Duke Primary Care is the community based primary-care network for the Duke University Health System. Over the past several years, DPC has been implementing components of the Duke University Health System electronic health record. The system is based on a very powerful clinical data repository, the eBrowser that interfaces with other programs to provide ePrescribing and messaging capabilities. In spite of this level of IT functionality, there remained significant areas of clinical documentation that relied on paper charts, including the four Duke Urgent Care sites.
As recently as a year ago, DPC had a variety of methods for capturing clinical documentation for the outpatient encounter. Notes were either handwritten or dictated and transcribed using several local vendors. There was significant variability in the level of service received from these local transcription services. Many practices still relied on the paper chart as the source of all clinical information.
Over the past year, leadership within DPC made a commitment to move towards a paperless system and have all of the clinical documentation in an electronic format. With over 85 medical providers representing adult continuity clinics and urgent-care facilities, a flexible, innovate solution was needed. Options considered were:
- Select a medical transcription service that could support the entire DPC network.
- Employ our own medical transcriptionists and manage the service internally.
- Implement speech recognition technology so that each physician and clinician could dictate their office notes via a computer-based software solution and then immediately review, edit and publish their report.
After careful analysis, Duke determined that option one was simply too costly, option two presented significant management and cost issues, but that option three merited further study. In conjunction with a key transcription services partner, we explored using speech recognition in our environment.