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July 18, 2005

AAMT Goes to Washington
By Peter Preziosi, PhD, CAE
For The Record
Vol. 17 No. 15 P. 26

Armed with ideas on issues such as privacy and security and standardized vocabularies, the MT organization ventured inside the Beltway to have its voice heard.

The key message brought to Capitol Hill this past April by medical transcriptionists (MTs) from across the country was that accurate and complete healthcare documentation is the foundation of the revenue cycle, critical to patient safety, and essential to continuity of care.

Clearly, transcription and the role of transcriptionists are vital to the healthcare team. Yet transcription remains relatively unthought of in most health policy circles or systems reengineering designs. If anything, healthcare purchasers would rather see transcription go away altogether through structured text, point-and-click technologies, or the evolution of speech-recognition and natural language processing software, mostly because CEOs and chief financial officers only see their bottom lines when it comes to transcription.

While transcription costs do hit a healthcare facility’s bottom line, part of the obsession with cost occurred when the transcription industry hitched its wagon to the pay-for-performance cause in the early ’90s, tying pricing to production and turnaround times. This public relations predicament is one reason why the American Association for Medical Transcription (AAMT) organized its first-ever lobby day. One way to dispel the notion of “transcriptionist as commodity and cost center” is to broaden the view of our federal policy makers. It is important to recognize that congressional policy ultimately determines how transcription and other allied health professions will perform their work in the future electronic healthcare age.

However, the purpose of lobby day in Washington was not to boast about transcriptionists and the work they do. More importantly, the goal was bringing solutions to lawmakers concerning healthcare reform and the engine that will help drive it—the electronic health record (EHR). However, one side benefit of lobby day was that we showed Congress—through our 110 attendees and nearly 1,300 letters hand-carried to congressional offices—that MTs can organize and hold elected officials accountable when it comes to making rational health policy decisions.

There is much at stake for the future of the medical transcription profession. New technologies, the EHR, healthcare privacy and security, offshore outsourcing, and training challenges all affect the practice of medical transcription. AAMT members urged Congress to sponsor and support the allocation of government funding for workforce and technology development to help the profession correct the present shortage of qualified U.S.-based MTs and help the profession respond to and embrace the new regulatory challenges imposed by the HIPAA privacy rules and the electronic health environment.

Solutions to Correct the Shortage of Qualified MTs
The consensus among industry experts is that there is a critical shortage of qualified MTs in the United States. In addition to the shortage of a qualified U.S. workforce, pressures by healthcare facilities to complete transcription more quickly at lower costs have encouraged companies to go overseas for services. Competition from overseas sources is also emerging in large part due to the lack of minimum wage laws in those countries. Low entry-level wages and lack of adequate compensation for skilled, experienced MTs have discouraged many individuals from selecting medical transcription as a viable career option at a time when the MT workforce is aging. Compounding the problem is the fact that many new MT graduates are not able to find employment because they are unable to meet experience and productivity requirements for U.S. MTs as mandated by the industry.

AAMT members requested that Congress develop economic incentives for hospitals and transcription services to employ MT graduates in internship programs and on-the-job training until they are capable of meeting the productivity and accuracy standards set by the industry and their employers. Traditionally, MT education programs have not adequately prepared graduates to meet industry standards because they do not always teach industry-aligned skills. They are often focused on enrollment numbers and do not consistently require certain skill sets in their instructors and graduates.

To augment government-funded programs and combat the issue, the AAMT, in collaboration with the AHIMA, has developed a medical transcription educational approval process, which sets standards for educational institutions and monitors inappropriate educational institutions from proliferating. As health information demands increase within an automated, electronic environment, the workforce will become more integrated and current roles will blur into new ones. No matter how advanced the technology becomes, documentation specialists entering data into the system must be as precise, specific, and accurate as the standard measures developed.

AAMT members lobbied for support of the Allied Health Professions Reinvestment Act to add our voices to a coalition of more than 30 other healthcare-related organizations. The proposed legislation will provide funding for student loans and recruitment campaigns to encourage individuals to seek and complete allied health education and training. The funding will help alleviate the shortage of all allied health professionals and bolster the nation’s healthcare infrastructure.

The allied health profession workforce is essential. The U.S. Census Bureau and other reports highlight the increased demand for acute and chronic healthcare services among both the general population and a rapidly growing older adult population. Additionally, the calls for a reduction in medical errors, increased patient safety, and improved quality of care have resulted in an amplified call for allied health professionals to provide healthcare services. In response to emerging technologies in healthcare delivery (charting software, electronic technologies, speech recognition, and database management software), allied health professionals will need significant training and retooling to meet the demands of a future technology-driven healthcare environment.

MTs and the National Health Information Infrastructure
The AAMT recognizes that interoperability of technology, standardized measures, and access to provider performance data will help decrease healthcare fragmentation and costs while improving patient safety and efficiency. However, from the perspective of the labor force responsible in large measure for working within an evolving national health information infrastructure, AAMT members suggested to Congress that the following issues be addressed:

• Privacy and security issues — As interoperability of information technology systems expands and health information becomes more readily accessible in the public domain, privacy protections for personal health information must be ensured and security measures for these systems must be put into place. Although HIPAA regulations have begun to address these issues, the healthcare community must continue to work on implementation processes and develop security technology solutions that protect consumer information and rights.

• Standardized vocabulary and data templates — Movement toward standardized measures of provider quality and efficiency requires a standardized vocabulary for all providers and data specialists. The use of a standardized vocabulary ensures that the information collected for analysis is accurate, specific, precise, and comparable. Some vocabularies have already been adopted; currently, however, each industry segment is exploring this independently. EHR vendors have their language, the AAMT has its, the pharmaceutical industry has theirs, etc. Progress would include getting everyone on the same page at this point, as some have already chosen their standard vocabulary.

The AAMT believes real-time efficiency and quality will require radical changes in data input with everyone involved in patient care and health information adhering to similar guidelines. Advanced technologies and standardized measures will only create accurate system information if the content is correct in the beginning. To move from a claims-based system to a clinical-based system of quality measurement, creation of effective input methodologies (point and click, templates, voice/speech recognition, transcription) is critical.

For health professionals, training in the use of these methods will likewise be essential. MTs have first-hand knowledge of best practices in data input and eventual outcomes. Utilizing MTs’ collective knowledge in the development of input methods and educating MTs in advanced technologies will meet the various goals we believe are imperative in patient documentation evolution.

Solving the Issues of Privacy and Security: Certification Before Accessing Protected Health Information
While the essence of dictation and transcription has not changed over the years, certainly the technology of voice capture and document transfer has. In fact, technology has brought the concern for security and privacy to the forefront. The issue of privacy is one that MTs were aware of long before the HIPAA regulations were written. The use of protected health information (PHI), as well as specific demographic data as mandated by insurance and other healthcare agencies, is an integral and necessary part of the documentation process.

AAMT members encouraged lawmakers to support certification as a requirement for entry into the medical transcription profession to ensure that only the most qualified and appropriately educated transcriptionists are able to access PHI. The medical transcription profession is highly fragmented and relatively unregulated. There are transcriptionists isolated from the profession who work from their homes and do not have access to the latest information on HIPAA regulations, medical procedures, and pharmaceuticals.

HIPAA regulators are equally concerned about the privacy and security of healthcare documents that are handled by U.S. home-based transcriptionists and overseas transcription services. Only roughly 2,800 of the approximately 250,000 to 350,000 MTs in the country are certified. Certification requires ongoing continuing education and encourages lifelong learning. The AAMT advocates for some form of entry-level certification or licensure to practice medical transcription before an individual is allowed access to PHI.

Outsourcing Transcription Offshore
The loss of U.S. transcription jobs to offshore competition and the potential impact on the industry was another major issue discussed with congressional leaders. MTs are frightened and frustrated about losing their jobs to offshore transcription companies. It is impossible to compete with an offshore labor pool that works for wages that fall significantly below a reasonably competitive margin. While we understand the myriad reasons for the offshore outsourcing of U.S. healthcare documentation, financial data, etc, the AAMT nevertheless is extremely troubled that some transcriptionists are losing their jobs because of the practice, and we would rather that U.S. healthcare documentation stay in this country with certified U.S. MTs.

However, given the current shortage of qualified MTs in the United States and the ability to perform transcription virtually anywhere in the world, healthcare policies focusing on the exportation of transcription outside our borders must ensure that all parties are held to the same standards of practice. The SAFE-ID (Safeguarding Americans From Exporting Identification Data) Act, introduced in the Senate by Sen Hillary Rodham Clinton (D-N.Y.) and in the House by Congressman Edward J. Markey (D-Mass.) begins to level the playing field. The act calls for overseas transcription companies to abide by the same privacy and security rules as their U.S. counterparts. The legislation also calls for full disclosure of where the transcription is performed. Further, it allows consumers to request that their medical information not be shipped overseas.

Ideologically, this is a great step forward for consumer rights. On the other hand, financially and administratively allowing consumers to choose their transcription service in this current market would raise healthcare costs exponentially and create an administrative burden to healthcare systems that employ multiple transcription services.

Conclusions
The AAMT believes the quality of transcribed U.S. healthcare documentation is critical to the continuity of patient care. Primarily, the goal of the medical transcription profession must be to protect patients and their families through documentation—setting standards of education and practice.

The AAMT’s role in this process is to bring together the collective voice and expertise in the profession to monitor standards of education and practice through the medical transcription education approval program, a code of ethics, certification, and quality assurance programs that ensure the highest quality, accuracy, and security of U.S. healthcare documents, regardless of where they are transcribed. We believe the medical transcription profession must set its own professional standards of education and practice or some other group will step in and do it for the profession.

The AAMT supports certification as a requirement for entry into the profession to ensure that only the most qualified and appropriately educated transcriptionists are practicing in the field. Until standards in the profession are raised, other healthcare disciplines will be unlikely to take the profession seriously and will undervalue its worth in the marketplace. Unless our government invests in our MT workforce and technology development, the U.S. medical transcription industry will be ill-prepared to meet the ever-growing demand for accurate, timely, and secure healthcare documentation.

— Peter Preziosi, PhD, CAE, is the executive director of the American Association for Medical Transcription.

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