document. the next time the patient visits the doctor, the doctor will call for the medical record or the patient's entire chart, which will contain all reports from previous encounters. the doctor can on occasion refill the patient's medications after seeing only the medical record, although doctors prefer to not refill prescriptions without seeing the patient to establish if anything has changed. it is very important to have a properly formatted, edited, and reviewed medical transcription document. if a medical transcriptionist accidentally typed a wrong medication or the wrong diagnosis, the patient could be at risk if the doctor (or their designee) did not review the document for accuracy. both the doctor and the medical transcriptionist play an important role to make sure the transcribed dictation is correct and accurate. the doctor should speak slowly and concisely, especially when dictating medications or details of diseases and conditions. the medical transcriptionist must possess hearing acuity, medical knowledge, and good reading comprehension in addition to checking references when in doubt. however, some doctors do not review their transcribed reports for accuracy, and the computer attaches an electronic signature with the disclaimer that a report is "dictated but not read". this electronic signature is readily acceptable in a legal sense. the transcriptionist is bound to transcribe verbatim (exactly what is said) and make no changes, but has the option to flag any report inconsistencies. on some occasions, the doctors do not speak clearly, or voice files are garbled. some doctors are time-challenged and need to dictate their reports quickly (as in er reports). in addition, there are many regional or national accents and (mis)pronunciations of words the mt must contend with. it is imperative and a large part of the job of the transcriptionist to look up the correct spelling of complex medical terms, medications, obvious dosage or dictation errors, and when in doubt should "flag" a report. a "flag" on a report requires the dictator (or their designee) to fill in a blank on a finished report, which has been returned to him, before it is considered complete. transcriptionists are never permitted to guess, or 'just put in anything' in a report transcription. furthermore, medicine is constantly changing. new equipment, new medical devices, and new medications come on the market on a daily basis, and the medical transcriptionist needs to be creative and to tenaciously research (quickly) to find these new words. an mt needs to have access to, or keep on memory, an up-to-date library to quickly facilitate the insertion of a correctly spelled device. medical transcription editing medical transcription editing is the process of listening to a voice-recorded file and comparing that to the transcribed report of that audio file, correcting errors as needed. although speech recognition technology has become better at understanding human language, editing is still needed to ensure better accuracy. medical transcription editing is also performed on medical reports transcribed by medical transcriptionists. medical transcription editors recent advances in speech recognition technology have shifted the job responsibilities of medical transcriptionists from not only transcribing but also editing. editing has always been a part of the medical transcriptionist job; however, now editing is a larger requirement as reports are more often being transcribed electronically. with different accents, articulations, and pronunciations, speech recognition technology can still have problems deciphering words. this is where the medical transcriptionist editor steps in. medical transcription editors will compare and correct the transcribed file to the voice-recorded audio file. the job is similar to medical transcription as editing will use a foot pedal and the education and training requirements are mostly the same. training and education education and training requirements for medical transcription editors is very similar to that of medical transcriptionists. many medical transcription editors start out as medical transcriptionists and transition to editing. several of the ahdi-approved medical transcription schools have seen the need for medical transcription editing training and have incorporated editing in their training programs. quality training is key to success as a medical transcription / healthcare documentation specialist. it is also very important to get work experience while training to ensure employers will be willing to hire freshly graduated students. students who receive 'real world' training are much better suited for the medical transcription industry, than those who do not. outsourcing of medical transcription due to the increasing demand to document medical records, countries have started to outsource the services of medical transcription. the main reason for outsourcing is stated to be the cost advantage due to cheap labor in developing countries, and their currency rates as compared to the us dollar. there is a volatile controversy on whether medical transcription work should be outsourced, mainly due to three reasons: the greater majority of mts presently work from home offices rather than in hospitals, working off-site for "national" transcription services. it is predominantly those nationals located in the united states who are striving to outsource work to other-than-us-based transcriptionists. in outsourcing work to sometimes lesser-qualified and lower-paid non-us mts, the nationals can force us transcriptionists to accept lower rates, at the risk of losing business altogether to the cheaper outsourcing providers. in addition to the low line rates forced on us transcriptionists, us mts are often paid as ics (independent contractors); thus, the nationals save on employee insurance and benefits offered, etc. unfortunately for the state of healthcare-related administrative costs in the united states, in outsourcing, the nationals still charge the hospitals the same rate as they did in the past for highly qualified us transcriptionists but subcontract the work to non-us mts, keeping the difference as profit. there are concerns about patient privacy, with confidential reports going from the country where the patient is located (e.g. the us) to a country where the laws about privacy and patient confidentiality may not even exist. the offshore provider has a clear business interest in preventing a data breach and could be prosecuted under hipaa or other privacy laws, yet the counter-argument is made that such a prosecution might never happen or if tried wouldn't get anywhere. some of the countries that now outsource transcription work are the united states and britain, with work outsourced to philippines, india, sri lanka, canada, australia, pakistan and barbados. the quality of the finished transcriptions is a concern. many outsourced transcriptionists simply do not have the requisite basic education to do the job with reasonable accuracy, as well as additional, occupation-specific training in medical transcription.