If you're frustrated with the expense and delays of Dictaphone transcriptions, Dr. Jonathan Krant's solution may be just what the doctor ordered.
“Until 5 years ago, I utilized a Dictaphone with off-site transcriptions [at a monthly cost of $3,000], a process that resulted in chart and referral consultation notes taking a week or longer to get to the referring physician,” said Dr. Krant, a rheumatologist in Pittsfield, Mass.
Dr. Krant invested $4,000 in an off-the-shelf version of Dragon Systems Medical Suite and a sophisticated Dell computer system. “I customized the voice recognition software with a rheumatology lexicon of about 10,000 words and corrected mistakes in real time on screen,” he said.
“Now, 5 years later, there are no charts on my desk. Follow-up appointments and new patient consultations are dictated at the time of service into either a portable handheld unit or a microphone connected to the computer. I can send either faxed notes or dictated copy with a keystroke [with] over 99.5% accuracy,” explained Dr. Krant, who has no financial interest in the technology.
And his practice has tallied up savings of $180,000 ($3,000 a month for 60 months).
“Several years ago, I spoke with Kim Bruce, then chair of computer science at nearby Williams College, about the advantages and pitfalls of vocal recognition software,” he said. Further investigation revealed that the Modifying the Dragon Systems Medical Suite had a tolerable error rate and could be modified to fit Dr. Krant's rheumatology practice needs.
“It took me about a month to create a database where I would dictate into the computer. A word would come up and I'd change it, then speak the word. For example, 'sedimentation rate' may come out as 'sentient rate'; that could be corrected in real time using the keyboard and [microphone].”
After several thousand entries and corrections, his system became a valuable tool in his practice. “It's fast, accurate, and even recognizes my voice when I have a cold or pharyngitis. Entire phrases and chart notes can be set up using templates that have assigned identifier numbers, so all I have to do is say the number and there's the phrase or chart, lickety-split.”
Dr. Krant receives referral patients from about 200 primary care physicians. He's now able to get his notes to them within 10 minutes of seeing a patient, making evaluation and therapeutic intervention almost simultaneous with the patient visit.
“If I've got a patient with leg swelling and his physician thinks he's got an effusion in the knee because of arthritis, but I'm concerned about a clot in a lower extremity, I have an ultrasound waiting to be performed and an admission pending for deep vein thrombosis lined up within 15 minutes of the patient's examination,” he said.