Cheaper, smaller, and more powerful computer technologies. Financial pressure to see more patients. More stringent reporting requirements for physicians (including the looming transition to EMR). Advances in telecommunication.

All had an impact on medical transcription over the past decade. However, while more options for recording patient visits are available, most small medical practices continue to operate pretty much they way they always have: talk in to a recorder, send off the recording to a transcriptionist or transcription company, and receive what was spoken back in a written document.
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