Medical Transcription into the Future….

I loved ACE this year! I thought we engaged in some of the most interesting and thought provoking conversation in years.

But I’m confused.

There was a lot of GREAT discussion about keeping transcription relevant in the changing world of clinical documentation – because clearly it IS still relevant. No one debates anymore that everyone from doctors to coders miss the narrative when it isn’t included in the EMR.

And I was excited to hear discussion about what additional skills and knowledge the MTSO and MTs will need going into the future. I LOVED it! I haven’t heard such lively discussion at AHDI in a long time!

But here is where confusion sets in.

There was talk about putting our existing skills and knowledge about document management systems and coding, particularly ICD-10 coding, to use. Hmm. What knowledge? Many MTs and MTSOs lost the connection to coding and complete document management long ago when MTs left the hospital. Not all of them – but very few MTSOs or MTs are exposed to coding or to document management beyond dictation capture and document delivery these days.

Document management goes far beyond the piece transcription is involved in, and includes documents not handled by transcription at all.

And when it comes to ICD-10, well this is a topic that has fulltime, lifelong coders and HIM directors shaking in their boots.

Let’s clarify two points that some of us in the transcription world don’t quite get.

  • Doctor’s don’t dictate codes. I heard comments about how all an MT has to do is capture codes dictated by the doctor and there you go, coding is done. With the possible exception of the clinic and practice worlds where E/M coding is used, or maybe radiology, when have you heard a doctor dictating codes?
  • You cannot code an inpatient encounter from one document. Even if MTs had access to all of the dictated and transcribed reports for an encounter, coders use the entire record, from the ED notes to the progress notes to nursing notes – many of which might be handwritten or entered directly into the EMR by the doctor or a nurse.

Can we assist with the coding process? We sure can! Can we code from the transcribed document? No.

Another point of confusion for me, mixed in the message about the MT’s changing role in the future of transcription, was a lot of advice about getting bachelors or even masters degrees, getting RHIT or RHIA certification, PMP certification, and collecting any number of EMR/EHR certifications. Then there were suggestions about becoming project managers, EMR product specialists, EMR trainers and implementation consultants, marketing specialists, and more.

Even the suggested future roles for MTs included preferences for RHIT or RHIA certification and even “masters’ degrees preferred.”

Folks, there is a difference between exploring the relevance of transcription into the future and the future role of the MT as the MT exists today, and listing jobs that will be available outside of transcription.

I’m not saying that MTs don’t have the ability to become any of these things. Of course they do! If they want to begin their careers and educations all over again, they can become high school biology teachers or real estate appraisers too.

But there is a difference between developing the role of the MT and replacing it.

And let’s be realistic about our current knowledge base and skill set. As a group, we do NOT know about ICD-10. We do NOT know about hospital document management systems. We do NOT know about RAC reviews and hospital revenue cycle management. How can we realistically figure out what we need to learn if we don’t take a realistic view of what we don’t know?

What is our goal here? To keep transcription relevant and to contribute to the value and usefulness of clinical documentation? Or to act as a job placement program for displaced workers?

For me, I say we’re not done yet! We have tremendous value! We may have difficulty understanding and articulating exactly what that value is, but it’s there.

What can MTSOs do? Something we can, and MUST do right now is to become true documentation experts. We must partner with our healthcare provider customers to create truly useful, meaningful, documentation NOW. Not when we get this or that certification, and not when (and if) our customers finally decide to adopt Health Story standards.

Some first steps:

1. Learn about your customers and how they are using the documentation you deliver to them.

2. Are they using it for coding? If not, why?

3. What parts of the documentation do they find useful?

4. What pieces are missing?

5. What can you do to help them complete the missing pieces?

6. Do your customers know about the Health Story project? Do they know that the Health Story is not just about standardizing the electronic format of the most common document types for upload into the EMR, and that it also defines content requirements which can be used today, right now, even if their EMRs aren’t accepting HL7 CDA yet?

7. Do YOU know about the Health Story project?

Most importantly –

Stop marketing yourselves as a commodity that can be replaced as soon as someone cheaper comes along offering the same service at a lower price!

If your healthcare provider partners rely on you to help them with compliance, coding, other revenue cycle tasks, and more – you will not easily be replaced.

Somehow our industry’s entire value proposition became that we will accommodate every individual user preference for document content and form there is. I have had countless MTSOs tell me that this is their market differentiator. If that is true – then stick a fork in us folks. We’re done.

But I for one am not ready to roll over yet….

Til next time,

4 Responses

  1. Terrific blog, Lynn! You have articulated what I have been ruminating for quite some time. We do have skills that would make transitioning to a new career in HIM easier than if we had no MT experience, but you have hit the nail on the head….we don’t need to come up with replacement careers, we need to EVOLVE our current skill set and highlight the relevance of what we do now and what we can do going forward.

    • Thanks for your comment Laura! I agree 150% percent. Sometimes I think we don’t even appreciate our own value…but we can fix that!


  2. Lynn, those are excellent suggestions for MTSOs, but not all MTs are owners or middle management or even frontline management for the owners, and these are the levels that could carry them out. In point of fact, those people may never have been MTs at all. I’m still looking for a description of the wonderful future for the valuable skills already possessed by the line MT who spends his/her day staring at a screen and doing the poundy-poundy. I’m not seeing it here or anywhere else for that matter. I’m not convinced it even exists.

    • Hi Karen: I too am looking for the description of the wonderful future for your skills…that is why I’m making the suggestions to the MTSO – to make sure we create a place for medical transcription in the world of new technology.

      But for now, the description is simple. Keep up your current skills – knowledge medical terminology, anatomy and physiology, medical language. Be willing to learn new skills including speech recognition editing. Advance the profession by being a Career MT, not a hobby MT.

      Just as it did when speech recognition came along, the rest likely be a combination of learning to use new computer applications and advancing your knowledge base.

      Stay tuned Karen!


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