I wrote an article titled 2001: A Transcription Odyssey that was published in the July-August 2000 issue of the Journal of the American Association for Medical Transcription (JAAMT). It’s now 10 years later, a good time to revisit that article and some of the predictions I made.

Unfortunately, I don’t have the original draft I had submitted, which got sent back to me for some editing because the PTB at AAMT didn’t feel I was being positive enough about the future outlook for medical transcription. That draft would have more accurately pinpointed my predictions for the industry and how I felt about the future of medical transcription. With that caveat…

Although many transcriptionists work through the internet, they may be unaware of the scope of technological changes and the jockeying for position currently taking place. Many see a threat from offshore labor, when they should be looking at the technology that resides on their own desktop. The very tools we use to enhance productivity are also available to the computer-literate physician, especially if packaged nicely and marketed aggressively by a far-sighted company. The advertising claims that physicians can replace their transcriptionists are not far-fetched. Some physicians have, in fact, done just that and are perfectly satisfied with the results. The number will increase exponentially over time, in much the same way the technology has advanced. Transcriptionists need to prepare themselves to work within the new model of  business that will be created by the available technology and the changing environment of business brought about by the internet.

I’m pretty sure that last sentence was part of the edit. Notice that I don’t say HOW MTs need to adapt. Quite frankly, if memory serves, I couldn’t think of a way they could that would keep them in this picture. After all, I just predicted that technology would give physicians more tools to facilitate reducing or completely eliminating medical transcription.

At the time the article was written, the AMA reported that 59% of physicians weren’t even using computers. I wasn’t able to find a recent study, which suggests to me that there’s an assumption that medical practices and healthcare facilities are using computers, including mobile devices.

My updated prediction is that this trend will continue and we’ll see an even bigger spike as more computer-literate physicians enter practice. They will not only be less resistant to entering data into the computer directly, they’ll be more proficient at it than their predecessors.

I also predict that as more computer-literate patients enter the system, and as technology advances, we’ll see patients entering their history directly into an EMR, either at the doctor’s office or online. Or, if interoperability issues are resolved, retrieved from a PHR. I predict updates will take place the same way, so you can review the history the physician or facility has for you and enter any updates or changes. As EMRs evolve and improve, the information you give the doctor will be available to any other facilities or offices in the system. There are already systems that share information with providers across the system. As always, the technology will only improve over time. Young adults who have used computers most or all of their life won’t wonder why they’re being asked to type in this information themselves – they’ll wonder why it isn’t available, or why they have to enter the same information multiple times in multiple places. I think there will even come a point when speech-to-text is so accurate that this data entry will take place in the form of speech, combined with touch screen and keyboarding.

A new tool becoming available to the individual transcriptionst and smaller business owners is the application service provider (ASP)… The purpose is to provide an “enterprise” solution for physicians (in plain English – one-stop shopping). By giving physicians access to something everyone knows they utilize, the portals hope to entice them to take advantage of other services and/or goods being sold through the portal. The advantage an ASP can give transcriptionists as a by-product is more equal footing with the large services. Access to both physicians and other transcriptionists becomes a possibility, at a price that is not beyond reach. It will no longer be necessary to take a deep breath, hyperventilage, then sign a five-year lease agreement for $ 60,000 worth of digital dictation equipment that will be obsolete before the lease is up. ASP networking will allow transcriptionists to work with each other to coordinate coverage for peak periods and time off… The ASP model provides state-of-the-art networking and upgrades inclusive with the other services offered.

I’m not sure the ASP model has been of great benefit to the independent MT, working solo or in small groups to provide service to select physicians. I think it has been of benefit to small transcription services looking for growth opportunities. In the past ten years, a model used by some ASPs is to do the marketing and sales, then contract with various independent MTs and small MTSOs to perform the work. In this scenario, the ASP sets the price to the client, not the MT or the MTSO. Like everything else, the ASP market has continued to evolve, with multiple acquisitions, change of ownership, mergers, and some winners and losers. Very few of them partnered with portals; instead, they became transcription platforms, with interfacing on the client end for compatibility with whatever technology the client used. Companies like InterFix made it easier to interface the ASPs with the multiple hospital IT systems and recently, in partnership with AHDI, created the Benchmark KB, a desktop application for transcriptionists that interfaces with various transcription platforms. The value of the Benchmark KB is that it reduces training and learning curve for transcriptionists working for a company that uses more than one platform.

Although currently many physicians remain blissfully ignorant of templates, macros and normals, that will change as doctors become more computer literate and money gets tighter. I predict more transcriptionists will be requested to discount or not charge for templates or normals.

I think I got this one right. What I missed completely was that anyone would not count spaces! I also missed that there would be transcription services (in my experience, predominantly overseas services) that would use this as a selling point, not only discounting the characters contained in templates, macros and normals, but also undercutting prices at the same time, further eroding the rates charged by US-only companies and the earning ability of medical transcriptionists here in the US.

The next level for speech recognition will be speaker-independent recognition. Translated for the technophobe, the technology will be able to understand the dictator who is your worst nightmare, with very little user training.

This prediction was accurate, in fact. Not that no training at all is required, but companies providing server-based (also known as back end) speech recognition do train the speech recognition engine, but they do it using a library of digital dictation files obtained from the system. Physicians are not required to sit and train the engine. Most of them are told they don’t need to change their dictation habits, which is more for the purpose of getting them to adapt to the system than anything else because there certainly would be a benefit to the accuracy of the documents if the physicians were willing to make some changes.

The question for transcriptionists is: will it matter if recognition accuracy is 100% when grammar, punctuation, syntax and language usage are not (how shall I say this?) – exactly representative of a strong foundation in English? My prediction is that it won’t. I believe as long as the document says what the dictator means it to say in a relatively clear (i.e., defensible) fashion, it will be accepted… While we may wring our hands that the quality of patient care is being compromised, who is actually compromising it – the physician, the transcriptionist, or the software used to create the transcript? Ultimately, the responsibility belongs to the physician. The more we try to take ownership of this responsibility, the more liability we expose ourselves to – a questionable tactic for assuring job security.

Well, I feel my crystal ball was working really well on this one and I probably don’t need to add anything to this.

If you don’t know the difference between DOS and Windows programs, it’s a reasonable conclusion that brushing up on your tech knowledge is necessary. I predict a future where computer literacy will be tested along with English literacy, and not just in the MT profession.

I found the following excerpts in current job listings for medical transcriptionists:

Cerner experience preferred. No satellite.

Meditech Client experience.

Are you reasonably computer literate? (This may be tested.)

Familiarity with transcription platforms (M*Modal, eScription, DocQScribe, and Spantel) a plus.

We are looking for editors who have had experience with the M*Modal platform.

You must have the necessary software (EditScript MT) and equipment (IN-DB9 or IN-USB pedal) in place with Microsoft word and a current electronic medical spell check loaded, ready to work.

Computer that is no older than 3 years. High-speed cable or DSL connection. Air card and satellite will NOT be supported. Internet service with AOL is not supported. RAM (memory) – 512 MB minimum. Hard Drive – 40 GB minimum. External computer speakers with volume control knob and headset plug-in. Good quality headset. USB port foot pedal. CD-ROM drive.

You MUST know how to use a FTP program to download and upload work. … Please DO NOT APPLY if you do not hve the required equipment or know how to use a FTP program.

I think it’s pretty obvious that computer literacy has become an essential part of the job, and we’re way past having to differentiate between DOS and Windows! What’s also become important is having a computer that has up-to-date software and current software. It would be difficult to find a job listing that doesn’t include software and hardware requirements, as well as internet connection requirements.

The article also completely neglected any mention of how technology would impact US medical transcription by facilitating overseas competition. Because digital technology and file transfer was available in 2000, I know overseas competition was a big concern for US MTs at that time. I’m not sure why I left out any mention of it – whether I was asked not to, or whether it was based on my opinion that there’s nothing you could say about overseas medical transcription that you couldn’t also say about onshore medical transcription, or whether I felt it had no place in a discussion that was about technology – I’m not sure. My memory isn’t what it used to be.

My crystal ball says that medical transcription as we know it will continue to deteriorate in both value and pay, and that advances in technology and a burgeoning population of computer literate physicians will contribute to that. We keep hearing that medical transcriptionists need to change their skill set and adapt in order to survive, and I agree with that. However, I see it evolving to an increasingly clerical position, with pay rates comparable to a clerical position. What MTs need to decide is whether or not they want to continue to work in the evolved position, at the evolved pay rates.

Hopefully, I’ll be around in another 10 years to see if the predictions I’m making here will take place.

MT Exchange

In the internet marketing world, there's what's known as a flog. A flog is fake weblog. In other words, it looks like a real person writing about real experiences – while promoting a product.

In a prior post, Internet Marketers and Medical Transcription, I noted how medical transcription is an attractive target for internet marketers. What I didn't talk about was flogs.

In the medical transcription world, a flog might look like this:

Hi, my name is Jill. A couple years ago, I was desperate for work I could do at home to make some extra money for our family. A friend of mine told me about medical transcription, so I checked it out and found out it's a great work-at-home career for people like me. I went to XYZ Transcription School and got my certification. When I graduated, I found a job right away and now I'm making extra money while my children are in school. I don't have to pay for daycare, either – by the time they come home from school, my work is done and my house is clean! If you want to work at home, you should sign up today to go to XYZ Transcription School and become a medical transcriptionist, just like I did!

What makes this a flog?

What would make this a flog is if the person who owns the site and posts the entries isn't named Jill, didn't go to XYZ Transcription School (or any other transcription school) and/or isn't working as a transcriptionist – and never has. The site exists solely for the purpose of attracting people who are searching for medical transcription careers, work-at-home careers, etc., convincing these people that medical transcription is a wonderful career and that XYZ Transcription School will do a fabulous job of preparing them for this career – then referring them to XYZ.

Why would they do that?

Because XYZ Transcription School will pay them $ $ $ . This is known as an affiliate arrangement, where you have the advertiser (the MT school) and the publisher (the web site). Depending on the program, they will get paid for a lead (an e-mail address, which is why many of these have a "free" giveaway that requires signing up for a mailing list), a phone call to the school and/or a sale. Most of them pay based on a sale and the amount can be substantial. For example, FutureMT pays $ 160 when an affiliate site sends them someone and a sale is generated.

Don't get me wrong – I'm all for generating revenue. And there's nothing illegal or immoral about affiliates or affiliate ads.

However, not only are flogs immoral (in my opinion) – they are also illegal. And they always have been.

Pity the poor FTC, having to police the internet.

Example of a suspected flog

I came across this site that just practically sat up and announced  "I am probably a flog" to me. Somehow, I really doubt that "Kate Delaney" is really someone who went through the program and now works as an MT. If you send her e-mail and ask her questions about FutureMT, getting a job as a new graduate, is she hiring, who does she work for, how does she like it – you aren't likely to get an answer. Even though her contact page gives an e-mail address and tells you to contact her if you have questions about a medical transcription career, an e-mail I sent 2 weeks ago from a gmail.com mail account still hasn't been answered. Maybe she's busy transcribing.

Or – maybe she's busy doing other stuff because she isn't actually Kate Delaney. Look who owns the domain name: Beth Stefani of Lariat Group. (I'm going to start the timer after I post this and see how long it takes Beth Stefani to make this registration private.)

Now, it's POSSIBLE that "Kate" hired Lariat Group to buy her domain name and manage it for her because teaching businesses how to manage blogs and be profitable is one of the services offered by Lariat Group.  I would hope that if a company like Lariat Group is advising "Kate," they would certainly make sure she complies with the FTC requirements for bloggers and endorsements. But it appears to me that Ms. Stefani gains her expertise for consulting through "hands-on experience running her own network of sites," so I suspect there is no Kate Delaney and that this is actually a site in said "network of sites."

Again let me reiterate – I have absolutely no problem with people putting up websites and trying to make money. Hell – I do that. But in my opinion, what Beth Stefani is doing at this site is immoral. And I guess the FTC agrees with me, because it's also illegal.

FTC Regulations for Bloggers

False advertising has always been illegal, anywhere. The FTC has recently updated its guidelines because flogs have been a real problem on the internet. For one thing, they're lucrative. Imagine if "Kate" can get 10 people a month to sign up with FutureMT – she made $ 1,600. Heck, most legitimate transcriptionists I know would be happy to create a REAL blog for that kind of money!

There's just one catch and that's the FTC's guides concerning the use of endorsements and testimonials in advertising.

When the advertisement represents that the endorser uses the endorsed product, the endorser must have been a bona fide user of it at the time the endorsement was given. Additionally, the advertiser may continue to run the advertisement only so long as it has good reason to believe that the endorser remains a bona fide user of the product.

What does "bona fide use" of an education mean? It means "Kate" not only must have actually done what her "blog" says she did (attended the FutureMT program and graduated), but she must also be working as a medical transcriptionist in order to endorse the product, which is an education that allegedly prepared her to be a medical transcriptionist. Even if "Kate" actually did attend FutureMT, she cannot endorse the product until she is working as an MT. And when she is no longer employed as an MT, she is no longer "using" the product of a medical transcription education.

One of the other requirements the FTC has clarified is that a blogger must disclose material connections with an advertiser, and that disclosure can't be hidden somewhere in the small print – it has to be easily apparent. Even if "Kate Delaney" is a real person who actually graduated from FutureMT and is working as a medical transcriptionist, there is no disclosure anywhere on the site.

When an advertisement is clearly an advertisement – such as a banner ad or Google block (who can possibly mistake those for anything but an ad??), no disclosure is required. Endorsements and testimonials are where people really seem to get into trouble. This is nothing new – the same rules apply for print ads and endorsements, infomercials, television and every other kind of media. For some reason, bloggers thought the rules didn't apply to internet advertising!

Can the advertiser be held responsible for what its affiliates do?

Let's look what the FTC says in their guide:

In order to limit its potential liability, the advertiser should ensure that the advertising service provides guidance and training to its bloggers concerning the need to ensure that statements they make are truthful and substantiated. The advertiser should also monitor bloggers who are being paid to promote its products and take steps necessary to halt the continued publication of deceptive representations when they are discovered.

That looks like a yes to me!

Last but not least – why do I care?

As noted in my last blog post, people who want to join the work-at-home workforce seem to be like cannon fodder – or lemmings. These flog sites are run primarily by people who make their living off affiliate sales and who know how to get to the top of the search engines so they'll be found. They don't care if someone scrapes and saves and spends their last dime to pay the tuition, then scrapes and lives hand-to-mouth during the entire time they complete the course, or that they are depending on the money they will make once they complete it and start their career. All they care about is getting more people to their site because it's a numbers game – more targeted traffic translates to more sales. And that's really what they care about – the sale. You won't find them promoting the best schools – you'll only find them promoting the schools that offer the highest dollar amount to their affiliates. By the time the prospective MT finds it's next to impossible to get that dream job, the affiliate has been paid – and isn't answering e-mails. They also don't care what this does to the industry and how it drags all of us down. First, it was "matchbook schools" we fought – now, it's internet marketers looking for the big-dollar affiliate payouts. I've made a good living from medical transcription all these years. No, I don't recommend it for anyone because of changes in the industry since I started – but I also acknowledge there are people who don't have as many options as I do, who really do need a job that's portable or that they can do at home, for a variety of reasons and not all of them having to do with having children. For those people, medical transcription may still be the best option. I just hate to see them given information based solely upon how much money the person disseminating the information will get if they can make the sale. Even if we believe in "let the buyer beware," the FTC has undertaken these guidelines to protect consumers. And for as long as I give even a small damn for the medical transcription industry, I will continue to try and not only call these people out when I find them, I will also try to outrank them in the search engines so that prospective medical transcriptionists come to sites where they are talking to real medical transcriptionists, not fake ones trying to make a sale.

Now for the disclaimer!

I am not 100% positive that the above-referenced site is a flog, I only suspect it is a flog. Heck, it may be legitimate. I will publicly retract my allegations if Kate Delaney will contact me with proof of her identity, a certificate of graduation from FutureMT and verification of current employment as a medical transcriptionist. As with everything else at MT Exchange, this is just my opinion based upon the facts availableto me at the time of publication.

MT Exchange

The question has been posed to me, on more than one occasion, about the possibility of medical transcriptionists transitioning to the role of a scribe. Every time, this is the article link that gets sent to me: Modern Healthcare – Docs using scribes to ease EHR transition. (This requires a login to Modern Healthcare; registration is free.) The company being discussed in the article is ScribeAmerica.

So here’s officially what I think.

On the surface, this appears to be a good job for a medical transcriptionist. I see several obstacles, however, to viewing this as the saving grace of a dying career.

Scribe candidates are college graduates, many of whom are multilingual and “highly motivated,” Pierog said. Typically, the person she is looking for to join her staff is “someone who has an intense interest in medicine and is looking to go on to something else,” quite often medical school.

“It’s not hard to find scribes,” she said. “The program has a 300-person waiting list.”

The majority of the current medical transcription workforce isn’t composed of college graduates. If a college degree becomes a requirement or a preference for scribing jobs – and based on this statement by ScribeAmerica, it looks to be heading in that direction – the majority of MTs would not be candidates for these jobs.

That’s not to say it should be ruled out as an option. It’s quite possible that, given the skill set medical transcriptionists possess and how it applies to the scribing position, the preference or requirement for a college degree would be waived. The articles says that about 30% of its hires are people with secretarial backgrounds.  It’s certainly worth a shot for any MT who is interested in doing this kind of work in order to transition out of medical transcription.

Speaking of the skill set, I read this paragraph and wondered how much of the skill set is actually the same:

Esquibel said there is “a very strong correlation” between eventual success as a scribe and a candidate’s prior successful work experience in service-sector jobs, particularly as a waiter or a waitress. “There are a lot of the same patterns,” she said, in keeping multiple food and drink orders straight in a restaurant and keeping tasks and records straight in a busy ER.

Transcriptionists sit in a (preferably) quiet room and do one thing – they transcribe. One could argue that working at home requires multitasking, but it simply isn’t conducive to productivity in transcription. There aren’t many things you can do while transcribing, and be productive/accurate.

However, one of the biggest obstacles I see in medical transcriptionists transitioning to scribing is the fact that it is an in-office job. Traditionally, the allure of medical transcription has been that it is a job that can be performed from home, on a fairly flexible schedule. It’s ideal for people who:

• are caretakers for children and/or adults
• have health problems that preclude working in an office but can be accommodated in the home office environment
• live in rural areas where there aren’t a lot of job opportunities
• move around frequently and need “portable” jobs (i.e., military spouses)

All of these advantages go away with the scribing position. It absolutely requires that the scribe go to where the physician practices medicine. In my opinion, that’s going to eliminate many current MTs who might otherwise be interested in this as a career.

Even supposing that the issues of caring for children and/or other adults are removed, I know a lot of MTs who say the ability to work at home has provided them with the only available option to make money, given their rural location and lack of local job opportunities.

Then there’s the pay rate…

Although there are plenty of jobs in healthcare and the job outlook in healthcare continues to be good, there’s not a lot of money in healthcare

Starting pay for a rookie scribe is about $ 10 an hour, she said, while chief scribes make $ 14 to $ 16 an hour.

OK, first of all – it’s better than no job at all, right? Second of all, I know MTs who make about that. The big HOWEVER is – they’re making that while working at home, not having to go into a hospital (where most of these jobs are based).

Those are the obstacles I see to current medical transcriptionists transitioning to the scribing career. The other obstacles require me to take out my crystal ball and making some predictions about the future.

Prediction #1: Technology always gets better. That’s not a crystal ball prediction, it’s a fact. Therefore, it stands to reason that EMR software will continue to improve in functionality. Hardware will continue to improve. The two put together will be more intuitive and easy to use. (Consider Apple’s iPad a major game changer – the healthcare technology forums are going crazy over what it will mean for mobile healthcare and EMRs.) As software and hardware improve, it will be easier and easier for doctors to use the technology without assistance.

Prediction #2: I think the demand for scribes will decrease as older doctors retire and are replaced more and more by doctors who can’t remember what life without a computer is like. Keep in mind that the youngest doctors already in practice probably remember not having a PC at home, but likely had one by the time they were in their teen years, depending on their family circumstances. Medical students currently close to graduation are very likely to do their internships and fellowships at hospitals that already have EMR technology. The “computer generation” of doctors will be comfortable with technology, likely more so than with dictating.

Prediction #3: Whether or not hospital  and clinics are going to want to add the expense of scribes will depend on how much they see billings drop as a result of doctors trying to deal with the documentation on their own, and how much value the scribes add and whether that all balances out. It appears to me from the article and the ScribeAmerica website that they’re specializing in ERs and in EMR transition. Is there longevity in a service that’s offered on such a limited basis; and, in the case of EHR transition, for a finite period of time – will healthcare providers be willing to continue the expense of a scribe post-EHR transition?

Medical transcriptionist to scribe

I think for MTs looking to transition to a different career, the decision to become a scribe depends on a number of things. First and foremost would be whether you are able or willing to work in an office, and whether you live in an area where this kind of job is available (or other jobs that are just as good or better).

Second, do you want to transition to a career that doesn’t pay much better (or any better) than MT and may be just as short-lived? If you believe my predictions are fairly accurate, then you’re looking at a career life that’s approximately equal to MT. It might be worthwhile if no additional expense for schooling is necessary.

Since the article states they have difficulty finding people who will stay or can do the job, I have to wonder if the same inverse supply-and-demand that has resulted in stagnant pay in medical transcription is going to take place in scribing as well. The pay rate doesn’t seem to be in alignment with the statement that good people are difficult to find and keep. Maybe there’s a lesson there that ScribeAmerica needs to learn, or maybe its due to the financial constraints of healthcare being in play again, I’m not sure.

While I just don’t see this as being a promising transition career in the long term, I think whether or not it’s a better option than MT will depend largely on the individual circumstances of the MT.

MT Exchange

You know you’ve really made the big time when your blog starts getting spammed by spammers who are actually on topic. That means your blog is ranking well for targeted search terms; in my case, that would be medical transcription.

I’d like to thank all the spammers out there who have tried everything imaginable to get their spammy medical transcription links on my blog pages. Now – cut it out.

Thank you. Have a nice holiday.

MT Exchange

In the internet marketing world, there's what's known as a flog. A flog is fake weblog. In other words, it looks like a real person writing about real experiences – while promoting a product.
In a prior post, Internet Marketers and Medical Transcription, I noted how medical transcription is an attractive target for internet marketers. What [...]
MT Exchange