May 29, 2007

On the Home Front: Mission Medical Transcription
By Kim Buchanan, CMT, FAAMT
For The Record
Vol. 19 No. 11 P. 10

On a sunny April Saturday in Jacksonville, Fla., more than 100 military spouses gathered at the Hyatt Regency Hotel to learn about the medical transcription profession from the industry’s two largest professional associations: the Association for Healthcare Documentation Integrity (AHDI, formerly the American Association for Medical Transcription [AAMT]) and the Medical Transcription Industry Association (MTIA). In a collaborative effort with the U.S. Department of Defense and the U.S. Department of Labor, the AHDI and MTIA spearheaded one of the most ambitious promotional campaigns in the history of either organization.

“Mission Medical Transcription: A Career That Moves With You” is an initiative to attract military spouses into the profession, focusing on the opportunities to work remotely, which fits with the mobile nature of the military lifestyle.

Military spouses will be encouraged to enroll in AHDI-approved medical transcription educational programs. Upon successful completion of school, eligible military spouses can take the entry-level credentialing exam, known as the Registered Medical Transcriptionist exam, which assesses readiness for employment. They can then join the Registered Apprenticeship program, a two-year, federally sponsored program launched by the MTIA earlier this year. This proven “recipe for success” will provide military spouses with a firm foundation to build on.

Why Military Spouses?
The Department of Labor’s Bureau of Labor Statistics expects the employment of medical transcriptionists to grow faster than average through 2014, explaining that the demand for medical transcription services is being spurred, in part, by an aging population. This surge is also driven by the push for electronic medical records at the federal level. President Bush has declared HIT a top priority of his administration and views it as a tool to drive down escalating healthcare costs, decrease medical errors, and improve patient safety.

A 2002 AAMT membership survey revealed that the average age of a medical transcriptionist is 49. “Facing an aging workforce and a critical shortage of qualified medical transcriptionists available to handle the growing demand for healthcare documentation, it is imperative that we identify the next generation of medical transcriptionists,” says MTIA President Jay Cannon. “We believe that military spouses will embrace the opportunity to learn a trade that can literally move with them.”

The initial idea to approach military spouses came from the Department of Labor during the development of the Registered Apprenticeship program. Vince Consoli, director of operations management and human resources at Webmedx, a transcription service provider, and a member of MTIA’s Workforce Development Committee, says, “As part of the Registered Apprenticeship program, we are required to do community outreach. The Department of Labor suggested we work with the Department of Defense because of the number of military spouses looking for portable careers.”

Leslie Slusarski, CMT, started her career as a medical transcriptionist in 1979 when her husband was in the Navy. She identifies with the struggle many military spouses face trying to build a career when they are constantly relocating. “I never worried about finding a job as a transcriptionist, but every time we were restationed, I had to start over at the bottom of the heap,” she says. “Advances in technology have made it much easier to work as a transcriptionist and stay with an employer.”

Military spouses are a unique population that are a natural fit for a mobile career such as medical transcription. Military spouses who are gainfully employed in today’s two-income families are more likely to be satisfied and willing to support their partner’s decision to stay in the military.

“The fact that we can help to increase our workforce while supporting our military families is a win-win for everyone,” says AHDI Executive Director Peter Preziosi, PhD, CAE. “The military spouse initiative will provide military spouses with an opportunity to train for a profession that can grow with them, regardless of where their partners are deployed, and will help them to build a pool of skilled transcriptionists to take us into the future.”

— Kim Buchanan, CMT, FAAMT, is director of credentialing and education at the AHDI.

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Wide Gap Between E-prescribing Vision and Reality
Some physicians who have embraced e-prescribing report barriers to using advanced e-prescribing features that many advocates believe offer the greatest potential to improve the safety and quality of healthcare, according to a study by the Center for Studying Health System Change (HSC) researchers published recently in Health Affairs.

“The gap between policy makers’ vision for e-prescribing to improve the safety, quality, and efficiency of care and the reality in physician practices is pretty wide,” says lead author Joy M. Grossman, PhD, a senior health researcher at HSC, a nonpartisan policy research organization funded principally by the Robert Wood Johnson Foundation.

While physicians were positive about the basic features of e-prescribing, products often lacked advanced features, or, if they had them, physicians often did not use them because of implementation hurdles or their perceptions that the features did not add value, according to Grossman and coauthors Anneliese Gerland, an HSC health research analyst; Marie C. Reed, a former HSC health researcher; and Cheryl Fahlman, a former HSC health researcher now with Mathematica Policy Research.

Advanced e-prescribing features include the ability to maintain complete patient medication lists; clinical decision-support tools, including alerts and reminders; access to patient-specific formulary data; and capacity for two-way electronic communication between the medical practices and pharmacies and pharmacy benefit managers (PBMs) to send prescriptions, clarifications, and renewal requests.

The Health Affairs article, titled “Physicians’ Experience Using Commercial E-Prescribing Systems,” is based on 44 discussions conducted between November 2005 and March 2006 with representatives of 26 organizations, including 15 medical practices using e-prescribing, six medical practices without e-prescribing, health plans, e-prescribing vendors, and pharmacies. Two thirds of the practices used the e-prescribing module of an electronic medical record, while the remainder used stand-alone systems. Most practices had different technology vendors.

Key study findings include the following:

• Challenges to maintaining complete patient medication lists. Most physicians were able to use e-prescribing systems to access prescriptions written by other physicians in their practice. But none were able to access comprehensive lists of patients’ medications prescribed outside their practices. As a result, physicians continued to rely on patients as the main source of information to complete medication lists.

• Limited use of clinical decision support. All but one of the practices’ e-prescribing systems offered some clinical decision support in the form of drug-drug interaction alerts. However, access to more advanced clinical decision support was limited; approximately one half of practices reported being able to check for drug-allergy interactions, and only 20% for drug-condition contraindications. There was general agreement that pop-up alerts were triggered too easily. As a result, physicians typically overrode them.

• Difficulty obtaining accurate patient-specific formulary information. Physicians in slightly more than one half of the practices did not have electronic access to formulary data because either the systems did not have the feature or the practice had chosen not to enable it. In the practices where physicians had access to formulary information, respondents pointed out information was available for only a subset of patients, with estimates ranging from 25% to 90%. Even when information was available, practices often questioned the data’s reliability. Physicians’ views varied on the value of the formulary information, and, in many practices, physicians routinely ignored it.

• Limited connectivity with pharmacies and mail-order PBMs. Only the practices with stand-alone e-prescribing systems were using electronic data interchange that allows electronic transmission between computers in the physician practice and those in the pharmacy or PBM. Local pharmacies’ lack of readiness was cited as a barrier to full electronic transmission.

• Challenges continue after initial implementation. Practices were not prepared for the amount of interaction needed with outside parties, such as vendors, state regulators, and local pharmacies, to implement and maintain the system. Practices continued to devote staff resources for maintenance well after e-prescribing products were in use.

— Source: Center for Studying Health System Change