The document discusses the debate around replacing dictation with electronic medical record (EMR) systems. While EMRs promise benefits from automation and subsidies, replacing established dictation workflows with rigid EMR templates can significantly reduce physician productivity. Integrating flexible digital dictation systems that allow narrative notes with EMRs may offer the best of both technologies by maintaining productivity while gaining paperless benefits. The key is finding solutions that adapt to existing workflows rather than disrupt them.

2. The Medical Records Institute estimated
in Fall 2008 that 90% of healthcare
documentation in the US was done in the
form of dictation and transcription.

3. Dictation has and continues to be a primary and efficient means of
creating documentation by busy physicians in small private
practices, as well as large clinics and hospitals.

4. The American Recovery and Reinvestment Act of 2009’s
promises of financial subsidies for physicians that adopt
and make “meaningful use” of Electronic Medical Record
(EMR) Systems has led to some concern on behalf of
healthcare providers who are finding themselves challenged to
replace dictation with EMR systems.

5. Is the replacement of dictation with
EMR templates in the best interest of
providers and their patients?

6. Does this “advancement” of
technology really help
doctors to do more with
less, increase productivity
while cutting costs,
OR
in this push toward EMR
standards are the positive
gains granted by the
implementation of EMR
systems offset by a
decline in overall
productivity due to
workflow disruption?

7. Is there an opportunity for
healthcare providers to adopt
technologies that bring them
the best of both technologies,
or are providers to be forced
to accept rigid solutions and
make the best of it?

8. Computer technologies
offer enormous
benefits to healthcare
organizations.
The key, however, is finding
the right solution to meet
the needs of each unique
organization that adopts it!

9. Technologies that disrupt established workflows or require
significant behavioral changes on behalf of its users can lead
to enormous short term, as well as long-term productivity losses
that can be challenging to overcome.
This is the primary concern
surrounding the nationwide
push for adoption of EMR
systems by year 2014.
* Note: There is currently no mandate in place forcing healthcare entities to adopt
EMR systems by this date despite widespread rumor to the contrary.

10. Many EMR systems use templates as the entry point for patient
history and exam information.
Physicians who have transitioned to EMR systems from dictation
platforms have reported significant declines in productivity as a
result of using the EMR without medical transcription support.

11. Typical productivity
losses associated
with EMRs1
• 1 - 2 extra hours per day, per physician spent on documentation
• 2 - 4 fewer patients exams per day, per physician
Despite claims by EMR vendors that template-based entry points
will cut down on physician workloads.
1.
Jusinski, L (2009). “Keeping The Pace", Advance, 19(6).

12. Point-and-click entry transfers administrative responsibility to the
physician, and the costs of that loss of productivity is significant

13. “Dictation is the most efficient way to document patient care. Take
the example of a typical outpatient visit to an internist. It takes
about one minute to dictate a note for an established patient and
about $4.30 in direct and indirect costs. By contrast, many EMRS use
structured data entry as the primary method for entering clinical
notes, in which physicians point and click their way through drop-
down menus. The time required is at best equal to that of a
transcribed note, and physicians often report it takes 8 to 10 minutes
to complete a note using structured data entry, meaning that the
indirect cost to physicians is anywhere from $13.50 to $27.00.” 2
2.
Daigh, R (2008). “Friend or Foe? – The EMR Mandate’s Effect on Transcription
Companies", For The Record, 20(17).

14. Problem with the simplicity of EMR templates:
Templates are difficult to use when patient diagnoses are more
complex and require narrative.
The New England Journal of Medicine reported in April 2008 that
template-based documentation may distract physicians and limit
thoughtful review and analysis of more complex scenarios. “Although
completing such templates may help physicians survive a report-card
review, it directs them to ask restrictive questions rather than engaging
in a narrative-based, open-ended dialog.” 3
3.
Hartzband M.D., P and J. Groopman, M.D. (2008). “Off the Record – Avoiding the
Pitfalls of Going Electronic", New England Journal of Medicine, 358:1656-1658.

15. The argument for continuing dictation and transcription for
documentation is clear, but how are physicians, under
pressure to migrate to a paperless office, to make that leap
with software that does not support dictation?

16. EMR systems are hyped as
solutions that save healthcare
organizations time and money
by eliminating paper charts
and reducing manpower
needed at the office.
With digital-based dictation
and transcription, these two
needs are met without
changing physician work
habits and forcing restrictive
EMR work environments.

17. The KEY to a successful software
implementation is finding the platform with the
greatest amount of FLEXIBILITY that adopts to
the physician’s own desired workflow.

18. Expecting to adopt an EMR package that drastically alters the
work habits that physicians are accustomed to will result in
nothing more than disorder, which will come at a cost, either
financial or in productive hours that could have been better
spent serving patients in need.

19. A far more efficient method is to continue to dictate notes
for transcription.
CASE IN POINT: OrthoMemphis
OrthoMemphis has saved several hundred thousand dollars by implementing a
hybrid system from SRSsoft. That hybrid system paid for itself in less than three
years due to a decline in support staff and elimination of storage space for
paper records. The hybrid approach that relies heavily on dictated records and
scanned documents far more pragmatic than the conventional alternatives. 4
4.
Anderson, H.J. (2009, April 1). “An EHR Is Not always a Perfect Fit", Health Data
Management Magazine, http://www.healthdatamanagement.com/issues/2009_64/
-27962-1.html.

20. The goal for physicians should be to
find the BEST in dictation and couple it with
the BEST in EMR

21. Dictation systems
have come a long way!

22. Today’s sophisticated digital dictation workflow management
systems can immediately route dictation captured from
ANYWHERE, ANYTIME via a number of leading technical devices
(i.e. BlackBerry, Nokia, and Windows Mobile devices, digital
handheld devices, speech microphones, traditional telephony, etc.).

23. Work is routed immediately for transcription to dedicated
typists or typist groups. Work can be routed by author, job
type or whatever unique workflow the organization desires for
maximum efficiency.
These systems are flexible and work the way that the
organization desires to work.

24. WinScribe Dictation
manufactured by WinScribe, Inc.
is such a system!
WinScribe Dictation is a non-proprietary solution that includes a
free software development kit enabling organizations to easily
integrate dictation with other solutions quickly and easily.

25. A KEY component when looking to gain the best
possible productivity out of software solutions is
integrating the software into other 3rd party
products to automate the manual tasks staff
normally need to undertake. Integration not only
speeds up the process, it also ensures that input
information is consistent between systems.

26. 
It is platforms like the solution
that will enable healthcare providers to leverage
the productivity they are accustomed to while still
positioning them to attain their goals of a
paperless office and the added efficiencies that
come with this adoption.

27. For more information about WinScribe or to request a demonstration of our
digital dictation workflow management software,
Contact us at: sales@winscribe.com or call us at 1.866.494.6727