According to CDC FastStats, in 2013 over 78% of office-based providers had converted from paper to digital, using an EHR system. This means that for the majority of providers, regardless of where they are in the stage of their profession, computer skills will become a necessity. In a 2014 census by the Federation of State Medical Boards, providers with active EHR licenses are split between about 47% age 49 and younger, and about 51% age 50 and older. Why is this important?
Simply put, the most likely computer-savvy users are Millennials and Generation X providers, which make up about 22% and 25% of providers, respectively. The Baby Boomers make up 42%, followed by the Silent Generation at 10%. The two latter groups, which represent slightly more than half of providers, may be less savvy and comfortable with the tools that support EHR systems.
EHRs are complex systems that evolved from supporting single practices to full blown networks, including hospitals. This has been further exacerbated by the need to support Meaningful Use requirements. For most providers the learning curve is very long and time-consuming — and providers have very little time to spare today.
As a patient, I have observed that the EHR detracts from the quality of my care. My PCP, a Generation Xer, sits at the computer with his back to me, pointing and clicking.
In my professional role, I have run tests where I documented an entire patient encounter strictly with the keyboard and mouse. It’s a wonder these providers ever get home for dinner. That’s why Dr. Chris Russell created NoteSwift, a solution that uses speech recognition technology to help eliminate clicking and mousing around.
Having worked with five different EHRs in the development of third party software, I have concluded that there were few providers involved in the design of the EHR user experience. A Medical Economics survey found nearly half of the respondents believe EHRs are making patient care less effective. They claim the EHR causes them to see fewer patients per day due to the documentation requirements and the cumbersome user interfaces.
Although some EHR vendors claim they had provider input in designing these systems, the vendors had to take that input and make it compatible across various specialty areas. This took away from the so-called “provider input.” Additionally, a quick search on the web returns numerous articles discussing the fact that EHRs were essentially designed to maximize billing. Supporting new requirements, like Meaningful Use, means more structured data must be entered from the patient encounter. Rather than designing a new user interface to support these requirements more efficiently, more and busier screens, requiring more clicking, typing, and scrolling, have been added to the EHR, and onto the provider’s shoulders.
On the optimistic side, there is some pretty cool technology available that can be applied to streamline the provider’s process of documenting a patient encounter. Speech recognition is one. While pretty much a commodity today, it hasn’t been exploited to the extent it could/should be in medical practices.
Existing speech recognition packages, such as Nuance Dragon Medical or M*Modal, provide a means to enter the narrative for the patient encounter, accommodating all the specific medical terms with a high degree of accuracy. The flip side is that it has to be done a certain way, and it did not overcome all the new menus, click boxes and requirements for structured data input.
Today, NoteSwift goes beyond basic dictation by leveraging speech to drive the EHR and enter structured data virtually hands-free. It was our response to providers’ dreams of returning to the number of patients they could treat before their EHR days. I believe the opportunity exists to go even further. Cloud-based speech engines now make it possible to access speech capabilities without the need for significant hardware systems. Cloud-based speech, such as Nuance’s Speech Anywhere technology, can also free the provider from the desktop to mobile devices, which are far more convenient and portable. Furthermore, advances in areas like Natural Language Processing can free the physician from the EHR user interface altogether, allowing the provider to do what s/he is most comfortable with, which is to dictate a SOAP note.
Our vision is to enable providers to work the way they used to by dictating a patient encounter according to their own workflow, while the NoteSwift software automatically navigates them through the EHR’s sea of menus and screens — all without them being tied to their desks. And, instead of putting all the technology in their faces, keep it behind the curtain where it belongs. Let’s leave the EHR to the billing office, and help providers get back to more quality face-to-face time with their patients.
Stan Swiniarski is Vice President, Product Development at NoteSwift