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 FutureACE 2010All 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. AgendaWhat is transcription and why is it still relevant?The Career-Minded MTManaging for efficiencyTranscription Innovation in the World of Meaningful Use 2

3. What is Transcription?3

4. 4Electronic Health Record UniverseTwo opposing needsEnterprise need for structured and coded information capturePhysician’s practical need for a fast and easy method for creating clinical notes.

5. 5The Current SituationDirect Data Entry: Structured and encoded information.Dictation: Fast and easy, expressive.Transcription can be expensiveSubject to longer turn-around timesClinical 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."11 - Waldrop, M. Mitchell. (October 31, 1996). “Dee Hock on management.” Fast Company. Retrieved from http://www.fastcompany.com/magazine/05/dee2.html , December 18, 20076

7. RealityMedical Transcription is competing with – Front-end speech recognition

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 DocumentationBack-end speech recognitionFront-end speech recognitionDictation and speech recognitionDirect into EMR Eliminates transcription costsDirect data entryPhysician data entry into fields of EMR8M*Modal Proprietary and Confidential

13. Transcription and EditingBackend speech recognition plus MT editingEfficiencies and cost savings

14. Cost avoidance

15. Comprehensive and complete documentation

16. High adoption by physicians

17. Pricing opportunities9

18. Value of Narrative DictationDoesn’t interfere with the doctor’s dayWhere and when he wants to do it

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 AdoptionWe can’t rely on lack of adoption to save us for long…Power shift - Physician to CFOPhysicians will eventually be forcedAlternative 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 Gracehttp://www.physicianspractice.com/display/article/1462168/159006012

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 historiesTranscribing exams and ordersDocumenting proceduresFollow – labs and x-raysRecording discharge information13

26. The CDI SpecialistEvolving 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.22 - Shepherd (July 22nd, 2009) Vive La Voice. For the Record. Vol. 21 No. 14 P. 2415

28. Value of Narrative DictationCMS reduction in hospital base ratesClinical Documentation ImprovementMS-DRG for coding - reimbursementSpecificity requires documentationICD-10POA indicators RAC review16

29. Reimbursement MS-DRG1Uncompensated CHF with

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 MT18

36. The Career-Minded MT ProfessionalismRemote workersSchedulingProductivity based payThe Independent ContractorThe “hobby MT” I’m not budging Compensation Training and educationCredentialing 19

37. Measuring Success20 Increased % gain is only one metric to be monitored!

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

39. Output versus “% Gained”21

40. Managing for Efficiency22

41. How Do You Measure Productivity?23

42. Workforce Management24 Output – not “% Gain”

43. Editing – Typing distribution

44. 75% rule