As a member of the military medical department for several years, I have seen multiple stages and changes in the military electronic health record. I am aware of the challenges and complications associated with the initial and ongoing use of AHLTA and impact on seeing patients. I realize that clinicians have assessed AHLTA as a pivotal issue whether staying in the military or not. Dragonspeak has alleviated some of the AHLTA challenges. However, I am a realist. Dragonspeak has not solved all of the "headaches." Personally, dragonspeak did improve the speed of patient encounters and offer some improved quality of life as a clinician. In addition, the macros program has helped with efficient documentation.
Dragonspeak is a definite advantage when completing the history of present illness and impression/plan sections. I found it easier to dictate these sections instead of trying to free text or "check boxes." Now, I use only one standard template, no "checking of boxes," and use macros for physical exam section. My typical patient encounter and documentation time has decreased by several minutes per patient encounter and quality of documentation has improved. Currently, I am trying to figure out when it is best to use dragonspeak -- during the patient encounter or immediately after the encounter before seeing the next patient.
However, there are disadvantages, but they do resolve over time. The initial start-up challenge was dictating with efficiency and not pontificating on unnecessary issues. While my typing has developed over time, learning how to "get to the point" and adhere to a relevant patient work up (basic differential diagnosis and general evaluation and plan), my initial dictations in dragonspeak resulted in long notes and included a lot of unnecessary comments and too much comprehenisve thought processes. After time, this improved. In addition, dragonspeak training required some time investment, but was well worth it.
I recommend trying out dragonspeak, do the training, and give it a chance. However, time to try is important. Allowing more time to see patients initially is very important when trying this out for the first several weeks. For most, quick adaptation will ensue. Administrators should realize that initially productivity will decrease, but will improve over time. Realistically, productivity does not drastically improve after adept use of dragonspeak, but mostly improves the clinicians' quality of life.
Overall, I recommend using dragonspeak. It has significantly improved my time and exposure with patient care. Once again, I use dragonspeak in the HPI, macro the PE, and then dragonspeak the impression/plan. Most other internists I speak to seem to follow this general pattern.
The veiws expressed are those of the author and do not reflect the official policy or postion of the Dept. of Defense, Dept. of Army, or US Govt.