Oops…Sorry about that!

Hi everyone: It was just brought to my attention that the link for my slides from the AHDI Florida Technology workshop was broken. I’m sorry about that! It should be ok now.


This week’s HIM Student Corner

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This week, our HIM student corner features Kaitlyn Crowther.  Kaitlyn is a senior in Pitt’s Health Information Management program and is from Allentown, Pennsylvania.  She currently works as a student abstractor in the vascular surgery department at UPMC Shadyside an also works as a tour guide at the University of Pittsburgh.  Kaitlyn hopes to have a long career in HIM and looks forward to the changing landscape of health information.  Kaitlyn is currently doing an internship with M*Modal and it has been our great pleasure to have her!

Visit Excellence in Health Information to see what Kaitlyn has to say..

Have a lovely weekend!



Quality Health Information – a Transcription Wake-up Call


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“This is better quality than I get from <insert MTSO company name here>”

That is a comment from a doctor that I gave a demo to at RSNA this year. He dictated into our front-end speech recognition, using an untrained author profile, and was pleased with his results. He is a radiologist who works at a hospital that is telling him he should be using front-end speech recognition. He was resistant – why should he have to spend time editing when he could be reading studies? But – as he explained to me – if the documents he gets back from a medical transcriptionist require as many edits as he’d have to make using front-end speech recognition, why should he pay for transcription?

I heard a similar story from a customer yesterday. Some of this customer’s physicians were using front-end speech at one point, but quality of the information degraded because physicians weren’t correcting the errors in the speech recognized text. So they brought the MTs back. But as often happens when a service initially transitions to editing, MTs are missing errors and delivering poor-quality documents back to the physician. And again – if physicians are seeing errors in their transcription, then why not use front-end speech and correct their own errors?

This is a wake-up call for anyone in the transcription business. Quality and integrity of the health information that you deliver is your only defense against the push to get physicians to do their own documentation. If your quality is in question – your customers have no reason to keep you. That is harsh – but it is reality. You can talk about transcription’s role in meaningful use, and in allowing the physician to focus on the patient instead of on a keyboard until the cows come home. But if you don’t deliver quality – nothing else matters.

Many users react to MT quality problems by blaming the technology or by removing the physician from speech recognition. They want to know, “did this error come from the MT or from the speech recognition?”

Guess what the answer to that question is?  Errors delivered back to the physician are not the problem of the physician. They are not the result of using speech recognition. They are MT errors. Always.

If an MT typed a document from scratch, and delivered errors back to the physician, would you remove that physician from transcription?  Of course not – removing the physician has a direct impact on your revenue – and you wouldn’t be likely to keep your customer if you told them that your MTs don’t have the skills to produce quality documents for their physicians.

When faced with MT errors in transcription, you deal with the MT. An MT who is editing should be handled no differently than an MT who is transcribing from scratch.

When making the transition to speech recognition, or if you are facing quality complaints, ask yourselves the following questions:

  1. Have you assumed that speech recognition would allow you to use lesser-skilled, cheaper MTs?
  2. Have you assumed that speech recognition means that MTs should no longer have to send questions or blanks to QA?
  3. Are you doing QA on MTs as they transition to speech?
  4. Have the MTs been adequately trained to edit? Are they getting follow up?
  5. Did the MT training include attention to quality – or just attention to productivity?
  6. Did you cut MT line rates such that they have no choice but to rush through their work in order to keep their pay whole?
  7. Do you financially motivate MTs to produce work fast? Or to produce quality documentation?

Remember – an MT who has had sufficient training and can make edits quickly and efficiently is much more likely to pay attention to quality than one for whom every edit is money out of her pocket. The most proficient MT editors I’ve seen have also been the highest quality editors I’ve seen. Why? Because making edits is no threat to them – they can fly through documents containing multiple errors almost as quickly as they can through a near-perfect document.

Lastly, I am going to take this discussion back to the topic of compensation and management. The potential ROI for the use of speech recognition goes far beyond cuts in MT line rates. If you don’t manage to – and pay for – quality, then stick a fork in transcription folks. It’s done.

Need more on compensation and management?  See previous articles here and here and here and here.

Til Next Time,


Important Advice – “Think Outside the EHR”

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This week on our Excellence in Health Information blog, we are honored to host Valerie Watzlaf as our guest blogger. Valerie J. M. Watzlaf, Ph.D., FAHIMA, RHIA is an Associate Professor within the Department of Health Information Management in the School of Health and Rehabilitation Sciences at the University of Pittsburgh. She is very active in professional and scientific societies having served on the Data Quality Task Force of the American Health Information Management Association (AHIMA), the Chairperson of the Coding, Policy, and Strategy Committee of AHIMA, the Research Committee of AHIMA, the Council on Accreditation of AHIMA and currently serving as a Board member of AHIMA.

Dr. Watzlaf asks HIM professionals and students to “think outside the EHR” to the true integrity and usefulness of health information in support of patient health.  She asks them to question, ” is it best to document to get it done and meet regulations or to provide documentation integrity, quality and perfection?”

Please join us in this important discussion  – HIM Professionals of the Future:  “Think Outside the EHR.”

All my best as always,


Transcription in Health Information – Understanding the Value

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I had the great pleasure of visiting with AHDI Florida on Saturday at their Technology Workshop, and of talking with them about the use of technology, including but not limited to speech recognition, as a means of staying viable into the future.  This group is so active, knowledgeable, and passionate about the health information industry (yes, transcription IS part of the health information industry) that they were truly a pleasure to visit!

We had some terrific discussions about the value of dictation and transcription and how we can use technology COMBINED with our human expertise, to produce efficiency – but most of all – to produce a value that customers understand.

These ladies clearly understood what they bring to the healthcare table. But unfortunately, the people in that meeting are not representative of the rest of the industry.

Over the years for various reasons, transcription has come to be seen as a commodity. A utility. Something you don’t notice until there’s a problem or your bill goes up. Do you notice your electricity? Not unless the lights go out, right? Do you really care with utility company gets your check? No – not as long as they keep the lights on. Do you say to yourself, “Gosh, the light from Duquesne Light is so much better than the light from Penn Power.” Not likely.

So why do we think the same old mantra – quality and turn-around time – is a value that anyone cares about?  These are not value-adds. They are givens. Of course the documentation is accurate – this is healthcare! It is SUPPOSED to be accurate. Of course it’s going to be delivered on time. Why wouldn’t it be? These are not value-adds. In the world of marketing, these items would be known as “dissatisfiers”…the types of things no one notices until they don’t get them.

If quality and turn-around time don’t demonstrate a marketable value – then what is left to talk about? Price. And we all know what happens when everyone offers the same product with the only difference being price.

And now that the question is no longer “inhouse versus outsourced transcription”, or “which transcription service”, but is now “direct-data entry into the EMR or transcription” – it becomes even more important that we understand the value that transcription brings. More importantly – we must learn to communicate that value to others.

So what are the value-adds in transcription? What does transcription provide to the healthcare provider that they cannot get elsewhere? We have all heard story after story of how loss of transcription caused a degradation in quality of health information, caused interruption and inconvenience to the physician, is increasing expenses because now providers are investing in more expensive scribes to fill the gap left by transcription.  Why are we so bad at convincing the healthcare provider that transcription is something worth paying for? Is it because we don’t understand it ourselves?

It seems like every other business in the world understands its own value – why don’t we?

I told the story at the meeting of the time I was ALMOST tempted into buying that beautiful, plum-crazy purple Dodge Challenger on display at the dealership down the road (perhaps aided by a margarita or two plus the fact that it matched my dress).  It was more than twice the price of the faithful little Jetta that gets me to work and home again every single day. Did I buy the Challenger? No – thankfully I came to my senses (or maybe the margarita wore off). But – did I understand WHY the plum-crazy purple Challenger was twice the price of my faithful Jetta? Yep. I sure did. I would not have expected to buy that Challenger at a Jetta price. I understood the value of that Challenger. And someday….

So let me ask –  where is the leadership that will bring the industry together to help it discover and communicate its value? Who will bring us back to the basics – business 101 – and provide the venue for discussion and education that transcription providers – inhouse and service-based – need if they are to survive to serve healthcare another day?

As the members of AHDI Florida showed me – the knowledge is there. The talent is there. The passion for high-quality health information that will play a valuable part in the care of the patient is there.

Let’s call on AHDI and CDIA (formerly MTIA) to help to bring us back to the basics. Yes, we do need to demonstrate the MT value proposition to Washington. Yes, we need to be aware of technologies such as health information exchanges. But if we don’t understand our core value, and how to produce it efficiently and effectively, where does all that advocacy get us?

The members of Florida AHDI, and the thousands of other dedicated medical transcription professionals like them, deserve the leadership that is going to help them through the turbulent times ahead.

Here are my slides from Saturday’s presentation (link above the purple Challenger of course).  I hope that they provide some small contribution to keeping dictation and transcription alive as a part of health information.

All my best as always,


AHDI Florida Technology Workshop

Florida AHDI

In Florida? Join us at the AHDI Florida Technology Workshop as M*Modal and AHDI continue the Management for the Modern MTSO series.

From 9:30 to 11:30 we’ll be discussing Innovative Transcription…

Folks, the more doctors I talk to, the more I’m convinced – without my natural bias for transcription – that transcription is integral to the creation of comprehensive health information.

But can we  compete? Can we stay relevant? How do we add the value that providers will be willing to pay for?

Let’s talk!  See you in Orlando!


HIM Student Corner!

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Hello everyone: I am pleased and excited to present our first HIM student posting! This also appears on Excellence in Health Information. Please allow me to introduce Mark Domm. Mark is a Health Information Management student in his senior year at the University of Pittsburgh. He is from Pittsburgh and hopes to pursue quality management and eventually consulting when he graduates. Thank you to Mark and to the University of Pittsburgh HIM department for letting us borrow him.

Here is what he has to say…

I’ll go ahead and speak for all of us students. Way back when our collective educational journeys began, the most any of us could envision at the mention of “Health Information Management” was musty medical records, drab thumb accessories utilized for flipping through drab medical records, and all of this occurring in, you guessed it, a drab medical records setting. Leading others in this environment (if you can call giving others instructions on where to file what leading) was as good as it was going to get (if you can call that good).

Many of us found ourselves in Health Information Management. And “found ourselves” is the most accurate way to put it. We didn’t seek this area out for the most part. Circumstances seemed to dictate this chosen career path more than desire, and most of our beginning clinical experiences (i.e. smack dab in outdated medical records departments) and classes (the history of coding followed by… well coding) cemented this thinking. The Anatomy and Physiology didn’t exactly dissuade us to think about things differently either.

I would venture to say that for most of us what we envision when presented with the term “Health Information Management” has changed dramatically, and that is putting it lightly. In fact all of my ideas about it are upside-down. After all of the subsequent classes and experiences and speakers I can’t help but view Health Information Management with wide eyes.

Now I am speaking boldly here, and I believe that I need to back up my change of heart and big words with some hard evidence. At one hospital the medical records department is being torn down because it is going completely electronic; where before there were files and people hunched over files there are now construction workers constructing. Consultants have been relating stories of flying everywhere on someone else’s dime. We have been presented with the reality that everything (and I mean everything) is going to be completely and utterly overhauled in the healthcare world (i.e. ICD-9 to 10). Technology that is in some cases ancient (that might be an exaggeration) such as telemedicine is the basis for new and revolutionary technology. Even the rooms that healthcare is taking place in is becoming smart (for example the case of the room that is literally called the Smart Room).

Frankly the last couple months have been a whirlwind of examples of Health Information Management Workers of all walks of life involved in a dizzying number of healthcare settings, the least of which is the traditional medical records department. And some of the stories related to us by HIM workers have ranged from touching (working with very troubled kids) to exciting (training in different parts of the country) to alarming (hole punchers flung in anger and defaced property).

Although I can’t pinpoint the precise moment, somewhere in there the subtle grimace I would display at the mention of my major changed. More and more I’m realizing that the future in HIM really is a bright one.

-Mark Domm

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