Physicians understandably exhibit a wide range of comfort with medical software. While Physician A may readily adapt to controlling an EMR by speech, Physician B may resist abandoning standard dictation. Similarly, some clinicians may be comfortable using “point and click” methods – with some keyboard use - to run their EMR, while others feel that typing takes their attention away from the patient – or changes their thought process.

Technology to capture patient data by speech has evolved to offer clinicians a range of dictation methods, from traditional to automated. The methods include:

• Manually – Driven EMR, where clinicians have deployed neither traditional nor speech-assisted transcription services within the EMR for creating free-text narratives. In this instance, clinicians become typists. While transcription savings are significant, they are more than overshadowed by the often significant reduction in physician productivity.
• Traditional Transcription. A clinician dictates into a digital recorder or standard telephone, which is then transcribed by a medical transcriptionist before being released for review and signature by clinicians in the EMR systems. Traditional dictation is the most labor-intensive and therefore the least cost-effective method of documenting findings in an EMR.
• Speech – Assisted Transcription, in which a clinician’s dictation is captured and is “recognized” by a speech recognition engine as a first-pass step. The initial recognition is then reviewed, edited and corrected by an Medical Editor and then released for review and signature within the EMR. Studies have shown that this “back end” (i.e., in the background) recognition, in conjunction with manual editing after the initial recognition has been completed reduces the cost of creating medical records vs. traditional transcription by as much as 50%.
• Speech – Driven or speech-enabled EMRs, where clinicians can dictate directly into free-text fields of the EMR and observe their findings on the screen, and can make edits as needed. This “front end” approach represents the fastest and most cost effective method for clinicians to document findings, requiring far fewer process steps (see graphic below). Voice macros – allowing clinicians to navigate any EMR system with a single voice command – improve ease of use immensely.