Using voice to create inpatient progress notes: effects on note timeliness, quality, and physician satisfaction

Abstract

Objectives We describe the evaluation of a system to create hospital progress notes using voice and electronic health record integration to determine if note timeliness, quality, and physician satisfaction are improved. Materials and methods We conducted a randomized controlled trial to measure effects of this new method of writing inpatient progress notes, which evolved over time, on important outcomes. Results Intervention subjects created 709 notes and control subjects created 1143 notes. When adjusting for clustering by provider and secular trends, there was no significant difference between the intervention and control groups in the time between when patients were seen on rounds and when progress notes were viewable by others (95% confidence interval −106.9 to 12.2 min). There were no significant differences in physician satisfaction or note quality between intervention and control. Discussion Though we did not find support for the superiority of this system (Voice-Generated Enhanced Electronic Note System [VGEENS]) for our 3 primary outcomes, if notes are created using voice during or soon after rounds they are available within 10 min. Shortcomings that likely influenced subject satisfaction include the early state of our VGEENS and the short interval for system development before the randomized trial began. Conclusion VGEENS permits voice dictation on rounds to create progress notes and can reduce delay in note availability and may reduce dependence on copy/paste within notes. Timing of dictation determines when notes are available. Capturing notes in near-real-time has potential to apply NLP and decision support sooner than when notes are typed later in the day, and to improve note accuracy.

A Randomized Trial of Voice-Generated Inpatient Progress Notes: Effects on Professional Fee Billing

“…Detailed descriptions of the VGEENS randomized trial and selected system outcomes have been published elsewhere. 12,13,16 In brief, physicians used VGEENS during or after rounds to record a dictation on a cell phone with an Android application. On a server, the digitally recorded dictation was converted to text using ASR (Dragon Medical Practice Edition, Nuance) and automatically edited.…”

“…A randomized controlled trial comparing VGEENS to manual note entry did not find superior outcomes in the domains of note timeliness, quality (as measured by PQRI-9), and physician satisfaction. 13 When notes were dictated soon after rounds, b notes were available in the EHR within 10 minutes.…”

Asynchronous Speech Recognition Affects Physician Editing of Notes

“…The clinical notes analyzed in this work were created through the voice-generated enhanced electronic note system (VGEENS) study, which was an effort to improve timeliness, quality, and physician satisfaction. [23][24][25] The VGEENS study developed and implemented a process for creating inpatient progress notes for patients hospitalized on the internal medicine service of two teaching hospitals (University of Washington Medical Center and Harborview Medical Center). [23][24][25] Study participants were internal medicine physicians, including resident physicians and attendings (but not nurses, medical students, or other health professionals).…”

“…[23][24][25] The VGEENS study developed and implemented a process for creating inpatient progress notes for patients hospitalized on the internal medicine service of two teaching hospitals (University of Washington Medical Center and Harborview Medical Center). [23][24][25] Study participants were internal medicine physicians, including resident physicians and attendings (but not nurses, medical students, or other health professionals). The study included an unblinded randomized controlled trial, consisting of: a control group of physicians that created progress notes by typing text into a note template (typical approach at these medical centers) and an intervention group that used the VGEENS to create notes.…”

“…The insertion of new information during editing raises the question of whether the dictated intervention notes are more informative than the control notes. The analysis of the VGEENS dictated intervention notes and manually typed control notes from Payne and colleagues 23,25 included measures of note quality using the 9-Item Physician Documentation Quality Instrument (PDQI-9). 28 These studies found no significant differences in the PDQI-9 scores between the VGEENS intervention and control notes.…”