Passage : Health Information Technology

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)

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.

Changing of the Guard!

Jeanne Johnston — Tue, 20 Jan 2009 17:57:00 GMT

It seems like an eon since the election, and like a little kid at Christmas, it hardly seems real that today is finally The Day. Regardless of how you feel about the transition, I think everyone agrees that we're on the cusp of some of the biggest changes in our lifetime. Certainly, not all of them will be good because we have to claw our way up from Ground Zero first, but one thing obstacles do is to unite people--and in a decidedly nonpartisan way because our problems aren't going to discriminate along party lines or other arbitrary criteria. We've already witnessed the biggest political awakening of our younger generation and political activism such as we haven't seen since the '60s. I think there are equal parts of trepidation and excitement. Did you volunteer for yesterday's Day of Service? Will you continue to do so? Do you know that you can actually have a voice, or at least vent your concerns to let this administration know what WE find important?

For those of us in health care specifically, it will be interesting to see how the new regime will affect us. I personally don't think EHRs (which are, unfortunately, supposed to be a priority) are going to be as great a boon as promised, unless you're the ones selling the software--which probably won't work so swiftly, if they operate anything like the crap MTs have to deal with already, especially speech recognition engines. More importantly, I'm anxious to see how the new agenda to keep jobs in this country will impact us, and whether we have new avenues to obtain education for those of us who've already been outsourced to extinction. What new jobs are likely under new regulations?

Yep, it's a new day dawning. After the pomp and circumstance, we all get down to business. We're sure to have a wild ride, but at least it feels like there's a steady hand at the helm. Out with the old and in with the new!

Advocate for ... Greed

Jeanne Johnston — Tue, 06 Jan 2009 12:42:00 GMT

I suppose not many MTs have paid attention to AAMT's (yes, I know they're AIrHeaDs now) 3rd edition of their Book of Style because it came out virtually on the heels of the 2nd edition--which was not a great improvement over the 1st edition. Frankly, when Ellen Drake pulled out of the project, I saw no reason to bother. The BOS and various certification gimmicks are obviously the lifeblood for an organization that can't seem to figure out why MTs aren't flocking to join the official ranks--except in India, where MTs are still uninformed enough that they're falling for the notion that all this will buy them a cachet in a field that's paying them the equivalent of about Rs. 5000 (i.e. about $100) a month. (Let's not forget that AAMT also negotiated a deal with Prometrics wherein they get to take the certification test at cut-rate prices because they make less than we do--forget that their cost of living is obviously a fraction of ours and the fact they've already driven our wages and ability to support ourselves into the dumper.) Every time we shell out an increasing amount of money (currently $80 for the book alone), we still get something incredibly counterintuitive and unsearchable. Also, beginning with the latest edition, they have opted not to offer a CD version, claiming it's too difficult to create a workable electronic version. Forget that it's a small feat for anyone to convert the previous CD to a .pdf file, which far easier to navigate than the book or CD, and forget that they should actually have focused efforts at offering an online version (which they could actually amend and improve on the fly) all along. Nope, the old guard has never been terribly adept at keeping up with the times. The reversal on the CD version has been a puzzlement to me, though. Whereas it had previously been offered as both a companion or an alternative to the hard copy version of the reference--and the CD was proving to be increasingly popular with MTs, who found they could either turn it into a text file or simply leave the CD in their drive and save themselves fumbling through the book constantly--there was just something "off" about their claims that the new edition could only appear as a hard copy.

Aha. . . but now the light comes on. Enter Interfix--thanks to their "partnership with the experts at the Association for Healthcare Documentation Integrity (AHDI), InterFix has created the first application that sets universal health data quality standards and deploys them to the workstation level, integrating them into the document creation process"--who can now offer "a fully integrated standards-based knowledge base" for MTs via their can't-live-without-it BenchMark KB, wherein for a mere $199 a year, you get:

* Access to the complete medical reference library from Stedman’s in a single user interface.. (sic)
* A continuously updated national physician database (850,000+)
* Quality alerts library highlight common transcription style errors, including Join Commission dangerous abbreviations.
* AHDI Book of Style in searchable format
* Annual electronic membership to AHDI
* Integration with all popular transcription and EHR platforms

Hmm. . . Suddenly, it's not so impossible to offer that BOS in an electronic format, eh? Interesting.

I think this proves my point beyond a doubt that The Organization Formerly Known as AAMT--a "professional organization" representing American medical transcriptionists--has now fully embraced its true purpose as a shill for software firms. Clearly, the "fix" has been on for a long time in their partnership with developers and salesmen, and the plan is to virtually corner the market on not only MT resources, but standards--including, no doubt, lobbying pressure (which AAMT has so proudly focused on in recent years) to attempt to make their credentials (for not only MTs, but MTSOs and schools) required and their products the default for transcription platforms and EMRs.

AAMT is officially dead and I challenge them to simply 'fess up and admit they're working against us. Those of you yet to find your lifeboats might want to form a line on the left. For those of you still in need of a style reference, I once again recommend heartily the totally free and infinitely more useful MT Reference Style Guide, created and maintained by MTs for MTs, and gee, whaddya know--easily searchable online.

Channeling Walter Mossberg

Jeanne Johnston — Thu, 12 Jun 2008 16:32:00 GMT

Still struggling to find a way to make my coursework doable on my Mac with the least contortions possible, I’ve spent the last week indulging my inner geek and trying on different software for size, and I have to say I’m enjoying it immensely.

My Computers In Healthcare course has presented more than a few challenges, not the least of which is that the text is written around things like Word 2003--absolutely ancient, in software terms. Granted, they mention frequently that students are not required to own M$ products and we can do the exercises using open source apps like OpenOffice (or any of its permutations--available for every platform out there). Now, last week I had slogged through all the chapters from Word to Access to Excel to Powerpoint, using my favorite of these, NeoOffice. This is basically a clone of OOo, except that it runs as its own application (OOo actually utilizes X11 and runs through UNIX, which can get a little tricky if you get confused by seeing that command line business.) It looks like the M$ Office applications. . . but as I discovered, there are occasional bugs in that a crucial button or function is missing here and there (hello, no one at OOo thought we might like to delete a record from a database?) I got through the exercises okay, but I knew it had been harder than it should have been.

I’m not sure why it took me until afterward to hit upon the idea of using the Mac counterparts I already had and simply saving them as Office-friendly formats. Rummaged around my hard drive and tried out my old iWork applications--which are so completely wonderful in comparison, it isn’t funny. Keynote versus Powerpoint is like comparing satellite HDTV to that 13” B&W set with rabbit ears that barely got four channels. It’s slick, it’s easy, it packs so much stuff in there that my mother (who didn’t do Ziploc bags until they came out with the ones with a zipper) could grope around it and look like a professional in the end. Likewise, Pages is Word to the nth degree--not just a WP app, but complete enough to do desktop publishing. Except. . . dang--Numbers is simply a spreadsheet app and I needed to be able to work with a relational database. It compares to Excel, but there was no way I could substitute that for Access. . .

So I flitted around the internet a bit and found the solution is Bento (lovers of Japanese cuisine will appreciate how cute and clever that name is), which is not just a database app from the makers of the old fave Filemaker Pro, but may be The Ultimate Database app. It syncs everything you’ve got into one place so your calendar, address book, iTunes library, iPhone/iPod, projects, event planning, and anything else you want to throw at it is in one cool spot. No fumbling around with formulas, queries, and awkward menus like I just learned in Excel--this is gorgeous, effortless, and powerful. Of course, I’m only able to vouch for that because I have no life and spent a morning watching all the tutorials. . . As I never got around to upgrading my OS from Tiger, I can’t even run the trial version yet. I had to throw some money at Apple and am awaiting my new Leopard installer this week so I can try it, but I have no doubt I’ll be paying to keep Bento around, even if I never use it for work.

In the meantime, however, how do I deal with this coursework? Well, much as I am loathe to install anything M$ on my computer, I decided just to bite the bullet and get the trial of Office 2008 and see if that didn’t make me see my homework in a little different light. Harumf--what a difference 5 years makes! It’s still a fairly ugly bunch of applications, but it’s nowhere near as basic as 2003. You can call up windows for tools, rather than just the mishmash of icons on the toolbar at the top of your window. You still have to run queries as a separate function, rather than filtering within the spreadsheet as you can do in the Mac apps (where you simply hold down a cell to bring up a menu), but it seems a little less clunky than what I’ve been working with. The jury is still out until I have time to go back and re-do all my exercises for comparison. In the end, however, I don’t see this as worth the price tag of over $300 because they chose not to include the most important part of the suite: Access! What the heck? In the end, it’s going to be cheaper to stick with my Mac apps and cough up another $70 for Bento, which I’ll use for everything IRL anyway, or continue plugging away with OpenOffice (FREE). Office 2008 without the database application is insane. I'm just glad I didn't buy the suite outright and then find it isn't complete!

I don’t know who decided that business applications needed to be ugly, boring, and soulless because keeping things cutting edge certainly makes the job easier to focus on, easier to impress people, and just more fun. If you're going to go utilitarian, it does make sense to use open source applications; I've encountered some pretty slick ones currently in use as ER and other hospital platforms, like Synapse EMR, which I believe was originally written by a doctor. The beauty of open source apps is that no one profits from their sale, only from providing support (ask Linux!), which means actual users can have a hand at developing products to maximize their usefulness, rather than software vendors who simply throw things together and make a fortune by endlessly correcting their problems. As a former accounting major, I do have a strange joy at plunking numbers into neat little boxes, but in the end, I really thrive on a 3D, Technicolor world. I don’t think I’m unique in that. Of course, in the end I’m going to wind up in a job that most likely will use the ugly, utilitarian, 2-dimensional applications because that’s what they do. I really have had a blast geeking out this week and playing with all the possibilities, though.

Stress and then some

Jeanne Johnston — Fri, 25 Apr 2008 17:26:00 GMT

I'm happy to see another career-changing blogger here, but I can't decide if her narratives are more comforting (aha--someone who can empathize with me!) or just compound my anxieties. I don't know if it's the fact that I'm approaching the do-or-die portion of my A&P course or her most recent entry that made me have that dream where I find myself in the middle of the halls at high school on finals week, the bell has rung, and I can't even remember my schedule. . . I guess in the balance of things, knowing someone else is surviving the craziness is the bigger thing. Quite comforting, actually. It's kind of like when I shattered my knee and the best part of going to rehab was seeing how far other people progressed--or how pathetic some were (honestly, there was an old lady who even cried when they slapped the TENS unit on her. . . I LOVED that thing!)

Seriously, though, it's interesting to see that it doesn't matter what level education you're battling. Whether you're a rank beginner taking your first transcription course or going for a major degree, the stresses are the same. Carol points out great advice about picking a reputable school, and I agree fully that online degrees have come into their own, as far as credibility. Of course, there's a huge difference in the number of scam schools at the various levels. Medical transcription is infamous for those hotel seminars that try to convince SAHMs how they can make $60K/year working part-time hours of their choosing (ha!) if they just take this matchbook course. From what I see, the higher the credential, the more a school has to meet standards and accreditation. Many traditional universities have embraced online education and they're just not going to throw away their reputations by slapping up a course worthy of those late-night Sally Struthers commercials. Indeed, they have to meet the professional organizations' requisites before they can even offer a degree, or it's useless.

Coming from MT, I know very well how little accreditation can mean on the other end of the spectrum. The so-called standards simply were watered down repeatedly until they have no meaning. This makes it really hard to figure out where to get your education. The consensus amongst the majority of working MTs, editors, QA folk, and MTSOs is that if you simply pick one of THE two online courses (M-TEC or Andrews), either will pretty much ensure you're not just employable, but sought after. Many of their grads have multiple job offers before they've had a chance to breathe a sigh of relief at the end. In this case, oddly enough, I believe having a certificate from either online school maximizes your employability, at least when you're applying to nationals or other 'net-savvy MTSOs. Even that community college course--though it may meet the same standards (many don't come close)--will not register a blip on the radar when trying to break into the field. Unless that school has a great working relationship with local clients to help with job placement, you may hit a wall very quickly. Unfortunately, the trend is not to local, in-house jobs, but telecommuting, and even a great local school isn't likely to even get you an invitation to test for such a job without experience. Whilst a diploma from those two online courses is often a fast track to a job, any lesser course does not give the benefit of that kind of reputation. Besides actually giving you the best possible foundation to hit the ground running, I believe that reputation is a priceless benefit of choosing either school.

It was quite a surprise when I started looking into CTR. As the requirements for educators is so much more strict, there are considerably fewer options. I was shocked to see so few accredited courses for CTR, but it did narrow down the search quickly. More surprising was hearing that where I get my training isn't going to matter to employers, only the fact that I am or will be certified as a CTR. In rummaging around the job bank, I see that's true. In the ads, they all want CTRs with experience and certification, though they also list internships for new grads needing those hours before they can even take the exam.

It sounds like Carol's travels to her master's degree have similar considerations and stressors as far as the general educational concerns and integrating a career change into the family dynamics. As I find my own nose sore from pressing ever closer to the grindstone, maybe she'll pass some hints on the personal stuff, like how to get teenagers to pitch in and how to actually get dressed out of the closet instead of the laundry basket. *grin*

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.