Honorable Mention

2002 Doctors' Writing Contest

Faster, cheaper transcription

When his service announced it was raising its rates, the author found a better deal.

By Pratik S. Pradhan, MD
ENT Specialist/Norwood, MA

The eight otolaryngologists in our group rely heavily on dictation to correspond with referring physicians. Like many practices, we had been outsourcing our medical dictation to a local transcription company. Turnaround time—even with a courier service to speed delivery—averaged one to two weeks.

For 2001, the company decided to increase its rates nearly 17 percent, from 12 cents to 14 cents a line. Granted, a two-cent increase doesn't sound like much, but as a group, it meant we'd be spending about $135,000 on transcription costs for the year. That made it one of our single biggest expenses, approaching the costs of our malpractice premiums and rent.

We discussed several options. We could dictate less and write more notes by hand; but, most of us found it quicker and cleaner to dictate. Or we could buy voice-recognition software. But since none of the programs we examined could handle names and addresses well, we felt we'd have to spend too much time editing the files manually.

Our ideal solution would be to find a similar transcription system at a more reasonable cost. I searched the Internet and found 40 to 50 transcription companies that were "Internet-based," with most located overseas. These firms charged rates from seven to nine cents per line, with a one- to two-day turnaround. After narrowing the field to 15 companies, we chose the one with the best combination of price, service, and turnaround. Moreover, it had a US-based office for support and technical assistance.

Next, we purchased handheld digital voice recorders, for $275 each, directly from the transcription company. The company also sold us inexpensive memory cards for the recorders, and card reading drives that allowed files to be transferred to our computers. We initially set up two of our five offices, purchasing a separate computer and high-speed printer for each. Altogether, we spent about $2,600 per office on these items.

One of our physicians tested the system. After two weeks, he happily reported that the new transcription service was as accurate as the old one, but a lot faster. We were getting transcriptions within two days! Over the next six months, we phased in the remaining seven physicians to the new service.

How does the new system work? Each physician dictates notes on a digital voice recorder that functions much like a tape recorder. When the physician is finished, he removes the memory card and inserts it into a reader connected to a computer. The voice file is then copied and sent over the Internet to the transcription company.

Most of these outfits—located in countries such as India, Malaysia, and the Philippines—employ skilled English-speaking medical transcriptionists. Their wages and overhead are much lower than they are in the US, and this translates into direct cost savings: In our experience, charges are one-third to one-half less than those of US-based companies.

When our India-based transcriptionists finish with our files, they send them back to us over the Internet as Microsoft Word documents, which can then be printed, mailed, and filed. The entire process is conducted using encryption technology that exceeds government mandates for patient confidentiality under the Health Insurance Portability and Accountability Act (HIPAA).

Overall, our group's transition has gone fairly smoothly. Nevertheless, there are some things you should be aware of if you're considering a similar system for your practice.

First, you'll need to invest thousands of dollars in digital recorders, computers, printers, and related equipment. In our case, though, we recouped these costs after only a few months.

Second, employees need to be trained in how to copy, upload, download, and print files. This averaged a few hours per employee. For the doctors, the learning curve was much shorter: It took each of them just 30 minutes to an hour to get the hang of the digital recorders.

Finally, it may take some time to establish a good Internet connection. It took us more than two months to get a high-speed DSL line to one of our offices, although part of the problem had to do with compatibility issues with our phone system. In addition, we discovered that our second office wasn't eligible for any type of reasonably priced high-speed Internet service due to its distance from the central telephone office. Unfortunately, we had to settle for a regular dial-up service. While usable, it takes nearly 20 minutes to transfer a 30-minute voice file.

There were other minor problems, too. Once in a while, a patient visit was missing from a day's dictation because the transcriptionist overlooked it. We eliminated this problem by carefully matching the number of patient visits in a day to the number of files returned to us. Another glitch concerned a bug in Windows 2000 that caused an occasional dictation file to be deleted. Fortunately, this problem went away when we upgraded our computers to Windows XP.

With reimbursements decreasing and documentation requirements increasing, it's heartening to see a real-world technology that both improves patient care and reduces cost. After 15 months of using Internet-based medical transcription, our group has been very satisfied. The quick turnaround has been extremely helpful when a patient's visits are close together, or when a covering physician needs to review the chart. In addition, referring physicians are receiving updates approximately one week after we see patients, rather than the two to three weeks it had taken previously.

Lastly, our transcription charges for 2002 were half what they had been the previous year; we saved more than $67,000. We've also reduced total overhead by nearly 3 percent, in essence giving each physician in our group an $8,000 raise.

Who says it doesn't pay to watch your pennies?

Questions to ask

Finding medical transcription companies is easy. Colleagues are eager to share information about the services they use, and the Internet can turn up dozens of others. For instance, I found plenty of companies, based in the US and abroad, by searching Google ( www.google.com) for "internet medical transcription."

Narrowing the field and selecting one was the hard part. Eventually, we hired a firm called WorldTech USA, but not before I had asked pointed questions of several companies—about their track record, infrastructure, costs, and turnaround times. Here are some of the most important ones.

• How many physicians are currently using your service?

• Could you give me at least two physician references in the US?

• Do you use secure servers to store and send transcriptions?

• Do your systems meet the patient confidentiality mandates required under HIPAA?

• Approximately how much do you charge per line?

• What's the average turnaround time?

• Can we create templates for routine or repetitive portions of our notes?

• Do you offer a no-cost or low-cost trial period?

• Do you have a US-based contact person?

Pratik Pradhan. Faster, cheaper transcription.

Medical Economics

May 23, 2003;80:54.