Medical records can be downright ugly. That's what Donna Brosmer, CMT, AHDI-F, NREMT-B, quality officer at Spheris, Franklin, TN, discovered when reviewing family members' records. As someone who values quality documentation, Brosmer was disheartened to see sloppy work in the reports about her loved ones. "That's not a great feeling when you're on the other side of [the document]," she said.

The Association for Healthcare Documentation Integrity (AHDI) and Medical Transcription Industry Association are currently revising their "Metrics for Measuring Quality in Medical Transcription." The new and improved document is headed for a fall premiere, but why wait? Find out which transcription faux-pas you're committing, and get on your way to a better score.

Diagnosis: Rushing
Symptoms: You know accuracy is important, but the all-mighty turnaround time has you racing against the clock.

Treatment: "If you focus on your speed, you're going to make more mistakes," warned Lesli McGill, director of U.S. operations, SPi Healthcare, Brentwood, TN. Focus on quality, especially when working on a new account. As you get more comfortable with the dictator, your speed will naturally improve, McGill said.

Brosmer also noted the "balancing act" MTs must perform, but said productivity is secondary to (and contingent upon) quality. "Two thousand lines at the speed of garbage, is garbage," she said. "So [speed] doesn't do anybody [any] good."

If MTs want to quicken the pace without compromising quality, they can try building macros, according to Barb Marques, CMT, AHDI-F, president-elect of AHDI. When a doctor has a standardized way of dictating certain sections, the MT can build a template and insert that instead of manually typing the same dictation over and over. But that doesn't mean MTs can cue through the recording, Marques said; they should still listen to the dictation to make sure it's the standard information.

Diagnosis: Zoning Out
Symptoms: Speech recognition (SR) frees up your hands, but it's tough to keep your head in the game when you're not typing.

Treatment: "You need to put on a different hat when you're working with SR jobs," Brosmer said. Editing requires critical thinking skills so MTs can catch where software might have erred. Stay alert by hunting for words that sound similar. Brosmer gave the example of an SR program that transcribes an elevated PSA as "elevated TSH." A good MT would use clues in the rest of the document, such as a prostate cancer diagnosis, to identify and correct the error.

Traditional MTs can zone out just as easily when working on a familiar account. "MTs need to have their mind actively engaged while they're working," Marques said.

It's easy to let your mind drift when listening to a routine dictation, but errors can sneak in when your guard is down.

"You can't be responsible for your own quality if you're not there, if it doesn't have your full attention," Marques said. She advised MTs to think critically; instead of typing aimlessly, ask whether the dictation makes sense.

Diagnosis: Distractions
Symptoms: Even with your headphones on, you can hear the kids watching cartoons in the living room, and you keep typing "Dora" instead of "Dr."

Treatment: Home-based MTs face a number of distractions they wouldn't otherwise encounter in the office, McGill said. When she worked from home, she escaped to a secluded room away from the everyday buzz.

Don't underestimate the power of good equipment, either. Poor quality headphones can produce irritating static, McGill said, while an uncomfortable chair can ruin your focus.

Brosmer recommended setting a daily schedule that includes break times and lunch, which gives your brain a rest but keeps you in the working mind frame. Use Caller ID and sign off instant messenger (if your employer doesn't require it) to stay on target, she advised.

Diagnosis: Blanks
Symptoms: You dread the moments when a word is unclear; that blank is standing between you and a perfect score.

Treatment: When a word trips you up, keep on chugging, Brosmer said. "Get to the end of the report and then go back and listen to it," she advised. "[You] might find that blank is-boom-right there."

Use your resources, both mental and technical, Marques said. Education in specific areas of medicine can give you the knowledge to figure out what the doctor said and the confidence to make that determination. Slow the recording down, listen to each word and consider the context. Marques has also used EHRs to check patients' charts and query physicians to clear up a garbled word. "It streamlines the process, so it helps the turnaround time," she said.

To keep things moving, some MTs set a time limit on blanks, Marques said. If they don't resolve the issue within the predetermined time, they'll pass it on to quality assurance (QA) for a fresh set of ears. It may still take time to clear up, but there's no use agonizing over it.

In the end, it's better to leave a blank than make a blind guess, the experts said. When someone's health is on the line, you can't take chances.

Diagnosis: Errors
Symptoms: You've never made a critical error, but typos and minor grammatical errors always find their way into your reports.

Treatment: "The biggest mistake transcriptionists make is they don't proofread their own work," Brosmer said. Take a few minutes to look over the file and make sure key words like "not" are where they should be, and double-check drug names and doses.

Brosmer also suggested creating a file for each account to keep track of formatting specifics and any errors you've made in the past. When it's time to transcribe for that doctor, reference the file to ensure you don't make the same mistake twice.

Word expanders and spell check can cut turnaround time, but they're not always 100 percent accurate. "A lot of databases have incorrect words added to them accidentally," McGill said, adding that she once found misspelled words that had been programmed by the software vendor.

With virtually no room for error in transcription, MTs should keep proofreading skills sharp, Marques said. Look for typos and misspellings wherever you go. "Menus, signs, everything," she explained, "because that gets you in the habit of seeing errors."

Diagnosis: Falling Short
Symptoms: You've held steady at 99 percent accuracy for the past year, but can't capture that coveted 100.

Treatment: "Perfection is always a goal, but in reality, not many of us achieve that," Brosmer said. The experts agreed: it's tough to generate a flawless report. But that's no excuse to stop trying.

Getting closer to that perfect score may be as simple as learning to accept criticism, according to the experts. Ask your QA supervisor or manager for regular feedback, and make the exchange as "real-time" as possible, McGill advised.

Take note of any comments, even when there's nothing "wrong" with the report, Brosmer said. A small suggestion may be the oomph you need to cross the 99/100 divide. Most importantly, she added, don't take comments personally.

Marques agreed. "I would hope QA is looked at as an opportunity to further educate the MT-that it's not punishment," she said.

QA can help MTs identify weaknesses, such as persistent grammatical errors, which can be improved through continuing education, Marques explained. But it's up to the MT to find the right workshop. "If you're not seeing the kind of continuing education you need," she said, "[you] need to be proactive."

Cheryl McEvoy is an editorial assistant with ADVANCE.