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Outsourcing transcription overseas comes with risks

In 2003, a woman in Pakistan hit the send button on a threatening email to the UC San Francisco Medical Center.

Unless the hospital paid her money she was owed from a medical transcription subcontractor, Lubna Baloch wrote, she would post confidential patient records on the Internet. And to make sure the administrators knew she wasn’t bluffing, she attached private discharge summaries for two UC San Francisco Medical Center patients, the San Francisco Chronicle reported.

This well-known case highlights the risks associated with outsourcing medical transcription overseas. At Silent Type, however, this has never been a risk we’re willing to take.

All of our work is performed by our own employees in the United States, and on company-secured equipment. This is an important distinction from a provider perspective because under the HITECH provisions of the Health Insurance Portability and Accountability Act (HIPAA), business associates are just as liable and contractually obligated to safeguard protected health information (PHI) as the provider. Both are subject to the same civil and criminal penalties. Even subcontractors of business associates face the same responsibilities and potential fiduciary and legal downsides.

Compliance with the HITECH provisions of HIPAA are greatly complicated, however, when MTSOs are offshore. That’s because foreign countries are not bound by U.S. law—HIPAA has no standing.

Even when outsourcing work to U.S.-based MTSOs, however, HIM directors need to do their due diligence. They need to make sure the companies with whom they work are taking all of the necessary precautions.

At Silent Type, we do a lot to ensure the integrity of our data security—a fact we’re always eager to share with our clients, for whom this issue is top of mind.

Protecting sensitive health information is priority one for Silent Type. We’ve built in a number of processes and measures that ensure the records we handle are closely guarded.

Silent Type regularly undergoes two levels of service organization control (SOC) audits. The first level of audit identifies opportunities for fortifying our systems so they’re protected from a breach. With the second-level audit, a team of experts reviews our equipment and connections. This third-party audit report is available for customer review and shows we are in compliance with all HIPAA regulations.

We also have a company-owned, company-secured data center—no one but authorized, HIPAA-trained employees have access—and host our own web-based document management system where documents are placed. This all ensures that Silent Type retains the tightest control over the records we keep.

We recognize the trust our clients place in us by using our services. By keeping our medical transcription services at home—and regularly scrutinizing and updating our security measures—Silent Type is working hard to safeguard sensitive health data.

Timely, accurate medical transcription key to improving revenue

Timely, accurate medical transcription key to improving revenue

HIM leaders told us loud and clear in a recent survey that accuracy is essential for improving revenue—and it’s no wonder why. Timely, accurate medical transcription boosts physician productivity and helps maintain a predictable revenue stream for organizations.

Quality medical transcription jump-starts the revenue cycle
Ensuring accurate transcription starts even before physicians dictate. Silent Type works with provider organizations at the beginning of our relationship to create a template for physicians to follow, making it easier for organizations to produce a more complete chart. This helps our transcriptionists quickly turn around consults, operation reports or discharges—usually in just six to 12 hours—and increase the availability of documents to be billed. Our transcribed documents go directly to providers, whose coders can gain access to them through our STARS web-based document management system, via HL7 feeds to an encoder interface or through the hospital EMR. Documents can be coded even before the physicians see them. This starts the revenue cycle, and within 15 days, providers are paid.

That’s if everything goes according to plan, and for far too many providers, it often doesn’t.

EMRs increase the likelihood of errors and diminish physician productivity
Many organizations, for instance, are replacing medical transcriptionists with voice-to-text capabilities of EMRs. While EMR technology is improving the coordination of health care in many ways, the lack of transcription support is often its pitfall. Aside from the fact that free-text typing into an EMR can have a high rate of error, copied-and-pasted notes from patients’ health histories or lab results may not always fully reflect a patient’s health status or most recent visit. And for physicians, free-text typing is a time-consuming task that eats into the time they’d otherwise use to see patients. One doctor told us that it can take hours to pull together all of the requisite notes for a single patient. For the physician, that time may be equal to five or six more patient visits—which would result in more revenue for the provider.

Domestic transcription improves accuracy
Another way organizations are trying to be more efficient and cost conscious is outsourcing medical transcription overseas. But what they’re saving in money is costing them in accuracy. The error rate of offshore MTSOs is much higher than better MTSOs in the United States, whose error rate is 1 to 2 percent. Because the charts providers receive are lower quality, they are forced to hire additional staff (increasing their soft costs) to double check for accuracy, negating any savings they hoped to achieve by sending work offshore.

Even in this age of EMRs, medical transcription is proving its worth to organizations. By sparing physicians the time-intensive task of typing lengthy EMR notes or cobbling together pieces of patient records, and quickly turning around transcribed documents, medical transcriptionists are helping protect the bottom line.

Photo Credit: Flickr/Tax Credit

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Accuracy and quality most important attributes of MTSOs, survey reveals

Silent Type recently surveyed HIM leaders in our service area, both from our client hospitals and from hospitals who used other transcription companies. Our goal was to see how opinions and attitudes about transcription services may be changing. The results show some interesting trends.

Our researchers asked HIM leaders what attribute they thought distinguished their medical transcription service organizations (MTSOs). Their answer, most often, was turnaround time. About one-third (36 percent) of our survey respondents said quick turnaround was their MTSO’s most distinguishing feature. The next highest attributes mentioned were accuracy (18 percent) and efficiency (14 percent). Other attributes mentioned included dependability, quality, service, accessibility and caring. No surprise there, right?

But when they were asked what attribute was most important for any MTSO to have, the most common answer—by a long shot—was accuracy of transcription. About four out of every 10 respondents said accuracy was the most important quality that an MTSO should exhibit. The next most important attribute was quality, which was mentioned by 18 percent of respondents. Accuracy could be a synonym of quality, but it could also encompass other aspects of an MTSO’s business, including customer service and technical support.

Service and efficiency were tied for third place with nine percent of respondents saying they were the most important attribute. Turnaround time—the attribute that HIM leaders pointed out was exhibited most by their MTSOs—came in dead last as the most important attribute. Interestingly, none of these answers were prompted—that is, our researchers did not give the respondent a list of attributes to rank. The answers were volunteered by the respondents.

Photo credit: Flickr/Richard Mathews

Our research sheds light on why accuracy was the most desired attribute for MTSOs

HIM leaders agree: Accuracy impacts revenue and patient care, helps achieve meaningful use criteria

Are opinions about medical transcription changing? It used to be that accuracy among Medical Transcription Service Organizations (MTSOs) was a foregone conclusion. But data from a Silent Type survey seems to show that HIM leaders aren’t taking accuracy for granted anymore.

Additional data from our research sheds light on why accuracy was the most desired attribute for MTSOs. Our researchers read statements to respondents and asked them to rank their level of agreement on a scale of one-to-five, five being the highest. The following statements related to accuracy elicited strong agreement from respondents:

  • “Accurate, complete documentation is essential for improving care quality”—Respondents strongly agreed, giving this statement an average score of 4.95 on a scale of 5.
  • “Accurate, complete documentation is essential for improving revenue”—Again, respondents strongly agreed. The score of this statement was 4.89 on a scale of 5.
  • “Accurately transcribed documentation helps my hospital achieve meaningful use criteria”—The score on this statement wasn’t as high, but respondents generally agreed; its average score was 4.10 on a scale of 5.

Most HIM leaders strongly agree that accuracy impacts revenue and patient care, as well as helps their facility achieve meaningful use.

When was the last time you checked your transcription company’s accuracy. We audit our own accuracy periodically—as reported in our last newsletter, our accuracy rate is greater than 99 percent.

Is transcription accuracy becoming a bigger issue in the eyes of HIM leaders?

Photo credit: Flickr/Oran Viriyincy

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More with Marilyn: Template-transcription combo saves time, maintains compliance

By Marilyn Trapani

In an era when the amount of health care information astounds, providers find themselves in a quandary: How do they ensure complete patient information is communicated to medical records, coding, and third-party payers? How do they integrate clinical documentation improvement and incorporate all of the changes needed for ICD-10 implementation while still giving clinicians the information they need for patient care?

In an EMR environment, physicians can enter information into the system manually, dictate portions of documents, and copy historical information from one document to another. It can be complicated, making compliance more difficult.

The physician must manipulate historical records, attempt to dictate, and incorporate the transcribed section into the same document while using check boxes that may or may not be descriptive of a particular patient. Physicians intend to create a complete record, but sometimes their good intentions fall short, and the medical records department must wait patiently for them to complete the process.

The complex nature of some cases generally is not reflected in an EMR’s check boxes. If physicians spend two to three hours per day coordinating partial dictation with historical sections of documents, patient care will suffer. Fewer patients will be seen, fewer procedures performed, and less revenue generated. There also are compliance concerns involving getting physicians to actually complete the tasks. It may result in hospitals paying clerical staff to chase down physicians to gather the information necessary to complete records.

One possible solution to maintaining timely, accurate data is utilizing full dictation and transcription with EMR modules identifying compliance problems. It remains the most efficient and time-saving system for physicians to complete medical records without changing their workflow. Dictation is simple, a process that can be accomplished at any time through multiple mobile applications as well as by telephone.

Designed by medical records committees and approved by physician leaders, templates for report types can be created to meet ICD-10 requirements. Trained physicians dictate the necessary information, and a transcriptionist enters the data into a concise file format. If an organization opts for partial dictation, the report’s transcribed section can be uploaded via a Health Level Seven International format to the chosen EMR and melded to the check-box information that the physician selected to begin the process.

Read the entire article at

Photo credit: Flickr/Michael Mandiberg

Medical transcription companies that are operationally lean are the best bet for saving money

Lean transcription companies can save money, add value

Cost conscious hospital leaders are always trying to keep costs down. The current increase in regulation coupled with the influx of baby boomers into Medicare and the expansion of Medicaid by the Affordable Care Act will continue to add cost pressure to hospitals.

It’s no wonder HIM leaders are being asked to save money on transcription.

To accomplish needed savings, many HIM departments turn to overseas medical transcription service organizations. That can result in lower costs, but most HIM directors find there are trade-offs in turnaround time and accuracy. The resources used (and headaches caused) due to lack of efficiency and lower quality often negate the money a hospital saves.

The best solution is to turn to medical transcription service organizations that have a lower cost structure and can pass their efficiencies on to you. Silent Type, for example, runs a lean organization that gives clients the most value for their dollar. And our accuracy and turnaround time are among the best in the industry.

If you need to save money on transcription, contact Silent Type online or by phone: 201-346-5900.

Silent Type's new speech recognition software helps transcriptionists save time and helps clients save money

Improve efficiency and save by combining speech recognition and transcription

Some in the transcription industry see speech recognition software as a replacement for transcriptionists. We don’t share that view. Speech recognition is a tool transcriptionists can use to decrease turnaround time and improve efficiency.

While no voice recognition software can be 100 percent accurate, speech recognition applications can facilitate transcription by allowing transcriptionists to do more work in less time, thus saving clients time and money. That’s great for clients as well as transcriptionists. Our staffers are giving STARS Speech—Silent Type’s new speech recognition solution—rave reviews.

STARS Speech analyzes physician dictation recordings, then creates a rough transcription. Since STARS Speech learns to recognize a physician’s voice and speech patterns the more it is used, the initial transcription gets better over time. A Silent Type transcriptionist then reviews the document for accuracy by comparing it to the original recording. Following that, the transcriptionist loads the corrected transcription into the software. STARS Speech then compares the accurate transcription to the voice file, which enables better accuracy for future transcriptions.

By improving on turnaround time and ensuring accuracy, Silent Type has been able to save clients money on their overall transcription costs. For a demonstration, contact Silent Type online or by calling (201) 346-5900.

Silent Type's transcription accuracy is close to 100 percent

How accurate is adequate?

How accurate should a transcription service be? According to a new Silent Type survey of HIM leaders, accuracy is by far the most desired attribute of a medical transcription company. Fifty percent of respondents stated that it’s the quality they value most.

While some HIM professionals consider transcription accuracy a foregone conclusion, not all transcription companies hold themselves to the same standards. Such was the case in the December 2012 insulin incident with a patient in Alabama, discussed in a previous newsletter. The medical transcription company involved in that case outsourced the transcription to an overseas company. Non-native English transcriptionists are at a distinct disadvantage when it comes to transcribing any sort of English document, but especially so when it comes to something as intricate as medical documentation.

Think of transcribing as translation from spoken English to written English. Transcriptionists occasionally need to make assumptions about what a speaker says, since the spoken information is not always clear. If the person doing the transcription is a native speaker of the source language, they have lifelong, first-hand experience of the language to draw on. In the medical field, an experienced transcriptionist pulls from an even deeper well of experience. But when transcribing is outsourced to overseas companies, non-native speakers don’t have years of in-depth exposure—to the language and to the English-speaking medical world—from which to draw.

Medical transcription company Silent Type conducts an internal accuracy audit every six months. On a recent audit, Silent Type transcriptionists scored a 99.8% accuracy rate, a good sign, for Silent Type clients. Silent Type can maintain a 99.8% accuracy for a few reasons:

  • First, we employ full-time, domestic transcriptionists, not contractors. You can be certain that your transcription is never outsourced.
  • Next, a consistent team of transcriptionists works on your account, which allows them to become familiar with the dictation habits of your clinicians.
  • Finally, we audit a sampling of our transcriptionists work, making sure that the work we provide is of the highest quality.

To learn more about Silent Type’s commitment to accuracy, click here or call 201-346-5900.

Doctors give the Silent Type dictation app high marks

Old school, new school physicians alike love iPad transcription app

An increasing number of medical professionals, especially doctors, are using mobile devices in the workplace. Black Book Rankings, an independent analyst of healthcare technology customer satisfaction, noted that most physicians are either using mobile devices to improve patient records and patient care, or plan to do so in the near future. For medical professionals and physicians alike, finding and using the most appropriate technology has become increasingly important.

One app that is boosting doctor efficiency is the Silent Type dictation app. The app offers physicians a time-saving tool for recording, storing, and saving documentation using iPads, iPhones, or iPod Touch devices.

One physician clinic manager noted that the app was easy to use and suitable both for those who are tech savvy and for those who are still adjusting to mobile devices. He writes, “I needed something for some very old-school surgeons who have migrated to electronic health records. My user base includes people who know enough to be dangerous down to the end user who could be outdone by a six-year-old.”

The process for using the app is simple. A physician types the appropriate medical record number into the app, and then dictates the patient encounter. The app records a physician’s dictation and automatically saves the recording in STARS, the Silent Type Automated Records System. As soon as the information is saved in STARS, it is made available for transcription.

Find out how Silent Type can help you improve the integrity of your electronic medical records with the Silent Type dictation app. Contact Silent Type online today or call (201) 346-5900.

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Transcription error leads to woman’s death, $140 million judgment

An Alabama circuit court awarded $140 million in December to the family of a woman who died due to a medication dosage error. The judgment came after a jury decided that Thomas Hospital in Fairhope, Alabama, medical transcription provider Precyse Solutions, and two India-based transcription subcontractors were responsible for mistyping an insulin dose that led to the death of the 59-year-old patient.

The source of the error was the subcontractors from India, according to a report in Birmingham News’

Information dictated by the doctor went via a computer in Atlanta to India, where the [subcontractors] prepared the discharge summary and sent it back to Thomas Hospital. [The family’s attorney] said the hospital saved 2 cents per line of text by using the outside firm. But he said it came at a price: Testimony indicated that the Indian firms operate under quality standards that are one half to one twelfth that of the United States in terms of acceptable error rate. He said Precyse officials claimed that the Indian subcontractors used American standards but that officials from those companies testified that they did not.

In the end, saving two cents per line didn’t help this hospital’s financial situation.

Mistakes happen, but the chances of this type of mistake happening due to an overseas contractor are much greater than with a domestic provider. Hospital and clinic leaders take note: saving a few dollars with a vendor that contracts overseas can be a losing proposition.

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