As physicians embrace the EHR and the flow of information changes from the traditional physician narrative to a computer generated note, it is becoming increasingly difficult to add a narrative report to each patient note.
The passage of last year's healthcare reform bill continues to have significant impacts on physician practices. More and more medical practices are transitioning away from the traditional paper chart and moving to a full featured electronic health record software package. As physicians embrace the EHR and the flow of information changes from the traditional physician narrative to a computer generated note, it is becoming increasingly difficult to add a narrative report to each patient note. There are several ways to modify this and allow physician notes to be easily modified to incorporate the all important narrative.
One way that I have modified my work flow using my EHR is to incorporate the use of voice recognition software. There are several software options available, however the most popular option is to use Dragon Naturally Speaking. I carry a tablet PC into each exam room for my patient encounters. My EHR allows me to easily document the encounter with the use of templates that are easily customized and specific for each problem. However, as patients return for routine follow up, the history and physical exam findings that are documented can lend itself to the production of notes that can be difficult to read and sometimes note after note can closely resemble the previous ones.
Most EHRs allow the user to add free text data entry into each template and this can allow for note production that can be very precise. However, the labor involved with free text entry can be very cumbersome and time intensive. This is especially true for users that are not very efficient typists. Some physicians utilize a scribe for data entry and this can provide for accurate note creation, however such workflow requires an additional staff member to accompany the physician into the exam room and also increases the overhead cost for each patient encounter.
I have Dragon installed on my tablet PC and utilize a Bluetooth microphone. The setup for Dragon is very easy and typically can be done in less than one hour initially. The method for adding text entry via voice recognition requires that the user activate the software either with a stylus click or mouse click and then activate the cursor on the screen in the area for which text is to be added. Once this is done, the user then speaks clearly into the microphone and the text appears instantly. I typically do not dictate in the exam room while a patient is present. If dictation is needed, I leave the note unsigned and modify it as needed after the patient leaves the room and typically this is done while my nurse is getting my next patient ready. One may suggest that this routine can be time consuming and may decrease the physician's efficiency, however if done correctly, voice recognition can allow very precise notes to be created and the overall time spent in touching up the notes can drastically improve the whole day's efficiency by the end of the day.
In order to use voice recognition effectively, I have found that the latest quad core Intel processors running Windows 7 professional 64 bit version on a PC with at least 4 GB of RAM is the sweet spot for Dragon. Such hardware specifications should prevent any sluggish performance on your PC and allow you to run the EHR software simultaneously without any problems. I also have Dragon installed on a desktop in my private office and use a corded headset for dictation. Even though the latest Bluetooth headsets are very accurate, the corded headsets provide for the greatest precision with voice recognition. If there are any notes that need additional editing, I generally batch these and finish them at my desktop at the end of the day, providing I have not already finished them on my tablet.
Voice recognition can be a very powerful tool for allowing the physician to create very accurate notes and simultaneously take advantage of the latest EHR systems and meet the requirements for such EHR use as defined by the federal government and qualify for the financial incentives available. Once the software has been properly installed and configured, the user will note that their efficiency will drastically increase and the overall quality of the encounters created will be excellent. Should anyone have any specific questions regarding the use of voice recognition, please feel free to add a comment to this posting.
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