Epocrates testing EHR at physician practices, partnership with Nuance for voice dictation is game changer

Epocrates foray into the electronic medical record ecosystem is getting closer to launch with the announcement that pilot trials of their EHR are occurring at physician practices. The web and mobile based electronic health record is aimed at solo and small physician group offices — targeting the ambulatory setting.

During HIMSS 2010 we spoke to Epocrates in great detail about their electronic health record.  They gave iMedicalApps a glimpse of the EHR’s mobile functionality, stating the EHR will be integrated with the iPhone, and use features provided by the iOS platform, such as push notifications.

Incidentally, during HIMSS 2010, Nuance made a large announcement of their own.  They announced three products for the iPhone: Dragon Medical Mobile Dictate, Dragon Medical Mobile SDK, and Dragon Medical Search (we reviewed Dragon Medical Search last year). We talked to Nuance about their mobile offerings, and their representatives gave us live demos of their products.

At that time, our senior editor, Felasfa Wodajo, made a very astute connection — In his article on Nuance last year, he stated it would be obvious for Epocrates to use Nuance for their EHR and mobile offerings. A year later, that’s exactly what Epocrates is announcing.

So why is this a game changer?

Epocrates is going to call the integrated mobile dictation feature “SpeechAnywhere”. They say it will allow physicians to create medical reports anytime and anywhere — whether in the exam room, office, or in the field. Basically, anywhere your have your iPhone, your EMR will be there, with voice dictation capabilities.

This type of functionality cannot be overstated.  In the current paradigm, physicians who want to dictate into an electronic medical record experience significant lag time, you have to dictate into a recorder, wait for your dictation to be transcribed by a service, and then edit and fix the final transcription.

This is the reason why many physicians decide to free text information.  But, if you ask most physicians, they can dictate a HPI (History of Present Illness) faster than they can type it.  And this is the reason why Nuance’s medical voice transcription software is so coveted by physicians — it’s considered the gold standard.

I even know a physician who uses the dragon dictation iPhone app, not even the medical version, to do basic procedure notes, e-mails them to himself, and then manually copies and pastes them into the electronic health record — showing how quick and useful real time mobile transcription can be.  Now imagine if this process was seamless, automatically inputting content into the patient’s electronic health record.

Speech to text integration within a mobile platform is what truly makes an EHR mobile.  Can you imagine typing in a patient’s HPI or chief complaint using an iPhone or other mobile device? It would be nearly impossible.  When you have the ability to dictate, you no longer need a keyboard — you’re fully mobile.

The pairing of speech to text within an electronic medical record is rare.  Currently the only medical speech to text offered by a mobile electronic health record is Dr. Chrono.  While we are in the process of reviewing their product, as mentioned, Nuance is still considered the standard bearer — making the Epocrates and Nuance relationship unique.

If Epocrates is able to properly execute their electronic health record seamlessly across the iPhone, iPad, and their desktop software — they should have a hit.  Although, we’re still waiting on Epocrates to launch an iPad customized version of their basic app……so we’ll see.

Source: The Street


Iltifat Husain, MD

Founder, Editor-in-Chief of iMedicalApps.com. Assistant Professor of Emergency Medicine and Director of Mobile App curriculum at Wake Forest University School of Medicine. He is also the founder of iPrescribeApps, a platform for prescribing apps to patients. Dr. Husain has given lectures on digital medicine globally. He went to North Carolina State University for undergrad and went to medical school at Wake Forest School of Medicine.

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6 Responses to Epocrates testing EHR at physician practices, partnership with Nuance for voice dictation is game changer

  1. drrjv April 4, 2011 at 4:38 am #

    I think they may have something here! Being able to dictate anywhere is a big plus. Dragon Dictate on the iPhone is amazing and easy to use for short notes; having it integrated in an EMR sounds really sweet!

    • Iltifat Husain April 4, 2011 at 7:17 am #

      Yep, we’re hoping Dragon releases the “real time” dictation app they previewed for us at HIMSS soon. Currently their medical dictation app is more or less just a recorder, and you aren’t able to see your “live” dictation results as you can for the nonmedical dragon dictation app in the App Store

  2. sgk April 5, 2011 at 11:33 am #

    I work for a medical transcription company and we have been offering dictation via any i- device for over a year, so your claims are a bit overstated. Through the EMDAT platform, dictation can be captured and transmitted to a medical language specialist. The document will be typed by this person or voice recognition will produce the first draft ant the specialist will provide final editing. Delivery can be one of many options. Prior to delivery, the physician can view and electronically sig-off on the document through the same device that captured the dictation. It can then be printed locally at the office, uploaded directly into an EMR (similar to cut & paste), or discrete clinical data points can be parsed out and populated into an EMR, providing part of the menaingful use equation. Do not overlook the importance of the medical lanaguage specialist as part of the documetnation process. Picking up on mistakes in dication, adverse drug references etc are only a small slice of the pie when it comes to the benefits provided by this person.

    • Iltifat Husain April 5, 2011 at 1:41 pm #

      We weren’t saying that dictation for i-devices is a new thing, we actually covered EMDAT in a review on iMedicalApps: http://bit.ly/gjVdBl

      We were saying that currently only one platform, Dr. Chrono, provides voice to text capability within an EMR — this type of capability cannot be overstated. The mechanism you are speaking of only adds more time to the process, and slows the workflow of a physician. I personally love dictating, but I hate having to wait for a transcriptionist to transcribe my voice to text form. And then, I find myself editing much of what they have transcribed.

      Picking up mistakes on dictation are the job of a physician, and shouldn’t be the job of a transcriptionist, who has no idea what exactly is going on with the patient. And picking up adverse drug reactions are the job of the physician and pharmacist, not a medical transcriptionist. At the end of the day, real time mobile voice to text medical transcription (directly into an EMR) using complex algorithms will only speed up the physicians workflow — having to wait for a transcriptionist to transcribe voice only slows down the process.

  3. mobilehc April 5, 2011 at 12:35 pm #

    “SpeechAnywhere,” is actually a Nuance term http://www.nuance.com/company/… any EMR vendor can enable the SpeechAnywhere capability

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