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Friday, February 27, 2009
E-health record transcription software frustrating doctors
By Marc Songini
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Doctors would like to take a hands-off approach to generating medical notes in their costly electronic health record systems, which will save them time and money.
As health-care providers move from paper-based medical records systems to multimillion-dollar electronic ones, they are finding the systems don’t automate the entire process.
Doctors must still type their notes or incur the cost and time to dictate and transcribe them. Such speed bumps in the process are causing user resistance, according to industry experts. For instance, doctors get frustrated that they must navigate through several screens to do the required reporting for tests or other processes. “It’s death by a thousand clicks,” said Keith Belton, senior director of product marketing for Nuance Communications Inc., a Burlington-based speech and imaging solutions company. “This is causing physicians a great deal of agitation.”
There’s no silver bullet that will completely revolutionize health records, said Eric Brown, an analyst at Forrester Research Inc. in Cambridge. “You give the physican a PC and let them use a computer, but the barrier is, you can’t just expect them to type a long narrative as part of a medical note that’s not easily captured in a dropdown box or field,” he said.
In fact, Nuance claimed that speech-recognition systems in medical documentation are used by more than 5,000 hospitals and by more than 400,000 providers. One such local provider is Worcester-based nonprofit Fallon Clinic, a 250-doctor health-care organization. Fallon has already been live for a year on the Epic Systems Corp.’s EpicCare platform as its electronic health records repository.
Fallon spent some $24 million on the three-year Epic implementation, which also involved rolling out billing and scheduling applications, according to Larry Garber, a practicing internist and medical director for informatics at Fallon Clinic. After going live a year ago, however, Fallon was still incurring expenses and time lags with medical notes creation.
“A lot of the physicians were not completely happy using the EHR to create notes, so 60 percent of the notes were still dictated and typed by transcriptionists,” said Garber.
At Fallon Clinic, the Epic records system offered a couple of ways to generate notes. One was to use existing dropdown fields, but those didn’t allow doctors to capture a lot of patient information, said Thomas Walsh, a Fallon practicing general internist. “You’d look back at the notes and get no feeling for what was going on with the patient,” he said.
Or doctors dictated their notes, as they had before the EHR rollout, and then sent them off to be transcribed and returned for reading and approval, said Walsh.
Transcription and dictation took four days to be completed and put in a patient’s file, and it cost the Fallon system about $10,000 per physician annually, said Garber. To remedy this, last summer, Fallon selected Dragon Medical speech-recognition software from Nuance to be used with Epic and deployed it for a pilot using 10 doctors. The doctors, from diverse medical specialties, dictated into a microphone attached to their workstation. “The note is created and edited by the doctor in real time, with the final note placed immediately into the Epic system,” said Garber. “Each physician’s Dragon voice-pattern file is stored on a central server so that the physician can dictate from workstations in each office that they work at.”
Garber said the time for the final note to appear in the patient’s electronic record has dropped from four days to 46 minutes and that “has a dramatic impact on the way we work.” The quality of the notes has improved as well — and there are roughly the same number of typos as in the transciption process. At Fallon, about two-thirds of the doctors now want Dragon, said Garber. The implementation should wrap in the summer.
“I feel I have better control of the note,” said Walsh. “Dragon has even forgiven my Brooklyn accent.”
The same results apply at health-care provider Atrius Health in Newton. In a recent pilot of Dragon Voice Recognition Health, most of the 20 physicians using the system found that it improved their efficiency, the timeliness of closing out records and the quality of their records, according to Michael Lee, director of clinical informatics at Atrius Health.
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