Decide how you want to use the software before you buy. Some practices want to drop transcription altogether. That's certainly possible. "I have a client in Boston where all five doctors use it ... all their consult letters, all their office notes, everything is done in speech recognition," says Nelson. This requires a significant commitment by all the physicians, including a willingness to change some workflow habits and to do all dictating and editing themselves. Other practices choose to use speech recognition less ambitiously — say, to impress referring doctors by getting notes to them the day the patient is seen, which is impossible with traditional transcription services.

Choose software from a vendor with a good reputation for technical support. Bachman speaks highly of his vendor, 21st Century Eloquence, (www.voicerecognition.com). Ask colleagues for their recommendations. "If you don't know anything about it, you should really buy from a vendor," rather than directly from a Web site or retail store, Bachman says. "There are a lot of little things that you probably need to have someone help you with."

Use macros to make your life easier. Many physicians dictate the same thing over and over again. You can set your speech recognition to recognize verbal macros — say a few words and it automatically inserts your entire spiel on, say, HIV counseling.

Don't let a pending EMR purchase stop you from trying speech recognition — or consider combining the two. Many EMR companies, recognizing the value of speech recognition, are now building the software into their systems, but you can integrate your own speech recognition system into your new EMR if you prefer.

Bob Keaveney, an editor for Physicians Practice, last wrote about the Practice of the Year in the November/December 2004 issue. He can be reached at bkeaveney@physicianspractice.com.

This article originally appeared in the January 2005 issue of Physicians Practice.