The Changing Role of Medical Transcription

Digital voice technology has had a significant impact on how physicians’ notes are entered into the medical record. Some hospital CIOs regard that trend as an opportunity to balance transcription costs with the needs of clinicians. They say that changes they have implemented in how transcriptionists are employed in their hospitals have helped to cut costs while providing more timely results. The transcription industry, meanwhile, maintains that medical transcriptionists will continue to be crucial link between the physician’s diagnosis and what appears in the medical record, particularly with regard to meaningful use requirements.

One hospital that has altered its medical transcription process is Poudre Valley Health System, Fort Collins, Colo. Russell P. Branzell, CIO and vice president of information services, says he took responsibility for transcription at the organization in 2004. At the time transcription was part of the medical records department, which reported to finance, Branzell says. As part of the overhaul, he moved transcription under information technology, he says.

According to Branzell, prior to the changeover, it took 30 to 45 days for the hospital to get discharge summaries out of the organization, and even status reports took hours to complete. One of his first tasks was to replace “a very old product that was jerry rigged at best” with eScription (supplied by Burlington, Mass.-based Nuance Communications, Inc.). His goal was that by the end of the first year 95 percent of the voice transcription software and come back ready to be edited, rather than conventional front-end transcription.

In his view, the results have been impressive. With the exception of discharge summaries, all reports were done in real time. The voice transmission from the physician was recognized at the back end and submitted to the transcriptionist for editing. Documents were ready for signoff by the physician in less than an hour, Branzell says. Discharge summaries were completed in 48 hours or less.

Branzell acknowledges that the hospital has only a small contingent of foreign speakers. “We have a fairly commonplace dialog of speech patterns among our physicians, so it was fairly easy for us to adapt to the system,” he says.

Most of the improvements so far have been at the back end, Branzell notes. He says Poudre Valley is now working on an initiative to use front-end voice recognition in the hospital’s radiology department. Currently, front-end voice recognition is used in about 10 percent of radiology department documentation. “The goal is to get significantly higher,” he says. He adds that Poudre Valley is also investigating ways to combine front-end and back-end voice recognition environments that will allow physicians to be able to choose one or the other, depending on complexity and time requirements. Doctors, he says, have been enthusiastic: “Our doctors actually push us to get to the next level,” he says.

Branzell says technology advances are changing the role of the medical transcriptionist from one of transcribing to one of editing. He says transcriptionists will always be needed in situations where fast turnaround is needed, such as trauma cases. But he does say that he can foresee a time, or at least the possibility, when many hospitals will not rely on traditional medical transcriptionists.

Yet Peter Preziosi, chief executive officer of the Washington, D.C.-based Medical Transcription Industry Association, sounds a note of caution. He says he is not technology-averse, and acknowledges that voice recognition software can improve productivity when it comes to preserving the medical record. Yet he says medical transcriptionists will be vital as hospitals strive to meet meaningful use rules, which call for rapid turnarounds of clinical summaries as well as up-to-date lists of current and active diagnoses, with entries recorded as structured data.

One of his concerns is that medical transcriptionists are at risk of being sidelined at a time of industry change. “The challenge of healthcare is that it is an art, and you have to have critical thinking skills that are attached to the technology,” he says. As technology makes itself felt in the medical record, it’s important to preserve a nuanced account that tells the whole patient narrative. “We need to have more robust information [for physicians] to make complex clinical decisions, and be able to coordinate that care,” he says.