1. Hard question to really answer definitively, as we only have one PIS, and I have no experience with others. However, I can say that we use Tamtron Powerpath, and it's awesome. We dictate, then the transciptionists type into the system and assign the case to you electronically, which is then available for editing on any computer in the department. You edit the case, then, when the case is done, assign it to the attending for further editing and signing. Routine cases are pretty much always signed out the same day. If cases are not signed out for whatever reason (eg ipox), it's really easy to login and see what the status is, even down to what time an additional section was cut and which histotech cut it.
We also rotate at a VA, which has essentially no computerized PIS, so the residents dictate (into the telephone--we outsource our transcription to a private company), then receive print outs. We write out our edits on these print outs, then give these back to the clerk, who enters your corrections (if he can read your writing). it usually adds an extra day or two, particularly if you need any additional corrections. This system drives all of the residents here batty, and we've been complaining about it for years.
I think human transcriptionists are vastly superior to voice recognition. I am always amazed at what they can do--sometimes it's like they are reading my mind. I dictate as fast as I can speak (i sound like an auctioneer when I gross), and I only very rarely catch them making a mistake. Admittedly, I've only played with voice recognition systems, but they seem very balky and difficult to use relative to a human with good english and typing skills. I don't have to train anything with a human transcriptionist, and they also check over the report to see "if it reasonable" and will highlight any glaring mistakes. I think the main reason people are moving to voice recognition systems is that transcription is a dying art--I hear that it's pretty difficult to hire good medical transcriptionists these days.
2. I think I answered this question in #1.
3. The residents enter ICD-9 codes, and I believe that CPT codes are entered by our transcriptionists, although I never see this. At our VA, we dictate SNOMED and CPT codes.
4. Residents here don't sign or e-sign the reports. The attendings electronically sign reports, which seems to cut down on time. I've never heard any big complaints one way or another.
5. Only acc# and name. We are sheltered from the whole billing aspect of things.
-mrp
