Having said that, of course, you'll need to check them out for yourself to see if any of them will meet your needs. There are certainly some very good commercial text expander applications on the market that may have features the free programs don't have, so you'll need to comparison shop to determine what will work best for you.

In any case, when it comes to increasing productivity in the transcription business, few tools can offer working MTs more bang for the buck than a good text expander. I've accumulated literally thousands of typing shortcuts over the years, and I wouldn't dream of working without them. Certainly it takes a little extra time in the beginning as you create your own library of shortcuts, but you'll more than make up for it in increased productivity in short order.

Whether you decide on a free or commercial text expander, it's an investment in yourself that's guaranteed to pay big dividends - and doesn't THAT sound good these days!

The quality of your dictation affects the accuracy and turnaround time of your transcriptions which directly impacts patient care and reimbursements. Your practice can benefit greatly by improving the precision of your dictation skills. Good dictation will bring you savings, as well: poor dictation consumes time and labor, increasing overall documentation costs. Finally, quality dictation can even help you legally: fewer transcription mistakes caused by poor dictation equate to fewer errors in patient care.

By incorporating the following top 10 tips for successful dictation, you can accelerate the time it takes medical transcriptionists to learn the style of your dictation, as well as improve their accuracy - all the better for you to run an efficient and high quality medical practice. A win-win for all.

The tips include:

1. At the start of your dictation, gather any papers, reports that you might need for your reference.

2. Dictate as if you are speaking to the patient in an exam room, speaking clearly so the Medical Transcriptionist will understand you without error.

3. Speak at a steady pace and not too loudly or softly. Keeping the recorder approximately 8-10 inches from your mouth will help improve clarity. Always move your face away from the recorder to sneeze or cough.

4. Minimize noises including the TV or radio, eating, drinking, chewing gum, shuffling papers, opening drawers, rearranging your desk or making loud noises as they can be very distracting to the medical transcriptionists. Likewise, do not dictate in a crowded room. The background noise is distracting and you may be sharing protected health information inadvertently.

5. Avoid multitasking while performing dictations. Use the pause button if you would like to take a sip of water or sort out documents. Do not dictate while driving. The sound quality is usually poor, not to mention that it is dangerous.

6. Identify yourself and state what type of report you will be dictating. Detail any special instructions at the beginning of the dictation. State, and then spell full details of information such as the patient's full name and proper mailing address on letters.

7. During the dictation be as specific as you can with spelling, phrasing, formatting and ‘normals'. Spell the names of patients that you think the Medical Transcriptionist may not understand (i.e. ‘Amy' spelled instead as ‘Aimee'), as well as local names or cities. Clearly spell words that may not be commonly used in the medical field, including new pharmaceuticals or treatments and unusual words representing diseases, drugs, or procedures not normally found in the mainstream of your daily work or specialty. Use the same phrases in each of your report types and follow the same order of headings whenever possible. Furthermore, be specific when inserting "normals". If you need to change any part of the normal, please indicate exactly what information the medical transcriptionist should delete and where to insert changes.

8. Include punctuation, especially when starting new paragraphs, and include "open" and "close" quotation mark instructions.

9. Avoid using a lot of "ahhhs," "ums," "ers" and "uhhhs." They can be confused for the letter "a".

10. While cellular phones are convenient, the sound quality is usually not ideal. Land lines will give the medical transcriptionist a better quality recording.

I must say it's refreshing to see a transcription company publicly acknowledging that the quality of dictation, which is the dictator's responsibility, has a direct impact on the accuracy, timeliness, and reimbursability of finished transcripts. Working MTs have long been pressured to produce accurate work on short turnaround time, but the fact is the quality of the original dictation has a lot to do with how well MTs can do their jobs. Whether or not this white paper will have any discernible effect remains to be seen, but I definitely give MxSecure kudos for making the effort.

Are there any other tips you'd like to give dictators if you could? Please feel free to comment.

Jeannie is 51 years old, a 32-year resident of New Hampshire, a special education paraprofessional at Bedford High School, co-owner of a health club, and mom of four raised children: Aubrielle, age 26, Justin, 23, Joshua, 20, and Christina, 19. Her journey across America really started more than 12 years ago when she got involved in spinning and strength training classes and recognized her ability for endurance on the bike. Jeannie began doing one-day cycling events for fun and for charities, and it was then that she started to dream about the idea of riding across America. Now at last that dream is becoming a reality as she cycles across 10 northern states, averaging over 80 miles per day, with a few rest days thrown in along the way.

I have the privilege of participating in this worthy endeavor by providing Jeannie with access to a call-in dictation system and transcription services so she can call in daily updates to keep her supporters informed of her progress. As the proud parents of two children currently serving in the military (Philip, age 25, U.S. Army, Ft. Benning, Georgia, and Daniel, age 23, U.S. Air Force, Hickam AFB, Hawaii), my wife Carol and I are honored to be able to support Jeannie and OLT as they work to provide assistance to military families.

Congratulations, Jeannie, on following through on your dream. Our thoughts and prayers are with you!

One of the consequences of the recent economic downturn has been to help us as Americans do some reprioritization, something that for many of us -- let's be honest -- was long overdue. I've lost track of how many people I know personally or have heard of through personal acquaintances who have had to make sometimes drastic lifestyle adjustments recently. I'm talking about things like downsizing housing, getting rid of extra vehicles, not taking expensive vacations, eating out less, driving less, etc. It's never pleasant, and can be downright painful, to have to lower one's standard of living, especially in a culture that has glorified material possessions and financial gain as the yardsticks by which we measure "success." For some, just putting food on the table or paying the light bill has become a major challenge, and my heart goes out to folks in that situation.

Still, I'm convinced there's a silver lining to these dark clouds, because we've been reminded, albeit painfully, that having a lot of "stuff" is NOT the measure of true wealth. The truth is, the most valuable resource we can claim are people - the people who love us and whom we love, the people who enrich our lives and provide support and encouragement, the coworkers, employees or employers who are decent and fair, the people in our neighborhood who make it a nice place to live. It's during hard times that we discover how frugally we can get by if we have to, and what a blessing it is to have family and friends to lean on and draw strength from.

Even businesses should learn something from these financially challenging times and focus less on the bottom line and more on treating employees with dignity and respect. Time, energy, and yes, money invested in the people in your organization will pay far greater dividends in the long run than all the technology you could buy or cost-cutting measures you could put into place in order to see a short-term improvement to the bottom line.

The wealth of our nation cannot accurately be measured by the GDP, the money in our bank accounts, nor the value of our stock portfolios. What makes this country great is the spirit of its people, and it is that indomitable spirit that, if given the chance, will turn these hard times into better times once again. Hopefully, when that does happen, we'll remember the lessons learned during this time of retrenchment and put a higher value on the people in our lives than on the material baggage we manage to accumulate.

MedQuist/AHDI Settlement Update

According to the AHDI website, the free program offerings for eligible members of the MedQuist settlement class are anticipated to become available in mid-July 2009.  Eligible participants will receive a notification letter by mail from AHDI when the program goes live.

Medical Transcription & Career Step Featured on Designing Spaces

A recent episode of the WE Network program Designing Spaces featured interviews with Career Step founder Andrea Anaya and with a recent CS graduate.  Overall I thought the piece did a decent job of informing viewers about the medical transcription profession and CS's training program, but I was bothered by a couple of statements, one from Anaya regarding the use of speech recognition technology in the MT industry.  She said, "We ARE seeing application of voice recognition, but it's the transcriptionist who's applying it, not from the other end."  Also, the CS graduate featured in the piece stated that "medical transcription isn't going anywhere."

In the interest of full disclosure, I've had a marketing affiliation with Career Step for some time because I believe the program is a good MT training option for individuals on a budget.  (Note to readers: please don't try to drag me into a "school wars" discussion!)  Even so, I don't feel the above statements by Anaya and the CS graduate accurately reflect the state of the MT industry today.  Clearly, back-end speech recognition technology is having a MAJOR impact on our profession, while to my knowledge there are only a relatively few MTs who are using front-end SRT to "re-dictate."  As to whether or not MT is "going anywhere," while I'm among those who believe MT as we know it will indeed be around for the foreseeable future, there's no question that the industry is undergoing some fairly dramatic changes even as we speak.  Furthermore, if you define "going anywhere" as the movement of MT jobs away from the U.S. to other countries, Career Step itself is involved in training programs in a number of offshore locations. 

Having said all that, I don't believe the purpose of the Designing Spaces piece was to deliberately deceive viewers who are looking for potential home-based careers.  I can tell you from personal experience that being interviewed on camera for broadcast isn't exactly the most comfortable experience, and not everything comes out of your mouth exactly the way you'd prefer.  It's easy to pick apart an interview after the fact and focus only on the negatives, and I don't want to do that in this case.  Still, I do believe it's important to make every effort to accurately represent the medical transcription field as it exists today and is likely to exist in the near future.

CBay Aggressively Marketing Subcontracting Services

CBay Systems recently unveiled its CBayScribe MTSO Partnership Program in an apparent attempt to expand its market reach by subcontracting to other MT service owners.  Basically the program allows MTSOs to bring on new clients using CBay's technology and human resource infrastructure with no up-front costs and a fixed per-line rate.  The website provides a toll-free number, 866-295-4600, to contact CBay Systems president Chris Foley for more information about this program. 

As a means of possibly recouping some of the money it has invested in its technology infrastructure while further expanding its market reach, this new strategy seems to offer CBay a lot of upside without much risk.  Whether or not it would be financially feasible for MTSOs to go this route is another matter, since I don't know what kind of line rate CBay is charging for its services.  I also think CBay will have to convince potential MTSO customers that they don't have to worry about CBay trying to steal their clients, a common concern in our business whenever you deal with subcontractors.  In any case, it'll be interesting to see how this all pans out.

"In some industries, when the products are relatively new and not very good in terms of performance, the early entrants must provide all of the parts of the product by themselves. For example, if you wanted to be in the computer industry in 1982, you needed to manufacture a computer's operating system, the application software, the peripheral devices, the processors, etc....even the cases housing the various components came from a single producer and the product was integrated. IBM, Digital Equipment, Unisys, and Wang were all companies from whom customers had to buy the entire package, including consulting, from a single vendor. 

"But over time, as the performance of the products improves, vertically integrated and proprietary companies whose approach was strongest during the early phases of the industry's development give way to a non-integrated and horizontally stratified population of companies whose products are capable of integrating, through standards, not by virtue of a single company owning all the components.

"This happens because the basis of competition changes. Customers become less and less willing to reward further improvements in functionality (e.g. adding a registry on to an existing EMR that initially doesn't have one) with premium prices. And companies that get better and better at conveniently giving customers exactly what they want (e.g. ePrescribing, or a registry) when they want it and at an affordable price, are able to earn attractive margins. And so they start to take business away from the vertically integrated firms.

"Modularity, in effect, enables the dis-integration of the industry. Which is exactly what happened in the computer industry. By 2002, virtually every part of a PC was modular and substitutable. Dell doesn't manufacture anything, it simply purchases all the components from companies in stratified groups - e.g. microprocessors, memory, hard disks, mother boards, OS, fans, etc. - and assembles them according to the wants and needs of the customer. By then, many of the leading, very top companies making computers in 1982...had gone out of business. DEC, Wang, Unisys.

"So....this same phenomenon helps to explain what is happening in the EHR technology industry. The vertically integrated, top-tier companies - GE Centricity, NextGen, Allscripts - would like to continue to sell their comprehensive EHRs to their best customers, who will pay their highest prices, and at the maximum profit margins. But they are really struggling to add value fast enough and at a price point that medical practices can afford. The proof of this is included throughout in the Nutting Report, and can be seen in countless practices and groups across the country, as they try to get these vertically integrated vendors to respond quickly to needed functionality, but find the workarounds and awkward installations maddeningly frustrating. They're quite literally screaming for the features they need, but getting a lot they don't need, at prices that seem like extortion.

"In brief, doctors have arrived at a next stage of value addition for EHR technology, one at which faster response, greater agility, convenience, and lower pricing have become as or more important than a very long list of features and functions that are no longer as useful or desirable as they once were (or were perceived to be)." 

In short, Dr. Kibbe is advocating for the same "iPhone approach" that I described in my last blog post: a basic, user-friendly platform with the ability to accommodate specialized modules from a variety of vendors to meet the demands of a diversified marketplace.

Naturally, the established EHR vendors who are selling expensive, integrated systems have a vested interest in keeping things as they are, as evidenced by the recent letter from HIMSS to the Department of Health and Human Services lobbying for CCHIT to be designated as the certifying agency for EHRs eligible for government subsidy money. But the reality is that in many cases the status quo isn't serving the best interests of the customers -- you know, those pesky little folks who actually have to use and pay for the software. A modular implementation approach would benefit EHR and PHR consumers just as it has customers in other market sectors. I sincerely hope HHS will take steps to encourage this kind of innovation, and not bow to pressure from vendors who will profit by maintaining the status quo. Let consumers dictate to vendors, not the other way around.

But coolness costs money, dang it, so I had to wait until the time was right.  Then my cell phone contract came up for renewal, meaning I was eligible for a phone upgrade, and the AT&T store offered me a deal I couldn't refuse.  I am proud to say I have now joined the ranks of the iPhoniacs.

Truth be told, this is my first exposure to an Apple product.  I've owned a couple of mp3 players, but never an iPod.  As someone who knows his way around a DOS prompt, the thought of purchasing an Apple computer has never even entered my mind.  But this iPhone has given me a little insight into the whole Apple mindset, and the "one thing" (think Jack Palance in "City Slickers") that is the secret to the company's success:

Their stuff simply works.

It's not just that Apple products such as the iPhone work -- they simply work.  Having used Windows PCs and Windows Mobile-based smartphones for decades, believe me, I know the difference.  Something as basic as turning the phone ringer off takes me four or five steps with my WM BlackJack; with the iPhone, there's an honest-to-goodness switch on the side of the phone.  A switch, for crying out loud! 

And rather than Apple trying to envision and create an application for every possible use of the iPhone, they made the radical decision to build a basic operating system and give third-party developers the ability to build applications to run on it.  Now, over 40,000 applications later, the result is a piece of technology that is very simple to operate and at the same capable of accomplishing extremely complex tasks. 

But the purpose of this blog post isn't to shill for Apple, or even to brag about having an iPhone (well, okay, maybe just a little on the bragging part).  In fact, the whole experience has got me to thinking about what a game-changer simple could be as we move toward a nationwide electronic health record infrastructure.

Let's just cut to the chase: the biggest obstacle to widespread adoption of EMRs and PHRs is going to be the unwillingness of the users - doctors and their patients - to learn how to use bewilderingly complicated new technologies.  New technology isn't going to solve problems that are rooted in not-new people.  Solve the people problem, like Apple has done with the iPhone, and the whole process becomes infinitely more doable. 

Now that that's settled, time to update Twitter and Facebook using my iPhone Vlingo speech recognition app...does it get any better than this?

"Years ago, when I started my business, one of my large clients was a large insurance company.  I did a lot of transcription for the risk management department.  The director of that department insisted that I transcribe verbatim, with no corrections or changes. It drove me absolutely crazy. One day, when I complained to him about this, he told me something that has stuck with me ever since. He said he knows I'm smart and know what I'm doing and can make corrections and flag errors - but I don't transcribe all the reports, I won't transcribe all the reports, he has no idea which ones I will do and which ones someone else will do or how long I will even be transcribing for this insurance company - and his people need to be trained to dictate the reports so they are correct, regardless of who transcribes them.

Wow - imagine a dictator taking responsibility not only for the accuracy of the finished document, but the accuracy of the dictation! Why is it we feel we have to take responsibility off the shoulders of physicians when their dictation has far more impact than a manufacturing company's risk management assessment report? So we can feel like our role is more important? All I can say is - wow."

Last week I advocated for a "National Verbatim Transcription Day" in order to call attention to the risk management role MTs bring to the table as part of our skillset as we routinely "clean up" after our dictators.  I think we do this partly out of concern for the patient, partly because the client's account specifics call for it, and partly because we're just wired that way.  But according to Julie, MTs shouldn't be taking on this responsibility at all, either voluntarily or as part of our job descriptions. 

I'd like to know what you think about this.  Do you consider medical transcription to be in a category of its own, one that cannot or should not be compared to other industries, as Julie does?  Will there be or should there be an ongoing risk management role for medical transcriptionists in order to ensure accuracy in medical records?

Or are we, in fact, enabling poor dictation practices simply as a means of preserving our jobs? Are we taking on too much responsibility (liability?) by doing so, and will we ultimately come to regret it?  If we as MTs refused to transcribe other than strictly verbatim, would that be the final nail in the coffin that would spell the end of medical transcription as we know it?

What do you suppose it would take for the health care field, not to mention politicians and the general public, to truly understand and appreciate the value medical transcriptionists bring to the healthcare documentation process?  I've thought about this a lot, and my conclusion is that we need a National Verbatim Transcription Day.  This would be a day when every MT transcribing American medical records would transcribe everything twice-once according to account specifics and with all the normal "cleaning up" we do on a daily basis, and another version which is totally verbatim, word for word, every sound, every stutter, every false start, absolutely everything.  All of the verbatim transcripts should be thoroughly de-indentified to avoid any HIPAA/HITECH issues, then compiled into one massive document and distributed electronically via the Internet to anybody and everybody who needs to see it. 

How crazy is this idea, do you think?  Would enough MTs ever be willing to do it?  Would MTSOs be willing to risk the fallout and encourage their MTs to do it?  And what kind of fallout do you suppose there would be?

I'd love to hear your feedback.

The problem, according to Dr. David Kibbe, a senior technology adviser to the American Academy of Family Physicians as quoted by the Globe, is that "Claims data is notoriously inaccurate and notoriously incomplete with respect to an expression of the problems a person has." Adds Dr. Daniel Zands, the primary care physician for one of the affected patients, "The problem is that this kind of information should never be used clinically, especially if you don't have starting or ending dates" attached to each problem.

On the other hand, the Globe quotes Dr. Roni Zieger, a product manager for Google Health, as acknowledging that billing information can sometimes be precise, but arguing that the overall benefit of having some information is better than no information, and that accuracy will improve over time.

Pardon me if I feel like Alice falling down the rabbit hole, or through the looking glass, or wherever the heck she went, but---

ARE YOU KIDDING ME??!!

I wonder if all this attention on health information technology is like making sure we use the most modern airplanes to deliver rotten food to a starving country. If our health care data is corrupt to begin with, streamlining methods of sharing that data just means we get more efficient at being wrong.

I know, I know. This kind of thing is old hat to folks who've made a career out of trying to wade through the morass that is our current medical coding/billing/reimbursement process, mandated by a system of health care delivery that rewards quantity over quality. But you'll have to excuse me while I look behind the curtain for Franz Kafka. Who else could have dreamed up a world where someone can say with a straight face that partially wrong medical information is better than no information, or that the data used to procure payment for medical care is "notoriously inaccurate and...incomplete with respect to an expression of the problems a person has?"

By no means am I the first to suggest that health information technology is, if not the least of our problems, certainly not the most important. I fear that HIT is being viewed as some kind of silver bullet that will drastically improve our health care system in and of itself. But no matter how advanced our technology becomes, there's no escaping this one fundamental truth:

Garbage In, Garbage Out.

One of the knocks against personal health records has been the potential for inaccuracies to creep into the medical record due to ignorance on the part of the patients who attempt to maintain their own PHR. All the more ironic, then, that in the case of the Beth Israel/Google Health brouhaha, the source of inaccurate information was not the patient, but the patient's health care provider!

Let me dial it back for a moment in order to say that I have a great deal of respect for Beth Israel and for its CIO, John Halamka, whose blog makes for great reading. Both Dr. Halamka and BIDMC have done the right thing by acknowledging that they made a mistake by using insurance claims information to populate Google Health PHR, and that practice has been discontinued. But this particular incident is, for me, simply a jumping-off point for a much broader discussion that needs to happen in this country. This really isn't about Beth Israel, or Google Health, or health care technology in general. The issue that needs to be addressed first is the way health care is procured, practiced, and paid for in the U.S. In the meantime, the proliferation of inaccurate and potentially dangerous information in the medical records of Americans is not going to be ameliorated simply by spending $19 billion dollars on modernizing HIT; if anything, things may very well get worse.

As patients, however, we're not without recourse. Take a few moments to read this blog post by Dave DeBronkart, the patient mentioned above, for some information and inspiration on how to go about finding out what's in YOUR medical record, and what to do with what you learn.

The Guidance is rather lengthy, but here are a couple of the salient points:

• PHI should be encrypted in order to be secure.
• If "secure" PHI is breached, the notification requirements under HITECH are waived.

On the first subject, the Guidance has this to say:

Protected health information (PHI) is rendered unusable, unreadable, or indecipherable to unauthorized individuals only if one or more of the following applies:

a) Electronic PHI has been encrypted as specified in the HIPAA Security Rule by "the use of an algorithmic process to transform data into a form in which there is a low probability of assigning meaning without use of a confidential process or key" and such confidential process or key that might enable decryption has not been breached. Encryption processes identified below have been tested by the National Institute of Standards and Technology (NIST) and judged to meet this standard.

i) Valid encryption processes for data at rest are consistent with NIST Special Publication 800-111, Guide to Storage Encryption Technologies for End User Devices.

ii) Valid encryption processes for data in motion are those that comply with the requirements of Federal Information Processing Standards (FIPS) 140-2. These include, as appropriate, standards described in NIST Special Publications 800-52, Guidelines for the Selection and Use of Transport Layer Security (TLS) Implementations; 800-77, Guide to IPsec VPNs; or 800-113, Guide to SSL VPNs, and may include others which are FIPS 140-2 validated.

b) The media on which the PHI is stored or recorded has been destroyed in one of the following ways:

i) Paper, film, or other hard copy media have been shredded or destroyed such that the PHI cannot be read or otherwise cannot be reconstructed.

ii) Electronic media have been cleared, purged, or destroyed consistent with NIST Special Publication 800-88, Guidelines for Media Sanitization, such that the PHI cannot be retrieved.

I don't pretend to be a HIPAA expert by any means, but what I get out of all of this is that in order to secure PHI, data MUST be encrypted, as opposed to the original HIPAA regulations which said data COULD be encrypted as one possible option. As far as I can gather, neither the HHS Guidance nor the NIST guide mention specific encryption tools/programs that meet the requirements, so once again, it's up to us to do the due diligence to make sure the tools we use to protect PHI are adequate.

In doing so, it's important to keep in mind all the various states in which data can exist. From the HHS Guidance:

"data in motion" (i.e., data that is moving through a network, including wireless transmission); "data at rest" (i.e., data that resides in databases, file systems, and other structured storage methods); "data in use" (i.e., data in the process of being created, retrieved, updated, or deleted); or "data disposed" (e.g., discarded paper records or recycled electronic media). PHI in each of these data states (with the possible exception of "data in use") may be secured using one or more methods.

What this means in practical terms is that data residing on your local hard drive may need to be protected differently than data which is in the process of being transmitted over the Internet, which in turn may need to be protected differently than data residing on a server somewhere on the Internet awaiting download by another party. For example, FTP applications which use SSL to encrypt files during transmission over the Internet generally do not protect files while they reside on the remote FTP server, and thus would not meet the criteria for securing PHI unless the files themselves were encrypted separately.

The second issue of interest to me in the HHS Guidance is in regards to the notification requirements of HITECH. From the HHS Guidance:

If PHI is rendered unusable, unreadable, or indecipherable to unauthorized individuals by one or more of the methods identified in this guidance, then such information is not "unsecured" PHI. Thus, because the breach notification requirements apply only to breaches of unsecured PHI, this guidance provides the means by which covered entities and their business associates are to determine whether a breach has occurred to which the notification obligations under the Act and its implementing regulations apply.

While covered entities and business associates are not required to follow the guidance, the specified technologies and methodologies, if used, create the functional equivalent of a safe harbor, and thus, result in covered entities and business associates not being required to provide the notification otherwise required by section 13402 in the event of a breach. However, while adherence to this guidance may result in covered entities and business associates not being required to provide the notifications in the event of a breach, covered entities and business associates still must comply with all other federal and state statutory and regulatory obligations that may apply following a breach of PHI, such as state breach notification requirements, if applicable, as well as the obligation on covered entities at 45 CFR 164.530(f) of the HIPAA Privacy Rule to mitigate, to the extent practicable, any harmful effect that is known to the covered entity as a result of a breach of PHI by the covered entity or business associate.

What this says to me is that as long as you properly use encryption to protect PHI at all stages of its lifecycle, if a breach does occur, you're not required to notify either the government or the individual whose PHI was breached. Furthermore, according to my reading of the Guidance, it's up to you to determine whether or not you properly protected PHI, and thus whether or not notification is required.

Quite frankly, this Guidance leaves somewhat to be desired, in my opinion, in terms of concrete guidelines for specific situations. In fact, the Guidance itself also includes a Request for Information, meaning, I suppose, that HHS could change its mind after gathering input from stakeholders. However, this is more than we had when ARRA/HITECH was first enacted, so I guess that's progress for our legislative system.

In order to participate in this settlement, you must have been a medical transcriptionist who transcribed work for MedQuist at any time during the period from November 29, 1998 to August 11, 2008, and were paid on a line-based unit of measure for their work.

The free program offerings from AHDI will include the following:

• free one-year individual AHDI membership, or
• free one-year subscription to AHDI's web-based knowledge base and information portal, or
• free registration for up to five (5) online AHDI educational webinars; or
• free registration for one (1) credentialing prep course and one (1) specialty online educational course, or
• free AHDI educational CD product bundle.

An AHDI representative indicated that the process of determining and verifying the individuals who will be eligible to participate in the free program offerings has yet to be finalized.

More information, including instructions for registering for one of the free program offerings, will be posted on the AHDI FAQ page as it becomes available.

This has always been one of my favorite quotes from the Founding Fathers, and it seems to me to be more apropos than ever recently.  These days I find myself contemplating a future that until now was unimaginable to me, a future in which the American people abandon the principles of freedom which have been the foundation of our nation since its inception, in favor of what can only be described as a "nanny state."  Our banking system is on the brink of being nationalized.  The government is dictating who can and cannot lead public corporations.  The country is going trillions of dollars into debt in order to expand the reach of government into seemingly every aspect of our lives.  What the heck is going on?

And what does any of this have to do with medical transcription?

My wife and I play a little game sometimes where she abruptly changes the topic of a conversation and I try to figure out how in the world she got from point A to point B.  Clearly this game is a losing proposition for me, being handicapped with a Y chromosome and all. Almost always she has to backtrack and explain step by step the rapid progression of her thoughts from one subject to another.  Having spent a great deal of time perusing the various online MT forums over the course of the last 10 years or so, I can attest to the truly mind-boggling ability of women to hijack a discussion on any given subject and end up light years away from the original topic.  I guess some of that has rubbed off on me, so allow me to explain how a conversation about speech recognition led to a blog post about the end of capitalism as we know it.

A few days ago I posted to my Twitter and Facebook accounts a link to a story about how Nuance is marketing its front-end speech recognition technology by encouraging its integration into EHR platforms.  The article mentioned a survey completed by 1,255 physicians who have adopted Nuance's Dragon Medical software.  According to the survey results, 83 percent said that it improved the quality of their electronic patient notes; 81 percent said that it significantly reduced transcription spending; and, 69 percent said it made their EHR faster and easier to use.

A couple of friends and colleagues in the MT community saw the link on Facebook and offered some input on the story.  One commented that she was suspicious of the survey results.  She wondered how it was that MTs had to train for hours, weeks, months to edit SR drafts, yet we're supposed to believe that doctors can pick up a microphone and produce accurate and timely reports in no time at all.  What about all the lousy grammar, run-on sentences, no punctuation and poor proofreading skills we MTs hear from doctors all the time?

My response was that perhaps it all comes down to the level of quality and accuracy an institution is willing to accept, and that I suspected many are satisfied with an encounter record that vaguely resembles what actually happened, as long as it's cheap.  That thought led me to another, which was that perhaps the healthcare sector will have to suffer a major liability catastrophe due to substandard documentation, on par with the banking meltdown, before they finally understand that the bottom line isn't the bottom line, it should be taking care of people.  I wondered if greed has so totally blinded us to what's important that America is no longer qualified to have a capitalistic economy any more.  My final comment was that if we end up with socialism, it'll be because we couldn't be trusted with capitalism.

Isn't THAT a lovely thought to get your week started!

Am I being overly pessimistic?  Perhaps.  Do I believe speech recognition will lead to a collapse of our economic system?  Of course not.  But I keep going back to what John Adams said about the revolutionary new form of government he and the other Founding Fathers left in our care.  He was right, you know.  The freedoms our system of governance has historically offered us are unsustainable in an environment where morality-simply doing the right thing-has been abandoned in favor of higher profits no matter what they cost.  I don't think we have appreciated how fragile a thing our brand of liberty really is when it's not nourished and nurtured and protected by a shield of morality and self-sacrifice.  Without those protections, freedom such as we take for granted cannot long endure, and authoritarian control will inevitably follow.

Only a virtuous people are capable of freedom. As nations become corrupt and vicious, they have more need of masters. - Benjamin Franklin

Please don't hear what I'm not saying.  I am a capitalist through and through, and big government is anathema to me.  But the harsh reality is that we haven't been willing to regulate ourselves, we haven't been willing to place the welfare of people above the profit margin, and we've all fallen into the trap of greed.  We love to point fingers at Wall Street bigwigs-or MTSOs in suits-but how many of US had to have a newer car, a bigger house, more toys, more clothes, more trips?  And what corners were WE willing to cut, what good deeds did WE leave undone, what charity did WE leave ungiven, in order to satisfy our wants?  Corruption and lack of character at the highest levels of government and commerce are, I believe, simply reflections of a broader collective covetousness that has infected us all.  I fear there is a price to be paid for our national transgressions.

But I am not without hope.  I'm not giving up on the combination of independence and interdependence that has made our nation great.  I think we've lost our way, but journey is not yet over.  Perhaps nowhere else but America do we the people have the opportunity to influence how the next chapter of our story will read.

"Well, Doctor, what have we got-a Republic or a Monarchy?"  "A Republic, if you can keep it." - Benjamin Franklin

The website provides links to both the Final Judgment and Order of Dismissal with Prejudice and the court's Opinion.  Among items of interest (to me, at least) from the Opinion (emphases mine):

The Court finds, based upon Plaintiffs' submissions and the evidence and argument presented at a Final Settlement Hearing convened on March 27, 2009, that this settlement represents a good value to the class for what has proved to be a very weak case. (p. 3)

In addition to the discovery produced by Defendants, Plaintiffs' counsel and their investigators interviewed hundreds of potential witnesses in their efforts to develop the evidence to support their claims. Plaintiffs hired the investigative firm of LR Hodges, which tracked down between fifty and one hundred potential witnesses across the country, and Plaintiffs' attorneys themselves interviewed between one hundred and two hundred potential witnesses, in addition to the approximately two dozen depositions taken, as described herein. (p. 5)

According to Plaintiffs, over the course of this discovery period, Defendants produced, and Plaintiffs reviewed, approximately one million pages of documents. (p. 6)

As Plaintiffs indicate in their submissions to the Court, and as became clear at the March 27, 2009 hearing, notwithstanding Plaintiffs' expansive discovery and investigative work, no evidence emerged to support their allegations that MedQuist had systematically underpaid its transcriptionists.  Plaintiffs' computer expert reviewed thousands of pages of medical reports generated by class members, as well as other data MedQuist produced during discovery, and was unable to find any evidence of a pattern of underpayment through the undercounting of lines. (p. 7)

In addition, over the course of their depositions, "a number of Plaintiffs' declarants retracted, contradicted or otherwise undermined the evidence upon which Plaintiffs intended to rely." In particular, as the parties indicated at the March 27, 2009 hearing, two of the individually named Plaintiffs - Dorothy Myers and Wendy Svoboda - reexamined their reports which had formed the basis of Plaintiffs' allegations of

undercounting and underpayment, and, during their depositions, testified that MedQuist had, in fact, accurately counted the lines in the reports. (p. 7)

Regarding the Summary Notice of Judgment:

The Notice was ...mailed to approximately 28,000 potential class members.  Between the responses received by the Settlement Administrator, and those sent to the Court, 202 potential class members opted to exclude themselves from the proposed settlement, and 153 potential class members wrote to object to the settlement; in all, these submissions amount to less than 1.7% of the class members. The vast majority of these objections target the distribution of the settlement fund to AHDI, with the objectors asserting primarily that the settlement fund should be divided and distributed among the class members directly. Additionally, approximately nineteen objectors state that the funds should not be distributed to AHDI, stating either (1) that AHDI does not represent the interests of American transcriptionists because it advocates on behalf of those who wish to outsource transcription work overseas, or (2) that AHDI benefits the transcription industry, not transcriptionists, and is too closely tied to MedQuist. (p. 11, 12)

With regard to the courses that AHDI agreed, through the settlement, to make available to class members, Dr. Preziosi stated that 10,000 places in a variety of courses were set aside for class members. At the hearing, the Court noted that the deadline of December 31, 2009 contained in the proposed settlement for class members to sign up for AHDI's courses afforded class members a somewhat narrow window in which to take advantage of the settlement, and the parties, along with Dr. Preziosi on behalf of AHDI, agreed to extend the registration deadline until July 1, 2010. Thus, as revised, a Class Member will have until July 1, 2010 to enroll in one of the AHDI offerings, which may be completed after that date. (p. 14)

...the Court is satisfied, based upon the testimony of Dr. (Peter) Preziosi, (AHDI Executive Director) that AHDI does not advocate in favor of foreign outsourcing of transcription work, and is not so closely tied to MedQuist that it cannot represent transcriptionists' interests. Dr. Preziosi's testimony was directly to the contrary. The Court acknowledges the objections that raise these concerns, but finds, in light of Dr. Preziosi's testimony, that the concerns are misplaced. Although some class members objected to AHDI's role in providing benefits to the class under this settlement, it appears that AHDI is best situated to advocate for class members generally and to provide courses and materials to class members specifically who choose to avail themselves of this benefit. (p. 31)

In light of Plaintiffs' failure to develop any evidence suggestive of systematic underpayment by MedQuist, the injunctive relief provides a resolution for what the evidence now suggests was the actual harm underlying this conflict - the misunderstanding between the parties over the definition of a payroll line. (p. 40)

All told, the collective market value for the AHDI offerings provided by the settlement is $2,048,500. (p. 41)

At the time of this writing, the AHDI web page with FAQs about this case had not yet been updated with news of the final settlement, nor with information as to when eligible class members will be able to take advantage of the various free offerings from AHDI as part of the settlement terms. 

Whoever dreamed up this little beauty is a genius. I know it's a bit early in the year, but this would make a GREAT Christmas gift for that very special "someone" (and you know the one I'm talking about, don't you?) you can always count on to make mincemeat (another holiday reference) of the English language.

When you order yours, be sure and tell them you heard about it here so I can get the referring bonus.

Thanks, and have a happy April 1^st.