Dragon Medical One Dictates Big Savings for Edward-Elmhurst Health

Physicians at more than 100 Edward-Elmhurst Health hospitals and clinics in Illinois are saving up to two hours—and in some cases significantly more—per shift with cloud-based speech recognition software tied to their electronic health record (EHR) software.

Four years ago, Edward Hospital doctors called upon a transcription service, literally, to type notes into their EHR system. They’d call the service and dictate their notes, which would then be transcribed into the system, says Don Fosen,  system director for technology and chief information security officer at Edward Elmhurst Health. Physicians could also manually enter notes into the EHR system used at that time.

When the healthcare provider changed EHR providers four years ago, Fosen and his staff knew it was time to upgrade its documentation technology. “The phone transcription service was pretty expensive, and we wanted to save money from that perspective; but we also wanted something more tightly integrated with physician workflows and with the applications they use.”

The merger of Edward Hospital and Elmhurst Memorial Healthcare took place around the same time, and Fosen was soon tasked with moving all 1,900 physicians employed by the combined healthcare provider onto one centralized speech and EHR systems.

Doctors now input notes verbally using the cloud-based Dragon Medical One medical speech recognition system from Nuance Communications. The notes are moved instantly into the EHR system and are available in real time—versus the roughly two hours required of the previous phone-in transcription service. Nurses and other doctors can access patient information more quickly than in the past, Fosen says.

Also, physicians tend to enter their notes into the system more immediately after seeing patients, and their notes are often more extensive and complete, he adds.

“In many cases, nurses are completely up to speed on a case before a patient arrives from the emergency room,” Fosen says.

Some doctors also use an auto-text feature that allows them to navigate through the system by voice commands rather than by mouse clicks. Most physicians save about three hours per month this way, and one doctor is saving up to 10 hours per month using voice navigation and commands, Fosen says.

“We have folks navigating applications with voice while they’re working on something else,” he adds.

A user creates his own profile, which takes into account and learns his accents, preferred microphones, and background-noise-reduction settings. The settings automatically adjust when the profile is called up, before the user begins speaking.

By having their profiles stored in the speech recognition system, doctors can enter their notes on any workstation that houses the software. This is handy for those who move between clinics or even workstations within a department or facility, Fosen adds.

With use, the system continues to learn about the vocal mannerisms of each speaker, thus increasing accuracy and response rates, Fosen says.

Profiles can also be optimized to include acronyms and phrases not already included in the software’s dictionary, he adds.

“We have all the medical vocabulary and language in the engine, but inevitably things aren’t in our dictionary, like hospital names, proper names of physicians, and organizational names,” Fosen says. “We can edit it to include the names of physicians in the directories or words unique to our organization, but then individual users can make edits and modifications. They can put in an acronym that would expand out the phrase in the notes.”

The system also gives immediate, real-time feedback to doctors whose notes are missing an issue likely to be caught by coders or clinical documentation specialists downstream who ensure that notes meet insurance and federal regulatory requirements. Doctors can then immediately add to or amend their notes.

“It’s very difficult to move the needle on physician productivity because they have so much going on, so this is a big win,” Fosen says.

Fosen’s team receives a monthly analytics report from Nuance. The analytics dashboards highlight top users and productivity statistics, providing detailed metrics about the effort clinicians put into creating their documentation, as well as estimated cost and time savings resulting from the use of speech recognition.

“We look for areas of improvement,” Fosen says. “So if we see other doctors aren’t using the auto-text feature as much, we encourage them and tell them they could save time doing it.”

Fosen also likes that the software is cloud-based, with Nuance maintaining and updating the system, which is housed on the Microsoft Azure hosting infrastructure.

Edward-Elmhurst is now piloting Nuance PowerMic Mobile, a mobile component that lets doctors dictate their notes on their smartphones or tablets using their speech-recognition profiles.

“They can enter their notes at different points within the hospital or at home remotely and can get the same consistent experience delivered through all those access points,” says Jonathon Dreyer, senior director of solutions marketing at Nuance.

Because smartphones or tablets include microphones, physicians could also use those devices to capture their vocal dictations on desktops that don’t have Dragon Medical One installed, he adds.

Based on the success it’s seen so far, Edward-Elmhurst Health is looking to expand its use of the Dragon software. “We’re also looking at other workflows we’ve found that could probably be optimized with Dragon Medical One,” Fosen says.

Dragon saves Edward-Elmhurst money, but a bigger financial windfall is the quicker compensation by insurance companies.

“We get compensated based on how accurate documentation is, so Dragon Medical One has a big impact across the board,” Fosen says. 

App at a Glance

Since using the cloud-based Dragon Medical One medical speech recognition system from Nuance Communications, Edward-Elmhurst Health has seen the following results:

• physicians save up to two hours—and in some cases significantly more—per shift dictating directly into their electronic health record software; and
• physicians save up to three hours per month using the auto-text feature, which allows them to navigate through the system by voice commands rather than by mouse clicks.