White Paper

A White Paper: Using Dictation with Your EMR Offers Multiple Benefits and a True ROI

by Christine Keele, COO, Transcription Unlimited, Inc.

For medical practices that have already invested in a legacy EMR, Transcription Unlimited, Inc. (TUI) offers EMR optimization services that re-introduce dictation into the physician’s workflow. Eliminating productivity declines and utility deficiencies, using dictation and transcription in conjunction with your EMR can significantly revitalize it, allowing medical practices to get the most out of their capital investment. TUI has built HL7 interfaces into the industry’s leading EMRs, so you can continue to dictate patient notes and still receive all the benefits of EMR technology.

One of the biggest drawbacks to the successful adoption of electronic medical record EMRs or EHRs – whichever terminology you prefer — is physician documentation; specifically, the use of point-and-click, structured templates. While hospital administrators and CIOs sometimes prefer full utilization of the EMR structured documentation capabilities over narrative dictation and transcription, physicians struggle with capturing the complexity of their patients’ stories within checkbox templates. Many prefer traditional narrative dictation and transcription.

HIM professionals and CIOs face a considerable challenge: how to balance physician productivity, satisfaction, and preferences with the need for structured, discrete data and meaningful use EMR adoption.

For physicians, every minute counts, and template-based documentation has the unintended consequence of lowering physician productivity. In addition, templates can tempt busy physicians to simply copy and paste documentation, thwarting HIM mandates for complete and accurate reports.

Likewise, CIOs are facing technology challenges. They must establish data-reporting infrastructures to support internal and external clinical outcomes reporting, statewide hospital reporting programs, meaningful use compliance reporting for HITECH funding, and preparation for broader transparency and accountability. However, these infrastructures must balance physician productivity and satisfaction against the heightened discrete data reporting requirements. It is a difficult balance to achieve and even harder to maintain.

Some organizations are approaching this challenge by integrating dictation and medical transcription into their EMR. By doing this, HIM professionals can work with CIOs to balance physician satisfaction, achieve meaningful use reporting for their EMRs, and most importantly, ensure accurate clinical documentation for quality patient care. Dictation and transcription have solid roles to play in the future as integrated partners with the EMR.

Transcription and the EMR: Reality versus Perception

Over the past decade, most EMR return-on-investment (ROI) calculations have included the assumption that physicians would adopt template-based documentation, and medical transcription costs would be significantly reduced or eliminated. When the ROI calculations are based largely on reduced transcription costs, they are almost always disappointing.

Provider organizations that originally hoped to entirely eliminate their transcription costs have discovered that approximately 30 percent of transcription still remains.  A recent survey by HIMSS Analytics on hospitals, that are almost completely automated and using paperless medical records, revealed a mix of report capture options that included speech recognition, voice recognition, and structured EMR templates. Hospitals in this survey averaged 35 percent using structured templates within the EMR, 62 percent using dictation and transcription, and 4 percent using voice recognition.

The Combination Model

For these organizations and thousands like them, a combination approach to physician documentation that uses both dictation and templates appears to be the norm. With the combination approach to physician documentation, different modalities are used to capture dictation based on physician preference, practice patterns, and document types. For example, structured history and physical templates populated by a physician assistant may be used in one care setting, while a dictated and transcribed narrative report may be the best documentation method for inpatient discharge summaries, encounter notes, findings, and assessments.

Physicians use templates where and when they make the most sense to them and still retain the option to dictate the details of a patient visit. This approach streamlines processes without sacrificing the unique facts that impact quality patient care.

It is important to note that while EMRs and the progressive use of structured templates offer many benefits for healthcare, there are points where templates fail the physician and result in unintended consequences. Many physicians agree that cookie-cutter templates and patient notes with no uniqueness are a challenge to creating a complete health story.

To meet the needs of physicians’ documentation requirements, and meaningful use incentives compliance, it just makes sense for healthcare providers to leverage the benefits of dictation and transcription in conjunction with their EMR usage.