Who Says Medical Transcription Can’t Be Innovative?

Published on February 6, 2013

This was the tag line of a blog that I used to write called Management for the Modern MTSO. My point was, and still is, that the medical transcriptionist (MT) can be an efficient, cost-effective part of the clinical documentation life cycle. The pressure on health care providers to implement and “meaningfully use” electronic health records has created an interesting dilemma for clinical documentation.

On one hand, no one argues over the benefits of accessible, legible, shareable clinical documentation over easily damaged or lost, often illegible, paper records. On the other hand, despite the pressures of Meaningful Use, physician adoption of documentation and use of structured templates in the EHR remains low. According to HIMSS EMR Adoption ModelSM 41.3% of providers have reached Stage 3 on the adoption scale for the 3rd quarter of 2012, but only 7.3% have reached Stage 6 which includes physician documentation and structured templates. Even among physicians who are using structured templates in the EHR, physicians often complain that “the computer comes between me and my patient” to “the EHR wasn’t designed to fit my workflow” to “every patient looks the same. I can’t tell how my patient feels today compared to how she felt yesterday.”

Compounding the problem is that health care providers frequently attempt to decrease costs by asking physicians to document directly into the structured fields of the EHR, transferring the total burden of documentation creation from the medical transcriptionist to the most expensive person in the organization – the physician. In an attempt to save time, physicians adopt short-cuts which might make documentation tasks faster, but could also make it easier for a physician to introduce problems due to inappropriate use of copy/paste and templates.

Interestingly, it seems as though the solution for some of these problems is something that has been around for a long time – medical transcription. Though many in the industry do not believe that medical transcription adds value to the clinical documentation workflow, time may prove that this view is shortsighted and more expensive in the long run.

How can medical transcription help?

  • Improves ease-of-use: Dictation and medical transcription fits into the physician’s workflow and can meet the needs of physicians who dictate during the patient encounter, in between patients, or at the end of the day. The physician can provide comprehensive information quickly and, unlike front-end speech recognition, medical transcription helps to ensure quality by bringing another pair of eyes to the documentation.
  • Improves collaboration between members of the patient care team: Dictation and medical transcription facilitates the conversational, narrative expression of the patient story, allowing physicians to capture the information that can’t be expressed in discrete data points.
  • Facilitates physician – patient interaction: Perhaps most importantly, allowing the physician to dictate without having to have eyes glued to a computer screen removes the obstacle that documenting directly into the EHR can place between the physician and the patient.

Aside from the benefits to the physician, I would go one step further about the value of medical transcription: The medical transcriptionist can increase the usefulness of clinical data by being the skilled human behind the validation of NLP-driven technologies.

“By ensuring that we make full use of the MT’s knowledge and skill, we can contribute to physician satisfaction and documentation quality, while enabling providers to realize the maximum return on expensive technology investments.”

We have all heard about natural language processing (NLP) and its ability to created discrete, encoded data from narrative information, but what is often missing is discussion about the validation process necessary to ensure the correctness of the results. NLP is not perfect and the assumption that NLP is the silver bullet that will solve all of our dilemmas is misguided. Requiring effort on the part of the physician to validate results of NLP is not the answer. The skilled MT may be the person in the documentation workflow who can fill this gap, becoming a Healthcare Documentation Specialist; a knowledge-based worker, not a “transcriber” of documents.

The Healthcare Documentation Specialist adds value to NLP-driven processes by:

  • Validating that the NLP has correctly captured the discrete data elements as well as the document structure before attempting to upload to the EHR or exchange through an HIE. By validating that the structure of the document and concepts such as medications and allergies are correctly encoded, the Healthcare Documentation Specialist prevents errors in the EHR.
  • Validating encoding of clinical concepts before the document gets to a coder or CDI specialist.
  • Validating results of population health studies before presentation to a researcher or case manager.
  • Correctly “tagging” concepts such as medications or allergies that might have been missed.

It is not, as many believe, necessary to eliminate narrative documentation in order to have semantically interoperable electronic information. The Health Story, HL7, IHE Consolidation project is making great strides towards the creation of interoperable standards for the exchange and use of health information which will allow us to have structured clinical data while retaining the narrative information that is required for human understanding.

A product of this project, Consolidated CDA, has in fact been accepted by the ONC as the standard for the electronic transfer of the patient Care Summary as part of Meaningful Use Stage 2. If fully adopted for all document types, consolidated CDA creates a standard both for content of clinical notes as defined by the Health Story project and for the electronic exchange of this information. What this means is that it is possible to have the benefits of electronically structured and encoded data while retaining the narrative created by dictation and medical transcription.

By ensuring that we make full use of the MT’s knowledge and skill, we can contribute to physician satisfaction and documentation quality, while enabling providers to realize the maximum return on expensive technology investments.

Is Medical Transcription the solution to all of today’s clinical documentation problems? Of course not. But when used as one of the tools in the provider’s documentation tool belt, it can be a great asset to any documentation workflow.

So again – who says Medical Transcription can’t be innovative?