| A psychiatry clinic in Texas was having a very hard | | | | dictation system whereby the physician could start |
| time documenting medical reports and records. Most | | | | dictating straightaway either via a cell phone/mobile |
| of the reports were handwritten with the legibility of | | | | phone or through any landline phone connection. Thirdly, |
| the reports such that even the physicians' own | | | | technical staff could have this toll-free dial-in dictation |
| secretaries could not decipher them. Besides the time | | | | system up and running within half an hour of receiving |
| wasted on writing the reports by hand and the | | | | an E-mail request from the client. Fourthly, the |
| expense of photocopying them for patients and | | | | physicians were also offered the option of utilizing a |
| referring physicians, the clinic was facing problems with | | | | brand new digital Dictaphone that would be provided to |
| getting these reports ready on time. | | | | them free of cost. They were also shown how to log |
| The backlog of reports to be delivered was piling up | | | | into the Indian company's secure file transfer protocol |
| and was reaching alarming proportions. Auditing of the | | | | server to upload their dictations and how this whole |
| records was proving to be a huge problem. The clinic | | | | process could be automated with the use of software |
| administration desired streamlining and moving towards | | | | that would also be provided to them free of cost. |
| a paperless office to address HIPAA regulations and | | | | Fifthly, the physicians were also told that they could |
| improve operational efficiency. Also, the stakeholders | | | | access the Indian company's exclusive online physician |
| (patients, referring physicians, government agencies, | | | | portal wherever they were, using a PDA or |
| and billing office) wanted to implement an electronic | | | | Blackberry. They could also view, edit (if necessary), |
| medical records system, and this led them to | | | | and E-sign the transcripts, and they could also fax or |
| reevaluate their existing operational processes. | | | | E-mail the transcripts to their patients or the insurance |
| Having the records transcribed locally by medical | | | | companies. Lastly, the clinic was offered a one-week |
| transcriptionists in the US was an expensive affair as | | | | free trial where different doctors were asked to |
| the average rate charged by American medical | | | | dictate files. The clinic was delighted to see that what |
| transcriptionists was about $15 an hour. Recruiting | | | | had been such a cumbersome process all these years |
| in-house transcription staff was a Herculean task as it | | | | was done in such a simple and cost-effective way by |
| involved a lot of formalities and huge cost implications. | | | | the Indian company. The Indian company was then |
| It worked out to about 40 cents per line to get a | | | | entrusted with the task of handling the entire |
| report transcribed using in-house staff. | | | | transcription process starting with capturing the |
| As more than 50% of the physicians were ESL | | | | dictation, transcribing the reports, editing them, quality |
| (English second language) dictators, most American | | | | control checks, and delivery of the final transcription |
| medical transcriptionists were not too keen to take on | | | | reports. |
| these jobs. This was when the clinic decided to | | | | The clinic's physicians realized that outsourcing |
| outsource the work to India where the same job could | | | | improved time-to-chart (TTC) metrics, that they could |
| be done at about $5 an hour or at 8.5 cents per line. | | | | concentrate on patient care instead of documentation, |
| After contacting and reviewing many vendors, this | | | | that insurance companies were billed sooner, and that |
| clinic approached an Indian medical transcription | | | | they themselves received payment sooner. Moreover, |
| company having its office in California and requested | | | | electronic medical record management facilitated |
| them to assist in streamlining their existing | | | | easier audit of healthcare facilities which is one of the |
| infrastructure. The Indian company deputed two of its | | | | US government's objectives. |
| outsourcing consultants to do a comprehensive | | | | Staying competitive is the most critical aspect in |
| investigation of the existing infrastructure with specific | | | | today's business world. Harnessing technology and |
| reference to time-to-chart metrics, a critical analysis of | | | | global sourcing of talent is the mantra of success. With |
| the need for creating and maintaining electronic patient | | | | nil-to-minimal investment, a paperless office can be |
| records, the need for a web-based document | | | | established in a healthcare facility and HIPAA |
| management system, and a cost-benefit evaluation of | | | | compliance ensured. A transition from a stage where |
| maintaining electronic patient records. The consultants | | | | medical reports are handwritten to a stage where |
| identified many critical areas and their repercussions on | | | | processes are done electronically can be done |
| the day-to-day functioning of the clinic. Specifically, | | | | smoothly and without any hassles when there is a |
| time-to-chart issues lead to cascading effects onto the | | | | dedicated team working on it. |
| entire chain of healthcare, patient care, and provider | | | | Outsourcing makes good business sense especially |
| accounts receivable management, thereby leading to | | | | when profitability is taken into account, all businesses |
| poor business performance of the physicians' practice | | | | primarily being run with the profit motive in mind. |
| and affecting the profitability of the clinic itself. | | | | Thomas L. Friedman said that in this twenty-first |
| The Indian consultants made several | | | | century, the world is flat. Nowhere is this truer than in |
| recommendations. Firstly, they opined that the job of | | | | the field of medical transcription where a physician can |
| transcribing psychiatry files be done by an exclusive | | | | dictate a report at noon in the USA, have it transcribed |
| team of medical transcriptionists who were well | | | | and edited in India an hour or so later, uploaded to his |
| versed with psychiatry because they felt that | | | | office almost immediately, and find the report ready for |
| transcribing psychiatry files was a specialist job. | | | | him to sign before he leaves for the day. |
| Secondly, they offered the use of a toll-free dial-in | | | | |