Commentators on meaningful use often focus on the "meaningful" part of the phrase: what the government considers constructive deployment of electronic health records.
But the "use" part is important as well. A sticking point in some deployments is the human interface. To wit: physicians may balk at having to key-in patient data.
Dr. Reid Conant, chief medical information officer at Tri-City Emergency Medical Group, in Oceanside, Calif., said EHRs use templates that let doctors click on discrete data elements"a drop-down box of symptoms, for example. The data entry job becomes more taxing, however, when it comes to filling in a narrative in a patient's electronic chart. That might include a clinical history of the illness, doctor's interpretation of lab results and discharge instructions" all usually keyed into an EHR.
Conant believes speech recognition offers a better option. "Typing takes far longer and it is a frustrating way to document," Conant said. "Providers that use speech"¦have a rapid way of dictating in the narrative and telling the complete story."
"As we all know, physicians are not typists," added John Shagoury, president Nuance Healthcare, a maker of speech recognition systems.
The use of speech recognition as an EHR front-end is gaining momentum, he said, citing the Defense Department and the Department of Veterans Affairs as long-time users of the company's Dragon Medical speech recognition products.
Conant said he uses Dragon with Cerner's PowerNote ED system, noting that anywhere he can type free text into a medical note he can dictate the entry with Dragon. He said it takes about two-and- a-half hours to grasp the essentials of using the product.
The meaningful use proposal also calls for providers to make a discharge summary and instructions available upon patient request. Conant said providing those elements via transcription involves built-in delays, while template-driven and paper documentation inadequately convey the information.
"Both of these documents are difficult to have available to the patient "˜upon request' on discharge from the hospital without the use of front-end speech recognition," Conant said.
