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The AHDI Lounge is an exchange blog for dialogue and discussion around trends, drivers, and challenges facing the healthcare documentation profession and a place for AHDI members to address these issues. It's just a spot for busy MTs, editors, educators, students, managers, and service owners to chat about the profession. So grab a latte and join us!

About AHDI

AHDI (Association for Healthcare Documentation Integrity) is the world's largest professional society representing the healthcare documentation sector. Our purpose is to set standards for education and practice in the field of health data capture that ensure the highest level of accuracy, privacy, and security for the US healthcare system.

TRSI To Train Medical Scribes

A press release today announces that TRS Institute, in collaboration with ScribeAmerica, will be offering an online training course for medical scribes:

TRSI CEO Peter Reilly says, "We are thrilled to partner with ScribeAmerica - the leader in medical scribe management and education. The new training represents a first. Until now, medical scribe training was limited in scope and available only in instructor-led environments." He adds that the cutting-edge course will open highly rewarding professional opportunities in the emerging healthcare documentation arena to program graduates.

The new Medical Scribe online training program will launch in January, 2011. As part of its ongoing commitment to make job training programs as widely accessible as possible to allied health professionals, TRSI will offer a time-limited partial scholarship for students who enroll between now and the first class, on Monday, January 10, 2011.

Jay Vance, CMT
AHDI Lounge Administrator/Moderator


  1. Anonymous said...

    So--what happened to advocacy for MTs?

  2. Anonymous said...

    I think this is just sad. This is an AHDI approved program and they're going to scribes? I wonder how we advocate for the knowledge base of the MT when we have programs like this who are supposed to get it saying it's possible to train for this in six months? I thought the people at TRS understood the industry better than this with all of the people there who are involved with the AHDI and MTIA boards.

  3. Anonymous said...

    I continue to remain perplexed as to why 'medical scribes' are needed when MTs have been around forever as an established profession, progressively working to perfect their craft.

  4. Anonymous said...

    Because AHDI has never been FOR the MTs, but rather for the services and corporations.

  5. Lea Sims said...

    To the last Anonymous above, this has NOTHING to do with AHDI. Just because TRSi's medical transcription program has been through our approval process does NOT mean we have any control over or offer any endorsement of their decision to offer this training. We don't "approve" scribe programs. This was a decision made by TRSi. I'm not sure why you would want to throw AHDI under the bus here. We weren't part of the decision.

    Lea M. Sims, CMT, AHDI-F
    Director of Professional Programs, AHDI

  6. Karen L. Fox-Acosta said...

    I think the concept of healthcare documentation professionals, MTs, medical language specialists working as scribes is exciting. As a patient, I would rather have the knowledge base an MT brings to the table working on my record as opposed to an MA, PA or intern who is 1) temporary and 2) in training.

    EHRs are here to stay and our professionals have the critical thinking skills to be a value-add to the "scribe sphere" of the documentation workload. As well, this could be an excellent foot-in-the-door position for new graduates. Just think what value could be added to a resume or career portfolio. Talk about truly learning how to understand documentation workflow!

    Thus far, we have met resistance with some scribe companies who would not even consider transcriptionists as a viable option to taking on this workload. I welcome the change in perspective. When and if scribing (following the MD through the hospital setting and performing point/click and short narrative information entry) makes it to prime time, such as out of the ER and into the whole hospital, who better than an MT who already has the best combination of knowledge and technical skills to embrace this new facet of what should be our domain.

    Input into an EHR also provides real-time information that is computable and can be acted upon thus enhancing clinical decision making, as long as the information is accurate. Wouldn’t we rather have information that is now being processed immediately to have highly skilled medical language specialists at the helm rather than an MD who is rushed and creating their own vocabulary or an intern who is actually learning their vocabulary on the job?

    Now, for all the techies our there – if we could solve the remote access challenge and the real-time TAT challenge, perhaps this rising step in documentation could be even more viable for our at-home workforce.

    Traditional dictation/transcription is evolving and we must transition with it, and actually an EHR scribe parallels what we did years ago with steno pads and more direct contact with the authors of the patient encounter.

    I would invite "anonymous" to contact any AHDI or MTIA board member with your concerns and let's have a conversation.

    Karen L. Fox-Acosta, CMT, AHDI-F
    AHDI Director 2009-2012

  7. Anonymous said...

    Are they training MTs to be scribes? The ScribeAmerica site does not say this and instead suggests more of the Scribe propaganda that concerns real health care documentation experts. Maybe they should instead focus on gaining CMT instructors for the MT program. This would be a much more beneficial venture for MT programs looking to strengthen a weak financial picture.

  8. Anonymous said...

    Of course AHDI has nothing to do with this private company's decision; however, I believe there is a serious conflict of interest here. "Anonymous" should not have to contact AHDI or MTIA with concerns. Let's have a public conversation about real advocacy for our profession, and perhaps EVERY member of the BOD could voice an opinion.

  9. Anonymous said...

    TRSi has also expanded into Speech Recognition Editing, Medical Billing and Medical Coding...just like many of the other training organizations..and how is this a "bad" thing?

  10. Anonymous said...

    I think, Karen, you're missing some of the point here. This is not a program to put MTs to work as scribes. It's a program to train "scribes" in a short six months, a timeframe that has never been "acceptable" in learning all the knowledge necessary. By their own website, it describes the medical terminology portion of the training as "This course is valuable for anyone preparing for a career in any non-clinical medical profession."

    Is that really the level of training we want someone to have who will be documenting our healthcare encounters, or those of our family members? If so, then why have we pushed for so much more for an MT?

    I do agree that this was not an AHDI decision. I think the challenge with that one is that the director of curriculum development for this school serves on the AHDI board. It does make one wonder how they came to a decision that is supposed to be so opposite of what the association has been saying for so long. In addition, their president is or has been on the MTIA board, another organization whose members are sure negatively impacted with the use of scribes. That is bound to create questions.

    I don't see scribes ever being a work at home option. The function of the scribe is to be present in the exam room and record the physician's findings at the time of the visit. Not likely that can be done from home.

    Times are sure changing the world as we know it.

  11. Anonymous said...

    As a 20 year (uncredentialed, BTW) MT, I have seen the writing on the wall for awhile now. AHDI only cares about CMTs and if they were honest they would acknowledge that we are fast being replaced by Voice Recognition. Having taking TRSi's Speech Recognition course recently, and been totally offended by the egregious mistakes deemed acceptable because they are made by a software program, I am totally on-board with scribing. If it gets me out of the house and, what a concept, even a job with benefits, I'll try it. With the only negative being that the pay scale is close to that of McDonald's, it might be a viable option to the brainwashing that needs to be done to partake in voice recognition editing.
    My 2 cents. And Lea don't bother responding. I believe you are too biased to be rebutting on this blog. Thank you.

  12. Lea Sims said...

    That's pretty funny. The day an AHDI employee (and member) can't respond on our OWN blog would be the day we shut it down. LOL

    And unless you're willing to identify yourself, it would be impossible to tell if you have any claim to know what my biases are. That would require actually knowing me, which I'm guessing you don't. ;)

  13. Anonymous said...

    Since the federal demands regarding medical documentation have changed, so will the marketplace have to change and innovate in order to keep up.

    The differences between a medical scribe and a medical transcriptionist are vast. The federal mandate to adopt the electronic medical record, has exposed the inherently click-intensive and therefore time-consuming inefficiencies of computer programs when doctors are the ones being asked to input medical data. It's imperative to understand the above, in order to understand what is propelling the medical scribe industry to widespread utility and acceptance.

    1. The medical transcriptionist records the physician-patient encounter AFTER the encounter has already occured aka "post-patient encounter dictation". On the other hand, the medical scribe, records the physician-patient encounter DURING the encounter. This is signficant in that it allows for real-time documentation. Because, it is happening in real time and not at the end of the physician's shift when he/she must rely upon their memory of the details of a dozen patient encounters, the medical scribe ensures the accuracy of the medical record and prevents errors (such as missing text, misunderstood words) more so than could be expected from the MT who is documenting the recorded memory of the often exhausted physician.

    2. While the medical transcription does an excellent job at documenting post-patient encounter dictations, the MT is of no assistance to improving the workflow for the physician. For example, the MT can not help obtain or expedite the medical data such as xray reports, lab results or facilitate communication between nursing staff, and the doctor when inquiring about wheter certain patient tests were ever obtained. The medical scribe, on the other hand, is able to make that call to the lab department, or pull up the xray image on the PACS system to be read by the MD, or ask the nurse if the patient lab has been drawn.

    3. The typical individual who chooses to become a medical scribe differs from the individual who chooses a career in medical transcription. Medical scribes are chosen from a competitive pool of college-educated and highly motivated pre-medical college students at the beginning of their medical careers. Given the scientific background needed, becoming a medical scribe can not be achieved by a significant slice of the general population. For this reason, over 90% of medical scribes today are either in college or have recently graduated from college. For proof, look at the "about us" section from the large national medical scribe company websites and notice how many of their scribe managers are university graduates and have advanced degrees. Furthermore, many of today's new medical school graduates were former scribes themselves. These individuals who have chosen a career in medicine, after a competitive elimination process during the first year of college, indeed possess the skill set needed to rapidly comprehend the analytical medical terminology. Furthermore, remember that the medical scribe is always communicating and working in close physical proximity with the doctor. Simply because an individual is able to pass the pre-clinical training, that is consistent with much of today's MT training (ie terminology, billing, documentation levels)it does not mean that he/she will be an acceptable medical scribe. Unlike the MT who does not does not have clinical training component, the medical scribe must pass a clinical training component and the doctor must approve.

    Change is difficult, but with every change comes opportunity for those who chose to realize it. The online medical scribe training program being announced today will provide an online resource for and enable distant learning to develop competency in a growing and much needed new field. If physicians experience that working with medical scribes is advantageous and allows them to document faster in real-time and see more patients, then it probably is.

  14. Jay Vance, CMT said...

    A word of caution: Comments that are overtly denigrating to individuals or companies will not be published. Admittedly this is a subjective process to some degree, but please keep the discussion civil. We can disagree without resorting to personal attacks. Thanks for your cooperation.

  15. Anonymous said...

    Are there practicing scribes teaching the program? Who developed the program? A CMT?

  16. Anonymous said...

    Well, are there CMTs teaching the medical transcription curriculum? Is the developer of the speech recognition product an CMT, even a MT? No names, however, there was an award presented for this effort. I too feel that AHDI, albeit a great organization, should really listen to the members as we say it's time to perhaps recognize that the organizations and the services are getting the benefits over the membership. I too think there is a bias. I think a shift of power is in order (not person but policy). If you call for mandatory credentialing, your educators should be likewise qualified. If you give an award for the development of a product, I believe the merit should go to the person who actually studied the skill, and then passed the trade to mentees by program, curricula, etc.

  17. Anonymous said...

    I remember when they used to be called Medical Assistants. Of course, back then the doctor would dictate following a patient exam and then a Medical Transcriptionist would produce a legal-medical document for the record. Not all doctors dictate at the end of the day. Radiologists dictate all day long and it is still the responsibility of the transcriptionist to create a legible document, flagging for missing text and querying the doctor for misunderstood words.

    My question, without being libelous, defensive or judgmental then would be where does the liability fall if the scribe makes a mistake? Will the scribes be covered under the doctor's malpractice insurance? As I said before, Medical Assistants have been doing clerical and/or clinical assisting forever. It is just in the age of EMR that new titles are being given to old jobs.

  18. Renee Kelly said...

    First of all, doesnt anybody see what I see? a) Scribes are going to move on to their " actual" professions" in a very short time. b) They are going to be in the same room as the patient and doctor - what about HIPAA and the comfort level of the patient? c) Are scribes to work as secretaries? d) Can scribes give the commitment levels shown by MTs to the process of documentation?

  19. Anonymous said...

    The TRSI Speech Recognition Editing Program was developed by an AHDI sponsored workgroup (inclusive of many CMTs) with volunteers from all facets of the industry. Why would someone (again, anonymous and unwilling to speak for him or herself) disparage something that he or she obviously does not know all the facts. For that matter, if I'm not mistaken, the only way one can register for the TRSI Speech Recognition Editing Program is via the AHDI website.

    Furthermore, the award given was for the creation of the industry's first online speech recognition editing training program and accepted on behalf of all who contributed - just as an actor winning the academy award shares the award with all who participated in the creation of the movie.

    Anonymous above appears to have a separate agenda than needs to be published in this type of forum.

  20. Anonymous said...

    My concern goes back to the core of MT education. How can you have educational developers who are not credentialed? You have uncredentialed people training potential MTs and even non-MTs developing curriculum. Now there is coding from uncredentialed people. Soon to be scribes from uncredentialed people again.

    Am I the only one frightened by how lax we are getting in our education process? What does this say when approved programs can educate in this way and maintain their approved status?

    Are we or are we not serious about a fully credentialed workforce? If we are, we need a better standard of practice in education before we ask the same of employers.

  21. Anonymous said...

    I think AHDI and the membership have to make the hard decisions to benefit the MT profession and the members. First of all, set aside the basic notes for scribes and EMR; transcription should be separated into the more acute care notes (I'd like to see the EMR or a scribe do a 4 pg open heart surgery report). To get there, you will need credentialed MTs, you need credentialed and experienced instructors and content developers. It could benefit MTs by sectioning these professionals making them 2 separate entities. There should be no blurring of the job duties; each requires different skills, and probably 2 different associations. We should go in 2 different directions. I do not think MTs should become Scribes or visa versa. They're night and day. We're not medical assistants either. I think training them under the guise of a medical transcription school is a profit decision and a conflict of interest.

  22. Karen Fox-Acosta said...

    Here’s a thought. After learning more about scribes through a post on this thread, perhaps the concept of healthcare documentation specialists and scribe educators working together could spawn some curriculum application of teaching clinicians how to document encounters. Typically dictation skills have been passed on peer-to-peer through some kind of a process but not necessarily through a formal dictation “class.” AHDI, through the work of one of our previous board members and AHDI volunteers, investigated having dictation/documentation training added to medical school curriculum a few years back. We were told in many cases there was no room in the unit load to add the class. Well, here’s a prime opportunity to educate clinicians in training on the creation of accurate, timely and comprehensive healthcare encounter documentation. This is another area where collaboration of MTs and other healthcare professionals, like the instructors teaching scribes, could be a win-win scenario.

    And, that’s my point. Any space where our professionals are given the opportunity to collaborate in any venture that involves healthcare documentation, the patient wins.

    I, too, agree the Lounge is an excellent place to share ideas, ponder challenges, debate concepts, learn new information in a group setting. In fact, my dream is that the AHDI Lounge will be "the" place to participate in robust of conversations about our industry all the time.

    Where I invite others to contact a board member of either association, it is my way of trying to broaden the conversation enough so I know who I am having a conversation with. To have a truly open dialogue, we must be willing to identify ourselves, and I applaud those who are able to do so, and if someone is not and prefers to remain “anonymous,” then I want them to know my door is always open for conversation outside of this open forum domain.

    Karen L. Fox-Acosta, CMT, AHDI-F
    AHDI Director 2009-2012

  23. Anonymous said...

    Karen, I don't think scribes and transcriptionists are the same. They should not be supported as such. We don't have to be everything to everybody. We should be true to what we are, upgrade the profession instead of being everything to everybody, grasping at straws like we're in the final death crawl. There is potential here to define ourselves as professionals and I hope the association will take this as the window of opportunity to actually define us as "this is what we do" and begin training the MT hopefuls as acute care documentation specialists. How can we be professional dogs if we're simple cats too?

  24. Anonymous said...

    Here, where I am at, I know of 2 different hospitals that use scribes in their ER. The scribes are paid minimum wage. Their hours are just short of what would be considered full time; therefore, they are not eligible for insurance or any other benefits, yet they are expected to know as much as, if not more than, MTs in terms of transcribing/documenting skills, including attendance at CEC programs that they pay for themselves. Not exactly what I would call an enticing job at minimum wage and I certainly see no benefit to MTs if the scribes are willing to work for minimum wage then you can bet the institution won't take long to decide that is what the MTs should get as well.

    Personally I think we will see more of these sorts of scenarios as our organization continues trying to "serve 2 masters." It is pretty obvious from this incident who is determining the direction the organization is headed these days. I think we have set ourselves up for more decisions that will require us to "speak with crooked tongue" to justify to the members how and why the focus is moving further and further away from MT, instead concentrating on corporate ideologies and business plans.

    Lea's point about having no control over what AHDI approved schools does is right, if they pay the money, get that approval, we have neither the people nor the resources to continue following individual schools to make sure they are doing what they said they would. A lovely catch 22 if there ever was one, and one I doubt our organization (as the MTIA viewpoints become more and more the norm) would even attempt to change that policy.

    To me then it seems pretty simple, if an approved school starts doing things the organization does not support or approve of, we simply yank that approval away, refund their money, and concentrate our efforts on other schools that are doing it right ... but, we gave the guy that runs this particular school for scribes a lifetime achievement award not too terribly long ago, so I guess the organization is stuck egg on its face no matter what it does in this instance.



  25. Anonymous said...

    My concern goes back to the core of education. How can you have program developers who are not credentialed? You have uncredentialed people training potential MTs and even non-MTs developing curriculum. Now their is coding from uncredentialed people. Soon to be scribes from uncredentialed people again?

    Am I the only one concerned by how lax we are getting in our education process? What does this say when approved programs can educate in this way and maintain their approved status?

    Are we or are we not serious about a fully credentialed workforce? If we are, we need a better standard of practice in education before we ask the same of employers.

  26. Anonymous said...


    What are you talking about? Do you have your facts correct? I know for a fact that more than 50% of the MT educators at TRSI have their CMT.

    In addition, if I read the press releases correctly, this is exactly why TRSI has partnered with the American Academy of Professional Coders (using AAPC certified instructors) and ScribeAmerica to ensure top notch training.

    Please do us all a favor and take your slander and innuendo elsewhere!

  27. Anonymous said...


    Please get your facts correct:

    More than 50% of the MT Educators at TRSI are CMTs. In addition, if I read the press releases correctly, TRSI has partnered with the American Academy of Professional Coders (using AAPC certified Instructors) and is partnered with ScribeAmerica - the The leader in professional scribe management and education.

    Please stop distributing your inaccurate information.

  28. Anonymous said...

    Significantly more than 50% of the MT Educators at TRSI are credentialed. In addition, if I read the press releases correctly, TRSI has partnered with the American Academy of Professional Coders (using AAPC certified Instructors) in support of its Medical Billing and Coding Program and now, TRSI has partnered with ScribeAmerican - the leader in professional scribe management and education.

    Seems to me TRS Institute is onto something special.

  29. Anonymous said...


    Thank you for re-visiting the topic of dictation education. If we are being held to a higher standard then the quality of dictation should also. With the coming of age of voice recognition and now medical scribing, it is about time that efficient dictation should complete the circle. We transcriptionists have been working quietly behind the scenes to make doctors look good and look where that "put up and shut up" work ethic has gotten us.

    My point is, if scribing is going to be done by "pre-med" students, then one of their courses should be quality dictation.

    Also, I took a look at the curriculum for the TRSi scribe program. Except for a module on EMR, it seems like a condensed pre-transcription program or a medical assisting program. And then there's the cost: of $2495.00!

    I'm just glad I'm almost done with my degree in Health Info. Mgmt. and about ready to get certified as a RHIT so I can bypass what is happening in our field. It is becoming a hard battle to fight.

  30. Anonymous said...


    While I stand behind my opinions and statements made here, given the state of our industry, I feel safer posting anonymously. I'd like to keep my job for as long as possible before I am replaced by Voice Recognition or a scribe. Apparently even though I have been in the industry for almost a quarter of a century, I am not qualified to be a scribe. I would think transcriptionists would be the first ones tapped for the job. Our training and experience surely should qualify us to take real-time dictation, no?

  31. Anonymous said...

    So about 50% do not have a CMT including the Director of Program and Delivery and Director of Curriculum Development? That proves the point that was trying to be made. It is not slander or innuendo. We have a clear issue with the approval process not requiring all CMTs while at the same time asking for mandatory credentialing in the industry.

  32. Anonymous said...

    And I agree that it's putting the cart before the horse to require the industry to be credentialed but to get those credentials you can be instructed by a noncredentialed MT. So we have instructors who have transcribed chart notes for 25 years training students who get their credentials. We have people making program content that we have to trust to have the capabilities but they don't have to prove themselves with a credential - only the graduates need the credential to work. Hummm... BTW, scribes are not transcriptionists. If you're an unemployed or underemployed MT and you want to be a scribe, fabulous! Let's put all this in proper perspective and not blur the information here. I think we have the potential to improve our profession.

  33. Anonymous said...

    If only 50% of the educators at TRSI are CMTs, do I get 50% off if I'm mentored by the noncredentailed employee?

  34. Anonymous said...

    While we're on the subject of credentialing our MTs, which is an excellent idea, how about certifying our board members too?

  35. Anonymous said...

    LOL. That was a good one! But sign me up if the answer is yes.

  36. Anonymous said...

    Karen--in this day of people running scared for their jobs, commenting with a "real" name isn't going to happen. What needs to happen is not private convos behind closed doors, but the AHDI BOD needs to get something out there--anything--and TALK to MTs. They are scared about their jobs, which are going away, plain and simple. Anything that threatens their livelihood, like EMRs and scribes, needs to be addressed by the AHDI BOD and solutions need to be offered. You cannot put your heads in the sand any longer. It is not enough for Lea to put out an official AHDI statement. Peter, the president and other board members need to address these specific issues, especially board members who are directly involved with training scribes. Where is Dewey Square in all of this? In the past 2 years, have they made any strides whatsoever? It sure seems like they have been paid for nothing. What benefit have I received for my $10? Signed, Concerned and Will Remain Anonymous.

  37. Anonymous said...

    Here is a real idea for some real change. Every BOD commit to getting their CMT before end of 2011, require it of all approved schools by end of 2011, and then use our partnership with MTIA to have them commit to requiring it by end of 2012 for all employees.

    Show the industry that the resolution was not just a hollow, meaningless resolution but a real purpose-driven promise.

  38. Lea Sims said...

    Okay, folks, if we can't keep the conversation respectful, we'll shut it down. This is not the venue to call a school or company on the carpet about the qualifications of their employees or the credentials of their leadership. Snide comments directed at individuals or organizations under the umbrella of anonymity will not be tolerated here. By all means debate the challenges of getting to a place where credentials can be required of all instructors and program directors of an approved school...what would that take, how reasonable is that expectation now, what transitional approach would it take to get there, etc. But take your potshots at those programs somewhere else, or we'll shut this thread down.

    And just to be very clear, this is not about AHDI defending TRSi or its decision to offer scribe training or the quality of that program. This is about the kind of high-integrity dialogue we want to see on our blog where respectful debate is the goal. Anyone who can't engage here within those parameters is welcome to take the desire for blood-letting to any of the many other forums where that kind of dialogue is not only tolerated by encouraged.

    Lea M. Sims, CMT, AHDI-F
    Director of Professional Programs, AHDI

  39. Anonymous said...

    I don't think we can get to the heart of the matter without stepping on a few toes. Sorry to the school who opened the can of worms but I feel like we can make progress if we're not chastized and forbidden the freedom to get to the place where we need to be. If you shut us down and shut us up, we are being denied a part. You have all the power to shut down the dialogue and censor what we desperately want to address. Our hands are tied and we have no control over what we so desperately want to change. It's time to do the hard work and bring the issues out in the open. I personally saw an opportunity and want to jump in and participate. My apologies to anyone offended but I feel these posts are true input (mine and others).

  40. Anonymous said...

    If you are going to have a blog, and welcome comments, you cannot turn around and "shut it down" because you do not like the opinions that differ from your own. It is called "FREEDOM OF SPEECH" and is a constitutional right.

    Go ahead, shut us down. Continue the censorship.

  41. Lea Sims said...

    Anonymous, I greatly appreciate the sincerity in that post. I have no desire to shut down the tough issues, just asking that people do it in a way that is respectful. With so many people posting anonymously, it's impossible for us to moderate in a way that directs our concerns to the persons or posts that cross that line. We kind of have to put it out there to the group. By all means, let's not avoid the challenges. Let's drill down on them, explore their complexities and how to address them.

    Since this entire thread started with a discussion of scribes (and it spun off onto a focus on TRSi specifically) - it seems to me the most productive dialogue is one that avoids criticism for the sake of criticism and focuses on critically thinking these issues through. We can't truly assess whether TRSi's new scribe program is an applaudable example of creating new opportunity or a questionable example of putting the cart before the horse until we have a better understanding of (a) what scribes are and do, (b) what skills and competencies separate them from MTs, (c) what it is about scribing that is of sudden value to the physician and is differnt and unique from transcription, (d) whether scribing is a good first role or alternative fit for an MT graduate, (e) whether the compensation structures being proposed here are even sustainable for healthcare facilities...and so many more questions.

    We need to drill down on those, I believe, before any of us could speak with authority on the impact of scribes as a profession, scribe programs as a new avenue for MT schools and/or MTs, etc.

    Why not start with the right information?


  42. Jay Vance, CMT said...

    Let me reiterate that we are NOT censoring anyone's opinions. Browse through the archives of this blog and you will see that there are plenty of comments that are less than complimentary to AHDI or other entities in the business, with many differing points of view represented. But blatantly insulting comments will not be permitted. We can discuss issues without attacking individuals or organizations.

  43. Anonymous said...

    The company made a press release to get word out about their scribe program and to generate discussion. Sadly, they were not in touch with the industry and how it felt about this topic. It should not be a problem for MTs to share their dissatisfaction and concern for a poor choice when the company invited this discussion.

  44. Anonymous said...

    I agree it was invited; I see posts of AHDI-TRSI Speech Recognition Course. To me, it sounds like our membership is promoting their products, therefore the membership should begin to comment. Agreed AHDI should not promote scribes if they don't know what they are yet, yet AHDI promotes TRSI products. AHDI is calling for mandatory credentaling. A point was brought up that there may be instructor certification conflict. The issues are clear: A school is promoting scribes, members are leary, AHDI is unsure what scribes are/do, but wants mandatory credentialing and uncertified instructors are still okay. What can we do about all this? It seems conflictual and could be resolved to everyone's advantage.

  45. Anonymous said...

    Sure--instead of spending 20 years as an MT, I should have spent time as a waitress instead so I could keep up with physicians.


    “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.

    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.

  46. Anonymous said...

    And that ladies and gents, is the writing on the wall. Although waitresses probably make more, with tips.

  47. Susan M Lucci, RHIT,CMT, AHDI-F said...

    Hi all,
    I have had some time to think about this and about 39 posts to read before posting myself. My thoughts may be a little different, but that's OK. I am not going to dispute anyone's opinions on the topic, simply to share mine.

    Why are scribes needed? An early question and an excellent one. In short, EHRs are cumbersome and not designed to enhance physician time, althought they claim to do so. Dr Kevin's blog recently illustrated this and mentioned the additional (huge) costs of providing scribes to do this work. EHRs "claim" (one of their mainstays in marketing) to "eliminate transcription costs." And if you do and then add scribes, you are financially right back where you started only now you have a very expensive system that if you are extremely fortunate, you too can file a multiple-page form with the government and get an incredibly small rebate. Yipee!

    Not being disrespectful - just stating the truth as I have investigated, researched and found it to be.

    Scribes are different from MTs, but to the poster who said that only scribes create efficiencies for physicians, I would suggest that may be true if they are pulling labs and calling radiology to get results and input them into reports. However, MTs still create enormous, proven efficiencies for physicians as opposed to physician self-entry.

    Another thought I would like to share is that businesses spring up as needs arise. Thus, ScribeAmerica didn't come into being through an AHDI conspiracy, folks - it happened because EHRs aren't efficient and docs were refusing to enter information into the record - they simply didn't have time. This arose through a perceived need and and a solution was put forth. Still am uncertain why (unless the marketing angle of eliminate transcription became overwhelmingly embarrassing) transcription wasn't the obvious solution. And by the way, it still is. THINK HEALTH STORY PROJECT!

    For those of you who work for MTSOs - go ask your CIO, COO, CFO and CEO when they plan to start delivering CDA language for all work types so that this can populate EHR systems and dictation and transcription can continue to keep its important place in healthcare documentation. That's one question you should all commit to asking before another day goes by. And we need to keep asking until we get a definitive answer. This is what will keep us all employed!

    I think we can do what we (as MTs) have often done and get angry about speech recognition, or scribes, offshoring, or EHRs or schools that train scribes and blame them and say they aren't listening to us, the members because technology & progress don't ask permission - they see needs and solve for them -- OR, we can figure out what WE - yes all of us plan to do to keep ourselves relevant. Did you know that 4 of 10 board members are enrolled in universities across the country for more education and additional credentials?

    While you are asking the BOD to do something about this please consider that it is not our place to try to stop technology or training programs or credentials that are born out of a need. It's our collective responsibility to own our own success and prepare ourselves for the evolving future. What will each of you do to keep yourself engaged as the future unfolds? It really is up to each individual your association is here for you to network, grow, get credentials, keep yourself informed, knowledgeable and up-to-date.

    Again, just my opinion - and shared in this open forum.

  48. Anonymous said...

    " I think we can do what we (as MTs) have often done and get angry about speech recognition, or scribes, offshoring, or EHRs or schools that train scribes and blame them and say they aren't listening to us, the members because technology & progress don't ask permission - they see needs and solve for them -- OR, we can figure out what WE - yes all of us plan to do to keep ourselves relevant. Did you know that 4 of 10 board members are enrolled in universities across the country for more education and additional credentials?"

    As I read the 40 or so posts above me, Ms. Lucci's words were exactly what I was thinking as I read.

    I have always felt that complaining online in a public forum accomplishes one thing and that is to make the poster feel better. There is nothing wrong with that, but if something bothers you so much then do something about it. An anonymous rant accomplishes nothing, in my opinion. Maybe I'm wrong and anonymous rants can change things, but I just don't see it. Write letters and make phone calls!

    The sky is always falling in this industry for one reason or another. Yesterday it was because of SR, today it is scribes, tomorrow it will be something else.

    The scribes and the school are being attacked but how many MTs started out many years ago with on-the-job training? How many MTs reading this began working without any formal training at all and through hard work and effort have become knowledgeable MTs? I attended a school whose director, a woman I admire very much and is very well respected in our industry, got her start like that for goodness sake! Some of these posts make it sound like every good MT in the industry got their start at an AHDI approved school, and we all know that just is not true.

    I love the mention of furthering our education or exploring options that will provide us with more job stability. I work full time as an IC in a job that I love. I'm also the mother of a herd of small children. That means I am incredibly busy 7 days a week. I make time to attend school to earn a second bachelors degree in Health Information Management and if I can do it anyone can. I took this semester off to focus on work a bit more, but usually I take 2 classes a semester. I am chipping away at it slowly but surely. In the future I will have RHIA after my name in addition to CMT and coding certificates. As happy as I am with my job, I am not delusioned into thinking I couldn't possibly be laid off. I'm also not about to sit back and complain about the state of the industry or listen to every negative person's perspective while not doing anything to make sure I am very marketable. If scribes suddenly take over the universe, I certainly want to be prepared for that.

    Lets be nice to each other, there is enough nastiness in the world without being that way to each other.


  49. Anonymous said...

    It sounds like what we are saying is that the Association should be more involved in educating vendors, facilities, the public, and legislators about the inefficiency of the EHR and looking for ways to fulfill the promises vendors and politicians have made but failed to live up to. It seems to me that creating 6-month scribe training programs when we openly state that is too short to be complete helps perpetuate a failed system instead of working to correct the underlying problems.

    We have held ourselves up as protectors of the patient record. Going with the flow is not living up to that standard if the final product is flawed.

  50. Laura said...

    I firmly believe that had the industry embraced certification and "owned this space" in patient-care documentation, we would not be having this particular discussion. If certification had been a barrier to entry into the field of clinical documentation, then I suspect MTs would have been approached to do this work. The majority of the workforce wanted the doors wide open (as evidenced by the percentage of CMTs), and now we see the consequences. I believe the "there's nothing in it for me" argument is backfiring on all of us.

    For years we have fought the perception that "you just type, how hard can it be?" But in an article about scribes published in the LA Times a few months back, the person from the scribe company said that they recruit the brightest college students they can find but even still as many as 40% of them don't make the final cut. Does that sound like a "no brainer job"? This same article pointed out that the EHR vendors were participating in the training of the scribes but they kept that information "low key" because it doesn't shine a very positive light on their product (ie, the software workaround requires one FTE per physician from this point forward!)

    I also wonder how long the scribe companies will continue to use a business model based on a high turnover rate. They are purposely recruiting individuals that require 4-6 months to train but will not stay on the job more than a few years at most. Did anyone notice in the previous article that the scribe companies charge the providers up to $25/hr but pay the scribes $10-$12? Is that 100% markup due to the training and high turnover rate? Is that a sustainable business model? MTSOs struggle to provide on-the-job training (hence the problem with newbies not getting hired). Do you think the scribe companies started in this business as naive as many MTSO owners that didn't understand what MTs REALLY do? "Just type what they say! and do it faster!" If the scribe companies already had the ideal business model, they wouldn't have needed the services of TRSi. What if their association with TRSi produces a better business model by hiring fully trained MTs? Maybe TRSi jumped into this market in the hopes of bridging the gap between scribes and MTs and promoting the value of a fully trained, credentialed documentation specialist that is fully committed to the job for the long term?

    Should we alienate these companies or promote our standards to them? Should we be creating barriers so that only qualified people enter patient-care data? What does that data entry look like? Only dictated data? Any kind of patient-care data?

    The real question here is how do we define our space in clinical documentation and how do we take ownership of it?

  51. Lea Sims said...

    I think the challenge is that as an association, we don't know enough about the scribe role to conclude that a 6-month training program is either too long or too short for this position. I was a health unit coordinator (HUC) years ago before I became an MT. I was responsible for translating all the hand-written daily orders placed on the patient's chart - putting new or changed medications and dosages onto the med flip charts, ordering labs and x-rays via the ordering system, transferring wound care and therapy note changes to the nursing note charts. I spent 4 weeks in training for that job - performed by the lead HUC at that hospital. And I can tell you that I was well trained and prepared to do those tasks assigned to me. We can't always know the depth and scope of another position or assume that it requires the same level of preparation that our allied health role does. Likely the only ones who've posted to this thread who have the authority to speak to that are those who have first-hand experience as scribes. If the scribe role is more of a supportive clerical role than it is an interpretive role (like MT), then it may very well be likely that 6 months of training is reasonable. Who among us knows for sure? So before anyone suggests that the Association needs to be reprimanding TRSi for offering a substandard program, we would kind of have to know that such an accusation was actually the case before we do that, right? One has to assume that TRSi has been guided by those at Scribe America who have been successfully training and placing scribes in ERs for quite some time now. I think there is a lot of assumption on this thread that scribing and transcription are the same thing and therefore require the same length, scope, and content of training. Based on what scribes have posted here and on KevinMD's blog, they are obviously not the same. What remains to be seen is whether the scribe role (regardless of scope or training) is really adequate to meet the documentation needs of clinicians, and more importantly, whether this is a sustainable business model - which is my personal concern.

    Whether having someone on-site versus in a transcription role is really the better documentation support for the physician is certainly worthy of exploration, but it seems to me that it is the sustainability of this business model that is the most concerning. This same thing happened to MTs. ERs outsourced transcription to MTSO's for high dollar, decided they didn't want to pay for it anymore, moved to template "T" systems, and now that the doctors have decided they just can't take care of patients and do their own data entry, they decide to herald the arrival of scribes as the best things since sliced bread. But aren't they just going through the same cycle? Outsourcing (at $25/hour) a role that eventually some hospital CFO will start scrutinizing and deciding is too costly? What makes this as a business model more sustainable than outsourced transcription was?


  52. Anonymous said...

    Good questions Lea and others. I look forward to seeing the answers when a representative from the company comes here to discuss them.

  53. Ava Marie George said...

    I find this discussion fascinating. Here we have change in our profession offering opportunity (albeit at a low rate of pay) to document patient encounters firsthand. It requires all transcriptionists to really evaluate what it is that we want. Do we want to stay at home and work? If so, this train will leave you at the station. Are we willing to change our point of view and take a lower rate of pay to assure that the documentation is correct? If not, you will be left at the station as well. Let's face it...we like what we do, we like where we work, and we are not open to change. If this describes you, you will also be left at the station.

    I'm seeing a lot of complaining here and not much in the way of solutions that are accepted by this group. What do we do about the growth of scribes? How do we make this perceived negative a positive? How do we help our members and fellow transcriptionists grow into this new reality, which includes scribes, EHRs, and other changes in our field?

    Throwing those questions out....what solutions can you develop here?

  54. Anonymous said...

    I read the ScribeAmerica site. This is not intended to cross train an MT who would go into a hospital. It is intended to train a "waitress" or other service-oriented person in six months to be a quasi-medical assistant/sort of MT/sort of secretary for minimum wage. Is this where MT is headed? Will some MTs be replaced with undertrained scribes? There is just a lot of unknowns in this new profession and many of us are waiting for the company to explain it better.

  55. Anonymous said...

    To Sarah above: I am headed in the same direction. Right now it is all about me and keeping myself relevant. I am working on my RHIA and starting in January, my coding certification. I can't waste a background and lifetime of medical experience, so this seems like the best thing for me. I have no interest in being a scribe; I did just exactly that as a medical assistant 25 years ago. It seems to me anyway that scribe companies have no interest in training MTs, after my research. It seems to not really be a career but a stepping stone to a medical or nursing degree. And it also appears to be very useful to hospitals...making MTs obsolete in that arena.

  56. Kathy Nicholls said...

    First, the idea of a scribe isn't a new concept. We had a discussion about it back in September on MT Tools Online (http://mttoolsonline.com/2010/09/26/medical-transcription-and-scribes/) and it was interesting to hear the reactions.

    I've really tried to stay out of much of this discussion except to follow it along. It's a pretty well known fact that this company is my previous employer and I don't generally care to comment on what they are or aren't doing these days. I also still have family and some friends who work there, people who, while we don't talk work for obvious reasons, I still care about. The last three posts have driven me to make a couple of public comments.

    First, to say MTs just have to accept this or "be left at the station" is so totally wrong in my opinion. That's how we have handled things for years, folks. Sit back and wait for "someone" to do "something" to us and then figure out how we can be unhappy about it. At the same time, to say "just live with it and make less money" sure doesn't seem like solid advice to me either, certainly not in today's economy. It seems rather defeatist.

    I've seen scribes at work, and at least in my town they are becoming more popular, not just in ERs, but also in physician offices. To think they are just using a "point and click" system is a misunderstanding, at least in what I've seen. They are writing narrative. They are not just checking boxes. That said, for me personally, I would worry about anyone having six months of training and working on my record, no matter who’s doing the teaching. Again, that's just my opinion on that one. I haven't seen the curriculum nor do I know what they're teaching. It just seems short when we are talking about needing credentialed people for any time someone is accessing the healthcare record, as in the resolution passed earlier this year by the HOD: "Support the restriction of access to protected health information to properly credentialed individuals and actively advocate for mandatory credentialing." From everything I’ve seen and read, scribes have no credentialing process and no professional association, much like MTs were many years ago. If we have, as suggested, things to fix in our own processes related to where credentialing is or should be required, then that’s up to the association; I just suggest we not shoot the companies who are only following the rules that WE set.

    The last thing I want to add here is so much has been said about the company involved, some even suggesting they “come here and explain.” First and foremost, TRSi is a business. I suspect they simply saw a business opportunity and a way to grow their business and took it. And for that, they really don’t owe an explanation to any of us, you, me, or AHDI. It really is that simple.

  57. Anonymous said...

    I'd like to know what dictionary some of you ladies/gents are using. A job that is designed to be part-time, low-paying and high turnover with absolutely no chance for advancement is not a "career." An inducement to take yet another step backward from what used to be a decent, but not stellar, career in order to take a part-time, even lower-paying, high turnover job is not an "opportunity" in any positive sense of the word. If you have another income source and just need some structure in your life or something to fill your time, then go for it. If you need to support yourself and/or a family, scribing is not going to do it. At best, this job is designed to be part of a work/study financial aid package and resume padder. At worst, it will put you in debt for a not insignificant sum, particularly if you are already desperate for work, and only perhaps prepare you for a minimum wage job that is not a living wage in large parts of this country.

    If you want to talk trains and solutions, then MT is a train that is already derailing. Scribing just sends one more car off the rails. If a train is derailing, you don't want to be on it. Young people just starting out need to avoid MT in the first place. Stay in the station and find another field. People already on the train who are young enough and can come up with the money to pay for schooling in a new career need to make that jump before it's too late. People on the train who are old enough to remember when MT was a decent career and are too old to start all over again - well maybe scribing, along with whatever they can scrounge in the speech wreck MT world and a job greeting at Wal-Mart give or take a job flipping burgers will get them through to Medicare and Social Security.

  58. Laura said...

    I don't think experienced MTs should expect to be hired as a scribe under the same arrangement as these temporary, part-time students. IF an experienced transciptionist wanted to be a scribe, most likely they would only need to be trained on the software (like every other new job we take on). That candidate wouldn't need the intensive training on terminology that these college students require. There would be no reason to assume that the MT was being hired as a short-term employee either. To assume that fully trained MTs would be hired under the same conditions as these temporary, to-be-trained college students is not reasonable (and I hope no one will go for it). If the hospitals/providers are paying upwards of $25/hr to the scribe agency, then they should be able to directly hire an MT for a reasonable wage. Surely, part of the 100% markup between the agency's fee and the scribe's pay is due to the training and high turnover rate. If the scribe really increases the number of patients seen, then their salary should be a wash. Of course, I can see that logic at the beginning but eventually CFOs may change their mind and forget that the scribes increased their billables--just like they did with MTs.

    I suspect that as scribes become more popular, the Scribe America business model will change. I can imagine that many physicians would want consistency--just like many physicians now appreciate that the MT that transcribes their work knows their thoughts and their next move. It is a better business model to hire a scribe that will stick around for the long term.

    I believe MTs need to stop thinking about "traditional transcription" as we have known it and think about our jobs as documentation specialists. That means we have skills that are transferrable to many different modes of data entry. With the EHR bearing down on us, I believe we need to explore the many different ways of capturing data and how we can continue to leverage our knowledge of medical terminology, anatomy, disease processes, HIPAA, etc. We may not all have the same work-from-home, word-processor-based job, but there are still common threads that should hold us together. We need to be identified by our KNOWLEDGE BASE, not by our keyboard skills!

    I believe we should be exploring ways to communicate our REAL skills and knowledge base to the information management sector so that they look to us for solutions and jobs. The EHRs are struggling to produce software that is physician friendly and meets meaningful use criteria. Our fund of knowledge has value and we need to communicate that value to the industry. Our credentialing system is just one way that we can do that. The CMT and RMT exam blueprint clearly spells out our knowledge base and would be an easy tool to use.

    Who has ideas for communicating this to the industry? How can we as individuals do this? How can we as an association do this? How can we as an industry do this?

    How do we prevent the next data-entry solution from cropping up and leaving us behind?

  59. Anonymous said...

    I tell you I must work in an alternate MT universe. I get pretty upset with myself on days I don't make a minimum of $20 per hour as an MT. To assume the entire industry is underpaid, overworked, and not appreciated is just...good grief words escape me to define what that is, polite words at least. I work on speech recognition too and, now this will blow your mind, I have less than 2 years of experience. I know I could lose my job tomorrow. Believe me, I realize that. I know the industry has changed and I have not been here to see those changes. I also know I get sick and tired of reading people talk about how MT is "derailing" while my paycheck tells quite a different story. I'm not working myself into a stroke either. I work your typical work week.

    I think it boils down to human nature. People who are unhappy and content to complain do not want to acknowledge that everyone around them is not in the same situation. I'm here to tell you that some of us have great jobs as MTs and stay with those jobs because of our salaries and how we are treated. I have other options. I'm not working as an MT because I have to! I know I have friends who feel the same way but we don't dare so say on an MT forum because we're told we're lying by people like that poster above me. Those attitude are not making this industry better for anyone.

    I hate coming to what should be a professional discussion and have others who should be acting as professionals degrade other jobs (wal-mart greeters and burger flippers) and tell everyone we're better off doing that. I can assure you that I could not make my salary flipping a burger. Don't be so fast to judge the burger flipper either! In these tough economic times, that burger flipper might have more education and more options in life than the MT who feels she can do nothing more than those jobs.

    You cannot blame the MT industry or AHDI if you did not further your education or job possibilities along the way. Their are scholarships and grants. If MT pays as poorly as some report, then you should qualify for a Pell Grant. Where there is a will, there is a way! Believe me, I had to find it myself. No job is so secure that it is safe to think you can stagnate and always have a job. You have to constantly better yourself. If MT does become extinct, be ready for it!

    Bring on the scribes! I'm not worried! If I lose my MT job I am prepared with other options.

  60. Kathy Handyside said...

    At least scribing couldn't be sent to India, as all the MT work is!

  61. Nae said...

    "Are we willing to change our point of view and take a lower rate of pay to assure that the documentation is correct?"

    Sure I will, just as soon as the light company, phone company, health insurance company all start taking my overwhelming desire to create correct medical records for less and less compensation as payment instead of insisting on cold hard cash. :)


  62. Nae said...

    And yes, it can be offshored, all it needs is the right sorts of computerized camera and recording devices on both sides :)


  63. Lea Sims said...

    Even though scribing could be offshored (and has...transcription is "remote" scribing after all), I don't think we'll see that here because ER physicians are scrambling for scribes because having someone physicially present and attached at the hip is probably a best-of-all-possible-worlds solution for them. They can focus on patient care and have someone follow them around handling all the minutia of documentation and data entry, playing gopher when necessary to track down stat lab results, etc. In many ways, this person is an ambulating executive assistant at the disposal of a physician in a practical, real-time way. I think we have to look objectively at the benefits to the physician for having that kind of hands-on support. Who wouldn't want someone shadowing them all day, taking care of the administrative minutia of our lives?

    So in my mind, the argument is not whether this role is a valid one or a reasonable new solution, especially in settings like the ER where scribes are probably a better "real time" documentation solution than any other. What we need to be exploring as an organization, I believe, is:

    1. What is the degree of quality risk associated with this role, such that standards of practice and credentialing need to be considered, established, and promoted for this new profession? I have to believe, as Kathy has suggested, that if this scribe is given the freedom to craft a care encounter in the EHR based partly on what they've been told by the physician and partly on what they've observed during the encounter (where application of judgment based on knowledge comes into play), then these folks need accountability and a defined scope of practice.

    2. Based on a more clearly defined scope of practice, what standards of education and job readiness need to be established to ensure that schools preparing scribes are doing so in a way that meets the needs of quality healthcare documentation? With respect to TRSi, they are really venturing out in uncharted territory, which was also the case with transcription - schools preceded the model curriculum, not the other way around. Establishing educational standards is a process over time where feedback from the marketplace drives and shapes model curricula and best practices in the educational community. Since scribing, and thus training for scribing, is so brand spanking new, it will take some time to ferret out best practices in that domain.

    3. Finally, if we can put some scope and expectation around this role and define its place on the spectrum of other documentation roles (including transcription), we'd have a better idea of where it fits. It is, at first blush, not likely to be a step up for most MTs in terms of compensation. I think that's easy to see. Some, as Ava suggested, might actually prefer to take a cut in pay to go work on site in an ER. I admit that I think the role sounds exciting and, at least for a time, could probably provide a frontline perspective on care delivery MTs are typically cut off from. But most seasoned MTs aren't going to give up a decent wage working from home to follow a physician around in the ER for $8 per hour, no matter how exciting working in an ER might sound.

    It may be more likely that scribing would be an early point of entry on the documentation career lattice, where scribes could seek additional training to bridge over to traditional transcription or SRT editing if they later decide to step out of scribing. I don't think this is an either/or, scribe-vs-MT argument.

    And there certainly aren't likely to be scribes everywhere in the hospital, unless they're going to scrub up and sit in a corner in the OR documenting the procedure - but, as that is how many OR transcriptionists started out years ago, it's not outside the realm of possibility, either.

    There's a lot to explore and get a handle on, to be sure.


  64. Anonymous said...

    If we are seeing MT programs developing scribe training programs, then it is definitely past time for AHDI to step into the discussion more and lead the future. This is a health documentation field with no credential and unknown training, something that AHDI has fought against with mandatory credentialing and the push for program approval.

    If we are not an MT only association but honestly concerned with all health care documentation, we need to immediately step up to the plate.

  65. Capi Glines, CMT said...

    How is this going to be cost effective if each doctor needs his/her own personal scribe?? Even if they pay minimum wage, it would be a heck of a lot cheaper for the doctor to dictate and for a transcriptionist to transcribe....Just not seeing the logic of this for immediate entry into an EMR -- the whole premise of the EMR vendors is that the doctor can do it all by his/her lonesome and save the cost of employees....maybe I've been doing this too long (40 years), but I just don't see any logic in this "scribe" business...

  66. Anonymous said...

    Perhaps AHDI could take a more proactive role and have some discussions with scribe schools and then pass the information on to MTs. At the very least it could start by asking questions of TRSi/Scribe America (not in an accusatory/defensive fashion but in a need-to-know forum). Certainly since there is an AHDI board member at TRSI, that might be a start for some information that MTs could use.

  67. Anonymous said...

    As an AHDI member, I am extremely disappointed with the comments made by Ava Marie George, an AHDI board member. This reinforces my feeling that AHDI is really telling MTs to jump ship now and move to another job before it's too late.

  68. cheryl said...

    To anonymous poster at 9:41AM: Amen and well said. I could not agree more. As a 20+ year career MT/MTSO, I've seen the train derailing and fortunately began a RHIT, HIT A.S. program three years ago and will hopefully be out of the "station" soon. My opinion is that the writing was on the wall for MTs when AAMT changed its name to AHDI and their priorities changed as well. Insisting on credentialing at least 5 years ago would have been advantageous instead of telling us certification was an option but not a requirement. I remember when speech "wreck" as you called it was tried and trashed over and over because it was "not there yet". Now it seems the rules have been relaxed and mistakes made by a software program are acceptable, for reasons that still baffle me.

    My two cents.

  69. Anonymous said...

    I think that is a great suggestion.

  70. Anonymous said...

    Monster job posting (reality check):


    I don't think I'll be applying for this job anytime soon. HS grad, 10-15 dollars an hour? No thanks.

  71. Brett McCutcheon, CMT, AHDI-F said...

    The one consistently clear message I have heard from AAMT/AHDI for the last several years is that our profession is changing. Obviously, we all would love to have a "crystal ball" to see exactly what healthcare documentation will look like in 10 years and how to begin preparing now.

    Without going into the pros and cons of TRSi's scribe program, I must say that this is one possible way of adapting.

    I see the MT "train" (using the analogy that was used previously in this discussion) not as derailing. Instead, I see that we are in a very large junction where individual cars are being pulled onto different, yet parallel, tracks.

    All of us have been or soon will be faced with a decision regarding how to continue along our career paths. The job descriptions, work environments, duties will vary; however, our knowledge base will be the common denominator. Again, how do we demonstrate this knowledge? Mandatory credentials are commonplace and accepted as necessary by the healthcare community in general. Without such mandatory credentialing in our sector, we will never be respected.

    When the time comes, each of us will need to evaluate our skills, interests, and work/lifestyle preferences against the emerging roles in our sector and decide which path to follow. However, considering the rapid pace at which these roles are emerging - and changing, we may not have the luxury of time when making this decision.

    [Please forgive me if I'm rambling. It's VERY early, and I'm running on 2-3 hours of sleep. :)]

  72. Nae said...

    Lea said:

    "2. Based on a more clearly defined scope of practice, what standards of education and job readiness need to be established to ensure that schools preparing scribes are doing so in a way that meets the needs of quality healthcare documentation? With respect to TRSi, they are really venturing out in uncharted territory, which was also the case with transcription - schools preceded the model curriculum, not the other way around. Establishing educational standards is a process over time where feedback from the marketplace drives and shapes model curricula and best practices in the educational community. Since scribing, and thus training for scribing, is so brand spanking new, it will take some time to ferret out best practices in that domain."

    I guess I am thinking along totally different lines.

    I thought TRSi was an AHDI approved school for MT? As such, shouldn't they have at least talked to AHDI about this scribe program, described it, answered all those questions Lea listed? Surely the fact that the course only lasts 6 months at an approved MT school should be sending up some big red flags? Especially when that approved school knows full well (as I, persoanlly, think they should as an approved school) that training for MT is considerably longer, more intensive, more skill driven?

    Surely the concept of talking to AHDI is not foreign to this school/business? These folks have now or have had in the past, members on our BOD haven't they? Didn't we give the guy who owns this school (or used to own it, I can't figure out the politics of that one) some sort of lifetime achievement award for his contributions to MT not too very long ago?

    I sort of get the impression from some of these posts that we are being told the BOD does not communicate with these approved schools once they get the check in hand, so to speak. Surely common courtesy would say that before they introduce new skill sets/training programs that will undoubtedly have an adverse impact on job availability for MTs those approved schools would at least talk to AHDI (or MTIA) about what is coming down the pike?

    Not to sound tacky, but I thought the BOD's job was that of letting MTs know what is coming BEFORE it smacks them head on?

    Certainly scribes, what they do, how they do it, how abysmally they are paid for it, have been discussed at MT Desk, MT Exchange, MT Tools, heck even Jay talked about them before on one his many web sites over the last couple of years and I am pretty certain AHDI has spoken of them before, so it is darn sure not a new concept. Why then do some of these posts make it sound like the BOD, and other officials of the organization, don't seem to really know how or what scribes do by now and what that impact is likely to hold for us?

    I guess my other question is why it sounds like those in positions of authority within the organization sound like they tacitly agree with the elected President's statement that MTs should be willing to work for less compensation than our already rapidly dwindling pay rates are now?

    I could be wrong, but I don't really think that is the message folks were elected to the BOD to put forth (well, okay, members of MTIA probably do like the notion of lower compensation to their workers, I suppose I would if I was the boss) ... that after all the time, money, training, the expertise and technical skill sets MTs are EXPECTED to have from their clients AHDI is now effectively telling those same clients, in print, that MTs really are only worth the $8-$10 an hour we are told a scribe is paid?

    I guess I am curious to understand how exactly does AHDI expect to keep members with that kind of message?

  73. Anonymous said...

    Ditto from me, Nae! I can't express how disappointed I am with the comments made by AHDI staff and board members. That's exactly how it sounds - after all the training, the expertise and technical skill sets MTs are EXPECTED to have from their clients AHDI is now effectively telling those same clients, in print, that MTs really are only worth the $8-$10 an hour we are told a scribe is paid?

  74. Lea Sims said...

    Nae, if you will review my post, you will see that I patently disagree with the assertion that MTs are going to want to leave MT jobs to earn 8-10 bucks an hour as scribes. I can't speak for Susan or Brett, but I don't think anyone is tacitly agreeing with Ava's assertions that MTs should be willing to take a cut in pay to do this (in fact, I've asked Ava to come out and address that statement, so hopefully she'll clarify her position on that).

    But beyond that, to all of your statements above that about TRSi, a really important point of clarification needs to be made here, Nae. AHDI does not approve schools; it approves MT programs. Our approval process is specifically designed to approve MT programs under our model curriculum requirements. Many schools that we approve offer a wide range of programs, both within the HIM domain and outside of it. We only review their MT programs. We don't review or approve those other programs. We partner with AHIMA to specifically approve MT programs and coding programs, but AHDI's committee solely reviews MT programs. We don't have a process, policies, model curriculum, or any grounds for reviewing/approving scribe programs (yet). We don't have jurisdiction over any school, Nae, to tell them what other allied health professions they want to provide training for or other programs they want to develop. Since scribing is not a role that sprung up out of our sector or via this association, it would be a bit difficult for us to claim that ground without some due diligence and connection to the organizations who have created that role.

    And again, you're wanting to lump the requirements for MT training into this scribe program TRSi is offering. They're not marketing this as a transcription program (which they already offer and have already sought approval for). This is a completely different program, skill set, role, and profession that, at least for now, AHDI has no jurisdiction over. And I can't speak to how TRSi hopes to bridge those programs together. You'd have to direct that question at TRSi.

    As for the assumption that this is a role or skill set that will have an adverse impact on the availability of MT jobs, I believe that statement is premature. Scribes have not been brought in to replace MTs. They have been brought in to replace "T" Systems and the EMR data entry work that ER physicians have been forced to use on their own for quite some time. The number of ERs using transcription for documentation has been on a decline for a long, long time.

    Again, I still question whether it's a sustainable business model for ERs, and for the reason someone stated above, having a scribe follow a single physician around the ER seems to be unsustainable from a cost perspective when you consider that an MT, while not "real time," could probably provide documentation on 3 times as many patients seen during the same period of time than a scribe can possibly provide, given the fact that a great deal of their time is spent observing the encounter and fetching lab and x-ray results. But again, if this is just a clerical support role for the physician, it's not surprising that it's not compensated at a professional level.


  75. Ava Marie George said...

    I think it’s very interesting that we diminish our argument by falling back to those age-old arguments about name changes, money, what AHDI is doing (or not doing for us, and other things that we have always used to try to bolster our position. Instead, I would like to challenge us again to leave all of those things behind, and come back to the discussion with solutions. I’m not hearing any solutions to the problems that our industry is challenged with here in this forum.

    Let’s take this from a neutral position and look at this from a marketing perspective using one company in particular. How do you think ScribeAmerica came into being? Directly from their website: “ScribeAmerica essentially created the Scribe industry, we are the nation's largest professional scribe training and management company, present in over 67 practice locations and over 800 employees. We have successfully completed scribe programs in every environment possible; rural, urban, residency program present and highly political organizations, providing us with unparalleled expertise. Our scribes have been able to prove time and time again that they can master any electronic medical record system, while dramatically increasing physician productivity. We've even successfully pioneered the concept of using scribes to mitigate the decrease in ED efficiency when rolling out EMR- the nation's first!”

    So, with the federal requirement of EMR use, the backers at ScribeAmerica saw a need to streamline the process that physicians would have to go through. They saw a solution. They also saw the evolution of the EMR as a way to make an entire profession out of delivering a service to physicians to lighten their load, negotiate the EMR, and make money at it at the same time. They also promote a compressed learning and educational turn around time: “Fact, the lack of standardization in training is the most common reason for scribe program failure. Through the creation of the nations first scribe textbook, the development of our series of scribe training audio and video series, we educate our scribes in all the components of EM from allergy to trauma surgery. Quality is the difference vs. competition.” They also say: “You NEED to have good penmanship and computer skills, your medical expertise is NOT required but is an added bonus.”

    Here is their program: “The scribe training program consists of 3 steps: Step 1 is a 2-week orientation course designed to get the scribe "up to speed" for his first day of collaboration with the emergency room physician. Step 2 is supervisory period during which a highly experienced scribe offers immediate review and feedback of the new scribes work. Step 3 is a periodic re-assessment that allows for indefinite and frequent review of the scribe's role and effectiveness in an effort to enable the scribe to always keep up-to-date with a dynamic workplace environment.” Of course, they also offer a 120 hour “Advanced Program” as well.

    Now, what’s wrong with this picture? ScribeAmerica developed an insufficient “training program” in an industry that they did not understand, using a transient workforce, and did not, and still do not, see the workforce that already exists in patient documentation. So, my challenge to all of us here again is what do you intend to do about it? What ideas to you have to market our workforce in this new emerging marketplace called the EMR? What are you willing to do to assure proper documentation of patient records by professionals? What action steps are you ready to take to assure that our patients are protected? I welcome and look forward any productive solution-focused comments.


    Ava Marie George, CMT, AHDI-F

  76. Anonymous said...

    Ava Marie George, I am an AHDI member and have been for a very long time. I work as an independent contractor at home but have also worked in various positions in the profession since my MT training. The thing that bothers me about your response is that you didn't address the statement you made about working for less pay and being happy about it. I underwent extensive, expensive training, the equivalent of what should have been an associate degree. AAMT/AHDI has been trying to have the profession acknowledged as a profession so we can be paid as professionals. Now, as president-elect of AHDI, are you telling us that is not the case any more? I cannot afford to be paid any less with a family to raise and bills to pay as the main source of income. Is this what the future holds for me? If so, maybe I need to change professions now and not wait for wages to go down.

  77. Anonymous said...

    I think we all want to know "What, if anything, is AHDI doing about scribes?" I do not mean doing as in stopping, but doing as in working to make sure training is adequate in order to protect the patient record. Are we just sitting on the sidelines and ignoring the industry? This industry falls in line with our scope of health care documentation. Has the president or CEO spoken to ScribeAmerica before this announcement to discuss what scribes are, what training they receive, if they will access or document the patient record, and how they can be certified? Have they spoken with TRSI or the director working there about it since the announcement and asked them to publically explain the idea. It seems to me that every official reply is that no one really knows what is happening and that worries MTs especially when we are told that we should accept lower pay.

    Scribes have been a known topic and a significant concern for a while now, but AHDI appears to have not actively engaged the industry. Now that it is in our face with an MT training program offering scribe training, it seems that we are out of touch as an association and arguably not relevant. Seventy plus posts should let everyone know how much this issue matters to members. I think we would all feel more comfortable hearing from the company and the AHDI president/CEO and have them lay the issue to rest.

  78. Anonymous said...

    I have been an MT for 30+ years. I have always dragged my feet at getting credentialed. It was interesting to see the AHDI House of Delegates pass a resolution regarding credentialing this year. After Ava's comment, who represents AHDI as President-Elect, I am once and for all crossing off my list the thought of getting credentialed. It would not be required to be a scribe.

  79. Lea Sims said...

    AHDI's CEO Peter Preziosi has proactively reached out to the CEO of Scribe America on several occasions and worked hard to get a meeting with that CEO a few months ago. In that meeting, Peter urged that organization to work with AHDI to evaluate the scope of practice of the evolving role of scribes, how that role fits into the spectrum of healthcare documentation as a practice domain, and what ways AHDI could assist in pulling scribes under the umbrella of this sector so that scribing can connect up to the significant work that has already been done to establish training programs, credentials, etc., around healthcare documentation by our organization and others. Scribe America was, to my understanding, appreciative of our CEO's efforts to start a dialogue on that issue, but they do not see an intersect between what their scribes do and what our MTs do. They quite frankly see this as a completely different role better suited for the future medical students who are currently doing it - because it meets the needs of the physicians and also provides premed students with hands-on practical training in care delivery that will benefit them as they move on to other health careers. They just do not see this as a competitive role with transcription or one that requires our oversight or management. While we may disagree and hope we can develop a more symbiotic relationship with scribe organizations as we move forward, we can't force an issue with them here. We are active advocates for the quality of healthcare documentation no matter where or how it's done, but we can't force our authority on either Scribe America or TRSi.

    The announcement made by TRSi and Scribe America last week came as a complete surprise to all of us. Neither organization approached AHDI about it or involved us in that announcement. It was a business decision made between those two organizations, and quite frankly, neither one of them owes us an explanation. As an organization, AHDI will continue to reach across the aisle to Scribe America and other companies who train/deploy ER scribes to see where we can work collaboratively in the best interests of physicians, patients, and healthcare delivery.

    Part of the HOD resolution at ACE this year was to give our staff and leadership the green light to continue to push for and advocate credentials for MTs as well as for emerging roles like scribing, which we will continue to do.

    But it is a process of relationship-building, research, and productive dialogue over time. In the meantime, I would respectfully suggest that there may be a lot of early overreacting here to this development, and it will be our goal to ferret out where the distinction is between these roles and what "threat" (if any) it poses to our sector.


  80. Anonymous said...

    Based on the AHDI mission statement, shouldn't they represent the scribe occupation as well? Or am I missing something?

    "The Association for Healthcare Documentation Integrity (AHDI), formerly the American Association for Medical Transcription, is the world’s largest professional society representing the clinical documentation sector whose purpose is to set and uphold standards for education and practice in the field of health data capture and documentation that ensure the highest level of accuracy, privacy, and security for the U.S. healthcare system in order to protect public health, increase patient safety, and improve quality of care for healthcare consumers. AHDI works to advocate for workforce development and credentialing in allied health and the critical role of the technology-enabled documentation knowledge worker in the electronic health record (EHR)."

  81. Anonymous said...

    Lea, I'm still afraid you are missing the point. Since AHDI represents and advocates for MTs, and a director of AHDI works for TRSi, I believe everyone would appreciate an explanation from that director about the scribe occupation. There is no need for her to explain her employer's business decisions. But I do think as an elected representative of AHDI, more clarification from her is needed to at least put some minds at ease; she is the perfect person to do so. I would venture a guess that the CEO of TRSi would also be more than happy to explain the scribe industry if asked to do so.

  82. Lea Sims said...

    Anonymous, I can't argue with that. I can certainly ask her.


  83. Lea Sims said...

    "Based on the AHDI mission statement, shouldn't they represent the scribe occupation as well? Or am I missing something?"

    We certainly COULD represent the scribe occupation and most of us agree that this new role falls well within our mission, goals and objectives as an organization, but I think you're missing the fact that we can't just walk over to an independent workforce group that formed on its own, stamp an AHDI logo on their heads and say, "Shazam, scribes. We own you." LOL

    But it is precisely our mission statement, as you have provided above, that compels us as an organization to attempt to make inroads with this new profession and the organizations that have innovated around this new role. Attempting to throw our weight around (such as it is) with these scribe companies and their scribes is not how you build relationships that elevate awareness around our goals and concerns for their new and emerging role. Since they already don't think there is a connection between what they do and what we do, it would be rather hard to ask them to just "yield" to our authority and experience and allow us to represent them and their interests. We have to convince them that there is a clear and compelling connection between their role and ours, their goals and ours, their scope of practice and ours.

    Those kinds of connections and relationships take time and a lot of professional finesse, quite honestly. But we will continue to reach out and extend our hand to the scribe group in a consistent and strategic way, I'm sure.


  84. Anonymous said...

    I think the statement everyone is referring to is very open to interpretation, but I would agree that after reading it I am really re-thinking renewing my AHDI membership in 2011.

    "Are we willing to change our point of view and take a lower rate of pay to assure that the documentation is correct? If not, you will be left at the station as well. Let's face it...we like what we do, we like where we work, and we are not open to change. If this describes you, you will also be left at the station."

    I'm hoping some clarification is going to come soon.

    After about the 3rd time I read it I decided it was a jab at most of these posts that want everything to remain exactly the same with exactly the same pay, but then again that first sentence sounds like we should be happy to take lower pay and if not get out of the field. I'm quiet happy with my MT job but I'm not sure I like hearing from my professional organization that there is no hope for my career.

    The first time I read it, I took it to mean this is a no-win situation. MT work is done and over with and we need to find new jobs or go work as scribes and hope we can make it. At first glance, it looks like Ms. George is telling us to jump ship now because we're going down in rough waters.

    I'm looking forward to hearing clarification on this.

    I just finished looking through newspapers, job websites, Advance for HIM, and all of my usual spots for job hunting and did not find a single job advertised for scribes in my local area or the area of the hospital I work for. I'm preparing for the future, but I'm not about to jump ship from a job I love.

    There is one job advertised locally for a "scribe" but after reading it further they want a medical office assistant that can transcribe. It pays $17.50 per hour with full benefits. I don't think any of us would complain about that. Another job that is out-of-state is for an ER scribe for an attending. It says "other duties as needed on occasion." It also requires the applicant be an MD.

  85. Anonymous said...

    While I do agree that we can't tell a company what to do, we sure can and should be setting standards of practice for this. It's not a matter of asking scribes if they want to be a part of AHDI, it IS what we said we would do with the change of our name and the redefining of our mission statement. Saying we can't do this is like saying we can't set standards of practice for medical transcription without asking all of the MTSOs first.

  86. Anonymous said...

    Ava's comment actually did come through and is above (twice now). I also agree that it still does not address her comments about pay and wages that seemed to be so "take it and get over it." I wonder if that's also what she tells the MT students she instructs? That's the part I think people are concerned about in an organization that is supposed to be advocating for MTs and the profession.

  87. cheryl said...

    Come on people. This is nothing new. When Speech Rec. got accepted with its flaws into the EHR, we were told we were now "SR editors" and oh, BTW this requires taking a huge paycut, increasing productivity and shortening turnaround time. By all means though, rush out and get your CMT before AHDI makes the credentialing education requirements stiffer. I call BS. The truth is what it is, the industry is changing and like any other industry we need to educate ourselves further in electronic medical records, coding, and other places we have not treaded before. A more educated approach is proactive in my opinion. While I am up for new things, and the thought of getting back into action in an ER after decades in my home office sounds "fun", I can't afford the pay cut.

    On a positive note, while our industry seems to be "shutting down", other avenues are opening up if we choose to look outside the box.

  88. Lea Sims said...

    Ah, so it did. I think I scrolled by it and missed it. I deleted the extra posting. I also think it's important to keep in mind that no one person, including our President Elect, speaks for the association and its members. Contrary to what people think or assume about associations, there is no such thing as "uni-mind" around here. I can't argue against the reality that when staff or board speak and post here or elsewhere, it is often seen as an official opinion or statement coming from AHDI, but to get a sense of what "AHDI" thinks, you'd have to talk to a whole lot more leaders and members than just one or two. Each staff, board, delegate, and member is unique - with unique experiences, opinions, and ideas about how the association should go about addressing the problems of the industry. I wouldn't suggest that should change your opinion about what Ava has chosen to say, but just a reminder that hers is only one opinion among many.


  89. Anonymous said...

    To address Ava's questions:

    "ScribeAmerica developed an insufficient “training program” in an industry that they did not understand, using a transient workforce, and did not, and still do not, see the workforce that already exists in patient documentation. So, my challenge to all of us here again is what do you intend to do about it?"

    I had intended to continue paying my dues for AHDI membership, thinking my professional association would lead the way regarding this issue. Maybe I'm wrong?

    "What ideas to you have to market our workforce in this new emerging marketplace called the EMR?"

    Again, I thought my professional association would lead the way on this. Maybe I'm wrong?

    Is it not true that any actions taken need to come from a united front of a large number of people? That's what AHDI has been telling me all year.

  90. Nae said...

    All I can tell folks is that after reading this thread all the way through again, I have never felt so right about my decision not to renew this year after a membership of 14-15 years, more than 10 of those years as a CMT, a credential it now seems that many of the elected officials of the organization do not esteem enough to sit for themselves, yet insist "we" must all have that credential to work. Is that a dichotomy happening or what?

    All the time AHDI tells members “we are representing you” and yet when someone screws up it’s “wait that’s NOT AHDI.”

    Honestly, is AHDI the voice (representation) of the membership or not?

    For me it became very simple, I don't want my money going to help someone else teach folks how to take my job. In this whole thread that is essentially what it boils down to. Undoubtedly groups like scribes will exist, and there is always threat of anyone losing their job these days, but darned if I feel like paving the road for it voluntarily with my membership money.

    And, if it is true than an organization takes on the personality of the leader then what is this organization in for next year? I think that is a very real concept that many long-time members like myself are taking a hard look at and the answers are not real pretty.

  91. Anonymous said...

    I agree with Nae - "And, if it is true that an organization takes on the personality of the leader then what is this organization in for next year?"

  92. just a simpleton said...

    I agree with Nae also. I am very glad at this moment that I did not bend to the pressure to get credentialed "or else", after 23 years of being a working MT/MTSO with the same client all of those years. I'm also glad I selected AHIMA instead of AHDI to renew this year. Onward and upward, I say. I choose to represent myself.

  93. Kristin Hagen said...

    Our nation continues to evolve as a result of electronic health record mandates. It is important as an MT to recognize we have many opportunities. Several of us who began as MTs now work in management, quality assurance, education, health information management, IT, and other sectors. TRSI is a workforce development company and recognizes the need to provide and support different roles in the broad allied healthcare industry. Our medical transcription training program is one of our benchmarks and will continue to be built on high-quality standards, as well as other emerging education.

    Many allied healthcare roles are evolving; medical transcription is not alone within the domain of health information management. Technologies implemented through natural language processing ensure our place at the table through the Health Story Project, capturing structured encoded data that is computable. The Medical Data Exchange is another avenue to stay networked and participate in. AHDI as a professional association supports the membership, continuing education, networking, outreach, and staying informed at the national level. Healthcare and technologies will continue to change significantly over the next several years through government-sponsored incentives. We cannot change this, but we can influence this process. We as individuals need to be aware and dialogue changes to rally around the industry together. Innovation will be seen everywhere fulfilling and bridging the gaps through the convergence of developing roles and multiple associations’ initiatives transition together.

    Working together to build best practices for quality documentation and education standards is a collaborative effort, utilizing all of our skill sets. How do we get involved to a deeper level? Start by looking into your state/regional information exchanges. Where are they at in the process? Is one setup in your area? If not, when? What are their plans for creating sustainable growth? There are 60+ Regional Extension Centers that will enable job creation in your states. It is important to communicate, understand, and advocate at the local, state, and regional sectors the changes that are happening in your area.

    There are several common threads that hold us together.

    Kristin Hagen, CPHIT, CPEHR, CPHIE, AHDI-F
    AHDI BOD, 2009-2012

  94. Anonymous said...

    Nae you do make some points to consider. And I just got the new Matrix this last week, with a big cover promoting the Power of 10 and asking that we donate to having our voice heard in DC. I would sure want to know what voice that will be from the leaders if I were going to make that contribution.

  95. Nae said...

    Okay, what exactly is the message here?

    You are a BOD member,you work for TRSi, it says you are the Director of Curriculum Development at the TRSI website, correct?

    It's great that you are willing to come forward and speak with us, but honestly, isn't that what our BOD elected officials are supposed to do, speak to the members? Explain things the BOD acts on or does not act on? Are you an MT? A CMT? Are you responsible for designing the curriculum for the scribes at TRSi? I don't really care about your company's mission or business tactics, I care about what impact this scribe training and the low wages they are paid will have on MTs in general? I want to know why AHDI's Communications Director seemed to think the association knows little about scribes and their role, yet tells us in a later post she and our CEO did meet with you folks months ago with a less than satisfactory result in having all those questions she so carefully wrote out for us at the beginning of this post answered? I know it is way up at the beginning of this thread, but are you planning to explain to AHDI members, in your role as a TRSi representative AND an AHDI BOD member, the answers to those questions for us. I can get the canned salesman's business cant about what a great company you work for from the website, that is really not where my concern lies.


  96. Anonymous said...

    What do all those initials stand for Kristin?

  97. Anonymous said...

    Never mind. I found the site where they offer the online tests. Not a bad idea if you want to skip getting a HIT degree, RHIT or coding certificate.

  98. Sheila said...

    Ava Marie George said:

    "Are we willing to change our point of view and take a lower rate of pay to assure that the documentation is correct?"

    No. HELL NO. I don't work because I love documentation and want to make sure it is correct. I work for the money. When I can no longer make good money doing MT, I am done with it. I am a hospital MT. If this job gets outsourced, I am done with MT. I will not work for 4 cpl.

    And who is the AHDI board member that works for TRSi? Weren't there AAMT board members going to India with companies they worked for to train Indian MTs? That sure worked out great for the American MTs, didn't it?

  99. Lea Sims said...

    Nae, it would behoove you to read posts more carefully. I said the association does not know enough about scribes and their roles to do some of the reprimanding that was being suggested here. I never said that I met with anyone. I said that Peter met with the CEO from Scribe America - one time, which certainly wasn't enough of a connection to suddenly make us an authority on scribing. It's a process, but as you are in demand of answers and a strategy right now, that's not likely a satisfactory answer to you. And, as your post was directed at Kristin Hagen, the suggestion that Peter and I met with TRSi (ie, "you folks") is also not what I said. Neither I nor our CEO had any idea that TRSi was working with Scribe America to develop a training program. To my knowledge, Scribe America did not offer this information to Peter when he spoke with their CEO. We found out exactly the same time you did that TRSi had engaged in a business arrangement with Scribe America.

    And at the risk of inciting more blog posts about my need to moderate here, I would ask that you and others take a deep breath and apply the same yardstick about "tone" to your own posts as has been asked of those posting on behalf of AHDI. If it's the opinion that only AHDI's representatives need to be respectful, this dialogue will deteriorate rapidly (as is already the case) and no good can come of it other than creating a space for people to dump their anger with no real interest in constructive discussion.

    As I shared with our board members today, they have a responsibility to our members to get out here and drill down on these issues, provide informed answers where they can, and humbly avoid making predictions where more research is warranted. They should be willing to answer tough questions and admit when they can't answer them. But tough questions can be posed in a professional manner. I can't force anyone to approach these discussions that way, but I will continue to ask.

    The complexity of these issues, the divided passions people have about them, and the frustration people may or may not have with AHDI does not make it okay to treat people poorly here, and I would just ask (respectfully) that we all keep that in mind and let cool heads prevail.


  100. Anonymous said...

    We are still waiting for an answer from Ava Marie George on what she meant by her comment about MTs taking lower pay willingly and from Kristin Hagen on what this scribe training is all about. It is frustrating to get replies from these two that answer neither question. They are both board members and should respond directly to members’ questions. None of their responses have as yet. My opinion is that those kind of replies do more harm than good. Is it possible for us to get some direct answers?

  101. Anonymous said...

    My only gripe here is the statements made by our Ms. George. I researched scribes as thoroughly as possible a while back because I considered marketing that service to a local hospital. What I found was I do not think MTs are qualified to be scribes. An MT assuming he/she is qualified to be a scribe is as absurd as the opposite. They are two very different jobs. TRSi training scribes just does not worry me. Call an MTSO and ask them what school they most often hire MTs from, I can guarantee you it won't be TRSi. I think we know that. So why are we worried? I'm just not worried.

    Lets say the President came out and told the American people that the economy was hopeless and then did not clarify that statement beyond those words. Can you imagine?

    I think some pretty nasty things have been said here that should not have been said. Very unprofessional things that do not put a positive light on our profession by people who are obviously very angry. I would guess the same people were just as angry when SR began evolving. I'm not saying they do not have a right to be angry, but there is a more constructive way of handeling this.

    I really do not feel like venting all of that here accomplishes anything though, much like someone many posts back said. The solution I see is to send a letter to AHDI (not an e-mail) with my name on it stating that due to the fact the president elect has stated I should either accept low wages or find a new job, I will not renew my membership until we have a new president with a more positive outlook on my career. I also have to consider though if not wanting to work under the leadership of someone who feels this way about my career is worth sacrificing involvement in an organization that might better our field? I don't know the answer and will have to think about it myself. I am very dissapointed by her statements but I am also dissapointed in the behavior of my colleagues.

  102. Nae said...

    I don't really think I read your posts wrong, so I guess we will disagree about what is really going on with the organization :) and the double speak of conflicting messages. I would call those questions asked of Kristin appropriate for an elected BOD member of an organization that keeps telling us they speak for all MTs, even nonmembers. That those questions are now uncomfortable ones is a situation the BOD put itself in, and is not of the members or nonmembers making.

    I certainly do agree with you that it is an impasse that the organization has worked itself into and one I think it will have to solve with less and less long time members like myself :)


  103. Laura said...

    I would rather discuss the issues than whether or not people are going to re-up their membership. Good grief! When every industry issue becomes a referendum on the association, the conversation digresses instead of meeting the issues head on and looking for solutions. Personally, I don't care who's going to re-up, and the threats of a stampeding membership is getting old, tired and meaningless.

    Can we stick to the issue at hand?

    Anonymous said...
    December 8, 2010 12:24 AM
    "I researched scribes as thoroughly as possible a while back because I considered marketing that service to a local hospital. What I found was I do not think MTs are qualified to be scribes. An MT assuming he/she is qualified to be a scribe is as absurd as the opposite."

    Can you tell us what you learned about scribes and the key points that you think make this job distinctly different and inappropriate for MTs?

  104. Barb Marques, CMT, AHDI-F, 2010/2011 President said...

    Where to begin? I appreciate the last post that requested we return to the original topic and others who posted, requesting that some answers be forthcoming. I had hoped to be able to target a few points and be very concise; I’m sorry – this won’t be brief. So this is Part I.

    Reviewing the posts this morning, here is some of what I glean:
    1. What, if anything, is AHDI doing about scribes, as well as other entities that affect our place in healthcare documentation?
    2. Is it the official stance of AHDI that MTs should be accepting positions such as scribes for lower wages?
    3. What is AHDI doing to promote our skills and knowledge base to the HIM sector and to decision makers who are overlooking our ability to offer a solution to the problems with EMRs?
    4. What are we doing to educate vendors, facilities, the public and legislators about the inefficiencies in EHRs? What has Dewey Squared done for us?
    5. What happened to advocacy for MTs? How does the individual MT fit into this bigger, scarier, more threatening picture?

    I will respond to these as best I can, admitting freely that, even as AHDI President, I do not have all the answers, or a crystal ball. I do know that I work from home as an MT and still find constant, joyful challenge in the work. I do worry that some day my job might be eliminated and I am concerned about what I am doing to prepare myself for that possibility, or decide if I even want to be doing exactly what I am now for the next 10 to 15 years. And I am passionate in my support for our workforce, our profession and our association.

    Our AHDI CEO Peter Preziosi met with the president of Scribe America. We looked at it as an opportunity to begin a conversation about the integrity of healthcare documentation and our concerns about accuracy, privacy, standards of practice in documentation and completeness of the medical record. That organization so far doesn’t see any particular need to associate with AHDI, but we haven’t thrown their phone number away! Basic descriptions of scribe responsibilities seem to portray them as a solution to keeping healthcare providers from serving as data entry clerks. Couldn’t we offer a more comprehensive solution? Probably. I think we can agree that the whole approach with scribes is a temporary fix to the frustrations of EMR use in their current formats.

    I can tell you that our conversations in many arenas continue as we DO point out that MTs could be the solution to many of the challenges in staffing and workflows, and we are actively looking at roles for the MT knowledge base and skills that compliment what we already do, such as in record audits and quality assessment. Why? We recognize that there are fewer traditional dictation/transcription jobs due to speech recognition, templated documentation and healthcare providers doing their own data entry. Specifically, our Managers’ & Supervisors’ workgroup is preparing a survey for HIM managers to ascertain who is currently filling these ancillary roles, and if not MTs, why not? What skills and training courses might AHDI need to offer to help our MTs move into these roles, if desired and appropriate? Survey release timeline: shortly after the first of the New Year.

    Please see Part II
    Barb Marques, CMT, AHDI-F
    AHDI President

  105. Barb Marques, CMT, AHDI-F, 2010/2011 President said...

    Part II:
    Furthermore, AHDI has asked AHIMA to recognize officially that the RMT/CMT certification is a valid inclusion in the HIM arena. I expect us to hear back on that process in the next week or so. What are the obstacles to MTs being sought out as a solution to work flow challenges? We are not a credentialed workforce, and those hiring for those positions, such an auditor, have no to way to judge our capabilities and skills as a workforce in the whole.

    That is why we have the push to have all MTs credentialed, not because AHDI will make more money (because we won’t) but to assure the visibility and credibility of our sector and secure our future in healthcare documentation.

    There are few constants in this world, few things that are for sure. But one prediction I think we can make is that there will be even fewer traditional roles for transcriptionists if all documentation were to move to check-marked templates and self-entry by healthcare providers. That is where the criticality of preserving the narrative portion of documentation is our key. That narrative frequently provides the basis for explaining a diagnostic thinking process as well as further understanding of how the patient came to need medical attention, and what will be needed to achieve the desired recovery course. I have yet to see a template document that contains such specificity.

    Preserving that narrative is the key to preserving dictation and thus an important part of our contribution to documentation. AHDI is gearing up to launch a formal “Preserve the patient narrative” campaign, with the help of Dewey Square Group, which will help us formulate that message for best potential outcomes with legislators through our advocacy efforts. (Connection here: Power of 10.) That same message is valid for our connections with the AMA and the American Hospital Association, and I have challenged Peter to set us up with an additional AMA meeting while we are in D.C. for the Advocacy Summit. We hear from our physician speakers at our meetings that they do not want to be data entry clerks, that they value our skills, and I want to pass even more of that on to the AMA national. CDIA is forming a physician advisory group, and I plan to try to add that voice to our meeting with the AMA.

    Content of records rich in specificity also guide a multitude of reimbursement codes. And there we are back to the money. If enough codes cannot be linked to that healthcare encounter, the reimbursement may not even cover the cost of seeing that patient. It’s easy for us to say, ”Just let them dictate!” That does not solve the conundrum of EMR vendors selling a decrease in medical costs though elimination of transcription, but proof of the quality that we bring to documentation I believe will sway some of those decisions to keep us and dictation included. We will continue to advocate that the definition of meaningful use of new EMRs include an option of dictation and transcription, by participating in the federal level discussion on that issue so the patient’s “story” is captured. We will be producing documents that support what accuracy is gained by including transcription and/or the MT editor in documentation. Audits are becoming more frequent to assess the errors contained in front end speech-recognized documents. Other audits are aimed at assessing if reimbursement is all that it can be and driving a return to dictation and transcription. I am determined to link our information to the results of those audits.

    Please see Part III

    Barb Marques, CMT, AHDI-F
    AHDI President

  106. Barb Marques, CMT, AHDI-F, 2010/2011 President said...

    Part III

    Is it the official AHDI position that MTs be willing to take lower-paying jobs such as those for scribes? Unequivocally NO. AHDI supports clear and fair compensation, and transparency of compensation practices. I believe Director George’s comment may have been meant to convey that in this economy, some may be left with few choices in order to make a house payment or afford electricity. In some cases, A Job is better than No job if it provides compensation one can live on; this is really up to the individual and their circumstances. If we were a labor union, we would be in a position to mandate that our workforce be paid more. We are not. AHDI is a professional association and our mission is to set the standards for education and practice in healthcare documentation. Is it within our scope of practice to dictate what fields will be included in a templated document? Not really. Is it within our sphere of influence to encourage scribes to understand HIPAA guidelines, accuracy issues and standards? I think we can work on that.

    We are building relationships and networking with those in influential positions. We can and do approve transcription programs and curricula that are already heavily weighted in favor of certified instructors. AHDI encourages the individual MT in their continuing education efforts. I encourage the individual MT to stay connected and be aware of technology and issues. Help your AHDI leadership continue to talk to those who make the decisions about our valuable contribution to accuracy of the medical record, if nothing else. Consider becoming credentialed, because that is our key to visibility.

    But we also need to arrive at an understanding among ourselves: Is keyboarding and working at home the crux of being an MT? What do you see as our core competencies? What exactly is our space and place in clinical documentation and how do we take ownership of it? It is difficult to move forward when we are not of one voice and one opinion as to what we should and could be.


    Barb Marques, CMT, AHDI-F
    AHDI President

  107. Anonymous said...

    I would normally be very happy to but I've now been told by my professional association that I should learn to be happy with low pay or find another job and now I've been told I should just shut up about that. I won't be participating here further or reading one more word of this. What I found, and in talking to other professionals, made it extremely clear MTs that have not worked in patient care are not qualified to be scribes. This is a mix between an allied healthcare professional in an entry-level hands on care position and an entry-level HIM professional, not an MT. Based on what I learned, an MT assuming they could be a scribe is exactly as arrogant as the doctor who assumes he could just be an MT in his free time. I'm not wasting another minute of my time with an organization that belives I should accept low pay or get out to answer more than that. The biggest issue in this entire thread for me is not that scribes are going to swoop in and take away our jobs but rather the statement that we should be happy with low pay or find another job. If that were said by Jane Doe Member it wouldn't be an issue. But it wasn't. It was said by someone who, per her own blog, had president of AHDI on her bucket list, and now refuses to clarify that statement further. I think a lot of people here are failing to see how powerful those words were. I'm not worried about scribes and I'm sure not worried about TRSi training anyone to do anything more than sit in the unemployment line. I honestly do not care that a business saw an opportunity and went for it. What does worry me is the horrible attitude of someone who is in a position to shape the future of my professional organization. If you don't care that quite a few of us will not renew because of that, then clearly we're making the right decision. I absolutely enjoy my MT job and am very satisfied with every aspect of it and want nothing to do with the negativity displayed by Ms. George and others.

    Kudos to Lea for the absolutely professional and polite way she has expressed herself in this thread.

  108. Anonymous said...

    I absolutely do understand how powerful Ava's words were - should be happy with low pay or find another job. I am very concerned with how her attitude is going to shape the future of AHDI, my professional organization. I think several readers feel the same way. It's unfortunate.

  109. Laura said...

    Barb, to add to your comments on the narrative and AHDI's efforts to retain the narrative, I want to also mention The Health Story Project. This project, started in late 2007, is directed at preserving the value of narrative information in the health record while still providing a viable mechanism for capturing discrete data that drives many of the advantages of an EHR. We like to say that it allows physicians to have their cake and eat it too!
    The Health Story project has an associate charter from HL7, is supported by AHDI, CDIA, AHIMA and many vendors (MedQuist, MModal, GE, Nuance, 3M, and many more) . It has the attention of ONCHIT, HITSP, and other standards-setting bodies that are contributing to the rules around meaningful use. At least one of the templates created by the Health Story has been cited by HITSP as a standard to be used in the certification of EHRs. The work of the Health Story project is consistent with and supports the CCD and CCR templates used for communicating patient information for continuity of care (patient hand-offs, transfers, referrals), which are part of mandatory meaningful use requirements for 2012.

    All this is to say that the Health Story project is a viable and respected project that seeks to retain the narrative in the EHR. This speaks directly to the role of MTs and how MTs can continue to have a meaningful and critical role in the future of healthcare documentation. This is a perfect example of how AHDI and CDIA are working directly to support future roles for MTs (in the "what have you done for me lately" column).

    I find the "selective" hearing of this audience to be quite confusing. AHDI leaders have been saying for years that certification is an important issue that should be embraced by the industry. It has been an official position of the association and spoken about by numerous staff and leaders for years. But, people have chosen to ignore it. BUT, now we have one leader who (probably through a poor choice of words) has suggested that MTs should accept lower pay in order to continue to work in the field. That one statement, made one time by one person, has been taken as GOSPEL and is suddenly accepted as the de facto position of the association. This is selective hearing at its worst.

    I think it is important that people recognize and catalog the knowledge base of an MT and the skill set that we have, because that is how people will continue to transition through emerging jobs (in all fields—not just medicine). Every job in every field is changing rapidly, and I can't think of very many professions where the job looks and feels like it did 20 years ago. But the underlying knowledge that supports that job is what remains. How do MTs take their knowledge of medical terminology, disease processes, written communication skills, listening skills, eye for detail, and knowledge of documentation guidelines and translate that into a job that fits into a future healthcare role? My background is in laboratory technology, which at first glance does not seem remotely related to MT, but I was able to translate my underlying knowledge of disease processes, laboratory medicine and technology into a career in MT. You can't look at merely the surface of the job--you have to look at the actual working knowledge required of a job to determine if the knowledge will translate to a different position. But, does that mean that every MT would want to transition to a scribe? No, not any more than all my colleagues in the lab would necessarily want, or be able to, translate their skills to transcription.

    Anyone else have real information to share about scribes and how their knowledge base and skill set distinctly differ from that of an MT?

  110. Cynthia Peacock said...

    I think there is much wing walking out there. I still make a good living in the medical transcription industry, but I have made a point in the recent past to expand my nontranscription skill set. It appears to me that AHDI was doing just that when it changed its name from AAMT to AHDI and aligned more closely with MTIA.

    I do not consider SRT, off-shore MTs, or scribes a significant threat to our profession, but rather I feel poorly prepared MTs hurt us each time they prepare a medical report. I appreciate AHDI's advocating for MTs, but I think with so many healthcare providers awarding low-bid transcription contracts, poorly prepared MTs will be overly represented in the transcription industry. These low paid, poorly trained MTs who typicallly choose this field because of its convenience have no incentive to even use reference materials because it slows them down.

    I think the ONLY choice AHDI has at this point is to take a stand that only certified transcriptionists are fit to transcribe sensitive medical reports, and, sadly, throw the uncertified MTs (many of whom are excellent MTs) under the bus. I was certified in the early 1990s and let my certification lapse in that it was not in the least useful to me. My plan is become recertified in 2011 and then become more vocal about the need for certification. My credentialing effort may not pay off if AHDI does not risk alienating the noncertified MTs. I'm not sure why MTSOs hire incompetent transcriptionists, but I don't see the quality of the transcribed medical record getting any better; in fact it has gotten much worse. I wish all MTs had the work ethic to do a better job, but I don't see that happening.

    While a physician is required to review the transcribed record, the physician should not have to spend protracted time editing the report because the MT was incompetent. When you see 20 blanks on a report that was dictated by a physician with the voice of a broadcast journalist, there is a real problem.

    I have no problem with medical scribes being included in AHDI. I know I'm a minority, but I've always wondered why MTs weren't part of AHIMA rather than a separate organization.

  111. Janet Kunze, CMT said...

    I think it's great that TRSI has the opportunity to train scribes. I hope they have the opportunity to teach MT values in the scribe course. That could pay off big time for MTs when these med students begin documenting their work in the future. Maybe we can look at this as a small way to get dictation training into the medical curriculum or at least a little more appreciation of MTs.

  112. Barb Marques, CMT, AHDI-F, 2010/2011 President said...

    I will look forward to adding your voice to those advocating for a credentialed workforce. I do think that before we throw the uncredentialed MTs under the bus that we should give them ample opportunities to become certified. Kaiser in Denver about 15 or so months ago mandated that all their MTs become credentialed, if they were not already. They studied and studied, tested and passed within a given time frame. If all employers took that stand, that where they need transcription, they need a provable skill set, I think we'd see more MTs moving in that direction. Part of the issue as well is that there are no barriers to entry into MT programs in most instances, basically not allowed if I understand community colleges. If you can type.... That would be a good step in the right direction as well. If you read my previous post here under "Extinction vs Invisibility" (October) I am concerned as well about what we can to do repair the reputation of MTs who are simply not qualified to do the work. Suggestions?

  113. Maggie Armbruster, CMT, AHDI-F said...

    Barbara, I have always been a proponent for a credentialed workforce and I do believe that ample time is going to be necessary to allow everyone to become either a credentialed professional or categorized apart from that sector as another type of career entity. Our transcription service requires our MTs to be credentialed (and all have obtained their credentials or are going to obtain them by early next year, including management). Our school also effectively pushes the students to graduate with their RMT. Hard decisions are ahead and the quickest most efficient way is to solve them by the top down, otherwise we continue the quest slowly from the bottom up. Barb, I would like the opportunity to respond to your answer to my question of: What is the biggest obstacle for AHDI to accomplish mandatory credentialing?

  114. Ava Marie George said...

    Communication is a very important action and ability. I’m afraid that I’ve executed the action, but not the ability so well. Let me first apologize to anyone who was offended by my remark regarding taking a job as a scribe at the salary that scribes currently are being compensated. I’ve had some time to think about how my comment was received. I would like to take this opportunity to explain my actual intent, if you would allow. When I was constructing that response, I was in full on professor mode. You know how we all can get when we’re in the role that we perform. I was thinking of what a wonderful opportunity the scribe position would be for our students…the students that our profession trains, certifies, and has confidence in the ability that they have to perform a job that is similar, yet not the same as we perform as veterans in the profession. We always talk about how to get our students into the profession without much experience. What an opportunity for them to enter into the documentation profession as a scribe as their first job experience. My miss on the communication spectrum is that my brain was thinking all of this, but my hands were not communicating it through the written word. For that mistake, I am sorry. I hope to continue to see constructive, respectful conversation here in the Lounge, taking into consideration that sometimes the flat words that we read are not all that was intended by the writer.

  115. 41b69c34-64b4-11e0-a07f-000bcdcb8a73 said...

    I'm a current scribe. The reason there is a high turn over rate is because scribes are only recruited from pre-med students or pre-physican assistant students. They are able to pay us only ten dollars an hour due to the fact that most of us desperately need the medical experience before applying to said pa, do, or md schools. It is a great learning experience for us, as the MD's and PA's are willing to teach us at length various theorys of medicine etc. They get "cheap labor," we get invaluable experience and in most case quick acceptances to schools. I can not see anyone being a lifetime scribe with the average duration usually 1 to 3 years at most. I enjoyed it immensely however, and ended up getting accepted to my first choice PA school :-)

  116. Anonymous said...

    I would encourage any American MT reading this *not* to join AHDI. They go to Congress and claim to speak on behalf of American MTs when in fact they use us to hide their overseas workforce who is also 'credentialed' in places like Pakistan (Taliban Typing anyone?) and India, the Philippines, Barbados, Kenya - anywhere - regardless if they have data privacy laws or not (India has no data privacy laws, never has). The whole intent of AHDI/CDIA is to have a token American front hide the exploitation of cheap labor. The scribe thing is just one more justification for their existence if they can somehow be involved.

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