Without a doubt, the world of dictation and transcription has undergone a significant transformation during the past five to 10 years. The proliferation of cellular phones, PDAs and other electronic devices has produced a “mobile mindset” – physicians, executives and other professionals can access the Internet, respond to messages and generate work virtually anywhere, any time.
Our orthopaedic surgery practice, Orthopaedic Associates of Duluth, P.A., (OAD) in Minnesota, is a high-volume, 10-physician and five-physician-assistant organization completing more than 3,000 procedures, treatments and patient encounters per year. Any technological changes to our physicians’ workflow could negatively impact their volume, so when the practice updated their dictation and transcription workflow, the decision was not made lightly. As it turns out, the new documentation process, which incorporates a secure cloud-based server for transferring recorded dictations to transcriptionists, is boosting the practice’s productivity, decreasing the time from dictation to entry into the electronic health record (EHR) by about a day. This helps our billers submit claims more promptly, which improves our cash flow. Most importantly, our physicians can dictate and share recordings wherever and whenever they want more efficiently and faster than in previous years.
Office-centric workflow inefficient, unpopular
OAD’s former process for sharing dictations with transcriptionists was rigid. At the practice, recordings were uploaded to a local network that was slow and not mobile compatible. Providers outside the office either dictated directly into their laptops with a dictation microphone or used handheld digital recorders. In both scenarios, files could only be uploaded on the practice network. Transcriptionists, likewise, needed to be at the office to access files although many requested to work from home.
Although somewhat inefficient, the office-centric dictation and transcription workflow helped the practice comply with the security requirements of HIPAA. Any process change involving the sharing of protected health information (PHI) on those recordings would also have to enable HIPAA compliance.
In 2015, we transitioned to a cloud-based dictation workflow management platform that allows physicians to upload and store encrypted dictation recordings from anywhere to a secure server. Thus, we really started to get into the “mobile mindset.” The recordings from the server can be accessed on most web browsers, which allows our transcriptionists to work from their preferred location. After a two-week trial run, we were confident this workflow modification would help our physicians dictate more efficiently outside the office while solving the work-from-home challenge.
Smartphone app proving popular
With 90 to 130 dictations per day, many of which are not recorded in the main OAD office, providers wanted flexible, mobile options to create patient care notes. Many physicians still dictate directly into their laptop with the dictation microphone, while others have begun using an integrated dictation recorder smartphone app that transfers recordings directly from their mobile device to the cloud. Either process allows them to dictate at the office, at a hospital after a procedure, or at home.
In the new workflow, physicians are prompted to embed meta-data, such as where care is delivered and the patient’s date of birth, to their dictation file through customizable dropdown menus. When the provider sends the file with the embedded data to the cloud, the files are encrypted in real time at the highest encryption standard available during upload and download. Files can be encrypted for a third time if recorded in the DSS Pro format. Transcriptionists can then securely access and clearly view and sort the files in several ways, such as by date, location or priority. Since transcriptionists work directly within the EHR, the meta-data added by the provider helps ensure that the proper information is matched with the correct patient.
Efficiency and quality care
Our providers appreciate being able to bill for services 24-hours sooner than with the former workflow thanks to the faster documentation turnaround. From a quality perspective, the ability to document care faster can also make information available more promptly to other providers around the care continuum, such as primary care physicians, who need to be updated about patients’ statuses.
However, our providers are perhaps most pleased that the cloud-based server has been seamlessly integrated into their established workflow, allowing them to concentrate on capturing clinical details through their voice instead of being distracted by technology.
About the author:
Timothy Gregorich is the director of information technology at Orthopaedic Associates of Duluth, P.A., and works with Philips dictation solutions.