Doctors find benefits in mobile dictation technology

Ask any physician in a high-energy setting like a busy clinic, and he or she will shrug off the latest in tablet technology and pull out a smartphone.

Once the scourge of hospital settings, that smartphone has become an indispensible tool to physicians looking to enter and access data quickly and efficiently. And they're doing it with mobile dictation technology.

"Doctors are trained in medical school to dictate – that's what they're used to," says Steve Jensen, network administrator at the Kearney Clinic in Kearney, Neb., a multi-specialty clinic serving Nebraska and parts of Kansas and South Dakota. "Our doctors want to dictate, and they don't want to be tied down to a tablet."

The clinic, with 30 physicians, sees about 500 patients a day, more than half of which are walk-ins, says Jensen. Physicians used to dictate their notes into handheld tape recorders – just one more tool on the proverbial bandoleer of devices. Those tape recorders were then passed on to the clinic's 25 transcriptionists, who deciphered and transcribed the tapes into notes that were passed back to the doctors at their earliest convenience, most likely long after the patient had left the clinic.

Nowadays, Jensen says, the clinic's physicians use the iPhone 4 (some use the iPad or an iPod) and the latest in speech dictation technology from Nuance. The clinic has reduced its stable of transcriptionists to six, he says, and physician productivity has increased by as much as 400 percent.

"Dictation is more personal, and it allows (the physician) to enter notes in front of the patient. There's no miscommunication," Jensen says. "Mobile technology … helps us do the job we're capable of doing."

The technology fits well with the clinic's busy schedule and high rate of walk-in patients. "We're not doing a lot of chart-pulling," Jensen points out.

With more and more doctors looking to capture notes on their smartphones, the speech recognition software market is booming. The largest players in the market are Nuance, Philips, 3M and M*Modal, but several smaller vendors are poised to keep the market competitive. The key to the market's growth may be in electronic health records, and several vendors – including Allscripts, Greenway and eClinicalWorks – are moving to add natural language processing (NLP) capabilities to their EHRs to help providers qualify for federal meaningful use incentives.

Speech recognition software has been gaining stature in the healthcare industry, with much of the growth tied to improvements in the technology. In a 2010 report, healthcare research firm KLAS estimated that one out of every four hospitals use the technology.

"Speech recognition’s influence continues to grow as speech systems become more and more common in hospitals, diagnostic imaging groups and other outpatient care sites," said the report, written by Ben Brown. "Once a novel technology, speech recognition today has earned a solid place in the elite club of healthcare-IT tools with demonstrable ROI. That position is more critical than ever as the healthcare industry focuses on HITECH/meaningful use (MU), clinical IT applications like physician documentation, and improved efficiency."

In his report, Brown further notes that the market will grow only as long as the technology improves to reduce errors tied to translation. Providers surveyed by KLAS pointed out that speech recognition technology is indeed a disruptive technology – with both good and bad results. While it changes workflow to improve meaningful use goals, the report said, it also forces physicians to make changes they don’t want.

Beyond the ability to capture and dictate a physician's speech, newer speech and language technology solutions process that information and analyze it for clinical efficiencies. This past February, Nuance introduced two Clinical Language Understanding (CLU) solutions, M.D. Assist and QualityAnalytics.

"Advanced voice and language understanding solutions make possible the capture of the complete patient story and enable unprecedented access and interaction with the data that has been captured," said Janet Dillione, Nuance's executive vice president and general manager, in a press release. "Through the use of CLU-powered solutions, healthcare organizations can process clinical information and assign meaning to it for use within other healthcare IT platforms and across the healthcare ecosystem.”

“When clinical documentation is built from rich, accurate information there is tremendous opportunity to extend its value – to analyze it and understand it so it can help to drive operational and clinical benefits,” added Judy Hanover, research director at IDC Health Insights, in a Nuance press release. “Doctors today work in a variety of settings and in many instances it is up to technology to support each and every scenario so bad data capture does not occur. The insertion of voice technologies as part of the clinical workflow has resulted in real benefits associated with productivity, quality and cost. With the introduction of language understanding technologies the industry can look beyond traditional capture hurdles and begin to explore how best to leverage and interact with data.”

Others are following suit. This month, M*Modal rolled out the Catalyst cloud-based suite of solutions, designed to extract information from its Speech Understanding platform and apply it to clinical systems like EMRs.

"M*Modal Catalyst uniquely positions us to assist providers in immediately revealing and extracting meaningful, actionable data from narrative text," said Vern Davenport, the company's chairman and CEO, in a press release. "Every day, healthcare professionals are faced with clinical, financial and quality-related decision-making. The right decisions would be more apparent if all medical documentation could be accurately assessed based on the true meaning embedded in the clinical narrative."

At the Kearney Clinic, Jensen said the older technology "wasn't always an easy ride," for physicians. But it has gotten better, and figures to play a significant role in the clinic's upcoming EMR and patient-centered medical home projects.

"And the doctors go home sooner at the end of the day," he adds.
 

Eric Wicklund

Editor of mHIMSS.org

Follow Eric on Twitter @eriwick