Category Archives: Dictation and EMR

For articles pertaining to dictation and electronic medical records.

Should Doctors be Forced to Use Speech Recognition?

Cat being dragged, nopeNo doubt you’ve read marketing articles written by Nuance extolling the benefits its voice recognition software for medical professionals. That’s to be expected — they’re trying to sell a product. A very expensive, time-consuming, imperfect product that is not for everyone, no matter how hard they try to convince potential buyers otherwise.  But they are very good at making it seem like it’s the best thing since sliced bread.  Because the buyers believe the hype, and because they’ve spent a boatload of money on the system, the Powers that Be are forcing their doctors to use speech recognition.  Not only is that wrong, it’s dangerous.

Look at any marketing materials written by Nuance and you’ll see buzz words and phrases like:

  • Best practice
  • Increased productivity
  • Uniform documentation
  • Workflow efficiencies
  • Cost cutting

Really? Where’s the proof? Have the software developers and marketing gurus actually listened to the providers who are unhappy with the product? No, they have not.

Here’s the other side of the story, the users’ side of the story.

Talk to providers being forced to use speech recognition that doesn’t work for the way they practice medicine. You’ll hear words and phrases like:

  • Epic fail
  • Not user friendly
  • Way too many errors
  • Dangerously inaccurate
  • Impersonal
  • Takes too much time
  • Most frustrating thing I’ve ever dealt with in my life
  • My patients suffer because of this
  • I don’t have time to edit my own charts
  • (and a few others that are not repeatable)

Here’s a small sample taken from a large body of evidence to confirm and justify their complaints. These come from actual patient charts:

“Under treatment patient currently doing well in Adipex for a new will continue to stay on low glycemic index diet will continue bowel walking for exercise and will recheck with me in the next 4 weeks thanks.”

“She is requesting medication to help her with her appetite for car.”

“She O she actually has refills on her medication.”

“She has a prescription if needed she believes she is going to check a bowel supinating tablets or left but she doesn’t want to take this right now.”

“Cocaine patches for her low back pain which occurs intermittently one half patch usually works.”

“His entire car was kind of crunched like a Korean and he hit the Listerine as well.”

“Sensorineural hearing loss with peak drop at 500 Hz down to 35 testicles.”

“The patient has an expensive past medical history.”

“Her allergy triggers are almonds covered by palpable penile.”

“Medications: Compelling fish oil.”

“He will contact me if any changes need to be made prior to his suicide.”

How about that last one? That is simply unacceptable. Some of these would be funny if they weren’t part of a human being’s medical record. Can you imagine the chaos that would ensue if an insurance company got hold of the record containing “cocaine patches?” These are serious errors, and they are in millions of patients’ records right now. And many (most?) remain uncorrected.

Here’s what one of my employees said when she read some of the egregious errors that are now part of patients’ records:

“Dragon cannot understand or interpret the nuances and inflections that a doctor always has when dictating. A simple comma, when placed properly, can change the entire meaning of a sentence.”Did you catch that word ‘nuance?’ And what is the name of the company that sells Dragon? Yeah. Can we say ‘irony?’

Here’s what else she said:

“One of the jobs a transcriptionist does (that Dragon cannot do) is to edit/question when a doctor dictates something inaccurately. We are trained to question things that a doctor may mistakenly say (dates, dosages, medications, etc.). Without listening to what the doctor is dictating, I believe that tons of errors will fall through the cracks, even if there is someone “editing” the Dragon-dictated medical records.

“I think one of the things the doctors should consider is that doctors have historically been viewed as being very professional and are looked up to by the general population. When their communication (which is the medical records) is so sloppy and full of errors, their professionalism may come into question. And this is what medical dictation has come to.”

Am I biased? You bet I am! I’m a patient. My mother is a patient. My other family members and friends are patients. I found an error in my own chart, a diagnosis that in no way, shape or form applied to me. The chart was dictated with Dragon Medical and obviously never reviewed or edited.

In addition, I’ve developed a relationship with my clients. They trust me to make a coherent, accurate medical record. They trust that I will question them if something doesn’t sound right. They trust my experience, my training in medical terminology, my common sense, and my ability to translate regional and local dialect.

This is about patients and doctors. That’s all it’s ever been about, or should be about. But Nuance and others like them only see dollar signs.

I’m not even going to quote a bunch of statistics; statistics can be manipulated, facts cannot. And the fact is, this is not working for many, many doctors and their patients. Ask your provider how to monitor your health records through the patient portal. (We all should – it’s like monitoring your credit.) The chances of an error occurring in a record dictated using speech recognition are far greater than those occurring in a dictated and human-transcribed record.

To sum it up, a colleague had this to say, which is so succint, yet profound: “I don’t understand the reasoning behind this.” That is a very good question. If speech recognition is so wrong for so many medical providers and their patients, then what is the reasoning behind forcing them to use it?

5 Comments

Filed under Dictation and EMR

Harvest Time

Photo by Sarah Potter

Medical transcription is a field ripe with opportunities for innovation. As medical transcriptionists, if we’re not innovating, thinking outside the norm and moving forward, we might as well turn off the lights and close the doors.

We must become not only medical language specialists, but also healthcare documentation specialists. To be successful as a business, we have to become educated about the laws and regulations that impact the healthcare industry, and understand where we can offer services to help facilitate compliance with those laws and regulations.

Once we understand the regulations, we may have to expand our scope of services to provide more of a non-traditional transcription role (i.e., transcribing directly into the client’s EMR).

Next, it’s up to us to educate the healthcare providers about how we can help. Remember, they’re pretty overwhelmed with all the regulations themselves, and may not even realize how employing medical transcription services can ease their documentation burdens.

And that leads to another area of business in which we find ourselves: developing marketing and advertising strategies designed to reach healthcare providers (and their practice managers), and demonstrating how we can be of great value to them.

Lynn Kosegi, Director of Solutions Realizations for M*Modal (http://mmodal.com/author/lynn-kosegi/) summed it up very well:  “By ensuring that we make full use of the MT’s knowledge and skill, we can contribute to physician satisfaction and documentation quality, while enabling providers to realize the maximum return on expensive technology investments.”

So get out there and harvest this wonderful, crazy, ever-interesting field of Medical Transcription!

(The photograph, taken by my niece, Sarah Potter, is a nod to my beautiful home state of Kansas.)

Leave a Comment

Filed under Dictation and EMR

Patient Portals Save the Patient Time and Money

patient_portal_iconHave you set up your patient portal with your doctor’s office?  I did so, skeptically, and then to my delight found it to be a very useful tool!  I also found it enlightening to read my own medical record.  There was information in it that I didn’t know about (i.e., a specific diagnosis).  I was also able to request a prescription refill, which was promptly called in to the pharmacy and ready for me to pick up in just a couple of hours.  This saved me the cost and time off work for an office visit.  Score!

So what is a patient portal?  Here’s what HealthcareITnews.com says:

“A patient portal is a Web-based access point that allows doctors and patients to communicate and share health information remotely, supplementing the ongoing management of the patient’s care. While portals can’t replace an in-office visit, they have many benefits: They are “designed to boost patient’s involvement in their care,” as portals encourage viewing test results and health documentation and can facilitate an ongoing doctor-patient dialogue. Additionally, portals can reduce costly paperwork by serving as online billing and payment centers. As part of the meaningful use Stage 2 requirements, providers must have “at least five percent of their patients using an online patient portal” to get incentive payments.”

Go to your physician’s office website to set up your own patient portal, or ask your doctor about it.

Leave a Comment

Filed under Dictation and EMR

Hello! Is Anybody Here?

Person talking to person on the computerHello?

I always snicker at that Ally Bank commercial in which a human at a dry cleaner’s business is replaced with a blender.  It sounds absurd, doesn’t it?  And yet, we’ve all had it happen to us in one way or another.  You’ve likely called “Customer Service” and were sent on a finger-fumbling journey through menu after menu, only to be either placed on hold or disconnected.  Or maybe you were asked to speak your choices from the oh-so-friendly-sounding automated voice cooing choices in your ear:  “Press 1 for technical support.  Press 2 for account information.  If you know your party’s 27-digit extension, enter it now.  Please wait while I try that extension.”  Don’t you feel silly talking to a machine?

The iDoctor

Unfortunately, we’ve come to expect such detached treatment from many service industries.  But think about this:  Could it be that your doctor is being (has been?) replaced by a machine?  Have you seen your doctor lately?  If you have, chances are he or she came into the room clutching a wonderful, magical machine.  No, it’s not a blood pressure monitor, EKG machine or defibrillator.  It’s a tablet or small notebook computer.  And chances are good also that he made more eye contact with that tablet computer in his hands than he did with you.

The iPatient

Thanks to electronic medical records, doctors have been forced to become one with their computers now.  When Dr. Peter J. Papadakos, an anesthesiologist and director of critical care at the University of Rochester Medical Center, wrote about these electronic distractions over two years ago, he correctly predicted the future when he said “it’s getting worse.”  While it’s true that those electronic gadgets contain a wealth of information that might be helpful in assessing a patient’s condition and improving patient outcomes, it may be that the doctor is relying too heavily on the gadget instead of the human sitting right in front of him for very real, very personal, very important cues about the patient’s illness.  After all, the gadget is not the patient:  the patient is the patient.

Making iContact

In an effort to help physicians engage their patients in the whole electronic extravaganza that is the patient encounter, Kaiser Permanente has developed the LEVEL system for paying attention to a patient while in the exam room:

L:    Let the patient look on
E:    Eye contact
V:    Value the computer
E:    Explain what you’re doing
L:    Log off

This is supposed to send the message to the patient (and reaffirm to the physician) that “the computer is our friend!”  So now, not only does the doctor have to remember how to navigate through drop-down boxes, menus, medication interaction sections, diagnosis codes and such, he also has to be retrained to make eye contact with the patient.  Do patients really care about the computer that’s in my doctor’s hand or what he’s doing with it?  I don’t think so.  I think a patient just wants to be heard and seen.  That requires the doctor’s full attention, and no nemonic system is ever going to replace good old fashioned one-on-one conversation and eye contact.

The iSolution

Dictating part of the patient encounter allows the doctor and patient to interact much more natural and personal way.  Instead of the doctor trying to type into the appropriate fields what the patient is conveying, he can instead just dictate it in a much more clear and detailed way than his data entry will allow.  If you’re a doctor struggling to find a balance between computer interaction and patient interaction, call us and together we’ll work to implement a system of dictation and transcription that suits the way you want and need to practice medicine.

Bumgarner Transcription and EMR Integration — 864-905-3559.

Leave a Comment

Filed under Dictation and EMR

The (Turnaround) Time is Now

The-Time-Is-NowThe (Turnaround) Time is Now

The days of 24-hour turnaround time are over.  That’s a bitter pill to swallow for some old-fashioned medical transcriptionists.  Not so long ago, we would drive to an doctor’s office, pick up micro cassettes, drive home, transcribe them, print them, and drive them back to the doctor’s office the next day to exchange the finished documents and erased tapes for more tapes filled with dictation.

What a difference a decade makes.  Now, a doctor dictates into a digital recorder, uploads the dictation to a file server and a transcriptionist retrieves and transcribes it, often directly into the patients’ electronic medical records, and often all in the space of 6, 4, or even 2 hours.

Why the rush?

In an article by Ann Donnelly, Owner of Transmedical Services, Inc. in Miramar, Florida, and ADHI District 6 Director, she says, “The healthcare documentation sector is being transformed by the changing healthcare environment.  Now is the time to address the increasing complexities in healthcare documentation that are being driven by the rapid changes in technology and the need for quality and accuracy of documentation.  Faster turnaround times must be met while at the same time lowering the costs associated with documentation.”

More time demands are being made on physicians and their staffs to complete documentation as soon as humanly possible.  Many portions of a record have to be completed even before the patient leaves the office so that a summary of his/her encounter can be printed and sent home with the patient.  Internal and external regulations require that documentation of the encounter be “closed” within a strict time frame.  Turnaround time is also critical to accelerating the billing cycle.

Jane, stop this crazy thing! *

How can this vortex of demands for increasingly faster turnaround times be slowed down to a reasonable pace?  The answer to that depends on how much doctors and their governing bodies are willing to sacrifice.  It comes down to quality for quantity.  Bob Thomas, an HIM consultant for transcription and computer-assisted coding, described it well when he said, “Think of it as a triangle.  If you shorten any one of those sides, it affects the others.  If you shorten turnaround time, it affects quality.  Something has to give.  You can’t cut costs without quality or turnaround times suffering.”

Some common sense has to come into play here, for the sake of the patients being treated and for the sanity of the providers who treat them.  There are MTSOs out there promising outrageously optimistic turnaround times.  They think they have to make these promises in order to attract the business of doctors who are expecting outrageously unrealistic turnaround times.  However, even though the medical documentation industry has changed dramatically, the basic principles of medical transcription must remain intact.

As medical documentation specialists, we must take the time necessary to logically evaluate the material we are transcribing, think critically about the subject matter, put the words in context with the entire encounter, procedure, or treatment being documented.  And, of course, not-so-small details like proper grammar, spelling, formatting and checks and balances must be correct.  Even the fastest, most efficient, most focused transcriptionist knows that a quality finished product takes time to produce.

Faster Than a Speeding Bullet

Not quite.  Not now, not ever.  But with all the great technology literally at our fingertips, medical transcriptionists can cut that 24-hour TAT down to an easily manageable fraction of that, and still produce a high-quality medical record.

* A famous line in the end credits of The Jetsons, for those of you who somehow lived through the ‘60s and ‘80s and missed it.

 

Leave a Comment

Filed under Dictation and EMR

Slay the Dragon!

Dragon slayer

So you believed the hype the salesman enthusiastically presented about speech recognition software.  His demo was dazzling, the resulting document flawless.  And the speed!  Are you kidding me?  It took him, like, two nanoseconds to do that!  You said, “Sign me up, I’m going to get my charts documented in record time!”

So now, say, a month later, how’s that working for you?  Are you flying through those charts and letters with the greatest of ease, or is your new software in a time-out, like a headstrong toddler whom you’re constantly trying to correct?  It just insists on typing “dysphasia,” when what you clearly said was “dysphagia.”  Or it referred your patient “to the moon” instead of “to Dr. Maroon.”

Maybe you did actually use it, but found that it was taking too much of your time to edit.  You found yourself thinking, “Hey, wait a minute!  I bought this thing thinking it would save me time.  Instead, I’m spending more time editing my charts than ever before.”

So you decided to send your dictated stuff to a transcriptionist to be edited.  The transcriptionist was able to correct some things but now you’ve spent a bundle on the software and you’ve hired a service to correct the mistakes the software makes.

And now for something really frightening.  Watch this.  Listen to what she’s saying while you watch the screen behind her:

As you see in the video, the text looked just fine but, in fact, the software skipped right over some of what was said and didn’t even transcribe it.  Just left it out.  And you found this out, didn’t you?  Or did you?  When you looked back over your dictated material, how did you know whether the software actually transcribed  – or made an attempt to transcribe – every single word you said?  And if you didn’t pick up on it while you were editing it, how is a transcriptionist going to pick it up on the back end?  What if the software left out a critical word of phrase in your patient’s medical record?  Ruh-roh.  Not good.

So you learned that:

  • if you have time and patience to train the software thoroughly
  • if you speak v-e-r-y   s-l-o-w-l-y   a-n-d   c-l-e-a-r-l-y
  • if you speak without an accent, slur or quirk
  • if you spell out even the most common of words
  • if you have time to edit your dictated material with perfect recall
  • if you have money to throw away on a dual system (speech recognition and back-end editing)

… then, yeah, speech recognition software works pretty well!

Let’s face it.  It’s time to slay the Dragon.  Dictation and transcription by a human being is by far superior to speech recognition:

  • It takes considerably less time to dictate
  • It costs considerably less to have your dictation transcribed
  • It yields a far more accurate result
  • It is interpreted by a medical language specialist who uses training, insight, judgment, and context to correctly interpret your speech
  • It is far more efficient in terms of time and cost

Call us.  Just do it!  Oh, we’ll edit your speech recognition documents if that’s what you want.  But we’d much rather help you save time, money and hassle by transcribing your dictation right the first time.  No gimmicks, no expensive software, no empty promises.  And if you call right now, we’ll even supply the Super-Duper Dragon Slaying Sword, at no extra charge, while supplies last.

Bumgarner Transcription and EMR Integration.  864-905-3559.

 

Leave a Comment

Filed under Dictation and EMR

That’s Just Rude!

 

A colleague, Norma Whitt, and I were talking about how impersonal medicine has become.   She said, “I can tell you the one theme that I hear just in chit-chat with friends/family is how patients cannot stand it when a doctor has his face in the computer the whole visit.”

Some patients may not know what electronic medical records are, and most likely don’t know the upheaval surrounding EMR and the federal mandating of same. But here’s the one thing they do know: They get highly offended when they’re sitting across from the doctor in the examination room, trying to talk about the reason they’re there, and the  doctor is looking at a computer screen instead of them. It makes them feel neglected and as though they’re not being heard. The frightening truth is, they are being neglected and they may not be being heard.

An article in Strategic Human Resource Management in Healthcare says that EMRs “do not reflect the natural flow of patient care,” particularly among ambulatory care clinicians.  Well, duh! Come on. We even teach our children that when someone is speaking to you, look at that person while they are speaking. That’s the natural thing to do, unless you’re just trying to be rude.

So what can be done about it?

Dictation and transcription  that’s what. Instead of burying his face in a computer screen, a doctor can dictate portions of the patient encounter. On the medical side, this will allow him to:

  • Face the patient, as in any other normal conversation with a human being
  • Hear and absorb what the patient is saying
  • Listen for and capture those nuances that each unique patient brings to his or her situation

On the business side, this will allow him to:

  • Spend less time entering data and more time face to face with the patient
  • Likely make fewer charting mistakes
  • Stop losing money on data self-entry (Rona Silkiss, MD, of Silkiss Eye Surgery www.eyework.com)

Call Bumgarner Transcription and EMR Integration at 864-905-3559.  Or email us at NancyDavis@Transcribable.com.  Tell us your situation, and we’ll implement a simple dictation and transcription solution. Start facing your patients again and get your face out of the screen. Because that’s just rude!

2 Comments

Filed under Dictation and EMR

3 Reasons Why Speech Recognition Software Sucks

This sucks

Haters Gonna Hate

Speech recognition seems to be a very polarizing subject.  You either love it, or you hate it.  And more often than not, stories are being told that you hate it.  (David Yeager, 02/10/12, For the Record)

1)  Dictator Must Enunciate
The truth is, many doctors do not take the time necessary to enunciate their dictation well enough for speech recognition to accurately interpret what they’re saying.  Even a simple sentence that’s dictated as, “She is not nauseated” comes out as, “She just got nauseated.”

2)  Doctor Spends Too Much Time Spent Editing
Doctors say they spend too much time editing the mistakes the speech recognition software made.  In a practice already pressed for time, do you really have time to edit your SR dictation?  When you do this, it essentially makes you a highly-paid document editor.  This is inefficient.  Isn’t the whole point of speech recognition to make the documentation process more efficient?  Yes, all dictated material needs to be reviewed for accuracy, even that transcribed by a human.  But because a human transcriptionist has a brain and therefore the ability to intuitively and intelligently interpret human speech, material transcribed by a human takes far less time to edit.

Even worse, speech recognition cannot recognize the subtle nuances in speech that could be cricital to a patient’s diagnosis and/or treatment. For instance, do you want to be checking all the time to make sure your program correct heard “dysphagia” instead of “dysphasia?” Or “abduct” instead of “adduct?” “Anuresis” instead of “enuresis”? “Ensure” (brand name) instead of “ensure” (the verb)? See what I mean? Kind of scary, huh?

3)  SR in Incapable of Thought, Recognition of Local Information
SR doesn’t recognize regional and local landmarks, names of local physicians, and local businesses.  Again, this is why it is far superior to have a human transcriptionist.  Even if your transcriptionist does not live in your area, he or she has innumerable resources at her fingertips to use to learn how “Dr. Loudermilk, neurologist,” spells his name.  When a human brain hears an unusual name (i.e., Loudermilk), it thinks, “Hmm, I don’t know how to spell that.  I need more information.  I’ll use my processing abilities.  I know Dr. Loudermilk practices in the Seattle area, and I know he’s a neurologist.  I’ll look in my resources to locate this person and then be able to transcribe the correct data.”  Speech recognition software with no reasoning ability, on the other hand, hears ‘Loudermilk” and probably types something like “louder milk” without giving it a thought.  (Vincent Desiderio, M.D., 11/13/12, Some Doctors Reluctant to go Digital)

Don’t be fooled by promises that speech recognition will make your life easier, cost less than a human transcriptionist, and eliminate mistakes.  It won’t.  In theory, it sounds great.  But in reality, it can be a nightmare for a busy physician.  Wouldn’t you rather put your patients’ medical records in the hands – and ears – of a human being capable of rational thinking and evaluative skills?

Call us now at 864-905-3559 to find out how simple, cost effective, and time effective it is to have us transcribe your dictation.  We can even import it right into your EMR.

Leave a Comment

Filed under Dictation and EMR

How to Stop Losing Money on Data Entry

 

How much money are you losing to data entry tasks?  To answer that question, let’s look at how much time you’re spending doing data entry for a patient encounter.

•  It take about 4 minutes for a doctor to enter a note into a patient electronic medical record.
•  It takes 1 minute or less to dictate a note for an average patient counter.
•  4 minus 1 equals 3 divided by 4 = 3/4, or 75%

You’re likely losing 75% of your clinic time on data entry.  No wonder so many doctors are revolting against EMR!  “We have become the most highly educated data entry operators on the planet.”  (Rona Silkiss, MD, of Silkiss Eye Surgery www.eyework.com.)  Notice how Dr. Silkiss didn’t say “highly paid, data entry operators.”  Every minute you spend on data entry is time for which you’re not getting paid to see a patient.

Think of how many more patients you could see if you were relieved of even a portion of those data entry tasks.

We will help relieve you of some of those data entry tasks by incorporating your dictation into your electronic medical records.  Call us now and we will get you started dictating again.  Soon, you’ll be reaping the benefits.  And as a bonus – ding, ding, ding! – you’ll be providing better patient care and a more complete encounter record!

Give us a call at 864-905-3559 or email me at nancydavis@transcribable.com

 

Leave a Comment

Filed under Dictation and EMR

You Can Do That?

 

You can do that?

You can do that?

Doctors are so busy with practicing medicine and overwhelmed by trying to learn a massive electronic medical records system, they often don’t stop to think that some of their tried-and-true routines don’t have to change.

A few years ago, a client told me with great sadness that they would soon have to stop using our transcription service because the hospital system to which they belonged would be implementing electronic medical records.  She was surprised when I told her that didn’t mean they had to give up dictating.  I saw at once a question and a glimmer of hope in her eyes.  I told her we would just take it a step further and transcribe their patient encounter note directly into the patient’s record.  They remained clients, and happy ones, at that.

That made me realize I need to do a better job of being proactive in our marketing efforts, and not assume that everyone knows they can still dictate and use EMR concurrently.  I still get that head tilt and, “You can do that?” when I visit prospective clients or market to them by email or on the phone.  It’s so gratifying (dare I say, fun?) to be able to explain to them how simply it all works and then welcome them as they become our clients.

If you want to see your daily production increase by 20-30%, and if you want to spend more face time with your patients, contact me and let me know your needs.  We can do this!

Leave a Comment

Filed under Dictation and EMR