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February 25, 2013

Making the Grade
By Selena Chavis
For The Record
Vol. 25 No. 4 P. 14

Medical transcription education attempts to keep pace with an evolving documentation landscape.

To say that the medical transcription profession is being turned upside down would be an understatement. An ever-evolving speech recognition industry delivered against a backdrop of government initiatives pushing for more timely, accurate, and cost-efficient care is profoundly changing the model and workflow for getting clinician documentation into patient charts.

It’s a fluid situation that is expected to continue to advance and evolve, which means the role of the medical transcriptionist (MT) also will continue to change. And while many in the transcription industry can point to some certainties, no one can predict exactly how an MT’s role may change or expand when all the dust settles.

“Healthcare facilities and vendors need to be looking toward this profession as having a lot of foundational skills to contribute to the accuracy and completeness of the EHR record,” says Karen Fox-Costa, CMT, AHDI-F, president of the Association for Healthcare Documentation Integrity (AHDI). “Part of the equation is having the skill set and comfort with the technology, and the other part is having the industry recognize the opportunity to use it.”

A 2011 AHDI survey on the roles and responsibilities fulfilled by various professionals in the EHR process life cycle mentions numerous emerging positions for MTs. Conducted in cooperation with Bentley University, the survey found that healthcare organizations are beginning to look to these professionals to perform several functions in the EHR process, including design, test, and best practice implementation; create templates; train users; provide user support; enter data for certain clinical encounters; and monitor for document accuracy and completeness.

While these findings paint a positive career outlook for MTs, it can be frustrating for educational institutions where attempts to develop and adapt curriculums to address industry needs come up against numerous challenges.

“A big concern on the part of educators is determining what exactly to teach students that is relevant,” says Betsy Ertel, AHDI-F, CEO of Speed Type and head of the Education Alliance for the AHDI. “What do our students need to know to be relevant in today’s market?”

According to Susan Dooley, CMT, AHDI-F, a professor at Seminole State College of Florida and member of the AHDI’s National Leadership Board, the AHDI recently introduced a new model curriculum that more effectively addresses the scope of new technology—in particular, speech recognition within EHRs—and lays a foundation to address current trends. One of the key changes within the curriculum is that the title used for professionals in the field has been changed to “healthcare documentation specialists” to better reflect the evolving parameters of the healthcare landscape.

Industry professionals agree that most of the core components that have existed in model curriculum programs for years should still form the foundation of a healthcare documentation specialist’s training. “A traditional transcription curriculum is still very important,” Ertel says. “Students still need to master medical terminology and language.”

Linda Allard, president of New England Medical Transcription (NEMT), echoes those sentiments, adding that most healthcare organizations are using a combination of speech recognition and traditional dictation/transcription models, making the typing skills that have been important in the past still relevant today. “It’s very normal for MTs to be doing both transcription and editing [for speech recognition processes],” she says.

As education programs work to adapt and evolve, the consensus is there is one area that needs immediate attention: better training for editing within speech recognition environments.

Classroom Challenges
The new model curriculum introduced by the AHDI is positioned to lay a better foundation for preparing healthcare documentation specialists for the future healthcare landscape. Like any new initiative, educational institutions face growing pains to successfully address the new components.

Dooley says the industry lacks appropriate education materials and curriculums to tackle speech recognition. “The speech recognition components can be a challenge to incorporate,” she explains. “There is currently nothing commercial that addresses this need in a high-level way. The tools available only cover the concepts of speech recognition.”

Fox-Costa, also a quality assurance manager at Shumaker Transcription Services, notes that while there are textbooks available that “discuss” speech recognition and the necessary skills to become a proficient editor, there is nothing commercial that addresses hands-on experience. “Foundational for students is the ability to develop a mindset for critical thinking skills,” she says. “Also, getting them used to using keyboard shortcuts rather than ‘mousing’ their way through the process is important for preparing for speech recognition.”

Some educational institutions are partnering with vendors or medical transcription companies to try to address the need for real-life skills application. NEMT has found that this kind of arrangement can be a win-win situation, even though it is a huge undertaking for a medical transcription company, according to Allard.

In the last few years, the organization has developed an externship program, where students can gain “on-the-job” experience. “It took quite a lot of doing to ensure everything was set up the right way,” Allard says, pointing out that the program had to be separate from any interaction with actual clients. “The benefit is that we have people who come out of it who are more work ready and familiar with our company. That’s our goal.”

Through a partnership among the AHDI, 3M, and the American Healthcare Documentation Professionals Group, a course on speech recognition editing has been developed. While this fills a specific training need within the industry, AHDI CEO Linda Brady, CAE, acknowledges that it does not address the need to have more refined and useful college curriculums. “Schools need some kind of connection with vendors for practical, hands-on application,” she says.

According to Ertel, the AHDI educational alliance is attempting to partner with vendors to create webinars for use within educational institutions. This summer’s AHDI Annual Convention and Expo also plans to offer numerous educational opportunities, including vendor demonstrations.

Outside of curriculum challenges, Dooley notes that new requirements under the AHDI model curriculum are posing staffing problems for some educational programs. The requirement that instructors have the certified medical transcriptionist certification for MT core curriculum classes is among the chief offenders. “Some instructors don’t have that credential, and some programs are struggling to fill that requirement,” Dooley says.

Expanding Skill Sets
Along with the obvious training needs associated with evolving technological frameworks within healthcare organizations, Fox-Costa suggests that MTs will need to hone their relational and communication skills to thrive in future workflows. In particular, many healthcare organizations are looking at the benefits of bringing transcription back in-house to leverage the full potential of healthcare documentation specialists.

Many national trends are pushing this movement, including the need for greater documentation specificity, the use of robust EHRs with narrative dictation, an emphasis on accurate and complete patient records, the desire to meet meaningful use requirements, a focus on revenue cycle efficiencies, higher quality outcomes expectations, and performance-based reimbursement models.

“It is the soft skills that new students and currently employed healthcare documentation specialists must also acquire and demonstrate besides just being willing to consider working somewhere other than home,” Fox-Costa says, adding that the partnership between healthcare documentation specialists and clinicians is more apparent when both are on site. “The ability to have a conversation with an author or clinician—whether that is on the phone, [via] text messaging, or through some other method—will be a needed skill.”

Allard agrees, adding that even healthcare documentation specialists working from home need better communication skills. “Professionalism is important,” she says, pointing to knowing the basics of appropriate e-mail communication and appropriate phone interview etiquette. “It’s a different world. They need to understand how to be professional in a virtual environment.”

In terms of workflow changes to address national trends and government initiatives, Dooley says Seminole State College has added education related to how transcription affects accurate coding and efficient revenue cycle processes. “It’s adding an awareness of quality assurance,” she says. “How does the wording or how does what a doctor say affect reimbursement?”

Other examples of soft skills that Fox-Costa says educational curriculums will need to address include broader competencies, such as the ability to correct discrepancies in real time; a willingness to accept flexible scheduling; and an openness to work on projects such as EHR customization. “Many of these could be introduced through the training program and then reinforced through involvement in AHDI as volunteers so they can develop not only soft skills as listed but also leadership skills to be able to market themselves as industry trends evolve,” she says.

Don’t Be Narrow-Minded
Dooley says recent healthcare documentation specialist graduates have an inherent advantage in that their knowledge is fresh. “To complete an approved program, they have to go through a rigorous curriculum,” she notes, adding that even with some of the growing pains currently being experienced in the industry, many new graduates may still be better positioned for transcription’s new world. “They may be slower initially, but they will produce quality work.”

Allard points out that healthcare documentation specialists who are flexible and willing to adapt will be positioned for the greatest success going forward. Specifically, professionals will have to accept odd work hours and expanded roles. “They have to broaden their horizons as much as possible,” she explains.

For example, Allard says in the past, healthcare documentation specialists working for third-party companies may have been tied to only one kind of account. As transcription volumes change, they now will have to be tied to several accounts.

Also, many will have to consider broadening their specializations. Speech recognition technology has been found to be more effective in departments such as radiology, pathology, and emergency where documentation and reports tend to be shorter and can be quickly input into structured fields. These specializations will require less transcription support than other areas of the hospital.

The ability to “quantify talent” to prospective employers can be a difference maker, according to Fox-Costa, pointing to credentialing as an excellent option for healthcare documentation specialists who want to show off their skill sets. “I also recommend that they include the transcription they have completed during their education experience,” she adds. “The same could hold true for speech editing.”

While heeding this advice is an important first step, Fox-Costa says nothing quantifies a healthcare documentation specialist’s talent better than practical workforce experience. “The first 30 to 90 days a person is on the job, whether they are new to the industry or changing employers or going out on their own as an independent contractor, their ability to do the job during that time is where the rubber hits the road,” she says. “In our industry, you also have to quantify your skills concurrently depending on employers and the robust nature of quality assurance or performance review processes.”

Fox-Costa, who works with new healthcare documentation specialists and a regular pool, says Shumaker Transcription employs a rigorous quality assurance program. “Oftentimes, however, production or cost of the service supersedes the option of demonstrating the intricacies of what the skills sets and knowledge base can truly offer, and those who do change positions find themselves having to balance what has priority in order to stay employed,” she says.

In the end, quality supersedes all other considerations, Fox-Costa says. “While the industry expectation is great production and great quality, which happens most of the time, sometimes one can get sacrificed for the other—to what degree is a vast variable,” she says. “If you are too slow or not flexible in work types and MDs you can transcribe, you might not keep the job or the account. If the only focus is production to meet turnaround time and ‘just get it on the chart’ or by virtue of what it takes to make a living wage, quality can get compromised.”

Production expectations should be introduced after establishing a foundation built on content and vocabulary, teaching students to get faster without compromising accuracy. “Add to all of this that authors/clinicians do not always read every report before they sign them, with technology-enabled solutions like auto-sign and programming the software to sign, and we have grave concerns regarding the integrity of patient care records and what may be the ‘new norm’ as far as quality of information is concerned,” Fox-Costa says.

When marketing their skills to potential employers, healthcare documentation specialists can lean on the AHDI, Brady says. “A lot of resources the AHDI produces help healthcare documentation specialists understand the unique skill sets and contributions they bring to the table,” she explains. Also, the AHDI annual convention offers education sessions on self-improvement topics such as résumé building and interview skills.

— Selena Chavis is a Florida-based freelance journalist whose writing appears regularly in various trade and consumer publications covering everything from corporate and managerial topics to healthcare and travel.