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Getting the Most From Your Documentation Dollars
By Randy Olver

Implementing an EHR system significantly impacts physician documentation workflows. Demands to measure, track, and monitor patient outcomes are intensifying, making efficient and thorough documentation challenging.

Documentation is not a one-size-fits-all model, and return on investment (ROI) is not a straightforward calculation. Organizations must keep individual physician work habits in mind—along with tangible and intangible costs—to select the best method of information capture for the practice. Each method of patient encounter documentation in an EHR has its benefits and drawbacks.

Point-and-click documentation requires physicians to document patient information directly into the EHR. This enables physicians to gather complete patient information and create a comprehensive visit record, which helps organizations comply with meaningful use standards. However, this approach has the greatest impact on productivity thanks to the complexity of navigation and usability, has the highest labor cost model due to the use of physician time, and can negatively impact patient satisfaction. Using a keyboard and mouse in the exam room reduces the encounter’s human element, as physicians shift their attention to the computer screen. Additionally, structured data entry can inhibit the inclusion of a clinical narrative that can be easily captured through dictation.

Front-end voice recognition allows the physician to dictate using familiar methods. The system captures and translates the physician’s spoken words, which are immediately edited within the EHR. This technology reduces the time spent on manual data entry, allowing the physician to focus his or her time on corrections and formatting and also decreases turnaround time for document distribution.

However, voice recognition, which requires up-front investments in technology and training, depends on physician speech patterns, speech engine processing capabilities, and EHR integration. Variance from physician to physician may delay distribution and increase the workload. In addition, physicians often find themselves tethered to physical workstations and microphones, limiting freedom and convenience.

A hybrid approach often can be the most efficient and cost-effective way to document patient encounters, leveraging dictation and templates to automatically populate the EHR. The system can capture more detailed narrative information, offering greater flexibility for the physician with only a slight delay in documentation hitting the EHR. This approach protects physician productivity while meeting meaningful use requirements. Dictation often can be completed on mobile devices, further maximizing convenience and limiting investments in phone systems or recorders. Not all EHR vendors are equipped to fully integrate with a hybrid solution, so this should be kept in mind when selecting a provider.

Measuring ROI for Documentation
Outsourced transcription is a valuable service that can prove to be worth the investment. Dictation is more efficient for physicians than point-and-click or front-end voice recognition and enables more comprehensive documentation to support ongoing care. Outsourced transcription helps organizations maintain a consistent level of revenue and maximize physician productivity by freeing up valuable time to see more patients. Transcription also helps reduce errors, as a second set of eyes reviews physician-entered data.

How can you accurately measure the return on your documentation investment? First, compare your current transcription costs with the cost of a new system. This includes staff salaries and outsourced services costs, along with the purchase and maintenance of transcription hardware and software. Operational costs also should be included, from telephone and Internet services to recorders and office space.

Additional savings gained by changing documentation methods are intangible but equally important. The cost of time spent by physicians on documentation cannot be underestimated. Point-and-click data entry takes physicians an average of 4.5 minutes, while front-end speech recognition takes 3.9 minutes. A hybrid system requires an average of 1.4 minutes to document a patient encounter. The time saved can be spent providing care to additional patients or shortening a provider's workday.

Look for transcription providers whose hybrid approach uses an innovative cost model to streamline costs. Templates help save transcription time and associated fees by reducing line counts, and a software-as-a-service vendor eliminates investments in hardware and software along with associated maintenance and upgrade costs.

Illinois Bone & Joint Institute recently underwent an analysis of their documentation process and chose Emdat’s single dictation and transcription platform to help maximize their transcription budget. The system allows the practice to use speech recognition and templates to reduce costs, and Emdat’s mobile features have helped increase adoption among the clinicians. The organization has experienced a 50% average cost savings on transcription year over year and an additional boost in productivity.

In Closing
To get the most out of your documentation dollars, start with a complete analysis of physician behavior to determine the best method. EHRs can help clinicians efficiently share information, and your transcription budget should support this effort. An effective combination of transcription and EHR will boost adoption rates and productivity and will make both tools more effective.

— Randy Olver is CEO of Emdat.