CBay Systems USA is a Medical Transcription Company, based at Annapolis, Maryland, USA offering offshore Medical Transcription Services, specifically from India. CBay Systems (I) Pvt. Ltd is the Indian arm of CBay, managing the development of a production center base in India. You can visit https://www.cbayusa.com/ and https://www.cbayindia.com/ for more info on CBay.

Three pioneers - Raman Kumar, Skip Conover and Mahidhar Reddy, founded CBay. Mr Kumar has an MBA from Yale University and has been in international business for over a decade. Skip Conover, is the CEO of CBay Systems Ltd, and Mr Mahidhar Reddy, is the Managing Director, CBay Systems (India) Pvt. Ltd. CBay currently has about 60 people in the US and an equal number in India (employed by CBay Systems India). In India, CBay has 25 production centers that are independently owned and managed, and these centers have been trained by CBay and constitute its processing capability. In the US, CBay has 40 editors who edit all work going out of India. CBay has also located three of their senior editors in India at production centers in order to provide accelerated training.

CBay India has been encouraging to MT India's efforts in making the MT industry transparent in India. The following is based on excerpts from a detailed talk with Mr. Mahidhar Reddy at Bangalore.

CBay has shown an extreme fast growth over the last year. Yet many companies who made investments in developing their intangible assets (trained MTs) are finding it difficult to face aggressive new entrants. We asked Mr Mahidhar to share some wisdom from his experience, regarding development and retaining of human resources. "As in any human resource intensive industry, it is important that the production center treats its MTs as partners and not as employees," he asserted. Spelling out his mantra, he said that the only way to combat human resource attrition is by having:

	A high quality physical infrastructure - airy, well-lit office with a tidy and comfortable layout, good international brand PCs, plenty of reference books and training material.
	Clearly documented and articulated human resources policies on incentives, performance appraisal, holidays, compensatory leave etc.
	Wages that are on par with industry standards.

In order to establish itself and build up a sustainable company, a production center has to invest in building a management team that possesses excellent human resource management skills, and a process orientation that is geared toward continuously improving quality (practices such as TQM, Kaizen etc), Mr Mahidhar stressed.

We discussed in length the issues involved in attempting to run a business model without a dedicated infrastructure in the US. "For a production center to grow in India it needs a US partner. This is because offshore outsourcing is still far too new for US hospitals to be comfortable with; they have many reservations including ones of quality, patient record confidentiality and enforceability of cross-border contracts." he explained. He went on to add that an Indian production center needs to partner with a good US company that can fulfill the front-ending and more important, with the following attributes:

	US partner has a long-term vision and is not "get rich quick" oriented in their attitude to the production center i.e. the US partner should have a deep involvement in building up the production center's capabilities and helping it meet with global requirements on the quality front.
	US partner should have an editing base in the US and be prepared to provide editing support for a minimum of 6 months for each of its production centers so that the production center staff can move up the quality curve.
	US partner should invest in training the production center by deputing senior editors to India and conduct supplementary programs to augment Indian MT skills.

We shifted our focus to career prospects in MT. "What were the basic qualifications and skills desirable in a prospective MT? What are the growth prospects in this career?" we queried. "The career prospects for an MT are excellent. Like any knowledge-based profession, the key asset is the knowledge and skill that an MT acquires and he/she can build an excellent career based on this asset. In India, medical transcription is still in a nascent stage and as the industry grows, numerous career growth options will open up, both in technical stream (transcription), lateral streams (editing, training) and in management." he highlighted. "The wonderful thing about this career is that virtually any graduate with good English skills and a reasonable IQ can make the grade. Production centers, when selecting MT trainees, look for people with a good command of the English language and a keenness to learn. In terms of remuneration, the range is quite wide depending on the locale (city) and also the skill level of the MT." he added.

While on career, we touched on the plethora of 'training institutes' having mushroomed all over the country, all of them claiming to offer comprehensive training. Mr Reddy expressed his deep concern about institutes not being upto mark, and promoted by fly by night operators. He advised that when evaluating a training institute, the potential trainee should evaluate the institute by:

	Checking with alumni of the institute who have secured jobs about the course content and its adequacy.
	Checking the background of the promoters - do they have a long-term commitment, do they have good managerial backgrounds or are they shady entrepreneurs out for a quick buck?
	How many hours of transcription practice is offered as part of the course? At a minimum, it should offer about 35 hours per week x 16 weeks.
	The credentials of the faculty.

While discussing about unscrupulous characters, we discussed the issue of resort to unsolicited bulk mail for marketing, and its repercussions. "For most of these 'fly-by-nighters', bulk e-mail (spamming) seems to have emerged as a favorite tool for marketing. I can tell you that this is a very poor technique for generating leads, as most people view unsolicited mail as an intrusion and generally do not even read it, let alone respond to it. In fact, I can personally remember at least half a dozen instances where I was sent marketing mail that had viruses attached!" said Mr Reddy. In addition, he added that the appalling grammar and awkward expression of these e-mails instantly obliterate any chance that the sender may have had of convincing the recipients to give him business.

We reviewed the future of Medical transcription, in the outsourcing context, with continuous speech recognition and formatted electronic records coming in use. "The future of medical transcription is bright. We follow continuous voice recognition developments very closely and we believe that a viable voice rec system for medicine is at least 10 years away. At the current level, voice rec is still at an 'interesting toy' stage, but I have no doubt that it will reach a reasonable level of reliability in the next few years." asserted Mr Mahidhar. He went on to say "When it does becomes more effective, then it is not a threat to the medical transcription industry, but an opportunity. The transcription industry can use this tool to 'pre-process' the data and then edit the document in order to bring it up to acceptable quality standards.

Thus the MT's role changes - it moves away from typing to a more 'document completion and quality assurance' role. So, in other words, voice rec becomes an excellent productivity tool that can significantly enhance the output of the MT. The reason I say that voice rec is an opportunity rather than a threat is that while it impacts the productivity model positively, it may not change the business model. It's illogical for a hospital to install expensive voice rec systems and maintain them with an IT department, since a hospital's core competency is in treating patients and not in document preparation. So transcription would continue to be outsourced to transcription agencies that employ voice rec as a productivity tool. And given the vast volume of business, I do not see any threat of the employment figure diminishing."

We discussed the issue of defining some Industry standards regarding quality. "Virtually every company I have ever encountered claims to achieve 98%+ quality. And this from companies that have trained their MTs for just 2-3 months!" retorted Mr Mahidhar. "There is an AAMT standard, but this is more a recommendation than a standard. I believe that it would be good if we can define a universal standard, however, this is a task that should not be underestimated in its complexity. For example, we have to take into account the quality of the voice file (accent, speed of dictation) etc as these are also variables in the quality equation. Also there are issues like punctuation, which is to some degree subjective. Some of these subjective 'judgment call' issues have made the definition of a universally unambiguous standard quite a prickly issue."

We asked Mr Reddy for his perceptions whether the 'outsourcing to India' model would ever be a threat to MTs in US. "In an era of rapid globalization, we have to accept global competition as a 'given'. Whether it is cars from Japan, chips from Taiwan, garments from China, or software from the US, global competition is here to stay and countries have to develop specific skill clusters in order to compete with the rest of the world. Given the level at which outsourcing is growing (20%+) annually, I believe that there is enough business for all and eventually a 'steady-state' will emerge where all players are represented in the marketplace (as in the US car marketplace)." was his considered opinion.

On confidentiality issues over the internet, Mr Mahidhar stressed that Indian companies need to deal with patient confidentiality issues in a pre-emptive manner in order to quell any apprehensions on this issue. His advice is that they specifically need to:

	Design and enforce confidentiality compliance procedures and processes in the production center.
	Ensure that the hardware and networking set-up is secure and does not permit hacking or stealing of data.
	Have all personnel who have access to transcripts sign confidentiality and non-disclosure agreements.

"As long as these are enforced, I believe that data confidentiality will be maintained. On the Internet, as they say, 'geography is history' and proclaiming that data will be safe as long as it within the boundaries of a state is not a valid argument, as the Net knows no boundaries." he said.

We tried to gain an insight on CBay's vision. "Our goal is emerge as a front-runner in the medical transcription industry world-wide and we set up CBay specifically with this aim. We have been funded by angel investors in the US and also by venture capital companies." said the Managing Director. He visualized CBay to:

	Emerge as a leader in the transcription industry
	Build a seamless global company that brings together the capabilities of India and US and
	Provide great share-holder return and
	Build a lasting, loyal customer base.

And on this note, imbibing some cheer from CBay's mission and vision, we took our leave.


By our special editor
Domlur, Bangalore
26 April 2000