Abstract

BackgroundThe context of the current study was mandatory adoption of electronic clinical documentation within a large mental health care organization. Psychiatric electronic documentation has unique needs by the nature of dense narrative content. Our goal was to determine if speech recognition (SR) would ease the creation of electronic progress note (ePN) documents by physicians at our institution.MethodsSubjects: Twelve physicians had access to SR software on their computers for a period of four weeks to create ePN. Measurements: We examined SR software in relation to its perceived usability, data entry time savings, impact on the quality of care and quality of documentation, and the impact on clinical and administrative workflow, as compared to existing methods for data entry. Data analysis: A series of Wilcoxon signed rank tests were used to compare pre- and post-SR measures. A qualitative study design was used.ResultsSix of twelve participants completing the study favoured the use of SR (five with SR alone plus one with SR via hand-held digital recorder) for creating electronic progress notes over their existing mode of data entry. There was no clear perceived benefit from SR in terms of data entry time savings, quality of care, quality of documentation, or impact on clinical and administrative workflow.ConclusionsAlthough our findings are mixed, SR may be a technology with some promise for mental health documentation. Future investigations of this nature should use more participants, a broader range of document types, and compare front- and back-end SR methods.

Highlights

  • The context of the current study was mandatory adoption of electronic clinical documentation within a large mental health care organization

  • Speech recognition (SR) has taken decades to mature to the point where it can be used in medicine

  • We found no statistically significant difference pre- or post-usage for comfort with speech recognition (SR) software, data entry time savings, quality of care, quality of documentation, or impact on clinical and administrative workflow

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Summary

Introduction

The context of the current study was mandatory adoption of electronic clinical documentation within a large mental health care organization. Our goal was to determine if speech recognition (SR) would ease the creation of electronic progress note (ePN) documents by physicians at our institution. Speech recognition (SR) has taken decades to mature to the point where it can be used in medicine. Acceptance of the SR has slowly increased as hardware and software have matured so that the technology ‘adjusts’ to the user rather than vice versa [1]. The introduction of continuous speech systems - which allow the user to speak in his/her normal vernacular and rate of speech - has increased the potential that this technology can enhance the efficiency and quality of creating documentation without negatively impacting the user’s time. Continuous speech recognition resulted in semantic accuracy up to 81% [6], but still was not good enough for clinical use. Another study comparing three different SR applications against each other concluded that increasing computer power, affordability, and software sophistication was making the replacement of transcription with SR more feasible [8]

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