The Case For Medical Transcription Credentialing
Now more than ever before, it is becoming very evident that the MT workforce should be moving towards mandatory credentialing. In late 2012, a settlement was reached that awarded 140 million dollars to a southern woman's family due to an incorrect insulin dosage that was not caught in her medical record.
This landmark case has brought worldwide attention to the fact that medical records are part and parcel of a patient's medical care and ultimate well being. The insulin dosage was incorrectly noted as 80 units by a speech engine when in fact the woman was on a dose of 8 units of insulin.
The report went through several MTs and even QA and no one caught the error. The physician never saw the report and in fact was not aware that the transcription was being done not only by an outside transcription service but one overseas.
The patient was transferred to another hospital along with the erroneous medical record, where she received 80 units of insulin instead of 8, which ultimately led to complications resulting in her death.
The Case for a Credentialed Workforce
Could this grievous error have been avoided other ways? Certainly--had a nurse noted the amount and questioned it, if a doctor had reviewed the record perhaps disaster could have been avoided. The reality though is that no one did catch the error and the ultimate responsible party would be the physician who didn't sign the record and the transcription service who perpetrated the error.
Would credentialing cut down on critical patient safety errors in medical records? This author (who has been in the medical transcription business for almost 40 years) believes emphatically yes. CPSEs are on the rise today as are major errors in medical records. As a top QA editor for a large company, I caught and flagged probably at least 25 per day. That's a staggering amount when you consider that the people doing the transcription are considered qualified already!
One of the problems in the MT industry today is that the workforce is paid on production. If you don't produce, you don't get paid. This leads to errors in and of itself.
The other problem within the industry today is not as easily understood by many. The advent of speech engines and voice recognition technology is a great boon to the workforce doing medical transcription. However, with it comes a high price tag--the propensity for errors to occur and very easily.
MTs are faced with paragraph after paragraph of text that "looks" right but may have several critical patient safety errors interspersed within the text. A physically taxing job before, MT work now has moved to the mentally taxing. It's an acquired skill that requires someone to focus on a screen for at least 8 hours per day reading from left to right, watching the bouncing cursor and thinking about every single syllable that is presented on the screen. Taking one's mind off the screen or being distracted for even 1 nanosecond can mean the difference between catching an error and not catching an error--80 versus 8.
Add to that the fact that medicine is an ever-changing arena with new drugs, new procedures, new instruments and techniques coming into play every single day and you have a profession which should carry with it an extremely high level of sophistication and qualification.
However, up to the present time, there have been relatively few transcription services who reward their employees for having credentials of RMT (registered medical transcriptionist) or CMT (certified medical transcriptionist). Even fewer hire only credentialed transcriptionists.
So what's the difference? Does credentialing mean you will have less errors in medical records?
Why Credentialing is Vital to Medical Transcription
This author has outlined to family and friends over the years the process of how their medical records come into being, how they are transcribed, and what technology is available today to include the good, the bad and the ugly.
In all cases, to a person, every single one of them has been rather shocked and not a little alarmed hearing that there are major errors made and critical safety errors that go unnoticed. People tend to believe that their medical records should be preserved and pristine and somehow treated as a sacred part of their life. In reality, who would welcome incorrect allergies or medications being populated in one report which went uncorrected only to show up in five more medical records down the road because the information was taken from the original report with an error in it that was never fixed?
In order to preserve the sanctity of the medical record or the electronic health record, only qualified professionals should have access or be involved in the creation of anyone's medical record. MTs have access to patient information and can accidentally assign health information to the wrong patient, type in, edit or not edit out an incorrect diagnosis, medications, dosages, surgeries--the list goes on and on.
As an example, in this author's opinion, having a noncredentialed MT work on your medical record would be like hiring a high school student to re-wire your house. Yes, maybe he could do it and yes, maybe he's really talented. But has he proven his expertise by having a credential behind his name that verifies that he knows his stuff?
Credentialing in the MT world comes in several different forms and at different levels. The beginning MT starts out as an RMT and then after several years of experience, is allowed to sit for the CMT test. There is also a requirement that upon passing either of these two tests and getting one's credential, it has to be renewed after 3 years.
In order to be renewed, in the case of the CMT certificate, the CMT must accumulate at least 30 continuing education credits across four (with two optional) core aspects of the medical world in a 3-year period in order to maintain his or her credential. These include Clinical Medicine, MT Tools, Technology in the Workplace, and Medicolegal Issues. All of these categories are important to the overall integrity of anyone working on medical documents. There are two optional categories CMTs can earn credits in such as Professional Development and Complimentary Medicine (including alternative medicine, acupuncture, etc).
Just as physicians must keep up with current day practices and provide proof of ongoing education, so must the CMT. The RMT can sit for the CMT exam after completion of the required experience, but cannot advance until they have successfully passed the CMT exam. The CMT who is recertifying can actually earn up to 50 CECs for extra recognition, something I believe is completely achievable by anyone and is further reassurance that the credentialing individual takes his or her job very seriously.
Would accuracy in medical records transcription improve if the workforce was required to be credentialed? This author believes most assuredly it would. Simply by requiring MTs to prove that they know their profession and are continuing to embrace new trends and discoveries assures the person most affected--the patient--a much better outlook in terms of accuracy of their medical record.
Would any of us want a physician's assistant treating us if he or she did not have a credential behind their name? I know I wouldn't. Why then should medical transcription be any different and why should unqualified or at least untried individuals practice medical transcription literally without a license? There should be some measure of ability in this highly trained, complicated branch of the medical profession and like every other, it should come with the understanding that to be hired, the applicant has to be licensed.
Strangely, this author has heard stories from students and MTs over the years who apply for MT jobs on-line (the norm) and have a friend help them with their test. As scandalous as this may sound, the fact that they would be allowed to work on one patient medical record is frightening to me. Usually these people's work speaks for itself eventually and they don't last but the possibility is certainly there for fraud and deceit. When you're dealing with something as vital as medical records, it just doesn't make sense to not have a better process for assuring quality of care at this most important level.
Are There Downsides to a Credentialed MT Workforce?
This author believes there will be protests about the proposal from AHDI advocating a completely credentialed workforce. Some of the arguments:
- It will cost more money
- It will involve studying more
- It will involve more computer work
- It won't get them anywhere
- It could potentially cost them their job if they don't measure up
- It's just a piece of paper and doesn't prove anything
To all the questions above, this author feels that the end justifies the means. Having a credentialed workforce in place will not only ensure greater patient care but it will also ensure less incidents such as the woman named in the suit being administered a wrong dosage of a medication.
In my way of thinking, it will mean greater job security for those of us who take the time to work for a credential and then maintain it by continuing education.
If companies and institutions are under the mandate to only hire credentialed employees, it makes everyone more credible and lends professionalism to a career that has sometimes been overlooked.
MTs are not just typists. They are health documentation specialists and are a vital part of the process of patient care and treatment. Raising them to the level of other healthcare professionals can only improve patient care and most importantly, patient safety.
The money spent acquiring credentials in the scope of all things considered is minuscule. The cost for taking exams or even purchasing materials to study for the exams are oftentimes deductible. Employers who believe in a credentialed workforce reimburse for the cost of testing and recertification. Realistically, the tests or references are not so inflated in price as to not be affordable to someone who is devoted to their career.
I personally feel that with establishment of a credentialed workforce and more credibility across the table for medical transcription as part of a viable healthcare team that the pay scale will also increase and may result in more policies geared towards quality over quantity in a workforce which has too long been production based.
Lastly, requiring credentials will weed out any individuals who don't have a care about the profession in terms of keeping up skills or learning for a lifetime. Medical transcription is a career which requires dedication but also the belief that you can never know it all or that you can't learn something new. People that feel this way or are content to stay in a rut and do the bare minimum will fall by the wayside voluntarily and thus strengthen the quality of the healthcare teams everywhere.
The Future of MT and Credentialing
This author has joined several committees through AHDI (The Association for Healthcare Documentation Integrity) for the sole purpose of furthering the cause for credentialing all transcriptionists. I believe this should extend to offshore workers as well as onshore workers.
Without it, the medical profession will see an increase in critical patient safety errors and major errors being perpetrated throughout medical documents which is what we should be trying to prevent.
People who know their job inside and out will never want for work in the proposed credentialing environment.
People who have less than adequate skills will be encouraged to work harder to perform better, which should be a fundamental part of anyone's goals who works in medicine.
People who have less aptitude for medical transcription will have to determine if they can meet the level of expertise required to remain in the profession or find another career.
Progress and change are living breathing entities, especially in modern medicine. We all have choices--we can embrace them, get on board the train moving forward, or be left behind as it takes off without us or passes us by. I personally believe that credentialing medical transcriptionists is the most positive step within the industry in decades and it will be a win-win situation for everyone. Most importantlhy though--for the patient whom we serve.
Demonstration of Voice Recognition
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