I recently was asked by Deanna from Mighty Oak to check out a demo of their Chart Talk EHR software (previously called DC talk). It’s always a challenge for me since there are only so many hours in a day to be demoing the more than 300 EHR companies out there. So, instead of doing a full demo, I asked Deanna to highlight a feature of Chart Talk that set them apart from other EHR software companies.

She told me that Chart Talk’s killer feature was its integration with Dragon Naturally Speaking’s voice recognition software. I was very familiar with DNS and other voice recognition software, so I was interested to see if they really could create a deep integration of Dragon Medical over the other EHR software I’d seen that integrated it as well.

I have to admit that I was pretty impressed by the demo. It was really quite amazing the number of things that you could do with your voice in the Chart Talk EHR software. Certainly standard transcription like documentation worked out well in Chart Talk. However, the impressive part was how you could navigate the EHR with your voice. Here’s a demo video that does a decent job illustrating it:

What made the documentation even more interesting (and is partially shown in the above video) is the use of various DNS macros and the even more powerful built in macros for pulling in vital signs, past history, etc. Plus, I like the idea that when you have any issues with Dragon Medical, you don’t get someone at your EHR company who doesn’t really know much about Dragon. Since Chart Talk’s completely focused on Dragon integration, you know they know how to support it properly.

I of course only saw a partial demo of the Chart Talk software. So, I’m only commenting on the Dragon Medical integration in this post. It would take a much longer and more in depth evaluation to know about the other features and challenges to the software.

Plus, there’s no doubt that voice recognition isn’t for everyone. They tell me that some people do the charting with their voice right in front of the patient. That feels awkward to me, but I guess it works for some people. Then, there’s the people who don’t want to go through the learning curve of voice recognition. However, I’d guess that Chart Talk could make a case for being some of the best at teaching people to overcome that learning curve since every one of their users uses it.

I also know that Chart Talk originally started as DC talk. So, anyone considering Chart Talk should likely take a good look at how well the software fits with their specialty. I know the people at Mighty Oak have been making a big effort to work for any specialty. However, like every EHR software out there, they just work better for some specialties better than others.

It’s also worth noting that Chart Talk is a client server EHR. I guess the web browser isn’t quite ready for the processing power that’s required to have a nice voice enabled user experience.

Needless to say I was impressed by the voice recognition integration and how pretty much every command can be performed using your voice. I’d be interested to know of other EHR companies that are striving for that type of deep integration. I’m not just talking about being able to basically dictate into a text field. I’m talking about actual navigating the EMR with your voice.

This will be a bit simplified, but I think you’ll get the idea. If you consider a doctor’s training. Doctors are trained in an incredible volume of information and then how to use that information along with a lot of other variables to be able to evaluate patients conditions, provide care and at the end of the day solve problems.

On the other hand, transcriptionists are trained to do repetitive tasks very well with high accuracy. Certainly they have to have some skills with the medical terminology. Also, many have moved beyond transcription into helping with the clinical documentation and ensuring that it’s documented properly.

None of this should be news to anyone. Now for the big finish…

Which training is more suited for someone doing a million clicks on an EMR?

Is it any wonder that scribes and other creative models for documenting a patient visit in an EMR are becoming an important part of the discussion? Watch for many more creative models using people to come out in the next year.

Neil already broke the news a few weeks ago that the MTIA (Medical Transcription Industry Association) changed its name to the CDIA (Clinical Documentation Industry Association). I was able to attend the press event that they held to officially announce the change.

I’m sure that many might not think this is such a big deal. Ok, the name change isn’t that big of a deal. However, I’d say that this part of the movement that I’ve been talking about for quite a while. Basically the survival of transcription for the forseeable future.

I don’t think I talked to any transcription companies at the event that weren’t working on some sort of EMR tied to transcription strategy (MD-IT, FutureNet, and MxSecure to just name a few). In many cases they’re doing their very own EMR offering.

I do think that the small transcription provider is likely in trouble. However, I won’t be surprised if transcription companies become successful EMR companies.

There’s still quite a few question marks with this strategy. For example, how well can a transcription company that’s use to working with people transition to making software?

The good thing is that these transcription companies already have relationships with a lot of doctors who want an EMR that somehow still uses transcription. I talked with one transcription company that offers an EMR and they had an interesting way of using transcription and voice recognition to transition them to EMR while helping them to learn to get use to doing the voice recognition. Very interesting approach.

Maybe transcription isn’t the long term solution. However, I wouldn’t count out the transcription companies just yet.

EMRandHIPAA.com’s HIMSS11 coverage is sponsored by Practice Fusion, provider of the free, web-based Electronic Medical Records (EMR) system used by over 70,000 healthcare providers in the US.

In a recent Healthcare IT News article, they wrote about a KLAS research study that found that the speech recognition market is ready to grow. Here’s a small portion of the article:

Providers report a demonstrable return on their speech recognition dollars, according to a new report from KLAS. Participants of the study indicated benefits of speech recognition such as staff reductions, improved report turnaround times and increased physician satisfaction.

“The speech recognition market is ripe for healthy growth,” said Ben Brown, author of the report. “Currently, less than one in four hospitals use the technology, however, in light of meaningful use and the benefits providers point out in this study, we expect it will assume a more prominent place in the role of clinical documentation.”

It seems like a bit of journalistic spin to say that speech recognition provides a “demonstrable return.” My personal experience tells me that users either love or hate speech recognition. The article does aptly state that it requires some up front investment to learn voice recognition and access the long term benefits that voice recognition provides.

The other obvious part of the report is that Dragon still dominates the voice recognition landscape. I recently also got an email from Eric Fishman of EMR Consultant, EHR Scope, EHR TV, etc fame (and also an advertiser on this site) about a new voice recognition, dictation and transcription software they’re distributing called Frisbee.

They have a bunch of videos showing Frisbee transcription software in action on EHR TV. I found the one called Frisbee, Dragon Medical and EMR Workflow pretty interesting.

I could see this type of software providing the platform for the future of the transcriptionist. Neil Versel recently posted the news that the Medical Transcription Industry Association (MTIA) will be changing their name to the Clinical Documentation Industry Association. No doubt transcription companies are looking at ways to survive. One of those ways will be for the transcriptionist to go beyond just transcribing to assisting with the clinical documentation (including the complicated ICD-10). Seems like Frisbee’s voice recognition into the EMR with the Frisbee routing capabilities for doctors approval and sign off could be an interesting workflow.

I’m not quite as bullish on voice recognition as the report linked above, but there’s no doubt that voice recognition will continue to play a role in healthcare. Especially as it continues to improve its recognition ability and becomes integrated with mobile devices.

Having this blog has given me the opportunity to talk with a number of different transcription companies over the years. I think one thing has become pretty clear. The face of transcription is certainly changing quickly, but the need for transcription is still going to be there for a long while to come. Although, it won’t be the same process of transcription as we know today. Transcription and EMR will start to come together more and more.

Many of us (including myself) were quick to use transcription cost savings as a way to justify the purchase of an EMR. What I think we’ve seen over the 5 or so years I’ve been writing about EMR is that transcription can still be a fantastic compliment to an EMR system. EMR cost justification will often have to come from some of the other EMR benefits.

With that as background, I was quite interested in a company called myMonolog that I met at the Mobile Health Expo. They’re creating an online marketplace for finding and utilizing a transcription service. I’ll admit that I’m not an expert in transcription, but I like the idea that you have a marketplace of transcription providers to choose from and you can see the ratings and reviews from other people who have used that transcription service. I also like that they have an app for Smart Phones to be able to record, send and view the transcriptions.

I’d still like to see them do some deep integrations between their system and EMR vendors, but I think it’s an interesting idea to create a marketplace for transcription services. Plus, if you choose to change transcription service providers, you can still use the same interface with a new provider. Or if your transcription company gets behind, you can just hire another transcription provider to catch you up.

myMonolog has offered Physicians, Nurses or administrators that read this site a 1 week free trial of transcription services if you use the promotion code: “emrandhipaa” when registering. If you need transcription services, try it out and let me know what you think of the service.

I’m currently in Denver attending the AAFP conference. So far I’m really glad that I’ve come to the conference. It’s really fantastic to be surrounded by providers. It’s a stark contrast to HIMSS where you’re mostly surrounded by industry insiders and not that many providers. The practical questions the doctors ask are fascinating.

Of course, the comments they make are also fascinating. The title of this post is a comment one lady made in the David Kibbe session on Meaningful Use:
“I use EMR and so I am MY OWN transcriptionist.”

The problem with this comment is that it just doesn’t have to be true. It could be true depending on which EMR software you selected and how you implemented the EMR. However, that’s a choice you make when you choose and implement an EMR without any transcription.

I’ve actually seen a number of EMR vendors that have some really nice and deep integration between their software and transcription companies. There are even transcription companies that are building their own EMR software which obviously leverages the power of transcription.

Plus, many doctors happily use voice recognition like Dragon Naturally Speaking to still do what essentially amounts to transcription with their EMR.

Add in developments around natural language processing and the idea of preserving the narrative that is so valuable and interesting while capturing the granular data elements is a really interesting area of EMR development.

Of course, one of the problems with this idea is that many people like to use the savings on transcription costs as a way to justify the cost of purchasing and implementing an EMR. Obviously, you’ll need to look for other EMR benefits if you choose to continue transcription.

Just to round out the conversation, there are a wide variety of EMR vendors which each have their own unique style of documentation. Part of the problem is that many people don’t look much past the big “Jabba the Hutt” EMR vendors which are these ugly click interfaces that spit out a huge chunk of text that nobody wants to see. There’s plenty of EMR vendor options out there. Keep looking if you don’t like an EMR vendor’s documentation method.

There’s lots of really interesting transformations happening in the transcription industry (as I’ve written about before). One of those that I haven’t seen many people talking about is the transition of Transcriptionists becoming Medical Documentation Specialists.

It kind of makes sense that transcriptionists could assist doctors in doing all the granular medical documentation. Certainly the doctor will still be the center of the documentation and they’ll be the source of all the documentation. However, I can quickly see the transcriptionists job continuing to move away from the straight transcribing of voice to text and more and more into the medical documentation arena. This trend had been happening for a while, but I can really see this accelerating as transcriptionists try to find their way in an EMR world.

In a post on EMR and EHR about Transcriptionists Partnering with an EMR Vendor, I got an interesting comment by George Catuogno from StenTel about the various technologies that the Medical Transcription (MT) industry are using alongside EMR software. George called the use of transcription with an EHR “practical use” while still showing “meaningful use.” I think it’s a mistake for any EMR company to ignore the transcription industry.

Here’s George’s description of the medical transcription technologies which I think people will find interesting:

The Medical Transcription (MT) industry actually has done a lot to advance itself amidst HIT, particularly EHR technologies, while supporting narrative dictation, which for many physicians is still the preferred method of information capture because it’s fast and easy (efficient) and it tends to more comprehensively captures the patient “story”. DRT, BESR and NLP are three examples of this. I’ll save the best for last.

1. Discrete Reportable Transcription (DRT) is the process of converting narrative dictation into text documents with discrete data elements than can be easily imported into the appropriate placeholders inside an EMR.

2. Backend Speech Recognition (BESR) has been in play for years which allows physicans to dictate without engaging the computer for realtime correction. The correction is instead done retrospectively by a medical transcriptionist. Some speech rec technologies (like M*Modal) support data structuring. The gap remains, however, in getting applications written that readily move that strucutred infomration into EHRs like DRT can.

3. Natural Language Processing (NLP) trumps both of these solutions because it takes a narrative report, regardless of how it was created, and codifies it (SNOMED) for a number of extraction, analytics and reporting applications: Patient Summary, DRT feed into an EMR, Core Measures and PQRI, coding automation, interoperability, and support for the majority of Meaningful Use requirements. Secondary use opens up to clinical trials and other applications as well.

Overall, if the transcription industry can market itself and get its messaging out through the right channels regaridng these innovations that augment transcription and keep physicians dictating, then transcription is a terrific EHR adoption facilitator, enables “practical use” along with Meaningful Use, and will remain relevant for the foreseeable future.

As I usually do, I want to welcome a new advertiser to EMR and HIPAA. I always appreciate those who advertise on EMR and HIPAA and allow me to bring a different perspective to most of those you find in the EMR world. I also want to extend my thanks to those of you who read my blog every day. I’m always amazed at the list of people that comment on my blog and subscribe to the EMR and HIPAA email list. Thanks for making this the best EMR blog on the internet (of course I’m a little bias in this opinion).

Now onto EMR and HIPAA’s new advertiser:
MxSecure – This is a really unique transcription services company compared to the others I’ve seen. They’re really looking at merging the two worlds of transcription and EHR in a variety of ways. See the full description of MxSecure at the bottom of this post.

You can find more details about advertising on EMR and HIPAA on our EHR advertising page. Also, we’re just starting to accept advertisers on my blog partnership EMR and EHR for those looking for an additional EMR advertising option. Just drop me a line on our contact us page for more details.

Read more…

We’ve discussed before the voice recognition software Dragon NaturallySpeaking (Medical and Preferred) and the microphone options and even announced when Dragon NaturallySpeaking Medical first came available. It’s enough to say that we’re big fans of voice recognition software and Dragon NaturallySpeaking in particular. It’s a great companion to an EMR or EHR implementation.

Today, I came across the Sony Digital Voice Recorder with Dragon NaturallySpeaking Software and I wondered if any of my readers have used this before. It seems like it could be an interesting way to replace a transcriptionist.

Basically, the doctor would record his notes on this device and then the Dragon NaturallySpeaking software would convert it to text and could be easily placed in the EMR. For $150, that seems like a bargain.

Really, the only question is how good Dragon NaturallySpeaking is at converting the recorded voice into text. I imagine it’s at least as good as doing it in real time. Does anyone have experience with it? If I hear some good reviews, then I’ll add it to my list of EMR technologies. This seems like it could be a really good solution for that doctor that doesn’t want to give up his/her transcribing ways.