Better Clinical Documentation with Medical Transcription

Clinical DocumentationMedical transcription is the process of converting the dictations of healthcare professionals into a suitably formatted text record. It plays an important role in the medical documentation industry. However, with the advent of EHR or electronic health records, healthcare providers have the responsibility of filling up details in the patient’s EHR. This can cause a negative impact on the treatment provided and the way providers interact with their patients. Moreover, physicians may adopt short cut methods in order to save time. Improper or incomplete medical records demonstrate that the treatment was incomplete, reflect poor clinical care, leads to loss of reimbursement, and compromises on the safety of the patient. HIMSS EMR Adoption Model shows that 41.3% of healthcare providers have reached Stage 3 for the 3rd quarter of 2012. Only 7.3% have reached Stage 6 that includes structured templates and physician documentation.  Inappropriate documentation can also result in legal issues. To prevent such problems, it is better to employ medical transcriptionists who will add value to the clinical documentation workflow. Now, physicians can conveniently utilize EMR integrated medical transcription services.

Usefulness of Outsourced Medical Transcription

  • Enhances patient-physician interaction: By using medical transcription services, physicians can focus more on interacting with the patient. The physicians only have to dictate and the medical transcriptionist will listen carefully and transcribe accurately. Physicians will no longer have to concentrate on documenting the clinical notes and instead focus only on providing quality care to the patients.
  • Helps members of the patient care team: Medical transcriptionist can transcribe the physician’s notes quickly and make them available. This will help the healthcare staffs and other medical administrators to access, review and share the medical records without any delay. It also helps the physicians to understand and capture the information that is required in narrative form.
  • A more comfortable documentation option: Dictation and medical transcription easily fits into a physician’s workflow. It removes the burden of documenting medical records from physicians and enables them to focus on their core duties. A good transcriptionist provides insightful transcription that is accurate and reliable, which is most important to ensure appropriate care and follow-up for the patients.

A medical transcription company with a good track record in the industry offers several levels of quality control to make sure there are no errors or incorrect medical terms, ensures improved accuracy and cost-effective services. Sensitive to the varying requirements of different medical specialties, they also provide customized services.