The healthcare process tends to be information intensive depending on the right data to arrive at the right course of treatment to be provided. Though this is the primary purpose for documenting the care process the information in patient medical records continues to play a role in numerous aspects of the smooth operations of the healthcare facility. Healthcare facilities and healthcare professionals have numerous options available to them for documenting the care process, however it is important to select a method of documentation that blends in well with the working life of healthcare professionals and helps create records that are usable for all purposes for which they are created.
The options available to healthcare professionals to document the care process range from the most primitive form to the most sophisticated means including:
• Handwritten notes
• In house medical transcription team
• Outsourced medical transcription services
• Point and click entry by the healthcare professional at the point of care
• Speech recognition software
Availing outsourced medical transcription is the option best suited to the working style of healthcare professionals, the budgetary constraints of healthcare facilities, the varied documentation needs of healthcare professionals and healthcare facilities etc as it is the method that meets all the usability criteria required of patient medical records.
What are the purposes of patient medical records and how do outsourced medical transcription services help meet these purposes?
Patient medical records are created as a means of recording the patient- healthcare professional encounter. The information from these patient medical records are used for various purposes including:
• Means of interaction: The patient medical records reflect the entire medical history of the patient and this helps in fruitful interaction with the patient and his/ her family. Medical transcription ensures that patient medical records are created with maximum detail in an accurate manner using a combination of skilled medical transcriptionists and a stringent process. Moreover outsourced medical transcription service providers encourage healthcare professionals to use dictation as a method of collecting the information. Healthcare professionals prefer dictation using familiar modes to record the patient encounter, as this helps them optimize their time and helps in recording the narrative portion of the patient record, which plays a vital role in the care process.
• Accountability: As healthcare is an important service requiring quality inputs from various healthcare professionals it is important that the patient medical record take note of this and reflect the origin of the care process as well as all the participants of the care process. Patient medical records created by the medical transcription process clearly reflect all the healthcare professionals that are part of the care process
• Legal requirements: A well-created patient medical record is not only mandatory for the care process but also fulfils statutory requirements and is a part of risk management. Medical transcription ensures that patient medical records are created by recording all the nuances of the narrative and details of the care process in a timely and accurate manner
• Quality and feedback: Patient medical records are also used as a means of assessing quality of care and providing feedback. Patient medical records created using outsourced medical transcription service providers reflect all the details required for this purpose
• Research: Often new drugs or procedures are used for which detailed records are to be maintained in an easily accessible manner. Outsourced medical transcription service providers ensure detailed medical records are created and are easily accessible by archiving records and enabling search using different criteria.
• Receivables management: Patient medical records not only aid in all above-mentioned area, but timely medical transcription can also help enhance the receivables management.
It can be concluded that outsourced medical transcription services help create patient medical records that meet usability criteria.
TransDyne, a leader in the outsourced medical transcription industry has used their extensive background in information technology and their experience in serving the needs of the healthcare sector to provide affordable and integrated medical transcription solutions.
TransDyne offers quality medical transcription at reasonable prices, executed by experienced and qualified medical transcriptionists with a very quick turnaround time executed through secure HIPAA and HITECH compliant channels, with very high levels of accuracy and all this with technology that is advanced but easy to use!
To avail complete and reliable medical transcription services from TransDyne, click here.
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