Chief Medical Information Officer, Tri-City Emergency Medical Group, Oceanside, Calif.
* B.A. in Animal Physiology/Neuroscience from UC-San Diego
* M.D., Jefferson Medical College, Philadelphia
* President of Conant and Associates, which advises emergency departments on information technology.
-Interview by Elizabeth Gardner
Every medical record tells a story, but the plot can get lost in the database-friendly templates that capture information for electronic records. Physicians think and communicate with one another in narrative notes - sometimes they need those stories quickly.
TriCity Medical Center, Oceanside, Calif., has 46 beds in its emergency department and sees 72,000 patients a year there. Busy ED physician Reid Conant, M.D., (who doubles as the department's chief medical information officer) was looking for an efficient way to get those patients' stories into the hospital's clinical information system, from Cerner Corp., Kansas City, Mo.
After much pondering and testing, he decided speech recognition was the way to go. Tri-City's emergency department now uses Dragon Medical 10.1, from Nuance Communications Inc., Burlington, Mass. The ED physicians speak their free text right into the narrative boxes, skipping transcription. They can use the program to navigate the EHR without touching a keyboard.
Conant estimates the department is now saving more than $1 million a year on transcription costs alone.
On the Importance of Stories
A template is great at organizing the objective data, like a white blood cell count of 15,000, but there's no room for interpretation. Ordinarily that count might make me think there's an infection. But if the patient is on steroids and doesn't have a fever, then I don't think there's an infection. You need interpretation in medical decision making, so some form of narrative is essential.
On Training
Training the software to learn your voice takes about 30 minutes. Training of the user takes two hours. They go through a tutorial and run through some practice patients. Then they're ready for their first shift. It takes a few shifts after that to get completely comfortable with it, but it's very rapid.
On Shortcuts
Physicians get very frustrated by the number of clicks and the time and effort it takes to get to where they need to be in an EHR. It's very helpful to be able to consolidate a series of keyboard commands into one voice command. We can create custom commands for each department.
On Speaking Versus Typing
Speech recognition is three to four times faster than typing. Many of the older generation - who might be less computer literate - are also not as strong with their typing skills. But once they learn the basic functionality, they are very comfortable.
Some of our doctors use a lot of navigation commands, while others just stick to the narrative boxes. But no one prefers to type.
On planning ahead
There's lots of rhetoric now about EHRs and meaningful use, but no focused conversation on security and privacy. It's a critical time for the administration and legislators to think about how to do identity management in health care. If we don't do it now, we'll have a high price to pay in five years. We'll be spending billions solving it on the back end when it should be solved on the front end.
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