HIPAA

Health Insurance Portability and Accountability Act (HIPAA)

HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. HIPAA also requires the establishment of national standards for electronic healthcare transactions and national identifiers for providers, health insurance plans, and employers besides addressing the security and privacy of health data. The standards are meant to improve the efficiency and effectiveness of the nation's healthcare system by encouraging the widespread use of electronic data interchange in the US healthcare system.

As a medical transcription company, iSource recognizes and is committed to help clients achieve HIPAA compliance within the timelines set forth by HIPAA regulations. The governing framework we have created is used for defining and managing the HIPAA initiatives.

Our HIPAA privacy officer facilitates and manages the HIPAA and information security needs of our organization and for our clients. He is responsible for developing and maintaining effective educational programs for training the internal staff and external clients on HIPAA compliance.

We also understand the fact that the HIPAA regulations have still not been finalized and are subject to change. Our principle is to make all reasonable efforts to be knowledgeable and responsive towards HIPAA regulations, reduce paperwork, streamline the inadequacies of the industry, make it easier to identify and bring to court fraud and mistreatment, and achieve HIPAA compliance within the mandated timeframe.

We provide HIPAA compliance requirements like limiting access to the application by User ID and password, role-based access, context-based access, user-based access, auto log off from the application if no activity is performed for a certain time, auto logging to provide an adequate report within the application for the last 12 months if the patient detail is accessed, modified or deleted, user authentication by providing an encrypted password and a personal identification number.

The future of medical transcription

The medical transcription industry will continue to undergo metamorphosis based on many contributing factors like advancement in technology, practice workflow, regulations etc. The evolution toward the electronic patient record demonstrates that, over time, documentation habits will change either through standards and regulations or through personal preferences. Until recently, there were few standards and regulations that MTs and their employers had to meet. First, we had the Health Insurance Portability and Accountability Act (HIPAA). It wasn't long ago "experts" stated that HIPAA would not have any effect on the medical transcription industry. Either in a state of denial or ignorance of the law, many transcriptionists and companies have continued on their existing course of providing medical transcription. Many providers are concerned that the majority of the transcription industry will not be able to meet several specific requirements: namely, access controls, policies and procedures, and audits of access to the patient information. Without the knowledge or resources to comply, many in the industry are claiming to comply and signing their Business Associates Agreements without taking the security measures required. Many are uninformed, and some are choosing to remain so, believing that the world of transcription cannot possibly be expected to make these adaptations. The fact is that the employers will demand HIPAA compliance and will change employees and contractors when they don't get it. There will also be demands to enhance patient safety, increase efficiency, and reduce costs. It is mandatory for service providers and healthcare practices to migrate to a HIPAA compliant environment.

Outsourcing of medical transcription

Due to the increasing demand to document medical records, countries started to outsource the services of medical transcription. In the United States, the medical transcription business is estimated to be worth US$10 to $25 billion annually and growing 15 percent each year^{[citation needed]}. The main reason for outsourcing is stated to be the cost advantage due to cheap labor in developing countries, and their currency rates as compared to the U.S. dollar.

There is a volatile controversy on whether medical transcription work should be outsourced, mainly due to three reasons:

1. The greater majority of MTs presently work from home offices rather than actually in hospitals, working off-site for "national" transcription services. It is predominantly those nationals located in the United States who are striving to outsource work to other-than-US-based transcriptionists. In outsourcing work to sometimes lesser-qualified and lower-paid non-US MTs, the nationals unfortunately can force US transcriptionists to accept lower rates, at the risk of losing business altogether to the cheaper outsourcing providers. In addition to the low line rates forced on US transcriptionists, US MTs are often paid as ICs (independent contractors); thus, the nationals save on employee insurance and benefits offered, etc. Unfortunately for the state of healthcare-related administrative costs in the United States, in outsourcing, the nationals still charge the hospitals the same rate as they did in the past for highly qualified US transcriptionists, but subcontract the work to non-US MTs, keeping the difference as profit.
2. There are concerns about patient privacy, with confidential reports going from the country where the patient is located (i.e. the US) to a country where the laws about privacy and patient confidentiality may not even exist, which was overcome as HIPAA (Healthcare information portability and accountability act) became mandatory for all the providers from the outsourced countries. Some of the countries that now outsource transcription work are the United States, Britain, and Australia, with work outsourced to Philippines, India, Pakistan, Canada and Barbados^[3].
3. The quality of the finished transcriptions is a concern. Many outsourced transcriptionists simply do not have the requisite basic education to do the job with reasonable accuracy, as well as additional, occupation-specific training in medical transcription. Many foreign MTs who can speak English are not familiar with American expressions and/or the slang doctors often use, and can be unfamiliar with American names and places. An MT editor, certainly, is then responsible for all work transcribed from these countries and under these conditions. These outsourced transcriptionists often work for a fraction of what transcriptionists are paid in the United States, even with the US MTs daily accepting lower and lower rates. However, some firms choose to employ American transcriptionists as they believe the quality of work is better.^[4]

Among outsourcing countries, the Philippines has recently attracted increased amounts of MT outsourcing from the United States due to the fact that aside from the Filipino language, English is one of the official languages used in almost all government transactions in the country and the high literacy in the English language and perhaps, the capability of average Filipino to understand American idioms, colloquialism, and slang used in medical transcription. This is very concerning to the US MTs. The Health Insurance Portability and Accountability Act (HIPAA)^[5] governs outsourcing of MT work. Stricter policies in compliance with HIPAA are implemented in such companies to enable security and confidentiality of work involved in such practices.

The medical transcription process

When the patient visits a doctor, the doctor spends time with the patient discussing his medical problems, including past history and/or problems. The doctor performs a physical examination and may request various laboratory or diagnostic studies; will make a diagnosis or differential diagnoses, then decides on a plan of treatment for the patient, which is discussed and explained to the patient, with instructions provided. After the patient leaves the office, the doctor uses a voice-recording device to record the information about the patient encounter. This information may be recorded into a hand-held cassette recorder or into a regular telephone, dialed into a central server located in the hospital or transcription service office, which will 'hold' the report for the transcriptionist. This report is then accessed by a medical transcriptionist, it clearly received as a voice file or cassette recording, who then listens to the dictation and transcribes it into the required format for the medical record, and of which this medical record is considered a legal document. The next time the patient visits the doctor, the doctor will call for the medical record or the patient's entire chart, which will contain all reports from previous encounters. The doctor can on occasion refill the patient's medications after seeing only the medical record, although doctors prefer to not refill prescriptions without seeing the patient to establish if anything has changed.

It is very important to have a properly formatted, edited, and reviewed medical transcription document. If a medical transcriptionist accidentally typed a wrong medication or the wrong diagnosis, the patient could be at risk if the doctor (or his designee) did not review the document for accuracy. Both the Doctor and the medical transcriptionist play an important role to make sure the transcribed dictation is correct and accurate. The Doctor should speak slowly and concisely, especially when dictating medications or details of diseases and conditions, and the medical transcriptionist must possess hearing acuity, medical knowledge, and good reading comprehension in addition to checking references when in doubt.

However, some doctors do not review their transcribed reports for accuracy, and the computer attaches an electronic signature with the disclaimer that a report is "dictated but not read". This electronic signature is readily acceptable in a legal sense. The Transcriptionist is bound to transcribe verbatim (exactly what is said) and make no changes, but has the option to flag any report inconsistencies. On some occasions, the doctors do not speak clearly, or voice files are garbled. Some doctors are, unfortunately, time-challenged and need to dictate their reports quickly (as in ER Reports). In addition, there are many regional or national accents and (mis)pronunciations of words the MT must contend with. It is imperative and a large part of the job of the Transcriptionist to look up the correct spelling of complex medical terms, medications, obvious dosage or dictation errors, and when in doubt should "flag" a report. A "flag" on a report requires the dictator (or his designee) to fill in a blank on a finished report, which has been returned to him, before it is considered complete. Transcriptionists are never, ever permitted to guess, or 'just put in anything' in a report transcription. Furthermore, medicine is constantly changing. New equipment, new medical devices, and new medications come on the market on a daily basis, and the Medical Transcriptionist needs to be creative and to tenaciously research (quickly) to find these new words. An MT needs to have access to, or keep on memory, an up-to-date library to quickly facilitate the insertion of a correctly spelled device,

Curricular requirements, skills and abilities

experience that is directly related to the duties and responsibilities specified, and dependent on the employer (working directly for a physician or in hospital facility).

• Knowledge of medical terminology.
• Above-average spelling, grammar, communication and memory skills.
• Ability to sort, check, count, and verify numbers with accuracy.
• Skill in the use and operation of basic office equipment/computer; eye/hand/foot coordination.
• Ability to follow verbal and written instructions.
• Records maintenance skills or ability.
• Good to above-average typing skills.

Basic MT knowledge, skills and abilities

• Knowledge of basic to advanced medical terminology is essential.
• Knowledge of Anatomy and Physiology.
• Knowledge of disease processes.
• Knowledge of Medical Style and Grammar.
• Average verbal communication skills.
• Above-average memory skills.
• Ability to sort, check, count, and verify numbers with accuracy.
• Demonstrated skill in the use and operation of basic office equipment/computer.
• Ability to follow verbal and written instructions.
• Records maintenance skills or ability.
• Above-average typing skills.
• Knowledge and experience transcribing (from training or real report work) in the Basic Four work types.
• Knowledge of and proper application of grammar.
• Knowledge of and use of correct punctuation and capitalization rules.
• Demonstrated MT proficiencies in multiple report types and multiple specialties.

Duties and responsibilities

• Accurately transcribes the patient-identifying information such as name and Medical Record or Social Security Number.
• Transcribes accurately, utilizing correct punctuation, grammar and spelling, and edits for inconsistencies.
• Maintains/consults references for medical procedures and terminology.
• Keeps a transcription log.
• Foreign MTs may sort, copy, prepare, assemble, and file records and charts (though in the United States (US) the filing of charts and records are most often assigned to Medical Records Techs in Hospitals or Secretaries in Doctor offices).
• Distributes transcribed reports and collects dictation tapes.
• Follows up on physicians' missing and/or late dictation, returns printed or electronic report in a timely fashion (in US Hospital, MT Supervisor performs).
• Performs quality assurance check.
• May maintain disk and disk backup system (in US Hospital, MT Supervisor performs).
• May order supplies and report equipment operational problems (In US, this task is most often done by Unit Secretaries, Office Secretaries, or Tech Support personnel).
• May collect, tabulate, and generate reports on statistical data, as appropriate (in US, generally performed by MT Supervisor).

As a profession

An individual who performs medical transcription is known as a medical transcriptionist or an MT. The equipment the MT uses is called a medical transcriber. The individual who performs medical transcription should always be called a "medical transcriptionist." A medical transcriptionist is the person responsible for converting the patient's medical records into typewritten format rather than handwritten, the latter more prone to misinterpretation by other healthcare providers. The term transcriber describes the electronic equipment used in performing medical transcription, e.g., a cassette player with foot controls operated by the MT for report playback and transcription. In the late 1990s, medical transcriptionists were also given the title of Medical Language Specialist or Health Information Management (HIM) paraprofessional.

There are no "formal" educational requirements to be a medical transcriptionist. Education and training can be obtained through traditional schooling, certificate or diploma programs, distance learning, and/or on-the-job training offered in some hospitals, although there are countries currently employing transcriptionists that require 18 months to 2 years of specialized MT training. Working in medical transcription leads to a mastery in medical terminology and editing, MT ability to listen and type simultaneously, utilization of playback controls on the transcriber (machine), and use of foot pedal to play and adjust dictations - all while maintaining a steady rhythm of execution.

While medical transcription does not mandate registration or certification, individual MTs may seek out registration/certification for personal or professional reasons. Obtaining a certificate from a medical transcription training program does not entitle an MT to use the title of Certified Medical Transcriptionist (CMT). The CMT credential is earned by passing a certification examination conducted solely by the Association for Healthcare Documentation Integrity (AHDI), formerly the American Association for Medical Transcription (AAMT), as the credentialing designation they created. AHDI also offers the credential of Registered Medical Transcriptionist (RMT). According to AHDI, the RMT is an entry-level credential while the CMT is an advanced level. AHDI maintains a list of approved medical transcription schools.

There is a great degree of internal debate about which training program best prepares a MT for industry work. Yet, whether one has learned medical transcription from an online course, community college, high school night course, or on-the-job training in a doctor's office or hospital, a knowledgeable MT is highly valued.In lieu of these AHDI certification credentials, MTs who can consistently and accurately transcribe multiple document work-types and return reports within a reasonable turnaround-time (TAT) are sought after. TATs set by the service provider or agreed to by the transcriptionist should be reasonable but consistent with the need to return the document to the patient's record in a timely manner.

As of March 7, 2006, the MT occupation became an eligible U.S. Department of Labor, a 2-year program focusing on acute care facility (hospital) work. In May 2004, a pilot program for Vermont was initiated, with 737 applicants for only 20 classroom pilot-program openings. The objective was to train the applicants as MTs in a shorter time period. (See Vermont HITECH for pilot program established by the Federal Government Health and Human Services Commission).

History

Evolution of transcription dates back to the 1960s. The method was designed to assist in the manufacturing process. The first transcription that was developed in this process was MRP, which is the acronym for Manufacturing Resource Planning, in 1975. This was followed by another advanced version namely MRP2. But none of them yielded the benefit of medical transcription.

However, transcription equipment has changed from manual typewriter electric typewriters word processors to computers and from plastic disks and magnetic belts to cassettes and endless loops and digital recordings. Today, speech recognition (SR), also known as continuous speech recognition (CSR), is increasingly being used, with medical transcriptionists and or "editors" providing supplemental editorial services, although there are occasional instances where SR fully replaces the MT. Natural-language processing takes "automatic" transcription a step further, providing an interpretive function that speech recognition alone does not provide (although MTs do).

In the past, these medical reports consisted of very abbreviated handwritten notes that were added in the patient's file for interpretation by the primary physician responsible for the treatment. Ultimately, this mess of handwritten notes and typed reports were consolidated into a single patient file and physically stored along with thousands of other patient records in a wall of filing cabinets in the medical records department. Whenever the need arose to review the records of a specific patient, the patient's file would be retrieved from the filing cabinet and delivered to the requesting physician. To enhance this manual process, many medical record documents were produced in duplicate or triplicate by means of carbon copy.

In recent years, medical records have changed considerably. Although many physicians and hospitals still maintain paper records, there is a drive for electronic records. Filing cabinets are giving way to desktop computers connected to powerful servers, where patient records are processed and archived digitally. This digital format allows for immediate remote access by any physician who is authorized to review the patient information. Reports are stored electronically and printed selectively as the need arises. Many MTs now utilize personal computers with electronic references and use the Internet not only for web resources but also as a working platform. Technology has gotten so sophisticated that MT services and MT departments work closely with programmers and information systems (IS) staff to stream in voice and accomplish seamless data transfers through network interfaces. In fact, many healthcare providers today are enjoying the benefits of handheld PCs or personal data assistants (PDAs) and are now utilizing software on them for dictation.