Q: The next day's patient schedule was mentioned. Is the purpose here to get an idea of the next day's potential transcription load?

JK: This would be one benefit; however, the major benefit of having the patient schedule is for the correct spelling of the patient's name as well as for referral information. In the case of a surgery center, the next day's schedule is imperative so you will know what dictations might be preops, which are given priority status, etc.

Incidentally, I never download this info from a client's computer; they fax it to me. This allows me to transmit and run so I can send approximately 2000 lines of transcription in about 5-1/2 to 6 minutes at 2400 baud, the fastest modem speed any of my clients have. My transmission phone bill per month is only about $23, and I just haven't felt it was worth it to insist that they all get faster modems.

GH: I personally use a fax also to get the patient list. One doctor puts a warning/disclaimer on his transmission to the effect that if this got to the wrong number, you should let us know and destroy the list because it is confidential, etc. The fact that an answering fax machine does not give the caller feedback in the way that a modem connection normally does, makes faxing just a little less secure, in my opinion.

JK: Correct. Intermittently, the faxes I receive do not go through for one reason or another. My fax gives me a line error message, and prints an error code to let me know why the message was not received. When I'm sending, it also lets me know who I'm connected to if they have taken the trouble to program their ID. All of my clients have. When I am sending a fax, at the end of transmission, my machine tells me "01 page sent" or whatever, so actually I consider this pretty reliable feedback.

GH: This is probably a good thing to do. I have mine set to print out error messages but didn't choose the one to log all the calls. Maybe I should change that in my machine. Unfortunately, I do not have a setting to convert the error to "English," so I always have to look up the code and then see if I can figure out what the code means. The documentation is not the clearest. I have a Sharp fax machine, definitely not the highest grade model.

JK: Should a line error occur when I am receiving, invariably my client will resend the fax in a few minutes, so they must be getting an error message too.

GH: Yes, I think most fax machines do have error codes that the sender receives if the fax doesn't go through. The same thing happens to me when I get an incomplete fax. The only time I didn't get an error message was when my machine runs out of paper. I had to call back and ask the physician's secretary to resend. For some reason I didn't see the little red line on the edge of the paper in time to change it as I normally do.

JK: I have a fax/data modem in my computer which I never use for faxing, because it is Windows based, and all my transcription software is DOS. It is kind of difficult because the fax side of it has to be disabled prior to going on-line with a Windows-based program like AOL, but Carbon Copy, at least, seems to recognize it as a data modem without any special setup.

GH: My modem is also a fax modem, and I have no problem with it kicking in when I use a Windows communications program. Maybe your Windows program is loading the fax software without your realizing it. Go into the task list and see if the fax software is running and close it down. If the setup program puts it in your start-up folder, drag it back out to the fax software's own group.

(I get really frustrated at the number of programs that install themselves into my start-up folder!)

Back to faxes, I have been lucky that I have not gotten any stray faxes, but my friend receives orders intended for a company near her. She calls the company and informs them of the stray fax, and they call the number on the fax my friend got. Apparently that company has a fax number very similar to hers. It could be worse, though. Another friend kept getting calls in the night from people calling a certain bar that used to have that number.

Ideally, one could use a fax/modem with a fax program that can change the text from the fax to text in the computer [ed. this is OCR or Optical Character Recognition], but I don't know how completely reliable this technology is. I do like having a fax machine that is stand-alone so that I can leave it on all the time and it is independent from my computer. I will not lose it if my computer is down.

As for a modem, I tried an internal modem, and it was not very satisfactory for me. It was not just the fact that it was internal; it was that the particular chipset was not very good. But I still like the idea of being about to unplug my modem and switch it easily to another computer.

Someone (I don't even remember now which group it was) in effect criticized me because I don't like having to look up doctors' addresses. I was reasonably willing to do this until I discovered the number of doctors who have multiple offices. So if I did find an address, I was still at a loss for which address the letter should use.

I do believe that if clients want me to look up an address, they should send me their database of referring physicians with the addresses they want me to use. Then it would be much easier for me to fill in the addresses when the doctors dictate them. One client did this several years ago, but apparently they changed computer systems and no longer have their referring physicians in their computer. The secretary now tells me she uses the "little blue book." That wouldn't help for the multiple address situation.

. JK: I do that too. I code all doctor's addresses in my PRD (ST or FF would do the same, I'm sure). Five keystrokes types the whole address.

GH: Once I find an address I do include it in my address list also. The problem is that they seem to think you should pay for the books to find addresses in but still don't tell you which offices they want them sent to. I believe that they should be willing to let you download their address lists if they want you to fill in the addresses.

If you don't use an address often enough to put it into your abbreviation expander, it is easy to write an address macro in WordPerfect that will pull it out for you. I use WordPerfect 6.0 for DOS right now and find the macro language much easier for writing nice picklist macros than it was using the macro language in WordPerfect 5.1. [Tip: Look for the Glossary macro in the Macros keyboard.]

Any new drug that I find gets loaded into a picklist macro, also, and the ones I find myself using more frequently get put into my abbreviation expander.

JK: In the case of multiple offices, I use the same code with a modifier; e.g., #giro-s and #giro-b indicates San Francisco and Burlingame offices for a certain physician. If dictator doesn't specify, he gets the address that is closest to the office he's dictating from, or a note on his computer screen, "I have rev files, please call."

GH: This is a very good idea. Different clients will respond differently. Some clients will want you to do any of the fill-ins, while others may say, "just leave a blank or '?' and we'll fill it in here." People need to settle that with the clients.

JK: Right. My note, 'I have REV files, please call' is a signal to the office personnel that I have reports to send that need revisions before they are transmitted. I ask the offices to call me, because getting through their holding systems can be just awful, especially when I'm calling long distance. This works pretty well, and is a real time/money saver for me.

GH: I have even tried to encourage them to respond to my questions that I add to my uploaded files and even use my dictation line if needed. I sympathize with anyone's having to call a doctor's office long distance. Even if they don't have one of those super complication voice mail systems, they always have to put you on hold while they get the person you really want to talk to.

JK: I have been transmitting most of my transcription by modem since 1987, and this is the 'only' way to go. I just wish some of my local doctors would do this as well; but, because I'm handy, I guess they think I should pick up and deliver. They love their little hand-held recorders! Actually, the ideal situation is to receive direct dictation over the phone line.

GH: I agree! I had one client who tried using the U.S. Post Office, just mailing tapes. Even though we were within a range where I should have got the tape the next day, I frequently didn't get it for 2-3 days. Not good.

If tapes have to be sent, they really should be sent via some kind of overnight or next-day service, not by first class mail.

JK: If you are transmitting reports back to the client, you are half way to running a fully electronic cottage. Call-in dictation systems vary widely in capabilities and price, and you can record dictation of superior quality on a single line for as little as $100.

GH: I know that an answering machine can be had for that price, but a regular dictation system with more than a 30-minute tape? I'd like to know more about this!

JK: The $100 price was an answering machine. We were talking here about getting started on a shoestring. Because of the inability to "scan" dictations on a tape dictated this way, it's also best to record just one dictation per tape, wrap an ID band around it, and drop it in the "in" box.

GH: This would mean you have to sit by the machine all day. Bummer!

JK: Unattended 24-hour systems, of course, are considerably more expensive, with the digital systems being the current vogue, apparently, although I do not have one yet.

For two of my lines, I am using a Sony RD-500 which has been reliable as rain, and has offered excellent quality, but is now discontinued equipment. When mine gets tired, or I lose a motor, I will be forced to make some kind of move, either lateral or upgrade. I too have the retirement thing looking at me, and this makes it a difficult decision, as my equipment will not be useful to my children who are into other things.

GH: I am still using my Lanier VoiceWriter 650, the one with four cassettes on a carousel. It works reasonably well for live call-ins, but we still have some problems to iron out for the ones that want to play tapes over the phone. It may surprise people, but getting the caller to press # to start a new tape seems to be a major project. Either they forget, or they press the # key 3 or 4 times so that the machine ends up using the same tape again and still having their machine play through the end of my tape so that I miss the part that was playing while my cassette was being changed.

I am now considering whether it would be reasonable for me to upgrade to a digital system. Part of my decision has to do with the fact that I don't have a long time until retirement time. My husband is already retired, so working full time all during the time he is enjoying his retirement doesn't really seem all that attractive. It is my understanding that used equipment does not bring much in resale.

JK: I have a three-line setup with roll-over capabilities, so if one line is in use, the next deck kicks in.

GH: My phone company, Ameritech, can set up the rotary in their facilities. I have two lines set up this way. I have the Lanier on the first line and an answering machine on the second line.

JK: The central system has full ID code and function code capabilities, and the last line on the system is a manual recorder which uses a different technology, but many dictators prefer it, as it can be more reliable for some dictators.

GH: Oh, I see. On my system, with the answering machine on the second line, it doesn't go bonkers when the caller's phone line is prone to send extra signals, either audible or not audible, that might tell the "smart" dictation system to hang up or something.

JK: When I first started out and cost was a real issue, I bought answering machines with telephone record capabilities and cassette technology, and these work great, although only if you plan to be at your desk during business hours.

GH: A word about using answering machines. Do not buy just any answering machine. Make sure before you leave the store that you can set the length of time for the caller's message to unlimited, that is, to the length of the tape.

More doctors than not dictate a series of reports at one sitting. If you get an answering machine that cuts them off after 3 minutes, you will lose your clients or at least give them ulcers from all the frustration of being cut off every 3 minutes.

I found at least one Panasonic model that allows unlimited message length, and some models of Code-o-Phone. I found the Panasonic at Office Max (kind of like Office Depot for those without Office Max). The Code-o-Phone I got from a special store on the other side of town. It had its outgoing message on a chip, though, and electric storms had a way of blitzing my message. So I changed over to the Panasonic which uses an outgoing message on tape. The Code-o-Phone that I got has battery backup (a slew of AA batteries), but those batteries didn't survive the electrical storms, either, so they didn't do a whole lot of good.

If anyone knows of other manufacturers of answering machines that make models that allow LONG incoming messages, please tell us. It might be handy to have a list of answering machine brands that are good for MT work for those who want to start out small.

You can get so-called surge protectors for your telephone equipment as well as your computer equipment, but they can protect only a certain amount. They will not survive the big stuff.

JK: When I added my surgery center, I had to invest in a 24-hour system as dictation came in at all hours. The monthly cost of my 800 dictation line is approximately the same as it used to be to run a courier a daily round trip distance of 238 miles three days a week, but I am now able to service stat dictation which I could not do with the courier, and my territory has expanded, as courier charged additional for each new stop; i.e. if I were using a courier today, it would be considerably more expensive than what I am paying for my 800 line.

GH: I agree that avoiding couriers is a huge part of making this work reasonably cost effect as far as our income is concerned.

GH: My current answering machine is a Panasonic KX-T2300 which I got at OfficeMax.

There is a slide switch called "recording time selector." It has three settings:

1. VOX: The recording time is unlimited. The trick is that if the person pauses for more than 8 seconds and no sound is heard by the machine, the machine disconnects. I tell them they can say "um" if they have to. (The Lanier VoiceWriter disconnects after 20 seconds of silence.

2. 1 min.: The recording time is limited to 1 minute.

3. Greeting only. (This would be for times when you don't want to get a message, but that would probably not be for us.)

BTW, we have call forwarding capability for our dictation lines so that while we are on vacation the doctors will have their dictations sent automatically to our substitute MT.

This Panasonic has a day and time setting that you can enable, but it does not have a date stamp.

While the tapes made with this answering machine don't have the same signals that a tape made on a regular transcriber/dictation machine will create, it is possible to find the new calls by using the fast forward or rewind with the sound going. On my machine, that happens when I use the foot pedal to rewind or fast forward the tape.

There is another button on answering machines that you want to watch for. On the Panasonic, it is called the CPC (Calling Party Control) button. It sets the sensitivity of the machine to signals from the phone company. At the "sensitive" (A) setting the answering machine "hears" the click when the other party hangs up and will disconnect immediately instead of waiting for the 8 seconds of silence. This is said to save time. But if you (or the other party) has Call Waiting, this can cause premature hang-up, and the setting should be set to what this company calls the "b" setting. Each company will probably call this function by a different name.

Some people mentioned the "record a phone call" function that they use to record dictations. If your machine does not have the message length feature that lets you set it to "vox," then this is the feature you have to use, but that means YOU must answer the phone and YOU can't hang up the phone until this "conversation" is finished. You'd better have a mute button on your phone, or your room sounds will get mixed up with the dictation. I don't know about the rest of you, but my computer makes noise that would interfere with a good dictation.

JK: Gail, are you saying here that answering machine dictation can actually be accomplished "unattended"? I have a GE that allows up to 4 minutes for a "message call" but the "telephone record" mode will go for the duration of the tape, if necessary. I am in the process of selecting a new "answerer/recorder" for an alternate 800 line that I have, and would certainly like to know if there is such a creature that can be set for "unlimited" message on an unattended call. This would be great! Could you give me the Model # of that Panasonic you mentioned? We have an Office Max in Sacramento.

GH: It's a Panasonic KX-T1450 answering machine on our home phone which uses regular sized tapes. I don't know if they make this model any more. I had thought it required a special "dictation" tape but was pleasantly surprised a couple nights ago. I thought this machine had bit the dust because it was stuck in the play position and I couldn't get the tape out. But before really ditching it, I asked my #1 son to take a look at it. He got the thing going again. He had to break the tape case to get it out (but figured out later he could have got it out without breaking it but it was too late by then.) Anyway, he found a short in the machine and got that fixed and working again. I didn't have a regular dictation tape so just tried a normal 90-minute cassette tape in the machine. Wonder of wonders, that thing rewound itself and then searched for the beginning of the magnetic portion of the tape! So it did not try to record on the leader! This means that I would have 45 minutes of dictation time if I wanted someone to call me on my home line in an emergency. I would have to get a transcriber that "does" regular cassettes, but for those who already have one of those, this machine might be worth looking for. It does not have a time stamp feature.

Aside from the Panasonic I mentioned above, I believe some models of Code-o-Phone answering machines will also let you set the message length to "vox" meaning unlimited -- actually, limited to the length of the tape.

I didn't like the fact that the outgoing message on that machine was digital and got lost when there was a power interruption.

You put so much in your message that I won't try to respond to all of it. I too hope that others can benefit from our experiences.

On Telecommunications Systems

JK: Gail, while you are checking telecommunications programs, you should keep Carbon Copy in mind as well.

GH: Carbon Copy is, like PC-Anywhere, a remote control type of program.

Many computer consultants like it because they can do computer support work remotely. If you are reasonably knowledgeable about computers, you could add computer support to your services.

It is amazing to me that some of the clients don't even know how to set their clocks. I get some strange times showing on their systems when I call in. The new gal calls you and says she can't find your files. You could call their machine and look for them yourself. As mentioned in another post, the software must be set up to provide that kind of access. You can't just call another machine anywhere and do it. The proper programs must be loaded and configured in order to really control their system.

JK: I like it [ed. Carbon Copy] far better than ProComm Plus primarily because it allows the use of DOS wildcards, i.e. if there are 20 patient reports in a directory, all 20 can be sent with one command by using *.* without having to combine reports into one file.

GH: Your ability to use wildcards is dependent on which transfer protocol you select. With YModem (YModem Batch in older versions) or ZModem you can use wildcards in Procomm Plus.

Some people bought Procomm Plus way back when and never upgraded when they made ZModem available from within the program. With a huge range of choices to choose from, recent versions of Procomm Plus do provide a wide range of choices.

If your client is still stuck on the shareware version of Procomm, then you'll need to choose YModem Batch in order to use wildcards for naming files to transfer.

In any case, if you want to use *.* as the wildcard, you will have to make very sure that there is nothing in your upload directory other than what you want to transfer. Otherwise, you might end up sending *.bak or *.bk! [ed. back-up files] to them as well as your intended files.

JK: This way the report retains the patient name, which makes reprints and report tracking much easier for the office staffs.

GH: Our clients use special software that sorts all the reports into their special medical records database, so they WANT their reports back in one main file. I would be willing to send one or more files, whichever they want.

JK: I have entered all the transmit commands in my PRD program so all I have to type for any given account is seven characters, and the computer does the rest.

GH: I use scripts to call in and log off the clients' systems. I do use my PRD+ to enter the particular filenames (filespecs if more than one file), though. But, I wouldn't have to. Procomm Plus has both a script language and programmable "metakeys" that I can enter such things into. Telix has even more capability for defining keys. Telix's script language is harder to learn, though. But if you are just calling the clients, Telix would be fine because you can program the function keys alone in all their shifted forms to enter your commands. I have never used QModem, but it is highly recommended by those who have. Telix and QModem can be downloaded from online services or BBSs, as they are shareware (try before you buy).

As for PRD+, I do use a separate database for my communications software. I don't want to inadvertently enter something that might be expanded to something else. Changing databases is very easy in PRD+.

I hope this helps anyone who is interested in learning more about this type of work.