Guide to A 3-Step Guide to medical dictation, transcription and the eventual electronic medical record

TechnologyFew organizations take the time to understand the steps currently followed by their employees to accomplish their daily tasks.Introduction“Healthcare processes were never designed, they were organically grown.” This is a quote from Dr. Paul Nagy of Froedtert Medical Center. This quote summarizes the sad state of affairs in many healthcare organizations. As a result costs have spiraled out of control, and efforts to reduce costs have failed to produce true cost reduction. Instead costs are often shifted from the balance sheet to the backs of the physicians and other clinicians. This white paper will discuss methods for truly reducing costs associated with the documentation process. It will point out pitfalls and provide specific examples of how successful healthcare organizations are truly reducing cost and increasing productivity.1 – Design Your Processes – Methodology Before Clinical and administrative personnel waste thousands of man-hours each year doing redundant tasks that can be accomplished or eliminated by technology. That said technology is not a magic bullet to cure everything. Before buying a technology solution you should understand your current processes and have a plan for improvement. Then you will be able to select the right technology to meet your needs. For example, prior to implementation, one of Scribe’s customers noted that there were 14 steps involved from dictating to filing the transcribed report in the patient’s chart. After assessing the current process and determining non-value added steps, they selected Scribe’s technology. As a result the customer was able to reduce the process to 8 steps. This new process resulted in a reduction in overtime and the delay of hiring a new FTE. That is true savings.Mapping Your Current ProcessesBefore selecting any technology partner, you should walk through your existing documentation process. List each step and action performed. If possible physically walk through the steps and enlist the assistance of each person involved. Here is a real example from an 18 physician, 7 location practice:

1. Physician dictates the referral letter into the tape recorder
2. Physician hands the tapes to his/her administrative assistant
3. Administrative assistant places the completed tapes into the transcription basket
4. The administrative assistant places a copy of the daily patient schedule next to the tape basket
5. Transcription vendor’s courier .......

17. Administrative assistant forwards one copy to billing While this process combines the old tape method with email, this process is not uncommon today. It is questionable whether this truly complies with HIPAA and certainly creates difficulties if a dictation is lost.Remove Non-Value-Adding StepsNow let’s examine the same process when properly designed and augmented using technology such as Scribe. Streamlined example:

1. Physician dictates the referral letter into the digital recorder or telephone. Physician dictates the patient Visit ID.
2. If dictated into a digital recorder, physician or administrative assistant uploads dictations via USB connection
3. The transcriptionist listens to the dictations and transcribes the documents on the Scribe Transcription Platform
4. Transcriptionist is able to confirm patient information via integration with ADT
5. Transcription supervisor only reviews documents flagged by Scribe’s QA artificial intelligence
6. Physician logs onto Scribe’s Clinical Information Platform to review, edit and digitally sign each document
7. Administrative assistant faxes a copy to the referring physician directly from the Scribe Platform
8. Administrative assistant batch prints all approved records and files them in their respective charts
9. Billing person(s) is able to log onto Scribe and access all appropriate records as needed

In addition to removing eight steps, several of the steps have become more efficient. The physician actually spends less time dictating, the administrative assistant is able to batch several of the steps – i.e. printing. And other authorized people have immediate access to records. In addition, technology that can streamline processes should be able to provide complete disclosure tracking and deficiency tracking. With a few clicks, the administrator can determine the bottleneck and make the appropriate calls.Maintaining ControlLarger transcription companies have made significant investments in technology to comply with governmental regulations and scale their business. Medium and small transcription companies simply don’t have the money to invest. As previously mentioned, it is often easier in the short-term to use the transcription company’s technology. That said, there are real business reasons to purchase your own technology and require your vendors to type on your platform:

1. The number one reason is control and switching costs. If you use their platform, switching vendors will cause significant retraining for your physicians and administrative personnel. As a result you may be forced to continue a relationship with a sub par vendor.
2. If you have multiple transcription vendors, managing the documentation process gets complicated with multiple systems. Line counting, lost documents and redundant points of integration are just a few of the items that complicate the system.
3. If you use templates, macros and/or voice recognition, you receive the cost saving benefits rather than the transcription vendor.

Remember, whether you purchase your own technology or use your transcription vendor’s technology, you will still be paying for it. So why not receive the full financial benefit?Reporting & Cycle TimeWith many organizations document cycle time has a direct impact on your ability to bill for services rendered. If this is true with your organization, reducing the cycle time for documentation will have a direct impact on your cash flow.

For the rest of this guide, go to www.scribe.com to download the entire White paper.