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Speech recognition technology and transcription: Build quality assurance into your program

Speech recognition technology coupled with transcription services has many benefits, including saving providers time and money. But not all companies assure the quality of their products and services, which can create serious problems for organizations.

A recent article published on The Joint Commission’s website highlights some of the vulnerabilities of speech recognition technology (SRT), which include improper use and expectations of SRT capabilities, mismanagement of SRT with degradation of translation over time, no standards for style, grammar and readability, and unclear roles and standards for editors of transcribed medical notes.

Additionally, the article points out, there are insufficient comprehensive quality assurance and process improvement programs for health care documentation. The result is lack of accountability, minimal regulatory oversight, and almost no monitoring of documentation processes.

Surveys show that critical error rates for speech recognition proofreading and editing are as high as 22 percent, according to an article published in the Journal of the American College of Radiology. It has been found that voice recognition takes 50 percent longer to dictate and there are 5.1 errors per case. Additionally, 90 percent of all voice recognition dictations contained errors prior to physician sign off. After sign off, 35 percent of voice recognition still had errors, reports the Journal of Digital Imaging.

What’s more, a recent study concluded that the physician-as-editor model does not guarantee that error will be found, and that physicians do not always take the time to edit and proofread the transcribed medical record, according to an article published in the International Journal of Health Care Quality Assurance.

So what can your organization do to minimize its risk of serious documentation errors?

To get the most benefit from SRT, AHIMA advises implementing consistent policies and procedures to address dictation best practices. This includes a style guide and consistency when applying edits.

AHIMA also recommends third-party editing. In current transcription practices, many reports are not reviewed closely before physicians sign them. Organizations may want to consider implementing a quality assurance program for physician front-end speech created documentation in addition to their current transcription quality assurance program.

Finally, AHIMA suggests that each organization define its acceptable standards of accuracy for all documentation, whether it is handwritten, checked off a form, dictated as free text, dictated for processing by speech recognition (front-end or server), or entered into an EHR by keyboard or speech commands.

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Using voice recognition software and transcriptionists together improves accuracy

In many of our previous Typewritings articles, we’ve recommended using a combination of speech recognition and transcription to improve the speed and accuracy of clinical encounter documentation. An article in a recent For the Record edition made, essentially, the same recommendations.

When speech recognition software made its debut in the 1980s, some experts predicted it would replace transcriptionists within five years, according to the article. Though speech recognition has made dramatic advances since that time, it’s transcriptionists who are helping bridge the gaps in the technology and ensuring clinical documents are accurate.

“There was the naïve expectation that this was the solution for documentation,” Claudia Tessier, an HIM educator, told For the Record magazine. “But it’s neither quick nor easy. Documentation is more than spoken and written words. The whole record needs to be accurate and complete regardless of how it’s done.”

So why is it that today’s speech recognition technology, after about 30 years of use, is imperfect? At the core of the problem are audio files that are inaudible or difficult to understand. Background noise, low quality recordings, or ungrammatical sentences can all contribute to an incomplete and inaccurate record. And one block of missing dictation or one incorrect character can change the meaning of a document.

Integrating transcriptionists into the voice recognition process can be highly effective. Transcriptionists are able to draw on their experience in health care to identify gaps or errors in documentation, helping organizations get a higher return on their investment in their software application. Integrating transcriptionists into the process also ensures that patients’ clinical documents are accurate and minimizes administrative tasks from physician workflow.

Health care consultant Karen Davis told For the Record recently that educating physicians about speech recognition’s capabilities is important.

“From the physicians’ standpoint, they believe they can buy speech recognition software and that’s all they need to do to have an accurate record. They underestimate what transcriptionists do,” she said. “They buy a package and don’t evaluate how it enhances their workflow.”

That’s why for years we’ve recommended using voice recognition software with the help of our transcriptionists. After our voice recognition software auto-transcribes a doctor’s notes, our transcriptionists edit and finalize the document. When providers use our Silent Type Automated Records System (STARS), their clinical encounter documentation can be easily accessed and incorporated into an EMR. The result is consistently accurate clinical documentation.

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EMRs: A boon to medical data, but a bane to physician efficiency

Allured by lucrative “meaningful use” incentives offered by the federal government as part of the 2009 Health Information Technology for Economic and Clinical Health Act, physicians have been steadily swapping out their pens and pads for EMRs.

But while EMRs have been billed as a more effective way to store, access and analyze health data, the impact on health care hasn’t been universally good. Some physicians report that their EMRs are clunky and difficult to use, which has eaten into the time they can spend with patients.

Several studies have shown that when physicians spend extra time entering data themselves, it cuts down time spent with patients and stretches out their workdays, according to a recent Harvard Working Knowledge newsletter. As a result, many practices have started delegating EHR-related tasks to clinical support staff.

Recent research published in the Journal of Graduate Medical Education also underscores how cumbersome EMRs have become. A survey of trainees in 24 specialties found that the current clinical documentation workload may be a barrier to optimal patient care, impacting time spent with patients, physician well-being, time available for teaching and quality of resident education.

Since we talk on a regular basis with organizations about improving the quality of their clinical encounter documentation, we’ve become all too familiar with these complaints. Physicians are telling us they’re spending an inordinate amount of their time typing and editing patient encounters, as well as trying to navigate and retrieve information.

That’s where using voice recognition with the help of Silent Type’s medical editors can help. We can significantly lighten the physician workload by using voice recognition to auto-transcribe doctor’s notes, then by editing and finalizing documents. When providers use our Silent Type Automated Records System (STARS), their clinical encounter documentation can be easily accessed and incorporated into an EMR. The result is more time physicians can spend with patients, and consistently accurate clinical documentation.

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Physicians embrace medical apps to become more efficient

These days, physicians are using mobile apps to do everything from making diagnoses to reading heart rhythms from afar. And they’re eager to use more, if it will make them more efficient.

Just last month, MedData found that 80 percent of the 375 physicians it polled use mobile apps or view professional content on mobile devices for work. The physicians’ main reasons for adoption, they reported in the survey, were improved patient care and communication, and time efficiency.

MedData’s survey also dug into what kinds of mobile apps physicians are using, and what they predict will be the most used this coming year. Among the top contenders, not surprisingly, were clinical notes.

That’s where Silent Type’s iPad, iPhone and iPod Touch dictation app can come in, helping busy physicians record and submit dictation when, how and where they want. With just a few swipes, this versatile app records, stores, transfers and saves dictation, integrating seamlessly into their workflow.

The app allows doctors to:

  • Dictate and store case reports for all patients, regardless of where patients are being treated
  • Send dictation to Silent Type for transcription any time, using a 3G or Wi-Fi connection
  • Save patient demographics on the device
  • Use one login to dictate files to multiple facilities

Silent Type’s latest version of this app, released this month, allows physicians to upload their patient demographics and medical record numbers. That means physicians can search for medical records using patients’ names versus finding their medical record number some other way and then having to type it into the app. A great new feature? We think so.

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The evolution of the medical transcriptionist

Today’s medical transcriptionists are busy as ever providing full transcription services for hospitals and physicians. But that’s not all they’re doing. Medical transcriptionists are also taking on the role of document editor, making sure medical records are accurate and properly entered into EMRs.

Like so many other health care providers, some of our clients are using voice recognition software to dictate medical records. Yet oftentimes those programs are producing documents and require heavy editing. That’s why even as new tools like voice recognition software have come about, there continues to be a backlog of transcription.

There are just some things that voice recognition programs seldom get right, including punctuation, names and sentence structure, to name a few. And using medical transcriptionists as document editors is a better option than using doctors to edit. Physicians are often so rushed that they leave misspelled words, grammatical errors and punctuation errors in the text document.

And let’s face it: doctors would much rather spend their time with their patients than editing documents. Doing the tedious work of an editor impacts not only doctors’ productivity, but also patient care. A 2012 study published in the Journal of the American Medical Informatics Association reported that dictating into an EMR resulted in lower quality of care and lower physician satisfaction.

We’ve seen accuracy of up to 90 percent of a document as good enough for an EMR—but that doesn’t equate to a quality medical record. That’s why we recommend facilities utilize voice recognition with the help of our medical editors. The results are accurate documentation and clear, consistent, organized documents that will save time and money.

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How to make speech recognition a documentation benefit, not a bother

What role can speech recognition play in developing quality documentation? On one hand, proper use of the technology can be a boon to productivity and efficiency, saving doctors’ time and saving facilities money. On the other hand, misuse of the technology can have the opposite effect, wasting physicians’ time and causing rifts between hospital leadership and medical staff.

Speech recognition is a proven technology that has been used in the healthcare industry for decades. Most solutions are trained to recognize the specific vocal patterns of clinicians and use that recognition to analyze recorded clinical dictation. The analysis results in a written document that, once edited, can be added to the medical record. This process can save healthcare providers money because it decreases the amount of time a transcriptionist needs to complete a record.

Sounds great, right? The problem comes when transcriptionists are taken out of the equation. Many of today’s electronic medical records include a speech recognition component. We know of hospitals that have severed relationships with transcription services in favor of using EMR speech recognition, then required attending physicians to edit their own transcription.

Physicians certainly have the ability to edit their own transcription, but is this the best use of their time? In our experience, doctors would rather be spending time with patients than doing clerical work.

We recommend facilities utilize speech recognition with the help of a transcription service. It still saves time and money, it results in accurate documentation, and it limits the time a doctor needs to spend reviewing his or her text. There are three phases of such as service:

Phase 1 – Full transcription plus speech recognition training: During this phase, transcriptionists review and transcribe recorded dictation, while the speech recognition system is trained to recognize each physician’s speech patterns. It “learns” by analyzing the voice of the physician compared with the completed and accurate transcription.

Phase 2 – Editing transcription plus speech recognition training: Taking a step closer to full speech recognition, physician recordings are analyzed by the system and a draft document is produced. The draft document is reviewed by the transcriptionist, who compares the recording of the physician with the system-generated document. The transcriptionist then edits the speech-to-text document and produces a complete transcription, making sure the final document is grammatically and functionally correct and based on the facility’s standardized templates. The completed transcription is sent back to the voice recognition system for the second level of training.

Phase 3 – Front end speech recognition: In this final phase, the speech recognition system is fully trained and produces its most accurate document. The system analyzes physician recordings, then produces an editable document. The document only needs minimal editing by the transcriptionist, who sends the document to the physician. The physician then reviews, signs and approves the document.

It should be noted that current speech recognition technology won’t be able to translate voice into text with 100 percent accuracy, hence the need for an edit by a transcriptionist. Also, some voices can’t be recognized by these systems with a high level of accuracy. We estimate that that only two out of three physicians will be able to progress to Phase 3.

Speech recognition can be a tremendous time saver. And, used in the right way, it can save organizations’ money without wasting physicians’ time.

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Save your organization time, money with dictation and transcription

It’s that time of year again when healthcare organizations are scrutinizing their budgets and finding ways to be more efficient. One cost-saving strategy that shouldn’t be overlooked is the wise use of dictation and transcription.

Dictation through electronic medical record systems can be time-consuming. While EMR-based clinical documentation has become the norm at hospitals, a 2012 study published in the Journal of the American Medical Informatics Association reported that dictating into an EMR resulted in lower quality of care and lower physician satisfaction. For many of those physicians, greater use of dictation and transcription as part of a broader documentation management program could represent a faster, easier and more cost-effective way to document their patient encounters.

EMR voice-recognition programs have proved cumbersome for many physicians to use. Physicians are spending too much of their valuable time dictating, typing and editing patient encounters, which impacts their productivity—and their organization’s bottom line. What’s more, once patient encounters are documented, other staff is involved tracking and managing those records. But there’s good news: Meaningful Use allows health care providers to use dictation and transcription to document sections of the patient encounter not specifically cited as needing to be structured.

Medical Transcription Service Organizations (MTSO) can save organizations from dictation time and frustration as well as help fine-tune an organization’s documentation management. Physicians’ workflows can be improved when organizations allow transcriptionists to transcribe, edit and incorporate patient encounters into EMRs.

For instance, with Silent Type’s iOS dictation application—a deferred voice recognition software program—a provider’s dictation results in a draft document that is routed along with the original voice file to one of our transcriptionists. Once that draft document is edited and finalized, it’s uploaded to our Silent Type Automated Records System (STARS), where it can be accessed by a provider and incorporated into an EMR. Importantly, our cloud-based server also securely stores and manages this data, a feature our clients have come to rely on when they have difficulty accessing records in their own system.

Sometimes, cost saving measures can backfire. Many organizations are trying to be more efficient and cost conscious is outsourcing medical transcription overseas. But what they’re saving in money is costing them in accuracy. The error rate of MTSOs offshore is significantly higher than MTSOs in the United States, whose error rate is 1 to 2 percent. One study showed that offshore transcription suffered from an error rate of 23 percent. Because the charts they receive are lower quality, providers need to hire additional staff—thus increasing their soft costs—to double check for accuracy, negating any savings they hoped to achieve by sending work offshore.

Medical transcription continues to bring value to providers. By sparing physicians the time-intensive task of typing and editing lengthy EMR notes and quickly turning around accurately transcribed documents, MTSOs are playing an important support role to organizations working to keep costs down.

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Automated records systems support clinical documentation management

Clinical documentation that is prepared accurately, uploaded timely and downloaded cleanly into an electronic medical record (EMR) can enhance patient care, improve workflow and support improved reimbursement. But once inside the EMR, documentation isn’t always easy to access or easy to use.

That’s where an electronic documentation management system can be beneficial for hospitals and other facilities, ensuring that clinical data can be moved or accessed in an accurate, timely and secure fashion.

So what are some of the features you should be looking for in a good documentation management system?

First, you want one that offers remote access. This makes it easy for providers to see dictated and transcribed documents via any secure web server. As cases are transcribed, they should be prepared and placed onto the web server.

Second, you want a system that allows authorized users to access records on demand—one that allows them to access new and past dictation at their convenience. This records-on-demand feature should allow users to:

  • Review dictated records
  • Print reports
  • Monitor turnaround time
  • Verify invoices
  • Upload to hospital EMRs
  • Use audit trails to review file access history
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Voice recognition works best as part of a centralized system for clinical documentation

The financial benefits that come with using electronic health records (EHRs) in accordance with federal “meaningful use” standards is encouraging more providers to use voice recognition software (VRS). It’s a technology that is fast becoming an integral part of the clinical documentation process.

But while there is a big push for providers to use VRS, some are finding the combination of EHR and VRS to bring with it unexpected issues. Some EHRs have proved cumbersome to navigate, or have disrupted provider workflow. Doctors report that it can take as long as 15 minutes to dictate and edit their own cases—and often the records they create aren’t complete enough to meet clinical documentation standards, medical directors say.

This is prompting organizations to seek out a more centralized system of documentation management that incorporates voice recognition with traditional dictation and transcription, complementing the EHR they have in place. Whether managed by a hospital or outside source, such a system makes it easier to track patient visits, clinical documentation and billing.

Silent Type is addressing these concerns in many ways. With Silent Type’s STARS SPEECH®—a back-end voice recognition program—a provider’s dictation results in a draft document that is routed along with the original voice file to our transcription editors. Once that draft document is edited and finalized, it’s simultaneously uploaded to our Silent Type Automated Records System (STARS) and to the hospital’s EHR, which receives it as a billable document that meets clinical documentation improvement requirements. Clients have relied on this feature when they have difficulty accessing records in their own system.

Documents not meeting voice recognition standards for direct editing can still be transcribed, keeping formatting and document features standarized. By sparing providers the job of having to edit and manage documents, they are able to spend more quality time with their patients. For organizations whose physicians are required to dictate and edit their own records, our soon-to-be released front-end component—STARS SPEECH DIRECT®—will provide direct access while still providing storage and retrieval in our cloud-based servers.

A system that fully integrates these components will centralize all document management for later use. And, by storing data in a secure and protected cloud-based server, organizations can build redundancy into their systems.

Voice recognition software is a great technological tool that—used as part of a centralized dictation, transcription and documentation management system—can lead to higher patient and physician satisfaction, better document standardization and increased revenue for the facility.

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Data security and medical transcription are interconnected

Health care data breaches are becoming a regular occurrence. In fact, an Experian report forecasts that the health care industry will be the most susceptible industry “by far” for hackers in 2014.

Hospitals not only need to worry about securing data on their own servers, but also securing data that belongs to them but that is stored on the servers of a third party, such as a medical transcription service organization.

Such service providers are legally responsible for securing protected health information (PHI). Under the HITECH provisions of the Health Insurance Portability and Accountability Act (HIPAA), business associates are just as liable and contractually obligated to safeguard PHI as the provider. Both are subject to the same civil and criminal penalties. Even subcontractors of business associates face the same responsibilities and potential fiduciary and legal downsides.

Compliance with the HITECH provisions of HIPAA are greatly complicated, however, when MTSOs are offshore. That’s because foreign countries are not bound by U.S. law. HIPAA has no standing.

Even when outsourcing work to U.S.-based MTSOs, however, HIM directors need to do their due diligence. They need to make sure the companies with whom they work are taking all of the necessary precautions.

Protecting sensitive health information is priority one for Silent Type. We’ve built in a number of processes and measures that ensure the records we handle are closely guarded.

First, all of our work is performed by our own employees in the United States, and on company-secured equipment.

Second, Silent Type regularly undergoes two levels of service organization control (SOC) audits. The first level of audit identifies opportunities for fortifying our systems so they’re protected from a breach. With the second-level audit, a team of experts reviews our equipment and connections. This third-party audit report is available for customer review and shows we are in compliance with all HIPAA regulations.

Third, we also have a company-owned, company-secured data center—no one but authorized, HIPAA-trained employees have access—and host our own web-based document management system where documents are placed. This all ensures that Silent Type retains the tightest control over the records we keep.

We recognize the trust our clients place in us by using our services. By keeping our medical transcription services at home—and regularly scrutinizing and updating our security measures—Silent Type is working hard to safeguard sensitive health data.

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