Hospital Medical Transcription
2/97, from Nancy, firstname.lastname@example.org:
I want to offer recognition here to the administration and staff at
Ashland Community Hospital in Oregon. The transcription room is NOT in a
basement. It is in the center of the hospital and has a window overlooking
the garden/lawn area. The administration just remodeled the entire room
with beautiful modular furniture and excellent lighting and has networked
the computers so you can share all the macros, etc. The room space is
very limited, but the set up is just about the best I have seen.
Transcription is recognized as a legitimate keystone function of medical
records. The MDs work well with the transcriptionists and actually stop in
to say hello to the MTs.
I am only on-call there now and it really took my breath away when first I
stopped in and saw the new setup. ACH deserves a real pat on the back,
2/97, from Becky:
We use MedWord by Lanier. The "normals" are
entered by the supervisor at the hospital (who, BTW, is not an MT). You
ask her to put it there, it's there - correct or not. Here are a few
examples that I marked incorrect when I did a quality check for the
supervisor last year:
"the patient was given a prescription for by mouth Biaxin"
"It was decided to keep him nothing by mouth for now"
"Darvocet-N 100 as needed pain"
"the laparoscopic was advanced into the esophagus"
There were literally scores of others - all caused by using the "normals"
. It is also a common practice in our office (NOT BY ME) to type "the
patient was prescribed Darvocet 100 milligrams by mouth three times per
day" "he was given 2 cubic centimeters of"
Now I'm a stickler for perfection, and I know it. I'm also sometimes
wrong, though I don't act like it right now :). My point is that there is
one focus in our department: more characters = more lines = more money -
PERIOD. There is no discussion about terminology, usage, grammar, and no
editing done. There are no more quality checks, either, because there was
too much hell raised by people who didn't meet their 99% accuracy quota
over stuff like I displayed above.
I say an error is an error. I look at all these posts on smt, people who
care about their work, and I'm thinking that the difference may be ICs who
are held accountable for what they do versus MTs who get paid no matter
how crappy their work is. But there are hospital MTs here who care about
their work too. What is the DEAL with our hospital?
I know - this is none of my business, as long as I produce work of good
quality and make my money. I keep telling myself this, too. But I wonder
if the doctors who complain about this stuff (all the way to Medical Care
Appraisal Committee) look at the initials and know that we're not all
2/97, from Kay:
I don't think it's just your hospital. The last
hospital I worked for as an IC also had a MR department headed by a person
who not only was NOT a CMT, but had never transcribed and could not type.
( However, that did not keep her from quoting AAMT incorrectly whenever it
was convenient for her). The bottom line is money. Period - end of
sentence. This hospital hired transcriptionists who did not know what the
most basic medical terminology was and thus, could not transcribe the
physicians and thus, the motto became: "Just leave it blank." The point
was this: GET THE WORK OFF OF THE SYSTEM ANYWAY YOU CAN. There was no
quality control, no continuing education. Everybody was too busy trying
to get the work off of the system to care. This does not mean that the
transcriptionist does not care. It is just the situation and pressure
that he/she is forced to work under. They give incentive for increased
production but no "incentive" for error-free work. Why? Because no one
checks it! So, poor quality hospital transcription becomes its own
In the age of cost cutting, it seems the advertising campaign for "this"
particular hospital outweighed the need for hiring, paying and training
professional quality transcriptionists. I won't even get into where I
feel AAMT's responsibility lies in all of this mess.
2/97, from Mary:
I worked in a hospital where the quality was poor.
Fast lines with sloppiness, padding and lots of blanks are a risky
business that makes people feel uneasy and cheap. The pressure to produce
is demoralizing as well; the two extremes of pushing and permissiveness is
Here's a suggestion: Get the MTs to submit a proposal for a department
style guide. That is what changed our hospital transcription unit a whole
lot for the better, along with morale building at the grassroots level
among the MTs. Of course, this can cause divisions between MTs, so it has
to be done with kindness and encouragement to grow rather than beating
people down into perfectionism. Another suggestion is to persuade your
supervisor to let you work from home where you can at perhaps work with
your own software. My last suggestion is to start applying to companies
that have high standards with style guides and no padding allowed. You
will feel so much better about your work and yourself, and you can make
better money as well!
2/97, from Janie:
It's been approximately 4 years since I worked in a
hospital medical records department so I don't know if they are still
employing these methods, but it WAS one of the hospitals that DID care
about quality. Twice yearly, the supervisor (and she was an MT) would
randomly pull 10-13 of our documents and edit them for quality, style,
etc. Some items were counted as errors (e.g. incorrect or nonexistent
term, capitalizing a generic med.) while others such as style errors (e.g.
putting commas in the incorrect place) were brought to the attention of
the MT but NOT counted as errors. We were given an accuracy rating that
probably figured in our raises and, later, figured in our incentive
program (we had to meet 98% accuracy in order to obtain the incentive pay
for production). So not ALL hospitals are out to jack up production at
the cost of quality. I learned the most from my time in this department.
The QA review was an excellent learning/teaching tool, and I only wish
other hospitals/services would employ this. I think occasionally some MTs
may look at it as punitive ("oh no, they're going over my reports with a
fine tooth comb"), but I felt it was not in that light. When we were
called in to discuss the QA of our reports, it was a two-sided
conversation, so you felt as if you had some input into the review.
From Becky again:
The MTs in my department do not care about any of
this, with the exception of the one person that I hired straight from
school (over the objections of everybody involved - I felt she had that
"extra chip in her brain" and she did. She's been there 8 years now and
is really good. My approach to quality checking when it was my job: The
MTs no longer lost $ for errors, as before; I tried to encourage
discussion and learning, and published a (VERY anonymous) list of common
errors, their corrections, with sources and the reasons they were wrong.
It all worked out so well until I stepped down. The issue is money.
I do work from home. I was the pioneer and worked at home for about a
year or two before we bought our software and sent the rest of the MTs
home. We are required to use their software because we print at the
hospital and all the reports have to be on the data base so they can be
accessed. We really "have it good" as far as that goes.
I'm going to be forced to apply to a service, in spite of my love for the
hospital where I've been employed for 15 years, and all my vacation,
benefits, friends, and the decent name I've made for myself. I just
didn't want to do this.
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