Hiring a Home Health Care Employee

Providing the primary care for an elder loved one can be difficult. When you cannot deliver all the elder care yourself and support from friends, family, and community organizations is not enough, it may be useful to hire a home health care worker. He or she can offer care from a few hours a week to 24 hours a day, and can provide many other helpful services. Types of in-home health care services include:

General Health Management like administration of medication or other medical treatments
Personal care such as bathing, oral hygiene, dressing, and shaving
Nutrition help like preparing meals, assisting eating, and grocery shopping
Homemaking services including laundry, dishwashing, and light housework
Companionship for example reading to the senior or taking them on walks
Recruiting and Interviewing Applicants
There are many avenues for hiring a home health care employee. Generally, home health care workers can be hired directly or through an agency. Home health care agencies often have a staff that includes social workers and nurses that will manage your care. However hiring an independent home health care worker is generally more cost effective, it will also give you more control over the type of care you receive.

Senior home care workers should be carefully screened for proper training, qualifications, and temperament. Fully discuss the needs of the elder care recipient during an interview with a prospective home health care employee. There should be a written copy the job description and the type of experience you are looking for.


Have applicants fill out an employment form that includes the following information:

Full name
Phone number
Date of birth
Social Security number
Educational background
Work history
Before hiring, you should ask to see the senior home care worker’s licenses and certificates, if applicable, and personal identification including their social security card, driver’s license, or photo ID.
References should be checked out thoroughly. Prospective employees should provide the employer with names, dates of employment, and phone numbers of previous employers and how to contact them. It is best to talk directly to previous employers, rather than just to accept letters of recommendations. Also ask the applicant to provide or sign off on conducting a criminal background check

Special Points to Consider

Make sure the person you are considering hiring knows how to carry out the tasks the elder care recipient requires, such as transferring the senior to and from a wheelchair or bed. Training may be available, but make sure the worker completes the training successfully before hiring him or her.

No one should be hired on a seven-day-a-week basis. Even the most dedicated employee will soon burn out. All employees need some time to take care of their personal needs. No worker should be on call 24-hours a day. If the elder care recipient needs frequent supervision or care during the night, a family member or second home health care worker should be able to help out or fill in.

Live-in assistance may seem to be more convenient and economic than hourly or per-day employees but there can be drawbacks. Food and lodging costs must be calculated into the total cost of care, and it could be difficult to dismiss someone without immediate housing alternatives. If you decide to utilize a live-in arrangement, the employee should have his own living quarters, free time, and ample sleep.

Job Expectations and Considerations

Before hiring a senior home health care worker, you should go over the tasks you expect them to perform and other issues, such as promptness, benefits, pay scale, holidays, vacations, absences, and notification time needed for either employer or employee before employment is terminated. If you work and are heavily dependent on the home health care worker, emphasize the importance of being informed as soon as possible if he or she is going to be late or absent so that you can make alternative arrangements. Be clear about notification needed for time off, or what to do in the case the home health care worker experiences a personal emergency that requires them to abruptly leave work. It is important to have a backup list of friends, family, other home care workers, or a home health care agency you can call on.

Be clear about issues concerning salary, payment schedule, and reimbursement or petty cash funds for out of pocket expenses.

You should spend the day with the home health care worker on his first day to make sure you are both in agreement over how to carry out daily tasks. It would also be helpful to supply the home health care worker with a list of information on the elder care recipient such as: special diets, likes, dislikes, mobility problems, health issues, danger signs to monitor, possible behavior problems and accompanying coping strategies, medication schedule, therapeutic exercises, eye glasses, dentures, and any prosthetics.

You should also provide the following information to your home health care worker: your contact information, emergency contacts, security precautions and access to keys, clothing, and locations of washing/cleaning supplies, medical supplies, light bulbs, flashlights, fuse box, and other important household items.


Another big consideration in hiring a senior home care worker is how he or she is going to get to work. If they do not have a reliable car or access to public transit, then you might want to consider hiring someone to drive him or her, which might be more economical than using taxis. Inform your insurance company if the home health care worker is going to drive your car when caring for the senior. Your insurance company will perform the necessary driving background checks. If the home health care worker is using his or her car to drive the elder care recipient, then discuss use of her or his car, and conduct a driving background check.

Insurance and Payroll

Check with an insurance company about the proper coverage for a worker in your home.

Make sure all the proper taxes are being drawn from the employee’s check by contacting the Internal Revenue Service, state treasury department, social security, and the labor department. If you do not want to deal with the complexities of the payroll withholdings yourself, than you can hire a payroll company for a fee.

Even if your home health care worker is working as a contractor, you are still obligated to report the earnings to the IRS. Talk to your accountant or financial adviser about making sure you are following IRS rules.

Ensuring Security

You should protect your private papers and valuables in a locked file cabinet, safe deposit box, or safe. If you are unable to pick up your mail on a daily basis, have someone you trust do it, or have it sent to a post box. You should check the phone bill for unusual items or unauthorized calls. You should put a block on your phone for 900 numbers, collect calls, and long-distance calls.

Keep checkbooks and credit cards locked up. Review credit card and bank statements on a monthly basis, and periodically request credit reports from credit reporting agencies. Lock up valuable possessions or keep an inventory of items accessible to people working in the house.

You can help to prevent elder abuse to your loved one by:

Make sure the home health care worker thoroughly understands his or her responsibilities, the elder care recipient’s medical problems and limitations, and how to cope with stressful situations.
Do not overburden the home health care worker.
Encourage openness over potential problems.
The following are possible signs of elder abuse or neglect:
Personality changes
Crying, whimpering, or refusing to talk
Sloppy appearance
Poor personal hygiene
Disorganized or dirty living conditions
Signs of inappropriate sedation, such as confusion, or excessive sleeping
Mysterious bruises, pressure sores, fractures, or burns
Weight loss
If you suspect abuse, act immediately. Do not wait until the situation turns tragic. Investigate the situation by talking to the elder care recipient in a safe situation, or install monitoring equipment. Examples of abusive behavior include yelling, threatening, or over controlling behavior that could involve isolating the senior from others. If the situation is serious, you should replace the home health care worker as quickly as possible. If you fear the elder care recipient is in danger, he or she should be separated from the home health care worker as soon as possible. Place the elder care recipient with a trusted relative or in a respite care facility. Make sure your loved one is safe before confronting the home health care worker, especially if there is concern about retaliation.
Report the situation to Adult Protective Services after ensuring the safety of the elder care recipient. The police should be contacted in the case of serious neglect, such as sexual abuse, physical injury, or misuse of funds.

Supervising a Home Health Care Worker

The most important thing to remember after hiring a home health care worker is to keep the lines of communication open. You should explain the job responsibilities clearly, and your responsibilities to the home health care worker. Do not forget that the home health care worker is there for the elder care recipient and not the rest of the family. For live-in arrangements, the maximum amount of privacy should be set up for the home health care worker’s living quarters. Meetings should be set up on a regular basis to assure that problems are nipped in the bud. If conflicts cannot be resolved after repeated attempts, than it is best to terminate the employee. In such a case, you may have to either place the elder care recipient in a nursing home temporarily or hire a home health care worker through an agency. Reserve funds should be kept on hand in the case of such an emergency.

General Eligibility Requirements for Home Care Benefits

Hiring a home health care worker directly is usually less expensive than hiring through a home health care agency; but if the elder care recipient is eligible and you wish to use assistance from Medicare, you must hire someone through a certified home health care agency. For the senior patient to be eligible, three or more services must be ordered by a physician. Other factors or eligibility are the required need for skilled nursing assistance, or one of the following therapies: physical, speech or occupational. The elder care recipient’s medical needs will determine asset and income requirements.

Hiring Home Health Care Workers through Home Health Care Agencies versus Independently

Different health professionals can assess the elder care recipient’s needs. A nurse or social worker can help with design and coordination of a home care plan. Your care manager, doctor, or discharge planner can help with services being covered by Medicare. They generally help make the arrangements with a home care agency.

You should ask the home health care agency how they supervise their employees, and what kind of training their employees receive. Find out the procedures for when an employee does not show up. Also ask about the fee schedule and what it covers, there may be a sliding fee schedule. Furthermore, find out if they have a policy for minimum or maximum hours. Ask the agency if there are any limitations on the types of tasks performed.

Especially if you have to pay for the care services yourself, find out if there are any hidden costs such as transportation. If all the costs for hiring a care worker through an agency become too much, you may want to consider hiring directly.

Hiring independent home health care workers is not only more economical than using an agency, but it also allows more direct control over the elder care.

Patient Abandonment – Home Health Care

Elements of the Cause of Action for Abandonment

Each of the following five elements must be present for a patient to have a proper civil cause of action for the tort of abandonment:

1. Health care treatment was unreasonably discontinued.

2. The termination of health care was contrary to the patient’s will or without the patient’s knowledge.

3. The health care provider failed to arrange for care by another appropriate skilled health care provider.

4. The health care provider should have reasonably foreseen that harm to the patient would arise from the termination of the care (proximate cause).

5. The patient actually suffered harm or loss as a result of the discontinuance of care.

Physicians, nurses, and other health care professionals have an ethical, as well as a legal, duty to avoid abandonment of patients. The health care professional has a duty to give his or her patient all necessary attention as long as the case required it and should not leave the patient in a critical stage without giving reasonable notice or making suitable arrangements for the attendance of another. [2]

Abandonment by the Physician

When a physician undertakes treatment of a patient, treatment must continue until the patient’s circumstances no longer warrant the treatment, the physician and the patient mutually consent to end the treatment by that physician, or the patient discharges the physician. Moreover, the physician may unilaterally terminate the relationship and withdraw from treating that patient only if he or she provides the patient proper notice of his or her intent to withdraw and an opportunity to obtain proper substitute care.

In the home health setting, the physician-patient relationship does not terminate merely because a patient’s care shifts in its location from the hospital to the home. If the patient continues to need medical services, supervised health care, therapy, or other home health services, the attending physician should ensure that he or she was properly discharged his or her-duties to the patient. Virtually every situation ‘in which home care is approved by Medicare, Medicaid, or an insurer will be one in which the patient’s ‘needs for care have continued. The physician-patient relationship that existed in the hospital will continue unless it has been formally terminated by notice to the patient and a reasonable attempt to refer the patient to another appropriate physician. Otherwise, the physician will retain his or her duty toward the patient when the patient is discharged from the hospital to the home. Failure to follow through on the part of the physician will constitute the tort of abandonment if the patient is injured as a result. This abandonment may expose the physician, the hospital, and the home health agency to liability for the tort of abandonment.

The attending physician in the hospital should ensure that a proper referral is made to a physician who will be responsible for the home health patient’s care while it is being delivered by the home health provider, unless the physician intends to continue to supervise that home care personally. Even more important, if the hospital-based physician arranges to have the patient’s care assumed by another physician, the patient must fully understand this change, and it should be carefully documented.

As supported by case law, the types of actions that will lead to liability for abandonment of a patient will include:

• premature discharge of the patient by the physician

• failure of the physician to provide proper instructions before discharging the patient

• the statement by the physician to the patient that the physician will no longer treat the patient

• refusal of the physician to respond to calls or to further attend the patient

• the physician’s leaving the patient after surgery or failing to follow up on postsurgical care. [3]

Generally, abandonment does not occur if the physician responsible for the patient arranges for a substitute physician to take his or her place. This change may occur because of vacations, relocation of the physician, illness, distance from the patient’s home, or retirement of the physician. As long as care by an appropriately trained physician, sufficiently knowledgeable of the patient’s special conditions, if any, has been arranged, the courts will usually not find that abandonment has occurred. [4] Even where a patient refuses to pay for the care or is unable to pay for the care, the physician is not at liberty to terminate the relationship unilaterally. The physician must still take steps to have the patient’s care assumed by another [5] or to give a sufficiently reasonable period of time to locate another prior to ceasing to provide care.

Although most of the cases discussed concern the physician-patient relationship, as pointed out previously, the same principles apply to all health care providers. Furthermore, because the care rendered by the home health agency is provided pursuant to a physician’s plan of care, even if the patient sued the physician for abandonment because of the actions (or inactions of the home health agency’s staff), the physician may seek indemnification from the home health provider. [6]


Similar principles to those that apply to physicians apply to the home health professional and the home health provider. A home health agency, as the direct provider of care to the homebound patient, may be held to the same legal obligation and duty to deliver care that addresses the patient’s needs as is the physician. Furthermore, there may be both a legal and an ethical obligation to continue delivering care, if the patient has no alternatives. An ethical obligation may still exist to the patient even though the home health provider has fulfilled all legal obligations. [7]

When a home health provider furnishes treatment to a patient, the duty to continue providing care to the patient is a duty owed by the agency itself and not by the individual professional who may be the employee or the contractor of the agency. The home health provider does not have a duty to continue providing the same nurse, therapist, or aide to the patient throughout the course of treatment, so long as the provider continues to use appropriate, competent personnel to administer the course of treatment consistently with the plan of care. From the perspective of patient satisfaction and continuity of care, it may be in the best interests of the home health provider to attempt to provide the same individual practitioner to the patient. The development of a personal relationship with the provider’s personnel may improve communications and a greater degree of trust and compliance on the part of the patient. It should help to alleviate many of the problems that arise in the health care’ setting.

If the patient requests replacement of a particular nurse, therapist, technician, or home health aide, the home health provider still has a duty to provide care to the patient, unless the patient also specifically states he or she no longer desires the provider’s service. Home health agency supervisors should always follow up on such patient requests to determine the reasons regarding the dismissal, to detect “problem” employees, and to ensure no incident has taken place that might give rise to liability. The home health agency should continue providing care to the patient until definitively told not to do so by the patient.


Home health provider personnel may occasionally encounter an abusive patient. This abuse mayor may not be a result of the medical condition for which the care is being provided. Personal safety of the individual health care provider should be paramount. Should the patient pose a physical danger to the individual, he or she should leave the premises immediately. The provider should document in the medical record the facts surrounding the inability to complete the treatment for that visit as objectively as possible. Management personnel should inform supervisory personnel at the home health provider and should complete an internal incident report. If it appears that a criminal act has taken place, such as a physical assault, attempted rape, or other such act, this act should be reported immediately to local law enforcement agencies. The home care provider should also immediately notify both the patient and the physician that the provider will terminate its relationship with the patient and that an alternative provider for these services should be obtained.

Other less serious circumstances may, nevertheless, lead the home health provider to determine that it should terminate its relationship with a particular patient. Examples may include particularly abusive patients, patients who solicit -the home health provider professional to break the law (for example, by providing illegal drugs or providing non-covered services and equipment and billing them as something else), or consistently noncompliant patients. Once treatment is undertaken, however, the home health provider is usually obliged to continue providing services until the patient has had a reasonable opportunity to obtain a substitute provider. The same principles apply to failure of a patient to pay for the services or equipment provided.

As health care professionals, HHA personnel should have training on how to handle the difficult patient responsibly. Arguments or emotional comments should be avoided. If it becomes clear that a certain provider and patient are not likely to be compatible, a substitute provider should be tried. Should it appear that the problem lies with the patient and that it is necessary for the HHA to terminate its relationship with the patient, the following seven steps should be taken:

1. The circumstances should be documented in the patient’s record.

2. The home health provider should give or send a letter to the patient explaining the circumstances surrounding the termination of care.

3. The letter should be sent by certified mail, return receipt requested, or other measures to document patient receipt of the letter. A copy of the letter should be placed in the patient’s record.

4. If possible, the patient should be given a certain period of time to obtain replacement care. Usually 30 days is sufficient.

5. If the patient has a life-threatening condition or a medical condition that might deteriorate in the absence of continuing care, this condition should be clearly stated in the letter. The necessity of the patient’s obtaining replacement home health care should be emphasized.

6. The patient should be informed of the location of the nearest hospital emergency department. The patient should be told to either go to the nearest hospital emergency department in case of a medical emergency or to call the local emergency number for ambulance transportation.

7. A copy of the letter should be sent to the patient’s attending physician via certified mail, return receipt requested.

These steps should not be undertaken lightly. Before such steps are taken, the patient’s case should be thoroughly discussed with the home health provider’s risk manager, legal counsel, medical director, and the patient’s attending physician.

The inappropriate discharge of a patient from health care coverage by the home health provider, whether because of termination of entitlement, inability to pay, or other reasons, may also lead to liability for the tort of abandonment. [8]

Nurses who passively stand by and observe negligence by a physician or anyone else will personally become accountable to the patient who is injured as a result of that negligence… [H]ealthcare facilities and their nursing staff owe an independent duty to patients beyond the duty owed by physicians. When a physician’s order to discharge is inappropriate, the nurses will be help liable for following an order that they knew or should know is below the standard of care. [9]

Similar principles may apply to make the home health provider vicariously liable, as well.

Liability to the patient for the tort of abandonment may also result from the home health care professional’s failure to observe, examine, assess, or monitor a patient’s condition. [10] Liability for abandonment may arise from failing to take timely action, as well as failing to summon a physician when a physician is needed. [11] Failing to provide adequate staff to meet the patient’s needs may also constitute abandonment on the part of the HHA. [12] Ignoring a patient’s complaints and failing to follow a physician’s orders may likewise constitute a tort of abandonment for a nurse or other professional staff member.

Performance Management in Healthcare

According to Fowler (1990), performance management is very crucial and remarks accountability of the organization’s mission, aims, and values. Following this the organization’s objectives are identified and these need to be intrinsically linked to, and support the firm’s mission. These objectives should be cascaded down the organization with strong links to the objectives of the various managers and individual employee. In particular, the healthcare industry mission to provide quality care to all individuals of different age, sex, caste, and demographic variation are deployed with objectives of service quality and customer satisfaction. These values are potentiated by healthcare providers (professional and other employees) managed well by the organization, who satisfy employee personal needs and promote service oriented environment in the organization.The basic concern for promoting service oriented organization requires enhancing employee performance. The employee’s competence, skills, and education contribute high level of performance standards in a knowledge based organization. Therefore performance management has positioned the process of performance appraisal for individual employee. There are two main perspectives of the performance appraisal process; one is evaluative, and the other is developmental (Anderson, 1992; Harris, 1995). An evaluative appraisal process procure judgment of individual employee performance evolved after examining employee’s behavioral, social, and technical aspects of the job, and compared with previously established objectives or fore mentioned operational items on the job description. This type of appraisal links to the allocation of extrinsic rewards, such as pay. A developmental appraisal emphasis need to identify potentials of an employee, develop his knowledge and skill, and initiate career uplifts, which together lead to management success.A number of different performance appraisal techniques or methods available, such as written report, critical incidents, graphic rating scales, forced choice appraisal, field review techniques, 360 degree feedback, and others. These methods elaborate and linked with the behavioral traits of the employees, and depend upon the subjective judging scales of human resource managers.1. Written report: – The appraiser writes a narrative about the strengths, weakness, previous performance and potential of the employee and remarks suggestion for improvement.2. Critical incident: – Under this method, the appraiser highlights incidents or key events that occur during the performance of the job, and rates appraiser’s behavior as exceptionally good or bad relevant to the given situation. The characteristics of employees are grouped by categories, such as co-operation, timeliness, and attitude.3. Graphic rating scales:- The performance is evaluated based on job related characteristics ( such as skill variety, task identity, task significance, autonomy, and feedback) and knowledge of job ( quality of work,technical knowledge).The scores are tabulated through the set of factors rating them, for example, on scale 1 to 5 where the highest number would denote the best rating.4. Forced choice appraisal: – This type of technique consists of a list of paired 9or larger groups of) statements that may both be positive or negative, or one could be positive and the other negative. An example of a pair of statements might be “always on time” and “never on time”. By incorporating several question that test different levels or degrees of the same behaviors, evaluators are able to generate an accurate representation of the individuals learning ability, interpersonal competence, etc.5. Field review techniques: – under this method, the managers ask question to the human resource specialist or the coworkers about an employee’s performance, his work progress, his strengths and weakness, promotion potentials, etc. He then evaluates the report and approves for rating.6. 360 degree feedback: -Depending upon the employee’s job, feedback on the employee’s performance may be solicited from patients, family, physicians, vendors, community organization’s as well as co-workers. The disclosure /feedback model of awareness known as the Johari window, named after Joseph Luft and Harry Ingham represents four panes: open, hidden, blind, and unknown.Know to self Unknown to selfOpen BlindHidden UnknownKnown to othersUnknown to othersTo access potential within us, the open pane could be expanded, hidden pane can be reduced by self-disclosure, and feedback received from others mitigate blind pane. Feedback provides an opportunity to disclose personal beliefs, values and attitudes, and to know about how others see us. 360 degree feedback perceives developmental perspective to review progress towards goals, identify training need, and reach mutual agreement on job expectations.For healthcare professionals, General Medical Council (2003) regards appraisal as “a process to provide feedback on disease performance, chart their continuing professional development, and identify their developmental needs”, and revalidation as a doctor retaining his/her license to practice.To improve practice, appraisal needs to be seen as part of the whole professional development, and includes critical self-reflection, development and support for the individual doctor. The CMO Sir Liam Donaldson (2006), recommend in his report, those relevant to NHS (National Health Service, UK) that Re-licensure (relates to the renewal of full registration and therefore a generic license to practice) and re-certification (relates to renewal of a doctor’s specialist certification) is required and remain the responsibility of the individual doctor. Effective revalidation needs to be based on a valid and reliable assessment of a doctor’s everyday practice to judge the safety of their practice and about the extent to which quality is embedded in their everyday work. Indications for good medical practice (www.gmc-uk.org) envisage seven areas, such as good clinical care, maintaining good medical practice, working with colleagues, relations with patients, teaching and training, probity, and health. The report seems to hope that appraisal will be the main mechanism, but also proposes a review of many methods that are used in other countries, including credentialing; use of stimulators; regional, national, and international audits; and primary care detection schemes.Healthcare organizations are knowledge-based and service oriented, that make necessary to provide accurate and timely information for evaluating problems and achieve better performance. The process of performance management based on the evidence of performance and practice are functioned through clinical audit, clinical assessment, and clinical surveillance formulated and governed by medical regulatory bodies.1. Clinical Audit: – Clinical audit is the process of setting explicit standards, measuring areas of medical practice against these standards and implementing any change necessary to improve patient care. Recent development in clinical audit have been the encouragement of multidisciplinary project work and projects which follow the path of the patient across the primary and secondary care interface.2. Clinical Assessment: – A clinical assessment sometimes refers to as a health assessment, is a documented process that is used to evaluate, diagnose, and treat individuals. These assessments provide results that only take into account the individual that is being evaluated, rather than evaluating individuals based on data that is compiled from multiple sources. It helps to determine the nature, cause, and potential effects of a patient’s injury, illness, or health. Some clinical assessments are mandated by federal agencies to ensure safe medical practices, or to disburse related health benefit payments.3. Clinical Surveillance: – A clinical surveillance (or syndrome survey)refers to the surveillance (systematic collection, analysis, and Interpretation) of health data about a clinical syndrome that has a significant impact on public health which is then used to drive decisions about health policy and health education.

Medical Transcription Outsourcing – Serving Healthcare Facilities At All Levels

Medical transcription is the process of creating patient medical records of the patient- healthcare professional encounter. It is a known fact that these services aid healthcare professionals in the provision of quality healthcare. And outsourcing this process helps create patient medical records in an accurate, speedy, secure and cost-effective services.But a lesser advertised and less known fact about outsourced medical transcription is how it aids the operations of healthcare facilities at every level.It has the following benefits:The managerial staff:Savings on investment: Helps the managerial staff save on investments substantially, by eliminating the need to invest in transcription equipment and furniture required for transcription.Saving information technology: Expenses for Information technology for executing transcription in-house can be avoided or substantially reduced.Staffing benefit: Enables the staff of the healthcare facility especially the managerial and executive level staff to focus on the core business of providing quality healthcare.The records management staff:Recruiting and retaining transcriptionist staff: One of the main inputs for quality services is that of qualified and trained transcriptionists. Outsourcing the process of creating patient medical records effectively outsources the need to recruit, train and retain the transcription team.Turnaround time: As turnaround time is the guaranteed by the transcription vendor it eliminates the responsibility of the records manager to constantly monitor and follow-up on turnaround time.Process for medical transcription: By outsourcing the transcription process, effectively the responsibility to have an organized process for maintaining services at requisite quality levels is also outsourced.Keeping track: The vendor would have a system in place that would provide a summary of the job status for transcription work, making it easier for the record management staff to keep track of dictations sent, transcripts received and the work-in-progress.HIPAA and HITECH compliance: The onus of securing confidential patient information by securing the team, the technology and processes becomes the responsibility of the vendorThe support staff:Multiple modes of document delivery: The support staff at the healthcare facility benefits from the multiple modes of document delivery provided by the service provider.Archives: Archival facilities provided by the transcription vendor enables the support staff to retrieve transcripts easily by using various search criteria.The Information technology staff:Redundancy and backup of data: The vendor would be making provisions for redundancy and backup of systems lessening the burden of the information technology staff.Interfacing of systems: By using advanced technology that is easy to use interfacing the healthcare facility system with that of the outsourced service provider would be very simple.Install/upgrade software: The responsibility of installing/upgrading software for transcription is undertaken by the service provider when it is outsourced.EMR adoption: Outsourcing medical transcription would help in adoption of EMR through HL7 interfacing