Forced by the paucity of talent in the large metros, medical transcription Companies are following the BPO bigwigs to smaller cities. With this, cities like Coimbatore, Madurai, Tirupur, Trivandrum are seeing a lot of action.

Medical transcription Companies employing home-based transcriptionists (HBT) is passe. It’s now the time to turn to tier-two cities. What began with business process transaction Companies and call centres, is now beginning to catch up among medical transcription Companies too.

Medical transcription giants like Healthscribe (part of US-based Spheris group) and Spryance, have started tapping the talent in smaller cities. For instance, Mumbai-based medical transcription company Spryance employs a large number of people in tier II cities. The company has adopted the HBT model and it hires people only for quality assurance and editing work. Spryance currently employs 1,110 people out of which around 770 people are HBT’s. Rajiv Shetye, vice-president, Spryance says that 60% to 70% of these HBTs come from cities like Coimbatore, Madurai, Tirupur, Trivandrum and Baroda. For Spryance, outsourcing work to HBT’s in tier II cities makes a lot of sense. “Outsourcing to HBT in B-class cities makes sense. B-class cities, especially in the South, have plenty of human resources which have largely remain untapped. We want to leverage on the talent available in these cities,” Mr Shetye says.

Spryance recruits HBT through employee referrals and advertisements. The company prefers candidates with experience. “We recruit people with excellent English language skills, typing skills and a knowledge of science. The recruits go through a training period which lasts for four to twelve weeks,” says Mr Shetye. Spryance runs background and referral checks on the employees. The company also has workflow processes and other security measures in place to protect data. It is not just Spryance which is outsourcing work to HBT’s in B-class cities.

Even Companies like the Bangalore-based Healthscribe have shifted their focus to tier II cities. In June this year, HealthScribe, a subsidiary of the US based medical transcription company, Spheris opened a facility at the STPI IT Park in the Kumaraguru College of Technology campus in Coimbatore. Coimbatore is Spheris’ second centre after Bangalore. The company has invested around Rs 10 crore on this facility. Choosing Coimbatore for setting up a second centre was an easy decision for the company. “A majority of Spheris’s employees come from the Coimbatore and Palakkad belt in the South. Coimbatore has a good educational system which churns out thousands of talented

Just when everyone thought medical transcription was down and out, it is staging a recovery and is all set to grow exponentially in India. Cbay Systems, incorporated in the U.S. as early as 1998, in the thick of the last round of IT euphoria, has emerged as the fourth largest medical transcription company in the U.S. and has started implementing its gigantic expansion plans based on its model of 95 per cent outsourcing from India. And it seems quite unfazed by the ongoing BPO controversy in the U.S. With 33 franchisees and five of its own centres in India, Cbay now employees about 1,200 people (which it has trained) and recorded revenues of $33 million and a 70 per cent growth rate. Its expansion plans are a mindboggling 10,000 people working to generate revenues of about $100 million by 2005, says, V. Raman Kumar, the U.S. based Chairman and founder of Cbay Systems. Mr. Kumar was here recently, visiting their new facility Ckar, which is managed by Karvy Consultants, under a management tie-up (without being a joint venture). It is talking to companies in Delhi, Ahmedabad and Chennai for further expansion. In Andhra Pradesh it is looking at stepping up the headcount from 700 in four franchisees and Ckar, to about 5,000 people, and is looking at places like Guntur also to set up operations. Mr. Raman says it has 50 clients (mostly missionaries) in the U.S., none of them government. While they do not fear any backlash, he says only one hospital dropped out but on religious grounds and not due to the ongoing controversy. The U.S. medical transcription industry alone is put at about $20 billion, of which only $3 billion is outsourced to U.S. based companies. Hardly $40 million is outsourced to India, which is quite small, he points out. So far Cbay has raised $20 million from venture capitalists and equity investors, and is planning to raise another $25 million for its next round of big expansion in India. The Indian market is put at about $40 million with about 5,000 trained medical transcriptionists working and appears all set to grow. As Mr. Raman says there is now a critical shortage of qualified MTs in the U.S., which is expected increase drastically as demand grows at double-digit rates. The shortage is expected to be to the tune of one lakh medical transcription by 2004 end, and India is obviously the destination to fill this void.

Healthcare and software services provider iMedX has announced that it has acquired Tidewater Medical Transcription Services Inc, (TMTS), as it complements its healthcare-focussed business. The company declined to disclose the deal value citing non-disclosure agreement and said that it was in pursuit of two more acquisitions, and is likely to close them during the year. The President and CEO of iMedX, Mr Venkat Sharma, who is a serial entrepreneur and part of a Swiss venture firm, said that the healthcare market is heavily regulated in the US by the Federal Government, making technology spend mandatory. The spend relates to maintaining medical records electronically and gradual shift towards electronic prescriptions. Mr Sharma claimed they were the first company to develop an electronic prescription system and launched it in July, and have commercially begun to offer it in the US. The company employs about 1,000 people in India and the US, both directly and through franchise partners, and may add about 500 more during the year. Mr Sharma said that its platform TurboScribe helps hospitals and doctors in better maintenance of electronic records of patients, and in medical transcription business for storage of records for longer time. The company hinted at the possibility of an IPO next year.

It was almost a cottage industry in the 90s, only to lose steam in 2000. But if you thought the medical transcription (MT) industry in India is history, think again. Latest studies reveal that it is raring to take off yet again. And this time, the future is well chalked out.

When it took off in the 90s, anyone with a little space and enterprise opened an unit in their living room.

Unfortunately, the boom didn't last and hit rock bottom in 2001. The reason: Too many entrants, lack of entrepreneurial skills and knowledge of industry and security issues. Many small players opted out.

But since 2004, the sector has slowly but steadily worked its way up. Now, it generates revenues worth $195 million. The figure is expected to go upto $647 million by 2010, according to ValueNotes study.

In fact, the study found that at present, India-based MT vendors employ around 18,000; by 2010, the numbers will go up to 52,000. A Nasscom study released last month too confirms this northward move of the Indian MT industry. It says India has 120 to 150 MT companies which earn an annual income of $220 to $240 million.

The ValueNotes study says that by 2010, work worth $860 million will be offshored globally. "While intense competition has driven out hundreds of small players, several large players are aggressively expanding their capacity through acquisitions.
Courtesy: The times of India

Max HealthScribe alone employs more than 1,000 medical transcriptionists in Bangalore to handle the workload from U.S. health care providers. The company says it can cut a hospital's transcription costs in half.

Nearly all Bay Area hospitals -- including those run by Sutter, Kaiser, UC San Francisco and Stanford -- outsource at least a portion of their transcription work.

"We outsource all our transcription," said Courtney Conlon, spokeswoman for Seton Medical Center in Daly City.

"If we didn't, we'd probably need eight to 10 full-time employees on staff. It's very cost-effective for us."

Seton, like many health care providers I spoke with, contracts with MedQuist, the nation's largest provider of medical-transcription services. In April, the New Jersey company reported quarterly net income of $10.51 million on revenue of $125 million.

MedQuist employs about 9,000 transcriptionists, most of whom work out of their homes in various parts of the country. More than 1,000 are in California.
Courtesy: The times of India

How does a fun club and a Chief Fun Officer at your workplace sound? Great and productive, say the employees of HealthScribe, one of India's leading medical transcription companies. Ajita Shashidhar reports.

What would be your answer if you were asked to expand the acronym CFO? Chief Finance Officer would be the obvious choice. But here is a CFO who knows nothing about finance. He is the Chief Fun Officer at the Bangalore-based medical transcription company, HealthScribe, who is in charge of its Fun Club. From organising cricket tournaments and cooking competitions to holding an on-the-spot film quiz on the work floor during working hours, the core objective of the Fun Club is to make the work-place livelier by constantly coming up with exciting activities.

"Fun at work is the mantra of our organisation and all our activities are driven by the Fun Club," remarks Prasenjit Ganguly, Vice-President, Human Resources, HealthScribe.

Ganguly says that the idea behind the Fun Club and its various activities is to break the monotony at the work-place. "A transcriptor's job, after a point of time, becomes quite stressful and it is likely that a person may lose enthusiasm to work. Therefore, we decided to work on a `fun at work' concept, by tapping the extra-curricular talents of our employees," he adds.

The employees, says Ganguly, can participate in a variety of activities such as sports, dramatics or oration. The Fun Club has a fun calendar, which has a list of the major activities it plans to organise throughout the year, as well as the weekly list of activities. "We also organise impromptu antaakshari or a film quiz to enliven the work-place," says Ganguly. The Fun Club organises at least one major activity such as a cookery competition or a sports meet, every month.

Apart from sports and dramatics, the club also provides formal training in Hindustani classical music, Carnatic music, Bharatnatyam and yoga. "We have professionals such as Hindustani classical music guru Parameshwar Hegde and the Karnataka State Rajyotsava Award winner for Bharatnatyam, Kalamani Guru C. Radhakrishna, who come to teach our employees," remarks Ganguly.

Apart from this, HealthScribe, remarks Ganguly, also encourages its employees to participate in various corporate meets and festivals. "During the corporate fest, Zestivity, HealthScribe emerged with flying colours in almost all the events by competing with 60 other corporates. We also won the Kingfisher Cricket Corporate Cup by defeating Mphasis by two wickets," says Ganguly.

The medical transcription field is picking up again after gong through a boom -and -bust phase in the past few years. A look at the scene now There are plenty of job opportunities in this field. The pay is commensurate with the output. It can be done as a part time job, and there is the option to work from home. And its nuances can be learnt in a few months .All these combine to make medical transcription an alluring option for G- next As one of India's fastest growing information Technology enabled services (ITES), it has the potential to change the outlook towards the health sector. Like call centres, insurance claims processing and legal transcription, medical transcription is also an emerging field born out of the fusion of globalisation and 24/7 economy.

English fluency

Fluency in English, logical reasoning and comprehension skills will help one pick up half spoken fragments or even monosyllables and convert them in to complete sensible sentences and make a successful medical transcriptionist.

Despite the trained manpower that India boasts of, there is shortage of people with the requisite skills in the field of medical transcription. This despite the fact that medical transcription made its foray in to India in 1993.

Shortage of hands

Quoting figures from the American Association of Medical Transcription (AAMT) Jose Maannully of EDS Solutions, a medical transcription firm at Kadavanthara in Ernakulam, says that there is a shortage of one-lakh medical transcription personnel in the US.

"The work out sourced amounts to just 4 to 5 % of the total volume. In India, there is shortage of 50,000 trained people. The available manpower is 12,000 he says.

This shows that there is a tremendous potential in the field and that the sky is the limit for job aspirants in India. Unless we grab the golden opportunity, Filipinos, Vietnamese and those from other developing countries will dominate the sector. Sadly the minimum level of learning (MLL) of youths who study in Kerala is very low. Worse still is their knowledge of written English and basic grammar. Ninety five percent of those who clear the test and interview are those who have studied outside the state. Short term or online courses in English may help those who prepare for jobs in call centres but not in medical transcription firms, Jose says Anoop S.R of WO, Vyttila says it is difficult to teach a person to gain fluency in English. The medical part of the job can be taught. The demand for medical transcription services is increasing because of the rise in health insurance claims in the US he says. Complaints in the US and in Europe began to outsource medical transcription because of the high cost of operations there. Medical transcriptionists feed in to the computer the medical history of patients dictated by health specialists in foreign countries and create a file. This is to enable insurance companies there to make payments.

Hirarchy

The hierarchy in most medical transcription firms is as follows: Transcriptionist (who attends the client and enters details in the computer), editor (who goes through the copy), Proof reader (who revises the copy) analyst and production manager The incentives depend on the number of lines (one line=65 letters) that one types out. The starting salary for a trained medical transcriptionist in Cochin is around 5000/-. It can go up to 30,000/- or even more, depending on the quantity and quality of work. Emergency files are returned within 8 hours and medical transcription firms charge a higher fee for this. Part time job

The medical transcriptionist job can also be done part time. The basic thing is that one should be fluent in English. And it would be ideal if I one has basic knowledge of MS office and MS word and have a background in science. Knowledge of American usages helps. People are attracted to this job because after a few months they can do it from home.

Advantage India

India has a time-zone advantage too- it is morning here when it is evening in the United States. Doctors there need to just read out details of their patients at the end of the day. Fast connectivity to Internet is another advantage, thanks to submarine cables entering the country through Kochi and Mumbai. Attrition rates are quiet high in this field since a person with a few years experience commands a high salary in metropolitan cities. Many firms offer free food coupons, incentives and pick up and drop back facility to retain their employees.

P Ram Kumar - Hyderabad What started with a bang seems to have quietened on a note feebler than a whimper. A couple of years back, there was a spurt of companies and training institutions in the area of medical transcription (MT). More than 300 companies in the country entered the MT industry two years ago, hoping to make a fast buck. But their high expectations were belied and today hardly 25 companies have sustained in their business. A large number of MT companies and training centres have downed their shutters and vanished.

In Andhra Pradesh alone, there were initially 100 MT companies in 1998-99, out of which around 50 were registered under the Software Technology Park of India (STPI), Hyderabad. This figure has today dwindled to around 12. Ramakrishna T, managing director of World Infotech Private Ltd of Hyderabad, one of the early entrants into the MT arena and still in this business, says the MT project is not of short gestation as believed by over-ambitious entrepreneurs. It takes a minimum period of at least three years to consolidate the operations before reaching the break-even level, he notes.

Most MT companies could not sustain their operations because they were new to the transcription field and could not understand the concept and overcome the practical problems. Ramakrishna points out, It is essential to first identify the customers, understand the American accent and get acquainted with the talking styles of doctors in the US. Every month thousands of words get added to medical terminologies. A person engaged in MT service in India willing to be successful, must have a representative office in the US to co-ordinate the works and extend the necessary support to the Indian companies. Above all, work standards and quality of service matter a lot to the clients in the US.

Hyderabad-based Care Technologies India Private Ltd, director, Dr Ram K Rao says, Medical transcription is a very knowledge intensive business. One cant earn money in just one or two years. Quality of service is very essential because the medical transcription that we send to the US becomes a legal document to the insurance companies.

Achieving accuracy of at least 98 per cent in MT is of utmost importance and most companies in India have failed to come up to the expectations.

On marketing, Ramakrishna says, The advantage in MT service is that when quality service is provided, doctors in the US remain with you and keep giving contracts. We have to build a good credibility. Marketing for this service is not needed unlike for software wherein one has to keep approaching the clients from time to time when new products are launched.

Both Dr Rao and Ramakrishna observe that there are good business opportunities in MT in the US. The US healthcare industry is worth $ 1.4 trillion (14 per cent of the GDP). According to the MT industry estimates in the US, while every year the business in this field is going up by 10 per cent, there is a proportionate decline in the number of medical transcriptionists in the US. Mostly youngsters leave this profession for better remuneration. The total transcription capacity that can be handled in the US is estimated to fall from 85.37 billion lines in 2000 to 50.80 billion lines by 2004. The shortfall to be outsourced internationally will go up from 106.27 billion lines in 2000 to 196.37 billion lines in 2004.

According to the same study, the value of MT business to India is projected to increase from Rs 4.35 billion in 2000 to Rs 19.29 billion in 2004. India has a market share of around 3 per cent in Americas MT business.

Nasscom projections

It may be recalled that according to a survey done by the National Association of Software and Service Companies (NASSCOM), medical transcription service in India generated over 3800 jobs and a turnover of Rs 140 crore in 1998. For 2008, it has been estimated that employment potential would be 1,60,000 and a revenue of Rs 11,000 crore. Going by the present trend, this seems to be an uphill task for India to hit these figures, though enormous business exists for this service in the US.

World Infotech, which entered the MT service in 1998, has around 150 medical transcriptionists and supports the operations of five other companies engaged in the same business. Says Ramakrishna, I still have 30 per cent spare capacity. We are now in the real take-off stage. Every month we add around 15 new recruits and train them. The company made a turnover of around Rs One crore in 1999-2000. It recently commenced providing other services to the doctors like taking up billing works and catering to their software needs.

With a total strength of around 200 medical transcriptionists and 100 computer terminals, Care Technologies has a three-year contract with US hospitals. We have well trained people and offer 24-hour service in shifts, besides providing medical billing and coding services, says Dr Rao, who is also a management consultant and has worked in the States.

As it happened in case of dotcoms, the medical transcription industry too seems to be witnessing a shake-out. But going by the potential in store for this business, it seem to emerge as a major money spinner for the Indian healthcare industry.

MS Maya Menon, a former customer relationship officer at Blue Dart, quit her job to take up a career in medical transcription (MT).

After a brief stint with one of the leading city-based MT companies, Ms Menon decided to become a home-based medical transcriptionist (HT). Today, as an HT and working from home Ms Menon is quite happy earning a considerable income and at the same time spending enough time with her children without affecting her job.

Ms Menon is not alone. There are hundreds of such HTs in the country. In fact, in Bangalore, a couple and two children work as HTs and the income for the family is quite substantial, says Mr Harikrishnan, Location Head, Acusis Software India Pvt Ltd, a 100 per cent subsidiary of the US-based medical transcription company, Acusis.

It is said that in the US, the HT is quite popular and accounts for almost 90 per cent of the transcription industry. In India, however, HT as a concept started about four years ago and is still in a nascent stage. Nevertheless, the concept is catching up even as multinational firms look for skilled manpower at a low cost.

For instance, Acusis recently said that it plans to invest about $5 million more in its Indian operations in 2002. The company, which set up its operations in India a few months ago, had pumped in $8 million in creating the necessary infrastructure at Bangalore, Mysore and Chennai.

The company caters mainly to the US market, and is one of the leaders in HT in India. Currently Acusis has about 100 medical transcriptionists, of whom nearly 70 per cent operate from their homes. The company expects this base to increase to some 4,000 in the next three to four years, he said. ``The HT market as a concept in the country is still at a nascent stage. But, it will explode in another five years," he added.

At the core of Acusis' home transcription plan is its software, AcuSuite. It allows transcriptionists to connect to the main office, sends them the voice files to be transcribed, then sends the documents back to the Acusis facility. To ensure quality, another team of transcriptionists review the files once they are submitted.

Says Ms Menon, to become an HT, one needs a personal computer, the requisite skills sets and to a certain extent the domain knowledge. Accuracy and speed is important in this field. Further, there is pressure on the HTs, as the companies normally work on a 24-hour turnaround time.

"HT provides the right combination of earning and spending time with the kids sitting at home," she says. Other than the PC cost (Acusis provides the software), said Ms Menon, who works for Acusis, an HT needs to pay a deposit to the company which could be Rs 10,000-Rs 60,000 depending upon the firm.

The deposit, according to Mr Harikrishnan, was to ensure that only genuine persons enter the HT field. For HTs, there is no exclusivity clause to work for a particular company, he added.

On the returns, Ms Menon said, on an average, an experienced HT can transcribe and type 600-800 lines per day. With 95-97 per cent accuracy, the income could be Re 1 per line, which translates into Rs 600-800 per day, she said. However, there may not be work all the time, she added.

Besides housewives, Acusis has doctors, nurses and pharmacists who take it up as a part-time job, he said. The company has a per line quantity/quality-dependent payment system, and an Acusis HT can plan the amount of work he/she would like to perform on a daily basis, he added.

While HT can make a good living, performing MT as a home-based business is not a ``get rich quick scheme". Medical transcription is hard work but can be rewarding both financially and personally, says sources. However, the transcriptionist working from home must make a significant investment in equipment and reference material and be willing to make frequent updates to both equipment and library in order to keep up with rapidly changing technology and terminology, say experts.

Welcome to the world of new age women. They are married, have understanding husbands, children whom they care for and a career they are passionate about.

Getting their career back on track or looking for a job after being a full-time mother is no longer an impossible task.

S. Kavitha, mother of three daughters, now a medical transcriptionist (MT) will tell you how she did it. After matrimony and motherhood and a sabbatical of 14 years, she's now back with a bang.

"I aspired to become a doctor but that dream didn't came true. When my children started going to school, I had enough time at my disposal. So, I enrolled for a training module in medical transcription and it has proved to be a turning point in my life. My job of transcribing medical records by doctors gives me the satisfaction of getting close to my dream," she says.

Hard work, meeting deadlines and having the drive to go that extra mile is all what you need, say the housewives who have taken up jobs as medical transcriptionists after a long break. It is a process where one accurately and swiftly transcribes medical records dictated by doctors, including history and physical reports, clinic notes, operative reports, consultation notes, discharge summaries, evaluations and laboratory reports.

"All along, I have never carried a wallet; all my needs were taken care of. Now, apart from economic independence and building confidence, my status as a working woman inspires my children too. The work atmosphere is home-like. I feel like I have got back to my school days where I am making friends with a lot of housewives. In terms of career advancement I have moved on to the second level as junior MT in a matter of six months," Kavitha adds.

For many, the work atmosphere in itself is a new experience. Says Janani. R, a BBM graduate, who is now a senior MT: "Working in a group with people from different age groups helps in moulding your overall personality. It also hones your leadership skills." C. Manjunathan, manager of a HR company says that the positive energy pumped into the work atmosphere by the youth, who are more in number, motivates others in a big way.

Another advantage is the option to work as a Home Transcriptionist (HT) after a couple of years of experience.

"What is required is correct awareness to help them understand the nuances of the job. Individuals should be prepared to take on the stress because quality is at the top," says Surya.