Feature Article

Where Dictation and Transcription Fall Short

When you think about the importance of efficiency in cardiovascular care areas, it can be frustrating to contend with the inefficiencies of traditional procedure reporting.

There have been ongoing efforts to improve it. But when it comes to Cardiology’s most pressing challenges, the conventional, non-structured approaches to physician reporting—dictation & transcription—are quickly falling behind.

Let’s take a look at the difficulties with this approach and what’s driving the move to a more structured one.

The challenges of cardiology reporting

How do you ensure the quality of your team’s procedure reporting with traditional methods? Chances are it’s a multi-pronged effort: speaking clearly with validated dictation solutions, using qualified transcriptionist's, taking quality assurance measures, avoiding interruptions. Advances in automation, voice recognition and machine learning help to translate speech-to-text in real time more accurately every day.

Yet, no matter how sincere your efforts to improve the data you put into your reports, there are at least two key barriers to getting real value out of them.

1. Physician variability

A primary driver of physician variability is cultural; based on training, preferences and experience. While some standards and guidelines are available, without structured data elements there can be wide variation report-to-report.

The American Society of Nuclear Cardiology meeting (ASNC 2019) brought up an interesting experiment. The investigator had instructed a group of physicians to view a series of imaging reports, but, unbeknownst to the readers, inserted several instances of invalid text. What the study found was that a majority of physicians—regardless of specialty or training—did not report seeing the information.

This is a phenomenon called in-attentional blindness. The idea, borrowed from psychology, is that our brains tend to focus on what we expect to see during a task and gloss over the unexpected. Apparently, no matter how nonsensical.

The implication for clinical reporting is clear: the possibility for patient-impacting errors to arise.

2. Unstructured data

Traditional reporting methods might be familiar and easy to learn. But these days, dictation and transcription simply don’t take maximum advantage of advances in cardiology systems and best practice workflows.

For example, they don’t allow physicians to easily consolidate and extract insights from data silos across the care continuum. Structured data vs. free text is critical to analyzing and optimizing clinical, financial and operational outcomes, sharing data with local and national registries and evangelizing the value of cardiology to the wider business.

Neither do these methods fully utilize the tools available. The ability to review cardiology images in parallel with structured data can go a long way to help reduce report turnaround times and adhere to guideline driven documentation. This speed and documentation consistency can enhance clinical communication (and help shorten the time to bill).

With these challenges in mind, the ACC has recommended a move away from dictation models. So what does the alternative look like?

Opportunities for improvement

In a recent global design study, we spoke to physicians about these issues and how they’d like to improve the reporting process. Their feedback aligned across the board on ideas like:

  • Reduce manual work: Automate cardiology workflows within the cardiovascular information systems (CVIS) and connectivity across the EMR.
  • Reduce clicks: Make navigation easier—no toggling between several forms to populate the information required.
  • Standardize templates: Create consistent, clinically relevant reports that are clear and concise for referring physicians.
  • Make it easy to deviate from the norm: Provide guidance and structure for documenting infrequent tasks consistently.

The bottom line: consistent reporting with structured data provides many clinical, financial and operational improvement opportunities but the workflow must be designed with the end user in mind.

Structured reporting as a solution

At its core, structured reporting is the capture of information as discrete data, integrated into clinical workflows, in a way that can be reused for multiple purposes. This evolving method takes out the unpredictability and unstructured data elements from dictation and transcription, upon which downstream processes rely so heavily. Instead, today’s structured reporting tools use advances in data capture and integration with key systems.

For example, following a Cath procedure, procedural data is extracted and recompiled to summarize what happened during the procedure, allowing the physician to focus on assessing findings rather than describing the procedure itself.

Despite breaking through more than a decade ago, structured reporting has been slow to gain traction outside of Echo. Some physicians still prefer the traditional way; as one Cardiologist put it “Old habits die hard. We’re taught in medical school that being verbose (as opposed to being structured) and writing an extensive dissertation about patients is the best way to achieve a high grade.”

And template-based traditional reporting methods (like transcription and dictation) can have the unintended consequence of lowering productivity of some other tasks like billing, accreditation and registry submissions to name a few.

So, what’s a tech-savvy Cardiovascular Director to do? How do you balance physician productivity and preferences with the need for structured, meaningful data?

In a recent webinar, we sat down with a practicing cardiologist to talk about the value of structured reporting, how to engage physicians to increase adoption and the results the hospital has achieved.  

Watch the recording to learn how structured reporting works in practice

To learn about GE Healthcare’s Cardiovascular IT solution, visit our website.