Voice recognition

Outsourced transcription solves EMR data-capture issues

By Rosie Lombardi

Voice-to-text conversion software is a great tool for some physician practices that are implementing EMRs – but not all. The Wharton Medical Clinic based in Burlington, ON tried various combinations of templating, editing by doctors and in-house transcriptionists for four years before finally giving up. The clinic then turned to Accentus, an Ottawa-based outsourced transcription service provider, to solve its problems.

Wharton is a weight management clinic dedicated to decreasing cardiovascular risk factors such as high blood pressure and diabetes in obese patients. The high-volume practice has 13 specialists on staff who each see about 50 to 100 patients daily and relay their reports back to the referring family physician.

The clinic implemented an EMR system four years ago to boost productivity, says Marcia Villafranca, director of operations. “The reduction in transcription costs by using voice-to-text software to transcribe dictations was a big selling point when we were considering EMR systems. Vendors always try to sell you this. But we’ve tried voice-to-text and it just doesn’t work for us.”

The clinic had 4 full-time transcriptionists initially when it went live with its EMR, but typically had a backlog of one to two weeks in turnaround, says Villafranca. “We thought we could wean our doctors off transcriptionists with voice-to-text.”

But training the software to recognize speech patterns turned into a major headache. Although it can achieve a certain degree of accuracy over time, it all depends on the user, she says. “It becomes difficult if you have doctors with heavy accents or a particular way of saying things, especially if you have multiple physicians working in a busy clinic. They aren’t necessarily interested in cutting costs – they’re more concerned about getting accurate letters off to family physicians.”

The clinic tried various approaches over the years, using templates instead of dictated free-form notes, voice-to-text with doctors self-editing, and other administrative processes. “Trust me, we’ve done it all. Our physicians were very frustrated.”

Wharton gave up on voice-to-text in the end and looked for an alternative solution. The clinic considered various options, such as overseas transcription services, but was leery about loss of control over sensitive patient data, and the quality and accuracy of transcriptions.

Instead, it settled on Ottawa-based Accentus, whose entire operations are based in Canada. The company offers both the technology and labour needed to process transcriptions remotely, and guarantees 24 hour turnaround time.

“So four years after implementing an EMR, we’re back to transcriptionists in a different form with Accentus. When selecting an EMR, avoiding transcription costs shouldn’t be a deciding factor. Physicians should consider their patient volume, efficient turnaround time, the professionalism needed for notes, and improved patient care,” says Villafranca.

The Accentus Solution
Wharton opted to invest in digital recorders for all its doctors, although Accentus can capture dictations from any phone or desktop as well. “Due to our work flow, we found it easier to do it this way although it’s more expensive,” says Villafranca.

Wharton’s doctors can walk around freely all day dictating their notes into their hand-held recorders. At the end of the day, these are docked into stations equipped with software that detects the doctor’s ID file and the number of dictations, then automatically transmits the files to Accentus’ system after labeling them.

The transcribed files are then transmitted back to Wharton for further processing by administrative staff, who input the notes into the EMR and the letters to family physicians.

But in the next phase of its project, Villafranca says the clinic plans to implement the interfaces needed to upload the transcribed notes from Accentus directly into the patient’s EMR record. “This would completely cut a whole step and role in our clinic.”

Productivity has been improved tremendously at Wharton. A rheumatologist can see a patient on Monday, and by Wednesday, the family doctor has the letter. “Our customers are family doctors, and we’re getting comments from them that our turnaround time is unheard of in specialist practices. We can even turnaround a letter the same day if it’s an urgent matter by asking Accentus to do it as a rush job.”

Wharton’s problems with voice-to-text are not unique, says Steve Rogers (pictured), CEO of Accentus. Many similarly frustrated physician practices are turning to Accentus. “We’re signing up three to five clinics a week. EMRs are being sold with a certain expectation that you can eliminate staff. But the overwhelming response we’re getting from clinics is that’s not so.”

Rogers says a technology issue that many doctors may not be aware of is that most EMRs that offer voice-to-text aren’t integrated to allow for third-party transcription. The audio files of a doctor’s dictation aren’t saved and can’t be made available to others.

“The incorporation of voice-to-text in EMRs is meant for physician self-editing but not transcriptionists. It creates a text file that only the physician can review because only he knows what he wanted to write. This is fine for short notes by radiologists who can dictate and edit on the fly, but it becomes cumbersome for longer notes.”

Accentus also uses voice recognition and voice-to-text in its technology platform, but it’s at the back-end, he adds. “It’s embedded in our transcription platform, which transmits both the audio file and the text file the system generates from it. The final edit is done by our specialized human editors who compare the two to ensure its accuracy.”

Rogers says no special software is needed to use Accentus’ service. Doctors can use any device anywhere to dictate and communicate their notes. There are no set-up fees or upfront commitments needed, and charges are based on minute of dictation.

Integration of Accentus with a clinic’s EMR so transcriptions are uploaded directly into a patient’s record can further boost productivity, he says. This requires implementing an HL7 interface from Accentus’ platform to the EMR.

“We advocate full integration into the EMR so you get to that last step without human intervention. This is just a matter of us working with the EMR vendor to establish the links to the clinic, and is a fairly quick and simple process. We’ve done similar integrations of our service with complex hospital systems across Canada, so setting it up for smaller EMRs is easy. A doctor could be set up and dictating in a day,” says Rogers.

Posted November 11, 2010