Study Shows 96 Percent of Doctors Concerned About Losing the Unique Patient Story with Transition to Electronic Health Records

BURLINGTON, Mass.--(EON: Enhanced Online News)--Nuance Communications, Inc. (NASDAQ: NUAN), has clinical documentation and communication solutions in more than 5,000 healthcare organizations, and more than 250,000 physician users across the United States. Nuance recently engaged more than 17,000 physicians in a survey to learn about physicians' hopes and concerns with respect to healthcare information technology, as well as to gauge their understanding of developing healthcare government policy. Today, Nuance is announcing results from its survey, which represent responses from nearly 1,000 physicians.

Over the last several months, the Centers for Medicare and Medicaid Services have been working closely with the Office of the National Coordinator for Health IT (ONCHIT) and the Department of Healthcare and Human Services (HHS) to define the incentive programs outlined in the HITECH Act. HHS is expected to publicly release a draft definition of electronic health record (EHR) "meaningful use" by the end of December 2009.

As the HIT Policy Committee works to finalize the "meaningful use" definition, Nuance's survey found that there is concern that too much emphasis will be put on data capture and quantitative measures alone vs. the capture of qualitative information that helps tell each patient's unique health story. There is also concern over the long-term impact of the HITECH initiative.

  • When physician respondents were asked how concerned they are "about losing the unique patient story with the transition to point-and-click (template-driven) EHRs," 96 percent voiced concern, reinforcing the need for patient health records to be created using a combination of structured and narrative information.
  • 94 percent said that "including the physician narrative as part of patients' medical records" is "important" or "very important" to realizing and measuring improved patient outcomes.
  • Less than 10 percent of physician respondents said they were either "confident" or "very confident" that "the federal government's health information technology and reimbursement standards will lead to higher quality patient health records."

"I am a clinician first and last. I believe in the sanctity of the physician-patient relationship and that without the focus and the belief that care must be patient centered, the quality of care will always be suboptimal," said Stephen M. Sergay, MB BCh, Immediate Past President, American Academy of Neurology. "Humanism needs to be restored to the overwhelming demands of technology, scientific advances and econometrics. I believe that delivery of high quality care begins with the physician-patient encounter, therefore demanding a quality narrative of the history of the main complaint."

As part of the survey, respondents were also shown two versions of a de-identified patient's note (history of present illness, also known as the HPI Note), which was shared by Dr. R. Hal Baker, CMIO, Wellspan Health (see the two notes below). The first note was created by a doctor via speech recognition describing the patient encounter and care plan in narrative form (through the use of speech recognition technology). The second note (on the same patient, for the same visit) was created using an EHR point-and-click template, based on the structured elements selected by the doctor.


HPI Note #1 (dictated with Dragon Medical) - "The patient is a 74-year-old female who presents with a complaint of fall, 74-year-old female presents with complaint of neck pain, headache. She states that she had mechanical fall at home where she tripped and fell downstairs, approximately 9 steps and landed on her back. She complained of shortness of breath right after the event. She noted that she had pain in her left ankle and left knee. She is not sure whether she had loss of consciousness and the patient further complains of the pain in the right wrist."


HPI Note #2 (produced using an EHR template) - "The occurrence was one hour prior to arrival. The course of pain is constant. Location of pain: Head leg. Location of bleeding: None. Location of laceration: None. The degree of headache is mild. The other degree of pain is moderate. The degree of bleeding is negative. Mitigating factor is negative. Immobilization no backboard in place and no cervical collar in place. Fall description tripped. Intoxication: No alcohol intoxication. Location accident occurred was home."


When the surveyed physicians were asked which note they would "consider more valuable in treating this patient," 97 percent said HPI note #1, the one created from free-form physician dictation via speech recognition. In addition, HPI note #1 was selected as the preferred note for addressing each of the following clinical communication objectives:

  • "Driving high quality caregiver-to-caregiver communication," selected by 98 percent.
  • "Recording the patient encounter, care recommendation and treatment history to safeguard them and/or their practice from medical/legal liability," selected by 93 percent.
  • "Getting physician thoughts into the note - ensuring the medical decision-making is captured," selected by 97 percent.
  • "Representing the uniqueness of the patient encounter - ensuring all relevant, personal information is captured and lives in the patient's health record," selected by 97 percent.
  • Future visits with the patient "for understanding and recalling the patient's history," selected by 98 percent.
  • 98 percent said HPI note #1 was "more complete and can be easily understood by the patient or another caregiver."

"It has become increasingly clear that capturing what the physician is thinking at the point-of-treatment contributes significantly to ongoing, high quality patient care and outcomes. Without an established regulation to require the inclusion of such detailed physician notes in addition to structured data, there is concern amongst caregivers that patients' medical records will be reduced to cookie-cutter documents that do not differentiate from one patient to the next," said Peter Durlach, senior vice president, healthcare marketing and product strategy, Nuance Communications, Inc. "The clear guidance from the physician community is that the Department of HHS should consider a requirement to ensure that each electronic patient note is not limited to templated text and structured data elements alone."

Even though entering additional information in the EHR by typing is possible, for most physicians it is an overly cumbersome process that significantly slows clinical documentation productivity and takes away time with the patient. As an alternative, speech-recognition technology effectively allows physicians to dictate patient information and findings directly into EHRs to generate both the critical narrative components of the note along with required structured elements. To learn more about Nuance's medical speech recognition solutions and how they contribute to improved safety, quality and efficiency of care as part of EHR meaningful use please visit: For the entire survey results please visit: .

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