"It's a big deal," says Dr. Alison Turnquist of the voice recognition software that's allowing emergency physicians to improve patient care.
"After we see a patient, we go to one of the many desktop computers we have in the emergency department. Each computer has a microphone that allows us to conversationally create, review, edit and sign our clinical notes directly into a patient's electronic health record," says Dr. Vern Behl, emergency physician and physician lead for clinical informatics.
Saskatoon's emergency physicians are at the forefront of the creation of electronic patient records. In all three of Saskatoon's emergency departments, they have been documenting electronically into Saskatoon Health Region's electronic patient record (Sunrise Clinical Manager or SCM) for over two years.
Before acquiring the voice recognition software, emergency physicians had to type their notes into SCM, a process that could take on average 10 to 15 minutes per patient. As a result, Turnquist says she used to spend up to two hours after a shift typing patient notes, as it was often not possible to get it done between seeing patients.
"When it's busy, you don't want to spend 10 to 15 minutes with your notes after every patient, so many of us would save it until the end of shift," she says, adding that because many physicians do not bill for patient charting, the bulk of this work was being done on personal time.
"Now, I dictate after every single patient because it takes me on average one to three minutes – it's really fast," she says, adding that in a recent 6.5 hour shift, where she had 25 patients under her care, she was able to finish on time.
"That would have never been possible without this software, not in a million years," she says. "My rate of stress and burnout is much better now and so is the quality of my charting. We can read the note as we're dictating it, so any mistakes, corrections and additions are done right then, and because we're doing it immediately after the patient encounter, our memory is much better."
The voice recognition software being utilized is called Fluency Direct – a module within the new provincial transcription system that allows dictation directly into clinical information systems. The software is designed to continuously analyze clinical narratives and provide immediate feedback to physicians, asking for additional information or clarification when appropriate, and suggesting specific actions to improve documentation quality and ensure a more complete patient narrative. It also automatically inserts dictated text into the relevant sections of the patient's electronic health record.
Saskatoon Health Region has partnered with 3sHealth (Shared Services Saskatchewan) to implement the voice recognition software that is supporting physicians to dictate directly into SCM.
"Now, it's an expectation in the department that you'll write a lot more on your thought process and your care plan for the patient, because we know it only takes a few minutes to record," says Dr. Turnquist.
"Documenting this thought process is so important that we're in the process of adding a new section to the electronic health record that will require physicians to explain their thought process when diagnosing a patient," Dr. Behl adds.
The most significant benefit of the software is on patient care.
"Because we're so much faster with our documentation, we have more time to spend with patients," says Dr. Behl.
Within the first six months of trialing the software, the emergency department has seen a five per cent gain in efficiency.
"A five per cent gain is a big deal because it means we'll be able to see about 5,000 more patients each year – that's less people waiting and leaving without being seen," Dr. Behl says, adding that being able to dictate his patient notes immediately after a patient encounter is also allowing him to print off the note and give it to the patient.
"I know for sure that I'm now doing my charting in half the time it used to take me, giving me more time to spend at the bedside," says Dr. Terry Zlipko. "Instead of spending 23 minutes typing a report, I can now do that same dictation, edit it and send it on its way in about three or four minutes tops."
Currently, all completed and saved physician notes are printed and mailed by the Region's health record department to the patient's family physician – a process that can take several weeks. In early November, the notes will be sent directly to the eHealth Saskatchewan's EHR Viewer, allowing family physicians to have immediate access to them electronically.
"It can be hard for patients to get an appointment with their family physician, but if they have a note from an emergency physician asking the family doctor to follow up within the next few days, the patient will often be accommodated," says Dr. Turnquist.
"Documentation is very important because it's how physicians communicate with each other," adds Dr. Behl.
Pathologists are also using Fluency Direct to dictate into their information systems, and radiologists are using similar software. As the region expands the use of SCM, and more clinicians and physicians begin documenting electronically, they too will be able to use the software to increase the efficiency and quality of their documentation.