II. A History of Medical Transcription

Medical transcription used to be done at the hospitals instead of being sent to medical transcription services.   At that time hospitals had large transcription rooms in the medical records department.  Transcribers performed the work on electric typewriters, with deafening background noise, requiring large numbers of desks and typewriters.  This was before the internet, when transcriptionists had to find answers to questions on shelves of very expensive hardback reference books and personally hoarded information in proprietary notebooks that were not shared, all the while competing with each other for productivity and objecting to doing the worst’s doctor’s dictation.  The tedious work was made even more difficult by the national hospital accreditation agency’s regulations, which for example prevented transcriptionists from pulling up and revising boilerplate documents; they required every document to be typed from scratch.

As computer hardware and software became more sophisticated, a generation or so ago, MTSOs (usually large nationwide agencies) run by MBAs (who had never done medical transcription), sensed money could be made and told the hospitals they should send all of their dictation digitally via computer to a service instead of doing it at the hospital.  The slick salespeople convinced the hospitals that, considering the associated payroll taxes, unemployment,  workers’ compensation,  etc.,  as well as reducing hospital expenditures on office space and computers, it was cheaper to outsource the medical transcription to their service.

One of the pitches used by the agencies was the fact that it was taking the hospital’s transcriptionists too long to complete the reports and get them on the patient’s charts (consider how the hospitals were making an already labor-intensive job even more time consuming).  The hospitals needed the agency’s guarantee of  “turn-around time”,  which gave the medical records director piece of mind.

These agencies were usually located out of state and sent the dictation electronically to transcribers in other states and even countries (India and the Philippines, etc.).  Many people are not aware how much of America’s doctors’ dictation is computerized and sent over the internet to multinational corporations who use transcriptionists in other countries.  Transcription is outsourced because it is a time-consuming process.  With foreign outsourcing, the dictation is converted to computer files, sent outside the U.S.  to other countries, done overnight and returned to the hospital by the following business day.

In an effort to reduce their expenditures on labor, the MTSOs have set up ultraexpensive computer software and hardware systems to convert voice to text, rather than use transcriptionists.  However, the resulting product is not at the 99.8% accuracy level required by the hospitals and provided by traditional transcription, so editors are required to review the computer’s work.  Those editors are generally paid half as much as a MLS.  The computer equipment is too expensive to be purchased by a local hospital and as a result medical transcription services have taken many jobs out of local communities.

In the previous century when it seemed that there was an unlimited amount of money available for medical care, hospitals could afford the convenience and increased cost of sending their medical transcription to large national agencies.  However, now with the large number of patients without medical insurance, as the United States population becomes older and with the impending reduced government revenues available for programs like Medicare and Medicaid, hospitals have realized they need to be more frugal and can save money by eliminating the middleman.  Hospitals can bring their medical transcription back under their control and done by telecommuting employees in an organized, efficient and less expensive manner.

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