Accuracy – at what cost?

The accurate capture of the physician’s encounter with a patient is a critical component in the delivery of excellent healthcare. Whether written electronically or by hand, the transcribed report is a permanent record for the current and future evaluation of a patient. Inaccurate information in the file carries patient safety and financial implications.

NEMT New Business Development Director Rick Bisson

The patient safety costs associated with inaccurately documenting a patient’s illness may be minimal but sometimes life threatening. Recently, a dictator said hypothyroidism in the body of the report and hyperthyroidism in the impression.

Another very common scenario is right/left and gender confusion within a report.  Had these examples gone undetected, the report would be inaccurate and in some situations inconclusive. Is there a price tag for these inaccuracies?

Are these trivial errors? You could argue that they are, but if this was your report or the report of your child or parent would you think these discrepancies unimportant? As you become a more educated consumer and increasingly intimate with your own and family members’ electronic medical records, these errors will be discovered and you’ll demand corrections. Remember, your current and future health and safety depends on the accuracy of this information.

Financially the cost of the physician’s time is greatest in this analysis. Doctors are the highest paid, highest income producing assets to a facility. When they are interrupted to correct a report, they are spending time away from seeing patients.

Perhaps the correction takes a matter of seconds, but consider the impact this seemingly small interruption has on the doctor’s workflow. They are probably not going to be happy with a distraction that consumes 15 to 20 minutes out of their working hours. It’s likely the doctor will vent to a health information manager, administrator or fellow physician. Repeated errors will escalate the issue for discussion at a physician, quality or clinical documentation improvement meeting. Clearly there is a heavy price tag on this process.

And what about the costs associated with workarounds designed to Band Aid the problem? I’ve seen scenarios where a hospital will spend hundreds of thousands of dollars installing a new system they’re told will improve accuracy. After months of discussions, a lengthy implementation and then a few months for the dust to settle, the problem still exists in a slightly modified state.

Soon doctors will again be voicing their frustrations with the accuracy of their transcribed dictation. Staff and administrators will be dedicating time to listen to doctors’ voice their dissatisfaction. This all sounds expensive and time consuming.

On the other end of the spectrum, some docs type their own reports or use speech recognition. This may be a personal preference or a mandated workflow. Either way, if the doctors are typing or self-editing their reports then they’ve taken on clerical duties. Furthermore, if a trained editor or transcriptionist is not reviewing the report then the physician has created a legal liability. Ask yourself; is this a best practice for a healthcare provider?

In another example I was speaking with an oncologist friend recently. He practices in the midwest and we usually catch up with each other in the summer.  As usual, the greeting was quickly followed by a check point conversation on his dictation. He offered up that he now spends three to four hours a day typing his patient notes directly into the facility’s EMR. Admittedly he could spend less time by following the pattern of his colleagues, who copy and paste large chunks of their reports, but he is unwilling to compromise the specific encounter with a generic narrative. In the best interest of the patient’s current and future health, he values accurately and completely capturing the patient’s specific encounter.

When asked how many fewer patients he was seeing in a day due to his newfound clerical duties he relayed that there were no fewer patients, only less time spent with his wife and their young children; he types his reports on his own time. Frustrated and discouraged, he revealed that he recently sought out a facility that did not require him to enter his own reports — he was moving on.

Would you agree that physician dissatisfaction and retention are another costly element in the battle to deliver quality care?

Since the HITECH legislation, the pace of change in healthcare documentation has been moving at hyper speed. The vision of an electronic file, accessible within and across state lines, is long overdue and it will change forever the speed and appropriateness of patient care. As EMRs mature and Meaningful Use requirements in Stages 2 and 3 are tied to incentives, an increased emphasis on capturing and sharing healthcare data will create a greater demand for the accuracy of the patient’s documented encounter.

What do you think? Are you seeing an increased emphasis on accuracy? What are you doing to monitor and improve the delivery of accurate patient documentation?

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