ASTM E1959-98
(Guide)Standard Guide for Requests for Proposals Regarding Medical Transcription Services for Healthcare Institutions
Standard Guide for Requests for Proposals Regarding Medical Transcription Services for Healthcare Institutions
SCOPE
1.1 This guide covers recommended guidelines to healthcare institutions for the development and issuance of requests for proposals, as well as guidelines for medical transcription services responding to RFPs. It does not purport to address all of the legal aspects of a request for proposal, if any, associated with its use. It is the respobsibility of the user of this guide to establish appropriate legal guidelines prior to use.
1.2 It is appropriate for healthcare institutions to issue requests for proposals (RFPs) from time to time or at regular contractual intervals for the purpose of facilitating the process of contracting for medical transcription services.
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An American National Standard
Designation:E1959–98
Standard Guide for
Requests for Proposals Regarding Medical Transcription
Services for Healthcare Institutions
This standard is issued under the fixed designation E 1959; the number immediately following the designation indicates the year of
original adoption or, in the case of revision, the year of last revision. A number in parentheses indicates the year of last reapproval. A
superscript epsilon (e) indicates an editorial change since the last revision or reapproval.
1. Scope set by the American Association for Medical Transcription
(AAMT), by demonstrating proficiency in the field, meeting
1.1 This guide covers recommended guidelines to health-
accepted standards, and maintaining the designation through
care institutions for the development and issuance of requests
continuing education activities as required by the Medical
for proposals, as well as guidelines for medical transcription
Transcriptionist Certification Program at AAMT.
services responding to RFPs. It does not purport to address all
3.1.3 compliance clause—item in a contract that defines
of the legal aspects of a request for proposal, if any, associated
remedies for default of contract specifications.
with its use. It is the responsibility of the user of this guide to
3.1.4 data destruction—eradication of data to a useless and
establish appropriate legal guidelines prior to use.
irretrievable state.
1.2 It is appropriate for healthcare institutions to issue
3.1.5 data disposal—transference of data to a medium or
requests for proposals (RFPs) from time to time or at regular
form that renders it inaccessible or useless.
contractual intervals for the purpose of facilitating the process
3.1.6 data elements—units of fundamental information
of contracting for medical transcription services.
from a healthcare record, organized in an analytical manner.
2. Referenced Documents 3.1.7 data extraction—specification of a subset of data from
a master data source for a new data format.
2.1 ASTM Standards:
3.1.8 data mining—extraction of selected elements of
E 1384 Guide for Content and Structure of the Computer-
stored data to be used for a purpose other than the one for
Based Patient Record
which the information was originally intended.
E 1762 Guide for Electronic Authentication of Health Care
3.1.9 dictation—information that is stated or read aloud to
Information
be transcribed by another.
E 1869 Guide for Confidentiality, Privacy,Access, and Data
3.1.10 dictator—one who dictates information to be tran-
Security Principles for Health Information Including
scribed by another; also known as originator.
Computer-Based Patient Records
3.1.11 digital dictation—informationwhichisstatedorread
E 1902 Guide for Management of the Confidentiality and
aloud and recorded by a digital recording system.
Security of Dictation, Transcription, and Transcribed
3.1.12 document—report in any form (print, electronic, or
Health Records
voice file).
3. Terminology
3.1.13 document access—ability to enter, exit, and, in some
circumstances, edit or make use of a document.
3.1 Definitions:
3.1.14 document destruction—eradication of all elements of
3.1.1 authentication—process of ( 1) verifying authorship,
a document to a useless state.
for example, by written signature, identifiable initials, or
3.1.15 document disposal—transference of all elements of a
computer key, or (2) verifying that a document is what it is
document to a medium or form that renders it inaccessible or
purported to be, such as comparison with other records, or
useless.
both.
3.1.16 document distribution—delivery of a document or
3.1.2 certified medical transcriptionist—medical transcrip-
documents (original or copies) to appropriate recipients, in any
tionistwhohasmetthequalificationsforvoluntarycertification
form (print, electronic, or voice file), authenticated or not
authenticated.
This guide is under the jurisdiction of ASTM Committee E-31 on Healthcare
3.1.17 document storage—repository for reports in any
Informatics and is the direct responsibility of Subcommittee E31.22 on Health
form (print, electronic, or voice files), authenticated or not
Information Transcription and Documentation.
authenticated, for later use or retrieval.
Current edition approved July 10, 1998. Published August 1998.
Annual Book of ASTM Standards, Vol 14.01.
Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.
E1959–98
3.1.18 electronic authentication—verification of authorship
JCAHO = Joint Commission on Accreditation of Health-
of a document or verification that a document is what it is
care Organizations
purported to be, or both, accomplished by electronic means or
MT = Medical Transcriptionist; Medical Transcription
in an electronic format. MTCP = Medical Transcriptionist Certification Program
MTS = Medical Transcription Service
3.1.19 full-time equivalent—work force equivalent of one
RFP = Request for Proposal
individual working full-time for a specific period, which may
TAT = Turnaround Time
be made up of several part-time individuals or one full-time
individual. (1)
4. Significance and Use
3.1.20 healthcare institution—any facility whose primary
4.1 This guide is intended to assist healthcare institutions in
purpose is delivery of health care, for example, hospital, clinic,
creating appropriate requests for proposals to be issued for
physician practice, multi-campus healthcare system.
medical transcription services.
3.1.21 medical transcription—process of interpreting and
4.2 This guide provides recommended guidelines for the
transcribing dictation by physicians and other healthcare pro-
essential elements to be included in requests for proposals
fessionals regarding patient assessment, workup, therapeutic
issued to medical transcription services. The purpose of these
procedures, clinical course, diagnosis, prognosis, etc., into
requests is contracting for production and delivery of tran-
readable text, whether on paper or on computer, in order to
scribed patient care documentation for a healthcare institution.
document patient care and facilitate delivery of healthcare
4.3 This guide does not preclude the necessity of research-
services. (2)
ing local, state, and federal requirements that may apply.
3.1.22 medical transcription service (MTS)—provider of
transcribed healthcare documentation; also referred to as ven-
5. The Current RFP Process
dor or contractor.
5.1 Healthcareinstitutionsoftenoutsourcetheproductionof
3.1.23 on-site users—individuals who use a facility’s com-
patient care documentation to an external vendor known as a
puter system via a terminal and other hardware elements that
medical transcription service (MTS). Therefore requests for
are physically connected to that system.
proposals (RFPs) for those services and their attendant awards
3.1.24 remote users—individuals who use a facility’s com-
or possible flaws are more important than ever for health
puter system via modem or wide area network connection.
information management consideration. Establishing sensible
3.1.25 taped dictation—information which is stated or read
standards for the RFP process is a necessary beginning for
aloudandrecordedbyananalogsystem,asopposedtoadigital
successful partnerships between healthcare clients and medical
system. Also called analog dictation.
transcription services. RFP standards will help to ensure that
3.1.26 turnaround time (TAT)—elapsed time beginning with
the healthcare client’s goals and expectations become an
availability of the voice file to the contractor (also known as
integral part of the working relationship with the MTS.
MTS or vendor) for transcription and ending when the tran-
5.2 In reviewing RFP styles presently in use in the United
scribed document is delivered to the client.
States,itisclearthatnoparticularstandardsarebeingfollowed
3.1.27 unit of measure—defined unit of production for
in their composition.
transcription, for example, character, word, line, minute; mea-
5.2.1 Because of the way RFPs are currently written, the
sure used to quantify transcription produced.
information necessary to select the best MTS may not be
3.1.27.1 Discussion—Because production statistics may
gleaned, and this may result in inadequate service or other
vary based on counting methods used, electronic or otherwise,
difficulties after the contract is awarded. If an RFPdoes not ask
even though units of measure are the same, the contractor
for sufficient information about the MTS for the healthcare
should clearly define the unit of measure being used, and the
client to be able to judge the company fairly or to make an
client should require full disclosure of the methods used to
informed decision, or does not give enough information to
quantify production.
enable the MTS to provide an informed response or set up the
3.2 Acronyms:Acronyms:
account adequately for its needs, bidding results can be
inferior.
5.2.2 On the other hand, if the RFP is so stringent or
AAMT = AmericanAssociation for Medical Transcription
unreasonable or detailed that even the best of transcription
CHIN = Community Health Information Network
services cannot meet the demands, then the only bidders will
CMT = Certified MedicalTranscriptionist (as designated
be those who do not recognize that they will be unable to meet
by the Medical Transcriptionist Certification
the requirements of the contract. If the contract is awarded to
Program at AAMT)
a bidder unable to follow through, that medical transcription
CPR = Computer-based Patient Record
service is likely to default on the contract, and it will then be
CPRS = Computer-based Patient Record System
awardedtoanotherbidder,ortheRFPprocesswillbeginagain.
FTE = Full-time Equivalent
HCFA = Health Care Financing Administration This may leave the healthcare client with poor service or no
service.
5.2.3 The healthcare documentation process and quality of
the text are often harmed by this lack of perceptive standards.
In the end, this means that patient care may be adversely
The boldface numbers given in parentheses refer to the list of references at the
end of this standard. affected and providers’ time may be wasted. Further, the
E1959–98
money spent by the healthcare client on repeatedly reestablish- physician clinic groups, is ignoring the vast impact such
ing relationships with medical transcription services can be changes will have on an MTS.
excessive, and the quality of service during the transition time
7.1.2 Organizational Picture—In describing the current sta-
may be less than optimal. tus, the entire picture should be delineated, not just the portion
to be involved in the contract. A general description of the
6. Systematic Approach to Writing RFPs
healthcare facility, with financial or associated corporate struc-
6.1 A systematic approach to the RFP includes items that
tures, should be specified. It makes a difference to the MTS to
make the situation of the healthcare client clear to the MTS,
know that a healthcare facility may include three hospitals at
including the client’s existing state of transcription, goals for
various campus locations, with sixteen additional clinic loca-
the future, and the requirements for success: response criteria,
tions at varied sites. The total census information at these sites
confidentiality fundamentals, security, disaster recovery, docu-
will also make a difference. Referencing the healthcare facili-
ment or data destruction guidelines, or both, as well as vendor
ty’s policies and procedures, and their availability to the MTS,
disclosure and reference requests. The RFP structure should
is not only helpful but makes a clear statement of their
include:
importance.
6.1.1 Current status of the healthcare client,
7.1.3 Healthcare Documents—A description of healthcare
6.1.2 Expectations of the healthcare client,
documentspresentlygeneratedforeachsiteshouldbespecified
6.1.3 Proposal response requirements,
and described:
6.1.4 Terms and conditions of contract,
7.1.3.1 Healthcare document description.
6.1.5 Confidentiality issues,
7.1.3.2 Theactualdefinedvolumeofeachdocumenttypeby
6.1.6 Information security issues,
number of lines, minutes, or other explicitly definable unit of
6.1.7 Disaster recovery issues,
measure appropriate for input measurement.
6.1.8 Document and data destruction,
7.1.3.3 Thepercentageofeachdocumenttyperelativetothe
6.1.9 Vendor disclosure,
total volume.
6.1.10 Reference requests,
7.1.3.4 The percentage of total healthcare documentation
6.1.11 Scope of services (to include quality assurance pro-
currently being dictated and transcribed.
gram and staffing),
7.1.3.5 The required turnaround time mandated by the
6.1.12 Product pricing, and
facility’s policies, and the present achievement level in meet-
6.1.13 Compliance clauses.
ing turnaround requirements.
6.2 TheRFPshouldbesetupinsuchawaythatitwillallow
7.1.3.6 The anticipated volume of each document type to be
the MTS an optimum opportunity to present the full scope of
involved in the proposal.
services to the healthcare client as a partner in achieving the
7.1.4 Equipment and Software—Thecurrentstatusofequip-
client goals. It should not be so rigid that the vendor cannot
mentandsoftwareusedatthevarioussitesshouldbeindicated,
demonstrate creative solutions and approaches to service and
including dictation and word processing or transcription equip-
pricing. This sort of openness, while making clear the require-
ment, as well as information system links and phone systems.
ments of the institution, promotes a response of cooperation
Disclosureofanticipatedinformationsystemchangesisvitalto
toward a common goal.
the MTS.
6.3 In each of the sections of the RFP, the document should
7.1.5 Document Format and Distribution—Specifications
set out the requirements in such a way that the compliance or
as to the actual documents presently produced should include
noncompliance of the MTS can be verified. This should be
the following areas:
followed by a field for comment by the MTS. In areas where
7.1.5.1 Format,
the healthcare client has a preference, but not necessarily a
7.1.5.2 Document access (for example, by dictators, con-
demand, the same format can be followed. Some sections may
sultants, and coding specialists),
be an invitation for information from the MTS and should be
7.1.5.3 Document distribution forms (print, electronic, and
so arranged. Such an invitation acknowledges respect for the
voice file),
MTS’s expertise in its field, while wisely protecting the
7.1.5.4 Document distribution copy requirements,
interests of the healthcare institutions.
7.1.5.5 Document distribution parameters (where, when,
7. Structure of the RFP Document
and h
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