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- Oct 17, 2011
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So - I've read people on this forum/elsewhere previously speaking about AI, dictation and what I assumed would be big hospital infrastructure costs ie. the good stuff would be inaccessible to small private practice doctors. Randomly yesterday, I saw an ad for Heidi on facebook (I had never heard of it before yesterday). I'm pretty skeptical about clicking ads and I'm very skeptical about anything medical that is shared online because its mostly teaser garbage that will rapidly lead to a string of ads and phonecalls and what not. I starred at their website for awhile and wondered what it would cost to try, would I have to download something, etc.
I went ahead and joined via my Google (we'll see if I regret this) and I've been bordering on shocked / pleasantly surprised since then.
If you've ever thought - God, I wish I lived in a future where I didn't have to dictate notes at all and everything was done for me the second I left the room - we are closer to this than I ever thought.
-There doesn't appear to be any sort of software requirement. Heidi runs from a google chrome window and uses your microphone when you turn it on. There's no app or download or big set-up. You turn it on and just start dictating. There's ways to template and specify but its got a handful of upfront templates that any note can easily be toggled between.
-Heidi is currently free for dictation. I dictated 2 surgery notes for procedures the other day. The notes were surprisingly flawless/well done. That said, since then I've dictated some more notes and there have been some typoes ie. "Liz-Frank Joint", "Aquinas", "Planar Fasciitis".
-If you are using some sort of half-ass knock off dictation software that is non-medical - this is better - and its currently free. You dictate your note and then select dictation from the options and instead of processing your note it will simply give you a straight word for word dictation.
-I haven't been able to find a way around this, but when you dictate into Heidi it always first transforms it into a medical note ie. H&P, Soap etc. Then you can reprocess it into a dictation. It literally took my dictation for a toe amputation and turned it into a medical progress note which I found somewhat humorous.
-As indicated above - if you dictate encounters after the fact it will reprocess and attempt to fit your note to populate whatever medical note template you selected. It will cut some of your text and attempt to refine / gussy it up. So example - it will create potential diagnoses in the impression/plan section and put your plan for each of these underneath it. I've had a few issues that were easily remedied where information I reported as physical exam were put into history.
-And now for the wild part. If you let it listen during a patient encounter - it will attempt to literally generate a note based on what you and the patient talk about and its honestly pretty good if you control the encounter.
-I had Heidi listen to 3 encounters today.
-The first was a follow-up of PTTD where I already knew the patient was getting better. This isn't a hard note to write, but the best part of this was - the patient pulled an audible and added a new problem. They wanted to continue their meloxicam for DJD of the right toe joint that I had never treated before or spoken to the patient about. I kid you not - the program captured that the patient had received a steroid injection from another doctor in Waco, TX. It added that to the history and created a new problem in the plan. I walked out of the room - hit stop record - and had a completely written note a second later. I had to add a little to the PE as I hadn't narrated my palpation of the great toe joint when I was in the room. To the best of my ability I would attempt to control the storyline / encounter - "so this is a new problem" and the program picked it up. The note was honestly pretty good - I could write a follow-up PTTD note in probably under a minute. That said - I didn't have to write anything and I would normally be ...half-heartedly annoyed by a patient adding a new problem. Now its just - another bullet point on the list.
-The next visit was a pre-op surgery visit. These visits for me are normally straight template notes - I use whatever physical exam I already have and then use a template discussing rehabilitation. I discussed pain medicine - the patient announced a new allergy - and we switched medications. The program essentially captured our discussion of it along with my concerns about her dosing on another medicine. Where the program potentially shined - it captured a bunch of patient questions that I either would simply not have written down or would have written down begrudgingly ie. can I take care of my mother at a nursing home.
-Last visit. A Spanish speaking patient with a diabetic ulceration and a new lesion on the other foot. I think it actually did quite well. The only flaw to this encounter was that I said what I thought I wanted to do, the daughter asked questions and I answered them (and I had already answered them), and then the patient who was spanish speaking only asked the same questions again and I answered them and it felt like the dictation repeated some of the text as if it was unsure if it needed to keep trying to capture things because we had repeated them so many, damn times. I narrated the ulcer dimensions and it kept them which was a nice touch.
-Are these great notes? I don't think they are bad. They aren't necessarily like having some sort of brilliant specialist dictate a well thought chain of thought, but they are better than most templated crap that comes out. Specifically - they are going to say what actually happened in the encounter as opposed to the doctor dropping a template and then putting in their own text that often disagrees with what the template says. I'm sure a patient can screw it up by doing the thing where nothing hurts anywhere, but you can potentially control for that by describing and spelling when/where it hurts. You likely have to try to control the nature of the encounter ie. try to be problem focused, move through things individually. The physical exam sections will likely be weak - in these sections it essentially puts down what you describe.
-There are things you can presumably template faster. And you probably won't use this for "HRFC" or for things that are procedural and explicitly templated or have bureacratic requirements.
Things that are fascinating to me
-There's essentially immediately a note written. Its fast. Its "on paper". I sometimes tell myself - that's not a hard note. I'll get to it and then jokingly its days later and I'm trying to remember exactly what we spoke about. In this case - hard or easy - most of a note is written about a minute after you walk out of the room.
-It very much seems like a threat to overseas scribes and dictation specialists and people like that.
-At present - this is affordable. The mid-tier version is $100 a month. I think people are paying that for Dragon.
-I do think you could improve your productivity with this program. To me it definitely provides protection against all the "alsos" that patients throw at us. The new problems. Maybe it all doesn't need to be written down - but this program will write it all down.
-I thought we were years away from something like this. It seemed like a Tech fantasy. Its here. Its probably a work in progress - but there can be a note done when you walk out the door.
-Wilder thought still - a program like this - could code your encounter in the future. Imagine if BCBS or someone owed this and created software to evaluate and decide the level of effort you put into your encounters.
*I was not paid, compensated, - anything for this. I wrote it because I was shocked what I was getting for free. I went into it thinking - I'll never pay for this. I'm actually considering paying for it. Writing notes is the worst part of my life.
I went ahead and joined via my Google (we'll see if I regret this) and I've been bordering on shocked / pleasantly surprised since then.
If you've ever thought - God, I wish I lived in a future where I didn't have to dictate notes at all and everything was done for me the second I left the room - we are closer to this than I ever thought.
-There doesn't appear to be any sort of software requirement. Heidi runs from a google chrome window and uses your microphone when you turn it on. There's no app or download or big set-up. You turn it on and just start dictating. There's ways to template and specify but its got a handful of upfront templates that any note can easily be toggled between.
-Heidi is currently free for dictation. I dictated 2 surgery notes for procedures the other day. The notes were surprisingly flawless/well done. That said, since then I've dictated some more notes and there have been some typoes ie. "Liz-Frank Joint", "Aquinas", "Planar Fasciitis".
-If you are using some sort of half-ass knock off dictation software that is non-medical - this is better - and its currently free. You dictate your note and then select dictation from the options and instead of processing your note it will simply give you a straight word for word dictation.
-I haven't been able to find a way around this, but when you dictate into Heidi it always first transforms it into a medical note ie. H&P, Soap etc. Then you can reprocess it into a dictation. It literally took my dictation for a toe amputation and turned it into a medical progress note which I found somewhat humorous.
-As indicated above - if you dictate encounters after the fact it will reprocess and attempt to fit your note to populate whatever medical note template you selected. It will cut some of your text and attempt to refine / gussy it up. So example - it will create potential diagnoses in the impression/plan section and put your plan for each of these underneath it. I've had a few issues that were easily remedied where information I reported as physical exam were put into history.
-And now for the wild part. If you let it listen during a patient encounter - it will attempt to literally generate a note based on what you and the patient talk about and its honestly pretty good if you control the encounter.
-I had Heidi listen to 3 encounters today.
-The first was a follow-up of PTTD where I already knew the patient was getting better. This isn't a hard note to write, but the best part of this was - the patient pulled an audible and added a new problem. They wanted to continue their meloxicam for DJD of the right toe joint that I had never treated before or spoken to the patient about. I kid you not - the program captured that the patient had received a steroid injection from another doctor in Waco, TX. It added that to the history and created a new problem in the plan. I walked out of the room - hit stop record - and had a completely written note a second later. I had to add a little to the PE as I hadn't narrated my palpation of the great toe joint when I was in the room. To the best of my ability I would attempt to control the storyline / encounter - "so this is a new problem" and the program picked it up. The note was honestly pretty good - I could write a follow-up PTTD note in probably under a minute. That said - I didn't have to write anything and I would normally be ...half-heartedly annoyed by a patient adding a new problem. Now its just - another bullet point on the list.
-The next visit was a pre-op surgery visit. These visits for me are normally straight template notes - I use whatever physical exam I already have and then use a template discussing rehabilitation. I discussed pain medicine - the patient announced a new allergy - and we switched medications. The program essentially captured our discussion of it along with my concerns about her dosing on another medicine. Where the program potentially shined - it captured a bunch of patient questions that I either would simply not have written down or would have written down begrudgingly ie. can I take care of my mother at a nursing home.
-Last visit. A Spanish speaking patient with a diabetic ulceration and a new lesion on the other foot. I think it actually did quite well. The only flaw to this encounter was that I said what I thought I wanted to do, the daughter asked questions and I answered them (and I had already answered them), and then the patient who was spanish speaking only asked the same questions again and I answered them and it felt like the dictation repeated some of the text as if it was unsure if it needed to keep trying to capture things because we had repeated them so many, damn times. I narrated the ulcer dimensions and it kept them which was a nice touch.
-Are these great notes? I don't think they are bad. They aren't necessarily like having some sort of brilliant specialist dictate a well thought chain of thought, but they are better than most templated crap that comes out. Specifically - they are going to say what actually happened in the encounter as opposed to the doctor dropping a template and then putting in their own text that often disagrees with what the template says. I'm sure a patient can screw it up by doing the thing where nothing hurts anywhere, but you can potentially control for that by describing and spelling when/where it hurts. You likely have to try to control the nature of the encounter ie. try to be problem focused, move through things individually. The physical exam sections will likely be weak - in these sections it essentially puts down what you describe.
-There are things you can presumably template faster. And you probably won't use this for "HRFC" or for things that are procedural and explicitly templated or have bureacratic requirements.
Things that are fascinating to me
-There's essentially immediately a note written. Its fast. Its "on paper". I sometimes tell myself - that's not a hard note. I'll get to it and then jokingly its days later and I'm trying to remember exactly what we spoke about. In this case - hard or easy - most of a note is written about a minute after you walk out of the room.
-It very much seems like a threat to overseas scribes and dictation specialists and people like that.
-At present - this is affordable. The mid-tier version is $100 a month. I think people are paying that for Dragon.
-I do think you could improve your productivity with this program. To me it definitely provides protection against all the "alsos" that patients throw at us. The new problems. Maybe it all doesn't need to be written down - but this program will write it all down.
-I thought we were years away from something like this. It seemed like a Tech fantasy. Its here. Its probably a work in progress - but there can be a note done when you walk out the door.
-Wilder thought still - a program like this - could code your encounter in the future. Imagine if BCBS or someone owed this and created software to evaluate and decide the level of effort you put into your encounters.
*I was not paid, compensated, - anything for this. I wrote it because I was shocked what I was getting for free. I went into it thinking - I'll never pay for this. I'm actually considering paying for it. Writing notes is the worst part of my life.
