A community of 30,000 US Transcriptionist serving Medical Transcription Industry

Lack of work - Cinge

Posted: Jul 06, 2012

Has anyone noticed less work in your queues lately? Has anyone had a hard time getting in to a new transcription company? I have 12 years experience, and had an easier time finding a job as a newbie than I do now. Think maybe this has anything to do with the cheap labor from India that is replacing American workers? I'm thinking about finishing my coding classes, but they give American jobs to India also. What does it take to earn a living in America now?

A 4-year degree is the general cutoff between those getting raises - and those getting a kick in the teeth. NM

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Might have to do with EMR mandate - b

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By the end of Aug, I will loose nearly more than 50% of my business due to the EMR mandate.

EMR mandate does not go into effect until 2014 - why 50%?

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Penalties not until 2015.

My MTSO told me our client already uses EMR in conjunction with our platform. And nothing should change on our end. From what I've read, EMR itself is so medical records can be accessed electronically, not something that is going to replace the MT, per se. Not sayin' that won't happen... already is through VR and overseas outsoursing anyhow.

LMAO! You are woefully ignorant about EMR. - MT

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Your post suggests you haven't read the law and don't know what it says.

Don't you know about the INCENTIVES? The feds are paying docs, groups, and hospitals CASH to get on board with EMR. Hardly ANYONE will be paying those penalties in '14 because most are on board already. THAT is why we in MT started seeing the DETRIMENTAL changes to our workload a few years ago.

Keep telling yourself it will have "no effect" on our workload as MTs. The rest of us has ALREADY SEEN the changes.

why would you call me woefully ignorant when you don't even know me? - why 50%?

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I stated the network of hospitals my MTSO has is already (I could cap every letter of already, but that might be rude). We are already integrated into EMR, which is the availability of the medical record electronically.

I shan't keep telling myself anything. I ask questions and I try to be wise with my decisions.

My MTSO has been very transparent in the past and currently regarding the disposition of our accounts, so please don't be so arrogant as to assume you know everything about every MTSO and that you know the exact effect it will have on any individual.

EMR - MT

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EMR is just Electronic Medical Records.

What is causing loss of MT business is the software used for EMR. There are programs that still employ transcription but, for example, point-and-click companies have convinced facilities that theirs is the only way to meet EHR/EMR requirements.

I should add what I believe is causing the lack of work: Offshoring, point-and click and other programs that reduce the need for medical transcriptionists, VR, and a glut of very experienced MTs applying for positions due to dissatisfaction with their current job (more and more common as the larger corporate MTSOs cut wages/cause stressful work environments). It doesn't help that newbies who just want to work at home are willing to take positions that experienced MTs who value their skills would never do - for example working for 5 cpl straight or 3 cpl VR.

I agree: all of the above - NC MT

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It is a combination of all of these factors:
(1) EMR where docs are being forced to complete a once-and-done document at the patient encounter, either by editing their own draft using SR, using drop-down menus or point and click to complete.
(2) Technology companies that over over-sold the benefits from VR, resulting in MTs working like slaves at ridiculous editing rates just to keep food on the table, thus taking more work off the system to barely make minimum wage.
(3) Hospitals that are financially destitute because of the economy and increased federal regulation who resort to offshoring to make ends meet.
(4) Decreased census at hospitals due to high unemployment and the economy--less patients means less dollars.

And yes, unscrupulous MTSOs who illegally use ICs without paying benefits or payroll taxes and/or don't pay minimum wage or overtime as required by law, and change timesheets after they're submitted.

It's everything combined that has contributed to the horrible situation we find ourselves in. But it's not just the bad MTSOs--it's the technology companies who have gotten rich at our expense (especially Nuance), and the government that just keeps on over-regulating healthcare. A doctor told me last week he has lost 1/3 of his income due to the EMR and he is spending at least 2 hours a day typing his own notes because he is committed to patient care, but the hospital requires him to point and click his encounters. He is afraid he will "lose" a patient because there is not enough documentation there to give him the whole picture--so he types his own notes--to the tune of 1/3 his income. Sad situation, and I don't know how we change anything.

Something shocking from my own personal experience - computer erased critical info in med record

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A friend of mine has a 10-year-old daughter recently diagnosed with a brain tumor. She was recovering as well as could be expected until someone erased information that she was to receive an antibiotic, resulting in an infection. I'm beyond angry to think that this young girl's life would depend on some person hitting the wrong key. Has the whole world gone insane?

No backup to records? That IS shocking. Our medical group - lost 14 years of family paper files, tho. Fraid

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the whole world's always been unreliable. No one ever kept duplicate sets of paper files, of course, so when they were gone, they were gone.

Here's a more current one: Last winter when I took my husband to the emergency room exactly 7 weeks after he had been there before, they had no record of him, no blood type, NOTHING. Turns out our local regional medical center has been routinely erasing electronic patient records every 6 weeks--all except the billing information. THAT they had.

In this case only the part about the medication she needed was erased - not the entire record

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It must have happened when they moved her from ICU to her room. I'm not sure what happened or when. Most of her record was there. They just erased the medication that would probably have kept her from having a life-threatening infection. She needs all the breaks she can get at this point. I'm so scared for her.

Blame the staff, not the EHR - Informaticist

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This was a human error. The EHR did not do this.

Nothing changed in the record when this patient went from the ICU to the room. The record remained exactly the same. It does not follow the patient around like a paper record. It is not taken out of one desktop computer and loaded into another.

The hospital, or possibly the entire healthcare system, has one main computer, which IS backed up, and the record exists on that system. It can be accessed throughout the hospital at any computer terminal.

Nothing gets lost or deleted by accident during moves because the record does not move.

What you are describing actually fits the PAPER record world more than the EHR. It is exactly what would happen if a paper record was moved before an order got entered and staff changed.

The blame lies with the doctor. Stop blaming the EHR.

How do you know this? Hearsay or do you hav proof? - Sigh

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I can buy that somebody failed to find your husband's previous record, and I can buy that somebody explained that away as the facility erasing records every six weeks, but I do not believe that anything got erased.

It does happen that a record cannot be found because the identifying information differs. Duplicate records are a huge problem. Especially in ERs, it is likely for a record to be created if the original cannot be found. Maybe the staff could not find the record the last time and created a second, then the next time you went in the original was retrieved and it (obviously) would not have had the last ER visit in it. It might be that the last visit's information got put into the wrong patient record. There are several explanations, none of which involve erasure.

There are many reasons a facility would not erase records. EHRs are built with them in mind. It is impossible to erase them. Records have to be retained for years according to the laws of the state. They have to be retained to serve as defense in the event the facility is sued. Facilities are also very diligent about this because they need them for billing and payer audits; they often have to submit them for review months after the fact.

Your husband's information is in there. He either has 2 records, or it is in the wrong patient's record.

There is not a universal EHR. There are many systems - Anything is possible

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There are dozens, probably hundreds of different systems. There is no one system that everyone uses. We don't know everything about every single system out there and what can or cannot be done with them.

No universal system, but there are universal STANDARDS - All EHRs follow

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You are correct that there is no universal system, but there are universal standards that all EHRs follow. There are national committees that develop those standards.

The scenario that was described, that of an order for antibiotics getting erased because someone pushed the wrong button, simply could not have happened. No order entry system used at any hospital is so slipshod that it could be possible to do that. That is one of the first and most obvious errors that would be made impossible.

A major focus of order entry systems is the elimination of error. You simply cannot erase a signed order by accidentally pressing a button.

These stories of EHR horror sound like some kind of medical urban legend. "Man wakes up in hotel room missing kidney!" "Entire school addicted to LSD by mimeographs!" "Child suffers deadly infection because nurse pressed wrong button!"

The nurse failed to give the drug or the doctor never ordered it. Period. They just thought they could get away with blaming the EHR.

And I DO know because I am an informaticist. I know exactly what they do, how they do it, and how doctors misuse them.

The EHR dog cannot eat your homework - Knows better

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While tragic, the scenario you describe could not have happened that way. An antibiotic might not have been given, but it was not because someone erased the order by hitting the wrong key. That may have been how it was explained, no doubt, but the reality was different.

EHR software is not like Word, where you can erase something by hitting the wrong key or forgetting to save it. It has more failsafes than that.

You know that authors of entries in a paper record are required to sign them. Those entries can be removed and discarded or never entered at all. Nurses can miss orders or forget to execute them. Medication orders in paper form have a far higher rate than electronic order entry.

In an electronic record, providers have to log in. The computer knows who they are and it tracks them. It tracks everything the look at, what they do, what they write, and it requires them to electronically sign everything they record. In a paper record, signed information is not supposed to be removed, but can be. In an EHR, signed information cannot be removed without intervention at a higher level. It cannot be deleted by accident or by pressing wrong keys.

What can happen is that a physician can forget to write the order or could have failed to sign it. He could still be scribbling them on paper for someone else to enter and that person forgot. A nurse can forget to administer what was ordered or administer it to the wrong patient. There are human errors that still occur, but they are the same errors that would have occurred with a paper record.

Order entry systems are very tightly controlled to prevent errors and accidental deletions. Once signed, no one could have erased it. Before signing, any erasure or failure to complete the entry was the fault of the physician, who is ultimately responsible for the care of the patient.

It may be that the doctor used the excuse that the computer erased something, or a nurse who did not understand explained it that way, or who knows, but the truth of the matter is that this was human error that cannot be blamed on the EHR.

It is a lot like blaming the transcriptionist for errors. Before electronic records, a classic excuse was "the MT didn't transcribe it" or "it was typed wrong" or "the MT lost the dictation." You know how bogus that was . . . it is THEIR responsibility no matter what. It is more likely they never said it or said it wrong or that the hospital never put it in the record. I know because I used to be an MT.

The minute EHRs get put into place, doctors start blaming them instead. "Somebody must have pressed the wrong key and deleted it." "There must have been a glitch and it disappeared." But that doesn't happen. If it did, the doctor is still responsible.

And that is who is responsible for that antibiotic . . . the child's doctor. Nobody else and not the EHR.

Impressed you know so much about EHR. - Questions for you.

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If I may ask, are you in/finished school for EHR-related positions? Working with EHR now? If yes, would you tell where you are getting/received your schooling and/or how you got your position? I want to change careers and starting to search for jobs in medical records, but there is so much info, I get confused which direction to go in.

Recmmendations - Informaticist

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Yes, I work with an EHR in health information management. I went the HIM route first, which had some informatics, but got most of it on the job and through employer-provided courses. Still doing it and will probably never stop because technology changes so fast. I like learning, so that is good.

There are community college programs but I think they are limited in value. Facilities do not seem to want a person with a certificate or associate's as much as they want a bachelor's. Maybe clinics and doctors's offices might. I see a lot of current HIM people expanding skills using those programs, so it is good for them.

Bellevue College has a program. Google HITECH and also look at Bellevue for information. There is funding available for this, so maybe you can do a program using that.

My recommendation in terms of an overall best bet is the informatics program at Western Governors University. It is completely online, very reasonably priced (nonprofit, not a diploma mill), and accredited by AHIMA for the RHIA.

Do not let their 4-year degree scare you. You can probably finish it as fast as you could an associate degree at a regular college. You can definitely finish it faster than a community college followed by a completer program for the RHIA at a university. Some RHIT programs take more than 2 years full-time and RHIA programs after that can take another 3 years because courses will not transfer, etc.

WGU teaches the entire RHIA program, not just the last half of it. It it also competency based so you can complete the work as fast as you are abl instead of being in lock-step with classes on the semester system. If you already know material, you can complete it faster. As an MT, you can probably whiz through a lot of coursework like med terms, anatomy, and English. You are also very bright, so you will move faster. A lot of their students do a 4-year degree in 2-1/2 years. When you consider that the 4-year degree can take 6 years full-time, WGU looks VERY good. The tuition is based on time, not courses, and a lot of materials are included, so you can save a lot of money if you are motivated.

The school is well-respected even though very new. It has a 100% pass rate on the RHIA exam, which is almost unbelievable. The pass rate from all schools is about half that.

You can begin at any time and there is no requirement to complete prerequisites in order to be admitted to the HIM program.

This is the only program I would consider worth student loans. You will definitely get a job worth the investment. With an RHIA you will be marketable in a variety of jobs, and with this one you will be marketable in informatics, as well. You are probably eligible for a Pell Grant, though, so perhaps you would even do better with this if you went to part time or quit in order to finish faster. RHIAs are in very short supply, too.

What do I not advise? I do not advise doing just an RHIT program online or locally because you can do WGU in roughly the same time frame and have better job opportunities. Pay is much higher for RHIAs. If you already have a bachelor's you could do a certificate in HIM to take the RHIA, but they do not cover informatics in any depth yet and only the University of Toledo's can be done in less than 2 years and at reasonable cost. Either way, WGU would be better.

Thank you, thank you! - Questions for you.

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You clarified some points for me. I will be looking into your recommendations after work today. Thanks for such a well written and informative response. Now I am really motivated to get going on a career change!

You are welcome - Informaticist

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Keep the motivation up! I got a bit discouraged now and then. Everyone does. Just decide you must do it and do not stop.

Ask WGU to have an enrollment counselor call you right away. They are not there to sell the school but to help you through the enrollment process. The school is nonprofit. It is there for you. Literally, that is why it was established. They offer only degrees in fields that pay decently, too.

MTs are very self-motivating people. You need that to fit well with WGU's teaching style. I think it would be just what you would enjoy. I think the salary you will make is good, too. Check the salaries for RHIAs n the AHIMA website.

Thanks very much for the good information, Knows Better. - Quality input much appreciated. NM

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