I work for Island Health as a medical transcriptionist at the Comox Valley Hospital.
On Jan. 30, all the VIHA medical transcriptionists, in Victoria, Nanaimo, Courtenay and Campbell River were notified that all the transcription for Island Health would be done by NUANCE, a multinational based in Burlington, Massachusetts.

VIHA has a contract with NUANCE to provide transcription software and for the last several years NUANCE employees, who work from home, have been doing VIHA’s “extra work”. This “extra work” currently amounts to over 80 percent of all VIHA transcription.

What does a medical transcriptionist do?

When a patient is admitted to hospital, discharged, seen by a specialist, in an outpatient clinic, etc. the treating doctor, midwife or nurse practitioner must dictate a report. That report goes to the patient’s medical record and is a medical/legal document signed by the dictating doctor and the transcriptionist.

The medical transcriptionist receives a typed draft report on their computer screen, along with the recording of the doctor’s dictation. The transcriptionist listens to the dictation, verifies the information about the patient, the doctor, the date and time that the patient was seen, and edits the dictation to ensure that when the report is entered electronically onto the patient’s chart it is an accurate record.

The report is, obviously, highly confidential and critical to patient care, includes patient’s medical history, diagnoses, current medications and treatment, family history, etc.

The transcriptionists who work for VIHA are required to have “graduated from an approved program in medical transcription” and are paid an hourly wage. If we have questions about something that is difficult to hear, the dosage or name of a medication, the name of a doctor, etc. we have access to the patient’s electronic chart and other sources for verification.

Usually there is a co-worker nearby who can be a second set of ears to listen to something that is unclear. People working for NUANCE have no access to the patient’s chart and no access to a peer to consult. The NUANCE transcriptionist who is doing piece work, not paid an hourly wage, and required to “produce, produce, produce” is under pressure to produce as quickly as possible.

If it takes five minutes of research to ensure that the record is accurate the VIHA transcriptionist can take five minutes. Five minutes may be a luxury a NUANCE employee cannot afford. If there is a “blank” (something that cannot be heard), the report is “pended” for review and completion by a supervisor.

If there is more than one blank in a report, regardless of whether it is done by a VIHA or NUANCE employee, instead of the report being uploaded to the patient’s chart it is automatically “pended”. The vast majority of “pended” reports, not surprisingly, are those transcribed by NUANCE employees, thus increasing the work that has to be done by VIHA supervisors.

My objection to privatization of any aspect of health care is that profit and highest quality of care cannot coexist and the motivation of a private “service provider” is profit. Since the 1980’s has there been a steady increase in the privatization of services directly related to patient care (as opposed to construction, paper supplies and other products and services that must be contracted from the private sector).

The consequence of this privatization is that the public authority that is responsible for ensuring the quality of care and the protection of patients, including confidential patient records which are essential to care, no longer has control of this work.

We were told that the decision to contract out all transcription on Vancouver Island was made following “lots of discussion at the Ministry of Health level.”

The timing of this announcement is interesting. A new collective agreement, if approved by the union membership, will take effect April 1, 2019. In that new agreement there is a memorandum of agreement entitled “Contract Retendering and Repatriation (Bill 47 Working Group).”

Bill 47 was passed unanimously in December last year. It repeals Bills 29 and 94, the legislation that opened the door to wide-scale privatization. The memorandum states “The parties agree that Bill 47 demonstrates Government’s commitment to a better path forward, one that provides stability and equal respect for all health care workers, and continuity of care for patients” and establishes a process for the Ministry of Health, the Health Employers’ Association of British Columbia, Health Authorities and the Union to discuss contracted out services and to “develop guidelines and processes that will be used to identify the opportunities, assess the practicability, and support the orderly return of these services to the direct control of the Employer where Government and/or the Employer make the decision to return of contracted services to the bargaining unit.”

Why would a government and employer with this intent move with such haste to complete the privatization of a service that is not yet completely privatized? In order to beat the April 1 date and present the union with a fait accompli and then say, sorry, not interested in repatriation?

What effort has VIHA made to hire more transcriptionists? There are jobs that have not been posted. Work that could be done by casuals is not offered to them. Several years ago the Health Authority claimed that it could not fill evening and night shifts that had been posted but most of the work done by NUANCE employees is done in the daytime so those jobs could have been re-posted as dayshifts.

The medical transcription certificate program is offered by BC colleges. An employer concerned about recruitment could actually partner with a college to encourage employees to take the training (which can be done on-line without time off work). An employer interested in solving the recruitment problem, if there is one, would work with the union to do so.

If there was a genuine commitment to highest quality care the decision would have been to find ways to repatriate all of medical transcription, not privatize all of it.

Barbara Biley lives in Courtenay