Dictation and EMRs: A Bad Marriage?

I know some people aren’t going to like hearing this — voice-recognition and dictation are very appealing to some — but the following study suggests that they may not marry well with an EMR.

To perform the study, which was conducted by researchers with Partners Healthcare in Boston, the researchers examined records on 7,000 patient visits to 234 primary care docs in the Partners system. All patients in the study had coronary artery disease or diabetes.

To determine how documentation affected care, they looked at how doctors using just an EMR did compared with those that did dictation on cases.

When they analyzed the data, researchers found that doctors who worked solely with EMRs provided better care than those who dictated their notes when weighed by 15 measures of quality. And physicians who did solely dictation didn’t score better than those using structured data on any measure.

It’s worth noting here that only 9 percent of doctors were using pure dictation. Sixty-two percent of doctors typed their notes as free text in the EMR, and 29 percent used the documentation structure the EMR provided.  So if you dig in, it seems that we’re not just talking about dictation vs. entry of structured data, we’ve got this huge group of MDs doing free text.

According to the researchers, the results suggest that doctors using structured EMR templates were more likely to take every recommended step in a care path. They also noted that if doctors entered structured notes, they would have the benefit of  using clinical decision support tools provided by the EMR. (Researchers didn’t say whether the doctors entering structured data actually did use those tools, though.)

All that being said, the study found that the physicians who were doing the structured data approach were the least satisfied with their documentation style.  Seems like a “damned if you do, damned if you don’t” situation.  Is there a way to make structured documentation more comfortable for doctors?  I certainly hope so.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • John…thanks for bringing this study to the light. It provides good support for structured templates. You are right. How can we make those templates more palatable to physicians? Sounds like an opportunity to me!

  • It’s not about making the templates more palatable, it is about making them more usable. I can dictate ten times faster and cover ten times more information over several disease states in the time it takes me to go through ONE template. I don’t mind the templates, in fact I would enjoy using them because they do make me think of things I forgot to ask or do with a disease state. Having said that, I DON’T HAVE TIME TO USE THEM!! Someone needs to invent a template that would work together with the dictation. Everytime you “hit” one the right words, it lights up the template. If you forget some important words they blink (kind of like an old time pin-ball machine).

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