In our ongoing review of the impact of new technologies on work flow we invariably need to focus on turnaround time and its impact on the overall cost of converting the medical narrative into actionable data sets. Turnaround time also serves as a proxy for quality, usability and timeliness.
With the production of the seminal review by the American Health Information Management Association and Medical Transcription Industry Association Transcription Turnaround Time for Common Document Types Joint Task Force on Standards Development (2008), a new understanding of the factors affecting turnaround time and the new forces shaping the industry.
Their report provided insights on how new practices and technologies affected turnaround time (TAT) and afforded new efficiencies, data capture and documentation approaches, and buttressed clinical decision making, all with a view to improving patient care. The report also offered a glimpse in the new working environment and conditions envisaged with the introduction of new digital tools and systems from both the health information management (HIM) and medical transcription service operator (MTSO) perspectives.
The task force’s research revealed that very few standards for performance exist in the area of transcription TAT. While the task force was looking to organize these considerations by document type to offer some structure to the then current and the long term view and understanding, one could almost argue that such structure and outlook is now blurred by the sweeping and wide ranging impact of new applications and practices which are redefining the very role reserved for medical transcription.
We will focus on three points underscored in the report.
A. Full faith in the narrative
In arguing that the need for a comprehensive free-thought narrative is integral to producing a medical record that supports continuity of care, it is natural to surmise that transcription services will not be fully replaced anytime soon, and this despite multiple replacement technologies, including point and click menus, front end speech recognition (FESR), and documentation by exception.
The promotion and safekeeping of a permanent narrative of the patient’s story continues to be prevalent, if not expanding, as a significant data source in the electronic environment.
This is a safe conclusion. Indeed the proffered benefits of integration and interoperability of new health information applications have yet to be delivered as digital health record platforms have failed to result in dynamic and efficacious repositories of data. The promise of real time value of actionable data sets still hinges on production time and on integrity (quality and relevance) considerations. And as is so often the case, rules and guidelines, even those that foretell best practices can only hope for the desired results such as with the goals of a “standardized approach to hand off communications”.
The report underscores that “Given the current lack of standards or benchmarks regarding TATs for dictation and transcription, it is not surprising to find a wide range of definitions” which assign different values to factors such as authentication, distribution, availability and quality assurance. It aptly points out that “Disregarding TAT as a component of quality fails to address and support the demands of the industry and will surely result in consumers of documentation seeking alternatives to dictation and transcription practices.”
B. Survey Findings
To support their conclusions, the joint task force undertook extensive surveys. When asked whether current TAT consistently met their needs, 46 percent of HIM respondents answered “No” and suggested that the most common factor of noncompliance were staffing (32 percent), and changes in work volume (31 percent) close behind. Transcription anomalies (poor dictation, blanks and missing information requiring review, etc. ) was also cited in 21% of the instances.
When asked, “What actions are you taking to improve TAT performance?” HIM respondents indicated that the actions included outsourcing (29% – in fact this was the number one action for 69% of the respondents), and reengineer the workflow and work process (18%) Followed by implementing SRT (17%), and adding transcription staff (15%).
When asked the same question, the number one answer, given by 60 percent of MT managers, was increasing the number of transcriptionists and editors to complete the work. A close second was reengineering the workflow and work process.
MT and MTSO managers were then asked, “If you are not consistently in compliance with your established TATs, what factors impact noncompliance?” The top three factors stated by respondents were change in work volume (30 percent) followed by staffing (28 percent) and transcription anomalies (22 percent). These three items together accounted for 80 percent of stated impacts on noncompliance.
C. Speech recognition technology
Speech recognition technology is finding its way into the mainstream HIM environment. This technology will have a positive effect on TAT as more and more healthcare facilities and MTSOs employ it. The next question on the HIM survey was “Are you using SRT?”. Among 87 responses, 56 percent of respondents stated that they do not use SRT; 23 percent stated that they use back-end speech recognition (BESR); and 21 percent stated that they use front-end speech recognition (FESR). 39% used SRT in radiology only and the combination of HIM and radiology.
Of 130 MT and MTSO managers answered a similar question: 12 percent are using FESR; 24 percent are using BESR; and 64 percent were not using SRT at such time.
MT and MTSO managers who use SRT also gave the following information: 29 percent use it for radiology only; 33 percent use it for HIM only; 36 percent use it for both radiology and HIM; and 2 percent use it for emergency department reports only.
In comparing both the HIM survey results and the MT survey results with other findings on the prevalence of SRT use in the healthcare market, it was determined that these percentages align with other findings. According to the Healthcare Information and Management Systems Society (HIMSS) survey of 2002, 19 percent of information technology (IT) executives were currently using SRT and 46 percent planned to use that technology in the future. In the 2005 HIMSS survey, the percentage of actual use of SRT was not given, but 60 percent responded that they planned to implement this technology in the next two years. SRT was not mentioned in the 2007 HIMSS survey.
C. Work Force Realities
An increasing demand for medical transcription of patient care documentation has been particularly notable over the past 10 years for the following reasons:
– An aging population
– A trend away from handwritten reporting for accuracy and legibility
– Focus on patient care time
– Perceived greater efficiency
– Ease and speed of dictating versus other methodologies
– Belief that dictation allows for more comprehensive reporting
– Integration with the EHR
These forces are set against the backdrop of a work force shortage which result from a combination of forces that include an aging work force, limited access to medical transcription training, poor visibility of the profession to the general public and competition from other health sectors or work-at-home opportunities, the steep learning curve, and finally, declining compensation
The task force aptly points out that the expectation of higher prices resulting form the impact of such forces did not happen, and quite the contrary despite high demand (increased documentation needs) and low supply (critical work force shortage). This, we submit, is probably the result of the ecology of work flow putting pressure on the industry to adopt new technologies to streamline the processing of reports, and not as an indictment of the need for this operation.
The relevant findings of this task force include the following:
– Medical transcription (including the editing of draft reports created with SRT) is currently the dominant and preferred method of creating narrative documentation in the U.S. healthcare system and is likely to remain a critical practice for at least 10 years.
– Fluctuating (unpredictable) dictation workloads and a critical shortage of skilled transcriptionists are factors affecting TAT in many instances.
– The adoption of EHRs and PHRs will increase demand for quicker TAT of patient information to achieve desired financial and clinical benefits.
– SRT and perhaps other technologies will grow as documentation solutions in the marketplace can enhance TAT in some circumstances.
– Faster TAT on transcribed reports in cases where skilled workers are critical to the process will likely increase overall costs.
This article was written by Larry Edward who follows medical workflow trends. He invites you to consider
Oracle Transcription www.oracletranscription.com which provides the most advanced digital dictation services with the highly experienced medical transcriptionists who are exclusively 100% American-based .