Front End Speech Recognition: A case of dime wise and dollar foolish?


medical-error-picA new study sponsored by Agency for Healthcare Research and Quality (AHRQ) identified the frequency with which errors occur when physicians use front end speech recognition.

” Critical errors were found in 15 percent of data entered into patients’ electronic health records by physicians using computerized speech recognition technology, according to a pilot study funded by AHRQ. The study evaluated front-end speech recognition technology that allows dictation and editing in an electronic record’s text field. The study examined speech recognition errors based on 100 patient notes by attending emergency department physicians in Boston from January to June 2012. Findings showed that there were 128 errors, or 1.3 errors per note, and that of the 71 percent of notes that contained errors, 15 percent contained one or more critical errors that could potentially lead to miscommunication affecting patient care. Annunciation errors were most common, followed by deletions and added words. Study findings represent the first estimates of speech recognition errors in dictated emergency department notes, researchers said. The study, “Incidence of Speech Recognition Errors in the Emergency Department,” and abstract were published in the International Journal of Medical Informatics.”

As you know for years EHR vendors and speech recognition technology vendors have been pushing front end speech recognition as an alternative to dictation. With fancy demos and presentations, they have been able to convince CFOs how hospitals can save millions by avoiding transcription. But by avoiding transcription and pushing the burden of documentation onto physicians, hospitals definitely saved money but in that process had to accept incomplete and inadequate documentation by physicians. To overcome the new problems with documentation they had to spend a lot more on clinical documentation improvement programs employing highly paid CDI specialists.

Due to this overwhelming burden of documentation, physicians are not only extremely frustrated as recent surveys have shown but are also financially impacted as they are able to see far fewer patients than before.  With hospitals owning more and more physician practices, the cost of their physicians seeing fewer patients is very high.

In conclusion, such high error rates in documentation are only expected because the medical records are now being asked to be completed by physicians who are fully frustrated, not trained at all in such a task and they are under continuous pressure coping with the ever changing rules and regulations of healthcare.