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.

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.

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.

If you are an intelligent person you may be able to learn on your own all the medical knowledge required to become an MT. For an experienced word processor, it is possible to learn medical transcription while working in an entry-level position, but it is rare because of the need to learn medical vocabulary and formats.

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.

A number of vocational programs also include an internship at a local hospital or similar facility, which is a real plus. A good MT course will probably be taught and/or administered by a MT or at least someone with a medical background. In most countries, medical transcriptionists are not required to be certified to prove proficiency. Many community colleges offer full-time day or part-time evening programs in medical transcription. There are many correspondence courses available in medical transcription, so you can learn at your own speed, in your own home, and at a time convenient for you.

Courses offered through training establishments or other in-class learning institutions may range anywhere from Rs 20,000 to Rs 30,000, in India and $2,000 to $3,000 in the US. This is the most expensive method of learning to be a medical transcriptionist, though educational bank loans and guaranteed placements are offered by most institutions. Correspondence or online courses are usually less expensive than in-class courses:

• Meditech, Inc., Personal Edge Course, https://www.meditec.com, 1572 South      400 East, Kaysville, UT 84037, 801, 451-9858.
• At-Home Professions, home study course, 2001 Lowe Street, Fort Collins, CO  80525. 1-800-333-2846, Fax 1-970-223-1678. https://www.at-homeprofessions.com/. Includes audio cassettes, lessons, text  materials and flashcards.
• The SUM program, https://www.hpisum.com/frameset.html, from HPI, Health Professions Institute, Box 801, Modesto, CA 95353, 209, 551-2112.
• Review of Systems, https://www.mtmonthly.com, Jennifer Martin, 809 Regency Drive, Kearney, MO 64060. 800-951-5559 or 816-628-3013. FAX: 816-628-3661.
• At Home Medical Transcription, https://www.breboco.com/medical.htm, P.O. Box 387, Yorktown, IN 47396, 800-484-1689, PIN 1851.
• CAI Transcription, Cheryl Izzo, https://www.caihometype.com
• Stedman's MT Computerized Tutorial Program, https://www.stedmans.com/s5.cfm,  800, 527-5597, Fax 800-447-8438, Lippincott Williams & Wilkins, 227 East Washington Square, Philadelphia, PA 19106, 215-238-4200

You are urged to check out all different kinds of programs before you purchase any of them. Be wary of any institutions promising job placement and try to confirm how they place you in a job, how many new MTs they have placed and where they have been placed. If it suggests potential income, a reference source for the amount should be cited. If it refers to certification, it should clearly state that a certificate would be granted upon completion of the educational course.

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 CBay Systems, HealthScribe and Heartland have developed their own in-house training programs for training their MTs, supervisors and editors in India. ASoft India Pvt. Ltd has launched Meditech's Personal Edge Medical Transcription Training Program 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. At the end of the course, students will take an online examination administered by Meditech, USA, who will directly award certificates to successful candidates.

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 500 lines per day accurately, in an eight-hour shift earns about Rs 8, 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.

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.’’

It is suggested that entrepreneurs should start a venture for medical transcription with in-hand contract that lasts for a period of 1-2 years. This would help to justify investments made in high cost infrastructure and capacity, an essential for this business. In an otherwise case, entrepreneurs may expect to have idle capacities for upto one year.
The main components for setting up a Medical Transcription unit include:

• Premises (Office Space), ergonomic furniture and adequate lighting and ventilation / air-conditioning. and power backup.
• Servers with Networking
• Computers with audio capabilities (sound card and headphones) and foot-pedals.
• Specialized software
• Medical Transcription Programs
• Telecom connectivity (ISDN / Leased Line)

Like any other IT Enabled Services business, it is important to have a certain critical mass in terms of capacity to be able to generate volumes transactions. Research has shown that a given capacity of about 50 computers / transcriptionists is the minimal requirement. This would translate to a total capacity of 150 people working in a total of three shifts of eight hours each.
In order to establish capacity for 50 people, there would be investment needed of the order of Rs. 45 - 50 lakhs.

Further manpower costs (for 150 people) would add about Rs. 1.2 - 1.5 crore to the total costs. In other words, an entrepreneur would need to have available funding of approximately Rs. 1.5 - 1.75 crore to cover asset building and recurring expenses for first year of unhindered operation for about 150 people. Further, with the above capacity, there would be a working capital requirement of at least Rs. 20 lakhs.
Cost structure a typical Medical Transcription company is normally found to be as below:

Profits in this business are reasonable; they can be much higher or lower than indicated above.

Medical transcription business by its very nature involves transcribing medical advice of various types. Therefore, its user base is in a variety of healthcare settings, including doctors’ offices, public and private hospitals, teaching hospitals, medical transcription services, clinics, laboratories, radiology and pathology departments, insurance companies, medical libraries, government medical facilities, rehabilitation centers, legal offices, research centers, veterinary medical facilities, and associations representing the healthcare industry.

Medical language specialists work with physicians and surgeons in multiple specialties. They work with pharmacists, therapists, technicians, nurses, dieticians, social workers, psychologists, and other medical personnel. All of these healthcare providers rely on information that is received, documented, and disseminated by the medical language specialist.

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Why does the client outsource when he can hire someone to do it internally?

The following is a quote from Bill Gates from an April 1999 issue of Time.

"As a business manager, you need to take a hard look at your core competencies. Revisit the areas of your company that aren't directly involved in those competencies, and consider whether Web technologies can enable you to spin off those tasks. Let another company take over the management responsibilities for that work, and use modern communication technology to work closely with the people - now partners instead of employees are doing the work. In the Web work style, employees can push the freedom the Web provides to its limits."

This next quote is from Inc. magazine January 1999.

In their book Unleashing the Killer App: Digital Strategies for Market Dominance (Harvard Business Press), Mui and co-author Larry Downes urge companies to perform internally only those activities that can’t be performed more cheaply in the open marketplace. When the marketplace in question is the Internet, where vendors with only "dot com" over their head can operate at very low costs, the savings from pushing out business tasks is considerable.

The typical benefits to clients who outsource:

Economic Benefits:

• Production-based compensation
• Minimization of employee expenses (benefits, payroll taxes, space requirements, sick time and down time, overtime, temp service).
• Re-utilization of employees
• Elimination of recruitment and training

Efficiency Benefits:

• Improved report turnaround time
• Centralization of work flow
• On-demand, on-line access to "status reports"
• 24-hour a day access to report retrieval
• No lost dictation

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• Managing Director / Chief Executive Officer
• Manager-Project
• Manager-Administration & Personnel
• Transcriptionists
• Supervisors and Editors
• Quality Assurance Specialists
• System / Database Administrator
• Accounts / Administrative assistant
• Secretary / Receptionist
• Store keeper / Office Boys
• Security personnel

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