iPad dictation

What you need to know:

  1. Physicians want to chart at the point of care
  2. Not all EHRs support an interface that promotes real-time encounter creation
  3. Physicians need a mobile device that is easy to use in the exam room
  4. EHR software must be optimized and native to the mobile platform
  5. Fingertip touch should be the primary means of data entry
  6. Many times fingertip touch needs to be supplemented with dictation
  7. Dragon products designed for medical use have become the dictation gold standard
  8. Dragon products are difficult to integrate with mobile devices such as the iPad
  9. The iPad has built in dictation functionality (iPad 2 – iPad Air)
  10. iPad dictation functionality has been improving and in many cases can replace Dragon Medical for short bursts of dictation

The gold standard for EHR use is the ability to chart at the point of care. The best way to facilitate point of care data entry is to offer providers a 3-prong strategy:

  1. Fingertip touch – may be the fastest method for data entry – buttons must be sized to approximate the width of a fingertip
  2. Dictation plays an important role for data that can not be easily templated. Dragon Medical Dictation helps clinicians in small practices, including physicians, nurses, NPs, PAs, therapists and other care providers dictate medical decision-making and treatment plans directly into a patient’s electronic record. This dictation methid offers virtually instant response time, improving care efficiency, reduces transcription and the cost of documentation, increases accuracy so that you can spend more time with patients, improves documentation, and will help your practice increase reimbursement.
  3. The slowest but perhaps the most precise method, depending on your typing skills, is keyboarding. Too much keyboarding in the exam room can distract the provider and detract from the optimal patient experience

Using a mobile tablet such as the iPad facilitates charting at the bedside or in the exam room. This means that the moment the patient leaves the exam room, greater than 95% of the charting is completed for the patient.

  1. Many products advertise that they are “iPad Compatible” but very few offer native and complete EHR functionality in an iPad
  2. Often providers are tricked into purchasing EHR products that are not completely compatible with the iPad platform and hence those providers lose out on the mobile computing experience
  3. Physicians that chart in the exam room have the highest encounter note accuracy since the data is being processed and recorded by the provider immediately while the patient is engaged

Products such as MediTouch EHR have complete functionality on an iPad. This means that every module is supported natively via the iPad built-in Safari browser. The interface is optimized for touch, making data entry via the fingertip fast and easy. In addition, MediTouch is designed to offer dedicated areas for the capture of dictated notations.

Note: Apple has not allowed Dragon Dictate Medical to run in the native Safari browser, therefore historically dictating could have posed a challenge for providers.

As the iPad has evolved the MediTouch technical team has continued to test the accuracy and usefulness of the native iPad dictation function. Remember, the first iPad did not have any dictation feature and since the release of iPad 2 we have seen a steady increase in the improvement of the iPad dictation feature. With iPad Air running iOS7 we have seen the biggest leap in the speed and accuracy of iPad dictation, especially with regard to medical terms. We find that iPad dictation is useful for short bursts of dictation rather than long consultation letters. The accuracy of iPad dictation does not match Dragon Dictate Medical. On the other hand Dragon Dictate Medical is expensive and is difficult to implement on an iPad.

Our team has tested iPad dictation with the new Air and the latest version of iOS – 7.1. To test the accuracy of native iPad dictation feature we tested over 600 commonly used medical terms and around 130 commonly used medications. Our results were:

Medical Terms  609 tested Success Rate 96% Download results
Medication Names 133 tested Success Rate 86% Download results

These results support the fact that native iPad dictation is useful for short bursts of medically related transcription and that the benefits of using the EHRs designed to incorporate iPad dictation can be quite meaningful. We believe the correction of any errors far outweighs the time, effort and cost of Dragon Dictate Medical or keyboard as the primary means of data entry.

About Cost:

  1. The investment in an iPad is relatively inexpensive compared to other computing platforms
  2. iPad dictation replaces expensive transcription costs for providers that use dictation as the primary method of recording encounters
  3. iPad dictation may negate the need to invest in Dragon Dictate Medical (Windows Edition $1500 – $2000)
  4. iPad dictation may also negate the need for expensive “scribes” that act as surrogates for EHR data entry
  5. When choosing an EHR, factor the savings of using iPad dictation into your evaluation

Conclusion:

  1. Use an EHR that is optimized for the iPad
  2. Be sure the interface is sized properly for fingertip touch
  3. The EHR must have dedicated areas that can leverage iPad dictation and record and edit the output

Using the combination of fingertip touch, augmented with dictation when indicated improves the chance that provider chart notes can be entered real-time at the point of care. This reduces charting “homework” and increases the accuracy of the encounter note. MediTouch EHR is the only EHR specifically designed to meet those criteria.

What about those terms that are difficult for the iPad to recognize? – See our upcoming blog post for a really great work-around.