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

Fatal outsourcing. - VickiK

Posted: Dec 15, 2012

See link. http://blog.al.com/live/2012/12/fatal_outsourcing_thomas_hospi.html

I guess some ppl dont read anything but what they - themselves post. nm

OP - VickiK

[ In Reply To ..]
I did the dastardly deed of putting it up for the 2nd time. I was in a hurry, sorry if this was annoying. I scanned the board quickly and obviously did not see the first post. No real harm done. Geesh.

Between us, once again, I'm glad you posted this. - mraker

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It may have been accidentally unnecessarily redundant, but it brought up a different line of points in the responses, so still worth it as far as I'm concerned. Like you, I looked but didn't recognize the original (I realize that the farther I scroll down, the more and lower the snowflakes are, which can indeed "confuse" me). I don't understand why some posters had to be so snarky about it. A simple "This has already been posted under the title of..." would have sufficed, IMO.

Also, despite what another poster said, only when a poster requests their own post deleted is there a strikethrough remaining for a while as notification of a deletion. When the mods delete something of their own accord, it's immediately gone without a trace. Ask anyone who saw the appearance and disappearance of the webinar link on the Nuance board recently.

Thanks, I was trying to find this again. - mraker (nm)

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nm

Deja Vu - Pete and Repeat

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Am I reliving this morning?

I know I shouldn't encourage this, but I missed whatever led... - mraker

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to the original post/s and apparently threads being deleted. Anyone who saw the responses that I missed like to clue me in a bit? Just a short synopsis would be appreciated.

don't know what you are confused about, - anon3

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This thread is a repeat of the thread not far below with the subject line of "$140 MILLION JUDGEMENT AGAINST PRECYSE," thats all. Nothing has been deleted and if it were, that would show on the board as well, so you know when looking for anything in particular.

In short, I guess you can say I don't get what you don't get here.

I obviously didn't realize the first post was still on the board. - mraker

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I also scanned the board quickly and missed it, partly because I thought it had a similar title to the above (I believe it was also posted on the company board at one point, but that's gone now ... I think). I haven't been one of the ones who complains about them, but the snowflakes can discombobulate me. Maybe I'll just turn off my Javascript for this site again (except I like being able to see the number of Likes and Dislikes and can't do that with Javascript off).

CRITICAL THAT YOU READ! - US MT

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Alabama hospital to pay $140 million for India transcription error (subcontractor for Precyse Solutions) This is only the beginning . . .

Fatal outsourcing - Schipperke

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It was inevitable. MTs have been predicting this sort of thing for years. It will happen again....

fatal outsourcing - corgi

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very interesting to read this; thanks for the link. I found it interesting that their standard in India is different than here for errors and also that the employees at the hospital didn't realize the work was being outsourced to India. I wonder how many patients know this is happening to their records and how many would prefer that they don't go off shore.

and how many mistakes go through that don't kill a patient - but do damage just the same. I believe

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those we'll never hear about, of course. These lawyers chasing after drug side effects or mesh implant recalls for law suits should just have people bring in their medical records for review and possible restitution gleaned from accuracy lost in translation.

I've heard of several unneeded amputations occurring on the wrong side... - mraker

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at least partly as a result of transcription error with right/left discrepancies. If you or a loved one is ever going into the hospital for an elective surgery, mark yourself with a marking pen on the side/area that IS to be operated on, and in the case of right vs. left, also the side that ISN'T.

I dont believe these happened b/c of MT error. More like - Dr error. Shouldnt Dr know what side? nm

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x

If a report is not flagged for discrepancy when both sides are mentioned... - mraker

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then it can be partly MT error too. I know of at least one case anecdotally, through a service I worked for, where that was the case.

Dr signs off, suppose to read report. If he doesnt, not MT - fault. nm

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x

Then you believe the insulin overdose in the above lawsuit - was no fault of the MT/MTSO too?

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nm

Drs put their trust into MT's and nurses - Bottome Line

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There should be no reason for a busy physician to feel he has to read each report. Never. You hire people that have the ability to do their job professionally and double check their work if they're unsure. If the doctors need to check our work then they would be doing it all themselves. Common sense.

Yes, but.... - if I were a physician, ....

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#1 I would want to make sure I was as understandable as possible and #2 I WOULD want to at least scan through EVERY report before I signed it. Because EVERYBODY makes mistakes, and no matter how careful we try to be, we ARE going to mess up once in a while! Therefore, the more we have checks and double checks, the less chance there will be that the mistake will go so far as to cause harm to a patient. And believe me, I am NOT saying that releases the MT from all responsibility.

Doctor's ultimate responsibility to read what he signs - MTPockets

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The doctor is the one responsible for the medical content of a record. He should be diligent to read the reports to make sure they accurately reflect what he has dictated.

The discharge summary was waiting to be authenticated. - sm

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It was a big ol' mess of not following best practices, including doc referring others to use his DS that he apparently hadn't even looked at yet, so no chance to sign it. See in the comments here, from someone who testified at the trial:

I hope no dr cuts off my bum leg just based on something MT typed, - without knowing himself, which leg is bum. nm

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x

No, you hope your report does not go off shore for the - error to be made. We would catch L/R errors.

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this is not an MT thing - it is a FOREIGN issue and getting the work done cheaply, the risks involved...did you read that article all the way?

No, I hope the Dr takes the final step in the process, READING the - report before signing off. sm

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And I hope he is not so swamped with pts that he does not know me and my problem. But then, if he did not know me, I wouldnt be seeing him. I would have found someone better than that. Final thing done to a report, DR READ IT and signs off.

These things are NEVER the MTs mistake. Dr has final sign off - the buck stops with Dr. nm

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x

We "should" catch L/R errors.... - S/M

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....but don't always. I think a lot of American MTs are paid so poorly now that they don't (or can't afford to) take time to stop and question, research, or be as careful as we should be. With VR, MTs aren't being paid well enough, period, and I see MTs here on this board say that they've been pushed to just zip through reports as fast as possible since that's all they're being paid to do. It is quite easy to forget that the doctor said the opposite side at the beginning of the report if all you're paying attention to is what you're hearing at the moment.

I remember years ago, long before VR or off-shoring were even factors in the equation, that one of our human MTs typed that the patient had undergone a "baloney amputation." She "should" have caught that but clearly wasn't thinking and was typing just what she was hearing. Do you really think that doesn't happen with U.S. MTs, ever?

I agree with the poster above. It is the doctor's responsibility - anon

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that any report they sign is accurate.

I had a doc call me one day while working in-house wailing about an error a nurse had caught in one of his reports saying, "I don't read these things." He was extremely angry and wanted the MT fired.

If docs want accurate reports then they better fight for straight typing American MTs. It isn't that American MTs never make a mistake but we obviously make far less of them based on the fact that we are required to have 99% accuracy while an Indian MT is required to have 70%.

There were 36 medical errors from 2005 to 2007... - mraker

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where the wrong procedure or operating on the wrong site or wrong patient occurred. No idea how many currently, but like I said before, as offshoring MT increases, the likelihood of this sort of thing happening increases as well. And as this Precyse lawsuit demonstrates, MT can certainly be a part of the "chain of errors."

It's not that they don't know... (sm) - Angie

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They often dictate on "auto-pilot" which doesn't involved thinking, just habit, i.e. how they race and slur through PEs and ROSs.

This, again, is on the Dr. If they dictate on auto-pilot, all - errors are doubly on them. nm

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s

"Luckily," in terms of patient care, I think the risk of this happening again... - mraker

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is lower than might be expected since the nursing staff as well as the physician who signed the report without reading it (obviously) are highly implicated in this case as well. But the point that the standards for accuracy are much lower for offshored transcription can't be emphasized enough. Not that it will likely ever make a hill of difference to the bean counters, unfortunately, unless they take more hits or threats of hits to the pocketbook like this one. I don't wish for that in terms of actual cases occurring, of course, but would definitely like to see malpractice suits include offshore MTSOs as defendants more often when they're actually a factor, which I think probably has been ignored a lot in previous cases.

you are so very right. started with the MTSO - who sent it there sm

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and everyone else then played a part. The actual guilty party overseas, the doctor who signed away, the nurses who should have had a red flag go up upon reading it. went full circle, it did.

Yes, a huge circle of incompetency and negligence. - mraker

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I've often silently agreed with the posters here who claim that what we do is not overall that important to actual patient care but more to just billing. The fact that the med rec form was unavailable in this case and led to the medications list from the transcribed report being used is surely a very rare event, but maybe has happened more than we'd ever guess.

And the fact that even just one person's life was definitely lost as a result of initially a transcription error means that however low the likelihood of such occurring, it still could happen again (especially with inevitable increased errors with increasing offshoring), and there should be no acceptable risk in terms of such an accident happening. I know that I'll be a lot more diligent with dosages from now on as I edit/transcribe my own work.

the whole point of this article for us is the fact incompetent - INDIA MTs screwed up where we would know better an

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it all happened to cut corners on the cost of transcription.

I'm not sure "incompetent" is right -- - (see message)

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I don't know any MTs in India, but the Indian people I do know here in the U.S. are very intelligent, gentle, and serious about education.

I don't know if "incompetence" is accurate. I think the fact that many errors are made on dictation that goes to India is more a problem with the language barrier....misunderstanding some words that are being said in an "American English accent" (as opposed to "British English," which they're probably more accustomed to hearing) and lack of knowledge about U.S. names, cities, business entities (like possibly misunderstanding that Home Depot is the name of a retail store and not typed "home Depo" as I saw on one report), etc., etc.

In the case of this fatal dosing error -- if you say "eight units" and very distinctly pronounce the "T" on the end of "eight," I can see where it might've sounded like "eighty," especially to the VR system. A human may have stopped and left a blank if they were unsure of the number.

In my opinion, the biggest problems with transcription accuracy lie with both VR and off-shoring to India.....possibly even just plain out-sourcing to other MTs around the country because of lack of familiarity with local physicians and their style of dictating. With so many docs, it takes a while to get used to what they typically say, and you just can't get that familiarity if you get a doctor's dictation one time and then maybe again a year or two later (if ever).

my opinion is what is...and you have yours. - done.

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X

Excellent points. Doctors need to know this. (sm) - Angie

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How many doctors in this country, if asked who does their transcription even know the name of the company, let alone which country or state it is in? I think most assume they still have an MT in their town who knows the names of all their associates, local businesses, medical facilities and surrounding cities. In at least half the Review of Systems and Physical Exams I transcribe, the dictation is so slurred that you cannot decipher everything they are saying because they aren't saying it, they are slurring it unrecognizably so that you have to spend time looking up their other reports to put the phrases together. An MT who was familiar with the doc would listen and say it was perfectly clear to her, just as I did when I subbed out my docs to MTs across the country. Doctors and medical facilities need to take SOME responsibility for accuracy of the records. They need to know who is transcribing them, that they are not in the same town, that they do not transcribe only for that doctor, and have likely never heard one of his Review of Systems dictations before. They also need to know that no one is being paid to research demographics and previous dictations, new drugs, dosages, etc. They need to know that we could be fired for taking the time to be conscientious because you can't spend more than half your time with hands off the keyboard and meet production requirements.

Bottom line is doctors and medical facilities need to get their heads out of the sand and recognize the current status of transcription services, and what they can no longer expect to receive from "their" MTs.

I don't necessarily agree with you - flipside

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We read posts on this board where people don't feel they are paid enough to look up dosages for accuracy. I could see this happening easily enough with any US MT who doesn't care about the quality of their own work due to being disgruntled. It could be someone we work with here in Small Town, USA, who is responsible for a similar error, not just in the offshore world of MT.

Not necessarily. The original error happened - because the SR put SM

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80 instead of 8. I am not up on all "normal" dosages but it is conceivable that this could have been missed by any MT now with SR onboard. Since we are being paid less and less for the same work and IMO they do not value our knowledge by pushing and pushing for more lines in less time, we are between a rock and hard place. Either value my knowledge and pay me for my time to research drug dosages or run the risk of errors such as these. It's all about greed and profit and unfortunately, according to what I read by someone who testified, the real problem was lost on this jury and not understood by the attorneys.

Something I don't understand. - If Precyse is the one doing the outsourcing,

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shouldn't they be doing QA on these reports that come back from overseas just like they do ours? I am relatively new at transcribing for nationals and don't know how this particular aspect works.

The nationals don't QA every report. No one does. - That being the case, theyre taking - sm

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a huge risk when they send such a large percentage of their work offshore, ask US MTs to edit it at top speed, for less than minimum wage, and then QA only a fraction of a percentage of it.

It's a miracle more people haven't died. Or, maybe they have, and we just don't know about it.

according to article, work went from offshore straight to facility. - did not even pass GO. SM

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and then it mentioned offshore standards no match to ours.

If it were me, 140 million or not, I'd go after EVERYBODY legally.

Outsourcing - me

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You're absolutely right, I work for a huge national and they took on a big hospital account and of course outsourced it and gave us ONE WEEK to QA the offshore work and offshore QA people. It was and is horrible with hideous mistakes being made, but we are on a massive quota that we are supposed to maintain including feedback. I was hurt by a wrong report as was a family member, and my injury was almost fatal. It should be a law that hospitals have to know who is doing their work.

yep, that was Precyse's second error in all this. - anon3

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First, they should not have off shored, and second...never ever have that crap send the reports straight back to the hospital. What were they thinking? Were they thinking?

They do not QA every single report. They depend on competent MTs. - anon

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However, in the end the doc is responsible. They have to sign/initial every report they dictate as having been read by them. That initial indicates they are taking responsibility for the content of that report.

Doctors need to figure out that VR and off-shoring are not beneficial for their bottom line. American MTs are not perfect but they certainly are held to a much higher standard then their off-shore counterparts.

I worked for a major co. that didn't have any QA for the specialty I was hired for. - Angie

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.

You're dreaming if you think only Indians - make these kind of mistakes

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which is why I continue to maintain that any doctor who makes a decision based on a transcribed report is asking for trouble.

no they don't but in this case they did. this is about someone's death - with the choice to go cheap. And

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yep, that is a sore spot for the US MTs who are sitting here waiting for work.

OMG look what I just found.... - ....see message posted....

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... with the same title under the discussion "140K lawsuit". For one thing, I found several errors. AND they even make some derogatory comments about U.S. MTs!

no link or URL - nm

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nm

Sorry. Here is the URL - me

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http://www.medusind.com/ss-medical-transcription.asp

This is an Indian transcription company! - anon

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They send out ads just about every week with misspelled words and grammar errors.

Yes, I know - original poster

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I wonder if Precyse has checked out their site! Also, did you see what they said about U.S. transcriptionists? Makes me angry!

Thanks. But what does that have to do with the 140K lawsuit? - nm

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nm

That apparently is one of the companies..... - Precyse

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....outsources to.

Nuance sent an email to MTs today regarding this. - anon

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You think they sent it to the Indian MTs?

READ remarks by one who testified in lawsuit - anon

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On MT Tools, more info is given on this lawsuit including remarks by one of the persons asked to testify for the defense. Interesting reading...I was actually rather angry after reading it but didn't post, wondering what everyone else thinks? One person commented about the poor US MT who is barely able to earn $20/hour, REALLY? Most working for the big MTSOs are pulling in far less, and would be thrilled with $14/hour!

Here is the link http://mttoolsonline.com/2012/12/17/the-value-of-quality-healthcare-documentation/

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