The Australian Healthcare System
Australia laws that came into effect in November 2012 state the following “From 1 November 2012, only medical practitioners, certain dental practitioners (for specified services), and registered medical radiation practitioners will be able to perform diagnostic imaging procedures for all diagnostic radiology services listed in the Medicare Benefits Schedule (MBS), excluding mammography.”. http://www.health.gov.au/internet/main/publishing.nsf/Content/di-factsheet-di
In layman terms, what this means is that practically all radiology images in Australia (sans remote rural areas) are legally required to be interpreted only by accredited Radiologists. According to the Australia Department of Health statistics, the number of medical images conducted over the last 7 years can be seen in Table 1. In the year 2016-2017, over 23 million medical images were recorded with yearly growth consistent throughout the board.
Medical Transcription in Australia
Most radiology specialists in Australia rely on using a mix of self-transcription, in-house transcriptionists, local off-site transcriptionists as other 3rd party transcriptions. The advance in technology also led to some adopting Speech-To-Text Dictation as a means of reporting on images. Each of these have their own pitfalls which will be described.
As stated, a radiologist is required by Australian law to report on any medical image. The number of images taken far exceeds the number of accredited radiologists in Australia, leading to situations where medical procedures are delayed, and huge backlogs occur.
Radiologists are paid by Medicare Australia by the number and type of reports they produce. Their main financial incentive is to produce as many reports as quickly as they can, while maintaining accuracy in the reports.
Self-transcribing reports is very time consuming for a radiologist, whose primary role is diagnosis and not administrative. It has been shown that they would much rather dictate a report and have another party type out the report. This frees the radiologist to focus on their primary role, and thus churn out more reports.
In-house transcriptionists in Australia typically consists of the staff, namely nurses, administrative personnel and receptionists type reports from dictations when they are not occupied in their primary role.
As these personnel are not formally transcription trained, and indeed some are not even medically trained, and they typically do not have a qualified full-time transcription supervisor overseeing transcription operations, quality and accuracy of reports varies. It is worth noting that these personnel are not hired to do typing of reports and as such, the value of their typing is not reflective of the salaries they receive. These personnel are paid more for their primary roles but end up doing jobs of lesser value to the company. Of course, the number of reports that can be completed by in-house transcriptionists is also limited.
It is also worth noting that as some medical procedures cannot be carried out without a diagnosis of medical images, patient care suffers. Even an Accident & Emergency patient cannot legally be treated if a medical image is not reported on. With In-house transcriptionist availability being questionable, there ends up having situations where the acceptable turn-around time is missed.
Local Transcription Companies
There have been several attempts to set up local Australian transcription companies. However, the high cost of doing business in Australia, and the lack of skilled and dedicated manpower results in these companies hiring housewives and students to transcribe reports on a part-time basis.
This model has been soundly rejected by the medical community as reliability is not assured and quality of work has always been proven to be far below acceptable levels.
3rd Party Transcription Companies
Initially, India dominated the global medical transcription industry, but for various reasons, they lost their lead to the Philippines.
Anodoctal evidence from radiologists stated that while costs were acceptable, quality of work and accuracy in transcribing did not meet the standards required. This led to the radiologists having to edit each report and detracted from their main duties. The situation got so bad as to have some radiologists to cancel the contracts with the Indian companies and revert to self or in-house transcribing.
SMART OFFSHORING Medical Transcription
At the behest of Australia’s top radiologist, Smart Offshoring was set up to address these issues. By integrating with the leading PACS (Picture Archiving and Communication System), Smart Offshoring is able to seamlessly access client images for reporting.
The Philippines was selected to base the bulk of manpower due to the strong command of English, the number of medically qualified personnel available and relatively low cost of labour. The transcription team started out with 10 MTs (Medical Transcriptionists) and the number quickly grew to 20 within a month. Since then, more than 140 MTs have been hired by Smart Offshoring.
By utilizing IT to facilitate access to client systems & manage transactions, high productivity was achieved. Data mining and expert systems were also written to check on quality of work and flag potential errors. A formal training methodology was set in place to train MTs in each level and staff career progression was also formalized.