Real Proofreading

button proofreadingI invite you to view a sample IME report that I recently reviewed.  I have doctored up the content and corrections to keep it unidentifiable, but also to give you some idea about what we do as IME QA specialists.  My peers can't believe that in the mainstream medical transcription industry, this type of process does not take place, the reports go straight to the record from the medical transcriptionist, that transcriptionists are also the proofreaders.  I mean, they think it is WILD.  The report is transcribed and sent to the QA department (there are 4 of us).  We review the report, more than once, communicating back and forth with the physician to bring the document into alignment with its purpose (to provide information to the insurance company about the patient's injuries as related to accidents).  If the doctor has not provided that, we prompt him/her to do so.  Of course, we also review for MT typos, formatting, and grammar, but we are not interested in them really, only to correct them; errors are an expected part of the process, as they are in other document-producing industries.  If we see something repeatedly, we might ask our manager to inform the transcription company.  Usually, these are formatting issues.  We spend our time on ensuring document quality, not sending sloppy ones through to save time and money, not in counting MT errors.

So, the doctor dictates, the report is transcribed, it is reviewed by QA, QA communicates with the physician to address content and correct errors (the doctor's and the transcriptionist's; it's not relevant to point them out, just fix them), the report is finalized and signed by the physician, an uneditible PDF file is created as the final document.

sample IME report.

In my opinion, one of the fundamental problems with the quality of our medical records is the manner in which the medical transcription industry has advocated and adopted procedures that don't truly ensure quality.  In a Daily Dose sent out last week, I referred to this article, "What is the Role of a Proofreader in Transcription?"  Once again, and I have mentioned this on many occasions, there is no other document-producing industry that has the transcriber of a document proofreading their own produced transcript.  This section of the article particularly resonated with me.

"Transcriptionists are simultaneously typing and listening to an audio file while transcribing, which leaves room for mistakes. Moreover, transcription is done at a rather fast pace, which makes it prone to errors. The role of the proofreader is to be the second set of eyes and ears before a document reaches the client, so as to maintain high accuracy levels."

As I began to work in this industry, this antagonized me to no end, to be part of a flawed process, to have my work and pay check measured against me having to navigate inside that flawed process (me proofreading my own work and being scolded for making human errors), QA people nagging about typos, an entire industry and its professional organization promoting this flawed process, not engaging in proper quality management techniques, everything falling on the worker, the medical transcriptionist, while our salary continues to diminish.  It is an insanity that few will comment on.

In the recent past, I began to explore the AHDI quality assurance tool kit with Sherry Doggett.  Unfortunately, the process came to a halt because I just fundamentally do not agree with the basic manner in which we do medical transcription, that which is promoted by our professional organization, and without that, I do not believe we have the proper foundation for promoting proper quality management procedures.  That is, how can I assist in revising a QA process when I disagree with the manner in which our industry produces documents to begin with?  We cannot assure quality documents in an environment that, in my opinion, has a poor foundation with regard to that.  The current processes at AHDI do still focus on and provide tools for measuring MT errors (though there are references that suggest reviewing other aspects, there are no tools for doing so, and I have seen no evidence that anyone in our industry is doing that0; MT errors should be found and corrected by a proofreader; an MT cannot listen, translate, transcribe, and proofread in a manner that assures quality.  It is not a method that ensures quality of the process.  There are references to other parts of the process.  But, to me, there remains a focus on counting MT errors.  After an accurate-promoting procedure is in place, THEN, a quality management process could be employed to find errors of the completed product, a product that has already been subjected to thorough qualitative efforts.  Performing quality management in a setting with a poor process is an inappropriate way to manage quality.

Hunting for human errors, as a sole means of accuracy assurance, as I have advocated on several occasions, is not what quality management is about.  It is about the analysis of an entire system.   This is what I am looking for The Joint Commission to impose on the medical records/medical transcription/healthcare documentation industry, standards that will properly teach and enforce this activity.

Our industry has come to accept quality as what we think the market will bear, as if it is our responsibility to mitigate that for American patients.  And, while we have poor processes in place in medical transcription, it seems the focus continues to be on how to stop the EHR, how to criticize the scribe industry, how terrible clinician-entry is, how to point our fingers at every other healthcare-document process while we continue to live inside our own huge mess with little acknowledgment of that or how to fix it.

What do you think?





  1. Name Hidden Due to Privacy - September 3, 2016, 10:03 pm

    I would be a great proofreader. Any ideas??

  2. Name Hidden Due to Privacy - June 27, 2016, 6:59 pm

    Hi Lynne – Sorry for the delay in commenting. I saw/approved your comments last week and meant to reply, but got away from it. Yes, I mean, IMO, we are asking way to much of each of these processes, then wonder why we don’t have quality. I don’t think we can expect a physician to have it all together as he speaks out a summary of a report, that he will have all the grammar correct, the sentences he wants, that he will address the whole of a thing, etc. I think we have to treat these things as the complex animals that they are. Having said that, I also don’t think a transcriptionist can do it all – hear, translate, transcribe, proofread, publish. There just is no other document-producing industry that does this anywhere else. It seems that it’s a process that got made up and never really scrutinized. The process of creating medical record documents demands more than these things, yet we keep arguing about it based on old ideas. I’m going to clean up another report I saw today that will be a good example to demonstrate. In it, the doctor adds some paragraphs and changes some of his own phrases and so forth. He/she should have that opportunity. Whatever it takes should be made available. And yea, in my own environment, there are repeated formatting issues that we should be asking the transcription company to fix, and we will, but right now we are just fixing those things. It’s not a huge deal, but it’d be really silly to be wasting time report those errors one by one, here and there, to them. THAT data is meaningless anyway, 5% samples and such. More later. Thanks so much for participating in the conversations.

  3. Name Hidden Due to Privacy - June 21, 2016, 8:07 am

    I enjoyed viewing the proofed IME. I type IMEs frequently, and I often wonder about the corrections that are made after the fact. It seems some things are simply a matter of style preference and could be communicated to the MTs and would result in less time spent editing. Of course, there are things that have to be clarified by the physician. I am not involved in that part of the process, but I would like to be involved. Working for an MTSO on production does not allow for that it seems.

  4. Name Hidden Due to Privacy - June 21, 2016, 8:01 am

    I completely agree with you Debbie that hunting for human errors as a sole means of accuracy assurance is not what quality management is about. Indeed, what those practices end up doing is destroying the confidence of highly skilled MTs, probably contributing to some leaving the profession for work that has less punitive practices and better pay to boot.

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