MedicalTranscription.com

Analog vs. Digital: Gone are the days of audio (analog) tapes that get lost, broken and worn out. Practices no longer wait for a tape pickup or paper report delivery. Digital technology is here, and it's a good thing. Digital sound files can be handled and transported like most other computer files via disk or modem with ease of storage and duplication. Nowadays, digital files are sent across the nation and in some cases, across the oceans for transcription within seconds. Digital technology also creates better quality recordings. Just think of the first time you heard a CD play a tune you formerly heard on cassette. For a transcriptionist, moving to digital technology can turn a nightmare job into a breeze. There are, though, a great many medical practices and transcriptionists still using tapes, which come in standard and microcassette size, and the machine used for transcription must of course match the tape.  Very few minicassette size tapes are in existence today.  Local arrangements must be made for pickup and delivery. 

Digital File Formats: Just as word processing programs create differing file formats (Word vs. WordPerfect, for example), digital sound technology has different file formats as well. Some of the formats created are .wav, .vox, .dsp, and .dss, to name a few. What's the difference? File size, or compression ratio. "wav" is the format used in windows for audio files. In digital systems, voice, which is an analog signal, is converted by a codec (analog to digital converter) to a digital signal. Depending on the codec, that signal is a compressed at varying rates into a smaller file size. The difference in the end is the compression factor (size of the file, and quality of the voice). The higher the compression, the lower the quality. DSP TrueSpeech is one such codec and ADPCM is another. The difference is in compression. Truespeech files are about 1/15 to 1/8 the size of other wav codecs and about 1/4 the size of the smallest ADPCMs. Sound quality is essentially unchanged for dictation and transcription purposes. This is done so that files can be stored and transferred more efficiently, because .wav files are very large. The resultant voice file must be converted back to the analog signal by reverse of the above in order to be heard by the transcriptionist.

Dictation Capture: There are many different devices out there for capturing dictation, most of which can be narrowed down to one of two methods: hand held or dial-in. Larger facilities may have an in-house system into which physicians will dial and dictate. The residing codec within the dictation system will convert the analog (voice) signal to a digital one. These systems can capture patient information as well, by entering data on the phone keypad.

Many transcription services have dial-in systems also, the only difference being that physicians are calling the transcription company's system instead of their own. Some of the pricier digital systems include file routing capabilities so a transcription manager can automatically route digital sound files to transcriptionists. A well established transcription company may have the technology to tap into a facility's in-house system to electronically transfer those digital sound files for transcription. This can be quite expensive, as many of the systems are proprietary in nature and require special software and equipment purchases.

Hand held digital recorders are a logical replacement for the old microcassette recorders that many physicians prefer. Some have removable media, others do not. An advantage to removable media is that physicians may fill up a "flash card", then insert another for more dictation. A disadvantage to removable media, of course, is that like micro-cassettes, flash cards can become misplaced. Since the non-removable media units have increasingly larger capacities, physicians may opt to use these over the former. As with dial-in systems, the residing codec determines the type, or compression ratio, of the resulting file format. Great care should be taken when selecting a hand held recorder and consumer research should be done beforehand. For instance, some recorders don't upload sound files to a PC at all. Some create only .wav files, which are too large for efficient transfer, and at least one records an ear-splitting noise when it is handled during recording. Hand held devices come as stand-alone units or as part of a system. A stand-alone unit will create sound files that are ready to transport once downloaded into a PC via a serial or USB cable or a docking station. A "system" requires that sound files first be downloaded into a proprietary system, and the resultant digital files may then be transported, again requiring special software and equipment purchases.

Computer Microphone (wireless and wired):  Similar to hand held digital recorders, wireless microphones capture dictation at the physician site and then digital files are transferred to the transcription service.

For the purposes of this discussion, PDAs, or Personal Digital Assistants, will be considered similar to hand helds and computer microphones in that they are portable palm-sized devices, some of which are capable of recording voice in a format that can be used for dictation. File formats compressed enough for efficient transfer have yet to be incorporated into PDAs.  However, they are a fast-evolving group of their own and vary in their capabilities, including charge capture, prescription writing, lab access, diagnostic and treatment plan programs, plus many more, and are a technology that bears watching with regards to transcription functions.

In the case of on-site proprietary systems, as mentioned above, a well established transcription company will have the capability to access and transport digital sound files. A second method is sometimes possible, in which a transcriptionist may dial into the system and "re-record" into an analog system. A distinct disadvantage to re-recording is that it is performed in real time, i.e. an hour's worth of dictation will take an hour to re-record, and the reduced efficiency is obvious, not to mention the phone charges incurred.

Transcription ASP: ASP stands for Application Service Provider, and of course a transcription ASP is one that serves primarily transcription functions. The usual customer of a TASP is an MTSO (medical transcription service organization), however, some hospitals employing remote transcriptionists are TASP clients as well. For a fee based upon use, a TASP will supply the transcription service, hospital or individual transcriptionist with the technology needed to get the job done. The best TASP will provide an end-to-end technology solution from the physician to the MTSO (or hospital transcription manager) to the medical transcriptionist and back, all with a high level of security and work flow automation.

A TASP will have made the investment into the servers, firewalls, software and security technologies, as well as T1 voice and data connectivity, and "rents" its use based upon volume. Three modules are generally employed in order to do this: one at the physician (dictating) level, one at the individual transcriptionist level, and in between, an administrative module that is used to direct work flow automation. The physician module will be used to send sound files, if they are not already called in on a phone, to the TASP server. A hospital transcription manager or medical transcription company administrator will decide to whom the digital voice files will flow for transcription, as well as to whom they will flow for quality check. The completed documents will then be uploaded to the TASP server for access and download by the physician or records clerk. Work flow automation can be a valuable component of a TASP, as the energy and effort expended by a transcription company or hospital manager to orchestrate and complete these tasks, and make sure work is delivered at the correct time to the correct place in the correct format, can at times be overwhelming.

A TASP will also have done the research to match sound file formats to players and footpedals and created a uniform system for transcription. As mentioned earlier, these elements can greatly vary and as such, the methods used by TASPs can vary as well. TASPs also have varying degrees of functionality, including work pooling, word expanders, template managers, line count and keyboard customization, accounting, and much more. Usage fees therefore vary but generally remain in the 2 to 4 cents per line range.