| The Challenge |
 | Sentara was spending far more than other peers on Medical Records and transcription. |
| Transcribed reports were backlogged several hours and even days due to the limited hours of transcriptionists, increasing the frustration of both transcriptionists and physicians. |
Evaluating the Options |
| Two performance improvement teams were established to examine the benefits of in-house versus outsourced transcription services. The Director of HIS pursued the redesign of the current system with the intention of keeping transcription services in-house. Meanwhile, another team was charged with investigating the advantages and disadvantages of outsourcing. |
| They started by reviewing the HMC functional benchmarking data and analyzed the number and type of physician complaints. |
| The teams proceeded by flow-charting the current transcription hierarchy. This simple, most fundamental step of the decision-making process pointed to the complexity of the current hybrid system. (Internal transcription services were being supplemented by outsourcing.) |
| Armed with the flow chart, Sentara participated in a HMC transcription networking conference call in which 15 organizataions participated. They discovered that half of the facilities were moving towards complete outsourcing because of limited transcriptionist availability, while the other half were bringing transcription back into the hospital to reduce costs, improve quality, and increase control over the transcription process. |
| Since the conference call gave no conclusive direction, Sentara invited three transcription service vendors to submit proposals, followed by presentations. A detailed scorecard was developed to evaluate the options. The purpose was to ascertain if these vendors could provide equal or better transcription services more efficiently and at a lower cost than the in-house proposal. |
Implementing the Plan |
| Based primarily on reference checks, financial analysis and performance guarantees, Sentara chose to outsource its transcription services to one of the vendors. |
| Existing staff was given the option of transferring employment to the outsourced firm and financial incentives to remain through the transition. |
| A contract manager was designated and given accountability for implementing the external service and monitoring ongoing performance indicators-seen as critical to success. |
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