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November 13, 2006
Which way will MTs fall? Industry experts offer their opinions on what the future has in store. Will medical transcriptionists (MTs) soon be going the way of the dinosaur? Not likely, according to the experts. The profession is—and will likely remain—ever-changing and evolving. But for the immediate future, there is still a pressing need for MTs, whether they are doing “straight” transcription or employing skills as an editor. Remaining Viable “What it comes down to is the MTs are looking at a draft document on the screen, comparing it with the associated audio. They are attending to the physicians in different ways,” he explains. “It is no longer a pure listen-and-type skill that involves ear-hand coordination. The new technology involves a transformation of work habits and skill sets.” The working concept, Fallati says, is that productivity gains will be in the act of editing rather than typing from scratch. “It will be faster and will improve turnaround times,” he says. “We have been able to demonstrate in our base that when we do [prestudies] and poststudies and look at the output levels that on average there was a 40% to 50% increase in productivity.” However, those figures are not consistent across the board because, as Fallati points out, some individuals type faster than they can edit. “The pool of truly talented MTs is shrinking and it may be easier to find individuals skilled in editing,” he says. With an average age of 49 and a propensity to become afflicted with carpal tunnel syndrome, MTs are leaving the profession without adequate backups. As with other technologies, being an MT editor will
rarely be a concept that will be swallowed whole; there has to be staging
and a rollout phase before a complete ramp-up. When asked how he believes speech-recognition technology is affecting MTs, Faulkner says that if you look at the spectrum of MTs worldwide, there are groups that are highly skilled at medical editing and those are the best and brightest in the field. “There are MTs who have many years of experience who understand the terminology on a deep level and their jobs have been changed dramatically with increased levels of productivity being expected—and fairly so because they are now touching up documents that require little editing,” he notes. Brenda J. Hurley, CMT, FAAMT, director of industry relations and compliance at Medware, Inc., says the American Association for Medical Transcription (AAMT) has changed its mission statement to reflect the change in the industry. “There is an evolution in our profession,” she explains. “We have seen a need for [speech recognition] but know it won’t replace the need for an MT, but it will change the skill sets necessary for the MT to perform his or her job.” With back-end speech recognition, once a report gets generated as a draft, it needs to be viewed by someone to ensure it makes sense. “There is a potential for faux pas from the hysterical to the serious, and that is now the arena in which an MT moves from typist to editor. We see them moving to the forefront with the [speech-recognition] technology,” Hurley says. Hurley says the AAMT views speech recognition as a productivity tool. “That is what MTs are about—how to generate work and do it well and faster and better,” she says. “Right now, there is so much work available and not enough people utilizing the technology. Working smarter, not harder is clearly one of the big tides of change going on within the industry right now.” What’s an MT to Do? “There are people across the spectrum,” Fallati says. “It takes a degree of commitment on the part of management to make the transition work smoothly. We recommend implementing a certain amount of editing into the course of each day as a way to gain proficiency. We like to see someone [spending] half of their day with speech recognition. If you are doing only two editing jobs per day and the rest of the time is spent in straight typing, the MT will have a difficult time getting up the curve toward proficiency.” Management commitment and support are crucial to implementing editing duties. It’s always easier in theory to make the changes than it is in practice, but Fallati believes a fast ramp-up and enrollment in the process is quicker and “less painful” than a drawn-out process. “The ability to ramp up and make changes in workflow and habits is not germane only to successful implementation but with an organization’s expectation of return on investment [ROI]. If it takes two, three, four years to get people up and running, ROI is seriously affected,” he says. “This technology is way beyond the early adoption phases. We’re not talking about towing water; people have gotten past the does-it-work phase to ‘how do we get there?’” MTs need to be invited to the strategic table when changes are being implemented, Fallati says. “The technology will impact their jobs greatly and they need to be involved in the dialogue from the beginning in order to make adoption more palatable,” he emphasizes. Faulkner counters by saying that the speech recognition vendor community is overinflating people’s expectations of the system. “[Speech recognition] is not 100% accurate and likely never will be, and whether clinicians would like to believe it or not, 100% accuracy would more than likely reduce document quality, because skilled MTs do a lot of editing. There will always be those physicians and disciplines that will not translate correctly,” he explains. “There are maybe 20% to 30% of physicians whose speech skills are quite horrible and the need for MTs will remain high. Also, the math doesn’t add up to having a physician sit behind a computer cleaning up their own documents.” Faulkner agrees that some disciplines—such as radiology—lend themselves to speech recognition when they are dealing with a potential vocabulary of 25,000 words in their domain. “If you broaden a discipline where a physician is taking a family history, you could be looking at a potential of 1 million words and algorithms that the speech-recognition technology won’t recognize, understand, or know how to correct,” he says. According to Hurley, some MTs have been embracing the changes because they are now able to use the medical knowledge they gained in their training rather than just being judged on how fast they transcribe. “They are excited about being able to shift their focus to medical knowledge from keyboard skills,” she says. “There are those also that just don’t want to move away from the work patterns they have established.” Hurley adds that proofreading and editing are skills that are not easily transferable. “Sometimes you know what the words are supposed to be and sharpening proofreading skills to catch the incorrectly placed or used words is a skill that needs to be honed,” she says. “It’s different from listening and looking at a screen than it is looking at a complete document and editing it.” What (Exactly) Am I Getting
Paid to Do? “The bottom line is compensation programs need to be implemented that promote the usage of speech recognition and when the MT is paid by line, that is not a complete solution,” Fallati says. “There have to be ways to incentivize MTs. Recalibration of output expectations have to be explored such as if your output would have been ‘y’ instead of ‘x,’ then compensations metrics need to be changed.” “Compensation is a challenge. It’s all over the board right now. Some places pay strictly by the hour and aren’t trying to figure out a production-based solution, but some are still trying to pay on a per-line basis,” Hurley explains. “In a hospital setting, switching to paying staff an hourly wage is not quite as big a deal as it is for a service determining pay. Services might be paying their staff in oranges but charging the hospital in apples because they are likely still charging by line but are now paying MTs a different way. That rubric needs to be addressed. The industry is still struggling with that.” Training Options Some organizations are looking to recruit new people to their HIM departments as speech editors. “They are saying, ‘You will be using this technology and we expect you to gain proficiency,’ and if an individual is hired with the understanding that coming in they will be an editor first and a transcriptionist second, they will likely be more receptive to that aspect of their career,” Fallati says. He adds that schools need to start offering more courses that lead the MT toward being a more productive member of the team and exposing them to the best and brightest technologies. “As in any profession, you’d like your newest trainees and students to graduate having been exposed to the current technologies and hope they will carry that knowledge with them into the HIM departments,” Fallati says. “An MT should be able to go to an employer and say, ‘I understand we are getting speech [recognition] and understand it might affect my job; I want to be one of the reasons this works rather than drawing a line in the sand,’” Faulkner explains. “So many decisions, though, are made without any input from the MTs and that is a mistake.” Bottom Line Some vendors point to the giant gains in productivity, but they don’t often figure in the technology’s cost. You may have 10 MTs that can now do the work of 20 but you have to spend $500,000 on the technology to get there, and, according to Faulkner, the math doesn’t add up. “We hear constantly that MTs are going away and that doesn’t serve anyone,” Hurley says. “Certainly, my role has changed over the 35 years, but to think that the skill sets that medical transcriptionists provide to quality documentation are not going to be needed in the future doesn’t equate.” — Robbi Hess, a journalist for more than 20
years, is a writer/editor for a weekly newspaper and a monthly business
magazine in western New York. |
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