This month, HIM Spotlight takes a look at medical transcription. ADVANCE asked four companies - Acusis, Nuance, Silent Type and Spheris - how they are responding to customers' needs in the current health care IT climate. Their responses follow.

Domestic or offshore options

Acusis offers U.S.-, India- and Philippines-based transcriptionists and editors. "We provide offshore-based production to save our customers money, but.we know that not all hospitals, clinics and physician groups choose to use only offshore-based transcriptionists, which is why you decide where you want your work performed," the company stated.

Acusis said it focuses on "generating the highest Total Quality Management" transcription within consistently delivered, defined turnaround times, with highly responsive customer and technical service support." The company conducts quality control reviews of all transcription work prior to its return to the customer. It also monitors the quality of its processes and procedures.

High-quality first drafts

"From a day-to-day health information management [HIM] perspective, Nuance customers' most pressing need is to create quality clinical documentation, and do so in the most cost-effective manner," said Lauren Richman, director of marketing for HIM solutions at Nuance. "In response to this need, we work continually to offer improvements to our background speech recognition platforms that allow us to create increasingly high-quality first draft documents for our customers' medial transcriptionists [MTs] to edit [vs. type from scratch]."

Richman said Nuance's speech recognition yield is "extremely high," meaning a higher percentage of dictating doctors can have their dictations speech-recognized, which drives cost savings. "We also work very hard to enhance and refine our training and communications programs for MTs - whether in-house or employed by an outsourced MT service organization. High-quality clinical documentation is more than just high-accuracy speech-recognized documents and highly qualified editors; the strategic management surrounding productivity and prioritization is also a major factor."

Richman said Nuance worked with customers to develop and make available a new Quality Assurance (QA) feature as part of the latest eScription Version 9 platform. With QA Review, customers can effectively manage the creation of high-quality documents that are consistent and align with agreed- upon grading criteria, she explained.

"Nuance customers have a pressing need to preserve and utilize the physician narrative as part of the patient's electronic health record [EHR], which tells the unique patient story from the physician's point of view. With the growing demand for meaningful EHR use and the need for data access and mining, we are working with our customers to recognize that the physician narrative must be preserved and not lost to point-and-click EHR templates alone," added Richman.

Nuance said the company will continue to develop and improve technology options that address this need, as demonstrated by an eScription/Epic integration at Prevea Clinic, and Dragon Medical integrations with various EHRs. "Most EHRs have not done well in supporting narrative text, according to our customers," commented Richman. "Nuance's speech recognition products provide both background and real-time options to incorporate clinician narrative into the EHR."

Flexibility for different processes

Silent Type provides customizable document management solutions. The company said flexibility allows it to integrate fast, accurate medical transcription into the customer's system to streamline workflow and increase cost-efficiency.

"We know how to accommodate different document management processes, work with your existing file formats and design systems that will adapt as your document needs evolve, regardless of the type or size of your organization," the company stated.

The company noted that it verifies the accuracy of all medical and scientific terminology using its proprietary electronic lexicon.

EHR transition

"Right now, many clients are looking to Spheris to help them transition to an EHR or develop realistic strategies to maximize the use of their EHR technologies, especially as they learn more about the ARRA and HITECH Acts passed by Congress this year," commented Kim Vernon, RHIA, vice president of product management at Spheris.

Among health care facilities with EHR technologies in place, physician compliance and adoption are the most common concerns, according to Spheris. For example, physicians typically can talk faster than they type, so many are resisting new procedures that require them to enter data manually into the EHR.

"We're working with our clients to increase physician adoption through new dictation/integration options such as dictation placeholders," noted Vernon. "We're also helping them implement strategies to return transcribed text in a form that is meaningful, such as XML-tagged text or discrete data elements."

Spheris recognizes that some customers may be evaluating their EHR strategy and have not made final decisions around technology. "We're helping them transition toward electronic capture of information and away from paper, with technologies such as electronic signature software that allows physicians to edit and sign clinical documentation online," said Vernon.