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Medical Transcription

What is Medical Transcription?

Medical Transcription is a permanent, legal document that formally states the result of a medical investigation. It facilitates communication and supports the insurance claims. There are three main processes involved in Medical Transcription. These include:
Process I: Hospitals are signed up. Doctors are trained in the process and then details(incl his /her voice sample) are stored in the server at the other end of the 800 number.
Process II: The sound is digitised and sent to the offshore outsourcing service centre as a WAVE file via satellite link. The digitised data is converted back to sound. The trained transcriptionists listen to the dictation and transcribes.
Process III: Transcribed files are sent out to quality control persons, who listen to the dictation and check the transcription. Corrections are made if required. Then the transcribed report are transmitted back to the US as word file.

Medical Transcription business

The practice of transcription involves an interesting pattern. As a matter of routine, doctors examine patients in hospitals, clinics and physicians' offices. They dictate important information about the patient's history, physical examination, diseases, procedures, laboratory tests and diagnoses. Since doctors normally make use of technical terms, and do that very quickly, a transcriptionists has to anticipate and record their uttering with maximum precision.
The typical process of Medical Transcription begins with receiving dictation by tape, digital system or voice data file. Conventionally, recorded advices were sent through physical means (i.e. a magnetic media). However, there is steady emergence of a new practice. Using a toll free telephone line, doctors can call up a designated number and dictate the message, which is converted and recorded into a dedicated server on a real time basis. This helps to save shipping costs and improves productivity manifold.

The transcribing company connects to this server through a high speed data link (preferably Internet or ISDN link of 128 kbps or above) and download any fresh dictations left by customer organisations / doctors. The transcriber company (if different) can start to immediately retrieve messages and transcribe them. Using ear phones and a foot pedal for start-stop control, transcriptionists are able to hear and control the speed of audio messages. These messages can be transcribed with the help of a suitable word processing program / application. A variety of word processing programs may be used as different forms of transcription / messages may require specific features. An outsourced or out located medical transcription centre then sends back these transcribed messages to the hub of medical transcription network from where it is routed to the concerned doctor / hospital. Most of the words processing programs used in medical transcription process typically are accompanied by libraries / dictionaries of medical terminology.

These libraries may also be categorized based on various disciplines. Several dictionaries are necessary like: Medical definitions, medications, medical terms by specialty, laboratory terms, surgical terms and abbreviations. Specialized word lists are also helpful, and journals and computer networking are helpful for current information about new medications and terms. Transcription is done more efficiently with the use of a medical spell checker and an abbreviation system such as PRD or Smartype, etc.

Customers

Medical transcription business by its very nature involved transcribing medical advice of various types. Therefore, its user base is largely confined to individual doctors, hospitals, special test / examination clinics, state owned medical centres, medical databases, etc.

Infrastructure and Investments Required

It is suggested that entrepreneurs should start a venture for medical transcription with in-hand contract that lasts for a period of 1-2 years. This would help to justify investments made in high cost infrastructure and capacity, an essential for this business. In an otherwise case, entrepreneurs may expect to have idle capacities for up to one year. The main components for setting up a Medical Transcription unit include:

  • Premises (Office Space)
  • Servers
  • Computers (with audio capabilities) and Pedal machines
  • Networking
  • Specialized software
  • Medical Transcription Programs
  • Telecom connectivity (ISDN / Leased Line / Internet)

Like any other IT Enabled Services business, it is important to have a certain critical mass in terms of capacity to be able to generate volumes transactions. Research has shown that a given capacity of about 50 computers / transcriptionists. This would translate to a total capacity of 150 people working in a total of three shifts of eight hours each.

In order to establish capacity for 50 people, there would be investment needed of the order of Rs. 45 - 50 Lakhs. Further manpower costs (for 150 people) would add about Rs. 1.2 - 1.5 crore to the total costs. In other words, an entrepreneur would need to have available funding of approximately Rs. 1.5 - 1.75 crore to cover asset building and recurring expenses for first year of unhindered operation for about 150 people. Further, with the above capacity, there would be a working capital requirement of at least Rs. 20 Lakhs.

Marketing

The best practice for marketing medical transcription services is to approach hospitals / doctors directly. However, in the beginning, entrepreneurs may find it difficult. Moreover, it is also important to build up sufficient experience and learning in the team before taking direct responsibility for execution of a project. Therefore, it is suggested that in the incubation stage, venture promoters may tie up with a larger medical transcription company in the capacity of an affiliate. Companies such a Health scribe or Heartland, not only subcontract their orders, but also help to develop a venture into a self sustaining affiliate by providing training and advisory services. These services may be offered for nominal fees.
Over a period of time, as the company begins to develop internal competencies, it may start to develop direct relationships with hospitals. This further helps to bypass intermediaries and improve margins. Companies may also consider opening an office in major markets, such as USA or Europe , to provide business promotion coverage to certain regions / states. Internet can also be used as a useful resource tool for tracking potential business points.
An aggressive marketing and sales team / network is a must in the US, either by having a tie-up with an American Transcription company or setting up one’s own network focusing on cost savings and better turnaround times to clients. One can form a marketing consortium, also. To ensure quality it is imperative to have ISO approved systems.

Recent Trends & New Technology Developments

The future looks bright for Medical Transcription as the medical practitioners profession continues to grow and offer opportunities for growth. However due to increasing maturity and decreasing differentiation between service providers, the vendors now aim to provide value differentiation by developing special features within constant cost bracket.
It has been constantly said that medical transcription is threatened by speech recognition technology and formatted electronic records. Though at present, voice recognition software has not developed to the extent that it is in wide usage in any industry, but as this technology matures, transcriptionists will be able to use it to increase their personal productivity, rather that considering it as a threat to their jobs. Medical Transcriptionists are quite good editors who will continue to fulfill that need in addition to transcribing medical records. The profession shall continue to have the need for more MTs worldwide.

Concern has also been raised, regarding the confidentiality issues over the Internet. New regulations in the future would make it mandatory for 128-bit encryption of patient records being transmitted over the Internet to uphold security. As per certain reports, legislation will soon be passed in the US that will require state-of-the-art security be in place for all transmissions of medical records. US and Europe have already signed data protection laws and it is imperative that such laws are introduced in India to maintain security and confidentiality.

Bottlenecks to Growth

While the MT industry has been growing in India , there are various bottlenecks that impede the growth of this industry. The important issues that need to be addressed are:

Although many state governments have announced that software and IT service units can operate from residential areas and can operate three shifts. However, this needs to be announced in all the states and moreover the local municipal authorities need to take cognizance of such notifications and not harass the companies. Therefore, Medical Transcription companies should be allowed to be set up in residential areas.
Constant Power Supply: Since the whole system is dependent on sophisticated computer systems, they should have access to clean and continuous power with no restrictions on the use of air-conditioners or generators.
Reliable telecom infrastructure needs to be available with single window and time bound provisioning of leased lines and availability of flexible bandwidth channels.

Cost of leased circuits needs to be brought down to internationally competitive rates.

There is an immediate need for a coordinated and quality training programme for this business in India .

Summary

Thus Medical Transcription is here to stay with multiple growth opportunities. The same competitive factors that are leading companies to outsource software developments to India are in operation here. The International recognition that India received in software is going to make it far easier for companies to sell the concept of outsourcing IT-enabled services to India .
With the advent of voice recognition software and the technological advances to grasp and analyze the human voice, there will  be a continuous need for skilled transcription specialists who have enough understanding of the health record to create an accurate final document.

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