In the late 1990s, the Joint Commission cited St. Mary’s Medical Center in San Francisco for poor handwriting. And the organization is still working to fully solve the problem, says John Umekubo, MD, medical director of clinical informatics. “The question was, ‘What are you doing about it?’ And we didn’t have any answer,” he says. “At that time we really didn’t have anything except dictating progress notes, but that’s very expensive.”
The organization started by identifying the worst offenders and asking them to print their notes in block letters. But that was so much slower than scrawling that ultimately the tactic was abandoned.
The next step was rudimentary word processing templates with prefilled fields. But the documents weren’t easily secured—and it was impractical to ask users to password-protect every document. “That was very short-lived,” Umekubo says.
In 2007 the organization started using Cerner’s electronic medical record and CPOE product and added some more prefilled data, such as vital signs, into the documentation. And now that the notes were legible, the organization realized it had content problems. Docs were cutting and pasting the same chunks of text over and over. The notes were becoming less concise and more generic. “Everything sounds the same,” Umekubo says. “The problem is I’m not getting the real story.”
Throughout these years, voice recognition software continued to evolve and improve.
St. Mary’s chose a Webmedx voice recognition product that has natural language processing—it learns and adapts to the individual’s voice. Special medical dictionaries and patient information, using patient account numbers, are preloaded into the program so the technology doesn’t get hung up on words that the average person would find difficult to pronounce. “In terms of medications, it’s right on,” Umekubo says. “Even really complex medications.”
And the information is imported into the EMR so it is available to other clinicians immediately. “It’s instantaneous; as soon as you dictate it—literally within a few minutes—it’s in the electronic record,” Umekubo says.