To Dictate or Not to Dictate?

The researchers evaluated 18,569 visits by 7,000 patients with coronary artery disease and diabetes to participating physicians in a regional healthcare delivery network in eastern Massachusetts. Of these 234 doctors in the study, 20 (9 per cent) dictated their notes, 68 (29 per cent) used structured documentation, and146 (62 per cent) typed free-text notes.

Dictation was done via telephone and transcribed and uploaded to the electronic health record (EHR). Structured documentation involved using templates that divided the patient visit note into separate sections (e.g., history of present illness, review of systems, family history) for the doctor to fill in. Free-text notes were created using a single window, similar to a word-processing program.

The main outcome measures were 15 coronary artery disease and diabetes measures assessed 30 days after primary care visits.
Compared to the other two documentation styles, quality of care was significantly worse on three outcome measures for dictators. These measures were antiplatelet medication, tobacco use documentation and diabetic eye exam.

Quality of care was better on three measures for doctors who used structured documentation. These measures were blood pressure documentation, body mass index documentation and diabetic foot exam. Doctors who used free-text notes had better quality of care in providing influenza vaccinations.

There was no measure associated with higher quality of care for doctors who dictated their notes.

"Dictating may be easier for the doctor, but patients need to be careful," said Doctor Jeffrey Linder of 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."; Source: Brigham and Women's Hospital (BWH)