June 2016

Partnership Leads to Improved Dictation App
For The Record
Vol. 28 No. 6 P. 6

More than a decade into the new millennium, why should doctors still be tied to landlines for dictation?

That's the thought that Linda Sullivan, CEO of New England Medical Transcription (NEMT), had as she prepared to start working with ChartNet Technologies on their new dictation app for iPhones. "Everyone has a smartphone with them all the time, so it seemed high time that NEMT provide an app that allows easy dictation from an iPhone while maintaining data security," she says.

The idea is simple, even if the development is not: Give physicians the ability to dictate reports from anywhere using a smartphone, a device they already have in their pockets practically at all times. With no landline, no hardware, and an intuitive interface, the app would make dictation much faster and less burdensome.

Sullivan's first step was to call Curt Hupe, chief operations officer at ChartNet, who had already developed an iPhone dictation app that met most of NEMT's requirements. However, it didn't boast a scheduling feature. "We've had the app for a couple of years," Hupe says. "What we did with NEMT was add scheduling integration."

ChartNet's original dictation app had similar capabilities to a voice recorder. Physicians could dictate, rewind, fast forward, and submit their recordings, but not much more. Because of development costs, Hupe decided to leave it at that until customer demand could justify adding more features. "We didn't want to take the cost on until we had someone say, 'Hey, we'll use this and our clients definitely want it,'" he says. "What NEMT did was to work with us on developing the scheduling integration and getting it beta tested by doctors."

The Genesis
Sullivan says an NEMT client had asked for a dictation app but specifically wanted one that allowed physicians to dictate based on their patient schedules. She called Hupe and the two immediately began working on an upgrade that integrates each physician's daily schedule with their dictations.

The idea was that on startup, the app would automatically sync with a physician's current schedule. This would allow physicians to view their scheduled patients regardless of whether they were dictating. Users also could dictate reports for patients regardless of whether they were scheduled.

But before ChartNet could start building a scheduling database, Hupe needed more information about scheduling feeds. Andrew Clarke, NEMT's director of IT, talked with the NEMT client, who forwarded approximately 50,000 sample ADT (admissions, discharge, and transfer) scheduling messages. After Clarke scrubbed, sorted, and encrypted the lot, ChartNet's development team attempted to build a scheduling database. "They needed the sample messages so they could see what the database and interface should look like," Clarke says. "Then the programmers used the entries to build the database."

It took a team of three developers three months to build the original dictation app. The same amount of time was required for the scheduling upgrade alone, even with help from outside developers.

Once the scheduling database was completed, NEMT had an app that allows physicians to view schedules, tap a patient's name to dictate reports, and send reports. Visual indicators identify which reports have already been dictated. "It's basically a checklist for dictation," Hupe says, adding that the ability to select by patient name eliminates the need for physicians to input demographic information, account numbers, and medical record numbers. "It's just so much more seamless for the physicians."

For physicians who don't use scheduling, the app works the same as dictating with a phone but eliminates the need to be tied to a landline. Previously, poor audio quality and lax security have made cellphones a less desirable dictation option. "This app solves both of those issues," Clarke says. "It records and saves the dictation locally onto the iPhone itself and then transmits the data securely over SSL communication. Audio quality is preserved and patient information isn't compromised by the transmission."

The recording remains on the phone, allowing physicians access to reports they've already dictated.

Roadblocks
The app's development faced several challenges, including how to overcome the fact that patients are sometimes intentionally scheduled to be in two places at once. For example, a patient may be scheduled for a 10:00 appointment with a physician to have a cast applied as well as a 10:00 session in the cast room down the hall. When the app was tested, Clarke says the tool wouldn't allow patients to be in two places at once. When the patient checked in for the cast room appointment, the doctor's appointment was deleted, an outcome that prevented the physician from dictating the report. "In real life, patients often have multiple appointments in the same office at the same time," Clarke says. "It was a bug that was problematic in a real-world scenario, so the developers revised the specifications so a patient really could be listed in two places at the same time."

One of the key elements to finding those bugs was beta testing. NEMT and the client who requested the scheduling feature worked together to determine what worked and what needed troubleshooting. "[The client was] extremely helpful in improving the functionality," Sullivan says. "Throughout the process, we talked to them several times a week, looking at their suggestions, working out glitches, and tweaking the interface until everyone was satisfied."

The app made its debut in early March at the Ohio Health Information Management Association convention, where Clarke demonstrated the tool to attendees. "People were really excited about it," he notes. "It's so intuitive that people know instinctively how to operate it."

Since NEMT is already a ChartNet partner, any NEMT client can use the app. Sullivan buys licenses from ChartNet and then provides them to clients at an annual cost of $25 per dictator. "Obviously, we want to keep the cost extremely low so technological advances aren't a burden to our clients," she says. "Technology is in the process of changing the entire health care experience and it's the duty of everyone in the industry to help that to happen. NEMT is on the front edge of change here, but this is the direction everyone is headed."

According to Hupe, any company that works with ChartNet can do likewise, including setting their own prices when they pass the licenses on to clients. However, physicians who wish to purchase the app must go through their medical transcription service organization (MTSO). Even at hospitals where ChartNet is a fixture, physicians can't decide on their own to get the app. "We thought about making this for the masses but we didn't want to be in competition with our clients," Hupe says.

Physicians interested in the dictation app should speak with their HIM managers, who can relay the information on to the MTSO. (ChartNet sells licenses to MTSOs.) To preview the app, anyone can download it for free from the iTunes App Store; it requires a license to fully work.

Thus far, the dictation app has about 300 licensed users, a large percentage of whom purchased the tool through NEMT. "It's our first foray into app development," Sullivan says. "It's been a major undertaking, but the combination of ChartNet, NEMT, and our client beta testers made for a great development team."

— A For The Record staff report.