How your transcription vendor serves you makes a difference in how you serve your organization's physicians and, eventually, your patients. Accurate, reliable and timely transcription is NOT a commodity service which creates the foundation for the patient medical record, it is a requirement for all patient care. Transcription alone can make a huge difference in a hospital's or clinic's level of physician service and satisfaction, quality of care, and speed of billing and collections.

Many healthcare organizations don't know what standards they can and should expect in a transcription services vendor. In a series of newsletters we will outline the criteria for evaluating your transcription services:

• Document accuracy/quality: how it affects medical records and patient safety
• Physician satisfaction: how reliability and accuracy can help or hurt your relationships with physicians
• HIPAA compliance: how the security of your transcription process can influence your organization's ability to comply with new rules regarding confidentially
• Turnaround times: how transcription turnaround affects departmental concerns, as well as enterprise concerns such as outstanding A/R
• Vender responsiveness and flexibility: what you should look for, and expect, in response to your needs
• Reporting: how you should be able to monitor your transcription

Accuracy, the foundation of patient service

Analyzing dictators' technology needs.
Are your dictation devices in good working order, or is the technology a challenge, with ailing or broken "parts" such as network, phone or device problems? Are there multiple dictation systems that require different knowledge or behaviors on the part of physicians (such as different codes, or different phone numbers)? Is it difficult to get dictators to adhere to policies because they change frequently or are too complicated and fragmented? If the technology causes a problem for a physician, how quickly can IT respond to his or her problem?

Analyze your dictators' behavior.
How many physicians and other clinicians do you serve? And of these, what percentage might be characterized as "problem" dictators because they don't adhere to requested processes, or are difficult to understand and transcribe? Do you have a lot of "new" dictators (such as residents at a teaching hospital) or dictators who irregularly use your facility and thus may not be aware of procedures?
How easy, or difficult, is it for you to meet turnaround expectations, given the dictation habits and equipment used by your physicians? Has the transcription function been able to maintain good relationships with the physicians served? Is it viewed as a valued ally or a source of headaches?

Analyze your dictation volume patterns.
How variable is the volume of dictation that your institution must transcribe? Do you live in a state, such as Florida, where patient volumes ebb and flow with the seasons of the year? Do you live in an area where population growth has recently soared? Are there identifiable patterns in the volume of reports, or are you frequently hit by unexpected fluctuations that make it difficult to staff for appropriate turnaround? How many "simultaneous" dictators do you have, and is that pattern easy to staff to? Do you have frequent periods of transcriptionist overtime due to unexpected volumes?

Small internal departments may be under- or overstaffed relative to dictation volume on an interim or regular basis. In this situation, it may be appropriate to outsource a part of your transcription volume to a vender who can shift to your organization on an as-needed basis.

From dictation to the transcriptionists
Once you have a handle on the patterns associated with dictation, look at the process path from dictation to transcription.

Analyze how voice files are delivered to transcriptionists.
What is the process-and the speed of that process-used to deliver the dictated voice files to the transcriptionists charged with completing reports? Does your hospital use different dictation systems that slow the process on the transcriptionists' and (e.i., having to "dial in" to some systems while being able to use others directly)? Can you track how much time is taken up by this process? A completely Internet-enabled process might take seconds, whereas one using dictated tapes, manually handed to transcriptionists, could cause a delay of hours.

Is there an intelligent procedure to prioritize files and route them to the transcriptionist best suited (and available) to transcribe this specific report? Is this process automated, or must a supervisor intervene?

Security is an issue here, as confidential patient information must now be protected, whether the process is automated or manual. Does your automated process operate within a secure network or VPN? If you are not transporting files electronically, is your manual process in line with HIPAA regulations?

Evaluate the transcriptionist pool.
How well does your existing pool of transcriptionists match the needs of your organization? The expertise, educational achievement, and mix of skills and schedules in the transcriptionist pool will greatly affect report turnaround times. Consistently accurate, high-quality documents depend on the expertise of the transcriptionist. As the American Association of Medical Transcriptionists (AAMT) Web site notes, "Keyboarding and transcription should not be confused. The primary skills necessary for performance of quality medical transcription are extensive medical knowledge and understanding, sound judgment, deductive reasoning, and the ability to detect medical inconsistencies in dictation. For example, a diagnosis inconsistent with the patient's history and symptoms may be mistakenly dictated. The medical transcriptionist questions, seeks clarification, verifies the information, and enters it into the report."

Transcriptionists should have a solid academic background, have experience in a healthcare setting, and go through a battery of qualifying tests and training sessions. After a short ramp-up time - generally no longer than a week or two - a transcriptionist should become familiar enough with a physician's dictation style to provide consistently high quality at a rate of 98percent to 100 percent. All of the initial work completed by a new transcriptionist should be assessed and measured until he or she is achieving a 98 percent or higher rate on every document. Subsequently, the quality of all transcribed documents should be measured and quantified by regular audits, with results made available to the customer.

Small internal departments may not be properly staffed relative to the amount of volume and the mix of skills needed to transcribe complex specialty reports. One transcriptionist may be extremely fast in turning out radiology reports, but may struggle with operative notes, while another may have extensive experience in outpatient report types but lack familiarity with hospital care. In this situation, it may be appropriate to outsource a part of your transcription volume to a vendor skilled in the specific report(s).