Home Forums Discussions General Discussion "External" Transcription and AC

Anyone using a transcriptionist outside your office?
How so?
Import the notes into II?
The service enters the dictation into AC and forwards the note?
Someone in the office copies the text into AC?
I haven't dictated in 20+ years, but my partner can't touch type.

My partner uses an online site called The Medical Transcription Company. He dictates using an Olympus digital recorder, and it uploads to the company site when he puts the recorder in the cradle. The dictation can be downloaded as Word files the next day, and our office staff checks the dictation accuracy and converts into a PDF, which is imported into II on AC. The staff also saves an encounter note on that date in AC, pointing to the dictation as a placeholder.

My partner (as well as yours) should probably try Dragon Medical before spending $1500 per month for transcription. But old habits die hard.

Roger,

I am working for a doctor who does a majority of his notes by dictation. Your questions are the very same I have been wrestling with for the past 3 months.

Right NOW, the transcription comes back in a Word doc batch, I use a microsoft word macro to 'split' the batch into individual files, scrub the files for blanks/errors, and drag+drop into Updox (where a staff member assigns it to the correct patient and it goes to live in the imported items tab).

The original idea was to setup an account for the typist in AC, forward the typist all the day's notes, the typist would 'remote in' to our server, listen to the dictations, and type into the corresponding fields. Then, forward the note to the Doc to be signed.

The typists had some pushback because they like to use their macros and formatting, which would be gone if typing straight into AC. My issue was that they couldn't remote in without 'occupying' a computer (we don't have a terminal server), AND that the typists may not be able to use their foot pedals. (Local Hardware on a remote system doesn't always play).

Our current plan for the immediate future is this: For routine care, use templates. When we need to dictate, Certain things will be filled into that patients encounter in the room by the nurses(vitals, and the 'left side' of the AC note). From the exam room the note is forwarded to a staff member. When the transcription comes back, the staff member copy-pastes it into the corresponding sections in the AC note, and forwards on to the doc to be signed.

Some considerations:

For my doc, dictating a full note using Dragon is not feasible. It can't keep up with how low and fast he dictates. We are looking into using it for voice Macros.

Having a company like John suggested (or like MModal) is a good idea. They are big enough to get your transcription back within 24 hours, and have some pretty sweet web software. We did a test with MModal and the accuracy was pretty good for their first time.

For $1500/month, I would learn how to talk loud and slow

My partner is very impatient with Dragon. Not sure he even completes the enrollment process. He has repeatedly just said "it doesn't work". So we haven't popped for Medical Dragon (didn't need it until we installed AC anyway).
Worse, in my mind, is that he uses a local transcriptionist who uses some proprietary system that can not produce a digital file of ANY type, just paper. I've tried for years to get him to change to a service (if he continued to refuse to use Dragon) that would deliver a file rather than paper, but comes from a long line of physicians (we have a surgical text book his great grand father is author of . . . 1876) and that's just the way it is done.
So he is struggling trying to come into the 21st century. He does try. what's strange is, he uses the EMR at the hospital fully.
To get back on post, I was looking to see if anyone had a transcription service that would input directly into AC. I think that is a "pie-in-the-sky" request.

We are also interested in other options. We have dragon on an i7 computer with the sennheiser mic. The doc I got it for does not use it.

So i am interested in other options for "slow-typers".

If anyone has experience with other transcription services I would love to hear it. $1500 a month is to expensive though.

Roger,

The 'big' transcription services won't touch remoting in and directly inputting into the patient note.

The best bet is to go for a local service; someone you are comfortable with having access to all your Amazing charts data, and who you are comfortable building an IT infrastructure for. (Remote access, PC's, etc)

AC does not have any 'built-in' 3rd party interfaces for transcription.

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Ben,

Expect to pay between 9-12 cents per line for transcription. I think a line is something like 65 characters. So it all depends on how many patients the doc sees and how long the notes are.

We went from transcription to Dragon, saved well over $1500/month, and the quality went way up. The "big" services we tried did not proofread at all. Roger, I would tell your partner that he is welcome to pay the $1500 out of his salary, but you are going with DNS. No reason to be held hostage by a partner who does not want to adapt.

The option of getting a file sent, proofreading, and importing into AC, while technically feasible, have huge issues or redundancy. Add to this that we found out our "big" transcription service was actually taking our dictation, having it re-read by non-native english speakers into Dragon, then sending us the files!! It is one thing to opt for class and convenience in dictation, similarly to opt for being ferried about in a limo rather than driving, but quite another to be treated like a special needs kid in the back of one of the little school buses.

I have to use this line at our next practice meeting!

Roger,
I have been using Dragon medical since 2003, and have noticed with the newest version, that it is even more accurate than the previous several upgrades. I use to pay over 1 grand a month as well for dictation, and as I age, I like getting the notes done right away and with dragon this is much easier to do, and if you are portaling any patient information then the summary can be jettisoned right away as well. I am not sure of your set up, but I have a partner that still transcribes (but uses an in house transcriptionist), she pays for that service. If you went with dragon, in one to two months of not paying your transcriptionist, would more than pay for the dragon and microphone set up.

When I first started dragon, the cardiothoracic surgeon called and asked what kind of terrorist camp I was running, and I was a bit confused and he directed me to the note of a mutual patient I had seen after a CABG with an infected saphenous vein graft site--unfortunately the proofreader (me) missed the slight mistake of Sadam Hussein, instead of ....

Agree each version has gotten more accurate. I'm on 11.5 non-medical

I've been using Dragon since 2.0. Even tried ViaVoice and a couple of others. Haven't dictated to a "person" since 2000 = when my hospital went live with a very capable documentation system. Prior to that in my office, ,y last "dictating" for transcription by person/service was circa 1990.
If my partner will train and use Dragon Premier, then we'll look at the Medical version. It's just he has "tried" previously, and come back and said "it doesn't work".
Even thought of in-house (a very small house), let staff use Dragon, repeating from a "tape".
We're slogging forward, slowly.

And I have gotten calls from referring doc's, laughing about what came out and was missed, and what went out. Just no references to foreign dictators though.

Roger,

Sorry misunderstood your post, and never did answer your question, I thought you were looking to start dragon yourself, and I don't know of an outside transcriptionist. So the issue is trying to get your partner convinced. Or find a workable transcriptionist. It sounds like in house transcriptionist may be a possibility. But as I am sure you have repeatedly done, is lay out the objective reasons why it makes the most sense, but he has to buy into it himself. This is tough. If you don't believe in prayer, can he be blackmailed? Seriously, I think your on the right track.

His wife rules the roost. She is very interested in the MU $. While actually creating documentation in AC is not necessary for MU (you can do all the MU stuff in AC and not the text of the note), if i let her believe that it is needed without actually lying about it, he might be more likely to use dragon
Thanks to all who have posted. As always sage advice.

Do you have a fairly low level person in your office (that is to say, someone at the low end of the pay scale) who knows some medical terminology and has some proficiency with AC? If so, the cheapest option may be for that person to sit down with a decent version of dragon (though not necessarily the medical version), a desktop mike, and headphones. At the end of each day, they listen to his dictation, and nearly simultaneously they simply repeat it into Dragon, placing it in the appropriate sections of AC. I bet with a bit of practice, they could get pretty quick. Cumbersome, and unnecessary, but an option to consider given the limitations your partner has established.

Jon, your suggestion paralleles my thoughts exactly. The only road block is the "end of the day" = he runs chronically late, and is often seeing the last patient well after the office staff should be gone (or ARE gone). So we would have to translate that to early the next day.
We would add a higher end (multi-core) workstation (right now we are using thin clients, some old win xp, some really tiny boxes from Ncomputing that run RDP (5 or 6 sessions simultaneously running on the host Win 7 Pro, I7 with 16gB Mem) that works REALLY WELL. Just can't run dragon over RDP (you can dictate into an RDP session, or LogMeIn session, just have to running natively on your client).
(Sorry about explaining something many of the ACUB members may already know).

End of one day or beginning of the next....still better than using a transcriptionist.

My inclination would be to invest in a decent workstation (you are still well under $1000; even less if it is used) and dictate with non-medical Dragon over LogMein or RDP. Just as I will always root for whoever is playing the Indianapolis Colts, I will always do what I can to limit Nuance's income since they screwed all docs with their pricing. John Ryan is the pioneer on this, and he should be able to insert a pithy quote here.... (and also give some input as to the relative accuracy of the Medical and Premier products).

One of our employees comes in about an hour before everyone else (to do billing and interact with insurance companies 4 time zones ahead of us) and it works out fine; so don't forget you could have your transcriptionist work different hours than the rest of you, and, as Jon says, it won't matter if it is done the first day or the second.

Roger,

I realize it may come up how to pay the individual who does the transcription work, and what we do is that the transcriptionist (she also works as a biller in our office) for our one partner does this on her time, because we cost share equally the gals who do our billing and reception. And we as a group did not want her double dipping. So this may work out well in terms of the timing of the work outside office hours.