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MEDICAL TRANSCRIPTION 

1.                  PRODUCT 

Medical Transcription (MT) is the process by which a patient’s medical record, as dictated into a dictation device/phone by medical professional and is converted to a wordprocessor document. The medical record comprises the patient's history, clinical findings, office notes, surgical notes, consultation notes, discharge summaries, letters laboratory and radiology reports and any other clinically relevant interaction between the patient and the healthcare facility. This fact that most of these reports is time critical and has a turn around time or less than 24 hours makes it a complicated problem for both the hospitals and the transcription house. Often lost or misplaced reports or even the incomplete reports are the fallout of these kinds of massive data transfer and tracking operations.                     

2.         NEED FOR PATIENT CARE DOCUMENTATION  

Medical record documentation is required to record pertinent facts, findings and observations about an individual’s health history including past and present illnesses, examinations, test treatments and outcomes. The medical record chronologically documents the care of the patient and contributes to quality healthcare.

 The medical record facilitates:

1.                  The ability of the physician and other healthcare professionals to evaluate and plan the patient’s immediate treatment, and to monitor his/her healthcare over time.

2.                  Communication and continuity of care among physicians and other health care professionals involved in the patient’s care.

3.                  Accurate and timely claims review and payment.

4.                  Appropriate utilization review and quality of care evaluations.

5.                  Collection of data that may be useful for research and education  

Maintaining the medical record became mandatory as legal and insurance claims have become dependent on this document. The biggest motivator is new documentation guidelines proposed by the federal Health Care Financing Administration (HCFA) which are expected to be adopted very soon in the US. Also some private insurers have begun to refuse payment to claims that don’t meet strict documentation rules.

3.         THE PROCESS  

The typical process of Medical Transcription begins with receiving dictation by tape, digital system or voice data file. Conventionally, recorded advice was sent through physical means (i.e a magnetic media). Nowadays, using a toll free telephone line, doctors can call up a number and dictate the message, which is recorded into a dedicated server on a real time basis.            

The parent US transcription company connects to this server through a high –speed data link (preferably Internet or ISDN link of 128 kbps or above) and downloads any fresh dictation left by customer organization doctors. The digitized data is then compressed and encrypted, for onward transmission via  satellite link to India. The local Transcription Company can then start to immediately retrieve the sound files, decompress the data and route them to different workstations for transcription. Using earphones and a foot pedal for start stop control, transcriptionsts are able to hear and control the speed of audio messages.  

The medical transcription center then sends these transcribed messages to the hub of medical transcription network from where it is routed to concerned doctor /hospital over seas. A response time of between 8-24 hours and an accuracy of over 98.5 is the norm. 

4.            GENERATING RECORDS 

1.                  The physician dictates a medical record or clinic note through a telephone or dictation device into a dictation system. The dictation is stored as a digital audio or voice file.;

2.                  The Medical Records wings of the Hospital assigns or out source these dictations to a MT or transcription service provider.

3.                  Reports are transcribed and formatted per client/report type specification.

4.                  The transcribed reports go through stringent quality checks and are transmitted back to the hospital.

5.                  The Medical Records wing prints out the report and sends it to the concerned physician.

6.                  The reports are attested by the doctor and archived for further use.

7.                  An electronic record is maintained as well. 

5.      MARKET 

Though an accurate forecast of the market assize is not available, estimates from various sources put the figures at 5-20 billion dollars. According to the U.S. Department of Labor, requirement for Mts. (medical transcriptionists) increased by 51 percent at end the year 2000.

Currently this service is being provided by:   

(a)               Home –based Transcriptionists in US

(b)               Medical transcription companies  

However outsourcing the job to other countries has been the trend of late . Countries such as India, Pakistan, Philippines, are favourite destination. The driving force behind this outsourcing has been the changing business scenario resulting from the Clinton Administration’s Healthcare reforms. The Healthcare organizations are increasingly resorting to out sourceing in a bid to take advantage of the cheap labour available in these countries .Business compulsions in the market have taken priority over the political implication of hundreds of US has MTs losing their jobs. Some of the other factors leading to outsourcing of MT to India are given below: 

§         Availability of a large English speaking population

§         Infrastructure: Communications, technology

§         Liberalization of the economy

§         Time zone: India is 11 hours ahead of US time and this helps sto meet the strict 24 hours turn around.

§         Trained manpower 

International Quality certifications are mandatory to survive in the increasing competition for MT business. 

The key elements of an effective quality assurance program should include : 

§         Appropriate work environment and adequate resources are provided and maintained.

§         Medical transcriptionists must have the appropriate education, training, and experience, as well as work under supervision and management.

§         Managers and supervisors must be dedicated to quality assurance and provide an environment that supports quality documentation.

§         Designated equipment is utilized skillfully and efficiently, with proper guidelines and demonstration for use available to transcriptionists and originators of the documentation. 

§         Patient demographics and originator identification are verified.  Designated formats are followed.

§         English language rules are adopted and used consistently.

§         Visual proofreading as well as electronic spell checking and grammar checking are performed.

§         Document storage and retrieval guidelines are followed.

§         A mechanism for feedback to the medical transcriptions is provided.  

      Voice Recognition Technology is observed to be a risk factor by analyst studying the medical transcription industry. Though voice recognition technology is unable to provide the accuracy expected for transcription at the moment, drastic performance improvement is expected in another five years.  

      Speech recognition vendors predict continued improvements in accuracy, mostly due to faster computers with more RAM and new hardware dedicated to sound and voice processing. Intel’s upcoming Pentium III central processing unit (CPU), which will contain dedicated speech circuitry. The chip is part of the PC’s operating system. That means care providers will see more ubiquitous voice input and voice control in generic office software. such as Microsoft Word and Excel, and in future versions of Windows itself. Though voice recognition technology would be more popular in the years to come, human intervention cannot be ruled out fully. Editors would still be required to fine-tune the electronic transcripts.

 6.         SKILL SETS 

            The Medical Transcriptionist has to have an understanding of the following: 

(a)      Medical terminology, anatomy, physiology, clinical medicine, surgery, diagnostic tests, radiology, pathology and pharmacology and the various medical specialties:

(b)     Excellent written and oral communication skills including English usage, grammar, punctuation and style.

(c)      Ability to understand diverse accents, dialects and varying dictation styles.

(d)     Ability to operate designated word processing, dictation and transcription equipment.  

For this, graduates or under-graduates with good knowledge of English can be trained.  

Hence this segment has the potential to create jobs for over 300,000 English –speaking persons with no other skills. Further they will all earn foreign exchange of more than 50 million US dollars in a year i.e. Rs 200 crores /year. The cost per line of transcription in US is between 10-12 cents. This can be supplied out of India at 6-8 cents / lines. This way there is a 25-35 percent benefit of both ends for both parties. 

7.            TRAINING PROCESS 

     The training aims at developing knowledge in the following areas. 

§         English : Grammar, spelling punctuation.

§         Medical terms: Parts of body, diseases, symptoms and treatment.

§         Transcription: Listening to dictation and transcribing.

§         Word processing skills. 

The classroom training in most cases is spread over 6 months. The trainees who clear this training program are provided on –the-job training and later confirmed based on their levels of competence.

8.            PROJECT COST           

            The essentials for setting up a Medical Transcription unit are: 

§         Premises (office space )

§         Hardware

§         Specialized Software

§         Telecom Connectivity (ISDN/Leased Line/Internet)

§         Training Costs

§         Manpower Costs 

Research has shown that the ideal capacity for a start –up is about 200 computers. This would require 200 employees working in three shifts of eight hours each. However it is observed that productivity levels are lower in the evening and night shift.

ESTIMATED PROJECT COST (Rs. In lacs)

9.        MEANS OF FINANCE

             Debt: Equity ratio of 1.5: 1 is proposed for the project. The tentative means of finance is as under: - 

 Pay back period anticipated is 3 Years. 

10.     INFRA STRUCTURE REQUIRED 

(i)                 High Speed data communication facility through STPI, VSNL, NIC etc.

(ii)                Built-up space on rental as well as on out right purchase basis.

(iii)              Plots for construction of own building.

(iv)              Single window clearance through STPI scheme.

(v)               Advance training institutes providing computer trained manpower.