The Role Speech Technology Can Play in Helping to Streamline the EHR Transition

Early adopters – the approximately 15 percent of
doctors who use an electronic health record (EHR) system successfully –
are hitting a major speed bump ahead of their peers: EHRs can slow physicians

Too much emphasis is being placed on EHR
deployment and not enough on utilization.  In the rush to
computerize patient information, per Obama’s five-year goal that all
medical records go digital, it has been assumed that once EHRs are widely
deployed, patient records will automatically be more complete and shareable, administrative
costs will be cut and that universal quality of care will be enhanced.  First,
we have to get doctors to meaningfully use the system…

In a study conducted by Fallon Clinic comparing EHR
technology used as is vs. with speech recognition technology (replacing traditional
transcription and keyboard-only control of the EHR), not only did speech
recognition prove to help doctors capture the patient encounter in more detail;
it helped to save $5,000 per doctor per year in transcription costs and generated
additional reimbursement per encounter.

Additionally, a recent survey of 1,241 doctors who use
speech recognition (Dragon
) to capture dictation and populate the EHR found that:

    83 percent said that it improved the quality of
    their patient notes

  • 81 percent said that it significantly reduced
    transcription spending
  • 69 percent said it made their EHR faster and
    easier to use

According to Dr. Dean Carr, a primary care physician at Group Health Cooperative and Epic EHR user in Seattle, WA,
speech recognition “has really shortened the process of creating
notes.  It shortens my day by 1–1.5 hours because I no longer have
to log in from home to complete chart.”

Studies have shown that in some cases, the adoption of EHRs
themselves does not lead to higher quality care. An April 2008 article in
the New England
Journal of Medicine by Groopman and Hartzband

cited the dangers of over reliance on EHR automation: “This capacity to
manipulate the electronic record makes it far too easy for trainees to avoid
taking their own histories and coming to their own conclusions about what might
be wrong.  Senior physicians also cut and paste from their own notes,
filling each note with the identical medical history, family history, social
history and review of systems.” 

By pairing speech recognition technology
with EHR deployment, doctors are more likely to successfully use the
system.  By dictating their patient notes directly into the EHR vs. typing
their notes, doctors can spend less time on clinical documentation and more
time on patient care.  The return is huge – patient notes are more
detailed and no longer rushed or sloppily-typed.  Moreover, traditional
medical transcription costs can be slashed and insurer reimbursement is often
higher because of more detailed “medical decision-making” – such
as history of present illness, review of systems, assessment and plan.

A solid ROI example of the value of speech
recognition improving the patient documentation process is Beth Israel Deaconess Medical Center in Massachusetts.  They
have achieved cost savings of more than $2 million and decreased turnaround
time (the time from when a patient is seen, to the documentation and
communication of their visit) by 90 percent because of their investment in background
speech recognition technology.  By leveraging speech recognition to support
clinicians’ “free dictation” which can be stored in the EHR, healthcare organizations can speed EHR utilization,
while cutting healthcare costs and improving patient care.

Some physicians have even deployed speech recognition prior
to EHR implementation to generate substantial cash savings which helps pay for
the EHR itself.  “Before we began implementing
the EHR, we leveraged speech recognition to nearly eliminate transcription
costs,” commented Douglas Golding, MD, Medical Director and Chief Medical
Information Officer at Lifetime Health
Medical Group
in Buffalo,
NY and NextGen EHR user.

Golding’s practice covered the full EHR cost with
transcription savings generated by speech recognition.  “As we
implemented the EHR, we found that [speech recognition] facilitated free text
entry where needed.  Now providers create and edit patient reports in one
sitting through free-form dictation.  Report turnaround times have gone
from as much as three weeks to a matter of minutes,” Golding detailed. 
“Best of all, we started saving money almost immediately.  The
payback on our investment took only six weeks.  Most technology payback
periods take two to three years to break even.”

Recent physician surveys, anecdotes and testimonials confirm
that speech technology is a complementary tool to make EHR systems user-friendly.
 So while the EHR transition
will happen
addition to making sure doctors’ efficiency isn’t compromised by
learning a new system, we need to ensure they don’t take shortcuts by
creating cookie-cutter medical records that are void of expression and patient
detail.  Speech let’s the patients’ records maintain their
doctor’s voice (literally) and doesn’t force physicians to be a
slave to the keyboard.

 Keith Belton is VP of Marketing at Nuance Communications.

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