White Paper

A White Paper: Adding Dictation to Your EMR Will Increase Acceptance and Provide a True ROI

by Christine Keele, COO, Transcription Unlimited, Inc.

The concept of using an electronic medical record for documenting and storing the details of a patient encounter has been around for over 30 years, and is still a sound idea.  Why then, after all these years, did it take an act of Congress to get healthcare providers to accept this concept in their care delivery process?

Why were financial incentives and penalties required to get healthcare providers to adopt an EMR?  Until the ARRA HITECH Act was passed in 2009, EMR adoption by healthcare providers hovered at around 12 percent. The three basic issues hindering the adoption of EMRs have always been: (1) acceptance of the technology by healthcare providers, (2) cost of the technology, and finally (3) the return on investment (ROI).

Early promises made by EMR companies that the technology would eliminate the need for dictation and transcription proved to be unfounded. Providers who had been dictating for years found it cumbersome to adapt to a point and click system for documenting the care they delivered. The providers quickly discovered that while it typically took two to three minutes to dictate a narrative patient encounter, getting that same information into the EMR, using a standardized screen template and point and click or typing technology, could take 15 to 30 minutes.

Even with the government incentives and penalties that have been used to encourage EMR adoption, the problems that prevented wide spread adoption in the past, still exists. The HITECH Act has significantly increased adoption, but the problems of user acceptance and a true ROI still haunt the healthcare industry.

What Is the Solution?

How can the healthcare industry overcome the problems of EMR acceptance and realize the ROI they have been promised? The answer:  they can re-vitalize their EMR technology with dictation.

For medical practices that have already invested in a legacy EMR, they can re-introduce dictation into their physician’s workflow. This will eliminate productivity declines and utility deficiencies. Optimizing their EMR with dictation will allow healthcare providers to get the most out of the capital investments they have already made. Proven technology interfaces exist today that easily allow the addition of dictation, so providers can continue to dictate patient notes and still receive all the benefits of EMR technology.

Dictation will maximize the number of patients a provider can see in a day and increase providers’ revenue streams.  Patient care is also improved because the physician can spend more time with each patient.  The time spent on navigating screen templates and typing or clicking information into the correct boxes can be better spent interacting with patients.  The hybrid use of dictation and the EMR to document a patient encounter is the best way to eliminate paper charts and enhance the delivery of patient care.

Today’s hybrid dictation/EMR optimization technology does not just “dump unstructured information” into the EMR. These systems utilize data entry technology that allows the dictated information to be entered into the correct sections and fields, therefore, populating the EMR appropriately and avoiding the time spent searching screen templates and pointing and clicking. This also allows the dictated information to be captured appropriately in the EMR, extrapolated and used to help meet the various stages of ARRA HITECH “Meaningful Use” compliance.

The Value of Dictation

For many patient encounters, dictation offers avenues for physicians to provide details that can’t be captured in EMRs, which only utilize typing or point and click technologies. Physicians have always known that dictation is the superior way for them to record what is on their minds regarding their patients. It allows them to capture nuances and subtleties that cannot be communicated strictly through structured EMR fields.

Other Optimization Technologies Are Also Available –
Natural Language Processing and mHealth Applications

A significant number of physicians indicate they would like to dictate the entire medical note. This technology is available through speech or voice recognition which allows physicians to dictate the entire note via voice recognition, and then have the entire note entered into the appropriate EMR fields.

EMR optimization technologies offer a variety of dictation options to meet clients’ specific needs:

mHealth (mobile) applications can also be used with EMR/dictation optimization plans. One physician group recently developed an optimization plan for their practice management system that allowed completed documents to be automatically dropped into the appropriate fields of the EMR using an iPhone. The doctors enjoy being able to use their iPhones to both dictate and review notes, and immediately felt the impact of a further streamlined documentation process.

mHealth solutions allow physicians to use their iPhone, iPad, iPod Touch or Android device to access application functions wherever they have Internet or 3G/4G access. These physicians have their patients’ schedules, dictation, document templates, and transcription history right at their fingertips. Documents created on the mobile devices can be reviewed, edited, electronically signed and integrated directly into an EMR as a narrative report or as a structured document.  mHealth solutions give physicians the tools they need to complete medical records without being tied to a work station. They can:


Using a hybrid dictation/EMR technology approach will maximize physician productivity and workflow. Your facility’s revenue stream will not be adversely impacted and may even increase, while your patient care is enhanced with more comprehensive documentation. A hybrid approach that includes dictation — the most efficient means of documenting patient encounters – allows physicians to practice at peak performance. The goal of an EMR should not be to take away dictation, but to empower physicians with the benefits of dictation.