Dictating notes to be uploaded to electronic health record systems is associated with "significantly worse" care quality than two other documentation methods, according to a new according to a new study published in the Journal of the American Medical Informatics Association, NextGov reports (Pulley, NextGov, 5/23).
For the study, researchers at Brigham and Women's Hospital partnered with colleagues at other organizations to study 18,569 visits by 7,000 patients to 234 primary care physicians (Durben Hirsch, FierceEMR, 5/23).
Researchers examined patient outcomes in 15 areas related to managing coronary artery disease and diabetes. Of the physicians studied:
- 62% typed their notes in free text into a patient's EHR;
- 29% used structured documentation, such as templates, to add data to a patient's EHR; and
- 9% dictated their notes so the information later could be transcribed and uploaded to a patient's EHR at a later time.
The study found that physicians who dictated their notes did not receive the highest care quality score for any of the 15 outcomes measures (NextGov, 5/23).
For three of the 15 outcomes measures, care quality was "significantly worse" when physicians dictated their notes than when they used the two other documentation methods, the study found (FierceEMR, 5/23).
According to the study, physicians who dictated their notes performed the worst for ordering antiplatelet medication, documenting tobacco use and performing diabetes-related eye exams.
Physicians who used structured documentation performed better than the other groups for measuring blood pressure, recording body mass index and performing diabetes-related foot exams. Those who used free-text documentation performed best for administering influenza vaccines (NextGov, 5/23).
Researchers Comment on Findings
The researchers wrote, "Physicians who more intensively interact with their EHRs through their documentation style may pay greater attention to coded fields and clinical decision support and thus may deliver higher quality of care" (FierceEMR, 5/23).
Jeffrey Linder -- lead study author and associate professor of medicine at of Brigham and Women's Hospital and Harvard Medical School -- said, "Dictating may be easier for the doctor, but patients need to be careful." He added that physicians who dictate their notes into EHR systems "may not be paying as close attention to information and alerts in the EHR that are important for patient health" (NextGov, 5/23).