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

Is Nuance going to outsource us overseas? - curly

Posted: Sep 21, 2013

Company I worked for recently outsourced us to Nuance, and now I'm wondering what the likelihood is that they will, in turn, outsource our entire account overseas? Do they pay less to their people who work overseas? Something's in the air recently - just in the past week or 2 - among me and some others on our account, and it just seems weird. We're getting harrassed more, we're getting more major errors marked BY FAR than previously, and some have even been threatened with being fired - again, just in the past week or 2 (we're coming to the end of an arrangement with our previous company and Nuance). I'm just wondering if anyone else has experienced anything like this?? Would appreciate some feedback.

Truth and Speculation - KC

[ In Reply To ..]
Yes, FIESA is hypercritical lately.

Yes, harrassment is up 200% and climbing. Threats of termination are real not imagined.

Speculation is that Apple is positioning itself to try to get the voice recognition portion of Nuance because Apple has been stockpiling cash assets since the beginning of the year, far more than they would need - AND Carl Icahn (a big investor in both companies) tried to bump his Nuance holdings to 20%. Nuance countered with a means to stop that from happening because they know without the voice recognition technology the foundation of how Nuance was formed what would be left no one would want.

Apple wants the technology because it has been the brains behind SIRI voice rec. for their Iphones and they don't want Nuance to be the keeper of that gold. In the end, I'd look for Apple to win the battle, and for Nuance to completely fold up. But - in the game of hostile take overs and stock, as we know anything could happen.

i don't get it - curly

[ In Reply To ..]
isn't it dragon, which anyone can get?

Hmmm - TS

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The difference would be like owning a car versus owning the company and the plans to manufacture cars. Does that make sense?

READ THIS! - curly

[ In Reply To ..]
well, i never knew that nuance owned dragon until just yesterday. for some reason, i got an email from nuance with subject "thank you for your interest in nuance." i thought, "what the heck? i already work for nuance," but when i opened it, it was about their products, including dragon. BUT GET THIS - i NEVER solicited information about nuance's products. the ONLY thing i did was talk about dragon in mt stars! so how did nuance know that i was talking about dragon, hmmmmmm? and - how did they get my email address??????

Weird, but did you know? - KC

[ In Reply To ..]
Might just be a coincidence for the dragon email from Nuance.

Nuance transcription is actually a subcompany of Nuance.

TRANSCEND doing business as NUANCE.

Front end SR - Informaticist

[ In Reply To ..]
I don't know about your immediate future, but Nuance is a major player in the front-end speech recognition market.

Most MTs still hold the view that dictation needs to be transcribed by an MT, or by a computer and at least "edited" by an MT. They see their "editor" jobs as the way the industry is going, with those jobs existing forever because they are so necessary. The worry for them is whether those jobs will be offshored.

Unfortunately, the end goal of SR is not "editors forever." It is not to continue enduring turnaround times ranging from hours to weeks. It is not to continue shipping dictation off-site for transcription at all.

The end goal is the installation of front-end SR software that works in conjunction with electronic record systems to transcribe the report WHILE THE DOCTOR IS SPEAKING IT. The doctor sees it on the screen exactly as if he were typing it. It appears word by word. The doctor can see if the transcription is correct or not, and he corrects it. The system is trained to understand his speech. The doctor is trained by the system to speak more clearly. No phone, no MTSO, no MT, no "editor," no delay, no medical errors -- just seamless integration with the medical record.

In the short term, I can't say what the plans are for your job. But, I can tell you that progress toward the MT-less future is being made faster than you would believe. All those big medical centers which are outsourcing their transcription departments to N are doing it because they have EHRs and are looking toward adding front-end SR to it soon.

MTs have not been able to see this shift in thinking because it isn't discussed much and because they work at home, where they have little to no contact with the institutions making the changes. If you are not working in big facilities with large informatics sections and medical records departments that are talking about this, you won't know.

Now would be a really, really good time for you to look for another line of work. Get some training if you need to, but get out of MT fast.

but of course - NOW i get it! - curly

[ In Reply To ..]
don't know why i didn't recognize all that before - that the dictators would see as they're transcribing and would be able to correct as they're transcribing - DUH! makes more sense, definitely. so - if i'm fired from nuance for not meeting qc, will i be able to get unemployment?

Is there a way to tell which facilities have already - implemented front-end SR?

[ In Reply To ..]
I am wondering if my primary account has already had the best dictators switch over to that since a big percentage of the work now seems to be poor dictation.

I am gonna stick with MT for the long haul, because I love it, and there are precious few other jobs safe at this time. I figure, even if this happens soon, they will certainly be required to pay UE and also we should certainly be eligible for TAA and then I will have to figure out something that I can do that isn't going to get offshored or computerized.

The more front-end VR - the better!

[ In Reply To ..]
Soon physcians will realize what a crock they have been sold as they face voicewreck day in and day out, correcting the same dumb errors over and over again, and being dumbfounded at the crazy ways their speech is being interpreted by the VR engine! Then maybe we will be valued again as making an essntial contribution to a system that is broken.

That is an incorrect scenario - Informaticist

[ In Reply To ..]
You have those problems, but they do not. You see poor output because the systems are not trained to the dictator and because the doctor has no feedback on the ability of the SR to transcribe him.

Once they see it on the screen, they change their speech. They learn to get good results. I know it is hard to believe, but they do.

We have had Dragon for years. If our doctors don't like it, they can use clicky templates or hand-type. Younger doctors are very computer savvy, often having taken notes and written papers on laptops all through medical school. They often have lots of computer programming, too. When you offer them the option of dictating, they think THAT is too much trouble.

Informaticist...are you a Dragon sales person? - sm

[ In Reply To ..]
What you are saying sounds like a sales pitch to me. I have worked with the docs in a very large facility and they ALL (young and old) would much rather dictate than type or watch a computer as they speak.

Nope, not affiliated with them in any way. - I work in healthcare

[ In Reply To ..]
In fact, I detest that company.

We don't cater to our doctors.

Thank you very much for the information. It's - greatly appreciated. I have heard

[ In Reply To ..]
also from someone in electronic research that in the last several years unbelievable advances have been made in computer technology, that they can potentially replace almost everything people do. He literally could not come up with the words to describe how revolutionary these advances are.

So I'm not surprised that clinicians plus computers will do significantly better without detouring through us, and before long too.

It's nice to have the way that's coming about laid out so clearly, though. So thanks again for the good deed. :)

Informaticist - nn

[ In Reply To ..]
I agree to disagree with you. I work in a clinic with several new physicians out of school and they are preferring to dictate and some even use traditional although they could change that to VR eventually. New physicians out of out school are computer savvy by far. I heard this 25 years ago and I am still working as an MT/VR editor. One oncology physician said and I quote "It takes me less than a minute to dictate what I do say in less time than I have to sit in front of a computer to dictate, make sure it is right and move on to the next patient. That is why I have you (he means me) and I am not changing it. I have too many patients to see. What I think the future holds is a preference from oranges to apples. Some will use it, some will not use it. I even know physicians who still use tapes! So maybe we will lose our jobs eventually and maybe some of us will not. I for one am staying in it til the fat lady sings because this is what I do for a living and do quite well at it with a great company. 'nuff said.

editor - nn

[ In Reply To ..]
Yes, I know have typos in my message but this is not a real professional board that I need to worry about it. I just worked all night and not worried about the particulars here. Just giving my 0 cents worth.

Big facility vs little office - Informaticist

[ In Reply To ..]
Your doctors have a good point. Using the SR available for your office and the desire of your doctors for optimum "presentation" appearance and time-saving, they well may opt to use an MT.

However, I was not talking about offices, but about large facilities. The question was about Nuance, which transcribes hospital dictation.

This discussion did not apply to your situation.

Do you happen to know where Dragon - curiousMT

[ In Reply To ..]
is manufactured? In the US or overseas?

I dunno, where is Nuance? - They own it. nm

[ In Reply To ..]
NM

Doctor speaking...EHR - Been there..

[ In Reply To ..]
AS someone who until recently worked as an MT in one of those "big facilities", actually a teaching facility, you are right about them trying this. However, unless the technology gets much, much better editors will always be needed. This facility closed MT department and then had to reopen and staff (under new titles) an editing department because anyone who thinks the doctors are going to be careful is just fooling themselves....as this facility found out.

Our experience was different - We hold the doctors responsible

[ In Reply To ..]
NM

Direct feedback of mistakes and sloppiness? - Well, we always wanted THAT. :) nm

[ In Reply To ..]
x

Was that failure of a completely front-end - system, BeenThere? nm

[ In Reply To ..]
x

Front end SR - anon

[ In Reply To ..]
You know when I read this post it sort of unnerved me. Nothing in this life is certain. We are not promised tomorrow so why worry about if we are going to be replaced by front end SR or by another person for that matter. I am all for being knowledgeable about matters but speculation and worry just isn't my thing! It isn't just MT, it is everywhere. Someone is always going to be replaced by another person who is cheaper or faster and so on. I like to read this board to keep up with the news but all this speculation lately makes me want to never check it again.

You nailed it. I'm working per diem - Dawnie

[ In Reply To ..]
for my hospital, after it went to WMX and then Nuance. WMX came in with promises of some fantastic system but it never happened. Nuance came in and are just about finished with installing stations, software, templates, training, etc. What's left are the really awful dictators.

The report quality is awful for the most part, but the bar was lowered a long time ago. We have perhaps 1 report a day that is edited. Volume in this department is about 1000 per day.

I was in ER last week with my hubby and watched (and listened) to the ER doc do his own reports. No waiting for anyone. H's CT scan was done and report was available within minutes of completion. Next day at MD follow up, all the reports were right there. It's a no-brainer for hospitals.

Informaticist - Millie

[ In Reply To ..]
Where did you get this information?

Millie - sm

[ In Reply To ..]
Where did I get this information? You make it sound like it is some kind of industry secret and I am a corporate spy.

The answer is that I know it because it is my job to know it. The state of technology and where it is going is fairly common knowledge in my field. It is nothing new where I work, either.

A better question is why you don't know it and, when it is pointed out to you, you attack the person telling you.

Informaticist - Millie

[ In Reply To ..]
You took this awfully personally. I merely asked a question. Hey, someone else actually thought you were advertising for Dragon! Ha!

Millie, what is an informaticist? - nm

[ In Reply To ..]
NM

nothing weird, usual for them - me

[ In Reply To ..]
They are having people picked to death. They first told everybody it was just to check on quality but that was a lie. Everybody under 99% is put on probation and then gone, and yes, more and more are going overseas. Another interesting thing, with the 401 statement that came, it said they had been removed from the options due to enormous bills and poor management. Heads are rolling even though the work force is NOT there even with India. Look for this company to go under and I for one will dance at the news.

incorrect scenario - aliceM

[ In Reply To ..]
ASR DOES NOT WORK!!!!! How can it, when the rudest bunch of people in the world, chomp on food when talking (mom didn't teach them anything), yawn, belch, can barely speak English or do speak English but mumble, stutter, stammer, etc. you can say all you want how great technology is but this sucks big time. The system does NOT learn. it puts commas and periods where there shouldn't be any or doesn't put any punctuation at all. If a dictator says patient comes in complaining of, I have had the system say something like the patient does not say anything or something so outlandish, I sit there shaking my head. So to those who think this is the next best thing to Wonder Bread, pffttt.

Oh, but it does work - KC

[ In Reply To ..]
The mere mechanics of it do work. When you feed in verbal language that is clear it works beautifully.

When you try to feed in jibber jabber, no, it doesn't work. How can it work? It is an automated machine process that has no reasoning to puzzle out what was meant.

If you feed lettuce into your printer to print you cannot expect to get out a document on linen-quality paper. In other words, what comes out of a machine is only as good as what goes into the machine.

Garbage in is garbage out, but if the quality of the voice going in is good what comes out is equally as good in VR.

Does it work, oh but it does? - whatever

[ In Reply To ..]
I've had SIRI on my Iphone for a couple of years. I enuciate clearly, she should be "trained" to my voice by now you would think yet 50% of the time she still can't tell her A** from a hole in the ground. I think this is jut another scare tactic.

Right, it does work - sm

[ In Reply To ..]
It worked on all the good dictators you never see anymore. That's why you think dictation is so awful now--you are seeing the dregs.

Our good dictators are fine with ASR. Our bad ones can just type it themselves.

Formatting and punctuation are not as important as content. They get the content right. The really good ones produce reports indistinguishable from MT-transcribed. Hard to believe, I know.

Alice, you've been saying that for over a decade. - You also waited forever before

[ In Reply To ..]
getting an expander, typing everything snail-style, before you finally got one and started using it in a limited way.

Yes, I'm guessing at this pattern of denial of and resistance to change. But if this doesn't fit you, it absolutely is a profile of all those you sound exactly like.

For your own good, maybe reread Informaticist's post and consider if it could possibly be true?

ASR can work excellently when it's allowed to. I've seen it. I see it every day with some dictators, in spite of dozens of editors who keep messing it up by editing dozens of different ways.

what is the 401 statement? - thanks! n.m.

[ In Reply To ..]
.

You can count on it - Me

[ In Reply To ..]
They originally told QA Fiesa was a tool to train, now we find it's a tool to fire people and yes, more and more jobs are being outsourced. Just saw another chain go to India. Yes, India is paid much less.

Of course they will... - miffedmt

[ In Reply To ..]
that's what they did when they took over our hospital in AK. Within a year they outsourced to India, AKA Follow The Sun, along with 11 other Banner facilities that Nuance had.

outsourcing - me

[ In Reply To ..]
of course they will - that's what they did when they took on our hospital. Trancriptionists are cheap in India.

overseas - Ari

[ In Reply To ..]
Don't quit what ever you do. If you quit no unemployment for you and that is what they want. Just hang in there and see what happens then if they fire you you will at least get unemployment. There are NO good jobs right now.

no intention of quitting - curly

[ In Reply To ..]
i've actually put myself in that position several times before, and i absolutely refuse to quit. i'll probably be fired because i can't seem to make the ridiculous qc. i'd say at least 50 percent of the things they mark wrong have NOTHING to do with anything medical and i'm sure the doctors don't care about these stupid things that do not change the medical meaning in the slightest.

Perhaps it is your keyboard? - sm

[ In Reply To ..]
Your shift key doesn't seem to work. LOL!

(Sorry! I couldn't resist! )

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