Blending your EHR with the right medical transcription
Western PA Hospital News & More newsletter, April 2010
A patient's care can often be a long and complex history, full of details based on clinical examinations, ancillary test results, and expert medical opinions, some in template format, but most in narrative format. Some refer to this accumulation of data and narrative as the patient's "Health Story."1 Over the years, the documentation of this "story" has progressed through many stages, from handwritten to typewritten, and now electronic/digital documentation. From the beginning of time, industry advancement has been driven by technology, and the healthcare industry is no exception.
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With the passing of the American Recovery and Reinvestment Act (ARRA), the government is providing billions of dollars as incentive to adopt the meaningful use of certified electronic health records (EHR). This incentive is undoubtedly creating a flurry of activity in ascertaining which EHR to purchase and how to implement it. Despite the legislative and fiscal obligations to adopt EHRs, technology should be embraced when it adds value, such as improving the speed or access to data, reducing costs, improving quality or decision making, and convenience.
There are times when a patient's story can best be told only through a healthcare provider's spoken word. For physicians, every minute counts, and template- based documentation can have the unintended consequence of lowering physician productivity. A study done by the AC Group has shown that it requires 140 minutes more per day to document in an EHR. The monetary cost to a clinician with average earnings of $100 per hour would be approximately $180 per day or approximately $4000 per month. The following chart illustrates a comparison of documentation costs between a transcribed note and a structured data note in an EHR.2 Clearly, a physician's time is better spent seeing patients, allowing the physician to do what they do best - rendering patient care. This not only benefits patients with more physician attention, it also benefits the practice with more revenue, reducing the practice's documentation cost in the process.
Adopting several means of documentation and data capture would allow a physician or hospital to meet the criteria for meaningful use, including utilization of the dictation-transcription process to feed structured narrative reports and discrete data elements through data tagging into the EHR. By acknowledging the dictation- transcription process as one of the methods to capture health information, physicians will be more likely to embrace the push for greater EHR adoption.
The goal should be blending the EHR with a dictation-transcription solution that gives a cost effective way to tell the patient’s entire story. So, what do you look for when researching a dictation-transcription solution?
ONE HAS TO CONSIDER MANY FACTORS
1. Technology: The transcription industry over the last decade has gone through tremendous technological change. The speech recognition engines now in use can have a huge impact on producing the discrete data derived from narrative reports, now called “narradata.” 3
2. Editing/Report finalization: After a dictation is run through a speech recognition engine, you have to decide whether back-end editing (done by internal transcriptionists or a transcription service) or front-end editing (done by the dictator) provides the best work flow for your particular situation.
3. Interfacing: After these reports are electronically signed by the dictator, they should be uploaded into an EHR using HL7 clinical document architecture that promotes the use of data mining tools for health information exchange, core measure reporting, medical coding for reimbursement, and clinical decision support systems. Your chosen transcription provider should be well versed in HL7 interfacing.
4. Cost: Do you have the budget for this initiative? Cost amounts to more than just the cost of the software and ancillary service. As shown above, there is an “opportunity cost” of the physician forfeiting additional patient billing in favor of documenting his or her own visits in an EHR.
5. Quality and turnaround time (TAT): These are factors that are paramount in any medical documentation. TAT requirements are getting shorter and shorter. Medical information is only valuable if it is accurate and in the hands of healthcare providers when and where they need it.
6. Portability and security: Now more than ever, portability and security must be addressed. The walls of healthcare have expanded to include a multitude of satellite facilities and healthcare providers on the move. Devices that handle voice input have to accommodate the mobility needed by today’s healthcare provider. Also, all technology involved with the dictation-transcription solution, from voice input to document delivery must be HIPAA and HITECH compliant.
Ultimately, the blending of a dictation-enabled EHR and the right medical transcription solution gives healthcare providers the best of both worlds, the use of template-driven documentation when it would be the most efficient and appropriate, and the use of narrative dictation and transcription to enable the capture of unique details for a more complete picture of the patient’s health story.
Barbara Wood, RHIA is the project manager, privacy officer, and Health Information Management Industry liaison for EHRscribe, Inc., a medical transcription service company based in Pittsburgh,PA. She can be reached at 412-963-9007 x130 or bwood@ehrscribe.com.
2 –Anderson, Mark R. “Digital Medical Office of the Future.” October 14, 2009.
3 – Journal of AHIMA. “Transcription and EHRs.” February 2010.
