The market for transcription software is growing, yet most surgeons still generate their operative notes the old-fashioned way: through call-in dictation and next-day transcription.

In addition to software's speech-recognition functions, easily adaptable procedure narrative templates and ability to add surgical images directly into the operative notes, some applications also integrate with your business office's software. Surgical data can become bi-directional information when a software program automatically suggests CPT codes for the procedures described in dictation or connects with your inventory system to let it know that specific implants have been used in a procedure. Some software goes beyond the spell-check and, recognizing key words and phrases in a report, can automatically compile for surgeons a reminder list of follow-up tasks associated with the findings described.

Even with these innovations, however, telephone transcription services aren't going away anytime soon. Doctors are creatures of habit, and convenience means a lot to them. As easy and as user-friendly as transcription software has become, it still represents a transition, something new for the surgeon to learn, in comparison to picking up the phone at the dictation station, pushing a button and delivering the facts of the case, at which point the job is done.

Telephone transcription services do have their advantages if you stick with them for any amount of time. Some services assign particular physicians to specific transcriptionists, so they'll learn each physician's voice and style for improved speed and accuracy. Over time you should notice consistent results that come with familiarity.

Whether you opt for a telephone transcription service or computer software, you want a system that gets smarter over time, which means the person on the other end of the line gets to know your callers better or the software is able to offer new possibilities in what it can do for you.

Turnaround time
How fast will you receive the notes your surgeons have dictated? One advantage of outsourcing your transcription services is that you're largely guaranteed a consistent turnaround time. You don't have to worry about the possibility of an in-house transcriptionist's sick days or vacation time.

A 24-hour turnaround time used to be the gold standard, but electronic communication now means everything is much faster. Some speedy transcription turnarounds are built on the efficiency of global time zones: Off-shore staffers type up physicians' notes while we sleep. And with speech-recognition software, the transcription is practically complete in as long as it takes to dictate the notes.

The speed of transcription turnaround can play a role in the cost of a transcription company's service, and speed depends on what you need the transcript for. For coding and billing purposes, it behooves you to get OR notes as soon as possible to get your cash flow moving. Also, the notes are important to have in hand when a patient returns for a post-surgical follow-up, especially if that visit is with a physician who didn't perform the surgery.

When considering a transcription service or speech-recognition system that networks outside of your facility, be sure to inquire about HIPAA compliance. Can they ensure the security of your information? Are any of its transcriptionists working from home? Do those who receive and connect to your electronic records have secure systems? Once, the biggest concern about off-shore transcriptionists involved the economic impact on domestic employment, but now it seems data security has taken the foreground.

Cost of compilation
There's nothing wrong with getting transcription as fast as possible, unless you want to save money. But transcription isn't always the best place to do that. Keep these 2 truisms in mind:

• You never appreciate good transcription until you lose it: It's easy to take for granted.
• If you've found a service that does consistent work, it's worth paying more for peace of mind.

Unlike hiring a transcription service, an in-house dictation and transcription system involves significant costs:

• a computer workstation, ever-available and conveniently placed for the surgeons ($1,000 or more);
• speech-recognition software (from $600 for a standalone package to $1,600 for an EMR-integrated application);
• a high-quality computer microphone ($200);
• the cost of your IT consultant's assembly, installation and maintenance of the system; and
• your surgeons' patience while they "teach" the software to recognize their voices, accents and vocal mannerisms.

A lack of setup costs doesn't mean an outside service is cheaper, though. You'll be billed per character, per line, per minute, per report or per hour of transcription, which can be expensive, depending on how much your physicians have to say. It's possible for a single physician to rack up an average of $5,000 a month in transcription fees.

When exploring your transcription service options, compare:

• their rates (some off-shore services charge 5 or 6 cents a line, while some domestic services charge 10 or 12 cents a line);
• the method by which they charge (by the minute generally costs less than by the line);
• whether your physicians can create templates for standard procedures from which transcriptionists can work; and
• your ability to audit the service's monthly charges to ensure correct billing.

Information flow
While the options that involve live transcriptionists tend to be hands-off solutions — call in and someone will type up your remarks — the speech-recognition option may require some do-it-yourself reviewing and editing.

If your facility runs on paper charts, almost any system will do the job: A transcription service will send its results and a software program can print hard copies. But if the OR notes will be a part of an EMR, there are issues of delivery and compatibility. Can your service or software deliver the notes directly into the EMR system, in the format necessary for the records and your users, and send electronic and paper copies to every provider who wants them?

Integrated Document Solutions
(800) 500-8614
www.idssite.com
FYI: Includes multispecialty transcription services, template-based reporting, speech recognition, document scanning, bar-coded forms management and administrative reporting, says the company.
Pricing: Transcription is typically charged by the line, with special pricing available for template-based reports and speech-recognition services.

Nuance Communications
eScription Computer-Aided
Medical Transcription
(781) 565-4419
www.nuance.com/healthcare/products
FYI: Speech-recognition software turns clinician dictations into formatted draft documents, says the company. Integrates with electronic medical records.
Pricing: Arranged either as a capital investment or on a performance basis. Pricing varies according to deployment options, which include on-site systems, on-demand systems and full-life-cycle solutions that include management of the speech-recognition platform and transcription and editing services.

ProVation Medical, Part of Wolters Kluwer Health
ProVation MD
(612) 313-1500
www.provationmedical.com
FYI: Lets physicians document procedures at the point of care, says the company. Software produces complete, coding-ready and image-enhanced documentation. Interfaces with other IT systems and offers robust data reporting and analysis for quality reporting initiatives.
Pricing: $14,000 to $18,000 per room, depending on the software's case mix. Capital purchase, lease and subscription arrangements are all available.

Q.E.D. Transcription Service
(800) 630-4704
www.qedtrans.com
FYI: Places an emphasis on customer service, turnaround time and quality documentation, says the company. Can interface the services it offers with any patient management system or EMR, and does not use off-shore, third-party transcription services.
Pricing: Based on requested turnaround time, the difficulty of the work, the method of dictation retrieval and the requested document delivery method.

Scryptions International
(877) 272-7978
www.scryptions.com
FYI: Turnaround times are expedited through the use of a blend of domestic and off-shore work forces, says the company, which promotes its availability to assist in tackling transcription backlogs. Quality is verified on several levels by the company's quality assurance team. HL7 interfaces are available for importing documents into electronic medical records and inter-hospital information transfers.
Pricing: Not provided.

Steadfast Healthcare
Business Services
(951) 461-1603
www.steadfasthbs.com
FYI: Transcripts are accessible immediately upon completion, and online storage keeps documents and dictations secure and available 24/7 even in the event of power outages or disasters. Steadfast says it meets or exceeds the security requirements set forth by HIPAA.
Pricing: Typically ranges from 10 to 12 cents per line for general transcription and 12 to 14 cents per line for rush transcriptions.

Surgical Notes
(800) 459-5616
www.surgicalnotes.com
FYI: SNChart software lets you manage, edit and audit reports online and verify their creation, transcription and distribution in real-time, says the company. Integration with practice management systems means surgeons can be notified via e-mail or text message at 12, 24 or 36 hours after surgery if dictation hasn't yet been performed.
Pricing: SNChart bundled with VMR Express, a forms generator and document imaging solution, is available for a fixed $10 per chart.