This document discusses the future of medical transcription and innovation in healthcare documentation. It notes that while transcription allows for fast, expressive dictation, clinical data can be lost if documents are not structured or encoded. New technologies like speech recognition and direct data entry into electronic health records are competing with traditional transcription. The document outlines different service level options for transcription, including focusing on creating meaningful clinical documents that meet standards for patient care, coding, billing, and compliance. It emphasizes training medical transcriptionists to focus on creating useful documentation that supports tasks across healthcare like coding, quality improvement, and electronic health records.

1. Transcription for the Future ACE 2010 All information methods and concepts contained in or disclosed by this document is confidential and proprietary to Multimodal Technologies Inc. By accepting this material the recipient agrees that this material as well as the information and concepts contained therein will be held in confidence and will not be reproduced in whole or in part without express written permission from Multimodal Technologies, Inc. Client use of M*Modal tools or information (excluding any services or tools provided to the Client that are covered under a separate written agreement) is subject to the terms of a legal agreement between the Client and M*Modal.

2. Agenda What is transcription and why is it still relevant? The Career-Minded MT Managing for efficiency Transcription Innovation in the World of Meaningful Use 2

3. What is Transcription? 3

4. 4 Electronic Health Record Universe Two opposing needs Enterprise need for structured and coded information capture Physician’s practical need for a fast and easy method for creating clinical notes.

5. 5 The Current Situation Direct Data Entry: Structured and encoded information. Dictation: Fast and easy, expressive. Transcription can be expensive Subject to longer turn-around times Clinical data lost, because documents are neither structured nor encoded. Tedious manual process, Time-consuming, Documentation lacks expressiveness of natural language

6. Substance V Form – Dee Hock “Substance is enduring, form is ephemeral. Failure to distinguish clearly between the two is ruinous. Success follows those adept at preserving the substance of the past by clothing it in the forms of the future. Preserve substance; modify form; know the difference. The closest thing to a law of nature in business is that form has an affinity for expense, while substance has an affinity for income."1 1 - Waldrop, M. Mitchell. (October 31, 1996). “Dee Hock on management.” Fast Company. Retrieved from http://www.fastcompany.com/magazine/05/dee2.html , December 18, 2007 6

8. EHR – Direct entry

9. Front-end speech rec

10. Templating

11. Direct data entry Hospitals are looking for the most cost-effective solution… 7

12. Changing Face of Documentation Back-end speech recognition Front-end speech recognition Dictation and speech recognition Direct into EMR Eliminates transcription costs Direct data entry Physician data entry into fields of EMR 8 M*Modal Proprietary and Confidential

14. Cost avoidance

15. Comprehensive and complete documentation

16. High adoption by physicians

17. Pricing opportunities9

19. Lots of information in a little bit of time

20. Comprehensive information

21. Documents intuition and inclination

22. Physician behavior modification -None! 10

23. Physician Adoption We can’t rely on lack of adoption to save us for long… Power shift - Physician to CFO Physicians will eventually be forced Alternative methods - 11

24. The “Scribe” Strategy: Could You Use a Scribe? Are your patient encounters hampered by incessant charting and documenting? Perhaps a medical scribe can help. By Shirley Grace http://www.physicianspractice.com/display/article/1462168/1590060 12

25. The “Scribe” “Rather, they allow the physician with whom they work to shift his focus off of his tablet PC or paper chart to his patient. Specifically, a scribe is responsible for:” Patient histories Transcribing exams and orders Documenting procedures Follow – labs and x-rays Recording discharge information 13

26. The CDI Specialist Evolving role… “More important than coding” “…pharmacology; knowledge of official medical coding guidelines, CMS, and private payer regulations related to the Inpatient Prospective Payment System; an ability to analyze and interpret medical record documentation and formulate appropriate physician queries; and an ability to benchmark and analyze clinical documentation program performance.” 14

27. The “Chart Reader” “…when Dragon Medical was integrated with the organization’s EHR, emergency department (ED) transcription costs went from $1.4 million per year to zero.2 2 - Shepherd (July 22nd, 2009) Vive La Voice. For the Record. Vol. 21 No. 14 P. 24 15

28. Value of Narrative Dictation CMS reduction in hospital base rates Clinical Documentation Improvement MS-DRG for coding - reimbursement Specificity requires documentation ICD-10 POA indicators RAC review 16

30. COPD - $4,820

31. Obstructive bronchitis and acute exacerbation

32. Acute respiratory failure - $6,921

33. Difference of >$2,000 (base rate of $5,500)

34. For how many patients per year? 1 - Pam Wirth, RHIA and Kerry Chase, Amphion Medical Solutions, April 23, 2009, The Impact of Coding and Increased Demands on Specificity in Healthcare Documentation. MTIA 17

35. The Career Minded MT 18

36. 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 19

38. Increased OUTPUT = organizational efficiencies!FACT!! MTE 2 with a 50% gain will produce 450,000 more lines over the course of a year than MTE 1 with a 125% gain!!!

39. Output versus “% Gained” 21

40. Managing for Efficiency 22

41. How Do You Measure Productivity? 23

43. Editing – Typing distribution

44. 75% rule

45. Use productive typists

46. FTE/PTE work assignment

47. Total efficiency –

48. Headcount impact

49. Gap analysis

51. Effective training

52. Ongoing Mentoring

53. Basic editing skills

54. Can your MTEs quickly –

55. Create sections/subsections

56. Create numbered lists

57. Replace incorrect text

59. Innovation for the Future 27

60. The New Buzz Words Meaningful Use Structured Data NLP Validation Reconciliation 28

61. Back to Basics Valuable Implementation Meaningful Documentation Useful Documentation Partnership Be the expert 29

62. Document Elements 30

65. Invisible service provider

66. Focus on print format

67. Reactive to complaintsNew Way Standards based on usefulness Expert service provider Focus on content Proactive to needs 31

69. Coding and billing and revenue cycle tasks

70. Compliance

71. CMS

72. Pay for performance

73. Quality improvement – PQRI32

74. 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 33 M*Modal Proprietary and Confidential

75. Lowest Cost Line Attract the low-cost seeking customer Retain the high-priced existing customer Financial incentives to hospital Driven by draft quality Hospital requirements changed to accommodate Transcription “as dictated” Most accurate drafts Highest productivity Involved at typing stage if possible 34 M*Modal Proprietary and Confidential

76. 35 Meaningful Clinical Document Standards based on useful content Highest quality for patient care Compliance CMS JCAHO Ease of use for healthcare providers Physicians HIM Risk management EMR readiness The Health Story Content requirements CDA4CDT HL7 CDA M*Modal Proprietary and Confidential

77. Premium Service Offering Keep the demanding customer Speech invisible to hospital Customized requirements Expectations for productivity adjusted Optimal account implementation including DMs to the work type and physician level Rendering automation Requires highest level of MTE skill Appropriate MT compensation Appropriate hospital billing 36 M*Modal Proprietary and Confidential

78. Premium Service Offering Cost Impact High-cost implementation Customization = Lower productivity Higher transcription production costs Higher implementation cost Lowest productivity benefit High-range line rates for MT Value proposition Invisible to healthcare provider Satisfy demanding physicians 37

79. Speech Technology and Pricing 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 are paying for Would they rather pay for – Physician specific preference Meaningful Clinical Documents 38

80. Transcription and the HIM 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?” 39

81. Coding – ICD-9-M Wanted – more documentation! 3 – 5 digit codes Additional digits add specificity “unspecified” is bad Severity indicators - resource consumption CC – Complications and Co-morbidity MCC – Major CC MS-DRG 40

82. Coding – ICD-10 And even more documentation! ~ 5x the number of codes Lots more specificity required 41

83. The CDI Specialist The value of complete, comprehensive information… How can transcription help? “ICD-9-CM Coding Essentials: What every CDI Specialist needs to know” CCDS credential Focus on documentation affecting the DRG (diagnosis Related Group) and payment 42

84. Standards for the future.. The Health Story www.healthstory.com CDA4CDT HL7 CDA More than electronic standards – think content standards! 43

85. Questions? 44