How EMR (EHR) Is Going To Affect Medical Transcription Industry?

Ever since healthcare reforms started to surface in Obama’s speeches or rather after he signed the stimulus package to law setting aside $19.2 billion for healthcare IT alone to reach a goal of full EHR by 2014 promising hundreds of thousands of new jobs by boosting healthcare, the question “How is it going to benefit or affect the medical transcription industry?” started gaining prominence.  There were doomsayers as well as welcomers.  However, nobody was able to give a clear picture all these days on how medical transcription industry is going to evolve through this phase, whether it will have adverse effects or if it will be an added advantage.  Earlier when speech recognition was considered as a challenge, my view was that it would be an advantage to improve productivity and unless we have artificial intelligence and robots understanding each and every command of ours, we will not have a completely reliable voice recognition output with no human intervention needed, so the possibility of speech recognition eliminating medical transcriptionists was completely ruled out.  However, this time that is not going to be the same case with EMR as the data here is directly fed by the doctors into the system.
As such, one of MT Herald’s readers who preferred to remain anonymous (as usual?) put forward these questions:
With Obama’s push for implementing EMR in every clinic/hospital, do you see the demand for MT decreasing?
My brother lives in Florida, USA, and he went to see an ENT doctor.  His clinic has about 3-4 doctors, and they have implemented EMR in their office and have stopped using transcription altogether.
Do you think widespread EMR adoption will be bad for MT industry?
What are the prospects of gaining business from other countries like UK, Canada, Australia?
We gain a lot of information by exchanging views. You gain more information when you answer questions than when you ask.  It is when you teach that you learn a lot than when you are a student.
However, this time before coming to a conclusion on my own for these questions, I thought to put across the question “Do you think widespread EMR adoption will be bad for MT industry?” to all my medical transcriptionist friends and some eminent personalities in the medical transcription industry by email, tweet and instant messaging. Interestingly, when I passed the question to the MTs, both onshore and offshore, many of them were still ignorant of what the acronym EMR deciphers! So do you know what is the difference between an electronic medical record, an electronic health record and a personal health record?  The National Alliance for Health Information Technology, (NAHIT) differentiates and defines these terms as follows:

What Is An Electronic Medical Record (EMR)?

An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization.

What Is An Electronic Health Record (EHR)?

An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization.

What Is A Personal Health Record (PHR)?

An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.
A research on Google Trends on which term that is extensively searched (electronic medical record v/s electronic health record) reveals that roughly four times more searches are performed for the term ‘electronic medical record’ than for the term ‘electronic health record’ in the searches originating from the US, and that there is a slight spurt in searches of these terms since the turn of this year since Obama got sworn in as President.  So despite the NAHIT definitions, market is still figuring out the appropriate term for common usage.
Now that you got some in-depth knowledge of EMR, let’s see have a look at the responses for the question “Do you think widespread EMR adoption will be bad for MT industry?” from some MTs, eminent personalities and CEOs of a couple of MTSOs.Abishai Demetrius (He’s also a religious blogger at Weird Worldz) who witnessed the evolution of medical transcription industry for the past 10 years or more, both onshore and offshore, when contacted to predict the impact of EMR on medical transcriptionists was rather pessimistic and thinks it is hard for the doctors to make a switchover and commented instantly:
What’s it gotta do with MTs? Do you think those lazy doctors also will do it?  ;) Before that happens on every medical practice out there and every doctor has to do it or just die, I don’t think we need to worry much, that’s just my 2 cents.
I don’t think it’s going to be that tough for doctors to make a switchover to EMR.  They have already been subjected to rigorous training according to the curriculum in their academic portion of life.  As a matter of fact, handling an EMR is not that tough than even learning to drive a car!  It’s just as the effort as writing a prescription in legible handwriting!  So I don’t think a doctor has to be a geek to operate a tablet PC to write a prescription or fill in a template by just a few clicks.
Lynette Cabeen who has been an MT for 10+ years and worked for several different companies either as an employee or as an independent contractor, says we are already working on electronic medical records by doing transcription from home over the internet and shares her views as (She just started blogging on medical transcription at Transcription Diary):
The fact is, we already deal with EMR when we work remotely from home over the internet — dictations are uploaded digitally, downloaded digitally and transcribed, then uploaded digitally and stored digitally.  You can’t stay the same and hope to compete in a changing marketplace.  I agree with an article I read recently that EMR developers need to stop trying create software to get rid of the MTs (which will NEVER happen, even though our jobs may evolve) and concentrate more on security/privacy, developing a less complex interface and becoming more user friendly.  Also, small physician practices may never make the leap to EMR because of cost issues, so that also has to be taken into consideration.  I think EMRs have the potential to make our jobs easier (think of being able to go back and read prior reports to be able to figure out what “the mumbler” is saying), but it can also cause problems by perpetuating incorrect information if it’s not caught the first time.  Then there’s the debacle recently regarding inaccuracies found in a medical record that makes one pause before jumping on board fully.
Bottom line, EMR is on the rise, and too many of the powers that be are pushing for it for things to stay the same, but I don’t think it’s going to impact our profession in a negative way.  It still has a long way to go, especially in regards to security and privacy.  One only has to take a look at the Conficker issue to know that having all records stored electronically can create a maelstrom of a mess if hacked.
To err is human, to really screw things up requires a computer.
Regarding hacking attempts:  If extremely sensitive bank, military, space program and government documents can be stored online safely and securely, why not these healthcare documents?  Of course, every one of these are have hacking attempts on a day-to-day basis, but have anyone gone back with this technology advance? Regarding the cost factor:  We saw in the video that for a subscription amount of mere $300 per month, the physician was able to maintain electronic health records online and the setup just costed him $6000.
Jay Vance, CMT, President & CEO, Global Healthcare Documentation Group, is rather in a wait and watch mode.
It is difficult to say with certainty exactly how the coming widespread use of EMRs is going to affect MTs.  This is partly because not all EMR systems take the same approach with regards to the mechanisms used to create patient encounter records.  Some EMRs are strictly point-and-click, template-driven systems that make no allowance for dictation and transcription, while other EMRs are DRT enabled, allowing physicians to use traditional dictation as a means of populating the EMR.  Obviously if the former type of EMR becomes more prevalent than the latter, the need for transcription is going to decrease.  But I believe it is too soon to state definitively whether or not physicians who are accustomed to dictating patient encounters will be willing to switch en masse to template-driven EMR systems.  Certainly it’s possible, but it is by no means a certainty, in my opinion.
I wish I had a more definite answer to your question, but right now there just isn’t enough information to make a reliable prediction for what the future holds for the transcription industry.
(DRT stands for Discrete Reportable Transcription)
Okay, it’s a long way to 2014 from now.  By that time, even Obama may have moved out of power but, what if the doctors have to do it on their own by that time just because of any legal compulsion from the government to avoid medical errors (the prime focus of making a switching over), leave aside the savings they make eliminating transcription?
Gift Jacob Chelraj, CMT, predicts it could be bad for the industry which is already in turmoil because of advancement of automations like voice recognition and stiff competition due to outsourcing.
My opinion about EMR is it is a tool for interoperability (sharing of information quickly) between hospitals.  Nowadays, this sharing of information is through expensive means like faxing, etc., and this also requires that whatever the MT transcribes be printed in a paper, resulting in additional expenses for the hospital.  This could be avoided if all the patient information is available through computer network.
There are certain drawbacks with EMR too, like cost, connectivity, health risks, etc. which are being speedily addressed by the US government, especially by President Obama, in a war footing to curb the rising costs of healthcare.
I am not sure how it would impact an MT’s job as “physician notes” still have to be transcribed or edited after going through voice recognition.  EMR can be automated and physicians can enter lab values and transmit radiology reports faster; however, reports like discharge summary, history & physical, etc., which require physician notes, need to be transcribed by somebody.  I pray to God that the hospital will not retain physician notes in voice format in order to cut costs :-).
My personal opinion is that if the axe falls on us, we will be required to be more productive and efficient (which is already happening through voice recognition).
In summary, YES, this is bad for our industry and good in terms of healthcare efficiency.
If I’m right, we are already in an arena where there is no permanent salary, instead all the pay structures are production based by which we are already under tremendous pressure to do more and more day by day.  How can we be further more productive and efficient?
Julianne Weight, CEO, AlphaBest Consulting and Transcription, who has over 20 years of experience in the industry witnessing all the ups and downs, evaluates the situation (She also exchanges views on interesting facts and observations at MT Exchange) and reports that it has already created the dent:
Yes, I see demand decreasing.  We’ve been seeing the trend here for the last couple of years and are already feeling the impact.
I’m not sure I’d say it’s good or bad for the industry.  I think the industry needs to change and evolve into something else.
She is sure that the industry needs to change or evolve into something or to a more stable form, but not sure how it would be and should be.
Miguel Lopez, President, Transcript, Inc., assesses the adopting of EMR in healthcare is not going to be a doomsday for medical transcription industry.  Here is how he assesses on how is it going to be:
It depends.  I think it will affect it as much as voice recognition has done so far in terms of job loss, but it will continue to be adopted because of the need to go to for electronic medical records.  It just means that MTs will need to adapt to the changing technology or lose the account.  The accounts will be going to EMR but if the MT is willing to dial in and type directly into the EMR or interface with it, they will be fine.  Those that continue to see the BIG cassette as the wave of the future will lose.  Just because they are going to EMR does not necessarily mean that they will be going to templates of voice recognition.  It just means they’re going paperless.  The smart MDs that still see the MT as necessary and cheaper than typing/reviewing the reports themselves will still use MTs.  I think, like with any new technology, there will be job loss due to the older local MTs unwilling or unable to adapt.
Yes, the busy, highflying doctors, who have hundreds of patients a day, to increase their productivity, to save time and to keep going, instead of themselves incorporating all the details will still have to rely on assistance of medical transcriptionists through dictations even to fill in those details in an EMR but that is not going to be the case with every single doctor.  The female doctors or doctors above middle age may be reluctant to adopt new technologies and cost factor also can deter adopting new technology but that won’t prolong for decades.
We end with that expert opinions with a clear answer.  Yes, EMR is going to affect the medical transcription industry or has already started affecting but none of them are able to predict the magnitude of the impact.  Consumer the king, the ultimate beneficiary of this evolution, is at the greatest advantage of this evolution, after all that is what anyone would need, but how we, the medical transcriptionists, or the medical transcription industry is going to survive these reforms?  There’s the fume coming around from the dormant or less active volcano but most of the MTs couldn’t assess the flame and danger behind it. Like Abishai or other MTs whom I didn’t mention here are either still ignorant about the looming guillotine or are overconfident that the doctors are lazy to make a complete switchover that they still have time to enact upon!  As long as the doctors are reluctant to change, it will keep us going.  However, if the axe falls this time, the impact is going to be much stronger than the already shaken medical transcription industry in the US with voice recognition and outsourcing with the interesting fact that this time it’s going to affect both onshore and offshore alike.  Even for planned surgeries, you can have template filling as the procedures will be almost stereotype ones.  However, emergency reports may need to be transcribed as the situations, complaints and problems will vary from patient to patient, case on case and I foresee only such rare possibilities of dictation and transcription.
Studies show physicians who use EHRs pay few malpractice claims and we already have reports of medical transcriptionists losing business as the doctors migrated to EMR, it is time for us to think and enact upon.  With cost advantage being remarkable with the adoption of EMR, it is time for MTs to think how to adapt to this growing challenge.
How can the medical transcriptionists be an inevitable part of these reforms?  By starting to think and deliver value addition to your services.  You should not confine yourself inside a shell as medical transcriptionist alone but have to keep on adding value to your services that the doctors should not be able to do business without you.  You should be a complete personal (virtual) assistant doing everything that the doctor wants to do on a computer.  Yes, nothing is stable in this ever changing world.  Your success lies in how soon you adapt and change yourself to the new things, latest demands and the need of that hour.  Unless you develop your skills and keep on polishing your resume, the going as a transcriptionist would get tough and at one point in time within the next few years you may get withered out and give up to EMR due to lack of efficiency.
I wish to thank everybody who shared their views and opinions with me when I contacted them, and their inputs have thrown good amount of light into the issues surrounding the adoption of EMR with reference to medical transcriptionists.  I was so amused that the answers were so instantaneous from all those who I quoted here that I think they are keenly watching on how things are turning around and are striving to get informed on this subject. A special big thanks to all of them again.
Now coming to the last part of the question “What are the prospects of gaining business from other countries like UK, Canada, Australia?”  Any of the readers in those countries could drop in their views.  But generally I’m of the opinion that if a doctor in the US can make a switchover to a completely automated healthcare documentation, won’t it be available for the doctors in the other countries too?  May be the cost may vary from country to country but if convenience and reliability outplace the cost factor, which is ought to happen, won’t the doctors in the other countries will also follow suit?