MTs v. EMRs - Along with SR/VR AND OFFSHORE FAQ’s

                                                                EMR – Electronic Medical Record                            SRT – Speech Recognition Technology

Can I replace my medical transcriptionist with an EMR? Well…what is your time worth?

Electronic Medical Records (EMR) cannot take the place of the Medical Transcriptionist (MT), however it might change the way the MT transcribes a physician’s dictation. FACT: The percentage of physicians that have successfully and satisfactorily transferred 100% to EMR with SR/VR (speech recognition and voice recognition) systems and stuck with them is very small!

Quite simply, EMRs will simply open up additional avenues for the use of MT such as medical report review and editing.

Some Physicians will change over to an EMR system completely (a low percentage), however most physicians will still need MTs because it will take too much time to dictate, transcribe, review and edit the document created by the EMR / SRT system. Current reviews show that most physicians get frustrated with the SRT and will use MTs to transcribe the reports and then upload the reports into the EMR system. It is most cost effective.

But I have a small practice. Can’t I cut some overhead with an EMR?

Some physicians working in private practice and small clinics use EMR systems to enter their own patient encounters instead of dictating to an MT, but for the most part, these systems are not taking jobs from MTs. If a physician doesn't have a busy practice it may be more cost effective for him to use his downtime between patients to create his own documentation, but when you consider that on average physicians earn 6-10 times more than an average MT, and 3-5 times greater than they value themselves, taking the role of a data entry clerk is not good use of their time.

With the average dictated report taking between 1 minute 20 seconds and 1 minute 45 seconds and the average input time for the physician into an EMR at 7+ minutes per encounter, it is a simple calculation to see value.

Example:       7m – 1m30s = 5m30s 5m30s x 20 patients/day = 110m/day
                       110m = 1h 40m
                       Avg Scheduled Patient Visit: 12 m
                      110m / 12m = 9.2 patient visits

Conservatively speaking – each practitioner would need to calculate the dollar savings, or missed earnings based on his own practice details, but, to see 4 additional patients per day x 3 days per week generally far outweighs transcription costs and a physician’s cost at hourly rate x 6, or the physician’s “real value” as a cost in the business.

Simply put – if the physician is not seeing patients, he is not making money to support himself and his overhead.

More consideration: Considering the sheer number of required reports, typically Physicians do not use EMRs to enter the majority of patient data. Just to get admitted and released from a hospital there are at least 2 reports that need to be created: The Admission History & Physical and the Discharge Summary. If it is a routine surgery, replace the admission H&P with a pre-op H&P. Then there's the operative note to detail the surgery as well as consultations from other physicians, labs and any special diagnostic procedures.

And what about Accuracy?

Those that do switch over to an EMR will find that they will still need the "extra eyes" of the MT to ensure accuracy of their medical reports. Every physician needs an “extra set of eyes” to review the patient report and make sure it is accurate. MTs are the best "extra set of eyes" there can be because of the knowledge they have in both medical terminology and medical diagnosis. More medical law-suits are because of inaccurate information than any other medical law-suit out there.

With EMR, patient information will be available to all of the patient’s physicians’ to look at. If a patient report has inaccurate information in it then the next physician could make a wrong decision for that patient based on the report from another physician. So you can see how very important it is to have MTs still review and edit these reports for complete accuracy. This is both for the patient and the physician’s benefit.
But isn’t the Government Mandating EMR Systems?

There is a push right now for storing medical records electronically, but most EMR systems have transcription interfaces and the ability to import transcribed data and store it in the database. Many large facilities have managed their medical records this way since the late 90s. In these instances, physicians dictate, the audio goes to an MT, the MT creates the report, and sends back a digital file. The data in the file is automatically parsed by the EMR import software and stored in the EMR database. The physician can then review the report, make necessary corrections, and accept or digitally sign the report. Billing information, carbon copies, prescriptions, or fax information is then handled by the EMR software.

So does that mean MTs won’t be needed in the future?

Not necessarily. Not even likely. Aging baby boomers need more healthcare, not less. That means more hospital admissions and more acute care dictation. Even in instances where an EMR was specifically implemented to replace an MT, many physicians have difficulty using the EMR system and interacting with patients. Patients may feel that their physician is spending more attention to their computer than to them.

It can also take a physician longer to go through the screens of the EMR and enter the data themself than it does to dictate the report. Because of these issues many offices hire "scribes" who follow the physician around and enter the data into the EMR for them.

What about Speech or Voice Recognition (SR or VR)?

Before 2006, when back-end SR began to pick up steam, physicians had to dictate to the SR/VR systems and correct the output in real-time. These early systems were very inefficient and not much better productivity-wise than asking the physician to type his own reports.
After 2006, MT line rates were cut by as much as 50% for editing SR/VR. Generally MTs couldn't edit twice as much work as they could type and they lost money. Predictably, MTs quit those jobs for the more lucrative traditional transcription positions which caused companies to raise rates to about 70% for SR and provide MTs with a mix of regular typing and editing.

SR/VR will change everything; wont it?

A lot of physicians’ tried SR/VR software and thought it was great… at first. Yet when they realized there was still a need to “train” software to their voice and then correct the mistakes the software would create on the report; they realized they were losing money and time. Many then went back to using the MT.

Physicians that continue to use the SR/VR are still having MTs listen to the dictation and edit the report that the SR/VR system created to ensure accuracy. MTs will be doing more editing of the dictated reports than having to transcribe the whole thing from scratch.

In any case, if a physician decides to use SR/VR software with an EMR system that would dictate and create a report for them, they would then have the MT listen to the digital dictation file and review the report that was created. This is important because computers do make errors.

Not every dictator is a good match for SR/VR

Companies have also had to be careful to only let certain physicians use the SR system. If the physician can't get to a certain rate of accuracy, it's not worth letting him use the system. The time the MT would spend editing garbage would be better spent typing the report from scratch or editing the work from a better dictator. Not to say SR/VR doesn’t have its place, but that place may well be with your MT Service provider in conjunction with living, breathing MTs.

I. What about Offshore? Can’t we get MT cheaper in India?

FACT: Even though offshore MTs make only 2-3 cents a line, sending MT work offshore isn't any cheaper than having it done in the US. Generally offshore MTs are not big producers and are typically paid around $2500 a year. The average production is about 300 lines of transcription a day. So, 5 days/week times 50 weeks/year =75,000 lines/year. $2500/year divided by 75,000 lines/year = 3.3 cents a line. So, it takes 4 times the offshore resources to produce what an average US MT produces given that the average US MT can do 1200 lines in an 8-hour day.

And don’t forget the cost of facilities and added QA

Most offshore MTs are not work-at-home positions so those extra resources add up to additional facility costs. Now add to that how many offshore companies must put their transcription through 3 levels of QA; the first level for common English terms and slang; a second for medical consistency; and a third level to check the entire report. Even if their QA salaries were only an extra penny per line, those extra layers of QA double the cost of transcription to 6 cents per line and still does not include the costs of running the site where the MTs and QAs work.

Yeah, but 6 cpl is still pretty cheap!

Okay, so 6 cpl is still pretty cheap and India has millions of people; some even highly educated physicians, nurses, and other professionals. Regardless of their education and level of medical knowledge, English grammar plays a large role in an MT's ability to create accurate documents. So, while there are successful offshore MTs who are licensed physicians and nurses, they are rare, and many end up contracting to US-based services directly for the same rates a US company might pay an independent contractor in the US.

There’s no place like home…

None of this is to say that there aren't successful offshore MTs or offshore MT companies. There are. However, due to the factors mentioned above, an MT company in the US with at-home workers is generally highly competitive with offshore. Considering that offshore MT began in the early 90s and, there's still an overwhelming demand for US MTs quite simply because people with the skills and temperament to be good MTs are in short supply, no matter where you live.