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For other articles and previous issues click here. February 7, 2005 Portable
Power — PDA Dictation PDA dictation uses a slightly different approach than the voice-recognition systems steadily spreading through radiology. As a hospitalwide application, PDA mobile dictation links the physician’s dictation and other patient data in the system directly to transcription through the hospital’s IT network. It doesn’t bypass transcription the way voice recognition often does. Mobile dictation is slowly but surely being integrated into hospitals and clinics nationwide. Although only a small percentage of physicians currently utilize mobile dictation, its potential effect on transcription is huge. “PDA [personal digital assistant] dictation restores mobility and convenience to the physician [while] providing the functionality of a handheld digital recorder,” explained Guy Mansueto, director of product marketing at Allscripts Healthcare Solutions, Libertyville, Ill. “Easier to use and more accurate than traditional dictation, physicians can access their patient schedule, inpatient visits, or personal lists with a simple tap. Dictations are captured without the need to dictate patient identifiers or the need to memorize phone key codes and work types. As a result, we have found that physicians are saving just over 24 seconds per patient over phone-based dictation. With dozens of patient visits per day, this time savings can deliver substantial results.” With mobile dictation, physicians can access patient records without dialing a telephone, and the dictation is more efficient because the doctor can utilize it at his or her convenience. Mobile dictation systems are integrated with a hospital’s information system, so the physician can also access available patient data without having to hunt down the paper records and/or x-ray images and test results. Information is transferred and updated automatically (every 24 hours, for example), or physicians have to synchronize their PDAs at a pod at least once per day, if not more often, to have the most up-to-date patient information in their hands. Mobile Goals According to Hansen, independent PDA dictation vendor studies show that PDA-based dictation, when implemented with a patient schedule or census list, saves the user an average of one minute per dictation by eliminating the need to look up and record information already contained in the patient data associated with the voice file. “With an average case load of 15 to 25 patients daily, the time savings associated with originating the dictation can average between half a day and a full day per month,” added Hansen. “Additionally, though not quantifiable by specific studies, the time savings realized by reduced document edits, improved QA [quality assurance], and reduced keystrokes serves to enhance workflow and productivity of the document originator, transcription staff, and [healthcare information management] resources while improving the final version document turnaround, revenue cycle, and patient care.” The conversion is often trouble-free because physicians don’t have to relearn anything when going from a telephone system to a wireless PDA for dictation. “All the patient information is accessible … it’s just automating the existing transcription process, not reengineering it. Mobile dictation is just reworking the transcription process for the better,” said Stephen Hau, cofounder and vice president of marketing at PatientKeeper in Boston. The advantages of mobile dictation, notes Mansueto, are improved physician productivity, increased transcription efficiencies, and decreased administration. “Dictations are wirelessly transferred and immediately made available for transcription, reducing courier costs and turnaround time compared to other mobile recording devices. Since each dictation is uniquely identified with the provider, patient information, and report type, the transcriptionist reduces the time it would otherwise take to locate the correct patient and encounter,” said Mansueto. “Since each job is individually captured, locating a priority job is convenient, reducing the likelihood of physicians dictating multiple reports on a single phone call or tape.” Mansueto sees three main advantages to mobile dictation: improved physician productivity, increased transcription efficiencies, and decreased administration. “Improving transcription accuracy helps eliminate misfiled documents,” he noted. “Jobs are individually tracked and reported on throughout the system. A variety of reconciliation reports ensure that each dictation arrives safely as a transcribed document and that documentation exists for each patient visit.” Hansen said the main advantages of mobile dictation are enhanced risk management, improved document turnaround and patient care, and better patient health information security. When evaluating the advantages and disadvantages of PDA-based dictation, comparisons should be drawn to the legacy dictation input methods, which include telephone dial-up (noncellular phones, which are typically not used for dictation due to sound clarity and reliable signal strength issues) and dedicated portable recording devices, both digital and tape-based (see comparison chart <WHERE>), according to Hansen. “There are several key advantages that stand out. PDA dictation solutions designed specifically for healthcare are designed to enhance the workflow processes of patient encounter documentation,” said Hansen. “Through simple patient scheduling and ADT/census interfaces, the provider’s patient is listed on their PDA. Solutions allow the physician to tap on the patient listing and begin their dictation. Results are a direct association of the patient demographic data, chart or visit number, user, location, and a myriad of other data elements directly with the voice file.” Enhanced risk management refers to the improved association of the dictated patient encounter with the correct patient. Documents require fewer corrections due to automerge of the patient data into the document with fewer transcription errors. “By functioning on a device [PDA] commonly used for other patient care functions, results dictation more frequently occurs immediately following the time of encounter, resulting in improved detail and faster turnaround of the documentation. Improved documented encounter detail additionally results in enhanced coding and billing with a positive impact on the revenue cycle,” Hansen said. Paula Howard, director of finance at the Blue Ridge Bone & Joint Clinic in Asheville, N.C., said that mobile dictation makes things run more smoothly. Mobile dictation has played a significant role in the clinic’s transition to a paper-free environment. She sees no disadvantages to the technology. One disadvantage some users may have noticed is a slight decrease in the accuracy of back-end speech-recognition products. “Due to the lack of high-quality, noise-canceling microphones built into a PDA or TabletPC, and/or the inconsistency in which a speaker dictates into the device, speech recognition may need to be enhanced through external or bluetooth microphones and improved codecs and compression techniques,” said Mansueto. “External microphones and increased dictation file size can add to the cost of the mobile solution for those organizations utilizing speech-recognition products.” EMR Intro Hansen pointed out that PDA use in healthcare is higher than any other commercial or professional sector. “This significant adoption of PDAs by the medical community carries through to physicians’ adoption of PDA-based dictation. If providers are current PDA users, acceptance of dictation solutions is very high. Non-PDA users require a bit more encouragement, which is typically facilitated by peer use,” he explained. “Adoption [of mobile dictation] has primarily been hampered by the lack of organizational encouragement and acceptance of internally supported PDA solutions… When institutions start providing PDA solutions, the burden of support for both the on-device application and the infrastructure to support it falls on the IT [information technology] staff and departmental champions/application support teams… In the ambulatory/clinic setting, physicians tend to drive the technology solutions and, therefore, adoption is more widespread in this setting.” Security Challenges Met Mobile PDA solutions present the best-available security options that meet or exceed HIPAA security guidelines, according to Hansen. “There are several third-party security software options in addition to PDA manufacturers and vendor dictation solution security offerings. When deploying mobile solutions in an enterprise setting, it is best to implement an enterprisewide security program. By doing so, system administration can impose security log-in requirements, manage audit logs, and age and enable/disable the log-ins according to the organizations’ security policies and guidelines,” said Hansen. “Some mobile dictation solutions provide on-device, real-time encryption of the PHI [protected health information] data and dictation while subsequently providing encryption end to end from the device to the back-end server and dictation system. When compared to dedicated mobile digital and tape recorders, PDA dictation provides a much better security model to these more traditional devices.” An additional security benefit to PDA dictation relates to the provider’s use of the device—PDAs are critical to his or her everyday workflow, much like a cell phone. “The implication is the PDA user will be more adamant about the retention and whereabouts of their PDA than a dedicated dictation portable device, which serves but one purpose and can frequently be shared between providers and dropped off with administrative and transcription personnel to facilitate the transfer of the dictation files,” said Hansen. “As with most dictation/transcription solutions, the more critical issues surrounding PHI security revolve around the transcribed report and services providing the transcription. Protecting electronic data is a challenge, regardless of the platforms, but typically [a PDA] provides much better security than the ongoing processes and issues of securing paper-based patient records.” Military-grade Encryption Once a decision has been made to further investigate or proceed with mobile dictation, prospective users are advised to learn about the myriad uses of PDAs in healthcare. “The decision processes and requirements will naturally be more complex for those in a hospital vs. a small to midsized clinic. PDA dictation is one of the only real advancements in dictation voice input in the last two decades,” said Hansen. “You won’t have a problem finding physicians to champion the solution, and with some vendors you can start out with a small controlled group and then expand as the processes are refined. You may even be able to get started quickly by covering the costs in operating expenses vs. a capital purchase.” Mansueto offered some different advice. “The transcription documentation challenge today goes well beyond simple transcription management tools used only to automate an inefficient dictation and transcription process. Transcription efficiency solutions on their own offer only partial assistance to the healthcare industry by addressing the time and financial challenges of clinical documentation,” he explained. “As a result, a mobile dictation solution should be part of a full health information strategy. An integrated application that supports structured documentation, prescription/order writing, charge capture, and full chart access, complete with clinical content and point-of-care decision support, is critical to today’s electronic health record environment and can avoid multiple applications fostering physician adoption.” Complementing EMR Hansen pointed out that “use and acceptance by providers varies significantly, and while the solutions will improve and resultantly be more widely used, implementations of EMRs are still very limited.” Due to the federal goals of interoperability, the Physicians’ Electronic Health Record Coalition (PEHRC) suggests that doctors wait until the PEHRC releases its recommendations within the next 12 months before buying EMRs. Even when template-generated reporting is implemented, expectations of 100% utilization will not always be realized, according to Hansen. Dictation will continue to provide supplements to any type of automated report generation, whether it is used for complete report creation or to voice-annotate templates for abbreviated transcription and/or voice recognition. “The use of limited speech and voice recognition with template-based report generation may serve to accelerate adoption. Voice-recognition solutions have improved in recent years, and while specialized stand-alone voice-recognition solutions—especially in radiology—prove to have very high recognition rates, back-end processing of general free-form dictation has resulted in only moderate successes,” said Hansen. “The transcriptionists become editors, and while institutions can typically negotiate lower transcription line rates when processed in this manner, the actual productivity gains and savings are not always what are promised.” Hansen believes the use of PDA dictation will provide significant productivity and efficiency gains today while serving to complement future template-based report generators. There is potential for template-based dictation at the PDA level based on the provider’s specialty. — Laura Gater’s medical and business trade articles have been published in Medical Imaging, 24x7, Podiatry Management, Veterinary Forum, Corrections Forum, and other national and online publications. Resource
Publications, Associations, and Consultants: Alliance: Vendors and Medical Transcription Service Organizations
With Healthcare-Focused PDA Dictation Solutions: PDA Vendors With Healthcare Vertical Sections
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