Can You Make Your EHR Less Annoying?

Paul Cerrato


November 20, 2018

In This Article

Transcription Services May or May Not Help

Although this service can potentially improve the doctor-patient relationship, it won't reduce the amount of time you spend filling out online forms. And as many clinicians have already discovered, most EHR products only offer a limited amount of personalization, which is why many practices are turning to medical transcription services, which include voice recognition software, and to scribes. Among the most popular software are Dragon NaturallySpeaking and NextGen Mobile Solutions.[2] These products can be cost-effective by reducing the amount of time physicians have to spend inputting information into an EHR, but they may create other challenges.

A recent study[3] examined the error rates generated by speech recognition software. It looked at 217 clinical notes taken from two healthcare organizations—including 83 office notes, 75 discharge summaries, and 59 operative notes—and found an error rate of 7.4%. The notes were transcribed using Dragon Medical 360/eScription by Nuance.

On a more positive note, the 7.4% error rate produced by the speech recognition program was reduced to 0.4% after a transcriptionist reviewed the clinical notes. In their report, Li Zhou, MD, PhD, and colleagues[3] concluded, "Seven in 100 words in speech recognition-generated documents contain errors; many errors involve clinical information. That most errors are corrected before notes are signed demonstrates the importance of manual review, quality assurance, and auditing."[3]

Should You Hire a Scribe?

Another option worth considering is hiring an assistant to input patient information into the EHR while you conduct the exam and interview the patient. If you can afford the initial cost, these scribes could eventually improve productivity, revenue, patient volume, and efficiency, according to the research.

Cameron Shultz, PhD, MSW,[4] and her colleagues in the Department of Family Medicine at the University of Michigan at Ann Arbor reviewed five studies that evaluated the advantages and disadvantages of using scribes in several clinical settings, including the emergency department, a cardiology clinic, and a urology clinic, and concluded that "[a]vailable evidence suggests medical scribes may improve clinician satisfaction, productivity, time-related efficiencies, revenue, and patient-clinician interactions."

But a few caveats are worth mentioning. Two of three studies found that scribes had no effect on patient satisfaction. On a brighter note, two studies that looked at clinician satisfaction concluded that the scribes did have a positive effect on that measure.

A few investigations also looked at the impact of using scribes on productivity. One study found that among cardiologists, relative value units per hour increased from 3.5 to 5.5 when a scribe was involved in documenting care. Another study, performed in the emergency department, found that using a scribe did not have any impact on the number of registered visits, but it increased the proportion of patients admitted to the hospital.

Among the five studies that Shultz and associates analyzed, one dealt directly with the effect of using scribes on revenue. Their report explains that "the per-patient increase in revenue was approximately $2540, or $205,740 when applied to the additional 81 patients seen in the outpatient cardiology clinic."[4]

For practices that do not want to hire an in-house scribe from a professional scribe service, another option is to use an online program that records the patient-doctor interaction and is then sent to a transcriptionist. The transcriptionist then creates the clinical notes for your existing EHR, which you then review for final approval.

EHRs are certainly a mixed blessing. When they are well-designed and are massaged to fit into one's workflow, they provide an invaluable record that no paper record can compete with. But when they fall short, they rob clinicians of time and resources and at the same time offend patients, who feel neglected. Advance planning, transcription services, scribes, and voice recognition software may not solve all your digital headaches, but they can make EHRs more bearable.


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