My experience (somewhat lengthy)

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Hey, everyone.  We have all been so worried about VR and India taking our jobs that I think we may have let something slip by that is so very much more dangerous. 

My uncle had to have a procedure at the local VA last week, which was an education in and of itself, but what was perhaps most interesting was that I was able to watch his doctor work with the VistA EMR system.  For those of you who are not aware, VistA is the EMR system the VA uses.  It was created by them for use throughout the VA system, and basically it is a click and choose transcription system, minus the transcriptionist.  It uses templates and normals, and if the doctor needs to add more specific information, they simply type it in.  As I sat there with my uncle and watched his doctor type a few words, click some boxes, ask some questions, and do a completed preop report in the time it would have taken him to dictate the darned thing, I was astonished.  It is a very slick system, very impressive to see up close and personal.  From the perspective of patient care, it is wonderful.  The doctor pulls up the report with a few clicks, the patient signs off on it with a little electronic signature pad, and a nurse approves the whole thing with a code.  Very slick. 

So why should this scare us?  Here is the kicker.  The VA/Government/Medicare system is giving this program away.  That is right, GIVING it away to any doctor who wants it.  The problem is that it is extremely difficult to install and set up for proper use, and hard to learn to use initially.  It is also hideously expensive, both for the equipment used to run it on and the installation, though for a large practice probably no more cost prohibitive than paying a team of transcriptionists (2-3) for a year.  Okay, now add to this equation that Medicare is encouraging doctors to learn and use this system, and the date 2014 has been thrown out there as a target.  Skeptics say that 2014 is not reasonable but I am not convinced.  Here is why.  I think we can all admit that the transcription workplace is most definitely not what it once was.  Part of the reason is that it is getting harder and harder to find decent, qualified transcriptionists.  I know there are many, many hard-working transcriptionists out there who know what they are doing and take pride in their work.  I also know that there are many folks out there who like to call themselves transcriptionists, people who think the job is nothing more than typing and see no need to further their educations and stay on top of things once they have obtained a job.  This is not a problem that is confined to our profession; many other areas of employment are suffering the same malady.  However, most other areas are able to weed out the bad seeds, if you will, before their business has been harmed and find the hard-working people they need after searching at length, but medical transcription is not one of these areas.  Because of the nature of the beast, the seriousness and responsibility of the job, if a Transcriptionist messes up people have the potential to die.  With wages decreasing over time and companies becoming more desperate to hire anyone who can type, experienced transcriptionists are moving away from the job, not being able to support themselves on the lousy wages companies are paying.  The dwindling experienced work force is being replaced by a new generation of transcriptionists whose only experience with doctors' offices is when they visit their own primary care physician.  They are educated online, and while there are some schools out there truly committed to producing qualified workers, most are fly-by-night operations.  This is why, in part, doctors are trying to find other avenues of getting the reports they need.  Two of the VR perks that are pushed by companies are cost reduction and accuracy.  The companies that are promoting VR are using our inaccuracies and poor performance to tout their new baby, and they are succeeding.  Because they still pay us a minimal pittance to edit the VR after it is dictated, the doctors never see the product beforehand and therefore are under the impression that we are, in fact, inept, and that VR is a much better system than using humans. 

Now, imagine this if you will.  Transcriptionists are already on the hot seat and so, when the government starts promoting its EMR VistA system, it appeals to doctors.  Not only does it eliminate the need for transcriptionists, it costs about the same overall as they are already paying in wages/fees.  It gives the doctor complete control over the reports they produce, and they have immediate gratification because in the time it takes them to dictate the report, it is finished and in front of them.  The impression one gets from reading all the articles and forum posts pertaining to transcription these days is that doctors are becoming frustrated with the services they are being provided, and are ripe for being swayed into something else that is more productive.  This is the perfect time for doctors to begin transitioning to EMR, and the proliferation of companies out there who have developed EMR systems is testimony to that fact. 

Do doctors look at the EMR as a potential end to the careers of tens of thousands of workers in the United States?  No, probably not.  They only look at how this is going to affect them, their practice and their patients.  Congress is supporting and pushing this initiative, as are certain presidential candidates.  The concept of losing this many workers to EMR is apparently not something they are concerned about.  Implementing this sort of system will make them look good, and the importance of image to politicians is a given. 

While there can be no doubt that outsourcing has hurt medical transcription, as has VR, I strongly believe that our biggest threat is coming from our own government.  I think the EMR system is, within the next 5-10 years, going to put 80% of transcriptionists out of business.  There will be holdouts, and I am sure not all types of reports will be producible from this system, but if a doctor is given a choice between paying for a transcriptionist to possibly do a report correctly and perhaps get that report back within 24 hours if all goes as it should, and using that same time they would be dictating to produce the report themselves, with very little actual work on their parts, which will they choose? 

Here is an important post from 2005.  It is lengthy and I have edited it to make it more concise…

Posted By: n on January 05, 2005 at 21:35:45:

In Reply to: offshore posted by beth on January 05, 2005 at 19:58:08:

Offshore medical transcription is a large enterprise financed with capital. The Soros money is in the Spheris deals. Look for more and more to go overseas.

From GeBBS Health Care Solutions http://www.gebbs.com/pressrelease062004.htm  : In a world of steadily rising medical costs, Nitin Thakor thinks he has a cure. It works like this: A doctor treats a patient and sends the medical record to Thakor's company, GeBBS HealthCare Solutions of Englewood Cliffs. The company ships the records electronically to India, where employees - earning about one-tenth of what they would get in the United States - process a bill for the patient's treatment, create a claim, and send it electronically to the insurance company. The process costs the doctor about half what he would pay in the United States, Thakor says. "It's faster. The quality is better," he says, brimming with confidence. "It makes perfect sense." It's also part of a growing trend in the health-care administration industry: sending work to low-wage countries - mainly India - in the same way that offshore outsourcing has sent U.S.-based IT, call center, and other jobs around the world.

The health-care work ranges from simple tasks - such as transcribing notes dictated by the doctor - to more complex processes, such as assigning a treatment code and filling in forms that doctors submit to insurance companies for reimbursement. In North Jersey, GeBBS, Allserve Systems of New Brunswick, and ClaimPower Inc. of Fair Lawn do work in India. Marlton-based Medquist, one of the largest transcription company's in the United States, also sends work offshore. Other players across the country include Perot Systems Corp. in Texas, HealthScribe Inc. of Virginia, and Alpha Thought of Chicago. "There is not a lot of offshoring yet," said Barbara J. Cobuzzi, president of Cash Flow Solutions Inc. of Brick, which does billing, coding, and collection. "But they [offshore companies] are going after it. ... They are approaching companies like mine and saying, 'Get rid of your staff and use us.

Cobuzzi said she spoke from experience: In October, she terminated a contract with a Florida-based company with offices in Chennai, India, to put patient demographic information into a computer. She said the work contained too many errors. "I'm sure the doctors would rather use someone who is not offshoring," Cobuzzi said. "But the doctors have this huge pressure to get their costs down." So, too, do their contractors, said Marilyn Grebin, president and CEO of Silent Type in Fort Lee, which transcribes doctors' notes. Though offshoring has not yet had a big effect on Silent Type's bottom line, the company has lost work, Grebin said. For instance, last week, she said, she lost a $50,000 contract with the John T. Mather Hospital on Long Island. Grebin said the hospital, which had been her company's client for five years, hired a company that will do the job in India. "I went to the client and said, 'What can I possibly do to help you, she said. "And they said, 'No, you can't possibly charge what we are getting - half the price.

On Long Island, hospital vice-president Kevin Murray said the non-profit community facility moved the work offshore in a pilot program - a small part of the facility's $500,000 annual spending on transcription services - to see what the quality of the work is like. "The hospital lost a significant amount of money last month," said Murray, putting the loss at $1 million and noting that many hospitals in New York face similar budgetary problems. "Every month is a struggle. ... This was one of our cost-saving ideas." Thakor knows the scenario well.  With about 85 employees in the United States, GeBBS provides health-care administration services and also develops software for the same field. The company's two centers in Mumbai, India, employ about 180 people, of whom 100 process health claims. Last year, the company had revenue of $12 million, and it expects to make $16 million this year, Thakor said. He reaps the benefit of Indian workers - all of whom have degrees - who earn about $2,800 to $3,300 a year, compared with the $35,000 to $45,000 that U.S.-based employees would make for the same job, he said. "We're making a 45 to 50 percent gross margin," Thakor said of his own company. "A client is seeing a 45 to 50 percent cut on their cost structure. So we're happy. They're happy."

Concerns about patient confidentiality in the offshoring era were heightened last October when a woman in Karachi, Pakistan, threatened to post patient medical records from a San Francisco hospital on the Internet unless she was paid the money owed her for transcribing notes dictated by doctors.

The woman dropped the threat after she was paid. But the incident helped bring the issue to the attention of lawmakers.

Sen. Hillary Rodham Clinton, D-N.Y., and Rep. Edward J. Markey, D-Mass., have introduced bills that would require companies to notify customers before they send confidential information overseas, giving the customer the right to refuse. Still, industry insiders are concerned. Cobuzzi and others said the main problem is that anyone who violates U.S. patient confidentiality laws abroad would be beyond the reach of U.S. prosecutors. But offshore companies say there is no danger of leaks. Thakor said GeBBS' facilities in India have guards and an electronic security system, along with a full-time privacy officer to ensure the company complies with U.S. confidentiality laws. In addition, the computer system that health-care administration employees work on is sealed, he said: The terminals have no hard drive and no connections to the Internet, floppy disk, or CD writers, or even a printer. They can only open files on the server, change the contents, and close them, he said. "So there is no way - unless you can memorize all the information - that you can take it with you," he said.  

I constantly see all these job openings asking for experience.  How can I get experience, when no one will hire me without experience???

ratio is about 3 to 4 on a large hospital account doing all specialities and report types.   I think it would be closer to 2 or 3 with clinic work.   

The most I have made working for another service was 11 cents per gross line.  That was 3 years ago and that company sold, I couldn't work for them anymore anyway.

Now I am ALWAYS offered 8 cents per line when looking for part-time.  I think this is low, considering they charge 14 or so and want to see perfect documents and never proofread.  Truly, I think that is a total ripoff.  No benefits either.

Well, a prominent man in our town (bigwig at newspaper) took him in and let him stay in his spare room while he worked here in town and coached our kids. Like I said, my son finally quit the team and it was several years later before it came out that he was gay. He had gone on to coach our local high school soccer team and it came out at that point. I guess older guys are not nearly as likely to keep this a secret as the younger guys. And to be honest, I'm not sure what all happened with the high school, but there was some trouble. He left town and I'm not sure what happened from that point. I was just glad that I had let my son quit after all. To this day, though, my son will clam up when I ask him about it. He has said he never tried anything with him, but I'm still not sure.

Alll the jobs state they need expereince.  How do you get hired with no experience.  Very frustrated.  Appreciate any help.  Want to do transcription from home.  What is the best way to get started.    

and you get hired by a company, they expect you to do your part by researching and looking up words and spelling them correctly as well as other aspects of the reports such as grammar and punctuation. 

Companies do not have the time or resources to teach people what they are supposed to know.  That's what schools get paid for. 

Considering the fact that you had less than two years' experience, you were lucky they hired you in the first place. 

Instead of being angry, try to make yourself a better MT and go to the table with a little more to offer.  It worked for me.

There are $.09 and $.10 jobs out there with decent bosses, on time pay, and easy work that isn't all ESL.

Does somebody who has been doing Multispecialty Clinic transcripation have a chance at landing an Acute Care job?  If not, what could I do to get more Acute Care experience?  I would love to get experience in Acute Care as well as what I have been doing.

Thanks for the advice!

If you love someone you can put up with a lot, if you don't - it's hard to take.  I stood by my man through thick and thin because I loved him but after time, that love just chipped away into nothing.  After that, it didn't take much at all to leave.   I sure was ready and never looked back.

In other words it depends on what the two of you have, because it sounds like a difficult situation.  Good luck. 

I want to become more proficient in op notes and ESL.  Is there a company that would be willing to work with me so that I can learn this?  I am not a newbie, with over 6 years hospital/clincial transcription experience, but we have very few ESL and the op notes are covered by others.  This is something that I really need and want to exceed in.  Can anyone point me in the right direction?

Thanks!!  Marceia

If they don't want to change or quit, they won't.  The addict has to really want it or they will not quit and will eventually go back.  I have had loved ones and family addicted to meth and it is nasty.  I've seen two men lose their wives and children because they couldn't/wouldn't quit.  Support them in their endeavor, but they have to do it on their own with the support of their family.

It is a tough and long road, and it sometimes has no end.