Transcription's Coopetition with EMRs
EMRs have been around for some 20 plus years and in that time frame, have slowly been adopted by more and more medical facilities. Many go into the implementation phase of an EMR based upon the information received from their EMR vendor during the sales process. Eliminating transcription is the number one cost justification for purchasing an EMR. EMR vendors know this is a thorn in the side of medical facilities and any system that can reduce or eliminate transcription would be widely received. The theory is a sound one. Take a clinician who dictates and utilizes a transcription service and eliminate that monthly transcription expense by having the doctor use a template on-line within the EMR. Immediately, the savings are realized in the elimination of transcription expenses. Administrators rejoice because this was one of the major reasons they elected to implement an EMR.
Within one to two weeks after implementing the EMR and its template features, clinicians are upset because they have increased their time in the office by 15-20%. At this point, either 1 or 2 things happen:
- The clinician begins to rely on support staff to document a patient encounter by having them enter template information into the EMR system. (this assumes the support staff has the time to take on a new responsibility)
- The clinician instructs the scheduling personnel to adjust his or her schedule either by reducing the number of patients seen or by increasing the visit time allocated for particular appointment types. Either way, the result is less patients seen.
Above, in the first scenario, the cost of transcription is simply shifted internally to a staff person who is probably paid more that a transcriptionist and eventually, either new staff is budgeted or the original duties maintained by the staff person begin to suffer. In the end, the result becomes a shift of work from a lower paid transcriptionist to a higher paid internal staff person. The first scenario can be successful if your medical facility is over staffed and staff personnel have the time to take on additional responsibilities. The bottom line is additional monthly expenses since over staffing is simply an administrative problem in itself that can be dealt with to eliminate expenses.
In the second scenario, the doctor, after a few weeks of putting in the extra time to make the system workable, adjusts his or her schedule so that they can see patients and have time to document their encounter. The end result is obvious; lower production thus leading to lower revenue numbers.
One to two months later, the same administrator who championed the EMR system is looking at revenue reports and realizes the numbers are down. This usually happens over the course of the first 3 months after clinician templates are utilized on an EMR system instead of dictation and transcription. After some research and speaking with the clinicians, the administrators learn that the clinicians are seeing less patients.
The bottom line is that a transcriptionist expenses, although a necessary evil in most administrators eyes, are in fact the least expensive way to document patient encounters. A doctor seeing 25 patients may pay on average $100 per day for transcription ($4 per transcript). If a clinician sees 2 less patients per day, the production revenue will drop by $300 per day. The result is a $200 revenue loss per day.
Having all patient information in one system is important especially when an EMR is being used. Administrators can rest easily knowing the systems are out there that integrate with EMR systems so that all transcribed notes are entered into the EMR system and readily available. In some systems including the Emdat solution, a doctor dictates in the traditional sense, but the transcription actually populates the EMR as if the doctor were doing on-line templates themselves. This solution is one whereby discrete data for each major heading in a transcription (HPI, Medications, etc) transfer to the EMR system and populate the discrete fields within an EMR. This type of transfer allows clinicians and administrators alike the ability to search and data mine within the EMR on information contained within the transcribed document.
I believe that EMRs are the future but I believe they are the future because of what they bring to health care, not the savings they bring in the form of transcription elimination. The EMR is a one stop system whereby all patient information is available, regardless of the source. Justifying an EMR should not be done at the expense of transcription. Doing so usually correlates to a decrease in production by your clinicians. An EMR is a capital expense and the Return On Investment (ROI) should be based upon improvements in the patient care process, not the reduction of the easiest and most cost effective documentation process, transcription.
