What were the challenges and advantages of implementing a new system that uses speech recognition?
Challenges included the following:
- Some provider adoption and training issues
- Time taken away from the patient care in the beginning
- Decisions on mobility and devices to use for this technology and the EMR
- Cost reduction in the long run
- Provider acceptance and efficiency, ability to tell the patient's story, while capturing severity of illness
- Reuse and templates developed for better documentation and CDI activities for revenue, quality, safety, regulatory data capture
How has using this technology influenced your healthcare documentation integrity specialists' daily roles?
Our CDI and Coding program have been able to train our providers at all levels to integrate critical data elements to prevent denials, increase the appropriate case mix severity, and provide timely clinical information for safe/highest quality of care.
We work with the providers to enhance their documentation to meet all the regulatory elements, while telling the patient story in a cost efficient and effective manner.
In what ways are you seeing a return on your investment?
Case mix, RUV's, Denial Management (RAC, HAC,DRG VALIDATIONS), provider/patient satisfaction.
How does this technology fit in with EHRs?
Both front end and back end speech recognition are very complimentary and enhance the use of the EHR so one of the frequent complaints we hear of physicians who are given an EHR who may not have the benefit of transcription or front end speech is that they are turned into typists and sometimes they complain about getting carpel tunnel syndrome. The obvious benefits of front end speech recognition is that the dictation is immediately in the EHR, so as soon as it is saved as a report it is immediately available for any other member of the care team so there's no turnaround time that's needed for a transcriptionist. There's very powerful advantages in an era when hospitals are trying reduce length of stay and improve communication among different members of the care team, among intensivists or the hospitalists or the nurses. It is very real-time documentation as the information is available to all members and they can more quickly react to any changes and care plans, and prescriptions are instantly available.
With back end speech recognition, we provide a ready interface to EHRs, in that while the physician is in one of those EHRs the physician can be dictating using a microphone. They're in the EMR and unlike the front end speech the words aren't appearing in the actual file of the patient's record but when the physician is done dictating it leaves a little dictation marker and when the physician has left the patient note, the dictation marker goes to the cue of a transcriptionist who then sees escription processed and reorganized draft, makes the file edits listening to the physician's dictation and automatically puts that transcription right into Epic, Cerner or Meditech or Allscripts system. So the benefits you are you have this very seamless workflow with back end speech. The disadvantage of back end speech is there's a little bit of a delay between the time the physician dictates and the editor makes the edits and the final text is uploaded into the EHR. But you have the benefit of all the information being in the EHR without having to do any sort of movement or integration of the text files.
How is this technology changing or influencing how historically called medical transcriptionists now their new title is healthcare documentation integrity specialists, how is this changing their roles?
The role of the specialists in the process has become less about creating the documents and much more serving as the editing and quality stewards. They are no longer typing from scratch; their basically listening to the physicians' audio file and then reviewing the final process draft that each transcription is provided, which lets them form a much higher value-added task, they are able to look at the completeless of the note, not just worried about did I get what her or she said word for word, but do I have all the clinical indications right, do I need to go back to the doctor to ask if there's more information, do have all the medications. It's allowed the health information management departments to really add more value in the clinical documentation process, which is better for them as professionals and it's better for the HIM department because they're providing a higher value-added service, and it's better for the clinicians because they're being asked questions that are more related to the quality and completeness of the document and less about whether I spelled that word completely. The technology has raised the value of the HIM department.
What do you see as the future trends?
It's less about typing word for word what the doctor says and then enhancing the clinical integrity of the note, does it have all the information needed to satisfy meaningful use reporting. Some HIM departments where those individuals are being asked to play a critical role in making sure that information is within the EHR, which provides better patient care and also enables the health systems to get the maximum reimbursement for reporting to CMS on core measures. We hear HIM departments taking much of their medical transcription function and entering it into coding experts, which is a very critical function, less about reporting to the government but making sure the appropriate DRG level is the information correct and complete and then working with the clinicians to make sure the information is correct.
I think it really gets to a fundamental and very positive change from these people from being typists to more analytical role. Which are more directly related to patient care and reimbursement, which will translate to higher compensation for those who are able to make that transition.