Physician Charting vs. Audio/Video Recording with Transcription

[Mount Asclepius]

This concept was previously brought to my attention by my insurance carrier who was looking into a novel idea. This benefits patients in a manner similar to police body cameras. Physicians just like police are hesitant to have patient encounters recorded, but if the benefit was no to little charting then might be worth the trade-off.

Potential downsides include invasion of patient privacy, likely increased testing given pan-positive HPI/ROS and need for increased data storage even if temporary just prior to transcription.

Pluses include perhaps a more accurately documented patient encounter, more time spent with patients and less time charting, as well as not wasting physician's more highly compensated time spent charting.

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[sylvanthus]

Helllllll noooooo.

 

[Groove]

What he said. No way.

 

[dadaddadaBATMAN]

The problem with healthcare is not that we are not perfectly capturing every moment of our encounters to review later for billing and legal purposes.

The problem with healthcare is that we have to do this in the first place.

The purpose of the note was originally to communicate with our future selves and our colleagues.

It has been warped into this abomination.

 

[Mount Asclepius]

The problem with healthcare is not that we are not perfectly capturing every moment of our encounters to review later for billing and legal purposes.

The problem with healthcare is that we have to do this in the first place.

The purpose of the note was originally to communicate with our future selves and our colleagues.

It has been warped into this abomination.

I partially agree. I don’t think we are getting away from increased documentation unfortunately though. I think recording could potentially be coming some day regardless of whether we want it to or not. Police weren’t thrilled by the idea either (I certainly recognize there are differences). I don’t love the idea, but charting to me is one of the worst parts of every shift, and I’d be potentially supportive of ways to eliminate it.

 

[clibby]

If we start recording everything then everyone might as well get a pan scan and every lab available when they arrive as any bad outcome can be traced back to the patient saying something on a pan positive ROS or you not specifically asking about something even if it wasn’t their chief complaint. Unless we are covered by some sort of malpractice immunity outside assault, fraud, or gross negligence it will only add to more unnecessary defensive testing. They say defensive testing is a small part of medicine, but my decision to test is always going to be as justified as possible in my note whether it was overly defensive or completely indicated.

 

[emergentmd]

Lord. I would quit medicine if I had to have a bodycam.

Just like with police bodycam, some video can be interpreted many ways depending on which side you are on.

 

[BoardingDoc]

This concept was previously brought to my attention by my insurance carrier who was looking into a novel idea. This benefits patients in a manner similar to police body cameras. Physicians just like police are hesitant to have patient encounters recorded, but if the benefit was no to little charting then might be worth the trade-off.

Potential downsides include invasion of patient privacy, likely increased testing given pan-positive HPI/ROS and need for increased data storage even if temporary just prior to transcription.

Pluses include perhaps a more accurately documented patient encounter, more time spent with patients and less time charting, as well as not wasting physician's more highly compensated time spent charting.

This is possibly one of the absolute worst ideas I have heard in a long time. Allowing a physician to discern what is and is not relevant in a presentation is part of why people see a doctor. Doing HPI by video is going to lead to such insane amounts of defensive testing that you literally should just save time and give the patients a menu of tests they can order when they come in.

I want a dimer for my chest pain! You're 16 and told me you just got punched in the chest. But I could have a clot! I told you it hurts when I breathe and it's on camera! Fine. Dimer is 503 because why the hell not. CTA is neg. Enjoy your increased risk of cancer because of this *****ic system.

 

[emergentmd]

This is possibly one of the absolute worst ideas I have heard in a long time. Allowing a physician discern what is and is not relevant in a presentation is part of why people see a doctor. Doing HPI by video is going to lead to such insane amounts of defensive testing that you literally should just save time and give the patients a menu of tests they can order when they come in.

I want a dimer for my chest pain! You're 16 and told me you just got punched in the chest. But I could have a clot! I told you it hurts when I breathe and it's on camera! Fine. Dimer is 503 because why the hell not. CTA is neg. Enjoy your increased risk of cancer because of this *****ic system.

This is why a body cam is a bad idea and you do not chart everything a patient states.

 

[Mount Asclepius]

I don’t think it’s just an idea. I think people that control the narrative more than you or I as pit docs are seriously considering, and it’s perhaps naive to think it couldn’t happen. I remember when police said it would never happen. A decent number of physicians quit when EMRs replaced paper charting. I also see a decent number quitting if encounters are recorded. Doesn’t mean it alters the outcome.

 

[sylvanthus]

I partially agree. I don’t think we are getting away from increased documentation unfortunately though. I think recording could potentially be coming some day regardless of whether we want it to or not. Police weren’t thrilled by the idea either (I certainly recognize there are differences). I don’t love the idea, but charting to me is one of the worst parts of every shift, and I’d be potentially supportive of ways to eliminate it.

Do you really believe charting would be eliminated? Ive never seen a form “that just takes a min” go away, Just more added.

 

[Mount Asclepius]

Do you really believe charting would be eliminated? Ive never seen a form “that just takes a min” go away, Just more added.

I’m equally skeptical. I just see the possible writing on the wall for documentation changing. I hate charting, and I’d equally hate to be recorded. Much of this job unfortunately is not what I was told, and nor what I imagined. I’d love to just be resuscitating emergencies, making lots of money and doing little else at work. I might be one though that just FIREs too early unless there is a shock to the system with dramatic improvement. I’m skeptical, but just curious what others think. There is always hope for the new year. 2022!

 

[sylvanthus]

I’m equally skeptical. I just see the possible writing on the wall for documentation changing. I hate charting, and I’d equally hate to be recorded. Much of this job unfortunately is not what I was told, and nor what I imagined. I’d love to just be resuscitating emergencies, making lots of money and doing little else at work. I might be one though that just FIREs too early unless there is a shock to the system with dramatic improvement. I’m skeptical, but just curious what others think. There is always hope for the new year. 2022!

If this whole thing ever happens like someone above said were gonna be ordering more testing to cover ones ass. Also likely gonna be doing more charting imo as wed have to explain what were thinking after the verbal diarrhea we were just subjected to by the patient and some high school coding grad/insurqnce company watches.

 

[thegenius]

If this ends up happening, what is the point of becoming a doctor? Parients should just order their own tests and give themselves their own medicine and interpret everything themselves.

8 years of medical training and residency out the door. Pt wants a CXR for their 2 hr cough, they think they see a spot on the CXR read as negative by the Radiologist, and demands Abx.

Medicine needs to go back to the way it was practiced 30-40 years ago where pts do what their doctor tells them to do or else they get fired. Pts have way too much power and entitlement with 1/100,000 the training as us.

 

[Mount Asclepius]

I’d love to get back to a time with more physician paternalism (/materialism?), but when health care became big business it made the consumer more in charge of their care. It’s a warped system because it’s not a straight business-consumer relationship with multiple other parties involved. The patient doesn’t always directly participate in the cost of their care despite driving what they receive.

I’d be fine with testing increasing as I think that is going to happen anyways. I also think patients should be more directly responsible for their utilization. They can have their unnecessary x-rays and d-dimers. They often already get them anyway. Maybe we’d like our jobs more if everyone got panned CTs and panned labs, but we just got to focus on emergent care of sick patients. They are usually my favorite patients as they don’t care what tests you order.

I just think audio/video recording in medicine is almost inevitable. It seems we should try to predict it and get ahead of it so we can help make it work for us. Police wear body cameras. Plumbers that come do repairs on my home take pictures and videos of everything. Even when I take my car in to get serviced they video the entire vehicle. We live in the digital age and I’m skeptical medicine is going to escape it. Hopefully we could find a way to make it work for us such as using it to decrease charting. I also think it would help potentially reveal how tough our jobs really are and how difficult and inappropriate many patients act. Just like police we wouldn’t like cameras (or even just audio), but I suspect more often than not it would show us in better light than patients.

Perhaps the only answer for a system like this benefiting us is by fighting off the destructive med-mal climate that always tries to take their pound of flesh. Otherwise folks are right that it opens us up even more to poke holes in.

 

[Matthew9Thirtyfive]

Just like police we wouldn’t like cameras (or even just audio), but I suspect more often than not it would show us in better light than patients.

Yeah it’s def different but police initially didn’t want body cams, and now just off the top of my head I can think of a dozen cases where the body cam likely kept an officer out of jail or from being crucified by the media. If the public saw what ED docs deal with on a daily basis, at least some of them would flip over to becoming sympathetic.

Edit: just to be clear, I think medicine is a different situation completely and think body cams are a terrible idea. Just commenting on that one aspect.

 

[emergentmd]

I actually think bodycams are worse from the police perspective. Or atleast before cell phones when police would do whatever they wanted. He said/she said, police vs bad guy. Police almost never got indicted.

If there were no recordings, Chauvin would have never been prosecuted.

 

[RustedFox]

I actually think bodycams are worse from the police perspective. Or atleast before cell phones when police would do whatever they wanted. He said/she said, police vs bad guy. Police almost never got indicted.

If there were no recordings, Chauvin would have never been prosecuted.

It also places too much power in the hands of *******es who Monday morning QB and act like they could have made the right call in the situation, when they really are nothing more than virtue-signaling, self-righteous mouthbreathers who can't "life".

Sorry if I seem elitist. My faith in the average muggle to do anything either correctly, for themselves, or both is close to non-existent.

 

[Matthew9Thirtyfive]

It also places too much power in the hands of *******es who Monday morning QB and act like they could have made the right call in the situation, when they really are nothing more than virtue-signaling, self-righteous mouthbreathers who can't "life".

Sorry if I seem elitist. My faith in the average muggle to do anything either correctly, for themselves, or both is close to non-existent.

This is true, however, from my own experience in security forces in the Navy, having actual video evidence of what went down would be a huge help. This day and age, media will almost always side against law enforcement no matter what (remember when CNN made up “hands up don’t shoot”). The cops who **** up and hurt someone who shouldn’t have been hurt should be prosecuted. The media and public assumption of guilt of law enforcement in every situation is doing way harm more than body cams.

 

[Angry Birds]

This concept was previously brought to my attention by my insurance carrier who was looking into a novel idea. This benefits patients in a manner similar to police body cameras. Physicians just like police are hesitant to have patient encounters recorded, but if the benefit was no to little charting then might be worth the trade-off.

Potential downsides include invasion of patient privacy, likely increased testing given pan-positive HPI/ROS and need for increased data storage even if temporary just prior to transcription.

Pluses include perhaps a more accurately documented patient encounter, more time spent with patients and less time charting, as well as not wasting physician's more highly compensated time spent charting.

Are you an attending?

This is the most terrible idea that anyone ever gave , such that I would quit the job.
First off, it would not cut down but increase charting need.

Second, no. Just no.

 

[Mount Asclepius]

Several responses just remind me so much of initial reactions to switching from paper to EMRs.

If insurers are looking at this as a way to reduce liability, it’s definitely worth considering. They aren’t doing it because they want to be a part of more physician litigation.

If encounters are recorded, you wouldn’t write an HPI/ROS. You’d have to verbalize your exam findings, testing results and MDM to the patient (caveats for psych, intoxicated, etc.). Patients would receive better communication and you’d spend less time redundantly charting everything that transcription would record.

This wasn’t my idea. Medicine isn’t stagnant. Change will come. It’s worth considering how medicine will look differently in the future. Perhaps though this forum is filled mainly with dinosaurs that will quit when the time comes. T-sheets were great, but EMRs are better. Hang on for the ride as it could get bumpy if this really is as bad as everyone here seems to think.

 

[clibby]

Several responses just remind me so much of initial reactions to switching from paper to EMRs.

If insurers are looking at this as a way to reduce liability, it’s definitely worth considering. They aren’t doing it because they want to be a part of more physician litigation.

If encounters are recorded, you wouldn’t write an HPI/ROS. You’d have to verbalize your exam findings, testing results and MDM to the patient (caveats for psych, intoxicated, etc.). Patients would receive better communication and you’d spend less time redundantly charting everything that transcription would record.

This wasn’t my idea. Medicine isn’t stagnant. Change will come. It’s worth considering how medicine will look differently in the future. Perhaps though this forum is filled mainly with dinosaurs that will quit when the time comes. T-sheets were great, but EMRs are better. Hang on for the ride as it could get bumpy if this really is as bad as everyone here seems to think.

I don't understand your scenario where I wouldn't have to review a transcribed recording. The ED is loud and things may not be heard or the camera may not see everything. In addition, how would you prevent any audio picked up about other patients from being included in the wrong patient's recording? Never mind needing massive data warehouses to store these massive files. Spelling errors would be rampant. Things go on in my head that have to be put into the MDM. Most of my exam is done visually, so how is verbalizing every thing I am seeing efficient? I also discuss things with consultants and review records that need documentation. I then have to review any automated note for accuracy and add my thinking. I also need to document discharge instructions too which isn't going to be transcribed in real time. If the recordings are not transcribed, how will anyone be able to review it in the future without having to sift through hours of video? Finally, I will have to log in on my day off to review these transcriptions as it likely isn't going to be real time any time soon. I have used scribes and transcriptions and they both have typos and need edits. The note is not just for patient and physician communication, it is a legal record and billing document which needs to be reviewed before it is signed. Until the regulations are changed, patient privacy is not a concern, and malpractice is virtually eliminated, I don't see this being a successful reality despite a lot of startup buzz. This is why healthcare is so frustrating for startups as they don't often get the regulatory and infrastructure burdens of healthcare.

What really would speed up documentation is malpractice reform, getting rid of the various metrics I need to explain in my note, and changing documentation to only need a focused HPI, PMH which is reviewed and updated by the patient for our review rather than waiting for me/RN/tech to ask for the 1000th time in their visit, only pertinent physical exam findings are needed, and an MDM/plan. Re-documenting my EKG in MUSE and the EHR, checking the vital signs reviewed box, making sure I have 4 elements in each HPI, making sure every patient is screened for smoking even though their chief complaint is a stubbed toe, documenting all my MIPS criteria, hitting 2 findings per system in my exam, etc. all while making sure the note sounds good if ever read in court are why charting really sucks. These aren't things that can be solved by automation.

Not everyone is opposed to this idea because we are dinosaurs. I don't think anyone thinks that T-sheets are better than the EHR for patients or for us reviewing the patient's history, but they likely (paper was before my time) were easier and UI designers at the EHR companies should learn from that. As for recordings, we don't have the same protections other industries have as well as having different challenges. Our notes are not used just by us with our patients and include more than what happens in the room with the patient. These companies trying to make this a reality are so far off in the current system that I do not see it on the horizon in the next 10 years.

 

[sylvanthus]

Several responses just remind me so much of initial reactions to switching from paper to EMRs.

If insurers are looking at this as a way to reduce liability, it’s definitely worth considering. They aren’t doing it because they want to be a part of more physician litigation.

If encounters are recorded, you wouldn’t write an HPI/ROS. You’d have to verbalize your exam findings, testing results and MDM to the patient (caveats for psych, intoxicated, etc.). Patients would receive better communication and you’d spend less time redundantly charting everything that transcription would record.

This wasn’t my idea. Medicine isn’t stagnant. Change will come. It’s worth considering how medicine will look differently in the future. Perhaps though this forum is filled mainly with dinosaurs that will quit when the time comes. T-sheets were great, but EMRs are better. Hang on for the ride as it could get bumpy if this really is as bad as everyone here seems to think.

Ive been an attending for 2 1/2 years and id stop picking up ED shifts if this happened.

 

[Angry Birds]

Several responses just remind me so much of initial reactions to switching from paper to EMRs.

If insurers are looking at this as a way to reduce liability, it’s definitely worth considering. They aren’t doing it because they want to be a part of more physician litigation.

If encounters are recorded, you wouldn’t write an HPI/ROS. You’d have to verbalize your exam findings, testing results and MDM to the patient (caveats for psych, intoxicated, etc.). Patients would receive better communication and you’d spend less time redundantly charting everything that transcription would record.

This wasn’t my idea. Medicine isn’t stagnant. Change will come. It’s worth considering how medicine will look differently in the future. Perhaps though this forum is filled mainly with dinosaurs that will quit when the time comes. T-sheets were great, but EMRs are better. Hang on for the ride as it could get bumpy if this really is as bad as everyone here seems to think.

Are you an attending? And, if so, of what specialty?

EDIT: Amazingly you are, based on another post of yours. Time to get a CT head.

 

[Mount Asclepius]

I don't understand your scenario where I wouldn't have to review a transcribed recording. The ED is loud and things may not be heard or the camera may not see everything. In addition, how would you prevent any audio picked up about other patients from being included in the wrong patient's recording? Never mind needing massive data warehouses to store these massive files. Spelling errors would be rampant. Things go on in my head that have to be put into the MDM. Most of my exam is done visually, so how is verbalizing every thing I am seeing efficient? I also discuss things with consultants and review records that need documentation. I then have to review any automated note for accuracy and add my thinking. I also need to document discharge instructions too which isn't going to be transcribed in real time. If the recordings are not transcribed, how will anyone be able to review it in the future without having to sift through hours of video? Finally, I will have to log in on my day off to review these transcriptions as it likely isn't going to be real time any time soon. I have used scribes and transcriptions and they both have typos and need edits. The note is not just for patient and physician communication, it is a legal record and billing document which needs to be reviewed before it is signed. Until the regulations are changed, patient privacy is not a concern, and malpractice is virtually eliminated, I don't see this being a successful reality despite a lot of startup buzz. This is why healthcare is so frustrating for startups as they don't often get the regulatory and infrastructure burdens of healthcare.

What really would speed up documentation is malpractice reform, getting rid of the various metrics I need to explain in my note, and changing documentation to only need a focused HPI, PMH which is reviewed and updated by the patient for our review rather than waiting for me/RN/tech to ask for the 1000th time in their visit, only pertinent physical exam findings are needed, and an MDM/plan. Re-documenting my EKG in MUSE and the EHR, checking the vital signs reviewed box, making sure I have 4 elements in each HPI, making sure every patient is screened for smoking even though their chief complaint is a stubbed toe, documenting all my MIPS criteria, hitting 2 findings per system in my exam, etc. all while making sure the note sounds good if ever read in court are why charting really sucks. These aren't things that can be solved by automation.

Not everyone is opposed to this idea because we are dinosaurs. I don't think anyone thinks that T-sheets are better than the EHR for patients or for us reviewing the patient's history, but they likely (paper was before my time) were easier and UI designers at the EHR companies should learn from that. As for recordings, we don't have the same protections other industries have as well as having different challenges. Our notes are not used just by us with our patients and include more than what happens in the room with the patient. These companies trying to make this a reality are so far off in the current system that I do not see it on the horizon in the next 10 years.

Those are fair considerations. Thanks for taking the time to discuss various implications.

 

[southerndoc]

Some of this stuff is already being trialed. Although not a direct recording, Amazon and Deepscribe are using voice recognition software to create a chart based on a conversation with a patient. I'm not sure if a recording is available. Texas Medical, Hartford Hospital, and a few other places are part of the trial.

 

[clibby]

Some of this stuff is already being trialed. Although not a direct recording, Amazon and Deepscribe are using voice recognition software to create a chart based on a conversation with a patient. I'm not sure if a recording is available. Texas Medical, Hartford Hospital, and a few other places are part of the trial.

I’ve seen a few of these. Most are actually using transcription from humans on the backend despite the promises of the companies as the voice recognition and AI are not advanced enough yet. I’m not saying it won’t eventually get to some point where it is useful, but I don’t see it getting there any time soon in the current US healthcare system with the regulatory and legal implications and certainly not without the physician having to review, edit, add decision making, and fix the notes just like with a scribe.