EHRs: The Physician Perspective
In an effort to understand physicians’ outlook on the EHR, Nuance Healthcare recently engaged more than 17,000 physicians in a survey designed to:
- Uncover physicians’ hopes and concerns with respect to healthcare information technology.
- Explore and measure physicians’ opinions of the EHR’s value from an adoption, feature-set, productivity, patient care and cost/benefit perspective.
- Gauge physicians’ understanding of developing healthcare government policy.
Summary results from this survey, which represent responses from nearly 1,000 physicians, include the following conclusions:
- Physicians don’t think EHRs save time: Ninety-three percent of doctors "disagree" or "strongly disagree" that using an EHR has reduced time spent documenting care (outside of work and at work).
- Money isn’t all that matters. When asked what doctors consider an "incentive to drive national EHR adoption," 75 percent of the physicians surveyed called for access to tools – such as medical speech recognition solutions – that help doctors better document within an EHR. Only 69 percent cited stimulus money.
Incentives are not created equal. When asked what they considered "important" or "very important" measures for EHR meaningful use payouts:
- 90 percent of physicians cited "access to medical records faster without waiting for records to come out of transcription."
- 83 percent of physicians said "more complete patient reports, with higher levels of detail on the patient’s condition and visit."
- 83 percent of physicians said "better caregiver-to-caregiver communication based on improved reporting that is more accessible and easily shareable."
- 79 percent of physicians thought "improved documentation by pairing the EHR point-and-click template with physician narrative."
Some EHR components are more important than others. Physicians identified the following as the most important EHR components:
- Lab test results reporting and review.
- Documentation tools that allow doctors to speak the physician narrative into the EHR.
- Secure health messaging between caregivers.
- Keyboard support via) medical speech recognition for data entry into the EHR.
Fewer than 10 percent of physician respondents were either "confident" or "very confident" the federal government’s health information technology and reimbursement standards will lead to higher quality patient health records. A key concern? Losing the unique patient story with the transition to point-and-click (template-driven) EHRs.
Medical Speech Recognition: Bridging the Narrative/Structured Data Gap
The study revealed a clear dilemma: While 67 percent of the doctors surveyed cited "time associated with reliance on keyboard and mouse to document within an EHR" as a major hurdle, 74 percent said EHR templates and "patient notes with no uniqueness" are challenges to realizing the full value of EHRs.
As part of the survey, respondents also were shown two versions of a de-identified patient’s history of present illness, or HPI Note, which was shared by Dr. Hal Baker, CMIO, Wellspan Health, York, PA
A doctor created the first note using medical speech recognition software to describe the patient encounter and care plan in narrative form:
- HPI Note #1 (dictated with Dragon Medical) "The patient is a 74-year-old female who presents with a complaint of fall, 74-year-old female presents with complaint of neck pain, headache. She states that she had mechanical fall at home where she tripped and fell downstairs, approximately 9 steps and landed on her back. She complained of shortness of breath right after the event. She noted that she had pain in her left ankle and left knee. She is not sure whether she had loss of consciousness and the patient further complains of the pain in the right wrist."
The second note on the same patient, for the same visit was created from an EHR point-and-click template, based on the structured elements selected by the doctor:
- HPI Note #2 (produced by an EHR template) "The occurrence was one hour prior to arrival. The course of pain is constant. Location of pain: Head leg. Location of bleeding: None. Location of laceration: None. The degree of headache is mild. The other degree of pain is moderate. The degree of bleeding is negative. Mitigating factor is negative. Immobilization no backboard in place and no cervical collar in place. Fall description tripped. Intoxication: No alcohol intoxication. Location accident occurred was home."
When the surveyed physicians were asked which note they would consider more valuable in treating this patient, 97 percent said HPI note #1, the one created from free-form physician dictation via speech recognition. Ninety-eight percent said HPI note #1 was more complete and easily understood by the patient or another caregiver. In addition, HPI note #1 was selected as the preferred note for addressing each of the following clinical communication objectives:
- "Driving high quality caregiver-to-caregiver communication," selected by 98 percent.
- "Recording the patient encounter, care recommendation and treatment history to safeguard them and/or their practice from medical/legal liability," selected by 93 percent.
- "Getting physician thoughts into the note – ensuring the medical decision-making is captured," selected by 97 percent.
- "Representing the uniqueness of the patient encounter – ensuring all relevant, personal information is captured and lives in the patient’s health record," selected by 97 percent.
- Future visits with the patient "for understanding and recalling the patient’s history," selected by 98 percent.
Ninety-six percent of physicians surveyed voiced concern about losing the unique patient story with the transition to point-and-click (template-driven) EHRs, reinforcing the need for patient health records to be a combination of structured and narrative information. Ninety-three percent either "agree" or "strongly agree" that "capturing physician narrative as part of the documentation process is necessary for complete and quality patient notes." Ninety-four percent said "including the physician narrative as part of patients’ medical records" is "important" or "very important" to realizing and measuring improved patient outcomes.
To view graphs and data related to each of the physician survey questions asked:
Dr. Steven McCullough
Nephrologist, Jackson Purchase Medical Associates
Time savings with Dragon Medical Macros"
Blended point & click and Dragon Medical is ‘best practice'"
Dr. Douglas Golding
CMIO, Lifetime Health Medical Group
Code at the maximum level with Dragon Medical"
Speaking in the note is a reality with Dragon Medical"
Impressive Cost Savings"
Dr. Jon Wahrenberger
Cardiologist, Dartmouth-Hitchcock Medical Center
Incredible ROI with Dragon Medical"
Narrative adds value to diagnosis"
Dr. Donald Brown
Director of Physical Therapy, Lifetime Health Medical Group
"Optimized communication with Dragon Medical"
Dragon Medical enhances quality of care"
Dr. Jon Wahrenberger
"Since using version 10, I'm discovering far fewer errors. The accuracy of version 10 is significantly better"
Dr. Brian Zimmerman
Emergency Physician, Premier Health
"I just dictated for about 30 minutes in our Epic EMR system (using Dragon Medical 10) with only three mistakes. Pretty amazing!"
Dr. Pierce Sanders
"Wow! Fast! Accurate ! I didn't think it could get any better."
Dr. Dan Field
Emergency Physician, Kaiser Permanente
"I have never seen a product (Dragon Medical 10) undergo such superb improvement over time and I have been a Dragon user since v6."
Dr. Loren Leidheiser
Chairman and Director of Emergency Medicine, Mount Carmel St. Ann's Emergency Department
"I've used Dragon Medical speech recognition for about 8 years. We use Dragon Medical in our busy emergency department with the Allscripts electronic medical record and have eliminated medical transcription. Dragon speech recognition has greatly increased the value of our medical records by including detailed narratives that point-and-click templates simply can't capture — accuracy is near perfect, even in a hectic emergency department environment. Based on my testing and use of Dragon Medical 10, the software seems more intuitive and the recognition has yet again improved from previous versions. Beyond the documentation efficiency gains for our providers, Dragon lets our team tell our patient's complete story and that raises our quality of care."
Dr. Betty Rabinowitz
Primary Care Internist, University of Rochester Medical Clinic
"We were most interested in the ROI associated with implementing a speech-enabled technology. We were spending close to $1.2 million on transcription costs in our primary care network and with the implementation of Dragon Medical to complement our Allscripts EMR, our projected cost for transcription has been brought to zero."