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The reputation of speech recognition systems usually ranks next to physicians’ handwriting: They both produce illegible results.
However, Lawrence Memorial (MA) Hospital’s emergency department is piloting a new integrated dictation and transcription system that provides articulate, efficient — and legible — information almost instantly, says Steven Sbardella, MD, chief of the emergency department. (The system’s radiological counterpart is already being used at Duke University Medical Center, Emory University Healthcare, and Cornell Medical Center.)
The PowerScribe EM, manufactured by fonix Corp. in Salt Lake City, not only reduced report turnaround time to almost nil, but also significantly cut billing and coding errors, leading to higher reimbursement.
"From a billing perspective, emergency room (ER) procedures that are documented but illegible result in a loss of money for the hospital. Patients cannot be charged for an undefined procedure," he says.
As a result, many hospitals end up eating the cost of procedures that cannot be translated from handwritten patient charts.
"We’ve done about 85% less handwriting than before, and patient reports are considerably more legible," Sbardella says. "Plus, we can dictate much more in three minutes than we could when were writing it. The quality and quantity of information has increased."
Last April, Sbardella’s four colleagues weren’t at all convinced that automation of patients’ charts in the complex and chaotic workflow of an emergency room was possible.
"It was a hard sell because all their experiences with voice transcription in the past were negative ones," he says. "They weren’t thrilled about trying this one."
He explains that old voice recognition technology was not user-friendly, nor particularly reliable.
"It required extensive training because you had to use a template on the menu and speak those entries specifically," he remembers. "A lot of what was on those systems was not applicable to emergency medicine. Not to mention the fact that one would have to practice cookbook medicine to be able to use the old technology."
High error rates and lack of real time transcription also frustrated early users of voice recognition software.
Fortunately, this system, which only has a one- or two-second delay from dictation to transcription, has won the favor of hurried ER docs.
"When they saw it only took about 20 minutes to train, and what it could do for them in such a short amount of time, they agreed to try it," he says.
With the fonix system, explains Sbardella, physicians aren’t burdened by intrusive or rigid templates. "Basically, you just sit back and speak naturally into the microphone; the barriers to use disappear."
Natural language technology enabled physicians to dictate clinical notes in a continuous, free-form manner without having to pause unnecessarily between words.
"Recognition accuracy is about 98%," he says.
The computer "learns as it goes. It takes the physician’s speech and compares it to their corrections. For example, the first-run through was 85% to 90% accurate; we turned on the adaptation and saw a dramatic increase in recognition."
It also permits multiple dictation sessions on the same chart. "This is vital for an ER, because we may see five or six patients at a time, dictate notes, return to the patients, and come back to the dictation again," Sbardella points out. "The system remembers where we were and we can pick up immediately from there."
Located at the nurses’ station, the PowerScribe is within easy reach of ER physicians and their staff. "We put the single PC station at the desk where the physician sits because it had to be convenient," Sbardella says, explaining that in a single-coverage emergency department, the system must be accessible at all times.
"We have to be able to sit down, use it quickly, and then move on," he says.
Within seconds after dictating, physicians can quickly edit the report because of the high recognition rate. "On a Level 5 service [the most complex one] we make only about 10 corrections," he notes.
It also helps physicians to meet the demanding documentation requirements of the Health Care Financing Administration by providing real-time feedback as to how well their reports meet its stringent Evaluation and Management codes.
After editing, the physician can approve and sign the report within minutes. They can be automatically stored in the PowerScribe’s own data repository or uploaded into the hospital’s information system and distributed to the intensive care unit, surgeons, or primary care physicians.
"Having legible charts instantly also expedites admission and improves quality of patient care," he adds.
The system has also increased the satisfaction levels of community physicians. "We did a survey of the physicians, who indicated the most important thing we could do was to get them legible charts in a timely fashion," Sbardella says.
By implementing a faxing system, the emergency department can fax the reports almost instantly. "It goes right to the doctors’ offices. They get it when we get it," he says.
Sbardella estimates payback time to be about six months.