Robin Daigh's blog

I received this email from a fellow
MD-IT employee, a medical transcriptionist with 18 years of experience transcribing narrative notes for a wide variety of specialists.  I thought her email perfectly captured the EMR experience from the patient’s perspective.  With her permission, I am reprinting it here:

"Do you know what the most important work done in a hospital is?” asked Babs, the head of human resources at Heimlich Hospital.

The Benefits of Structured Narrative Notes:

Efficiency:  Physicians report that EMR data entry can add from one to two hours to their workday, or cause them to see several fewer patients per day.  Structured narrative notes allow physicians to continue dictating, which is preferred by the vast majority of physicians.

Structured narrative notes can be created in several ways, depending on the balance of technology versus human intelligence desired by each user.

In a high tech, low touch system, dictated voice files are processed through a back-end speech recognition engine and a natural language processing system, and then edited for accuracy.  In a high touch, low tech system, dictated voice files are transcribed by medical language specialists using strucutred narrative notes with pre-defined XML fields.

A colleague of mine recently attended an IT conference to hear the latest and greatest on EMR implementations by hospitals and large medical groups.  During one panel presentation, a physician panelist said, “My ideal world is one in which I dictate my patient encounters, and all necessary information is magically imported and saved in the EMR.”  (Click here to see an example of a chart note generated by an EMR)

I just returned from visiting my family practice physician for my annual physical.  He is a forward thinking guy, and took the plunge several years ago by purchasing one of the leading EMRs at considerable cost to his solo practice.  

With the HITECH Act, the role of the medical record is being further stretched to serve as data repository for quality reporting, clinical studies, public health surveillance and more. The problem is that many electronic medical records systems are replacing the narrative note with computer-generated notes that, while useful for creating a data repository, are far less useful for supporting patient care. 
 

Are we losing sight of the primary purpose of a patient medical record, which is to support patient care?

Narrative notes serve several purposes by helping physicians and other caregivers:

Did you know MD-IT’s original business plan from ten years ago sought to eliminate transcription and replace it with technology?  We found out it wasn’t such a great idea.  That is why we are such vocal proponents today of dictation and transcription as part of the future of electronic medical records.

MD-IT started in 2000 as a software company selling front-end speech recognition combined with basic EMR functionality.  Here’s an excerpt from an early business plan:

Physicians use one of three methods for documenting care: dictation, structured data entry (keyboard, touch screen, mouse), or front-end speech recognition.  In our experience and that of many EMR vendors, dictation is the preferred choice of 80% of doctors.  Why?