The Future of Medical Transcription

3/96: Federal prisons do not train inmates for MT, according to UNICOR. We are researching other state prisons.

From Joe Weber:
CPRs (computer-based patient records) are a real hot topic in healthcare organizations. There are lots of implications. For example, if designed intelligently -- with empirically-validated clinical decision support modules -- they should truly increase the quality and reduce the cost of care. This is certainly a good outcome for all of us as patients. But as transcriptionists and medical reporters, there are other ramifications. In the short run, the demand for transcription service should significantly increase -- since a CPR requires that outpatient notes be included in the record. Scanning handwritten notes is just plain stupid, for a plethora of reasons (cost, legibility, non-retrievability, etc.). The only reasonable way to get these notes into the record today is through dictation and transcription. That's the good news.

The bad news, in terms of demand for this service, is that in the medium-to-short run there will be some erosion resulting from advances in continuous speech recognition and from the slow but increasing acceptance of structured (codified) input as a mode of clinical documentation. This will not happen overnight, and it will be pushed back in time in areas where transcription is highly productive and accurate, but it is something that transcriptionists who are strategic planners might want to plan for. Contact the CPRI (Computer-based Patient Record Institute) for more information at 708-706-6746. There's a (not inexpensive) newsletter and three meetings a year. It's a great chance to get together with people who want to use technology to increase both the cost effectiveness of healthcare and the health status of the entire population of the world.

I wanted to thank you for all your information yesterday on the phone concerning Dragon. I remain extremely interested in the system, and we may give it a try. I contacted Dragon again, who reports that the real-time, continuous speech program is to be available in 12 to 18 months. I do not know if that is an accurate estimate or a tight time line. Obviously, once real-time continuous speech becomes available, the whole MT world may have some change. Currently, they report that discrete speech requires 1/10-second pauses between words. This is obviously too slow for a physician to use directly when dictating long unique reports. Also, the editing and continuous-correction needs probably make it inappropriate for use by physicians themselves at this time. But continuous speech? That will be different.

Also, I have gone through many of the items on your Web page. I find that the topics provide a tremendous amount of information and give me a whole new look at the activities of MTs.

I have personally set up three MTs in their own home businesses. I can see that there is a real possibility for even closer working relationship between MTs and MDs, but I suspect that doctors don't really recognize the importance of spending time figuring out how to facilitate their transcription.

I notice discussion about MTs becoming "editors," but think the concept of MTs current activities should be broadened. I have suggested to my MTs the concept of being "Document Presentation Experts." We have a video capture card so that an image of a patient that is important can be included in the consultation report. We have a high-resolution color printer so that the document can be printed in color with the appropriate image in the physical exam section. I also sometimes need to make up graphs demonstrating response to medications that need to be in the report, imported from Excel. I suspect the future will need to include "document preparation" involving the appropriate alignment and placement, and image and graph size, as well as the more traditional MT work of transcribing dictation. While we have experimented with the video capture and document creation in this fashion, it currently is just that, an experiment. Basically, the video work is done on one computer system, then transferred to another computer. The transcription is done in WP and must be converted to MS Word. The image and text are then combined, and printed. Currently it is labor intensive, but we consider our consultative product, the report, to be the tangible work product of our office. MTs could evolve to broader "multi-media" activity.

My discussion with you and information from your page gives me new avenues to proceed with my projects. Thanks again and I look forward to visiting your page.