Abstract
BackgroundElectronic medical records (EMR) are considered the best solution to improved dissemination of health information for patients. The associated transcription caused a significant cost increase in an academic pediatric center. An educational campaign was implemented to achieve cost-effective transcriptions without compromising the number of EMR transcriptions.MethodsWe analyzed the effect of seniority on transcription times over a 4-month period. We also compared the dictation volume before and 4 months after educational interventions. This study was performed in a pediatric academic center with both inpatient and outpatient transcription utilization analyzed. All clinicians providing pediatric care and utilizing the hospital-based transcription over the study time period were analyzed. Interventions included targeted education about efficiencies in transcription, time-based dictation costs, avoidance of lengthy pauses and unnecessary detail, shortening of total transcriptions, superfluous phrases as well as structured templates. Level of training by postgraduate year of training and seniority within faculty were measured for impact on dictation time and effect of education to improve times.ResultsLearners in year one had an average dictation time of 7.5 ± 2.2 minutes, which decreased with seniority to an average of 4.1 ± 2.2 minutes for senior faculty (0.0007, ANOVA). After educational initiatives were implemented, there was progressive decline in dictation utilization. The total dictation time decreased from 8,750 minutes per month in August 2009 to 4,296 minutes in December of 2009 (p = 0.0045, unpaired t-test).ConclusionWe identified a substantial need for education in dictation utilization and demonstrated that relatively simple interventions can result in substantial costs savings.
Highlights
Electronic medical records (EMR) are considered the best solution to improved dissemination of health information for patients
Our academic health science center in London, Ontario, Canada has moved towards dictations being placed within our hospital EMR
Learners in year one had an average dictation time of 7.4 minutes/letter, which decreased with seniority to an average of 4.5 minutes/ letter for senior faculty (p = 0.0075, ANOVA, Table 3, Figure 1)
Summary
Electronic medical records (EMR) are considered the best solution to improved dissemination of health information for patients. Electronic medical records (EMRs) are considered the preferred choice for the rapid dissemination of clinical information [1]. Our academic health science center in London, Ontario, Canada has moved towards dictations being placed within our hospital EMR. As a cost containing measure, the hospital administration decided to invoice physicians for dictation utilization in excess of the median utilization percentage derived from peer institutions. This change in policy bore the potential of discouraging physicians to utilize the dictation system. An educational campaign was implemented to identify opportunities for succinct transcription and other cost containment strategies to maintain a high proportion of transcriptions without a decrease in the usage of transcription service
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