Passage : Coding

Is Coding Any More Secure Than MT?

Jeanne Johnston — Mon, 30 Mar 2009 12:08:00 GMT

I notice that Advance has no one here blogging about coding, yet the discussion forum is predominantly skewed that way. Does the topic just not lend itself to conversation because it is so black and white, like accounting? When I realized my art major...(read more)

Is that all there is?

Jeanne Johnston — Thu, 19 Jun 2008 15:51:00 GMT

Yes, I’m still studying for my Computers in Healthcare final, so nothing exciting (or dire) to report there--but I have been cogitating about the course in general and I’m curious to know if others have had the same, better, or worse experiences with this standard prerequisite for most healthcare courses. There are a couple alternate "schools" I had considered and I guess I'm just curious to know if anyone had a better experience in theirs. I do recall my son grousing about having to take a basic computer course to begin his degree (in digital media, at a school dedicated to computer brainiacs!), so perhaps this is just a cross we all must bear.

In a long preamble to the actual course, AHIMA informs us that since the class is taken by students in more than one course, “some” of the online coursework will be inaccessible to students in the cancer registry course and “some” of the test questions will pertain to these areas. Never fear, however--it won’t be many and it should still be quite easy to pass anyway. Mkay, that sounds a little odd, but I’m a sucker for a good reassurance, so plowed ahead.

In actuality, however, MANY of the sections had nothing whatsoever to do with the cancer registry side of the coin and HUGE numbers of questions pertained to this hidden wealth of knowledge. The coding students are apparently required to become members of AHIMA and thus, have access to the message boards and library that many of the lessons came from. Granted, in the final portion of the course pertaining to HIPAA and information security, many of these articles were reprinted so the rest of us had access, but in assessing the entire course I would say that almost three-fourths actually was irrelevant to cancer registry. Yes, it’s interesting to see how coding software works and no, I had no idea there were virtual shelves of dusty literature stockpiled in the AHIMA vaults, but really, what does all that have to do with the rest of us? And what the heck? The first module (one-fourth of the class) was spent getting us familiar with the message boards and online course format and how to navigate and post. That’s something that should be given as a free FAQ for anyone considering enrolling, not fleshing out a skimpy course! The way the online courses are presented, I know darned well most people probably have already taken the anatomy course and are also surprised that this information was not available beforehand.

I would humbly suggest that this course would better serve us--remembering that we’ve paid a hefty sum and want our money’s worth--by offering separate versions of the class to mesh with the specific courses of study it’s being required for. Utilize the modules with the word processing and database introductions and (yawn) security for everyone, but substitute more appropriate modules for the rest. It would be a lot more useful to know what software looks like for tumor registrars (yes, I know it’s probably similar--but not specific) and something else for the behind-the-scenes mumbo jumbo. Why not require us to become members of NCRA and walk us by the hand behind the scenes there to give us a leg up on mentors and resources? And fer cryin’ out loud. . . test us on things we really need to know. Half that stuff was from lessons I was instructed to skip over because they weren’t pertinent to my course of study and I simply had to guess at the answers. That just grates against my overdeveloped sense of what’s fair.

I dunno. It was just. . . lightweight. I suspect the course is also a prerequisite for other HIM courses and those students are even more bummed at what they need to learn. It would be far more valuable to have lessons more in depth about working with data in ways that we may actually encounter on the job. Biggest shock of all, perhaps, was that the actual hands-on part of the class involved Office 2003! That's amazingly outdated, as software goes. . .

Maybe I wouldn’t be such a whiner if the course was priced half as much as the others or if I hadn’t gone nuts last week researching software to better do my exercises (which actually proved totally unnecessary as they never went back to them!) *sigh* Well, I’ll just do my best to blow through the final and get back into the fun stuff.

As for my exercise in geekhood last week (LOL--as I know probably two people care), I did indeed install Leopard and with the new OS, Bento. I don’t see the latter as being quite powerful enough for serious database use in the big business world of brown-shoed squares (their FileMaker Pro is made for that), but WOW--it’s a blast! It takes those boring old tables of information and slaps a ton of Mac-style eye candy over it. My address book and calendar never looked so appealing and I’m going to be in danger of ruining my reputation as the black sheep of the family who can never manage a birthday card on time. I must have Virgo looming around my sign because I’m suddenly fantasizing about what I can catalogue next--recipes? books? movies? music? maybe a household inventory, complete with photos, or perhaps I'll finally organize and unload my stack of unused text and reference books I keep threatening to eBay!

Happily, though this computer course was not centered around the platform or applications I prefer, I can say that I am taking away some new knowledge that I’ll be able to apply everywhere. I just wish there was more of it.

In Which I Wonder How I Got Here

Jeanne Johnston — Wed, 30 Jan 2008 14:57:00 GMT

I don't think anyone who is not a medical transcriptionist has a real appreciation for what the job entails. How many of us have had someone marvel at the ability to work from home and ask for a quick tutorial in how to get started?

"Gee, I've got a computer and a toddler, and I'd love to avoid paying for day care. I could do this, too! You just type what you hear, right?"

Ummm. . . in a word, NO. Although the field has lent itself to outsourcing and telecommuting, that does not put it on a par with an Avon gig. You need to commit yourself to space, a schedule, and be every bit as reliable and professional as if you worked on site. Even doctors-and certainly, hospital administrators-often fail to realize that it's a very important part of patient care, risk management, and even reimbursement. I've heard it said that an acute care MT needs the equivalent fund of knowledge to a third-year medical student. Not only do we need to be self-motivated and self-disciplined, our English skills need to be impeccable, we need to know anatomy, pharmacology, surgical instruments, disease processes, fundamentals of Latin and Greek, computer, keyboarding, and research skills, and possess an ability to understand myriad foreign accents (or just inconceivably poor dictators). We don't even get to specialize. We have to know it all and be prepared to handle everything from trauma to morgue. Whilst transcription is often viewed as something a typing monkey (or now voice recognition) could do and thus, is one of the first things to take a hit in a budget crunch, those of us who do it know better.

I was thrilled to discover the field, which offered a way to utilize my love of language and medicine and seemed to be The Perfect Career to take me all the way to retirement and beyond. I thought I had researched thoroughly and had a good sense of job security, as well. From the beginning, I saw there were people predicting gloom and doom because of everything from the advent of the personal computer to offshoring, but I noted there were many grande dames of MT assuring us that the field wasn't going anywhere. People have been predicting an end to MT for decades and it's still here. Surely, there will always be a need for transcriptionists, right?

A lot has changed in the past five years, though, and I see many of those same people admitting that it may well be time to move on. To my vision, the issue of offshoring has not helped wages, but it's almost a nonissue now that the industry has been overrun with software developers, speech recognition, simplistic EMRs, and more and more clients being sold a bill of goods wherein they believe they are saving money by having a physician playing hunt and peck around a keyboard in the exam room instead of dictating and waiting for the MT to produce a much more useful record of patient care. Even the transcriptionists' supposed representative organization has abandoned the practitioner in favor of the "medical document." Yes, offshoring gave clients a sense that they could save huge quantities of money and that has become the driving factor. It's been said that transcription involves three client needs: Speed, cost, and quality. Of those, it's only possible to have two. Naturally, cost is the one clients seem to feel is most important. All this has conspired to drive down MT wages to a point where it's getting hard to make a living. Wages that seem generous in Bangalore translate to well below poverty level here. Editing speech recognition may sound easier than straight transcription, but in fact it often involves almost as much work-double the production quotas for half the pay or less. With downwardly spiraling wages, I don't see the field attracting qualified MTs as the veterans retire-not when you can make higher wages for so much less work at your nearest McDonald's. No, transcription is increasingly becoming viable only to people with limited options or as a second income, and even independent contractors are beginning to complain that clinic work is disappearing to computerized record-keeping.

In pondering all this, I have come to the sad conclusion that medical transcription as we know it is marching along toward its demise. It's no longer a matter of keeping up with the technological changes, but of turning into a whole 'nuther animal entirely. Transcriptionists are becoming SR editors. Those sometimes-eloquent physician narratives are giving way to point-and-click EMRs. The profession I'd been so thrilled to find and proud to be a part of is starting to feel like it's built on quicksand, and I finally reached the point where I knew I needed to prepare for Plan B.

So what do I do with this head full of medical lingo? I could become a nurse, but I don't exactly have youth on my side there. I'd probably enjoy being an OR technician, but again, am I physically up to long hours on my feet or heavy lifting? I seriously considered phlebotomy or x-ray technician, and ruled out coding because I have a strong feeling it's a bit too "left brain" and requires a mindset completely opposite transcription.

Amid all my mental floundering, I saw it: That fateful letter to Advance by a woman who gleefully related how she took her skills as an MT into a new career as a cancer registrar. I paid heed to that "aha" voice in my head and spent the next couple months using my MT research skills to figure out exactly what this involved, and came to realize my name might be all over this thing.