Transcription in the 21st century

The medical transcription industry is currently valued at approximately $12 billion. Medical transcription is the processing of clinical documentation, typically originating from narrative voice, from clinicians dictating their medical encounters, which are then transcribed by medical transcriptionists or in some cases, in part by speech recognition technology. Upon completion, the transcription then becomes part of the official medical record for a patient.

Typically, hospitals, physician practices and clinics outsource their transcription to medical transcription service organizations (MTSOs), and are usually charged for services on a per unit basis. Until recently, , there has been no standard unit to objectively measure volume and the resulting cost.. This makes it difficult to compare prices between MTSOs as they often include a number of modifying factors such as, length of contract, turnaround time and ownership of equipment.

Meanwhile, hospitals have seen costs for technology and software increase and there is a need for metrics to represent investments in budgets and service charges. This has lead to various definitions and much uncertainty of the comparison between methods. Jay Cannon, President of the MTIA, explains why a standard unit of measure has to be implemented: “We went through a period of time in the industry where numerous billing methodologies were being used and to a large extent, confusion existed around accurate, comparative capabilities.”

The previously advanced standard unit of measure was the 65-charcter line, which included the space bar, shift key, bold, underscore and other keystrokes. Practitioners worried that personal computers and word processors would deprive medical language specialists the credit for character count.

In February 2007, the American Health Information Management Association (AHIMA) and the Medical Transcription Industry Alliance (MTIA) joint task force on standards development convened to recommend the standard unit of measure for medical transcription of patient medical records. The goal was to implement a standard measurement, applicable to all types of medical reports

The AHIMA and MTIA task force spent almost a year evaluating previous systems and alternatives, interviewing both clinicians and transcriptionists and looking at new technologies. They came up with the visible black character, or the VBC.

The white paper prepared by the task force say the VBC is, “a character that can be seen with the naked eye. Under this counting scheme, spaces, carriage returns, and hidden formatting instructions such as bolding, underline, text boxes, printer configurations, and spell checking are not counted in the total character count.”

The are three major benefits of employing a standard measure. The first is that there will be improved tools for evaluating and selecting transcription service providers. Secondly, there is expected to be better business relationships between healthcare organizations and medical transcription service organizations. And thirdly, there will be the support of health information management departments in establishing and maintaining service level agreements, and means that patient medical record transcription may be managed in-house or by an outside service supplier.

Asked how the VBC will affect the medical transcription industry Cannon says, “The VBC standard adoption has been a very important step in eliminating the concern and confusion around various methodologies. It allows respective companies to have an intelligent dialogue without confusion around price and the billing component.” Cannon goes on to explain that the standard unit of measure will allow pricing to be totally reliant on service: “In my mind price will be reflective and will vary, based upon the level of service that is being provided. It will build a proposition that will help medical transcription companies to promote the differences and individuality they have in their business.”

Although the AHIMA and MTIA have officially endorsed the VBC standard, it isn’t yet in place. “The adoption will be at the discretion of consumers of medical transcription and those respective companies that both, from a customer request standpoint and then a pro-activity standpoint, desire to utilize the standard as part of their business,” remarks Cannon. “We have not set up a deadline for making it a mandatory requirement. That is going to be up to the industry and the consumers themselves.”

It has been predicted that medical transcription off-shoring will reach $647 million by 2010. Cannon suggests that there are a couple of reasons as to why off-shoring has become so popular. The first is that it was an automatic response to the shortage of medical transcriptionists available in the US. “The lack of adequate production capacity was the foremost driver in evaluating global or off-shore medical transcription,” says Cannon. Secondly, he points to the cost pressure that many healthcare organizations face and suggests that it is a response to reduce the overall cost. Although Cannon highlights this may be becoming less of a reason as wages go up and with the increase in technology it may be more off an offset cost. “India is probably the largest global off-shore producer of medical transcription compared to the U.S.,” says Cannon. “Where our night is their day and vice versa, it seems to complement the workflow requirement very well and we are seeing an increased turnaround in the medical transcription industry.”

The visible black character white paper found that the AHIMA/MTIA task force unanimously agreed that the VBC is the only counting method that could be easily understood, verified and replicated by all parties in the medical transcription business. It states: “In embracing this standard we cross an important threshold regarding a standard unit of measure for billing verification. Accordingly, we propose the visible black character as the standard unit of measure for medical transcription.”

Cannon believes that every publication around the requirement on clinical documentation indicates that the amount of clinical documentation is going up. Despite the increasing levels of technology around electronic healthcare records, the overall amount of medical transcription is increasing on an annualized basis of anywhere from 10 to 15 percent. “Responding to the labor shortage around the areas of speech recognition and further leveraging of the medical transcriptionist, as part of an intelligent workforce,” adds Cannon, “is enabling technology to realize its full value proposition, and I believe you will continue to see the supplement of global medical transcription as part of the processing of documentation.”