Archive for the ‘Healthcare Documentation’ Category

MTIA / CDIA – The End of an Era

Sunday, April 14th, 2013

The Clinical Documentation Industry Association (CDIA), formerly known as the Medical Transcription Industry Alliance (MTIA) has formally announced that they have ceased operations.  After many years of service to the medical transcription industry the CDIA / MTIA organization has conceded that it must close it’s doors, citing external factors relating to the contraction and consolidation of the medical transcription industry in  recent years and the financial ramifications of those transformations.

The past several decades has been characterized by significant industry consolidation fueled by mergers and acquisitions within the ranks of medical transcription service organizations.  These consolidations have helped the industry in some ways by allowing for economies of scale, resulting in a healthier, albeit smaller, group of growth oriented employers. However, with the consolidation of MTSO’s, the medical transcription industry has become less nimble and has clearly suffered the loss of some of the entrepreneurial dynamism that has allowed the industry to adapt to an ever changing technological and regulatory landscape. One of the other obvious casualties of this tsunami of consolidation unfortunately, was the Clinical Documentation Industry Association (CDIA) which has experienced a rapidly shrinking membership base as MTSO’s have merged and consolidated operations.

This is a regrettable announcement in light of the fact that the CDIA / MTIA has provided many years of forward thinking leadership and training to the industry. Additionally, it has provided valuable lobbying efforts on behalf of medical transcription service organizations as well as to medical transcription practitioners worldwide.

The industry will certainly move forward.  However, we will also miss attending the annual CDIA convention and expo with its insightful workshops, training, and networking opportunities.  We express our sincere appreciation to all those who were involved in providing these industry services over the years.  Their tireless efforts will be missed.  Below is a full transcript of the announcement posted by CDIA:

Dear CDIA Members and Supporters,

The Clinical Documentation Industry Association (CDIA) has weathered many financial challenges over the past few years from the significant contraction in the marketplace and overall unhealthy economic conditions. In response, we rebranded the association to expand our reach beyond medical transcription, editing, voice, and speech recognition to encompass every touch point in the clinical documentation continuum. Our flagship event, the CDIA Annual Conference, had broadened the educational program to bring together these complementary audiences.

Unfortunately, the external factors have become too strong for the association to overcome and this is why we are writing to you today. On behalf of the CDIA Board of Directors, we regret to inform you that the association is closing and the annual conference planned for April 2012 in Baltimore, MD has been cancelled.

This has been a very difficult decision that the Board did not take lightly. The association’s finances could no longer sustain the organization to serve the members and support the annual conference. Over the next several weeks, CDIA representatives will be winding down the association and information will be sent regarding recent payments made to the association.

Thank you for your support of CDIA and participation in the association. We encourage you to continue to promote the spirit of CDIA’s mission, values, and advocacy platform as you continue your involvement in other associations, including the Health Story Project ( and AHDI (


The Clinical Documentation Industry Association

The QWERTY Keyboard Sham: Taking Inefficiency to New Heights

Tuesday, December 20th, 2011

By:  Christopher Dunn

Did you ever wonder how the ubiquitous qwerty keyboard configuration came into being?  For those not familiar with the term, Q-W-E-R-T-Y refers to the six alpha keys on the left side of the top lettered row of the standard keyboard. Coincidentally, these keys spell “QWERTY”, which, of course, has no specific meaning other than what has become a favorite reference to this specific keyboard layout. Over the years the term QWERTY has evolved into a shorthand descriptor of the most popular international keyboard layout of all time.

If you’re like most people, you undoubtedly assume that sometime in the distant past, a group of highly paid efficiency experts were corralled into a room and forced to come up with the most brilliant and efficient keyboard arrangement possible.  Surely the individuals would have been charged with the task of developing a keyboard configuration for the ages – one that would promise to yield absolutely the fastest keystrokes with the minimum amount of stress.

Guess again.  The qwerty keyboard design was actually a far less noble effort and has a much more insidious history than that.

A Short History of the Mechanical Typewriter

The mechanical typewriter certainly represented one of the most important inventions of its time.  It played a key role in ushering in a new and unrivaled age of enlightenment and information sharing.  Nevertheless, the invention of the manual mechanical typewriter in 1868 came with its own unique set of problems and challenges. Among the most notable of these problems related to the propensity of the mechanical character arms to frequently jam.

The earliest versions of the mechanical typewriter had characters which were mounted on metal arms. As the typewriter keys were depressed, the downward force of the typist’s fingers would cause the metal arms to swing forward and strike the back of an ink ribbon and impress the characters onto a sheet of paper which was inserted firmly into a mechanical roller.

The jamming problem was exacerbated when two or more keys were struck in rapid succession.  Unfortunately, the fastest typists tended to get ahead of the swinging action of the arms causing frequent jams and resulting in errors that were difficult and time consuming to fix. In fact, the fastest typists ended up spending most of their time untangling metal swing arms and fixing errors resulting from mechanical mistypes.  It just didn’t pay to type too rapidly.

Development of the QWERTY Solution

Consequently, the QWERTY keyboard arrangement was designed specifically to solve this jamming problem.  The QWERTY keyboard was designed by Christopher Latham Sholes in the 1870’s – just a few short years after the first mechanical typewriters came off the production line. The final version of the Qwerty keyboard came about through a great deal of trial and error in an attempt to overcome what was the most pressing problem of the new typing device: the jamming problem.  It was discovered that by arranging the keys in such a way as to reduce the possibility of typing keys in rapid succession, enough inefficiency could be created in the typing process to circumvent the problem of tangling the metal mechanical character arms. Problem solved. Unfortunately, the burden of inefficiency rested squarely on the shoulders of typists who suffered a tremendous loss of productivity, incurred measurable additional stress, and were plagued by serious physical maladies such as carpal tunnel syndrome.

QWERTY:  The Most Inefficient Keyboard Layout Possible

1.  The ten most frequently typed letters in English language literature are in order: E, T, A, O, I, N, S, H, R, and D.   Of the eight home keys of a traditional QWERTY keyboard – that is, the keys where the fingers rest and spend most of their time – only three of the top ten letters are represented:  A, S, and D.  The other seven of the top ten most common letters require a reach up or down from the home keys to strike the key.

2.  What is more, the three “common” letters (A,S, and D) that are found on the home row of keys are located to the far left side of the keyboard. That is to say, they must be typed by the middle, ring, and little (pinky) fingers of the LEFT hand.  Most people are right handed. By forcing typists to type the most commonly encountered letters by either reaching or by using the least dexterous fingers of their weakest hand, the QWERTY keyboard all but guarantees the most painful, tedious and slow typing experience possible.

Hope for Change?

So why are we still clinging to a keyboard arrangement that is hopelessly outdated, completely irrelevant, and in every way counterproductive to speed and efficiency in an age of computers and high speed printers?  Could it be the same reason the United States refuses to embrace the more efficient and intuitive metric system?  Perhaps we are simply too entrenched and invested in an inferior system.  Maybe we perceive that a change of this magnitude would be too costly or chaotic. Possibly we simply lack the foresight or the will to change.  Whatever the reasons, it appears the QWERTY keyboard will be with us for the duration. As they say, it is hard to teach an old dog new tricks…

Medical Transcription and Healthcare Documentation Industry Publications and Professional Journals

Friday, April 8th, 2011

For those contemplating entry into the medical transcription career field and for experienced transcription practitioners alike, there are a number of outstanding publications focused on the medical transcription industry. These publications contain insightful articles about the profession and serve to keep the community up to date on trends affecting the industry. If you are serious about your career you should make it a practice to subscribe to a few of these medical transcription and healthcare documentation publications to stay abreast of changes in the industry. They also offer a great opportunity to network and become aware of job postings and opportunities. Some of the best publications include the following:

Plexus is a bi-monthly publication of AHDI, the Association for Healthcare Documentation Integrity. It’s readership includes medical transcriptionists, healthcare documentation and medical records professionals, business owners, MT employers, and others with an interest in the medical transcription profession. More information can be found at

Matrix is another solid bi-monthly publication offered by AHDI. It is focused specifically on the business and technology aspects of the healthcare documentation industry. Information is available at

eBrief – formerly known as Vitals is, according to AHDI, “a weekly e-newsletter designed to keep AHDI members and subscribers informed about news and trends in the industry and the strategic direction and initiatives of the association”. Information is available at

Advance for Health Information Professionals is a bi-monthly publication offered free of charge to health information professionals. Information can be obtained at

For The Record, is an informative publication for health information professionals. Information can be obtained at

Journal of the American Health Information Management Association (Journal of AHIMA), is the official publication of AHIMA. Subscription information is available at the AHIMA website

Journal of Healthcare Information Management, According to HIMSS, “JHIM is a quarterly, peer-reviewed journal edited specifically for healthcare information and management systems professionals.” For more information go to:

The Rocky Road to ICD-10 Medical Code Implementation

Sunday, March 27th, 2011

The US healthcare industry has been grappling for too many years now with the implementation of ICD-10 medical codes. The new ICD-10 code set promises to improve the classification of the massive and growing reservoir of health information and to bring the United States up to the international standard for healthcare documentation.

There is no question that the US is lagging significantly in this vital health information area. Most other developed countries have long since adopted and implemented the new standards. The need for an upgrade to the current system was identified formally in the early 1990’s when the National Committee on Vital and Health Statisics affirmed that the current code structure was “broken”. The numerous delays in implementation since that time can be traced to a handful of short-sighted economic and political considerations. Regardless of the cause, the US healthcare system can ill afford additional delays. The quality and integrity of health data in the US has been declining for several decades now.

The deterioration of health data can be blamed in large measure on the fact that the US has simply outgrown the ICD-9 medical coding system. While ICD-9 served the industry adequately for a number of years, the growth in medical procedures, treatments, diagnoses and technology have surpassed its limited adaptive capability. The universe of available ICD-9 codes is rapidly dwindling and certain code sets are becoming oversubscribed. This is resulting in tremendous inefficiency and is calling into question the integrity and completeness of the data delivered through the system. As the risk of compromised patient care increases, the need for change is becoming more obvious.

Advantages of the ICD-10 Medical Code Classification System

Implementation of the ICD-10 medical code set will confer a number of significant advantages on the industry. These include:

  1. Greater specificity and accuracy in healthcare documentation
  2. Reduction in manual intervention arising from the limited descriptive capability of the existing code set
  3. Increased level of detail in the final health record
  4. Improvement in care decisions with elevated data quality
  5. Reduction in errors and quality assurance activities
  6. Reduction in reimbursement holdups due to inadequate information or clarity
  7. Increased productivity of coding practitioners as automation becomes more applicable throughout the entire process
  8. Increased compatibility with other global health information systems
  9. Improved patient outcomes


While there are certainly some compelling economic costs associated with full adoption and implementation of the ICD-10 code set, the costs of non-adoption are growing every day and threaten to dwarf real implementation costs. Additionally, the negative impact on patient care will increase exponentially as the existing data model becomes less stable. The evidence for successful implementation is readily available. Virtually every other major developed country in the world has successfully adopted ICD-10. The time for discussion and analysis is past. The time for bold action and implementation is here.

Turning Healthcare Over to Computers: The Risks of Rapid Adoption of EMR and Speech Rec Technology

Friday, March 18th, 2011

Healthcare documentation has come a long way. A continuous stream of technological advancement and automation has generated significant gains in efficiency while increasing the quality of care through improved access to vital patient information. The future looks bright indeed, as incremental improvements in technology promise to confer additional benefits. Many health care providers are embracing new versions of technology as quickly as they are rolled out in the hope of delivering heightened levels of patient care at a lower cost.

Nowhere are the advances in technology felt more keenly than in the healthcare documentation arena. For many years, medical records departments have been viewed as cost centers and subordinated to other seemingly more important areas of the healthcare organization. As a consequence, healthcare documentation has historically received neither the glamour nor the funding that other front office and patient care activities have enjoyed. Over the past few decades, however, the balance of power has begun to shift. Healthcare documentation is now rightly seen as one of the keys to profitability and a catalyst for industry growth.

New talent and resources are beginning to flow into this area breathing new life and vitality into what was once an afterthought in most healthcare organizations. Leading the charge is a new breed of profit minded executives set on transforming the healthcare model. As the industry ushers in a new era of efficiency and profitability, decision making executives would do well to remain aware of some of the significant risks of an overly ambitious technology adoption timeline. For instance:


The risk of underdocumentation has the potential of increasing dramatically with new electronic medical record (EMR) protocols. That EMR technology promises to exponentially increase efficiency in some aspects of care – primarily by decreasing administrative workload and increasing the speed of information flow – is not in dispute.

However, it should be recognized that the rapid adoption of this technology in its current form has the potential to create down- stream issues with patient care as a result of improper or inadequate documentation. EMR threatens to increase costs as inadequately documented assessments and activities are reworked. Patient care may also be compromised as diagnoses are delayed due to lack of complete information flow.


EMR’s may steer physicians to point and click their way through a few standard procedures, potentially ignoring less obvious, non-charted options.

Undervaluing the traditional role of the physician

As technology asserts itself with fits and starts into the patient care process, there is a real risk that the transition from physician directed outcomes to technology driven outcomes will be too abrupt, again compromising patient care. Additionally, recent studies suggest that the physicians spend about 9 times longer entering an equivalent amount of information via EMR and EHR than with traditional dictation based narratives. Time is money, and physician resources are far too costly to be assigning tasks better handled by non-physician professionals.

Chronic under reporting

Pushing physicians in a direction of drastically less documentation when the trend has been toward greater documentation of patient care for the past several decades is at best imprudent and at worst reckless. While some efficiency in healthcare documentation may be good and necessary, it is simply unrealistic to expect a physician to render what has historically been a multi-page detailed medical record document with a few clicks of a mouse.

Undervaluing the role of the medical transcriptionist and medical record technician in the records process

Speech recognition has made some significant strides in recent years and now plays an increasingly prominent role in the healthcare documentation process. However, it has still not proven to be as effective as a seasoned transcriptionist in rendering a dependable output – particularly when it comes to some of the more complex documentation tasks. There are simply too many variables that require human intervention to achieve consistently accurate and completely automated documentation with today’s technology. While it seems clear that the role of the traditional medical transcriptionist will be forever transformed by new advances in technology, there will likely always be a role, and I trust, an increasingly important role, for the professional medical records technician.


As technology continues its steady march, there is no doubt that it will continue to encroach on traditional methodologies and bring a new and important measure of efficiency and profitability to the healthcare industry – benefiting patients and practitioners alike. Those organizations that are careful and thoughtful in their implementation strategies will tend to have smoother transitions and will likely manage their risk more successfully than their more zealous counterparts.