The XY Files in an MT World : Health Information Management

Free Text Expander Roundup

Jay Vance — Thu, 02 Jul 2009 11:55:00 GMT

Fellow blogger Raj over at MT Herald has put together a very useful list of free Windows text expanders . These are all available online free of charge, and in these economically challenging times, free is good! Having said that, of course, you'll need...(read more)

MT Service Publishes Dictation Tips for Physicians

Jay Vance — Thu, 25 Jun 2009 17:36:00 GMT

In a June 25, 2009 press release , medical transcription service company MxSecure, Inc. has announced the release of a white paper entitled, " Top 10 Tips For Successful Dictation " for physicians. From the document: The quality of your dictation affects...(read more)

Riding Across America for a Worthy Cause

Jay Vance — Wed, 24 Jun 2009 14:35:00 GMT

For 12 years, Jeannie Benton has dreamed of cycling across the United States, not just for the personal satisfaction, but in support of a worthy cause. For the next 7 weeks, that dream will become a reality for Jeannie, as she treks from Astoria, OR,...(read more)

Bits and Pieces

Jay Vance — Mon, 15 Jun 2009 18:35:00 GMT

Here are some of the happenings in the world of medical transcription as of late: 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...(read more)

A Call for Plug-and-Play EHRs

Jay Vance — Fri, 22 May 2009 14:37:00 GMT

Nothing like great timing. In my last blog post, I suggested that electronic health record (EHR) and personal health record (PHR) technology needs to become more like an iPhone in order to achieve widespread acceptance from technology-shy physicians and...(read more)

Lessons from an iPhone

Jay Vance — Tue, 19 May 2009 12:33:00 GMT

I admit it, I was suffering from iPhone envy. As an unabashed technophile (i.e., hard-core geek), I couldn't help but be intrigued by all the cool things the iPhone was supposedly capable of doing. When one of your colleagues says something to the effect...(read more)

Medical Transcription: "Specialized Secretarial Work?"

Jay Vance — Tue, 12 May 2009 13:00:00 GMT

My colleague and fellow blogger Julie Weight has had a lively discussion going on at her MTExchange.com site regarding mandatory credentialing for medical transcriptionists, an issue recently reported on by ADVANCE 's Lynn Jusinski. Julie, in her latest...(read more)

National Verbatim Transcription Day

Jay Vance — Mon, 04 May 2009 22:12:00 GMT

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...(read more)

Beth Israel/Google Health Fiasco--Is Technology Really the Problem?

Jay Vance — Tue, 28 Apr 2009 11:55:00 GMT

Recently the Boston Globe has been reporting on problems arising when Beth Israel Deaconess Medical Center sent insurance claims data (i.e., billing codes) to Google Health PHR as a means of summarizing patients' medical condition. As it turned out, this...(read more)

HHS Provides Guidance on Protecting PHI

Jay Vance — Tue, 21 Apr 2009 12:24:00 GMT

When you see a document with a title such as Guidance Specifying the Technologies and Methodologies That Render Protected Health Information Unusable, Unreadable, or Indecipherable to Unauthorized Individuals for Purposes of the Breach Notification Requirements...(read more)

The End of Capitalism?

Jay Vance — Mon, 13 Apr 2009 17:25:00 GMT

Our Constitution was made only for a moral and religious people. It is wholly inadequate to the government of any other. - John Adams This has always been one of my favorite quotes from the Founding Fathers, and it seems to me to be more apropos than...(read more)

A New Use for Speech Recognition

Jay Vance — Wed, 01 Apr 2009 15:01:00 GMT

I came across a great new product I'd like to give to every physician who mispronounces or slurs words while dictating. It's the BuzzWord Speech Recognition Wristband . This handy gadget allows you to program words into its memory and when the wearer...(read more)

New Organization Formed For U.S.-Based Transcription Providers

Jay Vance — Mon, 23 Mar 2009 17:46:00 GMT

A new membership organization aimed at U.S.-based medical transcriptionists and companies has been formed. The American Transcription Association (ATA) was founded by Donna M. Littrell, who identifies herself as the Executive Director of organization....(read more)

Is Speech Rec Wrecked?

Jay Vance — Mon, 09 Mar 2009 17:25:00 GMT

In response to my fellow HIM Insider blogger Jeanne Johnston's post entitled "Speech Wreck," I'd like to offer my own perspective on the use of speech recognition technology (SRT) in medical transcription. I have a fair amount of experience with back-end SRT, both as a working editor and in a supervisory capacity in a production environment. Over the past few years I've also managed to collect a lot of anecdotal and statistical information about how SRT impacts working transcriptionists.

I will tell you up front that I've long been a vocal advocate for fairness in compensation for SRT editors, as well as a vocal critic of the way SRT is often marketed. I believe there is plenty of objective evidence to prove that a good speech recognition platform will pay for itself on the basis of increased productivity alone without having to reduce the net compensation for editors. By that I mean that if SRT provides a 50% increase in productivity in the number of lines, characters, etc. that can be produced by a given number of editors in a given period of time, significant savings will be realized even if the payroll for editors remains the same. For the same money, the editors are producing 50% more work in the same amount of time. That's a win for the institution any way you look at it. For this reason, I get very cranky when I hear that SRT is being used as an excuse to reduce compensation for editors to the point where they make less money in a given period of time. But to be honest, some of the blame for that kind of scenario has to rest on the shoulders of the editors who put up with that kind of unfair treatment.

In 2006 I put together a small-scale survey (202 respondents) of MTs who had been working as speech recognition editors for at least six months, to find out how SR was impacting productivity and compensation. The results showed the following:

- 28% of respondents found that editing SR took about the same amount of time it would have taken to keyboard manually, meaning no productivity gain overall.
- 32% saw a 25% increase in productivity compared to manual keyboarding
- 19% saw a 50% increase in productivity
- 10% saw a 75% increase in productivity
- 9% saw a 100% increase in productivity, i.e., double the amount of lines, characters, etc. in the same time period.
- 2% saw a greater than 100% increase in productivity.

What this tells us is that the largest bloc of SR editors--a total of 51% of respondents--saw an average increase in productivity of between 25% and 50%. This confirms the anecdotal information I had collected via informal conversations with MTs working as SR editors in a variety of situations on a variety of SRT platforms.

In the same survey, I asked respondents how their rate of compensation had changed as a result of working as editors compared to traditional transcriptionists. Here are those results:

- 31% received the same rate of compensation for editing as they had received for transcription
- 18% received a rate that was 25% less for editing as compared to transcription
- 9% received a rate that was 33% less
- 27% received a rate that was 50% less, i.e., half of the rate they received for transcription
- 9% received a rate that was 67% less
- 6% received a rate that was 75% less

My interpretation of these figures is that while there was no doubt a statistically significant number of editors whose reduced rate of compensation combined with a relatively small increase in productivity had resulted in a decrease in their overall compensation, that group did not by any means represent a majority of SR editors.

A third question I asked respondents was how satisfied overall they were working as SR editors as compared to transcribing. The results I found quite fascinating:

- 21% said they were very dissatisfied
- 22% said they were somewhat dissatisfied. These two categories totaled about 43%
- 31% said they were somewhat satisfied
- 26% said they were very satisfied. These two categories totaled 57%

At least based on the results of this admittedly small sampling of editors, there was not an overwhelmingly negative attitude toward using SR, and in fact a solid majority was either somewhat or very satisfied with their overall experience with SR.

The overall picture I get from the survey results as well as the anecdotal information I've come across is that there is a wide spectrum in terms of the impact of SRT on productivity, compensation, and overall satisfaction among MTs working as SR editors. Consequently, I don't believe there is enough objective evidence to conclude that speech recognition has proven to be a widespread disaster for the MT working class. As with any scenario involving people, technology, and money, mileage is going to vary widely. In my experience, there are simply too many factors that can influence productivity, compensation, and overall satisfaction with speech recognition technology to draw hard and fast conclusions about the impact SRT is having on working MTs on the whole.

Having said that, as long as ANY working MTs or SR editors are being taken advantage of, there will always be a need for advocacy for fair compensation. Nothing I have written here is intended to minimize the culpability of employers who treat employees unfairly. But again, by far the most effective advocacy for fair compensation consists of being willing to say "No" to substandard compensation. Until MTs and editors are willing take that stand en masse, there will always be someone willing to squeeze one more drop of blood from the stone.

HITECH Makes Business Associates Liable Under HIPAA

Jay Vance — Mon, 02 Mar 2009 16:14:00 GMT

Medical transcription providers should be educating themselves on how the Health Information Technology for Economic and Clinical Health Act (HITECH) portion of the American Recovery and Reinvestment Act of 2009, also known as the stimulus bill, is changing the way HIPAA regulations will apply to business associates. Up to this point, business associates of covered entities were not directly liable under HIPAA for breaches of private health information (PHI). As a result of HITECH, however, business associates, including transcription providers, will now be directly liable for failure to adhere to HIPAA regulations regarding the use of PHI.

According to Ed Jones from hipaa.com:

Application of the Security Rule to business associates of covered entities is a significant change. Previously, if there were a breach involving a business associate of which the covered entity were aware, then the covered entity could just terminate the contract if the breach was not remedied. Responsibility and liability rested with the covered entity. With the change in the HITECH privacy provisions of ARRA, the business associate now has responsibility and liability directly for a breach. A breach requires notification, which is triggered when there is an incident of "unsecured protected health information." The Secretary of HHS is required to issue guidance on what constitutes "unsecured protected health information" within 6o days of February 17, 2009. In the absence of such guidance in the time specified, then a default definition pertaining to a failure of encryption as endorsed by the National Institute of Standards and Technology (NIST) of such information [applies]. The notification provision requires both covered entities and business associates to notify affected parties directly and individually in a timely manner, and to use appropriate public media for cases involving over 500 individuals. This is a specification that was not defined under HIPAA Administrative Simplification. Increased penalties for a breach by a covered entity are immediately effective.

Writing for WTN News, attorney John Barlament explains further:

For the first time, business associates must comply directly with many of HIPAA's Security Rules. This will require every business associate to take several actions, including appointing a security official, developing written policies and procedures, and training its workforce on how to protect electronic protected health information ("EPHI"). These provisions go well beyond the previous requirements for business associates, where business associates only had to comply with the written business associate agreement.
Business associates also will need to follow HIPAA's Security Rules relating to physical safeguards (such as locking computers that contain EPHI), technical safeguards (such as encrypting emails) and the requirement to adopt written policies and procedures. Failing to do so will - for the first time - subject a business associate to civil monetary penalties and criminal penalties for each notification (and, as discussed below, the civil monetary penalties are now increased).

A covered entity or business associate that has a specified security breach will be required to notify each individual affected by the security breach. This can involve written notification by mail or, if specified by preference by the individual, email. If the covered entity or business associate lacks current contact information, it may be required to post notice of the breach on its website or in newspapers or other broadcast media (e.g., television). For certain large breaches (involving more than 500 residents in a particular area) a "prominent media outlet" must be notified of the breach. The U.S. Department of Health and Human Services ("HHS") also must be contacted, and HHS is to establish a website listing these breaches. There is an exception for certain unintentional breaches.

The Act states that business associates must comply directly with certain HIPAA Privacy Rules, primarily the requirement to have and follow a business associate agreement. The scope of this change is unclear. It could mean that every entity must determine whether it is a business associate with respect to a covered entity. If so, the business associate may be required to enter into a business associate agreement with the covered entity. Previously, it was a covered entity's responsibility to identify all its business associates (a business associate did not need to identify whether it actually was a business associate).

The civil monetary penalties are significantly increased. Currently, the amount of the penalty is generally $100 for each violation. This $100 amount (and its related cap of $25,000 for multiple violations) increases to $1,000 per violation for a violation due to "reasonable cause and not to willful neglect" (with a maximum penalty of $100,000); $10,000 for each violation that was due to willful neglect and is corrected (subject to a $250,000 maximum penalty); and $50,000 for each violation if the violation is not corrected properly (subject to a maximum penalty of $1,500,000 during a calendar year). These changes are immediately effective (i.e., they are in effect today) and represent a dramatic increase in the penalties under HIPAA.
In addition, state attorney generals can now bring a HIPAA enforcement action against a covered entity or business associate that violates these rules. Further, the state attorney general can obtain attorney's fees under such an action (although the attorney's fees are discretionary and not mandatory).
HHS - the main enforcer of HIPAA - now is required to conduct "periodic audits" to ensure that both business associates and covered entities are compliant with these new rules. Audits were possible under the old regulations. However, audits tended to be fairly rare, perhaps due to a lack of funding at HHS. Now, some monetary penalties or settlements collected by HHS are transferred to HHS's Office of Civil Rights to be used for purposes of enforcing HIPAA. This appears to solve the funding issue that HHS had apparently experienced. Thus, clients can expect to see increased HIPAA audits and enforcement.

So what does all this mean for the independent MT contractor and mom-and-pop transcription provider, not to mention regional and national MT service providers? While we don't yet know what the final HHS guidelines will look like, it seems clear to me that a whole boatload of new liability has just been dumped on MTs, whether we're ready for it or not. I'll be following the progress of the HHS rule-setting process with great interest, and will report back as new information becomes available.