How can we make it easier for doctors and nurses to improve clinical documentation standards, while continuing to provide exceptional care to patients, and ensure that the investment in the EHR is realised?
The rapid investment in electronic health records (EHRs) across the UK has the potential to transform the medical landscape by giving patients and medical professionals instant access to their medical history, improving the safety and transparency of care, reducing errors and boosting medical research.
However, studies have shown that EHRs can add as much as 90 minutes to a medical professional’s day and this may start to negatively affect the quality time they can spend with their patients. So how can we make it easier for doctors and nurses to improve clinical documentation standards, while continuing to provide exceptional care to patients, and ensure that the investment in the EHR is realised?
One way this can be achieved is by using automated speech capture solutions that work with (or complement) other technologies used in EHRs. Encouraging medical professionals to adopt and become proficient in EHR related technologies will be essential to fulfilling their potential.
Huge strides have been made in quality, accuracy, performance, affordability and time-to-value of speech technology solutions and their use in healthcare is in on the rise. Speech technology is fast becoming one of the most used tools in the quest for EHR adoption and clinical documentationimprovement, anywhere, at any time, and on any device. In fact it will be the fastest-growing method used for clinical documentation between now and 2016, according to a new study from Health Business Group.
1. Improve Doctor and Nurse Satisfaction
Medical professionals want to spend as much time as possible with their patients. They don’t want to waste time on input processes based on rigid EHR templates. When they use speech as the input mechanism at both the beginning (during a patient consultation) and throughout the care pathway (adding comments, diagnoses and action plans), essential information is captured as part of their normal workflow. Speech also speeds clinical document creation and EHR input and updating by allowing the doctor or nurse to speak and navigate easily through the documentation and EHR versus hunting for each field and then clicking and typing. Speech technology also supports mobile devices, allowing doctors and nurses to create and update on-the-go as part of a streamlined, flexible workflow.
2. Put Patients at the Centre of Care
Healthcare has always been based on the doctor-patient interaction but as the adoption of electronic health records (EHRs) in healthcare increases the administration burden for the doctor associated with the capture, understanding and sharing of the data can get in the way of maintaining the doctor patient relationship and capture of the whole patient story. Speech-enabling dictation directly within the EHR captures a complete and accurate record of the doctor-patient encounter in real-time.
The medical professional can edit and sign their inputs there and then making them ready to share with medical colleagues and create referral and discharge notes to accompany the patient as the consultation concludes. Most importantly, speech-enabling the EHR frees up the time and resources of medical professionals so that they can re-focus on the patient relationship. This improves communication and transparency and the patient’s experience of care and feeling of well-being putting them back at the centre of care.
3. Increase Return on EHR Investment
There are technical and cultural barriers to uptake and adoption of the EHR but simplifying and naturalising the user interface by speech-enabling the EHR removes the greatest barrier of all – that of overloading the doctor or nurse with yet another tedious administration overhead. It puts the medical professional back in control by integrating into and adapting to any workflow. Now you can ensure that there is faster and greater uptake and utilisation of the EHR investment by doctors and nurses with all the benefits that brings for patients, medical professionals and the healthcare organisation.
4. Better Decision Support
Healthcare is awash with both unstructured and structured (discrete) data. However, this data is not always useful and can obscure, rather than illuminate potential improvements. Speech-enabled clinical documentation using normal, natural language, captures more and higher quality data than is usual through written input or typing. This provides healthcare organisations with a richer array of data for deep analytics. Accurate and complete data is the key to successful coding, compliance and quality projects and comes full circle in more accurate record keeping. In turn, a richer data set supports more informed decisions to have a positive impact on patient treatment, safety and outcomes and on healthcare services commissioning and budgeting cycles etc.
5. Raise patient safety and outcomes and meet turnaround targets
Speech-enabling the EHR improves clinical document accuracy, data gathering, decision making and patient safety because records of consultations with patients can happen in full and in real-time. By improving the efficiency of data capture, the detail of clinical documentation and rapid sharing of information between medical specialties and professionals reduces the likelihood of life threatening errors. Speech-enabled EHRs also help eliminate documentation backlogs and support the achievement of turnaround targets and avoidance of potential fines arising from missed targets relating to referrals and discharge summaries and other clinical documents.