Speech Recognition in the Electronic Health Record. Appendix C: Tasks and Skills List

This practice brief has been updated. See the latest version here. This version is made available for historical purposes only.

Current Tasks and Skills: Dictator

1. Operate audio capture equipment
   a. Digital telephone device
   b. Digital hand-held device
   c. Analog hand-held device
   
2. Dictate patient encounter
   a. Identify patient
   b. Identify report type
   c. Dictate details of encounter
   
3. Receive and review transcription
   a. Revise incorrect or missing text
   b. Resend for changes or
   
4. Approve and sign off

New Tasks and Skills: Dictator

Server-based SRT

1. No change in the basic tasks and skills for dictators is required.
2. Dictators should be made aware that speech recognition is being used to transcribe documents and trained in organizing and modifying their dictation slightly for better accuracy.

User-based (Front-end) SRT (Physician as Editor)
I. Operate speech recognition program

A. New user: enroll new speech user file
B. Pre-enrolled user: open speech user file
C. Open appropriate template
D. Begin dictating

1. Identify patient
2. Correct errors
3. Dictate formatting, including punctuation
4. Dictate details of encounter

E. Review
F. Revise incorrect or missing text
G. Approve
H. Sign off

User-based (Front-end) SRT (Third-party Editor)
I. Operate speech recognition program

A. New user: enroll new speech user file
B. Pre-enrolled user: open speech user file
C. Open appropriate template
D. Begin dictating

1. Identify patient
2. Correct errors
3. Dictate formatting, including punctuation
4. Dictate details of encounter

E. Transmit to third-party editor
F. Receive edited document

1. Review
2. Approve
3. Sign off

Current Tasks and Skills: Transcriptionist

1. Knowledge of grammar, punctuation, and style
2. Knowledge of English/American language usage
3. Knowledge of medical language, including all specialties and work types
4. Knowledge of computer word processing and performance enhancement applications
5. Ability to listen, interpret what is heard, and keyboard entries to software application
   a. Input cues from physicians, including ESL, rapid speech, and implied and direct instructions b. Query for ambiguous or conflicting elements and/or instructions
   c. Verify patient data and correct event
   d. Verify geographic-specific information and proper nouns
   e. Identify poor audio quality or other barriers to accuracy
   f. Prompt dictator or other appropriate management regarding errors in dictation
6. Transmit document to quality assurance or originating dictator as appropriate

New Tasks and Skills: Transcriptionist-Editor

1. No change
2. No change
3. No change
4. No change
5. Ability to operate speech recognition transcription editing program
   a. Listen to dictation carefully and compare to ranscribed document
   b. Make appropriate corrections and changes
   c. Input cues from physicians, including implied and direct instructions
   d. Verify patient data and correct event
   e. Prompt dictator or other appropriate management regarding errors in dictation
6. Transmit document to quality assurance or originating dictator as appropriate
7. Automated program transmittal of recognition correction for continuous accuracy training of speech user file

Current Tasks and Skills: HIM Department

1. Establish policies and procedures surrounding dictation guidelines
2. Define required content of all reports, including section headings and reports that are required for specific admissions
3. Establish turnaround time frames for every work type
4. Establish policies and procedures regarding the use of standard (canned text) reports. Gain medical staff approval of contents of each canned text report and templates
5. Determine formatting requirements to meet the needs of the facility and medical staff
6. Establish policies and procedures for signature requirements (residents, medical students, PAs, NPs, etc.)
7. Establish policies and procedures for auto-faxing if necessary
8. Establish policies and procedures for copy distribu- tion (referring physician, attending physician, consultants)
9. Establish policies and procedures for e-signature
10. Establish policies and procedures for addenda
11. Manage system for medical transcription, monitoring work in progress
12. Train new users of dictation equipment
13. Sort transcribed reports as received from print source and place in patient record
14. Query originator and resolve for clarification of any remaining missing or incorrect information (blanks, patient demographics, conflicting elements)
15. Check that all required reports are present in patient record
16. Any missing reports flagged as a chart deficiency
17. Request the appropriate clinician to complete dictation
18. Approve and sign off
    

New Tasks/Skills: HIM Department

1. No change
2. No change
3. No change
4. No change
5. No change
6. No change
7. No change
8. No change
9. No change
10. No change
11. No change
12. Most physicians understand generic use of dictation equipment. SRT will require more sophisticated training. HIM staff must be well versed in training methodology and trained on the system itself to effectively train physicians and other clinicians.
13. No change
14. SRT
    a. Server-based SR: no change
    b. User-based SR (physician as editor): report is complete and signed when physician completes report
    c. User-based SR (third-party editor): no change
    
15. No change
16. No change
17. No change
18. No change
    

IT Department

1. Identify best hardware configuration to support software applications selected
2. Install speech recognition software
   a. Macros (using content developed by clinicians and HIM)
   b. Templates (using content developed by clinicians and HIM)
   c. Interface with information systems
3. Provide ongoing user support