May 2015

Is Mobile the Answer to Closed-Loop Dictation?
By Subbu Ravi
For The Record
Vol. 27 No. 5 P. 6

HIT and mobile technology have finally come to a crossroad. The mobile industry has reached a point where experimenting with HIT integration is feasible, proven, and affordable. Cost barriers such as application hardware and software and design complexity that once prevented developers from exploring mobile integration have been minimized.

Developing applications has never been cheaper in the history of mobile technology, making now the perfect time for IT companies to begin seeking new ways to utilize mobile devices. Furthermore, hospital and health care environments are more mature at managing mobile devices. The HIM profession, which continues to move down the long road of modernization, is poised to benefit from mobile technologies as well.

Consider this: Most physicians carry pocket computers featuring greater processing capability than the computers used to land the Apollo on the moon. Yet physicians remain bound to the earthly confines of desktop computers, largely due to EMRs. Mobile technology has advanced at speeds faster than traditional HIT, so much so that truly revolutionizing the patient experience at the point of care is still not the No. 1 priority.

Mobile devices currently do little more than provide a better desktop experience, ultimately falling short of their full potential. The market has, however, reached a point where mobile integration can begin to streamline arduous and time-consuming hospital processes, specifically transcription. Within the next decade, hospitals will see mobile devices become the dominant tool for medical transcription, culminating in the creation of a seamless closed-loop dictation solution.

Closing the Loop
Under the current system, physicians record their dictations and asynchronously send them out for transcription. This process inhibits hospitals from adding value to patient care and facility performance in a real-time manner.

For example, take hip replacement cases. Under the current system, physicians dictate the procedure's details and describe the care to be provided at the hospital. Often, however, physicians fail to note that the patient was sent to rehabilitation or transition care planning. Given the time requirements of current procedures, it's likely that transcriptionists enter incomplete dictations into the system before physicians can address the missing items. Missing these key details creates issues with care coordination, quality of care, the patient experience, and the overall cost of care. Moreover, not having complete, timely information for providers to pursue appropriate follow-up care increases both the risk for readmission and the financial burden on both the patient and the hospital.

Where current systems have gaps in comprehensive dictation and timely execution, mobile technology has the capability to excel, starting from the moment a physician walks into a patient's room. In a closed-loop dictation system, physicians have access to all pertinent patient information at the time of dictation. They have the ability to instantly send dictated notes to a processor and finalize the transcription documents in a fraction of the time—and do it all from a pocket-sized computer.

Using geolocation on a mobile device, a dictation application can access a patient's EMR and prompt a physician to complete dictations on specific items based on the care given and scheduled follow-ups. In hip replacement cases, a dictation application highlights reminders on specific procedures and orders and will not finalize the dictation until the physician addresses all areas of care. Coding is performed instantly, with feedback (ie, closing the loop) provided to correct any dictation gaps.

The outcome is a decrease in transcription time and errors, resulting in improved quality of care and reduced costs. Integrating mobile dictation into the dictation, transcription, and revenue cycle workflows can boost hospital performance in the triple-aim initiatives of improving the experience of care, improving population health, and reducing the per capita costs of health care.

Ultimately, advances in medical technology aim to improve the manner in which patients receive care. The push toward closed-loop dictation extends beyond triple aim goals. During this year's State of the Union address, President Barack Obama spoke about a precision medicine initiative in which physicians are provided with the necessary equipment to better understand patients' health problems by personalizing care. The core of this initiative focuses on making patient information, including history, care provided, and follow-up procedures, accessible enough to generate an immediate response. These requirements make mobile integration desirable and necessary going forward.

Mobile Security
While some physicians and administrators are eager to make mobile closed-loop dictation an organizational priority, it must wait its turn behind constructing a solid foundation to support a comprehensive mobile-enabled approach to care. Hospitals nationwide have already begun laying the groundwork through improvements to corporate management and analytics, such as evidence-based guidelines, pay-for-performance bonuses, and EMRs. These initiatives, which are currently a priority for providers, should become standard practices within the next four to six years. A closed-loop dictation system relies on these upgrades to benefit clinician performance, hospital revenues, and patient care.

Development of mobile, closed-loop dictation comes at a time when industries have begun to address the growing need to improve information security, another key component of long-term success. As devastating as breaches such as the one that recently occurred at Anthem—in which 80 million patients were affected—have been, in a warped way they've helped highlight the need for stricter security measures.

As such, many hospitals and developers are working to address the mounting threats to patient data. Improving security now means that once hospitals are ready to make mobile dictation standard, the technology will integrate seamlessly with programs and procedures that already have been secured.

Mobile's Changing Role
Smartphones and tablets have reached the point where they've become ubiquitous the world over. While closed-loop dictation is several years away from widespread implementation, hospitals can begin to encourage physicians and staff to use their personal devices in a standard workflow. Many physicians already use recording applications on their mobile devices in the standard dictation and transcription system—a trend that will only continue to grow.

Hospitals can leverage current technology to give physicians the freedom to sign off on transcription records from a smartphone or tablet, a process that typically requires the use of a desktop computer or a laptop. From an HIM perspective, mobile devices can enable hospital staff to examine and manage patient backlogs, and optimize scheduling from remote locations. This empowers staff to immediately address pressing issues from any location, thereby improving the speed and quality of the care process.

Mobile technology will revolutionize patient care, hospital financials, and clinician performance. Hospitals need only to decide when they want to start. The task of moving from concept to fruition rests on the shoulders of hospitals willing to pioneer the use of mobile devices in the transcription process. Early adopters will have the unique opportunity to influence the application's design and functionality, thus laying the framework for closed-loop dictation.

While not all hospitals will begin adopting the technology immediately, those in the early and late majority must remain up to date on development trends and include mobile devices in their transcription strategies to ensure seamless integration in the future.

— Subbu Ravi is chief operating officer at Amphion Medical Solutions. He can be reached at subbu.ravi@amphionmedical.com.