A few thoughts from a tumor surgeon

Moving the doctor’s office on-line: milestones from the digital practice revolution

September 3, 2010 at 11:33 am Leave a comment

[Cross-posted from iMedicalApps.com]

While there seems to be a never ending stream of medical reference applications for smartphones, it might well be that medical apps for the more mundane parts of a doctor’s life that get the most use. Once outside the examination room, it seems we spend the bulk of our time charting and returning messages. Therefore, it is as much with relief as with pleasure that we welcome two iPhone applications that aim to facilitate medical transcription and handling phone calls: Emdat Mobile and PerfectServe Clinician.

Emdat Mobile

Emdat Mobile (iTunes link) is a simple application that allows dictation directly into the iPhone. It is not connected to a voice recognition engine such as Nuance’s Dragon but rather sends the recorded audio to a medical transcriptionist. Later, the transcribed record is available for viewing on the iPhone. While this may seem mundane, it is actually a very nice advance over using a digital dictaphone and special software to upload dictations.

It is likely that many readers have never heard of Emdat (“Electronic Medical Dictation And Transcription”). The company provides a web based platform for transcribed medical documents and was founded in 1999, early in the internet era . Emdat is not a transcription company but rather provides the infrastructure for independent medical transcription companies to store recorded audio as well as the finished documents. Clinicians and hospitals then use a simple web interface to edit and sign the documents.

While a lot of attention is given of late to computer voice recognition and transcription, many physicians still rely on voice dictation for documenting their patient encounters. The benefits are fairly plain, speaking is faster than typing or clicking and it does not require standing in front of a computer. Of course, many physicians who have converted to template based EHRs will say that, with time, they can document just as fast as with voice dictation. While this is likely correct, the catch is in the product. The dirty secret is that notes generated by clicking and choosing entries from templates are just barely usable as medical documents.

When you’re trying to read the notes of your colleague [in an electronic record], it’s almost impossible to figure out what happened to the patient. You have to read through two pages of all this junk that’s put in to increase billing.

This statement was made by a physician who was quoted in the Wall Street Journal and with whom, no doubt many physicians can sympathize. It was highlighted in EMDATs introduction to their new “DaRT” system which has the ambitious goal of integrating medical transcription with EHRs. The idea is to generate XML tags from within medical transcriptions that will automatically populate EHRs. Emdat feels this “hybrid” system may provide the best of both worlds, faster workflow for doctors and structured data output more friendly to EHRs and more apt to satisfy meaningful use requirements. According to their webpage

Emdat’s DaRT tags transcription content (Eg. Chief Complaint, Medical History, Family History, etc.) and discretely populates your EMR/EHR automatically, as if the clinician had entered it themselves.

While DaRT seems promising, it is not clear how completely it is currently implemented. Meanwhile, Nuance is also pushing aggressively into natural language processing to convert speech into structured text. I have been using the Emdat platform for nearly 3 years and have happily converted to using my iPhone to dictate and upload my office visits over the last few weeks. Now, if there was a seamless way to drive these transcriptions into a powerful EHR, it would be one big blow against the shackles of medical documentation.

PerfectServe Clinician

PerfectServe is a medical communication company that provides an automated answering service for physicians and hospitals. For physicians, it allows incoming calls from patients and other clinicians to be routed to various numbers, such as the office, home or cell phone, depending on the physician’s preferences and the time of day.

Compared to a traditional human-powered answering service, it is clearly more economical but it also offers many benefits, such as automated redial of numbers directly from the keypad, masking of your number when returning calls from patients and a log of previous messages.

Now, PerfectServe has released an iPhone app that allows all the above functions but with a much more fluid interface than listening to a series of voice prompts and pressing keys on the phone. Here is the list of features from their website:

• Contact colleagues directly without referring to phone lists, directories or call schedules [provided your hospital has uploaded it].
• Tap on a name, and PerfectServe connects you according to the contact preferences established by the recipient for that moment in time
• Call patients while protecting your caller ID and overcome caller ID block. Your office caller ID is presented to the parties you call, instead of your personal home or cell phone numbers.
• Change Your On-Call Schedule: Sign on or off call, and change who is covering for your group.
• Change How You’re Reached: Choose one of the contact processes (e.g., iPhone, home phone, pager).
• Change Your Status: Automatically trigger a different call routing process based on your status (e.g., “surgery,” “in-hospital,” “with patients”).
• View History: View your recent calls, voice and text messages, and pages. Return calls from the History screen

I have also been a satisfied customer of PerfectServe for three years . I am particularly looking forward to the option to easily change my status in the OR to “in-surgery”, especially around 4 PM, since there seems to be a natural inclination for patients to dial their doctors immediately after the office is closed. If the video is a fair representation of the app, then many PerfectServe customers have something to which to look forward.

This statement was made by a physician who was quoted in the Wall Street Journal and with whom, no doubt many physicians can sympathize. It was highlighted in EMDATs introduction to their new “DaRT” system which has the ambitious goal of integrating medical transcription with EHRs. The idea is to generate XML tags from within medical transcriptions that will automatically populate EHRs. Emdat feels this “hybrid” system may provide the best of both worlds, faster workflow for doctors and structured data output more friendly to EHRs and more apt to satisfy meaningful use requirements. According to their webpage

Emdat’s DaRT tags transcription content (Eg. Chief Complaint, Medical History, Family History, etc.) and discretely populates your EMR/EHR automatically, as if the clinician had entered it themselves.

While DaRT seems promising, it is not clear how completely it is currently implemented. Meanwhile, Nuance is also pushing aggressively into natural language processing to convert speech into structured text. I have been using the Emdat platform for nearly 3 years and have happily converted to using my iPhone to dictate and upload my office visits over the last few weeks. Now, if there was a seamless way to drive these transcriptions into a powerful EHR, it would be one big blow against the shackles of medical documentation.

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Entry filed under: app review. Tags: EHR, iPhone, practice management.