Please see article below that was published in 2003. Does anybody know if the law it mentions was ever passed in California?
a state senator said she will introduce legislation barring all California hospitals from allowing medical data to leave the country.
"California already has the strongest medical-privacy laws in the nation, " Figueroa told me. "But not strong enough. There's always something you didn't anticipate."
What she and other framers of the state's medical-privacy laws, which prohibit the sharing of medical information unless for clear medical purposes, didn't see coming is the explosive growth of the $20 billion medical- transcription industry.
U.S. hospitals have such a huge need for help transcribing doctors' dictated notes into written form that the work is routinely farmed out to private transcribers throughout the country. Those transcribers, in turn, frequently subcontract with other transcribers.
In the case of UCSF Medical Center, three separate subcontractors were involved in handling the facility's records. The last link in the chain was a woman in Karachi, Pakistan, who sent an e-mail to UCSF earlier this month demanding help in resolving a financial dispute with the Texas man who'd hired her.
The Pakistani transcriber said she'd post UCSF's files on the Internet unless the medical center assisted her. She backed up her threat by attaching actual UCSF patient records to her message.
This was the first time an overseas transcriber had used confidential records to threaten a U.S. medical institution. The transcriber withdrew her threat only after receiving hundreds of dollars from another subcontractor in the case.
Figueroa said her bill would prohibit anyone possessing information involving California patients from sending that information abroad.
State hospitals would likely be barred from outsourcing transcription work unless they could guarantee that all related files remain within the country -- a move that would make hospitals accountable for any subcontracting that ensues.
"We're not banning the practice of overseas workers doing transcription," Figueroa said. "But we can regulate the practice of medicine within California. "
The law, at least on the health care front, may be on her side.
In most instances, federal law would trump state law, and the federal Health Insurance Portability and Accountability Act of 1996 outlines rules for safeguarding medical data. Anyone doing transcription work for a U.S. hospital would be required to uphold HIPAA standards, although the law is virtually unenforceable overseas.
A unique aspect of HIPAA, though, is a provision that if a state adopts more stringent restrictions, state law will prevail.
"If there were a statute that no health care information in California could be disclosed outside the country, HIPAA wouldn't have a problem with that," said Paul Smith, a San Francisco attorney specializing in health care issues.
"The state has a clear interest in protecting health information," he added. "This would seem a legitimate exercise of state regulatory authority."
At the same time, though, Matthew Nakachi, a San Francisco lawyer who specializes in trade issues, said it's unclear how the proposed legislation would square with federal laws related to commerce. A hospital might argue, for example, that it has a right to do business with whomever it pleases.
"If California decides to do this," Nakachi said, "it would probably go into the courts and take years to fall out."
For her part, Figueroa expects the health care industry to fight the legislation, just as the banking industry opposed state restrictions on the use of customers' information. But she thinks that in light of the public's increased sensitivity toward privacy matters, her bill would eventually pass.
"The interesting thing will be to see where our new governor stands on privacy issues," Figueroa said. "At this point, we don't know."
Mystery woman: The Pakistani transcriber at the center of the case involving UCSF is still something of a mystery.
In her e-mail to UC officials, she identified herself as Lubna Baloch, "a medical doctor by profession." Beyond that, little is known of her.
In May, however, an interesting little exchange occurred on MT Stars, an online network for medical transcribers. Baloch, using the same e-mail address she used in her threatening message to UCSF, posted her resume at the site in hopes of attracting work as a subcontractor.
Sheri Steadman, who runs MT Stars, of Phoenix, said she's against U.S. transcription work going abroad and routinely deletes postings from overseas transcribers. In Baloch's case, she said she was concerned by the vagueness of Baloch's resume, especially as to her whereabouts.
Steadman wrote to Baloch to say that MT Stars is only for U.S. job seekers.
"I am US based," Baloch replied.
"Not enough info," Steadman responded. "Where?"
"Santa Monica, LA," Baloch wrote back.
For Steadman, this wasn't a very good answer.
"Santa Monica isn't in Los Angeles and it's not in Louisiana," she told me. "It was pretty clear that Baloch wasn't in the country."
Steadman confronted Baloch with her suspicion. Baloch never wrote back.
"She was trying to gain work in any way, shape or form," Steadman said. "She was trying to sucker U.S. medical-transcription services into sending her business."
It didn't work that time. A few months later, though, probably using a different online service, Baloch was more successful in her efforts.
That would turn out to be a very dark day for UCSF.
August 9, 2006 - EMR has revolutionized the healthcare industry in recent times. Many experts felt that EMR & Voice Recognition would totally replace Medical Transcription - however; the industry soon realized that transcription has certain advantages over point & click charting and many physicians preferred to dictate notes rather than document the data at the point of care themselves.
The most critical part of any Electronic Medical Record (EMR) is the method of data entry. EMR is about aggregation of patient encounter data at the point of care in order to provide a complete, accurate, and timely view of patient information. An electronic medical record is not just a typed record of the patient encounter, but an extremely useful decision support tool. The data can be entered into the EMR via any of the two general mechanisms: direct entry by the physician using point and click templates or transcription of dictated notes. Point and click template indicates that each data element, which is to be inserted, requires selection, navigation, point and click process for capturing patient information.
Transcriptions have been around for years for documenting patient encounters. A medical provider dictates the medical note into a phone or a recording device. The Transcriptionist receives the dictation and transcribes it. It may be reviewed by the supervisor for checking errors. The final computerized file is then either emailed directly to the healthcare provider or the file is transferred to a web site and is later downloaded by the provider.
Most EMR systems allow providers to generate clinical documentation, by selecting variable terms from pre-structured point-and-click templates. Users simply point and click to select appropriate choices from lists of choices to record a patient encounter. The end result would be a document that closely resembles a transcribed procedure note.
Completely customizable templates. The doctor can specify the layout of the template, which helps him to adjust the template as per his practice & procedure.
� Provide consistent, complete and accurate data. The chances of medical erros are reduced since the data is documented in customised forms.
� Store / organize data for subsequent retrieval.
� Each click adds data elements to the database. Point-and-click systems create data that can be used to generate clinically useful reports, such as health maintenance reminders, disease management etc.
� One of the major advantages of template based charting is the time needed to make the document available as a medical record. Since notes are created within the EMR, they are available immediately upon completion.
� It takes more time, and definitely more concentration for a physician to navigate through large data set and create progress notes using point and click templates.
� Templates must be customized as per the physician�s requirement. Customization can be inflexible and costly.
� Well accepted by only tech-savvy doctors.
� The approach of direct data entry by the physician has generally failed because busy providers reject it altogether.
� Output from these templates is too canned and identical. It loses individuality for each patient.
� It is difficult for a provider to capture complete patient encounter on computer in front of a patient.
Transcription has long been the standard for documenting patient encounters. It is more convenient for a provider as compared to handwritten notes or electronic data entry. There are many advantages of transcription in comparison to point and click charting. There are a few disadvantages as well.
� Corresponds intuitively to the physician's usual method of working. Dictation remains the most intuitive and least time-consuming means of data entry.
� Physicians can dictate anytime, anywhere using PDA, Dictaphone or telephone at their convenience.
� Providers need not change the way they practice just to accommodate an EMR. EMR can interact with transcription service so that transcriptions can be attached directly into the patient�s electronic medical record, if such a facility is provided by the EMR vendor.
� It requires minimal training for physicians.
� Provides expressive power to describe patient�s condition and other health related events.
� Transcribed reports are not immediately accessible. Physicians would normally have to wait for 12 to 24 hours for charts to be delivered, unless few vendors supporting 2-4 hours short turn around time.
� Transcription provides for more efficient use of doctor's time.
� Although average transcribed report costs $2 to $4, it can reduce the doctor's time spent on data entry. Considering the value of doctor�s time, transcription is not a costly proposition.
EMR should give the freedom to the physician to decide to use either Point & Click or Medical Transcription. For a physician, the EMR that fits into his practice workflow would be invaluable. A competent EMR must have a template driven charting feature and the ability to interact with a transcription service at the same time. Both are indispensable features of Electronic Medical Record Software, as doctors are not unanimous on point and click charting or transcription. Such an EMR will be both efficient and cost effective.
The trends in transcription itself are changing with Medical Transcription service providers aiming to adopt new technologies. These technologies will evolve to increase efficiency & accuracy, decrease turnaround time and support data capture. While many of these technologies like such as digital dictation and electronic signature exist today, several technologies are still on the horizon.
I watched a show on MSNBC last night about identity theft. You probably have seen it. They follow the chain of theives all the way to Europe and then they cannot even arrest the people.
About the medical records, the records would not be physically visiting any country, per se. Once they are in a computer and uploaded somewhere, they are already out there, so to speak. So, regardless of whose computer they are transcribed on or where that computer is located, the information is still out there. I know many insurance companies have online access to medical records and some physicians offer that as well to their patients. You're right, though, they should have asked that question.
This article was part of a reading assignment I had for one of my HIM classes. It is an old article, but I think MTs can understand this situation quite well. It just goes to show how quality is becoming decreasingly important in the healthcare industry.
Scroll down to "Current state of the industry" and it talks about the average age of today's MTs.
Interesting article but very long.
BANGALORE -- After seeing patients at the Arizona Medical Clinic in Sun City West, dermatologist Anthony Santos describes their cases on a hand-held digital recorder.
Parimala Jaggesh is an architect turned home worker in Bangalore. Each day, she receives audio files from doctors in the United States and types transcripts of their case notes for the Pittsburgh-based firm of Acusis Inc.
Before going home, he plugs the recorder into one of the hospital's computers. From there, his audio files are encrypted, compressed, shipped via the Internet through Pittsburgh and sent on to this bustling Indian city 9,100 miles away from Phoenix.
A few hours later, Santos' words end up in the laptop computer of Parimala Jaggesh, an at-home worker for Pittsburgh-based Acusis Inc., who will type a transcript of his dictation.
Santos and Jaggesh have never spoken to each other, so he has no idea that his voice is her favorite among the doctors whose dictation she transcribes.
When the Acusis staffers in Bangalore call Jaggesh to ask her to do extra transcribing, they only need mention they have a digital recording from the clear-voiced Santos.
"They know how to get work done from me," she says with a laugh. "They say it is Anthony Santos. Then I cannot say no."
Jaggesh is one of about 350 home transcriptionists Acusis employs in Bangalore and other Indian cities. The company, founded by native Pittsburgher David Iwinski Jr., has a lofty goal: to become the dominant player in the medical transcription business in the United States, using its cyber-partnership with educated, English-speaking workers in India.
Bangalore wakes up as night falls in the United States, so while American doctors sleep, Jaggesh and her colleagues transcribe their dictation.
Jaggesh, an architect turned home worker, hits the shortcut keys on her Compaq laptop to insert familiar phrases and consults online reference files when she is stumped by an unusual medical or pharmaceutical term.
Her finished work is downloaded to the Bangalore offices of Acusis. Editors there compare every line of her transcription to the original recording, make corrections if necessary, and grade her daily performance.
Santos' transcripts are sent back to the Arizona Medical Clinic within 12 to 24 hours after the doctor plugs his recorder into a PC. They can be returned even faster, under two hours, for an extra fee.
Even though the work is taking place halfway around the world, the result is speedier and more accurate than that done by a smaller local service, which used to take five to seven days to return transcripts, said Terry Daly, the clinic's chief information officer.
Medical transcription has a huge potential market of perhaps $12 billion to $15 billion a year. The current transcription companies are fragmented, ranging from small mom-and-pop operations to the industry leader, New Jersey-based Medquist Inc., which employs 10,000 transcriptionists to serve 3,000 health-care providers.
Acusis, just 3 years old, considers itself mid-size. The privately-held firm employs about 650 people here and abroad, 460 of whom are in India. The company serves about 40 hospitals and clinics across the country, including Children's Hospital of Pittsburgh.
Iwinski's hopes for becoming an industry leader rest on proprietary software written by 50 company programmers in India to manage the nearly instantaneous flow of words from hospitals in the United States to home transcriptionists in India and back again.
But it also relies on the cost advantages of Indian employees. The Acusis pay system for transcriptionists, based on volume and accuracy, ranges from 1 to 2 Indian rupees per line.
Jaggesh may do 1,000 lines a day. At the average pay rate, that would earn her roughly $27 a day, or $135 for a five-day week -- good wages in India, where the average annual income is about $500.
At the Acusis headquarters in Bangalore, each space has a name.
A training area is called Gurukul, meaning "abode of the teacher" in Sanskrit. A visitor's room is named Athithi, or guest. Quality control is dubbed, in English, the Potter's Wheel; software development, the Cutting Edge; and startups, the Test Tube.
"It's very challenging work," Naveen Janarbhan, a quality control specialist, said as he compared a transcriptionist's work to an original recording of a doctor reciting medical jargon at a fast clip, describing a patient who is a heavy smoker and has a family history of cancer.
A mechanical engineer by training, Janarbhan carefully went over the transcript, taking extra care when it came to the medications the physician had prescribed for the patient.
"We have to be careful. Our eyes should be here. Our ears should be here. Our mind should be here," Janarbhan said. "Concentration is the key."
He found a few mistakes in the transcription he was editing, all minor and none involving medication or diagnosis. Nevertheless, he called the home Transcriptionist to ask her to be more careful.
The system grades each transcriptionist and the results are available to everyone in the company. That peer pressure, according to Iwinski, is "a strong motivator" to do well.
The job isn't that easy. Sometimes, doctors are munching an apple or eating lunch while they talk, making them difficult to hear. A nurse interjects to ask about a patient's medication. Papers rumple in the background. The topics can be technical, the jargon heavy.
Occasionally, Jaggesh is distracted by music playing in the background of a doctor's recording, the noisy atmosphere of a hospital or extraneous chatting of passersby.
But she takes most of it in stride.
"It's fun. It's very challenging," said Jaggesh, who likes working in her three-story apartment, which she shares with two sons, two dogs and husband Navarasa Nayaka Jaggesh, a well-known comedy actor in Indian films whose screen name is simply Jaggesh.
Parimala Jaggesh works around her family's schedule, taking her laptop with her as she moves from floor to floor, and occasionally typing in a serene rooftop garden overlooking the city. At other times, she works in a top-floor room that contains a figurine of the elephant god Ganesh, thought to bring good fortune.
She keeps track of her daily reports, and if her accuracy dips below 96 percent, she studies the file so she doesn't repeat the same mistake. Sometimes she has a bad day, and she gets called by the office.
"We do appreciate the feedback. You get a call that you have dropped down in accuracy on one file. Then it's a challenge," she said. "I take it that if my editors find the fault, I should have been able to do it."
She enjoys the small personal things that sometimes show through in a doctor's dictation -- a laugh made over a mistake or a spouse in the background trying to hurry things along.
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About India take on offshoring. I don't think they are worried about loss of American jobs.
Interesting article. Curious as to what company?
The below quote is at least good news for US MTs. Now, if the rest of the hospitals and doctors would get in line, we might have a chance to keep our jobs here.
"Also in 2006, government investigators found that the VA's overseas contractors were handling personal information with lax security and oversight. The VA no longer uses international contractors, Budahn said."
Also known as virtual assistants, home-based administrative assistants use office experience and computer skills as support personnel. Many skills easily transition into this position which offers many part-time and temporary opportunities.
It's said that Americans are exposed to more than 3,000 ad messages a day. Advertising sales representatives sell or solicit advertising space in print and online publications, custom-made signs, or TV and radio advertising spots.
Computer software engineers are projected to be one of the fastest-growing occupations over the 2002-2012 period. Duties include design, development, testing and evaluation of computer software, and continual training is suggested for the quickly evolving industry.
Employed by a private company rather than a hotel or convention facility, a corporate event planner coordinates staff activities including group meetings, client presentations, special events, conventions and travel.
Copy editors mostly review and edit a writer's copy for accuracy, content, grammar and style. This is a competitive field; however, the growth of online publications and services is spurring the demand for writers and editors, especially those with Web experience.
Desktop publishers use computer software to format and combine text, images, charts and other visual elements to produce publication-ready material. Duties of this fast-growing profession include writing and editing text, creating graphics, converting photos and drawings into digital images, designing page layouts and developing presentations.
Like administrative assistants, job prospects should be best for those with expertise in computer software applications. By typing text, entering data into a computer, and performing other clerical duties, these workers ensure companies keep up with information and technology.
Insurance underwriters serve as the main link between the insurance carrier and the insurance agent. Underwriters analyze insurance applications, calculate the risk of loss from policyholders, decide whether to issue the policy and establish appropriate premium rates.
Market Research Analysts gather data on competitors and analyze prices, sales, and methods of marketing and distribution. They often design surveys, compile and evaluate the data and make recommendations to their client or employer based upon their findings.
While lawyers assume ultimate responsibility for legal work, much of their work is delegated to paralegals. Paralegals not only assist in preparation for closings, hearings, trials, and corporate meetings, they also perform a number of other vital functions including draft contracts, mortgages, separation agreements, trust instruments and may assist in preparing tax returns and planning estates.
I saw an interesting article on line from the local Rochester newspaper about captionists. They are people who assist with deaf students in helping them take notes in class.
Interesting article on MSNBC regarding repetitive motion strain and malaise.
I'm 57, learned on the job 28 years ago. I can out transcribe people half my age. I have no arthritis, no carpal tunnel syndrome, no fibromyalgia and only occasionally get a crick in my neck from my job. My QA score is 100%, has been for years, and I type 90 wpm, transcribe 200 lph at least and that's on an account that is almost all ESL. I could do this job another 20 or 30 years if I wanted to (barring sickness or accident that could happen at any age).
As far as the AAMT rep saying younger people are not lining up for this job - have they done anything to market MT to younger people? I'm sure a lot of high school kids or even community college people would be interested in this work if they were educated about it.
One last thought - the people they are offshoring this work to in India, Pakistan, Trinidad, the Philippines, are not spring chickens!!!
I for one am sick of AAMT trying to justify their greediness by blaming their victims, the US MTs.
There was an article in the news online that said it has spread to 3 more countries through ducks and geese and that it's only a matter of time before someone carries it here.
Can anyone tell me where this article was originally published? I forwarded it to a friend who asked... I wasn't able to tell her.
Try pasting this in your browser - it's an article from the latest Advance magazine called A New Set of Shoes for MTs!
My first thoughts were like you, just another way to cheat us. But then when I considered the possibility (trying to be kind here) that some companies are not giving us full credit for every character typed (as in perhaps counting 3 Keystrokes as 1 as has been mentioned here before), then even if they didn't pay us for spaces, we might make more in such a situation if they had to pay us for every single black character. They can't hide that from us! In other words, they would not be able to manipulate the line counting as much as I think they are doing now. Now how much they would pay us for every black character might differ from company to company, but I think this might work in our favor overall. If pay based on production is better for us than an hourly wage, we need to find what works most to our advantage. And with the difference there is out there now in line counts from one company to another, pay by character might help us.
And yes, even if it is a template, every character should still count as well as spaces, returns, tabs, demographic insertion, and also for our knowledge which comes into play every single time we keep the dictators from sounding like idiots and/or catching their mistakes. Let's face it -- we do at least basic editing too, folks. We are NOT just typists! We should be reimbursed for our knowledge as well as production. We're not donating our time to a charity here. This is a way of making a living. We should be paid for whatever we do for the company we work for, just like in any other job. This might be a step in the right direction.
I am cautiously almost hopeful.
outdated in reference to VR. Apparently she hasn't been out there in trenches lately. There is a LOT of VR work out there and unfortunately the pay isn't great, in fact it's awful for the work involved. Although it won't actually replace the MT, but rather move them into a different area, the pay is never going to match the effort that must go into it.
I just read an article yesterday in the Oakland Press that Oakland County, Michigan, is getting rid of all their court reporters and going electronic to save money.
I have done transcription for about 19 years. Over the years I have been concerned about off-shoring and voice recognition, but still felt fairly confident about still having work for a long time. Now, with the EMR system coming into play, along with the other factors mentioned above, I feel that eventually, not too far off, this is a losing battle.
I love doing this type of work. It has supported my family while my kids were growing up, I had a secure hospital job, and the luxury of working at home, I have to face reality though.
I am going to go back to school and maybe look into being a radiology tech and/or ultrasound. I will not take anything in medical records, such as coding or biling, as I think that will also become automated eventually, and is already in some instances.
I think doing the editing and/or transcription (if there is any) would be a good part-time second job to have in addition to another job, but not fulltime, as I don't think you could support yourself. I still have a good 15 years or more of working left and do not want to be left out in the cold whle hoping that this is not really going to happen.
It is ridiculous that the medical records of patients are so highly confidential, but yet we will send it to another country, and with the economy as horribile as it is too.
Maybe the government should retrain us LOL.
I do feel sorry for the newbies, and that these MT schools keep recruiting people into this occupation, and they probably know full well what is going on.
The economic stimulus plan currently being considered by Congress allocates $20 billion to health information technology such as electronic medical records (EMRs). Recent postings on Medscape Physician Connect (MPC), a physicians-only discussion board, offer frank opinions about the utility of EMRs in clinical practice -- opinions that are decidedly mixed.
"EMR is the worst thing that has happened to me professionally in over 25 years of practice. My care of patients is impeded and the quality of my care is worse as a direct effect of the introduction of EMR," says a MPC contributor who championed the installation of an EMR system for his physician group.
"I absolutely love our EMR," says a nephrologist. "It has improved the quality of our practice immensely. I spent a lot of time customizing for our practice, but it was worth it. Everything is point and click. To improve care and cost, all patients need a Web-based collection of medical records that include hospitalization, lab reports, x-rays, as well as office notes. That would be the ultimate care."
Physicians who are dissatisfied with EMR systems cite loss of productivity, the negative impact on patient care, and high maintenance requirements. Physicians who have embraced EMRs cite the increased efficiency the systems have brought to their practices. EMRs tend to get high marks from subspecialists and low marks from primary care physicians.
Some of the MPC physicians least satisfied with their EMR systems are those practicing at large healthcare companies or medical centers. "My hospital solicited medical staff support for EMR," says one MPC contributor. "After implementation, administration took over and now EMR is solely for the benefit of medical records as a storage device. To he11 with the medical and nursing staffs. RNs are input clerics rather than beside nurses."
"The very few efficiencies were all on the administrative side," says a regional medical director who helped bring an EMR system to a nationwide healthcare company. "A good sales pitch with nice graphics and testimonials sell it, then the clinical staff is left to suffer."
"EMRs need to address work flows and clinical efficiencies and not seek to provide administrative support," says a general practice physician. "Unfortunately, the administrators are the ones with the time and energy. The rest of us are seeing patients."
In smaller practices, issues of EMR maintenance and support infringe upon patient care. "In my clinic," says a family medicine physician, "provider meetings are completely dominated by EMR issues and problems. There is virtually never time left for discussing topics pertinent to improving patient care."
In speaking about their day-to-day experience with EMRs, primary care physicians complain that entering patient information is cumbersome and time consuming, often because of a template-based system that does not reflect the patient encounter.
"The assumption of the EMR is that you already know the diagnosis when the patient arrives." says an MPC contributor. "This may be better for specialty care, but in primary care, patients come in with fatigue, rash, insomnia, diarrhea, and cough. It's difficult to enter all this until after the visit."
An internist who describes herself as "tech savvy" says that her system's scripted entries for patient information are inadequate. "If you free-text, it is much more time consuming. And we are discouraged from free-texting by our administration because it doesn't trigger adequate billing codes. Not only has it reduced my time with patients, it has added an extra 2 to 3 hours of work each night from home."
"My advice to practitioners," says one MPC contributor, "is wait for a decent EMR that produces useful notes that accurately describe a patient encounter in a way that helps a clinician."
Waiting may not be an option for much longer, however. One provision of the government stimulus plan would impose reduced payments on physicians who are not "meaningfully using" information technology. Whatever is meant by the provision's phrasing, one thing is clear: the push is on to go electronic. Physicians must learn how to make information technology work for them. One EMR expert says that it starts with the choice of systems. "Primary care practices should stay away from templates and stick to a new program by Praxis� [Infor-Med Medical Information Systems, Inc., Woodland Hills, California] that uses pattern recognition of similar cases as well as rare cases. It decreases the workload immensely. For specialty practices, I recommend templates, and Visionary� Dream EHR [Visionary Medical Systems, Inc., Tampa, Florida] is excellent in being very user friendly," says an MPC contributor whose research in medical management focuses on EMR systems.
Another MPC contributor notes that the technologically adventurous can customize an EMR system by using open-source software. In open-source systems, he explains, the source code needed for programming is included in the software, making the program infinitely adaptable. "When you buy most proprietary software, you have to accept the functions that come with it, as designed by the developers. With open-source systems, you can modify the software to your heart's content."
Is a Choice of Systems Really a Choice?
For some physicians, however, EMR systems remain a nonissue, and the heavy government funding of healthcare information technologies is nothing more than a smokescreen obscuring the real issues in primary care.
"The government and the public are not able to deal with the real problems facing medical practice and the real solutions necessary to turn it around (ie, reasonable reimbursement rates, malpractice reform, regulation of the unscrupulous practices of the insurance industry)," says an otolaryngologist. He adds that once healthcare information technology is "fully implemented and solves nothing, we can start to talk about real reform and real answers."
Disclosure: Nancy R. Terry, has disclosed no relevant financial relationships.
understand it. Alas, many will not listen. Many would not even read the article if you printed it up and delivered it to their front door. Many don't care. Many believe it's a lot of "hype." But this country IS falling apart. And the big whigs know it too. I don't know if it's so much that they don't care, but that this is actually part of their plan. When the U.S. finally comes unraveled, they'll step in with a new dictatorship, and there will be precious little any of us can do about it.
I am angry. I am angry at the mayor of New Orleans. I am angry at the governor of Louisiana. I am angry at the Environmental Protection Agency (EPA). I am angry at the Federal Emergency Management Agency (FEMA), now part of the Department of Homeland Security. I am angry at George W. Bush. I am angry because they were warned last November that New Orleans was one of the �Disasters Waiting to Happen� � and did nothing about it. Consequently, hundreds, if not thousands, of people are dead. Needlessly.
In an eerie prediction of what happened as a result of Hurricane Katrina, an article titled, �What if Hurricane Ivan Had Not Missed New Orleans?� was published in the Natural Hazards Observer, a major journal headquartered at the University of Colorado in Boulder. It was written by Shirley Laska of the Center for Hazards Assessment, Response and Technology at the University of New Orleans. In other words, this was an article written by a reputable author in a reputable national publication that should have been read by people involved in disaster relief. If they had taken heed, many of the dead in New Orleans would be alive today.
- Inundated inhabited areas south of the Mississippi River.
Until I read this article, I had said one of the positive things that I hoped would come out of this disaster is that relief experts would realize that they need to make special provisions for the poor, elderly and homeless. In essence, I gave them the benefit of the doubt. Now, however, I realize that there is no benefit in doubt.
Laska spelled it out in even more detail.
During Hurricane Ivan in 2004, she continues, �Residents who did not have personal transportation were unable to evacuate even if they wanted to.
Approximately 120,000 residents (51,000 housing units x 2.4 persons/unit) do not have cars.
The additional problem of people having the means to leave, but refusing to do so was addressed in the article.
Those that dismiss environmentalists as kooks, should pay special attention to the observations about marshes.
George E. Curry is editor-in-chief of the NNPA News Service and BlackPressUSA.com. He appears on National Public Radio (NPR) three times a week as part of �News and Notes with Ed Gordon.� In addition, his radio commentary is syndicated each week by Capitol Radio News Service (301/588-1993). To contact Curry or to book him for a speaking engagement, go to his Web site, www.georgecurry.com.
Not trying to start an argument, just another point of view.
Press Release Source: Medquist Inc.
MT. LAUREL, N.J., Aug. 19 /PRNewswire-FirstCall/ -- MedQuist Inc. (Pink Sheets: MEDQ - News) announced today certain preliminary, partial and unaudited financial results. Once the Company completes the financial assessment and review of its billing practices disclosed in the Company's previous filings with the SEC, the Company expects that an independent registered public accounting firm will review and/or audit the Company's financial statements, as appropriate. While, at this time, the Company cannot estimate the total costs of (i) the billing review, (ii) defense of the class action matters, (iii) the SEC investigation, and (iv) compliance with the Department of Justice investigation, all of which have been previously disclosed in either the Company's filings with the SEC or the Company's press releases, the costs incurred to date by the Company in connection with the foregoing have been included in the results set forth below. Because the completion of the billing review and resolution of the litigation and governmental investigatory matters are pending, the Company is not certain whether any changes to the accounting treatment of any component of its consolidated financial statements will be required and, if any changes are necessary, whether any such changes would have a material impact on its consolidated financial statements. Accordingly, the financial information set forth below is preliminary, unaudited, and subject to change based on the completion of the financial assessment and review of the Company's billing practices and the completion of the review and/or audit of its financial statements, as appropriate.
The information set forth below is derived from the Company's internal books and records. The Company cautions investors not to place undue reliance on the information presented below. As a result of the developments described above and in the Company's previous SEC filings, the Company's financial statements have not been audited or reviewed by an independent registered accounting firm. The information contained in this press release also has not been audited or reviewed by an independent registered accounting firm. Such information is not a substitute for the information required to be reported in the Company's Forms 10-K and Forms 10-Q that have not yet been filed. There can be no assurance that the results of the billing review, and resolution of the litigation and governmental investigatory matters will not have a material adverse effect on the Company's revenue, results of operations and financial condition.
Preliminary, unaudited results indicate that the Company's revenue increased from approximately $486 million for the twelve months ended December 31, 2002 to approximately $490 million for the comparable 2003 period. The increase was largely the result of twelve months of Lanier operations being reflected in 2003 results as compared to six months of Lanier operations being reflected in 2002 results, as the acquisition of Lanier Healthcare LLC took place on July 1, 2002, largely offset by transcription service volume declines as well as declining pricing from both new and existing transcription clients.
Preliminary, unaudited results indicate that operating income declined from approximately $71 million, for the twelve months ended December 31, 2002 to approximately $61 million for the comparable 2003 period. The decline in operating income is largely the result of transcription service volume and rate declines, partially offset by the result of twelve months of Lanier operations being reflected in 2003 results as compared to six months of Lanier operations being reflected in 2002 results, as the acquisition of Lanier Healthcare LLC took place on July 1, 2002.
At December 31, 2003 the Company had $162 million in cash and cash equivalents. At December 31, 2003, the Company had less than $100 thousand in total debt. Other than minimal exercises of stock options, there were no additional issuances of capital stock or other securities for the twelve month period ended December 31, 2003.
Preliminary, unaudited results indicate that the Company's revenue decreased from approximately $490 million for the twelve months ended December 31, 2003 to approximately $456 million for the comparable 2004 period. The decline in revenues includes the impact of decreasing transcription service volume from existing and lost clients, partially offset by new clients, as well as the impact of pricing declines attributable to a competitive pricing environment. Additionally, the Company has recognized declines in revenue from its front-end speech recognition products as it transitioned from TalkStation to SpeechQ for Radiology.
Preliminary, unaudited results indicate that operating income declined from approximately $61 million, for the twelve months ended December 31, 2003 to approximately $23 million for the comparable 2004 period. The decline in operating income includes: 1) the impact of approximately $11 million in costs incurred in 2004 related to the ongoing billing investigation and associated litigation, 2) approximately $4 million in costs associated with separation and replacement of the Company's management team, including members at the executive level and 3) approximately $3 million associated with the write-off of intangible assets associated with products no longer being offered. In addition, the base business, as described above in the Revenues section, experienced a decline in transcription service volume from existing and lost clients and a decline in transcription service rates charged to customers. The impact of the revenue decline was partially offset by several cost saving initiatives including reductions in telecommunications costs, office consolidations and associated staff reductions.
At December 31, 2004 the Company had $196 million in cash and cash equivalents. At December 31, 2004, the Company had less than $100 thousand in total debt. Other than minimal exercises of stock options, there were no additional issuances of capital stock or other securities for the twelve month period ended December 31, 2004.
Preliminary, unaudited results indicate that the Company's revenue decreased from approximately $232 million for the six months ended June 30, 2004 to approximately $213 million for the comparable 2005 period. The decline in revenues includes the impact of the result of reductions in contracted transcription service rates from existing clients, further affected by new transcription business service volume replacing lost transcription service volume at a lower average price. Management expects these pricing pressures to continue and for revenue in the second half of 2005 to decline from first half levels.
Preliminary, unaudited results indicate that operating income declined from approximately $20 million for the six months ended June 30, 2004 to an operating loss of approximately $8 million for the comparable 2005 period. Operating income includes 1) approximately $16 million in costs incurred in 2005 related to the ongoing billing investigation and associated litigation, which represents an increase of approximately $11 million over similar costs incurred for the comparable time period in 2004 and 2) approximately $3 million in costs associated with separation and replacement of the Company's management team, including members at the executive level, which represents and increase of approximately $2 million over similar costs incurred for the comparable time period in 2004. In addition, the base business, as described above in the Revenues section experienced a decline in transcription service rates charged to customers. The impact of the revenue decline was partially offset by several cost saving initiatives including reductions in telecommunications costs, office consolidations and associated staff reductions. The Company continues to strive for improved profitability through service and technology enhancement initiatives, along with other cost reductions.
Preliminary, unaudited results indicate that the Company's revenue decreased from approximately $114 million for the three months ended June 30, 2004 to approximately $106 million for the comparable 2005 period. The decline in revenues includes the impact of the result of reductions in contracted transcription service rates from existing clients, further affected by new transcription business service volume replacing lost transcription service volume at a lower average price. As noted above, management expects these pricing pressures to continue and for revenue in the second half of 2005 to decline from first half levels.
Preliminary results indicate that operating income declined from approximately $7 million for the three months ended June 30, 2004 to an operating loss of approximately $6 million for the comparable 2005 period. Operating income includes 1) approximately $9.5 million in costs incurred in 2005 related to the ongoing billing investigation and associated litigation, which represents an increase of approximately $5.5 million over similar costs incurred for the comparable time period in 2004 and 2) $1 million in costs associated with separation and replacement of the Company's management team, including members at the executive level. In addition, the base business, as described above in the Revenues section experienced a decline in transcription service rates charged to customers. The impact of the revenue decline was partially offset by several cost saving initiatives including reductions in telecommunications costs, office consolidations and associated staff reductions. The Company continues to strive for improved profitability through service and technology enhancement initiatives, along with other cost reductions.
At June 30, 2005, the Company had $198 million in cash and cash equivalents and no debt. There were no additional issuances of capital stock or other securities for the six month period ended June 30, 2005.
MedQuist, a member of the Philips Group of Companies, is a leading provider of electronic medical transcription, health information and document management products and services. MedQuist provides document workflow management, digital dictation, speech recognition, mobile dictation devices, Web-based transcription, electronic signature, medical coding products and outsourcing services.
Some of the statements in this Press Release constitute "forward-looking statements" within the meaning of the U.S. Private Securities Litigation Reform Act of 1995. These statements are not historical facts but rather are based on the Company's current expectations, estimates and projections regarding the Company's business, operations and other factors relating thereto. Words such as "may," "will," "could," "would," "should," "anticipate," "predict," "potential," "continue," "expects," "intends," "plans," "projects," "believes," "estimates" and similar expressions are used to identify these forward-looking statements. The forward-looking statements contained in this Press Release include, without limitation, statements about the Company's results of operations and financial condition. These statements are only predictions and as such are not guarantees of future performance and involve risks, uncertainties and assumptions that are difficult to predict. Forward-looking statements are based upon assumptions as to future events of the Company's future financial performance that may not prove to be accurate. Actual outcomes and results may differ materially from what is expressed or forecast in these forward-looking statements. As a result, these statements speak only as of the date they were made, and the Company undertakes no obligation to publicly update or revise any forward-looking statements, whether as a result of new information, future events or otherwise. The Company's actual results may differ from the forward-looking statements for many reasons, including any direct or indirect impact of the matters disclosed in the Form 12b-25 filed by the Company on August 19, 2005 on the Company's operating results or financial condition; any continuation of pricing pressures and declining billing rates; difficulties relating to the implementation of management changes throughout the Company; and the outcome of pending and future legal and regulatory proceedings and investigations.
I am going to ask they stop sending me that magazine anymore, because every issue is more and more about AAMT pushing for the certs, telling American MTs we need to "keep up with the changes in technology," although no one ever says how, and what technology, etc., not even when I have e-mailed the great Ms. Tessier, et al.
Boy do you have it wrong....one article and you believe it!
I just found this article! OMG!
Circa 1997: A new industry is on the horizon. There is lot of excitement as people anticipate the benefits of the Internet age and talk of medical transcription as an opportunity that can potentially change the fortunes of many Indians. Along with computer training institutes, the medical transcription training institutes mushroomed in towns and cities promising placements to all trainees. Entrepreneurs were gung-ho as every mom and pop set up shop. And making hay in this excitement was the middlemen who promised abundance of business.
Circa 2001: It was clearly epitaph time for the industry. The booming industry had turned a whimper. The training institutes suddenly disappeared, companies downed shutters and the fledging industry died before it had learnt to walk. That was then.
Circa 2004: There is a sense of purposefulness and systematic ramp-up as the industry goes about its business. There is a steady flow of business despite the US backlash and some have even managed to raise funds. Led by a couple of US-based companies the medical transcription industry in India is in the resurgent mode.
Resurgent? Indeed! But sustainable? One can't help doubting the future of an industry that was once so hyped but which fizzled out as quickly. Judging by all parameters this growth looks sustainable. The industry seems to have learnt from its failure and is doing it right the second time with its focus on marketing, investment on technology and emphasis on delivery of quality service.
According to US Bureau of Labor Statistics (BLS), there were a total of 97,810 medical transcriptionists working in the US in May 2003, the latest period for which data was available. Surprising though it may sound, almost every seven out of ten MTs in the US were employed by the hospitals or offices of physicians. Less than 15 percent were employed by professional outsourcing service providers.
That means Indian companies have to sell to a business community that has hardly outsourced. Naturally, the only appealing reason for them to offshore is cost saving. Considering this fact, it was not very surprising that this industry was centered only around cost. That, as we will see a little latter, is changing.
occupation, even after factoring in the offshoring phenomenon. "Contracting out transcription work overseas," the 2002 Employment Outlook report noted, is "not expected to significantly reduce the need for well-trained medical transcriptionists domestically."
The drop in employment, say observers, has happened primarily because of an acute shortage of supply. This is reflected in a press release from the Medical Transcription Industry Alliance which said, "There are insuffcient number of qualified medical transcriptionists to meet the enormous demand."
This could work out in India's favor. Early signs-in fact the present resurgence-actually shows that it has already happened.
However, not everyone who started out pursuing this opportunity a few years back survives today to grab the second chance. Those who survive are the ones who invested in understanding the business and establishing a name for themselves in the market. These are the ones that are reaping the benefit. Fortune actually favors the prudent these days.
Medical transcription, commonly perceived as the lowest end of the spectrum, was the first back-office work to be offshored to India in the early 90s by HealthScribe and Heartland who started their pilot projects from South India.
As the Internet took off in the 90s, the industry caught the imagination of many entrepreneurs who rushed headlong without a base in the nitty-gritty of the business. The first mistake was that entrepreneurs did not have a front-office presence and relied on the middleman. In the absence of direct marketing presence, early entrepreneurs had absolutely no clue about the demands of the market and were at the mercy of sub-contractors. This dependence led to undercutting of prices that reached unrealistic levels and became completely unviable.
Says Raman Kumar, CEO of C-Bay Systems, arguably the largest medical transcription company in India with a controlled workforce (direct and indirect included) of 3,500 people, "Companies in the early phase relied solely on the middleman to get business. That cannot be a viable business model because it is important to own the customers. Otherwise the customer begins to dictate terms to you."
The C-Bay model was completely opposite to what most people were following in India during those days. "We set up our front-end office in the US and focused on building our presence in the market. It takes much more investment to set up the front-office so that's where we focussed initially."
It managed its back-end by setting up relationships with franchisees who were trained by C-Bay and by keeping a strict control on the quality of the work. Kumar reasons that, "We did not waste our efforts in the back-end at that time. After consolidating our front end presence, we focused on the back-end."
C-Bay had bought over three companies in the US: Arrendale Associates and Advanced Transcription Solutions in 2002 and Emergency Dictation Services in 2004. These acquisitions gave a stable customer base to the company.
With the front-end in place, C-Bay turned its attention to the back-end and set up its own center in Hyderabad, Bangalore and a joint venture with Godrej in Mumbai. It also acquired some of its franchisees and is still actively negotiating for some more deals.
And that is a very significant difference in the strategy of the companies that are dominating the medical transcription industry today. Needless to say companies like HealthScribe, Heartland, Spryance, Accusis, Focus Infosys have strong presence in the US.
"This business is based on relationship and clients need an interface to understand their concerns and requirements for which a direct US presence is absolutely critical," says Jayesh Nagda, CEO of Focus Infosys headquartered in US with its delivery center in Bangalore.
Agrees Vijay Kaul, Head, Customer Service, with Spryance, a company which promotes home based transcription in India in a big way. "The importance of having a good marketing network cannot be undermined. We are positioned as a huge aggregator of work. That is our primary strength." Spryance aggressively promotes home based transcription and hires people for Quality Assurance and editing work only. It employs a workforce of 1000 people, 70 percent of whom are home-based Transcriptionist (HBT). Incidentally HBT is a concept that has become quite popular in India and is being experimented by quite a few companies.
The requirement for experienced professionals is high in this model although freshers are also trained by providing extensive feedback. That is why some companies like HeathScribe is a little reluctant about this model.
Says Suresh Nair, CEO of HealthScribe India, "We have a small number of HBT but that is not our primary model. Our HBTs are essentially ex-employees who may have moved to different cities or may have quit for personal reasons." HealthScribe employees 1350 people with only about 100 people working from home.
Acusis that actively promotes HBT finds it a viable model. "Technology has matured enough to allow people to work from home", says KB Anand, COO of Acusis. "We have a tech team of 50 people who have developed a customized solutions called Accusuite which manages voice from US to India and assign it to specific HBT."
Today there are workflow processes and adequate security measures in place to allow working from home. This is one development that really has the potential to change the face of the industry. While ITES has been touted as the industry that could harness the idle talent of housewives, young mothers and others by allowing people to work from home, medical transcription is the only industry that has actually done it. It is estimated that HBTs execute between 10-20 percent of the MT work that is offshored to India.Companies have invested a lot in technology to streamline processes and ensure secure workflow. With stringent regulations in US about the security of patient information, this investment is absolutely necessary for serious players. This is a sustained investment and requires deep pockets.
All the top players have made heavy investments in technology particularly in ensuring information security. The Patient Health Information System of Spryance has been audited by Ernst & Young and is HIPPA certified.
HealthScribe has also invested a lot on technology to have its systems HIPPA compliant. It has developed its own workflow management system that allows the system to assign work in a systematic and secure manner.
The industry is leaving no stone unturned to address the security of patient information. It is one of the reasons why MT companies in Bangalore have come together under a banner called Indian Medical Transcription Industry Association (IMTIA). Says Suresh Nair who is also the President of the association, "The idea is to share experiences and best practices amongst members. Most often, security breaches occur because people are not aware of it."
Finally it is the quality of work that will decide the fate of the industry. The major reason why the industry went bust during the first phase of its growth was because the accent on quality was lacking. Hospitals were appalled at the poor quality of work that was being churned out by the industry. "Lured by the hype numerous garage start-ups came up with little focus on quality and processes which soon reflected in the shoddy work," says Som Marappa, President and CEO of US-based MedSoft with delivery centers in Bangalore, Coimbatore and Mysore.
Today the industry watchword is quality. "The industry has learnt that it is only the focus on quality that will see it through," says Suresh Nair. With 98 percent accuracy levels expected it is indeed a tall order.The industry is sparing no pains to gain this level of accuracy. The average training is of nine months and the employee gets productive only after a year. "The gestation period in training a medical transcriptionist can take up to two years and that is why it makes sense to look at destinations with lower cost structure," says V Raman Kumar.
Unlike the call center industry trainees do not have to get their accents right. They are trained in listening skills, introduced to medical language and taught some basic transcription skills. It is estimated that bigger firms invest anywhere between Rs 60,000 to Rs 1 lakh on training each transcriptionist while smaller firms may invest a little less.
The transcripts go through rigorous quality checks in India and US before it is sent to clients. Even companies who swear by the HBT model hire quality assurance people "because quality is the lifeline of the industry."
What is as critical as the quality is the turnaround time. Often turnaround time is 8-10 hrs, sometimes it can even be demanded with a few minutes. Says Nagda, "When we handle emergency dictation, doctors require notes immediately to perform surgery and the turnaround time is a few minutes then." Needless to say that 24x7 services command a premium in the market.
According to bpOrbit estimates, there were close to 12,000 people working in the Indian medical transcription industry as of August 2004. bpOrbit also estimates the industry size to be $115 million in the year 2003-04 (April-March). There were close to 250 companies doing medical transcription work, out of which many worked as a franchisee for a bigger company, such as C-Bay.
The margins, contrary to popular belief, are not small. At 15-18 percent, it is quite healthy by the outsourcing industry standard. But that kind of margin is expected only after reaching a scale, due to deployment of technology as well as economy of scale.
The average per line price commanded by the companies for transcription is close to 6-12 cents. Depending upon experience, the average lines transcribed by an MT could vary from a low of 200 lines to a high of 750 lines per day. On an average, this yields close to $4.5 per hour, which is what the low end voice call centers with much higher capex and opex, as also the salary, realize. The added advantage in this industry is that as unlike the voice work, here it is not just the quality but even the productivity of an employee increases with experience, resulting in direct increases in revenue. With lesser attrition and higher productivity, this industry is good for long term players, with high scale.
The MT industry does not necessarily have to work at night except in cases of offering 24x7 service. The attrition rate at 15 percent is therefore far lower than the BPO industry. Says Veer Sagar, Chairman of Selectronics Equipment and Service, "This is intelligent work which requires an analytical and logical mind. This goes a long way in curbing attrition because the work is not repetitive."
India's opportunity emerges in the backdrops of the consolidation that the US MT industry is undergoing. The dynamics in the healthcare industry changed with the adoption of technology. Billing became more transparent and US transcription companies came under intense pressure as result of which offshoring became a popular option.
At the same time, there was a shortage of qualified transcriptionists. In the Journal of AHIMA, Carrie Boatman, Director of Professional Relations for the American Association for Medical Transcription said, "The problem facing employers is that the majority of the transcriptionists graduating from a program require additional training before they can be truly productive. Training staff is not a popular option. Training transcriptionists is an expensive proposition that can require six months to a year."
Not many hospitals and health practitioners are ready to bear that kind of cost burden. Which means two things. One, that the healthcare industry has to move away from the dependence on employed labor and has to turn out to offshoring. Two, with large training costs becoming imperative, those with a scale would benefit from it. So what we are seeing is a big consolidation.
Viewed from this perspective, it will not be an exaggeration to say that India could be the epicenter-and not just another location-of this new phase of consolidation. Also, with US elections almost round the corner, the India-factor will not be so much a sensitive issue. In any case, in this industry, it has never been such a problem. Says Raman Kumar, "It has to be very clear that offshoring of work occurred because of the shortage of qualified professionals. Never has offshoring of MT grown at the cost of jobs in the US." This explains why even at the height of the backlash against outsourcing in US, MT was not really an issue.
The industry would do well to gear up its security measures. Although big players are conscientiously addressing the issue, the same cannot be said for all small players. Americans are absolutely paranoid about their health information. The incident regarding Pakistani Dr. Lubna Baloch blackmailing the American subcontractor to expose patient information if the alleged payment dues were not fulfilled has sent shock through the industry. A similar incident in Bangalore by two Heartland employees threatening to release sensitive patient data in lieu of some concession has further hackled the industry. "Another Lubna Baloch or Heartland could well be the beginning of the end of the transcription industry overseas," says Marappa of Medsoft.
Another threat is the emergence of the voice recognition software. The industry can ill-afford to remain ignorant of new technology trends. Voice recognition has not fully matured and shall still require editing skills. In anticipation, some companies like Focus Infosys have experimented with the software in-house. But there needs to be many more initiative to address this challenge.
A recent marketing trend is hospitals belonging to a particular group or chain are aggregating transcription work and offloading it to offshore vendors as a single deal. "The consolidation of suppliers in a bid to get better price from vendors has begun to happen," says Nair. This has the potential to squeeze the margins of major vendors.
Many of the medium and small Indian vendors are currently servicing the clinic segment in the US and the large hospitals remain untapped. The clinics account for between 30-40 percent of the overall market.
While marketing challenges can be over some with innovation concerns regarding security are potentially more explosive which can upset the applecart even before growth has stabilized. However with the growth momentum building up and a determined industry bent on success, it is unlikely that the industry will stumble the second time round.
I was just looking at an internet article. Supposedly Star was suppose to make the announcement on Thursday and Barbara feels betrayed by what she did. It goes into pretty good detail.
Wow...those people are downright scary! I don't understand their beliefs at all...a sign in a picture with this article says "God is your enemy"...thought they were all about God? Confusing yes, but they are still scary!
PS: See article - AND the name of the guy who wrote it!
OK, so a long time ago, people in Europe used to refer to everything to the east of them as the Orient, including for example the Middle East, since orient means "east". So far, so good. This mysterious area was the source of all sorts of wonderful things like silk and spices, so the Europeans attached also sorts of exotic, mysterious connotations to the Orient. As Europeans gained a better concept of world geography, they eventually used "the Orient" and "Oriental" to refer to East and Southeast Asia, where people look "Oriental" in our current usage.
The upshot is to use whatever word you feel most comfortable with, or that makes your listeners most comfortable, but don't be surprised if someone takes offense. And in the time you save by not worrying about word-usage, try to make the world a better place.
LOL - I couldn't have said it better myself.
A study of radiology reports generated by speech recognition software at a prestigious U.S. academic medical center found that even with fully trained system users the technology was introducing significant errors in almost one out of five signed, final reports. We structured a study where we could look at the types of errors and frequency of errors in attending dictated reports using Voice recognition software, said Dr. Ronald Dolin, who is from the department of radiology at Thomas Jefferson University Hospital in Philadelphia. Dolin and his team retrospectively reviewed radiology reports dictated and signed by attending radiologists from February to March 2006 at Thomas Jefferson.
According to Dolin, all radiology reports at the institution were generated using PowerScribe 4.7 from Dictaphone/Nuance Communications of Burlington, MA, which had been implemented for 16 months prior to the start of the study. A total of 395 reports, consisting of five to 10 consecutive reports from each of the 41 attending radiologists, were reviewed, according to the researchers. They categorized the dictation errors into 10 subtypes, such as missing word errors, wrong word errors, extra word errors, nonsense phrase, unclear meaning phrase, or abnormal phrase with meaning intact. Errors were classified as significant if they altered or obscured the meaning of the sentence in which they appeared, Dolan said.
A total of 239 errors were identified in 146 of 395 reviewed reports for an overall error rate in final reports of 37%, he reported. In addition, he noted that at least one error was identified in reports from 40 of the 41 attending radiologists at Thomas Jefferson. The researchers found that missing or extra words that did not alter the meaning of a sentence constituted 113 of the 239 errors, or 47% of the total. This type of error was found in the reports of 33, or 81%, of the attending radiologists, Dolan said. Other common errors reported by the scientists included the wrong word, which accounted for 21% of the total errors; typographical or grammatical errors accounted for 8.8% of the total; a nonsense phrase with unknown meaning showed up in 11% of the total errors; and an error in the dictation date presented in 2.9% of the erroneous reports. Most of the speech recognition technology errors, 83%, did not alter the meaning of the report, Dolin noted. However, the remaining 17% of the errors could have impacted patient care. Significant errors -- errors that could conceivably alter a patient outcome -- accounted for 40 of the 239 error total. He said that significant errors were found in 54% of the attending radiologist reports and that five radiologists had two or more significant errors. Dolin acknowledged that he set the criteria for classification of significant errors and determined what was and was not a significant error.
about India having a shortage of skilled workers and how they are worrying about having to pay them higher wages due to the shortage? Anyone else also find that they had a big old smile on their face after reading the article?
Did anyone read the article in Advance: Is Mandatory Credentialing Next?
The article says: "we have more and more companies paying premium for credentialed MTs." Is that true? The author is president-elect of AHDI. You all know what that is? Never heard of em. Or is it that new organization that used to be called something else, what was it... I think it had the words Medical Transcription in it. Maybe we should write a letter to tell about the reality of working out here.
I think the only way to get what we want is to get those bills passed. These companies that offshore are going to say just what that guy did - everything is protected and accurate. People aren't going to want to hear us whine about jobs getting sent overseas - well, most people anyway. But if they have to be informed that their information is being sent overseas, I would imagine that at least some people would refuse, forcing doctors to use US companies.
I always felt like I was "an accidental business owner" because when I got into MT work at age 25, I didn't realize how much of it was as an IC. I should have talked to an accountant from the start.
If anyone ever has the opportunity to review the page 24 article in Newsweek this week - dated September 24 - "Good doctors spot mistakes, save lives" - I found this extremely interesting - especially that since I am a transcriptionist, we oftentimes "hear" the mistake after the fact. This is pretty much just about doctors and their practice - but I think everyone would find it interesting - I would see this doctor any day. I wish I could copy t and post it but cannot. Please take the time at your grocery or newsstand to review page 24 of this issue.
The Sunday paper in my area had an article on headphones and the 3 that were compared were Bose,Sennheiser, and Clear Harmony. They basically said that Sennheiser has the best quality of sound and blocks noise the best. They are all very expensive but if you go online to E-Bay there are new ones listed that are about half-price. I have been looking at the Sennheiser, but like you, I have a very small head. The ones I use now I bought at Radio Shack. They also have very competitive headphones. Good luck.
Is this the article you were referring to?
"Foreign Medical Graduates May Get New Test" in the NY Times? If so, it was printed on May 1, 1988. It also stated that the foreign medical graduates have to take an English profiency exam, NOT that they will NOW have to take one if the new test guidelines occur. The new requirements are that they have to take the United States Medical Licensure Examination (USMLE) Step 1 and Step 2, the Test of English as a Foreign Language (TOEFL) and the Clinical Skills Assessment. This is before they can even begin a residency in the U.S. Might be nice if you had some reading comprehension skills.
I looked all over this article and could not find a date of publication. Everything vaguely says "later this year.' Which year? The only thing I could find on the entire page was 04/08/02 under the author's byline, and at the very bottom of the page, a copyright of 1995-2002. When you click on the link to discuss the article in the forums, the new page never loads. If you look up all other articles by this author, they are all dated 2000-2002.
I think you are getting upset over nothing. Call Time Warner directly and ask them what their plans are.
Costa Brava manager Andrew Siegel said in the letter to Medquist director Clement Revetti that Costa Brava 'reserves all of its rights and claims in connection with any sale of MedQuist'.
The warning follows a Dec 31 AGM in which neither of the six Costa Brava nominees were elected to the MedQuist board of directors....The nominations followed a Nov 2 statement from MedQuist indicating it is considering a sale of the entire company after Philips indicated it was willing to sell its 70 pct stake in the unit.


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This week, leadership in the Senate unveiled a short-term continuing resolution (CR) to fund federal programs once the new fiscal year begins on October 1. The Senate CR would have extended funding through December 11 and prohibited federal funding for Planned Parenthood for one year. The CR failed to garner the necessary 60 votes needed to advance in the Senate. The Senate plans to take up a "clean" CR with no policy riders early next week. With the announcement today that House Speaker John Boehner (R-OH) will retire at the end of October, odds have improved significantly that the House will accept the Senate's clean CR, avoiding a government shutdown. While there is still support from some members of the House Republican caucus to tie funding for Planned Parenthood to the CR, in announcing his resignation, Speaker Boehner has taken the option of being forced out of the speakership over the issue off the table. It appears likely that with Democratic support, a clean CR will pass the House.
This entry was posted in Advocacy, Latest News and tagged appropriations, budget, Featured, Legislative. Bookmark the permalink.


text:
Sandy Ground is een dorp en haven op het eiland Anguilla. Het telde 230 inwoners in 2011. In Sandy Ground bevindt zich Road Bay, de belangrijkste zeehaven voor vrachtschepen. Het dorp is bekend om zijn strand.

Overzicht
Sandy Ground is een lange dunne strook land tussen de Caraïbische Zee en het zoutmeer Road Salt Pond. De baai is beschermd door de omliggende heuvels en heeft zich ontwikkeld tot de belangrijkste haven van Anguilla. Sandy Ground heeft een druk strand met bars en restaurants. Het water is ondiep en rustig, maar het water moet worden gedeeld met containerschepen, vissersboten en jachten.

Het carnaval van Anguilla wordt in Sandy Ground gevierd met honderden boten. Het is tevens het centrum van het nachtleven van het eiland. Boten naar de onbewoonde eilanden Prickly Pear Cays en Sandy Island vertrekken van Sandy Ground.

Road Salt Pond
Het zoutmeer Road Salt Pond is het grootste meer van Anguilla, en werd door de inheemse bevolking gebruikt voor de winning van zout. Het drasland is bijna cirkelvormig, en wordt bezocht door vele trekvogels. In 2013 werd een gebied van 43 hectare aangewezen als Important Bird Area.

Plaats in Anguilla
Strand in Anguilla
Haven in Anguilla

redpajama_set_name: RedPajamaWikipedia


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text:
Archives for posts with tag: irresponsible
"Victory"? Somebody buy Ted Cruz a friggin' dictionary .
October 17, 2013 //
Ted Cruz thinks that defeat is victory; or at least, he thinks that being ahead during a contest means more than who actually wins or loses at the end of a contest: http://www.rawstory.com/rs/2013/10/16/cruz-it-was-a-remarkable-victory-until-senate-republicans-caved-on-the-shutdown/ From the article:
Sen. Ted Cruz (R-TX) on Wednesday blasted members of his own party after he said that they wasted a "remarkable victory" by making a deal with Democrats to re-open the government and avert a default on U.S. debt by raising the nation's credit limit
Of course, Teapublicans did not win a victory at the end of the recent shutdown/default debacle. At the end, they were forced to "surrender", in the words of Speaker Boehner. Most of us see a surrender as a, well, defeat. But not Teddy Boi Cruz. In his world:
Cleveland won a remarkable victory last week, because they led at the half. (Of course, Detroit won the game later)
Rome won a remarkable victory over Rebbe Yeshua bar Joseph when they crucified him. (Of course, the Christians are still around, and the Roman empire is long gone).
England won a remarkable victory over the rebellious American colonies…you get the idea.
Clearly, Teddy Boi hasn't a clue about the English language. Buy the fool a dictionary, someone, PLEASE.
Tags debt ceiling, default, House, irresponsible, remarkable victory, Republican, Senate, shutdown, Tea Party, Teabaggers, teapublican, Ted Cruz
When Doing Nothing Is What You Do
Recently we discovered that the House of "Representatives" will be giving itself about 2/3 of the year off. So they clearly don't plan on doing anything for their six-figure salaries.
This morning, Mr. Blunt and Cranky heard a story on the news about how Dizzy City has gotten into the habit of forcing other agencies to do nothing. So the trend is being spread across the government, like mold through bread.
Mind you, the government doing nothing might not be so bad if we weren't still paying full price. Most of us in the real world don't get paid if we don't work. But not "our" government, who take our money and provide little or nothing in return.
There's a word for such people, who take our money under false pretenses and then fail to deliver as promised.
That word is "thieves".
Tags Boehner, Congress, Democratic, House, inaction, irresponsible, least productive, McConnell, Republican, Senate, waste

redpajama_set_name: RedPajamaCommonCrawl


I've been asked several times to implement the oh-so-popular navigation drawer for folder selection in AquaMail, replacing the old-fashioned drop-down list.
The technical part is easy, but the more I get into it, the more it seems like a bad idea. Here is why.
TL;DR – I'm happy for the young energetic designers who are making a career out of "inventing imaginative ways to improve mobile device navigation patterns", but there are significant drawbacks which may outweigh the claimed benefits.
1 – I'm faced with the decision of whether I should keep the drop-down or not.
Having two entirely different UI elements that do same thing (let the user directly navigate between folders) is strange, putting it mildly.
– Remove the drop-down entirely and keep just the drawer.
This is bad for users who are not experts on Android UI patterns. Yes, the drawer indicator is there (the three tiny horizontal stripes to the left of the app's icon), but… Sometimes I get emails asking how to access the menu, and there are users who barely know about the Back button. Nothing wrong with these people, they're just not experts on technology or UI, and I'd rather not make the app more confusing to them.
– Remove the drop-down, make the folder name (where the drop-down is currently anchored) another way to open and close the drawer. The native Gmail app does this.
The issue is how to make it obvious that this is how things work? The drop-down is easy to see and understand because it has a little triangle bottom right, like all other drop-downs everywhere else.
Keeping the triangle makes the UI immediately inconsistent: it looks like a drop-down, but when tapped, it does something else (opens the side navigation drawer).
Removing the triangle is even worse (the native Gmail does this): now there is no visual clue that this is not just a piece of text, but an active UI element.
This last issue is now very common in Android and becomes more and more common. Personally, as a user, I find it confusing like hell. It used to be that buttons looked like buttons, lists looked like lists, etc. – now UI elements that "do stuff" no longer look like anything, they're just areas the user is supposed to tap (or slide? which way? or long press?), and the only way to find out is to use mind-reading skills.
2 – The navigation drawer is anatomically wrong.
It forces the thumb to move sideways (left to right) which is awkward in the first place, and then, when it's almost touching the palm, the thumb has to move vertically to select from the now open navigation drawer's list.
Really, if you're reading this, try it yourself and pay attention to how your thumb's muscles tighten when it's bent and closest to the index finger. It's at this point that the navigation drawer requires the thumb to start moving up and down to pick from the list.
Furthermore, a drop-down list can extend the entire width of the screen (or close to it), so the thumb does not have to move left much at all. A navigation drawer, by convention, is anchored on the left, and is more narrow than the screen (the shadow effect). Reaching sideways to the left is hard, especially on large screen devices. Reaching up is easier: the phone can shifted in the hand, up and down; but this does not work for reaching to the left.
3 – The navigation drawer doesn't achieve what it's supposed to.
Ostensibly, the motivation (or one of) is better usability on large screen devices, the explanation being that a drop-down anchored in the action bar is difficult to reach.
However, a side drawer also has a list, of same items, and it's natural to start them at the top (unless you have some UI element that can go first, just to take up space… see the Google+ app, it's the profile photo).
Let's see, we wanted to get away from a list that starts near the top, and we ended up with a list that starts near the top, which is not any easier to reach, and which puts additional stress on the thumb's muscles.
4 – How do other app do it?
The native Gmail app sort of manages to make its navigation drawer more usable by moving action bar icons to the top, which in turn pushes the drawer's activation area (the current folder's name) to the left.
Android 4.0 introduced a way to put action bar icons along the bottom on "narrow screen devices", i.e. phones. This is a great feature, making frequently used actions easier to reach (better location; a larger number of icons showing at the same time).
Now Gmail's way of implementing the drawer puts the icons back at the top. Let's see, the number of icons is now reduced from 4 or 5 to just 2, the rest require tapping the "three dots" icon or the hardware Menu button. And these two icons are now located — ta-da! — near the top of the screen.
In summary, "one small but very visible step forward, two giant steps back" is what Gmail's navigation bar treatment seems to me. They made 2 or 3 commands (tasks) less accessible, to improve accessibility of 1 command (task): switching folders.
Will I keep the already-almost-implemented navigation drawer?
Really don't know yet. Maybe I'll add a Prada logo instead.


This award provides funding for five years of support to participate in the U.S. component of the International Trans-Antarctic Scientific Expedition (US ITASE). US ITASE is made up of four major research disciplines: meteorology, remote sensing, ice coring, and surface glaciology and geophysics. US ITASE hopes to answer questions about the mass balance over West Antarctica and the influence of major atmospheric circulation systems and oceanic circulation on the moisture flux over West Antarctica. In addition, questions about the controls on climate variations over seasonal, inter-annual, decadal and centennial scales will be addressed. Other factors to be examined by US ITASE relate to the impact of anthropogenic activity on the climate and atmospheric chemistry of West Antarctica as well as the variations in biogeochemical cycling of sulfur and nitrogen compounds over the last 200 years. This project will perform analyses of the glaciochemistry (i.e. major anions and cations) of shallow and intermediate depth ice cores collected on the US ITASE traverses. The ionic composition of polar ice cores provides not only a stratigraphic tool for relative dating but also documents changes in chemical species source emissions and allows characterization of the major atmospheric circulation systems affecting the West Antarctic ice sheet.
This award is for support for a Science Management Office (SMO) for the United States component of the International Trans-Antarctic Scientific Expedition (US ITASE). The broad aim of US ITASE is to develop an understanding of the last 200 years of past West Antarctic climate and environmental change. ITASE is a multidisciplinary program that integrates remote sensing, meteorology, ice coring, surface glaciology and geophysics. In addition to the formation of a science management office, this award supports a series of annual workshops to coordinate the science projects that will be involved in ITASE and the logistics base needed to undertake ground-based sampling in West Antarctica.
This award supports a project to measure snow and firn bulk properties and microstructure along the route of the U.S. International Trans-Antarctic Scientific Expedition (US ITASE) traverses in West Antarctica. These parameters are important because they control the air-snow-firn transport processes and thus the manner in which heat, vapor, and chemical species in air are incorporated into snow and polar firn. The objectives of the project are to obtain field measurements of near-surface (down to 2 meters) snow and firn properties, which include surface roughness, permeability, density, grain size, surface-to-volume ratio, and tortuosity. In addition microstructural measurements and measurements of the above properties will be measured in firn cores down to 20 meters back in the laboratory. These measurements will be used in a transport model to elucidate the nature of the air-snow-firn exchange and firnification process at the various sites along the U.S. ITASE traverse. Since many of the snow and firn properties also affect the interaction of radiation in different parts of the electromagnetic spectrum, these measurements will provide valuable ground truth to those efforts using remote sensing to map the spatial variations of snow, firn and ice properties.
This award provides support for five years of funding to determine the mass balance and accumulation rate of ice along the traverse routes of the U.S. International Trans-Antarctic Scientific Expedition (US ITASE) program. The rate of ice sheet thickening or thinning will be measured along flow lines, along ice divides and along elevation contours in West Antarctica using a method which measures the vertical velocities of markers buried in subsurface ice. This method uses the Global Positioning System (GPS) and surveying techniques to determine the precise location of these markers. Vertical velocities so obtained are compared with long-term rates of snow accumulation and the difference in the two is a measure of ice sheet thickness change. A series of recording instruments will be installed to provide continuous records of firn densification and snow surface elevation change. These instruments will be deployed at selected sites to link transient changes in snow surface elevation, as measured by altimeters, to long-term rates of ice thickness change. Ice motion at drill sites, upglacier topography and upglacier gradients in accumulation rate will be measured and used to calculate ice flow-induced accumulation rate variations and remove them from the ice core records. This work will provide the capability to deduce true past climatic variations in accumulation rate from the US ITASE ice core records.
This award supports a project to improve understanding of atmospheric photochemistry over West Antarctica, as recorded in snow, firn and ice. Atmospheric and firn sampling will be undertaken as part of the U.S. International Trans-Antarctic Scientific Expedition (US ITASE) traverses. Measurements of hydrogen peroxide (H2O2) and formaldehyde (HCHO) will be made on these samples and a recently developed, physically based atmosphere-to-snow transfer model will be used to relate photochemical model estimates of these components to the concentrations of these parameters in the atmosphere and snow. The efficiency of atmosphere-to-snow transfer and the preservation of these components is strongly related to the rate and timing of snow accumulation. This information will be obtained by analyzing the concentration of seasonally dependent species such as hydrogen peroxide, nitric acid and stable isotopes of oxygen. Collection of samples along the US ITASE traverses will allow sampling at a wide variety of locations, reflecting both a number of different depositional environments and covering much of the West Antarctic region.
This award supports a program of radar studies of internal stratigraphy and bedrock topography along the traverses for the U.S. component of the International Trans-Antarctic Scientific Expedition (US ITASE). The radar will provide information immediately available in the field on ice thickness and internal layer structure to help in the selection of core sites as the traverse proceeds. These data will also be useful in siting deeper millennial scale cores planned at less frequent intervals along the traverse, and in the selection of the location for the deep inland core planned for the future. In addition to continuous coverage along the traverse route, more detailed studies on a grid surrounding each of the core locations will be made to better characterize accumulation and bedrock topography in each area. This proposal is complimentary to the one submitted by the Cold Regions Research and Engineering Laboratory (CRREL), which proposes a high frequency radar to examine the shallower portion of the record down to approximately 60 meters, including the presence of near-surface crevasses. The radar proposed herein is most sensitive at depths below 60 meters and can depict deep bedrock and internal layers to a substantial fraction of the ice thickness.
This collaborative proposal supports a project to perform stable isotope analyses of samples collected along the International Trans-Antarctic Scientific Expedition (ITASE) traverses which will begin during the 1999/2000 Antarctic field season. This work will focus on the spatial and temporal distribution of oxygen-18 and deuterium in West Antarctica (where data are particularly sparse) and the calibration of the isotope-climate relationship on a site-by-site basis, using instrumental and remote-sensing temperature histories. Specific objectives of this work which contribute to ITASE are: 1) to obtain detailed oxygen-18, deuterium and deuterium excess and stratigraphic histories in snowpits at most or all of the ITASE coring sites; 2) to provide direct calibration of the isotope-climate relationship at each site through a combination of direct (AWS) and indirect (passive microwave satellite) temperature measurements; 3) to obtain isotope profiles covering the last 200 years; and 4) to use the results to provide 200-year climate histories at high temporal and broad spatial resolution across West Antarctica that will allow testing of proposed relationships among isotopes, moisture source conditions, synoptic scale climatology, and site-specific meteorological parameters, and which will enhance our ability to interpret isotope records from older and deeper Antarctic ice cores.
This is a 4-year project to examine the visual stratigraphy, physical and structural properties of the U.S. ITASE ice cores spanning the last 200 years of snow accumulation in Antarctica. A first priority will be to examine visual stratigraphy to delineate annual layer structure for dating purposes and to determine to as great a depth as possible, accumulation variability over the full length of a stratigraphically dated core. A second objective will be to measure and analyze depth-density profiles. The rate of snow and firn densification depends on both the rate at which the snow is deposited and the in situ snow temperature. These data can and will be used to derive average snow accumulation rates for the sites where annual layer structure is difficult to decipher or where stratigraphic analysis fails altogether. A third objective will entail measurements of mean crystal size over the full length of a core. Crystal growth is a strongly temperature dependent process and measurements to be made on ITASE cores will help to bridge a significant data gap that exists in the mean annual temperature range, -31° to -50°C. Additionally, crystal size data can also be used, in conjunction with ice loads based on density profile measurements, to extract mean accumulation rates for these sites where stratigraphic dating of cores proves difficult or impossible to accomplish. This is likely to occur at the lowest accumulation/lowest temperature sites along the ITASE traverse routes.
Halogenated ethane derivatives (HFC, HCFC) have been introduced as environmentally friendly CFC substitutes. Trifluoracetate (TFA) is a highly persistent, atmospheric degradation product of these compounds and there is concern that the widespread introduction of HCFCs and HFCs will lead to the accumulation of TFA in aquatic ecosystems. Indeed, our pilot data on TFA deposition at South Pole indicate a significant increase in TFA deposition in the late 1990s. However, data on pre-industrial, background concentrations of TFA in meteoric and surface wasters are ambiguous and the impact of anthropogenic TFA on these background concentrations is unclear. We will develop a record of recent TFA deposition in Antarctica using surface-snow, snow-pit and ice-core samples collected at South Pole and, through participation in ITASE, in West Antarctica.


same i really needed this information on all of this thanks so much now gotta get back to studying bye.
Why was World War II omitted from your review of "Major periods of world history?
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