Jun 24, 2006
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EMRs & MT

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Dear Friends,

I got a frantic mail over the weekend:
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Please focus your forthcoming digest on Electronic Medical Record.
I have lost my contract from New York because of this. Many
clinics are switching to this. What is your personal opinion and
how is this going to effect our MT industry in India
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For those not following the advances in EMRs, it must be pointed
out that most EMRs have been offering physicians the opportunity to
fill in their clinical notes by selecting the appropriate data
right on their computers by interactive template-menu interfaces
and user-friendly input devices like touch-pens, or even voice
commands.

Unfortunately, there is a glaring gap between the potential and
actual use of information technology (IT) in healthcare. Experts
have long identified the lack of standardized clinical terminology
for electronic health records as one of these barriers.

The problem is not so much a question of language as a question of
standardization of the means of representing clinical meaning in
systems. Coding systems have historically been used to accomplish
this task; the International Classification of Diseases (ICD)
family of classifications are widely adopted and used both for
epidemiologic reporting and for coding for reimbursement purposes.

Despite their wide use and clear usefulness, these
classification-type coding systems fall short of supporting the
needs of electronic medical records. obvious problem is their lack
of clinical specificity - when taking the entire spectrum of
healthcare into account, classifications do not reach the level of
detail needed for clinical documentation in all areas. In response
to these and other needs expressed by developers and early adopters
of electronic health information systems, in 2002, the first
version of Systematized Nomenclature of Medicine - Clinical Terms
(SNOMED CT) was released for use as standardized terminology to
support electronic healthcare applications. In addition to lack of
clinical detail, other problems with existing classification-style
coding systems include the fact that their hierarchies are bound to
the codes, preventing multiple inheritance. In contrast, SNOMED CT
permits a given code to appear in multiple different hierarchies as
appropriate.

Going back to Electronic Medical Records, which should be a
structured, easily queried database, lending the information it
contains to easy analysis and therefore enhancement of knowledge;
rather than a digitized "soft copy" version of unstructured notes
not amenable to data processing and management, we need, direct
physician input of structured/codified data in the form of
controlled clinical vocabulary, such as SNOMED-CT. To make this
happen, physicians will have to stop dictating and, instead, enter
structured clinical data directly into a computer. But this is a
change, which is not 'waiting to happen.'

It is going to be a while before the majority of physicians start
direct entry of structured/codified data into EMRs. Even when
physicians agree to enter critical data this way, there will still
need a free-text "option" for information that doesn't fit into the
coding structure. Free-text entry methods (like medical
transcription), do not provide useful data for clinical data
management. Natural language processing (NLP) technology claims to
extract clinical facts from narrative reports, however, I am
skeptical this is going to mature enough in this century to be a
viable alternative.

To summarize and answer your question, Electronic Medical Records
or
Electronic Health Records are the natural progression towards a
modern healthcare record. MTs and MTSOs exist because of the way
healthcare documentation is carried out today. With evolution of
the documentation process, both professionals and the industry have
to evolve with it. As MTs it would require adding new skill sets
and might need new job profiles. As service providers, you probably
need a paradigm shift in mind set from being a medical
transcription service provider to being a more composite medical
records service provider, and opportunities would abound.

In conclusion, I must add that changing physician behavior is not
an easy challenge. It might take a decade or more for EMRs to
really "wipe out" MT, if that really happens. Losing one contract
does not necessarily signify an imminent industry trend - one
swallow does not make a summer!

Ciao!

Dr Amit Chatterjee, SM
Strategist / Founder ~ mailto:amit@...
MT India ~ www.mtindia.org
"The Community of MT Professionals"

"It takes years to become an overnight success! Inch by inch, it's
a cinch."

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NEWS AND VIEWS :
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1) Up and running

At a plush upmarket hospital in New York City, a doctor dictates
medical diagnosis for a patient onto a digital recorder. Thousands
of miles away, in Siliguri - a rapidly developing metropolis in the
state of West Bengal - a young Medical Transcriptionist receives
the dictation in a voice file, and then readies herself for the
task in hand.

Over the next few hours, the spoken words are efficiently
transcribed, formatted, proof-read and perfected into a digitised
medical record, which will eventually become a part of patients'
permanent files, ready to be retrieved by the hospital for
insurance and research purpose. Make no mistake. The Medical
Transcription (MT) outsourcing industry, which had come under a
cloud after its initial runaway success in the 1990s, is all set to
make a grand comeback.

According to the latest Market Intelligence Service report of
Nasscom, with at least 120-150 companies engaged in medical
transcription in India, the sector is clocking an annual revenue
aggregate of about $220-240 million. And this figure, analysts say,
will witness a meteoric rise in the coming years, given factors
such as increasing healthcare costs in the US, its ageing
population, and increasing regulatory emphasis on digitisation of
medical records and documentation.

"Today, India's share is roughly over $200 million. This means, as
an industry, we are capturing less than 2 per cent of the overall
size of the US market, but it also shows there is a tremendous
opportunity waiting to be tapped," says Suresh Nair, CEO of Spheris
India, and President of the Indian Medical Transcription Industry
Association.

K.B. Anand, Chief Operating Officer of medical transcription firm
Acusis India, sees a huge demand building up for MT work in US
hospitals. "For hospitals and clinics in the US, the bottom-line is
always a concern. One area to cut expenses is outsourcing good
quality work from offshore locations, at less than half the price.
Also, there is an immense backlog when it comes to transforming
dictations into medical records and dearth of professionals (the
average age of an American medical transcriptionist is 49 years) to
ease that backlog. Together these factors are creating a burgeoning
demand-supply gap in the US market," he reasons.

India, with its talent pool, English language skills, and the
advantage of a favourable time zone, is in a unique position to tap
this opportunity, say industry observers. In India, it is estimated
that service providers charge anywhere around 12-18 cents per line
of 65 characters, while the same work, when sub-contracted further
to smaller outfits, can go as cheap as 4-5 cents per line. "In
contrast, the work done within US shores could be billed at 15-25
cents per line," says Anand.

http://www.thehindubusinessline.com/ew/2006/06/19/stories/2006061900070100.htm

2) Mind your business - from home

Archana joined college but was forced to discontinue because of
family circumstances. In such a situation, most youngsters would
have given up hopes of making it good, especially in a city like
Mumbai. But Archana enrolled for training in medical transcription.
After two years on a job, she quit to work from home. Today, she
earns enough to support the family. "I am able to help my Mom and
don't have to worry about getting into the electric train to reach
the office on time during peak hours. The crowd is maddening," she
says. "A degree is important, but without that, I am making about
Rs 25,000 a month. I work for 6-7 hours a day," she says.

Down South, in Coimbatore, Sanjay, Rajan Bose and Janakiraman (all
commerce graduates) endorse Archana's sentiments. "After
graduation, I earned a meagre Rs 2,000 per month on small jobs.
Then I noticed an advertisement wherein a medical transcription
company invited applicants for training with a monthly stipend of
Rs 3,750. I opted for the training. After completion, I accepted
Spryance's offer and worked for two years before deciding to
continue from home," says Sanjay. He works 11-12 hours a day and
pockets nothing less than Rs 30,000 a month.

Rajan Bose has a problem. His father has to undergo dialysis every
fifth day and he is certain that no office will grant leave that
liberally. This way, "there is enough flexibility and I earn more
than I would sitting in some office. I am able to take care of my
father too," he says.

Subish, after completing his diploma in Software Engineering, was
jobless for almost six months. "I had to earn. Diploma holders are
not paid well by the industry. So I took up training in medical
transcription. I have no regrets."

They are all home-based MTs for Spryance, which is into medical
transcription. There are over 1,500 home-based MTs on the company's
rolls and the number is said to be rising by the day. In Coimbatore
alone, there are over 200 transcriptionists working from home.
Women particularly find it more convenient as they are able to work
at their pace and without much stress. But surprisingly, there are
a number of young men who prefer to work from home.

Economic independence, learning experience and the convenience of
working from home seem to have attracted more people, especially
those who hate the thought of travelling that extra mile to reach
their work spot on time.

The number of housewives with grown-up children taking up MT jobs
is on the rise. Over a period of time, they grow to become
proof-readers and editors.

"The training and growth may sound simple. Unless one has a flair
for the language and medical terminology, apart from hard work, you
can only dream big but achieve nothing," says Divya, Proof Reader
and Quality Analyst at Hykon Transcripts (P) Ltd.

http://www.thehindubusinessline.com/ew/2006/06/19/stories/2006061900060100.htm

3) Firm offers MT scholarship, employment in US co, rejects AAMT
curriculum for Filipinos...

"While other medical transcription schools are adopting the
American Association of Medical Transcription (AAMT) model
curriculum on medical sciences, English and transcription
methodology, ISMT - through actual experience - has proven the
model to be inadequate and ineffective for the Filipino learner," a
company statement said.

Mawit said ISMT redesigned the AAMT model to suit the peculiarities
of Filipino trainees and to enable them to meet global quality
standards for medical transcription. ISMT, she said, also provides
on-the-job training, modern technology and the necessary facilities
to its students.

http://www.sunstar.com.ph/static/ceb/2006/06/16/bus/firm.offers.medical.transcri\
ption.scholarship.employment.in.us.co..html

4) Unison condemns offshore medical transcription

NHS trusts that outsource the transcription of medical notes to
South Africa, the Philippines and India received a sharp rebuke
from health union, Unison, yesterday. General secretary, Dave
Prentis, speaking at the union's annual conference this week,
condemned the outsourcing as "a very dangerous practice." The union
has accumulated anecdotal evidence of potentially life-threatening
mistakes made by overseas transcribers, including:

. confusing "hypertension" (high blood pressure) with "hypotension"
(low blood pressure);
. confusing "A septic" (infected) with "aseptic" (not infected);
. mixing up "15mg" and "50mg" drug dosages.

Confidentiality is also a concern when notes are sent to countries
that do not have the kind of data protection laws that operate in
the European Union.

The issue of processing data offshore was raised earlier this year
by Connecting for Health (CfH) chief executive, Richard Granger,
when he expressed the view during a round table discussion in India
that the lack of a regulatory framework for processing personal
data in India was a constraint on the country's large players.
He was quoted in the Economic Times of India as saying that the NHS
had not crossed the line in terms of data being processed offshore
and that data would not go outside the European Union until there
is a regulatory framework in place.

In addition to concerns about accuracy and confidentiality, the
union says medical secretaries' jobs are being put at risk. It
cites the case of East and North Herts NHS Trust which, it claims,
has issued redundancy notices to 160 medical secretaries, asking
for 58 volunteers. "All the government is doing is looking for a
cheaper workforce - yet it's doctors and medical students in these
other countries that are being used to do the transcriptions."

James Fellowes, managing director of Dict8, a medical transcription
firm that uses only UK medical secretaries for its service, said he
was pleased to see the subject had been raised. "You can't compare
the skills of people who have worked in the NHS as medical
secretaries for a long time with people who are offshore," he told
E-Health Insider.

http://www.e-health-insider.com/news/item.cfm?ID=1961

5) Subcontractor put VA health records at risk: IG

Management controls by the Veterans Health Administration over the
acquisition of medical transcription services, and the privacy and
security of patient information are deficient and need improvement,
according to VA's inspector general.

The VA Office of Inspector General has been investigating
allegations that an offshore medical transcription subcontractor
threatened last year to expose 30,000 veterans' electronic health
records on the Internet in a payment dispute with another
subcontractor over $28,000.

VHA, an agency of VA, needs to develop the ability to perform its
medical transcription in-house, because there is no practical way
to ensure that contractors safeguard patients' protected health
information, said Michael Staley, VA assistant inspector general
for auditing, in a report:

http://www.va.gov/oig/52/reports/2006/VAOIG-04-00018-155.pdf
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The MTIndia Team
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