Healthcare Documentation Fundamental and Practice Transcription Exercise Students Module Users Guide

Transcription

1 Healthcare Documentation Fundamental and Practice Transcription Exercise Students Module Users Guide Contents Introduction... 1 Overview... 1 Key Terms... 2 Installation... 4 Updates... 4 Getting Started... 6 Completing Exercises... 7 Accessing the exercises... 7 Edit window... 8 Step by step:... 9 Controls Troubleshooting Unable to log in Pedal issues Introduction The Pearson Transcription Exercise System is a digital transcription processing, management and delivery platform used to complete the companion dictation/transcription exercises for multiple texts. The platform was designed to provide the user real-world experience working in a digital system while mastering the concepts presented in the text. License for this product is granted through purchase of the text. Overview The Pearson Transcription Software System is title specific. Please be sure that you install the correct system for your text. The system is divided into 2, title specific applications (modules). The Student module is used by the student to transcribe the companion transcription exercises and submit them to their instructor for grading. The Student module includes a built in voice file player with foot pedal control support, automated file transfer, file management capabilities and utilizes the students copy of Microsoft Word as the word processor. The Instructor module is used by the course instructor to grade students submitted exercises as well as to present sample dictation/transcription to their students. The 1

2 Instructor version includes a built-in player with foot control, exercise keys, side-by-side exercise to key presentation and a compare documents feature to quickly identify differences between the student version and the key. Once reviewed the instructor is prompted to assign a grade (numeric, percent, letter or pass fail) The author(s) for each text provide the transcription exercises. The exercises are grouped by chapter and are used to teach and reinforce the concepts covered in the chapter text. Not all chapters will have companion exercises. Key Terms Archive - A command which will save the changes to the document, upload the exercise to the Pearson Server (cloud) and remove the exercise from view in the list. Archived exercises can be viewed by selecting the Display Archived Exercises check box. Close a command used to close an individual document on the current (local) computer without saving changes to the system database. The document can be reopened on the local machine for further edits but will not be available to open on other computers until the changes are saved to the Pearson System Database (cloud). Cloud Cloud computing is term for network distributed computing. Cloud computing means to place some or all of a program or program data on a network or internet server where it is accessible by multiple computers. The Pearson Transcription System utilizes a secure Internet server to make it possible to access program content from any Internet connected computer. Comments notations made by the transcriptionist or the Instructor indicating the need for additional attention or clarification. These notations might include questions about the report, an explanation of blanks, or discrepancies noted during transcription. Complete In the student module a command which will save the changes to the document, upload the completed exercise to the Pearson Server (cloud) and submit it to the instructor to be graded. In the instructor module, the complete command saves any edits or comments made by the instructor, prompts the instructor for a grade, uploads the file to the Pearson Server (cloud) and reports the grade to the student. Default a software setting that is used automatically especially if the user does not indicate a preference. Demographics information about the patient and the encounter. This information includes the patient s name, medical record number, and date of service, and were applicable Admit and Discharge dates. Dictator ID A unique number assigned to each dictator. Document Editor (Edit Window) a component of the Pearson software which includes a voice file player, MS Word window and a patient demographic bar. The Document Editor opens an exercise template within MS Word and plays the associated dictation voice file, allowing the student to transcribe the report or

3 Instructor to grade a report. The demographics bar allows the quick entry of the patient s name, medical record number, date of service, and other demographic information. Changes to the demographics box will be reflected in and saved to the document. The Instructor version editor displays the student s submitted exercise and the exercise key simultaneously. Document Viewer (Viewer Window) a component of the Pearson software (Instructor module only) which includes a voice file player and a MS Word window used to display an exercise key with the associated dictation voice file. It is used to view, teach or demonstrate individual transcription exercises. DOS abbreviation for Date of Service. This corresponds to the date the patient was seen (e.g. date of visit, encounter date, date of exam). Download to move a file toward you. Usually, this term describes the movement of a file from a server to a workstation. Draft A printed copy of a report used for review and markup. Exit a command in the Document Viewer that will close the current document and the Document Viewer at the same time. See also Document Viewer. Job number a unique number assigned to each exercise (audio file/document pair). The job number begins with the student s numeric system ID and contains the chapter and exercise numbers for easy identification. MRN/Patient ID this number is a unique alphanumeric identifier assigned to every patient. Usually, in a clinical setting this number is the patient s account number as determined by the medical provider s practice management system or hospital billing/management system. This unique number is the primary record locator for the patient s information within an electronic medical record system or database. MRN numbers may be dictated or may be found in a census or schedule. Refer to application specific instructions. Park Command (button) a command which will save the changes to a document and store the edited document on the Pearson Server for future access from any internet connected computer. Recommended. Patient name the patient s name as it appears in the census or document. Within the Pearson System, all names must be formatted as last name, first name and middle initial (optional). The format of the patient s name within the document itself may be different, but the database entry must be written consistently. Pearson Server a central storage location for all dictation and transcription files on the Pearson Transcription System. Also referred to as the cloud. Priority Sets the urgency and therefore determines the order in which the file is transcribed. Stat dictation is always transcribed ahead of all other documents. Priority is normally determined by the work type and is set when the account is initially created. Stat dictation is marked at the time of dictation, or a file may be upgraded to stat.

4 Save Save changes to a document. Please use CLOSE, PARK or COMPLETE commands to save your document. Please see command definitions. Server a computer designed to store and control access to files or data. Access to server files and data requires network or Internet access to the server and user authentication. Status the following terms are used to describe the various stages of the dictation/transcription process. These descriptions will appear in the exercise list under the column "Status." Not attempted These exercises have been downloaded to the students computer and are available to begin. In Progress These exercises have been started by the student but not yet completed. Refer to the location column to ascertain if the exercise is currently open on the students computer or stored on the server (cloud) from retrieval from a different computer. Submitted for grade These exercises have been completed by the student and have been submitted to the instructor for grading. Being Evaluated These exercises are currently being reviewed by an Instructor. Completed These exercises have been graded by the Instructor. Please refer to the Grade column to see the grade given to the completed exercise. Archived These exercises have been graded and reviewed and no longer need the immediate attention of the student or instructor. Archived exercises are not listed in the current exercise list but can be displayed by select the Display Archived Exercises check box. Upload to move a file away from you. Usually this term describes the movement of a file toward (onto) a server. Installation The Pearson Transcription System is text specific. Please register for and install the system for your text. (Please refer to the installation guide for your product.) The installation process will create a desktop icon for quick access to the program. Updates The program will periodically check for updates automatically. You can check for updates anytime by clicking Help>Check for Updates. If an update is available, the updater will inform you and on your

5 confirmation affect the update.

6 Getting Started Log in to access the system. On first login, you will be reminded to download resource materials The Student will first download resources then download chapter content. Available chapter content is listed in the bottom window. A check mark indicates that chapter has been downloaded. As each chapter s content is downloaded, its individual exercises are listed in the upper window. The list displays current status and availability. Individual exercises are accessed by clicking the open button associated with that exercise.

7 Completing Exercises Accessing the exercises The Student module is used for completing the transcription exercises and submitting those exercises for a grade. Content (exercises) are grouped by chapter and contain exercise templates and voice files needed to complete the exercises. Not all chapters will have companion exercises. Chapters with available content are listed in the lower window. Chapter content must be downloaded to the computer prior to attempting. Click on the Download Button for each chapter to download that chapter s content. Individual exercises for each chapter downloaded will be listed in the upper window. Click the Open button to access a listed exercise.

8 Edit window. The exercise key is displayed in the center window. A patient demographic window is displayed to the left. Player is located at the bottom. Exercise templates are Microsoft Word documents. The software uses the students copy of Word to display and edit the templates. File naming and management is handled by the software. Do not use the MS word save or save as commands to manage files. Patient demographics (Name, MRN, Date of birth, date of Service, etc) are part of the exercise. Patient demographics are entered into the patient demographic window to the left. The Update command is used to save the demographic information entered and transfer it to the document. Playback of dictated voice file begins automatically and can be controlled with the mouse or with an optional USB foot control.

9 Step by step: 1 Enter demographics With exercise open (see accessing exercises), identify patient from dictation, click the Get Resource button to access the patient census used to retrieve demographics for this exercise. The patient census is provided in multiple formats for your convenience. Locate demographics and complete the demographics section. Click Update to save and transfer demographics to documents 2 Transcribe dictation using Word Listen to the dictation. Transcribe the dictation into the provided template. Playback starts automatically and can be controlled by the mouse or optional foot pedal. 3 Park exercise to resume editing at a later date. Click the Park button to save the current document to the database for later retrieval and further edits. or 4 Complete exercise to submit for grade. Click complete to save and submit exercise to instructor. 5 Archive graded reports After viewing a graded report, click Archive to remove from view.

10 Controls Get Resource Command opens the Resource folder to access Patient Census and other information. Update The update command is used to save changes to the demographics information and update the corresponding values in the document. Close The close command is used to close an individual exercise on the current (local) computer without saving changes to the system database. The document can be reopened on the local machine for further edits but will not be available to open on other computers until the changes are saved to the Pearson System Database (cloud). See Park Park The park command saves changes to the exercise and stores the document on the Pearson Server for future access from any internet connected computer. The status does not change; it still needs to be graded. Complete The complete command saves changes to the document, stores the document on the Pearson Server and notifies the Instructor that the exercise is ready for grading. Archive In order to keep the exercise display window more manageable, graded exercise can be removed from sight. Once the student reviews the graded document they can click the Archive button to archive that exercise. The graded exercise is stored on the Pearson Server (cloud) and the status changed to Archived. Archived jobs are removed from the exercises window. Archived jobs can be listed by selecting the Display Archived Jobs check box.

11 Troubleshooting Unable to log in - The following message indicates that either your username or password was entered incorrectly. Passwords are case sensitive. Check your computer caps lock to make sure it is not on. Correct and retry. If you continue to experience problems, try your login on the transcription exercise web site If you are unable to log in on the web site, use the lost or forgotten password link to recover your password Enter your username, choose the recovery question selected at registration and provide the correct answer. Your password will be displayed on screen.

12 Pedal issues The software contains a built-in player. Dictation files begin playing automatically. Playback can be controlled with the mouse or with an optional USB foot control. The infinity IN-USB1 and IN-USB2 foot pedals are supported. If you experience problems with the foot pedal, you may need to adjust the settings in the software. To adjust foot pedal settings double click the desktop icon to display the login screen. Open the File Menu and go to File>Settings>pedal Timeout Change the value in the pedal timeout field. Windows XP user normal values should between 1000 and 3000 Windows Vista, Windows 7 and Windows 8 users between 3000 and 6000 Increase or decrease the value by 1000 at a time. Click ok to save the new value. You will need to close and relaunch the program to test the pedal response.