Marketing transcription services in the USA

As a young industry, the best option at this point appears to be partnering with an existing transcription company in the US. This may appear to be a low growth and low profit model; the alternative is risky and expensive. Service industry solutions are often sold through relationship marketing. A traditional industry such as healthcare is very cohesive and it is often difficult to break in due to established relationships and long history. Proximity to the client and regular interaction with the client is necessary without which simple issues grow to become major problems.  A minor cost advantage is often not enough to sway the customers to switch their business and the sales cycle is often long and painful.

In the long run the doors will open to those transcription companies with the ability to deliver and build the experience.

This is not to rule out the possibility of direct marketing as several companies have taken this approach and have shown signs of success. It certainly is a risky way to enter the business. The cost of marketing in the US is an expensive proposition as it is apparent even in the high revenue IT industry. It is uncommon to see software products marketed by software developers from India in the US market. We continue to play the role of subcontractors as it offers the safe route to limited but assured success.

The external environment and factors that impact offshore transcription companies

• Regulations

During a HIPAA session at the MTIA annual conference, a professional consultant responded to the question “Does HIPAA prevent offshore transcription?” The answer was an unequivocal “No”.  As I continue to work on HIPAA related projects, it is clear that the intent of the law is not to specify how and where the healthcare related work is done but to ensure that the data is protected and adequate measures are taken to safeguard the use of the data.

The problem that is common to all the business associates is the transmission and distribution of the transcription documents. Use of unprotected e-mails and transmission of data over the network without ensuring secure access are problems that must be dealt with by all not just offshore companies.

• Technology

Computerized Patient Records

The move towards computerized patient records will result in an increased demand for transcription work. Though it might appear that EMR reduces the demand for transcription, a closer look at the existing conditions proves otherwise.”  The terms – EMR and CPR are often used interchangeably. There is a subtle distinction between CPR (Computerized Patient Record) and EMR (Electronic Medical Record) as between a set and subset. According to CPRI (Computerized Patient Record Institute) “A CPR is electronically maintained information about an individual's lifetime health status and health care. The computer-based patient record replaces the paper medical record as the primary source of information for health care meeting all clinical, legal and administrative requirements. It is seen as a virtual compilation of non-redundant health data about a person across a lifetime, including facts, observations, interpretations, plans, actions and outcomes. The CPR is supported by a system that captures, stores, processes, communicates, secures and presents information from multiple disparate locations as required."  By this definition, the EMR is a subset of CPR. The CPR may include systems that will allow direct entry of data into a clinical management system. Electronic medical records mean that the data is available electronically – feeds from laboratory equipment, paper documents converted through scanning and data entry, dictations converted to electronic document etc. A computerized patient record system entails availability of electronic medical records. It is the collection, organization and use of electronic medical records that makes a CPR. While it may appear that CPR has the potential to reduce transcription work, in order to create electronic medical records, administrative support such as document conversion (scanning & data entry) and transcription are required unless the source data is created using a computer. Just like speech recognition, the days of healthcare providers creating the records using computers is yet not at our doorstep. However, the trend in the major health organizations is to move towards computerized patient records. Many now require that the physicians use software to capture medical records directly on their computers. Widespread use of such direct-entry systems can have an impact on the transcription business. Template-assisted data entry and customized, easy to use data entry interfaces are in the works to facilitate data capture and eliminate voice dictation. Though it has not been widely deployed in the industry, it is a trend that should be monitored. The offshore companies will also be required to integrate with other data repository through open standards such as HL7, XML and EDI standards.

Speech Recognition

In spite of continually improving accuracy rate, unassisted use of speech recognition tools by care providers does not appear to be an immediate threat. But the technology has the potential to change the way transcription is done. Netrascribe has started an initiative to use speech recognition technology where it makes sense. Using deferred recognition capability, Netrascribe offers a variable rate transcription service that will allow us to share the reduced cost of transcription with an improved voice model over a period of time. Towards this objective, we have identified a new breed of transcriptionists who will be trained from the beginning to effectively use the recognition tools. The transcription companies must find ways to incorporate this technology and evolve with it. Speech recognition is not a threat to the transcription as of yet; but it is prudent to understand and experiment with the technology as it has the potential to reduce cost and improve quality.

The future

This is neither the first time nor is MT the first industry to see the movement of work to countries outside the US. Perhaps the critical nature of the MT work makes it difficult for the vendors to successfully manage the transition. But it is something that can be overcome with time and proper preparation. In spite of occasional obstacles due to protectionism and initial skirmishes, the US has always managed to put the final outcome as the driver of these decisions. The US is one of the few countries that has realized that the best way to crate and protect jobs is to let the market forces decide what works. By choosing a path that makes economic sense, growth is assured and the demands are met. The offshore transcription service offering makes good business sense for those who need the service and for the providers. By properly managing the expectations and working together, this has all the ingredients to become a success story.

Ó May 2002 Raj Krishnan
Raj Krishnan holds an MBA from India and MS in engineering from McGill University, Canada. Over the last 20 plus years in North America, he has worked for Fortune 50 companies including a Big Five consulting company, and Start-ups. He is a co-owner of Netrascribe, a Medical Transcription company based in Chennai and manages the US operations.