The Future of Clinical Dictation and Transcription

In the latest issue of For the Record Magazine, Robbi Hess discusses the pros and cons of the Once-and-Done transcription model (the other name for front-end speech recognition, whereby physicians see the results of their dictation on screen and make their own corrections). First, the article highlights findings from a Gartner Report by Barry Hieb, MD, healthcare research, titled “The Evolving Model of Clinical Dictation and Transcription:”

The lack of efficiency and the money that leaks through transcription cracks have always been issues in the healthcare industry. The role of dictation and transcription in clinical documentation is evolving in response to new technologies and new functional requirements…

Traditional dictation and transcription are giving way to ‘editor-based’ approaches and that once-and-done dictation will eventually be adopted in the majority of situations.” […] Because speech recognition makes increased productivity and associated cost savings possible, it is now an integral part of most new dictation and transcription contracts.

The OAD dictation model will take longer to unfold but will be driven by the need to provide value back to physicians at the time they are dictating reports.

The importance of the physician’s sign off
The Author then quotes Peter Preziosi, PhD, CAE, CEO of the Medical Transcription Industry Alliance and executive director of the Association for Healthcare Documentation Integrity (AHDI):

The reality today is that you have physicians that don’t even sign off on charts even though they are legally liable for the content. My concern is that when we look at building a national healthcare information infrastructure, it will be that much more critical to ensure the accuracy and completeness of information. The onus of chart accuracy must be on the clinician, not the MT, making the need for clinician sign-off imperative.

Back-end vs Front-end Speech Recogniton
Hieb says using speech recognition technology cuts significant costs from the entire transcription cycle:

The editors can crank out 50% to 100% more copy a day and, as a result, the hospital gets charged less money. But the downside is there is still a two-day turnaround time, and the hospital is still paying for both transcription and dictation costs.

The advantage to the editor mode of transcription is that the doctor is not being asked to change the way he or she operates, and the report is turned around faster. Presumably, the editor is happier, is doing more work, and is being more productive. And from a documentation standpoint, you are telling the physician that the report will be back more quickly, but you still have to look at it, revise it, and sign off on it.

The OAD model, carries with it a good news/bad news scenario: The hospital can save money and enhance performance, but the doctor has to change his or her dictation routine.

Doctors are hesitant now because we will be telling them, ‘You will be dictating at a computer, but you can see what you are dictating’. Hieb acknowledges that some doctors are poor dictators, but with OAD, they can receive direct feedback and make edits as they go, while the patient information is fresh in their minds.

What the future holds…
Hieb believes that one of OAD’s benefits is that when the clinician dictates, edits, and signs off on the record, it’s ready to go into the electronic chart:

The turnaround time has dropped from four days to two days [with back-end speech recognition] to two minutes, and now any doctor can see that report as soon as the physician signs off on it. That turnaround time brings nothing but benefits and better care to the patients.

Although a hospital would have to invest in the software and hardware technologies necessary to implement an OAD system, Hieb says those expenses would pay off in the long run. “There will be set-up and maintenance fees, but they will be nowhere near the costs of the money spent on dictation and transcription.” He agrees, though, that getting doctors to change their behavior will be the largest hurdle to overcome.

With OAD, there is no subsequent time added to that chart, little hassle, and minimal risk of error. The single best defense against malpractice is good documentation, and with once-and-done, you have given the doctor the chance to do the reports and be done with it.

How physicians are accepting speech recognition technology…
Hieb goes on to comment:

Doctors are surprised to see that they can save time and money. If they spend a little bit of time up front ‘training’ the system, they are reaping dividends in time and money saved.”[…] OAD is being accepted more readily in private practices. That is where the technology is really making inroads because the doctors see they can save time and money, and if they have an electronic copy of the record, the staff isn’t busy chasing down records. In fact, they may be able to reduce the amount of staff they are paying. The OAD knows to file the record in Susie Smith’s chart, and the general trend in medicine is toward more clinical automation.

OAD can also be effective in the emergency department (ED), where time is of the essence. In the ED, the real benefit is getting that data out there and into the chart instantly. The more quickly and effectively the information is captured in the chart, the more quickly the physicians have access to that data.

Conclusion

For Hieb, the reason to embrace OAD is because the goal of the healthcare system is to help sick people get well and healthy people stay healthy. “We are entering an age when information is a critical component of achieving these two goals, and once and done is a better, more efficient way to capture that information,” he says.

Preziosi says the concept is not feasible in today’s marketplace, even with the enabling technologies that will be seen in the future. “Given the cost restraints, the persistent labor shortages, and the increased demands on the healthcare system, I don’t see OAD as being realistic,” he explains. “I think the clinical documentation sector needs to listen to the concerns of the consumers of our services and adapt our service offerings to meet their ever-evolving demands.”

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