There is a mandatory credentialing movement afoot which would require all medical transcriptionists to become certified.  To be certain, mandatory healthcare credentialing is not without precendent.  Many health occupations require mandatory certification and credentialing.  There is certainly a rationale for mandatory credentialing among medical transcriptionists given the sensitive nature of the documents they work with on a daily basis.  However, it is not clear that a mandatory medical transcriptionist certification requirement would result in an increase in the level of competency of medical transcriptionists or an improvement in patient care.

Medical transcriptionists represent the front lines of the health documentation process.  In partnership with the dictating physician, they are the final gatekeepers for the medical record.  And while the physician has final say and responsibility over the content of the medical record document, in reality, the medical transcriptionist is often the last person to participate in the production and final modification of a patient record.  As a consequence, the influence of the medical transcriptionist in the development of the patient health record, and the need for competency, cannot be overstated.

The effective safeguarding of vital, confidential patient information demands a rigorous training, oversight, and ideally credentialing process for medical records documentation specialists.  AHDI (The Association for Healthcare Documentation Integrity), serves as the primary gatekeeper for industry credentialing for medical transcriptionists and medical language editors.  AHDI has aggressively promoted the CMT (Certified Medical Transcriptionist) credential, augmenting the exam substantially in recent years with significant foreign-physician dictation and speech-recognition components. Additionally, recognizing the need to attract new talent to a high growth industry, AHDI has rolled out the RMT (Registered Medical Transcriptionist) exam, which is targeted primarily to the entry level medical transcriptionist.

Impact and Influence of the Medical Transcriptionist on the Final Quality of the Patient Medical Record

How important is the medical transciptionist to the integrity and accuracy of the patient medical record? Quite simply, the medical transcriptionist is fundamental to the final patient record outcome.

While every attempt is made to create a completely verbatim medical transcript, the reality is that medical transcriptionists are called upon to continuously render judgments with regards to sometimes ambiguous or marginally intelligible dictation. Not infrequently, a trained medical transcriptionist will catch physician dictation errors, which must be corrected and brought to the attention of the physician.  Judgments are made based on the context of the dictation. Where a medical transcriptionist is unclear or where there is clear ambiguity, the physician will be called upon to clarify. Protecting the accuracy of the patient record along with the confidentiality of that record are two of the most important objectives in the medical records production process.  However, a third and not far distant objective is speed and efficiency. Successful patient outcomes quite frequently and literally require extremely rapid turnaround of patient documentation.  As a consequence, medical records departments are continuously managing the tradeoffs between the pressure to meet turnarounds and the need to maintain a high and uncompromised level of quality.  Expert quality control oversight systems are critical to simultaneously achieving these frequently conflicting objectives.

Clearly, it is imperative that medical transcriptionists, quality control specialists, and their managers and supervisors be fully trained, competent and ideally, credentialed.  The profession requires an exacting level of knowledge and training to protect the accuracy of patient records.  Errors in the medical records process, whether the fault of the dictating physician or the medical transcription unit, are unacceptable and highly risky.  A 2004 medical records error analysis study conducted by AHDI (then AAMT) concluded that 63% of the errors discovered in the study were determined to be critical in nature – having the potential to negatively affect the health and safety of the patient.

The Case for and Against a Medical Transcription Certification and Credentialing Requirement

AHDI has long argued, and recently more emphatically, that the medical transcription industry would be better served with a fully credentialed staff of certified medical transcriptionists. They insist that little would be lost and a great deal would be gained with mandatory certification of medical transcriptionists.  While a credentialed staff would certainly bring a minimum level of standardization and a demonstration of competency, the call for a fully credentialed medical transcription workforce is not without its problems.

For starters, the vast majority of active medical transcriptionists are currently uncredentialed.  Requiring these seasoned professionals to take time from their careers to meet the certification study, testing, and continuing education requirements would not be costless, particularly from an efficiency standpoint.  Taking your highest volume producers out of the production process for any period of time would have a measurable negative influence on an industry already burdened by capacity constraints.  Additionally, there is the cost of credentialing and certification and cost of periodically  renewing the medical transcription certification for tens of thousands of transcriptionists – which would not be inconsequential.

Of course, if a case could be made that the credentialing process would reduce the medical record error rate attributable to medical transcriptionists in a meaningful way, the costs and tradeoffs of medical transcriptionist certification may prove to have a good return.  However, there has been little evidence presented that would suggest if and to what extent such a quality improvement would occur.  It is an issue that will almost certainly continue to be pressed and that merits additional analysis.