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Tue 23 Oct 2007 11:15 AM

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Ask the expert?

Each month, Medical Times pitches your questions to our panel of experts. This issue, we focus on practices looking to upgrade their IT systems.

Each month, Medical Times pitches your questions to our panel of experts. This issue, we focus on practices looking to upgrade their IT systems.

Introducing this month's experts:

Dina Al Banna
is a marketing specialist with Avaya, a communications firm that supplies a range of telecommunications solutions to more than one million businesses worldwide.

For more information, visit www.avaya.ae or call +971 4 404 8100.

James Hildebrand is a senior consultant with InterHealth Canada's Middle East office. Interhealth Canada is an international consultancy firm for the healthcare sector.

For more information, visit www.interhealthcanada.com or call +971 4 331 8999.

Q: I am considering buying voice recognition software for dictation purposes, to cut the cost and time my admin staff spend on transcribing. Is it a worthwhile investment? Are there any problems to watch out for?

D.A.B. answers...
Digital dictation and transcription systems have the potential to revolutionise the efficient management and distribution of voice originated documentation, yet dictation backlogs persist in many practices. The lack of well-trained medical transcriptionists makes the problem difficult to overcome with labour alone, whether in-house or outsourced.

Transcription is a costly exercise for healthcare institutions. In radiology practices, for example, estimates suggest transcription services can absorb 3-6% of revenue. Speech recognition software attempts to solve this problem by offering comprehensive language models built from words taken from the most commonly used medical reports, such as histories and physicals, discharge summaries, and operative reports. It uses the human voice as the main communication mechanism between the user and the computer. While relatively simple to use, speech recognition software is now based on more sophisticated technology that uses ‘language modelling' to recognise and differentiate between sounds.

Dictation is the most versatile and widespread use for speech recognition software. Many practices that use it have decreased the number of support staff and require physicians to generate their own records. Even doctors who typically dictate documents for others to transcribe may use speech recognition occasionally, when they need to produce a document on the spot or after-hours, or when they are responding to e-mail.

In my experience, the savings associated with speech recognition software do justify the investment. Doctors can substantially reduce the turnaround time associated with traditional transcription and support staff can be reallocated to more productive tasks.

In order to maximise accuracy, make sure that you buy a speech recognition software program that includes a medical vocabulary - you should aim for a software system that incorporates a wide library of diseases, medications, procedures, and acronyms in addition to the standard business vocabulary. It is also important that it can automatically recognise and format prescriptions and patient encounters. Specialty medical vocabularies can also be created in-house or purchased from third-party sources.

Q: I am a physician in a primary care practice. We are in the process of selecting our first EMR system; do you have any tips to aid the selection process?

J.H. answers...
Before venturing into an EMR purchase there are a number of things to consider. The initial financial costs are usually substantial so you should plan how the system will be designed and implemented before diving in. This is best done by appointing an EMR champion; essentially one or more physicians who will lead the purchasing and implementation of the EMR. The role of the champion is also to ensure buy-in by the other physicians, and arrange for comprehensive support for staff.

The adoption of an EMR system into a primary care practice can produce a number of benefits, including reduction in paper chart pulls and transcription, better capture of charges, improved utilisation of radiology tests, savings in drug expenditures, better workflow, and increased patient safety. The benefits will depend on what type of system the practice is operating under - single payer versus multi-insurer systems - and, crucially, how well the EMR is adopted and utilised by the practice.

To ensure the EMR system is accepted by your practice, you must ensure that the system is intuitive and easy to use. If there are too many steps involved in switching from one area of the programme to another, it becomes frustrating. You want to be able to easily access and edit sections of the programme you use frequently.

When selecting an EMR system there are a number of questions organisations need to ask themselves about what they want the system to do. Will it be easy to look at the profile and know what is happening with the patient? Is it easy to go from billing to the EMR? How do you input the medication list? How simple is it to prescribe from the programme? To re-prescribe? How do you view the notes for the patient? Communication-wise, how does the system allow you to communicate with your staff? How secure is the EMR? Can you change the record in any way without having a trace? The latter is key for medico-legal reasons.

When deciding on a programme, you should try using the features yourself, not just watch someone do it. What looked simple during a product demonstration may feel complicated when you try to replicate it. How simple is it to get a label printed? How easy is it to search for patients? Does it allow you to search your practice and find, for example, all the patients who are diabetic and more than 65 years old?

How good and how expensive is your system's technical support and programme support? When the system is not working who do you call, how accessible are they, and how much will it cost you? It's important to plan for these ongoing costs, as they can become very expensive, even with good systems.

Lastly, it is important to understand how the various features of the programme integrate with each other. Some slick features may work well but rarely get used, while other features may be in daily use, yet not work well at all. An EMR is all about the flow of medical information, accessing it, using it, and transferring it to others. Above all, to succeed, your system has to flow.

The answers provided in this feature are for information purposes only, and intended to provide general guidance. They should not be relied upon by readers, who should seek further professional advice.

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