The Advisability of Mandatory Certification and Credentialing for Medical Transcriptionists
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There is a mandatory credentialing movement afoot which would
require all medical transcriptionists to become certified. To
be certain, mandatory healthcare credentialing is not without
precendent. Many health occupations require mandatory certification
and credentialing. There is certainly a rationale for mandatory
credentialing among medical transcriptionists given the sensitive
nature of the documents they work with on a daily basis. However,
it is not clear that a mandatory medical transcriptionist certification
requirement would result in an increase in the level of competency
of medical transcriptionists or an improvement in patient care.
Medical transcriptionists represent the front lines of the
health documentation process. In partnership with the dictating
physician, they are the final gatekeepers for the medical
record. And while the physician has final say and responsibility
over the content of the medical record document, in reality,
the medical transcriptionist is often the last person to participate
in the production and final modification of a patient record.
As a consequence, the influence of the medical transcriptionist
in the development of the patient health record, and the need
for competency, cannot be overstated.
The effective safeguarding of vital, confidential patient
information demands a rigorous training, oversight, and ideally
credentialing process for medical records documentation specialists.
AHDI (The Association for Healthcare Documentation Integrity),
serves as the primary gatekeeper for industry credentialing
for medical transcriptionists and medical language editors.
AHDI has aggressively promoted the CMT (Certified Medical
Transcriptionist) credential, augmenting the exam substantially
in recent years with significant foreign-physician dictation
and speech-recognition components. Additionally, recognizing
the need to attract new talent to a high growth industry,
AHDI has rolled out the RMT (Registered Medical Transcriptionist)
exam, which is targeted primarily to the entry level medical
transcriptionist.
Impact and Influence of the Medical Transcriptionist on the
Final Quality of the Patient Medical Record
How important is the medical transciptionist to the integrity
and accuracy of the patient medical record? Quite simply,
the medical transcriptionist is fundamental to the final patient
record outcome.
While every attempt is made to create a completely verbatim
medical transcript, the reality is that medical transcriptionists
are called upon to continuously render judgments with regards
to sometimes ambiguous or marginally intelligible dictation.
Not infrequently, a trained medical transcriptionist will
catch physician dictation errors, which must be corrected
and brought to the attention of the physician. Judgments are
made based on the context of the dictation. Where a medical
transcriptionist is unclear or where there is clear ambiguity,
the physician will be called upon to clarify. Protecting the
accuracy of the patient record along with the confidentiality
of that record are two of the most important objectives in
the medical records production process. However, a third and
not far distant objective is speed and efficiency. Successful
patient outcomes quite frequently and literally require extremely
rapid turnaround of patient documentation. As a consequence,
medical records departments are continuously managing the
tradeoffs between the pressure to meet turnarounds and the
need to maintain a high and uncompromised level of quality.
Expert quality control oversight systems are critical to simultaneously
achieving these frequently conflicting objectives.
Clearly, it is imperative that medical transcriptionists,
quality control specialists, and their managers and supervisors
be fully trained, competent and ideally, credentialed. The
profession requires an exacting level of knowledge and training
to protect the accuracy of patient records. Errors in the
medical records process, whether the fault of the dictating
physician or the medical transcription unit, are unacceptable
and highly risky. A 2004 medical records error analysis study
conducted by AHDI (then AAMT) concluded that 63% of the errors
discovered in the study were determined to be critical in
nature having the potential to negatively affect the
health and safety of the patient.
The Case for and Against a Medical Transcription Certification
and Credentialing Requirement
AHDI has long argued, and recently more emphatically, that
the medical transcription industry would be better served
with a fully credentialed staff of certified medical transcriptionists.
They insist that little would be lost and a great deal would
be gained with mandatory certification of medical transcriptionists.
While a credentialed staff would certainly bring a minimum
level of standardization and a demonstration of competency,
the call for a fully credentialed medical transcription workforce
is not without its problems.
For starters, the vast majority of active medical transcriptionists
are currently uncredentialed. Requiring these seasoned professionals
to take time from their careers to meet the certification
study, testing, and continuing education requirements would
not be costless, particularly from an efficiency standpoint.
Taking your highest volume producers out of the production
process for any period of time would have a measurable negative
influence on an industry already burdened by capacity constraints.
Additionally, there is the cost of credentialing and certification
and cost of periodically renewing the medical transcription
certification for tens of thousands of transcriptionists
which would not be inconsequential.
Of course, if a case could be made that the credentialing
process would reduce the medical record error rate attributable
to medical transcriptionists in a meaningful way, the costs
and tradeoffs of medical transcriptionist certification may
prove to have a good return. However, there has been little
evidence presented that would suggest if and to what extent
such a quality improvement would occur. It is an issue that
will almost certainly continue to be pressed and that merits
additional analysis.
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