Since SOAP does a wide range of work types for several hospitals and healthcare providers such as radiologists, wound clinics, behavioral health, and physical therapists, we have tailored the TATs to the needs of the client. With 2-4 hour turnarounds and up to 48-hour turnarounds, it is very important to monitor scheduling and production. Because of our 24x7 operation, we can easily facilitate the turnaround requirements for emergency departments, H&Ps, progress notes, and radiology. As for STAT requests, we have procedures and systems in place to accommodate the demands of STAT reports. The dictator can make reports STAT on the fly, a clerical person can change the report to a higher priority to be typed next, and/or they can call our staff and ask us to change the priority.

Our systems allow us to run reports to show turnaround times. We monitor it both with daily interactive systems with dashboard alerts and with periodic and monthly turnaround time reports.

Each hospital provides SOAP copies of it's current formats, and SOAP creates templates to match those formats.

SOAP works closely with it's clients to ramp up as quickly as possible. In some cases, with the appropriate documentation from the hospital, SOAP can facilitate the set up of dictation on our system and subsequent transcription in less than 48 hours. To interface with the hospital's system, SOAP will need 30-60 days for getting a dual HL7 interface up and working.

As part of the set up, SOAP will need a list of dictating and hospital physicians, along with the specialty for each physician and their dictate numbers. In addition, SOAP will need copies of hospital formats and requests copies of old dictations to get a feel for how each physician dictates. SOAP needs 30-60 days to ramp up to meet all contracted turnaround times.

SOAP provides training to physicians on the dictation equipment, if they are dictating on our system. A representative from SOAP works with the hospitals to set up the phones, handhelds, or other dictation systems (i.e., new technology comes out all of the time, for example IP phones ) and can assist in training the dictators. The training process may take a few days to accommodate those that are leaving a shift and the next ones that are starting a shift over a two to three-day period, if this is required. Some hospitals do not need this because we can mimic the existing system(s), so the dictators think it is the same familiar system.

In addition, we also train clerical staff in the department(s) and someone from medical records, and we leave written directions for the departmental staff.

SOAP is currently using multiple and separate systems. If one goes down, the second one automatically becomes active. In addition, voice and documents are backed up nightly. If the disaster is weather-related or electrical-related, SOAP has a natural gas-powered generator to keep the system going until the power is restored.

Our battery backup system is equipped with an auto transfer switch that automatically detects a loss of power. When no power is detected, the generator is started, and the transfer switch changes it's power source to the generator.

SOAP uses multiple and separate communication networks to assure uptime.

Unless otherwise contracted, voice files are kept for 60 days. Voice housekeeping is automatically run each evening. Unless otherwise contracted, SOAP keeps reports on our system for 90 days.

SOAP's definition of quality of work is that the content and grammar are correct. We stick as close to the physician's dictation as possible but will not type something in a report that we are sure is incorrect. (Example: If the patient is obviously a male, but the physician refers to him as a "she". If the physician says left arm twice and right arm three times, we will leave blanks and provide an explanation as to why there are blanks.) As for SOAP's policy for handling dictation that is difficult to understand or incomplete, SOAP's first step is to have a trainer or quality assurance specialist listen to clarify the situation. With 2-4 hour turnaround work types, we can call the physicians for clarification. Unfortunately, with 24 to 48-hour turnaround work types, the physician is not usually available to ask questions. If we are unable to clarify the situation, we will leave a blank and mark the report as having a blank.

SOAP has created a tracking system to make sure we have a document for each job on our dictation system. In addition, it confirms that each report successfully has been delivered to the hospital. This report is run every morning for the work typed on the previous day. We have been using this system since about 1998. It has cut down dramatically on the number of reports that inadvertently were not delivered to a hospital. Some of our clients do not even realize we do this but will comment on how few times they have to call us to get work resent.

During the interview process and first day of hire, SOAP stresses with an employee the importance of confidentiality and HIPAA Compliance. He/she are educated and tested accordingly. He/she are required to sign a confidentiality agreement. In addition, there is a confidentiality statement in our Employee Manual that each employee has to sign, affirming that he/she has read the information and that he/she will abide by it.

SOAP, itself, signs Business Associate Privacy Agreements with all of it's healthcare providers.

All of our systems are secure and HIPAA compliant. SOAP's employees access our system through our firewall and type directly onto our system. The voice and/or documents never reside on the at-home MLSs' computers. In addition, we provide computers for our employees that have been locked down. They cannot add software to them, add printers, and cannot receive or send personal e-mail on them.

We connect via a site-to-site VPN tunnel with mapped drive with most of our hospitals and clinic's systems to receive voice and ADT information and send documents. Some of our clients do, however, prefer the use of a secure FTP site.

Most of SOAP's hospitals download patient demographics to us. They are provided to us via HL7, bar delimited in ASCII format, Excel spreadsheets, or directly from their clinical information system. The demographic file may contain patient name, medical record number, attending physician, date of visit, date of birth, account number for the visit, and any other information they want us to provide in our reports.