Care quality 'significantly worse' when docs dictate notes by phone

How a physician documents patient encounters in an electronic health records system can impact the quality of care his or her patients receive, according to a new study published in the Journal of the American Medical Informatics Association.

Brigham and Women's Hospital researchers partnered with colleagues at other organizations to study 18,569 patient visits for 7,000 patients to 234 primary care physicians. the study measured 15 EHR-based coronary artery disease and diabetes measures assessed within 30 days of a patient visit.

Nine percent of the physicians dictated their notes by telephone, which were transcribed and uploaded into the EHR. Sixty-eight percent of them used structured documentation in the EHRs, such as templates; 62 percent typed their notes in free text into the EHRs.

The researchers found that the quality of care appeared "significantly worse" for those who dictated over the phone than for physicians using the other two documentation styles on three of the 15 measures. The structured documenters scored better on three measures, and the free texters scored better on one measure. 

"Physicians who more intensively interact with their EHRs through their documentation style may pay greater attention to coded fields and clinical decision support and thus may deliver higher quality care," the study's authors wrote.  

"Dictating may be easier for the doctor, but patients need to be careful," said lead author Jeffrey Linder, M.D., associate professor of medicine at BWH and Harvard Medical School. "Doctors who dictate may not be paying as close attention to information and alerts in the electronic health record that are important for patient health."

Docs often balk when asked to change their workflows and habits to accommodate EHRs, but in the search to improve physician adoption of health IT, CIOs may do well to share the benefits to patients of doing so. 

To learn more:
- here's the study abstract