TY - JOUR
T1 - Asynchronous Speech Recognition Affects Physician Editing of Notes
AU - Lybarger, Kevin J.
AU - Ostendorf, Mari
AU - Riskin, Eve
AU - Payne, Thomas H.
AU - White, Andrew A.
AU - Yetisgen, Meliha
N1 - Publisher Copyright:
© 2018 Georg Thieme Verlag KG Stuttgart · New York.
PY - 2018
Y1 - 2018
N2 - Objective Clinician progress notes are an important record for care and communication, but there is a perception that electronic notes take too long to write and may not accurately reflect the patient encounter, threatening quality of care. Automatic speech recognition (ASR) has the potential to improve clinical documentation process; however, ASR inaccuracy and editing time are barriers to wider use. We hypothesized that automatic text processing technologies could decrease editing time and improve note quality. To inform the development of these technologies, we studied how physicians create clinical notes using ASR and analyzed note content that is revised or added during asynchronous editing. Materials and Methods We analyzed a corpus of 649 dictated clinical notes from 9 physicians. Notes were dictated during rounds to portable devices, automatically transcribed, and edited later at the physician's convenience. Comparing ASR transcripts and the final edited notes, we identified the word sequences edited by physicians and categorized the edits by length and content. Results We found that 40% of the words in the final notes were added by physicians while editing: 6% corresponded to short edits associated with error correction and format changes, and 34% were associated with longer edits. Short error correction edits that affect note accuracy are estimated to be less than 3% of the words in the dictated notes. Longer edits primarily involved insertion of material associated with clinical data or assessment and plans. The longer edits improve note completeness; some could be handled with verbalized commands in dictation. Conclusion Process interventions to reduce ASR documentation burden, whether related to technology or the dictation/editing workflow, should apply a portfolio of solutions to address all categories of required edits. Improved processes could reduce an important barrier to broader use of ASR by clinicians and improve note quality.
AB - Objective Clinician progress notes are an important record for care and communication, but there is a perception that electronic notes take too long to write and may not accurately reflect the patient encounter, threatening quality of care. Automatic speech recognition (ASR) has the potential to improve clinical documentation process; however, ASR inaccuracy and editing time are barriers to wider use. We hypothesized that automatic text processing technologies could decrease editing time and improve note quality. To inform the development of these technologies, we studied how physicians create clinical notes using ASR and analyzed note content that is revised or added during asynchronous editing. Materials and Methods We analyzed a corpus of 649 dictated clinical notes from 9 physicians. Notes were dictated during rounds to portable devices, automatically transcribed, and edited later at the physician's convenience. Comparing ASR transcripts and the final edited notes, we identified the word sequences edited by physicians and categorized the edits by length and content. Results We found that 40% of the words in the final notes were added by physicians while editing: 6% corresponded to short edits associated with error correction and format changes, and 34% were associated with longer edits. Short error correction edits that affect note accuracy are estimated to be less than 3% of the words in the dictated notes. Longer edits primarily involved insertion of material associated with clinical data or assessment and plans. The longer edits improve note completeness; some could be handled with verbalized commands in dictation. Conclusion Process interventions to reduce ASR documentation burden, whether related to technology or the dictation/editing workflow, should apply a portfolio of solutions to address all categories of required edits. Improved processes could reduce an important barrier to broader use of ASR by clinicians and improve note quality.
KW - clinical documentation and communications
KW - electronic health records and systems
KW - natural language processing
KW - notes
KW - workflow
UR - http://www.scopus.com/inward/record.url?scp=85055079097&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85055079097&partnerID=8YFLogxK
U2 - 10.1055/s-0038-1673417
DO - 10.1055/s-0038-1673417
M3 - Article
C2 - 30332689
AN - SCOPUS:85055079097
VL - 9
SP - 782
EP - 790
JO - Applied Clinical Informatics
JF - Applied Clinical Informatics
IS - 4
ER -