AHDI Lounge

Today I came across a thread in an online MT forum that was...interesting...to say the least. I quote it verbatim here, with the name of the MT service deleted:

"I've been sending out resumes, and taking tests that must end up in cyberspace, even though I pass them, hear nothing. Then I hear from *******, passed the test, no problem. The recruiter calls me, and her dictation is awful, and her command of the English language equally as poor. I thanked her, and said I'd think about it. However, that first impression left me less than luke warm. The recruiter above all people in the company should excel in communication skills, and be an MT. She was friendly and nice, but atriculate, ah no. I say to *******, get a recruiter that has command of the English language, you want your MTs, Editors to have it, why should your recruiter be exempt from that skill set? (your buzz words)"

I must admit that things like this make me wonder about the future of the MT profession. There are so many problems here, I don't know where to begin. First of all, is it really standard practice for MT recruiters to not respond to those who are applying for jobs? Even if the applicant bombed the test, common courtesy would be to at least thank them for the effort, wouldn't you think? Secondly, it would be a shame if this really is an accurate portrayal of the way this particular MT recruiter presents herself. Certainly you want your recruiter, the face of your company to prospective employees, to be professional and well-spoken, and to have a good grasp of the MT industry. Does that mean they MUST be MTs? Not sure about that, what do you think?

But if the (supposed) actions on the part of the MT recruiter are troubling, the individual posting this information has some issues as well. It's a tad ironic for someone so concerned about communication skills to criticize someone for not being "atriculate" and having poor "dictation." And as anyone knows who has participated in online MT forums for any length of time, this scenario is all too common.

I realize this incident is just one little pixel in a very large photo, but am I the only one who occasionally feels "less than luke warm" about the future of our beloved profession?

UPDATE

This blog post has generated a number of comments on Facebook and elsewhere, including some mild and not-so-mild criticism to the effect that I "slammed" the MT who used grammatically incorrect language to criticize the communication skills of a recruiter for a large MTSO. It was not my intention to attack any individual, and I sincerely apologize for coming across that way. I also realize that the headline I chose for my post was rather sensational, and I apologize if anyone was offended in that regard. I do NOT believe the MT profession is doomed, but I freely admit that--as I tried somewhat unsuccessfully to say in my post--there are times when I become frustrated by the roadblocks that we ourselves in the industry throw in our own path sometimes. It's not as if there aren't enough external forces working against us! But again, I do not mean to come across as mean-spirited or to attack any individual or company.

One final note. I think it's important for AHDI members and nonmembers, supporters, critics and disinterested bystanders alike to understand that the organization is not a Borg collective or a bunch of Stepford wives (or husbands, as the case may be). Within our ranks are differing opinions, experiences and points of view. More to the point, the AHDI Lounge is a place where--I hope--honest dialogue and lively discussion can take place, and where a variety of viewpoints can be aired in an environment of respect and civility. The opinions I and others express here are our own, and do not reflect an official AHDI "party line," whatever that might look like. Having said that, my intention is never to offend or treat any individual, company or organization with disrespect, and I certainly apologize if anything I've said comes across that way.

Jay Vance, CMT
Lounge Administrator/Moderator

From the Nashville Post:

Nuance Communications Tuesday filed an objection to Spheris’ bankruptcy proceedings, arguing its proposed buyers MedQuist and CBay are being given a leg up on the competition.

Massachusetts-based Nuance said in its limited objection, available here, that parts of the bidding process for Spheris’ assets put “stalking horse bidders” MedQuist and CBay at an unfair advantage, “thereby chilling bidding and preventing a competitive and robust auction" for Spheris' assets. It’s asking the court to modify aspects of the bidding procedures.

From Modern Healthcare

Part two of a two-part series.

The use of scribes to help physicians document patient encounters has become common, if not widespread, in hospital emergency rooms, but independent, primary-care physicians in Arkansas are conducting a second round of trials using scribes along with electronic health records and a comprehensive overhaul of their practice organization to determine whether productivity gains experienced in the first round of tests can be reproduced.

Randall Oates is a family physician who founded an EHR-system development company, Soapware, Fayetteville, Ark., with software products designed for office-based physicians.

Oates said the combination of scribes, EHRs and practice redesign, could provide the saving grace for economically threatened primary-care physicians.


‘Fundamental change'

The current approach to EHR implementation, in which the physician is supposed to document the encounter on a computer, is, Oates said, “complete insanity, turning doctors into data-entry clerks. We're going to look back on these days the way we look back on bloodletting with leeches."

Instead, what's needed is a way to revolutionize healthcare, Oates said. “There's no choice. You look at reimbursement and primary care and it's going to be dead if there is not a fundamental change and the fundamental change is to become good businesses.”

Oates said a handful of physicians at two sites in his former group practice based in Fayetteville have completed the first round of testing of a practice overhaul regime using an EHR as a core tool with physicians leveraging their EHRs by using scribes. Oates said the group is in its second round of testing whether the process can be reproduced. Results are expected by summer, he said, but so far, the early returns are impressive.

“My ex-partners have twice the income of an average family practitioner,” Oates said. “The bottom line, and I'll make it real simple, the family practitioner only has to see one extra patient every three hours to cover the cost of the remote scribe and the technology.”

Physicians using the system have one computer in the exam room with the patient and another computer in a room set aside for the scribe, who listens in via a microphone in the exam room and documents the encounter.

“Both the scribe and the physician have to be able to control the desktop,” Oates said. “The scribe is creating the documentation, but most of the documentation is already collected before the doctor ever gets in the exam room. If the patient is in for hypertension, the scribe will know to automatically pull up the vital signs in a view. The doctor should not have to do that navigation. The doctor should be able to be empowered to do the high-touch patient care."

The system radically accelerates patient throughput, according to Oates.

“They're scheduling eight an hour with very high patient satisfaction, structured data entry and the note is completed at the end of the encounter,” Oates said.

Oates said the first scribe used in the experiment was a computer “geek” with no medical background, “but we needed a geek to help us make this technology work,” he said. After that, the practice trained “a highly intelligent former waitress” and “three burned-out medical transcriptionists.” Oates predicted there is “a whole community of unemployed medical transcriptionists that I think will jump on this.”

Todd Guenzburger is a hospitalist and medical director of information services at the five-hospital Legacy Health System in Portland, Ore.

In all, 38 physicians, maybe 30% of all physicians in the medical group working in the emergency departments at the five-hospital system, use scribes, Guenzburger said. The program began with scribes using the templated, paper-based, T-System, for charge capture and has been moving to an EHR over the past five years, he said.

At the one paperless hospital in the system, 139-bed Legacy Salmon Creek Hospital, Vancouver, Wash., scribes and ER physicians have been charting with the electronic version of the T-System, but entering orders with the hospital's Cerner EHR, Guenzburger said. “I think the success of the scribe program depends on the quality of the individual and the training,” Guenzburger said. “A lot of the scribes enter on into medical school. The training and experience has helped them.”

Physicians who do use scribes, “use them a lot and have favorite scribes,” Guenzburger said.

Going forward, as Legacy implements a new EHR systemwide, it remains to be seen whether any more physicians will be using scribes, since the system is trying to customize and improve the new vendor's emergency department module, Guenzburger said.

“We have about eight to 10 docs working on that to make it more robust,” Guenzburger said. “I think the people who are using scribes will continue using the scribes. I think scribes have their place. We definitely would not let them do order entry. It completely defeats the purpose of physician order entry, to my frame of mind, and it is beyond their professional scope. The whole point to me of computer order entry, if you're going to buy the argument that it is a safer way to provide care, is you get rid of the middle man and you increase the efficiency by making sure it gets done right the first time.”

Guenzburger, a primary-care physician by training, said, in his view, only the higher-paying, office-based specialties can afford to use scribes. Meanwhile, “It's just a little irritating to me that the little GP really can't afford to get a scribe” and keep a normal pace in which both the patient and the physician benefits.

“I couldn't imagine a worse thing to happen to primary care than doubling your practice from 30 patients a day, which I already think is too much,” Guenzburger said.

“It is everything about destroying the primary-care relationship when everything is about productivity,” he said. “People want that relationship,” he said, but “there is no place for the doc and the patient to have a relationship. That's why I left primary care. I didn't have the patience to try to change that and it probably won't change anytime in my professional career.”


Rethinking physician roles

Lyle Berkowitz is a physician informaticist who has written extensively on the need for an improved interface between computers and physicians. He uses an EHR in his outpatient internal medicine practice in Chicago. Berkowitz said he has never used a scribe, but in doing personal research on high-performance “superpractices,” he has run across several examples of physicians who do.

Berkowitz said he doesn't view scribes as an interim measure, but “as part of the evolution to get to the better solution.”

“A scribe is the ultimate of artificial intelligence,” he said.

From ModernHealthcare.com

Part one of a two-part series.

Scribes.

The word might conjure up images of ancient, white-bearded men, bent over papyrus scrolls, scratching away with quill pens.

And the profession has to be older than Methuselah, since what we know of Noah's 969-year-old grandfather was written down by succeeding generations of scribes.

Today, however, organizations seeking to implement the latest wrinkle in medical record-keeping, electronic health-record systems, are looking to new generations of scribes—to increase physician productivity and to overcome the pitfalls of the still typically clunky physician/EHR interface, and to ease the strain of EHR implementations and replacements.

“The word is biblical,” said Linda Pierog, practice manager for Emergency Medicine Services of Orange County, or EMSOC, and its ScribeMD service, which provides scribes as part of its emergency room physician staffing program.

“Transcriptionists came out of this whole thing, too—somebody who either takes the written word or the spoken word and puts it on paper,” Pierog said. In contrast, scribes do more than transcriptionists by assisting physicians in fully documenting a patient encounter, most recently, entering encounter data in an EHR.

Emergency rooms have given scribes a toehold in modern healthcare record-keeping operations because, unlike in some other medical specialties, ER records are created concurrent with patient care, said Pierog, who holds both an MBA and a master's degree in nursing.

Today the group in Orange, Calif. has 50 scribes working on 13 physician shifts a day, Pierog said. And the group is just beginning to branch out beyond the ER to provide scribe services to a hospital-based cardiology group and is in discussions with several primary-care offices, she said.

Scribe candidates are college graduates, many of whom are multilingual and “highly motivated,” Pierog said. Typically, the person she is looking for to join her staff is “someone who has an intense interest in medicine and is looking to go on to something else,” quite often medical school.

“It's not hard to find scribes,” she said. “The program has a 300-person waiting list.”

Pierog said she still enjoys working at least one shift a week as a scribe, as she has since EMSOC started its program in 2004.

“I like patient care,” Pierog said. “I think all the scribes feel they are all part of the patient care experience.”

Michael Murphy is a physician and former U.S. Army Ranger who in 2003 co-founded and is now CEO of ScribeAmerica, Lancaster, Calif., which provides both scribe consulting services and turnkey operations, taking over the training and staffing of hospital-based scribe programs.

About half their hires are students in pre-med, pre-nursing or physician-assistant or nurse-practitioner programs who go on to those professions after gaining invaluable, on-the-job educational experience working as scribes, Murphy said.

“We had a person at UCLA this year, in medical school, who knew so much, knew the tests to order, knew the differential diagnoses, they actually suspected her of cheating, because she knew way too much,” Murphy said. “It's now generally regarded as being the best pre-med job.”

Another 30% of ScribeAmerica hires are what Murphy described as “horizontal secretaries gone vertical. We have those people in the doctors' offices who were sitting down in chairs and they're walking around now.” The remaining 20% of scribes come from various walks of life, he said.

The scribe business is booming, according to Murphy, with his firm providing more than 500 scribes to support 36 healthcare organizations under contract. The company has eight teams ready to travel to set up new programs, he said.

There is no trade association for scribe companies and no professional organization for scribes, so hard data on the fledgling service industry are unavailable. Murphy estimates the three major companies and a couple of smaller ones probably have contracts with more than 150 hospitals, staffing them with about 2,000 scribes. In addition, there are another 30 to 40 “home-grown” programs with another 500 scribes, he said.

Still, with 4,500 emergency departments in hospitals nationwide, “a big market is left wide open for a scribe infiltration,” Murphy said.

Sarah Esquibel, chief operations officer for ScribeAmerica, graduated from the University of California at Santa Barbara with a bachelor's degree in biology and a plan to enroll in medical school. Murphy recruited her roughly four years ago to work as a scribe at 419-bed Hoag Memorial Hospital Presbyterian, Newport Beach, Calif., near her home in Irvine. She has since moved up at ScribeAmerica, where she has been setting up scribe programs for 2½ years.

“I still believe that one day I will end up in medical school, but at this point I'm content with working with the company and extending the business,” Esquibel said. “In the past year, I've probably lived in six states.”

Depending on the size of the hospital, getting a program off the ground takes anywhere from three to six months. “What takes so long is we have a pretty rigorous training schedule we put them through,” Esquibel said. Applicants are not the problem. In one engagement at a hospital in Lafayette, Ind., near Purdue University, Esquibel said she sent a couple of e-mails out to departments at the university and in three days had 65 applicants for 22 positions.


Finding the right people

The difficulty, Esquibel said, is in finding competent people. The washouts, roughly one out of four job candidates who are interviewed, typically don't surface until the would-be scribes are trained and on the job, she said.

“The job is appealing to everybody who is interested in medicine, but not everybody has the ability to multitask the way this position requires to keep up with these physicians,” Esquibel said. “It's very fast-paced.”

Esquibel said there is “a very strong correlation” between eventual success as a scribe and a candidate's prior successful work experience in service-sector jobs, particularly as a waiter or a waitress. “There are a lot of the same patterns,” she said, in keeping multiple food and drink orders straight in a restaurant and keeping tasks and records straight in a busy ER.

Another challenge comes from the demographics of the candidates themselves. They're almost exclusively students, 95% of whom work part time logging at least eight shifts a month, and almost all of whom “want to move on to other things,” Esquibel said.

Providing training to new recruits as needed to address frequent scribe turnover is “why we have a business that we do,” Esquibel said. “Physicians recognize that and hospitals recognize that and they want us to take the headaches. Before we leave, we designate a chief scribe, and that is our liaison between us and the physician group.”

Starting pay for a rookie scribe is about $10 an hour, she said, while chief scribes make $14 to $16 an hour.

Esquibel said she speaks from experience both as a manager and as a scribe herself that the work has more than just financial rewards. Medical students “frequently contact us and ask if they can work shifts over the Christmas break,” Esquibel said. “We hear back from them all the time how well they were prepared compared with their peers.”

Speaking for herself, “My personality is such that I like to be busy,” Esquibel said. “I have to be in an environment where I'm stimulated. I like having an impact, where I can see that on the physician's face. You're right there in the action, and it's good to feel needed. I know that if the physician doesn't have a scribe, he's typing, typing, typing. His numbers went from 2.7 patients per hour to 1.4.”

Scribes know “we're able to move patients more efficiently through the department,” she said. “The physicians are happier. The patients are happier because their wait times are reduced; they're getting admitted or sent home in a more timely fashion. So, everybody wins.”

Sathish Jetty is the physician chief medical information officer for 168-bed Adena Health System in Chillicothe, Ohio, which is about one-quarter of the way through rolling out an EHR system to its 24 group practices. Jetty sparked a lively and far-ranging online conversation when he sent a message last November to members of the listserv of the Association of Medical Directors of Information Systems, a physician informatics group, asking for their advice and experiences using scribes. “The reason we talked about scribes is the physicians have been complaining about productivity because the ramp-up of an EMR takes time,” Jetty said. “Productivity goes down 50%.”

But Jetty said Adena has a physician role model—an ear, nose and throat specialist—who uses two medical assistants, or MAs, as scribes and who had used his own EHR before the rollout. He continued using the scribes during the transition to the hospital-supplied EHR system, and the whole setup intrigued Jetty.

“Two of them go from one room to the other,” Jetty said. “One MA brings the patient to a room and he (the physician) goes in and does the encounter. By that time, the MA is ready in the other room.”

Jetty said the ENT reportedly can run through 60 patients in a very long and busy office day. But Jetty wondered whether that one practitioner's experience could scale up across the two dozen other Adena office-based practices. The hope had been to train medical records personnel in those offices to work as scribes, Jetty said, but so far, with seven practices either up and running on the new EHR or transitioning to it, none of the affected physicians have availed themselves of the hospital-offered scribes.

Some of Adena's busiest practices are set to transition this summer, Jetty said, so it remains to be seen if there will be any takers on his plan to smooth the move to EHRs by using scribes.

David Bragg, a physician and senior vice president of medical informatics at the HealthTexas Provider Network in Dallas, has a variation on Jetty's inquiry.

The 500-physician practice associated with Baylor University was not quite halfway through a rollout of an ambulatory EHR to its member physicians when it brought the program to a halt 15 months ago and decided to switch EHR vendors, Bragg said. He ran a pilot project at two offices last year to get a sense of whether scribes would help the group migrate from one EHR to another. Using a scribe "doesn't fit everyone's style,” Bragg said, but, “generally, the physicians were satisfied.”

Bragg said he has received funding and is awaiting board approval for a second, larger pilot to be run at about a half-dozen offices this year. In the tradition of a physician testing a new vaccine on himself, he said he plans to participate in the pilot, too.

“Migrating the data is going to be extremely difficult,” Bragg said. “We're looking at: Can you take a traditional scribe, or someone with clinical experience, like an RN, and use them to not only scribe but take a more complete history and do the wrap-up and allow the physician to see more patients and be more productive? Can we make that transition easier using scribes?”

From HealthcareITNews:

Wednesday’s bankruptcy filing by one of the nation’s largest medical transcription providers could touch off a bidding war for the company’s assets.

Spheris, a Franklin, Tenn.-based provider of document services for roughly 500 hospitals and health systems, confirmed a long-standing rumor on Wednesday by filing for Chapter 11 bankruptcy protection in Wilmington, Del. At the same time, the company announced plans to sell its U.S. and Canadian businesses to MedQuist, a Mount Laurel, N.J.-based provider of medical transcription services, under Section 363 of the United States Bankruptcy Code for roughly $75 million in cash. That deal, if concluded, could make MedQuist the largest provider of medical transcription services in the country.

According to officials, MedQuist will act as a “stalking horse” bidder in an upcoming auction of Spheris assets and set the initial bid for Spheris’ domestic assets, subject to court approval. Another part of the deal would have CBay, Inc., acquire the stock of Spheris India Private Ltd. through the auction. MedQuist and CBay are portfolio companies of CBay Systems Holdings, Inc.

MedQuist may have some competition at the auction, however. According to the Nashville Business Journal, Webmedx, Inc., based in Brentwood, Tenn., and described as the fourth largest provider of medical transcription services in the country, and Atlanta-based Transcend Services, Inc., described as the third largest, may join the bidding.

“In such a changing market as the clinic documentation market, it would not surprise me if other parties were interested in some or all of Spheris’ business due to synergies and concentrations in market strength,” Wedmedx Senior Vice President Chris Cashwell told the newspaper. Transcend President Susan McGrogan, meanwhile, told the paper her company could make a bid as well.

From Nashville Post Business:

In a regulatory filing this morning, medical transcription company MedQuist said its deal to buy the U.S. assets of Spheris will cost about $75.2 million in cash, plus the assumption of certain liabilities.

The agreement comes with a $2.1 million breakup fee, plus transaction expenses, if another buyer ends up winning the bidding and auction process required under Spheris’ bankruptcy.

For now, MedQuist has deposited $7.5 million into escrow that will be credited to the purchase price after the acquisition has closed. If Spheris ends the deal because the buyers breach the agreement, MedQuist must pay the difference between $15 million the $7.5 million plus interest as a termination fee.

From HIPAA.com:

Three new HIPAA/HITECH Act rules go into effect this month:

Two weeks from today, on Wednesday, February 17, 2010, Business Associates of Covered Entities must comply with the HIPAA Security Rule. For the first time Business Associates will be regulated by the federal government. Section 13401 of Subtitle D (Privacy) of the HITECH Act (42 USC 17931) states that “[t]he additional requirements of this title that related to security and that are made applicable with respect to Covered Entities shall also be applicable to such a Business Associate and shall be incorporated into the business associate agreement between the business associate and the covered entity.” [Public Law 111-5, p.260] In addition, penalties that apply to Covered Entities also will apply to Business Associates for noncompliance with the provisions of the Security Rule.

The next day, Thursday, February 18, 2010, a new restriction on disclosure of protected health information goes into effect that impacts Covered Entity health care providers. According to Section 13405 of Subtitle D of the HITECH Act (42 USC 17935), a health care provider must honor a patient request to restrict disclosure of protected health information to a health plan for purposes other than carrying out treatment (namely, payment or health care operations) if the patient pays the health care provider out of pocket in full.

Finally, on Monday, February 22, 2010, enforcement of the Breach Notification Rule goes into effect for “failure to provide the required notifications for breaches” of unsecured protected health information discovered on or after the February 22 date. [74 Federal Register 42757, August 24, 2009]. The Breach Notification Rule applies to Covered Entities and Business Associates, provides obligations for each regarding compilation and reporting of information pertaining to a breach by either party, and requires “incorporation [of those obligations] into the Business Associate Agreement between the Business Associate and the Covered Entity.” [42 USC 17934]

From Newsblaze.com: Spheris, a leading global provider of clinical documentation technology and services, today announced that it has entered into an agreement under which MedQuist Inc. and CBay Inc., portfolio companies of CBaySystems Holdings Ltd. and leading providers of medical transcription software and services, have agreed to purchase substantially all of Spheris' assets pursuant to a transaction that is to be implemented under Section 363 of the United States Bankruptcy Code. In order to commence the sale process, Spheris and certain of its affiliates filed voluntary petitions for relief under Chapter 11 of the United States Bankruptcy Code in the United States Bankruptcy Court for the District of Delaware (the "Court"). The Company expects its operations to continue as usual during the restructuring process. Spheris India, a subsidiary of the Company, will be part of the prospective transaction but will not file for bankruptcy.

Robert Butler, Chief Restructuring Officer of Spheris, stated, "Throughout the past year, Spheris has taken steps to strengthen its operations and customer service, and these initiatives are achieving solid results. Spheris has also been engaged in constructive discussions with certain key constituents of the Company to identify ways to enhance financial flexibility for our operations. We expect customers will continue to receive high-performing services through a company with a stronger capital structure."

Tony James, Chief Operating Officer of Spheris, added, "Spheris is committed to maintaining the highest levels of customer satisfaction and we will remain focused on our operations throughout this process. We expect the transition to be seamless for our customers and we appreciate their continued support. I would also like to thank the dedicated employees of Spheris for their commitment to the Company and for working hard to provide the outstanding service quality and quick turnaround times that our customers expect."

Prior to the Court approval of the MedQuist/CBay agreement, there will be a court-supervised auction process to facilitate competitive bidding by other qualified bidders. The auction process is intended to achieve the highest price possible for the assets and provide the Company with an efficient way to address its capital structure without disrupting operations. The bidding procedures, if approved, would require interested parties to submit binding offers to acquire some or all of the Company's assets within approximately 30 days of Court approval of the bid procedures. If qualified bids are submitted, an auction would be held a few days prior to the sale hearing. A Court hearing approving the sale to the winning bidder would be held soon after the conclusion of the auction, followed by a final closing. If the MedQuist/CBay agreement is approved and the conditions thereunder satisfied, Spheris expects that the transaction will be completed in the first half of 2010.

In addition, a syndicate of lenders has confirmed that they will enter into a Senior Secured Super-Priority Debtor-in-Possession Financing Agreement among the debtors under the bankruptcy case, with Ableco, L.L.C., as Collateral Agent, and Cratos Capital Management LLC, as Administrative Agent, to provide up to $15 million in Debtor-in-Possession financing upon the terms and conditions set forth therein, including entry of an order of the Court approving the financing. The financing facility will be used to fund ongoing operations and repay outstanding revolving credit loans under its pre-petition credit facility as of the filing date.

In conjunction with today's filing, the Company also filed a number of customary motions to continue to support its employees, customers and suppliers during the financial restructuring process and to facilitate a seamless transition to new ownership. As part of these motions, the Company has asked the Court for additional authorizations, including permission to continue paying employee wages, salaries and health benefits without interruption.

Additional information is available through the Company's website, www.spheris.com. Access to Court documents and other general information about Chapter 11 cases is available at www.gardencitygroup.com/cases/spheris.

From PRNewswire.com: MedQuist Inc. issued a statement today outlining its readiness for the extension of Health Information Portability and Accountability Act (HIPAA) security provisions in February 2010 to firms deemed "business associates" of healthcare providers, as well as the provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act addressing the privacy and security of protected health information (PHI). Standards and Safeguards related to PHI have been implemented across the full range of the company's business operations, including:

Overall Business Process, Transparency & Architecture

• Whether performed with domestic or offshore labor, unless otherwise specified by the customer, all transcription and editing work is processed through MedQuist's DocQment Enterprise Platform®, a centralized and secure workflow platform. This approach allows single-point control and visibility.
• MedQuist has complete transparency with its customers relating to the production of its transcription -- the customer designates and knows whether work is to be performed domestically, offshore or both.
• Offshore work is performed in a center-based model. Unlike many other offshore suppliers, no remote or home-based transcription is permitted, in order to maintain strong security control.
• MedQuist utilizes an independent accounting firm to perform an ongoing audit of its offshore operations and performance to ensure compliance with its Standards and Safeguards.
  

Physical Security

• MedQuist's offshore physical locations deploy a host of security tools. These include biometric access and identity checks to facilities and equipment, facility access rules and limitations on a 24/7 basis, and rigorous logging procedures.

Technical Security

• MedQuist's entire IT infrastructure supporting its service operations is independent, secure, and fully documented.
• Access to workstations and servers is controlled through a combination of unique login/password settings, biometrics, and prohibitions on e-mail, instant messaging, and printer access.
• Damaged hard drives and electronic media are handled according to DOD 5220 standards for electronic data shredding, or physical destruction when shredding is not possible. All MedQuist hardware is subject to full control logging.

Human Resources & Auditing

• All employees are required to execute PHI confidentiality agreements.
• All MedQuist partners execute a business associate agreement.
• An ongoing training program has been established on HIPAA requirements.
• MedQuist assigns a privacy compliance specialist to its own business partners to ensure that privacy and security standards are upheld.