May 2013

Stem Overflow by Increasing Efficiency
By David Yeager
For The Record
Vol. 25 No. 8 P. 25

Despite a transcription manager’s best efforts, overflow happens. Managing it can be a challenge, but with some judicious planning, stress levels can be reduced. The first step is to recognize why overflow occurs.

Unsurprisingly, the single biggest cause of overflow is lack of coverage in the transcription department. Often administrators believe that it’s cost-efficient to outsource transcription overflow. However, because of the chain of custody that’s required for medical records, outsourcing frequently has a negative effect on turnaround times.

“It was more time consuming for us to send out the work because you had to keep track of what you sent and then log back in what the transcription company sent you,” says Sara Proctor, CMT, who has worked for both hospitals and transcription companies and is immediate past president of the Missouri Association for Healthcare Documentation Integrity (AHDI). “More importantly, you had less control over quality.”

Proctor says the best way to avoid outsourcing is to gather and present supporting data to management. When she worked in a hospital, she compiled reports that tracked workflow over time to demonstrate that it was less expensive to hire additional transcriptionists than to seek help from outside the organization. It was a successful strategy, but it still was necessary to maintain an outsourcing option for emergencies. However, the department was able to cut down on outsourcing while increasing flexibility and quality control.

Finicky Physicians
Still, even with an appropriately staffed department, transcriptionists can process only what they receive. If physicians don’t keep up with their dictation, the transcription department can quickly find itself digesting a large bolus of reports. Although transcription managers have limited influence with physicians, Proctor says there are a few ways to help them stay on top of their dictation.

One effective method is to maintain turnaround times to the greatest extent possible. Although it may seem counterintuitive, physicians who perceive that the transcription department is falling behind will have less of an incentive to keep up with their dictation. Demonstrating that the work can be done on time provides positive reinforcement. Proctor says her department strived to maintain an aggressive timeline of six hours for history and physicals, operative notes, and physician consults, which left doctors with plenty of time to finalize the reports within 24 hours of dictating them.

Physicians reaching out to other physicians also are extremely important to the process. Proctor says a chief of staff who is on board with having dictations completed in a timely manner can help immensely. Physicians who dictate multiple patients on a single file should be directly spoken to since this makes it extremely difficult to spread the work throughout the transcription department, sapping efficiency.

Tough Economics
Unfortunately, the economics of health care require cost cutting wherever possible, which means nearly every department is being asked to do more with less. For transcription managers, that often means finding ways to increase productivity without adding more staff. Debra Hahn, RMT, president of the Kansas AHDI, says it may be a good idea to start training transcriptionists on the technology standards for medical record transfer so they can take a more active role in populating the EHR.

“I think a lot of transcriptionists are not really there yet for the standards like HL7 [Health Level Seven International] and speech and natural language processing as far as going forward into electronic health records,” Hahn says. “And I think that sometimes medical transcriptionists are sort of kept in the dark about that.”

Hahn points out that the transcription workforce is aging, with the average age falling between 40 and 60. In addition to not being exposed to some of the newer technologies, she says many transcriptionists can’t transcribe as fast as they once did. Bringing younger workers into the pool is one way to improve the workforce’s overall efficiency. Toward that goal, the AHDI is working with community colleges and other schools to encourage students to consider a career in medical transcription.

Technology Aids
Quality software also can provide help for overburdened transcriptionists. Proctor says good transcription software frees transcriptionists from spending too much time formatting documents and affords them more opportunities to transcribe text. Word-expanding software that allows some customization can be valuable, too. Phrases and words that are frequently used can be programmed and then inserted with just a few keystrokes. Headings, boldfaced words, and hyphenated words also can be linked to shortcuts.

“I loved it as a transcriptionist when I could make as many entries as I wanted to, and a really good word expander will even let you put an entire report in,” Proctor says. “You need software that allows standard entries for your department yet allows your transcriptionists to customize and name entries themselves because that’s going to help them remember the most without having to consult their list all the time.”

A clean document is another key item. If a transcribed file has numerous errors, it’s harder to efficiently spread that work around the department when overflow occurs because the next transcriptionist will have to make the corrections before proceeding. For this reason, implementing an effective quality assurance program is vital to maintaining efficiency. “For me, an error-free document is very important,” Hahn says. “That makes everyone happy.”

Encouraging transcriptionists to exceed the standard productivity level can spike efficiency even more. Proctor says an incentive program that allows transcriptionists to earn more while still meeting certain quality benchmarks can be a useful tool. She also has had success with work-from-home programs, which eliminate dealing with traffic, weather, and workspace constraints as well as provide more flexibility for transcriptionists and transcription managers who prefer to make their own hours.

“You’re always trying to think of ways to make staff faster,” Proctor says. “You’re always looking for time-savers. The more time you can save, the less [work] you have to send out.”

— David Yeager is a freelance writer and editor.