Dictation Degrades EHR Accuracy

Patient care is “significantly worse” when doctors dictate their notes into electronic health records compared with two other common forms of documenting care, according to a study published online this week by the Journal of the American Medical Informatics Association.

The findings suggested that doctors “who more intensely interact” with EHRs based on their style of documentation “may pay greater attention to coded fields and clinical decision support and thus may deliver higher quality care,” according to the article abstract.

The study, “Method of Electronic Health Record Documentation and Quality of Primary Care,” looked at records of visits by 7,000 patients with coronary artery disease and diabetes to a network of primary care practices over a nine-month period. They compared patient outcomes in 15 areas, looking for differences among patients whose physicians dictated their notes (9 percent), used structured documentation (29 percent), or typed free text notes (62 percent).

Results varied depending on the quality-of-care measure, but in none of the 15 measures was quality of care best among patients whose doctors had dictated their notes. Doctors who dictated their notes performed most poorly when it came to ordering antiplatelet medication, documenting tobacco use and performing diabetic eye exams.

Quality of care was better for “structured documenters” when it came to documenting blood pressure and body mass index, and performing a diabetic foot exam. Free-text documenters excelled in just one area -- administering influenza vaccines.

“EHR-assessed quality is necessarily documentation-dependent, but physicians who dictated their notes appeared to have worse quality of care than physicians who used structured EHR documentation,” concluded the authors, Jeffrey Linder and Jeffrey Schnipper of Brigham and Women’s Hospital in Boston and Blackford Middleton of Partners HealthCare System, also in Boston.

"Dictating may be easier for the doctor, but patients need to be careful," lead author Linder, an associate professor of medicine at Brigham and Women’s and Harvard Medical School, said in an article in MedicalExpress.com. "Doctors who dictate may not be paying as close attention to information and alerts in the electronic health record that are important for patient health."