Help for a Front-end Speech Recognition Nightmare

M*Modal attended the first night of the NEMA AHDI annual conference last night, and we met a couple of MTs with big concerns.

They work at a facility where the ED doctors are forced to use a traditional (read: NOT M*Modal) front-end speech recognition product for their ED notes.  The MTs were removed from the workflow.

The doctors are NOT EDITING their ED notes. NO ONE is editing the dictation.

These MTs are still on staff and see the documentation produced because they still perform filing, transcribe urgent H&Ps, etc. They see numerous horrendous errors in the final, signed-off ED records.

I asked if anyone was performing QA on the documentation and they replied that they were originally, but there was so much, and the workflow is now so cumbersome and inefficient, that administration told them to stop. They are told that the doctors cannot be forced to edit the notes before signing.

I asked what the doctors say, and the MTs state that the doctors are forced to use the front-end speech recognition whether they have time to edit or not and therefore don’t complain. No choice, no options.

This is so NOT the M*Modal way (we believe 100% in OPTIONS and QUALITY) – and if this was an M*Modal user, I’d be on the phone so fast heads would spin. But it is not an M*Modal user so I can’t help there.

These MTs would like to know if they have any recourse – is there anything that can be done to force the facility to review the quality of the documentation and take action?

I know some of you have been in situations where physician self-created documentation methods produced less-than-optimal results when MTs were taken out of the picture. Does anyone have any suggestions for these concerned MTs?

Your help would be appreciated!


13 Responses

  1. If risk management were made aware of the situation, things might change dramatically.

  2. I’m sorry to say, but my best advice for these MTs is to either back off or look for other work. I suppose they could file some sort of complaint with the Joint Commission and perhaps trigger an unannounced visit, but if this isn’t the Joint’s “bee in the bonnet” de jour, nothing is likely to come of it.

    Let’s get real – this decision was made at a much higher pay grade and probably with input from the hospital attorney and risk management. Their considered opinion was that the benefits outweigh the risks. Now, they may, indeed, be wrong about that, but they’re not likely to give the gals in the typing pool a medal for pointing it out.

    There’s also the dirty little secret, which we tend to conveniently forget, that not all human-produced transcription looks that good, either. Maybe these MTs, and their dictating docs and their equipment are spot on perfect every time, but I doubt it. As we continually pay less to do this job, the available talent pool is also going to shrink and it’s not going to be the best and the brightest, either. How long do you suppose it will be before machine output and human output can’t be told apart? And perhaps that’s the point of the exercise. And no, I don’t mean that in a good way.

  3. This is shocking! Why are MTs always considered the most dispensable? When actually MTs probably play a very important part in the documentation process. I agree with Crystal, this matter should be taken up with risk management.

  4. I work in the EXACT same environment. It echoes the comment I heard at ACE. Some are willing to “settle” for this front-end nightmare. Perhaps a HIPAA fine will stop this. That is my prediction.

  5. Lynn, your presentation at AHDI-NEMA was one of the highlights, for me, of a terrific conference.

    As you said in your presentation, it is so important for a transcription organization to include quality and productivity in their evaluation of the success of their technology process. Total output as measured by the combination of these two factors is so much more telling than simply the %increase, and you really captured and presented this issue very clearly.

    Is there a way to get a copy of your powerpoint? If possible, please email it to me, or let me know where to go to get it.

    Thanks again for a great presentation,
    Christine Tyrrell

    • Thank so much for reminding me Christine!! Link attached to latest post. 🙂 It was great meeting you!


  6. I agree with Karen: not all human-powered transcription is that wonderful, and that most definitely because of the low wages we’re paid, the more capable MTs venture off to more lucrative careers. Don’t get me wrong–there are plenty qualified and wonderful MTs out there, but we’re outnumbered by MTs who just do this job for X number of lines or whatever words get to the page “because the spellcheck took it.”

    And to answer Renee’s question, why are MTs the most dispensable, I think a lot of that has to do with our lack of presence in the workplace. Out of sight, out of mind. And who’s speaking up for you? Probably someone who isn’t even an MT. They don’t even know what it takes to do the job, so how can they relay its importance?

    Lastly, Debrah, you need to learn more about what HIPAA does and doesn’t cover; it has nothing to do with quality documentation. It’s about protection of your PHI.

    • Hi all – While I do agree 100% that wages are some of the reason for the decrease in more capable MTs – I also strongly believe that we have to take responsibility for our own behavior.

      If I was making subs at Quizno’s, I’d be doing my darndest to make the best subs I could make. I’d show up on time. I’d be reliable. I’d do high-quality work. Today at my M*Modal job, I do what needs to be done. If I get coffee and see crumbs on the counter, I clean them up. Do I get paid to do that? Is that my job? No! But it needs to be done.

      There is such a thing as professionalism, pride in your own efforts, dedication, and reliability. No matter what your job is and how you’re paid – if you take the job, it is your responsibility to DO THE JOB! I don’t care if that job is medical transcription or executive management or working in a fast-food restaurant.

      Hey all, I’m the first one to talk to transcription managers and healthcare providers about the need to take care of MTs financially – you all know that. I say some pretty unpopular things. Even things that are unpopular with some of my customers.

      Have you ever heard that in business, you should dress for the position you want, not the position you have? In my mind, this is the same thing. When you take a job, you work towards what you believe you SHOULD be paid.

      You want to be treated and paid as professionals? Behave like professionals. Because you will never get ANYWHERE if you do poor quality work and don’t work as much as you’re supposed to work using low wages as an excuse. You’re digging your own graves if that is the attitude.

      Sorry to be so blunt – but I work pretty hard to defend the MT. So to see posts from MTs complaining on MT Stars because their employers actually had the nerve to call them to find out why they weren’t working during their scheduled shifts – I’m sorry, but that makes me every bit as upset as the MTSO who doesn’t pay the MT for what the MT is worth.

      Diva MT, I know you are not excusing this type of MT – but you sure reminded me that this issue does not only fall on the side of management. Thanks for the swift kick!


  7. Lynn, you are absolutely correct in encouraging professionalism in the industry. That said, if employers continue to treat us like unruly children, the natural tendency is to behave in kind. The level of trust on the part of MTSOs has diminished to the point where we are now managed at the keystroke level. (And M*Modal helps make that happen.) That is insulting and demeaning. Not to mention being made constantly aware that every second spent not producing keystrokes is money out of our pockets, and cause for “demerits” from management reporting systems. We are discouraged from doing our jobs properly, told not to “over-edit,” penalized for taking time to do research. If we are doing anything but producing keystrokes we are assumed to be less than ideal employess. Yes, we as MTs encouraged pay for production, but the management of that activity has gone to extremes. There needs to be built into the management of the position a certain amount of “down” time where we actually enhance our abilities. Management should share in the payment of that time rather than making the employee do all the giving of time and pay. The MTSOs could give a little and get a lot.

    • Hi Crystal: First off – thank you for the great discussion!! This is the kind of stuff I’ve been hoping for! 🙂

      But I’m telling you – convincing companies that MTs deserve to be paid more is very difficult in this economic market. Margins for MTSOs are extremely thin these days. So this is already an uphill battle. MTs who feel justified in not behaving professionally because they don’t feel they are being treated professionally now are guaranteeing that they never will be. NO ONE is going to think, “This MT doesn’t show up on time, can’t be relied upon to work a full day, doesn’t produce great quality, and never does more than the absolute minimum – gosh, I’d better pay her more.” MTs who use “I’m not paid what I’m worth” as an excuse for unprofessional behavior are digging their own graves. Yep, I agree that it happens. I even understand why! And I agree that MTs should be paid more – I talk about it constantly. BUT – we don’t have control over what others do. Only ourselves. We can’t control our employers – but we can control our own behavior.

      Now, a couple of M*Modal specific things:

      1. Your comment about how M*Modal helps managers to manage at the keystroke level: Yes, we provide proficiency reporting. We do know if MTs are using the most effective keystroke techniques and we provide feedback on that. Let me be clear – that is to the MT’s benefit! We have seen case after case after case where MTs were not being provided feedback on their editing skills who greatly improved their productivity – and their paychecks – after we encouraged their managers to provide this feedback. We cannot control how the MTSOs pay MTs – but we can do our best to help them to be more productive. Let me also be clear – we also ONLY know what an MT does IN the editor. We do NOT, as we have been accused by some MTs previously, know which websites an MT goes to, what other software they are using, etc. We know what the MT does, in the editor, when jobs are open. Period. Feedback is provided to HELP Mts to be more productive. And since most companies pay on productivity – that is a direct benefit to the MT.

      2. M*Modal has NEVER and WILL NEVER, at least as long as I am here, discourage MTs from doing research or from doing any editing necessary to produce a quality document. Have you ever seen any of my presentations? Have you ever heard us tell managers that the draft text should be used as a tool to perform research and to help improve quality? Any one who has attended ANY of our presentations or training sessions knows we always say Quality first; Productivity second. Do we discourage UNNECESSARY over editing? When it comes to a purely cosmetic change that is only done out of MT preference, is not a requirement for the customer or for quality health information, and has no bearing on the quality or the usability of the document – possibly. But we ALWAYS state that MTs MUST follow their management’s instructions. We are NOT that speech rec company who tells MTs to “Type what you hear” regardless of the garbage they might be hearing. If you have that impression, you are confusing us with someone else. Again, we cannot control our partners – but I promise you, we spend a great deal of time and effort trying to promote high quality, useful documentation.

      3. M*Modal does know how much time MTs are inactive when jobs are loaded into the workstation. We completely understand that time must be spent doing research, doing patient and physician lookups, etc. What we tell our partners is to look for the reasonable amount of time for MTs to be inactive, and look for the outliers. Back in the in-house MT days, MTs worked in a hospital, with a supervisor, and even punched a time-clock. How is a supervisor of a remote staff to supervise if they don’t use tools such as our reporting? I kid you not…we see inactive times as high as 30-40% of the open job time (and you would be amazed at how frequently we see this). That is a dictation that is sitting open on a workstation with no activity, and that TAT clock ticking away…. Now, M*Modal has NO idea how many hours an MT is scheduled to work, which hours of the day an MT is supposed to work, or what an MT is doing when they are outside the editor. We know about things that will help to improve productivity (and paychecks) while the MT has jobs open. That’s all. No Big Brother, I promise you.

      So I guess what I’m trying to say is twofold:
      1. Change what you can change – control what you can control. MTs can control their behavior and work ethic even if they can’t change management.
      2. Use the tools at your disposal – including those that tell you how you can use keystrokes to be more productive – to your advantage.

      And I promise you that I’ll continue to do my best to promote the MT as a valuable, skilled professional. 🙂

      Thanks for the comment Crystal! As always, I love the discussion.

  8. Thanks for your response Lynn. Yes, I have seen several of your presentations and know that you are a champion for the MT. Thanks for that. Still waiting for the day when I love speech recognition software.

    You sort of made my points, but from the management perspective. There is no excuse for acting unprofessionally. Period. There should be no putting up with unprofessional behavior either. But rather than get rid of those who are less than stellar in their day-to-day performance, management has chosen to treat all the same as the worst. That speaks to a management style that is disappointing to me, but out of your scope of control.

    As for performance metrics, obviously M*Modal formulated these in response to customer requests and needs. As an MT I like feedback. But all keystrokes are not equal. What is more “efficient” for one may not be for another. There’s no way to tell if an MT is left or right handed, a fast typist, has a built-in trackball. We all work differently. Some take time to do more research than others. We should be judged on our final product, not our path to get there. Help is good, but I don’t think these reports are being used in such a purely altruistic way. ;-{

    The quality standard for speech recognition jobs is different from what it was for traditional transcription. We are encouraged to leave questionable grammar if it does not substantially alter the record. So “the cast on the leg was put” must not be “over-edited” because the meaning is clear. This causes some of us who strive for quality to cringe, and again drags us down toward the lowest common acceptable denominator in the name of the efficiency. This is bad for us and bad for the automated program doing the interpreting. By condoning bad grammar, the “artifical intelligence” will never learn. Granted, that is not M*Modal itself, but your clients who are making this decision. But I hear it over and over again from my peers in otheir places.

    Thanks Lynn, for providing us with a forum to discuss these issues. While there are things outside of your control that come up, the one thing we both agree on is that professional behavior is paramount to our personal success and the ultimate success of our profession.

    • Great comments Crystal…

      Just for the record, “the cast on the leg was put” makes me cringe too. Yikes.

      I hope someday to win you over to liking speech recognition Crystal! 🙂

  9. Actually, I think “the cast on the leg was put” sounds like the start to a pretty fine limerick. 🙂

    Excellent discussion. Thanks!

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