Tuesday, January 10, 2012

Is the Sun Setting on Medical Transcription?

Medical transcription in India started with a flourish more than a decade ago, but is now showing more and more signs of ending with a whimper.  Technology has caught up and the profile of the industry has changed radically; that it will no longer be an employee intensive industry is a fact all transcriptionists will have to recognize and live with. Companies in India for their own survival are opting for Voice Recognition systems and downsizing their workforce almost with a vengeance. The question is, will these companies themselves survive for more than 2-3 years?

At the beginning of the decade, things were looking great. There was always the risk of voice recognition coming into its own, but the quality of the transcript spewed out by voice recognition programs was beyond pathetic and transcriptionists heaved a sigh of relief, but voice rec bided its time and, well, the Empire Struck Back. Quality of transcripts improved dramatically, well not as great as company bigwigs claim them to be but they are definitely workable. I have some experience with Dragon and MModal, and some of my friends have worked on eScription used by Nuance. The general belief is eScription does a great job delivering consistently high accuracy outputs of above 90%. The other two are decent but there is still some way to go for them. One reason might be Nuance informs the clinics and hospitals it serves that they use a voice recognition platform and they actually take the trouble to spend time with the physician to familiarize them with the system and how best to dictate into it. With the dictator himself knowledgeable about the ins and outs of the system, obviously the output is that much better.

Some companies hesitate in informing their clients fearing possibly that the clients would demand their pound of flesh by slashing rates. Physicians unaware that they are dictating for a voice recognition  program dictate in their normal way—with all their quirks, their pauses, yawns and grunts and the voice rec program while it is reasonably intelligent still cannot recognize these things and spews out garbage making the job of the Editor or Quality Analyst that much more difficult. These companies know that they are asking too much of their employees but have no real qualms about it, the bottom line is what grabs their attention to the exclusion of all else.

The immediate goal of such companies is to remove the first layer-the medical transcriptionist completely and streamline their employee force into what is called the One-Touch process in MT jargon. They are not yet there, but they are moving inexorably in that direction. It has been quite noticeable that MT Training centers have shut shop for sometime now, earlier there used to be at least one in every center. Job opportunities at the MT level have dried up, and if you cannot transition to being a voice editor your days are numbered. It is not as if the voice editors have a cushy life either, they are having to work longer hours to at least keep their pay packets stable, the day of the “fixed salaries” has gone or will go soon. Everything will be incentivized cushioning the employer but punishing the employee perhaps unfairly.

It almost appears that MT companies have seen the writing on the wall and are out to make as much money as possible before they themselves become redundant. EMR programs with built in billing software might prove to be the death knell of these companies.  We have noticed clients who were earlier quite satisfied with Quality and TAT simply disappearing with not even a goodbye. On the CS team querying them, more often than not the answer is that they have migrated to EMR programs with built in voice rec and billing software. With a penalty clause for clinics and hospitals not moving on the EMR bandwagon and almost 100% subsidy on the EMR itself, the US Government has succeeded in pulling jobs out of India, much more so than any legislation prohibiting offshore outsourcing of healthcare documentation jobs.

So EMR and Voice Rec will do to the MT industry what Amazon did to the Brick and Mortar companies or what Apple and Android devices are doing to Nokia and RIM, making it obsolete. The future does appear bleak, the clinics have started vanishing and in another year will have completely gone. The hospitals too have initiated the move to EMR and steadily they too will disappear. I hate being a doomsday prophet but there is an even chance that the MT industry will become a thing of the past in the next 4-5 years.

I am not really worried about the Employers per se, they have made their money and with the dollar at 53+ quite a lot of money at that. My real concern is for the employee, most of them are really not suited for other jobs and will find it difficult to survive.  My exhortation for all these employees would be to explore all opportunities, as their language skills and hearing skills might prove useful in landing a job in business and legal transcription with some training. There are other avenues in medical data mining and other related industries too. It will take some effort on their part to attain the requisite skills, but it is not rocket science. 

I would be the happiest person if the MT industry survives, but I think barring a few niche players, the sun in this industry is SETTING.


This is a guest post by Dr. Ramesh Grandhi who has been a part of the  Medical Transcription industry in India since 1998 and has witnessed the evolution of MT from its early days in India to the present. The views expressed in this article are his own.


Shanthz said...

Yes, the sun is setting on medical transcription in America. I work in a large hospital (1500 bed) in New York City. Our Radiology Department depended on medical transcription until late 2009, when they moved to Voice Recognition (Nuance). Since then, they are saving a lot of money at a time when all hospital departments are facing budget cuts. Their turnaround time for final reporting has reduced from an average 24-36 hours to a mere 3 hours (final report signed by radiologist). This is happening in small clinics and big hospitals across America. In the late 1990s, I worked in a medical transcription company in Bangalore before moving to NY, and remember the mushrooming of medical transcription training centers and companies. Good old days.....

Subhorup Dasgupta said...

I strongly believe that the medical transcription industry globally is overdue for a "makeover," a self renewal of sorts. It would be tragic to see the several thousands of highly talented medical language specialists leave this magical and challenging field.

@ Shanthz Good old days indeed! Thanks for sharing your thoughts with us. Hope you didn't miss the Food Really Matters link on the sidebar.

Shanthz said...

Subho, I'm honored to be part of the Blog List...thank you. It surely motivates me to blog more often.

Anonymous said...

Great post , Thank you for writing so well on such a difficult but important subject. It was really helpful to solve my confusion,

Medical Transcription Company

Editor's Choice said...

Shanthz comment seems to bear out what I have written, but strangely I am quite ambivalent about it, not really happy that an industry which even now provides bread and butter to untold thousands is withering away even as I type. I do hope these highly qualified employees will find something else and soon as pink slips will soon become a reality for most of them.

medical transcriptionist said...

A lot of software and technology maybe available for the medical transcription field nowadays but I don't think that it is going to be one of the reasons why the industry is going to go down.

Editor's Choice said...

Thanks for your observation 'medical transcriptionist.' It would indeed be welcome news if what you have written turns out to be true, but indications are to the contrary unfortunately. Business is slowly drying up, but let me reiterate I would be delighted if your comment turns out to be true.

NEERAJ said...

Hi friends,

I have been in the industry since 1999. Have gone through the ups and downs along with the industry.

VRS is undoubtedly an excellent technological advancement, but please bear in mind that VRS produces transcripts after the voice file is run through a database of word documents pertaining to a particular dictator. The million dollar question is who will prepare the transcripts ?(you do need MTs for that)

Any hospital that transits from traditional to VRS mode of transcription must go through this process of building up a database initially. So, MTs please do not lose heart. Contrarily, while each one of you is preparing the database, wherever you are working, try to inculcate the methods and techniques that Editors and QAs use. This way, you will become a Direct Uploader and from here one can always develop into an Editor or a QA. Hope this brings some solace to my MT friends.

Now, to the question of EMR: Will the 100% subsidy and stuff reduce the following work types:
Operative Reports
Psychiatric Reports
H&P Reports
Progress Notes
Initial office visits
and you know there are more, to mere data entry fields where you need someone to only fill in the blanks ??

Few more points to ponder:
1. Doctors leaving one facility for another.
2. New doctors joining a hospital.
3. Will doctors stop dictating altogether?
4. Will the insurance sector in the US be satisfied with only the outlines and not the detailed transcript?

Dear friends, think deeply and intelligently. Technological advancement is good, but you all know, some technologies take the back seat due to some unavoidable handicaps that emerge once the technology is used to some extent.

So, have a heart, have patience and keep a sharp eye on the tide. Utilize every moment spent on your workstation, not merely typing what you listen, but trying to develop your skills and a thorough understanding of what is going on in the dictation.

There may be some, who might differ from the above, but EMRs will be effective with facilities having limited number of physicians not with big hospitals. Also, big hospitals transitioning to VRS will have to get someone to prepare a database for the software. Companies like CBay, Nuance, etc., have MTs in place for this very reason. They have their training centers too.

As for the training centers, I believe, a counted number of training centers will always be better than a mushrooming of training centers where the quality of training goes for a toss.

Hope I have not offended anyone in any respect and my views are well taken.

where to find healthcare jobs said...

@Shanthz, I can't say I disagree with you because I have known of a lot of companies laying off workers and outsourcing the needed services elsewhere. But, not a lot of companies outsource this service and according to the Bureau of Labor Statistics, the median wage for medical transcriptionists was $15.82 an hour in 2010 and many worked from home.

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