Can we think about Medical Transcriptionist?

OpenEMR Development
1

juggernautsei wrote on Monday, January 30, 2012:

Hi, I am starting this thread because of the thread that I started on Linked In has grown into a real heart felt discussion of the EMR industry from their point of view. There are tens of thousands of MT’s out there that are out of work. Here is the threa link.

http://www.linkedin.com/groupAnswers?viewQuestionAndAnswers=&discussionID=87354753&gid=3814010&commentID=66453847&trk=view_disc&ut=15Q49ekynfJl41

Here is what Ellen said:
well people can take action all they want but unless the idea of “saving a buck” by using Speech Recognition is something they agree is not worth it due to its lack of accuracy and learning/critical thinking ability, then all the action in the world won’t make a difference. If you pay someone 10 cpl say and SR does it for 0 cents a line, and then you pay an editor 5 cpl to edit it, (which is about the going rate for SR editing) and the SR editing takes an MT 3 times longer to edit our correctly and accurately than typing it themselves, but the MTSOs don’t care because they see 5 cpl and their profit margin has just shot up (cause they don’t care how difficult or frustrating or time consuming the editing takes as long as they are making that new profit margin), we can whine and complain and protest but they still look at that profit margin.

I think probably just communicating as best you can with who you work for, that the problem IS REAL and the SR programs are horrible, even the best of them, and if there are reasonable physicians, hospitals and health care providers who will look at it for themselves and see, then those are the ones who will likely drop SR and go back to just MTs. Smart people. But otherwise, humans are basically very greedy (sorry humans :() and will put through things whatever way they can best save a buck. SR does save money to be sure, BUT at whose expense. Not only the patient risking their lives by possible errors on a report, but the MTs losing faith in this industry, and eventually they will have no one left to edit and no one wanting to come into this industry, then what will they do? Good MTs won’t put up with SR for long, and they will leave to find other work. The MT resource pool dwindles, the need for SR editing increases, and one day they will be hooped because there won’t be anyone left to do their editing, or very few. Sad but true. You can’t even do SR editing until you’ve had at least a couple of years MT experience because medical language is so broad and so complex sometimes, not to mention formatting rules and guidelines yadda yadda yadda. So new MTs don’ t stand a chance at editing work. So I think that’s why we’re not all up in arms, we know the inside workings of the systems and their motivations and until many companies try out these SR systems and realize they are not that great, well we just have to bide our time on the whole issue, but make a case where we can with our local providers. I have talked to EMR providers here and told them about SR and its horribleness and they said they would let physicians know that. So that was a step. As for the EMR programs that have physicians punch in vitals and use a touch screen to write a report… have you ever seen those reports LOL? Unreal and lacking information that might otherwise be dictated because the doc only has so much time to punch at a touch screen so shortcuts everything. We need proper medical reports. It’s not like the industry can’t afford MTs, they’re just cheaping out. Have a good weekend everyone! Take care
Posted by Ellen Radysh

Jane wrote:
It’s too bad the physicians don’t realize that, for the most part, with the new EMRS, they will have to type themselves what we would otherwise be transcribing! There are some EMRs that are set up for the addition of medical transcription into the records, but they are few and far between. Not only is our work greatly decreased, but from what I have seen, patient care potentially is truly diminished because the physicians and office staff are so preoccupied with getting information into the computer that they can’t even interact properly with the patients! While the physicians used to devote that time to the patients’ medical concerns, now they are seeing the patients over a computer which they bring with them into the examining rooms. It is very disorienting for everyone involved and truly distressing to watch this deterioration in our profession and in patient care!
Posted by Jane Bulbin

And there are many many more. What can we do to position OpenEMR to make a difference is what I want this discussion to be about.

This is what I wrote to the National Association of Medical Transcriptionist:

"The above thread has been raging with people who has lost jobs and entire businesses to EMR’s.
There has to be a way to bring this industry back by make an EMR that includes them and not cut them out. There are millions of MT’s that need work and work that they can do can’t be replaced by a program. They need to be heard.

Will you listen?"

Will we listen?

Sherwin

2

aethelwulffe wrote on Monday, January 30, 2012:

Hi Sherwin.

I will gladly listen.
Let’s face it.  I am a wooden boat builder.  I am sure you can draw the corollaries.  I certainly have.  This issue is of re-training.  Doctors, (I call them “Tors”, because most do not now how to “Doc”.  They need re-training.  I should say “training” instead.  They were never educated in any broad sense.  The same applies for the rest of the medical industry.  Administrative assistants as well as doctors need more information technology skills.  When I use the term “Information Technology” I do not mean computer technology, programming or any of the like specifically.  I mean “the ability to manipulate information”.  It is hard to find anyone in a clinic that has a full range of the minimal data operator skills.  Most do not know basic keyboarding skills (no matter how fast they type).  Most do not know that they can use <CTRL>+/- to zoom data on their screen (valuable for OpenEMR by the way).  MT’s will need more knowledge to do their job properly as time goes by.  The old methods are fraught with inaccuracy (despite the high standards of the Transcriptionists).   To take advantage of new technology and new organizational advantages, old ideas of how things work must bite the dust.  Overspecialized people that cannot (or often simply refuse to) retrain may be lost.
  I wrote this note utilizing Dragon Medical 10.  I did the quick training only, and it manages to recognize my nasal combination of Texas Drawl with Key West Slur.  It can also recognize phrases like “atrial fibrillation” and “infarction” or lysergic acid diethylamide with ease.  Try playing back this same text with a reader, and have an M.T. go over it.  What would the difference be?  It is, ultimately, the provider’s personal responsibility to accurately document.  With proper training, they can do it well and easily.  In other cases, you have a whiny aristocrat that simply does not want to do a part of his/her job that is bringing in the big money.
  These are the tools and the expected results.  Professionals will achieve, and the Jacklegs will blunder along.

3

sunsetsystems wrote on Friday, August 03, 2012:

Is this thread going to touch on OpenEMR software development in some way?  :slight_smile:

If not, the Users forum would be more appropriate.

Rod
www.sunsetsystems.com

4

jojohit wrote on Friday, August 03, 2012:

I think there is a disconnect here. Speech Recognition software is not for logical transcription of dictated phrases, this is what the MTs do. SR is for (intelligent) recording of “dictated words” converting it into “electronic words”. Think of it like a tape recorder but instead of audio being recorded you will have (electronic) text written onto the computer. This system takes off a big chunk of what MTs do - the word per word transcription. It’s like the MTs are transcribers in a court room. The transcriber was replaced with Dragon because it was more efficient (this opinion is subject for an argument) than the transcriber and will not complain about rising cost of inflation.

Now IT thought that SRs could completely replace the MTs only if they can get the MDs do the SR themselves, after which the MD still have to do a small amount of proofreading the SR output. IT then would justify the one-time $1500 per MD cost of SR versus about $2000 per month for an MT service. Then, I think this is what the MTs are complaining - patient care is left behind because the MD has to do something else. MTs lose their business because of the robotic SR. And, the down-played logical transcription task is given to the MD.

I propose to all MTs to re-invent themselves. SR will not go away, instead it will be more intelligent than just word-per-word transcription. Imagine how Watson won the Jeopardy using racks and racks of computers; soon they can make Watson do logical transcription and laugh at your silly jokes too.

MTs can embrace SR. Instead, they can use SR as their tool to supplement their logical transcription processes. Imagine this: an MT with a laptop loaded with Dragon in it and a high def microphone installed. They can do their MT job watching the screen fill up with words translated by Dragon and all they have to do is correct the logic of the phrase (paraphrasing), if needed. Less effort, more accurate output, both MD and MT are happy campers. It is a $1500 Dragon investment, and a laptop and mic - about $1000.

JP

5

drbowen wrote on Tuesday, August 07, 2012:

Dear Sherwin:

MI-Squared has a nice working solution for Medical Transcription.  This is a LAMP module that allows a medcal transcription owner/manager to receive work as wave files from a Olympus digital dictation system, upload them to a server.  The owner then assigns the work to the transcriptionists.  The transcriptionist pulls the wave files down to their local work stations.  They transcribe the files.  Then a finished document such as Word.doc is pushed back up to the transcription service.  The transcription service then pushes the documents to the correct clinic, into the patients chart and correct encounter allowing the clinician to digitally sign the docuiment.

The software counts tth characters transcribed, divides by a predetermined line count to calculate what is owed by the client, and what is owed to the transcriptionist.  The software also digital signing of the documents which includes pdfs if needed.  Currently this is a MI-squared proprietary solution but it would likely save a lot of work.   This software was originally created for a small transcription company in Colorado Springs and has been evolving.  The original solution was completely rewritten already at least once.

The bottom line is many many doctors still don’t like computers and prefer dictating their notes.

Perhaps you ought to touch bases with Tony and investigate this.

Sam Bowen

6

drbowen wrote on Tuesday, August 07, 2012:

Most of this involves moving files from the clinician (wave files or mp3 files) to the transcription service.  And moving the completed transcription back.  What Tony’s module does is to tag the wave files with the correct clinician-pid-encounter so that the completed document can be loaded back into the instance of OpenEMR clinician-pid-encounter and notify the clinician through the messaging system so that the dictation can be reviewd.  This mostly involves system resoucres that are not directly related to OpenEMR per se.

Sam Bowen

7

yehster wrote on Tuesday, August 07, 2012:

I’ve written a module which uses libreOffice to parse .DOC files and looks for identifiers (name, PID, DOB).  It then checks OpenEMR for matching patient records and loads the contents of the .DOC into and OpenEMR form.

Couple of advantages/differences of this approach are the clinician can specify the patient’s identifiers as part of his dication.  He can just say the patient’s name/PID, rather than having to look the patient up in OpenEMR.  Also whatever existing mechanisms the transcription services and the clinician use for transferring audio and .DOC files don’t really have to change.  There is instead an additional step where someone in the physicians office needs to run the process for loading batches of files and making any corrections where there are Name/PID mismatches.

This isn’t in production anywhere, but for those interested here is some code:
https://github.com/yehster/integrallibre

8

rnagul wrote on Tuesday, August 07, 2012:

Hello,

Along similar lines ensoftek has a dragon integration into openemr, code is queue for submission. Once we receive confirmation of the other code submitted we can submit for review.

It uses dragon’s cloud services and charges by the dictated minute with excellent accuracy. Results are instantaneous. No hardware or software needed. You can use your existing computer hardware.

For urgent needs, please email support@drcloudemr.com

Ramesh

9

avantsys wrote on Monday, August 20, 2012:

While we’re active in a market where no medical transcriptionists exist (for numerous reasons that can all be simply attributed to the way Greek doctors prefer to work), I think I have identified a few possible solutions to the problem of diminishing jobs in the medical transcriptionist sector.

First of all, let’s take the situation at hand:

Medical transcriptionists see EMR software as a threat (nay, THE threat) to their jobs. In my eyes, this reminds me of the kind of ludditism demonstrated in Greece by the “Communist” (actually, Stalinist - there’s a distinction between the two) Party. Then there’s speech recognition - although I’ve yet to see any such software that’s halfway decent; and don’t get me started on speech recognition systems for the Greek language.

Sam and Kevin’s ideas sound good and could help cooperation between a doctor’s practice and a medical transcriptionist service.

But, as it was already pointed out in the discussion, there are numerous EMR applications, many of these are not interchangeable, and the world of medical software is proprietary hell. I can’t expect any medical transcriptionist to purchase (and learn how to use) all sorts of EMR software. It would be the biggest example of an unrealistic expectation.

So, the only solution for me is interoperability. You know what that is. Open file formats. Open standards. Common, easy to learn and use, layouts and forms that doctors and medical transcriptionists can use. So, I think we should get medical transcriptionists to understand that EMR is NOT the enemy, but a tool that they can use for their job. And, of course, we should get them to join us in the effort for common, open standards, so that doctors, medical transcriptionists and EMR applications will finally speak a common language.

Konstantinos
AvantSys Informatics