Lowering the Bar: Making "Once and done" documentation look good

I think I'm on to something here when it comes to answering the question: "Why would facilities make highly educated physicians with high earning potential spend the time to input their own medical records?" What chain of events would have to occur to make the time it takes for "once and done," performed by the MD, look attractive?

I think I've figured it out. Actually, a friend of mine figured it out and was not only kind enough to share, but encouraged me to come here and do what I do best.

I've always said that when the other benefits of an EMR outweigh the cost of having the physician do the data entry, physicians would be forced to do data entry. But what would make a physician willingly, even eagerly do it?

Crappy transcription.

Crappy customer service.

Expensive crappy transcription service.

Picture, if you will, a scenario where the doctor spends the time to dictate, waits days (if not weeks) for the transcribed document - then has to review and edit it. Or request corrections, wait for them to come back, review and possibly edit again.

How much time did that take?

If you want something done right, do it yourself, right?

Why don't they just get another transcription service? One medical records director told me they felt like they'd jumped out of the frying pan and into the fire when they did this. Unhappy with their "big box" service, they went with a smaller, local contractor. In the ensuing fiasco, two weeks' worth of untranscribed dictation was erased from the dictation server with no backup. She called the experience "a career killer." They went back to the big box service. They weren't any happier with them, but they were afraid of similar - or worse - experiences if they continued trying to find another service.

The devil you know is better than the one you don't, right?

Anyone who has really dug into the transcription industry and its practices can tell stories of the dark underbelly you'll find there. Sad, but true - there are plenty of services out there that are so bad, they make everyone else look good. Even when we're bad. Kind of like elections, isn't it? Imagine the pain of paying customers in having to choose between bad and not-so-bad and believing there is no such thing as good, better or excellent. Or not being willing to kiss that many frogs to find the prince, if you'll excuse the mixed metaphors.

Facilities of a certain size that only want to deal with one outsourced vendor have a very short list to choose from and every company on that list will make the same promises. Is there even a difference? In my opinion, there isn't much of one. Vendor selection could take place by putting the names in a hat and drawing one and the outcome wouldn't be appreciably different. (Note for those of you with attorneys on retainer: This is just my opinion, which I am allowed to express as one of my Constitutional rights. It's an election year. If you don't like it, go spend some money lobbying for a change in the Constitution instead of pushing for certification of MTSOs.)

It's even more difficult to differentiate between the smaller services. One question I am frequently asked is "how do I tell if someone is really a transcriptionist or if they just say they are?" Expand that to transcription services and you have the same dilemma. When my web site was being redesigned, I sent the designer to competitive web sites. He came back and asked me if everybody does it "faster, better, cheaper."

The problem between marketing and operations is there has to be some reality. The end effect of all of the above is that it hurts everyone in the industry, just like ambiguous and/or dishonest pricing does. The more companies provide substandard service, the more doctors and facilities will see "once and done" as a less time-consuming method of documentation. The more dissatisfaction there is with traditional transcription, the faster physicians will migrate to something that, overall, works better for them. Even though transcribed records can be imported into an EMR (or can be set up to import) and thereby provide a dual benefit, it won't be a consideration if everyone is so unhappy with transcription that they look only at options that allow them to completely eliminate it.

Pricing practices and client expectations regarding service and price are contributory factors, but I'm saving that diatribe for another blog.