption.

      Are we up to the challenge?  Sure we are!

      Let’s get started at the Great ACE Tweet-up!

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