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March 26, 2012

MTs Have Skills, so Let’s Use Them
By Elisabeth Altieri, BA, RHIT
For The Record
Vol. 24 No. 6 P. 8

While medical transcription is a unique skill in the HIM world, it is not as unique as it is currently being characterized. It is still in the family of HIM functions, incorporating many of the same skills of other HIM responsibilities. Unfortunately, as the future of medical transcription becomes increasingly uncertain, there appears to be a greater emphasis on the differences rather than the similarities between transcription and other HIM roles.

This misperception of the medical transcription skill set is a critical issue because it can translate into fewer opportunities for medical transcriptionists (MTs) trying to transition into other health information careers. Other factors contribute to this phenomenon as well.

MTs have seemingly always had to deal with the ancient practice of undervaluing members of female-dominated professions. “If this worker is a woman and has a keyboard in front of her, she’s a secretary and that’s it,” goes the reasoning. As anyone who’s done it will tell you, there’s nothing wrong with secretarial work. The problem is the perception that a secretary is someone who simply carries out the instructions of others with little independent decision making involved.

Too often, medical transcription is separated from the rest of HIM, a development that reared its head back in the 1980s and early 1990s when technology allowed transcription voice and text platforms to become computerized.

Ironically, medical transcription was the first medical record function to become electronic. Higher capital equipment needs often meant that transcription came out of another cost center than the rest of HIM. Technology also allowed transcription to be the first HIM function to be outsourced from the rest of the department.

Inevitably, HIM directors who dealt only with transcription vendors became less and less familiar with discrete transcription functions and skills, and HIM professional organizations became increasingly disconnected from the medical transcription world.

Within the HIM department, perceived differences were exaggerated by the need for MTs to be in a quiet environment so they could hear dictation. The fact that they appeared to have their backs turned on visitors, with their headsets on, and with their fingers zooming over the keyboard surrounded by bookshelves while sharing the occasional sarcastic joke about the text they were in contributed to an impression that MTs were in their own world and glad to be there.

It’s true that most of us loved what we did and laughed at word bloopers (like a lot of people do), but that doesn’t mean we wanted to exclude others in the department.

Today’s MTs are often accused of being stuck in the past (despite being computerized 20 years before their HIM colleagues), but we nevertheless have legitimate concerns about the quality of legal medical documentation now that it is increasingly reliant on voice recognition and other automated modalities. Oddly enough, MTs—the medical language specialists—are often excluded from discussions about quality documentation even though the issue could be addressed by processes that would better utilize the medical transcription skill set.

And how many former MTs are included in medical informatics departments, dedicated to checking for quality documentation in EHRs?

The idea behind medical scribes—a career option well suited for many MTs—is merely an extension of transcription work. MTs could have made suggestions about how technology can be utilized more effectively than by infringing on patient privacy by having a scribe present in the exam room, a situation that is not only old fashioned but also susceptible to compliance concerns.

The transcription profession missed out on this opportunity because of poor communication within the industry, so that when the medical world was casting around for the skill set it needed, there was nobody to remind them it was right in front of them at the other end of the phone or handheld dictation device.

Now that all of HIM is on the same page electronically, I encourage the HIM community as a whole, including AHIMA and other professional organizations, to work harder to find transitions and pathways for MTs who wish to remain and grow in the HIM field.

The skills that serve coders well—the ability to read a medical record with deep comprehension; abstract legal medical documents quickly and accurately; research effectively; and apply an understanding of anatomy, surgery, physiology, pathophysiology, pharmacology, and laboratory practice—are all present in a strong MT. Indeed, the documents that coders use the most—radiology and pathology reports, operation reports, discharge summaries, and history and physicals—are transcribed, edited, and formatted by their medical transcription colleagues. Knowledgeable MTs understand what they are transcribing, and their skill set should include editing, which is impossible if you only “type the words.”

To combat industry ignorance, MTs need to be proactive in this brave new environment. Even though it is discouraging to read numerous reports that the profession is near death and have your skill set undervalued and misunderstood by your HIM colleagues, it is still incumbent on MTs to reach out to their HIM cohorts in a professional way, which means to reject any suggestion of whining.

Encourage professional organizations to reestablish a connection between the transcription skill set and the many career pathways now available to experienced, credentialed HIM professionals. Share meaningful conversations about HIM processes. Write articles. Propose a talk on medical transcription issues for an HIM professional conference. Keep up with the HIM industry. Become familiar with EHRs and how your skills fit in an electronic environment.

If you need more education, go for it. If you need new credentials or certification, go for that, too. Now is the time for MTs to work with the HIM community to acknowledge the contributions we make to ensure first-rate medical documentation and to work with other MTs to reestablish the transcription skill set as a viable foundation for HIM careers, most notably in coding, quality, and compliance.

— Elisabeth Altieri, BA, RHIT, is a 20-year veteran of the medical transcription industry.