Healthcare // Mobile & Wireless
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1/3/2014
09:06 AM
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Voice Recognition Speeds EHR Use For Oklahoma Hospital

In addition to reducing doctors' note-taking burden, Dragon Medical software saved the Norman Regional Health System $1.8 million in transcription services last year.

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Dr. Brian Yeaman sees voice recognition as one way of making logging notes in electronic health records less of a hassle and more of a productive tool. "The further I can get away from a keyboard and a mouse, the better."

Yeaman is a family medicine physician and hospitalist as well as chief medical informatics officer for the Norman Regional Health System in Oklahoma. Using the Dragon Medical voice recognition software from Nuance Communications, Norman Regional has found it can minimize a key physician complaint about electronic health records and save the money that previously went to transcription services. The net savings after the cost of the software last year came to about $1.8 million, Yeaman said.

The Dragon software is currently being used mostly in the emergency department in combination with Nuance's Powermic, a noise-canceling microphone capable of working amid chaos -- proving its value even during a crisis. When a tornado wiped out a school and most of the town of Moore, Okla., in May, it also destroyed the Norman Regional medical center in that town. Casualties and displaced patients poured into the main campus in Norman. "We had patients in every room and lined up down the hall," but even then "we never abandoned the technology."

[What healthcare changes are on the way, for better or worse? 9 Digital Health Trends For 2014.]

Use of the Powermic is "a must," Yeaman said.

On a more routine basis, voice recognition allows doctors to record their notes quicker and easier. "That's certainly one of the largest physician complaints -- to say, 'I'm not a data entry specialist. I'm not a typist, not a transcriptionist. That's not my job.' What we have to bring to physicians is an experience that mimics what all get in our personal lives, that's more user friendly and keeps up with the expectation we've gotten from the utilization of mobile devices."

Too often, when physicians are forced to record notes electronically rather than jotting down unstructured notes, "you lose the story." The record is less complete on the physician's thoughts on "if this doesn't work, here's what I'll do next." Even though EHRs allow room for this sort of narrative note taking, the online medium tends to constrain what is recorded.

Nuance Powermic improves automated transcription of medical notes.(Source: Nuance)
Nuance Powermic improves automated transcription of medical notes.
(Source: Nuance)

"They're not going to type, as many of them do, 10 words a minute" and get all the same details on the record. "Or if they dictate, then transcription costs go through the roof." Voice recognition provides the convenience of dictation without that expense. The computerized transcription is not always perfect, but it's no worse than manual transcription. Physicians do have an opportunity to correct errors, though some are better about that than others.

The Nuance software has been integrated with the Meditech EHR for inpatient care and eClinicalWorks, which the health system uses for ambulatory care. In both cases, the integration was fairly straightforward. Dragon was first implemented in the emergency department but is beginning to find its way into the hospital's laboratory operations and ambulatory care services, with plans for a broader deployment throughout the health system this year.

Yeaman said he is also testing "clinical language understanding" software from Nuance with the hope of beginning to use it in 2014. The idea for the software not just to transcribe what is dictated, but also to understand the content of the dictation well enough to prompt a physician to enter more complete information -- with the ultimate payoff of more accurate processing of insurance claims and improved quality reporting.

"By recognizing that I said 'Congestive heart failure,' the software can ask, 'Systolic or diastolic?' If that can be a query that presents itself to the physician at the time of dictation, we can get a higher rate of answering those queries appropriately, and the hospital or clinic gets the right level of reimbursement," Yeaman said.

David F. Carr is the editor of Information Healthcare and a contributor on social business, as well as the author of Social Collaboration For Dummies. Follow him on Twitter @davidfcarr or on Google+.

Though the online exchange of medical records is central to the government's Meaningful Use program, the effort to make such transactions routine has just begun. Also in the Barriers to Health Information Exchange issue of InformationWeek Healthcare: why cloud startups favor Direct Protocol as a simpler alternative to centralized HIEs (free registration required).

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WKash
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WKash,
User Rank: Author
1/3/2014 | 12:47:45 PM
Digital dedication
I'm reminded of a doctor I see 4x/year.  After each examination, he jumps on a phone and dicatates a voice recording with the detailed outcome of the examination --  for his files and my family physician.  I pitty the person on the other end who has to transcribe his rapid, jargony thought stream.  But I'm impressed by his efficiency, and how quickly he captures the details of our examination.  I can imagine a day when digital voice recognition will be able to keep up with him, though I don't sense we're quite there yet.

 
Pooky
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Pooky,
User Rank: Apprentice
2/12/2014 | 8:10:06 PM
Re: Digital dedication
To WKash - it's already here. 

Real time http://www.flickr.com/photos/little_pooky/10578881796/

Off line transcription (digital voice recorder) http://www.flickr.com/photos/little_pooky/12164264164/ 

I can't live without it. 
WKash
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WKash,
User Rank: Author
2/12/2014 | 10:23:27 PM
Re: Digital dedication
Thanks for pointing us to medical transcription service. Very impressive.

 
MaggieM891
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MaggieM891,
User Rank: Apprentice
5/18/2014 | 7:50:33 PM
Re: Digital dedication
Well, I'm that person on the other end who has to transcribe notes like this (not for this particular doctor). I've been a medical transcription since 1980 and the industry has become a joke for the MT who struggles to barely make minimum wage these days, having previously made a decent living. The transcription services (the middle man) gets the big bucks. WE are the ones who sit and decipher and translate and make the details of examinations make sense. I just hope I can make it to retirement before digital voice takes over. When that happens, talk about the unemployment rate going up. I don't think people realize just how many medical transcriptionist there are in the US who rely on their jobs to support their families.  I get from your comment that you have a sense of respect to the person who translates all of the dictation, so thank you for that. Glad someone appreciates us and knows who tough our job really is.  It's NOT just knowing how to type.  
MaggieM891
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MaggieM891,
User Rank: Apprentice
5/18/2014 | 8:03:47 PM
THAT 1.8 MILLION DOLLARS IN SAVINGS SURE DIDN'T LINE THE POCKETS OF THE MT!
Sir, that 1.8 million you saved on the expense of medical transcription I can tell you first hand did not line the pockets of the individual medical transcriptionist. It lined the pockets of the medical transcription service that the MT is now forced to work for since hospitals and clinics now outsource all dictation. I've been an MT since 1980 and have experienced all the changes in the MT field since that time. I honestly don't think physicians or medical facilities know (or even care for that matter) what really goes on down at the old medical transcription service.  As we MTs now struggle to make minimum wage because somebody ???? decided we could edit dictation in half the time it takes to actually straight type it should only be worth half the amount. I make 0.04, that is 4 cents, per line on editing. So, when the VR makes a mess of the dictation and I'm spending time in a report cleaning up that mess, I'm making 4 cents a line. Multiply that by 150 lines (that is if I do a good job and send out a quality report) or I could edit 300 to 400 lines an hour and make more money and leave all the gramatical errors, not question medication doses, not look up the correct spelling of referring physician names, etc.  I'd like to see a poll of physicians who would comment on the quality of reports they are receiving back from these MT services they outsource to. We are told to "leave it the way it is as much as possible" even to the point of not taking time to correct capitalizing, for example, department names, facility names, etc., because "it doesn't change the meaning of the report." No, it doesn't but in my opinion if I read a report chock full of gramatical errors, and punctuation errors, I'd wonder to myself if the dictation is this shabby maybe so is this doctor's medical practice. I'm just hoping to make it through to retirement before VR totally takes over and I'm out of job completely along with thousands and thousands of other dedictated older MTS who take their responsibility to the patient seriously. 
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