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The Continuing Relevance of MedicalTranscription in Health Care
All information methods and concepts contained in or disclosed by this documentare proprietary to Multimodal Technologies Inc. By accepting this material the
recipient agrees that this material as well as the information and conceptscontained therein will not be reproduced in whole or in part without expresswritten permission from Multimodal Technologies, Inc. Use of M*Modal toolsor information is subject to the terms of a legal agreement between the user
and M*Modal.
Lynn [email protected]
Management for the Modern MTSOhttp://mmodal2.wordpress.com
Excellence in Health Informationhttp://community.advanceweb.com
/blogs/hi_18/default.aspx
Company Confidential
Management for the Modern MTSOhttp://mmodal2.wordpress.com
Excellence in Health Informationhttp://community.advanceweb.com
/blogs/hi_18/default.aspx
Agenda The state of medical transcription and speech
recognition today The new best practices for adoption and use Measuring success - Using the right metrics at the right time for
the right purpose A comparison of a 2006 AHIMA presentation given by this
speaker with what her message is today.
Dictation as the Key to Adoption and Acceleration Narrative documentation in an electronic world.
Company Confidential
The state of medical transcription and speechrecognition today The new best practices for adoption and use Measuring success - Using the right metrics at the right time for
the right purpose A comparison of a 2006 AHIMA presentation given by this
speaker with what her message is today.
Dictation as the Key to Adoption and Acceleration Narrative documentation in an electronic world.
Lynn Kosegi
Relevance in Today’s HIM WorldMedical transcription1. Is part of HIM2. Supports Meaningful Use, ICD-10
conversion, NLP and CAC3. Must provide documentation that is
valuable and useful; not cheap4. Must focus on quality of content5. Can support options and flexibility6. Can be cost-effective without sacrificing
MT payCompany Confidential
Medical transcription1. Is part of HIM2. Supports Meaningful Use, ICD-10
conversion, NLP and CAC3. Must provide documentation that is
valuable and useful; not cheap4. Must focus on quality of content5. Can support options and flexibility6. Can be cost-effective without sacrificing
MT pay4
What I’ve Learned…2006… Carefully Select
physicians Carefully Select MTs Low to mid producers No high producers
“As Dictated” Physicians must
change habits
Now… Bring ‘em on – let the
technology select thephysician All MTs – Editing IS
transcription Requirements per
meaningfuldocumentation
Company Confidential
2006… Carefully Select
physicians Carefully Select MTs Low to mid producers No high producers
“As Dictated” Physicians must
change habits
Now… Bring ‘em on – let the
technology select thephysician All MTs – Editing IS
transcription Requirements per
meaningfuldocumentation
Transcription is part of HIM…
6
Opposing needs
Enterprise need for structured andencoded data Physician’s need for a fast and easy way
to capture information Care givers’ need for context,
communication, and collaboration
Company Confidential
Enterprise need for structured andencoded data Physician’s need for a fast and easy way
to capture information Care givers’ need for context,
communication, and collaboration
Lynn Kosegi
Company ConfidentialLynn Kosegi8
Transcription and the HIMRe-connect with your HIM roots! What are the documents used for? Are they used for coding? If not, why? What works? What’s missing? “What can I do to make this document
more useful?”
Company Confidential
Re-connect with your HIM roots! What are the documents used for? Are they used for coding? If not, why? What works? What’s missing? “What can I do to make this document
more useful?”
9
ICD-10
More specificity Extensive training Decreased productivity – 50% Learning curve Hybrid phase
Loss of “super bills” Loss of staff – attrition
Company Confidential
More specificity Extensive training Decreased productivity – 50% Learning curve Hybrid phase
Loss of “super bills” Loss of staff – attrition
Speaker Name
GEMsGeneral Equivalence Mappings No direct mappings From SNOMED to ICD-9 Many to one relationship
ICD-9 to SNOMED – Not semantically equal; One to many
From SNOMED to ICD-10 More granular but still not one-to-one
Specificity requirements
Company Confidential
General Equivalence Mappings No direct mappings From SNOMED to ICD-9 Many to one relationship
ICD-9 to SNOMED – Not semantically equal; One to many
From SNOMED to ICD-10 More granular but still not one-to-one
Specificity requirements
Lynn Kosegi
Company Confidential12
AHIMA. "Putting the ICD-10-CM/PCS GEMs into Practice." Journal ofAHIMA 81, no.3 (March 2010): 46-52.
Retain the Narrative
Availability of context and concepts Application of rules for coding Retain use of encoders Retain and improve familiar workflow Increase ease of use Decrease learning curve Increase adoption
Company Confidential
Availability of context and concepts Application of rules for coding Retain use of encoders Retain and improve familiar workflow Increase ease of use Decrease learning curve Increase adoption
Lynn Kosegi
Increased information demands
14
Industry Stressors
Increased demand for information ICD-10 Meaningful Use Core measures, PQRS
More difficult methods of informationcapture Direct data entry Front-end speech recognition
Company Confidential
Increased demand for information ICD-10 Meaningful Use Core measures, PQRS
More difficult methods of informationcapture Direct data entry Front-end speech recognition
Lynn Kosegi
Information Demands
ICD-10: Specificity ~5 times the number of codes From 2011 CAC summit: One ICD-9 code with >7,500 ICD-10 mappings!
Impact on direct-data entry
Company Confidential
ICD-10: Specificity ~5 times the number of codes From 2011 CAC summit: One ICD-9 code with >7,500 ICD-10 mappings!
Impact on direct-data entry
Lynn Kosegi
Information Demands Meaningful Use Problem list “Problems” versus billable diagnoses Medications
Quality Core measures PQRS – CMS integration into Meaningful Use
reporting
Clinical Decision Support Patient-facing summary
Company Confidential
Meaningful Use Problem list “Problems” versus billable diagnoses Medications
Quality Core measures PQRS – CMS integration into Meaningful Use
reporting
Clinical Decision Support Patient-facing summary
Lynn Kosegi
Road to Adoption
Speech recognition plus MT editing• Efficiencies and cost savings• Cost avoidance• Comprehensive and complete
documentation• High adoption by physicians• Flexibility and options
Company Confidential
Speech recognition plus MT editing• Efficiencies and cost savings• Cost avoidance• Comprehensive and complete
documentation• High adoption by physicians• Flexibility and options
Discrete Data is not enough…
Limited to specific vocabularies - uses Many “standards” – link ICD-9, ICD-10 CPT LOINC RxNorm Radlex SNOMED Accepted standard for interoperability
Company Confidential
Limited to specific vocabularies - uses Many “standards” – link ICD-9, ICD-10 CPT LOINC RxNorm Radlex SNOMED Accepted standard for interoperability
Company ConfidentialSpeaker Name
Company Confidential
The Health Story Perfect foundation for CAC, quality
reporting, clinical decision support HL7/IHE Health Story Consolidation Health Level 7 Integrating the Healthcare Enterprise CDA4CDT HITSP C32/83 CCD Meaningful Use http://www.healthstory.com/pdf/HealthStoryC
onsolidation.pdfCompany Confidential
Perfect foundation for CAC, qualityreporting, clinical decision support HL7/IHE Health Story Consolidation Health Level 7 Integrating the Healthcare Enterprise CDA4CDT HITSP C32/83 CCD Meaningful Use http://www.healthstory.com/pdf/HealthStoryC
onsolidation.pdfLynn Kosegi
CCDContinuity of Care Document Combines ASTM CCR and HL7 CDA XML-based, CDA Specifies encoding and structure for
exchange of patient summary Mandatory narrative – Human interpretation
Encoded data elements
Company Confidential
Continuity of Care Document Combines ASTM CCR and HL7 CDA XML-based, CDA Specifies encoding and structure for
exchange of patient summary Mandatory narrative – Human interpretation
Encoded data elements
23
Narrative DocumentationEnables… Ease of human understanding Quality and compliance Usefulness Enterprise-wide efficiency
……across the continuum of care
Company Confidential
Enables… Ease of human understanding Quality and compliance Usefulness Enterprise-wide efficiency
……across the continuum of care
Lynn Kosegi
Company Confidential
Meaningful Use
The promise…
The EHR will – Improve patient care Reduce costs Improve population health
How?
Company Confidential
The promise…
The EHR will – Improve patient care Reduce costs Improve population health
How?
Speaker Name
Reality Difficult to get information into the EHR More difficult to get it to the PHR Text is of no use Adoption of physician self entry is low Systems designed for the clinician at
point-of-care are not useful for HIM LOTS of paper
Company Confidential
Difficult to get information into the EHR More difficult to get it to the PHR Text is of no use Adoption of physician self entry is low Systems designed for the clinician at
point-of-care are not useful for HIM LOTS of paper
Speaker Name
Quality of Content
28
Most importantly..
It’s not just about productivity
It’s about high-quality, comprehensivedocumentation to support increasingdemands for information….produced in away that happens to be cost-effective
Company Confidential
It’s not just about productivity
It’s about high-quality, comprehensivedocumentation to support increasingdemands for information….produced in away that happens to be cost-effective
Lynn Kosegi
From a Physician at RSNA..after reviewing draft text produced by
M*Modal’s front-end speech using an un-trained profile…
“this is better quality than I’m getting from<unnamed MTSO> MTs…”
If you are not delivering quality, none ofthe other arguments matter.
Company Confidential
..after reviewing draft text produced byM*Modal’s front-end speech using an un-trained profile…
“this is better quality than I’m getting from<unnamed MTSO> MTs…”
If you are not delivering quality, none ofthe other arguments matter.
30
Company ConfidentialSpeaker Name
Options and flexibility
32
Key to Adoption
Ease of use for physician Flexibility Options
Comprehensive information Timely Accurate Useful
Company Confidential
Ease of use for physician Flexibility Options
Comprehensive information Timely Accurate Useful
Lynn Kosegi
Dictation and Transcription..
In a new light… The Road to Meaningful Use Ideal capture method for physicians Human understandable information Options, flexibility, and scale Actionable information
Company Confidential
In a new light… The Road to Meaningful Use Ideal capture method for physicians Human understandable information Options, flexibility, and scale Actionable information
Lynn Kosegi
Cost-effectiveness
35
Beyond Speech Rec…Old Way ICs and home-based
workers Flexible scheduling Over staffing Avon-lady MTs Pay by productivity
New Way Employees Assigned schedules Appropriate staffing Career-minded MTs Pay for committed
time and quality
Company Confidential
Old Way ICs and home-based
workers Flexible scheduling Over staffing Avon-lady MTs Pay by productivity
New Way Employees Assigned schedules Appropriate staffing Career-minded MTs Pay for committed
time and quality
Changing Face of DocumentationMedical Transcription is competing with:• Front-end speech recognition• EHR – Direct entry• Front-end speech rec• Templating• Direct data entry
Hospitals are looking for the most cost-effective solution…
Company Confidential
Medical Transcription is competing with:• Front-end speech recognition• EHR – Direct entry• Front-end speech rec• Templating• Direct data entry
Hospitals are looking for the most cost-effective solution…
Lynn Kosegi
Company ConfidentialSpeaker Name
The Career-Minded MT Professionalism Remote workers Scheduling Productivity based pay The Independent Contractor The “hobby MT” I’m not budging
Compensation Training and education Credentialing
Company Confidential
Professionalism Remote workers Scheduling Productivity based pay The Independent Contractor The “hobby MT” I’m not budging
Compensation Training and education Credentialing
39
Lessons from the SummitSpeech Recognition Eliminate MTs Decrease MT pay Use lesser-skilled,
lower paid MTs “As dictated” It’s all about the $$$
CAC CAC for “mundane”
coding Elevate lower-skilled
coders Retain highly-skilled
coders It’s all about useful
Documentation
Company Confidential
Speech Recognition Eliminate MTs Decrease MT pay Use lesser-skilled,
lower paid MTs “As dictated” It’s all about the $$$
CAC CAC for “mundane”
coding Elevate lower-skilled
coders Retain highly-skilled
coders It’s all about useful
Documentation
Lynn Kosegi
The Myth of the “% Gained”
Company ConfidentialLynn Kosegi
Company ConfidentialSpeaker Name
Workforce Management
WorkforceManagement
Output –not “%Gain”
Editing –Typing
distribution
HeadcountImpact
Output – not “% Gain”
Editing – Typing distribution
75% rule
Use productive typists
FTE/PTE work assignment
Total efficiency –
Headcount impact
Gap analysis
Assign editing to highproducers
Company Confidential43
WorkforceManagement
FTE/PTEwork
assignment
GapAnalysis
Output – not “% Gain”
Editing – Typing distribution
75% rule
Use productive typists
FTE/PTE work assignment
Total efficiency –
Headcount impact
Gap analysis
Assign editing to highproducers
Performance Management
EffectiveTraining
WeeklyMentoring
FinalDocumentQuality
• Monitor final quality
• Effective training
• Ongoing Mentoring
• Basic editing skills
• Can your MTEs quickly –
• Create sections/subsections
• Create numbered lists
• Replace incorrect text
• Insert text
Company Confidential44
Performance
Management
WeeklyMentoring
Most-CommonEdits
KeyboardShortcuts
FinalDocumentQuality
• Monitor final quality
• Effective training
• Ongoing Mentoring
• Basic editing skills
• Can your MTEs quickly –
• Create sections/subsections
• Create numbered lists
• Replace incorrect text
• Insert text
Cost of the IC Linda Yaniszewski from ExecuScribeAfter changing from IC to employees –
“Results were communicated back to the entire team:• Morale improved.• There was a new sense of company loyalty.• MTs began “fighting” for work.• Company profits increased.• Everyone was able to do more with less”
http://bit.ly/e7YiQICompany Confidential
Linda Yaniszewski from ExecuScribeAfter changing from IC to employees –
“Results were communicated back to the entire team:• Morale improved.• There was a new sense of company loyalty.• MTs began “fighting” for work.• Company profits increased.• Everyone was able to do more with less”
http://bit.ly/e7YiQI45
Hospital versus Service MTs
Employee versus IC FT versus PT Enforced schedule vs “Oprah Effect” Training vs “throw it over the fence” Management vs 100 MTs/supervisor Optimization vs invisibility Doctors forced to accept change vs
invisible to doctors
Company Confidential
Employee versus IC FT versus PT Enforced schedule vs “Oprah Effect” Training vs “throw it over the fence” Management vs 100 MTs/supervisor Optimization vs invisibility Doctors forced to accept change vs
invisible to doctors
Commoditization“I’ll do the same thing cheaper” vs“I’ll add value to your documentation”
Given a choice, would you pay more toone electric company than to another? Who cares about the electric company as
long as the lights are on? You all know which companies(y) will
survive if you all become the electriccompany.
Company Confidential
“I’ll do the same thing cheaper” vs“I’ll add value to your documentation”
Given a choice, would you pay more toone electric company than to another? Who cares about the electric company as
long as the lights are on? You all know which companies(y) will
survive if you all become the electriccompany.
47
Service Level Options Lowest Cost Line Optimal Cost Reduction
Meaningful Clinical Document Useful clinical documentation EMR readiness Useful documentation
Premium Service Retention of demanding difficult customer Customization Keeping speech invisible
Company Confidential
Lowest Cost Line Optimal Cost Reduction
Meaningful Clinical Document Useful clinical documentation EMR readiness Useful documentation
Premium Service Retention of demanding difficult customer Customization Keeping speech invisible
48 M*Modal Proprietary and Confidential
Speech Technology and PricingWarning! Beware of demands for customization at
the price of a low-cost line Don’t provide a Cadillac for the price of a
bicycle
Educate customers about what they arepaying for Would they rather pay for – Physician specific preference Meaningful Clinical Documents
Company Confidential
Warning! Beware of demands for customization at
the price of a low-cost line Don’t provide a Cadillac for the price of a
bicycle
Educate customers about what they arepaying for Would they rather pay for – Physician specific preference Meaningful Clinical Documents
49
Appropriate Pricing
Know what your customer wants Know what you want to sell Price accordingly Pay MTs accordingly
Every other industry in the worldunderstands this concept!
Company Confidential
Know what your customer wants Know what you want to sell Price accordingly Pay MTs accordingly
Every other industry in the worldunderstands this concept!
50
Would you charge the same for a Jetta asyou would for this?
Company Confidential51
Quest for Semantic Interoperability
Company Confidential52
Discrete Data Elements
Discrete data points are not enough Narrative documentation provides – Ease of use for physicians Cost efficiency for facility Comprehensive information for HIM Expressiveness required for communication Encoded data for reporting
Company Confidential
Discrete data points are not enough Narrative documentation provides – Ease of use for physicians Cost efficiency for facility Comprehensive information for HIM Expressiveness required for communication Encoded data for reporting
Lynn Kosegi
From Detlef Koll, CTO and VP of Research andDevelopment, M*Modal
“We already have semantic interoperability inhealth information today. Narrative notes arethe one form of documentation that can beunderstood by every human in the patientcare team, including the patient himself…”
Company Confidential
From Detlef Koll, CTO and VP of Research andDevelopment, M*Modal
“We already have semantic interoperability inhealth information today. Narrative notes arethe one form of documentation that can beunderstood by every human in the patientcare team, including the patient himself…”
54
Questions?
Management for the Modern MTSOhttp://mmodal2.wordpress.com
Excellence in Health Informationhttp://community.advanceweb.com
/blogs/hi_18/default.aspx
Company Confidential
Management for the Modern MTSOhttp://mmodal2.wordpress.com
Excellence in Health Informationhttp://community.advanceweb.com
/blogs/hi_18/default.aspx