A Day in the Life of a Medical Transcriptionist (home-based position)
Medical transcription is a fast-paced, specialized healthcare field with our own language,
rules and regulations. More appropriately, today we are known as a Medical Language
Specialist (MLS) with responsibilities to preserve the accuracy and integrity of legal
medical documents. No two days are the same on the job, and the learning never ends.
Although we sometimes face challenges; they are resolvable, and there is always an
abundant workload. Moreover, the ability to work from home makes this position highly
desirable provided one is disciplined and focused.
At the medical center where I work, dictation can be done from either inside or outside
the hospital for all physicians with staff privileges by dialing into the dictation system to
a designated number. All dictation is recorded through a digital system and is managed
through an application called DVI that is now supported by Word Systems, Inc. At our
institution, dictation and transcription are separated into two separate categories;
radiology and medical. An on-staff dials into the DVI phone line and keys in the
pertinent information for the dictation. The dictations are set up in work types designated
for the specific report that they wish to dictate; i.e., history and physical, consultation,
operating report, discharge summary, cardiology procedure, radiology, etc. Once the
dictation is recorded on the DVI system, it is immediately off-loaded to our transcription
program.
The transcription platform used is an Internet-based system called TA Client and is a
program that was created and supported by Arrendale Associates out of North Carolina.
Within the TA application, the “jobs,” (each dictated report) are housed in an area called
job administration. This area holds all dictation that is waiting to be transcribed. Each
document is assigned a work type and is weighted according to priority. Each
transcriptionist has the capability to view job administration, which allows them to
manipulate documents (should the need arise) for problematic dictations, to move them to
a higher or lower priority, change the work type as necessary when there is an error, to
work through a specific backlog or dictator, as well as to route preoperative reports to a
designated area until the patient is assigned a current account number if the report is
being dictated preoperatively so it is not kicked around by multiple associates until they
are assigned an appropriate number.
The transcription system is set up such that when a transcriptionist signs in to the
program, the jobs auto-route to available transcriptionists two jobs at a time. As they
complete one job and submit it, the queue will refresh and load another job. Each time a
transcriptionist call up a report to do, she is prompted by a demographic screen that
populates the patient demographic information that the dictator has keyed in (on a good
day), providing there are demographics available. Sometimes, little to no information is
given wherefore the MLS detective skills come into play. Again, the patient’s medical
record is a number that stays the same no matter how many times they come to the
medical center. The different stays are called encounters, and those numbers change each
time they visit. These are called account numbers.
When the patient demographics populate on the screen and the transcriptionist has
verified through her headphones and the main frame (AS400) that the dictated text and
the patient information match, she then clicks the button on the TA demographic screen
that performs a lookup on the AS400 that will then link the patient demographics with a
Word document that is created. Now finally, the transcriptionist can begin the
transcription! With practice and repetition, this process moves quickly. The
transcriptionists at our institution have three packets that have been distributed that
outline our Transcription Overview, Transcription Style Guide, and Transcription
Formats set forth by the department and the medical center that are to be followed when
transcribing dictated documents. We also closely follow the AHDI (Association for
Healthcare Documentation Integrity) Medical Transcription Book of Style. IT is the
responsibility of each transcriptionist to also keep a medical library up to date concurrent
with use of reputable references from Internet web sites.
Once the medical document has been transcribed, it is the responsibility of the
transcriptionist to spell check the document and make any revisions necessary and adding
any carbon copies that need to be sent before submitting the completed record. Once the
document has been submitted, it flows back to the hospital main frame (AS400) and from
there is interfaced to the HPF (Horizon Patient Folder) in the form of a preliminary
document. At this point in time, a deficiency is created for the physician to sign the
document. It is imperative that the physician carefully reviews the content and makes
any necessary edits or changes before affixing their signature. This is now considered a
legal medical document. Once their signature has been affixed to the document, they can
no longer edit the report and would have to make any further changes or additions in the
form of a dictated “addendum or corrected copy,” that would require another signature.
We have the capability to create our own short cuts within the TA Client program and
have created normals and samples that help to enhance and boost our production. The
medical center has set average turnaround times for our specific report types. The system
is capable of monitoring these and we have the means to monitor how many jobs are out
of turnaround by the job summary function of our TA (transcription) program. These
turnaround times are monitored closely and are reported to out HIM director at the end of
each month, who then in turn reports them to administration.
Medical transcriptionists are paid by productivity and are paid by the 65-character line.
Our minimum requirement is equivalent to 150 lines per hour (for part-time) or an
average of 12,000 lines per pay period (two weeks) for a full time employee (80 hours).
Production statistics are submitted weekly by the individual transcriptionist and are
checked against the production report run from the transcription application. On the
medical side, we have a three-tier incentive program that affords the opportunity for a
greater earning depending on the lines per hour the transcriptionist transcribes and their
accuracy. All transcriptionists, while earning by production, are schedule for specific
shifts and punch their time through a time and attendance program, which is necessary
for calculation of their lines/reports per hour. Our part of the department is typically
considered a 24/7 department and our staff coverage complies with this time frame.
Each transcriptionist receives an annual evaluation at which time a transcription quality
assessment/audit is done to calculate average production (quality/quantity/accuracy) as
part of an overall assessment for potential merit increase. Included in this annual
evaluation are other things pertinent to our medical center as an individual institution and
includes pieces like compliance with Net Learning. These mini in-service modules set up
by the medical center for the purpose of continuing education that help us to stay abreast
of JCAHO requirements, medical center policies and procedures, patient safety goals,
OSHA requirements, hazardous materials and the like.
Medical transcription is an exciting but ever-changing field regardless as it is critical that
the medical documentation as dictated is as accurate as possible in order that we can
provide the most current and complete up-to-date electronic medical record possible with
the information that we are given. The medical record will follow the patient their entire
life and we try to make certain that while transcription, we consider that the patient we
are serving could be our own family members. It is through the documentation as a joint
effort between the dictator and the transcriptionist that other healthcare providers may be
basing their current assessment of a patient and their subsequent ongoing care.