• What is medical transcription?
• Just how does this work in India?
• What skills do I need to become a medical transcriptionist?
• How does one train to become a medical transcriptionist?
• What makes medical transcription an attractive career choice?
• Is medical transcription a good home-based business?
• What is India’s Advantage?
• What are the Industry trends / potential threats?

• What is medical transcription?

  Medical transcription is the process whereby one accurately and swiftly transcribes medical records dictated by doctors and other medical professionals. The material transcribed includes, amongst others, patient history and physical reports, clinic notes, office notes, operative reports, consultation notes, discharge summaries, letters, psychiatric evaluations, laboratory reports, x-ray reports and pathology reports and other similar kinds of medical records.

  Medical transcription may be carried out for any medical professional operating out of a small clinic or a large hospital. These transcribed records are used for purposes of archives, reference or for serving as a legal proof of medical advice.

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• Just how does this work in India?

  The typical process of Medical Transcription begins with receiving dictation by tape, digital system or voice data file. Conventionally, recorded advice was sent through physical means (i.e. a magnetic media). However, there is steady emergence of a new practice. Using a toll free telephone line, doctors can call up a designated number and dictate the message, which is converted and recorded into a dedicated server on a real time basis. This helps to save shipping costs and improves productivity manifold.

  The parent US transcription company connects to this server through a high speed data link (preferably Internet or ISDN link of 128 kbps or above) and downloads any fresh dictation left by customer organizations / doctors. The digitalized data is then compressed and encrypted, for onward transmission via satellite link to India. The local transcription company can then start to immediately retrieve the sound files, uncompress the data and route them to different workstations for transcription. Using earphones and a foot pedal for start-stop control, transcriptionists are able to hear and control the speed of audio messages.

  
  These messages can be transcribed with the help of a suitable word processing program / application. A variety of word processing programs may be used as different forms of transcription / messages may require specific features. An outsourced or outlocated medical transcription centre then sends back these transcribed messages to the hub of medical transcription network from where it is routed to the concerned doctor / hospital. Most of the word processing programs used in the medical transcription process typically are accompanied by libraries / dictionaries of medical terminology.

  These libraries may also be categorized based on various disciplines. Several dictionaries are necessary: Medical definitions, medications, medical terms by specialty, laboratory terms, surgical terms and abbreviations. Specialized word lists are also helpful, and journals and computer networking are helpful for current information about new medications and terms. Transcription is done more efficiently with the use of a medical spellchecker and an abbreviation system such as Instant Text or Smartype, etc.

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• What skills do I need to become a medical transcriptionist?

  A Medical Transcriptionist is often also called a "Medical Language Specialist." A Medical Transcriptionist or "MT" is a person who assists physicians and specialty surgeons usually by transcribing, formatting, and proofreading their dictated medically oriented reports. Most commonly, MTs transcribe physicians' dictation that outlines a patient's health. It requires good listening and language skills, computer skills and knowledge of medical terms.

  Medical Transcription business is classified as an IT enabled service in India. In other words, it does not require specialized IT or software development skills. However, an ideal qualification to look for in a medical transcriptionist is graduation with above average listening and English comprehension skills. Further, the candidates should be able to quickly develop new skills and adjust to differing accents and diction. Keyboarding and transcription should not be confused. The primary skills necessary for performance of quality medical transcription are extensive medical knowledge and understanding, sound judgment, deductive reasoning, and the ability to detect medical inconsistencies in dictation.

  A medical language specialist must be aware of standards and requirements that apply to the medical record, as well as the legal significance of medical transcripts. You must be able to work for long hours, often in a high-pressure environment. A high level of concentration for extended periods of time is also required.

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• How does one train to become a medical transcriptionist?

  If you are an intelligent person you may be able to learn on your own all the medical knowledge required to become an MT. Medical transcription requires a practical knowledge of medical terminology, anatomy, physiology, disease processes, and the internal organization of medical reports. Medical reports take many forms, including histories and physical examinations, progress reports, emergency room notes, consultations, operative reports, discharge summaries, clinic notes, referral letters, radiology reports, pathology reports, and an array of documentation spanning over various medical specialties. Thus, the medical transcriptionist, or medical language specialist, must be well versed in the language of medicine and surgery. In order to be sure that you are educating yourself in the proper areas, it is probably best to at least take a formal course in medical transcription.

  However, the recognized professional designation of "certified medical transcriptionist" (CMT) can be obtained only through successful completion of both parts of the core certification exam administered by the Medical Transcriptionist Certification Program (MTCP) at AAMT. This job requires a broad background in medical language and science, and experience, and the only way to get that is to take a reputable course and then work in a supervised position for a few years.

  Services and institutions are literally desperate to find qualified MTs. To overcome this shortfall, companies such Desiny Infotek Ltd. have developed their own in-house training programs for training their MTs, supervisors and editors in India. The course is spread over five months and includes English grammar, medical terminology and human anatomy, special emphasis on American spoken and written English and hands-on transcription of medical dictation.

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• What makes medical transcription an attractive career choice?

  Medical transcription provides unlimited intellectual challenge and the opportunity to make a unique contribution to quality patient care and service. Health care is a rapidly growing field, and the demand for quality documentation is increasing. The profession provides a high level of job security, and skilled medical language specialists may receive a premium for their services. Because their services are in demand, transcriptionists are often able to arrange convenient and flexible work schedules. Medical transcription is a portable skill that allows for professional and geographic mobility.

  Age restrictions are seldom found, with great value being placed on the experience and knowledge of the mature transcriptionist. Medical transcription can be a lifelong, satisfying career, providing the constant challenge of an expanding and advancing technology. The changes occurring in the healthcare industry promise to provide even more challenges to the forward-looking medical language specialist.

  Medical Transcription is a high-paying career in one of the most stable but always growing industries - health care. We estimate that there is a total of over 67 billion lines of transcription done annually, in the US. The industry lends itself to telecommunications, both in the US and internationally. While most transcription related to patients seen in the United States continues to be done within its boundaries, much of it is done across state lines and an increasing amount is done offshore (e.g., in India, the Philippines, Ireland, Bermuda) through telecommunication systems, including the Internet.

  The U.S. Department of Labor says there will be a 51% increase in MTs (Medical Transcriptionists) needed by the year 2000. This means that demand will exceed the supply. This forecast applies to most developed countries, including those with Government health systems such as Canada, Great Britain or Australia. They have similar needs and therefore opportunities. The medical industry is virtually recession-proof. If you become proficient at medical transcription, you will probably always have work. If you are good at it, you can certainly make a decent living. At an average, a newbie MT transcribing about 250 lines per day accurately, in an eight-hour shift earns about Rs 4, 000 per month.

  A dedicated, hardworking and experienced medical transcriptionist can certainly earn upwards of Rs 15, 000 per month, depending on how many lines one transcribes accurately per day. Your income is directly proportionate to your effort: MTs are paid on a production basis - by the line, by the word, by the page, etc. Also, making it a home-based business can be very personally rewarding. Tax incentives for a home-based business, home-office, or small-business which is an100% EOU, can be quite good. Once you have the skill and the equipment, you are only limited by how many clients you can service. With more experience, qualified medical transcriptionists who wish to expand their professional responsibilities may choose to become department heads, supervisors, managers, or owners of medical transcription services. Experienced medical language specialists may become teachers, working in schools and colleges and educating future medical transcriptionists.

  
  Services and institutions are literally desperate to find qualified MTs. To overcome this shortfall, companies such Desiny Infotek Ltd. have developed their own in-house training programs for training their MTs, supervisors and editors in India. The course is spread over five months and includes English grammar, medical terminology and human anatomy, special emphasis on American spoken and written English and hands-on transcription of medical dictation.

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• Is medical transcription a good home-based business?

  Many popular publications sing the praises of medical transcription as a home business, citing the potential for high income with little investment. Courses in medical transcription are proliferating, some offering quick fixes for students interested in becoming business owners. Failure to make the investment in quality education can result not only in business failure but also in shoddy documentation for the real client, the patient.

  
  Most often rumors circulating about how much money is involved seem to be the driving force behind the desire to be an independent MT contractor. Experienced MTs are lured by the enhanced paycheck(s) every month, compared to someone working "in-house," but this is fallacy. If you are working with a MT service provider, in addition to workspace, equipment, and supplies, your employer is contributing to your salary in the form of perks and benefits. For most independents there is no sick or vacation time; or medical benefits, insurance or provident fund schemes. Also most employers invest in continued education and training, while providing for perks like conveyance, catering services and terminal benefits.

  
  Performing medical transcription as a home-based business is not a "get rich quick scheme." If you are an enlightened person, you know there is really no way to get rich without a lot of hard work. Medical transcription is hard work but can be very rewarding both financially and personally. Make no mistake however, if you think that having your own business is a way to sit back and let the money roll in, you could not be farther from the truth. The transcriptionist working from home must make a significant investment in equipment and reference material and be willing to make frequent updates to both equipment and library in order to keep up with rapidly changing technology and terminology.

  Careful planning and the advice of legal and financial experts are essential to the success of a home-based business. If you are not willing to make personal sacrifices and work smart and / or hard, you are not the kind of person to have your own business. A significant factor is that small projects are not suitable for offshore outsourcing. This is because of the greater time involved in the initial communication, projects specifications and other set up offsets the savings. Hence you have to have a business size over the ‘‘ critical mass.’’

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• What is India’s Advantage?

  MT Services are a strategic and imperative fit for India as it offers immense jobs opportunities and ability to earn foreign exchange. A majority of the State Governments in India are offering incentives and infrastructure for setting up these services. Central Government has provided Income Tax exemption to profits from export of these services.

  Vocational colleges have started teaching the skills for these services. Moreover, setting up of these services is not capital intensive and is entrepreneur driven. India has emerged as the preferred Global Destination and the hub of MT Services. Amongst others, it offers cost and quality advantages plus much more:

  • A virtual 12-hour time zone difference between India and USA offers cost and time savings.
  • A huge pool of English speaking and computer literate graduate workforce who can continue to cater to the growing demand of professionals for MT Services.
  • With more than 115 ISO 9000 certified and four SEI Level 5 Software Companies, India offers the ultimate quality advantage with relatively less costs.
  • India enjoys very strong brand equity in major markets, thanks to its growing and globally competitive software industry.
  • A special thrust has been given by Department of Telecommunications, Government of India with reduction in prices of High Speed Datacom lease circuits.
  • Thrust by Government of India by providing Income Tax exemption to profits from exports of MT Services.
  • Central and State Governments as well as private sector are setting up state-of-the-art infrastructure for MT Services including IT Habitats

Nasscom has constituted a Vision Group for IT Enabled Services (MT is classified as an IT Enabled service in India). This is a special forum mandated with the task of identifying opportunity segments in the areas of IT Enabled Services. This Nasscom group would also devise segment specific strategies for market development, encouraging entrepreneurship and positioning India as a global hub for IT Enabled Services.

The following table amply projects present status and potential of employment and earnings opportunities From MT Services -

Nasscom is following a two pronged strategy for India’s success in I.T. Enabled Services. The first part involves continuous lobby with Government of India for removing procedural and other bottlenecks. Some of the demands include: income tax exemption; single window clearance at Department of Telecommunication; global telecom infrastructure in India; lowering of tariff and more availability of venture capital and marketing funds. In this regard, Nasscom’s lobby was very successful to get income tax exemption to profits derived from most of the I.T. Enabled Services under Section 80 HHE of the Income Tax Act.

The second strategy involves awareness, marketing as well as catalysing quality training of workforce. This is being done by organizing meaningful conferences and workshops and publishing useful publications for enthusiastic entrepreneurs. Nasscom has already mounted a campaign for marketing India’s advantage in this sector. The slogan at Nasscom is `Move Work to India.

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• What are the Industry trends / potential threats?

  One of the biggest fallout of our success in the software industry has been the creation of another huge opportunity i.e. IT enabled services. Though somewhat unheralded, the emergence of this industry is only logical. Our success in software export was based on simple value proposition, "World class services at a less than world-class price".

  Clearly, this value proposition applies beyond software, to a variety of back office functions such as medical transcription, call centres, legal databases and insurance claims processing. The same competitive pressures that are leading companies to outsource software development are in operation here. Perhaps even more so as many of these functions, is even lesser core to the company. This market is estimated to be over a whopping-trillion dollar in the next few years.

  The good news is that in these areas, manpower is far more abundant than software. And this manpower is available not just in the metros. Most of the infrastructure bottlenecks, that such an industry would have faced five years ago, have already been cleaned up as a result of the focus on software exports. The international recognition that we have received in software is going to make it far easier for companies to sell the concept of outsourcing IT enabled services to India from overseas.

  There is a very strong opportunity in medical transcription services. However, the last few years have witnessed consolidation in this industry. This is due to increasing maturity and decreasing differentiation between service providers. However, vendors may attempt to providers value differentiation by developing special features within constant cost bracket.
  Industry also perceives intelligent voice recognition software as a potential concern.

  However, in spite of the advances in this technology, it has been difficult for the computer to grasp and analyze the human voice and the English language with all its diversity. There will continue to be a need for skilled medical language specialists who expand their education and have the knowledge to identify and edit the inevitable errors created by speech recognition systems, and who have enough understanding of the health record to create an accurate final document. Medical transcriptionists will remain the best qualified to discern the nuances of human speech-indeed, the ultimate speech processors.

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