Dragon System: Taking Dictation to the Next Level

Brett Meyer, MD, using Dragon Voice Recognition.

The high costs and time delays of transcribing medical notes are being slain by a dragon…the Dragon Naturally Speaking Voice Recognition Software being deployed throughout the UC San Diego Medical Group and Medical Center. Christopher Clarke, clinical systems documentation coordinator, explains that when providers use voice recognition software with Epic-integrated software to document their patient encounters – rather than traditional transcription methods – they are entering clinical content immediately into that patient’s medical record, simply by dictating into their computers.

“The ultimate beneficiaries are our patients,” said Clarke. “Immediate documentation enhances the timeliness of entries in the medical record and eliminates the delay usually associated with outside transcription services.” And, it reduces expenses associated with transcription services, which is also a bonus.

The benefits for physicians are also tangible, according to Joe Ramsdell, MD, professor of medicine and chief of General Internal Medicine. He is an early adopter of the Dragon voice recognition software for his own practice and for the Internal Medicine Group, which was paying more than $300,000 to $500,000 annually for dictation services.

“The system is great for efficiency, economy, accuracy and legibility, and it allows us to spend more time with more patients and still go home at the end of the day,” said Ramsdell.

Relationships with referring physicians are also enhanced as a result of real-time documentation using this software. “Utilizing voice recognition software to update the patient’s record enhances the quality of feedback to community providers, providing complete clinical observations and timely delivery,” said Clarke. 

When traditional transcription services are used, the initial encounter information is sent to the referring physician via Epic Communication Manager and the dictation may not arrive back for days after. Dragon ensures that comprehensive progress notes are sent along with the encounter report, ensuring rapid, detailed communication with the referring physician regarding a patient’s status.

The same is true within the UCSD clinical system. For example, operative reports created with Dragon are immediately available on the Patient Care Information Systems (PCIS) to be sent to the nursing treatment unit where the patient will be receiving post-operative care. Clarke reported that more than 200 computers throughout the Medical Group and Medical Center have been loaded with Dragon software and more than 150 physicians have participated in the ongoing training program. When they receive training, physician users are provided with individual headsets that they simply plug into the computer. Physicians can also install the Dragon software on their home computers.   

The system types 160 words per minute, according to trainer Mark Kornheiser, (Mark is our trainer from A1 Productivity Products, who set up and trained their Doctors and users ) who is providing instruction for UCSD users. Templates and commands can be established to further expedite the dictation, allowing physicians to pre-program frequently used phrases or acronyms which the system will spell out, and create other shortcuts to rapidly and accurately fill out standard forms. By watching as the dictated record appears on the screen, the physician can verbally or manually correct any errors as they appear. 

“It takes a brief initial investment of time to make the system work for you, and you need to learn a little vocabulary to make things go quickly,” said Ramsdell, noting that, to aid the user during the first stages of learning the system, a pocket-sized reference card is provided during the training session. “Now, I have my normal exam set up as a macro, so I can record the information and edit very quickly. The system provides a lot of flexibility, and we have learned as we’ve implemented the system in our practice that whenever we’ve encountered a question or problem, there has been a solution.”

The Medical Group and Medical Center are committed to deploying Dragon Naturally Speaking Voice Recognition Software throughout the system. Dragon software has been installed in all physician work rooms, on the nursing units, in the OR lounges and in most ambulatory clinic work rooms.