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Fulfilling the requirements for Medicare compliance is a challenge for every healthcare organization. For a paper-based physical therapy practice, the challenge is accentuated by volumes of referral paperwork and documentation on patients' progress. Switching from handwritten reports and outsourced transcription to a voice recognition System helped us meet the challenge and save money in the process.

PROBLEM

Mid-Florida Physical Therapy is a large, 22-year old private practice located in Ocala, FL. We have six satellite offices and 17 providers, including eight physical therapists and assistants, and one occupational therapist and an assistant. On average, we see 545 patients per week and dictate 600 notes within the same timeframe.

Since the practice was established, we have outsourced our dictation to an external transcriptionist. This worked well in the beginning, but as the number of providers increased and our patient volume multiplied, the method proved costly, with monthly fees ranging from $2,500 to $3,000.

An additional ramification of our practice's expansion was that the transcription service slowed. Larger patient volume meant that reports might take from five to seven days to complete, and often up to 10 days total, from the time we initiated them to the time they were returned to our office.

This, of course, produced a subsequent slow down in billing, which only increased the lag time between service delivery and reimbursement. When the transcriptionist announced her retirement, we decided it was time for a change.

SOLUTION

In early 2000, we began our research to identify an alternative transcription solution. Our first idea was to use a telephone system for dictation and to hire a full-time transcriptionist. After evaluating six or seven different systems, we eliminated the idea of a new hire and narrowed the list down to two information technology products. One of those was a template-based point-and-click system, and the other was TalkNotes[R] from ProVox Technologies.

We used the template system on a trial basis for 30 days. One of our original goals was to afford our therapists greater freedom in using a dictation system to capture the detailed, yet free-form, notes they wanted to dictate. During the trial period, we determined that the presets in the template system were too uniform, forcing most of the dictation into "canned" format. Our therapists were unable to free-form dictate as they wished.

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SYRACUSE - The days when doctors and other medical professionals would use hand-written notes to record and convey information about patients' health are rapidly fading away.

Spectrum Software Solutions, Inc., through its SpectraMedi unit, is a fastgrowing Syracuse-based company that's taking advantage of the trend toward utilizing high-tech, medical-transcniption services.

Medical transcription involves converting medical records dictated by doctors and others into data that can be sent to a transcriber anywhere in the world, who then types it up. The material transcribed includes patient history and physical reports, clinic and office notes, operative reports, discharge summaries, letters, psychiatric evaluations, laboratory reports, X-ray results, pathology reports, and other medical records. These transcribed records are used for archives, reference, or for legal proof of medical advice.

Medical transcription has become more sophisticated over the years, graduating from the use of simple tape-recorders to various hand-held recorders such as the Pocket PC and the Olympus digital recorder, as well as advanced phone-in systems.

Frank and Ancy Kunnumpurath, natives of India, founded Spectrum Software Solutions in 1997 and the SpectraMedi division in 1999. By the end of its first year, SpectraMedi generated about $100,000 in sales. This year, SpectraMedi expects to reach $3 million in revenue and more than $100,000 in profit, which was last year's total.

"We've seen tremendous, exponential growth," says, Frank Kunnumpurath, coowner of the company, along with his wife.

SpectraMedi's customers include specialty medical practices, family doctors, and hospital departments. Central New York clients include: Internist Associates of CNY, CNY Family Care, Colon Rectal Associates of CNY, Family Medicine Services Group, Loretto Health & Rehabilitation CTR, Orthopedic Medical Service Group, the Onondaga County Health Department's Bureau of Disease Control, Oswego County Opportunities, and Vivian Teal Howard Health Center. But 95 percent of its customers are outside the Syracuse area, Kunnumpurath says.

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A group of health information organizations has urged state lawmakers and Congress to avoid regulatory action that could prohibit or limit outsourcing of medical transcription services to offshore companies. Demand for medical transcription and other health information processing services has grown significantly in recent years, but a critical shortage of skilled workers to handle the workload remains, the trade groups said. As such, some companies are sending work offshore.

The associations advocate increased investment in health information workforce development and adoption of communication technology and new technologies that advance critical healthcare outcomes.

"Legislation prohibiting or encumbering outsourcing would further exacerbate the shortage of health information workers and have a direct and immediate impact on patients and healthcare organizations," said Linda Kloss, executive vice president and CEO of the American Health Information Management Association (AHIMA), one of four groups that recently petitioned lawmakers. AHIMA and the other trade groups fear that such legislation might disrupt the flow of patient healthcare information and payment to healthcare providers. The California Health Information Association, the American Association for Medical Transcription and the Medical Transcription Indus try Alliance have joined AHIMA's efforts.

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