Page 15 - Winter 2024 Bulletin

Reflections (continued from page 13)
longer the issue. The problem now, because of the digital transformation of medical communication, is accuracy.
The electronic health record (EHR) is now the standard of the industry – for hospitals and doctors’ offices. Now the chart is typed and is eminently legible both on a computer screen and when printed on paper. Now the prescription is printed or, more commonly, communicated directly to the pharmacy digitally or by telephone. Many physicians now use the services of a scribe for initial data entry. Now the patient never sees the doctor’s handwriting. Hence, in the future, a joke about doctors’ handwriting will be met by...silence.
The medical record, however, is no joking matter. Even af- ter the introduction of the EHR, the potential for damaging errors persists. (As I typed this sentence, the word process- ing program insisted on changing “EHR” to ‘HER.”) At first, the doctor verbally recorded his or her report which was then typed and scanned for errors by a transcriptionist. It was sub- sequently reviewed and edited, perhaps with another trip back to the transcriptionist, by the doctor before it was finalized. Now, more commonly, the doctor directly enters the text into a keyboard, with or without employing a template, before per- sonally reviewing the report and before releasing it – all in a single sitting.
So the doctor’s handwriting problem is solved. But what about the accuracy problem? I recall a time in the early 2000’s when I received a urology specimen in the laboratory from an elderly man. The document was legible and easy to read. The clinical history accompanying the specimen noted that the pa- tient suffered from “penile dementia.”
Did the doctor mumble when dictating the note? Did he or she have a thick accent? Did the transcriber just hit the wrong key (“p” and “s” are far apart on the QWERTY keyboard)? Did the doctor do his or her own data entry? Was there an inad- equate review prior to releasing the document? I think you will agree that a single incorrect letter can change the meaning of a word.
Speech recognition software with artificial intelligence is a recent innovation in medical charting. It potentially learns from experience (from corrections made by a transcriber or the dictating physician) and gets better with time. However, speech recognition has been noted to have a relatively high incidence of errors. In one study, errors were found in seven out of a hundred words. The most accurate process for note generation is a multistep process involving the doctor’s dicta- tion followed by typing by a trained medical transcriptionist and review and sign out by the dictating physician.
The problem of legibility having been solved, what are the options for ensuring accuracy? The essential elements of the
process involve data entry, data conversion (by transcriber or by artificial intelligence), review, corrections, and sign out.
Research has shown that the more times that the dictation is reviewed – by the transcriptionist and the doctor – the more accurate is the final output. The least accurate is speech rec- ognition software alone (7 errors per 100 words, in one study). Review by a medical transcriptionist and a physician greatly reduces the error rate to less than 1 error per 100 words. (J Am Inform Assoc 2016 Apr;23(e1): e169-e179)
New technologies in speech recognition and artificial intel- ligence have shown improvement since inception and are still in their early years of adoption and innovation. These devel- opments in medical charting pose both an opportunity and a challenge to medical practitioners.
The opportunity lies in the realms of time savings, speedier turnaround time, reduced expense, potentially improved ac- curacy, and increased legibility.
The challenge is that the use of the new technologies re- quires the development of new skills, whether in dictation, in use of macros (templates), use of scribes or medical transcrip- tionists, and most important, increased attention to reviewing and editing.
But in at least one respect, the digitization of medical chart- ing is an unmitigated success – no more handwriting jokes!
CALL FOR CANDIDATES! - An invitation to serve...
Members are invited to consider being placed on the 2025 HCMA ballot. You must be a member in the ACTIVE, AFFILIATE, or LIFE membership categories and your 2025 dues must be paid.
Results will be announced on May 6th.
Open seats include:
Vice President - 1 year term
Treasurer - 1 year term
Secretary - 1 year term
District, At Large, USF, Moffitt, & Young Physician seats on the Executive Council - 2 year terms Delegate to the FMA - 3 year term (FMA dues must also be paid)
Nominations to specific seats will be determined by the Nominating Committee members at their February meeting. However, if you have a preference to serve in a certain capacity, please indicate such when submitting your request. Submit your name for nomination no later than February 10th by emailing ELubin@hcma.net.
HCMA BULLETIN, Vol 70, No. 3 – Winter 2024
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