The Price Of Quality: Managing Cost-Effective Clinical Documentation

Dale Kivi, FutureNet Technology Corporation

This white paper takes a comprehensive look at the strengths and weaknesses of traditional transcription services, speech recognition solutions, and point-and-click software systems in terms of producing cost-effective and accurate clinical documentation.

Have you ever been denied funds to do something you said was necessary only to have cash become available later to clean up the very issues you were trying to avoid? Inevitably, in the Health Information Management HIM world, the cross-roads between want-to and have-to are only passed when the cost of doing it wrong outweighs the cost of doing it right. Of course, by then, no one wants to hear that if the funds had been granted in the first place, lots of headaches and expense could have been spared (along with a few professional reputations).

A few years back, I supported the efforts of my then company president in preparing an article titled "The Price of Quality – Applying Six Sigma Processes to Outsourced Transcription."1 His article described the Six Sigma approach of focusing on each end users criterion for quality and why it is more cost effective to insert quantifiable checks for each variable as early as possible in the documentation process, rather than wait for errors to show up during inspection of the final reports. As the article explained, it is always cheaper to check for quality more during a process and fix less at the end than the other way around. Although this is an extremely simplified definition of the Six Sigma process management approach, as with any other production process, clinical documentation quality can most cost effectively be assured when quality is measured and monitored along the way. No matter how sophisticated the technology or experienced the staff, quality doesn't just happen.

When that earlier article was written back in 2003, traditional manual dictation / transcription was by far the predominant method used to create clinical documentation – and most quality and cost discussions were spent contrasting in-house versus outsourcing or domestic versus off-shore services. Speech recognition was just starting to take hold and so called point and click or hunt and pick systems, which generate documents based on diagnosis and procedure codes selected by physicians, really hadn't been introduced yet.

Fast forward to the current marketplace and, in part fueled by legislative and related financial pressures to comply with „meaningful use? criteria, the hot options for creating today's clinical documents lean heavily towards technology-based solutions and away from labor-intense efforts, regardless if the process is managed in-house or by a domestic or off-shore (or mixed) service provider. Adding even more fuel to those legislative pressures, any dictation / transcription technology purchases made in preparation for Y2K have reached the end of their usable life cycles. Combined, these factors position technology concerns as the clear driver of today's clinical documentation management decisions. Access This Content To Read This White Paper In Its Entirety.