Medical transcription is still in the 1980's
I went to the hospital today because I broke a toe on my left foot. My doctor was able to buddy tape the toe in mere minutes and yet my medical record at the hospital won’t be updated for over a month. How is this even possible in today’s modern world of medicine?
For starters, the doctor didn’t type anything into the hospital’s electronic health record system today. She listened to me and jotted down a few scribbles in a chart. The chart isn’t my electronic patient record sitting on computers at the hospital, but a piece of paper on a clipboard.
The doctor was very busy this morning and as such she moved on to the next patient when she was done. When she has time this week she will either pick up a handheld recorder on her desk, call a phone-in audio system from her cell phone, or dictate into a recording device at the hospital. This may take place today but if the national numbers hold true, she may not record it for up to 3 days. This doesn’t mean my patient record will be updated in 3 days.
In most cases the audio my doctor dictates will be sent to one of 4,300 outside transcription companies who’s job is to convert my doctor’s audio to a text document which will eventually find its way back into my electronic patient chart at the hospital.
Most of the 4,300 transcription companies do not connect digitally with the electronic health record systems at hospitals. The transcriptionists need to know my personal information such as my name, date of birth, social security number, and other sensitive information in order to type up the right document. In order for the transcriptionist to do their work a member of the hospital’s staff needs to print and fax a schedule of today’s patients to the transcription company. You read that right. They will print and fax my information later today — unless they already did this morning.
The process of printing and faxing is so wrought with problems that my mom called me one day to ask if I had faxed her a bunch of patient records to her home. It turned out they were accidentally faxed to her home fax machine from a hospital in southern California. Please don’t ask me why my mom keeps a fax machine at home.
Today’s faxed schedule will be sent along with my doctor’s audio files to a company with offices most likely in India where there are hundreds and sometimes thousands of amazing transcriptionists waiting to listen and transcribe my doctor’s words into readable text. This process can take from a couple hours to a couple days depending on their workload.
In most cases transcription companies are lagging a bit with technology. They normally use Microsoft Word with hospital-specific document templates and fill them in with the information contained in my doctor’s audio. The transcriptionist will then send the finished document back to the hospital via FTP, email, or another antiquated method. A hospital staff member will then download the document, open the electronic health record system, locate my patient record, and copy and paste the document into the system.
Stop me at any point if this sounds crazy.
Doctor approves the transcription
My patient record is still not updated because my doctor needs to review and “sign off” on the transcribed document. In some cases my doctor sends it back to the transcriptionist to make changes which again can take from a couple hours to a couple days. In some cases my doctor may not read today’s finished transcription in a timely manner.
Many hospitals now ask my doctor to do so within the first 72 hours of seeing me. If we are keeping track of timing, this can mean that it can be up to a week from the time my doctor saw me until the time she reads the finished transcription.
It is at the point my doctor will approve everything in the document or kick it back to the transcriptionist with some notes on what to change.
After the transcription is approved by my doctor, she clicks a button to make it a permanent document in my patient chart. For some hospitals this can take up to 30 days — especially if my doctor goes on vacation or is out sick.
It can get better.
Electronic health record systems made within the last 20 years offer something known as an HL7 interface. HL7 is the “language of medical record systems” and is the one they use to communicate back and forth with other systems.
Transcription companies today could leverage HL7 interfaces to their advantage. They can eliminate the need for hospital staff to print and fax the daily schedule to their transcription company. The reason is each patient seen at the hospital has their information communicated in real time to the transcription company.
Secondly, the transcription can be electronically sent back directly into the electronic health record system in real time with no human copying and pasting of the document. Not only can this save time and money, but it can reduce errors of having my patient record accidentally updated with another Richard’s exam results.
But there are problems with HL7
There are problems with HL7. It is very expensive to process HL7 messages because the software to do so can run hundreds of thousands of dollars, it is complicated to set up an HL7 interface to an outside third party, can take a long time for the hospital to approve and set up a virtual private network (VPN), and transcription companies don’t have the very expensive human and software resources to work with HL7.
That is why our company MI7 created our product codenamed: Q. It speaks the language of the medical record systems and translates it into JSON which most every software developer can work with. Q also removes the need to set up a VPN.
With the help of Q, transcriptions can get back into patient charts faster using more modern techniques which in turn can greatly benefit patient care and help reduce the overall cost of healthcare by eliminating wasted time and effort.
Please connect with me on LinkedIn if you are interested in talking about transcriptions, HL7, or Q.
If you liked the story please consider recommending it by clicking the heart icon below. You can also follow me on Twitter at @richardbagdonas.