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Predictive text in EHR systems

By [email protected]

EHR vendors have followed the lead of many other software developers by using “predictive text,” a feature that furnishes words or phrases based on a few characters that the user enters. For example, based on the characters “dia,” the system might display “diabetes,” allowing the user to click on the completed word to enter it, or override it by entering other text. Predictive text in EHR systems is usually context-dependent and is sometimes added or edited by physicians themselves.

There is some debate among physicians, IT people, and other EHR users on the merits of predictive text. All agree it can save time under ideal circumstances, but some are wary of introduced and potentially serious mistakes. It’s another EHR feature that benefits greatly from customization (and sometimes requires building from scratch).

Good for repetitive tasks

“I think it all depends on the design,” said IT consultant Tim Stone of Bullet Group Consulting. “If the system gives you a quick list based on a few letters and makes it easy to pick the correct one, I think that is fine. If the system is guessing based on past choices or your specialty, I think that leads in a bad direction. There are also versions of this where whole sentences are inserted based on what you type… This also can be good or bad based on design.

“[It works well for] repetitive tasks like giving an injection.  You want exactly the same thing each time [i.e. a checklist].  ‘I did this, I cleaned it this way, I prepped with this.’  But there are other times where you should accurately describe the condition instead of sticking in a canned block.” Predictive text should not be used for diagnosis or patient plans, he continued. “That can be a slippery slope.” Such documentation should be written patient by patient, said Stone.

Sure, it saves time…

“[Predictive text] can save a lot of time,” said an administrator at a mid-size Boston-area health network. “We have a retina specialist who uses certain terminology all the time. [Our IT department] developed specific… text just for her.” While some physicians in her practice complain that using electronic records is more time-consuming than paper, those who have taken advantage of such features as predictive text, as the retina specialist did, say EHR usually saves time for them.

…but still requires another step

Doctors and staff must use predictive text cautiously, warns Carolyn Hartley, president and CEO of Physicians’ EHR. When a medical office assistant (MOA) enters information into the system to assist the physician, for example, “the system starts coding for a diagnostic task… [If the MOA accepts the wrong displayed code], “the [EHR] system takes the patient record in a direction that the doctor didn’t want it to go… Now there are three players [doctor, MOA, and EHR system] where there used to be just two,” opening another avenue for errors.

Each provider or practice has to set up its own predictive text, said Hartley, who helps providers plan for and implement EHR systems. “Some vendors will embed a library of [predictive] text, but doctors must review [the entire library].” After initial setup, “[predictive text] is a really good tool” for physicians, but they have to go back and review it every time they create or edit a record, she said. This step cancels out some of the time saved, but must not be skipped.

Overall, Hartley recommends a combination of voice recognition software and predictive text to expedite data entry, as long the physician reviews the record for accuracy. Incorrect data in patient records not only can be bad for patients but leaves providers open to fraud or abuse lawsuits, Hartley said.

California family physician Robert Rowley agreed. Thanks to time-saving features such as predictive text and speech recognition, in addition to customizable templates, “I can now see more patients than I used to [when using paper charts],” he said. “[Predictive text] technology is coming along… but you’ve got to proofread the results.”

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