Author Name Jennifer Bresnick   |   Date May 28, 2013

Dr. Bud Lawrence, Director of Risk Management at Henry Mayo Newhall Memorial Hospital in Valencia, California gets to do something few emergency department physicians experience on a regular basis: he finishes his shift and gets to go home on time.  With voice recognition software integrated into the hospital’s EHR, documentation is simple and efficiency numbers are through the roof.  Dr. Lawrence sat down withEHRintelligence to discuss how physicians react to seeing voice recognition software in action, as well as how it can improve workflow and provide better patient care.
How has voice recognition changed your daily routine?
We were on paper, handwriting things and then using a transcription service.  That was costing the hospital about $1.5 million a year for the emergency department alone.  We were really able to take a huge slice off the top of that when we switched to voice recognition.  It also allowed us to change our whole workflow, moving from a transcription process where we really had to start a document and finish it at the same time.  When you start a patient, you can’t really stop and do something else and come back to it ten minutes later – it was very hard to do that.  We use Dragon Medical from Nuance, and it allows us to do half the document now and come back to it later.
Most doctors will stay two or three hours after their shift doing their dictation.  When we got really busy and saw a lot of patients, we would make a stack of our charts on the side, and at the end of the shift, we’d have to go back and dictate those charts.  That creates a poor medical record, because it’s hard to remember what you did twelve hours ago.  We were making errors because we weren’t remembering all the little details, and really not creating a good chart.
Now our documents are real time.  So even if I’ve only done half of the documentation, if I decide I’m going to admit the patient, any doctor can immediately open up the medical record and look at my document without even having to talk to me.  He’ll know exactly what’s going on, what my thought process is, and it allows us a lot more functionality.
The standard comment when you talk to someone about moving to an EHR is, “Well there’s no way I’ll ever be able to do it faster than the way I do it now.”  Everyone is always afraid of change.  The emergency department went live first as sort of a pilot, and everyone was surprised at how well we were doing.  We were efficiency-negative from zero to one month, efficiency-neutral until the second month, and then from that point on, we have been efficiency-positive.  We’re faster now, using voice recognition and EHRs than we were on paper, which I think is remarkable and important.
How are you getting physicians in your hospital on board?
I hear all the feedback from physicians.  We’re all creatures of habit, and we don’t want to do things differently.  But I would be standing somewhere creating a document, and all of a sudden I’d turn around and see a GI guy and a cardiologist watching me dictate a note and have it pop right up on the screen, and they’d say, “Wow, that’s pretty amazing”.  The backlash stems from not understanding that it can be just as efficient, or more efficient, than the old way.
We need to get out there and show people what it looks like, and that it’s not scary, and it can be done.  In the past, up to about 3 or 4 years ago, most EHR companies have targeted the wrong audience.  They’ve been targeting the CIOs, the IT department, the CMIOs.  But really, the right audience is the end user.  It’s really the physician.  A doctor isn’t going to believe someone from IT, but they are going to believe another physician.  It’s important that physicians see their colleagues utilizing the technology, and the vendors are realizing that.
I go home three hours earlier when I use this.  That was the first thing that my physicians said to me.  They were getting out on time every day, and they thought that was crazy.  So that’s a huge physician satisfier.  This is a lifestyle issue.
What is your advice to physicians who are still hesitant about EHR technology?
The underlying theme is that technology is good.  Although they may seem counterproductive when you first look at them, and don’t understand the full scope of what they can do, once you spend just a little bit of time looking into the products that are out there and understand what voice recognition can do, there’s so much power there.
There’s so much you can do to speed up what you’re doing in your daily workflow.  It can make your life better.  Physicians shouldn’t be scared of the change.  You need to put a little energy into it on the front end, and learn how to utilize it, and maximize its capabilities, but it’s absolutely a game changer.

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