not sure this will exactly help you, but there was an article in my local newspaper this a.m. sm

• New account - Jody
  • not sure this will exactly help you, but there was an article in my local newspaper this a.m. sm - LMT
    • ha! smart gal! good luck! nm - MQer
  • Here's a link to an article with backup info - Hayseed
    • Thank you - Jody

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outsourcing (their wording) work to India.  The contractors in India are now outsourcing the work to other places in India.  They figure if  we (the US) can outsource American work to India, why can't they outsource the work also.   Your medical info is going to be as private as if you took out a billboard and posted it there. 

RADIOLOGY TRANSCRIPTION
FT M-F/WE

This is the way the ad is listed. The FT M-F job was my job. The weekend job was the one the other Transcriptionist left in December (she graduated from nursing school).

This is copied directly from their ad in the nearest "major metropolitan newspaper".

It's mean of me, but imaging how much work the three remaining MTs must be trying to handle does give me a little bit of comfort. They wanted the office to themselves - well, by golly, they got it!

Quite a waste of money if they're downsizing. Oh, and did I mention - they just opened up a new clinic, which increased the work load by about one-third, and now they are building a second hospital? 

Nope. Not downsizing.

It is just a small town paper, asking some general questions about outsourcing/offshoring, pay, types of businesses, etc.  I told him I could not tell him what I actually do for a living or name my company.  Can he find that out? 

I also sent the letter to the Washington Post, Fox News, NY Times, Associates Press, 60 Minutes, and USA Today.  I inserted in the letter about uncertain figures that by my calculation, the number of jobs offshored would be more or less the equivalent to the total population in 3 states in the U.S. 

What will I do if they find out who I am and who I worked for?  Can I be sued?

I'm 57, learned on the job 28 years ago.  I can out transcribe people half my age.  I have no arthritis, no carpal tunnel syndrome, no fibromyalgia and only occasionally get a crick in my neck from my job.   My QA score is 100%, has been for years, and I type 90 wpm, transcribe 200 lph at least and that's on an account that is almost all ESL.   I could do this job another 20 or 30 years if I wanted to (barring sickness or accident that could happen at any age).

As far as the AAMT rep saying younger people are not lining up for this job - have they done anything to market MT to younger people?  I'm sure a lot of high school kids or even community college people would be interested in this work if they were educated about it. 

One last thought - the people they are offshoring this work to in India, Pakistan, Trinidad, the Philippines, are not spring chickens!!! 

I for one am sick of AAMT trying to justify their greediness by blaming their victims, the US MTs.

My first thoughts were like you, just another way to cheat us.  But then when I considered the possibility (trying to be kind here) that some companies are not giving us full credit for every character typed (as in perhaps counting 3 Keystrokes as 1 as has been mentioned here before), then even if they didn't pay us for spaces, we might make more in such a situation if they had to pay us for every single black character.  They can't hide that from us!  In other words, they would not be able to manipulate the line counting as much as I think they are doing now.  Now how much they would pay us for every black character might differ from company to company, but I think this might work in our favor overall.  If pay based on production is better for us than an hourly wage, we need to find what works most to our advantage.   And with the difference there is out there now in line counts from one company to another, pay by character might help us. 

And yes, even if it is a template, every character should still count as well as spaces, returns, tabs, demographic insertion, and also for our knowledge which comes into play every single time we keep the dictators from sounding like idiots and/or catching their mistakes.  Let's face it -- we do at least basic editing too, folks.  We are NOT just typists!  We should be reimbursed for our knowledge as well as production.   We're not donating our time to a charity here.  This is a way of making a living.  We should be paid for whatever we do for the company we work for, just like in any other job.  This might be a step in the right direction. 

I am cautiously almost hopeful. 

Read this

New Orleans: A Disaster Waiting to Happen
by George E. Curry
NNPA columnist
Originally posted 9/1/2005

I am angry. I am angry at the mayor of New Orleans. I am angry at the governor of Louisiana. I am angry at the Environmental Protection Agency (EPA). I am angry at the Federal Emergency Management Agency (FEMA), now part of the Department of Homeland Security. I am angry at George W. Bush. I am angry because they were warned last November that New Orleans was one of the “Disasters Waiting to Happen” – and did nothing about it. Consequently, hundreds, if not thousands, of people are dead. Needlessly.

In an eerie prediction of what happened as a result of Hurricane Katrina, an article titled, “What if Hurricane Ivan Had Not Missed New Orleans?” was published in the Natural Hazards Observer, a major journal headquartered at the University of Colorado in Boulder. It was written by Shirley Laska of the Center for Hazards Assessment, Response and Technology at the University of New Orleans. In other words, this was an article written by a reputable author in a reputable national publication that should have been read by people involved in disaster relief. If they had taken heed, many of the dead in New Orleans would be alive today.

Under the headline, “What if Ivan Had Hit New Orleans?” the author wrote, “New Orleans was spared this time, but had it not been, Hurricane Ivan would have:

- Pushed a 17-foot storm surge into Lake Pontchartrain;

- Caused the levees between the lake and the city to overtop and fill the city ‘bowl’ with water from lake levee to river levee, in some places as deep as 20 feet;

- Flooded the north shore suburbs as much as seven miles inland; and

- Inundated inhabited areas south of the Mississippi River.

“Up to 80 percent of the structures in these flooded areas would have been severely damaged from wind and water. The potential for such extensive flooding and the resulting damage is the result of a levee system that is unable to keep up with the increasing flood threats from a rapidly eroding coastline and thus unable to protect the ever-subsiding landscape.”

Until I read this article, I had said one of the positive things that I hoped would come out of this disaster is that relief experts would realize that they need to make special provisions for the poor, elderly and homeless. In essence, I gave them the benefit of the doubt. Now, however, I realize that there is no benefit in doubt.

The warning was there in black and white:

“For those without means, the medically challenged, residents without personal transportation, and the homeless, evacuation requires significant assistance.”

Laska spelled it out in even more detail.

During Hurricane Ivan in 2004, she continues, ‘Residents who did not have personal transportation were unable to evacuate even if they wanted to.
Approximately 120,000 residents (51,000 housing units x 2.4 persons/unit) do not have cars.

“A proposal made after the evacuation from Hurricane Georges to use public transit buses to assist in their evacuation out of the city was not implemented for Ivan. If Ivan had struck New Orleans directly it is estimated that 40-60,000 residents of the area would have perished.”

The additional problem of people having the means to leave, but refusing to do so was addressed in the article.

“Researchers have estimated that prior to a ‘big one,’ approximately 700,000 residents of the greater New Orleans area (out of 1.2 million) would evacuate,” Laska wrote. “In the case of Hurricane Ivan, officials estimate that up to 600,000 evacuated from metropolitan New Orleans between daybreak on Monday, September 13 and noon on Wednesday, September 13, when the storm turned and major roads started to clear…

“The fact that 600,000 residents evacuated means an equal number did not. Recent evacuation surveys show that two thirds of nonevacuees with the means to evacuate chose not to leave because they felt safe in their homes. Other nonevacuees with means relied on a cultural tradition of not leaving or were discouraged by negative experiences with past evacuations.”

Those that dismiss environmentalists as kooks, should pay special attention to the observations about marshes.

“Loss of the coastal marshes that dampened earlier storm surges puts the city at increasing risk to hurricanes,” the article noted. “Eighty years of substantial river leveeing has prevented spring flood deposition of new layers of sediment into the marshes, and a similarly lengthy period of marsh excavation activities related to oil and gas exploration and transportation canals for the petrochemical industry have threatened marsh integrity.”

Using the Hurricane Ivan model to predict what would happen if a major hurricane struck New Orleans, Laska wrote: “Should this disaster become a reality, it would undoubtedly be one of the greatest disasters, if not the greatest, to hit the United States, with estimated costs exceeding 100 billion dollars. According to the Red Cross, such an event could be even more devastating than a major earthquake in California. Survivors would have to endure conditions never before experienced in a North American disaster.”

It ended, “The hurricane scenario for New Orleans that these conveying risks portend is almost unimaginable. Hurricane Ivan had the potential to make the unthinkable a reality. Next time New Orleans may not be so fortunate.”


George E. Curry is editor-in-chief of the NNPA News Service and BlackPressUSA.com. He appears on National Public Radio (NPR) three times a week as part of “News and Notes with Ed Gordon.” In addition, his radio commentary is syndicated each week by Capitol Radio News Service (301/588-1993). To contact Curry or to book him for a speaking engagement, go to his Web site, www.georgecurry.com.

Please see article below that was published in 2003. Does anybody know if the law it mentions was ever passed in California?

Following news that a Pakistani medical transcriber threatened to post UCSF Medical Center patient records online unless she received more money,

a state senator said she will introduce legislation barring all California hospitals from allowing medical data to leave the country.

Sen. Liz Figueroa, D-Fremont, said she will introduce the bill in January when the state Senate returns for its next regular session. (A special session on financial matters is likely before then.)

"California already has the strongest medical-privacy laws in the nation, " Figueroa told me. "But not strong enough. There's always something you didn't anticipate."

What she and other framers of the state's medical-privacy laws, which prohibit the sharing of medical information unless for clear medical purposes, didn't see coming is the explosive growth of the $20 billion medical- transcription industry.

U.S. hospitals have such a huge need for help transcribing doctors' dictated notes into written form that the work is routinely farmed out to private transcribers throughout the country. Those transcribers, in turn, frequently subcontract with other transcribers.

In the case of UCSF Medical Center, three separate subcontractors were involved in handling the facility's records. The last link in the chain was a woman in Karachi, Pakistan, who sent an e-mail to UCSF earlier this month demanding help in resolving a financial dispute with the Texas man who'd hired her.

The Pakistani transcriber said she'd post UCSF's files on the Internet unless the medical center assisted her. She backed up her threat by attaching actual UCSF patient records to her message.

This was the first time an overseas transcriber had used confidential records to threaten a U.S. medical institution. The transcriber withdrew her threat only after receiving hundreds of dollars from another subcontractor in the case.

Figueroa said her bill would prohibit anyone possessing information involving California patients from sending that information abroad.

State hospitals would likely be barred from outsourcing transcription work unless they could guarantee that all related files remain within the country -- a move that would make hospitals accountable for any subcontracting that ensues.

"We're not banning the practice of overseas workers doing transcription," Figueroa said. "But we can regulate the practice of medicine within California. "

The law, at least on the health care front, may be on her side.

In most instances, federal law would trump state law, and the federal Health Insurance Portability and Accountability Act of 1996 outlines rules for safeguarding medical data. Anyone doing transcription work for a U.S. hospital would be required to uphold HIPAA standards, although the law is virtually unenforceable overseas.

A unique aspect of HIPAA, though, is a provision that if a state adopts more stringent restrictions, state law will prevail.

"If there were a statute that no health care information in California could be disclosed outside the country, HIPAA wouldn't have a problem with that," said Paul Smith, a San Francisco attorney specializing in health care issues.

"The state has a clear interest in protecting health information," he added. "This would seem a legitimate exercise of state regulatory authority."

At the same time, though, Matthew Nakachi, a San Francisco lawyer who specializes in trade issues, said it's unclear how the proposed legislation would square with federal laws related to commerce. A hospital might argue, for example, that it has a right to do business with whomever it pleases.

"If California decides to do this," Nakachi said, "it would probably go into the courts and take years to fall out."

For her part, Figueroa expects the health care industry to fight the legislation, just as the banking industry opposed state restrictions on the use of customers' information. But she thinks that in light of the public's increased sensitivity toward privacy matters, her bill would eventually pass.

"The interesting thing will be to see where our new governor stands on privacy issues," Figueroa said. "At this point, we don't know."

Mystery woman: The Pakistani transcriber at the center of the case involving UCSF is still something of a mystery.

In her e-mail to UC officials, she identified herself as Lubna Baloch, "a medical doctor by profession." Beyond that, little is known of her.

In May, however, an interesting little exchange occurred on MT Stars, an online network for medical transcribers. Baloch, using the same e-mail address she used in her threatening message to UCSF, posted her resume at the site in hopes of attracting work as a subcontractor.

Sheri Steadman, who runs MT Stars, of Phoenix, said she's against U.S. transcription work going abroad and routinely deletes postings from overseas transcribers. In Baloch's case, she said she was concerned by the vagueness of Baloch's resume, especially as to her whereabouts.

Steadman wrote to Baloch to say that MT Stars is only for U.S. job seekers.

"I am US based," Baloch replied.

"Not enough info," Steadman responded. "Where?"

"Santa Monica, LA," Baloch wrote back.

For Steadman, this wasn't a very good answer.

"Santa Monica isn't in Los Angeles and it's not in Louisiana," she told me. "It was pretty clear that Baloch wasn't in the country."

Steadman confronted Baloch with her suspicion. Baloch never wrote back.

"She was trying to gain work in any way, shape or form," Steadman said. "She was trying to sucker U.S. medical-transcription services into sending her business."

It didn't work that time. A few months later, though, probably using a different online service, Baloch was more successful in her efforts.

That would turn out to be a very dark day for UCSF.

David Lazarus' column appears Wednesdays, Fridays and Sundays. He also can be seen regularly on KTVU's "Mornings on 2." Send tips or feedback to dlazarus@sfchronicle.com.

EMR might not soon replace us after all....

http://health-information.advanceweb.com/common/Editorial/Editorial.aspx?CC=66392&CP=1

I am a volunteer at our local humane society and am active with several vets locally.  What this article suggests is absolutely ridiculous. 

August 9, 2006 - EMR has revolutionized the healthcare industry in recent times. Many experts felt that EMR & Voice Recognition would totally replace Medical Transcription - however; the industry soon realized that transcription has certain advantages over point & click charting and many physicians preferred to dictate notes rather than document the data at the point of care themselves.

The most critical part of any Electronic Medical Record (EMR) is the method of data entry. EMR is about aggregation of patient encounter data at the point of care in order to provide a complete, accurate, and timely view of patient information. An electronic medical record is not just a typed record of the patient encounter, but an extremely useful decision support tool. The data can be entered into the EMR via any of the two general mechanisms: direct entry by the physician using point and click templates or transcription of dictated notes. Point and click template indicates that each data element, which is to be inserted, requires selection, navigation, point and click process for capturing patient information.

Transcriptions have been around for years for documenting patient encounters. A medical provider dictates the medical note into a phone or a recording device. The Transcriptionist receives the dictation and transcribes it. It may be reviewed by the supervisor for checking errors. The final computerized file is then either emailed directly to the healthcare provider or the file is transferred to a web site and is later downloaded by the provider.

Each method has its pros and cons.
Point and Click Templates
Most EMR systems allow providers to generate clinical documentation, by selecting variable terms from pre-structured point-and-click templates. Users simply point and click to select appropriate choices from lists of choices to record a patient encounter. The end result would be a document that closely resembles a transcribed procedure note.
 
Advantages 
Completely customizable templates. The doctor can specify the layout of the template, which helps him to adjust the template as per his practice & procedure.
§    Provide consistent, complete and accurate data. The chances of medical erros are reduced since the data is documented in customised forms.
§    Notes for similar type of exams will appear to be standard and similar
§    Store / organize data for subsequent retrieval. 
§    Each click adds data elements to the database. Point-and-click systems create data that can be used to generate clinically useful reports, such as health maintenance reminders, disease management etc.   
§    One of the major advantages of template based charting is the time needed to make the document available as a medical record. Since notes are created within the EMR, they are available immediately upon completion.

Disadvantages
§    It takes more time, and definitely more concentration for a physician to navigate through large data set and create progress notes using point and click templates. 
§    Templates must be customized as per the physician’s requirement. Customization can be inflexible and costly.
§    Well accepted by only tech-savvy doctors. 
§    The approach of direct data entry by the physician has generally failed because busy providers reject it altogether.
§    Output from these templates is too canned and identical. It loses individuality for each patient. 
§    It is difficult for a provider to capture complete patient encounter on computer in front of a patient.  

Medical Transcription
Transcription has long been the standard for documenting patient encounters. It is more convenient for a provider as compared to handwritten notes or electronic data entry.  There are many advantages of transcription in comparison to point and click charting. There are a few disadvantages as well.  
 
Advantages
 
§    Corresponds intuitively to the physician's usual method of working. Dictation remains the most intuitive and least time-consuming means of data entry.  
§    Physicians can dictate anytime, anywhere using PDA, Dictaphone or telephone at their convenience.
§    Providers need not change the way they practice just to accommodate an EMR. EMR can interact with transcription service so that transcriptions can be attached directly into the patient’s electronic medical record, if such a facility is provided by the EMR vendor.
§    It requires minimal training for physicians. 
§    Provides expressive power to describe patient’s condition and other health related events. 
 
Disadvantages
§   Details of the exam can easily be forgotten and omitted while dictating, if dictation is not captured immediately at the point of care
§   It cannot be queried for generating reports unless transcribed in pre-formatted templates
§   Transcribed reports are not immediately accessible. Physicians would normally have to wait for 12 to 24 hours for charts to be delivered, unless few vendors supporting 2-4 hours short turn around time.
§   Transcription provides for more efficient use of doctor's time.
§   Although average transcribed report costs $2 to $4, it can reduce the doctor's time spent on data entry. Considering the value of doctor’s time, transcription is not a costly proposition.
 
EMR should give the freedom to the physician to decide to use either Point & Click or Medical Transcription. For a physician, the EMR that fits into his practice workflow would be invaluable. A competent EMR must have a template driven charting feature and the ability to interact with a transcription service at the same time. Both are indispensable features of Electronic Medical Record Software, as doctors are not unanimous on point and click charting or transcription. Such an EMR will be both efficient and cost effective. 

The trends in transcription itself are changing with Medical Transcription service providers aiming to adopt new technologies. These technologies will evolve to increase efficiency & accuracy, decrease turnaround time and support data capture. While many of these technologies like such as digital dictation and electronic signature exist today, several technologies are still on the horizon.

On ''Asian'' and ''Oriental'' 

By Alan Hu

OK, so a long time ago, people in Europe used to refer to everything to the east of them as the Orient, including for example the Middle East, since orient means "east". So far, so good. This mysterious area was the source of all sorts of wonderful things like silk and spices, so the Europeans attached also sorts of exotic, mysterious connotations to the Orient. As Europeans gained a better concept of world geography, they eventually used "the Orient" and "Oriental" to refer to East and Southeast Asia, where people look "Oriental" in our current usage.

Anyway, that usage of "Oriental" has survived a long time, and it still frequently carries all of the exotic/foreign/inscrutable/mysterious connotations. These connotations happen to coincide with many of the stereotypes held of Asian Americans. Furthermore, by definition, the word "Oriental" is Eurocentric, referring to things east of Europe. For these reasons, some Asian American activist types decided that "Oriental" was a Bad Word, and that "Asian" was more accurate, less Eurocentric, and less loaded with strange connotations. No big deal, right?

Well, a lot of people didn't want to change their language usage. Some people grew up using "Oriental" and saw nothing wrong with the word. Others came from other parts of the world, where hip-activist-American-English-linguistic-evolution hadn't hit. Still others never encountered anyone aware of Asian American politics, so had never heard of this word usage change. Some people were exploiting the exotic mysticism connotations and resisted change. (Very early on, you would see articles about business and trade in Asia, whereas the travel articles would talk about visiting the Exotic Mysterious Orient.) Finally, some people were convinced that this was a typical case of left-wing-politically-correct-thought-police-mind-control (which it was) and decided in typical right-wing-politically-correct-knee-jerk-response that the word usage change was intrinsically evil and had to be resisted at all costs.

For a while, therefore, you could identify a person as being an American who was aware of and sympathetic to Asian American politics by his/her word choice. Now, however, many exploitation-types have realized that saying "Asian" instead of "Oriental" is the cool thing to do, without changing any of their stereotypes and misconceptions. (You can force a person to change his/her behavior, but you can't force a change in thought.)

The upshot is to use whatever word you feel most comfortable with, or that makes your listeners most comfortable, but don't be surprised if someone takes offense. And in the time you save by not worrying about word-usage, try to make the world a better place. 

LOL - I couldn't have said it better myself. 

Yes, here's the link to the article about determining your rates if self-employed

http://www.businessknowhow.com/officesupport/hourlyrates.htm

I always felt like I was "an accidental business owner" because when I got into MT work at age 25, I didn't realize how much of it was as an IC. I should have talked to an accountant from the start.

Diane