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Stay-at-Home Scribe

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  • | 3:36 a.m. January 21, 2011
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Company. MedScribe Information Systems

Industry. Health care

Key. Technology is now available to create vast armies of stay-at-home workers.

By the numbers. Click here for revenue information on MedScribe Information Systems.

The last time John Langley hosted an office Christmas party was 1999 after some employees asked him if they'd be paid for showing up.

Turns out, Langley has never personally met many of the 220 people he employs. That's because the medical-transcription company he owns, MedScribe Information Systems, sent most employees to work from home starting 10 years ago.

Now, just six people work at Langley's corporate headquarters in Naples. Another 162 work from their homes in 36 states scattered throughout the country and the remainder at the company's offices in Jacksonville.

Despite the challenges of motivating and tracking all these work-from-home employees, Langley says the benefits are clear. Employees have no commute, he doesn't have to house them in office space and he doesn't have to equip them with costly computers.

Langley, 51, MedScribe's president and CEO, eats his own cooking. He moved to Naples in 2006 from his hometown in Jacksonville because he likes the climate better in Southwest Florida and married Naples resident Lori Eytel Langley, a health-information expert who is now vice president of MedScribe. “I could work from anywhere,” he says.

MedScribe saves doctors precious minutes by transcribing notes about their patients for their own records and insurance reimbursements. Instead of typing a report about each patient, a doctor calls a dedicated phone number or uses a digital recorder to relay details about each patient. Besides saving time, transcriptions are more effective in making sure physicians and hospitals are reimbursed for all the services they provide during a patient's visit.

Advances in technology such as Internet phone service, speech-recognition software and mobile applications promise even greater efficiency and lower cost of doing business.

But it's a double-edged sword.

“I'm worried about technology making us obsolete,” Langley concedes.

Clock in online

Managing 162 employees remotely takes superior technology, a key to making this business work. Running the technology behind the scenes is John Langley's brother, Bill Langley, 47.

Bill Langley was the lead mechanical engineer in support of the Navy's F/A-18 and A-6E Aircraft Avionics Weapons Attack Systems group in Jacksonville when his brother called him to join MedScribe in 1994. At the time, he was fixing his brother's computers on a part-time basis.

MedScribe employees who work from home are required to provide their own computers and communications equipment, while the company provides software that mimics the boss. “They really think they're invisible,” Langley chuckles.

“Our software tracks every keystroke they make,” Langley says. Employees connect to MedScribe's data center through the Internet and transcribe doctor's digitally recorded narratives about their patients.

Because doctors work around the clock, Langley needs to be sure transcribers who are supposed to be on the job are actually doing the work. Employees clock in with a “Web clock” and the system boots them out if they've stopped working for longer than five minutes. “I know what they're not doing,” Langley says.

MedScribe pays employees by the line and they're required to produce 150 lines per hour, with bonuses for extra lines. Depending on how productive they are, transcribers can earn between $25,000 and $70,000 a year.

Transcription applicants are required to have at least five years of acute-care experience. Employees who can't meet the minimum production requirements and near-perfect accuracy scores get pay cuts and usually leave.

“I don't have any mercy,” Langley says. This rigorous culling means only 20% of new hires are successful long-term employees. “Most of our turnover is in the first two or three weeks,” Langley says.

The demanding hiring process and monitoring of its U.S.-based staff is a key selling point for the company. While its competitors outsource the work overseas, Langley says the quality of the transcription work is better in the U.S. What's more, the financial savings of outsourcing overseas can't overcome the expense of editing sloppy work, he says.

Technology investments

For years, speech recognition software has threatened to shut down many transcription companies. But Langley says the software isn't close to achieving perfection. “Speech recognition has been going to put us out of business since 1995,” he laughs.

But MedScribe runs every dictation through speech-recognition software created by Pittsburgh-based M*Modal, which specializes in the health-care field. About one-quarter of the dictations are accurate enough to use, though one of the company's dozen editors still has to review those.

Because of the speed with which speech-recognition software works, Langley estimates that such software does 1.5 times the work of an employee. As speech-recognition software improves, it will eventually cost less than even outsourcing the work to India or the Philippines, Langley forecasts.

Employees can increase their productivity too. The software they use “remembers” certain commonly used words so a few keystrokes can call up longer words. For example, to transcribe the words “myocardial infarction” employees simply type the letters “m” and “i” and the longer words automatically appear.

MedScribe processes more than 100 million lines of transcriptions every year for 85 clients representing 20,000 doctors, so using technology to streamline the business is critical.

For example, MedScribe is shifting to an Internet phone system that will slash its long-distance phone bills by 64%, from $7,000 a month to $2,500. “At one point it was $40,000 a month for long-distance,” Langley recalls.

Some of those savings have gone to other investments in technology. “We just spent $170,000 on a new data center,” says Langley. The new Qwest center is located in Tampa. To maintain security, MedScribe spends $40,000 a year for a firewall and pays $1,200 a month to professional hackers to continually test the system for vulnerabilities.

Next project on the list: Developing a mobile application that will let doctors sign their reports on handheld devices.

Medical growth

MedScribe has benefited from the spectacular growth of two industries: Technology and health care. A CPA by training, Langley got into the business when he became partners of a medical-coding company in Jacksonville.

Langley and a partner he's since bought out spent $150,000 to start MedScribe in 1992. Within six months, revenues grew over $1 million with 30 employees.

It hasn't been straight-up growth, however. In 1997, MedScribe lost a $2 million-a-year account that represented over half the company's revenues. “No single account is going to hurt me,” he decided. “I'd rather have 20 smaller accounts, because if you lose one...” he says.

Langley, who enjoys playing piano and recently lost 40 pounds on an exercise regimen, says he has no interest in expanding the business beyond the health-care industry.

“I'd rather do one thing well than some things OK,” he says. That's because his current customers are the best leads for new business. “Every customer is a reference,” he says.


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