Ensuring Quality in Medical Transcription

Medical TranscriptionQuality is vital when it comes to medical transcription. If the transcribed documents are of poor quality, then they can affect document integrity (specialists or referring docs will find the documents difficult to understand), have negative financial consequences, and even put patients’ lives at risk.

In the context of medical transcription, ‘quality’ can be defined as explicit, unambiguous, consistent and complete health care data documentation from a clinician’s dictation. Of course, high quality audio recordings (clear voice/voices without much noise) are necessary for generating quality transcripts. However, a stringent quality assessment methodology can maintain quality throughout the transcription process so that the final document is at least 99% accurate.

A professional medical transcription company would have three types of quality checks in place:

  • First Level: In this level, the actual transcription is done by medical transcriptionists. After making the first draft, the transcriptionists will check the work twice – the first time using voice, and next, by reading the report for comprehensibility. The work is transferred to second level after these three steps.
  • Second Level: The documents prepared by the medical transcriptionist are checked at this level. Proofreaders check each file for integrity (both demographics and text/report) and ensure that there is no drop in quality. The transcriptionists are provided with solid feedback, which allows them to improve their work and avoid penalization.
  • Third Level: The third level of checking is carried out by medical editors. Mistakes which may go undetected at the other two levels are corrected at this level. A very rigorous quality check is performed and the proofreaders and transcriptionists are given daily feedback to help them avoid errors.

Constant audits are the other integral part of the quality assurance (QA) process. These audits help to ensure all the quality checking process is performed correctly and that client requirements are implemented. Advanced quality transcription software is employed for quality assessment at each level.

The Health Insurance Portability and Accountability Act (HIPAA) strictly restrict the public disclosure of a patient’s health care information. So in addition to quality, medical transcription companies have various measures in place to ensure transcript confidentiality. This includes the creation of the transcripts in a secure environment as well as safe modes of transfer such as FTP and encrypted browser-based file transfer.