Blog Archive

Future Medical Transcription

November 21, 2011
An Uncertain Future
By Selena Chavis
For The Record
Vol. 23 No. 21 P. 10
As the healthcare industry becomes increasingly electronic, medical transcriptionists are trying to find a new identity.
Like many facets of the healthcare industry, the medical transcription field is evolving around the electronic movement. Many questions are being raised as to how transcription will redefine itself to work alongside speech recognition technology and EHRs. As it stands, the verdict is still out as to what exactly the future holds for this field as it attempts to adapt and morph into something new.
Opinions on where transcription is headed run the gamut. Some industry professionals predict its demise, while others see an elevated role for medical transcriptionists (MTs) that will coincide with decreasing demand and the elimination of some jobs.
But what is certain, according to many MTs, is that it’s high time for the industry to become proactive about its future.
“The entire industry is in a huge state of flux,” says Kathy Nicholls, CMT, AHDI-F, owner of Nicholls Consulting Services and founder of an academy for MTs adjusting to life in an EHR environment. “What I don’t think we can do is sit around and wring our hands and just say, ‘We don’t know what the future will look like.’ If we don’t get proactive, all those roles will be redefined for us.”
While much anxiety exists within the transcription industry, savvy professionals are gearing up to meet the challenge. From redefined roles as editors to new careers as coders, MTs have a vast amount of medical knowledge that can be leveraged, according to industry experts.
“I’m not sure what direction to go in, but we cannot wait here for everyone else to decide our fate,” says a 16-year medical transcription veteran who requested anonymity.
A Challenging Outlook
According to Kathy Lengel, manager of transcription services for Pennsylvania-based Lancaster General Health, the comprehensive health system that operates one of the state’s busiest hospitals, has witnessed a huge change in its workflow over the past two years. She attributes the makeover to the deployment and use of the organization’s EHR.
“We had 74 transcriptionists in 2007 [in the health system’s central transcription department]. Currently, we’re down to 66,” she notes. “We do 75% of the work we used to do. I’m expecting huge decreases in staffing going forward.”
The challenging outlook is not just reserved for the hospital environment. Staffing decreases are the expectation across the industry whether an MT works directly for a hospital, a large transcription services company, or a mom-and-pop operation.
Carole Gilbert, RHIT, owner of Gilbert Medical Transcription Service, a small company that has been in business since 1984, has experienced some downsizing over the past two years after two of its hospital clients moved to speech recognition software. “We’re very cautious in hiring staff. Staffing has become much more difficult to manage, but we don’t want to overstaff,” she says.
Some of the challenge is directly related to the changing dynamics of the transcription function that is moving MTs away from their traditional responsibilities into more of an editing role. As speech recognition technology becomes more mainstream, the delivery of physician dictation becomes automated, requiring a different skill set—one that edits computer-generated documents for accuracy and quality.
Hospitals and healthcare organizations are capitalizing on the efficiencies speech recognition software creates within an EHR through automation. Industry experts predict that it will continue to enhance data-sharing efficiencies as EHRs integrate with established systems for interoperable healthcare reports that conform to standards for information exchange. The standardization and adoption of these electronic documents are expected to enlarge and improve the flow of data, including narrative documentation, into the EHR.
As this industry movement continues to evolve, experts suggest MTs will need to hone their listening skills, and adopt a more critical-thinking approach to their work. Such attributes will require a broad knowledge of medical terminology and processes, making certified MTs a valuable commodity while diminishing opportunities for those who lack this expertise.
Alongside decreasing demand and a need for more advanced skills, another issue clouds the future of MTs: declining pay rates. The drop in salary is creating anxiety in the industry as to whether a career as an MT will remain financially viable.
“Some [MTs] have gone from 9.5 cents per line to 3.5 cents per line,” says Gilbert, adding that productivity demands tend to be unrealistic in the new editing positions. “The jury is still out as to whether you can make the same income editing. The premise for speech editing is that it would be more efficient, but MTs should still be able to make the same amount. We’re finding that’s not necessarily the case.”
The 16-year industry veteran, who works for a large transcription services company, has dealt with pay decreases over the past few years. Alongside the EHR challenge, she points out that competition with offshore labor in countries such as India continues to drive down medical transcription salaries. “We’re either going to be zapped by India or EHRs,” she says. “The time expectations are not in line with what is really required for editing.”
Besides dealing with wage woes, owners of small transcription companies such as Gilbert Medical Transcription Service are finding that scheduling is becoming an increasingly difficult challenge. Because the workload varies and is more inconsistent than in the past, Gilbert says companies and staff have to be much more flexible.
“The variance in workload really affects us. People have to be ready to go at a moment’s notice,” she points out. “In order to meet clients’ needs, we have to work flexible shifts rather than set shifts.”
Unrealistic Claims?
Decreased demand for MTs may be a reality going forward, but some industry vendors and professionals have even suggested that speech recognition and automation can ultimately eliminate the need for transcription. However, those in the transcription trenches debunk this assertion.
“These claims are disingenuous,” says the longtime MT. “There are too many things that the software is not able to do without human intervention.”
Gilbert concurs, noting that computer-generated transcription “would be a completely inaccurate report without speech editing.”
In a study published in October by the American Journal of Roentgenology, researchers found dramatically higher rates of major errors in patient records created using front-end speech recognition technology compared with reports that were dictated and transcribed. The study’s abstract reveals that at least one major error was found in 23% of the reports generated with speech recognition as opposed to a 4% error rate in reports that used conventional dictation transcription, making speech recognition eight times more likely to result in major errors.
“The whole purpose is to have an accurate, timely report. That’s what the push is for the EHR,” Gilbert notes. “What is the sense of having an inaccurate record transmitted faster? It doesn’t make sense in the context of patient care.”
Nicholls points out that the errors found in documents transcribed in speech recognition would never pass the test in a traditional transcription environment, adding that there will always be the need for some type of quality follow-up.
“If we allow [the elimination of transcription] to happen, then we are going to have some serious errors,” she says, admitting that while there will always be some need for MTs, it is inevitable that the industry will shrink. “I think there will be much less transcription. We can’t hang our hats on the narrative.”
Leveraging Potential Opportunities
Gilbert notes that the industry needs to have a united voice that promotes the value of editing skills and the need to elevate pay scales to a livable wage.
Until editing becomes more prominent, MTs need to look at other skills, suggest industry experts.
For example, the transcription department at Lancaster General Health has started to redefine its role, even going so far as to consider changing the department’s moniker. “I’m hearing a lot more talk of data-quality checks in the industry now,” Lengel says, suggesting that such a change presents an opportunity for MTs to take their knowledge and expand it in a new direction. “That’s where I’m seeing the momentum going. We’re working with physician champions to roll out a data-quality program.”
In Lengel’s department, 15 MTs have been cross-trained to perform abstracting in the organization’s physician offices to get information into the EHR and eliminate errors. The department has also been involved with validating quality on a broader scale as the entire organization implements a new EHR.
In these roles, Lengel acknowledges that certified MTs (CMTs) definitely have an edge on their noncertified colleagues. “CMTs have the advantage because they have the general knowledge,” she says. “You need to have experience with the patient record. We will require CMTs in this role.”
Some MTs at Lancaster General Health are taking courses to broaden their knowledge base, and Lengel is working with hospital staff to determine other areas where MTs may be a good fit. In fact, two transcriptionists have successfully made a transition into the coding department.
“My director and I are just very honest with our staff. At least they know where things stand,” she says. “I strongly believe there’s going to always be a need for transcription … just decreased demand.”
— Selena Chavis is a Florida-based freelance journalist whose writing appears regularly in various trade and consumer publications covering everything from corporate and managerial topics to healthcare and travel.

A Two-Sided Perspective 
A physician assistant (PA) since 1982 and a medical transcriptionist (MT) since 1992, Sherry Roth, PA-C, DF-AAPA, CMT, AHDI-F, has been able to make the transition to working with an EHR without too many headaches. She attributes the ease of her metamorphosis to a background in the medical field and IT experience—two skill sets that will be important from a quality perspective going forward.
“Being a PA has been invaluable because I have such a broad knowledge of medical terminology and the field,” she notes. “Plus, technology is something I’ve always been interested in. Expanding the skill set from there becomes another step.”
Not all MTs will make the transition as easily as Roth, but she believes the skills that helped her adapt to a changing environment will be important to maintaining quality as more MTs become editors of computer-generated documents. Unfortunately, the industry appears to be moving in a direction that undervalues and underpays this skill set, she points out. As a result, the best MTs will begin to look for greener pastures.
“They are paying 3 cents a line for editing. It’s ridiculous and demeaning,” Roth says. “I think you don’t get the quality of people you need. They don’t realize our value as transcriptionists to promote good patient care and patient safety.”
As a PA, Roth sees firsthand how an EHR can improve patient care and outcomes. To that end, the availability of accurate documentation in a timely manner is essential to having the complete patient picture the industry is striving to capture. Without quality editing that draws from broad industry and medical knowledge, Roth fears the content in patient records will suffer, and it will become increasingly difficult to recruit qualified MTs.
“Unless and until 100% accurate documentation is produced, natural language processing [NLP] will be less effective in data mining and will miss or misinterpret things. The less human involvement you have in these processes, the more important it is to make sure that the information provided to the software program is accurate,” she says.
For example, Roth recalls going through a patient’s chart and finding a progress note with a physician’s interpretation of a slightly elevated troponin as being indicative of a non-ST segment elevation myocardial infarction (STEMI). Two pages later, however, a note from a cardiologist said it was not a non-STEMI and was related to coronary heart failure leak.
“How will NLP interpret this discrepancy? I’ve seen human coders make mistakes; how much more so a computer program?” Roth asks. “This is not to say that NLP is useless; on the contrary, it can be fantastic because of the speed with which it can fly through records and pull out information. However, data is not the same as information or knowledge. Humans must still be involved from beginning to end.”
— SC

Style guide

Importance of the Style Guide

Consistency in typing and editing is important to the development of voice models since
Auto Script analyses the dictation and compares it to the final written report. In order to
ensure consistency, each institution creates a Style Guide that defines what the final
reports will look like.
Style Guide Requirements
Style Guide requirements can include:

Voice model

The Voice Model

Voice models process what the clinician says to produce a draft document. Here is how it


  • The clinician dictates and the MT transcribes. AutoScript analyzes the dictation and compares it to the final written report.

  •  After approximately 1.5 hours of audio and 50 reports, AutoScript develops a voice model per clinician and work type.
  •  Based on each voice model, voice recognized drafts are produced.
  •  Voice recognized drafts are not perfect and always need some editing.

Voice models recognize sounds and strings them into words and phrases. Using complex formulas, they put these words into context and format the report based on the requirements of your institution. This is done by work type since each work type has its own terminology and possibly its own report format.

AutoScript does not produce a draft of a report if the quality is such that it would be faster to
transcribe the entire report. The goal is to make the job of the MT easier.

Examples of How the Voice Model Learns

  • You may work with a cardiologist who uses the phrase 'no rhythm' for 'normal rhythm'.

The MTs at your institution know this cardiologist and always change the phrase to 'normal rhythm'. AutoScript learns that 'no rhythm' should be recognized as 'normal rhythm' for that particular cardiologist. Soon the voice recognized drafts have the correct phrase, thereby eliminating the need to edit that phrase in the draft.

  •  Dr. Smith may use the word 'basically' repeatedly and inappropriately throughout his dictations. The MTs at your institution consistently omit 'basically' from Dr. Smith's reports. In time, AutoScript learns to eliminate the word 'basically' from Dr. Smith's reports even though he continues to use the word in his reports.

 Some clinicians may not be voice recognized.
Clinicians who are not organized speakers or who speak inconsistently may never be
recognized. As such, their reports will require standard transcription.
If a clinician is an organized speaker and has a thick accent or does not speak clearly, he

may be voice recognized.


Overview of eScription


Upon completion of this module, you will be able to:

  •  Describe the Dictation Workflow in EditScript
  •  Explain Voice Models
  •  Explain the Importance of the Style Guide

Dictation Workflow
The workflow of a dictation in eScription:

  •  IntelliScript – voice capture
  •  AutoScript – speech recognition
  •  EditScript Server – dictation workflow management
  •  EditScript MT – dictation transcription and editing
  •  NetScript/EditScript Online – web access to dictations and reports

  • What is IntelliScript?

IntelliScript is the server located at your institution that records high-quality, digital audio
dictations. Clinicians call IntelliScript and enter their ID and identifying information such as
patient medical record number and work type. Using IntelliScript, clinicians dictate, review,
edit or add to their dictations.

  • What is AutoScript?

AutoScript is the program that performs speech recognition. AutoScript learns how a
physician speaks, develops a voice model and creates a voice recognized draft of each

About EditScript MT

EditScript MT

About EditScript MT

EditScript MT™ is used by MTs to edit and transcribe dictations. EditScript MT is fully integrated with Microsoft Word and takes advantage of familiar word processing features. eScription has also added other shortcuts to address the specific needs of MTs as they transcribe and/or edit documents. In addition to this powerful editing mode, EditScript MT features an MT Review mode that allows staff to review and score completed reports, a Reviewed Dictation Retrieval (RDR) mode that allows users to see scored dictations, and a Pending List Management (PLM) mode that allows staff members to monitor


About EMon

EMon® delivers wide visibility into the dictation and transcription process, and
provides tools for efficiently managing that process on a day to day basis. Designed
for transcription supervisors and other administrators, the EMon administrative
console provides a single point of control for securely managing all system settings,
and for tracking the life cycle of a dictation in the eScription system.


Solutions : Error FAQs

Q: How do I fix error 53: File not Found?
A: This error can occur when the default Internet Browser is set up incorrectly. In order for EditScript MT to run smoothly Internet Explorer should be set as the default internet browser.

Q: How do I fix error 429?
A: When using Microsoft Office it must be installed as a complete install. Choosing not to install as a complete install may cause specific components needed by EditScript to not be installed as needed.

Common Errors

Common Errors EditScript MT FAQs (Frequently Asked Questions)

Error FAQs
  • How do I fix error 53: File not Found?
  • How do I fix error 429?
  • How do I fix error 430?
  • How do I fix error 462: Remote server machine does not exist or unavailable?
  • How do I fix error 1155?
  • How do I fix error 2738: Could not access VBScript run time for custom action?
  • The EditScript logo shows but EditScript never starts, how do I fix this?
  • I am getting an Automation error with EditScript, how can I fix this?

3rd Party Applications

EditScript and 3rd Party Applications

eScription does not support the use of 3rd party applications, although we are aware of some compatibility issues with our software. Here is a list of applications and known issues.


Configuring EditScript Dictionaries

When logging into ESMT v8 or v9 you may get this error message:

You have set an eScription dictionary as your default dictionary. This means that anything which you personally add to a dictionary will be stored in the eScription dictionary. These additions will be wiped out the next time this dictionary is updated. We strongly suggest that you change your default dictionary to a non-eScription dictionary. You can change your default dictionary by going to the "Spelling and Grammar" tab of the Word options dialog, and then clicking the "Custom Dictionaries" button.

If you follow the directions you will see the default dictionary set for MS Word is not your custom dictionary. What does this mean? If you were to add new words to your dictionary in MS Word (such as a name of a location or a person's name) it would be saved in one of the dictionaries that come with EditScript-MT. However the next time you update ESMT, eScription will also be updating the dictionaries that come with ESMT and the additions you made to your dictionary would be wiped out: you should configure MS Word to use your personal dictionary ("Custom") to store these additional words.

In MS Word (or ESMT) go to Tools à Options à Spelling and Grammar tab. Click on the "Custom Dictionaries" button. You will see this:

Change the default dictionary to "CUSTOM.DIC" by selecting "CUSTOM.DIC" and then clicking on the "Change Default" button. You will now see this:

Now you will not see this message again when you log into ESMT.

NOTE: If “CUSTOM.DIC” is not listed for you, please refer to the Microsoft help article about creating custom dictionaries:

Afterward, you should be able to see “CUSTOM.DIC” in the dialog boxes for the screenshots above. Settings for Word 2007 Settings for Word 2007

The file is a template that defines the default settings for a new document in Microsoft Word.  This assigns all of the various options such as font size, margins, spacing, colors, etc.  Word 2007 offers a new way to edit these defaults that may be more intuitive for some users.

For those who are unfamiliar with Word 2007; the Word Ribbon is part of Word shown in the screen shot below:

1.       Open Microsoft Word 2007.  This will display the defaults of Microsoft Word in the Word ribbon just above the text portion of the screen.  If there have been no changes to your file then it will appear with all of the settings in the screen shot below:

Here is how the default page looks when you first start Word 2007.

2.       First, ensure that your Style button is on the option furthest to the left in the Word Ribbon.  The style button will display the default text for that style in the box as well as formatting options.  You can see this box highlighted in the screen shot above.

3.       Next, without changing the Style button selection, begin to set the values you would like for font, size, paragraph etc.  Font settings can be adjusted through the font menu to the left bar at the top of the screen.  Paragraph settings can be found between the style buttons and the font menu.  All of these settings can be adjusted from the Word Ribbon.

4.       When this is completed the document should appear with all of the settings desired when Microsoft Word or EditScript is opened.

The Styles Ribbon menu extended.

5.       Next, click on the expansion icon underneath the style buttons in the Word Ribbon.  This will appear as a small arrow at the bottom left of the Style selection pane.  This will open a menu on the right side of the screen as shown above.  Select Options in the bottom right-hand corner.

The Style Pain Options dialog screen.

6.       The options button will open the menu shown above.  At the bottom of this menu click on the button labeled “New documents based on this template” and click OK.

7.       Next, right click on the Normal Styles button in the Word Ribbon and click the option labeled “Modify menu item.”  This will open the Modify Style dialog as shown below:

Right click the Normal box in the Styles portion of the Ribbon

Modify Style dialog screen --- click the radio button to apply template to future documents.

8.       In this dialog select the button labeled “New documents based on this template” at the bottom of the window.  Then select OK.

9.       Next, click the expansion icon under the paragraph section of the Word ribbon.  This will open the window seen below:

10.   Click the Default button at the bottom of the window and select “Yes” when prompted to apply these settings.

11.   Next, click the Page Layout button (just above the Word Ribbon) to view the page layout Ribbon.  Click on the expansion icon under the Page Setup portion of the ribbon.  Click the Default button at the bottom of the screen and select “Yes” when prompted to apply these settings.

12.   Now your version of Microsoft Word should have the correct settings applied as a default.  You can test this by closing Microsoft Word and opening a new document.  If the document opens with the settings you configured then you have successfully modified your file. 

This should automatically be accepted by EditScript but make take a few tries before the changes are accepted.  If you are having difficulty try modifying only one part of the file before continuing, meaning, adjust the font type but not the size or the paragraph settings etc.  If this works, continue this process until all of the necessary changes have been made.

Additional Issues Related to Formatting

Some users will continue to experience formatting issues even after changing the settings.  If this is the case there may be an issue with the mode Word is running in.  Changing this to compatibility mode has allowed EditScript to work with Word 2007 without formatting issues.  Steps to make this change are listed below.

  1. Open Microsoft Word and click on the Office Button in the top left corner.

  1. Click “Word Options” at the bottom of this window and then select “Save” from the panel on the left.

  1. The top option will be labeled “Save files in this format.”  Change this from “Word Document (*.docx)” to “Word 97-2003 Document (*.doc)”

  1. Click OK and now Word is in compatibility mode.  Formatting issues should be resolved at this point.
'� - i `� �� ;font-family:Arial'>A new window should pop up, type "tracert" and then hit enter

  • Let the trace route finish and then take a screenshot of the results if possible

  • On Windows Vista

    1. Click on the Start menu
    2. Either use the windows key+R shortcut or type "cmd" in the search box and hit enter
    3. A new window should pop up, type "tracert" and then hit enter
    4. Let the trace route finish and then take a screenshot of the results if possible

    It is best to take a screenshot of your trace route results and forward these results to a support representative or any other technical support for further analysis.

    Adjusting .doc file extensions for Template Issues

    Adjusting .doc file extensions for Template Issues

    Sometimes templates (ALT-M) won't open in EditScript and instead open in a separate Microsoft Word window. This is usually due to an issue where Windows doesn't have the correct information set up for the Microsoft Word .doc file extension. In order to fix this try the following:

    First make sure that you are signed out of Editscript MT. 

    Open up any folder and choose the folder options from the Tools menu.

    Select the File Types tab and scroll down to the DOC extension.  Highlight the DOC extension and click on the Advanced button.

    Make sure that Browse in same window is checked.

    You should now be able to log back into EditScript and use templates without any problems.

    Using Express Scribe with EditScript

    Using Express Scribe with EditScript

    Some MTs use Express Scribe for the audio processing portion instead of using EditScript's built-in foot pedal capabilities. In order to use Express Scribe with EditScript, there are a few steps that one must take which vary with the Operating System/EditScript version combination.

    Go to Options -> Incoming

    Add the below file path:

    If you are running Windows XP and EditScript 6 you must point Express Scribe to read from:
    C:\Program Files\eScription\EditScript\Downloads

    If you are running Windows XP and EditScript 8 you must point Express Scribe to read from:
    C:\Documents and Settings\<user name>\Application Data\eScription\EditScriptMT\Downloads

    If you are running Windows Vista and EditScript 8 you must point Express Scribe to read from:

    C:\Users\<user name>\Application Data\Roaming\eScription\EditScriptMT\Downloads

    Connection Problems and Communications Errors

    Connection Problems and Communications Errors

    If you encounter communications errors while trying to update the header or upload a dictation in EditScript MT, it is an indication that your computer is having difficulty connecting to the EditScript server. This could result from a temporary connection problem, or it could mean that your internet connection is unreliable or down. EditScript MT will continue to upload completed documents until it succeeds when connection is re-established.

    To verify this, please open up Internet Explorer and try to connect to Once here you should enter your institution name in the Customer Log In box on this page and sign into your institution's page. You will need to enter your user name and password that you use for EditScript. If this is slow or you are unable to connect to this page, your internet connection is not working properly. If this is the case you may be having network issues or other hardware trouble that may be causing this. The problem may also be with your internet service provider, so you should contact their support group to help in resolving this type of connection problem. If your internet connection is working fine please let us know and we can look into this issue further.

    Type the Institution shorthand name in this box (ex: Legacy)

    You should be prompted to Login with a username and password.

    What does it mean if I get communication errors?

    If you get communications errors while working in EditScript-MT trying to update the header, or upload a dictation, it means your computer is having trouble connecting to the eScription server. This could be a temporary connection problem, or it could mean you are having problems with you internet connection. You can check to see if you internet is working by trying to load any web page. This message is a warning, and not an error. You can keep working as long as you have dictations to work on, EditScript-MT will keep trying to upload until is succeeds once the connection is re-established.

    You could also try a few other things for further network diagnostics. The easiest thing to check is your upload and download speeds which will help determine if you are experiencing strictly a network/slowness issue as opposed to an EditScript problem.

    Visit any of these sites to run an internet speed test on your computer:

    You should see a screen that looks similar to this at the end of the test:

    Download Speeds

    Since the recommended connection types are DSL/Broadband, the ideal download speed is in the 8000 kbps range.
    2000 Kbps speed
    Length of Audio          
    Time it takes to download Audio
    1 Minute
    2.5 seconds
    5 Minutes
    12.5 seconds
    10 Minutes
    25 seconds
    15 Minutes
    36.5 seconds
    4000 Kbps speed
    Length of Audio          
    Time it takes to download Audio
    1 Minute
    1 second
    5 Minutes
    6 seconds
    10 Minutes
    12.5 seconds
    15 Minutes
    19 seconds
    8000 Kbps speed
    Length of Audio          
    Time it takes to download Audio
    1 Minute
    < 1 second
    5 Minutes
    3 seconds
    10 Minutes
    6 seconds
    15 Minutes
    9 seconds

    Upload Speeds

    Generally, upload speeds are much slower than download speeds. If your upload speeds are very low (in the low 100s for kb/s) you may experience problems uploading jobs even though you can download jobs just fine. This is strictly an Internet Service Provider issue (ISP) and the best thing to do is to contact your ISP should you encounter internet slowness issues.

    Another test you can perform is called a Trace Route. This is more on the technical side and is used to determine the exact path your computer uses to reach eScription services.

    On Windows XP

    1. Click on the Start menu
    2. Find and click on the Run option
    3. Type "cmd" in the box and then hit enter
    4. A new window should pop up, type "tracert" and then hit enter
    5. Let the trace route finish and then take a screenshot of the results if possible

    On Windows Vista

    1. Click on the Start menu
    2. Either use the windows key+R shortcut or type "cmd" in the search box and hit enter
    3. A new window should pop up, type "tracert" and then hit enter
    4. Let the trace route finish and then take a screenshot of the results if possible

    It is best to take a screenshot of your trace route results and forward these results to a support representative or any other technical support for further analysis.