Passage : Health Information Management

A Matter of Perspective

Jeanne Johnston — Thu, 16 Jul 2009 23:18:00 GMT

I love to toss off the headset and get a change of scenery, and find myself occasionally rummaging around other Advance boards to see what's up (did you even notice they've got like 243 magazines skewed toward different areas in health care?) Lately,...(read more)

MT as the Economic Canary

Jeanne Johnston — Fri, 19 Jun 2009 16:42:00 GMT

I suppose there is no real mystery in why I almost killed my computer. After a painful $300 for a new power supply, I vowed to mend my ways and not leave the poor dear up and running endlessly--yet here it hums since I got it back home. The fact that...(read more)

May I Mambo Dogface to the Banana Patch?

Jeanne Johnston — Tue, 09 Jun 2009 18:53:00 GMT

That line from Steve Martin's book, Cruel Shoes --where he thought it would be clever, if he ever had a child, to teach him the wrong words to everything so that when he went to school, no one would understand what he was talking about--used to be hysterical...(read more)

Fan Mail From Some Flounder

Jeanne Johnston — Tue, 19 May 2009 12:31:00 GMT

I am beat. Spent the last week being thrown into the deep end of the pool without swimming lessons (well, I had them, but that was almost 10 months ago and I forgot most of it) and am just now feeling like I'm starting to learn how to float again. I used...(read more)

Why Plan Ahead When You Can Panic Now?

Jeanne Johnston — Tue, 05 May 2009 12:34:00 GMT

Some of us in the medical field (especially transcriptionists, I think) are in a unique position to observe certain trends in society. If you work a clinic account, your work has definite seasons, even if you don't: Fall brings school physicals and general...(read more)

A Question of Style

Jeanne Johnston — Thu, 23 Apr 2009 15:53:00 GMT

When it comes to language, there are accepted formulae for how things work--not just the actual words used, but specifics as to punctuation, grammar, etc. They used to teach that in school, right? In the workplace, the rules are supposed to be more formal....(read more)

If Wishes Were Horses

Jeanne Johnston — Fri, 17 Apr 2009 15:01:00 GMT

Ahhh , it must be springtime because the scams are bursting out all over. On one MT message board alone, I have counted no fewer than six threads this last week or so from starry-eyed MT wannabes hoping for advice on school choice, or thinly-veiled propaganda...(read more)

Tempus Does Fairly Fugit

Jeanne Johnston — Thu, 09 Apr 2009 17:38:00 GMT

It's apparently time to go shopping for walkers because the unthinkable has happened. I have apparently jumped a generation gap. Amazingly, it's already been a year since Doctor Appreciation Day (never fear--they're as neglected on their day as MTs are...(read more)

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)

I'll Take My Sunshine Where I Can Get It

Jeanne Johnston — Fri, 20 Mar 2009 11:54:00 GMT

Just when I've started to despair that we are going to give spring a miss and head straight into the Florida summer, I found a bright spot in my week to counteract these winter blahs. . . Actually, the story starts out on a grumpy note because it all...(read more)

Can You Afford to Trade Your House Payment for a Political Statement?

Jeanne Johnston — Thu, 12 Mar 2009 16:37:00 GMT

I love the internet, but it does bring out the worst in some people. . . Whilst it is wildly liberating to people with limited ability to make connections in real life, the polar opposite is that it enables some real narcissists to run amok, as well....(read more)

Speech Wreck

Jeanne Johnston — Wed, 04 Mar 2009 14:04:00 GMT

I hate the term, and I find it intensely annoying that not only MTs are using this as a pet name for that silly, old speech recognition now making our lives miserable, but even employers are sending out "humorous" emails with today's funny from the engine that will not learn. Except for recent grads who went straight into SR editing and don't have a clue how big a step down it is from straight transcription or the full ramifications of it on our perceived value in the workplace, I don't know any MTs who are happy with it. After years of typing on a normal QWERTY or Dvorak keyboard, SR utilizes an awkward set of key commands, resulting in a whole new generation of occupational injuries. All those normals you've spent years creating in Shorthand, Instant Text, or other expander? Sorry, you're not supposed to just plug them in when SR makes mincemeat of what's actually dictated because unless you fix each mistake it makes individually, the poor thing can't learn from its mistakes and you will make it take longer to replace you.

Honestly, the only ones I've heard rave about SR are the crap sales people who foist it off on unsuspecting clients and the management of those greedy and gullible companies who are desperate to whip up some enthusiasm amongst their employees, who are now faced with the choice of working twice as hard for half the pay or not working at all. They seem unwilling to accept that this isn't equitable and is lousy for morale. There are incredible numbers of veteran MTs who are now crying because they are seeing their paychecks fall precipitously because there's no way to double production to make up for half the wages. MTs are finding there are fewer and fewer straight transcription jobs to go to, the ones out there are not paying any more for experience than for new grads, and many who have supported themselves adequately for years are now facing bankruptcy and foreclosure as a result. Hardly a joking matter.

Thanks to a friend who suffers as bad an internet addiction as I do, I was linked to a brilliant illustration of this on a message board I don't normally frequent. I've tried in vain to contact the author, who apparently (and justifiably) feels the need to remain anonymous, but perhaps when she leaves her position (retiring to clean toilets or something more lucrative, I wager), she'll put in an appearance and accept the kudos she so richly deserves. I predict this could be one of those things that appears for years to come in email forwards and MT message boards. It is just that good. If MTSOs are smart, they will take this as more than a harmless joke because, though it is funny on the surface, the message is anything but.

As an empty with plenty years experience comma eye was vary this dress to learn that I will shortly be demoted from an empty to a VR quote editor unquote making far less money than my training and years of experience deserve period you are comma node out comma counting on technology to eventually fix the bugs in yore VR soft wear period mean while comma you are ????? a viable resource period sum of us wood much rather retire than see our tail ends miss used by working as VR editors period to whom will you turn when this VR idea fails to pan out question mark period paragraph person alley what I have all ways enjoyed a bout transcription work is the actual typing comma the rhythm and flow comma inserting a punk situation mark here comma subtly colorectal sin tax there comma and turning a complete mismatch of a dictation in to a real double report period lets face it comma many doctors are complete idiots period the dictate the rung medications comma or the rite medications at potentially fetal doe sages period they mambo comma wrestle peppers comma talk to colleges comma eat comma bleach into the phone and make other bodily noises while they dictate period even naive English beakers often do not have the first idea of proper sentence structure or grammar period yet comma you expect olive us to clean up a VR mess for half the money we are making now question mark we think not explanation point paragraph so cut costs as you wish comma in one or 2 years when VR comes to our accounts parenthesis or before parenthesis we will have found something else to do comma and the profess shun will be pourer for the lost of all of us period have a nice stay explanation point

For those of you who aren't skilled transcriptionists (or are merely overwrought from dealing with this garbage on the job and are getting woozy at the prospect of having to waste your personal time on it, as well), here's the translation:

As an MT with 20 years’ experience, I was very distressed to learn that I will shortly be demoted from an MT to a VR “editor” making far less money than my training and years of experience deserve. You are, no doubt, counting on technology to eventually fix the bugs in your VR software. Meanwhile, you are jeopardizing a valuable resource. Some of us would much rather retire than see our talents misused by working as VR editors. To whom will you turn when this VR idea fails to pan out? Many of us believe it is time to retire or find another line of work.

Personally, what I have always enjoyed about transcription work is the actual typing, the rhythm and flow, inserting a punctuation mark here, subtly correcting syntax there, and turning a complete mishmash of a dictation into a readable report. Let’s face it, many doctors are complete idiots. They dictate the wrong medications, or the right ones at potentially fatal doses. They mumble, rustle papers, talk to colleagues, eat, belch into the phone and make other bodily noises while they dictate. Even native English speakers often do not have the first idea of proper sentence structure or grammar. Yet, you expect all of us to clean up a VR mess for half the money we are making now? We think not!

So, cut costs as you wish, in 1 or 2 years when VR comes to our accounts (or before) we will have found something else to do, and the profession will be poorer for the loss of all of us. Have a nice day!

To "so disappointed," the author of this masterpiece, I doff my hat to you. To the rest of the MTs out there who aren't at all happy at the prospect of being assimilated by this Borg, I'm afraid I don't see a solution because no one's ever bothered to ask for our input on the front end of this abomination. When clients start tearing their hair out and screaming about the sorry de-evolution of the medical record, we'll at least be able to say, "I told you so."

Globalization or Protectionism?

Jeanne Johnston — Fri, 27 Feb 2009 14:57:00 GMT

I see this week there is some outrage offshore over the new stimulus bill, specifically the part relating to the H-1B visas that have allowed foreign workers to come to the US, illustrated nicely in this article on India Times--and especially in the ensuing comments. Of course, many of these visas have gone to Indian engineers, IT specialists, and medical professionals, creating a very powerful subculture (both here and there) . The threat of losing these visas has many angry at the US. As our new President has indicated, there are still more important changes coming that may well impact us more directly, depending on specifics. Just off the top of my (admittedly lazy) head, I believe at the very least, companies that offshore will lose certain tax breaks, and though they certainly won't try to clamp down outright on firms that already have substantial offshore investments, I'm betting they will figure out a way to discourage any from moving more of their workforce away.

Those MTs who remember the resentment over the last decade or so about the loss of our jobs offshore and the resultant impact (all bad) on our wages are sensing a little irony here. We were admonished on the realities of globalization when our jobs filtered offshore, but now when someone threatens to bring jobs back, it's protectionism? I can't help but wonder if they'd see this in a little different light if they were talking about Indian jobs going to Chinese workers willing to work for a fraction of their wages. . .

I have to admit that I can see the rationale for globalization. A most fascinating demonstration of how that works correctly is evident in a game devised by Buckminster Fuller (creator of the geodesic dome), called the World Game, which is kind of the antithesis to the war game, Risk. Players (anyone from grade school kids to corporate bigwigs) represent countries, corporations, human interest organizations, etc., and are given unique resources and assets. In the ensuing hours, players trade their assets and quickly learn that it is possible to remain competitive AND profit if everyone cooperates. Greed may make for short-term profit, but it's necessary to factor in public opinion and mutual benefit for long-term successes. In the end, everyone compares notes and realizes that friendly cooperation makes for the most profits all around, to say nothing of world harmony. (Cue sunshine and daisies.)

Of course, communism works well in theory, too. The problem is that human nature tends to ruin things, especially when greed, profit, and personal gain manage to dominate as they have in the last two to three decades, which have been all about corporate profit and not at all about equity, and the entire world economy has reached the breaking point. The sweeping changes that threaten to rock our world are simultaneously frightening and exciting, and may well test the sensibilities borne of the Boomer generation. Can peace, love, and harmony really defeat the "evil axis" of world bankers, corporations, Big Oil, Big Pharma, and the insurance industries? Close to home, will a "government of the people, by the people, and for the people" once again become something more than lip service?

Obviously, we're running on hope here. I think there is still room for globalization and mutual benefit, but not at breakneck speed for the benefit of the elite few at the expense of the rest of us. If you go back to the feedback from this article, there is as much understanding as there is anger. Some are crying for a boycott of US companies overseas, which I think is just fine because face it--McDonald's, KFC, and Coca-Cola haven't added much to world culture as they have served to homogenize and dilute it. In emulating America, many countries seem to have lost sight of what makes them unique and worth preserving. I find many replies to this article especially insightful, like the one who suggests it's silly to expect the US to offer jobs to foreign workers whilst Americans sit around jobless and homeless, advocating logic because, "No one will share his food with an outsider if his family is starving."

Of course, this is only the tip of the iceberg and the effects of the stimulus package and more specific measures to undo the damage offshoring has caused are more likely to impact us personally. It will be interesting to see the long-term effects on wages now that MT wages have been driven so low that many of us can't even afford to stay in the field even if we can find jobs and few people are willing to consider entering the field given its dim prospects. The law of supply and demand would indicate that wages should go up, but now that speech recognition has replaced the offshore MT as our biggest nemesis, I'm not holding my breath.

"Interesting" times indeed.

EMRs for Better or Worse?

Jeanne Johnston — Thu, 12 Feb 2009 13:39:00 GMT

As I watched this week's first official presidential press conference, the thing that stood out to me (well, after the outrage at all the political posturing and stonewalling that are getting the stimulus plan nowhere) was a comment that reminded me of Pres. Obama's gung ho stance on EMRs. Mainly, I guess my feeling about this subject has been tainted by my own experiences with the automation of medical transcription and the abysmal impact speech recognition has had, not only on the field of MT, but also in driving the quality of the medical record down to the lowest common denominator. How will the EMR fare any better?

As a patient (more accurately, the daughter and mother of patients), my own experiences with EMR are mixed, but leaning heavily toward the negative. When I had to take my mom to the ER with an allergic reaction (repeatedly), we spent hours repeating the same information to everyone we dealt with--the receptionist, the triage nurse, the nurse in the cubicle, the doctor (when he finally came). Oddly enough, entering the information in that form did not seem to mean it was there for the next person, merely that they had to enter it all again, too. Shiny new workstations took up precious space and in the exam room; that even meant that every person who came in to treat the patient was guaranteed of hitting their head on the monitor and/or running into the keyboard. Subsequent trips were similarly not simplified by the information monster, sadly enough. It wasn't enough to simply show her ID bracelet so they could key in the number and call up her very recent past medical history. . . We once again had to repeat everything to everyone. By the third visit and after sitting in the waiting room for three hours (apparently, it was prime heart attack time at the nursing homes), she finally allowed me to play doctor and we bailed to head to the nearest drug store for a box of Benadryl.

This was a very expensive private hospital (the only one in my little burg) and clearly, some software salesman had sold them a very expensive system with the promise of saving them transcription expense and streamlining their record keeping. I notice he wasn't around for the fallout when they put it into practice and had doctors and nurses doing my job for them. Is it a savings when you pay a nurse $30/hr to enter data versus a transcriptionist who's nowadays lucky to get hired for 6-7 cents per line? How about that doctor who has to spend 15 minutes fumbling through a wizard and then has no patience to deal with the face-to-face patient care because he's got to run off to the next one and do it again? (My mom's doctor looked up from the monitor, declared that she didn't look too bad and dashed off a prescription. We waited three hours for less than 60 seconds of actual care.)

When my son was recently hospitalized with an infection, we opted for a much bigger, better, and public hospital. Once again, they had that evil EMR, only this was a more manageable laptop on wheels. We answered questions once and though people occasionally asked again, it was usually to clarify details as they read from the screen. They were indeed able to call up prior admissions to help jog our memories of past history. The real advantage I saw here was that in everything they did, they were able to answer questions. My son (probably not the easiest of patients because he has to ask WHY and HOW about everything) would ask for specifics and his doctor or nurse could pull it to the bedside and say, "Let's look at your lab values and imaging studies," or "I bet I can find a good illustration online." They utilized this to make the patient a working part of the team and not merely a victim or child. At discharge, they were also able to generate instructions and followup.

Nothing with the finesse of a carefully crafted and conversational dictation, but clearly more along the lines of how an EMR is supposed to work. After the latter experience, I have to say my sadness at being put out of a job was not uppermost in my mind. The biggest danger I saw was that a keyboard itself has got to be a major player in the spread of pathogens. As most of the patients I transcribe end up suffering as much (or more) from opportunistic infections, maybe I'm just attuned to this negative, but clearly, there is no way to prevent the spread of germs when everyone's sharing a keyboard and that device is being wheeled from room to room. This hospital also has instituted a protocol that provides antibacterial foam dispensers to use as you enter and leave each room, but does nothing to sterilize computers, IV poles, and other equipment.

But I digress. In my world, speech recognition engines are poised to eliminate straight transcription. This isn't because the technology is good, but because there are software people selling the product as though it were. I have yet to hear from an MT who's been asked to help develop a platform that truly works and in the end, we're merely asked to correct the gibberish, essentially working twice as hard as we do now, but for half the money. All those great Shorthand macros we've created over the years for those dictators who always say the same thing every time? Forget that it's a time-saver, a wrist-saver, and just plain more accurate to have a whole paragraph pop up with a few keystrokes. Nope, can't use them because the SR engine won't learn unless we work with what's already given to us and make specific corrections. We are working crap wages to train computers to take our jobs, and are supposed to be grateful to have jobs at all. In the end, those long, rambling office notes will no longer contain information that conveys a patient's humanity, but only the facts necessary to fill those key boxes on a form. I suspect the only thing holding them back is the fact that there are too many old-school docs who refuse to dictate carefully enough for SR to understand them. The new kids are learning and the old ways will die off as their generation takes over.

So how will EMR be any better? Once again, we're talking software developers, salesmen, and little to no input from the people who actually have to work with these things. To complicate matters, how does the government mandate a nationwide compliance with EMRs when competing platforms can't even communicate with each other? I think the answer is simple, but I don't see the money guys being too happy about it: There are already FREE EMRs out there (Practice Fusion and Synapse are good examples and seem to get favorable reviews), many developed by doctors with a geek gene on the side. The new technology czar (yes, we're actually supposed to be getting a cabinet position along those lines) should study what's already available and pick the best one. Make it open source--i.e. free to use and to customize--so that everyone's on the same page, and so that no one stands to profit at the expense of our healthcare or livelihoods. This would be totally in keeping with the new agenda to make our government itself more transparent and accessible to citizens.

Of course, I still think the EMR's greatest potential for evil lies in the fact it will serve as a storehouse of private information that can be farmed to deny us care on the basis of preexisting conditions, to deny us employment based on facts no employer should have access to, or to target us for marketers and other unscrupulous people, but at least we could avoid the snafus that have plagued the transcription world. If this administration does manage to do this right, who knows--maybe they really will succeed in disabling Big Pharma and Big Insurance, too, and making health care for all a right, not a privilege.

MTs are clearly not the only ones in a bad place right now. Change is inevitable, but it will be interesting to see if greed continues to make policy or if common sense finally becomes a player.

Epic Fail

Jeanne Johnston — Tue, 03 Feb 2009 13:56:00 GMT

Yes, I've been wallowing in grief all week, hardly sleeping, hardly eating, hardly leaving the house, even over the weekend. Though we're convinced the house is haunted (not in a bad way), Wee Ailís has not managed to join the activity and put in an appearance, and I'm feeling the void in a bad way. The dynamics in the house are changing in weird ways as the cats jockey for position (my nonfurry kids were never like this!) and the one-upmanship is riding a fine line between hysterical and downright obnoxious.

Worst of all, between the never-ending family crises, I have managed to neglect my insanely boring pharmacology course to the point of no return and now get to haul myself up by the bootstraps and just start over. I figure I will allow myself a very finite period of time to get my head on straight and rediscover my gusto.

For now, I've only made a feeble attempt and found one suitable self-help site that promises to help me learn the 10 Sure-Fire Ways to Be a Complete Failure At Everything. THIS, I can do:

1. Chase other people's dreams.
2. Start 17 Projects, Finish None.
3. Give Up When It Gets Tough.
4. Persist at all costs.
5. Never ask for help.
6. Trample On Other People.
7. Never say no.
8. Be Disorganized.
9. Stay In Your Comfort Zone.
10. Procrastinate.

Yes, some of them seem contradictory at first, but it is possible to exceed at several simultaneously. Clearly, I have a lock on numbers 2, 3, 4, 5, 7, 8, and 10, with the emphasis on the disorganization and procrastination. I don't see that they offer a prize for this, sadly enough. Of course, I lose points because I have not carried this loserishness into my workplace and in fact, have been so intent on ignoring my painful reality that I've managed record production numbers of late.

Obviously, this is all tongue in cheek and really offers a perspective on behaviors to avoid in chasing your dream. Perhaps I'll follow some links in the article and find further sage advice. Maybe I'll begin by making an entry on Dreaminder to kick myself in the whatsis every couple weeks because it usually takes me about six months into a new year before I finally remember to buy a new calendar and this will defeat #10, if only temporarily.