A+Network Solves Transcription Problems for University of Pennsylvania Health System

By Gerard Carmody 

In early 2003, after a detailed search for a more responsive and cost effective transcription services vendor, University of Pennsylvania Health System selected A+Network from CBay Systems, Ltd.  The University of Pennsylvania Health System (UPHS) is composed of four hospitals and as many as 100 outpatient practices located in and around the city of Philadelphia.  CBay Systems, Ltd. (CBay) offered A+Network, an end-to-end transcription solution, which facilitated the health system’s needs while earning CBay a preferred vendor status for medical transcription services.  Eight major transcription issues at UPHS outpatient facilities and the corresponding A+Network solutions are enumerated below giving specifics from the UPHS Orthopedic Surgery Outpatient Center.   

1. Turnaround time.  UPHS outpatient facilities were experiencing inconsistent and quite lengthy turnaround times.  In some cases the length of time from submitting the dictation to the transcription vendor until the time the document was returned to UPHS was one to two weeks.

CBay Systems, Ltd.  has a large body of over 2,500 highly-trained and certified medical transcriptionists to facilitate the needs of its clients.  This large work force has reduced the turnaround time for UPHS Orthopedic center to within 24 hours, according to Frances Jennings, the orthopedic secretarial coordinator. UPHS calculates turnaround time from the time UPHS dictation is sent to A+Network to the time the transcribed report is available on-line to UPHS. 

2. Incorrect patient demographics.  Often patient names were misspelled or missing.  Medical record numbers and encounter dates were missing or incorrect. 

Arrendale Associates, Inc. (AAI), the technology partner of A+Network, wrote an HL7 inbound interface to receive patient demographic information from the IDX system used by UPHS.  This gives each transcriptionist access to the patient demographics and virtually eliminates misspellings, wrong medical record numbers and incorrect encounter dates. 

3. Voice Capture.  Some of the outpatient facilities at UPHS were using cassette tapes to capture dictation.  This was problematic in that tapes could easily be lost, and it was necessary to use a courier service to transport the tapes to and from the transcription vendor.  Other facilities were using a phone-in option for dictating, which many physicians disliked since it required manually entering long strings of numbers for each dictation.  

CBay offers a variety of voice capture options including telephone dictating using an 800 number.  The physicians at UPHS have opted for CBay’s hand held digital dictation solution.  This method of dictation employs the Olympus DS-330 Digital Voice Recorder (DVR).  The recorders are lightweight and compact, and can hold up to 5.0 hours of dictation.  At any time, a physician may dock the DVR in a USB cradle attached to an Internet PC, and upload the voice files via a secure link to CBay.  This process is fast and easy, and the physicians at UPHS clinics have found that it saves considerable time over dictating via telephone or tapes.  CBay provided DVRs to the 18 staff physicians in the orthopedic center.   

4. Reconciliation.  Many of the outpatient centers at UPHS were using a manual process for reconciling transcribed reports with dictation. Specifically, doctors used a printed patient schedule to check off each patient as he/she dictated.  Department secretaries then used the patient schedule to check off transcribed reports when they were returned from the vendor.

A+Network’s proprietary platform, TAeSeries®, developed by AAI, eliminated the problems with reconciliation.  TAeSeries® (TAe) maintains a permanent searchable database of each facility’s transcribed reports in the A+Network ASP Center.  The Orthopedic Surgery Department maintained its manual reconciliation along with TAe for a period of one month to determine if TAe would reliably deliver all dictated reports.  After one month, Orthopedic Surgery decided to drop the manual process of reconciliation altogether, having seen first hand that TAe will do all of this for them automatically.  During the change to CBay, TAeSeries® software was loaded on Orthopedic Surgery PCs, providing multiple options such as auto printing reports on specified printers, auto faxing, editing documents and E signature.  TAeSeries® is Internet-based, allowing remote access for authorized users. A popular feature of TAe provides the user complete tracking of a dictation from the time it is uploaded to the time it is delivered back to the client.  The UPHS Orthopedic Center utilizes both batch and remote printing features and plans to add auto faxing in the future.   

5. Storage and retrieval of transcribed reports.  Previous to CBay, some of the outpatient centers at UPHS did not keep an electronic file of the transcribed reports at all, and relied on the transcription vendor to supply reprints on an as-needed basis.  Other facilities maintained the transcribed reports on a networked hard drive, sorted by date.  This made finding a specific dictation somewhat time consuming and tedious.

The outpatient centers at UPHS no longer need to maintain storage of their transcribed reports.  The A+Network ASP Center provides a permanent searchable database of all transcribed reports.  This database makes retrieval of specific documents much faster and easier and eliminates the need to take up valuable storage space on the clients’ PCs.  During start-up with CBay, TAeSeries® user profile rights were configured for viewing, printing and faxing of transcriptions to UPHS security specifications.  Per Ms. Jennings, “With TAeSeries®, we use the view documents button and then search by patient name or job number (for report retrieval)”. 

6. Epic interface.  UPHS required that their transcription vendor be able to electronically upload transcribed dictations into their practice management/electronic patient record software (Epic), thus eliminating the need for a paper record.  UPHS physicians then electronically sign their dictations using the Epic software interface.  

AAI provided an HL7 outbound interface to Epic, which automatically uploads transcribed reports, routing each report to the specific physician’s in box for their perusal and E-signature.  Once E-signed, a report automatically routes to that patient’s electronic record.  Some of the Epic users want letters to print automatically on a network printer so that the physician does not need to print each letter him/herself.  TAe is able to facilitate this by incorporating letterhead into a template and routing letters both to Epic and to a printer at the same time.  “The templates have been a time saver,” reports Ms. Jennings.   

7. Cost.  Like all healthcare providers, UPHS needed to control costs.  Transcription represents a considerable expense for major healthcare providers.  As such, UPHS sought a transcription service, which could facilitate its technical needs and, at the same time, reduce the overall costs of transcription services.  

Because of A+Network’s technological advantage and its leading position in the medical transcription industry, CBay was able to offer a significant reduction in costs to UPHS.  According to Shelly Little, business administrator for the Orthopedic Surgery Clinics, “We chose CBay because of their competitive cost, the technology they were able to offer, and because UPHS had chosen CBay as a preferred transcription vendor.” 

8. HIPAA Compliance.  UPHS sought a HIPAA-enabled transcription solution, which provided security at every phase of the medical transcription process.  In addition to professional medical transcriptionists, the new vendor needed to have sophisticated technology to maintain the high level of security necessitated by HIPAA regulations.

The TAeSeries® technology of A+Network enables UPHS to comply with HIPAA regulations for security and privacy considerations.  HIPAA considerations include removal of all transcribed reports from the desktop after logging off of TAeSeries® and preventing unauthorized transcript viewing.  Further, TAe offers support for network, dialup and triple DES encrypted Internet connections.  Detailed transaction log audits, including dictating, transcribing, viewing, printing, faxing and quality assurance activity are included with the TAeSeries® software to UPHS.  In short, there is an audit trail for each and every dictation.  A+Network uses VPN (virtual private network) technology to further ensure data transmission security.  Finally, A+Network maintains dual redundant hardware systems for uninterrupted availability and data security.  CBay’s A+Network solution virtually eliminated concerns over privacy for the University of Pennsylvania Health System. 

Conclusion   

UPHS identified several transcription-related issues including turn around time, incorrect patient demographics, voice capture, reconciliation, storage and retrieval of transcribed reports, Epic interfacing, HIPAA compliance, and costs.  CBay Systems, Ltd. provided A+Network, a secure, Internet-based, end-to-end transcription solution that eliminated or improved each of the transcription-related issues, earning CBay a preferred vendor status at the University of Pennsylvania Health System.  In summary, Ms. Jennings from the Orthopedic center describes CBay’s services as “time-saving and technologically advanced”.  This success has led to additional A+Network users at UPHS. 

Donna DiMeo, office manager of Presbyterian’s Renal-Hypertension Division, is very involved in the similar transcription process of her division at UPHS.  Since early summer of 2003 when A+Network took over the renal division’s work, Ms. DiMeo uploads the dictation each day from the DVRs to CBay and 24 hours later, after reports are returned, she also makes occasional edits on-line.  Ms. DiMeo concludes, “Our office, which includes three physicians, is much more productive with A+Network.  It (CBay) has cut down on the turn around time.  The interfacing to Epic is smooth.  We are very happy with the A+Network program”.

Author Gerard Carmody, CBay Director of Implementation, IT, has 25 years in the medical transcription industry.