Medical Transcription: How Does Technology Alter How We Do Things?
It’s been an interesting day with some conversations that I’d like to throw out to all of you. It’s not secret to this group that technology is changing our industry on a daily basis. New things get introduced, speech recognition plays an even bigger role than before, and sometimes it can be daunting to keep up.
At the same time, medical transcriptionists have also been really good at knowing and understanding the “rules” related to things like grammar and punctuation. It has been our responsibility to “fix” those things if they aren’t dictated and to be sure that we make the appropriate edits in the reports we transcribe.
Today the conversation centered around speech recognition, and particularly as it relates to using the Book of Style and making those kind of corrections to what the engine produces. One MT tells me that she is hearing editors are not allowed to make any changes to reports except where the engine had a word recognition error. Think about that for a minute.
When editing is done with a speech recognition engine, it “trains” the engine to recognize things correctly the next time. So does adding things like punctuation and changing grammar train the engine improperly? What about those reports where you have a left/right discrepancy, and you have enough information to know which one is correct? If you edit that “left” to now say “right,” have you just told the engine that when it hears “left,” it now needs to put in “right”? It’s not something I’ve ever really thought about until today.
I have said for a long time that the move to the electronic record will re-define the word “quality.” I can’t say that I’m sure what that means yet as I don’t think we’ve seen enough to know.
So, if the things above are the reality of our world, how do we prepare a new generation of medical transcriptionists? Does our focus change from things like the Book of Style? Teaching the rules in the Book of Style is now a critically important part of what we ask educational facilities to do, at least if they are seeking AHDI approval for their program. Will the future change that? Will we become more focused on content and context and less on the rules of grammar and punctuation? And yes, I know we do that now, I just mean will we shift even more?
I’d love to hear what YOUR experience is with using this technology! What changes are you seeing in how you do your work?
Related posts:
- How Does Technology Change Medical Transcription Tribes?
- Medical Transcription Pay: Are We Our Own Worst Enemy?
- Medical Transcription: The Future
- Medical Transcription: Let’s Tell Our Stories!
- Medical Transcription and the EHR: Doing it the Right Way
Tagged with: accuracy in healthcare documentation • medical transcription • medical transcription technology • quality in medical transcription
Filed under: Challenges in Medical Transcription • Technology
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Kathy: I have copied & pasted your blog into an email to my sister since she routinely works with word rec, so I hope she’ll reply and I can copy & paste her reply here. I have no real exposure to word rec myself, so I’m going to sit this one out and just read what everyone else has to say.
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I’m new to the field/industry, not having worked yet as an MT. Ditto to what Sherry said…I will also read what others have to say. Looking forward to those responses….!
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My experience is that quality of grammar is being thrown under the bus in deference to production speed. Have had editing instructors say to leave the “yoda” type grammar … “the cast on the leg was placed.” Clients are willing to throw out the grammar rules, but want the content correct. My prediction is that they will regret this decision and before long will want to return to good English. But they have to learn the hard way. One high-profile lawsuit where the medical record comes into play and all the rules would change in a heartbeat.
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Crystal: I have actually found that on the hospital account I am now on, I now work on my own computer, but for a time I actually used the hospital’s work station and directly reported to the hospital’s head of transcription. I didn’t do voice rec for her, but I can’t TELL you the number of times when I questioned something and asked her about it, her response was, “If the meaning is clear, just leave it.” That was in relation to poor grammar, made-up words, and just about everything that didn’t involve questions about medication dosages or possible discrepancies with right/left and things like that. I think it’s awful that doctors expect us to basically think of them as Gods, but they don’t hold themselves to the same exacting standards. I know doctors can get insulted and act “huffy” when they are questioned about things, but in the case of patient safety and medical record accuracy, I would hope that they would understand that our questions are only meant to maintain the highest in both safety and accuracy and not as a personal slight. I have always been told that if I question something, I should flag it. What happens when our QA people (or their supervisor, or our liaison with a facility) asks a question of the hospital’s transcription liaison? I’d hate to think that a transcription company could lose business due to bad feelings with a doctor when, in the end, we all only want the best result in terms of patient care and the medical record, but I think it could be a possibility as this is kind of a cut-throat business with facilities trying to save money everywhere and transcription companies bending over backwards to keep accounts and gain new ones.
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Kathy Reply:
June 30th, 2010 at 11:53 am
I think we see this is all of our work. It IS the idea of “if the meaning’s clear, it’s good enough.” With the use of technology that is coming and changing all the time, I am just wondering if we won’t see more of this kind of way of looking at things.
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Kathy: I do think that we need to pay attention to both the quality and production speed in this field as both are critical selling points for businesses in this industry. I came into this industry understanding there is a standard to achieve and maintain if this industry is to flourish. I do not think that one is more important than the other. I have had the privilege to work with voice recognition for the past year and it amazes me to see what the engine produces. With that said; if we are going to forego editing the grammatical errors as well as overlook the punctuation among other things, there would be no need for us as MTs/Editors. Doctors would be free to dictate their reports and upload them without having to go through us.
Let’s take a stand on this one and continue to EDIT; (not change the context of sentences or pad lines for financial gain), but showcase our ability and the reason behind studying and investing our time and money to learn for this career. A standard was set, instead of back sliding from it; we should look to improve on it.
Always remember: If we don’t stand for something we will fall for anything.
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Kathy Reply:
June 30th, 2010 at 11:52 am
Thanks, Kim, for your input. My point here isn’t that we, as MTs, should stop paying attention to quality, but to ask if the industry and technology changes aren’t going to change how quality is defined. And while it would be great to see MTs “take a stand on this,” the reality is that we are bound to do whatever is required by the person or company who writes our checks. When I start hearing that MTs are being told that things like grammar and punctuation are not things they should correct, it does give pause to what the future will look like. Great discussion!
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About half of my work recently has been in editing speech-recognition transcripts. I have to say that I enjoy it, as it is easier on the body (keyboard shortcuts can profitably stand in for the foot pedal controls, so the ergonomics improve) and often introduces me to unfamiliar terms already correctly presented. My instructions are to edit quickly and efficiently for clear meaning and correct medical content; however, I am also told that the client should not be able to tell the difference between an edited speech-recognition transcript and one transcribed from scratch. Learning how to walk this line is part of the growth process for me. How edits affect future “raw” transcripts probably depends on which speech-recognition technology is in use. With the system my workplace uses, only edits that are made consistently by many MTs change how the engine recognizes a word, so the occasional “left” versus “right” switch won’t mess anything up. The engine uses a large number of edited reports to “learn” from the edits, so the odd one-time edit does not affect future transcripts. I definitely notice the “raw” transcripts improving over time, as the system learns from our edits. I don’t see us becoming superfluous anytime soon, though, because it will be a very long time before a speech recognition engine can embody a human brain’s understanding of context and all of the factors needed to recognize discrepancies and medical errors and to flag or correct them before they can do harm.
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Kathy Reply:
June 30th, 2010 at 11:55 am
Charmaine, good input! Your insight into the left/right discrepancy helps a lot as I was taken back by that one. Thanks for adding to the conversation. I don’t think MTs will become superfluous either, just think that perhaps the definition of what is considered “quality” may be changing around us and we need to be aware of that.
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I have never worked with SR either – but our hospital did put it in the budget for next year, and the new dictation system we bought last year was based on the premise that we could add on SR capability easily. I am anxious to see what happens.
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The primary use of our product today is billing, not patient care. Either orders are handwritten or entered through a system outside of our transcription systems. Consequently, sad to say with a number of my accounts “good enough” has become the new quality standard, and catching discrepancies is not only not appreciated, but sometimes discouraged. I’m having a really hard time with that.
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Kathy Reply:
July 1st, 2010 at 9:18 pm
Crystal, I understand that. It’s tough when we feel like we’re the only ones who really cares about quality. What I wonder with all of these changes in technology is whether we aren’t seeing a shift in the definition of quality. That will take a real paradigm shift for us as MTs!
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The national company I work for provides me with both speech recognition to edit as well as new dictations to type. My pay is about half when I do editing. I have been told to ignore punctuation and grammer for edited reports, just ensure the content is correct. They expect all new transcribed reports to be letter-perfect, and I asked why an edited report would be different. They said MLS would not make any money if we focused on letter-perfect reports, and the customer was okay with that. My speed has now increased dramatically on edited reports, but my esteen is lowered each time I send a “not so perfect” edited report back to the customer. It just feels wrong to not want each and every report with my MLS number on it to not be perfect.
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