August 2013

NEMT, ChartNet to Provide SR Externship
By Tara Courtland
For The Record
Vol. 25 No. 11 P. 6

It’s no secret that medical transcriptionists are struggling to stay relevant in a rapidly changing industry. For many, that means moving from transcription to speech recognition editing. However, for students just starting school, there’s one problem: There’s no easy way to get real-world speech recognition experience—until now.

This spring, ChartNet Technologies and New England Medical Transcription (NEMT) teamed up to provide free speech recognition training to students, a development that could remove a longstanding barrier for industry hopefuls.

“It’s really been a problem,” says Paula Goode, a transcription instructor at Sheridan Technical Center in southeast Florida. “Speech recognition training is cost prohibitive for educators and students. Most schools just can’t afford the technology for the intense on-the-job training type of practicum the students need.”

How It Works
Speech recognition generally has two fees, explains Curt Hupe, director of operations for ChartNet. The first is the per user licensing fee, paid to a platform owner such as ChartNet. The second is a per minute audio fee, paid to a software provider such as Nuance.

In a professional environment, the transcription company pays the fees and includes the cost in its pricing plan for clients. But schools don’t have that luxury; they’d have to pay both parts of the fee and pass the cost on to the students. “We can’t do that,” Goode says. “It’s too much money for students, especially at public schools. So speech recognition is just something we haven’t been able to offer.”

NEMT and ChartNet are solving that problem by absorbing the costs. “This is just something that we as an industry need to start doing,” says NEMT President Linda Allard, CHPS. “We all spend a lot of time worrying about our future. This is how we secure it: by planning ahead for the next generation of workers and technology.”

NEMT already has a successful externship program where transcription students can receive real-world experience typing reports for real physicians as part of their coursework. The NEMT-ChartNet venture is an expansion of that program. In addition to transcription, the externs will now learn speech recognition as well. “ChartNet is waiving the licensing fee, and we’re providing all of the mentoring and assistance through our staff,” Allard says. Both companies will absorb the per-minute audio costs, according to Linda Sullivan, CEO of NEMT.

The initiative has gained support in transcription circles. “This is a really big deal for the industry,” says Betsy Ertel, CEO of SpeedType and steering committee chair for the Association of Healthcare Documentation Integrity’s (AHDI) Educators Alliance. “A number of companies train interns on speech recognition, but those are interns—they’re already committed to working for the company and are just being pretrained before beginning work. What NEMT and ChartNet are doing is teaching it earlier. They’re providing the training to externs who haven’t even finished school yet.”

Ertel adds that the collaboration offers a one-of-a-kind opportunity. “There is essentially no other way for students to get this experience,” she says. “The NEMT program is unique in that it works with schools rather than trying to compete with them. It’s basically a free add-on for school curricula.”

Allard plans for the NEMT program to be up and running by the fall using the existing externship process. Teachers at AHDI-approved schools will recommend their best transcription students for an externship. The students then will be processed like any other NEMT worker, completing HIPAA testing and paperwork and essentially learning to function as professional work-from-home transcriptionists.

Students then will access a secure site to transcribe real physician audio files that have been scrubbed of all protected health information. Once the reports are transcribed, the students will send them to their teachers, not to NEMT managers. “That’s been the key to making this cost-effective for the transcription company,” Allard says. “There’s a lot of time and effort in the setup, but the day-to-day mentoring and grading is done by the teachers, not by our staff. The intensive staff time has traditionally been what’s kept companies from adopting traditional student internships.”

Once the externship is complete, the teachers send the top students to Allard to test for paid positions at NEMT. Those who pass are given work transcribing for the same accounts and physicians with which they externed. This gives them an advantage, Allard says, helping them to be more productive and successful from the beginning while creating repetitive shortcuts along the way.

The only difference in the speech recognition part of the externship is that NEMT managers and mentors will provide the day-to-day editing and grading. “That’s something that works better coming from the company,” Goode says. “Since the speech recognition is software specific, the transcription company is in a better position to grade and edit.”

The software provider is not waiving the per-minute audio fees, so NEMT and ChartNet have committed to pay them on their own.

Possible Outcomes
Allard says that while NEMT hopes the best students will later join NEMT as skilled speech recognition editors, that’s not the objective. “It will cost us more than we gain from it,” she says. “There’s no way around that, so we look at it as part of our service work to the industry.”

Hupe says ChartNet has a similar take on the program but hopes that speech recognition providers will come forward and waive their audio fees. Andrew Clarke, IT director for NEMT, agrees: “For the speech recognition provider, there really is a huge benefit. It’s like Apple donating Macintosh computers to classrooms. Those students are trained from the beginning to use those computers and only those computers. When they finish school, what kind of computer do you think they’re going to buy?”

Clarke says speech recognition software works the same way. “There are only a few different programs, but each one is a little different. Opening a file, jumping between sentences, skipping forward—all of the functions are program specific,” he notes. “Editors have a huge advantage if they stick with the software they know.”

However, those proprietary commands are part of the difficulty for educators. Goode considered teaching students using a generic voice program just to give them some experience listening and editing, “but it’s not the same. They won’t use that software in the real world, so it’s not all that useful. The expense is too high without enough payoff.”

For the moment, the NEMT-ChartNet partnership is the only real-world corporate training for speech recognition students. “There are schools that offer speech recognition classes, but that’s coursework in an educational setting,” Ertel says. “It’s akin to going to nursing school: You can memorize the textbook and ace all of your classes but, in the end, you’ve got to work with real patients and real supervisors for your student practicum before you graduate.” The speech recognition externship is that practicum, she says, an important step that will give new graduates a leg up as they try to break into a tight job market.

A Shot in the Arm
For Sullivan, a 23-year veteran of the clinical documentation industry, bringing in new blood is vital. “The most experienced transcriptionists are retiring now, and the advent of EHRs and speech recognition have jolted the entire industry,” she says. “We have got to find a way to bring in new people, both as transcriptionists and as speech recognition editors. It’s not just good business; it’s also good health care.”

 Because speech recognition is a totally different animal, students learning its finer points need all the help they can get, according to Hupe. Transcriptionists type what they hear, more or less verbatim, while speech recognition editors, who are responsible for catching not only computer mistakes but also dictation errors, must have a more thorough knowledge of medicine and anatomy.

“‘Medical transcriptionist’ was already a fairly inaccurate term,” Hupe says. “[They] don’t just type; they also have to comprehend. Now we’ve got speech recognition editors who have to understand even more. It’s a mistake to think that if you just practice typing or editing, you can do this job. These people are medical experts.”

The term “medical language specialist” is much more appropriate for both jobs, Hupe says, especially because, in the end, it doesn’t matter much whether the report is created using transcription or speech editing. “They’re just different ways of reporting the same information,” he says.

— Tara Courtland is a journalist and serves as communications director for NEMT.

Editor’s Note: The NEMT externship program is open to any AHDI-accredited school at no cost. Educators can contact Betsy Ertel at 407-880-2189 or betsy@speedtype.org for information on how to participate.