Vol. 14 •Issue 1 • Page 17
Quality Assurance in Medical Transcription
Quality wasn’t always a concern in medical transcription. That’s not to say there was a time when health care professionals and medical transcriptionists (MTs) alike weren’t concerned with the finished product that becomes part of the medical record. But rather, the emergence of a formalized industry practice of quality assurance (QA) is something of a slow-growth trend with mature roots. It’s an idea, some say, whose time has come.
Back in the Day
“Quality wasn’t monitored at all,” said Debbie Strickland, operations specialist for Spheris in Franklin, TN. Recalling her early years in the field, she continued, “We sat down and we typed. We had two resources available, a medical book and a drug book.” Even though “The American Association for Medical Transcription (AAMT) increased awareness with its style guide nearly 20 years ago, hospitals didn’t actually begin considering quality programs until the last 10 to 15 years, and I don’t think quality has been formally monitored until just the last few years.” Then again, they didn’t really need to make the effort.
As Brenda J. Hurley, CMT, FAAMT, director of industry relations and compliance officer for MedWare Inc. recalls, “I remember when MTs worked in hospitals, in specialized areas such as pathology, the emergency department, radiology or even cardiology.” But the days of getting an anatomy lesson directly from a pathologist are over.
“Hospitals became centralized,” continued Hurley, who described the emergence of services to meet these larger systems’ needs. Flashing forward, “Today, it’s not unheard of in a nationwide service to have an MT—who more than likely works from home–transcribe thousands of different dictators” if the service has one or two major medical centers as an account, she added. Factor in combined specialties, faster turnaround expectations, newbie MTs from substandard training programs, as well as an increased sophistication of information being transcribed, and the margin for error naturally increases.
“I think QA is critical in doing transcription,” said Steven R. Palmisano, CEO of Chicago-based Emdat Inc., whose clients comprise between 80 percent to 85 percent medical clinics and 15 percent to 20 percent hospitals. In terms of it being a feature for a subscription-based software system like the one he sells, he puts it this way, “I don’t know if it’s the icing so much; I think it’s part of the cake.”
With their software, Palmisano explained, “For each transcription pool, you can set up varying levels of QA.” Left to the discretion of the manager, “You can have it so that everything goes to QA, or a percentage, or you can even designate specific doctors.”
But just what it means to “go to QA” varies greatly, depending on how a hospital or service handles scrutinizing the transcription process or end product. As Hurley points out, it can’t be measured with instruments. There are guidelines provided by AAMT, and more recently ASTM E31.22, but she adds, “It’s a different kind of business from anything else.”
This Document May be Monitored
At Spheris, for example, if you’ve just signed on as an MT, expect to be monitored “for at least two weeks, or until you have a 98 percent [accuracy] rate or better,” explained Strickland. Then there’s feedback.
In special cases, Strickland discusses a process she calls “shadowing,” something she’s written on extensively (see her article published in JAAMT January-February 2003). “Through our secured network and an off-the-shelf PC program, I can virtually ‘watch’ a remote MT transcribe,” she explained. While you can’t hear the dictators, she added, “I can tell the MTs some of the things they can improve on.” And there’s a right and wrong way to do that, too.
“The computer has no emotion but the person on the other end does,” said Strickland. Sometimes, upon learning of an error, MTs will have an I’ve-been-typing-it-this-way-for-X-number-of-years reaction. “They’ll ask, ‘when did it change?’ and you find a nice way to tell them, ‘it didn’t, you’ve been doing it incorrectly.'”
Hurley’s biggest criticism is for those who take a punitive approach to QA. “It’s throwing away a wonderful opportunity to get better results,” she said. She’s a big advocate of education and positive feedback.
Down the Road
In terms of QA becoming a formalized process, complete with rating systems, education, feedback and the like, Hurley sees some growth in this trend, and hopes that it’s growth in the right direction.
“QA is not going away anytime soon,” she observed. In part, low-cost outsourcing alternatives may be fueling this trend. Consider that “hospitals—some that have never looked before—are beginning to look at what’s coming back from their services, or their MTs,” Hurley offered.
As Strickland sees it, they have no choice. “With new MTs just coming out of these schools and taking jobs with services, companies have to monitor them for quality.”
Of course, the time it takes to assure quality competes with the push for faster turnaround times. But if it’s a race, it’s one Hurley hopes QA wins. “The hospitals are pushing for quality and turnaround. But personally, I’d much rather apologize for it being late than apologize for it being wrong.”
Linda Gross is an assistant editor at ADVANCE.