Medical Transcription: The Dead Moose on the Table
Okay, today I’m going to ask that you stick with me on this discussion because it’s one I think we need to start having and one that I think we’ve kind of avoided in our industry for awhile. So grab your coffee, take a deep breath, hang in there to the end, and then I want to hear your thoughts.
First let me tell you a story. Several years ago when I was on the (then) AAMT Board of Directors, our CEO told us a story about what we came to refer to as the “dead moose on the table.” It went (paraphrased) like this: There’s a big dead moose on the table. Everyone knows it’s there. Yet, nobody talks about it. And the longer no one talks about it, the more it stinks. Yet we continue to ignore it, hoping that both the moose and the stench will go away. Today we might even get out the Fabreze and try to do away with it like that. But in the end, there’s a dead moose, right there in the middle of the table, and unless somebody finally speaks up, the stink is only going to get worse. I believe we have a moose on the table.
Let’s look at some of the things that have happened over the last few weeks in our industry. First, we saw the announcement of the purchase of WebMedx, a medical transcription company, by Nuance, a technology vendor who is very active in the EHR world. The next thing I noticed was that Medquist, a transcription company, purchased M-Modal, a technology vendor. That was followed by the announcement that Transcend, yet another transcription company, purchased Salar, an EHR company. Along with that I saw a couple of other things. In the Medquist press release, the new CEO spoke of rebranding the company and assisting their clients with the move to the EHR. In a webinar sponsored by HIMSS, a representative of Nuance spoke of their plans to work with the IBM Watson technology and also described the “vision” of how documentation would be done by running it through an SRT engine, using natural language processing, which would also attach data tags so that the structured data could be immediately put into the EHR. And, no, transcription was not mentioned in that talk at all.
Now let’s look at what’s happening to the people in our world. In the past two weeks, I have heard more stories than I can even count about good, seasoned, well experienced MTs being laid off from their jobs. Why? Technology means companies can do more with less. And yes, sometimes it’s also because the company is outsourcing more of its work. I hear the stories from MTs who are small business owners of their workload being half of what it was a year ago because of the electronic health record. Schools are challenged with what to do to best prepare their students for sustainable future employment. How do you teach everything we teach now and yet still teach the new technologies that are emerging? Students in programs and who are new professionals in our industry are asking what the future looks like for them as well.
What we hear in the professional associations related to medical transcription is the mantra of the narrative. Now let me first say I think there’s value to the narrative in a medical record. It tells the patient’s story. Both associations are focused on promoting the idea of retaining the narrative as a way to “preserve” the profession, and industry, and perhaps even the organizations themselves. And yet in the background, the EHR is being implemented as the health care industry marches to the beat of meeting things like meaningful use and EHR adoption that, unlike the SRT technology of 10 years ago, isn’t just a nice improvement in productivity, but a mandate from the Federal government. AHIMA has a workgroup working on transcription roles and the EHR, and I imagine we’ll see a report when that’s done. Still, that’s the HIM world deciding for us what we will be and where we might fit. I really wish the transcription associations were this focused on the future and defining new roles.
So for the moose. Here’s what I think the moose is. The EHR is much like the rush we all saw with speech recognition technologies. Some said it would never happen, some said “not in my lifetime, I’ll retire first,” and some just waited for it to happen to them. A few learned the technology early on and that’s probably the group who has done the best with it. Remember, though, this technology was only a “nice productivity enhancer” or “something so you can do the same work with fewer people.” It was not mandated by the government. In 2016, as of right now, healthcare providers will be penalized for not having an EHR and meeting these requirements. Penalized means less money. It will force the stragglers to finally get on board.
I think the moose on the table is that everything points to traditional transcription going away more and more, perhaps until there is very little or none left. Okay, I said it. That means if we only have those skills that we’ve relied on for so many years, the future is going to get pretty scary. The EHR is here today, it’s not going away, and it’s critically important that we address the moose on the table and start figuring out how to do something with it. No amount of “narrative-scented Fabreze” is going to take care of this one.
This post is long. We’re going to do a series of discussions this week about this moose and how we can address it and be better prepared. I’ve watched our industry for a long time and too many times MTs have just let someone else decide their fate. I think it’s time to stop that and start doing something for ourselves. Without some honest, brutal dialogue, that will be tough to do.
So let’s chat. I want to hear your reaction so far. This isn’t a one day discussion so let’s get started!