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STANDARDS OF SERVICE

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  • 1. 1 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 STANDARDS OF SERVICE 20 FOR MEDICAL TRANSCRIPTION 21 22 23 24 25 26 27 28 29 30 VERSION 10 31 32 33 34 35 36 37 38 39 40 June 2005 2
  • 2. 1 1 2 VANDERBILT UNIVERSITY MEDICAL CENTER 3 STANDARDS OF SERVICE FOR MEDICAL TRANSCRIPTION 4 VERSION 10 5 6 7 8 9 Purpose 10 11 The purpose of this “Standards of Service for Medical Transcription” document is to ensure 12 the most accurate, cost-effective, timely, HIPAA-compliant, and systems-compatible patient 13 care and medical record dictation and transcription through transcription vendor pre- 14 qualification. 15 16 17 Background 18 19 Typically in the past, except for the Vanderbilt Hospital Medical Information Services 20 Department, medical transcription vendors have been selected primarily on the basis of their 21 quoted per-line prices. Little, if any, regard was paid during the selection process to 22 delivery, systems, invoicing, and other important standards or how to measure the 23 performance of the vendors against such standards. The result was a hodgepodge of 24 vendors, each significantly different from the others. Each of these vendors required special 25 adaptations in the VUMC Informatics Center interfaces and software in order for VUMC to 26 receive the transcription files and successfully deliver them to the StarChart electronic 27 patient record system. The result was lower “quoted” prices, but very large hidden costs, 28 major systems support problems, significant quality and billing issues, and document costs 29 that did not always reflect the lower “quoted” prices. In the aggregate, there were no 30 standards either for vendor selection or for determining a vendor’s overall performance. 31 32 An attempt was made to solve this problem of vendor hodgepodge by establishing a single 33 “prime vendor” for medical transcription. This approach largely worked for some time. 34 However, as vendors more aggressively sought new business with various departments by 35 quoting lower prices and promising higher accuracy rates and speedy delivery times, the 36 problems returned. Clearly, a medical transcription service standards document was needed 37 to help departments appropriately select new vendors, monitor those vendors against an 38 equitable standard, and eliminate those vendors who cannot consistently demonstrate strict 39 adherence to the standards. 40 41 This need for a medical transcription service standards document is met with this 42 “Vanderbilt University Medical Center Standards of Service for Medical Transcription” 43 document. Questions about this document and its application should be addressed to: 2
  • 3. 1 1 Vanderbilt Medical Information Services, Attn: Director, B-334 VUH, Nashville, TN 2 37232-7350. 3 2
  • 4. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 1 Definitions 2 3 “Turnaround Time” is defined as “The elapsed time—measured in hours and tenths— 4 beginning with the Vendor’s receipt of the dictator’s voice file and ending with the electronically 5 acknowledged receipt of the electronic transcribed document on the designated Vanderbilt 6 server.” The electronically acknowledged time of receipt on the designated Vanderbilt server 7 shall exclude any Vanderbilt server response delay. 8 9 “Maximum Turnaround Time” is defined as “The turnaround time—set for each 10 document type—beyond which the transcribed document shall be deemed late for purposes 11 of turnaround time measurement, reporting, and penalties.” 12 13 “On-Time Document” is defined as “A document with a turnaround time less than or equal 14 to the maximum turnaround time.” 15 16 “Late Document” is defined as “A document with a turnaround time greater than the 17 maximum turnaround time.” 18 19 “Lost Document” is defined as “A document which has not been and cannot be transcribed 20 and delivered by the Vendor because the Vendor cannot locate or recover the dictation voice 21 file, and for which the dictator can supply a Vendor-provided confirmation that the voice 22 file was received by the Vendor.” 23 24 “Stat Document” is defined as “Any dictated document requiring transcription turnaround 25 in less time than the standard turnaround time specified in Table 1 for the specific document 26 type.” “Stat” documents may be discharge summaries or any other approved document as 27 needed in less than the standard turnaround time specified for the respective document 28 types. 29 30 “Standard document header” is defined as “The first page of a delivered transcribed 31 document and containing specific defined information in a prescribed exact format as 32 required for the document’s acceptance by the Vanderbilt Medical Center’s StarChart 33 electronic medical records system.” 34 35 “Quality Assurance” is defined as “The processes by which the transcription Vendor 36 ensures the accuracy of the delivered transcribed documentation and which are in full 37 compliance with the American Society for Testing and Materials (ASTM) ‘Standard Guide 38 for Identification and Establishment of a Quality Assurance Program for Medical 39 Transcription.’ (ASTM Ref. #E2117-00, See Appendix “C”).” 40 “Transcription Services” are defined as “All Vendor services required to reliably receive 41 and track medical dictation produced both by telephones and digital dictation recorders; 7 4
  • 5. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 1 transcribe that dictation; systematically deliver a confirmed accurate, complete, and timely 2 electronic document to Vanderbilt’s designated server; electronically confirm receipt of that 3 document by Vanderbilt; generate an accurate invoice for these services; and produce the 4 required productivity and quality assurance reports as defined by Vanderbilt.” 5 6 “Standard Services” are defined as “All Vendor support and services required to provide 7 ‘Transcription Services’” 8 9 “Non-Standard or Extended Services” are defined as “All Vendor support and special 10 services not included in ‘Transcription Services’ as defined above, and which may be 11 separately provided by a second Vendor or even by Vanderbilt and therefore accounted for 12 and billed separately.” 13 14 “Document Type” is defined as “The transcription work type of the dictated document.” 15 The standard document types are listed in Table 1. 16 17 “98% Accurate” is defined as the minimum acceptable transcription accuracy level as 18 defined by and measured in accordance with the “Vanderbilt Quality Assurance Worksheet” 19 in Appendix “D.” 20 21 “Characters” are defined as any visible or place-holding letter, number, symbol, 22 punctuation mark, space, or hard line return contained in the transcribed document. 23 Visible characters are defined as ASCII characters : 9, 10, 12, and 32-126 only. 24 25 26 “Lines” are defined as sixty-five (65) “characters.” A “line” shall be calculated by counting 27 all above-defined “characters” contained in a document and dividing that total number of 28 “characters” by 65 to arrive at the number of 65-character lines in the document. 29 30 “Document” is defined as all “character” content inclusive of any “characters” included in 31 text boxes, but exclusive of all “characters” contained in the standard document header. 32 33 Turnaround Time Requirements 34 35 The maximum turnaround times for the various document types are prescribed in Table 1 36 below. Documents delivered after their respective maximum turnaround times shall be late 37 for purposes of individual document and overall turnaround time measurements and as well 38 as for transcription charge penalty calculations. The Vendor shall schedule all routine 39 hardware and software maintenance in such ways as to prevent interference with or 40 limitation of the Vendor’s ability to meet the maximum turnaround time requirements. 7 5
  • 6. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 DOCUMENT DOCUMENT MAXIMUM CODE TYPE TURNAROUND TIME ST STAT Report 2 Hours HP History and Physical 12 Hours PO Pre-Op History and Physical 6 Hours OR Operative Report 24 Hours DS Discharge Summary 24 Hours CO Consultation 12 Hours AN Admit Note 12 Hours ED Emergency Department Note 6 Hours CN Clinic Note 24 Hours RL Referral Letter 48 Hours CR Client-Requested Revision 24 Hours (Any Document Type) RR Radiology Report 6 Hours PG Pathology Gross Description 24 Hours Report PD Pathology Attending Diagnosis 3 Hours Report RO Radiation Oncology Report 24 Hours 2 3 Table 1 – Maximum Turnaround Time by Document Type 8 6
  • 7. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 Per-Line Charge Penalty for Late Documents 2 3 A per-line transcription services charge penalty shall be imposed on the Vendor for each late 4 document. The late-document per-line charge penalty shall be triggered at the moment the 5 document becomes late (see Table 1 above) and shall escalate in accordance with Table 2 6 below for each additional whole or fraction hour the document is late. The per-line charge 7 penalty shall not exceed the Vendor’s total charge for the document, which includes all per- 8 line and all unit-priced charges. For example, a History and Physical document that is 9 delivered in 15.3 hours as opposed to 12 hours (see Table 1) is 3.3 hours late and shall incur 10 a one-half-cent-per-line-per-hour penalty times 4 hours (Table 2), for a 2-cent-per-line total 11 charge penalty. If the document has 100 lines, the per-line charge is 13 cents, and the 12 charge for the system-generated document header is 25 cents, the maximum charge penalty 13 for the late document would be $13.25 (i.e., 100 x 0.13 plus 0.25). The Vendor shall 14 automatically reduce the charge for late documents and clearly report the charge reduction 15 consistent with the reporting requirements under the “Reporting” section. 16 17 8 7
  • 8. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 LATE-DOCUMENT PER- LATE DOCUMENT LINE CHARGE DOCUMENT CODE PENALTY TYPE PER HOUR LATE ST STAT Report 3 Cents/Line/Hour HP History and Physical 0.5 Cent/Line/Hour PO Pre-Op History and Physical 1 Cents/Line/Hour OR Operative Report 0.25 Cent/Line/Hour DS Discharge Summary 0.25 Cent/Line/Hour CO Consultation 0.5 Cent/Line/Hour AN Admit Note 0.5 Cent/Line/Hour ED Emergency Department Note 1 Cents/Line/Hour CN Clinic Note 0.25 Cent/Line/Hour RL Referral Letter 0.125 Cent/Line/Hour CR Client-Requested Revisions 0.25 Cent/Line/Hour (All Document Types) RR Radiology Report 0.25 Cent/Line/Hour PG Pathology Gross Description 0.25 Cent/Line/Hour Report PD Pathology Attending Diagnosis 2 Cents/Line/Hour Report RO Radiation Oncology Report 0.25 Cent/Line/Hour 2 3 Table 2 – Per-Line Charge Penalty by Document Type. The “Late- 4 Document Per-Line Charge Penalty Per Hour Late” for each document type 5 is equal to 6 cents per line divided by the “Maximum Turnaround Time” from 6 Table 1. For example, for a History and Physical (HP) document, 6 cents per 7 line divided by 12 hours equals 0.5 cents per line per hour as above. 8 8
  • 9. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 Penalty for Lost Documents 2 3 A one-hundred-dollars penalty shall be levied against the Vendor for each lost document. A 4 “Lost Document” is defined as any document which has not been and cannot be transcribed 5 and delivered by the Vendor because the Vendor cannot locate or recover the dictation voice 6 file, and for which the dictator can supply a Vendor-provided confirmation that the voice 7 file was received by the Vendor. A “Lost Document” is NOT a voice file that was cut off 8 prematurely during dictation. It will be presumed by Vanderbilt that if the Vendor provides 9 a confirmation of receipt of a dictation voice file, then it is reasonable to expect that the 10 Vendor should incur a penalty if that file should become lost or destroyed prior to the 11 Vendor’s transcription and delivery of the corresponding transcribed document. In each 12 such instance of lost documents, the Vendor shall pay the dictator $100. Payment of the 13 $100 penalty shall be directed to the dictator via the Vanderbilt Medical Center’s 14 Information Services Department Transcription Services Coordinator in order to ensure that 15 all such claimed instances are valid and logged. Frequent or major proven lost-document 16 occurrences may be deemed sufficient reason to initiate cancellation of the Vendor contract. 17 Justification for the severity of this lost-document penalty lies in the liability exposure each 18 occurrence places upon Vanderbilt and in the time and effort required by the dictating 19 physician to reproduce the dictation. (See also the “Dictation Voice File Receipt 20 Confirmations” paragraph under “Reporting.”) 21 22 8 9
  • 10. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 Quality of Transcription 2 3 Quality of delivered transcribed documents must be maintained at no less than ninety-eight 4 percent (98%) accuracy level as defined by and measured in accordance with the 5 “Vanderbilt Quality Assurance Worksheet” (see Appendix “D”). The Vendor shall provide 6 call-in help-desk assistance for each transcriptionist as well as optional routing to a 7 proofreader for the purpose of achieving maximum quality on each document. Using a 8 statistically valid, unbiased, whole-month sampling method agreed upon in writing by 9 Vanderbilt, the Vendor shall monitor a minimum of one percent (1%) of all documents for 10 the preceding month from each of its transcriptionists for adherence to the 98% accuracy 11 quality assurance standard. For any transcriptionist whose one-percent (1%) statistically 12 sampled work does not meet the minimum 98% accuracy standard, and for all 13 transcriptionists newly assigned to the Vanderbilt account, the Vendor shall immediately 14 begin monitoring a minimum of five percent (5%) of all that transcriptionist’s documents 15 and shall continue to do so for a minimum probationary period of two months. If that 16 transcriptionist’s 5% statistically sampled work does not consistently achieve the 98% 17 accuracy standard by the end of the two-month probationary period, the Vendor shall 18 remove that transcriptionist from the pool of transcriptionists serving the Vanderbilt 19 account. Any transcriptionist failing at any time to meet the minimum 98% accuracy 20 standard shall be provided additional training and assistance by the Vendor. Quality 21 assurance reports showing the quality measurement results for each transcriptionist shall be 22 provided by the Vendor to Vanderbilt on a monthly basis. These reports shall clearly show 23 actions taken by the Vendor regarding new transcriptionists, any transcriptionists who have 24 been placed on the 5%-sampling, two-month, work improvement probation, and 25 transcriptionists who have been removed from the pool of those serving the Vanderbilt 26 account. 27 28 29 Patient Demographics 30 31 To keep with the concept of quality in transcription, Vanderbilt requests that real-time 32 patient demographics are sent via an HL7 ADT interface to the vendor. We know that 33 mistakes can occur if we rely solely on a physician to dictate the MRN or patient name 34 correctly and a transcriptionist needs to keypunch the data into the report. An HL7 interface 35 will automatically post the demographics so dictation/keypunch errors are reduced. For 36 current requirements, please contact the Chief Information Security Officer (CISO) or the 37 HIPAA manager for information. 38 8 10
  • 11. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 Pricing 2 3 The Vendor shall provide a complete per-unit base pricing schedule for both “standard” and 4 “non-standard” transcription services. The purpose for this per-unit pricing schedule is to 5 eliminate “hidden” charges and thereby help ensure that all service recipients clearly 6 understand the cost for each provided service. 7 8 The Vendor shall also provide an electronic line-counting program with which the 9 Vanderbilt Medical Center’s Information Services Department Transcription Services 10 Coordinator can perform count audits at any time on the Vendor’s work. Alternatively at the 11 vendor’s option, Vanderbilt may provide the vendor with an example electronic line 12 counting program to demonstrate the counting algorithm. 13 14 Because of the extreme importance of consistently accurate document pricing and the 15 historical industry-wide problem of inaccurate billing for transcription services, a document 16 charge penalty shall be imposed for any documents incorrectly priced. The document 17 charge penalty shall be equal to the erroneous price charged for each erroneously priced 18 document. Repeated significant patterns of erroneous document pricing, in the absence of 19 clear evidence of progressive and sustained improvement, shall constitute sufficient reason 20 for contract termination. 21 22 23 “Standard Services” Pricing 24 25 Base “Per-Line” Pricing: For purposes of transcription services pricing, a “line” shall be 26 defined as sixty-five (65) “characters.” A “character” shall be defined as any visible or 27 place-holding letter, number, symbol, punctuation mark, space, or hard line return contained 28 in the transcribed document. A “document” shall be defined as all “character” content 29 inclusive of any “characters” included in text boxes, but exclusive of all “characters” 30 contained in the StarChart document header. A “line” shall be calculated by counting all 31 above-defined “characters” contained in a document and dividing that total number of 32 “characters” by 65 to arrive at the number of 65-character lines in the document. To be 33 billable, “characters” must be visually countable on the printed document. Also, only one 34 space between words and sentences may be counted toward the total number of “characters” 35 and no other use of spaces shall be billable. Hidden formatting instructions such as bolding, 36 underlining, text boxes, printer configurations, etc. shall not be included in the total 37 “character” count for billing purposes. For purposes of per-line pricing, all “characters” in 38 the system-generated, unit-priced standard document header (see Appendix “A”) shall be 39 excluded. (See also the “StarChart Standard Document Header Per-Document Pricing” 40 paragraph below.) 8 11
  • 12. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 2 Electronic Document Delivery Pricing: The electronic delivery of transcribed documents 3 to a specified Vanderbilt server, the provision of an hourly electronic manifest of documents 4 sent to the server, and the electronic cross-checking of that manifest against a return-receipt 5 manifest from Vanderbilt are considered to be part of the transcription services covered by 6 the Vendor’s base “per-line” pricing (see “Base ‘Per-Line’ Pricing” paragraph above). 7 Because these services are required for every transcribed document, they shall not be 8 separately priced. Electronic document delivery shall be included as part of the base per- 9 line pricing. Additional requirements related to electronic document standard delivery are 10 included in the “Document Delivery” section below. 11 12 StarChart Document Header Per-Document Pricing: The Vanderbilt StarChart electronic 13 medical records system requires a fixed-format standard document header (See Appendix 14 “A”) in order for documents to be accepted by the system. Because Vanderbilt requires that 15 these standard document headers be auto-generated by the Vendor’s computerized systems, 16 these headers shall be priced separately at an appropriately low fixed charge per document. 17 This low per-document charge will be the same for all documents, regardless of document 18 type, length, difficulty, or method(s) of delivery. 19 20 Surcharge Pricing for STAT Documents: STAT document surcharges shall be separately 21 priced on a surcharge-per-line basis. The Vendor shall not levy a STAT surcharge for the 22 standard document header lines that are required for all documents. The document type 23 surcharge code for “STAT” documents shall be “ST” on the Vendor’s monthly invoices (see 24 Appendix “E” example). 25 26 Surcharge Pricing for Special Document Formatting: Vanderbilt departments shall 27 provide the Vendor with one or more standard document formats for each of the standard 28 document types in Table 1. The per-line price for the first format per document type shall 29 be the base “standard services” per-line pricing rate (see “Base ‘Per-Line’ Pricing” 30 paragraph above). Second and subsequent document formats per document type shall be 31 priced by the Vendor with a per-line surcharge that reflects the difficulty of transcriptionists 32 in reproducing the specified format. The document type surcharge code for documents with 33 special formatting shall be “F” on the Vendor’s monthly invoices (see Appendix “E” 34 example). 35 36 Standard Reports Pricing (See “Reporting” Section): All reports specified in the 37 “Reporting” section below shall be defined as “Standard Reports” and shall therefore be 38 included in the Vendor’s standard pricing schedule. 39 8 12
  • 13. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 “Other Standard Services” Pricing: Vendor services not specifically required by this 2 standards document, but which are generally understood and accepted within the medical 3 transcription industry as normally expected services to be included in standard pricing, shall 4 be considered as “Standard Services” and therefore included in the Vendor’s standard 5 pricing schedule. Other “Non-Standard” or “Extended” services shall be priced separately 6 (see “‘Non-Standard or Extended Services’ Pricing” section immediately below). 7 8 9 “Non-Standard or Extended Services” Pricing 10 11 Remote Printing Pricing: An appropriately low separate per-document surcharge shall be 12 established for printing documents remotely to networked printers at Vanderbilt locations. 13 Remotely printed documents shall still be delivered electronically to Vanderbilt’s designated 14 server (see “Document Delivery” section below). The special delivery surcharge code for 15 remotely delivered documents shall be “RP” on the Vendor’s monthly invoices (see 16 Appendix “E” example). 17 18 Courier Delivery Pricing: A separate per-document surcharge shall be established for 19 delivery of pre-printed documents by courier to a specified Vanderbilt location. Courier- 20 delivered documents shall still be delivered electronically to Vanderbilt’s designated server 21 (see “Document Delivery” section below). The special delivery surcharge code for courier- 22 delivered documents may be “PD” (i.e., “Print and Deliver”) on the Vendor’s monthly 23 invoices (see Appendix “E” example). 24 25 One-Time and Other Special Reports Pricing (See “Reporting” Section): One-time and 26 other special reports not specified in the “Reporting” section below shall be defined as 27 “Non-Standard Reports” and may be separately and individually priced by the Vendor on a 28 per-Vanderbilt-request basis. 29 30 One-Time and Other Special Services Pricing: Charges for special one-time and other 31 special services shall be separately priced at specific hourly or unit rates. For example, 32 prices shall be established for such services as re-sending documents that were verifiably 33 previously sent and consulting and training services not universally recognized as expected 34 to be included as part of standard transcription services. 8 13
  • 14. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 Reporting 2 3 Specific standard reports shall be provided by the Vendor toward ensuring the accurate, 4 complete, timely and systematic delivery of transcribed documents. These standard reports 5 shall be priced as part of the Vendor’s standard pricing schedule (see “Pricing” section 6 above). The Vendor shall submit templates for each of these standard reports as part of the 7 pricing quotation package. The following reports shall be defined as standard reports. 8 9 1. Monthly quality assurance reports on each transcriptionist (see “Quality of 10 Transcription” section above). 11 12 2. Electronic delivery confirmation manifest of all documents delivered during the 13 previous hour to the Vanderbilt designated secure server (see “Document Delivery” 14 section below). 15 16 3. Monthly billing reports by dictator to accompany all monthly invoices. These 17 reports shall include at least the following data for each billed document: dictator name, 18 dictator number, transcriptionist number, document type, date and time of dictation, 19 date and time of completed document confirmed delivery, turnaround time for 20 transcription in “hours.tenths” format, hours late in “hours.tenths” format, total 21 document lines, standard per-line charge rate, per-line surcharge rate, per-line surcharge 22 reason code(s), late-document per-line rate penalty, net per-line charge rate, total of 23 per-line charges, StarChart document header charge, document surcharge(s), document 24 surcharge code(s), and total of all per-line and per-document charges. The format of 25 this report shall be such that it will clearly show the basis for each of the elemental 26 parts of the total amount charged for the document’s transcription services. The report 27 shall have a legend that defines each of the per-line and per-document surcharge codes. 28 See the monthly billing report template example in Appendix “E.” 29 30 4. Monthly graphic histogram (i.e., frequency) charts of total number of documents by 31 turnaround time and the cumulative percent of documents by turnaround time, each 32 done by document type for all document types (see examples in Appendix “B”) and by 33 dictator ID# for all dictators. 34 35 5. Daily electronic manifests via secure mechanism, indicated by vendor in the 36 Transcription Security Survey or approved by the Chief Information Security 37 Officer (CISO) and the HIPAA manager. These manifests shall be automatically 38 sent at approximately 6:00 a.m. seven days per week via approved mechanism. These 39 manifests shall provide at least the following for each of the dictator’s transcriptions 40 completed and electronically delivered to Vanderbilt during the previous 24-hour 8 14
  • 15. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 period (i.e., since the last daily manifest was sent): dictator’s name and number, 2 document job number, date and time of dictation, date and time of confirmed delivery, 3 and the patient’s name and medical record number. 4 5 6. Dictation Voice File Receipt Confirmations shall be provided for (1) telephone 6 dictation and (2) dictation voice files recorded on digital dictation recorders and 7 subsequently uploaded to the Vendor via the dictator’s computer workstation and 8 Internet connection. These individual dictation voice file receipt confirmations shall 9 serve as the Vendor’s formal acknowledgment and assurance that the dictator’s 10 respective dictation files were received, recorded, date and time stamped, and logged by 11 the Vendor’s digital voice recorder (DVR) or other computerized system. In any 12 instances of questions that might arise regarding whether a dictator actually dictated a 13 specific, undelivered transcribed document, these receipt confirmations shall serve to 14 confirm the Vendor’s receipt of the dictation and, therefore, that the dictator indeed 15 dictated the document.. 16 17 7. Internet-Accessible Tracking and Status Reports that enable authorized Vanderbilt 18 faculty and staff to view dictation file and transcription work tracking and progress 19 information in the Vendors’s database. Access shall be by secure Internet protocol. 20 Access shall be restricted to those one or more selected faculty or staff in each 21 Vanderbilt department who are responsible for ensuring the Vendor’s compliance with 22 the standards for timely turnaround of dictation transcription. The Internet-accessible 23 reports shall clearly provide at least the following information for each dictation file: 24 dictator’s ID#, Vendor’s job ID#, patient’s medical record number, work type, date and 25 time of dictation, dictation voice file length in minutes:seconds format, name or ID# of 26 transcriptionist to whom the work is/was assigned, current document status, and date 27 and time completed document was confirmed to be delivered to the designated 28 Vanderbilt server (see “Document Delivery” section below). 29 30 8. All Monthly Reports shall be delivered electronically by the Vendor to various 31 designated individuals, as applicable by report type and content. All monthly reports 32 shall be delivered not later than ten (10) days following the last day of the reported 33 month. Global reports (in contrast to department-level and dictator-level reports) shall 34 be delivered both electronically and in hard copy to the Transcription Services 35 Coordinator in the Vanderbilt Medical Center Information Services Department. 36 37 8 15
  • 16. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 Document Delivery 2 3 Standard Document Delivery: All transcribed documents, each with an appropriate special 4 StarChart document header in the Vanderbilt-required format (see Appendix “A”), and each 5 with transcribed dictation for one and only one patient, shall be delivered electronically by 6 the Vendor via a secure server link to a Vanderbilt-designated server. Hourly electronic 7 manifests, in an electronic format prescribed by the Vanderbilt Informatics Department, 8 shall be similarly delivered by the Vendor to the same designated server. The Vendor shall 9 in turn receive an electronic response manifest from Vanderbilt that shall confirm all 10 documents that were electronically received from the Vendor. The Vendor shall be 11 continuously responsible, as part of its hour-by-hour standard transcription services, to 12 automatically electronically cross-check the two manifests to ensure all documents that were 13 sent were acknowledged as received. In any instances of one or more documents not so 14 confirmed, the Vendor shall immediately resend the document(s) and list said documents on 15 the next electronic manifest. In the instances of a repeating problem with one or more 16 documents, the Vendor shall be responsible for immediately initiating a problem call to 17 Vanderbilt to discern where the transmission breakdown occurred. 18 19 For all documents delivered to the designated Vanderbilt server, the server shall confirm the 20 StarChart document header format and content upon receipt of each delivered document. If 21 the Vanderbilt server rejects the electronically received document due to one or more 22 StarChart document header format or content problems (see Appendix “A”), the Vanderbilt 23 server shall alert the Vendor to that rejection and the reason(s) for the rejection on the reply 24 electronic manifest. The Vendor shall be responsible for the immediate correction of the 25 problem(s) and retransmission of the document within twenty-four (24) hours. The date and 26 time each document is ultimately electronically confirmed to have been delivered and 27 accepted by the designated Vanderbilt server shall be the date and time used by the Vendor 28 and Vanderbilt in calculating the turnaround time from dictation to delivery and therefore 29 also any late-document charge penalty. 30 31 For any documents dictated without the dictator’s having specified the patient’s name, 32 medical record number, and/or date of service, the Vendor shall be no less responsible for 33 accurate, complete, and timely transcription delivery. However, the Vendor shall not in 34 such cases be penalized for the missing required data.. The missing patient’s name, medical 35 record number, and/or date of service shall be denoted by three asterisks (i.e., “***”) in the 36 corresponding StarChart-required header field(s). Additionally, for purposes of 37 communication to the dictator and/or his/her designee, the Vendor shall ensure that the 38 StarChart header “Problem Description” field has an entry that begins with three 39 corresponding asterisks. These three asterisks should be followed by a brief note explaining 40 why the data is missing in the one or more StarChart-required fields. The Vendor’s recourse 8 16
  • 17. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 for resolution of repeating problems with the dictation of one or more dictators shall be the 2 Vanderbilt Medical Center’s Information Services Department Transcription Services 3 Coordinator, with appeal recourse to the Director of the Information Services Department. 4 5 “Standard Document Delivery” must comply with all the above requirements. 6 7 8 Non-Standard Document Delivery: Any other method of delivery of transcribed 9 documents must be via a secure mechanism indicated by the vendor in the approved 10 Transcription Security Survey or approved by the Chief Information Security Officer 11 (CISO) and HIPAA manager. 12 13 8 17
  • 18. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 Job Maintenance 2 3 The Vendor shall provide an Internet based interactive access method for Vanderbilt’s 4 Information Services Department to enable Vanderbilt’s Transcription Services Coordinator 5 to modify job priorities, cancel jobs, modify work types, track jobs by dictator ID and work 6 type, and play back dictation voice viles and view their corresponding documents. This 7 access method must be indicated by vendor in the Transcription Security Survey or 8 approved by the Chief Information Security Officer (CISO) and HIPAA manager.(see 9 also“Voice Files and Data Warehousing” section below). 10 11 12 Voice Files and Data Warehousing 13 14 The Vendor shall maintain a secure database archive of all dictation voice files and their 15 corresponding transcribed documents for a period not less than ninety (90) days from the 16 date of dictation. The Vendor shall ensure that daily verified backups of the archival 17 database are made and carefully secured. Though archived in the Vendor’s backup storage 18 system(s), the voice and transcription files stored in these systems is the property of 19 Vanderbilt University Medical Center. The Vendor shall not provide access to or provide 20 any extracted, raw, or summary data from this archive other than as necessary to fulfill the 21 Vendor’s service requirements as governed by this standards of service document. All 22 access to and uses of the data warehoused by the Vendor as here specified shall meet all 23 HIPAA requirements. The Director of Vanderbilt Medical Center’s Information Services 24 Department shall serve as the authority for all Vendor questions about the use of all 25 warehoused data. The vendor’s database archived method(s), backup method(s), and all 26 related access security policies and practices shall be fully disclosed on the Vendor’s 27 submitted and approved Transcription Security Survey or otherwise approved by the Chief 28 Information Security Officer (CISO) and HIPAA manager. 29 30 31 32 33 8 18
  • 19. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 Vendor Provided Training 2 3 The Vendor shall provide training services and materials for Vanderbilt Medical Center 4 faculty and staff as applicable and necessary to ensure accurate and efficient dictation and 5 transcribed document production via the Vendor’s services, systems, and interfaces. These 6 training services and materials shall be made available to all dictators and their support staff 7 as they begin using the Vendor’s transcription services and as necessary or helpful 8 thereafter. The Vendor shall provide these training services and materials as part of the 9 global transcription services included in the Vendor’s standard per-line transcription charge 10 (see “Pricing” section above). These services and materials shall include, but not be 11 necessarily limited to, providing training for at least the following: 12 13 1 Proper methods of dictation to produce audibly clear and understandable dictation that 14 can be accurately and rapidly transcribed; 15 2 Proper and effective use of digital handheld digital dictation recorders or other digital 16 dictation devices (e.g., PDAs); 17 3 How to upload voice files recorded on digital handheld recorders; 18 4 How to effectively manage digital voice files archival on upload computers; 19 5 How to track dictation through the transcription and final document delivery processes; 20 6 How to efficiently download and edit Vendor-delivered transcribed documents; and 21 7 How to properly and easily submit edited and approved documents to StarChart. 22 23 24 25 26 8 19
  • 20. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 2 3 Security of EPHI (Electronic Protected Health Information) 4 5 Vendor shall keep all of Vanderbilt’s patient data secure via mechanisms as documented in 6 the Transcription Security Survey and approved by the Chief Information Security Officer 7 (CISO) and HIPAA manager. Approval must occur before execution of contract. The 8 Transcription Security Survey is available on the VUMC HIPAA webpage at: 9 http://www.mc.vanderbilt.edu/HIPAA. 10 11 12 Sufficient Causes for Consideration of Contract Termination 13 14 Repeated significant patterns of problems in meeting the requirements of this Standards of 15 Service document, in the absence of clear evidence of progressive and sustained 16 improvement, shall constitute sufficient reason for termination of the transcription services 17 contract.. 18 8 20
  • 21. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 1. 2 APPENDIX “A” 3 4 STARCHART 5 STANDARD DOCUMENT HEADER 6 FORMAT REQUIREMENTS 7 8 9 10 The StarChart standard document header is the required preamble to any document type in any 11 format; it allows StarChart to process all documents in the various formats and extract the 12 essential identifying, turnaround, and transcription services charge information. Without such 13 information, documents will be rejected and will not be placed into the StarChart system. It is 14 desirable, but not required, that the document header be placed on a separate page at the 15 beginning of each document; this will facilitate printing the actual document from a word 16 processor. Do not repeat the standard header as a page header! (In fact, page headers in 17 documents should generally be avoided, because they may be incorporated by StarChart as if 18 they were part of the text of the document). A file must contain one and only one patient’s 19 document and therefore one and only one standard document header! 20 21 The bolded lines on the following page define the required template for the standard document 22 header. 8 21
  • 22. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 @#$% 2 3 MARS PATIENT TRANSCRIPTION HEADER DOCUMENT 4 5 MRN: 6 PAT NAME: 7 DATE OF SERVICE: 8 SERVICE LOCATION: 9 PHYSICIAN NAME: 10 PHYSICIAN ID: 11 TYPE: 12 JOBID NUMBER: 13 TRANSCRIPTIONIST NUMBER: 14 SOURCE FILE: 15 PROBLEM DESCRIPTION: 16 DATE OF DICTATION: 17 TIME OF DICTATION: 18 19 @#$% 20 8 22
  • 23. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 The following StarChart standard document header requirements must be met: 2 3 Χ The two "@#$%" sequences delimit the standard header, and MUST be present. 4 5 Χ Each field name must appear verbatim at the beginning of its respective line, without 6 any extra spaces or other extraneous characters. 7 8 Χ All fields are mandatory and must appear in the exact sequence listed above on the 9 preceding page. 10 11 Χ With the exception of the “PROBLEM DESCRIPTION” field, each field must have a 12 value in its specific required format (see below). 13 14 Χ All fields must be present for the header to be valid and the document to be submitted 15 to StarChart. 16 17 Χ With the exception of the “PROBLEM DESCRIPTION” field, each field must consist 18 of a single line. 19 20 Χ Headers in which any of these fields do not have a value shall be rejected. 21 22 Χ A file must contain one and only one patient’s document and therefore one and only 23 one standard document header! 24 25 26 The following is a more detailed explanation of the meanings of the required StarChart standard 27 document header fields: 28 29 Χ MRN — VUMC Medical Record number, without dashes or spaces. Officially 9 digits; the 30 leading 0 may be omitted, resulting in 8 digits. 31 Χ PAT NAME — Legal patient name (preferred: Last, First M.). Titles, etc. may follow the 32 name. 33 Χ DATE OF SERVICE — The date of the encounter, in the format mm/dd/yyyy. Month and 34 day may have only one digit; for Y2K reasons, the year must be specified as 4 digits. 35 Χ SERVICE LOCATION — The location where the service was performed. Legitimate 36 entries will be provided on a list of approved service locations. 37 Χ PHYSICIAN NAME — Full name of the physician dictating the document. 38 Χ PHYSICIAN ID — Physician code (3 or 4 digits, usually). 8 23
  • 24. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 Χ TYPE — Type of document; e.g., "Clinic Note", "Stat Discharge Summary," etc. Allowed 2 document type names and codes appear in Tables 1 and 2. For example, the type code for a 3 “STAT” document is “ST” and for a “Clinic Note” is “CN” (See Tables 1 and 2). The 4 entries on this line may be either the document name or its code as specified in Tables 1 and 5 2. If a document is not of an approved type, its name shall be “SPECIAL” and “SP” shall 6 be its document code. 7 Χ JOBID NUMBER — Transcription company job number, if applicable. 8 Χ TRANSCRIPTIONIST NUMBER — Code that identifies the transcriptionist, if 9 applicable. 10 Χ SOURCE FILE — Name of the original voice or word processor file (may facilitate 11 communication with the transcription company in case of problems). 12 Χ PROBLEM DESCRIPTION — Any problem with the transcription, etc. should be listed 13 here, rather than in the body of the document (otherwise, the explanation shall be included 14 in the official patient record!). This is the only field that may consist of multiple lines or be 15 empty if no document problems. 16 Χ DATE OF DICTATION — The date on which the document was dictated in the format 17 mm/dd/yyyy. Month and day may have only one digit; for Y2K reasons, the year must be 18 specified as 4 digits. 19 Χ TIME OF DICTATION — The time of day that the document was dictated (for telephone 20 dictation) or was uploaded to the transcription company’s computer (for handheld digital 21 recorder voice file uploads). The time must be in 24-hour military format (as 1321 for 1:21 22 p.m.). 8 24
  • 25. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 APPENDIX “B” 2 3 EXAMPLE HISTOGRAM REPORTS 4 5 6 7 8 Turnaround Time 9 10 120 11 100 12 13 80 14 60 15 Turnaround Time in Hours 16 40 17 20 18 19 0 20 1 4 7 10 13 16 19 22 25 28 31 34 37 40 21 Frequency 22 23 24 Cumulative Percent 25 26 100% 27 90% 28 80% Cumulative Percent 29 70% 60% 30 50% 31 40% 32 30% 33 20% 34 10% 35 0% 36 1 4 7 25 34 37 10 13 16 19 22 28 31 40 Turnaround Time in Hours 37 8 25
  • 26. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 APPENDIX “C” 2 3 AMERICAN SOCIETY FOR TESTING AND MATERIALS 4 (ASTM) 5 6 “Standard Guide for Identification and Establishment 7 of a Quality Assurance Program for Medical Transcription” 8 8 26
  • 27. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 8 27
  • 28. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 8 28
  • 29. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 8 29
  • 30. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 8 30
  • 31. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 8 31
  • 32. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 5 6 7 1 APPENDIX “D” 2 3 QUALITY ASSURANCE 4 WORKSHEET 5 6 7 8 32
  • 33. 1 Standards of Service for 2 Medical Transcription 3 Version 10 4 Transcription Quality Assurance Work Sheet 5 6 Transcriptionist Id: 247 Document Type: Clinic Note Total # of Pages: 2 7 Document Number: 231244 Calculated Lines: 63 Transcription Date: 5/9/02 1 2 Error Types Occurrences Weight Score 3 Demographics: 4 1. Patient's Name 1.000 2. Medical Record Number 1.000 5 3. Physician's Name 1.000 6 4. Date of Service 0.500 7 Other: 8 5. Pharmaceutical Name and/or Dosage 1.000 9 6. Wrong Medical Word 1 1.000 1.000 10 7. Omission of Medical Word 1 1.000 1.000 11 8. Spelling of Medical Word 2 0.750 1.500 12 9. Spelling of English Word 0.250 10. Reports Contain Greater than 3 Blanks 0.500 13 11. PRD Error 0.375 14 12. Lab Value/Error 0.500 15 13. Grammar 0.125 16 14. Miscellaneous: 17 a. Capitalization 0.125 18 b. Numbers 0.125 19 c. Other (Specify Below) 0.125 20 0.125 0.125 21 0.125 22 0.125 23 0.125 24 TOTALS: 4 3.500 25 26 27 Pages Calculated Lines Error Score Errors Per Line x 100 Rating 28 2 63 3.500 5.6 94.4% 29 30 Rating > 98% Exceeds Standards Evaluator: Kaye Smith 5/10/02 Legend: 31 98% Meets Standards Name Date 32 95% to 98% Two-Month Probation Manager: Sara Turner 5/10/02 < 95% Remove from VUMC Pool Name Date 33 34 Comments/Recommendations 35 Susan was removed from the VUMC transcriptionist pool on 5/10/02. She wil be reinstated to the VUMC pool once she 36 demonstrates a two-month sustained accuracy rating of 98% or above. If reinstated, Susan's work wil be monitored with a 5% quality assurance sampling rate for two months to ensure she consistently maintains the 98% required accuracy rate. At the end of that two-month probation period, her work wil return to a 1% quality assurance sampling rate. 8 33
  • 34. 1 1 2 APPENDIX “E” 3 4 EXAMPLE MONTHLY BILLING REPORT 5 TO ACCOMPANY INVOICE 6 7 8 9 Comments: The example monthly billing report on the following page 10 contains a progressive breakdown of all the elements making up the total 11 charge for dictation transcription. The content of this report matches the 12 content in the Vendor’s system-generated document header, thus enabling the 13 dictator and his/her staff to fully understand total transcription cost 14 document-by-document. Such a document-by-document breakout of charges 15 and what generated them will both enable and encourage the dictator to work 16 toward reducing overall transcription costs. Such a breakout also helps 17 ensure that the Vendor is held accountable for accurate billing for services 18 rendered. 19 20 21 22 23 24 25 2 34
  • 35. 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 2 35