By Marsha Taicher
ICD-10, meaningful use (MU), and the Physician Quality Reporting System (PQRS) all require physicians to document with an enhanced level of clinical detail. Under ICD-10, for example, physicians must replace a single code under ICD-9 for “complications of foreign body accidentally left in body following a procedure” with as many as 50 new codes.
Training and automated coding tools can certainly help with creating and submitting clean claims to payers, but physicians and other providers still need to spend more valuable time typing or searching EHR dropdown menus to capture the clinical quality metrics for MU and PQRS and to select the correct diagnosis for ICD-10. In fact, one study anticipated the transition from ICD-9 to ICD-10 would increase documentation time for physicians by as much as 15%.
Integrated voice technology and digital dictation devices could be the answer to facilitating providers’ desired streamlined and flexible workflow. While not necessarily a new process, there are many new features on these devices, such as integration with speech recognition software that can help organizations improve the capture of quality metrics and clinical detail, while also saving time and cutting costs for providers and administrators.
Preferred Documentation Method
Dictation has been physicians’ preferred documentation method for decades. Only recently with the implementation of EHRs have documentation methods migrated to typing and point-and-click data entry. Even in fully electronic charting environments, many physicians still prefer using their voice. In a survey of 293 faculty physicians at a large academic medical center, nearly 45% rated dictation-driven documentation “critical or important” to their workflow.
Considering that most people speak seven times faster than they can type, it is no surprise that time-pressured providers prefer to use dictation in their charting. When speech recognition software is directly integrated with the EHR, dictation-driven documentation presents even greater value to health care organizations today than in the days of paper charts by offering the potential to reduce or eliminate transcription expenses. Research bears this out: “Dictation offers the most rapid method for capturing a fully detailed narrative with the least effort expended,” concluded the California HealthCare Foundation, in a report on EHR implementations and different documentation methods.
Flexible Workflow Options
In electronic environments, voice technology also offers physicians more flexibility over when and where they dictate. With paper charts, physicians would typically share a solitary dictation station or use handheld cassette recorders. This required manually transporting the analog tape to a transcriptionist who would then return the transcribed dictation documents for chart entry, adding steps to the workflow.
With digital voice technology, this process is streamlined and much more convenient for providers. They can use a handheld digital recorder or a dictation microphone (either wireless or USB-connected) that allows them to dictate at their practice, at a hospital, or even at home. Secure cloud-based servers allow physicians to easily transfer the dictations to a transcriptionist or directly enter the notes into the patient chart when integrated with speech recognition software, which in recent years has improved in both speed and accuracy.
While voice technology can certainly facilitate physicians’ productivity, allowing providers to more easily capture enhanced clinical detail also supports the coding and billing staff and benefits the entire health care organization. For example, during the transition to ICD-10 this October, coders will need to more closely verify that the code they submit to payers on the claim is accurate to avoid a time-consuming denial. When the diagnosis is clearly described in the physician’s notes, thanks to dictation, coders may feel less compelled to call the physician or medical assistant to clarify the note or request more information.
The more granular level of clinical detail also supports the organization with the quality data analysis and reporting for MU, PQRS, or any other pay-for-performance program. Ensuring providers accurately capture every quality metric can make the difference between earning the incentive payment or, such as with MU or PQRS, being penalized for noncompliance.
Recording Quality Essential
Although there are numerous voice technology tools available for dictation, not all devices will deliver the performance level physicians demand or the clarity that transcriptionists and speech recognition software requires. A device that is able to withstand providers’ frequent usage while still producing high-quality recordings is essential. When used with speech recognition software, a professional dictation microphone that can clearly capture the speaker’s voice regardless of background noise will improve the speed and accuracy of the software’s transcription.
Recording clarity is also crucial for capturing the detail necessary for MU, PQRS, and other clinical quality incentive programs. The Centers for Medicare & Medicaid Services conducts random audits for these programs, so having high-quality recordings to support the documentation is invaluable to an organization preparing for these investigations or any other record audits.
Although much has changed in health care since there were only paper charts and analog-tape dictation machines, the inherent efficiency of physicians using their voice to create documentation remains the same. When used with speech recognition software or transcriptionist support, dictation even can help providers work more productively and more easily capture the enhanced clinical detail that organizations need to transition to ICD-10 and comply with the numerous care-quality improvement programs that reward for superior performance.— Marsha Taicher is vice president and director of sales for Speech Processing Solutions North America, the manufacturer of Philips voice technology and dictation solutions.