The evolution of the transcription dates back to 1960s. The
systems were designed to assist the manufacturing process. The
first transcription that was developed in this process happens
to be MRP (Medical Resource Planning) in the year 1975. This was
followed by another advanced version namely MRP2 which is the
acronym for Manufacturing Resource planning. None of them
yielded the benefit of Medical Transcription.
However, transcription equipment has changed from manual typewriters to electric typewriters to word processors to computers and from plastic disks and magnetic belts to cassettes and endless loops and digital recordings. Today, voice recognition system (VRS) is increasingly being employed, with medical transcriptionists and or "correctionists" providing supplemental editorial services, although there are occasional instances where VRS fully replaces the MT. Natural language processing takes "automatic" transcription a step further, providing an interpretive function that speech recognition alone does not provide (though MTs do).
In the past, these reportings consisted of very abbreviated handwritten notes that were added in the patient's file for interpretation by the primary physician responsible for the treatment. Ultimately, this mess of handwritten notes and typed reports was consolidated into a single patient file and physically stored along with thousands of other patient records in a wall of filing cabinets in the medical records department. Whenever the need arose to review the records of a specific patient, the patient's file would be retrieved from the filing cabinet and delivered to the requesting physician. To enhance this manual process, many medical record documents were produced in duplicate or triplicate by means of carbon copy.
In recent years, things have changed considerably. Filing cabinets have given way to desktop computers connected to powerful servers where patient records are processed and archived digitally. This digital format allows for immediate remote access by any physician who is authorized to review the patient information. Reports are stored electronically and printed selectively as the need arises. Today we have speedy computers with many electronic references, and we use the Internet not only for web resources but also as our daily working platform. Technology has gotten so sophisticated that MT services and MT departments work closely with programmers and information systems (IS) staff to stream in voice and accomplish seamless data transfers through network interfaces. In fact, many healthcare providers today are enjoying the benefits of handheld PCs or personal data assistants (PDAs), and are now utilizing software on them for dictation.
With all that has changed, some things have not. The conversion of spoken medical language to text is a craft that is difficult to learn and takes time to perfect. Some individuals have a "knack" for it; some will never get it. Technology can and does assist in many ways, but transcription still comes down to people. Even with the transition of MTs to editors for VRS documents, medical language interpretation skills will still be imperative for a quality report. MTs welcome this transition as an editor for VRS documents.
Overview
Traditional medical transcription is a form of document creation that the medical industry considers outdated, but necessary as a means of providing the necessary documentation needed to satisfy regulatory and insurance provider requirements. The practice of Modern Medicine dictates that the physicians spend more time serving patient needs than creating documents in order to make financial ends meet. More modern methods of document creation are being implemented through the technology of computers and the internet. Voice Recognition (VR) is one of these new-age technologies. With the power to write up to 200 words per minute with 99% accuracy Voice Recognition has freed physicians from the shackles of traditional transcription services.
Pertinent, up-to-date, confidential patient information is converted to a written text document by a medical transcriptionist. This written text may be printed (and hand placed in the patient's record, archived, and/or retained only as an electronic medical record). Medical transcription can be performed in a hospital, via remote transmission to the hospital, or directly to the actual providers of service (doctors or their group practices) in off-site locations. Hospital facilities often prefer electronic storage of medical records due to the sheer volume of hospital patients and the accompanying paperwork. The electronic storage in their database gives immediate access to subsequent departments or providers regarding the patient's care to date, notation of previous or present medications, notification of allergies, and establishes a history on the patient to facilitate healthcare delivery regardless of geographical distance or location.
The term transcript or "report" as it is more commonly called, is used as the name of the document (electronic or physical hard copy) which results from the medical transcription process, normally in reference to the healthcare professional's specific encounter with a patient on a specific date of service. This report is referred to by many as a "medical record". Each specific transcribed record or report, with its own specific date of service, is then merged and becomes part of the larger patient record commonly known as the patient's medical history.
Medical transcription encompasses the MT, performing document typing and formatting functions according to an established criteria or format, transcribing the spoken word of the patient's care information into a written, easily readable form. MT requires correct spelling of all terms and words, (occasionally) correcting medical terminology or dictation errors. MTs also edit the transcribed documents, print or return the completed documents in a timely fashion. All transcription reports must comply with medico-legal concerns, policies and procedures, and laws under patient confidentiality.
In transcribing directly for a doctor or a group of physicians, there are specific formats and report types used, dependent on that doctor's specialty of practice, although history and physical exams or consults are mainly utilized. In most of the off-hospital sites, independent medical practices perform consultations as a second opinion, pre-surgical exams, and as IMEs (Independent Medical Examinations) for liability insurance or disability claims. Private practice family doctors rarely utilize a medical transcriptionist, preferring to keep their patient's records in a handwritten format.
Currently, a growing number of medical providers send their dictation by digital voice files, utilizing a method of transcription called speech or voice recognition. Speech recognition is still a nascent technology that loses much in translation. For dictators to utilize the software, they must first train the program to recognize their spoken words. Dictation is read into the database and the program continuously "learns" the spoken words and phrases.
Poor speech habits complicate the process for both the MT and the recognition software. An MT can "flag" such a report as unintelligible, but the recognition software will transcribe the unintelligible word(s) from the existing database of "learned" language. The result is often a "word salad" or missing text. Thresholds can be set to reject a bad report and return it for standard dictation, but these settings are arbitrary. Below a set percentage rate, the word salad passes for actual dictation. The MT simultaneously listens, reads and "edits" the correct version. Every word must be confirmed in this process. The downside of the technology is when the time spent in this process cancels out the benefits. The quality of recogniton can range from excellent to poor, with whole words and sentences missing from the report. Not infrequently, negative contractions and the word "not" is dropped all together. Voice recognition is similar to the voice prompts one hears on dialing "411", when information provides the wrong number and charges for the "411" call. These flaws trigger concerns that the present technology could have adverse effects on patient care. Control over quality can also be reduced when providers choose a server-based program from a vendor Application Service Provider (ASP).
Downward adjustments in MT pay rates for voice recognition are controversial. Understandably, a client will seek optimum savings to offset any net costs. Yet vendors that overstate the gains in productivity do harm to MTs paid by the line. Despite the new editing skills required of MTs, significant reductions in compensation for voice recognition have been reported. Reputable industry sources put the field average for increased productivity in the range of 30%-50%; yet this is still dependent on several other factors involved in the methodology. Metrics supplied by vendors that can be "used" in compensation decisions should be scientifically supported.
Another unresolved issue is high-maintenance headers that replace simple interfaces to become the "platform" of choice. Pay rates should reflect this lost-opportunity cost for the MT.
Operationally, speech recognition technology (SRT) is an interdependent, collaborative effort. It is a mistake to treat it as compatible with the same organizational paradigm as standard dictation, a largely "standalone" system. The new software supplants an MT's former ability to realize immediate time-savings from programming tools such as macros and other word/format expanders. Requests for client/vendor format corrections delay those savings. If remote MTs cancel each other out with disparate style choices, they and the recognition engine may be trapped in a seesaw battle over control. Voice recognition managers should take care to ensure that the impositions on MT autonomy are not so onerous as to outweigh its benefits.
Medical transcription is still the primary mechanism for a physician to clearly communicate with other healthcare providers who access the patient record; to advise them on the state of the patient's health and past/current treatment; to assure continuity of care. More recently, following Federal and State Disability Act changes, a written report (IME) became a requirement for documentation of a medical bill or an application for Workers' Compensation (or continuation thereof) insurance benefits based on requirements of Federal and State agencies.