Medical group decided that to be most successful with EMR adoption, 100 percent physician population utilization would be necessary.
Today, 40 physicians at Slocum-Dickson Medical Group (SDMG), a physician-owned medical group located in New Hartford, N.Y., are using real-time speech recognition to dictate into their electronic medical record (EMR) system.
Medical group decided that to be most successful with EMR adoption, 100 percent physician population utilization would be necessary.
Today, 40 physicians at Slocum-Dickson Medical Group (SDMG), a physician-owned medical group located in New Hartford, N.Y., are using real-time speech recognition to dictate into their electronic medical record (EMR) system.
SDMG’s first experience with an EMR was in 2000 when the group implemented the MedicaLogic EMR, which was later acquired by GE and branded Centricity EMR. This implementation proved to be successful, according to Rob LaPolt, chief information officer for the group. SDMG acquired other core applications by using a best-of-breed approach and interfacing them together. SDMG now also uses GE’s practice-management and RIS/PACS solutions in its efforts at less interfacing and more integration of the applications.
“The availability of advanced technology not only ensures quality patient care, but it also helps with physician recruitment and retention,” LaPolt says. “Physicians, particularly those just coming out of medical school and entering practice, are looking to work in the most up-to-date work environments where the level of care is consistently developing, maturing and improving.”
While the availability of healthcare information technology was the first hurdle to overcome, integrating that technology into the clinical work flow was no simple task, according to LaPolt. At the onset, the EMR steering committee decided that to be most successful with EMR adoption, 100 percent physician population utilization would be necessary, with the ultimate goal of eliminating transcription. Slocum-Dickson currently has 75 physicians and more than 500 staff members.
Once the original EMR system was operational, however, there were physicians who refused to use EMR forms to enter “structured” data; rather, they would type notes directly into the EMR. The reliance on the keyboard caused physician backlash in relation to the EMR. Many physicians were struggling with the work flow change and related time consumption. Quality was suffering.
At this point, SDMG identified the changes needed to be made for a successful outcome of improved work flows and full physician acceptance.
Philip Porter, SDMG executive director, provided staff with a clear directive: “One patient, one record, one system and one schedule.” When the patient leaves the examination room, the patient note is completed, follow-ups are scheduled, prescriptions are written and sent to the pharmacy, and billing information is sent and ready for submission.
Physicians were able to finish their documentation quicker with
speech recognition, allowing them to either spend more time with patients
or to complete their work in a reasonable time frame.
“The idea here is that if focus remains at the individual patient level, the service and care will be better than if staff were jumping from one task to the next without closing out the first,” LaPolt says.
LaPolt researched alternative documentation methods and came across speech recognition as an option to use with the EMR. Dragon Medical from Nuance was selected to capture the physician narrative as part of the structured EMR template.
Training was a necessity to ensure the time and money being spent was supported by a usability program. One-on-one sessions between physicians and trainers were conducted to clarify and emphasize the capabilities and connection between speech recognition and the EMR.
“Physicians quickly embraced and effectively used speech recognition as a way to populate their patients’ notes within the EMR,” LaPolt says. “The general consensus post-training was that speech recognition was speeding the clinical documentation process and eliminating time at the end of the day where doctors previously had to finish their documentation duties via the keyboard.
Physicians were able to portray the uniqueness of each patient encounter better within the note, says Dr. Nathaniel Gould, physical medicine and rehabilitation physician. “When you rely on transcription, and don’t see your work for a week, you may not even remember what you said or who the patient was,” he explains.
Physicians also were able to finish their documentation quicker with speech recognition, LaPolt says.
“One of the biggest takeaways from the pairing of speech recognition with the EMR has been the return on investment,” he adds, “which may be the quickest SDMG has achieved to date as compared with other IT initiatives that have been undertaken.”
Before Dragon Medical was installed, physicians had to pay for their documentation costs individually. Even though they had access to the EMR, most physicians were spending $12,000 per year on transcription. While approximately $2,600 has been invested for each physician ($1,599 per Dragon Medical license and $1,000 for training), in about 60 days doctors had fully stopped using transcription. The collective annual transcription savings has been about $750,000, a figure expected to increase as more physicians move away from transcription and embrace speech recognition.
Dragon Medical enables the specialists at SDMG to produce comprehensive referral letters – the same day the physicians see a patient. Some doctors say their patient volume has increased, with no impact on the quality of documentation for each encounter.
SDMG has also been able to appropriately maximize its reimbursement by more accurately coding patients’ records. Dragon Medical allows physicians to add all pertinent details of an encounter to the note, resulting in complete documentation that will fully substantiate a given code.
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September 2009
